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U.S. health insurers just posted their best financial results in years, shrugging off worries that the worst flu season in recent history would hurt profits. Aetna Inc., for instance, posted its widest profit margin since 2004. Centene Corp. had its most profitable quarter since 2008. And Cigna Corp., which reported on Thursday, had its biggest margin in about seven years. (Tracer, 5/3)

Cigna Corp. posted higher profit and revenue in the first quarter of 2018 as it grew premiums and membership in its commercial employer business. The Bloomfield, Conn.-based health insurer recorded net income of $917 million in the three months ended March 31, up 54.6% over the same period a year ago. Cigna also reported total revenue of $11.4 billion, an increase of 8.6%, driven by both its healthcare and supplemental benefits segments. (Livingston, 5/3)

Conservative groups are hoping to release a new ObamaCare replacement plan later this month as they try to keep alive the repeal effort. The effort has been led by the Heritage Foundation, the Galen Institute and former Sen. Rick Santorum (R-Pa.), who have been meeting at Heritage’s offices, along with other groups, roughly once a week for months. (Sullivan, 5/3)

The plan’s backers say they are laying out a strategy for this fall, when 2019 Obamacare insurance rates are expected to spike and trigger a political firestorm just before the midterm election. A new repeal effort could insulate the GOP from blame while possibly rekindling interest in gutting the health law. (Haberkorn, 5/3)

When Pam Leonard felt a lump in her breast last November, she hesitated, debating whether to get testing to see if she had cancer. She thought of her insurance policy, which carries a deductible of $2,600. She knew she would also have to spend as much as $5,700 on medical bills that would not be covered by an individual policy she bought under the Affordable Care Act. “I went back and forth for a couple of weeks,” Ms. Leonard recalled. “I had to do something,” she said. “It didn’t go away.” (Abelson, 5/4)

President Trump on Thursday promised he would “immediately” sign revamped legislation expanding veterans’ access to private medical care at taxpayer expense, if Congress passes a new plan being considered just weeks before the “Choice Program” runs out of money. In a tweet Thursday, the president noted that it has been four years since the wait-times scandal at a Veterans Affairs hospital in Phoenix. That controversy showed that hospital employees were lying about the amount of time veterans waited for urgent health care, including cancer treatment and mental-health counseling. (Wax-Thibodeaux, 5/3)

The Veterans Choice Program allows some veterans to see private doctors. It was created in the wake of the 2014 wait-time scandal that started with the Phoenix Veterans Affairs health-care system. Earlier Thursday, House Veterans' Affairs Committee Chairman Phil Roe (R-Tenn.) reintroduced a bill that would overhaul private-care options for veterans enrolled in the Veterans Affairs health-care system, as well as expand caregiver benefits for older veterans and create a process for closing excesses facilities. The bill would expand which veterans are eligible to see private-sector health specialists, as well as entitle veterans enrolled in the system to see a private doctor without a co-pay twice a year. (Kheel, 5/3)

House Veterans' Affairs Chairman Phil Roe, R-Tenn., introduced a draft bill Thursday to consolidate Veterans Affairs Department accounts funding private health care options and provide a $5.2 billion cash injection into one popular program in danger of running out of money by June. The panel is expected to take up the measure, which would also provide funding for VA construction projects, on Tuesday. (Mejdrich, 5/3)

It isn't clear how quickly the package could move through the House and Senate. A GOP Senate VA Committee aide told Modern Healthcare that the committee majority supports the legislation but did not respond to a question on timing. A spokesperson for Jon Tester of Montana, ranking Democrat on the Senate VA Committee, did not respond to a request for comment on his position. Tester supported the earlier draft version of the VA Choice reform bill that Congress failed to pass with the March spending omnibus. He had urged his fellow lawmakers to pass the reforms for months. (Luthi, 5/3)

Wall Street has plowed billions of dollars into DNA testing companies, one of the world's fastest-growing consumer services. By contrast, lawmakers in Washington have invested little oversight in to this brave new marketplace, leaving it to U.S. consumers to navigate it alone. (Leavenworth, 5/3)

Northern California detectives still trying to identify the infamous Zodiac Killer, who targeted victims in the late 1960s and taunted investigators with letters, say they hope to try the same DNA tracing technology recently used to arrest a suspect in another string of cold-case serial slayings — those blamed on the Golden State Killer. But first they have to get a better DNA profile. (5/3)

Detectives in San Francisco and Napa counties, where the Zodiac also killed during his macabre murder spree in 1968 and 1969, are also re-evaluating their evidence to see if it’s worth making a new try at getting DNA profiles. The Zodiac sent letters with cryptograms and taunts to newspapers, including The Chronicle, as he attacked seven people, killing five, throughout the Bay Area in one of the most notorious unsolved murder cases in American history. The letters often opened with “This is the Zodiac speaking,” and as the killings continued, and the letters got more sadistically boastful, dread spread across the region. (Fagan, 5/3)

The Trump administration should invoke government authority to slash prices of a life-saving overdose drug or provide funding to expand access amid the coast-to-coast opioid epidemic, Baltimore's health department and a national advocacy group said Thursday. America is in the throes of its worst-ever drug crisis, yet the generic medication available in other countries by the pennies remains pricey enough in the U.S. that Baltimore's health agency is rationing its naloxone supplies. Other hard-hit U.S. municipalities are also feeling the squeeze as rising overdose rates are fueled by synthetic opioids. (McFadden, 5/3)

By overriding patents for naloxone treatments including Kaleo Inc.’s injectable Evzio and Adapt Pharma Inc.’s Narcan nasal spray, the government could lower the cost and increase availability of the antidote, Baltimore’s health department and Public Citizen said in a letter to the White House on Thursday. “They can choose to lower prices and make these products available, accessible, and save lives,” Robert Weissman, president of Public Citizen, said at a press conference in Washington on Thursday. “Or they can choose not to offend Big Pharma, and let people die for no reason at all except their political consideration for the pharmaceutical industry.” (Yasiejko and Edney, 5/3)

Several federal agencies have recommended increasing access to naloxone, especially for prescription-opioid users, and the high prices have prompted scrutiny from congressional lawmakers. Meanwhile, the pricing has strained municipal government budgets because first responders increasingly rely on the product in the wake of the growing number of opioid overdoses around the country. (Silverman, 5/3)

Mayor Bill de Blasio is championing a plan that would make New York City a pioneer in creating supervised injection sites for illegal drug users, part of a novel but contentious strategy to combat the epidemic of fatal overdoses caused by the use of heroin and other opioids. Safe injection sites have been considered successful in cities in Canada and Europe, but do not yet exist in the United States. Leaders in San Francisco, Philadelphia and Seattle have declared their intention to create supervised sites, although none have yet done so because of daunting obstacles. Among them: The sites would seem to violate federal law. (Neuman, 5/3)

Overdose fatalities in New York City have more than doubled since 2000, with a record-high 1,441 people dying last year, according to a city report released Thursday. Proponents say safe-injection facilities will save lives and prevent the spread of disease, while critics say the sites would condone illegal activity and enable addiction. On Thursday, Mr. de Blasio said he would support a one-year pilot program in four city neighborhoods: Gowanus in Brooklyn and Longwood in the Bronx and Midtown West and Washington Heights, both in Manhattan. (King, 5/3)

In their latest effort to stem the opioid epidemic, Massachusetts lawmakers took a step Thursday toward establishing mandatory three-day substance use therapy for those in peril and requiring hospitals to stock buprenorphine or other medication to counter street drugs like heroin and fentanyl. (Metzger, 5/4)

Ricciuti is one of thousands of Virginia Medicaid members who was able to find a provider thanks to the state's Addiction and Recovery Treatment Services, or ARTS, program. Launched in April 2017, ARTS increased the rates paid for a host of substance abuse treatments for the first time in a decade. (O'Connor, 5/3)

To expand housing for patients recovering from opioid addiction, Texas made a big bet on Oxford House, a 40-year-old organization known for its sobriety programming. Now, in the face of the opioid crisis, the state is pushing Oxford House to fully embrace something it’s long opposed: medication-assisted treatment. (Rayasam, 5/3)

The Joint Committee on Mental Health, Substance Use and Recovery approved a measure that keeps some of the governor's original proposals, including one that would allow doctors to hold patients for up to three days if their addiction is deemed dangerous. (Becker, 5/3)

Lawyers for the state of Louisiana asked a federal appeals court Thursday to uphold a law requiring that doctors who perform abortions have admitting privileges at nearby hospitals. The arguments involve a law blocked by a federal judge in Baton Rouge last year after the U.S. Supreme Court struck down a similar Texas law. U.S. District Judge John deGravelles was wrong when he ruled against the law in April 2017, argued Elizabeth Murill of the state attorney general’s office. (McGill, 5/3)

As Iowans wait to see if Republican Gov. Kim Reynolds will sign the fetal heartbeat abortion bill into law, Iowa’s attorney general is deciding if he would defend the law in court. The Iowa House and Senate passed a bill Wednesday that would become the strictest abortion law in the country if Reynolds signs it into law. (Sostaric, 5/3)

The Food and Drug Administration is looking for a "large electronic medical record system" to conduct research about adverse drug reactions. The FDA's Bioinformatics and Biostatistics Division will use the EHR to look into the "safety and surveillance of FDA regulated products," according to the request for quote the agency posted earlier this week. Specifically, researchers will analyze VA data to look for adverse side effects from medications. It will use the EHR to develop "novel data mining and data visualization" to apply to the data. Right now, those data exist in different versions of VistA, the VA's home-grown EHR. But they might eventually exist elsewhere. (Arndt, 5/3)

Over several weeks, the Mayo Clinic has shuttled thousands of employees to sessions showing them how to use hospital's new electronic medical records system known around town as Epic after the company, Epic Systems, that makes it. (Richert, 5/4)

[Elisha] Creighton is like the dozens of other mothers, fathers and extended family members who land in the NICU at Tampa General with unexpected issues after their babies are born, said Pam Sanders, vice president of women and children’s services and the associate chief nursing officer at the hospital. The cameras provide a way for family members to stay connected to their child’s recovery when they can’t physically be in the hospital. (Griffin, 5/4)

Just outside Boston, there's a place where people who've been diagnosed with one of the most cruel and debilitating diseases are living longer and more meaningful lives than ever thought possible. The disease is Amyotrophic Lateral Sclerosis (ALS), or Lou Gehrig's disease. And the place is the Leonard Florence Center for Living. (Mullins and Joliocoeur, 5/3)

The throbbing, pulsing pain of a migraine headache is unmistakable, making life miserable at least several times a month for about 1 in 5 adults in the developed world. Some types include aura, a disturbance in vision that comes like a dreaded warning before the headache hits. When it does, exposure to light and sound can be unbearable. Nausea and vomiting are possible, too. Like many other common diseases, migraines run in families, but tracing exactly how these sometimes debilitating headaches pass from parents to children has been challenging. New research published Thursday in Neuron adds genetic detail to the growing body of evidence that migraines are caused by hundreds of common genetic variants that influence when migraines start, how severe they are, and whether family members are also affected. (Cooney, 5/3)

One stormy afternoon in Ljubljana, the capital of Slovenia, thunder rolled, a bolt of lightning streaked across the sky, and the television and air conditioner went dark in the apartment of a woman with electrodes implanted in her brain. Lightning had struck the building. But the appliances were not the only things affected. After about an hour, the woman, who had had the electrodes put in five years before to help with debilitating muscle spasms in her neck, noticed her symptoms coming back. (Greenwood, 5/3)

The CDC's disease detective program, the Epidemic Intelligence Service, is a two-year post-graduate training program — sort of a rapid response force of disease geeks. In addition to working on the early stages of the investigation from Atlanta, Patel flew to Liberia to help map the spread of the disease and write a report on the outbreak. (Beaubien, 5/4)

To the family of the former N.H.L. player Jeff Parker, the posthumous diagnosis of C.T.E., or chronic traumatic encephalopathy, was the predictable conclusion. All those hits to the head, including that final one that knocked him out of the game altogether, and all those subsequent years of struggle? In the final, difficult years before Parker’s death last September at age 53, the family figured that it must be C.T.E. “It just makes me sad,” John Parker, Jeff’s younger brother, said through tears. “It doesn’t bring him back. It just makes you feel sad, that he was living with this, and it’s a thing. It’s a real thing.” (Branch, 5/3)

With any luck, a screening mammogram that shows no sign of breast cancer means you won't have to think about the disease until it's time for your next exam. But about 15% of breast cancers turn up in that interval between regular screenings. These cases are troubling — and not just because the mammogram failed to catch the tumor before it had grown large enough to cause symptoms. (Kaplan, 5/3)

A diet rich in fish and vegetables may delay the onset of menopause, a new study has found. British researchers used health and behavioral data on 9,027 women ages 40 to 65, and followed them for four years. They assessed their diet using a detailed 217-item food frequency questionnaire that included information on portion size. Over the course of the study, and after excluding women who were pregnant, used hormone replacement therapy or had surgically induced menopause, there were 914 women who went through menopause naturally. (Bakalar, 5/3)

A state-run family planning program that Iowa lawmakers established last year to cut funding for Planned Parenthood and other abortion providers has seen a marked decline in patients and participating health care providers, which critics say shows it's not working as promised by its Republican backers. Iowa Department of Human Services data obtained by The Associated Press through a public records request show that just over 5,300 people were enrolled in the program as of March 1, compared to roughly 8,200 when it launched July 1. (5/3)

A pair of bills intended to shore up funding for the state’s Division for Children, Youth and Families and mental health services passed the House Thursday – but only after significant reductions from what the Senate had originally approved. Senate Bills 592 and 590 will go back to the Senate after voice votes in the House. The first, SB 592, would add more than 30 new positions to DCYF, which has been shaken by a pair of high-profile deaths of children under its watch. The bill contains more than $4 million intended to help restore services, reduce workloads and prevent future child fatalities. (DeWitt, 5/3)

Sacramento lawyer G. Ford Gilbert, the recently indicted founder of the national diabetes network Trina Health, hitched his clinic’s expansion plans to a big national name in organized medicine and health policy: Dr. Jack Lewin. The nation has a limited supply of healthcare dollars to spend on drugs and services, which is why the government and health plans require scientific evidence of patient benefit. This is especially important for the 30.3 million people in the U.S. with diabetes, whose medical costs in 2012 totaled $245 billion. Lewin was CEO of the California Medical Association for more than 11 years, CEO of the American College of Cardiology for more than five years and president and CEO of the Cardiovascular Research Foundation for four years. He chairs the board of the National Coalition on Health Care in Washington, D.C. (Clark, 5/3)

Two partners at the hedge fund Deerfield Management and two others were found guilty on Thursday of charges stemming from what prosecutors have described as an insider trading scheme based on leaks from within a federal healthcare agency. Rob Olan and Ted Huber, partners at Deerfield Management who are on leave, were convicted of counts including wire fraud, securities fraud and conversion of government property, as was David Blaszczak, founder of political consulting firm Precipio Health Strategies. (Pierson, 5/3)

Medicare, which has been issuing new cards this spring, does not call the public and ask for personal or private information. The state attorney general’s office on Thursday warned consumers to be aware of scams related to the new cards. Scams can be perpetuated by phone, email or text, the office said. (Nicholson, 5/3)

Former President George H.W. Bush expressed optimism about his recovery on Thursday, saying as soon as he’s cleared to leave the hospital “I’m outta here.” Bush has remained at Houston Methodist Hospital for nearly two weeks with an infection. The hospital announced Thursday it named one of its atriums after Bush and his late wife, Barbara. (Samuels, 5/3)

Executive Commissioner Charles Smith is out as head of the embattled Texas Health and Human Services Commission after a slew of contracting errors have come to light at the mega state agency. Smith, an appointee of Gov. Greg Abbott, announced Thursday he would retire at the end of the month after nearly 30 years of service. ...The move marks a major shake-up at the agency rocked by audits and findings that the contracts sought by HHSC were riddled with errors, miscalculated scores grading vendors and a failure to check references for a company trying to do more than $10 million in business with the state. (Zelinski, 5/3)

Georgia improved by one spot, reaching No. 40 in an annual ranking of states’ health systems, released Thursday. The state’s ranking in the Commonwealth Fund report is similar to the results on other national scorecards in health care. (Miller, 5/3)

A U.S. District Court judge refused to disqualify himself from an ongoing prison health-care lawsuit despite an Arizona Department of Corrections allegation that he is biased. ...[David] Duncan is considering whether to find the department in contempt of court for that "continuing failure" and whether to assess fines against the department for non-compliance that could add up to millions of dollars. (Kiefer, 5/3)

California health regulators have allowed poor care to proliferate at nursing homes around the state, and the number of incidents that could cause serious injury or death has increased significantly in recent years, according to a stinging state audit released this week. The state auditor singled out the California Department of Public Health for particular criticism, saying it had not performed necessary inspections or issued timely citations for substandard care. The audit also found that the department’s nursing home licensing decisions were inconsistent and lacking in transparency. (Gorman, 5/3)

After years of serving LGBTQ communities and people affected by HIV on their own, the Minnesota AIDS Project and Rainbow Health Initiative have merged to create a new nonprofit: JustUs Health. The merged organization will work to achieve “health equity for diverse gender, sexual and cultural communities,” according to a statement by the nonprofit. JustUs has also opened a new behavioral health clinic at 1000 W. University Ave. in St. Paul. Before the merger, neither organization had a behavioral health clinic. (Chavey, 5/3)

State social services czar Charles Smith, a longtime aide to Gov. Greg Abbott, is retiring from state government — the latest to leave the sprawling Health and Human Services Commission under duress over contracting problems. Smith announced Thursday that he would step down as executive commissioner of the Health and Human Services Commission on May 31.  He took over the agency amid one contracting scandal at the commission and is leaving as another is brewing. (Garrett, 5/3)

Sexual minority adolescents and adolescents with high levels of gender nonconformity are vulnerable to experience adversity. The disparities for lesbian, gay, bisexual, transgender, and questioning adolescents and adolescents with high gender nonconformity highlight the variation in patterns of childhood adversity that these youth are at risk of experiencing. The findings reveal the need for further research on the benefits and harm of screening for childhood adversity by physicians and pediatricians. (Baams, 5/1)

TGNC youth may present with mental health conditions requiring immediate evaluation and implementation of clinical, social, and educational gender identity support measures. (Becerra-Culqui, 5/1)

Lesbian, gay, bisexual, and transgender (LGBT) individuals often face challenges and barriers to accessing needed health services and, as a result, can experience worse health outcomes. These challenges can include stigma, discrimination, violence, and rejection by families and communities, as well as other barriers, such as inequality in the workplace and health insurance sectors, the provision of substandard care, and outright denial of care because of an individual’s sexual orientation or gender identity. (Kates, 5/3)

Hawaii, Massachusetts, Minnesota, Vermont, and Utah are the top-ranked states according to the Commonwealth Fund’s 2018 Scorecard on State Health System Performance, which assesses all 50 states and the District of Columbia on more than 40 measures of access to health care, quality of care, efficiency in care delivery, health outcomes, and income-based health care disparities. The 2018 Scorecard reveals that states are losing ground on key measures related to life expectancy. On most other measures, performance continues to vary widely across states; even within individual states, large disparities are common. (5/1)

In this meta-analysis of 6 studies, hospital costs were lower for patients seen by a palliative care consultation team than for patients who not did not receive this care. The estimated association was greater for those with a primary diagnosis of cancer and those with more comorbidities compared with those with a noncancer diagnosis and those with fewer comorbidities. (May et al, 4/30)

The Parkland tragedy lit a fire under supporters of gun regulation. Raw emotion quickly turned into calls for action. Student survivor Emma Gonzales addressed a rally three days after the shooting: “They say that tougher gun laws do not decrease gun violence. We call BS!”  This activism resulted in an array of new firearm legislation in Florida, including a three-day waiting period for firearm purchases. But will the waiting period actually reduce gun deaths? Whether waiting periods affect gun violence has immediate policy implications outside of Florida, too. Waiting period laws are being debated in other states, and there is at least one bill in Congress that would adopt a federal waiting period. Evidence supporting some gun regulations is limited or mixed, but our research suggests that firearm purchase delays — including waiting periods — will result in fewer gun deaths, although probably not in the way people might expect. (Griffin Edwards, Erik Nesson, Joshua Robinson and Fredrick Vars, 5/4)

Over some nine hours Tuesday, Iowa's women were scolded, guilt-tripped and branded as selfish, immoral killers and child abusers if they exercise their constitutional right to get an abortion after a fetal heartbeat can be detected, about six weeks into a pregnancy. And that was by their Republican elected representatives, who proceeded to pass a bill making such abortions illegal except in rare cases. ...“This is the third year I feel compelled to stand on this floor and defend my rights as a woman of childbearing age," said Rep. Abby Finkenauer, D-Dubuque. "You are right now stripping from me, your colleague, her rights." "How dare we think the privacy and decisions of a woman, and her medical choices are up to us to determine?" demanded Rep. Vickie Lensing, D-Iowa City. Remember that saying, "I love humanity. It's people I can't stand"? Many Iowa lawmakers seemed to be telling us they love fetuses unequivocally, but have little use for the women whose wombs they inhabit. (Rekha Basu, 4/3)

The “fetal heartbeat” bill, which passed both the Iowa House and the Iowa Senate this week, would ban most abortions after about six weeks into a pregnancy. If signed into law, this would be one of the most restrictive abortion laws in the country. Although some exceptions (and perhaps one would be the disease that affected my son) are provided, this would only add another layer of bureaucracy to a woman’s already difficult choice. The decision to end a pregnancy is a private one and must remain so. It is a decision that does not belong in the purview of the Iowa Legislature. ...I have hesitated writing this column with what is essentially a “pro-choice” message because I am not keen to get the hate mail that this view often engenders. Or in these very angry and divisive times, a response that might be scarier. (Fern Kupfer, 5.4)

Last week, courts sent the Trump-Pence administration a clear message: It can’t ignore science and the needs of young people to push its ideological agenda. Three Planned Parenthood affiliates — including Planned Parenthood of the Great Northwest and the Hawaiian Islands, Planned Parenthood of Greater Washington and North Idaho and Planned Parenthood of the Heartland — filed suit challenging the Trump-Pence administration’s early termination of federal grants that fund comprehensive, evidence-based sex ed, known as the Teen Pregnancy Prevention Program (TPPP). (Carole Miller and Rachel Todd, 4/3)

The photo instantly takes me back to the 1980s : boxy suits and lank haircuts, and most of all, the big-shouldered man with a broad smile. It’s a picture of President Ronald Reagan thanking the doctors who saved his life, sent to me by a relative. The man shaking Reagan’s hand in the photo was her father, George Morales — an immigrant from Mexico. Thirty-seven years ago, Reagan became the first president to survive being shot while in office. He lived, it is believed, because of the expert care he received at George Washington University Hospital. Less widely known is that every doctor on Reagan’s anesthesia team was foreign-born. (Claudia Kolker, 5/3)

One out of five Americans has no person they can talk to. And the loneliest generation? That would be Generation Z, defined in this survey as those 18 to 22. Their average loneliness score is nearly 10 points higher than the least lonely generation — the Greatest Generation, those 72 and older. While it’s tempting to blame Gen Z’s reliance on smartphones and social media, the data don’t bear that out: The survey didn’t find a significant difference in loneliness levels between those who used social media often or infrequently. Given the worrying consequences, the loneliness of Gen Z — and other generations — should be taken seriously. In fact, Cigna, citing a 2010 Brigham Young University study, says “loneliness has the same impact on mortality as smoking 15 cigarettes a day, making it even more dangerous than obesity.” (Katrina Trinko, 5/4)

The beauty of clinical trials is that they provide a standardized approach to developing a medical treatment within carefully prescribed conditions. The downside is that they focus on highly selective, homogenous populations and provide limited outcome measurements. Incorporating real-world data can help overcome these limitations and mitigate risk. That’s why the pharmaceutical industry needs to embrace it more strongly. (Neile Grayson, 5/2)

After 149 years, Nature, one of the top scientific journals in the world, is getting its first editor-in-chief who’s a life scientist. And its first editor-in-chief who’s on Twitter. Magdalena Skipper also happens to be the first editor-in-chief who is a woman. A geneticist by training and a longtime editor at other Nature publications, Skipper will take the helm as the eighth editor-in-chief of the prestigious journal in July. She will replace Philip Campbell, who is moving to a new role as the editor-in-chief at Nature’s publisher, Springer Nature. (Megan Thielking, 5/4)

The elimination of ObamaCare's individual mandate was a major victory for tens of millions of Americans struggling to pay inflated health-care costs. It has freed them from the mandate of propping up flawed aspects of ObamaCare by subsidizing the coverage costs for others — or paying a stiff fine for opting out.In today's era of "gotcha" politics, my recent remarks before the World Health Congress about the effects of the individual mandate repeal were taken completely out of context. Having made the commonsense observation that absent other reforms, I noted that ObamaCare patients will have to bear more of their own health-care costs as a result. (Tom Price, 5/3)

Ever since President Donald Trump took office, the Department of Health and Human Services (HHS) has promised that states would enjoy more flexibility in structuring their Medicaid programs than had been allowed under prior administrations. HHS leadership promised, among other things, to improve access to care and “create innovative programs for the people [states] serve.” Signaling its commitment to flexibility, the Centers for Medicare and Medicaid Services (CMS) subsequently authorized Medicaid work requirements under section 1115 of the Social Security Act, which allows states to waive certain federal restrictions for Medicaid funding. But for some states, the “people they serve” include millions of undocumented immigrants, many of whom have low incomes and no access to health insurance. How will states navigate an antiimmigration federal policy environment, and how will HHS interpret its promise of state flexibility when proposals include providing coverage for undocumented immigrants. (A. Taylor Kelley and Renuka Tipirneni, 5/3)

When I walk into a Starbucks or a Dunkin Donuts these days, the calorie count on my favorite cruller or apple fritter or frappe glares at me across the aisle, and I frequently choose the lower calorie blueberry crumb with a no sugar latte. But the point is that I don’t choose nothing. The idea that knowing what we are eating is somehow bad for business is unproven at best, destructive at worst. Do you want to know how many calories are in your hamburger or pizza or even salad? I do. Consider that we Americans eat and drink one third of all our calories away from home, and this is frequently where we get into the most trouble, especially at fast food chains or pizza joints. A year ago, the Food and Drug Administration, under new leader Scott Gottlieb, delayed implementation for a year of the so-called Menu Labeling rule of the Affordable Care Act. The rule requires that 20 or more locations operating under the same brand offer comprehensive nutrition information to consumers and display easily-seen calorie counts. where they can make a difference in terms of customer choice. The FDA has now decided to take the brakes off and the new rule will go into effect Monday. (Marc Siegel, 5/4)

The Center for Medicare and Medicaid Innovation was meant to be the government’s innovation laboratory for health care. But HHS has quietly hobbled the agency, imperiling its ability to generate meaningful data on strategies for reducing spending on Medicare and Medicaid. (Scott Levy, Nicholas Bagley and Rahul Rajkumar, 5/3)

Indeed, it is very good news that after the data were correctly adjusted, Texas’ 2012 maternal mortality rate was corrected from 38.4 deaths per 100,000 live births to 14.6 per 100,000 live births for 2012. But this is hardly cause for celebration. A maternal mortality rate of 14.6 percent is unacceptably high — especially when some of these deaths are possibly preventable. (Rakhi C. Dimino, 5/4)

In an editorial last week, The Eagle editorial board began its consideration of a Kansas Department for Children and Families staffing proposal with this statement: “At first glance, it seems a preposterous and careless proposal: Spend $5.4 million to hire 200 unlicensed social workers to investigate reports of child neglect and abuse around Kansas.”The editorial wondered whether the department really “wants neophytes watching over our state’s most vulnerable children.” Despite these rational reservations, the editorial throws caution to the prairie winds and endorses this misguided proposal. While this approach would make a mockery of the concept of protecting vulnerable children in Kansas, it is also an assault on the social work profession and a direct attack on the ability of these professionals to have a voice on how to care for abused or neglected children — and what resources are needed to perform this essential service. (Becky Fast and Sarah Lafrenz, 5/4)

St. Louis County’s prescription drug monitoring program marked its one-year anniversary with data showing that opioids are still vastly overprescribed and that opioid overdose deaths in the region reached a record high last year. The report said that enough painkillers are prescribed in the county for every adult and child to get three pills a month. Although the statistics are grim, there is at least a record of what is prescribed, how often, by whom and for whom. Before the program, there was an information void that prevented policymakers from identifying a major source of the addiction epidemic. The program also issued alerts for nearly 14,000 instances involving someone filling three different prescriptions at three different pharmacies over six months, indicating possible doctor-shopping or drug abuse. (5/3)

It is not news that the scourge of opioid abuse, made more lethal by the addition of fentanyl and its analogues, is one of the major problems we face in this country. In Ohio, drug overdose deaths rose by nearly a third from 2015 to 2016, the last full year for which data are available. Of the 4,050 unintentional drug overdose deaths in 2016, fentanyl and other synthetic opioids were implicated in more than half. And apart from the toll in human life, the craving for these drugs has spawned an increase in crime that reaches into every village and town. As local law enforcement and social services agencies struggle for solutions, there is one constant: They don't come cheap. But the problem cannot be ignored, and efforts to combat it should be supported. (5/4)