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Congress is still trying to send President Donald Trump his first unqualified legislative triumph, nearly six months after Republicans grabbed full control of Washington. Now, lawmakers are returning from their July 4 recess with an added objective — averting some full-blown political disasters. (Fram, 7/10)

Senate Republicans appear miles away from their long-sought repeal of Obamacare, returning to Washington on Monday with just a few weeks to put the pieces back together before they could be forced to abandon their partisan attempts at a health care overhaul altogether. (Everett, 7/9)

The White House and Senate Republican leaders are planning a final, urgent blitz to pressure reluctant GOP senators to pass an overhaul of the Affordable Care Act before their month-long August recess. Aware that the next 14 days probably represent their last chance to salvage their flagging endeavor, President Trump, Vice President Pence and Senate Majority Leader Mitch McConnell (R-Ky.) intend to single out individual senators and escalate a broad defense of the evolving proposal, according to Republicans familiar with their plans. (Snell, Sullivan and Costa, 7/7)

The focus on possible steps to take if Senate Republicans can’t unite around a health bill is the strongest sign yet of the growing pessimism about the fate of the GOP legislation and the party’s seven-year pledge to topple the ACA. Some Republicans now say a vote to pass a bill could stretch beyond August, if there is a vote at all. (Armour, 7/9)

It’s “almost impossible to try to solve when you’re trying to do it with 51 votes in the United States Senate, in which there is not significant consensus on what the final result ought to be,” Sen. Jerry Moran of Kansas said during a Thursday town hall, one of the few Republican members to host public events during the recess. Moran is among a handful of GOP senators to come out in opposition to the existing proposal after McConnell pulled the expected vote on the legislation, a group that now includes Sen. John Hoeven of North Dakota. (Williams, 7/10)

A week that Senate Republicans had hoped would mobilize conservatives and shore up support for their measure to repeal the Affordable Care Act instead ended with eroding enthusiasm, as usually reliable Republican senators from red states blanched at its impact on rural communities. With Congress set to return on Monday after a week’s recess, Republican lawmakers are increasingly aware that their seven-year promise to dismantle President Barack Obama’s largest policy achievement is deeply imperiled. (Steinhauer and Pear, 7/8)

It was a grim week for the Republican effort to repeal Obamacare. The few GOP senators who hosted town hall meetings over the Fourth of July recess were hammered by constituents for trying to undo the health care law. Reliable conservatives like Sens. Jerry Moran and John Hoeven outlined their opposition to the current version of the Senate repeal bill. Even Majority Leader Mitch McConnell acknowledged at a luncheon back home in Kentucky that the effort might fail. (Haberkorn, 7/7)

The Republican Congress returns to Capitol Hill this week increasingly uncertain that a major legislative victory is achievable in the three weeks before lawmakers leave town for their month-long summer recess. Most immediately, GOP leaders and President Trump are under enormous pressure to approve health-care legislation — but that is only the beginning. Virtually every piece of their ambitious legislative agenda is stalled, according to multiple Republicans inside and outside of Congress. (DeBonis and O'Keefe, 7/8)

Republicans expressed increasing pessimism on Sunday about the prospects for the healthcare bill in the U.S. Senate aimed at rolling back Obamacare as lawmakers prepared to return from a week-long recess. One prominent Republican lawmaker, Senator John McCain, said he thought the Republican bill would probably fail. (Abutaleb, 7/9)

The initial GOP bill to repeal and replace the nation's health law is probably "dead" and President Donald Trump's proposal to just repeal it appears to be a "non-starter," two moderate Republican senators indicated Sunday as their party scrambled to salvage faltering legislation. "We don't know what the plan is," said Sen. Bill Cassidy, R-La. "Clearly, the draft plan is dead. Is the serious rewrite plan dead? I don't know." Sen. John McCain, R-Ariz., said it may now be time for Republicans to come up with a new proposal with support from Democrats. (Yen, 7/10)

Sen. John McCain on Sunday warned his fellow Republicans not to shut out Democrats in the Senate's health-care deliberations, which he predicted will fail... During the television appearance, McCain also scoffed at President Donald Trump for suggesting that the United States and Russia could work together on cybersecurity and criticized Secretary of State Rex Tillerson for saying that maybe the Russians have "got the right approach and we've got the wrong approach" with regard to achieving objectives in Syria. (Nowicki, 7/9)

President Trump used Twitter on Sunday afternoon to urge Republicans to follow through on their pledge to get rid of the healthcare law pushed by his predecessor. (7/9)

The gloomy outlook highlights why McConnell had sought to finish work on the repeal-and-replace legislation before the July 4 recess. (Carney, 7/8)

Senate Republican leaders head into a difficult fight this week to win support for their health-care legislation after returning from a recess where some GOP lawmakers fielded angry complaints from constituents about the measure. Senate Majority Leader Mitch McConnell has made little progress on winning over his party’s holdouts as he negotiates with them over revisions to a bill he proposed last month that combines tax cuts with deep reductions in health spending. Changes under consideration include ditching a repeal of Obamacare’s tax increases on the wealthy, revising Medicaid cuts and adding more spending to stabilize premium costs in the individual insurance market, according to a GOP aide who requested anonymity. (Litvan, 7/10)

Senate Republicans clashed Sunday about the path forward for their stalled health-care bill, with passage of any plan before the August congressional recess in doubt and rival factions trying to pull it in opposite directions. Senator Bill Cassidy of Louisiana, speaking on “Fox News Sunday,” declared an earlier Republican leadership plan “dead” and suggested turning to a different bill that he drafted with Republican Senator Susan Collins of Maine. He put the odds of passing a bill in July at “50-50.” (Dennis, 7/9)

Shelley Moore Capito is the most popular politician in a deep-red state that loves President Donald Trump and distrusts big government. And yet the West Virginia Republican is threatening to torpedo the GOP’s best shot at dismantling Obamacare, one of Trump’s top domestic priorities. (Cancryn, 7/9)

West Virginia has one of the country's lowest median incomes. It's home to some of the worst rates of drug overdose deaths, smoking, obesity, diabetes, heart disease, cancer and disabilities. Around 3 in 10 West Virginians are on Medicaid, making it the state most dependent on the health insurance program for the poor, disabled and nursing home residents. Capito says she cares deeply about health care but that changes and reforms to Medicaid are necessary. (Virtanen and Fram, 7/8)

Capito's willingness to torpedo the GOP’s bill that repeals and replaces key provisions of ObamaCare comes even as several of her Republican colleagues have expressed their opposition or reservations about the bill in its current form. (Beavers, 7/9)

Sen. Bernie Sanders has ventured into a stronghold for President Donald Trump to urge West Virginia's Republican senator to resist efforts to repeal much of Barack Obama's health care law. Speaking to hundreds of supporters Sunday in Morgantown, Sanders said if GOP Sen. Shelley Moore Capito's opposes her party's health care bill, it would "make all of the difference" in derailing the legislation. (Schreiner, 7/9)

Vermont Sen. Bernie Sanders hoped to draw big crowds in Covington Sunday. More than 2,000 people showed up at the Northern Kentucky Convention Center, including the Covington Mayor, who introduced Sanders, I-VT.Sanders and the crowd wanted to send a message to Republicans, particularly Senate Majority Leader Mitch McConnell in his home state. That message: Don't destroy the Affordable Care Act. (Wartman, 7/9)

During a week most Republican senators spent in the political equivalent of the witness protection program, Sen. Ted Cruz willingly stood trial before his constituents all across this sprawling state over his push to repeal much of the Affordable Care Act. He debated a self-described “dirty liberal progressive.” He met a psychologist who told him that he and his colleagues were “scaring the living daylights” out of her. He encountered protesters in a border town, a conservative Dallas suburb and this liberal stronghold. (Sullivan, 7/9)

[Ted] Cruz and [Mike] Lee have been working quietly behind the scenes for weeks to devise a proposal that would appease both conservatives and moderates. Essentially, it would allow insurers to sell cheap health care plans, largely shorn of Obamacare essential benefits like maternity care and mental health and substance abuse treatment, if they also sell at least one plan that provides all that coverage. (Pianin, 7/7)

Put another way: With or without Obamacare, somebody will be telling you and me that we need to purchase health insurance, and that somebody must have the ability to punish us — in the wallet — if we do not. That’s the price of preserving the ability of those with pre-existing conditions to sign up for health insurance. (Galloway, 7/8)

Sen. Dianne Feinstein issued a stinging rebuke Friday to the push by congressional Republicans to repeal and replace Obamacare, condemning her GOP colleagues for advancing a health care bill she said was written in private “by 13 white men"... State health officials say it remains unclear how many Californians could potentially lose health coverage because the bill is still under negotiation, but early estimates show it could be as many as 5 million. (Hart, 7/7)

Sen. Dianne Feinstein said Friday that she thinks the Democrats have the votes to permanently stop the Republican health care bill in the Senate, noting “we’re very close to defeating it.” The Republicans can stand to lose only two votes from their own party, and nine Republicans signaled their opposition before leaving Washington for the July 4 recess. (Hutson, 7/7)

U.S. Sen. Jerry Moran is opposed to a bill crafted in secret by Republican leaders to repeal and replace the Affordable Care Act. But speaking to an overflow crowd at a town hall meeting Thursday in northwest Kansas, Moran said he is open to supporting a revised version if GOP leaders can address his concerns...Among other things, Moran said he is concerned about the effect of nearly $800 billion in proposed Medicaid cuts on rural health care providers and Kansans with disabilities. And he said he doesn’t like how the bill treats Kansas and other states that have not expanded eligibility for their Medicaid programs. (Mclean, 7/7)

Several voters here urged Sen. Chuck Grassley Friday to work with Democrats to pass a bipartisan health care bill instead of helping ram through the current Republican bill that would rein in Obamacare. “It seems like nothing can ever get done if you don’t listen to each other and work together,” Deb Egeland of Centerville told the Iowa Republican. “… I mean, both parties have intelligent people, good ideas. ”Egeland is a retired park ranger and a registered Democrat but considers herself politically independent. She was among about 25 people who attended the unadvertised meeting with the senator in a conference room at the Rathbun Regional Water Association headquarters. (Leys, 7/7)

U.S. Sen. Cory Gardner returns to Capitol Hill next week after a Fourth of July break in Colorado that was anything but a respite from the contentious debate over Republican plans to dismantle the Affordable Care Act. Over the roughly week-long recess, Obamacare supporters ramped up their opposition with several ads and protests, including a Denver rally, a demonstration in Colorado Springs and a radio hit by AARP that specifically targeted Gardner, a Republican from Colorado (Matthews, 7/8)

If the health care bill currently before the U.S. Senate fails, lawmakers should immediately repeal the existing law known as Obamacare and then get to work crafting a replacement, U.S. Sen. Ben Sasse told a Republican crowd here on Friday. The Nebraska Republican’s comments, delivered at a Story County GOP fundraiser, represent a rejoinder to Senate Majority Leader Mitch McConnell, R-Ky., who suggested this week that if the bill currently under consideration dies the party may have to negotiate with Democrats on fixes to the existing law rather than a wholesale overhaul. (Noble, 7/7)

A former House Democrat is revealing her battle with multiple sclerosis in an op-ed pleading for lawmakers to maintain healthcare coverage for people with pre-existing conditions. Former Rep. Donna Edwards (D-Md.) said she is worried she won't be able to cover medical costs of nearly $100,000 a year. (Beavers, 7/9)

Senate Republicans, having hit an apparent impasse in their long campaign to repeal and replace the Affordable Care Act, return to Washington this week in search of a way forward, with support dwindling, time running out and deep divisions within their ranks. Options are limited as Senate Majority Leader Mitch McConnell (R-Ky.) assesses the legislative landscape for his Obamacare replacement, which has virtually no hope of passing unless it is substantially amended. (Mascaro and Levey, 7/10)

Americans really, really don't like the Senate bill to repeal and replace the Affordable Care Act. Only 17 percent of U.S. adults approve of the health care bill, according to a recent NPR/Marist/PBS NewsHour poll. In fact, a majority of Americans now approve of the ACA, also known as Obamacare — but just nine months ago, that wasn't true. So what do they want? (Kurtzleben, 7/10)

When covering the GOP efforts to repeal and replace the Affordable Care Act, we tend to focus on the big picture: billions of cuts in Medicaid spending, say, or millions of fewer people with health coverage. But the real impacts would be felt in states, cities and towns, and they would vary a lot depending on where you live, how old you are and your particular health concerns. (7/10)

As Republican senators work to fix their troubled health care bill, there is one giant health insurance subsidy no one is talking about. It is bigger than any offered under the Affordable Care Act — subsidies some Republicans loathe as handouts — and costs the federal government $250 billion in lost tax revenue every year. (Zernike, 7/7)

The number of U.S. adults without health insurance has grown by some 2 million this year, according to a major new survey that finds recent coverage gains beginning to erode. The new numbers highlight what's at stake as Congress returns to an unresolved debate over Republican proposals to roll back much of former President Barack Obama's health care law. (Alonso-Zaldivar, 7/10)

Members of Congress returning home for the July 4 recess last week were met with rallies, sit-ins and Independence Day demonstrators, as activists on the left intensified their push to defeat Republican legislation to repeal and replace the Affordable Care Act. The groups on the right that once fueled the party’s anti-Obamacare fervor might as well have been on vacation. (Zernike, 7/8)

The Senate health care bill, called the Better Care Reconciliation Act, would roll back nearly $1 trillion in taxes imposed by the Affordable Care Act to expand coverage to the poor and middle-income individuals. ... That has given Democrats and other critics of the bill heavy ammunition to call the Better Care Reconciliation Act or ”Trumpcare,” as it’s detractors call it, a giveaway to the nation’s wealthy at the expense of helping middle-class Americans purchase health insurance and cutting Medicaid, the government-run health program for the poor. (Radelat, 7/9)

Republican senators return to Washington next week with the challenge of winning 50 votes for a health care bill that meets their broad goals of rolling back the Affordable Care Act and cutting taxes, but that also would cause millions of people to lose their health insurance. The bill has won lukewarm support among some conservatives as a step in the right direction. (Boulton, 7/7)

President Donald Trump’s ability to land his first major legislative achievement, on health care, now rests with a Republican who kept a studied distance from the party’s nominee during the campaign and since: Senate Majority Leader Mitch McConnell. The Kentuckian didn’t campaign with the president and rarely mentioned him. Shortly before the 2016 election, Mr. McConnell told businesspeople in his state that if they expected him to talk about the presidential race, they “might as well go ahead and leave.” Since the election, his most public engagement with the president has come in his admonitions to lay off Twitter. (Hughes, 7/9)

Senate Majority Leader Mitch McConnell is taking a risk by calling for a bipartisan health-care plan if the Republican-only bill fails: While his comments may encourage conservatives to fall in line with his approach, party moderates may be emboldened to abandon the GOP legislation. McConnell told a home-state Kentucky audience Thursday that if Republicans can’t “agree on an adequate replacement, then some kind of action with regard to the private health insurance market must occur.” (Litvan, 7/7)

U.S. Sen. Tammy Baldwin said Friday that Senate Majority Leader Mitch McConnell (R-Ky.) opened a door to working with Democrats to fix the Affordable Care Act. Baldwin was reacting to statements McConnell made Thursday at a Rotary Club luncheon in southern Kentucky. (Glauber, 7/7)

A leading House conservative is warning Senate Majority Leader Mitch McConnell (R-Ky.) he should not quit fighting to pass legislation to repeal and replace ObamaCare through the Senate. Rep. Mark Meadows (R-N.C.), the chairman of the conservative House Freedom Caucus, is not happy about talk that Senate Republicans might give up that effort and instead work with Democrats on legislation to shore up troubled insurance markets. (Bolton, 7/7)

The minority leaders have said for weeks that the Democrats were ready to bargain with the GOP and the White House on virtually any issue provided the Republicans abandoned their effort to repeal former President Barack Obama’s signature program. According to several policy experts, here are five areas where a bipartisan health care compromise might be struck. (Pianin, 7/8)

A non-partisan campaign watchdog group is accusing President Trump's Health and Human Services Secretary Tom Price of misusing congressional campaign money to push for his cabinet confirmation, according to a Wall Street Journal report. The Campaign Legal Center filed a complaint Friday with the Federal Election Commission (FEC) that pointed to a $40,000 payment in January made by the former Georgia congressman’s campaign team to America Rising, a Republican consulting firm. (Delk, 7/8)

In its complaint with the Federal Election Commission, the Campaign Legal Center cited a $40,000 payment the former Georgia congressman’s campaign committee made on Jan. 26 to America Rising, a GOP consulting firm. Around the same date, the complaint said, the firm released research and videos promoting the confirmation of Mr. Price and other cabinet nominees in the Senate. Mr. Price was the only cabinet nominee to use campaign funds to pay the firm, according to the complaint. (Hackman, 7/7)

At the Indian Health Service hospital in Pine Ridge, S.D., a 57-year-old man was sent home with a bronchitis diagnosis—only to die five hours later of heart failure. When a patient at the federal agency’s Winnebago, Neb., facility stopped breathing, nurses responding to the “code blue” found the emergency supply cart was empty, and the man died. In Sisseton, S.D., a high school prom queen was coughing up blood. An IHS doctor gave her cough syrup and antianxiety medication; within days she died of a blood clot in her lung. (Frosch and Weaver, 7/7)

The Indian Health Service is responsible for providing medical care to about 2.2 million tribal members across the U.S., but the system is in crisis after IHS hospitals repeatedly failed inspections, shut down services or lost access to crucial federal funds. The facilities, which operate in some of the poorest areas of the country, have rendered dangerous care and caused unnecessary deaths, according to federal regulators, agency documents and interviews. (Frosch and Weaver, 7/7)

Four days before Alexander Bonds ambushed and killed a New York City police officer, he was in a hospital emergency room getting a psychiatric evaluation. The hospital released him the same day. Now the hospital's actions are under a state review ordered by the governor. St. Barnabas Hospital says it handled Bonds appropriately and welcomes the inquiry. (Peltz, 7/8)

Why would an older person essentially discharge himself from a hospital, defying a physician’s recommendation and signing a daunting form that acknowledges he is leaving A.M.A. — against medical advice? Attend the tale of William Callahan. (Span, 7/7)

When most people today talk about wearables, they’re likely thinking about counting steps on a FitBit or tracking movement on an Apple Watch. But a growing number of medical practitioners see potential for these devices to improve the delivery of care. Wearables are inching closer to clinical use — from checking vital signs to warning of seizures — by letting doctors monitor patients in less invasive ways. Health care startups have developed some wearables to the point where hospitals and health clinics may soon embrace them as a way to improve patient outcomes and drive down the cost of care. (Blau, 7/10)

The Washington hospital where Louisiana Rep. Steve Scalise was taken for his gunshot wounds last month has scored extremely low in safety ratings, including for infections which the House majority whip is now being treated for. Medstar Washington Hospital Center scored a D in hospital safety ratings by Leapfrog Group and just two out of five stars in the ratings done by the Centers for Medicare and Medicaid Services (CMS) Hospital Compare website. (O'Donnell, 7/8)

Providence Health & Services, Oregon's largest private-sector employer, is preparing an aggressive cost-cutting campaign that will include layoffs. The move is clearest sign to date that hospitals face a difficult, uncertain future. Providence saw its financial position deteriorate markedly in 2016, posting an operating loss of more than $255 million, filings show. Though its annual revenue topped $22 billion and, as a non-profit, it pays no income taxes, Providence is looking to cut costs across its seven-state network, multiple sources say. David Underriner, chief executive of the medical provider's Oregon operation, would not disclose numbers or locations, but did say, "there will be an impact on people." (Manning, 7/8)

Trinity Healthcare System, by far the largest employer in Jefferson County and one of the largest employers in Eastern Ohio, likely would be forced to cut jobs and services under the health care plan proposed by Senate Republican leadership and backed by President Donald Trump, according to the health care network's top official. Trinity officials project the future Medicaid cuts proposed in the Better Care Reconciliation Act, currently under debate in the Senate, would mean a loss of $61 million in revenue over the next 10 years, interim CEO Joe Tassi said in an interview. (Tobias, 7/7)

Sioux Falls Specialty Hospital in South Dakota is regularly full. Its doctors and nurses often have to work longer hours or perform elective surgeries such as hip or knee replacements on weekends. "In many cases, patients have to wait forever," said Dr. R. Blake Curd, an orthopedic surgeon and the hospital's CEO. "We don't have the physical capacity to take care of them." (Leonard, 7/10)

Children’s Hospitals and Clinics are in-network again for policyholders with Blue Cross and Blue Shield. The Minnesota-based hospital network and insurance provider reached a deal Friday after the contract was terminated Wednesday following a monthslong payment dispute, Attorney General Lori Swanson announced at a news conference. Children’s Minnesota became an out-of-network provider for everyone insured by Blue Cross when the deadline for negotiations passed Wednesday without an agreement. Patients face paying more for medical care at out-of-network locations. Blue Cross had proposed a 31 percent cut to Medicaid reimbursements, which Children’s Minnesota said was an unreasonable reduction it could not accept. (Carson, 7/7)

Minnesota's largest individual health insurer and its largest children's hospital system have ended a standoff affecting more than 66,000 patients. Blue Cross and Blue Shield of Minnesota and Children's Minnesota hospitals had been unable to reach a new contract by Wednesday's deadline, meaning that thousands of patients and their families faced significantly higher costs because Blue Cross would treat Children's hospital operations as out-of-network for health coverage. (Cox, 7/7)

Partners HealthCare’s plan to acquire the Massachusetts Eye and Ear Infirmary will get close regulatory scrutiny after a state watchdog agency concluded the merger could have a significant effect on health care costs... The decision to launch what the agency calls a cost and market impact review dashes any hopes for swift approval of the merger between the state’s largest organization of hospitals and doctors and the specialty hospital next door. (Freyer, 7/9)

While the U.S. holds its breath on the fate of the Affordable Care Act, it's easy to forget that there are lots of other health care systems out there in the world. What would it be like to get a chance to try on a different health care system for a bit, like a new pair of shoes? (O'Leary and McHenry, 7/7)

Diabetes, high blood pressure and other chronic conditions account for the vast of health spending in the U.S. — more than 85 cents per dollar, according to the Centers for Disease Control and Prevention. Some health plans are beginning to offer free maintenance care for people with chronic health problems, hoping that spending a little more early on will save a lot money in the long run. (Zdechlik, 7/10)

Drug users, desperate to break addictions to heroin or pain pills, are pawns in a sprawling national network of insurance fraud, an investigation by STAT and the Boston Globe has found. They are being sent to treatment centers hundreds of miles from home for expensive, but often shoddy, care that is paid for by premium health insurance benefits procured with fake addresses. Patient brokers are paid a fee to place insured people in treatment centers, which pocket thousands of dollars in claims for each patient. They often target certain Blue Cross Blue Shield plans, because of their generous benefits and few restrictions on seeking care from out-of-network treatment programs. (Armstrong and Allen 7/7)

After three defendants fatally overdosed in a single week last year, it became clear that Buffalo’s ordinary drug treatment court was no match for the heroin and painkiller crisis. Now the city is experimenting with the nation’s first opioid crisis intervention court, which can get users into treatment within hours of their arrest instead of days, requires them to check in with a judge every day for a month instead of once a week, and puts them on strict curfews. Administering justice takes a back seat to the overarching goal of simply keeping defendants alive. (Thompson, 7/9)

No one has come up with a solution to the opioid epidemic that has decimated Rust Belt states, but for people who overdose, Naloxone is about as effective an antidote as there is. The results of the opioid antagonist, which is sprayed up a person's nose and reverses the effect of opioid overdoses, have been likened to resurrecting someone from the dead. Paramedics and firefighters routinely carry the easy-to-administer medication in their vehicles. For police officers in the nation's hardest hit areas, like southwest Ohio, the Food and Drug Administration-approved nasal spray, known by the brand name Narcan, can be as common as handcuffs. Even some librarians have learned to use the drug to revive people who overdose in their stacks. (Wootson, 7/8)

The opioid epidemic sweeping the country has taken a heavy toll on older people in Oregon as nowhere else – an unexpected trend that has caught doctors by surprise. Oregonians age 65 and up are landing in the hospital for opioid overdoses, abuse, dependence and adverse effects at a greater rate than any other state, federal figures show. A dozen other states including Washington and California also show seniors with high hospitalization rates for opioids, including Vicodin, OxyContin and Percocet. (Terry, 7/7)

Clinicians in Martinsville, home to fewer than 13,500 people, prescribed almost 4,090 morphine milligram equivalents per person. The national average was 640 milligram equivalents per person. That contrast underlines the dramatic differences in opioid prescribing across the country as health officials try to tackle a national epidemic. A report from the Centers for Disease Control and Prevention this week found that while prescribing fell nationwide from 2010 to 2015, places that prescribed the most opioids were still doling out drugs at rates six times higher than the lowest tier of communities. (Joseph, 7/7)

Minnesota’s rate of opioid-related hospital admissions for residents 24 and younger was seventh-highest in the nation. Minnesota also had the seventh-highest rate of senior citizens hospitalized for opioid-related conditions, ranging from emergency overdoses to addiction treatment. (Olson, 7/6)

Baltimore City will get $2 million to open a 24-hour "sobering center" to help those addicted to drugs, part of a larger pool of money the state is giving out to every county to fight the heroin and opioid epidemic. The Governor's Office of Crime Control & Prevention announced Friday how the more than $22 million would be distributed among the state's 24 jurisdictions. The money comes from funds the governor committed to fight the opioid epidemic, the federal government's 21st Century Cures Act and the state's crime control and prevention agency. (McDaniels, 7/8)

Despite the near blanket availability of treatment programs, the Enquirer review also shows none of the local jails offer all three FDA-approved medications for heroin and opioid addiction disease: methadone, buprenorphine and injectable naltrexone. Offering all the options is important, experts say, because there is no one-size-fits-all treatment. (DeMio, 7/9)

Biological threats pose some of the gravest health risks in our increasingly interconnected world. They can be naturally occurring, such as outbreaks of Ebola infections, or bioterrorism, such as the anthrax attacks in 2001. A study reported this week renews worries about human-made biological agents. Scientists synthesized an extinct horsepox virus closely related to smallpox, the deadliest microbe in human history. Smallpox has been eradicated, but the work raises the possibility that it would be relatively straightforward to synthesize the smallpox virus. (Sun, 7/7)

Scientists in Canada have used commercially available genetic material to piece together the extinct horsepox virus, a cousin of the smallpox virus that killed as many as a billion human beings before being eradicated. The laboratory achievement was reported Thursday in a news article in the journal Science. (Achenbach and Sun, 7/7)

The main goal of pre-operative (neoadjuvant) chemotherapy for breast cancer is to shrink tumors so women can have a lumpectomy rather than a more invasive mastectomy. It was therefore initially used only on large tumors after being introduced about 25 years ago. But as fewer and fewer women were diagnosed with large breast tumors, pre-op chemo began to be used in patients with smaller cancers, too, in the hope that it would extend survival. But pre-op chemo can, instead, promote metastasis, scientists concluded from experiments in lab mice and human tissue, published in Science Translational Medicine. (Begley, 7/10)

Palliative care has been shown to increase patients’ satisfaction with the care they receive and to save on medical expenses by reducing the need for hospitalizations and trips to the emergency room. One study of homebound, terminally ill patients with a prognosis of approximately a year or less to live, plus one or more hospital or emergency department visits in the previous year, found that the average cost of care for those receiving palliative care services — $95.30 per day — was less than half the cost for  those without palliative care — $212.80. Despite dramatic growth in the number of hospitals providing such care over the last decade, full palliative care services remain unavailable to many patients. But those who work in the field say they are encouraged by several developments over the last five years. (Ollove, 7/10)

Stem cell tourism — in which patients travel to developing countries for unproven and potentially risky therapies — should be more tightly regulated, according to a group of international health experts. With hundreds of medical centers around the world claiming to be able to repair tissue damaged by conditions such as multiple sclerosis and Parkinson’s disease, tackling unscrupulous advertising of such procedures is crucial. (7/8)

A new study by Harvard University researchers has found that pregnant women who forgo sugar-sweetened beverages — specifically soda and fruit drinks — may help their children avoid excess weight and even obesity later in childhood. “We found mothers who consumed more sugary beverages in mid-pregnancy had children with higher amounts of body fat, no matter what the kids’ intake was,” said Sheryl L. Rifas-Shiman, a biostatistician with Harvard Medical School and Harvard Pilgrim Health Care Institute. (Giordano, 7/10)

Not so long ago, people like my Aunt Muriel thought of sunburn as a necessary evil on the way to a “good base tan.” She used to slather on the baby oil while using a large reflector to bake away. Aunt Muriel’s mantra when the inevitable burn and peel appeared: Beauty has its price. (Hanson, 7/8)

A Franklin County jury decided that death wasn’t the appropriate penalty for Lincoln S. Rutledge after hearing testimony about his mental illness. The jurors recommended life in prison without parole after the defense called a parade of witnesses, including a psychologist who said Rutledge was suffering from a delusional disorder at the time of the crime. (Futty, 7/10)

New research from Iowa State University finds that men convicted of domestic violence are nearly 50 percent less likely to reoffend if they participate in an intervention that emphasizes emotional awareness. Men convicted of domestic violence are often required to participate in a program that teaches their violence is the result of a desire to control women. (Boden, 7/7)

A study by UC Berkeley researchers found that a sense of smell can influence the brain’s decision to burn fat or store it in the body — or a least the bodies of mice. Researchers Andrew Dillin and Celine Riera studied three groups of mice — normal mice, “super-smellers” and ones without a sense of smell — and saw a direct correlation between their ability to smell and how much weight they gained from a high-fat, “Burger King diet,” Dillin said. (Graham, 7/9)

A British court will assess new evidence in the case of 11-month-old Charlie Gard as his mother pleaded with judges to allow the terminally ill infant to receive experimental treatment. Great Ormond Street Hospital applied for the court hearing to be held Monday amid “new evidence relating to potential treatment for his condition.” (7/10)

The parents of terminally ill Charlie Gard told USA TODAY on Sunday that they hope the courts will reverse course and allow their 11-month-old son to receive experimental treatment in the United States. Another court hearing is scheduled for Monday in the controversial case that raises bioethical issues and caught the attention of President Trump and Pope Francis. (Hjelmgaard, 7/9)

In an abrupt shift, a London hospital said on Friday that it would reconsider its decision to turn off life support for Charlie Gard, a brain-damaged and terminally ill British infant, in light of “fresh evidence” about a potential treatment. (Bilefsky and Chan, 7/7)

State lawmakers on Friday approved an annual budget that imposes new fees on businesses to help pay the state’s ever-rising health care costs, but they rejected a controversial series of proposals from the Baker administration to rein in those costs, drawing a rebuke from the business community. Advocates for the poor applauded the Legislature’s decision to leave out policy changes that they said would have hurt families who rely on public health coverage. (Dayal McCluskey, 7/7)

[Charlie] Baker’s budget chief, in an e-mail to top lawmakers last week, disclosed plans to potentially sweep up to $139 million from a variety of state programs, many of them designated for mental health purposes... A Lepore spokesman said she sent the letter to “preserve the option” to use the funds to bring last year’s spending into balance. (O'Sullivan, 7/7)

A round of last-minute funding cuts to state public health programs has left administrators scrambling as they attempt to provide continued services to Iowans while grappling with the realities of dramatically reduced budgets. In all, 10 public health programs saw their funding through the state's Department of Public Health completely eliminated going into the 2018 budget year, including one that has since closed its doors. The cuts, announced in mid-June, took effect July 1. (Pfannenstiel, 7/9)

Missouri Republicans want to make it a crime for abortion clinic staff to ask ambulances to respond to calls at their facilities without sirens or lights, a move that abortion-rights advocates say is unnecessary and another veiled attempt to restrict access to abortion providers. (7/7)

An online petition protesting the Kansas City Royals’ relationship with an anti-abortion group has drawn thousands of signatures and raised questions about whether the team is endorsing the group’s views. Royals officials say the team takes no position on “culturally sensitive issues.” But the advertising relationship with the Vitae Foundation, now in its second year, appears to go beyond advertising and lend the Royals’ stamp of approval to an organization that promotes pregnancy centers, which have been widely criticized for disseminating medically inaccurate information. (Tufts, 7/7)

To some, the California Nurses Association’s political tactics in pushing for a single-payer health system seemed a bit, well, extreme. Never mind the raucous demonstrations it brought to the state Capitol in recent weeks, the “shame on you” chants in the hallways, the repeated unfurling of banners in the rotunda despite admonitions from law enforcement. (Bartolone, 7/10)

The state Department of Corrections and teen inmates filed plans with a federal judge late Friday to dramatically reduce the use of solitary confinement and pepper spray in Wisconsin's juvenile prison complex. U.S. District Judge James Peterson last month ordered those plans to be written after he found teen inmates' constitutional rights were likely being violated at Lincoln Hills School for Boys and Copper Lake School for Girls. (Marley, 7/8)

The executive director of The Center of Central Florida announced this week that he is stepping down from his position and accepting a new role as the head of communications for the LGBT advocacy center... The Center, one of the most prominent advocates for the lesbian, gay, bisexual and transgender community in Central Florida, offers free legal advice, AIDS and STD testing and support groups to those who need them. (Williams, 7/8)  

A Laguna Beach woman is the first person to test positive for West Nile virus in Orange County this year, the county Health Care Agency said Friday. A routine test at a blood bank last week revealed that the woman, who is in her 70s, is infected with the virus. She did not have any symptoms, according to the agency. (Fry, 7/7)

House Bill 2107 would’ve allowed health care specialists focused on neurological disorders to administer both low-dose THC and CBD to patients. But despite bipartisan support in the lower chamber — the bill had 77 House lawmakers signed on as co-authors — the measure never made it to the House floor for a vote. (Samuels, 7/10)

The University of Maryland School of Pharmacy will begin offering training to prepare prospective workers for the medical marijuana industry. The move puts the Baltimore school in league with few other established universities and colleges, including the University of Vermont College of Medicine’s Department of Pharmacology, seeking to bring educational standards to a growing national industry that grapples with evolving science and uncertain legal standing. (Cohn, 7/9)

It is tempting to think that the Republican health care proposal, which would do so much damage to so many Americans, will collapse in the Senate, since conservatives and centrists alike have come out against it. But that would be premature. After all, House leaders managed to cobble together a narrow majority for their bill after similar protests in that chamber. At least some of the Senate opposition to Majority Leader Mitch McConnell’s opening bid in the health care wars is mere political theater. (7/10)

Will 50 Republican senators be willing to inflict grievous harm on their constituents in the name of party loyalty? I have no idea. But this seems like a good moment to review why Republicans can’t come up with a non-disastrous alternative to Obamacare. It’s not because they’re stupid (although they have become stunningly anti-intellectual). It’s because you can’t change any major element of the Affordable Care Act without destroying the whole thing. (Paul Krugman, 7/10)

No matter which way the Republican health care bill goes, there's one group that should be seriously freaking out right now: Wall Street. Not because of what the bill says, but because of how Republicans are going about passing it. (Jonathan Bernstein, 7/10)

The ruling Republicans are trying to defy Washington's political gravity: pushing through massive health-care and tax overhauls crafted largely in secret, on a partisan basis, brushing aside congressional expertise and overcoming the policy ignorance of President Donald Trump with products of dubious quality, at best. (Albert R. Hunt, 7/9)

Mitch McConnell, the Senate majority leader, told his Republican colleagues that they needed to vote on their health bill before the July 4 holiday — then he gave them an extension. But don’t expect the health care debate to drag on forever. There are legal and political reasons that Republicans really do need to decide in the next few weeks whether their legislative effort will succeed or go back on the shelf. (Margot Sanger-Katz, 7/10)

All my life, I’ve mostly been active and healthy (save for the occasional sports injury). ... I thought I was in great health. I was not. ... I had multiple sclerosis, an autoimmune disease that attacks the central nervous system. ... A year later, I am no longer in Congress, and my future health care is uncertain. I am not employed, and I pay $800 a month for my COBRA coverage, which ends in June 2018. I’m not sure what I’ll do then. My medication, which has thankfully halted the progression of my MS, costs roughly $73,000 a year. (Donna F. Edwards, 7/7)

The Republican plan to undo the Affordable Care Act has spun out of control. GOP senators are frustrated by a process that excluded many of them and violates their promise to make health care more affordable. The abysmally unpopular plan is favored by only 12% in the latest USA TODAY/Suffolk University poll. In the face of this, the Republican Senate and president are abandoning their posts, and it’s now every man or woman for himself. Unless the bill dies, the result will reflect every bit of this chaos. (Andy Slavitt, 7/10)

Democrats have to defend Obamacare because people will be hurt if the Republican repeal goes as planned. But they should not be distracted from the need to offer an uplifting vision of their own for America. (Linda Valdez, 7/7)

Were it not for the provision that Patrick J. Toomey, the Pennsylvania Republican, put into the Senate’s proposed health-care reform, this legislation would be moderately important but hardly momentous. Toomey’s provision, however, makes it this century’s most significant domestic policy reform. It required tenacity by Toomey to insert into the bill a gradually arriving, but meaningful, cap on the rate of growth of per-beneficiary Medicaid spending. (George F. Will, 7/7)

Few politicians have acquitted themselves well in the health-care debate, but no one has dumped his former principles harder than John Kasich. Ohio’s Republican Governor has emerged as the media’s go-to source for substance-free lectures opposing Medicaid reform, and this debate could use a fact or two, not least about Ohio. (7/7)

A key budget issue between Gov. John R. Kasich's administration and his fellow Republicans in the General Assembly: Attempts by the GOP's state legislators to micromanage Medicaid. ... So, arguably, the real-world meaning of Ohio House Republicans waiting a while before trying to reinstate a Medicaid expansion freeze: They may want to try to make Ohio's congressional Republicans wear the jacket if Ohioans lose Medicaid expansion coverage. (Thomas Suddes, 7/8)

At the very least, your efforts over the last few weeks gave a whole lot of Ohioans a Fourth of July weekend free from worry about whether our families will have health insurance next year. ... At least for another week, you helped pull the plug on legislation that would reduce the insured by 22 million, while making coverage less robust and more expensive for millions more. (Don Mooney, 7/8)

Over the years, I have seen time and again how important it is for our kids to have access to affordable, comprehensive health care coverage. Since 1965, our Kansas Medicaid program has provided this for an ever-increasing number of children, more than 280,000. The U.S. Senate’s recently unveiled health care legislation, the Better Care Reconciliation Act, does not live up to its name. The sweeping, unprecedented cuts to Medicaid included in the bill would fundamentally change the way the program works and would leave children and families worse off. (Dr. Pam Shaw, 7/6)

The only silver lining in the massive storm cloud hovering over the Affordable Care Act is the persistence of bipartisan support for payment reforms aimed at improving healthcare quality and lowering its cost. ... But that doesn't mean the CMS is proceeding smoothly toward value-based reimbursement. (Merrill Goozner, 7/7)

I always considered the Affordable Care Act to be more about health insurance reform than healthcare delivery reform. While far from perfect, it has expanded coverage to millions of Americans who were previously unable to afford health insurance. ... Seven years later, I thought the national debate would finally shift from how we pay for healthcare to how we deliver it. By now, I thought the conversation would be about making Americans the healthiest people in the world and developing a healthcare system that's affordable, high quality and convenient for everyone. Instead, we're back to square one.​ (Dr. Rod Hochman, 7/10)

The opposition of the American Medical Association, American Hospital Association, AARP and other prominent groups did not stop the House from passing its version of a replacement for the 2010 health care law. Now, those lobbies are searching for the precious few pressure points to help derail the Senate bill. It’s already clear that the political forces driving the bill, or the ones that might ultimately take it down, are bigger than they are. After all, this is about a promise Republicans repeated for four elections: to undo Obamacare. (Kate Ackley, 7/10)

When it comes to health care coverage, House Speaker Paul Ryan says, “We’re going to have a free market, and you buy what you want to buy,” and if people don’t want it, “then they won’t buy it.” In this model of health care, the patient is consumer, and he must decide whether the goods and services he wants to protect his life are worth the cost. But this is often impossible. And what Republicans, and many Democrats, forget to stress, is that in a totally free market health care system, you must be willing to let some patients die. (Dr. Farzon A. Nahvi, 7/10)

This year, Congress has worked hard to craft solutions to the real challenges being experienced in the health care marketplace. In many states, including Wisconsin, the individual insurance market needs to offer more health plan options at a lower cost. (Bernie Sherry, 7/7)

The biggest problem with Obamacare is that it expanded health coverage through Medicaid, a program with notoriously poor access to doctors, because Medicaid pays doctors far less than private insurance. The Senate Republican health care bill aims to change that, by giving states the ability to offer an innovative new model to their poorest residents: direct primary care. ... The way to think about DPC is that it’s like concierge medicine, but for everyone, including the poor. The idea, at its core, is simple: for a nominal fee amounting to the cost of a gym membership, a patient gets broad access to a physician’s time. (Avik Roy, 7/9)

Charlie Gard, an 11-month old British child with a rare genetic disease, is today the most famous baby in the world. For all the wrong reasons. Even as he remains on life support at a British hospital, he has attracted the attention of the President of the United States, the pope, the British courts and the European Court of Human Rights. All because his government has backed medical experts who say the experimental treatment offered by hospitals abroad—treatments his family hopes to try and is willing to pay for themselves—would only prolong his suffering. (7/9)

An expanded child credit has a few advantages over paid leave. It would benefit a broader set of families. While it would arouse some opposition from conservatives -- the Wall Street Journal’s editors, for example, object to it on principle as tax-code favoritism toward an interest group -- it would draw less of it than paid leave. The child credit is an existing feature of the code that has enjoyed broad bipartisan support. And the credit has a stronger rationale than paid leave, because parents are overtaxed. (Ramesh Ponnuru, 7/7)

The agency that has been the main target of efforts to fire feds faster dismissed more than 500 employees this year — even before a new accountability law took effect. Since the Department of Veterans Affairs (VA) shamed itself in 2014 with a scandal over the coverup of long patient wait times, Capitol Hill politicians have demanded that the agency accelerate sacking — as if that were the main measure of good personnel administration. Department leaders joined the call and perpetuated the impression that life would be better if only more derelicts could be dumped. (Joe Davidson, 7/9)

Toward the end of the great adventure movie “A High Wind in Jamaica,” a gang of pirates is sentenced to hang for a murder they didn’t commit. “I don’t want to die innocent!” a crewman cries out to his captain. “Zac,” replies the captain, “you must be guilty of something.” One could cite that line to explain the lawsuits lodged against the giant consumer company Johnson & Johnson by more than a thousand women suffering from ovarian cancer, and their families. ... is the science strong enough to support judgments of this magnitude? The answer seems to be no. (Michael Hiltzik, 7/9)

[Sheila] Wilson, who co-founded Stop Healthcare Violence, a nonproft aimed at providing a safe workplace for providers, has been lobbying the Legislature to strengthen penalties. ... According to the federal Occupational Safety and Health Administration, or OSHA, healthcare violence accounts for nearly as many injuries as all other industries combined. From 2011 to 2013, healthcare workers suffered 15,000 to 20,000 such injuries each year -- and those were only the ones serious enough to require days off to recover. (Bella English, 7/7)

Throughout Planned Parenthood’s 101-year history, our opponents have repeatedly resorted to dishonesty in their efforts to shut us down. It’s understandable: When the truth doesn’t serve your interests, turn to lies. (Jodi Liggett and William Richardson, 7/7)

One in five people in the U.S. will experience a mental health condition sometime in their life. Depression, the most common mental disorder, will significantly affect over 16 million Americans this year – many more than the number of people living with cancer. ... So with such high prevalence, and such critical consequences, how can there still be a stigma associated with mental illness? (Gina Drosos, 7/8)

The most egregious form of surprise medical bills, also known as balance bills, happens when an out-of-network provider bills a patient despite having delivered care at an in-network facility. Often this occurs when a patient goes to an emergency department or hospital that accepts that person’s insurance, but then is seen by a physician who is not contracted with that insurance group. (Christopher Moriates and VIctoria Valencia, 7/8)

Whenever biopharmaceutical experts and policymakers discuss medical innovation, they seem to focus only on drug discovery and development and access. While these aspects of innovation are critical to ensuring patients have safe and effective treatments, they don’t provide a complete picture of the biopharmaceutical innovation model and the total investment needed to get the right medicine to the right patient at the right time. What’s missing? An understanding of the role of biopharmaceutical manufacturing and the need for a supportive policy environment. (Robert Popovian, 7/10)