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Joe Biden and Bernie Sanders are engaged in open warfare over health care that could harden party divisions and play into the hands of President Donald Trump. In the latest iteration of the battle, Biden’s communications director posted an article on Saturday, entitled “Let’s Get Real About Health Care,” that delved into the potential costs of the proposals favored by the Democratic party’s left flank. The tension points to a broader power struggle in Washington and on the campaign trail that pits long-dominant moderates like Biden against an insurgent wing led by Sanders and Elizabeth Warren. (Kapur, 7/19)

Democratic presidential candidates trying to appeal to progressive voters with a call for "Medicare for All" are wrestling with the thorny question of how to pay for such a dramatic overhaul of the U.S. health care system. Bernie Sanders, the chief proponent of Medicare for All, says such a remodel could cost up to $40 trillion over a decade. He's been the most direct in talking about how he'd cover that eye-popping amount, including considering a tax hike on the middle class in exchange for healthcare without co-payments or deductibles — which, he contends, would ultimately cost Americans less than the current healthcare system. (Schor, 7/19)

Joe Biden’s presidential campaign expanded his critiques against “Medicare for All” and pressed its opponents to fight to protect and expand the Affordable Care Act (ACA), which the former vice president played a crucial role in ushering through Congress. Deputy Campaign Manager and Communications Director Kate Bedingfield detailed Republican efforts to overhaul the Obama administration’s signature legislation. (Axelrod, 7/20)

Kaiser Health News: Biden’s ‘Incremental’ Health Plan Still Would Be A Heavy Lift

The headlines about presidential candidate Joe Biden’s new health care plan called it “a nod to the past” and “Affordable Care Act 2.0.” That mostly refers to the fact that the former vice president has specifically repudiated many of his Democratic rivals’ calls for a “Medicare for All” system and instead sought to build his plan on the ACA’s framework. Sen. Bernie Sanders, one of Biden’s opponents in the primary race and the key proponent of the Medicare for All option, has criticized Biden’s proposal, complaining that it is just “tinkering around the edges” of a broken health care system. (Rovner, 7/22)

All last week, while Washington was preoccupied with the president's Fox News-inspired war against four left-wing congresswomen, the Democrats running for president made pilgrimages to Iowa. Seventeen of them sat down with the Des Moines Register and AARP for 25-minute interviews about health care and aging — the most substantive big “cattle call” so far. It came at a critical time in the Democratic primary. Joe Biden kicked off the forums Monday by telling his audience that the Medicare-for-all plan supported by his highest-polling rivals would mean that “Medicare goes away as you know it.” Sen. Bernie Sanders (I-Vt.) closed the forums Saturday by warning that the former vice president was lying and that his plan would improve Medicare: “We should not have distortions of what Medicare-for-all stands for.” (Weigel, 7/21)

Medicare for All has dominated the Democratic presidential campaign. Some candidates support Sen. Bernie Sanders' plan, but others have different ideas for how to get to universal coverage. WSJ explains what Medicare for All is, what it isn’t, and how some of the major health care plans out there would change the health insurance industry. (7/22)

How much truth is there to Mr. Trump’s characterization of the Democratic Party? Here is a fact check. ... It is true that every Democratic presidential candidate vying to replace Mr. Trump has called for increasing the federal commitment to health care, education and the environment, among other proposals. Those plans would generally require substantially more government spending, higher taxes, an increased public-sector role in private markets and a reversal of the deregulatory push championed by Mr. Trump. (Epstein and Qiu, 7/20)

Montana Gov. Steve Bullock (D) said Sunday that he would not have joined his fellow 2020 Democratic presidential candidates who raised their hands on the debate stage last month to indicate they favored providing health care to undocumented immigrants. “A lot of the discussion that’s been happening on the debate stage is a bit disconnected from people’s everyday lives,” Bullock, who did not qualify for the Democratic National Committee’s first debate but is set to participate in the second, told ABC’s George Stephanopoulos. (Budryk, 7/21)

The Trump administration has backtracked on an announcement five days earlier that had required federal funded family planning centers to immediately stop referring women for abortions, giving the clinics two more months to comply. In a rare Saturday night notice to Planned Parenthood affiliates, state governments and other organizations that receive federal family planning grants, Health and Human Services Department officials wrote that no group would be penalized yet for failing to obey with this and other rule changes. (Goldstein, 7/20)

A notice sent Saturday night to representatives of the clinics by the Department of Health and Human Services said the government "does not intend to bring enforcement actions" against clinics that are making "good-faith efforts to comply." A copy of the notice, which includes a new timetable for the clinics, was provided to The Associated Press. The department had said last Monday that it would require immediate compliance. That caught clinics off guard and led Planned Parenthood and other providers to say they would defy the order. (Alonso-Zaldivar, 7/21)

The rule was intended to help Trump fulfill his 2016 campaign pledge to end federal support for Planned Parenthood, a non-profit group that runs about 600 healthcare clinics around the country and receives an estimated one-fifth of all Title X funds. Planned Parenthood has condemned the rule, saying it silences doctors and nurses and would harm their patients' health. (7/21)

Under the Trump administration’s changed rules, clinics must also must now financially separate any services that may involve abortion from those that don’t — a move that, Trump officials say, ensures that no funds intermingle and preserves the “integrity” of Title X’s family planning mission. “It will absolutely change the way in which services are delivered across communities in this country,” said one Title X grant recipient, who asked to remain anonymous. (Sherman, 7/21)

NPR's Sarah McCammon reported that Planned Parenthood is refusing to comply with what critics call a "gag rule." "It is unethical and dangerous to require health care providers to withhold important information from patients," Jacqueline Ayers, vice president of Government Relations & Public Policy at Planned Parenthood Federation of America, said. "During this period of limbo while we wait for the court to rule, our affiliates are not using federal Title X funds to provide care. We are continuing to fight this illegal rule in court and to provide care to all people — no matter what." (Van Sant, 7/21)

Alaska’s American Civil Liberties Union chapter is suing Gov. Mike Dunleavy after he said he would cut funding for the state’s Supreme Court in retaliation to abortion-related rulings. In a line-item veto, Mr. Dunleavy cut nearly $335,000 in funding for Alaska’s court system, which the Republican’s office said was the same amount the state pays annually to cover elective abortions under its Medicaid program. In February, the Alaska Supreme Court upheld a 2001 decision that prevented restrictions on Medicaid funding for abortions. (Millman, 7/19)

The Trump administration can continue to move ahead with its expansion of certain health plans that don’t comply with the Affordable Care Act, under a decision Friday by a federal judge. The ruling in Washington by U.S. District Judge Richard Leon dismissed a lawsuit by a plaintiff who had argued a Trump administration expansion of the so-called short-term health plans undermined the ACA. The plans are generally lower priced but can deny coverage based on consumers’ pre-existing health conditions. They also don’t have to cover the same benefits as ACA-compliant plans. (Armour, 7/19)

"Not only is any potential negative impact from the 2018 rule minimal, but its benefits are undeniable," Leon wrote about the regulations. The plans aims to "minimize the harm and expense" for individuals who might otherwise decide not to purchase insurance because of high premiums, Leon added.  (Hellmann, 7/19)

He said Congress' effective axing of Obamacare's individual mandate penalty for the uninsured makes the option for cheaper plans more desirable, since more people would likely forgo insurance rather than pay for expensive premiums in the Affordable Care Act's exchanges. Leon acknowledged that the ACA established "interdependent" reforms designed to work together throughout the individual market. But he also pointed out that the law exempted many types of health insurance and grandfathered in certain state-specific risk pools. (Luthi, 7/19)

The ruling represents a win for the administration, which recently has suffered a string of setbacks in court over its efforts to chip away at the Affordable Care Act and to reduce health care costs. Short-term plans, which have been available for years and were originally designed to fill a temporary gap in coverage, are typically cheaper than Obamacare policies. But that's because they are allowed to exclude those with pre-existing conditions and base rates on an applicant's medical history, unlike Obamacare plans. (Luhby, 7/19)

One of the plaintiffs, the Association for Community Affiliated Plans, said it plans to appeal the ruling. “We think this is arbitrary and capricious on the part of the administration, and that it does not comply with Congress’s intent in the Affordable Care Act,” said Meg Murray, chief executive officer of ACAP, which represents nonprofit safety-net health plans. (Harris and Tozzi, 7/19)

The development came after other courts struck down several Trump administration health policy actions. Those include expanding association health plans that do not have to comply with the 2010 law, requiring some Medicaid enrollees to work and, most recently, telling pharmaceutical companies to include the list prices of certain drugs in television advertisements. (McIntire, 7/19)

A long-troubled U.S. Indian Health Service hospital continued to be plagued by poor medical care, untrained staff and leadership turnover, despite improvements made there by top agency officials, a government watchdog said. A report being released Monday by the watchdog documents the intractable nature of some of the federal health system’s problems, even when additional resources are poured in. In a separate report, the watchdog found problems with how Indian Health Service hospitals prescribed opioids, saying that the agency’s failure to always follow its own regulations increased the risk of drug abuse and overdoses for patients. (Frosch and Weaver, 7/22)

Government hospitals placed Native American patients at increased risk for opioid abuse and overdoses, failing to follow their own protocols for prescribing and dispensing the drugs, according to a federal audit released Monday. The report by the U.S. Department of Health and Human Services' Office of Inspector General doesn't draw any conclusions about actual abuse or overdoses. But it said all five Indian Health Service hospitals it reviewed had patients who were given opioids in amounts that exceeded federal guidelines. (7/22)

Kaiser Health News: How The Eastern Cherokee Took Control Of Their Health Care

Light pours through large windows and glass ceilings of the Cherokee Indian Hospital onto a fireplace, a waterfall and murals. Rattlesnake Mountain, which the Cherokee elders say holds ancient healing powers, is visible from most angles. The hospital’s motto — “Ni hi tsa tse li” or “It belongs to you” — is written in Cherokee syllabary on the wall at the main entrance. “It doesn’t look like a hospital, and it doesn’t feel like a hospital,” Kristy Nations said on a recent visit to pick up medications at the pharmacy. “It actually feels good to be here.” (Ridderbusch, 7/22)

Federal inspectors visiting a California migrant detention center made a shocking discovery last year: Detainees had made nooses from bedsheets in 15 of 20 cells in the facility they visited. The inspection revealed the extent of a largely unseen mental health crisis within the growing population of migrants who are being held in detention centers in border states. President Donald Trump’s 2017 decision to reverse a policy that encouraged releasing vulnerable individuals while they await deportation hearings has left U.S. Immigration and Customs Enforcement unequipped to deal with conditions ranging from anxiety to schizophrenia. (Rayasam, 7/21)

Pictures of detention centers at the U.S.-Mexico border are deeply troubling, including images of hordes of children sleeping on the floor, huddled together under nothing but Mylar blankets. What's also troubling, but often overlooked, is the fact that the children are required to sleep under glaring lights. These children are entering the country at a rate of thousands per month and are placing enormous stress on the limited resources in place to take care of them. (Troxel and Ligor, 7/20)

More than 100 demonstrators protested Saturday in withering heat outside an Oklahoma Army base against the Trump administration's plans to detain migrant children there. Japanese Americans and Native Americans are among those who took part in Saturday's march to Fort Sill and rally in front of one of its entrances, briefly blocking a city street. They chanted "Close the camps" and carried signs with messages including "Human Rights Matter," ''Love Trumps Hate," and "Liberty and Justice For All." (7/20)

Citing what it calls a slew of human-rights violations, Amnesty International is calling on the U.S. government to shut down the Homestead detention center before children in Miami-Dade start school again next month. The global human-rights organization published a 41-page report Thursday on the Homestead facility — still the nation’s largest center for unaccompanied migrant children — after touring the shelter earlier this week. (Madan, 7/19)

Donald Trump’s presidency may be making some people sick, a growing number of studies suggest. Researchers have begun to identify correlations between Trump’s election and worsening cardiovascular health, sleep problems, anxiety and stress, especially among Latinos in the United States. A study published Friday using data from the Centers for Disease Control and Prevention found the risk of premature birth was higher than expected among Latina women following Trump’s election. The new study is particularly powerful, experts say, because unlike ailments such as depression or stress that can be hard to quantify, births come with hard data. (Wan and Bever, 7/19)

Birth outcomes have long been used in medical research as indicators of acute stress among populations of women, and preterm birth in particular is linked with maternal stress, the researchers noted in their study. "Because mothers and children are particularly vulnerable to psychosocial stress, our findings suggest that political campaigns, rhetoric and policies can contribute to increased levels of preterm birth," said Alison Gemmill, an assistant professor at the Johns Hopkins Bloomberg School of Public Health in Baltimore and first author of the study. (Howard, 7/19)

At Knuckleheads Bar & Grill, the subject on a sweltering Saturday afternoon was the drug crisis. More specifically, the recent disclosure that the CVS across the street received more pain pills — 6.4 million — over a seven-year period than any other drugstore in Cuyahoga County. “Location, location, location,” said Mike Gorman, 37, who was drinking and hanging out with friends. “It’s right near the highway, which makes it easy to access” from Cleveland. And there was the homeless encampment just beyond the CVS, over by the train tracks, behind the strip mall. It’s popular with heroin users, the regulars at the sports bar said. (Heller and Bernstein, 7/21)

Many of the nation’s largest drug manufacturers and distributors failed to implement even the most basic systems to halt suspicious drug orders as the opioid epidemic came into sharp focus, plaintiffs lawyers allege in a new court filing. The motion filed Friday by lawyers for two Ohio counties alleges companies failed to analyze potentially suspicious orders until after they had shipped, applied rudimentary controls on excessive sales that were easy for bad actors to game, and handed the job of halting shady orders to sales departments incentivized to keep pills moving. (Randazzo, 7/20)

The city of Laurel and Wicomico County filed suits on July 9. Calvert County did it a couple of weeks before. In the past two years, more than two dozen cities and counties in Maryland, as well as the state, sued opioid makers, distributors and others. They join Baltimore City and the area’s counties and more than 2,000 other governments in filing suit in state and federal courts around the country that allege the pharmaceutical companies had a role in the addiction and overdose crisis that has overwhelmed public resources. (Cohn, 7/22)

The Walgreens employee was bewildered by the quantity of opioids the company was shipping to just one store. Its pharmacy in Port Richey, Fla. (population 2,831) was ordering 3,271 bottles of oxycodone a month. “I don’t know how they can even house this many bottles to be honest,” Barbara Martin, whose job was to review suspicious drug orders, wrote to a colleague in a January 2011 email. The next month, the company shipped another outsized order to the same store. (Hoffman, Thomas and Hakim, 7/19)

Florida survives on tourism, but a decade ago thousands of visitors made frequent trips to the state not to visit its theme parks or beaches. Instead, they came for cheap and easy prescription painkillers sold at unscrupulous walk-in clinics. For a while, few in authority did much about it even though it was all done in the open with little oversight. The clinics started in the 1990s and began proliferating in about 2003, their parking lots filled with vehicles sporting license plates from Ohio, Kentucky, West Virginia and elsewhere. (Spencer, 7/20)

On May 8, 2018, a House Energy and Commerce subcommittee summoned five executives of the nation’s largest drug distribution companies to testify about the massive quantity of pain pills they had shipped into West Virginia, which has the highest opioid overdose rate in the country. The executives stood in the packed hearing room and raised their right hands as they were sworn in before testifying in front of the lawmakers. (O'Harrow and Higham, 7/20)

This week, The Washington Post published a massive database that tracks the distribution of opioids in the United States from 2006 to 2012, specifically where — and how many — drugs materialized. During that period, 76 billion prescription pain pills were manufactured and shipped to pharmacies all over the country, fueling a public health epidemic that killed 100,000 Americans in those seven years. Policymakers, media outlets and others are using this data to understand the sheer scope of the crisis, and many are demanding accountability. (Itkowitz and Zezima, 7/21)

The release of a massive trove of data from lawsuits over the nation's opioid crisis provides the most detailed accounting to date of the role played by the major pharmaceutical companies and distributors. In legal cases across the country, they have defended themselves as being little more than bystanders — dispensing government-approved drugs at the behest of prescribing doctors. (7/19)

America’s largest drug companies flooded the country with pain pills from 2006 through 2012, even when it became apparent that they were fueling addiction and overdoses. The Post shared its findings with a group of recovering addicts in southwest Virginia and asked them to respond. (7/21)

After his son was hit by a car in San Francisco and taken away by ambulance, Karl Sporer was surprised to get a bill for $800. Mr. Sporer had health insurance, which paid for part of the ride. But the ambulance provider felt that amount wasn’t enough, and billed the Sporer family for the balance. “I paid it quickly,” Mr. Sporer said. “They go to collections if you don’t.” That was 15 years ago, but ambulance companies around the nation are still sending such surprise bills to customers, as Mr. Sporer knows well. These days, he oversees the emergency medical services in neighboring Alameda County. The contract his county negotiated allows a private ambulance company to send similar bills to insured patients. (Kliff and Sanger-Katz, 7/22)

The House Education and Labor Committee isn't expected to mark up surprise billing legislation next week, according to four congressional aides, meaning the full chamber likely won't consider the bill until after August recess. The delay will give industry powerhouses more time to lobby on the legislation, which the Energy and Commerce Committee approved this week. The labor panel also has jurisdiction over the issue. (Roubein and Cancryn, 7/19)

The colorful ads on Facebook and Instagram promise a fantastic bargain: “Stop overpaying for contact lenses. Get 30 contacts delivered to your door for ONLY $1.” Captions like “wow” and “what a steal” splash across images of teal containers and lenses perched on fingertips, urging consumers to act fast. This social media marketing has been integral to the growth of the online contact lens start-up Hubble since its founding in 2016. It has raised more than $70 million from venture firms and companies like Colgate-Palmolive, which are attracted to its plan to disrupt the contact lens industry by providing a line of low-cost daily lenses through monthly $39 subscriptions. It’s like Dollar Shave Club — for eyeballs. (Maheshwari, 7/21)

Chicago-area hospitals that serve low-income patients say they won't survive under the proposed "fair workweek" ordinance. The measure, which would require Chicago employers to schedule workers two weeks in advance and pay them for last-minute changes, is set to be heard July 22 by the City Council's Committee on Workforce Development. Since the ordinance was first proposed in 2017, hospitals have asked for exceptions due to the unpredictable nature of their work, with patient volumes changing from shift to shift. (Goldberg, 7/19)

Hospitals are embracing specialization as cost pressures and consolidation upend healthcare service models. Expanding Chicago-area chains have begun reconfiguring themselves as networks of specialty hospitals with narrower offerings. Three-hospital Loyola Medicine is consolidating open-heart surgery at its flagship facility in Maywood. And NorthShore University HealthSystem is centralizing orthopedics, urology and open-heart surgery at various locations in its four-hospital network. (Goldberg, 7/19)

The vast majority of hospitals fail to comply with the Leapfrog Group's minimum volume standards for eight high-risk surgeries, according to a new analysis. The report, published Thursday, found most hospitals that participated in the 2018 Leapfrog Hospital Survey perform less than the recommended number of surgeries for the procedures to be performed safely. The Leapfrog Group volume standards were set by a technical expert panel and target eight procedures that have research showing a strong relationship between outcomes and the number of times the procedures are performed. (Castellucci, 7/18)

Children's Hospital Los Angeles will now be able to help many more kids, thanks to an anonymous $25 million gift. It is one of the largest single donations in the hospital's history, according to president and CEO Paul Viviano. "This truly transformative gift comes at a time when demand is growing quickly -- particularly among underserved children in Southern California -- both for pediatric neurological care as well as interventional radiology's broad range of minimally invasive procedures," Viviano said in a statement. (Sherry and Zdanowicz, 7/19)

For the past three decades, the number of hospitals in American rural areas has been declining at a steep pace. In California, 50 rural hospitals – close to 10 percent of the total hospitals in the state – are on the brink of closing. Twenty have shut down since 1995, experts say. On Thursday, the federal Department of Health and Human Services attempted to stop the bleeding with a $20 million grant, distributed across 21 states. (Ghisolfi, 7/19)

Intravenous immunoglobulin is used to treat many medical conditions, from chronic to acutely life-threatening, and its supply recently shifted abruptly and indefinitely, says Dr. Paul Biddinger, the chief of emergency preparedness at Mass. General. Signs of a crunch had been building for months, "but really, it's within the last couple of weeks that it's become a critical shortage across the whole country," he says. (Goldberg, 7/19)

A Chicago-area hospital says it regrets sending bills to the family of a baby boy who died about seven weeks after attackers cut him from his mother's womb. Advocate Christ Medical Center in Oak Lawn sent bills for Yovanny Lopez's care that totaled about $300,000, said the family's lawyer, Frank Avila. Some bills even referred to Yovanny as "Figueroa, boy" — the last name of Clarisa Figueroa, who is accused of orchestrating the attack on the baby's mother so that she could claim him as her own. (7/19)

When University of Kansas Hospital leaders announced the purchase of a $40 million proton beam therapy machine this month, they also entered one of the biggest controversies in cancer care. President and CEO Bob Page described it as a major boon for area patients. KU will be the first hospital in the region to have one of the high-tech, room-sized devices for delivering targeted radiation. (Marso, 7/22)

The drug industry’s lobbying group is calling on its lobbyists to push back on a potential budget deal that reportedly includes drug pricing reforms that will cost the industry $115 billion. In an email sent Thursday night to lobbyists both inside and outside the organization and obtained by STAT, PhRMA urged its small army of advocates to do all they can to block the potential deal, which is quickly becoming intertwined with a must pass, multibillion-dollar budget deal. (Florko, 7/19)

During a two-hour hearing Friday on the proposed $69 billion merger between the two health-care giants, U.S. District Court Judge Richard Leon seemed to take exception to Department of Justice arguments that because the department had settled its concerns about the merger, there was no further need to review it. But Leon has consistently argued that it is the court’s job to review the merger under the Tunney Act, a 1974 law designed to determine whether mergers such as the CVS-Aetna union would create a monopoly. (Wehrman, 7/19)

A federal judge on Friday ordered the state of Tennessee to mediate with a group of prisoners who are demanding treatment for their hepatitis C infections. The order by Chief U.S. District Judge Waverly Crenshaw came after a four-day trial that included emotional testimony from a mother whose son died of complications from hepatitis C while in state custody. Tennessee prisons saw at least 56 hepatitis C-related prisoner deaths between 2013 and 2017. (7/19)

There was a time, back in biotech’s leaner years, when any company hoping to raise even a dollar needed a clear path to get a single drug through clinical trials. Now, in today’s gilded age of VC largesse, companies can raise nine-figure funding rounds without so much as deciding on a discrete disease area. Such so-called platform companies raised $659 million in Series A dollars the first half of 2019, according to the latest report from Silicon Valley Bank, leading all other biotech categories. (Garde, 7/19)

Kaiser Health News: A Conservative Group Paints Trump’s Drug-Pricing Experiment As ‘Socialist.’ Is It?

As part of its effort to curb high prescription drug costs, the Trump administration is considering an experiment that has triggered strong opposition from Americans for Tax Reform, Grover Norquist’s powerful conservative organization, which the president typically counts among his supporters. One of the most visible elements of the group’s battle plan is a nationwide commercial, on which it has spent almost half a million dollars, according to estimates by ad tracker iSpot.tv. It has been on the air since May. (Luthra, 7/22)

Medicaid dental coverage has been eliminated for adults with Gov. Mike Dunleavy's vetoes, a cut of $27 million. It affects Alaskans like Michael Shelden who, after years of dental pain, had all of his teeth extracted with plans of going back four weeks later for dentures. But before he could get new teeth, the plan was vetoed. "I cried. I still cry. I wake up and I cry at night," Shelden said. (Palsha, 7/12)

The state's top health official predicted Thursday that Michigan's forthcoming work and employment-reporting requirements for low-income adults on Medicaid will lead to more uncompensated care for hospitals and lower life expectancies. Robert Gordon, director of the Michigan Department of Health and Human Services, said his agency is trying to take proactive measures to educate the nearly 680,000 low-income adults in the Healthy Michigan program about the Legislature's work requirements that go into effect Jan. 1, 2020. (Livengood, 7/19)

Nearly half of the 25 vetoes that Gov. Mike DeWine issued when he signed the two-year state budget deal with health care and Medicaid, which is the state’s largest program. A member of the conference committee that worked on the compromise budget deal isn’t happy with those rejections. Ever since former Gov. John Kasich pushed through Medicaid expansion in 2013, lawmakers have pushed back on Medicaid policy in the budget. (Kasler, 7/22)

Adrienne Hayes-Singleton falls in the Medicaid coverage gap, which would close if the state says yes to full Medicaid expansion. Hayes-Singleton, 36, of Wilmington, works in early childhood education and makes too much money to be covered under Medicaid as the program stands now in North Carolina. Her children are on Medicaid, and her husband, a disabled veteran, gets free health care, she said. But she doesn’t, and is the only steady income in her household. (7/21)

Gov. Tony Evers was unable to push Medicaid expansion through in his first state budget, a centerpiece of his 2018 campaign against former Republican Gov. Scott Walker, who rejected the federal funding provided under the Affordable Care Act. However, now that Evers has signed the 2019-’21 budget into law, the question of Medicaid expansion isn’t likely to disappear from view, with the governor pledging to continue fighting for the program’s expansion. (Anderson, 7/22)

At this year’s largest conference on Alzheimer’s disease, there was no big reveal. There were no major companies presenting late-stage data on promising therapies. There was little in the way of groundbreaking research. Instead, there was a sense from many researchers in the field that, after a string of high-profile clinical trial failures, there is nowhere to go but back to the drawing board. (Keshavan, 7/22)

Since the turn of the century, more Americans have died in car crashes than did in both World Wars, and the overwhelming majority of the wrecks were caused by speeding, drunk or distracted drivers, according to government data. “Where’s the social outrage? There should be social outrage,” said Robert L. Sumwalt, chairman of the National Transportation Safety Board. (Halsey, 7/21)

It’s late on a Tuesday night during the worst measles outbreak in decades, and doctors, nurses and other health-care providers are gathered at a medical center to learn better ways of talking to parents who are reluctant to vaccinate their children. Blima Marcus, an oncology nurse practitioner, leads the two-hour session on how to do a better job listening to and responding to parents’ questions — and, in the process, cultivating their trust. The key, she says, is hearing people’s questions about the science behind vaccines and addressing those directly. (Sun, 7/21)

Levi Hughes was 3 years old, on vacation with his family and five other families, when he slipped off the couch one evening last summer while the group was waiting for it to get dark enough for their annual crab hunt. The family was renting a vacation home in Alabama with a group of friends stretching back to Levi’s father’s residency in cardiothoracic anesthesia. “Our son drowned when there were six physicians in the room, 12 adults, 17 kids,” said his mother, Nicole Hughes, a writing teacher and literacy coach in Bristol, Tenn., who now works extensively in drowning prevention, including with the American Academy of Pediatrics. (Klass, 7/22)

The 92-year-old had a painful tumor on his tongue, and major surgery was his best chance. Doctors called a timeout when he said he lived alone, in a rural farmhouse, and wanted to keep doing so. "It was ultimately not clear we could get him back there" after such a big operation, said Dr. Tom Robinson, chief of surgery at the VA Eastern Colorado Health Care System. (7/19)

Dorothy Beckett has been a runner for decades and knows her body well, so the 61-year-old biochemistry professor was puzzled when her knee hobbled for no apparent reason after a routine run. Beckett took two weeks off to let it rest and then tried an easy run. She was met with excruciating pain and decided it was time to visit a doctor. What Beckett never expected was that she was about to begin a long, seemingly endless journey to figure out and properly treat her injury. (Loudin, 7/21)

Chains, saws and old logging equipment litter the back field of Wendy Norris' family farm, near the county seat of Altamont, Tenn. Norris used to be part of the local timber industry, and the rusted tools are relics from a time when health woes didn't hold her back from felling hardwoods. "I was nine months pregnant," Norris says. "Me and my husband stayed about 10 or 15 miles in the middle of nowhere, in a tent, for a long time." (Farmer, 7/22)

You vacuum it, sweep it and wipe it off your furniture. But do you know what it actually is — and how it may affect your health? Don’t feel bad if you’re clueless about your dust. Scientists are not that far ahead of you in terms of understanding the sources and health risks of indoor air and particles. That’s an issue, because people spend a lot of time indoors. Indeed, the average American stays within four walls for almost 90 percent of their day. (Filippelli, 7/20)

It's a common experience for family members or groups of friends: One person's mood can bring the whole group's energy down— or up. But why are we so easily influenced? In 1962, the reality television show Candid Camera offered a remarkable glimpse into a psychological phenomenon that helps explain how emotions spread. They did it through a now famous comedy stunt called "Face the Rear." It goes like this: We see an unsuspecting man walk into an elevator that has been secretly rigged with cameras. Two more people walk in after him. But weirdly, they turn to face towards the back wall of the elevator. (Simstrom, 7/21)

Some people are morning exercisers. For them, an early run or swim is as much a part of their wake-up ritual as that first cup of coffee. Others can’t abide the idea. They need a nighttime workout to rid themselves of the day’s stresses. Does it make a difference? Several recent studies suggest that it does. But it’s complicated. One recent paper indicates that morning exercise may activate certain genes in the muscle cells, boosting their ability to metabolize sugar and fat. While scientists say this finding requires further study, they think it ultimately might help those who are overweight or suffering from Type 2 diabetes. (Cimons, 7/21)

Sweet dreams, sweet spot, sweet as pie, sweet young thing: All have a positive connotation. But what about sweet tooth, which Americans seem to have cultivated to great excess? The health effects of this obsession with everything sweet are anything but positive. In fact, recent reports have found that regular consumption of sugary drinks heightens the risk not only of tooth decay, obesity, fatty liver disease and Type 2 diabetes, but also of heart disease and premature death, even in people free of other risk factors. (Brody, 7/22)

Oregon will allow students to take "mental health days" just as they would sick days, expanding the reasons for excused school absences to include mental or behavioral health under a new law that experts say is one of the first of its kind in the U.S. But don't call it coddling. The students behind the measure say it's meant to change the stigma around mental health in a state that has some of the United States' highest suicide rates. (Zimmerman, 7/21)

The bill, signed last month by Gov. Kate Brown (D), will give students the ability to take up to five excused absences in a three-month span for mental health reasons. Any additional absences will require a written excuse. Most schools were previously only able to excuse absences related to physical illnesses. (Daugherty, 7/21)

The Florida State Board of Education voted this week to require public schools to provide students with mental health education. Under the new directive, the department said in an announcement that schools will be required to “provide students in grades 6-12 at least five hours of mental health instruction” on an annual basis. (Foley, 7/20)

Education officials proposed the change to the statewide school curriculum in June, following discussions with First Lady Casey DeSantis, who has made the mental health issue one of her top priorities. The new requirement will require students to take courses aimed at helping them to identify the signs and symptoms of mental illness, find resources if they are battling with depression or other issues, and teach them how to help peers who are struggling with a mental health disorder. (Ceballos, 7/19)

Instagram is expanding a test to hide how many "likes" people's posts receive as it tries to combat criticism that such counts hurt mental health and make people feel bad when comparing themselves to others. The Facebook-owned photo-sharing service has been running the test in Canada since May. Now, Facebook said the test has been expanded to Ireland, Italy, Japan, Australia, Brazil and New Zealand. (7/19)

Nearly a third of high school students with disabilities in Greater Boston have experienced cyberbullying over the past year, despite efforts by the state and local districts to curb that kind of harassment, according to an analysis of health survey results by a local foundation. The online bullying can have profound impacts, with more than a third of those victims reporting they had suicidal tendencies due to the harassment they encountered on social media, according to the analysis by the Ruderman Family Foundation, a Boston nonprofit that works on behalf of people with disabilities. (Vaznis, 7/21)

As Trump doubles down on attacks against the four women of color in Congress known as “The Squad,” which includes Omar and Representative Ayanna Pressley of Massachusetts, some people of color in the Boston area describe a psychological toll that the episodes, and Trump’s frequent overt hostility, have had on their daily lives — not just this month, but in the many months since the 2016 presidential campaign began. (Greenberg, 7/21)

The contracts are a partnership between local hospitals, together with regional state-funded mental health agencies (called LME-MCOs) and the state DHHS. Funding for the contracts is allocated by the General Assembly with the intent of providing short-term psychiatric treatment in local hospitals, keeping people with less serious behavioral health issues out of state facilities. The funds are also meant to help inpatient psychiatric wards like the one at Vidant Beaufort remain open. The contract between the Washington-based facility, the state, and LME-MCO Trillium Health Resources, was worth more than $1.1 million in the state fiscal year which ended in June 2018. (Liora Engel-Smith, 7/22)

Those who are found incompetent to stand trial begin the rehabilitation process. [Mike] Ramsey said Butte County Behavioral Health Services checks to see if there is a local facility that will suffice, though that is often not the case. The default, Ramsey said, is to send them to a state facility, though this presents a problem as most facilities have long wait lists and the defendants end up sitting in the local jail, waiting for beds to open up. (Hutchison, 7/21)

As more and more people in prison need mental health care, more and more prison systems are turning to telepsychiatry. It’s basically a video psychiatry appointment, a doctor’s visit via Skype or FaceTime. ... It’s tough to find doctors who will work in rural areas. And it’s hard to recruit doctors to work in prison because the working conditions are usually pretty unpleasant. (Roth, 7/22)

A school district in eastern Pennsylvania faced criticism after sending letters this month to more than three dozen parents warning that if their debt for school meals was not paid, their child could be placed in foster care. “Your child has been sent to school every day without money and without a breakfast and/or lunch,” read the letter, which was signed by Joseph Muth, director of federal programs for the Wyoming Valley West School District. “This is a failure to provide your child with proper nutrition and you can be sent to Dependency Court for neglecting your child’s right to food. If you are taken to Dependency court, the result may be your child being removed from your home and placed in foster care.”A warning letter that was sent to those whose child owed $10 or more for school meals. (Taylor, 7/20)

The number of kids in summer meal programs declined sharply in one year, according to a recent report. Golden Harvest Food Bank is doing its part by stepping up its mobile pantry program for needy families. (Corwin, 7/20)

Covered California on Friday released the estimated 2020 rate changes for health insurance in each of its 19 pricing regions, and residents of the four-county Sacramento region will see average increases of 1.8 percent on the individual marketplace. That means premiums will actually drop slightly for some local consumers. (Anderson, 7/19)

Meeting the goal, a 25% reduction by 2030, would spare thousands of people from time-consuming dialysis and conserve the desperately short supply of donor organs that leaves transplant patients waiting for years. It also would save lives and some of the $35 billion in federal spending on this population, which makes up 1% of Medicare recipients but 7% of the program’s budget. Minnesota physicians and advocates praised last week’s challenge by President Donald Trump to improve treatment — noting that it was one of the first times a president has focused on kidney disease since the decision in 1972 to extend Medicare benefits to all kidney patients who needed dialysis or transplants. (Olson, 7/21)

Alameda County is one of 48 counties handpicked by federal public health officials to receive extra resources to end the spread of HIV over the next decade — and getting that done will take creative, grassroots approaches, local AIDS activists said Friday at a meeting with national leaders. Under a federal strategy announced by President Trump earlier this year, the U.S. Health and Human Services department has promised to pour money and other resources into communities that continue to be hardest hit by HIV. (Allday, 7/20)

The Laser Spine Institute may have closed its doors suddenly in March, but repercussions from the surgery center's business practices continue to reverberate in the courts. Two local lawsuits provide the clearest picture yet of the forces that led the Tampa company to shut down, resulting in the loss of some 500 jobs. Documents detail a years-long legal battle among three business partners, a penchant for paying large executive salaries and bonuses, and a struggle against mounting debt. (Griffin, 7/22)

California must enforce a federal law that protects patients who are transferred from skilled-nursing facilities and unable to be readmitted, a federal appeals court ruled Thursday. The plaintiffs—three Medi-Cal beneficiaries and the not-for-profit California Advocates for Nursing Home Reform—alleged that the state violated federal law by allowing nursing homes to transfer patients to hospitals and block their return, even after a hearing determined that the individuals must be readmitted. (Kacik, 7/19)

A former Lancaster Elementary School nurse has sued her insurance provider, claiming it repeatedly refused her requests for a lumbar-spine MRI that she says would have quickly found the tumor that has left her a paraplegic. In a lawsuit filed in Coos County Superior Court, Carolyn Daigle, 50, and her husband, Roger Daigle II, of Jefferson, are seeking a jury trial. ...According to the Daigles’ lawsuit, which was filed by attorney Nick Abramson, Carolyn Daigle was an active wife and mother who in the latter part of 2017 suffered a fall while helping an elderly relative get out of the shower. Abramson said Daigle’s “bright future has been sacrificed to avoid paying for a $2,000 MRI.” Daigle “should be able to live the life she worked so hard to obtain,” he said in a statement, but, “instead, she will spend the rest of her life in a wheelchair.” (Koziol, 7/21)

Two people have died following a multi-state outbreak of salmonella infections linked to backyard poultry, U.S. health officials said on Friday. One death was reported in Ohio and the other one in Texas, according to the Centers for Disease Control and Prevention (CDC). (7/19)

[Quintin] Beltran, a 60-year-old flooring contractor known to work from sunup to sundown, contracted Rocky Mountain Spotted Fever from a tick bite this spring. He was pulling weeds in the yard of what she calls their “dream home” when he found the small insect, an American dog tick, on his inner thigh. Within about 10 days, he started throwing up and alternating between chills and feeling feverish. Symptoms mimicked the flu, and a doctor at an urgent care said he had a viral infection. (Dyson, 7/21)

Local, state and federal officials have formed a working group to address Iowa’s PFAS contamination and any impacts to drinking water. Iowa is one of a number of states to grapple with the chemicals used at military bases and manufacturing sites. ...Despite the contamination, the chemicals haven’t been found in Iowa tap water. (Payne, 7/19)

Ethylene oxide is used on about half the medical products in the U.S. that require sterilization, according to industry estimates. It’s also used to make other chemicals, like antifreeze. ...By 2016, the agency had rendered its decision — ethylene oxide was far more dangerous than the scientists had previously understood. The agency moved it from a list of chemicals that probably could cause cancer to a list of those that definitely caused cancer. (Goodman and Miller, 7/19)

Much about California’s homelessness crisis has confounded state and local officials. But what to do about the tens of thousands of people living outdoors has perhaps done so more than anything else. �Թϲ�����ing for a solution, Los Angeles County Supervisor Mark Ridley-Thomas and Sacramento Mayor Darrell Steinberg, co-chairs of Gov. Gavin Newsom’s Homeless and Supportive Housing Advisory Task Force, are looking to New York. They want California to enact a legal “right to shelter.” (Oreskes, 7/21)

For months, community leaders have worked steadfastly to build the political will to support a now-proposed lead-poisoning prevention law. The city’s proposed strategy is built around a mandate that requires landlords to get inspections and lead-safe certificates for rental properties constructed before 1978, the year lead-based paint was banned for residential use. The legislation is working its way through City Council, with additional hearings set next week, where it will be publicly discussed, debated and tweaked based on feedback received since the ordinance was introduced in June. (Dissell, 7/19)

A fledgling medical marijuana operation has tapped former House Speaker Salvatore F. DiMasi to lobby on its behalf at City Hall, making the convicted felon the latest ex-politician to edge into the growing industry. Geoffrey Reilinger, the founder of Compassionate Organics, hired DiMasi to help in the “siting and establishment” of its proposed dispensary on Newbury Street, according to a disclosure DiMasi filed this month under the city’s new lobbying rules. (Stout, 7/19)

Advocates of a more comprehensive medical cannabis law in Iowa continue to push to make it a top legislative priority, and some who are enrolled in the program say it needs to be expanded. ...Assistant manager Shannon Cretizinger explained that the 300 hundred or so patients they serve have all been issued registration cards from the Iowa Department of Public Health. (Blank, 7/22)

Forensic and crime lab experts are optimistic state and local officials will support a new proposal that would allow for a faster, cheaper way to test suspected marijuana under the state’s new definition of the drug. But even if law enforcement and crime labs agree to move forward with the proposal, it would still be months before labs could start testing cases for prosecutors. (McCullough, 7/19)

This week, I left my position as the president and chief executive of Planned Parenthood. In my farewell message to colleagues, I cited philosophical differences over the best way to protect reproductive health. While the traditional approach has been through prioritizing advocating for abortion rights, I have long believed that the most effective way to advance reproductive health is to be clear that it is not a political issue but a health care one. I believed we could expand support for Planned Parenthood — and ultimately for abortion access — by finding common ground with the large majority of Americans who can unite behind the goal of improving the health and well-being of women and children. (Leana S. Wen, 7/19)

During the days following the death last Tuesday of Justice John Paul Stevens, admirers posted lists of their favorite and not-so-favorite Stevens opinions. Free speech on the internet? A great one. No First Amendment protection for burning an American flag? Not so great. Access to federal court for Guantánamo detainees? Definitely. Upholding an Indiana voter ID requirement? Hmm … Items on these lists, posted on blogs and websites, ranged widely. Missing, however, were opinions dealing with abortion. That’s surprising, since Justice Stevens wrote opinions in many of the abortion cases that came before the court during his 35-year tenure. (Linda Greenhouse, 7/20)

The Supreme Court completed its term in June with no major changes to its longstanding holding on abortion. Instead, changes to abortion law this year have taken place in states, and that’s how it should be. The 2019 state legislative sessions have shown that federalism is as important as ever to our republic. Blue states moved to legalize abortion on demand throughout (and even after) pregnancy, while red states moved to adopt strong limits on abortion, all in the expectation that the Supreme Court may soon overturn Roe v. Wade. So much for the claim that Roe is “settled.” (Clarke D. Forsythe, 7/21)

A few weeks ago, I was part of the photo shoot for The New York Times Magazine’s cover story about ABC’s “The View.” It should have been a moment of triumph — a vindication of the show’s significance as a place at the center of political debate, a ratings boom, a must for the top tier of presidential candidates. I should have been proud. I knew my father would have been proud. I look back at those pictures now, and I see a woman hiding her shock and sorrow. I am posed for the camera, looking stern and strong, representing my fellow conservative women across the country. But inside, I am dying. Inside, my baby is dying. (Meghan McCain, 7/19)

As the 20th century came to a close, the United States faced many challenges, but a high rate of death from prescription opioid overdoses was not one of them. In 1999, 3,442 people died from taking excessive pain-killing substances such as oxycodone or hydromorphone. Each such death, of course, was a tragedy; but the country as a whole could not speak of a crisis. Only eight years later, the number of prescription opioid-related deaths had nearly quadrupled, reaching 12,796 in 2007 — and the United States was in the grip of an addiction crisis. It would ultimately morph into new epidemics of heroin and fentanyl use, leaving hundreds of thousands of people dead and families shattered all over America. (7/20)

It’s finally official: On Wednesday, the government publicly released data showing that for the first time since 1990, drug overdose deaths in the United States have fallen from a little more than 70,000 in 2017 to 68,557 last year. That’s progress, but if half the number of people had died of opioid overdoses — or even a tenth — these figures would still qualify as a moral crisis. We still don’t know if this is the beginning of a sustained trend (deaths due to prescription opioid overdoses are plummeting, but overdoses involving fentanyl continue to surge). (Robert Gebelhoff, 7/19)

In the beginning, there were just four: the Godfather from Philly, the Army sergeant from Georgia, the professor from California and the feisty mom from Florida. It was the early 2000s, and they usually talked over old-school computer message boards. Occasionally they gathered in person, carrying posters of their children and middle-aged spouses — all dead from OxyContin overdoses. Today we know just how dangerous this drug is. Purdue Pharma, the company that made OxyContin, the first extended-release opioid to be widely prescribed, may finally be held to account. (Beth Macy, 7/20)

In the U.S., there were more than 72,000 deaths from drug overdose in 2017, two-thirds of which were linked to opioids. And while provisional data for 2018 suggest a modest slowing of fatalities, we are still grappling with a nationwide drug crisis that in addition to prescription and synthetic opioids now encompasses a resurgence of methamphetamine, heroin and cocaine use across the country. It is a dire public health problem with profound consequences for families, communities and the economy. (Michael S. Rosenthal, 7/21)

In a paper published early this year in Nature Human Behavior, scientists asked 500 Americans what they thought about foods that contained genetically modified organisms. The vast majority, more than 90 percent, opposed their use. This belief is in conflict with the consensus of scientists. Almost 90 percent of them believe G.M.O.s are safe — and can be of great benefit. The second finding of the study was more eye-opening. Those who were most opposed to genetically modified foods believed they were the most knowledgeable about this issue, yet scored the lowest on actual tests of scientific knowledge. (Aaron E. Carroll, 7/22)

For individuals suffering with end-stage liver disease, liver transplants — true miracles of modern medicine — can save their lives. Yet every day in the U.S., seven people die while waiting for a liver transplant. Many more die awaiting hearts, kidneys, and other organs. We have the technology, the high-tech operating rooms, the highly skilled clinical and surgical teams, all standing by. What we don’t have is enough organs. (Yuri Genyk, 7/19)

“Thin on the outside, fat on the inside.” That’s what my cardiologist called me, and I sure didn’t like it — or its abbreviation, TOFI, which sounds like a cross between tofu and toffee. But the moniker wasn’t the problem. A heart scan had revealed I had too much coronary calcium — plaque — in my blood vessels. With a score of 172, I was at “moderate to high” risk for a heart attack.This was in 2007, just before I turned 50. As my 40s waned, my total cholesterol, measured in a blood test, had begun to inch up. My triglycerides also had increased. My primary care physician wasn’t concerned. “You really fall into the gray area,” she told me. “We could go either way when it comes to starting you on a [cholesterol-lowering] statin.” (Petrow, 7/20)

For patients and their loved ones, navigating the U.S. health-care system can be a complex and daunting experience that often is made worse by the anxiety that accompanies a life-threatening illness or injury. But the vulnerabilities of patients and their families aren't the only problem. Because the system often relegates them to a passive role, doctors and researchers are denied the valuable insights an equal partnership might provide. (Tanisha Carino and Marc Boutin, 7/19)

Yes. Of course. I was thrilled to learn that my 31-year-old son and his wife were expecting their first child this summer. I just wasn’t thrilled with the idea that someone will soon expect me to respond to “Grandma!” Grandma means old. Admit it. Isn’t that your first thought when you hear the word? (Oldenburg, 7/21)

I managed to get through college in the 1980s without smoking marijuana. It wasn’t until I was diagnosed with cancer in the 1990s that I decided to give it a try. The anti-nausea medicine I was taking to combat the side effects of chemotherapy made me feel like I was going to jump out of my skin and it didn’t banish my queasiness. (Berman, 7/19)

What’s happening at the US border with Mexico is not a security crisis, but a humanitarian one, rooted in policies adopted decades ago. Its consequences won’t be fully understood for years, but we don’t have time to wait. Medics who treat the sick, injured, and dying on this civilian front line are calling for urgent action, and the government must heed that call. (Ieva Jusionyte, 7/18)