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U.S. District Judge Dana Sabraw appeared conflicted in early May on whether to stop families from being separated at the border. He challenged the Trump administration to explain how families were getting a fair hearing guaranteed by the Constitution, but also expressed reluctance to get too deeply involved with immigration enforcement. "There are so many (enforcement) decisions that have to be made, and each one is individual," he said in his calm, almost monotone voice. "How can the court issue such a blanket, overarching order telling the attorney general, either release or detain (families) together?" (Spagat, 7/22)

It’s a busy time for U.S. District Judge Dana Makoto Sabraw. On Friday in San Diego, he presided over jury deliberations in a criminal case against a man trying to prove he isn’t an illegal alien from Mexico but a California-born American citizen. And on Monday, Judge Sabraw is overseeing jury selection in an Apple Inc. patent dispute. Those matters come on top of what is by far the biggest case of his career: the legal effort to reunite thousands of migrant parents and their children. (Gershman, 7/23)

An Illinois shelter housing migrant children separated from their parents at the southern border is under federal investigation for allegations of child abuse. The Casa Guadalupe shelter in the Chicago suburbs told The Washington Post on Friday that the inspector general of the U.S. Department of Health and Human Services and the Illinois Department of Children and Family Services have each launched investigations. (Gstalter, 7/21)

An anti-abortion law Vice President Mike Pence signed as governor of Indiana could become the case that lets the Supreme Court reshape abortion rights as soon as next year. The Indiana law — which prohibited abortion because of the gender, race or disability of the fetus, such as Down syndrome — was blocked by lower courts and is one of three significant anti-abortion state statutes that are sitting one level below the Supreme Court. If Indiana appeals this fall, and the justices accept the case, it could be the opening for a broader ruling on Roe v. Wade that could redefine abortion rights nationwide. (Haberkorn, 7/23)

Rand Paul is one of a handful of senators who'll determine whether Brett Kavanaugh lands on the Supreme Court — and the Kentucky Republican has every intention of maximizing his leverage. Paul is again inviting fellow senators to play the will-he-or-won’t-he guessing game when it comes to his decision — expressing grave concerns about Kavanaugh’s approach to personal privacy while insisting his vote could go either way, depending on what the judge says in the coming weeks and months. (Everett, 7/23)

After months of tumult, Pentagon official Robert Wilkie is expected to become secretary of Veterans Affairs when the Senate votes Monday to confirm him, taking on the task of fulfilling President Donald Trump's promises to fire bad VA employees and steer more patients to the private sector. Wilkie is Trump's third pick for the job in 18 months. The long-time public official says he will "shake up complacency" at VA, which has struggled with long waits in providing medical treatment to millions of veterans. (Yen, 7/23)

Researchers hope a new partnership with the Minneapolis VA Medical Center and other veterans’ hospitals will boost growth in cancer studies and the development of drugs and personalized therapies. Political, financial and other obstacles have limited VA hospitals’ access to clinical trials offered by the National Cancer Institute, but a new NAVIGATE program is designed to address those barriers by increasing the screening of veterans with cancer for research, and eliminating criteria that might have ruled them out in the past. (Olson, 7/21)

No one at a ribbon cutting ceremony for the $1.7 billion Rocky Mountain Regional VA Medical Center on Saturday morning ignored the problems in getting the beleaguered facility to open. The hospital, designed for specialty care including spinal cord injuries and cancer screening, is $1 billion over budget and five years behind schedule. Politicians, local and national Veterans Administration officials, as well as the veterans who will now get care from inside the sprawling 1.2 million-square-foot campus in Aurora, all acknowledged the well-publicized woes surrounding the hospital’s opening during the ceremony. (Whaley, 7/21)

It's more than $1 billion over budget and five years behind schedule, but an elaborate new veterans hospital is finally ready to open in suburban Denver with the promise of state-of-the-art medical care. The $1.7 billion Rocky Mountain Regional VA Medical Center made it through nearly a decade of management blunders, legal battles, federal investigations and congressional hearings. (7/20)

Bayer announced on Friday that it would discontinue sales of its Essure birth control implant by the end of the year, bowing to a lengthy campaign by health advocates and thousands of women to get the device off the market. The implant has had a troubled history. It has been the subject of an estimated 16,000 lawsuits or claims filed by women who reported severe injuries, including perforation of the uterus and the fallopian tubes. Several deaths, including of a few infants, have also been attributed to the device or to complications from it. (Kaplan, 7/20)

The German company had billed the device as the only non-surgery sterilization method for women. As complaints mounted and demand slipped, it stopped Essure sales in Canada, Europe, South America, South Africa and the United Kingdom. The U.S. Food and Drug Administration has placed multiple restrictions on the device following patient reports of pain, bleeding, allergic reactions and cases where the implant punctured the uterus or shifted out of place. (Perrone and Tanner, 7/20)

In April, the U.S. Food and Drug Administration tightened restrictions on the sale and distribution of the birth-control implant, requiring both patients and health-care providers to sign an acceptance-of-risk form. That move followed an FDA decision in 2016 requiring Bayer to add a prominent warning to call attention to serious risks associated with the device, after studies linked it to pain and other health issues among women. In April the FDA said since adding the warnings, Essure sales have declined about 70% in the U.S. (Mohan, 7/20)

The average woman has her period for 2,535 days of her life. That’s nearly seven years’ time of making sure you have a pad or tampon, finding a makeshift solution if you don’t, and managing pain and discomfort. And lately, women — and transgender and nonbinary people who menstruate — are talking about it in public more than ever before. There are new products and services on the market, from menstrual cups to period underwear to medicinal cannabis and “period coaches.” Globally, advocates are pushing for recognition of a woman’s right to manage her period with dignity. And in the United States, activists are bringing the concept of “menstrual equity” into the public debate. (Zraick, 7/22)

In 1998, 25 weeks into her pregnancy, Sara Arey's cervix dilated and her amniotic sac started to descend into the birth canal. She was rushed to a hospital an hour and a half away from her home near Hickory, N.C., where she stayed for more than a week before her baby was born via emergency C-section. The baby, a girl, died 12 hours later in the hospital. Arey had already had two prior miscarriages and one preterm birth in 1994. Had she been able to take a test for her risk of preterm birth, she says that she would have. She would have liked to have known her risk as early as possible, she says. (Watson, 7/22)

A transgender woman in Arizona said this week that a CVS Health pharmacist refused to fill a prescription for hormone therapy, prompting the drugstore company to apologize, say the conduct violated its policy and note that the pharmacist was no longer employed there. Hilde Hall, who lives in Fountain Hills, Ariz., a suburb of Phoenix, said in a statement posted Thursday on the American Civil Liberties Union’s website that she went to the pharmacy in April after receiving her first prescriptions for hormone therapy. Ms. Hall, 25, said a CVS pharmacist refused to fill one of the prescriptions, did not provide a reason and then declined to return her doctor’s prescription note. (Jacobs, 7/20)

The company apologized on social media Friday saying the pharmacist is no longer an employee. CVS says it has a history of supporting LGBTQ rights, helping to develop a guide for pharmacy care for gay, lesbian and transgender customers. The apology comes after Hilde Hall shared her experience on the American Civil Liberties Union’s website. (7/21)

A transgender woman in Arizona is speaking out after she says a CVS pharmacist denied her hormone prescription. The pharmacist questioned her loudly in front of other customers and rejected her and her doctor's requests to transfer the prescription to another location, Hilde Hall said in a blog post published on the ACLU of Arizona's website Thursday. (Palmieri, 7/20)

The federal judge who will rule on the constitutionality of Texas’ embattled fetal burial law said a lack of vendors, cemeteries and crematories committed to handling fetal and embryonic remains could undercut the rights of women to have abortions. At the conclusion of the five-day trial, U.S. District Judge David Ezra said Friday he is also concerned the law could make it difficult for women having miscarriages to access health care and issued a list of questions he wants lawyers to address before he rules. (Zelinski, 7/20)

Ezra asked attorneys for both parties to submit written closing arguments to him by next Friday. He outlined questions he wanted them to address in their arguments, including if there is a "failsafe" or backup for women needing health care if abortion and medical facilities shut down because of this law. (Wang, 7/21)

Going into the trial, Ezra said he anticipated his ruling being appealed to the U.S. 5th Circuit Court of Appeals. Abortion opponents have argued that the law is a means to bring human dignity to fetuses, while reproductive rights advocates said it was another way for Texas to punish women who choose to have an abortion, saying the cost of the burials would be passed on to patients, making abortions harder to obtain for low-income Texans. (Evans, 7/20)

The law requires health centers to ensure that fetal tissue, whether from an abortion or miscarriage, is buried or cremated, with the ashes properly scattered. If clinics are forced to close because there are not enough businesses willing and able to pick up, transport and properly dispose of fetal tissue, “that is a concern of the court,” Ezra said. (Lindell, 7/20)

Theranos Inc., running on financial fumes, settled a suit filed by investors who had alleged they were defrauded by the blood-testing firm. The pact ends a civil case brought by Robert Colman, a former Silicon Valley investment banker, and other plaintiffs who made indirect investments in Theranos, court records filed Friday show. They alleged that Theranos made false and misleading statements about its technology. The company previously reached costly settlements with a major investor and its former retail partner Walgreens Co., and settled civil fraud allegations by the Securities and Exchange Commission in March without admitting or denying wrongdoing. (Weaver, 7/22)

Most patients don’t pay those charges, instead paying a sum based on rates negotiated between hospitals and health insurance companies. But even after those negotiations, stark differences often remain — disparities that can hit the wallet hard. Though consumers have long bemoaned rising health care costs, few people shop for health care the way they might shop for a car, comparing prices. Some don’t realize a procedure can cost tens of thousands of dollars more at one hospital versus another. Others would rather rely on referrals or don’t know where to go to find information. Hospital prices vary for a number of reasons, including differing overhead costs, market dynamics and, in some hospitals, a need to offset the costs of complex services by billing higher rates for simpler ones. (Schencker, 7/20)

A new set of religious directives from the U.S. Conference of Catholic Bishops could make it more complicated for Catholic and non-Catholic health systems to forge merger or partnership deals, even as more systems are entering or exploring such tie-ups. Last month, the bishops overwhelmingly approved the 6th edition of the Ethical and Religious Directives for Catholic Health Care Services, updating a section on collaborative arrangements with non-Catholic organizations whose last version was issued in 2009. (Meyer, 7/19)

Bryan Robbins smoked for 35 years before vaping helped him quit and prompted him to ditch driving trucks for selling e-cigarettes, first at flea markets and then at his own retail shops in Mississippi. The 52-year-old is a Donald Trump supporter who agrees with the president’s efforts to crack down on China’s trade practices, but it’s hitting close to home. The next round of proposed duties -- 25 percent on $16 billion worth of Chinese imports that could go into effect in a month -- includes vaping devices. Most e-cigarettes are made in China, leaving Robbins and his peers without an alternative. (Niquette and Townsend, 7/20)

Those not at their preferred residency may struggle more to find satisfaction working those long shifts and will be more prone to burnout. That, by proxy, could affect patient care. While expectations rarely meet reality, experts say the National Resident Matching Program could do more to properly pair residents with hospitals looking to get the most out of those four years. (Castellucci, 7/21)

Researchers from the University of Florida, Gainesville recently conducted a study, published in the Journal of General Internal Medicine, to explore clinical encounters between doctors and their patients. ... They said primary care doctors allowed more time than specialists as specialists generally know the purpose of a visit. (Parker, 7/20)

On July 14, the coal industry’s doctor-shopping was enshrined in Kentucky law as a spate of new laws took effect. One of them, House Bill 2, makes it harder for Kentuckians hurt on the job to qualify for workers compensation to pay for treatment of occupational injuries and diseases, especially if they are coal miners suffering from black lung. Enacted with mostly Republican votes, the new law excludes the most qualified physicians from being heard in black lung claims. (7/20)

Last week in Houston, a 3-year-old boy died after day care employees left him in a van for more than three and a half hours in 113-degree heat, a heartbreaking loss that could have been prevented, officials said. The death of the child, Raymond Pryer Jr., after a field trip on Thursday stunned Texans, raising questions about the day care’s safety procedures and prompting the police to warn the public about the dangers of hot cars. (Caron, 7/22)

How much fruit juice should kids drink? Not very much. That’s the essence of the juice policy statement from the American Academy of Pediatrics (AAP). School-age children (7 to 18 years old) should limit consumption to eight ounces a day. Preschoolers (ages 4 to 6) can have four to six ounces a day, while toddlers (ages 1 to 3) should have no more than four ounces a day, and babies should not drink any juice at all. Given that most Americans need to increase the amount of fruit and vegetables in their diets and that good diet habits can be established during childhood, why is juice so worrisome? (Adams, 7/21)

A major pediatricians’ group is urging families to limit the use of plastic food containers, cut down on processed meat during pregnancy and consume more whole fruits and vegetables rather than processed food. Such measures would lower children’s exposures to chemicals in food and food packaging that are tied to health problems such as obesity, the group says. (Rabin, 7/23)

Clesta Dickson, 86 years old, never married. The retired teacher lives on her own in a tidy apartment on the second floor of Pleasantview Towers, a subsidized apartment building for older adults and people with disabilities in Vienna, W.Va. When her own parents became frail, she bought a house for the three of them. They died years ago. She has a brother, but he is 82. Without children of her own, she wonders what will happen to her. “I think about it all the time,” she says. She made her funeral arrangements, after noticing how many people she knew died and never had a memorial service or obituary. (Ansberry, 7/20)

If you're in the hospital or a doctor's office with a painful problem, you'll likely be asked to rate your pain on a scale of 0 to 10 – with 0 meaning no pain at all and 10 indicating the worst pain you can imagine. But many doctors and nurses say this rating system isn't working and they're trying a new approach. The numeric pain scale may just be too simplistic, says Dr. John Markman, Director of the Translational Pain Research Program at the University of Rochester School of Medicine and Dentistry. It can lead doctors to "treat by numbers," he says and as a result, patients may not be getting the most effective treatment for their pain. (Neighmond, 7/23)

Elephants have 100 times as many cells as humans. But they seldom get cancer. This is surprising, because cancer is a result of cell division gone wrong, and the more cells an organism has, the higher the chances that some will mutate into tumors. Also, because elephants live so long — between 60 and 70 years — their cells have more opportunities to mutate. The counterintuitive observation that cancer risk does not always correlate with a species’ size or longevity is known as Peto’s Paradox, named after British epidemiologist Richard Peto, who first noted the phenomenon in 1977. It turns out that cancer does not strike all species equally: Some animals have evolved powerful strategies to keep the disease at bay, while others are particularly vulnerable. (Kohn, 7/21)

Jose Belardo of Lansing, Kansas, spent most of his career in the U.S. Public Health Service. He worked on the frontlines of disasters in places like Haiti, Colombia, Nicaragua and the Dominican Republic. At home with his three kids and wife, Elaine, he'd always been unfailingly reliable, so when he forgot their wedding anniversary two years in a row, they both started to worry. "We recognized something wasn't right and pretty much attributed it to being overworked and tired," Elaine says. (Smith, 7/22)

Among the more than 2.5 million men and women who have served in the wars in Iraq and Afghanistan, there are many veterans -- exposed to sandstorms, burn pits and other hazards -- who suffer from a mysterious pulmonary illness, as well as the confusion and doubt that surrounds their condition. (Sagalyn and Schifrin, 7/20)

How much potassium do you need? Is it worth shelling out for the botanical supplement du jour? What’s abetalipoproteinemia? When it comes to dietary supplements, there are often more questions than answers. Although many Americans report using them, their benefits can be questionable. And there are so many on the market that it can be hard to figure out which to buy and how to use them. The website of the National Institutes of Health’s Office of Dietary Supplements addresses such issues. (Blakemore, 7/21)

Jet lag can put the brakes on the most exciting vacations. Almost everyone who has ever flown across time zones knows what it feels like. The experience ranks somewhere between eating day-old cooked oatmeal and nursing a hangover. These food and drink metaphors aren’t just a coincidence. Jet lag, it turns out, affects more than our sleep; it affects our internal organs as well. Given what is known about the importance of intestinal bacteria (called the microbiome) and their connection to immune function and well-being, it’s clear that any discussion of jet lag, and how to deal with it, needs to consider “gut lag” as well. (Wellbery, 7/21)

Researchers in Australia have developed a blood test that could potentially detect melanoma, the deadliest kind of skin cancer, in its early stages. ... Of the 245 blood samples collected, the researchers were able to identify those with melanoma with 79 percent accuracy and those without the cancer with 84 percent accuracy. (Pirani, 7/20)

The virus, which can lead to AIDS if untreated, disproportionately affects African-Americans nationwide. This stubborn racial disparity persists in Connecticut and in neighboring New England states despite years of work to undo it, according to a Connecticut Mirror analysis of data from the Centers for Disease Control and Prevention. (Rigg and Kara, 7/23)

Growing up in Washington, D.C.'s Columbia Heights neighborhood, Rebecca Lemos-Otero says her first experience with nature came in her late teens when her mother started a community garden. "I was really surprised and quickly fell in love," she recalls. The garden was peaceful, and a "respite" from the neighborhood, which had high crime rates, abandoned lots and buildings, she says. (Chatterjee, 7/20)

After a colonoscopy two years ago, Patti Damare felt so delirious and weak that she couldn’t stand on her own. That was on a Friday, and she chalked up her symptoms to lingering effects of anesthesia. On Saturday, the San Marcos, Calif., woman wondered if she had contracted a killer flu or urinary tract infection.The next day, she couldn’t get out of bed. (Bazar, 7/23)

U.S. Attorney Andrew Lelling, the top federal law enforcement official in Massachusetts, is further dashing any chance of a supervised drug injection facility opening in the state. ...Lelling also talked about the discrepancy between federal laws against marijuana and state laws allowing it. (Becker and Citorik, 7/20)

Citing a near-doubling in the number of HIV diagnoses associated with injection-drug use, the Ohio Department of Health has asked the federal government for authorization to fund syringe programs with grant money designated for HIV prevention. In 2017, 121 HIV diagnoses across the state were attributed to injection-drug use, about 12 percent of the 1,015 total infections, according to state documents dated July 5 that include the request to the Centers for Disease Control and Prevention. (Viviano, 7/20)

More than 100 former Ohio State University students have come forward with allegations that a team doctor and professor at the school committed some form of sexual misconduct with them, university officials announced Friday, as the university begins to grapple with the sheer scope of a scandal that continues to grow. It is the latest in a series of sex abuse scandals that have rattled prominent universities, including the University of Southern California, where more than 50 women have accused a former campus gynecologist of misconduct; Pennsylvania State University, where child sex abuse sent one football coach, Jerry Sandusky, to prison and felled a legend, Joe Paterno; and Michigan State University, which is still contending with the fallout from the predations of a team doctor, Lawrence G. Nassar. (Edmondson, 7/20)

A private company that the state has tasked with providing Medicaid coverage to Texas foster children has repeatedly denied requests for critical care, many for children with disabilities. Between June 7 and July 13, Superior HealthPlan denied medical services to foster children 394 times, according to data the Texas Department of Family and Protective Services provided to the American-Statesman. (Chang, 7/20)

Reining in the cost of employee health insurance is high on the agenda as city officials prepare to negotiate new labor agreements with municipal and school workers later this summer. ...The city faces annual increases of 5 percent to 8 percent in health insurance costs for city and school employees, [Ruthanne] Fuller said. (Hilliard, 7/22)

On Saturdays since 2012, protesters have gathered outside the Choices Women’s Medical Center in Jamaica, Queens, starting at 7 a.m. to urge women arriving at the clinic not to have an abortion. For the next three hours, according to a lawsuit filed in June 2017 by Eric T. Schneiderman, the former New York attorney general, protesters violated federal, state and city laws guaranteeing access to reproductive health care by crowding women as they entered the clinic and ignoring their requests to be left alone. (Mays, 7/22)

Defending the Affordable Care Act and saying that a Medicare for All program ought to be considered, House Minority Leader Nancy Pelosi campaigned for Democratic Congresswoman Gwen Moore in Milwaukee Saturday. Pelosi spoke to a group of about 75 people at Independence First, a resource center for people with disabilities located on the city's south side. (Barrett, 7/21)

For the first time, Arizona cities must now track and report to the state details about how many of their police officers and firefighters have used newly expanded taxpayer-funded trauma counseling resources. The move is part of a bill passed by the Arizona Legislature that prioritizes post-traumatic stress as a health issue among public safety personnel. (Pohl, 7/20)

Sheila Brown was shocked to learn, in the spring of 2009, that the Los Angeles City Council was planning to raise the speed limit on Zelzah Avenue, a few blocks from her home in Granada Hills. A few weeks before, a 60-year-old woman had been struck and killed in a crosswalk on Zelzah, Brown told the City Council in an impassioned letter. She said the frequent sounds of screeching tires as drivers narrowly avoided collisions were proof that allowing higher speeds would put residents and students in danger. (Nelson, 7/22)

Health officials are investigating two cases of Legionnaires’ disease among residents at a southern Minnesota senior care facility. According to the Minnesota Department of Health, the cases were reported at the St. John’s Fountain Lake facility in Albert Lea. St. John’s provides assisted living, memory care, skilled nursing care and independent living services. The first resident’s symptoms began in early June, and the second resident’s symptoms were reported to the Health Department on Thursday. Both residents were hospitalized. (7/20)

Two and a half years after both Seattle and King County declared a state of emergency for homelessness, health professionals and some local officials on the King County Board of Health say not enough is being done. The three health officials on the public board are urging it to declare homelessness a “public health disaster” and advise local jurisdictions to respond accordingly — including potentially deploying large scale FEMA-style tents as emergency shelter before the winter. (Fields, 7/20)

Data privacy, once a second-order subject in Silicon Valley, has rocketed to the fore thanks to a battery of new laws. Europe’s groundbreaking data-privacy rule, the General Data Protection Regulation, took effect in May and requires continuing vigilance. Last month, Sacramento lawmakers piled on with a hastily passed law called the California Consumer Privacy Act directed at companies pulling in at least $25 million in annual revenue. (Galbraith, 7/22)

E. coli outbreaks occur every year in Minnesota, mostly as a result of eating food contaminated with the bacteria. Nine confirmed outbreaks in 2015 were traced to restaurants, a day-care center and even a county fair, according to the Minnesota Department of Health. This year, 12 E. coli infections and two deaths in Minnesota have been traced to a national outbreak involving contaminated romaine lettuce grown in the southwestern United States. (Olson, 7/21)

The Family First Prevention Services Act prioritizes keeping children out of foster care. It makes more money available for in-home counseling and parenting classes for families at risk of having children removed. And beginning late next year, the government will only pay for children to stay in group homes for up to two weeks. (O'Donnell, 7/23)

[Sharon] Quenton is one of those enrolled in a $6 million pilot project authorized last year by the Legislature and Gov. Jerry Brown. Run by the state Department of Health Care Services, it was launched in seven counties for 1,000 congestive heart failure patients in Medi-Cal, the state’s version of federal Medicaid care for the needy. ...Patients recently home from the hospital get some nutrition counseling and 12 weeks of homemade, heart-healthy meals with lots of fresh ingredients delivered to their doorsteps. (Gorn, 7/22)

Kaiser Health News: Can A Community Hospital Stay True To Its Mission After Sale To Large Corporation?

Mission Health, the largest hospital system in western North Carolina, provided $100 million in free charity care last year. This year, it has partnered with 17 civic organizations to deliver substance abuse care to low-income people. Based in bucolic Asheville, the six-hospital system also screens residents for food insecurity; provides free dental care to children in rural areas via the “ToothBus” mobile clinic; helps the homeless find permanent housing, and encourages its 12,000 employees to volunteer at schools, churches and nonprofit groups. (Findlay, 7/23)

Numerous health and safety violations at Hannah Neil were revealed this week by Disability Rights Ohio. The legal advocacy group conducted a nine-month investigation that included on-site visits and interviews with children, most of whom are in the custody of a county child-protective agency. Disability Rights alerted state and county agencies to their findings. (Price, 7/20)

Surterra, one of the largest medical marijuana treatment centers in the state, resumed processing cannabis Friday after complying with a missed inspection deadline that had forced it to halt operations at its processing facilities last week. In a letter to the state Department of Health, Surterra submitted documentation of the required certification for two of its facilities and said it intended to restart processing at those sites. (Koh, 7/20)

Efforts by state and federal Republican lawmakers to scale back safety-net programs that support millions of families are reshaping health care and deepening the digital divide for low-income Americans. These lawmakers are limiting opportunities during a time of increasing inequality across the country. Nowhere is this trend clearer than in states where President Trump is hugely popular, including Kentucky and Arkansas, where the president captured 62 and 60 percent of the vote respectively. In these states, access to Medicaid and Lifeline, an affordable internet program, are being stifled under the guise of innovation and cost-savings. (Jason Resendez and Carmen Scurato, 7/19)

As consumer health advocates, we were heartened to learn that a federal court struck down onerous Medicaid work requirements for Kentuckians. We believe work requirements run counter to the core value of the Medicaid program: to provide quality care for low-income populations. We hope this court decision prevents other states considering work requirement waiver applications before the federal government, including Michigan, from implementing burdensome work requirements for their most vulnerable residents. If implemented in Michigan, Medicaid beneficiaries would be at risk of losing their care. (7/22)

It’s appalling that this president wants to strip Title X federal funding from family planning clinics that provide abortions or refer patients to places that do. The direct attack on Planned Parenthood will have a negative impact on 850,000 women throughout California, most of whom are low-income and do not have the resources to go elsewhere. (7/20)

The Centers for Medicare and Medicaid Services is reconsidering its nationwide policy on whether, and under what circumstances, Medicare will pay for a less-invasive heart valve disease treatment called transcatheter aortic valve replacement (TAVR). Heart valve disease impacts an estimated 8.7 to 11.6 million Americans. Aortic stenosis is one of the most common types of heart valve disease, and it can be debilitating, costly, and deadly. Survival rates for severe aortic stenosis, if left untreated, are low at 50 percent at 2 years after symptom onset, and 20 percent at 5 years. Many with the disease are never diagnosed or treated, particularly minorities and underserved individuals. ...Volume is no longer a necessary surrogate for health outcomes in hospitals that offer TAVR. There should be more emphasis on: 1) timely intervention, because the longer patients wait to be treated, the more likely they are to die; and, 2) a focus on health outcomes. Additional measures such as quality of life, mobility, and length of stay in the hospital should be added into the mix. (Susan Peschin, 7/21)

Pam Holt, a teacher and school administrator in Granger, Indiana, was looking forward to her retirement. After her husband died when she was 40, she raised three children alone. She paid into a pension, made Medicare and Social Security contributions, accumulated some savings, and was only three years away from paying off her mortgage when, at age 66, she was diagnosed with multiple myeloma, a cancer that originates in bone marrow. Fortunately for her, taking a pill called Revlimid, made by Celgene, can hold the disease at bay. But its cost began eating her up. (Erin E. Trish and Geoffrey F. Joyce, 7/23)

The so-called “Cadillac Tax” would impose a 40-percent tax on the value of employer-sponsored health coverage that exceeds certain arbitrary cost thresholds. Employer plans affected by the tax will be forced to provide health plans with fewer benefits and higher deductibles — which have already risen 176 percent since 2006. While the name suggests that the tax would only apply to a few individuals with “luxury” health coverage, its actual design and rising health costs ensure that more and more Americans will be affected by it every year. A conservative estimate from Mercer indicates that over half of all companies will be subject to the tax by 2027. (Jim Klein, 7/21)

Earlier this year, Congress made the wise decision to once again suspend the medical device tax for two years. But this temporary reprieve doesn’t go far enough. To maintain the nation’s vibrant medical technology ecosystem, it’s time to eliminate the tax altogether and stop penalizing some of our most creative companies. (David Beier, 7/23)

Experts disagree on the likelihood that the Supreme Court will overturn Roe v. Wade, the legal case that established a right to abortion in the U.S. But they agree that even if that remains federal law, state-by-state regulations could continue to prevent women from receiving an abortion in a clinic or doctor’s office. That won’t end abortions, of course. Some women will undergo illegal and dangerous procedures outside the legitimate medical system, as was once common in the U.S. But now many women will have an additional option: abortion pills. Pills have become the predominant form of illegal abortion in Latin America, and they seem likely to become more common in the U.S. as abortion access is restricted further. (Faye Flam, 7/20)

The heroin epidemic that is sweeping America no longer seems to have racial, economic or geographic barriers. With increasing numbers of white people, including affluent ones, shooting up or sniffing opioids, parents have good reason to wonder if the next drug overdose that police respond to could be their own child’s. As the fear mounts, many Americans — including parents, lawmakers, health professionals and policymakers — have responded with resounding empathy toward such drug addicts. Perhaps it is time to ask ourselves if we have gone too far. (Dahleen Glanton, 7/20)

Promising health studies often don’t pan out in reality. The reasons are many. Research participants are usually different from general patients; their treatment doesn’t match real-world practice; researchers can devote resources not available in most physician offices. Moreover, most studies, even the gold standard of randomized controlled trials, focus squarely on causality. They are set up to see if a treatment will work in optimal conditions, what scientists call efficacy. They’re “explanatory.” (Aaron E. Carroll, 7/23)

The nation is in the midst of a staggering opioid epidemic. Over 115 people die from an overdose each day – and all signs indicate that the problem is getting worse. Unfortunately, of the more than 20 million Americans who need treatment for addiction, it’s estimated that only about 7 percent of them will actually receive specialty care. Ending the opioid crisis will require a multifaceted and sustained public health response – but increasing access to affordable quality treatment and encouraging patients to seek and sustain recovery must be the first priorities. We would expect policymakers and medical providers to do everything possible to increase the number of people entering treatment, not take actions that will discourage individuals from seeking treatment. But unfortunately, that’s exactly what the Overdose Prevention and Patient Safety Act would do. (Deborah Reid and Mark Parrino, 7/22)

The caregivers in our union at the University of Iowa Hospitals and Clinics (UIHC) got an ominous letter in the mail late last month. You can see it by scrolling to the bottom of this piece. It ordered them to send documents proving the identity of their spouses and children on the hospital’s health insurance plan. If they fail to do so, their loved ones’ coverage will be cut off. (Cathy Glasson, 7/20)

Back in 2010, Tom Price, then a congressman, said he knew the chief reason health care cost so much: “Defensive medicine” was costing the United States $650 billion per year — about 26 percent of every dollar spent. The widely dismissed estimate from Dr. Price, an orthopedic surgeon who went on to become President Trump’s health and human services secretary before resigning last fall, was memorable for its magnitude. But American doctors often rail against the country’s medical malpractice system, which they say forces them to order unnecessary tests and procedures to protect themselves if a patient sues them. (Margot Sanger-Katz, 7/23)

The health insurance company Anthem Blue Cross Blue Shield knows fully well the crucial role it plays in the lives of health care-strapped Missourians. The company, America’s second-largest health insurer, appears to be exploring every possible option to milk its advantage and maximize profits on the backs of patients. The only thing that appears to put the brakes on Anthem’s exploitative practices is the bad publicity it receives when those practices are exposed, such as when customers report being denied coverage for emergency room visits clearly necessary for the patient’s survival. An inquiry led by Sen. Claire McCaskill, D-Mo., determined that the numbers on denied coverage were far more than a handful. In the last half of 2017, Anthem denied the emergency-room claims of 12,200 patients in Missouri, Kentucky and Georgia, McCaskill’s inquiry found. During the final quarter of 2017, Anthem’s profits jumped 234 percent, to $1.2 billion, over the same period in 2016. (7/22)

While the issue of suicide can seem emotionally overwhelming or beyond what one person can do, studies show that demonstrating our humanity, reaching out and listening to others can have a lifesaving impact on people considering suicide. How to get help: If you or a loved one are experiencing suicidal thoughts, call the Milwaukee County Behavioral Health Division crisis line at (414) 257-7222. (John Schneider, 6/20)

Words are toxic, too. Labeling Flint’s children as “poisoned,” as many journalists and activists have done since the city’s water was found to be contaminated with lead in 2014, unjustly stigmatizes their generation. Let’s be clear. It’s unacceptable that any child was exposed to drinking water with elevated lead concentrations. We know that lead is a powerful neurotoxicant, that there is no safe level, that the very young are particularly vulnerable and that long-term exposure to low to moderate levels of lead is associated with decreased I.Q.s and other cognitive and behavioral problems, including criminal behavior. (Hernan Gomez and Kim Dietrich, 7/22)

I was taken aback by a collage of photos that a high school classmate recently posted. Instead of fond high school memories, it was filled edge-to-edge with faces of former friends. ...North Carolina has designed an Opioid Action Plan to address the problem, and there have been moves towards limiting opioid prescriptions and suing opioid distributors. But opioids will be prescribed as long as people have pain. In its plan, the government omitted a key underlying factor in opioid use: mental health. Drug abuse and mental health are intimately intertwined, and I believe that timely, accessible addiction and mental health services would give these kids a chance at life. (Rolvix Patterson, 7/20)

One proposal is for safe injection sites — facilities where drug users can go to inject without fear of arrest, violence, robbery or other problems of living on the street. ...Having evaluated the evidence and the need, the board of directors of the San Francisco Marin Medical Society voted unanimously in 2017 to support piloting safe injections sites here, and were soon joined by the AMA. (John Maa and Steve Heilig, 7/22)

There is a possible pathway to a compromise on community hospitals, too — but time is short, the disagreements are deep, and neither the House nor the Senate bill would be adequate on its own. If the negotiators can’t bridge their differences before the end of the legislative session, they shouldn’t let the reforms contained in the bills become a casualty. (7/23)

Drug pricing is a complicated issue, but that is no excuse for the media to misunderstand the changes currently taking place in drug markets. Your editorial ignores the significant reforms that have already taken place during President Trump’s time in office, and the much more fundamental shifts that are on the way. The Times misleads on the administration’s strong support for tougher drug negotiation by state governments. The paper chides us for disapproving a Massachusetts pilot program, but the model Massachusetts proposed involved implementing new negotiation powers while keeping federally negotiated rebates. This fact was left out by The Times and renders the proposal an attempt at double-dipping. (HHS Secretary Alex Azar, 7/20)