�Թϲ�����

Senate Republican leaders are trotting out their new, but reeling, health care bill and angling toward a showdown vote next week amid signs that they have lots of work ahead to win over GOP lawmakers or face a resounding failure. (Fram, 7/13)

The likely defection of two Senate Republicans has left their leaders no margin for error as they move on Thursday to unveil another version of their bill to repeal much of the Affordable Care Act — without an assurance that they have the votes even to begin debate next week. Senator Rand Paul of Kentucky flatly declared on Wednesday that he would not vote to take up the bill, which he said left too much of President Barack Obama’s health law in place. Senator Susan Collins of Maine has gone almost as far, saying that the bill cuts too much and that only major revisions could win her over. (Pear and Kaplan, 7/12)

Sen. Ted Cruz (R-Texas), who has demanded that the bill further loosen requirements on health plans, remained optimistic of passage, even though he indicated he would not support opening the debate unless his proposed revision was included in the new text. “I believe we can get to yes and we can bring together 50 senators behind Obamcare repeal,” Cruz said. (Mascaro and Levey, 7/12)

The revised bill is expected to include $45 billion more to combat the opioid epidemic, allow people to use funds from their health-savings accounts to pay insurance premiums, and retain the ACA’s two taxes on high-income households. Mr. McConnell responded Wednesday by warning Republicans about the perils of not coming together to pass a bill. “If we sit on our hands, families will continue to suffer,” he said on the Senate floor. (Armour, Peterson and Radnofsky, 7/12)

In a closed-door meeting of Senate Republican chairmen Wednesday, Lisa Murkowski ripped GOP leaders’ attempt to scale back Medicaid spending in their Obamacare repeal bill. The two matters were unrelated, she argued, because the Affordable Care Act did not change Medicaid spending levels across the entire program. The independent-minded Alaska senator was backed up by Sen. John Hoeven of North Dakota, a Republican generally aligned with leadership, according to senators and people familiar with the conversations. (Everett and Pradhan, 7/12)

Many Republican senators, from all wings of the party, are taking issue with the Senate GOP bill to replace most of the Affordable Care Act. The 12 below have been most outspoken, and each is flanked by like-minded senators behind the scenes. (McGill, Radnofsky and Zitner, 7/12)

Sen. Rand Paul (R-Ky.) in a new op-ed blasts the Senate GOP's healthcare bill, saying it doesn't repeal ObamaCare. In the piece published Wednesday on Breitbart News, Paul criticized ObamaCare and targeted those in the GOP who he said are not upholding their commitment to repeal the former president's signature healthcare legislation. (Savransky, 7/12)

Senate Republicans are desperately trying to craft health care legislation that can win 50 votes, and to do that they badly need skeptics like Jerry Moran. But the Kansas senator skipped a high-level GOP caucus this week, and there’s little evidence he’s about to change his mind. (Wise, 7/12)

“I want to see how funds are used to help ensure that people can get access to affordable coverage, and that’s the key,” said Senator Rob Portman of Ohio, who objected to McConnell’s original bill. “But we don’t have the specifics." (Litvan and Dennis, 7/13)

The Congressional Budget Office is analyzing versions of the revised bill that include and don’t include Cruz’s proposal. That analysis is still expected to be released early next week. “People who are really making a lot of the comments are fully invested in their point of view. There is an effort to get to compromise,” said Sen. David Perdue, R-Ga. “We really are down to one or two issues.” (McIntire, 7/12)

The White House on Wednesday released its own internal analysis of the Senate’s ObamaCare repeal and replace bill in an attempt to push back against the Congressional Budget Office’s (CBO) findings. In a statement, the White House said the CBO estimates about the Better Care Reconciliation Act’s (BCRA) Medicaid impact “should be discounted because of the large errors made by the agency in estimating the toll of the Affordable Care Act (ACA).” (Weixel, 7/12)

Senate Majority Leader Mitch McConnell (R-Ky.) is warning his colleagues to not block the chamber from taking up a bill to repeal and replace ObamaCare as leadership struggles to shore up support for the legislation. "I'm sure members will have other good ideas ... and I hope they will offer them. ... But if the Senate is prevented from even proceeding to the bill, none of us will have an opportunity — not Republicans, not Democrats, not anyone," McConnell said from the Senate floor Wednesday. (Carney, 7/12)

After hearing arguments weeks ago from Democratic and Republican aides, Parliamentarian Elizabeth MacDonough issued her opinion that the House bill (HR 1628) complies with jurisdictional requirements within Senate reconciliation instructions. The development is significant because it means the hotly debated health care repeal written by the House can move more smoothly through the Senate without procedural problems. There still may be other challenges under the Senate's Byrd rule, which bars extraneous matter, once the bill is under debate. (Krawzak, 7/12)

Just four days after Senate GOP leaders revealed their health-care bill this summer, Tucson Medical Center hosted a town hall thousands of miles away drawing roughly 700 people in person and 1,900 online. In its aftermath, hospital employees, doctors and members of the public sent nearly 2,900 emails to the state’s two senators, Republicans John ­McCain and Jeff Flake, urging them to reject any legislation that would jeopardize patient health care. The move was like nothing the hospital had done before, said Julia Strange, the center’s vice president for community benefit. (Eilperin and Cunningham, 7/12)

The tough lessons are piling up for Republicans as they struggle to repeal the Affordable Care Act, but one stands out as a harbinger of things to come: Tax cuts for the rich, paired with reduced services for the poor, are a politically unpalatable combination. Unable to get the first version of their health care bill off the ground, Senate Republicans are expected to release a revised bill on Thursday that would keep two of the taxes on the wealthy that were imposed by President Barack Obama’s health law: the 3.8 percent tax on investment income and the 0.9 percent surcharge on Medicare taxes, both imposed on high-income earners. (Rappeport, 7/12)

The elimination of an Affordable Care Act tax could result in a personal tax cut for President Trump of between $1.4 million and $2.8 million a year, according to a liberal advocacy group. Americans for Tax Fairness said the elimination of the 3.8% net investment income tax would, by its estimates, result in the big cut. The group based its estimates on Trump's financial disclosure form. (Estepa, 7/12)

Health insurers are blasting an effort by conservatives to modify the Senate Obamacare repeal bill and set up a two-tier market in which companies could sell plans that don’t meet Obamacare’s coverage requirements. Their big concern, according to documents obtained by POLITICO: The plan by Ted Cruz and Mike Lee would threaten access to coverage for individuals with costly medical conditions. (Demko, 7/12)

The main health insurer trade group is warning Senate Republicans against including a controversial conservative amendment in their healthcare bill, saying the move would destabilize the market and harm coverage for people with pre-existing conditions. America's Health Insurance Plans (AHIP) warns in a position paper obtained by The Hill that the proposal from Sens. Ted Cruz (R-Texas) and Mike Lee (R-Utah) would cause people with pre-existing conditions to “potentially lose access to comprehensive coverage and/or have plans that were far more expensive, as premiums in the Exchange market would rise much faster than under existing market conditions.” (Sullivan, 7/12)

Health insurance lobbying groups are raising concerns about a proposed amendment to the Senate health care bill, warning that a proposal from Sen. Ted Cruz would destabilize and fracture the individual insurance market. The Texas Republican is pushing to allow insurers to sell policies on the federal exchanges that don’t meet the regulations laid out in the 2010 health care law (PL 111-148, PL 111-152), so long as an insurer offers one plan that does comply with the law. (McIntire, 7/12)

AHIP’s cautious opposition was not enough to sink the House-passed version of the bill to repeal and replace the ACA, but the group’s skepticism may hold more weight with senators, who are awaiting the Congressional Budget Office’s cost estimate of the market impact of Cruz’s amendment. Senate GOP leaders are hoping to vote on revised legislation next week. (Reid, 7/12)

Senate Republicans are preparing to unveil a revised health care bill that aims to attract support from wary Republicans, but early indications suggest the proposed changes do little to address concerns about the current deep cuts to Medicaid, possibly putting the bill’s path to passage in peril. ... "My understanding is that remains the same," Sen. Pat Toomey, R-Penn., a proponent of the Medicaid cuts, of the Medicaid portion of the bill. (Caldwell, 7/12)

Sen. Pat Toomey, R-Penn., defended the Senate health care bill’s curbing of Medicaid spending by calling Medicaid the single-biggest driver of the federal budget deficit. ... Is Medicaid the primary culprit behind the federal budget deficit? We found Toomey is playing parlor games with budget figures. (Tobias, 7/12)

Your tax dollars provide health care benefits for millions of people. Currently, 74 million people receive health coverage under Medicaid, a government program for low-income people, including adults with disabilities and children. Under the program, beneficiaries pay low out-of-pocket fees for health services that are paid for by federal dollars. ... Medicaid ranks as the single largest source of health coverage in the United States, according to the government website. (Scutti, 7/13)

Senate Republican leaders are plowing ahead with their goal to pass a GOP-only bill to repeal and replace Obamacare next week, but behind the scenes a bipartisan group of senators is discussing how to move forward if the bill fails. “We’ve had great conversations — a lot of Democrats and Republicans,” Sen. Tom Carper, D-Del., told reporters Wednesday. Carper said he's been talking specifically with Sen. John McCain, R-Ariz., and they have agreed on the need to draft a bill in public with opportunities for amendments and a full debate. (Collins and Greene, 7/12)

More than half a dozen Republican and Democratic senators are looking at ways to stabilize the Affordable Care Act’s embattled marketplaces, for example. But any bipartisan push faces stiff challenges, notably from some Republicans who view any tweaking of the ACA has an abdication of the party’s seven-year pledge to uproot it. (Hackman, 7/12)

[M]any in the GOP privately say they might need a break between seven years of repeal attempts and a sudden repair effort. And some Democrats are already calling for single-payer health care — an automatic non-starter for Republicans. The sharp political divide underscores just how hard it would be for the parties to come together amid the ashes of a failed repeal. (Haberkorn and Cancryn, 7/12)

Ten House Democrats are proposing a plan to stabilize the ObamaCare markets and reduce premiums. The plan, released Wednesday by the New Democrat Coalition's Affordable and Accessible Health Care Task Force, comes as Republicans pressure Democrats to come up with their own plan to "fix" the Affordable Care Act. (Hellmann, 7/12)

The five-part plan by the coalition, led by Democratic Reps. Kurt Schrader, Ore.; Ami Bera, Calif.; and Ann McLane Kuster, N.H., is designed to stabilize the individual marketplace, control costs, promote enrollment and increase options for consumers. During a news conference announcing the plan, Schrader emphasized there is room for bipartisan discussions to improve the marketplace. “I’ve had conversations with Republican and Democratic senators and there’s a group of folks willing and wanting to work, and I hope our leadership will give us that opportunity,” Schrader said. “Hopefully moderate Republican senators will be looking at this" and conclude that, "well, geez, there are Democrats that are willing to step up, maybe buck our leadership a little bit and work across the aisle and solve the problems in the individual marketplace.” (Raman, 7/12)

President Donald Trump said Wednesday he will be "very angry" if the Senate fails to pass a revamped Republican health care bill and said Majority Leader Mitch McConnell must "pull it off," intensifying pressure on party leaders laboring to win over unhappy GOP senators and preserve the teetering measure. (7/13)

The comments, coming in an interview at the White House with televangelist Pat Robertson of CBN News, intensified public pressure on Majority Leader Mitch McConnell (R-Ky.), who plans to release a revised version of his health-care legislation Thursday morning. “I am sitting in the Oval Office with a pen in hand, waiting for our senators to give it to me,” Trump said. “It has to get passed. They have to do it. They have to get together and get it done.” (Sullivan, Wagner and Snell, 7/12)

Trump noted how often Republicans have touted repealing the landmark 2010 health care bill. “They’ve been promising it for years. They’ve been promising it ever since Obamacare which is failed,” Trump said. “It’s a failed experiment. It is totally gone. It’s out of business and we have to get this done.” (Tesfamichael, 7/12)

President Trump said he’ll be “very angry” if Senate Republicans aren’t able to pass a bill to repeal and replace ObamaCare, as GOP leaders get ready to unveil their updated legislation. Trump said Republicans have been promising for years that they’d repeal ObamaCare, and now with Republicans controlling Congress and the White House, he said he’s “waiting” to sign a repeal bill. If Senate Republicans aren't able to pass their bill, known as the Better Care Reconciliation Act, he said that’d be “very bad.” (Hagen, 7/12)

Vice President Mike Pence promoted a revamped Senate health care bill Wednesday, choosing the home turf of Kentucky's high-profile senators to "turn up the heat" on the struggling Republican effort to uproot former President Barack Obama's health care law. (Schreiner, 7/12)

The number of Native Americans without health insurance would increase sharply if Republicans in Congress succeed in repealing and replacing the Affordable Care Act, according to a new report. The report, from the left-leaning Center on Budget and Policy Priorities, says that proposed cuts to Medicaid and to the subsidies that reduce out-of-pockets costs for low-income individuals purchasing private insurance in the ACA marketplace would jeopardize the coverage of more than 300,000 Native Americans and Alaska Natives. (McLean, 7/12)

Hundreds of thousands of immigrants could be locked out of the health insurance marketplaces if the Senate’s new health-care bill becomes law. Buried among the bill’s provisions that roll back the Medicaid expansion and lower marketplace subsidies is a shift in eligibility requirements. Rather than all legal immigrants being able to receive tax credits and buy coverage in the marketplace like under the Affordable Care Act, the new bill — aside from a few, narrow exceptions — allows only permanent residents and people who immigrated for humanitarian reasons to participate. (Soffen, 7/12)

Aaron Albaugh peers out from under the brim of his cowboy hat, surveying the acres of hay fields in front of him. The fourth-generation rancher is raising about 450 cattle this year, in this remote corner of Lassen County. His closest neighbor lives a half mile away. “And that’s my brother,” Albaugh says. “If I want to go see a movie, it’s 70 miles round trip,” he adds. “If I want to go bowling, that’s 100 miles round trip.” Living a half day’s drive from civilization,  you learn to do without, he explains. (Dembosky, 7/12)

More than half of U.S. governors are meeting this week to discuss the biggest challenges facing their states. Those include the possibility of major changes to Medicaid and states' health insurances marketplaces under the Republican health care plan in Congress, the ongoing opioid epidemic and the impact of climate change. (McDermott, 7/13)

Vice President Mike Pence on Friday will continue his quiet campaign as the Trump administration’s ultimate inside player when he tries to convince governors to view President Donald Trump as a partner on issues such as health care and infrastructure. With Trump in France participating in that country’s Bastille Day festivities, Pence is being deployed to the National Governors Association conference in Rhode Island. (Bennett, 7/13)

“Obamacare is dead,” President Donald Trump frequently declares. But reports of its demise appear to be premature. For the first time ever this year, insurers selling plans in Obamacare’s markets appear to be on a path toward profitability. And despite the drumbeat of headlines about fleeing insurers, only about 25,000 Obamacare customers live in communities facing the prospect of having no insurer next year. (Demko, 7/12)

Diabetes, high blood pressure and other chronic conditions account for the vast majority of health spending in the U.S., according to the Centers for Disease Control and Prevention. Almost half of American adults have one or more chronic physical or mental health conditions, and spending on them adds up to some $2.3 trillion a year. Some health plans are beginning to offer free maintenance care for people with chronic health problems, hoping that spending a little more early on will save a lot [of] money in the long run. (Zdechlik, 7/12)

Anthem Blue Cross Blue Shield, one of Missouri’s largest insurers, no longer covers emergency room visits that it deems unnecessary. The policy aims to save costs and direct low-risk patients to primary care physicians and urgent care clinics. But doctors say patients may avoid going to a hospital when they really need it, if they fear a large bill. (Bouscaren 7/12)

Thursday, the Senate's health care bill, version 2.0, will be made public. Smaller businesses, in particular, will be interested because providing health care benefits can be a significant expense for them. (Ryssdal, Henderson and Hollenhorst, 7/12)

Startup Bright Health is betting it can compete in the lucrative market of covering U.S. seniors as congressional debate keeps the future of Obamacare’s insurance plans in limbo. Bright Health is preparing to offer Medicare Advantage plans in three markets next year in close collaboration with local health systems: Birmingham, Alabama; Phoenix, Arizona; and the Denver-Boulder area of Colorado. The company offered Obamacare plans in that area of Colorado this year, but is holding off on expanding amid doubts over the health law’s future. (Tracer, 7/12)

The Indian Health Service’s top official dodged frustrated lawmakers’ questions about unsafe care at the federal agency and whether proposed budget cuts would worsen the situation during a tense Senate committee hearing Wednesday. Members of the Senate Indian Affairs and Senate Appropriations committees repeatedly cited two articles published last week in The Wall Street Journal on the agency, which provides health care to 2.2 million tribal members. (Weaver and Frosch, 7/12)

Leaders of the Indian Health Service struggled Wednesday at a Senate hearing to defend the Trump administration’s plans to slash funding to the agency, which is reeling from quality of care problems at several of its hospitals, a doctor shortage and facilities showing their age. The lack of answers infuriated both Democrats and Republicans on the Appropriations subcommittee. (Galewitz, 7/12)

Appropriators Wednesday fumed over the Trump administration’s budget request for the Indian Health Service, with one top lawmaker noting he was leaving the hearing with his “hair on fire” after the agency’s top official failed to give clear answers to basic budget questions. “If you guys don’t advocate for a budget, how the hell are we supposed to fix it?” Sen. Jon Tester said in a heated exchange, after acting Indian Health Service Director Rear Admiral Michael D. Weahkee would not answer yes or no when asked if the budget request cut funding for hiring staff at the agency. (Mejdrich, 7/12)

California is harming medical care for more than 13 million lower-income residents, more than half of them Latinos, by failing to pay doctors enough to provide proper care, according to a lawsuit filed Wednesday. The lawsuit alleges the state violates Latinos' civil rights because poorly paid health care providers balk at providing treatment. (Thompson, 7/12)

The two groups that filed the case hope to get it certified as a class-action lawsuit on behalf of all Medi-Cal enrollees. The complaint claims that beneficiaries of Medi-Cal, the state’s version of the Medicaid program, often experience delays in care or are denied care altogether. And, it says, they may have to travel longer distances to find medical providers who are willing to see them. (Ibarra, 7/13)

Thomas A. Saenz, an attorney representing the plaintiffs and president and general counsel for the Mexican American Legal Defense and Educational Fund, said the state is required to provide coverage to low-income Californians through Medi-Cal that’s equivalent to the care other Californians receive through private insurance or Medicare. But Medi-Cal patients have a harder time finding doctors, wait longer for appointments, end up in the emergency room more often and have their diseases diagnosed later than those in other insurance programs, Saenz said. That’s in part because the state mismanages the health program and delays payments to doctors, making them unwilling to see Medi-Cal patients, he said. (Karlamangla, 7/12)

“Medi-Cal participants suffer from greater pain, illness, and undiagnosed and untreated serious medical conditions—with significant impact to their overall health—than do their fellow Californians with other insurance,” the complaint says. (Dembosky, 7/12)

“Medi-Cal is supposed to be a lifeline,” said Darin Ranahan, one of the attorneys who filed the suit. “It ends up being an empty promise.” (Tolan, 7/12)

The House subcommittee controlling the purse strings of the National Institutes of Health (NIH) on Wednesday proposed a $1.1 billion boost for the agency, defying the Trump administration's push for cuts. The White House had proposed slashing the nation’s medical research agency by $5.8 billion. But it was clear from the get-go that Congress wouldn’t support cutting NIH’s budget, with members of both parties in opposition. (Roubein, 7/12)

The House spending bill to fund the Department of Health and Human Services would decrease its fiscal 2017 allocation of $78 billion by $542 million for fiscal 2018, with cuts to family planning and refugee services going to offset a $1.1 billion increase to the National Institutes of Health. For the most part, the bill is a rejection of the Trump administration’s proposal to cut around $15 billion from HHS. The overall bill includes $156 billion in total funding, a $5 billion discretionary cut from fiscal 2017 levels. The Department of Education has the most significant cut of $2.5 billion, while the Department of Labor would face a $1 billion cut. HHS only faces around $500 million in cuts. (Siddons, 7/12)

As Georgia’s top public health official, Brenda Fitzgerald led the fight against childhood obesity in a state with one of the highest rates in the country. The program there, funded in part by the Coca-Cola Foundation, emphasizes exercise and makes little mention of the problems with sugary soft drinks — putting the effort at odds with research and the positions of many experts. (Sun, 7/12)

Federal prisons keep some mentally ill inmates in solitary confinement for at least 22 hours a day, sometimes for years, according to an audit released Wednesday by the in-house watchdog for the Justice Department. (Reinhard, 7/12)

The Department of Veterans Affairs is using an outdated and shortsighted planning process for managing its facilities and it's an obstacle for the VA's effort to repurpose or rid itself of old buildings and plan for future of care. That is the finding of the Government Accountability Office, which issued an opinion Wednesday on the VA's two processes it uses to plan for managing facilities and how they are used to provide medical care for the nation's veterans. (Lowary, 7/12)

A Food and Drug Administration panel opened a new era in medicine on Wednesday, unanimously recommending that the agency approve the first-ever treatment that genetically alters a patient’s own cells to fight cancer, transforming them into what scientists call “a living drug” that powerfully bolsters the immune system to shut down the disease. (Grady, 7/12)

The unanimous recommendation from the Oncologic Drugs Advisory Committee means the treatment could be approved by the FDA by the end of September, forging a new path in the immunotherapy frontier. Timothy Cripe, a panel member who is an oncologist with Nationwide Children's Hospital in Columbus, Ohio, called the treatment the "most exciting thing I've seen in my lifetime." (McGinley, 7/12)

The treatment takes cells from a patient's body, modifies the genes, and then reinfuses those modified cells back into the person who has cancer. If the agency approves, it would mark the first time the FDA has approved anything considered to be a "gene therapy product." The treatment is part of one of the most important developments in cancer research in decades — finding ways to harness the body's own immune system to fight cancer. (Stein, 7/12)

An advisory panel of the FDA voted 10-0 to recommend the approval of tisagenlecleucel, a treatment developed by the pharmaceutical firm Novartis. The treatment requires the extraction of a patient’s own infection-fighting T-cells, which are then genetically engineered to recognize and fight the cancer cells affecting the patient, and infused back into the bloodstream. (Garver, 7/12)

Two former sales reps pleaded guilty on Tuesday to bribing doctors in exchange for prescribing the powerful Subsys painkiller sold by Insys Therapeutics, which is under numerous investigations by state and federal authorities for its role in the opioid epidemic. In both instances, the sales reps pleaded guilty to violating the federal anti-kickback law for participating in a speaker program that prosecutors say was used to reward doctors and other medical practitioners for prescribing Subsys, which contains fentanyl and carries a high risk of dependency. (Silverman, 7/12)

A Texas doctor wrote unnecessary prescriptions for powerful drugs that contributed to the overdose deaths of at least seven people over a four-year period, according to a federal indictment unsealed Wednesday. Howard Gregg Diamond, 56, was arrested Tuesday on charges that include conspiracy to distribute controlled substances and health care fraud. (7/12)

Gov. Wolf on Wednesday joined Clarion University officials to announce the launch of an online certificate program in opioid treatment, which they said is the first of its kind in Pennsylvania. “Education is a powerful thing,” Wolf said at a news conference at the Capitol. “Armed with facts, health-care providers, drug counselors, EMTs, school counselors, therapists, anyone interested in learning more will be able to take this online course.” In 2015, 3,500 Pennsylvanians died of drug overdoses, Wolf said. He said it appears that the toll in 2016 was even higher. (Langley, 7/12)

Florida is enacting tough new penalties on dealers of the synthetic opioid fentanyl. Gov. Rick Scott was in West Palm Beach Tuesday for a ceremonial signing of Florida House Bill 477. (Haden, 7/12)

At the suggestion of a Palm Beach County Commissioner, the county is looking into suing drug companies whose products are at the heart of the opioid crisis. The Palm Beach Post reports the county attorney will have her staff examine the legal landscape to determine if pharmaceutical companies have been successfully sued, which jurisdictions have been involved and what law firms have taken on the work. (7/12)

Law enforcement in New Hampshire will soon get some help in fighting the state’s drug epidemic. Gov. Chris Sununu signed a bill this week putting $4.5 million towards drug enforcement. The legislation gives money to the state’s drug lab, the narcotics department and Granite Hammer – a program designed to get drug dealers off the streets. (7/11)

How we look at other people’s faces is strongly influenced by our genes, scientists have found in new research that may be especially important for understanding autism because it suggests that people are born with neurological differences that affect how they develop socially. (Belluck, 7/12)

After years of introspection, about 15 percent of men with localized prostate cancer regretted the decisions they made regarding treatment, a survey of almost 1,000 patients showed. About twice as many men expressed regret after radical prostatectomy or radiation therapy as compared with active surveillance. The single biggest contributor to regret was treatment-associated sexual dysfunction, as reported in the Journal of Clinical Oncology. (Bankhead, 7/12)

A long-term study of men diagnosed with early-stage prostate cancer has confirmed that patients who forgo immediate surgery have the same odds of living another decade or two as patients who have their tumors surgically removed. The results, published in Thursday’s edition of the New England Journal of Medicine, show that while each approach offers a different mix of benefits and risks, neither is likely to result in death due to prostate cancer. (Abed, 7/12)

Zika, the virus that sparked widespread concern last year? It’s on the wane, at least for now. The number of people infected with Zika is down substantially this year in the United States, reflecting a precipitous drop in mosquito-borne virus infections in Puerto Rico and other overseas locations. (Orr, 7/12)

A new study shows that such diet changes are better late than never — as long as those new healthy habits stick. That came from researchers at Harvard’s school of public health who tracked what over 70,000 people have eaten for decades. They found that long-term improvements in diet were associated with a significantly decreased risk of death. (Sheridan, 7/12)

Dieticians for years have used genetics on a limited basis, looking at mutations in one particular gene that may make patients prone to disease or more likely to have certain health conditions. For example, patients who are lactose intolerant can't break down the lactose found in dairy products because of a mutation in the lactose gene. So they suffer with gas and other uncomfortable digestive problems after drinking milk or eating cheese or ice cream. The sequencing of the human genome - or the mapping of every gene in the body - has enabled not just dieticians, but all doctors, to use genetics in a more comprehensive way. A doctor can look at a patient's entire genetic makeup to determine, for instance, if they have multiple gene mutations that would make them more prone to obesity or cardiovascular disease. (McDaniels, 7/13)

Potentially harmful chemicals that were banned from children’s teething rings and rubber duck toys a decade ago may still be present in high concentrations in your child’s favorite meal: macaroni and cheese mixes made with powdered cheese. (Rabin, 7/12)

Contamination at a German factory that makes crucial machines used during open-heart surgery is the likely source of a global outbreak of deadly infections tied to the devices, the largest analysis to date shows. Scientists using whole-genome sequencing matched the DNA fingerprints of samples taken from infected heart-surgery patients from several countries, including the U.S., to samples from the devices, called heater-cooler units, in multiple hospitals — and at the production site. (Aleccia, 7/12)

Do patients who hear voices — and suffer other symptoms that psychiatrists would consider severe —  have the right to direct their treatment, even if that means rejecting conventional therapies, such as psychiatric medication? Some mainstream psychiatrists have concerns that people who are out of touch with reality and spurn treatment may pose a danger to themselves or others. But the movement, which began in the Netherlands, has spread rapidly in the past three decades; there are now “hearing voices” support groups on all five continents, and over 180 in the U.K., alone, anchored by the Hearing Voices Network. The idea has been slower to take hold in the U.S., which has a strong medical model for treating mental illness, but is gaining steam there, too. (Wang, 7/13)

When people take medicine at home, mistakes happen. Some people end up taking the wrong dose of a medication or the wrong pill. Sometimes, they don't wait long enough before taking a second dose. Other times, it's a health professional who's at fault. A pharmacist might have dispensed a medication at the wrong concentration, for example. (Columbus, 7/12)

It was one of the very first motion pictures ever made: a galloping mare filmed in 1878 by the British photographer Eadweard Muybridge, who was trying to learn whether horses in motion ever become truly airborne. More than a century later, that clip has rejoined the cutting edge. It is now the first movie ever to be encoded in the DNA of a living cell, where it can be retrieved at will and multiplied indefinitely as the host divides and grows. The advance, reported on Wednesday in the journal Nature by researchers at Harvard Medical School, is the latest and perhaps most astonishing example of the genome’s potential as a vast storage device. (Kolata, 7/12)

More than 100 members of the striking Massachusetts Nurses Association made a symbolic effort to return to work at the Tufts Medical Center on Thursday, but they were rebuffed by security as the first nurses strike against a Boston hospital since 1986 turned into a lockout expected to last into Monday. The nurses union launched a one-day strike around 7 a.m. Wednesday, setting up a picket line that drew hundreds of union members along with political figures to the sidewalk outside the hospital on Washington Street in Boston’s Chinatown section. (Salinas and Sweeney, 7/12)

Hundreds of nurses lined the sidewalks in front of Tufts Medical Center Wednesday in what the union says is the largest nursing strike in Massachusetts history. It is also the first nurses strike in Boston in 30 years. (Bebinger, 7/12)

Nurses at a major Boston hospital went on strike Wednesday for the first time in three decades at a time of concerns nationally over labor costs at hospitals. Some 1,200 nurses at Tufts Medical Center staged a one-day strike over a contract dispute centered on the hospital’s efforts to alter retirement benefits by moving nurses who still have traditional pension plans into less costly 401 (k)-style accounts. (Levitz, 7/12)

In many cities, for patients needing complex medical care, Tufts Medical Center would be the only destination in town. But in Boston, a city rich with big hospitals, Tufts has long been overshadowed by larger competitors with more prestigious names and deeper pockets. The disparities between Tufts and its competitors have been thrown into sharp relief by an ugly labor dispute. On Wednesday, more than 1,200 members of the Massachusetts Nurses Association went on strike after the union and the hospital failed to come to terms on staffing levels, wages, and retirement benefits. (McCluskey, 7/12)

A fifth person has died in San Diego County’s ongoing hepatitis A outbreak — the state’s largest in two decades, public health officials said Wednesday. The outbreak started in November and has grown among the region’s homeless population. There have been 228 confirmed infections, including 161 people who had to be hospitalized, according to the county’s Health and Human Services Agency. (Sisson, 7/12)

New and expectant mothers across Colorado will soon be eligible to receive a free gift: a cardboard box that health workers hope will reduce infant mortality. The box comes courtesy of The Baby Box Co., a for-profit maker of the kinds of boxes that mothers in Finland have received for decades. The boxes include a basic foam mattress and can serve as a safe sleep space for infants up to about 6 months old. A smattering of other items — such as diapers, wipes and onesies — are also included with the boxes. (Ingold, 7/12)

Toni Atkins grew up without health insurance in a “crossroads out in the middle of nowhere. ”The family lived in rural Virginia, where her father worked as a miner and her mother was a seamstress. Her mom broke an arm at one point, reducing the family to one income while medical bills stacked up. “We had to get food stamps. It was excruciating,” Atkins said. (Luna, 7/13)

The University of Maryland Medical System board of directors executive committee voted Wednesday to bring Dimensions Health Corporation under the UMMS banner. The vote authorizes, Robert A. Chrencik, UMMS president and chief executive officer, to enter into an affiliation agreement with Dimensions in Prince George's County.The Dimensions board voted last month to allow the merger to go through. (McDaniels, 7/12)

When Jeffrey Brewer's son was 15, the boy nearly lost his life because he took too much insulin. The diabetic teen took insulin to eat a large bag of chips late at night. But about 20 minutes later, he forgot about that first dose and took another. He spent two days in the hospital, his father said...Now, Bigfoot Biomedical and north suburban-based Abbott Laboratories hope to help prevent such problems — and make life easier for millions of people with diabetes — with a new partnership announced Thursday. The partnership aims to combine several technologies to make it easier for diabetics to monitor their glucose levels and figure out how much insulin to take throughout the day. (Schencker, 7/13)

Get your patient records from Doctors hospital before they are destroyed — that’s the message that went out Tuesday from Contra Costa County Supervisor John Gioia’s office to anyone ever treated at the former Brookside Hospital, which became Doctors Medical Center before it was declared insolvent and closed its doors to patients in April 2015. (Lochner, 7/12)

There’s a downside to the rainy season in Florida: Mosquitoes. Orange County Mosquito Control has seen a tenfold increase to about 100 calls for service every day. The calls are primarily for nuisance mosquitoes, not the mosquitoes that can transmit Zika virus and other diseases. The county urges residents to drain standing water to cut down on mosquito breeding areas. (Aboraya, 7/12)

A new adult-care clinic in Newtown opened this month.  A community-wide partnership aims to make the clinic a ‘one-stop-shop’ for a variety of needs for the community just north of the city of Sarasota, where access to medical care and other services has been a challenge. (Davis, 7/12)

Last fall, California voters approved the biggest increase in cigarette taxes since the state first began levying tobacco in the 1950s. Advocates for Proposition 56, which passed with a fairly overwhelming 64 percent of the vote, argued that a $2-per-pack tax hike would hurt pocketbooks enough to nudge millions of California smokers to quit, or at least to light up less frequently. (Levin, 7/12)

The Missouri Department of Health and Senior Services is working with the Centers for Disease Control and Prevention to study ticks at Meramec State Park. The research, which began in June, aims to understand how ticks spread rare diseases, such as the Bourbon and Heartland viruses. (Chen, 7/12)

SSM Health will acquire two Wisconsin-based systems from the Congregation of Sisters of St. Agnes, the Catholic-sponsored providers announced Wednesday. The systems are Agnesian HealthCare and Monroe Clinic. St. Louis-based SSM Health owns St. Mary's Hospital in Madison, Dean Clinic and hospitals in Baraboo and Janesville. The facilities will likely carry the SSM Health brand. (Kacik, 7/12)

The wave of consolidations among health systems in Wisconsin is set to continue. Agnesian HealthCare, which operates St. Agnes Hospital in Fond du Lac and hospitals in Ripon and Waupun, would become part of SSM Health, which operates St. Mary’s Hospital in Madison and hospitals in Janesville and Baraboo, under a tentative agreement announced Tuesday. (Boulton, 7/12)

A San Rafael lawyer has filed a referendum measure to strike down the Board of Supervisors’ ban on flavored tobacco, which passed unanimously in June. ... The group represents tobacco manufacturers R.J. Reynolds and Altria, as well as several vaping advocacy groups and the Arab American Grocers Association, whose members opposed the supervisors’ ordinance, saying it hurt immigrant business owners. (Swan, 7/12)

Amid a string of high-profile police shootings involving mentally ill people, San Jose officers have joined a national effort to secure federal funding and resources to better train officers who are commonly first-responders to violent mental-health episodes. (Salonga, 7/12)

More than five decades after establishing the first state lottery, New Hampshire is for the first time dedicating a portion of lottery profits toward treatment for gambling addiction. (Ganley and Brindley, 7/13)

As Ohio's fledgling medical marijuana program ramps up, patients, business owners and advocates still have one major concern -- who will test the marijuana? All medical marijuana products must be tested for safety and potency before sale, per state law. But for the first year, testing lab licenses are limited to public colleges. (Borchardt, 7/12)

Former quarterback Troy Smith, a Heisman winner with the Ohio State Buckeyes, has joined forces with former Browns player Eric Metcalf and high school coach Ted Ginn Sr. to secure the rights to a marijuana dispensary in the Cleveland area. (7/12)

Senate Republicans will roll out a revised health-care bill as soon as Thursday, and then begin a final drive to a vote this month. So this is a moment to take stock of some of the larger political dimensions of the ObamaCare debate. Legislative progress has been slower and more difficult than it might have been for a party that ran for seven years on a repeal-and-replace agenda. The benefit is that Senate Republicans are better educated about health-care substance and prepared to make hard governing choices—if they can persuade the remaining Bartlebys. (7/12)

The biggest lie that President Trump and other Republican leaders have been repeating about the Affordable Care Act for years is that it is collapsing, imploding or exploding. The truth is that the law is actually working reasonably well, and even the part that has shown the most weakness — the health insurance marketplaces — has been stabilizing. (7/13)

When he talks about his efforts to repeal the Affordable Care Act, President Trump almost always asserts that Obamacare is “exploding.” Republican members of Congress make similar claims, insisting that Obamacare is unsustainable—and that they therefore have no choice but to “repeal and replace” it. There is some basis for this argument. More than 1,300 counties only have one insurer in their exchanges, meaning there is no competition. But there is a nuance that Republicans willfully ignore: This is a problem of their own creation that is largely confined to red states. (Dean Baker, 7/13)

We are 2 former Administrators of the Medicare and Medicaid programs, under Presidents Barack Obama and George H. W. Bush. Although we represent different political parties, we take pride in the accomplishments of these 2 programs, which collectively help millions of US residents get the health care they need. ... we are calling for Congress to separate reforms to the Medicaid program from the most pressing task at hand—stabilizing and improving the nongroup market. Given the divergent views on appropriate Medicaid changes, we recommend initiating a 12-month bipartisan review process that focuses on long-term reforms to improve care and reduce costs. (Andy Slavitt and Gail Wilensky, 7/11)

Over [the past 37 years], I have provided health care for thousands of children. A large number of those children have been Medicaid recipients. I have seen firsthand the importance of Medicaid to our community. I have seen firsthand the lives this program has saved. That is why I am so disheartened by the attempts of Congress to drastically cut funding to this program. (Dr. Dennis Cooley, 7/12)

Of all the magical thinking that has gone into Republican proposals to replace Obamacare, none has been more fanciful than the argument accompanying efforts to defund Planned Parenthood. The yarn that has been spun is that other health-care providers would easily absorb the patients left adrift if Planned Parenthood could no longer receive Medicaid reimbursements. In truth, there is no way community health-care centers cited by Republicans as an alternative could fill the gap. In truth, millions of women would lose access to critical health care. (7/12)

This odd dictum, from the famous American philosopher Charles Sanders Peirce, that likens us to insurance companies may serve us well as we struggle to find the best path forward in the health insurance debate. ... The usefulness of Peirce’s linkage between a financial concept and our humanity is also representative of how finance can be considerably more humane than usually assumed. (Mihir A. Desai, 7/13)

Frustrated by the ever-escalating opioid crisis, and short of effective strategies to tackle it, states are moving against drugmakers. More than half have joined a bipartisan investigation into whether the companies are to blame for the epidemic, because they marketed their prescription painkillers too aggressively, downplaying the risk of addiction. Some have already filed lawsuits seeking damages. (7/11)

There’s a story behind every firearm used in a crime. For example: How does a gun purchased legally out of state end up at a Lawrence shooting? Together, those stories can help uncover the drivers of gun violence. Do guns used for crimes in certain Boston neighborhoods, for instance, come more often from particular dealers? ... So far, the state has issued one annual report summarizing the data, but no detailed analysis has yet been performed to identify meaningful trends. (7/13)

Imagine you’re heading into surgery for a hip fracture. You might be anxious about how it will go and nervous about starting rehab. You also probably are hungry and thirsty. For decades, patients have been told to fast before surgery. Eight in 10 say their doctors instructed them to, according to a 2017 survey commissioned by my company, Abbott, and conducted by Clarus Research. (Hakim Bouzamondo, 7/12)