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The Trump administration for the first time will require pharmaceutical companies to include the price of prescription drugs in television advertisements if the cost exceeds $35 per month. The move, announced on Wednesday by Alex M. Azar II, the health and human services secretary, is the most visible action the administration has taken so far to address the rising cost of prescription drugs. It has been a key issue for American voters and one that both Republicans and Democrats have vowed to address. (Thrush and Thomas, 5/8)

Health and Human Services Secretary Alex Azar said Wednesday the Trump administration has finalized regulations requiring drug companies to disclose list prices of medications costing more than $35 for a month's supply. "What I say to the companies is if you think the cost of your drug will scare people from buying your drugs, then lower your prices," Azar said. "Transparency for American patients is here." In a tweet, President Donald Trump celebrated the announcement, saying: "Historic transparency for American patients is here. If drug companies are ashamed of those prices lower them!" (Alonso-Zaldivar, 5/8)

Drugmakers have opposed the mandate, saying the rule could improperly limit free speech and that providing only the list price would confuse and mislead consumers who might think they have to pay more than they actually would. The list price is the figure initially set by the drugmaker, but it is different than what consumers generally pay, because it doesn’t take into account rebates, discounts and insurance payments. “While we are still reviewing the administration’s rule, we believe there are operational challenges, particularly the 60-day implementation timeframe, and think the final rule raises First Amendment and statutory concerns,” said Stephen Ubl, president and chief executive of the Pharmaceutical Research and Manufacturers of America, in a written statement. PhRMA is an industry trade group. (Armour, 5/8)

Industry groups have fought this move since it was announced in October. They adopted voluntary rules, that would have directed ad viewers to a website with more detailed cost information. Today, in a statement, the Pharmaceutical Research and Manufacturers of America (PhRMA) wrote that the list price is confusing since that's not what most people pay. The rule addresses that by requiring an additional statement that reads, "If you have health insurance that covers drugs, your cost may be different." PhRMA also said that the rule raises "First Amendment and statutory concerns." Court challenges may be coming. The legal authority given by the White House is based on the laws that require Medicare and Medicaid to be run in a cost-effective manner, according to the rule. (Simmons-Duffin, 5/8)

The trade association said the rule would give patients watching TV the false impression that they’re required to pay the full price and that the ads would deter patients from seeking treatment. The group also said the proposal would violate the First Amendment by compelling commercial speech.(Edney, 5/8)

Azar said Wednesday that drug makers that choose to follow PhRMA’s proposal and only include a link to pricing information would not be complying with the rule. He told STAT that PhRMA’s proposal is “not acceptable.” “They put $4 billion a year into television advertising because the television ad is where people are getting their information, and to point them to the internet would be the equivalent of saying that they should simply be putting their ads on the internet and not running them on TV,” Azar added. (Florko, 5/8)

The CMS is relying on drug companies to effectively regulate each other, a break from how direct-to-consumer ads are currently regulated. The Food and Drug Administration already regulates direct-to-consumer ads and cracks down on companies that fail to list the side effects among other violations. However, HHS decided not to send the rule through FDA but rather through the CMS due to legal reasons. (King, 5/8)

HHS has said they think the rule is on firm legal ground, and Azar said there's no reason patients should be kept in the dark about the full prices of the products they're being sold. "We think it is a fundamental right to know whether that drug they’re being pitched is a $50 or $5,000 drug," Azar said. (Weixel, 5/8)

Sens. Richard J. Durbin, D-Ill., and Charles E. Grassley, R-Iowa, who have sought to pass legislation that would require these types of disclosures, said they would continue their legislative work. "When drug manufacturers flood the airwaves with these ads, our legislation – which passed in the Senate last year – would require common-sense price disclosure," they said in a joint statement. (McIntire and Siddons, 5/8)

The head of the federal Medicare and Medicaid agency said Wednesday in Atlanta that the new White House regulation on pharmaceutical TV ads will bring “much-needed pricing transparency to the market for prescription drugs. ’’The new policy, announced Wednesday, will require companies to disclose prices in TV ads for any drugs that will cost above $35 for a month’s supply or a usual course of therapy. (Miller, 5/8)

The battle over whether to allow state programs and Floridians to have access to prescription drugs imported from Canada has already been waged in the Legislature, but it is now shifting from the halls of Tallahassee to Washington, D.C. One week after state lawmakers gave final approval to create international drug-importation programs, Gov. Ron DeSantis met Monday with President Donald Trump and U.S. Department of Health and Human Services Secretary Alex Azar. Trump during the meeting directed his administration to “explore additional options, including drug importation opportunities, to reduce drug prices in a safe way for Floridians,” according to a White House pool report. (Sexton, 5/8)

Insulin in Canada sells for a fraction — roughly one-tenth — of what it costs in the U.S., and these Minnesotans were determined to see whether they could get a better deal by jumping in a car and crossing the border. So, that’s what they did. On Saturday, six advocates, three reporters, two photographers, and a pair of supportive parents piled into four cars, all emblazoned with hand-painted slogans of “#Insulin4All,” and made the pilgrimage from the Twin Cities to Fort Frances. (Florko, 5/9)

Senator Elizabeth Warren of Massachusetts escalated her criticism of the pharmaceutical industry, announcing she would donate the campaign contributions she has received from the family of the pharmaceutical magnate Raymond Sackler, and calling on Harvard University to remove the Sackler name from all campus buildings where it appears. Ms. Warren, who is running for the Democratic presidential nomination, made the announcement as she unveiled a plan on Wednesday to fight the opioid crisis raging in the United States. (Herndon, 5/8)

Warren's new opioids measure is modeled on a 1990 law passed to help fight the spread of AIDS and would be paid for using her proposed tax on the wealthiest American households. The Massachusetts senator released her new plan Wednesday ahead of a campaign trip to Ohio and West Virginia, where she'll visit a town that sued drug companies. Warren ties the opioid epidemic to the influence of drug companies' "money and power" in America. Drug companies have largely denied that their distribution practices contributed to the nation's rising opioid overdose rate. (Schor, 5/8)

Under her plan, $40 billion dollars would go to states and localities to deal with opioid addiction by prevention, treatment and recovery, according to a summary provided by the Massachusetts senator’s staff. An extra $27 billion would go to the hardest-hit counties and cities. The remaining money would be used for surveillance of public health, biomedical research and training health professionals, delivering services and broadening access to drugs that reverse overdoses. (Kapur, 5/8)

“Real, structural change to address this crisis is going to take new leadership in Washington,” Warren wrote in a Medium post. “Leadership that will hold business executives that cheat and defraud and addict people responsible for their criminal acts.” (Raman, 5/8)

Warren said that the opioid crisis has had a severe impact on “communities of color” and tied attacking the problem to her campaign’s themes of fighting greed and corruption while standing up for average Americans. “The ongoing opioid crisis is about health care. But it’s about more than that,” she wrote in a blog post on the Medium website Wednesday. “It’s about money and power in America - who has it, and who doesn’t. And it’s about who faces accountability in America — and who doesn’t.” (Prignano, 5/8)

US Senator and presidential hopeful Elizabeth Warren on Wednesday called on Harvard University to strip its buildings of the name of the Sackler family, whose company makes the drug OxyContin and faces multiple legal battles over the extent of its role in the national opioid crisis. Harvard has previously faced protests over its ties to the family, though the university has said it would be inappropriate to return donations or remove the name from the Arthur M. Sackler Museum, home of Harvard’s collection of Middle Eastern and Asian art. (Rosen, 5/8)

Ms. Warren, writing in a post on the website Medium—as she often does when announcing policy positions—takes aim at the Sacklers, noting that OxyContin is a powerful opioid painkiller that caused widespread addiction after hitting the U.S. market in 1996. Purdue and other companies are facing more than 1,600 lawsuits from cities, counties and states over their alleged role in sparking the opioid crisis through deceptive and aggressive marketing. The Sacklers have broadly denied the allegations. In 2007, a federal investigation of Purdue led the company and three of its executives to plead guilty in federal court to criminal charges of misleading the public about OxyContin’s addiction risks between 1995 and 2001, and to pay $634.5 million in government penalties and costs to settle civil litigation. (Jamerson, 5/8)

An aide for Warren’s campaign confirmed the plan to offset those donations to The Hill, while a spokesperson for the Sackler family said they "would welcome a genuine dialogue" with Warren on the opioid crisis. (Greenwood, 5/8)

Amid a flurry of new limits on abortion being sought in states around the nation, Alabama is weighing a measure that would go further than all of them — outlawing most abortions almost entirely. The effort in Alabama, where the State Senate could vote as soon as Thursday, is unfolding as Republicans, emboldened by President Trump and the shifting alignment of the Supreme Court, intensify a long-running campaign to curb abortion access. (Williams and Blinder, 5/8)

The House Appropriations Committee on Wednesday voted to block a new Trump administration rule allowing health workers to refuse services that violate their religious beliefs. The measure by Rep. Barbara Lee (D-Calif.) would prevent spending to implement the new rule, which Trump announced last week during a speech before faith leaders. The broad new rule allows health-care providers, insurers and employers to refuse to provide or pay for services that violate their religious or moral beliefs, such as abortion or assisted suicide. (Werner, 5/8)

Senators across the aisle voiced support on Wednesday for the Trump administration's recently announced plan to offer primary-care contracts with physician practices through Medicare fee for service. During a Senate Finance Committee hearing, Sen. Ron Wyden (D-Ore.) said he sees the Center for Medicare and Medicaid Innovation's Primary Care First policy as an opportunity for more chronically ill patients to be cared for in their home. (Luthi, 5/8)

The health insurance industry often attributes lower spending among Medicare Advantage seniors compared with those in traditional Medicare to care-management strategies. But a study published Monday turns that claim on its head. Researchers at the Kaiser Family Foundation found that traditional Medicare beneficiaries who opt to enroll in a Medicare Advantage plan offered by a private health insurer have lower average spending and use fewer services—before they ever switch to Medicare Advantage—than their counterparts who stay in traditional Medicare. (Livingston, 5/7)

Senate Finance Committee Chairman Chuck Grassley (R-Iowa) is working on a bipartisan plan to cap seniors’ expenses for prescription drugs in Medicare as part of a broader effort to lower drug prices. Grassley told The Hill on Wednesday that one idea he is working on with Sen. Ron Wyden (Ore.), the top Democrat on the panel, is “some sort of maximum amount that one person would have to pay” for drugs. (Sullivan, 5/8)

Marsha Cox worries about the well-being of waiters at restaurants and baggers at the grocery store. She wants legislators who stood in the way of Medicaid expansion to look those low-wage, uninsured employees in the eye the next time they eat out or get groceries and explain the willingness to let them get sick and die. Cox, of Topeka, took part in a demonstration Wednesday at the Statehouse to mourn the Legislature’s failure to pass Medicaid expansion before finishing work for the session. (Smith, 5/8)

Wisconsin Republicans planned to scrap expanding Medicaid, legalizing medical marijuana, raising the minimum wage and a host of other priorities of Democratic Gov. Tony Evers on Thursday, as they begin dismantling his two-year budget plan. Evers and Democrats remain defiant, saying the public is on their side in support of expanding Medicaid. They ran on their promise to expand the health program for the poor and believe their victories in 2018 were due in large part to that position. Polls also show broad public support. (5/9)

Iowa’s Medicaid director sought to reassure Iowans Wednesday that UnitedHealthcare’s exit from the giant health-care program would not cause major disruptions. “The first thing I want to emphasize is no one is losing benefits,” Mike Randol told more than 50 Medicaid members in the first of six town hall meetings he’s scheduled around the state. “…There are going to be bumps in the road, but we’re going to do everything we can to make it as seamless as possible.” (Leys, 5/8)

Georgia may be in line to forge a new path in the way the nation funds Medicaid expansion for the poor, potentially putting the state in line for millions of additional dollars from the federal government, a Trump administration official told The Atlanta Journal-Constitution on Wednesday. If it bears out, it’s a victory for Gov. Brian Kemp’s health care plans for the state, and a blow to Democrats who argued against his plan. And it’s just one way in which Georgia’s proposal might serve as a national model for more stringent Medicaid guidelines that the Trump administration favors, according to remarks from the official, Seema Verma. (Hart, 5/8)

At a public hearing on the state budget Tuesday, senators heard testimony in support of increasing funding for public schools and health care workers. Many spoke in support of a bill that would boost state aid for health care programs, address worker shortages, and increase Medicaid reimbursements. Kara Nickulas, executive director of Crotched Mountain Community Care, which helps adults with illnesses and disabilities remain in their homes, testified that keeping people out of nursing homes is often the best, most affordable option, but only when there are enough home health care workers. (Gibson, 5/7)

Insurers selling plans on the Affordable Care Act marketplace are expected to pay consumers $800 million in 2019 as a result of excess premiums, according to a new review of preliminary estimates. The Kaiser Family Foundation on Tuesday released a report that found uncertainty over the future of the ACA's individual health insurance market in 2018 led to spikes in premiums and some of the best annual performances by insurers. (Johnson, 5/8)

The trial of Elizabeth Holmes, the former Theranos chief executive, and Ramesh Balwani, its chief operating officer, is setting up to be the most extensive corporate prosecutions since executives at Enron were tried in 2006. And if the case gets to trial, one intriguing question is how Ms. Holmes and Mr. Balwani will defend themselves. A recent filing by Ms. Holmes, which was joined by Mr. Balwani, who goes by Sunny, outlines a possible defense: put the government on trial by claiming that regulators improperly brought actions against the company for its blood analysis technology. (Henning, 5/8)

Patients are often shocked when their insurance company denies coverage for a procedure or treatment, especially if that leads to a bigger-than-expected bill. These rejections can be fairly common, and people may not put up their best fight to get the decision reversed. Odds are tough, but denials can be resolved with phone calls or a formal appeal, which health care experts see as more of a last resort. Here's a look at the issue. (5/8)

The Justice Department on Tuesday gave companies new guidance to obtain greater leniency in False Claims Act investigations and limit their potential liability. False Claims Act cases in the healthcare industry grew to 506 in 2018 from 291 in 2008, and companies and physicians shelled out $2.5 billion in FCA settlements and judgments in fiscal 2018, making them a potentially costly concern. (King, 5/8)

A STAT examination found that producers for shows created by Education Alliance persistently pitch health care and biotech businesses, as well as startups and established companies in other industries, touting sky-high viewership numbers and implicit celebrity endorsements from the likes of James Earl Jones, Laurence Fishburne, and Rob Lowe, all of whom have hosted such public television segments created by the company. (Thielking, 5/9)

Genetic-testing startups are finding that selling consumers insights on their risk of getting cancer may not be as easy as telling them about their Irish roots. 23andMe Inc. and Ancestry.com LLC have capitalized on the public’s insatiable appetite for discovering their family trees. However, consumers have balked at paying other companies for health analysis of their DNA. ...Helix, which launched in 2015 with $100 million from genome-sequencing giant Illumina Inc., had planned to sell tests directly through an “app store’’ for DNA. Instead, it’s now looking to partner with health-care providers. Illumina said on April 25 that it would no longer hold equity or participate on Helix’s board, ending the partnership. (Brown, 5/8)

Faced with mounting costs, shifting regulations and burdensome billing requirements, physicians have been joining larger hospital systems that promise to handle it all for them. ...Over the past decade, DuPage Medical Group has quietly grown from a few hundred doctors to more than 700 today, its signs sprouting up across the west and southwest suburbs. Much of that growth happened under the leadership of CEO Michael Kasper, who died of undisclosed causes on Saturday at the age 46. The DuPage County coroners’ office has said it will not release a cause of death until toxicology tests are complete. Kasper’s family and DuPage Medical Group have declined to comment. (Schencker, 5/8)

Starting in July, people under the age of 21 will no longer be able to buy tobacco products from Walmart or Sam’s Club stores in the United States. Walmart Inc. announced on Wednesday that it would be raising the minimum age for buying the products on July 1, making it the latest retailer to make changes regarding tobacco sales to minors. Walmart’s move comes after a letter from the Food and Drug Administration last month that requested it to submit a plan to end illegal tobacco sales to minors. (Garcia, 5/8)

“We unequivocally acknowledge that even a single sale of a tobacco product to a minor is one too many, and we take seriously our responsibilities in this regard,” Walmart’s U.S. Chief Ethics and Compliance Officer John Scudder said in the letter. The retailer said it would double down on disciplinary action against employees who fail to verify customers’ ages, including possible termination. Walmart also said it would employ virtual reality technology in its age-verification training to allow employees to train under a variety of possible scenarios on the job. (Axelrod, 5/8)

The lead Democratic sponsor of bipartisan legislation to raise the minimum age to purchase tobacco to 21 called on Senate Majority Leader Mitch McConnell (R-Ky.) on Wednesday to co-sponsor the bill rather than introduce his own. Sen. Brian Schatz (D-Hawaii) said the legislation, which is supported by many major public health groups, is the best way to ensure minors are protected from the harms of tobacco. (Weixel, 5/8)

A brother, sister and niece of Robert F. Kennedy Jr. on Wednesday chastised him for campaigning against vaccines, saying he has been disseminating “dangerous misinformation” that discourages immunization even as measles spreads throughout the United States. They declared that they love him and praised his work to protect the environment. “However, on vaccines he is wrong,” they wrote in a column published in Politico under the headline “RFK Jr. Is Our Brother and Uncle. He’s Tragically Wrong About Vaccines.” (Rabin, 5/8)

On Wednesday, Kennedy’s siblings Kathleen Kennedy Townsend and former congressman Joseph P. Kennedy II (D-Mass.), as well as niece Maeve Kennedy McKean, published an article in Politico Magazine accusing him of being “complicit” in a misinformation campaign. “Robert F. Kennedy Jr. … is part of this campaign to attack the institutions committed to reducing the tragedy of preventable infectious diseases,” they wrote. “He has helped to spread dangerous misinformation over social media and is complicit in sowing distrust of the science behind vaccines.” (Epstein, 5/8)

Robert F. Kennedy Jr., Joseph P. Kennedy II, and Kathleen Kennedy Townsend are all the children of Senator Robert F. Kennedy, who was assassinated in 1968 during a presidential run. In the United States, 22 states are now reporting outbreaks of measles, and more than 700 cases have been reported so far this year, making 2019 likely to be the year with the highest number of measles cases in this country in decades, the op-ed said. It’s a medical problem that can be solved through the use of vaccines, something the op-ed said that members of the Kennedy political clan advocated for while in positions of power in Washington. (Ellement, 5/8)

City officials here are investigating whether a pediatrician illegally gave medical exemptions to parents seeking to not vaccinate their children for school entry, as the U.S. struggles to get control of a growing measles outbreak. A subpoena by City Attorney Dennis Herrera requests the patient records of Dr. Kenneth Stoller, an outspoken opponent of vaccination requirements. The patients’ names were redacted. California is one of three states in which only certain medical exemptions—such as having an allergy to a vaccine or undergoing chemotherapy—can be used to allow a child to attend school without inoculation against measles and other communicable diseases. West Virginia and Mississippi are the others. (Carlton, 5/8)

Some bills are just more trouble than they’re worth for nervous legislators who must worry about voter support. One such bill is a current measure to tighten the requirement that children be vaccinated against contagious diseases — like measles — before being admitted to school for the first time. Kids can be excused from that edict for medical reasons, such as having a weak immune system caused by leukemia. But a few unscrupulous doctors are peddling medical exemptions for phony reasons to parents who obsessively fear vaccinations. Many of these parents get very hostile when lobbying lawmakers and attacking vaccine advocates. (Skelton, 5/9)

The lawyer for a Kentucky high school student who wasn't allowed to participate in school activities because he wasn't vaccinated for chickenpox says his client has now contracted the illness. Attorney Christopher Wiest of Covington told The Kentucky Enquirer that 18-year-old Jerome Kunkel came down with chickenpox last week. Wiest says Kunkel is "fine" and "a little itchy." (5/8)

A Texas state legislator unleashed a vilifying attack on a leading vaccine scientist Tuesday, accusing the doctor of “sorcery.” It started with a report published Monday by the Texas Department of State Health Services that noted the state recorded a 14 percent rise in parents opting out of their children’s vaccinations. It was a new statistic that alarmed Peter Hotez, professor and dean of the National School of Tropical Medicine at Baylor College of Medicine. (Paul, 5/8)

Oregon is the first state in the country to allow dentists to administer vaccines to patients. In a year marked with heated debate about the state’s involvement in boosting vaccination rates, the bill was quietly passed and signed into law with little fanfare. But it sets a new precedent for the role dentistry plays in the health care system. Two other states have laws that allow dentists to give flu shots to adults, but in Oregon, dentists will soon be able to give out any vaccine available at a primary care doctor’s office. (Harbarger, 5/8)

It was three days before the last day of school, and the students inside Ms. Harper’s English classroom were whiling away the last period of the day watching “The Princess Bride” when one of their classmates walked in late and pulled out a gun. “The only thing he said out loud to the students was, ‘Don’t you move,’” said Nui Giasolli, an 18-year-old senior who was in the class at the time. (Turkewitz, Healy and Mazzei, 5/8)

He was a high school senior, set to graduate this week. But instead of celebrating Kendrick Castillo’s graduation, the family of the 18-year-old will be mourning his death. Castillo, a senior at STEM School Highlands Ranch in suburban Denver, was killed in a classroom Tuesday in a shooting that police say was carried out by a pair of his classmates: 18-year-old Devon Erickson and a younger classmate who has not been identified because she is a juvenile. Eight other students were injured. (Schaneman, Svrluga and Balingit, 5/8)

More Florida teachers will be eligible to carry guns in the classroom under a bill Republican Gov. Ron DeSantis signed Wednesday that immediately implements recommendations from a commission formed after a mass shooting at a high school in Parkland. DeSantis signed the bill in private and didn't issue a statement afterward. But he previously made it clear he supports the changes made to the law enacted after a rifle-toting former student walked into Marjory Stoneman Douglas High School and killed 17 people in February 2018. (Farrington, 5/8)

At Sturm Ruger’s annual shareholder meeting in New London, N.H., Wednesday, the gun manufacturer defended its business model and rejected a push to unseat two board members.In recent years Ruger, which is based in Connecticut and employs approximately 1,000 people at a facility in Newport, N.H., has been targeted by so-called activist investors who buy shares in publicly traded companies and then attempt to change internal policies. (Bookman, 5/8)

To scientists like Michael Snyder, chair of the genetics department at Stanford University, the future of medicine is data — lots and lots of data. He and others predict that one day doctors won’t just take your blood pressure and check your temperature. They will scrutinize your genome for risk factors and track tens of thousands of molecules active in your body. (Zimmer, 5/8)

The U.S. is better equipped than in the past to manage health emergencies, but progress slowed last year as regional inequities in preparedness persist, according to new data. The U.S. scored a 6.7 on the 10-point scale of the 2019 National Health Security Preparedness Index. That's a 3.1% boost over the year prior, and a 11.7% increase since the Centers for Disease Control and Prevention launched the index in 2013. At the current pace, it will take a decade to reach a strong health security level of at least 9. (Kacik, 5/8)

For the first time, scientists have used genetically modified viruses to treat a patient fighting an antibiotic-resistant infection. Isabelle Carnell-Holdaway, 17, began the experimental treatment after doctors lost all hope. She was struggling with a life-threatening infection after a lung transplant. With the new treatment, she has not been completely cured. But the Faversham, England, teenager has recovered so much that she has resumed a near-normal life. (Stein, 5/8)

Federal health officials on Wednesday rolled out two new draft guidances about how to study drug safety and efficacy in pregnant and lactating women, the latest in a series of steps to make sure women have the information they need to make medical decisions. The draft documents, released by the Food and Drug Administration, give drug makers insight into the agency’s thinking on when they should study a medicine in lactating women and how they can better monitor outcomes in pregnant women who are taking medications that have already been approved. The documents fall in line with 2018 recommendations made by a federal task force formed by Congress to study the lack of research involving pregnant and lactating women. (Thielking, 5/8)

The jury in Bayer AG’s third Roundup weedkiller trial was urged by a plaintiffs’ lawyer to consider socking the company with $1 billion in damages as punishment for covering up the health risks of the herbicide for decades. The aggressive demand on behalf an elderly couple who claim they got cancer from exposure to Roundup shows that plaintiffs are becoming bolder after winning the first two trials against Bayer, which together yielded $159 million in damages. (Rosenblatt, 5/8)

As the rate of obesity around the world has climbed steadily for decades, public health efforts to combat it have largely focused on people in cities. With growing numbers of people living in cities, the assumption by public health officials was that urbanization — with its sedentary lifestyle and easy access to highly processed foods — was driving much of the weight gain. But a growing body of research suggests that the bigger problem is in rural areas. (Wan, 5/8)

The life expectancy of Americans with diabetes is diverging based on geography, with metropolitan areas seeing improvement in mortality rates while rural areas do not. The result is that “rural America is being left behind” in efforts to reduce deaths caused by diabetes, the study says. “As recently as 1999, rates for diabetes mortality were very similar for urban and rural areas,” says the article published in the Journal of Rural Health. “Over time, however, the gains in urban areas have not diffused to rural areas.” (Marema, 5/9)

White people who are addicted to heroin or other opioids are 35 times more likely to receive treatment with a medication called buprenorphine than are African Americans or other people of color, according to a new study. For every outpatient appointment where a person of color received a prescription for buprenorphine, also known by the brand name Suboxone, white patients had thirty-five appointments, said researchers from the University of Michigan and VA Ann Arbor Healthcare System who analyzed national data from 2012-2015.  (Kovanis, 5/8)

Kaiser Health News: Addiction Medicine Mostly Prescribed To Whites, Even As Opioid Deaths Rose Among Blacks

White drug users addicted to heroin, fentanyl and other opioids have had near-exclusive access to buprenorphine, a drug that curbs the craving for opioids and reduces the chance of a fatal overdose. That’s according to a study out Wednesday from the University of Michigan. It appears in JAMA Psychiatry. Researchers reviewed two national surveys of physician-reported prescriptions. From 2012 to 2015, as overdose deaths surged in many states so did the number of visits during which a doctor or nurse practitioner prescribed buprenorphine, often referred to by the brand name Suboxone. The researchers assessed 13.4 million medical encounters involving the drug but found no increase in prescriptions written for African Americans. (Bebinger, 5/8)

Kaiser Health News: Needle Exchanges Find New Champions Among Republicans

Once repellent to conservative politicians, needle exchanges are now being endorsed and legalized in Republican-controlled states. At least four legislatures have considered bills to allow hypodermic needle exchanges, and two states, Georgia and Idaho, made them legal this year. In each of these states, the House and Senate are controlled by Republicans and the governor is a Republican. Florida, Missouri, Iowa and Arizona have introduced bills this legislative session that would allow needle exchanges in their state. The measures were all sponsored or co-sponsored by Republicans. (Knight, 5/9)

A police officer in Methuen was evaluated at a local hospital Wednesday after he was exposed to fentanyl while booking a prisoner, authorities said. The prisoner, according to police, allegedly ripped open a bag of white powder that had been taped to his groin. The bag had been discovered while he was being booked and processed at the police station, authorities said. (McDonald, 5/8)

Last November, as he rallied support for federal prison reform, President Donald Trump visited Gulfport, Mississippi, touting the legislation and what Mississippi had accomplished. Trump talked about the “fantastic job” that Mississippi Corrections Commissioner Pelicia Hall was doing of turning the state’s prisons into places that train inmates for jobs. The following month, Trump signed the First Step Act, whose goal is to reduce the federal prison population and better prepare offenders for life outside bars. (Mitchell, 5/9)

Juan de León Gutiérrez told his mother he was calling from a warehouse in Mexico, hidden by a human smuggler who had been paid to take the teenager into the United States. “He told me he had something of a headache, perhaps because he was hungry and had not been able to sleep,” said his mother, Tránsito Gutiérrez de León. The 16-year-old died on April 30 after officials at a Texas youth detention facility noticed he was sick, becoming the third Guatemalan child to die in U.S. custody since December. (Merchant and Perez D., 5/9)

The House on Wednesday joined the Senate in passing a bill that invests $18 million over the next two years to reform the state’s mental health services for children. The bill passed in the House on a voice vote Wednesday, cleared the Senate 24-0 in March, and will now be included in budget negotiations between the two chambers in June. Its provisions include an estimated $4.5 million to create a mobile crisis unit for children, with a group of practitioners who can be deployed on short notice for emergency mental health evaluations. (Solomon, 5/8)

The California Department of Education approved controversial changes to the state’s health and sex education framework on Wednesday, but removed five resources and books that some organizations called “sexually explicit,” including a book that explains sex to students as young as kindergarten. Despite large protests, the department unanimously approved new guidelines for elementary school grades about sex trafficking, sexual orientation and how to support transgender and non-conforming students in the classroom. (Morrar, 5/8)

Normally Greg Razer would prefer everyone just ignore the Westboro Baptist Church. But the second-term Democratic state representative from Kansas City — one of only four openly gay members of the Missouri General Assembly — decided to make an exception. Five activists from the Kansas anti-LGBT church, known for their “God Hates Fags” signs, traveled to Jefferson City last week specifically to protest Razer and urge Missouri House Republicans to stand strong against the “sodomite game plan.” (Hancock, 5/8)

Lawmakers approved a bill Wednesday requiring all of the state's public middle and high schools to provide menstrual products in female and gender neutral bathrooms free of charge. The bill was inspired by Rochester high schooler, Caroline Dillon, who said her peers were skipping school because they couldn't afford tampons or pads. (Gibson, 5/8)

For the second time in two weeks, the Texas House moved to change death penalty law. On Wednesday, the chamber tentatively passed a measure that would prohibit handing down a death sentence to someone with a severe mental illness, like schizophrenia or bipolar disorder. House Bill 1936 by state Rep. Toni Rose, D-Dallas, would let capital murder defendants present evidence at trial that they were severely mentally ill at the time of the crime. If the jury agrees, the defendant would be sentenced to life in prison without the possibility of parole if found guilty. (McCullough, 5/8)

The bill, HB 613, handily passed the House of Representatives by a margin of 96-17 on Tuesday, ahead of a legislative deadline that requires bills to clear one chamber or else die for the remainder of the legislative biennium. The Essential Services for Homeless Youth bill would make it easier for kids who are “unaccompanied” by any adults in their lives to more easily receive basic medical care, including physical screening exams so they can play school sports and receive mental health, dental and vision services. (Hoban, 5/9)

California is flooded with money and Gov. Gavin Newsom will outline how he thinks the nation's most populous state should spend it Thursday when he releases a revised version of his $200 billion-plus state budget. The Democratic governor has already proposed new spending to expand health care for young immigrants living in the country illegally, prevent and fight wildfires, spur more housing and boost early child care programs. (5/9)

In the Bronx, a man was choked from behind as an officer frog-marched him to a squad car. In Manhattan, a detective responding to a noise complaint wrapped his arm around a man’s neck and squeezed for 22 seconds. And in Brooklyn, a plainclothes officer pinned an 18-year-old up against a lamp post, his forearm choking off the teenager’s air supply while he was patted down. (Winston, 5/9)

California, one of the nation’s largest agricultural states, announced plans Wednesday to ban the widely used pesticide chlorpyrifos linked to neurological problems in infants and children even as federal regulators have allowed the product to remain on the market. State health officials said their decision came amid growing evidence that the pesticide, which is used on crops such as oranges, grapes and almonds, “causes serious health effects in children and other sensitive populations at lower levels of exposure than previously understood.” California Gov. Gavin Newsom (D) also has proposed $5.7 million to support the transition to “safer, more sustainable alternatives,” according to the California Environmental Protection Agency. (Dennis and Eilperin, 5/8)

The head of a child welfare agency in Missouri that has offices and a school in Independence has been arrested and charged with child endangerment and assault, according to court documents. Vincent D. Hillyer, president and CEO of Great Circle, has been charged in St. Louis County Circuit Court with six felony counts of first-degree child endangerment. Hillyer, 58, of Eureka, Missouri, has also been charged in a second case with one felony count of attempted second-degree child endangerment and a misdemeanor fourth-degree assault. (Cronkleton, 5/8)

The state’s largest health care provider has closed two of its walk-in urgent care clinics, in Burlington and Medford, citing staffing challenges and low patient numbers. Officials at Partners HealthCare described the closures as temporary. They said they expect to reopen the Medford location, but have no immediate plans to reopen the Burlington site. (Dayal McCluskey, 5/8)

Authorities said they are close to bringing criminal charges against staff at a northern Minnesota senior home where residents were allegedly beaten, sexually assaulted and denied vital medical care. The assisted-living facility, Chappy’s Golden Shores in Hill City, had its state license revoked in February following a far-reaching investigation by the Minnesota Department of Health. Since last fall, the agency has released a dozen separate reports alleging serious harm, including physical and sexual abuse, of residents at the now-shuttered facility. (Serres, 5/9)

Biotech firm MiMedx of Marietta, Georgia, had a problem with one of its biggest customers, the U.S. Department of Veterans Affairs. For help, it turned to a friendly senator in Washington, Johnny Isakson. ...It’s now clear those 2013 calls were part of a pattern by the Georgia senator. Over a five-year period, according to federal records, internal MiMedx documents and people familiar with the matter, Isakson personally reached out at least eight times to federal agencies on behalf of the company -- to the VA, the Food and Drug Administration and the Federal Bureau of Investigation. The extent of those efforts, supplemented by his staff, hasn’t been reported previously. (Melin, 5/9)

In the months after the Netflix documentary “The Keepers” aired in 2017, some board members of the University of Maryland St. Joseph Medical Center were so deeply concerned about how the publicity could affect the hospital’s reputation, they tried to oust one of their board colleagues — a high-ranking church official who was portrayed in the series, documents show. The board’s chairman, former state Senator Francis X. Kelly, approached Archbishop William E. Lori for permission to ask Msgr. Richard Woy to resign from the Towson hospital’s board of directors, according to correspondence recently obtained by The Baltimore Sun. (Knezevich, 5/9)

Union complaints over homeless camp cleanup led California’s workplace safety enforcer to fine the state’s transportation department, the department’s union announced Wednesday. The International Union of Operating Engineers filed a complaint with CalOSHA in November as part of broader effort to prod Caltrans into adding protections for workers who clean up human waste, used feminine hygiene products and needles when they clear homeless camps under bridges and along roadways, said Steve Crouch, the union’s director of public employees. (Venteicher, 5/9)

Phil and Michelle John know they have it better than most. Their house was among the 11 percent in Paradise that survived the Camp Fire, and they moved home in early April. Their street is largely intact, and many of their neighbors have returned. Even their cat is recovering, having miraculously turned up, half starved and reeking of smoke, a couple of weeks after the fire. (Kasler and Sabalow, 5/9)

A Cuyahoga County Jail officer was arrested Wednesday at the jail by drug investigators, an official said. County spokeswoman Mary Louise Madigan said the officer was arrested about 1 p.m. at the jail. Cuyahoga County Sheriff’s Narcotics Division deputies made the arrest, Madigan said. (Ferrise, 5/8)

Recent data shows a dramatic rise of confirmed cases of Lyme disease across the United States, including Florida. University of North Florida Researcher Kerry Clark said Tuesday on  First Coast Connect with Melissa Ross that data from Quest Labs shows that the two states with the largest absolute increases of infected patients were California and Florida, both of which have not historically been associated with high rates of Lyme disease. (Latta-Raines, 5/8)

After getting a reprieve from the Legislature, the public Halifax Hospital Medical Center has dropped a legal fight about building a hospital in western Volusia County. Halifax filed a notice Tuesday at the Florida Supreme Court dismissing the case, six days after lawmakers gave final approval to a bill that would clear the way for the new hospital. The issue stems from a decision by Halifax, which is based in Daytona Beach, to build a hospital in Deltona, which is outside the taxing district’s boundaries. (5/8)

Lagers, lobsters, lighthouses — and really good weed? After years of delays, Maine is finally kick-starting the recreational marijuana market called for by voters in 2016. And under proposed regulations recently unveiled by the administration of Governor Janet Mills, Mainers — not outside investors or national cannabis conglomerates — would be the first in line to profit, with residents getting exclusive access to licenses until 2021. (Adams, 5/8)

Ohio may allow patients with autism or who are experiencing anxiety to buy medical marijuana. The State Medical Board of Ohio’s Medical Marijuana Expert Review committee unanimously recommended Wednesday that the two conditions be added to the list of qualifying conditions for medical marijuana. The conditions will now go to a full vote by the State Medical Board on June 12. (Henry, 5/8)

States took steps in 2018 to ban or limit short-term plans and to increase the value of these products. State action aimed to protect consumers from products offering inadequate coverage and misinformation while safeguarding the individual health insurance market. New laws were passed with bipartisan backing and with support from consumer and patient advocates and health insurers. (Palanker, Kona and Curran, 5/2)

Use of commercial direct-to-consumer (DTC) telemedicine outside of the pediatric medical home is increasing among children, and acute respiratory infections (ARIs) are the most commonly diagnosed condition at DTC telemedicine visits. Our objective was to compare the quality of antibiotic prescribing for ARIs among children across 3 settings: DTC telemedicine, urgent care, and the primary care provider (PCP) office. (Ray, 5/1)

The early years of the Affordable Care Act (ACA) exchanges and broader ACA-compliant individual market were marked by volatility. Markets in some parts of the country have remained fragile, with little competition, an insufficient number of healthy enrollees to balance those who are sick, and high premiums as a result. By 2017, however, the individual market generally had begun to stabilize. Absent any policy changes, it is likely insurers would have required only modest premium increases to regain or maintain profitability in 2018. (Cox, Fehr and Levitt, 5/7)

Mounting evidence suggests that faculty in medicine are increasingly unhappy, dissatisfied, and burned out. Although purported to be a national crisis, the actual understanding of the origins, consequences, and effective approaches to prevent and treat burnout remains limited. Academic medical centers have a tripartite mission to provide high-quality clinical care, to advance knowledge through research, and to train the next generation of health care professionals, each in the context of increased financial pressures and administrative burdens. Comprehending what factors are associated with satisfaction at work in academic health care centers is an important step toward addressing faculty burnout. (Simpkin et al, 5/6)

Safe sleep environments can reduce infant suffocation deaths. Increased knowledge about the characteristics of suffocation deaths can help inform prevention strategies by targeting highest-risk groups. (Lambert et al, 5/1)

It’s the paradox of success. With 3.6% unemployment and 3.2% growth in gross domestic product, voters are turning to other issues. When the May 1 NBC/Wall Street Journal survey asked what “should be the top priority for the federal government,” 24% chose health care and 18% said immigration and border security. Job creation and growth came in third, at 14%. While this shouldn’t stop Republicans from selling their economic success, it points to a central challenge for 2020. (Karl Rove, 5/8)

The popular appeal of a single-payer system to solve the nation’s health-care problems is no secret. Everyone would have insurance, recognizing — as Sen. Bernie Sanders (I-Vt.) continually tells us — that health care is “a right, not a privilege.” Our medical expenses would be paid by some central agency, eliminating the wasteful overhead of today’s insurance companies that drives up costs and premiums.Presto, problem solved.Oh, were it that easy. (Robert Samuelson, 5/8)

Like more than 1 million Americans, I live with a chronic illness, a neurologic disorder called Parkinson’s disease. Diagnosed at 48 years old and now 51, I continue to work and have medical insurance that covers most of my medical care costs, including medications. But with each visit to my neurologist comes a reminder that a progressive illness does not get better. Nor does it get less expensive to manage.As we head into the 2020 presidential election, health care will be a leading issue. (Allan Hugh Cole Jr., 5/8)

As the Democratic presidential primary begins to take shape, I’m thrilled by the growing field of talented, capable contenders — any of whom would be a welcome breath of fresh air for the nation after President Trump’s divisive leadership. At times, though, I am also concerned that, in their rush to earn the support of the party’s highly energized primary electorate, some of the best prospective Democratic standard- bearers are embracing positions that would present serious risks when it comes to challenging and defeating Trump in the general election. An area of particular alarm is health care. (Former U.S. Senator Heidi Heitkamp (D-N.D., 5/8)

On Thursday Gov. Gavin Newsom plans to propose a budget for fiscal 2019-20 that includes hundreds of millions of additional dollars to help families with young children keep their heads above water in this expensive state. Among other things, he hopes to double the tax credit for families with children under 6, expand eligibility for the Earned Income Tax Credit and add two more weeks of paid family leave.Many of his proposals would have a meaningful impact on the lives of working families. Too bad Newsom sullied the package with two gimmicky sales tax exemptions — for diapers and menstrual products — that his predecessor wisely vetoed. (5/9)

The Georgia Patients First Act signed into law last month by Gov. Brian Kemp has the potential to put this state on a path that, if done well, could significantly reduce the number of uninsured people here. Given Georgia ranks fifth in the U.S. in its number of people without health insurance, gaining ground here is a worthwhile goal. The Georgia General Assembly and Gov. Kemp are right in recognizing that need. We’re early in the process to determine what waivers of both Medicaid coverage and of stipulations governing private health coverage under state insurance exchanges will look like in Georgia. (5/4)

[Robert F. Kennedy Jr.'s] and others’ work against vaccines is having heartbreaking consequences. The challenge for public health officials right now is that many people are more afraid of the vaccines than the diseases, because they've been lucky enough to have never seen the diseases and their devastating impact. But that’s not luck; it’s the result of concerted vaccination efforts over many years. We don’t need measles outbreaks to remind us of the value of vaccination. (Kathleen Kennedy Townsend, Joseph P. Kennedy II and Maeve Kennedy McKean, 5/8)

Rather than take proactive measures aimed at preventing shootings (such as New Zealand’s swift move to ban assault weapons), the United States operates on the seeming assumption that mass killing is inescapable, so citizens should learn how to best react. “Run, hide and fight” was the message blasted out to the UNC Charlotte campus when a gunman went on a rampage last month. (5/8)

The gifts that Riley Howell and Kendrick Castillo gave to the students they saved can hardly be measured. In photographs Howell and Castillo appear to be just kids. They were men of great courage. (5/8)

Concerns about Donald Trump’s fitness for the office of president arose during the campaign and continue to this day. But now, in the Mueller report, we have an abundance of new evidence that sheds light on these concerns. What makes this a unique opportunity is the quality and relevance of the data: They are derived from multiple sources both friendly and opposed to the president, were obtained under oath, and show us how the president conducted himself in the eyes of those who worked directly with him while in office. While we were concerned enough to put our initial cautions in a public-service book, “The Dangerous Case of Donald Trump,” each additional piece of evidence has substantiated the correctness of that assessment over time. Now, the Mueller report elevates this assessment to new levels. (Bandy X. Lee, Leonard L. Glass and Edwin B. Fisher, 5/9)

Anyone who is active on social media has come to expect a certain degree of tribalism around the issues of the day: guns, climate change, abortion, politics, and the like. We’ve been surprised to see it creep into the online conversation about nutrition science, especially the discussion about low-carbohydrate, high-fat diets. Even more surprising to us is that such advocacy sometimes comes from health professionals, scientists, and journalists, from whom we would normally expect a certain degree of objectivity. These diets aren’t new. (Nicola Guess and Ethan J. Weiss, 5/9)

There are people who do not matter much. That’s a painful truth, starkly at odds with our Jeffersonian creed and national mythology. But it is a truth, nevertheless, one frequently proven in actions if denied in words. In this country, by dint of race, gender, class or status, some people just don’t seem to matter. Apparently, Tammy Jackson is one of them. No other conclusion is possible after reading the May 3 letter her public defender, Howard Finkelstein, sent to Broward County Sheriff Gregory Tony. In it, he decries the “outrageous and inhumane” treatment accorded his client in a Broward lockup. And if anything, the lawyer is guilty of understatement (Leonard Pitts Jr., 5/7)

First, don’t panic. It’s true that a report published late last month in the journal Environmental Health found a link between California tap water and cancer. The study noted high levels of arsenic, plus numerous other contaminants that may be more toxic in combination than they are separately. According to the report, the tainted water could cause more than 200 cases of cancer a year. (5/9)

Reducing the lead poisoning of Cleveland children is urgent. But it cannot, and must not, come down to a new burden heaped on the shoulders of Cleveland. The Lead Safe Cleveland Coalition, a broad public-private partnership, has just presented 33 important policy recommendations to Cleveland. Their proposals are smart and packed with good ideas. (5/8)