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Twenty candidates are sharpening memorable lines and crafting strategies for butting into the conversation as they prepare for a second round of Democratic presidential debates that are expected to be explosive, particularly over topics of race, inequality and criminal justice. Former vice president Joe Biden, having concluded he was not aggressive enough in the first clash in June, has practiced criticizing his rivals on health care and other issues as he prepares for Round 2. (Viser and Sullivan, 7/29)

When 20 Democratic presidential candidates descend on Detroit this week, expect sparring over whether a major U.S. industry should even exist. Health care — particularly the question of whether America should adopt a universal single-payer system or take more modest steps to expand coverage — has towered over every other economic issue early in the 2020 Democratic primary. In the weeks since the first debate in June, two top-tier candidates — former Vice President Joe Biden and Sen. Bernie Sanders — have publicly litigated whether the U.S. should scrap its private insurance industry in order to cut costs. Based on the previous debate, health care isn’t the only economic or business issue likely to emerge on Tuesday and Wednesday in Detroit. (Pramuk, 7/28)

Warren and Sanders are vying for similar voters interested in taking the U.S. in a more boldly progressive direction on everything from income inequality and social justice to health care and student debt. And Warren has been gaining on Sanders in national polls and has even overtaken him on some state surveys. The Sanders camp has been clear that Sanders will not go after Warren, because he sees her as an ally in implementing progressive change. But they are competing for the same job, so at some point, that stance will likely have to change if Sanders continues to stagnate in the polls. (Montanaro, 7/30)

We asked you, Michigan, what matters most in the 2020 presidential election. More than 2,300 of you have answered so far, and here's how you rank the issues ahead of the Democratic debates on Tuesday. [Health care] is your No. 1 issue, with 45% of our informal survey respondents marking it important. We're a diverse state and everyone deserves care, the costs need to be controlled and rural areas need attention, you told us. (7/29)

Kamala Harris released a health care proposal on Monday that sought to bridge the Democratic Party’s disparate factions. Instead, she drew criticism from rivals across the political spectrum. Progressives took issue with the presidential candidate for stopping short of the full-scale health care overhaul embodied by the “Medicare for All” legislation. Her more moderate rivals, meanwhile, said she was trying to have it all without taking a firm position on one of the most animating issues in the primary. The onslaught offered a preview of the Democrat-on-Democrat fighting that will likely unfold over two nights of presidential debates that begin on Tuesday. (Summers, 7/29)

Harris’s rivals argued that in trying to address those concerns while continuing to say she favors Medicare-for-all, she was trying to have it both ways. Sanders campaign manager Faiz Shakir suggested that Harris was claiming the mantle of Medicare-for-all while advocating a far more modest policy. “So continues her gradual backdown from Medicare For All,” Shakir tweeted. “This is why you want a candidate with a lifetime of consistency and a track record on the big issues facing us.” (Janes, 7/29)

Josh Orton, the Sanders campaign's policy director, told CNN, "It's bad policy, bad politics, and compared to Medicare for All it vastly expands the ability for private insurance corporations to profit from overbilling and denying care to vulnerable patients who need it the most." On the role private insurance companies play in Harris' plan, the Sanders campaign's chief of staff Ari Rabin-Havt, told CNN, "It would give a lot of money and a lot of power to private insurance companies over people's health care, and that's not what we believe in." (Grayer and Nobles, 7/29)

Former Vice President Joe Biden’s campaign charged Harris with flip-flopping on her support for Sanders’ Medicare for All bill while still proposing a plan that would "unravel the hard-won Affordable Care Act that the Trump Administration is trying to undo right now.” “This new, have-it-every-which-way approach pushes the extremely challenging implementation of the Medicare for All part of this plan ten years into the future, meaning it would not occur on the watch of even a two-term administration,” said Kate Bedingfield, a Biden deputy campaign manager. “The result? A Bernie Sanders-lite Medicare for All and a refusal to be straight with the American middle class, who would have a large tax increase forced on them with this plan.” (Cadelago, Otterbein and Diamond, 7/29)

Harris’s plan seeks to find the path between the total elimination of private insurance under the Sanders version of Medicare for All, and Biden’s public option plan, which would strengthen the Affordable Care Act and keep employer-sponsored insurance in place. Harris has gone back and forth on whether she would eliminate private insurance. Her new plan would seek to expand coverage while preserving a role for private insurance companies. (Weixel, 7/29)

Her proposal did not have many details about how the transition would work or how it would be financed, but the plan promises not to raise middle-class taxes. Harris's proposal would not tax families making less than $100,000. (Weixel, 7/29)

Harris signaled in mid-July that she was distancing herself from complete support of Sanders’s Medicare-for-all plan — even though she was a co-sponsor of his bill — when she objected to what she called a “middle-class tax hike” embedded in the bill. On July 29, she unveiled her own plan in a post on Medium — a hybrid version that extends the phase-in to a new system from four to 10 years and allows a role for insurance companies (which Sanders’s plan would bar) to participate. For the purposes of this fact check, she also would carve out a big exemption for paying payroll taxes to fund the system. In her Medium post, Harris attacked a proposal by Sanders to levy a 4 percent tax on income above $29,000, saying it “hits the middle class too hard.” But Sanders insists that the middle class will save money on his proposal. So what’s going on here? (Kessler, 7/30)

Jay Inslee is running for president as the climate change candidate. But the two-term Washington governor can credibly claim to have accomplished more than most of his peers on health care, a key issue in the 2020 campaign. He created both the nation’s first public option and universal long-term care benefit — albeit a limited one — has run a successful Obamacare market, and expanded reproductive rights. His administration has also pushed forward a new plan for controlling drug costs, expanded Medicaid coverage to transgender patients and added programs for school children aimed at preventing chronic diseases later in life. (Goldberg, 7/28)

Kaiser Health News: ‘If You Like Your Plan, You Can Keep It.’ Biden’s Invokes Obama’s Troubled Claim.

Joe Biden invoked a risky — and familiar — phrase to sell his health care plan. At an AARP event in Iowa, Biden told voters he would create a government insurance plan to compete with private ones called a public option. It would give consumers, Biden said, another choice. “If you like your employer-based plan, you can keep it,” Biden said July 15. “If you have private insurance, you can keep it.” It was a time warp moment that whipped us back to 2013. (Greenberg, 7/30)

As Democratic hopefuls vie to stand out in a crowded field and appeal to urban voters stressed by rising rents, more candidates are bringing up housing on the campaign trail. Several of them have rolled out plans aimed at tackling problem that’s reaching crisis levels in Boston and other cities. (Logan, 7/29)

It seems a simple enough proposition: Give people the choice to buy into Medicare, the popular federal insurance program for those over 65. Former Vice President Joseph R. Biden Jr. is one of the Democratic presidential contenders who favor this kind of buy-in, often called the public option. They view it as a more gradual, politically pragmatic alternative to the Medicare-for-all proposal championed by Senator Bernie Sanders, which would abolish private health insurance altogether. (Abelson, 7/29)

Americans are eager to hear the Democratic presidential contenders talk about health care at his week's debates on CNN, but they are more mixed in their support for the candidates' proposals. Support for "Medicare for All," Sen. Bernie Sanders' sweeping vision to remake the nation's health insurance system, has slipped to 51%, down from 59% in March, according to a Kaiser Family Foundation poll, released Tuesday. (Luhby, 7/30)

Kaiser Health News: Democrats Favor Building On ACA Over ‘Medicare For All’

Most Democrats and Democratic-leaning independents would prefer to expand the Affordable Care Act rather than replace it with a “Medicare for All” plan, according to a new tracking poll from the Kaiser Family Foundation. The poll, released Tuesday, also examines opinions on a generic government-run “public option” health plan that would be available to all Americans and compete with private insurance. About two-thirds of the public said they support a public option, though more than 6 in 10 Republicans oppose it. (Huetteman, 7/30)

After Kim Lauerman was diagnosed with ovarian cancer, doctors wanted to give her a drug that helps prevent infections and fever during chemotherapy. Her insurer said no. Anthem Blue Cross told Lauerman the drug wasn’t necessary. She eventually got it after an infection landed her in the hospital, but that led to another problem: She ended up missing several chemo sessions. “The insurance has been great until I got to a point that I really needed something for survival,” Lauerman said. (Murphy, 7/29)

The Trump administration on Monday said it would begin forcing hospitals to publicly disclose the discounted prices they negotiate with insurance companies, a requirement intended to help patients shop for better deals on a range of medical services, from hip replacements to CT scans. The plan, issued as a proposed federal rule, would take effect in January, but would likely be challenged in court by an industry that has long held such rates secret. (Abelson and Goodnough, 7/29)

Health insurers and providers have fiercely opposed having to publicly reveal their negotiated prices, which they say would stifle competition. Yet the Trump administration has argued that forcing hospitals to post their prices will allow consumers to make more informed choices about where to get care and in turn help lower their health-care costs. Trump has said he is eager to make health care a central plank of his 2020 reelection bid, as voters consistently cite high costs as one of their top concerns. Trump’s June executive order laid out priorities for the Department of Health and Human Services and other agencies in crafting rules to address secrecy in health-care prices. (Abutaleb, 7/29)

Hospitals that fail to disclose that information could be fined, but the fines would be limited to only $300 a day. Hospitals are already required to publicly post their list prices for services, but in a call with reporters, Centers for Medicare and Medicaid Services Administrator Seema Verma said the proposal would expand that requirement to include gross charges before discounts as well as the insurer-specific negotiated charges for all items and services. (Weixel, 7/29)

Patients would be able to search by hospital and insurance plan, though the information would not have their personal deductible or copay details, so it would not tell them what they would have to pay out of pocket. "We are taking a big step today to ensure that we are empowering patients with the information they need to make informed health care decisions," said Seema Verma, administrator of the Centers for Medicare and Medicaid Services. (Luhby, 7/29)

Hospitals and insurers are certain to fight the proposed rule. These companies have already criticized Trump’s executive order requiring hospitals and insurers to disclose negotiated rates for services, saying transparency could actually increase prices. The effort announced Monday would codify Trump’s order. “Publicly disclosing competitively negotiated, proprietary rates will push prices and premiums higher — not lower — for consumers, patients, and taxpayers,” Matt Eyles, president and CEO of America’s Health Insurance Plans, said in a statement. (LaVito, 7/29)

Industry groups have argued the requirement goes beyond the executive branch’s statutory authority and could backfire by causing prices to rise if hospitals see their competitors are getting higher insurer payments. The White House has lost in court before: A rule requiring drug makers to post list prices in television ads was blocked in June by a federal judge who said the administration overstepped its regulatory authority. Some Republicans praised the administration’s focus. Sen. Lamar Alexander (R., Tenn.) said the proposal complements provisions in legislation he sponsored with Sen. Patty Murray (D., Wash.) to lower health costs. “We will carefully review how the proposed rule and our legislation interact,” he said. (Armour, 7/29)

The CMS would require gross charges and payer-negotiated prices to be posted online in a machine-readable format so that developers could incorporate them in consumer price transparency tools and electronic health records. Publishing prices in a standardized way will allow patients to do an "apples-to-apples comparison" on hospital prices, Verma said. However, the proposal stops short of requiring hospitals to post patient-specific price information that would show patients where they are in meeting their deductibles, for example. (Livingston, Kacik and Luthi, 7/29)

Backlash from the hospital industry was swift. “While we support transparency, today’s proposal misses the mark, exceeds the Administration’s legal authority and should be abandoned,” American Hospital Association President and CEO Rick Pollack said in a statement. America’s Health Insurance Plans also voiced support for the broad concept but opposition to the details, pointing instead to pricing tools that insurers offer their members.  (Clason, 7/29)

President Trump signed legislation on Monday that funds medical claims from victims of the Sept. 11 terrorist attacks for the rest of their lives. The legislation, signed during a ceremony at the White House’s Rose Garden, appropriates funds for all current and future approved claims made through the September 11th Victim Compensation Fund until 2090, at an estimated cost of $10.2 billion over the next 10 years. (Restuccia, 7/29)

Thousands of people have been diagnosed with cancers linked to the toxins in the air near the World Trade Center site, and thousands more have respiratory and other related illnesses. A fund set up to aid sick survivors and the families of those who have died had started to run dry and began cutting payments earlier this year. But shortly after the bill was signed into law Monday, the fund reversed the decision and announced that it now has "sufficient to pay all pending and projected claims without the need for any continued reductions in awards." (Durkin, 7/29)

The $7.4-billion September 11 Victim Compensation Fund was severely depleted, and administrators had recently cut benefit payments by up to 70%. The new legislation authorizes funding through the year 2092, effectively making it permanent. “Today we come together as one nation to support our Sept. 11 heroes and to care for their families … and to renew our eternal vow, never ever forget,” Trump said before signing the bill. (Stokols, 7/29)

Former New York City Mayor Rudy Giuliani, who has served as Trump's personal attorney, was among the lawmakers in the audience. The family of the late Luis Alvarez, a retired NYPD bomb squad detective who testified before Congress to advocate for the extension of the fund, was also in attendance. The President thanked Alvarez's family for his hard work. Trump told the crowd of 9/11 first responders and their families that he was also at Ground Zero in the wake of the terror attacks, though he said he doesn't consider himself a first responder. "I was down there also, but I'm not considering myself a first responder," Trump said. "But I was down there. I spent a lot of time down there with you." (Vazquez, 7/29)

President Trump walked into the Rose Garden on Monday and signed into law a bill that would permanently fund the care of emergency workers who became ill after the Sept. 11, 2001, terrorist attacks. He also revived an old claim that he spent time at ground zero alongside firefighters and police officers. Mr. Trump has a long history of making questionable and provocative statements about what he saw on the day of the attacks and how he reacted, some critical of Muslims. On Monday, surrounded by emergency medical workers who had lost colleagues and friends in the attacks, Mr. Trump sought again to place himself near the center of the recovery effort. (Rogers, 7/29)

U.S. News & World Report, the global authority in hospital rankings, today released the 2019-20 Best Hospitals rankings. The new and revised 30th edition provides a multifaceted assessment on nearly every hospital nationwide that is designed to assist patients and their doctors in making informed decisions about where to seek care. This year, U.S. News updated the methodology in its 12 data-driven specialty rankings. (7/30)

The U.S. News Best Hospitals analysis reviews hospitals' performance in adult and pediatric clinical specialties, procedures and conditions. Scores are based on several factors, including survival, patient safety, nurse staffing and more. Hospitals are ranked nationally in specialties from cancer to urology and rated in common procedures and conditions, such as heart bypass surgery, hip and knee replacement and COPD. Hospitals are also ranked regionally within states and major metro areas. The Best Hospitals Honor Roll recognizes 21 hospitals with outstanding performance across multiple areas of care. The Best Children's Hospital Honor Roll recognizes 10 hospitals with superior pediatric care. (7/30)

The Cleveland Clinic took the fourth-place spot overall in U.S. News & World Report’s Best Hospitals ratings, and earned the top nationwide ranking in cardiology and heart surgery for the 25th consecutive year. “Year after year, for 21 years, we’ve been ranked in the top five. It goes up and down as the methodology changes,” said Dr. Herbert Wiedemann, who was named chief of staff for the Clinic last year. “We’re delighted to be ranked so consistently as one of the top hospitals in the country.” (Christ, 7/30)

Like a student whose test score is disqualified, storied UC Berkeley — among the highest-ranking universities in the nation — has been kicked off the 2019 college rankings by U.S. News & World Report, whose listings are relied on by high school students everywhere to decide where to apply. (Asimov, 7/28)

UC Berkeley, Scripps College, Mars Hill University, the University of North Carolina–Pembroke and Johnson & Wales University all misreported statistics, resulting in their rankings being higher than they should have been, U.S. News said. The five schools have now been moved to an "unranked" category. U.S. News said the schools will keep this "unranked" status until the publication of next year's Best Colleges list, if the schools confirm the accuracy of their data submission. (O'Kane, 7/29)

Looks like Boston Children’s Hospital isn’t the only local medical center that’s tops in the nation this year. US News & World Report today released its annual list of the 20 best hospitals in the United States, and two from Boston made the cut: Massachusetts General Hospital was ranked second overall in the nation, while Brigham and Women’s ranked 13th. The top-rated hospital this year, according to US News, was the Mayo Clinic in Rochester, Minn. (Reiss, 7/30)

Northwestern Memorial Hospital is on a winning streak with U.S. News & World Report, which has again ranked the Chicago hospital as the best in Illinois and, this year, as one of the top 10 in the country. Northwestern was the only Illinois hospital to earn a spot on the publication’s national top 20 list. It is the eighth consecutive year Northwestern has taken the No. 1 spot in Illinois. (Schencker, 7/29)

Vanderbilt University Medical Center is one of the top hospitals nationally in five specialties, and it and a dozen other Tennessee hospitals are "high performing" in several areas, according to a report released Tuesday. Vanderbilt was the only Tennessee hospital to be nationally ranked by number in U.S. News and World Report's 2019-2020 Best Hospitals Rankings. It ranked No. 9 in the nation for nephrology; No. 18 for urology; No. 20 for ear, nose and throat; No. 35 for cardiology and heart surgery; and No. 38 for pulmonology and lung surgery. (Nelson, 7/30)

Three Southwest Florida hospitals have received top scores in the newest hospital rankings by U.S. News & World Report. Lee Memorial Hospital in Lee County and NCH Baker Hospital Downtown in Collier County are jointly ranked 14 among “best hospitals” in Florida, according to the news magazine that has been ranking hospitals for 30 years.Gulf Coast Medical Center in Lee is ranked 21 in Florida out of 40 hospitals ranked, data shows. Lee Memorial and Gulf Coast are owned by the publicly operated Lee Health system. (Freeman, 7/30)

Let’s get right to what most people want to know: Which are the top-ranked hospitals in Pennsylvania and where does their local hospital rank? But be sure to continuing reading to see the two Pennsylvania hospitals ranked among the very best in the United States, and to learn more about what the rankings are based on. (Wenner, 7/30)

A federal judge on Monday blocked Medicaid work requirements in New Hampshire, ruling for a third time that the Trump administration hasn't adequately addressed the potential loss of health coverage for low-income residents. The ruling by U.S. District Judge James E. Boasberg in Washington comes four months after he blocked similar work requirements in Arkansas and Kentucky. (7/29)

The ruling marks the third state for which U.S. District Judge James E. Boasberg has held that federal health officials were “arbitrary and capricious” when they approved the state plans, failing to consider the requirements’ effects on low-income residents who rely on Medicaid for health coverage. Boasberg, of the U.S. District Court for the District of Columbia, blocked New Hampshire’s plan four months after he ruled that Arkansas needed to stop the work requirements it had begun the previous June. At the same time, the judge struck down similar requirements in Kentucky for a second time. (Goldstein, 7/29)

Just as in Kentucky and Arkansas, Boasberg ruled that the Department of Health and Human Services (HHS) failed to take into account how many people subject to the work requirements would lose Medicaid coverage. HHS did not offer its own estimates of coverage loss, nor did it address the many comments projecting that the proposal would lead to a substantial number of residents being taken off the Medicaid rolls, Boasberg ruled. (Weixel, 7/29)

Medicaid beneficiaries who were subject to the state's work requirements were supposed to start reporting their work or volunteer hours in June. New Hampshire was set to start cutting those who didn't comply by August. But earlier this month, state health department Commissioner Jeffrey Meyers told GOP Gov. Christopher Sununu and the legislature in a letter that he would delay the community engagement provisions until the end of September. He cited pragmatic considerations, including the need for IT system updates and testing. (Luthi, 7/29)

Arkansas reported terminating coverage for over 17,000 individuals in 2018 before the work requirements program was shut down in 2019. The Department of Health and Human Services is expected to appeal the ruling, but has not yet released a formal statement. HHS is seeking an appeal of Boasberg’s decisions in both Kentucky and Arkansas. (Raman, 7/29)

Dawn McKinney with New Hampshire Legal Assistance, which served as co-counsel to plaintiffs in the case, reacted to the ruling on Monday afternoon. “This is huge. It’s going to give our clients and thousands of Granite Staters peace of mind,” said McKinney. “I think a lot of people will sleep better tonight knowing that their health insurance isn’t at risk.” (Moon, 7/29)

Gov. Chris Sununu issued a statement Monday calling the decision “disappointing but not surprising given this judge’s past rulings.” “New Hampshire’s work requirement is a key provision of the bi-partisan Medicaid expansion bill that passed with overwhelming support in the legislature,” Sununu said in a statement. “New Hampshire clearly demonstrated that the state was implementing its work requirement responsibly and in a manner that would ensure that no individual would inappropriately lose coverage. A ruling from one federal trial court judge in Washington, D.C. is only the first step in the process, and we are confident that New Hampshire’s work requirement will ultimately be upheld.” (Feely, 7/29)

The Trump administration's rejection of Utah's plan to partially expand Medicaid could send other states back to the drawing board on covering more low-income people under President Barack Obama's signature health care law. The decision is disappointing for leaders in conservative-leaning states who considered Utah's plan a compromise approach, said Matt Salo, executive director of the National Association of Medicaid Directors, on Monday. (7/29)

The Trump administration's rejection Friday of Utah's request for full Affordable Care Act funding for a partial Medicaid expansion likely ends the hopes of leaders in a number of states for a smaller and cheaper coverage program for low-income adults. Idaho and Georgia are two other states that currently are considering partial expansions. There are an estimated 2.5 million uninsured adults in non-expansion states who could qualify for Medicaid nationally through partial expansions, according to the Kaiser Family Foundation. (Meyer, 7/29)

Medicaid expansion advocates are eyeing 2020 wins in red states by taking the issue straight to voters, a strategy that yielded success last year in other Republican-led states. Proponents are petitioning Florida, Missouri and Oklahoma to include ballot measures asking residents if they want to broaden out the federal health care program to cover more low-income adults, many of whom are uninsured. (Hellmann, 7/30)

Ignoring the advice of community physicians and their own medical staff, officials overseeing Minnesota's Medicaid program have limited payments for birth control under certain conditions — one of several decisions that critics describe as missteps that are restricting patient access to critical forms of care. The agency has also been faulted for delaying access to a drug regarded as the gold-standard treatment for opioid addiction and limiting access to cutting-edge drugs for hepatitis C, a disease that is spreading rapidly. (Howatt, 7/29)

A government watchdog agency shined the spotlight on the funding disparities within Medicaid's disproportionate-share hospital program, finding four states' DSH payments exceeded their hospital uncompensated-care costs. The Government Accountability Office report released on Monday illustrated the unevenness of federal DSH spending as California, Illinois, Maryland and Missouri exceeded uncompensated-care costs, but Tennessee's DSH payments represented 0.7% of its Medicaid funding. Maine's payments represented nearly 97% of Medicaid funding. (Luthi, 7/29)

The longtime medical director of Minnesota’s Medicaid program is opening up about problems within the sprawling Department of Human Services, one month after he lost his job. In an open letter to Gov. Tim Walz and state lawmakers Monday, Dr. Jeff Schiff called leaders of the agency’s health care administration “hostile and dismissive” and said they often ignored clinical evidence when making key health care decisions. He called on state leaders to establish a mechanism for ongoing oversight of the agency, which has a nearly $18 billion budget and oversees a range of programs for vulnerable residents. (Faircloth, 7/29)

The government’s employee health plan will tighten its rules for covering prescription opioid painkillers starting this fall, the Trump administration said Monday. The announcement by a senior administration official was part of a White House drug policy briefing. The official spoke on condition of anonymity under the media coverage rules established for the event. The Federal Employee Health Benefits Program is the world’s largest job-based health plan, covering an estimated 9 million people, including workers, retirees and family members. (Alonso-Zaldivar, 7/29)

The CMS on Monday revealed new coverage options that state Medicaid programs can use to help moms and babies affected by opioid use disorder. In two informational bulletins, the agency clarified provisions included in the Support for Patients and Communities Act, a package of legislation signed into law in October to combat the opioid epidemic, that addresses treatment for pregnant and postpartum women with substance use disorder and for babies with neonatal abstinence syndrome. (LIvingston, 7/29)

The roughly 2,000 state and local governments suing the drug industry over the deadly opioid crisis have yet to see any verdicts or reach any big national settlements but are already tussling with each other over how to divide any money they collect. The reason: Some of them want to avoid what happened 20 years ago, when states agreed to a giant settlement with the tobacco industry and used most of the cash on projects that had little to do with smoking’s toll. (Mulvihill, 7/29)

Methamphetamine, an illegal drug that sends the body into overdrive, is surging through the United States. Federal drug data provided exclusively to NPR show seizures of meth by authorities have spiked, rising 142% between 2017 and 2018. "Seizures indicate increasing trafficking in these drugs," says John Eadie, public health coordinator for the federal government's National Emerging Threats Initiative, part of the High Intensity Drug Trafficking Areas program. "So if seizures have more than doubled, it probably means more than double trafficking in methamphetamines. And with that go additional deaths." (Bebinger, 7/29)

St. Louis County is creating a program to provide medication for opioid treatment in the county jail as part of a U.S. Department of Justice initiative that seeks to reduce the number of people overdosing on opioids. As part of the planning initiative, St. Louis County staff will be guided in how to set up a program where inmates and those leaving jail can be prescribed medications like buprenorphine and methadone that are used to treat opioid dependence. (Collins, 7/29)

Two pharmaceutical companies will pay the state of California a total of nearly $70 million to settle allegations that they violated antitrust laws by making agreements to delay generic drugs from entering the market, according to the California attorney general’s office. A third company will be subject to an injunction as part of the settlement. (Masunaga, 7/29)

The settlements with Teva Pharmaceutical, Endo Pharmaceutical and Teikoku Pharma are the largest pay-for-delay settlements received by any state and the only ones to secure injunctive relief for a state against future pay-for-delay agreements, Becerra’s office said. The companies’ actions delayed generic versions of Provigil, a branded narcolepsy drug, from entering the market for nearly six years, and prevented a generic version of the shingles medication, Lidoderm, from entering the market for almost two years, according to the announcement. (Ho, 7/29)

The California settlements also prohibit Teva and Endo from engaging in further "pay-for-delay" agreements for about a decade, Becerra announced. But in a statement, Teva said that these "injunctive provisions" were identical to those included in a February agreement with the FTC. Heather Zoumas-Lubeski, executive director of corporate affairs at Endo, called parts of the attorney general's news release "highly misleading." She distanced her company from Teva's multimillion-dollar payment, saying it "has nothing to do with Endo," and noted that California's settlement with Endo was reached in June. (Azad and Gumbrecht, 7/29)

The settlements come amid increasing scrutiny of steps taken by drug makers to thwart competition in order to maintain profits. In recent years, the Federal Trade Commission and a growing number of lawmakers have cited pay-to-delay deal as a concern. (Silverman, 7/29)

Pfizer, the country’s largest drugmaker, is creating a hybrid new drug company by combining its off-patent branded drug business with the generic pharmaceutical company Mylan. Pfizer’s Upjohn, which sells one-time blockbusters like Viagra and Lipitor that have lost patent protection, will be spun off and then it will combine with Mylan, a $10 billion company. The complex deal, expected to close in the middle of next year, will create a company with estimated 2020 revenue in excess of $19 billion, with sales in more than 165 countries. The name for the new company has yet to be determined. (Johnson, 7/29)

A deal to merge Pfizer Inc. ’s off-patent drugs business with generic drugmaker Mylan NV caps new Pfizer Chief Executive Albert Bourla’s remodeling of one of the world’s biggest pharmaceutical companies. In his nearly eight months at the helm, Mr. Bourla has moved quickly to remake Pfizer into a company focused on patent-protected prescription medicines with the potential for significant sales growth, from a more diversified but slower-growing player. (Hopkins, 7/29)

As more federal and state lawmakers propose bills to allow Americans to import medicines from Canada, several Canadian organizations representing hospitals, pharmacies, distributors, physicians, and patients late last week asked the Canadian health ministry to ensure domestic supplies are not disrupted. The missive was sent just as Sen. Bernie Sanders (I-Vt.) was set to take a highly publicized weekend trip to accompany a caravan of people with diabetes across the board to Canada to purchase lower-cost insulin. (Silverman, 7/29)

What if you could take your birth control pill just once a month? That’s the vision behind the newest effort from Lyndra Therapeutics, which is hoping its slow-release drug delivery technology can help improve adherence rates for pill-based birth control. Oral contraceptives fail more often than some other birth control options, in part because many people struggle to remember to pop a birth control pill at the same time every single day. (Thielking, 7/30)

The Trump administration today proposed continuing a nearly 30 percent pay cut to certain participants in the federal drug discount program, despite a federal judge's ruling against the reductions in previous years. U.S. District Judge Rudolph Contreras has sided twice with major hospital trade groups that challenged similar cuts the administration made in 2018 and 2019. (Roubein, 7/29)

For many years, Gregg Loomis hid the attempts from others. He worried about the effect on his insurance business. He had seen people’s view of him change once they found out. He had lost friends that way. So two days before his trip to Capitol Hill, Loomis sat in his office in a New York City suburb, agonizing over what he might say. How do you explain to total strangers the most painful, private moments of your life — the moments you tried to end it. A suicide prevention group had sent notes to him and other volunteers to prepare for the trip. (Wan, 7/29)

Nurses die by suicide at a significantly higher rate than the general population, according to a recently released study from a team of researchers at UC San Diego. Examining nationwide data on violent deaths from 2014, the only year for which occupation information is included, the team found that suicide rates were nearly 58% higher for female nurses and 41% higher for male nurses. (Sisson, 7/29)

A few years ago, researchers at Harvard and Kaiser Permanente Northern California had an inspired idea: Perhaps they could use the wealth of personal data in electronic health records to identify patients at high risk of getting infected with H.I.V. Doctors could use an algorithm to pinpoint these patients and then steer them to a daily pill to prevent infection, a strategy known as PrEP. (Kolata, 7/30)

Scientists don't know much yet about the long-term effects of "vape juice," the liquid used in e-cigarettes and vaporizers. But researchers analyzing the liquid and the vapor produced when it's heated say some kinds of e-liquids are reacting to form irritating chemicals called acetals while they're sitting on shelves. More than 3 million young people, as well as some adults, use e-cigarettes, according to the Centers for Disease Control and Prevention. Many of them could be inhaling these compounds regularly. And that could be irritating or even damaging to their lungs, Yale and Duke university researchers suggest. (Neilson, 7/30)

For many women, sex after menopause is not as satisfying as it used to be. But is menopause entirely to blame? New research suggests that the hormonal changes that come with menopause are only part of the reason a woman’s sex life declines with age. It’s true that many women experience symptoms after menopause, including vaginal dryness, painful intercourse and loss of desire — all of which can affect the frequency and pleasure of sex. (Parker-Pope, 7/30)

Some of the genetic factors linked to anorexia nervosa are also associated with metabolism, suggesting that there may be a biological explanation for why patients with the eating disorder lose weight so rapidly and struggle to keep weight on. The new discovery was part of the largest genome-wide association study of the disease ever done. The study, published July 15 in the journal Nature Genetics, found eight genetic regions linked to anorexia. (Reddy, 7/29)

Kaiser Health News: In The Battle Of The Fitness Trackers, The Most Steps Might Not Win

When Sonia Anderson got her first Fitbit step tracker, her poor pooch, Bronx, had no idea of all the steps that were coming. The device — which counts every step Anderson takes and displays those steps on an app — was a Christmas gift from her daughters two years ago. At the time, Bronx, a Yorkshire terrier, was younger and could still manage the additional walks up and down the trails along the sprawling apartment complex in Alexandria, Va., where Anderson lives. Anderson was on a mission to clock 10,000 steps a day. (Horovitz, 7/30)

A woman’s habit of keeping her contact lenses in while swimming and showering had serious consequences: She developed a rare eye infection that left her legally blind in one eye, according to a new report of the case. The 41-year-old woman, who lives in the United Kingdom, went to the eye doctor after experiencing blurry vision, eye pain and sensitivity to light in her left eye for two months, according to the report, which was published this month in the New England Journal of Medicine. (Rettner, 7/30)

CBD is a molecule found in cannabis. It is similar to tetrahydrocannabinol (THC), but doesn’t produce a high. The claims about this drug are promising: It reduces anxiety, it relieves insomnia and pain, and it can help with ailments like Crohn’s disease and fibromyalgia. These promises could be true, but the science isn’t there yet. (Lillie and Davis, 7/29)

After swimming one day at the Chelsea Recreation Center in New York, Allison Goldstein noticed that the walls in the shower were starting to buckle inward. “It looked like a giant air bubble was pushing out of the wall,” the Jersey City resident said. “Over time, the section where the wall met the ceiling started to peel back, and lo and behold, there was some delicious-looking brown and black sludge back there.” (Douglas, 7/29)

Florida's Republican attorney general is trying to scuttle a proposed constitutional amendment that would ban the type of rifle used in last year's Parkland school shooting, a move that comes as the state's gun control debate intensifies heading into 2020. Attorney General Ashley Moody asked the state Supreme Court on Friday to block the ballot initiative, which is being pushed by Miami-based Ban Assault Weapons Now, a group that wants to ban most semiautomatic rifles. The group has gathered more than 99,000 certified signatures so far, enough to trigger an automatic legal review of the amendment by the state's highest court. (Fineout, 7/29)

The gunman in the Gilroy Garlic Festival shooting used a military-style semiautomatic rifle that is illegal to own in California, although authorities have not yet publicly identified the specific type of weapon, according to officials Monday. Authorities initially said the weapon used was the WASR-10, a Romanian-built weapon that looks like an AK-47 and is considered an assault rifle under California law and therefore banned. (Winton and McGreevy, 7/29)

Schools in the United States have become more prepared for mass shootings over the last two decades, and that has meant learning how to talk with kids about active shooters and “bad guys” on campus. While the incidence of on-campus shootings is extremely low, they’re something many teachers and parents have prepared for. (Sung, 7/29)

More state abortion laws were enacted this year than at any time since 1973, the year the U.S. Supreme Court decided in Roe v. Wade that women have a constitutional right to end their pregnancy. Many of the new laws — either banning or protecting the right to abortion — came in reaction to President Donald Trump’s second nomination of a conservative justice to the high court, creating the possibility that the historic abortion rights decision could be overturned. (Vestal, 7/30)

Five years ago, New York City’s long-troubled adult home industry appeared to be facing a slow, painful death — a fate it had earned after four scandal-ridden decades of housing mentally ill residents for profit. The homes were once envisioned as an alternative to the state’s notoriously inhumane psychiatric hospitals. But in 2002, The New York Times exposed how they had become flophouses, rife with neglect, exploitation and despair. Residents threw themselves from rooftops and died of heatstroke in rooms that lacked air conditioning. (Sapien, 7/30)

The number of children dying while under the state’s watch has fallen to its lowest level in the past five years, according to new data from the Baker administration, but child advocates say the information raises as many questions as it answers. The new numbers — released in response to a request from the Globe after three deaths — show 34 children died in the past fiscal year, from July 2018 through June, down from 48 the previous year, and 52 in 2015. (Lazar, 7/29)

The Massachusetts House suddenly appears poised this week to pass a multi-pronged children's health bill, which includes provisions addressing behavioral health, the pediatric health workforce and insurance coverage for young people aging out of foster care. Speaker Robert DeLeo outlined the legislation Monday morning at a briefing with representatives involved in crafting it. (Lannan, 7/29)

Massachusetts House leaders plan to unveil legislation this week to help families navigate health care services and ensure that all children, including those in state custody, have access to services they need. The legislation would require health insurance companies to maintain accurate lists of all the providers in their networks, and to update their online directories at least monthly. (Dayal McCluskey and Lazar, 7/29)

The nonprofit All Hands and Hearts arrived here in January 2018, to fix roofs in the rural town where Hurricane Maria made its first, most damaging landfall. "We kept an open-door policy," partnership manager Nicole Franks said at the group's makeshift compound in an old schoolhouse. "We said: 'If you need help, come put your name on our list.'" (7/29)

An outbreak of Legionnaires’ disease in Atlanta has been linked to a Sheraton hotel downtown, and officials said dozens of people had likely been infected. The Georgia Department of Public Health said Monday that in addition to 11 confirmed cases of people who contracted the disease, 55 more cases were “probable.” There have been no reported deaths but some people have been hospitalized, a spokeswoman said. (Fortin, 7/29)

Newly released state figures on Legionnaires’ cases linked to an Atlanta hotel suggest that the outbreak could become among the biggest in U.S. history. The Georgia Department of Public Health said that in addition to the 11 confirmed Legionnaires’ disease cases, there are 55 “probable’’ cases. (Miller, 7/29)

The chemical company eventually entered a consent order with the state, agreeing in February of this year to pay $12 million in fines and to keep GenX out of the river, air and groundwater. It’s been a far different story in Pittsboro, where researchers have identified and documented contamination in the town’s drinking water for decades, but there’s been little done about it and almost no outcry. (Barnes, 730)

Rat bites were once a significant enough public health threat to prompt Johns Hopkins research on the spread of polio and rabies. In a study published in the Journal of American Medicine in 1947, Dr. Curt P. Richter called rat bites “a hitherto overlooked means of transmission of such diseases.” The study found that 65 people were treated at Johns Hopkins Hospital for rat bites from 1939 to 1943. But the prominent journal's editors noted that the health effects were likely no greater in Baltimore than in any other city, or even on farms. (Reed and Dance, 7/30)

Within three months, three patients came to Grady Memorial Hospital with similar, devastating eye injuries. And the circumstances of their accidents were strikingly similar. ...This cluster of 2017 injuries led Grady eye surgeon Dr. Yousuf Khalifa to study the problem as a potential safety issue. “These particular cases got me wondering if shattering sideview mirrors were causing injuries on a large scale,” he said. (Miller, 7/29)

Kansas legalized CBD, the cannabis extract cannabidiol, last summer. Since then, the state that came late to this multi-billion dollar industry has seen the number of CBD vendors skyrocket. Spas and massage parlors don’t want to miss their piece of an ever-expanding pie. Last month, Dillons supermarkets rolled out non-edible CBD offerings — balms, lotions and the like — in its Kansas grocery stores with pharmacies. But as Americans turn to CBD in search of help for everything from migraines to insomnia to cancer, scientists and regulators worry that some companies market unproven health claims, and that others sell products with inaccurate labels. (Llopis-Jepsen, 7/29)

An update to DHS Rule 144 would add the meningitis vaccine to the list of required vaccinations for students entering the seventh grade. The proposal says this requirement will "ease the burden on families, providers and schools" by ensuring vaccines are administered at the same visit and the same grade level. (Andrea, 7/29)

Nearly a month after spring water from a Haverhill company was found tainted with toxic chemicals, its gallon-sized jugs are still stocked on supermarket shelves across New England, despite a health advisory from state health officials that pregnant women, nursing mothers, and infants should not consume the water. Last month, as officials in New Hampshire were completing new standards to reduce exposure to per- and polyfluoroalkyl chemicals, part of a national push to tighten their regulation, they decided to conduct a random sampling of bottled water sold at supermarkets in the state, something rarely done. (Abel, 7/29)

The woman at the center of Attorney General William Tong’s lawsuit accusing a Watertown therapy company of Medicaid overbilling said Monday she has no plans to resign from the state’s Medicaid oversight committee. (Carlesso, 7/29)

Months before Texas district attorneys started dropping or delaying low-level marijuana cases, state lawmakers were told that a well-liked bill to legalize hemp was going to complicate pot prosecutions. The warnings fell flat. (McCullough, 7/30)

The legal marijuana business is a market that people of color have had trouble breaking into. Just 4% of licensed cannabis companies nationwide are African American owned and operated. For people of color, there are a lot of unique barriers to entry — from a lack of generational wealth and connections, to past history with what’s been an illegal drug. (Ruff, 7/30)

A Mentor podiatrist was sentenced Monday to 33 months in federal prison for defrauding Medicare and Medicaid by submitting claims worth more than $1.1 million for treatment he provided, even though he was prohibited from doing so. Dr. Robert Rosenstein executed a scheme through Community Foot & Ankle of Mentor to get money for claims submitted to both programs, according to charging documents filed in March. (Heisig, 7/29)

Sen. Kamala Harris (D-Calif.), an aspirant for the presidential nomination, jumped with both feet into the healthcare reform pool Monday with a proposal to cover all Americans via an expansion of Medicare. Harris’ plan is effectively a series of tweaks to Sen. Bernie Sanders’ “Medicare for all” proposal, which she earlier had endorsed. More on that in a moment. The tweaks are important, in part because they may simplify the political messaging to build support for universal healthcare. And in this electoral season, political messaging is the ball game. (Michael Hiltzik, 7/29)

Sen. Kamala Harris on Monday unveiled her own healthcare plan intended to free her up from being attached to the Sen. Bernie Sanders plan she has endorsed. But the new plan would still eliminate people's current private insurance plans that cover about 180 million people.In addition, her plan would raise taxes on employers that will inevitably fall on the middle class, as well as put a strain on the healthcare system that will lead to trade-offs of higher costs and reduced access to care. And she has no realistic plan to pay for it all. (Philip Klein, 7/29)

Are you looking for some Democratic infighting over relatively modest disagreements in health-care policy? Well, today is your lucky day. Sen. Kamala D. Harris (D-Calif.) has now unveiled her health-care plan, and after some uncertain answers to questions about what place private insurance would have in her vision, she has put together something that seems to take a path between Bernie Sanders’s fully single-payer idea and Joe Biden’s plan. (Paul Waldman, 7/29)

While Florida’s Senate has twice passed Medicaid expansion bills, the state House of Representatives has blocked it. Worse, this year they passed into law a measure that will make it even harder to achieve Medicaid expansion through a ballot initiative. When voters are given a chance to decide, expansion has been approved — even in conservative states such as Idaho, Utah and Nebraska. Most Americans intrinsically understand that illness and injury can strike anyone at any time and believe that healthcare is a human right, regardless of age or status. (Miriam Harmatz, 7/29)

Congress is broken. Except, in increasingly rare cases, when it isn’t. See, for example, a surprisingly calm and reasonable movement on Capitol Hill to eliminate surprise medical billing, a symptom of the nation’s unwieldy health-care system that saddles people with massive, unexpected financial debts stemming from the care they receive. Too many Americans have been there. They carefully choose hospitals or clinics that are inside their insurance networks, expecting to minimize their out-of-pocket costs. (7/29)

To truly address gun violence, we need to view it through a public health lens — one that reframes the issue as a preventable disease that can be cured with the help of all community members.This disease-control approach to gun violence is an effective one. Cure Violence, for example, a Chicago-based NGO, uses a public health perspective to help cities around the world reduce their gun violence levels. Under its model, outbreaks of violent behavior are responded to with three common epidemic-control methods: interrupting transmission, containing the risk and changing community norms. Cities that have applied these methods have seen as much as 73% drops in shootings and killings. (Michelle A. Williams and Mary T. Bassett, 7/29)

Put “Gilroy Garlic Festival” into Google and limit the search to anything on or before Saturday, July 26. You’ll discover a popular, three-day event, that draws “tens of thousands” of people to a small Northern California city that likes to think of itself as "the garlic capital of the world." There are garlic-flavored snacks, including garlic scampi and garlic calamari. In fact, there are all sorts of “great garlicky food” served at something called “Gourmet Alley.” There’s country music and celebrities, and children under the age of 9 don’t need to pay an admission. (Helaine Olen, 7/29)

It’s illegal to pay for a human kidney, but it’s perfectly fine to beg for one. So if you’ve driven through Alabama, Indiana, South Carolina, Manhattan or Los Angeles recently, you may have seen billboards taken out by patients urging passers-by to part with their kidneys. Hundreds more patients seek living donors online; others search abroad (often with grim results). There just aren’t enough organs to go around. For every 1,000 Americans who pledge to donate their kidneys after death, only three die in a way that permits a transplant. That frees up about 14,000 kidneys a year — about one for every seven people on the 90,000-strong transplant waiting list. The longer they wait — five years, on average — the sicker they get. Every day, some 13 people die waiting. (7/29)

At the National Latina Institute for Reproductive Health we encourage our Latinx community — many of whom are immigrants — to embrace their power and fight for access to health care in their communities. But for many of the people we work with, fulfilling their basic human right to health care is not easy. The Trump administration seemingly tries every opportunity to scapegoat, brutalize and instill fear in our immigrant communities — the challenge to access health care is greater than ever. (Jessica Gonzalez-Rojas, 7/29)

When the Human Genome Project began in 1990, bioethicists feared that giving people the results of genetic tests would do them a lot more harm than good. Experts feared that individuals who received genetic information about their future health status would be overwhelmed by depression or anxiety. Or as genetic testing became more widely available, it would increase the stigmatization of people with genetic variants. Others worried that people would turn into genetic essentialists and determinists, seeing themselves and others as nothing more than their genes, helpless to alter their behavior or shape their future. (Erik Parents and Paul S. Appelbaum, 7/30)

Every time a little girl or a young female student has asked me if she can be a surgeon, I wonder if I’m about to sell her a lie. The answer, of course, is yes, she can — I’m living proof. After all, I finished my specialty training to become one of the minuscule 5 percent of heart and lung surgeons who are female. But while I think women can do anything, the problem is that the people who think otherwise are often the ones in power with the ability to make or break you. This information is never divulged to young hopefuls. (Nikki Stamp, 7/29)

In Texas and most other states, there are no explicit state-level laws protecting LGBTQ people from discrimination like this. That lack of protection leaves people vulnerable to anti-LGBTQ harassment and mistreatment, on top of the other challenges they may already face, including racism, mental health issues and tenuous familial ties, to name a few. (Cece Cox, 7/29)