�Թϲ�����

President Donald Trump is sending Congress a $4.1 trillion spending plan that relies on faster economic growth and steep cuts in a range of support programs for low-income individuals to balance the government’s books over the next decade. (Taylor and Crutsinger, 5/23)

President Trump on Tuesday will propose cutting federal spending by $3.6 trillion over 10 years, a historic budget contraction that would severely ratchet back spending across dozens of programs and could completely reshape government assistance to the poor. The White House’s $4.094 trillion budget request for fiscal 2018 calls for cuts that hit Medicaid, food assistance and other anti-poverty programs. It would cut funding for the Children’s Health Insurance Program (CHIP), which provides benefits to the poor, by roughly 20 percent next year. (Paletta and Costa, 5/22)

Among the reductions, the president’s budget proposes $250 billion in saving over a decade through the repeal and replacement of the Affordable Care Act, President Barack Obama’s signature legislative policy. Those savings would come largely through reductions to Medicaid, the federal-state health insurance program for low-income people. Other unspecified reforms to Medicaid and the federal Children’s Health Insurance Program would shave another $616 billion from government spending through 2027. (Nicholas, Davidson and Timiraos, 5/22)

Over the next decade, it calls for slashing more than $800 billion from Medicaid, the federal health program for the poor, while slicing $192 billion from nutritional assistance and $272 billion over all from welfare programs. And domestic programs outside of military and homeland security whose budgets are determined annually by Congress would also take a hit, their funding falling by $57 billion, or 10.6 percent. The plan would cut by more than $72 billion the disability benefits upon which millions of Americans rely. It would eliminate loan programs that subsidize college education for the poor and those who take jobs in government or nonprofit organizations. (Davis, 5/22)

The proposal would transition the joint federal-state program from a traditional entitlement to either a block grant or per capita cap. It would also allow states to impose work requirements for certain Medicaid beneficiaries. “This proposal will free States to advance solutions that best serve their unique populations — for example, encouraging work, promoting personal responsibility, and meeting the spectrum of diverse needs of their Medicaid populations,” the budget document said. (Weixel, Roubein and Hellmann, 5/22)

Making low-income Americans work to qualify for so-called welfare programs is a key theme of the budget. “If you are on food stamps and you are able bodied, we need you to go to work,” said budget director Mick Mulvaney during a White House briefing on Monday. He said the strengthened requirements in the budget focuses on putting the 6.8 million unemployed or underemployed Americans back to work. “There is a dignity to work,” he said, “and there’s a necessity to work to help the country succeed.” (Dewey and Jan, 5/22)

Taken together, the cuts represent a significant reordering of the social safety net, away from poor families and toward older Americans, regardless of income. Medicare would be untouched, and the main function of Social Security — retirement income — would flow unimpeded. (Alcindor, 5/22)

The budget to be released Tuesday will show that the annual federal deficit, which was $585 billion in the fiscal year that ended Sept. 30, will steadily decline until fiscal year 2027, when the nation will have a $16-billion surplus — the first since the start of the George W. Bush administration, though small in the context of what by then would be a nearly $6-trillion budget. (Bennett, 5/22)

[E]ven if Congress goes along with the budget the president will send to Capitol Hill on Tuesday — which is unlikely — it requires rosy economic assumptions to work. (Groppe, 5/22)

Trump’s budget, like any other proposed by a president in recent years, is more of a statement of his priorities and policy beliefs than a document expected to approved as-is by Congress. The legislative branch is certain to come up with far different proposals through the appropriations process of horse-trading and House-Senate compromise. (Spangler, 5/22)

The budget proposes to extend funding for CHIP for two additional years through fiscal 2019. It calls for eliminating an extra 23 percentage point increase in the federal matching rate that the health care law had provided to states. It also would cap the matching rate so that states that want to expand the program would no longer get federal funds for kids in families with income that is more than 250 percent of the federal poverty level. “These provisions would return the focus of CHIP to the most vulnerable and low-income children,” says the budget. Some state officials in both parties are likely to oppose the reductions in CHIP funding. (Young, 5/22)

“This budget sort of sits on top of what is done in the AHCA, which is to cut Medicaid by a large amount, cut the Affordable Care Act subsidies by another $300 billion and provide a big tax break for corporations and wealthy people,” said Judith Solomon, vice president for health policy at the liberal Center on Budget and Policy Priorities. “It’s taking from the poor to confer benefits on the rich. . . . So it’s Robin Hood in reverse,” Solomon said. (Pugh, 5/22)

The budget proposal underscores the wide gulf between campaigning and governing, even for a president who promised to rewrite the presidential rule book. (Restuccia, Nussbaum and Ferris, 5/22)

That proposal assumes that the American Health Care Act — passed by the House earlier this month — will become law. That’s far from a sure thing, given big questions about the Senate’s plans for health care reform. But if Medicaid is going to be slashed, it’s worth taking a look at exactly how the program spends its money now. After all, Medicaid accounts for $1 out of every $6 spent on health care in the US. But there are major differences in what that spending looks like on a state-by-state level. And certain services cost Medicaid far more than others. (Thielking, 5/22)

President Trump's 2018 budget request to Congress seeks massive cuts in spending on health programs, including medical research, disease prevention programs and health insurance for children of the working poor. The National Cancer Institute would be hit with a $1 billion cut compared to its 2017 budget. The National Heart, Lung and Blood Institute would see a $575 million cut, and the National Institute of Allergy and Infectious Diseases would see a reduction of $838 million. The administration would cut the overall National Institutes of Health budget from $31.8 billion to $26 billion. (Achenbach and Sun, 5/22)

Many of the NIH cuts in the proposed budget would come from a reduction in how much grant money is given for costs that are not directly related to research. Historically, the NIH has spent around 30 percent of its grant money on these so-called "indirect costs," which include administrative overhead, facility repair and security. The Trump administration seems to want to decrease how much is spent in this area and argues that it would make it simple for research institutes to apply for the funds. (Siddons, 5/22)

President Donald Trump has repeatedly excoriated pharmaceutical companies for high drug costs, but the policy and spending plans in his administration’s 2018 health budget contain almost no major proposals that would impact the industry’s pricing practices. On the campaign trail and after taking office, Trump repeatedly criticized the drug industry. He said drugmakers were “getting away with murder” and said he’d have the U.S. government make the industry bid for government business, a dramatic proposition to cut prices that sent biotechnology and drug stocks spiraling downward on more than one occasion. (Edney, 5/22)

President Donald Trump’s 2018 budget proposed for the Food and Drug Administration puts the administration on a collision course with some in its own party in Congress over possible cuts in funding for the agency, according to FDA and congressional officials. The Trump plan calls for reductions in taxpayer funding of reviews of drugs and other medical products, as well as monitoring of food safety and medical-product safety, said staffers at the FDA and on Capitol Hill. Under the Trump plan, the cuts would be offset by an increase in user fees paid by the drug and medical-device industries to the agency for new-product reviews. (Burton, 5/22)

On Tuesday, President Donald Trump is expected to release a draft budget that proposes cutting more than $800 billion from Medicaid over 10 years. The cuts mirror changes to Medicaid proposed in the American Health Care Act passed by the House earlier this month. (Dickson, 5/22)

The Trump administration asked a federal appeals court on Monday to delay ruling on a lawsuit that could determine whether the government will continue paying subsidies under the Affordable Care Act to health insurance companies for the benefit of low-income people — effectively prolonging uncertainty that is already rattling the health law. The request could further destabilize insurance markets as insurers are developing rates and deciding whether to participate in 2018. (Pear, 5/22)

The two-paragraph filing said that both parties “continue to discuss measures that would obviate the need” for the court to rule — a reference to Republicans’ efforts to abolish most of the ACA and install more conservative health-care policies. ... The cost-sharing subsidies are one of two major types of assistance the law provides to most people who buy private health plans through the marketplaces. The cost-sharing subsidies, focused on lower-income ACA customers, reach nearly 6 in 10 such people. The other assistance helps cover insurance premiums for more than 8 in 10. (Goldstein, 5/22)

The Trump administration could still decide to drop the appeal at any time. According to a spokeswoman for the Department of Health and Human Services, the subsidies have been paid for May, but there have been no promises made about whether the payments will continue. (Wexiel, 5/22)

Insurers say they must know within weeks whether the federal payments will continue next year, since they face a June 21 deadline for deciding whether to participate in the exchanges in 2018. “It’s critical that we have certainty for 2018,” said Justine Handelman, senior vice president at the Blue Cross Blue Shield Association. “Plans are deep in their decision-making for 2018, and if there’s not certainty, you could see a significant impact on premiums, up to 20%, to account for the fact that those cost-sharing payments aren’t there.” (Armour and Radnofsky, 5/22)

"We need swift action and long-term certainty on this critical program,” said Cathryn Donaldson, a spokeswoman for America’s Health Insurance Plans, the industry lobbying group. “It is the single most destabilizing factor in the individual market, and millions of Americans could soon feel the impact of fewer choices, higher costs, and reduced access to care.” (Mershon, 5/22)

Uncertainty over the future of health care is growing deeper for millions of Americans who buy their own policies. While insurers released a blueprint Monday for stabilizing wobbly markets, the Trump administration is leaving in limbo billions of dollars in federal subsidy payments. ... a major insurer group released a framework for market stability that relies in part on a continuation of subsidies. The BlueCross BlueShield Association represents plans that are the backbone of insurance markets under the Affordable Care Act, or ACA, and would also be the mainstay with a Republican approach. (Alonso-Zaldivar, 5/22)

The dispute began in 2014 when House Republicans sued the Obama administration, saying the payments couldn’t be made without Congress’s approval. House Republicans won the case in district court, and the Obama administration appealed. The Trump administration has threatened to drop the appeal. Attorneys general from New York, California, 13 more states and the District of Columbia last week asked the appellate court for permission to intervene in defense of the payments, interruption of which “would directly subvert the ACA, injuring states, consumers and the entire health-care system,” they said then. (Edney, Tracer and Harris, 5/22)

Some Republicans, such as Sens. Bill Cassidy (R-La.) and Lamar Alexander (R-Tenn.), have said Republicans may need to fund the subsidies in order to maintain a stable insurance marketplace while they work to overhaul the ACA. But President Donald Trump has suggested he could end the payments at any time. (McIntire, 5/22)

Republicans in Washington may not be the only ones who can resolve the ambiguity around who is authorized to fund the CSRs. If states were allowed to intervene in the lawsuit—and 15 states asked to do so last week—that could change the outcome. University of Michigan law professor Nicholas Bagley wrote an analysis Monday that states are betting that the appellate court would disagree with the lower court's finding that the House of Representatives had standing to sue. (Lee, 5/22)

With concerns rising over the future of financial aid for low-income Americans who rely on Obamacare, senior congressional Democrats have asked the Trump administration for information on talks in which health insurance officials say a senior administration official linked the aid to the industry’s support for House Republican legislation to roll back the healthcare law. (Levey, 5/22)

Top Democrats are demanding answers from the Trump administration about whether a top healthcare official offered insurance companies a quid pro quo to get their support for the GOP’s ObamaCare repeal bill. Centers for Medicare & Medicaid Services Administrator Seema Verma sought political support from insurance companies for the American Health Care Act (AHCA) by offering a deal to continue funding congressionally mandated cost-sharing reduction (CSR) payments, the Los Angeles Times reported. (Weixel, 5/22)

Senate Republicans are showing early divisions over what to do about ObamaCare's protections for people with pre-existing conditions. Some conservatives, including Sen. Mike Lee (R-Utah), want to simply repeal those provisions and other ObamaCare regulations and leave them up to the states. But advocates of a more centrist approach, like Sen. Bill Cassidy (R-La.), are speaking out in favor of pre-existing condition protections and endorsing a "Jimmy Kimmel test" for the bill, where no one can be denied coverage.  (Sullivan, 5/23)

Republican senators working to craft their own bill to replace the Affordable Care Act are looking at possibly phasing out the requirement that Americans buy health insurance instead of ending it abruptly. Sen. Lamar Alexander, who chairs the committee that oversees health care issues, said Monday a “two-step” process for ending the insurance mandate and other provisions is something that senators have been discussing. (Collins and Whetstone, 5/22)

Two conservative groups are seeking to influence the Senate’s healthcare bill with a list of recommendations aimed at keeping the bill to the right. Americans for Prosperity and Freedom Partners detailed their requests in a letter sent Monday to Senate Majority Leader Mitch McConnell (R-Ky.), who has convened a working group of senators to examine what ObamaCare repeal-and-replace bill can pass the chamber. (Roubein, 5/22)

The American Health Care Act that recently passed the House would fundamentally change the individual insurance market, and it could significantly alter coverage for people who get coverage through their employers too. The bill would allow states to opt out of some of the requirements of the Affordable Care Act, including no longer requiring plans sold on the individual market to cover 10 “essential health benefits,” such as hospitalization, drugs and maternity care. (Andrews, 5/23)

House Republicans on Wednesday plan to start work on three Obamacare replacement bills they’re hoping to pass with bipartisan support, sources familiar with the matter said. These bills are part of the so-called third bucket of the GOP repeal and replace strategy — legislation that doesn't fit the fast-track budget reconciliation procedure being used to get Obamacare repeal through the Senate, but which further advances the Republican vision of reshaping health care. (Haberkorn and Everett, 5/22)

The number of Americans without health insurance has fallen drastically in recent years, according to new data from the National Center for Health Statistics. In 2016, there were 28.6 million Americans without health insurance, down from more than 48 million in 2010. Some 12.4 percent of adults aged 18 to 24 were uninsured, 69.2 percent were covered by private plans and 20 percent had public coverage. (Bakalar, 5/22)

An outside GOP group aligned with Speaker Paul Ryan (R-Wis.) unveiled a $2 million TV ad blitz on Tuesday defending the legislation to replace ObamaCare ahead of the highly anticipated Congressional Budget Office analysis of its effects. American Action Network’s ad will run in 21 House districts and nationally on MSNBC’s “Morning Joe” to tout the GOP’s bill, known as the American Health Care Act. (Marcos, 5/23)

A conservative advocacy group will run television ads thanking six California Republicans for voting for the GOP bill to roll back the Affordable Care Act. All 14 Republicans in California's congressional delegation voted for the bill, called the Affordable Health Care Act, when it passed the House without Democratic support last month. Democrats have pledged to make it a campaign issue. (Wire, 5/22)

Montana’s one and only seat in the House of Representatives is up for grabs, and in the final weekend before Thursday’s special election, the underdog Democrat was hammering the Republican health care bill in TV ads. The ads open with Democrat Rob Quist asking, “Did you know half of all Montanans have a preexisting condition?” He then attacks Republican challenger Greg Gianforte for supporting the House-passed American Health Care Act, which would allow states to drop preexisting conditions protections. (Whitney, 5/23)

A California bill that would eliminate health insurance companies and provide government-funded health coverage for everyone in the state would cost $400 billion and require significant tax increases, legislative analysts said Monday. Much of the cost would be offset by existing state, federal and private spending on health coverage, the analysis found, but total health care costs would increase by an estimated $50 billion to $100 billion a year. That's a massive sum in a state where the entire general fund budget is $125 billion. (5/22)

A proposed single-payer health system in California would cost about $400 billion annually, with up to half of that money coming from a new payroll tax on workers and employers, according to a state analysis. The report by the state Senate Appropriations Committee, issued Monday, put a price tag for the first time on legislation that would make the state responsible for providing health coverage to all 39 million Californians. The state-run system would supplant existing employer health insurance in California, as well as coverage through public programs such as Medicaid and Medicare. (Terhune, 5/23)

The price tag is in: It would cost $400 billion to remake California’s health insurance marketplace and create a publicly funded universal heath care system, according to a state financial analysis released Monday. California would have to find an additional $200 billion per year, including in new tax revenues, to create a so-called “single-payer” system, the analysis by the Senate Appropriations Committee found. (Hart, 5/22)

It would cost the state of California an estimated $400 billion per year to cover all of its 39 million residents, according to a staff analysis by the state’s Senate Appropriation Committee. That’s more than twice the state’s total annual budget of $180 billion. But the main legislative advocate for single-payer, Senator Ricardo Lara (D-Bell Gardens), explained the state could get access to half of that amount, $200 billion, by shifting over what it already spends on Medicare, Medi-Cal and other state-run health services. (Feibel, 5/22)

California’s universal health care bill could cost the state about $400 billion a year. Half of that could be covered by existing federal, state and local funding streams, but additional taxes would be required to make up the balance, according to a state committee fiscal analysis released Monday. While the bill’s financing has yet be worked out, the Senate appropriations committee’s report provides the first insight into what an audacious overhaul of the state’s health system could cost. It concluded that $200 billion would be needed in new taxes. (Colliver, 5/22)

The annual price tag for California’s proposed universal, single-payer health care system would come to a staggering $400 billion and possibly trigger substantial tax increases, according to a state review released Monday. That eye-popping number means the cost of Senate Bill 562, known as The Healthy California Act, would be three times higher than the state’s proposed $124 billion general fund budget for next year. (Seipel, 5/22)

Creating a single-payer health care system in California would cost $400 billion a year — including $200 billion in new tax revenue, according to an analysis of legislation released Monday by the Senate Appropriations Committee. The projected cost far surpasses the annual state budget of $180 billion, and skeptics of the bill say the price tag is “a nonstarter.” (Ho, 5/22)

Gov. Chris Sununu and the state’s top insurance official on Monday backed a revision in state law that would allow officials to waive some of the provisions of Obamacare — including provisions addressing pre-existing conditions. In a joint statement, Sununu and New Hampshire Insurance Commissioner Roger Sevigny endorsed an amendment to House Bill 469, which they said would authorize Sevigny to seek federal waivers if they would keep insurance affordable and available in the state. On Sunday, the New Hampshire Sunday News reported about a document that details a potential premium increase of 44 percent next year on the Obamacare Exchange. (Hayward, 5/23)

Granite State conservative groups weighed in Monday on a report in the New Hampshire Sunday News that health insurance policies through the Affordable Care Act could see high rate increases in the coming year. “The latest premium increases under Obamacare will break many families’ budgets. The law is obviously failing working people and is doing far more harm than good. Republicans in Congress are actively working to reform our nation’s healthcare system with a plan that lowers premiums while ensuring folks have access to quality coverage,” said New Hampshire Republican State Committee Chairman Jeanie Forrester. (5/22)

In interviews Trump gave in the 1980s and 1990s (with Tom Brokaw, David Letterman, Oprah Winfrey, Charlie Rose, and others), he spoke articulately, used sophisticated vocabulary, inserted dependent clauses into his sentences without losing his train of thought, and strung together sentences into a polished paragraph, which — and this is no mean feat — would have scanned just fine in print. This was so even when reporters asked tough questions about, for instance, his divorce, his brush with bankruptcy, and why he doesn’t build housing for working-class Americans. ... Now, Trump’s vocabulary is simpler. He repeats himself over and over, and lurches from one subject to an unrelated one. (Begley, 5/23)

Just one glass of wine or other alcoholic drink a day significantly raises the risk of breast cancer, while vigorous exercise such as running and bicycling reduces it, according to an expansive review of research on the effects of diet, nutrition and physical activity on the disease. The report, which was issued Tuesday, concluded that drinking the equivalent of one small glass of wine, beer or other alcohol a day — about 10 grams of alcohol — is linked to an increased cancer risk of 5 percent for pre-menopausal women and 9 percent for post-menopausal women. A standard drink has 14 grams of alcohol. (McGinley, 5/23)

A day in the sun often means slathering on sunscreen to stave off sunburns — but it can be a guessing game as to when SPF coverage is starting to dwindle. Now, scientists are working to develop a stick-on patch that can tell wearers when they’ve had too much time in the sun. ... The new sensor is a smart material sandwiched between two thin layers of silicone. The smart material contains a small molecule that splits in half in response to UV. That reaction causes the patch to turn orange, letting the user know when it’s time to reapply sunscreen or head indoors. The researchers can also tune the response rate — making it turn orange faster — to tailor the patches for people who are more UV sensitive. (Thielking, 5/23)

Remarks by a top U.S. health official have reignited a quarrel in the world of addiction and recovery: Does treating opioid addiction with medication save lives? Or does it trade one addiction for another? Health Secretary Tom Price’s recent comments — one replying to a reporter’s question, the other in a newspaper op-ed — waver between two strongly held views. Medication-assisted treatment, known as MAT, is backed by doctors. Yet it still has skeptics, especially among supporters of 12-step programs like Narcotics Anonymous, because it involves opioid-based medications. (Johnson, 5/22)

Giving new moms face-to-face education about safe sleep practices — and providing them with a cardboard "baby box" where their newborns can sleep right when they get home — reduces the incidence of bed sharing, a significant risk factor for SIDS and other unexpected sleep-related deaths, a study from Temple University in Philadelphia has found. (Pao, 5/22)

A Temple University Hospital initiative that coupled “baby boxes” – portable cardboard bassinets – with personalized safe sleep instruction cut down on the hazardous practice of parents and infants sleeping in the same bed, according to study results released Monday. Temple researchers found the hospital’s SAFE-T program – Sleep Awareness Family Education at Temple – reduced the rate of bed sharing in the first eight days of life by 25 percent. (Giordano, 5/22)

In a significant advance in the study of mental ability, a team of European and American scientists announced on Monday that they had identified 52 genes linked to intelligence in nearly 80,000 people. These genes do not determine intelligence, however. Their combined influence is minuscule, the researchers said, suggesting that thousands more are likely to be involved and still await discovery. Just as important, intelligence is profoundly shaped by the environment. (Zimmer, 5/22)

More than 3,200 transgender surgeries, from “facial and body contouring” to actual “gender reassignment,” were performed in the United States last year, the American Society of Plastic Surgeons said Monday in releasing the first such numbers ever reported. The 2016 total, reflecting a rapid evolution of public attitudes and health coverage, represented a 19 percent increase from the previous year, the data show. (Nutt, 5/22)

Nearly 18 percent — or about 1 in 5 students between ninth and 12th grades — had thought about attempting suicide over a 12-month period, according to the Centers for Disease Control and Prevention. Moreover, 14.6 percent of students nationwide had a plan detailing how they would kill themselves... Unlike adults, children may not admit to feeling depressed. Rather, they may be irritable, angry, have physical complaints or behavior changes. (Saltz and Furst, 5/22)

The Bay Area Air Quality Management District is to be commended for promoting climate-friendly diets and discouraging the consumption of meat as part of its plan to lighten our ecological footprint. Our animal-based food system is one of the greatest contributors to climate change, and it demands our attention. (Baur, 5/22)

Mental health disorders during medical residency are more like the rule than the exception. One study found that 26 percent of graduates were depressed during their following medical internships. That was the experience of Dr. Elisabeth Poorman, a primary care physician in Everett. (Chakrabarti, Goldberg and Mitchell, 5/22)

A group of St. Louis Catholics filed a lawsuit against the city Monday over a local ordinance that prohibits discrimination based on "reproductive health decisions," saying the law could force employers or landlords to go against their religious beliefs. The law, enacted in February, bars employers from hiring or firing people based on whether they have had an abortion, get pregnant outside of marriage, or use contraceptives or artificial insemination. Landlords also can't refuse to rent to someone based on those criteria. (Salter, 5/22)

The Archdiocese of St. Louis and the city are in a legal showdown over new provisions in St. Louis' anti-discrimination law regarding women's reproductive decisions. The archdiocese's schools and a private company, O'Brien Industrial Holdings, on Monday in federal court filed a lawsuit challenging a St. Louis ordinance that they say adds abortion rights supporters to a protected class, while discriminating those who are against abortions. (Pratt, 5/22)

Eric Seiff says his mother begged his father to end her life throughout the two years she suffered from breast cancer before dying in 1955. Mr. Seiff told himself at the time he would never prolong his death. Mr. Seiff, an 84-year-old lawyer, is among those plaintiffs arguing that doctors should have the right to prescribe a fatal dosage of medication, in most cases barbiturates, to mentally competent terminally ill people. Their case against the state is scheduled to be heard May 30 in the New York Court of Appeals in Albany, the state’s highest court. (Kanno-Youngs, 5/22)

UMass Memorial Medical Center, responding to sharp criticism from mental health advocates and the state, has revised its plan to close 13 psychiatric beds in Worcester and transfer patients to other Central Massachusetts hospitals. Worcester’s largest hospital submitted the updated plan late last week in response to officials at the state Department of Public Health, who said they were deeply concerned that the hospital’s original proposal would curtail patients’ access to services. (Dayal McCluskey, 5/22)

The Virginia Health Care Foundation has announced a new $1.5 million behavioral health program that is designed to increase access to mental health care for uninsured Virginians and those with little to no access to medical care... The foundation is a public-private partnership that helps uninsured Virginians and those who live in areas without robust medical, dental and mental health services. (Kleiner, 5/22)

Texans who take in abused and neglected children who are related to them could soon have access to monthly payments to help them pay for items like beds, food and clothes. State senators voted unanimously on Monday to approve House Bill 4, which would increase the amount of money given to relative caregivers. (Evans, 5/22)

The state’s largest healthcare workers’ union launched a new online ad Monday to protest the latest layoffs ordered by Gov. Dannel P. Malloy. The governor, who warned unions recently that he might have to order as many as 4,200 layoffs if concessions are not granted, has issued 113 pink slips in recent weeks. (Phaneuf, 5/22)

Last summer’s wave of local transmission of the Zika virus hasn’t yet bled into 2017 , but officials from Key West to West Palm Beach are gearing up for another round of mosquito control by creating new staff positions, adding more equipment and increasing outreach efforts. In 2016, Florida saw more than 250 cases of locally transmitted Zika, the mosquito-borne virus spread by the Aedes aegypti mosquito that can cause fevers, rashes and joint pain. (Stein, 5/22)

One person has died of botulism after eating nacho cheese sauce from a Walnut Grove gas station, California health officials confirmed Monday. The man was one of 10 people who fell ill with the rare form of food poisoning in recent weeks after eating food purchased at Valley Oak Food and Fuel. (Caiola and Chang, 5/22)

Centura Health’s chief executive will step down Sept. 1 after leading the Centennial-based healthcare network for nine years. Gary Campbell, the longest tenured CEO in Centura’s history, will be succeeded by chief operating officer Peter Banko, officials announced Monday. “Centura Health has been truly blessed with Gary’s visionary leadership,” Centura Health board chairwoman Patricia Webb said in a statement. “His faithful commitment to our ministry and efforts to transform the delivery of health care have allowed us to optimize health value across our region and meet the needs of consumers.” (Rusch, 5/23)

A bill moving through the Legislature in the last week of the session is pitting doctors against hospitals over how much testing doctors should have to undergo to maintain their certification... Senate Bill 1148 would ban the Texas Medical Board from using the MOC as a requirement for physicians to obtain or renew their medical license. (Mansoor, 5/23)

The owner and operator of the Fulton Rest Home, an independent living facility for men with disabilities in Berkeley, told residents last month they had 60 days to clear out... A private operator of a residential care facility can close the business and evict the tenants with only a 30-day notice, according to Disability Rights California, an advocacy group that runs a website listing tenant rights for people in care homes. (Taylor Jr., 5/22)

The St. Charles Board of Education voted Monday night to keep a sex education curriculum tied to an anti-abortion group, breaking with recent decisions by a few other St. Louis-area public school districts. Best Choice “is not a program to get rid of,” board member Leslie Knight before the panel's unanimous vote to keep the curriculum. (Delaney, 5/23)

That vomit- and diarrhea-inducing illness spreading through schools has reached more than 2,800 people in Yolo County as of Monday and could linger on campuses through the end of the academic year, health officials say... Kristin Weivoda, emergency medical services administrator for the county, said the spread of norovirus will be difficult to overcome before school is out because of the ease of transmission among children. (Kalb, 5/22)

While the rest of the country has been transfixed by Trumpian chaos, members of the Senate have spent the last two weeks talking about taking health insurance from millions of Americans. There is an alarmingly large chance that they’ll decide to do so. But if they do, they will almost certainly rely on a political sleight of hand to disguise their bill’s damage. Understanding that sleight of hand — and calling attention to it — offers the best hope for defeating the bill. (David Leonhardt, 5/23)

If you’ve been a regular reader of The Apothecary, you know that the key flaw in the American Health Care Act—the House Republican bill to replace Obamacare—is that the tax credits it offers to the uninsured will price low-income near-elderly workers out of the market. The problem is that Ryancare’s tax credits are, for the most part, unadjusted for income; a couple making $150,000 gets the same level of assistance as someone making $13,000. This flat credit ends up being especially problematic for older individuals, because their underlying premiums are much higher than those for younger people. (Avik Roy, 5/23)

Wondering what the country’s health-care system would look like under Trumpcare? Take a gander at Iowa, where the individual market is on the verge of collapse. Just one insurer remains in most of the state, and that insurer, Medica, is threatening to exit. Republicans love to point to Iowa’s struggles as evidence of Obamacare’s failures. But in reality, the Hawkeye State has functioned as a petri dish for the GOP’s health plan. The state’s problems provide useful lessons for what could go wrong if Trumpcare becomes law nationwide. (Catherine Rampell, 5/22)

There is strong bipartisan support in Congress for cutting the corporate tax rate to improve competitiveness. ... But what is really holding back the international competitiveness of American businesses isn’t so much the tax code as our health system. The United States is unique among major countries in that health insurance for the working population is provided almost entirely by employers. (Bruce Bartlett, 5/23)

If ever there was a time for careful, sober, data-driven policy analysis, that time is now. The nation has a president whose claims are a word cloud of superlatives, assertions that frequently bear little resemblance to reality. Add a Republican House so eager to advance a right-wing agenda that inconvenient truths and deficit worries are easily brushed aside, and the potential for long-term health care and fiscal harm is very real. (5/23)

Improving and reforming our health care delivery system is not a partisan issue. The need to improve health care delivery models, as a means for ensuring better patient outcomes and a more efficient health care system, enjoys broader consensus than elements surrounding health insurance coverage and financing. It is important for Congress, the Trump administration, and the health care industry to continue bipartisan efforts to shift our health care delivery system and provider payment models toward value-based care. (Alice M. Rivlin and Sheila Burke, 5/18)

Many political leaders who support the U.S. House of Representatives’ or whatever U.S. Senate version emerges of a new health care bill will proudly identify themselves as Christian, pro-life and pro-family. What puzzles me is how these leaders reconcile their personal values and commitments with embracing a plan that limits or excludes poor people, as well as persons with pre-existing conditions. (Allan Hugh Cole Jr., 5/22)

As policy makers grapple with potentially undoing or modifying the largest expansion of health insurance in a generation, the cost and generosity of benefits hold center stage. Traditional underpinnings of insurance plans—premiums, deductibles, copayments, and coinsurance—frequently create barriers to the optimal use of these plans by consumers. They also can exacerbate inequities in health care, by inhibiting the use of services known to benefit health. Novel approaches to insurance plan design to produce a more equitable and efficient distribution of health care expenditures are warranted. (Betsy Q. Cliff, Michael Rozier and A. Mark Fendrick, 5/22)

If President Trump’s 2018 budget, to be unveiled on Tuesday, was worthy of praise, you can bet Mr. Trump would be in Washington to bask in it. But his overseas trip keeps him at a distance physically, if not politically. As detailed in a preview on Monday by Mick Mulvaney, the White House budget director, the budget is a naked appeal to far-right Republicans aiming for a partisan rallying cry, even as a legislative victory most likely remains out of reach. Of 13 major initiatives in the budget, nine are drastic spending cuts, mostly aimed at low-income Americans. The biggest of those, by far, is an $866 billion reduction over 10 years in health care spending, mostly from Medicaid. (5/23)

President Trump released a proposal for fiscal year 2018 discretionary spending — the “skinny budget” — two months ago, and the $1.1 trillion plan garnered deservedly poor reviews. In a nutshell, Mr. Trump would have gutted the Environmental Protection Agency, the National Institutes of Health and similarly crucial domestic agencies to fund a big boost in defense spending and border security. On Tuesday the White House releases its ideas for the remaining $3 trillion or so in federal spending, including large-scale entitlements such as Medicaid, and the early indications are that the priorities embodied in this sequel will be no more humane or rational. (5/22)

This Tuesday, the president will release his Fiscal Year 2018 budget request. The title on the cover reads “A New Foundation for American Greatness.” But it’s what’s inside that’s more important. What people will see there is something that has been missing from Washington for a long time: “A Taxpayer First Budget.” ... For years, we’ve focused on how we can help Americans receive taxpayer-funded assistance. Under President Trump’s leadership, we’re now looking at how we can respect both those who require assistance and the taxpayers who fund that support. For the first time in a long time, we’re putting taxpayers first. (Budget director Mick Mulvaney, 5/22)

So, with two partial exceptions, the President’s budget cannot be viewed as anything other than the standard issue, highly partisan, thoroughly uncompromising budgets we’ve seen from Republicans since the rise of Paul D. Ryan. The purpose of these budgets, which even Ryan himself has characterized as more “visionary” than realistic, is to shrink government outside of defense and give the savings to their wealthy donors in the form of regressive tax cuts. Their ultimate targets are Social Security, Medicare, and Medicaid, and with this budget, we can see that strategy evolving. (Jared Bernstein, 5/22)

We pointed out back in March that Trump budget direct Mick Mulvaney displayed an alarming ignorance about Social Security disability benefits during an appearance on the CBS program “Face the Nation.” Now it turns out that there was method to his muttering. In effect, Mulvaney was telegraphing that the Trump White House was planning to cut disability benefits sharply. Axios reported Sunday that the Trump budget due out Tuesday will include $1.7 trillion in cuts to major social insurance and assistance programs, including food stamps, the Children’s Health Insurance Program, and Social Security disability. (Michael Hiltzik, 5/22)

On top of everything else, the Trump 2018 budget and OMB Director Mulvaney's first testimony about it, which is currently scheduled for Wednesday before the House Budget Committee, is virtually certain to get much less attention because the Congressional Budget Office is now expected to release its estimates of the impact of the House-passed American Health Care Act that same day ... and those numbers are very likely to be devastating. ... CBO's new AHCA numbers took on dramatically increased importance last week when the Republican leadership let it be known that the House might have to vote on the bill a second time because, as reported, it might not satisfy all of the Senate's Byrd rule requirements. (Stan Collender, 5/21)

Just before launching his presidential campaign, Donald Trump promised that if elected, he would not cut funding for Medicaid. Chalk that up to yet another campaign promise reneged on. Trump’s budget proposal calls for more than $800 billion in cuts. ... But even more is at stake than the lives of poor and disabled Americans, something the architects of these plans don’t seem to care much about. The cuts would jeopardize the entire health care system. (Robert I. Field, 5/23)

Trump, who once vowed “no cuts” to Medicaid, would now cut Medicaid by more than $800 billion, denying support to 10 million people. He lops a total of $1.7 trillion off that and similar programs, including food stamps, school lunches and Habitat for Humanity. Mulvaney, defending the budget Monday, made a frank admission: “This is, I think, the first time in a long time an administration has written a budget through the eyes of people who actually are paying the taxes. Too often in Washington I think we often think only on the recipient side.” (Dana Milbank, 5/22)

Watching your weight while grabbing a bite at your favorite chain restaurant, supermarket food bar or convenience store was supposed to get easier under a 2010 federal law requiring that certain businesses post calorie counts. This isn't rocket science. But after seven years, the final posting rules are still on hold, and this month the Trump administration delayed compliance again. If the newest date — May 7, 2018 — holds, it will have taken nearly as long to post calorie counts as it did to put a man on the moon after President Kennedy announced this ambitious goal in 1961. (5/22)

America’s pizza delivery companies want a reasonable 21st century solution to the nutrition labeling challenge: We simply want approval to put the information where our customers look for it. At Domino’s, we’ve been posting nutritional information on our website for nearly 14 years because it’s the easiest way to provide the information to our customers where they will most likely see it. Unfortunately, the menu labeling rule as written does not make accommodations for brands whose majority of orders come from people who order online. The rule seems better suited to sit-down chains and fast-food joints. (Tim McIntyre, 5/22)

A provision in the [North Carolina] Senate’s budget proposal, spearheaded by Sen. Ralph Hise, would rein in frequently-exploited loopholes in the state’s food stamps and Medicaid systems, bringing overdue protection to valuable resources for families who need them most and protecting the system from abuse. North Carolina’s current broad-based eligibility expansion in food stamps has been ripe for reform since 2010 when former Gov. Bev Perdue took advantage of a loophole that expanded welfare eligibility beyond the federal limits. (Josh Archambault, 5/22)

Many American children consume more than half of their fruit as juice, and the American Academy of Pediatrics has issued new guidelines clarifying its stance on that substitution: For most kids, it’s a bad thing. The new guidelines aren’t just intended to persuade pediatricians to talk to parents about the disadvantages of the ubiquitous juice box. They also take aim at the federal government’s Dietary Guidelines for Americans, which are the basis for the nutritional guidelines in the Department of Agriculture’s School Lunch Program — guidelines that allow for the replacement of half of the recommended daily servings of fruits with 100 percent fruit juice. (KJ Dell’Antonia, 5/22)

As many as two million Americans are struggling with prescription drug addiction across the nation. Tragically, heroin and opioid overdoses claim an average of 91 lives every day. This startling trend continues to get worse, especially here in Kentucky. ... I made securing crucial new resources to help combat heroin and prescription opioid abuse a top priority in the government funding bill that was recently signed into law. These new resources, which dedicates substantial funding through the appropriations process to address this crisis, will allow us to take another step towards ending it. (Senate Majority Leader Mitch McConnell (R-Ky.), 5/23)

In volunteering to help teach the course, neither of us anticipated that questions asked by first-year medical students would heighten our curiosity and passion for medicine. But they did. We looked for answers and followed up with the students who asked them. In the process, we also reflected on how to be better self-directed learners and more effective teachers. (Jasmine Rana and Taylor Freret, 5/22)