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President Trump backed off plans to introduce a Republican replacement for the Affordable Care Act after Senator Mitch McConnell privately warned him that the Senate would not revisit health care in a comprehensive way before the November 2020 elections. Reversing himself in the face of Republican consternation, Mr. Trump said his party would not produce a health care plan of its own, as he had promised, until after the elections, meaning he will only try to fulfill his first-term promise to repeal and replace his predecessor’s signature program if he wins a second term. (Pear and Haberman, 4/2)

"Not any longer." And with that, a triumphant Senate Majority Leader Mitch McConnell appeared to close the book Tuesday on a divisive Republican debate, convincing President Donald Trump to shelve plans to replace the Affordable Care Act until after the 2020 election. "I made it clear to him that we were not going to be doing that in the Senate," McConnell told reporters. (Mascaro and Lucey, 4/3)

“We had a good conversation yesterday afternoon and I pointed out to him the Senate Republicans’ view on dealing with comprehensive health care reform with a Democratic House of Representatives,” McConnell told reporters Tuesday, describing his conversation with Trump. (Bolton, 4/2)

The battles illustrate the difficulties Trump and Republicans have had in adjusting to Democratic control of the House after two years of uncontested GOP power in Congress and the White House. But many Republicans say they have adapted to the pandemonium — learning to privately sway Trump by warning him of the consequences of his policy declarations, many of which are launched in late-night or early-morning tweets. GOP lawmakers, for instance, think they have successfully headed off any major health-care effort, which they fear would open them up to damaging Democratic attacks. Even so, a legal challenge targeting the Obama-era health law, and backed by the Trump administration, virtually ensures that the issue will remain at the forefront of the president’s reelection campaign. (Kim and Werner, 4/2)

Heading into the campaign season, the GOP is now on track to pursue targeted measures aimed at lowering drug prices and out-of-pocket costs, as well as attacking such ideas as Medicare for All. Democrats are focused on driving down costs and defending the ACA against GOP-led legal attacks, with some in the party floating broader health-care proposals such as a government-run health system. (Armour and Peterson, 4/2)

President Donald Trump told House Republicans on Tuesday that they need to embrace health care reform and make it the first thing they vote on following the 2020 election. Speaking at an annual fundraiser for the National Republican Congressional Committee, Trump told GOP lawmakers and supporters they have the advantage on a variety of issues, but conceded that Democrats have the advantage on health care. "We have to take that away from them," Trump said. (4/2)

President Donald Trump said Republicans “blew it” on health care and will lose the 2020 election if they don’t devise a plan to repeal Obamacare that protects coverage for people with pre-existing conditions. “We blew it the last time, man I was fed a bill of goods,” Trump said Tuesday in a speech at the National Republican Congressional Committee’s annual spring dinner. “We can’t run away” from health care, he added, saying that if the party doesn’t address the issue: “we’ll lose.” (Sebenius, 4/2)

His border shutdown went from imminent to uncertain. A major health-care push was declared and then delayed. Funding cuts were inserted in his proposed budget and just as quickly taken out. President Donald Trump has been exploring the art of the climb-down. Trump pivoted on two big policy fronts this week, easing up on his threats to quickly close the southern border and deciding that a fresh effort to repeal and replace the Affordable Care Act should wait until after the 2020 election. (4/3)

The drumbeat of defeats grew hard to ignore. A federal judge struck down the Donald Trump administration’s plan to require some people to work for their Medicaid benefits. Another judge halted Trump’s plan to open Arctic waters to drilling. Yet another ordered an end to what critics said was the administration’s efforts to encourage an end run around the Affordable Care Act. All in the span of about a week. (Sexton, 4/2)

A federal court has allowed Wisconsin's Democratic attorney general to withdraw the state from a pair of lawsuits challenging the Affordable Care Act, also known as ObamaCare. Josh Kaul's office announced Tuesday that the U.S. District Court in Northern Texas granted Kaul's request to remove Wisconsin from two lawsuits the state is involved that challenge the health care law, according to the Wisconsin State Journal. (Burke, 4/2)

A federal judge let Wisconsin drop out of two lawsuits over Obamacare Tuesday, putting Democratic Gov. Tony Evers on a path to fulfilling a campaign promise that Republican lawmakers have blocked. Wisconsin remains a party to an appeal of one of the decisions. Democratic Attorney General Josh Kaul has asked to get out of the appeal, but the court has not ruled on his request yet. (Marley and Beck, 4/2)

President Donald Trump thrust Sen. Rick Scott into the center of his renewed effort to repeal the Affordable Care Act by suggesting the Florida Republican would help craft the GOP’s long-awaited replacement plan. (Contorno, 4/3)

House and Senate Democrats rallied on the steps of the Supreme Court Tuesday ahead of a vote on a resolution asking the Department of Justice (DOJ) to reverse its decision to side with a lower court ruling ObamaCare unconstitutional. The symbolic resolution will likely pass the Democratic-controlled House Wednesday, but it won't get a vote in the Senate, where Republicans are in the majority. (Hellmann, 4/2)

The House on Wednesday plans to vote on a largely symbolic resolution condemning the Trump administration for calling on the courts to overturn the 2010 health care law, escalating a messaging war that seems poised to continue through the 2020 elections. The vote is the Democrats’ latest rebuke of the Trump administration’s stance on the lawsuit brought by Texas and other conservative state attorneys general to overturn the health care law (PL 111-148, PL 111-152). The House became a party to the law’s defense earlier this year. (McIntire, 4/3)

Two Democratic senators rolled out a proposal Tuesday that would allow anyone to buy Medicare plans, a proposal they say is a more realistic than proposals like Medicare for all that would eliminate private insurance companies and reshape the American health care system. The introduction of “Medicare X” comes as the Democratic Party debates its next steps on health care, with the left wing of the caucus pushing for a single-payer "Medicare for all" system and more moderate members supporting efforts to strengthen the Affordable Care Act (ACA). (Hellmann, 4/2)

Congressional Progressive Caucus co-chair Pramila Jayapal (D-Wash.) on Tuesday confronted a top aide to Speaker Nancy Pelosi, expressing frustration over his private dismissals of "Medicare for All" legislation. Jayapal, a lead author of the plan, H.R. 1384, told Wendell Primus, who serves as Pelosi's senior health policy adviser, that she did not appreciate what she perceived as his efforts to undermine lawmakers’ bills. Jayapal pressed him to explain reports that he made disdainful remarks about the proposal in separate meetings with health policy researchers and insurance executives. (Cancryn, 4/2)

President Trump on Tuesday lashed out at Puerto Rico’s local lawmakers as “grossly incompetent” and singled out one of his favorite targets, Carmen Yulín Cruz, the mayor of San Juan, as “crazed and incompetent.” Mr. Trump’s latest invective toward the local leaders of an island devastated by a hurricane in September 2017 came in a torrent of tweets, which began on Monday night and spilled into Tuesday morning. Mr. Trump was reacting after the Senate on Monday blocked billions of dollars in disaster aid for Midwestern states, in part because Democrats said a proposed $600 million in nutritional assistance to Puerto Rico fell short of its needs. (Karni and Mazzei, 4/2)

House Democrats on Tuesday suggested that the National Institutes of Health is poised for another funding increase in fiscal 2020, continuing an upward trend after the research agency’s budget climbed significantly in recent years. “I would like to increase this budget as much as we possibly can,” New York Democrat Nita M. Lowey, the full Appropriations Committee’s chairwoman, told NIH officials at a hearing of the House Appropriations Labor-HHS-Education Subcommittee. (Siddons, 4/2)

A push to curb surprise medical bills has found support among both Democrats and Republicans on Capitol Hill but also ignited a fight within the health-care industry over how far the federal government should go in regulating prices. While President Trump and members of Congress are sharply divided over U.S. health-care policy more broadly, they have largely come together over the need to tackle surprise bills, which can leave patients with thousands of dollars in unexpected charges. The House Education and Labor Committee held a hearing Tuesday on protecting patients from surprise charges. (Armour, 4/2)

Lawmakers on both sides of the dais at the House Education and Labor Subcommittee on Health, Employment, Labor, and Pensions said they hope to tackle the subject this year. A bipartisan group of senators is also working on the issue and is expected to release updated draft legislation in the coming months. The issue is one that is widely expected to be an area where a bipartisan agreement could emerge, although lawmakers have not yet coalesced around a specific policy solution. “Health care has not recently been an area of bipartisan consensus,” said Subcommittee Chairwoman Frederica S. Wilson, D-Texas. “I am hopeful that this is an opportunity for us to work together on behalf of our constituents. Surely we can all agree that a patient should not have to spend the last few minutes before emergency surgery researching whether everyone in the operating room is in network.” (McIntire, 4/2)

As the hearing wrapped up, the American Hospital Association, the Federation of American Hospitals and the American Medical Association sent a letter to Committee Chair Bobby Scott (D-Va.) and Ranking Member Virginia Foxx (R-N.C.). They stated groups' support for legislation to limit patients' bills to their in-network co-pays but urged lawmakers to keep it simple. AHA's Executive Vice President Tom Nickels noted the panel's criticisms of hospitals and said it was "unfortunate" there weren't any providers on the panel "to be able to address those issues." "One reason we sent the letter today, though not the only reason, was to get our view of the issues out there," he said. (Luthi, 4/2)

Kaiser Health News: Fixing Surprise Medical Bill Problem Shouldn’t Fall To Consumers, Panel Told

One point drew clear agreement Tuesday during a House subcommittee hearing: When it comes to the problem of surprise medical bills, the solution must protect patients — not demand that they be great negotiators. “It is the providers and insurers, not patients, who should bear the burden of settling on a fair payment,” said Frederick Isasi, the executive director of Families USA. He was one of the witnesses who testified before the House Health, Employment, Labor and Pensions subcommittee of the Education & Labor Committee. (Bluth, 4/2)

The only three companies that manufacture insulin in the United States will testify in the House next week about their pricing practices. Rep. Diana DeGette (D-Colo.), chairwoman of the House Energy and Commerce oversight subcommittee, said the three companies— Eli Lilly, Novo Nordisk and Sanofi— will testify April 10. (Weixel, 4/2)

Next week's hearing before the House Energy and Commerce Oversight and Investigations Subcommittee will feature the top three makers of insulin and the three biggest pharmacy benefit managers, or PBMs. “It’s not my intention to blame these [industry] players,” said Chairwoman Diana DeGette, D-Colo., at the subcommittee hearing Tuesday. “This discussion is critical in advance of next week’s hearing when we will have many of these key players in front of the committee.” (Raman, 4/2)

House Democratic members of the Progressive Caucus met with a top aide to Speaker Nancy Pelosi (D-Calif.) on Tuesday and pushed for a controversial, progressive bill to lower drug prices. The meeting with Wendell Primus, the health care adviser to Pelosi, comes as House Democrats craft legislation on lowering drug prices, one of their signature priorities. (Sullivan, 4/2)

House Republicans on Tuesday launched a long-shot bid to force a vote on anti-abortion legislation — an issue they plan to hammer vulnerable Democrats on even if they can’t secure action on the floor. House Minority Whip Steve Scalise (R-La.), along with Rep. Ann Wagner (R-Mo.), filed a discharge petition to circumvent Democratic leadership and bring the “Born-Alive Abortion Survivors Protection Act” to the floor if it gets 218 signatures. The legislation would require infants who survive attempted abortions to receive medical care. (Zanona, 4/2)

Scalise and Rep. Ann Wagner (R-Mo.) have been leading GOP efforts to advance the Born-Alive Abortion Survivors Protection Act, which was reintroduced earlier this year. The two lawmakers have expressed confidence in their ability to garner the 218 signatures needed to implement the discharge petition, a rarely successful procedural tool. (Brufke, 4/2)

Actress Alyssa Milano has joined several Georgia-based TV and film industry workers in protesting a “heartbeat” abortion ban awaiting Republican Gov. Brian Kemp’s signature. Milano delivered a letter signed by other prominent Hollywood actors to Kemp’s office Tuesday before speaking against the bill. Republican Rep. Dominic LaRiccia confronted Milano in a packed reception area in front of Kemp’s office and asked her which Georgia district she votes in. (4/2)

An Ohio House committee on Tuesday added new language to a “heartbeat bill” that, if passed, would make what would become one of the nation’s toughest abortion laws even tougher. The changes adopted by the House Health Committee to Senate Bill 23 would, among other things, allow the Ohio State Medical Board to impose a $10,000 fine each time a doctor performs an abortion after a fetal heartbeat can be detected – which can be as soon as six weeks into a pregnancy, before many women even know they’re pregnant. (Pelzer, 4/2)

A Kentucky judge has ruled against a student who sued after he wasn’t allowed to play basketball because he wasn’t vaccinated for chickenpox. In the lawsuit against the Northern Kentucky Health Department, 18-year-old Jerome Kunkel claimed the vaccine is against his religious beliefs. WXIX-TV in Cincinnati reports Boone County Circuit Judge James R. Schrand on Tuesday denied Kunkel’s request to return to school activities. (4/2)

The surge of migrant families arriving at the southern border has led the Trump administration to dramatically expand a practice President Donald Trump has long mocked as "catch and release." With immigrant processing and holding centers overwhelmed, the administration is busing people hundreds of miles inland and releasing them at Greyhound stations and churches in cities like Albuquerque, San Antonio and Phoenix because towns close to the border already have more than they can handle. (Attanasio and Galvan, 4/2)

Federal officials are once again expanding a detention camp for migrant children in a Miami suburb as the number of immigrants crossing into the U.S. rises. Florida Democratic Rep. Debbie Wasserman Schulz said in a Tuesday statement that the Trump administration notified members of Congress that its capacity was growing from 2,350 to 3,200. (4/2)

Government officials, aid workers and activists in Central America are mystified by U.S. President Donald Trump's threat to cut off nearly $500 million in aid to Honduras, Guatemala and El Salvador in response to what he calls an immigration crisis. Over time, they say, it will only worsen the problem. At risk of falling on the chopping block are development programs that work to tackle the root causes driving migration: poverty, inequality, violence and corruption. (Aleman, 4/2)

Walgreens slashed its 2019 forecast and missed second-quarter expectations with a performance that sent its shares plunging Tuesday and helped knock down the Dow Jones Industrial Average. Company leaders told analysts that challenges they had been expecting like reimbursement cuts and lower price increases for branded drugs hit Walgreens much sooner than they anticipated. (4/2)

The drop in shares to a more than five-year low wiped off nearly $8 billion from the market capitalization of the worst performing stock in the Dow Jones Industrial Average this year, and weighed on shares of rival CVS Health Corp and drug wholesalers. Drug retailers like Walgreens and CVS Health have been squeezed by reimbursement pressure as their pharmacies receive less for filing prescriptions coupled with a steep decline in generic drug prices for several years. (4/2)

Smaller profit from the sale of generic drugs is squeezing the two biggest U.S. pharmacy chains, with Walgreens Boots Alliance Inc. joining rival CVS Health Corp. in lowering earnings goals for the year. Walgreens cut its forecast on Tuesday after experiencing what the company described as its most difficult quarter since the 2014 merger of Walgreens and Alliance Boots. Its shares fell 13% on Tuesday, while CVS lost 3.8%, extending a slump dating to late February when the drugstore chain lowered its 2019 profit target. (Terlep and Walker, 4/2)

Bayer's non-executive board reaffirmed its support for top management's decision to acquire seed maker Monsanto last year, after losing high-profile lawsuits to U.S. plaintiffs who claimed Monsanto's Roundup weedkiller caused their cancer. In documents posted on the company's website on Monday, the non-executive supervisory board said an expert opinion it commissioned from lawfirm Linklaters found that Bayer's management had complied with their duties when acquiring Monsanto for $63 billion last year. (4/2)

An ambitious effort to lower healthcare costs is taking shape in Summit County, Colo., and its leaders announced a major step forward Tuesday. Peak Health Alliance, a group of employers and individuals that together represent roughly 6,000 people, has directly negotiated payment rates for services with the area's major health system and the county's only hospital provider, Centura Health. The group will now send that contract to health insurers and solicit bids to see who can create the best plan. (Bannow, 4/2)

When Laura Hirsch of Keller Texas had to find a rehabilitation center to help her father recover from a difficult surgery in September, the caregiving service Cariloop saved her a whole day. A case manager at Cariloop, based in Richardson, Texas, sorted through more than a dozen rehab facility options, then armed Hirsch with the right questions to ask when choosing among the final contenders. (Pinsker, 4/2)

The Food and Drug Administration announced Tuesday that it is developing a framework for regulating artificial intelligence products used in medicine that continually adapt based on new data. The agency’s outgoing commissioner, Scott Gottlieb, released a white paper that sets forth the broad outlines of the FDA’s proposed approach to establishing greater oversight over this rapidly evolving segment of AI products. (Ross, 4/2)

Lack of stable IT leadership at the Department of Veterans Affairs will prove a major hurdle for the agency's technology modernization efforts, including its $10 billion electronic health records project, according to witnesses who testified at a House subcommittee hearing Tuesday. The Subcommittee on Technology Modernization under the House Committee on Veterans Affairs convened representatives from the Government Accountability Office and the VA Office of Inspector General to discuss the agency's Office of Information and Technology, which is tasked with implementing technology projects such as the Cerner EHR overhaul. (Cohen, 4/2)

University Health System is transitioning to an Epic electronic health records system, scrapping its current Allscripts and GE systems along the way. The San Antonio health system is putting $170 million toward the systemwide EHR, which includes costs associated with the Epic software, personnel training and retiring outdated software systems. University Health System reported $1.2 billion in operating revenue in its fiscal 2017, its most recent year reported, according to Modern Healthcare Metrics. (Cohen, 4/2)

Massachusetts authorities created a false picture of the Sackler family's role in promoting OxyContin, the Sacklers said Tuesday in their first court response to allegations that individual family members — not just their company, Purdue Pharma — helped fuel the deadly opioid epidemic. The Sackler family says a lawsuit filed by Massachusetts Attorney General Maura Healey that accuses Connecticut-based Purdue Pharma and the family of hiding the risks of opioids from doctors and patients is riddled with inaccurate and misleading statements. The Sacklers are accusing Healey of cherry picking from hundreds of internal documents in an attempt to wrongly vilify the family for the public health crisis. (4/2)

Insurers pushed back against an HHS task force's finding that they are not covering non-opioid pain management therapies such as acupuncture, while proponents of such treatment see a chance to argue for Medicare reimbursement. A congressionally mandated report from the Pain Management Best Practices Inter-Agency Task Force on gaps in treatment concluded that payers often don't pay for non-opioid therapies that are more expensive than opioids. But America's Health Insurance Plans, the top insurance lobbying group, said in comments to the report that it isn't that simple. (King, 4/2)

Gateway to Better Health is a state-sponsored program that provides health care to nearly 20,000 St. Louis and St. Louis County residents who often can’t afford health insurance but don’t qualify for the state’s Medicaid program. It provides primary, specialty and urgent care at the region’s five federally qualified health centers and at St. Louis County-run health clinics. (Fentem, 4/2)

In the midst of an opioid epidemic, the Georgia Legislature has voted to weaken enforcement of one of the investigative tools used against it. On Tuesday the General Assembly voted to take away the ability of the Georgia Composite Medical Board to discipline doctors who fail to register for an opioid prescription tracking database. (Hart, 4/2)

For the first time, Massachusetts prisons are providing a medication to treat opioid addiction to newly arriving inmates, as the state launches a groundbreaking program established by legislation passed last year. For now, the Department of Correction is providing just one of the two medications required under the law, which took effect Monday. (Freyer, 4/2)

The sites promise easy and embarrassment-free access to erectile dysfunction and libido pills. “E.D. meds prescribed online, delivered to your door,” one said recently. “Starting at $2 per dose.” “Low sex drive? That can be optional,” another one said. “Try today — $99.” The sites, Roman and Hers, as well as others now make obtaining lifestyle drugs for sexual health, hair loss and anxiety nearly as easy as ordering dinner online. (Singer and Thomas, 4/2)

There’s a rapidly expanding market for new DNA tests aimed at helping seemingly healthy people gain insights into their risk of developing all sorts of diseases. The latest entrant, launched on Tuesday, promises to analyze a canonical list of 59 genes that influence your likelihood of developing certain cancers and heart problems, along with other conditions. The new GenePrism test comes from PerkinElmer, a Massachusetts diagnostics company, and Helix, a Silicon Valley startup that’s developed something of an app store for DNA tests. (Sheridan and Robbins, 3/2)

Around 2010, a French biotech approached European officials with a wild idea. There are these viruses called bacteriophages, the team explained, which invade bacteria, multiply, and cause the pathogens to explode. As more and more bugs were becoming resistant to antibiotics, the company wanted to use these viruses to combat unrelenting infections — and proposed souping up these helpful parasites with some genetic modification. (Boodman, 4/3)

With keto-friendly recipes sweeping social media, some followers of low-carb eating are hoping for a nod of approval in the upcoming U.S. dietary guidelines that advise Americans on what to eat. It may seem minor, but backers say low-carb's inclusion could influence nutrition advice that doctors give and help shape government food programs like school lunches. Currently, the guidelines cite the Mediterranean, vegetarian and other diets as examples of healthy eating. "The main point is to get away from a one-size-fits-all diet," said Nina Teicholz, who has written about low-carb diets. (Choi, 4/2)

One morning last fall, 4-year-old Joey Wilcox woke up with the left side of his face drooping. It was the first sign of an unfolding nightmare. Three days later, Joey was in a hospital intensive care unit, unable to move his arms or legs or sit up. Spinal taps and other tests failed to find a cause. Doctors worried he was about to lose the ability to breathe. (4/2)

With CBD showing up everywhere, U.S. regulators announced Tuesday they are exploring ways the marijuana extract could be used legally in foods, dietary supplements and cosmetics. The U.S. Food and Drug Administration said it will hold a public hearing May 31 to gather more information on the science, manufacturing and sale of cannabis compounds such as CBD. (4/2)

Do world-class swimmers’ hearts function differently than the hearts of elite runners? A new study finds that the answer may be yes, and the differences, although slight, could be telling and consequential, even for those of us who swim or run at a much less lofty level. (Reynolds, 4/3)

UnitedHealthcare and the American Medical Association said Tuesday they want to expand the set of ICD-10 diagnostic codes to include more specific diagnoses related to a person's social determinants of health. The hope is that these codes would allow clinicians to document patients' social determinants in a standardized way, which would allow them to better tailor care plans or refer patients to community organizations that could meet those social needs. (Livingston, 4/2)

Vaccination against influenza is less effective at eradicating the infection than vaccines against measles or polio. There are valid biological reasons for this, one is the strains vary year to year and that is not the case with other vaccine-preventable infections. However, what is also true and often forgotten is you are less likely to get influenza if you have been vaccinated and if you do get influenza, you are less likely to die. (Gunter, 4/2)

Researchers at the Alzheimer’s Association and the University of California reported results of a new study Tuesday, showing that when doctors were able to definitively diagnose Alzheimer’s disease using brain scans, they changed their patients’ treatment in roughly two-thirds of the cases. Researchers said they had not expected the brain scan results, which used positron emission tomography, to have such a big impact on diagnoses and treatment, but that doctors and patients clearly benefited from seeing whether Alzheimer’s telltale amyloid plaques were visible in images. (Anderson, 4/3)

Probiotics are wildly popular. After all, the microbial cocktails are available over the counter and have been shown to be helpful in the treatment of gastrointestinal illnesses for some people. But some scientists worry probiotics aren’t as innocuous as they seem — and might be affecting the way other medicines work in the body. (Keshavan, 4/2)

Every night, parents around the globe fight a battle of wills when they tell their kids to power down their game consoles to do homework, eat dinner or go to bed. The directive is usually met with some serious side-eye and whining. In some cases, children yell, throw tantrums or slam doors. No one likes to be forced to stop having fun, but something unique appears to be going on here—you don’t hear much about kids having epic meltdowns when they’re told to stop playing with Legos. (Jargon, 4/2)

Cereal bars with spinach mixed in or veggie-infused tater tots are great at fooling children into eating greens or broccoli or carrots. But experts say that aside from the fact that these products often use only traces of vegetables, this strategy assumes the children can’t like kale or broccoli itself, and relying on such products makes it far more likely that they won’t. (Cernansky, 4/3)

The complex medical and psychological needs of transgender and gender-diverse youth have prompted Children's Minnesota to launch a clinic to provide more timely treatment and information to children and their parents. While almost 3 percent of Minnesota's high school students identify as gender diverse, this group of children often doesn't know where to turn when they first have questions, said Dr. Angela Kade Goepferd, medical director of the clinic, which started scheduling appointments Tuesday and will open to patients on April 22. (Olson, 4/2)

Governor Chris Sununu got a standing ovation during his budget address in February when he promised to build a new forensic hospital outside the walls of the state prison. The facility would treat people with mental illness who are considered dangerous to themselves or others. (Rogers, 4/2)

After they amputated the second toe on John Trumbla’s right foot last summer, doctors sent him to a nursing home because he still needed medical care — but not necessarily a hospital bed. The proud, burly Army veteran resisted at first, but he didn’t have a choice. Before his hospitalization at Santa Clara Valley Medical Center, Trumbla, 56, and his wife had been homeless, crashing in his boss’s construction shop or living out of their station wagon. (Ibarra, 4/2)

Several lawmakers spoke, including Rep. Donna Howard, D-Austin, Rep. Sarah Davis, R-Houston, Rep. J.D. Sheffield, R-Gatesville, and Rep. Michelle Beckley, D-Carrollton, whose vaccine-related amendment was approved last week as part of the state budget. It will require the Texas Department of State Health Services to assess the immunization rates at child care centers, which has not done for several years (Huber, 4/2)

Poverty has long been a political football, and the current polarized climate lays bare the tussle. At one end, child poverty has been called a “moral outrage” by California’s progressive governor, Gavin Newsom, who has vowed to end it. At the other end of the political spectrum, Housing and Urban Development Secretary Ben Carson has said poverty is a “state of mind,” echoing the Trump administration position that government aid is not the answer. (Fernandes, 4/3)

In early February, the group reached an agreement with Prime, netting the salaries they were owed — collectively more than $200,000 — as well as malpractice insurance and legal fees, according to O’Malley and two others privy to the settlement’s details who discussed the outcome for the first time publicly this week. One doctor, who had been fired by Prime, was excluded from the settlement and is mulling legal action. (Vella, 4/2)

A doctor who runs three Kansas anti-aging clinics, including one in Leawood, is suing the Kansas medical board for issuing an emergency suspension of his license before giving him a full hearing. It is the second such sanction by the Kansas medical board for Michael Reed Simmons, whose state license was temporarily suspended in 2002 because he had sexual relationships with patients and a co-worker. (Marso, 4/2)

An attempt to allow a sports medicine and training center in Alpharetta failed to clear the House Rules Committee on Tuesday. The proposed Legacy Sports Institute, endorsed by many sports VIPs, was included in some initial certificate-of-need (CON) bills, but ran into roadblocks along its legislative journey. (Miller, 4/3)

The doctor tapped by Gov. Ron DeSantis to become the state’s surgeon general has been embroiled in legal squabbles and investigations while working at the University of Florida. Scott Rivkees has been the subject of a university sexual harassment investigation, was found by a university auditor to have not properly filed financial-disclosure information and has sued a onetime colleague for libel and slander. (Sexton, 4/2)

A Cuyahoga County Jail inmate said in a lawsuit that inhumane jail conditions and treatment by corrections officers exacerbated his mental health issues. Andre Jenkins, of Cleveland, wrote in a lawsuit filed Monday that he was denied his mental health medication on Nov. 30. Jenkins said a corrections officer repeatedly denied his request for help and that “I started to act out in fear due to anxiety, and my P.T.S.D.” due to not receiving his medication, the lawsuit says. (Heisig, 4/2)

While acknowledging the state’s long-term need for more affordable housing, the assemblyman said homeless students need help right now. In 2016, the state passed a law requiring the colleges to give homeless students access to campus shower facilities. (Deruy, 4/2)

Most Americans are focused on what they're being charged for health care, not how much they or an aging population are consuming, according to a new POLITICO/Harvard T.H. Chan School of Public Health poll. Respondents blamed drug companies, insurers, providers and even the federal government for surging costs while dismissing overuse as a central issue. That's at odds with many politicians and health policy experts and raises questions about whether cost-cutting focused on overutilization could backfire politically. (Rayasam, 3/29)

A coalition that includes pharmacy middlemen and insurers has launched a six-figure ad campaign attacking a cornerstone of President Trump’s plan to lower drug prices, declaring it would amount to a “big pharma bailout.” The ads, launched by the Campaign for Sustainable Rx Pricing, are focused on Trump’s plan to end the rebates that middlemen and insurers negotiate with drug makers in exchange for a drug’s placement on insurance formularies. The ads seize upon the Trump administration’s own admission that the proposal could raise Medicare premiums, given rebates are typically used to make insurance cheaper for patients. (Florko, 3/28)

In an interview on Sunday's "Face The Nation," Sen. Bernie Sanders vowed that if he becomes president, he will cut prescription drug prices in half. "Let me make a campaign promise to you and you can repeat this, play this tape over if I'm elected president," Sanders said. "And that is, if I am elected president I'm going to cut prescription drug costs in this country by 50 percent so that we are not paying any more than other major countries are paying." (Hains, 3/31)

A 340B facility can now determine whether it's being bilked by a drug manufacturer for covered drugs thanks to an update to an HHS website. The Health Resources and Services Administration on Monday updated the Office of Pharmacy Affairs 340B Information System, which facilities use to register for the program. It now allows 340B providers to verify the accuracy of ceiling prices drugmakers are charging. (King, 4/1)

Amid intensifying scrutiny over the cost of insulin, a new analysis finds that total Medicare Part D spending on this diabetes treatment rose 840 percent in the decade between 2007 and 2017, from $1.4 billion to $13.3 billion, thanks to both rising prices and a growing number of patients. Average spending per person increased by 358 percent between 2007 and 2016, from $862 to $3,949. Aggregate out-of-pocket spending quadrupled from $236 million to $968 million. And among enrollees without low-income subsidies, average per capita out-of-pocket spending on insulin nearly doubled during that period, from $324 to $588, according to the Kaiser Family Foundation analysis. (Silverman, 3/2)

In a notable development, the Federal Trade Commission reversed a ruling by an administrative law judge who last year maintained that a so-called pay-to-delay deal between Impax Laboratories and Endo Pharmaceuticals (ENDP) was not anticompetitive. In doing so, the agency is not only reinforcing a 2012 U.S. Supreme Court ruling that found these agreements could be scrutinized for antitrust violations, but it is also buttressing a litmus test for determining when a pay-to-delay deal may be problematic. (Silverman, 4/1)

A new breed of online health-care startups are testing the boundaries of medical marketing, advertising prescription drugs for unapproved uses to college students with stage fright and men seeking to improve their sexual performance. Hims Inc. markets sertraline, a generic version of the antidepressant Zoloft, to treat premature ejaculation. “Ending the bedroom fun a little too soon? Sertraline can help treat premature ejaculation so sex can last longer for both you and your partner,” the company said in an Instagram post. (Brown and De Vynck, 4/2)

Pharmaceutical companies are spending millions on lobbying as lawmakers consider a bundle of bills that address rising prescription drug costs and transparency. “Drugs are a huge contributor to health care costs, and it’s becoming, as many other parts of health care, more and more of a crisis in terms of people’s ability to pay for their health care,” state Sen. Cindy Friedman told the Herald. “We need to start with much more transparency around drug pricing, the true cost of bringing drugs to market and how those true costs relate to the cost of our drugs.” (Markos, 3/29)

A recent regulatory review of a controversial Parkinson’s drug may not have found any new or unexpected safety findings, but a nonprofit watchdog argues the assessment was insufficient and the Food and Drug Administration should reconsider its approval. In its report, the Institute for Safe Medicine Practices maintained that an FDA review issued last fall “provides no new reassurance that the benefits of (Nuplazid) outweigh its risks. Instead, the post-market data and new study warrant increased concern.” At the very least, the nonprofit argues the FDA should issue a warning that the drug may “substantially increase patient deaths.” (Silverman, 4/2)

Starting a biotech used to be simpler, conceptually speaking; some scientist with an idea would pitch it to people with money. After a dozen years — and as many lucky breaks — that scientist might have a successful company. That doesn’t happen as much anymore. Some say that era is over. In its place, the “venture creation” model is fueling some of the highest-profile venture capital names in biotech, including Flagship Pioneering, Third Rock Ventures, and, increasingly, Atlas Ventures. They all work by gathering a bunch of seasoned executives around an idea they’ve developed in their own incubators. (Sheridan, 3/28)

Virginia and West Virginia became the first states to ban an insurer practice that prevents drug manufacturer coupons and copay assistance from counting against a plan's deductible or out-of-pocket limit, and patient advocates believe more states are going to follow suit. So far another 10 states are considering passing their own laws to ban copay accumulator programs. (King, 3/29)

After several years of courtroom squabbling, a federal court judge ruled that Novartis (NVS) must face trial in a case brought by the federal government and more than two dozen states, alleging the drug maker violated kickback laws by paying doctors to prescribe some of its medicines. In his order, U.S. District Court Judge Paul Gardephe concluded the federal government provided sufficient evidence of a “company-wide kickback scheme,” but does not have to prove a direct “quid pro quo” agreement between Novartis and doctors for the company to be liable under the False Claims Act. (Silverman, 4/1)

Novartis AG must face a U.S. government lawsuit accusing it of paying millions of dollars in kickbacks to doctors so they would prescribe its drugs, after a federal judge ruled in a decision released on Monday that the government had offered evidence of a "company-wide kickback scheme." U.S. District Judge Paul Gardephe in Manhattan also rejected the Swiss drugmaker's bid to keep key government evidence out of the case, and ruled that the government does not have to prove a direct "quid pro quo" agreement between Novartis and doctors for the company to be liable. (Pierson, 4/1)

The use of real world data to assess the safety and effectiveness of drugs and medical treatments is among the most controversial topics in medicine. As chief executive of Aetion, a New York City startup that sells software to analyze those data, Carolyn Magill is in the middle of the fray — one whose outcome will have a huge impact on how medicines are studied and priced in the future. During an interview with STAT at last week’s Health Datapalooza conference in Washington, D.C., the former insurance executive passionately made the case that analyzing real world data is crucial for incorporating patient experiences into decision-making by drug companies, insurers, providers, and regulators. (Ross, 4/1)

Coding boot camps have proliferated here, as a way to train workers to get entry-level jobs in the booming tech industry. Now, a local biohacker wants to adapt that model in biotech, with an online education program aimed at teaching job seekers how to pipette and centrifuge in the lab. The new “biotech school,” announced on Tuesday, will be something of an experiment to test whether unconventional training can help students land jobs in a field where even entry-level positions often demand graduate degrees. (Robbins, 3/27)

Mylan NV still has to fight a class-action suit over its EpiPen allergy treatment, though a judge narrowed its scope on Friday, throwing out allegations that the company made misleading statements, didn’t disclose its regulatory risks and fixed prices for some generic drugs. Claims that the EpiPen rebate scheme violated antitrust rules remain. The lawsuit “adequately alleges both harm to competition in the relevant market, and the predominance of anticompetitive effects,” U.S. District Judge J. Paul Oetken ruled. (Dolmetsch and Griffin, 3/29)

Bristol-Myers Squibb, fighting off investor protests of its planned merger with Celgene, has won over the most influential advisers on Wall Street, improving the company’s odds of pulling off the $74 billion deal. ISS and Glass Lewis, two powerful investment advisory services, endorsed the proposed deal Friday, siding with Bristol-Myers over dissident shareholders who argue that Celgene is too risky to justify the acquisition price. The firms’ coveted blessing comes weeks before the April 12 shareholder vote that will decide whether Bristol-Myers gets its way. (Garde, 3/29)

It’s the lucky biotech that has a short and sweet runway. Most companies bring a drug to market — and begin to bring in revenue — only after years or decades of work. But a company backed by Atlas Venture that’s less than a year old is the first acquisition of 2019 for Novartis. The pharmaceutical giant is paying more than $300 million upfront for IFM Tre, a Boston-based startup, in a deal that could be worth more than $1.5 billion if the company’s drugs meet certain undisclosed milestones. (Sheridan, 4/1)

The pharmaceutical industry has followed a brilliant two-pronged strategy to maximize its profits: raise prices and increase consumption of medications. Most of the attention has focused on just one side of the equation — prices. With politicians and advocates on both sides of the aisle vowing to lower drug prices, few people are talking about Americans being overprescribed medications, which not only adds to the cost of drugs but also harms millions of Americans each year. (Shannon Brownlee and Judith Garber, 4/2)

Are we headed for a drugstore apocalypse? CVS Health Inc., America’s biggest pharmacy chain, rang a warning bell in February with a disappointing 2019 forecast that reflected pressure on its prescription-drug business. A month later, Rite Aid Corp., another big pharmacy operator,  jettisoned executives amid continuing struggles as its stock price traded below $1. Then on Tuesday, No. 2 chain Walgreens Boots Alliance Inc. announced dismal second-quarter results and slashed its full-year guidance. Its shares tumbled more than 12 percent as both retail and pharmacy performance fell substantially short of expectations. (Max Nisen, 4/2)

Senator John Cornyn recently said he fears drug companies may be gaming America's patent system. According to the Republican senator from Texas, some firms are making insignificant tweaks to drug formulas and then filing new patents on the upgraded medicines. The firms then allegedly use these patents to prevent competing treatments from entering the market. (James Edwards, 3/31)

The 2018 General Assembly session was a banner year for health care affordability and access in Maryland, with members of both parties working together on the creation and funding of a reinsurance pool to drive down costs in the state’s Affordable Care Act exchange. The result was that as premiums continued to spike in the rest of the nation, they actually went down in Maryland, staving off what could have been a death spiral for the individual market. This year, the General Assembly has the chance to lead again in the effort to rein in prescription drug prices. (3/27)

What happens when strategic ambition meets financial constraint? The answer is found in AstraZeneca Plc’s $6.9 billion oncology tie-up with Japan’s Daiichi Sankyo Co. Ltd. The U.K. drugmaker is resorting to costly financing to get the deal done. Shareholders will not only have to take the potential upside on trust, they will have to share it. (Chris Hughes, 3/29)

You have insurance, so you assume you’re getting the best price for your prescription drugs. Not necessarily. Sometimes, because of high deductibles or high co-pays, it’s cheaper to skip the insurance and pay the retail price. I know, it sounds crazy, right? But I did that recently and was blown away by how much I saved — $108 on a 90-day refill of the generic drug I’ve been taking for years. By going to another pharmacy a few miles away, one that accepted an online coupon from GoodRx, I paid $12 instead of $120. (Herb Weisbaum, 4/2)

So much for President Donald Trump’s renewed health-policy push. It was only a week or so ago that his Department of Justice announced it would fully back a lawsuit aimed at repealing the Affordable Care Act, a move Trump brought further attention to by calling Republicans “the party of health care” while promising a superior plan. Now he’s punting, saying this great new plan — which appears to be a version of a previous failed effort — won’t come up for a vote until at least 2021, and only if he wins the election. (Max Nisen, 4/2)

The only plausible explanation for President Trump’s renewed effort through the courts to do away with the Affordable Care Act, other than muscle memory, is a desire to play to his base despite widely reported misgivings in his own administration and among Republicans in Congress. Reality check: But the Republican base has more complicated views about the ACA than the activists who show up at rallies and cheer when the president talks about repealing the law. The polling is clear: Republicans don’t like the ACA, but just like everyone else, they like its benefits and will not want to lose them. (Drew Altman and Mollyann Brodie, 4/3)

Let’s say you’re a 52-year-old bricklayer, and years of physical labor have taken their toll. Or you’re 54 and find yourself laid off. Or maybe you’ve worked really hard your entire career and would like to retire at age 60, volunteer, and spend more time with your grandkids. Wouldn’t it be great if Medicare were an option for you? Soon it could be, under legislation I’ve introduced with Democratic colleagues in the U.S. Senate and House, led by U.S. Rep. Brian Higgins, D-New York, to give people age 50 to 64 the option to buy into Medicare. Passing the Medicare at 50 Act is something we can do right now to expand health care and give people more certainty in a time of great uncertainty. (U.S. Sen. Debbie Stabenow, 4/3)

Nearly a quarter century ago, then Speaker of the House Newt Gingrich said this about the original Medicare program: “We believe it’s going to wither on the vine because we think people are voluntarily going to leave it — voluntarily.” Gingrich argued that original Medicare — based on a 1960s-style fee-for-service benefit package with a confusing set of deductibles, co-insurance, and copays — was stuck in the past. He saw a day when Medicare-contracted private health plans would prove so attractive that Medicare beneficiaries would have to choose them. It’s taken a generation, but Gingrich is on the verge of being right about Medicare. (Michael Adelberg and Kristin Rodriguez, 4/3)

Just last week, President Trump promised that any minute now, Republicans were going to produce a plan to solve all the problems in the health-care system, one that would be, and I quote, “spectacular.” In response, I argued he was putting his party in an uncomfortable position by forcing Republicans to talk about an issue they would much prefer to avoid altogether. Now Trump seems to have realized his mistake. (Paul Waldman, 4/2)

Lawmakers have the opportunity to dramatically improve our health and financial well-being by expanding Medicaid. Nearly a dozen bills are related to Medicaid expansion in the Texas legislature. Earlier this month, Rep. Garnet Coleman's bill (HB 565) to expand Medicaid and protect essential health benefits received a committee hearing, marking the first time the House Committee on Insurance has heard testimony on Medicaid in six years. And Senator Nathan Johnson has introduced a resolution, SJR 34, to put Medicaid expansion on the ballot with support from a diverse consumer coalition, Cover Texas Now. (Hussain Lalani, 4/3)

How to achieve universal health insurance in California? In our super-progressive, supermajority Democratic state, that’s the health policy question of the day. Not if we should lead the way on universal coverage, but how. ...We need to revamp our insurance mess. We can do this with a well-known and proven solution: single-payer. (James G. Kahn, 4/2)

Opioids have figured prominently in both our lives. For Kate, they were a lifeline after a surgical mishap left her unable to sit, stand or walk for more than a decade. For Ryan, they were a gateway to a dark decade of heroin addiction. With overdose deaths at record highs, many Americans believe that we have over-treated pain at the expense of those who became addicted to prescription opioids. Increasingly, the media and politicians all but deny that pain exists, highlighting the blight of addiction and doing precious little to address either. (Ryan Hampton and Kate M. Nicholson, 4/3)

Most of the ways we can extend our lives have little to do with pills or even with the health care system. High school dropouts, for example, have average life expectancies about a dozen years shorter than individuals with advanced degrees. A landmark study that linked IRS tax records to death records from the Social Security Administration found that men in the top 1% of income live 14.6 years longer than those in the lowest 1%. For women the difference was 10.1 years. And the effects of income on life expectancy systematically increased between 2001 and 2014.Perhaps such indicators are why guidance from the American Heart Association and the American College of Cardiology was recently revised to place much stronger emphasis on lifestyle and social determinants of health. (Robert M. Kaplan, 4/3)

So, here’s a suggestion. If these products are meant to shift cigarette smokers away from their habit, and if that is where their value lies, then let FDA evaluate their effectiveness as a smoking cessation device for smokers. If they prove to be effective, make e-cigarettes available by prescription only. A recent trial in the U.K. found that e-cigarettes were about as effective as medications such Chantix in helping smokers to quit. But even this evidence suggests that if it is an effective cessation device, it should only be available by prescription for those addicted to cigarettes. (Dan Romer, 4/2)

Socialism is in the air—a green, wired, mindful, glossy-lipped movement that’s going to usher in free college, free health care and heavily followed Instagram accounts for all. It’s presented as new and futuristic, but there’s no need to reinvent the wheel. In one corner of Washington, socialism has been a living, breathing reality for decades. Just go visit the Department of Veterans Affairs. Draw a military paycheck for a few years, and you’re entitled to cradle-to-grave support for you and family members. Health care at any of more than 1,200 sites. Housing guarantees. Up to 100% of college costs. Special unemployment checks. Life insurance. Nursing-home care. Uncle Sam will literally bury you. This is the socialist dream. But there’s trouble in VA paradise. (Karl Zinsmeister, 4/2)

For nearly two weeks last November, smoke from the Camp fire drained 150 miles down the Central Valley and out toward the sea, engulfing Sacramento and the whole Bay Area. San Francisco looked — and breathed — like New Delhi, the world’s most polluted city. Miles away in the mountain town of Paradise, the fast-moving conflagration killed 85 people — making the Camp fire the deadliest wildfire in state history. But pollution research suggests that once heart attacks and respiratory-related deaths are factored in, its soot was even more deadly than its flames. (David Fairley and Peter Fairley, 4/3)