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The Trump administration announced on Tuesday that it was slashing grants to nonprofit organizations that help people obtain health insurance under the Affordable Care Act, the latest step in an escalating attack on the law that threatens to destabilize its insurance markets. The cuts are the second round in two years. The government will provide $10 million this fall, down from $36 million last autumn and $63 million in late 2016 — a total reduction of more than 80 percent. (Pear, 7/10)

Under the latest cuts, so-called navigators who sign up Americans for the ACA, also known as Obamacare, will get $10 million for the year starting in November, down from $36.8 million in the previous year, according to a statement by the Centers for Medicare and Medicaid Services (CMS). This follows a reduction announced by the CMS last August from $62.5 million, along with an even bigger cut to advertising for enrollment, and represents the latest in a series of moves to weaken the ACA by the administration of President Donald Trump. (Walsh, 7/10)

Groups applying for funds will also be encouraged to provide enrollment assistance for the new plans that don’t comply with the ACA, a further weakening of administration support for the Obama-era health law. The administration argues that organizations getting the funding have often failed to reach enrollment goals. Democrats and advocates of the ACA, however, say the cuts are an attempt by the administration to gut a program that is essential to ensuring robust sign-ups during open enrollment, which begins in November. (Armour, 7/10)

“As the Exchange has grown in visibility and become more familiar to Americans seeking health insurance, the need for federally funded Navigators has diminished,” CMS said in a statement on Tuesday. The administration also maintains that navigators have proven to be ineffective. (Sullivan, 7/10)

Since Congress was unable to pass such legislation, Trump and his aides have been taking steps to weaken the law through administrative maneuvers. The cuts to grass-roots groups around the country were announced three days after health officials revealed that, because of a pending lawsuit, they were suspending a program created by the law to even out the burden on health insurers whose customers are especially unhealthy or sick. (Goldstein, 7/10)

Insurance-industry groups are pushing the Trump administration to resolve a legal dispute that led to the suspension of billions of dollars of payments that help stabilize Obamacare’s markets. The groups say the U.S. Centers for Medicare and Medicaid Services could quickly resume distributing the risk-adjustment funds by issuing what’s known as an interim final rule for the program. Doing so could help address a legal ruling that led the government to say this weekend it would halt the payments. (Tracery, 7/10)

Millions of Americans who buy their health insurance under the Affordable Care Act could have fewer options and face skyrocketing rates this fall because of the federal government’s decision to freeze billions of payments to insurers that cover a higher number of sicker patients, analysts are warning. The Trump administration announced Saturday that it is putting on hold the “risk adjustment" program in which money is collected from insurers with fewer high-cost plan members and then transferred to insurers with more high-need patients who require more expensive care. (Collins, 7/10)

Republicans remain eager to gut the Affordable Care Act, but some health plans say there’s no time like the present to be in the Obamacare business. Rising premiums in the marketplaces created by the health law are enticing insurers, who are looking past the political turbulence and a curveball this weekend from the Trump administration. More than a dozen insurers plan to enter new Obamacare markets for 2019, according to the Kaiser Family Foundation. (Tracer, 7/10)

The liberal base is fired up about abortion rights, but Senate Democratic Leader Charles Schumer (N.Y.) will seek to emphasize access to affordable health care as much as Roe v. Wade in the battle over the Supreme Court. In sharp contrast to the Obama era, Schumer thinks health care is the Democrats’ best weapon. By putting the charged issue of women’s reproductive rights within the broader framework of access to health care, the matter is likely to be less polarizing in red states. (Bolton, 7/9)

[T]o hold onto Democrats representing conservative states won by Trump, Democrats are increasingly talking about how Kavanaugh might shift the balance on President Obama’s healthcare law, a unifying issue that tends to poll well. And so far it seems to be working on vulnerable Democrats in red states. Sen. Joe Manchin III of West Virginia — who last year voted for Trump’s first Supreme Court selection — immediately picked up on the talking point, saying that he would consider the “nearly 800,000 West Virginians with preexisting conditions” when making his confirmation vote. Though Manchin promised to keep an open mind, the statement suggested a willingness to vote against the nomination, bucking Trump, who is popular in his state. (Wire and Bierman, 7/10)

Kaiser Health News: Democrats Rally Against Threats To The ACA To Block Trump’s Supreme Court Nominee

Democratic senators spent Tuesday trying to connect the dots between potential threats to health care and Trump’s high court pick. “President Trump as a candidate made it very clear that his priority was to put justices on the court who would correct for the fatal flaw of John Roberts,” said Sen. Chris Murphy (D-Conn.) on the Senate floor Tuesday. Chief Justice Roberts was the decisive fifth vote to uphold the ACA in a key case in 2012. “[Republicans’] new strategy is to use the court system to invalidate the protections in the law for people with preexisting conditions,” Murphy said. (Rovner, 7/10)

A number of important healthcare cases could make their way to the high court in the coming years, and Kavanaugh's vote could swing those decisions. They include a new Republican challenge to the constitutionality of the Affordable Care Act; a patient lawsuit against Medicaid work requirements; challenges to the Trump administration's cuts of ACA risk-corridor, risk-adjustment, and cost-sharing reduction payments to insurers; and lawsuits by Medicaid patients seeking the right to see the provider of their choice. (Meyer, 7/`10)

Brett Kavanaugh, President Trump’s nominee for the Supreme Court, has left a trail of rulings and opinions concerning the Food and Drug Administration, pharmaceutical companies, and medical device manufacturers in his dozen years on the District of Columbia circuit court. At one point, Kavanaugh urged judges to defer to the FDA and other scientific agencies, largely on the grounds that courts could not compete with the agencies’ expertise. He also sided with the FDA in a case over whether the agency should be forced to provide access to an unapproved drug. (Facher, 7/10)

On issues as diverse as abortion and gun rights to disputes over national-security policies and business regulations, Judge Kavanaugh emphasized textual limitations while frequently favoring corporations over regulators, and the government over individuals claiming rights violations. With a few exceptions, his pattern is typically conservative. To be sure, Judge Kavanaugh’s history on the bench is not a perfect guide to the approach he would pursue if confirmed to fill the Supreme Court vacancy created by the retirement of Justice Anthony Kennedy, for whom he once clerked. Appeals court judges are bound to obey Supreme Court precedent, but justices are free to vote to overturn past rulings. (Savage, 7/10)

President Donald Trump's Supreme Court nominee may not have to wait too long for controversial cases if he is confirmed to the job, with disputes involving abortion, immigration, gay rights, voting rights and transgender troops possibly heading toward the justices soon. Republicans are hoping Brett Kavanaugh, the conservative U.S. appeals court judge selected on Monday by Trump to replace retiring Justice Anthony Kennedy, will be confirmed by the Senate before the next Supreme Court term opens in October. (Hurley and Chung, 7/10)

Kaiser Health News: If High Court Reverses Roe V. Wade, 22 States Poised To Ban Abortion

What would the U.S. look like without Roe v. Wade, the 1973 case that legalized abortion nationwide?That’s the question now that President Donald Trump has chosen conservative Judge Brett Kavanaugh as his nominee to replace retiring Supreme Court Justice Anthony Kennedy. (Rovner, 7/10)

Vice President Pence said Tuesday that while he would personally like to see the Supreme Court one day overturn its landmark 1973 ruling legalizing abortion, neither he nor President Trump has discussed the issue with Trump’s Supreme Court nominee, Brett M. Kavanaugh. Asked by CNN’s Dana Bash whether he wants to see Roe v. Wade overturned, Pence replied, “I do, but I haven’t been nominated for the Supreme Court.” “I stand for the sanctity of life,” Pence added. “This administration, this president are pro-life, but what the American people ought to know is that, as the president said today, this is not an issue that he discussed with Judge Kavanaugh.” (Sonmez, 7/10)

Conservative Supreme Court nominee Brett Kavanaugh plunged into his confirmation battle Tuesday, meeting face-to-face with Senate leaders in what promises to be an intense debate over abortion rights, presidential power and other legal disputes that could reshape the court and roil this fall's elections. (Mascaro, 7/10)

Judge Brett M. Kavanaugh’s nomination to the Supreme Court could very well help Republicans hold or expand their control of the Senate. It could also hurt their efforts to maintain control of the House. That political oddity illustrates the complexities of this midterm election season, which is actually two very different midterms. One is the fight for the Senate, where Democrats are defending the seats of 10 incumbents in states won by President Trump, and the other is the contest for the House, where Republicans are defending a vast and expanding battleground that is every bit as forbidding, with nearly 60 Republican seats in play. (Hulse, 7/10)

Joe Donnelly knew his audience: Addressing a group of camouflage-clad union mine workers and retirees here last weekend, the Democratic senator trumpeted his efforts to protect their pensions and health care, asked attendees to raise their hands if they knew someone with a pre-existing health condition, and made not a single mention of the upcoming Supreme Court vote that could determine his political fate in November. (Jonathan Martin and Alexander Burns, 7/11)

Senate Democrats, facing an uphill struggle to defeat the nomination of Judge Brett M. Kavanaugh to the Supreme Court, opened a broad attack on Tuesday, painting him as an archconservative who would roll back abortion rights, undo health care protections, ease gun restrictions and protect President Trump against the threat of indictment. (Stolberg, Landler and Kaplan, 7/10)

Chuck Schumer, the Senate Democratic leader, says it's all about health care. Sen. Richard Blumenthal, D-Conn., worries about the impact on the special counsel investigation. And Sen. Kamala Harris, D-Calif., sees an assault that could set women's rights back decades. There's so much for Democrats to dislike about Brett Kavanaugh, President Donald Trump's Supreme Court pick. And that may be the problem. (Lerer and Peoples, 7/11)

Ever since Justice Anthony M. Kennedy announced his retirement, Gov. Andrew M. Cuomo has held rallies, issued statements and signed an executive order, all in the interest, he said, of protecting access to reproductive rights that could be at risk under a Supreme Court poised to lean further to the right. In doing so, Mr. Cuomo, who faces a re-election primary battle in September, continues to position himself as a liberal bulwark to the Trump administration. (McKinley, 7/10)

From the governor’s race to the battle for congressional seats, President Donald Trump’s nomination of Brett Kavanaugh to the U.S. Supreme Court quickly took center stage in New Hampshire politics. With U.S. Supreme Court Justice Anthony Kennedy’s retirement giving the Republican president a prime opportunity to replace the crucial swing vote on the high court with a reliably conservative justice, many supporters of women’s reproductive rights fear the court may overturn Roe v. Wade, the landmark 1973 high court decision that constitutionally protected a woman’s right to have an abortion. (Steinhauser, 7/11)

President Donald Trump’s newest nominee to the U.S. Supreme Court simply adds to the latest round of heightened political tensions in Missouri over reproductive rights and abortion. And, as expected, it’s already become a key issue in the state’s closely watched U.S. Senate race. Missouri Attorney General Josh Hawley is making the Supreme Court confirmation the centerpiece of the Republican U.S. Senate candidate’s first TV ad, which began airing Monday. (Mannies, 7/10)

After the two couples — President Trump and his wife and federal judge Brett M. Kavanaugh and his wife — gathered in the residence of the White House for over an hour Sunday night, Trump made Kavanaugh a historic offer: to be his choice to succeed Anthony M. Kennedy on the Supreme Court. Yet just hours later on Monday morning, Trump seemed to waver — making a flurry of calls to friends and allies and asking them what they thought of Kavanaugh and whom he should nominate. (Parker and Costa, 7/10)

Some immigrant toddlers are back in the arms of their parents, but others remained in holding facilities away from relatives as federal officials fell short of meeting a court-ordered deadline to reunite dozens of youngsters forcibly separated from their families at the border. (Spagat and Householder, 7/11)

The Trump administration said only 38 of 102 children younger than 5 had been reunited with their parents by the Tuesday deadline set by a federal judge in San Diego. The same judge has ordered that thousands of older children should be reunited by July 26. (Hennessy-Fiske, Kim and Fawcett, 7/10)

U.S. District Court Judge Dana Sabraw called on the administration to join 59 separated children in that age group with their parents “today or within the immediate proximity of today.” “These are firm deadlines,” Sabraw said during a court hearing in San Diego. “They are not aspirational goals.” (Hesson and Diamond, 7/10)

Federal officials said some parents were not eligible to be reunited with children either because they haven’t been verified, they have criminal records, or have otherwise been deemed unfit.(Weixel, 7/10)

A separate fast-track court designed to quickly process the steady stream of misdemeanor border-crossing cases under the Trump administration’s “zero tolerance” policy rolled out Monday in San Diego in a hearing that was punctuated by moments of confusion, tension and passionate objection. A total of 41 unauthorized immigrants who were arrested over the weekend were seen during the initial hearing. But this was no ordinary arraignment. (Davis, 7/10)

Chris Meekins, a senior official in the Department of Health and Human Services, pointed to safety concerns to explain the delay in the reunions and insisted that the process could not be rushed. “Our process may not be as quick as some might like but there is no question that it is protecting children,” Mr. Meekins, the chief of staff of the Office of the Assistant Secretary for Preparedness and Response, said in a conference call with reporters. (Dickerson and Fernandez, 7/10)

One mother had waited four months to wrap her arms around her little boy. Another had waited three months to see her little girl again. When the reunions finally happened Tuesday in Phoenix, the mothers were met with cries of rejection from their children. “He didn’t recognize me,” said Mirce Alba Lopez, 31, of her 3-year-old son, Ederson, her eyes welling up with tears. “My joy turned temporarily to sadness.” (Jordan, Benner, Nixon and Dickerson, 7/10)

With tears and smiles, Salvadoran asylum seeker Walter Armando Jimenez Melendez reunited with his 4-year-old son Jeremy on Tuesday after six weeks of anguished separation. "(I went) without knowing where he was - if he was eating, how they were treating him,” said Jimenez, 29, as he shared a meal with his child for the first time since May. “Imagine the joy I felt.” (7/10)

On the day the government rushed to reunite dozens of families separated at the border, one immigrant father showed up to a federal appointment downtown fearful that he would be deported without his 6-year-old son. Hermelindo Che Coc came from Guatemala in late May to seek asylum with his son, Jefferson Che Pop, his attorneys said. His son was taken from him with little explanation, he said, and sent to a shelter in New York. (Bermudez, 7/10)

Though the government is now under a court order to quickly put separated families back together by July 26, their efforts are hampered by bureaucratic disarray and distance. Some parents, like Heyli’s father, are on the brink of being deported or have already been repatriated to violence-torn countries without their children. (Root and Najmabadi, 7/10)

The Trump administration's use of DNA testing to match migrant children separated from their parents is justifiable as a last resort, medical experts say, but raises a host of ethical problems. That includes the risk of damaging the family fabric by revealing that an adult thought to be the biological parent really is not. (7/10)

A vacant office building used to hold immigrant children in central Phoenix became a target of political opponents this week, with the Republican governor and two Democrats hoping to win a primary bid to run against him in November all calling for action in response to an investigation by Reveal. Gov. Doug Ducey has ordered the Arizona Department of Health Services to monitor MVM Inc., the private defense contractor that held the children. (Fernández, 7/10)

HHS Secretary Alex Azar, the president’s point man on Obamacare and drug prices, has reluctantly taken on a new role — public explainer and punching bag for the migrant crisis created by Donald Trump’s zero tolerance border policy. Azar — an even-keeled technocrat whom the White House enlisted as the fixer after Homeland Security Kirstjen Nielsen’s highly criticized press conference last month — has since been attacked by dozens of lawmakers, interrupted by protesters and pilloried on cable TV. Meanwhile, he’s working through a thicket of court orders and red tape to try to reunite thousands of migrant children in his custody with their parents, including 102 under the age of 5. It’s sapped Azar’s time and pulled his agency away from other priorities, such as lowering drug costs and helping solve the opioid epidemic. (Diamond, 7/11)

A Senate panel voted Tuesday to approve President Donald Trump's nominee to lead Veterans Affairs, a department beset by political infighting and turmoil over providing health care. The Senate Veterans Affairs Committee agreed on voice vote to back Robert Wilkie, currently serving as a Pentagon undersecretary. Independent Sen. Bernie Sanders of Vermont cast a "no" vote. (Yen, 7/10)

The senators approved sending Wilkie’s nomination to the Senate floor in a voice vote, with only Sen. Bernie Sanders (I-Vt.) being recorded as a no, according to a committee spokeswoman. Sanders’s vote was not a reflection on Wilkie personally but as a result of his concern that the Trump administration plans to privatize veterans’ health care, a spokesman for the senator said. The committee’s chairman, Sen. Johnny Isakson (R-Ga.), issued a statement after Tuesday’s vote calling Wilkie a respected and talented nominee and urging the Senate to approve his nomination to run the embattled federal agency. (Rein and Sonne, 7/10)

Wilkie, who served as acting VA secretary until he stepped down after being nominated for secretary, is a Washington insider with years of administrative experience who has previously worked on Capitol Hill as well as in the Pentagon for two presidents. (Weixel, 7/10)

The Food and Drug Administration (FDA) on Tuesday approved freeze-dried blood plasma for use to treat combat injuries from U.S. troops, after a dispute over whether access would be allowed. House Armed Services Committee Chairman Mac Thornberry (R-Texas) last year tried to go around the FDA by granting the Department of Defense the ability to allow the freeze-dried plasma use. (Sullivan, 7/10)

The nation’s cancer experts say it is possible to eliminate more than one in five cancer deaths in the U.S. even if researchers never invent another test or treatment. For this plan to work, every single American would have to take full advantage of the best medical care the country has to offer. If they were to do so, the country’s cancer mortality rate would fall by 22%, according to researchers from the American Cancer Society. (Kaplan, 7/10)

There has been a lot of progress in the fight against cancer. Cancer death rates have dropped, but the gains haven't been experienced equally. Cancer death rates remain high for some minorities, including African-Americans. There are geographic differences, too. Death rates for breast and colorectal cancers have declined faster in New England than in other parts of the country. Cancer is also more likely to be fatal for people living in poverty or those without a college degree. (Chisholm, 7/10)

Study participants share their blood and spit in the name of biomedical research. Now, a national group of experts says these volunteers should be told what scientists learn about their health from those samples. In a report published Tuesday, an expert committee convened by the National Academies of Sciences, Engineering, and Medicine concluded that scientists and their institutions should routinely — and carefully — consider whether to return study results to participants. The report, which was sponsored by three of the leading federal health agencies, also recommends revising a federal regulation that’s caused confusion about when it’s permissible to share research findings with a participant. (Thielking, 7/10)

Women who work long hours may be at increased risk for diabetes, a new study has found. Canadian researchers studied 7,065 workers, following their working hours and health over an average of 12 years. They recorded diabetes diagnoses beginning two years after the subjects enrolled in the study. (Bakalar, 7/10)

In May, Myriad Genetics released the first large-scale test of whether treatment guided by genetics (pharmacogenomics) would improve overall outcomes for patients with major depression. The study found that patients were 30 percent more likely to respond to treatment when their medication selection was guided by the company’s GeneSight test. (Harris Bond, 7/11)

By some accounts, nearly half of America's incarcerated population is mentally ill — and journalist Alisa Roth argues that most aren't getting the treatment they need. Roth has visited jails in New York, Chicago, Los Angeles and Atlanta and a rural women's prison in Oklahoma to assess the condition of mentally ill prisoners. She says correctional officers are on the "front lines" of mental health treatment — despite the fact that they lack clinical training. (Davies, 7/10)

Kaiser Health News: Support Circle: Family Caregivers Share Stories And Tips To Ease Alzheimer’s Toll

Vicki Bartholomew started a support group for wives who are caring for a husband with Alzheimer’s disease because she needed that sort of group herself. They meet every month in a conference room at a new memory-care facility in Nashville called Abe’s Garden, where Bartholomew’s husband was one of the first residents — a Vietnam veteran and prominent attorney in Nashville. “My husband’s still living, and now I’m in an even more difficult situation — I’m married, but I’m a widow,” she tells the group one day. (Farmer, 7/11)

To address the unique challenges of HIV in rural Georgia — including a network of 159 counties and swaths of remote land without paved roads or hospital access — the state health department has been expanding its telemedicine infrastructure for both behavioral and specialist care over the last decade. (Hensley, 7/10)

The general public would have more ready access to overdose-reversing medication, pharmacies would start moving to electronic prescriptions and state prisons would need to work with health authorities on a pilot for medication-assisted substance abuse treatment behind bars, under a bill teed up for passage in the (Mass.) House this week. (Metzger, 7/10)

Ohio plans to give $3 million to a business that's working to make an abuse-free prescription pain medication as part of an effort to reduce overdose deaths in the state. Elysium Therapeutics has work underway on "a new class of opioid pain relievers that protect individuals from oral misuse, abuse, and fatal overdose" to combat the opioid-overdose epidemic. (DeMio, 7/10)

Planned Parenthood has closed its health center in Indiana's second-largest city, blaming what it called years of growing intimidation and harassment of the center's staff by supporters of anti-abortion groups. The Fort Wayne health center did not perform abortion procedures. It provided birth control options, sexually transmitted disease testing and early diagnosis of cervical, testicular and breast cancer, said Christie Gillespie, the president and CEO of Planned Parenthood of Indiana and Kentucky. (7/10)

More than 100 women were left waiting for breast and cervical cancer screenings after the City of Milwaukee stopped providing those crucial services earlier this year. Some of those women had symptoms such as lumps in their breasts, or reported pain or burning sensations, according to documents obtained by the Journal Sentinel through an open records request. (Spicuzza, 7/10)

Kehinde Majekodumi does not look desperately ill. A vibrant 24-year-old, she bears little outward sign except a scar beneath her collarbone where a catheter was once inserted. But three times a week she deviates from her regular commute between the apartment she shares with her twin sister and her job in a university admissions office to a dialysis center in East Flatbush, Brooklyn. (Alcorn, 7/11)

Hate crimes increased across California for the third straight year in 2017, an uptick experts have blamed on President Trump’s vitriolic rhetoric toward minorities and the resurgence of hate groups in the state. There were 1,093 reported hate crimes in California in 2017, a 17.4% increase, according to a report released Monday by the California attorney general’s office. Hate crimes have increased annually since 2014, jumping roughly 44% in that three-year span, records show. (Queally, 7/10)

Hundreds of lawsuits alleging Roundup weed killer caused cancer cleared a big hurdle Tuesday when a U.S. judge ruled that cancer victims and their families could present expert testimony linking the herbicide to non-Hodgkin's lymphoma. U.S. District Judge Vince Chhabria said evidence that the active ingredient in Roundup — glyphosate — can cause the disease seemed "rather weak." Still, the opinions of three experts linking glyphosate and non-Hodgkin's lymphoma were not "junk science" that should be excluded from a trial, the judge ruled. (7/10)

Houston Fire Department leaders on Tuesday proposed a sharp hike in ambulance fees, floating several new charges they hope will prevent repeat callers from using the city’s emergency medical services as a convenience. Ambulance transport fees would rise 70 percent, to $1,876; the accompanying $14.36-per-mile fee would not change. Aside from annual adjustments for inflation, it would be the first increase in the fees in six years. (Morris, 7/10)

Embattled conservative Rep. Jim Jordan is stepping up his efforts to fight accusations that he ignored sexual abuse decades ago, allegations that threaten to tarnish his reputation and undermine his standing in Congress. The Ohio Republican’s allies — from lawmakers on Capitol Hill to former wrestlers at Ohio State University — have released statements of support or gone on TV defending Jordan’s character. He has also hired a conservative-leaning public relations firm to help him deal with the media furor, Shirley & Banister Public Affairs. (Bade and Bresnahan, 7/10)

Angel Perez arrived at the river before sunrise, beating the other crabbers on the hunt at Matt's Landing in New Jersey, a popular spot to find  crustaceans near where the Maurice River meets the Delaware Bay. It was still morning on July 2 when he returned home with a haul of freshly snagged crabs and, unknown to him at the time, something much worse. By July 3, his right leg was swollen. Then it turned red and broke out in blisters. (Wootson, 7/10)

Losing money due to a Medicaid shortfall, South Shore Hospital sent a desperate plea to the state Tuesday, saying it needs $3 million in funding by Aug. 1 to avoid a shutdown. The small, 106-year-old nonprofit hospital, which serves mostly Medicaid patients on Chicago’s South Side, said it is falling behind in paying both doctors and vendors and would begin winding down operations without the appropriated state funding. (Channick, 7/10)

Verity Health System announced Tuesday it may sell some or all of its six hospitals as it works to fix the financial and operational problems that have dogged the safety-net provider for years. The Redwood City, Calif.-based health system has undergone significant ownership changes in recent years. One year ago, Los Angeles-based health technology company NantWorks, led by controversial entrepreneur Dr. Patrick Soon-Shiong, announced it had acquired a majority stake in Verity's management company. (Bannow, 7/10)

A dialysis company plans to pay $32 million to Minnetonka-based UnitedHealthcare as part of a settlement agreement after the nation’s largest health insurer alleged in lawsuits against the clinic operator schemes to receive higher payments for services. American Renal Associates (ARA), which is based in Massachusetts, did not admit wrongdoing or liability as part of the agreement, which calls for the parties to negotiate final terms by Aug. 1. (Snowbeck, 7/10)

In 2013, California had a shortage of 336 psychiatrists, according to national projections from the Health Resources and Services Administration, cited by the state Governor’s Office. ...Statistics from The Steinberg Institute, a local nonprofit focused on issues related to mental health and founded by Sacramento Mayor Darrell Steinberg, estimate that demand for psychiatry in the United States “will outstrip supply by 15,600 psychiatrists, or 25 percent” by 2025. (Holzer, 7/11)

Broadlawns Medical Center, Polk County’s public hospital, plans to spend $29 million to add a third floor to one of its main buildings, its leaders announced Tuesday. The expansion will be the latest step in a yearslong effort to improve the once-threadbare hospital. Broadlawns leaders said Tuesday that building a third floor onto to the Sands Building will add nearly 42,000 square feet. The project will include a new intensive care unit and birthing center, and it will allow the hospital to shift to all private rooms for medical and surgical patients. (Leys, 7/10)

Attorney General Maura Healey is raising concerns about the planned merger of Beth Israel Deaconess Medical Center and Lahey Health, a sign she may press for changes to the blockbuster deal. In a letter to the state’s health care watchdog agency, the attorney general said the hospital combination could increase health care costs and threaten access to care. (Dayal McCluskey, 7/10)

As the lockout at National Grid stretches into its third week, 1,250 out-of-work gas employees around the state are grappling with the loss of income and health insurance following the utility company’s decision to bar employees from working when contract negotiations stalled. One employee in Lowell who just found out he has a cancerous tumor in his bladder is unsure how he’s going to pay for surgery; another worker in Northborough is scrambling to get MassHealth to cover a biopsy for her 9-year-old daughter, who suffers from a rare lung disease. (Johnston, 7/11)

A Kansas City law firm filed a class action lawsuit Tuesday against Children’s Mercy Hospital after personal data from more than 60,000 individuals may have been compromised as part of an email phishing scam that targeted hospital employees. The suit, which was filed in Jackson County Circuit Court, is the fourth lawsuit filed by the firm McShane and Brady over the disclosure of patient medical records by the hospital. (Ryan, 7/10)

Health department officials announced Tuesday that a person working at The Back Corner, an entertainment venue at 1413 5th Ave. North, has been diagnosed with acute hepatitis A. The venue is located behind the popular eatery and bar 5th and Taylor. While the risk of contracting hepatitis A is low, Metro Public Health Department is issuing a public notice out of an abundance of caution, and will offer free hepatitis A vaccine to customers who visited The Back Corner on June 28, 29 or 30. Those customers have until July 14 to be vaccinated in time to protect against the virus.  (Alund, 7/10)

A school district northwest of San Antonio recently announced all high school students who plan to participate in extracurricular activities will be required to take a drug test. The students will be subject to one test at the end of July before activities begin, and additional random tests throughout the year. (Chavey, 7/10)

The Washington Medical Commission has reinstated, with restrictions, the medical license of  former Swedish Health neurosurgeon Dr. Johnny Delashaw. The commission ruled on July 5 that Delashaw, who was featured in a Seattle Times investigation about Swedish Health’s neuroscience unit, must submit to three years of oversight and cannot be employed in a position of medical leadership. The commission also ordered Delashaw to pay a $10,000 fine, agree to be evaluated for disruptive behavior and comply with recommendations from the evaluators. (Doughton, 7/10)

A doctor who practiced medicine in Houston pleaded not guilty to federal charges Tuesday that he aided in a wide-ranging fraud scheme that allegedly netted millions of dollars for pharmacies and allowed injured federal workers and members of the U.S. military to obtain pain medication that was not medically necessary. Dr. James Don Jackson, a general surgeon, is one of three doctors and 13 defendants under federal indictment for the alleged scam, which stretched from Houston to Atlanta and Columbus. (Banks, 7/10)

The controversial Texas law allowing students to bring guns into classrooms is facing another showdown as a lawsuit challenging the law heads to federal appeals court on Wednesday. ...The lawsuit, filed in federal court, sought to block the law and allow the professors to prohibit firearms in their classrooms. (Choi, 7/11)

What you pay at the pharmacy for generic drugs can vary widely based on where you live, according to a new analysis by the consumer website GoodRx. The study, which looked at 500 commonly used drugs in 30 American cities, highlights just how unpredictable drug prices can be. The cost of common drugs like the generic version of the cholesterol drug Zocor, or the diabetes drug metformin, differ significantly from coast to coast. (Thomas, 7/6)

On the surface, pharma’s latest ad and messaging campaign warns of a looming “cliff” for Medicare beneficiaries, suggesting that, unless Congress takes action, seniors’ out-of-pocket costs will soar. But, in a subtle mixing of messages, the ads also call for Congress to reduce the amount drug makers pay to cover drug costs for seniors in Medicare’s so-called donut hole. (Mershon, 7/10)

A handful of the world’s biggest drugmakers are canceling or reducing planned price increases in the U.S., following a new California drug pricing transparency law and continued political pressure over pharmaceutical costs. The California law, which began to take effect earlier this year, requires drugmakers to give insurers, governments and drug purchasers advance notice of large price increases, as a way of publicly pressuring pharmaceutical companies to keep prices down. In the past three weeks, Novartis AG, Gilead Sciences Inc., Roche Holding AG and Novo Nordisk A/S sent notices to California health plans rescinding or reducing previously announced price hikes on at least 10 drugs. (Elgin, Koons and Langreth, 7/10)

As pharmacy chains await Amazon.com Inc.’s entry into the prescription-drug market, the online retail giant is already undercutting them for non-prescription medicine for aches, colds and allergies. Median prices for over-the-counter, private-brand medicine sold by Walgreens Boots Alliance Inc. and CVS Health Corp. were about 20 percent higher than Basic Care, the over-the-counter drug line sold exclusively by Amazon, according to a report Friday by Jefferies Group analysts. (Kasumov, 7/6)

A tax policy group here is trying to rally outrage over last year’s Republican-backed tax cut by pointing to one of its main beneficiaries: the pharmaceutical industry. Americans for Tax Fairness, a coalition of left-leaning groups that advocate for placing a heavier tax burden on corporations and the wealthy, said in a report that drug companies are “among the biggest winners from the Trump-GOP tax cuts, but they are sharing few of the benefits with their employees and are offering no pricing relief to their customers.” (Facher, 7/9)

Medicare and Medicaid administrators earlier this year quietly killed a plan to pay for a breakthrough, half-million-dollar cancer treatment based on how well it worked, scuttling one of the Trump’s administration’s first and most highly touted attempts to lower the cost of drugs. The payment deal for Swiss drug giant Novartis' Kymriah therapy drew internal HHS scrutiny and is the target of current congressional investigations. (Karlin-Smith and Pittman, 7/8)

A key House panel is slated to consider on Wednesday a new packet of 340B legislation that would go further than previous measures to overhaul the controversial drug discount program. The bills on the docket include a long-negotiated measure by Rep. Chris Collins (R-N.Y.), who has led the House effort to curb the 340B program. Known shorthand as "patient definition," the proposal would designate in statute the patients who should qualify for the drug discount received by hospitals and clinics covered under 340B. (Luthi, 7/10)

A House panel that has been scrutinizing hospitals’ use of a drug discount program will examine on Wednesday  pieces of legislation that stem from members’ concerns over the discounts. The Energy and Commerce Committee’s oversight panel has had two hearings in the past year on the program, known as 340B. The committee has requested information from hospitals that participate and in January published a report outlining ways the drug discount program could be better run. (Siddons 7/9)

Kaiser Health News: State Prisons Fail To Offer Cure To 144,000 Inmates With Deadly Hepatitis C

State prisons across the U.S. are failing to treat at least 144,000 inmates who have hepatitis C, a curable but potentially fatal liver disease, according to a recent survey and subsequent interviews of state corrections departments. Many of the 49 states that responded to questions about inmates with hepatitis C cited high drug prices as the reason for denying treatment. The drugs can cost up to $90,000 for a course of treatment. Nationwide, roughly 97 percent of inmates with hepatitis C are not getting the cure, according to the survey conducted for a master’s project at the Toni Stabile Center for Investigative Journalism at Columbia University’s Graduate School of Journalism. (Thanthong-Knight, 7/9)

Possible conflicts of interest between the Kasich administration and CVS are fueling skepticism over whether Ohioans will see changes in a Medicaid setup that gives the national pharmacy company up to six times its actual cost of providing prescription drugs to Ohio’s poor and disabled. The relationships are shrouded in secrecy — in part because of confidentiality laws and in part because the administration of Gov. John Kasich has been less than forthcoming about critical aspects of CVS’s business with the state. (Candisky, Sullivan and Schladen, 7/8)

Millions of Americans are struggling to afford the medications they need, but efforts to bring down the cost of prescription drugs have been stymied by the efforts of special interests, which lobby against any real reform. The problem has been well documented. (Radelat, 7/9)

Three years ago, Kim Kardashian caused a ruckus when she touted a morning-sickness pill to her millions of followers on social media. Her posts failed to include any risk information, prompting regulators in the U.S. and Canada to issue stern warnings. Nonetheless, the gambit paid off handsomely. The faux pas, which was subsequently corrected, generated even more publicity for the Diclegis pill, and by the fall of 2015, sales jumped 21 percent to nearly $41.7 million, according to data from IQVIA, a market research firm. (Silverman, 7/10)

As frustration endures with prescription medicine costs, health plans are developing tools that highlight the best possible deal at the pharmacy counter. Bloomington-based HealthPartners launched one such program in 2017 in partnership with GoodRx, a company that gives consumers information about costs at rival pharmacies. Available via website or app, the tool shows a consumer’s out-of-pocket cost in the context of overall benefits, said Dr. Charlie Fazio, the medical director at HealthPartners. (Snowbeck, 7/7)

Like many of my fellow Republicans, I welcome the re-examinations of policy the Trump administration is bringing to Washington. As a physician, I especially appreciate the vocal recognition by the president that for many Americans, the prices of prescription drugs are simply too high. As a former member of Congress, I agree with those who also say we must ensure pharmaceutical companies can and will continue to pioneer the development of new drugs to help improve the health and well-being of Americans with serious, life-threatening, chronic, and disabling conditions. (Former Rep. Phil Gingrey, 7/5)

By conventional measures of stock prices, Amazon.com Inc. looks very expensive. It’s actually surprisingly cheap. Twenty-one years after it went public, a share of Amazon stock costs 70 times more than the company’s estimated per-share future earnings. That means investors are willing to pay much more for each dollar of Amazon’s earnings than for shares of Microsoft, Apple, Facebook, Alphabet or Alibaba. The everything store’s price-to-earnings ratio is four times higher than that of the S&P 500 index. (Matthew A. Winkler, 7/9)

When it comes to the persistent conversations about the U.S. drug crisis, one detailed conversation seems to be consistently disregarded. Exactly what substances are being used, and in what purity and potency. At face value, one may think that OxyContin is Oxycontin or heroin is heroin. But that couldn’t be further from the truth. If purchased from an individual or unlicensed dispensary, one actually has no idea what substances are mixed. For example, methamphetamines – which is included in many other distributed drugs – has largely shifted from homegrown labs in the U.S. (due to chemical regulation) to cartels in other countries. The result is that the purity of meth that is ingested by individuals has shifted from 39% purity in 2008 to more than 93% purity in 2018. (Nicole Fisher, 7/10)

As the chief pharmacy officer of a major health system, I’ve been aware of the financial shenanigans of pharmacy benefit managers, or PBMs, for some time. These companies are supposed to help control costs for payers and lower out-of-pocket costs for plan members. But as a team of investigative journalists with the Columbus Dispatch are revealing, some pharmacy benefit managers are skimming hundreds of millions of dollars in Ohio alone, boosting drug costs for everyone. The Dispatch team is shining much-needed light on the inner workings of pharmacy benefit managers. Even I have been surprised at what they have turned up. (Scott Knoer, 6/29)

Families across this country are struggling with rising prescription drug prices every day. Older Americans who rely on Medicare Part D — prescription drug coverage — take an average of 4.5 prescription medications and are hit particularly hard by these rising costs. Earlier this year, Congress took an important step to help reduce that financial burden on older Americans by passing the Bipartisan Budget Act of 2018 (BBA). The BBA closed the Medicare Part D coverage gap — known as the “doughnut hole” — in 2019, a year earlier than planned under the Affordable Care Act of 2010. (Leamond, 7/5)

With the Affordable Care Act under attack and all eyes on Dr. Atul Gawande as he starts this week as CEO of the new Amazon, JPMorgan, and Berkshire Hathaway venture, health care in the United States is more top of mind than ever. Surprisingly, a solution to reducing costs without government intervention and without reducing quality might be found in an unlikely place: India. We have visited more than two dozen hospitals and interviewed more than 125 executives across India and the U.S. We learned that some of the most proactive hospitals in the West are adopting the world-class innovations of Indian health care institutions in order to boost quality, lower costs, and expand access to the underserved — goals that have eluded U.S. policy makers for decades. (Vijay Govindarajan and Ravi Ramamurti, 7/10)

Much of the debate over the nomination of Brett Kavanaugh to succeed Anthony M. Kennedy on the Supreme Court will center on the fate of Roe v. Wade and the future of abortion rights in America. Nervous champions of the right to choose recall President Trump’s promise to only nominate “pro-life” judges to the court and marked Kavanaugh’s selection with a protest in front of the court. If Roe is overturned, the legality of abortion will be decided by individual states. How soon this might happen, and how many states would ban abortion, is not clear. (Carole Joffe, 7/10)

Fortunately I wasn’t drinking coffee on the train into work last week when I heard Sen. Susan Collins, R-Maine, say in a New York Times podcast that support for Roe v. Wade is “something like a 51-49” issue in America.The spittake would have drenched my fellow commuters and earned me a rough ejection at the next station. Susan Collins! The moderate supporter of abortion rights and a potential swing vote in the process to confirm President Donald Trump’s choice to replace retiring Justice Anthony Kennedy to the U.S. Supreme Court! So wrong about public opinion! (Eric Zorn, 7/11)

We need to mobilize in the states. For some reason, many abortion rights advocates have had a hard time grasping that the state level is where most abortion restrictions happen. If Roe is overturned, each state will be free to make its own laws. Every state election and every legislative session will become a battlefield. We need to get ready by electing legislators and governors now who support women’s reproductive rights. As of now, 17 states have laws that will ban or greatly restrict abortion the minute Roe is overturned. Only nine have laws to protect the right to an abortion regardless of Roe. We need to educate people today on the abortion politics of their state. If we wait until Roe is overturned, it will be too late. (Katha Pollitt, 7/10)

 Last night, while nominating Judge Brett Kavanaugh to the Supreme Court, Trump attempted to erase all the times he promised to appoint justices who would, in his words, “automatically” overturn Roe v. Wade — referring to the Constitution and the law, and denying that he asked Kavanaugh about his personal political beliefs. Maybe that’s because he’s finally listening to his staff. Maybe it’s because he read the polls showing that 70 percent of Americans believe abortion should be safe and legal, as it has been for 45 years. But I’m not buying Trump’s sales pitch on Kavanaugh, and neither should any U.S. Senator. (Dawn Laguens, 7/10)

Now that President Donald Trump has nominated Brett Kavanaugh to fill the United States Supreme Court seat recently vacated by Anthony Kennedy, an enormous amount of both hand-wringing and rejoicing (depending on one’s perspective) has begun with regard to the fate of Roe v. Wade, the landmark 1973 decision that fabricated a constitutional “right” to abortion. Much of this reaction is seriously misplaced, however, because both supporters and opponents of abortion rights misunderstand the meaning of Roe, and thus the implications of reversing it. (Kenneth Craycraft, 7/10)

On the other side of the aisle, liberals have never mustered the same level of discipline and far-sighted strategy, even though the court’s rulings also have direct implications for goals that liberals and Democrats claim to hold dear. Abortion and guns, to take just two, directly affect the lives of millions of Americans. A sincere commitment to upholding reproductive rights or enacting sane gun control — or protecting the environment, or upholding civil rights, or any number of other good causes — would require the same strategic approach to the judiciary as conservatives have shown, and the same willingness to subordinate short-term disagreements to long-term goals. (7/10)

Democracy happens in the trenches. Those officials make millions of decisions about the world we build together. Most don’t ever come near the Supreme Court. Voters must start caring more about these elections. Turnout in presidential election years hovers between 50 and 60 percent: an appalling baseline. Some (but not all) of that is due to unjustified restrictions on the franchise. But participation drops like a rock for other elections, and that’s difficult to blame on barriers alone. A Gallup poll two weeks ago asked whether voters were “absolutely certain” to vote in this fall’s midterm elections — and got the second most feeble response in 60 years.The lack of attention to downballot elections is part of what makes Justice Kennedy’s retirement so massively meaningful. But perhaps the fight over his successor will help progressives realize the urgency of fighting on other fronts as well. (Justin Levitt, 7/10)

As Judge Brett Kavanaugh’s Supreme Court nomination tees up another national debate about reproductive rights, is it too much to ask that abortion’s impact on the black population be part of the discussion? When the Supreme Court decided Roe v. Wade in 1973, polling showed that blacks were less likely than whites to support abortion. Sixties-era civil rights activists like Fannie Lou Hamer and Whitney Young had denounced the procedure as a form of genocide. Jesse Jackson called abortion “murder” and once told a black newspaper in Chicago that “we used to look for death from the man in the blue coat and now it comes in a white coat.” (Jason L. Riley, 7/10)

Over the weekend arrived some fresh political fury that the Trump Administration is trying to sabotage ObamaCare by suspending something called “risk adjustment” payments. Not so much. (7/10)

A campaign to sabotage the Affordable Care Act took another step forward over the weekend when the Trump administration announced it will indefinitely suspend “risk adjustment payments.” That’s bad news for the chronically ill, the disabled, the elderly and all others whose health care costs can run considerably higher than average. It’s bad news, as well, for all Americans who believe that nobody should be priced out of basic health care just to save the rest of us a buck. (7/10)

Seemingly every move the Trump administration has made when it comes to healthcare has been designed to maximize the harm to the insurance programs launched or expanded under Obamacare. In addition to the president’s (thus far unsuccessful) efforts to repeal the law outright, the Department of Health and Human Services has taken a series of administrative actions that undermine one the law’s main features: the state exchanges where Americans not covered by large employer health plans can shop for policies. The moves have caused plenty of anxiety, yet the exchanges are enduring. In fact, this year some insurers are expanding their offerings. But insurers are also responding with higher premiums, making coverage significantly more expensive for some of the Americans who shop there and — because the government subsidizes low-income consumers in the exchanges — driving up the cost to federal taxpayers. (7/10)

Who would have thought the retirement of a single U.S. Supreme Court justice could effectively decide whether you’re eligible for health insurance if you have a pre-existing medical condition? It sounds a little far-fetched, but it seems to be where we’re headed. There was a time when insurance companies refused coverage or jacked up the rates for people who had pre-existing conditions such as cancer, diabetes, HIV or Alzheimer’s and even for babies born with a congenital heart disease. That was insanity. Treating sickness — and paying for it — is the very reason why people have insurance in the first place. Despite its flaws, the Affordable Care Act effectively made insurance companies cover people no matter their medical history. The outcome has been a good one. (Katy Caldwell, 7/11)

If a child experiences an adverse event the young brain can recover and is remarkably resilient in large part due to the social-emotional buffering provided by a strong, loving parent relationship. But when you fracture that relationship by separating a parent and their child, the resiliency of the young brain erodes and if pro-longed, permanently changes the brain architecture. (Jaime Peterson, 7/10)

It turns out that the number of separated children is closer to 3,000 than the 2,000 originally cited by administration officials. Among them are about 100 under the age of 5. In dozens of those cases, parents have been deported minus their children, or HHS has apparently lost track of them. The results are abominations, like what happened Friday when a 1-year-old boy, sipping from a bottle of milk and playing with a blue ball, appeared as an immigration defendant before a judge in Phoenix. The child's father had been shipped off to Honduras. Small wonder that two out of three Americans abhor what Trump has done with these children. (7/9)

In 2015, the American Journal of Preventative Medicine published a study demonstrating that women experiencing homelessness in Massachusetts have a rate of cervical cancer diagnosis that is 4.4 times higher than the general population, and a rate of death from cervical cancer that is six times higher. Given that homeless women are much more likely to die of this potentially preventable cancer, screening for cervical cancer is an urgent priority for our patients. (Aura Obando, 7/10)

Truth be told, there has never been a public health concern, in any nation, resulting from an infant being denied formula as is being suggested in the context of marketing regulations. As pediatricians and neonatologists, the crisis we contend with is not a denial of formula. It is a lack of understanding of the remarkable ease by which breastfeeding is derailed in the earliest phase of initiation and, subsequently, the chances of success are terminally interrupted. (Nana Matoba and Daniel Robinson, 7/10)

Race associations are as common in medical training, from lectures and prep books to practice tests and board exams, as they are unquestioned. An analysis of a licensing exam question bank found that the number one disease associated with white patients is cystic fibrosis. Black patients are most commonly coupled with sickle cell and sarcoidosis. These ties are so recognizable they’ve been turned into jokes. Such racial associations are simple — too simple. They aren’t helping students learn and they might be harming patients. It’s hard to think outside the box when everything you’ve been taught fits inside it. The trouble is that no genetic mutation or disease is specific to race. (Jennifer W. Tsai, 7/11)

As insurance reimbursement for primary care has been rapidly outrun by reimbursement for specialists, it is difficult to convince the best and brightest to go into primary care. Today’s primary care physicians are expected to see an unrealistic number of patients every day, and usually can’t spend enough time with each. (Paula Stillman, 7/10)

Last September, three months pregnant with my first child, I began to feel shooting pains in my abdomen. I surmised that this was round ligament pain, a typical pregnancy symptom that occurs as the uterus expands. Later that night, wondering when I could expect the pain to subside, I Googled “round ligament pain how long.” The top results were from pregnancy message boards, where women asked (and answered) a flurry of questions: Is it normal to have round ligament pain all day? Could it feel like a constant ache instead of sharp pangs? Can one experience it as early as the first trimester? I clicked on post after post, reading about the experiences of dozens of women, and learned that the pain would probably subside by the third trimester. (Anna Wexler, 7/10)

The best way to ensure that gene-drive technology is developed safely is to discuss it openly — in laboratories, within governments, and in public. Engaging nonprofit organizations like the Foundation for the National Institutes of Health contributes to safeguarding public interest in this emerging disease-fighting tool. With so many people suffering from malaria every year, we cannot afford to leave this potential new tool unexplored. But we must do it the right way. (Anthony A. James, 7/10)