The New York Times: Immigrants, The Poor And Minorities Gain Sharply Under Health Act
The first full year of the Affordable Care Act brought historic increases in coverage for low-wage workers and others who have long been left out of the health care system, a New York Times analysis has found. Immigrants of all backgrounds — including more than a million legal residents who are not citizens — had the sharpest rise in coverage rates. Hispanics, a coveted group of voters this election year, accounted for nearly a third of the increase in adults with insurance. That was the single largest share of any racial or ethnic group, far greater than their 17 percent share of the population. (Tavernise and Gebeloff, 4/17)

The Wall Street Journal: UnitedHealth To Stop Offering Affordable Care Act Plans In Michigan In 2017
UnitedHealth Group Inc. will stop offering Affordable Care Act plans in Michigan in 2017, marking the third in a growing tally of states where the biggest U.S. insurer will withdraw from the health law’s marketplaces. Andrea Miller, a spokeswoman for the Michigan Department of Insurance and Financial Services, said the insurer planned to pull out of the individual insurance market in the state. Regulators in Arkansas and Georgia earlier said UnitedHealth had informed them it would no longer sell the ACA plans in their states. (Wilde Mathews, 4/15)

Meanwhile, a look at where the remaining Republican presidential candidates stand on the health law and other issues —

McClatchy: How GOP Presidential Candidates Compare On Health Care Issues
Six years after the passage of the Affordable Care Act, “Obamacare,” the nation’s health care remains at the center of political debate. Here’s a look at how the three remaining Republican presidential candidates view Obamacare, the cost of prescription drugs, the role of Medicare and Medicaid in confronting the nation’s provision of medical services, and abortion. (Douglas and Recio, 4/17)

Arkansas News: Supporters Of Medicaid Plan Asked To Vote Against It To Save It
The state Legislature’s fiscal session hit a snag on its second day last week, and the leading strategy that has emerged for resolving that snag is somewhat counter-intuitive. In a nutshell, supporters of Gov. Asa Hutchinson’s plan to continue and modify Arkansas’ Medicaid expansion program are being asked to vote against funding the plan to save it. (Lyon, 4/17)

The Associated Press: Governor Defends Line-Item Veto Plan For Medicaid Expansion
Gov. Asa Hutchinson says a plan aimed at allowing him to reinstate Arkansas' hybrid Medicaid expansion if it's defunded is the best chance lawmakers have at quickly resolving a budget standoff over the program. The Republican governor on Friday defended a plan to add a provision to Medicaid's budget that would defund the expansion, which uses federal funds to purchase private insurance for the poor. Hutchinson has said he'll veto that provision if the bill is approved by the Legislature, which would then allow the Legislature to effectively fund the program with a simple majority by upholding his veto. (DeMillo, 4/15)

Arkansas Democrat Gazette: Medicaid Strategy Faces Test In Session's Gridlock
After a four-day break, the Republican-dominated Legislature on Tuesday will resume tackling whether to proceed with Gov. Asa Hutchinson's line-item veto strategy as a means to allow the use of federal Medicaid funds to purchase private health insurance for low-income Arkansans in the next fiscal year. ... the Senate on Thursday failed to pass the state Department of Human Services' Medical Services Division appropriation as is, with the private-option funding intact. (Wickline, 4/17)

The Cleveland Plain Dealer: Public Debate Opens On Proposal To Make Ohio Medicaid Recipients Pay For Care
Gov. John Kasich's administration today filed a detailed draft of changes to the state's Medicaid program, kicking off public debate over a requirement that beneficiaries make monthly payments or lose their coverage. ... The proposal is already fueling a fiery debate in communities statewide. Supporters say it injects needed personal responsibility into the program and will help pare Medicaid's ever-rising costs. Opponents argue it undermines recent progress in expanding access to Medicaid and will erect a cost barrier in front of people who can least afford it. (Ross, 4/15)

The Concord Monitor: PolitiFact: Republican State Rep. Cites High Medicaid Enrollment In Two NH Counties
At a news conference last month, U.S. House candidate and state Rep. Jack Flanagan explained his vote to continue the state’s expanded Medicaid program. Flanagan, a Republican, supported the legislation because those in the second congressional district were relying on the expanded plan, he told reporters. (Wirestone, 4/15)

The New York Times: Bronx Needle Exchange, Once Dismissed, Finds Acceptance
When Joyce A. Rivera decided in 1990 to confront the AIDS epidemic that had claimed her brother’s life, she teamed up with unlikely allies: two drug dealers in the South Bronx. First, she educated them on how dirty needles and unprotected sex spread H.I.V., which causes AIDS. Then, she wound up distributing clean syringes to their customers in Mott Haven. ... Back then, her needle exchange program — St. Ann’s Corner of Harm Reduction — operated on the fringes of an impoverished minority community. The public saw her efforts as enabling drug users who would be better off behind bars. Today, her methods are viewed as part of an effective public health strategy that prevents the spread of disease and offers addicts help. (Gonzalez, 4/17)

PBS NewsHour: As Opioid Epidemic Worsens, Rethinking How Doctors Are Taught To Treat Pain
Pain is the most common reason that people go to the doctor. Yet physicians and medical students have limited training in pain management and prescribing opioids. As the nation suffers from an opioid epidemic, people within the medical field are reexamining what doctors are taught about pain. NewsHour Weekend's Christopher Booker reports. (4/17)

Elsewhere, media outlets offer coverage of the epidemic from the states —

New Hampshire Public Radio: Expert Says N.H. Opioid Prescribing Rules Are On Track, But Adds Some Cautionary Notes
Heroin pills. That’s how Andrew Kolodny describes oxycodone, one of the most widely prescribed – and abused – narcotic painkillers in the U.S. Kolodny is executive director of Physicians for Responsible Opioid Prescribing and senior scientist at the Heller School for Social Policy and Management at Brandeis University. He joined The Exchange this week to discuss the opioid crisis – its origins and how states, including New Hampshire, are trying to overcome it. (4/15)

The Houston Chronicle: State Sees Increase In Newborns Exposed To Opioids
Jessica had been hooked on heroin for two years when she found out she was 41/2 months pregnant. Shortly afterward, while in prison, she decided to start taking methadone to treat her addiction. She had been told if she quit cold turkey, she had a higher chance of miscarrying. But she was also told her baby would go through withdrawal once he or she was born because of the exposure to methadone, which — like heroin — is an opioid. (Rigg, 4/17)

The Associated Press: Wisconsin Nurses Slower To Self-Report Drug Abuse
The first time Ann Stanton stole drugs, she says, came after she watched one of her patients die in intensive care. Feeling responsible, she pocketed pain medication intended for an elderly patient soon after, setting off a six-month run of stealing that didn't end until she was caught in a hospital bathroom injecting a drug often used to treat anxiety disorders. (Godar, 4/17)

The Washington Post: Stronger, Potentially Lethal Heroin Shows Up In Rural Virginia
Authorities in Culpeper County, Va., recorded 11 heroin overdoses in the first 12 days of the month. Then, on Wednesday, three happened in the span of a day. Sheriff Scott H. Jenkins said investigators suspect a stronger-than-normal heroin — or one that is mixed with a synthetic opioid — is to blame. “I ask citizens to be alert to the symptoms of heroin use,” he said in a press release. “If you have friends or family that you suspect may be abusing heroin, or might abuse heroin, talk to them about this dangerous drug on the streets now.” (St. Martin, 4/15)

Los Angeles Times: Deaths From Powerful Opiate Fentanyl Rise In Los Angeles County
There are signs that deaths connected to fentanyl, a powerful painkiller tied to a string of fatal overdoses in Northern California, are on the rise in the Los Angeles area, law enforcement and health officials said this week. The drug, an opiate used on patients after surgery that’s up to 100 times stronger than morphine, is appearing now more than ever in overdoses in California as a prescription drug abuse epidemic evolves nationwide. (Serna, 4/16)

The Milwaukee Journal-Sentinel: Senate Hearing Searches For Common Ground On Heroin Scourge
To Republican U.S. Sen. Ron Johnson, the salient issue raised in Wisconsin by the nation's heroin and opioid epidemic is one of public safety. "Our borders are not secure," said Johnson, who as chairman of the Senate Committee on Homeland Security & Government Affairs held a field hearing on Friday at Waukesha County Technical College. (Stephenson, 4/15)

Minnesota Public Radio: Here's Why Minnesota Has A Big Problem With Opioid Overdoses
Deaths from opioid drug overdoses have hit epidemic proportions nationwide. In March, the Centers for Disease Control and Prevention for the first time urged doctors to avoid prescribing opiate painkillers for chronic pain, warning that the risks outweighed the benefits for most people. (Collins, 4/18)

The Associated Press: Connecticut To Expand Methadone Treatment For Prisoners
Connecticut officials are planning to expand methadone treatment to prisoners across the state over the next year or so, in what authorities believe would be the first statewide program in the country to use the drug to help prisoners avoid harsh withdrawal symptoms and overdoses. (Collins, 4/17)

St. Louis Public Radio: When Cracking Down On Opioids Means Tougher Access For Sickle Cell Patients
Growing up, as the searing pain of a sickle cell crisis would spread through her veins, Tanjila Bolden-Myers would ask her mother if this time, it would kill her. “I ask her now to this day, ‘Mom, how did you look me in my face and not break? Every time I asked you that?’” said Bolden-Myers, now 38. “And she was like, ‘No, baby, you’re not going to die this time. You’re not going to die.’” (Bouscaren and Hidalgo, 4/16)

The Kansas City Star: Slipping Away: As Schizophrenia Consumed Melinda Kavanaugh, Family And System Couldn’t Help
Mom was sick again. The 11-year-old boy riding with her in a cab bound for the Kansas City airport hoped somehow it wasn’t true. How could this be? How was she getting plane tickets to California? How could they really be going to Disneyland, completely out of the blue? (Robertson, 4/17)

In other news, New York's NYC Safe program worries mental health advocates —

The Associated Press: NYC Listing Of Potentially Violent Mentally Ill Stirs Qualms
When a homeless man was taken for a psychiatric evaluation because he argued with shelter police, doctors found no reason to commit him. Then City Hall stepped in. At the urging of a mayoral aide who cited a new city program to monitor mentally ill people considered potentially violent, the man was involuntarily hospitalized for a week. ... The case crystallizes the unease that has surrounded the NYC Safe program since Mayor Bill de Blasio launched it last summer after some high-profile attacks raised alarm about the mentally ill. The program — apparently unique among American cities — keeps tabs on a roster of people with psychiatric problems and a history of violence, hoping to help them before they reach a breaking point. (Pearson and Peltz, 4/18)

The Washington Post: The Most Unexpected Hospital Billing Development Ever: Refunds
At Geisinger Health System in Pennsylvania, hospital officials want to keep their customers happy. So when patients are upset about a long wait in the emergency department, or a doctor’s brusque manner, or a meal that never arrived in a room, Geisinger is doing more than apologizing. It’s offering money back on their care, no questions asked. (Sun, 4/15)

The Washington Post's Wonkblog: Perinatal Hospice Care Prepares Parents For The End, At Life’s Beginning
The baby who would soon die arrived at 34 weeks, eyes shut, squawking. Her father cut the umbilical cord with a pair of silver scissors. A priest in blue scrubs sprinkled Holy Water on her forehead. A photographer circled the delivery room, capturing her last moments. And Cathleen Warner quietly marveled: My baby is crying. ... This is perinatal hospice, a birth plan that revolves around death. Thanks to increasingly sophisticated diagnostics, families today can confront tragedy with advance notice — and a decision: Should they terminate a pregnancy that cannot sustain life? Or deliver a baby who won’t survive long outside the womb? (Paquette, 4/16)

The Associated Press: As Clinic Access Tightens, Group Touts Pregnancy-Ending Drug
The tightening of restrictions on abortion clinics in many states has emboldened some abortion rights advocates to launch an outreach effort, reminding women they have relatively safe and effective means of ending a pregnancy on their own through use of a miscarriage-inducing drug. Anti-abortion groups are wary of the phenomenon, disavowing any drive to prosecute women who self-abort but favoring crackdowns on illegal distribution of the drug. Even in the abortion rights community, the outreach effort has raised some concerns. (Crary, 4/15)

Elsewhere, a new ban in Mississippi is signed into law —

The Associated Press: Bryant Signs Bill Banning Second-Trimester Abortion Method
Mississippi's governor has signed into law a ban on a commonly used second-trimester abortion procedure, setting the state up for a possible legal challenge. Gov. Phil Bryant signed the law Friday that outlaws a procedure called "dilation and evacuation" unless it is necessary to prevent a woman's irreversible physical impairment. (4/15)

The Connecticut Mirror: Proposed Children’s Dental Cut Threatens CT’s Turnaround
Connecticut leads the nation in the percentage of kids covered by Medicaid who go to the dentist – a dramatic change from a decade ago, when the state ranked near the bottom, according to a national report. Other studies have found significant improvements in poor children's oral health over that time. But dentists and advocates say that progress could be set back under a proposal by Gov. Dannel P. Malloy to cut by 10 percent the Medicaid payment rates for children’s dental care. (Levin Becker, 4/18)

The Associated Press: Connecticut Dentists Say Proposed Cuts Could Hurt Needy Kids
The Democratic governor included a 10 percent cut in the reimbursement for children's dental services provided under the state's HUSKY health insurance program in the revised, $19.7 billion budget plan he released on Tuesday to help cover a projected $922 million deficit. The Connecticut State Dental Association, which represents 2,200, or 64 percent of the state's dentists, contends any reduction will discourage dentists from serving poor residents. (Haigh, 4/16)

The Associated Press: Revenue-Sharing Cut, Medicaid Reform Measures Passed By Alaska Lawmakers
A bill aimed at curbing and containing costs within Alaska's Medicaid program passed the Legislature Sunday. It was one of the major reform bills targeted by legislators this session. Others, aimed at oil and gas tax credits and the criminal justice system, were pending. The sprawling bill includes provisions geared toward ferreting out fraud and waste and bringing down state costs. Among other things, it calls for a primary care case management system to increase use of appropriate primary and preventative care and decrease unnecessary use of specialty care and emergency services. (4/17)

The Associated Press: Kansas Faces Questions About Future Of State Mental Hospital
A rolling landscape and tree-dotted vistas belie a flurry of activity at the state mental hospital in eastern Kansas, as administrators and employees work to bring it back into line with federal standards this summer and officials ponder its longer-term future. (Hanna, 4/16)

WBAY: State Documents Reveal Months-Long Gap In Reporting Elizabethkingia Outbreak
The State of Wisconsin’s Department of Health Services began investigating the Elizabethkingia outbreak in December 2015, several months before it was reported to the public, according to documents released to Action 2 News. Action 2 News made an open records request for documents detailing the state’s response to the potentially deadly bloodstream infection. (Hay and Roberts, 4/15)

The Orlando Sentinel: Orlando Health Issues $315 Million In Bonds
Orlando Health issued $315 million in bonds on Thursday to refinance some of its existing debt. This the health system's largest-ever debt offering. It comes shortly after it received an upgrade in credit ratings from A3 to A2 with a stable outlook by Moddy's Investment Services. (Miller, 4/16)

The Concord Monitor: Scientists Investigating Potential Link Between Toxic Cyanobacteria And ALS
Years ago, Dartmouth ALS doctor and researcher Elijah Stommel started noticing an unusual pattern around some of New Hampshire’s lakes and ponds. (Nilsen, 4/17)

The Associated Press: Vermont Health Care Providers Test Patient-Monitoring App
Vermont doctors and health care providers can now monitor if their patient has entered an emergency room or been admitted to a hospital or nursing home with a new online app. PatientPing is being used around the state in a pilot program supported by a federal grant. Before, health care providers had relied on phone calls or faxes to get that information about their patients. But that didn't always happen. (Rathke, 4/17)

The Columbus Dispatch: Nursing Assistants In Ohio Have Some Of The Toughest Work, Lowest Pay
Nursing assistants do some of the most intimate, as well as physically and emotionally draining, work in nursing homes. They make sure residents are bathed, groomed and dressed; lift them from their beds; and take them to meals, activities and medical and therapy appointments. Yet they earn near-poverty wages, work unpredictable hours, get limited training and are given little on-the-job support, according to a new report by PHI, the Paraprofessional Healthcare Institute, a New York advocacy group of home-care workers. (Pyle, 4/18)

New Hampshire Public Radio: Belknap County Nursing Home Employees Vote Down Labor Deal
Belknap County Nursing Home employees have voted down a proposed labor agreement. Chapter president Tanya Phillips says the proposal from the Belknap County Commissioners didn't add up for workers, because the additional health care costs would have more than offset the proposed wage increases. (Carlson, 4/17)

The Orlando Sentinel: Mosquito Control, Public Education At Forefront Of Fight Against Zika
Amador Rodriguez bent down next to a plastic bucket in the woods and suctioned a sample of brown water with a turkey baster. "Ouch. That one just got me," Rodriguez said, pointing to a mosquito and a fresh bloody spot on his forearm. (Jacobson, 4/16)

The New York Times: Geography’s Role In The Life Expectancy Of The Poor
An important new study shows that the poor in some cities, like New York and San Francisco, live longer than those with similar incomes in places like Detroit and Oklahoma City. The findings could help local and state governments figure out what they can do, or do better, to help people live longer and healthier lives. Researchers long ago found that the rich tend to live longer than the poor. What’s striking about the new research, which was published last week in The Journal of the American Medical Association, is that where people live also makes a big difference. (4/18)

Lexington Herald Leader: Inequality Makes Ky. Sick
Another General Assembly has adjourned without tackling the addiction that kills the most Kentuckians — tobacco. We are reminded of this by the 2016 County Health Rankings released last month; the places where smoking rates are highest have the worst health outcomes. We’re reminded also by The Washington Post’s exploration of why death rates are rising among rural women. A complex web of stressors, opioid addiction (thanks again, Purdue Pharma) and suicide help account for why death rates among rural white women are outpacing those of men and urban women. One of the killers is smoking; lung cancer kills more women than breast cancer. (4/15)

Los Angeles Times: Watch The U.S. Age Before Your Eyes In This Amazing Animated Graphic
The World Economic Forum reproduced Holzman's graphic for a discussion of the implications of the trend, which roughly parallels that in the rest of the world. "The potential consequences of an aging population," observes the WEF, "include economic pressure on healthcare and other welfare systems and a much smaller working-age population relative to the elderly." (Michael Hiltzik, 4/16)

Stat: Children’s Cancer Research Is Often Ignored. Make It A ‘Moonshot’ Priority
Cancer is the leading disease-related cause of death in children in the United States. Yet pediatric cancer is often left behind when it comes to funding research and developing new drugs. Not only does this give short shrift to children with cancer, but it also threatens to rob us of advances that could benefit cancer patients of all ages. That’s what I and fellow members of the Coalition for Pediatric Medical Research told the staff of Vice President Joe Biden, who is leading the cancer “moonshot.” We recently met in Biden’s Washington office to make the case that childhood cancer must be represented as the government considers ways to propel cancer research. (David A. Williams, 4/14)

Modern Healthcare: CMS' Bold Gamble On Primary Care
The skeptics were out in force last week when the CMS launched a major expansion of its comprehensive primary care initiative. They are way off base. It is a bold move and long overdue. Rank-and-file primary-care physicians—not only the limited number who participate in accountable care organizations—need significant financial incentives to coordinate care if we're going to dismantle our wasteful and inefficient fee-for-service payment system. Even if the program doesn't save money, it's the right thing to do for patients and the healthcare system. (Merrill Goozner, 4/16)

The Concord Monitor: Editorial: In Health Emergencies, Transparency Is Crucial
In the late 1970s, the nation belatedly learned about Love Canal, the toxic waste dump near Niagara Falls that sickened hundreds of people and led to a whole neighborhood being demolished. (4/17)

The Huffington Post: This One Line Sums Up The Big Clinton-Sanders Policy Argument
If you want to know why so many liberal policy wonks are exasperated with Sen. Bernie Sanders (I-Vt.) — and why so many Sanders supporters are exasperated with liberal policy wonks — you’ll find the answer in an unexciting but revealing statement Hillary Clinton made during Thursday night’s debate in Brooklyn. The subject was a familiar one: health care. (Jonathan Cohn, 4/17)

Los Angeles Times: You're Taking Care Of Someone With Alzheimer's, But Who Is Taking Care Of You?
After Ronald Reagan became America's most recognizable Alzheimer's patient, well-meaning friends, relatives and even strangers would routinely stop his daughter, Patti Davis, to ask: "How is he doing?" Only occasionally would someone ask, "And how are you doing?" (Rene Lynch, 4/16)

The New York Times: How Getting High Made Me A Better Caregiver
I’m 74 years old, and I have smoked marijuana almost every day since dinosaurs roamed the earth in the early ’70s. When my awareness is heightened, I’m on my game — the best I can be at thinking creatively, making decisions, focusing on my work, seeing the big picture ... and caregiving. For 20 years my wife, Anne, has struggled gallantly against the physical, cognitive, emotional and spiritual depredations of Parkinson’s disease. For the first 15, I took care of her myself. Now I have lots of help. Either way, enjoying a hit or two on the pipe every couple of hours has granted me tens of thousands of sweet clemencies that keep me from burning out as a caregiver. (Tom Huth, 4/16)

Politico: A Better Way To Provide Health Care To Our Troops
A core tenet of keeping faith with the men and women who serve in the United States military and their families is to provide them with the best quality health care. It is a central tenet of our promise to those who serve and sacrifice to defend the nation. In recent years, however, the defense health system has not kept pace with cutting-edge developments in civilian health care that help to deliver better health outcomes. (Michele Flournoy and Stephen Ondra, 4/18)

Arkansas Times: The Line-Item Veto Plan Continues The Medicaid Expansion And Gives The Tea Party Ten Nothing
The governor and the overwhelming majority of the legislature — all Democrats and a majority of Republicans — support continuing the private option via "Arkansas Works," signed into law last week. The private option has cut the state's uninsured rate by more than half, brings in billions of federal dollars into the state's economy, saves hospitals hundreds of millions in uncompensated care costs, and saves hundreds of millions more for the state budget. However, a rump group of ten Republican senators are so committed to taking health coverage away from those 267,000 people that they have threatened to shut down the entire Medicaid program unless the majority caves to their demands. The governor's proposed line-item-veto maneuver would allow the Tea Party Ten to make a meaningless show vote. (David Ramsey, 4/16)

The Washington Post: How Alexandria Can Cope With The State’s Failure To Expand Medicaid
The Virginia General Assembly adjourned this month without expanding Medicaid. This is a clear challenge to the city of Alexandria’s fiscal and economic vitality, and, more important, it is a significant threat to the health, well-being and quality of life of many of our most vulnerable and economically disadvantaged citizens. (Dan Hawkins, Richard Merritt and William D. Euille, 4/15)

The Concord Monitor: Our Turn: Stop The Attacks On Planned Parenthood
For decades, Planned Parenthood has won bipartisan support across the Granite State and nationwide for its dedication to providing women with accessible, affordable reproductive health care, which is essential to the economic security and vitality of our families. (Jeanne Shaheen and Maggie Hassan, 4/16)

Lexington Herald Leader: Lots Of Missing People If A Zygote Is Really A Person
Dr. A. Patrick Schneider II, in his attempt to claim “personhood” for a fertilized egg, is the one who actually ignores science in his April 4 commentary, “When life begins: Science ignored.” Here is what, to use his expression, “science really says.” Fertilization is the process in which a spermatozoon and ovum (egg) fuse, with the resultant entity designated a zygote. Conception, which is the onset of pregnancy, begins when the zygote, which has now developed into a blastocyst, implants in the endometrium of the uterus; typically occurring approximately seven days after fertilization. Biomedical science estimates that nature aborts about 55 percent of all fertilized eggs (zygotes) before they can be implanted in the endometrium, likely due to genetic abnormalities. (Dr. David Nash, 4/17)