The New York Times: Trump Declares Commitment To Ending Opioid Crisis ‘Once And For All'
President Trump, after a week devoted to criticizing the Mueller report and investigations by congressional Democrats, turned on Wednesday to a policy matter, vowing to “smash the grip of addiction” caused by the opioid epidemic. Addressing a conference of health professionals and addiction specialists in Atlanta, Mr. Trump promised to provide more funding for treatment, stronger scrutiny of what he called Big Pharma and tougher interdiction of drugs at the border with Mexico. (Tackett and Sullivan, 4/24)

The Associated Press: Trump To Keep Fighting Opioids 'Until Our Job Is Done'
"My administration is deploying every resource at our disposal to empower you, to support you and to fight right by your side," Trump said. "We will not solve this epidemic overnight but we will stop. ... There's just nothing going to stop us, no matter how you cut it." Before leaving the White House for the Atlanta event, Trump claimed credit for progress in combating the drug scourge. (Freking and Superville, 4/24)

Georgia Health News: Trump Headlines Emotional Atlanta Summit On Opioid Crisis
Trump pointed out that his administration has allowed states to use Medicaid dollars to pay for residential treatment, and that thousands of inmates have received addiction services through the recently passed criminal justice reform. Trump also discussed shutting down illegal online drug-selling networks and implementing more aggressive efforts to seize illegal drugs. The president said $19 million in cocaine was recently seized at the Port of Savannah. And he added that his border security initiative would help stop the flow of heroin into this country. On a related note, he mentioned that China, a major source of fentanyl, recently vowed to crack down on manufacture of the drug. (Miller, 4/24)

Reuters: Trump Says He Is Holding Big Pharma Accountable In Opioid Fight
On Tuesday, the government charged drug distributor Rochester Drug Co-operative Inc and company executives for their role in fueling the epidemic. The company agreed to pay $20 million and enter a deferred prosecution agreement to resolve charges it turned a blind eye to thousands of suspicious orders for opioid pain killers. "We are holding big Pharma accountable," Trump said at the Rx Drug Abuse and Heroin Summit in Atlanta. (Rampton, 4/24)

The Washington Post: Trump Defends Administration's Response To Opioid Crisis: ‘We Will Never Stop Until Our Job Is Done’
While accusing pharmaceutical companies of “rigging the system against our great seniors,” Trump also slipped in a veiled reference to special counsel Robert S. Mueller III’s Russia probe, telling the crowd, “I know all about rigging the system because I had the system rigged on me.” Then, demonstrating the canny instincts of a TV producer, he offered a faux lament: “Unfortunately, that will be your sound bite tonight.” (Parker and Sonmez, 4/24)

The Hill: Trump Vows To 'Smash The Grip' Of Drug Addiction
First lady Melania Trump, who also spoke at the summit, said her husband “cares deeply” about fighting the opioid epidemic. (Sullivan, 4/24)

Stat: The Authors Of The CDC’s Opioid Guidelines Say They’ve Been Misapplied
The authors of influential federal guidelines for opioid prescriptions for chronic pain said Wednesday that doctors and others in the health care system had wrongly implemented their recommendations and cut off patients who should have received pain medication. “Unfortunately, some policies and practices purportedly derived from the guideline have in fact been inconsistent with, and often go beyond, its recommendations,” the researchers wrote in a paper published in the New England Journal of Medicine. (Joseph and Silverman, 4/24)

USA Today: CDC: Doctors Were Too Cautious About Opioid Pain Pill Prescribing
The Centers for Disease Control and Prevention, in new guidance for opioid prescribing, said many physicians were guilty of a "misapplication" of 2016 guidelines that clamped down on the use of opioids. The new guidelines, published in the New England Journal of Medicine, was the latest federal acknowledgement that many physicians' responses to the opioid crisis went too far. Former Food and Drug Administration commissioner Scott Gottlieb, a physician, spoke out last July about the impact the opioid crisis response had on pain patients when he called for development of more options. (O'Donnell and Alltucker, 4/24)

The Associated Press: Feds Intend To Sue Tennessee Lawmaker Over Pain Clinics
Federal prosecutors said this week they intend to file a lawsuit against a Tennessee state senator and other co-owners of a now-shuttered pain clinic company. Court filings said Comprehensive Pain Specialists, which was based in Tennessee and once operated in 12 states, defrauded the government of millions of dollars by submitting claims for unnecessary procedures and falsifying documents. (Loller, 4/24)

The Center for Investigative Reporting: Rehab Patients' Unpaid Work For Big Companies Likely Illegal
A nationally renowned drug rehab program in Texas and Louisiana has sent patients struggling with addiction to work for free for some of the biggest companies in America, likely in violation of federal labor law. The Cenikor Foundation has dispatched tens of thousands of patients to work without pay at more than 300 for-profit companies over the years. In the name of rehabilitation, patients have moved boxes in a sweltering warehouse for Walmart, built an oil platform for Shell and worked at an Exxon refinery along the Mississippi River. (4/24)

The Washington Post: Trump Administration Prepares A Rule Civil Rights Groups Worry May Deny Care To Transgender Patients
Trump administration officials are working on a new rule that civil rights organizations fear could essentially blow up the nondiscrimination protections of the Affordable Care Act for LGBTQ individuals and make it easier for hospitals, physicians or insurers to deny care or coverage to transgender people for religious reasons. The debate centers on the word “sex” as it applies to those provisions. Some faith-based health-care organizations protested in 2016 when President Barack Obama’s Health and Human Services Department interpreted the term to include gender identity and transgender people as protected classes. (Cha, 4/24)

Politico: HHS Nearing Plan To Roll Back Transgender Protections
The long-expected rules have alarmed patient advocates and public health groups, which have warned the health department that the rules could harm vulnerable populations’ access to care. Meanwhile, the rules have been eagerly anticipated by religious-rights groups and conservative states that have lobbied for the changes. The controversial rules — which the Trump administration has been scrutinizing for more than a year to prepare for expected legal challenges — have been closely guarded inside the administration, following several media reports on the efforts that sparked backlash and complicated officials’ strategy. Officials say the two health department rules are now expected within the next 10 days. (Diamond, 4/24)

In other news about the administration's policies —

The Associated Press: Court To Hear Washington Challenge To Trump Abortion Rule
A federal judge in Washington state will hear arguments in two cases against new Trump administration rules that could cut off federal funding for health care providers who refer patients for an abortion. Washington Attorney General Bob Ferguson and the National Family Planning and Reproductive Health Association brought the lawsuits, saying that if the rules take effect next week as scheduled they would curb access to care such as contraception and breast and cervical cancer screening for millions of low-income people. (4/25)

Stat: Primary Care Experiment's Impact Depends On Answers To These Questions
The great hope of the primary care initiative unveiled by the Trump administration this week is that it will finally pay doctors to use technology to stay connected to their patients and intervene before — not after — health problems arise. The concept is simple: Front primary care doctors money to provide high-touch care to keep their patients healthy, instead of paying them to jam their calendars with so many in-person office visits that they can’t respond to emergent problems. (Ross, 4/25)

In other news from CMS —

Modern Healthcare: CMS Invites States To Test New Dual-Eligible Care Models
The CMS is inviting state Medicaid agencies to pursue new ways of integrating care for patients eligible for both Medicare and Medicaid—a population that has complex health needs and accounts for a big portion of spending in both public health programs. In a letter dated Wednesday to state Medicaid directors, CMS Administrator Seema Verma described three new ways states can test approaches to integrating care for dual-eligible patients with the goal of improving the quality of their care and reducing costs for federal and state governments. (Livingston, 4/24)

Modern Healthcare: CMS Backtracks On Requiring EHRs To Track Prescriptions In 2020
The CMS on Tuesday revised its IT efforts that target the opioid epidemic as part of its annual proposed update for the hospital inpatient prospective payment system. The IPPS proposal would update inpatient hospital reimbursements for federal fiscal 2020, which starts in October. Last year's proposal included broad changes for hospital IT, overhauling the Medicare and Medicaid Electronic Health Record Incentive Programs, better known as "meaningful use," to make the programs less burdensome and more patient-centered, according to the agency. Notably, the CMS renamed the programs "Promoting Interoperability" as part of the 2018 announcement. (Cohen, 4/24)

The Associated Press: US Measles Cases Hit Highest Mark In 25 Years
Measles in the U.S. has climbed to its highest level in 25 years, closing in on 700 cases this year in a resurgence largely attributed to misinformation that is turning parents against vaccines. "This is alarming," said Dr. William Schaffner, a Vanderbilt University vaccine expert. Not only is measles dangerous in itself, but its return could mean other vaccine-preventable diseases seemingly consigned to the past may be coming back as well, he said. (Stobbe, 4/24)

CNN: US Measles Outbreak Is Largest Since Disease Was Declared Eliminated In 2000
Wednesday evening, the CDC confirmed the milestone. In a statement the agency said that as of 3 p.m. Wednesday it counted 695 cases of the illness this year. This is a break from the CDC practice of updating measles numbers weekly on Mondays. The CDC said it will not update its website with this new number until Monday, as scheduled. (Howard, 4/24)

The Hill: US Measles Cases Reach Highest Number Since Elimination In 2000
Health and Human Services Secretary Alex Azar said the agency will undertake a comprehensive campaign to reinforce the message that vaccines are safe and effective. “Measles is not a harmless childhood illness, but a highly contagious, potentially life-threatening disease,” Azar said in a statement. “We have the ability to safely protect our children and our communities. The measles vaccines are among the most extensively studied medical products we have, and their safety has been firmly established over many years in some of the largest vaccine studies ever undertaken.” (Weixel, 4/24)

The New York Times: Measles Outbreak Infects 695, Highest Number Since 2000
Most cases are linked to two large and apparently unrelated outbreaks. One is centered in Orthodox Jewish communities in New York City and its suburbs; that outbreak began in October and recently spread to Orthodox communities in Michigan. The other outbreak began in Washington State. “The longer these outbreaks continue, the greater the chance measles will again get a sustained foothold in the United States,” the C.D.C. said in a statement. (McNeil, 4/24)

The Washington Post: Measles Outbreak: U.S. Measles Cases Surpass Previous Record, Highest Since 2000
This year, as in the past, officials say the majority of people in the U.S. who have fallen ill were unvaccinated. In some communities, anti-immunization activists have spread false claims about the measles, mumps and rubella vaccine, causing concern among parents about inoculating their children. When many people in a community have not been vaccinated, the disease can spread quickly. The CDC said misinformation about the safety of the vaccine is “a significant factor contributing to the outbreaks in New York."” The agency said some organizations, which it did not name, are “deliberately targeting these communities with inaccurate and misleading information about vaccines.” (Sun, 4/24)

The Wall Street Journal: U.S. Records Highest Number Of Measles Cases In 25 Years, CDC Says
The Brooklyn measles outbreak began last fall in the ultra-Orthodox Jewish community. Some 83% of the measles cases are concentrated in the Williamsburg area of Brooklyn in four ZIP Codes where the city has ordered mandatory measles-mumps-rubella vaccinations for all people, with fines for noncompliance. The city said Wednesday that 12 people have received summonses for not complying with the emergency order. People who receive a summons are given a hearing and could face a $1,000 fine, with a higher fine if they don’t appear for the hearing. The city started issuing summonses last week. (McKay and West, 4/24)

The Hill: New York Officials Confirm 31 New Measles Cases In Less Than A Week
New York City health officials on Wednesday said they have confirmed 31 new cases of measles in less than a week, including two pregnant women, inching the United States closer to a record. Officials said they also issued summonses to 12 parents for failing to vaccinate their children, a violation of an emergency order from the city’s public health department. (Weixel, 4/24)

Reuters: Millions Of Children Miss Measles Shots, Creating Outbreaks-UNICEF
More than 20 million children a year missed out on measles vaccines across the world in the past eight years, laying a path of exposure to a virus that is now causing disease outbreaks globally, a United Nations report said on Thursday. "The measles virus will always find unvaccinated children," said Henrietta Fore, executive director of the United Nations children's fund UNICEF, adding: "The ground for the global measles outbreaks we are witnessing today was laid years ago." (4/24)

USA Today: Measles Outbreak, Vaccinations: Distrust In Big Pharma Plays A Role
Bernadette Pajer doesn't trust the pharmaceutical industry. And she doesn't trust vaccines. The founder of a Washington state advocacy group says her dual distrust shouldn't come as any surprise. She notes drugmakers have a "pretty poor record over all" on safety and transparency. Not to mention the opioid crisis, though Pajer often does. Pajer is not alone. As distrust of the pharmaceutical industry grows, so too has the anti-vaccination movement. And that is a critical issue as the number of measles cases in the U.S. surges toward a record. (O'Donnell, 4/23)

The Associated Press: California Vaccine Rules Advance Over Emotional Opposition
California lawmakers advanced tougher rules for vaccinations late Wednesday after hearing hours of testimony from hundreds of opponents while the nation grapples with the highest number of measles cases in decades. The Senate Health Committee approved the proposal to give state public health officials instead of local doctors the power to decide which children can skip their shots before attending school. The push coincides with this year's national measles tally reaching the highest it's been since 1994, according to an Associated Press count. (4/24)

Los Angeles Times: Opponents Call It A ‘Crime Against Humanity,’ But Vaccine Bill Moves Forward
The emotional testimony on the bill comes as a measles outbreak has put public health officials on high alert. More than 100 doctors and medical students spoke in favor of Senate Bill 276, which would empower the state health department to vet medical exemptions sought by physicians. Sen. Richard Pan, a Sacramento physician and Democrat, introduced the legislation, which passed 6 to 2 on Wednesday in the Senate Health Committee. The Capitol hallways were hot and humid amid the mass turnout of mostly opponents, many of whom said their children were injured by vaccines. One opponent called Pan a “tyrant,” another labeled his bill a “crime against humanity,” while a third urged the senator to abandon the proposal to “save your soul.” (Gutierrez and Karlamangla, 4/24)

KQED: California Lawmakers Consider Crackdown On Fake Medical Exemptions For Vaccines
"We witnessed physicians who advertised exemptions for cash on social media and the internet," Pan said. "We’d see some parents post on social media that their child's regular physician refused to grant their child a medical exemption so they traveled to go purchase one from a distant physician." (Dembosky, 4/24)

The Oregonian: Vaccine Bill One Step Closer To Legislative Approval 
On a party-line vote, an Oregon legislative committee on Wednesday approved a bill that would eliminate non-medical vaccine exemptions for students. Oregon currently has an estimated 15,500 school-aged children whose parents used non-medical grounds to exempt their children from being vaccinated for contagious diseases including measles and hepatitis B. If the bill becomes law, such children would be barred from attending public or private schools, licensed day cares and preschools. Online schools and home school would be their only option. (Lehman, 4/24)

The New York Times: W.H.O. Says Limited Or No Screen Time For Children Under 5
In a new set of guidelines, the World Health Organization said that infants under 1 year old should not be exposed to electronic screens and that children between the ages of 2 and 4 should not have more than one hour of “sedentary screen time” each day. Limiting, and in some cases eliminating, screen time for children under the age of 5 will result in healthier adults, the organization, a United Nations health agency, announced on Wednesday. (Rueb, 4/24)

The Associated Press: UN: No Screen Time For Babies; Only 1 Hour For Kids Under 5
The guidelines are somewhat similar to advice from the American Academy of Pediatrics. That group recommends children younger than 18 months should avoid screens other than video chats. It says parents of young children under two should choose "high-quality programming" with educational value and that can be watched with a parent to help kids understand what they're seeing. Some groups said WHO's screen time guidelines failed to consider the potential benefits of digital media. (4/24)

The Washington Post: World Health Officials Take A Hard Line On Screen Time For Kids. Will Busy Parents Comply?
The WHO drew on emerging — but as yet unsettled — science about the risks screens pose to the development of young minds at a time when surveys show children are spending increasing amounts of time watching smartphones and other mobile devices. Ninety-five percent of families with children under the age of 8 have smartphones, according to the nonprofit organization Common Sense Media, and 42 percent of children under 8 have access to their own tablet device. (Timberg and Siegel, 4/24)

Modern Healthcare: Report: Public Health Funding Falls Despite Increasing Threats
Years of budget cuts to public health led to the elimination of more than 55,000 positions within local health departments from 2008 through 2017, according to a report released Wednesday. The Trust for America's Health estimates public health efforts are about $4.5 billion underfunded. That's led state and local health departments woefully unprepared to address public health emergencies such as infectious disease outbreaks, extreme weather events, and the opioid crisis. (Johnson, 4/24)

Los Angeles Times: Robotic Device Winds Its Own Way Through A Beating Pig Heart
Scientists have created a robotic device that safely guides itself through the delicate chambers of a beating pig's heart. The surgical robot, whose motion was inspired by the way cockroaches skitter along walls, is able to navigate without any help from a doctor or anyone else, according to a study published Wednesday in the journal Science Robotics. (Borenstein and Neergaard, 4/24)

The New York Times: After A Knee Injury, Be Wary When Returning To Sports
Athletes who have torn an anterior cruciate knee ligament often rely on elaborate batteries of physical tests to tell them if and when they are ready to return to competitive sports. But a new review of studies of athletes and A.C.L. injuries raises serious concerns about the reliability of these return-to-play tests. The review finds that athletes who pass the tests remain just as likely as those who fail to experience a subsequent knee injury once they return to sports. (Reynolds, 4/24)

Bloomberg: Valsartan Recall: Tainted Heart Drugs Face Lawsuits Over Cancer
Dozens of lawsuits have been filed against drug makers and sellers over widely prescribed generic heart medications tainted with potential carcinogens, the first claims in what some lawyers expect to be a wave of litigation. Millions of Americans have taken the drugs, which are at the center of a widening recall being overseen by the U.S. Food and Drug Administration, and have been for decades used to treat high blood pressure, heart failure and other common conditions. (Edney and Fisk, 4/24)

Miami Herald: More Losartan Sold At Kroger, Co. Stores Recalled For NMBA
In a domino recall after Torrent Pharmaceuticals pulled 104 lots of losartan for NMBA presence, Legacy Pharmaceutical Packaging added one lot to its recall of the heart and blood pressure medication. Legacy’s losartan was made by Torrent. (Neal, 4/25)

Marketplace: Some Nurses Are Pushing For Mandatory Patient Ratios. Do They Work?
Nurses across the country say they're caring for too many patients at a time. So some nurses are proposing a solution — mandatory nurse to patient ratios. But nurse staffing ratios could have unintended consequences, like decreased staff flexibility. And it's unclear whether they improve patient care. (Petersen, 4/24)

Kaiser Health News: Researchers Seek Sage Advice Of Elders On Aging Issues
Rachel O’Conor booted up her slides and began posing questions to six older adults sitting around a table: How should primary care physicians support patients and caregivers after a diagnosis of dementia? And what stands in the way of getting adequate support? “Please speak louder and go slower,” suggested Susanne Smith, a 75-year-old with early-stage Alzheimer’s disease. (Graham, 4/25)

The Philadelphia Inquirer: Millennials Are Less Healthy Than Gen X And It May Be Due To Mental Illness, Blue Cross Report Finds
Millennials are less healthy than the generation before them, and the difference — particularly in Philadelphia — is driven by mental illness, substance use disorders, and endocrine conditions such as diabetes, according to a report released Wednesday by the Blue Cross Blue Shield Association. The report, part of the association’s Health of America series that has published more than 25 studies, is the first to focus exclusively on millennials, who were 21 to 36 years old in 2017, when the data were collected. (Pattani, 4/24)

The New York Times: Widespread Testing Begins On Malaria Vaccine That Is Only Partly Effective
With malaria deaths rebounding worldwide, a pilot program testing a new and fiercely debated malaria vaccine began on Tuesday in Malawi. Dr. Katherine O’Brien, the World Health Organization’s director of immunization, called the rollout “a historic moment in the fight against malaria,” and said the testing will soon expand to malarious regions of Ghana and Kenya. (McNeil, 4/24)

The New York Times: Long-Term Use Of Antibiotics Tied To Heart Risks
Using antibiotics for two months or longer may be linked to an increase in a woman’s risk for cardiovascular disease. The finding, published in the European Heart Journal, applied to women who used the drugs when they were 40 and older. Researchers used data on 36,429 women free of cardiovascular disease at the start of the study who were participating in a continuing long-term health study. Beginning in 2004, the women reported their use of antibiotics. (Bakalar, 4/24)

The New York Times: Scientists Create Speech From Brain Signals
“In my head, I churn over every sentence ten times, delete a word, add an adjective, and learn my text by heart, paragraph by paragraph,” wrote Jean-Dominique Bauby in his memoir, “The Diving Bell and the Butterfly.” In the book, Mr. Bauby, a journalist and editor, recalled his life before and after a paralyzing stroke that left him virtually unable to move a muscle; he tapped out the book letter by letter, by blinking an eyelid. Thousands of people are reduced to similarly painstaking means of communication as a result of injuries suffered in accidents or combat, of strokes, or of neurodegenerative disorders such as amyotrophic lateral sclerosis, or A.L.S., that disable the ability to speak. (Carey, 4/24)

NPR: Scientists Tap Into Brain Signals To Synthesize Speech
"Finding a way to restore speech is one of the great challenges in neurosciences," says Dr. Leigh Hochberg, a professor of engineering at Brown University who wasn't associated with the study. "This is a really exciting new contribution to the field." Right now, people who are paralyzed and can't speak or gesture often rely on eye movements or a brain-controlled computer cursor to communicate. These methods allow them to spell out words one letter at a time. (Hamilton, 4/24)

The Washington Post: Americans Are More Focused On Health Costs Than Medicare-For-All, Poll Shows
Most Americans want Congress to take action to lower their family’s health care expenses, rather than make sweeping changes such as adopting Medicare-for-all, or repealing and replacing the Affordable Care Act, according to a new survey. At a time when Democratic presidential candidates are emphasizing universal health coverage — with those on the left advocating Medicare-for- all — not quite half of the respondents who identify as Democrats regard that as a priority for Congress in the latest poll by the Kaiser Family Foundation. That compares with 14 percent of Republicans. (Goldstein, 4/24)

The Hill: Poll: Majority Of Americans Want Laws Protecting Them From Surprise Medical Bills
Three-quarters of the public — including a majority of Republicans — think the federal government should protect patients from having to cover surprise medical bills, according to a new poll released Wednesday. A surprise bill usually occurs after a patient visits a hospital that is inside their insurer’s network, but received treatment from an out-of-network doctor, or the patient was taken by ambulance to an out-of-network emergency room. (Weixel, 4/24) 

Kaiser Health News: Americans Overwhelmingly Want Federal Protections Against Surprise Medical Bills
Four in 10 American adults under age 65 say that within the past two years they or a family member received an unexpectedly high invoice for a procedure, test or doctor’s visit they thought would be better covered by their insurer, according to the Kaiser Family Foundation poll. (KHN is an editorially independent program of the foundation.) Half of those people said the high bill occurred because the medical provider was not in their insurance network. (Rau, 4/24)

More Bills Of The Month: Check out KHN's special coverage on surprisingly high medical bills. 

In other news on health care costs —

Kaiser Health News: In 10 Years, Half Of Middle-Income Elders Won’t Be Able To Afford Housing, Medical Care
In 10 years, more than half of middle-income Americans age 75 or older will not be able to afford to pay for yearly assisted living rent or medical expenses, according to a study published Wednesday in Health Affairs. The researchers used demographic and income data to project estimates of a portion of the senior population, those who will be 75 or older in 2029, with a focus on those in the middle-income range — currently $25,001 to $74,298 per year for those ages 75 to 84. (Knight, 4/24)

Modern Healthcare: More Middle-Income Seniors Face Financial Insecurity
Most middle-income seniors over the age of 75 will not be able to afford housing and healthcare come 2029, new research shows. The often-overlooked demographic is estimated to nearly double in size to 14.4 million people in a decade, 54% of whom could not cover $60,000 for assisted-living rent and other out-of-pocket medical costs even if they sold their home and committed all their annual income, according to a new study conducted by NORC at the University of Chicago and funded by the National Investment Center for Seniors Housing & Care. (Kacik, 4/24)

Reuters: Anthem Beats Earnings Estimates, Outlines Plans For Pharmacy Benefits Unit
Anthem Inc on Wednesday posted a better-than-expected quarterly profit and laid out its plans to transition most customers to its revamped pharmacy benefits business this year. Based on its first quarter results, including higher than anticipated revenue growth, the company said it now expects 2019 adjusted earnings to exceed $19.20 per share, up from its prior view of more than $19.00. (4/24)

The Wall Street Journal: Anthem Raises Outlook Amid Concerns Over Political Environment
The insurer said it now expects per-share profit to be greater than $18.27 for 2019, up from its previous forecast of greater than $18. Analysts polled by Refinitiv expect full-year earnings of $17.88 a share. Profit rose 18% in the first quarter, lifted by higher revenue from solid membership growth and lower selling, general and administrative expenses. In Anthem’s government segment, the company flagged “elevated medical cost experience in some states” in the Medicaid business, and also said a decreased operating gain compared with last year’s quarter was tied to some adjustments that had boosted the 2018 Medicaid numbers. (Wilde Mathews and Chin, 4/24)

Modern Healthcare: Anthem Revenue Buoyed By Membership Growth
Anthem reported higher revenue and profit in the first quarter of 2019 as it grew membership across its business lines. The Indianapolis-based health insurer experienced the fastest growth in its government-funded programs. Its Medicare Advantage membership, including Medicare supplement plans, rose 15.6% to a little more than 2 million in the three months ended March 31 compared with the same period a year ago, driven by supplemental benefits. (Livingston, 4/24)

Modern Healthcare: Athenahealth Lays Off Nearly 4% Of Workforce Two Months After Acquisition
Athenahealth laid off less than 4% of its employees Tuesday as part of its restructuring. The layoffs come two months after Veritas Capital and Elliott Management Corp.'s Evergreen Coast Capital completed their $5.7 billion purchase of Athenahealth in February. Athenahealth did not comment on departments or locations affected in the layoffs. (Cohen, 4/24)

Modern Healthcare: Humana Announces Virtual Primary-Care Plan
Humana and telehealth company Doctor on Demand will launch a new health plan design allowing employers and employees to receive primary care predominantly through virtual visits. The plan, called On Hand, allows Humana members to avoid the doctor's office and access primary-care services virtually from one Doctor on Demand physician, with access to urgent care, preventive care and behavioral health services. (Livingston, 4/24)

Reuters: Bayer Asks California Appeals Court To Throw Out $78 Million Roundup Verdict
Bayer AG on Wednesday asked a California appellate court to throw out a $78 million judgment it was ordered to pay to a school groundskeeper who claimed the company's weed killers gave him cancer. In a filing in California's Court of Appeal, First Appellate District, the company said that there was "no evidence" that glyphosate, a chemical found in the company's Roundup and Ranger Pro products, could cause cancer. (4/24)

New Orleans Times-Picayune: Amendment To Make Abortion Unconstitutional In Louisiana Gets House Approval 
An amendment that would change the Louisiana Constitution to say there is no right to an abortion or public funding allowed for the procedure passed the Louisiana House of Representatives on Tuesday (April 23). Lawmakers approved state Rep. Katrina Jackson’s HB 425, called the Love Life Amendment, with an 80-10 vote. The bill now moves on to the Senate, where it needs a two-thirds vote to gain approval. The amendment would then be placed on the Nov. 16, 2019, ballot, at which point voters will decide whether to approve the measure. (Clark, 4/24)

The Associated Press: Lawyer: Massacre Suspect Allowed To Play Violent Video Games
An attorney representing the father of a victim in last year's Florida high school massacre told a judge that mental health counselors must share the blame, because they knew Nikolas Cruz was "a ticking time bomb" long before the mass shooting, and their actions sped up the explosion. Cruz's counselors supported his use of violent video games, and even suggested he get a punching bag and do target practice with non-lethal guns in hopes of containing his violent tendencies, according to the lawyer representing Andrew Pollack, whose daughter Meadow Pollack was among the 17 people killed. (4/24)

Pioneer Press: Dakota County Lyft Program Gets People With Disabilities To Work
Dakota County and ridesharing service Lyft are partnering to give certain residents on Medicaid waivers a new transportation option to and from work. The partnership is a pilot project focused on helping people with disabilities find work in nonpublic transit locations or hours, the county announced recently. Any residents who receive home and community-based services are eligible for the free program that started in April. (Clarey, 4/24)

The Star Tribune: Minnesota House DFL Puts Off Sweeping Health Care Budget For Another Day
Minnesota House Democrats on Wednesday inched toward passage of a sweeping health and human services budget that would reshape the state's insurance and prescription drug markets, setting the stage for an end-of-session clash with Senate Republicans over the future of health care in Minnesota. The House majority's spending proposal, which would funnel $15 billion to health and human services programs over two years, is a vehicle for some of the biggest policy debates looming over the nation's only divided Legislature. It includes a proposal from Democratic Gov. Tim Walz to allow all Minnesotans to buy into a public option on the state insurance marketplace and ends a private insurer subsidy program that lowered premiums on the individual market, replacing it with direct consumer discounts. (Van Oot, 4/24)

Tampa Bay Times: Lawmakers Seek Compromise On Hospitals’ Medicaid Reimbursements In Healthcare Budget Talks
The Florida House advanced its first counteroffer on how to reimburse hospitals for Medicaid cases late Wednesday night, suggesting that it and the state Senate were moving toward a potential compromise on one of the thorniest disputes between the chambers sooner than expected. During a joint conference of some of the Legislature’s lawmakers on the state’s health care budget, leaders announced that the House, which had advanced a plan to trim inpatient and outpatient payments to hospitals for Medicaid cases, was offering to roll back the proposed 3 percent cut to the state’s overall hospital Medicaid funding. (Koh, 4/24)

Milwaukee Journal Sentinel: Court Expands Wisconsin Medicaid Coverage Of Transgender Surgery
A lawsuit challenging Wisconsin's rule denying Medicaid coverage for medically necessary transgender surgeries has become a class action that could benefit hundreds of affected residents. An estimated 5,000 transgender Wisconsin residents are enrolled in Medicaid. But only some of them suffer from gender dysphoria, and only a portion of those would desire gender-confirming surgeries and meet the medically necessary threshold for coverage of the treatment. (Vielmetti, 4/24)

The Philadelphia Inquirer: A Hidden Crisis For The Severely Sick And Mentally Ill: Pa. Has No Facilities Left For Them
His family blames the jail and the state Department of Human Services, which, under a settlement with the ACLU, has struggled to reduce wait times for care at Norristown and Torrance State Hospitals — the only remaining state forensic psychiatric hospitals in Pennsylvania, where people with serious mental illnesses are cared for until they are competent for trial. Those hospitals will not accept individuals with acute medical needs such as Deska, which means they’re effectively stranded in jail. (Melamed, 4/24)

New Hampshire Public Radio: State Lawmakers Poised To Expand Telemedicine In New Hampshire
Lawmakers at the State House heard testimony on a bill Wednesday that would pave the way for an expansion of telemedicine in New Hampshire. Senate bill 258 would add primary care physicians and pediatricians to the list of doctors in New Hampshire who can bill Medicaid and private insurers for telemedicine. (Moon, 4/24)

Boston Globe: Lifespan Says Partners Takeover Of Care New England Would Cost R.I.
Seeking to block a deal between two of its rivals, Rhode Island’s largest health care provider went on the offensive Wednesday, launching a public relations campaign claiming Partners HealthCare’s proposed acquisition of Care New England Health System would lead to higher costs for local patients and shift jobs to Massachusetts. (McCluskey and McGowan, 4/24)

Kaiser Health News: States Weigh Banning A Widely Used Pesticide Even Though EPA Won’t
Lawmakers in several states are trying to ban a widely used pesticide that the Environmental Protection Agency is fighting to keep on the market. The pesticide, chlorpyrifos, kills insects on contact by attacking their nervous systems. Several studies have linked prenatal exposure of chlorpyrifos to lower birth weights, lower IQs, attention deficit hyperactivity disorder and other developmental issues in children. But the EPA in 2017 ignored the conclusions of its scientists and rejected a proposal made during the Obama administration to ban its use in fields and orchards. (Ibarra, 4/25)

The Philadelphia Inquirer: There Are Fewer 5-Star Rated Philadelphia-Area Nursing Homes Under New Federal System
The number of five-star nursing homes in the Philadelphia region fell by 20 percent, from 74 to 59, under a modified regimen for nursing-home ratings, federal data released Wednesday show. The number of one-star facilities in the eight-county region, which has a total of 236 nursing homes, jumped 58 percent, from 24 to 38. (Brubaker, 4/24)

Miami Herald: FL Lawmakers To Give Firefighters Coverage For Cancer
Firefighters in Florida will soon receive health coverage for cancer as part of their jobs, after House lawmakers voted Wednesday to designate the disease as an occupational hazard for those first responders. The votes, unanimous in both chambers of the state Legislature, are a win for firefighters who have sought such coverage for several years running. (Koh, 4/24)

North Carolina Health News: Rousing A Community To The Effects Of Child Abuse In Cumberland County 
Instead of framing abuse as a problem shouldered by individual families, an ambitious effort by a collection of two dozen nonproft partners, government groups and concerned residents are instead naming it a community problem deserving of a community-wide solution. The S.O.A.R.(Strengths in Overcoming Adversity thru Resiliency) program aims to use evidence-based strategies to make families stronger and more resilient to the ups and downs of life that can lead to parents lashing out or exposing children to harmful environments. (Ovaska-Few, 4/25)

Iowa Public Radio: Study Finds Thousands Of Iowans Are Drinking Contaminated Well Water
A survey of state data shows thousands of private wells in Iowa have been contaminated with nitrates and coliform bacteria. Under state law, most of Iowa’s private wells don’t have to be tested, and don’t have to meet water quality standards, leaving the residents who rely on them especially vulnerable. (Payne, 4/24)

Texas Tribune: Dallas Paid Sick Leave Requirement Passed By City Council
Amid a debate in the Texas Capitol over whether such rules should be banned statewide, the Dallas City Council on Wednesday passed a new ordinance requiring employers in the city to offer paid sick leave to their employees. The ordinance is similar to ones city leaders in both San Antonio and Austin put in place, though Austin’s ordinance is currently on hold after an appeals court said it was unconstitutional. (Samuels, 4/24)

Iowa Public Radio: Policy Group Argues For Tax Increases To Expand Water Quality Programs
Iowa is spending a fraction of what should be budgeted toward improving water quality, according to an analysis by the nonprofit Iowa Policy Project. The group argues state lawmakers should raise taxes in order to put more money toward solutions, but that doesn’t appear to be under consideration just yet. (Gerlock, 4/24)

KCUR: Rapidly Expanding AdventHealth Extends Its Reach To Ottawa, Kansas 
AdventHealth will take over operation of Ransom Memorial Health, a 44-bed acute-care hospital in Ottawa, Kansas, the Florida-based health system announced on Wednesday. Ransom Memorial will be renamed AdventHealth Ottawa. It joins other members of the AdventHealth network, including AdventHealth Shawnee Mission in Merriam, Kansas, formerly known as Shawnee Mission Medical Center. In 2017, Ransom Memorial partnered with Shawnee Mission Medical Center to offer expanded cardiology services at Ransom Memorial. (Margolies, 4/24)

Pediatrics: Parental Disengagement In Childhood And Adolescent Male Gun Carrying
Boys exposed to poorer parental engagement during childhood are more likely to affiliate with delinquent peers and exhibit externalizing problems during early adolescence, which (in turn) increases their risk of carrying a firearm in later adolescence. This suggests that gun violence prevention efforts with children should work to enhance aspects of parental engagement. (Beardslee et al, 4/1)

JAMA Internal Medicine: Association Between Receipt Of A Medically Tailored Meal Program And Health Care Use.
A retrospective cohort study was conducted using near/far matching instrumental variable analysis. Data from the 2011-2015 Massachusetts All-Payer Claims database and Community Servings, a not-for-profit organization delivering medically tailored meals (MTMs), were linked. The study was conducted from December 15, 2016, to January 16, 2019. Recipients of MTMs who had at least 360 days of preintervention claims data were matched to nonrecipients on the basis of demographic, clinical, and neighborhood characteristics. (Berkowitz et al, 4/22)

Health Affairs: Do Incentive Payments Reward The Wrong Providers? A Study Of Primary Care Reform In Ontario, Canada
Primary care payment reform in the US and elsewhere usually involves capitation, often combined with bonuses and incentives. In capitation systems, providing care within the practice group is needed to contain costs and ensure continuity of care, yet this is challenging in settings that allow patient choice in access to services. We used linked population-based administrative databases in Ontario, Canada, to examine a substantial payment called the “access bonus” designed to incentivize primary care access and to minimize primary care visits outside of capitation practices. We found that the access bonus flowed disproportionately to physicians outside large cities and to those whose patients made fewer primary care visits, received less after-hours care, made more emergency department visits, and had higher adjusted ambulatory costs. Our findings indicate a lack of alignment between these payments and their intended purpose. Financial incentives should be prospectively evaluated and frequently revisited to ensure relevance, alignment with system goals, efficiency, and equity. (Glazier et al, 4/1)

JAMA Internal Medicine: Findings From The Behavioral Risk Factor Surveillance System On Health-Related Quality Of Life Among US Transgender Adults, 2014-2017.
The National Institutes of Health has prioritized research into disparities affecting the transgender population. An important domain in disparities research is health-related quality of life (HRQOL), which reflects the burden of chronic and acute physical and mental health conditions as well as unmet health care needs.1 Historically, a lack of routine, standardized data collection has hindered explorations of transgender population health and HRQOL. In 2014, however, the Centers for Disease Control and Prevention (CDC) introduced an optional Sexual Orientation and Gender Identity module for the Behavioral Risk Factor Surveillance System (BRFSS). In 2014 through 2017, 36 states and territories representing almost 75% of the US population used the module at least once. This study compared HRQOL between transgender and cisgender adults in this rare probability sample of the transgender population. (Baker, 4/22)

Health Affairs: Knowledge Of Practicing Physicians About Their Legal Obligations When Caring For Patients With Disability
Disability civil rights laws require equitable treatment of the approximately sixty-one million Americans with disability. However, federal reports and numerous research studies indicate that this diverse and growing population often experiences health care disparities. To examine one possible contributing factor, we interviewed practicing physicians to explore their knowledge of their obligations to accommodate patients with disability under federal civil rights law. Interviewees reported having had little formal training about, and demonstrated superficial or incorrect understanding of, their obligations in three potentially problematic areas: deciding which accommodations their practices should implement, refusing patients with disability, and holding patients accountable for costs of accommodations. The fact that practicing physicians might not fully understand their legal responsibilities when caring for people with disability may contribute to persisting inequity in their care, and it suggests that further education in the Americans with Disabilities Act and other disability civil rights laws may be warranted. (Agaronnik et al, 4/1)

The Washington Post: No One Is Too Old To Be President
As the Democratic primary campaign heats up, the conversation is taking an unfortunate turn when it comes to discussion of candidates’ ages. Late-night hosts such as Jimmy Fallon “joke” that Bernie Sanders, age 77, is sponsored by Metamucil and was present for the signing of the American Constitution. The pundits are hardly better than the comedians when discussing candidates’ ages: In columns like these, they compare old age to a “shipwreck” and worry that “old duffers” are a danger to the republic.As two humanists who study the culture of old age, we view such rhetoric as a distraction from serious issues and feel it reproduces inaccurate stereotypes about aging. (James Chappel and Sari Edelstein, 4/25)

Bloomberg: School Lunch Nutrition Standards: Children Deserve Healthy Food
For seven years, the Healthy, Hunger-Free Kids Act required America’s schools to serve children plenty of fruits, vegetables and whole grains, and kept tight limits on added sugar and sodium in their lunches. These rules were a signal success of the Obama administration: According to one estimate, they would have prevented almost 2 million new cases of childhood obesity. That’s “would have,” because Agriculture Secretary Sonny Perdue has rolled them back. ...Perdue’s changes flout the federal Dietary Guidelines for Americans and ignore the alarming reality that nearly one in five children in the U.S. are obese. The American Heart Association, the Academy of Nutrition and Dietetics and 98 percent of those who formally commented on his intervention opposed it. (4/24)

The Washington Post: Everyone’s Practicing The Politics Of Evasion On Social Security And Medicare 
Just for the record, we ought to note that trustees for Social Security and Medicare recently released their annual reports. The two programs alone constituted 45 percent of the non-interest federal budget in 2018, a share that the trustees say is being driven up by the continuing retirement of baby boomers and the high cost of health care. The trustees issued their usual dire warnings that, absent congressional action, the trust funds that finance these programs will run out of cash: Medicare in 2026 and the Social Security in 2035. (Robert J. Samuelson, 4/24)

Stat: Pfizer Shareholder Meeting Offers Inside Look At The Pharma Industry
Pfizer’s board of directors will gather in New Jersey on Thursday for the company’s annual shareholders meeting. They will celebrate the enormous success Pfizer had in 2018, having made $53 billion in revenue and over $11 billion in profits, on top of the $11 billion windfall they posted from the Trump tax cuts alone at the end of 2017. Those numbers make Pfizer one of the most profitable companies on Earth.Despite these enormous profits, or perhaps to generate them, Pfizer raised prices on 41 of its prescription drugs in January. This includes the company’s big-selling breast cancer medication, Ibrance, a pack of 21 pills used to treat breast cancer, that cost $12,000 in 2017, up 5% from the previous year. (George Goehl and Felicia Wong, 4/24)

The Hill: Malaria Kills A Child Every 30 Seconds, Now There's A Vaccine To Fight It
The “world’s first malaria vaccine,” which is being rolled out in a large pilot program in Malawi, is rightly being lauded as a major milestone in the war between humans and the malaria parasite. If successful, the vaccine may be given to millions more children across Africa and save young lives that are needlessly lost every day. But in this war, which has been waged over millennia, we should be cautious not to vest too much hope in a single weapon. (Chris Plowe, 4/24)

The Washington Post: Health Officials Must Learn From Their Mistakes Before Ebola Jumps The Fence — Again 
When the Ebola virus appeared in Congo last year, the 10th outbreak in four decades, there was some hope of progress against what very often produces a trail of death. The hope was that a new vaccine developed by Merck after the epidemic in 2014-2016 would be effective and contain the outbreak, if enough people could be inoculated. Many months later, the news about the Merck vaccine VSV-EBOV in a clinical trial is promising indeed: It has shown to have an almost 98 percent efficacy. But lately, worrisome developments have overtaken the good news. Ebola infections are rising. (4/24)

Stat: New Texas Tech Med School Admission Policy Will Worsen Health Disparities
A recent agreement between the medical school of Texas Tech University Health Sciences Center and the Trump administration that forces the school to stop considering race as a factor in its admissions processes is a step backward for improving health care in the United States. The agreement ends a 14-year investigation by the U.S. Department of Education’s Office for Civil Rights into the university’s use of race in admissions. It represents a sharp reversal to the university’s holistic applicant review process, which includes the consideration of race and ethnicity. The agreement is, however, consistent with the current administration’s advocacy of “race-neutral” admission policies as well as its efforts to rescind Obama-era policies on affirmative action. (Marcella Alsan and Owen Garrick, 4/25)

Roanoke Times: Excessive Media Use Harms Families 
Technology has been woven into the very fabric of our daily lives, leaving us bombarded by the screens of the many devices with which we interact. For example, the other day I was sitting with my family at lunch when I looked up from my meal and noticed that everyone, including my five-year-old nephew, was staring at a screen. I am not alone in the concern that human interaction should not be superseded by technology screens. Studies have shown that excessive screen time, or time spent playing video games, watching TV/DVDs, or on computers/tablets/smartphones has harmful effects on our children’s development. Spoiler alert, it’s not just our children’s excessive use of media that’s the problem! (Josh Prol and April Wertz Prol, 4/24)

The Hill: In The Vaccine Fight, Measles Is Winning
Why is measles making a comeback, especially in the U.S. almost 20 years after it was officially declared eradicated? Much media attention has focused on the erosion of herd immunity due to pockets of unimmunized children and deservedly so. But another important reason is the public perception that measles is a mild childhood disease — uncomfortable for a few days but not serious. (Jonathan Fielding, 4/24)J

Los Angeles Times: California Still Has A Vaccination Loophole. Close It 
After a measles outbreak at Disneyland in 2014, the California Legislature eliminated the religious and “personal belief” exemptions that allowed parents to easily opt their kids out of the standard course of immunizations required to attend public school. It was a wake-up call, highlighting for those who hadn’t been paying attention how the anti-vaccination movement had been slowly eroding confidence in childhood immunizations by scaring parents with discredited science and dubious data. (4/25)