The New York Times: Trump Sided With Mulvaney In Push To Nullify Health Law
The Trump administration’s surprise decision to press for a court-ordered demolition of the Affordable Care Act came after a heated meeting in the Oval Office on Monday, where the president’s acting chief of staff and others convinced him that he could do through the courts what he could not do through Congress: repeal his predecessor’s signature achievement. Mick Mulvaney, the acting White House chief of staff and former South Carolina congressman, had spent years in the House saying that the health law should be repealed, and his handpicked head of the Domestic Policy Council, Joe Grogan, supported the idea of joining a Republican attorneys general lawsuit to invalidate the entire Affordable Care Act. (Haberman and Pear, 3/27)

The Washington Post: Mulvaney Pushes The Health-Care Fight Trump Wants Despite GOP’s Misgivings
[Mulvaney] pitch came during scheduled “policy time” with Trump on Monday and spanned several meetings throughout the day. It was met with resistance from some on the president’s legal team and his Justice Department, as well as with skepticism from Vice President Pence, who favors overturning President Barack Obama’s namesake health-care law but only if Republicans are ready with an alternative, according to White House officials familiar with the discussions who spoke on the condition of anonymity to describe the private talks. But Trump — fresh off a victory lap following the conclusion of special counsel Robert S. Mueller III’s Russia investigation — agreed with Mulvaney and was eager to forge ahead into dismantling his predecessor’s health law. (Dawsey, Parker and Paletta, 3/27)

The Associated Press: Trump Turns To Health Care With An Eye On 2020
Buoyed by word that the special counsel didn't find collusion with Russia, President Donald Trump is voicing new interest in policymaking, including a fresh effort to repeal and replace "Obamacare." But Trump has few detailed policy proposals to back up his words, suggesting he's as focused on highlighting issues that appeal to his political base as actually enacting legislation. Trump stressed his desire to revive his failed effort to kill the Affordable Care Act on Wednesday, a pivot to health care that both broadens and complicates the administration's agenda. Many in the GOP remain skeptical that Trump can notch many policy wins in the divided Congress. (Lucey, Miller and Mascaro, 3/27)

The Washington Post: Trump Pressures Wary Republicans To Produce Replacement For Health-Care Law
President Trump is pressuring Republicans to produce a replacement for the Affordable Care Act, a request the GOP considers unrealistic in a divided Congress and politically perilous ahead of the 2020 elections. Hours after meeting with Senate Republicans at the Capitol on Tuesday, Trump spoke on the phone with a handful of senators, urging them to write a new law — even though the party failed to coalesce around a plan when it controlled the House and Senate for two years. The White House has no proposal in the works, according to administration officials, but Trump wants Republicans to pass a bill before his reelection effort that would do what Obamacare does — provide coverage to millions of Americans. (Bade, Dawsey, Kim and Wagner, 3/27)

The Hill: GOP Senators Blindsided By Trump On ObamaCare 
Republican lawmakers were caught completely off guard by President Trump’s renewed push to repeal and replace ObamaCare and privately complain it’s a dumb political strategy heading into the 2020 election. Senate Finance Committee Chairman Chuck Grassley (R-Iowa), whose panel has jurisdiction over health care, said he received no heads-up from Trump or the White House that the president would call Tuesday for the GOP to become “the party of health care.”  (Bolton, 3/27)

Politico: ‘We Need A Plan’: GOP Shaken By Trump’s Healthcare Demands
“We’re going to be involved in health but most of it is going to be very, very bipartisan, unlike the issue you’re bringing up, which would not be very bipartisan,” said Chuck Grassley (R-Iowa), the leader of the Senate Finance Committee. That could include addressing “surprise” medical bills that hit insured people who end up with an out-of-network doctor even when they’ve chosen an in-network hospital, as well as more steps to address high drug costs and opioids. (Ollstein and Everett, 3/27)

The Hill: House GOP Leader Urged Trump To Hold Off On Latest ObamaCare Assault 
House Minority Leader Kevin McCarthy (R-Calif.) recently told President Trump he didn't agree with the administration's effort to have the Affordable Care Act deemed invalid in federal court, according to a source familiar with the conversation. McCarthy discussed with fellow GOP leaders how he voiced his disapproval to the president, the source said. (Brufke, 3/27)

The Wall Street Journal: White House, Congressional GOP At Odds Over 2020 Health-Care Message
Sen. Susan Collins (R., Maine), facing a competitive challenge in 2020, said she is “vehemently opposed” to the White House efforts to dismantle the ACA in the courts. “The president is very clear that he understands the importance of health care,” said Ms. Collins, who cast a key vote against the GOP effort to kill the ACA in 2017. “In order to do that, he has to have a detailed plan that is going to be an improvement over the ACA.” (Armour and Peterson, 3/27)

Bloomberg: Trump's Post-Mueller Victory Lap Includes New Obamacare Attack
Democrats have so far welcomed a fight over health care. It paid off for them in 2018 -- voter concerns over insurance coverage helped the opposition party reclaim control of the House of Representatives in the November midterm elections. Many of the Democratic candidates are calling for all Americans to have access to health insurance through Medicare, the program for the elderly and disabled. Trump has labeled the idea “socialism.” (Pettypiece, 3/28)

The Hill: Pence Aide Says Trump Will Submit A Healthcare Plan To Congress 'This Year'
Former White House aide Marc Short said Wednesday that President Trump plans to submit a healthcare plan to Congress "this year." “The president will be putting forward plans this year that we hope to introduce into Congress,” Short, who now serves as Vice President Pence's chief of staff, said on CNN's "The Situation Room." (Rodrigo, 3/27)

Cleveland Plain Dealer: Ohio’s Republican Attorney General Asks Federal Court Not To Overturn All Of Obamacare
Ohio Attorney General Dave Yost on Wednesday said he will ask a federal appeals court not to strike down the entire Affordable Care Act as unconstitutional. Yost, a Republican, announced in a release that he will file a brief arguing that while the health-care reform law’s controversial individual mandate is unconstitutional, other parts of “Obamacare” can and should remain in place – in particular, rules prohibiting insurance companies from denying coverage because of pre-existing conditions. (Pelzer, 3/27)

The Hill: Trump Doubles Down On ObamaCare Decision 
President Trump on Wednesday defended his administration’s controversial decision to back a legal effort to strike down the entirety of former President Obama’s signature health care law. The move has rattled congressional Republicans, introducing an issue that Democrats feel they can use in the 2020 election to win back the Senate majority and even expand their House majority. (Fabian, 3/27)

Politico: The New GOP Senator Who Wants To Be A Leader On Health Care
Just a year ago, Mike Braun was an underdog in the Republican primary for an Indiana Senate seat. Now he's a freshman senator, installed on the Senate's key health care committee — and pushing his own package of health reforms. Braun joined POLITICO's Dan Diamond to explain his frustration over how Washington regulates the U.S. health system, his criticism of the latest effort to strike down the ACA and why he thinks more Republicans need to make health care a policy priority. (3/28)

The Hill: Democrats Aim To Block DOJ Funds Supporting ObamaCare Lawsuit 
Senate Democrats are moving to try to block the Department of Justice (DOJ) from using federal funds to support a lawsuit targeting ObamaCare. Minority Leader Charles Schumer (D-N.Y.) said Wednesday that Democrats are offering an amendment to an unrelated disaster relief bill that would prevent the DOJ from spending money on the case, which is being litigated in an appeals court. (Carney, 3/27)

Politico: Senate Dems To Try To Stop DOJ's Funding For Obamacare Lawsuit Support
"It will very simply prohibit the Department of Justice from using any funding to litigate the downfall of the ACA in the Circuit Court. Let's see if all of our Republican colleagues who have said they don't want to take away protections for preexisting conditions," Schumer said on Wednesday. "Let's see how our Republican colleagues will vote on this." (Everett, 3/27)

The Associated Press: US Seeks More Time On How To Address Separated Children
The Trump administration wants more time to say how it will address potentially thousands of children who were separated from their families at the border. U.S. District Judge Dana Sabraw in San Diego had ordered the government to propose next steps by Wednesday on what to do about children who were separated on or after July 1, 2017. His previous order to reunify families applied only to children in custody on June 26, 2018. (3/27)

The Washington Post: U.S. Has Hit ‘Breaking Point’ At Border Amid Immigration Surge, Customs And Border Protection Chief Says
The nation’s top border official warned that the U.S. immigration enforcement system along the nation’s southern boundary is at “the breaking point” and said Wednesday that authorities are having to release migrants into the country after cursory background checks because of a crush of asylum-seeking families with children. Kevin McAleenan, the commissioner of U.S. Customs and Border Protection, said that for the first time in more than a decade, his agency is “reluctantly” performing direct releases of migrants, meaning they are not turned over to Immigration and Customs Enforcement, they are not detained, they are not given ankle bracelets to track their movements and they are allowed to leave with just a notice to appear in court at a later date. (Miroff and Sacchetti, 3/27)

The Associated Press: US Will Reassign Border Inspectors As Illegal Crossings Rise
The Trump administration said Wednesday it will temporarily reassign several hundred border inspectors as beleaguered forces already stationed along the U.S.-Mexico border struggle to keep pace with the growing number of migrant families who are showing up at the border in poor health and turning themselves in to agents to request asylum. (Attanasio, 3/27)

The Wall Street Journal: Border Patrol Stops Prosecuting First-Time Border Crossers In Texas Region
The Trump administration has curtailed a key component of its “zero tolerance” immigration policy, no longer charging first-time illegal border crossers with a crime along a busy stretch of West Texas. Prosecutions of single migrant adults caught crossing the border for the first time in and around Del Rio, Texas, were suspended in February amid lack of jail space, a U.S. Border Patrol official. The policy change hasn’t been previously reported. (Caldwell, 3/28)

The New York Times: Mammogram Centers Must Tell Women If They Have Dense Breasts, F.D.A. Proposes
Centers that provide mammograms to screen for breast cancer will have to tell women whether they have dense breast tissue, which can increase the risk of cancer and mask tumors, the Food and Drug Administration announced in a proposed rule on Wednesday. Dense tissue can hide cancer from X-rays, making mammography less reliable. Women with dense tissue are often advised to have other screening tests in addition to mammograms, such as ultrasound or M.R.I. scans. (Grady, 3/27)

The Associated Press: US To Require Breast Density Information After Mammograms
More than half of women over age 40 have dense breasts, with less fatty tissue and more connective and glandular tissue. That tissue appears white on X-rays, the same color as growths in the breast, making mammograms harder to read. Dense breast tissue is one of the factors that can increase a woman's chances of developing cancer. Under the FDA's proposal, all women would receive a short summary about their breast density. For those with dense breasts, the letter would note that their tissue "makes it harder to find breast cancer," and could require additional testing. The letter would also recommend that they speak with a doctor about their "individual situation." (3/27)

The Washington Post: FDA Proposes Mammography Rule To Provide Women With Information About Breast Density
Three dozen states, including California, already have laws involving breast-density notifications but the new FDA language would establish a minimum standard that would apply nationwide. The proposal would modernize the agency’s oversight of mammography services “by capitalizing on a number of important advances in mammography, like the increased use of 3-D digital screening tools and the need for more uniform breast density reporting,” FDA Commissioner Scott Gottlieb said in a statement. In addition, the changes would allow the FDA to directly notify patients and their healthcare providers if a facility did not meet quality standards and a repeat test might be needed, the agency said. (McGinley, 3/27)

Modern Healthcare: FDA Proposes First Changes To Mammography Standards In 20 Years
The agency on Wednesday issued its first proposed change in 20 years to regulations governing mammography facilities. Dr. Laurie Margolies, section chief of breast imaging at Mount Sinai Health System in New York, said having a national standard should requires providers to give information that is most relevant toward the care of that individual patient. "What's important for the patient to understand is ... what they may do in addition to mammography to find some cancers that might be masked by the dense breast tissue and therefore might not be found until a later time," Margolies said. (Johnson, 3/27)

Bloomberg: Are Generic Drugs Safe? FDA Moves To Regulate Tainted Pills 
U.S. regulators plan to revamp rules governing how medicines are manufactured, in an effort to ensure the safety of the nation's drug supply as recalls of contaminated imports from developing countries widen. "We’ve seen a lot of instances of adulterated products — contamination, impurities — recently,” said Food and Drug Administration Commissioner Scott Gottlieb, who plans to leave his post next month, in an interview. “The underlying causes have been traced back to manufacturing, inadequate quality controls and generally poor management oversight.” (Edney, 3/27)

Kaiser Health News: FDA Chief Calls For Release Of All Data Tracking Problems With Medical Devices
FDA Commissioner Scott Gottlieb announced in a tweet Wednesday that the agency plans to release hundreds of thousands, if not millions, of previously unpublished injury and malfunction reports tied to about 100 medical devices. “We’re now prioritizing making ALL of this data available,” Gottlieb tweeted. (Jewett, 3/27)

Kaiser Health News: Health Officials’ Plug For Next FDA Chief: Go Big On E-Cig Regulation
In an almost uniform response to the impending exit of Food and Drug Administration Commissioner Scott Gottlieb, city and county public health officials are urging the Trump administration to go bigger in its response to adolescents’ growing use of e-cigarettes. The issue, they say, is reaching crisis levels and many worry the FDA’s much-touted efforts are falling short. (Luthra, 3/28)

WBUR: FDA's Gottlieb: More Kids Vaping 'Changes The Equation' For E-Cig Regulation
In his almost two years as FDA Commissioner, Scott Gottlieb has overseen a crackdown on the tobacco industry and on electronic cigarettes. It's an effort he hopes the agency will continue after he steps down in April. That's because, he says, of increased e-cigarette use among America's youth. (Inskeep, 3/27)

The Wall Street Journal: Pedophile Doctor Could Get U.S. Pension Of More Than $1.8 Million While In Prison
A U.S. government pediatrician convicted of sexually abusing Native American boys under his care is still receiving his government pension, officials said, and records indicate he is due more than $1.8 million during his prison term. The government likely can’t stop the pension payments to Stanley Patrick Weber, unless Congress changes federal law. Mr. Weber worked at federal Indian Health Service hospitals for about 30 years. (Weaver and Frosch, 3/27)

In other news from the administration —

The New York Times: EPA: No Toxic Releases At Superfund Sites In Flooded Midwest
Flooding in the Midwest temporarily cut off a Superfund site in Nebraska that stores radioactive waste and explosives, inundated another one storing toxic chemical waste in Missouri, and limited access to others, federal regulators said Wednesday. The Environmental Protection Agency reported no releases of hazardous contaminants at any of eight toxic waste sites in flooded parts of Missouri, Nebraska and Iowa. It has not issued any public health advisories or alerts, nor has it tested any of the soil and water at those sites. (3/27)

Modern Healthcare: CMS Launches $1.65 Million AI Challenge
The CMS on Wednesday launched a $1.65 million contest to develop an understandable artificial intelligence tool that can predict patients' healthcare outcomes and adverse events. The right AI tool could improve quality and lower administrative burdens for doctors, The agency and the American Academy of Family Physicians, which is supporting the challenge, say the right AI tool could improve care quality and lower doctors' administrative burdens. (King, 3/27)

Modern Healthcare: Hargan Calls For Incentives To Boost Kidney Treatment Innovation
HHS wants to shift Medicare payment policies to encourage providers to shift dialysis to patients' homes, which would save money on treating end-stage renal disease, HHS Deputy Secretary Eric Hargan said. Medicare's payment program doesn't focus enough on prevention or home dialysis, which research has shown is cheaper but just as safe as going to a clinic, Hargan said at Academy Health's Datapalooza event Wednesday. (King, 3/27)

The New York Times: Monsanto Ordered To Pay $80 Million In Roundup Cancer Case
A federal jury on Wednesday ordered Monsanto to pay more than $80 million in damages to a California man whose cancer it determined was partly caused by his use of the popular weedkiller Roundup. The six-member jury found that Monsanto should be held liable for the man’s illness because it failed to include a label on its product warning of the weedkiller’s risk of causing cancer. (Jacobs, 3/27)

Reuters: U.S. Jury Says Bayer Must Pay $80 Million To Man In Roundup Cancer Trial
The jury in San Francisco federal court said the company was liable for plaintiff Edwin Hardeman's non-Hodgkin's lymphoma. It awarded $5 million in compensatory damages and $75 million in punitive damages to Hardeman after finding that Roundup was defectively designed, that Monsanto failed to warn of the herbicide's cancer risk and that the company acted negligently. (3/27)

The Associated Press: Man Awarded $80M In Lawsuit Claiming Roundup Causes Cancer
Hardeman said he used Roundup products to treat poison oak, overgrowth and weeds on his San Francisco Bay Area property for years. The same jury previously found that Roundup was a substantial factor in Hardeman's non-Hodgkin's lymphoma. "Today, the jury sent a message loud and clear that companies should no longer put products on the market for anyone to buy without being truthful, without testing their product and without warning if it causes cancer," said Jennifer Moore, one of Hardeman's attorneys. (3/27)

The Wall Street Journal: Jury Awards Over $80 Million In Roundup Exposure Case
Jurors heard competing narratives in the second phase on whether Monsanto did enough to test the safety of glyphosate and pass that information to customers. “A responsible company would test its product. A responsible company would tell consumers if they knew that it caused cancer,” Jennifer Moore, an attorney for Mr. Hardeman, said during closing arguments. “And Monsanto didn’t do either of those things.” Ms. Moore said Monsanto was driven by greed and urged the jurors to stop “the lying, the ghostwriting, the manipulation” with its verdict. (Bender and Randazzo, 3/27)

Meanwhile, in other news —

Bloomberg: Johnson & Johnson Settles Oklahoma Talc-Cancer Case 
Johnson & Johnson took the unusual step of settling three women’s claims that its talc-based products caused their asbestos-linked cancers rather than let juries decide the cases, potentially opening a new front in the growing litigation against the world’s largest maker of health-care products. Jurors in state court in Oklahoma City Wednesday spent about three hours weighing whether J&J’s baby powder was a factor in a 77-year-old woman’s development of peritoneal mesothelioma when a judge announced the two sides had cut a deal. Details of the accord weren’t made public. (Feeley, Fisk and Korosec, 3/27)

The New York Times: ‘You Can’t Put It Behind You’: School Shootings Leave Long Trail Of Trauma
Kelly Plaur is still having nightmares almost every night. In the mornings, she recounts them to her mother, though the theme is usually the same: the horror she witnessed at Marjory Stoneman Douglas High School last year when a gunman opened fire in her classroom, killing two students and injuring four others. A few weeks ago, Ms. Plaur, 18, had to withdraw from the paramedic training program she had started after she was overcome with anxiety while transporting a gunshot victim. Even the sight of certain window blinds can put her on edge, reminding her of the bullet holes that pierced the classroom blinds on the day of the rampage. (Mazzei and Jordan, 3/28)

Los Angeles Times: Suicides Highlight The Toll Of School Shootings And The Role Of ‘Complicated Grief’
After three suicides in 10 days involving people directly affected by school shootings, there’s renewed interest in a condition that psychologists call “complicated grief.” Long after a mass-casualty event, roughly 10% of people experience the enduring or chronic depression and distress that are hallmarks of the condition. Scientists are still trying to understand whether, or by how much, the circumstances of a loved one’s death raise the risk of complicated grief. (Healy, 3/27)

The Associated Press: Parkland Parents, Teachers Seek To Help Teens After Suicides
Days after the suicides of two student survivors of the Parkland school shooting, parents and teachers packed a town hall Wednesday night, anxiously wondering out loud how to get students to seek therapy as many have been unwilling — despite a barrage of offerings since the 2018 massacre. On Wednesday night, anxious parents in the standing-room only crowd spoke of fears and frustration in trying to get their children help after the Valentine's Day massacre that February, which killed 17 people. (3/27)

Miami Herald: Parkland Suicides Prompt Lawmakers To Consider More Funding
When lawmakers gave more than $69 million in mental health to school districts after the Marjory Stoneman Douglas High shooting, many cast the funding as a way to help prevent future mass shootings and identify troubled students who needed help. But there was little discussion while crafting the bill — and no mention in the final 105 pages of legislation — that specifically directed schools to consider suicide prevention efforts, the most pressing mental health challenge facing a generation and the second leading cause of death for young people under 35. (Koh, 3/27)

The New York Times: The Measles Emergency: What Are Religious Exemptions?
Measles cases have spread across the country this year, with the state of New York now facing its worst outbreak in decades. Since last fall, more than 150 measles cases have been recorded in Rockland County, a New York suburb home to a large ultra-Orthodox Jewish community where there has been some resistance to vaccinations. (Dias, 3/27)

The Associated Press: Kids Get Measles Vaccine After County Declares Emergency
Some parents who had resisted having their children vaccinated reluctantly brought them in for a measles shot Wednesday as a state of emergency took effect in a county in New York City's northern suburbs. Rockland County enacted the emergency order Tuesday night to fight a measles outbreak that has infected more than 150 people since last fall. The order bans unvaccinated children under 18 years old from public places such as schools, stores and churches. (3/27)

Detroit Free Press: 22 Measles Cases In Oakland, Wayne Counties As Outbreak Grows
Michigan's most severe measles outbreak in years continues to grow and has sickened 22 people in metro Detroit, health officials announced Tuesday. The confirmed cases — 21 in Oakland County, where the outbreak began, and one in Wayne County —  are all believed to be linked to a sickened traveler who visited the area earlier this month. Two other suspected cases are under investigation. (Zaniewski, 3/27)

The Associated Press: Whooping Cough Case At Texas Capitol Leads To Vaccinations
Nearly 50 people who work at the Texas Capitol have been vaccinated this week because a page contracted whooping cough, a health scare that comes as legislatures around the country grapple with rising immunization exemptions and recent measles outbreaks. Texas health officials have been offering the vaccinations since Monday, three days after lawmakers were notified that a page had come down with the highly infectious disease. (3/27)

NPR: Assaying Antibiotic-Resistant Bacteria In Raw Sewage Pinpoints Hot Spots
Humanity is rapidly approaching a post-antibiotic era. Overuse of these miracle drugs has contributed to the emergence of many bacterial strains that are resistant to once-effective treatments. Our interconnected world and bacteria's ability to quickly swap genes that confer resistance with distant relatives make mapping hotbeds of resistance especially important. Where should we look? (Lambert, 3/27)

The New York Times: Flu Tied To Heart Failure Worsening
When the number of reported flu cases goes up, so does the number of hospitalizations for heart failure. A study in JAMA Cardiology used data on 451,588 people, ages 35 to 84, in four geographic areas over four flu seasons, from 2010 to 2014. The researchers randomly sampled 2,042 hospitalizations for heart failure and 1,599 for heart attack. To track flu activity, they used surveillance data from the Centers for Disease Control and Prevention. (Bakalar, 3/27)

The New York Times: Can What We Eat Affect How We Feel?
The patient, a 48-year-old real estate professional in treatment for anxiety and mild depression, revealed that he had eaten three dozen oysters over the weekend. His psychiatrist, Dr. Drew Ramsey, an assistant clinical professor of psychiatry at Columbia University, was impressed: “You’re the only person I’ve prescribed them to who came back and said he ate 36!” (Schiffman, 3/28)

The New York Times: Air Pollution Tied To Mental Health Issues In Teenagers
Urban air pollution is associated with an increased risk for psychotic experiences in teenagers, researchers report. A study published in JAMA Psychiatry included 2,063 British teenagers whose health had been followed from birth through age 18. Almost a third of them said they had at least one psychotic experience, ranging from a mild feeling of paranoia to a severe psychotic symptom, since age 12. (Bakalar, 3/27)

WBUR: Is It Time To Rethink The Fly-In Medical Mission?
But today there's some real soul-searching going on about this kind of fly-in. At conferences and in academic papers, health professionals are asking: Is this really the most effective way to provide health care to the developing world? (Silberner, 3/27)

The New York Times: ‘Swat The Kaiser’, Stork Stands And Grenade Throws: The History Of Army Physical Fitness
Few tasks in American soldiers’ lives are judged as deeply as their performance on the Army’s required semiannual physical-fitness test: Push-ups, situps and a timed two-mile run are used to gauge physical readiness and also, supposedly, readiness for combat. But that long-predictable standard will soon change — radically. By October 2020, all soldiers will instead take the new Army combat-fitness test — a six-event exam that includes heavy deadlifting, a backward medicine-ball toss and dragging a 90-pound sled. (Lowe, 3/28)

Kaiser Health News: More Older Adults With Joint Replacements Recover At Home, Not Rehab
Older adults and their families often wonder: Where’s the best place to recover after a hip or knee replacement — at home or in a rehabilitation facility? Increasingly, the answer appears to be home if the procedure is elective, friends and family are available to help and someone doesn’t have serious conditions that could lead to complications. This trend is likely to accelerate as evidence mounts that recuperating at home is a safe alternative and as hospitals alter medical practices in response to changing Medicare policies. (Graham, 3/28)

The Associated Press: Study: Many In Ebola Outbreak Don't Believe Virus Is Real
One out of four people interviewed in eastern Congo last year believed Ebola wasn't real, according to a new study, underscoring the enormous challenges health care workers are facing in what has become the second-deadliest outbreak in history. The survey released late Wednesday found that a deep mistrust of the Ebola response resulted in those people being 15 times less likely to seek medical treatment at an Ebola health center, according to the study published in The Lancet Infectious Diseases journal. (3/27)

The Associated Press: Centene To Buy WellCare For $15B, Create Medicaid Powerhouse
Centene is spending more than $15 billion on rival WellCare to dive deeper into government-funded health coverage in the same week that President Donald Trump's administration renewed its attack on the Affordable Care Act. The insurer said Wednesday that its cash-and-stock deal to buy WellCare will create an insurer that manages Medicaid coverage for more than 12 million people and covers several million more in the federal government's Medicare program for people age 65 and older. (3/27)

Reuters: U.S. Health Insurer Centene To Buy Smaller Rival WellCare For $15.3 Billion
The announcement comes days after the Trump administration stepped up its opposition to former President Barack Obama's signature healthcare law. The Department of Justice (DOJ) on Monday said it believes the Affordable Care Act (ACA), popularly known as Obamacare, violated the U.S. Constitution and that the law should be struck down. Centene relies on its Obamacare business for about 40 percent of its earnings, making it among the most vulnerable companies should the law be overturned, according to SVB Leerink analyst Ana Gupte. (3/27)

The New York Times: Centene To Buy WellCare For $15.3 Billion, Creating Health Care Giant
If the deal goes through, the acquisition of WellCare will cement Centene’s dominance in Medicaid coverage, the state-federal program for the poor, as well as in the Obamacare market, where it is the largest player. (Abelson and de la Merced, 3/27)

The Wall Street Journal: Centene To Buy WellCare For Around $15.3 Billion
Together, the companies would achieve substantial scale, an important goal, as the biggest health-insurance players have consolidated to form ever-larger conglomerates that bring together multiple different businesses, from pharmacy benefits to clinics and drugstores. Centene also supplies coverage for members of the military and health care for prison populations. Michael Neidorff, chief executive officer of Centene, said getting to greater scale was a major reason for the deal. “It gets your overhead down, so you can be more efficient,” he said. “When you talk to government, the fact that you have that kind of scale is important.” He also said Centene would benefit from WellCare’s Medicare platform, while WellCare could use Centene’s technology. (Wilde Mathews and Prang, 3/27)

Modern Healthcare: Centene To Purchase WellCare In $17B ACA Insurer Deal
Centene Corp. on Wednesday said it will buy fellow Medicaid insurer WellCare Health Plans in an estimated $17.3 billion deal. All in all, the two insurers would cover nearly 22 million people in Medicare, Medicaid and the ACA exchanges. Centene CEO Michael Neidorff will serve as chairman and CEO of the merged company. (3/27)

The Associated Press: Local Jurisdictions Pay The Price For Nation's Opioid Crisis
As the nation's opioid crisis has devastated thousands of families, it also has taken a crippling financial toll on cities, small towns and counties around the country. Packed jails, increased ambulance runs and overworked coroners, sheriff's deputies and public defenders are just some of the consequences of the massive epidemic that has forced localities to divert millions of dollars to overdose-related emergencies and addiction treatments. (3/27)

In other news on the epidemic —

Cleveland Plain Dealer: Deaths From Cocaine And Fentanyl Mixtures A Growing Concern In Northeast Ohio: What You Need To Know
Cocaine is becoming more prevalent in Cuyahoga County’s drug overdose deaths, and officials say that’s largely because drug dealers are mixing it with the powerful opioid fentanyl. Data from the Cuyahoga County medical examiner’s office shows cocaine was a factor in approximately 45 percent of drug overdose deaths last year, the highest percentage in more than a decade. (MacDonald, 3/27)

Politico: Pushing For 'Heartbeat' Abortion Bills, More States Try To Force Supreme Court To Revisit Roe
More state lawmakers are pushing "heartbeat" bills that ban abortion as early as six weeks into pregnancy in a bid to trigger a Supreme Court decision overturning Roe v. Wade. Four states have enacted such prohibitions — nearly all blocked by the courts — and the number is poised to grow in the coming days, with Georgia expected to sign a bill shortly. (Pradhan, 3/27)

Stat: North Dakota Has Too Few Psychiatrists. Telemedicine Is Helping 
Until recently, when the North Dakota human services agency had an opening for a mental health provider, months might go by before a single application came in. But that’s started to change as the state boosts telemedicine as an option for mental health care. The department has started allowing providers who serve patients through its health centers to live in some of the state’s bigger cities — or even move out of state — and deliver mental health care to rural areas through video calls. The University of North Dakota’s medical school has started training its psychiatry residents to treat rural patients by computer. (Thielking, 3/28)

Tampa Bay Times: All Children’s Deaths Led To A Bill Adding Oversight. The Florida House Just Gutted It.
After Johns Hopkins All Children’s and another Florida hospital experienced serious safety problems within their pediatric heart surgery departments, state lawmakers filed proposals to increase oversight of the procedures. On Tuesday, the Florida House gutted its version of the bill. (McGrory and Bedi, 3/27)

Boston Globe: Trump Intends To Cut Family Planning Funds. Massachusetts Is Poised To Replace Them.
Massachusetts lawmakers intend to spend up to $8 million on family planning programs, replacing the federal funds the Trump administration is expected to halt in early May for health centers that discuss abortion. The House voted Wednesday to pass such a measure, and the Senate and Governor Charlie Baker are expected to approve. (Ebbert, 3/28)

The Baltimore Sun: Maryland House Of Delegates OKs Bill To Create A Prescription Drug Price Board For Government Employees 
The Maryland House of Delegates approved Wednesday a bill that would create a state board to set limits on how much state and local governments pay for medicines for their employees and retirees. The bill was approved largely along party lines on a 98-40 vote, moving the measure to the state Senate for consideration. (Wood, 3/27)

Kansas City Star: Kansas And Missouri Legislatures Mull E-Prescribing Mandate
In 2016 a University of Kansas pharmacy intern lost his license after he stole a pad from a Topeka hospital where he worked and used it to forge prescriptions for opioid pills that he used and sold. Now Kansas and Missouri lawmakers are considering a simple policy that drug stores say would prevent that type of fraud: Doing away with paper prescriptions and requiring doctors send them directly to the pharmacy electronically. (Marso, 3/28)

Modern Healthcare: Penn. Sued Over Proposal To Force Hospitals To Contract With All Plans
Broadening the stakes in a long-running battle, the Hospital Association of Pennsylvania has joined UPMC in challenging the state attorney general's effort to force UPMC to keep its provider network open to Highmark Health and other health plans. In its motion Monday to intervene in UPMC's federal lawsuit, the hospital association said Democratic Attorney General Josh Shapiro has proposed a plan that would potentially force all not-for-profit hospitals in the state to do business with any insurer regardless of payment or other contract terms. (Meyer, 3/27)

Miami Herald: Healthcare Priorities Move In FL House; Budget Debate Begins
Hospitals would have to provide infection rate information to patients and be required to inform them if they’ve been placed on observation status rather than admitted outright, under a handful of bills that cleared the Florida House Wednesday. The proposals, some of Speaker José Oliva’s healthcare priorities, are among those that are starting to clear the chamber as lawmakers prepare to shift from policy-making into negotiating over the state’s mammoth budget for the next fiscal year. (Koh, 3/27)

Texas Tribune: Texans Waiting For Birth, Death Certificates Amid Health Agency Understaffing
The Texas Department of State Health Services says that as of March 22, there were 60,873 requests for records, including birth certificates, death certificates, divorce records, and verifications of marriages and adoptions that the department had not yet fulfilled. That also includes requests for corrections to these records.The backlog — which stems from a longtime staffing problem and was exacerbated by the state's switch in January to a new computer system for processing records — comes as the agency vies for a boost in funding to more quickly process requests. (Evans, 3/27)

Houston Chronicle: UH To Open Safety-Net Health Clinic Monday 
The University of Houston will open a safety-net health clinic for low-income people in the area Monday, a key initial component of its planned medical school. The university is partnering with Georgetown-headquartered Lone Star Circle of Care, which already operates 19 such clinics around the state. The clinics, known as federally qualified health centers, provide health care to patients regardless of their ability to pay. (Ackerman, 3/27)

WBUR: At Prominent Roxbury Health Center, Patients Ask For Their Providers Back
Some patients at the Whittier Street Health Center, the main health center in Roxbury, are calling upon the center to rehire former health care providers that were either fired or laid off last fall during a union campaign. The providers said they formed a union to protect themselves from abusive practices by management that had driven many of their colleagues away. (Thys, 3/28)

Cleveland Plain Dealer: Health Care, Drug Abuse, Jobs Are Top Concerns Among Ohio Democrats, Poll Shows
Health care is a big deal. Immigration is down the list. In between are concerns about climate change and gun policy. Those are the issues on the minds of Ohio Democrats midway between presidential elections, according to new statewide polling from Baldwin Wallace University. (Exner, 3/27)

Houston Chronicle: Cypress Fairbanks Medical Center To Layoff Or Reassign Hundreds
Nearly 600 employees have been laid off at Cypress Fairbanks Medical Center on the heels of its parent company's decision to convert the entire full-service hospital into a free-standing emergency room, according to state documents and hospital officials. The job cuts will begin May 17 and are expected to be permanent although efforts are  underway to offer those employees similar positions within the health care system, said Sean Burnett, vice president of strategic communications for HCA Houston Healthcare, in a statement on Wednesday. (Deam and Leinfelder, 3/27)

The Baltimore Sun: University Of Maryland Medical System Confronts Yet Another Controversy 
The University of Maryland Medical System board of directors has confronted one crisis after another in the past year or so, from a patient-dumping accusation at one hospital and sexual harassment in its ranks to a shooting outside its Shock Trauma emergency room. But now it’s the directors themselves who have thrown the system into distress, with nine members found to be profiting while they served in volunteer posts on the high-profile board. They or their businesses have been making hundreds of thousands to millions of dollars off the taxpayer-backed hospitals they are charged with governing. (Cohn and Marbella, 3/28)

Pioneer Press: Following Outcry, Senator Clarifies Statement That People Who Need Insulin Should Go To The ER. That’s Not What She Meant.
No one should die from rationing prescription drugs they need to live. And if you get to the point where you’re having a seizure or going into insulin shock, you should go to the emergency room. That’s what state Sen. Michelle Benson, R-Ham Lake, said she meant in public comments this week that caused outcry from some, who took her comments as insensitive and suggesting that ER visits were somehow Benson’s policy solution to skyrocketing drug costs. (Orrick and Faircloth, 3/27)

Boston Globe: Massachusetts Marijuana Regulators Investigating Whether Companies Violated License Limits
State regulators acknowledged Wednesday they have been investigating whether large marijuana companies are flouting state rules on the number of licenses that can be controlled or owned by a single entity, potentially making it harder for smaller, independent entrepreneurs to compete. The revelation by the Cannabis Control Commission comes a week after the Globe Spotlight Team reported that two major companies, Sea Hunter Therapeutics and Acreage Holdings, have publicly bragged to investors about amassing large numbers of licenses in Massachusetts — despite rules barring any one entity from owning or controlling more than three licenses to operate medical marijuana stores or three licenses for recreational stores. (Wallack and Adams, 3/28)

JAMA Internal Medicine: Prevalence And Severity Of Rationing During Drug Shortages: A National Survey Of Health System Pharmacists.
Hospital medication shortages in the United States are associated with decreased quality and/or quantity of life. In severe cases, shortages require clinicians to decide which patients receive needed medications and which do not (ie, rationing drugs between patients). Previous studies have proposed ethical allocation frameworks and assessed the associations of specific shortages. We conducted a national survey of hospital pharmacy managers to investigate current drug allocation and rationing practices of US hospitals during shortages. (Hantel et al, 3/25)

Health Affairs: A Survey Of Americans With High-Deductible Health Plans Identifies Opportunities To Enhance Consumer Behaviors
Most high-deductible health plan (HDHP) enrollees do not engage in consumer behaviors such as price shopping. Why not? We surveyed 1,637 Americans in HDHPs—which can be linked to health savings accounts (HSAs) but usually are not—about factors that may predict, facilitate, or impede HDHP enrollees’ engagement in consumer behaviors. We found that having an HSA was associated with saving for future care, high financial literacy was associated with comparing prices and quality, and high confidence in talking with providers about costs and trying to negotiate prices was associated with engaging in these behaviors. Employer HSA contributions were the most frequent facilitator of saving, websites were the most frequent facilitators of comparing prices and quality, and “someone at the doctor’s office” was the most frequent facilitator of discussing costs with providers and trying to negotiate prices. The most frequent impediment to all of these behaviors was not having considered them when making decisions. These results suggest strategies that health plans, employers, and health systems should explore to promote greater engagement in consumer behaviors among patients in HDHPs. (Kullgren et al, 3/4)

Commonwealth Fund: Pharmacy Benefit Managers Practices Controversies What Lies Ahead
Pharmacy benefit managers (PBMs) are responsible for negotiating payment rates for a large share of prescription drugs distributed in the U.S. Recently, policymakers have expressed concern that certain PBMs’ business practices may not be consistent with public policy goals to improve the value of pharmaceutical spending. (Seeley and Kesselheim, 3/26)

The Henry J. Kaiser Family Foundation: Poll: Most Americans Say HIV Is Serious Issue For The Country As Trump Administration Rolls Out New Plan To End HIV By 2030; Black And Hispanic Adults Report More Personal Concern Than White Adults
With the Trump administration launching a new domestic HIV effort, the latest KFF Health Tracking Poll finds a large majority of Americans (80%) view the HIV epidemic as a serious national issue, including a third (34%) who view it as “very serious.” Nearly half (46%) view it as a serious concern for people they know, including a quarter (24%) who view it as “very serious.” The poll is the first to probe in depth about the public’s views and knowledge of the nation’s HIV epidemic since President Trump used his Feb. 5 State of the Union address to announce the new initiative to significantly reduce the HIV epidemic in the U.S. within ten years. (3/26)

Los Angeles Times: Healthcare Isn't A Game. Both Parties Need To Stop Playing Political Football With It
On Tuesday, Trump told reporters, “The Republican Party will soon be known as the party of healthcare.” And on Wednesday he declared, “If the Supreme Court rules that Obamacare is out, we'll have a plan that is far better than Obamacare.” Those promises, however, merely echoed the empty statements Trump made during the 2016 campaign, when he pledged to replace the healthcare law with “something great” — and, as we learned, imaginary. (3/28)

Bloomberg: Health Care: Bolstering Obamacare Is Smart Priority For Democrats 
Even before this week brought news of fresh Justice Department efforts to destroy the Affordable Care Act, the health-care law was already in dire need of reinforcement. Congress weakened it more than a year ago by withdrawing the tax penalty for Americans who go without health insurance. And the White House has inflicted a series of further wounds, from making it harder for people to learn about and enroll in Obamacare plans to enabling junk health insurance to be sold in place of good-quality coverage. The ACA remains under fierce assault. And that is all the more reason to welcome a new effort by Democratic leaders in the House of Representatives to buttress the law. (3/27)

The Washington Post: Republicans Can’t Destroy The Safety Net. So They’re Making It An Instrument Of Misery.
In many ways, America gets more liberal all the time. While you can see it vividly on issues such as marriage equality where rapid change is obvious to just about everyone, it can also come up in surprising ways. That’s what Republicans confronted in 2017 when they tried to repeal the Affordable Care Act and discovered to their chagrin that Medicaid is a hugely popular program. Everyone knew seniors love their Medicare, but they figured that drastic cuts to Medicaid would be much less likely to spur a backlash, particularly since its recipients are low-income Americans with little power. (Paul Waldman, 3/27)

USA Today: Trump Claims 'Party Of Great Health Care,' But Republicans Have No Plan
While President Donald Trump prattled Wednesday about some forthcoming, unspecified offering that would be “far better than Obamacare” and make the GOP "the party of great health care," he has no such plan. Such a plan has never existed for one simple reason: The ACA largely is that plan. Its basic architecture was devised in the 1990s as a conservative alternative to the proposals of Bill and Hillary Clinton. Later, it would be put into practice by Republican Mitt Romney, when he was governor of Massachusetts, and appropriated by Democrat Barack Obama when he was a presidential candidate. (3/27)

The Washington Post: Trump’s New Attempt To Undo Obamacare Is Senseless
President Trump humiliated the Justice Department this week, not with something he tweeted but in a move that could be far more consequential. According to Politico, the White House ordered the department to change its position on a major anti-Obamacare lawsuit — from weird to truly wacky — despite opposition from Attorney General William P. Barr. Indeed, Mr. Barr should be embarrassed: The legal reasoning at work in the decision is poor, and the erosion of Justice Department norms is worrying. (3/27)

The New York Times: Why Trump’s New Push To Kill Obamacare Is So Alarming
Attorney General William Barr was supposed to be a voice of reason in the Trump administration. An old Washington hand, he had the stature and the backbone to protect the Justice Department from a White House that often seems to disdain the rule of law. Turns out it isn’t so. In a stunning two-sentence letter to a federal appeals court, the Justice Department announced on Monday that it would now seek the invalidation of the entire Affordable Care Act — every last one of its thousands of provisions. (Nicholas Bagley, 3/27)

The Washington Post: Republicans Furious With Trump For Making It Harder To Lie About Health Care 
As we’ve been discussing here, the Trump administration has fully embraced a lawsuit that seeks to overturn the Affordable Care Act entirely based on a legal theory that is being widely dismissed by commentators across the spectrum as nothing but a bad joke. The problem is that a Texas judge has decided that this joke is good law, and has struck down the entire ACA as unconstitutional, using logic that is bafflingly difficult to follow. That’s up on appeal, however, and no doubt many Republicans have quietly been hoping against hope that the lawsuit — which was brought by a group of Republican attorneys general — ultimately fails. Yet the Trump administration embraced the lawsuit. (Greg Sargent, 3/27)

The Wall Street Journal: Medicare For All Means Hope For None
Medicare, as President Lyndon B. Johnson put it, is a “light of hope” for elderly Americans. Medicare for All proposals threaten to extinguish it. Medicare for All would break a sacred promise and harm seniors’ access to care by forcing a system designed to support them to take on every other American. They deserve a system that helps them get well, not get in line. As for your taxes, the question isn’t whether Medicare for All would raise them, but by how many tens of trillions. The Mercatus Center at George Mason University and Emory University’s Kenneth Thorpe calculate 10-year price tags of $32.6 trillion and $24.7 trillion, respectively. (Administrator of the Centers for Medicare and Medicaid Services Seema Verma, 3/27)