The Associated Press: Trump Says Abortion Comments Were Taken Out of Context
Republican presidential candidate Donald Trump now says his contentious comments on abortion were taken out of context. Trump was answering questions during an MSNBC town hall taping Wednesday when he said there should be "some form of punishment" for women who get abortions if the procedure is outlawed. He later reversed his position in a statement. In an interview Thursday night on Fox News Channel's "The O'Reilly Factor," Trump blamed the flub on a "convoluted" interview. (3/31)

The New York Times: Donald Trump Acknowledges Misstep On Abortion Question
Donald J. Trump on Thursday allowed that he might have misspoken on the topic of abortion when he told the MSNBC host Chris Matthews that women who have abortions should face some form of punishment if the procedure is banned. But he insisted the media attention to a misstep — amid the volume of questions he answers — gets outsize attention. “If you answer one question inartfully or incorrectly in some form, or you misunderstood it or you misspoke, it ends up being a big story,” he said. “That doesn’t happen with other people.” (Haberman, 3/31)

The Associated Press: Anti-Abortion Movement Unified In Swift Rebuke Of Trump
Trump soon backtracked from Wednesday's comments, but not before anti-abortion leaders forcefully repudiated him. "There was no time to get on the phone and compare talking points, but all the comments were consistent," said Mike Gonidakis, president of Ohio Right to Life. "The foundational premise of the pro-life movement is to protect both the mother and the unborn child. We don't leave one of them behind." The anti-abortion movement is by no means monolithic — there are sometimes sharp splits over political tactics and the question of whether abortion bans should make exceptions for rape and incest. But there is common ground around the belief that life begins at conception, and a consensus that this belief takes precedence over short-term political calculations. (3/31)

In other news, The Washington Post fact checks Carly Fiorina's portrayal of Hillary Clinton's abortion stance —

The Washington Post's Fact Checker: Fiorina’s Claim That Hillary Clinton Supports Abortion ‘Up Until The Moment’ Of Birth
Former GOP presidential hopeful Carly Fiorina, now a supporter of Sen. Ted Cruz (R-Tex.), appeared on Fox to make the case that front-runner Donald Trump had fishy credentials as an opponent of abortion rights, even before Trump caused new controversy for saying women who get abortions should be punished. But we were also interested in her attack on Hillary Clinton’s abortion position. Is it correct that Clinton supports abortion up to the moment of birth? (Kessler, 4/1)

And the governor of Arizona says he "stand[s] with those advocating life," after signing three bills targeted at limiting abortions, and medical schools and universities say House subpoenas over fetal research are a safety risk —

The Associated Press: Arizona Governor Signs 3 Bills Targeting Abortion Providers
Arizona Gov. Doug Ducey on Thursday announced he had signed three bills targeting abortion providers, including one requiring them to follow outdated federal guidelines for the most common abortion drug and prescribe it at much higher doses than needed. The law boldly defies new FDA rules implemented this week on abortion drugs. The signing of the bill, Senate Bill 1324, is likely to jump-start a federal court case that had blocked a previous version of the legislation. The bill bars doctors from prescribing the drug commonly known as RU-486 after seven weeks of pregnancy and requires it to be taken only at Food and Drug Administration-approved doses in effect until this week. It also requires the two doses of the drug to be taken at a clinic, while providers now send the patient home with the second pill to be taken days after the first. (3/31)

The Hill: Universities Protest Subpoenas For Fetal Tissue Researchers' Names
Medical schools and universities are protesting Republicans’ decision to issue subpoenas for the names of researchers involved in fetal tissue studies, saying it could put their safety at risk. The Association of American Medical Colleges, which represents all of the country’s medical schools, expressed its “significant concerns” in a letter on Thursday to the heads of the congressional committee set up to investigate Planned Parenthood. (Sullivan, 3/31)

The Wall Street Journal: Hospitals Brace For New Medicare Payment Rules
Starting Friday , nearly 800 U.S. hospitals face sweeping new payment rules that could have a direct impact on their bottom line, but not everyone is ready, industry experts say. The rules will hold hospitals accountable for all the costs of hip and knee replacements for 90 days. If patients recover and go home quickly, hospitals could reap savings. If they have complications or need lengthy stays in a rehab facility, hospitals could owe Medicare instead, starting next year. (Beck, 3/31)

The Associated Press: Medicare Opens New Push On Hip, Knee Replacement
From Akron to Tampa Bay, from New York City to San Francisco, Medicare on Friday launches an ambitious experiment changing how it pays for hip and knee replacements in an effort to raise quality and lower costs. The idea is to follow patients more closely to smooth their recovery and head off unwanted complications that increase costs. Hip and knee replacements are the most common inpatient surgery for beneficiaries, and Medicare will be using financial rewards and penalties to foster coordination among hospitals, doctors, and rehab centers. Improved care should also reduce costs, the government says. (Alonso-Zaldivar, 3/31)

Toledo Blade: Medicare Alters Payment Plan For Joint Replacement
The Toledo Metropolitan Statistical Area, which includes Lucas, Wood, and Fulton counties, and 67 other metro areas have a new mandate from Medicare. A five-year pilot program will track joint-replacement surgery patients for three months and combine the costs for surgery and any associated care into a single payment. Federal officials call this a “target price” or “bundled payments.” ... Putting hospitals in the position of managing the patient’s quality of care and costs three months after the surgery has forced closer collaboration between hospitals and local rehabilitation centers, [said Shannon Holley, associate vice president of patient care and operations at ProMedica]. (Harris-Taylor, 4/1)

Lincoln (Neb.) Journal-Star: Lincoln Among Cities In New Medicare Payment Program
Medicare patients getting hip and knee replacement surgeries at Lincoln hospitals will be part of a new payment program starting Friday. Lincoln is one of 67 metro areas in the U.S. -- and the only one in Nebraska -- where Medicare will debut a new bundled payment program for those surgeries. ... Doctors, hospitals, rehab centers, therapists, home health agencies and other providers will continue to get their regular reimbursements from Medicare. But at the end of the year, hospitals will be held accountable for the total cost of care over the 90-day period. "Everybody's going to get paid the same, but it's just the hospitals taking the risk," said Robb Linafelter, CEO of the Lincoln Surgical Hospital. (Olberding, 3/31)

In other Medicare news —

CQ Healthbeat: Groups Wary As Medicare Creates Measures For Judging Doctors
Health professional societies and consumer groups have asked Medicare to tread carefully while overhauling its system for paying doctors, raising concerns about an agency suggestion to include guidelines from a campaign that seeks to curb the use of often unneeded procedures and treatments. Medicare officials are awaiting White House clearance of a draft rule designed to tie payments for doctors to judgments about the quality of care they provide. The Office of Management and Budget has been reviewing this proposal since March 25. The Centers for Medicare and Medicaid Services rule would carry out the changes mandated in last year’s congressional overhaul of Medicare physician payments. (Young, 3/31)

USA Today: Insurers Cut Commissions To Restrict When And What Plans People Buy
Insurers increasingly are dropping agents' commissions to discourage the sale of the Affordable Care Act plans they're losing the most money on, especially when the consumers are more likely to be sick, according to health care industry officials and experts. The moves by nearly every major insurer over the last few months are often focused on times of the year and plans that attract the sickest people and starting to prompt action by state officials and legislators. Some, including the head of California's state insurance exchange, say federal regulators should help assure consumers get the help and plans they need, especially during special enrollment periods when they lose jobs, move or have babies. (O'Donnell, 3/31)

Earlier, related KHN coverage: Licking Wounds, Insurers Accelerate Moves To Limit Health-Law Enrollment (Hancock, 2/4).

Union Leader: NH Senate OK's Medicaid Expansion
Low-income adults will be eligible for publicly funded health insurance for two more years under the state’s Medicaid expansion program, thanks to a 16-8 Senate vote on Thursday. Gov. Maggie Hassan has said she will sign House Bill 1696. During two hours of debate, a majority of senators rejected proposals to change the bill. Six Republicans joined all 10 Democrats to approve the program, begun nearly two years ago under the Affordable Care Act. (Rayno, 3/31)

Concord Monitor: Senate Approves Medicaid Expansion In A Divided Vote
The bill extends the health care program for two more years, institutes new work requirements for enrollees and covers state costs with premium tax revenue and voluntary contributions from hospitals and insurance carriers. The Senate vote marks an end to months of legislative debate over how to continue the state’s Medicaid expansion program, which was set to expire at the end of this year. While Republicans authored the reauthorization bill, the party’s lawmakers remain divided over the health care program. (Morris, 3/31)

Reuters: Drug Shortages Prompt Question: Are Some Medicines Too Cheap?
Philip Aubrey buys medicines for British government-funded hospitals across London, capital of the world's fifth-largest economy, but last year he struggled to secure supplies of a basic AIDS drug. He is not alone. Shortages of essential drugs, mostly generic medicines whose patents have long expired, are becoming increasingly frequent globally, prompting the World Health Organization (WHO) to suggest minimum prices may be needed to keep some products on the market. (4/1)

Modern Healthcare: FDA Says Biosimilar Labels Should Rely On Reference Drug Data
Biologic manufacturers may not be pleased with the long-awaited biosimilar labeling guidelines released Thursday by the Food and Drug Administration. The agency is recommending that labeling for biosimilars use the clinical data gathered by the product the biosimilar is intended to emulate. Regulators would also allow biosimilar labels to state that the product is biosimilar to the reference product but has product-specific modifications. Biosimilars are derived from living organisms and therefore may not be identical to brand-name drugs. (Rubenfire, 3/31)

CQ Healthbeat: FDA Seeks To Add Identification Of Copycat Biotech Drugs To Labels
The Food and Drug Administration proposed that makers of copycat biotech medicines distinguish between their products and the original versions in new statements at the top of the prescribing information for the treatments, which is intended to be read by doctors. (Young, 3/31)

In other pharmaceutical news —

The Wall Street Journal: FTC Sues Endo, Alleges Company Paid Off Generic Drugmakers
The Federal Trade Commission said Thursday it sued drugmaker Endo International PLC, alleging the company violated federal antitrust laws by paying hundreds of millions of dollars to delay generic competition against two of its biggest drugs. The suit, filed under seal on Wednesday in U.S. District Court for the Eastern District of Pennsylvania, is the latest by the FTC to target alleged “pay-for-delay” agreements. (Walker and Hufford, 3/31)

The Wall Street Journal: Glaxo To Stop Seeking Drug Patents In Low-Income Countries
GlaxoSmithKline PLC said it would stop seeking patents for its drugs in low-income countries, a move the drugmaker said could help the world’s poorest people access copycat versions of its medicines at affordable prices. The U.K.-based company said it would take this approach in low-income and least-developed countries, a group totaling around 85 nations. In so-called lower-middle-income countries, a group of 51 nations that includes Vietnam, Cameroon and Sri Lanka, it said it would file patents but aim to grant licenses to generic manufacturers to supply low-cost versions of its drugs in those markets in return for a small royalty. (Roland, 3/31)

The Wall Street Journal: Regeneron, Sanofi Say New Eczema Drug Met Targets In Late-Stage Studies
Regeneron Pharmaceuticals Inc. and Sanofi SA said their experimental drug for a debilitating skin condition called atopic dermatitis met all of its major treatment targets in two late-stage studies, a key step in advancing a potential blockbuster medicine toward the market. The drug, called dupilumab, substantially improved rash, itching and other symptoms of the condition, the companies said, which is a serious type of eczema that in its moderate to severe form affects about 1.6 million American adults and a significant number of children. By some estimates, as many as 3% of adults world-wide suffer from some form of the disease. (Winslow, 4/1)

The Washington Post: Federal Employee Health Program To Boost Autism Benefits
Federal employee health-care plans will have to cover applied behavior analysis for children on the autism spectrum starting next year, and they are being encouraged to step up the incentives for enrollees to participate in wellness programs. The Office of Personnel Management since 2013 has encouraged carriers in the Federal Employees Health Benefits Program to cover that treatment for children diagnosed with Autism Spectrum Disorder, but “coverage has been uneven for this intense one-on-one therapy that is becoming a leading form of treatment for these children,” acting director Beth Cobert said Thursday morning. (Yoder, 3/31)

In other news, more employees are saying they'd rather have higher wages and fewer health benefits —

Kaiser Health News: Workers’ Desire Grows For Wage Increases Over Health Benefits
More wages, less health insurance. In a recent survey, one in five people with employer-based coverage said they would opt for fewer health benefits if they could get a bump in their wages. That’s double the percentage who said they would make that choice in 2012. “I do these surveys all the time, and it’s rare where you see things change that quickly,” said Paul Fronstin, director of the health research and education program at the Employee Benefit Research Institute, which conducted the survey of 1,500 workers with Greenwald & Associates. (Andrews, 4/1)

The Wall Street Journal: Theranos Devices Often Failed Accuracy Requirements
The blood-testing devices that Theranos Inc. touted as revolutionary often failed to meet the company’s own accuracy requirements for a range of tests, including one to help detect cancer, according to a federal inspection report. A redacted version of the report was released late Thursday. A full version was reviewed by The Wall Street Journal. The 121-page document details deficiencies found by the Centers for Medicare and Medicaid Services during its inspection of the closely held company’s Newark, Calif., laboratory last fall. (Carreyrou and Weaver, 3/31)

The New York Times: Report Shows Theranos Testing Plagued By Problems
Among other findings in the report, which ran 121 pages, the company used unqualified or inadequately trained personnel and stored samples in freezers that were not at the proper temperature. It also failed to ensure that the quality control for an important blood-clotting test was acceptable before reporting results for patients. (Pollack, 3/31)

Bloomberg: Theranos Inspection Report Details Quality-Control Failures
The document also includes Theranos’s plans for corrections, saying the new lab director, Kingshuk Das, has implemented extensive new procedures to improve the facility’s operations. “The lab directors during the period covered by the survey no longer hold any position with the lab,” Theranos wrote in the document. ... “We have no reason to believe that the issues raised by CMS have affected patients health,” company spokeswoman Brooke Buchanan said Thursday in an e-mail. “We’ve made mistakes in the past in the Newark, CA lab, but when the company was made aware of the deficiencies we have dedicated every resource to remedy those failures.” (Chen and Tracer, 3/31)

The Arizona Republic: Report On Theranos Cites Quality, Accuracy Issues
It was unclear whether CMS has accepted a proposed "plan of correction" that Theranos submitted as part of the inspection report. CMS officials declined to comment after releasing the report. A separate inspection of the company's Scottsdale lab found minor infractions that the company addressed. (Alltucker, 3/31)

Reuters: U.S., Canada Issue Joint Alert On 'Ransomware' After Hospital Attacks
The United States and Canada on Thursday issued a rare joint cyber alert, warning against a recent surge in extortion attacks that infect computers with viruses known as "ransomware," which encrypt data and demand payments for it to be unlocked. The warning follows reports from several private security firms that they expect the crisis to worsen, because hackers are getting more sophisticated and few businesses have adopted proper security measures to thwart such attacks. (Finkle, 3/31)

NBC News: MedStar Hospitals Recovering After 'Ransomware' Hack
A chain of hospitals serving hundreds of thousands of patients in the Washington, D.C. area is struggling to get back to normal, after it was hit with what's known as a "ransomware" attack. Ransomware is a strain of malware that encrypts data on infected machines, then typically asks users to pay ransom in hard-to-trace digital currency to get an electronic key so they can retrieve their data. (Williams, 3/31)

Stateline: As Fentanyl Deaths Spike, States And CDC Respond
When Ohio tallied what many already knew was an alarming surge in overdose deaths from an opioid known as fentanyl, the state asked the U.S. Centers for Disease Control and Prevention to investigate. The rash of fatal overdoses in Ohio — a more than fivefold increase in 2014 — was not an isolated outbreak. Fentanyl is killing more people than heroin in many parts of the country. And the death toll will likely keep growing, said CDC investigators Matt Gladden and John Halpin at the fifth annual Rx Drug Abuse and Heroin Summit [in Atlanta]. (Vestal, 4/1)

In other substance abuse news —

Modern Healthcare: Weaning Pregnant Women Off Addictive Drugs Not Harmful To Fetus, Study Says
Dr. Craig Towers says he's asked all the time by his pregnant patients who are addicted to opioids whether he can help them get completely off drugs so their baby doesn't suffer agonizing drug withdrawal symptoms after birth. ... Like nearly all doctors across the country, Towers previously would tell patients no, because detoxification would risk premature labor or even fetal death. Instead, he recommended that they receive medication-assisted drug maintenance therapy with methodone or buprenorphine through pregnancy. ... Challenged by his patients' insistent requests, however, Towers dug into the research literature and found several obscure studies suggesting that detox during pregnancy is not harmful. (Meyer, 3/31)

Kaiser Health News: The Wait For Opioid Treatment Can Mean Life Or Death In New Hampshire
For years, Eileen Shea says her former partner Eddie Sawyer struggled with a heroin addiction. But after losing his job and time with his daughter, he was ready to get help. He was on the waiting list for a bed at the Friendship House, northern New Hampshire’s only residential treatment facility. He never made it to treatment. Instead, Sawyer was one of 428 people in New Hampshire who died last year from a drug overdose. When the police found him in his apartment, there was list of rehab facilities on the table next to his bed. It was a list Shea had given to him a month earlier, and there were check marks next to the name of each one. Sawyer had called every place on the list. (Gotbaum, 4/1)

The Detroit Free Press: Lead Levels In Flint, Mich., Kids' Blood Could Rise In Summer Because Of Soil
The level of lead in the blood of children in Flint probably will rise over the next few months, not because of continued problems with the city's drinking water supply, but because of high levels of lead in the soil — especially in the city's oldest and densest areas — that gets inhaled into their bodies during the summer, according to a Michigan State University researcher. Richard Sadler, an assistant professor in the university's department of family medicine, said the yearly seasonal cyclical pattern — which is not unique to Flint, but is common to most big cities — is expected to recur, even as state officials expect the lead levels in Flint's drinking water to diminish. Sadler is coauthor of a study published this week in the International Journal of Environmental Research and Public Health related to lead poisoning in Flint. (Egan, 3/31)

The Detroit Free Press: How Race, Class Set The Stage For Flint Water Crisis
Darryl Wilson is tired of fighting and scraping just to get what most Americans take for granted: clean, safe drinking water. He wants to leave Flint for awhile so someone can replace the pipes and fixtures in his house and the city's lead and lead-soldered service lines that are leaching the toxin into the water. But he doesn't have the money. He can't drive. He's stuck just like thousands of other people in a poor, majority African-American city where people cried out for more than a year about odd-smelling, discolored water, rashes, stomach aches and hair loss. They say, and experts agree, they are victims of racial, economic and environmental injustice. (Shamus, 3/31)

Elsewhere, it's not just Flint that's dealing with water issues, and it's not just lead that's causing them —

Bloomberg: Des Moines Fights To Keep Its Water Clean
In the early spring of 2014, two lab workers for the Des Moines Water Works climbed into a truck and drove north. They pulled over on Highway 20 where the road crosses Cedar Creek, made their way to the water’s edge, dunked a cup attached to a pole, then poured the contents into a container. It was the first of 40 outings over the next nine months to collect samples from creeks, ditches, and drainage outlets—72 locations in all—amid the corn and soybean fields north of Des Moines. (Martin, 3/31)

NPR: Elevated Levels Of Suspected Carcinogen Found In States' Drinking Water
Water safety concerns aren't just in Flint, Mich., these days. Communities in three states in the Northeast have found elevated levels of a suspected carcinogen — perfluorooctanoic acid, or PFOA. Used to make Teflon, the chemical has contaminated water supplies in New York, New Hampshire and Vermont. (Wang, 3/31)

And Portland, Oregon is scrambling after discovering heavy metal hot spots —

The Associated Press: Green-Minded Portland Rocked By Heavy Mental Pollution
Fiercely proud of its reputation as one of the most environmentally minded cities in America, Portland is reeling from the discovery of poisonous heavy metal "hot spots" in the air and ground. Amid the crisis, two top state air regulators have resigned, residents are rushing to the doctor to get tested, and politicians in this city of 600,000 are scrambling to do damage control. Federal officials have also launched a nationwide review of small art glass-making factories, the suspected source of Portland's contamination. (3/31)

The Washington Post: Spread Of Zika Virus Appears To Be Slowing In Parts Of Latin America
In several Latin American nations hit hard by the Zika epidemic, the transmission of the virus appears to have peaked, with the number of infections declining in recent weeks, according to governments in the region and the latest World Health Organization data. The slowdown has prompted some countries, including Colombia, to significantly scale back their projections of the impact of the virus. (Miroff, 3/31)

NPR: Zika Is Linked To Microcephaly, Health Agencies Confirm
The World Health Organization says there is now scientific consensus that the Zika virus is connected with microcephaly — a condition in which babies are born with very small heads and brain damage. Scientists have been working for months to confirm a link between Zika and microcephaly, ever since Brazil reported a startling increase in cases last fall. Zika infection during pregnancy appears to increase the risk for several types of birth defects and miscarriages, a recent study found. And scientists have found the virus in the brains of affected babies. (Doucleff, 3/31)

Reuters: In War On Zika Mosquitoes, Puerto Rico Starting At 'Square One'
The United States faces its first real challenge with the Zika virus on the island territory of Puerto Rico, a part of the nation that is perhaps least prepared to cope with what is expected to be its worst outbreak. Zika is spreading rapidly in Puerto Rico and is expected to peak in late summer and early fall. By year's end, public health officials estimate, hundreds of thousands of people will have been infected. (Steenhuysen, 4/1)

The Associated Press: Iowa Moves To Private Medicaid Management Friday Amid Angst
Allowing several delays, Iowa's $4.2 billion Medicaid program will switch to private management on Friday. Some health advocacy groups have criticized the transition, originally slated to go into effect on Jan. 1 but delayed by federal officials amid concern about readiness. Democrats continue to argue the system isn't ready, and lawmakers in the split Legislature are still debating what state oversight should be in place under the new system. State officials have said lingering issues over communication and expected services are being addressed. (Rodriguez, 3/31)

Sioux City (Iowa) Journal: Siouxland Providers Ready; Patients Wary Of Medicaid Change
After lawsuits, protests and two delays, Gov. Terry Branstad's plan to shift management of Iowa's Medicaid program to private, out-of-state, for-profit health care companies goes into effect Friday, three months later than it was supposed to. ... The Branstad administration projects that moving Iowa's 560,000 Medicaid beneficiaries to its new managed care program, IA Health Link, will save the state $47 million in the first six months, down about $4 million from original estimates. (Butz, 4/1)

Iowa Public Radio: Medicaid Privatization Looms
With the privatization of Iowa’s health care program for the poor and disabled set to go into effect tomorrow, state lawmakers Wednesday grilled company representatives and Medicaid managers about the change. There was emotional debate in the House about a young cancer patient’s treatment being delayed. Representative Patti Ruff (D-McGregor) said one of her constituents, a nine-year-old boy, was scheduled to undergo chemotherapy at Mayo Clinic this week. But the boy’s mother says the therapy did not get underway because of issues with the family’s new for-profit provider. (Russell, 3/31)

KCRG (Cedar Rapids, Iowa): MAYO RESPONDS: Medicaid Privatization Delays 9-Year-Old's Cancer Treatment
Mayo Clinic now says it is advocating for Shaun Mohs to continue receiving cancer care at Mayo but is waiting for a decision under Iowa's privatized Medicaid system. Mayo Clinic Spokesperson Ginger Plumbo received permission to discuss 9 year-old Shaun Mohs case Thursday, a day after KCRG-TV9 reported the McGregor boy was forced to delay treatment for an aggressive brain tumor because of the Medicaid switch. Plumbo says Mayo plans to request an exception for Iowa Medicaid to cover Shaun Mohs cancer treatments at Mayo. However, it can't file that request until the three private companies take over Iowa's Medicaid system on Friday. (Wiedemann, 3/31)

The Oklahoman: Plan Aired To Expand Medical Coverage For Oklahomans
The head of the Oklahoma Health Care Authority briefed state leaders Thursday on a plan to provide health insurance to 175,000 Oklahomans who are currently uninsured. The proposal presented by Nico Gomez, chief executive officer of the authority, would also stabilize Medicaid provider rates, while moving 175,000 children and pregnant women from Medicaid to private insurance. It would also create a new Insure Oklahoma program that would cover adults ages 19 to 64 who have incomes below 133 percent of the federal poverty level. They would have a choice of commercial insurance plans and would pay premiums based on their income. (Green, 3/31)

The Associated Press: Oklahoma Medicaid Leader Unveils 'Rebalancing' Proposal
Gomez said the proposal still needs to be fully vetted and would require both federal approval and a state investment of around $100 million. ... Republican legislative leaders expressed some support for the proposal, which they described as an alternative to Medicaid expansion in Oklahoma. (3/31)

KGOU: Oklahoma Healthcare Authority Proposes Plan To Insure More Oklahomans
The third part of the plan would restore the Medicaid reimbursement rate to 86.5 percent of Medicare. Earlier this week, the Oklahoma Healthcare Authority proposed reducing the reimbursement rate to providers by 25 percent as a result of the estimated $1.3 billion general revenue shortfall in the upcoming fiscal year. (McCleland, 3/31)

Tulsa World: Oklahoma State Medical Association Urges Doctors To Mull Leaving Medicaid Over 25 Percent Rate Cut
Oklahoma State Medical Association leaders have voted unanimously to urge members to consider dropping out of Medicaid. The association’s executive committee took the unanimous vote on Wednesday following an announcement earlier in the week by the Oklahoma Health Care Authority that Medicaid rates could be cut by as much as 25 percent effective June 1. (Hoberock, 4/1)

The Connecticut Mirror: A Push For More Data On How Insurers Cover Mental Illness
Psychiatrists tell stories of suicidal patients being required to get prior authorization from their insurance company before being admitted to a psychiatric hospital. Advocates talk of patients struggling to find a mental health clinician who accepts his or her insurance plan. Some see it as a sign that insurance companies don’t treat mental health or addiction treatment as they would physical illness – despite a federal law requiring it. (Levin Becker, 3/31)

The Associated Press: Ad Campaign Launched Over Bill To Refuse Patient Counseling
A coalition of groups has launched an ad campaign against House Speaker Beth Harwell and other lawmakers over a controversial bill that would allow counselors to refuse to treat patients on the basis of "sincerely held religious beliefs." One of the online ads addresses Harwell and warns that "businesses won't come to a state that discriminates." Opponents say the proposal would allow therapists to turn away people in crisis because they are gay, transgender or practice a different religion. (3/31)

Heartland Health Monitor: KC Area Program Shifts How Police Deal With People In Mental Health Crisis
On Megan Younger’s third day on the job, she accompanied police officers to the home of a woman whose family hadn’t heard from her in days. The woman was found in the bathtub – where she had been for three days – and had chemically burned off all of her hair. She was psychotic and delusional, but she was otherwise healthy and her lawn was mowed, her house clean and her pets well-groomed. After talking with her for a while, Younger determined the woman wasn’t suicidal or harmful to others. She was left at home where a mobile crisis team checked on her the next day. (Worth, 3/31)

The Livingston Daily: Michigan Meningitis Patients To Share $15M In Steroid Lawsuit
More than 300 patients infected in the 2012 fungal meningitis outbreak and their survivors will share in a $10.5 million class-action lawsuit settlement reached Friday in Livingston County Circuit Court. The settlement involved patients of Michigan Pain Specialists, a Genoa Township clinic that injected patients with a contaminated steroid solution linked to the nationwide outbreak. (Peal, 3/30)

NPR: Industrial Science Hunts For Nursing Home Fraud In New Mexico Case
One of the keys to providing good care in nursing homes is simply having enough staff. The federal government says about a quarter of all nursing home complaints can be traced back to low staffing levels. And studies have connected low staff levels to lousy treatment. The state of New Mexico connects it to fraud. The state's Attorney General is suing a chain of nursing homes, alleging that the facilities were so severely under-staffed, they couldn't possibly have provided the care they charged for. Now New Mexico wants its money back. (Jaffe, 3/31)

New England Journal of Medicine: Opioid Abuse In Chronic Pain — Misconceptions And Mitigation Strategies
Chronic pain not caused by cancer is among the most prevalent and debilitating medical conditions but also among the most controversial and complex to manage. The urgency of patients’ needs, the demonstrated effectiveness of opioid analgesics for the management of acute pain, and the limited therapeutic alternatives for chronic pain have combined to produce an overreliance on opioid medications in the United States, with associated alarming increases in diversion, overdose, and addiction. Given the lack of clinical consensus and research-supported guidance, physicians understandably have questions about whether, when, and how to prescribe opioid analgesics .... Here, we draw on recent research to address common misconceptions regarding the abuse-related risks of opioid analgesics and highlight strategies to minimize those risks. (Volkow and McLellan, 3/31)

Health Affairs: Final 2015-20 Dietary Guidelines For Americans
The Dietary Guidelines for Americans: 2015-2020, eighth edition, was released on January 7, 2016. The guidelines were heavily informed by the Scientific Report of the 2015 Dietary Guidelines Advisory Committee (DGAC), which was charged with analyzing the latest in nutrition science since the 2010 guidelines were published and coming up with food-based recommendations of public health importance. ... The 2015-20 guidelines have, at the very least, resuscitated a vigorous debate about nutrition health policy, especially the role of saturated fat in one's diet and the influence of dietary cholesterol on cardiovascular disease. ... It may never be possible to definitively determine the extent to which, if at all, the past decades of dietary guidelines have helped create the country's obesity and chronic disease crisis. After all, most people ignore them. (Goldman, 3/31)

Urban Institute: Who Are The Remaining Uninsured, And What Do Their Characteristics Tell Us About How To Reach Them?
[T]his analysis presents estimates of the characteristics of those remaining uninsured after implementation of the Affordable Care Act’s coverage provisions. The researchers also analyze the characteristics of two subpopulations that they posit are those for whom additional outreach and enrollment efforts are likely to be most successful: those eligible for Medicaid/CHIP but not enrolled and those who are both eligible for Marketplace tax credits and have incomes below 200 percent of the federal poverty level. ... Together, these subgroups account for 37.5 percent of the remaining uninsured, or approximately 12.4 million people. Focusing on the characteristics of these individuals, we find high rates of school age children in the household, household receipt of other non-health public benefits, firm-based employment, and single parent households. (Blumberg et al., 3/30)

Urban Institute: Health Insurance Coverage And Health Care Access And Affordability In Massachusetts: 2015 Update
The 2015 Massachusetts Health Reform Survey (MHRS) highlights sustained gains in health insurance coverage since the passage of Massachusetts’ 2006 health care reform law, as well as persistent gaps in health care access and affordability for many of those with insurance coverage. Low-income adults and those with health problems tend to be disproportionately impacted by these gaps. The survey findings are a reminder that the goals of health care reform are not fully achieved by simply reducing the number of people who are uninsured. (Long and Dimmock, 3/23)

The Kaiser Family Foundation: Surprise Medical Bills
Surprise medical bills can contribute significantly to financial burden and medical debt among insured individuals, though data on the incidence and impact of this problem are limited. Federal authority to track the incidence and impact of surprise medical bills exists but has not yet been implemented. Policy makers have considered and adopted various responses, yet tradeoffs are involved in protecting consumers from surprise bills. There is concern among some as to whether or how new consumer protections might affect insurance premiums. Establishing requirements both on what health plans must cover and on amounts that out-of-network providers can bill can limit the impact on premiums, though providers may balk at restrictions on how much they can charge. (Pollitz, 3/17)

Brookings/Clinical Gastroenterology and Hepatology: Shifting Away From Fee-For-Service: Alternative Approaches To Payment In Gastroenterology
Fee-for-service payments encourage high-volume services rather than high-quality care. Alternative payment models (APMs) aim to realign financing to support high-value services. The 2 main components of gastroenterologic care, procedures and chronic care management, call for a range of APMs. The first step for gastroenterologists is to identify the most important conditions and opportunities to improve care and reduce waste that do not require financial support. We describe examples of delivery reforms and emerging APMs to accomplish these care improvements. (Patel et al., 3/22)

Avalere: Evolving The Risk-Adjustment Model To Improve Payment Accuracy In The Individual & Small Group Market
The ACA created risk adjustment for the commercial population in order to transfer funds appropriately between plans based on their relative healthcare costs. To accomplish this goal, CMS built a model using a similar framework to the model used for the Medicare Advantage population. However, although the commercial model is more accurate in predicting the costs of a sample population, it is unclear how well the model predicts actual costs. (March 2016)

Here is a selection of news coverage of other recent research:

Medscape: Study Suggests Bringing Back Whole-Cell Pertussis Vaccine
Switching to a whole-cell pertussis priming strategy could reduce incidence of whooping cough by up to 95%, new research indicates. Studies have widely agreed that pertussis protection from the current vaccine, tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap), is limited, and a new vaccine is not imminent. Meanwhile, cases are climbing. In 2012, there were 48,277 whooping cough diagnoses in the United States, a record high since 1955, and that number included 16 infant deaths. (Frellick, 3/29)

Reuters: Out-Of-Hospital Births On The Rise In U.S.
Giving birth outside of a hospital has become more common in the U.S., especially for white women, with almost 60,000 out-of-hospital births in 2014, according to a new study. “I think it speaks to some women’s growing discomfort with the standard hospital-based system of childbirth in the U.S,” said lead author Marian F. MacDorman of the Maryland Population Research Center at the University of Maryland in College Park. (Doyle, 3/28)

KQED: Study: Mandatory Waiting Period Stopped Few Abortions
Most women seeking an abortion were not deterred by a Utah law requiring a 72-hour waiting period before having the procedure, according to a recent study by the University of California, San Francisco. The 2012 law requires a 72-hour waiting period and at least two medical visits before an abortion. It was the first such law in the nation, and researchers found that it added financial costs and increased logistical hassles and anxiety for the women. (Fine, 3/30)

HealthDay News: Medicare Spends Billions On Chronic Kidney Disease
Chronic kidney disease affects nearly 14 percent of Americans and costs Medicare billions of dollars a year, a new study reveals. In 2013, Medicare spent $50 billion on chronic kidney disease among people 65 and older, and $31 billion on those with kidney failure, the researchers found. "This report is a one-stop shop to try to understand the prevalence of kidney disease, how it's being treated and how the burden affects various populations," researcher Rajesh Balkrishnan, a professor of public health sciences at the University of Virginia School of Medicine, said in a university news release. (3/30)

MedPage Today: Hip Fracture Slightly Lower With Mediterranean Diet
Women who ate a Mediterranean diet had a slightly lower risk for hip fracture, compared with women who ate other healthy diets, a post hoc analysis of the Women's Health Initiative (WHI) found. (Wickline Wallen, 3/28)

The Washington Post: Trump’s Abortion Gaffe Highlights The GOP’s Intellectual Dishonesty
As a matter of politics, Donald Trump’s comment that women who have abortions should suffer “some form of punishment” was a disaster. As a matter of intellectual and moral consistency, Trump’s got a point — one that exposes a fundamental tension in the Republican Party between its assertion that life begins at conception and the legal and moral implications of that absolutist view. (Ruth Marcus, 3/31)

The Wall Street Journal: Trump’s Mess Has Become His Message
This is almost always true: A woman who aborts a child is operating within an emotional and spiritual context of fear, disappointment, confusion and sadness. If she receives an illegal abortion she should not be “punished” by the law. This is in line with long human tradition and is based on the simple wisdom that she has already been gravely and tragically penalized: She has lost her child, someone who was very likely going to love her, someone she very likely would have loved. The doctor who performs such an abortion on the other hand is not in turmoil, he is in business. He breaks the law and ends the life of the child with full consciousness, and for profit. He should be “punished.” He should be in jail. That we even have to discuss this is absurd. (Peggy Noonan, 3/31)

The Washington Post: The Worst Stereotype Of The GOP Is Coming To Life In The Form Of Donald Trump
This campaign season has offered an unexpected form of reality television entertainment: Watching the light of discovery and calculation in Donald Trump’s eyes when he is presented with difficult policy issues, apparently for the very first time. Abortion is the current case in point. In the late 1990s, Trump supported the legality of partial-birth abortion. For a few hours on Wednesday, he endorsed criminal sanctions against women who have abortions. (Michael Gerson, 3/31)

The Washington Post: Trump Retreats To Mainstream Republican Rhetoric On Abortion
Although people’s views on abortion ultimately turn on their fundamental beliefs about the nature and beginnings of human life, there has always been a logical flaw in the antiabortion case. If abortion is the taking of a human life — knowingly and purposefully — how can it not be a crime for a woman to procure one? If a doctor who performs an abortion is little better than a murderer for hire, how can you punish the doctor and let the patient go free? Few antiabortion activists have troubled to ponder this anomaly. (Michael Kinsley, 3/31)

Los Angeles Times: Trump Doesn't Get It: Abortionists Are Criminals, Women Aren't
In his latest gambit to capture the news cycle, Donald Trump said Wednesday that “there has to be some form of punishment” for women who abort. (His Director of Retractions shortly thereafter issued a clarification.) The Republican front-runner's misguided notion contradicts historical legal strategies and is contrary to the long-held policies of state and national pro-life organizations. Before the Supreme Court's 1973 decision in Roe vs. Wade — which legalized abortion for any reason, at any time of pregnancy — state abortion laws targeted abortionists (those who performed abortions), not women. (Clarke D. Forsythe, 3/31)

The Des Moines Register: Will Trump's Guys Stick With Him Or With Their Sisters?
The good news is that some pro-life and pro-choice groups have found common ground. The bad news is that it took Donald Trump threatening to prosecute pregnant women for exercising their constitutional right to abortion. That position, expressed to Chris Matthews on Wednesday’s MSNBC town hall, was reversed within hours in e-mails to the press. Someone in Trump’s campaign (probably not his campaign manager, Corey Lewandowski) must have pointed out to him that even the farthest right of the right wing hasn’t gone as far as he did in penalizing women: Not Ted Cruz, not Mike Huckabee, not even Rick Santorum. They’ve limited themselves to advocating prosecution for abortion providers. (Rekha Basu, 4/1)

The Washington Post: Everyone Agrees Women Who Have Abortions Shouldn’t Be Penalized. Or Do They?
This week, Donald Trump stumbled upon the one position on abortion that almost everyone can hate: He endorsed not only criminal bans on abortion but also punishment for women who choose to terminate a pregnancy. “There has to be some form of punishment,” Trump told MSNBC’s Chris Matthews during a Wednesday town hall. He quickly retracted his statement, but the backlash from all corners against his comment deserves some attention. If the antiabortion movement believes abortion is murder, why does almost no one want to punish women who terminate their pregnancies? The answer can be found in the messy history of criminal punishment and abortion. Whether abortion has been legal or illegal, Americans have long been reluctant to send women to jail for having one. (Mary Ziegler, 4/1)

Modern Healthcare: Is Trump's 'Punish Women' Position Different From Cruz's And Kasich's Abortion Stances?
Both Republicans and Democrats are blasting GOP presidential frontrunner Donald Trump for his statement, since retracted, that women who seek abortions should face “some form of punishment.” But how different is Trump's original position from the real-world impact of laws and proposals supported by his two Republican presidential opponents, Texas Sen. Ted Cruz and Ohio Gov. John Kasich? (3/31)

The New York Times: Obamacare On Track
Largely as a note to myself. Amid all the discussions of how Obamacare is doing, it’s easy to lose sight of an obvious question: how’s it doing compared with expectations? You may have heard that fewer people have signed up on the exchanges then predicted; but did you hear about the smaller number of employers dropping coverage, or the unexpectedly strong growth in Medicaid despite red-state rejection? (Paul Krugman, 3/31)

Forbes: Did Obamacare Really Bend The Cost Curve? Data From The Medicare Actuaries Suggest Maybe Not
Judging from all the cheering going on among Obamacare enthusiasts–including the usual suspects such as Paul Krugman as well as the president himself–you would think Obamacare had bent the cost curve. This should not be a surprise given that President Obama pointed out 6 years ago, “Every single good idea to bend the cost curve and start actually reducing health care costs [is] in this bill.” If the law failed to bend the cost curve, there surely would be a lot of ‘splainin’ to do. (Chris Conover, 3/31)

The Wall Street Journal: Obama’s Greatest Triumph
History may quibble, but this death-spiral began with Barack Obama’s health-care summit at Blair House on Feb. 25, 2010. For a day, Republicans gave detailed policy critiques of the proposed Affordable Care Act. When it was over, the Democrats, including Mr. Obama, said they had heard nothing new. That meeting was the last good-faith event in the Obama presidency. Barack Obama killed politics in Washington that day because he had no use for it, and has said so many times. The Democrats survived the Obama desert by going to ground. But frustrated Republicans outside Congress eventually started tearing each other apart. (Daniel Henninger, 3/30)

The New York Times: The Growing Mess Of The Supreme Court’s Contraception Case
What, exactly, was the Supreme Court doing on Tuesday with its bizarre, lengthy, highly unusual order to the parties in a major case involving religious freedom and contraception? The optimistic answer is, trying to clean up a mess of its own making. ... At oral arguments on Mar. 23, the justices struggled to find less restrictive means that would satisfy the groups’ complaints while ensuring that women would continue getting contraceptive coverage, as the Affordable Care Act requires. ... The court’s strange order illustrates the mess it has waded into by essentially handing over interpretations of federal law to religious objectors. (Jesse Wegman, 3/31)

The New York Times' Upshot: New Health Insurance Customers Are Sicker. Should We Be Surprised?
Before Obamacare, health insurance companies routinely refused to sell policies directly to patients who had illnesses like AIDS, hepatitis C or heart disease. It should be no surprise to anyone, then, that once the Affordable Care Act required insurers to offer insurance to sick people, a lot more sick people signed up. That is the basic conclusion of a new report on health insurance customers from the Blue Cross and Blue Shield Association analyzing health insurance for 4.7 million Americans in 27 states and the District of Columbia. (Margot Sanger-Katz, 3/31)

Bloomberg: Bernie Sanders' Bad Medicine For Drug Prices
Bernie Sanders is worrying millionaires, billionaires and now drug patent holders.Sanders and 11 other members of Congress sent a letter on Monday supporting an earlier petition to the National Institutes of Health (NIH) asking the agency to hold a hearing on exercising its so-called "march-in rights" on the prostate cancer drug Xtandi. A 1980 law lets federal agencies force companies to license patents to other manufacturers in the interest of public health or safety, or if an invention is not available to the public on "reasonable terms." In this case, the idea is to reduce Xtandi's price by breaking a patent-protected monopoly. (Max Nisen, 3/31)

St. Louis Post-Dispatch: Through Step Therapy, Insurance Companies Dictate Decision On Medications
Step therapy protocols are becoming more and more common and affect patients with diseases from epilepsy, to mental illness, cancer, HIV/AIDS and those with autoimmune diseases, among others. I have been living with arthritis for more than 30 years. My husband, Gary, was diagnosed with multiple sclerosis eight years ago. Both of our diseases have forced us to fight our insurance companies to have access to the medications our doctors have prescribed. This is because of a cost-saving mechanism employed by insurance companies known as step therapy. (Kim Kitowski, 3/31)

Los Angeles Times: Prudential Pulls A Fast One On Long-Term Care Insurance Policyholders
Buying long-term care insurance isn't an easy decision. It's an increasingly pricey product that requires you to look way down the road, to the possibility of shelling out big bucks for a nursing home or some other form of assisted living. The last thing you want to worry about is having your insurer pull a fast one on you after you sign up for coverage. But that's what Prudential has done, making a sneaky change to policyholders' long-term care coverage. (David Lazarus, 4/1)

The Charlotte Observer: Medical Professionals Condemn House Bill 2
In a blatant act of malice and ignorance, the N.C. General Assembly and Governor Pat McCrory have set the state of North Carolina back decades. As physicians and health care providers who care for members of the LGBT community, we find this legislation deplorable and truly irresponsible. House Bill 2 was drafted to discriminate against the transgender community – human beings whose sex assigned to them at birth and their gender identity do not conform to societal expectations. Every human being has a gender identity and a sexual orientation. Every human being is equal and should have equal protection under the law. This is not just our position as medical and mental health providers, it is the truth and constitutionally and ethically correct. (Clayton A. Alfonso, 3/31)

Concord Monitor: Editorial: There’s More To Right-To-Try Bills Than Appears
[I]t’s no wonder that legislators in states across the country, including New Hampshire, have looked skeptically at the Food and Drug Administration. The FDA, after all, is the agency responsible for screening medicines for potential drawbacks before bringing them to doctors and patients. These legislators have introduced so-called “right to try” legislation, which is advertised as allowing patients to gain easier access to experimental drugs still in development. (3/31)

Bloomberg: Raise The Cost Of Cultivating Supergerms
Antibiotics meant for humans have no place on the farm. When they are fed routinely to chickens, pigs and cows -- to help them grow or fend off infections -- germs in animals can easily become resistant, and ultimately threaten people, too. It's a threat long recognized by Europe, the U.S. and Canada, where the use of antibiotics to promote growth in livestock has already or will soon be banned. Unfortunately, this progress is endangered by the ongoing, even expanding, antibiotics free-for-all taking place in countries where agriculture is less regulated. (3/31)

The New England Journal Of Medicine: The Science Of Choosing Wisely — Overcoming The Therapeutic Illusion
In recent years, the United States has seen increasing efforts to reduce inappropriate use of medical treatments and tests. Perhaps the most visible has been the Choosing Wisely campaign, in which medical societies have identified many tests, medications, and treatments that are used inappropriately. The result is recommendations advising against using these interventions or suggesting that they be considered more carefully and discussed with patients. The success of such efforts, however, may be limited by the tendency of human beings to overestimate the effects of their actions. Psychologists call this phenomenon, which is based on our tendency to infer causality where none exists, the “illusion of control.”1 In medicine, it may be called the “therapeutic illusion” (a label first applied in 1978 to “the unjustified enthusiasm for treatment on the part of both patients and doctors”2). When physicians believe that their actions or tools are more effective than they actually are, the results can be unnecessary and costly care. Therefore, I think that efforts to promote more rational decision making will need to address this illusion directly. (David Casarett, 3/31)

The New England Journal Of Medicine: The Zika Challenge
“There are many viruses that have similar characteristics to dengue, yellow fever, and Zika that have the potential to emerge. We don’t know why Zika emerged now. But we know how to develop surveillance systems that will allow us to pick these viruses up if they start to move as Zika has.” This starting point was outlined by tropical medicine expert Duane Gubler at a World Health Organization (WHO) meeting in Geneva in early March. Gubler has spent his career studying tropical infectious diseases with an emphasis on dengue virus (DENV), a flavivirus closely related to Zika virus (ZIKV).1 His introductory presentation at the international meeting about the ZIKV challenge emphasized the complexity of the flavivirus–host relationship and the inevitability, thanks to urbanization and globalization, of emergence and spread of viruses that were previously confined to small, remote geographic areas. (Charlotte J. Haug, Marle Paule Kleny and Bernadette Murgue, 3/30)