From Washington, DC

• The Wall Street Journal reports
  • “President Trump told Republicans wavering on the party’s fiscal framework to “close your eyes and get there.” GOP opponents of the plan say they are heading into the budget showdown with eyes wide open, and some appear willing to block the president’s push, setting up a too-close-to-call vote late Wednesday.
  • “Trump and House GOP leaders have routinely melted internal party opposition this year with promises and appeals to Republican unity. This time, they face dug-in critics of the budget passed by the Senate on Saturday.
  • “Republican leaders are optimistic they can get the measure through the House, and Speaker Mike Johnson (R., La.) told reporters that he thought it would pass. The House advanced the measure past a procedural hurdle in a 216-215 tally, setting up the final debate and vote. That procedural vote contained an unrelated provision that will make it harder this year for the House to reverse Trump’s tariffs.”

• Politico adds,
  • “House Republican leaders canceled a vote on the Senate’s budget resolution Wednesday night, as Speaker Mike Johnson came to terms with what had been clear for many hours: Too many Republicans would vote in opposition and the measure was bound to fail.” * * *
  • “Lawmakers are slated to head back to their districts Thursday for a two-week recess, meaning that the president could have to wait to see any forward motion on his “big, beautiful bill” if a compromise can’t be reached soon.
  • “Johnson said Wednesday night that House leadership will now explore either amending the Senate-adopted budget or going straight to conference with the Senate and working out differences there.
  • “We’re going to make that decision,” he told reporters just after the resolution was pulled.”

• The American Hospital Association News tells us,
  • “President Trump announced on April 9 (https://tinyurl.com/2t463edy) that reciprocal tariffs that went into effect after midnight for certain nations will be paused for 90 days, while tariffs for China would be increased to 125%. A 10% universal tariff on imported goods from all countries that began April 5 remains in effect.”
• and
  • “The Office of Management and Budget April 9 released a notice seeking public input on rules to potentially be rescinded, requesting detailed reasons for their rescission. Comments must be received by OMB no later than 30 days after publication of the notice in the Federal Register. The notice will be published April 11. Comments can be submitted at www.regulations.gov.”

From the judicial front,

• Federal News Network lets us know,
  • “For the second time in as many days, a higher court has paused a judicial ruling that ordered the reinstatement of federal employees who were fired en masse, leaving thousands of probationary workers vulnerable once again to potential termination.
  • “In a 2-1 ruling Wednesday, a three-judge panel of the Fourth U.S. Circuit Court of Appeals temporarily set aside a Maryland judge’s injunction that had ordered agencies to reinstate employees in 19 states and the District of Columbia. The majority found the government was likely to succeed in proving that the Maryland district court had no jurisdiction over the states’ claims that federal agencies had engaged in an illegal Reduction in Force (RIF).
  • “The panel’s ruling comes one day after the Supreme Court issued a separate stay that had a similar effect on a California court’s ruling that had also ordered the reinstatement of some agencies’ fired probationary workers. In that case, the high court, in an unsigned order Tuesday, also put the preliminary injunction on hold while claims of illegal firing work their way through the appeals process.” * * *
  • “And in California, the judge is considering whether to issue another preliminary injunction that could withstand the ruling the Supreme Court issued Tuesday. In that order, the justices found that the outside organizations harmed by the mass firings didn’t have standing to sue, but explicitly left open the possibility that other plaintiffs, including federal unions, could win an injunction of their own.
  • “In a San Francisco courtroom Wednesday, Judge William Alsup heard arguments over whether unions had standing to sue and win another injunction. However, he postponed issuing a ruling until attorneys in the case provide more information, including data about how many employees were affected by the mass terminations, their relationships with the union plaintiffs, and possible evidence that would show that agencies’ firing decisions were made at the behest of the Office of Personnel Management.”

• Bloomberg Law points out,
  • “US Chief Justice John Roberts let President Donald Trump temporarily oust top officials at two independent agencies while the Supreme Court decides how to handle a new showdown over presidential power.
  • “Roberts’ order Wednesday puts on hold a federal appeals court decision that had let National Labor Relations Board member Gwynne Wilcox and Merit Systems Protection Board member Cathy Harris go back to work. Roberts said his order will last until either he or the full court issues a longer-term decision.
  • “The case is testing a 1935 Supreme Court ruling that let Congress shield high-ranking officials from being fired, paving the way for the independent agencies that now proliferate across the US government. The legal wrangling ultimately could affect whether Trump has the power to fire Federal Reserve Chair Jerome Powell.”

• Beckers Payer Issues notes, “A New York federal [district] judge dismissed an antitrust lawsuit against UnitedHealthcare and MultiPlan that alleged the companies conspired to reduce reimbursement rates for an anesthesia services provider.”

From the public health and medical research front,

• AP reports,
  • “A day care facility in a Texas county that’s part of the measles outbreak has multiple cases, including children too young to be fully vaccinated, public health officials say.
  • “West Texas is in the middle of a still-growing measles outbreak with 505 cases reported on Tuesday. The state expanded the number of counties in the outbreak area this week to 10. The highly contagious virus began to spread in late January and health officials say it has spread to New Mexico, Oklahoma, Kansas and Mexico. 
  • “Three people who were unvaccinated have died from measles-related illnesses this year, including two elementary school-aged children in Texas. The second child died Thursday at a Lubbock hospital, and Health Secretary Robert F. Kennedy Jr. attended the funeral in Seminole, the epicenter of the outbreak. 
  • “As of Friday, there were seven cases at a day care where one young child who was infectious gave it to two other children before it spread to other classrooms, Lubbock Public Health director Katherine Wells said.”

• Per Newsweek,
  • “Cabot Creamery is recalling 1,700 pounds of butter after testing found elevated levels of coliform bacteria in the product, a marker of potential fecal contamination.
  • “The voluntary recall, initiated by Agri-Mark Inc, Cabot Creamery’s parent company, affects the brand’s 8-ounce Extra Creamy Premium Sea Salted Butter and was distributed in seven states.”

• The New York Times reports,
  • “During a recent five-year period, a substantial portion of maternal deaths in America — almost one-third — took place more than six weeks after childbirth, at a time when most new mothers think they are in the clear, researchers reported on Wednesday.
  • “The study, published in JAMA Network Open, is one of the first to track maternal health complications during pregnancy and in the year after delivery.
  • “Pregnancy-related death rates in the United States rose almost 28 percent from 2018 to 2022, the researchers found, surging at the height of the Covid-19 pandemic in 2021 before subsiding somewhat.
  • “Our study illustrates why we can’t take our eyes off maternal health,” said Dr. Rose L. Molina, an associate professor of obstetrics, gynecology and reproductive biology at Harvard Medical School and one of the study’s authors.
  • “Women need “access to high-quality care from the moment of conception to a full year after birth,” she added. While there has been a growing emphasis on care in the year after childbirth, “we’re not there yet.”

• The National Cancer Institute’s Cancer Information Highlights discusses “Targeting a Gene Fusion | Fat Cells to Starve Tumors | TIL Shrinks Solid Cancers.”

• Per an NIH news release,
  • “In a massive scientific effort funded by the National Institutes of Health (NIH), hundreds of researchers have helped to map the connections between hundreds of thousands of neurons in the mouse brain and then overlayed their firing patterns in response to visual stimuli. This breakthrough is a critical piece of foundational science to build toward understanding how our brains process visual information to reconstruct the images we see every day.
  • “Information processing in the human brain occurs via electrical firing of 86 billion neurons that make trillions of connections with each other. The secrets of how our brain enable us to think, feel, and act lie hidden in the complexity of its wiring diagram and the barrage of electrical signals that move across it in millisecond time frames. While the current findings focus on a tiny fraction of the brain, they reveal the complex connections between the cells and show how those connections are wired to produce functional responses. This information, which was previously beyond our reach, could help us understand how the brain functions normally and offer a guide to what goes wrong as the result of various disorders or injuries.”  

• Per UPI,
  • “Emergency room visits attributed to popular weight loss drugs such as Ozempic and Wegovy remain quite rare overall, but do show an unexpected link to hypoglycemia, according to a study released Monday.
  • “Semaglutide brand names include Ozempic, Rybelus, and Wegovy, all made by Novo Nordisk, and Mounjaro from Eli Lilly.
  • “The study, led by the Centers for Disease Control and Prevention and Cambridge Health Alliance, was published in the Annals of Internal Medicine. It provides reassuring evidence that serious adverse events associated with the burgeoning use of the drugs are uncommon.
  • “That’s impressive given the overwhelming popularity of semaglutides, which are among a class of “wonder drugs” known as GLP-1 agonists.”

• STAT New informs us,
  • Since 2021, when the information blocking rules kicked in, health systems and patients have been reckoning with the impact of electronic medical records that allow instant access to test results — good, bad, and in between — sometimes before a doctor has ever seen them. Patients overwhelmingly prefer having their health information as soon as possible, even before it’s interpreted. But there’s a tradeoff between medical transparency and the worry that can be caused when a result is unclear, or even inaccurate.
  • A new study published in JAMA Network Open on Tuesday aims to understand how health systems might find the right balance. “We were curious if refresh, refresh, refresh behavior could be measured,” said senior author Trent Rosenbloom, who directs the patient portal at Vanderbilt University Medical Center. Over two years, researchers and physicians at Vanderbilt tracked how 290,000 patients at the medical center viewed their test results online. In 2022 and 2023, more than 100,000 patients — 37% of the total — refreshed the portal as they waited for results to appear. Some patients clicked to check their results as many as 16 times.  * * *
  • “Across health systems, information officers are working on other ways to ensure automatic test results are more of a benefit than a burden. At Stanford Medicine, said chief medical information officer Christopher Sharp, every primary care practice now uses large language models to generate interpretations of test results, which a doctor can sign off on to send to a patient. The system is also being piloted in specialties with more high-sensitivity results, and Stanford hopes to have it implemented across the entire organization by September.”

From the U.S. healthcare business front,

• Beckers Payer Issue lets us know,
  • “Blue Cross and Blue Shield of North Carolina reported a net income of $69 million in 2024, Business North Carolina reported April 7. 
  • “The company recorded $11.9 billion of revenue in 2024, compared to $12.2 billion in 2023.
  • “Claims and medical expenses increased 7.2% to $10.4 billion in 2024, and the company’s reserves are equal to 3.3 months of claims and administrative expenses.”

• Per Beckers Hospital Review,
  • “Despite economic volatility, Fitch still expects healthcare providers to experience a “modest margin expansion” this year due to easing inflationary pressures and reimbursement increases, according to an April 9 report.
  • “The firm anticipates healthcare providers will see Medicare and commercial rate bumps 3% to 4% this year as rates increase and the volume of high acuity cases grows with the aging population.
  • “The workforce challenges plaguing healthcare providers over the last several years are lessening as well, according to the report.
  • “Chronic personnel shortages will continue to ease, suppressing wage inflation and reducing reliance on costlier external agency labour,” the report notes. “Wages are unlikely to exert pressure on provider margins in 2025, with revenue growth likely to match or exceed wage growth.”
  • “The healthcare providers in a more stable financial situation will be in the best position to grow over the next few years. Struggling hospitals will continue to have challenges, and some may seek merger or acquisition partners to stay operational.”

• Per Modern Healthcare,
  • “A court ruling striking down a federal nursing home staffing mandate brought a sigh of relief from nursing home operators even as the industry still faces financial uncertainty.
  • “An end to the mandate could bring stability to nursing home budgets and valuations. However, some nursing homes still face challenges, such as tougher state staffing minimums, as well as the threat of potential Medicaid rate cuts.
  • “A federal judge in Texas on Monday tossed the controversial nursing home mandate the Biden administration rolled out last year that required nursing homes to have a registered nurse onsite 24 hours a day, seven days a week. The court also blocked a requirement that nursing homes provide at least 3.48 hours of care per resident, per day.
  • “The Health and Human Services Department said in an email it does not comment on legal matters when asked about a possible appeal. However, many in the industry had been expecting the Trump administration to roll back the regulation.”
• and
  • “Nonprofit health insurance company CareSource has invested more than $400 million to buy struggling nonprofit insurer Commonwealth Care Alliance. 
  • “The deal adds nearly 50,000 Dual Special Needs Plan members who are eligible for both Medicaid and Medicare to CareSource’s book of business, the companies said in a news release Wednesday. CareSource also acquired Commonwealth Care Alliance’s two primary care clinics and its home care practice through the transaction. CareSource counts 2 million Medicaid, Medicare and exchange plan enrollees across seven states.
  • “CareSource CEO Erhardt Preitauer will take over as head of Commonwealth Care Alliance, replacing current CEO Chris Palmeri, who will depart the company. Palmeri currently serves on the board of directors of the insurance lobbying group AHIP. At the start of the year, he stepped down from his role as board chair of the Association of Community Affiliated Plans, a nonprofit Medicaid insurer trade group.
  • “The deal had not been previously announced.”