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Five dogs turned blue in Mumbai.

That was a story that journalist Deepak Gharat broke this past week. He was following up on a story in the industrial zone of Taloja, home to about 1,000 pharmaceutical and chemical factories. Every week, there’s something going wrong over there, he says. Industrial waste catches fire. Dead fish float up to the surface of the local river en masse.

Last week, he noticed a canine of unusual hue snoozing under a truck. Unable to believe his eyes, he took pictures and mailed them to his newsroom.

Puddles for the pooches

Some people, like local animal rights activist Arati Chauhan, suggested the dogs turned blue because of waste in the local Kasardi River, where the dogs were thought to have gone wading.

That theory appeared in many media outlets but does not appear to be true. The dogs hang out at a pigment and detergent factory about 2 miles away from the river, and they’re too territorial to venture that far, says Gharat.

“The dogs go looking for food in the dye factory compound,” Gharat found.

Locals have seen the dogs crawling on their bellies under the factory’s gate to loll in the ubiquitous puddles of cool, blue water in the grounds.

So they’re definitely not swimming in the river and instead are picking it up from the dye in the stagnant water on the factory grounds, Gharat observed.

Gharat confirmed with a local vet that the dye on their fur had dried to leave behind a powdery, blue residue.

While the dye isn’t permanent, it’s toxic to the dogs, who lick their fur to groom themselves and end up ingesting the chemical.

The dogs are lucky it’s monsoon season, because the dye washes off after several rainy rinses. After activist Chauhan and her organization, the Navi Mumbai Animal Protection Cell, filed a complaint, the local chapter of the Society for the Prevention of Cruelty to Animals checked the dogs, including one with an eye infection. All the animals have been given a clean bill of health, and the dye has been scrubbed off. The factory has put up a temporary net under the gate to prevent dogs from getting back in.

Not fine for fish

So the problem with the dogs was apparently cosmetic. But the media attention pushed the state pollution control board to shut down the chemical factory, identified as Ducol Organics & Colours Pvt Ltd. The factory was releasing untreated chemicals into the river and toxic residual dye powder into the atmosphere, violating India’s Water Act from 1974 and the Air Act from 1981.

That’s not a problem for dogs, because they don’t appear to drink from the river. But it is a problem for fish.

Last year, local fishermen complained that their catch volumes had dropped by 90 percent. They had the water tested at the municipal environment laboratory. Measured against guidelines from the Central Pollution Control Board, a national regulatory body, the pollution in the Kasardi River was 13 times over the safe limit for fish to survive, and 40 times over the limit for human consumption.

At the source of the Kasardi River, 24 miles away, the water is used for agriculture, drinking and washing clothes, says Gharat. “But where the industrial zone starts in Mumbai, the water is totally chemical.”

Factories were set up in this area in the 1960s, he says, and more than 300 of them make chemicals.

‘Successfully polluted’

V.M. Balsaraf, a professor of applied chemistry at the Datta Meghe College of Engineering and a researcher of groundwater pollution in Mumbai, is surprised at the sudden brouhaha over the river pollution. “We have found heavy metals and chemicals in the area water. Most of the industries don’t have treatment for sewage,” he says. “All our water sources are successfully polluted, they’ve become gutters. Even birds and animals have nowhere to drink water.”

Chauhan, the activist, has asked the pollution board to plant more trees, clean up the river and stop the dumping of untreated waste in the area.

Shutting down the factory, though, is shortsighted, she says. It would be better to hold all the factories accountable rather than depriving some workers a livelihood, she suggests.

“People are saying just implement the law, get the pollution under control,” echoes Gharat, who says that fixing the treatment plant, monitoring waste discharge and punishing offenders would be a good place to start.

But he and the activists are afraid that official action will taper off once the memory of the blue dogs fades away.

Chhavi Sachdev is a journalist based in Mumbai. Contact her @chhavi

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Congress and the Trump administration could boost insurance coverage by a couple of million people and lower premiums by taking a few actions to stabilize the Affordable Care Act insurance markets, according to a new analysis by the consulting firm Oliver Wyman.

The paper, which lays out a simple blueprint for making insurance more affordable for more people while working within the current health law’s structure, comes just days before the Senate Health, Education, Labor and Pensions Committee begins hearings on ways to stabilize markets in the short term.

“Together, these approaches could increase enrollment by roughly two million individuals, reduce average premiums by more than 20 percent and be roughly revenue neutral,” the analysis by Kurt Giesa and Peter Kaczmarek says.

The analysis concludes that under current law, about 17 million people will buy insurance in the individual market next year, many of them outside the ACA marketplaces. If the four actions outlined in the paper are implemented, about 19 million people would buy individual insurance, the study finds.

At the same time, the average monthly premium would fall from $486 to $384.

Some of the actions, including extending the Affordable Care Act’s cost-sharing subsidies, are already on the table for next month’s committee hearings.

These are the four steps that Oliver Wyman recommends to stabilize Obamacare.

1. Fund the cost-sharing reduction payments for the long term

These are payments the government makes to insurance companies as reimbursement for discounts on copayments and deductibles the companies are required by law to give to low-income customers. President Trump has said he wants to end the payments — which a court has ruled are unlawful since Congress never authorized them. But now lawmakers, including Republican Sen. Lamar Alexander of Tennessee, chairman of the health committee, say they want Congress to fund the payments through next year.

“State insurance commissioners have warned that abrupt cancellation of cost-sharing subsidies would cause premiums, copays and deductibles to increase and more insurance companies to leave the markets in 2018,” Alexander said in a statement on Aug. 16. “Congress now should pass balanced, bipartisan, limited legislation in September that will fund cost-sharing payments for 2018.”

2. Create a reinsurance program

The ACA included a temporary reinsurance program that protected insurance companies from huge losses while they transitioned to the new market under the new law.

Senate Republicans included a reinsurance program in the Better Care Reconciliation Act, the health care overhaul that failed earlier this summer.

Govs. John Hickenlooper of Colorado and John Kasich of Ohio are publicly advocating such a program.

“Top of our list would be this notion of having some sort of reinsurance to make sure the high-cost pool is not causing higher rates for all,” Hickenlooper said in an interview with Colorado Public Radio.

3. Strongly enforce the individual mandate

President Trump has suggested he doesn’t want the Internal Revenue Service to enforce Obamacare’s requirement that every person have insurance. Today, individuals who can’t prove they have coverage must pay a fine of $695 or more. Oliver Wyman’s analysis shows that if the mandate isn’t enforced, many young healthy people would drop their coverage.

“As younger and healthier people opt out of the market, the cost of coverage would increase, and market-average premiums would increase in parallel,” the study said.

4. Get rid of the health insurance tax

Obamacare includes a tax on health insurance companies to help offset the costs of federal subsidies that help people buy policies on the ACA markets. It was in place from 2014 through 2016, but then Congress passed a moratorium on the levy for this year. Insurance companies are lobbying hard to ensure it doesn’t return next year. Oliver Wyman’s analysis shows that continuing that moratorium would cut premiums by about 3 percent next year.

Insurance companies have until Sept. 27 to commit to selling policies on the ACA marketplaces in 2018. Alexander says he wants some legislation to pass before then to help stabilize the markets and cut premiums.

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A year ago, Maine was one of the first states to set limits on opioid prescriptions. The goal in capping the dose of prescription painkillers a patient could get was to stem the flow of opioids that are fueling a nationwide epidemic of abuse.

Maine’s law, considered the toughest in the U.S., is largely viewed as a success. But it has also been controversial — particularly among chronic pain patients who are reluctant to lose the medicine they say helps them function.

Ed Hodgdon, who is retired and lives in southern Maine, was just that sort of patient — at least initially.

Name a surgery, and there’s a decent chance Hodgdon has had it.

“Knee replacement. Hip replacement. Elbows. I’ve got screws in my feet,” he says.

Hodgdon has rheumatoid arthritis. And along with each surgery came an opioid prescription for pain. At first he got some relief from the drugs, but it didn’t last.

“It just numbed it for a while,” he says, “and then I needed more.”

Though Hogdon keptincreasing the dose, the pain never went away.

“And then I found Dr. Medd. That’s my angel right there,” Hodgdon says, nodding toward Dr. Donald Medd, a general internist in Westbrook.

Medd had already started to taper high doses among patients like Hodgdon before Maine put a cap on new prescriptions for opioids last July. The new limit allows a maximum of 100 morphine milligram equivalents (the standard used to measure potency for all prescription opioids) for most patients per day — with certain exemptions for some cancer patients, those in hospice care, and some others. Patients with existing prescriptions were, by and large, given a year to meet the new restriction.

Medd was ahead of the game because he’d noticed that many of his patients on high doses of opioids grew increasingly angry about their pain as time wore on, and tended to demand ever more medication. At the same time, they were struggling to function in daily life because of the drugs’ side effects.

“You know, at some point the medications get in the way of some sort of recovery,” Medd says.

Opioids were affecting Hodgdon’s mood and his memory. Medd worked with him to cut the dose he was taking every day by two-thirds and helped him get in touch with a psychologist for further help. Though Hodgdon still lives with some pain, he says his life is infinitely better.

“I can remember things,” he says. “I get along better with people.”

Despite success stories like Hodgdon’s, Medd says he initially opposed Maine’s law. He didn’t want the legislature to interfere with medicine.

But now he thinks the law gave a necessary nudge to many doctors. Compared to a few years ago, Medd says, he and colleagues in his medical practice have cut the number of their chronic pain patients who are on opioids by almost half — from about 1,500 to 800.

In nearly all counties in the state, the number of prescriptions for painkillers is dropping. It’s a trend that Gordon Smith, executive vice president of the Maine Medical Association, says was underway even before the law took effect.

“We had the fourth largest drop in the country,” he says, citing a 21.5 percent reduction in opioid prescriptions from 2013 through 2016.

The data only include the first few months after Maine’s prescribing cap went into effect, Smith says; he expects the law will accelerate further reductions.

“Now having said that, it’s not been easy,” he says. “It’s been particularly difficult for patients,” he says — specifically for the 16,000 patients on high-dose opioids who were expected to taper to the 100 morphine milligram limit by July of this year.

“I was about four times above that,” says Brian Rockett. He operates a wholesale business buying lobsters on the Maine coast. Rockett started taking opioids years ago to ease the pain of injuries from racing motorcycles and boats. When he tried to taper the dose, he says, he had unbearable pain. So, he filed a notice of intent to sue the state over its restrictions on how much he could be prescribed.

“I just knew that I was facing possibly losing my business,” he says.

Rockett wasn’t alone in his inability to taper his use of the drug, and Maine lawmakers — like Dr. Geoffrey Gratwick, a state senator who is also a rheumatologist — took notice.

“A certain group of people simply cannot come off [opioids],” Gratwick says.

He recently pushed through a change to Maine’s law that allows broader exemptions, so that people with incurable, chronic conditions can continue to take high doses.

It put the decision about that back in the hands of the doctor and patient, Gratwick says, “where it should be.”

Under the revised law, Rockett was able to increase his dose, and dropped his lawsuit.

Even though more patients could, potentially, seek exemptions, Maine’s law is seen by its advocates as an important step. Recent data from the federal Centers for Disease Control suggest that nationwide, despite an overall decrease in recent years, the number of opioids prescribed still triple what it was in 1999.

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In the wake of congressional Republicans’ failure to pass a health care bill, two governors from different parties are going to bring their own ideas to Washington.

Staff for Colorado Gov. John Hickenlooper, a Democrat, and Ohio Gov. John Kasich, a Republican, are working on a joint plan to stabilize the country’s health insurance markets. Kasich told Colorado Public Radio’s Colorado Matters that they expect to release it ahead of September hearings in the U.S. Senate. They also intend to get other governors from both parties to sign onto the plan, to show support at the state level.

“We’re getting very close. I just talked to my guys today, men and women who are working on this with [Hickenlooper’s] people, and we think we’ll have some specifics here, I actually think we could have it within a week,” Kasich said in a joint interview with Hickenlooper that aired Tuesday.

The plan will flesh out a set of principles the two men wrote about in an op-ed in The Washington Post, in which they said another one-party health care plan is “doomed to fail,” just like the Republican plans considered this year. In the op-ed, they asserted that the best place to start reform efforts is “to restore stability to our nation’s health insurance system.”

Bipartisan health care hearings, including the one the governors will appear at, are set to begin just after Labor Day when Congress returns from its August recess. Lawmakers will be consumed with a number of deadlines involving government funding, though — sending health care to the back burner.

“I’m not going to get into specifics with you until we have it all ironed out, but it’s not going to be some pie-in-the-sky, way-up-there kind of stuff. There will be things that we will address that will have specific solutions. And one of the things we’re finding out is the states do have some power to do some things unique to them, as long as these insurance markets are going to be stabilized,” Kasich said.

One specific they agree on and would discuss: changing the Affordable Care Act mandate that employers with 50 or more employees provide insurance coverage. The governors say that number is too low, which deters hiring at small companies.

They also agree that the possibility of national single-payer coverage is not on the table in their discussions.

In recent months, Hickenlooper and Kasich have appeared on national television shows to advocate for bipartisan health care reform that includes keeping the Medicaid expansion intact, with both took advantage of in their states. The two governors have even entertained running for the White House on a split ticket.

Interview Highlights With Govs. Hickenlooper And Kasich

On whether they think health care should be a “right”

John Hickenlooper: I come from the school that I think it is a right. I’m not sure how much health care is included in that right, but some basic coverage.

John Kasich: I don’t think that’s that important in this. I mean we want everybody to have health insurance. I mean that’s how I feel. Is it a right or is it a privilege or whatever? I don’t know why that declaration is important … The question is how do you do it, and that’s what we’re working on … Primary care is important. Catastrophic coverage is important. We don’t want anybody to get bankrupted because they get sick.

On what to change about the Affordable Care Act first

Hickenlooper: There are several important things, but the probably top one on our list would be this notion of having some sort of reinsurance [using public money to help insure the sickest people] to make sure the high-cost pool is not causing higher rates for all the people seeking insurance on the private markets … You use reinsurance in almost every type of insurance program to cut off those “hilltops” as we say.

On why this joint effort may gain traction

Hickenlooper: “[The Senate’s health committee] is now holding hearings [starting Sept. 5], and hopefully in those hearings we’ll get a chance to present, hopefully, what by that point a number of both Republican and Democratic governors think look like good ideas.”

The Colorado Matters website has the full transcript.

This story is part of a reporting partnership with NPR, Colorado Public Radio and Kaiser Health News.

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Seated at a kitchen table in a cramped apartment, Rosendo Gil asks the parents sitting across from him what they should do if their daughter catches a cold.

Blas Lopez, 29, and his fiancée, Lluvia Padilla, 28, are quick with the answer: Check her temperature and call the doctor if she has a fever they can’t control.

“I’m very proud of both of you knowing what to do,” Gil says, as 3-year-old Leilanie Lopez plays with a pretend kitchen nearby.

Padilla says that’s not a question they could have answered when Leilanie was born. “We were asking question after question after question,” she recalls.

Gil, who worked as a nurse in his native Mexico, is now a family support worker with the Imperial County Home Visiting Program. He has visited the El Centro, Calif., family dozens of times since Leilanie’s birth. At each visit, Gil teaches the couple a little more about child development and helps them cope with the stresses of work, school, relationships and parenting.

Gil and other home visitors around the nation face a daunting task: to help new parents raise healthy children and overcome poverty, substance abuse, depression and domestic violence.

Home visiting organizations operated out of the national limelight for decades until the Affordable Care Act created a nationwide program in 2010 to support them. The federal Maternal, Infant and Early Childhood Home Visiting program now awards $400 million in annual grants to help new families with young children and couples who are expecting.

The Imperial County, Calif., program serves roughly 100 families with its $630,000 annual budget from the federal government. Nationwide, federally-funded home visitors reached 160,000 parents and children in 2016, according to the Health Resources & Services Administration.

Funding for the program is set to expire at the end of September unless Congress acts to reauthorize it. With the deadline looming, advocates and providers are urging federal lawmakers to reauthorize it for five more years at double the current funding level. Two bills are pending in the House.

“Expiration is just not an option,” says Diedra Henry-Spires, chief executive officer of the nonprofit advocacy organization Dalton Daley Group and one of the leaders of the nationwide Home Visiting Coalition. “Too many families are relying on these services across the country.”

Studies have shown that home visiting programs get results – they help reduce child abuse and neglect and improve child and maternal health, for example. Researchers say home visiting also saves money that would otherwise be spent later on the child welfare system, special education, medical care and other services.

Organizations that provide home visits fear that some programs may have to reduce the number of families they serve, while others may have to close altogether if the funding is not renewed in time.

Chicago-based Healthy Families America sends social workers, nurses and others into homes in 35 states. Its national director, Cydney Wessel, hears from many participants who say they want to avoid the mistakes their own parents made and raise their children in homes without violence or substance abuse.

“Under stressful situations, parents often revert to how they were parented” if they don’t have somebody to help guide them along a different path, Wessel says.

Lopez and Padilla were determined to discipline Leilanie without spanking her. “I don’t want to follow that same pattern,” Padilla says.

The couple credits Gil with teaching them much about babies over the past three years — for example, that holding them a lot doesn’t make them clingy. Gil recently brought Leilanie a book called “Mommy’s Best Kisses,” reiterating to the parents the importance of reading to her every day.

“He’s like a friend,” says Lopez, a former migrant worker who is studying to get his high school diploma. “We have counted on him.”

Gil has also helped the couple live on their own and communicate better with each other, Lopez says. He helped them find services when Leilanie’s speech was delayed and encouraged Lopez, who has Crohn’s disease, to take his medicine.

Gil says it is crucial to gain the trust of his clients, which he sometimes does by telling them about his own alcoholic father or the challenges he faced raising his daughters. “It opens the door,” says Gil.

And over time, he sees changes and feels grateful he played a part.

“I see parents going back to work and back to school,” he says. “I see parents breaking the cycle on substance abuse. I see families becoming role models to other families. … This is so great to see.”

Kaiser Health News, a nonprofit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the Kaiser Family Foundation.

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Sierra Leone, a country that has been battered by Ebola, civil war and massive floods, suffered yet another tragedy this week. Government and international aid workers are racing the clock to find survivors after a mudslide struck capital city Freetown early Monday morning.

Some 600 people are still missing, and there are reports that some people are still alive, trapped in their homes underneath the mud.

At the same time, aid groups are trying to support roughly 9,000 people — who were injured, displaced, or found their lives disrupted by the devastation — and avert a potential public health crisis.

To make matters worse, rain keeps falling and it is not expected to slow down until next month, raising the risk for more mudslides. As it is, hospital morgues can’t keep up with the more than 200 victims’ bodies so far. Health facilities are also struggling to keep up with the hundreds of people treated for injuries related to the mudslide.

The Sierra Leonean government leads the response and is working with nonprofit organizations to fill in the gap. Groups like Oxfam and UNICEF are helping to determine what people who lost their homes to the mudslide need. And the government asked Catholic Relief Services to help with burials.

NPR spoke with Idalia Amaya, the deputy head of programs and the emergency response coordinator for CRS in Freetown, about the ongoing rescue effort, the challenges faced by aid groups on the ground and how the Ebola outbreak that struck Sierra Leone in 2014 helped prepare for the mudslide response. This interview has been edited for length and clarity.

Interview Highlights

What is the biggest challenge right now?

The rain. August is the peak of the rainy season in Sierra Leone. The timing of this is really horrible because every day it is raining and it will continue through the end of the month. It makes the emergency response slower.

We are getting reports that family members are receiving text messages and calls from people trapped in the mud. They are still inside their homes that were swept away by the mudslide. Attempts to reach them are hampered because there is not enough equipment to dig people out, and the continued rain makes the operation dangerous for the rescuers. There are concerns that people will get trapped themselves.

How are aid groups like Catholic Relief Services dealing with the response?

Being that Ebola happened a couple of years ago, there is a big international presence in the country. So it’s a blessing in disguise because there are so many groups already here that can get the boots on the ground to get the immediate assistance of food, water, shelter, mattresses and more to people.

What lessons were learned from the Ebola response?

Instead of setting up a parallel system like was done during the Ebola outbreak, it is led and owned by the government. Of course, there have been some challenges, but the international community is ready to help. They identified the need for burial teams, so CRS stepped up and said we can fill that role.

Are there other problems caused by the mudslide?

Because the morgue and the central hospital has been overwhelmed with bodies, the bodies have been laying outside. The bodies are decomposing and fluids are streaming into public water areas. We need to do dignified burials as quickly as possible.

People are also trying to move the bodies themselves without the proper training, using regular gloves and aprons. Government health officials said cholera is a leading concern during an infection prevention control meeting, due to the fact that drinking water for thousands of people in Freetown is affected by the mudslide.

How do you balance dignity and urgency when performing the burials?

We don’t want to retraumatize the community. There was an outcry when the mass graves were done during the Ebola outbreak and it became a public health hazard when people blocked the burials.

We are balancing it with a lot of education saying that we need to bury the bodies in a timely fashion and in a dignified way. We do that by making sure there is a religious leader accompanying the burial team to give the final rights to the individuals buried. It is also important that the president is expected to lead a funeral procession where some of the caskets are draped in the country’s flag.

What makes you optimistic about Sierra Leone?

The people here have survived a civil war, Ebola, cholera outbreaks. Regardless of this tragedy and their religious beliefs, they are coming together as a community. People are waking up each morning and getting out to help each other each day since the mudslide. Here, they are strong and tall and they will survive.

Tom Murphy is a journalist focused on foreign aid and development. His work has appeared in Foreign Policy, GlobalPost, Humanosphere and the Guardian. Tweet him @viewfromthecave.

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A federal appeals court has sided with the state of Arkansas against Planned Parenthood, saying it can block Medicaid payments to the medical provider. It reversed earlier injunctions that forbade the state from suspending the money in the wake of a controversial leaked video of Planned Parenthood staff.

That video, leaked by anti-abortion activists, purports to show Planned Parenthood staff outside Arkansas discussing fetal tissue sales. Planned Parenthood has said the tapes are fraudulent and multiple investigations have deemed the allegations as false.

In 2015, citing the video, Arkansas Gov. Asa Hutchinson terminated the state’s Medicaid provider agreements with Planned Parenthood’s local affiliate.

Then, three unnamed Planned Parenthood patients sued the director of the Arkansas Department of Human Services, saying that it was violating their federal right to choose any qualified provider offering the services they were seeking.

A district court then blocked the state from cutting off payments to Planned Parenthood for these three patients. A second injunction expanded that to an entire class of Medicaid beneficiaries in Arkansas who used Planned Parenthood services.

Today, in a 2-1 decision, the U.S. Court of Appeals for the Eighth Circuit vacated those injunctions. U.S. Circuit Judge Steven Colloton wrote that in the provision of the Medicaid Act cited by the plaintiffs, it is not clear that Congress intended to create a judicially-enforceable right for individual patients to choose any qualified provider that offers the services they seek.

He said that it would create a “curious system” to review a provider’s qualifications. “Under the Jane Does’ vision, while the provider is litigating its qualifications in the state courts, or after the provider unsuccessfully appeals a determination that it is not qualified, individual patients separately could litigate or relitigate the qualifications of the provider in federal court,” Colloton wrote.

At the same time, Colloton says “the lack of a judicially enforceable federal right for Medicaid patients does not mean that state officials have unfettered authority to terminate providers,” and notes that providers whose contracts are cancelled have the right to appeal.

In a dissenting opinion, Circuit Judge Michael Melloy notes that four other circuit courts and numerous district courts have ruled the opposite way, finding that there is a “private right of enforcement” to choose any qualified provider, such as Planned Parenthood.

The decision does not comment on the video as the rationale that Hutchinson provided for seeking to end the contract.

Planned Parenthood says it is “evaluating all options to ensure our patients receive uninterrupted care.”

“This is not over,” said Planned Parenthood Federation of America Chief Medical Officer Raegan McDonald-Mosley. “We will do everything in our power to protect our patients’ access to birth control, cancer screenings, and other lifesaving care. Extreme politicians are trying to defund and shut down Planned Parenthood — and this is not what Americans want.”

In a statement, Hutchinson described this as “a substantial legal victory for the right of the state to determine whether Medicaid providers are acting in accordance with best practices and affirms the prerogative of the state to make reasoned judgments on the Medicaid program.”

Jerry Cox, the executive director of the Family Council, an Arkansas-based conservative group, tells KUAR’s Michael Hibblen: “The videos aside, the question is should the state of Arkansas do business with an organization that aborts babies when they don’t need to.”

According to The Associated Press, “the state has said Planned Parenthood received $51,000 in Medicaid funds in the fiscal year before Hutchinson’s decision to terminate the contract,” and “none of the money paid for abortions.”

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About five years ago, Dillon Katz, entered a house in West Palm Beach, Fla.

“I walked in and the guy was sitting at this desk — no shirt on, sweating,” Katz says.

The man asked Katz for a smoke.

“So I gave him a couple cigarettes,” Katz says. “He went around the house and grabbed a mattress from underneath the house — covered in dirt and leaves and bugs. He dragged it upstairs and threw it on the floor and told me, ‘Welcome home.’ “

The house was a sober living house or “sober home” — a kind of privately owned halfway house intended to integrate recovering drug and alcohol users back into community life and help them stay on the right path. It was one of the first sober homes Katz lived in. He’s been in and out of drug treatment ever since.

Some sober homes are good places. But others see a person who has an addiction as a payday.

Amid the nation’s growing opioid crisis, South Florida has become a mecca for drug treatment. And as more people arrive looking for help, there’s more opportunity for corruption and insurance fraud. There are millions to be made in billing patients for unnecessary treatment and tests, according to officials investigating the problem.

The first step for unscrupulous rehab centers: Recruiting clients who have good health insurance. That’s created a whole new industry — something called patient brokering or “body brokering.”

The corrupt owner of a drug treatment center might pay $500 per week in kickbacks to the operators of sober homes who send them clients with health insurance — clients like Dillon Katz.

At her home in Boynton Beach, Fla., Dillon’s mom, Staci Katz, pulls out three huge binders where she keeps track of his medical bills. She’s tallied up the charges for the five years her 25-year-old son has been in-and-out of treatment: more than $600,000 dollars.

“You could see by the billing — this was very lucrative,” Staci says.

There are charges for all kinds of things — nutrition counseling, acupuncture and chiropractic care among them. But the big expenses were for testing — urine testing.

“When they had charged $9,500 for five urinalyses,” she says, “I was like, ‘Huh! Now I get it.’ “

State and federal officials have been cracking down on fraudulent rehab centers.

The Palm Beach County Sober Home Task Force has has arrested and charged more than 30 operators of addiction treatment centers and sober homes with body brokering in the past 10 months.

In July, U.S. Attorney General Jeff Sessions announced the arrest of Eric Snyder, the 30-year old owner of a Delray Beach rehab center. Prosecutors say he billed insurance companies for more than $58 million in bogus treatment and tests, and recruited addicts with gift cards, drugs and visits to strip clubs.

Dillon Katz was staying at a sober home across the street when Snyder’s place was raided.

Katz alternates between an easy smile and a piercing gaze. He was diagnosed with Tourette’s syndrome and attention deficit hyperactivity disorder at a young age. In high school, he loved acting and music but struggled socially. It was after high school that his drug use escalated — from cocaine to crack to heroin. And his behavior went off the rails.

“I ended up throwing my suitcase out of the window,” Katz says. “I was punching the garage. My hands were bloody. I was flipping out.”

His mom eventually decided she’d had enough of the chaos.

“I said, ‘If you want help, then I will help you,’ ” Staci remembers. “We had no idea what we were up against.”

That’s when their drug treatment rollercoaster started. For the next five years, her son went from one treatment center, to another, to another.

“The people my group counseling meetings would offer to help get me into a new place,” he says. “But they always asked first, ‘What’s your insurance like?’ “

He’s pretty sure now that they were doing it for the money.

Body brokering is a source of frustration for legitimate providers of drug rehab services.

“Kids are literally being bought and sold.” says Andrew Burki, founder of Life of Purpose — an addiction treatment center on the Florida Atlantic University campus in Boca Raton. “You want $500? Sell a friend! I mean, that’s crazy, right? But that’s literally what’s happening.”

Dillon Katz now lives in Port Saint Lucie in a house he shares two roommates. They hang out on the back patio, smoking Marlboro Menthols and cracking wise.

He’s doing well, he says — he’s been clean for eight months now and he’s a tattoo artist, a job he likes.

After the unsuccessful rehab stays, an arrest and stint in jail ultimately landed him in drug court — that means his incentive for staying off drugs now includes the need to convince a judge that he’s clean. Katz says he’s found that, for him, the best support is through a recovery fellowship.

“Any kind of spiritual program,” Katz says. “That’s the answer.”

And, he adds, there’s no insurance required.

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The Trump administration is giving insurance companies an extra three weeks to decide whether to offer insurance plans through the Affordable Care Act markets, and how much to charge.

The extension comes as insurance companies wait for President Trump to decide whether he will continue to make payments to insurance companies that are called for under the Affordable Care Act but that some Republicans have opposed.

The payments — known as cost-sharing reduction payments — reimburse insurance companies for discounts on copayments and deductibles that they’re required by law to offer to low-income customers. The Congressional Budget Office estimates the payments this year would be about $7 billion.

Trump has said he may end the reimbursements, which he calls “bailouts,” and has been leaving insurers to wonder month to month about whether they will receive a check.

A White House spokesman says Trump is “working with his staff and his Cabinet to consider the issues raised by the CSR payments.”

The U.S. Department of Health and Human Services says it is offering the extra time so insurance companies can plan ahead in case the government decides to end the payments. In a memo Friday, the agency said many states are now requiring companies to file their rates for 2018 on the assumption that they won’t be reimbursed.

Several companies say that without the cost-sharing payments, their rates will see double-digit increases. For example, Blue Cross Blue Shield of North Carolina says ending the payments would push its rates up 14.1 percent.

And Marc Harrison, CEO of Intermountain Healthcare, which covers 173,000 people on the ACA exchanges in Idaho and Utah, says premium increases could be “astonishing.”

Still, he says, his company will stick with the Obamacare markets. “These are our patients. We’re not going anywhere. We’re going to keep trying to figure this out.”

The HHS memo says “there have been no changes regarding HHS’s ability to make cost-sharing reduction payments to insurers.”

But it then says the agency intends to change the ACA’s risk adjustment program to compensate for the loss of cost-sharing payments.

The changes are technical and complex, but Timothy Jost, professor emeritus at Washington & Lee University’s law school, says in a Health Affairs blog that the memo just deepens the confusion.

“We still do not know if all of this is needed or not — the Trump administration has not made up its mind,” he says.

The cost-sharing payments have been at the center of a political battle over the Affordable Care Act since before President Trump took office.

House Republicans opposed to the health law sued then-President Barack Obama, saying the payments were illegal because Congress hadn’t appropriated money for them. A judge agreed but allowed the administration to continue making the payments during an appeal.

Now that Trump is in the White House, and Republican efforts to repeal and replace the Affordable Care Act have failed, many Republicans are urging the president to continue the payments rather than undermine the health care markets.

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