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The number of new Hepatitis C cases leaped nearly 300 percent from 2010 to 2015, according to a report released Thursday by the Centers for Disease Control and Prevention. And the CDC points to the likely culprit behind the spike in cases of the infectious disease: the use of heroin and other injection drugs.

And despite the existence of therapies that can cure more than 90 percent of infections, the organization says the disease remains a deadly threat. In 2013, for instance, the CDC says some 19,000 people died of their infections.

“Hepatitis C is associated with more deaths in the United States than 60 other infectious diseases reported to CDC combined,” the researchers write.

States that have struggled most with the unfolding opioid crisis also tended to have worst rates of new Hepatitis C infections. All of the seven states that have rates of infection at least twice the national average — Indiana, Kentucky, Maine, Massachusetts, New Mexico, Tennessee and West Virginia — have seen a statistically significant increase in drug overdose deaths in recent years, as well.

The CDC evinces little doubt that statistics like these are intimately related.

“Injection drug use is the primary risk factor for new HCV infections,” the researchers write, referring to the disease by its initials and recommending that lawmakers “create and strengthen public health laws” to fight the disease.

In particular, the CDC says some of the best ways to combat its spread are ways to boost access to clean needles — such as syringe exchange programs and decriminalization of the possession of paraphernalia.

“State laws that increase access to syringe exchange programs and clean needles and syringes, and policies that facilitate access to HCV treatment through state Medicaid programs can reduce HCV transmission risk,” the CDC says.

Of all 50 states, the CDC found that only Massachusetts, New Mexico and Washington had both a “comprehensive set of laws and a permissive Medicaid treatment policy that might affect access to both HCV preventive and treatment services for persons who inject drugs.”

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If, like many of us, you are reading this article on the toilet — then we’ve caught you at the perfect time.

When you’re done with your business, perhaps you’ll do a thorough hand washing. Or maybe just a quick rinse. Or maybe you’ll skip it altogether.

Failure to wash is a problem for ordinary folks. Germs on your unwashed hands can get into your body when you touch, say, your eyes or mouth. And into your food, too.

It’s a problem for health workers as well. The Centers for Disease Control estimates that medical staffonly remember to do so about half the times they’re supposed to. The CDC states: “This contributes to the spread of healthcare-associated infections that affect 1 in 25 hospital patients on any given day.” Worldwide, one in 10 patients acquires an infection while receiving health care.

So this month, the Centers for Disease Control is ramping up its campaign to get doctors, nurses and other medical staff to wash up.

But the question for medical workers (and really, for everyone) is: Do you do a good job?

CDC offers straightforward instructions: soap up, scrub and rinse. The process should take 35 seconds — about the time it takes to sing the alphabet song twice.

The World Health Organization has its own instructions. The process takes a tiny bit longer – 42.5 seconds. And there are six very specific steps.

WHO’s technique is a deliberate process to get rid of germs in all the nooks and crannies of the hands. First, rub your palms against each other, then rub the back of each hand against your palms. Rub your palms together with your fingers interlaced, rub your palms against each other while your fingers are interlocked, rub your fingers around each of your thumbs, and finally, rub each palm with the tips your fingers.

Both the CDC and WHO methods, which have been around for decades, are also taught at elementary schools (to germy kiddos) and restaurants (to staff who handle your food).

Recently, researchers wanted to compare them to see which was the best way to minimize bacteria.

In a small study recently published in the journal Infection Control and Hospital Epidemiology, researchers at the Glasgow Caledonian University in Scotland watched carefully as 42 doctors and 78 nurses cleaned their hands using either the CDC or WHO routine. They found that the WHO technique reduced the average bacterial count on the medical workers’ hands slightly more than the CDC’s method.

In any case, both organizations’ work really, really well, says study author says Jacqui Reilly, a professor of infection prevention and control at Scotland’s Glasgow Caledonian University who led the study.

The real issue is that health care workers aren’t cleaning their hands as often and as thoroughly as they should — basically every time they touch their faces or touch anything that isn’t sterile.

And when it comes to doing a good job, even having a set of directions doesn’t guarantee good results. In Reilly’s study, only 65 percent of the 120 participants completed the two techniques properly, despite having instructions right in front of them.

Reilly herself says she’s been using the six-step method since she was first taught it at medical school. “I don’t think about it consciously anymore,” she says.

She highly recommends you try it out after using the toilet. And if you don’t, at the very least, she says, remember that “any time you wash your hands, it should take at least 15 seconds.”

And avoid the making the rookie mistake of rubbing soap onto dry hands and then rinsing it off. If you wet your hands, first, Reilly says, the water works to dislodge any microorganisms clinging onto your skin, so that the soap can scrub them off:“So always wet your hands first.”

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Town hall meetings got loud for some Republican members of Congress this week, as they defended the passage of the American Health Care Act by the House of Representatives. Constituents have been asking a lot of questions, and we’ve been fact-checking the answers given by some leading GOP lawmakers.

Tom Reed, R-N.Y., at a town hall meeting in his district

“The pre-existing reform is not repealed by this legislation.”

Fact check: That’s not the whole truth

Reed was responding to a constituent who was concerned about a child with severe allergies: “His co-pays and deductibles will be through the roof,” the parent told Reed, “because he’s going to be in a high-risk pool — because he has a pre-existing condition.”

“No, no, no,” Reed told the parent.

The bill does have language that says insurers cannot deny people coverage or charge them more just because they have a pre-existing condition.

However, the GOP bill also has an enormous loophole in that regard. The plan allows states to apply for waivers from the federal government that get them out of many of the regulations put in place under the Affordable Care Act — including one that bans insurance companies from charging people with pre-existing conditions more for a health plan. A waiver would allow insurance companies to consider a person’s health status when determining what to charge for coverage. And that means that although someone with a pre-existing condition who lives in a state that got a waiver would have to be offered a policy, it could be very expensive.

Steve Scalise, R-La., on Fox News this week

“No matter what kind of plan you have today,” Scalise told Fox News, “if you have a pre-existing condition, under our bill, you cannot be denied coverage and you cannot be charged more than anybody else.”

Fact check: Not exactly true

Scalise, like Reed, is pointing to the language in the bill that retains the Obamacare rules that prohibit insurers from charging people with expensive medical conditions more than their neighbors of the same age for an insurance policy.

But the state waivers allow insurers a way around that guarantee.

Before the Affordable Care Act, insurance companies denied coverage or charged more if the person who wanted insurance had any of a long list of conditions — including arthritis, diabetes, heart disease, muscular dystrophy, obesity and sleep apnea, according to a list compiled by the Kaiser Family Foundation from insurers’ underwriting guidelines.

Insurers also could refuse to cover many medications, including drugs that treat cancer, diabetes, AIDS or arthritis, according to Kaiser.

If you have cancer and buy insurance that doesn’t pay for your cancer treatment, your pre-existing condition is effectively excluded.

Rod Blum, R-Iowa, at a town hall in Dubuque

“If you’re getting your insurance through the group health care marketplace — your employer — nothing changes,” Blum told constituents this week. “If you’re getting your health insurance through Medicare, nothing’s going to change. If you’re currently getting your health insurance through Medicaid, nothing’s going to change.”

Fact check: Partly false

Blum’s statement refers to a couple of big things — employer coverage and Medicaid.

As to employer coverage, whether your insurance would change under the GOP bill depends on whether your company is based — and buys its insurance — in a state that gets a waiver.

In “waiver states,” employers’ insurance policies might no longer be subject to Obamacare regulations around so-called essential health benefits — the minimal benefits that must be included in a policy.

They also might no longer be subject to restrictions on annual and lifetime spending caps.

That means, in those states, your employer-sponsored health insurance policy could deny coverage for some categories of care, such as mental health care or maternity coverage. And the health plan could impose annual or lifetime limits on insurance benefits. So workers with very expensive conditions, or their family members with such conditions, could see their costs pile up — even if they have health coverage through work.

Before Obamacare, about 60 percent of employers had lifetime limits on their health plans.

Blum’s second statement — the one in regard to Medicaid — is false. The GOP health bill makes major changes to Medicaid, first by rolling back the expansion of the program over time.

The bill allows people to keep their expanded Medicaid as long as they remain eligible. But people at or near the poverty level often see their incomes fluctuate, making them temporarily ineligible for the health care program. Under the GOP bill, once they leave the Medicaid rolls, they would not be able to return, even if their income declines.

In addition, the bill fundamentally changes how the U.S. government finances Medicaid. States would receive a fixed amount of money from the federal government for each beneficiary, rather than an amount that varies according to the numbers of Medicaid beneficiaries and their health care needs.

Most analysts say that, over time, the level of services Medicaid could provide would decline if the GOP health bill becomes law, and the states would have to cut back on services. That forecast is borne out by the Congressional Budget Office, which said the changes to Medicaid would cut the costs of the program by $880 billion over 10 years.

Many services provided by Medicaid today, including home health care and services for people with disabilities, are considered “optional” under the GOP health bill. Those are also the services that help keep people out of hospitals and nursing homes.

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Ryan Lennon Fines seems like a typical 2-year-old. He and his parents, Scott Fines and Brianna Lennon, flip through a picture book of emergency vehicles. Ryan is looking for the motorcycle, but a photo of an airplane catches his dad’s eye.

“That’s an air ambulance,” Fines tells him. “You’ve been on one of those.”

When Ryan was born in 2014, his mouth wasn’t connected to his stomach. It’s a condition known as esophageal atresia. After three months in a hospital in St. Louis, the family flew to Boston, where Ryan had surgery.

The surgery worked. Ryan is active and can eat normally — he had two big pieces of fruit leather and some crackers in the 45 minutes I was there. But all that time in the hospital was expensive. In the first six months of his life, Ryan’s insurance plan was billed $750,000. The family had to pay only $5,000 of that — Ryan’s maximum out-of-pocket expenses, under his insurance plan, for 2014 and 2015.

“We were lucky we had a really good, employer-provided [health insurance] plan,” Lennon says.

Now, the family is worried about Ryan’s future. He’ll still need between $20,000 and $30,000 of medical care every year. They have insurance through Fines’ work, but the health care bill that Republicans passed in the House last week could affect Ryan’s care.

All six Republicans from Missouri — including Rep. Vicky Hartzler, from the district where Scott, Brianna and Ryan live — voted for the bill, which unwinds many of the provisions and protections of the Affordable Care Act, known as Obamacare. In a video posted to Twitter, Hartzler says passing the bill was an important first step to replacing the ACA.

“It covers pre-existing conditions,” she says, “still retains the ability for young people to stay on their parents’ policies, and makes sure that there are no lifetime caps.”

That’s true, but the bill also gives states the authority to allow insurers a number of exemptions from the federal law. For example, while the GOP bill retains the ACA provision that people, like Ryan, who have pre-existing conditions cannot be denied coverage, there’s a potential loophole. In a last-minute amendment proposed by Rep. Tom MacArthur, R-N.J., a state could seek permission to allow insurance companies to charge patients more (based on their health history) if their coverage lapses for more than 63 days.

That provision in the GOP bill would tremendously weaken the ACA protections, says Larry Levitt, senior vice president of the Kaiser Family Foundation.

“This would guarantee access to insurance for people with pre-existing conditions in theory, but not really in practice — because they could be charged astronomically high premiums,” says Levitt.

Before the Affordable Care Act was enacted in 2010, he says, it was common for people with pre-existing conditions to be charged much higher premiums or to be denied coverage altogether. If a state decides to waive the federal law’s protections, this could happen again.

The amendment would require that states seeking a waiver must also help people who have high health care costs. High-risk pools are the most commonly cited type of program to do this, but they were often underfunded and expensive for consumers and states.

Missouri Gov. Eric Greitens, a Republican, supported the GOP health plan in March. His office didn’t respond to NPR’s questions about whether he supports the current version of this bill or whether he’d want Missouri to seek permission to opt out of some of the provisions. Levitt says it would likely be conservative states, like Missouri and the 18 other states that did not expand Medicaid, that may try to opt out.

Those states, Levitt says, “made a decision to not go along with the Affordable Care Act, and I think that those states are facing a similar kind of decision here.”

Fines and Lennon say they face tough decisions if this bill becomes law.

“We would have to either move to a state that didn’t waive community protections or out of the country entirely if we could,” Fines says. “I’m not going to risk my son’s health on the political whims of Jefferson City.”

But before any decisions are made in Missouri’s state capital, the GOP bill is in the hands of the U.S. Senate, where it could change before becoming federal law.

This story is part of NPR’s reporting partnership with KBIA, Side Effects Public Media and Kaiser Health News.

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Debates about health care are complicated, and it’s easy to get overwhelmed when complicated things like premiums, block grants, state waivers, Medicaid and Medicare are the main topics.

But what are the ideas driving this debate? And why do debates get so heated when we’re talking about something so technical?

To get some clarity about this topic, Michael Cannon, director of health policy studies at the libertarian Cato Institute, and Dr. Kavita Patel of the centrist Brookings Institution and a practicing primary care internist at Johns Hopkins Medicine spoke to Michel Martin on Weekend All Things Considered.

Interview highlights have been edited for clarity and length.

Interview Highlights

On health care as a human right vs. free market arguments

Cannon: It’s not like we have one side that wants people to have health care and one side that doesn’t want people to have health care. But the free market approach to this problem says, “Actually, a lot of the things that the government is doing to provide health care to people are preventing people from accessing health care.” Because what markets do is they identify and they disseminate innovations that fill in the cracks in our health care sector so fewer people fall through — innovations that make health care better and more affordable — and when the government gets involved it causes those cracks to widen.

Patel: I think one of the ideas that’s really at tension here is actually whether we believe health care is a human right. So you have people — I put myself in that category, a lot of physicians do as well — we think everyone should have access to health care. Now, there’s a lot of details to that. What does that mean? Who pays for it? But we feel very strongly, and many do in this country, that there are basic rights that people are entitled to, and access to health care is a right that all people in this country deserve.

On the American Health Care Act that just passed the House

Cannon: I don’t take positions on legislation, but Republicans have traditionally neglected health care as an issue. It’s just not a Republican issue, and as a result they haven’t been able to articulate why it is that their own principles would deliver better health care. What they’ve done here is, they’ve just tried to pass something that they can say is repeal, even if it doesn’t repeal the Affordable Care Act. And in the process, they may actually be making the Affordable Care Act worse and setting themselves up for a lot of electoral defeats in 2018, which would then, I think, cause the pendulum to swing back in the direction of the Affordable Care Act or maybe even a single-payer system.

Patel: I’m definitely opposed to the legislation. We will not see premiums come down for everyone. In fact, we know that premiums will go up for people who are older or have chronic conditions. This isn’t even repealing the Affordable Care Act. This is actually worse than what care was before.

On why politicians argue about health care so much

Patel: I think health care just touches on something that’s so personal to everyone, and then this sense of, “You’re taking away my hard-earned money and giving it to someone who doesn’t care about their health, and that’s wrong.” That’s tapping into something that’s really basal.

Cannon: Health care is a very emotional issue because we rely on health care at the most vulnerable points in our life — and that’s not just when we’re sick, it’s when a loved one is sick or a child is sick. If it appears that someone is trying to take health care away from you or from someone you love, you get a really strong fight-or-flight response from people. And usually it’s a fight response.

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After weeks of will-they-or-won’t-they tensions, the House managed to pass its GOP replacement for the Affordable Care Act on Thursday by a razor-thin margin. The vote was 217-213.

Democrats who lost the battle are still convinced they may win the political war. As the Republicans reached a majority for the bill, Democrats on the House floor began chanting, “Na, na, na, na … Hey, hey, hey … Goodbye.” They claim Republicans could lose their seats for supporting a bill that could cause so much disruption in voters’ health care.

Now the bill — and the multitude of questions surrounding it — moves across the Capitol to the Senate. And the job doesn’t get any easier. With only a two-vote Republican majority and likely no Democratic support, it would take only three GOP “no” votes to sink the bill.

Democrats have made clear they will unanimously oppose the bill. “Trumpcare” is just a breathtakingly irresponsible piece of legislation that would endanger the health of tens of millions of Americans and break the bank for millions more,” said Senate Minority Leader Chuck Schumer, D-N.Y.

And Republicans in the Senate have their own internal disagreements, too.

Here are five of the biggest flashpoints that could make trouble for the bill in the upper chamber.

Medicaid

House leaders correctly point out that their bill represents the biggest changes to the federal-state health program for the poor since its inception in 1965 — a point that appeared to be drowned out during the most recent House debate that focused on coverage for people with preexisting health conditions.

For the first time, federal funding for low-income people on Medicaid would be limited, resulting in what House Speaker Paul Ryan, R-Wis., described at an event sponsored by the conservative National Review as “sending it back to the states, capping its growth rates.” It’s a longtime goal for many conservatives. “We’ve been dreaming of this since I’ve been around,” Ryan said.

But it is not a consensus position in the party. Some moderates support the current program, especially for children and people with disabilities. In addition, many GOP governors took the federal government’s offer in the ACA of near-complete federal funding to expand Medicaid to non-disabled, working-age adults, and they are worried about the impact on their residents and their budgets if the expansion goes away and the program’s funding is restricted.

The House bill, wrote the Republican governors of Ohio, Michigan, Arkansas and Nevada in a letter to House and Senate leaders, “provides almost no new flexibility for states, does not ensure the resources necessary to make sure no one is left out, and shifts significant new costs to states.”

That pushback has also created doubts in the minds of some GOP senators. Sens. Rob Portman, R-Ohio, Bill Cassidy, R-La., and Shelley Moore Capito, R-W.Va., are among those who have expressed concerns about the House bill, as has Dean Heller, R-Nev., It’s not clear if any of the House changes have satisfied those senators.

Increase In Number Of Uninsured People

The Congressional Budget Office’s initial estimate that the bill could lead to 24 million more Americans without health insurance within a decade spooked many lawmakers in the upper chamber. “You can’t sugarcoat it,” Cassidy told Fox News when explaining that “it’s an awful score.” The final House bill passed without the score being updated, although most outside analysts said the changes were likely to increase the number who would lose insurance.

And Democrats have been using those initial numbers to score rhetorical points, even if they lack the votes in either the House or Senate to stop the bill or change it.

“The CBO’s estimate makes clear that Trumpcare will cause serious harm to millions of American families,” said Schumer. “Tens of millions will lose their coverage, and millions more, particularly seniors, will have to pay more for health care.”

Tax Credits

On one hand, even with the additional $85 billion added by House leaders to help older people pay for their insurance premiums, many moderates feel the age-based tax credits in the bill replacing those in the Affordable Care Act are too small, particularly for people in their 50s and early 60s. The CBO estimated that under the original version of the House bill, premiums for a 64 year-old with an income of $26,000 a year could rise from $1,700 currently to more than $14,000.

That brought a strong rebuke from the powerful AARP, which was an outspoken ACA supporter. “Although no one believes the current health care system is perfect, this harmful legislation would make health care less secure and less affordable,” said a statement from the group.

Sen. Susan Collins, R-Maine, has said she could not support the House bill in its original form because of concerns about the effects on older constituents.

On the other hand, some conservatives in the Senate are ideologically opposed to offering any tax credits. Sens. Ted Cruz, R-Texas, Mike Lee, R-Utah, and Rand Paul, R-Ky., have all expressed concerns about the bill being too much like the ACA, with Paul referring to it as “Obamacare Lite.” They worry that the tax credits amount to a new entitlement.

“For me, it’s a big stumbling block still that there’s taxpayer money that’s being given to insurance companies,” Paul told reporters in late April. “And I’m just not in favor of taxpayer money going to insurance companies.”

Planned Parenthood

As Republicans have been vowing for years, the House-passed bill would defund Planned Parenthood, although only for a year. That’s likely because a permanent defunding would actually cost the federal government more money, according to the CBO, as some women who lose access to birth control would become pregnant, have babies and qualify for Medicaid. Birth control is vastly cheaper than health care for mothers and babies.

But while cutting funding for Planned Parenthood is overwhelmingly popular in the House, there are a handful of GOP senators, including Collins and Lisa Murkowski, R-Alaska, who have said they are likely to oppose a bill carrying this provision.

Procedural Problems

The budget process Republicans are using to avoid a Democratic filibuster in the Senate, called reconciliation, has very strict rules that require every piece of the bill to be directly related to the federal budget. It will be up to the Senate parliamentarian, a Republican appointee, to make those determinations.

That’s why the bill does not wipe away all the ACA’s private insurance regulations, including the requirement that insurers not discriminate against customers who have preexisting health conditions.

Some analysts have suggested that the House amendment sought by conservatives to allow states to waive some of the health law’s regulations might run afoul of Senate’s “Byrd Rule,” which limits what can be included in a budget reconciliation measure.

“It could be argued that any budgetary effects of the waiver are ‘merely incidental,’ ” said the Committee for a Responsible Federal Budget in a blog post.

Even Rep. Mark Meadows, R-N.C., who negotiated that amendment that won the backing of conservatives, conceded that it could prove problematic in the upper chamber. “There’s still a lot of work that needs to be done before we can celebrate and all go home,” he said in an interview outside the House chamber.

Democrats say it is one of several provisions in the House bill that might not pass parliamentary muster in the Senate.

For example, analysts have suggested that the GOP replacement for the much-disliked “individual mandate” requiring most people to have insurance or pay a fine might not pass Byrd Rule scrutiny either. That’s because the 30 percent premium penalty that people with a lapse in insurance would have to pay under the bill would go to the insurance company, not the federal government, so it would have no budget impact.

A third potentially problematic element of the original House bill would allow insurers to charge older adults five times more in premiums than younger adults — up from a ratio of 3-to-1 under the Affordable Care Act. That provision could be viewed as not directly affecting federal spending, some analysts predict.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

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