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Even with the subsidies authorized under the Affordable Care Act, millions of individuals remain uninsured, possibly because they consider coverage still too expensive or they’d rather pay the penalty for not buying insurance. When the most recent enrollment period closed, 12.7 million people had signed up for Obamacare, up from 9.3 million last fall but still well short of earlier projections. Meanwhile, health insurers losing money on the added policies are raising rates. ... The bottom line, no matter who wins the White House in November: Improving or replacing Obamacare in ways that effectively address the problems the law was meant to resolve–as Chief Justice Roberts put it–will continue to prove every bit as difficult as enactment was in 2010. (Robert Litan, 2/19)

Whatever the GOP candidates say now, any Republican who wins the presidential election in November will face heavy pressure to roll back the ACA given the Republican base's strong opposition to the law and the candidates' repeated vows to repeal it. In an interview, Chris Jennings, a Democratic healthcare strategist and former senior adviser to the Obama White House, said a Republican president and Congress would at least substantially reduce the ACA's premium tax credits and cut and restructure Medicaid in a major way. Where a Republican-led government would run into big problems would be in reducing or eliminating the subsidies and repealing the individual mandate while trying to keep the requirement that insurers accept customers regardless of preexisting conditions. (Harris Meyer, 2/21)

One of the stated goals of proponents of the Affordable Care Act (ACA) was to prevent patients from being denied health care so that others could increase their profits. As then-candidate [Barack] Obama put it, one of his goals was “making sure that they are limited in the ability to extract profits and deny coverage”. Now, one of the lesser-known provisions of the ACA calls for the federal government to pay physicians and hospitals bonuses if they deny health care to seniors and the disabled – and even encourages them to form local monopolies to make it harder for them to find alternative sources of care. And most patients won’t even know that’s the reason they are being denied care. (Robert Book, 2/21)

Solving the Medicaid challenge is the toughest fiscal hurdle the state of Alabama faces. If its costs are not contained, Medicaid will continue to grow like kudzu, and lawmakers must either raise taxes or severely cut other state services to keep the program going. I am for neither of those options, so there has to be a third way. ... To keep costs under control, we have radically changed how care is delivered to Medicaid patients. In 2013, I sponsored legislation to create Regional Care Organizations (RCOs) to improve the delivery of care to Alabama's 650,000 non-nursing home Medicaid patients with the goal of bending Medicaid's cost curve down. (Alabama Senate Majority Leader Greg Reed, 2/21)

Insulin has been around for almost a century. The World Health Organization considers it an essential medicine, which means it should be available “at a price the individual and the community can afford.” So why is this product increasingly too expensive for many Americans? In the United States, just three pharmaceutical giants hold patents that allow them to manufacture insulin: Eli Lilly, Sanofi and Novo Nordisk. Put together, the “big three” made more than $12 billion in profits in 2014, with insulin accounting for a large portion. What makes this so worrisome is that the big three have simultaneously hiked their prices. (Kasia Lipska, 2/10)

Twelve states that undertook investigations of Planned Parenthood found no wrongdoing. An additional eight states refused even to investigate, citing lack of credible evidence. A grand jury in Texas and a federal judge in California exonerated the organization after each conducted extensive reviews. Three congressional committees failed to turn up any improprieties. In short, the hidden-camera videos purporting to show illegal selling of fetal tissue show no such thing. Despite all that, a Republican-led House panel is undeterred in conducting its own investigation, or, more accurately, witch hunt. Even more troubling than the considerable time and money that will be wasted is the potential damage to health care and medical research. (2/20)

Like Icarus edging too close to the sun, Pope Francis learned Thursday what it means to graze Donald Trump's news cycle: Even the most meticulously chosen words are burned away in the nebular heat. Largely overlooked in the uproar over the pope's criticism of Trump was an understated -- but no less intentional -- observation about contraception. Avoiding pregnancy is not an absolute evil, Francis noted, apropos of a question about the Zika virus. (2/19)

But more recently, opponents of abortion have begun to use Down syndrome in their attempt to roll back women’s reproductive rights. Last month, the Missouri Senate debated a bill that would outlaw selective abortion — that is, termination of an otherwise wanted pregnancy on the basis of a Down syndrome diagnosis. ... Proponents of these laws claim to be motivated by desire to fight prejudice against people with Down syndrome, rather than curtail women’s access to abortion. ... Let me suggest another way. These laws trivialize the often-wrenching decision to terminate a pregnancy by suggesting that women are acting out of simple prejudice. But women decide to abort after a diagnosis of Down syndrome for many reasons. (Rachel E. Adams, 2/19)

This month ESPN reported that the NFL and its partners have over the past several years become the nation’s largest and most powerful funder of brain research, exceeding the National Institutes of Health. Such investments—totaling more than $100 million—are commendable. Federal research dollars are limited, and despite the popularity and visibility of football, its risks directly affect far fewer people than other health concerns. But the role that the NFL has played in its largess has undercut the credibility of much of the scientific research into the risks of football, and thus compromises our ability to make the game safer for children, college students and professionals. (Roger Pielke Jr., 2/21)

It’s disturbing and puzzling news: Death rates are rising for white, less-educated Americans. ... Why are whites overdosing or drinking themselves to death at higher rates than African-Americans and Hispanics in similar circumstances? ... here is one solution to the death-rate conundrum: It’s likely that many non-college-educated whites are comparing themselves to a generation that had more opportunities than they have, whereas many blacks and Hispanics are comparing themselves to a generation that had fewer opportunities. (Andrew J. Cherlin, 2/22)

Should an autopsy have been performed on the body of Justice Antonin Scalia? When a Texas justice of the peace certified that the 79-year-old Supreme Court justice had died from natural causes, questions immediately erupted. No autopsy had been performed, and the certification had been made without even an examination of the body. ... Three forensic pathologists interviewed separately were divided in their opinions about the handling of the death of Justice Scalia. (Dr. Lawrence K. Altman, 2/20)

In our increasingly digital health world, wearables are exploding in their usage. While making hospital rounds last week, I noted that all of the housestaff and some of the patients were wearing some type of sensor device to track their steps, flights climbed, etc. ... But is more data always better? Are we healthier because of all of this additional monitoring or are we being distracted from what truly matters? Call me skeptical. To date, the evidence that commercial apps help to change users’ behavior, improve their health, or even take accurate measurements is sparse. (Rita Redberg, 2/19)

Until recently, the sophisticated view about calorie labels in restaurants was one of despair: A series of studies suggested that the practice, required by Obamacare and modeled on what has been done in New York and other cities, just doesn't succeed in promoting healthy food choices and reducing obesity. But comprehensive new research offers a dramatically different picture. It finds that if we divide Americans into subgroups -- the normal, the overweight, and the obese -- we’ll find that calorie labels have had a large and beneficial effect on those who most need them. (Cass R. Sunstein, 2/19)

“Can I have dessert?” “Did you eat all of your vegetables?” This is a common dinner conversation in our house and probably for most other families. Whether we call it bribery or not, parents bribe their kids in small ways every day. Eating more vegetables in exchange for a little dessert. Cleaning a bedroom in exchange for more time on a computer or video game. Good behavior to play with friends. (David Grande, 2/22)