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The American Hospital Association is attacking a bipartisan budget deal that would serve the American people well. ... The association’s complaint is that the bill ... would reduce a rapidly-growing source of unjust payments to hospitals. ... Section 603 of the bill would effectively force hospitals to stop pretending that physician offices and clinics they acquire as part of a merger are actually part of the main hospital campus. The distinction is important because Medicare pays outpatient clinics located at hospitals a lot more than it pays off–site clinics and doctors for the same services. For certain ambulatory surgeries, for example, Medicare pays roughly 80 percent more in a hospital outpatient department than in a freestanding off-site clinic. ... In fact, Section 603 is a much weaker reform than is needed. It would apply only to outpatient clinics acquired in the future. (Phillip M. Boffey, 10/29)

In 2009, prominent Republicans, skeptical of requiring people to buy health insurance under the legislation that became Obamacare, proposed an alternative approach: making large employers automatically sign employees up for health insurance, while also allowing them to opt out. A version of this idea made its way into the Affordable Care Act. But as a result of this week’s budget deal, it is now out -- and Republicans are celebrating. How come? The answers shed new light on some thorny issues in behavioral economics, and also on contemporary politics. (Cass R. Sunstein, 10/29)

We know the Wisconsinite has the principles and skills to succeed, but his speakership will be as much a test of the conservative movement as it is of Mr. Ryan. The question is whether conservatives can muster the unity and wit to revive Congress as a governing body. Mr. Ryan is promising to communicate better with the likes of the Freedom Caucus, to cut fewer backroom deals, and to advance an agenda that offers a clearer sense of conservative principles. This all sounds good, especially the last point. That would mean, say, trying to pass a plan to replace ObamaCare, not merely repeal it. Or pushing specific tax cuts or social-welfare reforms that could front-run major reform in 2017. (10/28)

Ben Carson began rolling out his policy alternatives for the American health-care system this week. Like many prescriptions, it’s a bit difficult to decipher at first glance — though not because of poor handwriting. To put it bluntly, CarsonCare is a muddle. It’s hard to know precisely what he’s proposing when he says, as he did in Wednesday’s debate, that it gives people “the option of opting out” of government health care. But based on what we know, it would neither expand access to health care nor improve quality, nor save a whole lot of money. (Ezekiel J. Emanuel and Andrew Steinmetz. 10/29)

Let me also suggest that these struggling Obamacare co-ops are tantamount to the canaries in the Obamacare coal mine. These plans are exclusively in the business of the Obamacare insurance exchanges. If you want to segregate the Obamacare insurance business model from the overall insurance business to examine it, the co-ops are pure Obamacare. Just how well have all of the co-ops done? As the Washington Post recently reported, of the 23 Obamacare insurance co-ops in business on June 30, 2015, each of them charted in the article, 20 of them were losing money–most of these relatively tiny insurance start-ups showed staggering losses in the range of $4,000,000 to $50,000,000! (Robert Laszewski, 10/26)

The Affordable Care Act (ACA) has passed its fifth birthday and completed two enrollment periods for coverage in the state-based insurance exchanges and Medicaid. The U.S. uninsured rate is lower than ever, and coverage gains appear to be improving access to primary care and medications, affordability of care, and self-reported health. But challenges for health care reform persist: millions of Americans are still uninsured, and even for those with coverage, substantial barriers remain to obtaining affordable, high-quality care. More than 30 million U.S. children and adults still lack insurance. Who are they, and what policy options exist for covering them? (Benjamin D. Sommers, 10/28)

We need to keep and strengthen implementation of the Affordable Care Act under kynect, our state’s health benefit exchange. More than 413,000 people in Kentucky and 105,000 people in Louisville have gained health insurance coverage under Medicaid expansion and Qualified Health Plans through kynect. While Kentucky has historically ranked at or near the bottom of all states in the nation on most health indicators, since 2014, Kentucky, along with Arkansas, has led the nation in reducing rates of uninsured adults. Expanding insurance coverage to so many more people in our state and city promises to vastly improve the health of present and future generations of Kentuckians and Louisvillians. (The Louisville Metro Board of Health, 10/29)

The Internal Revenue Service (IRS) recently finalized new requirements for nonprofit hospitals to maintain their tax-exempt status under the Affordable Care Act (ACA). Section 501(r) of the Internal Revenue Code now requires each hospital to establish a written financial-assistance policy that applies to all “emergency and medically necessary care.” ... Although the new requirements may do little to increase the scope of existing charity care policies, they could increase the proportion of people eligible for charity care who do receive it. As these requirements are fully enforced by the IRS in 2016, nonprofit hospitals will have to ensure that patients eligible for partial or full charity care receive it. If physicians practicing in nonprofit hospitals familiarized themselves with the charity care policies of their hospitals, they could encourage their patients to apply for charity care when appropriate and thereby reduce their burden of medical debt. (Sayeh S. Nikpay and John Z. Ayanian, 10/29)

Medical-imaging technology plays an essential role in the timely diagnosis and management of many conditions. Lately, however, it's become equally well known for its low-value uses and as the single largest source of per capita radiation exposure. Imaging is by far the most common service on the lists of unnecessary tests and procedures of the Choosing Wisely campaign, and an estimated 20 to 50% of imaging is unnecessary. Medical imaging is thus a valuable resource in dire need of better stewardship. (Daniel J. Durand, Jonathan S. Lewin and Scott A. Berkowitz, 10/29)

In August, the price of the 62-year-old drug pyrimethamine (Daraprim), used to treat many potentially fatal parasitic infections, was increased practically overnight from $14 to $750 per tablet. This colossal increase attracted renewed attention to generic pharmaceutical price spikes, prompting public outrage and a new round of proposals to address this issue. Over the past few years, increasing drug shortages and price spikes have affected generic drugs, which now account for 86% of prescriptions and 29% of pharmaceutical spending. A stable supply of affordable generic pharmaceuticals is crucial to improve health care access and appropriate utilization for many Americans. (Clay P. Wiske, Oluwatobi A. Ogbechie and Kevin A. Schulman, 10/29)