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When we are patients, we want our doctors to make recommendations that are in our best interests as individuals. As physicians, we strive to do the same for our patients. But financial forces largely hidden from the public are beginning to corrupt care and undermine the bond of trust between doctors and patients. Insurers, hospital networks and regulatory groups have put in place both rewards and punishments that can powerfully influence your doctor’s decisions. Contracts for medical care that incorporate “pay for performance” direct physicians to meet strict metrics for testing and treatment. (Drs. Pamela Hartzband and Jerome Groopman, 11/18)

Americans could find the new insurance rates for the Affordable Care Act in online marketplaces last week. Prices of many plans went up. But just how much depends on how you measured them. (Margot Sanger-Katz, 11/18)

The big revelation of this week has been how many political pundits have spent six years of the Obama administration opining furiously about the administration’s signature policy without making the slightest effort to understand how it works. They’re amazed and in denial at the suggestion that it has the same structure as Romneycare, which has been obvious and explicit all along; they are shocked, shocked to learn that it uses the mandate as an alternative to taxing and spending, which has always been completely obvious and open. (Paul Krugman, 11/18)

Poor Jonathan Gruber. Having written the 2010 Patient Protection and Affordable Care Act all by his lonesome, he now has to watch the accolades heaped upon the law upon its passage turn into denunciations because he revealed the shocking truth about its contents. Oh, wait -- Gruber, an economics professor at the Massachusetts Institute of Technology, didn't actually write the law, which has never had a lot of public support. And contrary to Gruber's comments about lawmakers disguising the tax increases in the ACA, critics have been offering detailed lists of the law's tax effects for years. Still, it was stunning to see someone so close to the Obama administration say such damning things about the way the ACA became law. (Jon Healey, 11/18)

I'm probably not alone among journalists writing about the Affordable Care Act in finding that the lowest-information emails landing in my inbox lately come from people who have learned one thing about the act, and one thing alone: that some guy named Jonathan Gruber, its ostensible “architect,” said some insulting things about American voters’ stupidity and how they had to be gulled into supporting the bill. So this is how low the debate over the most far-reaching social insurance program of our time has fallen. (Michael Hiltzik, 11/18)

Economist Jonathan Gruber has become a household name in the nation's capital and the media for saying that Democrats disguised unpopular provisions of the healthcare reform bill in order to win Congress' approval. Yet his comments didn't reveal anything about the substance of the 2010 Affordable Care Act that the public didn't already know. Rather, they betrayed Gruber's deep cynicism about the legislative process and the “stupid” American electorate. For someone who supposedly had a front-row seat, Gruber missed how well the months-long debate over the act conveyed what it would do and why. (11/18)

After the [health] law's Medicaid expansion and with the population aging into Medicare eligibility, the 107 million under Medicaid or Medicare in 2013 rapidly increases to 135 million just five years later, according to CMS projections. By the end of the decade, a full 140 million Americans will have their health care access directly controlled by the U.S. government, a growth rate far higher than private insurance. The problem is that government insurance does not correspond to access to medical care, nor does it imply good health outcomes. Medicaid is already refused by more than half of doctors across America, according to 2013 data from a 2014 Merritt Hawkins survey. (Scott Atlas, 11/18)

Dear Republicans: What’s the matter with Governor John Kasich of Ohio? Why didn’t he jump to the top of your list of 2016 presidential contenders with his stunning re-election in the ultimate swing state? ... Kasich is suspect as a squish, maybe even the last surviving example of that earlier species of Republican, the compassionate conservative. ... he did take his Medicaid expansion dollars. Aides who want the governor to keep his party card have since hedged his position but he is explaining why full repeal of the Affordable Care Act is a Republican pipedream. “The opposition to it was really either political or ideological," he said in October. "I don't think that holds water against real flesh and blood, and real improvements in people’s lives.” (Margaret Carlson, 11/17)

Expanding Medicaid may be anathema to Texas political leaders. For hospitals, though, it would be a godsend. ... Gov. Rick Perry and others have said Texas is not interested in pouring more money into a broken system. One way health care providers agree that Medicaid is broken is in the meager amount this state-federal partnership program pays for care. Hospitals say they lose money on every Medicaid patient they treat. The American Hospital Association calculates Medicaid paid only 93 cents of every dollar spent on Medicaid patient care in 2012. (Jim Landers, 11/18)

In Tennessee, inaction on Medicaid [expansion] has meant the loss of nearly $1 billion in federal funds, a number that grows by $2.5 million each day. This money would not have gone into some unnamed bureaucracy; it would have been used to provide quality, affordable health-care coverage to the 300,000 Tennesseans who fall in the Medicaid gap. The benefits of Medicaid expansion aren’t limited to the health of those individuals. Providing this coverage means that 300,000 people can go see a doctor on a regular basis, limiting their need for emergency care at hospitals. When these individuals did need ambulatory care, the admitting hospital would receive a Medicaid reimbursement rate for their services, which currently they have to write off as charity care. (Tenn. State Rep. Craig Fitzhugh and Tenn. State Sen. Jeff Yarbro, 11/18)

It appears that opponents to Medicaid expansion, after making arguments about costs of the program and need for reform, have simply chosen to not mention it in the upcoming session and hope it will go away. As for the economics, several studies have shown that Medicaid expansion will have a positive benefit on the state economy. The federal government will assume 93 percent of expansion costs over 2014- 2022. As it stands now, without Medicaid expansion, our federal tax dollars are now being lost to states in which Medicaid expansion has occurred. Missouri is losing approximately $5 million per day. With Medicaid expansion, the costs of uncompensated care by the state and local governments will decrease markedly. Medicaid expansion will save over 24,000 jobs primarily in the health care workforce in the state. (Dr. John Mihalevich, 11/16)