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Governor Mike Pence of Indiana has reached an agreement with the federal government to accept expanded Medicaid for the Affordable Care Act, even while radically changing the state's regular Medicaid system. ... It’s a huge deal because it's another sign that the U.S. Supreme Court has only delayed the Medicaid expansion required under the law rather than preventing it altogether. If even a conservative firebrand such as Pence can't hold out, it's increasingly clear that the federal incentives for state governments to sign on are just too strong to resist. (Jonathan Bernstein, 1/27)

It’s important to note that several of the states that have said yes — namely Arkansas, Iowa, Michigan, New Hampshire and now Indiana — got or are seeking waivers to modify the Medicaid expansion for their states. And with [Indiana Gov. Mike] Pence winning new concessions from the federal government, other Republican governors are expected to ask for similar provisions that may be more palatable to conservatives. (Dan Diamond, 1/27)

Having failed to repeal the Affordable Care Act outright, congressional Republicans are moving ahead with plans to dismantle it piece by piece. Earlier this month, the House passed a bill that would undermine the so-called employer mandate, which requires certain employers to provide insurance or pay a penalty. In all, 240 Republicans and 12 Democrats voted for the bill while 172 Democrats voted against it. In the Senate, two Democrats recently joined dozens of Republicans to sponsor a similar measure. Like other attempts to weaken health care reform, the bill, named the Save American Workers Act, is based on false premises and offers false promises. But its bipartisan patina makes it a threat, as do the catchy if misleading assertions of its supporters to win public support. (1/28)

Yesterday's announcement by the Department of Health and Human Services, setting firm targets for shifting Medicare away from fee-for-service payments, has for the most part generated positive reviews. That makes sense -- that payment structure provides incentives for excess care, and HHS is right to move past it. But that shouldn't mean the Medicare agency gets a pass on the details. There are a few reasons to wonder just how serious HHS is about these changes. (Christopher Flavelle, 1/27)

In 2013, according to statistics compiled by Medicare actuaries, spending grew 0.5 percent less than the previous year, the result of lower costs in both private health insurance and Medicare. The CBO has concluded that “the slowdown in health care cost growth has been sufficiently broad and persistent” to reduce significantly its spending projections for federal health-care programs. Nonetheless, the future is not pretty. (Ruth Marcus, 1/27)

Monday’s report from the Congressional Budget Office on the country’s long-term economic outlook underscores what budget experts have long known: The rising cost of health care is the single largest driver of the gloomy long-term fiscal outlook for the U.S. Yes, the pace of increase has moderated in recent years. But many of the factors reducing cost increases are likely to prove transient. ... There are grounds for hope, however. As often happens in the federal system, state experimentation may be blazing a trail for national policy. Oregon offers one of the most promising models. (William A. Galston, 1/27)

The new president (a gentleman named Barack Obama) shifted the CBO's projections by signing into law the Affordable Care Act. The CBO's new projections for the next 10 years of costs from Obamacare — the cost of subsidies and Medicaid expansion, less penalty payments and other income — are slightly lower than what it figured last year. ... By 2025, Obamacare will be losing the government $145 billion a year. That's only a measure of the economic costs of the program directly; it doesn't include economic and health benefits that the program will create. It also doesn't include the taxes outlined by our Post colleague Glenn Kessler which offset some of the costs above. (Philip Bump, 1/27)

It's time to ensure that more Californians are vaccinated.The outbreak this winter has illustrated quickly and forcefully how a highly contagious disease can spread when the vaccination rate falls below the level needed for "herd immunity." Herd immunity means that so many people are immune that the chance of outbreak is low, which protects the few who are not immunized because they are too young to have been fully vaccinated or because they are among the few in whom the vaccine doesn't "take" or because they haven't been vaccinated for valid medical reasons. (1/27)

Last year saw more U.S. measles cases than in any other year in nearly the last quarter century, and 2015 isn't looking a whole lot better, after someone at Disneyland infected people who infected other people in what has become a seven-state outbreak. Measles vaccines have been around for 50 years, but a vaccine is usually only as good as the percentage of the population that gets it. So how do some people in a country that rejoiced in vaccines for killers like polio wind up wary of them? Emory University historian Elena Conis goes sleuthing in her book, “Vaccine Nation: America's Changing Relationship with Immunization,” finding answers in science, politics and shifting cultural standards about how we vaccinate and what our doubts are. (Patt Morrison, 1/27)

The outbreak of measles that started at California's Disneyland last month and spread to 10 other states demonstrates how misinformation, misguided celebrities and lax state laws can have tragic consequences. (1/27)

While vaccines are promoted as safe and effective, this is not true for everyone. Vaccine risks are different for each child because we are not all the same, and doctors cannot predict which child will be harmed. Inflexible vaccine mandates threaten the health of those children. The federally recommended childhood vaccine schedule has exploded to 69 doses of 16 vaccines with hundreds of new vaccines in development. A baby today receives more vaccines by six months old than her mother did by high school graduation. Yet, there is incomplete testing of the safety of the current child vaccine schedule. (Mary Jo Perry, 1/27)

The entirely preventable California measles outbreak has now sickened more than 70 people. With perhaps hundreds more exposed, the outbreak will likely continue. As the disease spreads, experts will debate how we respond and what to do about the anti-vaccine movement that's partly to blame for this mess. Likely, all we'll agree on is better outreach to parents. That's not enough. Parents who do not vaccinate their children should go to jail. (Alex Berezow, 1/27)