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So maybe progress on health care is possible after all: Congress is close to repealing a two-decade budget cheat and reforming the entitlement state for the first time in the Obama Presidency. Miracles happen, though some members of both parties are trying to derail this one. An emerging deal would permanently void the formula that automatically reduces Medicare’s price controls on physicians, known as the sustainable growth rate, or SGR. These spending caps were introduced by Bill Clinton and Newt Gingrich in 1997 to supposedly contain entitlement costs, and reimbursement is scheduled to fall 18% in April. (3/15)

Spring is almost here: time for the annual Washington ritual known as the “doc fix.” ... The path of least resistance would be the well-trod one, passing yet another short-term patch. Yet there is increasing, bipartisan discussion of, at long last, a permanent solution. ... The big question is whether lawmakers would pay for such a plan through offsetting spending reductions or revenue increases, as they have paid for all previous short-term doc fixes. (3/13)

After a massive recession and years of partisan gridlock depleted their ranks, lobbyists are returning to Capitol Hill. The prospect of changes in health-care law -- something many deemed unlikely -- may be one reason. In the past four months, almost one in five new lobbying registrations listed "health issues" as a legislative interest. If the Supreme Court rules in June against Obamacare subsidies for millions of recipients, it could bring the health care debate roaring back by summer. (Jeanne Cummings, 3/13)

Residents in Florida and Texas stand to be the big losers if the court overturns subsidies in federal-exchange states. An estimated 1.5 million Floridians receive the subsidies, which reduce their average monthly premiums from $376 to $82; for a total flowing into the state of $5.2 billion a year. In Texas, more than 1 million residents get help, which reduces their average premiums from $328 to $89, or a total of nearly $3 billion a year. This is money that residents of those states could use for many other purposes, while still enjoying the benefits of health insurance. When you see figures like that, you have to ask of [Sen. Marco] Rubio, [Sen. John] Cornyn and [Sen. Ted] Cruz: Who in the world do you think you represent? (Michael Hiltzik, 3/13)

A number of states that had previously refused to expand their Medicaid programs for the poor are reconsidering that policy. They would be smart to embrace expansion as soon as possible to cover millions of people who would be left uninsured if the Supreme Court wipes out federal subsidies for low-income people buying insurance on the federal health exchanges. (3/16)

There is nothing like a budget crisis to remind some members of the Florida Legislature that, unlike wine, problems don’t get better with time. Tallahassee is poised to lose anywhere from $1 billion to $2 billion in federal funds for not expanding Medicaid, possibly crippling public hospitals statewide. ... There is some good news. Last Tuesday, the Senate Health Policy Committee moved ahead with a novel Medicaid-expansion program that provides vouchers to consumers to purchase health insurance. The plan mirrors one recently approved in Indiana under the leadership of Gov. Mike Pence who also opposed ACA. Under Florida’s Senate plan, Medicaid is expanded ,and the beneficiaries would pay $3 to $25 a month, depending upon income. (Helen Aguirre Ferré, 3/14)

My neighbor, a man in his 70’s, had mild epigastric (abdominal) pain. He was treated for ulcer disease, and when the pain did not disappear, he went to visit his cardiologist. The patient had several risk factors for heart disease, including high blood pressure, high cholesterol and diabetes. The cardiologist was a conservative physician, and he suggested that instead of doing a coronary angiogram or a nuclear stress test, which are the tests usually ordered in this situation, the patient should have a CT angiogram. The CT angiogram required approval by Medicare before it would agree to pay. The cardiologist waited for several days after submitting his request and then received a denial. Payment for the procedure was again denied. Needless to add, the cardiologist received no reimbursement for his time and effort in advocating for the patient. (Dr. Paula L. Stillman, 3/13)

Currently, only Oregon, Washington, Vermont, New Mexico and Montana allow health care providers, under strict guidelines, to hasten the death of terminally ill patients who wish to spare themselves and their loved ones from the final, crippling stages of deteriorating health. Lawmakers in 15 other states and the District of Columbia have introduced so-called aid in dying bills in recent months to make such a humane option available to millions of Americans at a time when the nation’s population of older adults is growing. (3/14)

Is Prime Healthcare bluffing? That's always been the big question about the company's promises to maintain medical services at the six California Catholic medical institutions it proposed to take over in an $843-million deal. Last month, state Atty. Gen. Kamala Harris forced Prime to show its cards. In approving the sale to Prime of five hospitals and a skilled nursing facility owned by the financially strapped Daughters of Charity chain, she etched some of those promises into stone — for at least 10 years. Now that Prime has exited from the deal with a snarl, we have a definitive answer. Yes, Prime was bluffing. (Michael Hiltzik, 3/13)

The financial crisis faced by the Daughters of Charity Health System appeared to be solved last year when Prime Healthcare Services of Ontario agreed to buy the chain and keep its six hospitals, including St. Francis Medical Center of Lynwood, open for at least five years. On Tuesday, however, Prime backed out of the deal, saying state Atty. Gen. Kamala D. Harris had gone too far in requiring a 10-year commitment to maintain most of the hospitals and their services. Now, everyone involved needs to focus on one thing: keeping the hospitals, and particularly the trauma centers that four of them operate, open for the long term. (3/13)

The Food and Drug Administration seems determined to show it is impervious to reform, even if it means dying on the smallest of hills. Now the bureaucracy is defying Congress and the White House by refusing to approve the modern sunscreens that everyone else in the world is allowed to use. Sunscreen’s active ingredients are regulated by the FDA like new medicines, albeit with even less moral urgency than usual. In this case the problem is skin cancer, most types of which are preventable. But their incidence is rising rapidly in the U.S. even as other cancer rates fall, and part of the explanation is the FDA’s unfathomable, dozen-year blockade of better sunblocks. (3/13)

It is estimated that 100,000 children each year are trafficked for sex in the United States. Lax laws and modern technology enable the predators, while their young victims often are treated like criminals instead of getting the help they need. Congress last week seemed poised to do something about this. Then politics intervened. This week the question will be whether senators can put the interests of scared, abused children ahead of the chance to score political points. (3/15)