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Most people think the ACA was successful in California because the state loved the law while it was under attack in most of the rest of the country. But there were many other more important factors, the first of which was the sheer size of California. (Micah Weinberg, 12/14)

In Kansas, there is an issue central to the success of local businesses and the growth of our state’s economy. It helps address the state’s budget crisis, brings much-needed jobs to our state, and allows us to sit in the driver’s seat – coming up with our own solutions, encouraging personal responsibility, and making sure our tax dollars are wisely spent. The issue might surprise you. It is expanding the state’s Medicaid program, KanCare. (Joe Reardon and Gary Plummer, 12/15)

This is about more than polls and election results – it’s about making a real difference in the lives of some of the most vulnerable populations in our state. Not only unborn children, but also minorities and the impoverished. Abortion impacts these communities on a devastating level. According to the latest U.S. Census and Ohio Department of Health statistics, African-Americans make up a little more than 12 percent of Ohio’s population, but of the nearly 21,000 children that lost their lives to abortion last year, more than 40 percent were African-American. And according to the Guttmacher Institute, an organization that advocates for abortion, children conceived in impoverished families are three times as likely to be aborted. (Aaron Baer, 12/14)

A new administration is coming to Washington, promising yet another health care reform. Although the debate over health policy will surely be more unpredictable with President-elect Trump than it has been with most other politicians, that does not mean it will be entirely novel. Indeed, the past half-century of health debate likely provides a good road map for what is coming. (David Cutler, 12/14)

Voters opposed to Obamacare have waited six years for the opportunity to repeal it. Since the election, Republicans have suggested that it might take as many as three more years to unwind the gears of the Affordable Care Act, especially when it comes to Medicare. The “repeal and delay” strategy to push off the heavy lifting until yet another election had passed, stirred grumblings of discontent among Republicans who had already expressed considerable disgust at the party’s inability to keep its promises on the ACA. (Edward Morrissey, 12/15)

The Zika crisis, which seems to have faded from memory since it became a big news item this summer, has roared back with a vengeance, thanks to a just-published study indicating that the virus’ effect on infants of women infected during pregnancy is much worse than previously known. The study, published in the New England Journal of Medicine, found that 42% of infants infected in the womb had serious birth defects. Previously, attention focused on an outbreak of microcephaly among infected babies, but that turns out to be merely the tip of the iceberg, appearing in 3% of the newborns. (Michael Hiltzik, 12/14)

Human illness caused by Zika virus infection has been described for several decades, but this pathogen was in a sense better classified as an infectious diseases “trivia question” before reports of larger outbreaks appeared within the last 10 years. Nonspecific symptoms of viral infection, including fever, rash, arthralgia, and conjunctivitis, have been described for Zika infection, and asymptomatic infection is fairly common. However, now that strong and accumulating evidence has implicated Zika infection during pregnancy in severe central nervous system sequelae after infection of the fetus, there has been increased urgency in acquiring a greater understanding of the pathophysiology of Zika disease, and efforts to control the spread of this virus have escalated. (William J. Muller and Emily S. Miller, 12/15)

Surgical residency is notoriously arduous and the longer hours compared with other specialties can take a toll on some residents. That’s why it’s important for mentors to keep a watchful eye on resident mentees. Those who are thinking about leaving may be too overwhelmed to see how their talents have great value. As educators and clinicians, we have a responsibility to cultivate—not waste—this valuable potential. (Julie A. Freischlag and Michelle M. Silva, 12/14)

As Jane’s 7-year-old daughter, Kelsey, lay in the intensive care unit, shaking from seizures, Jane needed people to listen to her and trust her. Jane — not a textbook — knew which of the five different seizure medicines worked best for Kelsey, and which had little effect. But the doctors weren’t paying much attention to “just a mom.” With help from her patient navigator, Jane convinced the doctors to stop treating Kelsey like a seizure disorder and start treating her like Kelsey. Navigators guide patients and their families as they move through the health care system. While interactions with navigators have traditionally happened outside of hospitals, particularly for cancer patients, their services are also needed for people in the hospital and their families. (Kelly Michelson, 12/14)

The risks of participating in a clinical trial cannot be predicted with certainty at the time of trial design, especially when evaluating novel therapies. Accordingly, once the trial is initiated, periodic and ongoing review of accumulating study data is necessary to ensure the continued appropriateness of enrolling and treating patients in the trial. This oversight activity is often conducted by a data monitoring committee (DMC), also known as a data and safety monitoring board, generally composed of scientific, medical, statistical, and other experts. Ideally, this oversight process ensures that a clinical trial is stopped if the benefit-risk balance for participants or the expected value to society no longer justifies continuing. (Roger J. Lewis, Karim A. Calis and David L. DeMets, 12/13)

Columbus’ decision to curtail its “Cadillac” emergency-medical-response system, by sending only one highly trained paramedic on basic runs along with an emergency medical technician, is a pragmatic one. It is the result of economic reality, a fast-growing city and a review of data. But this change is also a stop-gap solution for a fire division whose staffing is stretched too thin: City leaders seem to have a spare $5 million to help the Cleveland Browns build a practice camp in what could be the city’s fanciest recreation center, but they can’t seem to scrape together the dollars to add firefighters to meet a surging demand for service. (12/15)