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Compared to last year, Obamacare's 2015 open enrollment is a boring story -- no spectacular IT failures, no politically charged policy cancellations. And as Obamacare wends to the end of its second open-enrollment period, it would seem that we should know more about the shape of the final program. What have we learned so far? The answer is "less than you'd think." (Megan McArdle, 1/21)

Sometimes, you just have to stand in awe of the chutzpah. In the Republican rebuttal to Barack Obama's State of the Union address last night, Joni Ernst said: “We'll also keep fighting to repeal and replace a health-care law that's hurt so many hard-working families” .... "Keep fighting” to “replace”? Let’s review some evidence, please. (Jonathan Bernstein, 1/21)

Abortion got barely a mention in last year’s campaign, which led to unified Republican control of Congress. Voters in exit polls said their top priorities were the economy (45 percent), health care (25 percent), immigration (14 percent) and foreign policy (13 percent) — not surprising, given that these are the issues Republicans talked about. A Gallup poll after the election found that fewer than 0.5 percent of Americans think abortion should be the top issue, placing it behind at least 33 other issues. But instead of doing what voters wanted, House Republicans set out to make one of their first orders of business a revival of the culture wars. (Dana Milbank, 1/21)

Many people — including some who are pro-choice — would no doubt be troubled to learn that legal abortions were causing pain to fetuses, if it were true. If it were true, it might even present a challenge in the minds of some to the Supreme Court's determination that the viability of the fetus is the proper place to draw the line between a woman's right to control her body and the state's interest in protecting life. But apparently it is not true. The science that undergirds the so-called Pain-Capable Unborn Child Protection Act has proved unpersuasive to most medical experts. That's why this bill deserves to fail. (1/21)

Today, I join tens of thousands of fellow pro-lifers at the 41st annual March for Life in Washington, D.C. Before the march, I will open the National Memorial for the Pre-Born at Constitution Hall by making an unconventional plea. For nearly three decades, I have dedicated much of my ministry to the pro-life cause. I have advocated, demonstrated, raised money, lobbied, sued, been sued and done jail time pursuing my passion for the sanctity of nascent human life. But increasingly, I've come to realize our critics are right in saying pro-lifers champion the yet-to-be born while we often ignore the suffering of those already born. (Rob Schenck, 1/21)

But the president’s proposals do invite a case for a comprehensive tax and entitlement reform, one based not on redistribution but on growth, work and opportunity. ... Piling up child tax credits and subsidies for health care over narrow household income ranges, as the president proposes, leads to high rates of taxation on earnings from work as assistance is phased out. Likewise, raising marginal tax rates on investment by the well-to-do reduces asset prices and is a threat to continued economic expansion. So how can we enhance growth, work and opportunity? Four steps can help get us there. (Glenn Hubbard, 1/21)

In rolling out the issues he hopes will define the final two years of his administration, President Obama has proposed two workplace initiatives: requiring companies with 15 or more employees to provide them seven days of sick leave per year to their full time workers, and encouraging states to establish paid family leave programs for new parents or workers tending to family members with significant health issues. As with most such proposals, the devil will be in the details, but we believe the president is on the right track. In fact, California got there first. Under the state's Healthy Workplaces, Healthy Families Act of 2014, as of July 1 employees who work at least 30 days in a calendar year must be offered one hour of sick pay — up to 24 hours total — for every 30 hours worked. (1/21)

America’s welfare state transfers more than 14 percent of gross domestic product to recipients, with more than a third of Americans taking “need-based” payments. ... This is not primarily because of Social Security and Medicare transfers to an aging population. Rather, the growth is overwhelmingly in means-tested entitlements. More than twice as many households receive “anti-poverty” benefits than receive Social Security or Medicare. (George F. Willl, 1/21)

The fact that the SSDI trust fund is running dry is no surprise. Congress historically has authorized “reallocation” of dollars from the Social Security trust fund (which has enough money to last through 2034) to cover SSDI. Now, Republicans have made that once-routine maneuver — it has been done 11 times before — much more difficult, passing a rule stating that any reallocation must be accompanied by policies that improve the financial footing of Social Security. (Rourke L. O'Brien, 1/21)

So how is Gov. Scott Walker's health care plan for low-income Wisconsinites going? Not great. You will recall that Walker and the Legislature decided to extend BadgerCare coverage for everyone living in poverty .... They also decided not to accept federal funds for Medicaid expansion made available by the health care reform law known as Obamacare, and to cancel BadgerCare coverage for those just above the poverty line .... Medicaid costs have skyrocketed. The state Department of Health Services has requested an additional $760 million just to maintain current coverage. The state could decide to accept federal Medicaid funds any time it wants. But given the political world that we live in when it comes to all things Obamacare, we are not likely to see a full turnabout. (Robert Mentzer, 1/20)

During our time together in the Maryland House of Delegates, we worked persistently to address the need for accessible services and adequate funding for the one in five Marylanders who need treatment for mental health and substance use disorders. That's why we were disappointed to see long-overdue funding for behavioral health slashed by the Board of Public Works earlier this month as its members seek to close a state budget gap. (James W. Hubbard and Joseline Pena-Melnyk, 1/21)

Clinicians prescribing antidepressant medication to elderly and disabled Medicare patients have a wide array of choices because antidepressants are among the 6 protected classes of medications in Medicare Part D. ... In a draft rule in January 2014, the CMS proposed to lift the protected status of antidepressants, together with antipsychotics and immunosuppressant drugs, to give plans greater negotiating power. The proposal met with strong opposition from patient advocates, drug manufacturers, and lawmakers. Opposition was so strong that, 2 months later, the CMS rescinded the proposal. Absent from the debate over Part D formulary coverage of antidepressants, however, was an analysis of current prescribing practices for Medicare patients. (Yuhua Bao, Yan Tang and Julie Donohue, 1/21)

During the past decades, intensivists have learned how to care for critically ill patients and enable many to survive illnesses that previously would have been fatal. For example, the mortality rates associated with acute respiratory distress syndrome (ARDS) and with sepsis have both declined markedly during this interval. Improved short-term survival has resulted not only from better understanding of individual diseases but also (and perhaps more importantly) from optimizing intensive care unit (ICU) organization, standardizing best practices, and improving processes of care delivery. Even though this decline in short-term mortality is a major achievement, it has spawned new challenges. (Drs. John J. Marini, Jean-Louis Vincent and Djillali Annane, 1/20)

One of the most notable changes in the delivery of medical care in the United States in the past quarter-century has been the near disappearance of primary care physicians (PCPs) from general medical inpatient care, replaced by a new breed of generalist: the hospitalist. ... Hospitalist care is more efficient than traditional models of inpatient care and, on average, appears to be of similar quality. Good communication among hospitalist team members and between hospitalists and PCPs can lead to seamless, efficient, well-coordinated care; however, shift-work schedules and suboptimal communication and pass-offs can result in fragmented, impersonal care and excessive testing. ... These shortcomings suggest that the current dichotomous division of labor between hospitalists and PCPs warrants reconsideration, though any alternative approach needs to respect the achievements of the current system. (Drs. Allan H. Goroll and Daniel P. Hunt, 1/22)