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The ACA's successes seem to get lost in the shuffle for two reasons. First, because health care reform has become so politicized, particularly in Washington where Republicans in Congress have voted to repeal the law something on the order of 60 times. Terrorists don't suffer that many negative votes on Capitol Hill. But second, because an obvious problem has arisen that's received a disproportionate share of attention — the manner in which the individual market is out of whack, with rising premiums and insurers dropping out of exchanges. (9/18)

It has been a summer of bad news for the Affordable Care Act, but last week brought some numbers that should put worries about the law into perspective. The Census Bureau announced Tuesday that the proportion of people in the United States who lack health-care coverage continued to plunge last year — to only 9.1 percent. This figure is even better than it looks for Obamacare, because it factors in uninsured undocumented immigrants, of which there are perhaps several million, who are not eligible for the law’s programs. But the overall number could be cut much lower, and quickly, if Obamacare were working as it was meant to. (9/17)

While the political world focuses on the Affordable Care Act, changes have been occurring for the many more Americans who get health insurance through work. The biggest change: rising deductibles, which are transforming the nature of health insurance from more comprehensive coverage to skimpier insurance with higher out-of-pocket costs. This change has happened gradually and has not been the subject of a big legislative debate, as the Affordable Care Act was. The shift is not a result of Obamacare; the trend began well before the ACA was passed in 2010. The trend is not highly politicized or covered daily by the general news media. All of which contribute to making the changing nature of insurance the most important development in the U.S. health system the public is not debating. (Drew Altman, 9/18)

The Affordable Care Act has helped 20 million people gain health insurance, but it explicitly excludes one group: undocumented immigrants. Now, lawmakers in California want to help change that by letting all immigrants purchase policies on the state’s insurance marketplace without federal subsidies. This is a good idea that the Obama administration should support. The act bars undocumented immigrants from purchasing policies on the federal and state health insurance marketplaces with or without tax subsidies. California officials say they will seek a waiver from the federal government under a provision of the law that allows states to experiment with different approaches. (9/17)

Medicare's new payment system for physicians is causing anxiety because of the short stretch of road before their performance is judged for a raise or pay cut. In the long-term, though, Medicare and most everyone else want providers to leave that new system behind. It's value-based training wheels. (Gregg Blesch, 9/17)

Breast cancer surgeon Dr. Laura Esserman of San Francisco sings to her patients as they go under anesthesia. She tackles any song request, whether it's a top 40 hit or a Broadway ballad. This same patient-centric attitude drove Dr. Esserman to participate in adaptive clinical trials, a game-changing way to test new medications. It's past time that other researchers think beyond traditional clinical trials. (Peter J. Pitts, 9/18)

As the fiscal year nears its end on Sept. 30, the next Zika showdown will now be linked to the debate about the 2017 federal budget. This means that the overarching U.S. response to Zika may not be based on the best approach to stop the spread of the disease, but on compromise on other issues like reallocation of leftover Ebola money, politics around Planned Parenthood and, now, size of the federal funding package. (Rutschman, 9/18)

Amid the hue and cry over Gov. Matt Bevin’s proposed Medicaid revamp, an important point has been missing: It would not save very much money. Like his predecessors, Bevin is right to worry about the increasing drain that Medicaid, the health-care plan for low-income and disabled people, puts on the $11 billion General Fund, siphoning money that’s needed for education, infrastructure and other needs. ... But the modest savings from his rollback of coverage would come at a high price. To save the average $66.3 million a year projected by Bevin’s plan, Kentucky would have to forfeit $380 million a year in matching federal funds for health care, a poor tradeoff in a state that suffers a surplus of sick people and a shortage of primary care. (9/18)

The Ohio Department of Medicaid is asking the federal government for permission to change Ohio's Medicaid program in ways that will make it far less effective. Medicaid provides health care to those who cannot afford health insurance. It is our largest insurer, covering a quarter of Ohioans. (Wendy Patton, 9/18)

BlueCross BlueShield of Tennessee has been granted a 62 percent increase, while Cigna and Humana have been approved for increases of 46 percent and 44.3 percent, respectively. The 62 percent rate increase is one of the largest in the country, and the rates requested by Cigna and Humana are notable as well. But does this mean Tennessee will have the most expensive premiums? Not necessarily. (Alex Tolbert, 9/18)

Six years ago California voters were asked to make recreational marijuana legal under state law and they declined to do so. But the close decision — 46% voted “yes” on Proposition 19 — suggested that the battle was not yet over. At that time, The Times opposed Proposition 19 not because legalization was necessarily a bad idea, but because it was a poorly drafted mess that would have created a regulatory nightmare. In the years since, a lot has changed. (9/16)

Your dentist has probably offered dental sealants for your child. Mine has. Without knowing whether they work, I’ve always accepted them. Turns out, this was a good move. Introduced in the 1960s, dental sealants are plastic coatings applied to the surfaces of teeth. They fill in and seal pits and grooves of teeth, making them more resistant to bacteria that can cause cavities. Because molars are more cavity-prone, sealants are usually applied there. Dental sealants are most often recommended when children’s first, permanent molars come in — between ages 5 and 7 — and again when their “12-year molars” arrive — usually between ages 11 and 14. Dentists may also offer sealants for older children and for adults prone to cavities. (Austin Frakt, 9/19)

The tobacco industry might have retreated in the fight to keep Americans smoking, but the battle to ensure people stay addicted to nicotine still rages. St. Louis County has made the right call to give younger residents at least a fighting chance against a predatory industry that wants nothing more than to keep teens and young adults hooked for life. The County Council voted this month to raise the minimum legal purchasing age to 21 for tobacco and e-cigarette products. Critics suggest this is an ineffective and unnecessary effort to restrict personal freedoms. We see it as a way to delay dangerous behaviors and help young people avoid lifetimes of addiction. (9/18)

In 1914, The Lancet reported on a clergyman who was found dead in a pool; he had left behind this suicide note: “Another sleepless night, no real sleep for weeks. Oh, my poor brain, I cannot bear the lengthy, dark hours of the night.” I came across that passage with a shock of recognition. Many people think that the worst part of insomnia is the daytime grogginess. But like that pastor, I suffered most in the dark hours after midnight, when my desire for sleep, my raging thirst for it, would drive me into temporary insanity. On the worst nights, my mind would turn into a mad dog that snapped and gnawed itself. (Pagan Kennedy, 9/17)