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Increasingly, hospitals have chosen to keep some patients ... under observation — rather than formally admitting them — for days on end. Administrators hope to avoid the heightened attention that inpatient admissions can bring from private auditors hired by Medicare to root out what they consider excessive spending. Patients can become pawns in this game that pits providers against payers. For reasons that only a bureaucrat could attempt to justify, hours spent under observation don’t count toward the three days of care needed to trigger Medicare coverage for post-hospitalization nursing home care. (8/15)

Hillary Clinton admits she’s running to extend the Obama legacy, and so far she’s had a free ride in defending it. She hasn’t even had to explain the increasingly obvious failures of ObamaCare to deliver the affordable insurance that Democrats promised. The Affordable Care Act is now rolling into its fourth year, and even liberals are starting to concede that the insurance exchanges are in distress and Congress may have to reopen the law. Premiums are high and soaring; insurers have booked multimillion-dollar losses and are terminating plans; and the customer pool is smaller, older and less healthy than the official projections. (8/12)

There has been a lot of discussion recently about Obamacare premium increases. Donald Trump has weighed in–accusing the Obama administration of concealing big premium increases in the Affordable Care Act marketplaces and delaying them until after the election to influence the result. Here is a breakdown of how Mr. Trump’s assertion cannot be true: Mr. Trump said on Aug. 10: “The big increase is now going to come on November 1. And they’re trying to delay it until after the election, because it is catastrophic. It is going to be an increase like never before. ...." ACA premium increases have become a topic on the campaign trail–and voters should know that there is no way the administration can delay the ACA marketplace premium increases until after the election. Consider, first, that we already have a good sense of what the 2017 premium increases will be. Proposed rates have been submitted; the Kaiser Family Foundation and others have analyzed them. (Drew Altman, 8/14)

Montana can use expanded Medicaid to help reduce costs and crowding in our jails and prisons. States that expanded Medicaid sooner than Montana have reported significant annual cost savings by getting inmates enrolled. (8/14)

Some insurers have asked state departments of insurance — which have to approve any increase in premiums — for reasonable adjustments. But headline-grabbing 60 percent-or-more requests are certainly compelling evidence that the exchanges are not working. For example, in Tennessee, BlueCross BlueShield asked for an average premium increase of 62 percent. That’s one of the largest increases in the country. Tennessee’s other exchange carriers — Humana and Cigna — originally asked for less than half of that, but recently said they may refile with higher rates. (Alex Tolbert, 8/14)

It's been a little over a year since Ascension, the nation's largest Catholic healthcare system, announced it would join a handful of large corporations in raising its minimum wage to $11 an hour. As we plow through this summer of our political discontent, it's worth revisiting the issue of stagnant wages, since I believe it is stoking much of the anger propelling the candidacy of a man clearly unqualified to be president of the United States. (Merrill Goozner, 8/13)

If you’ve ever wondered whether Congress really deserves its approval rating, which just barely rises into the double digits, witness lawmakers’ reaction to the Zika virus. Although the virus ordinarily is relatively harmless, if a pregnant woman is infected, it can cause microcephaly in her fetus, a serious birth defect resulting in an abnormally small head and stunted brain development. ... Obama called on Congress to put politics aside and do its job. Democratic senators sent a letter to Senate Majority Leader Mitch McConnell and Ryan, urging them to bring Congress back from its long, ongoing vacation to vote for emergency funding. But they show no sign of backing down on the current bill’s partisan provisions. This is not how Congress is supposed to work, especially in the face of a national health crisis. (8/13)

Now is not the time to panic over the Zika virus. In fact, that time might never come.But there is a real risk to Americans, and it is time that everyone — especially lawmakers in Washington — start taking that risk seriously. Right now, there is so much we don’t know about the virus. It could come to a mosquito near you, or it could burn out of the population in a few years and thus become an afterthought. (Richard, Kuhn, 8/12)

Dr. Esper Kallas shared a prediction about Zika with me earlier this year. And I could have made big bucks betting that unfortunately he’d be right. Kallas, a leading Brazilian medical researcher at the University of São Paulo, told me back in January he expected Zika — the tropical mosquito-borne disease that has marauded through Brazil and South America — would soon be locally transmitted in the continental U.S. (Tim Padgett, 8/14)

Dear U.S. Sen. Claire McCaskill and Kansas City Mayor Sly James: Please help. Recently I was visiting at Research Psychiatric Hospital in Kansas City. Here are some things I need you to know: A young woman walked in with two young girls trailing. She was trying to be admitted. And she didn’t have anyone to support her. I wondered what would happen to her children as she filled out the assessment papers. (Melvina Young, 8/14)

My aunt’s journey toward “death with dignity” began last November. The first symptom was difficulty swallowing after a severe cold — nagging, but not too serious. By December, she was complaining that she couldn’t move her left arm and shoulder. And she was tired, tremendously fatigued. Finally in March, after a battery of tests, the doctor gave her a fatal, hopeless diagnosis — ALS, amyotrophic lateral sclerosis, also known as Lou Gehrig’s disease. My aunt would not get better; instead, each day would be worse than the one before, until eventually she suffocated or slowly starved to death as the muscles in her throat collapsed. (Linda Van Zandt, 8/14)

People in Texas were stunned by the murder of 18-year-old Haruka Weiser in April as she was walking back to her dorm at the University of Texas at Austin. Perhaps even more stunning is the suspect in the case: Meechaiel Criner, a 17-year-old runaway from a foster placement in Killeen. ... This is not an Austin problem. It could easily happen here. Bexar County faces its own crisis in caring for those with severe mental illness. The great danger is that these types of situations will become the “new normal” — whether they are individual tragedies or mass casualties like Sandy Hook — and the toll of untreated mental illness will grow even greater. (Steven R. Pliska, Bruce Adams, Sally E. Taylor and Dawn Velligan, 8/13)

If our neighbors east of the Sabine are looking healthier these days, there's a reason. Since changing governors in January, more than 265,000 Louisianans without health insurance now can visit a doctor for checkups, schedule long-delayed screenings, make a dental appointment and guarantee their kids are getting the preventive care they need to thrive. That's because the new governor, John Bel Edwards, signed an executive order on his second day in office that made Louisiana the 31st state to expand Medicaid health insurance. ... Sixty percent of Texans support expansion, according to a recent survey, but Republicans apparently know better. They contend that the federal government will someday renege and the states will be left with the bill. There's no reason to think such a thing. (8/14)

E-cigarettes do not contain tobacco. They contain nicotine, a chemical derived from tobacco and other plants. Plain English was never a deterrent, though, to regulators on an empire-expanding mission. The Food and Drug Administration this week rolled out new regulations on e-cigarettes based on a 2009 law giving the agency power over products that “contain tobacco.” That law, we’re duty-bound to add, was practically written by Philip Morris (now called Altria). (Holman W. Jenkins, 8/13)