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Amid this year’s good news about Americans’ enhanced access to health care, there is bad news as well: A new report by the U.S. Department of Health and Human Services says that half of the doctors who are supposedly enrolled in the Medicaid program of low-income health care either aren’t accepting new patients or aren’t participating in the Medicaid plans that list them. The reasons are no secret: Doctors are paid just a fraction of the cost of their services to each Medicaid patient — sometimes even less than the cost of performing a procedure. Few doctors are willing to take a pay cut to see Medicaid patients, and enrollees struggle with limited networks and long wait times as a result. (12/22)

Last week, Vermont Governor Peter Shumlin (D.) announced that he was pulling the plug on his four-year quest to impose single-payer, government-run health care on the residents of his state. “In my judgment,” said Shumlin at a press conference, “the potential economic disruption and risks would be too great to small businesses, working families, and the state’s economy.” Your first reaction might be “well, duh.” But the key reasons for Shumlin’s reversal are important to understand. They explain why the dream of single-payer health care in the U.S. is dead for the foreseeable future—but also why Obamacare will be difficult to repeal. (Avik Roy, 12/21)

The failure of the governor's signature policy initiative undermines his stature in the Statehouse and his influence among lawmakers. Giving up on single-payer erodes Shumlin's clout among political allies who stood by him as his health care plan came under attack. Single-payer Shumlin will have to find another handle. The governor will be dogged by questions about the timing of his announcement, coming just weeks after an election in which he only managed to squeak out a slim plurality. Shumlin's failure to win more than 50 percent of the vote in November gives the Legislature the final say on who will be sworn in as governor in January. His Republican opponent, Scott Milne, is questioning Shumlin's claim to office given overall most Vermonters voted for someone other than the incumbent. (Aki Soga, 12/21)

Democrat Gov.-elect Tom Wolf's insistence on full-blown ObamaCare Medicaid expansion is misguided advocacy for an idea that wouldn't improve treatment or costs but would worsen this federal-state welfare program's existing woes and Pennsylvania's bottom line. Medicaid fraud, already costing taxpayers an estimated $60 billion a year, would only grow with Medicaid expansion in Pennsylvania. And Pennsylvanians gaining coverage would have a hard time gaining actual care. (12/20)

Home health attendants work long hours with heavy lifting and save the public a great deal of money by enabling elderly and disabled people to remain at home instead of moving to institutional settings. In Missouri, aides who are paid with state Medicaid dollars have been doing this work for an average of $8.60 an hour. That’s a pathetic wage. Many of the aides are the sole financial providers for their families. They are devoted to their clients and work long hours, making it unfeasible to take a second job. (12/19)

[President Barack Obama] ends 2014 in surprisingly buoyant spirits, having proved that he still has the power to push policy in new directions in foreign affairs and on issues ranging from immigration to climate change. ... The federal health-care Web site, whose crash was an enormous political and practical problem for Obama and his party in 2013, is working smoothly. The fact that so many Americans are interested in obtaining health insurance under the Affordable Care Act, his aides argue, is a vindication of the effort Obama put in to passing it. (E.J. Dionne Jr., 12/21)

The National Children's Study was launched with a fanfare of expectation and ambition in 2000. The idea was to follow 100,000 American children from the pre-natal stage to age 21, collecting an unprecedented volume of data on "environmental influences (including physical, chemical, biological, and psychosocial) on children’s health and development," in the words of the enabling federal legislation, the Children's Health Act. As Science Magazine reported, it was the largest and most complex longitudinal study of its kind ever planned in the United States. Today, after 14 years and the allocation of $1.3 billion to the task, it's dead. (Michael Hiltzik, 12/19)

If 2014 should be remembered for anything in health policy, it's the year that marked a turning point in how we talk about dying. There was the Institute of Medicine report recommending an overhaul to end-of-life care, the story of the terminally ill 29-year-old Brittany Maynard choosing physician-assisted suicide, Zeke Emanuel declaring he won't try to extend his life past 75, and Atul Gawande's book "Being Mortal." You only have to think back to 2009 when the far right said a proposal to have Medicare pay doctors for holding end-of-life conversations amounted to "death panels." (Millman, 12/22)