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A new report from consultancy Avalere says the exchanges are struggling to sign up the middle class. People with incomes close to the poverty line and who can buy exchange policies for just a few dollars a month are eagerly snapping up the product. More than three-quarters of the eligible folks making less than 150 percent of the federal poverty line have enrolled. But as you get north of 150 percent of the poverty line, the numbers start rapidly declining .... What does that tell us? People don't seem to want exchange policies unless there's a substantial subsidy. Which means that at higher income levels, there could be substantial adverse selection. However, I think it's a little early yet to worry. (Megan McArdle, 4/2)

The “doc fix” bill that passed the House last week on a 392-37 vote is a piece of cheese that could smell really, really bad by the time the Senate comes back from its spring break to consider the measure. ... The bill could become a powerful enabler to drastically change, if not end, the traditional fee-for-service model of Medicare. That’s because the law would create—get ready for two more healthcare acronyms—MIPS and APM. MIPS stands for the Merit-Based Incentive Payment System, which would reward or penalize doctors based on patient health outcomes compared with performance thresholds. APM is short for Alternative Payment Model programs, which provide different rates and incentives for doctor payments. These programs could trigger big changes in how Medicare works and in how doctors perform medicine. (Philip Moeller, 4/1)

Mark Cuban is a billionaire entrepreneur. He’s a star of the “Shark Tank” reality TV show. He’s the savvy owner of an NBA basketball team, the Dallas Mavericks. He’s even invested in four health care companies. But Mark Cuban doesn’t understand health care. That’s the obvious conclusion after Cuban issued a string of lunkheaded tweets on Wednesday — encouraging his 2.8 million Twitter followers to get their blood tested every quarter — that only got worse when Charles Ornstein, a ProPublica reporter, gently challenged him. (Dan Diamond, 4/2)

The most damning portion of the indictment chronicles Mr. Menendez’s advocacy on behalf of Dr. Melgen when federal officials, in 2009, found that he had overbilled Medicare by nearly $9 million. “We have a bit of a situation with Senator Menendez, who is advocating on behalf of a physician friend of his in Florida,” an official at the Department of Health and Human Services warned a colleague who was designated to take the senator’s call. Senate staff members routinely work on behalf of constituents, but there appears to be no reasonable explanation for the hours of work they put into a billing dispute on behalf of a doctor from another state. Mr. Menendez took the matter up directly with the secretary of health and human services during a meeting in August 2012. Two months later, Dr. Melgen donated $300,000 to a political action committee that was working to get Mr. Menendez re-elected. (4/2)

Menendez's interventions on behalf of Dr. Saloman Melgen with both the Department of Health and Human Services over Medicaid reimbursements and with the State Department with regard to a port security firm in the Dominican Republic owned by Melgen, might not have piqued the curiosity of the Justice Department had the doctor been a resident of the state of New Jersey. The gifts Menendez received in the form of vacations and contributions to his legal defense fund and political causes, could get him into trouble if it turns out that they constituted a quid pro quo arrangement. If the Justice Department can establish that fact, Menendez is a goner and might face expulsion from the Senate and worse. (Ross K. Baker, 4/2)

Among the sophisticates it’s fashionable to despair over American progress against cancer, but the reality is that every year medicine makes steady and durable gains. On Monday the National Cancer Institute and other researchers published new findings on cancer’s incidence and death rate in the U.S. over the last decade that show better outcomes and longer lives. (4/2)

[T]there is a potential vehicle for a new Supreme Court examination of informed consent: a recent decision by the U.S. Court of Appeals for the Fourth Circuit that conflicts with other appellate court decisions. The Fourth Circuit struck down a North Carolina statute, called the Display of Real-Time View Requirement, that required physicians to “perform an obstetric real-time view of the unborn child” that the patient could see; to simultaneously explain the display ... and to offer the patient “the opportunity to hear the fetal heart tone.” ... Laws prescribing exactly what physicians must say, regardless of patients' needs or preferences, make a mockery of informed consent and patient autonomy. Laws that compel physicians to speak for the state devalue physicians' professional judgment and responsibility to act in patients' best interests. (Wendy K. Mariner and George J. Annas, 4/2)

Health care consumers won a significant victory when Massachusetts Suffolk County Superior Court Judge Janet Sanders blocked a settlement that would have allowed Partners HealthCare, the system that dominates the Boston area, to acquire three additional health care providers in eastern Massachusetts. Sanders concluded that the acquisitions “would cement Partners' already strong position in the health care market and give it the ability, because of this market muscle, to exact higher prices from insurers for the services its providers render.” ... But there is an even bigger reason for New Englanders to celebrate the judge's ruling. The danger lay not only in Partners' expanded dominance but also in the degree to which the settlement would have shut out other innovative competitors. (Regina E. Herzlinger, Barak D. Richman and Kevin A. Schulman, 4/2)