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A legislative push in Montana to extend Obamacare health coverage to the working poor advanced on Thursday after a last-minute reprieve thanks to a procedural play by supporters, even as similar efforts in other conservative states are flagging. Some half dozen holdout states have been considering whether to join 28 states and the District of Columbia in accepting billions of federal dollars to expand Medicaid under the Affordable Care Act, President Barack Obama's program to provide healthcare to most Americans. (Stein, 4/9)

Calling it necessary to keep rural hospitals open, 13 Republicans joined House Democrats to push Medicaid Expansion through the House on Thursday. Sen. Ed Buttrey's Senate Bill 405, the HELP Act, expects to expand Medicaid coverage to an expected 45,000 people. (Inbody, 4/9)

After a hard-fought battle to get the last-standing bill to expand the Medicaid program to the floor, the Montana House of Representatives gave it an initial green light on Thursday. The House voted 54-46 to endorse the amended measure on a second reading with support from 13 Republicans and all 41 Democrats after it was sent to the floor Wednesday. (Baumann, 4/10)

One day after a lengthy floor battle to free a Medicaid expansion bill from committee, the Montana House on Thursday endorsed the measure, voting 54-46 to accept millions of federal dollars to extend subsidized health coverage to thousands of low-income Montanans. ... Thirteen Republicans and all 41 House Democrats supported the measure Thursday, setting up a final House vote later this week. If the state Senate accepts the one amendment attached Thursday by the House – a likely prospect – the bill goes to Democratic Gov. Steve Bullock for his signature. Bullock hasn’t said whether he’d sign the measure, but his top health care adviser has testified twice in favor of SB405 in hearings before legislative committees this session. (Dennison, 4/9)

Hard-line conservatives made multiple attempts to amend or kill the bill when it hit the Republican-controlled House floor Thursday, but a coalition of 13 Republicans and all 41 Democrats agreed to end debate swiftly and vote. The bill picked up two more Republican supporters in the House than it had on Wednesday. The bill previously passed the state Senate with seven Republican votes. It faces one more vote Friday, but opponents now appear outnumbered. Gov. Steve Bullock is expected to sign it. (Whitney, 4/10)

Senate Bill 405, which would expand Medicaid to cover thousands of low-income adults in Montana, is a complex, multifaceted bill. Here’s a summary of its main elements. (4/9)

Ohio Gov. John Kasich said Thursday that he's hopeful state lawmakers will approve money to support an expansion of Medicaid after fellow Republicans jettisoned the idea from his last budget. The governor's $72.3 billion, two-year spending blueprint sets aside funds to help cover the more than 500,000 low-income Ohioans who enrolled in the expanded federal-state health program. (Sanner, 4/9)

Gov. John Kasich on Thursday voiced optimism that Ohio’s year-old expansion of Medicaid under the federal health-care law will continue without again having to resort to a budgetary panel to sidestep lawmakers to draw down the funds. The governor’s $72 billion, two-year budget currently in the Ohio House anticipates continuing the coverage expansion largely to working adults even as some lawmakers don’t expect it to make the final plan that reaches his desk by June 30. “I would not anticipate [using the Ohio] Controlling Board,” Mr. Kasich said during a news conference. (Provance, 4/10)

Cell phone users, widows and widowers, college students and small businesses are the latest pawns in a showdown over Medicaid expansion in Florida. On Thursday, the Florida House is expected to overwhelmingly pass a $690 million tax cut package that could save those groups money, but only if the Senate signs off on the plan. Senate leaders say that won’t happen as long as negotiations remain stalled between the state and federal government over a $2.2 billion program that helps hospitals treat low income patients. In a compromise with the federal government, the Senate is proposing to restore those funds by expanding Medicaid, which House Republicans oppose. (Van Sickler, 4/9)

As a legislative session focused on the Kansas budget problems winds to a close with no decision on Medicaid expansion, a new study says some states that have expanded eligibility have seen their budget situations improve. The State Health Reform Assistance Network, a partnership of the Robert Wood Johnson Foundation and Princeton University, studied the effects of Medicaid expansion on budgets in eight states. (Marso, 4/9)

The uncertainty over King v. Burwell is prompting a handful of states to allow health insurers to submit two sets of proposed 2016 premium rates — one for each Supreme Court scenario. If the Supreme Court in late June rules against the Obama administration and halts subsidies in 34 states, the cost of insurance is expected to increase significantly because mostly the sickest people would keep their coverage. The potential for such a sudden change makes it complicated for insurers to plan their rates for 2016 — a process that is beginning now. (Pradhan, 4/9)

Tens of thousands of people in Missouri and Kansas could see their health insurance premiums double or even triple if the Supreme Court declares that the tax credits they receive through Obamacare are illegal. Such a ruling could send both states’ insurance markets into a “death spiral,” a nightmarish scenario that means skyrocketing premiums and a financial crisis for hospitals, health policy experts say. (Wise, 4/9)

Hundreds of consumers trying to buy health insurance through the Massachusetts Health Connector continue to encounter snags, even as new leadership works to fix a balky system. (Freyer, 4/10)

Despite its rocky launch, the federal health insurance exchange did better than the exchanges run by individual states at both enrolling new people in Obamacare and hanging onto previous enrollees during the 2015 open enrollment period that ended in February, according to a recent analysis. (Andrews, 4/10)

The national divide over the Affordable Care Act is beginning to affect Americans' access to medical care and perhaps even their ability to pay medical bills, a new study of the country's four largest states suggests. Residents of Florida and Texas, which have resisted expanding insurance coverage through the health law, reported more problems getting needed care than residents of California and New York, which both guarantee coverage to their residents. (Levey, 4/10)

More than 4 in 10 Texans say they’ve had trouble getting needed health care because of its cost, including more than a third of those with health insurance, according to a survey by the New York-based Commonwealth Fund. (Landers, 4/10)

The steep cost of caring for the elderly continues to climb. The median bill for a private room in a nursing home is now $91,250 a year, according to an industry survey out Thursday. The annual "Cost of Care" report from Genworth Financial tracks the staggering rise in expenses for long-term care, a growing financial burden for families, governments and insurers like Genworth. The cost of staying in a nursing home has increased 4 percent every year over the last five years, the report says. Last year, the median bill was $87,600. (Craft, 4/9)

The top House and Senate budget negotiators are returning to Washington early from congressional recess to begin to hash out a final fiscal blueprint agreement, several sources told Politico. ... But they still have to iron out some differences, including the size and scope of future domestic spending, how specific to go in wringing savings out of Medicare and how to use a powerful procedural tool that allows the Senate to pass legislation on a simple majority vote instead of the typical 60-vote threshold. (Bade and Sherman, 4/9)

A plan to eliminate Congress’s annual scramble to protect doctors from cuts to Medicare reimbursement was hailed as a triumph of bipartisanship when it sailed through the House of Representatives last month. But some Senate conservatives aren’t ready to give the bill a free pass through their chamber. (Garver, 4/9)

The Obama administration took vendors of electronic health records to task for making it costly and cumbersome to share patient information and frustrating a $30 billion push to use digital records to improve quality and cut costs. The report, by the Office of the National Coordinator for Health Information Technology, listed a litany of complaints it has received about vendors allegedly charging hefty fees to set up connections and share patient records; requiring customers to use proprietary platforms; and making it prohibitively expensive to switch systems. (Beck, 4/10)

The Food and Drug Administration has announced a new program that will bring medical devices for life-threatening conditions to the market faster by shortening the up-front review process. On April 15, the agency will launch an “Expedited Access Program” for device makers seeking to bring the products to market, particularly those for unmet medical needs. The program will rely heavily on data collected once the products are commercially available. (Gustin, 4/9)

At the National Institutes of Health’s wooded campus northwest of Washington, America’s top medical researchers work in state-of-the-art labs to find a cure for cancer, map the brain and care for patients with Ebola. If they want to leave, though, to meet with scientists around the world at scientific and medical conferences, they spend their time doing paperwork instead. (Edney, 4/9)

U.S. cardiovascular disease testing laboratories Health Diagnostics Laboratory Inc (HDL) and Singulex Inc have agreed to pay $48.5 million to settle claims they paid kickbacks and conducted unnecessary testing, the U.S. Department of Justice said on Thursday. Both U.S. companies were accused of violating the False Claims Act by paying physicians in exchange for patient referrals and billing federal healthcare programs, including Medicare, for medically unnecessary testing, according to court documents. (4/9)

Federal authorities are cracking down on cardiac biomarker laboratories that they allege paid doctors kickbacks to provide patients’ blood samples for testing. Health Diagnostic Laboratory Inc. and Singulex Inc. agreed to pay at least $47 million and $1.5 million, respectively, to settle civil allegations filed by the Justice Department that they paid doctors for patient blood and billed Medicare for medically unnecessary testing. (Carreyrou, 4/19)

Walgreens will shutter about 200 U.S. stores as part of an expanded cost reduction push, but the nation’s largest drugstore chain has no plans to shrink in the wake of its combination with European health and beauty retailer Alliance Boots. The Deerfield, Illinois, company expects to open roughly the same number of stores and will consider more mergers and acquisitions, even as it continues to digest a nearly $16 billion deal that finalized its combination with Alliance Boots, which runs the United Kingdom’s largest pharmacy chain. (Murphy, 4/9)

Unionized doctors at UC campus student health centers in Northern California plan to walk off their jobs Thursday as part of the longest labor action waged by staff physicians in 25 years. Nurses and other health professionals routinely picket and strike over bargaining issues, but it’s rare for doctors to be unionized, let alone go through with a walkout. The Northern California walkout will end Monday morning. (Colliver, 4/9)

Unionized doctors began a rolling strike Thursday at student health clinics on UC campuses, accusing the university of unfair labor practices during negotiations for the physicians’ first contract. The walkout started early Thursday morning at five Northern and Central California campuses -- Berkeley, Davis, San Francisco, Santa Cruz and Merced -- and is scheduled to last four days. (Gordon, 4/9)

A new battle over organizing home health aides has sprung up in Pennsylvania as several groups try to block an executive order issued by Democratic Gov. Tom Wolf that could make it easier for unions to target the low-wage but fast-growing group of workers. The Pennsylvania Homecare Association and United Cerebral Palsy of Pennsylvania filed a lawsuit Monday in state court arguing that the February order violates state labor law. The order creates a path for labor to organize aides hired directly by consumers. (Maher, 4/9)

Idaho County commissioners have scheduled a meeting concerning health insurance for county employees who have religious objections to the county's existing plan. The April 21 meeting will offer employees options if they have objections to the county's existing Blue Cross/Blue Shield insurance plan through Regence, which covers abortion, contraception and sterilization procedures. (4/9)

Kansas medical regulatory boards and the state Attorney General’s Office are examining whether a recent U.S. Supreme Court antitrust ruling will have any effects on the boards’ memberships. In a Feb. 25 opinion related to a North Carolina dentistry board, the Supreme Court ruled 6-3 that if a “controlling number” of a board’s members are active participants in the industry it regulates, they could be sued as antitrust law violators if they aren’t being actively supervised by the state. (Booker, 4/9)

Much has been written in the past year about the dynamic Elizabeth Holmes and Theranos, her bold quest to overhaul the $60 billion blood taking and analysis business. Holmes’ twist: requiring only one drop of blood vs. many vials for a battery of tests using Theranos’ proprietary hardware and software. The 10-year-old startup – valued at $9 billion on $400 million in raised capital – remains in quasi-stealth mode, testing its proof-of-concept in its Theranos Wellness Centers inside a Walgreens in Palo Alto, Calif., and a number of them around Phoenix. (Cava, 4/9)

A California bill that would allow parents to opt out of mandatory school vaccinations for their children only if they have a medical condition that justifies an exemption was endorsed by a state Senate committee but still has a long, controversial path before becoming law. The bill was introduced in the California Senate in response to a measles outbreak at Disneyland in late December that’s now linked to almost 150 infections. (Bartolone, 4/9)

Two states this week have gone forward with new abortion restrictions that supporters hope will become models for the country. Bills in Kansas and Oklahoma ban what opponents of the procedure label a "dismemberment" abortion, a second-trimester procedure that has previously been known as "dilation and evacuation." (Sullivan, 4/9)

A man opposed to having a portion of his health care premium allocated toward elective abortions appeared in federal court Thursday for the first hearing in his case. Alan Lyle Howe of Guilford is suing the Department of Vermont Health Access, commissioner Steven Constantino and a host of federal officials. Howe's lawyer, Casey Mattox, has said that Howe is deeply religious and believes the use of his money for abortion is a violation of his religious freedom. (Murray, 4/9)

Venturing into the epicenter of Kentucky's fight against heroin addiction, national drug czar Michael Botticelli on Thursday touted needle-exchange programs as effective grassroots initiatives to combat the spread of infectious disease and to steer heroin users into treatment. Botticelli, director of the White House Office of National Drug Control Policy, also urged the medical community's vigilance against overprescribing pain medications. He called for mandatory medical education for prescribers as a way to stop the abuse of painkillers. (Schreiner, 4/9)

A federal judge has approved a $3 million settlement between patients and a former mental health facility in Putnam County. The class-action suit filed in 2007 alleged patients were illegally restrained, assaulted, punished and isolated by SLS Residential staff, while the facility falsely advertised compassionate care and effective treatment and received up to $900 a day from individual patients' insurers. The Office of Mental health says the facility lost its license for restraining residents contrary to state directives and restricting their rights to see visitors and communicate. (4/9)

A New York court has upheld a state restriction against a doctor convicted of bribing a state senator in a failed attempt to keep Parkway Hospital in Queens operating. The Administrative Review Board for Professional Medical Conduct sustained a professional misconduct finding against Dr. Robert Aquino and said he could have his own private practice but not own or operate a medical facility. (4/9)

During an emotionally charged hearing Thursday, lawmakers heard personal testimony from individuals who believed a loved one would have benefited from the right to choose to die with the help of a physician. The House Health and Social Services Committee discussed a bill proposed by Rep. Harriet Drummond, D-Anchorage, that would allow terminally ill patients to choose to end their lives. (Dischner, 4/9)

For years, Rikers has been filling with people like Mr. Megginson, who have complicated psychiatric problems that are little understood and do not get resolved elsewhere: the unwashed man passed out in a public stairwell; the 16-year-old runaway; the drug addict; the belligerent panhandler screaming in a full subway car. It is a problem that cuts two ways. At the jail, with its harsh conditions and violent culture, the mentally ill can deteriorate, their symptoms worsening in ways Rikers is unequipped to handle. As they get sicker, they strike out at guards and other correction employees, often provoking more violence. (Winerip and Schwirtz, 4/10)

Numerous studies have found that the provision allowing adults up to age twenty-six to remain as dependents on a parent’s private insurance plan reduced uninsurance among young adults by the end of 2011. ... In 2014 additional ACA provisions, particularly the Medicaid expansion and the availability of federal subsidies to purchase coverage in state and federal Marketplaces, increased access to affordable health insurance for other young adults. We found that the dependent coverage expansion disproportionately affected coverage among higher-income young adults. In contrast, the coverage provisions implemented in 2014 were associated with substantial reductions in uninsurance among young adults with low and moderate incomes, particularly in states that expanded Medicaid under the ACA. (McMorrow, Kenney, Long and Anderson, 4/6)

Critics of the [federal health law's] current subsidies have advanced alternative structures .... One of the most commonly proposed subsidy alternatives is a premium support (or "voucher") approach, ... Another alternative would require enrollees to pay a fixed percentage of the total premium, with the government paying the additional amount. ... The analysis found that the alternative subsidy arrangements could cause premiums to become more sensitive to the age mix of enrollees, especially the share of young adult enrollment .... If the share of young adults decreases by 1 percentage point, premiums would rise 0.44 percent under the ACA tax credit structure. In contrast, premiums would increase by 0.61 percent in the fixed-percentage-of-premium scenario and by 0.73 percent in the premium-support scenario. (Eibner and Saltzman, 4/6)

Medicare currently penalizes hospitals for high readmission rates for seniors but does not account for common age-related syndromes, such as functional impairment. ... [Researchers analyzed] a nationally representative cohort of 7854 community-dwelling seniors in the Health and Retirement Study, with 22 289 Medicare hospitalizations from January 1, 2000, through December 31, 2010. ... We found a progressive increase in the adjusted risk of readmission as the degree of functional impairment increased .... Subanalysis restricted to patients admitted with conditions targeted by Medicare (ie, heart failure, myocardial infarction, and pneumonia) revealed a parallel trend with larger effects for the most impaired (16.9% readmission rate for no impairment vs 25.7% for dependency in 3 or more [activities of daily living]. (Greysen et al., 4/7)

We measured annual payments for key service categories delivered to fee-for-service Medicare beneficiaries receiving care from 1,534 medical oncology practices in 2011–12. In 2012, differences in payments per beneficiary at the seventy-fifth-percentile practice compared to the twenty-fifth-percentile practice were $3,866 for chemotherapy (including administration and supportive care drugs), $1,872 for acute medical hospitalizations, and $439 for advanced imaging. Supportive care drugs, bevacizumab, and positron-emission tomography accounted for the greatest percentage of variation. ... These differences, even when clinical guidelines exist, demonstrate the potential for quality improvement that could be accelerated through alternative payment models. (Clough et al., 4/6)

Since the inception of the Medicare Rural Hospital Flexibility Program in 1997, over 1,300 rural hospitals have converted to critical-access hospitals, which entitles them to Medicare cost-based reimbursement instead of reimbursement based on the hospital prospective payment system (PPS). Several changes to eligibility for critical-access status have recently been proposed. Most of the changes focus on mandating that hospitals be located a certain minimum distance from the nearest hospital. Our study found that critical-access hospitals located within fifteen miles of another hospital generally are larger, provide better quality, and are financially stronger compared to critical-access hospitals located farther from another hospital. Returning to the PPS would have considerable negative impacts on critical-access hospitals that are located near another hospital. (Casey et al., 4/6)

People of color face longstanding and persistent disparities in accessing health coverage that contribute to greater barriers to care and poorer health outcomes. The Affordable Care Act (ACA) Medicaid expansion to adults with incomes at or below 138% of the federal poverty level (FPL) makes many uninsured adults of color newly eligible for the program, which would help increase their access to care and promote greater health equity. However, in states that do not implement the ACA Medicaid expansion, poor adults fall into a coverage gap and will likely remain uninsured. This brief examines the impact of this coverage gap by race and ethnicity and finds that it disproportionately impacts poor uninsured Black adults, which may contribute to widening disparities in health and health care over time. (Artiga and Stephens, 4/3)

In examining Medicaid expansion across eight states—Arkansas, Colorado, Kentucky, Michigan, New Mexico, Oregon, Washington and West Virginia—it is clear that states are realizing savings and revenue gains as a result of expansion. Savings and revenues by the end of 2015 (just 1.5 years into expansion) are expected to exceed $1.8 billion across all eight states. In Arkansas and Kentucky, savings and revenue gains are expected to offset costs of the expansion at least through SFY 2021. (Bachrach, Boozang and Glanz, 4/6)

In October 2014, the current forecast [by the CMS Office of the Actuary] suggested that national health expenditures will be $2.5 trillion less over the 2014-2019 period than under the ACA baseline forecast from September 2010. Over the 2014-2019 period, Medicare spending is now expected to be lower by $384 billion, Medicaid by $927 billion, and private health insurance expenditures by $688 billion compared to the September 2010 ACA baseline. Clearly, not all of the spending reduction is due to the ACA .... But it is also likely that the law contributed; though how much is impossible to estimate. The ACA reduced Medicare payments, established a managed care competition framework in the marketplaces, and imposes an excise tax on high cost health plans beginning in 2018. (Holahan and McMurrow, 4/7)

An estimated 56 percent of state prisoners, 45 percent of federal prisoners, and 64 percent of jail inmates have a mental health problem. ... Despite the evidence that mental illness in the criminal justice system is a pressing concern, our comprehensive effort to identify cost-effective, evidence-based programs and policies for managing and treating mentally ill persons in the criminal justice system brought to light how limited current knowledge is on this topic. There have been only a few rigorous evaluations of criminal justice programs and policies targeted at mentally ill offenders. This limitation, in and of itself, is a notable finding, as it shows what more needs to be done to better understand how to effectively alleviate the costs and challenges of treating and processing offenders with mental illness. (Kim, Becker-Cohn and Serakos, 4/7)

Popular weight-loss and workout supplements on sale in hundreds of vitamin shops across the nation contain a chemical nearly identical to amphetamine, the powerful stimulant, and pose dangers to the health of those who take them, according to a new study. ... The Food and Drug Administration documented two years ago that nine such supplements contained the same chemical, but never made public the names of the products or the companies that made them. (O'Connor, 4/7)

Most emergency department physicians order diagnostic imaging tests they know are unnecessary, according to the results of a national survey published online March 23 in Academic Emergency Medicine. A key driver behind these excess scans is the fear of malpractice lawsuits based on missed diagnoses, the researchers found. (Swift, 4/7)

If you're considering surgery for back pain, a new study suggests you first should try physical therapy, which is both less risky and less costly. The University of Pittsburgh study found that surgery and physical therapy were equally helpful for lumbar spinal stenosis, a common condition in older people that makes walking painful. (Burling, 4/7)

When hospitalized patients list nonrelatives as next of kin, state laws might interfere with those patients’ wishes – and a new study suggests the situation isn’t rare. In Connecticut, where researchers looked at medical charts of nearly 110,000 hospitalized veterans, eight percent had specified someone other than a close family member as next of kin – in conflict with the state’s “default surrogate consent” laws. Default surrogate consent statutes are designed to designate a proxy for patients who can’t make their own medical decisions. In most states, spouses are given first priority, followed by adult children, parents and siblings, the authors write in a research letter in JAMA. But states are inconsistent in their recognition of other relationships, like friends, distant relatives or unmarried or same-sex partners. (Doyle, 4/7)

About 10% of breast-milk samples purchased via Internet-sharing sites contained significant amounts of cow’s milk or formula based on it, according to a study in the journal Pediatrics. Most experts recommend waiting until a baby is at least 12 months old to introduce cow’s milk because it is too low in iron and too high in protein and minerals that are difficult for infants to digest. It also can cause allergic reactions ranging from mild distress to anaphylactic shock, according to the American Academy of Pediatrics. (Beck, 4/6)

The use of long-acting reversible contraception (LARC) by teens increased from 2005 to 2013 but still remained relatively low, researchers reported. The percentage of female teens, ages 15 to 19, selecting LARC, which includes subdermal implants and intrauterine devices (IUDs), at Title X National Family Planning Program sites was 7.1% in 2013, up from 0.4% in 2005 (P<0.001 for trend), according to Lisa Romero, DrPH, MPH, of the National Center for Chronic Disease Prevention and Health Promotion at the CDC in Atlanta, and colleagues. (Yurkiewicz, 4/7)

During the past four years, the state of Kansas has become ground zero in the war to criminalize all abortions, and in the process to remove a woman’s ability to control what happens in her own body. ... On Tuesday the state went still further, becoming the first to ban the safest and by far the most common method of ending a second-trimester pregnancy, dilation and evacuation, which involves dilating the cervix and removing the fetus, often in parts. (4/9)

If you could help 800,000 low-income working Floridians gain health care coverage at no cost to state taxpayers, would you? The Florida Senate would — but they have no dance partner. The Florida House, or at least the leadership of the House, adamantly refuses to do so and Gov. Rick Scott has reversed course once again on the issue. ... Taking the federal funds is a no-brainer. While polls show the vast majority of Floridians support taking the federal money to extend health care coverage to the working poor, some of Florida's elected officials in positions of power are dug in against doing so. And this year the federal Low-Income Pool funding, which has been going to hospitals to reimburse them for treating this same group of people, is being phased out. Shouldn't that factor into their decisionmaking and budget writing? (Paula Dockery, 4/9)

A hasty and ill-timed attempt to make a major policy change regarding how to oversee health care services for about 200,000 Medicaid recipients in Missouri requires a quick burial. In the early hours of Wednesday morning, Republican Sen. Kurt Schaefer succeeded in pushing through a plan to extend the use of for-profit companies to manage Medicaid in much of the state’s rural areas. The full Senate narrowly sent the managed care idea on to the House as part of a $26 billion annual state budget. That’s where it should die. (4/9)

Like many fields, public health is in the midst of a data revolution: randomized control trials, pay-for-performance and value calculations, all based on data, are changing our ideas about what works and how to finance it. The impact of these new methods to gather and evaluate data pales, however, next to the Global Burden of Disease Report, an attempt to understand what sickens us and kills us in every country in the world. The Global Burden of Disease study is a single scientific project on a scale with the moon landing or mapping the human genome. It has been going for a quarter century and involves hundreds, perhaps thousands, of scientists. In 2012, its most recent report, based on 2010 data, became the subject of the first issue that the medical journal The Lancet devoted to a single study. (Tina Rosenberg, 4/9)

Expanding hospital bundled payments to include physicians has been on the policy horizon for three decades. Previous efforts were derailed by concerns about physician autonomy and other implementation barriers, but it is time to reconsider. Such a payment change could remove unnecessary administrative and regulatory barriers, improve quality, and potentially provide greater freedom for individual hospitals and physicians to decide on the optimal way of delivering care. (Ateev Mehrotra and Peter Hussey, 4/9)

Medicare's recent decision to unbundle most postoperative visits from global packages of surgical services is striking. ... Medicare's experience with global surgical payments offers a cautionary tale for other bundled-payment programs. The discrepancy between the number of postoperative visits paid for and the number that actually occur highlights the importance of being able to monitor utilization so that payments can be adjusted as care delivery changes. Bundling of payments also creates a perverse incentive to “unbundle” services — that is, to change the time or location of care or the clinician providing it so that the care qualifies for separate payment. The global surgical packages as previously structured lacked mechanisms for updating bundles over time and for monitoring unbundling. (Andrew W. Mulcahy, Barbara Wynn, Lane Burgette and Ateev Mehrotra, 4/9)

In February, some parents’ decisions not to vaccinate their children caused great hubbub in the United States, fueled by measles outbreaks and a few politicians’ expressions of respect for this choice by “anti-vaxxers.” A natural concern is that lack of vaccination by some degrades herd immunity and makes spread of disease more likely. Because choosing not to vaccinate harms others—something we economists call a “negative externality”—it justifies government action to encourage vaccination. But in other cases in which a negative externality arises, government action is much less widely accepted as justified. Why the difference? (Austin Frakt, 4/9)