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Across the nation, millions of people who bought insurance through the exchange in this inaugural year of coverage under the health care law must decide by Monday whether to switch plans for 2015 if they want a new plan starting Jan. 1. If they do nothing, most of the 6.7 million people who remained enrolled as of last month will automatically be re-enrolled in their current plans or similar ones. More often than not, the premiums for those in the most popular plans will increase, according to a New York Times analysis of data from the McKinsey Center for U.S. Health System Reform. (Goodnough, 12/11)

HHS has a clear message to current Obamacare enrollees during this sign-up season: Shop ‘til your premiums drop. But some consumers who prioritized low premiums last year are feeling buyer’s remorse. (Wheaton and Pradhan, 12/11)

With only days to go before the deadline for consumers to choose next year’s health-law insurance plans, insurers and the federal government are bracing for what could be a crush of last-minute enrollment decisions. Of the approximately five million people who enrolled in 2014 health plans through the federal marketplace, only 720,000 had returned to the HealthCare.gov website to select a plan for 2015, according to the latest government tally through Dec. 5. Some 664,000 more people bought plans on the site for the first time. That leaves millions of enrollees who have yet to make a decision for next year. (Mathews, Radnofsky and McCabe, 12/11)

A working website and more new customers than expected has Obamacare headed toward enrollment that will blow past the lowered projections of its managers. With the program’s first deadline looming on Dec. 15, when people who want coverage beginning Jan. 1 must sign up, little has gone wrong so far in the second enrollment season for the Patient Protection and Affordable Care Act. Technical problems have been scattered and largely resolved. Consumer interest is strong, with 1.4 million people signed up through Dec. 5 in 37 states using the federal healthcare.gov system. (Wayne, 12/12)

The Department of Health and Human Services will promote HealthCare.gov at the bottom of some 7-Eleven receipts in an effort to reach demographics that could be uninsured, the department announced Thursday. The department is partnering with PayNearMe, an electronic payment processing system that lets businesses process large cash payments. (Ravindranath, 12/11)

Fewer than 1 percent of the people who learned they are eligible to buy health insurance plans on the Massachusetts Health Connector have taken the next critical step: paying for their coverage. Connector officials said that is to be expected, because the bills for 2015 coverage are not due until Dec. 23. (Freyer, 12/12)

Jonathan Gruber got some unaccustomed love Thursday morning. On Capitol Hill earlier this week, the Massachusetts Institute of Technology economist and architect of the Massachusetts health care law faced withering attacks from Republicans and Democrats for his controversial comments that seemed to ridicule the American voter and denigrate the political process. But Thursday in Boston’s McCormack Building, his image appeared at the center of a little red heart. (Freyer, 12/11)

With one week left to sign up for health insurance through the state health exchange for coverage Jan. 1, state health officials and advocates have turned to churches and religious leaders to ensure everyone gets the message. And Thursday, several said they would take it up with their congregations. About 81,000 signed up last year for private plans, and about 65,000 still had those plans as open enrollment approached this year on Nov. 15, according to the exchange. About 50,000 of those people received subsidies, so "that is the group that is our highest priority right now," said Dr. Joshua M. Sharfstein, state health secretary and board chairman of the exchange. However, he added, anyone who needs coverage to start in January needs to sign up by Dec. 18. (Cohn, 12/11)

As Monday's deadline to enroll in private health insurance through the state's online insurance website approaches, people who help consumers with the application process say business is booming. Aided by a marketing campaign from MNsure, the agency that runs the website, so-called "navigators" are seeing more visits from people who want to have insurance on Jan. 1. (Zdechlik, 12/12)

About 290,000 Californians filled out applications for exchange coverage since Covered California's second open enrollment period started Nov. 15. About 160,000 of those applications were found likely eligible for Medi-Cal and filled out those applications. Those numbers were amassed in less than three weeks between Nov. 15 and Dec. 2. (Gorn, 12/11)

One day after lawmakers met to discuss dissolving Cover Oregon, a top administrator said the state health insurance exchange later this year will open a website for small businesses to obtain health coverage for employees. (Budnick, 12/11)

Gov. Robert Bentley cracked the door open on the expansion of Medicaid, allowing new lawmakers to speculate the governor was mulling asking the federal government for a block grant to expand the federal health insurance program for the poor and disabled. (Stinson, 12/11)

Gov. Robert Bentley suggested Thursday that he could support an expansion of the state's Medicaid program in the form of a block grant with employment requirements. In remarks before lawmakers wrapping up three days of legislative orientation, Bentley — who for years has expressed staunch opposition to expansion — said he would not expand the system until proposed reforms of the state system go into effect. However, he added he would be open to discussing a block grant program, similar to an expansion that took place in Arkansas this year. (Lyman, 12/11)

Americans may not agree on much lately, but one opinion is nearly universal: There’s almost no chance that President Barack Obama, a Democrat, and the Republican Congress can work together to solve the country’s problems. What does the public think they’ll be able to do? A majority say Obama is likely to prevent Congress from repealing the health care law passed in 2010, while nearly half say the GOP is likely to block Obama’s executive order on immigration. (12/11)

A record number of Americans want the Affordable Care Act repealed, according to a new Fox News poll. If given the choice between repealing the health care law or keeping it, 58 percent would repeal it, while 38 percent would keep it, the December poll of registered voters found. (Villacorta, 12/11)

Congress managed to narrowly avoid another government shutdown crisis Thursday night when the House approved a $1.1 trillion spending package to keep most government agencies operating through next summer. The 219-to-206 vote came with less than three hours to go until government funding expired. (O'Keefe, 12/11)

Tucked away near the end of the 1,600-page spending bill is a long-awaited technical fix to the health overhaul law — one that benefits Blue Cross and Blue Shield insurers and has been in the works since the bill was passed in 2010. The backstory: Many of the nonprofit ‘Blue’ health plans receive tax breaks on their expenses and reserves as part of a 1980s arrangement in which they lost their broader tax-exempt status. Under the 2010 health law, Blue plans had to spend at least 85% of their revenue from insurance premiums on medical claims to continue to qualify for the breaks. The provision in the “cromnibus” bill ... would let the Blue plans count spending on improving health-care quality toward the 85% threshold. (Radnofsky, 12/11)

Philadelphia’s transit system is taking on Gilead Sciences Inc. over its sky-high pricing of the breakthrough hepatitis C drug Sovaldi. The Southeastern Pennsylvania Transportation Authority alleged in a lawsuit filed Tuesday in federal court in Philadelphia that Gilead is engaging in “price gouging” by charging $1,000 a pill, or $84,000 for a standard 12-week treatment. (Pfeifer, 12/11)

The federal lawsuit from Philadelphia's public transit agency appears to be the first directly challenging the price of Sovaldi, which costs $84,000 overall during a normal 12-week course of treatment in the United States. Since Gilead Sciences launched Sovaldi last year, the drug has shattered sales records and set off a contentious debate about how to make treatments affordable and accessible while also encouraging drugmakers to invest in new drug development. (Millman, 12/11)

A closely watched trial that many hoped would help clarify a contentious battle over access to generic drugs instead ended in disappointment last week. In fact, the outcome only seems to have underscored the difficulty in sorting out so-called pay-to-delay deals, a topic that has embroiled the pharmaceutical industry, regulators and the courts for years. (Silverman, 12/11)

Hospitals would have to give equal rights to the spouses of gay and straight patients no matter where they live, as long as the marriages are legal somewhere in the country, the Obama administration said in a proposal today. The new regulations would apply to virtually all U.S. hospitals as well as nursing homes, surgery centers, hospices and mental health clinics that accept Medicare, the U.S. insurance program for the elderly and disabled, or Medicaid, the state-federal program for low-income people. (Wayne, 12/11)

New York's financial regulators advised health insurers statewide on Thursday to cover transgender treatment deemed to be medically necessary. The Department of Financial Services said commercial insurers may not deny needed treatment for gender dysphoria — when someone's gender at birth is contrary to his or her identity. The guidance sends the message that discrimination against transgender people won't be tolerated, department Superintendent Ben Lawsky said. (Virtanen, 12/11)

Hawaii is taking small steps toward paying off its $20 billion unfunded liability for retiree pensions and health benefits. Actuaries say the state has $8.6 billion less than it should have to pay its pension obligations to current and future retirees. But its preparation to pay retiree health care benefits is worse. Hawaii's state and county employees have just 2 percent of projected retiree health care expenses set aside. The shortfall for retiree health benefits in Hawaii stands at $11.2 billion, according to an analysis by Gabriel, Roeder Smith and Co., an actuarial consulting firm. (Bussewitz, 12/11)

More than half of the 5.1 million children enrolled in California’s health care program for low-income residents did not receive dental care last year, and some counties may lack the providers to meet patients’ dental needs, according to a Bureau of State Audits review released Thursday. (Cadelago, 12/11)

With much at stake, lawyers for the School Reform Commission on Wednesday asked a panel of five Commonwealth Court judges to affirm their power to cancel the Philadelphia School District teachers' contract. The SRC wants to make teachers begin paying a portion of their health-care costs, a move it said would save $54 million annually. Those savings would be sent directly to cash-strapped schools, officials said. Teachers would pay from $72 to $700 a month depending on their salary, the plan they choose, and their family status. (Graham, 12/11)

Blue Cross and Blue Shield of Georgia will remain the dominant insurer for the state’s high-profile employee health plan. More than 80 percent of State Health Benefit Plan members selected insurance plans from Blue Cross during its recent open enrollment, a state agency said Thursday. (Miller, 12/11)

Few doubt that Congress will eventually reauthorize funding for the Children’s Health Insurance Program before it runs out next year. But when, and on what terms, are questions that promise to inject uncertainty as state lawmakers construct a two-year budget in the next few months. Advocacy groups for children, and Gov. Rick Perry, had hoped Congress would get the job done by now. It hasn't, apparently leaving the task to a new set of federal lawmakers. (Ura, 12/11)

Tenet Healthcare Corporation notified state regulators Thursday it was withdrawing its applications to buy five hospitals in Connecticut, ending a two-year effort by a national for-profit hospital chain to enter the changing Connecticut market. (Pazniokas, 12/11)

As soon as next week, St. Elizabeth’s Hospital in Belleville could receive word from a state regulatory board on whether its proposal to shutter its current location and build a new hospital 17 minutes away will be permitted. Public health officials say the move could leave some of St. Clair County’s most vulnerable residents without a hospital nearby. But St. Elizabeth’s, which is part of the Hospital Sisters Health System, contends the $288 million project would allow for necessary updates and would be more accessible to most of its patients. (Bouscaren, 12/11)

Abortion clinics in Baton Rouge and New Orleans have dropped their challenge to Louisiana's newest abortion law. An earlier lawsuit filed by clinics in Metairie, Shreveport and Bossier City remains intact. The law requires doctors who perform abortions to be able to admit patients to a hospital within 30 miles. Attorney Ellie Schilling said earlier that cost was the only reason that Delta Clinic of Baton Rouge, Women's Health Care Center in New Orleans and a doctor at each decided to drop their suit. (12/11)

The government has no constitutional obligation to provide health care to patients in state doctors' care, a state appeals court ruled Thursday. Disability Rights Wisconsin filed a lawsuit in May 2009 against five University of Wisconsin Hospital and Clinics doctors, claiming they violated the rights of two developmentally disabled patients by withholding medical treatment. One, a minor who had pneumonia and required artificial nutrition and hydration, died. The doctors were acting on guidance by parents or legal guardians who directed them to discontinue care. (Antlfinger, 12/11)

When Gov. Sam Brownback announced this week a list of stopgap measures to close a $280 million budget hole, one of the biggest chunks was $55 million from a "Kansas Department of Health and Environment Fee Fund Sweep" made possible in part by a federal law the governor has strenuously opposed and criticized. The $55 million comes from a Medicaid drug rebate program that was expanded as part of the federal Affordable Care Act. The health reform act, commonly known as Obamacare, increased the refunds that pharmaceutical companies must pay states for prescriptions provided to Medicaid patients and allowed states to collect rebates for Medicaid prescriptions administered by managed care organizations. (Marso, 12/11)

Anxiety, depression, guilt, sleeplessness, marital strife, drug and alcohol abuse — two years after the massacre at Sandy Hook Elementary School, the scope of the psychological damage to children, parents and others is becoming clear, and the need for treatment is likely to persist. "Here it is two years later, and it's still hard to deal with. But God, you didn't want to know me two years ago," said Beth Hegarty, a Sandy Hook mother who happened to be inside the school that day with her three daughters, all of whom survived. (12/11)

Two Washington-area hospitals said on Thursday that they are treating patients at risk for Ebola. The National Institutes of Health said Thursday it had admitted an American nurse who was exposed to the Ebola virus while volunteering in Sierra Leone. Washington Hospital Center also said that it admitted a patient who showed symptoms of the disease. (Zauzmer and Hedgpeth, 12/11)

A Supreme Court ruling this spring could upend health insurance markets in at least 34 states, eliminating the federal subsidies that make coverage affordable for millions of Americans. State governments, theoretically, have ways to forestall this outcome. But few have taken action. If they wait until the court rules, it may already be too late for a state to get started on an exchange so that it is ready for 2016. (Margot Sanger-Katz, 12/11)

Republicans do not have the votes to repeal the Affordable Care Act in the next Congress. A bill revising the health-care law looks more likely, presuming Senate Republicans can forge a united front and then pick up some doubting Democrats to get the votes necessary to overcome a presidential veto. The prospect of such an outcome could force the president to work out a bipartisan reform package in an effort to head off a showdown that many in his party may not want. (Robert Litan, 12/11)

You may have noticed when you last subscribed to a magazine that the company put you on an automatic renewal plan. ... Auto-renewals are also a key feature of the Affordable Care Act’s insurance marketplaces. ... The same forces that lead people to stick with an expensive cellphone plan or to watch the television program that follows their favorite show come into play with health insurance. But inertia is even stronger when it comes to insurance than many other markets, because people find shopping for a health plan to be so confusing and unpleasant. There are also real trade-offs in changing health insurance — a better premium may come at the cost of your favorite doctor, for example. (Margot Sanger-Katz, 12/11)

It's no secret that Medicaid struggles to attract as many doctors as other health-care plans do. Less clear is what makes that so hard. Everyone assumes it's all because of Medicaid's low payment rates. But a government watchdog suggests it may have more to do with the way states run the program. (12/11)

Two of the most heavily Republican states, Utah and Wyoming, appear to be moving closer to an expansion of Medicaid under the Affordable Care Act. Other GOP-dominated states, like Indiana and Tennessee, are also looking more closely at it, despite the hostility of their party’s leaders toward Obamacare. The reasons are no mystery. Conservative governors and lawmakers in those states are acknowledging that it is profoundly illogical to deny the benefits they would reap — both budgetary and humanitarian — by accepting federal funding to provide health insurance for tens or hundreds of thousands of low-income residents. (12/11)

Vermont's move to a single payer health care system moved a bit closer to reality — or at least a realistic assessment — last week when some people in the know leaked part of the proposed financing mechanism to the media. That part is an 8 percent payroll tax on all Vermont employers. ... Where will the other half come from? The simplest source would be the same 8 percent payroll tax levied on employees. ... Financing Vermont's single payer health care system entirely through payroll taxes would mean a very large payroll tax — more than we now pay in Social Security taxes. That's not acceptable to single payer advocates, who want to get a lot of the funding from wealthy Vermonters, which means using the income tax. (Art Woolf, 12/11)

But the problem for Democrats is that Gruber is not stupid. By all accounts, he is knowledgeable, candid and willing, on occasion, to criticize the Obama administration — an advocate for Obamacare without being a shill. But he is perfectly representative of a certain approach to politics that is common in academic circles, influential in modern liberalism and destructive to the Democratic Party. (Michael Gerson, 12/11)

In my career as a medical doctor and global health policy maker, I have been in the middle of monumental struggles, including fights to make treatment accessible in the developing world for those living with H.I.V./AIDS as well as multi-drug resistant tuberculosis. But the Ebola epidemic is the worst I’ve ever seen. (Jim Yong Kim, 12/11)

This positive development on food, however, is in stark contrast to the United States’ approach to India’s policies on affordable medicines. On Nov. 24, while the food deal was being finalized in Geneva, Michael B. Froman, the United States trade representative, was in India to demand reform of its patent laws. Those laws are friendly to generic medicines and public health, and the United States wants them restructured to favor American pharmaceutical corporations, often called Big Pharma. (David Singh Grewal and Amy Kapczynski, 12/11)