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House Republicans, responding to criticism that repealing the Affordable Care Act would leave millions without health insurance, said on Thursday that their goal in replacing President Obama’s health law was to guarantee “universal access” to health care and coverage, not necessarily to ensure that everyone actually has insurance. (Pear and Kaplan, 12/15)

Congressional Republicans say they will vote on repealing and replacing Obamacare “very quickly” early next year but may keep Obamacare in place for as long as four years. The incoming Trump administration and Republicans on Capitol Hill are sorting out the details of how to best deconstruct the Affordable Care Act. One of the thorniest problems is how long to leave parts of the law intact — to give 20 million Americans time to find other arrangements and health insurance companies the ability to develop and price new plans. (Haberkorn, 12/15)

Repealing Obamacare could take months and developing replacement health insurance plans could take years, senior Republican aides in the U.S. Congress said on Thursday, discouraging talk of a quick end to the program after President-elect Donald Trump takes office on Jan. 20. (Cornwell, 12/15)

House Republicans hope to be ready in January with a new system to replace President Barack Obama’s health care law, according to Ways and Means Chairman Kevin Brady. But he declined to provide specifics Thursday. GOP lawmakers on the panel are in the midst of a two-day policy discussion focused on taxes and health care. Republicans “are here in the Capitol while Congress is adjourned for the holidays to make sure we have ready for our new president and administration, the American people, a health care plan that is dramatically different than Obamacare,” the Texas Republican told reporters during a break in the closed-door meeting. (Williams, 12/15)

Republicans are committed to allowing young adults to stay on their parents’ health insurance policies until age 26 and keeping a ban on insurers yanking coverage if costs exceed a certain amount, Ways and Means Committee Chairman Kevin Brady said Thursday after a discussion on replacing the Affordable Care Act. Republicans on the committee huddled on Capitol Hill this week to develop plans for tax and health reform. Brady told reporters the panel is committed to crafting a plan that is affordable for patients and fiscally responsible, but offered few specific details. (McIntire, 12/15)

Congressional Republicans are marching determinedly toward a new session, insisting that a quick repeal of Obamacare will be a top agenda item. Outgoing Senate Minority Leader Harry Reid (D-Nev.) doesn’t think they really have it in them. “They don’t have enough nerve to repeal Obamacare. And if they do, they are just a lot more visionless than I can imagine,” Reid told The Huffington Post in an interview this week. “Let them repeal it. They will rue the day.” (Grim and Stein, 12/14)

A prominent liberal outside group issued a stern warning Thursday to Democratic senators who might help Republicans replace Obamacare: Do so at your own political peril. The broadside from the pro-abortion rights group NARAL Pro-Choice America came hours after POLITICO reported that some Senate Democrats would be open to working to rebuild the health care law as long as Obamacare’s core components are preserved. (Everett, 12/15)

Roughly 55 million Americans could lose insurance coverage if Obamacare is repealed, but that’s just a number. Those in jeopardy are making it personal. In a burst of Twitter activism, scores of people have begun sharing details of their health complications online, as well as those of their loved ones, to draw attention to the issue. The hashtag to watch — #the27Percent — reflects the 27 percent of Americans under 65 with preexisting conditions who risk losing health coverage. It was created by Dr. Atul Gawande, the surgeon, author, and executive director of Ariadne Labs, who on Wednesday posted his own testimonial to 178,000 Twitter followers. (Tedeschi, 12/15)

Immediate repeal of ObamaCare's individual mandate next year could cause chaos in the market and threaten coverage for some of the healthcare law’s enrollees, experts warn.  Congressional Republicans have not yet said whether they intend to scrap the mandate right away, but the bill they unsuccessfully pushed last year — and are now using as a blueprint for 2017 — abolished the mandate immediately. (Sullivan, 12/16)

An Affordable Care Act replacement that emphasizes state flexibility will be a top Republican priority once Congress reconvenes in January, according to congressional staffers. Addressing rising prescription drug prices may also be on the agenda.Republican and Democratic legislative aides shared their parties' agendas in background briefings with reporters Thursday. GOP staffers say under their party's proposed repeal and replacement of the ACA, states must take the lead in deciding how to maintain insurance coverage for the 20 million people who gained coverage under the law. One bill that's drawing interest among Republicans is the Patient Freedom Act, first introduced by Sen. Bill Cassidy (R-La.) in 2015. (Dickson, 12/15)

More than 100 Illinois health care advocacy groups, medical providers and social service organizations are urging Gov. Bruce Rauner to tell Congress that proposed changes to Obamacare and Medicaid could result in "grave harm to our communities and the financial well-being of the state." The groups sent Rauner a letter Thursday outlining their concerns and imploring him to pass them on to Congress. (Schencker, 12/15)

Donald Trump’s promises to repeal Obamacare have claimed another victim -- health insurer Centene Corp.’s 2017 profit outlook. The company said in a regulatory filing Thursday that Trump’s victory could limit margins in its business selling Obamacare plans, cutting its 2017 profit projections by about 20 cents. The insurer forecast adjusted earnings of $4.40 to $4.85 a share for 2017, compared with the $4.83 average of analysts’ estimates. (Tracer, 12/15)

Hundreds of insurers selling health plans in Affordable Care Act marketplaces are being paid less than 2 percent of nearly $6 billion the government owes them for covering customers last year with unexpectedly high medical expenses. The $96 million that insurers will get is just one-fourth of the sum that provoked an industry outcry a year ago, when federal health officials announced that they had enough money to pay health plans only 12.6 percent of what the law entitles them to receive. (Goldstein, 12/15)

Federal regulators Thursday night extended the midnight deadline for Affordable Care Act insurance by four days, as consumers fought to get through to call center operators and log onto Healthcare.gov to buy insurance that takes effect Jan. 1. "Nearly a million consumers have left their contact information to hold their place in line," Healthcare.gov CEO Kevin Counihan said in a statement late Thursday. "Our goal is to provide affordable coverage to everyone seeking it before the deadline, and these two additional business days will give consumers an opportunity to come back and complete their enrollment for January 1 coverage.” (O'Donnell, 12/16)

The unexpected extension was announced after close of business Thursday. Counihan said it's due to strong interest. The old deadline was Thursday. The Obama administration has set a goal of signing up 13.8 million people for 2017, a modest increase. So far enrollment is running about on par with last year, but the share of new customers is down. (12/16)

Federal health officials announced Thursday night that they have extended the deadline for consumers to sign up for Jan. 1 coverage through Affordable Care Act marketplaces, giving them until the end of Monday night to enroll. The announcement marked the second consecutive year that federal officials granted insurance-seekers a little extra time beyond the Dec. 15 deadline. (Goldstein, 12/15)

The Obama administration is again giving people more time to sign up for healthcare coverage for next year because of “extraordinary” demand, health officials announced late Thursday. “The final days heading into the December 15 deadline were some of the busiest we’ve experienced at HealthCare.gov,” the Department of Health and Human Services (HHS) wrote in a statement, without providing specific numbers. Customers will now have two extra days – until midnight on Monday, Dec. 19 – to buy coverage that will go into effect on Jan 1. (Ferris, 12/15)

Health officials extended Obamacare's Dec. 15 deadline by four days due to "extraordinary volume of consumers" visiting or calling healthcare.gov, they announced Thursday evening. The new deadline for consumers who want their health coverage to kick in on Jan. 1 is Dec. 19, 11:59 p.m. PST. (Miller, 12/15)

The open enrollment period for individual-market health plans runs through Jan. 31, but people who sign up after Saturday won’t have coverage until Feb. 1 at the earliest. The deadline for coverage that starts Feb. 1 is Jan. 15; those who sign up between Jan. 15 and Jan. 31 will get coverage that begins March 1. (Levin Becker, 12/15)

High volume caused an hourlong outage on the Connect for Health Colorado website Thursday, the last day for people to sign up for plans through the state’s Obamacare exchange in order to have health care coverage that kicks in on Jan. 1. The outage began at about 7 a.m., said Luke Clarke, a spokesman for Connect for Health Colorado. The website was back up around 8 a.m., he said. (Ingold, 12/15)

If the law were eliminated, as President-elect Donald Trump and members of Congress have pledged to do, the top 1 percent of earners would see an average tax cut of $33,000, while the top 0.1 percent would enjoy an average tax break of $197,000, the Tax Policy Center found. The non-partisan group is a joint venture of the Urban Institute and the Brookings Institution. Meanwhile, the lowest-income households, which make less than $25,000, would see their tax bills increase on average by $90 under a full repeal. But that average masks a wide variation -- most low-income households would see no change, researchers found, and 7 percent of them would get an average tax cut of about $1,200. But 4 percent would see a tax increase averaging almost $3,900. (Kapur, 12/15)

Republicans may be handing wealthy Americans a big tax cut by repealing President Barack Obama's health care law, according to a study released Thursday that spells out potential economic pitfalls behind the election-year slogans. The richest households — those with incomes above $3.7 million — would get an average tax cut of about $197,000, said the analysis from the nonpartisan Tax Policy Center, a joint venture of the Urban Institute and the Brookings Institution think tanks. (Alonso-Zaldivar, 12/15)

Repeal of ObamaCare would cut taxes for high-income earners while causing an increase in taxes for some lower-income people due to the loss of tax credits, a new analysis finds. The analysis from the Tax Policy Center, a joint effort of the Brookings Institution and the Urban Institute, finds that the top 1 percent of earners would get, on average, a $33,000 tax cut, or about 2 percent of after-tax income, from ObamaCare repeal.Among middle- and low-income people, by contrast, most people would either get a small tax cut or no change in taxes at all. (Sullivan, 12/15)

Repealing Obamacare wouldn’t just end health coverage for 20 million people. It would also mean a significant tax cut for the wealthiest Americans. These tax figures are important for understanding why Republicans are so committed to Obamacare repeal. It’s not just about delivering on a campaign promise to get rid of President Obama’s signature legislative accomplishment. It’s also about providing a significant tax cut to the top 1 percent of earners. (Kliff, 12/15)

Many congressional Republicans are pushing to swiftly repeal most of the Affordable Care Act through an expedited budget process next month. If they abolish the law, wealthy taxpayers, health insurers, medical-device manufacturers, hospitals, and other interest groups all are demanding that they also repeal the myriad revenue provisions that pay for the law's premium subsidies, Medicaid expansion, enhancement of Medicare benefits and extension of solvency for Medicare's hospital trust fund. (Meyer, 12/15)

The medical community’s better-paid specialists have poured at least $3.1 million over the past 13 years into the political committees of the orthopedist-turned-congressman who is charged with dismantling the Affordable Care Act. (Gordon, Clark and Goldstein, 12/15)

National Institutes of Health Director Francis Collins said in an interview with CQ Roll Call he would like to retain his position at the agency during the incoming Trump administration, but acknowledged he has had no contact with the transition team. Four GOP Senate and House committee or subcommittee chairmen earlier this month urged Trump in a letter to keep Collins in his role in order to maintain continuity. The NIH will soon implement parts of the Cures law (PL 114-255) that President Barack Obama signed this week and oversees initiatives with congressional interest, including one affecting personalized medicine and another supporting research on the human brain. (Williams, 12/15)

Potential upheaval of the insurance industry remains on trial as two major merger cases that could help define national insurance markets are progressing in the same Washington, D.C., building. Anthem is facing an uphill battle in its attempts to convince a U.S. district judge that its $54.2 billion proposal to take over Cigna meets legal scrutiny, analysts said. The government wrapped up its arguments this week in a separate challenge to the $37 billion merger bid between Aetna and Humana. If the insurers are successful in their arguments, the “big five” insurers would be down to three companies. Attorney General Loretta Lynch has said this would “fundamentally reshape the health insurance industry” and kill competition in key markets. (Muchmore, 12/14)

Two Molina Healthcare executives on Thursday stressed the company is ready to receive a huge chunk of private Medicare business that Aetna and Humana are selling off to win approval for their merger. CEO Mario Molina, during an antitrust hearing on the merger, said the $117 million deal to acquire nearly 300,000 Medicare Advantage customers from Aetna and Humana will jump-start his company’s expansion into the private Medicare market across 21 states. (Cancryn, 12/15)

One of the nation’s largest hospital operators is retreating from an ambitious plan to run its own insurance company, underscoring the risks faced by health-care providers seeking to compete with health insurers. Catholic Health Initiatives, which has 103 hospitals in 18 states, made an aggressive push into insurance markets roughly three years ago. (Evans, 12/15)

As the new administration and Congress look to improve our health care system, they must ensure addressing health insurance barriers many Americans face in accessing prescribed treatment remains a top priority. Federal and state policymakers now have an opportunity to improve care if they listen to the patient voice. A new poll, conducted by the Alliance for the Adoptions of Innovation in Medicine (Aimed Alliance) in conjunction with David Binder Research, shows that many Americans hold their health insurers to high standards and expect to receive quality care—conveying a disconnect between expectations and reality. (Worthy, 12/15)

A U.S. judge on Thursday temporarily halted until Jan. 6 a Texas regulation that would require abortion providers to dispose of aborted fetal tissue through burial or cremation, court documents showed. The regulation, which was supposed to go into effect on Dec. 19, also would require hospitals and other medical facilities to bury or cremate miscarried fetuses. (Herskovitz, 12/15)

In a victory for abortion rights advocates, U.S. District Judge Sam Sparks on Thursday temporarily blocked the state of Texas from implementing a rule that requires fetal remains from abortions and most miscarriages to be buried or cremated. The regulation was set to go in effect Monday. (Collins Walsh, 12/15)

A federal judge in Texas has issued a temporary restraining order blocking new state rules that regulate the disposal of fetal remains from miscarriages and abortions. A preliminary injunction hearing has been set for early January. (Hersher, 12/15)

Despite serious obstacles, Republicans who control the Ohio House are considering an attempt to override Gov. John Kasich’s veto of the “Heartbeat Bill.” While Speaker Cliff Rosenberger, R-Clarksville, believes Kasich “made an important step forward” by approving a 20-week abortion ban, “some members believe the veto of the Heartbeat Bill took a step backward on this important issue,” said House GOP spokesman Brad Miller. (Ludlow, 12/15)

Widespread abuse of powerful opioids has pushed U.S. overdose death rates to all-time highs. It has also traumatized tens of thousands of children. The number of youngsters in foster care in many states has soared, overwhelming social workers and courts. Hospitals that once saw few opioid-addicted newborns are now treating dozens a year. And many of the children who remain in the care of addicted parents are growing up in mayhem. They watch their mothers and fathers overdose and die on the bathroom floor. They live without electricity, food or heat when their parents can’t pay the bills. They stop going to school, and learn to steal and forage to meet their basic needs. (Whalen, 12/15)

America's attitude toward pain has shifted radically over the past century. Psychiatrist Anna Lembke says that 100 years ago, the medical community thought that pain made patients stronger. "Doctors believed that pain was salutary," she tells Fresh Air's Terry Gross, "meaning that it had some physiologic benefit to the individual, and certainly some spiritual benefit." But as prescription painkillers became more available, patients became less willing to endure pain. (12/15)

In Maryland, heroin-related deaths tripled from 2011 to 2015, rising from 247 to 748, according to the Maryland Department of Health and Mental Hygiene. The death rate from drug overdoses in the state is the fifth-worst in the country, and it’s only likely to get worse, experts say. (Lang, 12/15)

Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs and Health – released in November as the first such U.S. report to address substance use disorders and consequences related to alcohol and drug misuse – asserts an emphatic yes. In 2015, according to the report, more than 27 million people nationwide indicated current use of illicit drugs or misuse of prescription drugs, and 66 million-plus people (nearly one-fourth of the adult and adolescent population) reported binge drinking “in the past month" ...Related health-care treatments, meanwhile, haven’t nearly kept pace. (Candelaria, 12/15)

Dr. Keith Hamilton took his turn in the patient chair and braced for the sting of an experimental Zika vaccine. The injection was the easy part. Next, a nurse jabbed three tiny needles in his upper arm with a device that delivered two electrical jolts strong enough to flex muscle. He said it felt like a needle piercing his arm, again and again. Dr. Hamilton, an infectious-diseases doctor, was on a break from his rounds to volunteer in a landmark trial of a next-generation vaccine at the University of Pennsylvania’s medical school. (McKay and Loftus, 12/15)

Across Appalachia, coal miners are suffering from the most serious form of the deadly mining disease black lung in numbers more than 10 times what federal regulators report, an NPR investigation has found. The government, through the National Institute for Occupational Safety and Health, reported 99 cases of "complicated" black lung, or progressive massive fibrosis, throughout the country the last five years. (Berkes, 12/15)

As concern rises over the effect of continuous use of headphones and earbuds on hearing, a new paper by federal researchers has found something unexpected. The prevalence of hearing loss in Americans of working age has declined. (Kolata, 12/15)

When Angelina Jolie published an essay in the New York Times about her decision in 2013 to get a double mastectomy, the essay quickly went viral. Jolie's frank and candid admission that she had inherited a "faulty" BRCA1 gene that increased her risk of developing breast and ovarian cancer and struggled with what to do struck a chord with people. Jolie revealed that she had undergone a medical procedure rarely talked about openly, much less by A-list celebrities, and said she hoped her experience could help others. (Johnson, 12/15)

Behind the self-confident gait, the friendly greeting and the air of superb competence, as many as 13% of the nation’s commercial airline pilots may be suffering from depression, and roughly 1 in 25 report they’ve had suicidal thoughts in the last two weeks, a new study reveals. But the researchers — the first to ask a large sample of airline pilots about their mental health — suggest that depressed pilots are reluctant to seek treatment for their depression for fear of being grounded or damaging their careers. (Healy, 12/15)

[Aiden] DeLathower is one of a growing number of transgender people seeking medical care they believe is needed to make their brain match their body, experts said. But for many gender nonconforming people, health care can be difficult to access. Obstacles include a lack of specialized services, exclusions in private or public insurance coverage or the high price of full medical transition, which The Philadelphia Center for Transgender Surgery estimated could cost more than $100,000.As transgender people begin to feel more comfortable coming out and living as the gender with which they’ve always identified, they are facing a “patchwork of rampant discrimination amid pockets of progress” in the health care industry, said Harper Jean, the National Center for Transgender Equality’s policy director. (Crowder, 12/15)

Concentrated estrogen, paired with a testosterone blocker, is central to what’s now known as the “gender-affirmation” process. In mid-2015, Par Pharmaceuticals and Perrigo Co., which make Delestrogen and generic estradiol valerate, respectively, stopped shipments of the 10-ml, 20-ml, and 40-ml injectable dosages of the hormones, waiting for FDA clearance for their new active-ingredient supplier. That approval is still pending, and existing stock in Philadelphia, a hub for the trans community, seems to have eclipsed this summer. (Friedman-Rudovsky, 12/16)

Old age is not necessarily a barrier to kidney donation. A new study has found a kidney transplanted from a deceased 79-year-old can be as effective as one from a person 30 years younger. Generally, guidelines classify donors older than 50 as “extended criteria donors,” but shortages have led to using these donors more frequently. (Bakalar, 12/15)

Diana Teller never thought she was too old for anything, not scuba diving or traveling the world or taking Italian lessons late in life, her family recalled. So when the vivacious San Diego woman died last year at age 76 after a sudden brain hemorrhage, no one questioned whether she was too old to be an organ donor. “I guess I never really thought of her as her age,” said daughter Lori Teller, 57. “This was something she wanted to do.” Despite such convictions, donations from senior citizens like Teller — whose corneas, kidneys, liver and tissue were used — rarely happen. (Aleccia, 12/15)

Gov. Larry Hogan's health secretary will immediately leave his job, the governor's office announced Thursday.Outgoing Secretary Van T. Mitchell, a former lobbyist and Democratic state delegate, has led the Department of Health and Mental Hygiene since Hogan was inaugurated almost two years ago. This year, his department has been under scrutiny. State facilities do not have enough beds to treat dangerous patients with mental illness. And assaults on some workers have risen, an increase a state employee union has blamed on under staffing. (Cox, 12/15)

One of metro Atlanta’s last “standalone” hospital organizations will seek an alliance with another health system in the coming months. The DeKalb Medical system, which runs hospitals in Decatur and Lithonia, will look for both local and out-of-state potential partners, said Cheryl Iverson, vice president of marketing and strategic planning. (Miller, 12/15)

Elliot Health System broke ground Thursday on a new Bedford Medical Center being constructed on Leavy Drive near Copper Door restaurant. The first phase of the 58,000-square-foot medical office is expected to be open in January 2018...The new facility at 24 Leavy Drive is being constructed in two phases. The first phase includes two levels and should be completed in about a year; the second phase includes construction of a third level. The Bedford Medical Center will consolidate three existing primary care practices housed throughout different locations in Bedford — Elliot Family Medicine at Bedford Commons, Elliot Family Medicine at Bedford Village and Pediatric Health Associates of Bedford. (Houghton, 12/15)

The leaders of two of the most powerful governmental institutions in San Francisco are at odds over how to deal with one of the city’s most enduring problems, demonstrating how little agreement there is when it comes to tackling homelessness. (Green, 12/15)

Kansas was the only state where the obesity rate went up significantly in 2015, according to an annual report, and state officials are trying to figure out why and how to reverse the trend. The state also lagged on vaccination rates and remained stuck in the middle on overall health, according to the America’s Health Rankings Report, which was released Thursday by the United Health Foundation. Kansas ranked 27th in the report, which rates the 50 states on a broad range of measures, including health behaviors, access to care, state policies and residents’ health outcomes. The state has hovered at 26th or 27th since 2013. (Wingerter, 12/15)

A recently released study shows where babies in Wyandotte County are at the highest risk of dying, but figuring out how to prevent infant deaths and help their mothers stay healthy remain unsolved problems. The study on health disparities in Wyandotte County, sponsored by the Community Health Council, found that residents in some parts of the county were more likely to die prematurely, with residents of the least healthy neighborhoods dying at an average age of 59. While many factors contribute to early deaths, high numbers of infants dying can pull down the average. Infant mortality rates have been consistently higher in Wyandotte County than the state as a whole in recent years. (Wingerter, 12/15)

A newly released survey has found that half of Massachusetts student athletes who said they experienced concussion-like symptoms continued playing that day. At the same time, more than 200 schools have violated state rules by failing to report data on head injuries students suffered during the 2015-16 academic year. (Rocheleau, 12/15)

The health care market in southeastern Wisconsin has changed significantly in the past decade, with hospitals overall becoming more efficient and keeping rate increases for commercial health plans at roughly half the pace of a national benchmark, according to a study released Thursday. (Boulton, 12/15)

As the Alcohol, Drug and Mental Health Board of Franklin County took new steps this week to fight the still-raging opiate crisis, the Columbus Foundation added support by announcing a first-of-its kind community fundraising effort to aid in the battle. (Price, 12/15)

In hopes of avoiding a crisis as Arizona's minimum-wage rises, the state's Medicaid program plans to boost the amount it pays companies that serve people with disabilities. The companies that serve the state's most vulnerable residents have said they may not survive the voter-approved minimum-wage hike without a pay raise of their own from the state. (Rau, 12/15)

Ohio's medical-marijuana program is coming into focus with rules now proposed for cultivators who grow it, doctors who recommend it for patients, and dispensaries that sell it. The latest development came Thursday when the Ohio Board of Pharmacy recommended that 40 dispensaries be scattered around the state to sell medical marijuana to qualifying patients. (Johnson, 12/16)

There is a growing body of data about marijuana’s medicinal benefits, and groups like the American Nurses Association acknowledge it can help with chronic pain, MS, anxiety and many other conditions. But because it’s still illegal under federal law, there aren’t a lot of places medical professionals can learn about it. And if you ask your regular doctor whether it will help your particular ailment, there’s a good chance they might not know. (Stelzer, 12/15)

Up to 40 medical marijuana dispensaries would be licensed in Ohio under draft rules released Thursday morning. Would-be dispensary owners would have to pay a $5,000 application fee and an $80,000 license fee every other year. Applicants must show they have liquid assets totaling at least $250,000. (Borchardt, 12/15)

Johanna Watkins had hoped to be raising a family by now. Instead, the 29-year-old is battling a life-threatening disorder that’s forced her into isolation.Johanna hasn’t seen her parents, Gail and Jon Fuenning, in more than a year, the Post-Bulletin reported. Her husband’s mere presence in the same room has caused anaphylaxis — an acute allergic reaction that can be fatal — since April...The symptoms are startling: migraines that leave welts, food allergies that cause a distended stomach and pregnancy-like stretch marks, nonfunctioning bowels, life-threatening sensitivity to sunlight, odors and virtually all foods, among other things. She’s even allergic to common pill casings and pain relief medication, which makes surgery basically impossible. (Boese, 12/15)

A surprise medical bill is a bill from an out-of-network provider that was not expected by the patient or that came from an out-of-network provider not chosen by the patient. In 2014, 20 percent of hospital inpatient admissions that originated in the emergency department (ED), 14 percent of outpatient visits to the ED, and 9 percent of elective inpatient admissions likely led to a surprise medical bill. (Garmon and Chartock, 12/14)

This systematic review and meta-analysis found that the pooled estimate of attrition prevalence among general surgery residents was 18%, female residents were more likely to leave than male residents, and residents were most likely to leave after the first postgraduate year owing to an uncontrollable lifestyle. The most common destination of residents who left was relocating to another general surgery program or switch to another specialty. ... Attrition prevalence is relatively high among general surgery residents and future research should focus on developing strategies to limit resident attrition. (Khoushhal et al., 12/14)

This longitudinal cohort study observed 956 women semiannually for 5 years. Eight days after seeking an abortion, women who were denied an abortion reported significantly more anxiety symptoms and lower self-esteem and life satisfaction, but similar levels of depression, as women receiving abortions; outcomes improved or remained steady over time. (Biggs et al., 12/14)

This study provides national prevalence estimates of US military Veterans with severe pain, and compares Veterans to nonveterans of similar age and sex. Data used are from the 2010-2014 National Health Interview Survey (NHIS) .... It was estimated that 65.5% of US military Veterans reported pain in the previous 3 months, with 9.1% classified as having severe pain. In comparison to Veterans, fewer nonveterans reported any pain (56.4%) or severe pain (6.4%). While Veterans aged 18-39 had significantly higher prevalence rates for severe pain (7.8%) than did similar-aged nonveterans (3.2%), Veterans age 70 or older were less likely to report severe pain (7.1%) than nonveterans (9.6%). (Nahin, 12/13)

The current situation presents an opportunity to replace the Affordable Care Act with a more sustainable bipartisan law. ... starting with repeal and delay threatens to destabilize the individual market and harm ... everyone who now purchases insurance in the individual market. Estimates show that premiums would jump at least 20 percent and cause 4.3 million to lose health insurance as soon as next year, and that’s nothing compared to the damage that would be inflicted if a replacement plan subsequently failed to emerge. (Rivlin, Adler, and Butler, 12/13)

As a result of the Medicare provisions included in the ACA, Medicare spending per beneficiary has grown more slowly than private health insurance spending; premiums and cost-sharing for many Medicare-covered services are lower than they would have been without the ACA; new payment and delivery system reforms are being developed and tested; and the Medicare Part A trust fund has gained additional years of solvency. Full repeal of the Medicare provisions in the ACA would increase payments to hospitals and other health care providers and Medicare Advantage plans, which would likely lead to higher premiums, deductibles, and cost sharing for Medicare-covered services paid by people with Medicare. Full repeal would also reduce premiums for higher-income beneficiaries. (Cubanski et al., 12/13)

We present new evidence suggesting that a historic public health insurance expansion for pregnant women and children in the United States in the 1980s and 1990s may have had long-lasting effects on the oral health of the children gaining eligibility. ... We found that expanded Medicaid coverage geared toward pregnant women and children during their first year of life was linked to better oral health in adulthood among non-Hispanic blacks. Our results also suggested that there might be a benefit to expanded public health insurance eligibility for children at ages 1–6 among non-Hispanic blacks and Hispanics. (Lipton et al., 12/5)

This paper systematically analyzes CMS’s nursing home rating system, demonstrates the existence of inflation, and presents a model to detect likely inflators. We show that nursing homes have strong financial incentives directly related to higher star ratings, which may in turn drive the inflating behaviors. We then develop a systematical method which uses the independent third-party measure of patient complaints to demonstrate the existence of rating inflation. An inflation prediction model is then developed, which provides an estimate of the proportion of inflating nursing homes in the current system, and gives a quantifiable evaluation of the system performance. (Han, Yaraghi and Gopal, 12/15)

In this report, we analyze the potential policy benefits of taxing sugar content; document how content-based taxes have been used to discourage consumption of sugar, alcohol, and tobacco; and examine the legal and practical challenges of implementing such taxes at the federal, state, and local level. We conclude that taxing based on the amount of added sugar a drink contains, either by taxing sugar content directly or by levying higher volume taxes on drinks with more sugar, is feasible in many jurisdictions and reduces sugar consumption more effectively than comparable taxes on drink volume. Broad-based volume or sales taxes on all soft drinks, however, raise revenue more efficiently. (Francis, Marron and Rueben, 12/12)

Varying levels of patient volume and diabetes management experience influenced the quality of diabetes care provided by primary care physicians in the Canadian province of Ontario, researchers said. The cohort study found that patients of primary care physicians with higher ambulatory volumes tended to receive significantly lower-quality diabetes management, wrote Andrew Cheung, MD, of McMaster University, and colleagues in Annals of Internal Medicine. (Monaco, 12/12)

Annoyed business owners and frightened neighbors weren’t the only ones who noticed that the “Pokemon Go” craze sent a lot of people walking. Scientists took note too, and in a new study they confirmed that many of the mobile game’s players walked farther than before, to places they hadn’t previously visited, in search of elusive imaginary creatures visible in its augmented reality display. But, the findings published in BMJ indicate, that effect did not last long: Within six weeks they were back to their normal activity habits. (Samuel, 12/13)

The stresses of poverty in the United States have grown so intense that they are harming the health of lower-income Americans — even prematurely leading to their death. A report published Monday by the Hamilton Project at the Brookings Institution finds that stress levels have greatly increased for Americans at all income levels since the 1970s, but especially for low-income groups, as the chart below shows. (Swanson, 12/13)

About one in six American adults reported taking at least one psychiatric drug, usually an antidepressant or an anti-anxiety medication, and most had been doing so for a year or more, according to a new analysis. The report is based on 2013 government survey data on some 242 million adults and provides the most fine-grained snapshot of prescription drug use for psychological and sleep problems to date. (Carey, 12/12)

New research out Monday shows that when primary care patients get help attaining basic resources — like food, housing, heat and access to affordable medicines — it leads to improvements in their blood pressure and cholesterol levels. The findings, published in JAMA Internal Medicine, may be intuitive. But they provide further evidence that a Boston-based nonprofit founded 20 years ago by a Harvard undergraduate is on the right track by focusing on patients' "unmet social needs" as a critical pathway toward true health. (Zimmerman, 12/12)

In policy and political debates, we often forget the human impact of weighty choices. Abstract numbers, ideological arguments, “he said, she said” talking points and outright falsehoods — these are the currency of our public discourse. (Topher Spiro, 12/15)

Politico’s lead headline today blares: “Democrats open to replacing Obamacare.” The story accompanying that headline is more nuanced than that. But it does raise the prospect that some Senate Democrats might be going wobbly about the coming battle over repeal and replace. And it points out that Dems might find themselves under pressure to acquiesce to Republicans in ways that would produce a terrible outcome. (Greg Sargent, 12/15)

Not so long ago, Republicans took unbridled delight in mocking President Obama’s assertion that “if you like your health care plan, you can keep it” under the Affordable Care Act. The mockery was justified. Millions of Americans found their health insurance canceled, or suddenly too expensive to maintain, thanks to the law. PolitiFact went so far as to dub the president’s assertion the Lie of the Year for 2013. But now Republicans might wish they had toned it down a notch. (12/15)

Repeal Obamacare? Really? Repeal of the Affordable Care Act, also known as Obamacare, is a well-known priority of President-elect Trump and Republicans in Congress, bolstered by Trump voters. But, while “yes or no” polling about the possible repeal of the ACA tells us something about Republicans’ antipathy to the law, more detailed polling questions reveal a complex picture. (Jessica Schorr Saxe, 12/15)

Now is not the time for Governor Charlie Baker to slash funding for substance abuse treatment in Massachusetts. In 2015, there were 1,574 confirmed accidental opioid deaths, a 20 percent increase over the previous year’s 1,383. As of September, the state’s opioid epidemic claimed another 1,005 people, with an additional estimated, or unconfirmed, 392 to 470 deaths. (12/15)

Last week, as part of national LGBT Week of Action for Healthcare Enrollment, Secretary of Health and Human Services Sylvia Burwell, Director of the White House Office of National Drug Control Policy Michael Botticelli, and I held a phone conference with members of the LGBT community to discuss the importance of enrolling in healthcare coverage. The open enrollment period to purchase 2017 health insurance through the Health Insurance Marketplace runs through January 31st, but the deadline for coverage starting January 1st is December 15th. People who need coverage should check out their options — most HealthCare.gov consumers can gain coverage for less than $75 per month. (Valerie Jarrett, 12/15)

Digital health innovations and applications, including virtual doctor’s appointments and smartphone health apps, can help us live better and longer lives. But many rural Californians don’t have access to these services as access to broadband internet and access to health care is rapidly becoming one and the same. (Eric Brown, 12/15)

Earlier this week, the Ohio state legislature passed a bill that would ban all abortions after 20 weeks, with a very narrow exception for the health of the mother (since Ohio begins the clock with fertilization and not the traditional method of counting the weeks from the last menstrual cycle, it is in reality a 22-week ban). The rationale for the legislation is that at 20 weeks a fetus can feel pain, though there’s no serious medical evidence to support that conclusion. But the Ohio law would represent a significant shift from previous Supreme Court rulings that allowed abortions to occur before the fetus was “viable” (i.e., could live outside the womb), which is around 24 to 26 weeks. (Michael Cohen, 12/15)

The common goal of health policy leaders at the level of state government in the United States is promoting the health and well-being of all populations to the greatest extent possible within fixed resource constraints. Our health is affected by our physical and social environments, our genes, our economic and educational opportunities, and to a much lesser degree, the medical care we receive. State leaders understand that as a society we are spending our health care dollars in the wrong ways for the wrong things — emphasizing treatment over prevention and medical care over social services. (Christopher F. Koller, Thomas Alexander and Susan Birch, 12/14)

The research community is on the cusp of unlocking vital treatments for many rare diseases, as well as many common disorders that burden our society. The funding called for in the [21st Century Cures Act], as well as changes to the approval processes, will speed the discovery and translation of this work to improve lives now and in the future. (David J. Bailey, 12/15)

Being poor should not subject people to a different standard of health care. That is why, in my eight years leading the Maricopa Integrated Health System, I worked to improve clinical quality, train more doctors  and improve equipment and facilities. And it is why I oppose the creation of dental therapists in Arizona, the wrong answer to the real problem of access to dental care. An effort is underway to push this experimental, one-size-fits all solution. (Betsey Bayless, 12/15)

In 2012, the U.S. Court of Appeals for the Second Circuit handed down a landmark decision in the case of pharmaceutical sales representative Alfred Caronia. The Food and Drug Administration (FDA) had approved sodium oxybate (Xyrem) for treating narcolepsy, but Caronia promoted it for a wide range of nonapproved (off-label) indications, including insomnia, Parkinson’s disease, and fibromyalgia. Off-label use is common, especially in specialties such as oncology, in which it may even be considered the standard of care. However, surveys have revealed that supporting evidence is lacking for a majority of off-label uses of medical products. The uses Caronia proposed were not based on high-quality data and were likely to cause patients substantial harm. (Christopher Robertson and Aaron S. Kesselheim, 12/15)

As the new administration and Congress look to improve our health care system, they must ensure addressing health insurance barriers many Americans face in accessing prescribed treatment remains a top priority. Federal and state policymakers now have an opportunity to improve care if they listen to the patient voice. A new poll, conducted by the Alliance for the Adoptions of Innovation in Medicine (Aimed Alliance) in conjunction with David Binder Research, shows that many Americans hold their health insurers to high standards and expect to receive quality care—conveying a disconnect between expectations and reality. (Stacey L. Worthy, 12/15)

Integrating behavioral health care with primary care is now widely considered an effective strategy for improving outcomes for the many millions of Americans with mental or behavioral health conditions. Uptake of behavioral health integration (BHI) has remained limited, however, largely because BHI has not been paid for separately, which has left primary care clinicians without a clear business model for incorporating these services into their practice. But on January 1, 2017, the Centers for Medicare and Medicaid Services (CMS) will begin paying clinicians separately for the BHI services they provide to Medicare beneficiaries. (Matthew J. Press, Ryan Howe, Michael Schoenbaum, Sean Cavanaugh, Ann Marshall, Lindsey Baldwin and Patrick H. Conway, 12/14)

Review of the ethics of multicenter clinical studies is typically conducted by the institutional review board (IRB) of each participating center. Extensive evidence suggests that the current practice is costly, is unnecessarily duplicative, and delays commencement of research. The U.S. government has permitted single-IRB review and other streamlined review models since 1991, but few investigators have taken advantage of those options. (Ann-Margret Ervin, Holly A. Taylor and Stephan Ehrhardt, 12/15)