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The Obama administration on Thursday said that millions of people with health insurance purchased in the new federal marketplace would need to switch to different health plans to avoid increases in premiums or reductions in the subsidies they received from the government. In other words, officials said, consumers may need to find new health plans if they want to make sure their coverage under the Affordable Care Act is, indeed, affordable. (Pear, 12/4)

The Obama administration on Thursday issued a plea to Obamacare customers returning to the law's health insurance marketplaces: shop around if you want to get a better deal this year. More than 70 percent of people currently enrolled in Affordable Care Act health insurance marketplace insurance can find a 2015 health plan offering the same level of coverage at a cheaper premium, according to a report from the Department of Health and Human Services. Almost of 80 percent of current enrollees could find a health plan with a monthly premium lower than $100 after tax credits are applied, HHS said. (Millman, 12/4)

More than 70 percent of people who currently have insurance through the health law’s federal online marketplace could pay less for comparable coverage if they are willing to switch plans, officials said Thursday. With a Dec. 15 deadline looming for coverage that would begin Jan. 1, current policy holders should come back to healthcare.gov to see if they can get a better deal, the officials said. They’ll find more plans available and nearly 8 in 10 current enrollees can find coverage for $100 or less a month, with subsidies covering the rest of the cost. (Carey, 12/4)

More than 70 percent of people now enrolled in a health law marketplace plan could get cheaper monthly premiums by returning to the healthcare.gov marketplace and picking a different plan, Obama administration officials said on Thursday. But less than 6 percent of the 6.7 million current enrollees had renewed their coverage by Nov. 28, and those who don’t switch in the next 11 days will be automatically renewed in their same plan for 2015. Administration officials said Thursday that they did not know how many of the 397,870 people who renewed coverage by Nov. 28 chose different plans. (Adams, 12/4)

Nearly two-thirds of current Obamacare enrollees can get 2015 coverage with subsidized monthly premiums of $100 or less if they switch to a cheaper plan at the same metal level, HHS said Thursday, pressing its message that Americans should shop around to avoid unexpected cost hikes. (Pradhan, 12/4)

Many people covered under President Barack Obama's health care law will face higher premiums next year, the administration acknowledged Thursday. While the average increases are modest, it's more fodder for the nation's political battles over health care. Officials stressed that millions of current HealthCare.gov customers can mitigate the financial hit if they're willing to shop around for another plan in a more competitive online marketplace. Subsidies will also help cushion the impact. (Alonso-Zaldivar, 12/4)

Federal health officials reiterated their call Thursday for current HealthCare.gov enrollees to shop around for health plans, citing a new report that detailed significant financial benefits for doing so. Officials with HealthCare.gov, the online health insurance marketplace for 37 states including Missouri and Illinois, and the Centers for Medicare and Medicaid Services urged consumers to return to the site and explore new plan offerings. (Shapiro, 12/5)

More than 80 percent of Floridians who signed up for health insurance under the Affordable Care Act can buy coverage for $100 or less in monthly premiums after receiving tax credits, according to a report released Thursday by the federal government. The report examined the options available to people signing up for coverage in 2015. Some consumers may choose more expensive plans that offer better benefits and lower deductibles. (Nehamas, 12/4)

When the Affordable Care Act’s federal marketplace opened last year, Beth and Doug Warner of St. Petersburg asked a navigator to enroll them. But they discovered their income wasn’t high enough to get a subsidy. Without one, Doug Warner said, the policy for the couple would cost $700 a month. “Basically the choice was, ‘Keep the roof over your head or buy healthcare.'” It’s one of the great ironies of the health overhaul. Floridians most in need of health insurance -- adults below the poverty line -- are often blocked from coverage the Affordable Care Act provides. (Gentry, 12/4)

The Feb. 15 deadline to sign up for health insurance coverage on the federal Healthcare.gov website is quickly approaching, and low-wage workers like DeAngelo Morales and Isaac McQueen are stuck between a rock and hard place. McQueen, 35, a father of two, has worked at Domino’s Pizza for 10 years as a pizza maker. He says he doesn’t qualify for subsidies offered under the Affordable Care Act. He also doesn’t qualify for Medicaid after North Carolina declined to expand the program to adults who make more than 49 percent of the federal poverty level, which works out to $9,697 a year for a family of three. (Namkoong, 12/5)

Tom and LaDonna Appelbaum have a knack for good timing. The West County couple spent a nerve-wracking four years without health insurance but never had a serious medical issue to worry about. When it came time to sign up for coverage under President Barack Obama’s health overhaul last year, the Appelbaums decided they weren’t going to take any more chances. They qualified for a subsidy to help reduce the cost of their monthly premium. And it wasn’t a moment too soon. In June, Tom Appelbaum, a self-employed attorney, had a boating accident that required surgery on his right hand. And just two months later LaDonna Appelbaum was diagnosed with breast cancer. (Shapiro, 12/4)

Many members of mixed-status families have balked at enrolling in Medi-Cal or Covered California over concerns that application information might end up in the hands of immigration authorities. That won't happen, according to Pedro Ribiero, assistant director of public affairs for immigration and customs enforcement at the U.S. Department of Homeland Security. (Gorn, 12/4)

Premiums for health care policies sold in Dallas County by Cigna and BlueCross BlueShield of Texas are higher next year. Premiums for Aetna and Molina plans are lower. Aetna is raising deductibles and co-pays, though, while many BlueCross plans are standing pat on those costs. The changes offer consumers more choices, and more reason to look at total costs as well as premiums. (Landers, 12/4)

A St. Joseph, Minn., employer has received a religious exemption to the federal mandate requiring birth control coverage in workplace health insurance, a case that stems from the Hobby Lobby ruling that weakened a key plank of Obamacare. (Olson, 12/4)

In his re-election pitch, the likely incoming Senate Majority Leader Mitch McConnell vowed to repeal Obamacare, saying the law should be pulled out "root and branch." But now? The Kentucky Republican is singing quite a different tune. "We may have that vote," McConnell said of repealing President Barack Obama's signature health care law on Fox News Thursday. "But I don't think that there's six Democrats that are going to vote with 54 Republicans and pass it." Instead, McConnell suggested that an upcoming Supreme Court ruling may be the best way to undermine the law to the point of collapse. (Fischer, 12/4)

Republicans have a full menu of Obamacare repeal options when they take the majority in the Senate next month. Incoming Majority Leader Mitch McConnell wants to hold a vote on the full repeal of the health law, as well as repeal of specific elements such as the medical device tax, individual mandate and the 30-hour work week. Each has varying degrees of support. (Haberkorn and Norman, 12/4)

Twenty-five Republicans are asking the Supreme Court to take up another case against ObamaCare, this time challenging a controversial medical board that the party has labeled “a death panel.” Members led by Sen. Tom Coburn (R-Okla.) and Rep. Phil Roe (R-Tenn.) are urging the high court to reconsider a lawsuit against the Independent Payment Advisory Board (IPAB), which is charged with cutting Medicare spending if it exceeds a certain level. (Ferris, 11/4)

A Medicare cost-cutting board established by the 2010 health law but yet to be appointed reemerged as a Republican target Thursday, with GOP lawmakers endorsing a legal challenge and pushing for its repeal. A group of 24 House Republicans and Sen. Tom Coburn, R-Okla., filed a friend of the court brief asking the Supreme Court to take up a lawsuit challenging the constitutionality of the Independent Payment Advisory Board. The panel was included in the health overhaul to make annual cost-cutting recommendations if Medicare spending exceeds a target growth rate. (Attias, 12/4)

Former Senate Majority Leader Trent Lott (Miss.), a leading Republican figure over the past two decades, said Thursday his party should pass a technical fix to avert a court challenge to ObamaCare. Lott told reporters at a breakfast sponsored by The Christian Science Monitor that making technical changes to the landmark healthcare reform should not become a subject of political warfare. (Bolton, 11/4)

The relatively straight path from the House GOP’s closed-door discussion of their options Tuesday to next week’s passage of a bipartisan spending bill would stand in contrast to the run-up to the October 2013 partial government shutdown. Last fall, the House and Senate lobbed bills between the chambers, as Republicans sought to strip funding for the 2010 health-care law and Democrats insisted on restoring it. (Peterson, 12/4)

President Barack Obama will be awarded the bulk of his $6.2 billion request to fight Ebola in Africa, a senior member of the Senate Appropriations Committee said Thursday. (Taylor, 12/4)

Discretionary spending including defense is capped at just under $1.014 trillion — a virtual freeze at current levels. And the two big off-budget increases — to fight Ebola and the Islamic State forces in Iraq and Syria — are emergencies that Republicans can’t afford to ignore. For example, the tentative $5.3 billion agreement on Ebola funding — covering foreign aid and health accounts — would give Obama much of his $6.2 billion request. And Republicans want all — if not more — of the extra money requested by the president since last June to plus-up overseas contingency funds for the Pentagon, now expected to receive about $64 billion in OCO dollars under the draft 2015 bill. (Rogers, 12/4)

Virginia’s new laws governing regulation of the state’s 18 first-trimester abortion clinics will be rewritten. The Virginia Board of Health voted 13-2 Thursday to begin a lengthy regulatory process to amend the stringent requirements enacted during the administration of former Gov. Bob McDonnell, a Republican. (Nolan, 12/4)

The Virginia Board of Health decided Thursday to move forward with a review of rules for abortion clinics, the latest step in a lengthy process that could roll back controversial regulations finalized last year. The move was a victory for Gov. Terry McAuliffe (D), who campaigned on a promise to reverse the rules, which regulate abortion clinics as if they were hospitals by dictating such details as hallway widths and the number of parking spots. Opponents of the regulations say they were intended to block access to abortion by closing down clinics that do not meet the requirements. (Portnoy, 12/4)

The State Board of Health voted Thursday to begin revising Virginia's hotly debated abortion clinic regulations, giving new hope to abortion-rights advocates who argue that the current rules are driven by politics instead of science. The 13-2 vote starts a new regulatory process that could take up to two years. By then, the 15-member board will be dominated by appointees of Democratic Gov. Terry McAuliffe, who has vowed to act as a "brick wall" against abortion restrictions. McAuliffe has appointed six board members and will have a chance to replace four more Republican holdovers by June 2016. (O'Dell, 12/4)

The Virginia Board of Health agreed Thursday to revise the state’s abortion clinic regulations, making it likely that requirements that clinics meet the same standards as hospitals will be eased. (Winfield Cunningham, 12/4)

Both Fitch and Moody’s Investors Services say they expect a “stable” — neither positive nor negative — year ahead, thanks to a consistent but slow economic recovery. That outlook would improve if growth in tax revenues for state and local governments picks up speed, according to a pair of Moody’s reports issued Wednesday. Those conclusions are largely in line with an analysis of state governments from Fitch ratings agency earlier this week, which found that states enjoy mostly stable ratings for the year ahead. There are some risks to the outlook, though: namely pressures from anti-tax sentiment, building expenses for programs such as Medicaid and overall economic volatility. (Chokshi, 12/4)

In health policy circles, they are called “super-utilizers,” but the name isn’t meant to connote any special powers. Just the opposite. They are people whose complex medical problems make them disproportionately heavy users of expensive health care services, particularly emergency room treatment and in-patient hospitalizations. The cost of treating them is huge: Just 5 percent of Medicaid’s 68 million beneficiaries account for 60 percent of the overall spending on the program. Using a provision of the Affordable Care Act, many state Medicaid agencies are trying to diminish use of medical services by super-utilizers by better managing their care. The goal is to not only reduce costs, but to achieve better health outcomes for these patients. (Ollove, 12/5)

You'd expect the socially progressive states of the Northeast and Midwest to score well in a new state-by-state ranking of mental health services, and indeed, by some measures they do. When the advocacy group Mental Health America released the first-ever such rankings Wednesday, Massachusetts, Vermont, Maine, North Dakota, and Delaware received the highest overall scores when prevalence of mental illness is compared to access to care. Arizona, Mississippi, Nevada, Washington, and Louisiana received the lowest marks. (Bernstein, 12/4)

The rising number of workforce dropouts has troubling implications for the state's competitiveness, entitlement programs, consumer spending and more, economists said. An economic forecast released Wednesday by Chapman University suggested that the slack labor market still has room to grow. A shrinking labor force could force employers to recruit outside the state, raising immigration and visa issues. Households with fewer breadwinners might scale back spending. A disproportionately small pool of earners may mean less tax revenue for public programs such as Medicare. (Hsu, 12/4)

In Florida, as in the rest of the nation, the number of children without healthcare coverage has declined during the last five years — but the Sunshine State still has one of the country’s highest rates of uninsured children, a challenge that could be met or missed depending on policy decisions on the state and federal levels, according to a brief published this week by the Georgetown University Center for Children and Families. While the number of uninsured children aged 18 and younger in the state has decreased from about 668,000 in 2008 to 445,000 in 2013, according to the report, Florida has the highest rate in the South and fifth highest in the nation. (Chang, 12/4)

North Dakota's Insurance Department has levied $60,000 in fines against the state's largest health insurer for what Insurance Commissioner Adam Hamm calls "egregious" violations of state law. A months-long state examination prompted by consumer questions and complaints uncovered several violations and "deficiencies" in the way Noridian Mutual Insurance Co. did business between March 2010 and May 2013, Hamm said Thursday. Noridian operates as Blue Cross Blue Shield of North Dakota. (Nicholson, 12/4)

[O]nly about 2% to 7% of US adult patients with cancer participate in clinical trials. Poor accrual to clinical trials has far-reaching implications in the way it affects the pace of progress, cost of drug development, and generalizability of study findings. ... We found that 45.6%, 50.2%, 52.2%, and 38.4% of patients with metastatic breast, prostate, colorectal, and non–small cell lung cancer, respectively, would need to drive more than 60 minutes 1 way to access a clinical trial site. The Mountain, West North Central, and West South Central regions were generally associated with the longest travel times. ... Our findings suggest that innovative approaches are needed to improve the geographic accessibility of trials for patients with advanced cancer in the United States. (Galsky et al., 12/1)

Discharges to [post-acute care] PAC facilities rose nearly 50% over the 15 years, resulting in 1.2 million more discharges to PAC facilities in 2010 compared with 1996 rates. Concurrently, hospital lengths of stay progressively decreased .... There are several potential explanations for these findings. Medicare’s prospective payment system may have influenced other payers leading to “quicker and sicker” discharges, and penalties for 30-day readmissions ... may have had the unintended consequence of increased discharges to PAC facilities. The rise in hospitalist care and changes in the epidemiology of diseases admitted to the hospital may also be significant contributors. ... Policymakers must consider whether the increase in discharges to PAC facilities represents a positive phenomenon or unintended consequences of payment reform. (Burke, 12/1)

In 2008–2012, most older people with a disability had more than one type of disability, and they were likely to be women, aged 85 and over, with less than high school education, widowed, living alone, or living in or near poverty. There were also differences by race and Hispanic origin; older Blacks and Hispanics with a disability had higher rates of poverty, and older Blacks and Whites with a disability had higher rates of living alone. ... With the first Baby Boomers having entered the 65-and-older ranks in 2011, the United States may experience a rapid expansion in the number of older people with a disability in the next 2 decades. The future of disability among older Americans will be affected by how this country prepares for and manages a complex array of demographic, fiscal, medical, technological, and other developments. (He and Larsen, 12/2)

One-third of consumers in the United States who consulted physician website ratings reported selecting and/or avoiding physicians because of these ratings. However, little is known about the validity of these ratings. Available studies have focused mostly on hospital website ratings or non-US website ratings. We partially address this gap by measuring the association between US physician website ratings and traditional quality measures (QMs) of clinical and patient experience. ... The associations between physician website ratings and clinical QMs were small and statistically insignificant. ... For patient experience QMs, associations were also small but were statistically significant. (Gray et al., 12/1)

A common type of knee surgery may increase the chances of arthritis, a new study suggests. The procedure repairs tears in the meniscus, a piece of cartilage that acts as a shock absorber. ... In their study, the scientists used MRI scans to look at 355 knees with arthritis, and compared them to a similar number of knees without arthritis. ... All 31 knees that were operated on to repair meniscal tears developed arthritis within a year, compared with 59 percent of knees with meniscal damage that did not have surgery. (Preidt, 12/3)

Newly diagnosed diabetics generally don’t take advantage of educational programs that could help them manage their disease, a new study suggests. Diabetes self-management education and training (DMST) programs help patients learn to do all the self-care that is essential for control of their blood sugar, the authors of the study explain. ... When [researchers] looked at claims data from almost 100,000 adults with private insurance who were diagnosed with diabetes in 2009-2012, they found that less than seven percent participated in diabetes self management education training. (Lehman, 12/2)

Health information exchanges (HIEs) may reduce emergency department (ED) use and costs in some cases, but their effects on other outcomes are unknown, new research indicates. Robert Rudin, PhD, from RAND Health in Boston, Massachusetts, and colleagues found modest evidence of ED cost reductions in a systematic review of studies published between January 2003 and May 2014. They published their results in the December 2 issue of the Annals of Internal Medicine. (Frellick, 12/2)

Patients who suffer injuries, infections or mistakes during medical care rarely get an acknowledgment or apology, researchers at the Johns Hopkins University School of Medicine report. The study was based on responses of 236 patients who completed ProPublica's Patient Harm Questionnaire during the one-year period ending in May 2013 and who agreed to share their data. Results of the study, led by professor of surgery Marty Makary and conducted independently from ProPublica, were published online Nov. 13 by the Journal of Patient Safety. (Pierce and Allen, 11/21)

The utilization of medical care varies considerably across the United State .... This variation has often been interpreted to imply that areas of high spending are overusing or misusing services .... But at least when it comes to the use of cancer-related imaging, geographic differences in the allocation of care do not necessarily indicate overuse, according to a new analysis. In fact, say the authors, comparing utilization of cancer-related imaging across regions is not a reliable way of measuring the overuse of these services. The article was published online December 1 in the Annals of Internal Medicine. (Nelson, 12/1)

It’s easy to understand why Republicans wish health reform had never happened, and are now hoping that the Supreme Court will abandon its principles and undermine the law. But it’s more puzzling — and disturbing — when Democrats like Charles Schumer, senator from New York, declare that the Obama administration’s signature achievement was a mistake. (Paul Krugman, 12/4)

Eighty-five percent of Americans already had health insurance, argued Schumer. Yet millions have suffered dislocations for the sake of a minority constituency — the uninsured — barely 13 percent of whom vote. This has alienated the Democrats’ traditional middle-class constituency. Indeed, in a 2013 poll cited by the New York Times’ Thomas Edsall, by a margin of 25 percent, people said Obamacare makes things better for the poor. But when the question was, does it make things better “for people like you,” Obamacare came out 16 points underwater. Moreover, for whites, whose support for Democrats hemorrhaged in 2014, 63 percent thought Obamacare made things worse for the middle class. (Charles Krauthammer, 12/4)

At this point, the only real threat to the Affordable Care Act is one ridiculous Supreme Court case. There’s a phrase in the legislation that suggests, if ripped from context, that subsidies are only supposed to support consumers in states with their own exchange marketplaces – not those who enrolled in insurance plans through healthcare.gov. ... the Supreme Court majority may conclude, then it’s up to Congress to pass a bill to add clarity. In an interesting twist, a prominent Republican has suggested his former brethren do exactly that. (Steve Benen, 12/4)

Thanks to four justices of the Supreme Court, there is now a clear path to repealing and replacing the Affordable Care Act next year, finally bringing Obamacare to an end. But Republicans won't accomplish this by waiting for the court or just voting to repeal the law one more time. The only way they can succeed is by crafting their own replacement — and they need to start right away. (Randy E. Barnett, 12/4)

Positive action on multiple fronts and the recovering economy are helping to reduce the growth in health-care costs to historically moderate levels. But there is no comprehensive national approach to controlling health-care costs. Further, there is little coordination of the disparate efforts across the country, and we can’t say for sure what is working and what is not. (Drew Altman, 12/4)

At first glance, the 2015 health plans offered by the Ohio nonprofit insurer CareSource look a lot like the ones it sold this year, in the Affordable Care Act’s first enrollment season. The monthly premiums are nearly identical, and the deductibles are the same. But tucked within the plans’ jargon are changes that could markedly affect how much consumers pay for health care. (Charles Ornstein, Ryann Grochowski Jones and Lena Groeger, 12/4)

Express Scripts, which handles prescription-drug benefits for millions or people nationwide, is dropping coverage for 66 brand-name drugs next month in an effort to keep costs down. Rival CVS Health is dropping 95 drugs from its own list of covered drugs. Happy holidays. (David Lazarus, 12/4)

The United Nations estimates that 5,000 more international health care workers will be needed during the coming months in West Africa to fight the Ebola outbreak. But where they will come from is not entirely clear. As World Bank President Jim Yong Kim recently stated, “Right now, I'm very much worried about where we will find those health care workers.” (Helen Ouyang, 12/4)

When Ebola ends, the people who have suffered, who have lost loved ones, will need many things. They will need ways to rebuild their livelihoods. They will need a functioning health system, which can ensure that future outbreaks do not become catastrophes. And they will need mental health care. Depression is the most important thief of productive life for women around the world, and the second-most important for men. We sometimes imagine it is a first-world problem, but depression is just as widespread, if not more so, in poor countries, where there is a good deal more to be depressed about. And it is more debilitating, as a vast majority of sufferers have no safety net. (Tina Rosenberg, 12/4)

More than three years after county and state officials struck a deal with the University of Maryland Medical System (UMMS), a highly regarded nonprofit hospital network, to revamp Prince George’s run-down health-care facilities, final approval is still pending for a facility in Largo that could offer first-rate care to a community where it is still lacking. (12/4)