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Republican senators charged Thursday that the Obama administration had missed warning signs of financial distress at nonprofit health insurance cooperatives that failed last year, but a top federal official denied that the government had been negligent in its supervision. The co-ops were created with federal money under the Affordable Care Act. Democrats hoped the co-ops would increase competition in state insurance markets, creating additional choices for consumers and holding down premiums. But 12 of the 23 co-ops have shut down. (Pear, 1/21)

Senators on Thursday pressed a top ObamaCare official over a string of failures in non-profit health insurers known as co-ops. Twelve of the 23 co-ops, set up under ObamaCare to compete with larger private insurers, have gone out of business due to financial problems. (Sullivan, 1/21)

Federal officials still don't how much they will recoup of the $1.2 billion they spent on loans and startup costs for a dozen health care cooperatives that later failed, a top regulator said Thursday. “We are working closely with the Department of Justice,’’ Andy Slavitt, acting administrator for the Centers for Medicare and Medicaid Services, told the Senate Finance Committee. “We have taken the first step calling the loans." (Tumulty, 1/21)

An Obama administration official said Thursday the government is taking steps to help health cooperatives set up under the Affordable Care Act remain solvent, while seeking to recoup federal funds from those that failed. Andy Slavitt, acting administrator at the Centers for Medicare and Medicaid Services, told a Senate committee that the agency is working with the Justice Department and taking legal actions to collect the federal moneys in some cases. (Armour, 1/21)

Speaker Paul Ryan (R-Wis.) vowed to release a plan to replace Obamacare this year. There is plenty of skepticism about whether that will actually happen. ... Yet, the new House speaker intends to back a “bold alternative agenda,” and he committed to unveiling a replacement plan in his first major policy address. ... “As the speaker has said many times, committees, not leadership, will be taking the lead on policy development,” said Ryan spokeswoman AshLee Strong in response to an inquiry. (Viebeck, 1/21)

Former pharmaceutical executive Martin Shkreli was on a collision course with Congress on Thursday as lawmakers warned he could be prosecuted for contempt if he does not appear next week for a hearing about drug prices. Shkreli, 32, has said he would invoke his Fifth Amendment right against self-incrimination. On Twitter, he told followers it was "disgusting and insulting" for lawmakers to try to subvert that right. ... The dispute appeared likely to end in one of two ways: with Shkreli appearing in Washington on Tuesday to invoke that right, or with Shkreli staying home in New York, prompting the committee to vote to hold him in contempt and setting off a potential criminal prosecution. (Raymond and Ingram, 1/21)

The House Committee on Oversight and Government Reform has subpoenaed [Martin] Shkreli to appear at a hearing on exorbitant drug pricing next Tuesday. Shkreli became the public face of pharmaceutical-industry greed last fall, after hiking the price of a 60-year-old drug for a rare infection by 5,000 percent. Questions emerged Thursday about whether Shkreli would even attend the hearing, in spite of the congressional subpoena. Rep. Elijah Cummings, D-Maryland, said Shkreli has apparently not made any legal arrangements to travel to Washington, based on conversations with his attorney. (1/21)

Martin Shkreli, the former drug-company executive criticized for dramatically raising a pill’s price, has asked a congressional committee seeking his testimony to guarantee it can’t be used in a federal prosecution, according to materials reviewed by The Wall Street Journal. ... Lawyers for Mr. Shkreli have told the committee he won’t answer questions, citing his Fifth Amendment privilege against self-incrimination, according to emails between Mr. Shkreli’s lawyers and the committee. The lawyers indicated that position would change if the committee would grant Mr. Shkreli the immunity so prosecutors couldn’t use his testimony against him, according to the emails. (Rockoff, 1/21)

With many lawmakers and presidential candidates declaring open season on drug companies that have substantially jacked up the price of critically needed drugs, the pharmaceutical industry is bracing for a bruising battle this year over calls for price restraints and other reforms. (Pianin, 1/21)

Veterans Affairs Secretary Robert McDonald on Thursday disputed claims by members of Congress that his scandal-plagued agency hasn’t dismissed enough employees, saying, “You can’t fire your way to excellence.” McDonald told the Senate Veterans Affairs Committee that he and other top leaders are turning the VA around, “providing more and better care than ever before” and holding employees accountable, including firing about 2,600 workers since he took office 18 months ago. (Daly, 1/21)

A Senate investigation of deadly infections spread by contaminated scopes found that not one of the 16 or more American hospitals where patients were sickened appeared to have properly filed the required federal report. A Senate report titled "Preventable Tragedies" said the hospitals' failure to properly report the outbreaks left the Food and Drug Administration "with an inaccurate picture of the frequency and severity" of the outbreaks. (Petersen, 1/22)

The average ObamaCare premium rose to $408 per month for 2016 plans, about a 9 percent increase from this time last year, according to a new report from the Department of Health and Human Services. However, 83 percent of ObamaCare enrollees pay far less than $408 because they get tax credits under the healthcare law. The average tax credit for 2016 is $294, meaning that the average share of the premiums that enrollees have to pay is $113. That is up $8 from the $105 people paid on average last year. (Sullivan, 1/21)

Some consumers who buy coverage on the health insurance marketplaces in 2017 could see their out-of-pocket costs drop significantly under a federal proposal to create standardized plans, a recent analysis found. The government wants to create six plan options at the bronze, silver and gold metal levels, each with standard deductibles, maximum out-of-pocket spending limits and copayments or coinsurance for various services. (Andrews, 1/22)

The number of Marylanders who have signed up for private insurance plans under the Affordable Care Act is 60 percent higher than last year, and state health officials are making a final push for more ahead of the Jan. 31 enrollment deadline. About 155,000 have enrolled in private plans, surpassing a goal of 150,000, according to officials with the Maryland Health Benefit Exchange, the state's online insurance marketplace. (McDaniels, 1/21)

ConnectiCare continues to lead the market among customers of Connecticut’s health insurance exchange, with 52 percent of the nearly 109,000 people signed up so far for 2016 coverage. As of Wednesday, 108,830 people signed up for private insurance through the exchange, Access Health CT, including 15,214 new customers, officials said Thursday. The open enrollment period for private insurance runs through Jan. 31. (Levin Becker, 1/21)

Connecticut’s health insurance exchange plans to get tougher on those seeking to sign up for insurance coverage outside the open enrollment period, following concerns that people signing up midyear have been driving up costs for insurers. (Levin Becker, 1/21)

Georgia’s exchange sign-ups have nearly equaled last year’s open enrollment total, with the deadline more than a week away. Federal health officials reported that as of Jan. 16, 535,918 Georgians have signed up for health insurance through the exchange or were automatically renewed for coverage in 2016. (Miller, 1/21)

UnitedHealthcare apparently took steps to ensure that it did not sell too many health plans on the federal marketplace during the current open enrollment period for the Affordable Care Act. The steps included requiring paper applications and not giving brokers price quotes online. (Boulton, 1/21)

Kansas’ largest disability advocacy group urged Gov. Sam Brownback and legislators Thursday to stop citing waiting lists for disability services as a reason to refuse Medicaid expansion. The Big Tent Coalition, which represents Kansans with all types of disabilities, said the argument is disingenuous and is being used “as a method of evading sincere debate on the merits of a customized KanCare expansion plan.” (Marso, 1/21)

Department of Health and Hospitals Secretary Dr. Rebekah Gee said Thursday (Jan. 21) that she is "optimistic" about federal officials approving Louisiana's plans to expand Medicaid coverage to more than 400,000 people. Gee was in Washington, D.C. with Gov. John Bel Edwards to meet with federal officials about Louisiana's plans. Many of the plans Gee is proposing to speed enrollment have been done before in other states, but they require approval by the Center for Medicare and Medicaid Services. (Litten, 1/21)

Getting on Medicaid has never been so easy. In the past two years, 31 states and the District of Columbia have expanded eligibility for Medicaid under the Affordable Care Act, but even more have simplified sign-ups and renewals, according to a 50-state survey released Thursday. (Galewitz, 1/21)

[Hillary] Clinton, who has lost much of her lead to [Sen. Bernie] Sanders in Iowa and national polls, has also recently tried to put Sanders on defense when it comes to healthcare. Here on Thursday, she suggested that his proposal for a single-payer, "Medicare-for-All" system was unrealistic. (Fraser-Chanpong, 1/21)

Health care has emerged as one of the flash points in the Democratic presidential race. Vermont Sen. Bernie Sanders has been a longtime supporter of a concept he calls “Medicare for All,” a health system that falls under the heading of “single-payer.” Some of the details of Sanders’ plan are still to be released. But his proposal has renewed questions about what a single-payer health care system is and how it works. Here are some quick answers. (Rovner 1/22)

Democratic presidential candidate Bernie Sanders' health care plan dangles the prospect of "Medicare for all." But it's not the same as Medicare. [Here's] a closer look. (1/21)

Colorado Republicans could be forgiven for thinking that several years of fiery political contests over abortion and reproductive rights were behind them. Then, last year a pregnant woman close to giving birth was gruesomely attacked with a knife, and a few months later an anti-abortion zealot opened fire at a Planned Parenthood clinic in Colorado Springs, killing three. Think those cases won’t affect the 2016 races? Not a chance. (Wyatt, 1/22)

Aetna Inc's plan to buy smaller insurer Humana Inc for $31 billion will mean seniors will pay higher Medicare Advantage premiums, according to a new report by the think tank Center for American Progress (CAP). Aetna's proposed deal for Humana would combine Aetna's 7 percent of the Medicare Advantage market with Humana's 19 percent, and make it the largest provider, according to CAP, which was founded by John Podesta who worked in the White House under Presidents Bill Clinton and Barack Obama. (Humer, 1/21)

California's four largest health plans may be on the hook for $10 billion in state back taxes -- and at least $1 billion every year going forward -- if a closely watched legal case does not break their way. Should that happen, insurance industry critics say, it would end one of the biggest tax code abuses in state history -- one that for decades has allowed Kaiser Permanente, Anthem Blue Cross, Blue Shield of California and Health Net to avoid paying a state tax on health insurance premiums. The health plans, however, say they aren't insurers and thus shouldn't be subject to the tax. (Seipel, 1/21)

A proposed merger of the Centene and HealthNet health insurers in California is expected to get tight scrutiny on Friday when the California Department of Insurance holds a public hearing on whether or not that merger should be approved. Three hearings already have been held by a different state regulatory agency on health insurance company mergers, but this one will have a more open format. (Gorn, 1/21)

The Kansas Court of Appeals is expected to decide Friday whether to allow the state’s first-in-the-nation ban on a common second-trimester abortion method. The ruling, which will come on the anniversary of the U.S. Supreme Court’s Roe v. Wade decision, stems from a lawsuit filed by two abortion providers who said the 2015 law is an unconstitutional burden on women seeking to end their pregnancies. (Hegeman, 1/22)

A new app called Nurx wants to make it dead simple to get hormonal birth control on-demand. The San Francisco startup wants to do for the pill what Instacart did for groceries and Uber did for cabs. You don't need a previous prescription to use the app. There is no physical examination and no time consuming trip to a doctor's office. All that's required is an online questionnaire. The information is sent to a partner doctor who writes a prescription, then Nurx fills and mails it. Your pills, patch or ring arrive within a day or two, and refills can be scheduled automatically. (Kelly, 1/21)

Clinical studies show that U.S. Food and Drug Administration-approved opioid addiction medicines like buprenorphine offer a far greater chance of recovery than treatments that don’t involve medication, including 12-step programs and residential stays. But as the country’s opioid epidemic kills more and more Americans, some of the hardest-hit communities across the country don’t have enough doctors who are able — or willing — to supply those medications to the growing number of addicts who need them. More than 900,000 U.S. physicians can write prescriptions for painkillers such as OxyContin, Percocet and Vicodin. But because of a federal law, fewer than 32,000 doctors are authorized to prescribe buprenorphine to people who become addicted to those and other opioids. (Vestal, 1/18)

More than 12,000 doses of the drug Naloxone saved thousands of Ohioans who would otherwise have been overdose statistics in the first nine months of last year. (Johnson, 1/22)

The national move to home and community-based care away from nursing homes has been widely supported by senior citizen, consumer and disability rights communities. ... In recent years nearly a million people with disabilities or conditions severe enough to qualify for nursing home admission have been enrolled in Medicaid-managed long-term care programs .... In Medicaid-managed long-term care, states pay private health plans monthly fixed rates to provide eligible beneficiaries' health care and services .... But most of the 26 states involved are new to providing managed long-term supports and services for this population. It's been a rocky transition for many beneficiaries and their families, who have seen cuts in services to parents and loved ones. Many have scrambled to find new doctors, hospitals and personal attendants. And while states like Texas and Wisconsin have seen costs drop, others such as Florida have seen hikes in health care spending. (Taylor, 1/21)

By April 1 state Medicaid agencies must start reimbursing pharmacies for prescription drugs based on actual acquisition costs according to a final rule released Thursday. Medicaid programs until now have reimbursed pharmacies for prescription drugs based on the ingredient costs for the drug and a dispensing fee for filling the prescription, according to the Kaiser Family Foundation. The CMS says the change will more accurately reflect pharmacies' purchase prices. (Dickson, 1/21)

Gov. Peter Shumlin on Thursday unveiled a $1.53 billion general fund budget for the upcoming fiscal year that calls for new or higher fees on independent doctors and dentists as well as mutual funds, and strengthens security at state buildings following the August murder of a child protection worker. ... Among health care changes, Shumlin wants to save $4.9 million by lowering the income at which pregnant women are no longer eligible for Medicaid from 218 percent of the federal poverty level to 138 percent — the threshold at which others are deemed to be making too much to be eligible for Medicaid coverage. For a household of 3, 138 percent of this year’s federal poverty level is $27,724. (Gram, 1/21)

In the past year, roughly 20,000 Vermonters signed up for the expanded Medicaid program and the state didn't have the money to cover the new costs. To address this issue, Shumlin proposed expanding an existing health care provider tax to include independent doctors and all dentists. Hospitals and physicians employed by the hospitals already pay this tax. (Kinzel, 1/21)

Gov. Peter Shumlin is proposing to raise taxes on independent doctors and dentists, provide more low-income women with long-acting birth control, and cut some pregnant women from Medicaid to help balance the state’s budget. (Mansfield, 1/21)

Some lawmakers were told by state officials Thursday that “additional key observations” in an October report push the savings behind Gov. Terry Branstad’s plan to privatize Medicaid beyond budget projections. But those additional observations and other pieces of the report are also now drawing additional scrutiny by some lawmakers and an Iowa healthcare reform advocate. (Clayworth, 1/21)

Iowa Senate President Pam Jochum said Thursday she doesn’t believe Iowa’s Medicaid program will be ready for a March 1 rollout of a privately managed initiative, adding she worries the plan will hurt Iowa’s poor and disabled people. “This has never been about politics. It has been about policy,” said Jochum, D-Dubuque, whose developmentally disabled daughter, Sarah, is enrolled in Medicaid. Jochum said an adequate Medicaid provider network is needed, as well as a strong ombudsman’s program. (Petroski, 1/21)

A top Senate Democrat said Thursday she does not believe Iowa will have the safeguards in place by March 1 to proceed with the change to privately managed Medicaid services and she hopes federal regulators again will delay implementation of Gov. Terry Branstad’s modernization effort. ... Jochum said the final decision rests with the federal Centers for Medicare and Medicaid Services (CMS), which funds 55 percent of Iowa’s Medicaid program. (Boshart, 1/21)

A Virginia law that requires government approval for new or expanded health care facilities is constitutional, a federal appeals court ruled Thursday. A three-judge panel of the 4th U.S. Circuit Court of Appeals unanimously rejected a claim that Virginia's "certificate of public need" program impermissibly interferes with interstate commerce. (O'Dell, 1/21)

Hawaii lawmakers are introducing a bill that could make the state the first in the nation to offer long-term care benefits to seniors. Democratic Sen. Rosalyn Baker said during a legislative hearing Thursday that the bill would provide eligible seniors with a benefit of $70 per day for a year. The seniors could use the benefit to pay family caregivers, hire in-home aides and help offset the cost of safety equipment, like walkers and ramps. (Riker, 1/21)

Low-income Sacramento children aren’t going to the dentist as much as they should, according to a report released Thursday. That’s despite a five-year effort to bring more dentists into Medi-Cal managed care plans, expand community clinics and educate families about the importance of dental care. In Sacramento County, only 40 percent of children on Medi-Cal managed care plans use the dental services they’re eligible for, compared to 52.5 percent statewide. (Caiola, 1/21)

Florida legislators, meeting this month in Tallahassee, are looking down the barrel of a healthcare financial crisis for the second consecutive year — and once again, Miami-Dade, home to the state’s largest number of uninsured residents and its busiest public hospital, Jackson Health System, stands to lose more than any other county, according to a report released Wednesday. In the report, Florida Legal Services, a nonprofit advocate of expanding coverage through the Affordable Care Act, sounds an alarm about a confluence of state and federal health policy decisions that are likely to strain the healthcare safety net, forcing local hospitals to compete for a dwindling pot of money and to make difficult choices about how to best meet the needs of the uninsured. (Chang, 1/21)

The rising cost of health care is Delaware's biggest financial challenge, Gov. Jack Markell said Thursday in his final State of the State address, and he said he will propose reforms to help rein in state spending. The two-term Democrat said the current cost trend is not sustainable for taxpayers, and that he will seek reforms to improve the long-term outlook for the state's health care plans while ensuring that state workers have access to high-quality care. (Chase, 1/21)

If you need a hip replacement or colon surgery in Colorado, you have a relatively slim chance of picking up an infection in the hospital. Infection rates with breast surgeries, however, have been worse in Colorado hospitals than the national average for the past three years. Bloodstream infections in neonatal critical care units also have grown worse than the national average after being comparable to national rates the previous two years. Those are among the findings of the Colorado Department of Public Health and Environment's ninth annual report of health care associated infections. (Olinger, 1/21)

Most states have turned to telemedicine to some extent for treating prisoners — often in remote areas, where many prisons are located — because it allows doctors to examine them from a safe distance. It enables corrections officers keep potentially dangerous inmates behind bars for treatment rather than bearing the cost and security risk of transporting them to hospitals. And because more doctors are willing to participate, it makes health care more available for inmates. (Ollove, 1/21)

Health care giant HCA is contesting a Missouri court judgment that it must pay the Health Care Foundation of Greater Kansas City $434 million. In papers filed this week with the Missouri Court of Appeals in Kansas City, HCA said the foundation lacks legal standing in its long-running dispute. (Bavley, 1/21)

A group of northeast Johnson County cities wants to give their police officers better resources when answering calls involving suicide attempts, substance abuse or other mental health issues. The cities of Leawood, Prairie Village, Mission, Merriam, Fairway, Westwood and Roeland Park are considering a proposal to contract with Johnson County Mental Health to provide a mental health professional for the group. This professional, called a “co-responder,” would be available to accompany officers on calls at any time of day. (Twiddy, 1/21)

Maybe it was last January's big measles outbreak at Disneyland that scared more California parents into getting their kids vaccinated. Or maybe health campaigns have become more persuasive. Or maybe schools getting stricter about requiring shots for entry made a difference. Whatever the reasons, childhood vaccination rates last fall went up in 49 of 58 counties in California, according to data released Tuesday by state health officials. (Aliferis, 1/21)

This report ... analyzes competition in the Health Insurance Marketplaces ... in six states (Alaska, Florida, Kansas, North Carolina, Ohio, and Texas) ... states that had one or more potential indicators of “insufficient competition”—such as few insurers offering plans, low enrollment, high premiums, inadequately informed consumers, or sparsely populated rural areas .... Across the six states, respondents consistently said consumers have difficulty understanding health insurance and purchasing and retaining marketplace coverage. State research teams also reported a lack of outreach initiatives .... The ability of insurers to create effective, affordable provider networks was a key determinant to success in many states. ... State researchers also found that the population size and density was one of the main determinants of insurer participation. (Eibner and Rivlin, 1/19)

While rural hospitals and physicians have adopted health information technology at the same, or greater, rates as their urban counterparts, meaningful-use attestation varies dramatically among rural providers. Also, rural providers are more likely to skip a year of declaring that they have met meaningful-use requirements, putting them at a financial disadvantage compared to urban providers. (Heisey-Grove, 1/20)

We analyzed National Youth Risk Behavior Survey (YRBS) and Behavioral Risk Factor Surveillance System (BRFSS) data to assess HIV testing prevalence among high school students and young adults aged 18 to 24. ... During the study periods, an average of 22% of high school students (17% of male and 27% of female students) who ever had sexual intercourse and 33% of young adults reported ever being tested for HIV. Among high school students, no change was detected in HIV testing prevalence during 2005–2013, regardless of gender or race/ethnicity. Among young adult males, an average of 27% had ever been tested, and no significant changes were detected overall or by race/ethnicity during 2011–2013. Significant decreases in testing prevalence were detected during 2011–2013 among young adult females. (Van Handel et al., 1/19)

Although the number [of] women gaining access to health insurance coverage is rising, an increasing share of women are facing limitations in the scope of that coverage when it comes to abortion services. The impact of the abortion coverage restrictions disproportionately affects poor and low-income women who have limited ability to pay for abortion services with out-of-pocket funds. Today over half of women on Medicaid have abortion coverage that is limited to pregnancies resulting from rape, incest, or life endangerment. While millions of women have gained health insurance coverage as a result of the ACA insurance expansions, many are enrolled in plans that restrict the circumstances in which abortion services will be covered. (Salganicoff et al., 1/20)

Telling people they'll be screened for HIV unless they decline to be tested -- an approach known as "opt-out" testing -- could significantly increase the number of patients who agree to be tested, new research suggests. Other approaches to HIV screening, such as leaving it up to patients to specifically ask to be tested, could have the opposite effect, researchers said. (Dallas, 1/20)

Physical frailty among older people who have elective surgery is linked to a greater risk of death one year later, a new study suggests. Canadian researchers found the one-year death rate for frail older patients having certain surgeries was at least one death for every five people. To make an informed treatment decision, doctors, patients and their families should be aware of this heightened risk, the team advised. (1/21)

U.S. emergency rooms are increasingly running short on medications, including many that are needed for life-threatening conditions, a recent study documents. Since 2008, the number of shortages has risen by more than 400 percent, researchers found. Half of all emergency room shortages were for life-saving drugs, and for one in 10 there were no available substitutes, they report in Academic Emergency Medicine. Half of the individual shortage incidents had no explanation, the authors found. The rest had a variety of systemic causes that add up to a U.S. drug supply too low to meet public demand. (Kennedy, 1/15)

In a study of residential high-rise buildings, people who suffered cardiac arrest had a better chance of survival if they lived on lower floors, and survival odds decreased as floor number increased. "We thought there might be something here because once somebody collapses into cardiac arrest, their chance of survival decreases really quickly,” said lead author Ian Drennan, a paramedic with York Region Paramedic Services and a researcher with Li Ka Shing Knowledge Institute at St. Michael's Hospital in Toronto. (Doyle, 1/18)

Patients with mild to moderate Parkinson's disease don't appear to benefit much from physical therapy (PT) or occupational therapy (OT), a new study shows. The study, comparing PT and OT with no therapy, showed that these interventions were not associated with clinically meaningful improvements in activities of daily living or quality of life. (Anderson, 1/19)

Getting too little sleep during the week can increase some risk factors for diabetes, but sleeping late on weekends might help improve the picture, a small U.S. study suggests. Researchers conducted a sleep experiment with 19 healthy young men and found just four nights of sleep deprivation were linked to changes in their blood suggesting their bodies weren’t handling sugar as well as usual. (Rapaport, 1/18)

Melanoma may be even more dangerous when it’s diagnosed in women during pregnancy or within a year of giving birth, a U.S. study suggests. Among women under 50 with malignant melanoma, those diagnosed during or soon after pregnancy were significantly more likely to have tumors spread to other organs and tissues, and were also much more likely to have the cancer recur after treatment, the study found. (Rapaport, 1/20)

Men and women veterans who experienced sexual assault or repeated, threatening sexual harassment while serving in the military are at heightened risk of suicide, according to a recent U.S. study. Researchers with the department of Veterans Affairs found that men with a history of what the VA calls military sexual trauma (MST) are 70 percent more likely than fellow vets without such experience to commit suicide, and women veterans with MST are more than twice as likely as other female vets to do so. (Nelson, 1/20)

As the battle between Hillary Clinton and Bernie Sanders over health care has heated up, a number of liberal writers have published pieces taking a hard look at Sanders’ single payer plan. ... But the single payer flap suggests a line of questioning on health care for Hillary Clinton, too. ... The fair question for Clinton is: How, in detail, would you go about building on the Affordable Care Act to cover the remaining uninsured? (Greg Sargent, 1/21)

The Bernie Sanders health care plan, which the Vermont senator released this week, sounds pretty spectacular at first blush. It’s a proposal to create a single-payer system, which means that Sanders would wipe away existing insurance arrangements and replace them with a single government program. Everybody would get insurance, free of co-pays or deductibles. ... To help pay for his plan’s unprecedented benefits, Sanders proposes to extract unprecedented savings from the health care system. Here is where the details get fuzzy and hard to accept at face value, even beyond the usual optimistic assumptions that figure into campaign proposals. (Jonathan Cohn, 1/21)

Bernie Sanders probably knows that his plan to give all Americans free health care is never going to become law. Yet he's doing the country a service: His proposal has re-ignited a national debate -- the third since the 1990s -- over why the U.S. can't be like Europe, Canada and the rest of the industrialized world and adopt universal health care. ... [Sanders' plan] sounds appealing. But would it really be popular once Americans found out how it worked? There are strong reasons to doubt it. (Paula Dwyer, 1/21)

Louisiana is way behind on the Medicaid expansion that was part of President Barack Obama's Affordable Care Act. Gov. John Bel Edwards took advantage of the expansion the day after his Jan. 11 inauguration, but our state essentially missed the first two years of the program. So it is smart of the Edwards administration to try to fast track the process to enroll uninsured Louisiana residents who qualify. ... Fast track enrollment uses data from other government programs to help verify that low-income residents are eligible for the Medicaid expansion, which covers people earning up to 138 percent of the poverty level. (1/21)

No, there's no health insurance company named Land of Bait-and-Switch operating in Illinois. But we understand why people might think so. Over the past few months, many people signed up with upstart insurer Land of Lincoln Health in part because it offered the University of Chicago Medical Center and affiliated doctors in its network. You'll recall that thousands of people here had to scramble to find coverage after the state's dominant carrier, Blue Cross and Blue Shield of Illinois, eliminated a popular individual market plan that included U. of C. .... In late December, after many people had enrolled for 2016 with Land of Lincoln, the insurer dropped the U. of C. from its insurance network, effective March 1. (1/21)

Assessment of hearing is rarely included in routine primary care evaluations, and physicians often view hearing impairment in patients as a difficulty in communication (which it is) and not a medical problem that needs attention. One reason for this lack of attention is that hearing loss has been considered a normal aspect of aging and therefore not amenable to medical treatment. Another challenge, as noted by the US Preventive Services Task Force, is that there is limited evidence about screening (such as the most effective screening tools) for asymptomatic adults older than 50 years. It is time for the health care system to make hearing a priority, a key part of healthy aging, and to increase the availability of hearing technology to the millions of people who could benefit from it. (Christine Cassel, Ed Penhoet and Robert Saunders, 1/21)

Much has been written about the relative merits of Medicare Advantage (MA) and Medicare Fee-For-Service from the standpoint of efficiency and care coordination, but less attention has been paid to the supplemental benefits that distinguish MA plans. ... It has been suggested that Medicare Advantage’s supplemental benefits, such as gym memberships, have been designed to attract healthier enrollees. However, CMS data reveals that these are relatively trivial elements of MA supplemental benefit packages. The bulk of supplemental benefits under MA are features of greater value to the sick than to the healthy. In addition to mandatory supplemental protection from catastrophic out-of-pocket costs, the majority of MA plans include preventive dental care, eye care, and hearing assistance. (Christopher Pope, 1/21)

There’s been a heated debate over the past year over whether legislative incentives are needed to encourage certain types of therapeutic innovation. Much of this debate centered on the passage of the 21st Century Cures Act by the US House of Representatives (awaiting action by the Senate), which contained provisions intended to expedite availability of medical products such as new antibiotics and high-risk devices. Somewhat less prominent is legislation proposed in the Senate, the Combination Product Regulatory Fairness Act, which is intended to promote innovation among products that contain both a drug and device. (Bo Wang and Aaron S. Kesselheim, 1/21)