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The same Republicans who campaigned on doing away with legislative crises are careening toward government shutdown in less than two weeks with still no concrete plan to stop it. It’s not that Speaker John Boehner’s (R-Ohio) leadership team is hiding their best hand. They have no trick up their sleeve, no ace in the hole — pick your cliché. Nearly everyone in House and Senate leadership recognizes a simple reality: At some point in the next two weeks, they will move on a bill free of provisions to strip Planned Parenthood of its government funding. It just depends how long it takes, how painful it is and whether Boehner and Senate Majority Leader Mitch McConnell’s (R-Ky.) team stumbles into their second government shutdown in three years. (Sherman and Palmer, 9/17)

House Republicans continued to evaluate their options on Planned Parenthood funding Thursday as the number of scheduled legislative days until a government shutdown shriveled to six. After back-to-back closed-door conference meetings Wednesday evening and Thursday morning, GOP lawmakers said they have yet to decide whether to include defunding language in a must-pass continuing resolution. Outraged conservatives want to use the spending bill as a way to respond to videos targeting the women’s health group and its handling of fetal tissue. (Hallerman and McCrimmon, 9/17)

President Barack Obama met with top Democratic leaders behind closed doors at the White House Thursday as Congress scrambles to avoid a government shutdown. Speaking to reporters outside the West Wing following the hour-and-a-half-long huddle that focused on budget negotiations, Senate Minority Leader Harry Reid announced that he, Obama and House Minority Leader Nancy Pelosi were in agreement on a short-term continuing resolution to keep the government running and allow time for negotiations on a "meaningful" budget. Democrats want to keep pressure on Republicans to negotiate a broader budget deal that would remove the across-the-board forced spending cuts, known as "sequestration," that are in place now. The sooner they reach a deal, the sooner domestic programs would potentially be less impacted by these budget cuts. (Holmes and Walsh, 9/17)

Reid and Pelosi met with Obama for about 90 minutes to prepare for negotiations. They said they are willing to back a continuing resolution to keep the government open, but insisted that such a stopgap measure be a short-term one and include the same size increases for military and non-military spending. They said that they will also demand that it not include any language about ideological issues, such as funding for Planned Parenthood. (Mufson and Snell, 9/17)

House Minority Leader Nancy Pelosi huddled with Speaker John Boehner Thursday evening to discuss the looming government funding crisis. The roughly 20-minute meeting came after Pelosi had been pressuring him for weeks to start negotiations on legislation that would keep the government open past Sept. 30. ... Congressional Republicans are currently logjamed over funding for Planned Parenthood with a group of more than 30 conservatives refusing to vote for any spending bill that doesn't strip the health care organization of its federal money. But Senate Majority Leader Mitch McConnell (R-Ky.) said that proposal is unlikely to pass the Senate meaning that Boehner may have to rely on Democratic votes to pass a continuing resolution. (French, 9/17)

Majority Leader Mitch McConnell hasn't decided how next week's floor schedule will go. But Republicans are clearly entertaining a scenario in which the Senate must take the lead on avoiding a government shutdown on Oct. 1. "I guess he deserves credit for doing the right thing in ultimately passing a clean [spending bill], but it's a hell of a gamble since it leaves no time for a plan B," a senior Democratic aide said of McConnell, who opposes hardline tactics that could result in a shutdown over Planned Parenthood's funding. Cornyn said it remained unclear whether the House or Senate would vote first on the bill to defund Planned Parenthood. (Everett and Haberkorn, 9/17)

Republican leaders are eyeing an obscure budget tool called reconciliation to end funding for Planned Parenthood -- although it wouldn't necessarily prevent a government shutdown. House Speaker Rep. John Boehner, R-Ohio, said Thursday morning that "reconciliation is an option." A Republican move to defund Planned Parenthood was killed in the Senate in early August because Democrats had enough votes to block the measure. Reconciliation's appeal lies in the fact that it requires only a simple majority to pass the Senate instead of a filibuster-proof 60 votes. (Kaplan, 9/17)

House Energy and Commerce Chairman Fred Upton expressed uncertainty Thursday about whether budget reconciliation can be used to defund Planned Parenthood, one of the options that Republicans are considering to starve the family planning group of federal funds, appease unhappy conservatives and still avoid a government shutdown. “I don’t know that we can do that in reconciliation,” the Michigan Republican said in an interview with CQ Roll Call. His comments are significant because Energy and Commerce is one of three committees in the House that would be tasked with writing reconciliation legislation that likely would be focused on repealing parts of the 2010 health care law (Krawzak and Attias, 9/17).

Senate Republicans said on Thursday that they would take up legislation outlawing all abortions after 20 weeks of pregnancy, and the House voted to move forward with a bill that would end government financing for Planned Parenthood, intensifying a fight over abortion that threatened to paralyze budget talks and force a government shutdown at the end of the month. (Herszenhorn, 9/17)

Republican leaders hope House passage of bills targeting Planned Parenthood and curbing some abortion procedures will mollify fractious conservatives demanding a face-off with President Barack Obama that could trigger a federal shutdown. The GOP-run chamber was on track to approve the two measures Friday, despite White House veto threats and opposition from most Democrats. One would block Planned Parenthood’s federal funds for a year. The other would inflict criminal penalties on doctors who don’t try saving infants born alive during abortions. (Fram and Taylor, 9/18)

President Barack Obama "strongly opposes" and would veto a pair of House bills that would strip federal funds from Planned Parenthood and impose new restrictions on abortion, the White House said in a statement on Thursday. The administration said the GOP-backed bills "would have the same consequence of limiting women’s health care choices." The Planned Parenthood bill, in particular, would cut access to health care services for as many as 630,000 people, the Congressional Budget Office estimated Wednesday. (Bassett, 9/17)

House Oversight Committee Chairman Jason Chaffetz is setting up a battle of wills with a federal judge in California over unreleased footage in the sting operation against Planned Parenthood. Chaffetz has subpoenaed David Daleiden, the anti-abortion activist behind the videos, to turn over all of his footage on the women’s health organization. But U.S. District Court Judge William H. Orrick has already blocked Daleiden from releasing some of the tapes, particularly anything filmed at a National Abortion Federation conference. (Haberkorn, 9/17)

Mr. Boehner of Ohio was elected speaker on the House floor in January with the most opposition in a speaker election since 1923. Since then, a series of fights over spending bills, President Barack Obama’s immigration policy, and the nuclear deal with Iran have generated further friction with his party’s right flank. This month, conservatives angered by videos showing Planned Parenthood officials discussing fees for procuring fetal tissue for medical researchers have tangled with GOP leaders over whether to use a must-pass spending bill as leverage to seek to strip federal funding from the women’s health organization. Such a move could lead to a stand-off resulting in a partial government shutdown if no stopgap spending measure is passed by the Oct. 1 start of the next fiscal year. Rep. Matt Salmon (R., Ariz.) said conservatives are watching Mr. Boehner and that his behavior this month will affect his standing among House Republicans. (Peterson, 9/17)

A new bipartisan effort to cancel the Affordable Care Act's Cadillac tax -- the 40 percent levy on high-cost health insurance plans -- adds a wrinkle to an impending fight in Congress. The repeal bill unveiled Thursday in the Senate by Nevada Republican Dean Heller and New Mexico Democrat Martin Heinrich stands little chance of becoming law soon, especially with Barack Obama in the White House. Yet it demonstrates lawmakers' frustration with the tax, which takes effect in 2018. (Rubin, 9/17)

Forget "repeal and replace." An obscure Obamacare provision that takes effect in 2017 could empower a Republican president to unravel Obamacare — without a single vote from Congress. The provision allows the executive branch to waive big chunks of the law for a state that chooses a different approach to expanding health coverage. It was designed to allow progressive states to go further than Obamacare. Vermont, for instance, wanted to create a single-payer plan. (Pradhan, 9/17)

A federal appeals court ruled Thursday that President Barack Obama's health care law unjustly burdens religiously affiliated employers by forcing them to help provide insurance coverage for certain contraceptives, even though they can opt out of directly paying for it. The ruling by a three-judge 8th U.S. Circuit Court of Appeals panel in St. Louis upheld lower court decisions that sided with plaintiffs who included three Christian colleges in Missouri, Michigan and Iowa. (9/17)

Opponents of a compromise arrangement for providing birth-control coverage to workers at religiously affiliated employers won their first major federal-appeals-court victory Thursday, increasing the chance the contentious issue could find its way back to the Supreme Court. The Eighth Circuit Court of Appeals in St. Louis said the Obama administration didn’t go far enough to accommodate employers with religious objections when creating an alternative system to cover contraception for their workers. (Radnofsky and Kendall, 9/17)

The decision was at odds with that of every other appeals court that has considered the issue. Those courts have said the government’s compromise was adequate. Such splits among the courts usually compel the Supreme Court to settle the issue. (Barnes, 9/17)

Religious groups needn’t obey the Affordable Care Act mandate to provide workers with health insurance that covers contraception and can’t be forced to tell the government when they don’t, according to an appeal ruling that pushes the fight toward the U.S. Supreme Court. Deciding two cases Thursday, the U.S. Court of Appeals in St. Louis agreed with nonprofit groups that providing birth-control coverage burdens their right to free exercise of religion. The court also rejected the opt-out requirement for religious nonprofits. (Hanna and Harris, 9/17)

A U.S. appeals court has ruled that President Barack Obama's healthcare law violates the rights of religiously affiliated employers by forcing them to help provide contraceptive coverage even though they do not have to pay for it. Parting ways with all other appeals courts that have considered the issue, the 8th U.S. Circuit Court of Appeals in St. Louis on Thursday issued a pair of decisions upholding orders by two lower courts barring the government from enforcing the law's contraceptive provisions against a group of religiously affiliated employers. (Pierson, 9/17)

A private, faith-based Michigan university doesn’t have to offer contraceptive insurance coverage to its employees, a federal appeals court ruled Thursday. Cornerstone University, based in Grand Rapids, had challenged the so-called contraceptive mandate in federal court along with Dordt College, a small religious school in Iowa. The decision by the U.S. 8th Circuit Court of Appeals upholds a lower court decision in favor of the two schools, which sued the federal government over the mandate from the Obama administration. (Jesse, 9/17)

More than a year after launching, state-run health insurance exchanges, including Connecticut's, still hadn't fully completed key information technology functions, federal auditors said in a report released Wednesday. The Government Accountability Office’s report, which noted that states have spent close to $1.45 billion in federal funds on IT systems for the insurance marketplaces created by the federal health law, rated the 14 state-run exchanges' capabilities as of February in four categories. (Levin Becker, 9/17)

The Alaska Legislature has signed a contract for lawyers to take on Gov. Bill Walker's expansion of Medicaid, drawing criticism from some of its own members who had urged them to not continue after an early loss. The contracts signed Tuesday for up to $450,000 include a signing bonus of $100,000, said Sen. Berta Gardner, D-Anchorage. ... The Legislative Council, the Legislature's operating arm, decided in August to sue Walker and his commissioner of Health and Social Services, Val Davidson, to block expansion, but failed to get an injunction before the state began enrolling Alaskans in the program on Sept. 1. (Forgey, 9/17)

A new state audit takes issue with how MassHealth, the state’s health insurance for low-income residents, spent $4 million, WBUR reports. State Auditor Suzanne Bump says she found problems with how payments for wheelchairs and wheelchair parts were authorized. “We found that there were not proper authorizations for claims, we also found that nursing homes had submitted duplicative bills,” she said in an interview. (9/17)

There’s a growing list of warning signs that Massachusetts, despite lots of effort, may be losing the battle to control health care costs. Last month, the Division of Insurance approved a 6.3 percent increase in the base rate for small businesses. Then, we heard that Massachusetts came in over the target cap for health care spending last year. And now, an attempt to keep health care premiums flat for the largest employee group in the state has failed. (Bebinger, 9/17)

An Oregon legislator wants lawmakers to bar 15-year-olds from using the Oregon Health Plan to pay for sex reassignment surgery. No minors have yet used the state insurance to pay for such a surgery. But Carl Wilson, R-Grants Pass, said a 2014 decision to offer Oregon Health Plan coverage for transgender-related medicines and procedures could allow teenagers to make life-altering decisions they will later regret. (Parks, 9/17)

Among U.S. states, Texas had the highest percentage and greatest number of people without health insurance coverage in 2014, according to new U.S. Census Bureau data released on Wednesday. Of the roughly 25.9 million people in the Lone Star State, 19.1 percent, or just over 5 million, lacked health insurance last year, according to Census Bureau estimates. ... The map [with this post] shows some of the data the Census Bureau published for each state. (Lucia, 9/16)

The share of Americans without health insurance has plunged, but significant demographic gaps remain between who has coverage and who does not. The Census Bureau reported Wednesday that men, particularly young men, are much more likely to be uninsured than women. (Zumbrun and Overberg, 9/17)

When New Jersey Gov. Chris Christie suggested seven months ago, at the height of the Disneyland measles outbreak, that parents should have “a measure of choice” about whether to vaccinate their children, he was widely condemned — and quickly reversed himself. On Wednesday, two GOP presidential candidates who are both medical doctors, Ben Carson and Sen. Rand Paul (R-Ky.), waded into similar territory. This time, the fury rained down from a medical establishment that felt betrayed by its own. ... The notions that vaccines are linked to autism, or should be given in small doses over longer periods of time — both scientifically discredited — appear to be seeping into the Republican mainstream, potentially undermining a long consensus around the role of government in protecting populations from disease. (Allen, 9/17)

Republican presidential candidate Carly Fiorina won applause in Wednesday’s debate for her vivid description of a live fetus she said was shown in an antiabortion group’s undercover video about Planned Parenthood Federation of America. But the image she described isn’t in any of the videos released by the antiabortion group. Instead, one video from the group depicts a former employee of a tissue procurement company stating what she says she saw at a Planned Parenthood clinic. There was never any video that depicted, as Ms. Fiorina stated, a live fetus on a table being prepared for organ harvesting. (Armour, 9/17)

Many of the Republican candidates on the debate stage Wednesday night joined in a full-throated endorsement of Ted Cruz's damn-the-torpedoes strategy to defund Planned Parenthood, even if it means shutting down the federal government. But two candidates who’ll soon be casting votes on the matter were noticeably silent: Sens. Marco Rubio and Rand Paul. (Everett, 9/17)

Consumer-friendly ratings of the benefits of new drugs. Limits on what patients pay. Requiring drug companies to disclose how much they actually spend on research. With the public concerned about the high cost of new medications, these are some of the proposals from a policy center often aligned with the Obama administration. (Alonso-Zaldivar, 9/18)

Legislation to control rising drug prices was introduced in Congress last week, and federal prosecutors are investigating drug price increases. But the chief financial officer of a leading drug wholesaler said Wednesday that generic price inflation would continue, even as the rate of increase has eased in recent months. Michael C. Kaufmann, CFO of Cardinal Health, told financial analysts in New York that corporate takeovers in the generic industry had reduced the number of manufacturers, which can mean price increases, because fewer firms are competing. (Sell, 9/17)

Eli Lilly and Co's new Jardiance pill slashed deaths by 32 percent in patients with type 2 diabetes at risk of heart attack and stroke, a finding that could make it a mainstay diabetes treatment and triple its use, according to researchers and analysts. Lilly shares jumped as much as 9 percent after data from the trial was released Thursday at a medical meeting in Stockholm. (Pierson, 9/17)

The Food and Drug Administration warned doctors that bronchoscopes may transmit infections among patients when inadequately cleaned, the latest alert by the regulator about the risk of reusable medical scopes. The agency recorded 109 reports of infections or contamination related to bronchoscopes in the past five years, including 50 in 2014 alone, according to its safety notice. "A small number" of the incidents showed that the devices remained contaminated even when manufacturers’ cleaning instructions were followed, the agency said. (Tozzi, 9/17)

Rite Aid Corp. said profit in its latest quarter plummeted as the drugstore chain integrated recently acquired Envision Pharmaceutical Services and recorded a loss on retired debt. Meanwhile, the Camp Hill, Pa.-based company further cut its earnings outlook for the year, reflecting sales trends and additional expenses stemming from the recent deal. (Beilfuss, 9/17)

Drugstore chain operator Rite Aid Corp (RAD.N) cut its full-year forecasts for total earnings and drugstore sales, citing lower pharmacy reimbursements and expenses related to its $2 billion acquisition of pharmacy benefit manager EnvisionRx. Rite Aid shares fell nearly 9 percent in morning trading on Thursday. Rising generic drug prices are hurting drugstore operators as insurers and pharmacy benefit managers have been slow in raising reimbursement rates for those drugs. (Ramakrishnan, 9/17)

There's an app for everything these days. Some smartphone apps claim to detect cancer, improve mental concentration, or even help you see better. But not all may have science that backs up their claims. On Thursday, the Federal Trade Commission went after Carrot Neurotechnology, the maker of an app that promised to improve users' vision. (Peterson, 9/17)

Last year's flu vaccine didn't work very well. This year's version should do a much better job protecting people against the flu, federal health officials said Thursday. An analysis of the most common strains of flu virus that are circulating in the United States and elsewhere found they match the strains included in this year's vaccine, the federal Centers for Disease Control and Prevention said. (Stein, 9/17)

When healthy adults under age 65 get a flu shot to protect themselves, they may be helping older adults in their communities avoid the flu as well, according to a new analysis of nationwide U.S. data. The odds of having a flu-related illness were 21 percent lower among seniors living in counties with the highest flu vaccination rates among people 18 to 64 years old, compared to seniors living in counties with the lowest rates, researchers found. (Stephenson, 9/17)

Give flu vaccine another chance: This year's version got a recipe change that should make it more effective after last winter's misery from a nasty surprise strain of virus. Don't let a fear of needles stop you. Beyond the traditional shots, the squeamish for the first time could try a needle-free injection, or choose the nasal spray or tiny skin-deep needles that have been around for a while. (Neergaard, 9/17)

Planned Parenthood asked a federal judge Thursday to reinstate its Medicaid contract with Arkansas, arguing the state relied on "political disfavor" and not the law when it blocked funding over videos secretly recorded by an anti-abortion group. A state attorney argued that Arkansas was within its rights, saying the videos raised concerns about the standards and ethics of the organization. (DeMillo, 9/17)

Planned Parenthood of Southwest and Central Florida has asked the state Supreme Court to take up a property dispute that led to a decision preventing abortions from being performed at an Osceola County facility. Planned Parenthood filed a brief Monday seeking Supreme Court review of a May decision by the 5th District Court of Appeal. The case stems from a restrictive covenant in a Kissimmee medical park that houses the Planned Parenthood facility. The covenant bars outpatient surgical centers in the park, which another occupant, MMB Properties, argued should prevent Planned Parenthood from performing abortions. (9/17)

North Carolina will remake the system that provides health care for the poor and disabled under a compromise bill filed with the Senate clerk's office Thursday afternoon. Both the House and the Senate plan to take votes putting the $14 billion state-run program in the hands of private health insurers next Tuesday. Gov. Pat McCrory says he supports the bill. (Binker, 9/17)

Legislators have agreed to privatize North Carolina’s $15 billion Medicaid program, a change that doctors and hospitals have been fighting for months, but which some Republican legislators have championed as a remedy for unpredictable spending. Under House bill 372, three insurers would be given contracts to offer statewide Medicaid managed care plans. The state would have up to 10 contracts with “provider-led entities,” or groups of doctors and hospitals, that would enroll patients in regional managed care networks. (Bonner, 9/17)

Balance billing is particularly prevalent among a vulnerable subset of Medi-Cal recipients — those who also qualify for Medicare, the federal health program for seniors and disabled people. Folks who qualify for both are referred to as dual eligibles. A recent report by the federal Centers for Medicare and Medicaid Services revealed a nationwide trend of healthcare providers illegally billing these individuals for charges not covered by either type of insurance. In California, Lee said, the call volume on her organization's help line doubled in the last year in large part because of complaints about balance billing among people with Medi-Cal. (Zamosky, 9/18)

Two leading Democratic legislators are asking federal administrators to block Gov. Terry Branstad’s plan to turn the state’s Medicaid program over to private companies. Sens. Amanda Ragan and Liz Mathis contend that Branstad is trying to make the shift too quickly and that he has not shown how it will save money and help poor Iowans. (Leys, 9/17)

The Pennsylvania Department of Human Services on Wednesday took steps to put $17 billion worth of Medicaid business out for bid to private companies. At a time when the insurance industry considers goverment programs a growth sector, the moves are expected to attract new national competitors to Pennsylvania, where home-grown firms, such as AmeriHealth Caritas, have dominated for years. (Brubaker, 9/17)

The Virginia Board of Health voted Thursday evening to reverse hospital-style rules and building codes for abortion clinics, fulfilling a campaign promise of Gov. Terry McAuliffe and delivering a setback to abortion foes. (Portnoy, 9/17)

Representatives of Ohio's children's hospitals visited Capitol Hill this week to seek aid in fighting a growing prescription drug abuse problem that's made drug overdoses Ohio's top cause of death and has dramatically increased the number of babies born addicted to drugs. Carrie Baker of the Ohio Children's Hospital Association, who adopted a baby born with opiate dependency, said the number of drug addicted babies nationwide increased 800 percent between 2004 and 2013. (Eaton, 9/17)

An appeals court Wednesday asked the Florida Supreme Court to take up a dispute about the constitutionality of a 2012 legislative move that limited fees paid to attorneys who represented a child severely injured at birth. A three-judge panel of the 4th District Court of Appeal in July upheld the fee limit, which was included in a legislative "claim" bill for the child, Aaron Edwards. But the appeals court Wednesday asked the Supreme Court to resolve the constitutional issue, a legal step known as certifying a question to the Supreme Court. (9/17)

At the Republican debate on Wednesday and throughout the campaign, candidates led by Donald J. Trump have assailed illegal immigration, and some have questioned whether children who are born to immigrants in this country illegally should be considered American citizens. But here on the Texas border some local officials are engaged in activities that go beyond talk, enforcing some of the toughest rules in the country limiting the types of ID parents can show to receive copies of birth certificates. The result has been a refusal to issue birth certificates to many of the Texas-born children of immigrants here illegally. ... Without a birth certificate, illegal immigrants say they cannot have newborns baptized, have had difficulty enrolling their children in day care and school and have lost or fear losing Medicaid coverage and other government services and benefits for their families. They said officials required birth certificates for these programs, as proof of parenthood or the child’s Texas birth. (Fernandez, 9/17)

The hope in Watertown is to have as many businesses as possible learn more about how to better serve people whose decline in memory or other thinking skills is affecting their everyday activities. The goal is to train 75 percent of the community’s businesses by 2016, said Jan Zimmerman, director of dementia outreach and education for The Lutheran Home Association, which runs retirement communities in Wisconsin, Minnesota and Florida. (Antlfinger, 9/18)

Home health agencies are a segment of the medical industry that you may not know about if you or a loved one has never needed one. The companies send therapists and nurses into the homes of Medicare patients to help them recover from an illness or surgery. This summer the federal government started rating home health agencies – doling out one to five stars – to give consumers a better picture of the job they do. The top grades were elusive: only 239 agencies out of 9,000 nationwide earned five stars, according to a Kaiser Health News analysis. (Tomsic, 9/18)

A Flint-area Catholic hospital has until the end of Friday to change its mind and perform a tubal ligation on a pregnant woman with a brain tumor – or face a potential lawsuit from the American Civil Liberties Union. The ACLU is fighting on behalf of Jessica Mann, 33, of Flushing, a pregnant woman with a life-threatening brain tumor who was denied a request to get her tubes tied at the time of her scheduled C-section next month. (Baldas, 9/18)

Using early release data from the 2014 National Health Interview Survey (NHIS), we found that by the fourth quarter of 2014 the uninsurance rate for Hispanic adults, including both citizens and noncitizens, had fallen to 31.8 percent from 40.1 percent in the third quarter of 2013—which was just before the first ACA open enrollment period. Over the same period, non-Hispanic black adults ... saw a decline in uninsurance from 25.5 percent to 17.2 percent, and non-Hispanic white adults ... saw a smaller but still significant decline, from 14.8 percent to 10.5 percent. (McMorrow et al., 9/16)

Social Security projections suggest that between 2013 and 2050, the population aged 65 and over will almost double, from 45 million to 86 million. ... Average U.S. life expectancy was 67 years for males and 73 years for females five decades ago; the averages are now 76 and 81, respectively. ... Our major entitlement programs -- Medicare, Medicaid, Social Security, and Supplemental Security Income -- have come to deliver disproportionately larger lifetime benefits to higher-income people because, on average, they are increasingly collecting those benefits over more years than others. This report studies the impact the growing gap in life expectancy has on the present value of lifetime benefits that people with higher or lower earnings will receive from major entitlement programs. ... The report also explores, from a lifetime benefit perspective, how the growing gap in longevity affects traditional policy analyses of reforms to the nation's leading entitlement programs. (Lee, Orszag et al., 9/17)

Proposals to increase the eligibility age for Medicare may have unintended consequences for state government finances. Specifically, the medical care of some Americans who currently receive both Medicaid and Medicare benefits, also known as “dual eligibles,” could become the sole responsibility of Medicaid .... We estimate that the states’ share of Medicaid costs would increase $369 million per year if the Medicare eligibility age is increased to 67 and $1.9 billion per year if the eligibility age is increased to 70. ... the financial effect on an individual state depends on (1) its demographic composition, (2) the share of Medicaid expenditures for which the state is responsible, and most important, (3) whether the state has expanded the income eligibility threshold for Medicaid under the Affordable Care Act. (Waidmann and Lawton, 9/17)

While a small share of the Medicare population lives on relatively high incomes, most are of modest means, with half of people on Medicare living on less than $24,150 in 2014. ... the range of asset values among beneficiaries is wide and varies greatly across demographic characteristics. ... the income, assets and home equity values of Medicare beneficiaries overall are projected to be somewhat greater in 2030 than in 2014 after adjusting for inflation; yet, much of the growth is projected to be realized among those with relatively high incomes and assets. As policymakers consider options for decreasing federal Medicare spending ..., these findings raise questions about the extent to which the next generation of Medicare beneficiaries will be able to bear a larger share of costs. (Jacobson et al., 9/10)

In 2014, the American Board of Internal Medicine (ABIM) substantially increased the requirements and fees for its maintenance-of-certification (MOC) program. Faced with mounting criticism, the ABIM suspended certain content requirements in February 2015 but retained the increased fees and number of modules. ... [Researchers sought to] estimate the total cost of the 2015 version of the MOC program ("2015 MOC") and the incremental cost relative to the 2013 version. ... Internists will incur an average of $23 607 ... in MOC costs over 10 years, ranging from $16 725 for general internists to $40 495 for hematologists-oncologists. Time costs account for 90% of MOC costs. (Sandhu, Dudley and Kazi, 9/15)

In the Burwell v. Hobby Lobby decision, the Supreme Court ruled that “closely held” for-profit corporations may be exempted from the [contraceptive coverage] requirement. This ruling, however, only settled part of the legal questions ... as there are ... other legal challenges brought by nonprofit corporations. The nonprofits are seeking an “exemption,” meaning their workers would not have coverage for some or all contraceptives, rather than an “accommodation,” which entitles their workers to full contraceptive coverage but releases the employer from paying for it. ... This brief explains the legal issues raised by the nonprofit litigation and discusses the impact of the Hobby Lobby decision on the current litigation. (Sobel and Salganicoff, 9/9)

Under bundled payment programs, hospitals receive a single payment for all services provided surrounding an episode of care. Because health care providers, such as hospitals and physicians, accept more financial risk under these programs, they will need a better understanding of episode costs to identify areas to target improvements in quality and cost-efficiency. ... we used national Medicare claims data and identified patients undergoing bariatric procedures in 2011-2012 [for 24,647 patients at 463 hospitals]. ... Mean total payments for bariatric procedures varied from $11 086 to $13 073 per episode of care, resulting in a mean difference of $1987 (16.5% difference) per episode of care between the lowest and highest hospital quartiles. The index hospitalization was responsible for the largest portion of total payments (75%), followed by physician services (21%). (Grenda et al., 9/16)

In 2013 the majority of Medicaid LTSS [long-term services and supports] spending was for the first time focused on home and community-based settings instead of institutional care, and the Centers for Medicare and Medicaid Services (CMS) projects that community-based spending will reach 63 percent of all Medicaid LTSS spending by 2020. However, the fundamental structure of the Medicaid statute continues to promote an "institutional bias." ... state progress in providing choice of home and community-based alternatives ... has been uneven, and expenditures for certain population groups continue to be largely institutionally based. ... CMS enacted final HCBS [home and community-based services] regulations in January 2015 that, for the first time, attempt to create a national standard regarding the characteristics of home and community-based care settings. (Ryan, 9/17)

For hospital nurses, working 12 hours or longer is associated with adverse outcomes, including nurse burnout, that may endanger patients and nurses, a new study has shown. Chiara Dall'Ora, MSc, from the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (Wessex), University of Southampton, United Kingdom, and colleagues present their findings in an article published online August 23 in BMJ Open. (Brown, 9/14)

After a heart attack, black patients typically don’t live as long as whites – a racial difference that is starkest among the affluent – according to a new U.S. study. Researchers evaluated data on more than 132,000 white heart attack patients and almost 9,000 black patients covered by Medicare, the government health program for the elderly and disabled. They used postal codes to assess income levels in patients’ communities. After 17 years of follow-up, the overall survival rate was 7.4 percent for white patients and 5.7 percent for black patients, according to the results published in Circulation, the journal of the American Heart Association. (Rapaport, 9/14)

Cancer remains the leading cause of death among Hispanics in the U.S., driven in large part by lung malignancies in men and breast tumors in women, a new report finds. ... Every three years, the American Cancer Society reports cancer statistics for Hispanics based on data from U.S. health agencies and national cancer registries. For all cancers combined, Hispanics have 20 percent lower incidence rates and 30 percent lower death rates than white people in the U.S., [researcher Rebecca] Siegel and her colleagues report in CA: A Cancer Journal for Clinicians. (Rapaport, 9/16)

Race appears to affect the odds that a child or teen with appendicitis, a painful condition requiring surgery, will get pain medication, particularly opioid medication, according to a new study. ... Previous studies have documented racial disparities in emergency department treatment or management of adult patients, but these results specifically among children are particularly striking, [Dr. Monika K. Goyal] said. (Doyle, 9/14)

[R]esearchers say that eating a Mediterranean diet supplemented with four tablespoons per day of extra-virgin olive oil reduces the risk of breast cancer. "We found a strong reduction in the risk of breast cancer," says Miguel Martinez Gonzalez, an author of the study and a leading researcher on the preventive health effects of the Mediterranean diet at the University of Navarra in Spain. (Aubrey, 9/14)

People with relatively little education and comparatively low earnings don't live as long as those with higher levels of education and income. That much has been known for some time. But it turns out that this gap is widening significantly, and is starting to have big effects on Social Security, Medicare and other programs. The growing lifespan gap has been confirmed, most recently, by a committee of the National Academies of Sciences, Engineering and Medicine that we co-chaired, whose report is released Thursday. ... These trends mean that high earners will probably receive Social Security, Medicare and other such government benefits for many more years than low earners do. (Peter R. Orszag and Ronald D. Lee, 9/17)

What a difference four years -- and millions of people with health insurance -- can make in the Republican presidential campaign. In 2011, the last time GOP candidates for president gathered for a debate at the Ronald Reagan Library, the topic of the Affordable Care Act came up early and often. ... On Wednesday night, for this year’s debate at the Reagan Library, the health care law got almost no attention at all. Donald Trump made a quick reference to it during his introductory remarks, and Ted Cruz made his usual promise to repeal the law. ... So why didn’t the CNN hosts ask about it? Why didn’t any of the Republican candidates strain to bring it up, ... Here’s one theory: The issue is losing its resonance, even among Republicans. (Jonathan Cohn, 9/17)

The central question facing conservatives is how to bring Americas’ debt and deficit under control. And the central driver of America’s debt and deficit problem is the growth in government spending on health care: Medicare, Medicaid, and Obamacare. Furthermore, anti-Obamacare sentiment was a prime component of Republican electoral victories in 2010 and 2014. And yet, the CNN hosts asked a grand total of zero questions on how candidates would replace Obamacare or reform our health care entitlements. (Avik Roy, 9/17)

The second Republican presidential debate took place as the nation faces the possibility of another destructive government shutdown. Instead of the responsible discussion one would hope to hear from those asking to be entrusted with the fate of the country, the candidates by and large exacerbated the threat of a shutdown with inflammatory pandering on the subject of Planned Parenthood. (9/17)

Among the 15 candidates vying for the nation’s attention in Wednesday’s Republican presidential debate were two physicians, and late in the three-hour marathon CNN’s Jake Tapper gave them both an opportunity to strut their medical expertise before millions of TV viewers. First up was Ben Carson, who had earlier told viewers that his presidential candidacy is motivated by his concern for the future of America’s children. “Dr. Carson, Donald Trump has publicly and repeatedly linked vaccines, childhood vaccines, to autism, which, as you know, the medical community adamantly disputes,” Tapper began. (Brian Dickerson, 9/17)

Before the Affordable Care Act’s major provisions for coverage expansion were implemented in January 2014, there were concerns that the primary-care delivery system would struggle amid increased demand for services from patients gaining coverage, many for the first time. It’s not hard to find anecdotal reports of problems, but a systematic survey of primary-care physicians by the Kaiser Family Foundation and the Commonwealth Fund indicates that, so far, these fears have largely not come to pass. (Drew Altman and David Blumenthal, 9/18)

In this age of instant information, medicine remains anchored in the practice of releasing new knowledge at a deliberate pace. It’s time for medical scientists to think differently about how quickly they alert the public to breakthrough findings. Last week the National Institutes of Health announced that it had prematurely ended a large national study of how best to treat people with high blood pressure because of its exceptional results. ... The problem is that many details of the study have not been released. (Eric J. Topol and Harlan M. Krumholz, 9/17)

Like a lot of debates that hinge on deeply personal emotions and decisions, the right-to-die question rests for many people in that delicate balance between “what I believe” and “what I'd do if it were me or a loved one.” We can look at the history of another deeply fraught culture war battle — over abortion legislation — and see direct parallels in the way such issues tap into a particularly American brand of conflicted morality. (Meghan Daum, 9/17)

When can democracy become a bit too much for working politicians? In Montana politics, it seems, when leaders of the state’s solid Republican legislature go to court to complain that party orthodoxy is being unfairly compromised by non-conformist and moderate G.O.P. lawmakers daring to vote for such measures as expanded government health care, greater financial disclosure in elections, and a settlement with native Americans over water rights. (Francis X. Clines, 9/17)

Sylvia Burwell, Secretary of Health and Human Services, recently announced the department’s intention to tie most Medicare fee-for-service payments to value by 2018. Most commercial insurers already incentivize quality to some degree and encourage beneficiaries to consider quality and cost. Having payers aim for value should improve health system performance, certainly when compared with traditional incentives for the volume of services, which have failed to deliver the kind of care that is possible. Paying for value, though, requires measuring what actually matters to patients. Yet almost all current quality metrics reflect professional standards. ... serious, life-altering, and ultimately life-ending chronic conditions, often in old age, pose a particular challenge for the health care system because traditional professional standards may not effectively address what an individual most wants. (Joanne Lynn, Aaron McKethan and Ashish K. Jha, 9/17)