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A year after the Obama administration temporarily shelved an unfinished part of HealthCare.gov intended for small businesses, it has opened with reports of only modest technical flaws — but with doubts that it will soon benefit the millions of workers at little companies with inadequate health insurance or none at all. (Goldstein, 11/30)

Employees of St. Louis-area small businesses won’t have many options if their employers decide to use the new online health marketplace under the federal overhaul. Missouri was supposed to be one of a handful of states to offer a highly touted “employee choice” feature, designed to let workers pick their own health plans within a designated cost-sharing tier. But, it turns out, Missouri workers won’t be able to take advantage of that option for 2015 coverage. (Shapiro, 11/29)

The Obama administration has managed to launch the SHOP exchange for HealthCare.gov after a yearlong delay. But it could take years for the new small business marketplace to hit its stride — partly because of the Obama administration’s own decisions about phasing in the new coverage option. (Pradhan, 11/26)

A surge in health insurer competition appears to be helping restrain premium increases in hundreds of counties next year, with prices dropping in many places where newcomers are offering the least expensive plans, according to a Kaiser Health News analysis of federal premium records. KHN looked at premiums for the lowest-cost silver plan for a 40-year-old in 34 states where the federal government is running marketplaces for people who do not get coverage through their employers. Consumers have until Feb. 15 to enroll for coverage in 2015, the marketplace’s second year. (Rau and Appleby, 12/1)

After two years of vilifying the federal health overhaul and the state's health insurance exchange, Minnesota Republicans face Democratic opposition in the Senate and governor's office that will scale back their hopes for a wholesale makeover. Fresh off winning back the state House, Republicans are mapping out their plans to tweak MNsure in 2015. For now, they're leaving everything on the table: from altering its board to giving lawmakers budgetary control of the independent entity. (Potter, 11/27)

California's health exchange is leaning on insurance agents to enroll thousands of people in Obamacare coverage. Trouble is, some agents haven't been paid for months. In some cases, agents are owed thousands of dollars in commissions for getting folks signed up earlier this year. And they said they still face long waits on the phone to get simple issues resolved for customers. Their experiences could sap much of the enthusiasm among Covered California's most effective sales force. (Terhune, 11/26)

Hundreds of thousands of Pennsylvania residents left out of coverage under the 2010 federal health care law now have a chance to get insurance as the state undertakes a massive overhaul to health care for the poor. On Dec. 1, enrollment begins in the Healthy Pennsylvania program, the name given to Pennsylvania's Medicaid expansion by outgoing Republican Gov. Tom Corbett. Coverage will begin Jan. 1, and state officials say some 600,000 people — primarily low-income, single working adults — are newly eligible for coverage under guidelines set by the 2010 law. (Levy, 11/30)

Bad timing turned Karen Slone's medical problem into a crisis. Slone, 53, a former administrative assistant with diabetes, followed doctors' advice for years, getting regular checkups. Then, last year, she lost her job and her insurance, and stopped going to the doctor. When she spotted a sore on her foot, a common complication of diabetes, Slone tried Neosporin and Band-Aids. By the time she went to an emergency room weeks later, she had a raging infection. Surgeons had to remove bones in two toes. (Levey, 11/30)

With a plan released Wednesday by the administration of Gov. Matt Mead, a Republican, Wyoming has become the latest state seeking to expand Medicaid. The plan would provide Medicaid coverage to an additional 18,000 low-income people, according to the state’s health department. If it wins federal and state legislative approval, Wyoming will join 27 states that have expanded the program under the Affordable Care Act, including nine with Republican leadership. As several other Republican governors have done, Mr. Mead wants to require some people who receive coverage under the expansion to pay something toward the cost. (Goodnough, 11/27)

Leading U.S. CEOs, angered by the Obama administration's challenge to certain "workplace wellness" programs, are threatening to side with anti-Obamacare forces unless the government backs off, according to people familiar with the matter. Major U.S. corporations have broadly supported President Barack Obama's healthcare reform despite concerns over several of its elements, largely because it included provisions encouraging the wellness programs. The programs aim to control healthcare costs by reducing smoking, obesity, hypertension and other risk factors that can lead to expensive illnesses. A bipartisan provision in the 2010 healthcare reform law allows employers to reward workers who participate and penalize those who don't. (Begley, 11/28)

Legal immigrants are running into fresh problems signing up for insurance on HealthCare.gov, presenting a hurdle in the Obama administration’s efforts to cover more Hispanics. Immigrant groups say people born outside the U.S. who are entitled to private insurance under the Affordable Care Act are having trouble proving their identities to the federal insurance marketplace and uploading documents that demonstrate they are in the country legally. Some also are being routed first to Medicaid, the state-federal insurance for the poor, even though they don’t qualify. (Radnofsky, 11/27)

When the Affordable Care Act rolled out last year, Californians enrolled in both Covered California and expanded Medicaid in high numbers. But there are still millions in the state without health insurance. Undocumented people don't qualify for Obamacare benefits. And many others still find coverage too expensive — or face other obstacles in enrolling. One of those people is Leaburn Alexander. ... He says he makes just under $11 an hour, and after taxes, child support and other expenses, he brings home just enough to cover rent. ... There's no room in the budget for health insurance. (Morehouse, 11/30)

The Obama administration will promote health insurance coverage at shopping malls starting on Black Friday and continuing through the busiest shopping days of the holiday season, officials announced Wednesday. They said more than 462,000 people selected a private insurance plan in the first week of 2015 enrollment through the online marketplace HealthCare.gov. The government's enrollment push with Westfield Shopping Centers will involve setting up outreach tables at malls in Florida, Illinois, New Jersey, Connecticut, Maryland, New York and Washington state. Separately, the California insurance marketplace, Covered California, will work with Westfield malls in that state. (Johnson, 11/26)

While the law was touted as a way to keep health insurance costs down and limit the growth of the nation's debt, it taxes the rich in order to pay for health insurance for the poor. When all is said and done, the Congressional Budget Office says that 13 million Americans will gain coverage under the ACA's expansion of Medicaid — a program only available for the poor. And a substantial portion of the insurance subsidies offered under the ACA flow to those earning modest wages. (Goldfarb, 11/26)

What a difference a year makes. More than 460,000 people signed up for health insurance on the federal government’s website during the first week of open enrollment, officials said Wednesday. And there were no outages or other technical glitches. (Fox, 11/26)

In mounting the latest court challenge to the Affordable Care Act, House Republicans are focusing on a little-noticed provision of the law that offers financial assistance to low- and moderate-income people. Under this part of the law, insurance companies must reduce co-payments, deductibles and other out-of-pocket costs for some people in health plans purchased through the new public insurance exchanges. The federal government reimburses insurers for the “cost-sharing reductions.” In their lawsuit, House Republicans say the Obama administration needed, but never received, an appropriation to make these payments to insurance companies. (Pear, 10/29)

Two years ago, the chief justice surprised many by joining liberals on the court to uphold the constitutionality of Obama's Affordable Care Act. And he probably holds the deciding vote in a second legal challenge to the healthcare law — one that seeks to eliminate government insurance subsidies to low- and middle-income enrollees in two-thirds of the nation.But Roberts, an appointee of President George W. Bush, has shown an increasing skepticism toward what conservatives call Obama's tendency to overreach. (Memoli, 12/1)

A government watchdog report says the U.S. Health and Human Services Administration should determine whether hospitals are properly reporting revenue they can receive from group purchasing organizations such as Charlotte-based Premier to make sure Medicare payments aren’t being affected. The report, released last week by the Government Accountability Office, also drew sharp criticism from a physicians group that said the findings did not address their allegations that GPOs are contributing to generic prescription drug shortages. (Rothacker, 11/26)

Federal employees posing as consumers dialed a dozen outpatient clinics and hospitals in Portland last year, asking about the cost of two common procedures -- a colonoscopy and a hernia repair. Sometimes they got answers. Sometimes they didn't, even after calling three times. (Terry, 11/26)

U.S. officials trying to set up a network of hospitals in this country to care for Ebola patients are running into reluctance from facilities worried about steep costs, unwanted attention and the possibility of scaring away other patients. “They’re saying, ‘Look, we might be willing to do this, but we don’t want to be called an Ebola hospital. We don’t want people to be cancelling appointments left and right,’ ” said Michael Bell, director of laboratory safety at the Centers for Disease Control and Prevention. (Sun and Dennis, 11/28)

As the cost of healthcare rises, more and more Americans in nearly every economic class are choosing to delay medical treatment because they can’t afford it. A new Gallup poll released Friday found that about one in three Americans say they have put off treatment for themselves or a family member because of cost—the highest rate recorded in Gallup’s history. (Ehley, 12/1)

Open enrollment season is your annual opportunity to review your employer-provided benefit options and make elections for the upcoming plan year. Even if you're satisfied with your current health plan, compare your existing coverage with other plans. Premiums, out-of-pocket costs, and benefits often change from year to year. (Mokosak, 11/29)

(Hancock, 11/19)

She sued under the federal Pregnancy Discrimination Act, and the Supreme Court will hear her case on Wednesday. Women’s rights groups hope that Ms. Young’s case will snap their recent losing streak at the court, which has included decisions on equal pay, medical leave, abortion and contraception. (Liptak, 11/30)

A private woman, Peggy Young didn’t want all the world to know her most intimate business, including her two failed attempts at conceiving a child with her former husband before her pregancy in 2006 cost her her job delivering letters at United Parcel Service in Landover, Md. All Peggy Young wanted, she says, was to drive. But when her bosses at UPS told her to take unpaid leave until she was no longer pregnant, Young sued, saying the company violated the federal Pregnancy Discrimination Act of 1978 and failed to treat a pregnant Young the way it treated other employees. She lost twice in courts in Maryland, which agreed with UPS that Young did not prove the company discriminated against her because of her pregnancy. On Wednesday, the Supreme Court will hear oral arguments in her appeal of the closely watched case. (Schulte, 11/30)

Several cases involving gender discrimination and reproductive rights have hit a 5-4 roadblock at the conservative-leaning court under Chief Justice John Roberts. Now groups representing women, workers, employers and others are watching to see how the justices handle the company's refusal to reassign Young to light duty during her pregnancy. After last June's ruling that Hobby Lobby and other employers with religious objections could deny their employees health insurance coverage for contraceptives, Justice Ruth Bader Ginsburg went so far as to suggest her male colleagues had a "blind spot" on the issue. (Wolf, 11/30)

The big Republican gains in the November elections strengthened and enlarged the anti-abortion forces in the House and the Senate. But it’s the GOP victories in the statehouses and governor’s mansions that are priming the ground for another round of legal restrictions on abortion. (Winfield Cunningham, 11/28)

Colorado Democrats who credit a drop in teen pregnancy to expanding access to long-acting birth control such as intrauterine devices have to convince Republicans next year to use state funds for the contraceptives. This summer, Gov. John Hickenlooper and his chief medical officer praised a five-year pilot program — supported with a $25 million private donation — that they said helped decrease Colorado's teen birth rate ... Abortions also decreased, officials said. (Moreno, 11/28)

President Barack Obama's executive order to spare some immigrants from deportation has galvanized Democrats, immigration groups and health care advocates in California to push for expanding health coverage to a segment of the population that remains uninsured. The president's action excludes immigrants who came to the country illegally from qualifying for federal health benefits. But California has its own policy of providing health coverage with state money to low-income immigrants with so-called "deferred action" that allow them to avoid deportation. Immigrant and health care advocates say that means Obama's executive order will enable hundreds of thousands of low-income immigrants in California to apply for Medi-Cal, California's version of Medicaid. (Lin, 11/30)

The costs per patient for hospital-owned physician groups are higher than in groups owned by physicians themselves, according to a new UC-Berkeley study. (Norberg, 11/26)

It’s been almost a year since federal regulators approved a new hepatitis C treatment that costs about $1,000 per pill. But time hasn’t done much to ease concerns of state officials who worry about the drug’s budget-busting potential. Missouri officials estimate the new drug therapy cost the state $30 million through October of this year. Illinois says it spent $16 million during the last fiscal year that ended in July. (Shapiro, 11/30)

What began more than seven years ago as an experiment to more efficiently tackle Mesa's increasing numbers of medical calls is now a well-oiled system. In July, the federal Centers for Medicare & Medicaid Services announced it would hand the city $12.5 million to get a more formal, data-driven trial of its "Community Care units" off the ground, in the hopes that Mesa's concept could revolutionize the efficiency of emergency-response systems nationwide. (Polletta, 11/28)

A controversial trend in health care may make its first appearance in the Milwaukee area, with Froedtert Health proposing to convert its urgent care clinic in New Berlin to a free-standing emergency department. The move will enable Froedtert Health to charge patients much higher rates — two to three times higher by some estimates — than its urgent care clinic receives for the same care. (Boulton, 11/29)

New York state health officials have stopped a nonprofit group from providing free medical care to thousands of patients lacking health insurance during a four-day dental conference that starts Friday. The nonprofit, Remote Area Medical, had raised $3 million and enlisted hundreds of volunteer doctors and other medical workers to offer a range of health services, including dental care, new eyeglasses and other services. The group had planned to treat about 7,000 patients at the New York Sate event. (Brodsky, 11/28)

In the green-painted basement of a former parish school, old church pews serve as waiting-room seating and long fluorescent tube lights hum quietly overhead. Cast-off office cubicle dividers separate medical exam rooms. In one of them, Dr. Teresa Tallon of Fort Wayne is busy trying to decipher the medical situation of a first-time patient. A man, who says he's homeless, tells her, in no particular order, about problems with poison ivy, injuries from old bicycle and construction accidents and a swollen leg. He also says he could use a flu shot, after being offered one. It's not a particularly busy Wednesday at Clinica Madre de Dios in Fort Wayne. A half hour into the weekly no-appointment session between 12:30 and 3 p.m., only four patients have appeared. (Rodriguez, 11/30)

Some of Florida’s most influential health care groups are urging state lawmakers to expand the use of telehealth — web and videoconferencing technology that allows doctors and other healthcare specialists to treat patients — as a way to save money and deal with a growing shortage of doctors. (McGrory, 11/28)

Health care giant Kaiser Permanente is facing mounting criticism about the care it provides mental health patients in California. A union is accusing the company of understaffing its mental health unit, causing patients to face excessive delays before treatment. Last year, state officials fined the Oakland company $4 million for numerous violations related to patient access to mental health services. (Pfeifer, 11/27)

About a year ago at a Miami-Dade County school board meeting, superintendent Alberto Carvalho was happy to announce the district and the teacher’s union had just ratified a new contract. 'I believe that this contract honors and dignifies what you do every single day,' he told the school board members. It included bonuses for most teachers and it settled how to handle health care expenses after yet another year of rising costs. (Mack, 12/1)

Beginning Dec. 1, seniors living in three states will need prior approval from Medicare before they can get an ambulance to take them to cancer or dialysis treatments. The change is part of a three-year pilot to combat extraordinarily high rates of fraudulent billing by ambulance companies in Pennsylvania, New Jersey and South Carolina. (Gillespie, 12/1)

A surge in baby boomers has driven up the number of elderly people abusing drugs or alcohol, bringing more attention to the sometimes-delicate problems involved in treating addiction in the aging. Last summer, the Jewish Home Lifecare nursing home in the Bronx set out to address those issues. Patients 60 and older who come in for rehab after a hospital stay are also screened for addiction and offered a chance at recovery. (11/30)

It's a startling admission of political spinelessness. [Sen. Charles] Schumer gets the positive impact of the legislation wrong, he gets the politics of it wrong, and he displays a shocking ignorance of the problems facing the American middle class. The only good thing about his remarks is that they confirm how bad today's Democrats are at messaging. Let's put it this way: Franklin Roosevelt would never have tried to discredit his own policies the way Schumer just did. (Michael Hiltzik, 11/26)

Health reform may be working better lately, but polls still show that it is broadly unpopular, ... The real questions are: Why? And, what, if anything, can Democrats do about it? ... Democrats have periodically won public favor by promising to wield federal power to address long-neglected social and political ills, then lost it again when big-government solutions proved unsatisfactory. Parardoxically, the party of government struggles to gain politically from actually being in government. (Charles Lane, 11/26)

As a matter of political analysis, Schumer is correct. Had Democrats done more to boost the economy early on and gone after health-care reform in smaller pieces — as then-White House chief of staff Rahm Emanuel advocated at the time — they may well have wound up with more durable achievements on both and kept their majority intact to enact other priorities. The better question is why Schumer chose to reopen those wounds now. The new Republican majority will do everything it can to thwart Obama and the Democrats. Democrats hardly need to be thwarting themselves. (Dana Milbank, 11/28)

It's easy to be offended by Chuck Schumer's claim yesterday that Obamacare was a mistake, because it favored the interests of the poor ahead of Democrats' electoral fortunes. Harder is dismissing it, because other Democrats are probably thinking the same thing: What did Obamacare gain them? ... Obamacare has mostly been a policy success. Enrollment is high, costs are reasonable, and the sky hasn't fallen on employer-based insurance. Some people on the individual market saw their plans canceled, but for the most part it's working. Yet the political payoff for that success has been close to zero. The problem isn't only, or even primarily, that the poor are less likely to vote; it's that Obamacare's benefits haven't translated into support for the law or the party that brought it into existence. (Christopher Flavelle, 11/26)

[L]et’s all express gratitude to our fellow Americans who dare to run for the House and Senate. By way of offering mine, I want to thank a few good people we’re losing to retirement or electoral defeat. ... [Rep. George] Miller and [Rep. Henry] Waxman (like the late Ted Kennedy) spent their careers championing universal health care. So did Rep. John Dingell (D-Mich.), Sen. Jay Rockefeller (D-W.Va.) and Sen. Tom Harkin (D-Iowa). It’s fitting that all of them got to help Obamacare pass. (E.J. Dionne Jr., 11/26)

As Americans gather for Thanksgiving, there's plenty to worry about, ... But for just one day, forget all that, and focus instead on some of the positive trends that too often get overlooked. ... Millions more people have health insurance than did this time last year, thanks to the gradual phase-in of the Affordable Care Act. Even those who loathe Obamacare like some of its parts, such as no lifetime limits on health insurance in case of major illness and being able to keep offspring on the family policy until age 26. (11/26)

This is the most important lesson to be learned from Jonathan Gruber's honesty: The bigger and more complex the bill, the more vulnerable it is to political manipulation — and the more likely it is to deceive the American people. Obamacare epitomizes why Congress should tackle such sweeping reforms with a piecemeal, straightforward, and transparent approach. Hopefully the incoming Congress will remember this as they take up health care reforms of their own. (Luke Hilgemann, 11/29)

I understand we've turned the page to the next controversy -- Mr. Obama's unconstitutional immigration pander -- but I'd like to dwell a little longer on the previous travesty. Obama administration health-care consultant Jonathan Gruber was discovered to have boasted that Obamacare was designed to exploit the "stupidity" of American voters and elude honest accounting by hiding both its cost and the taxes necessary to pay for it. When asked about this in Brisbane, Australia, the president rolled his eyes at the controversy. ... the biggest lie is the one Mr. Obama left unsaid in Brisbane. He implied that he won the debate. He didn't. He won the fight in Congress -- by brute partisan force. But the majority of the American people watching this farcical debate were never convinced by Mr. Obama's claims. (Jonah Goldberg, 12/1)

Last month, ballot measures that would have given embryos the legal rights of persons were decisively rejected in Colorado and North Dakota. The defeats were hailed as a victory for defenders of the right to legal abortion. But such measures serve as a distraction from a far bigger threat to abortion rights from onerous rules known as Targeted Regulation of Abortion Providers, or "TRAP laws." (Caitlin Borgmann, 11/30)

This December marks the 15th anniversary of the landmark report from the National Academy of Sciences' Institute of Medicine that estimated up to 98,000 Americans die from preventable mistakes in hospitals every year. It is time to know if health care is safer now. Many hospitals in Iowa and elsewhere are working diligently to reduce medication errors, hospital-acquired infections and other causes of harm. Progress has been made, pockets of excellence created and people go home from the hospital alive and well. (Rosemary Gibson and David P. Lind, 11/30)

For many obvious reasons, people in prison are among the unhealthiest members of society. Most come from impoverished communities where chronic and infectious diseases, drug abuse and other physical and mental stressors are present at much higher rates than in the general population. Health care in those communities also tends to be poor or nonexistent. ... public health and criminal justice systems must communicate effectively with one another. (11/26)

A confluence of recent events has made the Supreme Court the most powerful, least accountable public institution in the country. It is time to make the justices more accountable to the American people. The court rules on wide-ranging issues fundamental to American life — where we can pray, who is eligible to vote and marry, how much regulation businesses should face, and who has access to health insurance. And with Congress gridlocked and relations between the legislative and executive branches at a historic nadir, the court's opinions are binding and irreversible. So much for checks and balances. (Gabe Roth, 11/30)

Most restaurants have little incentive to disclose calorie information on their own. The new FDA rule is meant to force such disclosure, and then to rely on the operation of the free market. The FDA hopes that once consumers see calorie counts, they will make healthier choices, and there is evidence to support the agency’s optimism. (Cass R. Sunstein, 11/28)