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Nearly 6 million Americans so far have enrolled in insurance for 2016 through HealthCare.gov, President Obama announced on Friday, touting a big increase over last year that he said shows the Affordable Care Act is succeeding. (Goldstein, 12/18)

Analysts had been concerned that higher premiums and deductibles might scare off new enrollees. But, according to the administration, 2.4 million of the roughly six million people who signed up as of Dec. 17 were new customers. Administration officials said that is about a third more than had signed up last year ahead of the deadline for coverage starting Jan. 1. (Armour, 12/18)

While retaining consumers is important, administration officials need to attract uninsured consumers to meet and hopefully exceed the modest goal they set of 10 million people insured on the exchanges at the end of 2016. (O'Donnell, 12/18)

Hundreds of thousands of additional consumers have selected plans through marketplaces operated by the remaining states, including California, New York, Connecticut and Maryland. The strong demand for Obamacare coverage in the law’s third enrollment period may further solidify the markets, which are still evolving as insurance companies and consumers continue to adapt to the new healthcare environment. (Levey, 12/18)

Gov. Asa Hutchinson encountered no vocal opposition last week when he outlined to a legislative task force his plan for a modified version of Medicaid expansion and his goal of cutting $835 million in costs from the traditional Medicaid program over five years — but that doesn’t mean fights aren’t coming. ... Hutchinson wants to impose new restrictions on the Medicaid expansion program known as the private option .... To get the changes approved, Hutchinson will need to obtain federal waivers and — perhaps a bigger hurdle — win over both supporters and opponents of the current program. “Some of these things sound great, but administratively the costs to them outweigh any benefit that you get from them,” said Sen. Keith Ingram, D-West Memphis, a member of the task force and a supporter of the private option. (Lyon, 12/20)

Pressure is building on some of the remaining 20 states that have yet to take advantage of federal dollars available to expand Medicaid programs for poor Americans under the Affordable Care Act. ... A snapshot of the pressure on the 20 states still opposed to Medicaid expansion can be seen this month in Kansas where GOP lawmakers and Republican Governor Sam Brownback have faced an onslaught of lobbying from hospitals in the state, advocates for the uninsured, media and Kathleen Sebelius, Kansas’ former Democratic governor and the U.S. Secretary of Health and Human Services in President Obama’s first term. (Japsen, 12/20)

Hillary Clinton was the only one of the three Democrats on stage Saturday night willing to pledge that she wouldn’t raise taxes on those making less than $250,000 a year. ... Her chief rival Bernie Sanders said he wants to move to a “Medicare for all” health-care system under which taxes would increase for many middle-class Americans. But Sanders argued the overall cost of care would go down for most people by “thousands of dollars” because they would no longer pay premiums or co-pays. (Wagner, 12/19)

In the Democratic debate on Saturday presidential candidates Hillary Clinton and Bernie Sanders talk about rising premiums and out-of-pocket costs for the privately insured after enactment of Obama's health care law and single-payer health care systems. (12/20)

The Democratic debate ranged from the battle against ISIS to the debate over health care and the Black Lives Matter movement. At the end of the evening, each of the three candidates may have achieved what they had hoped to do when they arrived. (Page, 12/20)

Two years ago, the Obama administration called the near-total, initial meltdown of the Obamacare federal exchange a technical "glitch." The term was widely ridiculed at the time, especially since it took weeks to fix the exchange's website, healthcare.gov. At Saturday night's Democratic debate, front-runner Hillary Clinton called soaring health care costs and deductibles "glitches" resulting from the Affordable Care Act. (Luhby, 12/20)

At the third Democratic debate on Saturday, all three presidential candidates called for smarter prescribing of painkillers as a way to combat a growing opioid and heroin epidemic in the United States. (Joseph, 12/19)

Congress gave final approval Friday to one of the most ambitious legislative packages in years — a $1.1-trillion funding bill, up to $680 billion in tax breaks and dozens of other substantial policy initiatives. The measure, which averts another shutdown and keeps the federal government running through September, was sent to President Obama, who signed it into law. (Mascaro, 12/18)

Republican foes of President Barack Obama's health care law may be able to get more by chipping away at it than trying to take the whole thing down at once. That's one lesson of the budget deal passed by Congress and signed by the president last week. (12/21)

Now that the Affordable Care Act has survived two Supreme Court challenges and has suffered only a small financial blow in this week’s spending deal, the president plans to press ahead with expanding health-care coverage. Obama noted that new ACA customers “are up one-third over last year, and the more who sign up, the stronger the system becomes.” (Eilperin, 12/18)

In 2016, much of what happens in the two chambers will involve Republican attempts to take swipes at Obama administration policies, including the nuclear deal with Iran, an international climate accord reached in Paris, and the Affordable Care Act. (Hughes, 12/20)

In a chaotic year, when Republicans in the House unseated a speaker, Congress produced a significant amount of bipartisan legislation that affects every American. It enacted laws recasting federal education policy, restricting government access to bulk phone records, renewing highway and transit programs and even resolving a longstanding problem of how Medicare reimburses doctors. (Daly, 12/21)

U.S. health regulators are investigating complaints about laboratory and research practices at Theranos Inc. by two former employees of the blood-testing startup company, according to people familiar with the inquiries. (Carreyrou, 12/20)

A Silicon Valley story with intoxicating appeal, Theranos by some measures has a $9 billion valuation because, in part, of its claims that its proprietary technology has the potential to disrupt the established players in health care. But an investigation published in The Wall Street Journal in October changed the narrative by raising serious concerns about whether the company’s technology actually works. (Abelson and Creswell, 12/19)

Telemedicine’s advocates, frustrated by the Congressional Budget Office's lack of enthusiasm for increasing payment for their technology, are crying foul at the federal budget keepers. They charge that CBO routinely overestimates the cost of new Medicare services — and there’s some evidence they are right. To date, CBO's estimates for telemedicine expansion have produced a resounding thumbs down. Senators, led by Hawaii's Brian Schatz, are preparing to introduce a bill to expand Medicare services paid for the technology, but like all other pieces of legislation, its fate lies in CBO's hands. (Pittman, 12/21)

Nearly 20 years after videoconferencing technology has been available for health services, fewer than 1 percent of Medicare beneficiaries use it. Anthem and a University of Pittsburgh Medical Center health plan in western Pennsylvania are the only two Medicare Advantage insurers offering the virtual visits, and the traditional Medicare program has tightly limited telemedicine payments to certain rural areas. And even there, the beneficiary must already be at a clinic, a rule that often defeats the goal of making care more convenient. (Galewitz, 6/23)

Rising drug costs are forcing tough decisions on those who foot the bill for much of American health care: employers. The pinch is most acute for the many large employers that are self-insured—hiring an insurance company to administer benefits but paying the bill themselves. (Loftus, 12/18)

Patients getting chemotherapy or other complex medications may have a sudden panic when shopping for health insurance: Their drugs often don’t appear to be covered. Despite advice to shop around before selecting a plan, consumers may find that getting answers about drug coverage can be an exercise in frustration, despite a federal health law requirement that insurers provide lists of the prescription medications included in their plans. (Appleby, 12/21)

In a boardroom overlooking Central Park, Dr. Laurence Cooper was being grilled, again. Cooper, an M.D. Anderson Cancer Center pediatrician, had come to Wall Street last year hoping to interest investors in his research. Up to that point, he had relied on grants - typically none more than $200,000 - to support his personalized therapy unleashing the immune system to attack tumors. Now he needed industry's financial backing to realize the vision. ... A buying frenzy had erupted over the type of immunotherapy that Cooper was peddling. Drug companies were investing heavily, gambling that complex treatments still in the earliest stage of development might provide the next generation of blockbusters. The payoff for patients could be a whole new way of treating cancer, even if it's likely to further escalate the disease's exorbitant costs. (Ackerman and Hawryluk, 12/19)

The pharmaceutical executive reviled for price-gouging resigned Friday as head of the drug-maker Turing Pharmaceuticals, a day after being arrested on charges of securities fraud related to a company he previously ran. (12/18)

Disputes over surgeons running more than one operating room have erupted at hospitals across the country in recent years, some of them long before double-booked surgeries became a divisive issue inside Massachusetts General Hospital — divisions that burst into public view after a Spotlight Team report this fall. The conflicts were, at the time, treated as local and separate events, and simultaneous surgery remained unknown to much of the public even though it is widely practiced. Now, in the wake of the Mass. General controversy — which led to the dismissal of the hospital’s leading critic of double-booking and ongoing federal and state investigations — the world’s largest surgeons’ organization is considering new guidelines for overlapping surgery, and numerous hospitals are examining their own policies. (Abelson, Saltzman and Kowalczyk, 12/20)

The practice of medicine has moved away from a paternalistic model toward one of collaboration between doctor and patient. This has happened as the information age, propelled by the Internet, has plunged us into an ocean of health information. In the past, doctors may have been happy with passive patients who followed orders and didn't ask questions, said Dr. Andrew Ellner, co-director of the Harvard Medical School Center for Primary Medicine. Today the most innovative medical programs recognize that such an approach does not promote optimal health outcomes for patients. "Patients need to be empowered to speak up and be partners in figuring out what's going on and designing care plans with their physicians," he said (Sadick, 12/19)

Kaiser Health News' Anna Gorman reports: "A lack of oversight in the rapidly growing home care workforce could undermine new wage and labor gains for many of the nation’s 2 million workers, according to a report released Monday." (Gorman, 12/21)

Some 5 million Americans have Alzheimer's, and more than 13 million family members care for them. "There are families in every town, in every state across the country that are dealing with the realities of Alzheimer's disease at this holiday season," says Ruth Drew, who runs the national phone helpline for the Alzheimer's Association. (Rancano, 12/21)

A bold federal effort to curb prescribing of painkillers may be faltering amid stiff resistance from drugmakers, industry-funded groups and, now, even other public health officials. The Centers for Disease Control and Prevention was on track to finalize new prescribing guidelines for opioid painkillers in January. The guidelines — though not binding — would be the strongest government effort yet to reverse the rise in deadly overdoses tied to drugs like OxyContin, Vicodin and Percocet. (Perrone, 12/19)

Anyone under the age of 18 would be barred from using indoor tanning equipment, under a federal proposal to help reduce skin cancer linked to the devices. The Food and Drug Administration also wants to require tanning bed users to sign consent forms acknowledging the risks of the radiation-emitting devices. Tanning salons and other businesses would have to collect the forms from customers before their first tanning session and every six months thereafter. (Perrone, 12/20)

A shake-up of the nation's kidney transplant system means more organs are getting to patients once thought nearly impossible to match, according to early tracking of the new rules. It's been a year since the United Network for Organ Sharing changed rules for the transplant waiting list, aiming to decrease disparities and squeeze the most benefit from a scarce resource: kidneys from deceased donors. Now data from UNOS shows that the changes are helping certain patients, including giving those expected to live the longest a better shot at the fittest kidneys. (Neergaard, 12/20)

UCSF’s suspension of its living donor program for kidney transplants this week after the death of a donor highlights a rare but potential complication for a procedure that’s typically an altruistic gift by a friend or family member to a kidney patient in need. The donor, who died last month, had provided a kidney to a recipient at UCSF Medical Center in October. Hospital and regulatory officials are investigating the cause of death. (Colliver, 12/19)

The U.S. Justice Department says 32 hospitals in 15 states have agreed to pay $28 million to settle allegations they admitted patients for certain procedures that could have been done on an outpatient basis, resulting in higher Medicare bills. (12/18)

The federal government said Friday that two Arizona hospitals are among 32 hospitals in 15 states that will pay more than $28 million to settle claims they overbilled Medicare for a spinal procedure. The two Arizona hospitals, Banner Boswell in Sun City and Banner Thunderbird in Glendale, agreed to pay nearly $2.7 million to settle claims. (Alltucker, 12/18)

The Cleveland Clinic is among 32 hospitals in 15 states that have agreed to pay the federal government a total of more than $28 million to settle allegations that they submitted false Medicare claims for spinal fractures, the Justice Department announced Friday. (Eaton, 12/18)

Federal officials say Maryland-based splint supplier Dynasplint Systems and its founder and president have agreed to pay more than $10 million to resolve allegations that they violated the False Claims Act. Dynasplint, founded by George Hepburn, was accused of mischarging Medicare for splints used by patients in Medicare-certified skilled nursing facilities. (12/18)

Five hospitals in the Tampa Bay region have agreed to settle allegations that they improperly increased their Medicare billings by frequently charging inpatient rates for a spinal procedure that can be performed less expensively on an outpatient basis, the U.S. Justice Department announced Friday. Topping the list was Citrus Memorial Health System in Inverness, which agreed to pay $2.6 million in fines. Tampa General Hospital will pay $2 million. And three hospitals affiliated with BayCare Health System in Clearwater — St. Joseph's Hospital in Tampa, St. Anthony's Hospital in St. Petersburg and Winter Haven Hospital — have agreed to pay a total of $1.5 million. (12/19)

In the latest government blow against rampant Medicare fraud, two doctors and a registered nurse in New Orleans were given stiff prison sentences and millions of dollars in fines this week in federal court for their roles in a long-term $50 million scheme. The trio and a fourth defendant were convicted of submitting roughly 8,000 fraudulent Medicare claims over a six-year period for referring patients to Memorial Home Health Inc. and three other “sham companies” for “medically unnecessary” home health services and treatment, according to a federal indictment reported by The Times-Picayune. In many cases, the treatments were never rendered. (Pianin, 12/18)

In the latest sign that federal regulators are uneasy about the flurry of proposed health care mergers taking place, the Federal Trade Commission said on Friday that it planned to block the combination of two large Illinois hospital groups. (Abelson, 12/18)

Why might a hospital in Fairfield County charge privately insured patients nearly $2,000 more for a Cesarean section than one in Hartford? Why would a hospital in the Bronx, N.Y. charge up to 12 times more for some MRIs than a hospital in Baltimore? The answer is a complicated one, having to do with negotiations between hospitals and private insurers, as well as the growing trend of hospital mergers and collaborations. A new study, co-authored by a Yale University economist, analyzed 92 billion health insurance claims from 88 million people covered by three of the nation’s largest insurance companies — Aetna, Humana and United Health — from 2007 to 2011. The researchers found that hospital pricing, and health care spending, varied by thousands of dollars depending on the region of the country. (Cuda, 12/19)

A judge says a hospital in Yakima has violated the state Charity Care Act by demanding payment from indigent patients. Superior Court Judge Susan Hahn said in a ruling this month that the actions of Yakima Regional Medical and Cardiac Center constituted a breach of contract between the hospital and the patients in question. She also granted a motion requiring the hospital to turn over certain information long sought by the plaintiffs to bolster their class-action lawsuit. (12/20)

The group ColoradoCareYES has gathered enough signatures — more than 100,000 — to put a single-payer health system on the ballot next fall. Under the plan, Coloradans would still pick their own providers, but the new system would pick up all the bills. There would be no deductibles, and fewer and smaller copays. (Daley, 12/21)

New York state health officials say it has been a busy few weeks for the state health-insurance exchange’s open-enrollment period as it adjusts to the collapse of the system’s only co-op and incorporates a new low-cost coverage plan. The exchange’s customer-service center answered more than 170,000 calls from Dec. 7 to 11, averaging 34,000 a day. Normally, outside of open enrollment, calls average 11,700 a day, according to the New York State Department of Health. (Ramey, 12/20)

First, there’s a heroin epidemic. Then, there’s a surge in hepatitis C cases. That’s the scenario that worries New Hampshire health officials, who fear the infectious disease will spread quickly among drug users who share needles. But right now, no one knows the size the problem, or how many people in the state are even infected with the liver-destroying disease. (Morris, 12/20)

Lawmakers are poised to decide today whether to raise the cost of health care co-payments for a portion of the state’s Medicaid population. The change would affect people covered by the health care program who make more than 100 percent of the federal poverty limit, roughly $11,700 for a single person, or $24,250 for a family of four. The proposal calls for most co-payment costs to rise just slightly, but the co-pay for mental health and substance abuse inpatient services would more than double, from $50 to $125. (Morris, 12/19)

The New Hampshire Attorney General is advising the Department of Health and Human Services to start issuing medical marijuana ID cards to eligible patients. In theory, patients could soon access medical marijuana, even though they can't yet buy it legally in the state. The decision stems from the case of Linda Horan, an Alstead woman with late-stage terminal lung cancer. Three weeks ago, a judge ordered the state to issue a medical marijuana ID card to Horan. The AG had wanted to hold off on issuing the cards until four dispensaries were open across the state, but those dispensaries are more than a year behind schedule. Horan's case asserted the state had an obligation to issue her a card under the law, whether the dispensaries were open or not. Horan plans to head to Maine Friday to access medical marijuana there. (Rodolico, 12/18)

For the first six years of the Obama era, many Republicans made an apocalyptic case against the president’s health care law. It was unconstitutional, immoral, borderline tyrannical. It wouldn’t just fail: It would fail disastrously, in a death spiral that would take down most of American health care as we know it. Then the apocalypse failed to arrive. ... Republicans, never particularly eager to grapple with the actual details of health care policy, began talking about the issue less and less. ... Yet the interesting thing is that as Republicans have fallen silent, the law’s struggles have actually increased. (Ross Douthat, 12/19)

Even as state after state has elected to expand Medicaid, thereby extending health insurance to millions of poor people who would otherwise remain without coverage, Virginia Republicans have stood pat. They have blocked expanding Medicaid under Obamacare, which would unlock tens of millions of federal dollars that would buttress Virginia’s hospitals and its economy, on the argument that the state might not be able to afford it. (12/19)

Far too often, in our view, the immediate reaction to a proposal for government to do something different is this: No way, won't work, can't be done. We have been reminded of the usual, predictable resistance to government change this year during criticism, sometimes shared in apocalyptic tones ("a catastrophe of monumental proportions," said one health care executive), over the proposal made by Iowa Gov. Terry Branstad last winter to privatize management of the state's Medicaid program beginning next year. We support privatization because we, in principle, support what Branstad seeks to do: Reduce the rate of growth in state Medicaid spending. (12/20)

Should the First Amendment protect what doctors can say to their patients in the privacy of the examining room? Weighing state prohibitions on gay conversion therapy, liberals have tended to think the state should be able to regulate medical treatment without worrying about free speech. Now the shoe’s on the other foot: Florida’s ban on physicians asking patients about gun ownership puts liberals in the position of wanting to protect the doctor-patient relationship. The U.S. Court of Appeals for the 11th Circuit upheld the Florida “docs vs. Glocks” law this week on the ground that the state’s interest in protecting gun ownership outweighs physicians’ free-speech interests -- a result sure to trouble liberals. (Noah Feldman, 12/18)

How many laws making it harder to get an abortion will pass before the Supreme Court sees them for what they are — part of a tireless, coordinated nationwide assault on the right of women to control what happens with their own bodies without the interference of politicians? One answer is, no fewer than 288. That’s how many abortion restrictions states have enacted since the beginning of 2011, when aggressively anti-choice lawmakers swept into statehouses around the country. (12/19)

The cost of drug prescriptions has become an issue in the presidential-primary season, most notably with Hillary Clinton and Bernie Sanders competing to see who can do the most to protect the wallets of potential voters. Mrs. Clinton this fall proposed capping out-of-pocket drug expenses at $250 a month, while Mr. Sanders vowed to make the federal government drop its unwillingness to negotiate prices with pharmaceutical companies. But the candidates’ proposals should start by addressing the misuse of the Orphan Drug Act, a well-intentioned law passed 33 years ago but now used in ways unanticipated by Congress. (Marty Makary, 12/20)

Computer documentation in health care is notoriously inefficient and unwieldy, but an even more serious problem is that it has morphed into more than an account of our work; it has replaced the work itself. [Nurses] charting, rather than our care, is increasingly what we are evaluated on. (Theresa Brown, 12/19)

[W]hile high-profile people like Caitlyn Jenner and Laverne Cox have brought newfound visibility to transgender issues, many transgender men and women cannot lead open and visible lives for fear of discrimination and violence. ... Health care also remains highly stigmatized and largely unavailable for many transgender people. Data from the National Transgender Discrimination Survey found that 28 percent of the more than 6,000 transgender respondents postponed medical care due to discrimination, and another 48 percent did so because they could not afford it. Both private and public insurance plans continue to have blanket bans on coverage for health care related to gender transition. Even where there has been progress on coverage generally, insurance coverage for care that transgender women need is still elusive. (Gilles Bissonnette and Stephanie Ramirez, 12/20)