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A coalition of 279 patient groups is urging the Department of Health and Human Services (HHS) to further define what constitutes insurance "discrimination" under the Affordable Care Act. In a letter Friday, the "I Am (Still) Essential" alliance thanked HHS for recent guidance that would strengthen transparency on the exchanges and push insurers to cover more prescription drugs. Groups urged regulators to do more, however, by issuing specific language prohibiting practices that can hamper sick patients in their effort to procure care and drug coverage. (Viebeck, 12/19)

Republicans on and off Capitol Hill are rallying behind using a rarely-deployed budget tool next year to dismantle ObamaCare. But the issue of how to use “budget reconciliation” has divided Republicans, with some calling for it to be implemented to overhaul the tax code or to push through major energy reforms. The tool is useful because it could allow newly-empowered Senate Republicans to pass legislation with a 51-vote simple majority rather than the usual 60, greatly increasing the chances of moving legislation to President Obama’s desk. (Wong, 12/21)

Many people will see their premiums increase significantly for 2015 if they haven’t yet taken the advice of my colleague, Margot Sanger-Katz, to shop around. But a new analysis from the McKinsey Center for U.S. Health System Reform suggests insurers had some luck in holding down prices if they offered plans that limited a consumer’s choice of doctors and hospitals. Plans featuring health maintenance organizations or restricted networks of providers typically had the lowest year-over-year premium increases, according to McKinsey, which sifted through information on the 223,000 plans offered in the marketplaces at the county level over the last two years. (Abelson, 12/19)

Exchange plans that had the lowest 2014 premiums and are being offered again for 2015 experienced double-digit gross premium increases, according to a new analysis from McKinsey & Company. (Pradhan, 12/19)

It's now clear that last year's disastrous rollout of the Obamacare health insurance exchanges will not be repeated. So far, people have been able to sign up with little or no trouble for private health insurance on the new exchanges that are the centerpiece of the Affordable Care Act. (Fox, 12/22)

Regardless of what your situation looks like in 2014, here are seven big changes that will affect a large number of taxpayers starting in January 2015. ... Part of the Affordable Care Act mandates that all Americans have health insurance, or pay a tax penalty as a result. In 2014, the penalties are 1% of your household income or $95 per person – whichever is greater. But in 2015, those penalties ramp up significantly to 2% of total household income, or $325 per person. That can really add up for a middle-class family of four. If you're not covered and paying a penalty on your 2014 taxes, make sure you get health insurance ASAP to avoid penalties as we enter a new tax year in January. (Reeves, 12/19)

When the public doesn’t come to Obamacare, then Obamacare goes right to the public. Consumers in many states can now buy health insurance at local storefronts — places that are popping up next door to hair salons, setting up in churches and surfacing in suburban malls, which right now may mean just around the corner from Santa. (Villacorta, 12/22)

With the deadline looming to re-enroll in California’s insurance exchange, Kuei Lin Liu faced a tough question: Do I want to go through this all over again? After a year of bureaucratic snags, data glitches and inexplicably dropped coverage, Liu wondered whether Covered California was worth the effort. “I’m so frustrated right now,” she said. “I spent the last year trying to work out this mess.” (Wang, 12/22)

Shoppers seeking health insurance for January through MNsure now have until noon on New Year’s Eve, but state officials don’t want people to wait. MNsure announced the change Friday, saying it’s driven by high consumer demand — not problems with the MNsure website. (Snowbeck, 12/19)

Despite the passage of a key open enrollment deadline on Dec. 15, there may still be a way for Oregonians to qualify for tax credits on health coverage that kicks in on Jan. 1. ... The key? Consumers must have 2014 Cover Oregon coverage in place now, [Portland insurance agent Andrew Eachon] said. And, importantly, they must fill out their Healthcare.gov exchange application carefully. (Budnick, 12/19)

The Massachusetts Health Connector is preparing for a signup surge as the state’s deadline for enrolling in 2015 insurance coverage approaches. The agency says more than 100,000 residents who must pay some or all of their premiums have registered online, but so far, only 18 percent have chosen a plan and paid. (12/19)

Each month, William Piorun has to choose between paying his mortgage or buying medicine that keeps his pituitary-gland tumor in check. This month and last, the 65-year-old Medicare patient paid the mortgage, and stopped taking a drug that his doctor says he needs to ward off the risk of premature death. Once, hard choices like these were commonly forced only on those without health insurance. Now more patients who have insurance or Medicare must confront them as drug bills for those with chronic and life-threatening decisions soar. (Langreth, 12/22)

For Iowa's Latino population, language and culture also are obstacles to improved health care. Latinos represented about 5 percent of Iowa's population in 2013, Census Bureau estimates show. Their poverty rate was double that of white Iowans, at 26 percent, in 2012, the most recent figures available from the Iowa Data Center show. But language barriers they may encounter with providers are not the only factors. "Beliefs and customs are different, which prevents some cultures from trusting providers or going for medical care," said Joan Jaimes, outreach counselor at Marshalltown Community College. (Lengeling, 12/20)

Isaiah Newsome likes to play sports and hang out with friends, like any 17-year-old. But most of the time these activities are cut short as his body, stricken with sickle cell anemia since birth, fills with pain. Getting insurance to cover his health care adequately all of these years has not been easy, but at least he has has had insurance the past year. Some other African-American families in Iowa with low incomes do not, adding to difficulties they face getting health care. A University of Iowa Public Policy Center study in December 2013 put the problem into perspective, showing that African-American and Latino Iowans do not have the same access to adequate health care that Asian and white Iowans have. (Lengeling, 12/20)

For a few weeks last year, Michael Tranfaglia and Katie Clapp saw a remarkable change in their son, Andy, who'd been left autistic and intellectually disabled by Fragile X syndrome. Andy, who is 25, became more social, more talkative, and happier. "He was just doing incredibly well," his father says. The improvements came while Andy was taking an experimental drug — a drug made possible by the efforts of his parents. (Hamilton, 12/22)

In a sign that price competition may take hold for hepatitis C drugs, the nation’s largest manager of prescriptions will require all patients to use AbbVie’s newly approved treatment rather than two widely used medicines from its rival Gilead Sciences. (Pollack, 12/22)

Express Scripts, which has been critical of the cost of Gilead’s treatments, said on Monday it had negotiated to receive a discount from AbbVie on the $83,319 wholesale price of the multidrug Viekira Pak, a standard 12-week course of treatment that was approved by U.S. regulators on Friday. In exchange, Express Scripts will no longer pay for Gilead’s drugs for patients with a type of hepatitis C known as genotype 1, representing about two-thirds of the people with the viral liver disease. (Walker, 12/22)

The U.S. Food and Drug Administration approved AbbVie’s Viekira Pak, an all-oral cocktail of several drugs that cured more than 90% of people with the most common subtype of hepatitis C in the U.S., genotype 1, in clinical trials. The regimen consists of several pills taken daily for about 12 weeks for most patients, eliminating the need for an older injected drug, interferon, which many patients find difficult to tolerate. (Loftus, 12/19)

About 3.2 million Americans are infected with hepatitis C, which generally doesn't cause noticeable symptoms until the liver is damaged. Without proper treatment, up to 30 percent of those people will eventually develop cirrhosis, an advanced liver disease in which excessive alcohol, fat and other substances kill off liver cells, causing scarring of the liver tissue. The virus can cause liver failure and liver cancer, resulting in the need for a liver transplant.(Johnson, 1219)

Insurers and state Medicaid programs have been eagerly awaiting the approval of the AbbVie regimen, which is called Viekira Pak, hoping that competition will drive down prices. But price competition might be limited. (Pollack, 12/19)

At any hospital, patient safety and quality of care depend on the willingness of medical workers to identify problems. The goal is for medical workers to be free to speak bluntly to — and about — higher-ups without being ignored or, worse, punished. In interviews and email exchanges, many doctors, nurses and other medical workers said military hospitals fall short of that objective. (LaFraniere, 12/20)

Los Angeles is hosting what is being billed as the largest "Stand Down" for homeless and hard-luck military veterans to ever take place in the country. The three-day relief effort got underway Saturday at the Los Angeles Convention Center and brings together dozens of government agencies, nonprofits and volunteers to provide veterans with a variety of health and social services. (Lozano, 12/20)

President Barack Obama signed legislation Friday that temporarily extends dozens of costly tax breaks for millions of businesses and homeowners, commuters, teachers and others. The measure also allows people with disabilities to open tax-free savings accounts. (Superville, 12/19)

Antibiotic resistance is a threat to national security. That's how President Barack Obama described the rapid growth of such resistance when he issued an executive order in September instructing HHS and the Defense and Agriculture departments to take aggressive action on the issue. The president cited federal data showing that at least 2 million Americans are infected with drug-resistant bacteria each year and 23,000 die as a result. He emphasized the critical need for improved antibiotic stewardship—coordinated practices promoting the appropriate use of antibiotics—in healthcare facilities. Federal officials say such programs are among the most effective ways to curb resistance and reduce the number of hard- or impossible-to-treat infections. (McKinney, 12/20)

By more than one measure, hospitals saw operating income slump in 2013. But that may actually be good news for some hospitals. Hospitals with contracts that reward efforts to hold down healthcare spending may have been heartened to see revenue fall. While such contracts remain limited, they've have multiplied in the last few years with endorsement from Medicare under the health reform law. (Evans, 12/19)

Eleven hospitals in New Mexico, including Presbyterian and UNM hospitals in Albuquerque, will see Medicare payments cut because of the rate of hospital-acquired infections or other medical complications, according to Kaiser Health News and the U.S. Centers for Medicare and Medicaid Services. The penalties mean Medicare reimbursements will be reduced by 1 percent over the fiscal year that began on Oct. 1 and runs through Sept. 30, 2015. Kathleen Davis, Presbyterian Healthcare Services senior vice president and chief nursing officer, estimates the penalty will cut around $900,000 from Presbyterian’s expected $95 million in Medicare payments in 2015. UNM Hospital was unable to provide a dollar estimate. (Rayburn, 12/20)

Texas Health Presbyterian, Medical City Dallas, Baylor University Medical Center and Parkland Memorial Hospital will lose millions of dollars in Medicare reimbursements next year because of accidents and infections acquired by patients. (Landers, 12/19)

Medicare is shaving payments to 12 Mississippi hospitals because too many patients come down with preventable new ailments while being treated for something else. The hospitals are among 721 nationwide losing 1 percent of their Medicare payments for the current fiscal year. Conditions tracked by the Centers for Medicare and Medicaid Services for such purposes include blood clots, bedsores, falls, urinary tract infections associated with catheters, and bloodstream infections associated with tubes inserted into a vein to deliver medicine or fluid. (12/20)

A hospital is Northern California has agreed to pay the federal government $2.25 million to settle allegations it submitted false Medicare claims. The settlement comes after a former employee of St. Helena Hospital filed a lawsuit under the federal False Claims Act. U.S. Attorney Melinda Haag said Friday the hospital knowingly charged Medicare for unnecessary angioplasty — a procedure to open narrowed or blocked blood vessels that supply blood to the heart. Prosecutors say the hospital in Napa County charged Medicare for such procedures during the period of Jan. 1, 2008 through July 31, 2011. (12/19)

Vermont was supposed to be the beacon for a single-payer health care system in America. But now its plans are in ruins, and its onetime champion Gov. Peter Shumlin may have set back the cause. (Wheaton, 12/20)

After Gov. Peter Shumlin dropped his long-sought goal of a universal, publicly funded health care system this past week, key members of his health care team immediately got back to work picking up less ambitious pieces of the plan. Appearing Wednesday before reporters and two boards that had advised him, the second-term Democrat said there were steps the state can still take in a bid to reduce health care costs. The less ambitious steps described by aides include pushing hospitals and health systems toward "global budgets" in which they are given a set amount of money each year for serving the health needs of a certain population and away from the traditional "fee-for-service" system in which the more procedures are performed, the more health providers get paid. (Gram, 12/21)

But as the numbers got more concrete — as they closed in on the plan the governor actually wanted — the financial foundation began to crack. [Vermont's director of health reform Robin] Lunge knew by that Friday that the single-payer system Vermont wanted to build would require about $2.5 billion in additional revenue in its first year. In Vermont, this is massive: the state only raises $2.7 billion in taxes a year for every program it funds. Early estimates said that Vermont's single-payer plan might need $1.6 billion in additional funds — a huge lift. But $2.5 billion was impossible. "It was disappointing to me and my team that we weren’t able to make the numbers work the way that we had hoped," Lunge said. (Kliff, 12/22)

Three private, nonprofit health systems have challenged the “equity in state funding” provided to the Virginia Commonwealth University and University of Virginia health systems to compensate them for treating indigent patients and teaching graduate medical students. In a presentation to state health and budget officials this fall, the Sentara, INOVA and Carilion health systems said they operate private teaching hospitals and Level 1 trauma centers in Norfolk, Fairfax County and Roanoke that receive less than one-eighth of the public compensation given to VCU and U.Va. for indigent care and medical education — $29.2 million compared with $243.9 million for the public hospitals in the last fiscal year. (Martz, 12/20)

Over the next 15 years, the number of people 60 or older in Colorado is expected to more than double, boosting the need for long-term care and services that enable older adults to live independently in their homes. Keeping needy senior citizens in their homes will require an expansion of services like transportation, meals-on-wheels, counseling and nutrition education, according to the Colorado Department of Human Services. To meet that need, the agency is asking for an additional $4 million next year, which would raise state funding for Area Agencies on Aging to $21.3 million. (McGhee, 12/22)

North Texas leaders have boasted for years about the unique way they provide mental health care to the poor. They say their partially privatized system called NorthSTAR uses less money to treat more people than in any other part of the state. More important, they say no one in need of care ever goes on a waiting list. But critics have argued that the system offers less comprehensive care and causes the region to lose out on state dollars. And now, an effort to break it up seems to be gaining steam. (Watkins, 12/20)

At her south Charlotte home one night in September, Beth Straeten got her kids to bed and grabbed her iPhone to download a new app. Within minutes, she was talking face-to-face with a physician assistant. As Straeten described the poison ivy rash on her arms, PA Dimple Joshi sat across town at Carolinas Medical Center-Pineville, in front of two computer monitors. On one, Joshi could see Straeten and on the other she could read Straeten’s medical record. Their conversation lasted for about 10 minutes, and Straeten came away with a prescription to help stop the itching, called in to her local drugstore. This “Virtual Visit” cost Straeten $49 but allowed her to avoid a trip to the doctor’s office or a long wait in an emergency room. It’s one of the latest conveniences emerging from Charlotte-area hospital systems and doctors groups as they embrace the world of electronic health records. (Garloch, 12/19)

The District’s most frequent 911 caller, Martha Rigsby, was due in court to again discuss her habit of excessively dialing the city’s emergency line. She arrived straight from Sibley Memorial Hospital, dressed in a red winter coat and borrowed baggy pants, with a social worker in tow. Also there was her close friend Demetric Pearson, who sat with Rigsby in the hallway until her case was called. The hearing was supposed to be a routine check to see whether Rigsby had reduced her 911 calls. But it quickly became an exercise in judicial matchmaking. (Brittain, 12/20)

At least 786 children died of abuse or neglect in the U.S. in a six-year span in plain view of child protection authorities — many of them beaten, starved or left alone to drown while agencies had good reason to know they were in danger, The Associated Press has found. To determine that number, the AP canvassed the 50 states, the District of Columbia and branches of the military — circumventing a system that does a terrible job of accounting for child deaths. Many states struggled to provide numbers. Secrecy often prevailed. (Mohr and Burke, 12/22)

A decision by the Paris City Council in March to ban smoking in public places, including restaurants, angered Brent McKee. A restaurant owner, McKee was thinking about the customers who enjoyed a cigarette or two while nursing their morning coffee. Now, McKee reluctantly acknowledges a change of heart. “I’m glad it happened, I guess,” he said last week. “Everybody says it smells so much better. It hurts the business in the morning time with the coffee and the smokers, but the rest of the day, everybody who wouldn’t come in here will come in here now.” Next year, Texas lawmakers will again consider a statewide ban on smoking in public places. It will be the fifth legislative session in a row in which such a measure has been proposed. More than 100 Texas cities — encompassing nearly half of the state population — have moved on their own, enacting some sort of ban on smoking in public places in an effort to reduce secondhand smoke exposure, according to state records. (Batheja, 12/19)

Amid this year’s good news about Americans’ enhanced access to health care, there is bad news as well: A new report by the U.S. Department of Health and Human Services says that half of the doctors who are supposedly enrolled in the Medicaid program of low-income health care either aren’t accepting new patients or aren’t participating in the Medicaid plans that list them. The reasons are no secret: Doctors are paid just a fraction of the cost of their services to each Medicaid patient — sometimes even less than the cost of performing a procedure. Few doctors are willing to take a pay cut to see Medicaid patients, and enrollees struggle with limited networks and long wait times as a result. (12/22)

Last week, Vermont Governor Peter Shumlin (D.) announced that he was pulling the plug on his four-year quest to impose single-payer, government-run health care on the residents of his state. “In my judgment,” said Shumlin at a press conference, “the potential economic disruption and risks would be too great to small businesses, working families, and the state’s economy.” Your first reaction might be “well, duh.” But the key reasons for Shumlin’s reversal are important to understand. They explain why the dream of single-payer health care in the U.S. is dead for the foreseeable future—but also why Obamacare will be difficult to repeal. (Avik Roy, 12/21)

The failure of the governor's signature policy initiative undermines his stature in the Statehouse and his influence among lawmakers. Giving up on single-payer erodes Shumlin's clout among political allies who stood by him as his health care plan came under attack. Single-payer Shumlin will have to find another handle. The governor will be dogged by questions about the timing of his announcement, coming just weeks after an election in which he only managed to squeak out a slim plurality. Shumlin's failure to win more than 50 percent of the vote in November gives the Legislature the final say on who will be sworn in as governor in January. His Republican opponent, Scott Milne, is questioning Shumlin's claim to office given overall most Vermonters voted for someone other than the incumbent. (Aki Soga, 12/21)

Democrat Gov.-elect Tom Wolf's insistence on full-blown ObamaCare Medicaid expansion is misguided advocacy for an idea that wouldn't improve treatment or costs but would worsen this federal-state welfare program's existing woes and Pennsylvania's bottom line. Medicaid fraud, already costing taxpayers an estimated $60 billion a year, would only grow with Medicaid expansion in Pennsylvania. And Pennsylvanians gaining coverage would have a hard time gaining actual care. (12/20)

Home health attendants work long hours with heavy lifting and save the public a great deal of money by enabling elderly and disabled people to remain at home instead of moving to institutional settings. In Missouri, aides who are paid with state Medicaid dollars have been doing this work for an average of $8.60 an hour. That’s a pathetic wage. Many of the aides are the sole financial providers for their families. They are devoted to their clients and work long hours, making it unfeasible to take a second job. (12/19)

[President Barack Obama] ends 2014 in surprisingly buoyant spirits, having proved that he still has the power to push policy in new directions in foreign affairs and on issues ranging from immigration to climate change. ... The federal health-care Web site, whose crash was an enormous political and practical problem for Obama and his party in 2013, is working smoothly. The fact that so many Americans are interested in obtaining health insurance under the Affordable Care Act, his aides argue, is a vindication of the effort Obama put in to passing it. (E.J. Dionne Jr., 12/21)

The National Children's Study was launched with a fanfare of expectation and ambition in 2000. The idea was to follow 100,000 American children from the pre-natal stage to age 21, collecting an unprecedented volume of data on "environmental influences (including physical, chemical, biological, and psychosocial) on children’s health and development," in the words of the enabling federal legislation, the Children's Health Act. As Science Magazine reported, it was the largest and most complex longitudinal study of its kind ever planned in the United States. Today, after 14 years and the allocation of $1.3 billion to the task, it's dead. (Michael Hiltzik, 12/19)

If 2014 should be remembered for anything in health policy, it's the year that marked a turning point in how we talk about dying. There was the Institute of Medicine report recommending an overhaul to end-of-life care, the story of the terminally ill 29-year-old Brittany Maynard choosing physician-assisted suicide, Zeke Emanuel declaring he won't try to extend his life past 75, and Atul Gawande's book "Being Mortal." You only have to think back to 2009 when the far right said a proposal to have Medicare pay doctors for holding end-of-life conversations amounted to "death panels." (Millman, 12/22)