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Republicans in Congress plan to move almost immediately next month to repeal the Affordable Care Act, as President-elect Donald J. Trump promised. But they also are likely to delay the effective date so that they have several years to phase out President Obama’s signature achievement. This emerging “repeal and delay” strategy, which Speaker Paul D. Ryan discussed this week with Vice President-elect Mike Pence, underscores a growing recognition that replacing the health care law will be technically complicated and could be politically explosive. (Pear, Steinhauer and Kaplan, 12/3)

The next Congress will begin work immediately next year toward repealing President Barack Obama's health care law but delay the changes as Republicans try to come up with an alternative, Senate Majority Leader Mitch McConnell said Saturday. (Schreiner, 12/3)

Repealing Obamacare will be the first priority of congressional Republicans when Donald Trump takes office in January, House Speaker Paul Ryan told CBS's "60 Minutes." "Well, the first bill we're going to be working on is our Obamacare legislation," he said in an interview airing Sunday night, though he declined to offer a timetable.  (Hellmann, 12/4)

House Speaker Paul Ryan discussed a path to repeal and replace the Affordable Care Act during a closed-door conference meeting with House Republicans on Friday. “The speaker walked members through the process for delivering on our promise of repealing and replacing Obamacare,” AshLee Strong, a spokeswoman for Ryan, said in a statement. “He told members this is one of the President-elect’s top priorities for Congress and one of the first things we will do in the House.” ... While a formal timeline hasn’t been laid out, Rep. Tom Cole guessed a bill repealing the law may be passed in February. (McIntire, 12/2)

Sen. John Barrasso (R-Wyo.) on Saturday highlighted the Republicans' mission to repeal and replace ObamaCare during the weekly GOP address. Barrasso underscored the importance of "revers[ing] the damage done by ObamaCare" through a smooth transition. ... Barrasso promised that the process of repealing and replacing the law would mean eliminating the health insurance mandate in order to ensure "more freedom and flexibility" for businesses and individuals. (Vladimirov, 12/3)

U.S. House Majority Leader Kevin McCarthy wants to repeal the Affordable Care Act first and replace it sometime later. That doesn’t sit well with Victoria Barton, who lives in McCarthy’s rural California district. “It’s like they dangled the carrot and now they’re taking it away,” said Barton, 38, of Bakersfield, an unpaid photographer and stay-at-home mother of two. (Bartolone and Bazar, 12/5)

As Republicans gear up to overhaul the federal health law, they face pushback from a couple unexpected corners over one of their goals: Giving health insurers greater ability to sell policies to consumers across state lines. Republicans for some time have billed interstate sales of insurance as a way to heighten competition and lower costs. It is one of the few specific health initiatives displayed on President-elect Donald Trump’s transition website. (Armour and Wilde Mathews, 12/5)

Hospital and insurance executives Thursday reminded First Coast lawmakers that even the smallest changes to policy could affect millions of patients. Health insurers and providers don't always get along. For proof, last session’s balance billing debate pitted emergency room physicians against insurers in a fight for who picks up an out-of-network patient’s tab. But on Thursday, two major leaders, in different parts of the continuum of care, shared a common request that Tallahassee commit to increasing patient access to health care overall. (Benk, 12/2)

One of the most vocal insurers about the problems with the Affordable Care Act marketplace made nearly $400 million in one state already this year, documents show. Blue Cross Blue Shield of North Carolina lost about $400 million on ACA individual plans sold on Healthcare.gov in 2014 and 2015. After raising rates by about 32% for 2016, the company made nearly the same amount for the first three quarters of 2016 for all individual plans sold on and off the exchange, data filed with the state department of insurance show. (O'Donnell, 12/4)

President Barack Obama is urging the public to help save his health care law, which is in serious danger of being repealed under President-elect Donald Trump. In a Facebook Live appearance, Obama says the Affordable Care Act has improved millions of lives over the six years it's been the "law of the land." He says the country can't go "backward." (12/2)

Obama spoke amid the fourth year’s enrollment period for consumers to buy health plans through ACA marketplaces, created for people who cannot get affordable coverage through a job. “If you haven’t gotten covered, now is the time to do it,” the president said, noting that Dec. 15 is the deadline for people to have insurance at the start of 2017. ... “Don’t let Republicans in Congress” take away the ACA’s most popular features, Obama said. “Tell them, ‘We want to build on the progress we’ve made, not abandon it.’ ” (Goldstein, 12/3)

“I know that lately there’s been yet another debate in Washington about health care reform, and it might make it sound like your insurance is somehow at risk, but here’s the bottom line: the most important thing for you to do is to get you and your family covered right away for 2017,” the president said. “Enrollment is open right now but only until Jan. 31. If you sign up by Dec. 15, you’ll be covered starting Jan. 1.” (Radnofsky, 12/2)

President Obama on Friday made the case for people to sign up for ObamaCare, pushing back on congressional Republicans calling for the law's repeal. In a video message streamed live on Facebook, Obama encouraged viewers to go to HealthCare.gov to sign up for coverage for next year before a Dec. 15 enrollment deadline. Obama addressed concerns that GOP repeal efforts could mean coverage won’t be there.He acknowledged that the debate in Washington “might make it sound like your insurance is somehow at risk,” but he said ObamaCare is still the law of the land. (Sullivan, 12/2)

The Connecticut Insurance Department plans to seek a court order to liquidate insurer HealthyCT at the end of the year, following an appointed overseer’s report that the nonprofit company – created with federal funds made available through Obamacare – is insolvent. As of October, the Wallingford company had 30,973 customers, but only about 7,000 are expected to still be covered through group plans in January, according to the status report, filed in Superior Court this week. The Connecticut Insurance Department prohibited HealthyCT from selling new policies or renewing existing coverage in July, and the company’s 13,527 individual-market plans are scheduled to end Dec. 31. (Levin Becker, 12/2)

Total spending on health care in the United States increased last year at the fastest rate since the 2008 recession, reaching $3.2 trillion, or an average of nearly $10,000 a person, the Department of Health and Human Services reported on Friday. The growth coincided with continuing increases in the number of Americans with insurance coverage, through private health plans or Medicaid. (Pear, 12/2)

The nation's health care tab grew at the fastest rate in eight years in 2015, driven by the coverage expansion in President Barack Obama's law and by costly prescription drugs, the government said Friday. The growth of 5.8 percent in 2015 boosted total health care spending to $3.2 trillion. That's an average of $9,990 per person, although the vast share of that money is spent caring for the sickest patients. (Alonso-Zaldivar, 12/2)

The current data suggest the pace of spending did begin to pick up again after the economy rebounded, with prescription drug price growth and an aging baby boom generation contributing to the acceleration. Growth in prescription drug spending was faster than that of any other service in 2015, CMS said. Spending on physician and clinical services grew at a rate of 6.3%, the first time in a decade the figure had topped 6%. (Radnofsky, 12/2)

While such surges in health spending have traditionally worried economists and policymakers, the 2015 increase is somewhat different, the new report from independent actuaries at the U.S. Department of Health and Human Services suggests. In the past, mounting prices for hospital stays, doctor’s visits and other medical goods and services were largely responsible for skyrocketing health spending.But the new report indicates that the latest increase – which tracks with a similar uptick in 2014 – was fueled by increased use of healthcare, likely caused by the health law, often called Obamacare. (Levey, 12/2)

Healthcare spending in 2015 increased at a rate of 5.8%, the fastest in eight years, as more people obtained health insurance and prescription drug costs continued to rise, according to a CMS report published Friday by Health Affairs. For the first time, the federal government accounted for the largest share of healthcare spending at 29%, mainly because of Medicaid expansion. Household spending made up 28%, private businesses were 20% and state and local governments were 17%. Federal government spending grew at a rate of 8.9% in 2015 after an 11% increase in 2014. The 2015 increase follows a 5.3% spending increase in 2014, which came after five years of historically slow growth. National healthcare expenditures represented nearly 18% of the GDP in 2015. (Muchmore, 12/2)

Health care spending accelerated nationally last year as more Americans got insurance and received medical care, according to a new federal study that could become ammunition in the upcoming fight over President-elect Donald Trump’s plan to scrap the Affordable Care Act. The United States spent $3.2 trillion on health care in 2015, a 5.8 percent increase over 2014, and the highest rate in eight years, the study released Friday said. Spending rose 5.3 percent in 2014. (Dayal McCluskey, 12/2)

The pace of U.S. health care spending picked up slightly last year, reaching a total of $3.2 trillion or $9,990 per person in the country. While a number of factors were at play, the increase was largely due to expanded coverage of individuals who signed up for Obamacare or who took advantage of a major expansion of Medicaid, according to a new study released on Friday. (Pianin, 12/4)

Public and private spending for U.S. health care increased to $3.2 trillion in 2015 or nearly $10,000 per person, according to a government report released Friday. The 5.8 percent spending increase last year is up from a 5.3-percent hike in 2014. Both increases followed five straight years of historically slower growth from 2009 to 2013. Credit the Affordable Care Act for the faster health care spending growth the last two years. (Pugh, 12/2)

Health care spending was slightly higher in 2015 than it was in 2014, an increase that researchers attribute to the newly insured under Obamacare using more medical services. National health care spending rose 5.8 percent last year, reaching $3.2 trillion, according to new Centers for Medicare and Medicaid Services figures published Friday in Health Affairs. (McIntire, 12/2)

Lawyers for insurance giants Aetna and Humana will begin battling government antitrust lawyers Monday in a Washington, D.C., court, seeking to get legal clearance to complete their planned $37 billion merger. Worried that the deal would raise prices and lower benefits for customers, the Department of Justice, eight states and the District of Columbia sued to block the deal. (Yu, 12/4)

If Aetna and Humana are allowed to merge, will the 17 million seniors in the Medicare Advantage market be left with too little choice and face higher prices for health insurance? That's the key issue in an antitrust trial on the proposed union set to begin in U.S. District Judge John Bates' courtroom Monday morning. The Obama administration argues in its pre-trial brief that the $37 billion deal would create Medicare Advantage monopolies in 70 counties and increase market concentration in hundreds more across the country. Aetna's attorneys counter that the private Medicare Advantage (MA) market competes with the traditional Medicare government program, so that seniors will continue to have choice. (Coombs, 12/4)

Aetna Inc.’s attempt to assuage U.S. antitrust concerns over its $37 billion takeover of Humana Inc. by selling assets to a smaller company landed with a resounding thud. On Monday, the insurers will try to convince a federal judge that the Justice Department’s rejection was wrong as the government’s lawsuit seeking to block the deal goes to trial in Washington. The company Aetna wants to sell assets to, Molina Healthcare Inc., is unlikely to replace the competition that would be lost from the merger, according a filing by the U.S. Molina was criticized by the government as a junk-rated company whose previous foray into the Medicare Advantage market flopped. (Harris and McLaughlin, 12/5)

Two weeks of proceedings have given way to halftime in the Anthem-Cigna antitrust trial, which has put a spotlight on the unusual degree of infighting between the prospective merger partners. The trial's first phase has dealt with national accounts, which the Justice Department defines as employers with more than 5,000 workers, and whether Anthem’s proposed $54 billion acquisition of Cigna would be detrimental to competition in that market. ... But for those worried they will suffer withdrawals while the Athem-Cigna battle is adjourned, have no fear: Trial on a separate lawsuit brought by DOJ challenging Aetna’s $37 billion acquisition of Humana will commence Monday morning in the same Washington, D.C., courthouse. (Demko, 12/5)

During his 12 years in Congress, Representative Tom Price has made clear what role he thinks the government should play in health care. It can be summed up in one word: less. Throughout his career, Mr. Price — who has been picked by President-elect Donald J. Trump to be secretary of health and human services — has argued that the government should get out of the way of doctors and give patients more control over their health care. (Pear, 12/4)

Retired Marine Gen. James N. Mattis, reportedly President-elect Donald Trump's pick for secretary of defense, had a long military career, leading the U.S. Central Command before he retired in 2013. But a series of emails obtained by The Post last year revealed that, in a lesser-known incident late in his military tenure, Mattis took the unusual step of personally pushing for a start-up company — the controversial blood-testing Theranos — to land a deal for a military field test. (Johnson, 12/1)

Gen. Mattis may face questions over his ties to Theranos Inc., the embattled blood-testing startup. He joined the board in July 2013, a couple of months after retiring. As of Friday, Theranos’s website listed him as a director. Theranos referred questions on Gen. Mattis’s directorship to him; a representative for Gen. Mattis didn’t respond to requests for comment. His ties to the company go back to his days overseeing the military’s operations in the Middle East and Central Asia. In 2012, Gen. Mattis, then leading the military’s Central Command, pressed for the U.S. Army to procure Theranos lab equipment and deploy it in the battlefield, senior military officials involved in Army medical research said. (12/2)

Francis Collins should stay on as director of the National Institutes of Health, four top GOP lawmakers said in a letter sent to President-elect Donald Trump Friday and obtained by The Hill Extra. “As the Director for over the past seven years, his distinguished scientific experience, effective leadership skills, and long standing relationships with Members of Congress, researchers, and advocates will service the Nation and your Administration well,” the letter states. (Roubien, 12/2)

In a letter sent Friday, top congressional Republicans urged President-elect Donald Trump to keep Dr. Francis Collins as director of the National Institutes of Health. Collins received the endorsement from key GOP members of Congress: outgoing House and Energy Commerce chairman Fred Upton, Senate health committee chairman Lamar Alexander, and the two chairmen of the appropriations committees that oversee NIH: Senator Roy Blunt of Missouri and Congressman Tom Cole of Oklahoma. (Scott, 12/2)

Zenefits, a once highflying human resources software start-up that defined Silicon Valley’s recent technology boom, has been trying to recover its footing after being rocked by scandal over its business practices earlier this year. Now David O. Sacks, the chief executive of Zenefits and the tech veteran who was charged with rejuvenating the embattled company, plans to leave his position. Mr. Sacks said that he would become Zenefits’s chairman and that the company was starting a search for a new chief executive. (Isaac and Benner, 12/2)

The U.S. Supreme Court on Friday agreed to hear appeals by Christian-affiliated hospital systems of lower court rulings that gave the green light to employee lawsuits accusing them of wrongly claiming a religious exemption from federal pension law. New Jersey-based St. Peter's Healthcare System, Illinois-based Advocate Health System and California-based Dignity Health each appealed separate federal appeals courts rulings that refused to throw out the employee lawsuits. The justices agreed to hear all three cases. (Pierson, 12/2)

On Tuesday morning, the CRISPR patent dispute reaches a much-awaited milestone: the case’s first and only oral arguments, slated to last less than an hour for a patent potentially worth billions of dollars. The hearing is open to the public, and it’s sure to attract the attendance of dozens of lawyers, company executives (Novartis has confirmed it’ll be represented), publicists, reporters, and even some genome-editing groupies. The nasty dispute pits the University of California against the Broad Institute of Harvard and MIT for rights to key patents on CRISPR genome-editing. Since April 2014, the Broad has received 13 CRISPR patents, based on work led by its bioengineer Feng Zhang, but UC believes it deserves some of the most foundational ones, reflecting earlier work by its biochemist Jennifer Doudna and her collaborator Emmanuelle Charpentier. (Begley, 12/5)

Wal-Mart Stores Inc. agreed to pay $7.5 million to settle a lawsuit accusing the company of discriminating against gay workers by failing to offer health insurance benefits to their spouses. The settlement covers employees who were affected by Wal-Mart’s conduct from January 2011 to December 2013, according to documents filed Friday in Boston federal court. A few thousand current and former workers were affected, Wal-Mart said in a statement without providing an exact number. The company employs 1.5 million people in the U.S. and Puerto Rico. (Larson, 12/2)

The health problems of Native Americans, who represent 2% of the U.S. population, are largely invisible to the broader public. Congress rarely investigates conditions at [Indian Health Services] facilities. The last piece of wide-ranging legislation to tackle its problems—the Indian Health Care Improvement Act—was passed in 1976 and was permanently reauthorized as part of the Affordable Care Act. But it never succeeded in righting the underfunded agency. Frustrated by the failure of the federal government to take their concerns seriously, tribes in other parts of the country over the past several decades have forced out IHS by creating not-for-profit community organizations to run their local facilities. (Hermand and Fei, 12/2)

A federal magistrate in San Francisco says the American Civil Liberties Union can proceed with a nationwide suit challenging government contracts to religious organizations that provide care for minors who enter the United States on their own but deny them access to abortion or contraception. The ACLU says it has received reports that between 60 and 80 percent of unaccompanied young women crossing the border have been raped or sexually assaulted. (Egelko, 12/2)

New Texas rules requiring the burial or cremation of fetal remains are likely to face a court challenge before taking effect, an abortion-rights attorney said Friday, months after the U.S. Supreme Court knocked down sweeping abortion restrictions in the state. The new regulations, which the state plans to implement starting Dec. 19, are the latest battleground in Texas over abortion and would prohibit facilities from continuing to dispose of fetal remains as biological medical waste. Lawsuits this year blocked similar measures in Louisiana and Indiana, where the law was signed in March by governor and now Vice President-elect Mike Pence. (Weber, 12/2)

Last fall, Shaun Durfey and five other veterans sat in a circle and drew their family trees. Durfey, a 29-year-old former Marine, had served three tours in the Middle East. Upon his return to the States, he’d been given a host of medications for insomnia, depression and post-traumatic stress disorder, or PTSD, and he had spent hours at a Veterans Affairs hospital talking about the wartime deaths of friends. Buthis doctors had never probed his family history, which included painful memories of childhood neglect. Now, Durfey was being asked to speak openly about these experiences. (Miller, 12/4)

Elenilson Franco, who suffers from post-traumatic stress disorder, depression and anxiety, first sought mental health care from the Department of Veterans Affairs nearly four years ago. He is still waiting. The VA lost his original paperwork and hasn’t yet approved a new application, he said. “It’s frustrating,” lamented Franco, 46, who served in Iraq as a U.S. Marine. “I am a veteran. The VA is supposed to be there for me.” (Gorman, 12/5)

As Chuck Peal lay in a Waterbury, Conn., emergency room one Sunday in early September, doctors furiously tried to make sense of his symptoms. Mr. Peal, 61, appeared to be dying, and they were not sure why. ... A doctor suspected a heart attack, but uncertainty left him urgently researching the situation on his phone. This was not a heart attack. Mr. Peal’s body was attacking itself, a severe reaction by his immune system that was a side effect of a seemingly miraculous cancer treatment aimed at saving his life. (Richtel, 12/3)

Despite decades of scientific confirmation and reconfirmation that smoking is a menace to your health, the decline of the myth of the Marlboro man, and a World Health Organization treaty on tobacco control signed by 180 countries, we still have a long way to go in the war against tobacco. While the prevalence of smokers has fallen dramatically in the United States thanks in large part to education campaigns, the big five tobacco companies have found a new market in developing countries. The number of people smoking the leaves globally has remained sky high — 1.1 billion — with an estimated 6 million dying each year from the health effects. Can Michael Bloomberg make a difference? (Cha, 12/5)

People once vigilant about vaccinating their children aren’t nearly as careful about protecting themselves as they age, even though diseases like influenza, pneumonia and shingles (a.k.a. herpes zoster) are particularly dangerous for older people. “Trying to prevent these common and often debilitating conditions is incredibly important for older adults,” said Dr.Carolyn Bridges, associate director for adult immunization at the Centers for Disease Control and Prevention. Yet in the C.D.C.’s 2014 and 2015 reports on vaccination coverage, she said, “we really didn’t see much change.” (Span, 12/2)

People with a history of incarceration are typically much sicker than the general population, especially returning inmates. Studies done primarily in Ohio and Texas have found that more than 8 in 10 returning prisoners have a chronic medical condition, from addiction to asthma. Egins says a lot of it has gone untreated, for a range of reasons — because the health care system is tough to navigate, because they're homeless and don't have insurance, or because they don't trust doctors. (Bichell, 12/5)

A full decade after the Food and Drug Administration approved a vaccine to fight the sexually transmitted, cancer-causing human papillomavirus, almost half of all adolescents have still not received their first dose. This low vaccination rate is dramatic when compared to other routine childhood immunizations like polio and measles, mumps and rubella, where compliance is above 90 percent. (Neighmond, 12/5)

For people who regularly struggle with disrupted sleep, sticking to consistent bedtimes, cutting back on caffeine or alcohol or removing electronics from the bedroom may not always be enough. Health experts have explored many remedies over the years with varying results, which makes them cautious about hailing some new intervention as the magic cure for people’s sleep issues. “There are a lot of things for insomnia that come along, but if it doesn’t work, it really doesn’t work,” said Anil Rama, director of Sleep Medicine Services at Kaiser Permanente in San Jose. (Ross, 12/2)

For someone battling a life-threatening illness, being surrounded by loved ones can be a source of strength and recovery. But for Johanna Watkins, a Minnesota woman locked in a desperate struggle for survival, being close to others is not an option. (Holley, 12/3)

In offices across the country, someone is probably sneezing, spreading a cold that's been going around. It sometimes seems like when one person at work gets sick, it's only a matter of time before everyone does. One potential reason why is the office itself. Most of the buildings we work in are completely sealed off from the outside world, in part to help save on heating and cooling costs.But this can also mean that when someone gets sick, the germs just circulate through the ventilation system. (O'Leary and Mills, 12/2)

When top US health authorities convened in late January to brief President Barack Obama on the Zika outbreak in Latin America, the post-meeting scuttlebutt was that the president was eager to push development of a Zika vaccine. The officials attending the meeting tried to convey an inconvenient reality: Real-world need and vaccine development speed are rarely in sync. Vaccines take years to produce, test, and license. The Zika virus, which had received scant study before 2016, was unlikely to prove to be an exception to that truth. And yet a mere 10 months later, despite funding delays from a fractious pre-election Congress, three experimental Zika vaccines are already being tested in people; another four or five should start human trials between now and next fall. (Branswell, 12/5)

Florida Gov.  Rick Scott announced Friday that the state Department of Health is lifting the Zika zone in Miami’s Little River neighborhood because 45 days have passed without any new local cases in the area. “This is a good news day,” the governor said repeatedly. But he urged residents to remain vigilant. Zika infections have been linked to the birth defect microcephaly, which can cause intellectual disabilities, seizures and cerebral palsy. (Stein, 12/4)

Florida confirmed two new travel-related cases of Zika on Friday, in Collier and Hillsborough counties.This brings up the state's total to 1,222, including 174 pregnant women. The four Central Florida counties, including Orange and Seminole, have reported 198 travel-related cases so far. No local cases have been reported here. (Miller, 12/2)

Starting Jan. 1, health-care providers in New Hampshire will have to check the state's prescription drug database every time they initially prescribe opioids for their patients - and then check again at least twice a year. It's not a simple task. Over the past year, more than 45 million doses of Schedule II painkillers - drugs such as oxycodone and fentanyl that have figured largely in the state's opioid crisis - were dispensed in New Hampshire, according to data from the state's Prescription Drug Monitoring Program. (Wickham, 12/3)

For every person with an opiate problem who walked through his agency’s doors in 2000, psychologist Joe Gay said, there are now 50. The years between have been a boon for addiction. Gay and others in southern Ohio watched it snake through their communities like a virus, flourishing in areas with high poverty, high unemployment and scant public resources. (Price, 12/2)

Physicians with the Centers for Disease Control and Prevention fear progress made in preventing the spread of HIV could be eroding because of the continued opiate epidemic. The doctors say addicts, particularly among whites, reuse needles to inject the deadly drugs. One consequence of the widespread heroin and fentanyl problem is the increased risk of the transmission of human immunodeficiency virus (HIV) and hepatitis B and C through unsafe or dirty needles, the physicians said. (Grossmith, 12/3)

The medical marijuana movement has pitted voters and states against the FDA — and the FDA is losing. The Drug Enforcement Agency, with advice from the FDA, has decided to keep marijuana classified as a Schedule I substance — the same category as heroin and LSD. As far as the federal government is concerned, marijuana is still an illegal drug with a high potential for abuse and no accepted medical use. But that classification exists mostly on paper. Most states have made clear that when it comes to marijuana, they see things differently, and the feds have mostly had a hands-off approach. (Karlin-Smith, 12/4)

More than 6 million Floridians voted in November to allow patients with conditions like cancer and HIV to use marijuana — nearly 2 million more than President-elect Donald Trump's state total. But such overwhelming support for the state constitutional amendment has not translated into urgency in the capital. (Auslen, 12/2)

Each year, Minnesota’s hospital emergency rooms see thousands of patients with minor illnesses — from coughs to fevers — who could be better treated at a neighborhood clinic at drastically lower cost. To stem that tide, state authorities are using a sophisticated computer screening tool that detects when people on public health insurance programs make dozens of unnecessary trips to hospital ERs and medical clinics. (Serres, 12/3)

Jacksonville Memorial Hospital recently started offering prescription medicine through an “RX-to-go” kiosk right in its emergency room. The idea of on-demand medicine is taking off. Three Jacksonville pharmacists launched a medical vending machine of their own Friday. (Kilbride, 12/4)

The facilities accused of negligence in the death of a jail inmate outlined on Friday changes made to improve the way they operate, but top state officials said Virginia is far from fixing its mental health and criminal justice systems. Jamycheal Mitchell, an accused petty thief who wasted away and died in custody, and the plight of thousands like him who are mentally ill and in jail were discussed at length in a landmark meeting that included the secretaries of health and public safety, elected officials and officials with multiple state and local agencies. (Kleiner, 12/2)

Rural hospitals across upstate New York are facing the prospect of having to pay back millions of dollars in federal funds that already have been distributed. U.S. Senator Charles Schumer says the Centers for Medicare and Medicaid Services recently decided to change a calculation used to determine certain funding for sole community and Medicare-dependent hospitals. He says it is retroactively seeking to recoup federal funds based on a new formula. (12/3)

Milwaukee County auditors have started a wide-ranging investigation into medical care at the county's two jails, where four people have died in recent months and a court-appointed monitor found numerous problems related to inmate treatment. Jerry Heer, director of audits for the Milwaukee County Office of the Comptroller, confirmed this week that auditors plan to investigate whether Armor Correctional Health Services is meeting contract requirements and standards of medical care. Armor, a Miami-based for-profit company, has contracted with the county since 2013 to provide medical care at the Milwaukee County Jail and the House of Correction. (Carpenter, 12/2)

The fate of the Affordable Care Act may be uncertain as President-elect Donald Trump prepares to take over with a Republican-controlled Congress, but don’t expect Georgia lawmakers to wait for Washington’s lead in 2017. At least that was the message Georgia Senate President Pro Tem David Shafer and House of Representatives Minority Leader Stacey Abrams shared during the Gwinnett Chamber’s Legislative Update Luncheon on Friday. (Yeomans, 12/3)

The union representing registered nurses at Hahnemann University Hospital, St. Christopher's Hospital for Children, and St. Christopher's Pediatric Outpatient Clinic announced Sunday that it had reached tentative agreements on first contracts with Tenet Healthcare Corp., the Dallas-based for-profit chain that operates the hospitals. Hahnemann's 940 nurses are scheduled to vote on the tentative agreement Monday. Voting by the 400 nurses at St. Christopher's Hospital and the 30 nurses at the outpatient clinic is set for Wednesday. (Von Bergen, 12/5)

But in the early 2000's, Florida and a handful of other states went on a business friendly cost-cutting binge. Orlando attorney Geoff Bichler says injured workers were left out in the cold. (Ash, 12/4)

An in-home caregiver for seniors has been indicted in federal court here for allegedly scheming to defraud three elderly people of more than $30,000. De'Janay Noldon, 27, of St. Louis County, was indicted Thursday on multiple charges including mail fraud, bank fraud, identity theft and Social Security fraud, according to the U.S. Attorney's Office for the Eastern District of Missouri. Prosecutors say Noldon assumed the identity of one of her victims to obtain three credit cards she used to make several personal purchases, get cash advances and pay bills. She also accessed the bank accounts of all three victims. (Benchaabane, 12/2)

For years, the state agency that oversees people with disabilities erroneously charged monthly fees to largely poor people who live in residential facilities. And they might never get any of the millions of dollars back. State auditors reported this week that more than 2,500 people might have been charged fees exceeding $4 million during just one year of their review from February 2012 to April 2014, but the payments were likely assessed for a much longer period. (Cohn, 12/3)

Father-and-son developers from Iowa City have received more than $26.4 million in federal tax credits to provide affordable assisted-living care for Iowa seniors — but they twice have decided to pull services and eliminate oversight of their facilities, state agency records show. A decade ago, Robert P. Burns and his son, Jesse Burns, accepted $6.4 million in tax credits over 10 years to build Walden Point, across from the Mercy Medical Center in downtown Des Moines. (Rood, 12/2)

A year ago the Metropolitan District Commission, the Capitol region’s water and sewer agency, approved the sale of up to 1.8 million gallons of water a day, with a volume discount, to a water bottling plant to be built in Bloomfield by the California-based Niagara Bottling Co. A lot of area residents didn’t see this coming, and when they learned of it, they were profoundly unhappy. (Condon, 12/5)

The recent discovery of high levels of a cancer-causing pollutant in Paramount has alarmed residents and led authorities to crack down on dangerous emissions from two metal-processing plants.But the interventions last week by air regulators and health officials followed years of slow and sporadic steps by several agencies in response to health concerns, say residents and activists in the small city southeast of Los Angeles. If regulators had done their jobs properly, they say, they might have found out years ago that toxic emissions from metal businesses were putting neighbors at risk — and taken action. (Barboza, 12/4)

Texas county jails have seen a sharp decline in inmate suicides since they began using a revised mental health screening tool last December. Since December 2015, 14 county jail inmates have taken their own lives, a drop from a record 34 suicides between December 2014 and November 2015. In the five years before that record, inmate suicides averaged 23 a year, according to the Texas Commission on Jail Standards, which monitors county lockups across the state... Last fall, lawmakers and other officials set their eyes on the screening tool, also called an intake form, used by jails to determine if inmates are suicide risks. (Silver, 12/4)

Group Health Cooperative pharmacy customers have experienced delays in recent weeks waiting for prescriptions to arrive by mail, waiting on the phone to talk to a pharmacy representative and waiting in line at a pharmacy to get prescriptions filled. The problems can be blamed on a “head to toe” update to the pharmacy system, according to Executive Vice President Erin Leff. Leff said the new system, which went live about three weeks ago, is working well for most, but a minority are suffering longer-than-usual waits, causing anxiety and irritation. (Young, 12/3)

But it’s already clear that bait-and-switch — big but empty promises, completely lacking in detail — will be central to Republican strategy on one key issue: the future of health coverage for millions of Americans. ... Republicans have promised to repeal the law as soon as they had a chance, replacing it with something much better. Strange to say, however, they have never described what their replacement would look like. And I don’t mean that they haven’t spelled out all the details. Almost seven years after Obamacare was enacted, Republicans haven’t offered even the broad outline of a health reform plan. Why not? (Paul Krugman, 12/5)

The worm is about to turn in health policy and politics when Republicans shift from throwing stones to owning the problems of the health system and the Affordable Care Act or its replacement, as President Barack Obama and Democrats have for the past eight years. It’s hard to predict how events will play out, but it’s likely that grand plans to repeal and replace Obamacare, convert Medicaid to a “block grant” program, and transform Medicare into a premium support program could be whittled down or delayed as details of such sweeping changes, and their consequences, become part of the debate. (Drew Altman, 12/2)

In 2004, the journalist and historian Thomas Frank wrote an insightful and prescient book, “What’s the Matter With Kansas?", in which he tried to puzzle out why voters in his native state backed Republicans whose policies undermined their own economic interests. Watching the apocalyptic response to Donald Trump's victory in the liberal precincts I inhabit, I’m struck by a similar quandary: Why are voters in states that pay a disproportionately large share of federal taxes, and benefit from a disproportionately small share of federal spending, so upset about the prospect of a cut in taxes and federal spending? ... If these states want to maintain the Obamacare insurance exchanges, the low-income subsidies and the expansion of the Medicaid program, they can do that, just as Massachusetts did under Mitt Romney even before passage of the federal law. (Steven Pearlstein, 12/4)

If your doctor is happier now than you’ve seen her in years, the reason is the potential dismantling of ObamaCare in favor of something that will help restore sanity to the health-care system. My first patient one recent Thursday morning was a smoker with an ObamaCare policy he purchased on the state exchange. A slight irregularity on his chest X-ray had led me to jump over insurance hoops for approval to do a CT scan. None of the radiology places I use accepted his insurance, but my staff finally found one that did. Now he was here to review the results. (Marc Siegel, 12/4)

Saying that “surprise” medical bills for emergency room visits are unfair to patients, Senator Bill Nelson, Democrat of Florida, is asking the Federal Trade Commission to investigate the practice. A study published in The New England Journal of Medicine last month found that many patients around the nation were being hit with big out-of-network bills even though they had taken care to go to hospitals that their insurers considered in-network. Such billing occurred in about 22 percent of visits covered by one large commercial insurance company alone, the study found. (Margot Sanger-Katz and Reed Abelson, 12/3)

On the surface, it looks like every healthcare special interest and their 1,400 lobbyists won an early Christmas present courtesy of the 21st Century Cures Act, which passed the House of Representatives by a whopping 392-26 margin last week and appears headed for Senate passage and enactment. The deeper ramifications of this behemoth bill will only emerge over time. The final details of the 996-page legislation (that's 600 pages longer than the original bill and 90 pages longer than the Affordable Care Act) weren't known until five days before it passed. While there's an old saying in politics that you should hold onto your wallets when the legislature is in session, taxpayers needn't be too concerned. The bill's provisions that captured headlines—new funding for the National Institutes of Health and long overdue attention to mental health and the opioid crisis—offered far less than advertised. (Merill Goozner, 12/3)

Since 1999, the number of deaths attributed to opioid overdoses has nearly quadrupled. In several states, drug overdose has become a leading cause of injury-related death. ... Those on the front lines of this fight have made it clear they need more resources. I heard them, and in February I proposed $1 billion in new investments to address the crisis. ... It will build upon steps we have already taken to expand overdose prevention strategies, improve opioid prescription practices, and ensure more Americans seeking addiction treatment can get the help they so desperately need. Those devastated by the heroin and prescription opioid epidemic cannot wait any longer. They need help now, and we need to help turn the tide of this epidemic. (President Barack Obama, 12/2)

California, thankfully, has never been the epicenter of the country’s opioid epidemic, but even in the state’s agricultural hubs, such as Stanislaus County, the number of people hooked on prescription painkillers and heroin is truly staggering. There, roughly 1,100 are in treatment and 400 more are waiting to get in. The story is the same all over the Central Valley and in the sparsely populated rural north, where many voters picked Donald Trump but never would have been able to afford help curbing their addictions without the Affordable Care Act that the president-elect so detests. (12/4)

Each day thousands of Texas patients see their health care provider for services ranging from the common cold or flu to delivering a new baby to geriatric care to mental health services. And for more and more Texans, it is highly trained and specialized nurses who provide this level of personalized care. Advanced Practice Nurses, or APRNs, perform many of the same duties as a physician, which is good news for our state’s health care provider shortage. The bad news for patients is that our current regulatory climate is restricting the ability of APRNs to practice to the full extent of their licensure and training. (Bill Hammond, 12/4)

D.C. officials have long, and rightly, complained about their inability to tax residents of Maryland and Virginia who work in the city. That these workers essentially get a free ride in city services galls leaders of the District, as does the fact that many other jurisdictions are allowed to impose commuter taxes. So it would seem contradictory — indeed, other words come to mind — that the District would even think about taking $250 million annually in new tax money from District residents to pay a benefit that will largely go to people who live outside the city. That, though, is exactly what will happen if the District presses ahead with a half-baked scheme to provide paid family leave. (12/4)