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Almost 52,000 people have enrolled in health plans on the state's online insurance marketplace, which launched Nov. 15, exchange officials reported Friday. As of Dec. 4, 29,543 signed up for private plans on the exchange, created under the federal Affordable Care Act to cover people who do not get their insurance from employers. Another 22,253 enrolled in Medicaid through the exchange by phone, in person or at marylandhealthconnection.gov. Open enrollment lasts until Feb. 15, but those who need insurance Jan. 1 must enroll by Dec. 18. And everyone who enrolled in private plans last year must re-enroll to keep federal subsidies. (Cohn, 12/5)

Nearly 52,000 people have enrolled for health coverage in Maryland since the second enrollment period began last month, the state’s health care exchange said Friday. Of those enrollees, 29,543 have signed up for private insurance plans for 2015. Another 22,253 enrolled in Medicaid. The updated enrollment numbers are for Nov. 15 through Thursday. (12/5)

Only about one in 10 Oregonians who previously signed up for private health care insurance through the state health insurance exchange has re-enrolled through the federal portal, officials said. The state abandoned the troubled Cover Oregon health care site in the spring and switched to the federal site, HealthCare.gov. Open enrollment on the federal site runs through mid-February. But all those who bought coverage through the now-defunct state exchange must re-enroll via the federal site by Dec. 15 or face a break in coverage in January. (Wozniacka, 12/5)

More insurers, more choices, more confusion — and a shorter time to sort it all out. That's what consumers are facing in the second year of the Michigan Health Insurance Marketplace, established under federal health reform. Enrollment began Nov. 15 and the first deadline is just eight days away — Dec. 15. That's to buy health care coverage that will kick in Jan. 1. Plans purchased between Dec. 16 and the close of enrollment, Feb. 15, are effective the following month if they're purchased and paid for by the 15th. In 73 of Michigan's 83 counties, the number of plan options on the exchange have more than doubled, according to an analysis by the Center for Healthcare Research and Transformation in Ann Arbor. (Erb, 12/7)

Last year, health reform supporters and advocates had pent-up demand on their side. This year bringing new consumers to the marketplace will require outreach that stretches much further. By the time the marketplace launched last year — Oct. 1 — customers who had been denied coverage or couldn't afford coverage previously were ready to enroll. In fact, the surge to the www.healthcare.gov website was initially blamed for its repeated technical snags. By the close of the six-month inaugural enrollment period March 31 — and after many of the technical knots had been unraveled — 272,539 Michiganders had chosen plans, according to the U.S. Centers for Medicare & Medicaid Services. And Healthy Michigan, the state's expanded Medicaid plan, has enrolled more than 464,000 people since it launched at 12:01 a.m. April 1 — far surpassing its first-year goal of 322,000, according to state officials But this year — after enrollment opened Nov. 15 — there hasn't been the same surge. (Erb, 12/7)

California is still struggling to clear tens of thousands of backlogged Medicaid applications from Obamacare’s first year and in the face of a lawsuit over coverage delays will temporarily give thousands of people benefits while concluding their case review. (Pradhan, 12/5)

The only thing certain about the alternative Medicaid expansion in Pennsylvania is that coverage will start on Jan. 1. Nineteen days later, Democrat Tom Wolf will move into the governor’s mansion. He has vowed to scrap his Republican predecessor’s plan and replace it with traditional expansion. If he follows through, GOP legislators say they can defund that during budget negotiations next summer — even if it means canceling new benefits for thousands of low-income Pennsylvanians. (Wheaton, 12/5)

[Terry] Sullivan believes that the federal government has no business being involved in his choice of health insurance. For 28 years, that insurance was Independence Blue Cross' Special Care plan. But the plan was discontinued in 2013 because it didn't meet the ACA's qualified health plan standards. So Sullivan, of King of Prussia, went on the marketplace .... So [this fall] back online he went, shopping for new coverage on healthcare.gov. ... But when he plugged in his $12,000 annual income, a message popped up that read, "This household may be eligible for free or low-cost care" through Medicaid. The self-employed accountant now will join an estimated 600,000 low-income Pennsylvanians -- many of whom have never had health insurance -- covered through Healthy Pennsylvania, the state's Medicaid expansion program, which starts Jan. 1. (Calandra, 12/7)

Michigan's expanded Medicaid was made possible under the same law that set up the state exchanges. However, unlike the exchanges, enrollment in the program — called Healthy Michigan — isn't limited to a three-month open enrollment period. You can enroll in Medicaid year-round. Last year, Michigan was among about two dozen states that decided to expand its Medicaid program under the Affordable Care Act. For years, its program generally was limited to children, parents of young children, and elderly and disabled people. That change means many single adults — including those who work but whose incomes still hover around the poverty level — are now eligible not only for health care when they're sick, but for preventative services such as regular doctor's visits, mammograms and colonoscopies. (Erb, 12/7)

A central Minnesota business has won state court approval to exclude birth control from its employees' health insurance plans. American Mfg Co., which makes mud pumps and pump parts, sought a religious exemption from the Affordable Care Act mandate, which requires contraceptive coverage in employers' health plans. The St. Joseph-based company won a preliminary injunction in 2013. (Zdechlik, 12/5)

Faith-based nonprofit organizations that object to covering birth control in their employee health plans are in federal court Monday to challenge a birth-control compromise they say still compels them to violate their religious beliefs. The plaintiffs include a group of Colorado nuns and four Christian colleges in Oklahoma. They are already exempt from covering contraceptives under the federal health care law. But they say the exemption doesn't go far enough because they must sign away the coverage to another party, making them feel complicit in providing the contraceptives. (Wyatt, 12/8)

Who will be the new health care leaders for Democrats? Sens. Chris Murphy of Connecticut and Ben Cardin of Maryland want more delivery system reforms. Sen. Patty Murray of Washington wants better contraceptive coverage and more doctors. All three want to beef up mental health coverage. And Sen. Ron Wyden of Oregon and Rep. Frank Pallone of New Jersey aren’t even saying what’s on their agenda — they want the Republicans to go first. It’s all smaller bore stuff — a real comedown from the visions of the past. (Nather, 12/7)

Last week, the Department of Health and Human Services welcomed its third group of “entrepreneurs-in-residence” — mainly private-sector tech experts and start-up founders who are spending a year advising the agency on its health IT projects. Two are working on data collection and analysis. Paula Braun, a data scientist with Charlottesville, Va.-based consulting firm Elder Research, is embedded in the Centers for Disease Control and Prevention to devise a better Electronic Death Registration System, so that the CDC can refine its analytics and predictive modeling. (Ravindranath, 12/7)

At 61, Ken Helms of Charlotte would love to have health insurance. Based on what he earned directing traffic this year, he’s eligible for federal help paying premiums and out-of-pocket costs under the Affordable Care Act. But he worried that his unpredictable income could leave him in the lurch. The subsidies are designed to provide more help to those with smaller paychecks. But in North Carolina, the floor drops out when a wage-earner falls below the poverty level, a distinct possibility for Helms. His fear: Getting health insurance – and long-delayed care – could leave him worse off if he loses his coverage and has to repay Uncle Sam. Experts say that won’t happen, but his trepidation is understandable. People who rely on tips, commissions or jobs with variable hours can have a tough time predicting annual income, which is the basis for ACA subsidies. In a recent Federal Reserve survey, almost one-third of Americans said their income fluctuates from month to month. (Helms, 12/7)

North Carolina’s rates for individual insurance vary significantly across the state and are among the highest in the nation. The state’s high insurance costs have been blamed on a grab bag of causes, including entrenched market dominance by Blue Cross, the state’s decision last year not to expand Medicaid, and a decades-long race among hospital companies to build one of the nation’s best health care networks. The Affordable Care Act has been blamed and credited for lots of things, but one of the legacies of the federal health law is greater transparency for insurance costs, which for years had been treated as a closely guarded secret. Today anyone with Internet access can get on healthcare.gov and compare rates within their own state or with other states. (Murawski and Raynor, 12/7)

Fewer uninsured Californians are seeking treatment in the state’s emergency rooms, a decline that experts say is a direct result of the federal Affordable Care Act. The trend represents welcome news for previously uninsured patients who had trouble affording a trip to the emergency room. But it has not brought down ER treatment costs for everyone else, health care experts said, nor has it slowed a years-long increase in overall emergency room traffic. (Reese, 12/6)

What happens when you break a leg and you live hundreds of miles from the nearest hospital? Or when you can't afford to get a new pair of glasses because you don't have health insurance? For many, the answer is to go without help. That's why the organization Remote Area Medical was conceived. As we've reported before, the team travels across the United States and abroad to provide health care to those in need. That's a lot of people — about 16 percent of Americans are uninsured, according to the latest Gallup poll. (Bruzek, 12/5)

A Supreme Court challenge that poses a grave threat to President Obama's health care law had its genesis precisely four years ago as a power-point presentation by a self-proclaimed pessimist from South Carolina. The idea was picked up by an Ohio law professor, given a policy and public relations push by a Washington health economist and turned into a lawsuit by an Oklahoma attorney general. Three more lawsuits followed. Nearly five years after the law was passed, their effort has reached the Supreme Court, which saved the president's signature domestic policy achievement in 2012 but now could deal Obama a significant setback. (Wolf, 12/7)

Rep. Bill Cassidy, who toppled Democratic Sen. Mary Landrieu in Saturday’s runoff election, says his top priority is to tackle Obamacare. "It’s pounding the American people,” the Republican senator-elect said on “Fox News Sunday.” “People are upset about this law, and we must do something about it.” “The Supreme Court is now considering a case as to whether the administration is breaking a law in terms of how they give subsidies - and a plain reading of the law suggests that they are,” he said. “If the Supreme Court rules that the administration is breaking the law, it crashes in 30 some odd states.” (Diaz, 12/7)

Cassidy, who unseated Sen. Mary Landrieu (D-La.) in a runoff election on Saturday, said the GOP takeover of the Senate illustrated how dissatisfied voters were with President Obama, especially in the Deep South. ... Cassidy, himself a doctor, said rolling back Obama’s healthcare law would be one of his top priorities in the Senate. But he appeared to put mostly hope that the Supreme Court, which will hear a case concerning ObamaCare subsidies, would do most of the work in eliminating the law. (Becker, 12/7)

Just one day after Rep. Bill Cassidy (R-LA) handily defeated three-term Sen. Mary Landrieu (D-LA) in a runoff election Saturday night, Louisiana’s new senator-elect announced his next target: Obamacare. ... Sen. Mitch McConnell (R-KY), the new Majority Leader-to-be in January, as well as House Speaker John Boehner (R-OH), have already vowed to vote to repeal Obamacare, though the health law will be safe as long as President Obama is in the White House. Still, Republicans are planning to go after vulnerable provisions of the law, such as the medical device tax and the employer mandate. The law also faces immediate danger from the judicial branch. (Ehley, 12/7)

Senator-elect Bill Cassidy is a doctor who says he first ran for office because he was horrified by the breakdown in health care after Hurricane Katrina. ... Mr. Cassidy effectively brushed aside criticism late in the campaign from Ms. Landrieu that he had filed timesheets for working at a Louisiana state hospital on days he was also casting votes in Washington. Mr. Cassidy said he often worked in the morning to meet his part-time obligations teaching students and treating patients, then flew to Washington in the afternoon. He said he also saw enough to know that patients were struggling to afford insurance under the Affordable Care Act. “I would like to repeal and replace Obamacare with something that would actually help them,” Mr. Cassidy said in a debate on Monday. “How can we give power to the patient?” (Bauerlein, 12/7)

It's the equivalent of finals week in Congress, when lawmakers are scrambling to pass legislation to keep the government and the military funded and more. But you can expect many on the hill to pause for a little while to watch former Obamacare adviser Jonathan Gruber's guest appearance on Tuesday. But watching the embattled economist is far different thing than, say, sitting next to him, which appears to be the way that the Centers for Medicare and Medicaid Services (CMS) sees it. (Amling, 12/5)

No one seems to want to sit next to Jonathan Gruber. The Obama administration is asking Rep. Darrell Issa not to put its senior Medicare official next to the now infamous Obamacare “architect” when both testify on Capitol Hill next Tuesday. (Haberkorn, 12/5)

The Department of Health and Human Services (HHS) is asking lawmakers not to seat ObamaCare consultant Jonathan Gruber next to Medicare's top official when the two testify on Capitol Hill next week. HHS Assistant Secretary for Legislation Jim Esquea wrote to the House Oversight Committee with the request, stating that government witnesses are "almost always afforded an opportunity" to sit alone or with other federal officials. (Viebeck, 12/5)

Republicans in the U.S. Congress plan to renew their attacks on President Barack Obama and his signature healthcare plan on Tuesday when they grill a consultant who said "the stupidity of the American voter" helped ensure the law's passage. Representative Darrell Issa, chairman of the House Oversight Committee, said panel members will ask consultant Jonathan Gruber about possible deceptions and a lack of transparency in the 2010 Affordable Care Act, better known as Obamacare. Republicans have seized on videos in which Gruber, a healthcare economist at the Massachusetts Institute of Technology and an Obamacare consultant, says the law was written in a "very tortured way" to hide taxes, and passed thanks to "the stupidity of the American voter." (Cornwell and Rampton, 12/7)

Senate Democrats are pushing to extend a health care tax break for laid-off workers into the upcoming House spending bill, arguing “this is an issue that cannot wait.” The healthcare credit expired at the end of 2013, but was one of a just a handful of lapsed incentives that House didn’t restore for this year that it passed on Wednesday. (Becker, 12/6)

A trio of senior GOP lawmakers talked up legislation the House passed this week to help people with disabilities, saying the measure was just one way Republicans were working to improve the life of working people. In the GOP’s weekly address, Reps. Ander Crenshaw (Fla.), Cathy McMorris Rodgers (Wash.) and Pete Sessions (Texas) said the Achieving a Better Life Experience, or ABLE, Act would “empower millions,” as McMorris Rodgers put it. (Becker, 12/6)

Tiptoeing into the broader accountability movement, some of the largest medical-device manufacturers are negotiating experimental deals with hospitals to take on performance-based financial risk for their implants. While drugmakers have been testing risk-based contracts for several years, devicemakers are just beginning to explore taking on risk for products such as pacemakers and other implantable devices. Experts say cardiac devices are a primary focus of new risk-sharing agreements under discussion, likely because hospitals face potentially lower payment rates for congestive heart failure patients. Experts say each risk-based contract between a hospital and devicemaker is structured differently. Some agreements may stipulate that the manufacturer return a percentage of the device's price if it doesn't meet certain performance goals or fails within a set period of time. Under other agreements, a hospital pays more for a device that fulfills a manufacturer's quality and economic claims. (Lee, 12/6)

Two years ago General Dynamics, one of the biggest federal contractors, reported a quarterly loss of $2 billion. An “eye-watering” result, one analyst called it. Diminishing wars and plunging defense spending had slashed the weapons maker’s revenue and left some subsidiaries worth far less than it had paid for them. But the company was already pushing in a new direction. Soon after Congress passed the landmark Affordable Care Act, the maker of submarines and tanks decided to expand its business related to health care. (Hancock, 12/8).

Is it time to load up on health-care and technology funds? Or is it too late? Health care has delivered the strongest mutual-fund performance of any U.S.-stock sector over the past five years, with a nearly 22% average annual return, according to Morningstar Inc. data. The tech sector’s annual return of 14.5% over that stretch trails that of several other sectors. But in November, tech’s 3.5% return beat health care’s 2.9% and made tech one of the month’s strongest U.S. sectors. Looking ahead, there’s a case to be made for both sectors. (Hodges, 12/7)

Manufacturers are more upbeat about their own companies’ prospects than at any time in almost a decade. Yet about three-quarters of them also feel the country is on the wrong track. The seeming contradiction is found in the latest National Association of Manufacturers/IndustryWeek quarterly survey to be released Monday, a copy of which was obtained by McClatchy in advance. ... The quarterly survey from the manufacturers’ group, conducted Nov. 13-26 and gauging the next four month of business, pointed to rising health care costs and regulatory burdens as major challenges. (Hall, 12/8)

The tax preparation company H&R Block releases its earnings report on Monday. And this year, the company has broadened its services; it will not only help file your taxes, it’s also offering to help you sign up for health care. This is a direct result of the way that taxes and healthcare have become linked by the Affordable Care Act. (Weinberg, 12/8)

A paralegal recently fired by French drugmaker Sanofi has filed a whistleblower lawsuit, claiming she was discharged after protesting an alleged kickback scheme to increase U.S. sales of its insulin medicines. The lawsuit, filed in New Jersey Superior Court in Newark by Diane Ponte, accuses Sanofi SA, recently ousted CEO Christopher Viehbacher and more than 10 other executives of paying consultants millions to induce pharmacists to fill prescriptions for generic insulin with Sanofi’s brand-name versions, rather than those of rival Novo Nordisk A/S. (Johnson, 12/5)

A small Iowa health insurance company says the state's dominant carrier illegally threatened to terminate the contract of a prominent insurance agent if he served on the smaller company's board. The large carrier, Wellmark Blue Cross & Blue Shield, denies wrongdoing. The allegations are contained in a complaint the smaller company, CoOportunity Health, filed last week with the Iowa Insurance Division. CoOportunity accuses Wellmark of "brazenly violating" state laws against anti-competitive behavior. (Leys, 12/7)

When the drug maker Genentech introduced a major product in 2006, it found itself in an awkward position: persuading eye doctors to start using its new more expensive drug instead of a popular cheaper version that the company already sold. (Thomas and Abrams, 12/7)

Videoconferencing doctors from other areas could help solve the problem of hospital closings and doctor shortages that hit heavily rural states, but proponents say states move too slowly in allowing it. This practice of telemedicine has been caught in a conflict between insurers, doctors and officials reluctant to allow physicians who haven't seen a patient in person — and may never follow up — prescribe drugs or treatment. (O'Donnell, 12/7)

The Papas were among the 6.7 million people who gained insurance through the Affordable Care Act last year, flooding a primary care system that is struggling to keep up with demand. A survey this year by The Physicians Foundation found that 81 percent of doctors describe themselves as either over-extended or at full capacity, and 44 percent said they planned to cut back on the number of patients they see, retire, work part-time or close their practice to new patients. At the same time, insurance companies have routinely limited the number of doctors and providers on their plans as a way to cut costs. The result has further restricted some patients' ability to get appointments quickly. (Kennedy, 12/7)

Rank-and-file members of Congress have been advising doctors in their districts to write the leadership begging for another delay of ICD-10 implementation, adding another twist to the political saga of the complex coding system. (Pittman, 12/5)

House and Senate lawmakers are poised to use the final days of the lame-duck session to pass a bill aimed at preventing veteran suicides. With only days left before the 113th Congress wraps up, lawmakers are looking to fast track the Clay Hunt Suicide Prevention for American Veterans Act. The legislation, named after a young Iraq War veteran who committed suicide in 2011, calls for independent evaluations of suicide-prevention programs in the Veterans Affairs and Defense departments. The review would determine which efforts are successful or should be eliminated. (Matishak, 12/6)

Veterans seeking mental health services at the Central Alabama Veterans Health Care System still have among the longest waits in the country, according to federal statistics. New patients seeking mental health care at the systems are waiting an average of 67 days for an appointment, according to Department of Veterans Affairs' data from Oct. 14. There were only three networks where patients experienced higher average wait times. Patients at the VA systems in Martinsburg, West Virginia; Amarillo, Texas; and Spokane, Washington waited between 76 and 88 days on average. U.S. Rep. Martha Roby of Montgomery, who has become one of the sharpest critics of the Alabama system, said she is concerned that the wait times are getting longer, not shorter, according to the federal data. A June audit reported the wait time was 57 days at the Central Alabama system, which was also among the worst in the nation. (Chandler, 12/6)

The state Department of Social Services continued providing Medicaid coverage to thousands of people for more than a year without checking whether they remained eligible, as is federally required, according to a contractor who recently left the department. (Levin Becker, 12/8)

The state Assembly is holding the second of six statewide public hearings on legislation to establish New York Health, a universal single-payer health coverage plan to replace insurance company coverage. Assembly Health Committee Chair Richard Gottfried will take testimony on the bill which would provide comprehensive, universal health coverage for every New Yorker. (12/8)

An effort to add more doctors in rural Iowa through a state-run loan forgiveness program moved forward this year, though backers say they still need more funding. The first group of students was awarded funding through the Rural Iowa Primary Care Loan Repayment Program this year. The eight recipients — four from the University of Iowa and four from Des Moines University — will each get up to $200,000 in loan aid in exchange for working for five years in small-town Iowa. (Lucey, 12/7)

North Carolina lawmakers initially seemed eager last summer to hammer out quickly a solution to stop recurring Medicaid shortfalls by shifting the risks of cost overruns to managed-care organizations or provider networks. Later, Gov. Pat McCrory's administration and House Speaker Thom Tillis hinted it was time to look at possibly expanding Medicaid to more of the working poor through President Barack Obama's health care law. (Robertson, 12/7)

New Mexico's attorney general on Friday sued one of the nation's largest nursing home chains over inadequate resident care, alleging that thin staffing made it numerically impossible to provide good care. The novel approach in the lawsuit filed by outgoing Democratic Attorney General Gary King could be applied in other states if it succeeds. It targets seven nursing homes run by Preferred Care Partners Management Group L.P. of Plano, Texas, a privately held company with operations in at least 10 states: Nevada, Arizona, Colorado, Florida, Iowa, Kansas, Oklahoma, Louisiana, Mississippi and Texas. New Mexico's lawsuit relies on an industrial simulation of how long it takes to complete basic care tasks — for example, 3.5 minutes to reposition a resident in order to prevent bedsores. By calculating the total minutes required to properly care for residents and comparing them to the actual number of hours worked, the state found deficiencies in the total hours worked by nursing assistants of as much as 50 percent. (Horowitz and Montoya, 12/5)

The migration to Colorado by families of sick children seeking medical marijuana is fueled by hope, not science. Little is known about the treatment’s effects, and researchers suggest that some parents see progress because they’re desperate to see it. (Ingold, 12/7)

One doctor said Bettie Tymkovich's staph-infected toe had to go. Another doctor saved it but released her from the hospital with strict rules about care and treatment. She also left with a diabetes diagnosis that required regular insulin shots and an entirely new diet. "I was so terrified about changing the dressing," the 56-year-old Eagle resident said. "Just even looking at it was pretty gross." Kevin Creek came to her rescue. The paramedic arrived at Tymkovich's home every other day. He arranged appointments with a local wound-care specialist. Changed her dressing. Tested her blood sugar. Recommended the right foods. Played with Jackie, her energetic heeler dog. Creek is the face of the pioneering Eagle County Community Paramedic Program, the first of its kind in the U.S. Since it was formed in 2010, the program has spawned more than 250 just like it. The program's third-edition handbook for expanding the role of paramedics as community caregivers has been downloaded five times a day since October 2011, and more than 200 colleges have adopted a national curriculum for training paramedics to do in-home medical services. (Blevins, 12/7)

Sago and 39 other young African American women at Faithful Central Bible Church recently participated in a UCLA-backed clinical trial that used a smartphone app to track their eating and activity and teach them healthful diet and exercise habits. Many such mobile health, or "m-health," programs are in their infancy. But researchers and advocates for underserved, hard-to-reach patient groups hope they soon will contribute to major advances in the treatment of diabetes, heart disease and other chronic conditions. (Brown, 12/5)

In 1996, the term "hospitalist" was coined in an article in the New England Journal of Medicine that described the growing medical specialty of doctors and other healthcare professionals devoted to caring for patients in hospitals. (White, 12/7)

Planned Parenthood on Friday dropped a federal lawsuit challenging a requirement in Kansas for abortion providers to have a link on their websites' home pages to state materials about fetal development and terminating pregnancies. U.S. District Judge Kathryn Vratil issued a one-page order closing the lawsuit, saying the parties had "settled" the claims, without providing details. A trial had been scheduled to begin Monday in Kansas City, Kansas. (Hanna, 12/5)

Workers at a Minnesota psychiatric facility are being hurt on the job more often due in part to a recent state law that has forced the facility to quickly admit more jail inmates. Through November, the first full year since the law requiring that psychiatric hospitals accept mentally ill inmates from county jails took effect, 40 assaults have been reported at the Anoka-Metro Regional Treatment Center, according to state data. That's up from 24 such reports in 2013. To date, the change has ushered nearly 150 possibly violent and volatile inmates into facilities that state officials say aren't equipped to handle them. The result? State legislators unanimously passed the so-called 48-hour rule last year, hoping to stop county jails from being dumping grounds for the mentally ill after a man stabbed himself in the eyes while awaiting psychiatric care in a Hennepin County. The law requires a transfer within 48 hours, often ahead of patients waiting in hospitals -- regardless of the severity of their condition. Hennepin County Sheriff Rick Stanek and other law enforcement officials have defended the law. Stanek said up to 30 percent of inmates in the state's largest jail system suffer from mental health issues. (Potter, 12/6)

There were many times during Khasiem Carr's tumultuous journey through Pennsylvania's mental health and prison systems when it seemed things couldn't get worse. Then, they generally did. After more than a year in solitary, he entered a guilty plea in hope of getting out of the hole and into mental-health care in a state prison. Instead, he would spend four more months in solitary confinement. By the end of that time, he had lost 100 pounds, and was talking about suicide. Khasiem, now 32, known as "KC," was one of more than 1,000 Pennsylvania inmates with mental illnesses kept in isolation for 90 days or more between May 2012 and May 2013. About 250 were in isolation for a year, causing "mental deterioration, psychotic decompensation, and acts of self-harm," according to a U.S. Department of Justice investigation released in February. Many, the department found, were in solitary because of their illnesses. (Melamed, 12/7)

It’s one of the most important economic questions today: Is the snail-like growth of health costs over the last several years a real trend, or is it merely a temporary part of the Great Recession’s aftermath? The data experts who compile the government’s official numbers on health spending lean toward the more pessimistic view. (David Leonhardt, 12/5)

Here’s a dirty little secret about recent attempts to fix ObamaCare. The “reforms,” approved by Senate and House leaders this summer and set to advance in the next Congress, adopt many of the Medicare payment reforms already in the Affordable Care Act. Both favor the consolidation of previously independent doctors into salaried roles inside larger institutions, usually tied to a central hospital, in effect ending independent medical practices. Republicans must embrace a different vision to this forced reorganization of how medicine is practiced in America if they want to offer an alternative to ObamaCare. (Scott Gottlieb, 12/7)

For the apparent crime of wearing a hoodie in public, an 18-year-old black man was approached by a sheriff’s deputy in Stafford County four and a half years ago. A caller had reported that the man, sitting on the grass across the street from an elementary school, might be armed. As it turned out, the suspicion was unfounded; the man, Reginald Latson, who has an IQ of 69, was doing nothing more than waiting for a public library to open its doors. (12/7)

It is unlikely that a majority of Virginia lawmakers will suddenly have an epiphany in the upcoming legislative session and move to expand Medicaid coverage to more low-income, uninsured Virginians. ... Nevertheless, few days pass without an opportunity to reflect on the folly of that resistance, and the harm that such partisan intransigence has on working class people across the commonwealth. (12/8)

Wyoming is negotiating with the Obama administration to draw down federal dollars to provide affordable, private health insurance to its low-income citizens who earn too little to qualify for premium assistance under the Affordable Care Act. ... And it’s not just Wyoming’s Republican Gov. Matt Mead who wants to pull down federal dollars to close its state health insurance coverage gap. The Republican governors in Indiana, Tennessee and Utah are also negotiating with the White House. ... So what about South Carolina’s coverage gap that has swallowed up over 200,000 of our low-income citizens? Over half of these uninsured are working. Nearly 10,000 are veterans. Forty-seven thousand are between the ages of 50 and 64. (Frank Knapp Jr., 12/7)

[W]hen it came to getting the zealots in Florida's House of Representatives to consider health care expansion, only one strategy was ever going to make sense: Playing the fiscal responsibility card. It is the bullet they can't easily dodge. The argument they are powerless to ignore. And that simple reality seems to be the driving force behind a new bipartisan group called A Healthy Florida Works. This statewide coalition recently unveiled a plan to use billions of dollars in federal funds — money our state Legislature has foolishly refused — to help nearly 800,000 low-income residents purchase health insurance. (John Romano, 12/6)

A stolen credit card can be canceled, as Jim Routh, Aetna's chief information security officer, pointed out. Erasing traces of your medical history once it's online, though, is much harder. What's troubling is that despite the volume of sensitive data health-care companies hold, they lack the robust security you might expect. A multitude of companies make up the health-care ecosystem -- providers, payers, pharmaceutical and medical-device makers and diagnostic laboratories -- and they have varying levels of security expertise. (Katie Benner, 12/5)