�鶹Ů��

Republican lawmakers and aides say there is broad enthusiasm for using the process known as reconciliation to try to repeal the 2010 health care law and potentially replace it with a GOP alternative. Another contender, looking less likely now, is using the process for a tax overhaul. (Peterson and Crittenden, 1/30)

The Republican-led House is set to begin February with a vote to repeal Obamacare, making clear that trying to dismantle the health care law remains a top priority. (2/1)

Three powerful committee chairmen — including Rep. Paul Ryan — will lead a working group to develop an alternative to Obamacare, the House Republicans’ most serious attempt thus far to develop their health care reform package, according to GOP sources. (Sherman and Bresnahan, 1/30)

Republican lawmakers are still vowing to repeal Obamacare — but this time they’re banking on the Supreme Court to help them. If the Court rules against the administration in the much-anticipated case of King v. Burwell, some 6 million people would lose their subsidies and far fewer people would be able to buy coverage on the insurance exchanges. This could have enormous implications that could upend the entire law. (Ehley, 2/1)

On March 4, the Court will hear a challenge to a section of the Affordable Care Act concerning the subsidies available to individuals who purchase competitively priced insurance from the American Health Benefit Exchanges. As things stand now, 16 states and the District of Columbia have established their own exchanges, while 34 states have opted to have federally-facilitated Exchanges. At issue: who qualifies for the subsidies? (De Vogue, 2/2)

An obscure Obamacare tax on medical devices has emerged as the Republicans’ best chance of repealing part of the health care law this year. The tax may not be what ordinary Americans who oppose Obamacare focus on — or even know about. (Norman, 2/2)

It flew through the Republican-run House in 2012, and a year later 79 of the Democratic-led Senate's 100 members embraced it. With Republicans now controlling both chambers of Congress, the chances for repealing the 2.3 percent tax on medical devices are better than ever. Yet abolishing the tax won't be easy, even though Republicans rank it a top priority and are backed by Democrats from states that rely on the industry for jobs. (Fram, 1/31)

The saga began in the 1990s, when Paul — now a senator representing Kentucky and a GOP presidential contender — hatched a plan to put his family’s free-market ideals into practice. He wouldn’t submit to the establishment. He would out-compete it by offering doctors an alternative with lower fees and fairer rules. His do-it-yourself medical board lasted more than a decade, becoming one of the most complex organizations Paul ever led on his own. But it didn’t work. Indeed, in a life of successes, it became one of Paul’s biggest flops. (Fahrenthold, 2/1)

Even before the massive budget books landed on lawmakers’ desks, Republicans were on the attack, accusing the president of seeking to revert to tax-and-spend policies that will harm the economy while failing to do anything about the budget’s biggest problem — soaring spending on government benefit programs. Obama’s fiscal blueprint, for the budget year that begins Oct. 1, proposes spending $4 trillion — $3.99 trillion before rounding — and projects revenues of $3.53 trillion. (Crutsinger, 2/2)

President Obama will propose a 10-year budget on Monday that stabilizes the federal deficit but does not seek balance, instead focusing on policies to address income inequality as he adds nearly $6 trillion to the debt. ... Republicans will put forward ideas for controlling the main drivers of the deficit — Social Security and health care programs that are expanding with an aging population — and will propose a budget that does balance. But, [Rep. Paul] Ryan indicated, they are not likely to force a showdown on entitlements. (Weisman, 2/1)

The administration said it “achieves these goals by replacing mindless austerity with smart reforms, paying for all new investments” and seeking new savings. That isn’t likely to appease Republicans, however, who are expected to quickly dismiss Obama’s budget request and start drafting their own blueprint that would seek to eliminate deficits entirely over the next 10 years and tackle the biggest drivers of government spending: Social Security and federal health programs. (Mufson and O'Keefe, 2/2)

The Republican preference is for continued austerity and lower taxes, which will probably be reflected in their own budget plans expected next month. To boost Pentagon spending as defense hawks want, their budgets are expected to slash more deeply into food stamps, healthcare and other safety-net programs. Rep. Tom Price (R-Ga.), the House Budget Committee chairman, promised Sunday on Fox News that a Republican budget would re-imagine Medicare, Medicaid and Social Security, and “will do what the American people have to do with their homes and in their businesses every single day — and that’s not spend more money than what comes in.” (Mascaro and Hennessey, 2/2)

The White House promised to reap savings from health care entitlements and to “support” the Affordable Care Act in a summary of the president’s budget put out before the release of the full document Monday morning. (Kenen, 2/2)

The proposal will include new healthcare initiatives aimed at combating diseases, fighting antibiotic-resistant bacteria and overhauling the payment system for Medicare. The president wants to reverse cuts that were part of the sequestration deal hatched with Republicans and that have defined an era of fiscal austerity in Washington. Obama is expected to propose increasing annual spending by roughly $70 billion, or 7 percent, over the current fiscal year. (Demko, 1/30)

Saying that “the possibilities are boundless,” President Obama on Friday announced a major biomedical research initiative, including plans to collect genetic data on one million Americans so scientists could develop drugs and treatments tailored to the characteristics of individual patients. (Pear, 1/30)

President Barack Obama on Friday laid out an ambitious effort to amass genetic data on one million or more Americans, a plan aimed at discovering genetic causes of disease and finding new drugs that will target dangerous mutations. Speaking at the White House, Mr. Obama called the $215 million Precision Medicine Initiative “one of the biggest opportunities for breakthroughs in medicine that we have ever seen.” (Burton, Rockoff and Winslow, 1/30)

In recent years, targeted therapies have led to more effective treatments for various cancers and other diseases, such as cystic fibrosis. The Food and Drug Administration has approved a growing number of specialized drugs for patients with specific genetic mutations, and the biotech industry has many more drugs in development. The trend has benefited from sharp declines in the cost of genome sequencing. (Dennis, 1/29)

The White House on Friday unveiled a $215 million program to study genes of a million Americans in various stages of sickness and health, with the hope of gaining vast new insight into diseases and how to cure them. (Allen, 1/30)

President Barack Obama is asking Congress for $215 million to pay for what he's calling a Precision Medicine Initiative — a plan to rev up more targeted treatments for people. The hope is to build on gains like those made recently in treating cancer. Scientists know that cancer isn't just a single disease and it's become clear that even specific types of cancer, such as breast cancer, are truly separate diseases with separate causes. The initiative would aim to take these discoveries across medicine. (Fox, 1/30)

The Massachusetts life sciences sector, a world leader in developing gene-based therapies and diagnostics, is ready to capitalize on a new program proposed by President Obama to invest in medical research into treatments tailored to an individual’s genes. (Newsham, 1/30)

When Indiana became the latest state to expand its Medicaid program, the reaction across the health advocacy community was decidedly mixed. While the decision represented yet another step toward a goal of expanding government-funded health insurance to millions of lower-income Americans, it came at a price — one some advocates say may be too expensive to pay. (Shapiro, 2/2)

Advocates continue to push for the expansion of Medicaid to include Missourians who fall in the so-called “coverage gap.” State legislators have made it clear that expansion is unlikely to happen this year either. But Medicaid advocate Richard von Glahn remains optimistic. (Phillips, 2/1)

Lawmakers convene a special session Monday to take up Republican Gov. Bill Haslam's proposal to extend health coverage to 280,000 low-income Tennesseans. The proposal is simple, but the politics are not. Haslam's plan is a two-year pilot project called Insure Tennessee. The deal calls on state hospitals to pay the $74 million state share to draw down $2.8 billion dollars in federal Medicaid money to offer coverage to uninsured Tennesseans. (Schelzig, 2/2)

As Iowa's modified Medicaid expansion hits the one-year anniversary mark, some enrollees will be asked to pay small monthly premiums because they have not yet completed a required physical exam and health questionnaire. For Gov. Terry Branstad, setting these health requirements was a key provision for expanding Medicaid in Iowa using funding from President Barack Obama's health care overhaul. The state received federal approval to make modifications to the traditional Medicaid terms, including setting health requirements and charging contributions. (Lucey, 2/1)

The much-anticipated debate over whether to continue Gov. John Kasich’s expansion of Medicaid through the next two-year state budget might be over before it starts. Kasich’s proposed two-year spending plan, to be unveiled today, won’t seek to reauthorize expanded eligibility guidelines that took effect last year and added 450,000 poor adults to the tax-funded health-care rolls. That doesn’t mean the governor no longer supports Medicaid expansion; he does, and he also wants to make changes to the program to save money and promote personal responsibility. But administration sources say they don’t believe lawmakers must reauthorize expansion because it is already in state law and remains so unless it is revoked. (Candisky, 2/2)

As Indiana won federal approval to move ahead with its version of Medicaid expansion, other Republican-governed states are lining up with their sketchbooks in hand. (Winfield Cunningham, 2/1)

DFL state Sen. Tony Lourey stood next to Gov. Mark Dayton two years ago as he signed legislation creating MNsure. Now, Lourey's ready to remake the health exchange's structure. ... after a troubled 16 months operating, Lourey wants more accountability. His bill would dissolve MNsure's board, put a commissioner in charge and have it run like other executive branch departments. (Richert, 2/1)

Connecticut’s health insurance exchange has delayed mailing 3,600 customers the forms they will need to file their tax returns, and might not get them out until the end of next month. (Levin Becker, 1/30)

Oregonians have just two weeks left to sign up for health insurance as required under federal law or face a potential fine at tax time next year. (Budnick, 2/1)

When Florida workers promoting President Barack Obama’s health law marketplace want instant feedback, they go to an online “heat map.” The map turns darker green where they’ve seen the most people and shows bright red dots for areas where enrollment is high. “The map shows us where the holes are” and what communities need to be targeted next, said Lynn Thorp, regional director of the Health Planning Council of Southwest Florida. She hands out information about the health law’s marketplace at rodeos, farmers markets, hockey games —almost any place where people gather. (Galewitz, 2/2)

Alma Ramos, a soft-spoken prep cook at a Tex-Mex restaurant, was eager to sign up for health insurance through the new healthcare.gov marketplace last year. But Ms. Ramos, a single mother of three, quickly hit a baffling hurdle. Because of a wrinkle in the Affordable Care Act, Ms. Ramos made too little money to receive federal aid for buying private insurance — and too much to qualify for Medicaid, the government health care program for the poor. But she found a solution. (Goodnough, 2/1)

Obama administration officials and other supporters of the Affordable Care Act say they worry that the tax-filing season will generate new anger as uninsured consumers learn that they must pay tax penalties and as many people struggle with complex forms needed to justify tax credits they received in 2014 to pay for health insurance. The White House has already granted some exemptions and is considering more to avoid a political firestorm. (Pear, 1/30)

The Obama administration on Friday proposed a plan to move most doctors, hospitals and their patients to national standards for handling electronic clinical data by the end of 2017. The U.S. Department of Health and Human Services (HHS), as part of an effort to propel the $2.9 trillion U.S. health care system away from a costly fee-for-service system, released a report draft aimed at establishing an interoperable health information technology system that can be accessed by patients and their health care providers. (1/30)

Companies including Google, Twitter, Yahoo and Advertising.com automatically obtain information from people visiting HealthCare.gov, according to analysis by congressional staffers. The finding builds on news last week that dozens of data-tracking companies were able to obtain information about people visiting the federal healthcare website, potentially including information about their age, location and pregnancy status. (Hattem, 1/30)

The battle to halt the spread of the measles outbreak that began at Disneyland has required both infectious disease expertise and a good amount of old-fashioned detective work. Health officials in California and seven other states have painstakingly traced the steps of measles patients, tried to identify anyone who came in contact with them, and quarantined those at greatest risk of getting the highly contagious disease to keep the virus from spreading. (Xia, Lin II and Muskal, 1/30)

California is grappling with an outbreak of measles. In Alameda County, health officials have told parents whose babies have been exposed to the virus to keep their children at home for 21 days. (Neighmond, 2/2)

Their children have been sent home from school. Their families are barred from birthday parties and neighborhood play dates. Online, people call them negligent and criminal. And as officials in 14 states grapple to contain a spreading measles outbreak that began near here at Disneyland, the parents at the heart of America’s anti-vaccine movement are being blamed for incubating an otherwise preventable public-health crisis. Measles anxiety rippled thousands of miles beyond its center on Friday as officials scrambled to try to contain a wider spread of the highly contagious disease — which America declared vanquished 15 years ago, before a statistically significant number of parents started refusing to vaccinate their children. (Healy and Paulson, 1/30)

Ending a monthlong standoff that rattled 284,000 health care consumers, Blue Shield of California and Sutter Health on Friday announced they had reached an agreement for a new two-year contract that will allow the insurer's patients to continue to use Sutter doctors and hospitals. (Seipel, 1/30)

Health insurance provider Blue Shield of California and the Sutter Health network of doctors and hospitals have reached agreement on a new contract, ending a dispute that threatened to force nearly 280,000 consumers in Northern and Central California to find new doctors. The companies announced the two-year contract on Friday. It means Blue Shield patients will be able to continue using Sutter doctors and hospitals without going out of their coverage network. (1/31)

Workers at Hawaii's largest health care organization started a six-day strike early Monday, union spokeswoman Paola Rodelas said. Licensed practical nurses, medical assistants and housekeepers were among those joining the work stoppage at Kaiser Permanente. The strike will last through Saturday. (2/2)

Hospitals that refuse to treat severely intoxicated patients and instead have them arrested would face steep fines of up to $300,000 per incident under a controversial bill unveiled Friday. (Calefati, 1/30)

Buried in debt, Centinela hospital of Inglewood was on the verge of bankruptcy in 2007. It had lost $50 million in four years, and local officials worried that it might close — following the path of several other South Los Angeles hospitals. But where others saw risk, cardiologist Prem Reddy saw opportunity. Reddy's company, Prime Healthcare Services Inc., bought Centinela and quickly turned it around, cutting expenses and increasing revenue. Centinela lost $63 million in 2007. Six years later, it made $39 million. Today it's rated among the better-performing hospitals in the state. (Pfeifer, 2/1)

California's ambitious effort to save billions of dollars by changing how the state's costliest patients get treated is on the ropes. The Obamacare program was designed to reduce medical costs by putting more of the nation's 11 million most challenging and expensive patients into tightly managed care. But the rollout in California — one of the first states spearheading the effort — has been marred by widespread confusion, enrollment glitches and a revolving door of health officials. (Terhune, 1/31)

Under health care reform, Medicare bonuses are going to hospitals that are getting things right, at least from the federal governments perspective. Medicare data shows 1,700 hospitals, more than half graded, will reap extra payment in 2015. In Colorado, where 44 hospitals participated in the program, 57 percent received bonuses, or increased Medicare payments in 2015, while 43 percent will have penalties, or reduced payments. None broke even. (Draper, 1/30)

State administrators are wrong when they say many patients at the state psychiatric hospital here could obtain similar services from private agencies in southern Iowa communities, mental-health professionals and patients alleged Saturday. Department of Human Services Director Charles Palmer told the crowd that new mental health treatment options are being considered as part of the statewide redesign of the overall system. He explained that new regional authorities, including the one that covers the Clarinda area, are considering opening short-term "crisis centers" or "step-down units." (Leys, 1/31)

Groups representing nurses and doctors met several times over the summer and fall but couldn’t reach a compromise on legislation to allow nurses with advanced training to practice on their own. The failed negotiations threw the dispute back into the laps of Kansas lawmakers, who don’t appear eager to settle it. (McLean, 1/30)

Bob Jeske grew up on a farm and always wanted to practice rural medicine. But it didn't hurt that a state program covered some of his student loans to do just that. State lawmakers in both parties want to expand the program that takes a big chunk out of Jeske's $182,500 in medical school debt. Their plan is one of many approaches to solving a looming shortage of doctors and other health care professionals expected to hit hardest in rural Minnesota. (Farhang, 2/2)

A bipartisan proposal would seek $5 million of state funds to continue giving intrauterine contraceptive devices to teenagers, a program state officials say has dramatically reduced the teen birth rate. The proposed bill is one of two legislative measures aimed at preventing teen pregnancies in Colorado. The other, already introduced, would expand a pilot education program. (Draper, 1/30)

[Alison] Hymes was no ordinary patient. Before landing at Western, she spent years urging others with mental illness and their families not to let doctors, judges and social workers make decisions for them. She was part of a state task force charged with reforming civil commitment laws at the time of the 2007 Virginia Tech massacre, serving alongside doctors, academics, and law enforcement officials. The daughter of a prominent University of Virginia linguist, Hymes argued vehemently — and unsuccessfully — against loosening the state’s commitment criteria. Hymes, now 58, believed those changes made it easier for authorities to involuntarily commit her in 2011 and again in 2013. (Shin, 1/31)

Reporting for Kaiser Health News, Barbara Feder Ostrov writes: "California spends less per person than any state on diabetes prevention programs, even as one in 12 California adults is estimated to suffer from the chronic disease, according to a new report from the California State Auditor. Using only federal grants, California spent just 3 cents per person on diabetes prevention in the 2012-2013 fiscal year, compared to New York’s 42 cents per person in state and federal money that year, the report noted." (Ostrov, 2/2)

Like many retirees, one couple from upstate New York visit doctors in their winter getaway in Florida. But on a recent routine checkup of a pacemaker, a cardiologist there insisted on scheduling several expensive tests even though the 91-year-old husband had no symptoms. ... The couple’s experience reflects a trend that has prompted some doctors up north to warn their older patients before they depart for Florida and other winter getaways to check in before agreeing to undergo exams and procedures. And some patients have learned to be leery after being subjected to tests — and expenses — that long-trusted physicians at home never suggested. (Rosenthal, 1/31)

It used to be that unvaccinated children in America were clustered in impoverished neighborhoods; now they’re often clustered among sophisticates in gilded ZIP codes where a certain strain of health faddishness reigns. According to a story in The Hollywood Reporter last year, the parents of 57 percent of the children at a Beverly Hills preschool and of 68 percent at one in Santa Monica had filed personal-belief exemptions from having their kids vaccinated. Why? Many of them buy into a discredited theory that there’s a link between the MMR (mumps-measles-rubella) vaccine and autism. (Frank Bruni, 1/31)

Is measles “benign”? The Centers for Disease Control and Prevention says measles “can lead to severe complications and death” and “even patients who experience uncomplicated acute measles have a small risk for developing a devastating neurologic illness . . . years after their infection.” Measles is common elsewhere in the world, with about 20 million cases reported each year and 122,000 deaths. Before vaccination began in 1963, about 3 million to 4 million people got the disease each year in the United States, of whom 400 to 500 died, 48,000 were hospitalized and 4,000 developed brain swelling. That does not fit our definition of benign. (1/31)

There is a secret that people outside of Washington, D.C., aren’t aware of right now: Some Republicans in Congress are on the verge of proposing an alternative to Obamacare that imposes new tax hikes on the American people. ... The reality is that while Beltway insiders in the elite salons of Washington can do and say whatever they want, the American people know better. A majority of voters — and even larger majorities of conservative and Republican voters — believe that “any replacement of Obamacare must repeal all of the Obamacare taxes and not just replace them with other taxes.” In other words, the voters won’t be fooled by quasi-liberal health plans masquerading in conservative clothing. (La. Gov. Bobby Jindal, 2/1)

Regulators in several states have raised concerns that these ministries offer the illusion of insurance while sidestepping the Affordable Care Act’s baseline standards of coverage and skirting requirements that apply to conventional insurance companies, like minimum cash reserves. Nonetheless, membership in the ministries has been growing, particularly since the act granted them an exemption as one of the only ways to avoid the law’s mandate to buy insurance without paying a fine. But the debate over consumer protections may disguise a more interesting question: Could this model scale up? These ministries seem to achieve a remarkable level of member satisfaction, even if they sometimes must portion out reimbursements when the bills outstrip monthly contributions. (Molly Worthen, 1/31)

The personalized medicine initiative that President Barack Obama announced on Friday was previewed in the State of the Union address and is scheduled for inclusion in the budget to be released Monday. But in devoting federal funds to this, the administration may have made an argument against another type of medical research funded as part of Obamacare. (Chris Jacobs, 2/1)

Gov. Bill Haslam ... announced right before Christmas that he had a verbal commitment from the Obama administration to expand Medicaid subject to some changes. But Mr. Haslam’s announcement was only the first step. Thanks to a law passed last year, Tennessee lawmakers must sign off on any expansion of Medicaid. ... Tennessee lawmakers must decide if they are going to burden more state residents—and American taxpayers—with ObamaCare’s broken promises, failed schemes and unsustainable policies, or whether their state will lead the march toward more freedom, greater access, and better health outcomes. With several other red states including Utah, Wyoming and Montana waiting in the wings on Medicaid expansion, what Tennessee does next week could have implications far beyond the state’s borders. (Christie Herrera and Justin Owen, 1/30)

The Montana Legislature has the opportunity to do more good for our state at less cost than will be available for decades. All we need to do is accept funds to which our citizens are entitled through Medicaid expansion to establish a Montana-based privately run health insurance program. As a 30-year investment professional, I find the business and financial benefits of expansion to be remarkable. Much attention has been focused on the 70,000 Montanans who would be provided healthcare coverage. Largely overlooked in the discussion is the fact that all Montanans will benefit through a stronger economy, substantial job creation, a more secure healthcare system, and a reduction in the costs we all pay to care for the uninsured. (Mark Semmens, 2/1)

The Pentagon budget is $496 billion, which sounds like a lot of money, and it is — until you take account of the fact that an increasing share goes not for weapons, training and readiness but for health care and pension benefits of former service members. ... Now comes the Military Compensation and Retirement Modernization Commission, a blue-ribbon panel established by Congress in 2013, with the latest package of proposed reforms. The panel has clearly done its homework, as demonstrated by the sheer mass of its 302-page report. In one respect, however, its work disappoints: The panel recommends no change to the so-called Tricare for Life program, essentially a free Medigap plan for military retirees age 65 and older that the CBO has repeatedly identified as a major cost center — and which is all but untouchable politically. ... More encouraging was the commission’s proposal to revamp the versions of Tricare that apply to the families of active-duty personnel and working-age retirees. (1/30)

An enduring injustice was supposed to end on Jan. 1. That was the effective date for new rules by the Labor Department that would have required employers of home care aides for the elderly and disabled to pay at least the federal minimum wage and time and a half for overtime. Specifically, the new rules would have ended a federal regulation from 1974 that labeled home care aides “companions,” a designation that lets their employers — generally, for-profit agencies — ignore basic labor protections. (1/31)

Representatives from the United States and 11 other Pacific Rim countries convened to decide the future of their trade relations in the so-called Trans-Pacific Partnership (T.P.P.). Powerful companies appear to have been given influence over the proceedings, even as full access is withheld from many government officials from the partnership countries. Among the topics negotiators have considered are some of the most contentious T.P.P. provisions — those relating to intellectual property rights. And we’re not talking just about music downloads and pirated DVDs. These rules could help big pharmaceutical companies maintain or increase their monopoly profits on brand-name drugs. (Joseph E. Stiglitz, 1/30)

Michael was receiving state-of-the-art treatments at a renowned cancer center in New York City. As he became sicker, the treatments got more intense. Each decision came with more difficult trade-offs and uncertainties. Each step to stay alive risked making things worse. He knew it. We’d talked openly about it. His life was precious and worth fighting for, so every option was worth carefully considering. But modern medicine has yet to make even one person immortal. Therefore, at some point, more treatment does not equal better care. (Ira Byock, 1/31)

Think about it: Faced with mass unemployment and the enormous waste it entails, for years the Beltway elite devoted almost all their energy not to promoting recovery, but to Bowles-Simpsonism — to devising “grand bargains” that would address the supposedly urgent problem of how we’ll pay for Social Security and Medicare a couple of decades from now. (Paul Krugman, 2/2)

Donald Hall, 86, a former poet laureate, probably captured the general mood when he wrote that nursing homes are “old-folks storage bins” and “for-profit-making expiration dormitories.” He wants to die in his farmhouse in New Hampshire. But I think that sounds pretty lonely. I wouldn’t mind going into a nursing home and not coming out. In due time, thank you. I’m 64. (Bert Stratton, 2/2)