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On the one hand, Republicans in Congress are urging the Supreme Court to strike down subsidies for health insurance provided to millions of people in more than 30 states. On the other, they are chiding the Obama administration because it has no plan to avert the hardship that could occur if they win in court. The Republicans now have realized that a court decision in their favor poses political risks to members of their party, who are frantically trying to come up with alternatives to the Affordable Care Act and a strategy to respond to such a ruling. (Pear, 2/7)

A key group of Republican leaders this week unveiled the latest attempt at an Obamacare replacement in a 9-page summary detailing what looks like a more compressed version of the current health care law. It’s an updated version of a proposal a small group of Republicans created a year ago. (Ehley, 2/8)

Congressional Republican leaders are hoping to rally their colleagues behind a new repeal-and-replace package for Obamacare. The impetus is the King v. Burwell case pending before the U.S. Supreme Court that could strike down premium subsidies for millions of Americans in states that haven't established their own exchanges. ... Republican leaders and conservative pundits have said they needed to offer a credible plan to convince the Supreme Court justices that they don't have to worry about creating chaos in the healthcare market if they strike down the subsidies. (Demko, 2/6)

When the House GOP made its latest attempt to repeal Obamacare this week, dozens of groups, from Americans for Tax Reform to the National Association of Manufacturers, cheered the move. But one organization was missing from the list of groups that had supported the bill: the Chamber of Commerce. (Ferris, 2/6)

That is in large part because some spending bills have become political lightning rods, particularly those involved with the Affordable Care Act or the Dodd-Frank financial overhaul. Republicans have also sought to use spending bills to push back against White House policy, including Homeland Security funding, slated to expire on Feb. 27. Republicans are seeking to use an extension of that funding to block implementation of the president’s executive action on immigration. ... Meanwhile, Republicans will have to address a rolling series of other funding deadlines this year, including stopgap measures on Medicare, the highway trust fund and children’s health insurance. (Timiraos and Peterson, 2/8)

Supporters of a state-federal program providing health coverage for children of the working poor have their fingers crossed that Congress will keep it alive. Funding for the Children’s Health Insurance Program expires in the fall. (Garrett, 2/7)

The lead plaintiff in the Supreme Court battle over the health law’s insurance tax credits appears to qualify for veterans’ medical coverage, raising questions about his ability to challenge the law. ... Standing issues with these three plaintiffs don’t jeopardize the case, legal experts say, because only one plaintiff needs standing for the suit to proceed before the court. Instead, they could create skepticism about the strength of the challengers’ case and highlight the difficulty of finding plaintiffs to show the health law’s subsidies harm Americans, these experts say. (Radnofsky, Bravin and Kendall, 2/6)

The attorneys challenging Obamacare’s tax subsidies say that the lead plaintiff’s potential eligibility for veterans health coverage won’t derail their lawsuit in the Supreme Court. ... The Competitive Enterprise Institute, which is coordinating and funding the lawsuit, says that the veteran’s status is a non-issue. And even if it were, there are other plaintiffs in King V. Burwell whose standing — the legal term for the right to bring a lawsuit — is not contested. (Haberkorn, 2/7)

Thousands of more friendly and better-trained call-center employees will be working starting Monday to deal with the expected late onslaught of people signing up before the Obamacare open enrollment ends Feb. 15. A 40 percent increase, to a 14,000-person workforce, is expected to help with wait times, which averaged about 2 1/2 minutes the last week of January, but are likely to get longer as the deadline nears. People who aren't covered by employer-provided insurance and don't sign up by the deadline won't be eligible for insurance this year and will face increasing penalties at tax time. (O'Donnell, 2/8)

Many people expected this year’s three-month enrollment period to be more challenging than last year’s six-month sign-up blitz, which included enrollment fairs across the state, widespread publicity about the health law’s rollout and millions of dollars in federal funds that helped pay more than 200 people from community organizations to conduct outreach. This enrollment period came with the added complication of trying to renew existing customers while appealing to those who were still uninsured – and with no federal dollars for outreach. (Levin Becker, 2/9)

Norma and Rodolfo Santaolalla have always worked but have never had health insurance. When the Arlington, Va., couple tried to apply online for coverage under the health care law, it was just too confusing. "I didn’t understand about the deductibles and how to choose a plan. It’s difficult. It’s the first time we’ve done that," said Norma, 46, who cleans houses for a living. Rodolfo, 47, is a handyman. "That’s why we came here, to ask them to help us.” (Carey, 2/9)

It's not unusual for churches, community centers, even shopping malls to sponsor Affordable Care Act enrollment events. But an ACA sign-up at 11 a.m. at a Fishtown hipster bar known for its indie rock shows? (Calandra, 2/8)

Health advocates across the state have begun the final push to enroll citizens in insurance plans under health care reform, enticing them with a star Orioles player, extended hours and late-night breakfast at Denny's. The Feb. 15 deadline to enroll is less than a week away, but those involved report that this year has been much smoother than last year, when technical problems plagued the state exchange, the website where people who do not get insurance through an employer or Medicare shop for plans. (McDaniels, 2/8)

Whereas 18 to 34 year olds accounted for 24.3 percent of MNsure enrollees last year, they accounted by late January for only 21.3 percent of the private insurance total during the current open enrollment period. MNsure officials say they aren’t worried. Younger adults were late to buying coverage last year, too, so the exchange expects a last-minute surge as the Feb. 15 deadline for people to enroll in private plans through MNsure draws near. (Snowbeck, 2/8)

Connect for Health Colorado's leaders say they need an additional $2.8 million to operate the health insurance exchange's call centers, as problems with the online enrollment system drive up call volume. The requested budget for the two call center sites is now $17.7 million. Board members deferred a decision on the request Thursday. (Draper, 2/6)

Proposals to expand Medicaid in Wyoming are effectively dead after senators voted down Senate File 129 and a House committee pulled its expansion plan from consideration Friday. The Senate voted 19-11 against expanding health care coverage to more than 17,600 uninsured Wyomingites. Proposals to expand were met on the Senate floor with stiff opposition to federal health care policy. (Graff and Hancock, 2/6)

The Wyoming Senate on Friday rejected a bill that would have supported the state's expansion of the Medicaid program for the poor under President Barack Obama's healthcare reform law, effectively shutting the door for the remainder of year. (2/6)

In December, Tennessee Gov. Bill Haslam, a Republican, got the deal he wanted from the Obama administration: Tennessee would accept more than $1 billion in federal funding to expand Medicaid, as allowed for in the Affordable Care Act, but Obama aides would allow Haslam to essentially write staunchly conservative ideas into the program's rules for the state. He dubbed the reformed Medicaid program "Insure Tennessee." But the state's chapter of Americans for Prosperity, the national conservative group whose foundation is chaired by controversial billionaire David Koch, argued Haslam was just trying to trick conservatives into implementing Obamacare in their state by giving it a new name. AFP campaigned aggressively Haslam's plans for the next six weeks, even running radio ads blasting GOP state legislators who said they might vote for it. (Bacon Jr, 2/6)

On one side of the debate was Zach Lahn, the man who managed Republican Sen. Steve Daines’ 2012 congressional campaign and later served as his state director. Lahn is now the director of the Montana chapter of the Americans for Prosperity, the group that hosted Monday’s meeting and two others like it across the state last week. ... Lahn organized the town hall events last week in Dillon, Roundup and Kalispell, the hometowns of three Republican lawmakers who refused to sign AFP pledge cards vowing to oppose any expansion Medicaid expansion plan, which AFP says is an expansion of Obamacare. (Adams, 2/8)

One year into the explosive, health law-induced growth of Medi-Cal, it appears one of the most alarming predictions of critics is coming true: The supply of doctors hasn't kept up with demand. One recent study suggests the number of primary care doctors in California per Medi-Cal patient is woefully below federal guidelines. (Seipel, 2/7)

The Affordable Care Act has ushered in an era of complex new health insurance products featuring legions of out-of-pocket coinsurance fees, high deductibles and narrow provider networks. Though commercial insurers had already begun to shift toward such policies, the health care law gave them added legitimacy and has vastly accelerated the trend, experts say. The theory behind the policies is that patients should bear more financial risk so they will be more conscious and cautious about health care spending. But some experts say the new policies have also left many Americans scrambling to track expenses from a multitude of sources. (Rosenthal, 2/7)

One of the biggest targets of health reform was the uninsured "super-user" who sought out care for everything and anything under the bright lights of America's chaotic emergency rooms. But emergency rooms at Detroit's two largest hospital systems, as well as emergency rooms at several other hospitals, are as busy — or even busier — than they've been in recent years, according to hospital officials. (Erb, 2/7)

Small businesses (50 or fewer employees) who voluntarily offer health insurance to their employees face no deadline for signing up through the federal government's online portal. But Healthcare.gov's small-business offering in Michigan, called the Small Business Health Options Program (SHOP), will lack full functionality for at least one more year. That's why most businesses in this category have been skipping this one-stop-shop and instead working through their regular agent or broker to obtain coverage. (Reindl, 2/7)

Some of the nation's most prominent healthcare groups are telling the Obama administration that its proposals to soften the financial risk involved in Medicare accountable care contracts won't be enough to make sure U.S. hospitals and doctors keep signing up. The central concession would be to give participants more time in the program before they have to accept the risk of penalties along with the opportunity to earn bonuses based on the quality and efficiency of the care they provide. (Evans, 2/8)

When the Affordable Care Act was launched a little over a year ago, there was some confusion about how the law would apply to U.S. territories like Puerto Rico, which is part of the U.S. but isn't a state. In July, the federal Department of Health and Human Services declared that U.S. territories aren't required to follow most of the rules of the ACA. That means four of the five U.S. territories — Guam, American Samoa, Northern Marianas, and U.S. Virgin Islands — have essentially been untouched by the bill. But Puerto Rico's government passed its own series of bills, adopting the ACA rules. (Kelto, 2/7)

North Carolina’s elected officials have steadfastly shunned the Affordable Care Act by refusing to create a state health insurance exchange and by blocking expansion of the Medicaid program for the poor. But this month the N.C. Department of Health and Human Services endorsed the federal health care law, albeit in a small way: North Carolina is paying for drug coverage for HIV-positive residents who have purchased health coverage through the federal insurance exchange. (Murawski, 2/7)

The first lawsuits in the Anthem hack, the nation's largest health care breach to date, have been filed. At least four have been launched so far, in Indiana, California, Alabama and Georgia. The suits allege that Anthem did not take adequate and reasonable measures to ensure its data systems were protected and that the 80 million Anthem customers whose information may have been affected could be harmed. (Weise, 2/8)

Insurance regulators will launch a national investigation into the recent data breach at Anthem Inc., adding a new layer of scrutiny for the company as it contends with the fallout from a hacker incursion that the company said likely exposed personal information of tens of millions of consumers. The National Association of Insurance Commissioners, a group representing state regulators, announced the probe Friday. In a statement, the president of the group, Monica Lindeen, said its members agreed “that an immediate and comprehensive review of the company’s security must be a priority to ensure protection of consumers who are covered by Anthem.” (Wilde Mathews, 2/6)

After an online attack on Anthem, by far the largest breach in the industry, security experts warned on Friday that more attacks on health care organizations were likely because of the high value of the data on the black market. ... Medical identity theft has become a booming business, according to security experts, who warn that other health care companies are likely to be targeted as a result of the hackers’ success in penetrating Anthem’s computer systems. Hackers often try one company to test their methods before moving on to others, and criminals are becoming increasingly creative in their use of medical information, experts say. (Abelson and Creswell, 2/6)

The hackers who stole millions of health insurance records from Anthem Inc. commandeered the credentials of five different employees while seeking to penetrate the company's computer network — and they may have been inside the system since December. (Bailey, 2/7)

Insurers aren't required to encrypt consumers' data under a 1990s federal law that remains the foundation for health care privacy in the Internet age — an omission that seems striking in light of the major cyberattack against Anthem. Encryption uses mathematical formulas to scramble data, converting sensitive details coveted by intruders into gibberish. Anthem, the second-largest U.S. health insurer, has said the data stolen from a company database that stored information on 80 million people was not encrypted. (Alonso-Zaldivar, 2/7)

After one of the biggest thefts of medical-related customer data in U.S. history, Anthem Inc. warned consumers Friday against email and phone scams seeking to take advantage of the breach. The Indianapolis-based health insurer says “phishing” scams are targeting Anthem customers to get personal information using the breach as a pretense. The company also said consumers should be aware of phone calls about the cyber attack that ask people for credit card or Social Security numbers. (Shapiro, 2/6)

Several large-scale cyberattacks in recent months have prompted a number of lawmakers and policy makers to call for a more forceful response, including suggestions that the U.S. engage in counterattacks that would disable or limit the culprits’ own networks. ... Noteworthy cyberattacks in recent months have forced policy makers to rethink their approach. Late last year, the White House alleged that North Korea stole large amounts of data from Sony Pictures Entertainment Inc. Also, the recent theft of personal information from tens of millions of Anthem Inc. ’s health-insurance customers may have originated in China, the company has suggested, though law-enforcement officials continue to investigate the breach. (Paletta and Nissenbaum, 2/8)

Students at the University of California’s 10 campuses will be required to be screened for tuberculosis and to be vaccinated for measles, mumps, rubella and other diseases under a new health plan set to take effect in 2017, the university said Friday. Announcement of the policy change, which goes beyond the hepatitis B shots required of all 233,000 UC students, comes amid measles outbreaks that have infected more than 100 people in California and more than a dozen more in 19 other U.S. states and Mexico since December. (Gorman, 2/7)

All UC students will have to be vaccinated against measles, meningitis, whooping cough and several other diseases or they will not be allowed to register for classes in fall 2017, university officials announced Friday. Those shots will be in addition to the current systemwide requirement for the hepatitis B vaccine. (Gordon, 2/6)

A leading autism advocacy organization, Autism Speaks, is urging parents to vaccinate their children amid a measles outbreak that has swept 14 states. As some continue to cite unfounded fears that vaccinations can lead to autism, Autism Speaks chief science officer Rob Ring has released a statement saying vaccinations cannot cause the disorder — and telling parents to vaccinate their children. (Bever, 2/9)

A national day care provider says that as of next week it will require measles vaccinations for all staff members who work with children less than 15 months old, after health officials in Illinois announced measles diagnoses in five infants who attended a suburban Chicago center. KinderCare Learning Centers, which has 1,500 locations nationwide, noted the requirement in a letter to parents posted on its website and dated Thursday, the same day the Illinois cases were announced. (2/6)

When large segments of a population are immunized against measles, it reduces the risk of exposure for everyone in the community, including families who refuse vaccines. The concept is called herd immunity. But when too many healthy people forgo vaccinations—as they have in pockets of California and other states—the whole herd becomes more vulnerable, not just those who skipped shots. Without vaccines, measles and other infectious diseases can proliferate, and people who were previously protected may become imperiled. (McGinty, 2/6)

As a medical doctor, Kentucky Sen. Rand Paul has a rare set of credentials at the intersection of science and politics. But the glare of the 2016 presidential race is searing, and under it, Paul had a rough week. ... Paul said Monday that he had heard about "many tragic cases" of children who got vaccines and ended up with "profound mental disorders." That assertion has no basis in medical research, and Paul clearly was still upset on Friday about how his comments had been received. "It may be a little because I'm a doctor, but really I think it's inaccuracies" fueled by reporters, he told The Associated Press. "From my point of view, that's frustrating." (Beaumont and Kellman, 2/7)

The president’s proposal to cut funding for the federal immunization program came into focus amid the measles outbreak and vaccine controversy. ... The president’s budget proposal for fiscal year 2016 proposes a $50 million cut, or 8 percent, from $611 million. Given President Obama’s push for all parents to vaccinate their children, [White House press secretary Josh] Earnest was asked, why would he cut the federal immunization program? Is Earnest correct that the Affordable Care Act “guarantees” every American has access to free preventive care, including vaccines? Does the Affordable Care Act decrease the need for funding for the 317 program? (Lee, 2/9)

The Internet rumors that claim vaccinations mean having tiny pieces of aborted fetuses injected into your body are flat-out wrong, yet there is a grain of truth in the assertion that vaccinations and abortions are linked. Many of the most common vaccines, for rubella and chicken pox for example, are grown in and then removed from cells descended from the cells of aborted fetuses. Pregnant women aborted them about 40 years ago by choice, and not with the intent of aiding vaccine production. Yet for some religious believers, those facts do not lift what they see as a moral prohibition against vaccination. (Markoe, 2/4)

Carla Muss-Jacobs didn’t give much thought to the tools her surgeon would use to replace her knee. Like most patients, she just wanted to feel better and trusted that any devices in the operating room would be safe. In her case, the surgeon sliced open her leg and positioned special cutting guides, like carpentry jigs, over her thigh and shin bones to line up his bone saw precisely. The device, called the OtisKnee, was supposed to speed the surgery and the recovery. ... As it turned out, the OtisMed Corporation, the maker of the OtisKnee, did not seek clearance from the Food and Drug Administration for its OtisKnee guides before it started selling them. When the company did apply for F.D.A. review, its application was rejected because, the agency said, the company failed to show that the product was safe and effective. (Allen and Pierce, 2/6)

Rewards like gift cards, a preferred parking spot or a certificate of recognition aren’t working. Enrollment in wellness or healthy rewards programs hovers around 20 percent. So more and more insurers and employers are turning to cash — albeit modest amounts so far, like Smith’s $20. (Bebinger, 2/9)

Wisconsin's older residents say Gov. Scott Walker's proposal to cut funding for the SeniorCare drug program could leave them struggling to make ends meet. The proposal would require SeniorCare enrollees to first sign up for Medicare Part D prescription drug program and use state benefits under SeniorCare as a supplement. The cut could save the state $15 million over the next two years. (Ferguson, 2/8)

Colorado lawmakers rejected a proposal to give dying patients the option to seek doctors' help ending their lives, concluding a long day of emotional testimony from more than 100 people. For one lawmaker who voted no, the issue was personal. Tearfully telling her colleagues she was a cancer survivor, Democratic Rep. Dianne Primavera recalled how a doctor told her she wouldn't live more than five years. (2/7)

An Omaha legislator is proposing that Nebraska join 28 other states in making birth control available to more women by expanding access through Medicaid, but so far his idea has met some skepticism. A bill introduced by Sen. Jeremy Nordquist would widen eligibility for family planning services, including contraceptives, to people with family incomes at or below 185 percent of the poverty level. Separately, the bill would spend $1 million over the next two years to expand a federally backed program called Every Woman Matters, which funds breast and cervical cancer screening for women ages 40 to 64. (Gronewold, 2/8)

The Kentucky Court of Appeals says a company that once managed 125,000 Medicaid recipients must pay the state damages for leaving the contract early. Kentucky Spirit was one of three companies that initially handled the state's Medicaid claims when it switched to a managed care model in 2011. But the company decided to terminate the contract after one year. State health officials said the company could not leave before three years without paying a significant penalty. (2/6)

House and Senate budget writers on Sunday unveiled competing spending plans that would give state employees a pay raise, provide Gov. Terry McAuliffe with extra cash to lure new businesses to the commonwealth and offer more care to severely mentally ill Virginians. Both panels also rejected Medicaid expansion, bucked the Democratic governor’s bid to hike some business fees, and poured more money into K-12 education, public universities and the state’s rainy day fund. (Vozzella, 2/8)

Medicaid payments for primary care doctors, including those in Missouri and Illinois, were slashed in half at the start of this year, a move that has left many physicians and their patients scrambling. Starting Jan. 1, Medicaid — the government-funded insurance program for lower income residents — stopped paying primary care doctors enhanced rates for treating recipients. As a result, some doctors aren’t taking new Medicaid patients and are struggling to afford their current ones. (Shapiro, 2/8)

A widely supported bill to let Washington State University open a medical school in Spokane hit a snag when a Seattle lawmaker asked the school to promise that it would not limit teaching on reproductive health or end-of-life care because of its partnerships with religious hospitals. (2/8)

A new report finds Illinois has continued making health care payments for people who died, despite officials saying last year that the problem needed to be fixed. A report from state Auditor General William Holland released Thursday found $3.7 million was paid for medical care for about 1,100 people who died. The report found nearly 6,000 people were still marked as eligible for medical services despite being listed as dead elsewhere in state or federal records. (2/6)

The state is investigating a Taos health care facility for leaving 80 workers without health insurance in order to cover paychecks. State Superintendent of Insurance John Franchini says Tri-County Community Services secretly used employee insurance premiums last year to make payroll. (2/8)

In a few backward parts of the world, extremists resist universal childhood vaccinations. The Taliban in tribal areas of Pakistan. Boko Haram militants in Northern Nigeria. Oh, yes, one more: Some politicians in the United States. Senator Rand Paul — a doctor! — told CNBC that he had delayed his own children’s immunizations and cited “many tragic cases of walking, talking, normal children who wound up with profound mental disorders after vaccines.” After an uproar, Paul walked back his remarks and tweeted a photo of himself getting a Hepatitis A vaccination. After that irresponsible scaremongering, I’d say he deserves to get shots daily for a decade. With really long needles. (Nicholas Kristof, 2/7)

Sadly, Governor Chris Christie and Senator Rand Paul, leading Republican lights and likely presidential candidates, didn't get the memo soon enough. They suffered a bout of hoof-in-mouth disease that led them to try to play nice with the activist anti-vaccine crowd (also known as: those most likely to vote in early 2016 caucuses and primaries). As they both now know, there's no vaccination against pandering going viral. The ensuing kerfuffle over their sympathy for those who would jeopardize the health of all to indulge a few is a lesson in the dangers of blowing a dog whistle. It is also a reminder of an older, simpler lesson: It pays to tell the truth. (Margaret Carlson, 2/6)

The dust appears to be settling after a couple politicians stepped into the national discussion about vaccination last week—and that’s something anyone who cares about public health should be cheering. ... If anything, the question of mandatory vaccination splits along generational lines rather than political ones. A recent Pew Research survey found that 41 percent of 18 to 29-year-olds believe vaccinating children should be up to the parents, compared to only 20 percent of adults over age 65—also those most likely to have lived through outbreaks of the diseases children now avoid with vaccinations. Given that older adults are more likely to show up to the polls, that makes Christie’s and Paul’s statements appear even more off-base. (Tara Haelle, 2/8)

The measles outbreak that has spread from California to Arizona and beyond has renewed debate over whether parents should be required to vaccinate their children. Medical professionals almost unanimously agree that doing so prevents the spread of dangerous diseases with little or no risk, while some parents on the left and the right are concerned about autism and big-government interference. In Mississippi, the debate has long been settled. Since the 1970s, the state has required parents to vaccinate any child attending public or private schools, and it’s very difficult for anyone to claim an exemption. (Reid Wilson, 2/6)

Amateurs and hucksters are not the only people telling parents not to vaccinate their children. Unfortunately some doctors — men and women sworn to the Hippocratic Oath — are purveying junk science. ... Doctors who purvey views based on anecdote, myth, hearsay, rumor, ideology, fraud or some combination of all of these, particularly during an epidemic, should have their medical licenses revoked. Thankfully, states have the right tools to do so. It’s time to use them. (Arthur L. Caplan, 2/6)

It wasn’t until I read Eula Biss’s January 2013 essay on vaccinations in Harper’s magazine that I understood, for the first time, how herd immunity works. ... I was reminded of a voice — my own voice from years before, when my first daughter was a baby — saying, “She’s safe even without her shots because everyone around her is vaccinated.” I actually said that, several times, to several people. Friends said the same thing to me about their unvaccinated children. We had that luxury — we could count on herd immunity to protect our children. I can’t say exactly why the idea of protecting others hadn’t hit me before. (Gal Adam Spinrad, 2/6)

[W]e favor eliminating Obamacare, capping the tax break for employer-provided coverage, and providing everyone who doesn't have such coverage with a tax credit that could be used to buy insurance that (at least) covers catastrophic health expenses. Louisiana Governor Bobby Jindal disagrees, favoring an alternative that would result in millions of people losing their coverage and deriding the higher-coverage proposals of other conservatives as "Obamacare Lite." In response to my criticism of his idea, Jindal argues that his plan would have the advantage of lowering insurance premiums, and that the disadvantage I mention -- it would result in millions of people losing their health insurance -- is a "feature" rather than a "bug." (Ramesh Ponnuru, 2/6)

In critiquing my proposal, Ponnuru falls into the typical trap of the left -- to evaluate a health plan primarily, if not exclusively, by how many people it provides with insurance cards, regardless of whether those cards translate into affordable deductibles or access to doctors. I fundamentally disagree with that premise. The American people are worried first and foremost about the rising cost of health coverage -- it's what makes their health care unaffordable, and Obamacare unsustainable. (La. Gov. Bobby Jindal, 2/6)

Sixty years after Virginia waged a campaign of “massive resistance” against integrating its public schools, the state is once again insisting on a policy that targets its least advantaged citizens. Even as one Republican-led state after another moves to tap available federal funds for extending health coverage to needy citizens under Medicaid, Virginia stands pat. ... Yet Republicans in Richmond, standing on the “principle” that Virginians bear no responsibility for their least fortunate neighbors, will not budge. (2/7)

Baton Rouge, La., is about to lose one of its crucial hospital emegency rooms, and the reason is clear: The administration of Gov. Bobby Jindal has refused to expand Medicaid under the Affordable Care Act, and won't put up any other money to keep the facility open. (Michael Hiltzik, 2/6)

Just when you thought there was some hope for the nearly 4 million people Republican leaders are denying access to health coverage across the country, the “hell no” caucus struck back. Conservative Indiana Gov. Mike Pence (R) concluded negotiations with the Obama administration last week to expand Medicaid in his state. “Indiana Medicaid Expansion May Tempt Other GOP-Led States,” declared one headline. “Will Mike Pence tip the GOP scales on Medicaid expansion?” asked another. Not in Tennessee, where the state legislature on Wednesday repudiated an expansion plan that its GOP governor, Bill Haslam. (Stephen Stromberg, 2/6)

The central debate that is emerging in Republican circles is between those who support a means-tested approach to subsidizing health insurance, and those who support a uniform subsidy that is the same regardless of one’s income. This may seem like a technical and obscure debate, but it is critical to the future of Republican health reform. Plans like Burr-Hatch-Upton and my own take into account the fact that we already massively subsidize health coverage for upper-income folks, through the employer tax exclusion and Medicare. They try to balance that out by offering comparable help to the uninsured, and limiting the tax break for high earners. ... An alternative approach—embraced by groups like the 2017 Project—prefers a uniform tax credit that would be the same for the poor and the rich. (Avik Roy, 2/5)

A New York Times article last weekend explained how the administration has moved to lessen the impact of Obamacare’s individual mandate “to avoid a political firestorm.” But there is a cost to taking political cover: President Barack Obama’s executive actions to blunt the mandate’s impact on the public will give future administrations an opportunity further to undermine the mandate and, with it, much of the health-care law. (Chris Jacobs, 2/7)

Opposing Obamacare in the abstract is easy enough, but it becomes more challenging when you present a specific alternative, because such cheaper alternatives inevitably cover fewer people and make consumers pay more for benefits. This explains why the House, in passing its 56th attempt at some form of Obamacare repeal this week, included no specific alternative but rather a suggestion that committees get together and come up with some ideas. (Dana Milbank, 2/6)

Gov. Steve Bullock made waves last week with the unveiling of his “Healthy Montana Plan,” which would expand Medicaid under the Affordable Care Act. He and his allies are supporting the plan with claims that the expansion will be accomplished with “free money” from the federal government and will provide high quality health care to 70,000 people. But Montanans should not be fooled. This is nothing more than ObamaCare by another name — and it will cost Montana taxpayers hundreds of millions of dollars and do little to improve the health conditions of the most vulnerable. (Zachary Lahn, 2/9)

Many Florida newspapers, including the Orlando Sentinel, have jumped on the bandwagon to promote Medicaid expansion in the state. Pressure to encourage the state Legislature and the governor to join this parade comes largely from a coalition of hospitals and businesses called A Healthy Florida Works. They argue this is good for the state's economy and for those Floridians who don't have health insurance. Responsible state legislators should be concerned about the costs of Medicaid expansion — and the quality of the health care their state residents would receive. (Robert S. Roberts, 2/8)

President Obama’s new budget contains a farsighted proposal that could ultimately transform the practice of American medicine. The proposal seeks to design treatments for the individual, which are sometimes called “personalized medicine” or “precision medicine” to distinguish them from the one-size-tries-to-fit-all approach. Despite the potential of the program, the president’s enthusiasm may have overtaken the science at times. (2/7)

We are gutting government. It is an extreme irony of the Obama presidency that a proud liberal — someone who believes in government’s constructive role — is presiding over the harshest squeeze on government since World War II. What’s happening is simple: Spending on the elderly and health care is slowly overwhelming the rest of the federal government. Spending on other vital activities (from defense to financial regulation) is being sacrificed to cover the growing costs of a graying nation. (Robert J. Samuelson, 2/8)

Total Medicare spending, however, is still growing as a share of the federal budget and will continue to do so as more baby boomers age into the system. The best way to slow this growth is not by putting the squeeze on Medicare beneficiaries, as well as drug companies, hospitals and other providers — as President Obama’s $4 trillion budget plan would do — or by creating new bureaucratic barriers to care, but by providing Medicare recipients with incentives to seek the best care for the best price. And you do that by allowing them to share in the gains from reducing costs. (John R. Graham, 2/6)

In the president’s budget released this week, the Obama administration proposed approximately $400 billion in health-care savings. While that sounds impressive, the number might actually be less—for one proposal relies on a board that does not yet exist and that the administration has made no effort to establish. (Chris Jacobs, 2/6)

Republicans and Democrats in Congress have found something meaningful they can agree about: strengthening the nation’s response to the tragic wave of veteran suicides. On Tuesday, by a 99-to-0 vote, the Senate approved a bill to improve suicide prevention and mental health treatment programs at the Department of Veterans Affairs. (2/9)

The nonpartisan Government Accountability Office this week released a scathing report on the lack of leadership in the Department of Health and Human Services for coordinating federal efforts related to serious mental illness. It described 112 separate programs in eight federal agencies with little coordination. “The absence of high-level coordination,” the GAO concluded, “hinders the federal government’s ability to develop an overarching perspective of its programs supporting and targeting individuals with serious mental illness.” The report was especially critical of the lack of any formal evaluation mechanism for the majority of the programs, so there is no way to tell whether they are working. (E. Fuller Torrey and Doris A. Fuller, 2/6)

A new analysis from New York Attorney General Eric T. Schneiderman suggests that Americans are spending billions of dollars a year on ground up radish, rice mustard, primrose, alfalfa, spruce and houseplants. If this sounds like the most unappetizing plate at an avant-garde vegan restaurant, think again: It’s what the attorney general found when his office conducted DNA testing on six popular dietary supplements sold as house brands at four major retailers — GNC, Target, Wal-Mart and Walgreens. (2/7)

An investigation of herbal supplements by the New York State attorney general’s office carries a sobering message for the rest of the nation as well. The investigation looked at the store brands of well-known herbal products sold by four prominent national retailers: GNC, Target, Walgreens and Walmart. Among the popular products examined were ginkgo biloba, St. John’s wort and ginseng pills. Four out of five of the products tested did not include any of the herbs listed on their labels. Even worse, hidden ingredients and contaminants could be dangerous to people with allergies to those substances. (2/6)