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It's been like a long-delayed New Year's resolution for Republicans. But 2016 will finally be the year when they put legislation on President Barack Obama's desk repealing his health care law. The bill undoing the president's prized overhaul will be the first order of business when the House reconvenes this coming week, marking a sharply partisan start on Capitol Hill to a congressional year in which legislating may take a back seat to politics. ... Obama will veto the health law repeal bill, which also would cut money for Planned Parenthood. (Werner, 1/2)

Within hours of reconvening Tuesday, the GOP-led Congress will finally act to fulfill a 2010 promise to repeal and replace ObamaCare. The effort is set to begin Tuesday afternoon when the House Rules Committee meets on the repeal measure, with a full debate and vote as early as Tuesday. With the Republican-led Senate having already passed its version, GOP congressional leaders will send the measure to President Obama, daring him to veto it. (Pergram, 1/4)

House Republicans are starting off 2016 with a renewed legislative push to roll back the president's landmark health care legislation, with proposals to defund Planned Parenthood tacked onto the bill. (Flores, 1/2)

Rep. Vicky Hartzler (R-Mo.) on Saturday touted legislation in the House that would repeal key aspects of Obamacare and defund Planned Parenthood. “As Congress returns next week, in one of our first acts of the New Year, the House will vote on a bill that would eliminate key parts of Obamacare and stop taxpayer funding for abortion providers, such as Planned Parenthood,” she said in the GOP’s weekly address. (Richardson, 1/2)

Congressional Republicans are planning to start the new year with another attempt to ban federal funds for Planned Parenthood. But after five years of fruitless legislative attacks, the House vote next week is likely to be the last, conservative activists say, until a Republican moves into the White House. (Calmes, 12/29)

Don’t expect an avalanche of big legislative accomplishments by Congress in 2016, with leaders already lowering expectations and political parties sharpening their contrasts for a year in which the White House and Senate control are up for grabs. First thing up for the new session: hitting President Barack Obama with a repeal of the Affordable Care Act’s core provisions that he will veto. Republicans who won the Senate in 2014 to complement their House majority are eager to show voters they’re still focused on the health-care law even though this vote -- like more than 50 previous ones in the House -- won’t succeed in repealing Obamacare. (House and Miller, 1/4)

It's 2016, and the health policy world’s focus will shift from Capitol Hill to the courts and the campaign trail. The courts will determine how far states can go in limiting abortion — and will also take up the House GOP lawsuit over whether the Obama administration overreached in financing the health law. The presidential contenders in both parties will keep debating the future of Obamacare and what, if anything, to do about prescription drug prices. (Haberkorn, 1/4)

ObamaCare left 2015 in a stronger position than it began, though the threats of rising premiums, skittish insurers and challenges from Washington loom for the president’s signature health law during his final year in office. The law, formally known as the Affordable Care Act, emerged largely unscathed from a government funding debate last month, a far cry from a 2013 shutdown fight in which opponents delivered fiery floor speeches against it and plotted its demise during infamous meetings at Capitol Hill’s Tortilla Coast restaurant. (Sullivan, 1/3)

Healthcare stakeholders should brace for a year of business uncertainty in 2016—an election year where the Senate and White House are up for grabs with Democrats and Republicans offering competing visions of the government's role in healthcare. The political conflict will play out across a public opinion landscape that has been transformed in recent months by high prescription drug prices, which have upstaged the Affordable Care Act as healthcare's biggest policy issue. (Meyer and Muchmore, 1/1)

Healthcare merger and acquisition activity is likely to remain strong in 2016, driven by the growth of value-based payment models. Private equity players will continue to scout out primary-care physician practices that have expertise in the managed-care environment. (Kutscher, 1/1)

While King v. Burwell made 2015 exciting, 2016 is shaping up to be a pretty exciting year for health care as well. The following are the top three news items to watch for in the new year. 1. Penalties for not having coverage skyrocket. ... 2. UnitedHealthcare stays — or leaves — the exchanges. ... 3. November’s election. Republicans running for president have promised, in one way or another, to repeal “Obamacare.” (Tolbert, 12/29)

In state after state, a gulf is opening between Republican governors willing to expand Medicaid coverage through the Affordable Care Act and Republican members of Congress convinced the law is collapsing and determined to help it fail. In recent months, insurers have increased premiums and deductibles for many policies sold online, and a dozen nonprofit insurance co-ops are shutting down, forcing consumers to seek other coverage. But in Arizona, Arkansas, Indiana, Iowa, Michigan, Nevada, New Jersey, New Mexico and Ohio, Republican governors have expanded Medicaid under the health care law or defended past expansions. In South Dakota, Tennessee and Utah, Republican governors are pressing for wider Medicaid coverage. ... That has created tension with Washington that some lawmakers can no longer ignore. (Pear, 12/27)

Gov. Matt Bevin announced Wednesday he has begun work to transform Kentucky's Medicaid program by 2017. But in the meantime he envisions no major changes in the government health plan that covers nearly 1.3 million Kentuckians. (Yetter and Loftus, 12/30)

As the 2016 session of the Kentucky General Assembly opens, lawmakers say they plan to keep a close eye on changes to the state's Medicaid system proposed by Gov. Matt Bevin, who has said he wants to reshape it along the lines of one operated by Indiana, which requires premiums, co-pays and provides different tiers of coverage. "It's going to be interesting to see how it shakes out," said Rep. David Watkins, a Henderson Democrat and retired physician who serves as co-chairman of the legislature's Medicaid Oversight and Advisory Committee. "We're already at the bottom of the heap here in Kentucky. We don't need to go down any further." ... Senate President Robert Stivers, a Manchester Republican, told the Kentucky Health News last week that lawmakers could enact legislation, but Bevin has the authority to redesign Kentucky's Medicaid program without legislative approval. (Yetter, 1/4)

Don’t expect another bruising fight this year in the Legislature over expanding Medicaid in Florida. But there are still issues to resolve as lawmakers decide how much more the state will have to contribute to the massive federal-state health care program for the poor that already consumes nearly a third of the state’s $79.3 billion budget. ... Florida lawmakers will spend this year’s session discussing ways to keep Medicaid costs under control. They also must determine how much more state money is needed to cover the loss of federal cash for a small Medicaid program that helps cover the cost of uncompensated care provided to the poor through hospitals and other providers. (Sarkissian, 1/3)

Gov. Peter Shumlin says he won't ask the Legislature to raise taxes to pay for an expansion of the Medicaid program. Shumlin says he tried that approach last session and lawmakers rejected it. According to Shumlin, much of the new money that will be needed to balance the Medicaid budget will have to be taken from other agencies of state government. (Kinzel, 12/29)

California officials never anticipated how many people would sign up for state-run health insurance under Obamacare. The state's health plan for the poor, known as Medi-Cal, now covers 12.7 million people, 1 of every 3 Californians. If Medi-Cal were a state of its own, it would be the nation's seventh-biggest by population; its $91-billion budget would be the country's fourth-largest, trailing only those of California, New York and Texas. (Karlamangla, 12/31)

They toil in America’s fast-food restaurants, call centers and retail stores — yet as many as 5 million Americans remain not only poor but also uninsured, despite an array of state and federal policies specifically intended to help them get health care. These people are caught in a health care netherworld. Their employers classify them as part-time workers or independent contractors, therefore avoiding any obligation to provide health care. Their state governments have not expanded Medicaid to include low-wage earners. And government mandates set a standard for “affordable” coverage that is not affordable at all for these families. (O'Donnell and Ungar, 12/28)

[C]ompanies, cities and states are trying to come up with solutions to help ensure the working poor get the health care they need — even in states that haven’t expanded Medicaid. One of those states is Alabama, where the city of Birmingham also raised its minimum wage after labor groups cited the lack of health care for low-income workers. With hourly wages of $10.10 an hour, activists such as LaDarius Hilliard argued that some low-wage workers could at least buy heavily subsidized health insurance on the federal insurance exchange. Meanwhile, Alabama’s Republican governor, Robert Bentley — citing the plight of the working poor — said in November he’s looking at Medicaid expansion after years of resistance although he hasn't made a final decision. Texas has said no to the expansion all along, but Harris County, which includes Houston, offers a taxpayer-funded “Gold Card” insurance program that provides help (Ungar and O'Donnell, 12/28)

The Affordable Care Act survived another challenge before the U.S. Supreme Court this year. But the still-fragile marketplace is showing the strain of rising health care costs. (Horsley, 12/30)

The Treasury Department on Monday gave employers an extension of critical reporting requirements, as it seeks to manage some of the most complicated parts of the federal health care law. Employers had previously faced deadlines in February and March to report 2015 health insurance information to their employees, and also to the IRS. If they need more time, employers can now have until March 31 to get information to their workers and until June 30 in certain cases to get details to the IRS. Treasury said it acted after many employers complained they might not be able to get the information processed in time. Companies that rely on outside vendors were running into a bottleneck. (Alonso-Zaldivar, 12/28)

A growing number of people are turning to health-care ministries to cover their medical expenses instead of buying traditional insurance, a trend that could challenge the stability of the Affordable Care Act. The ministries, which operate outside the insurance system and aren’t regulated by states, provide a health-care cost-sharing arrangement among people with similarly held beliefs. (Armour, 1/3)

President Obama is entering his final year in office having quietly secured significant expansions to the federal government safety net in the face of Republican majorities in Congress and increasingly insistent calls from GOP presidential candidates to rein in “free stuff.” The latest expansions came in the $1.8-trillion budget deal that Congress approved this month, which made permanent hundreds of billions of dollars in tax breaks for low- and moderate-income families -- measures enacted on a temporary basis in Obama’s first year. ... Moreover, although the budget deal delayed three taxes included in the president’s signature Affordable Care Act, it protected the core of the law, which has extended government-subsidized health coverage to millions of poor and working-class Americans in the last two years. Together, the permanent tax breaks and health protections that Obama has managed to lock into place mark the largest growth of government social programs in half a century. (Levey, 12/29)

When she turned 26 in October, Elif Karatas of Chicago was no longer covered under her parents' health plan. She also wasn't eligible for coverage from her employer because she works part time. So she turned to the public marketplace in Illinois created by the Affordable Care Act, President Barack Obama's signature health care law. But picking a plan on healthcare.gov, the online insurance exchange, was more difficult than she expected for a first-timer. (Sachdev, 12/31/15)

Health-plan enrollment season rolls on, and people shopping on healthcare.gov and the other marketplaces have until Jan. 31 to pick a plan. But even people trying to pick from their employers’ options can find the process complicated and difficult to understand. The jargon can be overwhelming, and it can lead people to make to costly mistakes or avoid care all together. (Zdechlik, 1/4)

Tax filing is getting even more complicated. The Affordable Care Act (ACA) requires employers and health insurance companies to give the IRS information about your income and health insurance coverage. So, the IRS has created three new tax forms, and you'll need them to prove you have health insurance and, therefore, aren't required to pay any tax penalties. You'll also need them to make a claim for tax credits you're entitled to. (Martin, 1/4)

Clint Murphy let the deadline for getting health insurance by the new year pass without a second thought. Mr. Murphy, an engineer in Sulphur Springs, Tex., estimates that under the Affordable Care Act, he will face a fine of $1,800 for going uninsured in 2016. But in his view, paying that penalty is worth it if he can avoid buying an insurance policy that costs $2,900 or more. All he has to do is stay healthy. (Goodnough, 1/3)

A federal rule issued Tuesday requires prior authorization before Medicare will pay for certain wheelchairs, prosthetics, orthotics and other medical equipment — sources of Medicare fraud and improper payments for years. The rule could save Medicare $10 million the first year, $200 million in five years and $580 million over a decade, says Aaron Albright, spokesman for the U.S. Centers for Medicare and Medicaid Services. (Ungar, 12/29)

Doctors frequently order patients to take urine drug tests to safeguard against prescription pain-pill abuse. But federal investigators and Medicare say these routine tests — designed to ensure patients properly use opioid drugs — have led to questionable billing practices by some for-profit labs, doctors, and addiction-treatment centers. ... The U.S. Department of Justice is cracking down on private labs that investigators say offer incentives to doctors to frequently refer patients for lucrative testing. And Medicare, citing the potential for billing abuses, is overhauling its billing codes and payment rates used for drug tests. (Alltucker, 12/26)

New regulations allow the Centers for Medicare and Medicaid Services to fine insurers up to $25,000 per beneficiary for errors in Medicare Advantage plan directories and up to $100 per beneficiary for errors in plans sold on the federally run insurance exchanges in 37 states. States are imposing their own rules and sanctions. (Beck, 12/28)

Small rural hospitals called critical-access hospitals have in recent years been performing more and more inpatient orthopedic surgeries, even as their overall stays decline, a Journal analysis of Medicare billing records shows. Inpatient joint-replacement surgeries covered by Medicare rose 42.6% at the hospitals from 2008 to 2013, far outpacing the growth of those services at general hospitals. The trend reflects financial incentives built into the way Medicare pays the nation’s roughly 1,300 critical-access hospitals—generally isolated facilities with 25 or fewer beds—experts say, but it has troubling implications for patient safety. Many studies suggest that patients generally get better results when their procedures are done at hospitals that perform them frequently. (Weaver, Mathews and McGinty, 12/25)

Due to an obscure bit of regulatory wording, Medicare patients pay far more out of pocket for outpatient care at the small, rural hospitals known as critical-access hospitals than they would for the same care elsewhere, according a Wall Street Journal analysis of Medicare billing records. (Beck and Weaver, 12/25)

Imagine you're diagnosed with cancer. Your doctor says your survival chances are good but that, even in the best case, it will take months to get better. Checking your health care coverage, you find you'll be paying thousands of dollars in costs before your high-deductible insurance plan kicks in. You may have other expenses too — maybe you'll need help talking care of your kids, or your house. It's a nightmare scenario that worries many, for good reason. (Zdechlik, 1/4)

Health insurers in several big cities will take some pain out of doctor visits this year -- the financial kind. They’ll offer free visits to primary care doctors in their networks. You read that right. Doctor visits without copays. Or coinsurance. And no expensive deductible to pay off first. Free. (Galewitz, 1/4)

Are hospitals doing everything they should to make sure they don't make mistakes when declaring patients brain-dead? A provocative study finds that hospital policies for determining brain death are surprisingly inconsistent and that many have failed to fully implement guidelines designed to minimize errors. (Stein, 12/28)

The Supreme Court is poised to deliver a midyear jolt, with rulings expected by June on issues that cut along partisan lines. The decisions are sure to remind voters that one of the next president’s greatest powers will be federal judicial appointments. ... Whole Women’s Health v. Cole looks at the extent to which states can regulate and restrict abortion. The court continues to hold that women have a constitutional right to terminate pregnancy, and has struck down restrictions that it concludes impose a “substantial obstacle” to getting an abortion. The case looks at a 2013 Texas law requiring abortion doctors to hold admitting privileges at a local hospital and clinics to meet the standards of ambulatory surgical centers. (Bravin, 12/30)

The court will decide whether Texas can enforce two regulations that would force about three-fourths of the state’s abortion clinics to close. ... In the background is a larger question about the nature of abortion rights set out in the Roe vs. Wade decision: Is it a constitutional right that trumps state regulations that may interfere with a woman’s choice, or is it a limited right subject to restriction? The case of Whole Woman’s Health vs. Cole will be argued March 2. (Savage, 12/29)

As the U.S. Supreme Court prepares to hear its first abortion case in nearly a decade, both sides have been quietly gathering vivid personal accounts from women to supplement the dry legal arguments, believing the effort could appeal particularly to swing-vote Justice Anthony Kennedy. (Biskupic, 1/3)

The law the judge ruled on Thursday, which was approved by the state legislature in March, would require organizations or individuals dispensing mifepristone to maintain a contract relationship with a physician who has hospital admitting privileges. It also stipulates that the patient receive two more doses of the drug than the four presently required by law. Mifepristone is intended to induce miscarriage when taken in the first two months of pregnancy. (Barnes, 12/31)

A federal appeals court on Wednesday put an emergency hold on Utah's move to defund the state Planned Parenthood chapter. The decision by the Denver-based 10th Circuit Court of Appeals allows federal money to temporarily keep flowing to the Planned Parenthood Association of Utah while the court considers whether to order a longer hold. (12/30)

With a deeper-than-ever split between Republicans and Democrats over abortion, activists on both sides of the debate foresee a 2016 presidential campaign in which the nominees tackle the volatile topic more aggressively than in past elections. Friction over the issue also is likely to surface in key Senate races. And the opposing camps will be further energized by Republican-led congressional investigations of Planned Parenthood and by Supreme Court consideration of tough anti-abortion laws in Texas. (Crary, 12/27)

Hillary Clinton, who arrived to loud applause here at one of three New Hampshire campaign stops Sunday, said prohibitively expensive education, lack of support for families coping with Alzheimer's disease, and the rising tide of opioid abuse are among problems she hears most commonly on the trail. (Lazar, 1/4)

Heading into a bruising U.S. Senate race expected to be one of the nation's most closely watched, Democratic Gov. Maggie Hassan says she is confident she can work with New Hampshire's Republican-controlled Legislature to find compromise on politically charged issues even as she fights to unseat the state GOP's top elected official, Sen. Kelly Ayotte. ... Throughout the campaign, Hassan will need to work with Republicans in Concord on significant issues including reauthorizing Medicaid expansion and the state's growing drug abuse crisis. (Ronayne, 1/3)

The pharmaceutical industry, after a long drought, has begun to produce more innovative treatments for serious diseases that can extend life and often have fewer side effects than older treatments. Last year, the Food and Drug Administration approved 41 new drugs, the most in nearly two decades. The catch is their cost. Recent treatments for hepatitis C, cancer and multiple sclerosis that cost from $50,000 annually to well over $100,000 helped drive up total U.S. prescription-drug spending 12.2% in 2014, five times the prior year’s growth rate, according to the Centers for Medicare and Medicaid Services. ... For many of the poorest Americans, medicines are covered by government programs or financial-assistance funds paid for by drug companies. For those in the middle class, it is a different story. (Walker, 12/31)

The federal government announced this month that prescription drug spending hit $297.7 billion last year -- up more than 12 percent, the largest annual increase in more than a decade. A new generation of specialized drugs and price hikes on existing medications helped to drive that spike, and officials have predicted that annual spending on medications will grow 6.3 percent on average through 2024. If there's a bright spot amid the troubling rise in the cost of prescription drugs, perhaps it is this: Many of the most widely used generic drugs actually were cheaper at the end of 2015 than when the year began, according to an analysis released Tuesday by the prescription drug price comparison site GoodRx. (Dennis, 12/29)

The torrid pace of consolidation among drug makers is bound to slow at some point. But that doesn’t mean deal bankers and lawyers will be idle in 2016. There have been more than 2,000 announced deals over the past two years within the pharmaceuticals and biotechnology sectors world-wide, according to Dealogic, for a total consideration north of $750 billion. The pace isn’t likely sustainable. (Grant, 12/31)

Employees and contractors at VA medical centers, clinics, pharmacies and benefit centers commit thousands of privacy violations each year and have racked up more than 10,000 such incidents since 2011, a ProPublica analysis of VA data shows. The breaches range from inadvertent mistakes, such as sending documents or prescriptions to the wrong people, to employees' intentional snooping and theft of data. Not all concern medical treatment; some involve data on benefits and compensation. Many VA facilities and regional networks are chronic offenders, logging dozens of violations year after year. (Ornstein, 12/30)

CVS is among hundreds of health providers nationwide that repeatedly violated the federal patient privacy law known as HIPAA between 2011 and 2014, a ProPublica analysis of federal data shows. Other well-known repeat offenders include the U.S. Department of Veterans Affairs, Walgreens, Kaiser Permanente and Wal-Mart. And yet, the agency tasked with enforcing the Health Insurance Portability and Accountability Act took no punitive action against these providers, ProPublica found. In more than 200 instances over those four years, that agency, the Office for Civil Rights within the U.S. Department of Health and Human Services, reminded CVS of its obligations under the law or accepted its pledges to improve privacy protections. (CVS did pay a $2.25 million penalty in 2009 for dumping prescription bottles in unsecured dumpsters.) (Ornstein and Waldman, 12/29)

Up until a few years ago, many physicians were using paper charts or dictating into recorders and typing charts out afterward. Now, federal mandates from the Centers for Medicare & Medicaid Services penalize hospitals and clinics that do not keep records electronically. (Caiola, 1/1)

Frank, who eight months earlier had received a diagnosis of psychosis, the signature symptom of schizophrenia, and had been in and out of the hospital, gradually learned to take charge of his own recovery, in a new approach to treatment for people experiencing a first psychotic “break” with reality. At a time when lawmakers in Washington are debating large-scale reforms to the mental health care system, analysts are carefully watching a handful of new first-break programs like the one that treated Frank in New York as a way to potentially ease the cycle of hospitalization and lifetime disability that afflict so many mentally ill people. (Carey, 12/28)

What has stuck with Vicki and Peter Brown for years, beyond the enduring grief of losing their only child, Matthew, are the emotional traumas they all suffered during his struggle with a rare form of bone cancer. ... The couple ultimately launched a years-long effort to try to ensure that children with cancer and their families get the help they need for the non-medical aspects of the disease. Last week, their hard work paid off with the publication of the first national standards for the “psychosocial” care of children with cancer and their families. (Dennis, 12/29)

Talks over a deal to improve mental health care for children broke down largely because the state didn't want a federal judge to oversee its implementation. That's according to a transcript of what lawyers for Mississippi Attorney General Jim Hood and the U.S. Justice Department told U.S. District Judge Henry T. Wingate. (Amy, 1/1)

Washington state says it needs more time to comply with a federal judge’s order requiring officials to quickly provide mentally ill defendants with competency evaluations and treatment. (1/2)

With a growing number of American women choosing to give birth at home or in birthing centers, debate is intensifying over an important question: How safe is it to have a baby outside a hospital? A study published Wednesday in The New England Journal of Medicine provides some of the clearest information on the subject to date. The study analyzed nearly 80,000 pregnancies in Oregon, and found that when women had planned out-of-hospital deliveries, the probability of the baby dying during the birth process or in the first month after — though slight — was 2.4 times as likely as women who had planned hospital deliveries. Out-of-hospital births also carried greater risk of neonatal seizures, and increased the chances that newborn babies would need ventilators or mothers would need blood transfusions. (Belluck, 12/30)

Roughly 99 percent of American women give birth to their infants in a hospital. But the number of women delivering babies at home or in a birthing center has been increasing dramatically in recent years — up nearly 30 percent between 2004 and 2009, for example. So scientists at the Oregon Health and Science University decided to try to get a better idea of how risky that is. The researchers took advantage of the fact that Oregon recently started requiring all birth certificates to list whether the mother had intended to give birth inside or outside a hospital. That designation helped researchers tease out births that were intended for home, but ended up in the hospital when something went awry. (Stein, 12/30)

Couples that plan to have their babies at home instead of in a hospital take on a slightly increased risk of serious complications for their newborns, including death, a new study shows. An analysis of births in Oregon finds that for every 1,000 deliveries intended to occur at home or in a residential-style birthing center, 3.9 end in perinatal death. That compares with 1.8 of every 1,000 births expected to take place in a hospital, according to a report in Thursday’s edition of the New England Journal of Medicine. (Kaplan, 12/30)

Mary Pazdur had exhausted the usual drugs for ovarian cancer, and with her tumors growing and her condition deteriorating, her last hope seemed to be an experimental compound that had yet to be approved by federal regulators. So she appealed to the Food and Drug Administration, whose oncology chief for the last 16 years, Dr. Richard Pazdur, has been a man denounced by many cancer patient advocates as a slow, obstructionist bureaucrat. He was also Mary’s husband. (Harris, 1/2)

Mainstream scientific consensus holds that there is little to no evidence that cellphone signals raise the risk of brain cancer or other health problems; rather, behaviors like texting while driving are seen as the real health concerns. Nevertheless, more than 500 pages of internal records obtained by The New York Times, along with interviews with former agency officials, reveal a debate and some disagreement among scientists and health agencies about what guidance to give as the use of mobile devices skyrockets. (Hakim, 1/1)

After decades of disappointingly slow progress, researchers have taken a substantial step toward a possible treatment for Duchenne muscular dystrophy with the help of a powerful new gene-editing technique. (Wade, 12/31)

Thanks to medical advances, a diagnosis of H.I.V., while still very serious, is no longer the death sentence it once was. For organizations trying to communicate information about testing and prevention, though, the devastation the virus has caused over the decades remains ever-present. Traditional public service announcements tend to rely on shock and shame, with mixed success. But when Arizona public health officials began contemplating a new campaign, they wanted to change that. (White, 12/27)

There's growing evidence that a lack of sleep can leave the brain vulnerable to Alzheimer's disease. The brain appears to clear out toxins linked to Alzheimer's during sleep. And, at least among research animals that don't get enough solid shut-eye, those toxins can build up and damage the brain. (Hamilton, 1/4)

A Kansas legislative panel is recommending that hepatitis C patients who drink alcohol or stop using their medications should lose Medicaid coverage. The KanCare Oversight Committee also recommended this week that the state health department use step therapy, which requires Medicaid patients to try cheaper treatments first and receive more expensive treatments only if the other medicines fail. State law currently forbids that practice. (1/1)

A legislative oversight committee has approved a controversial set of draft recommendations aimed at reducing the cost of drugs provided to Kansas Medicaid recipients. The joint committee that oversees the state’s privatized Medicaid program known as KanCare this week tentatively approved recommendations that direct the Kansas Department of Health and Environment to develop policies aimed at slowing a steady increase in the $3 billion program’s pharmacy costs. The most controversial of the recommendations calls for withholding expensive hepatitis C drugs from KanCare recipients who don’t follow treatment requirements, such as patients who fail to take all their pills or consume nonprescription drugs or alcohol during treatment. (McLean, 12/20)

Medicaid recipients being treated for hepatitis C who drink alcohol or go off their medication would lose coverage under a recommendation passed by a legislative panel Tuesday. Sen. Jim Denning, R-Overland Park, proposed that the state not cover high-cost medications for hepatitis C patients who don’t comply with treatment requirements. The proposal came toward the end of an all-day meeting of the KanCare Oversight Committee. (Lowry, 12/29)

In the last few years, new medications have come on the market that can cure hepatitis C with a more than 90 percent success rate. But these new drugs are famously expensive. A full 12-week course of Harvoni costs about $95,000. Because of that, Medicaid in many states restricts who receives the medication. Medicaid in at least 34 states doesn't pay for treatment unless a patient already has liver damage, according to a report released in August. There are exceptions—for example, people who also have HIV or who have had liver transplants—but many living with chronic hepatitis C infection have to wait and worry. (Harper, 12/27)

Massachusetts consumers and businesses are expected to pay more for health insurance in 2016. Blue Cross Blue Shield of Massachusetts, the state's biggest commercial insurer, is raising premiums an average of 5 percent. Tufts Health Plan's rates are set to increase between 3 and 7 percent; Harvard Pilgrim Health is raising rates 6 to 12 percent; and Fallon Health could raise rates as much as 17 percent. (1/4)

Eight weeks into open enrollment for Affordable Care Act plans, Floridians continue to sign up in greater numbers than residents of any of the 38 states using the federally run exchange at healthcare.gov, the Centers for Medicare and Medicaid services reported this week. More than 1.5 million Floridians have selected a health plan since enrollment began on Nov. 1. The deadline for eligible consumers to select a plan for 2016 is Jan. 31. (Chang, 12/31)

Low income pregnant women will be able to apply for health insurance Jan. 1 -- more than a year after Gov. Jay Nixon approved the program. Nixon, a Democrat, announced Thursday the state would begin accepting applications for the Show-Me Healthy Babies program from pregnant women who earn too much to qualify for Medicaid, but not enough to pay for a private health plan. The announcement comes about three months after the Post-Dispatch revealed the state was slow to implement the program. The governor approved the Republican-led Legislature's measure in 2014. (Stuckey, 12/31)

The Idaho Department of Health and Welfare earlier this month announced deep cuts to Medicaid reimbursement rates for in-home care of the developmentally disabled. Now, facing possible layoffs and loss of care, several providers and patients are fighting back in court. Eight care providers from around the state and two developmentally disabled patients filed the lawsuit last week in Boise against the Department of Health and Welfare as a whole, as well as its director, Richard Armstrong, and Lisa Hettinger, an administrator for its Medicaid program. (Ramseth, 12/30)

More than half of the 1,141 patients who sought inpatient psychiatric services last month in Franklin County were enrolled in Medicaid. On average, they waited 26 hours for that care — twice as long as the typical 13-hour wait for patients who had private health insurance. Fueling that disparity is the fact that most of the region’s private psychiatric beds remain largely off-limits to Medicaid enrollees, even as their numbers swell as a result of Ohio’s Medicaid expansion. (Sutherly, 12/29)

Typically older people focus on keeping taxes low, and are less worried about investments in education or economic development because their lives are already settled, Fowler said. While older residents are big consumers of government services and public revenue, they generally rely on federal programs like Social Security and Medicare over services provided at the state level. A Legislature made up of older members has benefits, including decades of life and job experience and institutional knowledge. On the flip side, graying lawmakers can be slow to embrace new ideas or technologies, some said. (Morris, 1/3)

More than two dozen West Virginia hospitals saved more than $265 million last year through reductions in uncompensated care from 2013 to 2014, according to data from the West Virginia Health Care Authority compiled by West Virginians for Affordable Health Care. More than 200,000 West Virginians have gained health insurance since the Patient Protection and Affordable Care Act expanded coverage in 2013, including more than 165,000 new Medicaid recipients and more than 34,000 newly insured in the individual market. Because the state’s uninsured rate has dropped markedly — from 17.6 percent in 2013 to an 8.3 percent in the first half of 2015, according to Gallup — hospitals have had to provide less charity care to the uninsured, and have seen more reimbursement from those now covered by expanded Medicaid. (Nuzum, 1/2)

Declines in uncompensated care have saved West Virginia hospitals millions of dollars, data compiled by an advocacy group show. More than two dozen hospitals saved a total of more than $265 million from 2013 to 2014, according to West Virginia Health Care Authority data compiled by West Virginians for Affordable Health Care. (1/3)

Cathi Grinaldi understands that most of us know little or nothing about how we are billed for medical visits and procedures. Because she does know, the veteran West Des Moines nurse felt obligated to appeal a $265 charge for a doctor’s visit that never happened. “Upcoding,” the practice of applying a billing code that results in a higher reimbursement rate to medical providers than is justified, is a common problem in the health care industry. Grinaldi, who references that coding sometimes in her work for an insurance company, believes she is a victim. (Rood, 1/1)

In Ohio, an estimated 4.3 percent of employers with at least 50 workers didn’t offer health coverage in 2013, according to the Kaiser Family Foundation. But that figure includes companies that have at least 100 employees — a smaller number of companies, but a group that is more likely to offer health coverage. Many small businesses have been scrambling since summer to comply with the requirement, which is part of the Affordable Care Act, said Randy Ayers, a board member and past president of the Columbus Association of Health Underwriters. (Sutherly, 1/3)

Two former mayoral assistants are fighting for perks — more than $10,000 worth of bonuses and continued health insurance — they were promised by Pat Murphy in her final days of office that have since been denied by the new administration. Murphy, the town’s longest-serving mayor who lost her bid in November for a seventh term, authorized bonuses for her former assistants, Tammy Reardon and Marla Scribner. Murphy also promised Reardon continued health insurance coverage under the town’s plan for four months after she left her position on Nov. 30. (Tuz, 1/4)

A state law that’s been in place for less than six months has improved access to key vaccines for Georgia adults. The legislation allows pharmacists and nurses to administer vaccines for influenza, pneumococcal disease, shingles and meningitis. This is a big development for Georgia pharmacists, who have been administering flu vaccine to all comers since 2009 and other shots to people with individual prescriptions from a doctor. (Han, 1/2)

All Ke’Aiden has known since birth has been a hospital room at St. Louis Children’s Hospital. Because of a high-tech mechanical ventilator helping him breathe, he’s only felt the outside world briefly a few times. The breathing machine, a new technology that more safely assists the fragile lungs of premature babies, is typically used for a short period before a newborn gradually weans from the assistance. But for some reason, Ke’Aiden’s lungs are not getting better. The machine that saved his life is now keeping him from fully living it. He’s the second child at the children’s hospital whose body is unable to wean from the machine. (Munz, 1/3)

A Massachusetts health insurer is apologizing after sending automated phone calls to as many as 10,000 senior citizens in the wee hours of the morning. Tufts Health Plan accidentally sent the robocall between 3 a.m. and 5 a.m. Tuesday to remind patients to get their flu shots. (12/30)

California will become the fifth state to legalize lethal drug prescriptions for terminally ill patients. Renee Montagne talks to Carin van Zyl, a palliative care doctor at Keck Medicine of USC. (1/4)

The line of patients starts to form outside South Central Family Health Center about 6:30 a.m. By then, Dr. Dennis Mull has sipped his coffee, reviewed his labs and stuffed his shirt pocket full of pens and 3-by-5 notecards. For 18 years, he's driven from Irvine to South L.A. to serve a population with limited resources: patients who work multiple jobs to make ends meet, who lack health insurance and often show up knowing little about their medical history. (Bermudez, 12/28)

This often surprises people: Tissues from millions of Americans are used in research without their knowledge. These “clinical biospecimens” are leftovers from blood tests, biopsies and surgeries. If your identity is removed, scientists don’t have to ask your permission to use them. How people feel about this varies depending on everything from their relationship to their DNA to how they define life and death. Many bioethicists aren’t bothered by the research being done with those samples — without it we wouldn’t have some of our most important medical advances. What concerns them is that people don’t know they’re participating, or have a choice. This may be about to change. (Rebecca Skloot, 12/30)

Over the course of my reporting, I’ve talked to hundreds of people who say their medical records were hacked, snooped in, shared or stolen. Some were worried about potential consequences for themselves and their families. For others, the impact has been real and devastating, requiring therapy and medication. It has destroyed their faith in the medical establishment. (Charles Ornstein, 12/30)

There is a grim connection between two worsening addictions in the U.S.: to prescription opioid painkillers and to heroin. Both can be partly traced to worthwhile public-health initiatives that deserve to be protected. The first initiative was a 1990s campaign to get doctors to take people's pain more seriously. This worked amazingly well -- for some people, too well. The second effort was the recent response to the ensuing spike in opioid addiction: Legal controls on painkiller prescriptions were tightened, and some of the drugs were reformulated to make them harder to overuse. (12/31/15)

The conflict between health plans and providers over coverage of medication-assisted treatment for patients with opioid addiction highlights the ongoing tensions over government regulation of insurance benefit packages. And it raises questions about whether current benefit designs of private health plans are necessarily consistent with the broader public health goals. (Harris Meyer, 12/28)

In the contrast between what has happened since 1964 with tobacco, on the one hand, and marijuana, cocaine, heroin and other banned substances, on the other, we have an instructive lesson in the comparative effects of choosing a public-health or a criminalization paradigm for dealing with addictive substances. The approach to tobacco has worked. Between 1964 and 2014, smoking rates declined by half; between 1996 and 2013, the number of eighth-graders who had smoked within the past 30 days fell from 21 percent to 4.5 percent. The progress against smoking has been steady and impressive. It’s an altogether different tale with banned substances. (Danielle Allen, 12/29)

But there is also a self-serving motive for letting intemperance go unchecked. An angry patient is far more likely to grade me poorly than a satisfied one is to grade me highly on one of the many doctor-rating Internet sites. I am also subjected to patient satisfaction surveys as dictated by the Affordable Care Act. Here’s a reasonable-sounding sample question: “How often did doctors treat you with courtesy and respect? The possible answers are “never,” “sometimes,” “usually” and “always.” My hospital has made it clear that some of the federal funding we receive is tied to the proportion of “always” answers; we get no credit for “usually,” which might as well be “never.” Nor is there a mechanism to identify what a patient might consider disrespectful. (Sarah Poggi, 1/1)

Here's a breathtaking statistic: Teen smoking has plummeted by half or more in just five years. Half! More teens than ever are wising up to the dangers of tobacco and shunning cigarettes, according to the latest survey from the University of Michigan's Monitoring the Future study. (1/2)

There are many reasons it doesn’t make sense to have a separate, federally managed health care system for our nation’s veterans. From the veterans’ perspective, the issue is typically one of access, as they are often forced to travel hours to the nearest U.S. Department of Veterans Affairs health care facility .... From the taxpayers’ perspective, this separate system is also problematic, creating needless and costly redundancies in service .... But it’s also a problem from a regulatory perspective. The VA can, and does, employ doctors and other health care professionals who aren’t even licensed in the states in which they practice. (1/4)

Our aging, ill prisoner population is both a humanitarian crisis and an economic challenge that demands the collaborative attention of physicians, corrections officials, legislators and advocates who can devise national guidelines for medical parole. Dr. Brie Williams, a palliative care physician at the University of California, San Francisco, who is an expert in correctional health, has called for a national commission to develop an evidence-based approach to address the compassionate release process, with an eye toward reducing the red tape that can tie up critical cases when every day matters. It shouldn’t be acceptable that my patient, who posed no danger to the community and who had a family who loved him, should have died incarcerated. (Rachael Bedard, 12/28)

Healthcare — a sector that accounts for one-sixth of the U.S. economy, contributes an almost permanent point of tensions between economics and politics, and remains a concern for millions of families — is an enduring topic of discussion in America. That was true in 2015 and will continue to be so in 2016. (Michael Hiltzik, 12/25)

Using the latest health-insurance-exchange enrollment data and a model funded in part by the U.S. Department of Health and Human Services, I recently estimated how the Affordable Care Act will affect the health insurance market over the next decade. In brief: Costs will continue to rise and coverage will continue to underwhelm. In fact, it will likely go into reverse, leaving millions more Americans uninsured than today. (Stephen T. Parente, 12/29)

Matt Bevin won the Kentucky governor’s race last year, 400,000 low-income people seemed doomed to lose their health coverage. An ardent Obamacare opponent, Mr. Bevin swore during his campaign to roll back the state’s Medicaid expansion. The expansion had extended coverage to nearly half a million Kentuckians, halving the state’s uninsured rate, under a provision of President Obama’s signature health-care law. This reversal would have added Kentucky to the list of 20 states irrationally refusing federal Medicaid money to cover needy people, and it would have put pressure on Republican leaders in other states to withdraw coverage, too. Thankfully, common sense prevailed. The governor announced Wednesday that he would seek to reform Kentucky’s Medicaid program rather than amputate it. (1/3)

Gov. Pete Ricketts remains a tough sell on expansion of health care insurance to the currently uninsured working poor by using available federal Medicaid dollars. Sens. John McCollister, Kathy Campbell and Heath Mello have been working on a proposal modeled after an Arkansas plan that would use the additional Medicaid dollars available to Nebraska under the Affordable Care Act to purchase private health care insurance for eligible recipients rather than expand the traditional Medicaid program. ... Even though the newest Nebraska plan would utilize the private market and not expand the traditional Medicaid program, Ricketts said he is "very skeptical that this is a proposal I would be able to support." It's "a model that hasn't worked," the governor suggested during an interview last week. (Don Walton, 1/3)

Remember death panels? The saga began in 2009, when a provision in President Barack Obama’s new health care bill proposed that doctors be paid for time spent having conversations with patients planning for end-of-life care. Betsy McCaughey, former lieutenant governor of New York, was the first to magically transform these voluntary talks into mandatory sessions that would tell seniors “how to end their life sooner.” But it was Sarah Palin, with her gift for disinformation, who renamed these talks death panels. ... The proposal was deleted from the plan and then later from regulations, and anything to do with “end of life” became the third rail of health care policy. ... Fast forward to this season’s greeting. In July, Medicare put forward nearly the same proposals for public comment. They sailed through with barely a ripple of protest. (Ellen Goodman, 12/30)

One of the largest ongoing sources of spending involves huge age-specific transfers: Our politicians are paying off older, higher-voter-turnout Americans in the form of generous benefits that those older people have not paid for and never will. Which means the tab will need to be picked up by someone else — i.e., someone younger. Older people themselves do not seem to recognize whose hard-earned cash is funding their hip replacements and motorized scooters, and they often insist that they paid for their benefits fair and square. ... “Invincible” youngsters are subsidizing health care for their not-yet-Medicare- eligible elders on the individual insurance market as well. And elsewhere on government balance sheets, spending on the old is crowding out spending on the young. (Catherine Rampell, 12/24)

The more drugs people take and the sicker they are, the more likely they are to experience problems paying for prescription medicines–or to forgo them altogether because of cost. It may not be surprising that people who use more drugs have the greatest problems paying for them. It’s also never a good thing when people with the greatest need struggle the most to pay for health care. (Drew Altman, 12/28)

The number of people who are in need of new kidneys in the United States is growing, but so is the waiting list for new organs. About 7 percent of the entire Medicare budget is spent on dialysis treatments for people with end-of-life kidney disease. The issue has become such a burden that some are calling for the government to take a new approach: paying for people to donate their kidneys. ... There’s one problem: Paying for human organs is illegal almost everywhere in the world. The U.S. strictly banned payments for organs in 1984 under the the National Organ Transplant Act. The medical industry has long referred to compensation for organs as taboo, as evidenced by the uproar following claims that Planned Parenthood has been selling body parts of aborted fetuses. (Robert Gebelhoff, 12/28)

A recent study in the American Journal of Transplantation just reached what to many people may be a shocking conclusion: Taxpayers would be able to save thousands of lives and about $12 billion per year if the government started compensating people for kidney donations. According to the study, “these numbers dwarf the proposed $45,000-per-kidney compensation that might be needed to end the kidney shortage and eliminate the kidney transplant waiting list.” For economists who have long advocated for the creation of a market of organ transplants, this news is not surprising. (Scott Sumner, 12/30)

Clearly, our current organ transplant policy is a qualified failure. And it is because our current system, by law, mandates altruism as the sole legitimate motive for organ donation. ... So, to save lives, let’s test incentives. A model reimbursement plan would look like this: Donors would not receive a lump sum of cash; instead, a governmental entity or a designated charity would offer them in-kind rewards, such as a contribution to the donor’s retirement fund; an income tax credit or a tuition voucher; lifetime health insurance; a contribution to a charity of the donor’s choice; or loan forgiveness. Meanwhile, the law can impose a waiting period of at least six months before people donate, ensuring that they don’t act impulsively and that they offer fully informed consent. (Sally Satel, 12/28)

[B]uying organs would be wrong. And aside from being wrong, it would also harm existing, voluntary donation programs and be ineffective in increasing the supply of organs. There are better ways to increase the number of organs donated than paying for donations. In recent decades, thousands of organs have been bought from the destitute around the world, for transplantation into the social elite in their own countries or “transplant tourists” from other nations. This has tarnished the reputation of organ transplantation and led to poor medical outcomes. In all countries, it is the poor who sell organs as a way out of their financial straits — usually only temporarily. (Francis Delmonico and Alexander Capron, 12/29)

The media attention that kidney transplant does attract often revolves around a tired debate about incentives framed by two unacceptable responses: Should we treat people like human vending machines and purchase their organs with cash? Or should we do nothing, repeat the words “pure altruism,” and let thousands of people continue to die each year? There’s a better way: a path of transplant support that treats organ donation like a public service and honors donors like public servants. That means giving donors lifetime health insurance to offset the risks of donation; providing them with annual research stipends to enable long-term follow-up; and paying for lost wages, travel and childcare expenses when they take time off to donate. It means making sure all patients and their families receive specialized education about transplants. (Josh Morrison, 1/1)

I was formerly skeptical about the prospects for growing a kidney, but the developments over the past two years have convinced me that this could be a viable option. Realistically, we are still probably 15 to 25 years away from success, so it remains important to pursue other avenues to increase the pool of transplantable kidneys. But certainly our patients have reason for cautious optimism. (Benjamin Humphreys, 12/31)