�鶹Ů��

Hospitals, doctors and consumers are preparing for the fallout if the Supreme Court strikes down subsidies that help about 6.4 million Americans buy health insurance under the Affordable Care Act. Some people are making medical appointments now, in anticipation of being unable to afford their insurance. Hospitals are exploring ways to increase charity care or planning their lobbying strategies should subsidies on the federal insurance exchange be found illegal. And doctors worry about what they would tell their patients. (Armour, 6/21)

Their industry already upended with the passage of the federal health care law, insurance companies are facing another upheaval if the Supreme Court rules that millions of Americans are not eligible for subsidies to help defray the cost of their coverage. The court is expected to decide by the end of June or in early July whether it agrees with the plaintiffs in King v. Burwell that the language in the Affordable Care Act allows the government to offer subsidies only in those states that have established their own insurance marketplaces. (Abelson, 6/21)

Tensions are building inside and outside the white marble facade of the U.S. Supreme Court building as the nine justices prepare to issue major rulings on gay marriage and President Barack Obama’s health care law by the end of the month. Of the 11 cases left to decide, the biggest are a challenge by gay couples to state laws banning same-sex marriage and a conservative challenge to subsidies provided under the Obamacare law to help low- and middle-income people buy health insurance that could lead to millions of people losing medical coverage. (Hurley, 6/21)

The fate of the Affordable Care Act is in the hands of the Supreme Court once again — and whether it lives as is or crumbles might depend on a justice who believes the heart of the law to be unconstitutional. Justice Anthony Kennedy is the traditional swing vote, and his views on the latest death threat to the law colloquially known as Obamacare will likely predict how the court rules. The fate of the decision could also rest with conservative Chief Justice John Roberts, who previously sided with the liberals to uphold the law. (Logiurato, 6/20)

Marilyn Lynch of Kansas City could lose her health insurance this year. So could Kristine and Kenny Cloughley of Pleasant Hill. So could tens of thousands more in Missouri and Kansas, and millions nationwide. It all depends on an upcoming U.S. Supreme Court decision that will either help cement the legal foundations of the Affordable Care Act or so destabilize the ACA that it sends shock waves through the nation’s health care system and the 2016 election campaign. (Bavley, 6/21)

Roughly half a million North Carolinians could soon lose money they depend on for health insurance. The U.S. Supreme Court will rule soon on a key part of the Affordable Care Act. It governs federal subsidies for insurance in states like North Carolina that did not set up their own exchange or marketplace. The result could be disastrous for many low-income Americans and for insurance markets in about three dozen states. (Tomsic, 6/22)

State Republican leaders are ratcheting up the pressure on Congress to overhaul the Affordable Care Act if the Supreme Court this month rules that subsidies on the federal exchange are invalid. Republicans from 33 states have written to Congress as part of a coordinated message urging federal legislators to develop a plan that would free states from the pressure of setting up their own exchanges to salvage subsidies, according to the Foundation for Government Accountability, a conservative think tank. (Armour, 6/19)

As the Supreme Court prepares to rule on whether to block health insurance subsidies in 34 states that use the federal insurance exchange, Pennsylvania and Delaware are the best prepared. They have submitted detailed plans for creating their own exchanges by next year, a move intended to keep subsidies flowing to their residents, though possibly with an interruption. (Goodnough, 6/21)

Days before the Supreme Court could strip it of a central component, there is still no "plan B" for Obamacare. Health and Human Services Secretary Sylvia Burwell warned the Obama administration will be unable to cover the millions of Americans who could lose their medical insurance if the Supreme Court decides to unravel much of the Affordable Care Act. (Acosta, 6/21)

Experts say the proposals floated by Republicans in response to the looming Supreme Court ruling on ObamaCare could lead to higher premiums, but also create improvements in the healthcare system over time. Congressional Republicans have for weeks been debating what they will do if the Supreme Court rules against the Obama administration in King v. Burwell. A defeat for the law could strip insurance subsidies from 6.4 million people. (Sullivan, 6/20)

The nonpartisan Congressional Budget Office said Friday that repealing the Affordable Care Act would significantly increase federal budget deficits and the number of people who are uninsured. But, it said, repealing the law would also raise economic output because it would create incentives for some people to work more. The estimates came in the first major study issued by the new director of the budget office, Keith Hall. It was also the first report to use new methods of fiscal analysis, according to instructions from the Republican majority in both houses of Congress. (Pear, 6/19)

Repealing the Affordable Care Act would cost the U.S. government $137 billion over the next decade and more than that in the following 10 years, the Congressional Budget Office said Friday. The report—the first federal assessment since the main provisions of the ACA took effect in 2014—found that repealing the law would increase deficits by $353 billion over 10 years. But after taking into account economic factors, including the slightly larger workforce participation that would result from repeal, that amount would fall to $137 billion. (Timiraos and Radnofsky, 6/19)

Repealing President Obama’s signature health care law would add significantly to the deficit, even under a new accounting method advocated by congressional Republicans who want to get rid of the Affordable Care Act. The Congressional Budget Office on Friday projected that scrapping the law would cost $353 billion over the next decade using its traditional scoring method and $137 billion under the model favored by Republicans, which takes into account the economic impact of tax and spending policies. (Snell, 6/19)

Repealing the federal health law would add an additional 19 million to the ranks of the uninsured in 2016 and increase the federal deficit over the next decade, the Congressional Budget Office said Friday. (Galewiz, 6/19)

Ahead of a much-anticipated Supreme Court ruling and just as the 2016 presidential race is kicking into gear, the Congressional Budget Office has weighed in on the costs and/or benefits of repealing Obamacare. The CBO released on Friday its report on the budgetary and fiscal impact of repealing the Affordable Care Act of 2010, shorthanded as Obamacare. It determined that on balance, getting rid of Obamacare would raise budget deficits from 2016 to 2025 by $353 billion under traditional measurement, and $137 billion by a measure that presumes economic benefits. (Hall, 6/19)

A nonpartisan government study says repealing President Barack Obama's signature health care law would modestly increase the budget deficit and the number of uninsured Americans would rise by more than 20 million. The report from the Congressional Budget Office comes ahead of a highly anticipated Supreme Court ruling that could have a major impact on the Affordable Care Act, nullifying health insurance subsidies for some 6 million people in more than 30 states. The budget analysts said that would add a host of new uncertainties to their estimates. (Taylor and Alonso-Zaldivar, 6/20)

The Congressional Budget Office’s conclusion today that sacking Obamacare would swell the budget deficit by as much as $353 billion wasn’t at all what Republicans were expecting. Using so-called dynamic scoring, which attempts to account for the economic effects of policy changes, a repeal would still hit the deficit, although by less — about $137 billion, CBO said. ... Republican reaction focused on the positive economic impact and played down the deficit implications. (Faler, 6/19)

Repealing President Barack Obama’s signature healthcare reform law would increase the U.S. budget deficit by $353 billion over 10 years, congressional forecasters said on Friday, more than triple the red ink compared to an estimate three years ago. But the Congressional Budget Office and the Joint Committee on Taxation said the deficit increase would only be $137 billion if economic feedback effects were considered, a sign of a new Republican mandate for increased use of “dynamic scoring” that includes the economic impact of legislation. (Lawder, 6/21)

California's health insurance exchange wants to know why you got sick this summer. With 1.4 million people enrolled, the state-run marketplace is embarking on an ambitious effort to collect insurance company data on prescriptions, doctor visits and hospital stays for every Obamacare patient. (Terhune, 6/21)

New York is poised to become the first state to allow women who become pregnant to sign up for health insurance under the Affordable Care Act – even after the open-enrollment period has passed. Legislation establishing a pregnancy as a so-called qualifying event that enables women to enroll in ACA health coverage at any time passed the New York legislature on Wednesday, and was sent to Gov. Andrew Cuomo for his signature. (Armour, 6/19)

For years, workers who receive health insurance through their employers have had a limited choice of health plans. At John Henry Foster, a company that distributes hydraulic and air compression equipment, workers long had to accept a plan from a couple of choices offered by their employer. ... But these days, the company's employees have dozens of choices. (Zdechlik, 6/22)

Jonathan Gruber, the Massachusetts Institute of Technology economist whose comments about the health-care law touched off a political furor, worked more closely than previously known with the White House and top federal officials to shape the law, previously unreleased emails show. The emails, provided by the House Oversight Committee to The Wall Street Journal, cover messages Mr. Gruber sent from January 2009 through March 2010. Committee staffers said they worked with MIT to obtain the 20,000 pages of emails. (Armour, 6/21)

MIT economist Jonathan Gruber, who claimed the authors of ObamaCare took advantage of what he called the "stupidity of the American voter," played a much bigger role in the law's drafting than previously acknowledged, according to a published report. (6/22)

A five-way takeover frenzy broke out into the open over the weekend, with Anthem Inc. taking its $47.5 billion bid to buy Cigna Corp. public in a contentious move that shows the pressure the big health insurers are under to quickly find merger partners. (Cimilluca, Mattiol and Hoffman, 6/21)

Anthem went public this weekend with its bid to take over Cigna -- and Cigna just as publicly said, No thanks! In a harshly worded letter to Anthem released late Sunday, Cigna called Anthem's offer "inadequate" and accused Anthem of refusing to address key issues raised in recent talks between the companies. (Wattles, 6/21)

Health insurer Cigna Corp rebuffed Anthem Inc's $47 billion merger proposal on Sunday, saying it was "deeply disappointed" with Anthem's recent actions and the offer was not in the best interest of shareholders. Anthem's offer for smaller rival Cigna is part of a daisy chain of potential deals in the health insurance sector. The biggest players are seeking acquisitions to boost membership in government-paid healthcare plans and employer-based insurance. The bigger the insurer, the more negotiating power it has with prices and improving its doctor networks. (Saba, 6/22)

In a fiery response, Cigna Corp. rejected a $54-billion takeover bid from Anthem Inc. and unleashed several criticisms of the health insurance giant. Cigna said Sunday that the $184-a-share offer was inadequate and not in the best interests of its shareholders. The nation's fifth-largest health insurer expressed frustration with Anthem taking its private negotiations public a day earlier and for failing to address key issues such as the fallout from a massive data breach at Anthem this year. (Terhune, 6/21)

Health insurance firm Cigna (CI) has turned down a $54 billion bid offered by larger rival Anthem. The most recent offer, which Anthem said was of $184 per share in cash and stock, "is inadequate and not in the best interests of Cigna's shareholders," said Cigna Corp. president and CEO David Cordani and the company's chairman of the board Isaiah Harris in a letter sent to Anthem's board of directors in Indianapolis. (Snider, 6/21)

The world of American health insurance may soon become even smaller, with the biggest companies seeking to become even bigger. A scramble has broken out within the industry as various providers jockey for position and make overtures to rivals. Anthem made the first public move, unveiling a $47 billion takeover bid for Cigna on Saturday after months of negotiations had stalled. On Sunday, Cigna fired back, rejecting the bid as “inadequate and not in the best interest of Cigna’s shareholders.” (de la Merced and Abelson, 6/21)

Anthem’s pursuit of Cigna comes as Cigna as well as Aetna Inc. size up Humana Inc., which has privately offered itself for sale. Aetna in the past few days made a takeover proposal to Humana, which has a market value of $30 billion, said people familiar with the overture. UnitedHealth Group Inc., meanwhile, recently made a takeover approach to Aetna. (Rockoff, Cimilluca, Mattioli and Hoffman, 6/21)

The nation’s biggest health insurers, which are pursuing a series of potential megamergers, have market overlaps that could damp competition in sectors such as private Medicare plans, an analysis of state and federal data by The Wall Street Journal has found. The board of Cigna Corp. on Sunday rejected a $47.5 billion bid from Anthem Inc. that was disclosed on Saturday. Aetna Inc. has made an offer for Humana Inc. in recent days. Those deals, if completed, would shrink the current top five insurers to a powerful big three, each with revenue on paper of more than $100 billion. Meantime, the largest player by revenue, UnitedHealth Group Inc., has recently made a takeover approach to Aetna. (Wilde Mathews and Weaver, 6/21)

Rumors have been swirling for the past few weeks: Some of the nation’s largest health insurance giants are looking to buy their rivals. No deals have been announced, but many analysts and policy experts agree that there likely will be fewer companies offering health insurance in the not-too-distant future. But is less competition a bad thing? It depends on whom you ask. (Shapiro and Liss, 6/21)

The thriving health-care sector is starting to look too rich for some investors’ taste. Health-care companies in the S&P 500, ranging from health insurers to medical-device makers to biotechnology firms, have risen 26% in the past year. That is the largest increase among S&P 500 sectors and more than three times the 7.7% gain in the S&P 500 in the same period. (Vaishampayan, 6/21)

The pressing problem for the 2016 Republican field falls into the “dog catches car” category: It’s one thing to call for the Affordable Care Act to be repealed or to promise an Oval Office signing ceremony for its repeal. It’s another to endorse pulling insurance subsidies used by more than 6 million people in 34 states, including at least 1.3 million Florida residents. A ruling that subsidies provided to consumers to help them purchase health insurance are not legal could spark chaos in the insurance marketplace and help shape the electoral landscape in several key swing states. Beyond those voters directly affected, many more could see their premiums increase if the law unravels, driving up the number of uninsured. (Zezima and Sun, 6/20)

A Supreme Court decision eliminating Obamacare subsidies in 34 states would pose an immediate challenge to the four sitting Republican governors eyeing presidential bids, as tens of thousands of people in their states could swiftly lose their health plans. Louisiana’s Bobby Jindal, Wisconsin’s Scott Walker, New Jersey’s Chris Christie and Ohio’s John Kasich all refused to set up Obamacare exchanges, as did most other GOP governors. Their states would be directly affected if the court rules that the health law’s subsidies can only go to people living in states that did establish the new online Obamacare markets. (Pradhan and Demko, 6/21)

The Republicans running for president have practically made careers out of skewering Obamacare — so when Ohio Gov. John Kasich makes his expected entry into the race, he’s likely to have a giant Obamacare target on his back. Kasich says he is no fan of the president’s health care law. But he fought his own party to implement one of its core components and is now gearing up to face GOP primary voters who want to rip the health law to shreds. His decision two years ago to embrace Obamacare’s expansion of Medicaid to provide health coverage to low-income adults — a move that offered bipartisan cover to the White House during a tumultuous period — is likely to dog him in Iowa and New Hampshire. (Pradhan and Cheney, 6/20)

One year after outrage about long waiting lists for health care shook the Department of Veterans Affairs, the agency is facing a new crisis: The number of veterans on waiting lists of one month or more is now 50 percent higher than it was during the height of last year’s problems, department officials say. The department is also facing a nearly $3 billion budget shortfall, which could affect care for many veterans. (Oppel, 6/20)

The number of veterans seeking health care but ending up on waiting lists of one month or more is 50 percent higher now than it was a year ago when a scandal over false records and long wait times wracked the Department of Veterans Affairs, The New York Times reported. The VA also faces a budget shortfall of nearly $3 billion, the Times reported in a story posted online ahead of its Sunday editions. The agency is considering furloughs, hiring freezes and other significant moves to reduce the gap, the newspaper reported. (6/20)

The Iowa Supreme Court struck down a rule on Friday that would have prohibited doctors from using telemedicine to dispense abortion-inducing pills to patients in remote clinics around the state, saying the ban placed an “undue burden” on a woman’s constitutional right to an abortion. Planned Parenthood clinics in Iowa have been using telemedicine to provide medication-induced, nonsurgical abortions since 2008, seeing it as a way to expand access to women living in the state’s many rural areas. (Goodnough, 6/19)

The Iowa Supreme Court has struck down a restriction that would have prevented doctors from administering abortion-inducing pills remotely via video teleconferencing, saying it would have placed an undue burden on a woman's right to get an abortion. Iowa is one of only two states that offers so-called telemedicine abortions — Minnesota offers them on a smaller scale — and doctors at Iowa's urban clinics that perform abortions had been allowed to continue offering the remotely-administered abortions while the ruling was pending. (Pitt and Rodriguez, 6/19)

Some questions and answers on Friday's Iowa Supreme Court ruling and its impact: Q: How does the Planned Parenthood telemedicine abortion system work? A: Doctors in urban clinics use a video-conferencing system to interact with patients in outlying clinics. The doctors view sonograms, blood tests and medical records via computer. If they decide a woman is eligible for a medical abortion, the doctors enter a computer command that opens a drawer in front of the woman. The patient reaches in the drawer, withdraws pill bottles and takes the first pill as the doctor watches. Then the patient goes home and has what amounts to an induced miscarriage. (Leys, 6/19)

Gov. Terry Branstad's administration could seek a federal appeal of Friday's Iowa Supreme Court decision on telemedicine abortions, but he would have a tough time winning, a Drake University law professor predicted. "I think it would be a very uphill battle," said Mark Kende, director of Drake's Constitutional Law Center. (Leys, 6/20)

The Iowa Supreme Court’s ruling that allows telemedicine-delivered abortions could indirectly lead to looser restrictions on the practice in other states, according to attorneys consulted about Friday’s decision, and might provide legal backing for telemedicine in general. (Pittman, 6/19)

A federal appeals court on Friday rejected a request from Texas abortion providers to temporarily put on hold a ruling that could leave Texas with nine abortion facilities. Abortion providers had asked the U.S. 5th Circuit Court of Appeals to delay its own ruling upholding most provisions of House Bill 2 — including requiring nearly all of Texas’ abortion facilities that perform the procedure to meet hospital-like standards — while they take their case to the U.S. Supreme Court. (Ura, 6/19)

Abortion is back before the Supreme Court, and the justices could signal by the end of June whether they are likely to take up the biggest case on the hot-button subject in nearly a quarter-century. If the court steps in, the hearing and the eventual ruling would come amid the 2016 presidential campaign. (Sherman, 6/22)

Planned Parenthood President Cecile Richards said Saturday that her organization has no immediate plans to build more abortion clinics in Texas, where only eight facilities are likely to remain if another round of strict regulations takes effect July 1. Only the U.S. Supreme Court can now stop Texas from forcing abortion facilities to be constructed like surgical centers, and prevent a second major wave of clinic closures statewide in as many years. Texas had 41 abortion clinics in 2012. (Weber, 6/20)

At the Interfaith Dental Center in Crown Heights, Brooklyn, people with dental pain can walk into a ground floor office off Bedford Avenue and get treated without an appointment. They might have to wait in a packed waiting room. But if they're in the door by 5 p.m., a dentist will see them. Residents in this low- to middle-income neighborhood likely don't realize how lucky they are. The majority of Americans have to travel miles to see a dentist who takes their insurance, particularly if they're covered by Medicaid. Many dental patients with private insurance cannot afford to pay their share of the bill. (Vestal, 6/21)

A proposal to include routine foot care by podiatrists for adult Medicaid recipients failed to gain the Nevada Legislature’s approval this year. But Nevada podiatrists say the state risks spending more money to address bigger problems that could be prevented. Foot care from a podiatrist is covered for children on Medicaid, and Medicare, the government program providing care to the aged, covers its recipients for such services. Foot and ankle care for adult Medicaid recipients is a covered benefit, but doctors of osteopathic medicine or a medical doctors must deliver such services. Podiatrists say they are more willing and better trained at providing routine foot, toenail and ankle care than general practitioners. (Moore, 6/21)

A months-long effort to keep Republicans from pushing Planned Parenthood out of a state cancer screening program for low-income women ended in defeat on Saturday when Republican Gov. Greg Abbott signed off on the proposal. By approving the two-year state budget, Abbott green-lit a provision that will prevent Planned Parenthood from participating in the joint state-federal Breast and Cervical Cancer Services program, which provides cancer screening for poor, uninsured women in Texas. The governor’s endorsement of the provision, which was expected, came as Planned Parenthood leaders vowed to maintain their presence in Texas despite lawmakers’ efforts to cut their funding. (Ura, 6/20)

Neighborhood Health Plan is looking to move into a new neighborhood. The nonprofit insurer, best known for managing the care of low-income people on Medicaid, is accelerating a push into the market for large businesses. The expansion plan is part of an effort by the company, an arm of Partners HealthCare, to rebuild its finances after losing more than $100 million last year. (Dayal McCluskey, 6/21)

Earlier this year when the legislature voted down Medicaid expansion, lawmakers realized that some hospitals were struggling to make up for the fact that some people cannot afford to pay their medical bills. So after a lot of discussion, they provided roughly three million dollars to be spread among the smaller rural hospitals. But some thought that was not enough, so two legislative committees are looking into what else can be done to help. (Beck, 6/19)

A bruising budget battle that divided Republicans in the Florida Legislature is over for now, but the truce is likely only to last a few months. Legislators passed a nearly $79 billion budget Friday with just days to spare. Legislators had until July 1 to pass a budget or state government would have been partially shut down. They didn't pass a budget during their regular session because they were divided over health care spending. That sparked a stalemate — and finger-pointing will remain when legislators return for their 2016 session. (Fineout, 6/20)

Florida legislators wrapped up a rancorous special session on Friday with passage of a $78 billion state budget, narrowly avoiding a state government shutdown at the end of the month. ... A standoff between the Republican-controlled House and Senate over expanding Medicaid coverage to serve about 800,000 working poor Floridians caused the state's regular 60-day session to end in disarray on April 28. Medicaid is a government health insurance program for the poor. ... Without a budget for the fiscal year starting July 1, lawmakers reconvened on June 1 and worked out compromises to fund a "low-income pool" of local, state and federal money to reimburse hospitals for care of the uninsured poor. The Senate sought again to expand Medicaid eligibility, but the House held firm. (Cotterell, 6/19)

The Montgomery County Council is poised to pass legislation next week requiring employers to provide workers at least seven days a year of paid sick leave, joining other state and local governments — including the District’s — in approving a benefit that has stalled at the federal level. Nearly 40 percent of the nation’s private-sector employees, many in lower-paid service industries, have no paid sick leave, according to the Bureau of Labor Statistics. Advocates say that means workers risk losing pay to stay home when they are ill or need to care for a sick child or relative. (Turque, 6/19)

Joe White didn’t use elaborate methods to bilk a federal stimulus program: He simply lied on application forms. But getting back the nearly $18 million in tax money that the feds plowed into the rural Texas hospital chain he managed won’t be so easy. It may be impossible, if his meager bank accounts and the government’s difficulties in collecting criminal debts are any indication. (Moffeit, 6/21)

The so-called Right To Try legislation would allow terminally ill patients who have exhausted all other options the opportunity to try experimental drugs, products or devices that have not been approved by the U.S. Food and Drug Administration. ... Yet some experts warn that providing unregulated treatments for those desperately searching for ways to extend their lives is not only taking advantage of their emotional state but could also harm dying patients. Others call it merely a symbolic gesture, saying drug manufacturers are unlikely to voluntarily participate outside of an existing FDA program that provides expanded access to experimental drugs, and health insurers are unlikely to cover the costs. (Seipel, 6/21)

A federal judge for the Eastern District of North Carolina ruled on Tuesday that HMC/CAH Consolidated Inc., which formerly operated the Yadkin Valley Community Hospital, was in contempt for closing the 22-bed hospital when a temporary restraining order to keep it open was in effect. The judge ordered HMC/CAH to pay damages to Yadkin County for expenses the county has incurred that include the cost of additional emergency services from the day the hospital closed until it reopens. The county must submit to Judge Terrance Boyle a plan to reopen the hospital and an assessment of the damages. (Sisk, 6/22)

In an effort to control costs in its rapidly expanding Medi-Cal program, California has relied heavily on managed care insurance companies to treat patients like Anderson. The state pays insurers a fixed amount per enrollee and expects the companies to provide access to doctors and comprehensive care. But a scathing state audit released last Tuesday shows that California is failing to make sure those plans deliver. Like Anderson, many enrollees have insurance cards but often have trouble getting in to see doctors. (Gorman, 6/22)

List prices at hospitals and physician’s offices are usually not good indicators of what insurers and consumers actually pay. The Health Care Cost Institute, using anonymous data from over 40 million patients provided by large private insurance companies, has compiled the average total cost for 78 types of care at Guroo.com. (Landers, 6/19)

Pennsylvania's highest court ruled Friday that a lawsuit over the use of tobacco settlement money to balance the state budget was brought by people who did not have standing. The Supreme Court ruled unanimously for the governor and legislative leaders and against those who wanted the tobacco money used for two health care related programs, reversing a lower court. The decision involves whether the state's revenues from a landmark 1998 settlement with tobacco companies had to go to adultBasic and Medicaid for disabled workers. The court said a provision in the state's 2001 Tobacco Settlement Act gave state policymakers flexibility in how the funds are used. (Scolforo, 6/19)

Hawaii's governor has signed a bill to make his state the first to raise the legal smoking age to 21. The measure aims to prevent adolescents from smoking, buying or possessing both traditional and electronic cigarettes. Gov. David Ige signed it into law Friday. Dozens of local governments have similar bans, including Hawaii County and New York City. (Bussewitz, 6/21)

In a tiny village in the Netherlands, all 152 of its residents are living with forms of dementia including Alzheimer’s disease. The town, called Hogeway, is actually an experiment in end-of-life care largely funded by the Dutch government, with a secure entrance, cameras and caretakers to provide safety without the feel of a traditional nursing home. Hogeway is also the model for a planned expansion of Miami Jewish Health Systems that will add a similar village to its campus in the next two to three years. (Adams, 6/20)

A Florida surgeon and a plastic surgery clinic will pay $4 million to resolve allegations that Medicare was billed for procedures that were unnecessary or never occurred. Dr. Donald C. Proctor Jr. also agreed under the False Claims Act settlement not to participate in the Medicare or Medicaid programs for at least five years. Proctor runs the Grove Place Surgery Center in Vero Beach. (Ferry, 6/22)

The state of Illinois is having trouble finding a bank or financial services company to process the large amounts of cash it anticipates receiving for taxes and fees from the new medical marijuana industry. The state treasurer’s office received no response to an official solicitation published last fall, so Illinois State Treasurer Michael Frerichs has started a formal process to find out why. (6/19)

As Maryland and other states move to make medical marijuana available to patients, former service members are still barred from getting the drug from the Veterans Administration. Marijuana remains in a legally precarious position, even as public support for its legalization and use to treat illnesses grows. Washington, Colorado and the District of Columbia have legalized the drug for all purposes — Maryland has decriminalized the possession of small amounts — and almost two dozen states, including Maryland, have authorized medical marijuana programs. (Duncan, 6/19)

A tired physician prescribes the wrong medication. A surgeon misreads a patient's chart. A nurse inserts the wrong IV or administers too great a dose of a drug. Even the best health care professionals may make mistakes, and some lapses can lead to illness, injury or death. But a growing body of research suggests it's not just the patients who are affected in such cases. (Pitts, 6/21)

The five largest commercial health insurers in the U.S. have contracted merger fever, or maybe typhoid. UnitedHealth is chasing Cigna and even Aetna; Humana has put itself on the block; and Anthem is trying to pair off with Cigna, which is thinking about buying Humana. If the logic of ObamaCare prevails, this exercise will conclude with all five fusing into one monster conglomerate. This multibillion-dollar M&A boom is notable even amid the current corporate-financial deal-making binge, yet insurance is only the latest health-care industry to be swept by consolidation. The danger is that ObamaCare is creating oligopolies, with the predictable results of higher costs, lower quality and less innovation. (6/19)

The Congressional Budget Office has released a report on the effects of repealing Obamacare. Bottom line: full repeal would blow up the long-term federal budget deficit -- and leave a lot of people without insurance. ... Does anyone expect supposedly deficit-obsessed Republicans to either drop repeal, or to find offsets to make repeal budget-neutral? Of course not. Although this estimate is new, the general finding that the Affordable Care Act reduces the deficit has been well-known, and denied or ignored by “repeal” Republicans. (Jonathan Bernstein, 6/19)

I was critical of CBO yesterday — probably excessively — for giving what seemed like undue cover for deficit scolds in its long-run budget projection. So credit where credit is due: the new report on the consequences of repealing the ACA is definitely not what the Congressional majority wants to hear. Despite including “dynamic scoring”, the report finds, unambiguously, that Obamacare reduces the deficit and repealing it would enlarge the deficit. (Paul Krugman, 6/20)

Because the ACA is intended to make health-care coverage more affordable for some people — in general, people who are older and sicker, with below-average incomes — it must make coverage more expensive for others. Part of that burden, like so many burdens these days, is borne by American taxpayers — and by the Treasury bondholders who leverage today’s burden onto tomorrow’s taxpayers. (6/21)

There's an old saying "be careful what you wish for, because you just might get it." That applies in spades to Republicans who have voted over 50 times to overturn Obamacare. It was a fool's errand, because even if they had been successful, President Obama would have vetoed any such bill. But now the GOP's fondest wish may be granted by the Supreme Court, set to rule by the end of the month in King v. Burwell, a case that experts say could gut the Affordable Care Act if the plaintiffs prevail. That has Republican lawmakers up for election next year in a bind. (Martha Burk, 6/22)

We are unlikely to know how this will play out until the court issues its ruling and Republicans in Congress and the states see how intense the political pressure is to fix the problem. That heat will not be one-sided: A ruling for the plaintiffs will be used by Republicans to validate their criticisms of the Affordable Care Act and what they view as the administration’s overreach in implementing it. If history is any guide, the public will view the arguments from each side through partisan prisms. ... Still, a failure to fix the problems resulting from a ruling for the plaintiffs would almost certainly result in a steady stream of media coverage of the personal stories of people who lost subsidies and their health insurance, and Republicans would feel the heat much like they did after the government shutdown. (Drew Altman, 6/19)

It received surprisingly little fanfare, but last week three states demonstrated how to "fix" the Affordable Care Act, should the Supreme Court rule adversely against a key provision within it. Arkansas, Pennsylvania and Delaware all received permission to set up state health insurance exchanges should subsidies be eliminated for those who participate through the federal government's ACA website. (6/22)

Has the Florida Legislature's special session been a success? That depends on whom you ask. ... Where they failed to make the grade was in meeting the needs of 840,000 of their constituents who lack health care coverage. The most recent polling shows 68 percent of Floridians support the federally funded Medicaid expansion. ... the House took up and disposed of the Senate's health care plan, forgoing billions in federal dollars. That created the need for a significant infusion of state revenues to make up for federal money lost in a smaller Low Income Pool, a program to reimburse hospitals for uncompensated or charity care. The House and Senate agreed on $400 million. That's $400 million that is no longer available for other budget priorities. (Paula Dockery, 6/18)

Republican opposition to the Affordable Care Act and Medicaid expansion has become a prolonged and frightening attack on the working poor, job creation and the health of the hospital system in North Carolina. ... The long lens of history may eventually recognize that Obamacare is mostly a Republican idea or at least an effective bipartisan initiative. We are a progressive, moderate state. It is time for the Republicans to honor and reflect that tradition. It is also time for them to remember that it is their sworn constitutional duty to uphold the law even when they don’t agree with it. (William C. Crawford, 6/19)

Legislative Finance Committee Director David Abbey, who probably knows more about state finances than anyone else alive, said last week that more than 216,000 people have joined the state’s Medicaid rolls under the expansion of Medicaid (authorized and funded by the Affordable Care Act) to able-bodied working-age adults. That puts total enrollment in New Mexico at almost 800,000 people. By 2020, he said, the LFC expects enrollment to reach 895,000, of whom 257,000 will have been added as a result of the expansion of Medicaid. Those are much bigger numbers than experts were expecting a year or two ago. ... A healthier population, along with an infusion of federal dollars, could help the state’s economy in a number of ways. (Winthrop Quigley, 6/21)

In a landmark decision more than 40 years ago, the U.S. Supreme Court ruled that women have a constitutional right to end an unwanted pregnancy. In recent years, irresponsible state lawmakers in Pennsylvania and elsewhere have ignored that ruling, passing medically unsupported restrictions on abortion at the behest of anti-choice activists. Abortion opponents won a big victory June 9, after a federal appeals court delivered a misguided ruling that upheld one of the most repressive abortion laws in the country: a 2013 Texas law that threatens to shut down more than half of the state’s remaining abortion clinics. (6/22)

One would imagine that congressional Republicans, almost all of whom are on record as adamantly opposing abortion, would be eager to fund programs that help reduce the number of unwanted pregnancies. That would be the common sense approach, anyway. And yet since they took over the House in 2011, Republicans have been trying to obliterate the highly effective federal family-planning program known as Title X, which gives millions of lower-income and rural women access to contraception, counseling, lifesaving cancer screenings, and treatment for sexually transmitted diseases. (6/22)

In a surprising moment of bipartisan unity, Republicans and Democrats seem to be in agreement that it's time to remove the prescription requirement for oral contraceptives. Right before Memorial Day, Sen. Kelly Ayotte (R-N.H.) and Sen. Cory Gardner (R-Colo.) introduced legislation aimed at making birth control pills available over the counter, and now Sen. Patty Murray (D-Wash.) has introduced a Democratic bill that also would add insurance coverage for a future OTC pill. Though the politics of these moves tend to get the disproportionate share of attention, it's worth exploring what the impact of either bill would be for women. (Daniel Grossman, 6/19)

Less than a month before she died, Brittany Maynard posted a video explaining her decision to move to Oregon to take advantage of the state’s law allowing terminally ill people to end their own lives. Maynard, 29, had been diagnosed with an aggressive and terminal brain cancer and said she wanted to die on her own terms. ... Death with dignity laws need to be carefully thought out, written and monitored. Oregon and the states that followed its example show that such care is possible. We hope the rest of the nation catches up with this humane option for life’s end. (6/21)

Jane Blumenfeld isn't sure when or how she contracted hepatitis C. All she knows is that back in 2000, when she tried to donate blood, the lab told her she had it. After that she shared the nightmare of millions of hepatitis C victims. ... So Blumenfeld, 64, a retired aide to state and Los Angeles city officials, was relieved when a new drug, Harvoni, appeared on the scene last year. Its side effects are minimal, and its cure rate has been measured as high as 99%. Here's the problem: The list price of the one-pill-a-day, 12-week treatment is nearly $100,000 and Blumenfeld's health insurer, Anthem Blue Cross, refuses to pay it.(Michael Hiltzik, 6/19)

A highly lethal contagious disease that has been detected in camels and humans in the Middle East is slowly spreading around the world and is causing havoc in South Korea. Known as the Middle East respiratory syndrome, or MERS, it has killed 35 percent of those it has infected. There have been 1,333 laboratory-confirmed cases of MERS in more than two dozen countries; at least 471 people have died. Officials at the World Health Organization and the Centers for Disease Control and Prevention have expressed confidence that the disease is not yet a global emergency. But a series of medical errors in South Korea shows what can happen to any country that lets its guard down. (6/20)