�鶹Ů��

Nearly a third of the innovative health insurance plans created under the Affordable Care Act will be out of business at the end of 2015, following announcements Friday that plans in Oregon and Colorado are folding. In just the past week, four co-ops, as the nonprofit plans are known, have decided or been ordered to shut down. Their demise means that eight of the 23 co-ops in existence a year ago will be unavailable to consumers shopping for 2016 coverage through insurance marketplaces created under the ACA. (Levine and Goldstein, 10/16)

Health cooperatives are collapsing at such a rapid clip that some co-ops and small insurers are forming a coalition to consider legal action to try to change health-law provisions they blame for their financial distress. Colorado’s co-op and one in Oregon announced Friday that they were folding, joining six others that have already collapsed or said they will unwind operations. The eight co-ops have received nearly $900 million in federal funds that may not be paid back. (Armour, 10/16)

The future of an ObamaCare program that was intended to create non-profit insurers is increasingly in doubt, ... Just 15 of the original 23 co-ops remain in operation, and the administration acknowledges that more of them could fail, potentially leaving a strike against President Obama’s signature law. (Sullivan, 10/17)

Colorado HealthOP will shut down, leaving 83,000 members scrambling for insurance coverage and taxpayers on the hook for about $72 million in federal loans used to start and support the co-op. The Colorado Division of Insurance dropped HealthOP from the state insurance exchange because it no longer meets state capital-reserve requirements. (Wallace, 10/16)

Colorado HealthOP ... can't sell 2016 policies on Connect for Health Colorado, the state health insurance exchange. The Colorado Division of Insurance cut the co-op from the exchange because it missed cash-reserve requirements just before the open enrollment period opens nov. 1. Anticipating that co-op customers would have questions, the insurance regulators offered this q&a. (10/16)

Health Republic Insurance, one of two nonprofit insurers created in Oregon under President Barack Obama's health care law, announced Friday that it is shutting down. Health Republic will continue to pay claims through the rest of the year but won't sell policies for 2016, the company said. The 15,000 individuals and 800 small businesses that get insurance through Health Republic will have to turn to another insurer. (Cooper, 10/16)

An Oregon insurer, Health Republic, has announced plans to pull its health plans from the 2016 market and shut down, saying recent federal and state regulatory decisions put its financial health in jeopardy. (Budnick, 10/16)

[I]t was surprising this week when Sylvia Mathews Burwell, the secretary of health and human services, predicted only slim gains [in health law marketplace enrollment] in the coming year, millions below earlier projections. ... Why did the Obama administration set such a modest goal? It was part of an elaborate numbers game played for several years by proponents and opponents of the health law. On the one hand, administration officials want to manage expectations in a presidential election year, when surpassing the goal will be better for Democrats than falling short. ... On the other hand, health policy experts said, the enrollment goal for 2016 may be realistic. (Pear, 10/16)

The big health news last week was that the Affordable Care Act appears to be losing steam and the Obama administration is predicting a modest increase at best in the number of Americans who will enroll with private insurers next year. Health and Human Services Secretary Sylvia Mathews Burwell announced on Thursday that an estimated 10 million Americas would be covered by Obamacare by the end of 2016, an increase of roughly 100,000 over the current year’s enrollment. That’s a lot lower than many were expecting. The Congressional Budget Office in June predicted 20 million Americans would be covered by the end of next year. (Pianin, 10/18)

The math is harsh: The federal penalty for having no health insurance is set to jump to $695, and the Obama administration is being urged to highlight that cold fact to help drive its new pitch for health law sign-ups. That means the 2016 sign-up season starting Nov. 1 could see penalties become a bigger focus to motivate millions of people who have remained eligible for coverage, but uninsured. They’re said to be more skeptical about the value of health insurance. (Alonso-Zaldivar, 10/19)

If you are looking for sympathetic plaintiffs to headline a major Supreme Court battle — well, it never hurts to have on deck an order of nuns called the Little Sisters of the Poor. That seems especially true when the subject is the Affordable Care Act’s contraceptive requirement. Out of an avalanche of litigation, those urging the court to take up the latest challenge to Obamacare have rallied around the petition filed by the Little Sisters of the Poor Home for the Aged. (Barnes, 10/18)

Kentucky, one of the only Southern states to expand Medicaid under President Barack Obama's Affordable Care Act, could become the first state to repeal that expansion depending on the outcome of a closely contested governor's race. Kentucky voters have made it clear they don't like Obama or his policies, with the president's disapproval rating consistently at or above 60 percent in public polls. But when outgoing Democratic Gov. Steve Beshear used Obama's signature law to allow more people to qualify for taxpayer-funded health insurance, about 400,000 people signed up for it. (Beam, 10/16)

While Gov. Bobby Jindal repeatedly refused to take billions in federal health care money to expand Louisiana's Medicaid program, the men seeking to follow him into office are less reluctant to accept the cash. The four main contenders vying to be Louisiana's next governor on the Oct. 24 ballot all say they'd be willing to extend government-financed health insurance to the working poor, as allowed under President Barack Obama's signature health overhaul. (DeSlatte, 10/17)

Century-old Mercy Hospital, which had been losing millions of dollars in recent years, shut its doors for good on Oct. 10, leaving the 9,500 residents of Independence unsure who their doctors will be or where those residents will go in a medical emergency. Mercy was the town’s only hospital. ... Generally small and isolated, rural hospitals struggle to provide the latest services and technology. Few doctors want to make their career in rural medicine. ... But in Kansas, there’s another factor to consider in the life and death of rural hospitals: Medicaid expansion. ... With more people covered, hospitals don’t have to write off as many unpaid bills from uninsured patients. Kansas and Missouri are among the dwindling number of states that have turned down expansion. (Bavley and Helling, 10/17)

Miami-Dade's Jackson Health System, Florida’s leading provider of healthcare for the uninsured, will be hit with another round of budget cuts next year after federal healthcare officials late Thursday stood firm on their promise to no longer fund care for people who otherwise would have health insurance if the state were to fully implement the Affordable Care Act. Jackson officials estimate their hospital system could lose $50 million or about 20 percent of its current funding under a program known as Low Income Pool or LIP, which pays hospitals for uninsured Floridians’ healthcare. The federal Centers for Medicare and Medicaid Services, or CMS, plans to reduce LIP statewide from the current $1 billion to $608 million for the year beginning July 2016. (Chang, 10/17)

Medicaid expansion under the Affordable Care Act in 29 states, including California, has driven record enrollment and spending for the program in fiscal year 2015, according to a report by the Kaiser Family Foundation. In California, about 12 million people are enrolled in the Medicaid program, called Medi-Cal. (Vesely, 10/16)

Ohio’s uninsured rate has plunged by half in recent years to 8.7 percent, but it could be even lower. Two-thirds of non-elderly Ohioans without health coverage — about 567,000 residents — are either eligible for Medicaid at no cost or qualify for tax credits to help pay for private coverage through the Affordable Care Act. (Candisky, 10/18)

The window is closing for congressional leaders to avert the double-digit premium hikes that are set to hit 8 million Medicare enrollees next year. Congress has only a handful of weeks to prevent the 52 percent premium hikes — the largest in the program’s history — that will harm seniors and drain state budgets. And with a key deadline missed on Thursday, aides of both parties say a deal between House leaders by year’s end is becoming less likely. (Ferris, 10/18)

Congressional Republicans are trying to project confidence, particularly Senate Majority Leader Mitch McConnell, whose “no shutdown, no debt default” vows are paramount to his party’s hopes of maintaining Senate control in 2016. But the Senate GOP has a major uphill battle: McConnell lacks a stable negotiating partner in the House and conservative forces in both chambers already are agitated about making sacrifices in any bipartisan compromise. But Democrats have flatly refused to entertain changes to Social Security or Medicare — a key demand for many congressional Republicans. (Everett, 10/19)

Months of deadly mass shootings are pushing mental-health legislation forward in Congress, with advocates and lawmakers describing a momentum for change that they haven’t seen for nearly a decade. Early this month, by sheer coincidence, leaders of five advocacy groups met with the head of a powerful House committee just hours after a student opened fire at an Oregon community college. As pictures of the campus flashed on the TV screen in his office, Energy and Commerce Committee Chairman Fred Upton (R.-Mich.) promised to make mental-health reform a priority this fall. (Sun, 10/18)

And she is pressing the Republican presidential candidates to speak out on the matter. “I am deeply concerned by how this could harm Medicare beneficiaries,” Mrs. Clinton said in a statement. “This is outrageous and senseless, and Congress must act to fix the law. I support efforts by the Obama administration and Democratic leaders in Congress to try to resolve this quickly. At a time when out-of-pocket medical costs are already rising, we cannot afford to let Republican obstructionism pile additional costs on our seniors. I urge the Republican candidates for president to call on their congressional majority to end the games and protect our seniors.” The statement from Mrs. Clinton came as the Obama administration is urging Congress to adjust the increase in health insurance premium increases, which could affect almost a third of Medicare beneficiaries. Discussions [are] taking place among leaders in Congress to resolve the problem, but there is a concern that House Republicans may not be persuaded to address it. (Haberman, 10/16)

Democratic presidential candidate Hillary Clinton on Friday urged Congress to rein in Medicare cost increases next year, expected to hit millions on the government health insurance program even as Social Security benefits stagnate. Medicare expects Part B premiums, which cover doctor's visits and outpatient care, to rise 52 percent next year, which could hit around 16.5 million people. At the same time, a lack of inflation will keep beneficiaries of Social Security from getting an increase in the amount they receive each month. (Lopez, 10/16)

Hillary Rodham Clinton is urging Congress to fix an "outrageous and senseless" expected increase in Medicare deductibles and premiums. Clinton says she is "deeply concerned" by news that there will be no cost-of-living increase in Social Security benefits next year. As a result, some Medicare bills are set to increase for many, unless Congress acts to prevent it. (Thomas, 10/16)

Democratic presidential frontrunner Hillary Clinton has received more campaign cash from drug companies than any candidate in either party, even as she proudly declares the industry is one of her biggest enemies. Clinton accepted $164,315 in the first six months of the campaign from drug companies, far more than the rest of the 2016 field, according to an analysis by Stat News. (Ferris, 10/17)

Sen. Bernie Sanders (I-Vt.) declined to accept a maximum campaign donation from the CEO of a company that increased the price of a drug used by HIV and AIDS patients by hundreds of dollars, choosing instead to donate the money to a Washington health clinic. (Levine, 10/17)

Republican presidential contender Marco Rubio blasted pharmaceutical company “profiteering” on high-cost prescription drugs during a campaign stop this week — a sign that drug prices are becoming a lightning rod for both parties in the election. (Norman, 10/16)

When Turing Pharmaceuticals raised the price of an older generic drug by more than 5,000 percent last month, the move sparked a public outcry. How, critics wondered, could a firm charge $13.50 a pill for a treatment for a parasitic infection one day and $750 the next? The criticism led Turing’s unapologetic CEO to say he’d pare back the increase – although no new price has yet been named – and the New York attorney general has launched an antitrust investigation. The outcry has again focused attention on how drug prices are set in the United States. Aside from some limited government control in the veterans health care system and Medicaid, prices are generally shaped by what the market will bear. (Appleby, 10/19)

Theranos, a closely watched start-up that vowed to revolutionize medical testing, said on Friday that because of questions raised by the Food and Drug Administration, it had temporarily halted its trademark practice of collecting tiny blood samples from finger pricks. The privately held Theranos has reportedly been valued at more than $9 billion, roughly akin to the laboratory giants Quest and LabCorp. That is based on Theranos’s purported ability to perform dozens of medical tests using only drops of blood from a finger, rather than the conventional larger vials collected from the crook of the arm. (Pollack and Abelson, 10/16)

On Theranos Inc.’s website, company founder Elizabeth Holmes holds up a tiny vial to show how the startup’s “breakthrough advancements have made it possible to quickly process the full range of laboratory tests from a few drops of blood.” The company offers more than 240 tests, ranging from cholesterol to cancer. It claims its technology can work with just a finger prick. ... But Theranos has struggled behind the scenes to turn the excitement over its technology into reality. (Carreyrou, 10/16)

A deeply reported story by the Wall Street Journal has pulled the curtain back on Theranos, the hot and intensely secretive Palo Alto, Calif., company that aims to revolutionize how we get our blood tested. The newspaper's investigation raises questions about the accuracy and also the novelty of what the company is doing. Here's a guide to the growing questions about this company, the industry, and why it matters. (Johnson and Cha, 10/17)

A few days ago, the chief executive of one of the hottest and most secretive health care companies was named one of "five visionary tech entrepreneurs who are changing the world" by the New York Times. Elizabeth Holmes, the head of blood testing company Theranos, has also appeared on the cover of Fortune, was the subject of an admiring profile in the New Yorker, and was this month splashed on the cover of Inc. with the understated headline "The Next Steve Jobs." A deeply reported investigative story by the Wall Street Journal on Thursday revealed that despite its $9 billion valuation and its board made up of political heavyweights -- including Henry Kissinger and former secretary of state George Shultz -- Theranos' actual revolutionary technology may be falling flat. (Johnson, 10/16)

Kite Pharma, one of the hottest biotech start-ups on Wall Street, hopes to revolutionize the treatment of a common, deadly lymphatic cancer — with a novel mix of highly trained lab techs and high-speed air travel. The Santa Monica company's treatment of non-Hodgkin's lymphoma reprograms a patient's T-cells — the kind that are supposed to fight disease — to seek and destroy only abnormal, cancerous lymph cells, not the healthy ones crucial for human life. But in order to do so, blood must be drawn from a patient, refrigerated and flown to Kite's headquarters, where the cells are modified, frozen and then flown back to doctors who re-inject them into patients. (Pfiefer, 10/17)

Welcome to Oscar Insurance Corp., a Silicon Valley-backed start-up promising big changes to the cumbersome healthcare industry through its sleek mobile app. The New York-based insurer, a new player in the Southern California market, plans to offer insurance next month in the individual market on the Covered California exchange, where the four largest companies control 94% of the individual market. (Khouri, 10/18)

As U.S. health insurers chart an unprecedented consolidation of the industry, hospitals across the country are taking a fresh look at becoming insurers themselves to keep more of their patients’ health care dollars in house. Among the country’s largest insurers, Aetna Inc. struck a deal to buy Humana Inc., while Anthem Inc. agreed to acquire Cigna Corp. Both transactions are expected to draw months of scrutiny by U.S. antitrust regulators and Congress. (Kelly, 10/16)

The Department of Veterans Affairs administrator in charge of reducing the huge backlog of veterans benefits, who was a frequent target of critics, resigned on Friday despite a vast reduction in pending claims. The administrator, Allison A. Hickey, became under secretary for benefits in 2011, overseeing 20,000 employees and benefits for more than 12 million veterans and their families. (Philipps, 10/16)

A top Department of Veterans Affairs official resigned Friday, weeks after the department’s internal watchdog found irregularities in promotions and reimbursements involving nearly two-dozen senior executives in her department. Allison Hickey, who was Under Secretary for Benefits at the VA, weathered the VA wait-time scandals in the summer of 2014 that led to the resignation of other top officials and then-Secretary Eric Shinseki. Ms. Hickey’s resignation was announced by Secretary Robert McDonald in a statement. No reason was given. (Kesling, 10/16)

After months of often rancorous meetings with veterans, Westside residents, health professionals and elected officials, the U.S. Department of Veterans Affairs on Friday released a draft master land-use plan for the agency’s long-neglected West Los Angeles campus. The document satisfies a key requirement of the January settlement of a 2011 lawsuit filed on behalf of chronically homeless veterans. The suit alleged that the VA was illegally leasing land to corporations, schools and other entities while failing to provide adequate care for men and women who had served in the military. (Groves, 10/16)

The state Department of Health and Human Services says a breach of security protocol may have compromised the confidential health information of 1,615 Medicaid patients. Agency spokeswoman Kendra Gerlach said the agency mailed out letters Friday to affected patients, informing them of the possible breach. (Leslie, 10/16)

A state agency says it has no documents or even a list of experts consulted to support its claim that a controversial plan to hire private companies to manage its Medicaid program would save taxpayers $51 million during its first six months. The absence of any public data behind the estimate is significant because the Legislature relied on the projection when it approved the budget for the current fiscal year, which began July 1. (Clayworth, 10/16)

The state has appealed a judge’s ruling that blocked pay cuts for therapists who treat more than a quarter-million Medicaid patients. The Health and Human Services Commission said Travis County District Court Judge Tim Sulak misinterpreted state regulations on Medicaid rates. (Garrett, 10/16)

An old battle between Georgia's hospitals and a national cancer treatment chain flared up this fall. The dispute is rooted in Georgia's "certificate of need" process. The regulatory system used to approve expansion or new construction of hospitals and other health care facilities can have a broad effect on local economies and patient options. In 2008, lawmakers approved a new category — "destination" hospital — to accommodate Cancer Treatment Centers of America. The chain, headquartered in Florida, operates in four states and is known for its ads describing access to medical care along with spiritual support and alternative remedies. (Foody, 10/17)

The ongoing fight over Connecticut’s state budget has centered in part on what Connecticut pays hospitals. The industry took the biggest hit in the emergency budget cuts Gov. Dannel P. Malloy issued last month, drawing criticism from hospital leaders and legislators from both parties. (Levin Becker, 10/19)

Boston Children’s Hospital and the Dana-Farber Cancer Institute have made the top 10 on a new scoreboard for US medical centers with the best patient care — hardly a first for these two world-renowned institutions. (Subbaraman 10/19)

Dimensions Healthcare Corp., which operates Laurel Regional Hospital, is facing a legal challenge from two Laurel residents and the union representing the hospital's employees, a suit the plaintiffs hope will stop the hospital from being closed. Dimensions plans to close Laurel Regional Hospital and replace it with an ambulatory care center, which is estimated to cost about $24 million. (Michaels, 10/16)

Jerry Wolfe has spent the vast majority of his 91 years within shouting distance of Rattlesnake Mountain. The mountain keeps watch over the Cherokee village, hub of the Eastern Band of the Cherokee Indians’ Qualla Boundary home, tucked into the Great Smoky Mountains of Western North Carolina. Last Thursday – a postcard-perfect early-autumn morning, the brilliant sun inching past Rattlesnake – the Cherokee community welcomed some 500 guests to the ribbon-cutting of their $82 million, 155-000-square-foot Cherokee Indian Hospital. (Sisk, 10/19)

A federal judge said he will decide by Monday whether to block Gov. Bobby Jindal’s attempt to cut off state Medicaid funding for Planned Parenthood’s Louisiana clinics. Jindal, a Republican presidential candidate, began the defunding effort after secretly recorded videos were released by an anti-abortion group purportedly showing Planned Parenthood illegally selling fetal tissue for profit. The videos led to similar defunding efforts by Planned Parenthood opponents in other states and in Congress. (McGill, 10/16)

Michigan anti-abortion advocates are targeting a common second-trimester abortion procedure, pushing bills in the Republican-led Legislature to prohibit what they say is "dismemberment" of a fetus. Similar criminal bans have been approved in two other states, Kansas and Oklahoma, where they temporarily are on hold after court rulings. The Michigan legislation was the subject of a House hearing on Tuesday and could advance this fall. (Eggert, 10/17)

The number of Iowa women obtaining abortions continues to plummet, even as national arguments over abortion rekindle. The abortion rate decline is dramatic, if unheralded. The number of abortions performed in Iowa dropped nearly 9 percent from 2013 to 2014, according to figures released last week by the Iowa Department of Public Health. The 2014 total of 4,020 reflects a 40 percent decline since 2007, when 6,649 abortions were performed in the state. (Leys, 10/17)

The federal Indian Health Service has finalized a policy that makes emergency contraception more accessible to American Indian and Alaska Native women. The written policy released this week requires the morning-after pill to be available to women of any age over the counter at IHS-run facilities, no questions asked. That's in line with a 2013 U.S. Food and Drug Administration decision to lift age limits and make the medication available without a prescription. (Fonesca, 10/16)

The Hampton University Proton Therapy Institute has treated a fraction of the cancer patients it was expected to serve since it treated its first patient in September 2010. The institute blames several reasons for the lower-than-anticipated number of patients, including increasing competition and decreasing insurance reimbursements, among other factors, The Daily Press reports. (10/18)

Terminally ill cancer patient Barbara Wagner's doctor wrote a prescription several years ago intended to extend her life a few extra months. But Oregon's government-run healthcare program declined to pay for the pricey drug, saying the projected odds of the medicine's keeping her alive were too low. (Karlamangla, 10/18)

Richard "Dick" Walters, a leader in the effort to get [Vermont] to pass aid-in-dying legislation, used the rules established under the law to end his own life on Friday. He was 90 years old and had been battling cancer. Walters, the leader of Patient Choices Vermont, died at a Shelburne retirement community where he had been staying, said the Necrason Group, a Montpelier lobbying firm that worked with him. (Gram, 10/16)

Mrs. Davidson is now one of 293 patients around Munster, Ind., who have filed lawsuits against Dr. Gandhi and two other doctors in his practice claiming that they performed needless procedures. The Indiana state Medicaid program has started an investigation .... Lawyers for Dr. Gandhi and his practice, Cardiology Associates of Northwest Indiana, said they had not received any subpoenas, and the doctors denied any wrongdoing. In recent years, federal officials have brought several prominent cases against cardiologists and hospitals, accusing them of performing unnecessary procedures like inserting stents into coronary arteries. While medical professionals say there is no indication that cardiology has more unnecessary procedures than, say, orthopedics, they do note that the specialty has come under increased scrutiny by regulators because the procedures tend to be reimbursed by Medicare and private insurance at significantly higher levels than those in many other specialties. (Creswell, 10/17)

Programs begun in the last two years to improve mental health services in Missouri are making substantial progress but much more work — and more money — are needed, state officials and mental health advocates said. Spurred by the deaths of 20 children and six adults at a school in Newtown, Connecticut in 2012, Gov. Jay Nixon's administration began looking to create or expand programs to help those with mentally illness, substance abuse or other behavioral health issues, said Mark Stringer, director of the Missouri Department of Mental Health. (Stafford, 10/17)

Rather than cut $4.7 million from mental health and substance abuse treatment providers, as Gov. Dannel P. Malloy called for last month, the state Department of Mental Health and Addiction Services plans to shift the cut elsewhere in its budget and delay the start of new programs. The tradeoff drew both criticism from proponents of one of the delayed programs and praise from those whose funding is being spared. (Levin Becker, 10/19)

Teen pregnancy continues to become much rarer than it used to be, mainly because many young people are more careful about sex than their parents and grandparents were, experts say. The rate has dropped by more than half in two decades, and by more than two-thirds since its peak in the late 1950s. In Iowa last year, fewer than 20 babies were born for every thousand women ages 15 through 19, according to new figures from the state health department. That level, which is a record low, marks a 10 percent decline in one year. Just since 2007, Iowa’s teen birth rate has fallen nearly 40 percent. (Leys, 10/17)

Iowa has convicted just one person since changing a state law last year covering the criminal transmission of infectious diseases such as HIV. Adam Musser could become the second. Musser, 34, of Coralville is accused of exposing multiple partners to HIV despite, police say, knowing he was infected. At least five women have brought charges against him, claiming he had unprotected sex with them and lied when asked if he was disease-free. He has pleaded not guilty to all counts. (Gruber-Miller, 10/16)

Screening might soon take on a whole new meaning for you and your family doctor. Starting Nov. 2, four OhioHealth-employed doctors will see a small number of their established patients for primary-care visits via video and online consultations. (Sutherly, 10/19)

A community college in the Bronx is getting a $10.7 million federal grant to train students for health-care jobs such as certified nurse assistant and patient care technician. Hostos ... Community College announced the five-year grant from the U.S. Department of Health and Human Services on Friday. It is the largest grant in the 47-year history of the college. (10/16)

Health care advocates are pushing a bill aimed at increasing children's access to healthy food in Massachusetts. Supporters say the bill takes a holistic approach to children's well-being by improving access to food assistance. The bill also aims to reduce barriers to emergency shelter and ensure all children are screened for medical issues and can get to medical appointments. (10/17)

In years when Social Security beneficiaries get no inflation bump, their Medicare premiums can’t go up — except for roughly a third of retirees, who must shoulder all of the burden of rising costs. Consequently, about 15 million seniors are looking at premium spikes of up to 50 percent for Part B, the program that covers outpatient care. A typical increase would be from about $105 per month to $159, according to a Congressional Research Service report. And older Americans are howling in protest, to a Congress that’s already having trouble meeting deadlines regarding the budget and the federal debt ceiling. (10/17)

Last Thursday the Social Security Administration announced next year’s cost of living adjustment for retiree benefits, and the news is not good. Thanks largely to falling gasoline prices, the index used by Social Security to adjust beneficiary payments for inflation is below what it was a year ago. That means no increase in seniors’ monthly Social Security checks. At the same time, millions of seniors will have to pay much higher Medicare premiums. On top of that, every beneficiary will have to pay more up front before Medicare covers their doctors’ bills. Although a political solution would block the increase, the problem will not be solved without structural reforms. (Joseph Antos, 10/19)

It's certainly true that millions of elderly people will face higher premiums for Part B, an optional but essential part of Medicare that covers doctors' charges and outpatient care bills. But it's just not true that nearly one-third of Medicare beneficiaries will face record increases in their premiums. Under federal law, enrollees in Medicare Part B pay one-fourth of its costs, with federal taxpayers essentially covering the rest. ... consider who's in the category being squeezed. The largest segment is nearly 11 million seniors and disabled Americans with incomes so low, they are also enrolled in Medicaid, the joint federal-state insurance program for the impoverished. Medicaid pays their Part B premiums, which means that federal taxpayers will have to fork over about $3 billion more, and state taxpayers about $2 billion. In California, the state's tab could be more than $500 million. (Jon Healey, 10/16)

The idea of Medicaid expansion isn’t going away. Not when the governor is pushing it, and not when he’s getting strategic about how to do that. It’s certainly not going away now that the state is facing up to $200 million in budget cuts. That’s because Gov. Matt Mead understands one key thing: Expanding Medicaid to 17,000 low-income adults is good for Wyoming. (10/18)

Now that the Utah Legislature has rightly rejected (again) a flawed proposal to expand Medicaid under Obamacare, the question is: What do we do now? ... The reason Utahns in the coverage gap do not have health coverage is that they cannot afford it — they are in poverty. Instead of addressing this moral issue, Medicaid expansion largely ignores it and simply tries to relieve one of poverty's symptoms. ... [An alternative] should address the fundamental reasons Utahns are in serious poverty. For a portion of the Medicaid expansion population — commonly referred to as the "medically frail" — this reason is their health status. Giving this targeted group access to Medicaid makes sense, whether that be the current Medicaid program or a targeted, Healthy Utah-style pilot program. (Derek Monson, 10/17)

Failed again is yet another attempt to pass Medicaid expansion and bring back to our state more than $700 million each year in tax money Utahns have already paid to the federal government. The most infuriating twist of this most recent tale was to hear the speaker of the House, Greg Hughes, say that Medicaid expansion would not be considered in our House until 38 House Republicans supported it. Why is that so outrageous? Because it means Utah more closely resembles the former Soviet Union than a democratic republic. (Brian S. King, 10/17)

It is getting harder for some legislators to argue against giving the dignity of affordable healthcare to about 100,000 of our Utah neighbors — especially when the federal government picks up the vast majority of the bill. ... Instead of facing this, somehow, the issue has now become how can this state possibly pay what amounts to about $50 million to $70 million to allow the impoverished access to life sustaining health care. This is about one-half of one-percent of a $14 billion Utah state budget — pocket change when it comes to running a state. (Scott B. Hayashi, 10/16)

The Cadillac plan tax would, if implemented, be a powerful force for containing health care costs, but it would not be painless or without consequences. It would be nice to think that there is some magic pixie dust for controlling health costs. Sadly, that kind of thinking is rooted in fantasy, not reality. Opposition to the Cadillac plan tax is building, on both political and substantive grounds. However, writing its epitaph is still somewhat premature, as there is no consensus on how to replace the revenues it raises or how to constrain health care spending in some alternative way. When a new president takes office in 2017, this may be one of the biggest health care issues awaiting him or her. (Larry Levitt, 10/15)

[I]mproper payments [by federal agencies] are, by definition, indefensible, and they’ve totaled $1 trillion since fiscal 2003, the first year in which the GAO produced a government-wide estimate. That’s not chump change. The battle against them, therefore, is a battle to protect the legitimacy of active government itself. ... This is especially true given the GAO’s finding that three-quarters of the improper payments come from just three programs — Medicare, Medicaid and the Earned Income Tax Credit — all of which are meant to help the elderly and the poor. Nearly 10 percent of Medicare’s $603 billion in outlays last year was improperly paid. (10/18)

Addiction and overdose deaths are seldom the stuff of presidential campaigns, but with an estimated two people dying every hour from overdoses of prescription pain medications, this primary season is different. ... Addiction to pain relievers containing opioids and to heroin — which many medication addicts turn to when opioids become more expensive and harder to obtain — is ravaging communities across the country. In New Hampshire, site of the first presidential primary, overdose deaths from opioids have doubled since 2009 and deaths from heroin have quadrupled. Voters are looking for solutions to an epidemic .... doctors are at the center of the problem and need to be at the center of any solution. Yet, too few have even joined the battle. (10/18)

Prescription drug monitoring programs (PDMPs) are incredibly useful patient safety tools. What health care provider (whether a pathologist or a pediatrician) would not benefit from knowing what controlled substances his patients are taking? However, I am concerned that mandating that clinicians check these databases before prescribing opioid pain relievers would restrict, rather than improve, patient care. (Gregory Terman, 10/18)

There is a way to keep [prescription] prices low while encouraging drug companies to innovate: Look to Europe and elsewhere, where drug prices are a fraction of those in the United States. Germany, Spain, Italy and a half dozen other countries have pushed drug prices lower with a system called reference pricing. ... A study published in the American Journal of Managed Care found that price reductions ranged from 7 percent to 24 percent. (Austin Frakt, 10/19)

[T]hanks to ... vociferous opposition, an increasing number of Americans view vaping as no safer than smoking, which is absurd. And e-cigarette manufacturers like NJOY can’t set them straight: The law giving the Food and Drug Administration regulatory authority over tobacco products, which passed in 2009, prohibits e-cigarette companies from making reduced-harm claims unless they jump through some near-impossible hoops. Thus, NJOY has no way to convey to adult smokers the critical message that e-cigarettes could save their lives. (Joe Nocera, 10/16)

People should be able to take medical leave, particularly during and after pregnancies, without worrying about getting fired or going broke. This is both a humane goal and, given that it promotes healthy childbearing and stable families, an investment in the nation’s future. Federal law in this area falls short. The 1993 Family and Medical Leave Act requires employers to offer 12 weeks of unpaid leave, but the law covers only about 60 percent of workers, according to the Council of Economic Advisers . Moreover, for those whose employers don’t offer paid leave, taking time off may be unaffordable. (10/17)

That ballyhooed new California law allowing terminally ill patients to end their suffering by swallowing a lethal pill won't take effect any time soon. And nobody knows when it will. Conceivably, it might not be until late next year — or even 2017. First, the Legislature must adjourn its special session on healthcare financing. Then 90 days later, the "right to die" act can become real. You probably haven't been paying much attention to the Legislature's special session. Don't feel guilty. Neither has the Legislature. (George Skelton, 10/19)

It’s no great surprise that conservative groups such as Americans for Prosperity are chiming in on the debate over health care regulation in Virginia. The only surprise is that it took them this long. After all, the rules at issue — a system requiring that hospitals and other providers obtain a Certificate of Public Need from the state for new facilities or equipment — provide a costly and an outdated solution to a problem that was solved long ago. (10/18)