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A change in government procedures has led to a big jump in people losing coverage under the Obama health care law because of immigration and citizenship issues. More than 400,000 had their insurance canceled, nearly four times as many as last year. The Obama administration says it is following the letter of the law, and this year that means a shorter time frame for resolving immigration and citizenship issues. But advocates say the administration's system for verifying eligibility is seriously flawed, and consumers who are legally entitled to benefits are paying the price. (Alonso-Zaldivar, 9/12)

Don’t be surprised if you feel a pinch during open enrollment this fall, especially if you’re generally pleased with the generosity of your employer’s health benefits. A looming federal excise tax might be partly to blame. In 2018, the so-called Cadillac tax will take effect and is expected to cost U.S. employers about $3 billion, according to a report last month by the Congressional Research Service. That amount is expected to continue to grow in subsequent years. (Sutherly, 9/14)

A high-profile Medicare experiment pushing doctors and hospitals to join together to operate more efficiently has yet to save the government money, with nearly half of the groups costing more than the government estimated their patients would normally cost, federal records show. (Rau and Gold, 9/14).

ACOs have become one of the most talked about new ideas in Obamacare. Here are answers to some common questions about how they work. (Gold, 9/14).

A Utah doctors' group has come out against a proposal from state officials to tax physicians and others to defray the cost of expanding Medicaid. Utah Medical Association CEO Michelle McOmber said physicians get paid less when they see patients covered by Medicaid and doctors shouldn't be required to help pay the $78 million annual cost of growing the government program. (Price, 9/11)

No government shutdown this year, Republican congressional leaders say. But with Congress, it's never easy. A band of conservatives say they won't back legislation financing government agencies unless the bill blocks federal payments to Planned Parenthood. A partial shutdown will occur Oct. 1 unless lawmakers provide money to keep government functioning. With time running out, GOP leaders haven't said how they will handle conservatives' demands while also rounding up enough votes to prevent a shutdown. (Fram and Taylor, 9/13)

With the Iran nuclear deal debate essentially over, Congress now turns to several other pressing issues, particularly agreeing on a temporary spending bill to avoid a partial government shutdown on Oct. 1. Leaders of the Republican-controlled Congress have vowed to avoid an unpopular government shutdown. But the party’s most conservative caucus could still create problems, especially if members attempt to link the spending bill to de-funding Planned Parenthood. (9/13)

The House will vote next week on legislation to defund Planned Parenthood for one year while Congress conducts an investigation into controversial undercover videos regarding the organization's use of fetal tissue donations. Next week's vote comes as the clock is ticking for Congress to find a way to avoid a government shutdown on Oct. 1. Many conservatives want to block any government spending on Planned Parenthood, which other Republicans worry could spark another disastrous shutdown, such as 2013's over the healthcare law. (Marcos, 9/11)

Very little has come easy to the VA hospital project in Aurora, and that pattern is threatening to repeat itself later this month when agency officials attempt to get $625 million more for the over-budget facility. The added $625 million in federal dollars is crucial for the unfinished veterans hospital. ... For now, there is a general agreement between Congress and the administration on how to drum up money for the hospital. But an unrelated fight over abortion, government spending and Planned Parenthood could complicate the effort. (Matthews, 9/12)

Senate Majority Leader Mitch McConnell said in an interview Friday he will back a plan to fund the government into December with no conditions, rejecting in his strongest terms yet calls from within his party to defund Planned Parenthood as part of a larger budget bill. “It’s an exercise in futility," the Kentucky Republican said of a strategy that would likely provoke a government shutdown. "I’m anxious to defund Planned Parenthood" but "the honest answer of that is that’s not going to happen until you have a president who has a similar view." (Everett and Bresnahan, 9/11)

Senate Majority Leader Mitch McConnell embraces the fight to defund Planned Parenthood though he thinks it can't be won by threatening to shut down the U.S. government, a spokesman said Friday. "It won't solve the problem," said the spokesman, Don Stewart, of McConnell's view. That suggests that the Kentucky Republican will push to keep a proposal to defund Planned Parenthood out of a government funding bill. For now, Stewart said McConnell will wait to see what's in a spending bill that comes from the House. (House, 9/11)

McConnell appears to have sufficient support to beat back against [Sen. Ted] Cruz’s plans to force a government shutdown showdown over Planned Parenthood funding, no matter what insults the Texan hurls. ... But as [House Speaker John] Boehner grapples with his own job security amid constant threats from the right, McConnell can at least focus on a few discrete policy targets without having to worry about a coup. He wants to force Democrats to again express support for the Iran nuclear agreement, and to vote against a bill to ban abortions after 20 weeks. ... This is not what the conservative base wants to hear. Led by Cruz, the House Freedom Caucus and conservative media figures like Mark Levin and Erick Erickson, the party’s right flank is agitating for a major showdown over funding Planned Parenthood. (Everett and Bresnahan,9/14)

The latest revolt to Mr. Boehner’s leadership began in late July when Rep. Mark Meadows (R., N.C.) submitted a measure aimed at pushing the speaker out of his post and enumerating a long list of grievances. Conservatives said they are watching to see how GOP leaders fare during September battles over Planned Parenthood and government funding levels to decide if they will attempt again to hold a floor vote on the measure. ... Mr. Boehner will have a harder time this month reaching a compromise with the 31 Republicans who have said they won’t vote for any spending bills that retain funding for Planned Parenthood after videos showed officials with the group discussing fees for procuring fetal tissue for medical researchers. This week the House will vote on a bill freezing all federal funding for Planned Parenthood for a year, while congressional investigations of the videos continue. (Peterson and Hughes, 9/13)

A new Novartis AG drug to treat heart failure should cost 17 percent less than its list price of $4,560 per year to keep health costs in line with growth in the overall U.S. economy, according to the nonprofit ICER. In a draft report released on Friday, the Boston-based Institute for Clinical and Economic Review set its "value-based" price for Entresto at $3,799 annually. The independent ICER evaluates clinical and cost effectiveness of new medicines. (Beasley, 9/11)

Two new treatments for congestive heart failure cost too much in the short term and would drive up spending by insurers and government programs, a nonprofit group said in an analysis released Friday, just days after the same researchers took similar aim at expensive new cholesterol drugs. The treatments – one a $17,750 sensor implanted in the pulmonary artery and the other a $4,600-a-year prescription pill – are the first new treatments in more than a decade for heart failure, a life-threatening condition. (Appleby, 9/14)

Amgen Inc said on Friday it had asked the U.S. Food and Drug Administration to approve a monthly single-dosing option for its recently approved cholesterol drug, Repatha. The FDA approved Repatha - one of two expensive treatments in a new class of injectable "bad cholesterol"-lowering drugs called PCSK9 inhibitors - in late August. A similar drug from Regeneron Pharmaceuticals Inc and Sanofi SA, called Praluent, was approved in July. (9/11)

Aiming lower saves more lives when it comes to controlling high blood pressure, says a major new study that could spur doctors to more aggressively treat patients over 50. Patients who got their blood pressure well below today's usually recommended level significantly cut their risk of heart disease and death, the National Institutes of Health announced Friday. (9/11)

For years doctors have been uncertain what the optimal goal should be for patients with high blood pressure. The aim of course is to bring it down, but how far and how aggressively remained a mystery. There are trade-offs — risks and side effects from drugs — and there were lingering questions about whether older patients needed somewhat higher blood pressure to push blood to the brain. The study found that patients who were assigned to reach a systolic blood pressure goal below 120 — far lower than current guidelines of 140, or 150 for people over 60 — had their risk of heart attacks, heart failure and strokes reduced by a third and their risk of death reduced by nearly a quarter. (Kolata, 9/11)

The new research advises people with high blood pressure to keep their “systolic” pressure — the top number in the reading that health-care providers routinely tell patients — at 120 or below. Clinical guidelines have commonly called for systolic blood pressure of 140 for healthy adults and 130 for adults with kidney disease or diabetes. Physicians have complained that there was no clear evidence for any specific standard on systolic blood pressure, compelling them to decide on their own how aggressive to be in treating the condition. Now there is a number, and it is significantly lower than the current targets. (Bernstein, 9/12)

The nation’s health care providers are under orders to start using a new system of medical codes to describe illnesses and injuries in more detail than ever before. The codes will cover common ailments: Did a diabetic also have kidney disease? But also included are some that are far less common: whether the patient was crushed by a crocodile or sucked into a jet engine. (Pear, 9/13)

Today, the stethoscope remains a fixture in medicine, draped around the shoulders of doctors. It's also overdo for a makeover. Now Eko Devices, a Silicon Valley start-up, has received federal Food and Drug Administration approval for its digital stethoscope, which brings the power of modern technology to an already essential device. The implications could be huge for patient care. (McFarland, 9/11)

Two non-politicians, businessman Donald Trump and retired neurosurgeon Ben Carson, dominate the contest for the Republican nomination, together accounting for more than half of the potential vote as support for traditional politicians continues to decline, according to a new Washington Post-ABC News poll. In the contest for the Democratic nomination, Hillary Rodham Clinton has lost significant ground over the past two months, as she has struggled to manage the controversy over her use of a private e-mail server while secretary of state. (Balz and Clement, 9/14)

Not long ago, Mr. Carson seemed the most far-fetched of candidates. He had compared President Obama’s health care law to slavery and was disinvited to speak at Johns Hopkins, his former employer, over comments about gay people. But he has found a legitimacy in his party thanks to his embrace from conservative voters, especially evangelical Christians. “Carson’s grass-roots support gives him a staying power that many of the other candidates don’t have,” said Erick Erickson, the founder of RedState, an influential conservative blog. But the real tests lie ahead, he cautioned: “Ultimately, votes are more important than money.” (Lichtblau and Gabriel, 9/13)

Ohio Gov. John Kasich said Saturday that he doesn't believe Congress should shut down the federal government in the fight to defund Planned Parenthood. Speaking to college Republicans at Saint Anselm College in New Hampshire, Kasich was asked by one of the audience members about the debate in Congress about the controversial women's health organization. (Kopan, 9/13)

California lawmakers on Friday approved legislation that would make the state one of only a handful to grant terminally ill patients the authority to end their lives with the assistance of a physician. The measure, known as the End of Life Options Act, passed the California Senate on a 23-14 vote. (Lazo, 9/11)

The bill would allow mentally competent patients to request a prescription that would end their lives if two doctors agree the patients have only six months to live. The measure, based on a similar law in Oregon, passed the state Senate on Friday on a vote of 23-14, after passing the Assembly on Wednesday. (Bernstein, 9/11)

If Gov. Jerry Brown signs the bill, California would become the fifth state to allow doctors to prescribe lethal medication to terminally ill patients who request it, after Oregon, Washington, Vermont and Montana. “Our hope, our fervent hope, is that Gov. Jerry Brown will sign this bill and bring relief to hundreds of dying Californians,” said Toni Broaddus, state campaign director for Compassion & Choices, an advocacy group. (Dembosky, 9/14)

“This is a real test for Jerry Brown,” said the Rev. Michael Russo, a Roman Catholic priest and retired professor of political communication at St. Mary’s College in Moraga. “It’s a real hot potato he’s been handed.” Brown, who studied to be a Jesuit priest in his younger years, has declined to speak publicly about the aid-in-dying legislation, which cleared its final legislative hurdle just hours before the end-of-session deadline Friday. (Gutierrez, 9/11)

Brown has not tipped his hand. He has 12 days to sign or veto the legislation, which passed the California Legislature over strong opposition from the Catholic Church and on the eve of Pope Francis’ visit to the U.S. If Brown does nothing, the bill becomes law and takes effect next January, making California the fifth state in the nation to allow doctors to prescribe life-ending drugs to dying patients. (Pradhan, 9/11)

Gov. Bobby Jindal's administration announced a new approach to defunding Planned Parenthood on Friday (Sept. 11), saying it will terminate the organization's Medicaid contracts "for cause." The change comes as a federal judge was set to rule on a request to block Jindal from canceling the contracts without cause, a move the administration had defended since announcing the defunding on Aug. 3. The administration now says Planned Parenthood is "in violation for entering into a settlement agreement under the federal False Claims Act in 2013." (Litten, 9/11)

Gov. Bobby Jindal's administration is trying a new approach to remove Planned Parenthood from Louisiana's Medicaid program, this time saying it has a reason to block the clinics. Jindal, an anti-abortion Republican running for president in 2016, had initially ended Medicaid provider agreements with Planned Parenthood without providing a reason. The administration said state law allowed cancellation with a 30-day notice. But a federal judge questioned that reasoning. Planned Parenthood had asked the judge to consider halting Jindal's maneuver. (DeSlatte, 9/11)

Louisiana said it will cut off Medicaid funding to Planned Parenthood on Monday, switching tactics in a legal fight against abortion providers. State health officials said the organization violated state law by entering a $4.3 million false-claims-act settlement in Texas two years ago. The move may end the clinics’ bid to hold on to their Medicaid funding through a court challenge. The clinics contend the state can’t terminate their contracts without evidence of wrongdoing. (Calkins, 9/12)

Planned Parenthood filed a federal lawsuit Friday challenging Arkansas’ cancellation of its Medicaid provider contract, which Gov. Asa Hutchinson terminated amid concerns about secretly recorded videos released by an anti-abortion group. (Lauer, 9/11)

South Carolina's public health agency suspended the licenses of two of the state's three abortion clinics Friday and threatened to close them—actions that an official at one of the centers called "extreme." The Department of Health and Environmental Control issued suspension orders for Planned Parenthood's Columbia clinic and the Greenville Women's Clinic, citing violations found during recent inspections. The violations cited at both places include incomplete records, performing an abortion sooner than 60 minutes after an ultrasound and not properly disposing of aborted fetuses. According to manifests, the fetuses were sterilized with steam and taken to a landfill, rather than incinerated or buried as required by law. (9/12)

It was painful to hear but ultimately seemed the best course to Jessica Mann and her family. Because of a dangerous tumor in her brain, her doctor gently suggested that she take steps to make sure that she could not get pregnant again. ... Mann, 33, who is due to have her third baby next month, decided that while she was under anesthesia during the birth, she would undergo a tubal ligation — a procedure that would prevent further pregnancies. But her hospital said no. Genesys Regional Medical Center, which is Catholic, denied the request on religious grounds. ... Mann’s situation is the latest to draw attention to the simmering debate over religious liberties and how far people and organizations of faith may go in denying people services that conflict with their beliefs. (Somashekhar, 9/13)

The upcoming closure of a hospital in the southeast Kansas community of Independence has highlighted the problems faced by rural medical providers in states that have refused to expand their Medicaid programs. "The climate of health care these days is very challenging, and particularly for small rural hospitals like ourselves," said Joanne Smith, spokeswoman for Mercy Hospital in Independence. "We are facing decreased reimbursement; the fact that Kansas did not expand Medicaid has been a significant factor in our reimbursement, and declining population here in our corner of Kansas, as well as a lot of outmigration of patients to other communities for their health care." According to the National Rural Health Association, at least 55 rural hospitals across the nation have closed since 2010, and 283 more are at risk of closure. (9/13)

A small-town mayor who's already walked more than 550 miles to bring attention to the closure of the town's hospital is putting more mileage on his sneakers in hopes of getting a certificate that would allow the facility to reopen. Mayor Adam O'Neal left his coastal town of Belhaven on Sept. 8 and plans to finish the 130-mile walk to the state's Capitol on Wednesday, when he hopes to meet with Gov. Pat McCrory. (Waggoner, 9/12)

In a 300-page report released Friday evening, the Centers for Medicare and Medicaid Services, or CMS, detailed dozens of violations in the lab at Cleveland Clinic's Marymount Hospital in Garfield Heights. The CMS report cites wide-ranging violations of federal standards. These include numerous failures to follow established procedures with regard to testing blood samples, maintaining and checking the temperature of blood products, calibrating machinery, labeling supplies, and using expired materials to perform tests. (Zeltner, 9/11)

Sheila Rush has been fighting for an adult trauma center on the South Side for five years. In August 2010, her 19-year-old son Damian Turner was shot in the back just blocks from the University of Chicago Medical Center — which doesn’t have an adult trauma center. He died after paramedics drove him nine miles away to a downtown hospital. On Friday, she stood outside the Hyde Park hospital surrounded by members of the group she helped form — the Trauma Care Coalition — who held signs that read “Trauma Care Won.” The “Won” used to read “Now” on the group’s posterboards. On Friday, the word was flipped as a sign of victory. (Sfondeles, 9/11)

If a child were to build a hospital out of Legos it might look like the new Children's Hospital of Michigan Specialty Center, an irregularly shaped, multicolored facility slated to open in February in the Detroit suburb of Troy, Mich. “Everybody drives by it and says, 'I know that's for kids, but I'm not sure what it is,'” said Ron Henry, chief facilities engineering and construction officer at Tenet Healthcare's Detroit Medical Center, which is building the facility. The look is appropriate because the facility is indeed for children. But the Lego analogy—building in pieces with the ability to easily convert the structure into something else—is apt for another reason. (Royse, 9/12)

An effort to craft a new tax on health plans to stave off a looming plunge in federal funding for Medi-Cal has stalled, the Brown administration said Friday. The health plans tax was at the top of the agenda for a special session on healthcare that was convened by Gov. Jerry Brown. California currently imposes a tax on plans that accept Medi-Cal patients, and the revenue goes into the state’s general fund to help pay for Medi-Cal and other services. (Mason, 9/11)

On Friday, the mayor lowered the boom on retirees — by completing a three-year phaseout of the city’s 55 percent subsidy for retiree health care and assuming that a lawsuit that seeks to reinstate the subsidy of $108.7 million a year falls flat. (Spielman, 9/11)

A woman called Emily, tears streaming down her face, stood on a ledge threatening to jump. For 15 minutes, a police sergeant used the common thread that connects them — they're both mothers — to gradually talk her out of killing herself. The scene, played out earlier this month at the New York Police Department's training facility, was an act, part of a training program meant to help patrol officers in the nation's largest department better handle the growing number of interactions they have with people in emotional or mental distress. (9/13)

The Texas Health and Human Services Commission will likely hear an earful when it holds a public hearing later this week. Agency officials meet Friday morning “to receive comment on proposed Medicaid payment rates for physical, occupational and speech therapy provided by comprehensive outpatient rehabilitation facilities/outpatient rehabilitation facilities, home health agencies and independent therapists,” the public notice reads. The agency finds itself in a tough position because a growing number of state legislators, including some influential Republicans such as Reps. Four Price and John Smithee, fear a plan to cut Medicaid rates — which the GOP-dominated Legislature approved two years ago — may do more harm than good. (Rangel, 9/14)

A commission appointed by Missouri’s governor after the fatal shooting of Michael Brown, an unarmed black teenager, by a white police officer is calling for sweeping changes across the St. Louis region on matters of policing, the courts, education, health care, housing and more. In a 198-page report to be made public in Ferguson, Mo., on Monday afternoon, the commission lays out goals that are ambitious, wide ranging and, in many cases, politically delicate. Among 47 top priorities, the group calls for increasing the minimum wage, expanding eligibility for Medicaid and consolidating the patchwork of 60 police forces and 81 municipal courts that cover St. Louis and its suburbs. (Davey, 9/14)

State officials say a recent Medicaid-overpayment settlement by an Iowa nursing home chain has no bearing on a controversy over whether patients from a state mental hospital should have been transferred to the company’s facilities. Signature Care Centers runs six nursing homes, including facilities in Perry and Primghar that accepted patients from the Clarinda Mental Health Institute before it closed. Two of the six elderly patients sent to those nursing homes died shortly after their transfers. The Johnston-based company recently agreed to repay $415,044 to the state and federal governments, according to federal prosecutors. The payments relate to what investigators in 2012 termed “credible allegations of fraud” in bills the company submitted to Medicaid. (Leys, 9/12)

A Perry nursing home mishandled the treatment of three patients transferred there from a state mental hospital, including one who died and another who suffered a broken leg, state inspectors have concluded. The Perry Health Care Center faces up to $13,500 in fines for its mistreatment of the three former state hospital patients, as well as a fourth resident, according to records obtained by The Des Moines Register. The Iowa Department of Inspections and Appeals report doesn’t name the patients or specify that they'd recently been transferred from the Iowa Mental Health Institute at Clarinda, which closed in June. (Leys, 9/12)

Colleen Scassellatti wants Iowans to know what has happened to her since she was transferred from the Clarinda state Mental Health Institute to the Perry Health Care Center. “I’m not happy here, but I’m running out of places to go,” she said from her nursing home bed. Scassellatti agreed to a reporter'a visit recently because she thinks it’s important for the public to understand the situation. (Leys, 9/12)

An Alabama Senate committee on Friday approved a cigarette tax and other revenue bills as legislators try to broker an agreement to minimize cuts to state services when the fiscal year begins Oct. 1. Legislators have 19 days to get a general fund budget in place or risk a shutdown of state government services. The first week of a special session on the budget brought progress, but not a solution, on how to handle a $200 million fiscal shortfall. (Chandler, 9/11)

Instead of having to go to the doctors, how about a physical, every day, without having to do anything at all? We visit a live-in laboratory in Fort Worth, Texas, designed for senior citizens. (Silverman, 9/14)

The average cost of a medical procedure or test — or even a basic office visit — can be one of the most elusive bits of information in health care. Now, drawing on data from tens of millions of insurance claims, a website backed by several major health insurers is making the information easily available to consumers in Milwaukee and other cities throughout the country. (Boulton, 9/12)

Presidential campaigns can be hesitant to put out policy proposals because these ideas are easily caricatured and attacked by political opponents. So, it takes some real courage to put plans in front of the electorate. That's why Bobby Jindal, Marco Rubio and Scott Walker deserve credit for their willingness to put forth thoughtful proposals to repeal the Affordable Care Act and replace it with sensible, patient-centered reforms. There are certainly policy differences between the three candidates' proposals, and voters would be well-served by a robust discussion about the distinctions between them. (Lanhee J. Chen, 9/13)

Right now, the U.S. accounts for a disproportionate share of the profits that make it attractive to keep looking for new drugs, precisely because we do not have a pricing board that attempts to hold down reimbursements to levels closer to marginal cost. That means we're providing a disproportionate share of the incentive for new research. Every so often, there is a clamor about lowering our prices and forcing other countries to pay their "fair share" of research costs, but there is no practical way to do it. So the only question is, are we willing to subsidize new research? (Megan McArdle, 9/11)

Two proposed mergers involving four of the nation’s biggest health insurers could reduce competition in an important industry. That’s why federal and state regulators need to closely study these deals and, if necessary, force the companies to sell some parts of their businesses. (9/14)

Section 9001 of the Affordable Care Act (ACA), set to take effect in 2018, imposes what it calls an “Excise Tax on High Cost Employer-Sponsored Health Coverage”, which has come to be known as the “Cadillac Tax.” This is a 40 percent tax on employer-sponsored health benefits that are defined as “excess benefits.” ... I’ll explain why some conservatives (or at least, some people who generally oppose the ACA) support the “Cadillac Tax” – or at least, think it’s a reasonable approach, if not the one they’d prefer. (Robert Book, 9/11)

Iowa’s experience with Obamacare’s Medicaid expansion has been turbulent. In 2014, state officials agreed to expand Medicaid, despite the fact that the Obama administration denied virtually all of their requests for flexibility. ... The program has seen double-digit premium hikes, one carrier becoming insolvent, both carriers eventually leaving the program, skyrocketing enrollment, cost overruns, and changes that make Medicaid enrollees less accountable. With that unfolding, it’s no wonder state officials announced in July 2015 that they were closing the Medicaid expansion waiver. (Jonathan Ingram and Josh Archambault, 9/14)

Five years ago, Congress brought some healthfulness to the National School Lunch Program , which spends more than $10 billion a year to feed about 30 million K-12 students. The law is up for renewal this month, and the School Lunch Industrial Complex is trying to make it less healthful again. Its arguments in favor of lowering nutritional quality for the nation’s children don’t add up, and Congress should reject them. (9/13)

President Obama signed an executive order on Labor Day requiring federal contractors to provide paid sick-leave benefits to employees and called on Congress to follow with a nationwide paid sick-leave law. His announcement emphasized standing up for the middle class. But there is scant evidence that mandatory paid sick-leave regulations help workers, and some evidence they do harm. (Maxford Nelson, 9/13)