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A million new customers have signed up for health insurance during the Affordable Care Act’s third open-enrollment season, Obama administration officials said on Wednesday, and call centers have been deluged with requests from others eager to enroll. The officials brushed aside reports of rising premiums and deductibles and concerns expressed by UnitedHealth Group and other insurers that say they are losing money in the new online insurance marketplaces, or exchanges. (Pear, 12/9)

Although premiums are increasing in most states, HealthCare.gov CEO Kevin Counihan says he's optimistic about a strong open enrollment season. Tuesday Dec. 15 will be the first big test: It's the deadline for consumers to sign up for subsidized private coverage that takes effect Jan. 1. (12/9)

Speaking to journalists, Slavitt said that some consumers are showing sophistication in scrutinizing the details of available plans before choosing coverage. Some 2 million people so far have used new features on HealthCare.gov that allow consumers to search whether a given health plan covers their medicine or includes their doctors. That online searching, Slavitt said, “means that people are not just ... going with the cheapest plan.” (Goldstein, 12/9)

The administration also says it won't be doing special enrollment periods for people who are shocked into wanting to sign up after they see their penalty at tax time for not having insurance, something they offered this year. Insurers have been critical of the unpredictability caused by these special periods — which are also offered for people in a variety of situations, such as those who move out of state, marry, divorce or lose their job. (O'Donnell, 12/9)

The officials cited the latest enrollment data as a reason for confidence in the long-term stability of HealthCare.gov, which was created under President Barack Obama's national healthcare law and sells individual insurance plans in 37 states. (Humer, 12/9)

Ten days before the deadline to get health insurance through Obamacare, 2.84 million people have signed up through U.S.-run marketplaces, the government said Wednesday. For the week that ended Dec. 5, the U.S. said that 804,338 people chose plans -- the biggest week of sign-ups since the markets opened on Nov. 1. The U.S. Department of Health and Human Services expects that millions more will be enrolled when people who had coverage for 2015 are automatically renewed this month, and when state-run markets, including California and New York, report their totals. (Tracer, 12/9)

The latest numbers from federal health officials show Florida is continuing to lead in enrollment on HealthCare.gov, with nearly 600,000 who have signed up so far. "We're so pleased with the reduction in uninsured,” U.S. Department of Health and Human Services Secretary Sylvia Burwell said after enrollment numbers were released Wednesday afternoon. “We also know there are still many folks in Florida who don't have coverage.” (Watts, 12/9)

Five weeks into open enrollment season, nearly 600,000 Floridians have signed up for coverage through the Affordable Care Act's insurance exchange at healthcare.gov, federal health officials reported Wednesday. Among the 38 states using the federal exchange, including Florida, about 2.8 million Americans have signed up for a plan, including about one million new consumers and about 1.8 million who renewed their coverage. (Chang, 12/9)

Federal officials say more than 11,000 West Virginia residents have signed up for the health insurance marketplace during the open enrollment period that began Nov. 1. Open enrollment runs through Jan. 31. However, people who need coverage starting Jan. 1 face a Dec. 15 deadline for signing up. (12/10)

Tennessee saw the number of people enrolled jump from 62,922 to 88,007 in just a week's span — a stunning increase in enrollment. An average of 3,583 people across the state signed up each day of that week, according to new numbers from the U.S. Centers for Medicare and Medicaid Services. (Fletcher, 12/9)

With five days left before the first sign-up deadline, officials expect a surge of people logging on to Healthcare.gov to make sure they have coverage starting Jan. 1. As of Dec. 5, a total of 120,375 people in Virginia had made plan selections on the Affordable Care Act marketplace. (Smith, 12/9)

The deadline is the first of several as part of the annual sign-ups for Obamacare, and this year there’s more incentive to participate because penalties for not having insurance continue to rise. ... It’s the first time that penalties are large enough that they exceed the cost of policies for some people, after income-based subsidies are applied. ... As of Dec. 5, 13,458 New Hampshire residents have signed up via the marketplace. It’s unclear how many are charging policies and how many had no previous health insurance. (Brooks, 12/10)

Individuals eligible to buy a health-insurance plan through a government-run marketplace will face an average penalty of $969 per household if they forgo coverage in 2016, according to a report issued on Wednesday. (Sutherly, 12/10)

California's biggest health insurers are among a select few to show a profit selling Obamacare policies. In the first year of the massive coverage expansion, California's three largest health insurers bucked the national trend of heavy losses and accounted for half of the gains reported under the Affordable Care Act in 2014. (Terhune, 12/9)

One of the five insurance companies on the federal health exchange in New Hampshire is unexpectedly backing out early this year. The CEO of Maine-based co-op Community Health Options says costs have simply gotten too high for them to continue. Under the Affordable Care Act, consumers can buy subsidized health insurance on the online federal marketplace. But those consumers tend to be the sickest, so they've got the highest healthcare costs. And CEO Kevin Lewis says that's pushing his company out of the individual market. (Rodolico, 12/9)

Community Health Options, a not-for-profit co-op insurance company based in Maine that also sells health plans in New Hampshire, will limit individual enrollments later this month because of “higher-than-expected claims costs.” ... The decision to halt enrollment early will not affect current members, and Community Health Options still plans on pursuing small employers into next year. (Herman, 12/9)

UnitedHealthcare plans to stop paying commissions for insurance policies offered through exchanges beginning Jan. 1, a move brokers say signals the company’s retreat from Obamacare business. (Levin Becker, 12/9)

The White House, against the will of some congressional Democrats, was resisting Republican attempts to pare taxes on medical devices and costly health insurance policies, which were enacted under Obama's 2010 health care law to help pay for that overhaul. "We're always willing to engage in conversations about ways to strengthen the ACA that don't harm health care access, affordability, quality or the middle class," said White House spokeswoman Katie Hill, using the acronym for Obama's Affordable Care Act. (Fram, 12/10)

The House on Friday will vote on a short-term funding measure to keep the government open until Dec. 16, and additional continuing resolutions are possible. With both sides confident that time is on their side, there is no pressure for a quick agreement; for Speaker Paul Ryan and Minority Leader Nancy Pelosi, a good deal is more important than a quick deal. Politically, Ryan can afford to continue passing short-term funding bills to keep the government open while he tries to reach an agreement. (Bresnahan, Sherman and French, 12/9)

Congress is targeting funding sources for the Affordable Care Act as it works to reach a budget agreement before the end of the year. Republicans want the omnibus budget package to extend funding restraints that insurance companies and failing co-op insurers say are forcing them out of the ACA's insurance exchanges. (Muchmore, 12/9)

Prominent ObamaCare supporters are lashing out against a plan backed by other Democrats to delay the contentious “Cadillac tax” for two years, warning that the delay would blow a hole in the healthcare law. A two-year suspension of the 40 percent tax on high-cost health insurance plans is expected to appear in a year-end package of tax breaks known as “tax extenders,” though negotiations aren’t yet complete. (Sullivan, 12/10)

White House spokesman Josh Earnest said Wednesday that the Obama administration would “strongly oppose” any efforts to repeal ObamaCare’s so-called Cadillac tax, but stopped short of a full veto threat. While Earnest said he would not comment on ongoing negotiations, he delivered his strongest criticism yet of efforts to repeal — or at least pause — the Cadillac tax as part of the year-end tax extenders package. (Ferris, 12/9)

The Senate Special Committee on Aging is holding the first of a series of hearings Wednesday into why the prices of medicines that have been on the market for decades are suddenly climbing. The investigation by the Senate committee, led by Maine Republican Susan Collins and Missouri Democrat Claire McCaskill, is focusing on four pharmaceutical companies that bought the rights to certain drugs, and then dramatically increased the prices. (Kodjak, 12/9)

The leaders of a Senate panel are condemning four companies for aggressively increasing prices for prescription drugs. They say the companies have exploited a system lacking in competition to hike prices for critically needed medicines. An investigation by the Senate Special Committee on Aging focuses on Turing Pharmaceuticals, Valeant Pharmaceuticals, Retrophin Inc. and Rodelis Therapeutics. The first two faced especially harsh criticism. (12/9)

The proposal would cut in half the portion of the federal payroll tax paid by employees for five years, reducing it from 6.2% to 3.1%. It also calls for greater technical assistance to the island and a series of reports on the territory’s public pensions and health care. (Timiraos, 12/9)

The Republicans’ measure would include up to $3 billion in cash relief, a payroll tax break for residents of the island and a new independent authority that could borrow for Puerto Rico — but with no taxpayer guarantee. ... To get the $3 billion, the bill proposed tapping a $12 billion public-health fund created under the Affordable Care Act, for research and preventive medicine programs nationwide. The bill summary said the money was as yet “unobligated,” and could be “repurposed” with federal supervision to help tide Puerto Rico through an alarming cash squeeze this winter. ... On the details of how to revive Puerto Rico’s failing pension system, or changing the way doctors on the island are paid by federal programs like Medicare, the bill proposes only further study. (Williams Walsh, 12/9)

Lawmakers from New York are leading a determined campaign for legislation to compensate and provide health care for first responders and survivors of the Sept. 11, 2001, attacks. The bill has languished in Congress despite widespread support. (Peterson, 12/9)

Republican presidential candidate Marco Rubio, seeking to win over conservative voters, told Reuters he was the only one running with a victory against President Barack Obama's signature health law. Rubio, a U.S. senator from Florida, has touted his effort to prevent what he called a potential taxpayer bailout of insurers as his rivalry heats up with U.S. Senator Ted Cruz of Texas, a chief critic of the 2010 Obamacare law. (12/9)

Marco Rubio is using a real-life example to talk about his commitment to the Department of Veterans Affairs — his big brother. The presidential candidate and Florida senator will appear in Iowa Thursday with his brother Mario, an army veteran. This is Mario Rubio's first time on the 2016 campaign trail. According to his prepared remarks, Sen. Rubio will offer ideas to reform a system that was exposed in scandal over long waits for those seeking health care and falsification of records to cover up delays. (Lucey, 12/10)

Republican presidential hopeful Ben Carson wants to raise the Medicare eligibility age to 70 as part of a health care plan released Wednesday that would reshape the popular program for the nation's elderly in addition to overhauling Medicaid and repealing President Barack Obama's health care law. The retired neurosurgeon is set to outline his health care plan for the first time on Wednesday while campaigning in Michigan. (12/9)

Republican presidential candidate Ben Carson unveiled a broad outline Wednesday to reform health care, detailing a restructuring of Medicare that would raise the eligibility age to 70. Carson's proposal rests on tax-protected “health empowerment accounts” — a de facto expansion of health savings accounts, which in Carson's vision would be opened for each citizen upon birth and grow over time based on individual contributions. (DelReal, 12/9)

Ben Carson is trying again. After float­ing a plan that would reportedly have scrapped Medicare and Medicaid, he took another shot Wednesday when he unveiled a new health care proposal. The neurosurgeon-turned-presidential-candidate’s latest iteration touts “more freedom and less government” and aims to empower the doctor-patient relationship. It repeals Obamacare and makes changes to both Medicare and Medicaid, yet doesn’t abolish the programs. (Roubein, 12/9)

The recent battles to win new four-year labor agreements with Detroit auto makers helped the United Auto Workers union reverse nearly a decade of givebacks, but the contracts allow for a change to health care plans that could reverberate on workers. Left open in the drive to win higher pay for union members was how the auto makers will handle their contracts’ health-care costs when a federal tax on high-cost health insurance plans begins in 2018. (Rogers, 12/9)

Elizabeth Holmes rarely slips out of character. When she responds to questions in an interview or on a conference stage, she leans forward, leg crossed ankle over knee in a half-lotus manspread power pose. She lowers her voice an octave or two, as if she’s plumbing the depths of the human vocal cord. Although she hates it being remarked upon, her clothing, a disciplined all-black ensemble of flat shoes, slacks, turtleneck, and blazer buttoned at the waist, is impossible not to notice. She adopted this uniform, as she calls it, in 2003, when she founded Theranos, a company seeking to revolutionize the medical diagnostics industry by doing tests using only a few drops of blood. (Kolhatkar and Chen, 12/10)

Increases in drug deaths, obesity and diabetes offset national declines in smoking, deaths from heart disease and infant mortality, a new report shows, but some states' dramatic improvement brightened the overall picture. The 2015 version of America’s Health Rankings showed there was little progress among many of the poorest, sickest states, with some of the southern states – Louisiana, Mississippi and Arkansas – remaining at the bottom of the list. (O'Donnell and Ungar, 12/10)

More states improved than worsened over time on most measures examined in new health rankings out Wednesday — the first since the Affordable Care Act’s coverage expansions took effect. The Commonwealth Fund Scorecard on State Health System Performance looks at access to medical care, prevention and treatment of disease, avoidable hospital use and cost, healthy lives and health equity. (Ungar, 12/9)

Minnesota is the fourth-healthiest state, according to a new analysis of the nation's health. Minnesota moved up two spots from last year's America's Health Rankings report, in part because of decreases in smoking, cardiovascular deaths and physical inactivity. (Benson, 12/10)

Georgia’s ranking on a health system score card has slipped to 46th in the nation. The Commonwealth Fund’s 2015 score card, which ranked the 50 states plus the District of Columbia, was released Wednesday. It noted that Georgia had improved on 11 measures, including having more children and adults with insurance, and more children up to date on vaccines. Still, the state slipped from its ranking of 45th in 2014. (Miller, 12/9)

Though both showed improvements, Kansas and Missouri continue to rank in the bottom half of states on measures of health care access, quality, costs and outcomes, according to a new report by the Commonwealth Fund. Overall, Kansas tied for 28th among the 50 states and the District of Columbia, and Missouri ranked 36th. Kansas improved on 10 indicators and worsened on one while Missouri improved on nine and worsened on one. (Margolies, 12/9)

Physicians’ efforts to make Texans more healthy lost steam this year as the state continued to score near the back of the pack on measures such as obesity and lack of activity, according to an annual study released Thursday. (Robinson-Jacobs, 12/10)

As America continues to age, many U.S. primary care physicians swamped by older patients fear that their practices are inadequate to fully treat and counsel the sickest and frailest patents, according to a new survey by the Commonwealth Fund. Nearly one in four primary care doctors – internists, family physicians, geriatric specialists and others – said their practices are not equipped to manage care for patients with multiple chronic conditions, such as heart and lung disease and diabetes, according to the study by the philanthropic and research organization. (Pianin, 12/9)

About one in four fatal police encounters involves someone with mental illness, according to the report, released Thursday by the Virginia-based Treatment Advocacy Center, which focuses on the needs of people with serious mental illness. The problem stems from a lack of police training, as well as a lack of treatment for those with serious mental illness, the report's co-author says. (Szabo, 12/10)

Iowa’s Department of Human Services says United Healthcare has signed the most Medicaid providers of the four private Managed Care Organizations that are slated to take over management of the state’s Medicaid system on Jan. 1. United Healthcare has signed almost 66 percent of the state’s nearly 30,000 Medicaid providers, Amerigroup has signed 57 percent, WellCare 50 percent, and AmeriHealth Caritas 43 percent. (Boden, 12/9)

Don Dew, a Medicaid beneficiary, received a packet in the mail informing him he had been assigned to one of the four managed care organizations (MCOs) hired by the state of Iowa to help run its Medicaid program. Dew, who has epilepsy, doesn't know if the neurologist he's been seeing in Dakota Dunes will be included in his MCOs provider network. "It could be a real possibility that instead of going seven miles up to South Dakota for a neurologist, I would actually have to go to Iowa City," he said. Siouxland patients and health care providers are grappling with the implications of Medicaid modernization just weeks before the state plans to shift management of its Medicaid program to four private, out-of-state, for-profit health care companies. (Butz, 12/10)

Baltimore residents living in struggling neighborhoods hard hit by riots last April will be able to apply for 375 new jobs at area hospitals thanks to an initiative approved by state hospital rate regulators. After three months of debates and hearings, state regulators reached a last-minute agreement on Wednesday requiring participating hospitals to pay a share of the cost of the program and the rest to come from hospital rate increases. (Cohn, 12/9)

Alaska's Medicaid patients may soon be getting recycled wheelchairs and walkers under new legislation that could reduce costs for the state program. State lawmakers and officials with the Alaska Department of Health and Social Services are working together to amend Medicaid regulations to allow reimbursement for reused medical items instead of having patients purchase new ones. (12/9)

Maryland health department officials have cut ties with the company hired to upgrade the state's Medicaid computer system and plan to hire outside counsel to review if the state is due any refunds. The state has paid the company about $30 million, with about 90 percent coming from federal funds, the agencies said. (Cohn, 12/9)

Medicare managed care plans in Harris County may get additional funds due to proposed changes in the way the federal government sets its payment rates. The Centers for Medicare & Medicaid Services adjusts payments to Medicare Advantage plans based on the health and demographics of the people who enroll. The agency has proposed increasing rates in 2017 for low-income Medicare beneficiaries who typically have higher costs. (Hawryluk, 12/9)

Florida legislators have cut $100 million from the state’s mental health budget since 2009 — and now an investigative series, “Insane. Invisible. In Danger.” by two Florida newspapers details how those cuts have put patients and staff in harm’s way. Health News Florida spoke with the Tampa Bay Times’ Leonora LaPeter Anton, one of the reporters who spent more than a year looking into Florida’s mental hospitals. You can hear the conversation about what this has meant for patients in these facilities here. (Mack, 12/9)

A Springfield clinic is in the middle of a $16 million expansion, planned to handle the volume of patients who are gaining insurance through President Barack Obama’s health overhaul. ... The clinic provides training for SIU family medicine residents. The expansion will double the number of exam rooms and make it possible for the clinic to hire about 40 more employees. The clinic sees up to 19,000 patients annually, a 60 percent increase from three years ago. (12/10)

Wisconsin is known for its dairy farming and rolling hills. But some healthcare experts call it a trailblazer. In the past few years, health systems have been eagerly launching or growing their own health plans, seeing it as an opportunity to cut out the middleman and take on more direct financial risk while caring for patients. (Herman, 12/9)

Kaiser Health News staff writer Anna Gorman reports: "California is overhauling its substance abuse treatment system for low-income people, embarking on a massive experiment to create a smoother path for addicts from detox through recovery. The state is the first to receive federal permission to revamp drug and alcohol treatment for beneficiaries of Medicaid, known as Medi-Cal in California. Through what’s known as a drug waiver, state officials will have new spending flexibility as they try to improve outcomes and reduce social and financial costs of people with substance abuse disorders." (Gorman, 12/10)

Sen. Marco Rubio likes to brag that he is the mastermind behind the Republicans' one successful attack on the Affordable Care Act -- that he stopped a "bailout" of private insurance companies and, in the process, saved taxpayers $2.5 billion. The boast has some truth. What the GOP presidential candidate doesn't mention is that, because of his efforts, some people are likely to face higher premiums for their health coverage and insurance markets on the whole are less stable. (Jonathan Cohn, 12/9)

Despite the success of the Affordable Care Act's supporters in fending off a raft of challenges to the law in Congress and the courts, at least one ACA provision seems headed for the scrap heap. That's the "Cadillac tax," a stiff tax that will hit especially generous employer health plans starting in 2018. (Michael Hiltzik, 12/9)

Republican presidential candidate Ben Carson unveiled his agenda to reform the American health care system Wednesday. (Young, 12/9)

If any state should be looking at Medicaid expansion, it is cash-strapped, economically stagnant Kansas, where one rural hospital recently closed and others are struggling. But key lawmakers have cited irrational opposition to “Obamacare” to avoid a meaningful discussion. Brownback disingenuously tries to entwine Medicaid expansion with other priorities. Thirty states have decided that Medicaid expansion makes sense for them. Surely Kansas lawmakers can find a model that would work here. (12/9)

Add South Dakota's Dennis Daugaard to the list of Republican governors who have changed their minds about Obamacare's Medicaid expansion. The second-term governor pitched a plan to expand the joint federal-state health insurance program to as many as 55,000 low-income South Dakotans without using state money during a speech to the overwhelmingly Republican legislature Tuesday. Daugaard rejected the expansion three years ago, objecting to allowing "able-bodied" people to get covered. (Jeffrey Young, 12/9)

Of all the missed opportunities, policy meltdowns and eroded capabilities that have marked state government’s last five years, none stands out quite like the failure to provide health care to 100,000 of our fellow citizens, at no cost to state taxpayers. Yet you’d never know this from reading newspapers or listening to the news. Maine’s inability to adopt any form of the Medicaid expansion included in the Affordable Care Act is, first of all, a human tragedy. Large numbers of Mainers are growing up with preventable illnesses and untreated, chronic conditions that will require huge amounts of remedial spending down the road — and their quality of life will never recover. And, although it’s somehow considered impolite to mention it, as Sen. Angus King once did, significant numbers will die because they couldn’t afford the care they need. (Douglas Rooks, 12/10)

This week, the U.S. Senate begins a series of hearings to investigate enormous spikes in the cost of prescription drugs. Over the past year, more and more pharmaceutical CEOs have been asked to respond to price gouging allegations, particularly for older, affordable medicines that work. Coming weeks before the Iowa caucuses, this hearing is timely. Voters cite rising drug costs as a central pocketbook issue. (Vijay Das, 12/9)

Just like that, Pfizer has decided it's no longer American. It plans to link up with Ireland's Allergan and move its corporate headquarters from New York to Ireland. That way it will pay less in taxes. ... Such corporate desertions from the United States (technically called "tax inversions") will cost the rest of us taxpayers some $19.5 billion, estimates Congress's Joint Committee on Taxation. Which is fueling demands from Republicans to lower the corporate tax rate. ... an easier fix would be to take away the benefits of corporate citizenship from any company that deserts America. One big benefit is the U.S. patent system that grants companies like Pfizer longer patent protection and easier ways to extend it than most other advanced economies. (Robert B. Reich, 12/9)

Well, since I’m a white male, they’re not so focused on my life – but what about the life of my daughter? In Cruz’s ideal world, Republicans would get to tell her whether and when she can use birth control, and what kind. They’d get to forbid her from getting an abortion. And if she was struggling for money, they’d get to prevent her from obtaining affordable cancer screening, family planning advice and prenatal care. (Andrew Rosenthal, 12/9)

Since May, about 9,000 children with unique medical needs have been purged from the Children’s Medical Services roster. State leaders call it the result of a reorganization. They can call it whatever they want. In reality, it’s Florida’s longstanding attempt to save money by rationing care, and it’s taking it out on the most vulnerable. It’s nothing new, but it remains a disgrace. (12/9)

I am telling you all this as a lead-in to a fascinating bill that was recently proposed in the Missouri House of Representatives. It would treat Missourians seeking to buy firearms the same way it treats Missourians seeking to end a pregnancy. “For instance, there would be a 72-hour waiting period,” said the sponsor, Representative Stacey Newman. Missouri has piled so many unnecessary requirements on abortion providers that it’s down to one clinic in St. Louis. Newman didn’t attempt to limit the state to one gun store — her bill just requires that residents buy their guns at a licensed dealer located at least 120 miles from their homes. After cooling their heels in a local motel for three days, the prospective buyers would have to listen to a lecture about the medical risks associated with firearms and view pictures of people with fatal gun wounds. (Gail Collins, 12/10)

Gov. Rick Scott continues to make excuses for his lack of action on stopping the flow of state taxpayer money to [Planned Parenthood] in Florida. And both he and Politifact has fallen back to the excuse that because no court has yet formally "found" Planned Parenthood "guilty" of the sale of human tissue, there's no reason to act. Is this leadership? Is this what pro-life Floridians expected of the governor they twice went to the polls to support? (John Stemberger, 12/9)

A colleague recently announced that he'd been diagnosed with a life-threatening cancer. Don't worry, he wrote. He promised to fight. He promised to recover. As a survivor of multiple cancers and rare diseases, I've had to write my fair share of group emails alerting friends and family to medical news. So I understand the impulse to sound upbeat. Diagnosis emails and social-media posts are now a genre with set tropes and expected turns of phrase. (Adam Baer, 12/9)

On November 2, 2015, President Obama signed the Bipartisan Budget Act of 2015. The new law lifted the debt limit and prevented a government shutdown. It also made several important changes to Medicare and the Patient Protection and Affordable Care Act. Of particular importance is Section 603, which excludes certain hospital outpatient department services from the facility fee under the Hospital Outpatient Prospective Payment System. With specified exceptions, services are excluded from this system if they are furnished by a provider’s off-campus outpatient department. This provision is an effort to end payment differences based on the site of service and was inserted at the request of the Administration. (Julius Hobson, 12/9)

Efforts to reduce low-value care can decrease spending while helping patients avoid potentially harmful treatments. ... The current approach focuses on 2 strategies to reduce low-value care. First, professional societies are exhorting physicians to consider costs and value when deciding among alternative treatments. ... These initiatives appeal to a sense of professionalism by promoting the idea that physicians are stewards of societal resources. Second, payers are promoting health care system innovation and implementing payment reforms to reduce the incentives to provide ineffective treatments. Unfortunately, discussions about how to reduce low-value care often gloss over a crucial third strategy: a sustained effort to generate evidence that will distinguish between high- and low-value care. (David H. Howard and Cary P. Gross, 12/8)

In the past, the care of adult patients in children’s hospitals was an uncommon occurrence. However, the face of pediatrics is changing rapidly as advances in care of once-terminal childhood illnesses allow patients to survive well into adulthood. Given the specialized care frequently required to treat these congenital and childhood diseases, adult survivors are often treated by pediatric specialists housed in children’s hospitals. This paradigm shift means that some children’s hospitals must be well equipped to care for these adults, which may stress the capabilities of both pediatric health care professionals and institutions. (Benjamin Kinnear and Jennifer K. O’Toole, 12/8)