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Anthem Inc., the country’s second-biggest health insurer, said hackers broke into a database containing personal information for about 80 million of its customers and employees in what is likely to be the largest data breach disclosed by a health-care company. Investigators are still determining the extent of the incursion, which was discovered last week, and Anthem said it is likely that “tens of millions” of records were stolen. The health insurer said the breach exposed names, birthdays, addresses and Social Security numbers but doesn’t appear to involve medical information or financial details such as credit-card or bank-account numbers, nor are there signs the data are being sold on the black market. (Wilde Mathews and Yadron, 2/4)

Anthem, one of the nation’s largest health insurers, said late Wednesday that the personal information of tens of millions of its customers and employees, including its chief executive, was the subject of a “very sophisticated external cyberattack.” The company, which is continuing its investigation into the exact scope of the attack, said hackers were able to breach a database that contained as many as 80 million records of current and former customers, as well as employees. (Abelson and Goldstein, 2/5)

Anthem has more than 37 million members in California and 13 other states. But the company warned that it also had information in its database on other Blue Cross Blue Shield patients from all 50 states who had sought care in its coverage area. Suspicious activity was first noticed and reported Jan. 27. Two days later, an internal investigation verified that the company was a victim of a cyberattack, the company said. The unauthorized access to the vast database goes back to Dec. 10. (Terhune and Parker, 2/4)

[Joseph R. Swedish, president and chief executive of the Indianapolis-based company] said the company would individually notify everyone whose information has been accessed and would provide credit monitoring and identity protection free-of-charge. The company referred customers to a dedicated Web site for further information. (Barbash, 2/5)

Because no actual medical information appears to have been stolen, the breach would not come under HIPAA rules, the 1996 Health Insurance Portability and Accountability Act, which governs the confidentiality and security of medical information. No credit card information was obtained, the company said in a statement e-mailed to USA TODAY. The hackers were probably not interested in medical information about Anthem's customers, said Tim Eades, CEO of computer security firm vArmour in Mountain View, Calif. (Weise, 2/5)

The Indianapolis-based insurer said credit card information wasn’t compromised, and it has yet to find evidence that medical information such as insurance claims and test results was targeted or obtained. It was still trying to determine exactly how many people were affected. A spokeswoman said the insurer was working with federal investigators to figure out who was behind the attack. (2/5)

In California, where Anthem offers Blue Cross Blue Shield plans, spokesman Darrel Ng said that as soon as the insurer learned about the attack, every effort was made to "close the security vulnerability." The FBI has also been contacted, Ng said, and the company and the agency are working together in the investigation. Anthem Inc. has also retained Mandiant, one of the world's leading cybersecurity firms, to evaluate its systems and identify solutions to prevent further security breaches. (Nelson, 2/4)

U.S. Rep. Michael McCaul, R-Texas, chairman of the Committee on Homeland Security, released a statement following the hack on Anthem, saying it illustrated why stronger cybersecurity laws are needed. "This attack is another reminder of the persistent threats we face, and the need for Congress to take aggressive action to remove legal barriers for sharing cyber threat information," said McCaul. "I will lead this effort with other committees in the house and senate to ensure we move forward with greatly needed cybersecurity legislation as soon as possible." (Williams, 2/4)

The attack is the latest in series of hacks targeting high-profile corporations. Previous victims have included retailers like Target and Home Depot, banks like J.P. Morgan & Chase and entertainment conglomerate Sony Pictures. Anthem said it had detected the breach itself and would notify affected customers via letter and e-mail. The insurer said it would also set up a information website and offer a credit-monitoring service. The early public disclosure is a departure from the tactics of previous victims like Target, which was heavily criticized for not reporting breaches soon enough. (2/5)

A group of leading Republican lawmakers on Wednesday proposed an outline for replacing the Affordable Care Act in a bid to advance traditional conservative healthcare goals, including deregulating health insurance, curtailing Medicaid spending and changing how health plans are taxed. The outline, which parallels a blueprint that senior GOP senators proposed in the last Congress, is not a formal bill. That precludes the nonpartisan Congressional Budget Office from calculating its cost and its precise effect on the nation's healthcare system. (Levey, 2/4)

Republicans released the outline Wednesday as Democrats continue pounding away at them for pledging to repeal and replace Obama's law, practically since its 2010 enactment, without advancing a substitute. That's a growing political liability for Republicans because the nonpartisan Congressional Budget Office estimates that this year, 19 million Americans will receive coverage as a result of the law, including large numbers in GOP-dominated states. (2/4)

Kaiser Health News staff writer Mary Agnes Carey reports: "Key GOP chairmen from the Senate and House plan to unveil a blueprint Thursday for repealing the health law and replacing it with a proposal the lawmakers said would reduce health care costs, improve quality and expand coverage. The measure retains many elements of a proposal Republican Sens. Orrin Hatch of Utah and Richard Burr of North Carolina released a year ago with former Sen. Tom Coburn, R-Okla. That proposal did not get traction, but the senators are pushing it again and now are working with House Energy and Commerce Chairman Fred Upton, R-Mich." (Carey, 2/5)

A top Republican senator accused the Health and Human Services secretary of being "contemptuous" of Congress on Wednesday by sidestepping questions about Obama administration preparations for a Supreme Court challenge to President Barack Obama's health care law. At a Senate Finance Committee hearing, GOP senators repeatedly asked HHS Secretary Sylvia M. Burwell about her plans should the court rule that federal subsidies for millions of Americans' health insurance are illegal. A decision in the case is expected by June. (2/4)

Health and Human Services Secretary Sylvia Mathews Burwell drew Republican ire Wednesday for repeatedly dodging questions about whether the Obama administration has contingency plans in case the Supreme Court invalidates the process for distributing health care law subsidies for insurance in states using the healthcare.gov federal exchange. A handful of GOP senators pressed Burwell at a Senate Finance hearing on the Obama administration’s fiscal 2016 budget proposal, with Majority Whip John Cornyn, R-Texas, initiating the most heated exchange. (Attias, 2/4)

Republicans and Democrats on Capitol Hill have miraculously come to an agreement on one Obamacare fix—but it comes at a cost. The Congressional Budget Office crunched the numbers on the “Hire More Heroes Act”-- which exempts working veterans from the health law’s employer mandate—and found that it would add nearly $900 million to the deficit. (Ehley, 2/4)

Congress should split the agency that runs the Affordable Care Act and Medicare from the Department of Health and Human Services to keep the White House from having too much influence over its operation, Senate Finance Chairman Orrin Hatch said Wednesday. The Centers for Medicare and Medicaid Services, which administers the health programs for the elderly and poor, is too big, said Hatch, a Utah Republican. (Wayne, 2/4)

Sen. David Vitter is not backing off his years-long quest to undermine Obamacare’s implementation on Capitol Hill, even as he runs for governor of Louisiana. As the Louisiana Republican preps for this year’s gubernatorial race, he’s using his new chairmanship of the Senate Small Business Committee to open up an investigation into what he calls a “Washington exemption” for the Affordable Care Act — the ability of some Capitol Hill aides to continue receiving federal contributions for their health care on Obamacare’s exchanges. (Everett and Haberkorn, 2/4)

This week, Paul’s ideas put him at the middle of a national controversy when he applied his trademark libertarian, skeptical thinking to the question of childhood vaccines. They should be largely voluntary, Paul said, as a matter of freedom. He also said he had heard of children who “wound up with profound mental disorders after vaccines.” Paul also ran into trouble on the P.R. front. At times, he has seemed disinterested — or unprepared — for the basic tasks of being a national politician. For instance, this week he “shushed” a female interviewer on national TV. After his vaccine comments drew angry reactions, he accused the media of misconstruing his remarks about vaccines and mental disorders. (Fahrenthold and Hamburger, 2/5)

Back in 2009, when Rand Paul was pursuing his long-shot bid to win Kentucky’s Republican Senate primary, he spoke to a small physicians’ association that has publicized discredited medical theories, including possible links between vaccines and autism and between abortion and an increased risk of breast cancer. At the time, Mr. Paul, an ophthalmologist, was no stranger to the group, the Association of American Physicians and Surgeons. He boasted at its annual meeting that he had been a member for more than two decades and that he relied on its research, statistics and views about the role of government in medicine. (Peters and Meier, 2/4)

Rand Paul, who has been mired in controversy over whether child vaccinations should be mandatory, has long been associated with a medical group that opposes mandatory vaccinations and has published reports promoting a handful of other dubious positions. The Kentucky Republican’s association with the Association of American Physicians and Surgeons dates back to at least 1990, though the group’s executive director, Dr. Jane Orient, told Politico that Paul stopped paying dues when he was elected to the Senate in 2010. (Debenedetti, 2/4)

Almost 10 million people have signed up for health insurance in state and federal marketplaces under the Affordable Care Act or were re-enrolled in coverage for 2015, federal officials said Wednesday. Nearly 7.5 million people have selected a plan or were automatically re-enrolled on the federal exchange, Sylvia Mathews Burwell, secretary of Health and Human Services, said at a Senate hearing. At least 2.4 million people have come in through state-run exchanges, she said. Those numbers include people who have selected a plan but may not necessarily have paid their first month’s premium. (Armour, 2/4)

The rate of sign-ups is expected to accelerate until the Feb. 15 deadline. Andy Slavitt, principal deputy administrator of the Centers for Medicare and Medicaid Services, urged people "not to wait until the last minute" to sign up. For those who do, however, there will be 14,000 call center employees available, up from 10,000 now. (O'Donnell, 2/4)

The Obama administration says sign-ups continue to build under the president's health care law ahead of a Feb. 15 enrollment deadline. Nearly 7.5 million people enrolled as of last Friday in 37 states where the federal government is running insurance markets, which offer subsidized private coverage for people who don't have a job-based plan. (2/4)

With just 11 days to go before the Feb. 15 deadline to secure individual coverage for 2015, federal health officials appear well on their way to meeting their cautious goal of enrolling up to 10 million people by year’s end. ... The Congressional Budget Office had projected marketplace enrollment under the health care law to reach 13 million in 2015. But in November 2014, HHS officials suggested the CBO’s enrollment estimate was unrealistic, citing “mixed evidence” and “considerable uncertainty” about underlying assumptions the CBO used to reach those projections. (Pugh, 2/4)

The administration did not say how many of these people have paid their first months’ premiums—that data will likely be available some time after the end of the open enrollment period on Feb. 15. (Ehley, 2/4)

The federal health insurance marketplace will have 40% more call center workers on hand starting Monday to help consumers deal with the final week of Obamacare open enrollment, the Department of Health and Human Services said Wednesday. Since open enrollment began Nov.15, nearly 7.5 million consumers selected a plan or were automatically re-enrolled on HealthCare.gov, which handles enrollment for 37 states, HHS said. (O'Donnell, 2/4)

Federal and local officials announced Wednesday that 969,461 people in Texas have signed up so far for insurance coverage under the Affordable Care Act. The enrollment effort already exceeds last year’s statewide enrollment by nearly a third. And a major sign-up push is underway as the Feb. 15 deadline looms. (Jacobson, 2/4)

According to the latest count, 182,581 people in Wisconsin have bought or been re-enrolled in health plans sold on the federal marketplace set up under the Affordable Care Act as of Jan. 30, according to the U.S. Department of Health and Human Services. (Boulton, 2/4)

About two million New Yorkers have signed up for insurance under the Affordable Care Act, with three out of every four of them poor enough to qualify for Medicaid, according to figures released Wednesday by the Cuomo administration. While Gov. Andrew M. Cuomo heralded the overall numbers as a sign of the success of the program, having such a large proportion on Medicaid, which is funded by the government, could impose a heavy new burden on public finances. (Hartocollis, 2/4)

Gov. Bill Haslam's proposal to extend health coverage to 280,000 low-income Tennesseans has failed during a special legislative session. The Senate Health Committee defeated the Republican governor's Insure Tennessee plan Wednesday on a 7-4 vote. (Johnson, 2/4)

Tennessee Gov. Bill Haslam’s alternative plan to expand Medicaid under Obamacare was dealt a devastating blow on Wednesday, when a Senate panel rejected it on the third day of a legislative special session called solely for that issue. (Pradhan, 2/4)

Gov. Bill Haslam's proposal to extend health coverage to 280,000 low-income Tennesseans has failed during a special legislative session after nearly two years of negotiating with federal officials. The Senate Health Committee defeated the Republican governor's Insure Tennessee plan on a 7-4 vote Wednesday. (2/4)

Shares in Gilead Sciences Inc. fell as much as 10% in morning trading Wednesday on the New York Stock Exchange, a day after the company estimated the discounts it gives on new hepatitis C drugs would more than double this year. Investors appeared surprised by the amount of the discounts, which Gilead said during an earnings call on Tuesday would increase to an average of 46% this year, up from 22% last year. (Rockoff and Stynes, 2/4)

File this under ‘You can’t please everyone all the time.’ On one hand, Gilead Sciences had great news yesterday for investors. The drug maker reported that revenue more than doubled in the fourth quarter thanks to $3.8 billion in sales of its Sovaldi and Harvoni hepatitis C treatments. ... But then there was the sobering news that discounts for the treatments, which Gilead and its supporters argue are more cost-effective than the previous standard of care, will more than double this year – to 46%, on average. (Silverman, 2/4)

California-based bio-pharmaceutical company Gilead Sciences released strong quarterly earnings Tuesday – revenues more than doubled from a year earlier and profits beat analysts’ estimates. Then, on Wednesday, the company’s stock fell more than 8 percent on the Nasdaq exchange. The stock decline is pegged to Gilead’s telling investors that the company will offer deeper discounts in 2015 than it did last year on its most successful new drugs – Sovaldi and Harvoni – that are highly effective treatments for hepatitis C. The list price for an eight-to-12-week course of treatment with either drug ranges from $84,000 to well over $100,000. (Hartman, 2/4)

California lawmakers are joining the national debate over what effect high-priced specialty drugs are having on medical costs for consumers and taxpayers. A hearing Wednesday led by state Sen. Ed Hernandez (D-West Covina) is expected to feature testimony from an executive at Gilead Sciences Inc. about Sovaldi, the company's $1,000-per-pill hepatitis C drug that has drawn criticism from members of Congress, Medicaid officials and health insurers. (Terhune, 2/4)

The company said it expected to post per-share earnings of $8 to $8.40 for the year. Analysts polled by Thomson Reuters were expecting $8.17 a share. Cigna said the most recent quarter capped a year that saw fee and premium growth across its segments. (Calia, 2/5)

A recent measles outbreak has California lawmakers rethinking the state’s immunization policies, with state legislators weighing changes to personal exemptions to vaccinations and its two U.S. senators urging the end of all exemptions other than medical. So-called “personal belief” exemptions to immunizing children against diseases have come under scrutiny in recent weeks, sparking debate over whether parents should be required to vaccinate their children before they enter school. (Lazo, 2/4)

A group of state lawmakers announced legislation Wednesday that would abolish an exemption from the mandate that children get vaccinated before they enter school if it conflicts with their parents' personal beliefs. Surrounded by mothers holding babies, five lawmakers said during a Capitol news conference that the legislation was needed to address a trend among many parents not getting their children immunized against common diseases and the spread of some preventable illnesses including measles and whooping cough. (McGreevy, 2/4)

State lawmakers in California introduced legislation Wednesday that would require children to be fully vaccinated before going to school, a response to a measles outbreak that started in Southern California and has reached 107 cases in 14 states. California is one of 19 states that allows parents to enroll their children in school unvaccinated through a “personal belief exemption” to public health laws. The outbreak of measles that began in December in Anaheim’s Disneyland amusement park has spread more quickly in communities where many parents claim the exemption. (Gold, 2/5)

There is no official breakdown of the nature of the beliefs specified by parents. However, significant numbers of Americans think vaccines are harmful to the health of children, despite the absence of supporting evidence, and are egged on by a few medical professionals as well as some libertarians. Anti-vaccine sentiment is blamed in part for the current measles outbreak that began in California’s Disneyland in early December and has since spread to at least eight states and Mexico, with 103 cases in California. (Barbash, 2/5)

In Southern California many schools are facing tough questions about measles. California is one of 20 states that allow students to opt out of school vaccination requirements when those rules conflict with their parents' personal beliefs. Many affluent areas along the California coast are home to schools with some of the highest "personal belief exemption" rates in the country. And that is creating some tension for administrators and health officials, (Siegler, 2/4)

Gov. Jerry Brown, who preserved religious exemptions to state vaccination requirements in 2012, on Wednesday appeared open to legislation that would eliminate all but medical waivers. The governor's new flexibility highlighted a growing momentum toward limiting vaccination exemptions partly blamed for the state's worst outbreak of measles since 2000 and flare-ups of whooping cough and other preventable illnesses. (McGreevy and Lin, 2/4)

California’s two U.S. senators on Wednesday called on state officials to reconsider California’s policy on allowing exemptions to childhood vaccinations. Democratic Sens. Dianne Feinstein and Barbara Boxer, in a letter to state Health and Human Services Secretary Diana Dooley, said the two parental exemptions allowed under California law, on religious grounds or due to a personal objection made after consulting with a health professional, are “flawed.’’ The senators support exemptions for medical reasons, such as a child with immune deficiency. (Willon and McGreevy, 2/4)

Dr. Bob Sears, a pediatrician in Capistrano Beach, Calif., says that he strongly believes in the protective power of vaccines to save lives. But he's also well-known in Southern California as a doctor who won't pressure parents who refuse to vaccinate their children, or who refuse some vaccines, or who want to stray from the recommended schedule of vaccinations. "They all come to me because, I guess, I'm more respectful of their decisions, more willing to listen to them," Sears says, "[and to] discuss pros and cons and acknowledge that there are some side effects to vaccines." (Neighmond, 2/4)

A report issued Thursday on the financial impact of Alzheimer’s disease in the United States warns that it could soar to more than $1 trillion a year by 2050, with much of it borne by the federal government, unless action is taken to shift current trends. (Kunkle, 2/5)

Health costs associated with Alzheimer’s disease are projected to skyrocket in the coming decades, a new report from the Alzheimer’s Association warns. The advocacy organization’s report, released Thursday, projects that as the population ages, Medicare and Medicaid costs for people with Alzheimer’s will more than double by 2030 and almost quintuple by 2050, from a level of $153 billion in 2015. (Sullivan, 2/5)

The cost of managing diabetes has more than doubled in the past 20 years, a new analysis says. The average diabetes patient now spends $2,790 more per year than they did in 1987 -- and more than half the additional spending is for medications. (Kennedy, 2/4)

According to surveys by the Department of Labor's Bureau of Labor Statistics (BLS), there are more than 35,000 back and other injuries among nursing employees every year, severe enough that they have to miss work. Nursing assistants and orderlies each suffer roughly three times the rate of back and other musculoskeletal injuries as construction laborers. In terms of sheer number of these injuries, BLS data show that nursing assistants are injured more than any other occupation, followed by warehouse workers, truckers, stock clerks and registered nurses. (Zwerdling, 2/4)

Neighborhood pharmacists say Medicare officials should do more to avoid situations where seniors have trouble filling prescriptions, as about 400,000 beneficiaries did earlier this year when Aetna Inc. incorrectly identified some pharmacies as being in their network. About 220,000 seniors lost the ability to use pharmacies that were allowed last year after Aetna changed its list of participating establishments. And pharmacies that the company encouraged 240,000 seniors to use in 2014 in order to lower out-of-pocket costs are no longer able to offer those discounts this year. (Adams, 2/4)

Tenet Healthcare and Gov. Dannel P. Malloy announced Wednesday that they are ending discussions about the Texas company's acquiring Connecticut hospitals. The company had been poised to become the first large, for-profit hospital chain in the state, with plans to buy Waterbury, Rockville General, Manchester Memorial, Bristol and St. Mary’s hospitals, in partnership with the Yale New Haven Health System. (Levin Becker, 2/4)

Patients at Denver's Veterans Affairs hospital and its satellite clinics wait longer for medical appointments than those at more than 90 percent of regional centers nationwide, new federal data show. The data show that 13.7 percent of veterans seeking medical help in Denver and at clinics in eastern Colorado waited for a month or more after their preferred date to see a doctor. That was more than twice the national average of 6.7 percent. (Olinger, 2/4)

Six months after Florida rolled out its Medicaid managed care program – transitioning almost 3 million Floridians into private insurers — some recipients with disabilities say the new model hasn’t fixed some of the old problems. Last week, about 30 people from the disabled community gathered at the Center for Independent Living of South Florida to discuss complaints about access and communication, ranging from lack of American Sign Language interpreters at doctor’s offices to confusing paperwork. (Herrera, 2/4)

As s measles cases continue to mount in the United States—the District of Columbia is the latest to report a fresh case—the media is depicting the issue of vaccinations as an increasingly partisan one. But it isn’t. Here is an overlooked fact about vaccines and politics: For the most part, there is broad bipartisan support for immunizations. Vaccine policy is one of those rare areas in which Republicans and Democrats have worked together to address vital public health issues. (Sarah Despres, 2/4)

Ah, the tempest of a media maelstrom. Headlines claim falsely that I am against vaccines or say they cause disorders. Quite ironic, that the press called me anti-vaccine on the same day I received my booster vaccine for Hepatitis A. In two interviews on the subject this week, I spent the bulk of my time defending vaccines as one of the greatest advancements in medicine. As a doctor, I am well aware of their need and effectiveness. (Sen. Rand Paul, R-Ky., 2/4)

Early this morning, I posted about the newly vocal majority on vaccination—the parents who are willing to fight back against the anti-vaccination trend that has been implicated in the latest outbreak of measles. Cases have reached more than 100. It’s still surprising to read the number of comments from people who say, why should anyone care? The vaccinated kids are protected. So before moving on to the good news of the day, here are the reasons why parents who vaccinate – and the public at large – have every reason and right to care deeply about this issue. (Karen Klein, 2/4)

So say to parents: You have a perfect right not to vaccinate your children, and we will not force you. But unless you have a vaccination certificate, a letter from a doctor explaining that your child falls into a small number of well-recognized medical exemptions, or a testament from your minister that vaccinating violates the tenets of a church of which you are an active member, failing to vaccinate your child also means failing to qualify for any public benefits for those children. No tax deduction. No public school, college or municipal activities. No team sports that practice on public land. No federally subsidized student loans. No airplane rides for anyone under 18 unless the TSA gets an up-to-date vaccination certificate. If you will not help society protect itself, then society will deny its help to you, and it will do its best to keep your child out of crowded spaces where they might infect someone. (Megan McArdle, 2/4)

Here comes one of Washington’s least favorite rituals: the “doc fix.” Every year, and sometimes more often, Congress passes a bill to make sure that doctors don’t absorb a big pay cut from Medicare. ... there is a movement in Congress to pass a “permanent doc fix.” ... The proposal, while a long shot because of its expense, has bipartisan support. But here’s the thing: The pressure on Congress to find a way to finance doctors’ pay every year has actually reduced federal health spending in general and the Medicare budget in particular. Even though Congress doesn’t let the doctors’ payments go down, the doc fix still usually achieves the deficit-cutting goals of the formula’s drafters. With only a few exceptions, Congress simply cuts other parts of the budget to compensate for the extra money for the doctors. (Margot Sanger-Katz, 2/5)

It has been five years since the Affordable Care Act became law, crystallizing partisan division in our national health care debate. The law made fundamental changes to how health care is financed, delivered and structured, yet serious challenges remain. What we need now is a conversation about how to truly strengthen our broken health care system by empowering patients, lowering costs, increasing quality and protecting the most vulnerable. Now is the time to present Americans with a path forward that is better than Obamacare. Thursday, we are unveiling our vision of policies that would strengthen our health care system while reducing federal spending and taxes. (Sen. Orrin Hatch, R-Utah, Rep. Fred Upton, R-Mich., and Sen. Richard Burr, R-N.C., 2/4)

Once again, the mostly male, mostly well-insured Republican majority of the House of Representatives voted to repeal the Patient Protection and Affordable Care Act, the law that extends health insurance to millions of Americans through Medicaid expansion, subsidies and mandates. Those who keep count say this was the 56th time Republicans voted to kill Obamacare. Remarkably, three Republicans sided with the Democrats and voted against repeal this time. Unremarkably, Andy Harris, Maryland's only Republican member of Congress, voted against the ACA, along with 238 other prophets of doom. (Dan Rodricks, 2/4)

In three ... jurisdictions -- Connecticut, San Francisco and Seattle -- researchers have examined the impact of [mandatory paid sick-leave] laws by surveying businesses and, in some cases, workers about what happened once they took effect. The findings suggest that while the economic consequences of those laws shouldn't be ignored, they aren't terribly strong either. (Christopher Flavelle, 2/4)