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With full federal funding for expanding Medicaid set to expire at the end this year, President Barack Obama is proposing to indefinitely extend the health law provision for any of the 19 states that have not yet adopted the enhanced eligibility. But Obama would need the Republican-controlled Congress to approve the offer. That appears unlikely considering Congress voted last week to repeal the Affordable Care Act, though the GOP critics did not muster enough support to override the president’s veto. Obama will seek congressional approval for extending the three years of full federal funding in his 2017 fiscal year budget proposal, which is scheduled to be released Feb. 9. (Galewitz, 1/14)

President Barack Obama will offer a financial incentive in his fiscal 2017 budget proposal to 19 state governments that passed up an earlier offer to help pay to expand Medicaid coverage to more low-income residents, the White House said on Thursday. Obama's new proposal would give states more time to opt in, and would pay for the expansion for three years, the White House said in a release. (Rampton, 1/14)

President Obama plans to propose giving new states that expand Medicaid coverage to the poorest of the poor more time before they have to chip in to cover the new recipients, the White House said in a blog post early Thursday. Obama's fiscal 2017 federal budget will include a legislative proposal to provide any state that expands Medicaid with the same three years of full federal funding and same phase down as the states that expanded the program in 2014. (O'Donnell, 1/14)

White House officials said President Barack Obama will ask Congress to include three years of full federal funding of expansion for any state that extends eligibility for the program to most low-income residents. "This common-sense proposal makes the expansion as good a deal for states that expand now as it is for the states that have already done so," wrote Shaun Donovan, director of the White House Office of Management and Budget, and Cecilia Muñoz, assistant to the president and Director of the Domestic Policy Council. (Radnofsky, 1/14)

Providing this additional assistance would probably be expensive. The White House did not provide a cost estimate. It also would require congressional approval, which is likely to be difficult, given persistent GOP antipathy to the health law. Congressional Republicans this month passed legislation, which Obama vetoed, that would have repealed large sections of the law, including the Medicaid expansion. (Levey, 1/13)

The administration defends its approach, but critics say the “risk adjustment” program is having a reverse Robin Hood effect — taking money from some plans that are small, innovative or fast-growing, while handing windfalls to some of the industry’s most entrenched players. The goal of the practice is to help keep insurance markets stable by sharing the “risk” of sicker people and removing any incentive for plans to avoid individuals who need more medical care. Such stability is likely to encourage competition and keep overall prices lower for consumers, while its absence can undermine both and limit coverage choices — the basic principles of the law. (Goldstein, 1/13)

A growing number of primary care doctors, spurred by the federal health law and frustrations with insurance requirements, are bringing a service that generally has been considered “health care for billionaires” to middle-income, Medicaid and Medicare populations. It’s called direct primary care, modeled after “concierge” practices that have gained prominence in the past two decades. (Luthra, 1/14)

Opponents of the Affordable Care Act's so-called "Cadillac" tax won a major victory last month when President Obama delayed its implementation for two years via a spending package. Under the Cadillac tax, companies pay a 40% levy on the value of generous employee health plans above a certain limit. The first year of the tax calls for a $10,200 annual cap for an individual plan and a $27,500 cap family coverage. (Ackerman, 1/14)

Sign up for health care coverage of pay the price. That's the message from Covered California officials, who urged consumers Wednesday to sign up for Obamacare coverage by the Jan. 31 deadline or face stiff tax penalties. This year, the penalties are hitting harder, ranging from a minimum of $700 for an individual to as much as $10,000 for a family of four, depending on income. The average penalty in 2016 will be $969. That’s a 47 percent increase from last year, according to a recent analysis by the nonprofit Kaiser Family Foundation. (Buck, 1/13)

Officials at MNsure vowed Wednesday to beef up call center staff for the final weeks of open enrollment, hoping to reverse lengthy call delays late last month that hark back to the exchange's disastrous first year rollout. Just past a key deadline for consumers to buy insurance effective for the new year, MNsure said it is on track to meet projections for signups for the private plans that fund its budget. Open enrollment ends Jan. 31. But after focusing last year on improving its call center to soothe frustrated customers, some people still spent more than an hour waiting for help in the final week of December. (Potter, 1/13)

There's a new song on repeat inside Stephanie Nelson's home, but it's not one you would expect. "That ping ping, just makes me want to punch somebody in the face," Nelson said. Nelson is talking about the hold music that plays over and over as she waits for a representative from Blue Cross Blue Shield North Carolina to answer. ... When WBTV visited Nelson Tuesday afternoon, she had been on hold for hours – nearly five to be exact – trying to work out her BCBS insurance policy that's somehow disappeared. (Morgan, 1/14)

There is no longer any question that Gov. Matt Bevin of Kentucky plans to shut down the health insurance exchange his state built to enroll residents for coverage under the Affordable Care Act. Now that he has notified the Obama administration of his intention to do so, the question is, will it change the law’s substantial impact there? It is hard to predict, partly because what Mr. Bevin is doing is without precedent. While a few states have been forced to largely rely on the federally run exchange after their own versions failed, Kentucky will be the first to abandon a homegrown exchange that functions well. (Goodnough, 1/13)

Kentucky Gov. Matt Bevin’s plan to eliminate the state’s health insurance exchange will diminish the level of enrollment support for low-income residents, who used it to sign up by the thousands for coverage under the 2010 federal health care law, according to the system’s advocates. Bevin told federal officials in a Dec. 30 letter that the state intends to drop its exchange, Kynect, and have its residents use Healthcare.gov, the federal health exchange, to sign up for insurance. Bevin’s office provided no details about the timing of the transition, but said there will be no impact on Kentuckians’ ability to obtain or continue health care coverage for the 2016 plan year. (Evans, 1/14)

The governor has submitted a two-year, $109 billion budget proposal that includes significant new spending to boost research and development and realign the state’s K-12 and higher-education systems to better prepare students for in-demand jobs, specifically computer science and coding. The budget, which will outlast [Gov. Terry] McAuliffe’s time in office, also includes the expansion of Medicaid under the Affordable Care Act, a key initiative for the governor that the GOP-controlled General Assembly has rejected as an ill-advised burden on state resources. (Moomaw, 1/13)

Gov. Nathan Deal said Wednesday that health care spending continues to burden Georgia’s budget, and he signaled that his longtime opposition to expanding the state’s Medicaid program has not changed. His comments in the State of the State address contrasted with the actions of some fellow governors, who recently have proposed or pushed Medicaid expansion. (Miller, 1/13)

Louisiana's new governor, Democrat John Bel Edwards, is getting a public "thank you" from President Barack Obama for rejecting the stance of his Republican predecessor and starting the process to expand the state's Medicaid program. Obama, for whom this is a key end-of-term policy priority, was appearing in Baton Rouge on Thursday as part of a post-State of the Union road trip. (Superville, 1/13)

Medicaid expansion was a key portion of [Gov. John Bel Edwards'] stump speech, and he never shied away from his plans to fully embrace it if elected. As Obama finishes out his last year as president, he's hoping to draw attention to some of his legacy policy initiatives. Louisiana didn't back Obama in either of his elections, but with Medicaid expansion, the president will have had a lasting impact on the way health care works in the state, even if he hasn't always been popular here. (O'Donoghue, 1/13)

With the race for the Democratic nomination tightening, front-runner Hillary Clinton is criticizing her chief rival Bernie Sanders for failing to say how he would pay for a health care plan some have estimated to cost $15 trillion. Clinton spokesman Brian Fallon told reporters Wednesday that it’s “alarming” that he will not say where he will get the money for the plan before the Iowa caucuses Feb. 1. (Kumar, 1/14)

The Clinton campaign intensified its attacks on Bernie Sanders' plan for a single-payer health care system on Wednesday, alleging that he would raise taxes on middle-class families while scrapping Obamacare in its entirety. Clinton's campaign accused Sanders of trying to hide the cost of a single-payer plan, which would guarantee health care for all Americans and is traditionally favored by liberals. (Cook, 1/13)

Hillary Clinton's campaign called on Bernie Sanders to outline how he would cover the cost of his plan to provide universal healthcare to Americans through a single payer, "Medicare-for-all" program. "From our perspective," said Clinton senior adviser Jake Sullivan on a call with reporters on Wednesday, "the campaign owes an explanation about why it is that they are touting a healthcare plan for which they won't provide any details." (Fraser-Chanpong, 1/13)

Bernie Sanders could break his pledge to release details on how he would pay for his health care plan before the Iowa caucuses, according to a top aide. (Keilar and Merica, 1/13)

Presidential hopeful Bernie Sanders, who’s been taking flak from his Democratic rival Hillary Clinton over his call for universal health care, expressed frustration Wednesday night with those “who want to demagogue the issue.” Sanders is advocating moving to a single-payer health-care system under which all Americans would be enrolled in Medicare, and private insurance would become a thing of the past. The Vermont senator introduced legislation with that aim in 2013 and has said he is working on an updated version as a presidential candidate. (Wagner, 1/13)

In the latest volley of her multi-front January offensive against Bernie Sanders, Hillary Clinton is zeroing in on his single-payer health care plan. The Clinton campaign launched an all-out assault on Wednesday, flooding cable television with surrogates to attack Sanders for not releasing details of his plan. The Clinton campaign also held a conference call with reporters to ramp up the pressure on how the proposal would raise taxes. (Seitz-Wald, 1/13)

Last Friday a group of 15 cancer researchers cut short a meeting at the Food and Drug Administration. The reason: They had been invited to Vice President Joseph R. Biden’s office to discuss his “moonshot” to cure cancer. ... [But] the idea that a concerted government push can lead to a “cure” for cancer is nearly a half century old, stretching back to President Nixon’s failed “War on Cancer.” (Kolata and Harris, 1/13)

Cancer research groups are pleased with the State of the Union pledge from President Barack Obama that Vice President Joe Biden Jr., who lost his son to cancer last year, will lead a bold charge to fight the disease. But advocates say that although the goal to reduce the 590,000 annual U.S. cancer deaths is more attainable than ever, the effort will require a targeted approach and sustained resources long after Obama’s presidency ends. (Zanona, 1/13)

The White House's "moon shot" to accelerate the search for a cancer cure has the scientific research community abuzz over the possibilities raised by such a high-profile push. Vice President Joe Biden may announce some specifics as soon as Friday when he visits a cancer center in Philadelphia to kick off the effort outlined in the State of the Union address. (Norman, Allen and Karlin, 1/13)

President Obama's final State of the Union address is in the books, and it was a speech largely empty of the policy promises that presidents usually make when they address the Congress — save one. The president said he is putting Vice President Joe Biden in charge of a "moon shot" to help find a cure for cancer. Biden has gotten some of the credit for securing additional research funding now headed to the National Institutes of Health. And now, cancer experts are calling on Biden to unlock patient data that holds the potential to help researchers, but that is nearly impossible to share. (Gorenstein, 1/13)

NPR's Kelly McEvers talks to Dr. William Nelson, director of the Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, about Obama's ambitious plan to end cancer and why we haven't found a cure. (1/13)

While [Speaker Paul Ryan and Sen. Mitch McConnell] are set to stand together Thursday at a retreat for congressional Republicans in Baltimore and cheerfully announce their unity against President Obama in his final year in office, they are operating on starkly different political planets in this election year, with little harmony in their legislative agenda. Mr. Ryan wants to finally offer a Republican alternative to Mr. Obama’s signature health care law. Mr. McConnell does not. Mr. Ryan would like to see his chamber explore authorizing military force against the Islamic State. Mr. McConnell would not. Mr. Ryan loves tax reform. Mr. McConnell loves it too — when there is a Republican in the White House to sign it. (Steinhauer, 1/13)

The Food and Drug Administration took 17 months to notify doctors and the public of “superbug” infection dangers from certain scopes used in gastrointestinal procedures in hospitals, according to a report by Senate Democrats released Wednesday. The document said that in Sept. 2013, the staff at a Seattle hospital had “traced a cluster of antibiotic-resistant infections to a medical device” called a duodenoscope, but that it wasn’t until early 2015 that the FDA sent out a public warning. (Burton, 1/13)

A major abortion-rights group on Wednesday criticized House Minority Leader Nancy Pelosi over what it called "disappointing and ill-advised" remarks, the second public rift in a year with a lawmaker such organizations have long considered one of their staunchest congressional allies. In an interview published Wednesday in which the California Democrat defended a woman's right to abortion, Pelosi said, "I don't believe in abortion on demand." (1/13)

Starting this month, firms with more than 50 employees must offer workers insurance or face fines, a new expense for some employers who until now didn’t have to offer any coverage. But one company’s problem is another company’s opportunity — BeneStream wants to help employers shift those costs to the federal government, specifically to Medicaid. ... For a price, BeneStream will comb through employee rolls to see who qualifies for Medicaid, the program created primarily for low-income and disabled Americans. (Gorenstein, 1/13)

The majority of people who leave the health law’s insurance marketplaces in California and on a broader national level are picking up other coverage rather than going uninsured, according to officials on a conference call hosted by the organization Families USA, which supports the 2010 overhaul. Peter Lee, executive director of Covered California, said California’s state-run exchange has surveyed a pool of people who left that marketplace over time and more than 85 percent left for other health coverage. (Attias, 1/13)

Humana Inc. has added its name to the list of mega-medical insurers to report big problems under Obamacare. The Louisville, Ky.- based company does not expect to make enough money this year in premiums from individual plans to cover what it will pay out in claims, according to a regulatory filing made last week with the U.S. Securities and Exchange Commission. (1/13)

Prescription painkiller abuse is drawing national attention as states battle increasing abuse cases, presidential candidates offer possible solutions and even President Barack Obama includes the issue in his State of the Union address Tuesday night. A new review article published Wednesday in the New England Journal of Medicine provides insights for policymakers on how to curb this deadly trend. (Luthra, 1/13)

Massachusetts House lawmakers have approved a bill aimed at addressing the state's alarming spike in opioid overdoses and deaths, while rejecting a proposal that would have allowed doctors to involuntarily commit those suffering from overdoses to drug treatment facilities for up to three days. The bill, which passed Wednesday on a unanimous vote, would limit initial opiate painkiller prescriptions to a seven-day supply and set an evaluation requirement within 24 hours for overdose victims seeking help at hospital emergency rooms. (LeBlanc, 1/13)

It may take more than a tub of yogurt to reverse the effects that a high-fat, low-fiber diet have wrought in the bellies of men and women in the industrialized world, says new research. Indeed, the depletion of gut microbes that comes with diets deficient in fiber extend well beyond the lives of those whose dietary choices made it happen, a new study finds. Over generations of exposure to diets low in fiber, the research shows that a microbiotic population die-off threatens to drive some of the trillions of microorganisms that live in healthy human guts to the brink of extinction. (Healy, 1/13)

On the heels of CNN's report about babies' deaths at St. Mary's, a team of researchers has proposed that policy makers consider telling some hospitals to stop doing complex heart surgeries on children. (Cohen, 1/13)

Many women in the U.S. are waiting longer than ever to have their first child. Fifteen years ago, the mean age of a woman when she first gave birth was 24.9-years-old. In 2014, that age had risen to 26.3. "It doesn't sound like a big change," says T.J. Mathews, a demographer at the National Center for Health Statistics and an author of the report published online Thursday. But, he says, the small shift underscores some important trends. (Bichell, 1/14)

University of Minnesota researchers say an alternative form of supportive care for pregnant women promotes better outcomes and can reduce health care costs. Doulas are non-medical professionals who provide emotional and physical support to mothers before, during and after childbirth. That support can include birth education, massage and words of encouragement. The word "doula" comes from ancient Greek. (Benson, 1/14)

The Alabama Medicaid Agency, the largest consumer of dollars from the state's General Fund, requested a $157 million increase today at budget hearings at the Alabama State House. That would be a 23 percent increase from this year's General Fund appropriation of $685 million for Medicaid. Medical inflation, the cost of transition to a managed care system and refunding of past overpayments from the federal government are factors in the requested increase. (Cason, 1/13)

The two-hour meeting on the program’s needs boiled down to two questions: Can the state afford to give Medicaid what it needs? And can it afford not to? Medicaid makes up the single largest expenditure in the state’s troubled General Fund budget. Medicaid should receive $685 million from the budget this year. The federal government pays about 70 percent of the $6 billion program’s total costs, and the state’s hospitals, pharmacists and nursing homes all make significant contributions. (Lyman, 1/13)

Nevada officials on Wednesday assured advocates in Clark County that any process to privatize Medicaid services for the elderly, blind and disabled will move slowly and will be transparent. Advocates with Nevadans for the Common Good, a coalition of Las Vegas Valley institutions advocating for several issues including protection for vulnerable senior citizens, and members of AARP, a lobbying group for retirees, met privately with state officials. Attendees at the closed-door meeting included Richard Whitley, director of the state's Health and Human Services Department. Barbara Paulsen, leader with Nevadans for the Common Good, said the meeting was positive and that advocates were pleased with what they learned. She said the coalition's push for transparency and the Las Vegas Review-Journal's reporting to get the information on the potential switch out to the public may have had an "impact on the process." (Amaro, 1/13)

The Bay Area’s health care systems — think Stanford, Sutter, John Muir and more — are continuing to align and consolidate in different ways to expand across the region, a new analysis shows, and it’s unclear if this will lead to lower or higher health care costs. (Aliferis, 1/14)

Cincinnati’s hospital systems saw a surge in net income in 2014, although the increases came about more from investments, government grants and philanthropy than from operations, a new review of Ohio’s health-care economy shows. The 13th edition of “Ohio Health Market Review” also found that the overall profits for Ohio’s health insurers went down even as the carriers picked up about 800,000 more customers through the Affordable Care Act and the expansion of Medicaid in Ohio. (Saker, 1/14)

Officials at New Hampshire Hospital are hoping a recently approved raise for its nurses will help draw new talent and alleviate a staffing shortage. At its first meeting of the year, the Executive Council unanimously approved $465,127 for the remainder of the fiscal year and an additional $1.6 million for fiscal year 2017 to boost nurses’ wages at the state-operated, publicly funded facility. The shortage has also delayed the opening of a new 10-bed crisis unit at the hospital. The unit is already constructed, and is meant to be a place for people who are forced to wait in their local emergency room until a bed becomes available at the state hospital. (Nilsen, 1/14)

Gov. Sam Brownback’s administration on Wednesday unveiled a budget proposal that would require new KanCare patients to try less-expensive drugs first and end a pilot program to improve the health of Kansans with severe mental illnesses. In a presentation to members of the House and Senate committees that control spending, Budget Director Shawn Sullivan outlined how Brownback planned to cover a projected $190 million shortfall in the fiscal year 2017 budget. The proposal relies on a series of revenue transfers and $105.7 million in spending reductions to balance the budget and generate an ending balance of nearly $88 million. (Hart, 1/13)

A House panel Tuesday quickly approved two high-profile bills that would revamp health-care regulations --- and are drawing opposition from at least parts of the hospital industry. The House Health Care Appropriations Subcommittee approved a measure (HB 437), filed by Rep. Chris Sprowls, R-Palm Harbor, that would eliminate the "certificate of need" regulatory process for hospitals. That process requires hospitals to get state approval for building or expanding facilities and for adding certain programs. (1/13)

To the surprise and delight of lawmakers who have long backed the proposal, House Speaker Steve Crisafulli on Tuesday called for eliminating a five-year waiting period for children of legal immigrants to be eligible for the state's KidCare health-insurance program. KidCare is a subsidized program that serves children from low- and moderate-income families. Children of lawfully residing immigrants currently have to wait five years before they can become eligible. The proposed bills lifting the waiting period would not apply to undocumented immigrants. (Menzel, 1/13)

A key member of Gov. Sam Brownback’s new rural health working group says he hopes the initiative is a serious effort to address problems facing rural providers, not an attempt to divert attention from a renewed push to expand the state’s Medicaid program. Republican Rep. Jim Kelly represents Independence, the southeast Kansas community that recently lost its only hospital due to budget problems exacerbated by federal reductions in Medicare reimbursement rates and the state’s rejection of Medicaid expansion. (McLean, 1/13)

There is this monthly meeting that is typically as bureaucratic as it sounds: the Governor’s Commission on Medicaid Care Management. But last month, things were different. A group of mothers were there to testify with their children in tow. Heather Donnell, the first to speak, ditched her written testimony at the last minute. (Rodolico, 1/14)

Many Minnesota doctors question the use of medical marijuana. An informal survey presented to a committee of Minnesota legislators and other involved with the subject Tuesday showed many doctors do not think they know enough about the subject to recommend their patients take it, worry that marijuana use is similar to narcotic use, do not support its use for severe pain and that the state medical marijuana law may cause conflict with patients. (Davis, 1/13)

Members of the Michigan National Guard began arriving in Flint on Wednesday for briefings on the drinking water crisis just as state health officials reported a spike in Legionnaires' disease cases in the county where the city is located. Gov. Rick Snyder activated the National Guard late Tuesday, and Lt. Col. William Humes confirmed about a half-dozen representatives arrived Wednesday morning. They are part of a larger contingent of Guardsmen who will help distribute bottled water, filters and other supplies to residents. (Schneider and Eggert, 1/14)

Thanks to advances in prenatal and neonatal care, the overwhelming majority of infants are born healthy and thrive. But sometimes things don’t go as planned. In Johnson County, for every 1,000 infants born in recent years, fewer than five don’t make it to their first birthday. In Wyandotte County, the number is closer to eight. For African Americans in both counties, the numbers are even higher. In fact, for the last few years the black infant mortality rate in Kansas has been the highest in the country. (Smith, 1/13)

Vera Cassata, 84, of Tinley Park [Ill.] depends on a home health care assistant to get her out of bed in the morning, wash her, dress her, buy food and help her go to the bathroom. Five days a week the home health care assistant visits, but due to the state budget crisis that help may disappear by the end of the month. Shay Health Care Services of Oak Forest provides home health care assistants for about 300 elderly residents of the Southland, which allows them to remain in their homes instead of going into nursing homes if their families can't provide the care they need. Shay has a contract with the state's Department on Aging to provide home care assistants and is supposed to be paid $170,000 a month. But since July 1, 2015, when the state failed to adopt a new budget, it has not been paid. (Kadner, 1/13)

A San Francisco judge is set to hear arguments Thursday over whether to require a Catholic hospital to perform a contraceptive procedure known as tubal ligation. Attorneys for Rebecca Chamorro, the woman seeking the procedure, say Mercy Medical Center in Redding denied her the procedure. Chamorro wants to get the procedure immediately following her scheduled cesarean section Jan. 28 because she and her husband do not want more children. (1/14)

The head of a southwestern Michigan mental health agency has learned his future: at least 32 months in prison for using public money to hire a fortuneteller. Ervin Brinker was sentenced by a Lansing-area judge Wednesday, two months after pleading guilty to embezzlement and Medicaid fraud conspiracy. (1/13)

Every remaining Republican presidential candidate supports repealing the Affordable Care Act. Yet their ideas for replacing the law are “still works in progress,” according to a headline last week in the Wall Street Journal. That’s a generous way of saying candidates have no comprehensive proposals. The newspaper said only Ben Carson and Jeb Bush have posted health plans, and both use “broad brush strokes.” (1/13)

Some liberal healthcare policy experts are urging an ambitious, costly program to expand and improve the Affordable Care Act's coverage. Meanwhile, conservative policy mavens are promoting an even more ambitious ACA replacement package they say would reduce the uninsured rate and lower healthcare spending with less government intervention. Falling in between, the centrist Bipartisan Policy Center recommended last month that the Obama administration meet with governors to advance new health insurance approaches, including flexible use of the ACA's Section 1332 state innovation waivers allowing implementation of alternative coverage models. These proposals represent efforts from the left, right and center to frame the health policy options for the next president and Congress. (Harris Meyer, 1/13)

With the polls tightening in Iowa and voting both there and in New Hampshire just a few weeks away, the Kumbaya feeling in the Democratic primary is gone. In particular, the Hillary Clinton camp has evidently decided it's time to go on offense against independent Sen. Bernie Sanders, lest 2016 start feeling like 2008 all over again. Predictably, one line of attack is on Sanders' record on gun control, which certainly has its blemishes. Another, though, makes far less sense, particularly in a Democratic primary: Clinton is lambasting Sanders' proposal for a universal, single-payer health care system. And she's doing it in a pretty dishonest way. (Pat Garofalo, 1/13)

The healthcare sector is digesting an important speech by the man tasked with rescuing Obamacare’s exchanges. Andy Slavitt, formerly of UnitedHealth Group UNH -2.77%, joined the Administration in June 2014. Last February, he took over the Centers for Medicare & Medicaid Services. (John Graham, 1/13)

Medical bills for out-of-network providers can surprise consumers with thousands of dollars in costs they didn’t plan for and sometimes cannot afford. I’m among those who have experienced this surprise despite efforts to determine that all my health-care providers are in-network. ... a significant share of people who had problems paying medical bills say that the issue was charges for providers they did not know were out of network. New York state has a solution to this problem that bears watching. Under the New York policy, patients who are surprised by out-of-network bills pay only the amount of their regular in-network cost-sharing provided they fill out a form authorizing the provider to bill the insurer for the remaining amount. (Drew Altman, 1/11)

Frederick Taylor, a son of Philadelphia aristocrats who lived at the turn of the last century, became known as the “father of scientific management” — the original “efficiency expert.” ... Meanwhile, the electronic health record (EHR) — introduced with the laudable goals of making patient information readily available and improving safety by identifying dangerous drug–drug interactions — has become a key instrument for measuring the duration and standardizing the content of patient–doctor interactions in pursuit of “the one best way.” ... The EHR was supposed to save time, but surveys of nurses and doctors show that it has increased the clinical workload and, more important, taken time and attention away from patients. (Pamela Hartzband,, MD and Jerome Groopman, MD, 1/14)

But when efficiency met medicine in the early 20th century, their relationship was no mere dalliance, and its form often diverged sharply from the Taylorist vision. One of its key figures was the industrial efficiency expert Frank Gilbreth, though his techniques were considered by many to be simply publicity-seeking smoke and mirrors. In place of a stopwatch, Gilbreth employed still and motion-picture cameras in his measurements, and he expanded his visual efficiency services — dubbed “motion study” — from industrial settings to the medical profession in the early 1910s. When he gained access to hospitals, Gilbreth transformed their operating rooms into efficiency laboratories, covering all available surfaces with gridded lines, and requiring the masked surgeons and nurses to don numbered or lettered caps to aid in his analysis of their movements across the axes of the surgical space. (Caitjan Gainty, PhD, 1/14)

The importance of shared decision making in health care has been increasingly recognized over the past several decades. Consensus has emerged that of the various types of decisions we make, those that involve choosing among more than one reasonable treatment option should be made through a process in which patients participate: clinicians provide patients with information about all the options and help them to identify their preferences in the context of their values. (Terri R. Fried, MD, 1/14)

“If you can’t measure it, you can’t manage it” is an often-quoted admonition commonly attributed to the late W. Edwards Deming, a leader in the field of quality improvement. Some well-respected health policy experts have adopted as a truism a popular variation of the Deming quote—“if something cannot be measured, it cannot be improved”—and point to the recent enactment of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) as a confirmation of “the broadening societal embrace” of this concept. (Robert A. Berenson, MD, 1/13)

During his Senate confirmation hearing in July 2014 to head the Department of Veterans Affairs, Robert McDonald pledged to “transform” the vast agency. After horrific reports of wait-time manipulation, coverups and even deaths at VA medical facilities across the country, veterans and the American people were calling for honest leadership to restore their trust in the department created to serve them. Sixteen months have passed but the VA’s culture of indifference persists, and the climate of accountability Mr. McDonald promised is nowhere in sight. (Jerry Moran and Jeff Miller, 1/13)

Again and again on the campaign trail, the presidential candidates have been faced by America's rising concern about addiction, particularly to opioid painkillers and heroin. And from Hillary Clinton to Chris Christie, the politicians have responded by pledging their support for drug courts. This bipartisan reaction is correct, in principle: Drug courts, which now exist in every state, can motivate people to overcome their substance-abuse problems more effectively than punishment can. But to make the courts work in practice, states need to see that they’re adequately funded and properly run. (1/13)