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Morning Briefing

Summaries of health policy coverage from major news organizations

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Thursday, Jan 7 2016

麻豆女优 Health News Original Stories 2

  • Medicaid To Fund More Addiction Treatment
  • Turning To Medicaid To Insure Lowest-Paid Employees

Health Law 4

  • Republicans Send Symbolic Health Law Repeal To Obama
  • Judge Dismisses Ohio Attorney General's Challenge To Health Law Tax
  • Incoming La. Governor Sets Aggressive Medicaid Expansion Deadline
  • Survey Shows Progress Slowing On Reducing The Number Of Americans Without Health Insurance

Capitol Watch 1

  • Doctors, Advocates Worry New Gun Rule May Exacerbate Mental Health Stigma

Campaign 2016 1

  • GOP Candidates' Lack Of Unified Health Platform May Come To Define Party's Agenda

Marketplace 1

  • High Drug Costs Make Some Cures, Precision Medicine Unaffordable For Many Patients

Public Health 1

  • Research Finds Link Between Sleep Apnea And Cholesterol

State Watch 3

  • California Governor's Budget Will Revamp Health Plan Tax
  • UnitedHealth Fined $100,000 After N.Y. Investigation Reveals Anti-Competitive Practices
  • Sutter Health To Issue Bonds To Finance Construction Of 3 Replacement Hospitals

Editorials And Opinions 1

  • Viewpoints: Jeb Bush On His Family's Addiction Crisis; Don't Penalize Doctors For Prostate Tests

From 麻豆女优 Health News - Latest Stories:

麻豆女优 Health News Original Stories

Medicaid To Fund More Addiction Treatment

Some Medicaid plans will now get federal funding for 15 days of inpatient treatment. But Pennsylvania fears the new rule will close a loophole the state has been using to pay for longer stints. ( Ben Allen, WITF , 1/7 )

Turning To Medicaid To Insure Lowest-Paid Employees

A startup company called BeneStream helps businesses get their low-wage workers on Medicaid to meet the health law's mandate for employers. ( Fred Mogul, WNYC , 1/7 )

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Summaries Of The News:

Health Law

Republicans Send Symbolic Health Law Repeal To Obama

The house passed the measure, 240-181, on Wednesday. It also includes a measure to defund Planned Parenthood. The vote highlights the partisan discord over the Affordable Care Act that hasn't faded over the last six years.

The U.S. Congress on Wednesday approved legislation dismantling President Barack Obama's signature health care plan, putting on his desk an election-year measure that faces a certain veto. ... The Republican-run House of Representatives finalized passage on Wednesday on a 240-181 vote, sending the bill to the White House. Republican leaders are expected to try to override Obama's promised veto, but they lack the two-thirds majority needed to do so. (Cornwall, 1/6)

While Democrats dismissed the bill 鈥 which would also remove funding for Planned Parenthood 鈥 as another ploy in the partisan drama that has played out in the Capitol since the law was enacted in 2010, the vote proved that a Republican congressional majority could deliver a measure that repeals the health law to a Republican president, even in the face of united opposition from Democrats. It also shows that nearly six years after its enactment, the law remains a divisive political issue not only because it is associated with Mr. Obama, but also because for much of the middle class, it is at least perceived as costly and lessening consumer choice, polls show. (Steinhauer, 1/6)

House Speaker Paul Ryan has vowed that Republicans will offer their Obamacare alternative this year 鈥 a familiar promise Republicans have made since it became law in 2010. "The people deserve a truly patient-centered health care system. And ultimately, this is going to require a Republican president," Ryan said. (Ehley, 1/6)

House Speaker Paul Ryan's next goal is to engineer and pass a bill 鈥 also for the first time 鈥 to replace the Affordable Care Act. Doing so could help Republicans respond to Democrats鈥 allegations that they have no viable alternative. Ryan is tempering expectations for the GOP in this exercise. In a recent meeting with reporters, the speaker indicated that the House was practically obligated to pass a health care reform replacement bill. He was confident the House could do so this year but underscored that he didn鈥檛 say the president would sign the legislation into law. (1/6)

The legislation was the product of an obscure budget procedure in Congress known as reconciliation. Under the process, it only needed a simple majority of 51 votes in the Senate to pass rather than a supermajority, meaning it's not subject to a filibuster. (Shabad, 1/6)

Republicans say they are playing the long game with the repeal vote, hoping it will give voters a glimpse of how they would govern if they win back the White House in November. All of the GOP鈥檚 presidential hopefuls have expressed support for rolling back the law. Democrats scoff at the idea of a Republican replacement for ObamaCare. (Sullivan, 1/6)

Republicans in Congress have achieved their longtime goal of sending a bill repealing the Affordable Care Act to President Barack Obama, who is certain to veto it. The House Wednesday evening passed the bill 240-181, with Representatives almost entirely voting along party lines. (Muchmore, 1/6)

The 114th Congress will kick off the new year on Wednesday by voting an eighth time to strip federal funds from Planned Parenthood, the nation's largest family planning provider, because its health services include abortion. The House of Representatives is expected to pass a budget reconciliation bill that guts the Affordable Care Act, pulls roughly $450 million in federal assistance from Planned Parenthood and prevents Medicaid recipients from getting reimbursed for their visits at Planned Parenthood clinics. (Bassett, 1/6)

Judge Dismisses Ohio Attorney General's Challenge To Health Law Tax

The lawsuit brought by Attorney General Mike DeWine argued that there is no precedent allowing the collection of millions of dollars from government entities. Meanwhile, the Connecticut Mirror offers consumers information about Obamacare tax forms.

A tax levied on state and local governments under President Barack Obama's federal health care overhaul is constitutional, a judge ruled, dismissing a lawsuit by Ohio Attorney General Mike DeWine. The 2015 lawsuit argued there was no precedent allowing the collection of approximately $6.4 million the previous year from government entities and nothing in the federal health care law that allowed such a tax. (Welsh-Huggins, 1/6)

Even if you don鈥檛 get your health insurance through Obamacare, you鈥檙e likely to get something related to the health law in the mail in the coming weeks: A new tax form. (Levin Becker, 1/7)

Incoming La. Governor Sets Aggressive Medicaid Expansion Deadline

Democrat John Bel Edwards says he will issue an executive order within 24 hours of being sworn into office so that people can have access by July 1.

Gov.-elect John Bel Edwards has set an ambitious timeline for a Medicaid expansion, saying he wants to have government-funded health insurance cards in thousands more people's hands by July 1. To make that happen, his new health care leader said Louisiana will have to hire nearly 250 new health department workers to handle the enrollment and find the dollars to pay them, in a state saddled with deep budget problems. (Deslatte, 1/6)

Meanwhile, in other news about Medicaid -

Companies must offer affordable coverage to all employees and will be subject to a penalty if their workers instead turn to the health exchange to buy subsidized coverage. There's no penalty for companies, it turns out, if workers qualify for Medicaid 鈥 though there could be controversy. ... Wal-Mart, McDonald's and some other large companies have drawn fire for not providing employees with health insurance, instead relying on taxpayers to fund workers' health needs via Medicaid. (Mogul, 1/7)

Physicians and hospitals want the CMS to require state Medicaid agencies to do more to make sure beneficiaries have access to care than called for under regulations issued last fall. A final rule published this past October outlines how Medicaid agencies must monitor access, particularly when they cut payment rates for physicians. (Dickson, 1/6)

For decades, if someone on Medicaid wanted to get treatment for drug or alcohol addiction, they almost always had to rely solely on money from state and local sources. Now, in a dramatic shift, the federal government is considering chipping in, too. The agency that governs Medicaid is proposing to cover 15 days of inpatient rehab per month for anyone enrolled in a Medicaid managed care plan. (Allen, 1/7)

Survey Shows Progress Slowing On Reducing The Number Of Americans Without Health Insurance

However, a Health Affairs report finds little evidence the health law has pushed people out of full-time employment.

Going into President Barack Obama's last year in office, progress has stalled on reducing the number of uninsured Americans under his signature health care law, according to a major survey out Thursday. (Alonso-Zalvidar, 1/7)

A new report in the journal Health Affairs finds little evidence that the health care law is pushing people out of full-time work. In 2015, companies with 100 or more employees had to start offering coverage to anyone working at least 30 hours 鈥 or face fines. (Gorenstein, 1/6)

News outlets also report on the impact of shuttered health insurance co-ops in New York and Colorado 鈥

Plagued by inadequate funds to cover their claims, Health Republic was shut down by state regulators in November. Similar scenarios have played out nationwide, with 12 of 23 co-ops closing this year. Some have asserted that co-op rates might have been unrealistically low given the high cost of health care. Monthly costs under Health Republic were in some cases hundreds of dollars less than those of other plans. (Karlin, 1/6)

Hospitals and doctors told New York senators Wednesday they've got $200 million or more in unpaid bills because of last year's financial failure of the insurance cooperative Health Republic, and they want the state to step in. Other insurers and care providers who met at the Capitol also questioned the state Department of Financial Services' methods for setting insurance rates lower than Health Republic had requested and obviously needed. (Virtanen, 1/6)

Less than half of the Colorado residents who lost their medical insurance when Colorado HealthOp folded have found new policies through the state health exchange. The numbers suggest that tens of thousands of people have decided to risk going without insurance this year instead of paying much higher prices for health coverage 鈥 although some are likely to have found policies outside the exchange. (Olinger, 1/6)

Capitol Watch

Doctors, Advocates Worry New Gun Rule May Exacerbate Mental Health Stigma

Some are concerned that President Barack Obama's new FBI reporting regulation, a measure that is part of his efforts to curb gun violence, has escalated tensions on Capitol Hill surrounding mental health legislation and could reinforce stigma around receiving treatment. Meanwhile, lawmakers have proposed a bipartisan bill expanding a 2014 law to create community mental health clinics.

Responding to Republicans who have repeatedly tied gun violence to mental health issues, President Obama鈥檚 new gun control plan will allow state agencies and the Social Security Administration to provide certain 鈥減rotected health information鈥 to the F.B.I. to help crack down on weapons sales to people who pose a danger to themselves or others or are unable to manage their own affairs. ... The Obama administration said the final rule 鈥渂alances public safety goals with important patient privacy interests.鈥 Many mental health professionals agree. But some doctors and lawyers said the rule could add to the stigma of mental illness and deter people from seeking treatment. (Pear, 1/6)

Only a few healthcare organizations report to the federal database that conducts background searches on people who want to buy guns, but those groups will get a little more latitude through a final HHS rule that's part of a White House package announced this week aimed at combating gun violence. (Conn, 1/6)

For a long time, the Republican response to more gun control was to double down on calls for better mental-health services to catch disturbed shooters who shouldn鈥檛 have access to guns. But the renewed focus on gun control in the wake of President Obama鈥檚 proposals may just exacerbate existing tensions on mental-health efforts that advocates hoped would gain momentum in 2016. (Demirjian, 1/6)

Sens. Debbie Stabenow (D-Mich.) and Roy Blunt (R-Mo.) on Wednesday announced they are introducing a bipartisan bill to increase funding for community mental health clinics. The bill would expand on a 2014 law that provides funding for a trial program for eight states to create community mental health centers. The centers are to offer services such as 24-hour crisis psychiatric care. The bill announced Wednesday expands on this effort by providing funding for 24 states to have the new clinics, an increase from the eight states designated in the 2014 law. While the bill is still being finalized, Stabenow鈥檚 office said it expects the measure to provide around $1.7 billion in new funding. (Sullivan, 1/6)

In Washington state, Gov. Jay Inslee follows the president's lead聽鈥

Washington Gov. Jay Inslee signed an executive order aimed at curbing gun violence by improving data-sharing among government agencies and starting a new public health campaign on suicide prevention. (Blankinship, 1/7)

Campaign 2016

GOP Candidates' Lack Of Unified Health Platform May Come To Define Party's Agenda

Experts warn that congressional leaders need to establish a clear health message for the Republican presidential field before front-runner Donald Trump's unorthodox ideas dominate the conversation. In Iowa, Ben Carson says he wants to replace the Affordable Care Act with "health empowerment accounts." Meanwhile, the Democratic candidates spar over health care in Nevada.

Even as congressional Republicans celebrated their latest symbolic jab at the Affordable Care Act, the GOP confronts an increasingly urgent challenge to develop a meaningful alternative in the face of Donald Trump鈥檚 enduring candidacy. More than five years after the health law was enacted, the party still has no unifying healthcare platform. And if Trump extends his run atop the Republican presidential field, his unorthodox healthcare positions may soon define the GOP. (Levey, 1/6)

Republican presidential candidate Ben Carson says he plans to repeal the Affordable Care Act, and replace it with what he calls, 鈥渉ealth empowerment accounts.鈥 During a town hall meeting in Panora on Wednesday, the retired neurosurgeon described health empowerment accounts as health-savings accounts, "but with no bureaucrats.鈥 Everyone with a Social Security number would get an account, and families would be able to shift money among themselves to pay for medical care. (Boden, 1/6)

[At the Nevada Democratic Party鈥檚 鈥淏attle Born Battleground鈥 dinner] Hillary Clinton cited progress made on health care under President Obama and warned against 鈥渢earing up the Affordable Care Act.鈥 That was a not-so-subtle jab at Sanders, who has proposed moving to a single-payer system. During his remarks, Bernie Sanders credited Obama for making progress in reducing the number of uninsured but said 鈥渨e must do better.鈥 鈥淭he time is long overdue for this great country to join to the rest of the industrialized world and pass a Medicare for all single-payer program,鈥 Sanders said. (Phillip and Wagner, 1/7)

Elsewhere, following the president's executive action on gun control, Ohio Gov. John Kasich is left to defend how he expanded Medicaid in the state聽鈥

Less than three years after Gov. John Kasich bypassed the full Ohio legislature to expand health coverage to low-income people, he assailed President Barack Obama for ignoring Congress and issuing executive orders to restrict gun sales and enhance background checks. (Torry and Siegel, 1/7)

Marketplace

High Drug Costs Make Some Cures, Precision Medicine Unaffordable For Many Patients

In other news, Bloomberg reports that Valeant's ailing CEO faces contractual and payout issues if he resigns for medical reasons.

Sophisticated drugs are opening the door, scientists say, to an era of "precision medicine." They're also ushering in an age of astronomical prices. Even with insurance, patients might pay thousands of dollars a month out of pocket. But patients aren't the only ones paying. Taxpayers underwrite the cost of prescription drugs provided by Medicare, Medicaid and other public insurance programs. (Szabo, 1/6)

If Michael Pearson leaves Valeant Pharmaceuticals International Inc. now, it would be without a parachute. Two potential payouts would disappear should the drug company鈥檚 ailing chief executive resign for medical reasons. At the moment, he appears unlikely to return to work quickly, and on Wednesday the company appointed an interim leader. Pearson鈥檚 employment contract states that if he steps down for 鈥済ood reason,鈥 such as a demotion, he would be entitled to a $9 million cash severance. An exit for medical causes wouldn鈥檛 trigger the payout, according to the contract. (Melby and Weinberg, 1/7)

And the聽Dementia Discovery Fund invests $100 million in a聽new avenue of Alzheimer鈥檚 research聽鈥

A promising new avenue in Alzheimer鈥檚 research that focuses on the eradication of brain plaque by the immune system has become the first investment for a $100 million fund dedicated to delivering new dementia drugs within a decade. The Dementia Discovery Fund, set up last year with backing from the U.K. government and several of the world鈥檚 biggest pharmaceutical companies, has led a $29.5 million investment round to back research under way at San Francisco-based Alector LLC. (Roland, 1/7)

Public Health

Research Finds Link Between Sleep Apnea And Cholesterol

The findings suggest that cholesterol-lowering statins could limit the cardiovascular damage sleep apnea causes. In other news, the Obama administration's new dietary guidelines back off earlier sodium rules, say lean meats are OK and still recommend cutting out added sugars.

Soon after many people fall asleep, they have trouble breathing. Their upper airway constricts and chokes them. They wake, startled, take a deep breath, and fall back to sleep. This condition, obstructive sleep apnea, affects about a fifth of American adults and triples the risk for cardiovascular disease. How exactly has been unclear. Research published Wednesday suggests that cholesterol, a common culprit in heart disease, plays a special role in raising risk for people with sleep apnea. (Chen, 1/6)

Some Americans may not have to cut back on eggs and salt as much as they once thought. And eating lean meat is still OK. But watch the added sugars 鈥 especially the sugary drinks. The Obama administration's new dietary guidelines, released Thursday, back off the strictest sodium rules included in the last version, while still asserting that Americans consume too much salt. The guidelines reverse previous guidance on the dangers of dietary cholesterol and add strict new advice on sugars. (Jalonick, 1/7)

New federal dietary guidelines, which dropped early Thursday morning, tell Americans to follow a healthy eating pattern that includes a variety of vegetables, fruit, grains, fat-free dairy, oils and a variety of proteins, including lean meats. The recommendations for what Americans should and shouldn't be eating, which the U.S. Department of Agriculture and the Department of Health and Human Services update together every five years, created unprecedented controversy in 2015 when the federally appointed panel of nutritionists that helps draft them considered sustainability in recommending in its report that people should eat less meat because it鈥檚 better for the environment. (Wheeler, 1/7)

News聽outlets report other public health developments聽related to the Chipotle contaminations, birth defects, brain injuries and cancer screenings聽鈥

Chipotle's bad winter is getting worse. A series of high profile foodborne illness outbreaks at the Mexican restaurant chain has meant a slew of lawsuits and a 43 percent drop in its stock price in less than three months鈥 and now the company has been served with a federal grand jury subpoena as part of a criminal investigation of an outbreak of norovirus in California. (Janssen and Channick, 1/6)

Pregnant women worry about all kinds of things. Now there's one less thing to fret about: harm to the baby when the mother takes birth control pill right before conceiving, or during the first few months of pregnancy. According to a study covering more than 880,000 births in Denmark, the overall rate of birth defects was consistent for women who had never taken the pill at all, for those who had used it before getting pregnant and for those who continued on the pill in early pregnancy. (Hobson, 16)

It's not just football players or troops who fought in the wars who suffer from brain injuries. Researchers estimate that hundreds of thousands of ordinary people in the U.S. get potentially serious brain injuries every year, too. Yet they and even their doctors often don't know it. One such doctor is Bryan Arling, an internist in Washington, D.C. His peers often vote to put him on those lists of "top doctors," published by glossy magazines. So it's ironic that the brain injury he failed to diagnose was his own. And he could have died from it. (Zwerdling, 1/6)

Bigger studies are needed to tell whether cancer screening really saves lives, according to a new analysis. While cancer screening may be linked to fewer deaths from tumors, finding cancers doesn't necessarily save lives when fatalities from all causes are taken into account, the authors point out. (Rapaport, 1/6)

State Watch

California Governor's Budget Will Revamp Health Plan Tax

The tax would replace California鈥檚 current tax on health plans that participate in Medi-Cal, which provides state-subsidized health care to the poor. The Obama administration has said the tax must be overhauled to include all health plans.

In an effort to break a political and policy logjam, Gov. Jerry Brown will unveil a state budget that revamps a controversial tax on health plans to avoid jeopardizing federal healthcare dollars. Sources who spoke on the condition that they not be identified prior to Brown's scheduled Thursday announcement said the reworked tax plan reflects intense behind-the-scenes negotiations with California's biggest insurance companies. (Myers and Mason, 1/6)

When Gov. Jerry Brown (D) unveils his fiscal year 2016-2017 budget proposal on Thursday, one of the big unknowns may be answered -- what he plans to do about the pending loss of the MCO tax and the $1.1 billion hole it leaves in the budget. The managed care organization tax is due to expire June 30, 2016. The state imposed a 3.9% tax on revenue generated by health plans through Medi-Cal managed care and received federal matching funds for the MCO tax. The state then reimbursed the MCOs. (Gorn, 1/6)

UnitedHealth Fined $100,000 After N.Y. Investigation Reveals Anti-Competitive Practices

Meanwhile, the insurer warns that its rates in New York may be too low because of the failure of a competing company.

The New York Attorney General has ordered UnitedHealth Group to pay a $100,000 fine after an investigation found the insurance provider engaged in anti-competitive practices involving elder and long-term care products, according to a person familiar with the matter. The settlement, which was signed late Wednesday, centers on efforts by UnitedHealth to force nursing homes to purchase other additional unwanted insurance services in order to participate in the insurance carrier's broader network, the person added. (Lynch, 1/7)

UnitedHealth Group Inc., the largest U.S. health insurer, said its rates for Obamacare plans in New York may be too low because the failure of a competing insurer last year might lead to shortfalls in payments designed to stabilize Obamacare markets. In states like New York, health insurers participating in the Patient Protection and Affordable Care Act negotiate annually with regulators to set prices for coverage. UnitedHealth鈥檚 rates were set anticipating risk-sharing payments designed to stabilize the new insurance markets, William Golden, the company鈥檚 northeast region chief executive officer, said Wednesday at a state Senate round table in Albany. If the loss of a participant reduces the funds available to UnitedHealth, the company鈥檚 rates in New York鈥檚 Obamacare market may be insufficient, Golden said. (Tracer, 1/6)

Sutter Health To Issue Bonds To Finance Construction Of 3 Replacement Hospitals

Meanwhile, three Connecticut hospitals are joining in a lawsuit challenging a 2013 Medicare payment decision, and an Indiana hospital is missing a USB drive that includes patient information.

Sutter Health, the 25-hospital, Sacramento-based system, is issuing $500 million in bonds to help finance the construction of three replacement hospitals. The bonds are expected to price next week. The proceeds will allow Sutter to reimburse itself for prior capital expenditures. (Kutscher, 1/6)

Three Connecticut hospitals have sued the federal government over its 2013 decision to reduce Medicare payments for inpatient treatments, joining several hundred other hospitals across the country that have already challenged the move. (Pierson, 1/6)

Officials with Indiana University Health Arnett in Lafayette say a USB flash drive containing information from more than 29,000 patients has gone missing. The hospital says the unencrypted drive disappeared Nov. 20 from its emergency department. Norma Gilbert, the hospital's director of quality and clinical excellence, said the hospital system hadn't received any patient reports of fraudulent activity as of Tuesday. (1/6)

Editorials And Opinions

Viewpoints: Jeb Bush On His Family's Addiction Crisis; Don't Penalize Doctors For Prostate Tests

A selection of opinions on health care from around the country.

As a father, I have felt the heartbreak of drug abuse. My daughter, Noelle, suffered from addiction, and like many parents facing similar situations, her mom and I struggled to help. I have so many friends and know so many families who have faced this terrible challenge. Addiction crosses all barriers, all lines, all races and all incomes. It creates real hardship and heartbreak in families. And, it places substantial demands on government at every level. (Jeb Bush, 1/6)

Both of us have raised serious questions about prostate cancer screening. Nevertheless, we hope Medicare chooses not to pursue a strategy of penalizing doctors for ordering prostate-specific antigen, or PSA, tests. ... Screening is really good at finding [nonlethal] cancers, and the prostate gland is full of them. Over half of men age 60 and older have small, indolent, nonlethal prostate cancers 鈥 many more than those who have harmful ones. That鈥檚 why men are much more likely to die with prostate cancer than from it. (H. Gilbert Welch and Peter C. Albersen, 1/7)

Oregon is making hormonal birth control legally available without a doctor's prescription, and California is set to follow suit. This is great policy, and the rest of the country should follow this example. Before I explain why they should, we should dispense with the policy hopes that easier access to birth control won鈥檛 fulfill. (Megan McArdle, 1/6)

A mere 2,116 days after Obama signed the Affordable Care Act, the House voted 240-181 Wednesday on a Senate-passed measure to eliminate the most important parts of Obamacare. ... The next thing that will happen is the repeal bill will speed its way to Obama's desk, where he will promptly veto it and carry on with whatever else he was doing. Self-congratulatory press conferences won't change the fact that Republicans haven't actually repealed anything and are nowhere near proposing their long-awaited "replacement" plan, despite new pledges from House Speaker Paul Ryan (R-Wis.) and other leaders. (Jeffrey Young, 1/6)

The president will of course veto the bill, but as Majority Leader Kevin McCarthy puts it, that鈥檚 the goal: 鈥淲ith this bill, we will force President Obama to show the American people where he stands.鈥 At last, the American public will finally learn whether Barack Obama supports Obamacare. Your days of keeping the public in the dark about this are over, Mr. President! Meanwhile, a spokesperson for Heritage Action, which exists to enforce conservative purity, has this to say about Congressional Republicans: 鈥淣ow, we have some reason to believe they will actually deliver on that promise鈥 to repeal the law. Because the first 61 votes left things in doubt. (Paul Waldman, 1/6)

There are few certainties in life, but you can count on these: death, taxes, and having to make a lot of choices about your health care. From selecting a health plan to choosing a physician to deciding among various treatments, health care in the United States is all about choice. Studies show that in making these choices, mistakes are common, as is overconfidence. (Austin Frakt, 1/6)

Imagine a world where kids on Medicaid with symptoms ... could find care at their local pediatrician鈥檚 office, instead of landing in the emergency department where an evaluation costs four times as much and the physicians are strangers. Taxpayers would save money by preventing illness, decreasing unnecessary emergency-room visits and reducing hospital admissions. How might we make this vision a reality? The answer lies in providing all children, rich or poor, equal access to medical care by raising Medicaid reimbursement rates. (Andrea Posa and Michael Dudas. 1/6)

The North Carolina General Assembly made a bold decision at the end of its uncommonly long session last fall. Legislators decided to invite managed care organizations as well as provider-led entities to administer our state鈥檚 Medicaid program, which provides health care for the approximately 2 million North Carolinians who have no other option to get the care they often desperately need. ... This massive shift in how Medicaid is run requires an enormous amount of planning, analysis and expertise to ensure that patients have access to and receive proper care and that those providing the care are treated fairly. (Docia Hickey, 1/6)

For decades, experts have described a profound imbalance between public funding of acute medical care and investments in upstream social and environmental determinants of health. By some estimates, more than 95% of the trillion dollars spent on health care in the United States each year funds direct medical services, even though 60% of preventable deaths are rooted in modifiable behaviors and exposures that occur in the community. ... As health systems are increasingly being held accountable for health outcomes and reducing the cost of care, they need tools and interventions that address patient and community factors contributing to excess utilization. (Dawn E. Alley, Chisara N. Asomugha, Patrick H. Conway and Darshak M. Sanghavi, 1/5)

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