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Days after the Supreme Court delivered a victory for his health care law for the second time, President Obama flew into mostly Republican territory on Wednesday and began an aggressive push to get states that have resisted parts of the law to expand care to more of their poor residents. (Harris and Goodnough, 7/1)

President Obama, fresh from a victory before the U.S. Supreme Court last week that preserved the Affordable Care Act, called for an end to the political fighting over the health law and for more effort to improve it. “This is about people. This is not about politics, it's not about Washington,” Obama said at a town-hall-style meeting at a Nashville elementary school. (Levey, 7/1)

Obamacare, as the president's law is known, envisions a major expansion of the program, but nearly half of all U.S. states, mostly Republican-controlled, have rejected that part of the law and opted out of a Medicaid expansion. (Edwards, 7/1)

Fresh off a Supreme Court victory, President Barack Obama said Wednesday that he’s “feeling pretty good” about the state of his health care law and pleaded for bipartisan cooperation on ways to make it work even better. Obama said he wants to refocus the debate on improving health care quality, expanding access and eliminating waste now that the high court has upheld a key element of the Affordable Care Act. (Superville, 7/1)

The town hall meeting on health care came one week after the Supreme Court shot down a major challenge to the massive government program that would have denied health-care subsidies to millions of Americans participating in the program through a federal marketplace. ... In Nashville, Obama touted the 166,000 Tennesseans — and 16 million people across the country — who have health care because of the Affordable Care Act. Health-care inflation has been trending down, the president said. (Jaffe, 7/1)

Largely absent in Mr. Obama’s remarks were the words “Medicaid” and “TennCare,” the name of the program in the state. Instead, he talked repeatedly about “options” for states, and said he hoped “a uniquely Tennessee solution” to the standoff could still be found. (Tau and Radnofsky, 7/1)

President Barack Obama called on Republicans Wednesday to find a bipartisan way to fix problems in the nation’s health care system rather than continue to fight over the health law. "Part of what I’m hoping is with the Supreme Court case now behind us what we can do is … focus on how we can make it even better because it’s not as if we’ve solved all the problems in our health care system," Obama said in remarks at an elementary school in Nashville, Tenn. "America still spends more on health care than any other advanced nation and our outcomes aren’t particularly better." (Carey, 7/1)

The president rattled off “a whole host” of benefits of the law, ranging from free preventative services such as mammograms to the ability of young people to stay on their parents insurance until they are 26. “You don’t always notice that until you need it,” he said of the benefits. He also made the case for the economics of the law, citing lower healthcare inflation. (Ferris, 7/1)

For a brief time on Wednesday, Davy Crockett became the face of President Barack Obama’s push to get more states to expand Medicaid. Mr. Crockett, who described himself as a fifth-generation great-grandson of Davy Crockett, the American folk hero, attended the president’s speech in Nashville, Tenn., and got the opportunity to ask a question. He expressed frustration about denials of his application for Social Security benefits. Mr. Obama promised to look into it. (Armour, 7/1)

After the Supreme Court declined to gut the law in a decision last week, there’s an opportunity to build on gains in health coverage and also rectify some missteps in the Affordable Care Act’s marketing, Sylvia Mathews Burwell, the U.S. health secretary, told Bloomberg’s Al Hunt in an interview for PBS’s “Charlie Rose” program. “We as an administration haven’t done as much as we could to make sure people understand the breadth of the benefits,” she said. “The ACA became about a very narrow thing. Even narrower than the uninsured, it became about the marketplace. It is about so much more.” (Wayne, 7/1)

Since the Supreme Court upheld the Affordable Care Act, what’s next for ensuring the health of the health reform law? Judy Woodruff speaks to Secretary of Health and Human Services Sylvia Burwell about its successes and what can be improved. (7/1)

It’s been almost a week since the Supreme Court’s momentous ruling that further cements the Affordable Care Act as the law of the land, and Wednesday President Barack Obama flew to Nashville, Tennessee, to talk about health care. While some consider this a bit of a victory lap, the president’s choice of Tennessee suggests it’s much more of an overture. (Gorenstein, 7/1)

The federal government’s release of new data on health-insurer payments under the Affordable Care Act is roiling the industry, including potentially affecting the timing of any deal for Humana Inc., as suitors pore over the detailed information disclosed late Tuesday. (Wilde Mathews and Mattioli, 7/1)

Insurers are sizing up their reimbursements under CMS' reinsurance program and some plans appear to be off on their estimates. As part of the Affordable Care Act's plan to protect against adverse selection and protect insurers from excessive losses that could come from a disproportionate share of consumers with high medical costs, money is transferred between plans with relatively lower risk enrollees to plans with relatively higher risk enrollees. (Dickson, 7/1)

The Centene Corporation, a managed health care company, said on Thursday that it had agreed to acquire its rival Health Net in a cash-and-stock deal valued at $6.8 billion, including the assumption of debt. The deal would combine two providers of managed care in the United States, creating a company with more than 10 million members and an estimated $37 billion in revenue this year, the companies said. It would also expand Centene’s scale and give it a larger market presence in the western United States.

In his 2014 study, Northeastern University law professor Daniel Austin dug into personal bankruptcy filings to figure out what happened after Massachusetts lawmakers made health insurance mandatory in 2005. His findings? Massachusetts residents who file for bankruptcy protection these days have way less medical debt compared to the rest of the country. The typical Massachusetts person or couple who filed in 2013 had $3,041 in medical debt, while people everywhere else had an average of $8,594 in medical debt. (Stech, 7/1)

Twice as many Americans support the Supreme Court’s decision last week to uphold a key provision of the health-care law as are opposed, according to a poll released Wednesday. When told that the court ruled to allow Americans to continue receiving subsidies to afford health insurance in all states, about 6 in 10 surveyed said they approve of the decision while about one-third disapprove, according to the latest tracking poll by the Kaiser Family Foundation. (Sun, 7/1)

The poll found overwhelming approval for the decision among Democrats, and strong disapproval among Republicans. But independents mirrored the national results, approving by 61 percent to 34 percent. (7/1)

Despite the public's largely favorable view of the court's decision, opinions regarding the Affordable Care Act are divided, with 43 percent of Americans viewing the law favorably and 40 percent of Americans viewing the law unfavorably. (Washington, 7/1)

The monumental lawsuits that threaten the core of Obamacare might be a thing of a past, but the same can’t be said about Americans’ enduringly negative perceptions of the law, several health experts said Wednesday. (Pradhan, 7/1)

It may have been fitting that the two marquee decisions — declaring a constitutional right to same-sex marriage and saving the Affordable Care Act from a potentially fatal challenge — came last week. That meant the court's liberal wing didn't lose a major case until Monday, the last day of the term. (Wolf, 7/1)

More than 220,000 Oregonians who buy their own health insurance will face higher premiums next year, and Portlanders could see some of the biggest hikes in the country. Oregon is the first state to announce 2016 rates for people who aren't covered by their employers or government programs. Overall, the news is not good for consumers. ... the least expensive "silver" plan premium available to a 40-year-old next year will run $271 per month under the new rates. That's up $49 per month over this year's low rate. (Budnick, 7/1)

Doing business with the government was a key source of income last year for Minnesota health insurers, but some of the money could be coming back to the state of Minnesota. Operating income from state health care programs including Medicaid and MinnesotaCare jumped by about two-thirds to about $195 million last year, up from $117.4 million in 2013, according to a report Wednesday from Allan Baumgarten, an independent health care analyst in St. Louis Park. ... Due in part to uncertainty about the health care needs of those gaining coverage under the law, contracts between the state and private insurers in the programs included provisions for retrospective severity adjustments. (Snowbeck, 7/1)

Washington’s health-insurance exchange will have to figure out how to get by on less money from the state than it hoped for over the next two years, but officials Wednesday said the budget is “sufficient.” Over the 2015-17 biennium, the Washington Health Benefit Exchange will have a $110 million budget to operate Healthplanfinder, the online exchange selling individual insurance coverage and plans for small businesses. The website is also where people enroll in Medicaid. (Stiffler, 7/1)

New ObamaCare enrollees are healthier and spent less on drugs than enrollees last year, according to a new analysis. The report from Express Scripts, the country’s largest pharmacy benefits manager, is a positive sign for the law, given the need to maintain a mix of healthy and sick enrollees to keep costs down. Still, ObamaCare exchange enrollees tended to be sicker than those in other health plans. Costs were 16 percent higher per member per month compared to non-ObamaCare plans, the report finds, largely due to higher spending on costly drugs for complex conditions. (Sullivan, 7/1)

Kentucky has awarded new contracts to the five private companies that manage its rapidly expanding Medicaid program, its growth fueled by hundreds of thousands of new members under the Affordable Care Act. The growth has been a windfall for some of the companies over the past year, but the new contracts are designed to limit potential profits and address complaints about slow payments and excessively complicated forms and procedures. (Yetter, 7/1)

Few days went by last year when New Hampshire nephrologist Ana Stankovic didn't receive a payment from a drug company. All told, 29 different pharmaceutical companies paid her $594,363 in 2014, mostly for promotional speaking and consulting, but also for travel expenses and meals, according to data released Tuesday detailing payments by drug and device companies to U.S. doctors and teaching hospitals. ... What is being seen for the first time now is how ingrained pharmaceutical companies and their sales reps are in the lives of those who write prescriptions for their products. A ProPublica analysis found that 768 doctors received payments on more than half of the days in 2014. More than 14,600 doctors received payments on at least 100 days in 2014.(Ornstein and Grochowski Jones, 7/1)

The details published Tuesday by the Obama administration mark the second batch of data on industry ties to medical providers. As part of the Affordable Care Act, federal health officials released information last year on payments made for five months of 2013. The latest data cover all of 2014. (Terhune, 7/1)

The sprawling field hospital that springs up in rural southwest Virginia every summer has been called the largest health-care outreach operation of its kind. This year, the event will host another first. Unmanned aerial vehicles — drones — will deliver medicine to the Wise County Fairgrounds in part to study how the emerging technology could be used in humanitarian crises around the world. (Portnoy, 7/1)

After years of waiting, families of kids with autism may finally get insurance coverage for treatment. A bill that would have North Carolina insurers reimburse for some evidence-based treatment is finally looking like it may pass both chambers of the General Assembly – but not before withstanding significant opposition and leaving advocates angry. (Editor in Childrens Health, 7/1)

[Virginia] is taking another stab at evaluating whether it’s time to ditch the regulatory framework for approving new health care facilities, given the dramatic changes that have occurred in health care since the last attempt to dismantle the state certificate of public need program more than a decade ago. (Smith, 7/1)

The nurses who showed up at state Senator Richard Pan’s Capitol office in May were furious. They had been assured by Pan, a Democrat from Sacramento, that he would be on their side when it came time to vote on Senate Bill 346, a charity care measure aimed at providing transparency to the state’s currently murky rules governing tax-exempt status for nonprofit hospitals. (Raden, 7/1)

If you’re one of the roughly 70,000 women who will give birth in Massachusetts this year, you may be planning to deliver at a hospital close to home or where your OB practices. But what you might not realize is that when it comes to childbirth, there are big differences in hospital quality across the state. (Bebinger, 7/2)

A former state assemblyman known for his defiant conservatism is seeking to reverse California’s newly passed vaccination mandate. The day after Gov. Jerry Brown signed Senate Bill 277, an intensely controversial bill requiring all California schoolchildren to be fully vaccinated, former Assemblyman Tim Donnelly submitted paperwork to overturn the law. Opponents of the bill have also predicted a legal challenge, arguing the law will unconstitutionally block unvaccinated children from receiving an education. (White, 7/1)

Jim Carrey has come out swinging against Gov. Jerry Brown for signing one of the nation’s toughest vaccination laws this week, barring religious and other personal-belief exemptions for schoolchildren. The Golden Globe-winning actor slammed Brown on Twitter, calling him a “corporate fascist” who was poisoning children by signing into law the vaccination requirements. (Rocha, 7/1)

A review by his office concerns an arcane payment method known as PON1, ostensibly used to make payments for “special, non-procurement expenditures,” Mr. Stringer wrote. These include payments to pension funds, health insurance companies and the United States Postal Service, among others. (Flegenheimer, 7/1)

Medicare Part D increased economic access to medications, but its effect on ... health outcomes and use of other medical services remains unclear. ... [Researchers analyzed a] nationally representative sample of Medicare beneficiaries ... from 2000 to 2010 [to see] changes in self-reported health status, limitations in activities of daily living (ADLs) ..., emergency department visits and hospital admissions (prevalence, counts, and spending), and mortality. Medicare claims data were used for confirmatory analyses. ... Five years after Part D implementation, no clinically or statistically significant reductions in the prevalence of fair or poor health status or limitations in ADLs ... were detected. Compared with trends before Part D, no changes in emergency department visits, hospital admissions or days, inpatient costs, or mortality after Part D were seen. (Briesacher et al., 6/16)

In 2010 the US Advisory Committee on Immunization Practices recommended that the seven-valent pneumococcal conjugate vaccine (PCV7) be replaced by the thirteen-valent version (PCV13), which provides protection against six additional serotypes of the bacterium Streptococcus pneumoniae. The higher price ... may be a concern for funding agencies and payers .... This study estimated the budgetary impact ... from 2010 to 2019. Implementing the PCV13 vaccine is projected to cost public and private payers $3.5 billion and $2.6 billion, respectively, more than PCV7. However, PCV13 is expected to provide net cost savings of $6.1 billion and $4.2 billion, respectively, to those payers during the ten-year period by preventing pneumococcal disease and its associated costs. An additional $1.7 billion in cost savings would be realized for uninsured patients. (Kohli et al., 7/1)

We examined changes in the ... frequency of indoor tanning among US adults [using] ... the 2010 and 2013 National Health Interview Survey .... We observed significant reductions in indoor tanning from 2010 to 2013: from 5.5% to 4.2% ... among all adults, from 8.6% to 6.5% ... among women, and from 2.2% to 1.7% ... among men .... The decrease in indoor tanning may be partly attributable to the increased awareness of its harms. Indoor tanning devices have been classified as carcinogenic to humans, their use has consistently been shown to increase skin cancer risk, and laws restricting access among minors may have changed public perceptions of their safety. In addition, a 10% excise tax on indoor tanning was implemented in 2010, which may have contributed to the decrease in indoor tanning. (Guy, Berkowitz, Holman and Hartman, 7/1)

This paper examines Massachusetts residents’ satisfaction with their health insurance coverage using the 2013 Massachusetts Health Reform Survey (MHRS). We find that nonelderly adults in Massachusetts are generally quite satisfied with their coverage, their network of health care practitioners, and the quality of care available with their plans. However, they are less satisfied with the financial protections afforded by their health insurance coverage and often report financial barriers to care and problems paying medical bills. Health care affordability continues to be a challenge for Massachusetts residents, despite near-universal coverage. (Long and Dimmock, 7/1)

We analyze how price competition in the ACA’s nongroup insurance marketplaces varies by insurer type: national, regional, Blue Cross Blue Shield, previously Medicaid-only, provider-sponsored, and co-ops. National insurers are expanding their presence, but are not yet pricing aggressively. Regional insurers have increased participation but seem to be losing price competitive ground. Blue Cross Blue Shield insurers have widespread participation but pursue very different pricing strategies. Previously Medicaid-Only insurers are a growing presence that is getting increasingly price competitive. Provider-sponsored insurers have a limited presence and an inconsistent competitive footing. Finally, co-ops are expanding and improving their competitive pricing position. (Blumberg, Holahan and Wengle, 6/25)

This brief presents an early analysis of changes in the premiums for the lowest- and second-lowest cost silver marketplace plans in major cities in 10 states plus the District of Columbia, where we were able to find complete data on rates for all insurers. ... In most of these 11 major cities, we find that the costs for the lowest and second-lowest cost silver plans – where the bulk of enrollees tend to migrate – are changing relatively modestly in 2016, although increases are generally bigger than in 2015. The cost of a benchmark silver plan in these cities is on average 4.4% higher in 2016 than in 2015. These premiums are still preliminary in some cases and could be raised or lowered through these states’ rate review processes .... We also find that the number of insurers participating has stayed the same or increased in 9 states. (Cox, Ma, Claxton and Levitt, 6/24)

This brief provides insight into ... questions [about the Affordable Care Act enrollment] through an on-the-ground view of ACA implementation in five states. ... Key findings from stakeholders ... show that, as of the second year, most major enrollment systems issues had been resolved. The states that expanded Medicaid continued to experience enrollment growth, and Marketplace enrollment goals were met or surpassed in four of the five states, although affordability remains a key enrollment challenge. ... Per enrollee costs of care for expansion enrollees have been lower than anticipated in the three states that expanded Medicaid. Expansion enrollees generally are able to access needed care, although there are access challenges for some services. (Artiga, Tolbert and Rudowitz, 6/22)

Outside of direct patient care, hospitals spend relatively little to foster health in their communities, a new study found. A report published online Thursday by Health Affairs revealed that for the $62 billion that not-for-profit hospitals allocated in 2011 for "charity care and community benefit," only $4 billion -- less than 1% of hospital spending across the board -- went toward improving health in surrounding geographic areas. ... One effect of this trend is a big spike in the value of the tax exemptions that not-for-profit hospitals receive. From 2002 to 2011, that value rose from $12.6 billion to $24.6 billion, according to the study, which based its findings on Internal Revenue Service data. (Harris, 6/26)

Patients who need to be rehospitalized within a month after major surgery have a lower risk of death over the next two months if they return to the hospital where they had the surgery rather than going to a different facility, according to a new study. “Most clinicians or surgeons feel like if you take the time to do a big operation on someone, you know the area operated on, how the operations went, if there were complications,” lead author Dr. Benjamin S. Brooke of the University of Utah School of Medicine in Salt Lake City told Reuters Health by phone. Doctors who did not perform the surgery won’t have that context, which may explain part of the survival benefit of returning to the original hospital, he said. (Doyle, 6/29)

Every year, about 395,000 people suffer cardiac arrest in their homes or other non-hospital settings — and less than 6 percent of them survive, the Institute of Medicine estimated Tuesday. ... An additional 200,000 cardiac arrests occur in hospitals every year, and even there only a quarter of patients survive, the report found. ... the IOM committee said fear, not understanding what cardiac arrest is, lack of first-aid training and concern about legal liability can hamper response and cost precious time. ... Moreover, there are wide disparities in outcomes: One study found that survival ranged from about 8 percent to 40 percent across 10 different communities. On Tuesday, the IOM called for a major public education effort to teach people how to recognize and react to cardiac arrest. (Neergaard, 6/30)

Phone-based surveys show that nearly four of every 10 kids and teens in the U.S. were exposed to violence or abuse over the previous year, researchers have found. “Children are the most victimized segment of the population,” said study leader David Finkelhor of the Crimes Against Children Research Center at the University of New Hampshire in Durham. ... Compared to 2011, the violence rates appear to be stable, and certain kinds of violence exposure may be decreasing, he said. While the rates are not going up, “the problem is that there is still way too much,” he said. (Doyle, 6/29)

Elder abuse may be more common than is recognized, particularly among adults with dementia or other cognitive impairments, a research review suggests. In North and South America, elder abuse prevalence ranges from 10 percent of lucid older adults to almost half of those with dementia, the review of previous studies found. In Europe, prevalence ranges from about 2 percent in Ireland to about 61 percent in Croatia and in Asia, exposure to elder abuse ranges from 14 percent in India to 36 percent in China. (Rapaport, 6/25)

Only about one in eight people with so-called pre-diabetes, often a precursor to full-blown disease, know they have a problem, a U.S. study found. Lacking awareness, people with the elevated blood sugar levels were also less likely to make lifestyle changes such as getting more exercise or eating less sugary food that might prevent them from ultimately becoming diabetic. (Rapaport, 6/29)

The long battle over ObamaCare’s subsidies that culminated at the Supreme Court last week has overshadowed a consequential shift in health insurance: toward high-deductible plans that will help put market forces back into medicine. (David Goldhill and Paul Howard, 7/1)

Now more than ever, it is imperative for every Republican presidential candidate to present a concrete plan to replace ObamaCare. The Affordable Care Act remains unpopular: Wednesday’s RealClearPolitics average of polls showed 51.4% disapprove while only 43.6% approve. Voters are more likely to be opposed than are adults overall, and opponents are more fervent than supporters. (Karl Rove, 7/1)

The Supreme Court has left the ObamaCare demolition job to Republicans, who at least until 2017 will have to chip away at its architecture piecemeal. Last week the House made a good start by voting to kill the Independent Payment Advisory Board (IPAB), aka ObamaCare’s rationing board. Eleven Democrats joined 233 Republicans to abolish IPAB, a 15-member jury of high priests appointed by the President that’s charged with making cost-cutting recommendations for Medicare. (7/1)

While the U.S. Supreme Court has removed much of the uncertainty surrounding the future of the Affordable Care Act (ACA), the impact of this far-reaching change in U.S. health care financing and delivery will be a complex story unfolding gradually for years to come. The ACA is a huge “disruptive innovation,” to borrow a popular term from the business school literature. Like other disruptive innovations, it will generate winners and losers and have a slew of unforeseen consequences. (Alice M. Rivlin, 6/30)

Discussion is growing about what rumored mergers between health insurance companies could mean for shareholders and the public. Initially, it was Humana exploring acquisitions by Cigna and Aetna. Then UnitedHealthcare approached Aetna. More recently, Aetna made a takeover proposal to Humana and Anthem announced a takeover bid for Cigna that seems to have been rejected. When the Justice Department grapples with these mergers, it can be expected to take into account these companies’ growing Medicare business. (Drew Altman, 7/1)

Now that the Supreme Court has settled the latest challenge to Obamacare, the next big health care news in Washington will likely be the 21st Century Cures Act, a $106.4 billion health care research bill that could come to the House floor in July. How will Congress pay for it? If you haven’t been watching, you’ve missed one of the stranger decisions of the year: the Energy and Commerce committee proposes to sell off 64 million barrels of crude oil from the Strategic Petroleum Reserve. (Larry Goldstein and Lucian Pugliaresi, 7/1)

The Supreme Court's decision Tuesday to allow nearly a dozen Texas abortion clinics to stay open while it considers whether to review an an onerous new antiabortion law was not just a welcome course of action for women in that state. It was also a promising indication that the court is concerned about the burdensome and unnecessary law, which requires clinics to be outfitted as ambulatory surgical centers and doctors to have admitting privileges at nearby hospitals. (7/1)

The right to swing one’s fist ends at the next person’s nose, and — at least according to California legislators — the right not to get vaccinated ends at a statewide measles outbreak. That’s what lawmakers decided last week when they passed a bill mandating vaccinations for schoolchildren, regardless of personal or religious objections. California’s move to increase vaccination rates is welcome, though it may go slightly too far. (7/1)

Too many people we love had not died in the way they would choose. Too many survivors were left feeling depressed, guilty, uncertain whether they’d done the right thing. The difference between a good death and a hard death often seemed to hinge essentially on whether someone’s wishes were expressed and respected. Whether they’d had a conversation about how they wanted to live toward the end. (Ellen Goodman, 7/1)

You know the old mantra: When you turn 65 you are eligible for Medicare and Social Security. But matters are no longer that simple. And because growing numbers of older Americans are not taking Social Security benefits until past 65, they may be making poor Medicare choices or missing out on some benefits entirely–simply because the government is not telling them they need to actively enroll for health coverage. (Howard Gleckman, 7/1)

Maximizing survival and minimizing disability are fundamental goals of patient care, but a new Institute of Medicine (IOM) report released this month, “Strategies to Improve Cardiac Arrest Survival: A Time to Act,” suggests that the United States is falling short in efforts to improve outcomes from cardiac arrest during the next decade. ... cardiac arrest is not a futile situation: it is a treatable event. Most survivors of cardiac arrest are not neurologically devastated but have long-term health-related quality of life. If advances achieved within some US communities could be implemented nationally, the rate of favorably functional survival from cardiac arrest could substantially improve. (Lance B. Becker, Tom P. Aufderheide and Robert Graham, 7/1)