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Congress on Wednesday avoided a government shutdown by passing a bill that keeps the government running through mid-December, but leaves unresolved a divide over federal spending that threatens to resurface this winter with more perilous economic consequences. ... Congress now confronts a new Dec. 11 deadline to try to strike a long-term budget deal at a time when House Republicans are losing their most experienced leader and remain split about how to negotiate with Mr. Obama and Democrats. (Peterson and Timiraos, 9/30)

The stopgap spending bill, which passed the Senate 78 to 20 and cleared the House 277 to 151, continues current funding levels through Dec. 11 and sets the stage for negotiations between congressional Republican leaders, who want to hew to strict caps on nondefense discretionary spending, and President Obama and Democrats, who want higher levels. ... Meanwhile, Republican demands to end Planned Parenthood’s access to Medicaid reimbursements and federal health-care grants, which nearly prompted a shutdown ahead of Wednesday’s midnight deadline, show no sign of abating. ... The influential conservative activist group Heritage Action for America, for instance, on Wednesday called on aspiring House leaders to end Planned Parenthood funding and respect the sequestration caps. (DeBonis and Snell, 10/1)

Conservatives in both chambers wanted the continuing resolution to cut federal funding for the women’s health care organization but nearly unified Senate Democratic resistance — not to mention a promised veto from President Barack Obama, meant the defunding language was jettisoned from the bill that the House cleared on a 277-151 vote and that will move on for Obama’s signature. A coalition of 91 Republicans joined 186 Democrats to pass the bill in the House. ... Conservative Republicans are already planning an aggressive tact to strip Planned Parenthood of its funding after falling short this round. ... And with the House GOP embroiled in leadership election intrigue after Boehner’s surprise resignation last week, there are several variables in play. Minority Whip Steny Hoyer (D-Md.) told reporters on Tuesday that he is worried that fights over spending caps, Planned Parenthood and overall government funding could lead to a shutdown in December. (French and Kim, 9/30)

The House of Representatives relied heavily on Democrats to secure passage in a 277-151 vote. A large majority of Republicans voted against the measure, which did not meet conservatives' demands to cut off money to women's healthcare provider Planned Parenthood amid an abortion controversy. The House also passed a companion bill aimed at restoring the Planned Parenthood defunding provision, but the Senate is not expected to act on it, effectively killing it. (Lawder and Cowan, 9/30)

The House Energy and Commerce Committee on Wednesday advanced a fast-track bill to defund Planned Parenthood for one year and repeal an Obamacare public health fund. The bill is part of the process called reconciliation, which will allow measures to bypass a Senate Democratic filibuster. President Obama is still sure to veto them, but Republicans say that they will at least reach his desk. (Sullivan, 10/1)

A law that provides medical monitoring and treatment for Sept. 11 first responders expires at midnight Wednesday due to the failure of Congress to act. For now, first responders who rushed to the World Trade Center after the 2001 terrorist attacks, worked for weeks and now suffer from illnesses like pulmonary disease and cancers will still be able to get their health care. But federal officials who administer the program say it will face challenges by February and will have to start shutting down by next summer. (9/30)

Congress recessed without reauthorizing the James Zadroga Health and Compensation Act, which covers medical care for those who became sick after working at the World Trade Center following the terrorist attacks on Sept. 11, 2001. ... "We never intended for this important legislation to expire so quickly, but, once again, Washington politics got in the way," Reps. Carolyn Maloney, Jerrold Nadler and Peter King of New York wrote in an op-ed Wednesday in the political newspaper The Hill. The act is fully funded well into 2016, and Senate Majority Leader Mitch McConnell, R-Kentucky, told reporters earlier this month that "we do plan to extend the program."(Johnson, 10/1)

The taxman is coming to employer-sponsored health insurance, and his visit may trigger changes to your benefits. The health care overhaul calls for a 40-percent tax starting in 2018 on the value of employer-sponsored coverage that costs more than $10,200 for single plans and $27,500 for family insurance. Employers are working to avoid this tax by cutting costs that have been rising for several years. (Murphy, 9/30)

The public opposes ObamaCare’s “Cadillac Tax” on high-cost health insurance plans by a wide margin, according to a new poll. (Sullivan, 10/1)

In a nearly empty House chamber on Monday afternoon, a little-noticed bill came up for a voice vote. The few lawmakers on the floor shouted “aye,” no one shouted “no,” and the bill was passed. Changing Obamacare has rarely been so drama-free. Passage of the bill, which would adjust the healthcare law’s definition of a small employer, is raising hopes that more bipartisan tweaks to ObamaCare could be on the way. (Sullivan, 10/1)

The biggest pieces of Sanders’s domestic agenda — making college, health care and child care more affordable — seek to capture these industries and convert them to run chiefly on federal money. ... Bernie Sanders — a senator from Vermont who describes himself as a “democratic socialist” — will never get everything he wants in Washington. And that still would be true if he became President Sanders. Republicans in the Congress would fight him fiercely. Democrats might not be much help. In fact, Sanders’s most recent Senate bills — legislation that would make college free and provide universal health care — attracted exactly zero Democrats as co-sponsors. (Fahrenthold, 10/1)

Hardcore Republicans are going to have a hard time getting their way. They’re rejoicing these days as a longtime thorn in the side, House Speaker John Boehner, prepares to step down and some of their ranks could start moving up in the House of Representatives leadership. They see new hope for efforts to repeal the Affordable Care Act, keep taxes low and slash federal spending. They’re dreaming. (Lightman, 9/30)

So you've been burned by flaming water skis? Attacked by an orca? Sucked into a jet engine? Try to remember the details for your doctor, because there's now a medical code for your condition. The crazy-sounding diagnostic codes are part of a huge change set to take place Thursday in doctor's offices, hospitals, nursing homes, insurance companies and just about every part of the U.S. health system. If things go according to the long-delayed plan, patients shouldn't notice and care shouldn't be affected. (Sun, 9/30)

If you're struck by an orca, sucked into a jet engine, or having relationship problems with your in-laws, fear not: Your doctor now has a medical diagnosis code for that. Today U.S. doctors, hospitals and health insurers must start using the ICD-10, a vast new set of alphanumeric codes for describing diseases and injuries in unprecedented detail. The transition, mandated by the federal government, has been called American health care’s Y2K moment, because the codes haven’t been updated in 36 years. Doctors and hospitals are on high alert since the arcane letters and digits are key to how health care providers get paid. If they don’t use the right codes, down to the decimal, they may not be paid sufficiently – or at all. (Feder Ostrov, 10/1)

The World Health Organization issued sweeping new guidelines on Wednesday that could put millions more people on H.I.V. drugs than are now getting them. The recommendations could go a long way toward halting the epidemic, health officials say, but would cost untold billions of dollars not yet committed. (McNeil Jr., 9/30)

The World Health Organization has revised its HIV guidelines to recommend that anyone who tests positive for the virus that causes AIDS should be treated immediately. That guidance fits with what is already recommended in many developed nations, including the United States. (Cheng, 9/30)

The first major change involves those already infected with HIV. Previously, doctors were to wait until a patient's viral load reached a certain severity before offering treatment. But new studies have shown that treating as early as possible can keep patients healthier and reduce transmission rates with minimal side effects. (Cha, 9/30)

Opponents of a new child vaccination law in California have reported that they turned in some 228,000 signatures on petitions for a referendum to overturn the measure, far short of the number needed to qualify it for next year's ballot. Referendum supporters needed the signatures of 365,880 registered voters by Monday to place the measure before state voters in November 2016. (McGreevy, 9/30)

A plan to ask voters to repeal a new California law tightening vaccination requirements for school-age children may falter due to a shortfall in signatures needed to put the referendum on the ballot. The effort is part of a backlash against a bill signed into law this summer by Democratic Governor Jerry Brown that requires pupils to be vaccinated against childhood diseases unless they have a medical reason to refuse. It was passed after a measles outbreak among unvaccinated people at Disneyland last year. (9/30)

The Texas Senate’s GOP leaders have told state social services officials that a state budget provision requiring reductions in Medicaid spending on outpatient therapy services sets a dollar amount for a goal. But that isn’t an absolute requirement, and disabled children’s access always was supposed to be considered, even if it keeps the savings from hitting the goal, Lt. Gov. Dan Patrick and Senate Finance Committee Chairwoman Jane Nelson said publicly on Wednesday. (Garrett, 9/30)

Amid an ongoing lawsuit over deep cuts that lawmakers made this year to a therapy program for children with disabilities, Lt. Gov. Dan Patrick on Wednesday offered a sternly worded defense of the Legislature’s move. (Walters, 9/30)

Advocates for elderly and disabled Kansans are anxiously awaiting the publication of the state’s plan to combine seven Medicaid waivers into one. The waivers currently provide home and community-based services for people within a range of support categories, including developmental disability, physical disability, traumatic brain injury or frail/elderly. (Marso, 9/30)

South Carolina’s Medicaid agency has paid for 222 abortions during the past five years, according to a state agency. Planned Parenthood could have performed up to two additional abortions, a S.C. House oversight panel looking into how state agencies interact with Planned Parenthood was told Wednesday. State Health and Human Services head Christian Soura told the panel those two payments could be medical coding errors. For example, one bill was for $78, far less than the cost of an abortion. (Cope, 9/30)

Medicaid paid for 222 abortions in South Carolina over the past five fiscal years, but none of those were provided by Planned Parenthood, the agency's director said Wednesday to legislators who are investigating state spending on abortions. South Carolina's Medicaid agency has spent $437,361 on 222 abortions performed between July 1, 2010, and July 30, 2015. Those numbers may adjust, as providers have a year to seek payment, and a review of 2014-15 payments is under way, Health and Human Services Director Christian Soura said. The law allows Medicaid to pay for abortions in cases of rape, incest, or when the mother's life is in danger. (Adcox, 9/30)

An Ohio chapter of Planned Parenthood has won a federal temporary restraining order against enforcement of a recently passed state law that would close two of the organization's abortion clinics. (Pierson, 10/1)

One of the people sickened in a new outbreak of Legionnaires’ disease in the city has died, health officials said Wednesday. The Department of Health and Mental Hygiene released few details about the person, saying only that the patient was between the ages of 40 and 49 and had “severe underlying health conditions.” (Gay, 9/30)

There's a story being written in metro areas around the country, over and over again. In Atlanta: Hospitals' merger goes through. In Detroit: Hospitals' merger goes through. But in California this spring, something different happened: A merger fell through. And that case -- the failed sale of Daughters of Charity to Prime Healthcare, and all the acrimony that's come after it -- is an interesting case study in regulatory power. (Diamond, 9/30)

New York City Mayor Bill de Blasio is expected on Thursday to introduce a multimillion-dollar initiative to improve health-care access for some of the city’s low-income, uninsured immigrant population by connecting them to primary and preventive health-care services. The initiative, called Direct Access, isn’t an insurance program, but it aims to create a kind of universal health care using existing providers already paid for by city, state or federal funds. Patients would have a primary-care doctor and a so-called medical home where care would be coordinated. (West, 10/1)

The new legal aid clinic for military veterans at Syracuse University College of Law has taken on dozens of appeals of denied benefits and less than honorable discharges. The free clinic began handling cases this year, established by two graduates, both now in the military, to meet the large unmet need they saw. (10/1)

New York state's experiment to better coordinate care for low-income and disabled residents who are dually eligible for Medicaid and Medicare is losing hundreds of enrolled beneficiaries. As many as 124,000 were eligible for New York's initiative, called the Fully Integrated Duals Advantage, when it launched Jan. 1 of this year. But as of Sept. 1, only 7,280 had enrolled. (Dickson, 9/30)

The N.H. Department of Health and Human Services is making changes to its licensing requirements for inpatient drug and alcohol treatment centers in order to address a statewide shortage of beds. The revision came after Gov. Maggie Hassan and head of the department, Nick Toumpas, requested that the requirements be reviewed in August.Under the change, treatment providers will now be able to house two adults in rooms that are 120 square feet rather than the 160 square footage in the current rules. Currently 21 states have the 120-foot standard or lower. (Sutherland, 9/30)

In Alabama, a positive drug test can have dire repercussions for pregnant women and new mothers. Their newborns can be taken from them. They can lose custody of their other children. They can face lengthy sentences in the most notorious women’s prison in the United States and thousands of dollars in fees and fines. Yet the hospitals that administer those drug tests — and turn the results over to authorities — are exceedingly reluctant to disclose their policies to the public. In many cases, they test mothers and babies without explicit consent and without warning about the potential consequences, ProPublica and AL.com have found. (Martin and Yurkanin, 9/30)

Students who have experienced trauma could be eligible for some of the same protections as students with disabilities based on the effects of that trauma, according to a ruling by a federal judge Tuesday. But the degrees, types and effects of trauma that would trigger such protections have yet to be determined. (Resmovits, 10/1)

One year ago, on Sept. 30, 2014, the CDC confirmed that Thomas Eric Duncan had Ebola. He was the first person diagnosed with the deadly virus on American soil. During his stay at Texas Presbyterian Hospital in Dallas, two nurses also contracted Ebola. Duncan died, but the nurses survived, as did a handful of Americans who fell ill in West Africa but were transported back to the U.S. for care. (Feibel, 10/1)

Miguel Dominguez didn’t know what to make of the notices he started receiving from the state toxic substances department a couple of years ago. They warned about Exide Technologies, a company he’d barely heard of. Then a community activist knocked on the door. He explained that Exide’s battery recycling plant – just minutes from Dominguez’s home — had been polluting the air and soil with lead and other toxic chemicals for decades. (Gorman, 10/1)

Hillary Clinton rolled out several modest but serious health-care proposals last week. This week she canceled out any claim to responsibility on the subject by calling for repeal of the “Cadillac tax” on employer health-care plans. The tax, set to take effect in 2018, is a key component of President Obama’s health-care plan and its most effective means of controlling health-care costs. Without it, Obamacare becomes one more entitlement program facing ever-rising health-care costs that the country will eventually be unable to afford. (9/30)

Hillary Clinton has called for the repeal of the “Cadillac Tax,” a part of the Affordable Care Act that is soon to go into effect, and which most Americans probably know nothing about. You can look at this as a cynical effort to win the support of certain constituencies that are important to Democrats, which it may be. But it’s also yet more evidence that only one party’s presidential candidates are even remotely interested in grappling with the difficult work of policy-making, particularly on the issue of health care. (Paul Waldman, 9/30)

After five years, two midterm disasters, and a rollout that reminded Americans why they fell out of love with big government in the 1970s, reality has finally begun to dawn on some Democrats about Obamacare. With open enrollment about to start and a third straight round of premium spikes about to hit voters’ pockets, the Democrats’ leading presidential candidate has offered a “major break” with the Obama administration on its signature domestic policy achievement. (Edward Morrissey, 10/1)

Who says there’s no bipartisan consensus in the United States? Based on their campaign promises so far, if any of the leading contenders for the Republican and Democratic presidential nominations actually wins in November 2016, Obamacare as we know it is doomed. The Republicans, of course, pledge to repeal the whole thing. The Democrats, by contrast, merely want to hollow it out, by removing a crucial systemic reform, the absence of which will make the Affordable Care Act less able to meet its twin goals of curbing costs and expanding coverage. (Charles Lane, 9/30)

House Republicans called for an investigation of Planned Parenthood this summer, after a series of deceptively edited videos issued by an anti-abortion group, the Center for Medical Progress, alleged that Planned Parenthood profits from the sale of tissue from fetuses. But at a hearing on Tuesday, members of the House Oversight and Government Reform Committee deluged Cecile Richards, Planned Parenthood’s president, with a variety of questions entirely unrelated to that issue. (Anna North, 9/30)

Give the Republican majority in Congress credit for abandoning its threat to shut down the federal government in a futile effort to stop funding for Planned Parenthood. Instead, Republicans now aim to attack Planned Parenthood though a powerful budgetary tool called reconciliation, which, unlike a spending bill, cannot be filibustered in the Senate. This shift in tactics will be good for the country, avoiding the needless and economically damaging disruption that a second government shutdown in 24 months would have caused. But the GOP's new approach won't hit its target either. (9/30)

Ten years ago, did you imagine that Planned Parenthood would be the center of our national political life? No, 10 years ago we were just worried about George W. Bush and high oil prices. Sometimes I miss high oil prices. On Wednesday the House passed a bill to keep the government running until December. Only 91 Republicans supported the idea, because it included funding for Planned Parenthood. (Thank you for keeping the national parks open, Nancy Pelosi.) John Boehner resigned because he was exhausted with the fight. (Gail Collins, 10/1)

As s the top ranking Democrat on both the Benghazi and Oversight committees in the House of Representatives, I have a front row seat to watch House Republicans push their highest priorities. Right now, the top two goals for Republicans are to damage Hillary Clinton’s campaign to become the nation’s first woman president and to attack and defund Planned Parenthood, an organization that provides critical healthcare services to millions of women across the country. My assessment is based not only on Republicans’ statements, but also on their actions, and particularly the way in which they are structuring and paying for these efforts in the House. (Rep. Elijah Cummings, D-Md., 9/30)

If congressional squabbling causes the U.S. government to shut down this year, the economy will be fine. Unfortunately, the same cannot be said if the misshapen priorities embedded in the current federal budget are left to fester. ... [U]nder current law, domestic discretionary programs—programs that must be reauthorized each year by Congress—will shrivel to 2.3% of the country’s gross domestic product, the broadest measure of economic output, by 2025, the Congressional Budget Office projects. That would be the lowest since before 1965, down from 3.4% in 2007. ... At the same time, mandatory programs, which don’t need annual authorization and include most of the social safety net, will balloon to 14.1% of GDP by 2025 from 10.1% in 2007, according to the CBO. This is due partly to the Affordable Care Act, but even more to the impact on Social Security, Medicare and Medicaid of an aging population and health care costs, which, after a respite, will outstrip inflation in coming decades. (Greg Ip, 9/30)

So here–in non-ideological terms that hopefully make common sense–is why we cannot afford [conservatives' tax] cuts: based on a number of easily identifiable factors, like our aging population and infrastructure, our government is going to need more, not less, revenue in the future. ... Second, there’s demographics, or to make it personal, aging boomers: we’re gray, we’re here to stay and we’re not going away! ... Well, not for a while, anyway. The figure above shows that the 65 and up population is around 15 percent of the total today, stabilizing a bit north of 20 percent around 2040. The point is again a mechanical one: the fact that a larger share of the population will be in the age ranges supported by Medicare and Social Security implies more spending. According to the Congressional Budget Office’s latest projections, by 2025, spending on Social Security and Medicare will need to go up by just under 2 percent of GDP. (Jared Bernstein, 10/1)

The straight-talking, chain-smoking Ohioan was also the architect of this year’s entitlement reforms. Each year for nearly the past 20, Congress spent time crafting a short-term “doc fix” to stave off mandated cuts in Medicare payments to doctors. Mr. Boehner engineered a permanent solution to the problem and, in the process, passed the first significant reforms in entitlement spending in a decade. (Karl Rove, 9/30)

“Gray’s Anatomy” illustrated the entire human body with 1,247 engravings when it was published in 1918, but starting today doctors must employ nearly 70,000 codes to document their efforts to heal it. The bureaucrats who crowd the corridors of power like plaque in a clogged artery have dreamed up new hoops for medical professionals to jump through. It’s about keeping up with the complexification of health care. (9/30)

After a D.C. ambulance transports someone to a hospital, it takes on average 45 minutes to process the patient. During that time, the ambulance is out of service and unable to respond to other, often more pressing emergencies. That lost time can have life-and-death consequences for a city scrambling to keep up with a spike in calls for medical help. That is why Fire Chief Gregory Dean wants to enlist private ambulances for less serious calls, an idea that has worked well for other cities. (9/30)

It’s official: the James Zadroga 9/11 Health and Compensation Act has expired. Today, Congress missed an important deadline to reauthorize the World Trade Center Health Program and the 9/11 Victims Compensation Fund, and soon the first responders and survivors of the worst terrorist attack on American soil in our history will receive notice -- the programs that provide healthcare and offer financial support to our 9/11 heroes are expiring. In the final hours of 2010, more than nine years after the attacks, Congress passed the Zadroga Act. We never intended for this important legislation to expire so quickly, but, once again, Washington politics got in the way. We now know 33,000 first responders and survivors across the country suffer from at least one 9/11-related illness or injury, and many have multiple, severe illnesses that impact their lives every day, including 4,000 responders and survivors with cancer. (Reps. Carolyn Maloney, D-N.Y., Jerrold Nadler, D-N.Y., and Peter King, R-N.Y.)

In 2010, the Patient Protection and Affordable Care Act (ACA) created a link between [US Preventive Services Task Force] recommendations and various [insurance] coverage requirements. ... In essence, the ACA leaves discretion to payers regarding coverage for non-A and non-B graded services—as was the case for all preventive services before the ACA. The law adds a “shortcut” to first-dollar coverage for A and B graded services only, leaving discretion to payers for other services. ... Although the ACA has provided an opportunity to link evidence to coverage for the most highly recommended services, these A and B recommended services are a floor, rather than a ceiling, on coverage of preventive services. (Albert L. Siu, Kirsten Bibbins-Domingo and David Grossman, 9/30)