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The House on Wednesday overwhelmingly adopted a crucial bipartisan budget accord that in one relatively tight 144-page bill stands to end five years of bitter clashes between Republicans and the Obama administration over fiscal policy .... It also will prevent a default on the federal debt that the Treasury Department had said would occur next week without congressional action, and called for cuts in Medicare payments to doctors and other health care providers as well as changes to a Social Security disability program that supporters of the measure said would save the government billions, while preserving the program for decades to come. (Herszenhorn, 10/28)

The $80-billion bipartisan accord between congressional leaders and President Obama reverses steep spending cuts to defense and domestic programs, and staves off hits to Medicare and Social Security disability benefits. It also raises the federal government’s borrowing limit through March 2017, well after the presidential election. The bill passed 266 to 167. Every Democrat voted for the deal, as did 79 Republicans. Most GOP lawmakers voted no. The Senate is expected to approve the deal. (Mascaro, 10/28)

The agreement has drawn GOP opposition in both chambers and on the presidential campaign trail from conservatives upset that it raises spending by $80 billion through September 2017 and extends the government’s borrowing authority through mid-March 2017. ... The legislation also incorporates fixes to two federal safety-net programs lawmakers wanted to address well before next year’s elections. (Peterson, 10/28)

Conservatives, on the other hand, loathe the deal. They’ve hammered leaders for negotiating the agreement in secret, without input form the rank and file, and many of them have strong, principled objections to raising the debt limit. (French, 10/28)

The agreement would lift the so-called sequester spending caps to increase discretionary spending by about $80 billion over two years, an amount that would be split equally among defense and domestic programs. To offset this cost, negotiators tapped a number of sources, including by making changes to Medicare and Social Security, auctioning off spectrum controlled by the government, selling crude oil from the Strategic Petroleum Reserve and tightening tax rules for business partnerships. (Snell, 10/28)

Republicans nominated Rep. Paul Ryan as their choice for House speaker Wednesday, coalescing around a fiscal conservative who has vowed to move the party past years of infighting with a more open and inclusive approach to running the chamber. (Hughes, 10/28)

A final floor vote is set for Thursday, almost ensuring the Wisconsin congressman will replace retiring Speaker John A. Boehner (R-Ohio), who called it quits rather than continue clashing with hard-right lawmakers. Behind closed doors, signs of GOP unrest remain. Ryan won 200 votes, well over a majority of the House GOP, but less than the 218 he will need in the upcoming floor vote. Still, even those who voted against him believe he will prevail Thursday. (Mascaro, 10/28)

Among the party’s larger group of mainstream conservatives, there was widespread relief that weeks of uncertainty over who would succeed Boehner ended with Ryan agreeing to take the job. There was also open excitement about the type of leader Ryan might be. Ryan has spent much of the past decade burnishing his credentials as a conservative ideas man, from his 2008 “Roadmap for America’s Future” though his four-year tenure as House Budget Committee chairman, his 2012 vice-presidential nomination and his ascent earlier this year to chairman of the Ways and Means Committee. (DeBonis, 10/28)

Mr. Ryan also could highlight more of his party’s vision for strengthening the fraying federal safety net, particularly Medicare and the troubled Social Security Disability Insurance program. But those changes are politically fraught. In the face of liberal criticism, Mr. Ryan’s own ideas for revamping Medicare have evolved in recent years from establishing an individual voucher system to enacting a less-sweeping change known as “premium support” in which the government pays insurers on behalf of enrollees. He has also delayed some cost controls in recent versions of his Medicare overhaul. (McKinnon, 10/29)

[Retiring Speaker John] Boehner delivered Mr. Ryan from his most vexing conflicts by negotiating an $80 billion bipartisan budget agreement that would increase spending for the military and some popular domestic programs, lift the debt ceiling and avert premium increases of as much as 50 percent for millions on Medicare right before an election. ... But the relief may be short-lived. The budget deal creates room for the House and Senate appropriations committees to draft a huge spending bill for the current fiscal year that can increase spending on defense as well as politically popular programs like medical research, federal law enforcement and wildfire suppression. But the spending bills already drafted are replete with conservative policy prescriptions, from crippling Mr. Obama’s signature health care law to blocking his climate change and financial regulations. Mr. Ryan will have to decide how far to push that clash with the president. (Steinhauer, 10/29)

But despite criticism that he was a weak speaker who had to regularly cajole his conference rather than dictate marching orders, Mr. Boehner, a longtime fiscal conservative, can claim significant success in influencing federal budgetary policy even if it took a rolling series of near economic calamities to do so. He won $2 trillion in spending reductions in a 2011 budget deal, set Medicare on a course to save $3 trillion over the long term with a bipartisan deal earlier this year and helped preserve most of the tax cuts enacted during the George W. Bush administration. (Hulse, 10/29)

State and federal health officials, facing growing concerns about the cost of insurance plans offered through the Affordable Care Act, are scrambling to deploy new Web-based tools to help Americans find the most economical coverage. This fall, state and federal insurance marketplaces created by the law, including in California, plan to offer consumers more comprehensive ways to compare health plans, check physician networks and estimate their total healthcare costs. (Levey, 10/29)

In an effort to ensure Williamson County residents have access to health care, United Way of Williamson County will be helping residents apply for health insurance through the health insurance marketplace. State and federally certified bilingual, health insurance marketplace navigators will be working to help individuals, families and small business owners get health insurance during the 2015 open enrollment period, which begins Nov. 1 and ends Jan. 31. (10/28)

Anthem Blue Cross and Blue Shield in Wisconsin will no longer sell health plans on the marketplace set up through the Affordable Care Act in Milwaukee, Racine and Kenosha counties. The Milwaukee market — where six other companies are selling health plans on the HealthCare.govwebsite — has emerged as one of the most competitive in the state. (Boulton, 10/28)

Seniors enrolling in Medicare are facing a tough decision when it comes to which plans they should sign up for. The enrollment period started about two weeks ago, but the federal government has yet to confirm a price for Part B plans. Most people currently enrolled in Medicare Part B pay about $105 a month. (Miller, 10/29)

A nonprofit Utah health insurer created by the federal health care law will shut its doors after learning it would receive only a fraction of the U.S. money it was counting on, state insurance regulators said. Arches Mutual Insurance Co. will keep paying claims for its customers this year but will halt operations in 2016 because it doesn't have enough money to meet its obligations, Utah's Insurance Department said Tuesday. (Price, 10/29)

Nearly half of the 23 non-profit insurance plans created under Obamacare in 2011 at a cost of $2.4 billion have announced they will close by the end of the year. Utah’s Arches Health Plan on Tuesday became the 10th health insurance co-op to announce that it was closing its doors. The move comes soon after the Obama administration’s decision on Oct. 1 to provide just 12.6 percent of the $2.87 billion that insurers were seeking to offset losses caused by unexpectedly high coverage costs. (Pianin, 10/28)

The health insurance co-ops created under the Affordable Care Act are have seen better days — much better days, in fact, as nine have either closed or plan to by the end of this calendar year. Co-ops are nonprofit insurers owned by their policyholders, who are generally individuals and small employer groups. (Gorenstein, 10/28)

Negotiations over Medicaid expansion in states heavily populated by Native Americans have prompted the CMS to propose fully funding medical services that are often not available at tribal healthcare facilities. The agency is looking to provide a 100% federal match rate for primary and specialty healthcare services that are purchased from private healthcare providers because they are not available at Indian Health Service or tribal healthcare facilities. This can include hospital and outpatient care, as well as physician, laboratory, dental, radiology, pharmacy and transportation services. (Dickson, 10/28)

Montana officials and health-care activists are hoping – and planning – that federal approval is imminent for the state’s Medicaid expansion, which will extend health coverage to thousands of low-income Montanans beginning in 2016. The state has asked federal health officials to approve Montana’s unique plan by Sunday. (Dennison, 10/28)

Sen. Kathy Campbell of Lincoln urged a Chamber of Commerce audience Wednesday to carefully consider the economic advantages that long-delayed Medicaid expansion would bring to the state. At stake are $2.3 billion in federal funding over the next five years and 10,000 potential new jobs, Campbell told a legislative breakfast gathering sponsored by the Lincoln Chamber of Commerce and the Nebraska Chamber of Commerce. Campbell said she and two legislative colleagues who are helping craft a new Medicaid expansion proposal -- Sens. John McCollister and Heath Mello, both of Omaha -- will meet with the Greater Omaha Chamber of Commerce next week to discuss the outlines of their plan. (Walton, 10/28)

In a letter to legislators, Gov. Asa Hutchinson said he agrees with a consultant that two of the seven points in his proposal to change the state's private-option Medicaid program should be scrapped. In the letter to members of the Health Reform Legislative Task Force dated Tuesday, Hutchinson said he no longer supports eliminating a nonemergency medical-transportation benefit for private-option enrollees or requiring that the poorest enrollees be served by the traditional fee-for-service Medicaid program instead of the private option. (Davis, 10/29)

The White House will not push back against states like Texas, whose leaders chose not to expand Medicaid to get health coverage to the poor, Health and Human Services Secretary Sylvia Burwell said during a brief stop Wednesday in Houston. "That is not something we will do," she said in response to questions about possible retaliation by withholding federal money that helps fund social and health care programs. Burwell met privately with community leaders and toured the Lois J. Moore Eligibility Center and adjoining El Franco Lee Community Health Center during the second leg of her Texas tour to help kick off enrollment in the 2016 Affordable Care Act's marketplace, which begins Sunday. President Barack Obama's administration has identified Texas as one of four states it will focus on in an effort to boost numbers in the federal exchange as it enters its third enrollment season. With more than 4 million still uninsured, Texas continues to lead the nation in the rate and number of uninsured. (Deam, 10/28)

The parent company of pharmacy giant Walgreens posted increases in sales and profit in its fiscal fourth quarter as attention turns to the financial benefits and regulatory risk of the company's pending acquisition of U.S. rival Rite Aid. (Bomey, 10/28)

Two influential U.S. senators called for close scrutiny of Walgreens Boots Alliance Inc's plan to buy Rite Aid Corp for $9.4 billion, a deal that would unite two of the three biggest U.S. drugstore chains. Walgreens Chief Executive Stefano Pessina said the company had analyzed the antitrust aspect of the deal but would not speculate on the number of drugstores it might need to divest in order to win regulatory approval. (10/28)

Walgreens will use its $9.41 billion takeover of rival Rite Aid to spread its philosophy on making drugstores destinations for customers looking to stay healthy or buy beauty products. The nation's largest drugstore chain also is expected to flex its beefed-up negotiating muscle to wring better deals from drugmakers and other suppliers. But experts say those discounts won't automatically trickle down to consumers. (10/28)

Change is coming to local drugstores after Walgreens Boots Alliance Inc. said Tuesday it is buying rival Rite Aid Corp. for about $9.4 billion. The deal combines two of the nation's largest drugstore chains, helping them to better compete in the rapidly consolidating healthcare industry. Drugstore chains face increased competition from mail-order pharmacy services and pharmacies inside grocery store chains. (Masunaga, 10/28)

Walgreens will use its $9.41 billion takeover of rival Rite Aid, based near Harrisburg in Camp Hill, to spread its philosophy on making drugstores destinations for customers looking to stay healthy or buy beauty products. The nation's largest drugstore chain also is expected to flex its beefed-up negotiating muscle to wring better deals from drugmakers and other suppliers. But experts say those discounts won't automatically trickle down to consumers. In fact, customers may not see a huge effect on their wallets if the deal announced Tuesday goes through. But they will likely see some store closures or name changes and fewer brand choices after Walgreens Boots Alliance Inc. adds the nation's third-largest drugstore chain to its portfolio. (Murphy, 10/29)

A mail-order pharmacy used by Valeant Pharmaceuticals International Inc. had a simple message for staffers charged with getting health insurers to pay up: Don’t take no for an answer. If a health insurer wouldn’t work with Philidor Rx Services LLC, the pharmacy instructed staff to try again using the identification number of a partner pharmacy to secure payment. “We have a couple of different ‘back door’ approaches to receive payment from the insurance company,” a Philidor training manual said. (Rockoff and Whalen, 10/28)

Anthem increased third-quarter profit by 4 percent and beat Wall Street forecasts as the number of people the health insurer covers edged slightly higher, driven by enrollment in government health plans. The Blue Cross-Blue Shield insurer also boosted its adjusted 2015 net income forecast for the third time this year, to $10.10 to $10.20 per share. That's up from its July forecast for more than $10 per share, but still below the $10.20 Wall Street is anticipating. The company cited lower profit margins expected in the fourth quarter. (10/28)

HealthSouth Corp. cut its 2015 outlook and reported third-quarter earnings rose 1.2% as higher costs masked revenue growth. Shares fell 9.1% to $33 in recent after-hours trading as per-share earnings missed expectations and the company cut its 2015 guidance to reflect expenses related to recent acquisitions and expectations that pricing pressures, rising costs and bad-debt expense trends in its inpatient rehabilitation segment will continue in the current quarter. (Stynes, 10/28)

UnitedHealthCare said it will expand its high-profile test of whether bundled payments for chemotherapy can help slow rising cancer treatment costs, part of a growing effort by insurers to find new ways to pay for care. Results from United’s initial pilot test – reported last year – were puzzling: The overall cost of cancer care for patients in the study dropped by 34 percent, even as spending on chemotherapy drugs spiked significantly. (Appleby, 10/29)

The Army has agreed to a monetary settlement with a former infection control analyst at one of the busiest military hospitals, after federal investigators found that she was punished for reporting dangerous health and safety conditions for patients to a group that accredits hospitals. (Rein, 10/28)

Shuttering a Veterans Affairs hospital in Hot Springs and moving its services to Rapid City would be the cheapest option among six under consideration for revamping care in the Black Hills region, according to a much-anticipated federal study released Wednesday. The 780-page Environmental Impact Study by the Department of Veterans Affairs considered six options for changes to the facilities in Hot Springs and Rapid City as part of an effort ongoing since 2011 by the VA Black Hills Health Care System to reconfigure its services. The study found that closing the historic Battle Mountain Sanitarium, which the VA has said is its preferred option, would have an estimated 30-year cost of over $148.5 million, the lowest of the six. Taking no action would come with a more than $215 million price tag over the same time period. (Cano, 10/28)

Texas health officials have asked an appeals court for permission to proceed with cutting payments to a therapy program for children with disabilities — the latest development in an ongoing lawsuit over the budget state lawmakers crafted this year. (Walters, 10/28)

California risks losing billions in health care dollars if the state and federal governments can’t agree this week on a plan to fund reforms of the Medicaid program, hospital officials and experts said. Public hospitals throughout the state are counting on the $7.25 billion in state and federal funds to treat large numbers of low-income and uninsured patients. The plan, known as a Medicaid waiver, also would allow the state to continue improving the efficiency, safety and quality of its Medicaid program, called Medi-Cal. (Gorman, 10/29)

Attorneys representing four children with serious heart conditions have challenged a move by the Florida Department of Health to repeal cardiac-care standards related to a program that provides specialized services to children. The Department of Health has pursued the repeal despite strong opposition from pediatric cardiologists associated with the Children's Medical Services program. Some of those doctors have warned that lowering the program's cardiac standards could have dire consequences. (Menzel, 10/28)

Florida’s emergency room doctors say they’re seeing patients delay health care—even if they have insurance—according to the results of a survey published by the American College of Emergency Physicians (ACEP). “Patients with health insurance were delaying health care decisions—and delayed medical care—because of their fear of high out-of-pocket expenses, high deductibles or high co-insurance,“ says Dr. Andrew Bern, a South Florida emergency physician and a spokesperson for ACEP. (10/28)

Ardina, is a health-care membership company providing 24/7 telemedicine support with licensed physicians, plus discounts on out-of-pocket health-care expenses such as prescriptions and dental services. It’s not a health-care plan; it’s a supplement to health-care plans. After Young launched Ardina last month, he likened it to a AAA auto-club membership. (Feran, 10/29)

More than 67,000 Florida children gained health insurance coverage last year with the full implementation of the Affordable Care Act, according to a report released Wednesday by Georgetown University’s Health Policy Institute. And yet Florida remained near the bottom of the states in covering kids, with nearly 378,000 children still uninsured. In sheer numbers, the report said, Florida ranked 49th, behind only Texas and California. (Gentry, 10/28)

Telemedicine has been praised as a cost-effective way to link doctors and patients, enabling physicians to monitor their medical conditions and consult with specialists in a way that overcomes time and distance. But despite a half-century of technological advances, the ready availability of interactive devices, and the full-throated encouragement of the Obama administration, advocates say telemedicine has failed to reach its full potential, due largely to policies in some states that make it difficult to practice, and pay for, such care. (Ollove, 10/28)

New York state will require physicians to complete an educational course before they can authorize medical marijuana for patients — a condition generally not applied to new drugs or seen in other states with existing medical pot programs. (10/28)

A federal judge on Wednesday ordered Alabama to restore Medicaid funding to Planned Parenthood, money the state tried to cut off in the wake of undercover videos shot by abortion opponents. U.S. District Judge Myron Thompson issued an order that temporarily bars Alabama from cutting off Medicaid contracts with the group's clinics in Alabama. Planned Parenthood Southeast and a Medicaid recipient filed suit in August, days after Alabama Gov. Robert Bentley announced he was ending the Medicaid agreements with the two clinics. (Chandler, 10/29)

The Obama administration has warned state officials that pushing Planned Parenthood out of the state’s Medicaid program could put Texas at odds with federal law. Officials with the federal Centers for Medicare & Medicaid Services contacted the state Medicaid director on Tuesday to give notice that removing Planned Parenthood from the program "may be in conflict with federal law" because poor women who obtain family planning services through Medicaid would be limited from receiving health care from the qualified provider of their choice. (Ura, 10/28)

In a parting gift to the conservatives who hectored him out of office, House Speaker John A. Boehner (R-Ohio) negotiated a budget agreement with Senate leaders and the Obama administration that increases federal spending and raises the debt ceiling in exchange for — well, not much that Republicans covet. There are no big changes in entitlements, no defunding of Planned Parenthood. Yet this backroom deal delivers the goods that matter most: It will avert the risk of a shutdown until after the next president takes office, providing a welcome measure of stability at a time of increasing anxiety about the global economy. (10/28)

Granted, the budget deal negotiated with the Obama administration could have included major entitlement reforms, overhauled the tax code or taken some other steps toward solving Washington's fundamental fiscal problems -- had Congress actually laid the groundwork for any of those things. But it hasn't. For all the theorizing House Republicans have done on the subjects of Medicare and Medicaid costs, they've not tried to implement the overhauls they've suggested in their annual budget resolutions. Tax reform gathered some momentum last year, but that seems to have dissipated now. (Jon Healey, 10/28)

Monday night’s spending agreement between the White House and Congress would repeal part of the Affordable Care Act. But the provision is a narrow one that few people knew existed .... The clause ... calls for automatic enrollment by large employers. If the administration fully implemented the provision, all companies that have more than 200 full-time employees and offer job-based insurance would sign up their workers for coverage. ... But the provision was unpopular almost from the get-go. Conservatives and employer groups complained that it would be difficult to implement and create unnecessary hassle. Some of the loudest cries came from the restaurant and retail industries -- which, perhaps, were less than enthusiastic about having to cover more of their workers. Liberals had worries of their own. (Jonathan Cohn, 10/27)

Unfortunately, [the budget deal's] virtues come with some glaring vices that lower the deal’s overall grade. The largest is the absence of any serious public debate. What this country desperately needs -- and has avoided for decades -- is a genuine debate over the role of government. In the 1950s and 1960s, this seemed less important, because rapid economic growth promised steady increases in tax revenues to pay for new programs. But now, slower economic growth and an exploding elderly population, raising the costs of Social Security and Medicare, have created a yawning gap between what people expect from government and what they’re willing to pay in higher taxes. Hence, endless budget deficits. (Robert J. Samuels, 10/28)

Mr. Ryan promised last week that his speakership would bring “real reform.” Every American should hope he succeeds in establishing a governing majority that acts on issues Congress has let fester for years. ... He may waste more of the people’s time attempting to repeal Obamacare. But he might also push to reform corporate taxes and federal anti-poverty programs. He has already devoted considerable energy to these matters, which could produce useful results. ... Yet a House in which the hard right still holds considerable sway could easily sit more or less idle instead. (10/28)

When some premiums increased last year, a lot of Obamacare customers were able to find good deals by switching to a new health plan. New calculations from the federal government suggest that many consumers will need to do the same to find the best price in 2016. That means, once again, that the marketplace will offer customers a tough choice: stick with the plan you have and pay more, or switch to a new one to pay a lower premium. The savings may be substantial. Instead of simply renewing, the average returning customer who chooses the best deal in the same category as an old plan could find one costing $610 a year less, say analysts for the Department of Health and Human Services. About eight in 10 returning customers on HealthCare.gov can find a cheaper premium by switching. (Margot Sanger-Katz, 10/28)

[I]f the goal was to increase competition by stimulating the creation of new health insurers, then the ACA’s co-op program was, like other parts of the legislation, badly designed. The program offered federal loans and grants to startup insurers, but required that they be non-profits, not have anyone affiliated with an existing health insurer on their boards, and not spend any of their federal funding on marketing. Co-ops are also subject to another provision of the ACA requiring all health insurers to pay out in claims at least 80% of premium revenues, or refund the difference to policyholders. By law, insurers can retain no more than 20%, out of which they must fund sales and administrative costs before booking any remainder as free cash. That significantly constrains a non-profit carrier’s ability to accumulate capital needed for growth. (Ed Haislmaier, 10/29)

In the Hobby Lobby case 16 months ago, the Supreme Court ruled that a company with owners who objected on religious grounds to birth control was entitled to opt out of the federal requirement to cover contraception in its employee health plan. An opt-out mechanism was already in place for religious nonprofit employers, the court observed. ... A new wrinkle quickly emerged. It turned out that the very mechanism the Hobby Lobby majority held up as a model for how to accommodate the competing concerns of church and state was not accommodating enough for the religious nonprofits themselves. By the dozens, religiously affiliated colleges, nursing homes and similar organizations sued the government on the ground that even having to request the opt-out made them complicit in the eventual enabling of their employees to obtain birth control. These organizations are refusing, in other words, to take yes for an answer. (Linda Greenhouse, 10/29)

In the last few years, there has been something of an acquisition boom in doctors’ practices, as hospitals have been snapping them up. Congress may have just cut a deal to slow down all that deal making. As part of the big budget agreement between the White House and congressional leaders, lawmakers want to take away a big incentive driving those mergers: the higher prices that doctors’ offices could charge Medicare when they were owned by a hospital. (Margot Sanger-Katz, 10/28)

What began as an uproar over undercover videos of Planned Parenthood officials callously discussing how to collect fetal tissue is now threatening research vital to finding treatments for devastating conditions from Alzheimer's to blindness. At least a half dozen states are moving to restrict potentially lifesaving studies because they involve tissue collected from abortions. A measure in Wisconsin, approved by two legislative committees, would ban such research. Colorado State University, under pressure from a Republican congressman, suspended tissue collection from one source and pledged to seek alternatives. And several members of Congress are pursuing bans on federally funded research. (10/28)

Controversy over the use of fetal tissue in research has led some to believe that it offers the only way to treat, for example, a devastating disease afflicting their child. In reality, fetal tissue has not been the essential element in developing many important treatments. So, it’s misleading to suggest, especially to women considering donating their aborted fetus to research, that important medical advances depend on fetal tissues. (Tara Sander Lee and Kathleen M. Schmainda, 10,28)

This month marked the beginning of the open enrollment period for Medicare. Many plans make changes to cost, coverage, network providers, and pharmacies throughout the year, and this period gives beneficiaries the opportunity to change their plans accordingly. Currently, 54 million Americans depend on Medicare for health-care services. And, unfortunately, they are often subject to fraud - especially during open enrollment, when changes and confusion can leave beneficiaries vulnerable to misinformation. (Mariel Lorenz, 10/29)