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Congress returned Monday from a two-week recess facing what is expected to be months of wrangling between Republicans and Democrats over competing budget plans. The latest budget report showed that government revenues over the last six months totaled $1.42 trillion, up 7.3 percent from a year ago. Government spending over the same period totaled $1.86 trillion, an increase of 7.1 percent over the previous year. Spending on Medicare rose 8 percent, and spending on Medicaid shot up 23 percent. (Crutsinger, 4/13)

The U.S. budget deficit widened slightly during the first half of the 2015 fiscal year, ending a streak of sustained declines. ... Deficits are still near their lowest levels in six years. ... Congress and the White House agreed to a series of spending curbs—known as the sequester—four years ago that sharply reined in government spending. A growing economy also has boosted tax receipts. More recently, government spending has climbed amid an uptick in outlays on entitlement programs such as Medicare and Social Security. The bite of the sequester has also eased after lawmakers agreed two years ago to slightly higher government funding levels. (Timiraos, 4/13)

As top Republicans continue negotiating a final spending blueprint, House GOP leaders aren’t backing away from their plans to use a fast-track budget procedure to do more than just move an Obamacare repeal. The expedited procedure, called reconciliation, allows the Senate to pass legislation by simple majority instead of the typical 60-vote threshold, provided the two chambers can agree on a budget resolution. ... House Republicans want to use reconciliation to speed several priorities, from an Obamacare repeal to a possible tax overhaul to entitlement changes. The Senate prefers to use reconciliation just to take on Obamacare. (Bade and Sherman, 4/13)

The Senate returned to Washington this week with a busy agenda, facing major legislative action on Medicare, Iran, education policy, and President Obama's attorney general nominee. On some issues, lawmakers are up against an imminent deadline - doctors will face a 21 percent cut in government reimbursements for treating Medicare patients unless the Senate can pass a so-called "doc fix" before Wednesday, for example. (Miller, 4/14)

Curbs on amendments and a desire to resolve an issue that has long plagued lawmakers added momentum Monday to Senate leaders' push toward final congressional approval of legislation reshaping how Medicare reimburses doctors. Sen. Jeff Sessions, R-Ala., said he and other conservative senators want to amend the Medicare legislation to force Congress to eventually find a way to pay for the entire bill. The nonpartisan Congressional Budget Office says the measure would drive up federal deficits by $141 billion over the coming decade. (Fram, 4/13)

The Senate is working on a deal to allow each party to put up a very limited number of amendments to the Sustainable Growth Rate repeal bill, but a final agreement hasn’t been reached even as Wednesday’s deadline draws near. (Haberkorn and Mershon, 4/13)

Congress appears to be on the brink of passing a long-anticipated permanent “doc fix” to change the way Medicare pays physicians. But the House-negotiated deal may not be as permanent as the moniker implies. (Attias, 4/13)

Mr. Rubio has developed a policy platform that offers something to different slices of the party. His tax plan rewards families by expanding the Child Tax Credit, something evangelicals will likely appreciate. In a nod to fiscal conservatives, he wants to give states more discretion over their federally financed health-care and poverty programs. In addition, Mr. Rubio has used time in the Senate—he was elected in 2010—to build the profile of a defense hawk, calling for higher levels of military spending and repeatedly criticizing the Obama administration for its negotiations with the Cuban and Iranian regimes. (O'Connor, 4/13)

In his Detroit speech Monday, Mr. Kasich sought to introduce himself to voters in a relatively formal way, recounting his modest upbringing and efforts in Congress to reform military spending and balance budgets. But the two-term governor also decried the lack of recent compromise in Washington that has led to legislative gridlock on a number of issues including immigration. As governor, Mr. Kasich has been seen as more moderate than some in his party. He has supported Common Core educational standards, Medicaid expansion under the Affordable Care Act, and higher taxes on the oil and gas industry. He also shook off strong disapproval ratings in 2011. Voters had rejected his effort to curtail collective-bargaining rights for public workers, similar to the effort that has polarized Wisconsin under Gov. Scott Walker, a fellow Republican. (Dolan, 4/13)

Gov. Bill Walker said Monday that he could not support Medicaid reform legislation without Medicaid expansion. In an interview with The Associated Press, Walker said reform and expansion go hand-in-hand. To have reform and not expansion, he said, would be unacceptable. (Bohrer, 4/13)

With one week left in this year’s 90-day legislative session, Gov. Bill Walker for the first time hinted at vetoing a bill that would cut the costs of the public Medicaid health care program without expanding it to cover more Alaskans. Alaska’s Medicaid program primarily covers low-income families and residents who are pregnant or disabled. ... The House Finance Committee heard hours of public testimony Saturday on Walker’s legislation to expand the program, with most of the comments favoring his proposal. But the committee’s chairs on Monday left Walker’s bill off their agenda, instead scheduling a hearing on a new House bill they sponsored that, like a Senate bill introduced earlier, would cut Medicaid costs without expanding it. (Herz, 4/13)

A Republican lawmaker from Eagle River sent an e-mail Friday attempting to rally opposition to Medicaid expansion. In the email, obtained by KTUU, Lora Reinbold distributes the call-in number to testify at a Saturday House Finance hearing. She writes, “We are trying not to get the number out to the pro expansion for they are much more organized.” ... Reinbold says the email was intended to encourage people who want to “preserve the fiscal future of Alaska” to have their voices heard. (Feidt, 4/13)

A bipartisan group of South Carolina senators will introduce a proposal Tuesday to allow about 194,000 uninsured state residents to use federal and state dollars to buy private health insurance. ... Previous attempts to expand the federal-state insurance program for the poor in South Carolina, as part of the federal Affordable Care Act, have failed. And Republican Gov. Nikki Haley repeated Monday that she would fight the latest Senate attempt as well. The senators’ proposal would cover the working poor, those who make too much to be eligible now for Medicaid insurance for the poor but cannot afford to buy health insurance. (Cope, 4/13)

A bipartisan group of senators plans to push for S.C. lawmakers to accept federal health care money that Gov. Nikki Haley and other Republicans have previously rejected. A state budget amendment would allow more of South Carolina’s poorest residents access to health care through new money from the federal government. ... Sens. Joel Lourie, D-Columbia; Ray Cleary, R-Murrells Inlet; Paul Campbell, R-Goose Creek; and John Matthews, D-Orangeburg, are calling for debate during upcoming budget talks, according to a news release Monday from AARP South Carolina, which supports the change. (Borden, 4/13)

If North Carolina were to expand Medicaid coverage, savings and revenue would likely offset the cost to state taxpayers, a recent study from the Robert Wood Johnson Foundation indicates. North and South Carolina are among 22 states that have refused to accept federal money to extend Medicaid to able-bodied, low-income adults as part of the Affordable Care Act. Although the federal government pays 100 percent of the cost for expansion through 2016 and at least 90 percent after that, some state leaders have balked at the additional state cost, which is estimated at just over $3 billion for North Carolina over 10 years. (Helms, 4/13)

In the wake of the Legislature's third denial last week of a bill that would expand Medicaid, at least two petitions with more than 2,000 signatures were delivered to Gov. Pete Ricketts Monday. They were added to several other petitions that have been signed in the past three years, according to Cathy Lohmeier, who started one petition in 2012. "I had over 2,000 people sign it," she said. (Young, 4/13)

The state House has voted 90-2 to approve an annual $450 million assessment on Tennessee hospitals to draw down $826 million in federal money. Democrats were quick to point out that the about 2-to-1 match rate pales in comparison to vastly more favorable rate the state would have received if lawmakers approved Gov. Bill Haslam's Insure Tennessee proposal. Under Haslam's plan, hospitals would have covered the $74 million state share to draw down $2.8 billion in federal Medicaid funds to cover more than 280,000 low-income Tennesseans. (4/13)

In all the turmoil in health care, one surprising truth is emerging: Consumers seem increasingly comfortable trading a greater choice of hospitals or doctors for a health plan that costs significantly less money. “Are they willing to trade choice and access for price? There’s no question about that,” said Mark Newton, the chief executive of Swedish Covenant Hospital, a Chicago hospital that recently teamed with an Illinois insurer, Land of Lincoln Health, to offer a health plan. (Abelson, 4/13)

The deadline to file taxes is just two days away, and yet nearly half of all uninsured Americans have no idea that they will be subject to Obamacare’s tax penalty for not having health coverage this year. A new study from the Robert Wood Johnson Foundation and the Urban Institute found that of the uninsured population that will be filing a federal tax return this year, about 47 percent said they didn’t know anything at all or very little about Obamacare’s individual mandate penalty. (Ehley, 4/13)

Wednesday’s deadline for filing income-tax returns marks the first time that Americans without health insurance must pay a tax penalty under the Affordable Care Act, and while it’s too late to avoid the tax for 2014, there’s still time to avoid paying the full penalty for this year. In New Jersey, tax preparers are finding that some clients are facing an entirely different problem: having to pay back some of the subsidies they received when they applied to buy health insurance last year. That’s because those people wound up having a higher income than they estimated when they applied and received the the tax credits. (Kitchenman, 4/13)

Tax day is bringing lousy news to some customers of Colorado’s health exchange. A Gilpin County couple faces a shocking tax bill of nearly $7,500 after Colorado’s health exchange set them up with subsidies that their accountant says they now must give back. (Kerwin McCrimmon, 4/13)

Higher education and its comfortable inhabitants on campus have long been hotbeds of support for Obama and Obamacare. Now, along with business and labor, i.e., the other inhabitants of what passes for the real world, they are about to become victims of ... its high “Cadillac” tax on generous health plans. (Rosenberg, 4/14)

IBM is joining with Apple Inc., Johnson & Johnson and Medtronic Plc to create a technology that will make it easier for health-care companies to analyze patient data. International Business Machines Corp. announced a cloud-computing platform, called Watson Health Cloud, which can store and analyze anonymous patient data. A business unit will be created around the offering with at least 2,000 specialists, IBM said in a statement. (Koons and Barinka, 4/13)

An unlikely set of partners teamed up to capitalize on a gathering flood of health-related personal information. International Business Machines Corp. unveiled on Monday a partnership with Apple Inc.,Johnson & Johnson and Medtronic Inc., as well as the acquisition of two medical-data software companies. Known as Watson Health, the effort transfers IBM’s experience in data processing to the sensitive field of health care, part of an evolving strategy to pool and analyze data from other companies, such as Twitter Inc. and the Weather Channel. It will attempt to leverage the tech company’s analytics and health-care software businesses into a new generation of apps for patients and providers. (Dwoskin, 4/13)

The health care sector has become the hot target for hackers in recent months, according to researchers at Symantec, a leading cybersecurity company that says it's also seeing big increases in "spear-phishing," ''ransomware" and efforts to exploit newly discovered vulnerabilities in software used by a wide range of industries. (4/14)

As the privacy officer for The Advisory Board Co., Rebecca Fayed knows a thing or two about privacy and what can happen when it's violated. But when Fayed received a letter telling her that she, like nearly 80 million others, was the victim of a hacking attack on health insurer Anthem Inc., she couldn't figure out why. Anthem wasn't her insurance provider. (Ornstein, 4/14)

A former candidate for Kansas governor said Monday that he and other attorneys who are suing two subsidiaries of Anthem Inc. can show that individuals were harmed after hackers breached the health insurer's computer networks. Paul Davis and other attorneys who filed the lawsuit earlier this month in Douglas County District Court on behalf of a Kansas City, Kansas, woman also are urging participants in the state's Medicaid program to consider joining the case. A similar lawsuit was filed in February in St. Louis County, Missouri. (Hanna, 4/13)

ManTech International Corp. has named John Dorman vice president and chief information officer for its health IT unit. He’s the first CIO for the firm’s health-care business as the federal technology provider expands its work with electronic health records and information sharing. Mr. Dorman will oversee technology products and services for public sector customers including the Defense Health Agency, the Centers for Medicare and Medicaid Services and the Department of Veterans Affairs, the company said in a statement. He will report to Steve Comber, SVP and general manager of ManTech Health. (Norton, 4/13)

Driven by innovative but pricey new drugs for hepatitis C, U.S. spending on prescription drugs jumped 13% last year to a record $374 billion, according to an industry report. The new hepatitis C drugs accounted for more than $11 billion of the spending, according to a report by IMS Institute for Healthcare Informatics, an industry research firm. Its annual report analyzes pharmaceutical sales, top-selling drugs and trends in the industry. (Pfeifer, 4/14)

People newly covered by Medicaid drove a significant increase in prescription drug use in 2014, even as those with private commercial coverage filled fewer prescriptions and, over all, patients did not visit the doctor as often, according to a new report by the IMS Institute for Healthcare Informatics, which tracks the health industry. (Thomas, 4/15)

U.S. spending on prescription drugs saw the largest increase since 2001, with the nation’s pharmacy bill rising to $373.9 billion last year as new treatments came to market and manufacturers increased prices on old ones. (Burger, 4/14)

U.S. spending on prescription drugs soared last year, driven up primarily by costly breakthrough medicines, manufacturer price hikes and a surge from millions of people newly insured due to the Affordable Care Act. Spending rose 13 percent, the biggest jump since 2001, to a total of $374 billion, according to a report released Tuesday by the IMS Institute for Healthcare Informatics. (Johnson, 4/14)

Prescription drug spending spiked 13.1 percent last year — the highest increase since 2001 — as dozens of new drugs came on the market and fewer brand medicines lost their patent protections, according to a report released Tuesday. (Norman, 4/14)

A lawyer for the Irish manufacturer of an Alzheimer's drug urged a U.S. appeals court on Monday to let it replace a two-pill daily regimen with a single-dose version of the drug even if it cheats generic drugmakers of profits. Attorney Lisa Blatt told the 2nd U.S. Circuit Court of Appeals in Manhattan that Dublin-based Actavis PLC makes no apologies for maximizing its profits, though a December court ruling has already caused it to lose at least $200 million in sales and forced it to spend tens of millions of dollars in promotions that otherwise would not be necessary. (Neumeister, 4/14)

The Food and Drug Administration warned consumers not to use a muscle-growth supplement called Tri-Methyl Xtreme that it said has been linked to cases of severe liver injury. The product is distributed by a Las Vegas-based company called Extreme Products Group, according to the federal agency. A call to the company for comment wasn’t returned. (Burton, 4/13)

There are hospital doors at the half-built ­Veterans Affairs medical center outside Denver that were supposed to cost $100 each but ended up ­running $1,400. There’s a $100-million-and-still-rising price tag for an atrium and concourse with curving blond-wood walls and towering glass windows. And entire rooms that had to be refashioned because requests for medical equipment changed at the last minute and in other cases the equipment didn’t fit. No one had bothered to measure. (Wax-Thibodeaux, 4/13)

The number of whistleblower cases reported at the Department of Veterans Affairs remains "overwhelming," a year after a scandal broke over chronic delays for veterans seeking medical care and falsified records covering up the delays, a top federal investigator said Monday. Carolyn Lerner, head of the independent Office of Special Counsel said complaints of waste, fraud and abuse — as well as threats to the health and safety of veterans — continue to pour in, even after Congress gave the department an extra $16 billion last year to shorten waits for care and overhaul the agency. (Daly, 4/14)

Military children may be missing out on important childhood vaccines, researchers reported on Monday. A check of their medical records shows many are either missing vaccines, or they are missing the records to show they had them. Either way, it's not good, says Dr. Angela Dunn, who led the study, published in the journal Pediatrics. (Fox, 4/13)

In a step intended to address concerns of patients and providers, the state has decided to seek bids for new standardized contracts to manage the massive Kentucky Medicaid program. ... The new contracts, Haynes said, will incorporate many improvements including increasing oversight of denial of claims, offering managed-care companies incentives to decrease overuse of emergency rooms, and encouraging the companies to help in the expansion of behavioral health services. (Loftus, 4/13)

A group of Chicago-area hospitals facing dramatic cuts in state funding under Gov. Bruce Rauner’s first budget emphasized the dire situation of community health care in a meeting Monday with legislators at Norwegian American Hospital. Rauner’s plan to cut more than $1.5 billion from Medicaid — with over $800 million coming from hospitals — has leaders of hospitals such as Loretto in the Austin neighborhood concerned they will have to significantly limit services or just shut their doors. (Novak, 4/13)

Critics say the audits are making some pharmacists, doctors and other providers consider dropping out of Medicaid. And some wonder if DSS has become more aggressive in auditing as a way to fill the state’s coffers to help cope with tight budgets. (Levin Becker, 4/14)

The state Medicaid program had accumulated $350 million in liabilities as of June 30 last year, about the same time that state health officials were boasting of a $63 million budget surplus in the government health insurance program. The difference represents cash-on-hand vs. money owed. The state Auditor’s Office released a two-year detailed balance sheet for the state Department of Health and Human Services, an accounting of department finances that state Auditor Beth Wood said had not been done in 20 years. (Bonner, 4/13)

Federal health regulators have given preliminary certification approval to NCTracks, the state’s controversial Medicaid claim payment system. The N.C. Department of Health and Human Services announced Sunday it was notified Friday by the Centers for Medicare and Medicaid Services. Officials expect formal notification within a week. ... The CMS preliminary approval comes nearly two years after DHHS launched NCTracks in July 2013. At a $484 million contract cost for development, implementation and support, it represents the biggest information technology project in state government history. (Craver, 4/13)

North Carolina's computer billing system for Medicaid claims has met the federal government's accuracy standards nearly two years after it first came online. The state Department of Health and Human Services announced that NCTracks has earned certification from the Centers for Medicare and Medicaid Services. That means the federal government will cover more of the billing system's operating costs, retroactive to when NCTracks began in 2013. The state will get $19 million more in federal funding. (4/14)

A new audit recommends that Missouri refund more than $34 million to the federal government because the state did not comply with Medicaid regulations. For at least three years, the state failed to bill drug manufacturers for rebates the companies owed on drugs administered by physicians at a hospital, according to the audit scheduled for release Tuesday by the Office of Inspector General of the U.S. Department of Health and Human Services. (Shapiro, 4/14)

A large labor union is seizing on merger negotiations between Boston Medical Center and Tufts Medical Center as an opportunity to increase its membership among hospital workers. (Dayal McCluskey, 4/13)

The final pieces of a Republican plan to expand mental health care are approaching approval in the Legislature. The measures would boost local services for crisis intervention and overnight mental health care. Gov. Steve Bullock offered amendments last week removing a stipulation for future funding procedures and clarifying the definition of treatment beds. (4/13)

Following years of negative reports that found the District wasn’t reaching enough of the city’s poorest children with mental health issues, a local advocacy group is publishing a report that shows significantly more children were treated for behavioral problems last year than in 2013. About 12,550 children had a Medicaid mental health charge last year, representing a 30 percent increase from 2013, when the total was 9,569 children, according to the report being released Tuesday by the Children’s Law Center. (McCoy, 4/13)

In the closing hours of the 90-day session, the Senate and the House of Delegates voted along party lines to approve a spending plan that included less funding than Hogan sought to shore up the state pension fund and did not go as far as the governor wanted in trimming the state’s structural budget deficit. As a result, Hogan said he would refuse to use money the legislature earmarked to preserve state pay raises, full funding for the most expensive school districts and several health-related initiatives. (Johnson and Wiggins, 4/14)

Health care coverage for the undocumented gets its first test this week when a bill to extend Medi-Cal coverage and Covered California health plans to the undocumented will be heard by the Senate Health committee. (Gorn, 4/13)

A former California hospital executive at the center of a $500 million kickback scheme that subjected injured workers to risky spinal surgeries is attempting to spread the blame by suing his alleged co-conspirators, according to a recent court filing. (Jewett, 4/13)

Los Angeles County officials plan to spend more than $100 million over the next year to reduce abuses in the county's crowded jails, improve treatment of mentally ill inmates and divert others with mental health issues from entering lockups. ... As well as continuing jail reforms that have been driven in part by pressure from federal authorities, the proposed spending plan sets aside money for improvements in the county healthcare system driven by the Affordable Care Act and for ongoing reforms in the child welfare system. (Sewell, 4/13)

In a welcome break from political stasis, Congress may be on the verge of passing important bipartisan legislation to fix the way Medicare pays doctors. A bill before the Senate this week, which the president is willing to sign, would shift toward paying based on how well doctors care for their patients, rather than on how much care they provide. The fix isn't perfect, but it's far better than most of us expected from a polarized Congress. Yet much of the commentary about the bill is very negative. Stranger still, it comes in the form of two contradictory arguments -- both wrong. (Peter R. Orszag, 4/14)

Tomorrow, the Senate will consider H.R. 2, a Medicare-reform bill that has already acquired a classic Beltway acronym, MACRA. Conservatives should give their full support: According to a report released last week, MACRA not only would pay for itself but would result in large net savings to the Medicare program over time, reducing unfunded liabilities and preventing massive new debt. (Ryan Ellis, 4/13)

The estimate of the legislation’s long-term impacts by Medicare’s chief actuary is sober reading. The legislation provides for a bonus pool that physicians can qualify for over the next 10 years but applies only in 2019 to 2024. The budgetary “out-years” provide for minimal increases in reimbursement rates. Beginning in 2026, physicians would receive a 0.75 percent annual increase if they participate in some alternative payment models or a 0.25 percent annual increase if they do not. Both are significantly lower than the normal rate of inflation. (Chris Jacobs, 4/13)

There are two major differences between this so-called “fix” and previous ones. The first one is real: Previous increases have been offset by cuts to other government spending, and this one is not. The second one is fiction: That this doc fix is a permanent solution to the fee problem. (John R. Graham, 4/14)

Early this summer the Supreme Court will render a decision on King v. Burwell, the case challenging the IRS workaround that allows ObamaCare subsidies to be paid through federal exchanges. Many on the right believe that if the justices rule against the administration, it would be the final stake in the heart of ObamaCare. Nothing could be further from the truth. ... Without an effective response from Republicans, there is little doubt that the crisis would allow President Obama to permanently cement ObamaCare in place. (Sen. Ron Johnson, R-Wis., 4/13)

One of the core purposes of the Affordable Care Act is to expand health care to people who previously lacked it, and today Gallup-Healthways released new numbers showing once again that the law is accomplishing this goal. But buried in the data is an indicator of a different kind of success: Republican resistance to the law at the level of states is also having a substantial impact by limiting the drop in percentages of uninsured people, keeping the uninsured rate higher than it might otherwise have been. (Greg Sargent, 4/13)

As the figure above shows quite incredibly clearly, since the implementation of the Affordable Care Act, the share of the uninsured has fallen sharply. As this Gallup-Healthways poll indicates, about 88 percent of adults are now covered, compared to about 82 percent at the peak uninsured rate before Obamacare kicked in. Moreover, the largest gains have accrued to the young, those with low incomes and Hispanics. For example, since late 2013, the share of the uninsured is down just two percentage points for those with incomes about $90,000 (most of whom already had coverage); for those with incomes below $36,000, it’s down nine percentage points. (Jared Berstein, 4/13)