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Four years ago, Alabama’s new Republican governor, along with the state's first majority-GOP legislature since Reconstruction, faced a tough, high-stakes decision: Make the best of a federal health care reform law they hated, or stiff-arm President Barack Obama. ...One thing they didn’t seem to consider was whether Alabamians would be able to receive subsidies to make their health insurance more affordable if the state defaulted to a federally operated exchange, according to documents and interviews with principal figures in the debate. ... In June, the Supreme Court is expected to issue a ruling on King v. Burwell, a lawsuit alleging that these tax credits should only be available in state-run exchanges. The consequences for those in Alabama and 33 other states who get health insurance from federally operated exchanges could be dire. (Young, 4/6)

So far, few provider practices have benefited from the CMS' value-based payment modifier program, according to agency data. The payment initiative, outlined in the Affordable Care Act, is meant to encourage physicians and practice groups to provide high quality and cost-effective care. Eventually, the value modifier will apply to all healthcare practitioners, but this year it was voluntary and applied only to groups of 100 or more eligible professionals. (Dickson, 4/6)

People who didn’t sign up for health insurance on the online marketplace this winter have one last chance to sign up in coming days. As the Affordable Care Act goes fully into effect, people who are eligible to buy insurance but who chose not to in 2014, will have to pay a fine when they file taxes next week. (Hoban, 4/7)

Health exchange managers plan to increase user fees and assessments on Coloradans who buy health insurance in order to fund exchange costs that could soar to $44 million a year. (Kerwin McCrimmon, 4/6)

Independence Health Group Inc., the nonprofit holding company for Independence Blue Cross and other businesses affiliated with the Philadelphia region's largest health insurer, on Monday reported a decline in net income to $69.18 million last year from $142.64 million in 2013, despite a 19 percent gain in revenue, to $13.2 billion, and the addition of two million members to Independence's operations in 25 states. Alan Krigstein, executive vice president and chief financial officer of Independence, said the company spent $40 million to be ready for the Affordable Care Act in 2013 and an additional $20 million to $25 million last year. The spending paid off in 2014 with the addition of 285,000 individuals in Pennsylvania and New Jersey buying Independence Blue Cross policies through the exchanges established to implement the act, Krigstein said. (Brubaker, 4/6)

Gov. Rick Scott reversed course Monday, saying he no longer supports Medicaid expansion as talks break down between Florida and its request for the federal government to extend funds to hospitals that serve low-income patients. Scott wants the federal Centers for Medicare and Medicaid Services to give Florida about $1 billion in hospital funds, but federal officials have denied that request for about a year, standing firm that the funds will end June 30. Negotiations between state and federal health officials turned ugly last week, with the state sending a series of frenzied statements accusing the feds of walking away from the discussion while a key federal health official was on vacation. Federal health officials said they remain in contact with the state. (Fineout and Kennedy, 4/6)

Republican Gov. Rick Scott backed off his support of Medicaid expansion Monday, triggering a political backlash and giving the Florida House ammunition in its ongoing budget battle with the Senate. ... Scott's office refused to elaborate on his statement, which was quickly characterized by some media outlets as a "flip-flop" and put the governor in opposition to not just the Florida Senate but a wide range of pro-business and pro-consumer groups. (McGrory and Bousquet, 4/6)

Florida Gov. Rick Scott (R) has again reversed his stance on expanding Medicaid under ObamaCare, which would use billions of federal dollars to extend coverage to about 800,000 people. For the first time Monday, Scott turned his back on a Medicaid expansion plan that was recently proposed by Florida’s GOP-controlled Senate but had been rejected by its GOP-controlled House. (Ferris, 4/6)

A little more than two years ago, Florida Gov. Rick Scott made an announcement that shocked the political world: the Republican, who had spent a portion of his personal fortune to oppose Obamacare when it was being drafted in Congress, now supported expanding Medicaid in his state. ... But the Florida state legislature didn't go along, passing up tens of billions of dollars in federal support. ... And yet the Florida legislature now appears to be reconsidering its stance, or at least debating it again. ... Scott now says he opposes the Medicaid expansion. (Millman, 4/6)

The fight over renewing $2 billion in funding for Florida’s safety net providers isn’t just between the state and the feds. The Low-Income Pool program — and the question of whether it can survive sans Medicaid expansion — has also managed to pit Republican Gov. Rick Scott against the state’s GOP-controlled Senate. And their stand-off is escalating by the day. (Pradhan, 4/6)

Illinois inmates who will soon get out of jail won't pass "Go" and get $200, but they may collect their Medicaid card. A new plan working its way through the Illinois statehouse would start the enrollment, or re-enrollment, process for inmates 30 days before their release through the state's Obamacare office. (Yount, 4/6)

Low-income consumers whose earnings fluctuate or family circumstances change over the course of the year risk losing their health coverage if they shift between eligibility for Medicaid and coverage on the health insurance exchanges. That “churning” isn’t new to Medicaid, but the health law’s addition of millions of customers whose incomes hover near the Medicaid line raises concerns about how well the insurance marketplaces can handle the flux. (Andrews, 4/7)

President Barack Obama will ask Americans to think of climate change as a threat not just to the environment, but also to their health. Obama on Tuesday was to announce a series of steps that private entities like Google and Microsoft are taking to better prepare the nation's health systems for the inevitable effects of a warmer, more erratic climate. He was to be joined at Howard University Medical School by Surgeon General Vivek Murthy and the head of the Environmental Protection Agency, Gina McCarthy. (Lederman, 4/7)

After thousands of people were sickened by tainted eggs, peanut butter and spinach, Congress passed a sweeping food safety law in 2010 that gave the Food and Drug Administration new powers to prevent additional outbreaks. But lawmakers have not provided enough money for the mission. The Congressional Budget Office said the F.D.A. would need a total of $580 million from 2011 to 2015 to carry out the changes required by the Food Safety Modernization Act. So far, Congress has appropriated less than half of that amount, even as the agency is moving to issue crucial rules under the law this year. (Nixon, 4/7)

A judge should consider the "widespread harm" done by a major 2010 salmonella outbreak and the food safety lapses that preceded it in sentencing two egg industry executives whose company was responsible, prosecutors said Monday. ... Jack DeCoster, 80, of Turner, Maine, and 51-year-old Peter DeCoster, of Clarion, Iowa are scheduled to be sentenced April 13 by U.S. District Judge Mark Bennett in a federal courtroom in Sioux City, Iowa. Both pleaded guilty last year to introducing adulterated eggs into interstate commerce and face up to one year in jail. (Foley, 4/6)

For years, the federal government has advised Americans that they are eating too much salt, and that this excess contributes yearly to the deaths of tens of thousands of people. But unknown to many shoppers urged to buy foods that are “low sodium” and “low salt,” this longstanding warning has come under assault by scientists who say that typical American salt consumption is without risk. (Whoriskey, 4/7)

[D]espite the proliferation of claims that one diet or another is “proven,” actually determining how eating influences health is famously challenging. Salt is a case in point. To study medical issues, scientists prefer to arrange randomized controlled trials, or RCTs. When it comes to long-term diet questions, though, these can be all but impossible to conduct. (Whoriskey, 4/6)

Sharpening a medical debate about the costs and benefits of cancer screening, a new report estimates that the U.S. spends $4 billion a year on unnecessary medical costs due to mammograms that generate false alarms, and on treatment of certain breast tumors unlikely to cause problems. The study published Monday in the journal Health Affairs breaks the cost down as follows: $2.8 billion resulting from false-positive mammograms and another $1.2 billion attributed to breast cancer overdiagnosis. That's the treatment of tumors that grow slowly or not at all, and are unlikely to develop into life-threatening disease during a woman's lifetime. (Alonso-Zaldivar, 4/6)

Americans are spending more than $4 billion a year misdiagnosing breast cancer or overdiagnosing the disease, according to a new study in Health Affairs. (Mershon, 4/6)

False-positive mammograms, which suggest a woman has breast cancer when she actually doesn't, cost the nation $4 billion a year, new research shows. And a second study, also released Monday, shows that new treatments for women who really do have breast cancer may cost more, but they are helping them survive longer than older treatments. (Fox, 4/6)

Taking the financial burden of organ donation off the shoulders of donors and their families is not only more fair, but it might also lead to more organs for transplant, experts say - and they urge Americans to find ethical ways to get rid of financial “disincentives” to organ donation. In addition to removal of financial barriers, they would also like to see careful consideration and testing of potential financial incentives for organ donation. (Belisomo, 4/6)

The American Civil Liberties Union is seeking a court order to force the federal government to turn over records related to reproductive healthcare policy for undocumented immigrant minors in the care of federally funded organizations. The civil liberties organization said in a lawsuit filed Friday that many of these minors end up in the care of Catholic organizations that refuse to refer them to healthcare services for emergency contraception or abortion even in cases of sexual assault. (Pierson, 4/6)

Even the most enthusiastic advocates of health IT concede the proliferation of EHRs and other software has introduced new safety hazards into already complex healthcare settings. A 2011 Institute of Medicine report found poorly designed EHRs were causing dosing errors, failures to detect life-threatening illnesses and delayed treatments because of poor human-computer interactions or data losses. In some cases, the errors had led to serious injuries and deaths. ... Nearly four years later, none of [the report's] recommendations has been carried out. Critics blame a variety of factors. (Tahir, 4/4)

Consumers know to be careful about identity theft, but the growth of digital medical records has led to a rise in the theft of medical records. (Fitzsimons, 4/6)

Aetna must pay the federal government $1 million because its websites and customer service agents allegedly relayed inaccurate information about which pharmacies were in-network for various Medicare Advantage and prescription drug plans. (Dickson, 4/6)

Californians are increasingly likely to visit a hospital emergency room for complex medical problems rather than an injury, according to new research. Although hospital emergency departments, or EDs, were once known as "accident rooms," a review of all non-federal hospital emergency rooms in California from 2005 to 2011 found that injury-related visits have declined over that time period, according to a study published Monday in the journal Health Affairs. (Morin, 4/6)

It had been several months since a 29-year-old cancer patient, Brittany Maynard, had moved to Oregon to take advantage of that state's Death With Dignity law — ingesting a lethal dose of drugs and jump-starting the push to legalize physician-assisted death in at least 20 states, including California. [Ira Byock, one of the nation's leading experts on hospice and palliative care] had become the public face of physicians' discomfort with her choice. (Brown, 4/6)

The state Legislature reconvenes on Monday after having a week off for spring recess and the health care agenda is full. A number of high-profile bills are on the docket before the Senate and Assembly health committees, where they'll get their first public hearings Tuesday and Wednesday. (Gorn, 4/6)

The Los Angeles school district and its employee unions have reached a multibillion-dollar tentative agreement on healthcare benefits that would run through 2018. The agreement factors in modest annual increases in benefit expenses and resolves some long-term unfunded costs for the L.A. Unified School District. But the pact still could strain the annual budget, possibly contributing to cutbacks or layoffs. ... The agreement would factor in cost increases of between 6% and 7% a year, totaling $200 million over three years. The terms also call for partly drawing down a health benefits reserve fund. The unfunded debt for providing lifetime health insurance to retirees and their dependents has more than doubled since 2005, resulting in an estimated $11 billion in future costs. (Blume, 4/6)

With the 2015 General Assembly session ending last week, here’s a list of the health care winners and losers during the 40 days of the Legislature. (Miller, 4/6)

An executive order issued by [Penn.] Gov. Tom Wolf to address shortcomings in the home care of the elderly and disabled is being challenged in court as an illegal attempt to unionize direct care workers. An organization of care providers and others sued the Wolf administration Monday. The Pennsylvania Homecare Association's lawsuit says domestic service workers can't unionize under Pennsylvania state law. (4/6)

Two hospital systems will pay for the cost of replenishing the supply of the nasal spray Narcan when police departments in Gloucester County use it to revive heroin overdose victims, authorities and hospital officials said Monday. The agreement involves Inspira Health Network, Kennedy Health, and the Gloucester County Prosecutor's Office. It is in response to the rising costs of Narcan, which police departments across New Jersey have begun using in recent years to battle an increase in heroin use. (Boren, 4/7)

Advocates for the minority business community in the nation's capital are set to rally in favor of a prison health-care contract that has exposed divisions among city leaders. Democratic Mayor Muriel Bowser has asked the D.C. Council to approve a contract with Corizon Health to provide health services to the city's inmates. But many council members oppose the contract, citing litigation and complaints about Corizon in other states. Corizon is the nation's largest for-profit correctional health provider and is under growing pressure around the country after losing five state prison contracts. (4/7)

I know most of the woman’s doctors. Each one is compassionate, smart and dedicated. Indeed, her diseases were largely under good control. Yet her health was declining, she was missing appointments and she was less and less able to care for herself and her apartment. Several of her clinicians recognized this, but none took action. This was not because of personal or professional failings. Their actions — and inaction — were the inevitable result of their medical training and our medical system’s sometimes myopic focus on medicine at the expense of health. Medical education prioritizes the same specialties today as it did a century ago, when life expectancy in the United States hovered around 50 and when tuberculosis and childbirth were among the leading killers. People in their eighth, ninth and 10th decades are as dissimilar, physiologically and socially, from middle-aged adults as children are. (Louise Aronson, 4/6)

Hospitals know their chances of getting paid plummet as soon as the patient walks out the door. Patients, meanwhile, are often unprepared for paying thousands of dollars for their health insurance deductibles and out-of-pocket ceilings. Yet a patient could face a payment demand for as much as $13,200 even before checking into a hospital. It’s not a happy moment for patients or providers. (Jim Landers, 4/6)

Blaming post-King chaos on Obama and Democrats will obviously be the first thing GOP governors like Walker try to do. But Democrats don’t control Congress anymore. And according to law professor Nicholas Bagley, who has taken a close look at the administration’s options for a forthcoming legal paper, there is little Obama can do on his own. “The Obama administration has no good options for picking up the pieces after an adverse ruling in King,” Bagley tells me. (Greg Sargent, 4/6)

Just when it looked as if Florida might do the right thing and accept federal money to provide health-care coverage for about 800,000 of the state's working poor, Gov. Rick Scott throws a wrench in the works. Scott, who in 2013 backed taking some $51 billion in federal dollars as part of the Affordable Care Act but then did nothing to press the Legislature for action, says he now has doubts. So much for the hard work of Florida's business community, which has lobbied for passage of Senate Bill 7044, an alternative free-market plan being pushed by Senate President Andy Gardiner, R-Orlando. (Sandra Powers, 4/7)

Tomorrow, April 7, scores of Montanans will be at the state Capitol in Helena, hoping to make one last plea to members of the House Human Services Committee to pass a bill expanding Medicaid. This time, their pleas mustn't fall on deaf ears. (4/6)

People without health insurance get health care at the wrong time, in the most expensive manner, and often they get it for free. Free for them, at least, but at a serious cost to the state and to those who purchase health insurance. This is reality, and is the main reason behind the efforts to create a unique, one-of-a-kind solution for Montana. While created by Republicans, this nonpartisan solution is about reform, personal responsibility, and people helping themselves in life. (Republican State Sen. Ed Buttrey, 4/6)

Montana has 125,000 Medicaid recipients, about one out of every eight people who live here. This is up from 77,000 in 2002. The program costs $1.431 billion a year, about $4,200 each spread across all state taxpayers. ... Medicaid is the behemoth overtaking our state budget as well as state budgets all around the country. ... Medicaid is the horse galloping away with state budgets. It needs to be fixed, not expanded. (Republican State Rep. Tom Burnett, 4/6)