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Sign-up season for President Barack Obama's health care law doesn't start for another couple of months, but the next few days are crucial for hundreds of thousands of customers at risk of losing financial aid when they renew coverage for 2016. Call them tardy tax filers: an estimated 1.8 million households that got subsidies for their premiums last year but failed to file a 2014 tax return as required by the law, or left out key IRS paperwork. (8/24)

The latest analysis of the so-called “Cadillac tax” on rich medical plans projects one in four employers offering health benefits “could be affected” by the regulation in 2018 if they don’t make changes to their benefit structures. The Cadillac tax was created as part of the Affordable Care Act largely as a way to help fund benefits to the uninsured under the law. Starting in 2018, employers pay a 40 percent tax on costs of health plans that are above $10,200 per individual and $27,500 for family coverage. (Japsen, 8/25)

If you like your flexible spending account...you might not be able to keep your flexible spending account. Obamacare's looming "Cadillac tax" on high-cost health plans threatens to hit 1 in 4 U.S. employers when it takes effect in 2018—and will impact 42 percent of all employers by a decade later, according to a new analysis. (Mangan, 8/25)

Has battling to kill Obamacare lost cachet for Republican presidential candidates? Two leading GOP contenders strode into their party’s most vexing policy fight last week, offering blueprints to replace the 5-year-old health law. The response? A collective yawn. A week later, Scott Walker and Marco Rubio’s Obamacare alternatives have all but disappeared from the campaign trail conversation, eclipsed by new twists in Trump’s GOP-leading candidacy and the fight he picked over birthright citizenship. (Cheney, 8/24)

Just before Louisiana Gov. Bobby Jindal revealed his plan to replace ObamaCare last year, he sat down with 15 of Washington’s top conservative healthcare wonks to discuss it. They didn’t approve. “Near the end, they said, ‘You make a good point, but what you’ve put forward, we just don’t think it’s politically viable,’” Jindal’s long-time adviser Curt Anderson recalled in an interview this week. To his surprise, he said the group agreed the next GOP nominee couldn’t entirely roll back ObamaCare for fear of losing votes from millions already with coverage. In other words, even ObamaCare’s toughest critics say that parts of the law are here to stay. (Ferris, 8/24)

While congressional leaders continue to debate whether to pursue near-full repeal of the Affordable Care Act through budget reconciliation, and GOP presidential candidates lay out Obamacare-replacement proposals, House Republicans are looking at a smaller batch of changes to the health care law they think could make it to President Obama's desk. House Ways and Means Health Subcommittee Chairman Kevin Brady told National Journal that his panel could mark up health care tax legislation later this year. He floated bills related to over-the-counter drugs, health savings accounts, and—perhaps most ambitiously—a repeal of Obamacare's unpopular "Cadillac tax" on high-end insurance plans. The health care agenda will be determined in part by Capitol Hill's other business. (Scott, 8/24)

House GOP leaders are eyeing a package of healthcare bills this fall that will target some of the most despised taxes under the Affordable Care Act. Rep. Kevin Brady (R-Texas), chairman of the Ways and Means Committee's Health Subcommittee, said he expects a comprehensive bill repealing healthcare taxes to be ready sometime after lawmakers return from recess. (Ferris, 8/24)

An explosive confrontation brewing between the House Republican leadership and conservatives over Planned Parenthood is threatening to shut down the government for the second time in three years. And House GOP leaders have yet to settle on a strategy to avert it. Desperate to avoid another closure, Speaker John Boehner (R-Ohio) and his team would prefer to build bipartisan opposition to funding the group through a series of high-profile Congressional investigations. But, at this point, that seems unlikely to cut it with a bloc of House conservatives who have said they simply won’t vote for a large-scale spending plan that funds Planned Parenthood. (Sherman and Palmer, 8/25)

Menendez, who was first elected to Congress in 1992 and became a senator in 2006, was indicted in April for allegedly accepting hundreds of thousands of dollars in improper gifts and campaign contributions as bribes in exchange for using his office to aid Melgen. Both men have sought to have the charges against them dropped. According to the indictment, Menendez received nearly $1 million worth of gifts and campaign contributions from Melgen in exchange for using his Senate office to aid Melgen in a multimillion-dollar billing dispute with the Centers for Medicare & Medicaid Services; to attempt to enforce a $500 million port security contract Melgen had with the Dominican Republic; and to obtain visa applications for several of Melgen’s girlfriends. Melgen would reportedly send his private jet to pick up Menendez and a guest in New Jersey for flights to Florida or Melgen’s resort home in the Dominican Republic, all at no cost. Menendez subsequently was compelled to repay tens of thousands of dollars for unreported flights. (Bresnahan, 8/24)

The investigators found “repeated and substantial use of defendant Menendez’s power and influence to further the personal whims and financial interests of defendant Melgen,” the filing says. “No ordinary constituent from New Jersey received the same treatment, and the quid pro quo outlined in the indictment is clear and unmistakable.” ... The 14-count indictment accused Menendez of using the influence of his office to advance Melgen’s financial interests in exchange for luxury gifts, lavish vacations and more than $750,000 in campaign donations. Prosecutors charged that Menendez, a former chairman of the Senate Foreign Relations Committee, twice intervened on the doctor’s behalf — first with federal regulators investigating Melgen’s Medicare billings and then when Melgen sought to secure a ­port-security contract in the Dominican Republic, according to the indictment. (Leonnig, 8/24)

Justice Department prosecutors scolded Senator Robert Menendez and his lawyers on Monday, rebuking the indicted lawmaker for what they described as a disingenuous attempt to have corruption charges against him thrown out in federal court. In a series of filings answering Mr. Menendez’s request that his case be dismissed, Justice Department lawyers defended their handling of a lengthy investigation into the senator, which resulted in a 14-count indictment in April. (Burns, 8/24)

As some of the nation’s largest health insurers plan to merge, a new report raises fresh concern over the lack of competition in the private Medicare market. The analysis, released on Tuesday, concludes “there is little competition anywhere in the nation.” The report from the Commonwealth Fund, a research group, looked at the market share of insurance companies offering private Medicare Advantage plans in 2012. The authors found that 97 percent of markets in United States counties were “highly concentrated,” in which a small number of insurers dominated. The lack of competition was worse in rural markets. (Abelson, 8/25)

Competition among Medicare Advantage plans more closely resembles local oligopolies instead of a buzzing market overflowing with options for seniors, a new study from the Commonwealth Fund shows. The lack of competition is especially relevant as the U.S. health insurance market teeters on the precipice of further consolidation. Aetna and Anthem are undergoing federal scrutiny over their deals that would drastically enlarge their Medicare Advantage memberships. (Herman, 8/25)

The gap between the price offered and the trading price of a number of companies that are subject to pending takeover bids widened dramatically last week, a sign of investor nervousness about deals whose outcome could help determine whether the merger boom continues. ... For patient, steel-nerved investors, though, there could still be big profits to be made. A wager placed Friday that Aetna Inc. will complete its $34 billion takeover of rival health insurer Humana Inc., for example, is set to return some 22% should the deal close on schedule in late 2016. The spread, which largely reflects nervousness that regulators will reject the deal and possibly an accompanying tie-up between Anthem Inc. and Cigna Corp., rose from 21.2% a week earlier. That is a relatively modest move showing that not all spreads widened dramatically last week. (Raice and Hoffman, 8/24)

Inovalon, a publicly traded healthcare analytics company, has entered into a definitive agreement to acquire healthcare consulting firm Avalere Health. The purchase price is $140 million, which is composed of $135 million of cash and $5 million of restricted stock. Inovalon said the deal would significantly expand its footprint in the pharma/life sciences market, which it estimates could be worth $30 billion or more. (Aguilar and Conn, 8/24)

The largely consolidated dialysis sector has been quiet on the M&A front of late, but the transition to value-based payment models could be renewing the drive for scale. Two large kidney-care providers announced transactions Monday that will increase their footprints, provide more leverage with payers and allow them to gain access to additional patient data. The deals are expected to close by the end of 2015. (Kutscher and Rice, 8/24)

The Department of Veterans Affairs said Monday it now has fewer than 100,000 disability claims older than four months, a "historic milestone" that is one-sixth the size of a long-term backlog that reached a record 611,000 claims in 2013. Allison Hickey, the VA's undersecretary for benefits, said the current backlog of 98,535 claims older than 125 days is the lowest since the agency started measuring the claims backlog in 2007. (8/24)

The backlog of just over 98,000 is an 84% drop from its peak in March 2013, said Allison Hickey, the VA’s undersecretary for benefits. The fall was due in part to more employees processing claims and using digital records rather than paper copies.A backlogged claim is one that has awaited a decision for more than 125 days. VA officials say the backlog can never be eliminated, partly because claims can include multiple health problems that must be adjudicated. (Kesling, 8/24)

The backlog has long plagued VA and fueled criticism that the department was poorly managed and failed to meet the need of the veterans it served. The news comes as a rare positive development for a federal organization that has for years faced the scorn of lawmakers and the veterans community. The department attributed the backlog reduction to a transformation plan it launched in 2011. The overhaul included a refocus on paperless claims processing, a more streamlined coordination of private medical records and specific metrics aimed at eliminating the backlog entirely by this year. (Katz, 8/24)

But VA officials Monday also indicated that they may never fully eliminate that backlog because doing so could unnecessarily rush some veterans' claims through the system. ... Outside advocates have offered cautious praise of the work so far, with veterans organizations lauding the effort but also warily reminding of past promises to end the backlog. The progress also has drawn criticism from groups mistrustful of any VA data in the wake of its 2014 records manipulation scandals, and for a corresponding 27 percent increase in the total pending disability appeals cases in the last two years. (Shane III, 8/24)

Breast-cancer specialists are sharply divided over a new radiation technique that costs less and is more convenient than conventional therapy. The technique, known as intraoperative radiation therapy, or IORT, involves administering a single dose of radiation at the same time a patient is having lumpectomy surgery to remove a tumor. A large, randomized controlled trial concluded that IORT has fewer side effects and appears to prevent the return of cancer nearly as well as traditional treatment, in which patients undergo radiation sessions five days a week for up to seven weeks. (Beck, 8/24)

Second cancers are on the rise. Nearly 1 in 5 new cases in the U.S. now involves someone who has had the disease before. When doctors talk about second cancers, they mean a different tissue type or a different site, not a recurrence or spread of the original tumor. Judith Bernstein of suburban Philadelphia is an extreme example. She has had eight types over the last two decades, all treated successfully. (Marchione, 8/24)

Some of the services are sponsored by established medical centers, including Massachusetts General Hospital and Cleveland Clinic. Others are independent businesses that work with specialists on a consulting basis. Employers increasingly are contracting with such services, and insurance companies at times require patients to get a second opinion, such as for surgery. (Reddy, 8/24)

Playing hardball with Florida hospitals over their rising profits and growing reliance on government funding, Gov. Rick Scott on Monday revealed that he has ordered state regulators to audit 129 hospitals to ensure they are not overcharging for patients who have Medicaid, the public health insurance program for low-income people. Scott’s office disclosed the number of audits — some of which are under way, others pending, and still more to be conducted at random — in a letter from the governor to Florida Attorney General Pam Bondi. Scott first ordered the audits on Aug. 3, two days after a state-imposed deadline for hospitals and health plans to certify that their business contracts did not exceed the statutory limit. (Chang, 8/24)

Another 100 Florida hospitals — 17 of which are in the Tampa Bay area — will be audited by the state to determine whether they're receiving more in Medicaid payments than legally allowed, Gov. Rick Scott said Monday. They join 29 hospitals already being audited for failing to provide information about their Medicaid contracts to the state Agency for Health Care Administration before Aug. 1. Those added Monday responded on time. But in a letter to state Attorney General Pam Bondi, Scott said they still needed to be audited "because of the nature of the explanations they provided in their responses." (McGrory, 8/24)

Gov. Rick Scott is ordering state health officials to audit more than 100 hospitals as part of his ongoing battle with hospitals, which he says are driving up Medicaid costs. The state had asked hospitals and insurers to prove that their contracts aren't charging rates higher than 120 percent of the Medicaid rate. But Scott said roughly 130 hospitals didn't comply and would be audited. The Republican governor also said in a statement Monday that all hospitals would be randomly audited. (8/25)

On Friday morning, Lilia Pineiro was finishing up an appointment for lab tests and an ultrasound to keep her diabetes and high blood pressure in check — all at no cost to her. The round-faced 62-year-old, originally from Mexico, makes about $200 a week cleaning houses, so she can’t afford health insurance. But for the past five years, she’s managed to obtain regular treatment from the Light of the World Clinic in Oakland Park. (Adams, 8/24)

More than 1,100 Georgia pediatricians have joined a new physician-led network that aims to improve quality of care and eventually contract for payments from insurers. The sign-ups so far represent roughly one-third of the total number of pediatricians practicing in the state. (Miller, 8/24)

A man who came down with Legionnaires’ disease and spent several days in a hospital has filed a civil lawsuit against the hotel identified by authorities as the source of the deadly outbreak. Leslie Noble’s lawsuit against the Opera House Hotel says its “negligence, carelessness and recklessness” caused him physical pain and mental anguish. The lawsuit by Noble, a 54-year-old security guard, was filed last week and seeks unspecified damages. (8/24)

The citizens of Yadkin County aren’t alone in their uncertainty about the future of health care in their community, though with the closure of Yadkin Valley Community Hospital they have more urgent decisions to be made than most. But Yadkin County is only one of of many rural communities across the nation grappling with the question of how to keep their hospitals afloat against a rising current of challenges. Hospitals are cornerstones. Beyond meeting a community’s medical needs, “A hospital is an economic-development tool,” said Yadkin County Manager Lisa Hughes. (Sisk, 8/24)

Following complaints by legislators and case managers, state officials say they are changing how they notify people on Medicaid that they’ve been placed in a “health home” program to coordinate their care. Mike Randol, director of health care finance for the Kansas Department of Health and Environment, acknowledged complaints from case managers who say they provide months of services to Kansans with mental illness only to find those services aren’t eligible for reimbursement because those clients have been placed in health homes. (Marso, 8/24)

Five years ago, New Orleans attorney Ermence Parent was struggling to find out what was wrong with her leg. She was 58 years old, and her right leg hurt so much that she needed a cane. That was not only painful, but frustrating for a woman who routinely exercised and enjoyed it. Parent sought advice from several doctors and a chiropractor, but got no diagnosis. (Neighmond, 8/24)

Health centers that serve Kansans who lack insurance or struggle to pay for primary health care are seeing no lack of demand for their services. Rebecca Lewis once was among those Kansans. In 2011, the McPherson woman found herself working three part-time jobs and trying to complete a college degree. As a single mom with three young boys — then ages 8, 5 and 2 — it was hard to make ends meet. (Thompson, 8/24)

A national right-to-die group convicted of assisting in the 2007 suicide of a Minnesota woman was ordered Monday to pay a $30,000 fine — the maximum sentence allowed under state law. Final Exit Network Inc. was convicted in May of assisting in the suicide of Doreen Dunn, a 57-year-old Apple Valley woman who took her life after a decade of suffering from chronic pain. In addition to the fine, the group was also ordered to pay nearly $3,000 to Dunn’s family to cover funeral expenses. (Forliti, 8/24)

Twice already Narseary and Vernal Harris have watched a son die. The first time — Paul, at age 26 — was agonizing and frenzied, his body tethered to a machine meant to keep him alive as his incurable sickle cell disease progressed. When the same illness ravaged Solomon, at age 33, the Harrises reluctantly turned to hospice in the hope that his last days might somehow be less harrowing than his brother’s. (Varney, 8/25)

Paramedic Jacob Modglin parks on a palm-lined street in Oxnard and jumps out of his ambulance. He is prepared for any kind of emergency. But his patient is standing in the driveway of a one-story house, holding a thermos, and smiling. It's time for his 8 p.m. appointment. Modglin is part of a new cadre of "community paramedics" working in a dozen pilot programs across California. Their jobs are to treat patients before they get sick enough to need emergency care. (Karlamangla, 8/25)

When kids start school this fall, it’s a sure bet that some won’t have had their recommended vaccines because their parents have claimed exemptions from school requirements for medical, religious or philosophical reasons. Following the much publicized outbreak of measles that started in Disneyland in California in December, these exemptions have drawn increased scrutiny. (Andrews, 8/25)

More than 40 Republican legislators are requesting that Iowa Attorney General Tom Miller investigate how medical providers in the state handle the donation or sale of fetal tissue obtained in abortions. The lawmakers sent a letter to Miller, a Democrat, dated Monday and containing 10 detailed questions on how "abortion providers (or any affiliates, subsidiaries or associates thereof)" dispose of aborted fetus remains, and whether any of those remains are donated or sold for medical research. (Noble, 8/24)

Gov. Bruce Rauner on Monday sought to rewrite a wide-ranging measure aimed at curbing heroin use, eliminating a requirement that the state's Medicaid health care program for the poor pay for medication and therapy programs to treat addiction. The Republican governor said the state can't afford the extra cost while "facing unprecedented fiscal difficulties." Supporters of the original legislation argued the governor's change creates an unfair system in which those who can afford insurance get help for their addiction while low-income patients end up in an emergency room or a courtroom. (Garcia and Geiger, 8/24)

Employees at Worcester Polytechnic Institute saw something in their paystubs this year that they had not seen in many years: smaller deductions for health insurance. The decline was the result of an initiative that has brought WPI together with 10 other Massachusetts colleges and universities to form their own health insurance company, covering a combined 8,900 employees and their families. The initiative, called Educators Health LLC — or EdHealth — allows the schools to bypass commercial insurers by pooling their risk and money, and paying claims from that pool. (Dayal McCluskey, 8/25)

It is tempting to dismiss the latest anti-choice salvo from Ohio lawmakers, which would criminalize abortions based on a fetal diagnosis of Down syndrome, as a blatantly unconstitutional ploy that would never be enforced. That would be a mistake. The bill stands a disturbingly good chance of approval this fall by the state’s Republican-controlled legislature, which has been passing abortion restrictions as quickly as it can write them in the four-plus years since Gov. John Kasich, a Republican who is also running for president, took office. (8/25)

Ohio is considering legislation that would ban abortion, even before viability, if the reason for the termination is that the fetus has Down syndrome. On the surface, the law seems blatantly unconstitutional: The U.S. Supreme Court has affirmed a woman’s basic right to be free of any “undue burden” on terminating her pregnancy before viability. ... Yet on closer examination, the legal issue is more complicated. Seven states have laws banning abortion aimed at selecting the sex of a child. These laws are arguably constitutional, and haven’t been struck down by the courts. The argument in favor of those laws is that the state has a compelling interest in combating sex discrimination. It seems possible that countering discrimination against those with Down syndrome is a compelling interest on par with combating discrimination against women. (Noah Feldman, 8/24)

Trying to repeal Obamacare has long been a popular (if futile) Republican pastime. Now replacing Obamacare is catching on, at least among Republican presidential candidates. This would count as progress, except that none of their proposals quite meets the definition of "replacement." (8/24)

Taking on the Affordable Care Act is de rigeur for Republican candidates, but Republican voters are not of one mind about Obamacare–and the different positions candidates take may not have much effect on their primary prospects. Republican presidential candidates Scott Walker, Bobby Jindal, and Marco Rubio have put forth plans to replace the ACA. But the proposals are not detailed enough to analyze their likely impact. (Sen. Rubio’s approach, for example, was laid out in an op-ed.) We can, however, analyze the political strategy here. (Drew Altman, 8/25)

The long term prospects of many of these Obama initiatives will depend on whether the next president will build on them or instead will try to roll them back. ... Clinton has vowed to build on Obamacare’s coverage expansion; the 2016 GOP candidates are all vowing to repeal it, and those who are purporting to offer their own plans would, at a minimum, roll that coverage achievement back. (Greg Sargent, 8/24)

A person’s health care spending tends to be high in the last year of life — but not as high as conventional health economics suggests. The biggest spending comes from years of custodial, disability care endured in nursing homes and hospitals — mostly by women who don’t have long-term care insurance. A paper released this summer by a team writing for the National Bureau of Economic Research found spending concentrated among a small cohort of elderly Americans, who tend to stay at the high end for three years or more. (Jim Landers, 8/24)

Consumers are trying to figure out how they’ll absorb the double-digit increases in health insurance premiums that many insurers have announced for next year. American employers, meanwhile, are worried about what will happen to health costs several years out, in 2018. That’s because 2018 is when one of Obamacare’s most onerous taxes takes effect — the “Cadillac” tax. The levy will apply to employer-provided insurance plans deemed too costly by the federal government. (Sally Pipes, 8/24)

The [Utah] state Legislature is still looking for ways to expand Medicaid under President Obama’s Affordable Care Act. After years of “studying the issue,” legislators quickly learned what experts have been telling them for months — that such a plan is plainly unaffordable for Utah taxpayers. Such a discovery has made the state government look desperately for alternative ways to make expansion work. To pay for this boondoggle, lawmakers want to extract much of the $78 million needed to expand Obamacare from our health care providers. Put another way, they want a “doctors’ tax.” (Evelyn Everton, 8/25)

On the 50th anniversary of Medicaid, it’s time to ensure the oral health of all Americans. ... Despite the great strides made to provide coverage to those who need it most, 83 million Americans still face obstacles in receiving dental care each year. As more Americans become eligible for Medicaid — average enrollment is projected to increase by 3 percent annually over the next 10 years — the number of those who face barriers in receiving dental care will continue to rise unless state and federal leaders act now. (Steve Pollock, 8/24)