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Insurance agents and consumers faced longer than usual wait times on the federal HealthCare.gov call center's lines Monday, the deadline for insurance that takes effect Jan. 1 — and many were told they would get a returned call up to a week after the deadline, associations representing agents said late Monday. Consumers phone the call center when they have questions or issues with the site or to reset their passwords. (O'Donnell, 12/15)

Consumers rushed to meet a Monday deadline for picking or changing Affordable Care Act health plans for the new year, creating a surge of visitors to HealthCare.gov that tested the revamped site. The federal enrollment portal, which was hobbled by technical problems last year, appeared to hold up well despite a swell in volume, according to people familiar with its operation. Some state-run insurance sites extended enrollment deadlines and in-person sign-up hours due to heavy last-minute demand. (Armour and Radnofsky, 12/15)

MNsure officials say Minnesotans now have until 4:30 p.m. on Dec. 20 to enroll in a health plan through the exchange for coverage starting Jan. 1. The enrollment period was set to close at midnight tonight. (Zdechlik, 12/15)

Minnesota became the second state to push back its deadline to sign up for healthcare coverage on Monday, citing “historic interest” in its program. (Ferris, 12/15)

California's health insurance exchange extended its deadline for consumers who want Obamacare coverage in effect beginning Jan. 1. Uninsured rates fell under Obamacare, but who's reaping the benefit? Peter Lee, executive director of Covered California, said people who start the application process or made some "good faith effort" by Monday will have until Dec. 21 to finish signing up. Monday at midnight was the original deadline. (Terhune, 12/15)

[Alice] Jaye lives in the southwest corner of the state – a region that had extremely high premiums for exchange coverage in the first year of enrollment. Southwest Georgia gained national prominence for those insurance rates, which were reported to be the second-highest in the country, behind only ski resort areas of Colorado. ... With the hours ticking away till the Monday deadline, insurance counselors said ACA coverage appears to be picking up more interest from southwest Georgia residents like Jaye, who would be joining the exchange for the first time. ... This time around, though, the region is seeing significantly lower premiums. The Albany area of southwest Georgia will have a 23 percent drop for the second-lowest silver plan, according to Bill Custer, a health insurance expert at Georgia State University. (Miller, 12/15)

Trying to head off a new round of consumer headaches with President Barack Obama's health care law, the insurance industry says it will give customers more time to pay their premiums for January. America's Health Insurance Plans, the main industry trade group, says the voluntary steps include a commitment to promptly refund any overpayments by consumers who switched plans and may have gotten double-billed by mistake. Though the HealthCare.gov website is working far better this year, the industry announcement highlights behind-the-scenes technical issues between the government and insurers that have proven difficult to resolve. (Alonso-Zaldivar, 12/16)

In a major policy move, Gov. Bill Haslam has announced the new Insure Tennessee plan, a two-year pilot program that would provide health care coverage to tens of thousands of Tennesseans who currently don't have access to health insurance or have limited options. The plan would be leveraged with federal dollars, said Haslam, who has been working for more than a year on a Medicaid expansion plan that could gain approval from both federal officials and the Republican-dominated state legislature. ... Haslam said the program will not create any new taxes for Tennesseans and will not add any additional cost to the state budget. The Tennessee Hospital Association has committed that the industry will cover any additional expenses created by the plan, he said. (Boucher, 12/15)

Tennesseans who make too much to qualify for Medicaid and too little to afford their own health insurance could be eligible for a new health-coverage plan proposed by Gov. Bill Haslam, if the state legislature approves it in early 2015. The governor on Monday unveiled the alternative approach to Medicaid expansion that he negotiated with President Obama’s administration: a two-year pilot program he’s calling Insure Tennessee that could include up to 200,000 low-income working Tennesseans currently without health insurance. (Locker, 12/15)

The news comes after months of wrestling between Mr. Haslam and the Obama administration. If finalized, it would make Tennessee the 28th state to expand Medicaid, the federal-state insurance program for the poor, to residents with incomes near the federal poverty level. The expansion must be approved by the state’s GOP-controlled legislature, and requires a final signoff by the Obama administration. (Radnofsky, 12/15)

Under mounting pressure from financially strapped hospitals, Gov. Bill Haslam of Tennessee proposed on Monday an alternative plan for expanding Medicaid that he said would bring health coverage to tens of thousands more poor residents of his state without following traditional Medicaid rules. (Goodnough, 12/15)

Tennessee has moved to the forefront of a new group of Republican-led states jockeying for hundreds of millions of dollars available under Obamacare for Medicaid expansions. Governor Bill Haslam, a Republican, announced today that the state would expand its Medicaid program for the poor under a “real Tennessee solution” that the Obama administration supports in principle. Indiana, Utah, Wyoming and Alaska are also considering an expansion, at least 90 percent of which would be funded by the federal government. (Wayne, 12/15)

Tennessee Governor Bill Haslam will call a special session of the state Legislature to consider a plan aimed at providing healthcare coverage to state residents who either do not have insurance or whose options are limited, he said on Monday. ... The Republican governor said his plan had received verbal approval from the U.S. Department of Health and Human Services. In addition to getting legislative approval, the state must submit a waiver to HHS. (Ghianni, 12/15)

Tennessee is the latest conservative state to pursue Medicaid expansion under Obamacare. It just doesn’t want to call it that. (Pradhan, 12/15)

Republican Tennessee Gov. Bill Haslam has announced his alternative pathway to expand Medicaid in the state with a unique voucher program for low-income employed individuals. He also announced a surprising partnership with hospitals to help fund the expansion. (Dickson, 12/15)

Gov. Terry McAuliffe will make a renewed push to expand Medicaid under the Affordable Care Act this week when he presents legislators with a budget plan that calls for extending the government health-care program to 400,000 uninsured Virginians. (Vozzella, 12/15)

Independent Bill Walker, who won election last month in a governor’s race so tight the results weren’t known a week after the voting was over, campaigned on the promise that he’d expand Medicaid as one of his first orders of business. To make good on that, he’ll have to face Alaska’s Republican-controlled legislature that hasn’t been willing to even consider the idea. But for Walker, it’s a no-brainer. Around 40,000 low-income Alaskans — mostly childless adults — would receive health benefits under Medicaid expansion. The federal government would pay 100 percent of the costs until the end of 2016. After that, the state’s share would slowly increase to 10 percent by 2020. Plus, he says, Alaskans already pay taxes that fund the expansion. (Feidt, 12/16)

Gov. Scott Walker of Wisconsin, fresh off his re-election, said he would propose his state join several others in mandating drug screening for people seeking nutrition or cash assistance. Utah Republicans want to require that certain residents allow the state to assist them in finding a job if they want to collect benefits through Medicaid, the health-care program for low-income and disabled Americans. Indiana Gov. Mike Pence is proposing Medicaid recipients kick in at least a few dollars a month as a condition for receiving benefits. Critics say the new welfare requirements, particularly drug screening, unfairly target low-income people and are aimed at cutting recipients off the benefit rolls. (Paletta and Peters, 12/15)

Forty miles north of Seattle, in the largest building in the world, Boeing assembles its biggest commercial airliners. Thousands of workers on a 98-acre factory floor piece together hulking wings and fuselage pieces, miles of electrical wiring and millions of rivets on a production line so precisely choreographed that Boeing can roll out a new jet every other day. The largest plane built here, the 747, has some 6 million parts. With similar attention to detail, Boeing has helped shape medical care in and around Seattle, one of the healthiest regions of the country. ... Boeing and other major employers here, including Starbucks and Costco, have aggressively pushed local hospitals and doctors to meet the kinds of rigorous standards they use to build airplanes or brew coffee. (Levey, 12/15)

[Mike] Brey owns four Hobby Works toy stores in Maryland and Virginia, and he’s got about 50 full and part-time workers. ... There’s no time to sleep around the holidays if you own a toy store, and no time to look over health insurance plans — one of his least favorite chores. ... Still, Brey does provide insurance for his employees. ... [Brey has] been noodling around on Maryland’s SHOP website, which was set up under the Affordable Care Act to connect small businesses with health insurers. ... Brey says he used to have only a couple of plans to choose from. But on the SHOP exchange, “You have CareFirst offering, Coventry, Evergreen, Kaiser, United.” But here’s the thing: Brey’s just browsing, not buying. And he’s not alone. “It’s been, admittedly, a little slow getting out of the starting gate,” says Sabrina Corlette, a senior research fellow at Georgetown University’s Center on Health Insurance Reforms. (Marshall-Genzer, 12/16)

Last year, the administration decided to give businesses more time to stay on their current “grandfathered” coverage before moving to plans that comply with the Affordable Care Act. But the relief of being able to keep the same plan was short-lived for some small business owners. Kurt Barks, the CEO of Complete Auto Body, found that the premiums for his company plan that covers about 40 workers would rise about 38 percent, even though it’s the same coverage he has had for the last few years. (Shapiro, 12/16)

WellCare Health Plans Inc. has appointed Chief Operating Officer Kenneth A. Burdick as its new chief executive, a year after firing Alec Cunningham over differing perspectives. Mr. Burdick, who was 55 years old as of April’s proxy filing, replaces Chairman David J. Gallitano, who has served as interim CEO since November 2013. ...Tampa, Florida-based WellCare focuses on government-backed health-care programs, expanding its business with several acquisitions of Medicaid-focused plans in recent years. Drug costs have weighed on health insurers’ results, in general, particularly with expensive hepatitis C treatments hitting the market. (Chen, 12/15)

The U.S. Senate on Monday approved President Barack Obama's nomination of Dr. Vivek Murthy to serve as U.S. surgeon general, despite opposition from Republicans and some Democrats over his support for gun control and past statements that gun violence is a public health issue. The U.S. has been without a Senate-confirmed surgeon general since July 2013. The surgeon general does not set policy but is an advocate for the people's health. (Daly and Neergaard, 12/15)

The Senate confirmed the long-delayed nomination of Dr. Vivek Murthy for surgeon general on Monday, as Democrats pushed to approve some of President Barack Obama's stalled choices for government posts before Republicans take power in Congress next year. ... Obama nominated Murthy a year ago, but some Republicans and the National Rifle Association criticized his gun-control views. Senator Ted Cruz, a conservative Republican, called Murthy an "anti-gun activist." ... Supporters of Murthy noted more than 100 public health organizations endorsed him, calling him a "well qualified, forward-thinking, innovative leader with a strong commitment to public health." (Cornwell, 12/15)

Dr. Murthy’s nomination was opposed by both Republicans and some Democrats over the gun issue, opposition that stalled his confirmation vote for months, leaving the public-health post unfilled while the U.S. government wrestled with issues such as the global Ebola outbreak. His critics said the 37-year-old Dr. Murthy, who was born to Indian immigrant parents and is an associate physician at Brigham and Women’s Physicians Organization in Boston, has been too politically outspoken. In addition to his comments on gun control, which drew the opposition of the National Rifle Association, he also co-founded a group of doctors that advocates in support of the federal health-care law. (Crittenden and Radnofsky, 12/15)

The Senate confirmed Vivek Murthy, a physician who has called gun violence a public health issue, as U.S. surgeon general more than a year after President Barack Obama chose him for the job. The vote was 51-43 on one of the Senate’s last work days before Democrats turn the majority over to Republicans in January. After Obama nominated Murthy in November 2013, his confirmation was delayed amid opposition from Republicans and the National Rifle Association, a Fairfax, Virginia-based pro-gun lobby. (Miller, 12/15)

Senators voted 51 to 43 to confirm Vivek Murthy, a Harvard and Yale-educated doctor at Brigham and Women’s Hospital in Boston, whose nomination had been in limbo amid concerns about his experience, and opposition from the gun lobby. (O'Keefe and Dennis, 12/15)

A Brigham and Women’s physician will become the next U.S. surgeon general. Democrats squeaked out a 51-43 vote Monday to confirm Dr. Vivek Murthy, 37, in the waning days of their control over the U.S. Senate. (Bebinger, 12/15)

Dr. Vivek Murthy, the Harvard professor whose nomination for surgeon general was held up because of his support for gun control and his political activity in President Obama’s campaign, was confirmed Monday by the Senate, more than a year after he was nominated. (Bierman, 12/15)

The Senate confirmed President Obama's controversial choice for surgeon general Monday, a victory for the administration after Republican infighting gave Democrats the upper hand in the final stretch of the lame-duck Congress. The 51-43 vote followed a drama-filled weekend session in which Sen. Ted Cruz (R-Texas) forced senators to cancel plans and file into work as he tried to use a government funding bill as leverage to stop the president's immigration policy. (Mascaro, 12/15)

A job that's been open in President Obama's administration since July of 2013 was finally filled Monday, as the Senate voted to confirm Vivek Murthy as America's new surgeon general. The tally was 51-43, ending a confirmation process that began after Obama nominated Murthy to the post in November of 2013 — yes, that's one year ago. (Chapell, 12/15)

Dr. Vivek Murthy, a 36-year old physician, was approved 51-43 as the nation’s top doctor despite opposition from the GOP for his support of gun control and ObamaCare. Three Democrats voted against him, while Sen. Mark Kirk (Ill.) was the only Republican to vote in favor. (Ferris, 12/15)

The nomination was strongly opposed by the National Rifle Association because of Murthy’s support of gun-control laws and by Republicans who doubted that a 37-year-old physician was qualified for the public health position. ... Democrats confirmed him, 51-43, with the support of a lone Republican: Mark Kirk of Illinois. Democrats Heidi Heitkamp of North Dakota, Joe Donnelly of Indiana and Joe Manchin of West Virginia opposed him; all hail from red states where the gun lobby is particularly powerful. (Haberkorn and Everett, 12/15)

The Senate’s confirmation of Vivek Murthy to surgeon general on Monday gave Democrats a chance to troll GOP firebrand Ted Cruz on twitter. (12/15)

A broad array of healthcare organizations had been pushing for approval of Murthy's nomination. They cited public health emergencies, particularly the ongoing Ebola outbreak, as evidence of the need for the position to be filled. (Demko, 12/15)

Testing has become to the United States’ medical system what liquor is to the hospitality industry: a profit center with large and often arbitrary markups. From a medical perspective, blood work, tests and scans are tools to help physicians diagnose and monitor disease. But from a business perspective, they are opportunities to bring in revenue — especially because the equipment to perform them has generally become far cheaper, smaller and more highly mechanized in the past two decades. (Rosenthal, 12/15)

Doctors who are the most prolific prescribers of powerful narcotic painkillers and stimulants often have worrisome records, a ProPublica analysis of Medicare data shows. In 2012, 12 of Medicare's top 20 prescribers of drugs such as oxycodone, fentanyl, morphine and Ritalin have faced disciplinary actions by their state medical boards or criminal charges related to their medical practices, and another had documents seized from his office by federal agents. These drugs have a high potential for abuse and are classified as Schedule 2 controlled substances by the Drug Enforcement Administration. (Ornstein and Grochowski Jones, 12/15)

The Food and Drug Administration’s warning last month was unusual: Doctors shouldn’t use a common surgical tool on most women because it can spread hidden uterine cancer. A year earlier, the FDA had no official concerns about laparoscopic power morcellators, which it began approving in 1991. (Kamp and Burton, 12/15)

Federal officials who investigated Rivers’ death, which has been classified by the medical examiner as a “therapeutic complication,” found numerous violations at the accredited clinic, including a failure to notice or take action to correct Rivers’ deteriorating vital signs for 15 minutes; a discrepancy in the medical record about the amount of anesthesia she received; an apparent failure to weigh Rivers, a critical factor in calculating an anesthesia dose; and the performance of a procedure to which Rivers had not given written consent. In addition, one of the procedures was performed by a doctor who was not credentialed by the center. (Boodman, 12/16)

A federal judge on Monday ordered an Irish drug manufacturer to halt its plans to discontinue its widely used Alzheimer's medication, allegedly in an effort to drive patients to a newer patented drug. U.S. District Judge Robert Sweet told Dublin-based Actavis PLC to continue making the drug Namenda available for 30 days after generic alternatives become available on July 11 "in order to allow for an orderly transition." His injunction orders the company to inform doctors and pharmacists of the decision and tells Actavis not to impose any hurdles for filling prescriptions of the drug. (Virtanen, 12/15)

A federal court judge issued an injunction Monday that prevents Actavis PLC from pulling an older version of its Namenda medication for Alzheimer’s disease from pharmacy shelves in favor of a newer version of the drug. The case involves a controversial tactic in the pharmaceutical industry to manage a product’s life cycle. (Silverman, 12/15)

Daniel S. Loeb is making an investment into Alzheimer’s research that he hopes will have maximum impact. On Tuesday, Mount Sinai Hospital and the Icahn School of Medicine at Mount Sinai will announce a $15 million gift from Mr. Loeb—founder and chief executive of hedge fund firm Third Point LLC—to fund the Ronald M. Loeb Center for Alzheimer’s disease. (West, 12/15)

The U.S. Supreme Court declined an opportunity to approve tighter restrictions on abortion, turning away an appeal by Arizona officials defending a law that would restrict the use of drugs to end a pregnancy. The justices, without comment today, left intact a ruling that blocks the 2012 Arizona law while a legal challenge plays out. The measure, described by opponents as the country’s most extreme, has the effect of barring medicinal abortions after the seventh week of pregnancy and perhaps earlier as well. (Stohr, 12/15)

Arizona said the new restrictions in the law were meant to protect women’s health. But the groups challenging the law said it would make it extremely difficult for some women to obtain medical abortions, which are used in the earliest stages of pregnancy. (Barnes, 12/15)

The U.S. Supreme Court has blocked enforcement of an Arizona law aimed at limiting use of the increasingly popular abortion pill. In 2012 nearly half of the abortions in the state were via the pill, known as RU-486. The pill was approved by the FDA in 2000 for the first seven weeks of pregnancy. Since then, scientists have developed safer and smaller doses that allow the drug to be used through the ninth week. (Totenberg, 12/15)

The Supreme Court on Monday turned down Arizona's bid to limit how doctors prescribe drugs that are commonly used in early abortions. The justices in an unsigned order dismissed an appeal from Arizona state lawyers and let stand a lower court ruling that blocked the abortion regulation from taking effect. (Savage, 12/15)

The Department of Veterans Affairs misled Congress and members of the media about how many veterans died or suffered serious harm as a result of extreme treatment delays, according to a new report by the department's top watchdog. (Griffin, Devine and Black, 12/15)

Military personnel facing less-than-honorable discharge would have their cases reviewed by at least one mental-health professional under the defense-spending bill that Congress sent to President Obama late last week. The requirement, attached to this year’s National Defense Authorization Act, was inspired by war veteran Kristofer Goldsmith, who says he was removed from service without a proper diagnosis. (Hicks, 12/15)

The bipartisan bill passed in the House last week. But Coburn was the final hurdle to passing the legislation before the Senate adjourns for the year. H.R. 5059 would have required the Secretary of Veterans Affairs and the Secretary of Defense to annually arrange for an independent evaluation of the VA and DOD mental health care and suicide prevention programs. (Cox, 12/15)

The death, which was ruled a homicide by the medical examiner, underscores the vulnerability of frail nursing home residents in New York State, where rates of substandard care, neglect and abuse are high, according to national studies. Advocates for elderly and disabled residents complain that state enforcement has dwindled in recent years, even as private companies have been on a buying spree, acquiring nonprofit facilities and often cutting staff to enhance profit margins. (Schlossberg and Bernstein, 12/15)

Groups that advocate for Kansans with disabilities and for frail seniors say they will file objections to proposed changes in the waivers defining the state’s approach to Medicaid-funded services that help them live in community-based settings rather than in nursing homes. (Ranney, 12/15)

The Kansas Department for Aging and Disability Services has proposed allowing the managed care companies that have administered the state’s Medicaid program since February 2013 to have a say in deciding which services “best meet (a) participants needs.” (Ranney 12/15)

Gov. John Hickenlooper booted a vocal critic from Colorado’s health exchange board after the November elections and before Colorado auditors released a scathing account of financial mismanagement at Connect for Health Colorado last week. Hickenlooper had appointed Ellen Daehnick, a supporter of the Affordable Care Act and a small business owner, to the exchange board in July of 2013. Now registered independent, Daehnick said she has always voted for Democrats including Hickenlooper and President Obama. (Kerwin McCrimmon, 12/15)

The campaign aims to increase Missouri’s cigarette tax from 17 cents to 67 cents a pack. Campaign leaders estimated the increase would generate $250 million in state proceeds, which they said is about seven times more than Missouri currently spends on early childhood care and education programs. (Sherry, 12/15)

If I had a pill that would extend your life by one day, but it cost a billion dollars, it’s unlikely that many people would argue that health insurance should pay for it. We all understand that while the benefit might be real and quantifiable, it’s not worth the expense. But what if the pill cost a million dollars? And what if it extended your life by 10 years? Such discussions are about cost effectiveness. For the most part, we’re avoiding them when we talk about health care in the United States. (Aaron E. Carroll, 12/15)

It's still too early for a thorough evaluation of the effects of the federal Affordable Care Act, since some major provisions have only recently gone into effect. Still, a deep dive into the data on national health care spending through 2013 offers some reasons for optimism. The data show that even with the economy steadily recovering, overall US health care spending has been increasing only moderately. The 3.6 percent rise in 2013 is the lowest since the federal government started tracking that statistic in 1960. ... As Obamacare critics are quick to note, one circumstance restraining costs is an economy that still isn’t operating on all cylinders. That is true, though with this important qualifier: The use of health services is actually nudging up again, but the effect on total spending has been moderated by lower growth in medical prices. (12/16)

Americans visiting Healthcare.gov to purchase 2015 health-insurance plans are finding a nice surprise: Average premiums for the cheap “bronze” plans have increased only by 3.4% and premiums for the middle-of-the-road “silver” plans are rising by 5.8%, according to the American Action Forum. Where are the double-digit premium increases that so many predicted? Check back around this time in 2016. That’s when you’ll see the real spikes. (Stephen T. Parente, 12/15)

What’s it take to see a doctor in December? ... Medical offices are often jammed these days, and patients and providers can feel the stress. Some spike in business is unavoidable, because flu season arrived early and more now have health coverage, thanks to Obamacare. There’s also a doctor shortage. But much of the surge stems from the way we design insurance and incentivize treatment. Deductibles, co-payments and pretax spending accounts encourage people to delay elective care in the first half of the year and then rack it up in the last quarter. (Mitchell Schnurman, 12/15)

It’s open enrollment again for Obamacare, this time for 2015 coverage. Analysts will carefully count the new enrollments, and the number will become another talking point for proponents of the law who promised that it would significantly expand private health insurance coverage. Yet that’s not how the law is shaping up in reality. Rather than helping those who lack insurance, the law’s far greater impact has been to shift already-insured people into lower-quality, government-controlled health plans by massively expanding Medicaid (the dysfunctional insurance program meant for those with the lowest incomes) and by offering Obamacare plans through exchanges, which mimic the worst characteristics of the Medicaid program. (Hadley Heath Manning, 12/15)

Researchers from Cornell and Harvard have found that, compared with their uninsured counterparts, children covered by Medicaid or CHIP are more likely to complete high school, as well as attend and complete college. Medicaid or CHIP health coverage helps children perform better academically through adulthood, which can help them succeed in life. That's an important finding for Florida policymakers to keep in mind: A state's education and health care investments complement each other. When states invest in robust, affordable health coverage options, they can help children achieve more in school. (Dee Mahan, 12/15)

Jonathan Gruber should have been Time's Person of the Year. The magazine gave it to the "Ebola Fighters" instead. Good for them; they're doing God's work. Still, Gruber would have been better. (Jonah Goldberg, 12/15)

Doctors are licensed by their states to practice medicine, but they’re also expected to be “board-certified” in their particular field — surgery, obstetrics, pediatrics, etc. This certification comes from the professional organization of each field. In my case, it’s the American Board of Internal Medicine. It used to be that you tackled those monstrous board exams just once after residency. Then you went into practice and never looked at a No. 2 pencil again. But in 1990, the boards decided that doctors should recertify every 10 years. This seemed reasonable, given how much medicine changes. Over time, though, the recertification process has become its own industry. (Danielle Ofri, 12/15)

With problems associated with EHRs [electronic health records] so substantial—and physicians’ experiences using medical scribes so positive—are there any risks engendered by the rise of a medical scribe industry and its potential for becoming integral to US health care delivery? Despite scribes’ reported value, this industry should be viewed as what it is: a workaround or adaptation to the suboptimal state of today’s EHRs. ... The answer to today’s inadequate EHRs is not scribe support. Instead, physicians should demand improved products, should educate vendors to ensure that they understand how physicians think clinically, and should clarify what is needed for an intuitive, quick, and navigable user interface. (George A. Gellert, Ricardo Ramirea and S. Luke Webster, 12/15)