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The Internal Revenue Service is ramping up to figure out who has health insurance and who doesn’t under Obamacare — but for now it is giving people the benefit of the doubt. For the first time, come January, people will have to indicate on their 2014 tax forms whether they have health coverage. The IRS will have to figure out who is covered and who is fibbing to avoid the Affordable Care Act’s penalty for not holding insurance. (Dixon, 12/2)

Health insurance giants are eating up a bigger slice of the marketplace in most states, despite intense efforts under ObamaCare to increase competition. The three largest insurance companies held an average of 86 percent of customers in the individual market last year, up from 83 percent in 2010, when the healthcare reform act was passed, according to a Monday report from the Government Accountability Office. The biggest companies held at least 95 percent of all customers in nearly a dozen states, including Alabama, Iowa, Kentucky and New Jersey. (Ferris, 12/1)

Such atypical approaches to selling health insurance policies are playing out across the country since the second round of enrollment under the federal Affordable Care Act opened in mid-November. Insurance companies and some states are focusing heavily on signing up eligible Hispanics, a group that accounts for a large share of the nation’s uninsured but largely avoided applying for coverage during the first full year the health care reform law was in effect. Hispanics accounted for just 11 percent of those who enrolled in the private policies sold during the initial sign-up period, which ended in March. (Dalesio, 12/1)

For Martha Gruberman, a 63-year-old resident of south suburban Steger, obtaining health insurance through the Affordable Care Act hasn't made it any easier to pay for routine medical care. ... Gruberman and others who picked plans with the lowest monthly costs have found that medical care is still out of reach because of the plans' high deductibles. As a result, many consumers with high-deductible plans are following old habits: delaying care or taking their needs to community health centers that have traditionally served the uninsured, local health administrators said. (Venteicher, 12/1)

The Affordable Care Act is expected to provide around $10 billion in subsidies this year to make health insurance affordable for low- and middle-income people. But a quirk in the law is denying subsidies to a significant number of low income people, especially those with families. Benfield has run up against this quirk. To cover only himself, Benfield would have to pay a little more than $2,200 a year. He says he can't afford that, but that's an affordable amount, according to Obamacare regulations, and that means Benfield could not get subsidies if he tried to get coverage on the Obamacare exchange. (Ydstie, 12/2)

Exactly what would happen to the Affordable Care Act if the Supreme Court invalidates tax credits in the three dozen states where the federal government runs the program? Legal scholars say a decision like that would deal a potentially lethal blow to the law because it would undermine the government-run insurance marketplaces that are its backbone, as well as the mandate requiring most Americans to carry coverage. (Rovner, 12/2)

With its technical and managerial problems out of the way, MNsure officials are focusing on a big challenge: convincing Minnesotans who are still uninsured to obtain coverage. MNsure is trying to re-enroll people who signed up initially and convince the remaining 5 percent of Minnesotans to comply with federal health insurance mandate. (Zdechlik, 12/1)

Access Health CT, the state's health insurance exchange, has added policies that exclude abortion coverage to those available from the state's insurance marketplace. The plans are included in the 2015 open enrollment period. Their inclusion ended a lawsuit against Access Health that had been filed by Barth and Abbie Bracy of the Dayville section of Killingly. (Radelat, 12/1)

New Jersey consumers seeking health care coverage through the Affordable Care Act can choose from more plans now than they could a year ago, possibly resulting in less expensive options, an Obama administration official told a state Senate panel Monday. (Seidman, 12/1)

In North Carolina, about one in five blacks lacks health insurance. Now grassroots organizers are targeting black churches to enroll people in Obamacare for the coming year. (Hoban, 12/2)

As millions of Ohioans, including thousands in the Toledo area, consider enrolling in Medicaid during the second enrollment period of the Affordable Care Act, some doctors are still hesitant to accept new Medicaid patients .... Dr. William Feeman, Jr., who has operated a family medical practice in Bowling Green for more than 40 years, said he is leery of taking new patients with Medicaid insurance plans. He said there is the traditional state-run Medicaid that reimburses doctors for services and has been operating for years. There are also new private insurance companies that are contracting with the state to provide health care for low-income patients. ... He said many doctors are worried about reimbursements and other perceived problems when dealing with health-care companies that cover Ohio’s low-income residents. One of the concerns he expressed is that it can be difficult to get approval from some of the Medicaid managed-care plans for patients to take tests that doctors believe are routine. (Harris-Taylor, 12/1)

A state hotline jammed up Monday as some of the hundreds of thousands of Pennsylvanians frozen out of the first year of coverage under the 2010 federal health care law's Medicaid expansion began seeking the insurance. Many callers to the Department of Human Services' hotline were met with a recording telling them their call could not be taken because of excessive volume. Mary Hicks, 48, said she had hoped to apply right away after being unable to hold down a full-time job because of severe sleep apnea that makes it difficult to stay alert during the day or safe to drive in the morning. Hicks, of Murrysville, near Pittsburgh, now works part time in the late afternoon and evenings, making a little more than minimum wage. (Levy, 12/1)

CMS wants Medicare accountable care organizations to take on more risk, but the agency is pulling back on the reins for a few more years — a move that experts say isn’t surprising given providers’ reticence to expose themselves to penalties if they don’t perform to certain standards. (Pradhan, 12/1)

Health care systems experimenting with a new way of being paid by Medicare would have three extra years before they could be punished for poor performance, the federal government proposed Monday. The proposal is one of dozens of changes that the Centers for Medicare & Medicaid Services wants to make to rules governing accountable care organizations. ACOs are affiliations of doctors, hospitals and other providers that jointly care for Medicare patients with the goal of pocketing a portion of what they save the government. Those that spend above Medicare estimates stand to lose money. (Rau, 12/1)

Douglas W. Elmendorf is an obscure figure beyond a narrow radius around Capitol Hill. As the director of the Congressional Budget Office, his nuts-and-bolts job is to serve as the official scorekeeper on the price of legislation and the referee on the budgetary and economic impacts of policy, from the Affordable Care Act to an increase in the minimum wage. So it is one of the stranger surprises of the midterm election fallout that the question of whether to reappoint him to his post has become a hot topic of debate — among Republicans. (Weisman, 12/1)

Back in 2012, the GOP presidential candidates all ran promising full repeal of the president’s health care law. It was a particularly tough stance for eventual nominee Mitt Romney, who was pilloried during the primaries because the health care plan he created as Massachusetts governor also had an individual mandate. This time, several GOP governors who might run will take heat for expanding Medicaid under Obamacare. The expansion option comes with the promise that Washington will cover the full cost the first few years and 90 percent of it thereafter. (Hohmann, 12/2)

Mr. Bush also offered some tough love to the incoming Republican majority in Congress that seemed aimed at heading off a showdown over the federal budget that could lead to a repeat of last year’s government shutdown. Quit trying to “make a point,” Mr. Bush said, and forge compromises to pass legislation. Stop seeking to repeal the Affordable Care Act, he suggested, and offer alternative health-care proposals. “We don’t have to make a point any more as Republicans,” he said. “We have to actually show that we can, in an adult-like way, we can govern, lead.” (Reinhard, 12/1)

Health-care spending by middle-income Americans rose 24% between 2007 and 2013, driven by an even larger rise in the cost of buying health insurance, according to a Wall Street Journal analysis of detailed consumer-spending data from the Bureau of Labor Statistics. That hit has been accompanied by increases in spending on other necessities, including food eaten at home, rent and education, as well as the soaring cost of staying connected digitally via cellphones and home Internet service. (Knutson and Francis, 12/1)

The emerging popularity of low-premium, high-deductible health insurance plans that hold patients responsible for a greater share of their medical care costs is exacting a financial and administrative toll on small physician practices and ambulatory surgical centers. The CEO of a Pittsburgh company that handles billing for local independent physicians says one of her client practices has seen its outstanding accounts receivable double in the last four years, a trend directly tied to patients who can’t pay their deductible at the time they receive care. (Twedt, 12/1)

Holiday shopping is ramping up, but the time for enrolling in a Medicare Advantage plan is drawing to a close. Dec. 7 is the last day to sign up for Medicare Advantage plans and prescription drug coverage (Part D). Among the options for King County shoppers is a new Medicare Advantage plan from the Humana insurance company and Iora Health, which operates primary care clinics nationwide. The health-care companies have joined up to offer a plan that follows an accountable care organization (ACO) sort of approach to deliver health care to seniors. (Stiffler, 12/1)

Aetna Inc. named Karen S. Rohan as its president, positioning her as a possible successor to Chief Executive Mark T. Bertolini. Mr. Bertolini, 58 years old, has served as the insurer’s president since 2007, adding the CEO title in 2010 and becoming chairman in 2011. Ms. Rohan, 51, will take on the new position on Jan 1. She has been an executive vice president overseeing local and regional business, and she now will add responsibility for national and government segments, as well as specialty products. She also has led Aetna’s integration of Coventry Health Care. (Wilde Mathews, 12/1)

Do it or else. Increasingly, that’s the approach taken by employers who are offering financial incentives for workers to take part in wellness programs that incorporate screenings that measure blood pressure, cholesterol and body mass index, among other things. The controversial programs are under fire from the Equal Employment Opportunity Commission, which filed suit against Honeywell International in October charging, among other things, that the company’s wellness program isn’t voluntary. It’s the third lawsuit filed by the EEOC in 2014 that takes aim at wellness programs and it highlights a lack of clarity in the standards these programs must meet in order to comply with both the 2010 health law and the landmark Americans with Disabilities Act. ( Andrews, 12/2)

The rate of abortions in the U.S. has reached “historic lows” after dropping by double-digits over the last decade, according to a new government report. The number of women having abortions dropped 13 percent between 2002 and 2011, new data from the Centers for Disease Control and Prevention show. (Ferris, 12/1)

The number of abortions in the United States has fallen to its lowest point in a decade, with the greatest drop among teenagers, according to a new report from the CDC. Just over 730,300 abortions were performed in 2011, a 5 percent decrease from the year before. The report also notes that the rate of abortions dropped by 5 percent and the ratio of abortions to live births by 4 percent. (Winfield Cunningham, 12/1)

For Tony Solomon, an Army veteran turned behavioral health advocate, a newly announced state initiative is just what Texas needs to focus on the coordination of mental health care programs for veterans. “It’s about how can we tackle one or two or three issues with several agencies working together,” said Solomon, director of the Harris County Veterans Behavioral Health Initiative, whose mission is to connect veterans and their families with local, state and federal resources. Solomon is one of more than 50 people who this week will learn how to apply for grants during the pilot phase of the Texas Veterans Initiative — a joint effort between the state and a nonprofit to provide state matching funds to local mental health efforts benefiting veterans. (Rocha, 12/2)

The Department of Veterans Affairs has imported a new boss to temporarily oversee health-care operations in the Southwest — one with a history of VA controversy at her permanent post in Florida, including a hidden video camera installed in a patient's room. (Wagner, 12/1)

The HIV diagnosis rate dropped about 33 percent over a decade, from 24.1 per 100,000 population in 2002 to 16.1 per 100,000 in 2011. That's according to a recent analysis from the Centers for Disease Control and Prevention, which found significant decreases in diagnosis rates for most demographics, ... However, diagnoses attributable to male-to-male sexual contact saw increases for nearly every group, with those 13-24 years old recording the largest increase. (Millman, 12/1)

A long standing federal regulation that many in the gay community say stigmatizes and discriminates against them could change. Members of the gay community, along with many others in the medical field, will gather in Washington on Tuesday to find out if the FDA panel will support the measure, ... When the rule was imposed in 1983, regulators wanted to prevent HIV from infecting the nation's blood supply at the time the disease was known as "gay-related immune deficiency." (Goldman, 11/2)

Mayor Bill de Blasio’s plans, to be announced Tuesday, are based on the recommendations of a task force he appointed following a series of reports by The Associated Press detailing problems at Rikers, including the deaths of two inmates suffering from serious mental illness. (12/2)

In an effort to reduce the growing number of inmates with mental health and substance abuse problems in New York City’s jails, the administration of Mayor Bill de Blasio announced plans on Monday to significantly expand public health services at almost every step of the criminal justice process. City officials, who are allocating $130 million over four years to the project, said their goal was to break the revolving door of arrest, incarceration and release that has trapped many troubled individuals in the system for relatively minor, quality-of-life offenses. (Winerip and Schwirtz, 12/1)

The plan represents the latest step by city officials to overhaul law enforcement, courts and jail systems in the wake of high-profile episodes involving mentally ill inmates at Rikers Island. The jail complex also has come under scrutiny after reports of dangerous conditions and lapses in treatment and supervision. (O'Brien, 12/1)

Texas should pursue a waiver from the federal government for more flexibility to administer Medicaid, heighten the "visibility" of the state's mental health programs to "ensure adequate leadership and accountability" and consolidate its three major women's health programs, the Senate Committee on Health and Human Services said Monday. In a lengthy report, the interim committee released its recommendations for the 2015 legislative session, addressing charges from outgoing Lt. Gov. David Dewhurst to expand access to women's healthcare, improve the state's mental health services, stop prescription drug abuse, and provide affordable care options for the state's uninsured — all under the constraints of a fiscally conservative budget. (Walters, 12/1)

California voters who went to the polls on the matter in November might not have the final say on whether that state's cap on medical malpractice damages should remain at $250,000. The California Supreme Court announced last Wednesday that it will hear Hughes v. Pham, a case that challenges the constitutionality of the state's Medical Injury Compensation Reform Act of 1975, known as MICRA, which caps pain and suffering, or noneconomic damages, at $250,000. The case also looks at how noneconomic damages should be paid. The court agreed to hold the case until after it hears another, Rashidi v. Moser, addressing several tangential issues. (Schencker, 12/1)

Vermont lawmakers say they're skeptical of Gov. Peter Shumlin's forthcoming single-payer financing plan because it relies on economic modeling provided by Jonathan Gruber. (12/1)

Medicare spending on doctors who make house calls rose to $236 million in 2012 — a 40% increase since 2006. But the effort to help aging patients with limited mobility get medical care has been riddled with fraud due to lax regulations in some areas of the U.S. Nowhere is this more pronounced than in Michigan, where nearly a fifth of all the spending on Medicare home visits nationwide take place. In 2012, physicians in Michigan received Medicare funds for home visits equal to 42 other states combined, a USA TODAY data analysis reveals. The result: more than $60 million in fraudulent billing by Michigan doctors in the past few years. (Hoyer, 12/1)

After surviving a suicide attempt in the summer, Todd Arko hoped he was ready to get his life back in order. But first, he needed medical care to mend broken bones in both feet, his back and right wrist. And he needed psychiatric help to make sure he was no longer a danger to himself. And that’s how two Dallas hospitals ended up in trouble with regulators. Arko sought treatment at Parkland Memorial Hospital and Greens Oaks Hospital, a psychiatric facility. (Jacobson, 12/1)

Proposed updated rules governing North Carolina's 14 current abortion clinics were released Monday, more than a year after the Republican-led legislature demanded that they be treated like outpatient surgery centers. The regulations were developed from the state Department of Health and Human Services with feedback from doctors, clinic representatives and other medical professionals. Officials say it will raise standards of care within the clinics. The proposal now is subject to public scrutiny before being finalized. Ultimately, the rules likely will be reviewed again by the General Assembly next year. (Robertson, 12/1)

AARP Kansas leaders hope to introduce the Caregiver Advise, Record, Enable Act in the upcoming legislative session. The bill is still in draft form, but it is intended to allow patients to designate a caregiver upon admission to the hospital. Hospital staff would then be required to notify that caregiver if the patient is to be discharged to another care facility or home. If the patient is being sent home, the hospital must “provide an explanation and live instruction of the medical tasks” that will have to be performed at home. (Marso, 12/1)

For this town of 2,600 people who are facing 33 slippery, curvy miles to the next nearest hospital in Frisco, time and distance equate to life and death. The town is scheduled to lose its ambulance service in January. (Bunch, 12/1)

Sen. Ricardo Lara (D-Bell Gardens) reintroduced two bills, one of which would create a new Office of New Americans to help the 2.6 million people in the state illegally get services and special status proposed by the federal government to avoid deportation. ... Lara also reintroduced a proposal to provide health care coverage to some of those in the country illegally. The measure would expand state-funded Medi-Cal, and set up a mirror marketplace similar to Covered California, for those not eligible under the federal Affordable Care Act. (McGreevy, 12/1)

Jerry Dubberly is leaving his position as Georgia’s Medicaid director, effective Jan. 2. He’s stepping down from what experts consider a vitally important job in Georgia health care. As Medicaid chief, Dubberly oversees the services for about 1.9 million Georgians in Medicaid and PeachCare, with a state budget of more than $2.5 billion. (Miller, 12/1)

Most of us now are familiar with MIT economist Jonathan Gruber ’s boast that he and others took advantage of the “stupidity of the American voter” to push ObamaCare through Congress. Behind this boast is something that many Americans don’t know: When it comes to major U.S. fiscal legislation, the most powerful player is the Congressional Budget Office, whose rules were exploited by Mr. Gruber and other parents of the Affordable Care Act. If the new Republican congressional majority wants to put the country on a path toward solvency, it will have no more important task than to reform the CBO. (Avik Roy, 12/1)

The Affordable Care Act, like most health care reform efforts, focuses on people without insurance. That’s fine, because those people do face significant problems obtaining health care in the United States. But underinsurance is a real concern, too, and it’s often ignored. (Aaron E. Carroll, 12/1)

Do you know that pecan pie is nearly twice as caloric as pumpkin pie? Or that a Burger King Whopper with fries and a Coke make up the better part of the calories you should consume in a day? Or that a buttered popcorn at the movies can have a higher calorie count than a steak dinner? Apparently many Americans don't, as more than a third of the nation's adults are obese. (12/1)

The Food and Drug Administration issued a final regulation last week that will bring consistency and reliability to the nutritional information offered at chain restaurants. But it included grocery stores, ruling that their recipes are as formulaic as the menu boards at fast-food restaurants. On the contrary, food retailers are in the business of customization, and the nation's grocery stores have been representing their shoppers' health interests for decades through personal relationships. (Leslie G. Sarasin, 12/1)

[A] majority of Americans spend their entire adult lives in a desperate, losing struggle against fat. We spend billions of dollars on diet products. We starve ourselves with Paleo and other diet fads, only to see the pounds creep back on as soon as the diet is finished. We buy gym memberships and castigate ourselves for never using them. It isn't enough to simply say that the U.S. has an obesity problem. We are drowning in fat. It’s time to wake up and recognize the seriousness of the problem. Only then can we muster the national will to actually take steps to slim down the national waistline. (Noah Smith, 12/1)

My college roommate — the most immediately likable person I’ve ever met, a man who would now be such a present to the world — died of AIDS at the age of 30. Back then, people with the disease did not so much die as fade, becoming gaunt and ghostly images of themselves, as the virus gradually destroyed enough T-cells to cut their ties with the flesh. Metaphors don’t really capture the horror. Declined? Withered? At any rate, he died. (Michael Gerson, 12/1)