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Large numbers of doctors who are listed as serving Medicaid patients are not available to treat them, federal investigators said in a new report. “Half of providers could not offer appointments to enrollees,” the investigators said in the report, which will be issued on Tuesday. Many of the doctors were not accepting new Medicaid patients or could not be found at their last known addresses, according to the report from the inspector general of the Department of Health and Human Services. (Pear, 12/8)

The number of Americans applying for Supplemental Security Income benefits dropped in the first six months of this year compared to the same period last year, and experts are debating whether the decline is partly related to the healthcare reform law's Medicaid expansion to low-income adults. A total of 1,189,567 SSI disability claims—mostly related to physical or mental disability— were filed in the first six months of 2014, compared with 1,330,169 during the same period last year, a drop of 10.6%, according to data obtained by Modern Healthcare from the Social Security Administration through a Freedom of Information Act request. The total decline in SSI claims in states that expanded Medicaid in the first six months of 2014 was 11.2%, compared with 10.0% in non-expansion states. (Dickson, 12/8)

Does the Obama administration support wellness programs or doesn’t it? That’s the question Big Business is asking as it fumes over three lawsuits filed by the Equal Employment Opportunity Commission against company wellness programs — most notably, an October lawsuit against Honeywell International Inc. (Levine, 12/9)

Oscar Health Insurance, which sells health plans on Obamacare exchanges in New York and New Jersey, said it will pay members up to $240 per year in Amazon.com Inc gift cards for the thousands of steps they take each day. The plan is the latest effort by venture-capital backed Oscar to distinguish itself in the individual insurance market, where it is rare to offer members incentives to improve their health. Employer-sponsored health plans regularly use incentives such as lower premiums or higher contributions as part of their "workplace wellness" programs. (Humer, 12/8)

Investors are pouring money into the operators of U.S. rehab centers as many more Americans get health care coverage for addiction treatment, driving up valuations and triggering a consolidation of businesses in the fragmented sector. Under President Barack Obama’s healthcare law, new health plans must cover ten core health benefit areas. This includes substance abuse and mental health disorders, opening up services such as alcohol and drug detox or addiction therapy to many Americans who previously couldn’t afford them. (Oran, 12/8)

Workers in the U.S. should expect health care to take a bigger bite out of their paychecks next year, according to Bank of America Merrill Lynch. Finance chiefs at U.S. companies expect the Affordable Care Act to increase health care costs next year, and the majority expect to pass that along to their employees. The bank surveyed 602 CFOs and other finance executives at companies with annual revenues between $25 million and $2 billion. Of those, 69% said they expected their labor costs to rise to cover the costs of the ACA. The CFOs expected an average increase of 7.1%. (Monga, 12/8)

Ahead of the next week’s first deadline for Obamacare’s second season, HHS is carefully focusing on getting key demographic groups — Latinos, African Americans and young adults — to take the health insurance plunge. (Pradhan, 12/9)

It took a junior congressional staffer about 20 minutes to discover what the U.S. Department of Health and Human Services says it didn't know about its own health exchange enrollment data. Marilyn Tavenner, the administrator for the Centers for Medicaid and Medicare Services, told Congress in September that 7.3 million people had enrolled in coverage through Obamacare. (Korte, 12/8)

The state health insurance exchange's lack of adequate financial controls led to almost $489,000 in "unallowable or unreasonable" payments to vendors and service providers, the state reported in a highly critical audit released Monday. Auditors also identified more than $32 million in "problems" with procedure or documentation in their sampling and review of exchange payments and contracts. The 92-page report, which focused on exchange finances for fiscal years 2012-14, listed a litany of high-dollar irregularities at Connect for Health Colorado. The exchange is the state's health insurance marketplace under the Affordable Care Act. (Draper, 12/8)

A scathing audit of Colorado’s health exchange uncovered more than $32 million in problematic spending of federal tax dollars and possible illegal use of tax money to pay for barred activities such as lobbying and marketing. (Kerwin McCrimmon, 12/8)

In the latest installment of its nasty breakup with Oracle America over the state's health insurance exchange website, Oregon will scrap its beleaguered Medicaid enrollment project and replace it with a system built by Kentucky, state officials told lawmakers Monday. (Budnick, 12/8)

Oregon is planning to use an online Medicaid enrollment system from Kentucky after giving up on its own troubled software. Oregon's Medicaid director, Judy Mohr Peterson, told a state legislative committee about the plan Monday. Kentucky's health insurance exchange, kynect, has been applauded as a success story. Oregon's exchange, called Cover Oregon, became a political embarrassment for Democratic Gov. John Kitzhaber when it failed to launch. (12/8)

President Barack Obama’s home state of Illinois has once again decided not to set up its own health insurance exchange, despite concerns the Supreme Court could rule that subsidies are illegal in the federal exchange. (Pradhan, 12/8)

In the latest religious challenge to the federal health care law, faith-based organizations that object to covering birth control in their employee health plans argued in federal appeals court Monday that the government hasn’t gone far enough to ensure they don’t have to violate their beliefs. Plaintiffs including a group of Colorado nuns and four Christian colleges in Oklahoma argued in the 10th U.S. Circuit Court of Appeals in Denver that a federal exemption for groups that oppose contraceptives, including the morning-after pill, violates their beliefs. (Wyatt, 12/8)

A group of Colorado nuns told a federal appeals court on Monday that the government is forcing them to violate their religious beliefs by providing access to birth control in their employee health plans. In another round of religious objections to the federal health care law, the Little Sisters of the Poor and other faith-based nonprofit organizations argued in the Denver-based 10th U.S. Circuit Court of Appeals that filing an exemption compels the groups to go against their beliefs. (Steffen, 12/8)

It’s not enough for the Little Sisters of the Poor to be able to opt out of the Affordable Care Act provision that requires health insurance for employees to cover contraceptives. In a hearing Monday in Tenth Circuit Court of Appeals in Denver, their lawyer argued that even to acknowledge to the government that they will not provide contraceptive coverage forces them to do something they consider immoral. (Carman, 12/8)

In high-level strategy sessions on Capitol Hill, Republicans are going through reams of historical information and sitting through marathon slide show presentations, trying to figure out how to gut Obamacare through a complicated budget process that requires only a simple majority — a sign of how seriously they’re taking their best shot yet at dealing a long-term blow to the health care law. Behind closed doors, Washington’s top budget experts have quietly met with Sen. Mitch McConnell, the incoming majority leader, and the Senate Republican Conference to detail options for action next year. (Haberkorn and Raju, 12/8)

Congress has gotten tagged with a reputation for gridlock. Now that the House and Senate are both in Republican hands, what’s the prospect for real activity and real change? For insight into the prospects, Gerald Seib, Washington bureau chief of The Wall Street Journal, spoke to incoming Senate Majority Leader Mitch McConnell. ... [McConnell on the health law:] I think it’s the single worst piece of legislation we’ve passed in at least the last half-century. Having said that, it bears the president’s name. The chance of his signing a full repeal are pretty limited. There are parts of it that are extremely toxic with the American people: the elimination of the 40-hour workweek, the individual mandate, the medical-device tax, the health-insurance tax. I think you could anticipate those kinds of things being voted on in the Senate. Such votes haven't been allowed in the past. (Seib, 12/8)

When the new Senate convenes in January, only half of the 60 Democrats who voted for President Obama’s health care law will still be in office. As Bloomberg Politics noted, Sen. Mary Landrieu of Louisiana became the eighth Democrat who voted for the Affordable Care Act in 2010 to lose re-election this year when she was defeated Saturday by GOP Rep. Bill Cassidy. Greg Giroux of Bloomberg Politics noted that 19 Democrats who voted for Obamacare four years ago have retired or resigned from office and three others died in office. Of the eight senators who were defeated by voters, Landrieu joins Alaska’s Mark Begich, North Carolina’s Kay Hagan, Arkansas’ Mark Pryor and Colorado’s Mark Udall in losing in a year when ties to Obama became a prominent theme for Republicans. (Camia, 12/8)

Sen. Ted Cruz is blocking a bill that would change the way expatriate health insurance must comply with Obamacare, a measure to alter the president’s health care law that has rare bipartisan support. (Haberkorn, 12/8)

Senate Democrats are trying to confirm before year’s end President Barack Obama ’s surgeon general nominee, a pick that appears to be gaining momentum after being stalled for months. Vivek Murthy, Mr. Obama’s choice for the public-health post, is the highest-profile of the few dozen nominees who could come up for a vote in the chamber if Senate Democrats and Republicans reach a procedural agreement this week. Even in the absence of a deal, Senate leaders might take steps to set up a separate vote on Dr. Murthy’s nomination, a Senate Democratic aide said. (Peterson, 12/8)

President Barack Obama’s troubled pick for surgeon general may get a Senate vote before the end of this year’s lame duck session — though it’s not clear if he can win confirmation. Vivek Murthy, who has drawn opposition for remarks drawing a link between gun violence and health, is likely to get a vote before Democrats hand control of the chamber to Republicans in January, a senior Senate Democratic aide said Monday evening. But winning confirmation is another matter. (Everett, 12/9)

For four years, Rep. Darrell Issa, R-Calif., has used the committee chairmanship to probe and attack the administration on issues such as the IRS scandal, misplaced guns and U.S. deaths in Benghazi, Libya. Talk radio conservatives love him. But even some GOP colleagues say he overdoes the combative partisanship at times. (Babington, 12/9)

Republicans in Congress plan to launch its final assault on ObamaCare as consultant Jonathan Gruber will face questions about possible deceptions and a lack of transparency in the 2010 Affordable Care Act Monday. (12/9)

Seizing on the massive expansion in Medicaid, Blue Shield of California has agreed to acquire Care1st, a Monterey Park-based health plan with more than 500,000 patients. Until now, insurance giant Blue Shield hasn't participated in Medi-Cal, the state's Medicaid program for low-income people. As a result, it has missed out on the program's growth to 11.3 million Californians as part of the federal health law expansion. (Terhune, 12/8)

Gov. Terry Branstad suggested Monday that the state should consider consolidating services among its six institutions for people with mental illnesses or disabilities. "The facilities are obsolete, and it's extremely expensive" to use them the way the state now does, he said. His comments came in a brief interview after a budget presentation by the Department of Human Services. The department runs four mental health institutes, which are at Cherokee, Clarinda, Independence and Mount Pleasant, and two resource centers for people with mental disabilities, which are at Glenwood and Woodward. (Leys, 12/8)

Virginia’s legislative watchdog agency won’t be asked to conduct a sweeping study of the state Medicaid program after all. Instead, the Joint Legislative Audit and Review Commission agreed Monday to leave the issue to both houses of the General Assembly to define specific areas of the $8 billion federal-state program to study. (Martz, 12/8)

Kaiser Health News staff writer Jenny Gold reports: "New York lawyer Brett Stark, who has worked with dozens of unaccompanied Central American children who crossed into the United States in the past year, says getting the courts to grant these kids asylum is extremely difficult. So he often turns to a special advocate — a doctor. Such medical-legal partnerships have cropped up in New York and California, where thousands of unaccompanied minors have settled with their families or friends who were already in the U.S." (Gold, 12/9)

Two years ago, Horizon NJ Health cut reimbursements to home health providers by 10 percent, leaving those agencies fuming -- and alleging that the cuts would affect their ability to attract and retain workers to what were already low-wage positions. In fact, the home health agencies say Horizon wouldn’t meet with them to discuss the reductions. That’s one reason why they’re supporting a bill that would require Medicaid managed-care organizations (MCOs) -- large insurers like Horizon that oversee long-term care for Medicaid recipients -- to discuss cuts at least three months before implementing them. It’s the second attempt at a legislative solution to the problem, after Gov. Chris Christie vetoed an earlier bill that would have required state approval for reimbursement cuts. (Kitchenman, 12/8)

Primary care providers on Jan. 1 will have their Medi-Cal reimbursement rates lowered -- twice on the same day. A two-year Medicaid federal rate increase for primary care providers is due to expire on the first day of 2015. On the same day the California Department of Health Care Services plans to implement its state-ordered 10% reduction in reimbursement rates for fee-for-service Medi-Cal primary care providers. (Gorn, 12/8)

Many Senate hearings are mere theater, but one that took place on July 16, 2009, mattered. With Congress in the midst of writing the bill that became Obamacare, senators asked Douglas Elmendorf, the director of the Congressional Budget Office, to evaluate their efforts. (David Leonhardt, 12/9)

The CBO has long enjoyed a reputation for objectivity, but now some conservatives are clamoring for changes that would undermine the CBO's independence and lead to bigger, hidden federal deficits. The critics are pushing to dump the current director, Doug Elmendorf. Elmendorf, first appointed in 2009 when Democrats controlled both chambers of Congress and reappointed in 2011 when control was split, has a well-earned reputation for facing down political pressure from both parties. (12/8)

Most Americans have never heard of the Congressional Budget Office, so it may come as a surprise that an intense debate is occurring in Washington about the agency and its director, Doug Elmendorf. While some are urging the new, Republican-controlled Congress to keep the Democratic appointee, the better approach would be to bring in new blood. CBO scores have an outsized impact on the workings of Capitol Hill; unfavorable scores often end legislative debates before they begin. Elmendorf's CBO is widely respected as a supposedly neutral arbiter of legislative costs. But on several occasions its rulings — rosy estimates of job gains from the stimulus and predictions downplaying job losses from Obamacare, for example — have done the policy debate a disservice. (Michael A. Needham, 12/8)

Mary Landrieu ’s defeat in Saturday’s Louisiana Senate runoff was no surprise, but that doesn’t mean it should be ignored as inevitable. Ms. Landrieu was a widely liked three-term incumbent, and her GOP foe was hardly a juggernaut, yet she lost by 14 points after Washington Democrats all but wrote her off. Think of Ms. Landrieu as one more Democrat who has sacrificed her career to ObamaCare. It’s hard to find another vote in modern history that has laid waste to so many political careers. Sixty Democrats cast the deciding 60th vote for the Affordable Care Act in 2009 and 2010, but come January only 30 will be left in the Senate. (12/8)

One criticism of the Affordable Care Act is that it imposes a costly, one-size-fits-all standard, drastically increasing premiums by requiring everyone to buy health insurance that covers the same mandated benefits. This is not so. (Austin Frakt, 12/8)

Homicides account for close to two-thirds of all gun deaths of young people 19 years and younger. Gunshots (from both suicide and homicide) are the second biggest killer of teens and the top killer of black teens. Yet, stories like Jorge’s garner far less attention in the popular press than do the unintentional shooting deaths of children. Unintentional shootings—which sometimes involve very young children who find a gun in a parent’s or friend’s home—account for only 4% of pediatric gun deaths. ... pediatricians can enrich the conversation about pediatric gun safety so that urban teens are not left out. While acknowledging obvious risk factors for gun homicide, such as poverty and gang involvement, we cannot ignore the connection between unfettered access to guns and high rates of gun death. (Nancy A. Dodson and David Hemenway, 12/8)

Patients with disabilities face barriers when they attempt to access health care. These barriers include physical barriers to entering health care establishments, lack of accessible equipment, lack of a safe method for transferring the patient to an examination table, and the lack of policies that facilitate access. ... Many patients with disabilities receive their health care through government programs, such as Medicare and Medicaid. How is it that the federal government does not adequately enforce the federal laws to protect patients with disabilities? (Tara Lagu, Christine Griffin and Peter K. Lindenauer, 12/8)