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The Senate unaminously confirmed Trump nominee David Shulkin to be secretary of Veterans Affairs Monday night. Shulkin, the lone holdover from the Obama administration among President Trump’s Cabinet picks, has been the VA undersecretary for health since July 2015 and has not drawn the harsh opposition from Democrats that other Trump nominees have faced. (Slack, 2/13)

Senators voted 100-0 to approve the former Obama administration official, who was the VA's top health official since 2015, in a rare show of bipartisanship amid partisan rancor over Trump's other nominees. Shulkin secured the backing of Senate Democrats after pledging at his confirmation hearing to always protect veterans' interests, even if it meant disagreeing at times with Trump. (Yen, 2/13)

Over the past two years, Shulkin oversaw the implementation of the Veterans Access Choice and Accountability Act, a $16 billion congressional fix for the long wait times for veterans seeking care. But an NPR investigation found that the fix itself is broken: A $10 billion program to help veterans get care in the private sector resulted in mountains of red tape, and a $2.5 billion hiring program didn't significantly increase the hiring of new doctors and nurses inside the VA. (Lawrence, 2/13)

The 57-year-old Pennsylvania native will run the second-largest federal agency after serving 18 months as undersecretary for health in charge of VA’s sprawling medical system, which takes care of nearly 9 million veterans a year. After a long search for a leader who could turn around a system Trump denounced on the campaign trail as a tragic failure, the president surprised critics by turning inside rather than outside for a VA leader. (Rein, 2/13)

"Veterans are very fortunate to have Dr. Shulkin voluntarily stay in what has evolved into the most scrutinized and criticized position in the country," Veterans of Foreign Wars National Commander Brian Duffy said in a statement. "And it should be," he added. The conservative Concerned Veterans for America, which has pushed for veterans to obtain greater health care from the private sector and has criticized the VA for not holding problem employees accountable, said Monday it was "encouraged" Shulkin had "acknowledged systemic failures within the VA and the need for transformational reforms to fix them." (O'Brien, 2/13)

Some Republican leaders are promoting state high-risk pools as an alternative to the Affordable Care Act's popular provision requiring health plans to accept consumers regardless of pre-existing medical conditions. They cite Wisconsin's pre-ACA pool, the Health Insurance Risk-Sharing Plan, as a model. But a Wisconsin insurance official recently cautioned a House panel that high-risk pools need a stable funding source and are not a solution for every state. Other experts say state high-risk pools generally were a policy failure across the country, and making them work properly would require a large amount of taxpayer funding. (Meyer, 2/13)

For many Republicans looking to scrap the Affordable Care Act, the fix will come from separating people into two pools. The lower-cost one would be for healthy people. Those with expensive medical conditions that drive up health spending would be sorted into the more expensive "high-risk" pool. (Zdechlik, 2/13)

Republicans in Congress are hitting roadblocks as they try to devise a plan to replace Obamacare, stuck over issues like how to structure tax breaks they want to give people to buy insurance. The party stalemated on many of the same obstacles in 2014 during its most extensive effort to devise an alternative, according to lawmakers and aides involved with that effort. "It wasn’t easy for us," said Eric Cantor, then the House majority leader, who led the effort. "There were a lot of thorny issues. The easy way was to gloss over the thorny details and the intra-party divisions." (Kapur, 2/13)

House conservatives — anxious that the GOP’s effort to end Obamacare is getting bogged down in the fight over what a replacement should look like — are plotting a major push to repeal the law immediately without simultaneously approving an alternative. The House Freedom Caucus and a number of Republican Study Committee members this week will urge Speaker Paul Ryan (R-Wis.) and his lieutenants to forego their plan to add replacement provisions to a repeal bill, dubbed “repeal-plus.” Instead, they want to approve the same standalone repeal bill that Congress sent to President Barack Obama in 2016. (Bade, 2/13)

The conservative House Freedom Caucus voted Monday night to oppose an ObamaCare repeal bill if it does not go as far as the repeal measure that passed in 2015, drawing a line in the sand that could complicate Republican repeal efforts. Conservatives have been pushing for the 2015 repeal bill, which kills the core elements of the law including its subsidies, taxes, mandates and Medicaid expansion, to be brought up again. But the move Monday night to oppose an effort if it falls short of that bill is a significant new development. (Sullivan, 2/13)

A political group aligned with House GOP leadership is launching a yearlong ad campaign targeting 50 House members to support repealing and replacing ObamaCare. American Action Network (AAN) will concentrate on 50 members from both sides of the aisle ahead of the 2018 midterm elections. AAN will use digital ads that appear when constituents in these districts type in keywords — including the lawmaker’s name — into the search engines Google and Bing. (Hagen, 2/13)

Delays in repealing the Affordable Care Act are complicating Republican plans to muscle tax reform through Congress. Republicans want to pass two budgets this year so they can twice tap budget reconciliation — once to push an Obamacare replacement through the Senate on a party-line vote, and a second time to do the same for a tax-code rewrite. (Faler, 2/13)

Republicans leaders have a lengthy list of talking points about the shortcomings of the health law. Shortly before his inauguration last month, President Donald Trump said that it “is a complete and total disaster. It’s imploding as we sit.” And they can point to a host of issues, including premium increases averaging more than 20 percent this year, a drop in the number of insurers competing on the Affordable Care Act marketplaces and rising consumer discontent with high deductibles and limited doctor networks. Yet a careful analysis of some of the GOP’s talking points show a much more nuanced situation and suggest that the political fights over the law may have contributed to some of its problems. (Rovner, 2/14)

Michelle Roelandts had a question for her congressman: If the Affordable Care Act and its premium subsidies were repealed, what would happen when her daughter turns 26 this year and needs to get her own health insurance while attending law school? Representative Jim Sensenbrenner, a durable Wisconsin Republican who has served in the House since 1979, had little to offer in response. “If I could give you an answer today, I would, but I can’t,” Mr. Sensenbrenner said at a town-hall-style meeting on Saturday, where about 70 people packed a room at the Pewaukee Public Library. (Kaplan, 2/13)

Representative Gus Bilirakis was determined to walk into his health-care town hall in Florida through the front door -- even though local deputies suggested a side door might be a safer route. "Nah," said the sixth-term Republican congressman, of the notion of keeping such distance from constituents angry and confused about plans by President Donald Trump and congressional Republicans to repeal and replace Obamacare. "Their worries are real. And their stories are genuine," Bilirakis said Saturday during a car ride to the event at a local government office in New Port Richey, near Tampa. (House, 2/14)

Bill Akins achieved his 15 minutes of fame — and, he says, death threats — after a clip of him making this statement at a Florida town hall when viral. The audience immediately hooted him down, and he responded by saying, “Okay, children. All right, children.” In 2009, former Alaska governor Sarah Palin first promoted the idea that the emerging law contained death panels, referring to a provision that would allow Medicare to pay for doctor’s appointments for patients to discuss living wills and other end-of-life issues. (Kessler, 2/14)

House Ways and Means Committee Chairman Kevin Brady (R-Texas) said Monday that crowds of people at town halls across the country worried about the fate of ObamaCare will not alter Republican plans to repeal and replace the law. Brady, a key player on healthcare, was asked by reporters if the pro-ObamaCare sentiment at town halls would “have any impact to the Republican push to repeal and replace.” "I don't think it will,” Brady replied. (Sullivan, 2/13)

Despite his colleagues’ continued attempts, New York Republican Rep. Chris Collins has no intention of holding a town hall meeting. “Because what you get are demonstrators who come and shout you down and heckle you. They are not what you hope they would be which is a give and take from people actually interested in getting some facts,” Collins told WGRZ-TV in Buffalo. Collin’s comments come in the wake of an increase of protests at town halls held by Republican members of Congress since President Donald Trump’s election. Many in the audience are loudly voicing concerns about President Donald Trump’s policies and GOP plans to repeal Obamacare. (Prater, 2/13)

A recent ruling by a federal judge that the U.S. government must pay more than $200 million to an Oregon insurer could mean serious financial and political headaches for the Trump administration in the months to come. The decision last week by a judge on the U.S. Court of Federal Claims requires the government to pay Moda Health Plan Inc. money it said it was owed under an Affordable Care Act provision intended to cover insurers financial shortfalls. (Armour, 2/13)

Twenty-seven employer groups asked the Trump administration on Monday to reject calls to replace the Affordable Care Act’s “Cadillac Tax” on high-cost health benefits with a plan that caps the individual tax exclusion for job-based health coverage. Premiums paid by employees for job-based health insurance aren’t taxed as income, which reduces the amount of payroll taxes and income taxes owed by workers. (Pugh, 2/13)

Two new studies show that although gains from Accountable Care Organizations (ACOs) are moderate, they increase with time and come from diverse versions of ACOs. The studies and an invited commentary were published online February 13 in JAMA Internal Medicine. (Frellick, 2/14)

In the ongoing debate over how accountable care organizations can lower costs and improve health, two new studies offer insights into the nuances of how ACOs affect spending, utilization and quality. Authors of both studies emphasized the importance of time in assessing the effectiveness of ACOs. But this resource is in short supply as President Donald Trump and his new health secretary, Tom Price, look to dismantle the Affordable Care Act, which launched numerous initiatives to pay for healthcare on the basis of value, not volume. (Whitman, 2/13)

Accountable care organizations are getting favorable reviews as a way to reduce costs and improve health quality for Medicaid and Medicare patients in two new studies out this week in JAMA Internal Medicine. The studies come as Dr. Tom Price, a conservative Georgia Congressman, begins his first week on the job as U.S. Secretary and Health and Human Services .... Price has spoken somewhat favorably about value-based care models but it’s unclear just how committed he will be to the move away from fee-for-service medicine. (Japsen, 2/13)

Aetna and rival Humana are terminating their merger, after their $34 billion deal was blocked by a federal court on antitrust grounds. Aetna will pay Humana a $1 billion break-up fee, in accordance with the agreement. (Coombs, 2/14)

After the Jan. 23 court ruling, Aetna and Humana had said they were weighing whether to appeal the decision and extend their agreement, which was set to expire on Feb. 15. Aetna and Humana announced the deal in July 2015, just a few weeks before Anthem Inc and Cigna Corp said they would also combine. A year later, the U.S. Justice Department sued to block both transactions and won in separate lawsuits, derailing what would have been a massive industry consolidation to three insurers from five. (Humer, 2/14)

"While we continue to believe that a combined company would create greater value for health care consumers through improved affordability and quality, the current environment makes it too challenging to continue pursuing the transaction," [Aetna Chief Executive Officer Mark] Bertolini said. "We are disappointed to take this course of action after 19 months of planning, but both companies need to move forward with their respective strategies in order to continue to meet member expectations," Bertolini said.

The end of their deal, which would have forged a diversified insurance powerhouse, leaves both insurers with challenges as they forge separate paths forward. ... In his ruling last month, U.S. District Judge John D. Bates said the merger would unlawfully threaten competition, harming seniors who buy the private Medicare coverage known as Medicare Advantage. The 156-page decision said that combining the two companies likely would lead to a substantial lessening of competition for Medicare Advantage plans in 364 counties. (Wilde Mathews, 2/14)

Aetna and Humana, which had agreed to combine in July 2015, are free to make new deals or spend billions of dollars on buying back their own shares. Another massive health insurance deal, meanwhile, is grinding forward -- for now. Anthem Inc. said on Monday that it’s seeking a fast-track appeal of a different judge’s ruling that blocked its own proposed $48 billion acquisition of Cigna Corp. (Tracer, 2/14)

Medical expenses are undeniably burdensome and difficult to plan for, but that’s exactly why it’s important to try. We asked some medical billing experts to share their top tips for consumers who want to be prepared for whatever their healthcare providers send them in the mail. (DiGangi, 2/14)

House bill 81 would allow Georgia hospitals that are owned by public hospital authorities to get outstanding medical debts paid by deducting the money owed from a pending state tax refund. The bill would include authority-owned facilities that are operated by non-profit organizations, which is the case with many hospitals in Georgia. (Teegardin, 2/13)

State lawmakers are advancing a measure giving women the opportunity to sue over physical or emotional injuries from an abortion. The measure could impact doctors’ liability insurance. Doctors can already be brought to court through the medical malpractice system, but Vero Beach Republican Representative Erin Grall’s bill would give patients a new way to sue for physical or emotional damages. (Evans, 2/13)

Abortion rates are at an all-time low in California, and both sides of the political aisle are taking credit. New abortion data from the Guttmacher Institute, a nonprofit organization that studies reproductive health, shows that fewer women than ever are obtaining abortions nationwide. Abortion opponents call it proof that their efforts to sway women away from the procedure are working, while abortion rights advocates point to increased sexual education and contraceptive use as drivers of the decline. (Caiola and Reese, 2/13)

Iowans overwhelmingly support continued public funding to Planned Parenthood for health services that do not include abortion, according to a new Des Moines Register/Mediacom Iowa Poll. Seventy-seven percent of adult Iowans surveyed favor continued state funding for non-abortive services at Planned Parenthood, up 3 percentage points from February 2016. Eighteen percent do not support that funding going to Planned Parenthood and 5 percent are not sure. The poll found 62 percent of Republicans believe non-abortion funding should continue, as do 62 percent of evangelical Christians. (Petroski, 2/13)

As Republicans in Congress seek to cut off federal funds to Planned Parenthood, Gov. Dannel P. Malloy has proposed legislation that would allow the state to make up any federal Medicaid dollars the clinics would lose. ... But Chris McClure, a spokesman for Malloy’s budget office, said the language included in one of the governor’s budget bills is intended to “ensure there is no disruption in family planning services provided to Medicaid recipients.” (Levin Becker, 2/14)

That future is already visible in Sacramento County and neighboring Yolo County, where West Sacramento is located: by 2013 the combined population of Hispanic, black, Asian and other nonwhite residents had edged out whites. In West Sacramento, a historically working-class county across the river from the state capital, more than 2 out of 5 public schoolchildren already speak a language other than English at home. Sacramento-area hospitals, community health centers and doctor’s offices have had to adapt. They’ve hired more multilingual, bicultural staff. They’ve contracted with interpretation services. The medical school at the University of California, Davis, is trying to figure out how to recruit more Latino students to a profession that remains largely white and Asian. And doctors are being trained to deliver culturally appropriate care to patients of many backgrounds. (Quinton, 2/13)

Dentists have become a significant source of opioid prescribing – especially for younger patients undergoing wisdom teeth extractions. They prescribe about 8 percent of the opioids in this country, according to government researchers, but are the top prescribers of these drugs to adolescents, accounting for 31 percent of all opioids given to patients aged 10 to 19 years old. That’s particularly concerning because that age group is among the most likely to abuse drugs and develop addictions. (Armstrong, 2/14)

A new anti-opioid advertising campaign is directed at family and friends of potential opioid abusers rather than addicts themselves. Attorney general Lori Swanson is spearheading the ad, called "Dose of Reality," and is urging TV stations and movie theaters to run it. The video features a woman trying to wake an unconscious teenager with an open pill bottle nearby. (Bakst, 2/13)

Patients with chronic back pain should try therapies such as tai chi, yoga, acupuncture, and mindful meditation before being prescribed opioid painkilling drugs, according to new guidelines from the nation’s largest specialty physicians group. Monday’s release from the American College of Physicians is the latest in a continuing deluge of recommendations that seek to reframe how patients and doctors think about the prescription drugs blamed for fueling a national addiction crisis. (Sapatkin, 2/13)

Thousands of inmates nationwide suffer from substance abuse disorder, officials say, and many become incarcerated while struggling with drug addiction. Many prisoners are arrested on drug offenses or crimes such as break-ins and robberies, which many say are conducted in the pursuit of feeding their addictions. Now the UMass Medical School is partnering with corrections officials across New England to study the treatment of addicted inmates while they are still behind bars, with the hope that specialized care will prevent their return to jail. (Hanson, 2/13)

The supremely self-confident billionaire behind that vision has drawn attention at the highest levels: He’s talked cancer research with Joe Biden, Bill Clinton, even the Pope. He’s met with President Donald Trump at least twice since the election. Riding high on his pledge to win the war on cancer, [Dr. Patrick] Soon-Shiong is said to have pitched a role for himself as national health care czar in discussions with Trump’s team. But a STAT investigation of Soon-Shiong’s cancer moonshot has found very little scientific progress. At its core, the initiative appears to be an elaborate marketing tool for Soon-Shiong — a way to promote his pricey new cancer diagnostic tool at a time when he badly needs a business success, as his publicly-traded companies are losing tens of millions per quarter. (Robbins, 2/14)

Dr. James Weinstein, a back pain specialist and chief executive of Dartmouth-Hitchcock Health System, has some advice for most people with lower back pain: Take two aspirin and don’t call me in the morning. (Kolata, 2/13)

The number of retirement-age Americans taking at least three psychiatric drugs more than doubled between 2004 and 2013, even though almost half of them had no mental health diagnosis on record, researchers reported on Monday. The new analysis, based on data from doctors’ office visits, suggests that inappropriate prescribing to older people is more common than previously thought. Office visits are a close, if not exact, estimate of underlying patient numbers. The paper appears in the journal JAMA Internal Medicine. (Carey, 2/13)

It’s been called the final indignity: after men have their prostate removed to treat cancer there, at least two-thirds find that their penis has shrunk, typically by nearly an inch. But in a much-needed glimmer of hope, a new study finds that, after the penis hits a nadir 10 days after surgery, it usually recovers to its pre-surgery length after a year. ... The shrinkage hits men especially hard because it’s a side effect that surgeons usually don’t warn patients about. While one small study (of just six men) found that the most common reaction to the loss of length was resignation — prostate cancer patients are often simply glad to be alive — on social media and in private discussions, many patients have a less sanguine view. (Begley, 2/13)

They are called superspreaders, the minority of people who are responsible for infecting many others during epidemics of infectious diseases. Perhaps the most famous superspreader was Typhoid Mary, presumed to have infected 51 people, three of whom died, between 1900 and 1907. Now scientists studying how Ebola spread during the 2014-2015 epidemic in West Africa say superspreaders played a bigger role than was previously known, according to findings published this week in the Proceedings of the National Academy of Sciences. (Sun, 2/13)

De Lorimier, a pediatric gastroenterologist at UC Davis Children’s Hospital, was searching for pressure points on Moncerrat’s body that he hoped would ease the pain in her abdomen. He’s one of the only physicians in his field using acupuncture on children with functional abdominal disorders. (Caiola, 2/13)

Researchers have created mice that appear impervious to the lure of cocaine. Even after the genetically engineered animals were given the drug repeatedly, they did not appear to crave it the way typical mice do, a team reports in Nature Neuroscience. (Hamilton, 2/13)

It can be difficult to socialize and make friends for many children with autism. Often that's because reading body language and others' emotions doesn't always come easily. Many of us seem to learn these social skills naturally, but maybe there's also a way to teach them. The Psychology Lab at Indiana State University is trying to tap into that idea with improvisational theater. (Balonon-Rosen, 2/13)

These donors don’t get paid for their blood. But while the raw product is free, the process around collecting and distributing the blood is not.Hospitals pay blood banks for components — like plasma and red blood cells — and blood banks use that income to stay viable, even when donations are down. But over the past decade, medical advances have had unintended consequences on this delicate balance. (Brown, 2/14)

A bill advancing in the [Virginia] General Assembly would require health insurance companies to cover a 12-month supply of prescription birth control. A Senate committee approved the measure Monday. It has already passed the House of Delegates with only one no vote. (2/13)

A gubernatorial appointee who chairs the Colorado Developmental Disabilities Council has filed dozens of lawsuits against small businesses over the past two months claiming they violate federal disability laws. The 64 lawsuits filed so far by Mellisa Umphenour of Arvada are nearly identical in content and scope to scores of others filed in U.S. District Court last year in Colorado – and thousands of others filed in federal courts nationwide the past few years. Umphenour filed the suits on behalf of her 11-year-old son, who is disabled. Often called “drive-by lawsuits,” they rely on the Americans with Disabilities Act and are often filed by disabled people or their caretakers. (Migoya, 2/13)

The fight is raging on in Topeka over whether to roll back a law that would let almost anyone carry a concealed gun on a college campus, in a library or public hospital. The debate has mostly been around whether guns enhance or detract from people’s safety. Less talked about is just how much allowing guns on campuses could cost. For one Kansas City area institution it could run into the millions. Most Kansas Board of Regents institutions have said they have little choice but to let people carry concealed weapons on university or community college campuses. Any of the institutions could prohibit guns but they would have to buy metal detectors and post armed guards at each entrance of every area that they want to keep firearm-free. (Zeff, 2/13)

Two Tennessee lawmakers want to do away with a 40-year-old state law granting legitimacy to children conceived through artificial insemination. Critics say the bill is aimed at gay couples and their children. The bill would remove a single sentence applying to child custody when artificial insemination is involved, one that’s been interpreted to make no distinction between same-sex and heterosexual couples. But opponents warn that changing the law could prevent both same-sex parents from appearing on the children’s birth certificates, affecting their ability to make parenting decisions ranging from medical care to education. (Schelzig, 2/13)

A California state senator is taking another stab at introducing a law that would require sugary drink manufacturers to put a warning label on their products, the latest effort in the "War on Sugar." Officials and public health advocates have heightened their criticism of sugar as a key contributor to health epidemics like obesity and diabetes, and California has become a major battleground in the fight against what they say is excessive sugar consumption. (Prentice, 2/13)

Bankrupt North Philadelphia Health System has reached a deal to sell its shuttered St. Joseph’s Hospital at Sixteenth Street and Girard Avenue for $8.1 million to MMP Hospital Partners LLC., according to a bankruptcy-court motion Monday. The agreement of sale, dated Feb. 13, was signed by David Waxman, managing partner at MMPartners LLC., which has been building in Brewerytown since 2001. Waxman declined to comment on the pending purchase. The health system filed a motion Monday to be able to sell the property free and clear of liens, which would then attach to the net proceeds. (Brubaker, 2/13)

A teacher at Montara Avenue Elementary School in South Gate died last week after contracting meningitis, leading parents to worry about whether their children might have been exposed. The Los Angeles Unified School District issued a statement saying the Los Angeles County Public Health Department "is taking appropriate measures to identify and protect those who may have come in contact with our employee. They have provided preventative antibiotics, as well as information about meningococcal disease." (Kohli, 2/13)

The Jacob House — a century-old, single-story brick bungalow — is set to become the first primary care medical clinic the mountain community has had in years, an asset Clear Creek County leaders say is required to keep both residents and the local economy healthy. With no doctor’s office or hospital within many snow-packed, traffic-jammed miles of the county’s towns, Clear Creek County EMS is the only source of medical care for the community of about 9,000 people and the tens of thousands of motorists passing through each day. That dearth of options has led people to languish without care and proved a deal killer for highly sought employers considering a move to town. (Paul, 2/13)

Zeltiq Aesthetics has struck a $2.48 billion deal for Botox-maker Allergan to buy the company and its CoolSculpting technology, which reduces fat. The deal is expected to close during the second half of this year, the companies said. (Avalos, 2/13)

A lawsuit filed in U.S. District Court last week claims that officials and employees at the Warren County Jail repeatedly failed to address the mental health issues of a man who eventually hanged himself with a sheet in his cell. Justin Cory Stewart was arrested April 19 for failing to comply with mental health treatment, a condition of his probation related to a previous conviction. He took his own life on Aug. 30. (Knight, 2/13)

When an individual goes up against a multibillion-dollar company, odds of prevailing are slim. But every now and then, justice smiles on the little guy. It’s smiling on Tampa internist Jose Ignacio Lopez, who won $1.5 million in a slander suit against a global health-finance powerhouse. Of the award, $1 million constitutes punitive damages for “gross negligence” by OptumRx Inc., a subsidiary of UnitedHealth Group Inc. OptumRx was negligent in two ways, the arbitrators said:  It said bad things about an innocent doctor and then failed to correct the mistake. (Gentry, 2/13)

Tanisha Anderson was 37 years old, suffering from mental illness, when she died in an encounter with Cleveland police in 2014. Her family recently settled a $2.25 million lawsuit against the city. Anderson’s death sparked a court-ordered agreement to reform Cleveland’s police department, which the U.S. Justice Department said showed a pattern of using excessive force on people with mental illness. Now, Cleveland police, in cooperation with the Alcohol, Drug Addiction and Mental Health Services Board of Cuyahoga County, are unveiling a new set of guidelines and training on how law enforcement treats suspects with mental illness and addiction. (Young, 2/13)

Speaker of the House Paul D. Ryan (R-Wis.) seems to reiterate weekly that the GOP has a health-care plan to replace the Affordable Care Act. To be honest (why isn’t he?), his “A Better Way” plan provided a rough outline of health-care reform, but there are a zillion details to be determined. In addition, thanks to President Trump, the bar for a replacement has risen considerably since Ryan presented his plan. It must “have insurance for everybody,” be cheaper, be more flexible and offer better care. Oh, and Republicans promise no tax increases to pay for it. Most important, so far the Republicans have yet to converge on any single plan. And that is all before we get to the task of corralling eight Democratic senators to break a filibuster.  (Jennifer Rubin, 2/13)

The ACA is the latest in a series of laws designed to improve an employment-based health care system that has never delivered universal coverage. The characteristics of the employment-based system coupled with the intrinsic qualities of insurance make it difficult to cover everyone. Combine that with the fact that our political process relies heavily on lobbying by insurance companies, pharmaceutical firms, the American Medical Association, and others, and curing the common cold seems more likely than “fixing” health care. (Melissa Thomasson, 2/13)

Remember the good ol’ days of U.S. health care? You know, when you could be denied insurance or charged a higher premium for a pre-existing condition, or kicked off of your health insurance plan if you got very sick. Back when there was no cap on your out-of-pocket loss .... With the repeal of Obamacare/the Affordable Care Act (ACA) a foregone conclusion, that past could become our future. And without an equivalent replacement, here’s what else you could lose. (Kimberly Kennedy, 2/13)

When President Obama was in office, Republicans made a mantra of their call to “repeal and replace” his signature health care program. But now that they are actually in position to do something, they’re flummoxed. They have no plan for a replacement anywhere near as robust as Obamacare. They can't even agree on what a significant rollback would look like. So might we suggest an alternative approach? It starts by treating Obamacare the same way that a doctor would treat a patient: First, do no harm. (2/13)

Many argue we should keep the Affordable Care Act intact because it has provided health insurance for more people. But to what end? Insurance under the ACA is too expensive for most to afford. Average premiums on the law’s marketplace have soared by double digits since its implementation — including an average 25% hike in 2017. Research from health care economist Stephen Parente shows there is no end in sight for substantial increases going forward. And while the law does provide subsidies, they won’t be able to keep up with these premiums. (Tim Phillips, 2/13)

Promises made by Donald Trump and Republicans in Congress to repeal and replace the Affordable Care Act are proving to be more complicated than they sounded on the campaign trail. With reality now setting in, what's most likely to happen? I expect to see Republicans stage a dramatic early vote to repeal, with legislation that includes only very modest steps toward replacement -- and leave most of the work for later. Next, the new administration will aggressively issue waivers allowing states to experiment with different approaches, including changes to Medicaid and private insurance rules. ... In other words, the repeal vote will be just for show; the waivers will do most of the heavy lifting. (Peter R. Orszag, 2/14)

The Affordable Care Act's (also known as Obamacare) days are numbered. Last week, both the Senate and House approved a budget resolution over the objections of the chamber's Democrats ordering several congressional committees to draw up legislation repealing much of the law. ... The GOP's replacement contains a lot that Democrats should be able to support. (Sally C. PIpes, 2/14)

When state lawmakers in 2013 decided to expand Medicaid as President Obama encouraged with the Affordable Care Act, they knew their plans would require a significant tax increase. ... Since then, the enrollment and costs for the program have skyrocketed above the original estimates. By the middle of 2017, state officials estimate that 650,000 Arizonans will be enrolled in the Medicaid expansion, which is roughly double the original estimates. (Naomi Lopez Bauman and Christina Sandefur, 2/13)

Paying for performance is a growing trend across the health care industry. Insurers have been striking deals with pharma companies that will land them discounts on pricey drugs if those treatments don't demonstrably improve patients' health outcomes; hospitals are penalized if they have high rates of patient readmissions. But this model is also making its way to the C-suite, Modern Healthcare reports. To cite just one example: Executives at Trinity Health, which operates 93 hospitals, have their pay tied to the system's overall effectiveness in keeping patients out of the hospital, lowering smoking and obesity rates, and other population health metrics. (Sy Mukherjee, 2/13)

Should we blame technology for the growth in healthcare spending? Austin Frakt, a healthcare economist who writes for the New York Times, thinks so. Citing several studies conducted over the last several years, he claims that technology could account for up to two-thirds of per capita healthcare spending growth. (Michel Accad, 2/13)

Controversial executive orders have been a hallmark of Donald Trump’s young presidency, but it’s worth noting that there is one that he has so far refrained from issuing. During the presidential campaign, Trump said he would “defund” -- that is, stop providing federal funding to -- Planned Parenthood. He can advance that goal by executive order if he wants. (Ramesh Ponnuru, 2/13)

The battle cry to defund Planned Parenthood was a guaranteed crowd-pleaser at GOP rallies and fundraisers throughout the 2016 campaign in Iowa. This wasn’t just a reliable applause line, it was a prompt for roars of approval. Few other issues generated as much enthusiastic reaction on the campaign trail. So what’s the deal with the new Des Moines Register/Mediacom Iowa Poll? It shows that three out of four Iowans support continuing state funding for non-abortion services at Planned Parenthood. (Kathie Obradovich, 2/13)

Gov. Chris Christie’s recent State of the State speech included the concept of placing supply limits on opioid prescriptions, a blueprint some patient-advocates would call a quick-fix, and others not a solution at all. As lawmakers such as Christie attempt to combat negative outcomes associated with prescription treatment options, elected officials must not forget about the unintended consequences that can result from proposed legislation that limits a patient’s access to medically necessary treatments. (Shaina Smith, 2/13)

The undercover investigation you’re about to see today is going to make you really angry, because we’re exposing the worst kind of scam — one that takes advantage of those most vulnerable, stealing not just their money, but their hope, their dignity.” That’s how Dr. Mehmet Oz introduces a series of segments scheduled to run on his daytime television program Tuesday. His quarry: those for-profit clinics offering supposed stem cell treatments for an implausible host of diseases — unproven, unlikely and very expensive cures. (Michael Hiltzik, 2/13)