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The night his administration’s Affordable Care Act passed in 2010, President Obama described the victory the way he hopes historians will: as a “stone firmly laid in the foundation of the American dream.” But Mr. Obama’s prospects for a legacy of expanding health care coverage in the United States for generations have never seemed as uncertain as they do today. The Supreme Court is expected to rule by the end of the month on a critical provision of the Affordable Care Act — insurance subsidies for millions of Americans — and even Mr. Obama’s closest allies say that a decision to invalidate the subsidies would mean years of logistical and political chaos. (Shear, 6/23)

The Supreme Court is expected to issue a ruling in the next week that could have serious consequences for millions of people who have received subsidized health coverage through the president’s health care law. The high-stakes case of King v. Burwell centers on whether language in the Affordable Care Act provides health care subsidies to people who signed up for coverage on the federal exchange, HealthCare.gov. (Ehley, 6/22)

The case the justices are mulling, King v. Burwell, poses a legal challenge to the tax credits offered to consumers in 34 states who bought health insurance through the Affordable Care Act's (ACA) federally run exchanges. About 6 million people in those states who used the government program to buy insurance could lose their subsidies if the High Court agrees that the law's wording -- "established by the state" -- limits federal assistance only to those states running their own exchanges. For opponents to Obamacare, meanwhile, the ruling likely represents the final chance to challenge the 2010 law. (Picchi, 6/23)

If U.S. states had a Facebook setting for Obamacare status, it would say: "It's complicated." This month, that might change to: "It's very, very complicated." The catalyst would be a Supreme Court ruling that could—for the second time in less than two years—cause a dramatic shift in the differences between states in their uninsured rates and in the financial burden on hospitals and other medical providers from caring for the uninsured. (Mangan, 6/22)

The Supreme Court sure knows how to put an eager audience on edge. ... As in prior years, it looks like the court is saving the best for last. Cases still outstanding include those dealing with the legality of Obama administration health insurance subsidies under the Affordable Care Act, same-sex marriage and EPA regulations on power plant emissions. ... Seven cases remain in total, and the court is scheduled to decide them no later than next week. ... Court watchers are also speculating on which justice may be writing the majority opinion in the blockbuster health-care case on the legality of insurance subsidies received by more than 6 million Americans. Three justices representing a range of ideological leanings haven’t written opinions from the session in which the health-care case was considered: Chief Justice Roberts, Justice Anthony Kennedy and Justice Ruth Bader Ginsburg. (Kendall, 6/22)

Another much-anticipated decision will be whether the Obama administration may continue to subsidize health insurance for low- and middle-income people who buy coverage in the 36 states that failed to establish an official insurance exchange of their own and instead use a federally run version. If the court rules against the Obama administration, about 8.6 million people could lose their subsidies under the Affordable Care Act. In all, the court will hand down more than two dozen decisions on matters invovling politics, civil rights, free speech and air pollution. Several of these cases have been pending for months, suggesting the justices have been sharply split. (Savage, 6/22)

The right of same-sex couples to marry and the ability of low- and middle-income Americans to receive subsidies to help them afford insurance under the health care overhaul are the two biggest cases among the seven still to be decided by the Supreme Court. The justices will meet again Thursday to hand down more opinions and almost always finish their work by the end of June. (6/22)

The U.S. Supreme Court on Monday did not issue rulings in its two most closely watched cases -- gay marriage and a challenge to President Barack Obama's healthcare law -- and the justices will next release decisions on Thursday. With the rulings due by the end of the month, the court also scheduled sessions on Friday and next Monday to issue decisions. (6/23)

Barbara Butler takes home $250 a week for driving a school bus with blind children to a Catholic day school part time. Her health insurance premiums are $517 a month. She pays 76 cents, and Washington picks up the rest. The Supreme Court is expected to rule within a week on whether that subsidy, a key part of President Obama's health-care law, is legal in 34 states. If it decides not, then the West Philadelphia resident's premiums would swell to half her income. (Sapatkin, 6/22)

Kay Arthur moved to Dublin from West Virginia to become the full-time caregiver to her 91-year-old mother. After her husband’s death in October 2012, Arthur briefly retained health insurance through his employer. But when that coverage ended, a pre-existing health condition threw up hurdles to finding a new health plan. So she turned to the new federally run health-insurance marketplace and found a policy with a $2,500 deductible. A $182-per-month tax credit made her premium more affordable. Arthur, 63, is one of more than 161,000 Ohioans at risk of losing tax credits worth more than $41 million per month. Sometime in the next two weeks, the U.S. Supreme Court could strike down those subsidies flowing to 6.4 million people in Ohio and 33 other states that refused to establish their own marketplaces — known as exchanges. (Sutherly and Torry, 6/22)

The share of poor Americans who were uninsured declined substantially in 2014, according to the first full year of federal data since the Affordable Care Act extended coverage to millions of Americans last year. The drop was largely in line with earlier findings by private polling companies such as Gallup, but was significant because of its source — the National Health Interview Survey, a long-running federal survey considered to be a gold standard by researchers. The findings are being released on Tuesday. (Taversnise, 6/23)

Millions of people gained health insurance last year as Affordable Care Act benefits took effect, according to the first official accounting by the federal government. In 2014, 36 million U.S. residents, or 11.5 percent of the population, were uninsured on the day they were surveyed, a decline of 8.8 million people and 2.9 percentage points from the year before, according to the Centers for Disease Control and Prevention's National Health Interview Survey. The Affordable Care Act remains unpopular, and is besieged politically and legally. The Republican-controlled Congress continues efforts to unwind the law, GOP presidential hopefuls vow to shepherd its repeal and the Supreme Court is poised to rule on a lawsuit conceived by conservative and libertarian activists that would undo much of Obamacare's expansion of health coverage. (Young, 6/23)

The share of working-age people without health insurance fell by more than 4 percentage points in 2014, the biggest drop since the U.S. Centers for Disease Control and Prevention began reporting the data in 1997. Last year, 16.3 percent of adults under age 65, or about 31.7 million people, lacked medical coverage, according to a CDC survey published Tuesday. That’s down from 20.4 percent a year earlier. (Burger, 6/23)

Only a dozen or so insurers still sell policies covering it, but one thing hasn't changed: Long-term care is still extraordinarily expensive. The median outlay for a private room in a nursing home was $240 a day ($87,600 a year) in 2014, more than twice the average household income of seniors. And consumers are reluctant to buy the insurance, according to a 2015 study by Wharton School professors Olivia Mitchell and Daniel Gottlieb. (Arvedlund, 6/22)

The Affordable Care Act isn’t popular with many in Republican Rep. Bradley Byrne’s district on the Gulf Coast of Alabama. If the Supreme Court strikes down crucial tax credits to subsidize insurance costs here and in many other states, constituents like Ann Lanier want Mr. Byrne to take additional steps toward dismantling the law. “Are Republicans doing anything?” Mrs. Lanier, a 58-year-old retiree from nearby Fairhope, asked Mr. Byrne at a recent town-hall meeting. (Peterson and Radnofsky, 6/22)

Republicans for months have been planning to use a fast-track budget procedure to extend Obamacare subsidies if the Supreme Court strikes them down — all while completely gutting the underlying law. But just days before the court’s ruling, the party is still grappling with the question of how much of the law to repeal, in part because of its exorbitant cost. (Bade, 6/23)

Congressional Republicans want to strip the Federal Trade Commission of some powers to block mergers with legislation that has strong support from the American Hospital Association. The Republican control of the Senate in the current Congress may put them closer to their goal. Rep. Blake Farenthold, R-Texas, has introduced a bill (HR 2745) that would require the FTC to face the same judicial standard as the Justice Department to block a merger deemed anti-competitive. The FTC has a lower burden. (Chamseddine, 6/22)

The House Appropriations Committee's fiscal 2016 Agriculture spending bill includes a provision that could allow companies to continue selling e-cigarettes and some tobacco products by limiting the Food and Drug Administration’s ability to regulate the products. Public health groups say the provision would undermine efforts to stop teenagers and younger children from smoking. (Ferguson, 6/22)

Scientists who have devoted years developing medicines to cure disease are now working for tobacco companies to make e-cigarettes. Philip Morris International Inc has hired more than 400 scientists and technical staff at its research facility in Neuchatel, Switzerland, including toxicologists, chemists, biologists, biostatisticians and regulatory affairs experts. (Clarke, 6/23)

Health insurer Anthem Inc. pressed ahead with its pursuit of a $54-billion merger with Cigna Corp. despite a spurned bid and increasing concerns about industry consolidation. Joseph Swedish, Anthem's chief executive, went on the offensive Monday trying to rally support for his takeover offer among Cigna shareholders and put pressure on the company's board, which rejected his $184-a-share offer over the weekend. He also took on critics of health insurance consolidation who fear it will lead to higher premiums and less choice. (Terhune, 6/22)

Cigna is apparently playing pretty hard to get. Anthem should be careful in how it goes about trying to seal a deal. Anthem, the second largest U.S. health insurer by membership, proposed to buy Cigna, the nation’s fourth-largest, for more than $47 billion. Cigna rejected the overture on Sunday. Anthem, though, is evidently determined. (Grant, 6/22)

Anthem sees its more than $47 billion bid to buy rival Cigna as a way to muscle up on technology that helps consumers and to strengthen its rapidly growing Medicare Advantage business. Leaders of the Blue Cross-Blue Shield insurer reaffirmed on Monday their commitment to getting a deal done a day after Cigna shot down the idea in a letter delivered to Anthem's board. (Murphy, 6/22)

U.S. health insurer Anthem Inc on Monday dismissed concerns that buying smaller competitor Cigna Corp would be considered anti-competitive, even as antitrust experts said the combination would earn regulatory scrutiny. Any merger could require asset sales and would be complicated by potential deals among other insurers, which after years of change due to President Barack Obama's healthcare reform are now scrambling to tie up. (Humer and Bartz, 6/22)

Health insurance giant Anthem (ANTM) on Monday reiterated support for its $47.4 billion cash and stock takeover bid for Cigna (CI), undeterred by the smaller rival's rejection of the latest offer. Indianapolis-based Anthem also tried to build Cigna shareholder support for the proposed transaction, webcasting a conference call with Wall Street analysts to discuss the deal terms. (McCoy, 6/22)

Humana Inc. shareholders have the most to lose if the health insurer gets spit out of the tide of consolidation sweeping the industry. Speculated as the likeliest target among the top five U.S. managed-care providers, Humana could be left to fend for itself -- or forced to take a lower offer than it might like -- if potential suitors merge with each other instead. Anthem Inc. had weighed a bid for Humana, but on Saturday announced a $47 billion proposal for Cigna Corp. While Cigna rejected the $184-a-share cash and stock offer, Anthem reiterated it on Monday. (Sutherland, 6/22)

The average consumer should catch a price break if major health insurers like Anthem and Cigna combine and cut their expenses. That’s the basic theory, at least. The reality will be much murkier for the more than 50 million people who may be affected if Anthem Inc. succeeds with its bid to buy smaller rival Cigna Corp. or if other major insurers combine as many on Wall Street anticipate. (Murphy, 6/22)

Some doctors are nervous about the mergers leading to just a handful of powerful health insurance companies. The American Academy of Family Physicians has already reached out to the Federal Trade Commission to express concerns. In a letter to FTC chairwoman Edith Ramirez, the AAFP wrote that "mergers in the health insurance industry would have an immediate and profound negative impact on the availability and affordability of health insurance for millions of consumers." The organization's chief worry? Bigger insurers will have more clout. They could raise premiums and reduce the number of doctors and hospitals that are part of network coverage plans. (LaMonica, 6/22)

The nation’s largest health insurance company is leaving America’s Health Insurance Plans, the industry’s powerful trade organization. UnitedHealth Group will leave AHIP at the end of the month, the company told POLITICO on Monday. (Haberkorn, 6/22)

The pushback against soaring cancer drug prices is gaining steam. A leading doctors group on Monday proposed a formula to help patients decide if a medicine is worth it — what it will cost them and how much good it is likely to do. The move by the American Society of Clinical Oncology is the third recent effort to focus on value in cancer care. Two weeks ago, the European Society for Medical Oncology proposed a similar guide. Last week, Memorial Sloan Kettering Cancer Center in New York posted an online tool suggesting a drug's fair price, based on benefits and side effects. (6/22)

A leading oncology group has developed a formula designed to help doctors and patients weigh the value of cancer treatments, in the latest example of rising concern over the price of new drugs. The American Society of Clinical Oncology published Monday a template for assessing new treatments based on the benefits and side effects seen in clinical trials and on the cost for individual patients. The formula is an initial step toward producing software-based tools that doctors and patients can use in deciding among treatment options for the disease, ASCO said. (Winslow, 6/22)

In a bid to inject clarity into the fast-moving, high-stakes world of cancer drugs, a task force of cancer doctors announced Monday that it has devised a decision-making aid to help physicians and their patients weigh the pluses and minuses of newly available options for treating malignancy, including their costs. In a trial run of the proposed system, which distills a single "net health benefit" number for cancer drugs, several costly new medications fared poorly. Others, despite high costs, appeared to offer major returns for patients with few effective options. (Healy, 6/22)

The mood at a White House Rose Garden reception with President Barack Obama on April 22 was jovial. Advocates celebrated the signing a week earlier of a Medicare law that included two years of continued federal funding for the Children’s Health Insurance Program along with a little-discussed but dramatic boost in aid to states. Starting in October, states will get a 23-percentage-point increase in the share of the coverage costs that the federal government will pick up. ...[But] advocates say that the $5.6 billion net increase for CHIP for the next 11 years won’t do much to expand coverage for kids. That’s largely because states are free to use the money they save as they see fit. (Adams, 6/22)

Carl Buher was a 14-year-old in Mount Vernon in 2003, when the high-school freshman was hit with a sudden illness: high fever, pounding headache, disorientation and purple splotches over his face and arms. Within a day, he’d been diagnosed with bacterial meningitis, a rare and fast-moving infection, and flown by helicopter to Seattle Children’s for lifesaving antibiotics. ... Within months, he had lost three fingers and both legs below the knee, amputations forced by the ravages of the disease. ... On Wednesday, the CDC’s Advisory Committee on Immunization Practices (ACIP), which sets U.S. standards, is expected to decide whether a new vaccine to prevent meningitis strain B — the type Buher contracted — should get the nod for widespread use.(Aleccia, 6/22)

Iraq war veteran Doug Mercer had been home in McAlester, Oklahoma, for just four days when he was in a motorcycle accident that left him broken and brain-damaged. His wife Michelle became his caregiver after he left the hospital, but nobody there explained how to transport him safely. A few weeks later, Michelle struggled as she tried to get Doug from the car to his wheelchair, breaking his leg. The Mercers’ story was a driving force behind an Oklahoma law that took effect in November that requires hospitals to train a designated family caregiver to tend to the medical needs of a released patient. Since then, 12 more states (Arkansas, Colorado, Connecticut, Indiana, Mississippi, New Hampshire, New Jersey, New Mexico, Nevada, Oregon, Virginia and West Virginia) have approved similar laws. In Illinois and New York, legislation is awaiting the governor’s signature. (Milligan, 6/22)

NATO leaders are working with a telemedicine hub in southeast South Dakota to develop a multinational system that could deliver medical services remotely during natural or manmade disasters. Representatives from NATO nations, including Romania, the United Kingdom and the U.S., are visiting Avera Health's telemedicine center in Sioux Falls this week to look at the technology and equipment options available to provide health care services from distant locations. The goal of the NATO-funded research project is to increase survival rates in emergency situations, when immediate access to medical specialists is not always possible. (Cano, 6/22)

The idea sounds simple, right? Spend $100 for a week’s worth of meals as a way to head off the repeated trips to the hospital that can run $6,000 to $10,000 a visit. Save a lot of healthcare by spending a little bit more on social services. But here’s the problem: Doctors don’t know who is going to end up in the hospital. (Gorenstein, 6/22)

A federal judge who ordered the government to return $90 million in Medicaid funds it was mistakenly credited by Georgia's health department has reduced the figure to $75 million, finding that the remainder of the claim was time-barred. U.S. District Judge Gladys Kessler of the District of Columbia ruled on Monday that Georgia could collect only the money it had actually paid to the federal government. The remaining $15 million was federal funding that Georgia would otherwise have received, but instead used to offset the $90 million credit. (Pierson, 6/22)

A split among African American leaders on the issue of government-required vaccination has roiled the Capitol as lawmakers consider whether to eliminate most exemptions to state immunization laws. A leader of the Nation of Islam has warned African American lawmakers of political repercussions if they support a bill that would require many more children to be vaccinated. A coalition of other black organizations on Monday countered that message with support for the measure. (McGreevy, 6/22)

Mississippi’s attorney general says the nation’s largest tobacco company will pay the state $15 million to settle claims that it was underreporting the number of cigarettes it was shipping to the state. On Monday, Attorney General Jim Hood announced the settlement with Reynolds American of Winston-Salem, North Carolina. Reynolds American succeeded two companies that Mississippi raised claims against - R.J. Reynolds and Brown & Williamson. (Amy, 6/22)

Planned Parenthood has launched mobile apps that let users in California, Minnesota and Washington state request a home lab kits that tests for two of the most common sexually transmitted diseases. Residents of those states can download Planned Parenthood Direct through Apple or Android app stores and order a kit to test for chlamydia and gonorrhea. Downloading the app is free, but the test kit costs $149; users pay through the app with a credit or debit card. (Gaitan, 6/22)

The medical director of a northwest Louisiana abortion clinic testified Monday that it probably would close if the state is allowed to enforce a law requiring doctors who perform the procedure to be able to admit patients to a hospital within 30 miles of their clinics. (McConnaughey, 6/22)

Indiana’s top health official, Jerome Adams, says he understands the backlash that often greets proposals for needle-exchange programs, even though most public health experts say they are key to stopping disease outbreaks related to a nationwide surge of opioid abuse. “As the brother of someone who suffers from addiction, I would be insulted if someone just tried to hand him a needle,” Adams tells CQ. Adams’ experience pleading alongside his parents and siblings in court to get their brother treatment, and growing up in rural southeast Maryland where poverty and drug abuse were the norm, influenced his handling of public health challenges since being appointed Indiana State Health Commissioner last October. (Evans, 6/22)

Each year in Jacksonville, a nonprofit called JASMYN hosts a prom for LGBT youth. Kourtnee Armanii Davinnie was crowned this year’s prom queen. She’s scared of horses, but loves unicorns. And she sometimes snaps when she talks. Davinnie is a trangender teen, just 18-years-old. Davinnie is not the name she was given at birth, it’s the name she’s chosen as a woman. This day, Davinnie wore a navy blue dress, gold wedge sandals and gold tone eyeshadow. On her wrist, a black wristband says “SPEAK OUT.” It’s part of a campaign to get people talking about HIV. Davinnie was underage when she got into treatment. She hadn’t told her parents, and JASMYN shuttled from appointment to appointment. That kind of support and access to care is critical. About 1,000 youth a year are diagnosed with HIV in the United States, according to the U.S. Centers for Disease Control and Prevention . In Florida, roughly 15 percent of all new HIV infections happen to people who haven’t hit their 25th birthday. (Aboraya, 6/22)

If you're talking about older people and sex, you have to talk to Kate GeMeiner. "I'm also known as Doctor Truth, the Condom Lady," the 85-year-old says. GeMeiner lives in Broward County, and spends a lot of her time at senior centers, nursing homes and assisted living facilities. "And I ask the seniors: How old do you think you are when you stop thinking about sex? And they all say, when you're dead,” she says with a laugh. “Or they'll say things like when the casket is closed or something like that." (Watts, 6/21)

Massachusetts Governor Charlie Baker unveiled a $27 million plan on Monday to increase the state's capacity to treat drug addicts and reduce the stigma around addiction, as the United States battles a surge in heroin and opioid use. Heroin overdose deaths in the United States tripled from 2010 to 2013, according to a study by researchers at the U.S. Centers for Disease Control and Prevention, with most users turning to heroin after first using prescription opioids. (Tempera, 6/22)

As the report was being drafted, the state was moving on a parallel track to require changes to the Youth Welcome Center for children 12 and older and the Children's Welcome Center for younger youths, requiring the county to come up with solutions to care for this particularly challenging population. The two centers, the only foster care facilities that turn no child away, are on the campus of Los Angeles County-USC Medical Center. Together they serve hundreds of children and teens each year as they wait to be placed in increasingly scarce foster homes. Most young people at the Youth Welcome Center are older teenagers. Many have some type of mental illness or medical issue. Some are gay, lesbian, bisexual or transgender. Most have been thrown out of multiple foster homes. (Therolf, 6/22)

But the real question about King (if the challengers win) isn’t about which party gets the blame for chaos in Republican-state insurance markets. It’s whether important groups in those states pressure their politicians to do something about it. If sufficient pressure is applied, the likely outcome is that subsidies are restored, full stop. ... All in all, if the King plaintiffs win in the Supreme Court, don’t pay attention to Democratic or Republican spin. The whole ballgame will be whether people whom Republican politicians care about demand action if subsidies dry up. (Jonathan Bernstein, 6/22)

Regardless of how the Supreme Court decides this month on King v. Burwell, which challenges the legality of the administration’s decision to allow private insurance subsidies in federally run exchanges, what the episode reveals, yet again, is the Republican party’s historic failure to truly engage with the difficult realities and trade-offs of health policy—and how that failure has crippled the party’s ability to respond even when faced with events like big Supreme Court decisions that should force them to come up with an actual plan. (Peter Suderman, 6/22)

The gender gap in retirement income security happens because women are marrying less and working more but still being paid less than men. In 2013, the most recent year for which these data are available, women earned 82% of the median earnings of full-time male workers. Lower earnings lead, on average, to lower Social Security payments, retirement savings, and pensions. Lower savings are a particular concern for older women, who tend to live longer than men and need to stretch savings further to cover expenses as they age. Social Security, Medicare, and often Medicaid are fundamental to their retirement security. Issues like Social Security and Medicare are seldom regarded as “women’s issues,” and they are not women’s issues alone. But they are central to the economic security of a growing population of economically disadvantaged older women. (Drew Altman, 6/23)

The Supreme Court will soon decide King v. Burwell, the case that will determine whether tax credits being paid in at least 34 states without their own exchanges are legal. If the Supreme Court makes the administration follow the letter of the law, billions of dollars of federal tax credits will continue to flow to 16 states, but not the rest. This will result in a political crisis giving Congress and President Obama the opportunity to fix the worst aspects of Obamacare. Here is one suggestion: Remove Obamacare’s rule forbidding accurate premiums by age. ... instead of reducing premiums for older applicants, the rule dramatically increases premiums for younger ones. (John Graham, 6/22)

People who have health insurance have less health-related financial stress. That’s a not-so surprising finding from a recent survey from the Centers for Disease Control and Prevention. There’s good reason to expect the Affordable Care Act to reduce financial strain. Exposure to health care costs fell for those who gained coverage, as it has for those whose coverage became more generous, too. (Austin Frakt, 6/22)

The report, which was prepared at the request of Senate Budget Committee Chairman Mike Enzi (R-WY), concluded that eliminating Obamacare would definitely, unambiguously and undeniably (Get the picture?) increase the deficit. This is directly contrary to what Republicans have been saying since the law was enacted and should be a body blow to their insistence the law was a mistake and should be repealed. ... It’s difficult to find a silver lining in the report for congressional Republicans. They’ve tried. (Stan Collender, 6/22)

Our nation’s spending on health care is 17 percent of the gross domestic product, while other developed countries typically spend only 9-10 percent and achieve similar patient outcomes. We spend an estimated $2,600 more per capita on healthcare than the next most expensive nation, Norway. Despite our higher spending, Norway has more doctors and beds per 1,000 and a higher life expectancy. Adjusting for population size, the U.S. spends roughly $835 billion more on health care than Norway per year. (Howard Peterson, 6/22)

President Obama signed the Affordable Care Act more than five years ago. At the time, members of the health care industry — hospitals, doctors and insurers — were anxious about what it would do to the business. Everyone had an opinion, but nobody knew for sure. We’re now beginning to see the answer: consolidation on a huge scale. Just in the last couple of weeks, the nation’s five largest health insurers began a round robin of merger talks — some still semiprivate, others now out in the open — that could whittle their number to three. Anthem made a bid for Cigna; Aetna approached Humana; and the UnitedHealth Group made overtures to Aetna. (Andrew Ross Sorkin, 6/22)

Efforts to improve quality while reducing cost in health care are changing the way we pay doctors and provide care for our seniors. After decades of "fee-for-service" payments -- meaning payments for individual visits and tests -- there is now a determined effort to reward "value-based care." The idea is that we should be rewarding quality care that improves health -- not just episodes of service. After years of debate, Congress and the Obama administration have taken important action to drive this positive change for seniors and for all Americans. And Medicare, the nation's largest health-care program, is at the center of this transformation. (Allyson Y. Schwartz, 6/22)

The United States spends $3 trillion annually on health care — much of it funded by taxpayers through programs such as Medicare — yet only a limited amount of information exists about what treatments work best for which patients. ... The good news is that the federal government is now making a significant investment in health services and patient-centered outcomes research to identify waste and improve the safety, effectiveness and quality of care. The bad news is that House Republicans are trying to abolish one of the main agencies carrying out this research, the Agency for Healthcare Research and Quality (AHRQ), and cut the funding of another, the Patient-Centered Outcomes Research Institute (PCORI). The puzzle is why. (Eric Patashnik, 6/22)

As the Obama administration’s push to require employers to provide paid sick leave languishes in Congress, a number of states and localities have acted. In most cases, the local measures have sensibly set the bar somewhat higher for big corporations than for small businesses. Montgomery County would be wise to adopt a similar approach. (6/22)

A shared goal of all health professionals is to relieve suffering and prolong life. At times these goals are at odds, particularly in oncology care. Patients with severe disease and low chance of survival may be offered therapies in the hope of buying a few more weeks or even months. However, the treatments themselves are often toxic, with many unpleasant adverse effects .... It is a difficult choice: extend life, or offer higher quality of life at home. Or is it? This choice assumes that the drugs really do extend life. (Rita F. Redberg, 6/22)

The system by which the US Food and Drug Administration engages in medical device postmarket safety surveillance needs strengthening. ... While [current] efforts have successfully detected potential safety issues and contributed to reassessments of the benefits and risks, these systems are likely to identify only a small proportion of the totality of adverse events that occur. (Joseph S. Ross, 6/22)

Personalized or precision medicine maintains that medical care and public health will be radically transformed by prevention and treatment programs more closely targeted to the individual patient. ... Even though personalized medicine will be useful to better understand rare diseases and identify novel therapeutic targets for some conditions, the promise of improved risk prediction, behavior change, lower costs, and gains in public health for common diseases seem unrealistic. Proponents of personalized medicine should consider tempering their narrative of transformative change and instead communicate a more realistic set of expectations to the public. (Michael J. Joyner and Nigel Paneth, 6/22)