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Acknowledging at least tacitly the difficulties of some health care consumers, the Obama administration plans major changes to HealthCare.gov this year to make it easier for shoppers to find health insurance plans that include their doctors and to predict their health care costs for the coming year. With substantial premium increases coming in some states in 2016, administration officials are expecting that many consumers already in the Affordable Care Act’s networks will have to switch health plans and find new doctors as they scramble for cheaper alternatives. (Pear, 10/12)

Nearly half of the 32.3 million Americans without health insurance are eligible for Medicaid or federally-subsidized marketplace coverage, according to a new analysis by the Kaiser Family Foundation. And of these 15.7 million uninsured Americans eligible for assistance, roughly 40 percent reside in just five states: California, Texas, Florida, New York and Pennsylvania. (Pugh, 10/12)

In advance of the Nov. 1 start of open enrollment for Covered California, new numbers show that just over half of the state’s remaining uninsured are eligible for health insurance coverage under the Affordable Care Act. The estimate was part of a state-by-state analysis compiled by the Kaiser Family Foundation. (Aliferis, 10/13)

The pending demise of Health Republic, the largest of the nonprofit cooperatives created under the Affordable Care Act and the only co-op in New York, removes a significant player from the state’s insurance industry. It also left the insurers’ 215,000 members, about half of whom are individuals and half are insured through small businesses, in need of new coverage. Individual Health Republic plans will end on Dec. 31, and small-group plans end as early as Oct. 31, although some will continue into next year. (Ramey, 10/12)

The federal government is increasing its scrutiny of a cooperative in Westerville that was set up to help ensure a lower-cost option for Ohioans who shop the federally run health-insurance marketplace. The health-insurance cooperative, which does business as InHealth Mutual, is now under “enhanced oversight,” having reported a net loss of $9.1 million through the first six months of this year. (Sutherly, 10/13)

Health insurers selling individual policies on Montana’s “marketplace” will be shorted millions of dollars in federal payments this year, thanks to an Obama administration decision unveiled this month. But two of the three insurance firms say it shouldn’t hurt their financial position too much. “This hurts us and it hurts a lot of (health) co-ops, but because of the way we’ve managed our costs, we’re still in good financial shape,” said Jerry Dworak, CEO of the Montana Health Co-op. ... The Co-op, which insures 23,000 people in Montana and another 20,000 people in Idaho, had expected about $6 million this year in federal “risk-corridor” payments to help offset losses for 2014, its first year of operation. ... But 10 days ago, federal officials announced the government would cover only 12.6 percent of the requested payments. That means the co-op gets only $800,000. (Dennison, 10/12)

House Republicans are expected to pull the plug Tuesday afternoon on the latest attempt to expand health coverage to tens of thousands of low-income Utahns, with one representative anticipating the supporters of the expansion plan could be counted on both hands. Republicans in the House are scheduled to meet in a closed-door caucus to determine whether there is enough support to warrant a special session later this month. ... Utah Access Plus was the product of months of negotiations between legislative leaders and Gov. Gary Herbert. It calls on health care providers ­— doctors, hospitals, pharmaceutical companies and others — to pay about $50 million to bring in $450 million of federal matching funds in order to subsidize health coverage for about 95,000 of Utah's poor. (Gehrke, 10/12)

Gov. Gary Herbert said he's optimistic his efforts to expand Medicaid in Utah won't end when House Republicans meet behind closed doors Tuesday to take a straw vote on the latest proposal. "I expect they're going to try to negotiate some kind of alternative. What they've got on the table right now may not be acceptable, but there's more than one — or two or three — ways to skin the cat," the governor told reporters Monday. (Romboy and Riley Roche, 10/12)

For more than three years, state elected officials have debated if and how they'll insure thousands of Utah's poor by expanding Medicaid, but top officials aren't sure if that effort will survive a closed-door vote Tuesday by conservatives in Utah's House of Representatives. If there isn't enough support, legislative leaders and Herbert's office won't predict if they'll still consider the issue in a special session or if they'll walk away from the issue entirely. (Price, 10/12)

The conservative group Americans for Prosperity (AFP) is stepping up its attacks on ObamaCare’s Medicaid expansion as the decision-making enters a key phase in Utah. AFP, backed by conservative donors Charles and David Koch, is launching new mail pieces sent to the constituents of roughly a dozen key Utah state lawmakers. (Sullivan, 10/12)

You can save hundreds or even thousands of dollars by doing some smart shopping for your health care coverage under Medicare. During Medicare's open-enrollment period, which begins on Oct. 15 and ends on Dec. 7, you have the opportunity to make changes in your plan for 2016. Many people don't bother to shop for a plan and automatically re-enroll in their current one, but doing so might cost you an opportunity to save money next year. (Vernon, 10/13)

As you choose benefits during open enrollment, it's worth checking up on the coverage in your dental plan. Dental insurance is usually cheap. The most popular kind of group plan costs just $32 a month, on average, and three-fourths of employers help pay the tab, according to the National Association of Dental Plans (NADP). That cuts the average employee premium down to about half the original cost -- or even less. But you get what you pay for. The coverage is awful. Still, if your employer subsidizes your coverage, you probably should take it, says Evelyn Ireland, executive director of the NADP. The plan likely covers routine care, such as cleanings and exams every six months, and most of the cost of basic procedures, such as filling a cavity. (Cross, 10/13)

Republican presidential candidate Jeb Bush on Monday proposed repealing and replacing President Barack Obama's health care law with one that would increase tax credits for individuals, allowing them to buy coverage protection against "high-cost medical events." But the two-page proposal, which would give more power to states to regulate health insurance, contained no specific details on how many people could be left without coverage. (Bustos, 10/13)

Republican presidential candidate Jeb Bush is hitting familiar GOP themes by vowing to repeal the Affordable Care Act and pledging to give states and individuals a greater role in establishing its replacement. Mr. Bush, in broad proposals released late Monday, didn’t say how he would go about overturning the 2010 federal health-care law—large portions of which have been in effect for years. The former Florida governor said he would leave states in charge of overseeing a “transition plan” for as many as 17 million people who currently get coverage under the law, with limited federal funding to carry out their plans. (Radnofsky and Reinhard, 10/12)

Jeb Bush will reach back to his own legacy as Florida governor on Tuesday to unveil his vision for replacing Obamacare, showcasing what he calls state-tested ideas for bringing down health care costs and revamping health coverage for the poor. But Democrats are ready to make the case that his record in Florida is nothing to emulate — that in particular, his changes to Medicaid harmed Florida’s poorer residents, something that could make him vulnerable in the general election if he becomes the GOP presidential nominee. (Cook and Sexton, 10/12)

Ahead of the Republican hopeful's Tuesday morning speech at the New Hampshire Institute of Politics, Bush's campaign said his plan would accomplish three things: "promote innovation," "lower costs" and "return power to states." Bush's plan would "provide a tax credit for the purchase of affordable, portable health plans that protect Americans from high-cost medical events," according to his campaign, and it would "increase contribution limits and uses for Health Savings Accounts to help with out of-pocket costs." The campaign did not provide more details about the credit or what the new contribution caps would be. (Sullivan, 10/12)

By offering the latest in a series of policy proposals, the former Florida governor is seeking to position himself as the most substantive of the 15 candidates in the race for the Republican presidential nomination. (10/12)

Bush doesn't favor doing away with everything from the current law. He supports the continuous coverage guarantee provision for people with pre-existing conditions, and previously Bush has said he favors allowing kids to stay on their parents' insurance plans until the age of 26. (Killough and Luhby, 10/12)

There are still big differences between Clinton and Sanders, and they’ll come into focus during the candidate forum. Sanders wants to break up the big banks, while Clinton would penalize bankers who violate the law. He would also raise the minimum wage higher than she would, to $15 an hour, and expand health care coverage through a major Medicare expansion. She says she wants to improve the Affordable Care Act. Clinton also voted for the Iraq War as a senator, while Sanders opposed it while in the House. Yet Clinton’s greatest challenge is probably not on any specific issue. Rather, she'll need to convince Democratic voters that her recent leftward drift is genuine and not just political opportunism amid the heat of a primary battle. (Przybyla, 10/13)

U.S. prices for the world's 20 top-selling medicines are, on average, three times higher than in Britain, according to an analysis carried out for Reuters. The finding underscores a transatlantic gulf between the price of treatments for a range of diseases and follows demands for lower drug costs in America from industry critics such as Democratic presidential candidate Hillary Clinton. (10/12)

In 2012 when Mitt Romney picked Mr. Ryan, Republican of Wisconsin, as his running mate, the concern among some in their party was that Mr. Ryan was too conservative, particularly when it came to overhauling social programs like Medicare and Medicaid. Now, as he agonizes over whether to answer the appeal of his colleagues to become their next speaker, the far right is trotting out a fresh concern: Mr. Ryan is too far left. ... The conservative rap on Mr. Ryan’s fiscal positions is especially curious. As Budget Committee chairman, Mr. Ryan was the author of plans that would convert Medicare into something akin to a voucher plan, where seniors would get government subsidies to purchase private insurance and move away from government-run health care. He also wanted to turn Medicaid into increasingly tight block grants to state governments, and he also called for drastic cuts in food stamps, Pell grants and many other domestic programs. (Steinhauer, 10/12)

When it comes to loved ones with mental health problems, U.S. Sen. John Cornyn says, families have traditionally faced two troublesome options: do nothing or institutionalize their relatives. And as a result, families don’t have the tools to help provide the treatment needed, Cornyn said Monday in Austin, as he promoted federal legislation that would require mental health checks before denying anyone the ability to purchase firearms. (Silver, 10/12)

A new front is emerging in the war on the overuse of antibiotics: the nursing home. Health officials and health-care executives, concerned by a rise in dangerous drug-resistant infections, are turning more attention to nursing homes, where antibiotics are some of the most frequently prescribed medications. They have concentrated over the past several years on curbing misuse of antibiotics in hospitals. (McKay, 10/12)

Patients who are having a heart attack, stroke or other serious health emergency have a greater chance of surviving if they're taken to the hospital in a basic life-support ambulance rather than one loaded with sophisticated equipment, according to a study released Monday. (Sun, 10/13)

A multimillion-dollar IT project for the North Dakota Department of Human Services successfully went live this week with the question now being how much it improves services for residents. The Medicaid Management Information System project was up and running on Monday following a two-month transition period away from a more than 35-year-old system. The project went live after a series of delays and changes in scope. (Smith, 10/12)

Texas was within eight days of slashing the amount of money it pays therapists for poor and disabled children when a state district judge last month stepped in and blocked the move. It was the latest round in a high-profile legal and public relations battle that has ensued since lawmakers ordered a roughly 25 percent cut in Medicaid funding for pediatric therapy services. The conflict has mostly been cast as a battle between government budget ax wielders and helpless children, and the cuts are now in limbo at least until a January trial date. (Walters, 10/13)

In September 2013, the state funneled more than $270,000 of taxpayer money to True Behavioral HealthCare of Gastonia – payment for counseling and coaching mentally fragile patients. The workers who delivered that care were never paid. For five weeks, more than 50 counselors, nurses and social workers toiled without wages, refusing to leave ailing clients. But when it came to protecting the caregivers, the state failed. Year after year, some private companies dependent on Medicaid funding don’t pay their employees. Mental health agencies, home health care companies and group homes accounted for more unresolved wage payment cases than any other single industry in North Carolina in fiscal year 2014, a News & Observer review of cases shows. (Locke, 10/12)

Depending on who you ask, the decision by its parent company to scale back the services at Windham Hospital was a prudent one that will help preserve the financially struggling facility, or it was a troubling sign of the need for better state oversight to ensure that communities don’t lose access to care. And to one key lawmaker, that’s a sign of the debates that are likely to become more common as more Connecticut hospitals join larger systems, raising the possibility that parent companies will seek to consolidate services rather than offering every type of care at each hospital in their network. (Levin Becker, 10/13)

Missouri hospitals have seen a drastic increase in prescription painkiller abuse over the past decade. According to a study from the Missouri Hospital Association, the rate of hospitalization due to the abuse of prescription opioids has increased by 137 percent since 2005. The numbers localize a problem usually shown through national statistics. For instance, according to the Center for Disease Control and Prevention, 44 people die every day in the United States from prescription painkiller overdoses. (Phillips, 10/12)

Republican Gov. Mike Pence announced Monday that he will expand Indiana's affiliation with a nonprofit organization that counsels pregnant women against abortion and pushes abstinence as the only method of birth control. Pence cited the successes of a $1 million pilot program as reason for granting a new $3.5 million contract to Real Alternatives, a Pennsylvania-based charity that provides "life-affirming" counseling on everything from breastfeeding to finding maternal homes, adoption agencies and social services, according to its website. (Slodysko, 10/13)

New York Health Commissioner Howard Zucker and Secretary of State Cesar Perales joined Lt. Gov. Kathy Hochul for the visit Monday. The trip comes after Gov. Andrew Cuomo traveled to the island last month to offer New York's assistance as it deals with billions in public debt, much of it related to the state's Medicaid and Medicare programs. (10/12)

Rhonda Enzinna has discovered it’s nice to be in a room where people accept that her hurting is real. She knows that tepid “hmm” that clinicians and others express when Enzinna, 61, of Kansas City, tells them she has lived with pain since she was a girl. In chilly or windy weather, and when she touches an ice cube, her neck, limbs and joints feel as if they’re on fire. (Montgomery, 10/12)

A proposal for paid sick leave will be debated Tuesday at a Prince George’s County Council hearing that could offer a preview of the 2018 county executive’s race. The council’s planning, zoning and economic development committee is considering a bill that would require all businesses in the county to offer employees up to seven paid sick days annually — a benefit that was approved in Montgomery County earlier this year and has been touted by President Obama (D). (Hernandez, 10/13)

A non-profit health care group focused on serving low-income patients plans to expand its medical services on four extra acres of land located in one of Rock Hill’s business parks. On Monday, the Rock Hill City Council voted to sell some city-owned land on Lakeshore Parkway to Affinity Health Center, a medical office looking to expand its offerings. Affinity bills itself as providing inexpensive care and other services to address more than a patient’s medical needs. The center uses a case management system that helps patients access community resources such as housing and transportation, as well as insurance. The group fills a need for local low-income residents. The federal government estimates 65,000 low-income residents in York County need access to health care, but only about 15 percent of them are served by a community health care center or a free medical clinic. (Marchant, 10/12)

J.R. Robinson rubbed his hands together. A hollow sadness sits behind his eyes, punctuating a broken expression. "I'm struggling every day," said the 51-year-old Holland resident; a Tennessee accent filling soft, steady words. His appearance at the Holland Drop-In-Center on Sept. 29, was no easy feat. Without scheduled classes two days a week at Community Mental Health of Ottawa County, motivating himself to leave his apartment is a battle. (Biolchini, 10/12)

The state Senate's health committee is expected to vote on a pair of bills that would strip Planned Parenthood of federal funding and raise its Medicaid expenses. One measure would require the state to apply for $3.5 million in federal Title X grant money, which currently all goes to Planned Parenthood. The bill would forbid abortion providers from getting any of that money and instead give it to the state's Well Woman program that provides breast and cervical cancer screenings. The bill passed the full state Assembly in September. (10/13)

Crisis pregnancy centers that discourage women from getting abortions are suing to block a new law that would make California the first state to require them to provide information about abortions. (10/12)

Most developers in the medical-office-building business put speculative projects on hold during the recession. Now some are revisiting the idea, breaking ground on new projects without having any tenants lined up. Consider Downtown West Medical Offices, a medical-office-building project in central Los Angeles expected to be announced this week. The developers plan to build a four-story, 60,000-square-foot contemporary building consisting of primary- or specialty-care medical space that may include a pharmacy or physical-therapy facility on the ground floor. (Friedman, 10/13)

Jeb Bush on Tuesday will introduce a plan to repeal and replace the Affordable Care Act. But “replace” may not be quite the right word. The Bush plan calls for a familiar mix of conservative ideas on health care, according to campaign documents obtained by The Huffington Post. ... The Bush plan would weaken those standards on insurance: People buying coverage would have more freedom to buy less-generous policies that cover only catastrophic costs. And the tax credits that Bush would provide, by design, guarantee access only to these catastrophic policies. (Jonathan Cohn, 10/12)

Tonight, the first Democratic debate of the election season will kick off. With two GOP debates in the rearview mirror, the first of the debates on the left should offer an opportunity to see how the candidates will distinguish themselves. In particular, one issue that’s been largely absent (at least from the GOP debates beyond “repeal and replace”) is health care. In this coming debate, and in the later GOP debates, the moderators ought to seek out the candidates’ positions on a slew of health care issues. (Yevgeniy Feyman and Alex Verkhivker, 10/13)

There was a sharp drop earlier this year in the number of people enrolled in health insurance plans purchased through federal and state marketplaces established under the Affordable Care Act. That poses a big challenge for insurers, health care providers and enrollment counselors when a new open enrollment period starts on Nov. 1. (10/13)

In apparent recognition of the distinct unpopularity of the Affordable Care Act’s Cadillac tax—an excise tax on high-value, employer-provided health benefits—more than 100 economists have signed a letter defending it. As the Washington Post headline about the letter read: “101 Economists Just Signed a Love Letter to the Obamacare Provision Everyone Else Hates.” ... The reason the tax has so many opponents is its impact on American workers. It is going to force employers, who understandably do not want to pay the steep 40% levy, to reduce the benefits they offer in order to bring the costs of their plans below the ACA’s value threshold. (Tevi Troy, 10/12)

Risk corridor data released on October 1 by the administration shows that insurers lost a lot of money on Affordable Care Act (ACA) plans in 2014. The ACA established a three-year risk corridor program to transfer funds from insurers with lower-than-expected medical claims on ACA plans, i.e., profitable insurers, to insurers with higher-than-expected claims, i.e., insurers with losses. Despite administration claims that incoming payments from profitable insurers would cover losses from unprofitable ones, the risk corridor program shortfall exceeded $2.5 billion in 2014. Insurers with lower-than-anticipated claims owed about $360 million, and insurers with higher-than-anticipated claims requested about $2.9 billion from the program. Using available data, mostly from the administration, I estimate that insurance companies likely lost at least 12% on ACA plans in 2014. (Brian Blase, 10/12)

With the church-held belief that integral to the right for life is the right to basic health care, I joined with my brother Catholic Bishops in Texas to call upon Gov. Greg Abbott, Speaker Joe Straus and Lt. Gov. Dan Patrick to end a political standoff and reconsider the state's refusal to expand Medicaid coverage for an estimated 1.3 million uninsured Texans. We made this appeal guided by our belief that achieving affordable and accessible health care coverage for all stems from God's precepts about the fundamental right to life and dignity. (Bishop Brendan Cahill, 10/12)

Democrats are making a federal mandate for paid family leave part of the 2016 campaign, part of their drive to use government benefits to help voters forget seven years of stagnant incomes. The right Republican response would be to say it’s great if businesses can afford to offer leave, as thousands do. But when government mandates it, the result is often less employment and lower pay for everyone. The better solution is faster economic growth and more job openings. Instead, [Republican Sen. Marco] Rubio has countered by proposing a tax credit that offsets 25% of the cost for employers that provide at least four weeks of paid family leave. ... Sorry to say, the Floridian has fallen into a familiar trap of me-too politics. (10/12)

In recent years, medical science has uncovered the high risk and devastating effects of traumatic brain injury, or TBI, among U.S. combat soldiers and athletes, especially football and hockey players. What if a vastly greater population were also suffering these effects: women and children living with the consequences of domestic violence? (Maria E. Garay-Serratos, 10/12)