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Some 11.4 million Americans picked health plans through HealthCare.gov and state-run insurance exchanges during the official sign-up window for insurance under the federal health law, the White House said Tuesday. The announcement, made through the White House Twitter account, followed a relatively smooth enrollment period that saw few of the technological problems that hobbled the online exchanges that were launched in the fall of 2013 as part of the Affordable Care Act. (Radnofsky, 2/17)

The Obama administration signed up about 11.4 million people for health coverage during Obamacare’s second enrollment period, exceeding its modest enrollment goal with a final-day rush. The White House trumpeted the figures Tuesday evening via a video posted on social media. In it, HHS Secretary Sylvia Mathews Burwell gives President Barack Obama the preliminary estimates of who “signed up or re-enrolled” from the start of enrollment Nov. 15 to its conclusion Sunday. (Haberkorn, 2/17)

About 11.4 million Americans are now signed up for private health coverage, thanks to the Affordable Care Act, the White House said Tuesday. "We just got great news today," President Obama said in a video posted on the White House's Facebook page. "In the final day (at the original enrollment deadline Sunday) we had more consumers sign up than we have ever had," said Department of Health and Human Services Secretary Sylvia Burwell. (O'Donnell and Ungar, 2/17)

About 11.4 million Americans have signed up for private health insurance coverage through Obamacare exchanges by the official end of the law's second-ever enrollment period, the White House announced in a video Tuesday night. The announcement indicates the Obama administration will beat its own 2015 enrollment goals after a much quieter sign-up season this year. But the announcement also comes just weeks before the Supreme Court will hear a case challenging the legality of premium subsidies provided through the nearly three dozen states relying on HealthCare.gov for enrollment. (Millman, 2/17)

The White House celebrated the latest numbers as evidence of the success of the health law, which was adopted in 2010 without any Republican votes. “The Affordable Care Act is working,” Mr. Obama said. “It’s working a little bit better than we anticipated — certainly, I think, working a lot better than many of the critics talked about early on.” More than a million people selected health plans in the last nine days of the latest open enrollment period. (Pear, 2/17)

But that preliminary estimate — 11.4 million people — comes with a couple of asterisks: The final number could grow because the administration is offering a grace period for people who started applications — but couldn't finish them — before last Sunday's official deadline. They have until February 22, this coming Sunday. ... The final number could shrink if consumers who've enrolled for 2015 coverage don't follow through by paying their share of premiums. (Alonso-Zaldivar, 2/17)

President Obama trumpeted the success of his signature healthcare law on Tuesday, releasing a video on Facebook that boasted that 11.4 million people who have signed up or re-enrolled in Obamacare in 2015. ... While the number of people signed up for healthcare under the Affordable Care Act has given the White House reason to celebrate, the administration has reason to worry about whether the news will remain positive for Obamacare. With the April 15 tax deadline approaching, an estimated 6 million Americans are expected to to face a penalty for not enrolling in a healthcare plan. ... Even more troubling for the healthcare law, the Supreme Court will soon begin hearing arguments in the King v. Burwell case, which will decide the ultimate fate of the program's federal subsidies. (Knowles, 2/17)

Approximately 11.4 million people have signed up for health coverage through the Affordable Care Act this year, President Obama announced Tuesday, signaling a strong conclusion to the federal health law’s second enrollment period. ... More still may enroll if the Obama administration decides to hold a special enrollment period after April 15. The administration has been considering doing so to allow people who had to pay a penalty for not having health coverage in 2014 get insurance this year and avoid a second year of penalties. (Levey, 2/17)

More than 11 million people signed up or renewed for health insurance on the state and federal exchanges this year, the White House announced Tuesday. (Fox, 2/17)

Behind the scenes, HealthCare.gov is still a mess. The “back end” of the Obamacare website still isn’t properly wired to the health insurance companies. It’s slow going for health plans to make sure the 11.4 million people who have signed up end up in the right plan. Subsidy payments aren’t automated, so the insurers get payments based on estimates. And adding information like a marriage or the birth of a child is a convoluted, multi-step process. ... Instead of a swift process, health plans use clunky workarounds and manual spreadsheets. It takes time and it costs money. (Pradhan and Norman, 2/17)

The Obamacare window technically just closed this weekend, but a new round of political headaches could just be beginning for the administration. That's because it's tax season, and many Americans could soon be getting an unwelcome surprise that they owe the government a penalty for skipping health insurance coverage. Up to 6 million Americans are expected to pay a penalty for not having coverage in 2014, according to recent Obama administration projections. (Millman, 2/17)

CMS officials have yet to say if the agency will implement an open-enrollment extension for people facing tax penalties who don't have coverage, an extension several states also are considering after Washington state enacted one. Some Congressional Democrats have been urging the Obama administration to implement a special-enrollment period for tax filers facing penalties. Sen. Tammy Baldwin (D-Wis.) and 10 other senators who caucus with the Democrats, on Monday sent a letter to HHS Secretary Sylvia Mathews Burwell calling for additional time to sign up for coverage. (Demko and Herman, 2/17)

The Obama administration often touts the health benefits women have gained under the Affordable Care Act, including the option to sign up for coverage outside of open enrollment periods if they’re "having a baby." But advocates complain the special insurance enrollment period begins only after a birth. As a result, uninsured women who learn they are pregnant outside of the regular three-month open enrollment period, which this year ended Sunday, can get stuck paying thousands of dollars for prenatal care and a delivery — or worse, going without care. (Galewitz, 2/18)

A looming Supreme Court case reviewing a key component of the Affordable Care Act is raising questions about what would happen if the Obama administration loses. ... Earlier this month, Health and Human Services Secretary Sylvia Burwell told a Senate committee that a decision from the Court striking down the current subsidy structure would be "devastating," but refused to say if the administration has a back-up plan. ... [Republicans] have so far taken a wait-and-see approach, instead of trying to immediately repeal the law or dismantle it in parts. Some ACA critics fear the Supreme Court may hesitate to block the current subsidies because of a lack of confidence in the legislative branch in general.(Bream, 2/18)

The Supreme Court on March 4 will hear the case of King v. Burwell, which threatens to unravel the Affordable Care Act, a.k.a. Obamacare, because the plaintiffs argue that the health-care law does not authorize subsidies through federally run insurance marketplaces .... In recent weeks, advocates of the law have pointed to statements made by leading Republican lawmakers that have suggested that at one point they too assumed the subsidies would be made available to all Americans. ... An upside-Pinocchio is awarded for an unacknowledged flip-flop on an issue. [Rep. Paul] Ryan, [Sen. John] Barrasso and [Sen. John] Cornyn appear to qualify. They should simply acknowledge that their understanding of the law has changed, rather than pretend that they knew all along that people living in states on the federal exchange would not qualify for premium subsidies. (Kessler, 2/18)

California's health exchange, after notching 1.4 million in Obamacare enrollment as of Sunday's deadline, said it may give uninsured people subject to a tax penalty yet another chance to sign up. In addition, the Covered California exchange granted applicants until this Sunday to finish enrolling in case they ran into long lines or computer glitches. That matches what the federal marketplace is doing in 37 other states. California had previously offered an extension till Friday. (Terhune and Karlamangla, 2/17)

House Republicans are using the resignation of embattled Oregon Gov. John Kitzhaber (D) to reexamine one of the most troubled state-based health care exchanges in the country. In a letter to Kitzhaber’s office sent Friday, Republican members of the House Oversight and Government Reform Committee asked Kitzhaber’s administration to produce documents related to Cover Oregon. ... Cover Oregon was one of the most flawed state-based exchanges set up after passage of the Affordable Care Act. The state spent more than $240 million on outside contractors who built the site, mostly through lead contractor Oracle. But it flopped so badly that state officials decided last year to scrap it entirely and route Oregonians looking for health insurance through the federal HealthCare.gov Web site. (Wilson, 2/17)

The number of people who bought private health plans on the Maryland exchange set up under health reform doubled from last year. Private plans were bought by 119,096 people during the three-month open enrollment that ended Sunday, the Maryland Health Benefit Exchange said Tuesday. Last year, about 63,000 bought private plans during open enrollment. (McDaniels, 2/17)

An expansive new study that chronicles MNsure’s troubled debut concludes that failures outweighed achievements in the health insurance exchange’s first year. (Snowbeck and Olson, 2/17)

An exhaustive state legislative audit on the start-up problems with Minnesota’s health insurance exchange lacked contributions from a key source — the executive director who had been in charge. (Olson and Snowbeck, 2/17)

Minnesota Legislative Auditor Jim Nobles on Tuesday ripped MNsure and its leadership for bungling the launch of the health insurance exchange. (Richert, 2/17)

More Missourians complained about health insurance than any other type of coverage last year, state regulators announced this week. About 1,600 residents filed complaints with the state insurance department against their health insurer last year. That's a considerable jump from 2013's total of about 900 health-related grievances. (Shapiro, 2/17)

CVS Health on Tuesday warned that costs of a potent new class of cholesterol treatments and other specialty drugs in development could eclipse those of expensive new medicines and overwhelm the healthcare system "if rigid cost control mechanisms are not put in place." CVS, the second largest U.S. pharmacy benefit manager which negotiates drug prices for 65 million people through contracts with employers and health plans, noted that two of the new injectable cholesterol fighters - called PCSK9 inhibitors - could be approved by mid-2015 and likely each cost $7,000 to $12,000 a year. (Pierson, 2/17)

The first patients to use the PCSK9 drugs are likely to be those who have a form of high bad cholesterol caused by a genetic variation that affects about 620,000 Americans. Once the drugs are approved for broader use, the population taking them could grow to as many as 15 million, according to CVS. The total costs of the medicines, and the strain on the finances of the health system, could be much greater than from Gilead Sciences Inc.’s hepatitis C drug Sovaldi, which first hit the market at $84,000 for a course of treatment. (Koons, 2/17)

High medical expenses are Americans' biggest financial worry about retirement, topping concerns about running out of money, according to a new report by Bankrate.com. The report found that 28 percent of Americans said medical costs were the biggest concern and households with income of more than $75,000 were more worried than average. (Karp. 2/17)

For many Americans, the idea of a secure retirement free from financial anxiety has become increasingly out of reach. One report showed last year that more than one-third of all working-age adult Americans have no retirement savings. People are also fretting about another key issue that everyone eventually faces in retirement: health care. (Kennedy, 2/18)

Like [Pam] Durocher, many consumers who take pains to research which doctors and hospitals participate in their plans can still end up with huge bills. Sometimes, that’s because they got incorrect or incomplete information from their insurer or health-care provider. Sometimes, it’s because a physician has multiple offices, and not all are in network, as in Durocher’s case. Sometimes, it’s because a participating hospital relies on out-of-network doctors, including emergency room physicians, anesthesiologists and radiologists. Consumer advocates say the sheer scope of such problems undermine promises made by proponents of the Affordable Care Act that the law would protect against medical bankruptcy. (Appleby, 2/18)

Thousands of people from other countries go to Cuba each year for what is known as medical tourism: travel abroad for surgery or other medical care, often because the treatment is less expensive there or is not available where patients live. Now, the Obama administration has relaxed restrictions on travel to Cuba. Americans can come here for a range of reasons, including family visits, academic conferences, public performances, and religious and educational activities. While tourism or traveling to receive health care are still not allowed, the administration lifted a restriction requiring many Americans to travel with authorized groups or get a license in advance to visit the island. (Neuman, 2/17)

Under Medicare rules, long-term acute-care hospitals like Kindred’s typically receive smaller payments for what is considered a short stay, until a patient hits a threshold. After that threshold, payment jumps to a lump sum meant to cover the full course of long-term treatment. That leaves a narrow window of maximum profitability in caring for patients at the nation’s 435 long-term hospitals, which specialize in treating people with serious conditions who require prolonged care. General hospitals are paid under different rules. A Wall Street Journal analysis found that many long-term-hospital companies discharge a disproportionate share of patients during that window when hospitals stand to make the most, a sign that financial incentives in the Medicare system may shape patient care. (Weaver, Wilde Mathews and McGinty, 2/17)

Suffering. The very word made doctors uncomfortable. Medical journals avoided it, instructing authors to say that patients “ ‘have’ a disease or complications or side effects rather than ‘suffer’ or ‘suffer from’ them,” said Dr. Thomas H. Lee, the chief medical officer of Press Ganey, a company that surveys hospital patients. But now, reducing patient suffering — the kind caused not by disease but by medical care itself — has become a medical goal. The effort is driven partly by competition and partly by a realization that suffering, whether from long waits, inadequate explanations or feeling lost in the shuffle, is a real and pressing issue. (Kolata, 2/17)

Despite all the reports about overdiagnosis and overtreatment in the United States (and estimates are that almost a third of all medical interventions in this country are unnecessary), many doctors want to take a more reasoned and less wasteful approach to medicine. But those “lone ranger” doctors are up against a powerful medical industrial complex that “just keeps on delivering treatments patients don’t need,” as journalist Shannon Brownlee (“Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer”), now senior vice president of the Lown Institute, explains in a recent article for the website KevinMD. (Perry, 1/17)

Gilead Sciences Inc. may be one of the first drugmakers in history to have people asking why it’s not doing more to pitch its medicine. Truvada, Gilead’s HIV drug, has been approved since 2004 for people with the virus. In 2012, use was expanded to people without HIV as a way of preventing transmission -- a practice called PrEP, or pre-exposure prophylaxis. Taken daily, it can prevent infections 92 percent of the time, meaning it could drastically reduce new infections in sexually active gay men, among the U.S.’s highest-risk communities. (Chen, 2/18)

As the measles outbreak spreads across the country, tens of thousands of children remain in a paperwork limbo — unsure whether they are fully vaccinated, a big unknown in assessing the risk at many schools. A USA TODAY analysis of school vaccination records found that at more than 2,200 public and private schools in 12 states, at least a tenth of kindergarten students had either incomplete vaccination records or had fallen behind schedule in receiving their shots. In some cases, schools dismiss that as a documentation problem, pointing out that many students have had at least one shot. Not knowing can exacerbate a crisis. (Hoyer, 2/17)

E-cigarettes keep popping up for sale at county jails around the country even as some government officials, schools and health experts urge tighter control over the devices, especially in public buildings. Electronic cigarettes, growing in popularity since their U.S. introduction about a decade ago, are showing up at jails in more than a dozen states, including Ohio, Illinois, South Carolina and Texas. The battery-powered, smokeless devices heat liquid nicotine solutions to produce inhalable vapor. (Cornwell, 2/17)

A California nursing home fined by the state for substandard care and facing multiple lawsuits by patients and their families has taken the extreme measure of filing for bankruptcy protection in the face of millions of dollars in potential payouts. The action, taken by North American Health Care, which operates more than 30 homes in California and other Western states, is being derided by plaintiffs’ lawyers as a legal maneuver to avoid what could be catastrophic legal verdicts, while defenders of the strategy say they are facing mounting lawsuits from overly aggressive trial lawyers. (Thomas, 2/17)

The number of children receiving [occuptional] therapy in New York and elsewhere has shot up in recent years, the byproduct of increasing numbers of special-needs students, a new approach toward teaching them and, to a lesser extent, greater academic demands on all young children. ... And it is widely used to give a boost to children who have trouble with their handwriting, typing or other fine motor skills. And widely used it has been. Over the last four years, New York City public schools have seen a 30 percent increase in the number of students referred to occupational therapy, to nearly 42,000 students. (Harris, 2/17)

The Department of Health and Human Services is supporting an effort by 10 entrepreneurs to come up with solutions to 10 healthcare problems in 10 days. The endeavor is part of a new event in Denver called 10.10.10, which is looking for solutions to tough problems that could become the basis for start-up companies. (Sullivan, 2/17)

The number of doctors practicing psychiatry and general surgery is expected to reach critically low levels in the next 10 years, according to a new study from the state’s teaching hospitals. If Florida continues on its current training and population trajectories, the state will fall nearly 7,000 doctors short in 19 different specialties, said Tim Dall, managing director of IHS Global and author of the Florida Physician Workforce Analysis released Tuesday in Tallahassee. (Shedden, 2/17)

Illinois' new Republican governor on Wednesday will pitch a plan for fixing the state's budget mess that includes deep cuts to Medicaid and higher education and a new plan for reducing pension costs, according to three lawmakers with knowledge of the proposal. ... The three legislators, briefed on details of the plan discussed in a Tuesday meeting between Rauner and legislative leaders, told The Associated Press that the governor will recommend cutting Medicaid by $1.5 billion and reducing funding for higher education by nearly $400 million, or 31 percent. (Burnett and Lester, 2/18)

Personal or philosophical opposition to vaccines would not be an authorized exemption for the parents of school-age children under a measure that received a public hearing before a House committee on Tuesday, drawing at least two dozen opponents to the proposed change. Rep. June Robinson, a Democrat from Everett and member of the House Health Care & Wellness Committee that heard her bill, said she introduced the bill in response to the current measles outbreak that has sickened more than 100 people across the U.S., including in Washington state, and in Mexico. No deaths have been reported. (La Corte, 2/17)

Iowa could become the third state in the nation to outlaw therapy techniques designed to change the sexual orientation of gay and lesbian youths. A state Senate subcommittee advanced a bill Tuesday that would ban mental health practitioners from providing so-called conversion therapy to minors. (Pfannenstiel, 2/17)

The state’s most powerful health care system on Tuesday abandoned its three-year effort to acquire South Shore Hospital, the centerpiece in Partners HealthCare’s controversial expansion drive, which had riveted and divided the Massachusetts medical community. (Weisman, 2/17)

Partners HealthCare is withdrawing its bid to acquire South Shore Hospital, state Attorney General Maura Healey’s office announced Tuesday. (2/17)

[Montana] Republican lawmakers Sen. Fred Thomas and Rep. Art Wittich proposed legislation Monday that they said would rein in abuse of public assistance programs. Thomas introduced Senate Bill 206 in the Senate Public Health, Welfare and Safety Committee. It would require the state to seek federal permission to limit the foods that can be purchased under the supplemental nutrition assistance program. (Noon, 2/17)

Advocates for nursing home residents want legislators to mandate that facilities have more and better-trained staff. Nursing home representatives say they would like to provide that, but they don’t have the money or the available workforce to do so. (Marso, 2/17)

Obamacare ... has been variously justified by the cost to the state of emergency room care; the cost to society of free-riding young folks who don't buy insurance until they get sick; the public health cost of people who don't go to the doctor and get really, expensively sick; an unhealthy workforce that is less productive; and the cost to friends and relatives who have to chip in to cover uninsured medical expenses. I didn't find any of those arguments particularly convincing. (Megan McArdle, 2/17)

As people hear that health spending is beginning to grow more quickly again, many may recall reports they may have read recently about the shockingly high cost of some medical procedure, or how much a hospital CEO is being paid, or what they pay for their own prescription drugs. The prices Americans pay for health services are a big problem, but the culprit behind the renewed growth we are seeing in spending is not the rising price of health services. (Drew Altman, 2/17)

This basically sums up the U.S. health-care system: poor quality and not much to show for it. Other nations keep their people healthy at a much lower price. There is much we can learn from them. In 2013, the U.S. spent over $9,000 to provide health care for each man, woman and child—one-third more per person than any other wealthy nation. Thanks to the recession and the early impact of the Affordable Care Act, expenditures are growing by the slowest rate since 1960. However, we’re leveling off at a very high-cost plateau—$2.9 trillion. (Drew Harris, 2/17)

Being the dean of Harvard Medical School imposes a need to anticipate the ways that science and medical practice will evolve over the coming decades. The reasons should be obvious. We need a medical curriculum that reflects the values and skills physicians will need, the changing ways they will access and employ information, and the health care system within which they will likely operate. On a recent sojourn to Silicon Valley, I had a chance to meet with leaders at Apple and Google, as well as with several aspiring health startups. These meetings clarified and focused my thinking on the ways that health care may be different in 10 to 20 years. (Jeffrey Flier, 2/17)

For years, clinical science has been linking ailing mental health to physical problems. Alcohol addiction can result in cirrhosis of the liver; obesity can be a manifestation of chronic depression rather than merely the result of poor food choices. Back pain could be musculoskeletal or it could be the result of anxiety or stress manifesting in physical pain. The science is clear: It’s time to reintegrate mental health with the rest of health care. (Atul Grover, 2/17)

Last month, three ethicists from the University of Pennsylvania argued in the Journal of the American Medical Association that the movement to deinstitutionalize the mentally ill has been a failure. Deinstitutionalization, they wrote, has in truth been “transinstitutionalization.” As a hospital psychiatrist, I see this every day. Patients with chronic, severe mental illnesses are still in facilities — only now they are in medical hospitals, nursing homes and, increasingly, jails and prisons, places that are less appropriate and more expensive than long-term psychiatric institutions. The ethicists argue that the “way forward includes a return to psychiatric asylums.” And they are right. (Christine Montross, 2/18)

Republicans have been railing against big government for years, but for the past two decades they have all but ignored the growth of one of the nation’s biggest and costliest programs: Social Security Disability Insurance (SSDI). That may be changing. Congressional Republicans are making noises about fundamental reforms, voicing concerns that “malingerers” are swelling the ranks of the beneficiaries .... SSDI is a big target. It provides a monthly check to more than 10 million people at a cost of $140 billion annually in 2013. The program has been growing for years, a surge attributed to a mix of factors, including the increase in Social Security’s full retirement age, the aging of the baby boomers and the growth of women in the workforce (which has increased the pool of possible recipients). (Thomas F. Burke and Jeb Barnes, 2/17)