�鶹Ů��

President Barack Obama told congressional leaders Tuesday that he doesn’t expect the Supreme Court to rule that Obamacare’s tax subsidies can only go to residents of states running their own health exchanges, according to one of the law’s biggest critics. Sen. John Barrasso (R-Wyo.) asked Obama during a roundtable discussion with congressional leaders why the administration hasn’t notified the public that premium subsidies could be eliminated and whether contingency planning is under way in case the court rules against the White House in King v. Burwell. He said he interpreted Obama’s public confidence as a sign that no contingency plans are in development. (Haberkorn, 1/13)

For years, Republicans have debated if it was enough to simply attack President Obama’s signature health care law and seek its repeal or advance a detailed alternative to Obamacare that would benefit policyholders and the economy. In a speech kicking off a two-day Heritage Foundation policy summit, Rep. Tom Price (R-GA) – the new chair of the House Budget Committee – said the GOP must finally spell out a new, more conservative approach if the High Court rules the federal insurance exchanges have been giving subsidies to people in defiance of the law. (Pianin, 1/13)

Tea Party darling Sen. Ted Cruz (R-TX) did his level best to stay relevant among his conservative base Monday night by stoking the flames of the anti-Obamacare debate. ... Cruz challenged the freshman Republicans to make good on the campaign promises that got them elected to the 114th Congress. He noted that all 12 new members ran on the idea of repealing the president’s health care law. (Ehley, 1/13)

U.S. Sen. Chuck Grassley is asking whether federal administrators contributed to the collapse of an Iowa-based health-insurance carrier. The Iowa Republican sent a letter Tuesday to President Obama’s top healthcare official, asking for details about why CoOportunity Health suddenly hit a cash flow crisis. (Leys, 1/13)

The U.S. House of Representatives voted unanimously Monday, 401-0, to amend the Affordable Care Act so it’s clear volunteer firefighters don’t count as full-time employees under the health care law. (Radelat, 1/13)

A tax on medical devices, imposed by the Affordable Care Act, has become a prime target for Republicans, some Democrats and a small army of lobbyists for the industry. But a new report from the Congressional Research Service challenges economic arguments that are being made to justify repealing the tax. Critics of the tax say it is destroying jobs and encouraging manufacturers to move operations overseas. Repealing it is a priority for Republicans on Capitol Hill. (Pear, 1/13)

The measure from Sens. Orrin Hatch (R-Utah) and Amy Klobuchar (D-Minn.) would repeal the healthcare law's 2.3 percent excise tax on medical products and equipment. With support from members of both parties as well as industry, the bill is one change to the health care law that seems likely to pass Congress this year. (Viebeck, 1/13)

Obamacare’s Medicaid expansion is under renewed assault in the states even as the health law faces threats in Washington from the Supreme Court and a Republican Congress. A handful of Republican governors said that after the November elections, they’d be open to taking billions of federal dollars to cover millions of their low-income residents under the Affordable Care Act Medicaid expansion. Instead, Medicaid faces possible retrenchment after a Republican tide swept emboldened Obamacare foes into every level of government. (Wheaton, 1/14)

Another influential business group wants to see Florida lawmakers accept federal dollars to help extend healthcare coverage to uninsured Floridians. In a report issued Tuesday, the the Florida Chamber of Chamber said it opposes "the traditional expansion of Medicaid." But the group would be willing to support a plan to use the federal funds that "embraces private solutions with flexible steps to eliminate the $1.4 billion cost shift on Florida families and caps Florida's Medicaid budget at 32 percent." (McGrory, 1/13)

California's health insurance exchange said 217,146 people have newly signed up for Obamacare coverage after nearly two months of open enrollment. The Covered California exchange said Tuesday the number of applications slowed during the holidays, but it remains confident of reaching its 2015 goal for health-law enrollment. ... During the initial rollout of the Affordable Care Act, 1.2 million people had purchased a private health plan through Covered California. State officials are trying to hold on to those existing policyholders and add about 500,000 more to finish open enrollment Feb. 15 with 1.7 million consumers. (Terhune, 1/13)

State health insurance exchange officials Tuesday said they're on track to reach their goal of signing up at least 500,000 new enrollees by Feb. 15, the deadline for the second open-enrollment period under the nation's health care law. (Seipel, 1/13)

California's health insurance exchange is reminding consumers that they will face a penalty under ObamaCare for remaining without coverage, a messaging tool to boost enrollment that other marketplaces have hesitated to embrace. Covered California, one of the nation's most successful exchanges, made no effort to downplay the individual mandate penalties that took effect last year and are set to rise in 2015. The marketplace is encouraging consumers to pick plans by Thursday, the deadline for insurance that kicks in Feb. 1. (Viebeck, 1/13)

U.S. companies are increasingly penalizing workers who decline to join "wellness" programs, embracing an element of President Barack Obama's health care law that has raised questions about fairness in the workplace. (1/13)

Be prepared for the tax man to get even more personal this year — with questions about your health insurance. For the first time, you’ll have to state whether you had health insurance, through an employer, one of the exchanges or purchased privately. And if you didn’t, you could face a penalty. (1/13)

Kaiser Health News staff writer Jay Hancock reports: "Obama administration officials have warned that ambitious experiments run by the health law’s $10 billion innovation lab wouldn’t always be successful. Now there is evidence their caution was well placed. Only a small minority of community groups getting federal reimbursement to reduce expensive hospital readmissions produced significant results compared with those from sites that weren’t part of the $300 million program, according to partial, early results. The closely watched program is one of many tests to control costs and improve care being run by the Center for Medicare and Medicaid Innovation, which was created by the Affordable Care Act." (Hancock, 1/14)

Aetna Inc. expects to add more Medicare and public-exchange members in its current quarter than it had previously projected, as the insurer continues to benefit from the new health-care law. Ahead of a presentation at the J.P. Morgan Healthcare Conference on Tuesday, Aetna backed its per-share earnings outlook for the current year of at least $6.90 a share and its revenue guidance of at least $62 billion. Analysts polled by Thomson Reuters are expecting $7.15 a share in earnings on $62.5 billion in revenue. (Dulaney, 1/13)

Beginning in 2016, the Hartford, Conn., insurer also plans to cover more of the healthcare costs of about 7,000 of its workers. Some employees could see savings of up to $4,000, the company said in a statement. "We are committed to fostering a strong and successful workplace and a resilient workforce, as well as increasing our ability to attract and retain the best talent," the company said in a statement. (Panzar, 1/13)

The Colonial Room of the St. Francis Hotel in San Francisco was filled beyond capacity Monday afternoon, and the offices of digital-health seed fund Rock Health were buzzing with hundreds of partygoers just a couple of hours later. Both events were connected to the JP Morgan Healthcare Conference, but neither was geared toward pharmaceutical or medical-device executives looking to make deals, as has traditionally been the focus at the vaunted, 33-year-old conference. Instead, digital health software–and analytics that bring more transparency and more insight to the delivery of health care has grown from being a sideshow at the conference to being one of the main events. (Hay, 1/13)

While Actavis is busy fighting a court battle over marketing plans for a newer version of its big-selling Alzheimer’s pill, the drug maker is also working hard to convert many patients from its older version of the drug before generic rivals emerge later this year. At the moment, the newer Namenda XR accounts for about 40% of all prescriptions written for both the old and new versions of the drug. But Actavis believes Namenda XR can capture as many as 70% of prescriptions by July, when generic copycat versions of the older Namenda IR become available. (Silverman, 1/13)

Each governor who spoke Tuesday — Christie, Walker and Indiana Gov. Mike Pence — outlined a few signature policy proposals designed to lead local news coverage: Pence called for a balanced budget amendment to the state constitution, to be ratified by voters in a future election. Walker proposed merging several state agencies together that he said duplicate work. Christie pushed for mandatory treatment programs for drug offenders. ... Pence stressed that he will never accept traditional Medicaid expansion under the Affordable Care Act. “We have been saying ‘no’ to ObamaCare in Indiana, ‘no” to establishing a state-based exchange and ‘no’ to expanding a broken Medicaid system,” he said. “Medicaid is not a program we need to expand. It is a program we need to change.” (Hohmann, 1/13)

Mr. Christie, a potential 2016 Republican presidential candidate, touched on themes such as tax cuts, school choice, slowing Medicaid spending and reining in benefits for public workers. He spent a significant portion of the speech discussing drug addiction treatment, an issue that some conservatives support. (Haddon and Dawsey, 1/13)

Medical residents who work in under-served parts of Nebraska could receive up to $120,000 in loan repayments under a new bill in the Legislature. Sen. Kathy Campbell of Lincoln proposed a loan reimbursement program Tuesday for areas designated as having a shortage of health care professionals. The bill would largely apply to rural areas which lack doctors. (1/13)

Los Angeles County supervisors voted Tuesday to move toward consolidating three departments dealing with different aspects of public health. But they did so over the objections of mental health advocates who worry that those services will get buried in a larger health agency. The move, proposed by Supervisor Michael D. Antonovich, would integrate the departments of public health—responsible for controlling disease outbreaks, managing substance abuse programs and conducting health inspections—and mental health with the Department of Health Services, which runs county hospitals and clinics. (Sewell, 1/13)

The state is “woefully inefficient and inconsistent” in its oversight of parental fees for 24-hour, out-of-home care for disabled children in California, leaving hundreds of thousands of dollars unbilled and charging some parents with similar incomes more or less than others, the state auditor said Tuesday. (Siders, 1/13)

More than half of Colorado hospitals receiving Medicare payments will lose a portion of those reimbursements this year as penalty for having relatively high rates of readmissions. Hospital readmissions deemed avoidable — unplanned and occurring within 30 days of discharge — happen 2 million times a year at a cost estimated by the government of $26 billion a year. (Draper, 1/14)

Madison County [Miss.] economic development officials had to cope for years with the sting of losing in 2008 a $450 million Department of Homeland Security research lab for which Flora was among a group of finalist cities. Tim Coursey, executive director of the county Economic Development Authority, said the experience of competing for that facility — Manhattan, Kansas, was ultimately chosen — convinced him Madison County had the technology and the know-how to support a top-notch research facility. He said such a place is taking shape in Canton. (Ayres, 1/14)

In the upcoming legislative session, the North Carolina General Assembly must pass a new Medicaid plan, one that utilizes accountable care organizations, Department of Health and Human Services Sec. Aldona Wos said Tuesday. Speaking at Community Care of North Carolina’s Innovation Forum held at the McKimmon Center on the NC State University campus, Wos called on attendees to champion ACOs as the health care solution that would preserve doctors’ ability to treat patients. (Hoban, 1/14)

State officials have proposed several changes in the Medicaid waivers that define the state’s approach to helping frail elders and people with disabilities live in community-based settings rather than in nursing homes. The proposed changes, now posted on the Kansas Department for Aging and Disability Services website, were filed with the Centers for Medicare and Medicaid Services on Dec. 31. (Ranney, 1/13)

[Montana] Attorney General Tim Fox has approved the sale of Community Medical Center in Missoula to a joint business venture between Billings Clinic and a Tennessee company. Fox said Monday that his Office of Consumer Protection still must sign off on the way $74.8 million received from the sale will be distributed. Because Community Medical Center is a nonprofit, the proceeds from its sale to a for-profit group must go to a foundation with a health-focused mission that serves the same area as the hospital. (1/13)

Health care topics getting visibility in the first week of the General Assembly include proposals on autism, facility regulatory rules, Medicaid payments, and raising the state cigarette tax. (Miller, 1/13)

Christa Allen wasn't your typical inmate. Back in 2002 — four years before she was sentenced to time in the Rockville Correctional Facility — Allen had undergone a male-to-female gender-reassignment surgery. Shortly after she entered Rockville, Allen explained her medical situation to prison officials and doctors. Specifically, she informed them that the doctor who had performed the surgery had prescribed her a female hormone as well as a vaginal stent. (Guerra, 1/13)

An Indiana lawmaker has introduced a bill to prohibit abortions if the provider knows the procedure is being sought because of the fetus's gender or due to a genetic mental or physical disability such as Down syndrome. The bill filed by Republican state Sen. Travis Holdman would make it a felony for providers to perform abortions in those instances. (Wang, 1/13)

The governor, a Democrat, nominated his acting health commissioner, Dr. Howard A. Zucker, to take over formally at the Health Department. Dr. Zucker stepped into the spotlight late last year after he concluded that hydraulic fracturing, a controversial form of extracting natural gas from deep underground known commonly as fracking, could not be conducted safely in the state. (Craig, 1/13)

The U.S. Supreme Court is expected to decide by late June whether millions of Americans in three dozen states are benefiting from illegal health insurance subsidies. If the justices invalidate those subsidies, Republicans must have a free-market alternative waiting in the wings. Otherwise, there will be tremendous pressure on Congress to pass a “fix” allowing existing benefits to continue. Obamacare will be entrenched before Republicans even get a chance to retake the White House. The time to stop that is now. (Philip Klein, 1/13)

Justice Antonin Scalia was missing from the bench this morning when the U.S. Supreme Court handed down two statutory interpretation cases -- apparently he was stuck in traffic. But even in his physical absence, Scalia’s presence was looming. It’s not only that he wrote both of the opinions, each decided by a unanimous court. It's that both opinions reflect his approach of “textualism” -- a form of literal legal interpretation that has become his most distinctive contribution to U.S. law. And that in turn provides a strong indication that the Supreme Court will use the same technique later this year to reach a ruling that effectively puts an end to the Affordable Care Act. (Noah Feldman, 1/13)

How much money does Arkansas save by offering stingier Medicaid than Vermont? It looks like a straightforward calculation. Arkansas makes it tougher for children to qualify for Medicaid than Vermont does, and it spends much less on each beneficiary. ... But there is a price to pay for such parsimony. Children in Arkansas get fewer regular checkups at the doctor and dentist. More adults forgo care because of the expense. More Arkansans are overweight and have diabetes. More are disabled. They die younger. (Eduardo Porter, 1/13)

Among the Affordable Care Act’s many economic and political disruptions, the law has unintentionally encouraged employers to convert full-time jobs into part-time jobs. ObamaCare mandates that employers offer health insurance to employees who work more than 30 hours a week, or pay a penalty up to $3,000 an employee. But employers have no such obligation for employees who work less than 30 hours a week, making part-time employment less costly. (Andy Puzder, 1/13)

EHRs [electronic health records] are supposed to simultaneously reduce costs, increase efficiency, and improve quality. Unfortunately, such predictions have not played out as well as many individuals have hoped. ... Just recently, the American Medical Association called for an overhaul of EHRs, arguing that the meaningful-use requirements set by the government require EHRs to do too many things adequately, making them perhaps unable to do too few things well. The American Medical Association argued for a new framework that would focus on making EHRs more usable and more likely to achieve better patient care. Given what we know about physician satisfaction, this seems aligned with what physicians want: EHRs to be more functional, more user friendly, and less of an impediment to workflow. (Dr. Aaron E. Carroll, 1/12)

[T]he effect that unprecedented budget pressures are having on biomedical research cannot be ignored. Due to inflation, the NIH budget has lost almost 25% of its purchasing power over the last decade. The decline has had important consequences; the NIH once funded 1 in 3 research proposals, but now only has enough resources to support 1 in 6. As a result, a great deal of excellent science is being left unfunded. These challenging fiscal times are also impeding the ability of the NIH and NIH-funded institutions to recruit and retain the brightest minds in science. ... If the United States wants talented, young scientists—especially physician-scientists—to pursue high-risk research that will improve human health over the long term, timely and stable funding for biomedical research is needed. (Francis Collins, 1/13)