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Brimming with confidence, the president struck a colloquial tone as he rattled off a series of positive statistics about the country’s recent economic rebound. ...The question facing Obama is whether his final two years in the White House can come close to repeating the record of his first two. He has neither the Democratic majority that ushered through major bills revamping the nation’s fiscal and health-care systems, nor the sky-high poll ratings he had shortly after taking office. ... Another factor beyond the White House’s control is the much-anticipated Supreme Court ruling later this year that could undercut the federal subsidies that help millions of Americans buy plans under the Affordable Care Act. “The legacy of the president, and the health-care legacy of the president, depends on those nine people in the Supreme Court,” said Jonathan Oberlander, a professor of health policy at the University of North Carolina at Chapel Hill. (Eilperin, 1/20)

At times boastful, confident and even cocky, Obama appeared unfazed by his party’s electoral pounding in the midterm election less than three months ago or his year of slouching approval ratings. ... Obama pledged to veto any measures that would undo his sweeping immigration executive actions or his healthcare law. ... In the end, though, he returned to the heart of his message, an economic policy aimed at strengthening the middle class. (Hennessey and Parsons, 1/20)

President Obama claimed credit on Tuesday for an improving economy and defiantly told his Republican adversaries in Congress to “turn the page” by supporting an expensive domestic agenda aimed at improving the fortunes of the middle class. ... In the speech, he promised that any attempt to roll back his health care law, an overhaul of regulations on Wall Street or his executive actions on immigration would also face vetoes. (Shear and Hirschfeld Davis, 1/20)

Republicans are hoping to use their newfound control of both chambers of Congress to nullify Obama's executive actions on immigration, and make major changes to Obama's health care law and to the 2010 Dodd-Frank financial overhaul. But Obama says the U.S. can't put businesses or the economy at risk through government shutdowns. He says the U.S. must not take away Americans' health insurance, refight previous immigration battles or unravel new rules governing Wall Street. (1/20)

President Barack Obama called for a new medical research push in his State of the Union address, which the White House says will include fighting antibiotic resistance and the pursuit of targeted therapy based on a patient’s genetic makeup. The beefed-up research into antibiotic resistance, while not further specified, would potentially include new medicines that could be reviewed by the Food and Drug Administration, and new ways to avoid antibiotics’ becoming less effective. The White House said the plan is to nearly double the federal investment into grappling with the issue of antibiotic resistance. (Burton, 1/20)

While his party suffered significant setbacks in the November elections, the president arrived at the Capitol Tuesday night with some political momentum, with the economic outlook brightening and his job-approval ratings ticking upward. Some 46% of Americans approved of Mr. Obama’s job performance in a Wall Street Journal/NBC News poll released this week, up from 40% in September. (Lee and McCain Nelson, 1/20)

Whereas last year, President Barack Obama used nine full paragraphs of his State of the Union speech to sell his health care plan, the subject got less attention tonight. (Kane, 1/20)

Ten years ago, President George W. Bush briefly mentioned electronic health records in a State of the Union address and the federal government is now in the midst of a multibillion dollar effort to promote the technology. Can the same thing happen with cybersecurity? President Barack Obama's proposed federal cybersecurity legislation has healthcare data security experts applauding. (Conn, 1/20)

“No” seems to be all anyone wants to say in this town anymore. In his State of the Union address on Tuesday, President Obama enumerated policies that he opposed, from rolling back Wall Street regulations to exempting more businesses from their obligation to provide health insurance under the Affordable Care Act. To drive home his displeasure with the Republican agenda, the White House also issued two new veto threats in the hours before the president spoke — this time for bills that would ban abortions after 20 weeks of pregnancy and accelerate approval of natural gas pipeline construction. For their part, Republicans immediately rejected most of the proposals that were central to Mr. Obama’s address, saying he was obviously not serious about working with them to pass consequential bipartisan legislation. (Peters and Huetteman, 1/20)

Ernst pledged that the new GOP majority would reform Congress “to make it function again” and would pass “serious job-creation ideas,” naming the approval of the Keystone XL pipeline as a top priority. She also took a shot at Obama’s health-care law, saying that it was part of a “stale mind-set” and that Republicans would “keep fighting to repeal and replace” it. (Costa, 1/20)

Republicans vowed to repeal and replace ObamaCare following President Obama's State of the Union address, a speech that repeatedly touted the successes of the healthcare law. Newly elected Sen. Joni Ernst (R-Iowa) criticized the reform law for canceling healthcare plans and claimed it has raised premiums and "hurt … hardworking families." (Viebeck, 1/20)

The federal government skipped key contracting requirements when awarding hundreds of millions of dollars to build the troubled HealthCare.gov site, according to an inspector general’s report. The investigation published Tuesday by the Office of Inspector General for the Department of Health & Human Services found the federal government failed to probe fully the past performance of CGI Federal Inc., a subsidiary of a Canadian information technology firm, before awarding it a contract to construct basic parts of the insurance enrollment site. (Radnofsky, 1/20)

Almost 140 small businesses have signed up their employees for health coverage through the state's new small business exchange by using outside contractors and paper applications, according to information presented at the exchange's monthly board meeting Tuesday. The long-delayed business website created under the Affordable Care Act will allow employees to compare plans and enroll completely online by Jan. 1, 2016, exchange officials said. (Cohn, 1/20)

Oklahoma State Rep. Mike Ritze is a foot soldier — one of hundreds — in a passionate war over the Affordable Care Act that is reigniting as state legislatures convene across the country. The Republican lawmaker, a family doctor, has stood behind three anti-Obamacare bills supported by conservative groups in Oklahoma and other states. None has made it into law, but Ritze plans to pick up the fight in the 2015 legislative session that convenes in the Sooner state next month. (Schulte, 1/21)

Are you thinking about tax day yet? Your friendly neighborhood tax preparer is. IRS Commissioner John Koskinen declared this tax season one of the most complicated ever, and tax preparers from coast to coast are trying to get ready for the first year that the Affordable Care Act will show up on your tax form. (Dembosky and Cohen, 1/21)

New York's health exchange says it is sending out more than 300,000 tax statements to households where someone enrolled for private health coverage through the exchange last year. The statements required under the federal Affordable Care Act are for use in filing federal tax returns for 2014 by those who enrolled through the exchange in a qualified insurance plan and are taking tax credits. (1/21)

The Affordable Care Act is supposed to make health care coverage universal and more affordable to millions of Americans, but it might also make filing your 2014 taxes more cumbersome and more expensive. (Cole, 1/20)

A range of citizens and professional groups urged Wyoming lawmakers on Monday to accept federal money to expand the federal Medicaid program to offer health insurance to thousands of low-income adults. The overwhelmingly Republican state Legislature has rejected the federal expansion offer repeatedly in recent years. Many critics say they don’t trust federal promises to continue to pay for the program. (1/20)

One of the key backers of a Senate bill to expand Wyoming’s Medicaid program is dismissing estimates that the bill would require higher administrative costs than the plan favored by Gov. Matt Mead. ... Sen. Charles Scott, R-Casper, is chairman of the Senate Labor, Health and Social Services Committee. He says this method would help control costs by making residents more responsible for their health care. (Chilton, 1/21)

A House Democrat introduced a package of bills Tuesday to counter Republicans blocking expansion of Medicaid in the state, to allow people with disabilities to exit the state’s overhauled Medicaid program and to abandon a plan for joining a multi-state compact to operate Medicare for the elderly. Rep. Jim Ward, a Wichita Democrat on the House Health and Human Services Committee, has been a fierce critic of Gov. Sam Brownback’s opposition to widening eligibility for Medicaid. (Carpenter, 1/20)

The state's largest physicians' organization says it is fully backing Republican Gov. Bill Haslam's Insure Tennessee proposal to extend subsidized health insurance coverage to an estimated 200,000 lower-income residents. Tennessee Medical Association officials said the group's Board of Trustees voted over the weekend in support of the plan. (1/20)

Florida health officials and lawmakers are facing a quandary over how to replace the likely annual loss of $1.3 billion in federal funds which compensate hospitals and providers that care for large numbers of uninsured and Medicaid patients. (1/20)

House Republicans say Gov. Terry McAuliffe has implemented a poorly conceived plan to provide health care coverage for low-income Virginians with severe mental illnesses. Republicans said on the House floor on Tuesday that McAuliffe's plan is a political ploy that was implemented without General Assembly approval by improperly invoking emergency authority. Their criticism signals the latest chapter in a long-running battle with McAuliffe over public health care spending for poor. (Suderman, 1/20)

States have broadened Medicaid coverage dramatically in the past decade, particularly as 27 states and the District of Columbia expanded coverage to adults last year under the health care law, according to a new report by the Georgetown Center for Children and Families and the Kaiser Family Foundation. But in almost all of the 23 states that did not broaden coverage as the health care law allows, adults who don’t have children often do not qualify for Medicaid, no matter how low their income is. (Adams, 1/20)

Democrats and health care advocates had hoped that Mr. Abbott would reverse Mr. Perry’s refusal to expand Medicaid in the state, which has the highest rate of uninsured residents in the country. But Mr. Abbott made it clear recently that he would not expand the government health insurance program for low-income and sick people, with a spokeswoman saying that he had “fought Obamacare and will continue to fight against it.” Such statements angered Democrats, many of whom worry that Mr. Abbott will continue to promote Mr. Perry’s small-government mantra, which they said fails to provide an adequate safety net for all. But Mr. Abbott’s approach has reassured Republicans, who control the Legislature and every top office and who argue that the Texas model has brought jobs and built a strong economy. (Fernandez, 1/20)

House Republican leadership is planning to move forward with a bill banning abortions after 20 weeks, despite opposition from female lawmakers who fear the legislation is too harsh and could turn off young voters. (Sherman and French, 1/20)

While Republicans cannot expect a full repeal of the health law while President Barack Obama remains in office, the GOP intends to “strike away at it, piece by piece,” Senate Finance Committee Chairman Orrin Hatch, R-Utah, said Tuesday. But in a speech at the U.S. Chamber of Commerce, Hatch also said he expected that Republican and Democratic lawmakers would work together on several other key pieces of health legislation. (Carey, 1/20)

House Democrats haven’t been able to make much progress on expanding health insurance coverage since Republicans took control in 2011. But they’ve scored a minor victory this month for some House cafeteria employees. (Haberkorn, 1/20)

UnitedHealth Group Inc. said results in its December quarter topped expectations as nearly all of its segments posted revenue growth. Like its fellow health insurers, UnitedHealth has sought to contain costs related to medical care, particularly as expensive, high-profile treatments for hepatitis C and cancer enter the market. Last month, in a bid to explore expense-controlling options, the company unveiled a test program in which it will pay MD Anderson Cancer Center a flat rate for a year’s worth of treatment for certain patients. (Calia, 1/21)

The company's premium revenue rose 6 percent to $29.38 billion in the quarter ended Dec. 31, while overall medical cost trends remained well in control, with decreased inpatient hospital usage per person, the company said. UnitedHealth's shares were up 2.2 percent in premarket trading. The company reported a medical care ratio, or the amount it spends on medical claims compared with the insurance premiums that it brings in, of 79.8 percent. It was 81.2 percent a year earlier. (Humer and Penumudi, 1/21)

Revenue for the quarter was $33.43 billion, compared with $31.12 billion during the same quarter a year earlier. Revenue for the year was $130.47 billion, compared with $122.49 billion in 2013. The company said an anticipated decline in its customer base served through commercial benefits — health care offered by employers — was more than offset by growth in its government-funded customer base of people in Medicare and Medicaid programs. (Sturdevant, 1/21)

The Minneapolis-based insurer's CEO, Stephen Hemsley, said Wednesday in a statement that the company enters 2015 "with a positive outlook and rising business momentum." That's a contrast to how UnitedHealth started 2014, filled with worry about another round of funding cuts to a key business: Medicare Advantage plans, the privately run versions of the federal government's coverage program for people who are over 65 or disabled. Wednesday's proclamation garnered strong early reviews from investors, who pushed the stock price higher before markets opened. Most investors have turned their focus to what lies ahead by the time companies report their fourth-quarter results. (Murphy, 1/21)

UnitedHealth Group shares are poised for Wednesday gains after the health insurer posted solid gains in fourth-quarter revenue and earnings and forecast better-than-expected prospects for 2015. (Strauss, 1/21)

The cost of having a knee or hip replaced varies wildly and can be up to four times more in one place than another -— even in the same area, a report out Wednesday found. A total knee replacement averaged about $31,000 in 64 markets where Blue Cross Blue Shield analyzed its claims data. But in Dallas, it ranged from $16,772 to $61,584.86. Across the USA, knee replacements costs as little as $11,317 in Montgomery, Ala., and as much as $69,654 in New York City. (O'Donnell and Ungar, 1/21)

Teamwork may be one way to help reduce the incidence of diagnostic mistakes, in which patients' conditions are missed, delayed or diagnosed incorrectly, a study suggests. When two doctors worked together, their confidence in a diagnosis was boosted and their determination was more accurate. One out of every 20 U.S. adults could be misdiagnosed during outpatient visits, and about half of those errors could prove to be harmful, recent estimates find. (Rice, 1/20)

Pharmacists are about to finish one phase and start another in the march toward broadening their scope of practice in California to include more primary care services. Using new guidelines created in a bill signed into state law about a year ago, pharmacists have been retooling regulations to include new duties. (Lauer, 1/20)

A Republican member of the Missouri Senate is proposing expanding Medicaid to military veterans who are currently ineligible. Last year, state Sen. Ryan Silvey, R-Kansas City, put together an alternative Medicaid proposal that would have combined expansion with various reforms, but it went nowhere. Silvey said his new bill, which he expects to file Wednesday, would make veterans earning between 19 percent and 138 percent of the federal poverty level eligible for Medicaid. (Griffin, 1/20)

With Republican legislative leaders declaring Medicaid expansion dead on arrival this year, Sen. Ryan Silvey is hopeful Missouri will at least be able to expand coverage for veterans. The Kansas City Republican plans push for legislation allowing veterans and their families to qualify for Medicaid if they make less than 138 percent of the federal poverty level. Currently, to be eligible for Medicaid in Missouri, a non-elderly adult must have a dependent child and can earn no more than 19 percent of the poverty level, or roughly $3,700 for a single mother with two children. (Hancock, 1/20)

When Brenda Love of Wichita worked as a hospital emergency-room nurse, she often treated patients who had just gotten out of the hospital and were on their way back in – especially seniors. ... Experiences like that brought Love to the [Kansas] state Capitol last week as part of a group of seniors and supporters pressing for a bill requiring hospitals to interact more directly with caregivers when they discharge a patient. The red-vested volunteers, members of the American Association of Retired Persons, met with numerous members of the Legislature and even buttonholed the governor in the Statehouse lobby to pitch for their bill. (Lefler, 1/17)

[The proposed budget] also passes additional costs on to cities and counties and, in one case, presumes voter approval for changing how state trust lands are run, as well as approval of cuts to health-care reimbursements from federal officials within three months. (Hansen and Pitzl, 1/20)

Advocates for Minnesota's nursing home industry are looking for $200 million from the state, saying underfunding has forced some facilities to close. The plan would overhaul reimbursements to nursing homes. Patti Cullen, president of Care Providers of Minnesota, said these payments haven't kept up with inflation amid previous budget cuts. State laws don't allow facilities to charge private patients more than what's provided by Medicaid. (1/20)

Six West Virginia hospitals will lose 1 percent of their Medicare reimbursement after the Centers for Medicare and Medicaid Services found that each had high rates of potentially avoidable “hospital acquired conditions,” including falls, bed sores and certain infections. (Nuzum, 1/20)

During his long tenure, Feckner has steered CalPERS away from sometimes strident, anti-corporate activism; backed a campaign that successfully defeated a 2005 initiative that would have reduced some pension benefits; and helped the nearly $300-billion fund recover billions of dollars in losses from the recession of 2008-09 and its aftermath. ... It is also confronting the growing costs of providing promised lifetime health insurance to retirees and dealing with a gap of tens of billions of dollars in fund assets needed to pay for current and future retirement benefits to 1.7 million members. (Lifsher, 1/20)

When a woman had gall bladder surgery at a Massachusetts hospital in 2013, doctors noticed something suspicious on a CT scan that they thought could be ovarian cancer. But the recommendation that the patient get a pelvic ultrasound fell through the cracks. Months later, she was diagnosed with stage 3 ovarian cancer. Normally, this type of medical mistake could mark the start of a protracted malpractice lawsuit. But in Massachusetts, where medical, legal and consumer groups have worked together in support of a recently enacted law that tries to preempt litigation by establishing a process and timeframe for discussing mistakes, that’s not what happened, according to her attorney who recounted the case in an interview. (Andrews, 1/20)

It was hardly surprising that a president who expects so little from Congress devoted some of his speech to celebrating the things that he has accomplished against considerable odds. With Congress’s help, he rescued the automobile companies, jump-started the renewable energy industry, imposed new rules on financial institutions and, most dramatically, engineered a major overhaul of the health care system. ... His task will be to defend these initiatives from almost certain congressional attack, wielding his veto pen, or threatening to wield it, much as President Bill Clinton found himself doing after Newt Gingrich and his Republican majority took over the House in 1995. (1/20)

While Medicare and Social Security dominate discussion about entitlement reform, too little attention is paid to the dire financial straits of the Social Security Disability Insurance trust fund. Without legislative action, SSDI benefits will be cut nearly 20% by the end of 2016. Congress likely will pass a short-term measure to shore up the trust fund and enable it to pay full benefits. But to survive long term, the program needs far-reaching reform. (Lanhee J. Chen, 1/20)

During the past half century, the supply of inpatient psychiatric beds in the United States has largely vanished. In 1955, 560 000 patients were cared for in state psychiatric facilities; today there are fewer than one-tenth that number: 45 000. Given the doubling of the US population, this represents a 95% decline, bringing the per capita public psychiatric bed count to about the same as it was in 1850—14 per 100 000 people. A much smaller number of private psychiatric beds has fluctuated since the 1970s in response to policy and regulatory shifts that create varying financial incentives. As a result, few high-quality, accessible long-term care options are available for a significant segment of the approximately 10 million US residents with serious mental illness. (Dominic A. Sisti, Andrea G. Segal and Ezekiel J. Emanuel, 1/20)

Death and taxes might be life’s only certainties, but birth and deductibles are poised to become their equivalent in the private US health system. Childbirth is the most frequent reason for hospitalization in the United States, and high-deductible health plans (HDHPs)—combined with their high out-of-pocket cost “bronze” counterparts in state health exchanges—will soon become the most common insurance arrangements for expectant mothers. Although the Affordable Care Act (ACA) mandates that health insurers cover birth hospitalizations, it does not limit cost sharing except through relatively high annual out-of-pocket maximums. Thus, childbirth-related cost sharing may increase markedly for US families in the coming years. (J. Frank Wharam, Amy J. Graves and Katy B. Kozhimannil, 1/20)

Governor Corbett will leave office today. Unfortunately for working Pennsylvanians, his vision for health care – more bureaucracy, higher costs, more complexity and fewer benefits – will remain. That is, unless incoming Governor Wolf sets about immediately to reverse course on Corbett’s direction. (Antoinette Kraus, 1/20)

Republican legislators think that changing Medicaid’s oversight structure will fix problems in predicting costs for the federal/state health care program. That’s not necessarily so, given how the rolls change depending upon eligibility, population and economic conditions. ... Advocates for the poor are rightly suspicious of Republicans who now talk of setting up an independent board to run Medicaid. After all, GOP lawmakers and Gov. Pat McCrory have balked at expanding Medicaid. (1/20)

The Affordable Care Act has fostered major enhancements in our health care system and improved the lives of millions of people who are newly insured and getting care. Community-based health centers played a major role in that progress by expanding services and providing free or affordable care to many more people, thanks to increased federal funding. (H. Duane Taylor, 1/20)

Top healthcare executives who gathered in San Francisco this past week at the J.P. Morgan Healthcare Conference widely agreed that the healthcare reform law's coverage expansion and other provisions are not in jeopardy at the hands of congressional Republicans or the Supreme Court. Really? (Harris Meyer, 1/17)

In just 15 years, one in every four Coloradans will be 60 or older. This unprecedented demographic shift has important implications for all. Addressing it begins with good planning. Medicaid is a critical safety net for tens of thousands of Coloradans, including thousands of seniors. But, especially with seniors, it often is not the most cost-effective option for those in need of some assistance. (Ed Shackelford, 1/20)

“All new patients have an x-ray before seeing the doctor.” As a physician, I found this sentence baffling—I had been taught that the physician’s role is to first see a patient, take a detailed history, perform an examination, and consider the differential diagnoses. Only then could I consider the investigations required to get closer to a diagnosis and determine a treatment plan. As a patient, however, my experience was different. (Dr. Sunita Sah, 1/19)