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House Republicans called it streamlining, empowering states or “achieving sustainability.” They couched deep spending reductions in any number of gauzy euphemisms. What they would not do on Tuesday was call their budget plan, which slashes spending by $5.5 trillion over 10 years, a “cut.” ... The plan contains more than $1 trillion in savings from unspecified cuts to programs like food stamps and welfare. To make matters more complicated, the budget demands the full repeal of the Affordable Care Act, including the tax increases that finance the health care law. But the plan assumes the same level of federal revenue over the next 10 years that the Congressional Budget Office foresees with those tax increases in place — essentially counting $1 trillion of taxes that the same budget swears to forgo. (Weisman, 3/17)

Senate Republicans are putting down a marker with their budget blueprint, one day after the House GOP unveiled a 10-year plan that boosts the military, makes deep cuts in social programs and targets President Barack Obama's laws on health care and financial reforms. Slated for release Wednesday afternoon, the GOP senators' companion measure contains greater cost cuts to Medicare — $431 billion over the coming decade, which matches Obama's savings if not his policies — but doesn't call for the dramatic transformation of the program for future beneficiaries that House Republicans are pushing. (Taylor, 3/18)

Senate Republicans, led by Budget Chairman Mike Enzi, R-Wyo., will unveil a competing budget resolution Wednesday. Both chambers are scheduled to vote on their plans next week, with a goal of passing a joint budget resolution by the April 15 statutory deadline. (Davis, 3/17)

House Republicans released a 2016 spending blueprint Tuesday that seeks to fulfill the GOP goal of balancing the budget in 10 years, but does so by slashing Medicare and other safety net programs while dramatically boosting military spending. The proposed annual budget, at $3.8 trillion, promises to lower taxes and revisits well-worn Republican ideas for shrinking government, including its signature proposal for overhauling Medicare with a voucher-like private insurance option. (Mascaro, 3/17)

The [House] plan uses a budgetary maneuver, already contentious, designed to address the concerns of both defense hawks worried about curbs in military spending and deficit hawks uneasy over waning fiscal discipline. It would boost military spending through the use of emergency war funds that aren’t subject to congressionally mandated spending caps, known as the sequester. ... The budget blueprint maintains last year’s overarching focus on eliminating the deficit, with savings also generated by a repeal of the Affordable Care Act. It relies on several policy proposals introduced in recent Republican budgets. (Timiraos and Peterson, 3/17)

The plan, which pares more than $5 trillion from the federal budget, will instantly renew long-running hostilities with the White House and Democrats regarding spending and debt. But the biggest clash is likely to be between GOP budget hawks determined to reduce spending and defense hawks who want to bolster the Pentagon in the face of rising threats from the Islamic State and other terrorist groups. (Kane and Wilson, 3/17)

[House Budget Committee Chairman Tom] Price is also projecting $2 trillion in savings over the next decade from repealing the 2010 Affordable Care Act, according to documents provided by the Budget Committee. That, of course, is not going to happen while Obama is still in the White House. Another $913 billion in savings would come from turning Medicaid into a block grant program, as well as changes to other federal health programs. Those proposals will run into strong objections from Democrats and the Obama administration as well. In addition, Price is estimating more than $1 trillion in cuts to other “mandatory” or entitlement programs, including food stamps. The federal food stamp program, formally known as the Supplemental Nutrition Assistance Program, would be turned over to state control starting in 2021. (Bresnahan, 3/17)

The Republican proposal would leave Social Security untouched and reduce projected spending on Medicare by 2 percent over 10 years while making steep cuts in projected spending for Medicaid and other health programs and eliminating all spending for the Affordable Care Act. ... It was a contrast to the budget Obama proposed Feb. 2, which seeks to boost middle-income families through new programs paid for by more taxes on wealthy Americans. Obama would also use a one-time tax holiday to bring home foreign earnings in order to pay for major infrastructure spending. His plan would not balance the budget, instead leading back to $1 trillion-plus annual deficits. (Hall, 3/17)

The spending plan stands little chance of ever being signed by President Obama, but makes clear that the party is not dialing back its ambitions despite a rocky start to the latest congressional session. After some internal debate over the Republican strategy for taking on the Affordable Care Act, the budget plan renews GOP calls to repeal and replace the law. (3/17)

A new round of cuts to a popular program that provides health care to seniors will touch off a spate of partisan finger-pointing in the coming weeks, handing Republicans a new opportunity to blast the Obama administration. The Centers for Medicare and Medicaid Services is expected to announce in April how much it will cut from payments in 2016 to health insurers for Medicare Advantage, the popular program that covers seniors through private HMO and PPO plans. CMS in February recommended a 0.9 percent cut, though the agency may cut up to 0.95 percent, which would result in seniors paying higher premiums. (Wilson, 3/17)

The House Republican budget proposal got a chilly reception at the White House on Tuesday, with President Barack Obama saying that it failed to make necessary investments in the country’s future. “It’s not a budget that reflects the future. It’s not a budget that reflects growth,” Mr. Obama said in remarks to reporters in the Oval Office. “It’s not a budget that is going to help ensure that middle-class families are able to maintain security.” (Tau, 3/17)

President Barack Obama is criticizing a $3.8 trillion budget plan put forward by House Republicans, saying it won’t invest in “all the things that we need to grow.” ... The House Republican plan would favor the Pentagon and partially privatize Medicare and slash other social programs to help eliminate deficits at the end of a decade. Senate Republicans were outlining their budget plan on Wednesday. (Superville, 3/18)

Clinton blasted a budget proposal released by Republicans on Tuesday, saying on Twitter it "fails Americans" on investments in jobs and economic growth, would cut college aid for students and undermine President Barack Obama's health care law. It was the second straight day that the former secretary of state turned to social media to criticize Congress, a tactic used extensively by President Barack Obama during his 2012 re-election campaign. (Thomas, 3/17)

Bipartisan House leaders are working on a $213 billion plan to permanently change how doctors are paid for treating Medicare patients, a costly problem that's vexed Congress for years, a document circulating among lawmakers showed Tuesday. Many of the tentative plan's details had already been disclosed by lobbyists, legislators and congressional aides. Some particulars were new, such as setting a 2020 starting point for higher out-of-pocket expenses for people buying new Medigap policies, which cover costs not insured by Medicare. (Fram and Taylor, 3/17)

Senate Democrats insist they’ll hold a hard line on four years of CHIP funding in the House’s Medicare SGR deal, which is expected to fund the children’s health insurance program for only two years. (Haberkorn and Mershon, 3/17)

A widely supported anti-trafficking measure stalled again in the Senate over a contentious abortion provision, which Democrats refuse to accept. Minority Leader Harry Reid, D-Nev., was unapologetic as he rallied his party to reject 55-43 cloture on the bill (S 178), which would use fines and penalties against perpetrators for restitution and assistance funds for victims. Sixty votes were needed to advance the bill. (Chacko, 3/17)

The Senate remains deadlocked over what appeared to have an easy bipartisan bill. The legislation creates a victims restitution fund for victims of human trafficking, typically children. But Democrats object to language they say only recently discovered that bans federal money for abortions. One consequence of the logjam is a delay for a vote on attorney general nominee Loretta Lynch. (Chang, 3/18)

Obamacare Medicaid expansion can’t seem to catch a break. Expansion plans have received lethal blows in some red states and are barely hanging on in others. Republican governors in Tennessee and Wyoming were swiftly shot down by their own GOP Legislatures earlier this year on their plans to cover more low-income people. Montana Democratic Gov. Steve Bullock’s idea met the same fate at the hands of a GOP-dominated state Legislature. (Pradhan, 3/17)

As a Republican state senator on Tuesday unveiled his plan to expand Medicaid coverage for thousands of low-income Montanans, he called it a “nonpartisan, long-term solution” that will provide health care and a “path out of poverty” for the poor. But while Great Falls Sen. Ed Buttrey claims bipartisan support for his plan, it has considerable hurdles to clear before it takes effect. A leader of GOP conservatives in the Legislature declared the plan to be “worse than the governor’s,” which House Republicans killed last week. (Dennison, 3/17)

With the governor’s Medicaid expansion proposal defeated, a Great Falls lawmaker unveiled another health coverage plan Tuesday that seeks to reduce the number of people in poverty and, over time, reduce the number of people who qualify for Medicaid. The Montana Health and Economic Livelihood Partnership (HELP) Act was introduced by Republican Sen. Ed Buttrey in a news conference at the Capitol. It would accept federal funds to expand Medicaid eligibility to people with incomes at or below 138 percent of the federal poverty level — about $16,200 per year for an individual in 2015 — but coverage would also come with various strings attached. (Bauman, 3/17)

Supporters of expanding Medicaid in Kansas are finally getting an opportunity to make their case to lawmakers. Republican legislative leaders opposed to expansion have blocked hearings on the issue for two years. They agreed to allow hearings this year only after supporters in the Kansas House threatened to force an immediate vote on the floor. (McLean, 3/17)

Faith leaders are calling on Nebraska lawmakers to pass a new version of a Medicaid expansion bill that is slated for debate this year. Church pastors circulated a letter Tuesday signed by more than 175 faith leaders in support of the Medicaid Redesign Act. (Ozaki, 3/17)

After weeks of saying he wouldn't, Gov. Bill Walker reversed course and on Tuesday answered legislators' demands that he introduce his own bill to expand Medicaid. Walker's legislation would expand Medicaid eligibility to some 40,000 Alaskans by accepting $146 million from the federal government through the Affordable Care Act. It also puts forward some reforms to the program. (Buxton, 3/17)

After failing to expand Medicaid through a budget item, Gov. Bill Walker is trying again. He has introduced a standalone bill that would allow the state to accept federal funding for Medicaid expansion, while also offering some reform measures. When he was campaigning for governor, Bill Walker aggressively stumped on the issue of Medicaid expansion. (Gutierrez, 3/17)

Federal officials are objecting to a compromise plan intended to quell a dispute among the state’s health insurers. State officials floated an idea this month to phase in over several years a new measure of the Affordable Care Act that requires some insurers to make payments to others, based on the health of their patients. (Dayal McCluskey, 3/17)

A member of the board that oversees the state exchange where people buy insurance plans under health reform said the entity needs to take more care in approving contracts. "I think we can do this with a little more deliberation," said the board member, Dr. Georges Benjamin, who was also state health secretary under Gov. Parris N. Glendening. (McDaniels, 3/17)

Premiums in Georgia’s insurance exchange showed only a slight increase in 2015, as compared with the South overall and the nation as a whole, according to a new analysis released Tuesday. The Urban Institute study found that nationally, the average premium increase in the lowest-cost “Silver” plan was 2.9 percent. ... The Georgia increase in the lowest-cost Silver plan was just 1.8 percent in 2015, rising from $255 to $260 a month. (Miller, 3/17)

Obamacare’s employer mandate on large businesses barely had an impact on enrollment in employer- sponsored plans this year, according to a new survey. Human resources firm Mercer on Tuesday released a survey of 572 employers and found very little change between 2014 and 2015 in the average number of full- and part-time workers getting health coverage through their job. (Pradhan, 3/17)

More than 3.3 million children could lose their health care coverage if Congress does not renew the Children’s Health Insurance Program, the Supreme Court strikes down subsidies in the federal marketplace and states scale back coverage. That scenario is the most dramatic of seven situations affecting children’s coverage that the Urban Institute analyzed in a report released Tuesday. (Adams, 3/17)

The price of the cheapest ObamaCare plan increased an average of 2.9 percent nationally, according to a new report by the Urban Institute. The new data, which were collected frome every state over the last year, ease widespread concerns that ObamaCare was fueling massive premimum hikes. (Ferris, 3/17)

While it has traditionally relied on its ability to provide high-priced specialty care, the system, along with every stand-alone community hospital and large academic medical center, is being forced to remake itself. Patients are increasingly seeking care outside the hospital — in a family health center, a doctor’s office, a drugstore or at home. Medicare and other insurers are moving away from volume-based payments to new models, to pay less for better care. (Abelson, 3/17)

Health insurer Premera Blue Cross said hackers gained access to the personal information of around 11 million consumers, including bank account and clinical data for some. Premera, a Washington state-based not-for-profit, said it detected the breach on Jan. 29, but the incursion may have initially occurred last May. The records exposed could include names, birthdays, Social Security numbers and addresses, as well as bank-account information and health data from claims paid by the insurer, said Eric Earling, a Premera spokesman. (Wilde Mathews and Yadron, 3/17)

A data breach may have exposed sensitive information of 11 million customers and employees of a major health insurer in the northwest United States. Premera Blue Cross, based near Seattle in Mountlake Terrace, Wash., said it discovered Jan. 29 that it had been the victim of a “sophisticated attack” that gained access to its information technology systems. (Pfeifer, 3/17)

Premera Blue Cross, a health insurer based in the Pacific Northwest, said Tuesday that it was the victim of a cyberattack that could affect 11 million people. The company said hackers gained access to its systems on May 5 and that it did not discover the breach until Jan. 29. (3/17)

A large American insurer said Tuesday that hackers broke into its computer systems last year, exposing the data of 11 million people. Premera Blue Cross, based in the Pacific Northwest, said hackers "may have" accessed millions of health profiles that included Social Security numbers, birthdays, emails, physical addresses, bank account information, clinical information and detailed insurance claims. (Pagliery, 3/17)

Premera Blue Cross, a health plan in the Pacific Northwest, was hit with the second-biggest cyberattack in healthcare industry history, exposing the personal, financial and medical information of more than 11 million customers. The Mountlake Terrace, Wash.-based company discovered the attack on Jan. 29, 2015. An investigation revealed that the initial attack occurred May 5, 2014. The breach affected Premera Blue Cross, Premera Blue Cross and Blue Shield of Alaska, and Premera affiliate brands Vivacity and Connexion Insurance Solutions. (Rubenfire, 3/17)

The federal electronic health-record incentive program has produced too few benefits for the cost involved and imposed overly harsh mandates on providers, senators of both parties said Tuesday during a Senate Health, Education, Labor and Pensions Committee hearing. The program started in 2009 by giving providers and hospitals cash in exchange for using EHR systems. Its goal was to improve care by moving data seamlessly through the healthcare system, but, “The evidence suggests these goals haven't been reached,” said Committee Chair Sen. Lamar Alexander (R-Tenn.). (Tahir, 3/17)

Federal regulatory efforts to create a unique identifier system for medical devices has raised concerns that incorporating such data on insurance claims will add yet another stumbling block to healthcare's implementation of electronic health-record systems. As a result, “I think the whole process is going to go better if we're very thoughtful about starting with UDI cases where the clinical benefits and the administrative burden reduction benefits are the greatest,” said Dr. Mark McClellan, a senior fellow and director of the Health Care Innovation and Value Initiative at the Brookings Institution. (Johnson, 3/17)

The New York attorney general has reached agreement with the largest upstate health insurer to cover more mental health and addictions treatment for its 1.5 million members. The settlement with Rochester-based Excellus Health Plan cites recent state and federal laws requiring mental health coverage at the same level as medical treatment. (3/18)

While legislation expanding how and where Texans can carry weapons is dominating the Legislature this week, one state lawmaker is targeting the doctor's office as a place to keep the federal government from learning who owns guns. Over the objections of the medical community, state Rep. Stuart Spitzer, R-Kaufman, has filed a bill that would prohibit doctors from asking patients whether they own a firearm and makes the Texas Medical Board, which licenses physicians, responsible for doling out punishment. (Walters, 3/18)

Attorney General Maura Healey on Tuesday proposed banning the sale of e-cigarettes to people younger than 18 and subjecting the devices to the same sales restrictions applied to traditional cigarettes. The regulations, which Healey can put into effect after seeking public comment, would help standardize practices around the state, where Boston and 151 other municipalities, representing nearly two-thirds of the population, have enacted age-based limits on e-cigarettes. (Freyer, 3/17)

Every few years, stories appear about Vashon Island and its high percentage of unvaccinated kids. It happened again a few weeks ago in the wake of reports of measles outbreaks nationwide. Then the temporary publicity fades and this island of 11,000 goes back to the same old, same old. Which is: a deep divide between the pro and con camps that in most other ways are so much alike. Except that this time it got pretty vitriolic. (Lacitis, 3/17)

The Arizona House has scheduled debate on a bill barring women from buying any health care plan through the federal marketplace that includes abortion coverage after a one-day delay. Debate on the proposal backed by the Center for Arizona Policy is now set for Wednesday. (3/18)

The Montana House backed a bill this week that would ban abortion via telemedicine while rejecting a motion to amend the legislation to "protect" men from vasectomy in the same manner. House Bill 587, sponsored by GOP Rep. Keith Regier of Kalispell, Mont., would make it a crime for doctors to administer pregnancy-ending pills without being in the same room — but telemedicine abortion is not happening in the state now. Regier said his concerns with abortion via telemedicine are that the doctor prescribing the pills may not have determined exactly how far along in a pregnancy the woman is nor whether she may have complications from an ectopic pregnancy. (Inbody, 3/17)

The Utah Legislature took a step last week into territory where state lawmakers rarely tread. It passed a law giving children conceived via sperm donation access to the medical histories of their biological fathers. The law itself stirred no controversy. The oddity was that the legislature ventured into the area of “assisted reproduction” at all. Assisted reproductive technology (ART) helps infertile couples to conceive. Compared to many other industrialized nations, neither the U.S. nor state governments do much to oversee the multibillion-dollar industry. (Ollove, 3/18)

Los Angeles County supervisors chided officials with the L.A. Care public health plan after an audit found that the agency spent $476,000 on meals and entertainment between October 2013 and January of this year. The audit released last week found that the health plan -- an independent tax-exempt agency that has a $4.1-billion annual budget and provides managed healthcare services to low-income county residents -- was in good financial shape and that administrative costs were lower than those of other similar plans. (Sewell, 3/17)

[House Budget Committee Chairman Tom] Price’s budget would slow the annual growth of federal spending to a manageable 3.3% on average from the current 5.1%. That’s no small achievement given the accumulating obligations for ObamaCare and baby boom retirees. Mr. Price does this with targeted policy changes to the real drivers of the federal debt—the open-ended entitlement state. Mr. Price retains Mr. Ryan’s “premium support” reform, which would gradually modernize Medicare by introducing more competition among insurers and more individual choice of health plans. The budget also calls for repealing ObamaCare, and it makes a valuable contribution on Medicaid, which as a share of GDP has increased 240% since 1980 and is due to rise another 75% over the next 10 years. (3/17)

The plan’s deep cuts land squarely on the people who most need help: the poor and the working class. The plan also would turn Medicare into a system of unspecified subsidies to buy private insurance by the time Americans who are now 56 years old become eligible. And it would strip 16.4 million people of health insurance by repealing the Affordable Care Act (the umpteenth attempt by Republicans to do so since the law was enacted in 2010). (3/18)

The budget proposal released by House Republicans on Tuesday promises it can repeal Obamacare and save the government a lot of money in the process. But the document relies on some vague accounting to justify this claim. It is easy, of course, to save the federal budget a lot of money by simply eliminating the spending provisions of the Affordable Care Act. Getting rid of the law’s Medicaid expansion to low-income people and its premium subsidies for middle-income insurance shoppers would save about $2 trillion over 10 years, according to the House budget estimates. That number is published clearly and prominently in the budget’s accompanying tables. Less explicitly accounted for is the fact that the health law ... was also designed to reduce the deficit. (Margot Sanger-Katz, 3/17)

The Republican assertion that "Obamacare is not working" fits this definition perfectly. You'll find it, among other places, on Page 16 of the budget resolution released Tuesday by the GOP-controlled House Budget Committee. There the magic power of the incantation is designed to justify repealing the Affordable Care Act in its entirety, a central goal of the budget resolution. The Republicans should hope that the magic is strong, because the mantra will have to do battle with hard facts and figures that flatly contradict it. (Michael Hiltzik, 3/17)

[T]he majority-Republican House has produced a budget blueprint that serves no particular purpose except to demonstrate the inadequacy of pure, no-tax-increases GOP policy doctrine. To be sure, the document calls for an essentially balanced budget by 2025, which would reduce debt held by the public to 55 percent of GDP. It achieves this, however, entirely by cutting scheduled spending by $5.5 trillion , the largest chunk of which would be a $2 trillion 10-year savings from repealing the Affordable Care Act — which is neither sensible nor politically feasible. (3/17)

It was altogether fitting that Republicans rolled out their budget during a festival of inebriation in honor of the man who magically (and apocryphally) banished snakes from Ireland. What Republicans have done with their budget is no less fantastic: They have employed lucky charms and mystical pots of gold to make them appear more sober about balancing the budget than they actually are. ... It proposes to repeal Obamacare but then counts revenues and savings from Obamacare as if the law remained in effect. ... It doesn’t account for the $200 billion plan now being negotiated to increase doctor payments under Medicare and to extend a children’s health-care program. (Dana Milbank, 3/17)

Programs that provide affordable health coverage for the middle class (Obamacare, which they repeal) and the poor (Medicaid, which is “block granted”) face large spending cuts. Future elderly persons do not escape unscathed, either, as Medicare is “voucherized” beginning in 2024. The budget includes more than $1 trillion in unspecified cuts that would appear to fall on nutritional support for the poor and tax credits for low-income, working families. (Jared Bernstein, 3/17)

The plan, released Tuesday, leads with a broad principle that middle-class voters -- and all voters, really -- endorse: It reduces the deficit and, in 10 years' time, balances the budget. But the road to balance is paved with budget cuts that middle-income voters, polls show, don't much care for. As they have in past years, Republicans are proposing to cut spending on Medicaid, food stamps and, eventually, Medicare. They'd also repeal the Affordable Care Act and reduce taxes on investment income and corporations. Those cuts are likely to balance the budget more on the backs of the poor than of the middle class (though you can make a case, as the Congressional Budget Office did on Tuesday, that falling deficits will eventually lead to stronger economic growth for the entire nation). (Jim Tankersley and Scott Clement, 3/17)

Looking back, [Wilbur] Cohen’s prescription [that only universal programs that served all Americans could achieve the broad political support] looks spot on. Social Security and Medicare remain the most politically robust bits of the United States’ social insurance apparatus — survivors of repeated attempts at privatization. Almost everything else, including food stamps and child subsidies for the poor, is vulnerable. (Eduardo Porter, 3/17)

Could the Barack Obama administration really ignore an adverse Supreme Court judgment in the King v. Burwell health-care litigation, as a University of Chicago law professor has proposed? Of course not. Obeying the court only with respect to the plaintiffs in this case would be a flagrant violation of the rule of law. It would put the administration in the position of flouting the court’s authority. It would be substantially more outrageous even than the Alabama Supreme Court’s order to its probate judges to ignore a federal ruling striking down the state’s anti-gay-marriage law. For these reasons, it’s also completely unrealistic. (Noah Feldman, 3/17)

We already know that a ruling against the Obama administration in King v. Burwell, this year’s Affordable Care Act Supreme Court case, would be a public health disaster: Millions of people would lose insurance coverage, and insurance markets across the country would stumble out of balance. But what would happen to children, a vulnerable group with specific health-care needs that any rational society would address? The nonpartisan Urban Institute released an analysis Tuesday that games out the possibilities. The bottom line: In a worst-case scenario, a whopping 3.3 million more kids could end up without health coverage. (Stephen Stromberg, 3/17)

Recently, the Centers for Medicare and Medicaid Services declared that Medicare would now be paying for lung cancer prevention with spiral CT scans. The scans would be offered annually to people between the ages of 55 and 77 with at least a 30-pack year smoking history (calculated by multiplying packs per day by the number of years smoking) and who either still smoke or who quit less than 15 years ago. The controversial decision came four years after the National Lung Screening Trial (NLST) of 53,000 current or former heavy smokers demonstrated what was characterized as a 20 percent reduction in lung cancer death among those who had annual spiral CT scans of their lungs. Before meaningful shared decision making between doctor and patient can ensue, it is important for both to understand the actual risks and benefits of spiral CT screening in absolute terms. (Andrew Lazris and Erik Rifkin, 3/17)

The Institute of Medicine (IOM) report Dying in America concluded that patients near the end of life often receive undesired, burdensome treatments and called for improvements in advance care planning to ensure that patients’ values guide medical care. There is no clear path to accomplish this because there are major shortcomings to existing advance care planning. ... In this Viewpoint, we propose 2 interrelated strategies to create the next generation of advance care planning tools: (1) leveraging web-based technologies to create online interventions and (2) using the science of user-centered design to ensure that advance care planning meets the needs of patients, families, and clinicians. (Drs. Jared Chiarchiaro, Robert M. Arnold and Douglas B. White, 3/17)