Yet despite that interest, abortion is not top of mind for many voters, found. Three-quarters of registered voters said inflation and gas prices were their top concerns when considering decisions in the upcoming midterm elections. Abortion access was a key priority for 55% of voters, about the same as health care costs and gun violence. That was up from the 46% recorded by a Â鶹ŮÓÅ poll in February, after the Supreme Court had heard arguments in the case.

Democrats were much more likely to cite abortion as a top issue in their voting considerations than Republicans or independents. Increased concerns among female voters ages 18 to 49 were also evident in the poll, which found nearly 3 in 4 of them said abortion access was very important in their election considerations, up from 59% in February. Large majorities of Democratic and independent women in that age group said they want their states to guarantee abortion access, as do 4 in 10 Republican women of reproductive age.

The Supreme Court’s decision, however, does not appear to have had the galvanizing effect that some politicians expected. The poll found just a small increase in the percentage of voters who said they are now more motivated to vote from the percentage in May — 43% compared with 37% — after a leaked draft opinion from the court was published.

Among some key groups, however, the issue was more salient. About 6 in 10 female voters of reproductive age, up from 42% in May, said they are more likely to vote following the decision. Democratic and independent voters each reported a 9 percentage point increase among those who said abortion access was a motivating factor for the fall elections. A majority of Hispanic voters also said they are now more likely to vote.

More than half of independent voters and 83% of Democratic voters said they would support candidates who promise to protect abortion rights. One in 5 Republicans said the same, but just over half of GOP voters said they will favor candidates who want to limit abortion access.

The court’s decision appears to have created a split among Republican women, the poll found. A third said they disapprove of the decision and about a quarter of them say they plan to support a candidate who favors abortion access. The majority, however, said they will vote for people seeking to limit abortion.

Just over half of people living in states with pre-Roe abortion bans or laws that triggered bans or severe restrictions if Roe was overturned said they would rather have the state guarantee abortion access, while 32% of residents in those 17 states said they favor abortion bans.

Non-Hispanic Black Americans were also strongly opposed to their states banning abortions. Eighty-six percent said they did not want abortion bans, compared with 70% of non-Hispanic whites and 69% of Hispanic respondents. At the same time, 68% of Black Americans said they wanted their states to guarantee abortion rights, compared with 60% of white respondents and 61% of Hispanics. (Hispanics can be of any race or combination of races.)

The poll, conducted July 7-17 online and by telephone, has a 4 percentage point margin of sampling error for the full sample. For some of the subgroups, the margin of sampling error may be higher.

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The changes were hailed by religious groups, including the U.S. Conference of Catholic Bishops, it was “a return to common sense, long-standing federal practice and peaceful coexistence between church and state.” But others, including the National Women’s Law Center, said they plan to file suit against the rules. The National Health Law Program said that the rules appeared “legally suspect.”

Here are some frequently asked questions and answers about the new rules.

Q: What is the new policy?

Trump administration they are significantly rolling back rules requiring many insurers to provide contraceptive coverage to women. Employers with a moral or religious objection to contraceptive services will be allowed to stop offering that coverage.

Under provisions of the Affordable Care Act, the Obama administration had requiring most plans to cover all contraception methods that have been approved by the Food and Drug Administration with no out-of-pocket cost to women.ÌýThe provision does not cover plans that have a grandfathered status under the law.

That guarantee was whittled back through regulation and court actions to exempt some religious-based organizations, such as churches, and some privately held companies in which the owners have strong objections to contraception. Other nonprofit religious employers were offered an accommodation so that they didn’t contract or pay for the insurance coverage for their workers.

The rules unveiled Friday expand those exemptions to any nonprofit organizations and for-profit companies with firm religious opposition, as well as health plans provided to students at colleges with a religious affiliation. A second rule extends an exemption to organizations and privately held companies that have moral objections.

If an employer doesn’t have any moral or religious objections to contraception coverage, current ACA guidelines still apply. Federal policy for programs that offer free or subsidized coverage to low-income women also will not change.

The rules become effective as soon as they are published in the Federal Register, which is expected soon. View them online and .

Q:ÌýWho is covered by the ruling?

Exactly who will be affected is in dispute.

In a , the Department of Health and Human Services said that the rules “will not affect over 99.9 percent” of the 165 million women in the United States. The exemptions announced Friday, HHS said, “may impact only about 200 entities, the number that filed lawsuits based on religious or moral objections.”

Groups that favor the ACA’s contraception coverage say the impact will be far larger.

“The Trump administration just took direct aim at birth control coverage for 62 million women,” Cecile Richards, president of the Planned Parenthood Federation of America, said in a statement. “With this rule in place, any employer could decide that their employees no longer have health insurance coverage for birth control.”

Mara Gandal-Powers, a senior counsel at the National Women’s Law Center, said that even though many employers will not change their coverage, women in some places could find it difficult to get the health care they need.

HHS estimated in 2015 that were covered by policies that provide no-cost contraceptives. The number of women paying for contraceptives fell from nearly 21 percent in 2012 to by 2014, according to the Kaiser Family Foundation. Ìý(Kaiser Health News is an editorially independent program of the foundation.)

While some employers will be exempt from the ACA rules covering contraception, they may not be exempt from applicable state laws. Eight states currently have laws to employees, while another 20 states have laws requiring coverage of prescription contraceptives with the option of asking employees to pay some of the cost. Those state laws still apply, said Laurie Sobel, associate director of women’s health policy at the Kaiser Family Foundation.

Q: How have the courts ruled previously on the ACA and contraception coverage?

In 2014, the Supreme Court voted 5-4 to allow a key exemption to the health law’s contraception coverage requirements when it ruled that closely held, for-profit businesses could assert a religious objection to the Obama administration’s regulations.

The court’s majority said that the companies that filed suit — Hobby Lobby Stores, a nationwide chain of 500 arts-and-crafts stores, and Conestoga Wood Specialties, a custom cabinet manufacturer — did not have to offer female employees all of the Food and Drug Administration-approved contraceptives as part of a package of preventive services that must be covered without copays or deductibles under the law. The companies had argued that several types of contraceptives violate their owners’ religious beliefs.

The companies are family-owned, and they said that the health law’s contraception requirement violated their religious views. While both employers’ health plans covered some forms of birth control, they found some forms of emergency contraceptives objectionable, such as Plan B and Ella that can prevent a pregnancy if taken within a short window after unprotected sex. They said these contraceptive methods prevent a fertilized egg from implanting in the woman’s uterus and therefore are a type of abortion.

In another lawsuit, religious groups, including the Little Sisters of the Poor, an order of Roman Catholic nuns, said that complying with an Obama administration accommodation for religious-affiliated groups violated their religious views. In May 2016, the Supreme Court sent that lawsuit back to the lower courts to see if a compromise was possible.

Q: How does the Obama administration’s accommodation work?

The Obama administration’s policy also did not apply to churches or houses of worship. And in response to protests from other nonprofit religious organizations — such as church-affiliated hospitals or schools — officials set up an accommodation that allowed those employers to not contract for contraceptive coverage as part of the insurance that they offered workers. Instead, the insurance plan that served their employees would provide coverage, at no cost, to the workers. Some of those groups, such as the Little Sisters of the Poor, objected to this setup and challenged the policy in court.

KHN’s coverage of women’s health care issues is supported in part by .

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Medical debt is worrisome and embarrassing, but more importantly, it can have long-term financial consequences.

Here are some tips that may be helpful to avoid or alleviate medical debt:

— Try to talk to your doctor or hospital before being treated to find out what the services will cost and how much your insurance will cover. Don’t be afraid to tell the provider that you don’t have the money up front and try to work out ahead of time a payment plan for your share of the bill. Estimate your ability to pay honestly so that you don’t find yourself responsible for monthly payments you cannot cover. Both insured and uninsured patients can sometimes qualify for programs to help with the cost of their care.

— When negotiating a price with your doctor or hospital, ask if they will accept the price that pays for the treatment.ÌýThat can be considerably cheaper than the price they offer individuals.

— Check your . Make sure the charges are for care you actually received and no mistakes were made.Ìý A found that in 2010, about 9 million people were contacted by a collection agency because of a billing mistake.

—ÌýWatch your mail for the “explanation of benefits,” or EOB, from your insurer. It is often the most reliable way to know what you owe.

— Make sure that the bill from your hospital or doctor includes payments made by your insurance company. If the provider’s bill doesn’t jibe with your EOB, check with the insurer. Perhaps that company still has its portion to pay or there is some problem with the bill the insurer received from your doctor that can be remedied to reduce your charges.

— If you bought a silver plan on the online insurance marketplaces set up under the health law, see if you qualify for cost-sharing subsidies. Those may help bring down your out-of-pocket expenses.Ìý

— Be careful about paying for your medical debt with a credit card. They can often have very high interest rates that may make the debt even more difficult to pay off. Also, be careful about accepting a doctor’s offer of a credit card to put that debt on. Some of those cards have come under scrutiny for fraudulent practices. Ìý

— Don’t hesitate to ask a family member or friend to help you understand the bills. Patients can often be too sick to make the calls and do the research needed to stay on top of the billing. Ask someone you trust to give you a hand.

— If you need other help, many states have consumer affairs offices or the office of the state attorney general may have information or resources than are helpful to patients facing debt concerns.Ìý Non-profit counseling services and the state-based civil legal services offices may also be helpful.

Sources:Ìý Washington Law Help.org, The Wisconsin Department of Health Services, The National Foundation for Credit Counseling, The Kaiser Family Foundation, The Commonwealth Fund, The American Academy of Family Physicians.

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: Amid Pressure, House Passes Fiscal Deal Ending a climactic fiscal showdown in the final hours of the 112th Congress, the House late Tuesday passed and sent to President Obama legislation to avert big income tax increases on most Americans and prevent large cuts in spending for the Pentagon and other government programs. … In approving the measure after days of legislative intrigue, Congress concluded its final and most pitched fight over fiscal policy, the culmination of two years of battles over taxes, the federal debt, spending and what to do to slow the growth in popular social programs like Medicare (Steinhauer, 1/1).

: Congress Passes Cliff Deal But the compromise bill, which blocked most impending tax increases and postponed spending cuts largely by raising taxes on upper-income Americans, left a host of issues unresolved and guaranteed continued budget clashes between the parties. … At the same time, the bill defers some of America’s toughest spending problems—in particular the ballooning cost of health care—and it doesn’t come close to the kind of $4 trillion deficit-reduction deal the country’s leaders had hoped to negotiate (Hook, Boles and Hughes, 1/2).

For more headlines …

: Divided GOP House Approves Senate ‘Fiscal Cliff’ Plan A divided Republican House passed the Senate’s “fiscal cliff” agreement Tuesday night, following a tense day of GOP protests that the plan does not do enough to rein in federal spending. … Spending cuts totaling $24 billion over two months aimed at the Pentagon and domestic programs would be deferred. That would allow the White House and lawmakers time to regroup before plunging very quickly into a new round of budget brinkmanship certain to revolve around Republican calls to rein in the cost of Medicare and other government benefit programs (Davis and Jackson, 1/2).

: ‘Fiscal Cliff’ Plan Clears House With GOP Divided Speaking at the White House before leaving to rejoin his family on vacation in Hawaii, Obama called the compromise “just one step in the broader effort” to reduce the deficit, and specifically pointed to spending on Medicare for an aging population as the major force driving the red ink. “I am very open to compromise,” he said. But, he added, “we can’t simply cut our way to prosperity.” Solving the problem will (Mascaro and Hennessey, 1/1).

: The Fiscal Cliff Deal That Almost Wasn’t But the failure to address several big issues sets up another fiscal showdown in late February, when the two-month delay in the sequester coincides with the deadline to raise the country’s $16.4 trillion debt limit. The pact also does little to reduce trillion-dollar-plus deficits, shore up entitlement programs, overhaul the tax code or stimulate the U.S. economy — the casualty of a polarized political culture that scorns compromise (Bresnahan, Budoff Brown, Raju and Sherman, 1/2).

: Insurance Program Is Cut To Help Reach An Accord The bill, the American Taxpayer Relief Act, also freezes Medicare payments to doctors, which otherwise would have been cut by at least 26.5 percent in 2013. The Congressional Budget Office said the freeze would cost $25 billion over 10 years, with most of that coming in 2013-14. Congress offset the cost with changes in Medicare and other federal health programs. For example, it reduced Medicare payments to hospitals by $10.5 billion over 10 years after finding that many hospitals had increased their Medicare revenue by describing the severity of patients’ illnesses in more detail (Pear, 1/1).

: Senate Cliff Bill Would Avert Cuts For Doctors The Senate’s fiscal cliff package would avert a steep cut in payments to doctors and officially wipe out a contentious piece of the health overhaul law. The bill would delay for one year a cut in reimbursements to physicians who treat patients on Medicare, the federal insurance program for the elderly and disabled. The cost: $25.2 billion (Adamy, 1/1).

: Companies Prepare For Health Law One of the biggest decisions for many companies this year will be what to do about their health benefits. They have just 12 months before the major provisions of the federal overhaul law take effect on Jan. 1, 2014, reshaping health coverage in the U.S. Employers with at least 50 workers will owe penalties if they don’t cover full-time employees. Most Americans will face a parallel “individual mandate” to obtain insurance. And new online marketplaces called exchanges will sell insurance plans in each state, paired with federal subsidies for lower-income people (Mathews, 1/1).

: Under Health Law, Employers Must Insure Workers’ Dependents Large employers who are subject to the health overhaul law’s requirement to provide insurance or pay a fee must also extend coverage to their workers’ dependent children, according to federal regulations released Friday. The 144-page proposed regulation that the Obama administration unveiled late Friday offered new details for how employers will have to comply with the health overhaul law, which is set to take full effect in 2014. The law is designed to expand insurance coverage to about 30 million Americans, in part by requiring businesses with 50 or more full-time workers to offer insurance or pay a penalty (Adamy, 12/28).

: Pete Stark, Health Policy Warrior, Leaves A Long Legacy The 113th Congress will be the first one in 40 years to convene without California Congressman Pete Stark as a member. Stark was defeated in November by a fellow Democrat under new California voting rules. Stark may not be a household name. But he leaves a long-lasting mark on the nation’s health care system (Rovner, 1/2).

: Study Suggests Lower Mortality Risk For People Deemed To Be Overweight The report on nearly three million people found that those whose B.M.I. ranked them as overweight had less risk of dying than people of normal weight. And while obese people had a greater mortality risk over all, those at the lowest obesity level (B.M.I. of 30 to 34.9) were not more likely to die than normal-weight people (Belluck, 1/1).

: A Few Extra Pounds Won’t Kill You—Really In a finding that could undermine many New Year’s resolutions, a new government study shows that people who are overweight are less likely to die in any given period than people of normal weight. Even those who are moderately obese don’t have a higher-than-normal risk of dying (Beck, 1/1).

: Research: A Little Extra Fat May Help You Live Longer Being a little overweight may tip the odds in favor of living a long life, according to a new study. Researchers say there may be some benefit to having a little extra body fat (Aubrey, 1/2).

: Energy Drinks Promise Edge, But Experts Say Proof Is Scant Energy drinks are the fastest-growing part of the beverage industry, with sales in the United States reaching more than $10 billion in 2012 — more than Americans spent on iced tea or sports beverages like Gatorade. … The drinks are now under scrutiny by the Food and Drug Administration after reports of deaths and serious injuries that may be linked to their high caffeine levels. But however that review ends, one thing is clear, interviews with researchers and a review of scientific studies show: the energy drink industry is based on a brew of ingredients that, apart from caffeine, have little, if any benefit for consumers (Meier, 1/1).

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: Boehner Cancels Tax Vote In Face Of G.O.P. Revolt Speaker John A. Boehner’s effort to pass fallback legislation to avert a fiscal crisis in less than two weeks collapsed Thursday night in an embarrassing defeat after conservative Republicans refused to support legislation that would allow taxes to rise on the most affluent households in the country. … The stunning turn of events in the House left the status of negotiations to head off a combination of automatic tax increases and significant federal spending cuts in disarray with little time before the start of the new year (Weisman, 12/20).

: Boehner’s Budget ‘Plan B’ Collapses House Speaker John Boehner, facing a rebellion in his party’s conservative ranks, abandoned his own plan to avert tax increases for most Americans Thursday night, throwing Washington’s high-stakes budget negotiations into disarray and bringing the prospect of tumbling over the fiscal cliff into sudden focus. … Mr. Boehner was already under pressure from party conservatives for concessions he had made in earlier talks with Mr. Obama, including a weekend offer to raise tax rates on millionaires and allow a one-year increase in the debt limit, in exchange for Mr. Obama proposing cuts in Medicare and other fast-growing entitlement programs. Administration officials now say they doubt whether Mr. Boehner would have been able to pass that proposal (Hook, Bendavid and Lee, 12/21).

For more headlines …

: Boehner Abandons Plan To Avoid ‘Fiscal Cliff’ House Speaker John A. Boehner threw efforts to avoid the year-end “fiscal cliff” into chaos late Thursday, as he abruptly shuttered the House for the holidays after failing to win support from his fellow Republicans for a plan to let tax rates rise for millionaires. … Emboldened liberals quickly argued that Democrats should demand additional concessions from Republicans, either upping the demand for fresh tax revenue or withdrawing Obama’s offer to seek savings through cuts in federal health and retirement programs (Montgomery and Helderman, 12/20).

: Boehner’s ‘Fiscal Cliff’ Plan Fails House Speaker John A. Boehner abruptly canceled a vote on his Plan B tax proposal late Thursday after failing to find enough GOP support, a stunning political defeat that effectively turned resolution of the year-end budget crisis over to President Obama and the Democrats. … Now, Obama faces a crucial test of his leadership, with little time left to craft a deal. Obama’s most recent offer is likely to be the starting point. He made a substantial concession: raising taxes only on household income above $400,000, rather than the $250,000 threshold he campaigned on for reelection. As he pursues votes in Congress, the president will need to face down Democrats, particularly the liberal wing that may feel emboldened to demand that a deal be tilted toward their views — perhaps with additional spending on infrastructure or unemployment benefits (Mascaro, Memoli and Parsons, 12/21).

: Cliff Chaos: Boehner Pulls GOP Bill The House Republican Conference turned its back on Speaker John Boehner Thursday, forcing GOP leadership to abandon its plan to extend Bush-era tax breaks for income under $1 million. … Earlier on Thursday, Boehner, using his harshest tone of the fiscal cliff debate, said the White House has “done nothing” since he relented on letting low tax rates lapse on wealthy Americans. “For weeks the White House said if I moved on rates, that they would make substantial concessions on spending cuts and entitlement reform,” Boehner said in an afternoon news conference. “I did my part, they’ve done nothing” (Sherman, Budoff Brown and Bresnahan, 12/20).

: Obama’s Dilemma Thursday’s revolt was a grim reminder of how closely Obama’s future is tethered to that of his political rivals. If House Speaker John Boehner can’t muscle his own bill through the House, his power to persuade his colleagues to accept a deal with the White House appears greatly diminished. And that means it might be tough for Obama to forge any agreement with House Republicans to avert the fiscal cliff this year — or to push through his second-term agenda in the years to come (Budoff Brown, 12/21).

: Double Hit Looms For Doctors, Hospitals If Jan. 1 comes around with no fiscal cliff deal, the doctors and hospitals who take Medicare patients are going to get dinged twice — once by sequestration, and again by the lack of a “doc fix.” It’s an industry that has gotten all too accustomed to Congress letting big cuts go through, only to fix them retroactively. In the past few years, more than one cut in the Medicare physician formula has gone into effect, only to be patched up later. But this time, the stakes are much larger — and health care interests are deeply intertwined with the bigger political battles on Capitol Hill (Haberkorn and Norman, 12/20).

: Connecticut Shooter’s Problems All Too Familiar To Many Parents For parents around the U.S., the mass school shooting in Connecticut fueled fears about how to ensure the safety of their own children. But for parents like (Elizabeth) Guzman, the tragedy affected them in a different and terrifying way, as they saw signs of their children in the shooter. … Guzman and other parents say getting the right help for their mentally ill children is a constant and emotionally exhausting challenge. Schools are often unprepared to cope with their illnesses, which can include schizophrenia, bipolar disorder and borderline personality disorder, according to experts and advocates. And years of state and local budget cuts have led to fewer mental health services nationwide (Gorman, 12/20).

: Gaps In F.B.I. Data Undercut Background Checks For Guns Nearly two decades after lawmakers began requiring background checks for gun buyers, significant gaps in the F.B.I.’s database of criminal and mental health records allow thousands of people to buy firearms every year who should be barred from doing so. The database is incomplete because many states have not provided federal authorities with comprehensive records of people involuntarily committed or otherwise ruled mentally ill. Records are also spotty for several other categories of prohibited buyers (Schmidt and Savage, 12/20).

: Lack Of Data Slows Studies Of Gun Control And Crime There is no shortage of opinions about whether gun-control laws accomplish what they are designed to do—reduce violent crime. What is lacking are data. As U.S. lawmakers prepare once again to take up the contested issue in the wake of the Newtown school massacre, they will find that all data on guns are surprisingly scarce. … Researchers say the CDC hasn’t funded primary research in gun control since the mid-1990s, in part because of pressure from the National Rifle Association. Congress has barred the agency from funding research that promotes a position on gun control, and the CDC has limited its efforts in the area to compiling data on firearm injuries, rather than studying the effect of gun-control laws (Palazzolo and Bialek, 12/21).

: Doctors Move To Webcams Virtual doctor visit services—which connect patients from their homes with physicians whom they meet via online video or phone—are moving into the mainstream, as insurers and employers are increasingly willing to pay for them (Wilde Mathews, 12/20).

: When The Doctor Works For The Insurance Company Some insurance companies are taking a page out of their own history books: running their own doctors’ offices and clinics. Though the strategy previously had mixed results, insurers think that by providing primary care for patients, they might reduce costly diseases and hospital stays in the long run (Samuelson, 12/21).

: One Boy’s Death Moves State To Action To Prevent Others Prompted by the death of a 12-year-old Queens boy in April, New York health officials are poised to make their state the first in the nation to require that hospitals aggressively look for sepsis in patients so treatment can begin sooner. Under the regulations, which are now being drafted, the hospitals will also have to publicly report the results of their efforts (Dwyer, 12/20).

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: Obama And Boehner Diverge Sharply On Fiscal Plan Hopes for a broad deficit-reduction agreement faded on Wednesday as President Obama insisted he had offered Republicans “a fair deal” while Speaker John A. Boehner moved for a House vote as early as Thursday on a scaled-down plan to limit tax increases to yearly incomes of $1 million and up, despite Senate opposition and Mr. Obama’s veto threat (Calmes and Weisman, 12/19).

: ‘Cliff’ Standoff: Boehner Works To Wrangle Votes For ‘Plan B’; Obama Threatens Veto House GOP leaders scrambled to rally their members Wednesday behind a plan to extend tax cuts on income up to $1 million, defying President Obama’s veto threat and setting up a showdown that could send Washington over the year-end “fiscal cliff.” … If Boehner’s limited proposal were to be enacted, the economy would still take a hit: Jobless benefits would begin to expire for the long-term unemployed; physicians with elderly patients would see a sharp drop in Medicare reimbursements; and $100 billion in across-the-board cuts to federal agencies would begin (Kane and Helderman, 12/19).

For more headlines …

: Boehner’s ‘Plan B’ Gets Pushback House Republicans hustled Wednesday to build support for a fallback proposal that would eliminate most of the tax impact of the “fiscal cliff,” providing a test of Speaker John Boehner’s leadership as the year-end deadline approached. … Some lawmakers suggested the Obama-Boehner budget negotiations—currently stalled—could resume if Plan B passes the House. Messrs. Boehner and Obama still appear to want a broader deal than Plan B, which doesn’t address across-the-board spending cuts set to take effect next year and does little for the budget’s long-term problems, such as health-care costs (Favole and Palette, 12/19).

: Boehner Seeks Support For Tax Increase On The Wealthiest As President Obama and House Speaker John A. Boehner took turns blaming each other for the sudden lull in the budget talks, the action continued off-camera Wednesday as the Ohio Republican focused on building support from his conservative majority to increase tax rates on the wealthy. … Conservatives railed against Boehner’s proposal, which he calls Plan B, as an affront to the party’s core values, but Boehner received a crucial lifeline Wednesday from Grover Norquist. The influential anti-tax activist’s Americans for Tax Reform said voting for the measure would not violate the pledge most GOP lawmakers had taken not to raise taxes (Mascaro, Parsons and Memoli, 12/19).

: Medicare Premiums Could Rise For Many Retirees It’s a health care change that President Barack Obama and Republicans both embrace: Expand a current, little-known law so more retirees the government considers well-off are required to pay higher Medicare premiums. That plan is likely to be part of any budget deal to reduce the overhang of federal debt, raising $20 billion or more over 10 years. It could come as a shock to many seniors who will have to pay the higher premiums even though they consider themselves solidly middle-class, and by no means wealthy (Alonso-Zaldivar, 12/20).

: Next Challenge For The Health Law: Getting The Public To Buy In On its face, the low-key discussion around a conference table in Miami last month did not appear to have national implications. Eight men and women, including a diner owner, a chef and a real estate agent, answered questions about why they had no health insurance and what might persuade them to buy it. … The sessions confirmed a daunting reality: Many of those the law is supposed to help have no idea what it could do for them. In the Miami focus group, a few participants knew only that they could face a fine if they did not buy coverage. … There lies the challenge for Enroll America, a nonprofit group formed last year to get the word out to the uninsured and encourage them get coverage, providing help along the way (Goodnough, 12/19).

: Health Costs On His Mind Owner Carl Schanstra … is worried that as Automation Systems continues to expand, it will be subject to a provision in the health-care overhaul that could damage its bottom line. … That is because his plant, with sales of about $1.6 million for 2012, currently employs 40 full-time workers, mostly low-paid employees who monitor the factory equipment. If sales were to continue to rise, the plant could, conceivably, employ 50 full-time workers in 2014. Under the new health-care law, the Affordable Care Act, businesses with 50 or more full-time equivalent employees will be required, starting in that year, to offer workers health insurance or potentially pay a penalty. The expense, he says, would drive up the cost of his labor. So he doesn’t want to let employment at the factory reach that number (Maltby and Needleman, 12/19).

: Utah Exchange The Next Affordable Care Act Test Utah says it doesn’t want to do much to alter its existing exchange, which it started for small businesses before President Barack Obama’s health care law was enacted in 2010. Gov. Gary Herbert’s administration says it’s ready to add individual coverage, but not much else. So Utah has become a test of how much flexibility the Obama administration is willing to give to states so they’ll agree to build these centerpieces of the health care law — the new health insurance marketplaces for people who don’t have another source of coverage (Millman, 12/19).

: F.D.A. And States Discuss Regulation Of Drug Compounders The Food and Drug Administration conferred with public health officials from 50 states on Wednesday about how best to strengthen rules governing compounding pharmacies in the wake of a national meningitis outbreak caused by a tainted pain medication produced by a Massachusetts pharmacy. It was the first public discussion of what should be done about the practice of compounding, or tailor-making medicine for individual patients, since the F.D.A. commissioner, Dr. Margaret Hamburg, testified in Congress last month about the need for greater federal oversight of large compounding pharmacies. So far, 620 people in 19 states have been sickened in the outbreak, and 39 of them have died (Tavernise, 12/19).

: FDA Lagged On Specialized Pharmacy Regulations The Food and Drug Administration under President Barack Obama didn’t push for a law to regulate drug-mixing pharmacies before a recent outbreak of more than 600 meningitis cases tied to such a pharmacy, the head of the agency said Wednesday. FDA Commissioner Margaret A. Hamburg said her agency didn’t press for such a law despite numerous deaths and illnesses over several years linked to compounding pharmacies. She made the remark at a summit meeting the FDA held Wednesday with officials of all 50 states who regulate compounding pharmacies (Burton, 12/19).

: Rogue Pharmacists Fuel Addiction Pharmacists are supposed to be a last line of defense against misuse of prescription medications. By law, they are required to scrutinize prescriptions, size up customers and refuse to dispense a drug when they suspect the patient has no medical need for it. Some, however, provide massive amounts of painkillers and anti-anxiety drugs to addicts and dealers with no questions asked, according to state records, regulators and law enforcement officials. Rogue pharmacists are key enablers of drug abuse and an important source of supply for the illegal market (Glover, Girion and Branson-Potts, 12/20).

: Obama Vows Fast Action In New Push For Gun Control President Obama declared on Wednesday that he would make gun control a “central issue” as he opens his second term, promising to submit broad new firearm proposals to Congress no later than January and to employ the full power of his office to overcome deep-seated political resistance. … Having avoided a politically difficult debate over guns for four years, Mr. Obama vowed to restart a national conversation about their role in American society, the need for better access to mental health services and the impact of exceedingly violent images in the nation’s culture (Shear, 12/19).

: White House Task Force To Tackle Gun Violence Announcing his first steps in response to the Newtown, Conn., school massacre, President Obama on Wednesday charged a task force with drawing up a list of proposals to reduce gun violence across the nation and urged Congress to hold votes on gun control legislation early in the new year. … Obama acknowledged the challenging politics of gun control. He emphasized that the task force would look beyond stiffer gun laws for solutions, including measures that address cultural influences and mental health services (Hennessey, 12/19).

: Surgeons Make Thousands Of Errors They are known as “never events”—the kind of mistake that should never happen in medicine, like operating on the wrong patient or sewing someone up with a sponge still inside—yet new research suggests that they happen with alarming frequency. Surgeons make such mistakes more than 4,000 times a year in the U.S., according to a study led by Johns Hopkins University School of Medicine, published online in the journal Surgery (Landro, 12/19).

: Teen Smoking Keeps Falling Cigarette use among U.S. teenagers fell to historic lows and a four-year rise in marijuana use appears to have leveled off, according to a national study released Wednesday. The annual report, funded by the National Institute on Drug Abuse and conducted by the University of Michigan, found the number of teenagers who reported smoking cigarettes in the prior 30 days fell to 10.6% this year from 11.7% in 2011, the lowest level recorded since the survey began in 1975 (Dooren, 12/19).

: Survey: 1 In 15 High School Seniors Smoking Pot As states increasingly adopt laws allowing medical marijuana, fewer teens see occasional marijuana use as harmful, the largest national survey of youth drug use has found. Nearly 80% of high school seniors don’t consider occasional marijuana use harmful — the highest rate since 1983 — and one in 15 smoke nearly every day, according to the annual survey of eighth-, 10th- and 12th-graders made public Wednesday (Leger, 12/19).

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: Hospitals Fear They’ll Bear Brunt Of Medicare Cuts As President Obama and Congress try to thrash out a budget deal, the question is not whether they will squeeze money out of Medicare, but how much and who will bear the brunt of the cuts.Ìý… But any significant tinkering with the benefits for older Americans comes with significant political risks, and most Democrats in Congress strenuously oppose raising the age when Medicare coverage begins. With growing pressure to reach an agreement on deficit reduction by the end of the year, some consensus is building around the idea that the largest Medicare savings should come from hospitals and other institutional providers of care (Pear and Abelson, 12/18).

: Cleveland Clinic Diagnoses Health-Care Act Just over a year from now, the Affordable Care Act is set to unleash enormous change in the health-care sector, and Cleveland Clinic Chief Executive Delos “Toby” Cosgrove is preparing his institution by expanding its reach and striving to make caregivers more cost-conscious. … Dr. Cosgrove has pushed efforts to translate the system’s research work into new commercial opportunities ranging from a social-media site on beauty to a medical-device startup developing artificial-heart technologies. Cleveland Clinic is also striking deals with employers such as Wal-Mart Stores Inc. to send workers to there for complex procedures, moves that lock in patients for high-end surgeries. The new federal provisions—which include cutbacks to Medicare payments and the creation of new health-insurance marketplaces for consumers—will test institutions like Cleveland Clinic (Mathews, 12/18).

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: Boehner Plan Addresses Taxes But Delays Fight Over Spending Cuts House Republican leaders struggled on Tuesday night to rally their colleagues around a backup measure to ease the sting of a looming fiscal crisis by allowing tax rates to rise only on incomes over $1 million. The plan would leave in place across-the-board spending cuts to military and domestic programs that Republicans have been warning could have dire consequences, especially to national defense. … Republicans would resume the fight for broad spending cuts, especially to entitlement programs like Medicare, in late January or February, when the government will face raising its borrowing limit and when, many Republicans believe, they will have much more leverage than they do now (Weisman, 12/18).

: GOP Unveils A ‘Plan B’ If Budget Talks Fail Despite progress toward agreement on a budget deal with the White House, House Republican leaders on Tuesday proposed a backup plan to prevent most Americans from facing an income-tax increase if negotiations collapse. … Both leaders face perils as they enter what could be the final stages of high-stakes negotiations to avoid the “fiscal cliff” of higher taxes and spending cuts in early January. Mr. Obama will have to deal with liberals unhappy about entitlement cuts. Mr. Boehner faces a potential backlash from Republicans for contemplating tax-rate increases—both in his talks with the White House and in Plan B (Hook, Lee and Boles, 12/19).

: Boehner’s Backup Tax Plan Shakes Up ‘Fiscal Cliff’ Negotiations House Speaker John A. Boehner (R-Ohio) veered off the bipartisan course he had been charting toward a broad tax-and-entitlement deal with President Obama and instead Tuesday pushed a GOP package to extend tax cuts for income up to $1 million. The move shook the Capitol after several days of significant progress between Obama and Boehner, who had moved closer to a pact raising taxes on the wealthy and curbing government spending, including on Social Security (Kane and Montgomery, 12/18).

: Boehner Changes Gears In ‘Fiscal Cliff’ Talks With Obama The speaker made clear that he is not cutting off talks with Obama, but Democrats characterized Boehner as walking away just as compromise appeared within reach. This week, Obama made what White House aides saw as a substantial concession by telling Boehner that he would accept an agreement raising taxes on household income above $400,000, rather than the $250,000 threshold he had previously insisted on. He also proposed changes to reduce the long-term cost of government benefit programs, including Social Security (Mascaro, Parsons, and Memoli, 12/18).

: Cliff Talks Turn Into Public Posturing House Speaker John Boehner’s decision to pursue a fiscal cliff backup plan looked like an attempt to go his own way. But it was really about bolstering his position in the one-on-one talks with President Barack Obama (Sherman, Bresnahan and Budoff Brown, 12/18).

: Many Democrats Unhappy With CPI Offer After weeks of gleefully watching Republicans struggle to find their footing in fiscal cliff talks, it’s time for the Democrats to do some painful soul-searching of their own. President Barack Obama’s latest offer to congressional Republicans crosses lines that Democrats have long portrayed as untouchable. The provision causing the most heartburn for Democrats on Capitol Hill is one that would change the way inflation is measured to ultimately reduce payments to Social Security beneficiaries (Sloan and Kim, 12/18).

: Budget Hawk Is Now Quiet As A Mouse What will Paul Ryan do? … With talks at a crucial phase, Republicans are keeping close tabs on their recent vice-presidential nominee. His support for a compromise could stem conservative defections. His opposition could sink the deal entirely (O’Connor, 12/18).

: Eric Cantor Plays Loyal Lieutenant To Boehner In the “fiscal cliff” drama, Cantor has been casting himself as a supportive bit player to Boehner, a contrast from the debt-ceiling showdown of 2011. At that time, Cantor had a starring role as a lead negotiator in high-level talks with Vice President Biden and as a chief antagonist to Obama, tangling with the president in one tense White House exchange. But that role did not go well for Cantor. It neither strengthened the GOP’s hand in the fiscal crisis nor served the lawmaker’s image. He emerged with a taint of disloyalty toward Boehner and a new reputation, carefully stoked by Democrats, as the leader of hard-liners unwilling to compromise (Helderman, 12/18).

: Most Americans Benefit From Entitlements Forget the 47%. A new study finds that 71% of Americans live in a household in which at least one member has benefited from one of the federal government’s major entitlement programs. The new data, based on a survey by the Pew Research center, underscore the wide reach of the spending programs that make up the lion’s share of the federal budget. More than half of Americans (55%) have personally benefited from one of the government’s six best-known entitlement programs, including 53% ofÌý people who voted for Mitt Romney in November’s election and 59% of those who voted for President Obama (Lauter, 12/18).

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: Some In GOP Urge Lawmakers To Back Tax Hikes For Changes In Safety-Net Programs A growing chorus of Republicans is urging House leaders to abandon their staunch opposition to higher tax rates for the wealthy with the aim of clearing the way for a broad deal that would also rein in the cost of federal health and retirement programs (Montgomery and Helderman, 12/6).

: Participants In Talks On A Budget Deal Shrink To Two At House Speaker John A. Boehner’s request, Senate leaders and Representative Nancy Pelosi have been excluded from talks to avert a fiscal crisis, leaving it to Mr. Boehner and President Obama alone to find a deal, Congressional aides say. All sides, even the parties excluded, say clearing the negotiating room improves the chance of success. It adds complexity as the two negotiators consult separately with the leaders not in the room. But it also minimizes the number of people who need to say yes to an initial agreement (Weisman and Baker, 12/6).

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: Some See Hope As Talks Resume Over ‘Fiscal Cliff’ After days of public posturing, budget talks resumed Thursday between the staff of House Speaker John Boehner and the White House. The talks broke a nearly weeklong lull since administration officials had traveled to Capitol Hill for contentious, unproductive meetings with Republicans. Mr. Boehner (R., Ohio) and President Barack Obama spoke by phone Wednesday and committed to renewing negotiating efforts, according to people familiar with the call (Hook, 12/6).

: Little Movement On ‘Fiscal Cliff’ Budget Talks Congress and the White House appear no closer to an agreement on the year-end budget crisis, although House Speaker John A. Boehner and President Obama have opened lines of communication that could produce a deal later this month. … The president and his Democratic allies in Congress maintain that wealthier Americans should pay more, saying the country can no longer afford the estimated $900-billion cost of continuing the Bush-era tax rates for another decade. Several influential Republicans have suggested the GOP should accept the president’s offer to extend the tax rates for most Americans while the broader budget battle continues. … Top Republicans are seeking steep cuts to Medicare, Medicaid and Social Security in exchange for producing some new tax revenue (Parsons and Mascaro, 12/7).

: W.H. To House GOP: We’re Not Moving If Wednesday’s phone call between Speaker John Boehner and President Barack Obama seemed like a hopeful sign in the fiscal cliff standoff, think again. On Thursday, with the House out of session, White House congressional liaison Rob Nabors trekked to Capitol Hill and delivered a firm message: We aren’t moving. In a meeting with leadership staff, Nabors reiterated the administration’s hard line that tax rates on top earners must go up, according to Republican sources with knowledge of the meeting. The White House is also insisting that Congress give it power to raise the debt limit on its own. Furthermore, in a development that could signal a step closer to the fiscal cliff, Nabors said the White House’s offer stands on mandatory spending on entitlement programs, the sources said (Sherman, Bresnahan and Budoff Brown, 12/6).

: Q&A: What Would It Mean To Raise Medicare’s Eligibility Age? As they debate ways to control the federal deficit, President Obama and congressional Republicans have both acknowledged the need to rein in federal spending on healthcare programs such as Medicare, which provides health insurance to about 50 million elderly and disabled Americans. Among the leading proposals to slow Medicare spending — a key ingredient of a budget deal — is to raise the eligibility age for the program, an option frequently championed by conservatives. Here are answers to some basic questions about the concept and its potential effects (Levey, 12/7).

: Raising Medicare Age Saves Money For Taxpayers But Could Lead To Higher Premiums For Seniors Americans are living longer, and Republicans want to raise the Medicare eligibility age as part of any deal to reduce the government’s huge deficits. But what sounds like a prudent sacrifice for an aging society that must watch its budget could have some surprising consequences, including higher premiums for people on Medicare (12/6).

: Christie Rebuffs Health Exchange New Jersey Gov. Chris Christie on Thursday joined a string of Republican state leaders in turning down a key component of the Obama health-care overhaul, a move freighted with political consequences for GOP governors eyeing potential presidential runs. Some Republican governors have made a show recently of rebuffing President Barack Obama’s chief domestic initiative, but Mr. Christie struck a softer tone. He rejected a bill Thursday that was designed to establish a state-run health insurance exchange, while leaving open the possibility he might change his mind later (King and Radnofsky, 12/6).

: Chris Christie Nixes State-Run Insurance Exchange New Jersey Gov. Chris Christie rejected a state-run health insurance exchange Thursday, paving the way for the federal government to step in and run one. Christie — who was in Washington on Thursday pushing for Hurricane Sandy aid — rejected a bill passed by the Democratic state Legislature that would have built an exchange, a key part of the president’s health care law that makes available subsidies to help low- and middle-income individuals purchase coverage in new health insurance markets starting in 2014 (Millman, 12/7).

: Likely Increase In Births Has Some Lawmakers Revisiting Cuts When state lawmakers passed a two-year budget in 2011 that moved $73 million from family planning services to other programs, the goal was largely political: halt the flow of taxpayer dollars to Planned Parenthood clinics. Now they are facing the policy implications — and, in some cases, reconsidering. The latest Health and Human Services Commission projections being circulated among Texas lawmakers indicate that during the 2014-15 biennium, poor women will deliver an estimated 23,760 more babies than they would have, as a result of their reduced access to state-subsidized birth control. The additional cost to taxpayers is expected to be as much as $273 million — $103 million to $108 million to the state’s general revenue budget alone — and the bulk of it is the cost of caring for those infants under Medicaid (Ramshaw, 12/6).

: Stem Cell Agency Board Criticized For Conflicts Of Interest The board of California’s stem cell funding agency is rife with conflicts of interest and should be restructured to improve the integrity of its grant-making process, according to a new report from independent experts convened by the national Institute of Medicine. The committee found that “far too many” of the board members are from organizations that stand to benefit from the $3 billion the California Institute for Regenerative Medicine is supposed to dole out to researchers over 10 years. Making matters worse, the panel said, the 29 board members are too closely involved in the agency’s day-to-day decisions (Brown, 12/7).

: Post-Election, ‘Morning After’ Pill Advocates Want Age Rules Revisited Friday marks a not-so-happy anniversary for some of President Obama’s biggest supporters: It’s exactly one year since Health and Human Services Secretary Kathleen Sebelius decided not to lift the age restrictions on availability of the so-called morning-after pill, Plan B. But now, with the election safely behind them, backers of the pill are hoping the administration may be willing to revisit the issue (Rovner, 12/7).

: Administration Weighs Legal Action Against States That Legalized Marijuana Use Senior White House and Justice Department officials are considering plans for legal action against Colorado and Washington that could undermine voter-approved initiatives to legalize the recreational use of marijuana in those states, according to several people familiar with the deliberations (Savage, 12/7).

: States Cut Antismoking Outlays Despite Record Tobacco Revenue Faced with tight budgets, states have spent less on tobacco prevention over the past two years than in any period since the national tobacco settlement in 1998, despite record high revenues from the settlement and tobacco taxes, according to a report to be released on Thursday (Tavernise, 12/6).

: Rules Eased for Veterans’ Brain Injury Benefits The Department of Veterans Affairs will propose new regulations on Friday that will make it easier for thousands of veterans to receive health care and compensation for certain illnesses that have been linked to traumatic brain injury. The regulations, which will be published on Monday in the Federal Register, lists Parkinsonism, unprovoked seizures, certain dementias, depression and hormone deficiency diseases related to the hypothalamus, pituitary or adrenal glands as eligible for the expanded benefits (Dao, 12/7).

: New Waves of Meningitis-Related Cases Emerge Health officials in at least two states are reporting waves of new infections from contaminated steroids linked earlier this fall to a deadly outbreak of fungal meningitis, but say the latest cases aren’t life-threatening. The new infections are mostly abscesses in the spines of patients who received steroids produced by a specialized Massachusetts pharmacy that were recalled this fall after they were found to be contaminated with fungal material, officials said. The infections haven’t developed into fungal meningitis, but could if left untreated, they said (Martin, 12/6).

: Federal Agreement Aims To Increase Access To Health Care For Native American Veterans Native American military veterans will be able to access health care closer to home thanks to an agreement between the U.S. Department of Veteran Affairs and the Indian Health Service. The agreement allows for Veterans Affairs to reimburse IHS for direct health care services provided to eligible American Indian and Alaska Native veterans (12/6).

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: Administration Defines Benefits That Must Be Offered Under The Health Law The Obama administration took a big step on Tuesday to carry out the new health care law by defining “essential health benefits” that must be offered to most Americans and by allowing employers to offer much bigger financial rewards to employees who quit smoking or adopt other healthy behaviors. The proposed rules, issued more than two and a half years after President Obama signed the Affordable Care Act, had been delayed as the administration tried to avoid stirring criticism from lobbyists and interest groups in the final weeks of the presidential campaign (Pear, 11/20).

: Administration Affirms Key Mandates Of Healthcare Law The Obama administration reaffirmed key requirements of the new healthcare law Tuesday, setting out how insurance companies will cover nearly all Americans, even if they are already ill, and provide plans with minimum benefits. Consumer advocates, insurers and business groups were looking for signs the administration might try to modify some of the law’s requirements as the federal government races to implement the legislation by the end of next year. But the proposed rules issued Tuesday hew closely to the Affordable Care Act that President Obama signed in 2010 (Levey, 11/20).

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: States Get A Say In Health Law The Obama administration Tuesday issued new rules to implement several key provisions of the health-care-overhaul law, giving states some additional discretion over plans sold within their borders. The long-awaited rules underscore that the millions of customers who get new insurance through the law will see their plans vary from state to state. For example, the administration said it would let states choose whether to ban insurers from taking into account consumers’ tobacco use when setting prices for their policies (Radnofsky, 11/20).

: Administration Unveils Health Care Regulations The Obama administration released new health care regulations Tuesday that preclude insurers from adjusting premiums based on pre-existing or chronic health conditions, tell states what benefits must be included in health exchange plans, and allow employers to reward employees who work to remain healthy (Kennedy, 11/20).

: Administration Lays Down Rules For Future Health Insurance Now that the Supreme Court has found the Affordable Care Act constitutional and the president’s re-election made clear that big chunks of the law will take effect Jan. 1, 2014, the administration is finally releasing rules of the road that states and insurance companies have been clamoring for. The big one makes clear how companies will have to comply with anti-discrimination requirements starting in 2014. The law requires that health insurance be made available to everyone regardless of health status and that people with pre-existing conditions not be charged higher premiums (Rovner, 11/20).

: Obama Administration Officials Propose Altered Rules For Health Insurers The Obama administration proposed new rules Tuesday that would loosen some of the 2010 health-care law’s mandates on insurers while tightening others. Certain health plans, for instance, would be able to charge customers higher deductibles than originally allowed under the legislation. But all plans would be required to cover a larger selection of drugs than under an earlier approach outlined by the administration (Aizenman, 11/20).

: Many Americans Unaware Of Health-Care Law Changes After surviving a Supreme Court decision and a presidential election, the Obama administration’s health-care law faces another challenge: a public largely unaware of major changes that will roll out in the coming months. States are rushing to decide whether to build their own health exchanges and the administration is readying final regulations, but a growing body of research suggests that most low-income Americans who will become eligible for subsidized insurance have no idea what is coming (Kliff, 11/20).

: Next Up For Obamacare: Launching The Exchanges In 2014 Now that the elections saved the health care law from the threat of repeal, the Obama administration and its backers are turning their attention toward getting the law right — before the next elections come around in 2014. All eyes are on January 2014, when the health insurance exchanges — online portals where individuals and small businesses can get their health coverage — are slated to start covering millions of people. Consumers will have access to tax subsidies, if they qualify, to help them buy coverage, and almost everyone will be subject to the mandate to have insurance. Each step holds the potential to reinforce — or change — public perception (Haberkorn, 11/20).

: HHS Looks To Step Up Role In Health Exchanges The last thing the Obama administration wanted to do was come into a bunch of states and start running health insurance exchanges. But when the new insurance marketplaces open for business late next year, it’s clear that the Department of Health and Human Services will have a much bigger job than it wanted (Millman, 11/20).

: Rough Start For Fiscal Cliff Talks The opening round of negotiations this week between White House and senior GOP congressional staffers left both sides pessimistic about their ability to reach a quick deal on averting the fiscal cliff, according to sources familiar with the talks. Hill Democrats say Republicans aren’t serious about crafting a deal that President Barack Obama can accept. The GOP’s opening offer, the sources said, would freeze the Bush-era tax rates, change the inflation calculator for entitlement programs, keep the estate tax at 2012 levels and authorize a major overhaul of the Tax Code — although they did not provide a revenue target. … For their part, Republicans remain unconvinced that Obama and Senate Majority Leader Harry Reid (D-Nev.) will make the kind of significant concessions on entitlement programs like Medicare and Medicaid that would make them agree to tax rate hikes (Sherman, Bresnahan and Budoff Brown, 11/20).

: Medicare Cuts Give Health Providers Jitters The $716 billion in Medicare “cuts” that got so much attention in the presidential election have already begun sinking their teeth into health care providers. And there are widespread jitters that any further cuts as part of a year-end deal to stave off sequestration or strike a “grand bargain” for a long-term fiscal deal would deeply gouge some providers, if not put them out of business (Norman, 11/20).

: Union Ads Take New Tack: Praising GOP Members Labor unions seeking a fiscal solution that protects entitlement programs and raises taxes on the rich are trying the carrot approach before taking the stick to lawmakers. A new six-figure ad campaign backed by three major unions includes radio spots praising four Republican House members as “leaders willing to put people ahead of partisan politics.” … Union officials said the four GOP House members were selected because they were among those who signed a bipartisan letter this summer calling for a balanced budget deal that considers both cuts and new forms of revenue. … The commercials call on the lawmakers “to stand up for us by investing in job creation, extending the middle class tax cuts, and protecting Medicare, Medicaid and education from cuts.” The labor unions also released a poll showing that voters overwhelmingly oppose cuts to Social Security or Medicare (Gold, 11/20).

: U.S. Fake-Drug Probe Puts Spotlight On Role Of Doctors A Tennessee cancer doctor has pleaded guilty to purchasing illegal foreign drugs, as part of a long-running investigation into overseas distributors that sold fake versions of the cancer drug Avastin and other unapproved medicines to U.S. clinics. The physician, William Kincaid of Johnson City, Tenn., who signed a plea agreement last week, is among the first to face charges in the probe. Dozens of doctors were warned by the U.S. Food and Drug Administration that they may have purchased the fake Avastin from distributors owned by Canada Drugs, a Winnipeg Internet pharmacy company (Weaver, 11/20).

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: With Obama Re-Elected, States Scramble Over Health Law After nearly three years of legal and political threats that kept President Obama’s health care law in a constant state of uncertainty, his re-election on Tuesday all but guarantees that the historic legislation will survive. Now comes another big hurdle: making it work (Goodnough and Pear, 11/8).

ACA Opponents Scramble For A Plan B What’s the plan for Obamacare’s opponents now? Judging from Republicans’ mixed messages Thursday, the plan is: disarray. On a day when House Speaker John Boehner declared that “Obamacare is the law of the land” — and then quickly scrambled to insist he hadn’t given up on repeal after all — the law’s critics often seemed to be scrambling to find a game plan. That doesn’t mean they’d given up the fight, though (Norman and Millman, 11/8).

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: ACA Now Faces Contraception Test President Barack Obama’s health reform law has cleared its biggest obstacle to date — Obama’s reelection — but a wave of lawsuits means a new hurdle is quickly taking shape. Dozens of lawsuits have been filed challenging the law’s requirement that employers cover contraceptives in their health insurance policies, arguing that it’s a violation of their right to exercise their religion without government interference. In recent days, two developments have emerged that show the challenge could get significant attention from the courts (Haberkorn and Smith, 11/9).

: Obama, Boehner Again Prepare To Tackle National Debt With another dangerous deadline for the economy approaching, Tuesday’s election returned to power the same men who have battled for two years over the nation’s budget problems: President Obama and House Speaker John A. Boehner (Ohio). The president and the most powerful Republican in Washington hold the keys to any deal to tame the national debt. And as they prepare to go another round, the political winds have shifted in Obama’s favor. … In Boehner’s view, aides said, the starting point should be the deficit-reduction deal that he and Obama were close to sealing in secret talks during the summer of 2011. With Congress locked in a bitter battle over the federal debt limit, the two tentatively agreed to slice $2.4 trillion from future borrowing in part by trimming Medicare and Social Security benefits and generating $800 billion in new revenue by overhauling the tax code (Montgomery and Goldfarb, 11/8).

: Congress Sees Rising Urgency On Fiscal Deal Senior lawmakers said Thursday that they were moving quickly to take advantage of the postelection political atmosphere to try to strike an agreement that would avert a fiscal crisis early next year when trillions of dollars in tax increases and automatic spending cuts begin to go into force. … The accelerated activity in Washington showed that members of Congress believed the election had amplified the imperative to strike a deal. Still, signs that the two sides are open to some compromise are no guarantee that they can reach an agreement after warring for two years. Many Republicans will continue to resist any proposal that can be read as increasing taxes, and many Democrats will balk at changes in entitlement programs and spending cuts (Weisman, 11/8).

: Pressure Rises On Fiscal Crisis The White House and Republican lawmakers faced pressure to reach a solution to the looming budget crisis after a nonpartisan agency detailed Thursday how inaction would push the U.S. economy back into recession next year, and skittish investors continued to drive stocks lower. … The White House is looking for a formula that would stabilize the government’s debt as a share of the economy to around 75%, according to one person familiar with the matter. Before the 2007-09 recession, the debt-to-GDP ratio was below 65%. Offering a framework rather than a detailed proposal could be attractive to the White House because of concerns that Republicans might reject a plan with too many details. The White House also was trying to decide whether any offer should include deficit-cutting proposals that Democrats might find unappealing, such as changes to Medicare and Social Security (Paletta, Lee and Bendavid, 11/8).

: Boehner Sees Short-Term Budget Fix House Speaker John Boehner, R-Ohio, says he will resist any effort to make major tax or spending changes in the lame duck session of Congress beginning next week, seeking instead a short-term deal to delay the year-end “fiscal cliff.” “I’ve never seen a lame duck Congress do big things. And as speaker I feel pretty strongly that a lame duck Congress shouldn’t do big things,” he said in an interview with USA TODAY. … Boehner is proposing what he calls a short-term “bridge” that would extend all of the tax rates for one year and buy more time to overhaul the federal tax code. Boehner says that would increase revenue by closing tax loopholes, not by raising the rates individuals pay on their wages. “There’s a lot of ways you could do this that would allow the Congress to fix our tax code next year, look at real spending cuts and entitlement reforms that would produce what the president’s called for — a balanced approach,” he said (Davis, 11/8).

: Behind Boehner’s New Tone Speaker John Boehner thinks he’s learned from his mistakes. After his secret debt negotiations last year with President Barack Obama sparked a sharp round of blowback from conservatives, his leadership and members of his House Republican Conference, Boehner has launched a carefully choreographed campaign on the high-stakes fiscal cliff talks. … Boehner said he was prepared to raise new revenue for the government — but not increase tax rates — as long as the White House would agree to entitlement reform. Republicans were “ready to be led,” Boehner said, attempting to shift the burden for what comes next squarely onto Obama’s shoulders (Budoff Brown and Bresnahan, 11/8).

: Boehner: Obamacare Is Law Of The Land, Ryan Not The GOP Leader In a wide-ranging interview, House Speaker John A. Boehner (R-Ohio) said raising tax rates is “unacceptable,” vice presidential nominee Paul D. Ryan is not the new leader of the GOP and the reelection of President Obama means the nation’s new healthcare law is “the law of the land.” … Boehner also suggested House Republicans would not entertain repeated votes to repeal the nation’s new healthcare law, as happened this past session of Congress. “The election changes that,” Boehner said. “Obamacare is the law of the land.” The speaker later tweeted that “our goal has been, and will remain, full repeal” of the healthcare law. Boehner’s spokesman provided a transcript of the exchange in which the speaker also said, “There certainly may be parts of it that we believe – need to be changed.Ìý We may do that.Ìý No decisions at this point” (Mascaro, 11/8).

: Coalition Pushes New Proposal To Avoid Medicare, Medicaid Cuts With President Obama and congressional Republicans turning to address the looming budget crisis, a coalition of consumer groups, labor unions and major employers is pushing new approaches to control federal health spending without cutting benefits for seniors and others who rely on Medicare and Medicaid. The plan, released Thursday by the National Coalition on Health Care, includes several potentially controversial proposals such as a new penny-per-ounce federal tax on sweetened beverages and tougher penalties on under-performing hospitals (Levey, 11/8).

: Sanofi Halves Price Of Cancer Drug Zaltrap After Sloan-Kettering Rejection In an unusual move, a big drug company said on Thursday that it would effectively cut in half the price of a new cancer drug after a leading cancer center said it would not use the drug because it was too expensive. The move — announced by Sanofi for the colon cancer drug Zaltrap — could be a sign of resistance to the unfettered increase in the prices of cancer drugs, some of which cost more than $100,000 a year and increase survival by a few months at best (Pollack, 11/8).

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