First Edition: January 4, 2016

Kaiser Health News: Obamacare Insurers Sweeten Plans With Free Doctor Visits
Health insurers in several big cities will take some pain out of doctor visits this year -- the financial kind. They’ll offer free visits to primary care doctors in their networks. You read that right. Doctor visits without copays. Or coinsurance. And no expensive deductible to pay off first. Free. (Galewitz, 1/4)

Kaiser Health News: Do You Speak Health Insurance? It’s Not Easy.
Health-plan enrollment season rolls on, and people shopping on healthcare.gov and the other marketplaces have until Jan. 31 to pick a plan. But even people trying to pick from their employers’ options can find the process complicated and difficult to understand. The jargon can be overwhelming, and it can lead people to make to costly mistakes or avoid care all together. (Zdechlik, 1/4)

The Associated Press: Health Care Repeal Vote To Open A Political Year In Congress
It's been like a long-delayed New Year's resolution for Republicans. But 2016 will finally be the year when they put legislation on President Barack Obama's desk repealing his health care law. The bill undoing the president's prized overhaul will be the first order of business when the House reconvenes this coming week, marking a sharply partisan start on Capitol Hill to a congressional year in which legislating may take a back seat to politics. ... Obama will veto the health law repeal bill, which also would cut money for Planned Parenthood. (Werner, 1/2)

The New York Times: Break Is Likely in Planned Parenthood Funding Battle
Congressional Republicans are planning to start the new year with another attempt to ban federal funds for Planned Parenthood. But after five years of fruitless legislative attacks, the House vote next week is likely to be the last, conservative activists say, until a Republican moves into the White House. (Calmes, 12/29)

The New York Times: Many See I.R.S. Fines as More Affordable Than Insurance
Clint Murphy let the deadline for getting health insurance by the new year pass without a second thought. Mr. Murphy, an engineer in Sulphur Springs, Tex., estimates that under the Affordable Care Act, he will face a fine of $1,800 for going uninsured in 2016. But in his view, paying that penalty is worth it if he can avoid buying an insurance policy that costs $2,900 or more. All he has to do is stay healthy. (Goodnough, 1/3)

The Wall Street Journal: More People Turn to Faith-Based Groups For Health Coverage
A growing number of people are turning to health-care ministries to cover their medical expenses instead of buying traditional insurance, a trend that could challenge the stability of the Affordable Care Act. The ministries, which operate outside the insurance system and aren’t regulated by states, provide a health-care cost-sharing arrangement among people with similarly held beliefs. (Armour, 1/3)

Louisville (Ky.) Courier-Journal: Bevin: Medicaid Changes To Come In Time
Gov. Matt Bevin announced Wednesday he has begun work to transform Kentucky's Medicaid program by 2017. But in the meantime he envisions no major changes in the government health plan that covers nearly 1.3 million Kentuckians. (Yetter and Loftus, 12/30)

Politico: Are Democrats Crippling Obamacare?
Obamacare has survived a pair of Supreme Court battles and half a decade of Republican repeal efforts. But as the Obama administration enters its final year, the Affordable Care Act is facing formidable hurdles that are largely of Democrats' making. (Wheaton and Demko, 12/28)

NPR: 2015 Was Another Rough And Tumble Year For Obamacare
The Affordable Care Act survived another challenge before the U.S. Supreme Court this year. But the still-fragile marketplace is showing the strain of rising health care costs. (Horsley, 12/30)

The Wall Street Journal: Key Supreme Court Decisions Coming In 2016
The Supreme Court is poised to deliver a midyear jolt, with rulings expected by June on issues that cut along partisan lines. The decisions are sure to remind voters that one of the next president’s greatest powers will be federal judicial appointments. ... Whole Women’s Health v. Cole looks at the extent to which states can regulate and restrict abortion. The court continues to hold that women have a constitutional right to terminate pregnancy, and has struck down restrictions that it concludes impose a “substantial obstacle” to getting an abortion. The case looks at a 2013 Texas law requiring abortion doctors to hold admitting privileges at a local hospital and clinics to meet the standards of ambulatory surgical centers. (Bravin, 12/30)

Reuters: As U.S. Abortion Case Looms, Both Sides Seek Personal Touch
As the U.S. Supreme Court prepares to hear its first abortion case in nearly a decade, both sides have been quietly gathering vivid personal accounts from women to supplement the dry legal arguments, believing the effort could appeal particularly to swing-vote Justice Anthony Kennedy. (Biskupic, 1/3)

The Associated Press: Activists Predict Abortion Will Be A Hot Issue In Campaigns
With a deeper-than-ever split between Republicans and Democrats over abortion, activists on both sides of the debate foresee a 2016 presidential campaign in which the nominees tackle the volatile topic more aggressively than in past elections. Friction over the issue also is likely to surface in key Senate races. And the opposing camps will be further energized by Republican-led congressional investigations of Planned Parenthood and by Supreme Court consideration of tough anti-abortion laws in Texas. (Crary, 12/27)

Reuters: Federal Judge Blocks Arkansas Restrictions On Abortion Pill
The law the judge ruled on Thursday, which was approved by the state legislature in March, would require organizations or individuals dispensing mifepristone to maintain a contract relationship with a physician who has hospital admitting privileges. It also stipulates that the patient receive two more doses of the drug than the four presently required by law. Mifepristone is intended to induce miscarriage when taken in the first two months of pregnancy. (Barnes, 12/31)

NPR/ProPublica: Privacy Violations Rising At Veterans Affairs Medical Facilities
Employees and contractors at VA medical centers, clinics, pharmacies and benefit centers commit thousands of privacy violations each year and have racked up more than 10,000 such incidents since 2011, a ProPublica analysis of VA data shows. The breaches range from inadvertent mistakes, such as sending documents or prescriptions to the wrong people, to employees' intentional snooping and theft of data. Not all concern medical treatment; some involve data on benefits and compensation. Many VA facilities and regional networks are chronic offenders, logging dozens of violations year after year. (Ornstein, 12/30)

NPR/ProPublica: Repeat Violators Of Health Privacy Laws Often Go Unpunished
CVS is among hundreds of health providers nationwide that repeatedly violated the federal patient privacy law known as HIPAA between 2011 and 2014, a ProPublica analysis of federal data shows. Other well-known repeat offenders include the U.S. Department of Veterans Affairs, Walgreens, Kaiser Permanente and Wal-Mart. And yet, the agency tasked with enforcing the Health Insurance Portability and Accountability Act took no punitive action against these providers, ProPublica found. In more than 200 instances over those four years, that agency, the Office for Civil Rights within the U.S. Department of Health and Human Services, reminded CVS of its obligations under the law or accepted its pledges to improve privacy protections. (CVS did pay a $2.25 million penalty in 2009 for dumping prescription bottles in unsecured dumpsters.) (Ornstein and Waldman, 12/29)

The Wall Street Journal: Patients Struggle With High Drug Prices
The pharmaceutical industry, after a long drought, has begun to produce more innovative treatments for serious diseases that can extend life and often have fewer side effects than older treatments. Last year, the Food and Drug Administration approved 41 new drugs, the most in nearly two decades. The catch is their cost. Recent treatments for hepatitis C, cancer and multiple sclerosis that cost from $50,000 annually to well over $100,000 helped drive up total U.S. prescription-drug spending 12.2% in 2014, five times the prior year’s growth rate, according to the Centers for Medicare and Medicaid Services. ... For many of the poorest Americans, medicines are covered by government programs or financial-assistance funds paid for by drug companies. For those in the middle class, it is a different story. (Walker, 12/31)

The Washington Post: Many Medications Actually Became Cheaper This Year — But That Doesn’t Mean Americans Are Paying Less Overall
The federal government announced this month that prescription drug spending hit $297.7 billion last year -- up more than 12 percent, the largest annual increase in more than a decade. A new generation of specialized drugs and price hikes on existing medications helped to drive that spike, and officials have predicted that annual spending on medications will grow 6.3 percent on average through 2024. If there's a bright spot amid the troubling rise in the cost of prescription drugs, perhaps it is this: Many of the most widely used generic drugs actually were cheaper at the end of 2015 than when the year began, according to an analysis released Tuesday by the prescription drug price comparison site GoodRx. (Dennis, 12/29)

The New York Times: F.D.A. Regulator, Widowed by Cancer, Helps Speed Drug Approval
Mary Pazdur had exhausted the usual drugs for ovarian cancer, and with her tumors growing and her condition deteriorating, her last hope seemed to be an experimental compound that had yet to be approved by federal regulators. So she appealed to the Food and Drug Administration, whose oncology chief for the last 16 years, Dr. Richard Pazdur, has been a man denounced by many cancer patient advocates as a slow, obstructionist bureaucrat. He was also Mary’s husband. (Harris, 1/2)

The Wall Street Journal: Big Pharma: Dealing With Fewer Biotech Targets
The torrid pace of consolidation among drug makers is bound to slow at some point. But that doesn’t mean deal bankers and lawyers will be idle in 2016. There have been more than 2,000 announced deals over the past two years within the pharmaceuticals and biotechnology sectors world-wide, according to Dealogic, for a total consideration north of $750 billion. The pace isn’t likely sustainable. (Grant, 12/31)

Arizona Republic: Labs, Doctors Scrutinized Over Lucrative Drug Tests For Pain-Pill Abuse
Doctors frequently order patients to take urine drug tests to safeguard against prescription pain-pill abuse. But federal investigators and Medicare say these routine tests — designed to ensure patients properly use opioid drugs — have led to questionable billing practices by some for-profit labs, doctors, and addiction-treatment centers. ... The U.S. Department of Justice is cracking down on private labs that investigators say offer incentives to doctors to frequently refer patients for lucrative testing. And Medicare, citing the potential for billing abuses, is overhauling its billing codes and payment rates used for drug tests. (Alltucker, 12/26)

NPR: States Deny Pricey Hepatitis C Drugs To Most Medicaid Patients
In the last few years, new medications have come on the market that can cure hepatitis C with a more than 90 percent success rate. But these new drugs are famously expensive. A full 12-week course of Harvoni costs about $95,000. Because of that, Medicaid in many states restricts who receives the medication. Medicaid in at least 34 states doesn't pay for treatment unless a patient already has liver damage, according to a report released in August. There are exceptions—for example, people who also have HIV or who have had liver transplants—but many living with chronic hepatitis C infection have to wait and worry. (Harper, 12/27)

USA Today: New Federal Rule Targets Medical Equipment Often Subject To Fraud
A federal rule issued Tuesday requires prior authorization before Medicare will pay for certain wheelchairs, prosthetics, orthotics and other medical equipment — sources of Medicare fraud and improper payments for years. The rule could save Medicare $10 million the first year, $200 million in five years and $580 million over a decade, says Aaron Albright, spokesman for the U.S. Centers for Medicare and Medicaid Services. (Ungar, 12/29)

The Wall Street Journal: New Risks At Rural Hospitals
Small rural hospitals called critical-access hospitals have in recent years been performing more and more inpatient orthopedic surgeries, even as their overall stays decline, a Journal analysis of Medicare billing records shows. Inpatient joint-replacement surgeries covered by Medicare rose 42.6% at the hospitals from 2008 to 2013, far outpacing the growth of those services at general hospitals. The trend reflects financial incentives built into the way Medicare pays the nation’s roughly 1,300 critical-access hospitals—generally isolated facilities with 25 or fewer beds—experts say, but it has troubling implications for patient safety. Many studies suggest that patients generally get better results when their procedures are done at hospitals that perform them frequently. (Weaver, Mathews and McGinty, 12/25)

The Wall Street Journal: Comparing Costs For Outpatient Care
Due to an obscure bit of regulatory wording, Medicare patients pay far more out of pocket for outpatient care at the small, rural hospitals known as critical-access hospitals than they would for the same care elsewhere, according a Wall Street Journal analysis of Medicare billing records. (Beck and Weaver, 12/25)

The Wall Street Journal: Health Insurers To Face Fines For Not Correcting Doctor Directories
New regulations allow the Centers for Medicare and Medicaid Services to fine insurers up to $25,000 per beneficiary for errors in Medicare Advantage plan directories and up to $100 per beneficiary for errors in plans sold on the federally run insurance exchanges in 37 states. States are imposing their own rules and sanctions. (Beck, 12/28)

The Associated Press: Health Insurer Apologizes For Early Morning Robocalls
A Massachusetts health insurer is apologizing after sending automated phone calls to as many as 10,000 senior citizens in the wee hours of the morning. Tufts Health Plan accidentally sent the robocall between 3 a.m. and 5 a.m. Tuesday to remind patients to get their flu shots. (12/30)

The New York Times: Programs Expand Schizophrenic Patients’ Role In Their Own Care
Frank, who eight months earlier had received a diagnosis of psychosis, the signature symptom of schizophrenia, and had been in and out of the hospital, gradually learned to take charge of his own recovery, in a new approach to treatment for people experiencing a first psychotic “break” with reality. At a time when lawmakers in Washington are debating large-scale reforms to the mental health care system, analysts are carefully watching a handful of new first-break programs like the one that treated Frank in New York as a way to potentially ease the cycle of hospitalization and lifetime disability that afflict so many mentally ill people. (Carey, 12/28)

The Washington Post: How One Couple’s Loss Led To A Push For Psychological Care For Kids With Cancer
What has stuck with Vicki and Peter Brown for years, beyond the enduring grief of losing their only child, Matthew, are the emotional traumas they all suffered during his struggle with a rare form of bone cancer. ... The couple ultimately launched a years-long effort to try to ensure that children with cancer and their families get the help they need for the non-medical aspects of the disease. Last week, their hard work paid off with the publication of the first national standards for the “psychosocial” care of children with cancer and their families. (Dennis, 12/29)

The New York Times: As Home Births Grow In U.S., A New Study Examines The Risks
With a growing number of American women choosing to give birth at home or in birthing centers, debate is intensifying over an important question: How safe is it to have a baby outside a hospital? A study published Wednesday in The New England Journal of Medicine provides some of the clearest information on the subject to date. The study analyzed nearly 80,000 pregnancies in Oregon, and found that when women had planned out-of-hospital deliveries, the probability of the baby dying during the birth process or in the first month after — though slight — was 2.4 times as likely as women who had planned hospital deliveries. Out-of-hospital births also carried greater risk of neonatal seizures, and increased the chances that newborn babies would need ventilators or mothers would need blood transfusions. (Belluck, 12/30)

NPR: Giving Birth Outside A Hospital Is A Little Riskier For The Baby
Roughly 99 percent of American women give birth to their infants in a hospital. But the number of women delivering babies at home or in a birthing center has been increasing dramatically in recent years — up nearly 30 percent between 2004 and 2009, for example. So scientists at the Oregon Health and Science University decided to try to get a better idea of how risky that is. The researchers took advantage of the fact that Oregon recently started requiring all birth certificates to list whether the mother had intended to give birth inside or outside a hospital. That designation helped researchers tease out births that were intended for home, but ended up in the hospital when something went awry. (Stein, 12/30)

NPR: Researchers Find Lapses In Hospitals' Policies For Determining Brain Death
Are hospitals doing everything they should to make sure they don't make mistakes when declaring patients brain-dead? A provocative study finds that hospital policies for determining brain death are surprisingly inconsistent and that many have failed to fully implement guidelines designed to minimize errors. (Stein, 12/28)

NPR: Lack Of Deep Sleep May Set The Stage For Alzheimer's
There's growing evidence that a lack of sleep can leave the brain vulnerable to Alzheimer's disease. The brain appears to clear out toxins linked to Alzheimer's during sleep. And, at least among research animals that don't get enough solid shut-eye, those toxins can build up and damage the brain. (Hamilton, 1/4)