Politico: GOP Free-For-All Over Reconciliation
Maine Sen. Susan Collins wants to use it for a tax overhaul. Texas Sen. Ted Cruz, for entitlement reform and a massive “pro-growth” agenda. And Rep. Bill Flores of Texas, who chairs the conservative Republican Study Committee, insists it should be used only to gut President Barack Obama’s signature health law. The fast-track reconciliation process — a rare budget procedure that would allow Republicans to jam sweeping legislation through the Senate with a simple majority — is quickly turning into a free-for-all. Dozens of members have different ideas for how to take advantage of the powerful tool, but the two chambers’ leaders will have to settle on a single set of priorities if they want to deploy it. (Bade and Sherman, 4/16)

Politico: After Bipartisan Bonanza, Senate Goes Back To Bickering
A day after a Senate committee unanimously approve an Iran review bill, party leaders were back to bickering: Majority Leader Mitch McConnell accused Democrats of aiding doctors and shunning sex trafficking victims. Minority Leader Harry Reid shot back that his counterpart’s complaints were “illogical” and devoid of facts. (Everett, 4/15)

The New York Times: Doctors See Benefits And Risks In Medicare Changes
Dr. Robert Wergin, president of the American Academy of Family Physicians, made little effort to contain his glee Wednesday over the news that Congress had voted to end a reviled payment system for doctors, simultaneously averting a 21 percent physician pay cut and overhauling the way Medicare will pay doctors in the future. ... Then he added: “Now, what next?” ... Doctors and health policy experts have begun to take stock of the practical implications of the legislation, which seeks to move away from paying doctors solely on the volume of their services and toward reimbursing them based on the quality and value of the care they provide. Many said the legislation was short on details about how such quality will be measured, and others expressed apprehension about whether the system will be fair. (Thomas and Abelson, 4/15)

Los Angeles Times: A Look At Key Parts Of Sweeping Bill Changing How Medicare Pays Doctors
The historic compromise legislation passed by the Senate this week will overhaul the way Medicare pays physicians and will create new systems to reward high-performing doctors. The bill, which drew unusual bipartisan support in both chambers of Congress, also includes new funding for state insurance programs for children and for thousands of community health centers nationwide. (Levey, 4/15)

Chattanooga (Tenn.) Times Free Press: Federal 'Doc Fix' Will Bring Millions To Tennessee Hospitals
Though Tennessee hospitals are still smarting from the failure of Gov. Bill Haslam's attempt to expand Medicaid, they have found some consolation in a congressional bill passed Tuesday night that will bring $80 million in federal and state funding to hospitals each year for the next decade. "This doesn't take the sting out of Insure Tennessee, but it's still a major victory for Tennessee hospitals," said Craig Becker, president of the Tennessee Hospital Association. For many safety-net hospitals in Tennessee, the funding "can mean the difference between them having anything on their bottom line or being in the negative," Becker explained. "For some of our smaller rural hospitals it can mean keeping their doors open." (Belz, 4/16)

Connecticut Mirror: Despite Reservations, CT Senators Join In Approving ‘Doc Fix’ Bill
While they had reservations about some provisions of the bill, Sens. Richard Blumenthal and Chris Murphy joined an overwhelming majority in the U.S. Senate to approve a bill preventing a 21 percent cut in Medicare fees for doctors. (Radelat, 4/15)

The Hill: Despite 'Doc Fix,' Some Doctors Still Face Cuts
Some Medicare doctors will still face a temporary 21 percent hit to their pay this month, even after Congress met the government’s Wednesday deadline to stave off the cuts. ... While Congress finalized the bill with several hours to spare before the deadline, CMS said in a notice to providers on Wednesday that some would face temporary cuts. Those providers will be reimbursed at a later date after CMS re-processes their claims. (Ferris, 4/15)

Politico Pro: Report Finds Little Impact Of Employer Mandate
Despite new coverage requirements under Obamacare, large employers have seen only modest increases in health care premiums as well as a steady level of workers signing up for insurance, according to a report released Wednesday. (Norman, 4/15)

The Hill: IRS Chief: No Backup Plan If Obamacare Tax Subsidies Struck Down
The head of the IRS said Wednesday that his agency does “not spend any time thinking” about whether the Supreme Court could strike down ObamaCare tax subsidies for millions of people this summer. IRS Commissioner John Koskinen told a Senate Homeland Security Committee that he is not preparing for the high stakes case, King v. Burwell. That responsibility, he said, rests with the White House, Congress and the states. (Ferris, 4/15)

Reuters: Clinton Pledges Help For Small Businesses At Last Stop On Iowa Tour
When one of the roundtable participants said his company was struggling to afford a health insurance plan for employees, Clinton said she was committed to building on President Barack Obama's landmark healthcare law. Clinton said allowing the free-market sale of health insurance across state lines should be examined to see if it would reduce costs. (4/15)

NBC News: Hillary Clinton Talks Health Care Policy With Small Business Owners In Iowa
Hillary Clinton said Wednesday that she wants to build on "what works" in the president's health care law, suggesting that she may be open to allowing health insurance to be sold across state lines and saying that she would fight for lower prescription drug prices. (Dann, 4/15)

Orlando Sentinel: Legislative Leaders: Session Likely Headed For Overtime Over Medicaid Impasse
Lawmakers will likely need a special session to resolve a deadlock between the House and Senate over health care spending, top lawmakers from the House and Senate said Wednesday. “If we’re not (agreeing on Medicaid expansion) then there’s no reason to sit here and kid ourselves. So we’ll finish out the business that we have before us on the policy and then we come back and do the budget at a later time,” House Speaker Steve Crisafulli, R-Merritt Island, told reporters. The House and Senate are $4.2 billion apart in their preferred budgets, mainly because the Senate includes a plan to expand Medicaid as well as a replacement for the Low Income Pool, a separate Medicaid program that pays hospitals for the care of low-income and uninsured patients. The House budget includes neither. (Rohrer, 4/15)

The Associated Press: Lawmakers Likely To End Session Without Deal On Health Care
Saying that the "sand is running out of the hourglass," the Republican leaders of the Florida Legislature said Wednesday it appears they will end their annual session on May 1 without reaching a deal on health care and a new state budget. The House and Senate are $4 billion apart in rival budgets and the leaders of the two chambers remain at an impasse over how to bridge the gap - which stems from a deep divide over whether to accept billions in federal aid to expand Medicaid. (4/15)

Tampa Bay Times: Florida Legislature Heads Toward Special Session Because Of Medicaid Impasse
Even though the session is scheduled to end May 1, state law requires that the final budget be on the desks of lawmakers 72 hours before they vote on it. That moves up the deadline to wrap up budget negotiations to April 27, giving lawmakers little more than a week to bridge a $4 billion gap between the Senate and House proposed budgets. But neither the House nor Senate seem ready to back down. (Van Sickler and McGrory, 4/15)

The Washington Post's Wonkblog: These States Leave The Most Mentally Ill Adults Untreated. Guess What Else They Have In Common.
The politics of Obamacare have produced a geographic divide in mental health care. Uninsured, low-income Americans in the east, mid-Atlantic and Pacific are receiving more treatment through the Medicaid expansion, while those in the south and central U.S. are not, according to a new report. Nearly 568,000 uninsured people who have been diagnosed with a serious mental health condition would have received treatment in 2014 if their states had chosen to expand Medicaid, according to the American Mental Health Counselors Association, a professional organization that does advocacy and education. (Swanson, 4/14)

Arizona Central-Republic: New Arizona Law Puts Subsidized Health Insurance At Risk
Health insurance for more than 150,000 Arizonans if the U.S. Supreme Court rejects subsidized coverage in Arizona and 33 other states. Ducey last week signed House Bill 2643, which forbids Arizona setting up its own Affordable Care Act health exchange. The bill has little immediate impact on the Arizona residents who get coverage through the federal marketplace, but it could have a big impact in a few months. (Alltucker, 4/15)

The Denver Post: Colorado Heath Insurance Exchange Overseers Beef Up Scrutiny
The legislative oversight committee for the state health insurance exchange Wednesay advanced its plans to change its name and expand its calendar for reviewing Connect for Health Colorado. The Senate passed a bill sponsored by committee members that would allow them to meet as often as they want during the legislative session and up to 10 times after it ends May 6. (Draper, 4/15)

Bloomberg: UnitedHealth Boosts Forecast As Quarterly Profit Beats Estimates
UnitedHealth Group Inc., the largest U.S. health insurer, raised its 2015 forecast after posting first-quarter profit that topped analysts’ estimates as it added customers and its Optum technology unit boosted revenue. Earnings, excluding certain items, will be $6.15 to $6.30 a share, the Minnetonka, Minnesota-based insurer said Thursday in a statement. The company had said as recently as last month that 2015 profit would be $6 to $6.25 a share. Analysts had estimated $6.21, on average, according to data compiled by Bloomberg. (Tracer, 4/16)

The Wall Street Journal: UnitedHealth Raises Full-Year Guidance
The company raised its full-year revenue outlook by $2 billion to $143 billion due to strength in the first quarter. It increased per-share earnings expectations to a range of $6.15 to $6.30 from the previous range of $6.00 to $6.25. Analysts polled by Thomson Reuters are expecting earnings of $6.21 a share and revenue of $141.68 billion. (Chen, 4/16)

The Associated Press: UnitedHealth Tops Street 1Q Forecasts
UnitedHealth Group Inc. (UNH) on Thursday reported first-quarter profit of $1.41 billion. On a per-share basis, the Minneapolis-based company said it had net income of $1.46. The results surpassed Wall Street expectations. The average estimate of 16 analysts surveyed by Zacks Investment Research was for earnings of $1.33 per share. (d4/16)

The Wall Street Journal: HCA Holdings Raises Full-Year Guidance
Hospital operator HCA Holdings Inc. on Wednesday reported better-than-expected preliminary results for the March quarter and raised its full-year guidance amid higher admissions and emergency-room visits. Shares of HCA, up 62% over the past year, rose 3.1% to $79.70 in morning trading. (Chen, 4/15)

Modern Healthcare: Wall Street Loves Health Insurance, But Medical Cost Trends Lurk
Investors have flocked to publicly traded health insurers, as evidenced by soaring stocks so far in 2015. Although optimism runs high in the managed-care sector, signs have emerged that medical costs are on the rise and could dampen earnings. The most prominent sign came Wednesday from HCA, the nation's largest for-profit hospital operator by revenue. The company said its inpatient, outpatient and emergency room admissions were all up significantly in the first quarter this year, an announcement that immediately brought down the stock prices of every large payer. (Herman, 4/15)

The Wall Street Journal's Pharmalot: Will A New Vertex Drug For Cystic Fibrosis Become A Budget Buster?
As the national debate over the cost of prescription medicines intensifies, a pharmacy benefits manager is warning that a forthcoming combination treatment for cystic fibrosis may become the latest example of a budget-busting drug. In an analysis of insured patients, Prime Therapeutics estimates that it may cost as much as $4.5 billion annually for the nation’s health care system to pay for a combination medicine that includes Kalydeco – an existing and treatment sold by Vertex Pharmaceuticals – along with another Vertex compound. (Silverman, 4/15)

The Associated Press: FDA Approves New Type Of Heart Failure Drug From Amgen
Patients with chronic heart failure, a disabling, deadly disease that worsens as the heart gradually pumps less efficiently, are getting a much-needed new option with U.S. approval Wednesday of a novel drug from Amgen Inc. Corlanor is the first medication in a dozen years for heart failure, which is becoming more common with obesity — and more people surviving heart attacks due to better treatments. (Johnson, 4/15)

The Wall Street Journal: Health Insurers Call For Stronger Rules On Medical Devices
The U.S. health-insurance industry is calling for tougher rules for approving and tracking medical devices, citing regulatory gaps exposed last year when a tool used for decades in hysterectomies was found to spread cancer. America’s Health Insurance Plans, a trade group, said in a letter to Sen. Bob Casey on Tuesday that the dangers of the laparoscopic power morcellator reveal weaknesses in how devices are cleared for use and monitored once they are on the market. The letter was reviewed by The Wall Street Journal. (Kamp, 4/15)

The Washington Post: Congress To VA About Denver Hospital: ‘How Are We Going To Pay For It?’
How is the Department of Veterans Affairs going to pay for it? That was just one of the woes tackled at a tense, nearly three-hour congressional hearing on Wednesday on the most expensive construction project in the VA’s history: a still uncompleted $1.7 billion hospital in suburban Denver, which a number of lawmakers again and again said was causing “bipartisan heartburn and angst.” (Wax-Thibodeaux, 4/15)

The Associated Press: VA Employee Says He Was Fired After Warning Of Hospital Cost
A whistleblower said he was fired by the Veterans Affairs Department after warning of cost overruns at the Denver VA hospital, prompting a rebuke Wednesday from members of Congress who questioned why higher-ranking executives haven't been punished. VA contract specialist Adelino Gorospe warned department executives in 2011 that the hospital would cost more than official estimates, The Denver Post reported. Gorospe told the newspaper that he was fired in 2012 for allegedly disobeying a supervisor. (Elliott, 4/15)

Two other VA cost-management issues also made headlines: A blistering 79-page audit cites deficiencies at a Philadelphia facility, while the Senate may push the VA and Pentagon to improve electronic medical records sharing -

The Associated Press: Audit Finds Wide Mismanagement At Philadelphia VA
Unreasonable workloads and poor leadership at the Veterans Affairs facility in Philadelphia have led to mismanagement and delays in handling veterans' disability and pensions claims, according to a government audit released Wednesday. In a blistering 79-page report, the VA's inspector general cites a litany of problems, all part of a rush to reduce persistent backlogs that go beyond the widely reported wait times for medical care at department facilities. (Yen, 4/15)

CQ Healthbeat: Appropriators Want VA, Pentagon To Speed Sharing Of Electronic Medical Records
Senators writing the fiscal 2016 Military Construction-Veterans Affairs spending bill intend to push the Department of Veterans Affairs and Pentagon to do more to share electronic medical records. Mark S. Kirk, the chairman of the appropriations subcommittee overseeing the agencies, said Wednesday the agencies should have a seamless system allowing discharged personnel to shift to the VA health system without difficulties. (Adams, 4/15)

Modern Healthcare: Health IT Chief DeSalvo Urges More Patients To Seek Access To Electronic Records
The chief federal information technology policymaker stopped short of denouncing a recently released CMS proposed rule that patient-engagement advocates say is a step backward for their cause. Instead, Dr. Karen DeSalvo, head of the Office of the National Coordinator for Health Information Technology at HHS, said she hopes a “call to action” by her predecessor seeking to pressure the CMS to walk back the proposed rule change encourages more patients to seek access to their electronic health records. (Conn, 4/15)

The Fiscal Times: $30B Digital Health Record Push Hits Big Roadblocks
The federal government has poured nearly $30 billion into modernizing the health care industry by incentivizing hospitals to shift to digital health records. The idea is for health providers to be able share a person’s vital health information with doctors and hospitals others across the country – when someone moves, when they travel, no matter where they are. While about 62 percent of all U.S. health providers have adopted the technology, very few can actually share their digital files with other hospitals and providers - a feature that is required in order to receive financial incentives from the government. (Ehley, 4/15)

The San Jose Mercury News: Vaccine Exemption Bill Temporarily Stalls In California Senate Education Committee
A controversial bill to require vaccinations for all California school children ran into trouble Wednesday, when its author delayed a key Senate committee vote after enraged parents opposed to the legislation demanded lawmakers answer a central question: Don't all kids -- whether they are vaccinated or not -- have a right to a public education? (Seipel, 4/15)

The Sacramento Bee: California Vaccine Bill Stalls As Parents Worry About Keeping Kids In School
Bowing to concerns from parents and lawmakers that children would be denied an education, a state senator on Wednesday delayed a vote on a bill requiring most California parents to vaccinate their children as a condition of enrolling them in private or public schools. (White, 4/15)

Health News Colorado: Colorado Makes It Far Tougher To Opt Out Of Vaccines
Opting out of vaccines for potentially deadly diseases like the measles will become much harder in Colorado after the Board of Health on Wednesday voted for a set of tougher rules for parents seeking exemptions. The new rules mark a striking change in Colorado after a bill that aimed to increase immunizations got watered down during the 2014 legislative session. Then the widely publicized measles outbreak tied to Disneyland in California heightened concerns about highly contagious diseases like the measles. (Kerwin McCrimmon, 4/15)

The Denver Post: Colorado Strengthens Vaccination Rules, Adding Exemption Requirements
The state Board of Health on Wednesday passed new immunization rules that officials say strengthen school policies and will improve the state's low vaccination rates. The new rules, effective July 2016, will require parents seeking non-medical exemptions from school and child-care vaccine requirements to submit them more than once. They will be required at each age when recommended vaccines are due for pre-kindergartners and annually from kindergarten through 12th grade. (Draper, 4/15)

The Wall Street Journal: N.J. Cities Pass Paid-Sick-Leave Laws Despite Opposition From Christie
Gov. Chris Christie opposes requiring businesses to give workers paid sick days, calling it another onerous regulation that deters companies from investing in New Jersey. That hasn’t stopped officials in nine municipalities, including Newark, Jersey City and Montclair, from passing paid-sick-leave laws and enforcing them—without the consent of Mr. Christie or the state Legislature. (Dawsey, 4/15)

Health News Florida: Florida State Worker Health Premiums May Change
Since 2005, monthly health insurance premiums for state workers in Florida have stayed the same. But a bill making its way through the Florida House could make big changes to the state group employee health plan, which covers more than 300,000 state employees and their families. (Watts, 4/15)

USA Today: Half The States Look At Right-To-Die Legislation
More than a dozen states, plus the District of Columbia, are considering controversial medically assisted death legislation this year. The laws would allow mentally fit, terminally ill patients age 18 and older, whose doctors say they have six months or less to live, to request lethal drugs. (Monir, 4/15)

The Sacramento Bee: With Funding In Doubt, Immigrant Health Care Bill Advances
After stalling last year because of funding concerns, a scaled-back plan to expand health coverage to Californians in the country illegally passed its first Senate committee on Wednesday. But SB 4, which would make undocumented immigrants eligible for Medi-Cal and seek a federal waiver allowing them to purchase unsubsidized health insurance on the state exchange, still faces its biggest hurdles over cost. (Koseff, 4/15)

The Associated Press: Texas Senate Votes To Partially Consolidate State Health Agencies
The Texas Senate has voted to partially consolidate the state's health and human services bureaucracy — but stopped short of creating a single, super entity as proposed amid a no-bid contract scandal. Senators unanimously approved merging three agencies beginning next year — the Health and Human Services Commission, the Department of Aging and Disability Services and the Department of Assistive and Rehabilitative Services. (4/15)

The Washington Post: A New Fetal Homicide Bill In Colorado Resurrects An Old Abortion Debate
On Tuesday, a new bill was introduced to the Colorado Senate directly in response to the horrific attack. The bill, its supporters say, would make it easier for prosecutors to bring murder charges against those, like Lane, who are accused of killing a fetus. The new measure’s opponents, however, have argued that the bill is too similar to previous proposals in the state that would have included fetuses in the state’s definition of a person. (Ohlheiser, 4/15)

Milwaukee Journal-Sentinel: ProHealth Has Hopes For Cardiothoracic Surgery Partnership
ProHealth Care is betting that its agreement with Indiana University Health to oversee its cardiothoracic surgery program will enable it to offer new procedures and remain competitive in an important service line. The three-year agreement marks the first time a health system in the Milwaukee area has partnered with an out-of-state health system to run one of its program. The agreement was announced more than a year ago, but took longer than expected to put in place. (Boulton, 4/15)

Minnesota Public Radio: Mayo Clinic Hiring Means Nursing Shortage For Other Facilities
Across Greater Minnesota, nursing homes are in a bind, trying to keep nurses from being scooped up by better paying jobs, often at hospitals. That's especially true in southeast Minnesota where nursing home workers are often lured away by higher-paying jobs and working conditions at Mayo Clinic. (Baier, 4/15)

The Charlotte Observer: Hospitals To Fight Bill That Would Open NC Medical Market
An influential state senator wants to repeal laws that were designed to curb health care costs, arguing that they have actually accomplished the opposite. A bill introduced by Sen. Tom Apodaca, the Henderson County Republican who chairs the Senate Rules Committee, would eliminate the state’s certificate-of-need laws. Intended to prevent excessive facilities and equipment, the CON program requires hospitals and other medical providers to get state approval for expansions and major acquisitions. (Alexander, 4/16)

The Associated Press: Vermont Health Department Says Some Decline TB Treatment
A handful of the people connected with the Charlotte Central School who tested positive for tuberculosis earlier this year are declining treatment with antibiotics that can wipe out the infection before an infected person becomes sick, a Vermont Health Department official said Wednesday. (Ring, 4/15)

The Associated Press: Mississippi Law Could Expand Services For People With Autism
Brian and Laura Beth Johnston of Madison learned in December that their 4-year-old son, Fraiser, has autism. But because their private insurance doesn't pay for the therapy he needs, Fraiser has gone without services that could help him with language development and other skills, his mother said. The diagnosis alone cost the couple $1,200. A new Mississippi law is designed to help people like the Johnstons as they try to help children with autism spectrum disorder, Gov. Phil Bryant said during a news conference Wednesday. (Pettus, 4/15)

The New York Times: Has Obamacare Turned Voters Against Sharing The Wealth?
With the advent of the Affordable Care Act, the share of Americans convinced that health care is a right shrank from a majority to a minority. This shift in public opinion is a major victory for the Republican Party. It is part of a larger trend: a steady decline in support for redistributive government policies. Emmanuel Saez, an economics professor at Berkeley and one of the nation’s premier experts on inequality, is a co-author of a study that confirms this trend, which has been developing over the last four decades. A separate study, “The Structure of Inequality and Americans’ Attitudes Toward Redistribution,” found that as inequality increases, so does ideological conservatism in the electorate. (Thomas B. Edsall, 4/15)

Los Angeles Times: A U.S. Court Quashes The Dopiest Obamacare Lawsuit Of All
It is widely held that the dopiest anti-Obamacare lawsuit is King vs. Burwell, a conservative contrivance that tortures four words in the Affordable Care Act to assert that consumer healthcare subsidies in three dozen states should be invalidated. But the Supreme Court has taken up King for a ruling, which implies that at least four justices think the assertion is worthy of consideration. (A decision is due early this summer.) That leaves a lawsuit entitled Johnson vs. U.S. Office of Payroll Management holding the crown. On Tuesday, however, the Chicago-based U.S. Court of Appeals for the 7th Circuit tossed the case with a horselaugh, so its reign may be ending. (Michael Hiltzik, 4/15)

Bloomberg: Obamacare's Tax Day Mystery
For a while now, I’ve been saying that the most important Obamacare deadline this year was not the end of open enrollment on the exchanges, but April 15. That’s when lots of people find out that they owe money to the government -- either because they didn’t have insurance and therefore get hit with the individual mandate penalty, or because they found out they received too much in subsidies and now owe money to the government. So how’s it going? As with many things about this law, it’s hard to tell. (Megan McArdle, 4/15)

The Wall Street Journal: In Praising ObamaCare, They Bury It
In the five years since the passage of ObamaCare, the battle over the law has not abated. One popular salvo is the supposedly objective “let’s just see how it is working” analysis carried out by the law’s supporters. There are two tricks common to this line of reasoning. (Cliff Asness, 4/15)

The Wall Street Journal's Washington Wire: Public Vs. Private Health Insurance On Controlling Spending
No single fact can settle the long-running debate of whether public or private health insurance is preferable. But by one basic metric, the rate of increase in per capita spending, public insurance has an edge. The Federal Office of the Actuary in the Centers for Medicare and Medicaid Services has charted the annual rate of increase in spending for Medicare, Medicaid, and private health insurance. ... by cumulative growth in per capita spending, Medicare and Medicaid have generally grown more slowly than private insurance and are projected to continue doing so through 2023. Per capita spending is an especially useful measure for comparing public and private health insurance spending because it shows how much Medicare, Medicaid, and private insurers spend on each person irrespective of the number of people covered. (Drew Altman, 4/16)

Tampa Bay Times: End Fiscal Folly On Medicaid
Gov. Rick Scott and Florida House Republicans love to complain about government wasting money, particularly when they are focused on Washington. Yet they demand that the Obama administration keep sending money to cover hospital charity care and oppose helping low-income Floridians buy private health insurance. It is an indefensible position at odds with their support for fiscal restraint and private market solutions, but partisan politics has clouded their vision and put the health of nearly 1 million residents at risk. (4/15)

The Washington Post's Plum Line: Battle Over Florida Medicaid Expansion Is A Big, Big Deal
You really should be paying attention to the ongoing battle over the Medicaid expansion in Florida. If supporters of Obamacare get their way, it could help weaken the blockade of opposition that conservatives have successfully used to stall the expansion in multiple states this year, after it seemed to be progressing last year. (Greg Sargent, 4/15)

St. Louis Post-Dispatch: Missouri Should Choose Common-Sense Solution On Medicaid
Missouri is facing a health care crisis, one that is threatening both urban and rural communities. Hardworking families cannot afford health insurance, hospitals are struggling to keep their doors open, and services for low-income Missourians are being cut or eliminated. Meanwhile, bureaucrats in Washington, D.C., and our legislators in Jefferson City are blocking common-sense solutions to protect our vital health care safety net. ... Unfortunately, anger over Obamacare has confused the issue. (Christopher S. Bond, 4/15)

The Tennessean: Legislature's Fear Is Costing Tennessee Thousands Of Jobs
If the Tennessee General Assembly had passed Gov. Bill Haslam's plan to extend insurance coverage to the working poor, about $3.1 million would have been spent today at doctor's offices, pharmacies and hospitals big and small across the state. ... The Insure Tennessee plan proposed by Haslam, and rejected by a fearful legislature with little debate, is one of the best economic stimulus programs for small towns and rural communities in this state that can be conceived. ... No matter the scorn that is being heaped on legislators now, they are not going to bring the Insure Tennessee plan to a vote before the session ends in a couple of weeks. But we would hope that legislators pay more than lip service to a summer study and that they talk to a broad swath of their constituents when they go home. (Frank Daniels III, 4/15)

Bloomberg: Doc Fix May Hit A Wall: Doctors
Congress has finally crafted a permanent doc fix, which passed the Senate in a stunning display of bipartisanship, 92-8. This is a good reminder of what we didn’t like about bipartisanship: Congress found agreement so easy because what it agreed to do was not pay the full price tag of this rather expensive fix. On the other hand, it had long been clear that the cuts would never be allowed to take effect, and the things it found to finance its annual gifts to the doctors' lobby were getting increasingly ridiculous, so it’s hard to be too upset. (Megan McArdle, 4/15)

The New York Times: Keep Patients Healthy, And Doctors Sane
I opened the curtain and found my patient stretched out flat on the recliner, one arm thrown across his eyes. Worried, I reached for his pulse, but then I heard a soft snore. He was sound asleep, before I’d given him any anesthesia. I felt far less relaxed than he seemed to about his upcoming surgery. Thanks to the Affordable Care Act, this man had health insurance for the first time in over a decade, and his diabetes, hypertension, clogged blood vessels and early emphysema — the death threats silently stalking him for years — had finally been identified and treatment had been started. Already an ophthalmologist had discovered that he would most likely go blind without surgery, and every day he delayed put his vision at risk. But you don’t undo 10 years of neglected health in six months. (Carol W. Cassella, 4/15)

CNN: Will More Medical Tests Make Us Healthier?
I usually think of April as tax month, but it seems to be morphing into National Get Tested Month. Dallas Mavericks owner Mark Cuban advised Twitterers to have their blood tested for everything available -- and to do so every three months. Following her mother's cancer diagnosis, singer Taylor Swift urged her fans to remind their parents to get screening tests. And Arizona Gov. Doug Ducey signed legislation to allow Arizonans to get any lab test without a doctor's order. ... Some might argue that this freedom to test is the path to a healthier society. But the primary effect won't be more health, but rather more medical care. (H. Gilbert Welch, 4/15)

JAMA: The Ethics Of Patient Care
So, as much as physicians must commit to long hours of hard and careful work and practice to deliver best care, they must also commit to always providing ethical care according to the virtues and values of the profession. Mindful self-knowledge may help, but a strong will and moral commitment are required to guard against ethical lapses. The center of medical ethics can be redirected by making explicit the moral nature of ordinary physicians’ work. A very wise ethicist said that medicine has a primary end, “which is healing and helping and which supersedes the doctor’s self-interests.” In today’s environment, it bears re-emphasis that providing the best possible care for patients is a moral mandate encompassing not just resolving ethical dilemmas, but the whole of a physician’s work. (William T. Branch Jr., 4/14)

JAMA: Cognitive Aging: A Report From The Institute Of Medicine
Cognitive aging is a lifelong process of gradual, ongoing, yet highly variable changes in cognitive function that occur as people get older. ... Cognitive aging is not a disease or a quantifiable level of dysfunction. It is distinct from Alzheimer disease and other neurocognitive and psychiatric disorders that affect older adults’ cognitive health .... An individual and society can be affected by cognitive aging because of 2 issues. First, older adults lose an estimated $2.9 billion a year, directly and indirectly, to financial fraud. ... Second, older adults may develop problems with driving, especially because reaction time is critical and decision making must be at times almost instantaneous. (Drs. Dan G. Blazer, Kristine Yaffe and Jason Karlawish, 4/15)

JAMA: Regenerative Medicine
The Culture of Organs, a book published in 1938 by Nobel Laureate Alexis Carrel and well-known aviator Charles Lindbergh, described how organs could be kept “alive” in culture for months, with the intent to reuse them. Decades later, regenerative medicine, a field of science that aims to restore or establish normal function by replacing or regenerating human cells, tissues, and organs affected by disease, is becoming a reality. The field is a progression of previous efforts to restore function, ranging from prosthetics to organ transplants. Advances in cell biology, biomaterial science, and biological molecule discovery have led to new options for cellular therapies, engineered tissues and organs, and new strategies to stimulate endogenous repair and regeneration. (Anthony Atala and Sean Murphy, 4/14)