The Wall Street Journal: Rate Falls For Often-Deadly Ailments Acquired In U.S. Hospitals
The incidence of often-deadly ailments that patients fall prey to inside U.S. hospitals fell by 17% between 2010 and 2013, the Obama administration said Tuesday. Such accidental ailments include infections, falls and adverse reactions to drugs. The administration estimates that the decline resulted in as many as 50,000 fewer people dying while hospitalized over the three-year period. (Radnofsky, 12/2)

Los Angeles Times: Obama Administration Announces Major Decline In Medical Errors
Infections and other medical errors that harm patients in hospitals have declined significantly, the Obama administration said Tuesday, hailing the progress as a sign that new efforts to improve patients' safety are bearing fruit. From 2010 to 2013, so-called hospital-acquired conditions declined 17%, according to a new report from the Department of Health and Human Services. (Levey, 12/2)

The Washington Post's Wonkblog: Hospitals Are Killing Tens Of Thousands Fewer People
Wide-ranging efforts to make hospital care safer have resulted in an estimated 50,000 fewer patients dying because of avoidable errors in the past three years, according to a new report presented by government and industry officials on Tuesday. (Millman, 12/2)

Reuters: U.S. Hospitals Make Fewer Serious Errors, 50K Lives Saved
About 50,000 people are alive today because U.S. hospitals committed 17 percent fewer medical errors in 2013 than in 2010, government health officials said on Tuesday. The lower rate of fatalities from poor care and mistakes was one of several "historic improvements" in hospital quality and safety measured by the Centers for Medicare and Medicaid Services. They included a 9 percent decline in the rate of hospital-acquired conditions such as infections, bedsores and pneumonia from 2012 to 2013. Secretary of Health and Human Services Sylvia Burwell is scheduled to announce the data on Tuesday at the CMS Healthcare Quality Conference in Baltimore. It is based on a detailed analysis of tens of thousands of medical records, but because data was collected differently before 2010, it is not possible to compare pre-2010 figures to later ones. (12/2)

NBC News: Hospital Errors Drop, Saving 50,000 Lives: Government
Hospitals are making fewer mistakes, from giving patients the wrong medications to giving them infections, according to a government report issued Tuesday. (Fox, 11/2)

McClatchy: Fewer Hospital Mistakes Mean 50,000 Lives, $12 Billion Saved
Improved patient safety and fewer mistakes at U.S. hospitals saved the lives of roughly 50,000 people from 2011 to 2013, the Obama administration reported Tuesday. Incidents of hospital-induced harm – such as adverse drug events, infections, falls and bedsores – fell by 17 percent, or an estimated 1.3 million episodes, from 2010. The improvements, driven by a number of public and private initiatives, saved an estimated $12 billion in health care spending, according to a new government report that found dramatic progress in the fight to curb preventable medical injuries at U.S. hospitals. (Pugh, 12/2)

The Fiscal Times: Drop In Hospital Error Rate Saves $12B Since 2010
Preventable medical errors and hospital-acquired infections have long plagued the U.S. health care system and led to thousands of unnecessary deaths, serious injuries and billions in health care costs each year. Now, a new report from the Health and Human Services Department suggests that new provisions under Obamacare, as well as a joint effort with health officials and hospitals, have dramatically curbed the problem over the last four years – resulting in 50,000 fewer preventable deaths and a savings of $12 billion. (Ehley, 12/2)

Politico Pro: HHS Sees Progress In Fighting Hospital-Acquired Harm
More than 50,000 lives and $12 billion have been saved in the past three years amid a drop in the rate of patients being harmed in the hospital, HHS Secretary Sylvia Mathews Burwell announced Tuesday. An estimated 1.3 million fewer injuries have been sustained in the hospital — apart from whatever health problem brought people there in the first place — amounting to a 17 percent decline from 2010 to 2013, according to a report released by HHS in time for a CMS safety conference in Baltimore. (Norman, 12/2)

Meanwhile, a survey commissioned by the Lehman Center for Patient Safety in Massachusetts found that medical errors often go unreported by patients -

The Boston Globe: Medical Errors Affect One-Quarter Of Mass. Residents
Nearly one-quarter of Massachusetts residents say they, or someone close to them, experienced a mistake in their medical care during the past five years, according to a survey released Tuesday. And about half of those who reported a mistake said the error resulted in serious health consequences. The poll of 1,224 residents by Harvard School of Public Health researchers found that many people did not report the medical mistakes, often because they did not believe it would do any good, or they did not know how to report it. (Lazar, 11/2)

WBUR: After High-Profile Death, Medical Errors Still Harm Hundreds Of Thousands
Two decades after a Boston Globe reporter died from a preventable medical error in one of the nation’s top hospitals, hundreds of thousands of patients in Massachusetts are still suffering as a result of medical mistakes. A new survey finds that one in every four Massachusetts adults reports a mistake in their own medical care or that of someone close to them over the past five years — a rate that translates to more than a million people. Half of them say they or someone close to them suffered serious harm as a result. (Knox, 12/2)

Modern Healthcare: Few States Move To Establish Exchanges Despite Subsidies' Legal Peril
The Democratic-controlled Illinois Legislature appears poised to approve legislation this week establishing a state-based insurance exchange. The bill has gained urgency because of the U.S. Supreme Court's decision to take up the King v. Burwell case, which could invalidate federal premium subsidies in the 34 states, including Illinois, that did not establish their own exchanges and instead rely on HealthCare.gov for enrollments. (Demko, 12/2)

Los Angeles Times: Poll: Nearly 4 In 10 Say California Obamacare Exchange Not Working Well
Nearly four in 10 Californians say the state's health exchange isn't working well as the second open enrollment gets underway, a new survey shows. The results from the Public Policy Institute of California survey may reflect persistent service problems experienced by some consumers as well as continued partisan opposition to the federal overhaul. (Terhune, 12/2)

The Seattle Times: Another Glitch Afflicts An Estimated 6,000 Exchange Customers
About 6,000 enrollments in health plans offered by the Washington Healthplanfinder insurance exchange were improperly canceled because of an error, according to the Washington Health Benefit Exchange, which manages the exchange. “Early analysis indicates that our system integrator, Deloitte, ran an automated enrollment cancellation process in error,” said Richard Onizuka, CEO of the exchange, in a statement issued Tuesday evening. The enrollments involved policies that take effect in 2015. Most of those affected have not yet been notified. (Marshall, 12/2)

The Associated Press: Utah Advocates: Health Care Website Much Improved
Two Utah men who benefited from the federal health care law said Tuesday that while the law has been politically divisive, it has saved their lives by allowing them to get affordable insurance. James Phillips of Midvale said he lost his job and came down with an illness several years ago that left him unable to find work and health insurance that cost less than $750 a month. (Price, 12/2)

The California Health Report: Even With Subsidies, Some San Francisco Residents Can’t Afford Covered California Premiums
With the high cost of living in San Francisco, many low-income residents who qualify for federally subsidized health insurance under Covered California still can’t afford it. The San Francisco Board of Supervisors is looking at helping that population afford insurance by providing additional subsidies funded through employer contributions. (Graebner, 12/2)

The Washington Post: Wyoming’s Republican Governor Will Push To Expand Medicaid
Wyoming Gov. Matt Mead (R) was once among the handful of state executives to sue the federal government over the Affordable Care Act. Now, he says he wants his state to expand Medicaid under the ACA to cover thousands of low-income residents. In a Monday press conference, Mead said he would press the state legislature to act on a Medicaid expansion plan put forward last week by the state Department of Health. (Wilson, 12/2)

Casper Star-Tribune: Wyoming Governor: Time To Act On Medicaid Expansion Is Now
Gov. Matt Mead said that while he dislikes the Affordable Care Act, he believes the Legislature needs to act on Medicaid expansion. ... “What I will tell the Legislature is: We have fought this,” Mead said. “I agree it is not a good piece of legislation, but as I see where we are, I think we have to be realistic and say, 'This is the current law of the land and we need to either go forward with this' or if the Legislature wants to come up with a different plan, I certainly would be open to that. But I don’t think we can say to those people in Wyoming who are working who cannot get insurance that we’re not going to do anything.” (Hancock, 12/1)

The Philadelphia Inquirer: Action Brisk First Day Of Expanded Pa. Enrollment
Toll-free phone lines were jammed, and low-income workers streamed into sign-up sites as enrollment opened Monday for expanded health insurance coverage under Medicaid. An estimated 600,000 people -- most working at low-wage jobs -- are eligible for Medicaid through Healthy PA, the state's alternative to Medicaid expansion under the Affordable Care Act. First-day enrollment numbers were unavailable, Kait Gillis, a spokeswoman for the Department of Human Services, said at the end of the day. (Worden, 12/2)

The Associated Press: Lack Of Coverage A Factor In Bankruptcies
A lack of health insurance is driving many of Nebraska’s personal bankruptcies and shifting more costs onto hospitals and businesses, advocates who want Nebraska to expand Medicaid told lawmakers Tuesday. Supporters are once again preparing to introduce a Medicaid expansion bill that would extend coverage to an estimated 54,000 Nebraska residents whose incomes are too high to qualify for Medicaid but too low to receive subsidies available under the federal health care law. (Schulte, 12/2)

Kansas Health Institute News Service: ACA To Increase Kansas State Employees Eligibility For Benefits
Beginning in January, more than 80 percent of workers currently eligible for part-time benefits within the Kansas state employee health plan will be eligible for full-time benefits under changes mandated by the federal Affordable Care Act. The ACA, also known as Obamacare, establishes 30 hours as the threshold for full-time employment. Starting next year, large employers – those with 50 or more employees – will be required to offer health coverage to all full-time workers. The threshold for state employees to be considered "full-time" for health insurance purposes in Kansas previously was 36 hours per week. (Marso, 12/2)

The Associated Press: Appeals Court Hears Challenge To Health Care Law
A Texas doctor's challenge to President Obama's health care overhaul is before a federal appeals court in New Orleans. Tuesday's arguments at the 5th U.S. Circuit Court of Appeals center on the contention that the law is unconstitutional because it imposes a tax — and all tax bills must originate in the House. The lawsuit contends that the law originated in the Senate. (McGill, 12/2)

Kaiser Health News: One Man Explains Why He Is Still Uninsured
When the Affordable Care Act rolled out last year, Californians enrolled in both Covered California and expanded Medi-Cal in high numbers. But there are still millions without insurance. Undocumented people don’t qualify for Obamacare benefits. Many others still find coverage too expensive or face other obstacles to enrolling. One of those people is Leaburn Alexander. I meet up with him at 6 a.m. as he is finishing his shift as the night janitor at a hotel near the San Francisco Airport. He clocks out just in time to catch the hotel’s shuttle back to SFO, where he will catch a bus. (Morehouse, 12/3)

USA Today: Kathleen Sebelius: Jonathan Gruber? Who?
Former Health and Human Services secretary Kathleen Sebelius, disputing the description of MIT professor Jonathan Gruber as an architect of the Affordable Care Act, says she had never met with him and minimized the significance of his controversial comments describing passage of the law. Gruber, a prominent health economist and federal consultant, is scheduled to testify before a House committee next week about his remarks that the 2010 law deliberately was drafted "in a tortured way" to obscure the reality that it created a system in which "healthy people pay in and sick people get money." (Page, 12/2)

The Washington Post: Watchdog’s View: HHS Inspector General Talks Healthcare.gov, Ebola, Obamacare
Daniel Levinson has served as inspector general of the U.S. Health and Human Services Department since 2005, working for two presidents, monitoring two of the largest Medicare expansions in U.S. history and keeping watch of an organization that accounted for about $1 trillion in federal spending this year. (Hicks, 12/2)

Also in the news, UnitedHealth Group's chief executive talks about how the health law will continue to impact the health care marketplace -

Reuters: UnitedHealth CEO Expects 2016 Growth As Reform Law Effects Wane
UnitedHealth Group Inc. Chief Executive Stephen Hemsley said on Tuesday that as the effects of the national healthcare reform law diminish in 2016, the health insurer expects its pace of growth to be above 2015 and to accelerate from there. In 2014, lower payments to insurers for Medicare Advantage plans and new taxes that insurers must pay under the Affordable Care Act, often called Obamacare, cut into after-tax operating profit by $400 million, UnitedHealth said. That figure takes into account some offset from the positive effects of Medicaid expansion, it said. In 2013, the effects of the ACA cost the company $1 billion. (12/2)

The Wall Street Journal's Washington Wire: McConnell: Supreme Court Is Best Hope For Obamacare ‘Do Over’
Incoming Senate Majority Leader Mitch McConnell (R., Ky.) on Tuesday said the Senate is likely to vote on a series of measures to pick apart the Affordable Care Act starting next year, but pointed to a pending court case as the best opportunity to disassemble President Barack Obama’s signature health-care law. “Who may ultimately take it down is the Supreme Court of the United States,” Mr. McConnell said at The Wall Street Journal CEO Council annual meeting. “If that were to be the case, I would assume that you could have a mulligan here, a major do-over of the whole thing–that opportunity presented to us by the Supreme Court, as opposed to actually getting the president to sign a full repeal which is not likely to happen.” (Sparshott, 12/2)

Reuters: Top Senate Republican Sees Possible Major Health Care Legislation
The senior Senate Republican on Tuesday raised the possibility of Congress writing comprehensive healthcare legislation if the Supreme Court next year strikes down a subsidy provision of Obamacare. Senate Republican leader Mitch McConnell, who will lead the chamber starting in January, told reporters: "If the court would rule the way they might, we could be in a very large comprehensive revisitation" of U.S. healthcare policy. (12/2)

Also, the Medicare physician pay issue and the expiration of the Children's Health Insurance Program could be caught up in a cloud of congressional fiscal and political uncertainty -

The New York Times: Uncertainty In Washington Poses Long List Of Economic Perils
As House Republicans mull another round of fiscal brinkmanship with President Obama, a dark cloud is threatening to return to otherwise clearing economic skies: fiscal and political uncertainty. ... On March 28, unless lawmakers act, physician reimbursements from Medicare drop off a cliff. ... Then on Sept. 30, the entire Children’s Health Insurance Program faces its expiration. A few days later, across-the-board spending cuts loom once again. (Weisman, 12/2)

Meanwhile, on the legislative front -

CQ Healthbeat: Mental Health Bill Seen As Ripe For Revival Next Year
The 113th Congress is almost certain to wrap up without action on comprehensive mental health legislation, but the sponsor of a bipartisan House bill is pledging to “revise and revive” his proposal next year. Pennsylvania Republican Tim Murphy said he is reviewing the wide-reaching measure (HR 3717) to see what needs to be clarified after getting feedback from lawmakers, families and professionals. The goal is to introduce an updated version early next year, he said. (Attias, 12/2)

The Associated Press: Bipartisan Bill To Widen Federal Help For Disabled
Congress is poised to allow Americans with disabilities to open tax-sheltered bank accounts to pay for certain long-term expenses — the broadest legislation to help the disabled in a quarter-century. The House was set to vote Wednesday on the bill, called the Achieving a Better Life Experience Act, which stands out in a bitterly divided Congress for its wide-ranging support. First introduced in 2006, the legislation now lists an overwhelming 85 percent of Congress as co-sponsors, even after a conservative group criticized it as "decisive step in expanding the welfare state. " (Yen, 12/3)

NPR: Did UPS Discriminate Against A Pregnant Worker By Letting Her Go?
Women's reproductive rights are once again before the U.S. Supreme Court on Wednesday. Only this time, pregnancy discrimination is the issue and pro-life and pro-choice groups are on the same side, opposed by business groups. In 1976, the Supreme Court ruled that an employer that does not include pregnancy in its disability plan is not discriminating based on gender; it's just omitting coverage for one disability. Congress quickly amended the sex-discrimination law to ban discrimination based on pregnancy. But since then, most appeals courts have interpreted the law narrowly. Wednesday's case is a test of what is now required under the Pregnancy Discrimination Act. (Totenberg, 12/3)

Marketplace: Supreme Court Hears Pregnancy Case
The Supreme Court is hearing a pregnancy discrimination case Wednesday that involves a woman who sued the United Parcel Service. Lower courts have basically dismissed the lawsuit, brought by former UPS worker Peggy Young. Still, businesses are paying attention to this case. (Marshall-Genzer, 12/3)

CBS News: Pregnancy Discrimination Case Brings Together Unusual Allies
After a streak of Supreme Court decisions perceived as setbacks, women's rights advocates are hoping for a better outcome for women in a case involving a pregnancy discrimination charge. The high court on Wednesday hears arguments in the case, Young v. United Parcel Service, in which former UPS worker Peggy Young is arguing the company violated the Pregnancy Discrimination Act of 1978 by refusing to make accommodations for her while she was pregnant. (Condon, 12/3)

Bloomberg: Medicare Spending Cuts On Erection Aids Would Save $444 Million
Congress is poised to prohibit Medicare from spending an estimated $444 million for vacuum pumps used to treat erectile dysfunction in the next decade, a cost-saving move that may frustrate people who can’t afford drugs such as Pfizer Inc.’s Viagra. Medicare’s prescription-drug benefit, created in 2003, generally isn’t permitted to cover Viagra or other erectile-dysfunction medicines. A bill under consideration by Congress would put a similar ban on the pump devices some people use as an alternative. The spending estimate was published yesterday by the Congressional Budget Office. (Wayne, 12/4)

The Wall Street Journal's Pharmalot: A Drug Maker Uses Doctors With Troubled Pasts To Promote A Painkiller
An analysis of payments to physicians by Insys Therapeutics, a small drug maker that markets a powerful, but highly restricted painkiller, found that five of the 20 doctors who received the most money recently faced legal or disciplinary action, The New York Times writes. And some of the physicians had allegedly prescribed painkillers inappropriately. Moreover, many of the 20 highly paid doctors, who were paid for consulting, travel or meals, were also among the top Subsys prescribers, according to the Times analysis, which relied on filings with the federal government Open Payments database, as well as internal Insys documents and prescribing information from Tricare, which is the health insurance program for military families. (Silverman, 12/2)

Kaiser Health News: Consumers Will Pay More Out Of Pocket Next Year For Specialty Drugs
Americans with health coverage – including those who buy it through government insurance exchanges and Medicare beneficiaries – are likely to pay more out-of-pocket next year for so-called “specialty drugs,” which treat complex conditions, according to two studies from consulting firm Avalere Health. (Appleby, 12/2)

The Washington Post: The 2015 Outlook For States Is Stable, Fitch Finds
The toughest challenge ahead for states in the coming year is Medicaid, “the area of state budgets that is usually the most difficult to control.” While states have been able to contain Medicaid costs in recent years, the introduction of the president’s health-care reform law and its Medicaid expansion introduces new variables for budget managers to grapple with, [credit rating agency] Fitch finds. (Chokshi, 12/2)

The Associated Press: Advocates Continue Push For Single-Payer Health
Supporters of a plan to make Vermont the first state in the country to enact a single-payer health care system urged Gov. Peter Shumlin and the Legislature on Tuesday to move forward with the overhaul, despite Shumlin's narrow victory in the November election. Sixteen groups, including the state employees and teachers unions, held a Statehouse press conference to rebut critics of Green Mountain Care who say the election was a referendum on the publicly funded system. They say the election was so close because of property taxes and other issues. (Rathke, 12/2)

The Associated Press: Ohio Bill Would Shield Doctors Who Say ‘My Fault’
Doctors talking privately to patients or families after a medical mishap could acknowledge responsibility or even admit a mistake without that conversation being used against them later in court, according to a proposal in the Ohio General Assembly pushed by physicians. (12/2)

The Corpus Christi Caller Times: Texas, Feds Reach Agreement On Health Care Funding
Texas and the federal government tentatively resolved a high-stakes health care funding inquiry on Monday, averting a major disruption to hospital funding. The Texas Health and Human Services Commission and the federal Centers for Medicare and Medicaid Services reached the tentative agreement Monday. They expect a formal, written agreement during the next two weeks. After requesting records over the summer, the Centers for Medicare and Medicaid Services deferred a $74.9 million payment to the Health and Human Services Commission in September. The payment covered uncompensated care provided by hospital systems in Dallas County, Tarrant County and Nueces County — where the local Hospital District works with the Christus Spohn Health System to provide health care to the county's poorest residents. Driscoll Children's Hospital and Corpus Christi Medical Center also benefit from payments through the federal program. (Hendricks, 12/2)

The Des Moines Register: Disabled Iowans Still Waiting For Care, Despite New Money
More disabled Iowans are being added to waiting lists for state assistance, despite $6 million that legislators earmarked last spring to reduce the number of those waiting for help. More than 9,000 Iowans are waiting, often for more than two years, for therapies and services to help them deal with mental or physical disabilities. Patient advocates say they've been told that the Iowa Department of Human Services has spent little of the $6 million that was supposed to speed up access to the services, starting July 1. A department spokeswoman said Tuesday that the agency will soon ramp up the effort. (Leys, 12/2)

Los Angeles Times: Hospitals Grapple With Challenge In Caring For Homeless
Biederman's study, published in the Journal of Community Health Nursing, found that homeless patients were more likely to be readmitted to "safety net" hospitals when they had no safe place to recover from illnesses. Sending them to a homeless shelter, a boardinghouse or back to the street did not provide the security and medical attention they needed. The patients in the study complained of developing infections in shelters. Their pain medications would be stolen. They couldn't handle stairs or had other impediments. (Jacobson, 12/2)

Health News Florida: Telemedicine To Be Revisted Next Session In Florida
Florida lawmakers appear ready to reignite talks on the future of telemedicine. The issue of how to handle doctors who treat patients remotely was jumbled into a larger health-related bill, which contributed to its defeat last session. Florida TaxWatch’s Tamara Demko says lawmakers need to pare down their goals for addressing telemedicine in the state. (Hatter, 12/2)

The Associated Press: Medicaid Costs Up $950M As Hospitals Privatize
Louisiana's Medicaid spending rose about $950 million while the state privatized public hospitals and much of Medicaid, a legislative audit found. Medicaid annual spending stayed about $6.6 billion to $6.8 billion from 2010 through 2012 but hit $7.6 billion by June 30, when fiscal 2014 ended, according to the report released Monday. (12/2)

The Wall Street Journal: Pregnancy At The Court
Sympathetic plaintiffs make good headlines, but they often make bad law. That’s the case at the Supreme Court on Wednesday, where the Justices will consider whether UPS illegally discriminated when it didn’t go far enough to accommodate a pregnant employee’s work restrictions. In Peggy Young v. United Parcel Service, Ms. Young is a longtime UPS employee and delivery truck driver who in 2006 asked the company to reassign her temporarily when a midwife told her she shouldn’t be lifting more than 20 pounds. UPS declined, on grounds that the company’s pregnancy-neutral policies provide special allowances for those injured on the job but not those whose disabilities happen outside the workplace. (12/2)

The New York Times' Taking Note: Déjà Vu Pregnancy Discrimination
When the Supreme Court hears argument in a major pregnancy discrimination case on Wednesday, Justice Ruth Bader Ginsburg will be returning to familiar legal terrain. In the 1970s, Justice Ginsburg was a pioneering litigator working for women’s equality as the founding director of the ACLU’s Women’s Rights Project. One aim was combating pregnancy discrimination and the resulting denial of equal opportunity and equal status in society. (Dorothy J. Samuels, 12/2)

The Washington Post: For Pregnant Women, A Needed Accommodation
Peggy Young’s Supreme Court case sounds like a throwback to the “Mad Men” era, when employers weren’t expected — or required — to welcome women in general and pregnant women in particular. Unfortunately, Young’s situation reflects the reality, especially for lower-wage workers, that many companies continue to balk at reasonable accommodations for pregnant employees. (Ruth Marcus, 12/2)

USA Today: Give Pregnant Women Justice In Workplace
Young didn't ask for a new or special accommodation, only that the "lighter duty" accommodation provided to others should have been available to her. The plain language of the [Pregnancy Discrimination Act in 1977] requires employers to provide pregnant workers with the "same" accommodations that they provide to other employees who have "a similar ability or inability to work." The court has the opportunity to wipe away the judicial gloss and apply the act as written. Thirty–six years after the act was enacted, it's time that the law was fairly applied to fulfill its goal to assist working women who want a family, too. The court may not be able to fix, in one case, all of the negative cultural fallout of [Roe v. Wade], but at least it can fairly apply the legal remedy that Congress enacted. (Clarke D. Forsythe, 12/2)

The New York Times: Is Obamacare Destroying The Democratic Party?
It’s not often that a politician provokes conflict within the ranks of his party’s core supporters. [Sen. Charles] Schumer did just that in a National Press Club speech on Nov. 25, three weeks after devastating Democratic losses in Senate, House, gubernatorial and state legislative elections. According to Schumer, President Obama and his party suffered defeat last month in large part because of the strategic decision to press for enactment of the Affordable Care Act soon after Obama won the presidency. (Thomas B. Edsall, 12/2)

Bloomberg: Obamacare Isn't Driving Up Health Costs. Really.
So how should we account for the apparently widespread perception of higher costs under Obamacare? There are at least two answers. The first, [Kaiser Family Foundation's Gary] Claxton said, is that although average premiums aren't rising any faster, the premiums differ less from company to company. Before the law was passed, those premiums were based in part on the health and age of the employees using the plan, which meant that employers with younger or healthier workers could pay significantly less. ... The second explanation has nothing to do with premiums; it attributes rising costs to the way employers attempt to shift premiums to workers. On that count, the numbers are clear: Workers are getting hit harder than they have in years. (Christopher Flavelle, 12/2)

The Wall Street Journal's Washington Wire: An Issue That Could Define Alternatives To Obamacare
A line buried in a Heritage Foundation policy paper issued just before the November elections hinted at a major fissure point in discussions surrounding a conservative alternative to Obamacare. The distinctions it raised could shape the form of any health-care alternatives the Republican-led Congress considers next year. (Chris Jacobs, 12/2)

The New York Times' The Opinionator: The Secret Therapist
When a new patient between the ages of 18 and 25 arrives at my office, he or she generally has a specific request: a physical exam as clearance for football season, a refill of an asthma inhaler, reassurance that a sore throat isn’t strep. These young men and women are healthy and don’t expect to be asked very much, or little beyond the usual waiting room questionnaire. My job, as I see it, is not only to respond to any requests or questions, but also to ask them about the things 18- to 25-year-olds do: attend college (or consider it), search for employment, separate from (or return to live with) parents, find romantic partners, shrug off one-night stands, run out of money, feel confused or depressed or anxious, experiment with drugs and alcohol. (Michael Stein, 12/1)

JAMA Pediatrics: Addressing The Challenges Of Clinician Training For Long-Acting Reversible Contraception
Long-acting reversible contraceptive (LARC) methods are gaining greater popularity in the United States as both patients and health care professionals become educated about their high contraceptive efficacy, relatively few contraindications, and ease of use. In fact, LARC is recommended by the American Congress of Obstetricians and Gynecologists and the American Academy of Pediatrics as a first-line contraceptive option for adolescents. ... However, few primary care clinicians, especially those outside of family medicine, have received the procedural women’s health training necessary to offer these highly effective contraceptive methods. Despite an upsurge of interest in LARC, there is no standardized LARC training in pediatric residency programs or adolescent medicine fellowships. This lack of training poses one of many barriers to young women trying to access these methods. (Drs. Julia Potter, Atsuko Koyama, and Mandy S. Coles, 12/1)

JAMA Internal Medicine: Why I’m Opting Out Of Mammography
Whenever I write about mammography, I receive letters from women who tell me that a mammogram saved their life. Some of them are correct, but the inconvenient truth is that most of them are actually victims of overdiagnosis. In every decade studied—40s, 50s, and 60s—a mammogram is more likely to “cure” me of a harmless cancer (by subjecting me to life-disrupting and potentially harmful treatments like chemotherapy and radiation) than it is to prevent me from dying of breast cancer. For me, that’s a deal breaker. ... Looking at the numbers, it’s clear that the risk of a mammogram leading to unnecessary diagnosis and treatment for breast cancer is tiny, but the chance of a mammogram saving my life is even more miniscule. (Christie Aschwanden, 12/1)

JAMA Internal Medicine: Unintended Influence: When Our Words Mean More Than We Think
Many patients may believe that we would not offer a test if it isn’t needed. Our efforts to “offer” are often perceived by patients as an endorsement of the test or procedure. ... It’s time we get beyond a “cookbook” approach of simply offering mammograms. It may seem like the safe bet, to offer it so we don't “miss” breast cancer. Yet finding breast cancer or having a false-positive test result can be a stressful and traumatic experience. Quality of life and patients’ values and preferences must be considered. After age 75 years, or, in this case, 83 years, would detection and treatment of cancer improve quality of life? Is the risk of a false-positive test result worth the benefit a mammogram might offer at this age? This is a decision each patient can make for herself, but only if she understands the tradeoffs. (Tom Bartol, 12/1)