The New York Times: U.S. Toughens Rules For Latecomers Trying To Enroll In Health Care Act
The Obama administration, responding to complaints from insurance companies, announced several steps on Tuesday that will make it harder for consumers to obtain health insurance after the annual open enrollment period. ... Kevin J. Counihan, the chief executive of the federal insurance marketplace, said that special enrollment periods “are not allowed for people who choose to remain uninsured and then decide they need health insurance when they get sick.” Mr. Counihan said the administration would eliminate six of the special enrollment periods. ... In addition, he said the government would clarify eligibility standards and step up enforcement to prevent abuse of special enrollment periods. (Pear, 1/19)

USA Today: Feds Tighten When People Can Enroll In Obamacare Plans
Bowing to pressure from insurers, federal officials on Tuesday tightened the conditions under which people can sign up for plans on the HealthCare.gov exchange outside open enrollment. The move by the Centers for Medicare and Medicaid Services comes after complaints by health insurers that it was too easy for people to wait until they were sick to sign up and to drop coverage after they got treatment. Earlier Tuesday, UnitedHealth announced a 19% drop in profit and downgraded its earnings forecast citing concerns about its Obamacare enrollment and the flexibility people had to change insurance plans. (O'Donnell, 1/19)

The Associated Press: Please Hold: Insurance Customers Begin New Year With Delays
Thousands of health insurance consumers around the country have started the new year dealing with missing ID cards, billing errors and other problems tied to an enrollment surge at the end of 2015. Brokers and insurers in several states told The Associated Press that they've been inundated with complaints about these issues from customers with individual plans and those with coverage through small businesses. Insurance provider Health Care Service Corp., for instance, has been dealing with delays for around 10,000 companies, while billing errors caused bank overdrafts for 3,200 individual customers of a North Carolina insurer. (Kennedy and Murphy, 1/19)

Meanwhile, UnitedHealth is taking steps to pull back on its exchange business after its fourth quarter losses —

The Wall Street Journal: UnitedHealth Raises Forecast For Losses On Affordable Care Act Plans
UnitedHealth Group Inc. said its projected losses on the Affordable Care Act exchanges for 2016 deepened as enrollment grew despite the company’s efforts to reduce sign-ups. UnitedHealth had taken steps to pull back on its exchange business in anticipation of losses, including reducing marketing and slashing commissions to health-insurance agents. But enrollment nevertheless grew, widening the company’s exposure. (Wilde Mathews, 1/19)

The Associated Press: High Court Rejects New Challenge To Obama Health Overhaul
The Supreme Court has rejected another challenge to President Barack Obama's health care overhaul. The justices on Tuesday left in place lower court rulings that dismissed a lawsuit against the national health care law. The suit argues that the law violates the provision of the Constitution that requires tax-raising bills to originate in the House of Representatives. (1/19)

USA Today: Supreme Court Refuses To Hear Another Obamacare Case
The justices turned down a challenge from conservatives that contended Congress violated the Constitution when it approved the law in 2010 by sending a bill that raised revenue through the Senate before the House. The Constitution says revenue-raising bills must originate in the House. A federal appeals court had turned down the petition because, a panel of judges said, the law was predominately a bill to improve health insurance coverage, not a revenue-raising bill. (Wolf, 1/19)

Bloomberg: Obamacare Left Intact As U.S. Supreme Court Rejects Appeal
In declining to hear that contention, the high court all but ensured that the Affordable Care Act, or Obamacare, will remain intact through the November election. The rebuff leaves health care as one of the core issues in the presidential and congressional campaigns. (Stohr, 1/19)

The Huffington Post: Supreme Court Trashes Latest Legal Attack On Obamacare
The U.S. Supreme Court has snubbed yet another Obamacare case. The justices on Tuesday declined to take up the latest legal challenge to the Affordable Care Act -- a quirky lawsuit that sought to invalidate the law on the grounds that it violates the Origination Clause of the U.S. Constitution. (Farias, 1/19)

And in other court news —

California Healthline: Supreme Court Union Ruling Could Have Significant Effect On Health Care System
The U.S. Supreme Court's ruling in a case challenging mandatory union dues in California will deal only with government employees and probably won't have an immediate impact on health care either nationally or in California. But if the court removes the requirement for public employees to pay "fair share service fees," which are tantamount to membership dues, the long-term ramifications could significantly change the health care delivery system, experts predict. (Lauer, 1/19)

The Associated Press: High Court Rejects Appeal Over $63M Judgement In Motrin Case
The Supreme Court has rejected an appeal from the manufacturer of Children's Motrin over a $63 million judgment awarded to a family whose daughter developed a life-threatening disease after taking the medicine. The justices on Tuesday let stand a lower court ruling that said Johnson & Johnson should pay the judgment awarded to the family of Samantha Reckis. (1/19)

Politico: Democratic Rift Spurs Questions About Obamacare's Future
With less than two weeks until the Iowa caucuses, the Democratic primary has morphed into an all-out brawl over Obamacare, with Hillary Clinton and Bernie Sanders offering starkly different prescriptions for its future. That’s a potentially risky proposition for the candidates and for a law that is still opposed by more than half of all Americans, according to recent polls. (Cook, 1/19)

The Fiscal Times: Medicare For All? Why Sanders Has The Edge Over Clinton On Health Care
Healthcare reform has emerged as a central issue between Hillary Clinton and Vermont Sen. Bernie Sanders in the hard-fought Democratic presidential campaign, and for now Sanders appears to have the upper hand. (Pianin, 1/19)

The Atlanta Journal-Constitution: Hillary Clinton Urges Georgia To Expand Medicaid
Democratic front-runner Hillary Clinton joined the House Democratic caucus in calling for Georgia to expand the Medicaid program under the Affordable Care Act. The former secretary of state urged lawmakers to pass legislation to expand the program and for Republican Gov. Nathan Deal to put the “well-being of Georgia’s families ahead of ideology by signing it into law.” (Bluestein, 1/19)

McClatchy: Majority Of Americans Support Abortion Restrictions
A majority of Americans support restrictions on legalized abortions, including those who identify themselves as abortion rights supporters, according to a new Marist poll commissioned by the Knights of Columbus. The poll finds that 81 percent of Americans would restrict abortion to – at most – the first three months of pregnancy. The Marist survey also shows that 82 percent of women and 66 percent of self-identified abortion rights supporters favor limiting the procedure to the first trimester of pregnancy. (Douglas, 1/19)

The New York Times: Anti-Abortion Groups Join Battles Over Frozen Embryos
Anti-abortion groups are seeking a foothold on a new battlefield: custody disputes over frozen embryos. ... As scientific advances have made frozen embryos common, they have brought new complications to divorces. Most courts have treated embryos as marital property, often favoring the party that plans not to use the embryos, emphasizing a right not to be forced to procreate. Some have applied contract law, decided which half of the couple more deserved the embryos, or required mutual consent. But anti-abortion groups argue that such cases should be decided according to the best interests of the embryos, the same legal standard used in child-custody disputes. (Lewin, 1/19)

In other news, the Zika virus is raising health concerns for pregnant women —

The New York Times: C.D.C. Urges Zika Testing For Some Who Are Pregnant
Pregnant women who feel sick and have visited countries in which the Zika virus is spreading should see a doctor soon and be tested for infection even though the tests are imperfect, federal health officials said on Tuesday. That advice was at the core of interim Zika-related guidelines for pregnant women issued by the Centers for Disease Control and Prevention. The authors are specialists in emerging diseases and reproductive health. (McNeil, 1/19)

CBS News: Families Give Insights Into End-Of-Life Choices
Families of terminally ill cancer patients say end-of-life care is better when the patient is at home or in hospice care, not in the hospital intensive care unit. The study by Dana-Farber Cancer Institute researchers surveyed the families of 1,146 older Medicare patients who had died of either advanced-stage lung cancer or colorectal cancer in the previous year. (Brophy Marcus, 1/19)

The Washington Post's Wonkblog: The U.S. Is Not As Bad At End-Of-Life Cancer Care As Most People Think
One of the most pervasive ideas about death in America is that we don't do it well, dying in hospital beds after enduring unnecessary medical procedures instead of at home. It's our uncomfortable relationship with death, the thinking goes, that's pushing the relentless rise of our health-care spending to the highest in the world. A new study of cancer patients over age 65 complicates that notion, finding that while pieces of the story are right, much of it is not. Among the seven countries studied, American cancer patients were the least likely to die in a hospital bed. (Johnson, 1/19)

In other news, Vice President Joe Biden wants to speed up the combination therapy approval process —

Reuters: Biden Pledges Faster U.S. Approval For Cancer Drug Cocktails
U.S. Vice President Joe Biden said on Tuesday that the United States would speed up the approval of promising new drug combinations in his government's newly announced drive to cure cancer "once and for all." Biden, who lost his 46-year-old son Beau to brain cancer last year, set out his plans at a World Economic Forum meeting of international cancer experts in Davos, a week after being appointed to lead the initiative by President Barack Obama. (Hirschler, 1/19)

The Associated Press: McCaskill Says Missouri Needs Tighter Drug Monitoring
U.S. Sen. Claire McCaskill said Tuesday that Missouri needs more tools to fight opiate abuse, including a prescription drug monitoring program, more specialized treatment centers and better research about average drug use. The Senate's committee on aging, on which McCaskill sits as the ranking Democrat, heard testimony on opioid abuse Tuesday during a field hearing in Jefferson City. Opioids include prescription painkillers as well as illegal drugs such as heroin and opium. McCaskill was the only U.S. senator in attendance, though at least nine state lawmakers sat in on the hearing. (Aton, 1/19)

The Associated Press: Ohio Sets New Guidelines For Short-Term Pain Prescribing
People with short-term pain from injuries or surgery should be given alternatives to prescription painkillers whenever possible and be provided only the minimum amounts if absolutely needed, according to guidelines announced Tuesday by Gov. John Kasich's office. Alternatives to the class of painkillers known as opioids could include ice, heat, wraps, stretching, massage therapy, acupuncture, seeing a chiropractor or physical therapy, along with medicines that don't have addictive qualities, such as ibuprofen, said Dr. Mary DiOrio, medical director for the state Department of Health. (Welsh-Huggins, 1/19)

The Associated Press: NY Rebate Extended For Heroin Overdose Antidote
New York's attorney general has announced an agreement with Amphastar Pharmaceuticals to extend a nearly 20 percent price cut for naloxone, an antidote for heroin and other opioid overdoses. The attorney general's office says Tuesday that Amphastar for another year will cover a $6 rebate per dose, which will also automatically increase, dollar-for-dollar, to match future growth in the wholesale price. (1/19)

Meanwhile, NPR takes a look at opioid addiction and the workplace —

NPR: Opioid Abuse Takes A Toll On Workers And Their Employers
According to one study, prescription opioid abuse alone cost employers more than $25 billion in 2007. Other studies show people with addictions are far more likely to be sick, absent or to use workers' compensation benefits. When it comes to workers' comp, opioids are frequently prescribed when pain relievers are called for. How often doctors choose opioids varies by state, with an analysis finding the highest rates in Arkansas and Louisiana. (Noguchi, 1/20)

And The New York Times examines the spread of the opioid epidemic across the country —

New York Times: How The Epidemic Of Drug Overdose Deaths Ripples Across America
Deaths from drug overdoses have jumped in nearly every county across the United States, driven largely by an explosion in addiction to prescription painkillers and heroin. Some of the largest concentrations of overdose deaths were in Appalachia and the Southwest, according to new county-level estimates released by the Centers for Disease Control and Prevention. (Park and Bloch, 1/19)

The Associated Press: States Hone Health Crisis Plans To Activate In Catastrophes
The scenarios are grim: A pandemic influenza swamps the availability of hospital ventilators. A chemical spill exhausts antidote supplies and decontamination abilities. A terror attack overwhelms ambulances and trauma centers. A big earthquake, wildfire or hurricane throws emergency rooms into crisis. At the prodding of the federal government, state health departments nationwide are hurrying to complete "Crisis Standards of Care" plans to guide medical professionals in such catastrophes and determine what should trigger them. It's no easy task: Plan architects must navigate the ethical and legal minefields that would arise if there are more patients than providers at hospitals, clinics and other medical settings are set up to handle in usual fashion. (1/19)

NPR: People With Minor Injuries Are Increasingly Getting CT Scans
If you fall off a curb, bop your head and go to the ER to make sure you're OK, there's a good chance you'll be trundled off for a CT scan. That might sound comforting, but people with injuries minor enough that they get sent home are increasingly being given computed tomography scans, a study finds. That's despite efforts to reduce the unnecessary use of CTs, which use radiation and increase the lifetime risk of cancer. (Shute, 1/19)

Earlier KHN coverage: Heavy Use Of CT Scans Raises Concerns About Patients’ Exposure To Radiation (Boodman, 1/6)

The Associated Press: HIV Testing Uncommon In Teens Despite Recommendations: CDC
Fewer than 1 in 4 high school students who’ve had sex have ever been tested for HIV, a troubling low rate that didn’t budge over eight years, government researchers say. Young adults fared slightly better, although testing rates have declined in black women, a high-risk group. The Centers for Disease Control and Prevention and an influential preventive health panel recommend routine HIV testing at least once for teens and adults. They also advise at least yearly screening for high-risk patients including those with multiple sex partners, gay or bisexual boys and men and injection drug users. (Tanner, 1/19)

Kaiser Health News: For Hospitals, Treating Violence Beyond The ER Is Good Medicine And Good Business
Ask David Ross to describe an average day on the job. He says it doesn’t exist. Ross is a violence intervention specialist at the University of Maryland Medical Center. Though he isn’t a doctor, he’s been working at the hospital as part of its Violence Prevention Program for close to 10 years. His team works with patients who are victims of violent injuries — stabbings, gunshots or physical assaults — and who physicians flag as candidates for the program’s assistance. His challenge is to figure out the factors in their lives that put them at risk of violence. The work he does is time-consuming, and the relationships he builds with these patients can last months and even years. (Luthra, 1/20)

Lincoln (Neb.) Star Journal: New Health Care Plan Avoids Budget Strain
Sponsors of legislation to access federal Medicaid expansion dollars to purchase private health care insurance for the working poor said Tuesday they have devised a plan that would have no impact on the state tax-supported general fund. The proposal would require small premium contributions from most enrollees and some co-pays while pointing recipients to employment, education and skills training programs. The state would turn to its health care cash fund as "a backup" for financing the plan, which would extend health care insurance coverage to 77,000 Nebraskans, 72 percent of whom are employed in low-wage jobs. (Walton, 1/19)

The Associated Press: Supporters Unveil New Plan To Cover Medicaid Gap Population
Lawmakers unveiled a new plan Tuesday to cover the so-called Medicaid gap population in Nebraska while opponents made clear that the proposal faces a steep uphill slog. Supporters hailed the latest bill as a bipartisan, business-friendly approach to cover an estimated 77,000 childless, low-income adults. Three previous attempts to expand Medicaid coverage under the federal health care law have failed because of conservative opposition. (Schulte, 1/19)

And in Iowa, debate continues regarding the state's move to a Medicaid managed care system -

Des Moines Register: Ombudsman Warns Lawmakers About Medicaid Oversight
Iowa’s long-term care ombudsman delivered an unflinching message to lawmakers Tuesday: Provide proper oversight for a plan to privatize Medicaid or face the fraud and mismanagement fate that has dogged other states. (Clayworth, 1/19)

Los Angeles Times: Guidelines Issued For California's Assisted Suicide Law
With the state’s assisted death law taking effect in months, the California Medical Assn. on Tuesday issued guidelines to physicians on writing prescriptions of lethal doses of drugs for terminally ill patients. The 15-page guide details the complicated legal and medical path that doctors must take before they can authorize medication to hasten a patient’s death, and helps physicians understand their legal rights to participate or not participate based on their own moral or religious values. (McGreevy, 1/19)

The Associated Press: Insurance Regulator Eyes An End To 'Surprise' Medical Bills
Pennsylvania’s insurance regulator is floating a proposal to protect people against expensive medical bills at out-of-network rates, including emergency care. Insurance Commissioner Teresa Miller said Tuesday her goal is to take consumers out of billing disputes between insurers and health care providers. Under her proposal, the consumer would be liable for nothing more than they would pay a provider for an in-network service. Providers and insurers would have to work out any additional payment, if there’s anything beyond that. (1/19)

The Orlando Sentinel: Average Florida Smoker Spends $1.45M In Lifetime, Study Says
The dangers of smoking tobacco are well-documented, but it can be just as deadly to your bank account. Personal finance website WalletHub.com has released a study calculating the cost of smoking in a lifetime for smokers in each state. The study took potential monetary losses like the cumulative cost of a cigarette pack per day over several decades, health-care costs, income losses and other costs to come up with the figures. (Mauney, 1/19)

The Associated Press: Nebraska Lawmakers Reject Copayment For Inmate Health Care
A bill to permit jails and prisons to charge inmates a copayment for health care services has been rejected by the Legislature for the rest of the year. Lawmakers voted unanimously Tuesday to hold the measure until April 20, nearly guaranteeing it will not be revisited this session. (1/19)

The Associated Press: Arizona Democrat Introduces Death With Dignity Measure
A Democratic lawmaker has introduced a bill granting terminally ill patients the right to take their own lives with prescription life-ending drugs. The measure by Sen. Barbara McGuire, D-Kearny, says patients with an incurable disease and six months left to live can request medication to end their lives under the care of a physician. The measure specifies patients must provide oral and written confirmation of their decision. It also makes it a felony to tamper with forge or destroy evidence relating to a patient's decision. (Velzner and Christie, 1/19)

NPR: Small Alabama County Offers Cash Amid Struggle To Stop Tuberculosis Spread
There's only one health department in Alabama where people can go to be tested for tuberculosis. That's in Perry County, where an outbreak claimed three lives in 2015. For every 100,000 people there, 253 would be infected; normally in Alabama it's only 2.5. Now, health officials are trying to get handle on the disease. But it hasn't been easy, so officials there decided to take a new approach ... To identify carriers of the disease, the health department last week started paying people to come into the clinic - $20 for a screening, $20 to come back for results, another $20 for a chest x-ray. (Douban, 1/19)

WABE: Grady Memorial Hospital Settles Over Alleged ADA Violations
Grady Memorial Hospital in Atlanta has reached a settlement agreement with the U.S. Attorney’s Office over allegations that the hospital violated the Americans with Disabilities Act, according to a press release from the U.S. Department of Justice. The U.S. Attorney’s Office initiated an investigation when it received a complaint alleging Grady failed to provide the appropriate aids and services necessary to ensure effective communication. (Such, 1/19)

The Pioneer Press: Fairview Hospital System Becomes Sole Owner Of Insured PreferredOne
Hospital chain Fairview announced Monday that it has purchased insurance company PreferredOne, the latest example of integration between health care providers and insurers. PreferredOne will operate as a wholly owned subsidiary of Fairview Health Services, and the insurer's president and CEO David Crosby will remain as PreferredOne's leader, according to a news release Monday. (Montgomery, 1/18)

The Lawrence Journal-World: Douglas County Commission To Consider Ambulance Rate Increase
Douglas County commissioners are scheduled to consider a resolution Wednesday that would increase ambulance rates for Lawrence-Douglas County Fire Medical. Commissioners were informed last month about the plan, which the Lawrence City Commission also will be asked to approve, to increase ambulance fees for 2016, 2017 and 2018. When the last of the increases becomes effective in 2018, rates will be 25 percent higher than present. (Jones, 1/19)

The Chicago Tribune: Land Of Lincoln Drops U. Of C. Medical Center; Customers Claim 'Bait And Switch'
Land of Lincoln Health, a struggling Chicago health insurer, will drop the University of Chicago's medical center and affiliated doctors from its insurance network March 1, an unexpected change that has upset some customers. The move comes after some customers bought coverage at the end of last year from Land of Lincoln because their University of Chicago doctors were in the network at the time. Members who want to keep their U. of C. physicians anyway will face higher out-of-pocket costs with Land of Lincoln. (Sachdev, 1/19)

Los Angeles Times: The Dream Of Medicare For All: Here's Why The Sanders Health Plan Is More Hope Than Change
Otto von Bismarck's famous definition of politics as "the art of the possible" gives us a good assessment of the single-payer health proposal unveiled by Democratic presidential candidate Bernie Sanders on Sunday: impossible. That's not to say that the "Medicare for All" plan offered by Sen. Sanders (I-Vt.) is worthless. Quite the contrary. As an aspirational document it serves the valuable purpose of placing single-payer healthcare firmly in the forefront of our political debate. (Michael Hiltzik, 1/19)

The Dallas Morning News: The Difference Between Clinton And Sanders
The 2016 Democratic debate has focused mainly on differences of degree between Bernie Sanders and Hillary Clinton. Sanders wants to provide an expanded Medicare for all Americans. Clinton wants instead to build on the Affordable Care Act. (Carl Leubsdorf, 1/19)

Bloomberg View: Sanders' Health Care Plan Works In Europe
One of the more important arguments between Bernie Sanders and Hillary Clinton during Sunday’s Democratic debate occurred over whether to push for “Medicare for all,” as Sanders insisted, or to build more slowly on the limited success of President Obama’s health care law. In Europe, all the big economies there have universal health-care systems under which everyone is insured. Even the most conservative politicians support them. (Leonid Bershidsky, 1/19)

The New York Times Upshot: For Now, Bernie Sanders’s Health Plan Is More Of A Tax Plan
If you read the news articles over the weekend about Senator Bernie Sanders’s new single-payer health reform plan, you might have thought you were reading about tax policy, not health care. That’s because the plan, released two hours before Sunday night’s Democratic debate, was full of details about the taxes that would be collected to finance it. The plan would charge a special income tax, called a premium, increase payroll taxes and raise a variety of taxes on high-income Americans, including income and capital gains taxes. Those are big, specific changes, worthy of detailed coverage. Missing, however, were more than a few sentences about how the proposal would change the health care system in the United States. (Margot Sanger-Katz, 1/19)

The Washington Post: Mr. Sanders Needs To Come Clean About The Funding For His Health-Care Plan
Previously a non-starter in American politics, democratic socialism is gaining traction due to the presidential campaign of Vermont Sen. Bernie Sanders, a nominal independent running as a Democrat. If Mr. Sanders is to close the sale with voters, he must show he has learned from socialism’s mixed history abroad and devised an updated version that will work in the United States. Judging by the sketchy single-payer health-care plan he unveiled just before Sunday’s Democratic debate, Mr. Sanders is not up to the challenge. (1/19)

Forbes: Bernie Sanders' Single-Payer Health Care Plan Would Increase Federal Spending By At Least $28 Trillion
While Sanders bills his plan as “Medicare for all,” it bears little resemblance to Medicare, which does in fact require premiums and cost-sharing from its enrollees, though this cost-sharing is heavily subsidized by younger taxpayers. In addition, Medicare does not cover every category of health care service, nor does it cover catastrophic health care needs. ... we owe Bernie Sanders and Gerald Friedman a measure of thanks. By unintentionally pointing out the utter foolishness of single-payer, government-run health care in America, they’ve given us more impetus to think about how we could make the health care system better—and expand access to more people—by putting individuals back in charge of their own health care dollars. (Avik Roy, 1/18)

Vox: Bernie Sanders’s Single-Payer Plan Isn’t A Plan At All
Sanders promises his health-care system will cover pretty much everything while costing the average American almost nothing, and he relies mainly on vague "administrative" savings and massive taxes on the rich to make up the difference. It's everything critics fear a single-payer plan would be, and it lacks the kind of engagement with the problems of single-payer health systems necessary to win over skeptics. (Ezra Klein, 1/17)

Forbes: The Costs Of Medicaid Expansion Are Real And Often Much Larger Than Expected
The decision states face of whether to expand Medicaid to non-disabled, working-age, childless adults—the Affordable Care Act (ACA) primary expansion population— involves tradeoffs. These tradeoffs include higher taxes, reduced spending on items like education, transportation, or infrastructure, or reduced spending on other Medicaid populations such as the disabled, children, or the elderly. The ACA funding formula allows states to pass a much greater share of the costs of covering non-disabled childless adults to federal taxpayers, but the tradeoffs still exist. (Brian Blase, 1/19)

Lexington Herald Leader: Save Kynect
A Washington Post article recently told the story of a mother in Eastern Kentucky who showed up at a small clinic without health insurance and frantic over her 4-year-old daughter’s 103-degree fever and mysterious pain. Stories about poor health and the hurdles in receiving health care have been common throughout Kentucky’s history. But today’s stories often end dramatically differently than those in the past. Thanks to the state’s wise embrace of the Affordable Care Act, the Washington Post reported on the ease the mother experienced in quickly receiving a WellCare card and a diagnosis and treatment for her daughter. (State Reps. Jeffrey Donahue, Derrick Graham, Joni Jenkins, Mary Lou Marzian, Darryl T. Owens, Rita Smart and Jim Wayne, 1/19)

Los Angeles Times: Obamacare Dodges Another Bullet At The Supreme Court
The Supreme Court declined on Tuesday to take a third swing at the 2010 Patient Protection and Affordable Care Act, better known as Obamacare. It was the right call because the case -- Sissel vs. U.S. Department of Health and Human Services -- was built on a fanciful vision of how Congress should operate. Matt Sissel, an artist in Oregon, sued the federal government because he doesn't want to buy health insurance, as required by the ACA. When the Supreme Court upheld the law's individual mandate in 2012, Sissel's initial claims appeared to be dead. But with the help of the conservative Pacific Legal Foundation, he found a clever way to assert a new challenge to the entire law. (Jon Healey, 1/19)

The New York Times: Insurer Rewards Push Women Toward Mammograms
How widespread is the practice of incentivizing mammograms? It is hard to know. Unfortunately, there is no requirement that these incentives be reported, and plan benefits are not typically public. In a brief online search, I found 17 current and recent programs by major employers and health plans. Incentives ranged from $10 to $250, possibly a significant inducement to lower-income women. In choosing among competing guidelines, women are being asked to strike a delicate balance. The trade-offs are complex, and dependent on personal values, like how comfortable with risk you are. Employer and health plan incentives suggest that mammograms are inherently worthwhile and risk glossing over these nuances. (Harald Schmidt, 1/18)

JAMA: Quantity And Quality Of Life
A bitter debate is continuing (including in this issue of JAMA) about the role of clinicians in enabling a good death for the small number of people who wish for assistance in dying. That discussion—about how best to balance respect for the sanctity of human life with the principle of autonomy—has drawn substantial public attention. However, the vital goal almost all people want from medicine is not having a good death but having as good a life as possible all the way to the very end. The evidence indicates that the medical profession is harming vast numbers of patients by neglecting this goal—and that this is not just a US phenomenon but a global one. People everywhere have essential needs aside from just living longer. Medical practices, research, and policies must ensure that clinicians have the skills to understand those needs and have the capabilities to serve them for patients with life-limiting illness. Everyone dies. Death is not an inherent failure. Neglect, however, is. (Atul Gwande, 1/19)

JAMA: The Liberty To Die
On October 5, 2015, Governor Jerry Brown signed the End of Life Option Act into law, thereby legalizing physician aid in dying in California.1 The significance of this development cannot be overstated. The most populous state in the nation resolved to replace a sesquicentennial aid-in-suicide penal code with a death-with-dignity statute. Other states may soon enact similar statutes. (Ryan P. Clodfelter and Eli Y. Adashi, 1/19)

The New York Times: Is It Better to Die in America or in England?
We frequently hear complaints about how people near the end of life are treated in America. Patients are attached to tubes and machines and subjected to too many invasive procedures. Death occurs too frequently in the hospital, rather than at home, where the dying can be surrounded by loved ones. And it is way too expensive. Each year, the care of dying seniors consumes over 25 percent of Medicare expenditures. Death in America is frequently compared unfavorably with death in other countries. ... But is it actually true that end-of-life care in America is more invasive and expensive than in other countries? (Ezekiel J. Emanuel and Justin E. Bekelman, 1/19)

JAMA: Physician-Assisted Dying: A Turning Point?
In 2014, Brittany Maynard, who was dying of brain cancer, took a deliberative decision supported by her family to move from California to Oregon to utilize the Oregon Death with Dignity Act. Highly visible, deeply personal decisions by Maynard and others have influenced social and political discourse around physician-assisted dying (PAD). Although PAD broadly encompasses physician-assisted suicide (PAS) (medicines prescribed specifically for the purpose of being taken by patients to end their lives) and euthanasia (lethal medicines administered by physicians at the patient’s request), states currently only authorize the former. (Lawrence O. Gostin and Anna E. Roberts, 1/19)

JAMA: Why Physicians Should Oppose Assisted Suicide
Is physician-assisted suicide ever justifiable? —No. ... That we are debating this question of whether physician-assisted suicide (or “physician-assisted death”) is ever justifiable shows how far medicine has shifted toward redefining the role of physician. If the medical profession accepts physician-assisted suicide, it will be declaring decisively that “physicians” are mere providers of services, to be guided only by the desires of the individual patient, the will of the state or other third parties, and what the law allows. The idea of medicine as a profession, which embodies a shared commitment to care for persons who are sick and debilitated so as to restore their health, will quickly fade into memory. Those made vulnerable by sickness and debility, to whom physicians owe their solidarity as physicians, will have much less reason to entrust themselves to physicians’ care. (Y. Tony Yang and Farr A. Curlin, 1/19)

JAMA: Responding To Patients Requesting Physician-Assisted Death
Is physician-assisted death ever justifiable?—Yes. ... Patients with serious illness wish to have control over their own bodies, their own lives, and concern about future physical and psychosocial distress. Some view potential access to physician-assisted death as the best option to address these concerns. Appropriate safeguards, as enacted into law in Oregon, Washington, Vermont, Montana, and (recently) California, create a context in which individual physicians and their patients need not act in secrecy. Patients should be informed about palliative care options (including hospice), have access to expert symptom management, have a predictable time window between making the request and receiving the prescription, and have access to mental health services if needed. (Timothy E. Quill, Anthony L. Back, and Susan D. Block, 1/19)