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The day after suffering a political blow in the Alabama special Senate election, congressional Republicans sped forward with the most sweeping tax rewrite in decades, announcing an agreement on a final bill that would cut taxes for businesses and individuals and signal the party’s first major legislative achievement since assuming political control this year. ... In a break from the House bill, the agreement would allow taxpayers to continue to deduct high out-of-pocket medical expenses, and it would retain a provision allowing graduate students who receive tuition stipends to avoid paying taxes on that benefit. Also included in the consensus bill is the Senate’s repeal of the Affordable Care Act requirement that most Americans have health insurance or pay a penalty and a provision that opens the Arctic National Wildlife Refuge in Alaska to energy exploration. (Tankersley, Kaplan and Rappeport, 12/13)

Republican lawmakers will overturn a key piece of the Affordable Care Act in their tax overhaul, a victory in a long GOP campaign against the health law. Senate Majority Leader Mitch McConnell said the compromise tax bill from House and Senate negotiators will end the health law’s requirement that all individuals buy insurance or pay a fine. Doing so could jeopardize Obamacare’s already-shaky marketplaces, by reducing the number of healthier people who sign up for insurance. (Tracer and Rausch, 12/13)

As a group of progressive activists and constituents prepared for a 15-minute meeting on Wednesday with Senator Susan Collins, Republican of Maine, they sat in the lobby of her office and developed a last-ditch strategy to persuade her to vote against the $1.5 trillion tax bill barreling through Congress: tears. “If Senator Collins actually saw you as a human, saw me as a human, then she wouldn’t pass any of this,” said Ady Barkan, a member of the Center for Popular Democracy, who recently learned he had amyotrophic lateral sclerosis, or A.L.S., and uses a wheelchair. (Rappeport, 12/14)

Meanwhile, states are watching the negotiations unfold —

Massachusetts officials remain on alert for attempts in Washington to squeeze the northward flow of federal health care funds, but the so-called individual mandate to purchase health insurance, an important ingredient of Obamacare, is not a top concern within the Bay State. (Norton, 12/13)

Before he terms out of California’s highest office, Gov. Jerry Brown has one more budget to negotiate – a deal that may be complicated by actions taken far outside the state’s borders. Republicans in Congress are in the final stages of a massive overhaul of the federal tax code, which they are eager to pass before Christmas. It could have profound implications for Californians’ pocketbooks, particularly if the cherished deduction for state taxes is eliminated, but the impact on California’s overall fiscal health is not yet clear. (Koseff, 12/13)

More than one million people signed up last week for health insurance under the Affordable Care Act, pushing the total in the federal marketplace to nearly 4.7 million, the Trump administration said Wednesday, days before the annual enrollment period is scheduled to end. The number of sign-ups on HealthCare.gov from Nov. 1 through Saturday was about 17 percent higher than the same time last year. But the final tally is likely to fall short of the 9.2 million who were in plans at the end of the last open enrollment period, which was twice as long as the current one. (Pear, 12/13)

Nearly 4.7 million people signed up for an insurance plan through HealthCare.gov in the first six weeks of the Affordable Care Act's open enrollment this year. At the same time last year, a little more than 4 million people had signed up for a plan. But because this year's open enrollment period is half as long as in previous years, the ACA exchanges have a lot of catching up to do to reach last year's enrollment total of 9.2 million HealthCare.gov plan selections. (Livingston, 12/13)

The number of consumers who signed up for 2018 Obamacare health insurance surpassed the 1 million mark in the second-to-last week of enrollment, the government said on Wednesday, but it did not appear to be enough to grow the program. The Trump administration has worked to undercut former President Barack Obama's national healthcare law by decreasing advertising and discussing ending the mandate that Americans have health insurance, which has weighed on 2018 enrollment. (Humer, 12/13)

With three days remaining in most of the country to buy Affordable Care Act coverage for 2018, enrollment is ahead of the same time last year but is almost sure to fall short in the end because of a compressed enrollment season. During each of the six weeks of this sign-up period, the number of consumers choosing plans through the federal HealthCare.gov website has outmatched that of 2017, according to a federal enrollment snapshot released Wednesday. The overall sign-ups of nearly 4.7 million Americans through last Saturday was about 650,000 higher than through the parallel week a year ago. (Goldstein and Shaban, 12/13)

Friday is the last day to enroll in a health insurance plan through the federal government's insurance exchange, HealthCare.gov. And in a little office park in Northern Virginia, Brima Bob Deen is dealing with the rush. He is the president of a church-sponsored job training center called Salvation Academy. But this time of year, he acts mostly as an enrollment counselor for Affordable Care Act health plans. And this week, his calendar is full. (Kodjak, 12/13)

The strong numbers so far come despite cuts the Trump administration made to ObamaCare's advertising and outreach budget. The initial surge has also put the administration, which has long claimed the health-care law is failing, in a difficult spot. But if the final enrollment numbers are significantly lower than in the past, which many analysts expect, it could bolster the GOP's argument that ObamaCare is failing and needs to be repealed. (Hellmann, 12/13)

Obamacare’s open enrollment period closes for most states Friday. Thanks to a complicated federal formula, a spike in premiums this year has given consumers who are eligible for subsidies more money to buy insurance. (Gorenstein, 12/13)

Maryland is extending the deadline by one week for people to enroll in ObamaCare through its state exchange. The new deadline is Dec. 22. The previous deadline would have been Friday, the same date for states that use the healthcare.gov federal exchange. (Weixel, 12/13)

Georgia’s ACA exchange enrollment for 2018 may fall far short of the current year’s totals, new federal figures show.Through last week, 246,270 have signed up for coverage in the state exchange. (Miller, 12/13)

Enrollment in Affordable Care Act health insurance coverage sped up last week, the Trump administration said Wednesday, ahead of a Friday deadline that could catch some people by surprise. More than one million consumers chose plans on the ACA (or Obamacare) exchanges during the week that ended Saturday in the 39 states that use Healthcare.gov. That brought the total since enrollment started Nov. 1 close to 4.7 million, including 206,000 Pennsylvanians and 139,000 New Jersey residents. (Sapatkin, 12/13)

Gene Kern, 63, retired early from Fujifilm, where he sold professional videotape. "When the product became obsolete, so did I," he says, "and that's why I retired." Kern lives in Frederick, Md., and has been an enthusiastic enrollee in Maryland's health exchange since it began in 2014. But this fall he received a letter from his insurer explaining that the cost of his policy's premium would jump from $800 a month to $1,300 in 2018. (Simmons-Duffin and Farmer, 12/14)

Meanwhile, a new report touts the benefits of the Affordable Care Act —

Fewer Americans are putting off doctor visits or struggling with medical bills, according to a new report examining the effect of the Affordable Care Act. The report – based on a state-by-state survey of data collected by the federal government – provides powerful new evidence that insurance gains made through the 2010 healthcare law are helping millions of patients get needed medical care. (Levey, 12/13)

Funding for key ObamaCare insurer subsidies is likely to be included in the upcoming government funding bill, Sen. Susan Collins (R-Maine) said Wednesday. Collins said she had received reassurances Tuesday from Vice President Pence that the subsidies, opposed by House conservatives, would be in the funding bill. (Weixel, 12/13)

In Congress, where most lawmakers are hesitant to spill secrets about ongoing negotiations, answers are often found in what lawmakers are not saying. And House Republican leaders are not saying much about subsidies for health care insurers lately. GOP leaders’ continued refusal in recent weeks to rule out funding the cost-sharing reduction subsidies, or CSRs, which President Donald Trump’s administration has stopped paying, is not a guarantee that Congress will do so. But it’s certainly a green light for negotiations to continue. (McPherson, 12/14)

House Freedom Caucus Chairman Mark Meadows said on Wednesday morning that GOP leaders never vowed to keep funding for key Obamacare insurance subsidies out of a year-end spending agreement. That contradicts claims made last week by the head of another group of conservative House members, Republican Study Chairman Mark Walker, who said that Speaker Paul Ryan had promised not to restore the cost-sharing payments that President Donald Trump halted earlier in October. (Cancryn, 12/13)

In other news —

House appropriators tonight introduced a bill to fund the government through Jan. 19 that includes funding for the CHIP program and community health centers. The bill includes the CHIP language approved by the House Energy and Commerce Committee and the full House to fund the children's health program for five years and the health centers for two. (Haberkorn, 12/13)

The surprise election of a Democrat in Alabama has dealt a major blow to Republican hopes of reviving ObamaCare repeal next year. Republicans already failed multiple times this year to pass an ObamaCare replacement through the Senate with a 52-48 majority. Next year, thanks to the election of Democrat Doug Jones in Alabama, their margin for error will be even slimmer, at 51-49. (Sullivan, 12/14)

Michael Dourson, whose nomination to become the Environmental Protection Agency’s top chemical safety official drew widespread criticism, withdrew from consideration Wednesday after it became clear the Senate probably would not confirm him. Dourson’s decision, which was confirmed by two senior administration officials who spoke on the condition of anonymity to discuss personnel matters, prevents him from likely becoming the first Trump nominee rejected by the Senate. (Dennis and Eilperin, 12/13)

North Carolina’s two Republican senators, Richard Burr and Thom Tillis, said last month they would vote against Dourson’s nomination after The Associated Press and other media outlets detailed his past work as a toxicologist hired to defend major chemical companies. The Senate’s 48 Democrats were united in opposition, meaning only one more GOP defection would be needed to defeat Dourson’s nomination. In his letter asking the president to withdraw his name from consideration, which was obtained by the AP, Dourson said his stepping aside “avoids unnecessarily politicizing the important environmental protection goals of Administrator Pruitt.” (Biesecker and Colvin, 12/13)

It lasted only a short time, and it hardly eclipsed the bitterness of partisan politics that has consumed the country. But for nearly five minutes on Wednesday morning, Joe Biden and Meghan McCain shared an emotional exchange about the aggressive form of brain cancer that has affected both of their families. The clip from “The View,” on which Mr. Biden, the former United States vice president, was a guest, drew a powerful and heartfelt outpouring online from viewers. Ms. McCain, a Republican who co-hosts the morning talk show, told Mr. Biden, a Democrat, that she “couldn’t get through” his new book, “Promise Me, Dad,” about his son Beau’s battle with the disease. (Salam, 12/13)

“I think about Beau almost every day and I was told that this doesn’t get easier but that you cultivate the tools to work with this and live with this,” Meghan McCain said, her voice breaking. “I know you and your family have been through tragedy I couldn’t conceive of.” Biden, who served with John McCain in the Senate, stood up and moved from his seat on the set to sit next to her and hold her hand. He told Meghan McCain not to lose hope and that a medical breakthrough is possible. “And it can happen tomorrow,” Biden said, adding that if anyone can beat brain cancer, it’s John McCain. (Lardner, 12/13)

Biden added that while the glioblastoma diagnosis was "about as bad as it gets," medical advancements were ongoing in the battle against cancer. And that McCain, a renowned-war veteran and congressional leader, would persevere. "If anybody can make it, [it's] your dad," Biden said. "Her dad is one of my best friends." (Lima, 12/13)

U.S. Sen. John McCain has been hospitalized at Walter Reed Medical Center where he's being treated for "normal side effects of his ongoing cancer therapy," according to a statement Wednesday from his office. McCain, who missed votes on Monday and Tuesday, will return to work in the U.S. Senate "as soon as possible," the statement said. (12/14)

When Julia Raposa overdosed on opioids last year, she was rushed to a hospital in Leominster, Mass., where her aunt says she was treated and released within 90 minutes. Days later, Ms. Raposa’s next overdose killed her. A big challenge in the opioid crisis is getting overdose patients from emergency rooms into treatment. Failed opportunities can be fatal. In an aggressive, new proposal, Massachusetts authorities want to allow hospital staff to send overdose patients to treatment centers against their will for up to three days. The goal is to buy more time for addicts facing imminent risks to accept longer-term treatment. (Kamp, 12/13)

Last March, the state Department of Public Health sent a confidential letter to every health care provider who prescribes opioids and other controlled substances, showing how each practitioner’s prescribing practices compared with those of his or her peers. ...But an article in Thursday’s New England Journal of Medicine concludes that the letter probably didn’t work. (Freyer, 12/13)

In other news on the opioid crisis —

Kellyanne Conway, counselor to President Trump, has been leading weekly meetings at the White House with officials across a dozen federal departments to develop a plan to respond to the opioid crisis and to implement recommendations from a presidentially appointed commission, she and other officials told STAT. The “opioids cabinet,” as the group is known, is intended to help streamline efforts across the government and includes staffers from the Department of Health and Human Services and the Office of National Drug Control Policy, among other executive branch offices. (Facher, 12/14)

After noticing a large uptick in claims for addiction treatment services, including expensive emergency room visits, CareFirst BlueCross BlueShield administrators said Wednesday that the insurer was developing a comprehensive method of caring for its customers. The effort was announced by the state’s largest health insurer during an event at Baltimore City Hall, along with a plan to provide$1.5 million to nonprofit groups in the region to curb an opioid epidemic that has ravaged the city in particular. (Cohn, 12/13)

Kaiser Health News: Telemedicine For Addiction Treatment? Picture Remains Fuzzy
When President Donald Trump declared the opioid epidemic a public health emergency, it came with a regulatory change intended to make it easier for people to get care. The declaration allows for doctors to prescribe addiction medicine virtually, without ever seeing the patient in person. In Indiana, this kind of virtual visit has been legal since early 2017. But among a dozen addiction specialists in Indiana contacted by a reporter, just one had heard of doctors using telemedicine for opioid addiction treatment: Dr. Jay Joshi. (Forman, 12/14)

Living within half a mile of a hydraulic fracturing site carries a serious risk for pregnant women, a new study has found. The drilling technique, also known as fracking, injects high-pressure water laced with chemicals into underground rock to release natural gas. Women who lived within that distance to fracking operations in Pennsylvania were 25 percent more likely to give birth to low-weight infants than were mothers who lived more than two miles beyond the sites. (Fears, 12/13)

That research underscores a problem that has bedeviled the industry and regulators: While the benefits of hydraulic fracturing are widespread, the costs are very localized. The drilling and completion technologies commonly known as fracking have turned the U.S. into an energy superpower while lowering both energy prices and carbon dioxide emissions. To accommodate the industry’s rapid growth over the past decade, several regions of the country—including parts of Pennsylvania, Colorado, Texas and North Dakota—have been turned into industrialized zones, sometimes overlapping with communities. (Gold, 12/13)

Many of the toxic chemicals used in the hydraulic fracturing process are known carcinogens. Toxic gases, including benzene, are released from the rock by fracking. And the high-pressure pumping of a slurry of chemicals into the ground is widely thought to release toxins and irritants into nearby air and water. The noise and pollution emitted by trucks and heavy machinery also may affect the health of people living nearby. (Healy, 12/13)

Cigarette smoking has dropped so sharply among American teenagers that vaping and marijuana use are now more common, according to a national survey of adolescent drug use released Thursday. The report, sponsored by the federal government’s National Institute on Drug Abuse and administered by the University of Michigan, found that 22.9 percent of high school seniors said they had used marijuana within the previous 30 days and 16.6 percent had used a vaping device. Only 9.7 percent had smoked cigarettes. (Hoffman, 12/14)

About 1 in 3 middle and high school students surveyed in 2017 said they had used some kind of illicit drug sometime in their life. Two decades ago, that figure was 43%. Likewise, 17% of students surveyed in 2017 said they smoked cigarettes at least once, and 26% said they had been drunk. In the 1990s, those figures reached highs of 58% and 46%, respectively. “The rates of drug use among teenagers in our country are the lowest they’ve ever been for some drugs,” said Dr. Nora Volkow, director of the National Institute on Drug Abuse. (Kaplan, 12/13)

Rapid advances in personalized medicine have sparked interest in another new idea: precision public health. Essentially, it’s the thought that if doctors could pinpoint populations with genetic vulnerabilities — like those prone to obesity, depression, or cancer — they might be able to treat those diseases sooner, slow their progression, or even prevent them altogether. It could be a more effective preventive medicine tactic than the blanket approaches used right now (Thielking, 12/13)

As many as 646,000 people may die from influenza each year worldwide, according to the latest estimates from the Centers for Disease Control and Prevention — a larger number than what other health experts have predicted in years past. The CDC said between 291,000 and 646,000 people die from seasonal flu-linked respiratory illnesses. (Santhanam, 12/13)

The patients were gravely ill, their hearts scarred by infections or heart attacks. In each, the electrical system that maintains a regular heartbeat had been short-circuited. They suffered frequent bursts of rapid heartbeats, which can end in sudden death. The condition kills an estimated 325,000 Americans each year, the most common cause of death in this country. And these people had exhausted all conventional treatments. (Kolata, 12/13)

Intense treadmill exercise can be safe for people who have recently been given diagnoses of Parkinson’s disease and may substantially slow the progression of their condition, according to an important new study of adults in the early stages of the disease. But the same study’s results also indicate that gentler exercise, while safe for people with Parkinson’s, does not seem to delay the disease’s advance. (Reynolds, 12/13)

More than 6 million American children have been diagnosed with ADHD. As the girls among them grow up and have children of their own, concern has been rising that taking ADHD medication in early pregnancy could heighten the risk of birth defects. (Goldberg, 12/13)

Fact or old wives’ tale? A change in the weather can make bones and joints ache. A new study has an answer: old wives’ tale. Other studies have looked at whether an increase in humidity, rainfall or barometric pressure can bring on pain, but never with as much data as in this newest study, in BMJ. Researchers looked at medical records of 11,673,392 Medicare outpatient visits. Matching the dates of the visits to local weather reports, they found that 2,095,761 of them occurred on rainy days. (Bakalar, 12/13)

Immediately after Vanellope Hope Wilkins was born, she was put in sterile plastic to protect her heart — which was beating outside her tiny chest. It was a moment that her parents, Dean Wilkins and Naomi Findlay, had hoped for but were not certain would actually come — a moment in which their baby girl would come into the world, and live. The newborn, who was born Nov. 22 at Glenfield Hospital in Leicester, England, was delivered by Caesarean section several weeks premature with a rare and often fatal congenital condition called ectopia cordis, in which the heart is growing either completely or partially outside the chest cavity. (Bever, 12/13)

Stubborn people might have another reason to be headstrong — it could keep them alive longer. That’s according to a new study published Tuesday in the journal International Psychogeriatrics, which found that traits like stubbornness, optimism, a love for family and country and a willingness to work hard are common among some Italians aged 90 to 101. (Magness, 12/13)

Kaiser Health News: Good Friends Might Be Your Best Brain Booster As You Age
Ask Edith Smith, a proud 103-year-old, about her friends, and she’ll give you an earful. There’s Johnetta, 101, whom she’s known for 70 years and who has Alzheimer’s disease. “I call her every day and just say ‘Hi, how are you doing?’ She never knows, but she says hi back, and I tease her,” Smith said. There’s Katie, 93, whom Smith met during a long teaching career with the Chicago Public Schools. “Every day we have a good conversation. She’s still driving and lives in her own house, and she tells me what’s going on.” (Graham, 12/14)

Kaiser Health News: Fear Compromises The Health, Well-Being Of Immigrant Families, Report Finds
Luis Ramirez has lived in the U.S. without immigration papers for two decades, but he is more worried about deportation now than ever before. Ramirez said he and his wife, Luz Cadeo, who is also here illegally, have already made plans in case they are arrested by immigration police: The couple, who live in Lakewood, Calif., would try to find work in their native Mexico while their youngest U.S.-born children, ages 15 and 18, stayed in the U.S. with a relative. (Gorman, 12/13)

In one of their last acts of the year, Ohio lawmakers moved Wednesday to ban abortions based on a diagnosis of Down syndrome and sent the measure to Republican Gov. John Kasich, who is likely to sign it. Two states, Indiana and North Dakota, already have passed laws like the one that Ohio is advancing, touching off an emotional debate over women's rights, parental love and the relationship between doctor and patient. (12/13)

The Ohio Senate on Wednesday gave final approval to House Bill 214 in a 20-12 vote. The bill was passed by the House in November. Three Republicans, including Gayle Manning of North Ridgeville and Matt Dolan of Chagrin Falls, voted with Democrats against the bill. Kasich, who has signed 18 abortion restrictions into law since 2011, told cleveland.com last month he generally supported the idea but wanted to see the legislation before deciding how to act. (Borchardt, 12/13)

Pennsylvania Gov. Tom Wolf (D) vowed to veto a bill passed by the state's legislature that would ban abortions after 20 weeks of pregnancy. "This bill is an attack on women, and it should never have reached my desk," Wolf tweeted Wednesday. "I will veto it, because all Pennsylvania women deserve to make their own health care decisions." (Hellmann, 12/13)

Two Arkansas abortion facilities were threatened with suspension — one for not listing the Red Cross on its emergency number list and another for using cloth booties on an exam table — under a new law that the abortion providers are challenging in federal court, according to documents released Wednesday. The state Department of Health issued notices of suspension to Planned Parenthood’s Fayetteville facility and to Little Rock Family Planning Services last week following their annual inspections, according to documents filed by the providers in federal court. The providers are challenging a law enacted this year requiring Arkansas to suspend or revoke abortion clinics’ licenses for violating any rule or law. (Demillo, 12/13)

The board of D.C.’s public hospital voted Wednesday to permanently close the facility’s nursery and delivery rooms, leaving a broad section of the nation’s capital east of the Anacostia River without a hospital where women can give birth and seek prenatal care. The obstetrics ward at United Medical Center has been closed since Aug. 7, when regulators shut it down after uncovering what they said were serious medical errors in the treatment of pregnant women and newborns. However, elected officials, maternal-health advocates and residents of Southeast Washington had expressed hope that it would reopen. (Jamison, 12/13)

The number of doctors practicing in Florida has not kept up with the state’s surging population growth, and more money is needed to recruit and keep them here, hospital leaders said Wednesday. The shortage is particularly acute in four speciality areas: urology, thoracic surgery, nephrology and ophthalmology, according to a second annual report by the Safety Net Hospital Alliance of Florida and the Teaching Hospital Council of Florida. (Griffin, 12/13)

Out of a senseless tragedy, they have sought ways to find meaning in advocacy. Many relatives of the 26 children and educators killed five years ago at Sandy Hook Elementary School have dedicated themselves to charity, activism and other efforts to channel their grief and, in many cases, to help prevent violence. (12/14)

In what is believed to be the first study to measure the impact of Uber and other ride-booking services on the U.S. ambulance business, two researchers have concluded that ambulance usage is dropping across the country. A research paper released Wednesday examined ambulance usage rates in 766 U.S. cities in 43 states as Uber entered their markets from 2013 to 2015. (Seipel, 12/13)

A retired Indianapolis fertility doctor accused of inseminating patients with his own sperm is set to plead guilty to charges that he lied to investigators. Dr. Donald Cline is scheduled to appear in a Marion County court Thursday, when a judge is expected to sentence him on two counts of obstruction of justice. Prosecutors say the 79-year-old Cline initially wrote to investigators denying he used his own sperm. (12/14)

Less than 48 hours after the Metro Council last week signed off on Nashville Mayor Megan Barry’s $275 million Major League Soccer stadium, many African-American council members say they were blindsided by the next big proposal. With no warning, Barry announced plans to end inpatient care at Nashville General Hospital, a longtime symbol in the city’s black community, which has fought for years to keep the safety-net hospital in operation. The mayor cited the facility’s long-standing fiscal instability. (Garrison, 12/13)

New Hampshire ranks near the bottom in the country when it comes to funding anti-smoking programs and prevention. According to a national report released Wednesday, New Hampshire ranks 47th among the 50 states. (Sutherland, 12/13)

Starting in 2012, the city eliminated four of the five psychological tests used to screen applicants for its police academy. Those tests — at least one of which the department had used since at least the mid-1990s — were dropped even though a federally funded study conducted in the Minneapolis Police Department showed some were effective at identifying problem officers. (Gilbert, 12/14)

The Brookhaven City Council on Tuesday night approved several steps that will enable Children’s Healthcare of Atlanta to move forward with its planned $1 billion North Druid Hills campus. The 72-acre campus will serve as a catalyst for more than $40 million of transportation improvements in the surrounding area, officials said. (Miller, 12/13)

A former supervisor in the patient appointments department at the Johns Hopkins Health System Corp. has accused the medical system in a lawsuit of prioritizing out-of-state patients over Maryland residents to boost revenue. Anthony C. Campos said in the lawsuit filed Wednesday in U.S. District Court that his department was directed with the task of “filling the plane” with patients from outside Maryland. The directive to bring in more of these patients came from the highest ranks at the medical system, the lawsuit contends. (McDaniels, 12/13)

A group of 20 Pennsylvania nursing homes, including three facing $1.2 million in federal fines for deficient care, will have new operators after less than three years in the hands of a nonprofit formed to run them. The nonprofit, Oak Health & Rehabilitation Centers Inc, headed by Bala Cynwyd lawyer Howard Jaffe, was put into receivership by its landlord in September after failing to make at least three rent payments totaling $10.5 million and missing financial targets. (Brubaker, 12/14)

The GOP-crafted tax changes are about as popular as a root canal with Americans. A recent poll found the vast majority of voters do not believe their own taxes would be reduced. But Congress can’t move fast enough to deliver more “reform” to the people. Next on the agenda: health insurance programs covering 100 million Americans. (12/13)

You could almost hear healthcare industry stakeholders sigh with relief when Democrat Doug Jones was projected the winner of the special Senate election in Alabama Tuesday night. That's because Jones' narrow victory over Republican Roy Moore dims GOP hopes of successfully reviving their drive to repeal and replace the Affordable Care Act and cutting and block-granting Medicaid in 2018. Providers, insurers, and consumer advocacy groups almost universally opposed the GOP effort, fearing massive insurance coverage losses and healthcare spending cuts. (Harris Meyer, 12/13)

It’s not just sleigh bells ringing we hear this time of year, it’s snuffle, moan and cough. And here’s the bad news: Even if you got your flu jab, your chances of avoiding the misery-inducing bug aren’t so good this year; the dominant strain of influenza that is here is less vulnerable to vaccines. (12/13)

[T]he opioid crisis and the frightening rate at which it has accelerated doesn’t allow for the outright dismissal of this idea — or any others — that could have prevented even one of the more than 60,000 deaths caused by drug overdoses in the United States last year. As a health care professional, I can’t stand idly by with the knowledge that a better way exists for reaching and caring for those suffering from the disease of addiction. We can’t allow individuals to die cruel deaths alone in alleyways or under the cover of darkness in public parks. (Henry L. Dorkin, 12/13)

A patient who doesn't speak English lies in bed, looking up at doctors who don't speak Spanish, who point their fingers at the patient’s body, chest, belly, and ask the only question they can: “¿tienes dolor?” We’ve all seen this, more or less. Yes or no—that's the entire story this patient is allowed to tell. No, lo siento, I’m not here to argue for the use of medical interpreters—hopefully your moral compass argues for that on its own. I'm arguing for something else. (Anna DeForest,12/12)

How should we measure quality in meaningful and efficient ways? The answer could either smooth the transformation to a value-based delivery and payment system or continue to allow performance measurement to impose a significant roadblock to this transition to value. I say “we” because physicians and other health care providers share ownership of this issue with patients, payers, and purchasers. (Jerry Penso, 12/13)

Josephine "Joey" Gay should have celebrated her 12th birthday this week. She should have been surrounded by friends and family in a place festooned with purple, her favorite color. Chase Kowalski should have been working toward a Boy Scout merit badge and training for a triathlon. Avielle Richman should have been where her parents said she was happiest, on a horse. (12/13)

Five years ago today, Adam Lanza shot and killed his mother in Newtown, Conn., then took two semiautomatic handguns and a semiautomatic rifle from her cache of firearms to massacre 20 children and six staff members at Sandy Hook Elementary School. Of course, people declared at the time, such a tragic, senseless event would be a turning point. Surely a slaughter of innocent children would be too much even for the National Rifle Assn. and its adherents, and finally Congress would act to ban civilian possession of the guns of war. Nope. (12/14)

While most of Congress and K Street is preoccupied with tax reform, keeping the government funded and deciding which holiday parties to attend, other issues in Congress are moving ahead under the radar. If the American people are not vigilant, Congress is going to get away with supporting some fairly anti-free market policies that will have real, negative effects on millions of people. (Easton Randall, 12/13)