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WASHINGTON — Under extreme pressure from conservative activists, House Republican leaders and the White House have restarted negotiations on legislation to repeal the Affordable Care Act.

But efforts to revive the legislation in the House could take weeks, lawmakers conceded, as Congress moves forward with a full plate of other time-consuming issues. And the renewed push did not meet with much enthusiasm from Senate Republicans, who said they had other priorities at the moment.

Nonetheless, Speaker Paul D. Ryan vowed to renew efforts to repeal the law, despite last’s week crushing setback when House Republicans tossed aside a repeal bill because they lacked the votes to pass it.

“We’re not going to retrench into our corners or put up dividing lines,” Mr. Ryan said after a meeting of House Republicans was dominated by talk of how to restart health negotiations. “There’s too much at stake to get bogged down in all that,” he added. Democrats had celebrated what they thought was the demise of the repeal bill on Friday. But the House Republican whip, Steve Scalise of Louisiana, said on Tuesday, “Their celebration is premature.”

“I think we’re closer today to repealing Obamacare than we’ve ever been before, and surely even closer than we were Friday,” Mr. Scalise said. It is not clear what political dynamics might have changed since Friday, when a coalition of hard-line conservatives and more moderate Republicans torpedoed legislation to repeal President Barack Obama’s signature domestic achievement.

The new talks, which quietly began this week, involve Stephen K. Bannon, the president’s chief strategist, and members of two Republican factions that helped sink the bill last week, the hard-right Freedom Caucus and the more centrist Tuesday Group.

Any deal would have to overcome significant differences about how to rework a law that affects about one-fifth of the American economy. Those differences were so sharp that they led Mr. Trump and Mr. Ryan to pull the bill just before the House was to vote on it.

Still, Republican members of Congress said they were hopeful. But then Mr. Trump suggested that he could also cut a deal with Democrats, a move that would almost certainly make more conservative members of the House balk. “Do not worry,” he said on Twitter, “we are in very good shape!”

At a White House reception for senators on Tuesday night, Mr. Trump called for Republicans and Democrats to work together as he predicted that “we are all going to make a deal on health care.”

“That’s such an easy one,” Mr. Trump said. “I have no doubt that that’s going to happen very quickly.”



Your federal income taxes are due April 18 and, likely for several million people, so is a fine for failing to get health insurance.

Despite a lengthy debate, Congress has not yet acted on a bill to repeal portions of the Affordable Care Act. That means the law and almost all of its regulations remain in force, for now.

For the majority of tax filers, who had insurance through an employer or government program for 2016, all they have to do is check the box on Form 1040 that says they were covered for a full year. That’s it.

Under a decision by the Trump administration, however, leaving that box blank will not get your tax return kicked back to you. The IRS under President Barack Obama also did not reject returns with the box left blank last year or the year before, but it had announced it would step up enforcement of what’s known as the “individual mandate” for tax year 2016. That plan was canceled under Trump’s executive order calling on federal agencies to “minimize the burden” of the health law.

Still, those who lacked insurance for more than three consecutive months, or who bought individual insurance and got federal help paying the premiums, need to do a little more work.

Those with no insurance or a lengthy gap may be required to pay what the federal government calls a “shared responsibility payment.” It’s a fine for not having coverage, on the theory that even those without insurance will eventually use the health care system at a cost they can’t afford and someone else will have to pay that bill.

Many people without insurance, however, qualify for one of several dozen “exemptions” from the fine. Nearly 13 million tax filers claimed an exemption for 2015 taxes, according to the IRS. The most common were for people whose income was so low (less than $10,350 for an individual) that they are not required to file a tax return, Americans who lived abroad for most of the year and people for whom the cheapest available insurance was still unaffordable (costing more than 8 percent of their household income).

The fine for 2016 taxes is the greater of $695 per adult or 2.5 percent of household income. Fines for uncovered children are half the amount for adults. Fines are pro-rated by the number of months you or a family member was uninsured.

The maximum fine is $2,676; that is the national average cost of a “bronze” level insurance plan available on the health exchanges. But most people do not pay anywhere near that much. Last year, said the IRS, an estimated 6.5 million tax filers paid a fine that averaged $470.

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Physician pay has increased for the seventh year in a row to an average annual compensation of $294,000 for full-time physicians in 2016, according to Medscape's 2017 Physician Compensation Report, which has tracked pay data for seven years.

Here are five things to know about the latest data on specialist and primary care physician pay.

1. PCPs still earn less than specialists, despite the industry's greater emphasis on primary care. Specialists earned 45.6 percent more in 2016 — which equates to roughly $100,000 more, according to the report. After a year of growth in primary care pay in 2015 — when internist pay grew 12 percent over the year prior, pediatrician pay grew 7 percent and family practitioner pay grew 6 percent — primary care pay experienced little to no growth in 2016.

2. Seven specialties experienced significant growth in compensation. Medscape flagged seven specialties with double-digit growth in compensation between 2015 and 2016. Those specialties included:

  • Plastic surgery (24 percent growth)
  • Allergy and immunology (15 percent)
  • Otolaryngology (13 percent)
  • Ophthalmology (12 percent)
  • Pulmonology (11 percent)
  • Orthopedics (10 percent)
  • Pathology (10 percent)

3. Two specialties experienced little to no growth, due in part to CMS changes in reimbursement.

Cardiologists and oncologists did not experience pay growth in 2016, according to the report. Medscape attributed this to reductions in Medicare reimbursement for stent placement and cancer drugs.

4. Self-employed physicians still bring home the biggest paychecks, but employers are upping the ante for PCPs. Self-employed physicians generally earn about 28 percent more than employed physicians, but the gap is much smaller among PCPs. Self-employed PCPs earned average compensation of $223,000 in 2016, compared to employed physicians' $214,000.

5. Pay is greater where demand is greater. This means physicians are earning most in rural areas. Pay is highest in North Dakota, where the average physician earned $361,000 in 2016. It is lowest in Washington, D.C., where the average physician earned $235,000 in 2016. The highest paid states for physicians after North Dakota include Alaska, South Dakota and Nebraska.

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#4 Above is critical – Self-employed physicians still bring home the biggest paychecks. Private practice allows physicians to set their own schedule, treat their patients according to guidelines deemed best for patient care, participate with the insurances that offer favorable reimbursement and treat the patient with respect. There is a growing trend with physicians leaving the hospital conglomerates after serving out their contract term. Unkept promises by the hospitals as well as dissatisfaction with patient care procedures are cited as the top reasons providers return to private practice.

With significant changes being made with the new president-elect, healthcare practitioners, as well as those not in the industry, need to be aware of what’s coming. Hint: The future is tech.

Here are some healthcare trends we’ll see in 2017.

1. An Influx of Wearable Devices

The global wearable medical device market is worth 13.2 billion as of 2016, according to research firm Kalorama Information. That number is expected to more than double by 2021. Wearable devices include:

FitBit, Activity monitors, Sleep monitors, Fetal monitors and other obstetric devices, Neuromonitoring devices, Wearable pain management devices, Glucose/insulin monitoring devices, Wearable electroencephalographs and electromyographs

2. Embracing Telemedicine

We telecommute more in our work, and Facetime with our loved ones overseas, so why not adopt this for medicine?

3. Medical care will go increasingly retail

Just like patients get eye exams and glasses at their local superstore, they’ll embrace having other medical care at their convenience.

4. A Focus on Senior Care

With baby boomers aging and an influx of young people avoiding having families, a re-focus on elder care has emerged.

5. A Focus on Nutrition as Medicine

As technology emerges, a more natural way of living is also coming back: relying on nature to heal us. A recent HRI survey found that consumers want more nutritional advice, especially from their healthcare resources.

People want faster, more reliable healthcare that’s natural and authentic. They want easy-to-read labels and receive compassionate care without waiting in line for an eternity. Although the state of healthcare is in a vulnerable position right now, people want a more clear, honest and natural relationship with their medical care.

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Will opening the door to cheaper, skimpier marketplace plans with higher deductibles and copays attract consumers and insurers to the exchanges next year? That’s what the Trump administration is betting on.

In February, the administration proposed a rule that would take a bit of the shine off of bronze, silver, gold and platinum exchange plans by allowing them to provide less generous coverage while keeping the same metal-level designation. But consumer advocates and insurance experts say the proposal fails on two fronts. It doesn’t address key concerns among insurers about plan design, and it might push consumers away from the exchanges because it could increase their out-of-pocket costs and reduce the amount they receive in premium tax credits.

The proposal is one of several rule changes the administration put forward to help stabilize the insurance marketplaces while Republicans work to repeal and replace the Affordable Care Act.

The proposed rule would let insurers offer plans with higher consumer out-of-pocket costs than now allowed by lowering the minimum coverage requirements, called a plan’s “actuarial value.”

Because all plans must cover the 10 essential health benefits mandated by the ACA, insurers have few options apart from cost-sharing adjustments to alter a plan’s coverage to be more or less generous. If you’re a healthy person who doesn’t need much care maybe that seems like a decent deal, but some consumer advocates aren’t so sure.

“Young adults really care about overall cost sharing and not just premiums,” said Erin Hemlin, director of training and consumer education at Young Invincibles, an advocacy group for this demographic. According to the group’s analysis of 2017 exchange enrollment, 75 percent of 18- to 34-year-olds bought silver plans while just 20 percent bought bronze plans. Cheaper premiums might not be a lure for this group, which is highly sought after by insurers because young people tend to be healthy.

Marketplace customers with incomes up to 400 percent of the federal poverty limit (about $48,000 for one person) may qualify for tax credits to use toward the premium. But the amount of the tax credit is based in part on the cost of the premium of the second-lowest priced silver plan in the geographic area. If insurers offer some plans with actuarial values of 66 percent, it’s likely one of them will become the “benchmark” on which tax credits are based. Since the premium for that plan would generally be lower than that of a more generous policy, consumers’ tax credits would be smaller too.

The proposed rule change isn’t going to help make marketplace participation more attractive to insurers either, said Robert Laszewski, a health policy consultant and longtime critic of the Affordable Care Act. Insurers are hampered in critical ways by other requirements in the law that limit the types of plans they can offer, he said, citing maximum out-of-pocket spending limits for consumers (currently $7,150 for an individual plan and $14,300 for a family plan), maximum deductibles (the same as the spending limits) and being prohibited from offering plans with even lower actuarial values. “The biggest obstacles to creating far more flexible plans and particularly appealing to younger, healthier people, are in the statute that the administration can’t change,” Laszewski said.

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A bipartisan Senate bill unveiled Thursday would impose strict limits on some opioid prescriptions, a small tweak to federal law that is part of an ongoing effort in Congress to curb overuse of the drugs.

The legislation, introduced by Sens. John McCain (R-Ariz.) and Kirsten Gillibrand (D-N.Y.), would bar doctors from supplying more than a week’s supply of an opioid drug to patients suffering from acute pain. Refills for those patients would also be prohibited, but prescriptions to treat chronic illnesses and end-of-life care would not be subject to the rules. Several states, including New York and Arizona, have already enacted similar policies.

“We have a long way to go to end the scourge of drugs across our communities, but this legislation is an important step forward in preventing people from getting hooked on these deadly drugs,” McCain said in a statement.

The overuse of addictive prescription opioids has been an area of top concern for lawmakers in both parties. In the run-up to the 2016 election, Congress worked in rare, bipartisan fashion to pass legislation combating the nation’s opioid addiction epidemic by bolstering treatment and recovery efforts.

Most recently, the issue also appears to be a focus for Scott Gottlieb, the nominee to head the Food and Drug Administration, who said the opioid crisis would “require dramatic action.”

The senators are still working on a strategy to get the bill signed into law, a Gillibrand spokesman said in an email. Several legislative vehicles, including the Food and Drug Administration user fee reauthorization and government funding legislation, are possible options.


Pioneering Canadian HIV/AIDS researcher and social activist Mark Wainberg, PhD, died April 12 at age 71. Dr Wainberg drowned while swimming in Bal Harbour, Florida. It appears Dr Wainberg's son swam out to where he had seen his dad, was able to locate him, and began to swim back to shore with him. Other people on the beach went into the water to help bring him onto the shore. He was transported to the hospital, where he was pronounced dead.

In a release from the International AIDS Society (IAS), President Linda-Gail Bekker, MBChB, PhD, also commented on Dr Wainberg's impact. "We have lost one of our fiercest champions," she said. "To those of us in the research community, he was the epitome of dedication from the earliest days of the response. The impact of his work both through and beyond his role with the IAS will live on through the millions of people accessing HIV treatment and those of us who were lucky enough to know him."

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