Patients are being required to pay more of the cost of prescription drugs from their own pocket. In 2009, in Medicare Part D prescription drug plans for people age 65 and older, the median copayment increased by 40 percent for generic drugs and 27 percent for preferred brand drugs. Co-payments are one way of keeping a lid on employer costs (or taxpayer costs for Medicaid and Medicare) and of requiring that people bear some of the financial burden of their own medical care. But researchers at the federal Agency for Healthcare Research and Quality and George Washington University point out in a new study that “excessive cost-sharing may lead to the underuse or inappropriate use of medications; thus, leading to medical complications and ultimately, higher medical costs.” What’s the right balance between fiscal responsibility and cost-effective drug treatment?

The debate over the Democrats health care reform bill has focused mainly on how to expand insurance coverage and change the private insurance marketplace. But it's not just insurance that's in the insurance reform bill. Topics addressed in the bill range widely from diabetes among urban Indians to research on "neglected parasitic diseases" such as "Chagas disease, cysticercosis, toxocariasis, toxoplasmosis, trichomoniasis, the soil-transmitted helminths, and others." The opportunity to pass comprehensive legislation won't likely come again very soon which may explain why the House leadership chose to include many topics in the bill.

As President Obama said in his State of the Union address, the overhaul of the nation's health insurance system "is a complex issue." The Democrats' plan tries to accomplish several goals at once, among them: expanding insurance coverage, controlling the rate of increase in federal health care spending, making medical care more cost-effective, encouraging preventive treatment, and tightening the regulation of private-sector insurers. To do all this, the House bill grew and grew, until, by final passage last November, it had reached 2,016 pages in length. One of our readers says he heard that the bill would create 150 new federal agencies. Would it?

In a report released this week, actuaries at the federal Centers for Medicare and Medicaid Services (CMS) estimated that medical spending last year by government programs grew by 8.7 percent, far faster than the 3 percent spending growth by private insurance payers. The actuaries said a primary factor driving the surge in government outlays was the nearly 10 percent increase in spending on the Medicaid program. As the recession decimated private-sector employment last year, more people became eligible for Medicaid to pay for their care. Medicaid enrollment jumped by 6.5 percent last year, the actuaries estimated. Total federal and state Medicaid outlays reached nearly $380 billion. Is this simply a short-term cyclical trend, and will private health care spending grow faster than government health spending once the economy revives? What do you think?

The House insurance reform bill requires most employers to offer coverage to their employees. But it offers employers the option of not providing insurance and, instead, paying an amount equal to 8 percent of their payroll costs into an insurance fund that would be used to pay for coverage of the uninsured. If the company you work for decides to not offer insurance, you'd be required to buy coverage yourself through the insurance exchanges (marketplaces) that will be set up by the bill. If you don't, you would pay a penalty. The House bill would provide $574 billion in subsidies over 10 years to those buying coverage. But, one reader asks, "How much will coverage cost me? I make nearly $100,000 a year and I'm a single person. I won't be eligible for a subsidy? Or will I?" What do you think?

The Democrats' insurance overhaul requires that individuals buy coverage if their employer doesn't provide it for them, or if they are not in a government-paid program such as Medicare. The Senate bill would, after a phase-in period, require those without coverage pay a tax penalty of $750 per year, up to a maximum of $2,250 per family, or a penalty of 2 percent of household income. The non-partisan American Academy of Actuaries says this penalty is too weak, which will limit its effectiveness in deterring "adverse selection," the tendency of sick people to buy insurance and of healthier people to go without coverage. Adverse selection creates insurance risk pools with too many sick people and too few healthy ones. But for critics of the insurance overhaul, the penalty is too high or is an unacceptable use of federal power. What do you think?

Governors and state legislatures have been struggling to keep paying for Medicaid, the joint federal-state health insurance program for poor people. On average, Medicaid now ranks equal to public education as the biggest expenditure in state budgets. Since last year, states haven't had the tax revenues they did when the economy was thriving. But their caseloads increased by 5 percent last year and are expected to increase by 6 percent this year. More than the half the states have had to cut Medicaid spending or eligibility. Last year's stimulus bill gave states a temporary increase of 6.2 percent in their federal Medicaid matching funds as well as additional amounts for states with the highest jobless rates. The stimulus sent states about $87 billion in additional Medicaid money, but that money was set to end in December 2010. What do you think?

Meeting Friday with Republican House members, President Obama engaged in a debate with Rep. Paul Ryan, R-Wisc., the top Republican on the Budget Committee, over his proposal to redesign the Medicare program that covers nearly 50 million Americans. Obama said Ryan's plan would "hold Medicare cost per recipient constant as a way of making sure that (spending) doesn't go way out of whack." Obama said a problem with Ryan's proposal is that "if recipients are suddenly getting a plan that has their reimbursement rates going like this" -- he made a flat-line gesture with his hand -- "but health care costs are still going up like that" -- he made an upward-line gesture with his hand, "then over time the way we're saving money is essentially by capping what they're getting relative to their costs." Was Obama correct?

Following Democrats' loss of their filibuster-proof majority in the Senate due to last week’s Massachusetts special election, Democrats are looking for ways to pass their health insurance legislation, without having to round up 60 votes in the Senate. Some Democrats are urging the Senate to resort to its reconciliation process, which is used for revenue and tax-related measures, to enact a series of "fixes" to the bill which the Senate passed before Christmas. Some House Democrats want the Senate to go further and use the fast-track reconciliation process to enact a public insurance program. "The public option would clearly qualify as budget-related under reconciliation, and with the majority support it has garnered in the Senate, it should be included in any health care reform legislation that moves under reconciliation," said Rep. Chellie Pingree, D-Maine. What do you think?

At the start of the recession in December 2007, the number of unemployed was 7.7 million, and the unemployment rate was 5 percent. Since then, both the number of unemployed and the unemployment rate have doubled, with 15.3 million people searching for jobs in December. In the latest NBC News/Wall Street Journal survey, 51 percent of respondents said President Barack Obama has given too little attention to the state of the economy. In Wednesday night’s State of the Union address, Obama told Congress, "I want a jobs bill on my desk without delay" and added, "We cannot afford another so-called economic 'expansion' like the one from last decade -- what some call the 'lost decade' -- where jobs grew more slowly than during any prior expansion." What do you think?

Congressional Budget Office director Douglas Elmendorf said Tuesday that in the current fiscal year, which ends on Sept. 30, the deficit will be 9.2 percent of gross domestic product (GDP), a bit smaller than the FY 2009 shortfall of 9.9 percent of GDP. Last year's deficit was the largest since the end of World War II. Elmendorf predicts that the deficit for FY 2010 will be the second largest since 1945, or perhaps bigger if Congress enacts major new spending or tax cuts. Deficits will "drop markedly" after FY 2010 "but remain high -- at 6.5 percent of GDP in 2011 and 4.1 percent in 2012," said Elmendorf. Faced with these numbers, President Obama has proposed to freeze non-security discretionary spending for three years, starting this October. Would this freeze affect the money that the government spends on medical care? What do you think?

In a self-insured plan, the employer acts as its own insurer, using money that it would have paid an insurance company and paying the medical claims filed by its employees. According to the Employee Benefit Research Institute (EBRI), more than 70 million workers, or 55 percent of workers with health insurance, were covered by a self-insured plan in 2008. Nearly nine out of 10 workers employed by large firms (those with 5,000 or more employees) were in such plans. One advantage for companies that self insure: They can tailor coverage to their particular workforce and, as a 2008 EBRI report said, "design financial incentives, such as deductible and co-payment structures, that encourage wise use of health benefits." Would the Democrats' reform bill change this?

Last week the Supreme Court ruled that for-profit and nonprofit corporations could use their money to pay for campaign ads praising or attacking candidates by name. The court overturned its 1990 Austin decision which had banned direct corporate political expenditures. The Austin decision referred to what it called "the corrosive and distorting effects of immense aggregations of (corporate) wealth." But last week, five justices agreed that corporations, as well as individuals, have a First Amendment right to broadcast campaign ads. Prior to last week's ruling, corporations did use political action committees, as permitted under federal law, to support or oppose candidates. In the 2008 campaign, the political action committee of the Pfizer Corp., for instance, gave a total of $1.8 million to both Democratic and Republican candidates, ranging from Senate Democratic Whip Dick Durbin to Republican Sen. Charles Grassley.

Last August, centrist Democrat Rep. Joe Donnelly of Indiana, said of the Democrats' insurance reform effort, "Sometimes when it becomes too big, it makes it impossible to get any part of it done." He asked rhetorically, "Are there a couple of incremental steps, rather than trying to bite off the whole thing at one time?" He wondered, "Would people accept it better if it were just one or two steps to try to fix some of the things that are broken?" Now, five months later, with the Democrats' loss of Tuesday's Senate election in Massachusetts, other Democrats are pondering what Donnelly discussed: taking a few pieces from the bill and trying to enact them. For example: limiting insurers' ability to deny coverage to people with pre-existing medical problems, and sending subsidies to low-income people to pay premiums.

Can lessons of Tuesday's Massachusetts election be nationalized? The state's electorate is atypical: Massachusetts is the only state that has already enacted its own insurance overhaul resulting in near-universal coverage. A Suffolk University poll of 500 Massachusetts registered voters conducted from Jan. 11 to Jan. 13 found that 54 percent supported the state's insurance system, while 36 percent opposed it. Republican Scott Brown did make the argument during the campaign that, "We already have insurance. We have 98 percent of our people insured, so why we would we in fact cut medical -- you know, Medicare half-a-trillion, have longer lines, lesser coverage, subsidize other states? It makes no sense. It's not good for Massachusetts." Was Tuesday's outcome a case of self-interested voters trying to preserve what they had? Was the election not an indicator of national sentiment? What do you think?

Republican Scott Brown won Tuesday’s election in Massachusetts, the first Republican to win a Senate election in that heavily Democratic state since 1972. Democrats have now lost their 60-vote supermajority in the Senate which had allowed them to pass a first version of insurance reform on Christmas Eve. Sen. Russ Feingold, D-Wisc., who is up for re-election in November, said on Monday that if Democrat Martha Coakley lost "it's probably back to the drawing board on health care." But House Speaker Nancy Pelosi rejected that idea. "There is no 'back to the drawing board,'" she insisted. The chance to overhaul health insurance "is the opportunity of a generation." Does Pelosi push on, or does she heed calls to retool the insurance legislation?

On Tuesday, Massachusetts voters are choosing a senator to fill the unexpired term of Sen. Edward Kennedy, who died last year. Republican Scott Brown, a state senator, is vying with Democrat Martha Coakley, the state attorney general, and with independent Joseph Kennedy, (no relation to Sen. Kennedy). No Republican has won a Senate seat in Massachusetts in 38 years. But polls show a tight race between Brown and Coakley. Senate Republican Leader Mitch McConnell said Sunday that the election "is, in effect, a referendum on the national health care bill which the Democrats, in secret, are trying to work out now." He said, "If it's unpopular in Massachusetts, it's unpopular everywhere." What do you think?

The Democrats' insurance reform legislation begins with the premise that too many Americans are uninsured — 46.3 million in 2008, the Census Bureau's most recent estimate. The legislation would raise hundreds of billions of dollars in taxes and fees to expand insurance coverage. Which income groups would benefit most?

We're looking for a few local writers to post blog entries daily on political happenings in Washington, DC.

Stuff like: council meetings, local political celebrity sightings, mayoral news, local elections, police/crime stuff, and D.C.-specific stories like the ongoing same-sex marriage legislation and continued drama with taxi cab regulations.

If you or anyone you know would fit the bill, please let me know right here in the comments. I will consider people with Newsvine columns (or a written track record elsewhere on the web) displaying DC-related material ahead of others who indicate interest in participating, but haven't yet written about these topics or otherwise demonstrated knowledge of the subject matter. So, help speed along the process by including relevant links to your work.

Once I have narrowed it down to a group of potential candidates, I will provide additional details. This is an ongoing, paid gig.

The number of unemployed has doubled since the start of the recession and stands at 15.3 million. But one bright spot in the recession has been the brisk hiring in the health care sector, which has added 631,000 jobs since December 2007. According to the Bureau of Labor Statistics (BLS), there were 485,000 job openings in November in what it calls the "health care and social assistance" sector. The BLS said hiring of nurses will grow by more than 20 percent from 2008 to 2018, "much faster than the average for all occupations" -- creating 581,500 new jobs, "among the largest number of new jobs for any occupation." From New Jersey to Colorado, hospital executives and others are forecasting nursing shortages, partly due to an aging work force. What do you think?

Anthem Blue Cross Blue Shield of Maine, the only major carrier still serving the individual market in that state, has asked state regulators to approve a 22.9 percent rate increase. Regulators limited the premium 2009 increase to 10.9 percent. "Asking for a 23 percent rate increase for individual insurance rates in the middle of a recession is outrageous and is an example of why we need to pass comprehensive health care reform," protested Rep. Chellie Pingree, D- Maine. Last week the Centers for Medicare and Medicaid Services reported that medical spending in the United States in 2008 increased by 4.4 percent, after a 6 percent increase in 2007. Why are costs for individual insurance increasing so much faster than the cost of the medical procedures for which the insurance pays? What do you think?

A for-profit health insurer, like other profit-seeking firms, can make decisions about its investments, its profits, and its cost of services. Health insurers are subject to some regulation by state insurance commissioners and by federal laws such as the 1996 Health Insurance Portability and Accountability Act, which limits excluding people from coverage due to preexisting medical conditions. Insurance firms can, and in some cases do, compete for customers. But insurance industry critics say the competitive model has broken down and Congress must step in to take control. How about making insurance firms more like electricity, gas and water suppliers? A public utility provides an essential service, but usually operates under noncompetitive conditions where barriers to new competitors entering the market are high. State and federal regulators control the utility's services and profits. What do you think?

The two insurance overhaul bills passed by the House and Senate last year differ substantially on the subsidies they would provide to insurance purchasers, the way they raise revenue to pay for expanding insurance coverage, and other matters. House and Senate Democratic leaders are meeting to try to square the differences between the two bills and perhaps even to add new features that hadn't been in either the House bill or the Senate one. Once the final bill is ready, what hurdles must it overcome?