HCR Update from Mark Sanna: The lack of competition in nearly a dozen states could present problems when the insurance exchanges that are part of the Affordable Care Act launch in October. The exchanges are supposed to give Americans who do not get health insurance from their employers the opportunity to choose from an array of private insurance plans. The idea is to generate competition between insurers that will lead to lower premiums. But in states with a dominant insurance carrier, competition and lower prices may not arrive for quite some time.

HCR Update from Mark Sanna: A new study published in the journal Biological Psychiatry  raises the possibility that analyzing the placenta after birth may provide clues to a child’s risk for developing autism. The study, which analyzed placentas from 217 births, found that in families at high genetic risk for having an autistic child, placentas were significantly more likely to have abnormal folds and creases.

HCR Update from Mark Sanna: Those who lost limbs in the Boston Marathon bombings now need care to learn to navigate the world in a new way and navigate a thorny area of health care coverage, too. In the case of the Boston bombings, pledges and offers of support have poured in to help with the health care costs of the 14 people who lost all or part of a limb. But for some amputees, covering the staggering cost for prosthetics care could be a struggle. Even those with health insurance may find that their plan places limits on specific services, like physical therapy or psychological counseling.

HCR Update from Mark Sanna: Law enforcement agencies are reporting an increase in these sorts of health insurance scams across the country. Many of the fraudsters seem to be preying on the public's confusion over the massive changes taking place in the nation's health care system.

HCR Update from Mark Sanna: This week, Senate Finance Committee Chairman Max Baucus accused the Obama administration of failing to educate Americans about the health care reform law, a situation he said could lead to "a huge train wreck" and disrupt its implementation. He said, "The administration's public information campaign on the benefits of the Affordable Care Act, I think, deserves a failing grade."

HCR Update from Mark Sanna: A study, which was published Tuesday in The Journal of the American Medical Association, found that hospitals earned 330% higher profit margins on surgeries with one or more complications, because private insurers pay them for longer stays and extra care.

HCR Update from Mark Sanna: For decades, pharmaceutical companies have deployed an array of tactics aimed at preventing low-cost copies of their drugs from entering the marketplace. The new approach is almost elegant in its simplicity: brand-name drug makers are refusing to sell their products to generic companies, which need to analyze them so they can create the copycat versions. Traditionally, the generic drug makers purchased samples from wholesalers. But because of safety concerns, an increasing number of drugs are sold with restrictions on who can buy them, forcing the generic manufacturers to ask the brand-name companies for samples. When they do, the brand-name firms say no.

HCR Update from Mark Sanna: President Barack Obama today released a proposed $3.8 trillion budget for fiscal 2014 that would shrink the federal deficit by $1.8 trillion over the course of 10 years, but not on the backs of physicians. Instead, they are on the receiving end of some federal largesse. For starters, Obama's deficit reduction would replace the automatic, across-the-board cuts called sequestration that include a 2% decrease in Medicare reimbursement for physicians.

HCR Update from Mark Sanna: Some members of the Medicare Payment Advisory Commission suggested Medicare take stronger steps to recognize and reward the work of advanced practice registered nurses (APRNs) and physician assistants (PAs). If a particular state allows an APRN to operate independently of a physician, Medicare will pay the APRN 85% of what a doctor would receive for providing that service. But if the APRN must work under a physician, that doctor receives 100% of the payment for that service -- at the regular physician fee schedule rate -- even if the doctor didn't provide it.

HCR Update from Mark Sanna: Previews of President Barack Obama's budget proposal, which is expected to be released next week, indicate that he will signal a willingness to compromise with Republicans by including trims to Medicare. The blueprint, though, reportedly will not make major dents in Medicaid.

HCR Update from Mark Sanna: The most rigorous study to date of how much it costs to care for Americans with dementia found that the financial burden is at least as high as that of heart disease or cancer, and is probably higher. And both the costs and the number of people with dementia will more than double within 30 years, skyrocketing at a rate that rarely occurs with a chronic disease. The research, by the RAND Corporation was published Wednesday in The New England Journal of Medicine.

HCR Update from Mark Sanna: Unable to meet tight deadlines in the new health care law, the Obama administration is delaying parts of a program intended to provide affordable health insurance to small businesses and their employees. The law calls for a new insurance marketplace specifically for small businesses, starting next year. But in most states, employers will not be able to get what Congress intended: the option to provide workers with a choice of health plans. They will instead be limited to a single plan.

HCR Update from Mark Sanna: Nearly one in five high school age boys in the United States and 11% of school-age children over all have received a medical diagnosis of attention deficit hyperactivity disorder, according to new data from the federal Centers for Disease Control and Prevention. These rates reflect a marked rise over the last decade and could fuel growing concern among many doctors that the A.D.H.D. diagnosis and its medication are overused in American children.