Running out of time.

After a glitch-plagued rollout of state and federal healthcare exchanges, officials are scrambling to fix the marketplaces before a crucial mid-November deadline. If the problems can't be fixed in time for consumers to get enrolled by Jan. 1, it will hand ammunition to Republicans who want to delay the ACA's individual mandate. "If you can't enroll people, how can you penalize them?" asks Tom Miller of the American Enterprise Institute.

Long-term tab. As D.C. waits for a new panel to explore how to pay for long-term care, Medicaid is bearing the brunt.

With a new commission set to tackle the nation's thorny long-term care problems, providers and policy experts are watching anxiously. Some think a solution will depend on a joint effort of individuals, government and the private sector. "We believe it will take all three of those working together to create some kind of unified, coherent and efficient approach to it," says Larry Minnix, left, of LeadingAge.

Critical debate. Proposal to strip critical-access status for some of those hospitals called a death knell for many.

A proposal to cut back the critical-access hospital program has rural hospital advocates fearful many of those hospitals will be forced to close. "This facility would lose money without critical access. Then what do we do to break even, to survive? ... If you lose money, you have to pull back and decide what you can keep," says John Russell, left, CEO of Columbus (Wis.) Community Hospital.

Device-tax repeal surfaces as key in budget stalemate. White House says it's unwilling to compromise until shutdown ends.

As lawmakers in D.C. continue to wrangle over how to solve the government shutdown and debt ceiling impasse, the Affordable Care Act's medical device tax is emerging as a likely bargaining chip. But many wonder how the tax's $29.1 billion in funding for coverage expansion will be replaced. Minnesota GOP Rep. Erik Paulsen, says he's encouraged that there is a strong chance the device tax could be overturned.

Beyond the glass ceiling. The top 25 women in Healthcare honorees take on key roles as significant change in the industry unfolds.

At a time when a national conversation is focused on the gender imbalance atop most professions, healthcare can boast of having women in some of the most important policy and executive positions. Those honored in ourTop 25 Women in Healthcare program have a few lessons to share. "Be willing to take the job that everyone else isn't migrating to and make it work for you," says Marilyn Tavenner, acting CMS administrator.

Exercising their influence. As policymakers struggle in battle against obesity, providers and insurers are offering their own solutions.

Policymakers aren't making much progress in their battle against obesity, with New York Mayor Michael Bloomberg, left, suffering a big blow last week when a judge invalidated limits on sugary drinks. But providers and insurers are using their influence to offer a different range of solutions.

Shaky support. GOP candidates back new premium plan for Medicare, but details and impact a little fuzzy.

A variety of premium-support models for Medicare are floating around D.C. these days, but details are sketchy. However, now is the time for discussing such changes, according to one author, Sen. Ron Wyden, left, because unless lawmakers make fundamental changes, they must make incremental cuts "that will hurt seniors, will hurt healthcare providers, and that will essentially continue until the Medicare guarantee--and I use this word specifically--has been vaporized".

Firing blanks. CBO says experiments fail to cut Medicare spending; providers not ready to give up.

The results are in, and it's bad news for saving money in care coordination and disease management, according to the Congressional Budget Office, which found demonstration projects in those areas didn't save Medicare money. Randy Brown, left, of Mathematica Policy Research, says it's not surprising since it's hard to save money on a very sick population with chronic problems.

Essential debate.

With the election settled, the Obama administration has forged ahead with a draft rule on essential benefits and other provisions under the Affordable Care Act. Key players are still digesting the proposals, but HHS Secretary Kathleen Sebelius, left, says she's confident that the new rules-and an extended deadline related to exchanges-will give states what they need to implement the law.

Less than expected. With projections that the Supreme Court's ACA ruling means fewer will be insured, providers are scrambling to find out how they'll fare and sending PAC cash to those who can help.

The CBO has come up with its numbers on how the ACA ruling will affect hospitals. And providers are worried. "When the law was passed, the idea was there would be less DSH money, but more people will be covered, and we won't need as much DSH money," says Dr. Bruce Siegel, left, of the National Association of Public Hospitals and Health Systems. "Now, half of that is gone-the coverage is expected to be less".

Docs on the Hill. ACA still prime target for GOP-dominated physician delegation.

Twenty physicians, including Rep. Tom Price (R-Ga.), left, will be part of the 113th Congress that gets to work early next year. But this GOP-dominated group of doctors will wield influence beyond their numbers on healthcare policy and are armed with focused agendas on what to do next. We looked at the legislative records of these representatives and senators and got their perspectives on some key issues.

Doing the math. Groups say the debt-ceiling law's $11.1 billion hit to Medicare would lead to mass layoffs in healthcare.

As Washington wrestles with looming mandatory cuts forced by a deficit agreement, the AMA, AHA and ANA are warning of massive job cuts. "If I've got a choice of maintaining these beneficial programs or contract them for my core mission, you're going to choose your core mission. And that will cost the community more in terms of health and of dollars," says Rich Morrison, of Adventist Health System.

The second act. With Obama and the reform law here to stay, big decisions are ahead for healthcare.

The re-election of President Barack Obama to a second term and the preservation of a Democratic majority in the Senate removed doubts about the survival of the Patient Protection and Affordable Care Act as the law of the land.

Payday for payers. Compensation of the top execs at investor-owned insurers outpaced that of the leaders at hospitals and specialty care.

Top executives at investor-owned hospital chains saw their compensation packages take a hit last year, amid the debt-ceiling crisis and concerns over how it might affect Medicare. Wayne Smith at Community Health Systems led the pack in that sector, with a $21 million payday, while Trevor Fetter, left, of Tenet, came in a distant second with $10.7 million.

Left in the dark: Seven years after Katrina, Sandy is teaching hospitals more lessons on how to survive nature's fury.

In the wake of the devastation Sandy wreaked along the Atlantic Coast, some hospitals were forced to close. But others took on new roles, whether as makeshift phone-charging stations or dealing with healthcare needs patients usually turned to outpatient centers for. "The biggest challenge is making up for the other services that are not available in the community," says Steven Littleson, of Jersey Shore University Medical Center.

Cloudy outlook. Supercommittee failure leaves healthcare providers questioning future cuts, impact on hospitals.

President Barack Obama responded to the failure of the so-called supercommittee with a message that he won't allow Congress to water down the automatic cuts triggered under the August deficit law, which would include a 2% reduction in Medicare payments.

Recruiting agents of reform. CMS healthcare program seeks innovators at local level.

The CMS is going local in its latest effort to spark innovation. Teams of "innovation advisers" are being sought to devise and carry out reform initiatives in their communities. "Until recently, Medicare's role has been to pay the bills. In the last 10 years, Medicare has been seeing its role--more appropriately, I think--as providing access for their beneficiaries to the care they need," says Stuart Guterman, left, of the Commonwealth Fund.

Fee-for-all. Physician fees are the source of increased spending in U.S., researchers find--but some say there's more to it than that.

As pressure mounts to contain healthcare spending, a study says U.S, doctors are outearning their foreign rivals. But some stressed doctor fees are just a small part of the puzzle. "Hospitals, physicians, payers, policymakers all need to be pushing for more transparency and more understandable metrics of qualities of cost for physicians," says Dr. Kevin Bozic.

The bare essentials. Release of LOM report leaves HHS to determine what should be covered by health benefits packages.

In the wake of an IOM report on the criteria HHS should use to determine what benefits will be "essential" under reform, various stakeholders are weighing in. The National Association of Public Hospitals and Health Systems would like "enabling" services--such as language, transportation and case-management services--included, because they help make medical care more effective, says Xiaoyi Huang, left, of the NAPH.

Reform the hard way. Healthcare providers say budget committee plan's would dismantle Medicare, Medicaid.

The House Budget Committee's 2012 budget plan proposes massive changes to Medicare and Medicaid. New Medicare beneficiaries starting in 2022 would choose from a list of health plans while the proposal for the Medicaid program would convert federal dollars to block grants for states. Sister Carol Keenan, left, of the CHA, says, "Clearly, going to vouchers doesn't take into consideration the best use of the Medicare dollar or the Medicare population".