Daily Health Policy Report

Monday, January 13, 2014

Last updated: Mon, Jan 13

KHN Original Reporting & Guest Opinion

Administration News

Health Reform

Capitol Hill Watch

Women's Health


State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

A Reader Asks: Will A Tax Lien Affect My Premium Tax Credit?

Kaiser Health News consumer columnist Michelle Andrews answers a reader’s question (1/13). Read her response.

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Political Cartoon: 'The Brush Off?'

Kaiser Health News provides a fresh take on health policy developments with "The Brush Off?" by Milt Priggee.

And here's today's health policy haiku:  


So long CGI...
Hello Accenture... Will change
make it work better?

If you have a health policy haiku to share, please send it to us at http://www.kaiserhealthnews.org/ContactUs.aspx and let us know if you want to include your name. Keep in mind that we give extra points if you link back to a KHN original story. 

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Administration News

Accenture Tapped To Take Over Efforts To Fix Healthcare.gov

CGI, the company that was responsible for the construction of the federal health insurance website, will be replaced next month when its government contract to run the online portal ends.  

The Wall Street Journal: Accenture To Take Over Fixing HealthCare.gov Website
Accenture Federal Services, a subsidiary based in Arlington, Va., won a one-year contract to continue technical improvements to the site after the government chose not to renew its contract with CGI Group Inc. CGI, which has had a contract to run the website since 2011, had been largely responsible for assembling the portal and fixing it. The company and the Obama administration have blamed each other for enrollment problems that dogged the portal since its launch (Armour, 1/12).

Bloomberg: CGI To Be Replaced By Accenture On Obamacare Contract
CGI Group Inc. (GIB), the company that built the main Obamacare website, will be replaced next month when its contract with the U.S. federal government expires, a person familiar with the decision said. The Obama administration intends to sign a contract with Dublin-based Accenture Plc (ACN) to complete unfinished work on healthcare.gov and run the site, said the person, who asked not to be identified because the decision isn’t public (Wayne, 1/10).

The New York Times: Contractor For Health Portal Replaced, But Says ‘We Were Not Fired’
The contractor hired to build the computer enrollment system for President Obama’s health care law said Friday that it would stop working on the troubled insurance exchange when its contract expires at the end of February. CGI Federal, which was blamed by many in the administration for the glitches and missed deadlines that plagued the law’s rollout, will not pick up its option for a two-year maintenance contract for the HealthCare.gov website. “Let me be very clear, we were not fired,” said Lorne S. Gorber, the senior vice president for the CGI Group of Montreal, of which CGI Federal is an American subsidiary (Austen, 1/10).

The Washington Post: Obama Administration To End Contract With CGI Federal, Company Behind Healthcare.gov
According to officials familiar with the matter, who spoke on the condition of anonymity because the decision is not yet public, leaders of CMS became frustrated with the pace and quality of CGI’s work on the repairs. As federal officials and contractors have been trying to fix various aspects of the Web site in the past few months, about half the new software code the company has written failed when it was first used, according to internal federal information (Eilperin and Goldstein, 1/10).

Los Angeles Times: Obama Administration Replaces Contractor On Troubled Healthcare Site 
CGI, which has drawn sustained criticism for its work on a centerpiece feature of the president's health law, was effectively demoted last fall, when administration officials turned to a subsidiary of insurance giant UnitedHealth to rescue HealthCare.gov from its disastrous Oct. 1 debut (Levey, 1/11).

CNN: White House Awards Accenture HealthCare.Gov Contract
The Obama administration has tapped the world's largest consulting firm to take over its beleaguered Obamacare website. Accenture, a consulting and technology services company with 281,000 employees and $28.6 billion in revenue, won the one-year contract to continue fixing HealthCare.gov, the online health insurance marketplace set up by the Affordable Care Act. The Centers for Medicaid and Medicare Services made the announcement Saturday (Finnegan, 1/11).

Reuters: U.S. To Part With Contractor CGI For Obamacare Website
The U.S. government will part ways next month with contractor CGI Federal over the troubled Obamacare enrollment website, HealthCare.gov, which failed to work when it launched in October for millions of Americans shopping for insurance, the company said on Friday. ... CMS would not confirm or deny CGI's departure. "We are working with our contract partners to make a mutually agreed upon transition to ensure that HealthCare.gov continues to operate smoothly for consumers," a CMS spokeswoman said (Rampton and Humer, 1/10).

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Health Reform

Insurers Complain Of Slow Payments; Enrollees Wait

News outlets report on consumers struggling to prove they have enrolled in coverage and on insurers wondering when and if they will get paid.

The New York Times: Enrollees At Health Exchanges Face Struggle To Prove Coverage
Paul D. Donahue and his wife, Angela, are among more than a million Americans who have signed up for health coverage through the federal insurance exchange. Mr. Donahue has a card in his wallet from his insurer to prove it. But when he tried to use it to get a flu shot and fill prescriptions this week, local pharmacies could not confirm his coverage, so he left without his medications. Similar problems are occurring daily in doctors’ offices and drugstores around the country as consumers try to use insurance coverage that took effect on Jan. 1 under the Affordable Care Act (Pear and Goodnough, 1/10).

The Wall Street Journal: Health Insurers Cite Slow Premium Payments For New Plans
Insurers are struggling to get their premium payments from people who signed up for coverage through the health-law marketplaces, leaving many plans with fewer enrollees than expected at the start of the new year. ... "It's been pulling teeth," said Shaun Greene, chief operating officer of Utah-based Arches Health Plan, a startup. As of Thursday, Arches had collected about 60% of premiums for people who signed up for coverage that took effect Jan. 1. He said Arches would urge customers in email and phone calls to pay for at least a few more days, even after the deadline (Mathews and Weaver, 1/10).

The CT Mirror: Exchange CEO: Anthem Acknowledges Billing, Payment Problems
The head of Connecticut’s health insurance exchange said Friday that officials at Anthem Blue Cross and Blue Shield have acknowledged “administrative challenges” in setting up coverage for people who signed up for plans that were supposed to begin Jan. 1. As of last Friday, only 8 percent of customers slated to have coverage effective Jan. 1 had been recorded in Anthem’s system as having paid their premiums, said Kevin Counihan, CEO of Access Health CT, the state’s health exchange. That figure includes people who bought plans through the exchange and those who purchased them outside the exchange (Becker, 1/10).

Meanwhile, for Spanish speakers, the shopping experience is fraught with difficulties -

The Associated Press/Miami Herald: Health Care Website Frustrates Spanish Speakers
Mirroring problems with the federal health care website, people around the nation attempting to navigate the Spanish version have discovered their own set of difficulties. The site, CuidadoDeSalud.gov, launched more than two months late. A Web page with Spanish instructions linked users to an English form. And the translations were so clunky and full of grammatical mistakes that critics say they must have been computer-generated — the name of the site itself can literally be read "for the caution of health" (Kennedy and Contreras, 1/12).

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O'Malley Defends Md. Exchange Despite Reports That Officials Ignored Warnings

News outlets also report on developments from Florida, Oregon, California and Minnesota.

The Washington Post: Maryland Officials Were Warned For A Year Of Problems With Online Health-Insurance Site
More than a year before Maryland launched its health insurance exchange, senior state officials failed to heed warnings that no one was ultimately accountable for the $170 million project and that the state lacked a plausible plan for how it would be ready by Oct. 1. Over the following months, as political leaders continued to proclaim that the state’s exchange would be a national model, the system went through three different project managers, the feuding between contractors hired to build the online exchange devolved into lawsuits, and key people quit, including a top information technology official because, as he would later say, the project “was a disaster waiting to happen” (Wagner and Flaherty, 1/11).

Politico: O'Malley Defends Maryland Health Care Exchange
Maryland Gov. Martin O’Malley on Sunday defended his state’s Obamacare exchange, saying that despite its initial rocky rollout, the website is now running smoothly for most Marylanders. ... Appearing on CNN's "State of the Union," O’Malley said “oh no” when asked if he and other Maryland state officials were asleep at the switch during the launch of the state’s health-care exchange, which has been riddled with glitches and problems since its Oct. 1 debut. “This complex IT challenge had ups and downs every step of the way,” O’Malley said. “There were lots of cautionary red lights” but green lights as well, the Democratic governor said (Kim, 1/12).

The Baltimore Sun: O'Malley Continues Defense Of Health Exchange
Gov. Martin O'Malley took his defense of Maryland's struggling health exchange onto national television Sunday after CNN host Candy Crowley described its rollout as "disastrous by most accounts." O'Malley's defense came as Rep. John Delaney of the Western Maryland 6th District renewed his call for the state to abandon its exchange for the federal system, and O'Malley's remarks prompted criticism from some skeptical lawmakers (Walker and Cox, 1/12). 

The Associated Press: O’Malley Says Maryland Will Meet Health Care Goal
Gov. Martin O'Malley is acknowledging a troubled start for Maryland's online health insurance exchange, but he predicted Sunday that the state will still meet its enrollment goal by the end of March. In an interview with CNN's "State of the Union," O'Malley said the online health insurance exchange faced complex technology challenges every step of the way. But he said the state is more than halfway to its enrollment goal. Medicaid enrollments have exceeded expectations. But the state has said it wants to enroll 150,000 people in private plans by the end of March. As of Jan. 4, only 20,358 people had enrolled in private plans (1/12).

Health News Florida: State's Report Wrong, Navigator Says
The chief navigator for Healthcare.gov plans for Southwest Florida says a state report on costs that Florida families have to pay for health insurance greatly overstates the premiums. ... Friday morning in a phone interview, Troncoso said the premium cost listed in the report represents an average of the cost for all of the silver plans in each area. That naturally skewed the prices higher than would happen in the real world, where a family looks for the most economical plan that meets their needs (Gentry, 1/10).

The Oregonian: New Oregon Health Plan Enrollees Swamp State Phone Lines
The Oregon Health Authority is getting so many questions from new enrollees that its main phone line has been overloaded, leading some readers to think it's disconnected. It's not, according to the state. The number, 1-800-273-0557, couldn't handle the call volume, but it should improve soon, according to a state spokeswoman. Also, about 30,000 enrollment packets have been mailed and should arrive in the mail for new enrollees starting Jan. 10. The issue came up after readers alerted us that the numbers provided in recent articles haven't worked. The numbers are intended for people with questions about their application for Oregon Health Plan coverage (Budnick, 1/10).

The San Francisco Chronicle: Covered California Applicants Still Hit By Snags
Julie Snyder and Robert Weaver have been on an odyssey since they tried to sign up for a health plan through Covered California. It started in October, shortly after the state's new health insurance marketplace began selling coverage. After numerous futile attempts to complete their online application, the Berkeley couple finally succeeded, in mid-November. But 10 days later, a letter came in the mail. It informed them that Covered California could not verify their Social Security numbers, citizenship or household income, despite their being born in this country and having filed taxes for more than three decades (Colliver, 1/12).

The Star Tribune: Dayton Says MNsure Fell 'Far Short Of The Mark'
Gov. Mark Dayton said Friday that he believes Minnesotans deserve a “reckoning” for the problems with the MNsure website, but he’s not ready yet to point fingers of blame. “The people of Minnesota have been terribly inconvenienced,” Dayton said. “The best I can determine at this point in time is that it’s not for lack of intent or professional desire to make this as successful as possible from the very beginning. Obviously we’ve fallen far short of the mark” (Crosby, 1/11).

MinnPost: Dayton Says He Didn’t Learn For MNsure Problems And Contract Changes Until After Launch
Dayton said he first heard about the contract shift in late October or early November. Before that, he said, it wouldn’t have occurred to him to question such a decision by MNsure. At this point, the governor said, he didn’t know whether it was a good idea for the state to take over the project from its lead vendor, Maximus, Inc., early last year. … The governor also said he was unsure if senior MNsure staff were keeping him apprised of the serious issues with the exchange as soon as they came up (Nord, 1/10).

Health Policy Solutions (a Colo. news service): Key Players Assess ACA Implementation In Colorado So Far
State Insurance Commissioner Marguerite Salazar said that the geographic ratings that make health coverage much costlier in the resort areas of the state are “nothing new. What’s new is the transparency. Now you can see that if you live in Denver, your plan costs 50 percent less.” Establishing rates across such a diverse landscape is “a very difficult, convoluted process” done by the insurance carriers – not the Division of Insurance, she said. “I do believe there’s probably another way to do this, but we have to sit down and have a broad discussion” about how to negotiate better rates, control costs and deliver care (Carman, 1/10).

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More GOP Governors Give Medicaid Expansion Another Look

Politico reports that while Republican governors in Texas and Louisiana remain firmly in the no camp, others in Pennsylvania, Tennessee, Indiana and Oklahoma are giving the program a second look. News outlets also offer updates from Florida, Pennsylvania, Kansas and Georgia.

Politico: GOP Governors May Still Go For Medicaid Expansion - And Cash
Republicans counting on a year of nonstop Obamacare-bashing may be in for an unwelcome surprise: more red-state governors ditching the political script to take a second look at the law’s huge expansion of Medicaid. Governors like Rick Perry of Texas and Bobby Jindal of Louisiana remain firmly in the “no way” camp. But Pennsylvania and Tennessee are actively working with the Obama administration to expand Medicaid, although their efforts to squeeze policy concessions on the GOP wish list — like requiring enrollees to pay more — could be a dead end. Indiana and Oklahoma are eyeing alternative versions of expansion and were granted a one-year reprieve by the Obama administration to extend existing state health care programs while they think about it (Cheney and Millman, 1/10).

Miami Herald: Expanding Medicaid An Uphill Battle In Florida Capitol
Florida’s 2013 legislative session practically started and ended with Medicaid expansion at the center of debate, with House Republicans blocking a plan to use federal dollars to reduce the number of uninsured Floridians. This year, House Republicans pledge to tackle issues that have long lingered on the back burner, such as more independence for highly trained nurses, increasing the number of medical students who go into primary care and regulating virtual doctor visits. But even as the focus shifts from Medicaid expansion, Democrats say it remains a top priority (Mitchell, 1/12).

Philadelphia Inquirer: Questions Persist About Corbett's Health-Care Plan
Depending upon whom you listen to, Healthy Pennsylvania, Gov. Corbett's plan to reform and expand the Medicaid program is a disappointing flip-flop; a good plan in need of tweaking; a bureaucratic nightmare; or all of the above. Those were some of the opinions voiced at a public hearing - one of six statewide - held a little over a week ago at the National Constitution Center on the administration's plan to extend health insurance to as many as 500,000 commonwealth residents (Calandra, 1/12).

Kansas Health Institute: Hospital Officials Say Refusal To Expand Medicaid Will Hurt Their Bottom Lines
For Jodi Schmidt and other hospital administrators across Kansas, Medicaid expansion is a critical business issue not a political one. Schmidt is chief executive of Labette Health, a 99-bed regional medical center that serves Parsons and several surrounding communities in southeast Kansas. She said the money being lost because of the decision by Gov. Sam Brownback and legislators to not participate in the first year of expansion could mean the difference between the hospital finishing the year in the black or with a deficit (McLean, 1/13).

Kansas Health Institute: Roundtable: The Politics Of Medicaid Expansion In Kansas And Missouri
Lawmakers in Kansas and Missouri return to start their 2014 legislative sessions this week. In Jefferson City, expanding Medicaid eligibility in accordance with Obamacare will be among the top five issues competing for attention, according to the Associated Press. In Topeka, the top priority for lawmakers likely will be school finance, with a potential decision coming from the Kansas Supreme Court that could force lawmakers to spend $400 million more on schools. It is less clear to what degree Medicaid expansion will be considered in Kansas, in part, because 2014 is a gubernatorial election year. In the roundtable discussion below — which aired Jan. 10 on KCPT — journalists who cover Medicaid expansion in Kansas and Missouri take a look at the politics of the issue (McLean, 1/12).

Kansas Health Institute: Kansas Medicaid: A Primer
Medicaid is a publicly financed source of health insurance and long-term care coverage for certain eligible population groups. It is the second-largest source of health coverage in the nation, following employment-based coverage (Bruner, Meissen-Sebelius and Mertz, 1/12).

Atlanta Journal Constitution: Nearly 6 In 10 In Georgia Favor Medicaid Expansion
More than half of Georgians in a new AJC poll say that all or at least parts of Obamacare should be repealed, but an even larger proportion believe the state should expand Medicaid. The poll, conducted for The Atlanta Journal-Constitution by Abt SRBI Inc., measured the views of registered voters across the state last week. While 53 percent favor repeal of the law, or at least parts of it, 57 percent of Georgians said the state should expand Medicaid under the terms of the Affordable Care Act — something Gov. Nathan Deal has so far decided not to do (Williams, 1/13).

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Early Numbers Show Lagging Enrollment Of Young Adults

A Reuters analysis of data from October and November for the District of Columbia and seven states running their own insurance marketplaces indicates that 18- to 34-year-olds were a smaller percentage of enrollees than had been projected. Also in the news, a look at how small businesses and student health plans are faring under the law.

Reuters: Obamacare May Get Sick if Young Americans Don't Sign Up
Data from seven states and the District of Columbia, which are running their own marketplaces, show that of more than 200,000 enrollees, nearly 22 percent are 18 to 34 years old, according to a Reuters analysis. The administration had hoped that over 38 percent, or 2.7 million, of all enrollees in 2014 would be 18 to 35 years old, based on a Congressional Budget Office estimate that 7 million people would sign up by the end of March (Krauskopf, 1/12).

The Washington Post: Second Wave Of Health-Insurance Disruption Affects Small Businesses
When millions of health-insurance plans were canceled last fall, the Obama administration tried to be reassuring, saying the terminations affected only the small minority of Americans who bought individual policies. But according to industry analysts, insurers and state regulators, the disruption will be far greater, potentially affecting millions of people who receive insurance through small employers by the end of 2014 (Cha, 1/11).

USA Today: Student Health Plans Forced To Adapt To ACA Requirements
Thanks to the Affordable Care Act, most young Americans can stay on their parents' health insurance until age 26 — a shift in law that has extended health coverage to more than 3.1 million people, according to the Obama administration. But many college and graduate students — either by choice or because their parents lack coverage — are still enrolling in university-sponsored health care plans, which have been forced to adapt or discontinue with the gradual implementation of the ACA over the past few years (Dame, 1/11).

Meanwhile, the Obama administration responds to employers' challenges to the overhaul's contraception coverage mandate -  

Politico: Administration: Birth Control Doesn’t Directly Violate Company’s Religious Rights
The Obama administration has asked the Supreme Court to uphold the Affordable Care Act’s requirement that most employers provide contraception in their health plans, even if a company’s owners have religious objections. In arguments filed late Friday, Justice Department lawyers told the court that an employer’s religious beliefs aren’t a legitimate reason to deny something as important as preventive care to an employee who is entitled to it under the health law (Haberkorn, 1/11).

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Capitol Hill Watch

House Votes To Boost Health Website's Security

House Republicans were joined by 67 Democrats to send to the Senate legislation requiring the government to inform consumers within two days of a security breach in the insurance marketplaces.

The New York Times: House Votes To Increase Security Measures On Health Care Exchanges
The House voted on Friday to strengthen security protections on the HealthCare.gov website, requiring all security breaches of the health insurance exchanges to be reported in a timely fashion. The bill — known as the "Health Exchange Security and Transparency Act" — passed largely on party lines, 291 to 122, with 67 Democrats voting for the legislation. The measure would require the health department to inform affected consumers within two business days of any possible breach of the federal or state exchanges (Parker, 1/10).

The Wall Street Journal: House Passes Bill To Notify Users Of Health Exchange Security Breaches
House Republicans on Friday sought to keep up political pressure on the Obama administration's health-care rollout, with the House passing legislation intended to address alleged security weaknesses with the HealthCare.gov website. ... The legislation is part of a Republican strategy to keep attention on problems with the Affordable Care Act ahead of November's midterm elections. Republican leaders hope to blunt an aggressive push by the White House and Democrats to shift the policy debate to domestic economic issues (Crittenden, 1/10).

The Washington Post: House Approves HealthCare.gov Security Bill
Republicans' aides openly boasted Friday about the 67 vulnerable Democrats willing to buck President Obama, who strongly opposed the measure. The White House said the proposal would create "unrealistic and costly paperwork requirements" that wouldn’t improve the safety or security of the site's users (O'Keefe, 1/10).

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Wyden's Finance Committee To-Do List Includes Various Health Policy Issues

The Wall Street Journal outlines how Sen. Ron Wyden, D-Ore., the likely successor to Sen. Max Baucus as leader of the Senate Finance Committee, is likely to approach various health issues. Also in the news, GOP senators take various weekend opportunities to speak out against the health law.   

The Wall Street Journal: Sen. Ron Wyden Is Set To Get A Wider Platform
He wants to shore up Medicare by better focusing the program on treatment of chronic health problems, according to his former chief of staff, Josh Kardon. In addition, Mr. Wyden could want more protections for workers and digital firms in pending trade legislation, which would also move through the Finance Committee. During 2014, Mr. Wyden also will have to focus on the relatively unglamorous task of finding ways to keep some costly programs going. Those include temporary tax breaks for businesses, as well as reimbursement rules for Medicare physicians. Both will likely require cuts elsewhere in the budget, higher revenue, or both (McKinnon, 1/12). 

Texas Tribune: In Austin, Cruz Renews Attack On Obama, ACA
Speaking at the Texas Public Policy Foundation policy orientation Friday, U.S. Sen. Ted Cruz bashed the Obama administration for what he called a culture of “lawlessness,” saying that the administration picked and chose what legislation to follow. Cruz cited exemptions for “big business” from the Affordable Care Act and delayed deadlines for the implementation of provisions of the law, commonly known as Obamacare, which requires most individuals to carry health insurance (Ura, 1/10).

CBS News: GOP Suspicious Of Obamacare Enrollment Figures
Another week, another demand from Republicans to repeal the Affordable Care Act. Carrying the torch this week: Sen. Thad Cochran, R-Miss., who called Saturday for the law to be defunded or repealed and disputed figures from the administration touting a robust expansion of health insurance coverage under Obamacare. "The Affordable Care Act was supposed to be fully operational by January 1 of this year, but here we are two weeks into 2014, and the administration continues to struggle to implement the law’s burdensome mandates," Cochran said in the weekly Republican address (Miller, 1/11).

The Hill: GOP Knocks Obamacare’s Delayed Mandates
Republicans took aim at the Jan. 1 ObamaCare deadlines that were not met as they called for President Obama’s signature health law to be repealed. In the weekly GOP address, Sen. Thad Cochran (R-Miss.) criticized the president’s healthcare law for not being fully in place by 2014, noting that implementation of some of the law’s mandates have been delayed. "The Affordable Care Act was supposed to be fully operational by January 1 of this year. But, here we are two weeks into 2014, and the administration continues to struggle to implement the law’s burdensome mandated," Cochran said (Herb, 1/11).

The Milwaukee Journal Sentinel: Ron Johnson Defends Obamacare Lawsuit In Waukesha County GOP Speech
If a roomful of Republican supporters is any indication, then U.S. Sen. Ron Johnson may have quite a bit of support among his party's grass-roots in his bid to make Congress pay for health care coverage. Appearing at a Waukesha County GOP Pints and Politics event Friday night, Johnson received spirited applause when he brought up his lawsuit to block the federal government from helping to pay for health care coverage for members of Congress and their staffs. "It's no slam-dunk, but it's not frivolous," the Republican from Oshkosh told about 250 people (Glauber, 1/10).

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Women's Health

Supreme Court To Examine Abortion Clinics' 'Protest-Free' Zones

The court will hear arguments this week over whether the 35-foot buffer zone around the entrance of Massachusetts abortion clinics is an infringement on free speech.

The New York Times: Where Free Speech Collides With Abortion Rights
A couple of mornings a week, Eleanor McCullen stakes out a spot outside the Planned Parenthood clinic here and tries to persuade women on their way in to think twice before having an abortion. But she has to watch her step. If she crosses a painted yellow semicircle outside the clinic’s entrance, she commits a crime under a 2007 Massachusetts law (Liptak, 1/12).

Politico: Supreme Court To Consider Abortion Clinic Protests
The Supreme Court is wading back into the nation’s long battle over abortion, this time to examine limits on protesters’ speech outside clinics. Abortion opponents who regularly gather outside Massachusetts clinics want the court to strike a 2007 state law that established a 35-foot “buffer” zone around entrances to the facilities. They argue it puts unconstitutional limitations on speech because they are prohibited from crossing the line while certain people associated with the clinic can go through (Haberkorn, 1/12).

The Associated Press: High Court To Hear Case On Abortion Clinic Protest-Free Zone
Eleanor McCullen clutches a baby's hat knit in pink and blue as she patrols a yellow semicircle painted on the sidewalk outside a Planned Parenthood health clinic on a frigid December morning with snow in the forecast. The painted line marks 35 feet from the clinic's entrance and that's where the 77-year-old McCullen and all other abortion protesters and supporters must stay under a Massachusetts law that is being challenged at the U.S. Supreme Court as an unconstitutional infringement on free speech. Arguments are set for Wednesday. Outside the line, McCullen and others are free to approach anyone with any message they wish. They risk arrest if they get closer to the door (1/12).

In other high court news -

The Hill: High Court To Hear Susan B. Anthony List Case
The Supreme Court announced Friday that it will hear a free speech case involving a prominent abortion-rights group and its effort to discredit a candidate over ObamaCare four years ago. The Susan B. Anthony (SBA) List, which works to elect politicians who oppose abortion rights, argues that an Ohio statute penalizing false political speech prevented it from launching certain ads against then-Rep. Steven Driehaus (D-Ohio) in 2010.  In a statement, the group cheered the court's move to hear its case and said that the Ohio law chills legitimate political debate (Viebeck, 1/11).

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Obama Administration Proposes Medicare Drug Change

The Associated Press/Miami Herald: Proposed Medicare Drug Change Stirs Access Worries
In a move that some fear could compromise care for Medicare recipients, the Obama administration is proposing to remove special protections that guarantee seniors access to a wide selection of three types of drugs. The three classes of drugs — widely used antidepressants, antipsychotics and drugs that suppress the immune system to prevent the rejection of a transplanted organ — have enjoyed special "protected" status since the launch of the Medicare prescription benefit in 2006. That has meant that the private insurance plans that deliver prescription benefits to seniors and disabled beneficiaries must cover "all or substantially all" medications in the class, allowing the broadest possible access (Alonso-Zaldivar, 1/11).

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State Watch

State Highlights: Va. Gov. Calls For Medicaid Expansion; States Examine Paid Sick Leave

The Associated Press: Terry McAuliffe Takes Oath As Va.'s 72nd Governor
In his speech, McAuliffe made a brief pitch for one of his top legislative priorities — expanding Medicaid to about 400,000 low-income Virginians under the federal health care reform law. The proposal faces a tough hurdle in the GOP-controlled House. "Like the majority of other states, we need to act on the consensus of the business community and health care industry to accept funding that will expand health care coverage, save rural hospitals, and spur job creation," the governor said (O’Dell, 1/11).

The Washington Post: Eight Things To Watch In The McAuliffe Administration
Abortion access. McAuliffe has promised to be a "brick wall" against new limits on the procedure. But how far will he go in trying to roll back some of the restrictions imposed under McDonnell? Abortion rights activists hope — and anti-abortion groups fear — that he will soften the strict building codes imposed on clinics through administrative action. ... Medicaid expansion. House lawmakers are flatly opposed the Democrat's top legislative goal, which they say will cost Washington money it doesn't have, with Virginia left picking up a $5 million-a-day tab. McAuliffe hopes delegates from conservative rural districts will be swayed, if not by him then by hospitals in their districts, which stand to lose money if the health-care program for the poor is not extended to more Virginians (Vozzella, 1/11).

Richmond Times-Dispatch: Analysis: Newly Minted Governor Opens Term With Short List Of Goals
But Republicans sat quietly as McAuliffe called on the General Assembly to expand Medicaid to provide coverage for the uninsured under President Barack Obama's health care law. The idea is favored by business and hospitals as a way to pump billions into the economy. "We’ll have to agree to disagree," said Del. R. Steven Landes, R-Augusta, an opponent of Medicaid expansion and a senior member of the budget-writing House Appropriations Committee (Schapiro, 1/12).

USA Today: States, Cities Prescribe Paid Sick Leave Rules
A growing number of cities and states are starting to require employers to provide paid sick leave. Jersey City's Earned Sick Time Ordinance goes into effect Jan. 24. New York City's Earned Sick Time Act -- passed in June when the City Council overrode a veto by then-Mayor Michael Bloomberg -- goes into effect April 1. They join such cities as Portland, Ore., where paid sick leave rules went into effect Jan. 1; Seattle, where paid sick leave rules went into effect Sept. 1, 2012; Washington in 2008; and San Francisco, which passed such regulations in 2006 and implemented them in 2007 (Daneman, 1/12). 

The New York Times: Twinned Cities Now Following Different Paths
The soaring Blatnik Bridge spans a modest body of water but a political gulf. ... This is a well-traveled commute between the Minnesota and Wisconsin cities, separated by the St. Louis River. Together, they are known as the Twin Ports for their shared role as a major cargo port, and people on both sides share Scandinavian, German and Irish roots, working-class pasts and a stoic sensibility hardened by a steady chill off Lake Superior. ... But these days, when residents cross the bridge, they enter starkly different political territories. Since Republicans in Wisconsin took control of the State Legislature and governor’s office in 2011, and since Democrats gained full dominance in Minnesota last year, people here have watched essential elements of their daily lives -- their savings plans, job expectations, personal relationships and health insurance -- veer apart (Davey, 1/12). 

The Associated Press: NY Gov. Takes Careful Step On Medical Marijuana
Gov. Andrew Cuomo made a political splash by introducing a medical marijuana plan in the State of the State speech, but his cautious approach has been met with skepticism from pot advocates who question whether the proposal is mostly for show. While nearly two dozen states have OK'd marijuana for medical purposes and Colorado and Washington have legalized its use for pleasure, Cuomo is tapping a 1980 state law to allow as many as 20 hospitals to dispense the drug to people with certain severe illnesses as an experimental research project (Peltz and Caruso, 1/11).

The CT Mirror: Fewer Kids Losing Medicaid, But Those Turning 1 Or 18 Still Vulnerable
The number of children and adolescents dropped from the state's HUSKY health care program fell during a recent two-year period, but those turning 1 and 18 are still especially vulnerable to losing their medical benefits, according to a report released Friday. The report follows up on earlier findings that thousands of 1-year-olds and 18-year-olds were inadvertently losing Medicaid coverage because of administrative glitches and confusing notices from the state Department of Social Services (Becker, 1/10).

California Healthline: Advocates Surprised, Disappointed At What's Missing From Brown's Budget
Health care advocates were "surprised and upset" that so many recent cutbacks and program eliminations remained static in Gov. Jerry Brown's (D) proposed budget released yesterday. "For this year, there's very good news," Brown said yesterday at a Sacramento press conference. "But by no means are we out of the wilderness. We must be very prudent in the way we spend public funds" (Gorn, 1/10).

The Associated Press: Doctor Shortage In New Mexico Expected To Worsen
New Mexico officials say the state is facing its worst shortage of primary-care providers at a time when thousands are expected to enroll in state and federal health insurance exchanges. The Albuquerque Journal reported Sunday that the federal government has designated every county statewide, except one, as having a shortage. The latest figures show the state has 1,429 active primary physicians but another 219 are needed, based on the population (1/12).

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Editorials and Opinions

Views On Health Law: Taking On The Little Sisters Is A 'Political Loser'; Rubio Calls For End To Insurers' 'Bailout'

USA Today: Obamacare Overreach Tramples Little Sisters: Our View
When the Obama administration picked a fight with Catholics and other religious groups over free birth control coverage for employees, sooner or later it was bound to end up doing battle with a group like the Little Sisters of the Poor. And sure enough, the administration is now stuck arguing that it is justified in compelling nuns who care for the elderly poor to assist in offering health insurance that they say conflicts with their religious beliefs. Talk about a political loser (1/12).

USA Today: Freedom Of Religion Untrampled: Opposing View
The Obama administration has struck the right balance between religious liberty and the right to affordable health care with the Affordable Care Act's birth control benefit. It includes an expansive religious exemption, allowing approximately 350,000 churches and houses of worship to refuse to provide this benefit to their employees. Exempting this number of organizations from providing a health care benefit is nearly unheard of (Cecile Richards, 1/12).

The New York Times: Enemies Of The Poor
The most important current policy development in America is the rollout of the Affordable Care Act, aka Obamacare. Most Republican-controlled states are, however, refusing to implement a key part of the act, the expansion of Medicaid, thereby denying health coverage to almost five million low-income Americans. ... Well, Republicans weren't always like this. In fact, all of our major antipoverty programs -- Medicaid, food stamps, the earned-income tax credit -- used to have bipartisan support. And maybe someday moderation will return to the G.O.P. For now, however, Republicans are in a deep sense enemies of America's poor (Paul Krugman, 1/12).

Fox News: Sebelius, Congress Should Take ObamaCare Bailout Off The Table
Health and Human Services Secretary Kathleen Sebelius is in Tampa today, Monday, January 13, for an Obamacare outreach event, and she owes Floridians an answer. Why should taxpayers have to bail out health insurance companies in the increasingly likely event that Obamacare leaves them with financial losses? The answer should be simple. Whatever larger differences we have about Obamacare, we should completely eliminate any chance of a taxpayer-funded bailout for health insurers (Sen. Marco Rubio, R-Fla., 1/13).

The Washington Post: Maryland's Costly Health Care Blunder
There's now a preliminary price tag on Maryland’s failure to roll out a functional health-insurance Web site: $5 million to $10 million. That's an estimate of how much it will cost the state to offer emergency health coverage to people who couldn't sign up on Maryland's online Affordable Care Act (ACA) marketplace before Jan. 1. Extending last-minute coverage to these people is the right thing to do. But it's not a substitute for a working Web site, nor for holding the state's leaders to account (1/11).

The Washington Post: Va.'s New Democratic Gov. Terry McAuliffe Maneuvers To Cast GOP As 'Party Of No'
The GOP is determined to draw the line against accepting about $2 billion a year in federal money under President Obama’s health care law to extend insurance to about 400,000 low-income Virginians. McAuliffe is equally determined to push the issue, partly because it was a core promise of his campaign. He has told associates that this position is "in the marrow of my bones," and added, "You don't always win, but you sure better fight." Although Obama's health reforms are generally unpopular now, the governor has powerful allies. The state's chambers of commerce and hospitals favor Medicaid expansion, because they don't want to turn away money there for the asking (Robert McCartney, 1/11).

The Richmond Times-Dispatch: Regional Health Care: Disrupt The Pace Of Innovation
This month marked the launch of the major provisions of the Affordable Care Act, or Obamacare. Change is coming across the country in the way health insurance is offered, along with new coverage for the previously uninsured. What will it mean for the Richmond region? Richmond’s Future has been investigating that question for more than a year to recommend steps that the region should be taking now in order to participate successfully in these health care changes (Louis Rossiter and Tonya Mallory, 1/12).

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Viewpoints: Reflections Of Smoking Study And LBJ's War On Poverty; Md.'s Gov. Applauds Hospital Pay Changes

The New York Times: Down To The Last Cigarette?
It's hard to remember now just how prevalent smoking used to be. In the mid-1960s, around half the men in the country smoked; for women, the number was 35 percent. People smoked in their offices, smoked in restaurants, smoked on airplanes. Indeed, Paul Billings of the American Lung Association recalls that the airlines often gave passengers small packets of cigarettes when they boarded the plane. But by the 1950s, scientists were beginning to equate cigarettes with lung cancer and other fatal diseases, a linkage the tobacco industry vehemently denied (Joe Nocera, 1/10).

Los Angeles Times: After Waging War On Poverty For 50 Years, Let's Not Surrender
The truth is that the nation's investment in the War on Poverty has yielded huge and lasting gains. That's partially because LBJ's program was not just a plan for financial handouts. It also encompassed a broad approach encompassing "better schools, and better health, and better homes, and better training, and better job opportunities," as he put it in his address on Jan. 8, 1964. LBJ's campaign brought us Head Start (in 1965) as well as Medicare and Medicaid (Michael Hiltzik, 1/12).

The Baltimore Sun: New Md. Health Care Delivery System Will Prioritize Wellness
Beyond the political debates over the Affordable Care Act is a bipartisan consensus about the future of our nation's health care system. Across the political spectrum, officials and experts agree that we must shift from a near exclusive focus on treating people when they get sick to a balanced approach that also promotes health and wellness. Such a shift will both reduce costs for families and small businesses and keep many Americans from dying of preventable causes. ... In Maryland, we are taking a giant step away from this outdated system. We are adopting an innovative approach to setting rates for hospitals — one that supports lower costs, enables better outcomes and creates a better experience for patients. It will also accelerate efforts in support of community health and wellness (Md. Gov. Martin O'Malley, 1/11).

The New England Journal of Medicine: Maryland's All-Payer Approach To Delivery-System Reform
For 5 years beginning in 2014, Maryland will limit the growth of per capita hospital costs for all payers, including the growth of costs of both inpatient and outpatient care, to 3.58%, the 10-year compound annual growth rate of the per capita gross state product. ...The resulting changes should be visible at hospitals throughout Maryland in the form of more coordinated care, a greater emphasis on care transitions, and a renewed focus on prevention. ... a critical challenge for national delivery-system reform is to align payment incentives across multiple payers.  ... implementing this model throughout a state with more than 5.8 million people living in urban, suburban, and rural settings will test these reforms in many different environments (Dr. Rahul Rajkumar, Ankit Patel, Karen Murphy, John M. Colmers, Jonathan D. Blum, Drs. Patrick H. Conway, and Joshua M. Sharfstein, 1/10).

The Washington Post: Va. Doesn’t Need Another Mental Health Task Force
Virginians should be embarrassed and angry that a newly appointed state mental health task force convened Tuesday in Richmond. It is the 16th task force asked to investigate the state's mental health system. Are Virginia legislators so dense that they need yet another expert panel to tell them what's wrong? Four major studies, from 1997 through 2000, in Virginia each identified the same problems and made similar recommendations. Yet the system remains a mess. Why? (Pete Earley, 1/10). 

The New York Times: Heroic Measures
Lisa Bonchek Adams has spent the last seven years in a fierce and very public cage fight with death. Since a mammogram detected the first toxic seeds of cancer in her left breast when she was 37, she has blogged and tweeted copiously about her contest with the advancing disease. She has tweeted through morphine haze and radiation burn. Even by contemporary standards of social-media self-disclosure, she is a phenomenon. (Last week she tweeted her 165,000th tweet.) A rapt audience of several thousand follows her unsparing narrative of mastectomy, chemotherapy, radiation, biopsies and scans, pumps and drains and catheters, grueling drug trials and grim side effects, along with her posts on how to tell the children, potshots at the breast cancer lobby, poetry and resolute calls to "persevere" (Bill Keller, 1/12).

The New York Times: The Next Frontier In Fertility Treatment
The more than 700,000 transgender people living in the United States have long faced discrimination by health care providers. Over the past 15 years, activists have fought to compel insurers to cover transgender-related health care — from hormone therapy to gender reassignment surgery — or at least be prevented from excluding transgender clients from buying policies for basic services. Finally, starting this month, thanks to the Affordable Care Act, "transsexualism" can no longer be considered a pre-existing condition. What's been left out of the spotlight: having babies. Many Americans have come to accept gay parents; the transgender community is next in line for recognition (Sarah Elizabeth Richards, 1/12).

Philadelphia Inquirer: Time Doesn't Always Heal
Over the past month, the media has been following the untimely deaths of Jahi McMath and Marlise Munoz—two bodies kept on ventilator support despite brain death diagnoses. Much of the discussion surrounding these high-profile cases perpetuates the misconception that brain death is not as final as cardiac death; that somehow these women can recover. Unfortunately, these tragedies highlight the importance of separating specialists from charlatans (Krystyna Dereszowska, 1/13).

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Stephanie Stapleton

Andrew Villegas

Lisa Gillespie
Shefali Luthra

The Kaiser Daily Health Policy Report is published by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. (c) 2014 Kaiser Health News. All rights reserved.