Daily Health Policy Report

Wednesday, January 29, 2014

Last updated: Wed, Jan 29

KHN Original Reporting & Guest Opinion

Administration News

Health Reform

Capitol Hill Watch

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Ex-Microsoft Exec Brings Lists And Whiteboard To Overhaul Of Obamacare Website

Kaiser Health News staff writer Daniela Hernandez, working in collaboration with Wired, reports: "Kurt DelBene’s office is on the sixth floor of the fortress-like Department of Health and Human Services, overlooking the Capitol reflecting pool. With little but a desk, a small laptop, and monitor, it looks barren, like someone just moved out. But DelBene, a longtime Microsoft executive, moved in six weeks ago. He came from the other Washington, after President Barack Obama named him healthcare.gov’s new fix-it guy — the successor to 'tech-surge czar' Jeff Zients. DelBene is here to shore up the famously flawed Obamacare website, not decorate an office. The most telling evidence of his arrival is on the wall to the right of his workstation, where a large whiteboard is covered with scribbled notes about databases, security features, website capacity, and the like" (Hernandez, 1/29). Read the story.

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Capsules: To Schedule A Doc Visit, Get In Line; More About Treating Clubfoot

Now on Kaiser Health News' blog, Jenny Gold reports on a survey about waiting times for new patients' physician appointments: "Need to see a doctor? You may have to wait. A survey of physician practices in 15 metropolitan areas across the country found that the average wait time for a new patient to see a physician in five medical specialties was 18.5 days. The longest waits were in Boston, where patients wait an average of 72 days to see a dermatologist and 66 days to see a family doctor. The shortest were in Dallas, where the average wait time is 10.2 days for all specialties, and just 5 days to see a family doctor" (Gold, 1/29).

Also on Capsules, Gold writes more about clubfoot treatment: "We’ve had a lot of response from readers and listeners to our story on NPR’s Morning Edition on Monday, The Clubfoot Correction: How Parents Pushed For Better Treatment. Readers wrote that they or their children had received casting and boots-and-bars treatment for clubfoot. Some happened many decades ago—some fairly recently. We thought some more explanation is in order" (Gold, 1/28). Check out what else is on the blog.

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Video: Obama Says 9 Million Have Enrolled Under Health Law

Kaiser Health News has a video except of remarks by President Barack Obama during Tuesday night's annual State of the Union address, in which he urged more Americans to enroll in the new insurance exchanges (1/29). Watch the video or read the transcript.

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Political Cartoon: 'Dr. Smith Goes To Congress?'

Kaiser Health News provides a fresh take on health policy developments with "Dr. Smith Goes To Congress?" by John Deering from "Strange Brew."

And here's today's health policy haiku:


Want to see a doc?
You may have to wait. How long?
18.5 days.

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

Obama Urges People To Sign Up For Coverage In State Of The Union

The president extolled the health law during his State of the Union address, describing those who are benefiting and challenging Republicans for their ideas. Utah Sen. Mike Lee hit back, calling the law "an inequality Godzilla that has robbed working families of their insurance, their doctors, their wages and their jobs," while Washington Rep. Cathy McMorris Rodgers cited its troubled rollout.

Politico: State Of The Union 2014: Obama Embraces Obamacare
President Barack Obama left no doubt Tuesday night what his Obamacare sales technique will be: loud voice, lots of confidence and no apologies. Don’t dwell on the scratches on the hood. Just tell the customer how good it will feel to rev the engine and drive the car off the lot (Nather, 1/28).

The Washington Post: In State Of The Union, Obama Vows To Expand Opportunity, With Or Without Congress
Instead, Obama also praised his health care law, which is both the signature achievement of his administration and -- because of the fraught rollout of healthcare.gov last year -- the centerpiece of Republicans’ case against him. Obama described the situation of an Arizona woman, Amanda Shelley, who he said had obtained coverage Jan. 1 because of the law. On Jan. 6, she had emergency surgery -- which, Obama said, “would’ve meant bankruptcy” if she had not been covered. Then, after saying that the law had made changes for the better, Obama made a blunter argument aimed at congressional Republicans: No matter what they think of the law, they now have no choice but to live with it (Nakamura and Fahrenthold, 1/28).

Los Angeles Times: In State Of The Union, Obama Focuses On America’s Economic Divide
The speech represented an attempt at a political comeback for the president, whose approval rating was damaged by the disastrous rollout of his signature health care law and whose Democratic Party faces the prospect of losing control of the Senate in the November election. Obama mounted his most pointed recent defense of the health care law, and issued a challenge to Republican critics to put forward their own plans (Hennessey and Parsons, 1/28).

The New York Times: In State Of The Union Address, Obama Vows To Act Alone On The Economy
Despite his vow to move ahead without Capitol Hill, Mr. Obama said he was not giving up on Congress altogether and recycled calls for many past legislative priorities, like extending unemployment insurance. “Let’s see where else we can make progress together,” he said. … And he offered a vigorous defense of his embattled health care program. “Let’s not have another 40-something votes to repeal a law that’s already helping Americans,” he said (Baker, 1/28).

The Wall Street Journal’s Washington Wire: Obama Touts Health-Law Developments In Speech
There was plenty of speculation about whether President Barack Obama would address the health-care overhaul in his State of the Union address -- his signature domestic initiative that took full effect 27 days ago with a problematic rollout. He answered that question right at the top, when he included the law among a list of American achievements during his administration: “A rural doctor gave a young child the first prescription to treat asthma that his mother could afford.” Eventually, he came back to it. For several years, administration officials have emphasized some of the earliest consumer provisions of the law to kick in, which happen to be the best known and most popular. That habit has stuck, since the first number the president touted on health care is that three million young adults have been able to stay on their parents’ plans until their 26th birthdays (Radnofsky, 1/28).

Watch Kaiser Health News' video excerpt from last night's speech.

Politico: 20014 Dems Plot Obamacare Strategy
One of President Barack Obama’s rowdiest standing ovations Tuesday night came when he demanded Republicans drop their endless crusade to repeal his signature health care law. But there’s a more critical bloc of lawmakers he needs to implement Obamacare: vulnerable Democratic senators facing reelection in 2014 (Raju, 1/29).

Los Angeles Times: As The President Shifts Topics, The GOP Is Still Focused On Obamacare
In his State of the Union address, President Obama will touch on his health care law but keep the focus instead on his agenda to tackle income inequality: a push to increase the minimum wage, extend unemployment benefits and boost access to pre-kindergarten education. That was not the case across town Tuesday at the Republican National Committee, where the pre-buttal to the speech was all Obamacare, all the time. Though the administration has made progress by enrolling some 3 million people through the marketplaces created by the Affordable Care Act, Republicans show no signs of backing off their opposition as they hammer Democratic lawmakers over the problems created by the law. At RNC headquarters, Republican leaders handed the microphone to 10 constituents from eight states who were asked to share the problems they have faced -- from premium increases to canceled plans -- as a result of the health care law (Reston, 1/28).

CNN: Tea Party SOTU Response: ‘Obamacare Is An Inequality Godzilla'
Utah Sen. Mike Lee blamed big government for growing inequality in America, calling Obamacare an “inequality Godzilla.” Lee’s comments came during his Tea Party response to President Barack Obama’s State of the Union address on Tuesday night. “Obamacare -- all by itself -- is an inequality Godzilla that has robbed working families of their insurance, their doctors, their wages and their jobs,” Lee said. “Many Americans are now seeing why some of us fought so hard to stop this train-wreck over the last four years” (Fischer, 1/29).

Los Angeles Times: Republicans Blame President Obama For Nation’s Economic Woes
Both Lee and [Rep. Cathy] McMorris Rodgers cited the troubled rollout of the Affordable Care Act. Lee said Obamacare “all by itself is an inequality Godzilla that has robbed working families of their insurance, their doctors, their wages and their jobs. Many Americans are now seeing why some of us fought so hard to stop this train wreck over the last four years.” McMorris Rodgers said the nation “shouldn’t go back to the way things were,” but said the new healthcare law “is not working.“ “Republicans believe healthcare choices should be yours, not the government’s, and that whether you’re a boy with Down syndrome or a woman with breast cancer, you can find coverage and a doctor who will treat you” (Reston, 1/28).

The Wall Street Journal’s Washington Wire: Health Care Is Ticket For Some SOTU Guests
Health care isn’t expected to take a starring role in the State of the Union speech Tuesday night but that doesn’t mean it will be entirely absent. The White House has invited Kentucky Gov. Steve Beshear to sit with First Lady Michelle Obama during the speech because his state’s health insurance exchange worked surprisingly smoothly when others stumbled, and has now signed up 182,000 residents, chiefly in Medicaid. Mr. Beshear, a Democrat in a red-leaning state, said in a December interview that the exchange was “succeeding beyond our wildest dreams at this point,” which he attributed to starting work early with a contractor that worked closely with state officials and took a no-frills approach to the site (Radnofsky, 1/28).

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Health Reform

DelBene Takes On Challenge Of Correcting Healthcare.gov's Flaws

Kaiser Health News profiles the Obama administration's new website fix-it guy. And, in other news, The Associated Press reports that some workers at a federal health care call center for the health exchanges are now suing the government because they allegedly were forced to work unpaid overtime.    

Kaiser Health News: Ex-Microsoft Exec Brings Lists And Whiteboard To Overhaul Of Obamacare Website
Kurt DelBene's office is on the sixth floor of the fortress-like Department of Health and Human Services, overlooking the Capitol reflecting pool. With little but a desk, a small laptop, and monitor, it looks barren, like someone just moved out. But DelBene, a longtime Microsoft executive, moved in six weeks ago. He came from the other Washington, after President Barack Obama named him healthcare.gov's new fix-it guy — the successor to "tech-surge czar" Jeff Zients. DelBene is here to shore up the famously flawed Obamacare website, not decorate an office. The most telling evidence of his arrival is on the wall to the right of his workstation, where a large whiteboard is covered with scribbled notes about databases, security features, website capacity, and the like (Hernandez, 1/29). 

The Associated Press: Health Care Call Center Lawsuit Alleges Unpaid OT
Customer service workers at a call center for insurance exchanges established under the federal health care overhaul have sued their employer in federal court, saying they were forced to work unpaid overtime. The nine workers at a Boise facility who brought the suit against Maximus Inc. say the case could potentially apply to thousands of employees, and they’re asking a judge to award damages exceeding $5 million (Boone, 1/28).

News outlets also offer health exchange updates for Maryland, Kentucky, Washington state, Iowa and New Hampshire.  

The Associated Press/Washington Post: Md. Health Exchange Bill Could Be Finalized Soon
A final vote is near on a measure to help people who could not enroll in a private health plan on Maryland's health exchange website due to computer problems last year. The Senate, which already approved a version of the bill, could take up final passage as soon as Wednesday on the bill that has some changes made by the House of Delegates (1/29).

The Baltimore Sun: Maryland To Allow Small Businesses To Offer Small Group Health Plans
Maryland approved a plan Monday to allow small businesses to offer employees small group health plans in April, but pushed back the launch of its small business health care exchange website to Jan. 1, 2015, in line with the federal health exchange. The program, which would give small business employees access to federal tax credits, was initially slated to open in October, but was delayed due to glitches that have plagued the state's exchange. Certified plans and access to tax credits worth up to 50 percent of the employer's contribution toward employee premium costs, will be available directly through carriers, third party administrators and brokers starting April 1 (Campbell, 1/27).

The Associated Press: Obama: Beshear 'A Man Possessed' About Health Care
Kentucky's high performance for health care sign-ups through its state-run website has earned Gov. Steve Beshear a White House invitation to attend President Barack Obama's State of the Union speech. Beshear, a strong supporter of Obama's health care law, was among the guests sitting with first lady Michelle Obama when the president delivered the annual speech to a joint session of Congress on Tuesday night (Schreiner, 1/28).

The Seattle Times: Obamacare Enrollment Continues To Climb In Washington State
More than 320,000 people have signed up for insurance or newly enrolled in Medicaid through Washington's online health insurance exchange. Of that number, more than 86,000 are now covered by private insurance purchased through the exchange, according to state data ending Jan. 23. The rest are new participants in Medicaid (Stiffler, 1/28).

Des Moines Register: Iowa Notes Health Insurance Progress
State officials say they're making progress in helping thousands of Iowans who were caught in health insurance limbo because of technical problems with the federal government's new online insurance marketplace. Officials said in late December that nearly 16,000 Iowans who applied for insurance via the healthcare.gov website were caught in the foul-up (Leys, 1/29).

The Associated Press: Insurer's Limited Health Network Prompts NH Bill
Insurance companies selling policies under the Affordable Care Act in New Hampshire would be required to negotiate with all willing health care providers, under a bill before the state Legislature. Just one company — Anthem Blue Cross and Blue Shield of New Hampshire — is currently offering health insurance in the new markets required under President Barack Obama's health care overhaul. Its provider network includes 74 percent of the state's primary care providers and 85 percent of specialists, but just 16 of the state's 26 acute-care hospitals (Ramer, 1/28).

Meanwhile, in other news from the insurance marketplace -

CQ HealthBeat: Catastrophic Health Plans Attract Few Buyers, Leaving Their Future In Doubt
Catastrophic insurance plans were seen by the authors of the health care law as a way to ensure that young adults would have a way to buy affordable coverage. But now that very few people are buying the policies, the future of the plans is in some doubt (Adams, 1/28).

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Va.'s Proposed Medicaid Expansion Gets Lower Cost Estimate; Ark. 'Private Option' Expansion Plan Faces New Challenges

The new numbers are expected to get a skeptical reception from Virginia's House Appropriations Committee.

The Richmond Times-Dispatch: Estimated Cost Of Medicaid Expansion Lowered
Virginia health officials will face a skeptical House Appropriations Committee today over a new analysis that shows $1 billion in savings to the state over nine years from expanding its Medicaid program. Secretary of Health and Human Resources William A. Hazel Jr. and state Medicaid officials had a dress rehearsal for the presentation on Tuesday, when they appeared before a Senate Finance Committee, which welcomed the analysis. “This is actually very good news -- great news -- to discuss,” said Sen. Emmett W. Hanger Jr., R-Augusta, who is sponsoring a budget amendment to allow some form of expansion as early as July 1 (Martz, 1/29).

The Associated Press: Governor Warns Against Ending Health Care Program
Arkansas Gov. Mike Beebe warned sheriffs from around the state Tuesday that new funding he has proposed for the prison system could be at risk if lawmakers halt the compromise Medicaid expansion approved last year. Facing an increasingly uphill fight to renew the “private option” expansion during next month’s legislative session, Beebe also defended his administration’s estimate of how much the state budget would have to be cut if the program ends (1/28).

In other Medicaid-related news --

The Associated Press/Washington Post: Answers Sought On Families’ Medicaid Problems 
A congresswoman from New Hampshire asked the U.S. government Tuesday to clarify how families can obtain coverage under the federal health insurance law when children are eligible for Medicaid but their parents are not. Parents in New Hampshire, California and Florida have been surprised to learn that children who qualify for Medicaid can’t be covered under subsidized family plans purchased through the federal online markets, The Associated Press reported this week. Some children are going without coverage temporarily while their eligibility is determined. Others are stuck with no options because they applied for Medicaid and were rejected, but can’t be added to their parents’ plans (1/28).

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Capitol Hill Watch

Lawmakers File Briefs In Hobby Lobby Health Law Contraception Case

Republican senators also are weighing in.

The Hill: House Dems Enter Legal Fray Over Obamacare Birth Control Mandate
Scores of House Democrats entered the legal fight over Obamacare's birth-control mandate Tuesday, filing an amicus brief before the Supreme Court in defense of the contentious coverage requirement. Behind House Minority Leader Nancy Pelosi (D-Calif.), the lawmakers say the provision -- which requires most employers to cover birth control for their workers -- does not infringe on religious freedoms, as the Hobby Lobby, a Christian-owned retail chain, contends in its lawsuit (Lillis, 1/28).

USA Today: Lawmakers Weigh In On Supreme Court Contraception Case
Dozens of GOP and Democratic lawmakers have filed competing legal briefs to the Supreme Court as it prepares to take up challenges to provisions in the Affordable Care Act mandating contraception coverage. ... Senate Budget Chairwoman Patty Murray, D-Wash., led a group of Senate Democrats in filing a separate legal brief defending the government’s position in support of contraception coverage. “Allowing a woman’s boss to call the shots about her access to birth control should be inconceivable to all Americans in this day and age, and takes us back to a place in history when women had no voice or choice,” Murray said (Davis, 1/28).

Fox News: Dem Senators Intervene In Hobby Lobby Case, Urge Justices To Deny Obamacare Exemption
Republican senators returned fire, jumping to Hobby Lobby's defense in a brief of their own. "The ability to practice the faith we choose is one of our great constitutional rights. The Obama administration's contraceptive mandate stomps on that right," Sen. David Vitter said in a statement (1/28).

Meanwhile --

The Wall Street Journal’s Law Blog: Notre Dame Revives Bid For Injunction Over Contraception
The University of Notre Dame is trying again to get a court injunction so it can stop covering contraception for its employees, following a favorable Supreme Court order in a similar case. Notre Dame struck out once at the U.S. Court of Appeals for the Seventh Circuit last year. Then the Supreme Court last week blocked the federal government from enforcing the contraception requirement against the Little Sisters of the Poor, a Roman Catholic nonprofit that operates homes for the elderly poor. On Tuesday, Notre Dame filed a new request to the Seventh Circuit, saying the Supreme Court’s order suggests the university is also entitled to a stay while litigation continues (Radnofsky, 1/28). 

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House Passes Bill To Ban Health Law Subsidies For Abortion Coverage

But the restriction, which would apply to private plans bought with the help of health law subsidies, stands no chance of passage by the Democratic-controlled Senate.

The Associated Press: Republicans Vote To Bar Subsidies For Health Plans That Cover Abortions
The House voted Tuesday to bar federal subsidies to Americans signing up for health insurance plans that cover abortion, as Republicans issued a fresh warning about the impact of President Obama’s health care law. Ignoring a White House veto threat, majority Republicans led the House in voting 227-188 for the measure that they insisted was necessary to permanently bar any taxpayer dollars for abortion amid implementation of the four-year-old law (Cassata, 1/29).

Politico: House Bans Obamacare Subsidies For Abortion Coverage
Half the states have already passed legislation limiting abortion coverage in exchange plans, but this measure would apply nationwide and possibly discourage insurers on the exchanges from offering abortion coverage at all (Winfield Cunningham, 1/28).

The New York Times: House Votes to Restrict Payment For Abortions
The bill stands no chance of being passed by the Democratic-controlled Senate. But that mattered little to members of both parties, who seemed to relish the chance to accuse their opponents of blatantly twisting the issue to their political advantage. ... Six Democrats voted yes, one Republican voted no and another voted present (Peters, 1/28).

McClatchy: House Passes 'No Taxpayer Funding For Abortion Act'
The bill, according to sponsor Chris Smith, R-N.J., would end public funding for abortion coverage included in the Affordable Care act as of next year. ... Federal funding is now barred for most abortions (Lightman, 1/28). 

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Sen. Coburn Pays Out-Of-Pocket To See Cancer Doctor

Sen. Tom Coburn, R-Okla., who is undergoing treatment for prostate cancer, says the new insurance plan he purchased under the health law doesn't include his longstanding oncologist. He says he is paying out of pocket to see that doctor and is "doing well from a health standpoint."

The Washington Post: Did Sen. Coburn Lose His Cancer Doctor Because Of Obamacare? 
Sen. Tom Coburn (R-Okla.) has long been politically opposed to the Affordable Care Act. As recently as Monday, he offered a major repeal-and-replace plan. Now, he has a more personal grievance against Obamacare: Coburn, who is undergoing treatment for prostate cancer, says he lost coverage for his oncologist when he purchased a plan on the new health exchange. “I’m doing well from a health standpoint, got great docs,” Coburn said Tuesday morning in an interview on MSNBC. “Fortunately, even though my new coverage won’t cover my specialist, I’m going to have great care, and I have a great prognosis” (Kliff, 1/28).

Politico: Obamacare: Tom Coburn Loses Cancer Doctor
Cancer-stricken Sen. Tom Coburn revealed Tuesday that his health insurance under Obamacare doesn’t cover his oncologist, but said he still is receiving excellent care. “I’m doing well from a health standpoint, got great docs,” Coburn said on MSNBC’s “Morning Joe” on Tuesday when asked about his health. “Fortunately — even though my new coverage won’t cover my specialist — I’m going to have great care, and I have a great prognosis” (Kopan, 1/28).

Fox News: Coburn Says ObamaCare Cost Him Coverage For Cancer Doctor
Republican Sen. Tom Coburn revealed Tuesday that his ObamaCare insurance plan does not cover his cancer specialist, forcing him to pay out of pocket -- in the latest reminder of complications with the health law as President Obama prepares to address the nation. The Oklahoma senator, who has been suffering from a recurrence of prostate cancer and plans to retire at the end of the current session, briefly discussed his personal situation in an interview Tuesday morning. "I'm doing well from a health standpoint, got great docs and fortunately, even though my new coverage won't cover my specialists, I'm going to have great care and I have a great prognosis," he said (1/28).

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State Watch

State Highlights: Will Doc Cuts Like Those In Conn. Become More Common?

A selection of health policy stories from Connecticut, California, Vermont, Minnesota, Virginia and Georgia.

The CT Mirror: In UnitedHealthcare Doctor Cuts, Some See Larger Trend
UnitedHealthcare sparked an intense backlash from physicians, seniors and elected officials last fall when it notified more than 2,000 Connecticut doctors that they would be dropped from its Medicare Advantage network. Some of the criticism has focused on things particular to the way the insurer made the changes. But many people in health care believe that what UnitedHealthcare is trying to do -- cover fewer doctors and other health care providers -- is likely to become increasingly common in Connecticut. In other states, some insurers already offer plans that cover narrow networks of doctors and hospitals, in some cases, excluding major medical centers. They're betting that customers will opt for reduced provider choice if it means lower premiums (Becker, 1/28).

Los Angeles Times: Report Criticizes California Health Plans For Treatment Of Chronic Ailments
Most California health plans make it hard for patients to get care easily and do a poor job of controlling chronic conditions such as asthma and diabetes, a new state report shows. The findings were published Tuesday in the state's annual report card on California's 10 largest HMOs, six biggest preferred-provider organization plans and more than 200 medical groups. The scores on clinical performance and patient satisfaction reflect care for about 16 million Californians with private health insurance (Terhune, 1/28).

NPR: In Vermont, A Network Of Help For Opiate-Addicted Mothers
While it may not fit Vermont's bucolic image, the state's addiction problem has long been acknowledged. And as the state has expanded treatment, it's also been coming to grips with one of the most difficult and emotional aspects of the issue: addicted mothers (Zind, 1/28). 

Minnesota Public Radio: Doctors Learning The Art Of Negotiation
Agents, car salesmen and lawyers all have to be good negotiators. But what about your doctor? Do you ever find yourself negotiating with him or her? A recent essay in the New York Times says that you probably do. Dr. Jon Hallberg, a physician in family medicine at the University of Minnesota and regular medical contributor for All Things Considered, spoke with MPR News' Tom Crann about negotiation (Crann, 1/28).

The Richmond Times-Dispatch: Mental Health Task Force Backs Doubling Emergency Custody
With time a matter of life and death, a gubernatorial task force wants to double the duration of emergency custody orders to evaluate people in psychiatric crisis and find a hospital bed for them if they pose a threat to themselves or others. The Governor’s Task Force on Improving Mental Health Services and Crisis Response voted Tuesday to recommend a 12-hour time limit for the orders, which now expire after six hours, and require state mental hospitals to take the patients if no bed can be found in community psychiatric facilities. The 37-member task force also endorsed a 72-hour limit on temporary detention orders -- now capped at 48 hours -- to hold someone involuntarily for additional evaluation in a psychiatric crisis (Martz, 1/29).

Georgia Health News: Limited Use Of Medical Marijuana Gains Traction 
In just a matter of weeks, a proposal to legalize the use of medical marijuana to treat seizures has captured the attention of Georgia lawmakers, the public and the state’s medical community. State Rep. Allen Peake (R-Macon) is expected to introduce such legislation Tuesday in the Georgia General Assembly. His position on the issue, he said, arose from a visit with a 4-year-old girl who suffers up to 100 seizures a day. The bill would allow the parents of young epilepsy patients to apply to an academic medical center to get an oil derived from cannabis that may reduce their number of seizures (Miller, 1/28).

The San Jose Mercury News: Grant To Boost Medi-Cal Enrollments Includes 11 Greater Bay Area Counties
The California Endowment is awarding $23 million to three dozen California counties or county groups -- including 11 in the Greater Bay Area -- to help increase enrollment in Medi-Cal, the state's health program for the very poor. As part of the terms of the award, grantees must emphasize outreach to specific populations, including those with limited English proficiency or in families of mixed-immigration status; young men of color; homeless, and those with mental illness or substance-abuse problems. County grantees must make at least half of the funding available to community-based organizations (Seipel, 1/28).

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Editorials and Opinions

Viewpoints: Senate's GOP Health Plan Could Have Enabled Bipartisan Compromise--In 2009; Sen. Cruz On Obama's 'Imperial Presidency'

The New York Times: Comparing Obamacare To Its Alternative
From the moment the ink dried on March 23, 2010, Republicans said they intended to "repeal and replace" the Affordable Care Act. They have voted more than 40 times to wipe the law from the books. But Republicans have never gotten around to describing, in detail, the set of policies they believe should replace Obamacare. That is, until yesterday. ... Senators Tom Coburn, Richard Burr and Orrin Hatch deserve credit for developing this plan. Putting together a proposal to reform the American health care system is hard and politically courageous. And while it is lacking in important details, this plan contains some interesting ideas that might have enabled bipartisan compromises had they been offered in 2009 (Ezekiel J. Emanuel, 1/28). 

The New York Times' Taking Note: Looking Callous At The SOTU
Discussing health insurance reform, Mr. Obama said at one point: "Because of this law, no American can ever again be dropped or denied coverage for a preexisting condition like asthma, back pain, or cancer. No woman can ever be charged more just because she's a woman." Democrats stood and cheered. Republicans sat in stony silence. House Speaker John Boehner grimaced on the podium behind Mr. Obama, as he did several times during the portion of the speech dedicated to the Affordable Care Act. Conservatives felt they had to convey their disapproval of the law — no surprise there — but in the process they seemed uncaring of the very real ways in which it's helping real people (Andrew Rosenthal, 1/28). 

The Washington Post's Post Partisan: What Obama Didn't Say On The Affordable Care Act
Obama's health-care reform can significantly expand access to decent health-care coverage without blowing up the health-care system to which most Americans are accustomed. It sets out to accomplish an important social goal in a way that majorities in Congress could accept — though just barely. Republicans profess to favor many of the ACA's outcomes. "No, we shouldn't go back to the way things were," Rep. Cathy McMorris Rodgers (R-Wash.) said in Tuesday night's GOP response. But despite the usually small-ball GOP proposal here and there, the party still has not coalesced behind an approach that has the potential to extend good coverage to as many people and pass Congress. The president was right to take credit for threading a pretty tight needle, and he was right to stick up for a policy that could still do a lot of good in the coming years, particularly for the uninsured (Stephen Stromberg, 1/29).

The New York Times: Roadblocks On Health Reform
Onerous restrictions imposed by Missouri on federally approved counselors who help people understand and enroll in health insurance plans under the Affordable Care Act have rightly been blocked by a federal district judge in Kansas City. Although the ruling by Judge Ortrie Smith applies only to Missouri, its reasoning applies to similar laws or regulations adopted by more than a dozen Republican-led states that are doing their best to sabotage health care reform (1/28). 

The New York Times' Economix: She's A 29er
Part-time employees do not create a health-insurance requirement or a penalty for their employer, which gives large and small employers an incentive to reduce at least some employees' hours to 29 hours. A number of employers plan to do exactly this. But the incentives are not limited to penalty avoidance by employers, and began this month. Employees in families with income of less than 400 percent of the poverty line will lose access to generous federal subsidies if they make themselves eligible for employer health coverage by working full time at an employer that offers coverage to such employees. In other words, employees may have something to gain, or less to lose than they did before this year, by limiting themselves to a 29-hour work schedule (Casey B. Mulligan, 1/29). 

The Wall Street Journal: The Imperial Presidency Of Barack Obama
There is no example of lawlessness more egregious than the enforcement—or nonenforcement—of the president's signature policy, the Affordable Care Act. Mr. Obama has repeatedly declared that "it's the law of the land." Yet he has repeatedly violated ObamaCare's statutory text (Sen. Ted Cruz, R-Texas, 1/28). 

Bloomberg: The Vital Medical Research Obama Isn't Pushing
The growth in Medicare costs continues to be slow, in what is perhaps the most encouraging fiscal development for the U.S. in decades. If the health-care system is to continue to provide better value for Americans, policy makers need to seize this moment. Sadly, they are instead largely sitting on the sidelines. The sluggish activity at the Patient-Centered Outcomes Research Institute provides a vivid illustration. It is simply not possible to make health care more efficient without knowing how treatments stack up against one another (Peter Orszag, 1/28).

The San Francisco Chronicle: The State Of The Affordable Care Act Isn't Healthy
I contacted some readers who had written to me about Obamacare for their thoughts on the Affordable Care Act and President Obama's State of the Union address. Most of these correspondents were unhappy because their insurers had cancelled their private plans, while others faced cancellations but welcomed the chance to buy policies available to all. One reader, not a happy camper, told me he wouldn't be watching because he couldn't "think of anything that Obama might say that wouldn't have me lobbing projectiles at my TV" (Debra J. Sanders, 1/28).

And on other issues -

Los Angeles Times: That Crowd In The Emergency Room? Kids, Shot By Guns. Why We Need To End This.
No matter how you count up the disparate numbers about the effects of some of our fellow Americans' infatuation with guns, the answer is the same: Our laws are killing and maiming us. The medical journal Pediatrics this week reported that, based on the most recent data from 2009, children are hospitalized for gunshot wounds at a rate of 20 a day, or one child every 72 minutes, for a total of 7,391 hospitalizations in 2009. Nine of 10 wounded kids are male, and disproportionately African American, which focuses the problem even more (Scott Martelle, 1/28).

JAMA Internal Medicine: A Consumer's Pursuit Of Health Care Outcomes: Daunting Even With A Guardian Angel!
One would think, given the huge amount of health care information available today, that by practicing proper due diligence we should be able to make reasonable and rational informed decisions about care options. ... Even the best guardian angel, however, would struggle to find information on all relevant hospitals and physicians, encountering different and confusing methods and limited details. ... So what is the solution? First, it is incumbent on medical professionals to keep striving to make medical decision-making information tools readily available and transparent to the public (Dr. Michael Mack, 1/28).

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Stephanie Stapleton

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