Daily Health Policy Report

Monday, January 6, 2014

Last updated: Mon, Jan 6

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Administration News

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Millions Of Lower-Income People Expected To Shift Between Exchanges And Medicaid

Reporting for Kaiser Health News, in collaboration with The Washington Post, Jenni Bergal writes: "While government officials have spent months scrambling to fix the federal health law’s botched rollout, another issue is looming that could create new headaches for states, health plans – and patients. In 2014, millions of people are expected to shift between the health exchanges and Medicaid, as their income fluctuates over the year. That could be costly for states and insurance companies, and patients could wind up having gaps in coverage or having to switch health plans or doctors" (Bergal, 1/6). Read the story.

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Thousands Waiting For Medicaid Coverage Are Stuck In Limbo

Kaiser Health News staff writer Phil Galewitz reports: "For years, Obama administration officials talked about how the health law’s online marketplaces would offer a seamless shopping experience for consumers looking for health coverage. But that’s turned out to be an empty promise for many low-income people who went to healthcare.gov, the federal enrollment portal, and were deemed eligible for Medicaid or the Children’s Health Insurance Program" (Galewitz, 1/6). Read the story.

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Capsules: 364 Hospitals Have High Rates Of Overall Readmissions, New Medicare Data Show; Maryland Plan Offers Retroactive Coverage Due To Sign-up Problems

Now on Kaiser Health News' blog, Jordan Rau reports on new data regarding hospital readmission rates: "Medicare's new comprehensive measure of hospital readmissions shows that at least 20 percent of the hospitals in Illinois, Maryland, Massachusetts, New Jersey, New York and Rhode Island have higher rates of patients returning than the national average" (Rau, 1/6).

Also on the blog, Jay Hancock reports on steps by one Maryland health plan to sign people up for new coverage: "A consumer-owned cooperative started with federal loans, Evergreen runs four health centers in metro Baltimore and Greenbelt, near Washington, D.C. Since Oct. 1, the company has struggled with Maryland’s dysfunctional online insurance marketplace, Maryland Health Connection, which so far has enrolled 18,257 people in private health plans like the ones sold by Evergreen. The online exchange has gotten ‘mildly better,’ Beilenson said. But even after the New Year launch date of coverage under the health law Evergreen got 'significant numbers of calls — in the dozens of people — who have tried to go on the exchange for between a week and 10 weeks and have been frozen out,' he said. 'Now they're calling us out of desperation'" (Hancock, 1/5). Check out what else is on the blog.

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Political Cartoon: 'Back In The Game?'

Kaiser Health News provides a fresh take on health policy developments with "Back In The Game?" by John Darkow.

Here's today's health policy haiku:  

HABLA ESPANOL

Health law coverage
Not so good for Latinos
Que sera sera?
-Beau Carter 

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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Health Reform

Medicaid Expansion Efforts Facing Challenges From Healthcare.gov

The Washington Post and Kaiser Health News report that some people who would be eligible for this coverage may be falling through the cracks. Meanwhile, Bloomberg examines how accessing health care plays out differently in states that pursued the expansion and those that didn't, and a look at the difficult issue of people moving between Medicaid and private insurance.   

The Washington Post: HealthCare.gov Defects Leave Many Americans Eligible For Medicaid, CHIP Without Coverage
More than 100,000 Americans who applied for insurance through HealthCare.gov and were told they are eligible for Medicaid or the Children’s Health Insurance Program (CHIP) remain unenrolled because of lingering software defects in the federal online marketplace, according to federal and state health officials. To try to provide coverage to these people before they seek medical care, the Obama administration has launched a barrage of phone calls in recent days in 21 states, advising those who applied that the quickest route into the programs is to start over at their state’s Medicaid agency (Goldstein and Eilperin, 1/4).

Kaiser Health News: Thousands Waiting For Medicaid Coverage Are Stuck In Limbo
For years, Obama administration officials talked about how the health law’s online marketplaces would offer a seamless shopping experience for consumers looking for health coverage. But that’s turned out to be an empty promise for many low-income people who went to healthcare.gov, the federal enrollment portal, and were deemed eligible for Medicaid or the Children’s Health Insurance Program (Galewitz, 1/6).

Bloomberg: Obamacare Medicaid Split Creates Two Americas For Poor
Amber Sanchez, a San Francisco cancer survivor, skipped visiting the gynecologist last year to check a growth on her ovary because she was uninsured. This year, it's at the top of her New Year's plans. … The women's fates are the consequence of a political debate that's divided the U.S. roughly along party lines: Democratic-led states have expanded Medicaid programs for the poor under the health law; most Republicans have refused. While the law's online exchanges draw more scrutiny, it's Medicaid that may determine the health of millions of Americans (Nussbaum, Vekshin and Douban, 1/6).

Kaiser Health News: Millions Of Lower-Income People Expected To Shift Between Exchanges And Medicaid
While government officials have spent months scrambling to fix the federal health law's botched rollout, another issue is looming that could create new headaches for states, health plans – and patients. In 2014, millions of people are expected to shift between the health exchanges and Medicaid, as their income fluctuates over the year. That could be costly for states and insurance companies, and patients could wind up having gaps in coverage or having to switch health plans or doctors (Bergal, 1/5).

Also in the news, reports from Missouri and Idaho -

Idaho Statesman: Stuck In The Medicaid Gap In Idaho
Amy Workman and her 12-year-old son spent the holidays stuffing their Coeur d’Alene home into a moving truck. They gave away some furniture. They gave a neighbor their Christmas tree. A few days after Christmas, the mother of three and her youngest son hit the road for Oregon. They headed west in search of health insurance. Workman is one of the estimated 54,780 adults in Idaho who fall into the so-called Medicaid gap — a health insurance no-man’s-land being created this year in Idaho and 24 other states where lawmakers decided not to expand Medicaid programs (Dutton, 1/5).

The Associated Press: Prospects Remain Slim For Mo. Medicaid Expansion
Medicaid expansion remains a priority for Gov. Jay Nixon as Missouri lawmakers open their annual legislative session this week. Yet the prospects of that occurring appear slim. Like last year, Missouri's Democratic governor and Republican legislative leaders are entering the session with a wide rhetorical and ideological gap on the question of whether Missouri should expand Medicaid eligibility to thousands of lower-income adults (Lieb, 1/5).

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Calif. Extends Payment Deadline For New Insurance Plans; Md. Gov. To Push Emergency Legislation For Exchange Woes

Meanwhile, news outlets also report on state health law implementation action in Minnesota, Iowa and Pennsylvania.   

Los Angeles Times: California Extends Payment Deadline For Obamacare Policies To Jan. 15 
Amid deepening consumer frustration, California's health exchange extended the payment deadline to Jan. 15 for insurance coverage starting Jan. 1 under the federal healthcare law. The state's move late Saturday comes as many enrollees continue to report problems getting an invoice from their insurance company or paying their first month's premium so coverage is retroactive to Jan. 1. Consumers say they have encountered website glitches trying to pay online and jammed phone lines when attempting to get help from their insurer or the Covered California exchange (Terhune, 1/4).

The San Jose Mercury News: Covered California Extends Deadline To Pay Health Insurance Premiums To Jan. 15
Californians scrambling to pay their first month's health insurance premium, originally due Monday, now have until Jan. 15 to do so, according to the state's health insurance exchange. Covered California announced the reprieve late Saturday, saying its 11 participating health insurance companies had agreed to the extension, which also assures those companies have time to mail invoices, and for consumers to have received their insurance documents. The exchange said payment for coverage taking effect Jan. 1 must be in the hands of the health insurance companies by Jan. 15, and not simply postmarked or in-transit (Seipel, 1/5).

The Associated Press: Calif. Health Exchange Extends Payment Deadline
The agency running California's health insurance exchange extended the deadline for payments until Jan. 15 following a surge in the number of consumers signing up for coverage. Covered California said on its website that health coverage still took effect Jan. 1 but the payment deadline was pushed back to prevent consumers from feeling rushed to pay recently received invoices (1/5).

The Washington Post: O'Malley To Push Emergency Health Insurance Legislation
Maryland lawmakers are expected to pass legislation as soon as next week to assist the hundreds of people — or, possibly, thousands — who tried to sign up for health insurance through the state's new exchange program, encountered problems and were left uncovered when the new year began. Gov. Martin O'Malley (D) and Lt. Gov. Anthony G. Brown (D) said Friday that they plan to introduce emergency legislation that would expand enrollment in the Maryland Health Insurance Plan, a separate state-run program that normally covers high-risk individuals. Those enrolled would have to pay a premium, which is determined by income but is often slightly higher than market rates, and would probably be allowed to stay on the plan for only a few months (Johnson and Davis, 1/3).

Kaiser Health News: Capsules: Maryland Plan Offers Retroactive Coverage Due To Sign-Up Problems
A consumer-owned cooperative started with federal loans, Evergreen runs four health centers in metro Baltimore and Greenbelt, near Washington, D.C. Since Oct. 1, the company has struggled with Maryland’s dysfunctional online insurance marketplace, Maryland Health Connection, which so far has enrolled 18,257 people in private health plans like the ones sold by Evergreen. The online exchange has gotten "mildly better," [CEO Peter] Beilenson said. But even after the New Year launch date of coverage under the health law Evergreen got "significant numbers of calls — in the dozens of people — who have tried to go on the exchange for between a week and 10 weeks and have been frozen out," he said. "Now they're calling us out of desperation" (Hancock, 1/5).

MinnPost: Dayton Blames Tech Vendor IBM Curam For Many Of MNsure’s Problems
Gov. Mark Dayton has accused one of MNsure's main technology vendors of misleading the health insurance exchange about the status and reliability of its product — a key system used to determine insurance eligibility. Problems with the function have plagued MNsure since its launch (Nord, 1/3).

Pioneer Press: Dayton Letter Blasts IBM For MNsure Website Failings
In a letter last month, the governor blamed the IBM software for everything from a "black hole" where applications were irretrievably lost to inaccurate determinations for whether consumers should get financial assistance from the government for their coverage. The letter was made public Friday. IBM's Curam division is one of four primary software vendors on the MNsure health insurance exchange project, and Dayton sent the letter to a company official Dec. 13 (Snowbeck, 1/3).

The Star Tribune: Dayton Slams IBM For Failures With MNsure Website
A little more than a week before Minnesotans faced the first deadline to purchase coverage under the new health law, Gov. Mark Dayton fired off an angry letter to the chief executive of IBM Corp., in which he blamed the technology services giant for troubles plaguing the state’s online health insurance exchange. In the five-page letter, dated Dec. 13, Dayton told CEO Virginia Rometty about 21 specific problems in IBM software and demanded that the company "immediately deploy whatever people or resources are needed to correct the defects in your product that are preventing Minnesotans from obtaining health insurance through MNsure." The response was swift: IBM sent dozens of workers to St. Paul and pledged to spend up to 4,000 man-hours working on MNsure, the state's new insurance exchange, with no expense to the state (Crosby, 1/4).

Minnesota Public Radio: Most Of MNsure's Website Shut Down This Weekend
Most of Minnesota's troubled online health insurance website will be shut down this weekend while improvements are made. As a result, people who want to use the MNsure site to apply for insurance will have to wait until Monday. MNsure's website has been a source of much consumer frustration as at least 2,000 users have been stuck in the process of applying for insurance online (Stawicki, 1/3).

Minnesota Public Radio: MNsure Enrollment Picked Up At Year's End
Enrollment in health care policies sold on Minnesota 's online health insurance marketplace surged in the final days of 2013. Nearly 68,000 people had picked a plan and were in the process of paying for it by Dec. 31, MNsure officials said. Here's how the numbers break down (Richert, 1/3).

The Associated Press: Iowans Grapple With New Health Law
The federal health care law is now in effect, but many Iowa residents are still trying to figure out their new insurance plans or are continuing to seek health coverage. Jan. 1 marked the first day for many provisions of the new law, including insurance coverage for those who signed up for private plans on the federal enrollment website. Iowa's modified Medicaid expansion — which uses federal dollars to offer coverage to some low-income Iowans — also started that day (Lucey, 1/5).

The Philadelphia Inquirer: You're Covered; Now, Find The Right Doctor
Three, two, one -- happy health insurance. OK, so no one yelled that at the stroke of midnight Wednesday. But if someone had, it would have been understandable. After all, for many of the more than a million Americans who signed up on healthcare.gov by Dec. 24 -- including tens of thousands of Pennsylvania and New Jersey residents -- the new year heralded health insurance coverage (Calandra, 1/5).

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How Obamacare Coverage Is Shaking Out

Even with the health law's insurance options, consumers struggling with chronic diseases may still face such high out-of-pocket costs on some plans that they could have trouble staying out of debt, reports the Associated Press. Meanwhile, several major drugstore chains are offering to fill prescriptions for those who enrolled in new health plans but don't have ID numbers yet.

The Associated Press: Skimpy Health Plans Leave Gaps
For working people making modest wages and struggling with high medical bills from chronic disease, President Barack Obama’s health care plan sounds like long-awaited relief. But the promise could go unfulfilled. It's true that patients with cancer and difficult conditions such as multiple sclerosis or Crohn's disease will be able to get insurance and financial help with monthly premiums. But their annual out-of-pocket costs could still be so high they’ll have trouble staying out of debt (Alonso-Zaldivar, 1/3).

Related, earlier KHN story: Despite Health Law’s Protections, Many Consumers May Be 'Underinsured' (Andrews, 12/31/13).

Marketplace: Obamacare Backlog: Walgreen's Offers Month Of Drugs
With the new year come millions of people who will be newly insured under the Affordable Care Act, and pharmacies are among the many companies competing for their business. This week several drugstore chains offered temporary supplies of medications for those still sorting out their coverage. Walgreens, CVS, Walmart, and Kroger are among the retailers offering to fill prescriptions for people who enrolled in new health plans but don't have ID numbers yet. They'll settle the bill later (Scott, 1/3).

NPR: Dental Coverage Deciphered, And The Latest On Sign-Up Deadlines
New Year's Day marked the halfway point to sign up for health insurance through the Affordable Care Act for coverage this year. And after a dismal start, things seem to be going a lot better on the healthcare.gov website. Federal officials say more than 1 million people enrolled in coverage by the Christmas Eve deadline for coverage that began January 1. People have until March 31 to purchase a plan, or enroll in Medicaid if you're eligible. If you're uninsured after that, you may be subject to a tax penalty in 2015 (Rovner, 1/6).

The Associated Press: Providing Health Care Complicated In Rural Areas
In this rural part of the [Florida] Panhandle, Christopher Mitchell finds few takers when he delivers his message about the importance of exploring insurance options under the federal health overhaul. People in the conservative-leaning area tend to have a bad impression of President Obama's signature law because of negative messages they hear on talk radio or from friends, said Mitchell, marketing director for a network of nonprofit health clinics (1/5).

The Associated Press: Health Care Law May Add Volunteer Firefighter Costs
Fire chiefs and lawmakers are working to protect the system of volunteer firefighting that has served rural America for more than a century but is threatened by an ambiguity in President Obama’s health care law. Small and rural fire departments from California to Maine, which has one of the country’s highest percentages of volunteer and on-call firefighters, rely on volunteers to avoid the cost of paying them to be on duty in between fighting fires (Durkin, 1/5).

Reuters: Health Reform's Grand Experiment: Will It Play In Peoria
By all accounts, Sandy Wright of Mackinaw, Illinois, is a challenging patient. The spunky 69-year-old with a rare autoimmune disease has been in the hospital more than a dozen times since she was first diagnosed in 1997. … Now, patients like Wright are at the forefront of an experiment, under way in Peoria, Illinois, and hundreds of other U.S. cities, that could transform the way doctors, nurses and hospitals deliver care to patients. Amid the barrage of criticism over the rollout of Obamacare, groups known as Accountable Care Organizations (ACOs) are quietly going about the business of testing the potential for healthcare reform (Steenhuysen, 1/5).

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Have More People Lost Health Insurance Than Gained It?

Fact checkers from the Washington Post and FactCheck.Org examine GOP claims about the number of people who have lost coverage -- both in terms of individual and employer-provided coverage -- as a result of the health law.

The Washington Post's The Fact Checker: The GOP Claim That More Americans Have Lost Insurance Than Gained It Under Obamacare
On its face, this claim by the Daily Caller is wrong because the law included a significant expansion of Medicaid, which in just three months has added 3.9 million people to its rolls. The article also incorrectly assumes that everyone whose plan did not meet Affordable Care Act standards but who did not sign up for a plan via the exchanges has been left without coverage. In reality, many people who received notices that their plans were canceled were told they would be automatically enrolled into another plan by the same insurance company (Kessler, 1/6).

FactCheck.Org/USA Today: Fact Check: Workers 'Losing' Employer Health Plans? 
Michigan Rep. Fred Upton exaggerated the impact of the Affordable Care Act when he claimed that "perhaps as many as 80 to 90 million Americans with employer-based health care are going to lose their plans" by late this year. Upton doesn't mean that those millions of Americans would no longer have health insurance through their employers. And these workers won't be receiving cancellation notices in the mail. Instead, he's talking about health plans losing grandfathered status, which means they are exempted from some requirements of the Affordable Care Act because they existed before the law was enacted (Robertson, 1/3).

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Capitol Hill Watch

Wis. Senator Suing Obama Administration Over Health Law Subsidies

Meanwhile, fellow Republicans Sen. Rand Paul and Phil Gingrey also are heavily criticizing the law.

Politico: Ron Johnson To Sue OPM Over Obamacare
Sen. Ron Johnson plans to file a lawsuit Monday against the Office of Personnel Management over its policy permitting lawmakers and Hill staff to receive Obamacare subsidies for their health plans. The Wisconsin Republican and other opponents of the policy say that the OPM decision to allow the government to fund a portion of members’ and staffers’ health insurance is not authorized in the text of the Affordable Care Act (Haberkorn, 1/6).

The Milwaukee Journal Sentinel: Sensenbrenner: Johnson's Obamacare Lawsuit A 'Political Stunt'
U.S. Sen. Ron Johnson is being accused of "an unfortunate political stunt" by one of his fellow Wisconsin Republicans. Rep. James Sensenbrenner released a statement Sunday criticizing Johnson ... "Senator Johnson should spend his time legislating rather than litigating, as our country is facing big problems that must be addressed by Congress -- not the courts," Sensenbrenner said (1/5). 

ABC News: Sen. Rand Paul Says Obamacare 'A Mess,' Unsure if Family is Covered
Democrats have pointed to Kentucky’s state health exchange as an Obamacare success story, but Sen. Rand Paul of Kentucky said on "This Week" that the system is "a mess," describing how his son was incorrectly enrolled in Medicaid, and saying he's unsure if his own family is currently covered. ... "I have here my son's Medicaid card," Paul told George Stephanopoulos Sunday, waving the card. "We didn't try to get him Medicaid, I'm trying to pay for his insurance" (Blaine, 1/5).

MedPage Today: 10 Questions: Rep. Phil Gingrey
Eliminate Obamacare, says Rep. Phil Gingrey, MD (R-Ga.). … What's the biggest barrier to practicing medicine today? Obamacare. Plain and simple. The president's health reforms threaten tens of thousands of private practices with the very real possibility that they may have to close their doors. Several doctors lucky enough to keep practicing are losing their patients due to being dropped from their provider networks and not being able to provide care under Medicare (Pittman, 1/3).

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Eyes Peeled On Health Law, GOP Shrinks Expectations For Major Election Year Action

Republican lawmakers are refocusing their election-year political efforts on hammering the health law's unpopularity even as the agenda for getting legislation done shrinks amid a tightening political climate, which could stall immigration and unemployment benefit measures.

The New York Times: House G.O.P. Trims Agenda, Looking To Avert Election-Year Trouble
Expectations for the session are so low that lawmakers say early action on White House priorities like raising the minimum wage, restoring unemployment benefits that expired and overhauling immigration laws are likely to go nowhere. Instead, Congress is likely to focus on more prosaic tasks: finishing negotiations on a farm bill that has languished for two years, agreeing on a law authorizing water projects, passing a spending bill for the current fiscal year and raising the debt ceiling by March. Only then might lawmakers move on to modest, piecemeal immigration measures (Weisman, 1/5).

Los Angeles Times: Congress Looks Ahead To A Year Of Pre-Election Battles
For Republicans the focus will be a singular one: attacking President Obama's health care law. Their campaign aims to convince voters, especially sought-after independents, that the law's troubled launch proves Democrats cannot be trusted to run the government. "Obamacare, Obamacare, Obamacare," said Andrea Bozek, communications director for the House GOP's campaign arm. "That theme really works in the races -- from the Northeast to the South to the Midwest to the West." Democrats will counter by trying to turn attention to pocketbook issues. They plan to begin Monday with a test vote in the Senate on a measure to extend unemployment insurance. About 1.3 million jobless Americans lost their benefits Dec. 28 because Congress declined to continue the federal aid (Mascaro, 1/5).

The Associated Press: Health Care Squarely In GOP Crosshairs
Congress returns to work today with election-year politics certain to shape an already limited agenda. Republicans intend to focus on every facet of President Barack Obama's health care law. They see a political boost in its problem-plagued rollout as the GOP looks to maintain its House majority and seize control of the Democratic-led Senate (Cassata, 1/6).

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Administration News

HHS To Release Slow-Growth Health Spending Numbers As Obama Readies Big Push For Law

News outlets covered administration efforts to build public confidence in the Affordable Care Act.

The Hill: Obama Administration To Tout Slow Growth In National Healthcare Spending
The agency responsible for implementing ObamaCare will release a report on Monday showing slow growth in national healthcare spending. The Centers for Medicaid and Medicare Services (CMS) will brief reporters at the National Press Club on what the Obama administration has touted as a trend of slower healthcare spending growth since the implementation of the Affordable Care Act (Easley, 1/5).

Politico: The Obamacare Fixer
Phil Schiliro’s work on Obamacare has come full circle. As President Barack Obama’s legislative director, Schiliro helped get the Affordable Care Act through Congress. Now, he’s back as the fixer. Even with the website now working, many Democrats have run out of patience with an administration that has failed to anticipate and address problems before they become political disasters. ... Shortly after his unexpected return last month, Schiliro met with more than a dozen Democratic senators to convince them the White House gets it (Budoff Brown and Allen, 1/3).

The Washington Post: For Obama, A Full 2014 Agenda: Income Inequality, NSA Reforms, Health Care
With millions of Americans receiving health-care coverage under the Affordable Care Act, Obama will try to shift the public’s attention from the disastrous rollout of the HealthCare.gov Web site to the real-life benefits of the law. Obama plans to do some outside-the-Beltway travel in the weeks ahead to showcase successes, according to administration officials who spoke on the condition of anonymity to discuss the president’s plans (Rucker and Wilson, 1/4).

The Wall Street Journal: U.S. Weighs Tech Fixes After Health-Site Woes
The Obama administration, stung by the failures of the HealthCare.gov rollout, is considering loosening hiring rules for technology specialists and creating a new federal unit dedicated to big tech projects, officials said. ... The Centers for Medicare and Medicaid Services initially served as its own general contractor on the project, but its lack of technical expertise quickly became apparent. Only after the site's launch did the White House bring in experts from Silicon Valley as well as a new general contractor (Nagesh, 1/3).

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Administration: Contraception Rule Does Not Burden Religious Groups

In the latest legal skirmish over the so-called contraceptive mandate in the health law, Obama administration lawyers urged Justice Sonia Sotomayor to drop an appeal from the Little Sisters of the Poor and other Catholic groups. Nonprofit religious charities can opt out of the requirement, they argued. The rule already faces a challenge from several for-profit companies that will be heard by the high court.

Politico: Administration Faces Tough Fight On Contraception Cases
As a new round of religion-based challenges to President Barack Obama’s health care law head to the Supreme Court, advocates on both sides of the issue say the administration’s arguments are likely facing a chilly reception. On Friday, the Obama administration urged the court to reject a plea from an order of nuns who say a provision of Obamacare conflicts with their opposition to birth control. Already, the Supreme Court is preparing to hear two cases filed by private companies who say contraception provisions in the law violate their firms’ rights to religious freedom. Together, the cases could recreate a broad left-right coalition on the court that has emerged in the past decade to defend religious rights against alleged government intrusions (Gerstein, 1/4).

CQ HealthBeat: Solicitor General Argues Contraception Rule Doesn't Burden Religious Groups
The Justice Department on Friday appealed to Supreme Court Justice Sonia Sotomayor to reconsider her Dec. 31 decision to temporarily block the federal government from requiring a nonprofit Catholic organization in Colorado to make birth control coverage available to its employees under the 2010 health care overhaul (1/3).

McClatchy: No Need To Delay Obamacare Birth Control Rule, Administration Says
Obama administration lawyers strongly urged Justice Sonia Sotomayor and her fellow Supreme Court members to drop an appeal from the Little Sisters of the Poor and other Catholic groups who object to the so-called contraceptive mandate in the new health care law. Nonprofit religious charities already can opt out of the requirement to pay for insurance coverage for contraceptives and therefore have nothing to complain about, U.S. Solicitor Gen. Donald Verrilli Jr. told the court. "With the stroke of their own pen," the nuns and other Roman Catholic charities "can secure for themselves the relief they seek from this court" (Savage, 1/5).

CNN: 5 Things To Know About Obamacare And Contraceptives
A court order could ultimately impact scores of religious groups and non-profit businesses, ... But it would be only a stop-gap or temporary measure, either blocking or allowing enforcement until the federal courts decide larger legal and constitutional questions. ... Separately, the justices in March will take up a related challenge to the birth control coverage mandate. That appeal concerns whether some for-profit corporations should be exempt, again on religious liberty grounds (1/3). 

Earlier KHN news coverage summary: Justice Dept. Defends Birth Control Rule Against Nuns' Suit (1/5).

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White House Seeks To Tighten Background Checks To Keep Guns From Those With Mental Illness

The Obama administration is proposing regulatory changes to clarify who is prohibited from owning a gun for mental health reasons and to tighten background checks. In the meantime, lawmakers consider increasing mental health funding after the Sandy Hook massacre.

Bloomberg: Obama Seeks Tighter Mental Health Restrictions On Guns
The Obama administration took steps to tighten gun background checks to keep firearms out of the hands of the mentally ill as the president's broader gun-control proposals remain stalled in Congress (Talev, 1/4).

CQ HealthBeat: More Mental Health Funding After Sandy Hook? Not Yet
Congressional leaders face a decision this month whether it’s time to increase mental health funding in response to the mass shootings more than a year ago at Sandy Hook Elementary School in Newtown, Connecticut. Lawmakers on a bipartisan basis have been urging them to do so (Young, 1/3).

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State Watch

New Abortion Restrictions Continue Torrid Pace With Texas Law At Center

Between 2011 and 2013, more than 200 abortion restrictions were passed in states, NPR reports. At the center of recent controversy is a Texas law that would require doctors giving abortions to have admitting privileges at nearby hospitals.

NPR: 22 States Curb Access To Abortion In 2013
While much national attention was focused on efforts to restrict abortion in Texas, a new study from the Guttmacher Institute reports that as many as 22 states enacted 70 provisions aimed at curbing access to abortion. That makes 2013 second only to 2011 in the number of abortion restrictions enacted in a single year, according to the think tank for reproductive rights. To put the recent trend in some perspective: The 205 abortion restrictions enacted between 2011 and 2013 were more than the 189 enacted during the entire previous decade (Rovner, 1/4).

The New York Times: Access to Abortion Falling As States Pass Restrictions
A three-year surge in anti-abortion measures in more than half the states has altered the landscape for abortion access, with supporters and opponents agreeing that the new restrictions are shutting some clinics, threatening others and making it far more difficult in many regions to obtain the procedure. Advocates for both sides are preparing for new political campaigns and court battles ... On Monday, in a clash that is likely to reach the Supreme Court, a federal appeals court in New Orleans will hear arguments on a Texas requirement that abortion doctors have admitting privileges at local hospitals -- a measure that caused one-third of the state’s abortion clinics to close, at least temporarily (Eckholm, 1/3).

Bloomberg: Texas Seeks To Revive Abortion Law As Clinics Cut Service
Texas officials are seeking to revive a state requirement that abortion doctors ... affiliate with local hospitals by overturning a federal judge's finding that the measure isn't medically necessary and places an unconstitutional burden on women seeking to end pregnancies (Fisk and Lawton, 1/6).

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State Highlights: N.C. Officials Detail Medicaid Personal Info Mishap

A selection of health policy stories from North Carolina, Massachusetts, Florida, Virginia, Wisconsin and California.

The Associated Press: DHHS: Some Officials Knew Of Medicaid Card Misfire
North Carolina health officials have clarified precisely when they first learned that cards with the personal information of nearly 49,000 children receiving Medicaid benefits had been mailed to the wrong addresses. State Department of Health and Human Services spokesman Ricky Diaz told The Associated Press on Friday the agency first learned about the massive privacy breach the prior day. On Saturday, the agency issued a new statement saying some state employees had actually been aware of the issue days earlier (Biesecker, 1/6).

WBUR: 5 Measures To Compare Childbirth At Mass. Hospitals
Childbirth is one of the most important medical events of our lives, if not the most important. We want to make sure our moms and babies get the best possible care. But we often choose that care based solely on reputation or word of mouth. A WBUR data analysis aims to offer more. We've pulled together childbirth quality data that, for the first time, enable pregnant women and their families to compare hospitals across Massachusetts (Bebinger, 1/6).

Health News Florida: Time To Fix Glitch In Pharmacy Law?
After a long delay, the Florida Department of Health wants to fix a gap in the law that made it powerless over out-of-state compounding pharmacies. When tainted injections from New England Compounding Pharmacy caused a fungal meningitis epidemic in 2012, the state discovered it had licensed hundreds of such facilities to send drugs into Florida. It also found that Florida law gave DOH no authority over those located in other states (Gentry, 1/3).

Miami Herald: The State of Medicaid Devices In South Florida Innovation
Kevin W. Smith and his partners split nearly $200 million when they sold Miami-based surgical equipment manufacturer Symbiosis in 1996 to health care heavyweight Johnson & Johnson. Smith and other Symbiosis alumni became independently wealthy the day of the sale. But they're back in the game in a big way (Seemuth, 1/5).

The Washington Post: Left Flank Upset With Va. Gov.-Elect McAuliffe Over Cabinet Appointments
Some of the activists who helped launch Terry McAuliffe to victory in November sound as though they’re not savoring the big win in the Virginia gubernatorial election as much as they are working through the stages of grief. "You just have to move on, accept it," said Katherine Waddell, a Republican who backed McAuliffe (D) largely because of his support for abortion rights. "You believe in the governor and what he said. And you move on" (Vozzella and Weiner, 1/5).

The Milwaukee Journal Sentinel: Sen. Glenn Grothman's Bill Would Exempt E-Cigarettes From Smoking Ban
A state senator wants to ensure people can puff on electronic cigarettes in restaurants, bars and other public places by introducing a bill that would explicitly exempt the products from the state's 31/2-year-old smoking ban. Sen. Glenn Grothman (R-West Bend) said he put forward the bill because he was concerned "busybody public health" officials and interest groups would attempt to limit the use of e-cigarettes. He pointed to New York City's recent decision to include e-cigarettes in its smoking ban as a reason to be worried it could happen here (Marley, 1/3).

California Healthline: Legislature Returns, So Will Some Bills
Several high-profile bills are likely to resurface this session, including expansion of mid-level caregivers' scope of practice and rescission of a Medi-Cal provider rate cut that went into effect last year. … The Legislature in 2011 passed a 10 percent cut in Medi-Cal reimbursements to providers. Phased-in cuts did not start until September 2013 after being held up in court challenges for more than two years. Legislation did pass last session to exempt rural acute-care skilled nursing facilities from the cut, but the bulk of providers in California still are feeling it (Gorn, 1/3).

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Editorials and Opinions

Viewpoints: Rethinking What Health Insurance Should Cover; Sen. Johnson Suing Over Congressional Health Plan; Medicaid's Unsung Success

Los Angeles Times: It's Time To Rethink Health Insurance
The proper role of health insurance should be to finance necessary and expensive medical services without the patient incurring devastating financial consequences.  Over the last decade, however, Americans have come to expect their health insurance to subsidize the consumption of all medical care. ... This shift in expectation has meant that health insurance stands out as entirely different from all other types of insurance. Ask yourself: Would you use automobile insurance to buy gasoline? Would you use homeowner insurance to finance painting your house? This wrongheaded view has played an important role in contributing to rapidly rising health care costs (George P. Shultz, Scott W. Atlas and John F. Cogan, 1/5).

Los Angeles Times: The Quasi-Final 2013 Tally For The ACA: More Than 9 Million Insured
Enrollment figures for insurance under the Affordable Care Act are all over the place, largely because the act has so many moving parts: the individual insurance exchanges (federal and state), Medicaid (in expansion states and otherwise), children enrolled in their parents' employer-sponsored plans. Keeping track of the numbers requires an obsession. So be thankful that one Charles Gaba has taken on the responsibility. Gaba's conclusion is that the ACA has brought insurance in one form or another to more than 9 million Americans, possibly 9.5 million (Michael Hiltzik, 1/3). 

The Wall Street Journal: Obamacare Is Redistribution, Not Reform
Every piece in Obamacare is being postponed or rewritten. The individual mandate is becoming a comatose letter if not a dead one. In the latest doomed innovation from the White House, insurers are being sandbagged by a new requirement to sell to older, sicker customers policies designed and priced for a healthier, under-30 crowd. Obamacare's authors are being mugged by reality in real time, before our eyes. This is the most propitious development for health care reform in decades (Holman W. Jenkins, Jr., 1/3).

The New York Times: An Error Message For The Poor 
More than two million people have signed up for health insurance coverage under the Affordable Care Act, a tribute to the effectiveness of the "tech surge" the Obama administration deployed to overcome the highly publicized problems with healthcare.gov that emerged in October. ... Sadly, food stamp and Medicaid recipients can only look on in envy. ... students of anti-poverty programs remember a litany of automation and contracting meltdowns -- some of them prolonged, even epic. ... [A]ttention, oversight and willingness to act decisively to remedy fiascoes seem to depend on the wealth and clout of those who are affected (David A. Super, 1/3).

The Wall Street Journal: I'm Suing Over Obamacare Exemptions For Congress
On Monday, Jan. 6, I am filing suit in the U.S. District Court for the Eastern District of Wisconsin to make Congress live by the letter of the health care law it imposed on the rest of America. By arranging for me and other members of Congress and their staffs to receive benefits intentionally ruled out by the Patient Protection and Affordable Care Act, the administration has exceeded its legal authority (Sen. Ron Johnson, R-Wis., 1/5). 

The Wall Street Journal: Little Sisters Of The Government
[The Little Sisters of the Poor] belong to a special type of insurance collective known as a church plan, also run by a Christian order. This plan will itself also qualify for the accommodation, in the same way as a Christian soup kitchen.The Administration never envisioned that a religiously affiliated organization would contract with a religiously affiliated insurer, probably because there are so few church plans. ... This case is simply a raw assertion of state power directing the religious to follow orders (1/3).

Bloomberg: How Obama Can Get His Groove Back
Even with no real scandal and only one demonstrable policy blunder, the health-care rollout, President Barack Obama had a miserable 2013 as his public standing plummeted. History suggests it is tough for a second-term president to rebound. ... The president and Democrats are paying a huge price for the dreadful rollout of the Affordable Care Act and HealthCare.gov. The goal of 7 million enrollees by April 1 is beyond reach. There must, however, be a substantial number -- say 5 million, with a quarter of those young people -- to keep the support of the insurance industry and prevent an explosion in premiums. Obama had to enlist an expert to fix the website. The critical question in 2014 will be whether a chief executive is tapped to run the entire program (Albert R. Hunt, 1/5).

Bloomberg: Let's Celebrate Medicaid's Success
But the fact remains that Medicaid enrolled well over twice as many people as signed up for private insurance through the exchanges. It’s "the biggest ACA success story that has not yet been told," says Ron Pollack, head of Families USA, a nonpartisan health-care advocacy group (Ezra Klein, 1/3).

New Hampshire Union Leader: Expand Medicaid? Why Would NH Do That?
Medicaid is a boondoggle. There are far better ways to insure low-income people than by enrolling them in Medicaid. The one and only reason the left so passionately advocates expansion is to sweep more people into government-provided health insurance. People who are more dependent upon the government are therefore more dependent upon the party of government -- the Democrats. This is what Medicaid expansion is all about (1/4).

New Hampshire Union Leader: A 2014 Agenda For New Hampshire
Without question, the single most important thing we must accomplish as soon as possible is expanding access to health care to 58,000 men, women and children across our state. ... With nearly all of the northeastern states engaging in Medicaid expansion, we put our state at a competitive disadvantage (and a loss of $500,000 per day) by refusing to participate in the program. On Wednesday, one of our first orders of business will be to amend a related retained bill to include Medicaid expansion (New Hampshire House Speaker Terie Norelli, 1/4).  

Health Policy Solutions (a Colo. news service): Driving Into Obamacare's Future Using The Rear-View Mirror
I view the website rollout and the paucity of recent enrollments with a jaundiced eye. After all, it took Amazon, Google, Facebook and Twitter five years before they got their mojo. Obamacare, in the end, has the penalties and subsidies to drive demand. By 2017, enrollment will meet expectations and the wrinkles will be ironed out of the system. The insurance companies and federal government will use their deep pockets to make it happen. The news media have temporarily found a perverse form of currency in the problems. While advertisers like the attention of all the eyeballs and ears, the talking heads have missed the big picture (Francis Miller, 1/3).

And on other issues --

The New York Times' Opinionator: Can Upward Mobility Cost You Your Health?
Even in an age of soaring inequality, we like to think that people can still make it big here if they work hard and stay out of trouble. The socioeconomic reality of most of the last four decades -- stagnant wages, soaring income and wealth inequality, and reduced equality of opportunity -- have dented, but not destroyed, the appeal of the American dream. Those who do climb the ladder, against the odds, often pay a little-known price: Success at school and in the workplace can exact a toll on the body that may have long-term repercussions for health (Gregory E. Miller, Edith Chen and Gene H. Brody, 1/4).

CNN: Is Lung Cancer Screening Right For You
This week, the U.S. Preventive Service Task Force issued its long-awaited guideline on lung cancer screening. They recommend annual screening for lung cancer with low-dose computed tomography (CT) in adults ages 55 to 80 who are at high risk for lung cancer ... The Affordable Care Act mandates that health insurance cover screenings the task force deems useful. ... Many health care centers will have to work to ensure they have the appropriate equipment and skills to provide screening. Just as with the introduction of mammography for breast cancer screening, it may take years for these skills to be available throughout the country (Dr. Otis Brawley, 1/3).

The Boston Globe: Boston Must Rein In Retiree Health Plans
While the problems of Detroit have highlighted the large deficits in municipal pension plans, less attention has been given to the even larger unfunded obligations of cities to pay the health care benefits of their retired employees -- called retiree health care plans, or RH plans. Most recently, in 2011 Boston reported an unfunded deficit of $3 billion for its RH plan (Robert Pozen, 1/5).  

WBUR: A Phrase To Renounce For 2014: 'The Mentally Ill'
I wince every time I read it. So does the president-elect of the American Psychiatric Association, Dr. Paul Summergrad, he says. I saw it most recently in The New York Times, in the headline pictured above and a recent masthead editorial: "Equal Coverage For The Mentally Ill." It's all over, from The Boston Globe -- "New Era for the Mentally Ill" -- to The Wall Street Journal -- "Crime and The Mentally Ill." Just about any media outlet you care to name. What's so bad about "the mentally ill"? Isn’t it reasonable shorthand in the usual headline space crunch? (Carey Goldberg, 1/3).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Marissa Evans
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.