Daily Health Policy Report

Tuesday, February 11, 2014

Last updated: Tue, Feb 11

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Health Care Marketplace

Public Health & Education

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Pharmacists Increasingly Take On Clinical Roles

Kaiser Health News staff writer Anna Gorman, working in collaboration with USA Today, reports: "Once limited to filling and dispensing drugs, pharmacists are increasingly providing direct care to patients. Across the country, they are working with doctors to give immunizations and help patients safely manage medications. In some places, they can even write prescriptions after a physician's diagnosis. California is among the states to give pharmacists the greatest flexibility, thanks in part to a law that took effect this year. Other states, including New Mexico and North Carolina, have also allowed pharmacists to take on more clinical responsibilities" (Gorman, 2/11). Read the story.

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States Accelerate Shift Of Nursing Home Residents Into Medicaid Managed Care

Kaiser Health News staff writer Phil Galewitz, working in collaboration with USA Today, reports: "(Social worker Jodie) Muenz' visit is part of a transformation of how Medicaid, the state-federal health insurance program for the poor, is providing long-term care to hundreds of thousands of people in Florida and a growing number of states. After two decades of shifting millions of Medicaid enrollees into managed care, most of them women and children, Florida is mandating that approach for 45,000 nursing home residents and another 40,000 who get long-term care services at home or assisted living facilities. The job of a case worker like Muenz is to make sure her clients get what they need to stay healthy – and that they live in the least-restrictive and least costly setting possible" (Galewitz, 2/11). Read the story.

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Insuring Your Health: Some Same-Sex Couples Denied Family Policies On Insurance Marketplaces

Kaiser Health News consumer columnist Michelle Andrews writes: "Carl Bechdel and Dan Miller started looking for a family plan on the Pennsylvania health insurance marketplace last fall. After submitting their application for a bronze-level plan to Highmark Blue Shield in early December, they became concerned when the end of the month approached and they hadn’t heard from the insurer. Bechdel called customer service and finally learned the reason: The company doesn’t offer family coverage to same-sex couples" (Andrews, 2/11). Read the column.

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Political Cartoon: 'The Healthy Alternative?'

Kaiser Health News provides a fresh take on health policy developments with "The Healthy Alternative?" by Jimmy Margulies.

And here's today's health policy haiku:

AGAIN WITH THE EMPLOYER MANDATE

Another delay...
Is it good policy or
just more politics?
--Anonymous  

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

Obama Administration To Delay Requirement For Mid-Sized Employers To Provide Health Insurance To Workers

Officials announced Monday that the government will not enforce the mandate for businesses with 50 to 99 workers until 2016. In addition, larger employers will also be allowed to cover just 70 percent of workers in 2015, instead of the 90 percent originally required. 

The New York Times: Further Delays for Employers In Health Law
The Obama administration announced on Monday that it would postpone enforcement of a federal requirement for medium-size employers to provide health insurance to employees and allow larger employers more flexibility in how they provide coverage (Pear, 2/10).

The Washington Post: White House Delays Health Insurance Mandate For Medium-Sized Employers Until 2016
For the second time in a year, the Obama administration is giving certain employers extra time before they must offer health insurance to almost all their full-time workers. Under new rules announced Monday by Treasury Department officials, employers with 50 to 99 workers will be given until 2016 — two years longer than originally envisioned under the Affordable Care Act — before they risk a federal penalty for not complying. Companies with 100 workers or more are getting a different kind of one-year grace period. Instead of being required in 2015 to offer coverage to 95 percent of full-time workers, these bigger employers can avoid a fine by offering insurance to 70 percent of them next year (Eilperin and Goldstein, 2/10).

Politico: Obamacare Delay Sparks New Mandate Fight
Once again, it's employers who are getting a break from their Obamacare mandate – and that's sure to increase the pressure on the Obama administration to delay the mandate for individuals, too. Regulations announced by the Obama administration Monday give two levels of delay to employers who would have had to cover their workers next year. Some businesses will get an extra year – until 2016. And the bigger businesses that do have to worry about the mandate will have it phased in over two years (Norman and Nather, 2/10).

Los Angeles Times: U.S. To Further Delay Obamacare Employer Mandate
Now, under Monday's action, the employer mandate will be phased in and won't fully take effect until 2016. The additional delay is likely to have little effect on employees because the vast majority of large employers already offer health benefits. The phase-in plan drew praise from several leading business groups that have worried about complying with the complicated documentation required by the law (Levey, 2/10).

The Wall Street Journal: Health-Law Mandate Put Off Again
 The move came after employers pressured the Obama administration to peel back the law's insurance requirements. Some firms had trimmed workers' hours to below 30 hours a week to avoid paying a penalty if they didn't offer insurance. A senior administration official said the shift was a response to businesses' concerns, though the official said no one reason was behind the change (Radnofsky and Francis, 2/10).

NPR: Health Law's Employer Mandate Hits Another Speed Bump
Republicans were quick to blast the Administration for selective implementation of the law. "Once again, the President is rewriting law on a whim," said House Speaker John Boehner a written statement. Sean Spicer, communications director for the Republican National Committee, was more direct. "I think there is a huge bit of irony," he told NPR, "that the administration and Democrats in Congress accused Republicans of trying to undo a law that they have unilaterally continued to undo or delay, week after week, as they have recognized how unpopular it is throughout the country." But not everyone sees the move as purely political. Neil Trautwein, of the National Retail Federation, says his group is grateful for the new flexibility the rules provide
(Rovner, 2/10).

The Washington Post: Obama Administration Pushes Back Deadline For Some Businesses To Provide Health Care
In the final regulations published Monday, Internal Revenue Service and Treasury Department officials established three separate timetables for business owners, no longer spliting employers into only "large" or "small." Here’s what employers need to know (Harrison, 2/10).

The Associated Press: Employers Scrutinize Latest Health Care Concession
It may take weeks to render a verdict on the Obama administration’s latest health care concession to employers. But that could make a difference for Democrats battling to keep control of the Senate in the fall congressional elections (Alonso-Zaldivar, 2/11).

ABC News: Small Businesses Get One-Year Reprieve From Obamacare 'Employer Mandate'
The Obama administration has once again delayed a major provision of the president's signature health care law. Small businesses will get a one-year break from Obamacare's controversial "employer mandate," the requirement that businesses must provide health care coverage if they employ more than 50 workers at more than 30 hours per week, the U.S. Treasury announced today. "We think the phase-in approach really is a way to administer the law better and enhance overall compliance with the law," an administration official told reporters on a conference call (Good, 2/10).

Fox News: Republicans Renew ObamaCare Battle After Latest Mandate Delay
Republicans renewed their calls to delay or repeal ObamaCare Monday after the Obama administration announced another delay in the requirement for businesses to provide health coverage to workers, giving some employers a reprieve next year while phasing in the mandate for others. The administration had already delayed the implementation of the so-called employer mandate by a year, initially pushing the requirements off until 2015 -- past the midterm elections. In a concession to business, though, Treasury Department officials announced Monday that the administration would not enforce the rules across the board next year (2/11).

Roll Call: One Obamacare Mandate Delay Announced As GOP Senators Question Another
Smaller employers will have another year to comply with the requirement to provide health care to employees under Obamacare's new requirements, even as Republican senators question how the administration will enforce the individual mandate at all. The employer mandate had already been delayed for one year, but the Treasury Department announced Monday afternoon that the final rule for implementation provides a further phase-in for smaller employers (Lesniewski, 2/10).

Meanwhile, regarding another health law mandate --

CNN: Hobby Lobby Asks Supreme Court For Exemption To Obamacare Mandate
Hobby Lobby asked the U.S. Supreme Court on Monday for an exemption to the requirement under the Affordable Care Act that certain for-profit corporations provide contraception coverage to their workers. Ahead of oral arguments next month, the craft store giant is seeking exclusion on religious grounds from the health care law's requirements, maintaining that some contraceptive products, like the morning-after pill, equate to abortion. Oral arguments for the case, Sebelius v. Hobby Lobby, begin March 25. The issue is whether secular, private corporations can claim religious exemption from federal laws (Davidsen, 2/10).

And here's how the law's big picture is playing in social media -- 

Politico: The Web’s Cacophony Of Anti-ACA Sentiment
The ire at #brokenpromises is beating the push to #getcovered. Anger is contagious on social media, and it has been easier to use Twitter and Facebook to stoke opposition to Obamacare than to implore people to sign up. Social media experts say supporters of the president's health law just haven't been as effective as the seething anti-Obamacare forces in getting out sharp, clear messages (Cunningham, 2/11).

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Weekend Maintenance Will Affect Healthcare.gov

Meanwhile, Maryland officials say the problems with that state's enrollment website are unlikely to be fixed before the March 31 enrollment deadline. Elsewhere, California is hiring more call center workers, and Illinois is reaching out to young adults with ads in the satirical online newspaper, The Onion.

The Associated Press/Washington Post: Weekend Tech Maintenance To Affect Healthcare.gov
This time, they’re giving you notice. Some consumers won’t be able to finish their online health insurance applications this weekend because Social Security’s computer system will be undergoing heavy maintenance. It will not be able to verify Social Security numbers and certain other personal details needed for coverage under President Barack Obama’s health care law (2/10).

The Associated Press/Washington Post: Official: Md. Looking At Health Exchange Options
Maryland’s online health care exchange has some significant problems that are not on track to be corrected by the March 31 deadline for open enrollment, and officials are exploring other options for the second enrollment period starting in November, state officials told a legislative oversight panel on Monday (2/10).

The New York Times: California’s Physician Directories Removed Because Of Errors
The California health care exchange has taken down its physician directories, amid continuing complaints from doctors and patients alike that the lists of doctors and hospitals included in each insurance plan were error-riddled and unreliable. Since the October rollout of Covered California, inaccuracies have posed countless problems: The lists described doctors as fluent in languages they did not speak; obstetricians were labeled as ophthalmologists; and physicians were falsely listed under insurance plans that did not cover care at their offices (Lovett, 2/10).

Los Angeles Times: Covered California Is Hiring More Workers To Fix Service Problems
California's health insurance exchange is racing to fix persistent service problems before it faces another surge of Obamacare applicants eager to beat a March enrollment deadline. The Covered California exchange said 250 new call-center workers began training Monday, and as many as 150 more employees will come on board in the coming weeks to ease phone wait times that stretch nearly an hour. Those additions would bring the total number of call-center staff to 900 people from about 500 now (Karlmangla, 2/10).

The Associated Press: California Expands Health Exchange Call Centers
The executive director of California's health insurance exchange said Monday that he is hiring 400 call-center workers, many in Fresno, with the goal of alleviating telephone backlogs that have frustrated those applying for health care. Peter Lee, executive director of Covered California, formally announced the staffing increase in a visit to a Fresno call center, where 250 new employees began training on their first day of work (Smith, 2/10).

The San Jose Mercury News: 350 Workers Added To Covered California Call Lines
Hundreds of customer service representatives will be added to Covered California’s phone lines, to help cut wait times and to enroll more state residents into health care plans before a March deadline, state officials announced Monday. At least 350 customer service representatives will be added to the 900 already in place, said Peter Lee, Executive Director for Covered California. About 30 of the new people hired will speak Spanish, while others will offer help in Mandarin, Vietnamese and Korean languages. The extra employees represent an increase in staff of roughly 40 percent and the hiring comes just as Covered California, the state’s health plan exchange, is hoping to enroll thousands of state residents by their March 31 deadline (Abram, 2/10).

The Associated Press/Wall Street Journal: NY Health Exchange Insures Thousands More 
The state's new health exchange reports nearly 697,000 New Yorkers have completed applications for insurance while more than 412,000 of them have now enrolled for specific coverage (2/11).

The Associated Press/Washington Post: Illinois Using The Onion To Reach Young Uninsured
Trying to sell young adults on the idea of health insurance before an upcoming deadline, Illinois officials announced Monday they are launching an ad campaign with the satirical online newspaper The Onion (2/10).

The Oregonian: Cover Oregon: Senate Panel Advances Bill Extending Health Insurance To High-Risk Oregonians
A Senate panel on Monday advanced a bill to extend health insurance to high-risk people previously covered under theOregon Medical Insurance Pool. Senate Bill 1582 would ensure money is available for a temporary health plan that Oregon Health Authority officials created at the beginning of the year to provide continued coverage for pool members who weren’t able to enroll through Cover Oregon by Jan. 1. The bill, sponsored by Senate President Peter Courtney, D-Salem, is one of several on Cover Oregon that lawmakers are considering (Zheng, 2/10).

The Star Tribune: Cost Of MNsure Insurance May Leave Target Group No Better Off
Jamie Ward has run the numbers over and over -- even consulting a financial counselor -- and still doesn’t know if she can afford the health insurance she found on MNsure. With two months left to enroll for benefits this year, the 29-year-old from East Bethel must decide whether to buy coverage for herself and her husband -- or risk staying uninsured and paying a penalty imposed by the new federal health law. “It might be cheaper to pay a hospital bill if something happens than to pay a premium every month,” she said in a recent interview. Setting aside the problems that have hounded the state’s troubled health insurance website, the key measure of MNsure -- and the federal health law it embodies -- is whether it successfully extends health benefits to Minnesota’s estimated 490,000 uninsured -- people such as the Wards (Olson, 2/11).

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Arkansas Lawmakers Could Retreat From Innovative Medicaid Expansion Plan

The legislature may reverse course just at Republicans in other states are weighing whether to follow the Arkansas proposal to use federal funds to buy private insurance for some of the state's low income residents.

The New York Times: In Arkansas, 'Private Option' Medicaid Plan Could Be Derailed
Last year, the Republicans who control this state's Legislature devised a politically palatable way to expand Medicaid under President Obama's health care law. They won permission to use federal expansion funds to buy private insurance for as many as 250,000 poor people instead of adding them to traditional Medicaid, which conservatives disparage as a broken entitlement program. But just as the idea is catching fire in other states with Republican or divided leadership — Iowa has adopted a version of the plan, and New Hampshire, Pennsylvania, Utah and other states are exploring similar avenues — Arkansas may abruptly reverse course, potentially leaving the 83,000 people who have signed up so far without insurance as soon as July 1 (Goodnough, 2/10).

Earlier, related KHN coverage: Arkansas' Medicaid Experiment, Key To Obamacare Expansion, On Ropes (Galewitz, 2/10).

Health News Florida: On Medicaid, FMA Punts Again
The Florida Medical Association's Board of Governors turned aside a resolution in support of Medicaid Expansion last weekend, sending it to a committee. While FMA did not say that effectively kills it for this legislative session, its supporters did (Gentry, 2/10).

The Richmond Times-Dispatch: Medicaid Audit Backed
A resolution to launch a two-year audit of Virginia's Medicaid program sailed through the House on a 70-29 vote on Monday. House Joint Resolution 40 would direct the Joint Legislative Audit and Review Commission to contract with an outside consultant to perform the audit, which is likely to be included in the proposed budget the House Appropriations Committee will unveil Sunday (2/11).

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Capitol Hill Watch

GOP Wants To Restore Some Military Retiree Pensions, Tie It To Debt-Limit Raise, Extend Medicare Cuts

Republicans are considering tying an increase in the debt ceiling to restoring pension cuts for military retirees and paying for it by extending automatic cuts to programs, including Medicare. The Medicare doctor payment fix that the GOP was considering tying to the raise is now moving on its own track.

The Associated Press/Washington Post: GOP Mulls Raising Debt Limit, Undoing Pension Cut
The GOP bill would extend Treasury’s borrowing authority for at least another year, repeal the curb passed in December on pension inflation adjustments for military retirees under the age of 62, and extend automatic cuts to Medicare and other programs to 2024 (2/11).

The Washington Post: House GOP Homes In On Debt-Ceiling Plan Tied To Military Pension Benefits
Despite the uncertain fate, Boehner’s team moved ahead with the option linking a restoration of recently cut military pension benefits to a one-year extension of the Treasury’s borrowing authority. The cost of restoring that cut to military pensions, about $7 billion, would be offset by an extension, by one year, of planned automatic spending cuts to entitlement programs. … Other GOP ideas, floated during the past week, were jettisoned by Monday, including the perennial fix to the way Medicare reimbursements are calculated. That legislation is now moving on its own separate track amid bipartisan talks (Costa and Kane, 2/10).

The New York Times: House Republicans Seek To Trade Debt Deal For Repeal On Military Pensions
“As a senator from the most military-friendly state in the nation, I’m pleased that we have voted to advance this legislation that will affect so many brave men and women who have served our country,” Senator Hagan declared after Monday’s vote, adding that the cut would siphon an average of $80,000 over a military retiree’s life. “We can never balance the budget on the backs of those who have answered the call of duty.” House Republican leaders argued that the measure they were championing would not add to the deficit. That is because it would extend to 2024 a 2 percent cut to Medicare health care providers that already is in effect until 2023 (Weisman, 2/10). 

The Hill: GOP Debt Ceiling Bill Includes ‘Doc Fix’ Fund
House Republicans late Monday released the text of legislation to deal with the debt ceiling, which also deals with the "doc fix" issue relating to Medicare physician reimbursements. GOP leaders said the bill would come up for a vote on Wednesday. The Temporary Debt Limit Extension Act was proposed as a substitute amendment to a Senate bill, S. 540, to name an air traffic control tower in New Hampshire. Replacing the text of that bill, which already passed the Senate, will allow the Senate to approve it more quickly (Kasperowicz, 2/10).

The Hill: Hospitals Push Back On Proposal To Extend Cuts
Hospital groups are pushing back on a proposal from House Republicans to extend the Medicare sequestration cuts as part of a bill to raise the debt ceiling. The idea from Speaker John Boehner (R-Ohio) would "undermine care for seniors" and add to onerous reductions already facing Medicare providers, a coalition of hospital groups wrote in a letter to lawmakers Monday (Viebeck, 2/10).

The Associated Press/Washington Post: AMA Supports Overhaul Of Medicare Doctors’ Pay
The American Medical Association says it strongly supports legislation that would change the way Medicare pays doctors, to emphasize quality care and not just sheer volume of services (2/10). 

CQ HealthBeat: ‘Doc Fix’ Bill Gains Backing From AMA, But Short-Term Patch Does Not
The American Medical Association will fully support the bipartisan compromise “doc fix” bill to replace how Medicare pays physicians, but the organization is not yet offering ideas on how to pay for the measure. In addition, the influential physicians’ group is throwing cold water on the idea of a nine-month patch that’s currently being floated in Congress (Ethridge, 2/10).

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Health Care Marketplace

AOL CEO's Assertions Spur Skepticism, Privacy Concerns

Experts say that a company the size of AOL, which pays for its employees' health costs directly, likely has a “stop-loss” policy that covers expenses after they reach a certain point. The New York Times, meanwhile, explores how the comments by CEO Tim Armstrong raise privacy concerns about how employers treat employees' private medical data.

NBC News: Million-Dollar Babies Should Have Been Non-Issue For AOL
Tim Armstrong has had to apologize twice now for his announcement last week saying the company was changing its 401(k) retirement plan policy in part because it had some hefty health care claims, including two babies costing a million dollars each for care. Experts say he may also have something else to apologize for -- not knowing what he was talking about. No company the size of AOL should be strapped by having to pay for the medical care of two “distressed” newborns. And while it might have once been a problem for smaller employers, they say, the issue shows how the new health care law might provide some relief going forward (Fox, 2/10).

The New York Times: Revelations By AOL Boss Raise Fears Over Privacy
Tim Armstrong, the chief executive of AOL, apologized last weekend for publicly revealing sensitive health care details about two employees to explain why the online media giant had decided to cut benefits. He even reinstated the benefits after a backlash. But patient and work force experts say the gaffe could have a lasting impact on how comfortable -- or discomfited -- Americans feel about bosses’ data-mining their personal lives (Singer, 2/10).

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Public Health & Education

GAO: Medicine Shortages Remain Stubbornly High

Some experts say the solution is to pay more for generic injectable drugs.  

CQ HealthBeat: Progress On Drug Shortages Reported By GAO, Total Number Remains High
The Food and Drug Administration has made progress in addressing some immediate causes of drug shortages, but the total number of shortages remains high, according to a Government Accountability Office report issued Monday (Ethridge, 2/10).

The New York Times: Drug Shortages Continue To Vex Doctors
The number of annual drug shortages — both new and continuing ones — nearly tripled from 2007 to 2012. In recent years, drug shortages have become an all but permanent part of the American medical landscape. The most common ones are for generic versions of sterile injectable drugs, partly because factories that make them are aging and prone to quality problems, causing temporary closings of production lines or even entire factories (Tavernise, 2/10).

Marketplace: Problems In The U.S. Drug Pipeline
Drexel Health Professor Robert Field says shortages started to crop up about ten years ago, in large part, after the feds lowered reimbursement rates for generic oncology drugs. ... The solution – ironically – may be bumping up those same reimbursements that got cut a decade ago (Gorenstein, 2/10).

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State Watch

State Highlights: WellPoint Deal Gets Regulator Scrutiny

A selection of health policy stories from California, Virginia, New York, Florida, Connecticut and Georgia.

The Washington Post: Ethics, Mental Health Bills Advance In Virginia General Assembly
Virginia lawmakers moved forward Monday on an ethics law overhaul and mental health legislation, two causes given urgency by recent events. The Senate passed the ethics package with only one dissenting vote, despite grumbling by some lawmakers that the legislation is poorly designed. A similar bill was approved on a preliminary vote in the House. The mental health bill passed the Senate with no opposition and was backed by the House on a preliminary vote (Weiner, 2/10). 

The Richmond Times-Dispatch: Senate Approves Deeds-Backed Mental Health Bill
The painful journey that began almost three months ago for Sen. R. Creigh Deeds, D-Bath, continues now on the other side of the Capitol in the Virginia House of Delegates. Deeds reached a milestone in his quest for mental health reforms on Monday in the Virginia Senate. It voted 38-0 to approve legislation he sponsored in the aftermath of the Nov. 19 attack by his son that left the senator bleeding from multiple stab wounds and Austin R. “Gus” Deeds dead by his own hand. The centerpiece of Senate Bill 260 is a 24-hour limit on emergency custody orders to hold people involuntarily for psychiatric evaluation — quadrupling the current limit of six hours to prevent people from being released, as his son was, despite being found a danger to themselves or others (Nolan and Martz, 2/11).

The Wall Street Journal: Regulators Seen Taking Notice Of WellPoint Deal In New York
An agreement by WellPoint Inc. to grant some New York health-law marketplace consumers a three-week break on premiums could draw attention from regulators in other states where insurers have struggled with service issues. The New York governor's office said the agreement came after an investigation by state regulators into consumer complaints about service issues. The insurer has agreed to provide payments equivalent to three weeks of premiums for people who enrolled through the state's exchange, paid a premium for January and didn't receive care during that month, the state said. WellPoint sells plans in New York under the Empire BlueCross BlueShield brand (Mathews, 2/10).

Kaiser Health News: Pharmacists Increasingly Take On Clinical Roles
Once limited to filling and dispensing drugs, pharmacists are increasingly providing direct care to patients. Across the country, they are working with doctors to give immunizations and help patients safely manage medications. In some places, they can even write prescriptions after a physician's diagnosis. California is among the states to give pharmacists the greatest flexibility, thanks in part to a law that took effect this year. Other states, including New Mexico and North Carolina, have also allowed pharmacists to take on more clinical responsibilities (Gorman, 2/11).

The California Health Report: A Quiet Revolution In Primary Care
Amidst the furor over last year’s failed attempt to ease a shortage of primary-care physicians by letting nurse practitioners operate without direct doctor supervision, a more modest piece of California legislation is quietly taking effect. Senate Bill 493 became law on Jan 1. Pending the approval of California State Board of Pharmacy protocols later this year, it authorizes pharmacists to provide such medical services as furnishing routine vaccinations, hormonal contraception and nicotine replacement medications, as well as certain prescription drugs for travelers (Richard, 2/11).

Los Angeles Times: L.A. Care Health Plan CEO Howard Kahn To Step Down In January 2015
Howard A. Kahn, the chief executive of L.A. Care Health Plan, said he plans to leave in January after leading the large Medicaid managed-care provider for 13 years. The organization announced the move late Friday. Kahn said it was time to do something different (Terhune, 2/10).

Kaiser Health News: States Accelerate Shift Of Nursing Home Residents Into Medicaid Managed Care
(Social worker Jodie) Muenz' visit is part of a transformation of how Medicaid, the state-federal health insurance program for the poor, is providing long-term care to hundreds of thousands of people in Florida and a growing number of states. After two decades of shifting millions of Medicaid enrollees into managed care, most of them women and children, Florida is mandating that approach for 45,000 nursing home residents and another 40,000 who get long-term care services at home or assisted living facilities. The job of a case worker like Muenz is to make sure her clients get what they need to stay healthy – and that they live in the least-restrictive and least costly setting possible (Galewitz, 2/11).

The CT Mirror: Malloy: Let Nurse Practitioners In CT Work Independently Of Doctors
Nurse practitioners would be allowed to treat patients and prescribe medications independently under a proposal by Gov. Dannel P. Malloy’s administration, a potentially significant -- and controversial -- change in the medical landscape aimed at expanding access to primary care. The ability of nurse practitioners to work independently of doctors has long been an issue of contention between the two professions, and states vary widely in how they allow nurse practitioners to practice. But the federal health law commonly known as Obamacare puts the debate in a new context: The expansion of insurance coverage to thousands more people is expected to raise the demand for primary care, at a time when the state already faces a shortage of primary care doctors and an aging physician population (Becker, 2/11).

The Miami Herald: State Lawmakers To Explore Telemedicine
The doctors at Miami Children’s Hospital use advanced communications technology to diagnose sick children in Ecuador, Peru and the Dominican Republic. Helping young patients in remote parts of Florida or other states, however, is not so easy (McGrory, 2/11).

Georgia Health News: State Workers, Blue Cross Await Coverage Change 
Blue Cross and Blue Shield of Georgia is gearing up to handle the transition of the State Health Benefit Plan (SHBP) to a co-pay system next month. Teachers, state employees and other members of the SHBP will get new ID cards, said Morgan Kendrick, president of Blue Cross, the state’s largest health insurer, in an interview with GHN. Consumers may get a rebate or credit on their previous health care transactions for this year, as a result of the switch to a co-pay system. Currently, patients are operating with a co-insurance model, where they pay a percentage of the costs of a health service (Miller, 2/10).

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Editorials and Opinions

Viewpoints: Obama's 'Lawless Rewrite' Of Health Law; AOL's CEO Gets The Villain Wrong; CBO (Politely) Rebuts GOP On Job Loss

The Wall Street Journal: Obama Rewrites Obamacare
"ObamaCare" is useful shorthand for the Affordable Care Act not least because the law increasingly means whatever President Obama says it does on any given day. His latest lawless rewrite arrived on Monday as the White House decided to delay the law's employer mandate for another year and in some cases maybe forever (2/10).

Bloomberg: AOL's Armstrong Needs Obamacare
Let's get the obvious out of the way: As chief executive officer of AOL Inc., Tim Armstrong shouldn't have stood up and blamed proposed changes to the company's 401(k) plan on two discrete  and, to many AOLers, recognizable medical catastrophes. ... Although Armstrong's comments were a disaster, the problem he's facing is real. Large companies such as AOL self-insure. Even companies that are much smaller than AOL self-insure. That means their risk pools are made up of their employees. If their employees are older or sicker than average, their premiums rise. ... An irony of Armstrong's predicament is that Obamacare, which he partly blames for his company's increased costs, might be its salvation (Ezra Klein, 2/10).

MSNBC: Was AOL’s Tim Armstrong right?
There is one aspect to Armstrong’s behavior in this otherwise-dishonorable episode that deserves praise: honesty. Armstrong dared—foolishly, in this instance—to acknowledge that providing decent health care coverage requires taking money away from some people in order to give it to other people. Insurance, like the government, redistributes income. Indeed, in the case of insurance, redistributing income is—shhhh!–pretty much the whole idea (Timothy Noah, 2/10).

Los Angeles Times: The CBO Tells Republicans (Politely) They're All Wet On Obamacare
As a bipartisan agency, the Congressional Budget Office has to tread lightly when it tells any of its clients on Capitol Hill that they're full of it. So the agency's remarks Monday about the employment impact of the Affordable Care Act is remarkable for its bluntness, even if it is spelled out with the CBO's customary tact (Michael Hiltzik, 2/10). 

The Washington Post: The U.S. Insurance Model Doesn’t Work
The left-right battle that erupted over last week’s Congressional Budget Office (CBO) report showing that Obamacare reduces work incentives was, on the surface, yet another argument about the health-care law’s impact on the U.S. economy. On a deeper level, however, what's at issue are long-standing American assumptions about government assistance and who deserves it (Charles Lane, 2/10). 

The Wall Street Journal: Obamacare Is A Job-Killer? Not At All
The political echo chamber reverberated loudly last week after a new Congressional Budget Office report allegedly projected that cumulative job growth over the next 3-10 years could be 2 million-2.5 million lower because of the Affordable Care Act (ACA). Does that mean "ObamaCare" is a job killer? Not at all. But to understand why, we need to take a trip down memory lane—back to Economics 101 (Alan S. Blinder, 2/10).

Los Angeles Times: Obamacare: Breathing New Life Into Obama's Broken Promise
Remember "If you like your health plan, you can keep it"? The Obama administration may try to breathe new life into that broken promise. In particular, the Associated Press' Tom Murphy reported last week that the administration is mulling whether to let insurers continue offering policies that do not meet the minimum standards set by the 2010 Affordable Care Act, better known as Obamacare. After insurers canceled a huge number of individual policies, President Obama announced in November that those policies could be resurrected for 2014. The administration is now considering whether to give insurers up to three more years before terminating noncomplaint policies (Jon Healey, 2/10). 

USA Today: Religious Liberty Should Trump HHS Mandate
Like many startups, Hobby Lobby began in founder David Green's garage. Now, more than 40 years later, the Green family business has 16,000 full-time employees in stores across the country with 70 new stores opening this year. They are a quiet family that loves God, honors their employees and enjoys serving people in their stores around the nation. But two years ago, the rules changed for every business. As of 2013, the Green family had to decide if they would follow their faith or follow the Obama administration's new regulations (James Lankford and Tony Perkins, 2/10). 

Fox News: ObamaCare Patients May Encounter Fewer Doctors, Longer Wait Times
Those who signed up for ObamaCare or were forced into it now are learning they're going to face some nasty surprises when they seek care. "Many consumers ended up purchasing a plan through the exchange, thinking it would cover their normal set of physicians, and hospitals," says Jim Capretta of the Ethics and Public Policy Center. "Now as they are using services, they are figuring out that they don't." Which is why President Obama was forced to confess he was wrong to say that people could keep their plans or their doctors, no matter what (Jim Angle, 2/11).

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Stephanie Stapleton

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