Daily Health Policy Report

Thursday, February 13, 2014

Last updated: Thu, Feb 13

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Report: Nearly 3.3 Million Americans Have Enrolled In Private Obamacare Plans

Kaiser Health News staff writer Phil Galewitz reports: “Nearly 3.3 million Americans have signed up for private health insurance plans since October through the online marketplaces created by the health law, with enrollment continuing to surge through January, an Obama administration report said Wednesday. But the number of young adults signing up continues to lag expectations, which could impact insurance premiums next year. Insurance industry officials have been closely watching the mix of customers to make sure they get enough healthy people to balance the cost of covering older Americans who generally require more medical care” (Galewitz, 2/12). Read the story.

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Florida Moves To Manage Health Care For Foster Kids

Kaiser Health News staff writer Marissa Evans, working in collaboration with The Miami Herald, reports: “Chris and Alicia Johnson have 10 kids -- three biological, five adopted out of foster care and two foster children -- all under one roof on the outskirts of Orlando, Fla. While providing love, support and encouragement for their foster kids, they’ve sometimes run into roadblocks trying to get them health care, including needed mental health services, because few providers take Medicaid insurance. Another problem? Not being able to take foster children in different health care plans to the same doctors. Those difficulties are not unusual for the nation’s nearly 400,000 foster children, whose health care can be complicated by cycling from one placement to another, undiagnosed childhood trauma and a failure to receive preventive care, according to experts” (Evans, 2/13). Read the story and check out the related chart.

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Political Cartoon: 'Phone-y Baloney?'

Kaiser Health News provides a fresh take on health policy developments with "Phone-y Baloney?" By Lisa Benson.

And here's today's health policy haiku:


Today, numbers talk
could be about snow tallies
or new enrollees...

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

More Than 1 Million People Signed Up For Health Plans In January

According to Obama administration officials, the overall enrollment figure, which tops three million, reflects people who enrolled in coverage through the federal or state exchanges from October through January.

The New York Times: 3.3 Million Enrolled On Health Marketplaces, Including More Young People, Government Says
The administration reported a modest uptick in the enrollment of young adults, a group avidly sought by insurers because they are usually healthier and need fewer costly medical services. In a new report on enrollment, the administration said that 1.9 million people had selected health plans in the federal marketplace from October through January, while 1.4 million chose plans in state-run insurance exchanges (Pear, 2/12).

The New York Times: Over 1 Million Added To Rolls Of Health Plan
More than 1.1 million people signed up for health insurance through federal and state marketplaces in January, according to the government, and the number of young people enrolling increased faster than that of any other group. The results were hailed by Obama administration officials, who expressed increased optimism that they had overcome their initial stumbles and erased many doubts about the viability of the health care law (Shear and Abelson, 2/12).

USA Today: More Than 1M Signed Up For Health Coverage In January
Sebelius called the statistics "very, very encouraging news. We're seeing a healthy growth in enrollment." Young people between the ages of 18 and 34, who are considered essential to the long-term financial health of the insurance market, went from 24% of enrollees between Oct. 1 and Dec. 31 to 27% in January, according to the new records. … The Obama administration isn't concerned about the number of young people who have signed up for insurance, said Julie Bataille, communications director for the Centers for Medicare and Medicaid Services. The number of young insurance customers is "on track" with expectations, she said (Kennedy, 2/12).

Los Angeles Times: Obamacare Enrollment Continues To Increase
The national total was still short of the administration’s goal of 4.4 million enrolled by the end of January. It remains unclear how many people who have selected a health plan have actually paid and how many did not have insurance previously. But the latest report provides new evidence that the marketplaces are gaining traction after a disastrous launch last fall (Levey, 2/12).

The Washington Post: Health Insurance Enrollment On Target In January
Still, the lingering imprint of those early problems remains visible in the new report. Overall, the 3.3 million people who have signed up for coverage are about 1 million fewer than federal officials had anticipated by the end of January. That difference dovetails with a revised prediction last week by congressional budget analysts — that 6 million Americans, instead of 7 million, are likely to get insurance through the marketplaces by the time this year’s sign-up period ends March 31 (Goldstein, 2/12).

Politico: More Than 3 Million Signed Up Through Obamacare Exchanges, Officials Say
Key data is still missing. The numbers don’t show how many of the sign-ups on the state and federal exchanges have actually paid their premiums. Nor do officials know how many were previously uninsured (Cheney and Millman, 2/12).

Kaiser Health News: Report: Nearly 3.3 Million Americans Have Enrolled In Private Obamacare Plans
But the number of young adults signing up continues to lag expectations, which could impact insurance premiums next year. Insurance industry officials have been closely watching the mix of customers to make sure they get enough healthy people to balance the cost of covering older Americans who generally require more medical care (Galewitz, 2/12).

NPR: After January Surge, More Than 3 Million Have Enrolled In Obamacare
January was a miserable month for weather, but the wintry blasts in much of the country weren't enough to stop people from shopping for health insurance. More than 1.1 million people signed up for coverage through state and federal health exchanges in January, according to a just-released report, bringing the total to just shy of 3.3 million people (Rovner, 2/12).

The Wall Street Journal: Health Exchanges Hit 3.3 Million Enrollees Through January
But Republican lawmakers said there was no reason for the Obama administration to cheer, given the continuing troubles with the 2010 federal health-care law. They noted independent reports indicating that many of the people using the exchanges already had been buying insurance on their own (Radnofsky, 2/12).

The Associated Press/Washington Post: Most States Lag In Health Insurance Sign-Ups
Most states are still lagging when it comes to sign-ups under President Barack Obama’s health care law, but an Associated Press analysis of numbers reported Wednesday finds a dozen high-achievers getting ahead of the game. Huge disparities are emerging in how well states are living up to federal enrollment targets, and that will help determine if the White House reaches its unofficial goal of having 7 million signed up by the end of March, six weeks away (2/12).

ABC News: Obamacare Enrollments At 3.3 Million, Nearly Halfway To Goal
It’s slightly better than the 1 million initially projected for the month. It also comes off December’s dramatic surge of 1.8 million newly enrolled. The boom was partially the result of fixes to the marketplace’s disastrous October launch and the resulting backlog of users (Larotonda, 2/12).

CNN: Obamacare Sign-Ups Jump To 3.3 Million
The non-partisan Congressional Budget Office last week projected that 6 million people would enroll in the exchanges for coverage for 2014. That estimate was previously downgraded from 7 million because of the vast technical problems that plagued the initial roll out of the exchanges (Luhby, 2/12).

Politico: Obamacare Finally Clears The Tower
There are still reasons to be skeptical of the numbers, and health care experts warn that the administration still has a lot of work to do by the end of March — when enrollment ends for this year — to get the right mix of customers so there are enough healthy people to pay for the sicker ones. But the new report is good enough that it might reset Washington’s expectations: maybe Obamacare isn’t going to be a train wreck after all. Maybe it’ll be more like one of those Metro trains that runs kind of slowly, and sometimes stops in the middle of the tracks for no apparent reason, but eventually gets you where you need to go (Nather, 2/12).

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HHS Enrollment Figures Indicate Sign-Ups Even In States Where Officials Have Opposed The Health Law

News outlets offer a sampling of state-specific health plan enrollment numbers. Even Oregon, with its non-working exchange, signed up more than 33,000 people.

Health News Florida: FL A Leader In Enrollment
Despite state officials' opposition to the Affordable Care Act and the relative scarcity of helpers available, Floridians are finding their way to Healthcare.gov and signing up for plans. Through the end of January, according to a federal report released Wednesday, nearly 300,000 Floridians had selected a plan through the federal Health Insurance Marketplace (Gentry, 2/13).

The Des Moines Register: Obamacare Adds 4,300 Iowans In January
Nearly 4,300 Iowans signed up for private health insurance in January via the Obamacare website, a new federal report shows. The results were not as dramatic as those seen in December, when more than 6,000 Iowans used the system to select private policies. But the new numbers show continued progress in fixing the website, whose October launch was crippled by technical problems (Leys, 2/12).

The Texas Tribune: Obamacare Enrollment Continues Steady Climb
Enrollment in the federal health insurance marketplace continued to steadily climb in January, according to data the U.S. Department of Health and Human Services released Wednesday. In January, another 89,500 Texans selected a health plan on the insurance marketplace created by the Affordable Care Act, the department reported (Aaronson, 2/12).

The Associated Press: Insurance Exchange Sign-Ups Break 100K Mark In Pa.
More than 123,000 Pennsylvanians have selected an insurance plan under the new federal health care law as troubles with the gateway website have subsided, the U.S. government said Wednesday, although tens of thousands more who might be eligible for Medicaid were suspended in limbo. The U.S. Department of Health and Human Services released a report with the figures for all states through Jan. 31. National numbers showed that nearly 3.3 million people signed up for health insurance from Oct. 1 through Feb. 1. The government's initial target was 7 million by the end of March (Levy, 2/12).

The Oregonian: Cover Oregon Enrollment Climbs Despite Non-Working Exchange
Oregon's health insurance exchange, Cover Oregon, signed up more than 33,000 people for commercial health insurance in the individual insurance market by Feb. 1, according to a new federal report. The figure means that despite long delays for some, and numerous complaints about missing applications and bureaucratic nightmares, the state is still managing to hold its own with states that have working exchange websites. Oregon has done so using a manual enrollment system that employs more than 400 temporary and other workers to process paper and electronic applications (Budnick, 2/12).

Georgia Health News: State’s Exchange Enrollees Now Exceed 100,000
The number of Georgians signed up for health coverage in the insurance exchange has topped 100,000, according to a federal report released Wednesday. The Georgia enrollment of 101,276 through January lags behind that of two other states using the federal exchange that have similar-sized populations – North Carolina’s 160,161 and Michigan’s 112,013. Still, the new figure represents a 73 percent jump from Georgia’s October-through-December total of 58,611 signing up. And it surpasses that of two states with slightly larger populations, Ohio and Illinois (Miller, 2/12).

The Chicago Sun-Times: 88,000 In Illinois Select Health Plan Under Affordable Care Act
More than 88,000 Illinois residents have selected a health insurance plan created by President Barack Obama’s health plan, according to enrollment numbers that came out six weeks before the deadline to enroll this year. Illinois’ previous total, released in January, was 61,111 people who had selected a plan created by the Affordable Care Act between Oct. 1 and Dec. 28. The new figures, released Wednesday, are to Feb. 1. Of the 88,602 state residents who got a plan, 75 percent of those qualified for tax credits, according to the federal report (Thomas, 2/12).

The Richmond Times-Dispatch: Nearly 30K Sign Up For Health Insurance In January
Almost 30,000 Virginians enrolled in health insurance plans through the new federal marketplace in January, an increase of two-thirds over sign-ups in the difficult first three months of the program. More than 1.1 million people enrolled in federal and state marketplaces across the country last month, although enrollment is uneven among the states, according to numbers released Wednesday by the U.S. Department of Health and Human Services. Total enrollment through the end of January was 74,199 in Virginia — compared with 44,676 in the first three months of the program — with a total of 3.3 million across the country (Martz, 2/13).

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Indicted Colorado Exchange Director Had Been Fully Vetted, Officials Say

Colorado's Connect for Health director was placed on paid administrative leave Tuesday after being indicted for stealing from her last employer. Meanwhile, the new head of Massachusetts' exchange pledges to fix it quickly, and Kansas navigators say they're overcoming healthcare.gov's rocky start.

The Denver Post: Colorado Health Exchange Officials Say Indicted Director Was Vetted
State health care exchange officials said they had thoroughly vetted Christa Ann McClure, the Connect for Health Colorado director they placed on paid administrative leave Tuesday after learning she had been indicted for stealing from her last employer. McClure, 51, pleaded not guilty Feb. 6 in federal District Court in Montana to eight counts of theft and fraud from a nonprofit housing agency in Billings (Draper and Bartels, 2/12).

Kansas Health Institute: Kansas Navigators Overcome Obstacles Of ACA Marketplace's Rocky Start
There is an emotional element to Rochelle Bryant's work that might surprise some people. "We use a lot of tissues," she said. "It's overwhelming for them [many of her clients] to find out they can finally see a doctor, that they can be treated." Bryant is one of about 300 or more people across the state working as "navigators" to help people enroll in health plans through the Affordable Care Act's insurance marketplace (Shields, 2/10).

The Boston Globe: State Health Care Site Official Blasted
Facing a swell of anger from legislators, Governor Deval Patrick's new point person in charge of fixing the state's broken health insurance website pledged a Herculean effort, but did not offer an exact timeline or a specific plan for when and how the website will be repaired so people can enroll in the coverage of their choice. During a State House hearing that lasted more than three hours Wednesday, Sarah Iselin, an insurance executive who Patrick said last week would take the lead in fixing the troubled Massachusetts Health Connector site, said she understands the gravity of the problem, is working to fully grasp its parameters, and will lead an all-out push to fix it (Miller, 2/12).

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GOP States Struggling With Medicaid Expansion Issues

Meanwhile, McClatchy News reports that higher rates of mental illness and substance abuse among the newly enrolled will be a problem because there aren't enough therapists who accept Medicaid patients. Medicaid expansion developments in New Hampshire, North Dakota, Wyoming and Virginia are also covered.

McClatchy: Medicaid Expansion Is Expected To Strain Mental Health Services
As millions of Americans gain health coverage through the Affordable Care Act’s Medicaid expansion, experts say their higher rates of mental health and substance abuse disorders will be difficult to treat due to a lack of counselors and behavioral therapists who accept Medicaid patients. In the District of Columbia and the 25 states where the expansion is under way, nearly 1.2 million uninsured adults newly eligible for coverage will have substance abuse problems, according to federal estimates, and more than 1.2 million are projected to have some sort of mental illness (Pugh, 2/13).

Concord Monitor: Details Of Medicaid Expansion Plan Emerge
The bipartisan group of senators behind a Medicaid expansion deal announced last week said they’ve created a system unique to New Hampshire that will give low-income people access to health care while increasing health care competition and decreasing uncompensated care costs. “I think the federal government could’ve built a model much like we’re building now for the whole thing and been better off,” Senate President Chuck Morse, a Salem Republican, said (Ronayne, 2/12).

New Hampshire Union Leader: State Senate Unveils New Medicaid Expansion Plan
The new proposal would allow the state to begin the program by July, although it would end in a year if the state does not receive federal waivers for key aspects. It would end Dec. 31, 2016, anyway if the Legislature does not reauthorize the program. ... The plan announced Wednesday uses the existing Health Insurance Premium Payment program for those with insurance from their employers, so they could continue their coverage while Medicaid would pay the premiums. The program would cover about 12,000 of the 50,000 people helped by expans (12/2).

Bismarck Tribune: Medicaid Enrollment Steadily Rising In North Dakota
State Department of Human Services officials told lawmakers Wednesday that enrollees covered through the Medicaid expansion authorized last year surpassed the 3,000 mark this month. ... That was up from approximately 1,700 through Jan. 1 and 2,138 through Jan. 15. Despite the steadily increasing enrollment, it still amounts to barely 15 percent of the number DHS has long estimated would be eligible under the expansion (Smith, 2/12).

Caspar Star-Tribune: Wyoming Senate Defeats Medicaid Expansion Bill
The Wyoming Senate on Wednesday voted down a bill endorsed by an interim legislative committee that would have allowed the expansion of the Medicaid program in the state. The Senate voted 16 to 14 against considering a bill endorsed by the joint Labor, Health and Social Services Committee. The bill would have allowed the use of Medicaid funds to pay private health insurance premiums (Neary, 2/12).

The Richmond Times-Dispatch: House GOP Leaders Maintain Stance Against Medicaid Expansion
Expansion should not move forward, party leaders say ... The proposal, sponsored by Sen. John Watkins, R-Powhatan, would rely on billions of dollars in federal funds reserved for Medicaid expansion, so the private option plan would require approval of the Centers for Medicare & Medicaid Services. Del. S. Chris Jones, R-Suffolk, who chairs the House Appropriations Committee, said his panel won’t back the Watkins proposal until pending changes to the state’s Medicaid program are complete (Schmidt, 2/12).

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Poll: Uninsured Rate Lowest In Five Years

In other Obamacare implementation news, some regions are finding few plan options. And HHS is trying to resolve some healthcare.gov issues with a personal touch.

The Washington Post’s Wonkblog: The Uninsured Rate Is At A Five-Year Low. Is Obamacare The Reason?
Gallup's newest poll shows another decline in the uninsured rate, in a survey taken in late January and early February. It found that 16 percent of American adults reported lacking insurance coverage, the lowest number Gallup has recorded since 2009. ... [I]t will take a few more months to get a sense of whether the lower rate recorded this month is here to stay (Kliff, 2/12).

The Fiscal Times: Gallup: Uninsured Rate Hits 5-Year-Low
Though the poll comes four months into Obamacare’s rollout, Gallup cautions that it is too early to credit the president’s signature health care law for the decline. According to the survey, about 16 percent of American adults are uninsured, down from the high of 18 percent last year. ... The poll shows more people are getting health coverage through Medicaid as well as the individual market (Ehley, 2/12).

Bloomberg: Obamacare Damage-Control Teams Seek To Calm Complaints
The day after Addie Wilson was quoted in a newspaper article complaining about her experience with President Barack Obama’s health-care law, her mobile phone rang while she was in the bathroom. It was an employee from the U.S. Department of Health and Human Services offering help. ... [T]he Obama administration is borrowing a corporate tactic and tracking down consumers who air their grievances in news reports or on social media. The goal: Get a case worker in touch within 24 hours to resolve the issue (Dorning, 2/13).

The Wall Street Journal: For Many, Few Health-Plan Choices, High Premiums on Online Exchanges
Hundreds of thousands of Americans in poorer counties have few choices of health insurers and face high premiums through the online exchanges created by the health-care law, according to an analysis by The Wall Street Journal of offerings in 36 states. Consumers in 515 counties, spread across 15 states, have only one insurer selling coverage through the online marketplaces, the Journal found. In more than 80 percent of those counties, the sole insurer is a local Blue Cross & Blue Shield plan (Martin and Weaver, 2/12).

Related, earlier KHN story: The 10 Most Expensive Insurance Markets In The U.S. (Rau, 2/3).

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Covered California Infomercial Hits The Web; Koch Brothers Ad Attacks Mich. Dem

Ads are appearing ahead of the March 31st health insurance enrollment deadline and the 2014 congressional primaries.

The Sacramento Bee: California Republicans Seeking To Capitalize On Health Law Vulnerabilities
The Barack Obama impersonator is well into promoting the president’s health insurance overhaul when he concedes a deficiency of the law: “It’s not going to stop you from doing stupid things.” “But if those stupid things were to break your legs, it is going to be right there,” the impressionist says in the introduction to “Tell a Friend, Get Covered,” a promotional Web video produced on behalf of Covered California for $1.37 million. The six-hour infomercial, aimed at a young audience and funded by federal taxpayers, has become the latest flashpoint as Republican officeholders increasingly raise questions about the rollout of the new health law (Cadelago, 2/13).

The New York Times: Conservative Group Enters Michigan Fray On Side Of Tea Party
The group, Americans for Prosperity, will spend about $230,000 on advertisements thanking Representative Justin Amash for fighting against President Obama’s signature health care law, officials there said -- a shot at establishment donors who are rallying behind his challenger, Brian Ellis. ... Americans for Prosperity, co-founded by the billionaire David H. Koch, has spent about $27 million in recent months, most of it attacking Democratic candidates for the Senate over health care (Confessore, 2/12).

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Capitol Hill Watch

Senate Sends President 'Clean' Debt Limit Bill

The Senate has approved and sent President Obama a "clean" debt limit bill, allowing the federal government to borrow money. The tactic by the GOP to pass the clean bill is criticized by non-Washington conservatives but allows most Republican lawmakers to vote against it. In the meantime, the Senate also passes House-approved legislation to extend Medicare cuts to restore some retiree benefits for veterans.

The Associated Press/Washington Post: Senate Clears Debt Limit Measure For Obama
The president is now clear to sign the bill, which allows the government to borrow all the money it needs to pay bills such as Social Security benefits, federal salaries, and payments to Medicare and Medicaid providers. Failure to pass it would have likely sent the stock market -- which dipped modestly as the voting dragged on -- into a tailspin (2/12).

The Wall Street Journal: Boehner Strategy Signals A Shift For Republicans
Conservative and tea-party groups outside Congress were incensed by the move, orchestrated by Speaker John Boehner of Ohio. But GOP lawmakers defended the strategy, which enabled Mr. Labrador and 198 other Republicans to oppose the debt-ceiling bill -- it passed with the votes of Mr. Boehner, 27 other Republicans and 193 Democrats -- and clear the way for them to try to redirect attention to the president's health care law (Peterson and Hook, 2/12).

The Washington Post: Senate Votes To Restore Benefits To Veterans
Senators voted 95 to 3 Wednesday to restore military retiree benefits cut last year as part of a compromise budget deal, adopting a House bill that covers the move by extending reductions to Medicare (Lowrey, 2/12).

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State Watch

State Highlights: Ariz. Group Urges Public Hospital Changes

A selection of health policy stories from Arizona, Florida, California and Pennsylvania.

Reuters: Vaccine Exemption Bills Often Introduced But Rarely Passed
Legislation to change whether parents may refuse school vaccinations for their children appears to be common in some states, according to a new analysis. However, those bills are rarely passed into law. Researchers identified 36 bills that were introduced in 18 state legislatures between 2009 and 2012 to change school immunization requirements. Most of those bills aimed to allow more parents the ability to refuse vaccinations for their children (Seaman, 2/12).

The Arizona Republic: Maricopa County Health Overhaul Urged
A citizens committee has endorsed a $935 million overhaul of Maricopa County’s public hospital system to decentralize its services and improve access to health care for the Valley’s poorest residents. County voters likely will be asked this November to approve a bond initiative capped at $935 million to pay for a new county hospital, a new behavioral-health facility and new, expanded or renovated clinics throughout the Valley, mainly in areas with the most underserved and uninsured patients. The 15-member committee’s final report, approved unanimously Wednesday, essentially validates hospital executives’ long-standing desire to transition the Maricopa Integrated Health System into a network of community-based clinics that provide primary, preventive, specialty and outpatient care (Lee, 2/12).

Kaiser Health News: Florida Moves To Manage Health Care For Foster Kids
Chris and Alicia Johnson have 10 kids -- three biological, five adopted out of foster care and two foster children -- all under one roof on the outskirts of Orlando, Fla. While providing love, support and encouragement for their foster kids, they’ve sometimes run into roadblocks trying to get them health care, including needed mental health services, because few providers take Medicaid insurance. Another problem? Not being able to take foster children in different health care plans to the same doctors. Those difficulties are not unusual for the nation’s nearly 400,000 foster children, whose health care can be complicated by cycling from one placement to another, undiagnosed childhood trauma and a failure to receive preventive care, according to experts (Evans, 2/13).

Los Angeles Times: Animosity Between Head Of AIDS Group, L.A. County Supervisor Emerges 
Long-simmering animosity between two Los Angeles political figures reached new heights this week when their bad blood surfaced in a footnote attached to a federal judge's ruling. The footnote revealed a series of vitriolic remarks made by AIDS Healthcare Foundation President Michael Weinstein about Los Angeles County Supervisor Zev Yaroslavsky (Sewell, 2/12).

NPR: Judge Dismisses Assisted Suicide Case Against Pennsylvania Nurse
A Pennsylvania county judge has thrown out an assisted suicide case against a 58-year-old nurse named Barbara Mancini, who was accused of homicide last year for allegedly handing her 93-year-old father a bottle of morphine. The decision is the latest in a series of recent developments signaling a reluctance of courts and state legislatures to criminalize medical care that may hasten death (Knox, 2/12).

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Weekend Reading

Longer Looks: Women's Advantages In Health Law; Health Effects Of The 'American Dream'

Every week reporter Ankita Rao selects interesting reading from around the Web.

The Atlantic: How Women Get More Than Men Do From Obamacare
In the wake of a recent report showing that about 2 million additional people may stay out of the workforce because of Obamacare, for example, the law was heralded/derided as a win for the lazies. ... Young men will probably pay more for coverage than they did previously, though. And if we look at a breakdown of the actual conditions that the Affordable Care Act will cover, it looks like the law will disproportionately help, yes, the ladies. Some of the benefits are well-known: Private insurance is now required to cover birth control free of charge. And health insurers can no longer discriminate against people with pre-existing conditions by charging them extra. Such "conditions," in extreme cases in the past, have included pregnancy and being the victim of spousal abuse. But there are other, hidden ways women benefit from Obamacare (Olga Khazan, 2/11).

60 Minutes: Sex Matters: Drugs Can Affect Sexes Differently
Earlier this year, the Food and Drug Administration made an unusual and surprising announcement. It cut the recommended dose of the most popular sleep drug in the country, Ambien, in half for women. It turns out men and women metabolize Ambien, known generically as Zolpidem, very differently, leaving women with more of the drug in their bodies the next morning, and therefore at a greater risk of impaired driving. ... it is far from an isolated example of differences between the sexes we never imagined. More and more, scientists are realizing that the differences are dangerously understudied and that pervasively and fundamentally, sex matters (Leslie Stahl and Shari Finkelstein, 2/9).

Politico: The Rise Of Ron Wyden
[Sen. Ron Wyden, D-Oregon], a one-time backbencher with a penchant for big ideas, is now poised to take over the Senate’s most powerful committee. It will instantly vault him into the ranks of the chamber’s most influential, giving him a major say over taxes, health care, trade and programs like those Build America Bonds that made its way into Obama’s stimulus plan. Wyden, who will officially become chairman of the Finance Committee as soon as Tuesday, will confront a raft of unfinished business. ... He’s proposed taxing health care benefits that employers provide their workers, something that earned him the enmity of unions; Wyden would have replaced the health care tax exclusion employers get with a deduction for individuals, with the goal of breaking the link between having a job and having health care coverage (Brian Faler, 2/11).

U.S. News and World Report: The 'American Dream' May Be Bad For Your Health
My heart warmed when I saw Coca-Cola's Super Bowl ad last week and heard the first strands of "America the Beautiful" sung in Hindi. As an Indian immigrant, I felt pride seeing the faces and voices that reflect a modern, diverse United States. ... It didn't take long, however, before my stomach turned. ... The real message behind the ad was not about embracing diversity, but rather, "Drinking Coca-Cola is American. Coke is part of the American Dream."  ... For more than a decade, the U.S. food, tobacco and alcohol industries have been targeting immigrants as a distinct market segment. As a physician whose research focuses on heart disease and diabetes prevention in immigrants, I have seen the terrible impact that targeted advertising has on the health of immigrants. It is well known that the over-consumption of sodas and other sugary drinks is an important driver of the high rates of obesity, diabetes, heart disease in the U.S. (Dr. Namratha Kandula, 2/11).

Medscape: "Coma" Author-Physician On His New Medical Thriller, "Cell"
Medscape Editor-in-Chief Eric J. Topol, MD, recently spoke with New York Times best-selling author Robin Cook, MD, about his work as a physician and writer. Dr. Cook's 33rd medical thriller, Cell, is out on February 4. ... [Dr. Cook:] We're looking for primary care physicians; we're looking to lower costs; we want to incorporate genomics. Nanotechnology is coming down the line. It is advancing so rapidly, particularly with wireless sensors, etc., that you have the convergence of all of these things. I woke up in the middle of the night and said, "The cell phone is going to be the doctor" (Drs. Eric J. Topol and Robin Cook, 2/3).

The New York Times: Prescription Painkillers Seen As A Gateway To Heroin
The life of a heroin addict is not the same as it was 20 years ago, and the biggest reason is what some doctors call "heroin lite": prescription opiates. These medications are more available than ever, and reliably whet an appetite that, once formed, never entirely fades. Details are still emerging about the last days of Philip Seymour Hoffman, the actor who died last week at 46 of an apparent heroin overdose. Yet Mr. Hoffman's case, despite its uncertainties, highlights some new truths about addiction and several long-known risks for overdose. ... Millions of people use these drugs safely, and doctors generally prescribe them conscientiously. But for some patients, prescription painkillers can act as an introduction — or a reintroduction — to an opiate high (Benedict Carey, 2/11).

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Editorials and Opinions

Viewpoints: Decoupling Jobs And Insurance; Overblown Fear: Medicaid Willl Take My House

The New York Times: Work And Health Insurance: Is There An Alternative?
Three blog posts and a column should probably suffice to cover the debate over Obamacare and work incentives, but I don’t want to let the topic drop without first stepping back and talking about the actual health policy disagreement here. My column and posts last week criticized what struck me as a kind of insouciance from liberals about this issue, shading into a post-work utopianism that doesn’t wrestle with what, in practice, the decline of work is actually likely to mean for issues of class, mobility, and social equality. But it’s also important to recognize that for many liberal writers, the controlling assumption here is not anti-work or pro-work. It’s just pro-universal health care as a basic standard for a decent society, with the consequences taken as they come (Ross Douthat, 2/12).

Los Angeles Times: Today's Overblown Obamacare Fear: Will Medicaid Take My House?
The word is beginning to percolate through public discourse as the Affordable Care Act takes hold: If you're in the cohort receiving your healthcare through Medicaid, the government can seize your house later to pay for your bills. Is that really true? In technical terms and under limited circumstances, yes. But in real terms, that concern is vastly overblown, and certainly not a reason to shun the Medicaid option if it's offered to you. For the vast majority of enrollees, it won't be happening. So let's distinguish facts from fears (Michael Hiltzik, 2/12). 

The Wall Street Journal: Behind The White House's Health Law Dodges
Earlier this week, Mr. Obama demonstrated his imperial flexibility again, delaying another important provision of the Affordable Care Act. For firms with 50-99 employees, the president waived until 2016 the requirement they provide health insurance or pay a fine. Also, companies with 100 or more workers can avoid most of the law's penalties if they provide coverage to at least 75 percent of their workforce. The House Energy and Commerce Committee says this is Mr. Obama's 22nd delay or modification of his signature law (Karl Rove, 2/12).

Politico: The Whatever President
We were told that President Obama would wield his executive power this year to defy Congress. Instead, he is defying his own health care law. ... The first delay was bad enough, but the latest move is more brazen. It creates a distinction between employers with fewer and more than 100 employees that doesn’t exist in the law, and delays the mandate for another year for businesses with 50-99 employees. At the same time, it changes the obligation on employers with more than 100 employees. These aren’t waivers or delays, but detailed revisions at variance with the law as passed by a duly elected Congress of the United States. Last year, the Treasury Department justified the delay as "transition relief," a euphemism right up there with "shared responsibility payments," the administration’s favored term for fines on employers (Rich Lowry, 2/12). 

USA Today: Healthcare.gov Is Improving: Opposing View
HealthCare.gov continues to perform well under strong demand, and it has had more than 3.4 million site visits this month alone. The traffic shows there continues to be strong demand for affordable medical coverage. Consumers are shopping, applying and enrolling online every day. This Saturday is the final day to enroll in Marketplace coverage that begins on March 1 (CMS Administrator Marilyn Tavenner, 2/12).

USA Today: Obamacare Errors Weaken Support: Our View
Nearly four years after the Affordable Care Act was signed into law, you'd think most of the kinks would have been worked out. And, of course, you'd be completely wrong. True, the website that could sign up only six customers on Oct. 1, the day it debuted, is working better. The administration said Wednesday that 1.9 million people have signed up in the federal marketplace. But vital parts of the portal still haven't even been built. One critical omission is the part that processes the appeals of people who end up with the wrong health insurance coverage or no coverage at all (2/12).

The Washington Post: The Fault Lies Not In Obamacare, But In Obama
Four months after the botched rollout of Obamacare, things are starting to look up a little for the president and his troubled program: Some three million Americans have selected a plan through the state or federal exchanges, and numbers in December were seven times that of October and November combined. And yet reviews of the Affordable Care Act in the wake of its disastrous opening days remain stubbornly negative. While much of the attention has focused on technological and bureaucratic failures, or recently the delayed requirements, the Web site’s botched launch also illustrates the key weaknesses of this president’s leadership style (Drew Westen, 2/12). 

New Hampshire Union Leader: Medicaid Expansion Is Bad Medicine For New Hampshire
The recently announced deal in the New Hampshire Senate of a "framework" to expand Medicaid is a bad deal for our state’s future. The fundamental problem is not just that the plan implements a key component of Obamacare here, but it continues to build on a profoundly flawed Medicaid program desperately in need of reform (John Stephen, 2/12). 

The New England Journal of Medicine: Beyond Repeal -- A Republican Proposal For Health Care Reform
By voting repeatedly to repeal the Affordable Care Act (ACA) over the past 4 years, Republicans have risked being identified as a party without a positive health policy agenda. On January 27, 2014, however, three Republican senators -- Orrin Hatch (UT), Tom Coburn (OK), and Richard Burr (NC) -- unveiled a proposal that would not only repeal the ACA, but also replace it with comprehensive legislation based on Republican health policy principles. ... Senators Hatch, Coburn, and Burr are to be commended, however, for moving beyond simply demanding repeal and putting out a proposal, the effects of which can now be debated (Timothy Stoltzfus Jost, 2/12).

The New England Journal of Medicine: PCORI At 3 Years — Progress, Lessons, And Plans
[The Patient-Centered Outcomes Research Institute (PCORI)] board of governors has adopted three strategic goals to meet its mandate under the Affordable Care Act. These goals are to increase the quantity, quality, and timeliness of usable, trustworthy comparative research information; to accelerate the implementation and use of research evidence; and to exert influence on research funded by others to make it more patient-centered and useful. ... Over the next 3 years, PCORI will commit as much as $1.5 billion to research projects (Dr. Joseph V. Selby and Steven H. Lipstein, 2/12). 

And on other issues --

The New York Times: We Need Proof On Marijuana
Dozens of other anecdotes of miraculous responses to marijuana treatments in children with severe epilepsy are rife on Facebook and other social media, and these reports have aroused outsize hopes and urgent demands. Based on such reports, patients and parents are finding official and backdoor ways to give marijuana to their children. But scientific studies have yet to bear out the hopes of these desperate families. The truth is we lack evidence not only for the efficacy of marijuana, but also for its safety. This concern is especially relevant in children, for whom there is good evidence that marijuana use can increase the risk of serious psychiatric disorders and long-term cognitive problems (Drs. Orrin Devinsky and Daniel Friedman, 2/12).

Los Angeles Times: A No-Drama Debt-Limit Vote By The House GOP
Many House Republicans voted against raising the debt limit in the apparent hope that the public won't hold them accountable for the continuing deficits. If they're really serious about the growing debt, though, they'll get working on bills to solve the main source of the government's long-term fiscal problems: the rising cost of healthcare entitlements, such as Medicare and Medicaid. So far, they've addressed those issues only with rhetoric, not legislation (2/12). 

The Washington Post: The Global AIDS Response Can Help In Fighting Hepatitis C
A decade after the global AIDS response began in earnest, it’s worth asking whether the lessons learned will be sustained over time and used to avoid past mistakes when tackling new challenges. One such challenge is chronic hepatitis C infection, which afflicts an estimated 170 million people worldwide. Since its discovery 25 years ago, hepatitis C has become the leading indication for liver transplant in the United States and a common cause of liver failure around the world. For some, however, it is about to become eminently curable (Dr. Paul Farmer, 2/12). 

The Wall Street Journal: Why 'Metrics' Overload Is Bad Medicine
"Quality" has been the buzzword in health care for a decade, but the worthy goal is driving health-care providers to distraction. All stakeholders -- insurers, patients, hospital administrators and government watchdogs -- are demanding metrics to ensure that money is spent wisely. ... Primary-care providers like me are bearing the brunt of these often misguided efforts. As front-line providers responsible for a patient's health, we have had every aspect of our professional lives invaded by the quality police (Dr. Victoria McEvoy, 2/12). 

Bloomberg: Too Many Mammograms
A 25-year study of 90,000 women has found that mammograms do nothing to lower the death rate from breast cancer. That's pretty strong evidence, to say the least. And it's only the latest from many studies over the last several years indicating that mammography often doesn't help prevent advanced cancer. Yet women -- and, even more crucially, their doctors -- remain unwilling to give up annual mammograms (2/12).

The New England Journal of Medicine: "Misfearing" -- Culture, Identity, And Our Perceptions Of Health Risks
During my cardiology fellowship, I worked at a women's cardiovascular clinic where we asked every new patient the same question: "What do you think is the number-one killer of women?" ... Ms. S., a middle-aged woman with high blood pressure and hyperlipidemia, answered in a way that sticks with me: "I know the right answer is heart disease," she said, eyeing me as if facing an irresistible temptation, "but I'm still going to say 'breast cancer.'" If helping women understand their cardiovascular risk were about right answers, I would simply have reiterated the facts about heart disease. ...  Her sense of risk was clearly less about fact than about feeling. Would more facts really address those feelings? (Dr. Lisa Rosenbaum, 2/13).

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Stephanie Stapleton

Andrew Villegas

Lisa Gillespie
Shefali Luthra

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