Daily Health Policy Report

Wednesday, February 26, 2014

Last updated: Wed, Feb 26

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch



Health Care Fraud & Abuse

Public Health & Education

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Could Medicaid Expansion Debate Turn Into An Immigration Issue?

Kaiser Health News staff writer Julie Appleby and the Miami Herald’s Patricia Borns report: "Florida lawmakers backing expansion of the state’s Medicaid program plan to mount a new argument this legislative session: That voting against extending the program would deprive low-income U.S. citizens of access to insurance that’s available to some legal immigrants" (Appleby and Borns, 2/26). Read the story.

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Capsules: Poll: For Right Price, Consumers Will Accept Limited Choice Of Doctors, Hospitals; Tenet Expects 15% Of Its Uninsured To Get Obamacare Coverage

Now on Kaiser Health News' blog, Jordan Rau Reports on new poll findings: "People buying health insurance through the health law’s new online marketplaces are more willing than the public at large to accept a limited roster of doctors and hospitals in return for lower premiums, a poll released Wednesday finds. But that enthusiasm nosedives if they are told their regular doctor isn’t included in the plan" (Rau, 2/25). 

Also on Capsules, Phil Galewitz reports on Tenet’s call with analysts: "Tenet Healthcare Corp., the nation’s third largest for-profit hospital operator, said Tuesday it expects 15 percent of its uninsured patients to get covered this year as a result of the Affordable Care Act. But the company isn’t counting yet on any higher profits from the shift, Tenet officials said after a conference call with Wall Street analysts to discuss its fourth quarter earnings and outlook for 2014" (Galewitz, 2/25). Check out what else is on the blog.

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Political Cartoon: 'Take One Tablet?'

Kaiser Health News provides a fresh take on health policy developments with "Take One Tablet?" by Steve Kelley and Jeff Parker.

And here's today's health policy haiku:


In many "red" states
Native born get turned away 
Immigrants welcomed

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

Obamacare Enrollment Reaches 4 Million

About 700,000 people have selected a health plan so far in February, but officials couldn't say how many of those people have paid their first month's premium. For enrollment to reach the revised goal of 6 million, about 2 million more people will have to sign up in March.

Los Angeles Times: Obamacare Enrollment Hits 4 Million
Enrollment in health plans sold on marketplaces created by President Obama’s health care law has hit 4 million, the administration announced Tuesday, marking another milestone in the law’s implementation. The number suggests sign-ups have continued at a brisk pace in February, with about 700,000 people selecting an insurance plan so far this month (Levey, 2/25).

The Associated Press/Washington Post: Obama: Health Insurance Enrollment At 4 Million
Pressing for a final rush of health care enrollees, President Barack Obama said Tuesday that about 4 million people have signed up for health insurance through federal or state marketplaces set up under his health care law. But with a key deadline approaching fast, he urged some of his most steadfast backers to help sign up millions more by then (2/25).

Politico: Obamacare Enrollment Hits 4 Million
In a blog post, Center for Medicare and Medicaid Services Administrator Marilyn Tavenner released the new number of signups through the state and federal exchanges. But she provided few details and no demographic breakdown, such as the number of young adults who have signed up or the percentage who have paid their premiums. Tavenner said health officials continue to see “strong demand nationwide” and that more than 12 million calls have come into the federal call center since the fall (Levine, 2/25).

CNN: Obamacare Enrollment Hits 4 Million, Push Underway To Hit Revised Goal
Some 700,000 people have enrolled in Obamacare so far in February, raising total enrollment to roughly 4 million with a little more than a month to go before the sign-up deadline expires to get insurance this year. The new figures for state and federal exchanges released by the Centers for Medicare and Medicaid Services on Tuesday illustrate participation in the sweeping initiative continues to grow steadily, a point raised by President Barack Obama at a White House event later in the day. But the current pace indicates his administration will need a record month in March to reach a 6-million enrollment target, one that falls short of the original goal (Aigner-Treworgy and Acosta, 2/25).

CQ HealthBeat: CMS Says 4 Million Have Signed Up For Insurance Through Exchanges
About 4 million people have signed up for insurance through federal and state health exchanges, the head of the Centers for Medicare and Medicaid Services said Tuesday. In a blog post released in the evening, CMS Administrator Marilyn Tavenner announced the latest enrollment estimate, reflecting activity since October (Young, 2/25).

The Fiscal Times: Obamacare Jumps 33 Percent to 4 Million Sign Ups
Roughly 4 million Americans have signed up for health coverage on the new insurance exchanges, the Obama administration said Tuesday. That’s still about 3 million short of the White House’s goal of enrolling 7 million people before the March 31 deadline. Still, administration officials are touting the numbers as a success, and say they are confident that enrollment will continue to surge ahead of the open enrollment deadline. Health and Human Services Secretary Kathleen Sebelius walked back the much-cited 7 million figure during a HuffPost Live interview on Tuesday (Ehley, 2/25).

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Health Exchanges Create Cybersecurity Challenges, Hacker Opportunities

The Associated Press reports that a number of state health exchanges that were supposed to link to the federal computer system were initially rated as "high risk." Meanwhile, coverage of state-level online insurance marketplace fits and starts continues with reports from Maryland, Hawaii, Idaho, North Dakota, California, Connecticut and Minnesota.   

The Associated Press/Washington Post: AP Exclusive: Health Law Cybersecurity Challenges
As the Obama administration raced to meet its self-imposed deadline for online health insurance markets, security experts working for the government worried that state computer systems could become a back door for hackers. Documents provided to The Associated Press show that more than two-thirds of state systems that were supposed to tap into federal computers to verify sensitive personal information for coverage were initially rated as “high risk” for security problems (2/25).

The Washington Post: Maryland Sticks By Its Overall Goal For Health Insurance Enrollments
Maryland health officials received some convenient news last week: The enrollment goal they had set for the state’s health exchange was based on incorrect research, and a more realistic projection was one they had already met. But the state is sticking with its original too-high goal, a member of Gov. Martin O’Malley’s Cabinet told lawmakers on Monday. “If you know the governor, he’s not someone who is inclined to lower goals once he sets them,” said Joshua Sharfstein, Maryland’s secretary of health and mental hygiene. “We’re going to keep doing our best” (Johnson, 2/25).

The Washington Post: Maryland’s Four Major Options For Fixing Its Dysfunctional Health Exchange
Maryland’s new online health insurance marketplace is so structurally flawed and dysfunctional that state officials say they will have to make major changes as soon as the first open enrollment period ends on March 31. They are still trying to figure out what those changes will be (Johnson, 2/25).

Los Angeles Times: Hawaii Health Marketplace Off To An Especially Rough Start
Hawaii already had one of the highest insured rates in the nation as the result of a 40-year-old state law requiring employers to provide coverage. The state received more than $205 million in federal money to build a health insurance exchange to serve those still uninsured. Yet four months after enrollments began, the Hawaii Health Connector has allocated $120 million while signing up only about 4,300 people for health plans — fewer than any other state. Despite officials' initial hopes of enrolling tens of thousands of Hawaiians, only 400 employers have applied for plans for their employees (Reston, 2/25).

The Associated Press: Boise Health Care Act Call Center Lays Off 1,600
A Boise call center that helps people sign up for health insurance under the Affordable Care Act is laying off 1,600 people — nearly its entire workforce — as the federal exchange open-enrollment period ends. Maximus Inc. hired about 1,800 people for the Boise facility last year (Boone, 2/26).

The Associated Press: ND Seeks To Link To Federal HealthCare Computers
North Dakota has yet to gain approval on its security preparations needed to link the state's system to federal computers that enroll people for coverage under the new health care law, documents show (MacPherson, 2/25).

The Associated Press: Covered CA Website Had ‘Vulnerability’
More than three months after it opened for business, California's online health insurance marketplace had what federal officials described as a potential security flaw in its computer system and one that had already been disclosed publicly. The concern is noted in a Jan. 10 email between officials with the federal Centers for Medicare and Medicaid Services, the agency that oversaw development of the online exchanges (2/25).

The California Health Report: Coaxing The Coachella Valley To Sign Up For Insurance
The Inland Empire is on track to meet the state’s goal of enrolling 76,069 people from the region into plans from the Covered California insurance exchange, according to figures just released.  Enrollment hit 39,474 during the first half of the sign-up period, which is 52% of the goal. A big part of the effort in the Coachella Valley is a push by local hospitals to enroll the uninsured before the deadline of March 31st (Potter, 2/26).

Marketplace: Connecticut's "Health Exchange-In-A-Box" For Struggling States
Connecticut is getting entrepreneurial with its healthcare exchange. AccessHealth CT has done so well that it started getting calls for help and advice from other states. "And so we’ve had discussions with those states," says AccessHealth CT’s CEO, Kevin Counihan. "And it came to us that there could be a business model here." Connecticut is now setting up a consulting business to help other states copy its success. The model is called "exchange-in-a-box," a term healthcare consultants at Leavitt Partners says they coined a few years ago in a white paper trying to market the concept to states (Gardner, 2/25).

Minnesota Public Radio: MNsure Says Its Work Is 'Paying Off' For Consumers
MNsure says it has reduced call center wait times and the number of pending applications for health insurance. The state's online health plan marketplace was beset by technical problems that hampered enrollment for months. The agency, however, says hold times averaged three minutes in mid-February, down from an hour in December. The decline follows a surge in call center staffing (Catlin, 2/25).

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Ark. House Delays Vote On Medicaid Expansion; Maine Lawmakers Offer Compromise

In Arkansas, the House held off on a fifth vote for funding the state's "private option." The Maine compromise would expand Medicaid while also reforming the program.

The Associated Press: House Delays Vote On Medicaid Expansion
Arkansas House Speaker Davy Carter challenged opponents of the state's compromise Medicaid expansion Tuesday to offer an alternative that could break a legislative stalemate threatening the future of a program that provides subsidized coverage to more than 93,000 people. The House delayed plans to vote for a fifth time on the "private option," after Carter backed off his vow to take up the bill every day on the program's future until it passes (2/25).

Bangor Daily News: Moderate Republicans Unveil Medicaid Compromise That Expands Coverage, Dramatically Reforms System
A bill drafted by two moderate Republican senators, meant to be a compromise on the divisive issue of Medicaid expansion, was unveiled to lawmakers Tuesday. The plan combines House Speaker Mark Eves' planned expansion of Medicaid, known here as MaineCare, to roughly 70,000 low-income Mainers under the auspices of the Affordable Care Act, with a plan by Sen. Roger Katz, R-Augusta, to reform the state's MaineCare program (Moretto, 2/25).

The Associated Press: Maine GOP Lawmakers Craft Medicaid Expansion Bill
Maine would expand Medicaid under the federal health care overhaul while also implementing other significant changes to the program, under a bill laid out Tuesday by two Republican lawmakers who hope to garner the support of more of their GOP colleagues to override the objections of Republican Gov. Paul LePage (Durkin, 2/25).

And in other states --

Politico Pro: Corbett Predicts Approval Of Medicaid Expansion Plan
Democrats have piled on Pennsylvania Gov. Tom Corbett over a proposal to expand Medicaid that they say is too restrictive to win federal approval. But Corbett has a message for them: Think again. "You want a good inside tip? Go bet them, and bet on me," the Republican told Politico at the National Governors Association winter meeting. Corbett, who's facing a difficult fight for a second term, announced a plan last week to accept Obamacare's huge Medicaid expansion and use it to buy private health insurance for Pennsylvania's poorest residents (Cheney, 2/25).

Newark Star-Ledger: Christie: 'Proud' Of Expanding Medicaid But Costs Need Better Management
Gov. Chris Christie said today he was "proud" of his decision to expand Medicaid through the Affordable Care Act, but plans to introduce better oversight to the $12 billion program so it can serve the 1.4 million people who rely on it for health care, housing and other services. In his budget address today, Christie took aim at what the medical professionals call "super-utilizers:" the people with chronic health conditions that frequently end up in emergency rooms and get admitted to the hospital. He said he has enlisted the nine schools that make up Rutgers Biomedical and Health Sciences, as well as University Hospital in Newark, and Rutgers Camden, to find a more cost-effective way to reduce their reliance on costly hospital care (Livio, 2/25).

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In Some States, Medicaid Expansion Intersects With Immigration Issues

News outlets examine how federal and state provisions on health care coverage set out an uneven landscape for low-income Americans, legal immigrants and those who came to the country illegally as children and who were given legal status for two-year periods.

Los Angeles Times: Report: 125,000 Immigrants Given Deferred Action Eligible For Medi-Cal
A new report shows that as many as 125,000 young California immigrants may qualify for an expansion of Medi-Cal, the state's Medicaid program. The Affordable Care Act bars insurance subsidies and enrollment in the Medicaid expansion for undocumented immigrants, but a wrinkle in California rules does offer coverage for those with "deferred action status" (Karlamangla, 2/25).

Kaiser Health News: Could Medicaid Expansion Debate Turn Into An Immigration Issue?
Florida lawmakers backing expansion of the state’s Medicaid program plan to mount a new argument this legislative session: That voting against extending the program would deprive low-income U.S. citizens of access to insurance that’s available to some legal immigrants (Appleby and Borns, 2/26).

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Administration May Be Scaling Back Estimates Of Young Adult Enrollment

CNN reports that the White House tamps down expectations that the exchanges will meet CBO's original projection that 40 percent of enrollees would be between the ages of 18 and 34. Also, Politico Pro looks at the large number of states that are not carrying out a health law provision that allows young adults who were enrolled in Medicaid before aging out of foster care to receive coverage through age 26.

CNN: White House Appears To Scale-Back Expectations For Younger Obamacare Signups
The Obama administration appears to be scaling back its expectations for enrollment of young adults under the Affordable Care Act. For months, administration officials embraced estimates by the Congressional Budget Office anticipating 2.7 million of the 7 million enrollees under Obamacare by the end of March would be people between the ages of 18 and 34, or nearly 40 % of the total. The overall metric is critical for making the program work economically. The larger the pool of healthy, younger people paying premiums, the lower the cost of providing coverage for older, sicker enrollees (Acosta, 2/25).

Politico Pro: ACA Coverage For Former Foster Youth Out Of Reach
A provision in the Affordable Care Act intended to expand coverage for former foster care youths has been tripped up in implementation, putting health insurance out of reach for tens of thousands of young people. The provision is intended to allow young adults who were enrolled in Medicaid before aging out of foster care to receive coverage through age 26, regardless of their income or state of residence. ... But CMS has left it up to each state to decide whether to cover young people who were in foster care outside of its borders. And since the measure took effect in January, less than a quarter of states have chosen to offer Medicaid coverage to this group (Kalter, 2/25).

Related, earlier KHN coverage: When Your Parent Is The State, It’s Tough For Young Adults To Stay Insured (Gorman, 2/3).

Kaiser Health News: Capsules: Poll: For Right Price, Consumers Will Accept Limited Choice Of Doctors, Hospitals
People buying health insurance through the health law's new online marketplaces are more willing than the public at large to accept a limited roster of doctors and hospitals in return for lower premiums, a poll released Wednesday finds. But that enthusiasm nosedives if they are told their regular doctor isn't included in the plan (Rau, 2/25). 

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White House Leaning On Party Stalwarts, Core Supporters To Sell Health Law

The White House is using former President Bill Clinton and a Democratic governor from a Republican state to sell the health law to a still-skeptical public. In the meantime, volunteers for Obama's Organizing for Action are urged to focus their efforts on enrolling the public in Obamacare.

The New York Times: Ex-President Ventures Where Some Might Not
The peril posed by what conservatives call Obamacare underscores the limitations of just what Mr. Clinton, popular as he may now be, can do for Democratic candidates running in conservative-leaning states this year. Kentucky, for example, is a national model for the law; 244,000 residents of the state now have health care because of the Affordable Care Act. Just in the last month, [Kentucky Gov. Steve] Beshear was a guest in the first lady’s box at Mr. Obama’s State of the Union address and at a White House state dinner, both invitations widely seen as a way of thanking the governor. Yet despite what Democrats see as the success of the law here, it is Republicans who are focused on the topic (Martin, 2/26).

The Wall Street Journal: Obama Trims To-Do List For Core Supporters
President Barack Obama offered an abbreviated to-do list Tuesday as he asked Organizing for Action volunteers to help him raise the minimum wage and ensure that more people sign up for health coverage through the Affordable Care Act (Nelson, 2/25).

Politico: Obama: OFA Volunteers Doing 'God’s Work'
The president urged OFA members to recruit Republican friends and relatives to enroll in Obamacare -- telling them to tell people not to believe what they might hear on “the wrong newscast.” He cited “a combination of an implacable opposition that has spent hundreds of millions of dollars, if not billions of dollars, to spread misinformation” and the faulty healthcare.gov as the reason “a lot of people who really could use this coverage are unsure. We’ve got to make sure that they know that this will pay off for them” (Epstein, 2/25).

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Weighing Medicare Claims And Health Law 'Job Killer' Accusations

As the political season heats up, fact checkers are getting increasingly busy.

The Washington Post's The Fact Checker: Is Obamacare A 'Job Killer'?
We have delved into this issue before and find the certainty with which both sides hold their positions to be dismaying. Each side can point to data to make their case, even though the law has only begun to be implemented (Kessler, 2/26).

USA Today/FactCheck.Org: Fact Check: Old Medicare Claims In Arkansas Race
Democratic Sen. Mark Pryor taps his party's playbook in attacking Republican challenger Tom Cotton for his support of Rep. Paul Ryan's Medicare plan. Two ads from Pryor make misleading claims about seniors' costs rising or benefits being cut — the likes of which we've seen before. The Ryan Medicare plan has been a hot topic for Democratic attacks for several years running (Robertson, 2/25).

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Capitol Hill Watch

Obama, Boehner Meeting Touches Health Law, But Resolves Little

The president and the House speaker met Tuesday in the Oval Office, but there was little indication any progress was made on resolving their differences on the health law.

The New York Times: White House Meeting Turns Into A Lightning Round For Obama And Boehner
At the same time, Mr. Boehner has done little to suggest his House would advance any of the president’s agenda in the months leading up to the midterm elections, telling his members this month that he would not pursue the immigration legislation that Mr. Obama supports, but that angered conservative Republicans. Republicans have vowed to continue their push to roll back or change the Affordable Care Act, and in a message posted on Twitter, even as the speaker was arriving at the White House, Mr. Boehner took a political jab at the president’s top domestic policy (Shear, 2/25).

In the House, Republicans are contemplating health law alternatives --

Roll Call: GOP Leaders To Huddle On Obamacare Alternative
House Republican leaders will meet Friday to begin crafting an alternative to Democrats’ health care law, but they face a slate of challenges from inside and outside the conference to advancing a credible plan. Majority Leader Eric Cantor, R-Va., will meet privately with relevant committee heads, his staff said. Budget Chairman Paul D. Ryan of Wisconsin, Education and the Workforce Chairman John Kline of Minnesota, as well as Ways and Means Chairman Dave Camp and Energy and Commerce Chairman Fred Upton, both of Michigan, will attend (Newhauser, 2/25).

And Democrats are themselves criticizing a GOP proposal they say would cause 1 million to lose their health coverage --

CQ HealthBeat: GOP Employer Bill Would Lead To Loss Of Health Insurance, Analysis Finds
House Democrats on Tuesday promoted a joint cost estimate that found a GOP bill to change the threshold for employer-mandated health care would cost $73.7 billion and cause 1 million people to lose their employer-based health insurance (Ethridge, 2/25).

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Medicare Official Defends Proposed Changes To Prescription Drug Program

In written testimony, Jonathan Blum, deputy administrator of the Centers for Medicare & Medicaid Services, says the changes are needed to head off cost increases, but an industry-sponsored study argues some of the changes could cost taxpayers more.

Reuters: U.S. Medicare Chief Defends Proposed Part D Drug Benefit Reforms
The Obama administration's top Medicare official on Tuesday defended proposed changes to the popular Part D drug benefits program for the elderly and disabled that are fiercely opposed by a broad network of drugmakers, insurers, healthcare providers and patient advocates. The Centers for Medicare and Medicaid Services (CMS) proposed a new rule in January that would fundamentally alter the program's private insurance coverage for certain drugs, change the pharmacy networks that some plans cover and limit the number of policies available to beneficiaries in any given region. ... Medicare chief Jonathan Blum said in written testimony to a congressional panel that the 2015 policy changes are needed to head off higher costs to the program from expensive new biologic therapies and rising subsidies for insurers and lower-income consumers (Morgan, 2/25).

Politico Pro: Study: Part D Rule Could Cost Feds Up To $1.6 Billion
If CMS follows through with its proposed revision of the Medicare prescription drug benefit, the federal government could spend up to $1.6 billion more on the program in 2015, according to a report released Tuesday by Milliman. The study, commissioned by the Pharmaceutical Care Management Association, comes ahead of a House hearing Wednesday on a proposed rule for the Part D program that the agency released in January. The study highlights CMS policy changes for "preferred provider networks" and new requirements on the mail-order drugs provided by pharmacy benefit managers (Norman, 2/25).

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Study: Medical Homes Haven't Saved Money Or Substantially Improved Care

A study published in the Journal of the American Medical Association found a pilot project that organizes care for patients in order to improve care quality and reduce costs improved neither substantially.

JAMA: Limited Quality Improvement But No Cost Reduction In Medical Home Pilot
There's been great hope that the patient-centered medical home model could help alleviate rising health care costs and improve the quality of care. But results from a large pilot study published in JAMA today found no cost savings and only a modest improvement in quality (Kuehn, 2/25).

The New York Times: Study Finds Limited Benefit To Some 'Medical Homes'
You may have heard the term "medical home" to describe a way of organizing doctors' practices to provide more comprehensive, less costly, patient-friendly treatment. Insurance companies often offer more money to practices that become recognized as medical homes, which use a team approach to coordinate care. States are even looking to medical homes to help save money in their Medicaid programs (Carrns, 2/25). 

The Wall Street Journal: Study Questions Benefits Of 'Medical Home' Programs For Chronically Ill
Health-policy experts often talk up the notion of a "patient-center medical home" -- in which a medical practice actively manages patients' chronic conditions to improve their health and avoid hospitalizations -- as the ideal model for transforming the U.S. health-care system. But a study of one of the earliest and largest medical-home pilots found that after three years, patients' health improved in only 1 of 11 measures (Beck, 2/25). 

Reuters: Popular U.S. Health Reform Plan May Not Cut Costs, Boost Quality: Study
Increased attention given to patients in primary care practices organized into so-called medical homes may not improve quality of care or reduce health costs as reformers of the U.S. healthcare system had hoped, researchers said on Tuesday. Thousands of primary care doctors in the United States are revamping their practices based on this new medical home model (Steenhuysen, 2/25).

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Health Care Fraud & Abuse

Record $4.3 Billion In Health Care Fraud Recovered

Federal efforts to combat health care fraud recovered a record $4.3 billion in fiscal 2013 and have recouped more than $8 for every $1 spent on enforcement over the past three years, according to an annual report released Wednesday.

McClatchy: Feds Recover Record $4.3 Billion In Health Care Fraud Funds Last Year
The Obama administration’s health care fraud efforts recovered a record $4.3 billion in taxpayer cash in fiscal year 2013, up from $4.2 billion in 2012. And for every dollar spent investigating health care fraud and abuse in the last three years, the government recovered $8.10, the Obama administration reported Wednesday. That’s the largest three-year average return on investment in the 17-year history of the federal Health Care Fraud and Abuse Control Program (Pugh, 2/26).

The Hill: Holder, Sebelius Tout Billions In Healthcare Fraud Recoveries
The U.S. recovered $4 billion last year through healthcare fraud prevention and enforcement efforts, according to a report released Wednesday by Attorney General Eric Holder and Health and Human Services (HHS) Secretary Kathleen Sebelius. The report says that the Health Care Fraud and Abuse Control Act (HCFAC) recovered more than $8 for every $1 it spent on healthcare fraud investigations over the last three years, the best ratio in the 17-year history of the program (Easley, 2/26).

Politico Pro: Record $4.3 Billion In Health Care Fraud Recovered
Federal efforts to combat health care fraud recovered a record $4.3 billion in fiscal 2013 and have recouped more than $8 for every $1 spent on enforcement over the past three years, according to an annual report released Wednesday. The latest results brought the total to more than $25.9 billion since the Health Care Fraud and Abuse Control Program began in 1997. The program, a joint effort of HHS and the Department of Justice, targets schemes by individuals and companies to defraud the government’s hugely expansive health care network, particularly Medicare and Medicaid (Norman, 2/26).

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Public Health & Education

Obesity Rate For Young Children Falls 43 Percent

The study by the Centers for Disease Control and Prevention reported the decline among 2- to 5-year-old children -- the first significant drop ever reported. Rates for the broader population remain unchanged, however.

The New York Times: Obesity Rate For Young Children Plummets 43% In A Decade
Federal health authorities on Tuesday reported a 43 percent drop in the obesity rate among 2- to 5-year-old children over the past decade, the first broad decline in an epidemic that often leads to lifelong struggles with weight and higher risks for cancer, heart disease and stroke (Tavernise, 2/26). 

The Washington Post: New CDC Data Shows 43 Percent Drop In Obesity Rates Among Children 2 To 5
The finding comes from a government study considered a gold standard to measure public-health trends. Researchers found that just over 8 percent of children 2 to 5 were obese in 2011-2012, down from nearly 14 percent in 2003-2004. Although the drop was significant, federal health officials noted that obesity rates for the broader population remain unchanged, and for women older than 60, obesity rates rose about 21 percent during that period (Sun, 2/26).

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State Watch

Georgia Docs Finally See Medicaid Pay Raise

In the meantime, Minnesota's hospitals saw their uncompensated care costs increase at the slowest rate in five years.

Georgia Health News: Long-Delayed Doc Pay Hike Finally Arriving
The physician pay hike for Medicaid services is finally beginning to reach Georgia doctors, more than a year after it was intended to take effect. The three managed care organizations serving the majority of Medicaid beneficiaries are sending the extra payments to physicians starting this month, according to a schedule released by the Department of Community Health. The pay hike was required under the Affordable Care Act, with the goal of paying family physicians, pediatricians and internists the same for Medicaid services as they get under Medicare (Miller, 2/25).

The Star Tribune: Hospitals Provided $521 Million In Uncompensated Care
Minnesota’s largest hospital systems provided $521 million in uncompensated medical care in 2012, an increase of 2.3 percent from the previous year. It was the slowest rise in five years, according to a new report from the Minnesota Hospital Association, which has shown a steady increase in care given to patients who don’t have insurance or the means to pay, particularly during the economic downturn. With the final elements of the Affordable Care Act rolling out this year, hospitals could see levels of uncompensated care decline in coming years, as more people come through their doors with insurance coverage (Crosby, 2/25).

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Editorials and Opinions

Viewpoints: Health Law's Forgotten Taxes; 'Lame Documentation' By Critics; Hospital Closing Crisis

The New York Times' Economix: The Affordable Care Act's Multiple Taxes
The Affordable Care Act contains at least two economically distinct taxes on labor market activity. Even the experts on the law have failed to recognize all of them (Casey B. Mulligan, 2/26). 

Los Angeles Times: A Tea Party Group's Lame 'Documentation' Of Its Anti-Obamacare Ad
Greg Sargent on Tuesday unveiled the "documentation" offered by the Koch brothers-funded tea party group Americans for Prosperity to back up its recent anti-Obamacare campaign commercial airing in Michigan. The ad featured a local leukemia patient named Julie Boonstra, complaining about her experience under Obamacare. The ad's target, Gary Peters, a Democratic candidate for Senate, demanded that the group back up its claims. As you might expect, the documentation does nothing to contradict the expert debunking of the original ad performed by Glenn Kessler of the Washington Post. We reported on the back-and-forth here, and placed it in the context of the short, sad history of conservative efforts to undermine the Affordable Care Act with "horror stories" that don't stand up to scrutiny (Michael Hiltzik, 2/25). 

The Washington Post's Plum Line: Obamacare 'Horror Stories' Fall Apart Under Scrutiny
The documentation provided by AFP, which was passed along from TV stations by the Peters campaign, doesn't actually back up the ad's key claim. But it tells us something interesting about how the AFP campaign — and by extension, the broader GOP strategy against Obamacare — really work (Greg Sargent, 2/25). 

The Washington Post's Right Turn: Obamacare's Bad News Multiplies
Over the past few days Republican leaders and advocacy groups have pummeled the administration over an announced cut of 3.55 percent in Medicare Advantage. In a letter signed by a batch of GOP senators to HHS Secretary Kathleen Sebelius, they complain that the change will necessitate significant cuts in benefits and/or cost increases (Jennifer Rubin, 2/25). 

The Washington Post's Post Partisan: The Insiders: Another Day, Another Obamacare Disaster
In a colossal "oh by the way" revelation, last Friday afternoon the Centers for Medicare and Medicaid Services (CMS), a federal agency under the United States Department of Health and Human Services (that would be the executive branch run by President Obama), quietly released a report exposing the fact that under Obamacare, two-thirds of Americans who work at small businesses will see their insurance premiums increase. So this report – which is more than two years late – says over 11 million American workers will have higher health insurance premiums because of Obamacare. Despite the administration's attempts to, as House Speaker John Boehner put it, "delay and deemphasize" the report, we now have it straight from the Obama administration that Obamacare will raise health-insurance premiums for American workers (Ed Rogers, 2/25). 

The Washington Post's She The People: Experts Disagree About Job Losses And The Moral Status Of Obamacare
As a general matter, economists don't know how Obamacare will affect the economy. "There's a wide range of opinion on the effects of the ACA on long-run growth," according to Jay Bryson, who is the policy survey chair for the National Association of Business Economists. He coordinated a survey of 230 NABE members that showed 30 percent said it would hurt, 18 percent said it would help, and 42 percent said the ACA would have no impact on economic growth (Joann Weiner, 2/26). 

Bangor Daily News: Support Managed Care, Expand Medicaid, Keep Patients Front And Center
Republican Maine Sens. Roger Katz of Augusta and Tom Saviello of Wilton rolled out legislation Tuesday that would overhaul the state's health insurance program for low-income residents. It would permit the state to expand Medicaid under the Affordable Care Act for three years, and it would fundamentally change the way Maine administers Medicaid for all recipients by contracting the program out to private companies or nonprofits, a model known as managed care. ... As long as rulemaking resulting from the bill ensures greater access to care for Maine's low-income patients and fair rates for providers, there's no reason not to pursue the new health care delivery system (2/25).

Richmond Times-Dispatch: Audit Medicaid
"All I've heard from the other side is 'Let's do an audit,' " said Del. Patrick Hope in a speech urging expansion of Medicaid. "That's not a plan. That's a stall tactic." ... Former Virginia Attorney General Ken Cuccinelli recovered scores of millions of taxpayer dollars through the Medicaid Fraud Control Unit. The fact that the AG’s office has an entire division, with nearly 100 employees, dedicated to Medicaid fraud should tell you all you need to know. Auditing Virginia's Medicaid system might, indeed, be a delaying tactic. That doesn't mean it's uncalled for (2/26).

And on other health issues -

Los Angeles Times: Another Healthcare Crisis: Closing Hospitals
Lower Oconee Community Hospital in southern Georgia closed its doors this month, eliminating 25 hospital beds and up to 100 hospital jobs. This was the fourth Georgia hospital to fold in two years and the eighth rural hospital in the state to close since 2000. Although Lower Oconee's shutdown may not have registered much media coverage, those in search of medical attention in Glenwood, Ga., should be mindful that the closest hospital is now 30 miles away. As reference, Santa Ana is 30 miles from Los Angeles. When faced with a medical emergency, no one fancies a long road trip (Craig B. Garner, 2/26). 

The New York Times: Rethinking Our 'Rights' To Dangerous Behaviors
Similarly, we need to be asking not "Do junk food companies have the right to market to children?" but "Do children have the right to a healthy diet?" ... In short, says [Nicholas Freudenberg in his new book]: "The right to be healthy trumps the right of corporations to promote choices that lead to premature death and preventable illnesses. Protecting public health is a fundamental government responsibility; a decent society should not allow food companies to convince children to buy food that’s bad for them or to encourage a lifetime of unhealthy eating" (Mark Bittman, 2/25).

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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.