Daily Health Policy Report

Wednesday, February 5, 2014

Last updated: Wed, Feb 5

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Public Health & Education

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Medicaid Expansion Only A First Step To Better Health In Troubled W.Va. Communities

Kaiser Health News staff writer Ankita Rao, working in collaboration with USA Today, reports: "It was a frosty December afternoon in downtown Williamson, with hot tomato and beef soup on the menu at Jacobs Well. Ronald Washington warmed up at a long wooden table. The 58-year-old security guard, wearing a striped winter hat and brown jacket, came during his lunch break for one of the free meals that the faith-based mission provides" (Rao, 2/5). Read the story and the related sidebar, A Small West Virginia Town Rallies For Better Health (Rao, 2/5) .

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A Third Generation Doctor Questions The Profession

Reporting for Kaiser Health News, in partnership with NPR, Eric Whitney writes: "Being a doctor in America is changing, in part because of the Affordable Care Act and also because of longer trends in the practice of medicine. Drs. Robert and Michael Sawyer practice at Denver Health, the city's big public hospital downtown. Sawyers have worked or taught here as physicians since the 1930s, so they have a unique perspective on how today's challenges stack up against those that physicians have faced in the past" (Whitney, 2/5). Read the story.

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Capsules: CBO Reports That Health Law Provision Called ‘Bailout’ By GOP Will Raise $8B

Now on Kaiser Health News' blog, Mary Agnes Carey reports: "New findings from the Congressional Budget Office may make it harder for Republicans to portray a provision in the health law designed to limit insurers’ losses and gains as a ‘bailout’ for the industry" (Carey, 2/5). Check out what else is on the blog.

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Experts: Moving New Medicaid Patients Out Of ER Will Take Time

The Chicago Tribune's Karen Springen, working in partnership with Kaiser Health News, reports: "Lela Morgan, a nurse, says she lived for years without health insurance after a nervous breakdown in 2005 left her unable to work. Every 90 days, when she was running low on medications for osteoarthritis and hypertension, she commuted about 45 minutes from her Englewood home to the emergency room at Stroger Hospital. Often, she said, she waited three or four hours" (Springen, 2/4). Read the story.

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Patient Coordination Would Get Boost If Medicare Changes How It Pays Docs

The St. Louis Post-Dispatch's Tara Kulash, working in partnership with Kaiser Health News, reports: "Expectations are high this year that Congress will finally reach an agreement to overhaul the way Medicare pays doctors for services, scrapping a method that’s been the target of criticism for more than a decade. If that happens, experts say, Medicare beneficiaries will see changes in how health care is provided, with an increased emphasis on coordinated care and preventive services" (Kulash, 2/4). Read the story.

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Political Cartoon: 'Groundhog Day, Redux?'

Kaiser Health News provides a fresh take on health policy developments with "Groundhog Day, Redux?" by Nate Beeler.

And here's today's health policy haiku:


If you're craving to
"Smoke, smoke, smoke that cigarette"
CVS won't help.

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

CBO: Health Law's Increased Access To Health Care Could Lead Many To Quit Work, Reduce Hours

The Congressional Budget Office report, released Tuesday, which updated estimates regarding how many people will be able to gain health insurance without necessarily having a job, became an immediate political flashpoint and reignited the political debate surrounding the health law.  

The New York Times: Health Care Law Projected To Cut The Labor Force
A Congressional Budget Office analysis released Tuesday predicted that the Affordable Care Act would shrink the work force by the equivalent of more than two million full-time positions and recharged the political debate over the health care law, providing Republican opponents fresh lines of attack and putting Democrats on the defensive. The nonpartisan budget office’s analysis, part of a regular update to its budget projections, was far more complicated than the Republican attack lines it generated. Congressional Republican leaders called the findings “devastating,” “terrible” and proof that the health care law was a job killer (Lowrey and Weisman, 2/4).

NPR: More Access To Health Care Means Millions Can Quit Or Cut Hours
What might have been a routine update on the state of the federal budget Tuesday instead became the newest front in the ongoing political war over President Obama's signature health care law. At issue: a revised estimate about how many people would voluntarily leave the workforce because they can get health care without necessarily holding down a job (Date, 2/4).

Los Angeles Times: Affordable Care Act Will Prompt Some To Work Less, Report Says
President Obama's healthcare law will reduce the ranks of the uninsured by about 13 million this year and 25 million once it is fully phased in, but will prompt some people to work less because of the availability of insurance subsidies, the Congressional Budget Office said Tuesday. The latest projections by the nonpartisan budget analysts inspired new talking points for both sides in the deeply polarized debate over the Affordable Care Act, popularly known as Obamacare (Lauter, 2/4).

The Washington Post: Health-Care Law Will Prompt Over 2 Million To Quit Jobs Or Cut Hours, A CBO Report Says
More than 2 million Americans who would otherwise rely on a job for health insurance will quit working, reduce their hours or stop looking for employment because of new health benefits available under the Affordable Care Act, congressional budget analysts said Tuesday. The findings from the nonpartisan Congressional Budget Office revived a fierce debate about the impact President Obama’s signature health-care program will have on the U.S. economy (Goldfarb and Goldstein, 2/4).

The Wall Street Journal: Health Law To Cut Into Labor Force
The agency also said the rough launch of the health law's online insurance portals shrunk its estimates of the number of people who will get coverage in 2014. It said six million people would obtain private coverage through the exchanges and eight million people would sign up for Medicaid, compared with its earlier estimates of seven million and nine million, respectively. The report, part of the budget office's annual economic and budgetary outlook, provides the agency's most detailed analysis yet of the ways in which the law is expected to change incentives in the workplace as it takes full effect. The report indicates that, in effect, some workers will either leave the workforce entirely or cut back on hours because the law lets them get coverage on their own without regard to their medical history, in some cases with a subsidy (Radnofsky and Paletta, 2/4).

The Associated Press/Washington Post: Health Care Law Will Mean Fewer People On The Job
Republican lawmakers seized on the report as major new evidence of what they consider the failures of Obama’s overhaul, the huge change in U.S. health coverage that they’re trying to overturn and planning to use as a main argument against Democrats in November’s midterm elections (2/4).

USA Today: Health Law Could Mean Fewer Full-Time Workers, CBO Says
Workers eligible to buy cheaper health insurance or receive financial incentives under the Affordable Care Act may choose to work fewer hours, according to a Congressional Budget Office report released Tuesday. Those choices, the report said, may cut the number of full-time workers by 2.3 million people by 2021. CBO originally had estimated that 800,000 people may make those choices (Kennedy, 2/4).

Bloomberg: Obamacare To Cut Hours Of Work By 2017 CBO Estimates
Obamacare will reduce the hours Americans work by the equivalent of 2 million full-time jobs in 2017, the Congressional Budget Office said, sparking renewed Republican criticism of the law and a fresh defense from the White House. The total number of hours worked will fall about 1.5 percent to 2 percent from 2017 to 2024 as a result of the health-care overhaul, the CBO said yesterday in a report (Wayne, 2/5).

CBS News: Obamacare Will Shrink Workforce By 2 Million, Report Says
Given the new incentives offered by the Affordable Care Act, people will choose to work less in the coming years, nonpartisan budget analysts say -- shrinking the workforce by the equivalent of 2 million full-time workers by 2017 and by 2.5 million by 2024. Republicans, already intent on making the controversial health care law a 2014 campaign issue, seized on the new data from the Congressional Budget Office (CBO) to argue the law is hurting the economy. The White House, however, defended the law, charging the GOP with spinning the facts (Condon, 2/4).

CNN: Obamacare May Prompt People To Work Less
Many workers may opt to work less to retain their eligibility for Medicaid or federal subsidies under Obamacare, a new report has found. The Affordable Care Act could reduce the labor force by the equivalent of 2.5 million workers in 2024, according to the non-partisan Congressional Budget Office's annual outlook. That doesn't mean employers will start swinging the ax or even that that many jobs will be lost, CBO says. Rather, more people will likely opt to reduce their hours, or leave the workforce entirely, so they stay under the income caps for Medicaid and federal subsidies (Luhby, 2/4).

Fox News: ObamaCare Could Lead To Loss Of Nearly 2.3 Million US Jobs, Report Says
The long-term effect of ObamaCare on the U.S. economy was rewritten Tuesday with the Congressional Budget Office issuing a revised projection that nearly 2.5 million workers could opt out of full-time jobs over the next 10 years -- allowing employers to wipe 2.3 million full-time jobs off the books. Budget experts say that because ObamaCare offers an insurance alternative to employer provided coverage, many Americans who hold full-time jobs may decide to work part-time -- or not at all -- and get their coverage from the exchanges. Following the release of the report, House Speaker John Boehner said the report showed how “the middle class is getting squeezed in this economy” (2/4).

McClatchy: CBO: Obamacare Would Lead Employees To Work Less
A government analysis sparked fierce debate Tuesday, projecting that the Affordable Care Act will lead American workers to voluntarily put in fewer hours on the job, a total that would add up to the equivalent of as many as 2.5 million jobs over the next decade. The nonpartisan Congressional Budget Office said it expected total employment and compensation in the whole economy to increase over the next 10 years. But “that increase will be smaller than it would have been in the absence of the ACA.,” it said in a report (Hall, Clark and Pugh, 2/4). 

The CBO updated other projections, including health care enrollment numbers, the financial impact of the overhaul's risk corridor provision and Medicare growth -    

The Associated Press/Washington Post: Web Site Woes Will Reduce Health Care Enrollment
Website woes have largely cleared up, but the nonpartisan analysts said Tuesday they expect 1 million fewer people to sign up through the new insurance exchanges, for a new total of 6 million in 2014. They predict enrollment will pick up and top 20 million in 2016. CBO also revised its Medicaid projection down by 1 million, for a new total of 8 million (2/4).

CQ HealthBeat: CBO: Botched Health Law Rollout Means Fewer Insured Americans In 2014
The Congressional Budget Office estimated Tuesday that 1 million fewer people will receive health insurance through the law’s exchanges in 2014 than previously projected, mostly due to the troubled federal exchange website rollout (Ethridge, 2/4).

The Wall Street Journal’s Washington Wire: CBO: Medicare Growth to Remain ‘Slower Than Usual’
The Congressional Budget Office, in its new economic outlook report released Tuesday, said the recent slowdown in the growth of Medicare costs has been “broad and persistent,” prompting a projection “that growth will be slower than usual for some years to come.” Total spending for Medicare is projected to grow about 6% per year over the next decade because Medicare case loads are expanding as baby boomers become eligible for benefits at age 65. In 2013 there were about 51 million Medicare beneficiaries and that number is expected to climb to 71 million by 2024 (Corbett Dooren, 2/4).

Kaiser Health News: Capsules: CBO Reports That Health Law Provision Called ‘Bailout’ By GOP Will Raise $8B
New findings from the Congressional Budget Office may make it harder for Republicans to portray a provision in the health law designed to limit insurers' losses and gains as a 'bailout' for the industry (Carey, 2/5).

The Fiscal Times: Obamacare ‘Bailout’ Actually Saves $8 Billion: CBO
Many congressional Republicans believe that they should not raise the nation’s borrowing limit unless President Obama agrees to give them something in return. Approval of the Keystone XL pipeline or a repeal of the so-called risk corridors in the Affordable Care Act are the two items topping their potential wish list. The CBO report might shift the balance between those options because it projects that the risk corridor program, which Republicans have insistently characterized as a bailout of the insurance industry, will probably generate a net profit for the federal government (Garver, 2/4).

The Wall Street Journal’s Washington Wire: Five Takeaways On New Health-Care Projections
There is plenty of material in today’s Congressional Budget Office report about the impact of the Affordable Care Act. Here are five key takeaways (Radnofsky, 2/4).

News outlets also covered the White House reaction to the CBO numbers -

Politico: White House Pushes Back Hard Amid CBO Fallout
The White House pushed back hard Tuesday on the Congressional Budget Office’s projection that the Affordable Care Act will cut labor supply by the equivalent of two million full-time jobs, contending that the law is a good thing because it gives Americans “choice” on how much they’ll work. While the CBO “consistently does outstanding work,” Council of Economic Advisers chairman Jason Furman said at the White House press briefing, its findings in Tuesday’s report can be “subject to misinterpretation” (Epstein, 2/4).

The Hill: WH Not Worried About O-Care Enrollment
The White House on Tuesday brushed aside questions about a Congressional Budget Office report lowering estimates for first-year enrollment in the president's signature health care law, saying they remained “confident we're going to have a substantial number of Americans covered.” The nonpartisan CBO downgraded its initial estimate of 7 million first-year enrollees in the president's signature health care law to 6 million, likely thanks to the botched early rollout of the law (Sink, 2/4).

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GOP Gubernatorial Candidate Says Mass. Should Seek Obamacare Waiver

Charlie Baker, a former CEO of Harvard Pilgrim Health Care who is running for governor, said Massachusetts ran into problems because it tried to meld its successful state law with new federal requirements. Meanwhile, a mini-health exchange in Florida, which will sell discount cards and other products to "fill benefit gaps," nears launch and Connecticut exchange officials announce they are close to their enrollment goals.

The Associated Press: GOP's Baker: Mass. Should Seek [Waiver] Out Of Health Law
Republican candidate for governor Charlie Baker said Tuesday that Massachusetts should seek a waiver from President Obama's health care law, adding that he's had to personally help people get insurance after they were stymied by the state's troubled website. The former Harvard Pilgrim Health Care CEO said Massachusetts already has a successful health care law — which helped provide a blueprint for Obama’s 2010 law — but ran into trouble when it tried to knit together the state and federal mandates (LeBlanc, 2/4).

Health News Florida: Discount-Plan Site Set To Launch
Florida's answer to the Affordable Care Act,  a mini-health-exchange that will sell discount cards and other products to "fill benefit gaps," says it will open for business in a few days. Florida Health Choices, six years in the making, will sell products that cannot be called "insurance" because they don't meet the legal definition (Gentry, 2/4).

Related KHN Coverage: Florida Readies Its Own Health Insurance Exchange (Galewitz, 10/9/2011).

The CT Mirror: Connecticut Obamacare Exchange Adding Members. Were They Uninsured?
Connecticut's health insurance exchange is nearing its goal of getting 100,000 people signed up for coverage this year. But how close it is to another key goal -- substantially reducing the number of state residents without health insurance -- remains unclear. A central aim of the federal health law commonly known as Obamacare was to get the uninsured covered. But the application for Connecticut’s exchange, Access Health CT, doesn’t ask whether people have coverage at the time they’re applying (Becker, 2/5).

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Expanded Medicaid Enrollment In Washington State Exceeds Expectations

By Jan. 30, the state had enrolled 172,700 people, already surpassing its goal for April. But in Missouri, enrollment in the government health program has actually declined with state officials blaming error-ridden data from the federal exchange. Media outlets also follow developments in Arkansas and Nevada.

Spokesman Review: Washington Medicaid Enrollments Surpassing Expectations
With two months to go, Washington residents are pouring by the thousands through the online gateway to 2014 health insurance coverage, blowing away expectations for Medicaid enrollments, the expanded government program for the working poor and their children. In Spokane County, one in four residents relies on Medicaid coverage. Nathan Johnson, director of policy planning and performance for the state Health Care Authority, said the statewide sign-ups mean “there’s a tremendous amount of demand, and maybe more than we realized, for affordable coverage from those who are at or near the poverty level” (Webster, 2/5).

Seattle Times: Medicaid Enrollment Soars Statewide
Medicaid enrollment in Washington state has grown so high so fast that the state already has met its April goal for new participants under Medicaid expansion. By Jan. 30, more than 172,700 newly-eligible adults had signed up for the free health insurance. The state was aiming for 136,000 enrollees by the start of April (Stiffler, 2/4).

St. Louis Post-Dispatch: Medicaid Applications From HealthCare.Gov Called Flawed; Enrollment Dips
Missouri’s Medicaid program expected to see an uptick in enrollment with the rollout of HealthCare.gov because outreach efforts would attract more people — particularly children — who were already eligible. Indeed, the federally run marketplace has turned over to the Missouri Department of Social Services more than 25,000 applications from people who seemed to meet the state’s income criteria. But the state hasn’t added any of them to the Medicaid rolls ... The state says application data forwarded by the online exchange is fraught with errors and duplication. “We’re in the process of sorting it out,” said Brian Kinkade, acting director of the social services department (Young, 2/4).

Arkansas News: Lawmakers Consider Whether Private Option, Medicaid Waiver Conflict
Arkansas’ so-called private option for expanding health insurance coverage does not conflict with the federal Medicaid waiver that allowed the state to implement the program, state Department of Human Services officials and a legislative researcher said Tuesday. Representatives of three conservative groups disagreed. The House and Senate committees on public health, welfare and labor took up the issue less than a week ahead of the start of this year’s fiscal session, during which lawmakers will decide whether to appropriate a second round of federal funding for the private option. The program uses federal Medicaid money to provide private health insurance to low-income Arkansans (Lyon, 2/4).

KUAR: Gov. Mike Beebe Touts Reasons For Continuing Private Option
Gov. Mike Beebe said Tuesday there are a “multiplicity” of reasons Arkansas legislators should vote to fund Arkansas’ private option plan, and he also took a shot at Republican gubernatorial candidates who “don’t understand the budget” with respect to the private option (Brock, 2/4).

Las Vegas Review-Journal: Nevada’s Medicaid Caseload Grows, Hits Backlog Of About 50,000 Applicants
Nevada’s Medicaid caseload is growing rapidly as eligible residents sign up under Obamacare, creating a backlog of about 50,000 applications awaiting processing in the system, a state panel was told Tuesday. Mike Willden, director of the Department of Health and Human Services, told the state Board of Examiners, including Gov. Brian Sandoval, that the agency ran a backlog of about 10,000 applications before the federal health care law took effect on Jan. 1. “We’re on track to enroll 500,000 people by the end of the year,” he said. The Medicaid caseload as of the end of January was 377,363 (Whaley, 2/4).

Kaiser Health News: Medicaid Expansion Only A First Step To Better Health In Troubled W.Va. Communities
It was a frosty December afternoon in downtown Williamson, with hot tomato and beef soup on the menu at Jacobs Well. Ronald Washington warmed up at a long wooden table. The 58-year-old security guard, wearing a striped winter hat and brown jacket, came during his lunch break for one of the free meals that the faith-based mission provides. ... More than 75,000 people have enrolled [in Medicaid] so far, exceeding the state's projection of 63,000. Some advocates for the poor are thrilled, but they caution that insurance coverage alone won't overcome the deeply rooted health problems of many poor West Virginians who live in isolation and poverty (Rao, 2/5).

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HHS To Insurers: You May Have To Add More Doctors, Hospitals In Obamacare Plans

Other stories today examine the administration's enrollment effort and how many people it could reach if it just focused on 116 of the nation’s 3,143 counties. Also examined is how the insurer WellPoint's bottom line is changing because of the law.

Bloomberg: Obamacare Insurers May Be Forced To Add Medical Providers
Insurers participating in Obamacare may have to expand their plans to include more federally funded health clinics, safety-net hospitals and other medical providers used by low-income people, under a U.S. proposal. Health plans offered through government-run insurance exchanges may be required to cover 30 percent of “essential community providers” in their areas in 2015, an increase from 20 percent this year, according to a letter to insurers issued today from the Health and Human Services Department (Wayne, 2/4).

Modern Healthcare: Insurers Selling Exchange Plans Would Have Tougher Standards In 2015, CMS Proposal Says
Insurers that want to sell plans through the federal exchanges for 2015 may have to do more to ensure members have access to adequate networks of providers. Participating health plans would be required to submit a list to the CMS of all in-network providers and medical facilities covered under a plan, according to a proposal detailed in a letter from the CMS on Tuesday. The CMS will review them, in conjunction with state regulators, to ensure that there is “reasonable access” to all types of providers (Demko, 2/4).

Los Angeles Times: Obamacare Enrollees Hit Snags At Doctor’s Offices
After overcoming website glitches and long waits to get Obamacare, some patients are now running into frustrating new roadblocks at the doctor's office. A month into the most sweeping changes to healthcare in half a century, people are having trouble finding doctors at all, getting faulty information on which ones are covered and receiving little help from insurers swamped by new business (Terhune, 2/4). 

The Associated Press: Administration Drills Down To Find Uninsured
Uninsured Americans are still procrastinating about President Barack Obama’s health care law. With less than 60 days left to enroll, can the administration find the millions of customers needed to sustain new insurance markets? Geography could hold the answer, according to a study conducted for The Associated Press. It found the uninsured aren’t scattered around the country willy-nilly; half live in just 116 of the nation’s 3,143 counties. That means an outreach campaign targeted to select areas can pay off big (Alonso-Zaldivar, 2/5).

The New York Times: WellPoint, A Onetime Critic Of Health Law, May Yet Profit
Just a few years ago, the health insurer WellPoint outraged its customers — and regulators — by proposing an increase of nearly 40 percent in some of its annual premiums. Now, WellPoint has captured a large portion of the government money being spent on Medicaid, the federal-state health care program for the poor, and can gamble on the new insurance marketplace because of protections offered by the federal government in the early days of the law’s introduction (Abelson, 2/4).

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Capitol Hill Watch

GOP Hammers "Risk Corridors" As Bailout; Democrats Worry About Explaining Law

Republicans are trying to tie a vote raising the debt ceiling to repealing the health law's "risk corridors," which help mitigate insurer risk. In the meantime, President Obama faces some pushback on the law's rocky rollout from his own party.

The Hill: Republicans Count Votes On Tying Debt Hike To Health Care Law
House Republican leaders are canvassing their members to see whether they have enough votes to pass an increase in the debt ceiling that is tied to a repeal of the “risk corridors” provision in Obamacare. The party on Tuesday held its second private session in the last week devoted to finding a plan to raise the debt limit by the late-February deadline set by the Treasury Department (Berman and Becker, 2/4).

Related, earlier KHN story: The Health Law's '3 Rs' For Insurers: A Bailout Or Necessary Safeguards? (Carey, 1/30)

Politico: GOP Weapon 2: Hit Obamacare Over ‘Insurer Bailouts’
The last thing Democrats want to do, with a law as complicated and full of moving parts as the Affordable Care Act, is explain what the law actually does. And yet, they’re going to have to come up with something to answer the Republicans’ latest line of attack. The program that’s causing all the trouble is supposed to help insurers get through the first few years of Obamacare if their costs are higher than they thought. And it’s not an emergency measure -- it was built into the law all along (Nather, 2/5).

The Wall Street Journal’s Washington Wire: Obama Faces Fresh Democratic Pressure On Health Care
Some Democratic lawmakers intensified pressure on President Barack Obama Tuesday to take actions he has been resisting when it comes to health care and the nation’s energy supply. Mr. Obama hosted a private meeting at the White House for House Democrats. Both sides afterward described the session as productive and friendly. But Rep. Carol Shea-Porter (D., N.H.) told Mr. Obama at one point that some people should have left their jobs over the flawed rollout of the health care law that is the centerpiece of his domestic legacy (Nicholas and Hook, 2/4).

The Associated Press: US Senate Candidate Wants To Open Medicare To All
U.S. Senate candidate Rick Weiland said Tuesday that Medicare is so efficient and popular among the elderly that he wants to open it to all Americans. Weiland, the sole Democrat running for the seat being vacated by Sen. Tim Johnson [D-S.D.], pledged to introduce legislation letting anyone of any age the opportunity to buy health insurance from the government program (Lammer, 2/4).

Meanwhile --

Politico: Poll: 51% Disapprove Of Obamacare
In a Gallup Poll, released Tuesday, 51 percent of Americans said they disapprove of the Affordable Care Act and 41 percent say they approve of the law. Nevertheless, these numbers are a slight improvement from Gallup’s previous poll released last month, which showed 54 percent disapproval and 38 percent approval (McCalmont, 2/4).

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Surgeon General Nominee Faces Skeptical Senate GOP At Hearing

Republicans questioned the bona fides of President Obama's choice for surgeon general, grilling him over his stance on gun control and the health law.

Los Angeles Times: Republicans Criticize Surgeon General At Senate Hearing
President Obama's choice to become the next surgeon general spent much of his confirmation hearing Tuesday deflecting criticism from Republicans, who attacked him for his political activism, ties to the president and relative inexperience. Vivek Hallegere Murthy, who at 36 would be one of the youngest surgeon generals, was chided for advocating gun control in the aftermath of the December 2012 school shooting in Newtown, Conn., and for backing the Affordable Care Act as a co-founder of Doctors for America, formerly Doctors for Obama (Clozel, 2/4).

The Washington Post: Republicans Question Surgeon General Nominee Over Advocacy For Health-Care Law
Murthy, 36, who would be the first Indian American to become chief U.S. doctor, works at Brigham and Women’s Hospital in Boston and is an instructor at Harvard Medical School. If confirmed, he will take over for acting surgeon general Boris D. Lushniak, who stepped in when Regina Benjamin left the post in July (Hicks, 2/4). 

Earlier, related KHN coverage: Fixing Health Care Isn't About Party, 'It's About Building A Sustainable System' - The KHN Interview (Kulkarni, 10/24/2012).

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Public Health & Education

CVS To Stop Selling Cigarettes By Fall

The move is part of a trend of pharmacies becoming health providers.  

Reuters:  CVS To Become First Major U.S. Drugstore To Drop Cigarettes
CVS Caremark Corp said on Wednesday that it would stop selling tobacco products at its 7,600 stores by October, becoming the first U.S. drugstore chain to take cigarettes off the shelf. Public health experts called the decision by the No. 2 U.S. drugstore chain a precedent-setting step that could pressure other stores to follow suit (Wahba and Steenhuysen, 2/5).

The Wall Street Journal: CVS To Stop Selling Cigarettes
The move is a bold and expensive one for CVS, a unit of Woonsocket, R.I.-based CVS Caremark Corp. It reflects a major push by retail pharmacies away from simply dispensing drugs toward a more integrated role of providing basic health services to Americans—including millions of newly-insured—amid an expected shortage of primary care doctors (Martin and Esterl, 2/5).

The New York Times: CVS Plans To End Sales Of Tobacco Products By Oct. 1
The company's move was yet another sign of its metamorphosis into becoming more of a health care provider than a largely retail business, with its stores offering more miniclinics and health advice to aid customers visiting its pharmacies. While the company's decision will cost it an estimated $2 billion in sales from tobacco buyers, that is a mere dent in its overall sales of $123 billion in 2012 (Strom, 2/5).

Los Angeles Times: CVS Caremark, No. 2 Drugstore Chain, Will End All Tobacco Sales
CVS, CVS, based in Woonsocket, R.I., also pledged to launch what it called a "robust national smoking cessation program" this spring. Nationwide, less than 5% of cigarette sales occurred in pharmacies in 2009, according to a study by the Center for Global Tobacco Control. But sales at pharmacies have been increasing, even as overall cigarette sales declined (Levey and Hsu, 2/5).

The Washington Post: CVS To Stop Selling Cigarettes By Oct. 1
CVS executives said the decision could cost billions of dollars in revenue because cigarettes draw so many customers in their stores. But by jettisoning tobacco products, CVS can further define its pharmacies as full-fledged health-care providers and strike more profitable deals with hospitals and health insurers. CVS stores already are home to over 750 MinuteClinics, the country's largest chain of pharmacy-based health clinics, offering flu shots and diagnosis of common ailments like ear infections and strep throat (Kliff, 2/5). 

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State Watch

State Highlights: Colo. County May Sue Over No Change To Insurance Ratings

A selection of health policy stories from Colorado, Oregon, Iowa, Connecticut, Minnesota and California.

Health News Colorado: Garfield County May Sue, Accuses State Of Rubberstamping Insurance Lobbyists’ Plan
Enraged that Colorado officials are refusing to change health insurance rating systems for this year or next, Garfield County’s attorney and commissioners are considering suing the state. “They’re violating the law,” said Garfield County Attorney Frank Hutfless. He said the state is discriminating against Garfield County by placing it with the highest-cost resort areas and therefore making it too difficult for people to afford health insurance, which was the primary purpose of the Affordable Care Act (McCrimmon, 2/4).

The Associated Press: Fewer ER Visits For Ore. Medicaid Patients
People on the Oregon Health Plan are making fewer visits to the emergency room and more visits to primary care clinics, according to a new report on Oregon's year-old coordinated care organizations. The Oregon Health Authority says the report shows Gov. John Kitzhaber's overhaul of the state Medicaid program is achieving its goals in reducing unnecessary use of the emergency room (Cooper, 2/4).

The Associated Press: Iowa Universities Refuse To Pay Health Subsidies
A nonprofit that subsidizes insurance policies for Iowans with health risks is suing the state's three public universities, claiming they are refusing to pay millions in legally required fees. The Iowa Individual Health Benefit Reinsurance Association says the universities' nonpayment could lead to higher assessments for other government agencies that are members and higher costs for patients (Foley, 2/4).

Kaiser Health News: A Third Generation Doctor Questions The Profession
Being a doctor in America is changing, in part because of the Affordable Care Act and also because of longer trends in the practice of medicine. Drs. Robert and Michael Sawyer practice at Denver Health, the city's big public hospital downtown. Sawyers have worked or taught here as physicians since the 1930s, so they have a unique perspective on how today's challenges stack up against those that physicians have faced in the past (Whitney, 2/5).

The CT Mirror: Leonardi Cool On Federal Regulation Of Insurance Industry
Connecticut's insurance commissioner told members of Congress Tuesday he has serious reservations about extending federal oversight of the insurance industry. Thomas Leonardi, commissioner of Connecticut’s Insurance Department, was invited by a Republican member of the House Financial Services Committee to weigh in on new federal oversight of the insurance industry, which is largely regulated by the states. At issue is the new Federal Insurance Office that was created by the Dodd-Frank financial reform bill and tasked to report on weaknesses in the insurance industry (Radelat, 2/4).

Minnesota Public Radio: Patients Need An Affordable, Stable Home To Be Healthy
Health care companies are increasingly focused on patients like (Vanessa) Smith, whose housing difficulties can compromise their health. Indeed, a growing body of research indicates a strong link between health and housing. If patients' rent is too high, they might avoid spending money on medications to treat diabetes and other diseases. Frequent moves also can lead to or deepen mental health problems (Baxter, 2/4).

The California Health Report: A Dozen California Hospitals Among Most Expensive In U.S.
When a doctor sees a patient at Olympia Hospital in Los Angeles for a routine, 15-minute consultation, the hospital typically bills Medicare about $1,100 for the service. Two miles away, Cedars-Sinai Medical Center bills the government just under $200 for the same kind of visit. Medicare sets its own rates, so the program ultimately pays both hospitals the same amount, or nearly so, regardless of how much they try to charge. But the huge disparity in billing for the same procedure in the same city raises questions about how hospitals establish their rates, who pays them, and what connection, if any, the charges have to the actual cost of providing care. The mysterious billing practices are fueling a nationwide drive for more transparency (Richard, 2/5).

Salem, Ore., Statesman Journal: Oregon Health Plan Reforms Preventing Costly Hospital Care, Report Shows
Oregon’s new program that is changing how its Medicaid patients are being treated received another positive review in the quarterly report released today. According to the Oregon’s Health System Transformation report, which covers the first nine months of coordinated care organizations’ performance in 2013, emergency visits and spending are down, primary care visits and spending are up and hospital readmissions are down (Yoo, 2/4).

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Editorials and Opinions

Viewpoints: CBO Report On Health Law: Damaging The Labor Market Or Freeing Workers From 'Insurance Trap'?

The Wall Street Journal: The Jobless Care Act
There are 7.8 million Americans working part-time who want full-time work, including a fry cook whose restaurant cut his hours to avoid Affordable Care Act mandates and confronted President Obama in an online Google Q&A last week: "We can't survive. It's not a living." Mr. Obama changed the subject to raising the minimum wage. But he can't dodge reality forever as the evidence piles up that ObamaCare is harming the labor market. On Tuesday no less than the Congressional Budget Office reported that the health law is causing Americans to work less or not at all (2/4).

The New York Times: Freeing Workers From The Insurance Trap
The Congressional Budget Office estimated on Tuesday that the Affordable Care Act will reduce the number of full-time workers by 2.5 million over the next decade. That is mostly a good thing, a liberating result of the law. Of course, Republicans immediately tried to brand the findings as "devastating" and stark evidence of President Obama's health care reform as a failure and a job killer. It is no such thing (2/4).

Los Angeles Times: Why The New CBO Report ON Obamacare Is Good News
The Congressional Budget Office is out with its latest report on the Affordable Care Act, and here are a few bottom lines:
— The ACA is cheaper than it expected.
— It will "markedly increase" the number of Americans with health insurance.
— The risk-adjustment provisions, which Congressional Republicans want to overturn as a "bailout" of the insurance industry, will actually turn a profit to the U.S. Treasury.
Given all this, why are the first news headlines on the CBO report depicting it as calling Obamacare a job killer? You can chalk up some of that to the crudity of headline-writing, and some to basic innumeracy in the press (Michael Hiltzik, 2/4). 

The Washington Post: Obamacare’s Scorekeepers Deliver A Game-Changer
This is grim news for the White House and for Democrats on the ballot in November. This independent arbiter, long embraced by the White House, has validated a core complaint of the Affordable Care Act’s (ACA) critics: that it will discourage work and become an ungainly entitlement. Disputing Republicans' charges is much easier than refuting the federal government's official scorekeepers (Dana Milbank, 2/4). 

The New York Times' Economic Scene: Health Law Goals Face Antitrust Hurdles
With the midterm elections fast coming into focus, politics in Washington will remain consumed by health care for months to come. ... This political theater, however, has little relevance to the actual delivery of medical services. For that, the debate that matters has been taking place far from the klieg lights, in a remote courthouse in Idaho, where less than two weeks ago a district judge sided with the Federal Trade Commission and ordered the unwinding of the merger between one of the state’s biggest hospital systems and its biggest independent network of doctors (Eduardo Porter, 2/4). 

Los Angeles Times: Red Vs. Blue: The Battle Lines Of 2014
The conventional wisdom is that this fall's congressional election will be all about Obamacare. Republicans, it's argued, will try to expand their majority in the House and take the Senate with a campaign focused mostly on the failings of President Obama's health insurance law; Democrats will fire back with warnings that the GOP would simply repeal the law and leave consumers on their own. But the conventional wisdom is wrong. Obamacare will be a major issue this fall, but so will the economy and a host of other issues, including immigration and -- if Democrats have their way -- pay equity for women. Over the last two weeks, leaders of both parties have staked out new ground on which they plan to fight in the nine months until election day (Doyle McManus, 2/5). 

Politico: The Latest GOP Lie About Obamacare
The target of Republicans' new criticism is a sensible mechanism to ensure an even distribution of risks across insurance companies. According to Republican leaders like House Budget Chairman Chairman Paul Ryan of Wisconsin, these risk corridor provisions are "massive insurance company bailouts." ... What’s most remarkable about their comments on risk corridors is that Republican leaders are denouncing a model they created to smooth out rate increases in prescription drug coverage under Medicare (Reps. Henry Waxman, D-Calif., Sander Levin, D-Mich., and George Miller, D-Calif., 2/4).

Raleigh News & Observer: Renewing The Call To Expand Medicaid In NC 
Soon after [state leaders opted not to expand Medicaid], I began asking physician colleagues around our state about their patients, mostly the working-class poor, who were most affected by the decision. ... Reflecting on my own patients I provide primary care for, several have refused all preventive health care until their 65th birthday kicks in. This includes refused mammograms, colonoscopies, diabetes screenings and the shingles vaccine. And the list goes on. At the moment, a formidable 318,710 adults in North Carolina are working for incomes less than $11,500. These folks are too poor to qualify for subsidized tax credits for private insurance and do not qualify for Medicaid under our current standards. In refusing the expansion, [Gov.] McCrory not only turned down much needed money for our state, but also might have shortened the lives of our working-class poor (Dr. Laura Musselwhite, 2/4).

The Richmond Times-Dispatch: McAuliffe Has Cards To Play In Obamacare Gamble
Gov. Terry McAuliffe is trying to sell a cow for a horse. The Democratic power grab in the Virginia Senate preserved the bipartisan coalition that supports his debut initiative: Medicaid-for-Obamacare. The Republican-dominated House of Delegates continues to resist the frosh chief executive. However, even the House may have its price (Jeff Schapiro, 2/5).

The Boston Globe: Mass. Model Of Health Care: Wait For It
Is Massachusetts now in its seventh year under Chapter 58, the health care overhaul signed into law by Governor Mitt Romney in 2006, a preview of what the rest of the country can expect under Obamacare? If so, my fellow Americans, you’d better get used to waiting. According to a national survey of approximately 1,400 medical practices in 15 major metropolitan markets, the average wait for new patients scheduling a non-emergency doctor appointment between June and November 2013 was 18.5 days. In Boston, however, patients had to wait an average of 45 days, and considerably more than that for some specialties. The wait was 66 days to see a family physician and 72 days to see a dermatologist (Jeff Jacoby, 2/5).

The Washington Post: Dodging Accountability In Annapolis
The Democratic party's commissars in Maryland have decreed that meddlesome questions about the state's disastrous online health-insurance exchange are distracting and, for the time being, terribly inconvenient. Having closed ranks behind the gubernatorial candidacy of Lt. Gov. Anthony G. Brown, who bore putative responsibility for getting the operation up and running, party leaders have put out the word: No official inquiries that might embarrass Mr. Brown will be tolerated before the Democratic primary on June 24 or the general election in November (2/4). 

And on other issues --

The New York Times: Overselling Testosterone, Dangerously
A large study has found substantial risks in prescribing testosterone to middle-age and older men for a variety of ailments. One part of the study found that testosterone doubled the risk of cardiovascular disease in more than 7,000 men who were 65 years old or older, essentially confirming findings in previous studies. The other part found that testosterone almost tripled the risk of heart attacks in a group of more than 48,000 middle-age men with previous histories of heart disease. The harm in both cases occurred within 90 days of receiving the prescription (2/4). 

Reuters: Philip Seymour Hoffmann And The Middle-Aged Drug Epidemic
Celebrated actor Philip Seymour Hoffman’s death at age 46 from an apparent heroin overdose is yet another indictment of the ongoing failure of drug war officials, interest groups, and politicians to confront the rising, decades-long epidemic of middle-aged abuse of illicit drugs, which now kills an American age 40-64 every 20 minutes. ... [O]piate and other illicit-drug deaths have been increasing for three decades. Although public service campaigns have long invoked "new" scourges of heroin and opiates that afflict middle-class young people, the group that most frequently dies from the most-abused drugs -- street and pharmaceutical opiates -- is white, middle-aged adults, not teenagers and young adults (Mike Males, 2/4).

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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.