Daily Health Policy Report

Thursday, February 6, 2014

Last updated: Thu, Feb 6

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Health Care Marketplace

Public Health & Education

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Insurers Eye Market For Supplemental Health Coverage To Fill Gaps Left By Obamacare, Employer Plans

Kaiser Health News staff writer Jay Hancock, working in collaboration with The Washington Post, reports: "As out-of-pocket medical costs grow for many Americans, the insurance industry is offering a way to help and, at the same time, expand its business: by selling supplemental policies that may fill the gaps for consumers. Insurers are increasingly marketing these limited policies that pay cash after a hospital stay or specific disease diagnosis, such as cancer" (Hancock, 2/6). Read the story.

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Health On The Hill: Republicans Hammer Health Law's 'Risk Corridors'

Republicans labeled the provision a bailout for insurers despite projections it will raise $8 billion. Kaiser Health News staff writers Julie Appleby and Mary Agnes Carey discuss it (2/5). Read the transcript or listen to the audio.

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Capsules: Humana ACA Enrollees Younger Than Expected

Now on Kaiser Health News' blog, Jay Hancock reports: "Here’s more fodder for the debate over whether older, sicker members will swamp insurance plans created by the Affordable Care Act. Insurers have wondered whether enough younger, healthier 'invincibles' would sign up through online exchanges to subsidize folks with poorer health. The worry was that, without their premiums, expenses for older folks would drive up average costs and make plans less affordable" (Hancock, 2/5). Check out what else is on the blog.

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Political Cartoon: 'The Doctor Is In?'

Kaiser Health News provides a fresh take on health policy developments with "The Doctor Is In?" by Paul Fell.

And here's today's health policy haiku:


Is it a bailout?
Or good policy? Why call
them risk corridors?

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

Report: Fewer Than 2 Million Medicaid Enrollees Are Result Of Health Law

The study by consulting firm Avalere Health concludes that less than a third of the 6.3 million who have signed up for Medicaid have done so because of the health law's expansion of eligibility. Developments in Virginia and Florida are also covered.

The Washington Post: Fewer Than 2 Million Signed Up For Medicaid Under The Health Law, Report Says
Between 1 million and 2 million Americans signed up for Medicaid last year because of the health-care law, according to a new report suggesting that many of the people who have joined the program since the initiative’s rollout in October would have done so absent the law. The Obama administration has said that 6.3 million people were determined to be eligible for Medicaid between October and December. But the study, from health-care industry consulting firm Avalere Health, suggests that only a fraction of the enrollments are strictly the result of the health-care law (Somashekhar and Sun, 2/5). 

CNN: Study Puts New Medicaid Enrollment Under Obamacare At Fewer Than 2 Million
Just a fraction of the more than 6 million people the Obama administration has touted as being determined eligible for Medicaid under Obamacare are new enrollees, according to an independent study released Wednesday. The new study, published by the health advisory company Avalere, estimates that between 1.1 and 1.8 million people are newly enrolled in Medicaid thanks to the Affordable Care Act over the final three months of 2013. While federal officials have frequently cited increased Medicaid enrollment as an example of Obamacare's success, they have been unable to report how many of those enrollees would have been eligible for the government program without the law's expanded eligibility requirements (Aigner-Treworgy, 2/5).

The Washington Post: McAuliffe Pushes For Medicaid Expansion
Gov. Terry McAuliffe used the occasion of his first bill-signing Wednesday to make a far-reaching pitch for Medicaid expansion as an economic development tool. Saying he's flexible about the details, hungry to find bipartisan compromise and "willing to work with anybody, around the clock, 24 hours a day, seven days a week," McAuliffe (D) said that the commonwealth should seize the chance to insure hundreds of thousands of low-income Virginians under the new health-care law — for their sake, and the sake of the economy (Laris, 2/5). 

The Washington Post: Virginia Hospitals Are Lobbying For An Expansion Of Medicaid
Loudoun County area hospitals have joined a statewide lobbying effort launched by the hospital industry to urge the Virginia General Assembly to expand Medicaid eligibility in Virginia. The hospitals face an uphill battle trying to persuade local lawmakers, nearly all of whom are Republicans. GOP members in the General Assembly have generally resisted the expansion of Medicaid eligibility in Virginia, citing problems with the program and potential long-term costs to Virginia taxpayers (Barnes, 2/5).

Health News Florida: FMA To Tackle Medicaid Expansion
The Florida Medical Association, one of Tallahassee's most influential lobby groups, sat out last year's legislative nail-biter over Medicaid expansion, saving its firepower for pocketbook issues, such as making it harder for patients to sue and keeping non-physicians off their turf. But now an FMA advisory committee that studied the issue is backing Medicaid expansion (Gentry, 2/5).

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Maryland, Minnesota And Oregon Attempt To Boot Up Exchanges

Meanwhile, PBS NewsHour looks at why enrollment lags among Latinos, the ethnic group with the highest uninsured rate, despite tens of millions of dollars being spent on outreach in states like California.

The Washington Post: Maryland Lawmakers To Resume Inquiries Into Troubled Health Exchange
Members of Maryland’s House of Delegates on Wednesday said they plan to forge ahead with questioning the leaders of the state’s troubled health insurance exchange, even though days earlier a high-ranking state senator said the General Assembly was largely done with its inquiries (Johnson, 2/5). 

The Baltimore Sun: State Lawmakers Now Want Briefings on Health Exchange
State lawmakers may have abandoned hearings into what went wrong with the glitch-ridden health exchange, but they're now considering regular briefings to make sure the state is fixing it. Sen. Thomas "Mac" Middleton said Wednesday the tentative plan is to resume briefings about how the exchange officials are repairing the site, how much it has cost, and future plans on whether to abandon it entirely (Cox, 2/5).

The Associated Press: MNsure Enrollment Grows, But Private Plans Lag
Insurance sign-ups through Minnesota’s health care marketplace continued to grow into February to more than 90,000 people, but enrollment continues to be weighted more toward public plans over private insurance. MNsure released its latest enrollment measures on Wednesday, which covered mid-January through Feb. 1 (2/5).

Minnesota Public Radio: MNsure Getting 100 New Workers To Help At Overwhelmed Call Center
A Mendota Heights company will supply MNsure with up to 100 workers to help the troubled online insurance marketplace's overwhelmed call center. Workers from APAC Customer Services will help handle the upcoming expected influx of people signing up for health insurance to beat a March 31 deadline. The MNsure Board approved spending up to $750,000 for the temporary workers. MNsure interim CEO Scott Leitz told the agency's board members the cost could be covered within the existing MNsure budget (Stawicki, 2/5).

The Star Tribune: MNsure Will Deploy Up To 100 Temporary Call Center Operators
As MNsure took steps Wednesday to bolster its shorthanded call center, some of its board members said they regretted not raising concerns earlier about problems that have plagued the state’s health insurance exchange. “I don’t feel the approach I’ve taken in the past has been appropriate based on the current experience,” said Tom Forsythe, a vice president of General Mills Inc. Since its Oct. 1 debut, the MNsure website has been beset with technical issues that have made enrollment difficult. The call center, which was supposed to be a resource for residents with questions, was overwhelmed with callers at levels far above projections and staffing (Crosby, 2/5).

PBS NewsHour: Language Barrier, Immigration Status Keep Some Latinos From Health Care Enrollment
As the largest uninsured ethnic group in the country, Latino Americans are considered key to the success of the Affordable Care Act. In California, enrollment numbers continue to lag despite tens of millions of dollars spent to reach Latinos, who represent more than half of the 7 million who lack coverage in that state. The NewsHour’s Cat Wise reports (Wise, 2/5).

The Oregonian: Former Lawmaker Reported Oregon Health Exchange To FBI
One of the great mysteries of the Oregon health exchange fiasco is how the $160 million information-technology project passed the federal government's readiness reviews with flying colors, only to fail abysmally when officials flipped the "on" switch. One former Oregon lawmaker says he has an idea how Oregon fared so well with the feds and he thinks it might even entail criminal behavior. Patrick Sheehan, a former Clackamas Republican legislator, says he approached the Federal Bureau of Investigation in December 2012 and relayed an allegation that misleading information was knowingly provided to the federal government during one of several "gate reviews" conducted of the Oregon exchange, Cover Oregon, by the federal government (Budnick, 2/5).

The Oregonian: Politics Threaten To Hijack Cover Oregon Legislation
Election-year politics quickly threatened to hijack one of the main Cover Oregon bills in the Oregon Legislature. Lawmakers are eager to tackle the messy rollout of the health insurance exchange, especially because it’s expected to be a big issue on the campaign trail. On Wednesday, lawmakers -- especially those seeking higher office -- got their first crack during a public hearing (Zheng, 2/5).

The Texas Tribune: Interactive: A Look At Texas’ Uninsured And Obamacare Enrollment
For more than a decade, Texas has maintained the highest rate of people without health insurance in the nation. Currently, more than 6 million Texans don't have health insurance. The Affordable Care Act requires most people to obtain health coverage in 2014 and sets forth a variety of ways to assist the uninsured. So far, fewer than 120,000 Texans have obtained coverage through the federal health insurance marketplace (Aaronson, 2/4).

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Study: More Than Half Of The Nation's Uninsured People Live In Just 116 Counties

The study, conducted for the Associated Press, suggests that, even as the clock ticks down on the insurance sign-up period, outreach to this target population may not be so difficult. Also in the headlines, the administration announced a new theme for its campaign to reach "young invincibles," while a group of athletes is also getting into the game.     

The Associated Press: Finding Uninsured Americans By The Numbers
Wanted: Millions of uninsured Americans willing to give President Barack Obama's health care law a chance. With time running out, it may not be so hard for the administration and its allies to find them. A study for The Associated Press finds that the uninsured aren't scattered evenly across the country: half of them live in just 116 of the nation's 3,143 counties (Alonso-Zaldivar, 2/5). 

The Washington Post’s Gov Beat: Half The Nation's Uninsured Live In Just 116 Counties
Those without health insurance have less than two months to enroll in new plans before penalties kick in, and the Obama administration is racing the clock to get them signed up. A new study conducted for The Associated Press shows the administration is best off focusing on a relatively narrow geographic area: Half of those under 65 without insurance live in just 116 of the nation's 3,143 counties. And half of all 19-39 year olds without insurance — the most coveted demographic as health-care providers look to expand their risk pools — live in 108 counties (Wilson, 2/5). 

USA Today: Athletes Pitch Health Care As Life 'Game Plan' With Gameplan4me.com
A group of athletes who say access to health care saved their lives have volunteered to help young people understand that insurance needs to be part of their life "game plan." "Sometimes, when you're young, you don't think about the importance of having [insurance] until it's too late," Sanya Richards-Ross told USA TODAY. "I think I'm the same way, perhaps even more as an athlete. I eat well, I train really well, I rest well. I think, like most people, I thought I would never get sick" (Kennedy, 2/5). 

Politico: New Ad: Hey Kids, Your Mom Wants You to Sign Up For Obamacare
Listen to Mom. That's the message in the latest Obamacare outreach ad announced by the White House Wednesday. It targets mothers of "young invincibles" and urges them to get their young adult children to sign up before the 2014 open enrollment season ends at the end of March (Kenen, 2/5).

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Insurers Say Limited Doctor Choice Key To Plan Affordability Under Health Law

Insurers are saying that offering more narrow networks of doctors and hospitals is vital to keeping costs down in plans offered under the health law. In the meantime, some insurers are offering supplemental plans to fill in these gaps.

The Wall Street Journal: Insurers Face New Pressure Over Limited Doctor Choice
Insurers are facing pressure from regulators and lawmakers about plans that offer limited choices of doctors and hospitals, a tactic the industry said is vital to keep down coverage prices in the new health law's marketplaces. This week, federal regulators proposed a tougher review process for the doctors and hospitals in plans to be sold next year through healthcare.gov, a shift that could force insurers to expand those networks (Mathews and Weaver, 2/6).

Bloomberg: Insurers Slash Specialty Hospitals To Keep Premiums Low
Health insurers under pressure to keep premiums low are eliminating some hospitals from coverage in a cost-cutting strategy that threatens to freeze out centers that provide specialized care, limiting patient options. Left out are hospitals such as Seattle Children’s, excluded from five of seven plans on Washington’s state insurance exchange (Chen, 2/6).

Kaiser Health News: Insurers Eye Market For Supplemental Health Coverage To Fill Gaps Left By Obamacare, Employer Plans
As out-of-pocket medical costs grow for many Americans, the insurance industry is offering a way to help and, at the same time, expand its business: by selling supplemental policies that may fill the gaps for consumers. Insurers are increasingly marketing these limited policies that pay cash after a hospital stay or specific disease diagnosis, such as cancer (Hancock, 2/6).

In other news -

Politico: Feds Fight Notre Dame On Contraception Rule Reprieve
The Obama administration is fighting the University of Notre Dame's request for a reprieve from complying with Obamacare's contraception coverage requirements. Justice Department lawyers filed a legal brief Tuesday with the 7th Circuit Court of Appeals opposing the Catholic university's latest bid to be exempted from the law's mandate on contraception coverage (Haberkorn, 2/5).

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CBO Report Reaction Leads To Fact-Checking, Heavy Dose Of Political Debate

Despite the political storm it has generated, the latest report by the nonpartisan Congressional Budget Office projects the law will give several million people an opportunity to work less or not at all, because they won't be stuck in jobs simply to keep their job-based insurance.

The Associated Press: Report On ‘Obamacare’ Doesn’t Indicate Millions Will Be Laid Off From Jobs
New estimates that President Barack Obama's health care law will encourage millions of Americans to leave the workforce or reduce their work hours have touched off an I-told-you-so chorus from Republicans, who've claimed all along that the law will kill jobs. But some aren't telling it straight. The analysis by the nonpartisan Congressional Budget Office predicts the law will give several million people an opportunity to work less or not at all, because they won't be stuck in jobs just for the sake of keeping the health insurance they get from employers (Woodward, 2/5).

The Wall Street Journal’s Washington Wire: Health-Care Storm Roils White House Again
Since Democrats passed President Barack Obama’s health-care overhaul in 2010, the White House has tried to move its agenda beyond the storm of criticism that followed. Yet every time Mr. Obama and his aides find reprieve from one politically charged battle – the Supreme Court case, the many Republican attempts to repeal the law and the 2012 election, to name a few – another emerges. This week it was a report by the nonpartisan Congressional Budget Office that predicts the law will insure fewer people than expected and reduce the number of hours that Americans work by more than previously thought. Republicans seized on the findings (Lee, 2/6). 

The Washington Post: What Small Business Owners Should Know About The New Obamacare Report
Congressional budget analysts on Tuesday released revised estimates concerning the economic footprint of the health care law, spawning another round of headlines declaring that Obamacare will take a massive bite out of workers’ hours and eliminate millions of jobs. Thing is, that’s not what the report said at all. In fact, the nonpartisan group’s predictions actually refute some of the warnings from small business leaders — namely, that the law will force employers to trim hours for their current workers and think twice about hiring new ones (Harrison, 2/5). 

NPR: One Day After CBO Report, It's Time To Start Your Spin Cycle
On Tuesday, economists with the Congressional Budget Office announced findings that indicated the new health care law may result in hundreds of thousands leaving the workforce. The findings spurred new debate on the merits of the law and its economic impact. NPR's Scott Horsley has more on the reactions to the report (Horsley, 2/5). 

NPR: Reining In Health Care Costs Key To Trimming Deficit
The Congressional Budget Office earlier this week said this year's deficit is likely to be about a-third the size it was back in 2009 when the Great Recession bottomed out. A recovering economy is the main reason for the deficit's improvement, but moderating health care costs have also contributed. Harvard economist and health policy specialist David Cutler says getting the federal government's finances under control is all about health care (Ydstie, 2/6).

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Capitol Hill Watch

'Risk Corridors' Become Key GOP Anti-Health Law Talking Point

During a hearing of the House Oversight And Government Reform Committee, Republicans tagged this provision as an insurance industry bailout despite Congressional Budget Office projections cited by Democrats that it ultimately will collect billions of dollars from insurers rather than paying them money.  

The Washington Post: Republicans Take Aim At Health-Care Provision; CBO Chief Forecasts Reduced Unemployment 
Congressional Republicans took aim Wednesday at a provision of the health-care law that they claim amounts to “an insurance company bailout,” using a House oversight hearing to push for the measure’s repeal. In a separate House committee hearing, Democrats countered what has emerged as a key GOP talking point by eliciting testimony from the Congressional Budget Office director that the Affordable Care Act would reduce unemployment over the next few years by boosting overall demand for goods and services (Branigin, 2/5). 

Kaiser Health News: Health On The Hill: Hill Republicans Hammer Health Law's 'Risk Corridors'
Republicans labeled the provision a bailout for insurers despite projections it will raise $8 billion. Kaiser Health News staff writers Julie Appleby and Mary Agnes Carey look at the latest GOP attack on the law (2/5).

The Wall Street Journal’s Washington Wire: CBO Estimate on ‘Health Corridors’ Doesn’t Change GOP Concerns
Republicans lawmakers weren’t swayed by Tuesday’s Congressional Budget Office report that seemed to exonerate the “risk corridor” provision in the Affordable Care Act – a provision many Republicans have called a bailout for insurance companies. The CBO estimated the government would actually collect about $8 billion rather than pay money to insurance companies. Previously, it had projected no returns for the government. At a House Oversight and Government Reform Committee hearing Wednesday, Republicans continued to press for legislation to undo the provision, which had been designed to reduce the financial risk to insurers who sold health care plans on the new exchanges (Corbett Dooren, 2/5). 

NPR: Obamacare Opponents Open New Front For Debate In 'Risk Corridors'
Some Republicans have begun to demand the repeal of a key feature in the president's health care law, which protects insurance companies taking part, in exchange for agreeing to raise the nation's debt ceiling. But according to Congressional Budget Office Director Douglas Elmendorf, the so-called "risk corridors" actually benefit the Treasury, rather than costing taxpayers money (Welna, 2/5). 

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CBO Findings On How The Health Law Will Impact The Workforce Become Flashpoint

During a House Budget Committee hearing, and also across the Capitol and on social media and the airwaves, Democrats and Republicans sparred over the Congressional Budget Office report released this week.   

The Wall Street Journal: Lawmakers Spar Over CBO's U.S. Health-Law Findings
Republicans at a House Budget Committee hearing said the report, released Tuesday, shows the health law will drive people out of the work force. Democrats countered that the report shows the law will give workers flexibility to leave jobs they are locked into because of health-care benefits. The sparring came in response to a Congressional Budget Office analysis concluding that subsidies in the law, combined with easier access to health care, would create incentives for many Americans to cut their work hours, leading to a net reduction of 1.5% to 2% from 2017 through 2024 (Paletta, 2/5).

McClatchy: Obamacare: The Political Issue That Keeps On Giving
Republicans and Democrats on Wednesday engaged in a fierce brawl to define what the Affordable Care Act means to consumers – making it clear that Americans’ qualms about the law will remain a volatile issue throughout the election year. Top officials from the two parties clashed in the House Budget Committee, on social media and in states with hot political races. They relentlessly attempted to put their own spin on a Tuesday report from the nonpartisan Congressional Budget Office, which estimated that the law will cause people to voluntarily work less (Lightman, 2/5).

NBC News: Democrats Mount Affordable Care Act Counteroffensive
Democrats waged a counteroffensive Wednesday after the Congressional Budget Office found that the health care overhaul will reduce hours worked and cause a decline in the number of full-time-equivalent workers of about 2.5 million in 2024. At a House Budget Committee hearing where CBO director Douglas Elmendorf said the health insurance subsidies in the Affordable Care Act will create “a disincentive for people to work,” Rep. Chris Van Hollen of Maryland, the senior Democrat on the panel, defended the law. By providing insurance that’s not tied to a job, it “allows Americans to choose to spend more time with their family or pursue their dreams. And that is not a bad thing; it is a good thing,” he said (Curry, 2/6).

CBS News: Democrats Defend Obamacare’s Impact On Economy
The Affordable Care Act will shrink the workforce by the equivalent of 2 million full-time workers by 2017, according to a nonpartisan report, but Democrats on Wednesday stressed the fact that it will not increase unemployment -- in fact, the health law is expected to grow the economy and boost the demand for labor over the next few years. “I just want it to be very clear that the director of the Congressional Budget Office says for this year and the next couple years, actually, it will help reduce unemployment,” Rep. Chris Van Hollen, D-Md., the top Democrat on the House Budget Committee, said in a hearing. “More people who are looking for work will find work as a result of the Affordable Care Act.” Congressional Budget Office chief Doug Elmendorf confirmed that over a 10-year window, the Affordable Care Act is expected to reduce national deficits and consequently lead to stronger growth (Condon, 2/5).

Fox News: ObamaCare Job Loss Report Turbocharges Twitter; Sen. Roberts Asks ‘Were The Books Cooked?’
The CBO predicts nearly 2.5 million workers could opt out of the work force to stay eligible for Medicaid and other federal subsidies -- resulting in the loss of 2.3 million jobs. GOP brass hopped on the report like frogs on a lily pad, and the “I told you so’s” reverberated into the far corners of the Twitterverse. Late Tuesday night, Kansas GOP Sen. Pat Roberts tweeted that he wants the CBO to explain itself … in Congress. He took to the Senate floor earlier in the day to demand the Senate Finance Committee hold a hearing to investigate conflicting CBO reports (Ashburn, 2/5).

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New Bill Would Expand Health Law Subsidies For Those In High-Cost Areas

The bill would tie subsidy levels to cost of living around the nation instead of to the national federal poverty level. In the meantime, a lawmaker from Colorado introduces a bill to speed construction of VA hospitals.

The Sacramento Bee: Obamacare: Two Bay Area Legislators Want To Expand Law's Subsidies In High-Cost Areas 
Hoping to increase the number of Americans eligible for tax subsidies under the new federal health care law, two Bay Area lawmakers introduced a bill Tuesday that would expand the subsidized income level for those living in high-cost areas of the country. U.S. Reps. Anna Eshoo, D-Palo Alto, and Mike Thompson, D-Napa, say the Fair Access to Health Act ties health insurance subsidies to the cost of living in a geographic area instead of to the national federal poverty level (Seipel, 2/4).

The Denver Post: Colorado Rep. Mike Coffman Targets Delays Of VA Hospital Projects
Rep. Mike Coffman introduced legislation Wednesday to speed construction and rein in costs of three Veterans Affairs hospital construction projects, including the one in Aurora. Coffman's legislation, co-sponsored by a Democrat and fellow member of the House Veterans Affairs Subcommittee for Oversight and Investigations, would require that an emergency manager from the Army Corps of Engineers be appointed to provide oversight for all existing VA major medical facility projects under construction (Sherry, 2/6).

And in Arkansas --

USA Today: Mark Pryor Criticizes Tom Cotton On Medicare In New Campaign Ads
Sen. Mark Pryor is going on the air in Arkansas with new ads hitting GOP Rep. Tom Cotton over Medicare. Pryor, one of the most vulnerable Democrats up for re-election this year, criticizes Cotton in both ads for supporting a Republican plan to “change Medicare into a voucher system.” That’s a reference to House Budget Chairman Paul Ryan’s bill in the last Congress to dramatically overhaul the federal health care program for seniors by allowing them to buy their own insurance plans from private companies (Camia, 2/5). 

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Health Care Marketplace

Humana Posts Loss But Says New Members Are Younger Than Expected

Insurer Humana said it lost money in the fourth quarter of last year over increased expenses and a drop in membership. At the same time, it says its health law enrollees are younger than expected.

The Wall Street Journal: Humana Swings To Loss On Increased Costs 
Humana Inc. swung to a fourth-quarter loss as the Medicare-focused insurer posted an increase in operating expenses and a slight drop in medical membership. Humana and its peers face shrinking government funding for Medicare Advantage plans, which are the private industry's version of the health plan for the elderly and disabled. Humana is more tethered to these plans than any other big insurers, making its ability to digest lower incoming payments while guarding profit margins a key issue. However, the company said it expects continued growth in 2015 and beyond due to changes in public policy surrounding government programs (Rubin and Mason, 2/5).

Kaiser Health News: Capsules: Humana ACA Enrollees Younger Than Expected
Here’s more fodder for the debate over whether older, sicker members will swamp insurance plans created by the Affordable Care Act. Insurers have wondered whether enough younger, healthier 'invincibles' would sign up through online exchanges to subsidize folks with poorer health. The worry was that, without their premiums, expenses for older folks would drive up average costs and make plans less affordable (Hancock, 2/5).

The Fiscal Times: Humana: More People Under 40 Signing Up For Obamacare 
Good news for Obamacare.  The group most crucial to Obamacare’s success are signing up for coverage through the new health exchanges ahead of the March 31 enrollment deadline according to Humana, a large health insurer.  During a meeting with analysts and investors, Humana’s CEO Bruce Broussard said the insurance behemoth is “seeing enrollees skewing to the younger side,” Forbes reported. Humana execs added they are pleased with the mix of people they have enrolled so far and say they are confident that “they have priced their exchanges appropriately” (Ehley, 2/5).

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Public Health & Education

CVS' Tobacco Move Brings Praise, Analysis As Marketing Move

Some are praising CVS' decision not to sell tobacco products while others say it's a marketing ploy meant to position the drugstore keenly in the middle of consumer health care.

Los Angeles Times: CVS’ Halt On Tobacco Wins Praise
CVS Caremark Corp.'s imminent exit from the cigarette and tobacco business -- an unprecedented move for a major pharmacy company -- is being cheered by many medical professionals and lawmakers as a triumph of corporate responsibility over the bottom line.But industry experts say the strategy shift is less an altruistic endeavor than a savvy marketing ploy from a drugstore giant trying to promote itself as a retail health hub in an age of increasingly self-serve health care (Hsu, Levey and Karlamangla, 2/5).

PBS NewsHour: Considering The Ethics And Economics Of CVS Stores Ending Tobacco Sales
CVS, the nation’s second-largest drug store chain, has announced that it will stop selling tobacco products because they pose a conflict with the health mission of the business. Judy Woodruff gets reaction from Dr. Ronald Depinho of the M.D. Anderson Cancer Center and Stephanie Strom of The New York Times (Woodruff, 2/5).

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State Watch

State Highlights: At Least 6 States Enrolling Inmates In Medicaid; Ore. Lawmakers Eye 'Basic Health Plan'

A selection of health policy stories from Illinois, Maryland, Oregon, Minnesota, Florida and Georgia.

Bloomberg: Jails Enroll Inmates In Obamacare To Pass Hospital Costs To U.S.
Being arrested in Chicago for, say, drug possession or assault gets you sent to the Cook County Jail to be fingerprinted, photographed and X-rayed. You’ll also get help applying for health insurance. At least six states and counties from Maryland to Oregon’s Multnomah are getting inmates coverage under Obamacare and its expansion of Medicaid, the federal and state health-care program for the poor (Niquette, 2/6).

Minnesota Public Radio: Disability Care Funding Re-Tool Breeds Anxiety
Minnesota is starting to overhaul its system for determining how to direct $1.7 billion toward caring for people with disabilities so they can live more independently. For many years, calculating those rates has been the task of Minnesota's counties. But that led to a patchwork system with 87 different ways for setting rates, said Loren Colman, assistant commissioner of the state Department of Human Services. He said some providers were paid more than others, depending on where the recipient lived (Yuen, 2/6).

The Lund Report: Health Committee Approves Basic Health Plan Study On First Day Of Session
The drive toward a Basic Health Plan for working-class Oregonians leaped over its first hurdle, as House Bill 4109 passed out of the House Health Committee 7-1 on the first day of the 2014 session. HB 4109 calls for the Oregon Health Authority to study the option of a “Basic Health Plan” for Oregonians who earn less than 200 percent of the federal poverty level but don’t qualify for the state’s Medicaid program, the Oregon Health Plan (Gray, 2/4).

Health News Florida: Long-Term Care A Lifeline For Poor
Milagros Medina rents a room in a quiet subdivision on the outskirts of Lakeland. At 68, her arthritis, high blood pressure and chronic back pain are not going away. And she doesn’t want to end up in a nursing home. This retiree who likes being called Miss Millie tries to keep going by getting help with the chores most people take for granted. She says without financial help from Florida’s Medicaid program, she couldn’t afford it. And her health would suffer (Shedden, 2/6).

Georgia Health News: Community Service Boards May Get New Oversight
The 26 community boards that offer services to Georgians with behavioral health problems and developmental disabilities would face new oversight under a state Senate bill introduced this week. The legislation follows recent trouble connected with one such community service board in Coastal Georgia. A September state report on Gateway Behavioral Health Services last year said its operation was riddled with financial irregularities and management problems. The Department of Behavioral Health and Developmental Disabilities (DBHDD) took control of Gateway last year, firing its CEO and asking its chairman to resign (Miller, 2/5).

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Weekend Reading

Longer Looks: 'Irradiating Ourselves To Death'; Women And Pain Treatment

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

The New York Times: We Are Giving Ourselves Cancer
Despite great strides in prevention and treatment, cancer rates remain stubbornly high and may soon surpass heart disease as the leading cause of death in the United States. Increasingly, we and many other experts believe that an important culprit may be our own medical practices: We are silently irradiating ourselves to death. The use of medical imaging with high-dose radiation — CT scans in particular — has soared in the last 20 years. ... emergency room physicians routinely order multiple CT scans even before meeting a patient. Such practices, for which there is little or no evidence of benefit, should be eliminated. Better monitoring and guidelines would also help (Drs. Rita F. Redberg and Rebecca Smith-Bindman).

Slate: Why Philip Seymour Hoffman's Death Is So Scary
He got sober when he was 22 and didn't drink or use drugs for the next 23 years. During that time, he won an Academy Award, was nominated for three more, and was widely cited as the most talented actor of his generation. He also became a father to three children. Then, one day in 2012, he began popping prescription pain pills. And now he's dead. The root causes of addiction, like those of many multifactorial diseases, are frustratingly elusive, a nebulous mixture of genetics, exposure, and environment. ... [In August 2011] I was 39 years old and married; my wife and I had a 1 ½-year-old boy and another child on the way. I’d written three books, won some awards, and was about to start teaching at MIT. ... Being back in Boston was a visceral reminder that there’s an important part of my past that isn’t on the bio page of my website: From 1995 to 1997, the last time I’d lived in the area, I’d been an IV drug addict (Seth Mnookin, 2/4).

The Wall Street Journal: Why Women Are Living In The Discomfort Zone
Several years ago, my neck suddenly went bonkers—bone spurs and a long-lurking arthritic problem probably exacerbated by too many hours spent hunching over a new laptop. … I had been inducted, apparently, into the growing army of American adults living in chronic pain. I discovered that there are 100 million of us, according to the Institute of Medicine. That was surprise No. 1. Surprise No. 2 was that most of us are women. Nobody really knows why. There are cultural factors, to be sure. Women are "allowed" to be emotional about their pain, and men often aren't, so perhaps women's pain gets noticed more. There are complicated hormonal factors too. There are research biases at work as well, ... Both men and women often have to be extremely persistent in the search for a physician who can help with their suffering (Judy Foreman, 1/31).

VQR: Pain
My father was never one to complain. On the morning of the day he died, an ulcer he'd suffered from for years, and left untreated, ruptured and began to bleed. Two days later I met with the town coroner. He told me the end had been painless, that, as his life leached away, my father would only have felt increasingly weak and light-​headed. The coroner, trying to make me feel better, was lying. By any other account, when an ulcer perforates and blood, bile, bacteria, and partially digested food begin to spill into the abdominal cavity, you feel as if a knife has just been buried in your guts. ... All these years later, I’m still struggling to understand why he didn’t just ...  speak that single word: "Help" (Will Boast, 2/2014).

JAMA: Drowning
Dear future self, You watched a child die today. He drowned actually, and you stood in a corner, watching. That’s not fair, of course; as a medical student, you were supposed to just observe. There were already 20 people around him, all trying to save his life. … You didn't talk to anyone about it afterwards. You left the hospital, business as usual. ...  So I want to know how death makes you feel now, years later. How did you cope? ... Do you see a medical student, nurse, or anyone else standing there in the back left corner? You've been there; you should understand what they are going through. Go over and talk to them. Tell them that it's okay to feel (Robert Swendiman, 2/3). 

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Editorials and Opinions

CBO Report Stirs Commentary On Health Law: The 'Town Goes Nuts;' Disgust With Left's 'Giddy Celebration;' The Debate's 'Willful Stupidity'

The Wall Street Journal: ObamaCare's New Theory Of Employment
The Congressional Budget Office report estimating that ObamaCare will cause the economy to lose the equivalent of 2.5 million workers is remarkable on its own. But the reaction from the left -- giddy celebration -- is another order of magnitude. U.S. politics used to have enough of a center that politicians could agree that fewer Americans working and others working less as a result of qualifying for a new taxpayer-funded benefit wasn't desirable. But liberals are now actively glorifying another political incentive not to contribute to U.S. economic life (2/5).

The New York Times' Economix: A Report's Real Message: It Wasn't About Health Care
Only in Washington could the following occur: the Congressional Budget Office releases a dense, technical report wherein it tweaks its estimates of how labor supply will be affected by the health care act over the next decade … and the whole town goes nuts (Jared Bernstein, 2/5).

Los Angeles Times: 'Job-Lock' And The Republican Dilemma Over Obamacare
A day or so of careful reading and cogitation by the media has begun to turn the tide on what had been the Congressional Budget Office's most widely misunderstood finding about the Affordable Care Act. It is now recognized that, no, the CBO didn't say that Obamacare would lead to job losses, but instead that it would allow many workers to voluntarily leave their jobs or retire without giving up health coverage (Michael Hiltzik, 2/5).

Los Angeles Times: Obamacare Not A Job Killer. But Is It Still A Campaign Issue?
In my column Wednesday, I argued that this fall's congressional election campaign won't focus solely on Obamacare, even though some Republican candidates say they think that's the way to win. But wait, I hear you ask: Doesn't the latest forecast from the Congressional Budget Office -- the one that says Obamacare could prompt many people to leave the workforce -- guarantee that the campaign will be all about Obamacare? Maybe. But that could turn out to be a mistake for the GOP (Doyle McManus, 2/5).

The Washington Post: Willful Stupidity In The Obamacare Debate
One of the best arguments for health-insurance reform is that our traditional employer-based system often locked people into jobs they wanted to leave but couldn't because they feared they wouldn't be able to get affordable coverage elsewhere. This worry was pronounced for people with preexisting conditions, but it was not limited to them. Consider families with young children in which one parent would like to get out of the formal labor market for a while to take care of the kids. In the old system, the choices of such couples were constrained if only one of the two received employer-provided family coverage (E.J. Dionne Jr., 2/5).

Politico: Democrats Hit Media For ACA CBO Coverage
Another day, another media fight over Obamacare. On Tuesday when the CBO released its 181-page report on the Affordable Care Act, the one statistic that got the most headline attention was this: "The reduction in CBO's projections of hours worked represents a decline in the number of full-time-equivalent workers of about 2.0 million in 2017, rising to about 2.5 million in 2024." The headlines and attack ads seem to write themselves. Here was a bona fide, nonpartisan government organization saying the Affordable Care Act will mean 2.5 million fewer full-time workers by 2024. And indeed many headlines zeroed in on "jobs lost" or how Obamacare will "cost 2.5 million workers," as the Washington Post's Erik Wemple pointed out. But as our colleagues David Nather and Jason Millman note, "there’s a lot more fine print about what those numbers really mean, and whether the jobs were 'lost' " (Hadas Gold, 2/5).

Politico: The Party Of Less Work
The Democrats once styled themselves the party of workers. Now, they are the party of people who would have been workers, if it hadn't been for Obamacare. The Congressional Budget Office released a new analysis of the economic effects of the health care law on Tuesday that estimates that it will reduce the number of workers, in effect, by 2.5 million in 2024. ... It turns out that discouraging work is just another one of the wonders of Obamacare (Rich Lowry, 2/5).

The Fiscal Times: Obamacare Jobs Plan -- Turn On, Sign Up, Drop Out
The argument that government subsidies from redistributed wealth is a disincentive to work is hardly new. Conservatives have made that argument that for decades, and it has been a recent component of the debate over whether to keep extending long-term unemployment benefits that originated as an "emergency" measure five years ago in the midst of the Great Recession's massive job losses. It is, however, novel to see the Barack Obama White House embrace that effect as a feature of its central social-engineering program, the Affordable Care Act (Edward Morrissey, 2/6).

CNN: Obamacare Doesn't Kill Jobs
On Tuesday, the CBO released its update to the budget and economic outlook. Many in the media got it wrong. This isn't the first time that's happened. In early 2011, after winning a decisive victory in the House of Representatives, the newly Republican Congress brought H.R.2 -- a legislation that would repeal Obamacare -- up for a vote. It was called "Repealing the Job-Killing Health-Care Law Act." It was named under the notion that the Affordable Care Act would result in the loss of millions of jobs. The claim was based on a CBO report on the Budget and Economic Outlook published in summer 2010. But the words "job killing" never appeared in the report (Aaron Carroll, 2/5).

And on other health law issues -

The New York Times: A Missing Argument On Contraceptives
One of the most anticipated showdowns of the Supreme Court's current term will take place March 25, when the justices are scheduled to hear two cases brought by secular, for-profit corporations whose owners want an exemption, based on their religious beliefs, from the requirement that employers' health plans cover the full range of contraceptive services without a co-payment. ... Oddly, the Justice Department has relegated to a footnote what may be the strongest single argument against allowing the two companies to deny their workers contraceptive coverage that they would otherwise be entitled to under the health care law. That would be the Constitution's establishment clause enforcing the separation of church and state and barring government from favoring one religion over another or nonbelievers. But that is exactly what would happen if the restoration act were to be read as a congressional order requiring federal courts to grant private for-profit employers an exemption that would effectively allow them to impose their beliefs on employees to deny them a valuable government benefit (2/5).

The Washington Post: From Obamacare To The IRS Scandal, Republicans Are Ignoring The Facts
Sen. Marco Rubio was a day late and $8 billion short. As part of his political comeback since his lenient position on immigration antagonized the conservative base, the Florida Republican introduced the "Obamacare Taxpayer Bailout Prevention Act." The idea, a back-door way to repeal the health-care law, was to get rid of the "risk corridors" and reinsurance that protect health insurers from big losses. The idea caught on: House Republican leaders floated the idea of linking it to this month's debt-limit talks (which means they would again threaten a U.S. debt default if Obamacare isn't dismantled), and the House Oversight and Government Reform Committee made Rubio the featured witness at a hearing on the matter Wednesday (Dana Milbank, 2/5). 

The New England Journal of Medicine: A Legal Victory for Insurance Exchanges
Health care reform won a big victory in court on January 15, when a federal judge in Washington, D.C., rejected a challenge to the new health insurance marketplaces, or exchanges, created under the Affordable Care Act (ACA). Had this challenge succeeded, it could have crippled the ACA by denying its generous tax subsidies to the more than 12.5 million Americans expected to use this financial assistance to buy their health insurance through a federally run exchange. ... This is really a political fight, not a legal one. It belongs in Congress, not the courts (Abbe R. Gluck, 2/5).

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Viewpoints: CVS Decision On Tobacco Is 'Welcome Sign;' For Smokers, It's An Insult; Entitlement Debate Turns On Understanding Financial State Of Elderly

USA Today: CVS Not Just Blowing Smoke: Our View
The simplistic way to look at CVS' announcement Wednesday that it will quit selling cigarettes later this year is that it's the right thing for a major retailer to do -- one more welcome sign that a product that sickens and kills people when used as intended has become even more socially unacceptable (2/5).

USA Today: CVS Insults Its Own Customers: Opposing View 
Many of us have been smokers for years. We have lived through losing out on jobs, paying higher taxes, being cast out of establishments we once went to for fun, and watching places we once loved close down after smoking was banned. Society has acted as if one-fifth of its people don't exist, simply because they choose to smoke. We believe smoking is a choice, of using a legal product (Jan Johnson and David W. Kuneman, 2/5). 

Los Angeles Times: CVS Stubs Out Tobacco Sales, A Step Other Companies Should Take
It's long struck me as odd that drugstores, the places where most of us get our prescriptions filled for all manner of illnesses, also are go-to spots for cigarettes. With the latter, drugstores worsen the nation's health; with the former, they profit from it. ... Wait, maybe there is a method to that madness. Regardless, the CVS chain, owned by CVS Caremark, is doing the nation a service by ending the sale of tobacco products at its more than 7,600 retail outlets. And the chain is doing it for the right reasons: Tobacco kills and costs the nation a ton of money in health care costs (Scott Martelle, 2/5).

JAMA: Ending Sales Of Tobacco Products In Pharmacies
CVS Caremark believes that now is the time for retailers, perhaps spurred by policy makers, to eliminate sales of cigarettes and other tobacco products by institutions that also have pharmacies. ... This action may not lead many people to stop smoking; smokers will probably simply go elsewhere to buy cigarettes. But if other retailers follow this lead, tobacco products will become much more difficult to obtain. Moreover, if people understand that retail outlets that plan to promote health, provide pharmacy services, and house retail clinics are no longer going to sell tobacco products, the social unacceptability of tobacco use will be substantially reinforced -- indeed, the continued sale would appear to sanction the most unhealthy habit a person can maintain. If pharmacies do not make this effort voluntarily, federal or state regulatory action would be appropriate (Dr. Troyen A. Brennan and Dr. Steven A. Schroeder, 2/5).

The Washington Post: The True State Of The Elderly
How well-off are the elderly? The answer is crucial to public debate about Social Security, Medicare and other programs to help older Americans. If most live on the edge, then cuts are hard to justify. On the other hand, if many elderly are financially comfortable, then their government benefits and taxes should be open to change -- just like other Americans' (Robert J. Samuelson, 2/5).

The Wall Street Journal: I Gave Away A Kidney. Would You Sell One?
Seven weeks ago, at 6:30 a.m. on Dec. 19, I was admitted for surgery at the Brigham and Women's Hospital in Boston. I swapped my street clothes for a hospital gown, and an hour later I was sucking down oxygen from a mask that drowsed me as no breath of air ever has. By the time I came to at 5 p.m., my right kidney was halfway across the country, being implanted in a middle-aged woman an algorithm selected for me. There are more than 77,000 Americans currently on waiting lists for a kidney and, unlike the woman that got mine, many won't get one. In 2012 fewer than 17,000 of those waitlisted received a transplant, and 4,903 would-be recipients died while waiting (Dimitri Linde, 2/5).

The New York Times: At 90, This Doctor Is Still Calling
Dr. [Catherine] Hamlin gave the crowd a pep talk about the need for a big push to improve the world's maternal care. "We have to eradicate Ethiopia of this awful thing that's happening to women: suffering, untold suffering, in the countryside," she said. "I leave this with you to do in the future, to carry on." Ethiopia this month nominated Dr. Hamlin for the Nobel Peace Prize, and she deserves it. I hope she gets it along with other extraordinary leaders in women’s health such as Dr. Denis Mukwege of Congo, Dr. Hawa Abdi of Somalia, and Edna Adan of Somaliland (Nicholas Kristof, 2/5).

The New England Journal of Medicine: Death in Pregnancy -- An American Tragedy
Marlise Muñoz was 33 years old and the mother of a 15-month-old when she collapsed on November 26, 2013, from what was later determined to be a massive pulmonary embolism. ... In most circumstances, this tragic case would have ended there, but Marlise was 14 weeks pregnant and lived in Fort Worth, Texas. ... Practically speaking, what is a clinician to do when what a hospital's attorney says must be done seems different from what should be done? As Martin Luther King, Jr., famously wrote, "One has a moral responsibility to disobey unjust laws." ... Using a dead woman's body as an incubator against her wishes (as interpreted by her family) should be of grave concern to everyone who cares for and about both women and our nation's moral health (Dr. Jeffrey L. Ecker, 2/5).

The New England Journal of Medicine: Accepting Brain Death
Two cases in which patients have been determined to be dead according to neurologic criteria ("brain death") have recently garnered national headlines. ... The current U.S. approach to determining death was developed in response to the emergence of technologies that made the traditional standard of cardiopulmonary death problematic. ... Sound public policy requires bright lines backed up by agreed-on criteria, protocols, and tests when the issue is the determination of death. The law and ethics have long recognized that deferring to medical expertise regarding the diagnosis of brain death is the most reasonable way to manage the process of dying (David C. Magnus, Dr. Benjamin S. Wilfond and Arthur L. Caplan, 2/5).

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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.