Daily Health Policy Report

Monday, March 10, 2014

Last updated: Mon, Mar 10

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Next Step For Smart Phones: Keeping Tabs On Patients

Kaiser Health News staff writer Daniela Hernandez, working in collaboration with Wired, reports: "Dr. Eric Topol, a cardiologist at the Scripps Clinic in San Diego, knows when his patients’ hearts are racing or their blood pressure is on the rise, even if they’re sitting at home. With high-risk patients hooked up to ‘personal data trackers’ — a portable electrocardiogram built into a smartphone case, for instance — he and his researchers can track the ups and downs of patients’ conditions as they go about their lives. ‘It’s the real deal of what’s going on in their world from a medical standpoint,’ says Topol, whose work is part of a clinical trial. ‘The integration of that with the classical medical record is vital'" (Hernandez, 3/10). Read the story.

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Health On The Hill: How Proposed Part D Changes Are Playing On Capitol Hill

Kaiser Health News staff writer Mary Agnes Carey and CQ Roll Call’s Emily Ethridge Officials discuss how officials the Centers for Medicare & Medicaid Services is proposing to remove some drugs from Medicare’s prescription drug plans and to limit how many plans insurers can offer (3/7). Watch the video or read the transcript.

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Capsules: Obamacare On Campus: Reaching The Young And Uninsured; What’s Next For Pennsylvania’s Medicaid Expansion?

Now on Kaiser Health News’ blog, KUHF’s Carrie Feibel reports on efforts in Texas to sign up young people: "Young adults may be key to the success of Obamacare. Insurance companies need a mix of ages, and a mix of healthy and sick people to balance out the costs for everyone – and young people tend to be healthier. But persuading them to sign up for health insurance is no easy task. Many don’t know about the law, don’t think they need coverage, or are confused about how to sign up" (Feibel, 3/10).

Also on the blog, WHYY's Elana Gordon reports on Pennsylvania's Medicaid expansion: "Pennsylvania Gov. Tom Corbett has backed away from a controversial work search requirement in his Medicaid overhaul proposal that’s now under federal review. Even so, experts say it’s unclear whether that move will be enough for the plan to gain final approval. At stake are billions of dollars in federal funding for Pennsylvania and new health care options for up to half a million residents" (Gordon, 3/10). Check out what else is on the blog

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Political Cartoon: 'Three Reid Circus?'

Kaiser Health News provides a fresh take on health policy developments with "Three Reid Circus?" by Lisa Benson.

And here's today's health policy haiku:


Like your new health plan?
We wanted you covered. Now,
please show up on time.
-Larry Beresford 

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

Survey Credits Health Law For Lowered Uninsured Rate

News outlets report on implementation issues including the declining rate of uninsured people, confusion created by recent administrative changes and a union's assertion that the law will increase inequality.

The Associated Press/Washington Post: Survey: Uninsured Rate Drops; Health Law Cited
With just three weeks left to sign up under President Barack Obama health care law, a major survey tracking the rollout finds that the uninsured rate keeps going down. The Gallup-Healthways Well-Being Index, released Monday, found that 15.9 percent of U.S. adults are uninsured thus far in 2014, down from 17.1 percent for the last three months — or calendar quarter— of 2013 (3/10).

The Washington Post: Slew Of Changes To Health-Care Law Creates More Confusion For Consumers
As the deadline approaches for most Americans to obtain health insurance, a flurry of changes by the Obama administration has led to a frenzied effort among employers, insurance companies, politicians and consumers to try and understand what they might mean. ... By allowing many people to keep their old plans for two years longer, the administration softened the blow for congressional Democrats up for reelection this fall. No longer do members have to fear a wave of cancellation letters right before the November midterm election (Somashekhar, 3/8).

The Washington Post: Timeline Of Major Change To The Affordable Care Act
As it has been implementing the 2010 law reshaping the U.S. health-care system, the Obama administration has instituted a series of delays and other changes to the way the statute works in practice. Some changes were prompted by the government’s technical and other difficulties in launching HealthCare.gov, the online insurance marketplace on which three dozen states rely. Other changes respond to complaints by specific groups of consumers or parts of the health-care industry. Major changes and the dates when they were announced (Goldstein, 3/8).

Fox News: ObamaCare Will Hasten Income Inequality, Union Report Says
A new report from a major U.S. union says ObamaCare will hasten income inequality. Although it defends the intent behind the Affordable Care Act, the report, entitled “The Irony of ObamaCare: Making inequality worse,” concludes that the law will transfer a billion dollars in wealth to insurance companies, uneven the playing field in the market, force employers to cut back on hours and result in pay decreases, Ralston Reports said. “The promise of Obamacare was the right one and the hope for extending healthcare coverage to the un-and under-insured a step in the right direction,” the report says. “Yet the unintended consequences will hit the average, hard-working American where it hurts: in the wallet” (3/10).

The Wall Street Journal: Health-Care Penalty Will Surprise Many
For many households, the penalty for not having health insurance under the Affordable Care Act will "almost always" run more than the $95 figure often cited in news reports. That's according to the Tax Policy Center, which recently rolled its ACA Tax Penalty Calculator. It helps people figure out how large their tax penalty will be if they don't get required coverage by March 31 (Radnofsky, 3/8). 

Politico: The Obamacare Money Under The Couch
The Obama administration is dropping some new hints about how it has moved money around to fund Obamacare without Congress — but not nearly enough to put the controversy to rest. Forced to reveal more details under a provision tucked in this year’s bipartisan budget deal, the Department of Health and Human Services declared Friday how it used Secretary Kathleen Sebelius’s authority to move about $1.6 billion in departmental funds around last year — the Cabinet secretary’s version of looking for change under the couch cushions and hitting the jackpot (Norman and Nather, 3/8).

Denver Post: Colorado Not Tracking Premiums For Canceled Health Plans 
As U.S. Sen. Mark Udall's office and the Colorado Division of Insurance clashed last fall over health policy cancellations and early renewals, Julie Dagnillo experienced the turmoil of health insurance changes firsthand. Anthem canceled the small-group policy at her work because it did not meet the minimum requirements of the Affordable Care Act. She said she earns too much to qualify for a subsidy on the state health insurance exchange (Kane, 3/10).

Asbury Park Press: Feds: New Medicaid Enrollees' Estates Shouldn't Be Billed 
Can someone newly eligible for Medicaid really have their home and other assets seized after their death to repay the state for the cost of their medical care? Technically, yes, under existing federal and New Jersey laws, though the rules apply only to costs incurred from age 55 on (Mullen, 3/9).

Modern Healthcare: CMS Issues ACA Basic Health Program Final Rules
Starting in 2015, states will have the option of establishing subsidized health insurance plans for individuals and families with incomes between 138% and 200% of the federal poverty level (Demko, 3/7).

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With Three Weeks To Go, The Sign-Up Push Is On

News outlets report on the creative outreach efforts, including those geared to moms, young people and Latinos, to increase the number of newly insured people before March 31. Even prison inmates are signing up.   

USA Today: 5 Things To Know For March 31 Health Exchange Deadline
Americans have until March 31 to sign up for health insurance or face a penalty when they file their 2014 taxes next April. Millions of uninsured people qualify for subsidies to pay for their insurance, but there are still — even after months of advertising, community meetings, door-to-door information sessions and even speeches by the president — many who don't know about the exchanges, don't know they're eligible for financial help, or who don't know the Affordable Care Act still stands. Others simply haven't gotten around to enrolling yet (Kennedy, 3/8). 

NBC News: Obamacare Supporters Beat The Bushes For Final Sign-Ups
The final deadline to enroll in health insurance under the Affordable Care Act is less than three weeks away, and the White House and its allies are pulling out the stops to get more people signed up after one of the most disastrous debuts ever of a government program. The administration has rounded up every Democrat it can find -- mayors, county executives, state representatives as well as nonprofit groups whose main goal is to support Obamacare -– to spend Saturday pushing Americans to sign up for health insurance in a "Day of Action." In Atlanta, supporters will be in libraries. In Charleston, S.C, they're holding a waterfront enrollment fair. And in Houston, Spanish-language ads will urge the uninsured to show up at sign-up events staffed by Spanish speakers (Fox, 3/8).

Politico: Politico: Calling All Moms: It's Obamacare
Open enrollment ends March 31, and President Barack Obama, first lady Michelle Obama and top administration officials all have events this week that aim to reach America's moms, who typically drive health care decisions for their families — including the young adult children who are a key demographic for the new insurance exchanges. ... The pace of enrollment has picked up this winter as HealthCare.gov improved. More than 4 million people have chosen plans, although not all have begun paying their premiums. But the White House and its allies have a lot of work to do to hit the 6 million enrollment target by the end of the month. That mark was revised from 7 million after the website’s botched launch dampened sign-ups in the fall (Kenen, 3/9).

The New York Times: Little-Known Health Act Fact: Prison Inmates Are Signing Up
In a little-noticed outcome of President Obama's Affordable Care Act, jails and prisons around the country are beginning to sign up inmates for health insurance under the law, taking advantage of the expansion of Medicaid that allows states to extend coverage to single and childless adults — a major part of the prison population (Goode, 3/9). 

Kaiser Health News: Capsules: Obamacare On Campus: Reaching The Young And Uninsured
Young adults may be key to the success of Obamacare. Insurance companies need a mix of ages, and a mix of healthy and sick people to balance out the costs for everyone – and young people tend to be healthier. But persuading them to sign up for health insurance is no easy task. Many don't know about the law, don't think they need coverage, or are confused about how to sign up (Feibel, 3/10).

Health News Florida: Signup Efforts Get Creative 
Supporters of the Affordable Care Act continue to push Floridians to sign up for health insurance, and they're using everything from college computer labs to community carnivals as their enrollment hotspots. Through January, nearly 300,000 Floridians had signed up so far on the health insurance marketplace, and updated numbers could come next week (Shedden, 3/7).

NBC News: After Obama's TV Plea, Will Latinos Enroll In Obamacare?
Signing up Latinos for health care has been a bumpy enterprise. With less than stellar enrollment for health coverage and just 3½ weeks before the signup deadline, everything is being tried to get Latinos' attention. President Barack Obama decided to appeal directly to Latinos via a live-streamed town hall this week that was to be broadcast on Spanish-language television networks Saturday, including on Telemundo, at 8 p.m. EST. "If you get in an accident or get sick, then the cost of health care without health insurance is so high that either you may not be able to get the treatment you need, or it could end up bankrupting you, losing your home, everything you have, all your savings," Obama warned (Gamboa, 3/8).

Los Angeles Times: California Drafts Labor Icon Huerta To Woo Latinos To Obamacare
With time running short to sign up for Obamacare, California officials have recruited labor activist Dolores Huerta to urge Latinos to get health insurance. The state's move comes amid struggles at enrolling Latinos, who represent about 60% of the state's uninsured population. Open enrollment under the Affordable Care Act ends March 31 (Karlamangla, 3/7).

The California Health Report: The Faces Of Obamacare In Humboldt County
In many ways, Jude Ehrlich is the face of federal health reform on the northern California coast. The good face, anyway. The 44-year-old McKinleyville man never used to have much trouble getting health insurance. He had employee-offered plans until 2000, when he started his own small business and purchased his own policy, which helped cover his treatments for psoriasis, psoriatic arthritis, migraines and other health problems. But paying for the Blue Cross policy increasingly became a challenge, especially as his computer repair and consulting business slogged through the recession and his monthly insurance premiums steadily climbed to $400 (Greenson, Scott-Goforth and Walters,  3/6).

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Massachusetts Looks To Other States For Website Fixes

Among possible ways to resolve the continuing issues, state officials are contemplating the possibility of buying or leasing technology from states where the online insurance marketplace is working. They also are considering scrapping the current website and starting over. News outlets also track developments in Maryland, California and Illinois.  

The Associated Press: Mass Eyes States With Functioning Health Websites
Massachusetts officials struggling to repair the state's hobbled health care website said Friday they're looking at the possibility of leasing or buying technology from states with functioning insurance sites. Officials said that while they're speeding up the processing of insurance applications, the website still has serious flaws, and may ultimately be scrapped (LeBlanc, 3/7).

WBUR: Despite Continued Health Site Troubles, Progress Made On Applicant Backlog
Massachusetts health care officials struggling to repair the state’s hobbled website are looking at the possibility of leasing or buying technology from states with functioning insurance sites. Gov. Deval Patrick’s special assistant, Sarah Iselin, said Friday that looking for solutions from other states is just one of four options being weighed. Others include forging ahead with the current website contractor CGI Group, looking for a new vendor that would build on the existing site, or scrapping the website and starting over (3/7).

Baltimore Sun: Federal Inspector To Audit Md. Insurance Site
A federal inspector general is launching a review into what went wrong with Maryland's health insurance exchange, the first examination focused specifically on how millions of dollars in federal money was spent by the state, according to the lawmaker who requested the probe. Rep. Andy Harris, a Baltimore County Republican and vocal opponent of President Barack Obama's health care law, said officials with the inspector general for the U.S. Department of Health and Human Services had contacted him and indicated they will look into the creation of the state's glitch-prone exchange (Fritze, 3/9).

The Washington Post: Maryland Online Exchange Problems Cloud Doctor's Vision For Health Care 
[Dr. Peter] Beilenson, a physician who has spent his career improving public health in Baltimore City and Howard County, used federal loans set aside for nonprofit insurance providers to launch Evergreen Health Co-op, a hybrid creation that provides insurance coverage and health centers. In the past, such a start-up could never have competed with industry giants such as Maryland-based CareFirst BlueCross BlueShield. Now, the online marketplaces mandated by the health-care law are supposed to make it easier for customers to browse plans and pick what best fits their needs. Evergreen’s business plan called for at least 10,000 enrollees its first year. But it has signed up only 650 since October (Johnson, 3/7).

The San Jose Mercury News: Obamacare: Fifteen Percent Of Covered California Enrollees Haven't Paid
With less than a month left to sign up for private insurance under the federal health care law, California's enrollment numbers are closing in on the magic number of 1 million as 8,000 people sign up every day. If only everyone would pay their premiums. Roughly 15 percent of the Californians who had enrolled by Jan. 31 still haven't sent in their first month's payment, according to four major health insurance companies participating in the Covered California exchange. So those lofty enrollment numbers could soon be dropping substantially (Seipel, 3/9).

The Associated Press/Washington Post: Tool To Compare Health Plans Tested With Consumers 
A website that offers Illinois consumers more information about insurance costs could help address widespread confusion about choosing a plan on the government sites that are a cornerstone of President Barack Obama’s health care law. It can be frustrating now to try to compare health plans on the government online marketplaces. For instance, the federal website that serves Illinois and 35 other states has no central directory to easily show which plans include which doctors in their networks (3/7).

Also in the news, a look at the financial impact for middle class Californians of enrolling in a marketplace plan -

The Sacramento Bee: In California, Middle Class Feels Health Insurance Squeeze
If (Dawn and Nick LaPolla of Fair Oaks) earn less than $94,200 a year, the family of four’s preferred plan through the California health exchange would cost about $750 a month. But if they make even slightly more, they’ll pay about $1,040. That’s because they would exceed the threshold to qualify for federal subsidies. Their current high-deductible plan, which expires in two months, costs $573 a month. Unlike wealthier state residents who more easily can afford the new, often more comprehensive plans, or lower-income people aided by government subsidies, the LaPollas are part of a sizable segment of Californians slowly coming to grips with dedicating a greater percentage of their income to new policies (Cadelago and Reese, 3/8).

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No Deal On Medicaid Expansion In Va. As Lawmakers Adjourn

In Virginia, lawmakers also failed to pass a budget or make a deal on proposed mental health legislation. Virginia Gov. Terry McAuliffe promised a special session to settle the budget issue.

The Washington Post: Medicaid Debate In Va. Government Echoes Among Residents
At a strip-mall laundromat halfway between Washington and Richmond last week, the question in Virginia’s fierce struggle over expanding Medicaid was whether the government-backed health program should extend to the asthmatic in the black hoodie or remain reserved for the pregnant mom with a smiling frog on her sweatshirt. The two Virginians loading laundry to blaring reruns of “Gilligan’s Island” and “Taxi” are at the heart of the fiscal and philosophical quandary that forced the General Assembly to adjourn without a state budget Saturday and now threatens weeks of uncertainty (Laris, 3/8). 

The Washington Post: Va. General Assembly Adjourns Without Budget Or Medicaid Expansion
Virginia’s General Assembly wrapped up its 60-day session Saturday without passing a budget or expanding Medicaid, leaving Gov. Terry McAuliffe’s biggest priority in limbo and raising the specter of a protracted standoff that could shutter state government. McAuliffe (D) called on the House and Senate to return to the Capitol in two weeks to continue work on a two-year, $96 billion budget to fund schools, universities, local governments and other state services. But there was little optimism that the special session would lead to a quick resolution of the budget stalemate, which turns on whether to expand Medicaid under the federal health-care law known informally as Obamacare (Vozzella, Laris and Weiner, 3/8).

The Richmond Times-Dispatch: Lawmakers Adjourn Without Budget, Reach Deals On Mental Health, Ethics
Legislators also leave in limbo proposals for state employee raises, a plan to make over the Capitol Square complex, and, for Richmond, money to help memorialize the slave trade in Shockoe Bottom. The budget’s fate is linked to the deep division between House Republicans and Senate Democrats over whether Virginia should expand Medicaid to as many as 400,000 of Virginia’s uninsured, working poor. Minutes after the General Assembly adjourned Saturday afternoon, Democratic Gov. Terry McAuliffe, an ardent supporter of harnessing federal funding for closing the coverage gap in health care, signed paperwork calling lawmakers back for a March 24 special session that he envisions lasting three weeks (Martz, Meola and Nolan, 3/8).

The Washington Post: McAuliffe Tells Virginia Legislators He Will Call Special Session To Resolve Budget Impasse
Virginia’s House and Senate expect to adjourn the General Assembly session Saturday without a state budget, their standoff on Medicaid expansion forcing legislators to return for a special session later this month. House Republican leaders firmly opposed to lengthening the state’s Medicaid rolls met Friday with Gov. Terry McAuliffe (D), who has made expansion of the health-care program for the poor and disabled his chief priority. McAuliffe told them that he would call a special session March 24, allowing for a break that will give both sides an opportunity to hear from constituents (Vozzella and Weiner, 3/7). 

Medicaid expansion makes news in New Hampshire, Missouri, Louisiana, California and Pennsylvania --

The Washington Post: New Hampshire Clears Major Medicaid Expansion Hurdle
After months of negotiations, the New Hampshire Senate on Thursday voted to expand Medicaid to cover as many as 50,000 low-income residents using tens of millions of dollars in federal aid. About 12,000 residents who would qualify for coverage would be given subsidies to pay for insurance through their employers. Thousands more would receive subsidies to buy private insurance through the state’s health-care exchange (Wilson, 3/7). 

St. Louis Public Radio: With Medicaid Expansion In Limbo, Some Lawmakers See Promise In Collaborating With Critics
State Sen. Rob Schaaf is a force to be reckoned with when it comes to health-care policy. But some believe that this staunch opponent of Medicaid expansion holds the key to ending the legislative impasse over it. The St. Joseph Republican and family physician was a major figure throughout the 2007 overhaul of the state’s Medicaid system (Rosenbaum, 3/9).

The Hill: Dems See Healthcare Opening On Medicaid
States run by Republican governors and legislatures are slowly adopting the Medicaid expansion under Obamacare, boosting Democratic hopes they can run on the issue in the midterm elections. Sen. Mary Landrieu (D-La.) has launched a petition on her website urging Gov. Bobby Jindal (R-La.) to agree to the expansion, which she argues would bring health insurance to more people who cannot afford it (Easley, 3/9).

The California Health Report: Newly Eligible Stuck In Medi-Cal Backlog In Sonoma County
About 9,000 Medi-Cal applications from newly eligible Sonoma County residents have not been processed yet, due to the deluge of applications under Obamacare, said Joy Thomas, communications and outreach manager for the Sonoma County Human Services Department. It’s unclear how long the newly eligible will have to wait for their applications to be processed in the county. The county’s goal is to enroll 75 percent of its 18,000 previously uninsured residents by the end of 2014. An additional 18,000 people who once had private insurance are also now eligible for Medi-Cal in Sonoma County (Clark, 3/10).

The California Health Report: Medi-Cal Patients Face Hurdles To Specialists In Northern California
Unlike many specialists in Northern California, neurosurgeon Jeff Lobosky accepts Medi-Cal, California’s insurance program for the poor. But the Chico doctor has been forced to turn away some Medi-Cal patients this year, because of the influx of new enrollees under the Affordable Care Act. This conundrum is just one of many that doctors and patients in the Chico area and statewide are facing as Obamacare rolls out. The ACA is providing coverage to millions of low-income people nationwide through Medicaid, but there weren’t even enough doctors for those in the program before (Speer, 3/9).

Kaiser Health News: Capsules: What’s Next For Pennsylvania’s Medicaid Expansion?
Pennsylvania Gov. Tom Corbett has backed away from a controversial work search requirement in his Medicaid overhaul proposal that’s now under federal review. Even so, experts say it’s unclear whether that move will be enough for the plan to gain final approval. At stake are billions of dollars in federal funding for Pennsylvania and new health care options for up to half a million residents (Gordon, 3/10).

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HHS Extends Contract With Company Hosting Healthcare.gov Through March 31

The contract with Verizon Communications Inc.'s Terremark subsidiary, which hosts healthcare.gov, had been set to expire March 30, the day before the end of open enrollment. The move comes even though the government has already hired another firm to take over the work.

The Wall Street Journal: Government Extends HealthCare.gov Contract For Verizon's Terremark
The Department of Health and Human Services extended its contract with Verizon Communications Inc.'s Terremark subsidiary as the web-hosting provider for the federal health-insurance marketplace, HealthCare.gov. The extension means that the government won't attempt to move the website to its new hosting provider, Hewlett-Packard Co., while the insurance enrollment period under the Affordable Care Act is still open through the end of March (Ante, 3/7). 

Reuters: U.S. Extends Terremark Contract As HealthCare.gov Host
The Obama administration said on Friday Verizon Communications Inc's Terremark unit will remain under contract as host of the federal website HealthCare.gov to better ensure a smooth end to Obamacare's open enrollment period on March 31. Terremark's contract with the Department of Health and Human Services was due to expire on March 30, the day before the end of open enrollment for 2014, a time when high daily volumes are expected as consumers from 36 states rush to use the website to sign up for subsidized private health insurance (3/7).

The Washington Post's Wonkblog: CMS Awarded $58M To Healthcare.Gov Firm It Already Fired
The Obama administration has awarded a contract extension to a Healthcare.gov vendor, months after federal health officials had selected another firm to replace it. According to a posting on the main federal contracting Web site Thursday, the Centers for Medicare and Medicaid Services and Verizon Terremark signed a contract extension in late January for cloud computing services, even though the federal agency overseeing HealthCare.gov had already selected HP Enterprise Services last July to take over the work (Millman, 3/7). 

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Capitol Hill Watch

Lawmakers Ready Minor Changes To Obamacare Amid Bipartisan Support

Also on Capitol Hill, doctor groups oppose tying a fix to how Medicare pays them to a repeal of the health law, and Republicans look to use the law -- as well as the law's changes to Medicare -- to their advantage in upcoming elections.

Politico: More Obamacare Bills Next Week, But Fewer Fireworks 
House Republican leaders are planning to bring up three changes to Obamacare next week -- but unlike dozens of prior bills, these are more minor measures that are not expected to be controversial. All three bills essentially fix drafting errors, perceived oversights or unintended consequences in the president’s Affordable Care Act. They have bipartisan support and are scheduled to be considered under a suspension of the rules, which limits debate and requires support from two-thirds of House members -- a signal that leaders of both parties do not expect any heated debate (Haberkorn, 3/7).

The Hill: Obamacare Bill Gets Chilly Reception 
Powerful physician groups that are Washington’s loudest voice for a permanent “doc fix” are shooting down a Republican effort to link the bill to a delay of ObamaCare’s individual mandate. ... House Republican lawmakers have set a vote for next week on a bill that could cover the $150 billion cost of the “doc fix” by ending the controversial mandate to have insurance. ... Lobbyists for the medical profession said the Obamacare connection isn’t helpful because the permanent doc fix can’t happen unless the parties work together (Bogardus, 3/7). 

Reuters: Republicans Press Medicare Attack In Congressional Elections 
Republicans, looking for ways to turn November's congressional elections into a referendum on President Barack Obama's signature health care law, are trying to portray Obamacare as a danger to Medicare. The aim is to court one of the biggest and most reliable voting blocs in midterm elections, senior citizens and people near retirement, by depicting Republicans as defenders of the federal healthcare program for 42 million seniors (Morgan, 3/9).

The Hill: Cruz On O-Care Repeal: ‘We’ll Do It In 2017’
Most Republicans backed off the repeal-or-shutdown position after sustaining political damage during the two-week standoff in October, but Cruz promised on Sunday during an appearance on ABC News’s “This Week” to continue trying to get rid of Obamacare during the remainder of the president’s term. ... “I’ll give you one scenario where it could [be repealed before Obama leaves office],” Cruz said. “If there’s one thing that unifies politicians in both parties is that their top priority is preserving their own hide. If enough congressional Democrats realize they either stand with ObamaCare and lose ... that’s the one scenario we could do it in 2015. If not, we’ll do it in 2017" (Laing, 3/9).

The New York Times: Is There A Doctor In The House? Yes, 17. And 3 In The Senate. 
First thing on a recent Monday, Monica Wehby could be found in the operating room performing brain surgery on a child. But the Saturday before, she was shooting guns, because sometimes that’s what you do when you’re running for office. ... The politicking is all new for Dr. Wehby, 51, who wants to unseat Senator Jeff Merkley, a first-term Democrat. And when people find out that she wants to leave one of the most highly specialized and well-compensated fields in medicine for Washington, they often react with disbelief. Yet she is hardly alone among her physician peers (Peters, 3/7).

Kaiser Health News: Health On The Hill: How Proposed Part D Changes Are Playing On Capitol Hill
Kaiser Health News staff writer Mary Agnes Carey and CQ Roll Call’s Emily Ethridge Officials discuss how officials the Centers for Medicare & Medicaid Services is proposing to remove some drugs from Medicare’s prescription drug plans and to limit how many plans insurers can offer (3/7).

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State Watch

Florida Could Be Bellwether State For Obamacare Election Strategies

Both parties are trying out messages in Tuesday's special election for a House seat. And Charlie Crist, former governor who is running again, is also in the news. 

The New York Times: Florida Election A Crash Course For Midterm Races
Both parties and their surrogates have swooped into this laid-back House district [in Pinellas County, Fla.), which was overseen by Representative C. W. Bill Young, a Republican, for four decades until his death last year, ... Outside groups have dumped millions of dollars into mostly acrimonious messages meant to fire up voters and test the potency of the Affordable Care Act as an election issue. ... Even if the bragging rights outweigh the tangible impacts of one congressional race, the two sides see the contest as a potential harbinger, particularly on the health care law (Alvarez, 3/8).

Reuters: Republicans Press Medicare Attack In Congressional Elections
The strategy faces an early test in Tuesday's special U.S. House election in Florida, where analysts say Republican David Jolly and his allies are using Medicare in an 11th-hour effort to create an Obamacare liability for Democrat Alex Sink among older residents who make up 45 percent of the local population. ... The Republican strategy is to tie Obamacare to controversial proposals for two popular Medicare programs: Medicare Advantage, which allows seniors to obtain healthcare benefits through private insurance plans, and Medicare Part D, which covers prescription drugs (Morgan, 3/9).

The Associated Press: Dems, GOP Test Fall Strategy In Florida House Race 
Having focused much of his campaign on the botched launch of the health care law, Jolly has lately found himself on the defensive about entitlement programs. ... Sink, formerly the state's chief financial officer, tries to blunt the criticism in her own ads. One spot says repealing the health care law would "force seniors to pay thousands more for prescription drugs." "We can't go back to letting insurance companies do whatever they want," Sink says in the ad (Mishak, 3/9). 

Los Angeles Times: In Florida, A Local Race With National Scripts
The two parties' congressional campaign committees, along with allied "super PACs," have already spent at least $8.6 million, ... For Republicans, the strategy aims at motivating core conservative voters — a sharp reversal from last year's vow to try to broaden the party's appeal. They've kept a singular focus on President Obama's healthcare law, which Jolly has attacked in nearly all of his ads and public appearances. Democrats, who need to make up for the typically low turnout of young and minority voters in midterm elections, hope to attract independents and Republican moderates by playing on the perceived hyperpartisanship of the House GOP (Lauter, 3/8).

Meanwhile --

The Hill: Crist: ObamaCare Has Been 'Great'
Former Florida Gov. Charlie Crist (D) said Sunday that President Obama’s controversial healthcare law has been “great” for residents of his state. Crist has sharply criticized the healthcare law in the past. But the former Republican governor and 2008 GOP vice-presidential short-lister is running for his old post this year as a Democrat this year. Crist said during an appearance on CNN’s “State of the Union” that he would have no problem running on the healthcare bill, which is known colloquially as ObamaCare, as he seeks to regain his former office (Laing, 3/9).

Politico: Crist: Dems Need To 'Strengthen Up' On Obamacare
Effusive in his praise of President Barack Obama, former Florida Gov. Charlie Crist says Democrats need to "strengthen up" when it comes to Obamacare. ... “This president is leading and leading well. ... What [Democrats] need to do is support him - support him and support him strongly," Crist added. "He deserves it. And that will bring them home and unify them, and I think that will make November very good for Democrats" (McCalmont, 3/9).

Wall Street Journal: Crist To Democrats: Support Obama, Obamacare
Mr. Crist advised Democrats to embrace, rather than shun, Obamacare, even though its rocky start last year alienated some voters. “People getting healthcare is like a civil right,” Mr. Crist said. “People need to have shelter, they need food, they need water, they need healthcare. They deserve it. We’re the richest country in the world, and we ought to provide it and God bless [Mr. Obama] for doing it" (Phillips, 3/9).

CNN: Charlie Crist's Political Comeback
The former Republican politician, who governed Florida from 2007 to 2011, is running for his old job again, but this time as a Democrat. ... the race between Crist and current governor Rick Scott has become one of the most high-profile in the country. Given his political provenance, Crist has predictably come under scrutiny for “flip flopping” as he has assumed different positions on a myriad of issues - from the Cuban embargo to gay marriage to abortion to healthcare ... Obamacare, now supported by Crist and opposed by Scott, has been a particularly hot topic (Koepp, 3/8).

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State Highlights: Kan. Autism Coverage Mandate

A selection of health policy stories from Virginia, Kansas, Minnesota and Louisiana.

The Washington Post: Mental-Health Advocates Fear Fundamental Problems In Virginia Have Been Left To Fester
After the Virginia Tech massacre in 2007, Virginia lawmakers injected tens of millions of dollars into the state’s mental-health system, including local mental-health agencies that are the first stop for people in crisis. But last November, when Austin “Gus” Deeds needed a local agency to find him a psychiatric bed, the staff was smaller, its wait list for psychiatric services had tripled and a long-planned online registry of beds that could have speeded the search was not ready (Shin, 3/9). 

Kansas City Star: Proposal Mandating Insurance Coverage Of Autism Takes Shapes In Kansas 
The bills for treating 6-year-old Brody Christiansen’s heart defect would have left almost any family bust. Four open-heart surgeries. Six heart catheterizations. ... Insurance covered those treatments ... But the Christiansens weren’t so fortunate when Brody was diagnosed last summer with autism (Cooper, 3/9).

The Star Tribune: Device Firms Adjust To Increased Payment Disclosure
Mark DuVal’s law firm has been busy teaching medical device and drug makers how to obey the Physician Payments Sunshine Act. It is no easy task, says DuVal, a Minneapolis attorney who used to work for Medtronic Inc. and 3M Co. New federal reporting requirements that began Feb. 18 are complicated and eventually will include public disclosure of most business expenditures to medical professionals valued at more than $5 per event or more than $100 cumulatively per year. Thousands of companies across the country, including hundreds in Minnesota’s medical technology sector, fall under the act, which arose from concerns that undisclosed financial relationships between drug and device makers and health care providers influenced patient treatment (Spencer, 3/8).

Los Angeles Times: What Makes A Community Healthy?
Patients begin lining up outside Capitol City Family Health Center before the doors open at 7:30 a.m. The clinic, on a ragged stretch of the boulevard that separates the black and white sections of [Baton Rouge], is a refuge for thousands of this old southern capital's poorest and sickest residents. ... Twelve hundred miles up the Mississippi River, in the shadow of a public housing tower in St. Paul, Minn., the waiting room at the Open Cities Health Center also fills daily with the city's poorest. But the patients in Minnesota receive a very different kind of care, which leads to very different outcomes. They are more likely to get recommended checkups and cancer screenings. If very ill, they can usually see specialists. Their doctors rely on sophisticated data to track results (Levey, 3/9).

The Star Tribune: Electronic Health Records: A Hard Pill To Swallow For Some Doctors
Electronic health records are supposed to represent the next great leap in medicine -- reducing medical errors and enhancing the physician’s diagnostic powers. A 2007 state statute requires all Minnesota health care providers to adopt them by 2015, and the 2010 Affordable Care Act includes a host of incentives for their adoption. Yet, health professionals have mixed feelings about the digital records even though they are now in place at scores of Minnesota clinics and most Minnesota hospitals. Some praise them as a teaching and diagnostic tool, while others say they clutter up the patient-doctor relationship (Harrington, 3/10).

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Editorials and Opinions

Viewpoints: No Reason To Delay Health Law; GOP May Need An Alternative Message; Shrinking Abortion Options

The Washington Post: Stop Stalling On The Affordable Care Act 
HealthCare.gov is working better, so the technical barriers to pushing people into new plans aren't as high. The law, meanwhile, attempts to establish a norm that all Americans should have coverage of a certain quality and comprehensiveness. In general and over time, this is good for them and for the system as a whole. There's no reason, other than avoiding another wave of cancellation notices before this year's elections, to delay the transition again (3/7).

Bloomberg: How To Tell Good Obamacare Changes From Bad
The many updates, exclusions, delays and revisions that have marked the administration's implementation of the Affordable Care Act in part validate [Republicans'] concerns about how cumbersome the law is. But with an effort as sweeping and necessary as Obamacare, some unwieldiness is inevitable. What’s important is getting the law right, and that calls for judgments separating good changes from bad (3/7).

Los Angeles Times: So How Many People Had Their Insurance Canceled? Fewer Than You Think
In a debate almost totally infected with myth, perhaps the most tenacious myth about the Affordable Care Act involves the tsunami of old insurance policies that were supposedly canceled by insurers because they didn't comply with the ACA. How many policies? The figures are all over the place -- some say 17 million, some say 4.7 million. The implication is also murky -- however many cancellations happened, were all these people left without insurance? (Michael Hiltzik, 3/7). 

Bloomberg: How Not To Help The Uninsured
With Obamacare in train, who is buying insurance? Half of uninsured adults have looked for insurance online, according to an Urban Institute survey cited in the Washington Post. But only 10 percent of them have actually bought it, according to a different survey from McKinsey & Co. Overall, McKinsey says, just one quarter of the people who bought insurance on the exchange were previously uninsured (Megan McArdle, 3/7).

The Wall Street Journal: Do Republicans Need A Plan B?
But the more immediate concern for the GOP is this year's midterm elections, and there are at least two schools of thought on how to win back the Senate and increase their House majority. One side—which includes most of the Republican leadership in Congress—wants to stay laser-focused on the president's unpopular health-care law. According to the Real Clear Politics average, public support for ObamaCare is just 38 percent, and opposition is now 53 percent. The president's decision this week to make additional changes to the law is further acknowledgment that the issue is hurting his party politically as the midterm elections approach. But another group of Republican pols insists that ObamaCare-bashing can only get you so far and may have diminishing political returns (Jason L. Riley, 3/7). 

The Wall Street Journal: Obamacare And The Midterms
Twenty-seven House Democrats voted with 223 Republicans this week to delay the ObamaCare individual mandate for a year. While the measure is dead on arrival in the Senate, the vote was instructive in exposing potential Democratic trouble spots in this year's midterm elections (Allysia Finley, 3/7). 

The Richmond Times-Dispatch: This Time, McAuliffe Wrestles Political Alligators
Terry McAuliffe is wrestling alligators again. This time, they could tear a chunk out of him. In 1980, as a youthful fundraiser for President Jimmy Carter’s re-election campaign, McAuliffe grappled with an 8-foot, 260-pound gator in return for a $15,000 contribution from the Seminole Indian tribe. The beast was toothless and tranquilized, ensuring McAuliffe’s stunt could not literally come back to bite him. Thirty-four years later, as a neophyte governor, McAuliffe is tangling with two figurative alligators, both of which are baring their teeth: A House Republican majority resisting him on Obamacare and pro-gay rights Democrats in revolt over his choice of Richmond Mayor Dwight Jones, an opponent of same-sex marriage, for state party chairman (Jeff E. Schapiro, 3/9).

Bangor Daily News: With More Poverty And Less Health Care, Rural Maine Would Benefit Most From Medicaid Expansion 
Both nationally and in Maine, data show that rural residents are less healthy and face greater obstacles to health care compared with their urban counterparts. They are more likely to die prematurely, suffer from chronic disease and lack insurance. Maine’s rural rim counties have the highest percentages of uninsured residents (17 percent of Washington County residents are uninsured) due to a combination of factors, including lower annual incomes and higher rates of self-employment. ... Because a significant percentage of working Americans earns too little to afford private coverage, the Affordable Care Act provides federal dollars for states to expand their Medicaid programs to cover low-income, working people (Christy Daggett, 3/9).

And on other issues -

The New York Times: Cloudy And Cold
If the courts don't intervene, by the end of the year Texas may be down to six places where a woman can go to end a pregnancy. That's in a state of 268,000 square miles, with 26 million people. ... The state now requires that any doctor who performs abortions have admitting privileges at a hospital. Few of them do, and it's not medically necessary. ... Texas is leading the pack on this crusade, but other states are right behind it, restrained only by legal challenges. If Mississippi's admitting privileges law is upheld, the state's last abortion clinic will be closed. Alabama and Wisconsin are in the same situation; if their laws are upheld, they would be down to two clinics each (Gail Collins, 3/7).

NPR's SHOTS blog: When Facts Are Scarce, ER Doctor Turns Detective To Decide On Care
In the last hour, five ambulances have arrived at the emergency room where I work. A sixth pulls up. The paramedics wheel out a stretcher carrying a man, 73, strapped to a hard board, a precaution in case his spine is fractured. ... Medical history? None the paramedics could find. Same goes for whatever medications the patient might be taking. The only thing they know is his name and address. ... The next day, I get a call from the patient's son and daughter-in-law. They're irate. ... We emergency physicians frequently hear complaints from other doctors about how we order too many tests and admit too many patients. While medical overuse is a problem — and fear of malpractice and financial conflicts of interest sometimes play a role — it's easy to make harsh judgments after the fact (Dr. Leana Wen, 3/8). 

The New York Times: When Health Costs Harm Your Credit
[T]here are few standards governing medical debts: One billing office might give you — or your insurer — 60 days to pay before pursuing collection. Another might allow you to pay off a bill slowly over a year. Many will sell the debt to collection companies .... The problem is accelerating for several reasons. Charges are rising. Insurance policies are requiring more patient outlays in the form of higher deductibles and co-payments. More important, perhaps, is that while doctors' practices traditionally worked out deals for patients who had trouble paying, today many doctors work for large professionally managed groups and hospital systems (Elisabeth Rosenthal, 3/8). 

Los Angeles Times: Courts To Decide Which Comes First, The Chickens Or The Eggs
The individual mandate in the 2010 Affordable Care Act forced the courts to consider anew the limits of Congress' power to regulate the insurance market. Now, a California law governing the size of hens' cages is testing the limit of a state's power to regulate interstate food sales. At issue is a 2010 law that bans the sale of eggs from hens kept in cages that California voters deemed too small in 2008, when they passed Proposition 2. Sponsored by the Humane Society of the United States, the ballot measure requires the state's egg-laying hens, calves raised for veal and pregnant pigs to be housed in a way that allows them to stand up, turn around and extend their limbs fully (John Healey, 3/8). 

Bloomberg: E-Cigarettes Aren't For Kids
Could someone please send the U.S. Food and Drug Administration a copy of the latest study on teenagers and e-cigarettes? The agency obviously needs a push to come out with its overdue regulations. Drawn from two surveys of tens of thousands of American middle-school and high-school students, the research found that adolescents who tried battery-powered nicotine vaporizers were more likely to smoke tobacco cigarettes. And if the kids were already regular smokers at the time they experimented with "vaping," they became less likely to quit (3/10).

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Andrew Villegas

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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.