Daily Health Policy Report

Tuesday, March 11, 2014

Last updated: Tue, Mar 11

KHN Original Reporting & Guest Opinion


Health Reform

Capitol Hill Watch

Health Care Marketplace

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Insuring Your Health: Window Is Closing To Sign Up Or Seek Changes To Obamacare Plans

Kaiser Health News consumer columnist Michelle Andrews writes: "People who got off to a rough start with Obamacare or have yet to pick a plan still have options— but only if they move quickly before the open enrollment period ends on March 31. Those who were unable to sign up for a marketplace plan because of the glitches with federal or state websites can receive retroactive coverage to the date they originally applied, as well as retroactive premium tax credits and cost-sharing subsidies, the federal government announced in late February" (Andrews, 3/11). Read the column.

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Capsules: Medicare Officials Back Away From Changes To Rx Plan; Missouri Pulls Out Stops, But Lags Better-Funded Illinois Effort; Business Groups Split On Medicaid Expansion

Now on Kaiser Health News’ blog, Mary Agnes Carey reports on the latest news regarding proposed changes to the Medicare drug program: "Facing heavy bipartisan opposition on Capitol Hill as well as from patient groups, businesses, insurers and others, the Centers for Medicare & Medicaid Services said Monday it did not plan to move ahead 'at this time' with several proposed changes to the Medicare prescription drug program" (Carey, 3/10). 

In addition, Phil Galewitz reports on the different business community views on Medicaid expansion: "With several states weighing whether to expand Medicaid under the federal health law, supporters are looking to powerful business groups to help sway skeptical state legislators. But those groups are split on the issue — just like the public at large" (Galewitz, 3/10). 

Also on Capsules, the St. Louis Post-Dispatch’s Tara Kulash reports on enrollment efforts in Missouri: "Cover Missouri — a coalition of 400 organizations led by the Missouri Foundation for Health — has 130 enrollment events statewide this month. The St. Louis Effort for Aids, for example, planned the Rock Enroll event last Saturday" (Kulash, 3/10). Check out what else is on the blog.

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Union Pushes To Get Philadelphia Cab Drivers Insured

The Philadelphia Inquirer's Robert Calandra, working in partnership with Kaiser Health News, reports: "It's a job where stress mounts like dollars on a taxicab meter. The hours are long, the wages are low, and the competition for customers is often fierce. Toss in an eat-on-the-go, fast-food diet, little exercise, a sore back and achy joints from jockeying through traffic all day and you start to grasp the health burdens Philadelphia cabdrivers face" (Calandra, 3/10). Read the story.

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Political Cartoon: 'Cone Of Shame?'

Kaiser Health News provides a fresh take on health policy developments with "Cone Of Shame?" by Marty Bucella.

And here's today's health policy haiku:


Maybe NSA
Could give health care a lesson
On numbers to watch
-Janice Lynch Schuster, Altarum Institute

Plus, because this one is impossible to resist, a bonus:


Young invincibles:
It's not like they are watching
The Charlie Rose Show.

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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Administration Reverses Course On Proposed Medicare Drug Changes

After advancing a number of changes to the Medicare Part D program earlier this year, the Centers for Medicare & Medicaid Services withdrew its plan, which had drawn significant opposition from patients, drug companies and lawmakers in both parties.   

The Wall Street Journal: Proposed Medicare Part D Drug Changes Are Scrapped
In January, the Centers for Medicare and Medicaid Services proposed broad changes to the Medicare Part D prescription-drug program that covers medicines for about 39 million beneficiaries. Among the most contentious proposals was one to end the practice of covering essentially any type of antidepressant, antipsychotic or immunosuppressant prescription drug for consumers in the program. Medicare had said the plan was meant to save taxpayers money and simplify the program for seniors (Corbett Dooren, 3/10).

The New York Times: White House Withdraws Plan Allowing Limits To Medicare Coverage For Some Drugs
Under pressure from patients, pharmaceutical companies and members of Congress from both parties, the Obama administration on Monday withdrew a proposal that would have allowed insurers to limit Medicare coverage for certain classes of drugs, including those used to treat depression and schizophrenia (Pear, 3/10).

Kaiser Health News: Capsules: Medicare Officials Back Away From Changes To Rx Plan
Facing heavy bipartisan opposition on Capitol Hill as well as from patient groups, businesses, insurers and others, the Centers for Medicare & Medicaid Services said Monday it did not plan to move ahead "at this time" with several proposed changes to the Medicare prescription drug program (Carey, 3/10).

The Associated Press/Washington Post Administration Drops Proposed Medicare Changes
The Obama administration says it’s pulling the plug on proposed changes to the Medicare prescription program that ran into strong opposition on Capitol Hill. Among other changes, the regulation proposed to remove three classes of drugs from a special protected list that guarantees seniors access to a wide selection of critical medications (3/10).

Politico: Medicare Drug Changes Put On Hold After Criticism
CMS Administrator Marilyn Tavenner wrote in a letter to Congress Monday that she was shelving changes proposed in January that could have loosened the requirements that Medicare Part D insurance plans cover a broad range of drugs in six “protected classes” of medications. The changes also would have limited the number of drug plans that were available (Norman, 3/10).

Reuters: US Administration Pulls Back On Medicare Drug Benefit Proposal 
The Obama administration, in an abrupt about-face, said on Monday it would drop proposed changes to Medicare drug coverage that met wide opposition on grounds they would harm health benefits for the elderly and disabled. Late last week, more than 370 organizations representing insurers, drug makers, pharmacies, health providers and patients urged the Centers for Medicare and Medicaid Services (CMS) to withdraw changes it had proposed for Medicare Part D (Morgan, 3/10).

McClatchy: Obama Administration Abandons Medicare Changes
The Obama administration announced Monday that it will not proceed with several contentious proposals to change the Medicare prescription drug program in 2015 after congressional Democrats and Republicans expressed major concerns about the plans. "Given the complexities of these issues and stakeholder input, we do not plan to finalize these proposals at this time," wrote Medicare Administrator Maryilyn Tavenner in a letter to Congress on Monday. "We will engage in further stakeholder input before advancing some or all of the changes in these areas in future years” (Pugh, 3/10).

In other Medicare news -

USA Today: Law, Healthier Beneficiaries Helping Trim Medicare Costs
Health care spending per Medicare recipient will slow in the future, because of lower payments to doctors, fewer services per beneficiary and a lower average age of beneficiary, according to a February monthly budget review by the Congressional Budget Office. "Under current law, spending per person in Medicare will increase much more slowly during the next decade than it has during the past few decades," CBO states in the review (Kennedy, 3/10).

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Health Reform

As Enrollment Deadline Looms, Subsidies Still Confuse Some Consumers

The Wall Street Journal unveils a calculator to help explain these tax credits, or subsidies, while the CT Mirror looks at last-minute consumer questions.

The Wall Street Journal’s Health Blog: Healthcare.gov Explorer: Decode The Health Law's Subsidies
With just over three weeks left to choose new coverage in the health law marketplaces, deciphering the complex system of subsidies remains a key challenge for many would-be insurance customers. To help users decode the law’s new system of tax credits, The Wall Street Journal has added a calculator to its healthcare.gov Explorer (Weaver, 3/10).

The CT Mirror: Obamacare Q&A: Exchange Deadlines, Insurance Options And Tax Credits
March 31 is the deadline for buying insurance through the exchanges created by the federal health law. And although much about the law commonly known as Obamacare has changed in recent months, federal officials have indicated  that the deadline isn't moving. Here’s what you need to know about the end of the 2014 open enrollment period, the insurance options you'll have once it's over, when you'll face a penalty if you don't get covered, and the possibility of getting federal financial help buying a health plan outside the exchange (Becker, 3/11).

Kaiser Health News: Insuring Your Health: Window Is Closing To Sign Up Or Seek Changes To Obamacare Plans
People who got off to a rough start with Obamacare or have yet to pick a plan still have options -- but only if they move quickly before the open enrollment period ends on March 31. Those who were unable to sign up for a marketplace plan because of the glitches with federal or state websites can receive retroactive coverage to the date they originally applied, as well as retroactive premium tax credits and cost-sharing subsidies, the federal government announced in late February (Andrews, 3/11).

And in Louisiana -

Reuters: Louisiana Insurers To Accept Funds From Federal AIDS Program For Obamacare Premiums 
Three Louisiana insurers agreed on Monday to continue to accept payments from a federal program for low-income people with HIV/AIDS to cover their Obamacare insurance premiums, the carriers said during a hearing in U.S. District Court. Earlier this year BlueCross BlueShield of Louisiana, the state's largest carrier, said it would begin rejecting checks from a federal program called the Ryan White HIV/AIDS Program that for decades had helped low-income people with HIV and AIDS pay for both AIDS drugs and insurance premiums (3/10).

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HHS Inspector General To Examine Maryland's Troubled Health Exchange

Rep. Andy Harris, the state's only Republican member of Congress, requested the investigation even as lawmakers from both parties -- who have used the difficulties of the online insurance marketplace in the run up to this year's gubernatorial election -- say they welcome the review. News outlets also track developments in California, New York, Missouri, Hawaii, Colorado and South Carolina.  

The Washington Post: HHS Inspector General To Review Md. Health Exchange After Congressman Requests Probe
The inspector general for the U.S. Department of Health and Human Services plans to review Maryland’s troubled online health insurance marketplace, according to a Republican congressman who called for an investigation into the tens of millions of dollars the state spent on the system, which has been marred with technical glitches and might soon be replaced or abandoned (Johnson, 3/10).

The Associated Press/Washington Post: Lawmaker: Feds To Review Maryland Health Exchange
The inspector general of the U.S. Department of Health and Human Services has agreed to review Maryland’s troubled health care exchange, a congressman said Monday. Rep. Andy Harris, the state’s only Republican congressman, said he has confidence that the nonpartisan and independent inspector general, who has subpoena power, will thoroughly investigate problems that have plagued the exchange since it opened in October (3/10).

Politico: Feds To Investigate Flawed Maryland Obamacare Exchange
The HHS Office of the Inspector General is launching an investigation into Maryland’s troubled health insurance exchange, the latest target of expanding federal oversight of poorly performing Obamacare exchanges. As requested by Rep. Andy Harris, a Maryland Republican and foe of the Affordable Care Act, investigators will look at the procedures state officials followed in contracting with the tech companies behind the site’s botched development and at troubles with Medicaid enrollment that are expected to significantly drive up costs (Norman, 3/10).

The Baltimore Sun: State Officials Welcome Federal Review Of Health Site
Elected officials from both parties said Monday they welcome a pending federal review of Maryland's troubled health insurance exchange, even as they used the latest development to take swipes at one another ahead of this year's gubernatorial election. The inspector general for the U.S. Department of Health and Human Services will examine how millions of dollars of federal money was spent on the site, according to the Republican lawmaker who requested it (Fritze, 3/10).

U.S. News & World Report: Higher-Cost Obamacare Plans Don't Guarantee More Choice
A U.S. News analysis of health plans currently available on California's new insurance exchange found little correlation between the monthly price a consumer pays for a plan and the number of hospitals in the plan’s network. The findings indicate that, with careful selection, it’s possible for most Californians to buy an Obamacare plan that offers some freedom in choosing a hospital without paying top dollar in monthly premiums (Heilbrunn, 3/10).

The Associated Press/Wall Street Journal: NY Health Exchange Reports 591,000 Enrollees
The state's new health exchange reports more than 908,000 New Yorkers have completed applications for insurance while more than 591,000 of them have now enrolled for specific coverage (3/11).

Kaiser Health News: Capsules: Missouri Pulls Out Stops, But Lags Better-Funded Illinois Effort
Cover Missouri — a coalition of 400 organizations led by the Missouri Foundation for Health — has 130 enrollment events statewide this month. The St. Louis Effort for Aids, for example, planned the Rock Enroll event last Saturday (Kulash, 3/10).

The Associated Press: Lawmakers Propose Fees For [Hawaii] Health Exchange
State lawmakers are proposing charging a fee to insurers that are not participating in the state's insurance exchange under President Barack Obama's federal health care overhaul. The fee would help prop up the financially troubled Hawaii Health Connector. The exchange has enough money to cover its bills for this year — but not beyond that, without some help (Bussewitz, 3/10).

Health News Colorado: Exchange CEO Complains Of ‘Cuts, Cuts, Cuts,’ But Board Refuses Fee Hikes
Colorado’s health exchange board refused to hike user fees by 21 percent Monday despite complaints from Connect for Health Colorado’s CEO that she’ll have to cut spending without more revenue. The news comes as managers have slashed projected enrollments. The most optimistic projections once predicted that as many as 204,000 Coloradans would have signed up for private health insurance by the end of this month. Mid-level projections called for about 133,000 while about 90,000 people have actually signed up so far. New projections now call for as few as 152,000 people buying through Connect for Health both this year and next (McCrimmon, 3/10).

Charleston, S.C., Post and Courier: Health Insurance Enrollment Continues To Climb In South Carolina
About 10,000 South Carolinians purchased a private insurance policy through the federal health insurance marketplace last month, driving total enrollment since Oct. 1 to nearly 37,000, according to the S.C. Department of Insurance. This includes only new customers who have actually paid their first month's premium. Monthly reports released by the U.S. Department of Health and Human Services use a broader definition of enrollment, and include some customers who have picked a plan but not paid (Sausser, 3/10).

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Legal Concerns Raised Over Making Medicaid Recipients Work In Missouri

Elsewhere, some business groups enlist help to get their states to expand the program. Also, HHS Secretary Kathleen Sebelius urges Georgia's governor to accept the expansion, which also makes news in New Hampshire and Utah.

The Associated Press: Legal Experts Cite Concern About Missouri Medicaid Bill
Legal experts raised concern Monday about Missouri legislation that would require many adult Medicaid recipients to work in order to receive health care coverage. The work requirement is part of a broader proposal that would remodel Missouri’s Medicaid program to be more like private-sector insurance and expand coverage for hundreds of thousands of lower-income adults (Lieb, 3/10).

St. Louis Post-Dispatch: Proposed Medicaid Work Requirements Questioned At Missouri Hearing
Measures intended to require new working-age Medicaid recipients to participate in the workforce drew questions at a House committee hearing Monday. The hearing focused solely on the cost-saving and "reform" elements of a proposal put forward by Rep. Noel Torpey, R-Independence. Those include treatment for those with drug or alcohol problems, lessening emergency room use, encouraging the use of private plans and requiring providers (French, 3/10).

Kaiser Health News: Capsules: Business Groups Split On Medicaid Expansion
With several states weighing whether to expand Medicaid under the federal health law, supporters are looking to powerful business groups to help sway skeptical state legislators. But those groups are split on the issue — just like the public at large (Galewitz, 3/10).

The Atlanta Journal-Constitution: Sebelius Urges Deal To Expand Medicaid
With three weeks to go before the end of open enrollment for the Health Insurance Marketplace, Health and Human Services Secretary Kathleen Sebelius on Monday urged Georgians to explore their coverage options before it's too late. Sebelius, visiting Atlanta Monday morning, also said she hopes Gov. Nathan Deal will still consider expanding the state’s Medicaid program, another key element of the Affordable Care Act. Georgia is losing out on $9.2 million in federal funding every day because it’s not expanding, she said, pointing out that, meanwhile, hospitals and taxpayers are picking up the cost of caring for the uninsured (Williams, 3/10).

Georgia Health News: Sebelius Urges Georgians To Sign Up For Exchange
Sebelius also made a pitch for Georgia and other states to expand their Medicaid programs. Under the ACA, the federal government is picking up 100 percent of the costs of expansion for the first three years for states that opt to expand coverage. Georgia is one of many states that have decided not to do so. "Georgia is losing $9.2 million a day in federal funding" by not expanding the program, Sebelius said. The uninsured “are still coming through the doors of the emergency room," she said. "In the meantime, taxpayers are picking up that cost." But expansion in Georgia appears to be a political long shot, at least for now. Gov. Nathan Deal says expansion would ultimately cost the state too much (Miller, 3/10).

New Hampshire Union Leader: Medicaid Expansion's Benefits Extolled Before House Finance Committee
State Sen. Sylvia Larsen called last week's 18-5 Senate vote in favor of Medicaid expansion the "culmination of a long bipartisan process," as she urged the House to follow suit and approve a plan to extend the federally funded health insurance program to 50,000 or more low-income New Hampshire residents. In testimony on Monday before the House Finance Committee, the Concord Democrat used the word "bipartisan" at least four times, calling the Senate compromise similar to bills previously passed in the House (Solomon, 3/10).

Concord Monitor: House Committee Reviews Senate's Medicaid Expansion Bill
With a few pointed questions, House lawmakers took their first look at the Senate's plan to expand Medicaid to low-income New Hampshire residents. The Democratic majority of the House passed its own versions of an expansion program in January and November, but the bill before the House Finance Committee yesterday is the only proposal so far to win support from Republicans in control of the Senate. Gov. Maggie Hassan, a Democrat, has advocated for expanded Medicaid since taking office last year and has said she will sign this bill if it reaches her desk (Palmero, 3/10).

Deseret News: House Won't Consider Senate's Partial Medicaid Expansion Plan
The Utah Senate passed a partial Medicaid expansion plan Monday that also gives Gov. Gary Herbert the ability to seek a federal block grant to pay for the proposal he rolled out last month. But majority Republican leaders in the House won't consider the bill, meaning lawmakers won't have a united approach to deal with the issue before the 2014 Legislature ends Thursday (Romboy, 3/10).

Salt Lake Tribune: Senate To Gov. Herbert: Negotiate Utah Medicaid Plan
Any decision on how Utah will provide health coverage to tens of thousands of its poorest residents seems to be months off and rests largely in the hands of Gov. Gary Herbert after the House and Senate reached an apparent impasse on the issue. The Senate on Monday passed SB251s1, which would draw on federal Medicaid funds to provide health-insurance subsidies to about 54,000 Utahns who make less than $11,600 a year. At the same time, the bill gives Herbert the green light to go to Washington to try to strike a better deal with the Obama administration, if he can. ... But House Speaker Becky Lockhart, R-Provo, said the House will not consider Shiozawa’s bill or the Medicaid expansion proposal Herbert recently offered -- but that doesn’t prevent (Gehrke and Davidson, 3/10).

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Uninsured Rate Hits Lowest Point In Five Years

According to a Gallup survey released Monday, the health law appears to be achieving its central goal -- reducing the number of Americans without insurance. But NBC News reports that Latinos continue to be more likely to be uninsured than white or black Americans.

NPR: As Health Law Takes Hold, Rate Of Uninsured Falls
Since the Affordable Care Act kicked in fully, the percentage of Americans without health coverage has fallen to its lowest point in five years. In the last quarter of 2013, just before the federal health law took full effect, 17.1 percent of Americans reported they lacked health insurance, according to a Gallup survey (Rovner, 2/10).

Los Angeles Times: Obamacare Meeting Goal Of Reducing Number Of Uninsured, Data Indicate
Evidence has begun to resolve one of the odder controversies surrounding Obamacare: The new law appears to be achieving its top goal of reducing the number of Americans who lack health insurance. The dispute over that question is a strange one because the answer would seem to be fairly obvious: Under the Affordable Care Act, the government will spend hundreds of millions of dollars to subsidize families who decide to buy insurance, a product that the vast majority of Americans value highly. Basic economics would seem to say that those subsidies would have to increase the number of people buying insurance (Lauter, 3/10).

The Associated Press/Washington Post: Health Law Cited As US Uninsured Rate Drops
The share of Americans without health insurance is dropping to the lowest levels since President Barack Obama took office, but sign-ups under his health care law lag among Hispanics — a big pool of potential beneficiaries. With just three weeks left to enroll on the new insurance exchanges, the Gallup-Healthways Well-Being Index, finds 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).

NBC News: A Drop In Uninsured, But Latinos Still Most Without Coverage
Hispanics continue to be more likely to be uninsured compared to white and black Americans, despite a slight drop in those lacking coverage. The Gallup-Healthways-Well-Being Index released Monday showed 37.9 percent of Latinos lack insurance, down from 38.7 percent uninsured in the last three months of 2013. Black Americans saw the biggest drop in uninsured rates in that time period from 20.9 percent to 18.3 percent uninsured. For whites the share of uninsured fell from 11.9 to 10.9 (Gamboa, 3/10).

CBS News: Obamacare Working? Uninsured Rate Lowest In Years, Poll Finds
In what may be a sign that the central aim of the Affordable Care Act is working, a new Gallup survey finds that the percentage of Americans without health insurance is on track to reach its lowest quarterly rate since 2008. The uninsured rate has fallen to 15.9 percent, Gallup reports, after conducting 28,000 interviews with Americans from Jan. 2-Feb. 28. By comparison, the uninsured rate in the fourth quarter of 2013 was 17.1 percent. If accurate, that translates to a difference of about 2.5 million adult Americans. The survey's margin of error was one percent (Condon, 3/10).

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Parsing The ACA's Impact On Farmers, Community Health Centers

Farmers, who often rely on individual policies, may find it easier to get routine medical care through policies sold on the health law's online exchanges. Meanwhile, community health centers face reduced federal support in fiscal 2016, and the battle over the law's contraception mandate highlights a dispute over whether certain forms of birth control prevent conception or destroy a fertilized egg.

The Milwaukee Journal Sentinel: Affordable Care Act Impacts Farming Families
Farm families, as small business owners, often need to purchase health insurance coverage for themselves. They also often manage employees and need to make decisions about what they will offer as healthcare coverage. The Affordable Care Act, with its many changes to parts of the health insurance system, will impact farm families in many ways (Hafemeister, 3/10).

CQ HealthBeat: Without A Cushion From Funding Cliff, Health Centers Face 2016 Closures
Community health centers, long a bipartisan funding priority on Capitol Hill, face a sharp drop off in federal support in fiscal 2016 that could force a number of centers to close, slash staff, or curtail services. If lawmakers do not intervene, a key part of the strategy for meeting growing demand for healthcare services as coverage expands under the health law will be undermined, advocates for centers say (Reichard, 3/10).

Reuters: U.S. Top Court Case Highlights Unsettled Science In Contraception
As the U.S. Supreme Court prepares to hear a religious dispute over the Obamacare contraception mandate, advocates on both sides are trying to set the court straight on the science. The case, to be heard on March 25, is one of the most closely watched of the year, partly because it taps into the enduring debate over abortion and reproductive rights (Begley, 3/11).

The New York Times: Obama’s New Approach Takes A Humorous Turn
In “Between Two Ferns,” an off-color online parody of celebrity interview shows, the comedian Zach Galifianakis has spanked Justin Bieber with his belt, discussed Charlize Theron’s thighs and asked Natalie Portman for her phone number. ... Aides said Mr. Obama’s immediate reason for subjecting himself to Mr. Galifianakis is to urge young people to sign up for health insurance on the government’s website, healthcare.gov (Shear, 3/10).

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Capitol Hill Watch

Senate Dems Launch Counterattack On Koch Brothers

Charles and David Koch have underwritten millions of dollars' worth of ads criticizing Democratic candidates on the federal health law and their ties to President Barack Obama. Meanwhile, The Washington Post's fact checker gives one of those ads claiming a cancer patient had lost her "wonderful doctor" three Pinocchios.

The Associated Press/Washington Post: Senate Democrats Aim Ire At Rich, Obscure Brothers
Democratic Senate candidates, facing withering criticism on the national health care law, are gambling they can turn voters against two billionaire brothers funding the attacks — even if few Americans would recognize the pair on the street. In an accelerating counteroffensive stretching from the Senate chamber to Alaska, Democrats are denouncing Charles and David Koch, the key figures behind millions of dollars in conservative TV ads hammering Democratic candidates and their ties to President Barack Obama (3/10).

The Washington Post’s The Fact Checker Update: Julie Boonstra’s Claim Her Obamacare Plan Is ‘Unaffordable’ Gets Downgraded To Three Pinocchios
The problem with the original ad was two-fold. First, Boonstra, a cancer patient, suggested she had lost her “wonderful doctor” when in fact she could keep that doctor in the new plan. Second, her premiums were cut in half, from $1,100 a month to $571, and the savings were slightly more than the out-of-pocket costs permitted under the health care law. So it seemed highly suspicious that the costs were “unaffordable” (Kessler, 3/11).

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GOP To Vote Friday On Tying Medicare Doctor Pay Fix To Repeal Of Health Law's Insurance Mandate

The strategy could force Democrats into a difficult vote.

The Fiscal Times: GOP Pits Doc Fix Vs. Individual Mandate In Obamacare Fight
House Republicans are rallying around a new strategy to undermine the president's signature health care law. House Majority Leader Eric Cantor scheduled a vote on Friday to tie a delay of Obamacare's individual mandate, requiring all Americans to possess health insurance by March 31 or pay a penalty, to a piece of bipartisan legislation that would permanently fix Medicare's flawed physician payment system. Since 1997, the federal government has been using the sustainable growth rate (SGR) formula to determine how much to pay Medicare doctors. But since Medicare spending has exceeded the target every year since 2003, doctors have been left vulnerable to major pay cuts (Ehley, 3/10).

CQ HealthBeat: Physician Practices Not Ready For 'Doc Fix' Transition
For years, doctors have pushed lawmakers to do away with Medicare's outdated physician payment formula and move to a more stable system that would reward quality work, not just volume. Congress is now closer than ever to repealing the sustainable growth rate formula, which has resulted in repeated short-term "doc fixes" to avert drastic cuts in Medicare reimbursements (Ethridge, 3/10).

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Health Care Marketplace

Cancer Doctors Push For Payment Changes

Also, some health companies are trying to improve patient outcomes by using predictive software to deliver care more efficiently, and a company lost another court decision to patent a genetic test.

Reuters: U.S. Cancer Doctors Urge Payment Fix As Cases Set To Rise 
U.S. cancer doctors are worried about their ability to handle an expected surge in cancer cases in the coming years as they face cuts to government health plans and efforts to reduce payments to physicians. The influential American Society of Clinical Oncology, in a report released on Tuesday, cited estimates that cancer will become the leading killer in the United States by 2030 as the population ages, while treatment costs reach new heights (3/11).

Marketplace: Health Companies Eye Predictive Software For Patient Care
Pharmacy giant Walgreens recently announced it has begun using predictive software to help guide patient treatment.  It’s just one of the latest efforts where health care hopes to standardize day-to-day operations. With estimates that hundreds of billions of dollars is wasted every year on redundant or inefficient services, many industry leaders think healthcare needs to be more like Burger King, where a sandwich in Santa Fe tastes a lot like the sandwich in Seattle. For some the path to slowing health costs may mean medical care has to look more like factory work (Gorenstein, 3/11).

The New York Times: Patentholder On Breast Cancer Tests Denied Injunction In Lawsuit
Myriad Genetics, which lost a closely watched Supreme Court case last year involving the patenting of genes, has suffered another setback in its efforts to protect its main genetic test from competition (Pollack, 3/10).

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State Watch

State Highlights: Calif. Insurer Satisfaction; Md. Mental Health Legislation

A selection of health policy stories from California, West Virginia, Maryland, Connecticut and Minnesota.

Los Angeles Times: Survey: Kaiser Leads In Customer Satisfaction, Blue Shield Ranks Last
For the seventh consecutive year, Kaiser Permanente ranked highest in customer satisfaction for health insurance among California policyholders, according to ratings firm J.D. Power & Associates. But two other major rivals -- Blue Shield of California and Anthem Blue Cross -- scored the lowest on member satisfaction among seven California health plans (Terhune, 3/10).

Politico: Joe Manchin Backs West Virginia Abortion Bill 
West Virginia Sen. Joe Manchin is “supportive” of a West Virginia bill banning abortions after 20 weeks and is considering backing a similar federal ban in the Senate. “I am pro-life and supportive of the principles in the bill that was just passed in the West Virginia Legislature,” Manchin said in a statement (Everett, 3/10).

The Baltimore Sun: Legislation Pushes Involuntary Mental Health Treatment
Maryland lawmakers are moving to make it easier to medicate mental hospital patients against their will, while examining the idea of court-ordered therapy for mentally ill people who aren't hospitalized. The legislation is based partly on recommendations from a panel convened by Gov. Martin O'Malley after the 2012 shootings at Sandy Hook Elementary in Newtown, Conn. (Walker, 3/10).

The CT Mirror: Proposal To Let Nurse Practitioners Practice Independently Advances
A controversial proposal that would allow nurse practitioners to practice independent of doctors cleared the legislature’s Public Health Committee Monday. Legislators voted 22 to 4 to advance the bill to the Senate floor. Some members of the committee indicated that they believed the bill should move forward, but that it would need fine-tuning before becoming law. In particular, committee members raised concerns about malpractice insurance requirements for nurse practitioners and “truth in advertising” that would make clear to patients whether they’re seeing a doctor or a nurse practitioner (Becker, 3/10).

The San Francisco Chronicle: Campos Wants Stricter Rules On S.F. Health Care Accounts
It looks like it's loophole closure time all over again. Supervisor David Campos is once again proposing legislation to stop employers from pocketing millions of dollars that were supposed to pay for employee health care as part of the city's universal health care law. The centerpiece of Campos' proposal is a requirement that money employers deposit in savings accounts to reimburse their workers for their health care expenses actually gets used for that. Now, employers may take back the unused portion of the money after two years, and some do (Cote, Knight and Lagos, 3/10).

The Star Tribune: Minnesota's 'Unsession' Should Undo Health Care Access Barriers
In rural Minnesota, a highly educated nurse who has spent years developing therapeutic relationships with dozens of people with mental illness, monitoring and adjusting their psychiatric medications, must tell them she can no longer help them. Insurance isn’t the problem, and it has nothing to do with either the patients or the specialized nurse. It’s because someone else is retiring. The nurse specialist paid that person, a physician, several thousand dollars for permission to practice. When he retires, that agreement and the nursing care it permitted ends. He has never seen the nurse’s patients and has not collaborated in their care, yet he controls their access to the health care they appreciate and need (Weber, 3/10).

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Editorials and Opinions

Viewpoints: Exploiting Botched Exchanges; Falling Number Of Uninsured; Medicare Drug Plan Retreat

The New York Times: Harassment Of Troubled State Exchanges
Now that the badly botched rollout of the federal government's health care website seems to be behind us, Republicans have shifted their criticisms to several states that are experiencing problems enrolling people on their state-run exchanges. Their attacks would be more credible if they showed the slightest desire to help fix the problems. But their main goal is to belittle the efforts of states that are working hard to make their systems better, to scare people away from the state websites and to discredit the health care reform law itself (3/10).

The New York Times: The Democrats Stand Up To The Kochs
Democrats have for too long been passive in the face of the vast amounts of corporate money, most of it secret, that are being spent to evict them from office and dismantle their policies. By far the largest voice in many of this year's political races, for example, has been that of the Koch brothers, who have spent tens of millions of dollars peddling phony stories about the impact of health care reform, all in order to put Republicans in control of the Senate after the November elections. ... Democrats may never have the same resources at their disposal — no party should — but they can use their political pulpits to stand up for a few basic principles, including the importance of widespread health-insurance coverage, environmental protection and safety-net programs (3/10).

Los Angeles Times: New Data Show Obamacare Gaining Traction
Here's a rundown of the latest metrics on the Affordable Care Act. -- The percentage of uninsured Americans is falling sharply, reaching 15.9% as of the end of February, according to Gallup. That's the lowest rate the survey firm has measured since 2008. The greatest gains in insured status were shown by people earning less than $36,000 -- a prime target for the act -- and black Americans. Hispanics still lag. -- The cost of health insurance and medical care came sharply down in January, according to number-crunchers at Goldman Sachs and the Commerce Department. Goldman Sachs attributed the slide to cuts in the reimbursement formulas for Medicare services, which are written into the law. The ACA is effectively putting more money in people's pockets -- the Commerce Department estimated that the expansion of Medicaid benefits under the ACA amounted to $19.2 billion in January (Michael Hiltzik, 3/10).

Bloomberg: Good Obamacare News That Might Even Be True
Is the Affordable Care Act starting to reduce the number of uninsured Americans? Democrats and ACA supporters are buzzing about a new Gallup poll showing that the percentage of uninsured has dropped to 15.9 percent, the lowest level since 2008. I’d be cautious, however. On the plus-side, this is a large survey, with a 28,000-person sample. But this line of questioning also has a history of spikes in both directions. The latest results need to be reconciled with the finding just six months ago -- in the third quarter of 2013 -- of 18 percent uninsured, the worst-ever rate (Jonathan Bernstein, 3/10). 

Bloomberg: Unions Suffer For Obamacare
Unite Here, a union that represents service industry workers, has released a pretty blistering report condemning Obamacare. ... Notwithstanding my reservations about the quality of this report, unions actually do have three big problems with Obamacare. As the Official Blog Spouse has chronicled, Obamacare has made things hard for the multiemployer health plans that many unions offer (Megan McArdle, 3/10).

The Richmond Times-Dispatch: Medicaid Expansion
As we have said before, the Senate's "Marketplace Virginia" plan – using federal Medicaid money to provide premium support for low-income Virginians’ purchase of insurance on the private market – makes the most sense and would be the best course to pursue. It deserves to pass. At the same time, we see no need to link the Medicaid dispute to the state budget. If House Republicans are wrong to oppose the Senate plan, then Democratic leaders and the governor are wrong to play parliamentary games. It's time to decouple Medicaid expansion from the budget and settle each issue separately (3/10).

On other health care issues -

Los Angeles Times: CVS Probed In Alleged Loss Of Painkillers
CVS Caremark Corp. could face as much as $29 million in fines for allegedly losing track of prescription painkillers at four of its California stores, from which authorities said thousands of pills may have been sold on the black market. Officials at the U.S. Drug Enforcement Administration and the California Board of Pharmacy told me Monday that more than 37,000 pills were apparently taken from CVS stores in Modesto, Fairfield, Dixon and Turlock. Meanwhile, CVS pharmacists in Southern California said they've been instructed by the drugstore chain to get their paperwork in order so that no other prescription meds are found to be missing (David Lazarus, 3/10).

The Washington Post: Health-Care Costs And The 'Moral Hazard' Problem
An article posted Sunday on the Los Angeles Times's Web site reports that two new, potential blockbuster drugs to treat hepatitis C, Sovaldi and Olysio, will be priced as high as $1,000 per pill, or $84,000 for a 12-week treatment cycle. Given the incidence of the illness, these prices could cost patients, insurers and taxpayers billions of dollars a year for California patients alone. This story illustrates one problem – although certainly not the only one – with the U.S. health-care system that makes it by far the most expensive in the world. (We spend about 18 percent of economic output on medical care.) In the United States, private health insurance sometimes excludes from coverage certain categories of care but essentially covers all treatments with any medical efficacy for illnesses that are covered, without any consideration of cost effectiveness (Russell Korobkin, 3/10).

The Wall Street Journal: The Medicare Drug Benefit Revolt
Liberals claim that only government can control health costs, and when market competition proves otherwise, the White House tries to hide the evidence by sabotaging the market. So taxpayers can be thankful that, amid a bipartisan political backlash, the Administration on Monday shelved its plan to ruin the Medicare prescription drug benefit (3/10). 

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Stephanie Stapleton

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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.