Daily Health Policy Report

Wednesday, March 12, 2014

Last updated: Wed, Mar 12

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Public Health & Education

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

UCLA Memory Program Offers 'Gym For Your Brain'

Kaiser Health News staff writer Anna Gorman, working in collaboration with The Washington Post, reports: "Memory loss can have profound impact on patients, leading to an erosion of independence, a sense of helplessness and depression. Yet in some ways, it can affect their caregivers more. It’s hard to be the only one who can remember shared times. 'It is extremely stressful for the spouse,' said Barry Gordon, professor of neurology and cognitive science at Johns Hopkins University School of Medicine. 'It is like taking care of a child … and it never stops'" (Gorman, 3/12). Read the story.

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Nearly 1 Million More Sign Up For Obamacare Plans In February

Kaiser Health News staff writer Phil Galewitz reports: "About 4.2 million Americans have signed up for private health plans through the end of February via the online insurance marketplaces established by the federal health law -- with enrollment jumping by nearly 1 million people last month, the Obama administration said Tuesday" (Galewitz, 3/11). Read the story.

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Capsules: Should Healthier Patients Be Asked To Wait To Use Costly Hepatitis C Drugs?

Now on Kaiser Health News’ blog, Julie Appleby reports: "New treatments for hepatitis C that cost at least $66,000 to $84,000 may work better than older drugs, but their cost undermines their value to the health system, a panel of experts said during a daylong forum in San Francisco" (Appleby, 3/11). Check out what else is on the blog.

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Political Cartoon: 'Snake Bit?'

Kaiser Health News provides a fresh take on health policy developments with "Snake Bit?" by Clay Bennett.

And here's today's health policy haiku:

FORESHADOWING THE MIDTERMS?

Was Florida's vote
about more than a House seat?
Did the health law sink?
-Anonymous 

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

Administration: 1M More Sign Up, But Enrollment Is Short Of Target

Almost a million more people enrolled in insurance coverage under the health law during the month of February, bringing the total to about 4.2 million, according to a report released Tuesday.   

The New York Times: Health Care Enrollment Falls Short Of Goal, With Deadline Approaching
Almost a million people signed up last month for private health insurance under the Affordable Care Act, federal officials said Tuesday, bringing the total to date to 4.2 million but leaving the Obama administration well short of its original goal, with less than a month to go before the end of the open enrollment period (Pear, 3/11).

Kaiser Health News: Nearly 1 Million More Sign Up For Obamacare Plans In February
About 4.2 million Americans have signed up for private health plans through the end of February via the online insurance marketplaces established by the federal health law -- with enrollment jumping by nearly 1 million people last month, the Obama administration said Tuesday (Galewitz, 3/11).

Los Angeles Times: More Than 4.2 Million People Sign Up For Obamacare
The new enrollment report confirms that the administration and its allies probably will fall well short of the 7 million sign-ups that they had hoped to get in 2014. Administration officials would not even say if they believe they will enroll 6 million people, as projected by the nonpartisan Congressional Budget Office (Levey, 3/11).

The Washington Post: Pace Of Health Exchange Enrollment Slows In February, Figures Show
The pace at which Americans signed up for health plans slowed last month in the fledgling federal and state insurance marketplaces, according to new government figures showing that slightly fewer than 1 million people enrolled in February. The Obama administration said 943,000 Americans selected health plans, compared to 1.2 million in January. Overall, enrollment stood at 4.2 million as of the end of last month (Somashekhar and Goldstein, 3/11).

NPR: Young People Lag Behind In Health Insurance Enrollment
While the 943,000 people who signed up in February through the federal HealthCare.gov site or a state health exchange is slightly less than the original February projection of about 1.3 million, the exchanges have mostly put behind them their very sorry starts, when enrollments were often counted in the tens or hundreds (Rovner, 3/11).

The Wall Street Journal: More Americans Buy Insurance Under Health Care Law
The total signals the administration has been able to move beyond the technical issues of the HealthCare.gov site that shut out many would-be users in the fall. But the administration's effort to boost enrollment by the March 31 deadline still faces stiff challenges stemming from last year's problems. Supporters are ramping up those efforts, including deploying President Barack Obama and first lady Michelle Obama to promote the law (Radnofsky and Meckler, 3/11).

The Associated Press/Washington Post: Steady Health Care Sign-Ups May Miss Goal
The Obama administration said Tuesday it’s making steady progress on health care sign-ups, but the White House needs something close to a miracle to meet its goal of enrolling 6 million people by the end of this month. It could happen with a sustained surge in consumer demand and a foolproof website. But they’re not seeing it yet, and time is running out (3/11).

USA Today: 4.2 Million Enrolled In Insurance Through February
The latest statistics show the gulf between the original estimate of 7 million new customers from the Congressional Budget Office and how many people have come forward to comply with the requirement that those without insurance buy it or pay a fine. They provide mixed messages in terms of who is buying insurance and how quickly. For example, 942,000 people signed up for private plans in February, a drop from 1,146,000 in January. That's about 3,300 a day fewer in February. More than 1 million people signed up in both December and January (Kennedy, 3/11).

Politico: Administration: 4.2 Million People Signed Up For Obamacare Plans Through February
Yet the pace of new sign-ups wasn’t appreciably stronger than in January, when 1.1 million people selected health plans. That appears to be largely because there were fewer days in February than there were in the previous month’s report, but it’s an explanation that doesn’t help support messaging about major momentum (Cheney, 3/11).

Reuters: Obamacare Enrollment In Private Coverage Rises to 4.2 Million People 
The Obama administration said on Tuesday that 4.2 million people have signed up for private health insurance under Obamacare, and indicated that total enrollment could surpass a 6 million-enrollee forecast by the end of March. New enrollment data for a five-month period from October 1 through March 1 came out as the administration threw its public relations campaign into overdrive, with President Barack Obama appearing for an interview on the comedy website, "Funny or Die," in a direct appeal to the site's audience of young adults (Morgan, 3/11).

ABC News: Obamacare Enrollment Over 4 Million, Still Missing Critical Millennials
Less than three weeks remain in the open enrollment period for the healthcare insurance marketplace commonly known as Obamacare, but according to new statistics from the administration today a critical age group still isn’t turning out in needed numbers. As of March 1 over 4.2 million have found insurance coverage through the online state and federal exchanges mandated by the Affordable Care Act, according to the Department of Health and Human Services. It’s a 22 percent increase over January’s 3.3 million and within possible striking distance of the 6 million estimated by the non-partisan Congressional Budget Office to enroll before the March 31 deadline. But persons aged 18-34 represent only a quarter of the enrolled, down two points from a month ago (Larotonda, 3/11). 

Fox News: New Report Shows Administration Lagging Far Behind ObamaCare Enrollment Goals
In the final stretch of enrolling Americans in ObamaCare, the administration is lagging far behind its own goals -- leaving uncertain whether the program is attracting enough people for the system to work.  The Department of Health and Human Services reported Tuesday that more than 940,000 people signed up in February, bringing the total enrollment number to 4.2 million. That's well short of the unofficial goal of signing up 7 million by the end of open enrollment on March 31. The numbers renewed calls from Republicans to push off the looming penalty for not buying insurance. And they revived accusations that the administration still is not telling the whole story behind those numbers (3/12).

NBC News: No Last-Minute Health Insurance Pile-On Yet
If people are waiting until the last minute to buy health insurance on the new Obamacare marketplaces, they really are waiting until the last possible minute. The latest official government figures show that 4.2 million people bought health insurance on the online exchanges as of March 1. Just three weeks remain until the March 31 deadline to buy insurance on the exchanges. The Obama administration had been hoping for the 7 million people that the Congressional Budget Office had forecast would sign up in this first year. The CBO later revised that down to 6 million. "We expect that even more will sign up as we approach the March 31st deadline," Health and Human Services Secretary Kathleen Sebelius told reporters on a conference call (Fox, 3/11).

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Some States Weighing Enrollment Extension

Several states that are running their own marketplaces and have experienced problems are considering allowing residents more time to sign up for insurance. Also, a number of local news outlets examine their states' enrollment totals released this week by HHS.

The Washington Post’s Wonkblog: Facing Obamacare Enrollment Deadline, These States Are Pushing For More Time
As the Obama administration emphasizes the March 31 deadline to enroll in Obamacare health plans, some states running their own health insurance exchanges are weighing an extension of the enrollment period because of struggles signing people up for coverage. ... some states controlling their own insurance marketplaces have struggled with glitchy exchange websites the past five months of open enrollment and now want more time to get their residents covered (Millman, 3/11).

Los Angeles Times: Website Glitch Slows Obamacare In California
Enrollment in Obamacare coverage slowed last month in California, hurt by a recent website outage. New federal data show 868,936 Californians signed up for health insurance in the state's exchange through March 1. But that's a modest gain of about 40,000 people since mid-February. More than 100,000 people had picked a health plan during the first two weeks of February, according to the Covered California exchange (Terhune, 3/11).

The Associated Press: California Has Nearly 870,000 Health Care Sign-Ups
Nearly 870,000 Californians have signed up for an insurance policy through the state's health care exchange, the federal government reported Tuesday, as the state intensifies efforts to boost participation and target younger people ahead of the March 31 enrollment deadline. California leads the nation in enrollments, accounting for roughly 20 percent of all sign-ups across the country (Verdin, 3/11).

The Oregonian: Cover Oregon Health Insurance Exchange Not Attracting Younger Enrollees; Half Of Applicants Don't Sign Up
The Cover Oregon health insurance exchange is one of the worst in the country at attracting younger enrollees, according to a new federal report. Only 18 percent of those who've enrolled through the Oregon exchange fall between the ages of 18-34, a healthier age bracket considered crucial to keeping future premiums down. The age-related data for Oregon is available for the first time. The Oregon number, which ties with West Virginia as the nation's worst, falls well below the national average of 25 percent (Budnick, 3/11).

The Associated Press: Feb. Insurance Sign-Ups In Pa. Jump 30 Percent
The number of Pennsylvanians signing up for insurance under the 2010 federal health care law rose by 30 percent in February, reaching a total that is equal to one in 10 Pennsylvanians who were estimated to have been uninsured. The U.S. Department of Health and Human Services released a report Tuesday with the figures for all states through March 1 (Levy, 3/11).

Houston Chronicle: Texas Health Insurance Enrollment Numbers Lag As Coverage Deadline Nears
Data released Tuesday show hundreds of thousands more people bought coverage in the health insurance marketplace last month, but both state and national participation continues to lag original forecasts, and analysts doubt the government will hit its goals when enrollment closes at the end of the month (Hines, 3/11).

The Associated Press: Nearly 300,000 Texans Get New Health Insurance 
Fewer than 90,000 Texans bought health insurance through the new federally subsidized marketplace in the past month, leaving navigators, assisters and other officials working to enroll people with a hefty task as they near the March 31 deadline for open enrollment. Up until mid-March, some 295,025 Texans had purchased health insurance through President Barack Obama's signature overhaul program, according to data released Tuesday by the U.S Department of Health and Human Services (Plushnick-Masti, 3/11).

Health News Florida: 442,000 In FL Enroll So Far
With less than three weeks left in open enrollment, 442,000 Floridians have enrolled in a health plan through the federal insurance marketplace, health officials reported Tuesday. And 83 percent of those who have enrolled in Florida received financial help in the form of tax credits, according to a report released by the U.S. Department of Health and Human Services (3/12).

The Associated Press: Va. Health Insurance Signups Meeting Projections
Virginia is meeting federal projections for enrollment in the Obama administration's health care program but still has a ways to go to reach the final target on March 31. Figures released Tuesday by the U.S. Department of Health and Human Services show that 102,815 Virginians had enrolled by March 1. The government had projected 101,600 by Feb. 28 (3/11).

The Richmond Times-Dispatch: Health Care Insurance Enrollments Tops 100,000 In Virginia
Almost 103,000 Virginians have enrolled in health plans through the marketplace operated by the federal government, or 101.2 percent of the target of 101,600 set by the U.S. Department of Health and Human Services, according to The Associated Press. Nationally, the federal and state marketplaces are lagging behind their target of about 5.7 million, with 4.2 million people signing up for coverage through the end of February. But in Virginia, one of 36 states that chose not to operate its own exchange, the totals represent a huge shift after the disastrous rollout of the federal marketplace in October and November, when just 4,000 people were able to enroll here (Martz, 3/11).

North Carolina Health News: Obamacare Enrollment In N.C. Among The Country's Strongest 
Enrollment in the online health care exchanges continues to be strong in North Carolina, as federal numbers reveal more than 200,000 people in the state have signed up for coverage provided as a result of the Affordable Care Act. Original projections were that about 191,000 people in North Carolina would sign up, but the February numbers put the total at about 40,000 beyond that (Hoban, 3/12).

The CT Mirror: Access Health CT Has 152,561 Enrollees; Not Clear How Many Were Uninsured
More than 150,000 Connecticut residents have signed up for private insurance plans sold through the state’s health insurance exchange and for Medicaid since Oct. 1, according to Access Health CT, the state’s exchange. Of the 152,561 enrollees, just under 40 percent -- 60,534 -- signed up for private insurance plans. The other 60 percent will receive Medicaid coverage. That balance is a reversal of the exchange’s early enrollment trends. Last fall, Connecticut was the only state in the country where more people had used the exchange to sign up for private insurance than Medicaid (Becker, 3/11).

The Arizona Republic: Affordable Care Act Sign-Ups Slowing, But Deadline Surge Expected
Arizona’s pace for Affordable Care Act sign-ups cooled in February as 14,116 residents selected a health-insurance plan, raising the state’s total to 57,611 with just weeks to go before enrollment ends. January enrollment was slightly more robust, with 15,552 Arizonans signing up for private health insurance through the federal marketplace, healthcare.gov. Nationwide, about 943,000 Americans signed up last month to bring the five-month total to more than 4.2 million (Alltucker, 3/11).

Georgia Health News: Exchange Enrollment Growth Slows In February
More than 38,000 Georgians signed up for coverage in the health insurance exchange in February, according to a federal report released Tuesday. That is slightly down from the number that enrolled the previous month. But the February enrollees represent a 37 percent increase from the total Georgia enrollment of 101,276 through January (Miller, 3/11).

Bangor Daily News: Maine Beats Affordable Care Act Enrollment Target
The number of Mainers signing up for private health insurance under the Affordable Care Act dropped off in February, but far surpassed a federal enrollment goal as a March 31 deadline looms. From the Oct. 1 launch of Healthcare.gov through March 1, 25,412 Maine residents selected a private health plan through the federal government’s gateway for the marketplaces in Maine and 35 other states, according to a new report from the U.S. Department of Health and Human Services. That’s up from 20,511 Mainers at the end of January, but a lag from the previous month’s sign-up rate. ... Maine, however, has emerged as a leader in health insurance enrollments compared to other states using Healthcare.gov. The state beat not only the federal target of 18,400 enrollments by the end of February, but also outperformed, ahead of schedule, a goal of 23,000 enrollment by the end of the month (Farwell, 3/11).

And in news on Medicaid enrollment and the political fight for expansion of the program under the health law --

The Olympian: Wash. Medicaid Enrollment Surpasses Reform Goals
At least one part of health care reform has exceeded expectations in Washington state: Medicaid sign-ups since the state expanded eligibility for the safety-net program for low-income people. Washington health officials say 202,000 adults who became eligible for Medicaid because of the Affordable Care Act have signed up as of March 1. That number is well above the state's goal of enrolling 136,220 people by April 1 (Gordon Blankinship, 3/11).

The Associated Press: In Reversal, Maine GOP Embraces Part Of Health Law
Maine Republicans who are fiercely fighting an effort to expand government-subsidized health care coverage to roughly 70,000 residents have come up with an alternative: government-subsidized health care. The lawmakers have long opposed President Barack Obama's signature health insurance law.

In related news --

Seattle Times: Push Is On To Woo Thousands Left As Obamacare Deadline Looms
There’s a growing urgency to get more Americans signed up for health insurance as the end of March and the deadline for open enrollment draw closer. By March 31, under the Affordable Care Act, U.S. residents will need to have health insurance or coverage through a government program such as Medicare or Medicaid -- or face a potential penalty (Stiffler, 3/11).

Minnesota Public Radio: As Deadline Looms, MNsure CEO Answers Questions
MNsure's interim CEO Scott Leitz, speaking March 10th at the University of Minnesota Humphrey School and answering questions about problems and promise of Minnesota's health insurance exchange. March 31, 2014 is the enrollment deadline for the troubled program launched October 1, 2013 (3/11).

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Skip Health Coverage And The Penalty May Exceed Expectations

The notion that, during its first year, the penalty for not getting health insurance is relatively small is not entirely accurate. News outlets also report on how the health law is affecting retiree health care, insurers' rate-setting processes, pregnant women's coverage and provider networks.    

NPR: You Might Pay A Lot More Than $95 For Skipping Health Insurance
2014 is the first year most Americans will have to either have health insurance or face a tax penalty. But most people who are aware of the penalty think it's pretty small, at least for this first year. And that could turn into an expensive mistake (Rovner, 3/12).

Reuters: Why Employers Are Shifting Retiree Health Into Insurance Exchanges
A dwindling number of retirees get supplemental health insurance coverage from their former employers. But for those who do, big changes are afoot. A growing number of companies are dropping single-employer group insurance plans in favor of privately run insurance exchanges, where a third party sets up a marketplace offering Medicare coverage offered by dozens of carriers, with costs subsidized by their former employers (Miller, 3/11).

Reuters: Insurers Wary Of Obamacare Unknowns As They Plan For 2015
U.S. health insurers are struggling to set prices for their Obamacare plans in 2015 and decide which regions to return to before the deadlines for submitting those plans to regulators. Some insurers already expect to lose money this year following the rocky launch of President Barack Obama's Affordable Care Act, which aims to provide coverage to millions of uninsured Americans with the help of government subsidies (Humer, 3/11).

Modern Healthcare: Health Advocates Seek Clarity On How ACA Affects Pregnant Women
Health advocates are pushing the Obama administration to address widespread confusion about how the Patient Protection and Affordable Care Act affects coverage options for pregnant women (Dickson, 3/11).

The CT Mirror: Latest Obamacare Confusion: Exchange Plan Provider Networks
The rollout of the federal health law in Connecticut has been smoother than in many parts of the country, but it hasn’t been without hiccups. The latest one: finding providers who take the new coverage. Some of the more than 60,000 people who have bought private insurance plans through the state’s exchange, Access Health CT, have had trouble navigating their plans' networks of covered health care providers. "There remains confusion, I think, about the networks," Access Health CEO Kevin Counihan said. "Everybody's sensitive to it. It's clearly a big member issue" (Becker, 3/12).

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Obama Pitches Health Coverage On 'Funny Or Die' Show

The president appeared on an edgy Internet comedy show called, "Between Two Ferns," to urge young people to sign up for health insurance before open enrollment ends on March 31.

NPR: March Marks A Crucible For Obamacare As Deadline Nears
Facing a deadline, the Obama administration is desperate to boost enrollment in health care exchanges. Still millions from their goal, they're stepping up outreach and forgetting politics — for now (Liasson, 3/11).

Reuters: Obama Takes Health Plan Pitch To Edgy Comedy Show
President Barack Obama took his quest to sign young people up for health insurance to a comedy website on Tuesday, where he traded insults with host Zach Galifianakis while plugging his signature Obamacare health program. Obama sat for an interview on "Between Two Ferns with Zach Galifianakis," on the Funny or Die comedy website (Felsenthal, 3/11).

CNN: No Joke: Obama Interviewed By Zach Galifianakis
President Obama took his message of health care for all to a cult internet comedy show in an effort to get young people to sign up for Obamacare. He appeared alongside Zach Galifianakis in the comedian and actor's mock talk-show called "Between Two Ferns." The interview with the president was recorded last month and posted Tuesday morning on the popular website "Funny or Die” (Hoye, 3/11).

Politico: White House: ‘Funny Or Die’ Generating Record Referrals To ACA Site
President Barack Obama’s sit-down with Zach Galifianakis led to a spike in traffic to HealthCare.gov on Tuesday, the administration said, as it touted the effectiveness of the president’s latest effort to reach out to young adults. As of 1 p.m. ET Tuesday, the website had racked up more than 19,000 referral visits from Obama’s “Between Two Ferns” video for Funny or Die, which was posted around 7 a.m., Centers for Medicare & Medicaid Services spokesman Aaron Albright said (Epstein, 3/12).

McClatchy: Comedian In Chief? President Obama Pitches Health Care On Funny Or Die
President Obama traded barbs with Zach Galifianakis on the comedian’s ‘Funny or Die’ show “Between Two Ferns” in a bid to convince young invincibles to sign up for health care. Galifianakis posed a few questions to Obama, including “What should we do about North Ikea” before giving Obama a chance to tout healthcare.gov. “Let’s get this out of the way,” Galifianakis sighs. “What’d you come here to plug?” As Obama launches into his pitch -- that young people can get health care “for what it costs you to pay your cell phone bill” -- Galifianakis rolls his eyes (Clark, 3/11).

Fox News: White House Defends Obama's Snarky Interview With Zach Galifianakis
The White House is defending President Obama's snarky appearance on comedian Zach Galifianakis’ mock-interview show “Between Two Ferns," touting it as a creative, effective way to promote ObamaCare to young adults. White House Press Secretary Jay Carney claimed Tuesday that the video was the "number one referral" to HealthCare.gov the morning it was released online. He said he believes the "viral" video will be a big factor in getting young people to visit the website and explore coverage.  Asked whether Obama's appearance on the "show" was beneath the office of the president, Carney said he did not think so, saying "we made the right call here” (3/11).

PBS NewsHour: Deadline Approaching, Obama Administration Takes Creative Approach To Push ACA Enrollment
The Obama administration is getting creative in an intense push to accelerate enrollment in health care, especially among younger adults and Latinos, who trail almost every other demographic group in signing up. Judy Woodruff talks to Politico's Joanne Kenen and Larry Levitt of the Kaiser Family Foundation about the “hard sell” ahead of the March 31 deadline (Woodruff, 3/11). 

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Polls Examine Support For Health Law, Contraceptive Coverage Requirement

A CNN/ORC poll detected a slight increase in support for the overhaul, with much of it coming from upper-income and college-educated people. Meanwhile, an NBC News/Wall Street Journal poll found 53 percent of Americans agree with the rule requiring most employers to cover contraception.

CNN: Poll: Support For Obamacare Slightly Edges Up
Support for the country's new health care law appears to be rebounding slightly, according to a new national poll. A CNN/ORC International survey released Tuesday indicates that nearly all of the increased support comes from upper-income and college-educated Americans. The poll's Tuesday release comes on the same day that a special election is being held in Florida's 13th Congressional District to fill a vacant U.S. House seat. Obamacare has become a major issue in the competitive contest to fill the remainder of the term of the late GOP Rep. Bill Young (3/11).

The Wall Street Journal’s Washington Wire: WSJ Poll: Majority Agree With Obamacare Contraception Rule
A majority of Americans side with the Obama administration in saying that most employers should be required to include contraception coverage in workers’ health plans even if the business owners have moral objections. An NBC News/ Wall Street Journal poll found 53% of Americans believed that employers who opposed the use of birth control should not be exempt from the coverage requirement in the 2010 federal health law. Some 41% said employers who had objections should have the same exemption as religious organizations. Around 6% said they were not sure (Radnofsky, 3/12).

In addition, Republican officials are reportedly looking at building a database of the names of Americans whose insurance policies were canceled -

MSNBC: RNC Eyes Health Care Database
As party officials are often quick to admit, Republicans have generally trailed Democrats when it comes to technology and online innovation, but the RNC is reportedly putting together one database unlike anything the DNC has. The Republican National Committee (RNC) is building a database with the names of those who received insurance cancellation notices under ObamaCare, with the hope of capturing voters who believe they’ve been negatively affected by the healthcare law. An RNC spokesman wouldn’t provide any further details on the initiative for fear of giving away the strategy, but confirmed what Chairman Reince Priebus first told The Washington Examiner over the weekend (Benen, 3/11).

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Capitol Hill Watch

GOP Victory In Florida May Spell Trouble For Democrats

The race largely turned on the federal health care law, with the Republican candidate campaigning for its repeal and the Democrat saying it should be fixed, not abandoned.

The Associated Press/Washington Post: Florida House Race Could Be Warning For Democrats
After months of railing against President Barack Obama’s health care overhaul, Republicans scored a key victory in a hard-fought congressional race that had been closely watched as a bellwether of midterm elections in November. Republican David Jolly defeated Democrat Alex Sink in a Florida special election Tuesday that largely turned on the federal health care law, with both sides using the race to audition national strategies in one of the country’s few competitive swing-voting districts (3/12).

The Wall Street Journal: Republican David Jolly Wins Florida Congressional Race
The results are likely to embolden Republican candidates intent on attacking Democratic opponents over the troubled rollout of the federal health-care law. Mr. Jolly and his GOP supporters made Obamacare a centerpiece of their attacks on Ms. Sink, seeking to wed her to the law and calling for its repeal (Campo-Flores, 3/11). 

USA Today: GOP Wins Special Election For Florida House Seat
Republican David Jolly defeated Democrat Alex Sink in a hotly contested special election Tuesday for the U.S. House with a campaign in which he championed repeal of President Obama's health care law and said Sink would be a vote to advance the president's agenda (Davis, 3/11). 

Politico: Florida Loss Big Blow To Democrats’ 2014 Hopes
Democrats are scrambling to launch a counteroffensive -- and if they don’t come up with one fast, Tuesday’s loss could foreshadow a brutal year for the party at the ballot box this fall (Isenstadt, 3/12).

Los Angeles Times: More Than $12 Million Later, Florida Voters Deliver Verdict
The topic in the spotlight all along has been President Obama’s health care law, which Jolly advocates repealing. He and his allies, including GOP campaign committees, the Chamber of Commerce, the National Rifle Assn. and conservative "super PACs," pounded relentlessly at Obamacare during the campaign, hoping to stimulate a large turnout of conservative voters. Sink and her allies, including Democratic campaign committees, environmental groups, unions and women’s advocacy groups, pushed back with ads saying that the health law should be fixed, not abandoned (Lauter, 3/11).

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House GOP Votes To Expand Health Law Religious Exemptions

If approved, the bill would expand who doesn't have to buy health insurance because of their religious beliefs. Its prospects in the Democratic-controlled Senate are unknown.

The Wall Street Journal: House Votes To Widen Religious Insurance Exemption
The House on Tuesday approved three bills that would modify the Affordable Care Act including one that would expand religious exemption requirements in the law. The measures were all approved with broad bipartisan support, marking a departure from most prior measures brought up in the House that would have either partly or fully repealed the 2010 federal health law. The measures would have to clear the Democratic-controlled Senate before becoming law, and prospects for action there weren't clear, according to senior Democratic aides (Corbett Dooren, 3/11). 

CQ HealthBeat: Health Care Law's Religious Exemption Would Expand Under House Measure
The House is poised to take up bipartisan legislation Tuesday that would expand the religious exemption from the health care law requirement that most individuals buy health coverage or pay a penalty. The bill (HR 1814), sponsored by Illinois Republican Aaron Schock, comes to the House floor just weeks before the March 31 deadline for open enrollment in the new insurance exchanges and for individuals to sign up for coverage before they would be responsible for the penalty payment (Attias, 3/11).

CBS News: As Obamacare Reaches Crunch Time, Kathleen Sebelius Faces Congress
Health and Human Services (HHS) Secretary Kathleen Sebelius on Wednesday heads to Capitol Hill to make the case for her agency's proposed 2015 budget -- including the millions it is asking for to continue implementing the Affordable Care Act. Sebelius' appearance before the House Ways and Means Committee comes at a critical juncture for the health care law -- Americans have fewer than 20 days left to enroll in a health insurance plan on the new Obamacare marketplaces. The secretary announced Tuesday that about 4.2 million Americans had signed up for an Obamacare plan by the end of February. While the administration says it's satisfied with the pace of enrollment, the early, significant technical problems with healthcare.gov and other Obamacare sites clearly slowed down the process (Condon, 3/12).

Also, lawmakers in both chambers agreed to a measure to use political convention money for health research --

The Washington Post: In Rare Bipartisan Effort, Congress Votes To Shift Convention Money To Health Research
In a rare instance of Senate Democrats and House Republicans working together, Congress agreed Tuesday to shift funding formerly allocated to presidential conventions to programs focused on pediatric medical research (Costa, 3/11). 

The Richmond Times-Dispatch: Bill On Pediatric Medical Research, Inspired By Va. Girl, Heads To Obama
Legislation named for a young girl from Virginia that would boost funding for pediatric medical research is headed to President Barack Obama’s desk. The U.S. Senate on Tuesday passed the Gabriella Miller Kids First Research Act, a measure that was championed in the Senate by Sens. Mark R. Warner and Timothy M. Kaine, both Democrats, and in the House by Majority Leader Eric Cantor, R-7th. The legislation, which would expand pediatric research with money currently spent on taxpayer financing of presidential elections, passed the Senate by unanimous consent. It seeks to save more than $100 million over 10 years from the Presidential Election Campaign Fund and spend more on research of pediatric diseases and disorders at the National Institutes of Health (Meola, 3/11).

And a payment fix to how Medicare pays doctors looks increasingly unlikely --

CQ HealthBeat: Hatch Says Nine-Month ‘Doc Fix’ Patch May Be Needed
With just 20 days to go before a scheduled 24 percent Medicare reimbursement cut to physicians, it doesn’t appear Congress will strike a grand bargain to replace the formula responsible for the draconian reduction. The major stumbling block is the $138.4 billion in offsets required over 11 years to eliminate the sustainable growth rate formula, or SGR (Reichard, 3/11).

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Public Health & Education

Hepatitis C Drug Fuels Cost Debate

A panel of experts said this week that the drug represents a "low value" to the health system because of its cost.

Kaiser Health News: Capsules: Should Healthier Patients Be Asked To Wait To Use Costly Hepatitis C Drugs?
New treatments for hepatitis C that cost at least $66,000 to $84,000 may work better than older drugs, but their cost undermines their value to the health system, a panel of experts said during a daylong forum in San Francisco (Appleby, 3/11).

The Associated Press/Washington Post: Medical Groups Question Price Of New Hep C Drug
An innovative hepatitis C drug that was only recently hailed as a breakthrough treatment is facing skepticism from some health care providers, as they consider whether it is worth the $1,000-a-pill price set by manufacturer Gilead Sciences Inc. A panel of California medical experts voted Monday that Gilead’s Sovaldi represents a “low value” treatment, considering its cost compared with older drugs for the blood-borne virus (3/11). 

In other news about cost and quality -

The New York Times New Old Age Blog: Questions About A Popular Heart Procedure
Enter a newcomer, transcatheter aortic valve replacement. T.A.V.R., as it is known, involves a catheter, usually inserted through the groin, that delivers a new valve without a big incision and sometimes without general anesthesia. The Food and Drug Administration approved it in 2011 for patients whose aortic stenosis is considered inoperable, then in 2012 for the larger group of patients deemed “high risk” (an expansion skeptics call “indication creep”). It sounded like a big step forward. “Here was this new, sexy-sounding procedure that had a huge amount of press,” said Dr. Torrey Simons, a palliative care specialist at Stanford University who has been analyzing the operation’s cost-effectiveness (Span, 3/12). 

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State Watch

State Highlights: No-Bid Contract Decision In Calif.; Navigator Restrictions In Kan.

A selection of health policy stories from California, Florida, Kansas, New York, Virginia, Maryland, Wisconsin and Minnesota.

Los Angeles Times: Split Decision In No-Bid Contract Suit Against County Health Agency
Both sides are claiming victory in the latest flare-up between Los Angeles County and the AIDS Healthcare Foundation. In a March 7 decision, Los Angeles County Superior Court Judge Luis A. Lavin struck down the foundation's challenge to two county contracts that were awarded without a competitive bidding process. The contracts went to UCLA and St. John's Well Child and Family Center for providing health care and other services to young people living with or at risk for HIV (Brown, 3/11).

The Associated Press/Washington Post: Florida Hospital Settles Medicare Lawsuit
A Florida hospital has agreed to pay $85 million to settle a Medicare fraud whistle-blower lawsuit. Halifax Hospital Medical Center of the Daytona Beach area reached the agreement with federal authorities Monday (3/11). 

Kansas Health Institute: Senate OKs Bill Restricting Obamacare Navigators
A bill similar to one struck down recently by a federal judge in Missouri was tentatively approved today by the Kansas Senate. The proposal would create new requirements for Obamacare navigators, including fingerprinting and background checks (Shields, 3/11).

The Associated Press/Wall Street Journal: NY Medicaid Payments Called ‘Excessive’
Federal oversight officials say New York's Medicaid payments for disabled residents have been "excessive," with the federal share $320 million higher than actual costs in 2010. In a report Wednesday, the inspector general of the U.S. Department of Health and Human Services says New York's Medicaid reimbursement rates at state-operated residences were more than double the rates at privately operated residences offering the same services (3/12).

The Washington Post: Overlooked After Va. Tech Shooting, Children’s Mental Health Gets Attention 
Lawmakers cleared out of Richmond Saturday after largely accomplishing their goals on mental health reform. But they also failed to come to a budget agreement, leaving some differences on mental health funding unresolved, including money for mental health services for children and adolescents (Shin, 3/11).

The Baltimore Sun: Measure To Protect Health Workers Clears Both Chambers
Legislation aimed at reducing acts of violence against health care workers is poised for final passage in Annapolis. Identical bills have passed the House and Senate that would require health care facilities to conduct an annual risk assessment and document all violent workplace incidents (Wheeler, 3/11).

The Milwaukee Journal Sentinel: Senate Passes Bill To Reform Milwaukee County Mental Health Care
A bill to put a board of medical professionals -- instead of politicians -- in charge of Milwaukee County's embattled mental health system won unanimous approval Tuesday in the state Senate. The measure now moves to the Assembly, where it is expected to pass easily next week. It then would go to Gov. Scott Walker for his signature. Walker has likened Milwaukee's system to "a natural disaster" and declared "it's time for dramatic action” (Kissinger, 3/11).

The Star Tribune: Bill Advances To Suspend Licensed Health Professionals Over Behavior
Licensed health care pro­fes­sion­als in Minnesota whose behavior pre­sents an im­mi­nent risk of harm to their patients could be auto­mat­i­cal­ly sus­pend­ed un­der a bill passed Tues­day night by a Minnesota House committee. The de­ter­mi­na­tion of risk would need to be made by a licens­ing board or a Health de­part­ment com­mis­sion­er, which would have 60 days to in­ves­ti­gate and hold a hear­ing with the health care pro­vid­er after a suspension. That was one of sev­er­al pro­po­sals in­clud­ed in a bill that was prompt­ed by a se­ries of Star Tribune in­ves­ti­gat­ions last fall that found nurses have con­tinued to prac­tice de­spite crim­i­nal his­tories, including get­ting caught steal­ing drugs on the job and harm­ing pa­tients (Stahl, 3/11).

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Editorials and Opinions

Viewpoints: 'Middling News' On Enrollment; 'Secret Mandate Exemption;' Obama's Surprising Appearance Between Two Ferns

Bloomberg: February's Middling News For Obamacare
By the beginning of the month, 4.2 million people had selected a plan. But that doesn't mean they have insurance. Reporters on a conference call asked about the number who had paid, and the administration's representatives said they don’t know. They didn't dispute estimates from surveys that showed about 20 percent are not paying. But they didn't confirm them, either. If the 20 percent attrition rate holds, then as of March 1, about 3.4 million had actually paid for insurance. That would put the administration about 2.3 million behind their September projections (Megan McArdle, 3/11).

Bloomberg: Obamacare Enrollment Proves Whatever You Want It To
The worst-case scenario for Obamacare enrollment isn't that premiums go up because the risk pool was worse than expected. Rather, it's that Democrats overestimated the demand among Americans, and particularly young Americans, for insurance coverage that's both less generous than employer-based plans and more expensive than the plans prohibited by the law. ... But after five months of open enrollment, the level of demand among young Americans to buy subsidized health insurance remains unclear (Christopher Flavelle, 3/11).

The Wall Street Journal: Obamacare’s Secret Mandate Exemption
ObamaCare's implementers continue to roam the battlefield and shoot their own wounded, and the latest casualty is the core of the Affordable Care Act—the individual mandate. To wit, last week the Administration quietly excused millions of people from the requirement to purchase health insurance or else pay a tax penalty. This latest political reconstruction has received zero media notice, and the Health and Human Services Department didn't think the details were worth discussing in a conference call, press materials or fact sheet. Instead, the mandate suspension was buried in an unrelated rule that was meant to preserve some health plans that don't comply with ObamaCare benefit and redistribution mandates. Our sources only noticed the change this week (3/11). 

Los Angeles Times: Obama Stumps For Obamacare 'Between Two Ferns'
Is Barack Obama the nation's first hipster president? Obama appeared Tuesday in an episode of "Between Two Ferns With Zach Galifianakis," a recurring comedy sketch on the Funny or Die website. Maybe it was just good prep work by his aides, but Obama's grasp of the "Two Ferns" conceit — the mutual antagonism between host and guest — suggested that he was actually familiar with the cringe-worthy series (Jon Healey, 3/11). 

Los Angeles Times: Obama & Galifianakis: Not A Yuck Fest, But That Wasn't The Point
Here's the thing about President Obama's decision to appear with Zach Galifianakis on Funny or Die's "Between Two Ferns," one of the funniest faux-interview series you will ever see on the Web or off. It's not that Obama was particularly funny (his jokes seemed strained). Or that Galifianakis was at his offensive best (I'd save that praise for his interview with Justin Bieber, though asking whether Obama was going to put his presidential library in Hawaii or Kenya was pretty funny). But right now, with the end of the first enrollment period looming, the president is looking for ways to goose the enrollment of young adults in Obamacare. Appearing on "Between Two Ferns" is a sure-fire way to get the word out. Will it generate any sign-ups? That remains to be seen. But everyone's talking about it (Robin Abcarian, 3/11). 

The Washington Post: President Obama's Unbecoming Appearance
The president, a.k.a. the leader of the free world, appeared on the show allegedly to pitch health care to the demographic worshiped by producers and presidents alike — Young People. This is because young people rule and, specifically, they rule over the success or failure of the Affordable Care Act. If the young and healthy don't buy insurance to help cover the sick and elderly, the plan could collapse. ... What better time for the president to kick back and be a comic foil in service to the greater good of universal health care? Health care is important, of course, but, I repeat, he’s the leader of the free world, parts of which are under siege (Kathleen Parker, 3/11). 

USA Today: Contraception Mandate Doublecross
As a member of Congress, I was proud to vote for the Affordable Care Act, providing 32 million Americans with access to quality, affordable health care. I was eager to see many of the reforms in the act, including its provision to lower health care costs for women by increasing access to affordable preventive care. Today, as a private citizen, I'm proud to stand with the Green and Hahn families and their corporations, Hobby Lobby and Conestoga Wood, in seeking to uphold our most cherished beliefs that we, as American citizens, should not be required to relinquish our conscience and moral convictions in order to implement the Affordable Care Act (Bart Stupak, 3/11). 

Los Angeles Times: High Deductibles And Obamacare Derangement Syndrome
We've remarked before on the tendency of businesses and others to use the Affordable Care Act as a scapegoat for changes in their healthcare benefits or in the healthcare landscape that have other causes -- such as their own greed or long-term trends. Galen Benshoof, a guest contributor at theincidentaleconomist.com, identifies a good case of what we might call Obamacare derangement syndrome -- the conviction that everything that happens in healthcare today must have been caused by the ACA (Michael Hiltzik, 3/11). 

The Fiscal Times: HealthCare.gov Application Sets Off Privacy Alarm Bells
I am now among the more than 4 million who've accessed HealthCare.gov to review and select policies. The experience was disconcerting. Although I know a bit more about insurance than most Americans — I've been writing about it for more than quarter century — the process still raised some palpable privacy concerns. Actually picking a policy is also daunting; the government isn't providing enough help online to make it any easier (John F. Wasik, 3/12). 

The Washington Post: McAuliffe's Defining Moment
Terry McAuliffe may face his defining political moment earlier than any Virginia governor in the modern two-party era. He confronts a General Assembly deadlocked on the budget, solely due to disagreement on McAuliffe's position regarding Medicaid expansion. The new governor favors the "full monty," demanding that Virginia add 400,000 needy residents to the traditional Medicaid rolls. Virginia Republicans, led by the GOP's huge House of Delegates majority, oppose any such expansion as unaffordable and threatening to the state’s AAA bond rating. New governors usually get more time before having to pass such a legacy-making test (Norman Leahy and Paul Goldman, 3/11). 

Kansas City Star: The Cost Of Kansas' Medicaid Expansion
There’s no such thing as "free money," right? Those who support Obamacare's expansion of Medicaid in Kansas think there is. According to them, expanding the low-income health care program will give Kansans the coverage they need at no cost to our state. It's the best of both worlds — and it's too good to be true. If Kansas expands Medicaid under Obamacare, we’ll actually find that what we were promised can’t be delivered, and both Medicaid recipients and the middle class will pay the price (Steve Anderson, 3/11).

Kansas City Star: Thanks To Obamacare, There Are Many Ways To Get Health Coverage
People may choose to go uninsured and pay a relatively small fine imposed by the IRS, and accept that remaining uninsured is risky. There are some exemptions to paying that fine, but there are no exemptions for what is owed for medical bills. If you or an immediate family member becomes ill or is injured, you are responsible for paying for all the necessary medical care. Non-payment of medical bills is the most common reason for declaration of bankruptcy. You may decide that Obamacare is socialized medicine, and that a requirement to be insured violates your freedom of choice. But in fact, Obamacare uses private insurance companies, free markets, and freedom of choice to provide coverage (Steve Luptak, 3/11).

Salt Lake Tribune: Flexible, Utah-Specific Solution Best For Medicaid
Our community will be healthier and financially stronger as we utilize available federal dollars to provide access to health coverage for the poorest among us. This is both the right thing for our citizens most in need and the right thing for our economy. We should pursue all available federal dollars to develop a flexible solution that strengthens a competitive, private insurance market, promotes individual accountability by those receiving assistance, and prevents the state from being left on the hook for providing additional ongoing benefits if the federal government becomes unable or unwilling to hold up its end of the bargain(Marc Bennett and Andrew Croshaw, 3/11).

Bangor Daily News: More Dependency Or Opportunity: What's At Stake In Maine's Medicaid Expansion Debate
After all Maine's budget and economy have been through at the hands of Medicaid over the years, it is shocking that Democratic politicians would propose a new, record expansion of the state's medical welfare program under Obamacare. Their proposal comes just months after finally paying off our state’s massive debt to its hospitals — debt racked up by the very program they want to expand. It comes just as we're trying to patch an $80 million hole in the state budget caused by — you guessed it — the very program they want to expand (Speaker of the Maine House Kenneth Fredette, 3/11).

Norfolk Virginian-Pilot: For The Love Of God, Leave The Almighty Out Of Medicaid Debate
Yet in Tuesday's letters to the editor, one reader objected to a column I wrote on the failure of the General Assembly to complete its business on time. This person echoed what some liberals - oops, progressives - have been saying about the expansion of Medicaid. "It's the Christian thing to do." Good Lord. Why is it that some of the same folks who become apoplectic when conservatives invoke Christianity to argue against abortions and gay marriage use similar language when they want to justify bloated government programs? (Kerry Dougherty, 3/11).

Digital First Media: How Surprising Are The Obamacare Studies? 
Whatever else it does, the 2010 health care law has been a boon for researchers. Wall Street analysts, college professors and think tank staffers have all taken a crack at understanding how Obamacare is affecting American health care (Teague Beckwith, 3/11).

On other health care issues -

The Wall Street Journal: How Attention-Deficit Disorder Went Global
In March 2013 the federal Centers for Disease Control and Prevention released data showing that 11% of school-age children in the U.S.—an astonishing 6.4 million kids—had received a medical diagnosis of attention-deficit hyperactivity disorder, a 41% increase in the past decade. Over two-thirds of kids with an ADHD diagnosis receive prescriptions for stimulants like Adderall or Ritalin. The data sparked a much-needed debate about whether American children were being overdiagnosed and overmedicated for ADHD (Stephen P. Hinshaw and Richard M. Scheffler, 3/11). 

WBUR: Storytelling For Health: Doctor Promotes Intimate Patient Narratives
My experience in the health care system — both as a physician and as a patient living with multiple sclerosis — has convinced me that the current practice of medicine squeezes out what is a most essential element of healing: the stories of peoples' lives. In response to this void, I started collecting patient's stories in 2010, and these pieces have been featured here on CommonHealth, as part of the Listening to Patients series. Through these deep connections, I've seen firsthand that there is tremendous healing power in stories — for both the storyteller and for those listening (Dr. Annie Brewster, 3/11).

WBUR: Project Louise: Sometimes It’s Just Plain Hard
You know what? This is really hard. ... Even with great support, even with a trainer at the ready and a terrific strategy coach and friends cheering me on, even with wonderful guidance on changing my eating habits and practicing new exercise routines and being kinder to myself – even with all that, I am just not changing as fast as I want to. Or, more to the point, as consistently. Yeah, I’m eating better. Most of the time. But I am really, really not getting to the gym. And I can’t quite figure out why (Louise Kennedy, 3/11).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Lisa Gillespie
Marissa Evans

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.