Daily Health Policy Report

Thursday, March 13, 2014

Last updated: Thu, Mar 13

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Health Reform

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

What Went Wrong With Minnesota’s Insurance Exchange

MPR News’ Elizabeth Stawicki and Catherine Richert, working in partnership with Kaiser Health News and NPR, report: "Behind MNsure's upbeat façade was a swamp of management failures and technical glitches that crippled the more-than $100 million website. MNsure leaders blamed tight deadlines and evolving federal requirements for the website's malfunctions. However, internal MNsure documents and interviews with insurance company officials, county workers and other stakeholders reveal a more complicated story" (Stawicki and Richert, 3/12). Read the story.

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Capsules: Ryan Quizzes Sebelius On Savings Estimate From IPAB; Injured Who Lived Near Closed Trauma Centers More Likely To Die; Employers See Negligible Increase In Workers Participating In Job-Based Coverage

Now on Kaiser Health News’ blog, Mary Agnes Carey reports on a Capitol Hill appearance by Health and Human Services Secretary Kathleen Sebelius: "On Wednesday, Rep. Paul Ryan, R-Wis., asked Department of Health and Human Services Secretary Kathleen Sebelius how the agency determined that IPAB savings would be $12.9 billion over the next decade and why it was so much higher than the fiscal 2014 budget estimate, which was $4 billion. ‘The question is, where does it come from?’ Ryan asked'" (Carey, 3/13). 

In addition, Roni Caryn Rabin reports on a new California study of trauma centers: "Injured patients who had to travel an average 13 minutes longer to reach a hospital trauma center because a facility nearer to home had closed were more likely to die of their injuries in the hospital, according to a new California study" (Rabin, 3/13). 

Also on Capsules, Julie Appleby reports on a new survey of employers regarding workers and job-based coverage: "Employers saw only a tiny increase in enrollment in their health insurance plans this year, even as key provisions of the health law — including a requirement that nearly all Americans carry coverage or face a fine — went into effect, a survey by benefit firm Mercer finds" (Appleby, 3/12). Check out what else is on the blog.

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Political Cartoon: 'The Hangover, Part Four?'

Kaiser Health News provides a fresh take on health policy developments with "The Hangover, Part Four?" by Steve Kelley.

And here's today's health policy haiku:

IMPROVEMENTS OR ILLEGAL CHANGES?

ACA delays!
Legal fixes? Better law?
Thou protest too much.
-Team Haiku, Altarum

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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Capitol Hill Watch

Sebelius: No More Health Law Delays; No Enrollment Extension

Health and Human Services Secretary Kathleen Sebelius testified Wednesday before the House Ways and Means Committee, taking questions on a range of health law questions.

The New York Times: Health Mandate Won’t Be Delayed, Sebelius Says
Kathleen Sebelius, the secretary of health and human services, said Wednesday that the Obama administration would not extend the deadline for people to sign up for health insurance or delay the requirement for most Americans to have coverage. And she declined to say whether the administration was still committed to its original goal of enrolling seven million people in private coverage through federal and state exchanges by March 31 (Pear, 3/12).

The Wall Street Journal: Health Insurance Rates Likely To Rise In 2015
Health and Human Services Secretary Kathleen Sebelius said health-insurance premiums are "likely to go up" in 2015, an acknowledgment that the Obama administration doesn't believe the sweeping changes to the health-insurance marketplace will end premium increases in the near term. Testifying Wednesday before the House Committee on Ways and Means about the White House's 2015 budget proposal, Mrs. Sebelius was peppered with questions about the impact of the Affordable Care Act, including one from Rep. Erik Paulsen (R., Minn.) about its effect on insurance rates (Corbett Dooren and Radnofsky, 3/12).

Politico: Kathleen Sebelius: No More Obamacare Delays
HHS Secretary Kathleen Sebelius said Wednesday that there would be no delay of Obamacare’s individual mandate, the penalty for violating it or the March 31 closing date of the enrollment period, the strongest statement yet that the administration has no plans for more major changes to the law in the final weeks of the first sign-up period. Asked by Rep. Kevin Brady (R-Texas) at a House hearing whether the administration would change its policy for enforcing the individual mandate after all the other delays, extensions and adjustments it has made to different provisions in the law, Sebelius bluntly replied, “No, sir” (Norman, 3/12).

Kaiser Health News: Capsules: Ryan Quizzes Sebelius On Savings Estimate From IPAB
On Wednesday, Rep. Paul Ryan, R-Wis., asked Department of Health and Human Services Secretary Kathleen Sebelius how the agency determined that IPAB savings would be $12.9 billion over the next decade and why it was so much higher than the fiscal 2014 budget estimate, which was $4 billion. "The question is, where does it come from?’ Ryan asked" (Carey, 3/13). 

Reuters: Sebelius Says No Obamacare Mandate Delay, Enrollment Extension 
There will be no delay in the penalty most Americans face under President Barack Obama's healthcare reform law if they fail to obtain health coverage this year, U.S. Health and Human Services Secretary Kathleen Sebelius said on Wednesday. Sebelius also said there would be no postponement of this month's deadline for enrolling in coverage through new private health insurance marketplaces or the Medicaid program for the poor (Morgan, 3/12).

CBS News: Kathleen Sebelius Redefines Success For Obamacare
Last year, embracing nonpartisan estimates for the Affordable Care Act, Health and Human Services Secretary Kathleen Sebelius set a benchmark for the new insurance marketplaces: "Success looks like at least 7 million people having signed up by the end of March 2014," she said to NBC. Enrollment, however, began at a snail's pace in October because of all the technical problems with HealthCare.gov, the federal Obamacare website serving 36 states. Some state-run Obamacare websites have had their own problems as well. Within that context, Sebelius on Wednesday redefined what success looks like: "Success looks like millions of people with affordable health coverage, which we will have by the end of March," she told the House Ways and Means Committee (Condon, 3/12).

The Fiscal Times: Republicans Grill Sebelius on Unanswered Obamacare Questions
Republicans slammed Health and Human Services Secretary Kathleen Sebelius on Wednesday for not providing answers to a lingering question most crucial to understanding how the Affordable Care Act is working so far. How many people are actually getting coverage through Obamacare? The administration released the latest enrollment figures on Tuesday—revealing that some 4.2 million Americans have signed up for coverage on the new exchanges. However, that figure does not include how many people have actually paid for their plans—a metric that could make the actual number of enrollees significantly lower (Ehley, 3/12).

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Voter Turnout, Not Obamacare Support, Doomed Florida Congressional Election, Democrats Say

Democrats are disputing the notion that their support of the health law will play a big role in November's elections. But the GOP isn't backing off on using the issue as a key point in trying to win races.

The Associated Press: Analysis: Dispute On Obamacare Role In House Race
Republicans have a new calling card for the midterm elections, same as the old one. It’s Obamacare all the way to Nov. 4 after the party's triumph Tuesday in the race for a House seat in Florida. Soon it will be time for rank-and-file Democrats in both houses of Congress to decide how closely to stick to the controversial health care program as their own races develop (Espo, 3/13).

Politico: Florida Loss Exposes Democrats' Disarray On Obamacare
Democrats can’t even agree whether Obamacare was the reason for their crushing loss in a Florida special election Tuesday. Now picture how their messaging plan for the health care law is shaping up for 2014. Republican lobbyist David Jolly’s victory over Democrat Alex Sink has many Democrats privately worried and publicly split about how to talk about Obamacare. A few Democrats are advocating a drastic rhetorical shift to the left, by criticizing their own party for not going far enough when it passed the law in 2010. Other Democrats plan to sharply criticize the Affordable Care Act when running for re-election. Many plan to stick to the simple message that Obamacare is flawed and needs to be fixed — a tactic that plainly didn’t work for Sink (Sherman and Everett, 3/13).

Los Angeles Times: Low Turnout, Not Obamacare, Poses Chief Threat, Democrats Say
Following their loss in Tuesday's special congressional election in Florida, Democratic strategists increasingly are willing to say publicly that the party faces a problem in this year's midterm election -- but it's not necessarily the one you'd think of. Not Obamacare, Democrats argue. Republicans may point to the president's health care law as the centerpiece of their election strategy, the subject which the vast majority of their television ads in the Florida race talked about, but Democrats deny that's the key (Lauter, 3/12).

The Washington Post: Democrats Pinning Fla. Special Election Loss On Dismal Turnout Effort
Democrats spent Wednesday trying to explain away a disappointing loss in a Florida special congressional election that they had been expected to win. "The takeaway from the special in Florida is that Democrats will need to invest heavily in a national field program in order to win in November. Nearly 50,000 fewer people voted in the special than in the 2010 general election, a 21% drop off," officials at the Democratic Senatorial Campaign Committee (DSCC) wrote in their daily morning memo (Kane and Sullivan, 3/12).

ABC News: White House Press Secretary: Obamacare Not A Factor In Florida Loss
Democrats may have lost the first congressional election of 2014, but the White House insists the Democratic loss has nothing to do with Obamacare. "Any fair assessment of the role that the debate about the Affordable Care Act played reaches the conclusion that at best for the Republicans, it was a draw," said White House Press Secretary Jay Carney of the special election to replace Rep. Bill Young, R-Fla., who died last year. So why did the better-known, better-funded Democratic candidate, Alex Sink, lose to an unimpressive Republican candidate who constantly hammered her over her support for the President's Affordable Care Act? (Karl, 3/12).

McClatchy: After Fla. Victory, GOP Will Continue To Bash Health Care Law
Republicans were rejoicing Wednesday over their surprising Florida congressional victory the night before, a triumph that they said proved that opposition to the health care law would be a powerful political weapon this year. Their success was unsettling news for Democrats, who've been on the defensive for months over the glitches, breakdowns and tweaks to the new health care system they've proudly championed. Most Republicans never liked the 2010 law, and their relentless efforts to repeal and replace it became so persistent that Democrats took to mocking them (Lightman, 3/12).

Bloomberg: Americans Stick With Obamacare As Opposition Burns Bright 
President Barack Obama's health-care law is becoming more entrenched, with 64 percent of Americans now supporting it outright or backing small changes. Even so, the fervor of the opposition shows no sign of abating, posing a challenge for Obama's Democrats during congressional races this year, as a Republican victory in a special Florida election this week showed (Dorning, 3/12).

The Fiscal Times: Why Dems Are More Worried Than Ever About November
These are tough times for President Obama and the Democrats. Republican David Jolly, a former Washington lobbyist, won a closely watched House special election in Florida on Tuesday after relentlessly hammering away at Obamacare – a win that's a bad omen for other Democratic candidates across the country. Add to that an NBC News-Wall Street Journal poll just out showing Obama's approval rating at an all-time low of 41 percent, suggesting Democrats may be facing strong political headwinds less than eight months before the November midterm elections (Pianin, 3/12).

Politico: $700K Ad Buy Hits Mark Pryor On Obamacare
Americans for Prosperity is launching a major ad buy hitting Sen. Mark Pryor (D-Ark.) on Thursday, pushing the group's advertising investments in the race to more than $1.4 million so far this year. Pryor, who is facing off with Rep. Tom Cotton (R-Ark.) in one of the most hotly contested races of the year, was the subject of a six-figure negative ad buy last month from the outside conservative group. The second batch of ads, shared first with Politico, totals about $700,000 and links Pryor to cancelled insurance plans tied to Obamacare (Glueck, 3/13).

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House Republicans Plan: Delay Individual Mandate For Five Years

The idea is to use the savings to reverse the annual SGR cut for Medicare doctors. Also, a group of Catholic employers in Oklahoma is suing about the health law's contraception coverage exception.

Reuters: GOP Takes Aim At Obamacare To Fund Medicare 
U.S. House Republicans said on Wednesday that they are pushing a plan to delay for five years the penalties for failing to buy health insurance under Obamacare, and to use the savings to spare doctors from a steep cut in Medicare payments. Delaying until 2019 the financial penalty for not signing up for health insurance would slow down Obamacare signups and save the government billions of dollars that would otherwise be paid out in taxpayer subsidies to enrollees, the Republicans say (Cornwell, 3/12).

The Associated Press: House Backs Bill To Sue President Over Laws
The vote was 233-181 in the Republican-led House as GOP lawmakers excoriated Obama for multiple changes to his 4-year-old health care law, steps he’s taken to allow young immigrants to remain in the United States and the administration’s resistance to defend the federal law banning gay marriage (Cassata, 3/12).

In other news -

The Associated Press: Catholic Groups Mounts Challenge To Health Care Law
A group of nearly 200 Catholic employers filed a new lawsuit in Oklahoma against the federal government Wednesday, hoping to stop parts of the federal health care law that force them to provide insurance that covers contraceptives. The recently formed Catholic Benefits Association, ... takes issue with a compromise in the Affordable Health Care Act offered by the Obama administration that attempted to create a buffer for religiously affiliated hospitals, universities and social service groups that oppose birth control. The law requires insurers or the health plan’s outside administrator to pay for birth control coverage and creates a way to reimburse them (McBride, 3/12).

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Health Reform

Insurers Plan 2015 Prices While Facing Many Unknowns

Health insurers are deciding whether to return to the same exchanges in 2015 and how much to charge for their policies, but many unknowns make that difficult. Among them is how many people will ultimately pay their first premiums to complete sign-ups -- so far, about 15 to 20 percent of enrollees have yet to do so, reports Politico. Four of five employers, meanwhile, report raising deductibles or considering doing so this year, according to a Mercer survey.

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, 3/12).

Politico: So How Many Have Paid ACA Premiums? 
The White House insists it doesn’t know how many people are fully enrolled in Obamacare, but insurers say they’ve handed over enough data to show that the sign-up numbers are not as rosy as federal officials say. The latest administration figures show that 4.2 million people have selected health plans in the new insurance markets. Insurance industry officials at four of the big national health plans tell POLITICO that about 15 to 20 percent of people who have signed up have not yet paid their first monthly premium — the final step to get coverage (Cheney, 3/13).

Kaiser Health News: Capsules: Employers See Negligible Increase In Workers Participating In Job-Based Coverage
Employers saw only a tiny increase in enrollment in their health insurance plans this year, even as key provisions of the health law — including a requirement that nearly all Americans carry coverage or face a fine — went into effect, a survey by benefit firm Mercer finds (Appleby, 3/12).

Bloomberg: Employers Raise U.S. Worker Deductibles To Cut Health Costs 
Four of five U.S. companies have raised deductibles or are considering doing so as health costs increase, according to a survey of more than 700 employers. About one-third of the companies have already increased deductibles or other cost-sharing provisions like copays, and 48 percent are considering similar moves, the survey by New York-based consulting firmMercer LLC found (Chen, 3/12).

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Officials Look For Budget Fixes For Minnesota's Insurance Exchange

In Minnesota, a proposed budget indicates that some officials want to spend $12.5 million to continue repairing the marketplace website and call center as well as spend $5 million in grants next year when the exchange is supposed to be self-sufficient.

Kaiser Health News: What Went Wrong With Minnesota’s Insurance Exchange
Behind MNsure's upbeat façade was a swamp of management failures and technical glitches that crippled the more-than $100 million website. MNsure leaders blamed tight deadlines and evolving federal requirements for the website's malfunctions. However, internal MNsure documents and interviews with insurance company officials, county workers and other stakeholders reveal a more complicated story (Stawicki and Richert, 3/12).

Pioneer Press: MNsure Tapping Grants To Fix Customer Services, Balance 2015 Budget 
MNsure wants to spend an additional $12.5 million this year to continue repairs to its website and call center, officials said Wednesday as they unveiled plans for a balanced budget in 2015. Meeting in St. Paul, the health insurance exchange's board approved a $39.8 million budget for next year that will be balanced if the federal government lets MNsure change the timing for when it can spend $5 million in grants (Snowbeck, 3/12).

Minnesota Public Radio: MNsure Faces $5M Shortfall Next Year
Preliminary budget projections for MNsure, the state's online insurance website, show a $5 million shortfall for next year. But officials say they won't need additional state funding because of left over federal funding. MNsure leaders estimate MNsure will have about $40 million in expenses but take in about $35 million in revenue next year. Although MNsure has $5 million in hand from federal grants, the federal government has limited states to using that money to create their insurance marketplaces in 2014 (Stawicki, 3/12).

The Star Tribune: MNsure Outlines Plans To Keep Its Budget In Balance
MNsure officials laid out figures Wednesday under which the exchange would put $10 million into fixing its website this year and the organization would become self-sufficient in 2015, as required by federal law. Next year’s $39.7 million budget does not seek additional funding from the Legislature, but it relies on getting federal approval to carry over $5 million in grants to fill a shortfall created by lower-than-expected enrollment in private health plans. MNsure leaders say they feel confident that federal officials will allow the state added flexibility to hold on to the last slice of a package of two-year grants totaling $155 million. Those funds were originally earmarked to build the MNsure system and to staff and operate the agency in its first year (Crosby, 3/13).

Elsewhere, exchanges make news in Washington state, Maryland and New Jersey --

The Seattle Times: Washington Insurance Sales Beat Most Other States
Nearly 800,000 people have used Washington’s insurance exchange to purchase health insurance or enroll in Medicaid. More than 109,000 residents have bought coverage through Healthplanfinder, while nearly 223,000 adults who now qualify for Medicaid under the recent expansion signed up for free medical care (Stiffler, 3/12).

The Baltimore Sun: Finger-Pointing Continues On Maryland's Health Exchange 
Weeks after officials at the state's health care exchange began blaming IBM software for the worst problems, including lost applications, IBM began pushing back, saying the state shares some of the blame. It's the latest salvo in the blame game that has been going on since the exchange launched, and crashed, on Oct. 1 (Cohn, 3/12).

Newark Star-Ledger: Widespread Backlog Roils NJ Health Insurance Market
The implementation of the Affordable Care Act has clogged the system for nearly all types of health insurance in New Jersey, causing frustration and delays for consumers, agents and policyholders say. Lingering backlogs have left thousands in limbo, unsure of whether they’re covered and unable to reach anyone to find out. Some people who completed applications late last year — before the deadline for coverage to begin on Jan. 1 — are still waiting for insurance cards. And so are those who have signed up for N.J. FamilyCare, the state’s newly expanded Medicaid program, and private policyholders (O'Brien, 3/13).

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Va. Officials Using Two-Week Respite To Bolster Arguments On Medicaid Expansion

The state's legislature adjourned without a budget because of arguments over growing the program for low income residents, and lawmakers will come back to try again March 24. Meanwhile, state efforts on similar questions also make news in Maryland, Georgia and Maine.

The Washington Post: Virginia’s Fight Over Medicaid Expansion Shifts From Capitol To Cities, Towns, Rural Enclaves
Legislators left dug-in Richmond on Saturday after an impasse on Medicaid expansion prevented the passage of a state budget. They return March 24 to try again in a special session. That gives them two weeks to beat the drum for or against Medicaid expansion and to line up support from mayors, business leaders and ordinary Virginians (Vozzella, 3/12).

The Associated Press: Republicans Confident On Va. Medicaid Fight
Virginia House Republican leaders said Wednesday the momentum is in their favor in the battle with Gov. Terry McAuliffe and Democratic lawmakers over whether to expand Medicaid eligibility. House Majority Leader Kirk Cox said growing public opinion agrees with the Republican position that lawmakers should pass a budget before debating Medicaid (3/12).

The Washington Post: Mizeur: Maryland Is Not Doing Enough To Boost Medicaid Enrollment
Amid all of the shortcomings and embarrassments of the Maryland health insurance exchange, Gov. Martin O'Malley (D) and other leaders have pointed to one bright spot: The number of people signing up for Medicaid has exceeded their expectations. But Del. Heather R. Mizeur (D-Montgomery), who is running for governor, says Maryland is still not doing enough to get as many low-income families and individuals as possible signed up for Medicaid. Given that the federal government is picking up the cost of these new enrollees for the next few years, she said that not maximizing enrollment will only continue to cost the state in uncompensated care. State health officials argue their own strategies are working just fine (Johnson, 3/12).

Georgia Health News: Medicaid Expansion Bill Gets New Twist
House Bill 990 started out the day as what its sponsor called a "straightforward, one-paragraph proposal" — requiring legislative approval of any expansion of the Georgia Medicaid program. But after a committee hearing Wednesday, the bill has acquired a lot of added material: It now has the original Senate-passed foster care reform legislation attached to it. Sen. Renee Unterman (R-Buford), with a committee substitute, added the foster care language to 990 in a surprise move that reflects the late-session tug-of-war between the state Senate and House over certain key legislation, including the gun-carry bill (Miller, 3/12).

Bangor Daily News/Sun Journal: Maine Senate Passes Medicaid Expansion Bill But Falls Short Of Veto-Proof Majority
After more than three hours of debate on a Republican compromise to a Democratic effort to expand Maine’s low-income health care program, known as MaineCare, the compromise passed 22-13 Wednesday in the state Senate. The measure failed to garner the 24 votes it would need to be considered safe from a Gov. Paul LePage veto (Thistle, 3/12).

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How Many Sign-Ups To Reach 6 Million Goal? 42 A Minute.

That's how fast signups would have to be happening for the health law to "pass its first physical," reports The Associated Press. Meanwhile, health consultant Avalere projects that 5.4 million are actually on track to sign up for coverage by March 31.

The Associated Press: Obama's Health Care Law Needs 42 Sign-Ups A Minute To Reach Goal 
If the Obama administration's health care plan is going to pass what amounts to its first physical, people have to sign up this month at a pretty speedy rate: 42 times a minute. That's somewhere between the steady rate you breathe and how fast your heart beats (Borenstein, 3/12).

McClatchy: Health Care Enrollment May Only Reach 5.4 Million
Only 5.4 million people are on track to purchase marketplace health coverage by the time open enrollment ends on March 31, according to a new analysis from Avalere Health. After the Congressional Budget Office predicted 7 million Americans would sign up for coverage, they downsized their estimate to 6 million when technical problems with the HealthCare.gov website slowed enrollment in October and November. And even though the website has been functioning well since December, those early problems have cast a large shadow over enrollments ever since (Pugh, 3/12).

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Final Days Of Health Law's Open Enrollment Marked By Stepped Up Outreach Efforts

News outlets detail the various strategies that are being employed to encourage more people to sign-up for coverage. Insurers are paying for ads and supporting the work of grassroots organizations. Meanwhile, students are volunteering and navigators are staying busy.  

The New York Times: In Alabama, College Students Take On Challenge Of Health Insurance Sign-Up
Students at the University of Alabama Honors College here are encouraged to do volunteer work in the community and on campus. For Marlan Golden, a senior, that has included being a Big Brother; running an education project for local Latinos; serving as president of the Alpha Tau Omega fraternity; and, most recently, signing up people for health insurance under the Affordable Care Act (Winerip, 3/12).

St. Louis Post-Dispatch: Navigators Reach Individuals Through Businesses
A health insurance application counselor stood in the center of a downtown barbershop. “I’ll repeat myself,” announced Gloria Bailey, an outreach worker for Grace Hill Health Centers. “If anyone in here is uninsured...” (Kulash, 3/13). 

Marketplace: The Final Push For Affordable Care Act Signups
If you haven't signed up for health insurance by March 31, you'll likely face a penalty. The thing is, a lot of the uninsured don’t seem to know that the deadline is March 31.  Kantar Media says  insurance companies are now devoting almost half of all their ad spending to commercials with a health reform theme.  Insurers are also giving financial support to some grassroots groups, like Enroll America (Marshall-Genzer, 3/12).

In related news --

The Washington Post’s Wonkblog: HHS Will Push Back Against State Restrictions On Obamacare Ground Troops
After a number of states have passed laws limiting the reach of Obamacare “navigators,” the Obama administration is getting ready to push back. HHS has signaled it will soon take on restrictions that states have placed on the federally funded program meant to educate consumers about health insurance. There are different designations of Obamacare-related in-person help: navigators, in-person assisters and certified application counselors. Each designation has varying responsibilities, but the general idea is that they’re supposed to help people understand their insurance options under the health care law, though they can’t actually enroll anyone in coverage (Millman, 3/12).

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Consumers With Canceled Insurance Exempted From Individual Mandate Through 2016

Those who lost coverage because insurers canceled their plans have been given a hardship exemption through October 2016 from the requirement to have health insurance or pay a fine. Other stories look at rising medical identity theft and the frustration of a cancer survivor who enrolled in a plan based on misinformation that her doctor was included in its network.

Fox News: Obamacare Band-Aid? Millions Potentially Exempted From Individual Mandate Through 2016
The Obama administration is throwing another Band-Aid at the millions of people wounded by the Affordable Care Act when they were booted from their existing health coverage. The latest change, quietly announced last week, allows many of them to skirt the law's "individual mandate" through 2016. The change was included in last week's announcement that the government would let people keep otherwise out-of-compliance health plans for another two years. Buried in the official memo was a line giving people whose policies were canceled a "hardship exemption" through October 2016 (3/12).

NBC News: U.S. Health Care System Has $5.6 Billion Security Problem
Health care organizations are under attack. Criminals are stealing patient records to commit medical identity theft. And the Affordable Care Act (ACA) has made the situation worse, according to a new report from privacy and information security research firm Ponemon Institute. Ponemon estimates that these breaches cost the industry about $5.6 billion a year (Weisbaum, 3/12).

Fox News: New York Cancer Survivor Stuck In Obamacare Mess Over Doctor Confusion
Months after cancer survivor Annette Frey was dropped by her insurance provider and forced to sign up for Obamacare, the New Yorker is still finding herself on the losing end of a bureaucratic runaround. At the heart of her maze of problems is the fact that the plan she signed up for on the New York exchange listed doctors she needed as "in network" -- she later found out they were not. Frey tells FoxNews.com she’s at her wit’s end trying to decode what she needs to do to be able to see the doctor who diagnosed her lung cancer two years ago (Chakraborty, 3/12).

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State Watch

Gov. Jan Brewer, Arizona's Medicaid Expander, Won't Run Again

The Republican governor pushed the state legislature to expand Medicaid coverage to most poor people in the state.

The Associated Press/ABC News: Arizona Gov. Jan Brewer Won’t Seek Third Term
She signed the immigration crackdown law known as Senate Bill 1070 in 2010 and sparred with the Obama administration over health care, joining states that sued to overturn his health care law. But she then surprised last year when she embraced a signature part of that law, the expansion of Medicaid (Christie and Galvan, 3/12).

The Wall Street Journal: Arizona Gov. Brewer Will Not Seek Third Term
Ms. Brewer's backers also note she battled her own party at times—pushing for a one-cent sales-tax increase against the wishes of Republicans, and expanding the state's Medicaid rolls. But Ms. Brewer also cut state medical coverage for patients in need of lifesaving organ transplants. Ms. Brewer "will be remembered for making the tough decisions," said her former spokesman, Matthew Benson (Lazo and Audi, 3/12).

Los Angeles Times: Arizona Gov. Jan Brewer Declines To Seek Reelection
Brewer was never a knee-jerk conservative. She angered many in her party by proposing an expansion … under the president's healthcare program — a move made by few Republican governors but driven, in Brewer's case, by a desire to restore cuts to medical and mental health programs in the state (Decker and Carcamo, 3/12).

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State Highlights: Vt. Health Care Costs Plan; Iowa Inmate Coverage; Mich. Abortion Law Takes Effect

A selection of health policy stories from Vermont, Iowa, Michigan, California, Florida, Wisconsin and North Carolina.

The Associated Press: Vermont Has New Plan To Slow Health Care Costs
More than 2,500 health care providers that serve Vermonters could be working together to help control costs by focusing on keeping people healthy rather than being paid to treat patients when they are sick, Gov. Peter Shumlin and other top officials said Wednesday. The two new "shared savings programs" offered through health insurance plans offered by Vermont Health Connect and the state's Medicaid program are designed to move away from the traditional fee-for-service model of health care to encourage providers to work together, keep people healthier and as a result reduce the growth of health care costs (Ring, 3/12).

Des Moines Register: Iowa Plans To Grant Health Insurance To Inmates As They Leave Prison
Iowa inmates should soon have health-insurance cards when they leave prison. Officials from the state corrections and human-services departments are setting up a method to enroll inmates in a public health-insurance program shortly before they’re released (Leys, 3/12).

MLive: New Michigan Laws Governing Abortion Insurance, Medicaid And BYOB Wine Take Effect This Week
Beginning Friday, insurance companies can no longer include abortion as a standard feature in health plans sold in Michigan. The new law, initiated through a petition drive by Right to Life, allows insurers to sell a policy "rider" to cover abortion. Seven insurers plan to sell the add-on coverage alongside small- and large-group employer plans, but no companies plan to offer a rider for individual policies. While the law takes effect this week, it will not affect current policies. The real change will be felt when women seek to renew their plans or complete an open enrollment period with their employer (Oosting, 3/13).

Los Angeles Times: Health Clinic Operator To Raise Workers’ Pay To $15 An Hour
A nonprofit that operates 10 health centers downtown, in South Los Angeles and in Compton will increase its employees' pay to a minimum of $15 an hour in what it deemed an anti-poverty measure intended to jump-start "living wage" efforts around the region. The wage hike by St. John's Well Child and Family Center, to be announced Thursday, will increase the pay of 137 workers, many of whom now make $11 to $12 an hour (Rainey, 3/12).

Kaiser Health News: Capsules: Injured Who Lived Near Closed Trauma Centers More Likely To Die
Injured patients who had to travel an average 13 minutes longer to reach a hospital trauma center because a facility nearer to home had closed were more likely to die of their injuries in the hospital, according to a new California study (Rabin, 3/13). 

Miami Herald: Proposal Would Limit Medicare Coverage For Some Florida Drug Testing 
Attorney General Pam Bondi is fighting a plan that would limit Medicare coverage for some drug testing in Florida and could allow accidental deadly drug combinations. The proposal, by the Jacksonville-based Medicare contractor First Coast Service Options, would restrict reimbursement for confirmatory tests, which are used to check the accuracy of drug screenings (McGrory, 3/12).

The Milwaukee Journal Sentinel: Brett Davis Is Leaving The Walker Administration As Medicaid Director
Brett Davis, a former state lawmaker who implemented key parts of Gov. Scott Walker's response to Obamacare, is leaving the administration to take a job in the private sector. Davis has been Walker's Medicaid director since he took office in 2011 but will leave his post on March 21, according to state Health Services Department spokeswoman Stephanie Smiley. A replacement has not yet been named (Marley, 3/12).

The Milwaukee Journal Sentinel: Scott Fitzgerald Uses Maneuver To Prevent Cancer Drug Vote
Senate Majority Leader Scott Fitzgerald employed an unusual gambit Wednesday to keep his house from passing -- at least for now -- a bill to help cancer patients afford chemotherapy drugs. The action by the Committee on Organization chaired by the Juneau Republican blocked supporters Wednesday from forcing a Senate vote on the bill, which would require insurance plans overseen by the state to provide coverage for expensive forms of chemotherapy drugs that patients take as pills rather than as infusions and injections. Fitzgerald blocked the vote by scheduling -- and then canceling -- the second committee hearing in the last month on a bill that already had its usual public hearing last year (Stein and Boulton, 3/13). 

WRAL: [North Carolina] Scrambling On Medicaid Rules
State Department of Health and Human Services officials are asking federal Medicaid officials for a waiver due to continuing issues with NC FAST, the state's new benefits management program. Under the Affordable Care Act, all states were required to recertify all Medicaid recipients and applicants under new income guidelines as of Jan. 1. North Carolina already received one three-month extension, making the state's new deadline April 1 (Leslie, 3/12).

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Weekend Reading

Longer Looks: The 'Making Of Obamacare;' Unlocking An Autistic Son's Secrets

Every week, KHN reporter Marissa Evans selects interesting reading from around the Web. 

The New York Times: The Fat Drug
If you walk into a farm-supply store today, you’re likely to find a bag of antibiotic powder that claims to boost the growth of poultry and livestock. That’s because decades of agricultural research has shown that antibiotics seem to flip a switch in young animals’ bodies, helping them pack on pounds. Manufacturers brag about the miraculous effects of feeding antibiotics to chicks and nursing calves. Dusty agricultural journals attest to the ways in which the drugs can act like a kind of superfood to produce cheap meat. But what if that meat is us? (Pagan Kennedy, 3/8).

The Wall Street Journal: Inside The Making of Obamacare
As a White House special adviser on health policy, I was party to many of the internal debates that shaped the Affordable Care Act. Looking back, I believe that three key issues were emblematic of the sometimes tortured interplay of policy and politics in crafting Obamacare—and of the inherent difficulty of fashioning complex legislation in today's Washington. To control costs and improve quality in health care, the White House economic team believed that we had to change the way physicians are paid. About 85% of payments to physicians are fees for individual services—which gives doctors incentives to order more tests and interventions. Fee-for-service puts volume above value; it rewards treating sickness rather than promoting health (Dr. Ezekiel J. Emanuel, 3/7).

The Atlantic: The Man Working to Cure His Own Cancer
In January 2006, when Josh Sommer was still an aspiring environmental engineering student at Duke University on winter break, he began experiencing debilitating headaches out of nowhere. Though he felt fine and was an otherwise healthy 18-year-old, an MRI would soon reveal he had a slow-growing tumor pressed against his brainstem and wrapped around several major arteries. ... Only after the surgery did his doctor make an official diagnosis: chordoma, a malignant form of bone cancer so rare it occurs in just one out of every one million people. ... By the time Sommer returned to school in the fall, he was determined to do whatever he could to try to change his prognosis. ... Government agencies tend to fund research that will have the biggest effect across the population, so common cancers—breast cancer, prostate cancer, and so on—usually receive the most funding (Aimee Swartz, 3/11).

The New Yorker: The Reckoning
Inadequate gun control and poor mental-health care are problems that invariably define the debate after atrocities such as the one at Newtown. But, important as those issues are, our impulse to grasp for reasons comes, arguably, from a more basic need—to make sense of what seems senseless. When the Connecticut state’s attorney issued a report, in December, CNN announced, “Sandy Hook killer Adam Lanza took motive to his grave.” ... Had we found out—which we did not—that Adam had schizophrenia, or had been a pedophile or a victim of childhood abuse, we still wouldn’t know why he acted as he did (Andrew Solomon, 3/11). 

The New York Times: Reaching My Autistic Son Through Disney
In our first year in Washington, our son disappeared. Just shy of his 3rd birthday, an engaged, chatty child, full of typical speech — "I love you," "Where are my Ninja Turtles?" "Let's get ice cream!" — fell silent. He cried, inconsolably. Didn't sleep. Wouldn't make eye contact. ... We ask our growing team of developmental specialists, doctors and therapists about it. We were never big fans of plopping our kids in front of Disney videos, but now the question seemed more urgent: Is this good for him? They shrug. Is he relaxed? Yes. Does it seem joyful? Definitely. Keep it limited, they say (Ron Suskind, 3/7).

Time Magazine: The 300 Workout: How Movies Fuel Boys' Insecurities
Young men—whether they were looking for their battlefield gore fix or a chance to geek out over the historical inaccuracies of a sex scene between Themistokles and Artemisia—lined up for the opening of 300: Rise of an Empire on Friday. And though some parents may forbid their teens from seeing the R-rated film because of the blood and violence, they should probably be more concerned about the Greeks’ sweaty, washboard abs. ... The average guy wants 15-27 more pounds of muscle and a three to four percent decrease in body fat. And a new study published in JAMA Pediatrics in January found that 18 percent of boys are very concerned about their weight and physique. Failure to attain these unrealistic body goals can lead to depression, high-risk behaviors (like drinking and drugs) and eating disorders (Eliana Dockterman, 3/11).

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Editorials and Opinions

Viewpoints: The Impact Of Florida's Special Election; Drug Testing For Doctors; The Toll From Alzheimer's

The Wall Street Journal: Riding The 2014 Wave
A rule of electoral politics is that when a Democratic wave is building, the media broadcast it like a foregone conclusion. When a Republican wave is building, Beltway pundits are the last to admit it. After Tuesday's GOP win in a Florida special House election, even the press corps now agrees that Republicans are poised for major gains in November, assuming the GOP has the wit to exploit it (3/12). 

The Wall Street Journal: GOP, Beware Of Tuesday's Victory
To Republicans, a word of caution over the special election in Florida's 13th congressional district: Don't uncork the champagne. David Jolly's victory on Tuesday over Democrat Alex Sink by 48.4%-46.6% is significant. President Obama won the district twice, and its changing political demographics make it Democratic-leaning—despite being held for 42 years by C.W. "Bill" Young, a popular Republican, until his death last fall. Still, special elections don't always dictate how midterms turn out (Karl Rove, 3/12). 

The Washington Post: Midterms An Obamacare Referendum? Not So Fast.
Democrats are likely to have a lousy midterm election — Republicans are forecast to pad their House majority by a few seats and to have a decent chance of taking control of the Senate — but this has nothing to do with what happened in Florida on Tuesday. An NBC News-Wall Street Journal survey this week found Obama’s job approval rating at a record low and an unusually high percentage of voters eager to register that dissatisfaction at the polls. But the causes of the party’s difficulties this year are larger than any issue, candidate or president, and those who are casting November’s vote as the Great Obamacare Referendum are almost certainly overdoing it (Dana Milbank, 3/12). 

Los Angeles Times: Obamacare And Rising Deductibles: A Dialogue
David Goldhill, whose Wall Street Journal review of Ezekiel Emanuel's book on healthcare policy was at the heart of our post this week on Obamacare's effect on rising deductibles, takes issue with my interpretation of the trends and how the Affordable Care Act will influence them in the future. Goldhill, who is president and CEO of the Game Show Network, is a serious student of the healthcare landscape. His 2013 book "Catastrophic Care: How American Health Care Killed My Father -- and How We Can Fix It" is a sober and worthwhile examination of the American healthcare system, as seen through the prism of one family's experience (Michael Hiltzik, 3/12). 

Los Angeles Times: Watch An Expert Teach A Smug U.S. Senator About Canadian Healthcare
A U.S. politician's I-don't-need-no-stinkin'-facts approach to health policy ran smack into some of those troublesome facts Tuesday at a Senate hearing on single-payer healthcare, as it's practiced in Canada and several other countries. The countries in question have successful and popular government-sponsored single-payer systems, provide universal coverage and match or outdo the United States on numerous measures of medical outcomes -- for far less money than the U.S. spends. ... By far the high point of the morning was an exchange between Sen. Richard Burr (R-N.C.) and Danielle Martin, a physician and health policy professor from Toronto. ... Martin bats down the myths and misunderstandings about the Canadian system that Burr throws at her (Michael Hiltzik, 3/12).

The Washington Post: Better Health Through Good Choices
A significant portion of America’s health-care bill — caused by violence, vehicular accidents, coronary artery disease, lung cancer, AIDS, Type 2 diabetes brought on by obesity, among other problems — results from behavior widely known to be risky. So as we wallow waist deep in the muddy debate about health care, we should remember that the relationship between increased investment in medicine and improvements in health is complex and tenuous (George F. Will, 3/12). 

The Wall Street Journal: Sibelius Vs. Accuracy
There have been dozens of ObamaCare delays or major revisions via administrative fiat, including four so far this year, but there's one in particular that the Health and Human Services Department prefers to keep hidden: the individual mandate waivers that we exposed Wednesday. HHS Secretary Kathleen Sebelius also happened to testify Wednesday in front of the House Ways and Means Committee, and Tennessee Republican Diane Black asked about "ObamaCare's Secret Mandate Exemption" (March 12). Ms. Sebelius said she hadn't read the editorial but did call Ms. Black's gloss "not accurate"—before going on to confirm that it was, in fact, accurate (3/12). 

Fox News: ObamaCare: The Impossible Enforcement Of An Unworkable Law
Does "ObamaCare" truly exist? Are we actually living with the law that was passed with so much fanfare four years ago? I had to ask myself that question while reviewing the New York Times list of unilateral ObamaCare changes, a list that chronicles ObamaCare’s utter failure (Jay Sekulow, 3/12).

Fox News: Not Funny Or Die: Obama Gambles On Health Plan With Zach Galifianakis
I'm not one who is aghast when Barack Obama goes outside the traditional Beltway press and tries to connect through comedy. But there is a problem when the president does the web show "Funny or Die" with Zach Galifianakis. He wasn't funny. He died (Howard Kurtz, 3/12). 

The Tennessean: Time For Republicans To Explain Their Endgame On Medicaid
What is the end game on Medicaid expansion for Republicans? More importantly, what is the solution for those who will bear the consequences? Democrats have made the case for expanding Medicaid under the Affordable Care Act for two years now. We have pressed for full expansion, awaited a unique plan put forth by our governor, and recently presented a narrow expansion to avoid catastrophe. So far, Republicans have stood united in opposition to all three, but they have not had to explain their position (State Sen. Jim Kyle, 3/12).

Bangor Daily News: Maine's Medicaid Program Is In Perpetual Crisis. Don’t Let Expansion Make It Worse.
Every day, state agencies make difficult decisions to manage requests for services and programs amid limited resources. This prioritization is not done in a vacuum, and funding one part of state government affects available resources in other programs. Regardless of assertions by this or any other media outlet to the contrary, we know it’s true. We experience this reality with every state budget assembled in Augusta. Why, then, would anyone question whether the Medicaid expansion being debated in Augusta, which will require more than $800 million in state resources over 10 years — according to an Alexander Group report — will affect spending on other critical programs and services such as investments in job training, support for our children’s education, or improvements in our transportation infrastructure? (Maine Department of Health and Human Services Commissioner Mary Mayhew, 3/12).

On other health care issues -

The New York Times: Why Aren’t Doctors Drug Tested?
People go to hospitals to get well. We all know that medical care involves risks, but what patients don't expect is that the doctors, nurses and other staff members charged with their care may deliberately cause them harm. As an important recent case demonstrates, that's exactly what can happen without stronger controls (Daniel R. Levinson and Erika T. Broadhurst, 3/12). 

The New York Times: High Mortality From Alzheimer's Disease
A provocative new study has suggested that Alzheimer's disease causes six times as many deaths as the official statistics would indicate. The Centers for Disease Control and Prevention estimated that, in 2010, Alzheimer's caused almost 84,000 deaths in the United States, a number derived from death certificates in which Alzheimer's was listed as the main cause. But, in reality, the new study said Alzheimer's was the underlying cause in more than 500,000 deaths in 2010 that were often attributed to conditions, such as pneumonia, caused by complications of Alzheimer's. Those numbers would catapult Alzheimer's from the sixth-leading cause of death in the United States to the third, behind heart disease and cancer (3/12). 

The Washington Post: Relative-Value Health Insurance
On Monday, I posted about how new hepatitis C drugs priced as high as $1,000 per pill are a symptom of a fundamental problem with our health-care system. When most private insurance has relatively low deductibles and co-payments and covers all "medically necessary" treatments without regard to their cost (except for items that are specifically excluded by contract), patients have an incentive to demand all treatments with a positive expected benefit, no matter how small the benefit and how high the cost. As medical technology continues to improve and becomes more expensive, this "moral hazard" problem becomes more and more severe, and the price of health care spirals ever higher. The benefits might be worth the increased costs, but they might not be (Russell Korobkin, 3/12).

The New England Journal Of Medicine: The Checklist Conundrum
Assessing the outcomes of all surgical procedures performed in Ontario during 3-month periods before and after hospitals implemented a surgical safety checklist, they found no reduction in surgical mortality or complications, despite self-reported use of a checklist by 98% of hospitals. ... it is not the act of ticking off a checklist that reduces complications, but performance of the actions it calls for. ... Regulation works best when a practice of unquestioned value has become the norm. ... What should be mandated — and nationally funded — are large-scale state and system wide collaboratives to motivate, train, and support local efforts to implement checklists (Dr. Lucian L. Leape, 3/13).

JAMA: The Innovation Vs Consumer Protection Tug-Of-War In Health Policy
In the overheated political environment surrounding the Affordable Care Act (ACA), it's easy to miss the fact that conservative and liberal health policy proposals exist along a coherent continuum: each strikes a different balance between the desires to promote innovation and protect consumers. For convenience, let’s situate the ACA at the political center (Austin Frakt, 3/12). 

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Lisa Gillespie
Shefali Luthra

The Kaiser Daily Health Policy Report is published by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. (c) 2014 Kaiser Health News. All rights reserved.