Daily Health Policy Report

Monday, March 19, 2012

Last updated: Mon, Mar 19

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Health Reform

Administration News

Campaign 2012

Health Care Marketplace

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

AARP Arming For Medicare Battle

Kaiser Health News staff writer Marilyn Werber Serafini reports: "Against a backdrop of proposals to overhaul the popular social insurance program and a presidential campaign likely to address entitlement spending, AARP is launching 'probably the biggest outreach effort we've ever done on any issue' to activate its 37 million members, said Nancy LeaMond, AARP's executive vice president" (Werber Serafini, 3/19). Read the story.

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Capsules: HHS Floats New Ideas For Contraception Coverage Compromise; New Rule Cuts Student Health Plans Temporary Breaks; HHS Issues Final Rule For 2014 Medicaid Expansion

Now on Kaiser Health News' blog, Jordan Rau reports on the HHS contraception rule: "Again wading into the conflict between religious liberty and reproductive rights, the Obama administration on Friday suggested a number of ways it might arrange for insurers to pay for the contraception of employees of religious organizations without using any premium money from those groups" (Rau, 3/16).

Also on Capsules, Christian Torres writes about the student health plan rule issued Friday: "Beginning next school year, student health insurance will fall in line with many of the requirements established under the 2010 health law – with some temporary exceptions announced Friday in new rules released by the Obama administration" (Torres, 3/16).

In addition, Phil Galewitz reports on the 2014 Medicaid expansion: "The Centers for Medicare and Medicaid Services Friday released final rules for how the Medicaid program will work with the marketplaces, also called insurance exchanges, which are expected to be operational in 2014" (Galewitz, 3/16). Check out what else is on the blog.

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Political Cartoon: 'Take Cover?'

Kaiser Health News provides a fresh take on health policy developments with "Take Cover?" By Milt Priggee.

Meanwhile, here's today's health policy haiku: 


Long term insurance 
We plan ahead otherwise
Why not to grow old
-Paul Hughes-Cromwick

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

Medicare Plan Will Be Central To Ryan GOP Budget

House Budget Committee Chairman Paul Ryan, R-Wis., is set to unveil a new budget plan on Tuesday. Both Democrats and Republicans are poised to revive the pitched debate over controversial proposals related to the Medicare programs.

The Washington Post: House GOP's Ryan To Unveil New Budget
Congress is preparing to renew its bitter fight over government spending, as both parties eagerly await the arrival Tuesday of a new budget plan authored by Republican Rep. Paul Ryan (Wis.). A year ago, embracing Ryan's budget with its deep spending cuts and a proposal to privatize Medicare, became a badge of loyalty for conservatives. Democrats, meanwhile, used the plan as a political cudgel, accusing the GOP of working to end the retiree health program (Helderman, 3/18).

Reuters: Ryan Budget Plan Aims To Seize U.S. Spending Debate
Republicans in the U.S. House of Representatives will try this week to seize control of the election-year spending debate by rolling out a plan to slash trillion-dollar deficits and revive controversial reforms to the Medicare healthcare program for the elderly. The effort from influential House Budget Committee Chairman Paul Ryan aims to portray Republicans as unafraid to face the tough decisions needed to avoid what they warn is a looming U.S. debt crisis (Lawder, 3/18).

Reuters: Republicans' Revised US Medicare Plan Seen As Tough Sell
In a new Internet video previewing his upcoming budget plan that aims to slash spending and overhaul the Medicare healthcare program for the elderly, Republican lawmaker Paul Ryan warns of a coming debt crisis if U.S. lawmakers fail to act. It is part of the latest effort by Ryan, the influential chairman of the House of Representatives Budget Committee, to project bold ideas for reining in huge budget deficits. But Republican strategists warn that Ryan's plan to partially privatize Medicare is fraught with political danger for the party in its bid to maintain control of the U.S. House of Representatives in the Nov. 6 election (Smith and Lawder, 3/16).

Politico: GOP On Budget: Bitten, But Not Shy
For the second year running, Republicans are betting big on the budget. Despite getting hammered by Democrats last year, the GOP is gambling that going big and bold on their fiscal blueprint — think major changes to Medicare and Medicaid — will convince voters the GOP is the nation’s responsible party, comprised of lawmakers attuned to the nation’s fiscal woes. But it’s a gambit fraught with political peril, especially in an election year. Rep. Paul Ryan’s budget last year gave Democrats an opening to paint Republicans as willing to end Medicare as voters know it and batter Medicaid — while cutting taxes for the wealthy (Sherman, 3/18).

The Associated Press: GOP Preps For Budget Battle With Democrats, Obama
After a few months of relative peace on the budget front, Democrats and Republicans are readying for a party-defining, election-year fight over trillion dollar-plus deficits and what to do about them. The focus in the week ahead will be on the conservative-dominated House, where the Budget Committee chairman, Rep. Paul Ryan, R-Wis., is fashioning a sequel to last year's "Path to Prosperity" manifesto that ignited a firestorm over Medicare (Taylor, 3/17).

In the background -

Kaiser Health News: AARP Arming For Medicare Battle
Kaiser Health News staff writer Marilyn Werber Serafini reports: "Against a backdrop of proposals to overhaul the popular social insurance program and a presidential campaign likely to address entitlement spending, AARP is launching 'probably the biggest outreach effort we've ever done on any issue' to activate its 37 million members, said Nancy LeaMond, AARP's executive vice president" (Werber Serafini, 3/19).

USA Today: Seniors See Savings On Rx Drugs Under 2010 Health Law
Almost 4 million seniors saved about $2.16 billion through discounts for their prescription medications in 2011, the Department of Health and Human Services plans to announce today (Kennedy, 3/19).

And a look at last year's budget negotiations -

The Washington Post: Obama's Evolution: Behind The Failed 'Grand Bargain' On The Debt
The actions of Obama and his staff during that period in the summer reflect the grand ambitions and the shortcomings of the president's first term (Wallsten, Montgomery and Wilson, 3/17).

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IPAB And Health Law Repeal Efforts Mixing Up Political Loyalties

Some Senate Demcrats are considering voting with Republicans to repeal the health law's Independent Payment Advisory Board, while several GOP lawmakers are voicing concerns about the broader repeal strategy. Also, Sen. Mary Landrieu, D-La., has introduced legislation to change the law's medical-loss ratio.  

The Hill: Vulnerable Senate Dems Don't Rule Out Voting Against Obama Cost-Control Board
Several Senate Democrats up for reelection tell The Hill they haven't ruled out bucking President Obama by voting to repeal the health law's cost-control board. The House is expected to repeal the Independent Payment Advisory Board next week, putting pressure on the Senate to follow suit. While the bill has broad bipartisan support in the House, no Senate Democrats have so far signed onto repeal legislation despite coming under increasing pressure to do so (Pecquet, 3/17).

The Hill: GOP Split On Health-Law Repeal Strategy
Two conservative Republicans on Friday blasted House leaders for scheduling a vote to repeal an unpopular provision of the healthcare reform law. Rep. Steve King (R-Iowa) and Sen Jim DeMint (R-S.C.) wrote in the The Washington Times on Friday that a 2012 electoral debate focused simply on whether to repeal the law would "do our nation credit and do great service to the electorate" (Pecquet, 3/16).

ProPublica: Senate Bill Could Roll Back Consumers' Health Insurance Savings
This summer, health insurance companies may have to pay more than a billion dollars back to their own customers. The rebate requirements were introduced as part of the 2010 health-care reform law and are meant to benefit consumers. But now an insurer-supported Senate bill aims to roll back the rebate requirements. ... Last month, Sen. Mary Landrieu, D-La., introduced a bill that would change what costs companies can include in the 15 to 20 percent they are allotted for overhead, salaries and marketing. The bill, similar to a House bill introduced in March 2011 that has yet to come up for a vote, focuses on payments to insurance agents and brokers (Groeger, 3/16). 

In a look at those rebates -

Fox News: Millions Could Receive Insurance Rebates In 2012, Despite Industry Opposition
Millions of Americans stand to receive insurance company rebates by the end of the summer, as a result of a new requirement in the federal health care overhaul that strictly governs how insurers spend their cash. The insurance industry, along with a slew of state officials, have been fighting the policy. Based on rules that were issued at the end of last year, Washington will require insurers to spend between 80 and 85 percent of premium dollars on medical care. Insurance companies that violate the rule will be required to effectively refund their customers (Berger, 3/17).

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Health Reform

Key Health Law Question For High Court: How Far Does Congress' Power Reach?

Media outlets analyze the questions, personalities and precedent-setting issues that will be in play as the Supreme Court takes up the constitutionality of the health law.

The Associated Press: Court Weighs Making Health Coverage A Fact Of Life
Death, taxes and now health insurance? Having a medical plan or else paying a fine is about to become another certainty of American life, unless the Supreme Court says no. People are split over the wisdom of President Barack Obama'shealth care overhaul, but they are nearly united against its requirement that everybody have insurance. The mandate is intensely unpopular even though more than 8 in 10 people in the United States already are covered by workplace plans or government programs such as Medicare. When the insurance obligation kicks in, not even two years from now, most people won't need to worry or buy anything new (Cass, 3/19).

Los Angeles Times: Healthcare Law Poses A Question For Top Court: How Far Can Congress Go?
Critics say the mandate to buy insurance crosses a line. Supporters say the Constitution allows the federal government to "promote the general welfare." The Supreme Court hears arguments next week (Savage, 3/19).

The Associated Press: How Health Care Law Affects Lives Of 7 Americans
As the U.S. Supreme Court prepares to hear arguments on President Barack Obama's health care overhaul, The Associated Press spoke with a variety of people to hear their experiences so far with the landmark legislation, whose major provisions don't take effect until 2014. Reporters asked: How has the health care law affected your life? Here are snapshots of seven Americans (Johnson and Alonso-Zaldivar, 3/19).

The Washington Post: Health-Care Law Activists to Reach For Broad Political Targets At Supreme Court Hearings
Expect demonstrators to brandish placards reading "Hands off my health care!" and demanding a repeal of the 2010 health-care law. Expect doctors in white lab coats and patients who have suffered at the hands of insurance companies to hold news conferences lauding the law’s consumer protections and pleading for its preservation (Aizenman, 3/18).

Reuters: "Friends" Line Up For Obamacare Supreme Court Challenge
So many friends. So little love. Such is the state of the amicus, or "friend of the court," briefs that have piled up in the upcoming U.S. Supreme Court case involving President Barack Obama's healthcare reform law. In all, some 136 amicus briefs have been filed with the high court in the Patient Protection and Affordable Care Act litigation. That's a stack about 2 feet (61cm) high, according a Reuters estimate, or two full carts, as Solicitor General Donald Verrilli put it in a recent speech at Georgetown Law. It's also a third more amicus briefs than were submitted in the previous Supreme Court amicus record-holder - two affirmative action lawsuits against the University of Michigan, decided in 2003 (Baynes, 3/18).

The Associated Press: 'Obamacare' Foes Fear Ballooning Big Government
They're coming. The mom from North Carolina who opposes vaccinations and dislikes doctors and chooses to forgo health coverage because, she says, it is her right as an American. The Massachusetts Navy vet who feels health reform in his state has limited choice and ballooned costs. The husband-and-wife private investigators from Georgia who are satisfied with their own health plan and fear being forced to buy something more expensive. They're coming, along with so many others, to Washington, D.C., this month (Arrillaga, 3/17).

The Wall Street Journal: Insurers Set Plans In Case Mandate Is Quashed
The insurance industry and advocates of the health-care overhaul are sketching out contingency plans in case the Supreme Court strikes down a central part of the law in the coming months (Radnofsky, 3/18).

Politico: Health-Care Reform Still Standing
Despite all the bombs thrown at the health reform law — and there have been bombs aplenty — two years after President Barack Obama signed his crowning domestic achievement, the core provisions remain essentially unscathed, and reform is kicking in haltingly around the country (Norman, 3/18).

Bloomberg: Health-Care Challenge Evokes Roosevelt New Deal High Court Clash
In reviewing Barack Obama's health care overhaul, the U.S. Supreme Court has pushed into territory it hasn’t approached since the days of Franklin D. Roosevelt: ruling on a president’s signature legislative victory in the midst of his re-election campaign. Justices will take more time to hear arguments -- six hours over three days next week -- than for any other case in the last 44 years. The court will determine whether the government can force millions of people to obtain insurance (Stern, 3/19).

The Washington Post: How The Roberts Court Could Save Obama's Health-Care Reform
[T]he Obama administration will try to convince the justices that the Constitution grants Congress broad power to regulate interstate commerce and provide for the national interest. Broad enough to require that almost every American purchase health insurance or pay a penalty. [Chief Justice John] Roberts, who appears less dedicated to federalism than was his predecessor and mentor, William H. Rehnquist, may be "gettable" on such a question. Justice Anthony M. Kennedy, the usual go-to conservative for liberals, is a realistic possibility. Even Justice Antonin Scalia, the court’s most irascible conservative, might be lured (Barnes, 3/16).

The Associated Press: 4 GOP-Appointed Justices Control Health Law's Fate
Here's a thought that can't comfort President Barack Obama: The fate of his health care overhaul rests with four Republican-appointed Supreme Court justices. His most sweeping domestic achievement could be struck down if they stand together with Justice Clarence Thomas, another GOP appointee who is the likeliest vote against. But the good news for Obama is that he probably needs only one of the four to side with him to win approval of the law's crucial centerpiece, the requirement that almost everyone in this country has insurance or pays a penalty (Sherman, 3/19).

Medscape: The ACA and the Supreme Court: What Are the Scenarios?
Stuart Altman, PhD, of Brandeis University, talks with host Eli Y. Adashi, MD, about US healthcare reform and the upcoming Supreme Court hearings ... [Altman:]  There are a lot of people that want a single-payer system and to simplify the system, make it fairer. ... one thing that comes as a big surprise to most people when you talk to them, including I'm sure your colleagues, is that people say, "Well, yes, we need universal coverage, but even more important we need to control healthcare costs." But you cannot do both of them (3/16).

The New York Times' The Caucus: Health Care Debate Returns With Intensity
This week is the two-year anniversary of Mr. Obama’s health care law, and Republicans in Washington are planning to celebrate with a series of attacks. Next week, the Supreme Court will hear three days of arguments about whether the law is constitutional. The hoopla will be enormous. The string of events will serve to push health care to the front of the public and political agenda — a development that is bound to embolden Mr. Romney's Republican rivals as they seek to undermine his march toward the presidential nomination (Shear, 3/19).

The Washington Post: Low-Key Solicitor General Verrilli To Be In Health-Care Spotlight
But for now, Solicitor General Donald B. Verrilli Jr., who will represent the United States when the Supreme Court considers the constitutionality of the nation's health-care overhaul, is focusing on the "it's an honor" part (Barnes, 3/18).

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High Court Says No To Allowing Cameras To Broadcast The Health Law Arguments

This announcement, made Friday, is consistent with tradition. However, the court will make available same-day audio of the oral arguments because of "extraordinary public interest."

NPR: Supreme Court Will Release Same-Day Audio Of Health Care Arguments
The U.S. Supreme Court has announced that it will make available same-day audio of upcoming oral arguments later this month, arguments that could determine the fate of the Obama health care overhaul. In a three-paragraph announcement, the court said it is making the same-day audio available because of the "extraordinary public interest" in the health care cases. The legal challenges to the law are to be argued for six hours over a three-day period at the end of March (Totenberg, 3/16).

The Washington Post: Supreme Court Will Not Allow Cameras For Health-Care Arguments, Will Release Audio
The Supreme Court will stick with tradition and bar cameras from the courtroom this month, turning down requests that it televise oral arguments on the constitutionality of the nation's health-care overhaul, the court said Friday. The court will release same-day audio recordings of the arguments, which are scheduled to last six hours over three days, March 26 to 28 (Barnes, 3/16).

Reuters: Supreme Court To Release Audio In Healthcare Cases
The U.S. Supreme Court said on Friday it will release audio recordings and transcripts of oral arguments in the healthcare challenge immediately after the March 26-28 sessions, responding to what it called "extraordinary public interest." The court rejected a request, however, from C-SPAN, endorsed by some members of Congress, to allow video recordings of the arguments. The court has long barred cameras from its white marble setting - a practice that has drawn criticism from Congress and media groups (3/16).

Des Moines Register: Chuck Grassley: No Cameras In Health Care Hearing A Disappointment
A request that cameras be allowed in a federal courtroom where arguments will be heard on the constitutionality of the 2010 healthcare reform has been denied and is disappointing, Iowa Sen. Chuck Grassley said in a statement today... In a letter sent in November to the Chief Justice, Grassley had recommended that audio and video coverage of the arguments be allowed. Grassley argued that the law was so massive in size and scope and had an effect on every American (Clayworth, 3/16).

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Administration News

Obama Administration Offers Proposal To Fix Contraception Coverage Rule

Under the plan, insurance companies would pick up the cost for providing contraceptives to women employed by religious affiliated employers, but the administration offered ways to help cover those expenses.

Reuters: Obama Administration Details Contraceptives Rule Fix
The Obama administration began laying out its blueprint on Friday for accommodating the moral concerns of religious institutions that oppose its policy of requiring free coverage for women's contraceptives through employer-sponsored health plans. ... The U.S. Conference of Catholic Bishops, which has spearheaded opposition to Obama contraceptives policies, said it would examine the administration's new proposed language to see if it met its demands. But conference spokeswoman Sister Mary Ann Walsh chided the administration for releasing the document late on a Friday as Catholic leaders prepared to observe St. Patrick's Day on Saturday (Morgan and Simon, 3/16).

The Associated Press: Admin. Outlines Options On Birth Control Coverage
The Obama administration signaled Friday it's willing to help insurance companies offset the cost of providing free birth control to women working at church-affiliated institutions like hospitals and colleges. By finding a way to make the middlemen whole, the administration may be able to extricate itself from an unexpected political furor over birth control that has mobilized partisans across the political spectrum a half-century after the advent of the pill (Alonso-Zaldivar, 3/16).

Kaiser Health News: Capsules: HHS Floats New Ideas For Contraception Coverage Compromise
Again wading into the conflict between religious liberty and reproductive rights, the Obama administration on Friday suggested a number of ways it might arrange for insurers to pay for the contraception of employees of religious organizations without using any premium money from those groups (Rau, 3/16).

National Journal: Obama Administration Tries To Clear Up Contraception Coverage Questions
The Obama administration proposed three ways self-insured religious employers could avoid paying for contraception. The first would have a third-party administrator pay for the contraception coverage and recoup the costs through drug rebates or other fees. The second would have the federal government pay the third-party administrator a rebate within an insurance fee program that starts in 2014 and is established under the health reform law. The third option would have the third-party administrator contract with an Office of Personnel Management plan on state insurance exchanges to offer contraception coverage alone (McCarthy, 3/16).

Politico: HHS Spells Out New Options For Contraception Coverage Rule
Self-insured employers always presented one of the biggest problems with the policy. They directly cover employees' health costs out of their own funds, rather than paying premiums to an insurer (Feder, 3/16).

Modern Healthcare: Administration Offers Proposals On Contraceptive Coverage, Seeks Public Input
The Obama administration's controversial preventive-services policy resurfaced Friday when HHS and the Labor and Treasury departments issued an advance notice of proposed rulemaking that includes proposals and seeks comment from all Americans on how to implement a new policy that President Barack Obama and HHS Kathleen Sebelius announced last month. In that February proposal, the administration sought to accommodate religious employers that object to providing contraceptive services in health plans by requiring insurance companies, not the employers, to offer those services directly to women at no charge (Zigmond, 3/16).

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Religiously Affiliated Colleges, Universities Avoid Paying Directly For Birth Control

The Obama administration announced Friday a rule on student health plans that will allow some religiously affiliated colleges and universities to avoid directly paying for the costs of mandated contraception coverage.

The Washington Post: Birth Control Rule Won't Apply To All Student Plans At Colleges, White House Says
The Obama administration's controversial birth control health insurance coverage rule will not apply to a type of plan used by about 200,000 college and graduate students, officials said Friday (Aizenman, 3/16).

CQ HealthBeat: Administration Announces Moves On Contraceptive Coverage, Student Health Plans
The Obama administration announced late Friday that student health plans offered by universities must comply with consumer protections required under the health law. However, if those plans are offered by religiously affiliated organizations that object on moral grounds to the requirement for coverage of contraceptives, the sponsor would not have to directly pay the costs of birth control. Instead, the insurer with which the university contracts to provide the student health plan would have to pay for the contraceptives without charge (Reichard, 3/16).

Kaiser Health News: Capsules: New Rule Cuts Student Health Plans Temporary Breaks
Beginning next school year, student health insurance will fall in line with many of the requirements established under the 2010 health law -- with some temporary exceptions announced Friday in new rules released by the Obama administration (Torres, 3/16).

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Medicaid Expansion Rule Focuses On Enrollment Process

The Obama administration released a rule Friday detailing the specifics of this coverage expansion and trying to simplify the enrollment process. 

The Wall Street Journal: States Get Medicaid Rules
The Obama administration on Friday told states how to enroll millions more low-income Americans into Medicaid under the health care overhaul, 10 days before the Supreme Court begins considering a challenge to the law. The regulations, published by the Department of Health and Human Services, detail the scheduled expansion of Medicaid to cover a larger batch of low earners in 2014, when much of the health-care law is set to take effect (Radnofsky, 3/16).

CQ HealthBeat: Medicaid Expansion Rule Aims For Vastly Simpler Enrollment Process
A final rule released Friday spells out the terms for the expanded Medicaid eligibility in 2014 under the health care law and requires "real-time" enrollment that documents income, citizenship and other data without the applicant having to bring in paperwork. The rule also collapses the many eligibility categories now in Medicaid into just four: adults, children, parents and pregnant women (Reichard, 3/16).

Kaiser Health News: Capsules: HHS Issue Final Rule For 2014 Medicaid Expansion
The Centers for Medicare and Medicaid Services Friday released final rules for how the Medicaid program will work with the marketplaces, also called insurance exchanges, which are expected to be operational in 2014 (Galewitz, 3/16). 

Also in the news, a report on another health law rule released Friday, as well as a big picture view of implementing the measure --

Modern Healthcare: HHS Issues Reform Rule To Limit Insurer Risk
A final rule issued Friday will implement several provisions of the 2010 federal health care law that aim to shift funds among insurance plans when many of the industry's practices designed to maintain their solvency are banned in 2014. The rule finalizes the designs of programs for risk adjustment, reinsurance, and risk corridors (Daly, 3/16).

Kansas Health Institute News: Q and A with HHS Regional Administrator Jay Angoff
As a senior adviser with the U.S. Department of Health and Human Services, Jay Angoff works with state and local governments on implementation of the federal Affordable Care Act. Q: How would you say the new regulations move the ball down the court in implementing the Affordable Care Act? A: It makes it real clear that the states have a lot of flexibility. One key area is whether the exchange is going to be strong or weak (Sherry, 3/16).

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Campaign 2012

Ever-Evolving Birth Control Issues Affect Fundraising, Messaging

As the birth control issues pump up some campaign coffers, one prominent Republican says his party needs to stop talking about it.

Politico: Birth Control Controversies A Fundraising Boon
EMILY’s List — whose mission is to elect pro-abortion rights Democratic women — has raised nearly twice as much for candidates at this point in the 2012 cycle as it did during the entire 2010 cycle, according to spokeswoman Jess McIntosh. And that’s with about eight months to go (Bravender, 3/18).

The Hill: McCain: GOP Needs To Move Away From Birth Control Debate
Sen. John McCain (R-Ariz.) said Sunday that Republicans needed to fight the 'perception' that their policies were anti-women. … Polls suggest that Republicans are losing the public relations battle over the Obama administration's contraception mandate, which would force [some] religious institutions to provide birth control coverage to employees. GOP lawmakers have painted the ruling as an attack on religious liberty, but Democrats have portrayed the debate as an attack on women's health, a view a recent Bloomberg poll found six in ten American agree with (Mali, 3/18).

Elsewhere, Obama's account of his mother's fight with an insurer is fact-checked --

The Washington Post: The Fact Checker: 'The Road We've Traveled:' A Misleading Account Of Obama's Mother And Her Insurance Dispute
The sequence, in fact, evokes a famous story that candidate Obama told during the 2008 campaign -- that his mother, Stanley Ann Dunham, fought with her insurer over whether her cancer was a pre-existing condition that disqualified her from coverage. But the story was later called into question by Dunham's biographer (Kessler, 3/19).

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Health Care Marketplace

In Insurance, Gender Rating Continues

The New York Times: Gender Gap Persists In Cost Of Health Insurance
Women still pay more than men for the same health insurance coverage, according to new research and data from online brokers. The new health care law will prohibit such "gender rating," starting in 2014. But gaps persist in most states, with no evidence that insurers have taken steps to reduce them (Pear, 3/19).

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State Watch

Maryland Officials Seek To Boost Enrollment In High Risk Insurance Plan

People with medical problems often have trouble buying insurance, but the program, funded by the federal government, offers plans designed for them.

The Associated Press/Washington Post: Md. Lt. Gov. Launches Campaign To Market Federal Options For People Without Health Insurance
Maryland Lt. Gov. Anthony Brown wants to increase the number of applications to a federally funded health insurance program run by the state. Brown will kick off the second anniversary of the federal Affordable Care Act on Monday with a marketing campaign designed to enhance participation in the Maryland Health Insurance Plan (3/19).

The Baltimore Sun: Campaign To Highlight Options For Uninsured
For those who have heart disease, cancer, diabetes or another condition, buying health insurance can be impossible. … After some searching, [Jamie Engels, a 29-year-old Baltimore woman with a kidney disorder,] found a federally subsidized state program and has a plan she can afford. State officials want to make sure others in Engels' shoes know about the Maryland Health Insurance Plan. They're launching their biggest marketing push ever today (Cohn, 3/19).

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Texas Files Lawsuit Over Federal Defunding Of Women's Health Program

Texas Attorney General Greg Abbott filed the suit Friday, saying that the federal government improperly decided to stop funding the state's Women's Health Program.

The Texas Tribune: Abbott Sues Feds Over Women's Health Program
[Abbott said] that the federal government's action is unconstitutional because it seeks to "commandeer and coerce the states' lawmaking processes into awarding taxpayer subsidies to elective abortion providers." In the complaint, Abbott asks that the federal government resume funding for the program (Ramshaw, 3/16).

Houston Chronicle: Abbott Sues U.S. Over Women's Health Funding
The program provides family planning and preventive-care services such as cancer and sexually transmitted disease screenings to 130,000 Texas women annually. The federal government provides 90 percent of the funding, the state 10 percent. CMS/HHS officials said they don't talk about pending litigation but Friday released a statement reiterating that "patients, not state government officials, should be able to choose the doctors and other health-care providers best for them and their families" (Ackerman and Fikac, 3/17).

The Dallas Morning News: Texas Sues Over Feds' Cutoff Of Women's Health Funds In Planned Parenthood Dispute 
The filing came as newly released federal documents showed that the state should have known its strategy to seek a waiver would fail. The records, released to The Dallas Morning News, show that a similar request to exclude Planned Parenthood when the program was being started six years ago was turned down (Hoppe, 3/16).

Related, from KHN: Feds Drop Women's Health Program (Feibel, 3/15) and earlier summary of news coverage: Feds Begin Funding Cuts To Texas Women's Health Program

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N.Y. To Ease Medicaid Audits As Fla. Pushes Hard To Cut Program's Costs

The N.Y. audits have been successful in recouping funds but have created an industry backlash. Florida, at the heart of the lawsuit against the federal health law that will expand Medicaid, is trying hard to get approval from the Obama administration to revamp its program.

The New York Times: Under Pressure, New York Moves To Soften Tough Medicaid Audits
New York State was paying for the medical care of dead people when Gov. George E. Pataki and the State Legislature created the Office of the Medicaid Inspector General to curb billions of dollars in fraud and misspending by health care providers. ... But a backlash from the politically powerful health care industry has erased broad support for the crackdown (Bernstein, 3/18).

NPR: Florida Challenges Medicaid Spending 'By Force'
When Florida's Republican Gov. Rick Scott rolled out his 2012 budget, he brought along a chart -- a graph with two lines. One showed that since 1999, Florida's budget has grown 30 percent. The other line showed that Medicaid spending is up 180 percent. ... Health care advocates [note] that Medicaid spending in Florida is a third less than state economists predicted eight years ago (Allen, 3/19). 

Also, California consumer groups are looking at cutbacks there.

California Healthline: Pediatric Centers Argue Retroactive Payments Don't Make Sense
California's 14 pediatric day health centers are a form of home health agency serving a 21-and-under population. Those are two groups exempted from the state's 10 percent Medi-Cal provider rate reductions in June. ... DHCS officials now say the pediatric facilities have to pay the 10 percent difference for all of those months during which the status of PDHCs was in question. That's 10 months' worth of cash PDHCs don't have, according to Terry Racciato, president of two Together We Grow pediatric day health centers in San Diego (Gorn, 3/19).

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State Roundup: CalPERS Savings; Harvard Pilgrim Challenges 'Partners'

A selection of state health policy stories from California, Minnesota, Massachusetts and Wisconsin.

Modern Healthcare: Stay Away
The California Public Employees' Retirement System happily ended 2010 with insurance rates $15 million lower than they might have been ... Catholic Healthcare West, now Dignity Health, which helped deliver those savings, ended that year with millions of dollars less in revenue. The San Francisco-based hospital system was among the early adopters of accountable care ... Hospital executives trying to control spending face the costly prospect of actively trying to keep patients out of the hospital (Evans, 3/17).

San Francisco Chronicle: Calif. Court Rules Nurses Can Give Anesthetics
Nurses who are trained as anesthetists do not need a doctor's supervision to give anesthetics to California hospital patients, a state appeals court has ruled. Thursday's decision by the First District Court of Appeal in San Francisco was particularly important for rural areas, where nurses commonly administer anesthesia in hospitals, under a doctor's orders but without in-person supervision (Egelko, 3/19).

Boston Globe: Schools Retool Mental Health Counseling Tack
[S]chool officials in Boston and other cities are increasingly importing private clinicians to deliver much-needed mental health services to behaviorally troubled students. ... Some private insurers also pay for mental health visits in school settings, though often with limits on the number of sessions or with large copayments. Children whose insurance will not cover the visits, or who are uninsured, cannot see the therapists unless special arrangements are made (Wen, 3/19).

Boston Globe: Urgent Care Center Trend Growing In Eastern Mass.
With health care costs climbing and emergency rooms overwhelmed, one potential solution is gathering steam across Eastern Massachusetts ... a national company, Doctors Express, said it plans to open 19 urgent care centers in Eastern Massachusetts by the beginning of 2014 (Kowalczyk, 3/19).

Boston Globe: Harvard Pilgrim Set To Launch A Lower Cost Network
Harvard Pilgrim Health Care is teaming up with more than 50 hospitals and 16,500 doctors across the state to offer Massachusetts employers and their workers a 10 percent savings on health insurance by forming what they call a "focused network"’ of medical care groups that excludes Partners HealthCare System Inc. and other high-priced providers (Weisman, 3/18).

Milwaukee Journal Sentinel: Community Clinics Key To Improving Access To Care
Next month, Progressive Community Health Centers expects to find out whether it will receive a $5 million federal grant to build a clinic in the heart of one of the poorest neighborhoods in Milwaukee. ... Hiring additional doctors, dentists, nurse practitioners, physician assistants and other staff would take years. But expanding Progressive's main clinic is one example of what could be done to increase access to health care in low-income neighborhoods in Milwaukee (Boulton, 3/17).

Minneapolis Star Tribune: Minnesota Seniors Facing A Spike In Long-Term Care Cost
Premiums are soaring by 20 to 90 percent for thousands of Minnesotans who carry long-term care insurance, and many older people are struggling to figure out what to do. ... [Peter Wyckoff, 67, of Shoreview] got a letter recently saying that the annual premium for the John Hancock policy covering him and his wife, Sue, will rise from $1,816 to $3,834. The unforeseen premium increases have caused a rash of calls to state regulators and advocates from worried or irate older Minnesotans (Wolfe, 3/19).

HealthyCal: Suicide Prevention Line Reaches Out To California Seniors
The Friendship Line is a suicide prevention and mental health hotline for seniors. Last year, they got 18,000 calls. But they also make outgoing calls to remind elders to take their medication or to offer emotional support to people ... They made 40,000 of those calls in 2011  (Shanafelt, 3/18).

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Editorials and Opinions

Viewpoints: The Argument For The Health Law; No One Wins Contraception Battle

The New York Times: Hurray For Health Reform
It's said that you can judge a man by the quality of his enemies. If the same principle applies to legislation, the Affordable Care Act — which was signed into law two years ago, but for the most part has yet to take effect — sits in a place of high honor (Paul Krugman, 3/18). 

The Philadelphia Inquirer: Rejecting Affordable Care Act Is Rejecting Constitution
The justices have the power to declare the (health) law unconstitutional and thereby kill "Obamacare" before it even leaves the birthing chamber. While some believe that such an outcome would be proper, we disagree. A court decision overturning the Affordable Care Act would be an egregious misreading of the Constitution (Akhil Reed Amar and Todd Brewster, 3/18).

Houston Chronicle: Health Care Reform And Your Insurance
If the ACA is repealed, one in 5 will be uninsured by 2020 -- 66 million. Those seeking to repeal the ACA had better come up with a substitute bill that works, or 66 million votes could swing an election (Arthur Garson Jr. and Carolyn Long Engelhard, 3/17).

Boston Globe: On Mandate, Romney Plays Both Sides
They say all things must end, but the wrangling over Mitt Romney’s support for an individual health insurance mandate persists without letup. It has been nearly six years since Romney, with much fanfare, signed the Massachusetts health care overhaul into law. On the eve of the signing ceremony, he had praised the bill's requirement that every resident obtain health insurance, and suggested with pride that the rest of the nation might want to follow the Bay State’s lead. "How much of our health care plan applies to other states?" he wrote in The Wall Street Journal. "A lot.’" It was a message he would reiterate time and again (Jeff Jacoby, 3/18).

McClatchy / The Kansas City Star: If Our Government Can Do This, What Can They Not Do?
It's always fascinating when people on either side of a partisan divide give each other gifts. Case in point: President Obama's approval of a rule ordering Catholic institutions to offer insurance policies covering birth control, sterilization procedures and the morning after pill — all contrary to church teachings. … For Republicans, it was an unexpected gift (E. Thomas McClanahan, 3/17).

The Dallas Morning News: Thanks Obama, But I Need More
I really appreciate your insisting that insurance companies and employers provide me with free birth control without regard to my ability to pay. Giving away free stuff to the middle class has worked so well in other areas of our national life. Just look at how well Medicare is working. And Social Security. And the auto bailouts. And your recently announced plan to help speculators who bought second, third or fourth homes with the hope of flipping them. Is this what you meant when you promised that Obamacare would reduce medical spending in the United States? (Mona Charen, 3/16).

Bloomberg: Anti-Contraception Battle A Loser On Policy and Politics
The federal government is right to encourage access to contraception. No church is required to dispense it; no congregant is required to use it simply because health insurance policies cover it. (The majority of private insurers covered birth control services and supplies before the Obama administration’s decision.) At this point contraception’s role in American culture and public health is firmly established. Why turn it into a political pill? (3/18).

Forbes: Yes, Virginia, There Can Be A Free Market For Health Care
Of the $2.6 trillion Americans spent on health care in 2010, according to the Centers for Medicare and Medicaid Services, $814 billion—31 percent—was for hospital care. And not all hospital care is acute. So, the inability to shop for care applies to less than three-tenths of all health spending. So, it seems to me, those who strongly believe in the shopping argument for socialized medicine should adopt a hybrid approach. Let’s have a free market for the 70-plus percent of health care where market forces can most directly apply, and let’s have universal catastrophic insurance for those situations where market forces work less well (Avik Roy, 3/18).

The Washington Post: 'Mediscare,' Republican Style
Are Republicans ready to be trusted with the reins of power? If you're thinking of answering this in the affirmative, you might want to pause long enough to learn what transpired on the third floor of the Capitol on Thursday. There, four prominent Republican lawmakers announced their proposal to abolish Medicare — "sunset" was their pseudo-verb — even for those currently on the program or nearing retirement. In Medicare's place would be a private plan that would raise the eligibility age and shift trillions of dollars worth of health-care coverage from the government to the elderly (Dana Milbank, 3/16). 

The Washington Post: This Cost-Cutting Reform Deserves A Chance
One of the most promising cost-control measures in the new health-care law is an entity called the Independent Payment Advisory Board, or IPAB. To be launched in 2015, IPAB will have the authority, if growth in health-care costs exceeds a certain target, to recommend changes to the Medicare program. Those changes would take effect automatically unless Congress came up with equivalent savings elsewhere (3/18). 

Bloomberg/The New York Times: Letter From Washington: Saying Goodbye To The Dysfunctional Senate
The health care measure exemplified the political pettiness and paralysis in Washington. The Finance Committee, on which (Sen. Olympia Snowe) serves, was working on a bill as Congress adjourned in August 2009. During that recess, Tea Party conservatives and some Republicans ginned up the threat of "death panels," a canard that Ms. Snowe said "ignited a firestorm politically" and made bipartisan deals almost impossible. A few months later, Democratic Senate leaders forced a huge bill onto the floor with no explanation of some provisions. The measure passed, the country remains divided, and the issue will be settled in June by a politically split Supreme Court (Albert R. Hunt, 3/18).

Des Moines Register: Lawmakers Seeking To Shame Women
Arizona is now trying to outdo Texas in efforts to shame women seeking to control their fertility. Lawmakers are close to passing a bill to require a woman who files an insurance claim for birth control pills to prove she's not taking them to prevent pregnancy. Birth control, the Arizona legislators claim, could violate employers' (any employer, not just a religious one) moral beliefs. But violating a woman's dignity and right to make her own health care choices apparently isn't a problem (Rekha Basu, 3/17).

Arizona Republic: GOP Legislature Continues To Boost Obama
No one should be so foolish as to believe that mere embarrassment will keep Arizona lawmakers from meddling in the minutia of people's lives. Or from whipping up some new, wrongheaded scheme to stuff the Obama administration. But our so-called conservatives are becoming Exhibit A nationally in the case against Republicans taking back the White House. On an almost daily basis, they are producing YouTube fodder for their political opposition. ... The latest birth-control legislation, sponsored by Rep. Debbie Lesko, R-Glendale, is a great case in point (3/17).

Des Moines Register: Senate Takes Strides To Improve Iowa Health Care
One of the great collaborations in my legislative career has been the reform of our health care system. This year, in a bipartisan vote (32-18), the Senate passed the Mental Health Redesign Bill. Positioned to completely redesign the way our mental health system is structured and financed, we passed SF 2315, which creates a comprehensive system of patient-centered care with statewide standards, regionally administered and locally delivered (Iowa state Sen. Jack Hatch, 3/16).

The Minneapolis Star Tribune: A Proper Approach To Treating Cancer
Contrary to "An affront to cancer sufferers" (March 12) by Dr. Irv Lerner, the moratorium on the construction of new radiation facilities in the Twin Cities does have patients in mind. Radiation-therapy services provided in Minnesota hospitals ensure integrated care -- at their hospitals and in their clinics. Hospital-based radiation facilities serve both outpatients and those hospitalized, without requiring an expensive and unnecessary ambulance ride. Cancer patients often have other health issues that can all be managed under one roof with a full-service facility (Steve Kolar, 3/18).

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Stephanie Stapleton

Andrew Villegas

Lisa Gillespie
Shefali Luthra

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