Daily Health Policy Report

Wednesday, March 19, 2014

Last updated: Wed, Mar 19

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch


State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

10 States Are Critical To Administration's Efforts To Enroll 6 Million In New Health Plans

Kaiser Health News staff writer Phil Galewitz, working in collaboration with USA Today, reports: "Ten states — seven of them controlled by Republicans —hold the key to whether the Obama administration succeeds at signing up 6 million people by the deadline of March 31. Those large states account for nearly 30 million uninsured — almost two-thirds of the nation’s 47 million uninsured" (Galewitz, 3/19). Read the story.

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Doctors Say Obamacare Rule Will Stick Them With Unpaid Bills

Reporting for Kaiser Health News, Roni Caryn Rabin writes: "Doctors groups fear their members won’t get paid because of an unusual 90-day grace period for government-subsidized health plans and are urging physicians to check patients' insurance status before every visit" (Rabin, 3/19). Read the story.

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Some Young People Won't Get Tax Help For Obamacare Insurance

WHYY’s Elana Gordon, working in partnership with Kaiser Health News and NPR, reports: "Subsidies in the health law were designed to lower insurance costs for people who make around $11,000 to $46,000 a year. But for young people earning toward the higher end of that range, it's more complicated than that. A new study shows that in major cities, some young people are falling into a gap where they make about $46,000 or under, but don't actually qualify for government help to pay their insurance premiums" (Gordon, 3/18). Read the story.

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Capsules: Mass. To Drop Contractor Behind Flawed Health Insurance Website; What You Need To Know As Health Care Deadline Looms

Now on Kaiser Health News’ blog, WBUR’s Martha Bebinger reports on the latest news regarding Massachusetts’ flawed online insurance marketplace: "Massachusetts is negotiating an end to its contract with CGI, the Canadian vendor that built the state’s flawed health insurance website while scrambling to fix it" (Bebinger, 3/18). 

Also on the blog, listen to KHN’s Mary Agnes Carey on NPR’s Tell Me More program Tuesday talking about the upcoming deadline for many Americans to buy health insurance or face a fine (3/18). Check out what else is on the blog.

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Political Cartoon: 'Operators Are Standing By?' By Jimmy Margulies

Kaiser Health News provides a fresh take on health policy developments with "Operators Are Standing By?" By Jimmy Margulies.

And here's today's health policy haiku:


Blame human error
for that blip. It's fixed now... let
the surge continue.


If you have a health policy haiku to share, please send it to us at http://www.kaiserhealthnews.org/ContactUs.aspx and let us know if you want to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

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Health Reform

Counting Down To March 31 -- The End Of The Health Law's Open Enrollment Period

News outlets offer tips and answer questions about what consumers need to know as the deadline to sign up for health insurance approaches.

Los Angeles Times: Obamacare Countdown: What You Need To Know About The March 31 Deadline
The buzzer is about to sound on Obamacare enrollment. Less than two weeks are left to sign up for health insurance under the Affordable Care Act, the federal law that went into effect this year. It requires that most Americans have health insurance and provides government assistance to make coverage cheaper (Karlamangla and Terhune, 3/18).

The Wall Street Journal: Tax Experts: Brace For Insurance Tumult
Headaches over the health care overhaul are likely to grow in the coming year as tens of millions of Americans face the task of establishing that they have insurance coverage to avoid paying penalties, tax experts say. … Perhaps the biggest problem is a lack of public understanding of the complex and frequently-changing program, tax experts say. They expect that to be compounded by a misunderstanding of the penalties, as many don't realize they could pay more than the minimum $95 for not having insurance (McKinnon, 3/18).

Kaiser Health News: Capsules: What You Need To Know As Health Care Deadline Looms
Listen to KHN’s Mary Agnes Carey on NPR’s Tell Me More program Tuesday talking about the upcoming deadline for many Americans to buy health insurance or face a fine (3/18).

The CT Mirror: Obamacare Q&A: Health Insurance Deadlines And Taxes
There are two weeks to go in the first-ever open enrollment period for buying private insurance coverage as part of the federal health law commonly known as Obamacare. After March 31, Connecticut residents won't be able to buy individual-market health plans for this year, unless they go through a change in circumstances like losing a job or getting divorced (and no, getting sick doesn't count). Here’s what you need to know about the deadline, how you can qualify for a special enrollment period if something changes and you need coverage after March 31, the penalty for not having insurance and how to get an exemption from the individual mandate (Becker, 3/18).

The Baltimore Sun: Deadline Looms To Enroll In Health Insurance
Edward Brown heard a radio ad recently and realized the clock was ticking: If he wanted health insurance, the Baltimore truck driver needed to find time to sign up before the end of March. ... Exchange officials in Maryland are trying to lure as many walk-ins like Brown as possible before the end of open enrollment through a barrage of methods (Cohn, 3/18).

CNN: The Affordable Care Act Wants You
Less than two weeks remain before the March 31 deadline to apply for the Affordable Care Act and the Obama administration is getting creative in reminding Americans to sign up by trying to reach every demographic imaginable.The administration this month is deploying quirky stunts and niche messaging to reach as many people as possible, including those "young invincibles" considered essential to making the program work economically. So far, the administration says it has signed up 5 million people. Here's what it's doing to boost the rolls between now and the end of the month when those who don't have insurance of any kind would face a fine of $95 or 1 percent of their income, whichever is higher (Caldwell, 3/18).

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A Blip, A Plan, A Hotline ... What's New With The Exchanges?

On Tuesday, the federal online marketplace -- healthcare.gov -- went down for 30 minutes even as officials were pointing out a spike in sign-ups. Meanwhile, news outlets offer reports about the states that are integral to the administration reaching its enrollment target as well as updates from Maryland, Massachusetts, Colorado, Oregon, Washington and Nevada.

Politico: Healthcare.gov Hits A Blip
HealthCare.gov went down for at least 30 minutes Tuesday, an outage blamed on “human error.” Although resolved quickly, the occurrence was an immediate reminder of how much is riding on the federal enrollment website’s smooth functioning in the final two weeks of the 2014 enrollment season. On Monday, administration officials described a sharp increase in sign-ups during the first half of March that brought the total to 5 million people nationwide (Cheney, 3/18).

Kaiser Health News: 10 States Are Critical To Administration's Efforts To Enroll 6 Million In New Health Plans
Ten states — seven of them controlled by Republicans —hold the key to whether the Obama administration succeeds at signing up 6 million people by the deadline of March 31. Those large states account for nearly 30 million uninsured — almost two-thirds of the nation’s 47 million uninsured (Galewitz, 3/19).

The Associated Press/Washington Post: Md. Health Exchange Board Adopts Enrollment Plan
Maryland’s health exchange board has adopted a plan to help people who have tried to enroll before the deadline at the end of the month but were unable to complete an application. The board approved the plan Tuesday (3/18).

The Baltimore Sun: Hotline Offered To Those With Applications Stuck In Health Exchange Website
Consumers who have attempted to enroll in health insurance through the Maryland exchange but have become stuck in the website can call a new hotline to ensure they are covered before the end of open enrollment March 31. The exchange board approved a plan Tuesday to set up the hotline – 1-800-396-1961 – to guarantee the chance for coverage (Cohn, 3/18).

The Associated Press/Wall Street Journal: NY Health Exchange Reports, 666,000 Enrolled
The state's new health exchange reports more than 995,000 New Yorkers have completed applications for insurance while more than 666,000 of them have now enrolled for specific coverage (3/19).

Kaiser Health News: Capsules: Mass. To Drop Contractor Behind Flawed Health Insurance Website
Massachusetts is negotiating an end to its contract with CGI, the Canadian vendor that built the state’s flawed health insurance website while scrambling to fix it (Bebinger, 3/18).

The Boston Globe: State Dismisses Health Site Firm
Massachusetts is dropping the contractor that created the state’s dysfunctional online health insurance marketplace, ending a troubled partnership that has left thousands of consumers frustrated and many without coverage for months. The state notified CGI last week that it was being terminated, and officials have started negotiating a transition. The $68-million contract with the Montreal-based technology consulting company expires in September, and Sarah Iselin, who was hired last month by Governor Deval Patrick to oversee repairs to the Health Connector website, said that exactly when CGI finishes its work and how much the state pays for it are subject to bargaining. Massachusetts has paid just $15 million to CGI and has not made any payments since the fall (Kowalczyk, 3/18).

Fox News: Vegas Man Stuck With $407,000 Medical Bill After Obamacare Breakdown
The busted ObamaCare websites cost a lot of people a lot of time. But for one Nevada man, problems with the state insurance exchange reportedly cost him $407,000. The Las Vegas Review-Journal reported that Larry Basich, a 62-year-old Vegas resident, has been stuck with the massive medical bill despite signing up for an insurance plan via the state exchange last fall. Basich, according to the article, selected a UnitedHealthcare plan in November, and even paid his first premium. But he never received confirmation that he was enrolled, despite being assured that he was by Nevada Health Link (3/18).

The Oregonian: Oracle's Contracts For Cover Oregon Health Insurance Exchange Bypassed Standard Rules, Lacked Teeth
Three weeks ago, a federal report declared that poor contracting is a "root cause" of the Cover Oregon health insurance exchange debacle. More than $130 million has gone to California-based Oracle Corp., the main exchange IT vendor, under contracts that, according to the federal report, do "not have any leverage" to hold the firm accountable for missed deadlines or shoddy work. So how did the project's weak contracting get that way? (Budnick, 3/18).

The Seattle Times: State Waiting For Insurance Enrollment Bump
Many uninsured residents appear to be waiting until the last moment to enroll through Washington’s health insurance exchange. More than 112,000 people have purchased insurance through the state marketplace, but by the middle of the month, the state still hadn’t seen an uptick in the rate of enrollment (Stiffler, 3/18).

Health News Colorado: Sign-Ups Top 100,000, Colorado Fifth Among State Exchanges
Colorado ranks fifth among 14 states operating their own health exchanges for selling private health plans to the highest percentage of the state’s population. But in Colorado and across the country, sign-up rates are still very low. That’s not a surprise says John Stuart Hall, an emeritus professor of public affairs at Arizona State University, who helped conduct a study of health reform implementation throughout western states (McCrimmon, 3/18).

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Arrests In Ga. After Medicaid Expansion Protests

Several dozen people were arrested Tuesday after protests at the Georgia state capitol targeting Gov. Nathan Deal's decision to not expand Medicaid under the health law. Elsewhere, Medicaid expansion makes news in New Mexico, New Jersey and California.

The New York Times: Budding Liberal Protest Movements Begin To Take Root In South
By the end of the day, they were among the 39 people who were arrested Tuesday during choreographed waves of civil disobedience here at the [Georgia] state Capitol in protest of the state’s refusal to expand Medicaid as part of the Affordable Care Act (Buchsbaum, 3/18).

Atlanta Journal-Constitution: Arrests Follow Protests At State Capitol
More than 40 people were arrested Tuesday in a string of protests targeting Gov. Nathan Deal’s decision not to expand Medicaid in Georgia under the Affordable Care Act. Dr. Raphael Warnock of Ebenezer Baptist Church where the Rev. Martin Luther King Jr. was pastor, was among those placed in handcuffs by Georgia State Patrol troopers. Warnock and a group of supporters staged a sit-in outside of Deal’s office Tuesday afternoon. They were arrested without incident and led away as the remaining crowd of protesters sang “We Shall Not Be Moved” (Davis and Joyner, 3/18).

The Associated Press: New Mexico Enrolls 103k In Medicaid Since October
Gov. Susana Martinez's administration reports that about 103,000 low-income New Mexicans have enrolled in Medicaid since the state expanded who qualifies for the health care program last year. Human Services Department spokesman Matt Kennicott said the state is on track to meet projections that about 130,000 people will gain medical coverage during the first year of the Medicaid expansion (Massey, 3/19).

Marketplace: Signing Up New Patients Is Just The Beginning
Uninsured Americans have just 15 days left to enroll for health coverage through one of the exchanges before the Affordable Care Act’s March 31 deadline. But when it comes to Medicaid -- the health plan for people with low-incomes -- there is no deadline. People can, and are, signing up. In Camden, New Jersey -- the community Marketplace is watching throughout the ACA's first year -- thousands of applications are pouring in every month, and all three of the city’s hospitals are serious about enrolling uninsured patients in some kind of insurance under the Affordable Care Act (Gorenstein, 3/18).

The California Health Report: Homeless Are Hesitant To Use Medi-Cal
The expansion of Medi-Cal under the Affordable Care Act means that the homeless have more health care options this year than ever before.Yet the handful of free homeless medical clinics in Modesto continue to see lines of patients eager to use their services. Some homeless people have trouble understanding the Medi-Cal enrollment process or providing the needed paperwork. Others would just rather be around other homeless people. Because of their hard life on the streets, they don’t always feel comfortable in more traditional settings (Renner, 3/19).

And movement on the proposal to expand Medicaid in Virginia --

The Richmond Times-Dispatch: Warner Says He’ll Support Bipartisan Marketplace Virginia
Sen. Mark R. Warner, D-Va., is urging lawmakers in Richmond to find a compromise on Medicaid expansion and pledged to back the bipartisan Marketplace Virginia plan that has emerged in the state Senate. “If Virginia passes a Virginia-centric plan, I would support at a federal level getting the appropriate waivers,” Warner said in an interview Tuesday in Richmond, where he met with students, educators and college graduates to discuss college affordability issues. Warner, who is up for re-election this year, also reiterated his support for an increase in the minimum wage and for pursuing alternative energy sources while finding cleaner ways to burn coal (Schmidt, 3/18).

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Some Well-Known Cancer Centers Are Not Included In Many Obamacare Plan Networks

An Associated Press survey finds examples across the country of renowned medical centers left off plans. Meanwhile, other news outlets report on implementation issues related to young people as well as premium costs.

The Associated Press: Health Law Concerns For Cancer Centers
Cancer patients relieved that they can get insurance coverage because of the new health care law may be disappointed to learn that some the nation's best cancer hospitals are off-limits. An Associated Press survey found examples coast to coast. Seattle Cancer Care Alliance is excluded by five out of eight insurers in Washington state's insurance exchange. MD Anderson Cancer Center says it's in less than half of the plans in the Houston area. Memorial Sloan-Kettering is included by two of nine insurers in New York City and has out-of-network agreements with two more (Alonso-Zaldivar, 3/19).

Kaiser Health News: Some Young People Won't Get Tax Help For Obamacare Insurance
Subsidies in the health law were designed to lower insurance costs for people who make around $11,000 to $46,000 a year. But for young people earning toward the higher end of that range, it's more complicated than that. A new study shows that in major cities, some young people are falling into a gap where they make about $46,000 or under, but don't actually qualify for government help to pay their insurance premiums (Gordon, 3/18).

The Hill: Obamacare Premiums To Skyrocket 
Health industry officials say ObamaCare-related premiums will double in some parts of the country, countering claims recently made by the administration. The expected rate hikes will be announced in the coming months amid an intense election year, when control of the Senate is up for grabs (Viebeck, 3/19).

FactCheck.Org/USA Today: Fact Check: Obama Mixing And Matching Insurance Stats
President Obama jumbled his facts when asked about "skyrocketing" premiums for people who get insurance through work. He was correct to say that, generally, the Affordable Care Act isn't to blame for "skyrocketing" employer-sponsored premiums, but he made two dubious claims to back up his argument (Farley and Robertson, 3/18).

In North Carolina, lawmakers are scrutinizing the impact of the overhaul -

The Associated Press: NC Legislators Look At Health Care Law's Effects
Legislators heard and offered divergent perspectives Tuesday on the federal health care overhaul's effectiveness in North Carolina as a new committee met and revisited debates in Raleigh on the Affordable Care Act. House Speaker Thom Tillis, R-Mecklenburg, and Senate leader Phil Berger, R-Rockingham, created the 46-member committee to examine the effects the law's requirements were having on businesses, individual and group insurance markets, and health care services (Robertson, 3/19).

North Carolina Health News: Obamacare Faces Scrutiny At Legislature
On Tuesday, lawmakers on a committee tasked with finding market-based solutions to health care problems started the day hearing suggestions on making the health care system more responsive to market forces. But as they talked about competition, experts called to educate legislators about the health care system invariably talked about how the Affordable Care Act (commonly referred to as Obamacare) is changing the marketplace (Hoban, 3/19).

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Capitol Hill Watch

RNC Chief Predicts GOP 'Tsunami' In Mid-Term Elections

Reince Priebus says the health law will tank Democratic candidates, while Republicans have made inroads with minorities and women since the 2012 presidential election.

The Washington Post: Republican Chairman Priebus Says Midterms Will Be 'Tsunami' Wave Election 
The Republican Party's chairman on Tuesday predicted a "tsunami" wave that would return the Senate to GOP control, arguing that President Obama and his signature health-care law had become "total poison" for Democratic candidates running in November's midterm elections. "I think we're in for a tsunami-type election in 2014," Republican National Committee Chairman Reince Priebus said. "My belief is that it's going to be a very big win, especially at the U.S. Senate level, and I think we may even add some seats in the congressional races" (Rucker, 3/18).

Politico: Reince Priebus Predicts 2014 GOP 'Tsunami'
Since last year's report, the RNC also has tried to improve the party's showings with groups including minorities, young people and women —all demographics with which the GOP stumbled significantly in 2012. "I'm just guessing here, but I think among youth and women, we're gonna see the greatest increase in 2014 because of, No. 1, Obamacare," Priebus said. "It's very, very, very personal among women losing your doctor, getting your insurance canceled." As he has argued before, he continued: "Then young people, Obamacare is intentionally designed to screw young people over. Actuaries sat down, decided, let's just screw over everyone 35 and younger. That’s what they did" (Glueck, 3/18).

The Wall Street Journal: Republican Candidates Big And Small Slam Health Law In Ads
Republicans running for office this year are going to great efforts to show their opposition to the 2010 health-care overhaul. But many of these candidates aren't vying for the chance to change the law from a seat in Congress. Instead, they are running for state legislatures, attorney general jobs—and in the case of Mr. Beeker, for a slot on a state public utility commission. The law known as Obamacare is being featured in television ads up and down the ticket, a measure of how potent the GOP believes the issue has become in motivating voters (Meckler, 3/18).

And in a sign that vulnerable Democrats are seeking to avoid controversy -

Fox News: White House Backs Off Surgeon General Nominee Push Amid Dem Resistance
The latest nominee facing trouble with Senate confirmation is Dr. Vivek Murthy, a Harvard Medical School physician and a strong political ally, tapped for the post of U.S. surgeon general. The White House is still backing its controversial nominee but acknowledges that officials are "recalibrating" their strategy -- amid vocal GOP opposition, waning support from Senate Democrats and concern about back-to-back defeats. ... The nominee is being targeted by the National Rifle Association for his support for gun control. Such opposition has created a tough situation for Senate Democrats facing re-election a year after the NRA led efforts to defeat Obama’s push for new firearms restrictions (3/19).

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House GOP Health Plan Still Long Way Off

Politico examines the difficulties for Republicans in Congress as they weigh offering a health reform plan. Meanwhile, The Fiscal Times highlights four fixes that would help the current law.

Politico: GOP Health Plan Could Be Road To Nowhere
Here's the dirty secret about the House Republicans' efforts to replace Obamacare: They haven't even decided if they will hold a vote. Not to mention, the House GOP would still have to repeal Obamacare in order to implement whatever alternative health care plan they release, which isn't going to happen as long as President Barack Obama is sitting in the Oval Office (Bresnahan and Sherman, 3/18).

The Fiscal Times: Four Ways To Help Fix Obamacare
Now that a few million Americans have gained health coverage through the new insurance exchanges, Republicans have shifted their Obamacare-strategy.  Instead of symbolically voting to repeal the law, the GOP is proposing "fixes" in order to satisfy voters ahead of the midterm elections. House Speaker John Boehner told reporters this week that the House GOP is working on an eight-to-10-point plan aimed at fixing the Affordable Care Act. Both Democrats and Republicans seem to agree that the law has issues that have had unintended consequences on families, businesses and the economy that need to be addressed -- including the millions of people whose plans were cancelled under the law last fall (Ehley, 3/19).

Meanwhile, N.J. Gov. Chris Christie is challenged on his actions on health care --

Politico: Christie, Obamacare Advocate Clash
Republican Gov. Chris Christie got into a testy exchange with an Affordable Care Act advocate at a town hall-style event in New Jersey on Tuesday, accusing her of misleading people about his position. Christie gained his reputation as a colorful straight-talker largely through interactions with critics like these -- but the potential White House hopeful has displayed that side less since a traffic scandal shook his administration earlier this year (Titus, 3/18).

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WellPoint Dips Toe Into Advising Providers On Managed Care

Other Medicare issues are examined: Observation care and cost to Medicare beneficiaries, hospice care and an experiment to give curative and palliative care at the same time.

The Wall Street Journal: WellPoint Advises Health Care Providers
WellPoint Inc. is pushing into the business of advising health care providers, with a deal between the insurer's CareMore unit and Emory Healthcare to jointly manage Medicare patients. CareMore will collaborate with Emory to revamp the care of the Atlanta nonprofit's private-plan Medicare patients, including people who will be covered by WellPoint's Blue Cross & Blue Shield of Georgia and also rival health plans. CareMore executives will help run the new joint operation, and Emory doctors and other health-care providers will implement a version of CareMore's clinical model (Mathews, 3/18).

The New York Times: When A Hospital Is Not A Stay
If you go to the emergency room and end up staying in the hospital, you may assume that you have been officially admitted. But it turns out that even though you are receiving treatment in a hospital bed, you may simply be under observation, and technically are still an outpatient. That can cost you money if you are covered under Medicare, the federal health plan for older Americans (Carrns, 3/18). 

Politico Pro: Medicare To Test New Approach To Hospice Care
Medicare will test a program to allow terminally ill people to get hospice and more aggressive care at the same time, a model long championed by advocates for better end-of-life care. Currently, people on Medicare can get hospice care if they have a life expectancy of six months or less, but many end up in hospice for only a few days, if that. The “either/or” approach -- hospice or aggressive care -- is widely seen as a barrier to hospice use. The new program will test the idea that “concurrent care” can expand patients’ choices, giving them the option of both palliative care and intense treatment without costing more (Kenen, 3/18).

Modern Healthcare: CMS Will Try Offering Hospice Patients Both Palliative, Curative Treatments
The CMS is moving forward with an experiment called for under the 2010 health reform law that will allow Medicare's hospice beneficiaries to get treatments aimed at helping them get better at the same time they get palliative care to help them die as comfortably as possible (Zigmond, 3/18).

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State Watch

State Highlights: Maine's Health Problems; Minn. Insurance Costs

A selection of health policy stories from Maine, Minnesota, Maryland, Missouri, Massachusetts, Georgia and Florida.

Stateline: Some States Lag In Using Electronic Health Records
Less than a decade ago, nine out of 10 U.S. doctors updated their patients’ records by hand and stored them in color-coded files. Today, nearly half of all office-based physicians type their clinical notes into computers and maintain electronic files that include patients’ demographic information, complaints, procedures, test results and prescribed drugs. This greater use of electronic health records is supposed to help doctors and hospitals better coordinate their patients’ care and allow them to meet the cost-containment goals in the Affordable Care Act. Nationwide, 48 percent of office-based doctors used electronic records in 2013, up from 40 percent in 2012 and 11 percent in 2006. While the doctors and hospitals in some states are forging ahead, in other states they are lagging behind (Vestal, 3/19).

Los Angeles Times: In Health Care, What Makes Maine Different? 
Many of the nation's healthiest communities are wealthy and have large numbers of college-educated residents. But northern Maine is among a handful of telling exceptions, making it an important guidepost as the country searches for ways to improve health. ... [N]orthern Maine ranks high on national measures of health, according to a yearlong review of health care data from communities around the country that The Times conducted with help from public health researchers (Levey, 3/19).

Minnesota Public Radio: Insurers, Doctors Warn Lawmakers: Don't Tinker With Insurance Rules To Aid SE Minn.
When the state's new health insurance marketplace posted premium rates last fall, southeast Minnesota stood out as the region with the highest costs and fewest coverage options. State lawmakers from Faribault to Winona want to change that. They're already hearing warnings, however, from insurers and doctors that tinkering with state rules that dictate how much insurance can cost and how distant doctors can be from their patients could drive health plans from the market and hurt care (Richert, 3/18).

The Washington Post: Number Of Staffers With Health Coverage Emerges As Issue In Race For Governor In Md.
In Maryland’s Democratic primary for governor, you’re more likely to be getting help with health insurance coverage if you work for the campaigns of Anthony Brown or Heather Mizeur than Doug Gansler. Brown, the state’s lieutenant governor, and Mizeur, a delegate from Montgomery County, both offer employer-sponsored plans to staff members on their gubernatorial campaigns. Seventeen of Brown’s 25 employees are covered, as are five of Mizeur’s 12 paid staffers, according to campaign spokesmen (Wagner, 3/18).

St. Louis Public Radio: The Doctor Shortage In Rural Missouri: Are Advanced Practice Nurses A Solution?
Lisa Schofield regards her business as an example of the future of health care in rural Missouri. ... In addition to having the second highest percentage of uninsured residents among all counties in the state, Ozark faces the usual problem of doctor access (Joiner, 3/18).

WBUR: Report: In Mass. Health Care, System Skewed So Rich Get Richer
A report released today by the Healthcare Equality and Affordability League (H.E.A.L.) -- a partnership between the for-profit Steward Health Care System and the union, 1199 SEIU United Healthcare Workers East -- finds that disparities in hospital costs and financing across the state are driving “a vicious cycle” of inequality in health care. The result, according to this analysis, is that medical care is becoming less affordable for lower-and middle-income families in Massachusetts, and the disparities in hospital financing are “compromising the viability of community hospitals.” The group is calling for new, and what they call more “fair” reimbursement rates so that poorer, community hospitals (with a greater proportion of Medicare and Medicaid patients compared to the higher-cost Boston teaching hospitals) can continue to serve the lower-income patients, among other financial recommendations (Zimmerman, 3/18).

Minnesota Public Radio: Mental Health Centers Abruptly Shut In East Central Minn.; Officials Scramble To Aid Clients
State and county officials are working to find a way to find care for people with mental illness in east central Minnesota after a major mental health care provider abruptly shut its doors Monday. Riverwood Centers closed its clinics and mobile crisis services. The nonprofit was the designated mental health provider for Chisago, Isanti and Pine counties and also provided crisis services to Kanabec and Mille Lacs counties. It's not clear how many people are affected (Helal, 3/18).

Minnesota Public Radio: Newborn Blood Sample Bill Clears House Hurdle
A bill that would allow the state health department to keep newborn blood samples and test results indefinitely cleared its final House committee today. The House Civil Law Committee narrowly approved the legislation on a 9 to 8 vote. Supporters say the legislation would help Minnesota rebuild its newborn screening archive. In January the health department was forced to destroy 1.1 million blood spot cards because the agency didn't have the authority to store them (Minor, 3/18).

The Atlanta Journal Constitution: Abortion Bill Passes Georgia Legislature
Legislation that would bar the state employee health insurance plan from covering abortions in most cases received final passage Tuesday from the Georgia Legislature, sending it to Gov. Nathan Deal for his signature. ... The bill makes no exception for rape or incest, only allowing consideration of a medical emergency involving the life of the mother (Torres, 3/18).

The Atlanta Journal Constitution: A Down-Sizing Of Rural Hospitals Seen As A Solution For Struggling Health Care Facilities
When state Rep. Sharon Cooper publicly mused in January about closing some rural hospitals because their communities are too small to support them, she may have unwittingly revived a discussion among state leaders about what to do with the facilities. Gov. Nathan Deal is set to speak at a rural caucus meeting at 12:30 p.m. today on the topic of healthcare. His office won’t comment on what he’ll say, but a meeting Department of Community Health meeting last week offers a hint. At the meeting, commissioner Clyde Reese said board members would soon be asked to approve a plan for a “step-down rural access for communities that have lost their hospitals.” That could clear the way for struggling hospitals, or even those recently shuttered, to more easily drop expensive offerings and scale back to limited services such as emergency care (Bluestein, 3/19).

Georgia Health News: A Health Care Q&A With Gov. Deal
Nathan Deal has been involved in many high-profile decisions on health care while serving as Georgia’s governor. Deal, who is running for re-election this year, has staked out his opposition to the Affordable Care Act (often called Obamacare) and to expanding the state’s Medicaid program. He has also supported changes to the health plan covering state employees and educators, following a wave of criticism that occurred after a new benefits framework debuted Jan. 1.Georgia Health News recently emailed questions to Deal on a wide range of  major health care issues in the state. We received his reply Monday,  shortly before the scheduled close of the 2014 General Assembly (Miller, 3/18).

Georgia Health News: Senate Hopefuls Share Views On Health Care
How do the U.S. Senate candidates in Georgia differ on covering the uninsured? What are their ideas for improving health outcomes while controlling costs? What would the candidates do about decreased federal funding for Georgia hospitals? Seven candidates for the Senate seat in 2014 answer these and other health care questions in a newly released election guide from Healthcare Georgia Foundation (Miller, 3/18).

Georgia Health News: 39th Day: Votes On Medicaid, Drug Tests, Abortion
An anti-Obamacare bill that appeared dead in the Senate apparently still had a pulse late Tuesday afternoon, the 39th and penultimate day of the 2014 General Assembly session. But another bill targeting an Affordable Care Act provision passed the Senate as expected and now moves to Gov. Nathan Deal for his signature.That second bill, HB 990, would require legislative approval of any expansion of Medicaid in Georgia. The bill is sponsored by House Speaker Pro Tempore Jan Jones (R-Milton), who has argued that Georgia can’t afford Medicaid coverage for hundreds of thousands of uninsured residents under expansion, as outlined by the ACA (Craig, 3/18).

The Associated Press: Assisted-Living Facilities Face New Scrutiny
The public could read anonymously posted reviews and complaints of assisted-living facilities and owners of such facilities would face higher fines for repeated serious violations under a measure passed unanimously by the [Florida] Senate on Tuesday. Senate Bill 248 also requires increased licensing for homes that handle mentally impaired residents and requires a rating system be in place for assisted-living facilities by March 2015 (Miller, 3/18).

Minn Post: Late-In-Life Care: Fragmentation And Complexity For The Chronically Ill
If this day is typical, 106 Minnesotans will die before midnight. Of those passings, 16 will be unexpected. Most of the other 90, though, will represent the sad culmination of lingering diseases (Schmickle, 3/18).

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Editorials and Opinions

Viewpoints: Supreme Court On Religion And Health; A GOP Senate's Effect On Health Law; Where Are The Young Adults?

USA Today: Obamacare Challenge Could Empower Discriminators 
Should corporations have the right to get out of obeying federal law and refuse services and deny health care coverage to some people because of the corporate owners' religious beliefs? That's the question the U.S. Supreme Court is weighing this month – and the answer could affect millions of Americans' everyday lives (Cecile Richards and Chad Griffin, 3/18).

Los Angeles Times: Obamacare And Religious Rights In A For-Profit World
Next week, the Supreme Court will hear arguments on whether the Affordable Care Act's contraception mandate — the requirement that employers provide employee health insurance that covers contraception — impermissibly infringes on the religious liberty of religiously motivated corporations. The legal battles over the mandate have been legion; more than 300 plaintiffs have field more than 90 cases across the country, all contending that providing health coverage for contraception would require them to violate their faith (Michael A. Helfand, 3/18). 

Bloomberg: Can Republicans Kill Obamacare If They Win the Senate?
With Republicans running both sides of Congress, Obamacare would receive no discretionary funding. Indeed, funding for key aspects of the law's implementation has already been spent down or restricted by congressional action. That's not fatal. The law's mandatory funding -- mostly Medicaid expansion and tax credits to help consumers buy insurance on the exchanges -- can't be stripped out by a hostile Congress. In addition, the user fees ..., which will be paid by insurance companies to the health care exchanges, will probably yield at least hundreds of millions of dollars. And Barack Obama presumably will rely on one more thing: a new constituency of millions of Americans who are insured through Obamacare and won't want to lose their subsidized health care (Francis Wilkinson, 3/18).

The Washington Post's Right Turn: What's A Democrat To Do?
Multiple presidential campaign loser Robert Shrum intones: "[Alex] Sink didn't lose because of Obamacare. . . . Obamacare's numbers are getting better and better — in both public opinion and enrollments. Democrats have the specifics on their side." Hmm. Actually support for Obamacare is pretty weak, especially in the red states in which many vulnerable Democrats must operate (Jennifer Rubin, 3/18).

The Washington Post's The Plum Line: What The Obamacare Enrollment Numbers Mean
The Obama administration announced late yesterday that 800,000 people have signed up for new health insurance so far in March. That brings the total under the Affordable Care Act to over 5 million and makes it likely that 6 million will have enrolled by March 31, the last day to sign up before getting a fine. That 6 million number would meet a projection made by the Congressional Budget Office. So what are we to make of those numbers? (Paul Waldman, 3/18). 

The Washington Post: President Uses March Madness To Sell People On Health Care Before The Buzzer
But the Obama administration is using the excitement over the brackets for the NCAA basketball tournament to sell people on the Affordable Care Act and get them covered at HealthCare.gov before the end of open enrollment on March 31 (Michelle Singletary, 3/18). 

Bloomberg: March Madness Opens Door To Political Madness
You may notice something a little different about this year’s March Madness, a little something extra. In addition to all of the buzzer-beating, bracket-busting action, you're going to be hearing a lot about Obamacare, the fate of which is also going down to the wire (Jonathan Mahler, 3/18).

Bloomberg: Young Invincibles Are Killing Obamacare
As the clock ticks down to the end of open enrollment for health coverage, one thing is becoming clearer: what the final demographics will look like. Demographics matter a lot because they will help determine whether the health insurance market goes into a death spiral (or requires hefty federal subsidies to keep it from doing so). Young healthy people, and a lot of them, are needed to keep the market stable and premiums low. As we head into the final few weeks, we have a pretty good idea of how many young healthy people there will be, and the answer is: a whole lot fewer than the health-care wonks were expecting (Megan McArdle, 3/18).

The Fiscal Times: A Procrastinator's Guide To Picking An Obamacare Plan
The final enrollment deadline for getting Obamacare coverage this year is coming up at the end of March. If you're still thinking about signing up, or plan to, you're going to need to do some math. Of course, nobody likes doing the gnarly math when picking an insurance policy. It would be great if the Obamacare exchanges all offered a flexible calculator to do this, but they don't, so you have to crunch the numbers on your own (John F. Wasik, 3/19).

The Tennessean: Good, Affordable Health Insurance Is Here
Right now, 800,000 uninsured Tennesseans have an incredible opportunity before them, one that was unavailable just six months ago. The health insurance marketplace offers quality, affordable coverage to uninsured and underinsured Tennesseans, but only two weeks remain to enroll. As the mayors of Tennessee’s four largest cities, we're coming together because we want to see our own residents — and folks all over the state — take advantage of these benefits by getting covered (Nashville Mayor Karl Dean, Chattanooga Mayor Andy Berke, Knoxville Mayor Madeline Rogero and Memphis Mayor A.C. Wharton Jr., 3/16).

The Witchita (Kan.) Eagle: Bring Medicaid Money Back To State
It is true: There is no such thing as free money. ... In 2013 and 2014, Kansans will have contributed $161.7 million in "pay-fors" for Medicaid expansion. These "pay-fors" will continue whether or not our state decides to expand Medicaid. These "pay-fors" come in the form of Medicare cuts to hospitals and providers, insurance provider fees and, in the future, employer penalties. We all are affected by these losses to our state. ... Kansas hospitals as well as 72 percent of Kansans (according to a recent poll by the American Cancer Society) would like to see our money returned to Kansas to cover more of the uninsured, and not go to states like California, Colorado and Ohio (Tom Bell, 3/19).

Lincoln (Neb.) Journal Star: Fiscal Conservatives Should Support Medicaid Expansion
I would suggest its time for fiscal conservatives to support LB887. The proposed Wellness in Nebraska Act, LB887, is our state’s version of Medicaid expansion. ... Medicaid expansion under LB887 will have a total net cost to Nebraska taxpayers of just over $62 million in general and cash funds, while ensuring health care for an additional 65,000 Nebraskans by 2020. But during that same period, the fiscal note indicates that LB887 will result in the Federal government injecting almost $2.2 billion into the Nebraska economy to help fund the program. ... fiscal conservatives should want to recoup these dollars (Tom Briese, 3/19). 

And on other health issues -

WBUR: Doctors 'Aghast' That Surgeon General Nominee Blocked For Gun Control Views
In another time and place, a nominee like Dr. Vivek Murthy, with a narrative so akin to conservative politicians like Sens. Ted Cruz and Marco Rubio, would sail through Senate confirmation as the nation's surgeon general. But in our time and place, special interest groups have hijacked Dr. Murthy's nomination, as they have the entirety of the American political process. As physicians and students of public service, we are aghast (Ali Khan, Sanjay Kishore and Christopher Lillis, 3/18).

The Journal of the American Medical Association: Transforming From Centers Of Learning To Learning Health Systems
Society needs academic health centers to train the next generation of health professionals and advance scientific knowledge and its application to improve health. Academic health centers must become more attentive to patient-centeredness, population health, and health care value. As centers of learning, academic health centers should accept the challenge to become exemplars of learning health systems and transform practices at their own institutions under a unified mission to improve health and health care through advancing, applying, and disseminating knowledge (Drs. Kevin Grumbach, Catherine R. Lucey and S. Claiborne Johnston, 3/18).

The Journal of the American Medical Association: Breaking Good
A patient recently complained to me that her oncologist never called to let her know her test results. ... When I asked my associate about it, he said, "As a matter of policy, I call back only if results are abnormal." Did he inform the patient of policy? ... I found this "policy" to be not only insensitive toward patients but also self-defeating for physicians. They forfeit opportunities to savor positive moments, reduce risk of burnout, and capture professional highs. Giving good news can also be a make-or-break process in the evolution of patient-physician relationships and it, too, isn't easy. As we return to the long-neglected emotional underpinnings of medicine, our profession will achieve new insights into the science of communicating. The good news is we're learning. Now the question: how do we communicate that good news so that all can clearly hear (Dr. Benjamin W. Corn, 3/18).

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Stephanie Stapleton

Andrew Villegas

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Shefali Luthra

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