Daily Health Policy Report

Thursday, March 20, 2014

Last updated: Thu, Mar 20

KHN Original Reporting & Guest Opinion

Health Reform

Public Health & Education

Health Care Marketplace

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Justices To Weigh Contraceptive Mandate Against Religious Freedom Claims

Writing for Kaiser Health News in collaboration with The Daily Beast, Stuart Taylor Jr. details the upcoming Supreme Court action regarding the birth control coverage mandate: "The Affordable Care Act, which the Supreme Court partially upheld in 2012 when it issued one of the most important decisions in decades, has spawned more litigation -- topped by two consolidated cases that could become the justices' biggest ruling on religious liberty in years" (Taylor Jr., 3/20). Read the story.

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Political Cartoon: 'My Experience With Obamacare'

Kaiser Health News provides a fresh take on health policy developments with "My Experience With Obamacare" by Jen Sorensen.

And here's today's health policy haiku:


The first day of spring
means winter weather soon ends...
but not health law fights.

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

High Court To Hear Religious Freedom Challenge To Contraceptive Mandate

The health law returns to the Supreme Court next week when justices consider a challenge by two companies seeking relief from the contraceptive coverage requirement.

USA Today: Religious Challenge To Health Care Law Hits High Court
President Obama's health care law gets a return engagement at the Supreme Court next week in a case full of hot-button issues: religious freedom, corporate rights, federal regulation, abortion and contraception. Put another way, it's a case about God, money, power, sex — and Obamacare (Wolf, 3/19).

Bloomberg: God Meets Profit In Obama Contraceptive Rule Court Case
Hobby Lobby Stores Inc.’s 600 U.S. craft shops close each Sunday, posting a notice that employees are spending the day with their families and at worship. It’s a visible sign that the company is as focused on honoring God as it is on making money. That dual mission is at the core of an ideological showdown over President Barack Obama’s health-care law, set for argument before the U.S. Supreme Court next week. Hobby Lobby, a family-owned business that says it looks to the Bible for guidance, is seeking a religious exemption from the requirement that employers cover birth control as part of worker-insurance plans (Stohr, 3/20).

Kaiser Health News: Justices To Weigh Contraceptive Mandate Against Religious Freedom Claims
The Affordable Care Act, which the Supreme Court partially upheld in 2012 when it issued one of the most important decisions in decades, has spawned more litigation -- topped by two consolidated cases that could become the justices' biggest ruling on religious liberty in years (Taylor Jr., 3/20).

A new poll explores public opinion on the question -

NBC News: Poll: Majority Opposes Employers Opting Out Of Contraception Mandate
Ahead of next week's oral arguments before the U.S. Supreme Court, a majority of Americans oppose allowing employers to opt out from the health-care law's contraception requirement, according to the most recent NBC News/Wall Street Journal poll. Fifty-three percent say employers should not be exempt from the requirement that their health plans offer birth control and other contraceptives even if they have religious objections, while 41 percent say they should be exempt. On Tuesday, the U.S. Supreme Court will hear oral arguments in a case -- Sebelius vs. Hobby Lobby Stores -- to decide if for-profit companies like Hobby Lobby can refuse to offer mandated contraception coverage to its employees due to the owner's religious beliefs (Murray, 3/19).

Meanwhile,  Republicans say the administration overstepped its authority on another health law provision -

The Wall Street Journal: Republicans Challenge Administration's Authority
Republicans are pointing to statements by a top Treasury Department official as evidence that the Obama administration overstepped its authority in delaying the health-care law's requirement that employers offer coverage or pay a penalty. Mark Mazur, assistant Treasury secretary for tax policy, said in a January interview with staff from the GOP-led House Oversight and Government Reform Committee that he wasn't aware of any examination of the legal basis for the administration's authority to delay the employer mandate (Radnofsky, 3/19).

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Obama Uses March Madness To Pitch Health Law Enrollment

The president ties his NCAA picks to a campaign aimed at enrolling young people in health insurance before the March 31 deadline.

The New York Times: Administration Plays to Young In Health Push
Russian troops were rolling through Crimea when Denis R. McDonough, the White House chief of staff and a foreign policy expert, was deployed on a mission to do media outreach. But the focus of Mr. McDonough’s calls to local talk radio stations was not geopolitical tensions in Eastern Europe, it was health care. Mr. McDonough chatted with Andy Baskin and Jeff Phelps, hosts of a popular sports talk radio program on WKRK-FM (92.3) in Cleveland, about the coming N.F.L. draft, basketball at the White House and his days playing college football in Minnesota. Mr. McDonough then pitched a new website featuring games, videos and superstar athletes explaining the benefits of health insurance: a sports-themed portal to healthcare.gov (Shear and Vega, 3/19).

NPR: In ACA March Madness, Obama's Bracket Is Just A Role Player
In an annual ritual, President Obama filled out his NCAA tournament bracket. Beyond his picks, though, he's got an ulterior motive -- convincing young people to enroll in health care exchanges (Horsley, 3/19).

NBC News: First Thoughts: Obama Touts Sweet 16 In Last Health Care Push
With now 12 days to go until the deadline for all Americans to have health insurance, the Obama White House is making a health-care push that appears targeted specifically to young men. For starters, President Obama’s NCAA bracket today will be featured on the White House’s website, which will be counting down the “16 Sweetest Reasons to Get Covered.” The president tying his NCAA picks to the health-care push comes as the White House already has basketball coaches Roy Williams and Geno Auriemma promoting the importance of obtaining coverage. NBA superstar Kevin Durant is tweeting the same message. And the White House is advertising on NBA.com. Bottom line: This is all about signing up as many more Americans -- especially men under 35 -- under the federal and state health-care exchanges (Todd and Murray, 3/19).

Fox News: Sen. Wicker Blasts Obamacare Push During NCAA Tournament
Sen. Roger Wicker, R-Miss., on Wednesday slammed the Obama administration’s decision to advertise Obamacare during the NCAA basketball tournament. “This is yet another desperate attempt by the administration to persuade young people to enroll in the president’s unaffordable, unworkable, and unpopular policy,” Wicker said in a statement. “Rather than spending an inordinate amount of time and taxpayer dollars to roll out celebrity endorsements and slick advertisements, the president should work with Republicans to find real market-driven solutions to America’s health care crisis” (3/19).

CQ HealthBeat: White House Wagers March Madness Tie-In Will Drive Interest in Health Law
The White House may attract more young people to healthcare.gov with an aggressive marketing campaign linked to the NCAA men’s basketball tournament, but it’s unclear how many more will sign up for insurance as a result of the March Madness tie-in, three researchers said. “There will be some who go on the site and explore some of the reasons to get coverage,” said Matthew J. Bernthal, an associate professor in the department of sport and entertainment management at the University of South Carolina, adding that challenges remain even beyond ideological arguments about the new health insurance programs (Young, 3/19).

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Higher Insurance Premiums Forecast For 2015

With less than two weeks to go in open enrollment, analysts size up the likelihood of reaching signup targets for young people and worry about the impact of that and other factors on 2015 premiums for exchange plans. The role of insurance brokers is also examined.

Bloomberg: Obamacare's Young Healthy Target Is Slipping Away
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 (McArdle, 3/19).

The Fiscal Times: Insurers On Obamacare: Expect Premium Prices To Soar
Health insurance premiums will likely skyrocket next year, despite the Obama administration’s consistent assurance that consumers will not experience sticker shock under the president’s health care law. That’s according to industry insiders who told The Hill that they are expecting the price of monthly premiums to increase significantly. In some states, rates could increase by as much as 300 percent (Ehley, 3/19).

Marketplace: Where Obamacare Is Shunned, Insurance Brokers Step In
Uninsured people only have until the end of the month to buy coverage under the Affordable Care Act if they want to avoid the new penalty for not having health insurance. In states where politicians are dead set against Obamacare, the task of getting people enrolled is falling to a group that's only too happy to help -- private insurance agents. Despite having one of the highest rates of uninsured people in the nation, Georgia is no friend to the Affordable Care Act. Recently, the state House passed the “Georgia Health Care Freedom and ACA Noncompliance Act” by Republican State Rep. Jason Spencer (Ragusea, 3/19).

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Medicaid Expansion Compromise Fails In Nebraska Legislature

This "carefully crafted" approach fell short of the needed support, but its backers vow to return next year with a new proposal. News outlets also provide updates on expansion efforts in Nevada, Virginia and Ohio.  

The Washington Post’s Wonkblog: Nebraska Rejects Compromise Effort To Expand Medicaid
Nebraska legislators spent the past year crafting a conservative version of Obamacare’s Medicaid expansion that they hoped would gain support in a pretty red state. But after a failed vote in the state legislature Wednesday, the Medicaid expansion is officially dead in Nebraska this year. So far, 25 states and Washington, DC.., have expanded their Medicaid programs in 2014, the first year of Obamacare coverage. With some exceptions, these are mostly blue states that joined the expansion, which was made optional by the Supreme Court’s 2012 decision on the health care law (Millman, 3/19).

Lincoln (Neb.) Journal Star: Supporters Short Of Votes To Expand Medicaid
A change in a Medicaid expansion proposal from last year had given Lincoln Sen. Kathy Campbell hope. It included elements supporters thought last year's opponents wanted. And it was tailored for Nebraska. But this year's bill (LB887) didn't persuade any more senators to join the supporters' inner circle. In fact, a few may have sidled away. An attempt to force a vote on the bill Wednesday morning fizzled 27-21. Thirty-three votes were needed. Only 25 would have been needed to move the bill forward without the filibuster (Young, 3/19).

Omaha World-Herald: Effort To Expand Health Coverage To More Low-Income Nebraskans Dead For The Year
An effort to expand government-funded health coverage to more low-income Nebraskans is dead for this year. But legislative supporters were only temporarily deterred. After failing to end a filibuster Wednesday on the expansion proposal, key senators vowed to return with a new proposal next session (Stoddard, 3/20).

The Associated Press/Washington Post: No Sign Of Movement On Medicaid Debate
There’s still no sign of any compromise between Democratic Gov. Terry McAuliffe and Republican leaders in the House of Delegates over whether Virginia should accept federal Medicaid funds in order to expand health insurance coverage to as many as 400,000 low-income residents. McAuliffe, who wants to expand Medicaid eligibility, and House Republican leaders, who don’t, said Wednesday that there had been no movement on the issue after meeting to discuss an upcoming special legislative session (3/19).

The Associated Press: Nevada Medicaid Enrollments Soar
Nevada Medicaid enrollments under federal health care reform have surpassed initial projections and are on pace to reach 500,000 by summer, a mark initially not expected to be reached until the end of the 2015 fiscal year, a state official said. Mike Willden, director of the Department of Health and Human Services, said his agency has a 60,000 backlog of pending Medicaid applications and he may need to speed up hiring to keep up with the demand (Chereb, 3/19).

Columbus Dispatch: Obamacare Website Snafus Slowing Ohio Medicaid Sign-Ups
Since Ohio decided to expand Medicaid under the federal health-care law last fall, 200,000 low-income residents have applied for coverage. Three-fourths of the requests were submitted in the past two months, as the March 31 deadline nears for signing up for insurance under the health-care law. Ohio Medicaid spokesman Sam Rossi said 80 percent of the applications have been processed. However, county caseworkers have not been able to process any of the additional 106,000 applications submitted to the problem-ridden federal online exchange, Healthcare.gov, that seem to meet eligibility requirements. They were supposed to be transferred electronically to the state, but the federal system still has not worked as intended (Candisky, 3/20).

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State Exchanges Report Stepped Up Activity As Sign-Up Deadline Nears

According to The Denver Post, Colorado's marketplace is seeing an acceleration in the rate of enrollment, hile the Los Angeles Times highlights specific outreach efforts as the clock ticks toward March 31. In Oregon, though, the countdown is on for the release of a report detailing what went wrong. And, in Connecticut, GOP state legislators want to know any of the consumers using the state's online portal were previously uninsured.   

The Denver Post: Colorado Health Insurance Sign-Ups Gaining Momentum As Deadline Nears
With less than two weeks left before the deadline, the rate of health-insurance enrollment has been accelerating, with more than 251,000 Coloradans having signed up for health coverage, state officials announced Tuesday. Connect for Health Colorado, the nonprofit health insurance marketplace established by state law, reported that 100,112 residents have signed up for private health insurance (Draper, 3/19).

Los Angeles Times: Clinic Chain AltaMed Is Signing Up Latinos For Obamacare
Much of the activity is centered at its two enrollment offices in East L.A. and Santa Ana, where people often line up in the morning before the doors open at 8 a.m. Overall, AltaMed has nearly 120 enrollment counselors. Health plan sign-ups end March 31, and enrollment doesn't reopen until November. The clinic's roots go back 45 years, and it has become a trusted name in the communities it serves (Karlamangla and Terhune, 3/19).

The Oregonian: The State's Cover Oregon Health Insurance Exchange Review Is Expected Soon
The consulting firm hired by Gov. John Kitzhaber to review what went wrong with the Cover Oregon health insurance exchange debacle has completed its report, which should be released as early as Wednesday or Thursday, officials say. As the public awaits the report, conducted by Atlanta-based First Data, here's some background on the Kitzhaber-initiated review of how the exchange went off the rails. On Dec. 13, Kitzhaber's office announced "initial steps for an independent review of every stage of the development of the Cover Oregon website” (Budnick, 3/19).

The CT Mirror: CT GOP Wants To Know How Many Exchange Customers Were Uninsured
Thursday is the deadline for the legislature’s Insurance and Real Estate Committee to move forward its proposals for this session. Among the measures still awaiting action is a controversial bill that would require the state’s health insurance exchange, Access Health CT, to report on the number of enrollees who were previously uninsured. The proposal would require the exchange to provide legislators with monthly reports on enrollment. ... The extent to which the exchange is covering the uninsured or attracting customers who had other insurance plans in the past has been a sticking point for exchange critics (Becker, 3/19).

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Across Races, Republican Candidates Use Health Law Issues In Their Ads

The health law, however, is part of an ongoing debate among some GOP strategists on the best paths going forward.    

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 (Meckler, 3/19).

The Wall Street Journal: Republican Strategists Split: Focus On 2014 Or 2016?
Some Republicans argue that with President Barack Obama's poll numbers sinking and his health-care law unpopular, the party is on course for big House and Senate gains this fall. The worst thing the party could do, they say, is to take up contentious matters such as an immigration overhaul or some social issues, which would divide the party and could prompt GOP voters to stay home. But others say the party has become too risk-averse. It needs to take steps now, they say, to reverse the party's losing record in the popular vote in five of the last six presidential elections and start appealing to the more diverse electorate that will turn out for the 2016 election (Meckler and Reinhard, 3/19).

Also in the news, Medicare Advantage ads -

USA Today: Reports, Experts Dispute Medicare Advantage Ads
Claims made in a recent series of TV ads by the trade group for American insurance companies are disputed by the chief federal Medicare watchdog organization and the companies' own corporate filings, a USA TODAY analysis shows (Kennedy, 3/19).

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Public Health & Education

Study Finds New Heart Guidelines Would Put About Half Of Older Adults On Statins

The New England Journal of Medicine study is the first independent assessment of guidelines released last fall on the use of the heart medications, and it shows 56 million people between the ages of 40 and 75 are eligible for the treatment.

Reuters: New Heart Guidelines May Put 12.8 Million More Americans On Statins 
New guidelines on heart health that sparked fierce debate among U.S. cardiologists last fall could lead 12.8 million more Americans to take cholesterol-lowering statin drugs, U.S. researchers said on Wednesday. The new estimate would mean 56 million people, or nearly half of the U.S. population between the ages of 40 to 75, could be eligible for taking a statin to prevent heart disease (Steenhuysen, 3/19).

The Associated Press: Half Of US Adults 40 To 75 Eligible For Statins
It's the first independent look at the impact of the guidelines issued in November and shows how dramatically they shift more people toward treatment. Supporters say they reveal the true scope of heart risks in America. Critics have said the guidelines overreach by suggesting medications such as Zocor and Lipitor for such a broad swath of the population (Marchione, 3/19).

USA Today: Millions More Would Get Statins Based On New Guidelines
A study published Wednesday by the New England Journal of Medicine found that the guidelines, released in November, would add nearly 13 million people to those already receiving or eligible for statins. Among people aged 60-75, 87% of men (up from 30% now) and 53% of women (up from 21% now) should take statins if they aren't already, the analysis found. Basically, the guidelines imply "if you're a 60- to 75-year-old man and not on a statin, you should go get one, and every other woman of this age should get one," said Michael Pencina, director of biostatistics at the Duke Clinical Research Institute in Durham, N.C. Pencina led the new study, which examined data from more than 3,700 people nationwide (Weintraub, 3/20).

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Health Care Marketplace

Advertisement For Pricey Surgical Robot Violated University Policies

Propublica/NPR: Ad For Surgical Robot Violated University Of Illinois Policies
An internal review by the University of Illinois has found that an advertisement in which a university surgical team endorsed a pricey surgical robot violated school policies. Though the team acted "in good faith," the review concluded, the episode pointed to the need for clearer rules and stronger enforcement (Ornstein, 3/19).

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State Watch

State Highlights: N.Y. Veterans' Benefits; Ga. Rural Hospital Deal

A selection of health policy stories from New York, Georgia, Maryland, Minnesota and Colorado.

The Associated Press/Wall Street Journal: NY Audit Faults Referrals For Veterans’ Benefits
New York auditors say poor coordination of health benefits for military veterans by local social services departments and the state health department has resulted in many veterans placed in the state's Medicaid program rather than federal programs (3/20).

The Atlanta Journal Constitution: Gov. Deal Endorses Plan Aimed At Keeping More Rural Hospitals Open
Struggling hospitals could scale back their services under a plan unveiled Wednesday by Gov. Nathan Deal meant to help rural communities keep healthcare facilities open. Deal’s plan involves a “step-down” that clears the way for ailing hospitals, and those that were recently shuttered, to offer only more limited services such as emergency care. “Communities should not have to go without crucial services – many of them life-saving – simply because they don’t fall within a certain zip code,” said Deal (Bluestein, 3/19).

Georgia Health News: Deal Plan Would Allow Rural Mini-Hospitals
In the wake of some recent closures of rural Georgia hospitals, Gov. Nathan Deal announced Wednesday an initiative to help such facilities survive tough financial times. Deal, speaking to the Rural Caucus of the General Assembly, said he is proposing a change in licensure rules that would allow a struggling rural hospital — or one that has recently closed — to offer downsized services that would include an emergency department. Such a facility could also provide childbirth services and some kinds of elective surgery, he said (Miller, 3/19). 

Georgia Health News: Anti-ACA Bill Gets Late-Night Approval 
An anti-Obamacare bill that appeared to have died in the Georgia Senate was revived late Tuesday night and now heads to Gov. Nathan Deal’s desk to become law. HB 707 had captured the attention of the health care industry, policy experts and consumer advocates throughout this year’s General Assembly session. The legislation would prohibit Georgia employees of any state unit from spending state funds to advocate for the Affordable Care Act’s Medicaid expansion provision, and would eventually halt the navigator program run by the University of Georgia (Miller and Craig, 3/19).

The Washington Post: Md. Senate Chair Seeks Pay Raise For Workers Who Care For Developmentally Disabled
The chairman of a key Maryland Senate Committee said Wednesday that he does not plan to act on a bill to raise the minimum wage until a related issue is resolved involving the way the state reimburses workers who care for the developmentally disabled. Sen. Thomas M. Middleton (D-Charles) made his comment during the latest in a series of work sessions his committee has held as it attempts to craft its version of a minimum wage bill, which Gov. Martin O’Malley (D) has said is his top legislative priority this year (Wagner, 3/20).

Minn Post: Minnesota's 'Health Care Homes' Aim To Fill Gaps In Support For Late-In-Life Patients
As the giant boomer cohort of Americans begins to reach senior status, neither individuals nor the disparate components of the U.S. medical system have fully prepared for a new reality: People can expect to live far longer than their forebears. And as they age, patients frequently will need years of coordinated care and support services before they enter the end stage of life (Schmickle, 3/19).

Health News Colorado: Health Officials Want Go-Ahead For $10 Million In Pot Research
Colorado’s health department could begin funding $10 million in marijuana research by next year if a bill to authorize new studies passes the Colorado legislature this spring. The unconventional research of what has long been an illegal drug would aim to determine whether pot has health benefits or harms people. One of the highest priorities for the Colorado Department of Public Health and Environment is to learn whether marijuana can help children who suffer from seizures and whether there are any harmful side effects (McCrimmon, 3/19).

Health News Colorado: Vaccine Supporters Deploy Moms, Want Immunization Grades At Schools
Mobilizing moms may be the secret to boosting Colorado’s dismal immunization rates. Anti-vaccine activists long have been well organized and aggressively share their concerns about vaccines, despite an outcry from scientists that research does not support those fears. Now public health advocates who support immunizations are trying to light a fire under ambivalent parents by hitting them where they hang out: at their kids’ schools (McCrimmon, 3/19).

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Weekend Reading

Longer Looks: The Politics of Face And Hand Transplants; Apple's Healthbook

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

The New York Times: Income Gap, Meet The Longevity Gap
Fairfax County, Va., and McDowell County, W.Va., are separated by 350 miles, about a half-day’s drive. Traveling west from Fairfax County, the gated communities and bland architecture of military contractors give way to exurbs, then to farmland and eventually to McDowell’s coal mines and the forested slopes of the Appalachians. Perhaps the greatest distance between the two counties is this: Fairfax is a place of the haves, and McDowell of the have-nots. ... One of the starkest consequences of that divide is seen in the life expectancies of the people there. Residents of Fairfax County are among the longest-lived in the country: Men have an average life expectancy of 82 years and women, 85, about the same as in Sweden. In McDowell, the averages are 64 and 73, about the same as in Iraq (Annie Lowrey, 3/15).

The Boston Globe: The Future Of Face And Hand Transplants
Transplant leaders are debating national rules for the distribution of deceased donors' faces and hands, tackling ethically challenging questions such as which disfigured patients across the country should get priority for these surgeries as they become more common. The thorny issues are likely to include whether certain patients, such as children or the most severely maimed, should go to the top of waiting lists for donor faces and hands. The organization that oversees kidney, liver, heart, and lung transplants in the United States has assembled 18 industry leaders, including two from Boston, to recommend policies for faces and hands, a step that signals mainstream medicine’s growing acceptance of these once-futuristic operations (Liz Kowalczyk, 3/17). 

The Atlantic: Life Of A Police Officer: Medically And Psychologically Ruinous
It was 1995, and for the next 19 years, Brian [Post] would blame himself for not being closer to Whispering Pines, for not saving Sangeeta [Lal, who was killed by an abusive ex-boyfriend]. Brian was 31 when she was killed, and had been an officer for five years. "She was in the worst environment, and she was trying," said Brian, now 50. "You never know when you've saved a life, but you know when you've lost one." Sangeeta’s death marked the beginning of a downward spiral in Brian's health, spurred on by a psychologically and physically challenging law enforcement career. Brian had been a healthy and fit ex-airborne infantry soldier when he began his policing career. But he eventually developed hypertension, anxiety, peripheral neuropathy, hearing loss, arthritis, and post-traumatic stress disorder (Erika Hayasaki, 3/17).  

9 To 5 Mac: This Is Healthbook, Apple’s Major First Step Into Health & Fitness Tracking
Seven years out from the original iPhone's introduction, and four years past the iPad's launch, Apple has found its next market ripe for reinvention: the mobile healthcare and fitness-tracking industry. Apple’s interest in healthcare and fitness tracking will be displayed in an iOS application codenamed Healthbook. I first wrote about Apple’s plans for Healthbook in January, and multiple sources working directly on the initiative’s development have since provided new details and images of Healthbook that provide a clearer view of Apple’s plans for dramatically transforming the mobile healthcare and fitness-tracking space (Mark Gurman, 3/17).

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Editorials and Opinions

Viewpoints: Romneycare And Cutting Workers; Fla.'s Surprising Ruling On Malpractice Reform

The New York Times: 'Romneycare' And The 29ers
Health reform in Massachusetts in 2006 did not cause many workers to have their work hours cut, but that is no comfort for those workers nationwide who will begin to experience this side effect of the federal Affordable Care Act (Casey B. Mulligan, 3/19). 

Los Angeles Times: Sanity On 'Malpractice Reform' – From Florida, Of All Places
"Tort reform"--read that as "shutting the courthouse door to malpractice victims"--again is rearing its ugly head as a means to reduce healthcare costs, most recently as a plank in the recent GOP healthcare proposals. So it's refreshing to see the rationales for malpractice reforms authoritatively eviscerated, and even more refreshing to see that done by the heavily Republican Supreme Court of Florida (Michael Hiltzik, 3/19). 

The Washington Post: HHS, Playing Selective With Obamacare Enrollment Numbers
The federal Department of Health & Human Services (HHS) scored on Monday with a cheery press release on Obamacare. "Marketplace Enrollment Hits 5 Million Milestone," noted the release .... The HHS announcement had an improvisational, ad hoc feel to it. Unlike the more comprehensive monthly Obamacare reports, it was more of an update, a celebration of a key milestone in the drive to promote Obamacare. ... In other words, precisely the sort of incremental disclosures that HHS officials months ago said they wouldn't be providing (Eric Wemple, 3/19). 

The Washington Post: James Blumstein On Halbig V. Sebilius
Next week, the U.S. Court of Appeals for the D.C. Circuit will hear oral arguments in Halbig v. Sebelius, a challenge to the legality of an IRS rule purporting to authorize tax credits and cost-sharing subsidies in federal exchanges. Below is a brief commentary on the issues in Halbig by James F. Blumstein, university professor of constitutional law and health law and policy and director of the Health Policy Center at Vanderbilt University (Jonathan H. Adler, 3/19). 

Bloomberg: Obamacare's War Of Leaks
The Obama administration has said it expects premium increases for health insurance next year to be considerably slower than the pace before implementation of the Affordable Care Act. That's not what insurance industry executives told the Hill ... One executive, described as being "from a populous swing state," expects his company to triple the rates on next year’s exchange policies. Time to freak out about a death spiral? Not yet (Megan McArdle, 3/19).

Lincoln (Neb.) Journal Star: Time For A Rule Change
Now that a minority of state senators has beaten back the attempt to expand Medicaid in Nebraska, perhaps next year the Legislature will be more open to lowering the number of votes required to end a filibuster. Supporters of expansion were able to muster only 27 votes on Wednesday in favor of ending the filibuster, far short of the 33 votes required under the Legislature's current rules (3/20).

Milwaukee Journal Sentinel: Expanding Medicaid Helps Wisconsin Children As Well
You may wonder why pediatricians are writing in support of accepting federal funding under the Affordable Care Act to expand Medicaid to higher eligibility levels. ... Our interest in expanding health coverage is based on the very simple fact that children live in families. Due to proposed changes announced last year by Gov. Scott Walker, parents of children will lose their coverage. These changes will increase the number of childless adults eligible for BadgerCare — but at the cost of removing an almost equal number of working parents from coverage. While this may seem an even exchange at worst, parenting can be challenging under the best of circumstances. When a parent suffers from untreated chronic illness, both the parent and child suffer (Drs. Dipesh Navsaria, Gail S. Allen, Elizabeth J. Neary And Ellen R. Wald, 3/19).

Des Moines Register: There Are Good Reasons For 'Estate Recovery'
Among the challenges states like Iowa face in implementing the Affordable Care Act: reconciling the new law with existing laws. Obamacare encourages states to expand their Medicaid programs to cover more low-income Americans. Decades-old federal law requires states to try to recover money from the estates of deceased Medicaid enrollees (if there is any money or assets) that the government paid for their health bills. ... It's likely the vast majority of states are not invoking the estate-recovery policy for people on expanded Medicaid programs because this is all so complicated. But that does not mean Iowa should entirely abandon the effort (3/19).

The Milwaukee Journal Sentinel: How Not To Market Obamacare To Millennials
The White House is desperate to sign up Wisconsin's millennials for Obamacare. With the March 31 enrollment deadline closing fast, the latest figures show that only 19% of the state's Obamacare sign-ups are between ages 18 and 34. That's a far cry from the 40% that the White House wants. Blame the Obamacare marketing team. Since the health care exchanges launched last October, their attempts to convince us to sign up have been inappropriate, incoherent and simply insulting (Evan Feinberg, 3/19).

The Star Tribune: MNsure Made Me Cry. My Three-Month Quest For Health Insurance
As a self-employed, small business owner, I had high hopes for the Affordable Care Act.  I was giddy at the thought of lowering my premium costs, which now total $6,000 a year for an individual policy with a very high deductible. Obamacare, as it is usually called, was passed in spring 2010, but didn't go into effect until this year.  I couldn't wait to sign up. If only it were that easy (Nancy Wurtzel, 3/19).

And on other health issues -

The New York Times' Opinionator: A Wedding In Intensive Care
There wasn't going to be a happy ending. The patient had metastatic cancer and had just gone through her third unsuccessful regimen of chemotherapy. Now it seemed that everywhere we looked, we found disease. ... I was just setting the clipboard aside when she raised a hand and told me, in a moment of lucidity: "Doc, do everything you can. I need to make it to my daughter's wedding." ... In today’s outcome-driven, efficiency-obsessed medical world, it's easy to forget that healing patients isn't just about treating diseases and relieving symptoms. There are things doctors and nurses can do, meaningful interventions — like helping patients fulfill final goals or spend quality time with their families — that cannot be documented in a discharge summary or be converted into a blip on a screen (Haider Javed Warraich, 3/19).

Bloomberg: Psychotic? Homicidal? You Can Still Buy A Gun
Let's say your mental landscape is similar to that of Colby Sue Weathers back in 2012: suicidal, homicidal, paranoid, schizophrenic. Oh, and with a drug and alcohol problem. You are too disabled by mental illness -- schizophrenia was diagnosed in 2011 -- and recurring hospitalizations to work. You are not great about maintaining your psychotropic drug regimen, which you administer inconsistently and sometimes to woozy excess. And you have an occasional hankering, occasionally satisfied, to consume a fifth of liquor. In other words, your life is utterly out of control. One trouble you probably don't have -- provided you live in the U.S. -- is gaining access to a lethal firearm (Francis Wilkinson, 3/19).

The Washington Post: Relative Value Health Care: Some Obstacles
Last week I put up two posts (Health-care costs and the 'moral hazard' problem; Relative-value health insurance) about my idea of relative value health insurance ("RVHI"). RVHI could help control health-care cost inflation by providing consumers with the opportunity to purchase insurance that would cover only medical treatments that satisfy a specified cost effectiveness standard rather than all treatment with any expected medical benefit regardless of the size of that benefit or its cost. The government would facilitate a market by rating medical interventions provided for different conditions on a scale of 1 (most cost effective) to 10 (least cost effective). This would allow private insurers to offer, and consumers to purchase, insurance coverage of different "depths" at different prices. Today I’m going to discuss some of the most significant challenges to implementing such a system (Russell Korobkin, 3/19).

WBUR: Emergency Care 'Insult To Injury': Medical Bills That Make You Say What?!
I knew there were scads of financial horror stories out there that would make my $446 bill for an ear rinse look like chump change. But when I wrote about it last week — Lesson Of The $446 Ear Rinse: Medical Bills That Make You Say 'What?!' — little did I know that The Tampa Bay Times had just published a fabulous series documenting some truly astronomical-beyond-all-reason trauma center charges. … On a smaller scale, many readers' responses to the ear-rinse pricetag sounded a similar ER theme. One — whose cut knuckle didn't need stitches and so was treated with Neosporin and a Bandaid — was charged $600 (Carey Goldberg, 3/19).

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Stephanie Stapleton

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