Daily Health Policy Report

Monday, March 24, 2014

Last updated: Mon, Mar 24

KHN Original Reporting & Guest Opinion

Health Reform

State Watch



Editorials and Opinions

KHN Original Reporting & Guest Opinion

FAQ: What Are The Penalties For Not Getting Insurance?

Michelle Andrews, writing for Kaiser Health News, reports: "If you're uninsured, now's the time to buy a plan. March 31 is the end of the annual open enrollment period when people who don't have coverage through their employers can sign up on or off their state's marketplace. With limited exceptions, people who miss this enrollment window will be unable to sign up for health insurance until next fall for coverage that starts in January 2015. In addition to being uninsured, they'll face a penalty for not having coverage. The fine may be bigger than they expect. Here are the details" (Andrews, 3/24). Read the story.

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Draft Rules Would Help Protect Seniors When Medicare Advantage Plans Drop Doctors

Susan Jaffe, writing for Kaiser Health News in collaboration with The Washington Post, reports: "Federal officials are considering new Medicare Advantage rules to help protect seniors when insurers make significant reductions to their networks of doctors and other health care providers. The proposals follow UnitedHealthcare's decision to drop thousands of doctors from its Medicare Advantage plans in at least 10 states last fall" (Jaffe, 3/24). Read the story.

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Connecticut Customers Rush To Retail Store To Buy Insurance

WNPR's Jeff Cohen, working in partnership with Kaiser Health News and NPR, reports: "Mike Dunn stands inside a store in downtown New Haven, Conn., looking through the big glass windows at his future customers outside. He's not selling phones or food or clothes. He's selling Obamacare. There's one week left to get health insurance through the Affordable Care Act marketplaces, and states have gone to great lengths to enroll as many people up as possible. In Connecticut, the exchange has opened two retail storefronts where people can walk in and sign up" (Cohen, 3/24). Read the story.

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Capsules: AHIP President Calls For New Level Of Insurance Under Health Law

Now on Kaiser Health News' blog, Mary Agnes Carey reports: "A new tier of coverage should be added to the health law’s online marketplaces, or exchanges, that would be less comprehensive than what plans are now required to offer, the head of the health insurance industry's trade group said Sunday. 'I would create a lower tier, so that people could gradually get into the program, so they could be part of the risk pool, so we don’t hold the healthier people outside,' Karen Ignagni, president and CEO of American’s Health Insurance Plans, said in an interview on C-SPAN’s Newsmakers.  'What I would do is give people more choices' " (Carey, 3/24). Check out what else is on the blog.

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Political Cartoon: 'Youth Will Be Served?' By Nate Beeler

Kaiser Health News provides a fresh take on health policy developments with Political Cartoon: "Youth Will Be Served?" By Nate Beeler, The Columbus Dispatch

And here's today's health policy haiku:


Ninety-five dollars
Is that all you'd have to pay?
Time to check the math

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

Even While Traveling, Obamas Are Plugging Health Enrollment

With just a week to go before the sign-up deadline, the Washington Post looks at the White House's systematic effort to get more people signed up for insurance. But consumers still confront some obstacles, such as concerns about immigration status, tax issues and the multitude of policies with confusing names.

The Washington Post: Even While Overseas, The Obamas Urge Americans To Get Covered
While Barack and Michelle Obama will be overseas this week, the White House is ensuring they will have a virtual presence in targeted media markets across the country before the Affordable Care Act's initial enrollment period ends March 31. ... The Obama administration has devoted most of its outreach efforts for the past several months on a handful of constituencies: young people, women and Hispanics, often in the two dozen U.S. cities that have a disproportionately high numbered of uninsured residents. In many ways, the approach mirrors what Obama’s staff did during his two presidential campaigns, where they used local and niche media outlets to reach targeted voting blocs (Eilperin, 3/23). 

USA Today: Obama Hails 4th Anniversary Of Health Law
President Obama hailed the fourth anniversary of his signature health care law on Sunday, and reminded supporters that a key deadline looms. "Since I signed the Affordable Care Act into law, the share of Americans with insurance is up, and the growth of health care costs is down, to its slowest rate in fifty years," Obama said in a written statement. Obama signed a health care bill into law on March 23, 2010. Now, the administration faces a March 31 sign-up deadline for coverage this year (Jackson, 3/23).

ABC News: Biden: Sign Up For Obamacare So Law Can 'Last Forever'
To a chorus of cheers, whistles and a standing ovation, Vice President Biden addressed a group of community health care workers -- calling them "the moral backbone of the country" and professionals who on the frontline of signing people up for Obamacare. "For the first time in American history the idea that health care is a right and not a privilege is legislated," said Biden. He urged the audience gathered  at the annual conference of the National Association of Community Health Centers, which serve primarily poor and rural communities, to push as hard as they can to sign up as many as people as possible before the March 31st deadline (Hughes, 3/21).

CBS News: Biden Envisions The Public's Take On Obamacare In 20 Years
On the eve of its fourth anniversary, the Affordable Care Act remains controversial, but Vice President Joe Biden on Friday predicted that the public will feel very differently about it in 20 years from now -- if all goes as planned. "Twenty years from now everyone's going to wonder, 'What's the big deal? Doesn't every country do this?'" Biden said at a meeting of the National Association of Community Health Centers in Washington, D.C. Before it gets to that point, though, Biden said the law needs to survive the current political pushback against the law (Condon, 3/21).

Christian Science Monitor: Obamacare Turns 4: Who's Cheering, Who's Heckling?
Perhaps the most telling statistic about the Affordable Care Act as the controversial law turns four years old on Sunday is this: 70 percent of Americans still don't know they could get their healthcare subsidized under the law. But for those who do understand what the law is, what it does, and how it's changing life in America, Obamacare's 4th anniversary is a major turning point for the biggest federal entitlement expansion since the 1960s (Jonsson, 3/22).

The Associated Press: Millions On The Sidelines For Big Health Care Push
Millions of people in the United States will remain uninsured despite this week's final, frenzied push to sign them up under the health law. Their reasons are all over the map. Across the country, many of the uninsured just don't know much about the health overhaul and its March 31 deadline for enrolling in plans that can yield big discounts, researchers say. ... But the complexities of the Affordable Care Act can stymie even the well-informed (Cass, 3/23).

USA Today: Voices: Afraid To Apply For Health Care For Their Kids
For Esperanza Cuevas, the phone call has become disturbingly common. Undocumented immigrants balk at registering their U.S.-born children under the Affordable Care Act, because they fear furnishing the information will lead to their deportation (Gomez, 3/23).

The Wall Street Journal: Worries Over Fines Aid Health-Insurance Sign-Ups
In launching the Affordable Care Act, the Obama administration has emphasized the appeal of inexpensive insurance policies and financial subsidies to lure people to new online marketplaces. But what seems to be motivating many as the final deadline for signing up looms is more the fear of financial penalties (Radnofsky, 3/23).

The New York Times: Names Of Health Plans Sow Customer Confusion
As Americans race to sign up for health insurance in the final days of open enrollment, many consumers and consumer advocates say the names of plans are unhelpful, confusing and in some cases misleading. A number of insurers sell their plans under names like Select, Preferred, Premier, Exclusive, Enhanced, Essential, Essential Plus, Prime, Ultimate and Deluxe. Multiple offerings from one company may have the same benefits and cover the same share of a consumer’s costs, but go by different names (Pear, 3/22).

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Certain Drugs In Obamacare Plans Carry Hefty Price Tags

Insurers selling Obamacare plans have set drug prices according to a tiered system that in some cases requires consumers to pay as much as 50 percent of the cost, The Associated Press writes. Meanwhile, The Philadelphia Inquirer reports that although a glitch that had disseminated incorrect subsidy information on healthcare.gov has been fixed, wrong information might still be given out by independent sites. Also, the administration signaled it would allow people to enroll in health plans after March 31 if they had tried but been unable to sign up because of glitches. 

The Associated Press: Obamacare Plans Bring Hefty Fees For Certain Drugs
Breast cancer survivor Ginny Mason was thrilled to get health coverage under the Affordable Care Act despite her pre-existing condition. But when she realized her arthritis medication fell under a particularly costly tier of her plan, she was forced to switch to another brand. Under the plan, her Celebrex would have cost $648 a month until she met her $1,500 prescription deductible, followed by an $85 monthly co-pay. Mason is one of the many Americans with serious illnesses — including cancer, multiple sclerosis and rheumatoid arthritis — who are indeed finding relatively low monthly premiums under President Barack Obama's law. But some have been shocked at how much their prescriptions are costing as insurers are sorting drug prices into a complex tier system and in some cases charging co-insurance rates as high as 50 percent. That can leave patients on the hook for thousands (Kennedy, 3/22).

Reuters: U.S. To Allow Some People To Enroll In Obamacare After Deadline 
The Obama administration will soon issue new Obamacare guidelines allowing people to enroll in health coverage after a March 31 deadline, but only under certain circumstances, according to sources close to the administration. The sources said the new federal guidelines for consumers in the 36 states served by the federal health insurance marketplace and its website, HealthCare.gov, would allow people to enroll after March 31 if they had tried earlier and were prevented by system problems including technical glitches (Morgan, 3/21).

Reuters: Insurers See Double-Digit Obamacare Price Rises In Many States Next Year 
U.S. consumers eligible for Obamacare health plans could see double-digit price hikes next year in states that fail to draw large numbers of enrollees for 2014, including some states that have been hostile to the healthcare law, according to insurance industry officials and analysts. The early estimates come as insurance companies set out to design plans they intend to sell in 2015 through the state-based health insurance marketplaces that are a centerpiece of the Affordable Care Act, President Barack Obama's signature domestic policy achievement that is widely referred to as Obamacare (Morgan and Humer, 3/21).

The Wall Street Journal: Expect Health-Insurance Premiums To Rise
You could continue to see prices increasing this year for your health-care coverage. Several recent studies point to provisions in the Affordable Care Act—such as the requirement that insurers cover sick individuals as well as preventive care, like mammograms—that could lead to higher prices, at least in the short term. The underlying cost of care itself, meanwhile, continues to rise at a steady clip (Johnson, 3/22).

The Washington Post: For Some Who Are Married But Filing Taxes Separately, Another Healthcare.Gov Hurdle
In May 2012, when the Internal Revenue Service proposed its rules for Americans to get government subsidies for health insurance, officials acknowledged that a legal quirk needed to be fixed: The Affordable Care Act was written in a way that inadvertently denied such help to some people who live apart from spouses who abuse them, are in prison or are on the cusp of a divorce. The problem is that the law’s authors, in creating tax credits to help pay for health plans bought through the new insurance marketplaces, had overlooked the fact that some married people file their tax returns separately (Goldstein, 3/23).

NPR: Insurance Chief Suggests Adding A New, Lower Level Of Health Plan
Rather than letting people keep their old health plans that don't comply with the new requirements of the Affordable Care Act, the head of the group that represents the nation's health insurance companies is floating an alternative: weakening the requirements. "If you take 10 categories of coverage," said Karen Ignagni, president and CEO of America's Health Insurance Plans, in an interview taped for C-SPAN's Newsmakers, "no matter how meritorious each and every one of those benefits may be ... you have a giant step up" from what many people had before, and wanted to pay for (Rovner, 3/21).

Kaiser Health News: Capsules: AHIP President Calls For New Level Of Insurance Under Health Law
A new tier of coverage should be added to the health law’s online marketplaces, or exchanges, that would be less comprehensive than what plans are now required to offer, the head of the health insurance industry's trade group said Sunday (Carey, 3/24).

The Philadelphia Inquirer: Latest Obamcare Glitch Fixed, But Other Sites May Repeat The Error
A glitch in the Obamacare window-shopping tool that incorrectly responded "not eligible" to queries about financial help from households just above the poverty line was fixed hours after the administration learned of the issue, officials said Friday. For 35 days, Healthcare.gov used the wrong year's federal poverty-level guidelines for informal assessments of eligibility. … similar mistakes uncovered at independent sites raise the possibility that wrong information is still being disseminated less than 10 days before open enrollment ends for the year. (Sapatkin, 3/23).

Fox News: Another Glitch: Newly Discovered HealthCare.Gov Error Giving Bad Info On Premium Aid
A newly discovered glitch in the main ObamaCare website reportedly is giving thousands of people the wrong information about whether they qualify for premium subsidies. The Philadelphia Inquirer discovered the glitch while entering hypothetical incomes into the calculator on HealthCare.gov. The newspaper found that the calculator is using the wrong year's poverty guidelines -- a simple mistake that, for months, has resulted in would-be enrollees getting inaccurate guidance. Because of the glitch, some people may be initially told they qualify for subsidies when they don't. Others may be told they don't qualify when they do (3/21).

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Supreme Court To Hear Health Law Contraceptive Case Tuesday

At issue is whether for-profit companies, such as Hobby Lobby, are entitled to the same religious protections as individuals or religious organizations.

The Wall Street Journal: Are Firms Entitled To Religious Protections? 
Tuesday's Supreme Court hearing will be the second time the health law will be scrutinized by the justices. At issue is whether for-profit companies such as Hobby Lobby are entitled to the same religious protections as people or churches. Hobby Lobby covers most forms of contraception in its health plan, including the pill and sterilization. It objects to a requirement that it include certain emergency contraceptives and intrauterine devices, which Hobby Lobby's owners consider a form of abortion. The case is distinct in a couple of ways from legal challenges to the law brought by some Catholic schools and charities, now winding their way through lower courts (Adamy, 3/21).

The Washington Post: High Court With Vocally Devout Justices Set To Hear Religious Objections To Health-Care Law 
There’s something that makes the current Supreme Court different from some of its recent predecessors. The justices got religion. Or at least they seem more open about their faith, appearing before devout audiences and talking more about how religion shaped their lives or guides them now. As the court this week weighs religious conviction vs. legal obligation in the latest challenge to the Affordable Care Act, those who study the court say the change is hard to quantify but easy to notice (Barnes, 3/23).

The Associated Press: Health Law Birth Control Coverage Before Justices
The Obama administration and its opponents are renewing the Supreme Court battle over President Barack Obama's health care law in a case that pits the religious rights of employers against the rights of women to the birth control of their choice. Two years after the entire law survived the justices' review by a single vote, the court is hearing arguments Tuesday in a religion-based challenge from family-owned companies that object to covering certain contraceptives in their health plans as part of the law's preventive care requirement (Sherman, 3/24).

NBC News: Supreme Court Takes Up Dispute Over Obamacare And Religion
The Supreme Court on Tuesday takes up the most closely watched issue of its term: Does the Obamacare law violate the religious freedom of private employers by requiring them to provide insurance coverage for contraceptives? To answer that question, the justices must first decide whether the companies challenging the law, three for-profit corporations, even have religious views in the first place. The Obama administration says they do not, arguing that freedom of religion is an individual right, not a corporate one. At issue is a provision of the healthcare law that requires companies with more than 50 employees to cover preventive care services, which include such contraceptives as morning-after pills, diaphragms, and IUDs (Williams, 3/21).

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Democrats Launch New Messaging Offensive On Law's 4th Anniversary

Democrats gear up a social media campaign as part of "health care strike teams." In the meantime, the GOP and tea party members use the law in their campaign messaging.

The Hill: Dems Ramp Up Offense On Obamacare 
The White House and congressional Democrats are ramping up a coordinated effort to celebrate Obamacare’s fourth anniversary this weekend, looking to go “on offense” ahead of the final week of open enrollment. The effort includes a social media campaign by members of Congress and administration officials, enrollment events featuring lawmakers and Senate floor speeches marking the four-year anniversary. The tightly coordinated final push was the result of work between the White House and House and Senate “health care strike teams,” which were created in the aftermath of the botched Obamacare rollout to push back against a flood of bad headlines. The White House has provided members of Congress with packets that detail state-by-state benefits of the law, and what the cost of repeal would mean for constituents within their districts (Sink and Viebeck, 3/22).

NPR: Health Law's 4th Birthday Divides Democrats, Unites GOP On Message 
With the fourth anniversary of President Obama's signing of the Affordable Care Act this weekend, if you were a Democrat boasting about the health law, you were more than likely a party official or lawmaker with a seat so safe you could publicly celebrate the occasion. ... Meanwhile, Republican lawmakers, and even GOP candidates not in Congress but hoping to get there, are observing the anniversary with events that underscore the long-running Republican message: The health law is causing more harm than good (James, 3/21).

Los Angeles Times: After Setbacks, Tea Party Members Vow To Reinvent Movement 
Five years after it emerged as the most potent force in conservative American politics since the Reagan revolution, the tea party is at a crossroads -- and some critics have declared the movement all but dead. Insisting that they've learned from the setbacks, however, stalwarts are vowing to reinvent their defiant brand of politics to ensure they stay part of the debate in Washington and particularly in the Republican Party. ... And they plan to take the fight to repeal Obamacare to the state level, pushing legislatures to enter into interstate health compacts that they say would allow states to ignore federal regulations and enact their own reforms. Though dismissed as a long shot by some, proponents hope the strategy will render the Affordable Care Act inoperable in those states and give compact members control over federal healthcare dollars (Memoli, 3/23).

And lawmakers get specific on the law --

The Associated Press: Udall Says Family Has Benefited From Health Law 
Under fire for his support of the Affordable Care Act, Sen. Mark Udall said President Barack Obama's landmark legislation isn't perfect but has benefited many, including his own family. During a visit to an energy conservation company on Thursday, the Colorado Democrat said the law has allowed his 23-year-old daughter to stay on the family health plan. In addition, he said, he was happy with the coverage and savings he got by purchasing a plan on the state health insurance exchange (Riccardi, 3/21).

Fox News: Pelosi Scolds Reporter For Saying 'Obamacare' -- Though Obama Embraces It
Nancy Pelosi doesn't like the term "Obamacare." The House Democratic leader scolded a reporter on Thursday who used that label in describing President Obama's health care law.  "I believe that it's a winner and by the way it's called the Affordable Care Act, it's called the Affordable Care Act," she said. "I know you didn't intend any compliment or derogatory. ... It's called the Affordable Care Act." Yet Obama himself embraced the term during the 2012 campaign, repeatedly saying on the stump and the debate stage that he was fine with it (3/21).

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Va. Lawmakers Head Back To Richmond On Medicaid Expansion

Vice President Joseph Biden believes that GOP officials in every state will have to accept the expansion. And Florida's Sen. Bill Nelson, a Democrat, said he's talked with federal officials about a plan to go around the GOP-controlled state legislature.

The Washington Post: Virginia Lawmakers Return To Richmond To Try To Break Impasse Over Medicaid Expansion
Virginia’s pitched battle over Medicaid expansion returns to the Capitol on Monday with no indication that Gov. Terry McAuliffe is any closer to a deal on his top priority. Two weeks after an impasse over Medicaid prevented passage of a two-year, $96 billion budget, the legislature is coming back to Richmond to try again in a special session (Vozzella, 3/22).

The New York Times: Virginia Governor Finds Jollity Is No Guarantee Against Gridlock
The sticking point forcing the special session is Mr. McAuliffe’s desire to expand Medicaid to up to 400,000 of Virginia’s poor and disabled under the Affordable Care Act. The proposal was a centerpiece of his campaign last year and his top priority in office, ... His opponents are just as dug in, noting that in the three weeks since Republicans defeated expansion in a test vote in the House, 67 to 32, there have been no defections on their side (Gabriel, 3/23).

The Washington Post: Biden: GOP Governors Will Eventually Take Medicaid Expansion
Vice President Biden predicted Friday that Republican governors who have declined the federal Medicaid expansion will eventually be forced to reverse course and take the expansion because of political pressure. Speaking to the National Association of Community Health Centers in Washington, Biden criticized the GOP governors who have declined the extra funding but said he expects them to come around. "I'm convinced, as a practitioner of the so-called art of politics, that they ... will not be able to sustain the heat," Biden said. (Blake, 3/21).

The Hill: GOP Governor: Medicaid Expansion Is A Conservative Ideal
Ohio GOP Gov. John Kasich is defending his decision to expand Medicaid in the state, saying the move is a logical reflection of conservative values. ... Kasich's assessment [on Fox News Sunday] runs starkly counter to that coming from many conservatives – including many members of Ohio's Republican legislature – who characterize ObamaCare's broad Medicaid expansion as a case of big-government overreach ... Adopting a Democratic line, [Kasich] emphasized that the expansion of the low-income health insurance program will bring billions of dollars to Ohio while benefiting some of the state's most vulnerable people (Billis, 3/23).

The Washington Post: Florida Senator's Secret Medicaid Expansion Plan Won’t Work
Florida is one of 24 states that hasn't joined Obamacare's Medicaid expansion, which would cover about 1.3 million uninsured adults in the state and bring in about $51 billion in federal funds over the next decade. Only Texas stands to benefit more from the Medicaid expansion. Florida Sen. Bill Nelson said he's talking with federal health officials on a plan to go around the state legislature, which strongly opposes expanding Medicaid. But federal officials say their hands are tied (Millman, 3/21).

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March 31 Health Law Deadline Questions Answered

Some might be surprised that if they don't sign up for health insurance by the March 31 deadline, they'll owe more than $95.

Kaiser Health News: FAQ: What Are The Penalties For Not Getting Insurance? 
If you’re uninsured, now’s the time to buy a plan. March 31 is the end of the annual open enrollment period when people who don’t have coverage through their employers can sign up on or off their state’s marketplace. With limited exceptions, people who miss this enrollment window will be unable to sign up for health insurance until next fall for coverage that starts in January 2015. In addition to being uninsured, they’ll face a penalty for not having coverage (Andrews, 3/24).

Pioneer Press: Penalties In Place For Those Without Health Insurance 
he federal Affordable Care Act calls for penalties on people who don't have "minimum essential coverage," which is a standard that's defined in the law. Penalties for people who lack minimum essential coverage this year will be assessed on taxes filed during 2015. For most people, there is no impact from the federal health law on taxes being filed this spring, according to the IRS. Some people could be exempt from penalties, including those with incomes below $10,150 (Snowbeck, 3/22).

St. Louis Post-Dispatch: Insurance Penalty More Than Many Expect
If you think not having health insurance will mean paying a simple $95 fine, you might be wrong. Because for most people, it’s more complicated than that -- and potentially more expensive. ... For example, if you and your spouse have two children, your family’s uninsured, and you file taxes jointly, you face a tax penalty of at least $285 (Kulash, 3/23).

The Oregonian: As Final Deadline Looms, Oregonians May Face A Tax Penalty For Lack Of Health Coverage
The state of Oregon is considering a special enrollment period to effectively extend the deadline to sign up for insurance. But that doesn't necessarily mean the federal government won't charge a tax penalty to those who don't apply before March 31. ... Adding a wrinkle to the deadline push is that consumers should expect delays in getting help to sign up. The last-minute frenzy is "unbelievable," said agent Rick Skayhan of Leonard Adams Insurance in Portland" (Budnick, 3/21).

And for those who still have not bought a plan --

Los Angeles Times: Tips For Last-Minute Obamacare Shopping 
If you don't have health insurance and want it, now is the time to act. The deadline to sign up for coverage under Obamacare is fast approaching. Experts have many suggestions. Some recommendations are as easy as calling the state insurance exchange, insurers, insurance brokers or one of many enrollment counselors hired to help you. But have patience. It could involve a long wait. Here are things to consider (Zamosky, 3/23).

NPR: Final Call For Questions On Health Insurance As Deadline Looms 
[W]hile previous deadlines have been a little fluid, the Obama administration, including the president himself, has been firm that this deadline is really the deadline. This affects not just the health exchanges. After March 31 you won't be able to buy individual health insurance at all unless you have some special circumstance during the year, such as losing your job, getting married or moving. If you miss the deadline you will have to wait until the next open enrollment period (Rovner, 3/24).

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State Watch

Enrollment Push Is Tough In Mississippi

Politico reports on efforts to sign people up for health care as Humana sends a lime green bus through some of the state's poorest areas. Other outlets look at enrollment campaigns in Maine, California, Connecticut, Minnesota, Oregon and Colorado.

Politico: Obamacare Enrollment Rides A Bus Into The Mississippi Delta
In the poorest state in the nation, where supper is fried, bars allow smoking, chronic disease is rampant and doctors are hard to come by, Obamacare rolls into town in a lime green bus. It took some real convincing by the Obama administration and a leap of faith by one state Republican official to get one of the nation’s largest insurance companies — Humana — to set up shop across Mississippi. Virtually no other insurer was willing to do so, discouraged by the acute health needs here and most elected officials’ outright hostility to the law. Four months and more than 200 bus stops later, enrollment numbers here remain dismal. Only 9 percent of the state’s Obamacare-eligible population have signed up, putting it near the bottom of yet another national statistic (Haberkorn, 3/22).

The Associated Press: Health Law A Lifeline For Some Maine Lobstermen
So over the past several months, advocates set about educating lobstermen and their families about the law, listening to their concerns and signing up hundreds of the 5,000 or so lobstermen who work off the coast of Maine for insurance through the marketplaces created under the law. That signup rate is seen as a win by the advocates, who say many more have likely enrolled without their knowledge (Davis, 3/22).

Los Angeles Times: California Pitches Obamacare At CVS, Ralphs As Deadline Nears
Milk, bread and Obamacare. Ahead of the March 31 enrollment deadline, the Covered California exchange said Friday that it reached a deal with pharmacy giant CVS Caremark Corp. and the Ralphs grocery chain to promote the healthcare law inside their stores. The state said it will have health insurance information displays at the front of CVS stores. At Ralphs supermarkets, shoppers can get brochures and other information, hear in-store announcements and see messages on their receipts about health coverage (Terhune, 3/21).

Kaiser Health News: Connecticut Customers Rush To Retail Store To Buy Insurance
Mike Dunn stands inside a store in downtown New Haven, Conn., looking through the big glass windows at his future customers outside. He's not selling phones or food or clothes. He's selling Obamacare. There's one week left to get health insurance through the Affordable Care Act marketplaces, and states have gone to great lengths to enroll as many people up as possible. In Connecticut, the exchange has opened two retail storefronts where people can walk in and sign up (Cohen, 3/24).

Pioneer Press: Can MNSure Avoid Another Deadline 'Nightmare' This Month? 
When Minnesota launched its new health insurance exchange Oct. 1, the problems came quickly. By late October, the error rate at the MNsure website peaked at 22 percent. ... In December, the call center was overwhelmed, and people endured waits of more than two hours while trying to finalize coverage before a New Year's Eve deadline. The next big deadline for MNsure comes March 31 (Snowbeck, 3/22).

The Associated Press: Health Insurance Out Of Reach For Some Oregonians 
Diedre Gibbons' disability income and her older husband's part-time job on a construction crew barely pay the bills. And though the Oregon couple need ongoing health care and qualify for subsidies on the state's insurance exchange, they remain uninsured (Wozniacka, 3/23). 

The Denver Post: Colorado Health Exchange's Marketing Budget Draws Enrollee Critics 
Colorado's health care exchange has spent nearly $8 million marketing itself to residents .... Connect for Health Colorado conducted surveys to measure the effectiveness of its marketing. It found that the share of people who had heard of the exchange increased from 19 percent in April to 60 percent in December. But the survey also showed apparent setbacks in key areas. The share of those who said they believe the exchange is for them dropped 19 percentage points, and those who thought it was for small business dropped 20 points (Kane, 3/24).  

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State Highlights: Fla. Employees' Unequal Premiums; Abuse By Calif. Doctor Alleged

The Associated Press: Highest Earners Pay Lowest Premiums 
The Florida Cabinet, state agency managers and legislative staff are among 30,000 top-ranked state workers who will continue to pay ultra-low health insurance premiums in the coming year. In a reverse of the Robin Hood principle, the state charges lower-paid workers six times more than those who have the highest earnings pay. ... [B]oth the House and Senate this week released initial budgets that would keep premiums at the same rate (3/22).

The Associated Press: Women's Issues Could Dominate Texas Election
Women's pay and health care are taking over the headlines in the Texas governor's race, and for good reason: Women comprise the majority of voters. U.S. Census data shows that in the 2012 general election, 4.72 million Texas women cast ballots compared to 3.92 million men (Tomlinson, 3/23).

Los Angeles Times: O.C. Pain Doctor Caused Deaths Of Three Patients, Authorities Allege
An Orange County pain doctor caused the deaths of three patients by negligently prescribing them powerful narcotics, state medical authorities said in a complaint made public Friday. The Medical Board of California is seeking to suspend or revoke the license of Dr. Van H. Vu, who was linked to more than a dozen patient overdose deaths by a Times investigation in 2012 (Glover and Girion, 3/21).

The Milwaukee Journal Sentinel: Assembly Signs Off On Oversight Of Milwaukee County Mental Health
After decades of ignored calls for reform, Milwaukee County's mental health system is getting a major overhaul. Medical professionals and others with experience in the system -- not politicians -- will now make decisions about how to care for people with mental illness, thanks to a bill the state Assembly passed at 3:45 a.m. Friday with bipartisan support. The bill passed 89-1, with Rep. Fred Kessler (D-Milwaukee) voting against it (Kissinger, 3/21).

The Associated Press: NY Bill Seeks Police Training On Mentally Ill
Mental health advocates ... propose the state spend $2 million so New York and other cities statewide can establish training programs to help officers assess and de-escalate confrontations with such suspects while establishing "crisis intervention teams" with mental health professionals (3/22).

Los Angeles Times: UC Hospital Strike Averted By Tentative Contract Agreement
A strike planned this week by 13,000 UC hospital technical workers was averted with the announcement Sunday of a tentative four-year contract agreement. The pact between UC and the AFSCME 3299 union concludes more than a year of tense negotiations and means that UC's five major medical centers and numerous health clinics around the state will operate as normal Monday. Up until the agreement, the union for respiratory therapists, operating room technicians and radiology workers had threatened to start a five-day strike Monday and the university had been prepared to hire replacement workers, potentially costing millions of dollars (Gordon, 3/23).

The Boston Globe: Bill Could Ease Burden Of Those Disfigured By HIV Medications
(John) Wallace suffers from lipodystrophy, an atypical distribution of fat brought on by an interaction between HIV and the toxicity of medications introduced in the 1990s to treat the virus. The disorder causes fat to gather around the neck, in what is called a "horse collar," and on the upper back, in a "buffalo hump." He is one of many with the condition, doctors say, who rarely leave home, avoiding the eyes of strangers by disengaging from the world. Wallace has sought approval for liposuction to remove the fat deposits three times, through two different doctors. Twice, MassHealth rejected his claims, declaring the treatment cosmetic, he said. A third time, his doctor declined to submit a claim (Fox, 3/24).

The Associated Press: Gov. Dayton Seeks $2.2M For Marijuana Study 
With a push for legalizing medical marijuana stalled this session, [Minn.] Gov. Mark Dayton said Friday he would ask for $2.2 million for research into its possible benefits. Mayo Clinic would head the study, which would focus on cannabidiol, commonly known as CBD, a marijuana compound that does not produce a high (3/21).

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Effort To Fix SGR Formula Snagged Over Cost

Prospects are growing dim that Congress will permanently fix Medicare's outdated payment formula this year because lawmakers have been unable to agree on a way to pay for it. Meanwhile, federal officials have drafted rules to protect seniors when Medicare Advantage plans cut doctors from their networks.

The Associated Press: Congress Confronts Medicare Cuts To Doctors' Fees
Hope is fading for a Capitol Hill drive to permanently fix Medicare's outdated payment formula and spare doctors from automatic cuts in their fees next month. Now the question is whether lawmakers can regroup and come up with a short-term solution when the current patch expires (Taylor, 3/21).

Kaiser Health News: Draft Rules Would Help Protect Seniors When Medicare Advantage Plans Drop Doctors
Federal officials are considering new Medicare Advantage rules to help protect seniors when insurers make significant reductions to their networks of doctors and other health care providers. The proposals follow UnitedHealthcare's decision to drop thousands of doctors from its Medicare Advantage plans in at least 10 states last fall (Jaffe, 3/24).

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Democratic Lawmakers Ask Hepatitis C Drugmaker To Justify Price

The developer, Gilead Sciences, sells each pill for $1,000.

The New York Times: Lawmakers Attack Cost of New Hepatitis Drug 
A new drug to treat hepatitis C that costs $1,000 a pill has caused rising concern among insurers and state Medicaid programs. It has now also spurred interest from Democratic congressmen whose queries about the drug prompted a sell-off in biotechnology stocks on Friday. Three Democratic members of the House Energy and Commerce Committee have demanded that Gilead Sciences, the developer, justify the price of its drug, which is called Sovaldi (Pollack, 3/21).

Los Angeles Times: Gilead Sciences' $84,000 Price For Hepatitis Drug Is Scrutinized 
Medical experts say previous therapies for hepatitis C helped only about half of patients ... clinical trials of Sovaldi have shown cure rates approaching 90% with far fewer complications. The lawmakers noted those potential benefits for patients, but they said the expensive medication could impose substantial costs on taxpayer-funded Medicaid programs and lead to premium increases for those with employer or individual health coverage (Terhune, 3/21).

Earlier, related KHN story: There's a Life-Saving Hepatitis C Drug. But You May Not Be Able To Afford It (Appleby, 3/3).

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Editorials and Opinions

Viewpoints On Challenge To Contraceptive Coverage Mandate

The New York Times: Crying Wolf On Religious Liberty
This week, the owners of two secular, for-profit corporations will ask the Supreme Court to take a radical turn and allow them to impose their religious views on their employees — by refusing to permit them contraceptive coverage as required under the Affordable Care Act. The Supreme Court has consistently resisted claims for religious exemptions from laws that are neutral and apply broadly when the exemptions would significantly harm other people, as this one would. To approve it would flout the First Amendment, which forbids government from favoring one religion over another — or over nonbelievers (3/22).

The Washington Post: If The Contraceptive Mandate Passes, It Will Ruin A Core U.S. Ideology 
Religion is a way of life. ... The outcome of Sebelius v. Hobby Lobby will affect every American because any religion allowed to be practiced only inside a house of worship, and not in the day-to-day business of life, is a worthless faith (Rev. Rick Warren, 3/21).

The Washington Post: Contraception As A Test Of Equality
More than half of all American women experience an unintended pregnancy, according to a 2008 study, and 40 percent of those pregnancies end in abortion. Improved access to the most reliable methods of contraception would significantly reduce both unintended pregnancy and the need for abortion. For all women, denying practical access to the method of contraception that is right for their health and life circumstances, as well as the well-being of their families, can represent a serious incursion into their individual moral autonomy (Walter Dellinger, 3/23). 

USA Today: Obamacare Shackles Religious Freedom
Legal niceties aside, Hobby Lobby is, at bottom, the five Green family members. They are its nerve center and soul. They determine, with accountability only to and among themselves, whether to turn aside substantial profits by closing the doors of their 600 stores on Sundays; to greet Hobby Lobby patrons with strains of Christian music; to advertise Christian holidays (Ken Starr, 3/23).

USA Today: Religion Case Threat To Worker Rights
Should a company have the right to refuse to hire certain female employees if the owners have religious objections to mothers working outside the home? Or can a company's owners fire pregnant employees because the owners find their presence distracting? Many federal and state laws now prohibit such blatant forms of discrimination against women. ... This is not the first time in our country's history that religion has been used in an effort to thwart civil rights and workers' rights laws. Owners of hotels and other businesses once claimed that forcing them to open their doors to mixed-race couples violated their religious liberty (Mary Kay Henry (SEIU) and Lee Saunders (AFSCME), 3/23). 

USA Today: Obamacare Challenge Could Empower Discriminators
In fact, birth control prevents pregnancy from happening in the first place, and nearly 60% of women who use the birth control pill also use it for other medical reasons, like managing migraines and acne. As a matter of law, the corporations are asking the Court to dramatically upend the balance we've struck for generations to protect everyone's rights and liberties. In fact, this case would mark the first time in history that corporations would be given the right to exercise religion like people or churches do (Cecile Richards and Chad Griffin, 3/23).

USA Today: For-Profit Doesn't Mean No Conscience
The administration has effectively told the Supreme Court that for-profit companies have no right to act on moral convictions the government opposes. They are about profits. That position is deeply mistaken. For one thing, it ignores the law. The Religious Freedom Restoration Act extends religious liberty to corporations without regard to their for-profit and non-profit status. More important, the administration's position betrays a remarkably cramped view of free enterprise (Joshua Hawley, 3/23). 

In another legal case -

The Wall Street Journal: ObamaCare's Latest Legal Challenge
Unlike the challenge to the individual insurance mandate, Halbig v. Sebelius involves no great questions of constitutional interpretation. ... The Affordable Care Act—at least the version that passed in 2010—instructed the states to establish insurance exchanges, and if they didn't, the Health and Human Services Department was authorized to build federal exchanges. The law says that subsidies will be available only to people who enroll "through an Exchange established by the State." The question in Halbig is whether these taxpayer subsidies can be distributed through the federal exchanges, as the Administration insists (3/23).

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Viewpoints: McConnell, Wasserman Schultz, Barasso On 4th Anniversary

CNN: Blindsided By The Realities Of Obamacare
[T]he promises that were made to sell Obamacare — that it wouldn't disrupt people's previous health care arrangements and that premiums would go down — are now being exposed for the cheap and deceptive sales pitch they were. It may be tempting for some to brush all this aside as standard politics. But it's hard to think of anything even comparable to the scope of the deception involved in selling this law (Senate Minority Leader Mitch McConnell, R-Tenn., 3/23).

USA Today: Obamacare Reflects America's Values 
A few years ago, I used to enter my local drug store and stand behind seniors as they left prescriptions behind because they couldn't afford all the medications they needed. I used to talk to cancer survivors like myself whose daunting diagnosis was compounded by the financial stress of having to choose between essential treatments like chemotherapy and radiation. Those days are finally over. Four years ago today, President Obama signed the Affordable Care Act into law. It ushered in significant change. More than 5 million Americans have signed up for coverage through the state and federal marketplaces alone (Rep. Debbie Wasserman Schultz, D-Fla., 3/23).

Fox News: On ObamaCare's Fourth Anniversary Let's Take Action, Skip Celebration
Republicans are taking steps now that include helping patients with pre-existing conditions, allowing small businesses to pool resources in order to buy health insurance for their employees, expanding health savings accounts, allowing people to buy insurance across state lines, and increasing transparency about the costs of medical care. In contrast to ObamaCare, all of our proposals are focused on giving Americans the flexibility and freedom to make their own health care choices. After watching ObamaCare fail for four years, we know that this law is never going to work well for a majority of Americans (Sen. John Barrasso, R - Wyo., 3/21).

The Wall Street Journal: Progress, With Caveats 
Despite the calamitous rollout of the federal exchanges and persistent headwinds in public opinion, the law is producing real, measurable, positive progress across the health-care system. ... At least 12 million Americans have now received coverage directly through a provision of the law. ... more than five million Americans have selected a private insurance plan on an exchange, a figure robust enough to ensure the exchanges will be a stable way for Americans to get health coverage for a long time to come. ... Conservative fear-mongering and predictions of calamity notwithstanding, the Affordable Care Act is moving American health care in the right direction (Dr. Ezekiel J. Emanuel, 3/21).

The Wall Street Journal: A Costly Failed Experiment
Most of those who were uninsured before the law was passed will remain uninsured, according to the Congressional Budget Office. Democrats also fixated on another goal: protection for people with pre-existing conditions. One of the first things the new law did was create federal risk pools so that people who had been denied coverage for health reasons could purchase insurance for the same premium a healthy person would pay. Over the next three years, about 107,000 people took advantage of that opportunity. Think about that. One of the main reasons given for interfering with the health care of 300 million people was to solve a problem that affected a tiny sliver of the population (John C. Goodman, 3/21).

Los Angeles Times: As Obamacare Turns Four, HHS Toots The Wrong Horn
Trying to put the best possible spin on the anniversary, Health and Human Services Secretary Kathleen Sebelius offered "four big reasons to celebrate" in a blog post Friday. Unfortunately, at least three of those reasons are, if not bogus, at least misleading. And I say this as someone who thinks the Affordable Care Act is a good thing (albeit a work in progress) (Jon Healey, 3/23).

Los Angeles Times: Where Are The Positive Stories About Obamacare?
[Rita] Rizzo, 60, owns a management consulting firm for nonprofit groups and government offices in Akron, Ohio, with her husband, Lou Vincent, 64. Vincent, who suffers from Type 2 diabetes and high blood pressure, has gone without health insurance for 10 years. "We got 30 denial letters," Rizzo told me ... In December, Rizzo signed up for Obamacare. She now has a policy that covers her and Vincent together ... [But] the airwaves and news columns have been filled to overflowing with horrific tales from consumers blaming Obamacare for huge premium increases, lost access to doctors and technical frustrations — many of these concerns false or the product of misunderstanding or unfamiliarity with the law (Michael Hiltzik, 3/23).

The New York Times: Health Care Caricature
Republican leaders are making preposterous assertions that President Obama has abandoned a centerpiece of his health care reforms — the requirement that most people obtain comprehensive insurance or pay a penalty. In a cartoonish misrepresentation of how so-called hardship exemptions will be determined, the leaders, egged on by their allies in the conservative media, contend that recent steps by the administration undermine the individual mandate by giving virtually everyone who wants one a free pass to escape the penalty. These steps are modest midcourse corrections to deal with individual problems in the rollout of a large and complex program (3/21).

The Washington Post: The Next Health-Care Debate
Everyone who believes that reducing economic insecurity requires a strong government role in guaranteeing health insurance to all Americans should take advantage of this opportunity. This obligation falls on President Obama, but it also encompasses Democratic members of Congress who voted for the law but now fret over the political consequences of a full-hearted embrace of the system they created. They can’t just duck. ... Say what you will about the Koch brothers: They fully understand the long-term importance of the health-care battle. Supporters of indispensable government programs must be as shrewd and as committed as they are (E.J. Dionne Jr., 3/23).

The Washington Post: McAuliffe’s New PAC Distracts Attention From Where It Belongs — On Medicaid
It's hard to think of a more tone-deaf political move lately than Virginia Gov. Terry McAuliffe’s unveiling of his Common Good Virginia PAC, which peddles dinners and sit downs with Mr. McAuliffe, a Democrat, his wife and unnamed "policy experts" for fat cats with a policy agenda for fees reaching $100,000. ... And why now? Mr. McAuliffe is in a no-holds-barred fight with Republicans over whether to embrace Medicaid expansion, which would unlock billions in federal dollars that Virginia badly needs. Mr. McAuliffe has called a special session starting Monday on the contentious issue. This can only weaken his own hand and blur the focus on his top policy priority (3/21).

The Washington Post's Volokh Conspiracy blog: Was Delaying The Employer Mandate Legal? Did The IRS Even Check?
The legal justification for the employer mandate delay offered by the Treasury Department has been exceedingly weak. Perhaps this is because the Treasury Department never considered whether it had legal authority to delay the employer mandate until after it made the decision to delay it. ... This has led some to speculate that the order for the delay came from the White House, where political considerations would have trumped legal constraints. ... This is eminently plausible given some of the White House’s other announcements seeking to alter PPACA implementation in unauthorized ways (Jonathan H. Adler, 3/22). 

The Chicago Sun-Times: Unemployment Insurance Saved Me
Twelve years ago I was free-lance graphic designer living in downtown Chicago and taking advantage of my two bachelor’s degrees, leading an enjoyable life and earning enough to go on vacation every so often. Then I was diagnosed with AIDS and my life changed forever. ... I have been underemployed or unemployed ever since, never making more than $25,000 a year because my health care under the Ryan White Act limits the amount I can make (Will Wilson, 3/23).

On other health issues -

Los Angeles Times: Why NRA Opposition Shouldn't Doom Obama's Surgeon General Nominee 
The National Rifle Assn. has a problem with Dr. Vivek Hallegere Murthy, President Obama's nominee for surgeon general, but it has nothing to do with Murthy's medical expertise. It's that Murthy thinks gun control is smart public health policy. Unfortunately, too many members of the Senate share the gun lobby's skewed view of the world, much to the detriment of the country and, it seems, to Murthy's chances of being confirmed (3/23).

The Washington Post: Guns Are A Health-Care Issue
[He] once dared to claim that “guns are a health care issue,” a fact that any doctor with experience in the emergency room knows well. Mr. Murthy, the NRA fumed, would remove the ban on physicians asking patients whether they keep guns in the home and lift restrictions on gun death research at the Centers for Disease Control and Prevention (CDC). All of those ideas sound pretty modest to us. Even if they weren’t, they don’t provide any pretext to oppose Mr. Murthy’s confirmation, since he would not be in a position to set firearms policy as surgeon general. The fact that he’s right just makes the insult worse. (3/22). 

The New York Times: Making Vaccination Mandatory For All Children
An outbreak of measles in Manhattan showed that even doctors had overlooked the disease as childhood vaccination became widespread. But over the last decade more people have objected to immunization. Along with the religious exemptions that almost all states allow, 19 states allow exemptions for philosophical reasons. But are broader outbreaks like those in Britain evidence that parents should no longer be allowed to get any exemption from having their children immunized? (3/23).

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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.