Daily Health Policy Report

Tuesday, March 25, 2014

Last updated: Tue, Mar 25

KHN Original Reporting & Guest Opinion

Health Reform

Health Care Marketplace

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Insuring Your Health: How Do Marketplace Plans Differ From Others; Will Cost-Sharing Subsidies Affect My HSA; Who Pays The Penalty For An Adult Child?

Kaiser Health News consumer columnist Michelle Andrews writes: "The open enrollment period ends March 31, and people continue to have many questions about how the health law and the exchanges work" (Andrew, 3/25). Read the column.

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Capsules: Insurance Agents Key To California Success Enrolling Asian-Americans

Now on Kaiser Health News’ blog, KQED’s Lisa Aliferis reports: "While Latino enrollment has lagged in California’s insurance marketplace, Asians have signed up in numbers outstripping their representation in the pool of eligible people. According to new Covered California data, the overwhelming majority of Chinese, Korean and Vietnamese enrollees are buying plans through certified insurance agents, as opposed to community groups or the Covered California website" (Aliferis, 3/25). Check out what else is on the blog.

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Political Cartoon: 'Playing It Safe?'

Kaiser Health News provides a fresh take on health policy developments with "Playing It Safe?" by Pat Bagley.

And here's today's health policy haiku:

TOUCHY SUBJECTS: RELIGIOUS FREEDOM AND BIRTH CONTROL

The health law returns
to the high court... Arguments
will touch hot topics.
-Anonymous

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 Arguments In Case Mixing Religious Freedoms And Birth Control Coverage

The case, which touches various politically charged issues, could have implications beyond the health law's birth control coverage requirement.

The Washington Post: At Supreme Court Today: Health-Law Cases Mix Questions Of Religious Freedom, Worker Rights
The Supreme Court on Tuesday prepared to hear a second challenge to President Obama’s Affordable Care Act, this time to decide whether employers must provide their workers with insurance coverage for contraceptives even if the owners say it would violate their religious principles. What is likely to be the signature ruling of the court’s term presents the justices with complicated questions about religious freedom and equality for female workers. It could have long-term implications for what other legal requirements companies could decline because of religious convictions. And it asks a question the court has never confronted: whether the Constitution or the Religious Freedom Restoration Act (RFRA) that protects an individual’s exercise of religion extends to secular, for-profit corporations and their owners (Barnes, 3/25).

The Associated Press/Washington Post: Justices Tackle Health Law Birth Control Coverage
Supreme Court justices are weighing whether corporations have religious rights that exempt them from part of the new health care law that requires coverage of birth control for employees at no extra charge. The case being argued at the Supreme Court on Tuesday involves family-owned companies that provide health insurance to their employees, but object to covering certain methods of birth control that they say can work after conception, in violation of their religious beliefs (3/25).

Los Angeles Times: Religious Case At Supreme Court Could Affect Obamacare And Much More
A challenge to part of President Obama's healthcare law that hits the Supreme Court on Tuesday could lead to one of the most significant religious freedom rulings in the high court's history. … At issue in Tuesday's oral argument before the court is a regulation under the Affordable Care Act that requires employers to provide workers a health plan that covers the full range of contraceptives, including morning-after pills and intrauterine devices, or IUDs (Savage, 3/24).

The New York Times: Ruling Could Have Reach Beyond Issue Of Contraception
The Supreme Court on Tuesday will hear arguments in a case that pits religious liberty against women’s rights. That issue is momentous enough. But it only begins to touch on the potential consequences of the court’s ruling in the case, notably for laws banning discrimination against gay men and lesbians (Liptak, 3/24).

The Wall Street Journal: Health-Law Contraceptive Case Skews Ideological Lines On High Court
Tuesday's Supreme Court case over whether religious objections trump the federal health law's contraceptive requirements seems at first blush to be a typical conservative-liberal struggle over social policy. But behind the battle is an ideological role reversal: The legal doctrine conservatives are citing to limit government burdens on religious expression was written by the Supreme Court's liberal champion, the late Justice William Brennan. The jurist who rolled it back in the early 1990s was Justice Antonin Scalia, a contemporary conservative icon (Bravin, 3/24).

NPR: Hobby Lobby Contraceptive Case Goes Before Supreme Court
The U.S. Supreme Court hears arguments Tuesday in the latest challenge to the Obama health care overhaul. This time the issue is whether for-profit corporations, citing religious objections, may refuse to provide some, or potentially all, contraceptive services in health plans offered to employees. It is a case that touches lots of hot-button issues (Totenberg, 3/25).

Politico: Contraception Coverage Heads To SCOTUS
Obamacare goes back before the Supreme Court on Tuesday, in a closely watched challenge that mixes controversies over the health care law, contraception and religious freedom. The justices will hear two related cases seeking to overturn the Affordable Care Act’s requirement that nearly all companies with more than 50 employees provide various forms of birth control in their employee health plans at no charge. The outcome won’t topple the whole health care law, but it could become a political thorn in the side of both parties before the November midterm elections (Haberkorn, 3/25).

CBS News: Supreme Court Hobby Lobby Case Revisits Divisive Political Issues
Some of the most politically divisive themes and issues of the 2012 election --Obamacare, the left's "war on religion," the right's "war on women," and the notion of corporate personhood -- all come into play in two cases that will be argued before the Supreme Court on Tuesday. Two privately-held, for-profit companies -- Hobby Lobby Stores, Inc. Conestoga Wood Specialties Corp. -- are suing the United States government over a provision in the Affordable Care Act that requires large employers to offer their workers comprehensive health coverage, including contraception, or pay a fine. Hobby Lobby's owners, David and Barbara Green of Oklahoma, say they have strong objections based in their Christian faith to providing health care coverage for certain types of contraception. The Pennsylvania-based Hahn family, the Mennonite owners of Conestoga Wood Specialties, have the same complaint (Condon, 3/25).

Fox News: Supreme Court To Take Up ObamaCare Contraceptive Mandate In Landmark Case
The Supreme Court will hear arguments Tuesday in a landmark religion-based legal challenge from family-owned companies that object to covering certain contraceptives in their health plans under ObamaCare. The case challenges the health care law's so-called "contraceptive mandate," which requires employers to offer health plans with a range of services at no extra charge, including all forms of birth control for women that have been approved by federal regulators. Some of the nearly 50 businesses that have sued over covering contraceptives object to paying for all forms of birth control. But the companies involved in the high court case are willing to cover most methods of contraception, as long as they can exclude drugs or devices that the government says may work after an egg has been fertilized (3/25).

Earlier, related KHN coverage: Justices To Weigh Contraceptive Mandate Against Religious Freedom Claims (Taylor, 3/20).

 

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Report: 32 Million Americans Underinsured In 2012

Those consumers had insurance that didn’t meet their needs, the report finds. Meanwhile, the Associated Press examines the difficulties Latinos have getting insurance. Members of the nation’s largest minority group account for a third of those people nationwide without coverage. But they also face unique hurdles in signing up before the March 31 deadline.

NBC News: 32 Million Underinsured in U.S., Report Finds
A new report finds that 32 million people were underinsured in the U.S. in 2012, meaning their health insurance didn’t do enough to cover their costs. That makes for 80 million Americans who either have no health insurance at all, or who don’t have enough, the report finds. It will be important to watch and see if the provisions of the Affordable Care Act cut into this number, the non-profit Commonwealth Fund said in issuing the report (Fox, 3/25).

Marketplace: Being Uninsured Versus Underinsured
As Monday's deadline to sign up for health insurance or face a penalty approaches, there's plenty of attention on the uninsured. But how about the underinsured? Nearly 32 million people were underinsured in 2012, meaning they had insurance but that it wasn't robust enough to protect them from major medical costs, according to a new report from the Commonwealth Fund. The figures are from before individuals could buy insurance on Affordable Care Act exchanges, but some say the problem persists (Wilson, 3/25).

CQ HealthBeat: Think 6 Million Was Tough? Next Year's Enrollment Target For Exchanges Is 13 Million
This week’s mad dash by health law supporters to enroll at least 6 million people in exchange plans before open enrollment ends on March 31 appears to be within reach — a major accomplishment considering the disastrous rollout of the online federal marketplace last fall. But the enrollment projection by the Congressional Budget Office widely adopted as a measuring stick for the early success of the health law will rise to 13 million in 2015 and to 22 million in 2016 (Reichard, 3/24).

The New York Times: Insurers Push To Enroll People As Health Care Deadline Looms
It’s last call for health insurance. A new insurance company in Colorado dispatched a throng of models dressed as cocktail waitresses onto the streets in recent days, offering nonalcoholic shots of juice to lunch-hour crowds in Denver. The models, in form-fitting dresses and high heels, handed out fliers reminding people of the fast-approaching March 31 deadline to sign up for health care coverage this year under the federal law (Abelson and Thomas, 3/24).

The Associated Press/Washington Post: Latinos Being Left Behind In Health Care Overhaul
The nation’s largest minority group risks being left behind by President Barack Obama’s health care overhaul. Hispanics account for about one-third of the nation’s uninsured, but they seem to be staying on the sidelines as the White House races to meet a goal of 6 million sign-ups by March 31 (3/24).

The CT Mirror: CT’s Latinos Face Hurdles In Enrolling In Obamacare
No group of people in Connecticut is more likely to be uninsured than the state’s Latinos, and Obamacare won’t change that. The Hispanic community is facing unique hurdles signing up for the Affordable Care Act. Some of those barriers were anticipated by both the Obama administration and administration of Gov. Dannel P. Malloy. Others took supporters of the ACA by surprise (Radelat, 3/24).

Los Angeles Times: Health Insurance Basics Stump Many Obamacare Shoppers, Survey Finds
Amid the final frenzy for Obamacare enrollment, a new survey shows that many consumers may be ill-equipped to shop for health insurance. A study published Monday in the Proceedings of the National Academy of Sciences found that 42% of people surveyed could not describe a deductible and 39% didn't understand the relationship between a premium and deductible (Karlamangla, 3/24).

The San Jose Mercury News: Eight Things You Need To Know Before Monday's Deadline To Enroll In Health Plans
The real definition of madness in March? Waiting until now to sign up for health insurance under the new health care law. With the March 31 deadline fast approaching for millions of Californians who still don't have insurance (that's midnight Monday, folks), you're facing some painful hurry-up-and-wait scenarios: brave the mad dash of procrastinators and finally enroll or prepare to pay a hefty penalty at tax time next year. Whatever you choose, expect to hear from experts and advocates sounding a lot like your mother over the next few days: "Don't play Russian roulette with your health," warned Larry Hicks, a spokesman for Covered California, the state's health insurance exchange. Enrolling sooner than later, he said, will help you avoid "long waits and lots of frustration" closer to March 31 (Seipel, 3/24).

The CT Mirror: Obamacare Q&A: Deadline Scramble, Repaying Subsidies And What The New Plans Cover
Next Monday is the final day to enroll in individual-market health insurance for 2014. After that, if you haven’t had coverage this year and haven't signed up, you could face a penalty under the federal health law commonly known as Obamacare. This Obamacare Q&A includes questions about what to do about that deadline if your coverage is slated to run out later this year, what the government can and can't do to you if you don't get insurance, what the new plans cover, and the possibility that some people might have to repay some or all of the federal funds used to discount their premiums (Becker, 3/25).

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Report: Prescription Barriers More Likely In Exchange Plans

The analysis by Avalere Health says that consumers who purchased health law coverage are more likely to have to get prior authorization, among other requirements, when filling prescriptions.

Modern Healthcare: Exchange Plans Pose More Prescription-Use Barriers 
Patients covered by exchange-based insurance are more likely than those in employer-sponsored plans to face utilization management controls—such as prior authorization and step therapy—in filling their prescriptions, a report Monday from healthcare consultancy Avalere Health contends (Tahir, 3/24).

Meanwhile, exchange developments in California and Minnesota are tracked -

Kaiser Health News: Capsules: Insurance Agents Key To California Success Enrolling Asian-Americans
While Latino enrollment has lagged in California’s insurance marketplace, Asians have signed up in numbers outstripping their representation in the pool of eligible people. According to new Covered California data, the overwhelming majority of Chinese, Korean and Vietnamese enrollees are buying plans through certified insurance agents, as opposed to community groups or the Covered California website (Aliferis, 3/25).

MinnPost: MNsure: Legislators Likely To Keep Hands Off Health Exchange This Session
Key DFL lawmakers don’t want to act on legislative changes to MNsure this session, making it very unlikely that the health exchange will be substantially transformed through political action. Republicans have introduced a bunch of bills – many of them amendments they proposed to the initial MNsure legislation last year – to reshape its governing board authority, legislative oversight and budgeting process (Nord, 3/24).

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MNsure To Give Some Deadline Flexibility To Last-Minute Health Exchange Shoppers

Minnesota officials announced Monday that people who hit technical snags that prevent them from completing the sign up process by March 31 may still be able to avoid the federal tax penalty for not having health insurance.   

The Wall Street Journal: Some Leeway On Coverage Deadline
Some states are worried that lingering technical problems may prevent people from completing the sign-up process, especially if a surge of enrollees clogs sites in the final days. Consumers have until March 31 to sign up for insurance coverage and avoid facing a financial penalty for 2014 under the Affordable Care Act. On Monday, Minnesota said it would extend a completion deadline for anyone who starts the process of enrolling in a plan by midnight on March 31 but doesn't finish it. Maryland and Nevada also have extended the deadline for people who can show they began to sign-up before the end of the month (Corbett Dooren, 3/24).

Pioneer Press: MNsure: Last-Minute Consumers Won't Be Penalized If They Run Into Glitches 
People who run into technical problems at MNsure that prevent them from obtaining health insurance by March 31 still might be able to avoid a federal tax penalty, health exchange officials announced Monday. The deadline for people to obtain coverage remains March 31, said Scott Leitz, the interim chief executive officer at MNsure (Snowbeck, 3/24).

Minnesota Public Radio: MNsure Grants Reprieve For Late Enrollment Snags
Consumers who make a good faith effort to enroll in health coverage through Minnesota's online insurance marketplace can avoid a penalty even if they don't complete the process by the deadline of midnight March 31, MNsure officials said Monday. Until now, agency officials have said consumers had to select and pay for a plan by the deadline. But given a likely rush of last minute enrollments, MNsure will offer an extension for consumers who have started the process but couldn't finish before the clock runs out, MNsure interim CEO Scott Leitz said (Stawicki, 3/24).

The Star Tribune: MNsure Lays Out Flexible Deadline Options For Health Insurance Sign-Ups
Aiming to give Minnesotans every possible chance to buy health insurance before the March 31 deadline, MNsure officials on Monday said they will grant some flexibility to those making a good-faith effort to buy coverage when the clock strikes midnight that night. MNsure interim CEO Scott Leitz stressed the state insurance exchange isn’t softening the deadline. He compared the newly announced steps to allowing people to vote if they’re standing in line when the polls close (Crosby, 3/24).

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Calif. Health Exchange Shoppers Will Get Voter Registration Form

The state will send voter registration cards to nearly 4 million state residents who visited the online insurance marketplace to ease voting rights group worries.

Los Angeles Times: State To Send Voter Registration Cards To Obamacare Applicants
Heading off a lawsuit over compliance with a federal voting rights law, California officials have agreed to help millions of state residents register to vote. Under a deal announced Monday by several voting-rights groups, the state will send voter registration cards to nearly 3.8 million Californians who have applied for health insurance under the Affordable Care Act (Merl, 3/24). 

The Washington Post: Californians Who Used Health Marketplaces Receive Voter Registration Forms
California officials have started sending voter registration forms to 4 million people who shopped on the state’s new online health insurance marketplace, as part of a legal settlement with voting rights groups that are urging states to make it easier for people to sign up to vote as they enroll in coverage (Somashekhar, 3/24).

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Va. Gov.'s Medicaid Expansion Proposal Denied

Republicans in a House committee rejected the proposal, which is holding up a two-year budget deal.

The Washington Post: McAuliffe Offers New Budget, But House Lawmakers Aren’t Buying
Gov. Terry McAuliffe tried to shake up Virginia’s deadlocked Medicaid debate Monday by proposing a new budget that would expand the health care program and shower a projected $225 million in related savings on teachers, state employees, pre-kindergarten programs and other Democratic priorities (Vozzella, 3/24).

The Associated Press/Washington Post: McAuliffe Proposes 2-Year Pilot Medicaid Expansion
Gov. Terry McAuliffe proposed a two-year pilot of an expanded Medicaid program Monday in a bid to persuade Republicans to end an impasse over the state’s budget. The new Democratic governor announced the plan shortly before the General Assembly returned to Richmond for the start of a special session. A few hours later, the Republican-controlled House Appropriations Committee voted to reject McAuliffe’s proposal. The Democratically controlled Senate took no action (3/24).

Reuters: Virginia Governor, Lawmakers Fail To Reach Medicaid Deal
Virginia's Democratic governor, Terry McAuliffe, and the state's Republican-dominated House of Delegates on Monday failed to reach an agreement over Medicaid expansion during the first day of a special session called in hopes of reaching a budget deal. The impasse over Medicaid, the federal health care program for the poor, is holding up passage of a two-year, $96 billion budget (Robertson, 3/24).

The Richmond Times-Dispatch: McAuliffe Proposes Budget With Medicaid Pilot
The House of Delegates will meet tonight to set up a state budget confrontation that has a new player in the game -- Gov. Terry McAuliffe -- while the Virginia Senate has left town. McAuliffe moved Monday to take advantage of a rare opportunity for a first-year governor to introduce his own budget, including expansion of Virginia’s Medicaid program to provide health coverage to up to 400,000 uninsured people. The governor’s budget proposal, encompassing 104 amendments and proposals for using an estimated $225 million in state savings from Medicaid expansion, rankled House Republican leaders who want to deal with Medicaid separately (Martz, Meola and Nolan, 3/25).

And a new study looks at people in the states that aren't expanding the program -

The Hill: Study: States Refusing Medicaid Expansion Would Benefit The Most 
There are more than 15 million uninsured or underinsured people living below the poverty line in the 23 states that have refused to expand Medicaid under Obamacare, according to a new study by The Commonwealth Fund. Many of these states have among the highest rates of uninsured or underinsured people in the country, the study found (Easley, 3/25).

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Appeals Court To Weigh Challenge To Health Law Subsidies

Opponents of the health law argue that the legislative language never says subsidies can be used to defray premium costs for low- and moderate-income people who live in states that did not set up their own online marketplaces and are served instead by the federal exchange. Also, in news about how the law is being implemented, a look at who is exempted from the mandate to get insurance.

Bloomberg: Obamacare Subsidies Seen As Illegal On State Exchanges
If President Barack Obama’s signature health-care law unravels, it could be for want of a single number in crucial passages of the 2,409-page statute. The missing number, 1321, refers to a section of the Patient Protection and Affordable Care Act that directs the federal government to establish an insurance marketplace in states that decline to create the exchanges, where low- and moderate-income people can buy health insurance and get subsidies for it. Key passages of the law, including who's eligible for a subsidy, are missing that reference. That’s provided an opening for Obamacare opponents to argue today to the U.S. Court of Appeals in Washington that millions of otherwise qualified people in the 36 states that haven't set up marketplaces are ineligible to receive the subsidies (Zajac, 3/25).

Politico: Honey, I Shrunk The Mandate
Filed for bankruptcy in the past six months? Had medical bills you couldn't pay in the past two years? Been a victim of domestic violence? Received a shut-off notice from a utility company? If you don't want to buy insurance under Obamacare, you don't have to. No penalty. The individual mandate may be the most despised part of Obamacare, but the reality is that it's much smaller than people think. It's riddled with exemptions, hardships and other loopholes that allow millions of people off the hook for enrollment by March 31 (Norman, 3/25).

And in other news -

Propublica: Smoking Mad: Tobacco Users Caught Up In Insurer's Obamacare 'Glitch'
[Retired nurse Terry] Wetherby was among about 100 smokers in New Hampshire caught up in a "technical glitch" that caused them to lose their new health insurance policies because they had been mistakenly charged non-smoking rates, according to the New Hampshire Department of Insurance. It is unclear if the error affected smokers in other states served by Anthem (Ornstein, 3/24).

The San Francisco Chronicle: Health Care Law Opens Opportunities For Tech Startups
The Affordable Care Act's website started out as a technological disappointment, but digital startups see plenty of opportunities to capitalize on the legislation on the eve of the enrollment deadline. The law has prompted entrepreneurs to launch websites and mobile apps designed to help people sign up. The Obama administration, which took heated criticism for the botched rollout of HealthCare.gov last fall, will enroll as many people as it can by the March 31 deadline. "Before the ACA, you really didn't have a centralized and large influence to push the industry toward these kinds of innovations," said Judd Hollas, CEO of EquityNet, who has seen an increase in health care-related ventures on his crowdfunding site that helps companies raise money from private investors (Lee, /24).

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New Pro-Health Law Bumper Stickers Take Aim At Tea Party

Also, Americans For Prosperity is airing new anti-Obamacare ads. As the political back-and-forth action continues, The Washington Post checks some of the facts.

The Wall Street Journal’s Washington Wire: Obamacare Bumper Sticker Pokes Fun At Tea Party
[Organizing For Action] has begun mailing a bumper sticker with the slogan “Don’t tread on my Obamacare” and the logo of a coiled stethoscope -- in the place of a rattlesnake -- to people who have connected with the organization’s Facebook page and provided their mailing address. The initiative, aimed in part at boosting OFA’s mailing list, also appears to be a jab at the tea party, whose members have commonly flown the yellow Gadsden flag -- with the slogan “Don’t tread on me”-- at their rallies (Ballhaus, 3/24).

The Wall Street Journal’s Washington Wire: AFP Airs New Anti-Obamacare Ad In Michigan
Another day, another ad blasting Obamacare from the conservative Americans for Prosperity. The latest television spot in the group’s $30 million media blitz is airing in Michigan, where the U.S. Senate race pits the former secretary of state, Republican Terri Lynn Land, against Democratic Rep. Gary Peters (Reinhard, 3/25).

The Washington Post’s The Fact Checker: New Anti-Obamacare Ad Makes Misleading Claims 
This 30-second ad from the pro-GOP group Americans for Prosperity claims it’s not about politics. But it’s really all about making life difficult for Democrats. In fact, the ad goes by so quickly that viewers may have little time to process the information offered in the ad -- except that the Affordable Care Act is really bad for Americans. The Truth Teller team has produced a video (above) which provides instant fact checks as the actress hired for the ad speaks her lines. More detail about the claims is provided below (Kessler, 3/25).

Meanwhile, odds makers look hard at Republican chances to regain the Senate --

Bloomberg: Republican Odds Of Senate Takeover Rise As Obama Declines 
The election that will determine control of the U.S. Senate is more than seven months away, an eternity in American politics. Even so, independent analysts are increasingly bullish on Republican prospects of gaining the six seats the party needs to win control of the chamber (McCormick and Giroux, 3/25).

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Health Care Marketplace

Study: Many States Do Poorly On Health Care Price Transparency

Also, ProPublica examines doctor-drug company "double-dipping" at some academic medical centers.

Modern Healthcare: Most States Score Poorly On Price Transparency
A report card on health care price transparency concludes that most states have been all talk and no action when it comes to providing patients with information to make informed choices -- even worse than last year. ... Last year, the report [by the Catalyst for Payment Reform and the Health Care Incentives Improvement Institute] explained that states received points for having transparency laws. But this year, states were also judged on how well they had implemented those laws. In 2013, for example, New Hampshire received an A in part for its law calling for price information to be publicly posted on the Web. This year, the state was given an F because its website is inoperative (Robeznieks, 3/25).

ProPublica: Double Dip: Doctors Paid To Advise, Promote Drug Companies That Fund Their Research 
Pharmaceutical companies pay for the clinical trials that Dr. Yoav Golan conducts on antibiotics at Tufts Medical Center. They also pay him tens of thousands of dollars a year to give speeches and advice on behalf of their drugs. If Golan worked at some teaching hospitals, he would be barred or severely restricted from accepting both research funding and personal payments for promotional speaking or consulting from drug makers. These hospitals fear the money could influence clinical findings, or at least create the appearance of a conflict of interest. Yet Tufts and many other academic medical centers allow doctors to accept overlapping payments — and some doctors still take them (Ornstein and Grochowski Jones, 3/25).

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State Watch

State Roundup: Calif. Malpractice Cap Ballot Measure

A selection of health policy stories from California, Colorado, Florida, Arizona, Virginia, Maryland and Massachusetts.

Los Angeles Times: Backers Of Malpractice Cap Ballot Measure Submit Signatures
Proponents of a measure to raise the cap on some medical malpractice damages submitted signatures Monday afternoon to qualify for the November ballot, paving the way for a costly initiative fight. The measure would change a 1975 California law that has limited pain and suffering damages in malpractice cases to $250,000 (Mason, 3/24).

Health News Colorado: Governor Supports Immunizations As Bill Advances
A bill that would make it tougher for parents to skip immunizations passed Colorado’s House today. Gov. John Hickenlooper stopped short of endorsing the precise language in House Bill 14-1288, but signaled strong support for vaccines. “I support finding ways to get more kids immunized,” Hickenlooper said during a press conference to unveil the 2014 Kids Count report. Hickenlooper said myths that vaccinations cause autism are still prevalent among parents even though “every scientific study seems to disprove that” (McCrimmon, 3/24).

The Associated Press: Bill Aims To Close Fla. Cash-Only Clinic Loophole
Cash-only medical clinics are allowed to skirt the licensing and regulation most other clinics are subject to, a loophole that a Florida lawmaker contends allows some of them to dispense drugs illicitly. State Sen. Eleanor Sobel, D-Hollywood, addresses the secrecy in these clinics, which don't accept Medicare or insurance payments, in a measure that sailed through the Senate Committee on Criminal Justice on Monday (Miller, 3/24).

The Arizona Republic: Phoenix Ambulance-Ride Cost: $860
Being transported in an ambulance in Phoenix costs an average of $860, the Fire Department said. While that may appear expensive, officials said the rate has remained relatively steady over the past several years, and charges are higher in rural areas and in Tucson. The rate for the Tucson Fire Department, for example, is $1,105 for advanced life-support service. The average ground ambulance bill includes treatment, fuel, mileage and supplies for both basic and advanced life support. Rates are regulated by the Arizona Department of Health Services (Pineda, 3/24).

Bloomberg: Cigarette Smuggling Increase Prompts Crackdown By States 
Higher cigarette taxes are prompting a burgeoning smuggling trade along routes such as I-95 on the East Coast, and states are trying to stem the flood of illegal smokes to fight crime and regain lost revenue. Lawmakers in Virginia and Maryland passed bills boosting the penalties on smuggling in the past year, and the Massachusetts Commission on Illegal Tobacco released a report March 1 with recommendations to crack down on trafficking (Niquette and Deprez, 3/24).

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Editorials and Opinions

Viewpoints: Be Careful What You Pray For; Health Law 'Freakouts;' Concerns About Imported Drugs

Los Angeles Times: Hobby Lobby Case: Defenders Of Religious Freedom Should Be Careful What They Pray For
On Tuesday, the Supreme Court will consider a proposition that will strike many Americans as bizarre: that large, for-profit businesses can refuse on religious grounds to comply with a federal mandate that they include contraception in their employee health plans (3/25). 

The Washington Post: The Government's 'Compelling' Interest In Protecting Contraceptive Coverage
The Supreme Court on Tuesday will devote a double session to hear arguments on one of the most contentious pieces of the Affordable Care Act: the rule that companies providing health-care insurance to their employees include coverage for a range of contraception services. Two firms — Hobby Lobby and Conestoga Wood — contend that complying with the law would violate their owners' religious principles, so the Religious Freedom Restoration Act (RFRA) demands that the government grant the companies an exception from the rule. We think the firms are wrong (3/24).

Bloomberg: Obamacare Confronts Sex, Religion And Free Speech
Every few years a U.S. Supreme Court case comes along that seems magically to involve every important issue of the day. Hobby Lobby v. Sebelius, which will be argued tomorrow, does the trifecta one better: It involves the Affordable Care Act, religious liberty, contraception and the question of whether a corporation is a person with fundamental rights. It would be the professor’s all-time dream question for a final exam in constitutional law -- except that even the best students couldn’t possibly have time to address all the issues (Noah Feldman, 3/24).

Reuters: Why Corporations Don't Deserve Religious Freedom
The cases challenge a provision of the ACA that requires employer-provided insurance plans to include contraception coverage. The rulings' importance extends beyond the ACA, however. Hobby Lobby and Conestoga Wood, its companion case, are also about Citizens United — which established that corporate personhood includes freedom of speech, exercised, in part, by giving money to political causes. Now the court will decide whether corporations have freedom of religion as well, and whether on the basis of those rights, corporations can deprive services to others (Jay Michaelson, 3/24).

USA Today: Hobby Lobby Case Fuels Bigotry
Today, the Supreme Court will hear arguments by Hobby Lobby, a nationwide chain of craft stores, asking the court for the right to discriminate against their employees who are entitled to reproductive health care under the Affordable Care Act. I know that Hobby Lobby's owner family, the Greens, are deeply religious people, and I respect their beliefs. They object to certain forms of birth control, claiming they constitute abortion (a "fact" disputed by much of the medical community). The Greens claim that corporations, through their owners, have freedom of religion — a very slippery slope. But should the entire company and its 14,000 employees be held hostage by the beliefs of its owners? (Rev. Gene Robinson, 3/24). 

Los Angeles Times: Today's Obamacare Freakout: 'But How Many Have Paid???'
Affordable Care Act ill-wishers -- who take a curiously gleeful view of suggestions that the act isn't working, as if failing to bring health insurance to millions of people is something to celebrate -- have trolled a succession of "concerns" suggesting that even if you think Obamacare is working, it's really not, because... So we've had the "Yes, millions have signed up, but most of those already had insurance" freakout. And the "Yes, millions have signed up, but not enough of them are young" freakout. Related to the latter is the "Bad demographics will cause an insurance death spiral" freakout. These were icing on a cake whose original ingredients included the "death panel" and "government-controlled healthcare" freakouts (Michael Hiltzik, 3/24). 

The Washington Post's The Plum Line: What We Should Demand From Coverage Of The Affordable Care Act
Next Monday is March 31, the deadline for people in the individual market to sign up for health insurance without incurring the fine they'll have to pay when they file their taxes a year from now. There's going to be a wave of stories in the news about the Affordable Care Act as this deadline approaches, and if the pattern we've seen over the last few years holds, there will be some informed and informative coverage, mixed in with a whole lot of crappy coverage written by journalists who don’t know very much about the law and what its effects are (Paul Waldman, 3/24). 

The Washington Post’s The Plum Line: Where Does Scott Brown Stand On New Hampshire's Medicaid Expansion
Now that Scott Brown looks all but certain to run for Senate in New Hampshire, sooner or later he'll be asked: Do you support or oppose the Medicaid expansion that's currently moving forward in the state you want to represent? The question goes beyond just New Hampshire and is a reminder that the politics of Obamacare are not quite as clear cut for Republicans as they like to claim (Greg Sargent, 3/24).

Politico: The Affordable Care Act Is Working
It is now four years since the Affordable Care Act was enacted. And in more than 30 years in government, I've never seen a law get so little recognition for doing so much good so quickly. The right measure of the ACA isn't whether it avoids political controversy; it's whether it makes America better by achieving its five most fundamental goals: expanding health-insurance coverage, lowering costs and promoting fiscal responsibility, increasing quality through innovation, protecting seniors and delivering peace of mind to American families by guaranteeing essential rights in dealing with insurance companies. By that standard the law is already a success (Phil Schiliro, 3/24).

McClatchy: Health-Care Law Is A Winner For All, Especially Women
It's not much of a stretch for us to say the Affordable Care Act is one of the most significant pieces of legislation for women in our lifetimes. Not because of the battles we fought to get it to the president's desk or because of the size or scope of the law. But because of the tangible and positive impact it has had, and will continue to have, on the health and well-being of American women and their families. On Sunday, this law celebrated its fourth anniversary, serving as a stark reminder of where our nation's health-care system was four short years ago. Just four years ago, the insurance companies had all the leverage, and, too often, women paid the price (Sens. Patty Murray, D-Wash., and Barbara Boxer, D-Calif., 3/24).

Fox News: Democrats Will Never Be Able To Turn ObamaCare Lemon Into Lemonade
Here is a newsflash for Democrats trying to make lemonade out of ObamaCare: It's never going to happen. President Obama’s failed health care experiment has left a bad taste in Americans' mouths and they will reject candidates who support this atrocity come November. Those arguing for Democrats to take an aggressive stance defending ObamaCare will regret it (L. Brent Bozell III, 3/24).

The Milwaukee Journal Sentinel: The Demand For Health Insurance
Obamacare isn't perfect — and the rollout was anything but perfect. It was downright awful. But to have 5 million people signed up despite these frustrations says something about what people need and want. Obamacare remains a reasonable way for them to get it (3/24).

On other health care issues -

The New York Times: Scare Tactics Over Foreign Drugs
About five million Americans buy medication internationally each year because of high costs in the United States. These drugs are considered "foreign unapproved drugs" by the Food and Drug Administration, and federal law makes it illegal to buy them. ... For almost 15 years big drug companies have vigorously lobbied Congress and the federal government to stop Americans from buying foreign medicines. As part of that lobbying, they have made it seem as if all medications purchased from Canada and other international sources are the same as those that come from websites that sell counterfeit drugs. ... That assertion is just not true and will scare lawmakers and consumers into believing that all imported drugs bought online are dangerous (Gabriel Levitt, 3/24). 

Los Angeles Times: Feeling Ill-Effects Of Private Long-Term Care Insurance
Critics of safety-net programs such as Social Security and Medicare are fond of saying that the private sector would do a much better job of protecting people thanks to the magic of the marketplace. Mike and Judy Holtzman of Laguna Woods are now experiencing the magic of the marketplace for long-term care insurance. And it stings (David Lazarus, 3/24). 

Reuters: Combatting TB 2.0
Earlier this month, health officials in Los Angeles confirmed they are treating a patient for extensively drug resistant tuberculosis — a deadly form that does not respond to most of the antibiotics. The United States is one of 100 countries that have reported cases of “XDR-TB” since it was discovered in South Africa less than a decade ago. Congress is holding public briefings Tuesday and Wednesday to look into the threat posed by tuberculosis, seeking expert recommendations to help develop a U.S. response. To be effective, public health efforts must adapt to the ways TB is evolving (Jose Luis Castro, 3/24).

The Boston Globe: Code Book Changes Put Hospitals In Bureaucratic Bind
Your doctor is about to get a serious headache. The medical establishment in Boston and beyond is howling over new government rules that dramatically alter one of the most important documents in health care, the code book hospitals must use to describe an injury, the essential element in all medical record-keeping and billing. Exactly how detailed are all these new medical descriptions? (Syre, 3/25).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Lisa Gillespie
Shefali Luthra

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