Daily Health Policy Report

Tuesday, March 27, 2012

Last updated: Tue, Mar 27

KHN Original Reporting & Guest Opinion

Health Reform

Campaign 2012

Coverage & Access

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Health Law Accelerates Industry Changes

Kaiser Health News staff writer Phil Galewitz, working in collaboration with USA Today, reports: "More consumers in Indianapolis, for instance, are getting their care from doctors employed by large health care organizations, who are collecting and sharing their medical records electronically and beginning to be rewarded for keeping patients healthier and holding down costs – largely by keeping them out of the hospital" (Galewitz, 3/26). Read the story.

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Your Guide To The Health Law At The Supreme Court, Day 1 (Video)

This Kaiser Health News video features KHN’s reporter inside the court, Stuart Taylor, talking with Jackie Judd, about the court's first day of arguments. The disucssion focused on the Anti-Injunction Act and whether the court can rule on the case before a penalty is imposed on those who do not have health insurance. All the justices, except one, seemed eager to ask questions (3/26). Watch the video or read the transcript.

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Insuring Your Health: Some Insurers Paying Patients Who Agree To Get Cheaper Care

In her latest Kaiser Health News consumer column, Michelle Andrews writes: "In recent years, insurers have tried to cajole consumers into using less-expensive health-care providers by promising lower co-payments and other cost-sharing breaks for members who select those doctors and hospitals. Lately, they're trying an even more direct approach: cash rewards" (Andrews, 3/26). Read the column.

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Capsules: Hundreds Brave Chilly Weather For Chance To Witness History; In Massachusetts, SCOTUS Case Is (Mostly) Irrelevant

Now on Kaiser Health News' blog, WBUR's Martha Bebinger, working in partnership with Kaiser Health News and NPR, writes about how the SCOTUS case doesn't necessarily impact Massachusetts: "The health care battle that began this morning at the Supreme Court is one of the most important of our lifetime. But the direct effect on Massachusetts, which created the framework for the federal Affordable Care Act (ACA), is minimal, at best" (Bebinger, 3/26).

Also on Capsules, Phil Galewitz reports on the demonstrations taking place Tuesday as the Supreme Court considered arguments on the individual mandate: "With the Supreme Court poised Tuesday to hear arguments about the health law's mandate requiring most Americans to buy health insurance, about 200 advocates for and against abortion rights marched outside the court on a sunny, but chilly morning. They carried signs saying, 'Abortion is not Health Care,' and 'Protect the Law' (Galewitz, 3/27). Galewitz also detailed demonstrations on Monday (3/26). Check out what else is on the blog.  

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Slideshow: Citizens Gather As Supreme Court Begins Review Of Health Law

Inside the Supreme Court building this week, the nation's highest court is hearing oral arguments in a case that seeks to overturn the 2010 health law. This Kaiser Health News slideshow offers glipses of what was happening outside the building, where Americans gathered to express their support or opposition to the law -- or just to see history being made (Marcy, 3/26). Check out the slideshow.

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The Health Law Arguments At The Supreme Court: Day 2 - The Individual Mandate

Tuesday's Supreme Court oral arguments are scheduled to last 120 minutes and focus on "what many consider the central issue: whether the mandate, which is unprecedented, should be voided because it represents an unconstitutional exercise of Congress' powers to regulate commerce and to levy taxes" (Taylor, updated 3/23). For more information about the arguments, read KHN's Primer For The Upcoming Oral Arguments.

Also, check out Kaiser Health News resource page, The Supreme Court Decides: Health Law At The High Court, for our complete coverage. It includes KHN's scorecard, which tracks the course the legal challenges followed to arrive at the high court; as well as anaylsis, news, briefs and other documents. KHN also has a collection of its coverage related to the law's second anniversary and the high court's review, and will update the web site throughout the day with the latest information and news summaries.

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Political Cartoon: 'Check Up'

Kaiser Health News provides a fresh take on health policy developments with "Check Up" By John Darkow.

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

RIGHT V. LEFT

The mandate was theirs
Before Obama passed it.
Now the right loathes it?
-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

If It's Tuesday, It's The Individual Mandate

In the second day of oral arguments, the Supreme Court is considering the "individual mandate," which is considered the "heart" of the health law. The issue is steeped in politics. 

The Associated Press: Justices Take Up Heart Of Health Care Overhaul Law
The Supreme Court is taking up the key question in the challenge to President Barack Obama's historic health care overhaul: Can the government force people to carry insurance or pay a penalty? The justices hear extended arguments on that topic Tuesday. It's the linchpin of the law's aim to get medical insurance to an additional 30 million people, at a reasonable cost to private insurers and state governments (Sherman, 3/27).

The New York Times: For Justices, A Matter Of Framing The Core Issue On Health Care
However the questions are ultimately framed, the Supreme Court's answers will be grounded in the text of two provisions of the Constitution and in the precedents interpreting them. ... The two powers at issue in the case, set out in Article I, Section 8, concern the regulation of interstate commerce and the imposition of taxes (Liptak, 3/27).

USA Today: Supreme Court To Tackle Controversial Health Care Debate
Monday's hearing paves the way for two more days of oral arguments in a case that has played a central role in this year's presidential campaign and raises questions about the scope of Congress' powers (Health and Wolf, 3/27).

Politico: Mandate A Lose-Lose Proposition For President Obama?
If the Supreme Court upholds health reform's individual mandate, will it really be a victory for President Barack Obama? Or will it just mean he gets to keep owning the least popular part of the law? (Haberkorn, 3/27).

The Washington Post: Health-Care Provision At Center Of Supreme Court Debate Was A Republican Idea
[The mandate] was the brainchild of conservative economists and embraced by some of the nation's most prominent Republicans for nearly two decades. Yet today many of those champions — including presidential hopefuls Mitt Romney and Newt Gingrich — are among the mandate's most vocal critics (Aizenman, 3/26).

NPR: Justices Tackle The Big Question: Can Congress Force You To Buy Insurance
The law provides generous subsidies if you can't afford it, but you must have health insurance, and if you don't, you pay a penalty through your income taxes. The mandate is essentially a trade-off for reducing the costs of health care policies overall and guaranteeing affordable coverage for people with previous medical conditions (Totenberg, 3/27).

The Wall Street Journal: A Small-Business Lobby's Million-Dollar Assault
National Federation of Independent Business lawyer Michael Carvin will argue against the "individual mandate" in President Barack Obama's health-care law, together with former Solicitor General Paul Clement, who is representing 26 states (Needleman and Loten, 3/26).

Bloomberg: Health Law Centerpiece At Risk As High Court Hears Core Argument
The government, defending the president's signature legislative victory, will contend that Congress can require people to buy insurance under its constitutional power to regulate the interstate health-care market (Stohr and Asseo, 3/27).

Reuters: Supreme Court Moves To Heart Of Healthcare Case
The two-hour session on the second day of a historic three-day oral argument will offer a first concrete look at how the nine justices view the law Obama signed two years ago and that still divides his Democrats and rival Republicans (Biskupic and Vicini, 3/27).

Roll Call: Anxiety Permeates Health Care Case
With protests and press conferences outside and respectful silence within, the court began the rare three-day argument Monday with anxiety on both sides over the fate of the most far-reaching federal law in decades. In the first 90 minutes of argument, the justices gave few clues as to how they will ultimately rule, but they appeared eager to do so (Dennis, 3/27)?

NewsHour: Supreme Court Reviews Health Reform Law: A Guide To Day 2
(Tuesday) is really the "main event" from the perspective of many organizations, politicians, businesses and individuals who have been involved with or just have followed the debate ... Both sides in this battle look to one very old and four more recent Supreme Court decisions to bolster their arguments (Kane and Coyle, 3/27).

Fox News: Supreme Court Hearing On Individual Mandate Tees Up Blockbuster Decision
The issue on Tuesday will present the justices the opportunity to determine how much power the federal government has in forcing Americans to purchase a product or enroll in a government program they might otherwise avoid (Ross, 3/27).

CNN: Supreme Court Set To Debate Heart Of Health Care Law
Typical of the ideological divide, the opposing sides do not even agree on what the individual mandate was designed to accomplish. Supporters see it a way of spreading health care costs to a larger pool of individuals, ensuring affordable, quality medical care. ... But opponents see a fundamental constitutional violation: an intrusion into a citizen's personal lives, forcing Americans to purchase a commercial product they may not want or need (Mears, 3/27).

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High Court Unlikely To Push Health Law Ruling Into The Future

Based on justices questions' during the opening day of oral arguments in the challenges to the health law, it appears the court was receptive to arguments by both the federal government and the measure's opponents that the case should be decided now rather than waiting until after the individual mandate's penalties for not having health insurance have kicked in.   

Kaiser Health News: Your Guide To The Health Law At The Supreme Court, Day 1 (Video)
The first day's arguments focused on the Anti-Injunction Act and whether the court can rule on the case before a penalty is imposed on those who do not have health insurance. KHN's reporter inside the court, Stuart Taylor, tells Jackie Judd that all the justices, except one, seemed eager to ask questions (3/26).

The New York Times: Justices Hear Argument That Health Case Is Premature
At the opening of three days of arguments, the justices' questions suggested that they were receptive to a point on which both supporters and opponents of the law agree: that the court should decide the case now rather than waiting until the law's penalties for not having health insurance become due (Liptak, 3/26).

Reuters: Supreme Court Unlikely To Delay Healthcare Ruling
The Supreme Court on Monday appeared prepared to decide the fate of President Barack Obama's sweeping healthcare law soon, rather than delaying for years a ruling on the mandate that Americans buy insurance or pay a penalty. In the first of three days of historic arguments, the justices voiced doubt that a U.S. tax law requiring that people pay first and litigate later should postpone a ruling on the legal challenge to the president's signature domestic legislative achievement (Biskupic and Vicini, 3/26).

The New York Times: Arguing That Health Mandate Is Not A Tax, Except When It Is
Throughout the two-year history of the health care litigation, judges have mocked the Obama administration'’s have-your-cake approach to the central question debated at the Supreme Court on Monday: whether the constitutional challenge is even ripe for judicial review before the law takes full effect in 2014. During the opening 90 minutes of oral argument, the justices found that they too could not resist (Sack, 3/26).

The Washington Post: Supreme Court Begins Review Of Health-Care Law
The court began the first of three days of oral arguments on the 2010 law by examining a statute that keeps courts from hearing tax challenges before they go into effect. But the justices’ questions indicated skepticism that the penalties prescribed for those who do not buy health insurance by 2014 amount to taxes under the 1867 law forbidding tax challenges (Barnes, 3/26).

The Wall Street Journal: Court Unlikely to Delay Ruling
Supreme Court justices showed little sympathy Monday for the position that they must wait until 2014 or after to decide on the challenge to President Barack Obama's health-care overhaul law. … The case's central issue is whether Congress can require Americans to carry health insurance or pay a penalty along with their income taxes. But the court couldn't entertain that question until the penalty takes effect in two years, said Washington litigator Robert Long, who was appointed by the court to argue the position (Bravin, Radnofsky and Kendall, 3/27).

Politico: 5 Supreme Court Takeaways
On the opening day of Supreme Court arguments over President Barack Obama's signature health care law, justices signaled Monday that they most likely will rule on whether the heart of the law is constitutional (Haberkorn and Gerstein, 3/26).

NPR: Reading Between The Lines Of Monday's Supreme Court Arguments
The argument against the court's role in the case hinges on justices buying the theory that penalties assessed under the law on those who fail to obtain health insurance by 2014 are tantamount to taxes. Unfortunately for Washington lawyer Robert Long, who was making the argument, they appeared not to be buying it (Halloran, 3/26).

The Wall Street Journal: If It Looks Like A Tax, And Acts Like A Tax …
If the Obama health-care law ultimately is struck down by the Supreme Court, the reason could be the absence of a single word: tax. The high court long has recognized broad congressional authority to levy taxes, and both supporters and opponents say the law would be on firmer ground if the penalty for those who refuse to carry health insurance were labeled a tax (Bravin, 3/27).

Market Watch: Supreme Court Leans Toward Ruling On Health Care
Questions from Supreme Court justices on Monday indicated a likelihood that they will rule on the legality of landmark health-care legislation, rather than delaying it for at least another two years. The nine justices heard arguments that a law called the Anti-Injunction Act, from 1867, prevents any ruling on the legality of a tax until it has been applied (Goldstein, 3/26).

Bloomberg: Court Opens Health-Care Clash With Law That May End Case
The U.S. Supreme Court opened its historic hearings on President Barack Obama's health-care overhaul with several justices suggesting they'll brush aside an argument that they can't rule until the law takes full effect. Justices including Stephen Breyer and Ruth Bader Ginsburg today suggested they didn’t view an 1867 law as barring them from ruling immediately on the law's requirement that Americans either get insurance or pay a penalty (Stohr, 3/26).

The Hill: Supreme Court Signals It Will Not Punt On Health Care Decision
The Justice Department says the mandate is constitutional, in part, under Congress’s power to levy taxes. But in urging that the justices should not postpone a decision until the mandate takes effect, sometime after 2014, the administration has had to argue that the mandate is not a tax. Justice Samuel Alito raised the issue as Solicitor General Donald Verrilli Jr. argued Monday that the fine is a not a tax (Baker, 3/26).

The Philadelphia Inquirer: Supreme Court Opens Health Case Hearings
In 90 minutes of oral arguments, before a packed courtroom, the justices took up the question whether legal challenges to the law by 26 Republican state attorneys general and a national alliance of small business owners is premature because central features of the law, signed in March 2010, have yet to take effect. "I find it hard to think that this is clear," said Justice Antonin Scalia, one of the court's conservatives, at one point. "It is easy to think that it is not clear" (Mondics, 3/26).

CQ HealthBeat: Supporters, Opponents Agree: Justices Want To Resolve Health Care Law Constitutionality Soon
Detractors and supporters of the health care law emerged from the first of three days of oral arguments Monday agreeing that the Supreme Court wants to resolve the measure’s constitutionality without delay. At issue Monday was whether the Anti-Injunction Act bars the court from considering the constitutionality of the law until 2015 (Reichard, 3/26).

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Poll: Two-Thirds Of Americans Want At Least Part Of Health Law Overturned

News outlets examine polls and public opinion related to the health law and explore how much of a campaign issue it may ultimately turn out to be.

The New York Times: Most Oppose At Least Part Of Overhaul, Poll Finds
Two-thirds of Americans want the Supreme Court to overturn some or all of the health care law, even though large majorities support a few of its major aspects, according to a poll by The New York Times and CBS News (Sussman, Cooper and Phillips, 3/26).

National Journal: Poll Says One In Four Americans Want Supreme Court To Uphold Health Care Law—Report
Only one in four Americans would like the Supreme Court to keep intact President Obama's 2010 Affordable Care Act, according to a new CBS News/New York Times poll. The court began Monday hearing arguments in the case. Just over half of respondents -- 51 percent -- say they disapprove of the law’s individual mandate, which will require nearly all Americans to have health-insurance coverage or pay a penalty. Twenty-nine percent of respondents said they would like the Court to invalidate the coverage mandate only, according to the poll, conducted March 21-25 among 986 adults (Chamberlain, 3/27).

ABC: Why Health Care Won't Be a Campaign Issue In 2012
Most Americans have already formed an opinion of the Obama health care law,  and a Supreme Court ruling isn't going to change that. One Democratic strategist who was closely involved in the 2010 midterm elections – an election in which a vote for the health care legislation cost many Democrats their seats- says the health care issue has "been played out and litigated out" (Walter, 3/26).

FactCheck/iWatch News: How Americans really feel about 'ObamaCare'
Mitt Romney says "most Americans want to get rid of" President Obama's two-year-old health care law. Is he right? That depends on which poll-taker is asking the question, and how it's worded. ... a Bloomberg News national poll asked the question this way: "Turning to the health care law passed last year, what is your opinion of the law?" 37 percent agreed with the statement, "It should be repealed." ... [A Gallup poll asked] "If a Republican is elected president in this November's election, would you strongly favor, favor, oppose, or strongly oppose him repealing the healthcare law when he takes office?" Gallup reported these results: 26 percent "strongly favor." 21 percent "favor" (3/26). 

Politico: Why Obama May Not Win If Mandate Is Upheld
But as the Supreme Court takes up the mandate Tuesday, what’s at stake is not just the legal question — whether Congress overreached by requiring nearly all Americans to buy health insurance. There’s also the broader political question of whether Obama can really win this one. The public has never liked the idea that the health law will require Americans to buy insurance starting in 2014. Even Obama opposed the mandate during his presidential run. And if the court puts its constitutional stamp of approval on the mandate, the justices are not likely to change public sentiment (Haberkorn, 3/27).

Also, a survey probes employers' perspectives on the health law -

Chicago Tribune: Survey: Employers Keeping Health Coverage
Most employers who said they would drop health insurance coverage for employees because of new health reform legislation, have not done so, according to a new survey. The survey, in its third year, is conducted by the Midwest Business Group on Health and co-sponsored by the National Business Coalition on Health, Business Insurance and Workforce Management, and asked 440 employers in 34 states their perspectives on the Affordable Care Act (Wernau, 3/26).

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Demonstrators Provide Punctuation, Personality To Ongoing Debate

Though events inside the Supreme Court were staid and steeped in the high court's rules and processes, outside activists converged to argue their positions and to shape public opinion about the health law.

The Wall Street Journal: Outside The Court, Activists Argue Their Cases
Doctors in white coats and union activists who support the law marched in a circle chanting "I love ObamaCare," adopting a term coined by the measure's foes. Opponents, many sporting tea-party T-shirts, hoisted "Don't Tread on Me" flags. A shouting contest—"Health care is a right" versus "Where in the Constitution?"—dominated the sidewalk. The spectacle was the latest revival of a debate that started at heated town-hall meetings and rallies in 2009. Each side has spent months preparing for this week, obtaining everything from bongo drums to a rented building for radio broadcasts to further their cause (Radnofsky and Grossman, 3/27).

The Washington Post: Outside Supreme Court, protesters have already rendered health-care verdicts
Inside, nine justices sat in a quiet, camera-less courtroom to hear reasoned testimony and weigh their opinions about health-care reform. Outside, hundreds of protesters paraded on the steps of the court, postured for cameras and shouted at one another through bullhorns. Reason gave way to political theater. Opinion was already in abundance (Saslow, 3/26).

Reuters: Dueling Chants As Demonstrators Vent Over U.S. Healthcare Law
Supporters of President Barack Obama's signature healthcare law chanted "We love Obamacare" while opponents replied "We love the Constitution" in lively demonstrations outside the U.S. Supreme Court on Monday as the justices weighed the fate of the statute. Gusty winds whipped American flags, signs and banners as hundreds of supporters of the law outnumbered opponents at the white marble columned court building on the first of three days of arguments over the law signed by Obama in 2010 (Simpson, 3/27).

National Journal: Supreme Court Winds Up 'Boring Day' Of Health Care Case
Outside the building, it was chaos, with nonstop demonstrations, news conferences, interviews, and generalized grandstanding – even a brass band. … Virginia Attorney General Ken Cuccinelli, who is leading one of the challenges to the health care law, descended from the steps of the high court around 3 p.m., sending up shouts among the tea party group. He says he is looking forward to hearing arguments on Tuesday (Khan and Mimms, 3/26).

The Associated Press: Chants, Marching, Debate, Even Jazz, Outside Court
Demonstrators with dueling chants, singers, doctors in white coats, even a presidential candidate and a brass quartet joined hundreds of people sounding off Monday on the broad sidewalk in front of the Supreme Court as the justices considered President Barack Obama's health care law. As the justices listened to legal arguments, demonstrators said it was important their messages be heard too (Gresko, 3/26). 

The Hill: Tea Party Converges On Court For Main Event In Health Care Debate
Hundreds of protesters, including both supporters and opponents of the healthcare law, rallied near the Supreme Court’s steps Monday, but the scene outside the court could get even more chaotic. The group Tea Party Patriots is holding a rally in front of the court just as Tuesday’s hearings get under way, with a long list of prominent conservatives scheduled to attend that includes Reps. Michele Bachmann (R-Minn.), Louie Gohmert (R-Texas) and Steve King (R-Iowa). Sen. Jim DeMint (R-S.C.) is also scheduled to appear outside the courthouse Tuesday (Baker, 3/27).

NPR: Outside Court, Protesters Face Off Over 'Obamacare'
Supporters and opponents of the law engaged in a sing-song call-and-response debate just in front of the court's towering marble steps."We love Obamacare!" shouted supporters. "No, we don't!" responded members of the Tea Party Patriots, one of the most vocal and disapproving groups of the law present at the court Monday. Sometimes the exchanges became personal (Tomassoni, 3/26).

CQ HealthBeat: Outside The Court, Groups Battle To Shape Perceptions Of Health Care Law
On Monday morning, at least, opponents of the law were having a hard time getting a word in edgewise. But with the sun brightly shining and a bracing wind blowing, everyone seemed energized by the scene and their particular, outside-the-court take on how to conduct discourse. The spectators were light on citing precedent and extended argument but heavy on waving flags and homemade placards, putting campaign buttons on cute little dogs and pounding on bongo drums (Reichard, 3/26).

Kaiser Health News: Capsules: Debate Over Law Sparks Mostly Civil Exchanges Outside High Court
Scores of opponents and supporters of the health care law rallied next to each other for over three hours Monday, before, during and after the Supreme Court hearing. It was mostly civil. Supporters of the law seemed to have the upper hand outside the court — largely because the United Methodist Church next door was being used as a staging ground for left-leaning Families USA and the advocacy group Health Care for America. The location had bathrooms and a place for media to do interviews and file stories. Opponents had neither" (Galewitz, 3/26). 

Kaiser Health News: Slideshow: Citizens Gather As Supreme Court Begins Review Of Health Law 
Inside the Supreme Court building this week, the nation's highest court is hearing oral arguments in a case that seeks to overturn the 2010 health law. Outside the building, Americans gathered to express their support or opposition to the law -- or just to see history being made (Marcy, 3/26).

In related news -

The New York Times: Vindication For Challenger Of Health Care Law
When Congress passed legislation requiring nearly all Americans to obtain health insurance, Randy E. Barnett, a passionate libertarian who teaches law at Georgetown, argued that the bill was unconstitutional. Many of his colleagues, on both the left and the right, dismissed the idea as ridiculous — and still do (Stolberg and Savage, 3/26).

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What Individual Mandate, Other Health Law Rulings May Mean For Americans

News outlets analyze arguments around the individual mandate and what a ruling by the Supreme Court will mean for most Americans. Kaiser Health News looks at changes in the health care industry as a result of the law, and how most of those shifts will continue regardless of what the Court decides.

The Connecticut Mirror: Supreme Court Begins Arguments On Landmark Health Care Law
Sen. Richard Blumenthal, D-Conn., was one of a handful of lawmakers who managed to snare a seat for Monday's oral arguments, considered one of the hottest tickets in town. ... [He] said the first day of the case was "fascinating" and "exciting." ... Connecticut's health insurers, including Aetna, Anthem Blue Cross and Blue Shield, and Cigna will be watching closely. In an amicus brief, the nation's health insurers have asked the Supreme Court to free them from some of the Affordable Care Act's reforms if the mandate is judged unconstitutional (Radelat, 3/26).

Politico: Health Care Reform: Individual Mandate Will Not Affect Most Americans
The fight over the individual mandate has been so loud that people may think it will hit nearly everyone, whether they can afford health insurance or not. But what's usually overlooked is that the health reform law has so many exemptions that millions of Americans are likely to be off the hook, including a wide range of middle-class Americans. Most Americans already have coverage that satisfies the mandate (Feder, 3/26).

NPR: Uninsured Will Still Need Money To Meet The Mandate
On Tuesday, the Supreme Court hears its second day of testimony about the Affordable Care Act. At issue is a central tenet of that law: Whether it's legal to require individuals to purchase healthcare. But apart from the legal debate, there are questions about the economics of the mandate. Some … worry it may be difficult to find the money to pay for health insurance, even with government subsidies (Noguchi, 3/27).

The New York Times: Awaiting Health Law Ruling, And Preparing Plan B
State officials and insurance executives are devising possible alternatives to the coming federal requirement that most Americans buy health insurance, even as the Supreme Court hears arguments about the constitutionality of the mandate (Abelson, 3/26).

ProPublica: What's at Stake in the Supreme Court's Health Care Decisions
Here we map the possible outcomes, following the Court's schedule over the next three days. The Court ... is unlikely to issue a decision on the case until late June or early July. For more information on different states' progress implementing health care reforms, see this comprehensive list  (Groeger, 3/26).

WBUR's CommonHealth blog: Supreme Court Health Law Hearing: The 3-Minute Cartoon
Finally, I decided ... I’d ask for help from an expert teacher:Kevin Outterson, director of Boston University’s Health Law Program and a frequent blogger on health policy at The Incidental Economist. I told him that three minutes was the limit of my attention span for this topic, and though this challenge required of him a degree of simplification perhaps more radical than any he has ever attempted before, he was a great sport (Goldberg, 3/27).

The health law's changes are also transforming the health care industry and how it cares for patients --

Kaiser Health News: Health Law Accelerates Industry Changes
More consumers in Indianapolis, for instance, are getting their care from doctors employed by large health care organizations, who are collecting and sharing their medical records electronically and beginning to be rewarded for keeping patients healthier and holding down costs – largely by keeping them out of the hospital (Galewitz, 3/26).

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Campaign 2012

As Court Brings Health Overhaul Into Focus, Politicians Pounce

Rick Santorum picks up his criticism of Mitt Romney's efforts in Massachusetts, which set up mandatory health coverage, but the former governor continues to assail the federal plan.

The Washington Post: Review Of 'Obamacare' Puts GOP Spotlight On Romney's Massachusetts Health Care Law
The state overhaul [Romney] championed as governor of Massachusetts is so similar to the sweeping federal law conservatives deride as "Obamacare" that it was once widely regarded as a big enough liability to doom his presidential chances. … This week, as the Supreme Court reviews the Obama administration’s health-care law, Romney's remaining opponents for the Republican presidential nomination are trying to capitalize on what may be one of their last opportunities to deny him the prize (Rucker and Balz, 3/26).

The Hill: Santorum Visits The Court, Says He's Best GOP Candidate Vs. Obama On Health Care
Rick Santorum visited the Supreme Court Monday and accused Mitt Romney of not wanting to repeal the Obama administration's healthcare law. Speaking on the high court’s steps just after the first of three days of oral arguments on the national law ended, Santorum said Romney's absence was proof that Santorum is the only candidate in the race who actually wants to repeal the law (Strauss, 3/26).

Politico: Santorum: Only I'm Qualified To Repeal Obamacare
"There's only one candidate … who can make this the central issue that will be a winning issue to win the presidency back," Santorum said at the Court (Haberkorn, 3/26).

National Journal: Santorum At Supreme Court: Romney 'Uniquely Disqualified' To Attack 'Obamacare'
Santorum pledged to center his campaign on opposition to the health care law and said that Republicans should make him their nominee if they really want the law repealed (Kaplan, 3/26).

The Associated Press/Chicago Sun-Times: Santorum Is *Bleeping* Mad
An agitated Rick Santorum on Sunday called Mitt Romney "the worst Republican in the country to put up against Barack Obama." ... Santorum later lashed out at reporters, using a profane word as he accused them of "distorting" his speech. … "On the issue of health care. That's what I was talking about, and I was very clear about talking about that. OK?" Santorum told reporters (Elliot, 3/26).

Reuters: As Pressure Builds, Santorum Shows A Dark Side
 On the campaign trail, Santorum wraps his speeches in somber warnings about Americans losing their freedom in Obama's America -- particularly when it comes to the president's healthcare overhaul, whose requirement for Americans to buy health insurance is the focus of a case before the U.S. Supreme Court this week (Jacobs, 3/26).

Reuters: Romney Scrambles To Raise Cash For Santorum Battle
Romney used his San Diego speech at NuVasive, a company that produces devices for spinal surgery, to attack the healthcare overhaul that Obama steered through the U.S. Congress ... The healthcare law, said Romney, will increase regulation and costs on companies like NuVasive, forcing them to pay more in taxes and hire fewer workers as a result (Holland, 3/26).

The Associated Press: Romney Trumpets Rush Of Conservative Endorsements
In California, Romney stood in front of a "Repeal & Replace ObamaCare" sign at the medical device company, which was founded with venture capital. He attacked the medical device tax included in the health care law — though he didn't, during a more than 20-minute speech and despite the sign, explicitly call for the law's repeal  (Hunt, 3/27).

Roll Call: Mitt Romney Earns GOP Health Care Truce
Even as Rick Santorum steps up his attacks on Mitt Romney over health care, Senate Republicans are expressing confidence in the GOP presidential frontrunner and his ability to lead their party on this crucial issue come November. ... "I still don't like the plan the way it ended up in Massachusetts, but I like the fact that he tried to solve a problem," Sen. Jim DeMint (R-S.C.) said in an interview last week. ... "It's very different than a federal model that you can't change" (Drucker, 3/27).

Meanwhile, the president and his campaign aren't so upset about the GOP's name for the health law.

Reuters: Obama Campaign: Obamacare Not A Bad Word After All
If you can't beat 'em, join 'em. President Barack Obama's campaign has embraced the term "Obamacare," seeking to turn the negative name Republicans assigned to his healthcare reform effort into a positive branding tool ... "Happy birthday, Obamacare," Jim Messina, the president's campaign manager, wrote in an email to supporters last week to note the anniversary of the reform becoming law (Mason, 3/26).

And the Boston Globe examines the competition for women voters.

Boston Globe: President Obama, Mitt Romney Vie For Female Support
Both camps are trying to exploit very different issues as they stake their claim on women, a coveted group of voters whose shift from supporting Democrats in 2008 to Republicans in 2010 helped the GOP take over the House. The Obama campaign is trying to sell the benefits of the president's health care law, sensing an opportunity to appeal to women repelled by the Republican focus on social issues. ... Republicans are responding by trying to keep women focused squarely on the economy (Levenson, 3/27).

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Scott Brown Turns To Olympia Snowe For Help In Appealing To Women Voters

The Massachusetts senator, who has riled some women's groups for his stand on the Obama administration's contraception coverage policy, is seeking to raise the profile of women in his campaign.

Boston Globe: Senator Brown Steps Up Focus On Women
Brown, a Republican facing a difficult challenge from Elizabeth Warren, a Democrat, has been hard to spot without a woman by his side in recent weeks. The focus on women follows Brown's vote on March 1 in favor of a failed measure that inflamed many women's groups. The so-called Blunt amendment would have allowed employers to deny health coverage for contraceptives and other treatments if they had a moral objection (Bierman, 3/27).

The Associated Press: GOP's Snowe: Reward Scott Brown For Bipartisanship
Maine Republican (Sen. Olympia Snowe) downplayed Brown's recent support for an amendment that would have let employers or health insurers deny coverage for services they say violate their moral or religious beliefs, including birth control. Snowe also opposed the amendment, which failed. (Snowe) chalked up her difference with Brown on the amendment to what she called an "honest disagreement" on the best way to craft a conscience exemption for religious groups (LeBlanc, 3/26).

WBUR: Sen. Brown Works To Gain Women's Vote
U.S. Sen. Scott Brown is enlisting the help of a fellow Republican in his quest for re-election. Maine Sen. Olympia Snowe was in Boston Monday to campaign for Brown. Snowe defended Brown's vote in favor of giving employers a religious exemption to providing certain health coverage, but some Republican women in Massachusetts have been worried about the direction the national party has been taking. ... Brown co-sponsored a bill that would have allowed employers to opt out of providing contraception coverage if they have religious or moral objections (Thys, 3/27). 

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Coverage & Access

Study: Insurance Loss Or Acquisition Means More ER Visits

News outlets report on findings published in the latest issue of the Archives of Internal Medicine.

MedPage Today: ER Use Up with Any Change in Insurance
Changes in health insurance status -- whether gaining or losing coverage -- are associated with increased likelihood of an emergency department (ED) visit, researchers said. Among some 160,000 people completing the National Health Interview Survey (NHIS) from 2004 to 2009, both newly insured and newly uninsured respondents reported using an ED in excess of 30% more often than those who were continuously insured (Gever, 3/26). 

Modern Healthcare: Shifts In Coverage Status Tied To ER Use: Study
The newly insured may have deferred treatment when uninsured and may continue to struggle to find primary-care access, the researchers said. The newly uninsured "may experience a sudden decrease in access to care and require EDs for medical services," the paper said. Healthcare providers should also expect more emergency room demand, the researchers said. "Although in our study only 7.8% of U.S. adults had changes in health insurance status during the prior 12 months, legislative and economic factors are poised to increase the frequency of recent gain or loss of insurance," they wrote (Evans, 3/26).

HealthyCal: Study: Newly Insured Use ER More
While it has been anticipated that the expansion of insurance coverage might lead to more visits to an already over-burdened primary care system, many policymakers seem to have counted on a reduction in emergency room visits. ... But if covering more people leads to even more visits to emergency rooms, then those anticipated savings may not materialize (Weintraub, 3/26).

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State Watch

States Continue Epic Struggle Over What The Health Law Means For Them

Minnesota GOP lawmakers are being criticized by their Democratic governor for how they are trying to create a health insurance exchange. Elsewhere, California insurance rates are increasing as the Supreme Court hears arguments on the health law and a pair of protests targets the health law and unions in Missouri.

(St. Paul) Pioneer Press: Dayton Criticizes GOP Health Insurance Exchange Efforts
As the U.S. Supreme Court began its historic review of the federal government's sweeping health care overhaul, the political debate in Minnesota over how to implement the law heated up at the state Capitol. Gov. Mark Dayton, a Democrat, sent a letter on Monday, March 26, criticizing Republican bills moving through the Legislature for taking a "piecemeal" and "ideological" approach to creating in Minnesota a health insurance exchange -- a key piece of the federal health care legislation. "Unfortunately, there are some who would rather play politics with this exchange in an election year, than work sincerely and cooperatively to advance it in Minnesota," Dayton wrote in the letter to Sen. Chris Gerlach, R-Apple Valley, and Rep. Joe Hoppe, R-Chaska (Snowbeck, 3/26).

MSNBC/Orange County Register: As High Court Takes Up Health Care, Calif. Insurers Raise Rates
Health insurance premiums for many Californians are set to increase as much as 20 percent in the coming weeks, according to insurance company reports to federal and state agencies. The rate increases come as U.S. Supreme Court starts hearing oral arguments Monday on the constitutionality of the federal Affordable Care Act, which became law March 23, 2010, although most provisions have not yet gone into effect. Also, Consumer Watchdog, funded by trial lawyers is trying to qualify an initiative for the state November ballot to mandate government approval of insurance premium hikes. The California HealthCare Foundation says that health insurance costs increased in 2011 for 38 percent of Californians (Norman, 3/27).

St. Louis Beacon: Competing Rallies Set For Jefferson City, To Protest Federal Health Care Law, Anti-Union Measures
Lt. Gov. Peter Kinder and state House Speaker Steve Tilley, R-Perryville, are among the scheduled speakers for the “Hands off My Health Care Rally,” to be held indoors. ... Meanwhile, Missouri’s labor leaders are planning for a massive afternoon rally outside the state Capitol to protest “an outrageous number of anti-worker issues currently being considered” by the Republican-controlled General Assembly (Mannies, 3/27).

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Legislatures, Governors Contentious On Health Care Issues

In New York and Kansas, health insurance exchanges are under scrutiny.

The New York Times: Cuomo And Top Legislators Near Accord On The Budget
But the Legislature, with a Senate controlled by Republicans and an Assembly by Democrats, was unable to agree on whether to establish a health insurance exchange to comply with the much-debated federal health overhaul championed by President Obama. Mr. Cuomo, a Democrat, is now planning to sidestep opposition from Senate Republicans by creating an exchange via executive order (Kaplan and Hakim, 3/26).

The Washington Post: Virginia Senate Approves State Spending Plan
After two failed attempts, the Virginia Senate on Monday passed a state budget that includes tens of millions of additional dollars for public schools, health care and transportation ... But the evenly-divided chamber rejected an attempt by Democrats to force the state to pay $1.5 million a year for a Republican-supported law that will require women to undergo ultrasounds before abortions (Kumar, 3/26).

Kansas Health Institute News: Budget Negotiators Meet
The House and Senate budget plans each hew closely to the total $14.1 billion in spending proposed by Gov. Sam Brownback for the fiscal year that starts July 1. ... The House, which has a number of Republican freshmen who campaigned against the health reform law, included provisions in its budget that would bar Insurance Commissioner Sandy Praeger from spending about $1.2 million in federal grant dollars her agency received to help plan for a health insurance exchange (Shields, 3/26). 

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State Roundup: Minn. Can Cut Health Care Aide Pay; Ore. CCO Guidelines Released

A selection of state health policy and politics stories from Georgia, Minnesota, Kansas, California, Oregon, Missouri and Pennsylvania.

The Atlanta Journal-Constitution: New Abortion Restrictions Likely Stopped 
One of the most controversial bills this legislative session, that sought to put new restrictions on late-term abortions, was all but gutted Monday after a bipartisan coalition in the state Senate forced key changes.  The original proposal would have cut by about six weeks the time women in Georgia may have an elective abortion. With the changes, it would now also include an exemption for "medically futile" pregnancies, giving doctors the option to perform an abortion when a fetus has congenital or chromosomal defects. The change hits at the heart of the controversy: Should fetuses once they hit 20 weeks be protected even if those protections mean women are forced to continue medically risky pregnancies? (Torres, 3/26).

Minneapolis Star Tribune: Health Care Aides' Pay Can Be Cut, Judge Says In Ruling
The state can impose a 20 percent pay cut on nearly 7,000 Minnesotans giving personal care assistance to low-income relatives, a district judge has ruled. The Friday ruling by Ramsey County District Judge Dale Lindman reversed a temporary order he issued last fall blocking the cuts. The eight home-care agencies that brought the lawsuit opposing the cuts plan to appeal Lindman's ruling, which found that a state law cutting payments to personal care assistants (PCAs) who were earning about $11 per hour in a federal-state Medicaid program does not violate the state constitution or the federal civil rights of the aides (Wolfe, 3/26).

Kansas Health Institute News: KHIE Committee Changes Course On Funding Scheme 
The operations of Kansas Health Information Exchange Inc. probably should be funded by fees assessed on the networks it licenses instead of by charges levied against individual medical providers, KHIE officials have concluded. ... The networks, called Health Information Organizations or HIOs, weren't even on a list of potential funding sources discussed at the previous meeting (Cauthon, 3/26). 

California Healthline: Inland Empire Hospitals Grapple With Chronic Bed Shortage 
Health care reform is expected to shake up the established business model for hospitals in much of California, resulting in some closures, consolidations, layoffs and ultimately fewer hospital days for patients. But experts say some areas of the state, such as the Inland Empire, could be more insulated from economic pressures. ... One indication of how underserved the region is has to do with its ratio of hospital beds. With 1.9 beds per 1,000 residents, California lags well behind the national average of 2.7 beds per 1,000. The High Desert only has 1.1 beds per 1,000 (McSherry, 3/26). 

KQED's State of Health blog: Health Insurance Executive Is Longtime Backer of Universal Coverage 
Bruce Bodaken, CEO of Blue Shield of California, one of California's largest health insurance companies ... first proposed a system of universal coverage for Californians ten years ago. ... "[W]e proposed that all people in California have at least basic coverage. Those that can’t afford it would be subsidized and all groups and individuals would be mandated to be covered" (Aliferis, 3/26). 

The Lund Report (an Oregon news service): Guidelines Set for Community Health Workers To Participate In CCOs 
Community health workers who will work with coordinated care organizations (CCOs) will be expected to need 80 hours of training and education, but not be licensed, according to recommendations that a subcommittee of the Oregon Healthcare Workforce Committee expects to approve Wednesday. ... Once CCOs get under way in August, community health workers will engage with patients outside of a doctor's office, visiting them at home, connecting them to health and social services, and working closely with people who have chronic health conditions so they can remain out of the hospital and lead healthier lives (Waldroupe, 3/27). 

HealthyCal: Telemedicine Brings Pediatric Specialists To Rural California
UC Davis has a well-established telemedicine program, where specialists consult with doctors in remote or underserved locations. The numbers suggest that the need for specialists to test kids’ hearing is acute in the far north of California. Depending on the year, anywhere between 20 and 40 percent of children in that region who don’s pass the newborn screen don’t return for follow-up tests and treatment, according to Anne Simon, pediatric audiologist at UC Davis Medical Center (Gilligan, 3/26).

St. Louis Beacon: Waiting for Medicare: Uninsured 59-64 year Olds Hope Their Health Holds Up
Census data show that roughly 47,000 Missourians between the ages of 59 and 64, representing 12 percent of the state’s residents in that age group, were uninsured between 2008 and 2010. The Beacon interviewed some to find out how they are coping while they wait for Medicare. One is Leslie Caplan of Olivette. ... Caplan came to learn about the world of the uninsured following a divorce. She previously was insured through her husband’s job at a corporation (Joiner, 3/27).

The Wall Street Journal: Health-Care Rivals Battle For Patients In Pittsburgh
In Pittsburgh, the acrimonious battle between Highmark, the region's most powerful health insurer, and UPMC, the dominant health-care provider, is drawing national attention as a test case on the impact of consolidation in the health-care industry (Mathews and Miller, 3/27).

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Editorials and Opinions

Viewpoints On Health Law: Court Decision Will Determine Federal Role 'In Caring' For People; Law Is Scaring Business

News sites reflect on the arguments being made before the Supreme Court about the 2010 federal health law.

The Wall Street Journal: ObamaCare Opening Day
The Supreme Court's epic oral arguments on the constitutionality of the Affordable Care Act began Monday with a kind of tease. The 90-minute exchange explored a technical side issue about taxes, but even so it suggested that the Justices will rule on the merits and are skeptical of some of the Obama Administration's claims (3/26).

The New York Times: Getting To The Merits
During an hour and a half of oral arguments on Monday, the justices showed their interest in addressing the merits of the case and their skepticism that the Anti-Injunction Act posed an insurmountable hurdle to doing so. That instinct seems right (3/26).

The New York Times: Step To The Center
The Obama health care law represents another crucial moment in the move toward centralization. With its state insurance exchanges, Obamacare is not as centralized as a single-payer system. Still, it centralizes authority in at least four ways (David Brooks, 3/26).

The Washington Post: Why The Individual Mandate Holds The Key To Health-Care Reform
Does the Constitution give Congress the power to order all individuals above a certain income level to buy health insurance? ... The mandate is an indispensable tool for achieving the government’s compelling goals of universal coverage and lower costs. Insurance companies would be unable to offer affordable coverage to those with preexisting conditions, for example, unless they also were guaranteed enrollment of the young and healthy customers who are less likely to consume health-care services (3/26).  

Politico (Video): Health Care: Will We Take Care Of Our Own?
Tuesday, the Supreme Court is hearing arguments on this key question: Will we take care of our own? In the three days of arguments, Tuesday is the most important. The court will decide what the role of government is in caring for our people. Boiled down, if you believe access to health care is a right, then you want the government to make it available to all. If you believe health care is a privilege, then each person earns their own and government's role is minimal. Does it get any more important than this? Any more fundamentally defining (Jennifer Granholm, 3/26)?

The Hill: Obama's Health Law Proving Successful
In my world of people and politics there are two relevant issues. First, does the law provide better medical care for Americans? And is it reducing the cost of healthcare? While the new law will not be fully implemented until 2014, the parts that have been enacted show that the indisputable, factual answer to both questions is "yes." But at the moment, the facts do not seem to matter in the court of public opinion. Republican opposition remains as solid today as the day the act was signed into law (Juan Williams, 3/26).

The Wall Street Journal: The Gay Alternative To ObamaCare
(GOProud) argues that the problem with our tax code isn't just that it discriminates against gays. It's that it discriminates against every American who doesn't have his or her health insurance through an employer. ... they want a system in which all health-care consumers are treated equally. They argue that this requires a thriving national marketplace for individual insurance—which is why GOProud also favors removing restrictions that prevent health-insurance plans from competing across state lines (William McGurn, 3/26).

Bloomberg: All Americans Lose If Health-Care Law Is Overturned
It's not perfect, of course; nothing with so many facets could be. We don't yet know, for example, whether the law's incentives to move doctors and hospitals away from a fee-for-service system to one more focused on efficiency will work. ... But the law takes a great many small steps in the right direction -- toward a health-care system that provides good-quality care at a reasonable price for the largest possible number of people (3/26).

Bloomberg: Supreme Court Case Won't End Republican Obamacare Attacks
If the court keeps the law and [Sen. Mitch] McConnell becomes Senate majority leader, he vows that "the first item up would be to try to repeal Obamacare"…. Signing the health-care legislation was probably the most consequential action (President Barack) Obama has taken, yet it seems likely that both major presidential candidates will be hesitant to talk about it. Obama will avoid the topic because it’s unpopular, while his probable challenger, Mitt Romney, will do the same because the health-care law he himself signed as governor of Massachusetts bears an embarrassing resemblance to it.  McConnell faces no such constraints. He is going to do what he can to keep the issue alive, whatever the Supreme Court decides (Ramesh Ponnuru, 3/26).

Bloomberg: Obamacare Is Unconstitutional?  Now They Tell Us
Basically anything the government does that has ever been justified by the Commerce Clause will be open to challenge (if the court overturns the health law). For the sake of their own sanity and summer recesses, the justices ought to proceed cautiously.  Conservatives also ought to pause and consider all the lectures they have delivered over the past half-century about the need for judicial restraint (Michael Kinsley, 3/26).

Milwaukee Journal Sentinel: High Court Should Uphold Health Care Reform Law
We've had our concerns with health care reform. We never were convinced, for example, that the bill passed by Congress in 2010 did enough to get costs under control. But the law, overall, was a major step toward a healthier America…. No matter how the court decides, the issues raised by health care reform will not go away. They will be central to the presidential campaign this fall. But two years in, the country is better off with the Affordable Care Act than without it (3/26).

Fox News: Why We Went To Court Over 'Obamacare'
Small-business confidence is measurably lower today than it was this time last year, and the (health) law has been identified in study after study as the primary contribution to this erosion of faith in the future. People are afraid to expand and hire—they are unable to plan for future growth while the fear of new costs shrouds them like a fog on the horizon. But the biggest cost—the one that carries no dollar figure and affects every American—is the incalculable loss of economic freedom (Dan Danner, 3/26).

CNN: U.S. Must Keep Its Promise On Health Care
Many of those who want the individual responsibility requirement struck down also express support for the patient protections that the provision makes possible. Several states have tried such an approach by enacting insurance protections for patients with pre-existing conditions without compelling healthy people to enter the insurance market as well. These states are now among the most expensive in the country in which to buy insurance, and two of them, Kentucky and New Hampshire, ended up repealing those protections because of increasingly unaffordable premiums (Nancy Brown, Larry Hausner and John Seffrin, 3/27).

JAMA: Dinner Conversations—The Health Care Law And The Supreme Court
Although first proposed by a conservative think tank, the Heritage Foundation, the individual mandate has become a lightning rod for those opposed to the ACA. I pointed out to John that he would probably qualify for subsidies to purchase insurance that are built into the ACA, and then I explained why the individual mandate was included: it's 1 part of a 3-legged stool for reforming the health insurance market. The other 2 parts require insurers to cover all those with preexisting conditions who want to be insured and prohibit insurers from charging sick people more for coverage than they charge healthier people (Diana J. Mason, 3/26).

JAMA: What Is The Economic Rationale For The Health Care Law's Individual Mandate?
While some have portrayed the mandate as a novel and dangerous encroachment on freedom, it's important to realize that it has a reasonably long and well-thought-out rationale supporting it. ... the mandate requires decision makers (individuals) to bear the costs of their actions either by purchasing insurance or paying a penalty. This at least partially transfers some of the cost of free riding back to the decision maker ... and bring the health insurance market closer (but by no means all the way to) the ideal (Austin Frakt, 3/26).

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Viewpoints: Opposition From The Right Weakening Support For Ryan's Budget Plan; Doctors Need To Confront Overweight Patients

The Wall Street Journal: Ryan And The Right
It's no surprise that the White House has denounced Paul Ryan's new House budget as the end of welfare-state civilization. The puzzle is why some conservatives are taking shots at the best chance in decades for serious government reform (3/26).

The Wall Street Journal: Ryan For Vice President?
The news from Paul Ryan on Fox News Sunday had nothing to do with the budget. Chris Wallace asked the House Budget Committee chairman if he is open to becoming the vice presidential nominee, and Mr. Ryan didn't close the door. He also said he had given the matter no thought, but if that's true he probably should start thinking because it's possible he could be invited to join a Mitt Romney ticket. Let's ignore the 2012 electoral calculations for today and consider the choice from Mr. Ryan's point of view (Paul A. Gigot, 3/26).

The Philadelphia Inquirer: Doctors, Nurses Must Talk About Weight
The reality is that health-care providers and patients often fail to discuss excess weight and obesity when they should. If the American obesity epidemic is going to get better, it's going to have to start with improved communication. A 2009 study published in the journal Patient Education and Counseling found that patients whose health-care providers told them they were overweight or obese were almost nine times likelier to perceive their excess weight as damaging to their health (Denice Ferko-Adams, 3/27).

Minneapolis Star Tribune: Boomers Unready For Long-Term Needs
The sobering preparedness gap revealed by a new poll on long term care in Minnesota spotlighted one of the most pressing concerns of this era -- how to pay for aging baby boomers. … So far, one innovative solution -- helping Minnesotans tap into life insurance policies for long term care needs -- hasn't gotten much traction with legislators. The Dayton administration and the state Department of Human Services, however, will soon roll out an "Own Your Future" program to raise awareness and study possible solutions. The program is an important step forward, but it's just a start (3/26).

Archives of Internal Medicine: Emergency Department Care: When Needed—Not When Better Choices Are Unavailable
The point of (emergency departments) is to rapidly triage and diagnose those with serious illnesses. However, it is clear that EDs in the United States function more as safety valves than as triage centers. They care for patients with no other place to go, no other place they can afford to go, no other place open when they are off from work, or no right place to go. ... If the United States is ever to have a system that provides high-quality care at an affordable price, we must direct patients to the right place at the right time to see the right person. The ED should not be the default option (Dr. Mitchell H. Katz, 3/27).

Archives of Internal Medicine: Does Motivational Interviewing Improve Outcomes?
Motivating behavioral change has become a core competency for clinicians and a major priority for the health care system as chronic disease management and disease prevention encompass an increasing proportion of clinical medicine. Nonadherence to treatment programs represents an important barrier to successful chronic disease management and is associated with significant morbidity, mortality, and preventable health care costs across a wide variety of conditions. Clearly, we need interventions that can successfully elicit behavior change to prevent and manage disease. But how successful are the current strategies? (Dr. Seth A. Berkowitz and Dr. Kirsten L. Johansen, 3/27).

Archives of Internal Medicine: Deferred Admission To The Intensive Care Unit: Rationing Critical Care Or Expediting Care Transitions?
There are several reasons to doubt that we can expand the supply of high-quality critical care to meet the expected surge in demand brought on by an aging population. First, critical care expenditures already strain nations' abilities to meet other socially desirable goals. Second, most critically ill patients are cared for by physicians who lack specific training in critical care medicine, a staffing model that has been associated with worse outcomes in most studies. Third, severe shortages are projected in critical care workforces. Therefore, if the capacity of critical care is relatively fixed, we must instead try to improve the efficiency of care (Dr. Jason Wagner and Dr. Scott D. Halpern, 3/27).

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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.