Daily Health Policy Report

Monday, March 3, 2014

Last updated: Mon, Mar 3

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Administration News

Public Health & Education


Health Information Technology

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Administration Faces Opposition To Changes In Medicare Prescription Drug Program

Kaiser Health News staff writer Mary Agnes Carey, working in collaboration with USA Today, reports: "Medicare’s prescription drug program was controversial when it arrived, but a decade later it is widely considered to be a Washington success story. Now, though, the Obama administration is proposing a series of significant changes to fix what critics say isn’t broken" (Carey, 3/3). Read the story and the related sidebar detailing some of the specific proposed changes.

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There’s a Life-Saving Hepatitis C Drug. But You May Not Be Able To Afford It.

Kaiser Health News staff writer Julie Appleby, working in collaboration with The Daily Beast, reports: "There's a new drug regimen being touted as a potential cure for a dangerous liver virus that causes hepatitis C. But it costs $84,000 -- or $1,000 a pill. And that price tag is prompting outrage from some consumers and a scramble by insurers to figure out which patients should get the drug —and who pays for it" (Appleby, 3/3). Read the story.

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Political Cartoon: 'And The Winner Is?'

Kaiser Health News provides a fresh take on health policy developments with "And The Winner Is?" by Rick McKee.

And here's today's health policy haiku:


Solvaldi's high cost
is raising many questions --
like who should get it?

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

March Is The Final Month Of The Health Law's Open Enrollment Period -- And The Rush Is On!

News outlets report that the White House -- facing high political stakes -- is attempting to increase the enrollment numbers with a targeted push aimed at African Americans, Latinos, young people and residents of cities with the highest uninsured rates. 

Politico: Obamacare's Under-The-Radar Sales Push 
President Barack Obama and Vice President Joe Biden spent their week pushing Obamacare — but most of the country probably didn’t notice. The final month of the White House enrollment campaign isn’t about daily events in Washington or speeches aimed at a national audience. Instead, Obama, Biden, First Lady Michelle Obama, cabinet members and senior administration officials are showering attention in very targeted ways on African Americans, Latinos, young people and the top 25 cities with the most uninsured Americans (Budoff Brown, 3/1).

The Hill: Pressure Rises As O-Care Deadline Nears
Pressure is rising on the White House as ObamaCare reaches its final month of enrollment roughly 3 million sign-ups behind its target goal. The administration hoped to enroll 7 million people in private plans during the reform's first year, but that became all but impossible after the botched launch of HealthCare.gov. Now, with 4 million people signed up as of this week, officials are counting on a final pre-deadline rush to bolster the exchanges and raise morale among vulnerable Democrats already exhausted by ObamaCare attacks. It's a heavy lift between clamoring Republicans and a public that's in the dark (Viebeck, 3/2).

The Arizona Republic: Biden Promotes Health-Care Law At Scottsdale Restaurant
Vice President Joe Biden breezed into the Valley on Friday to chat up the Affordable Care Act and stress the importance of extending coverage to the uninsured during the final month of enrollment. The Obama administration is focused on the looming March 31 enrollment deadline for health-insurance coverage, and local advocates plan a late push to encourage eligible Arizonans to sign up. A coalition of non-profits, health clinics and other organizations has scheduled enrollment fairs today across Arizona at community centers, libraries and health clinics (Alltucker, 2/28).

The Associated Press: This Month's Big Deadline: What You Need To Know
The big deadline is coming March 31. By that day, for the first time, nearly everyone in the United States is required to be signed up for health insurance or risk paying a fine. Here's what you need to know about this month's open enrollment countdown (Cass, 3/2).

Also in the news, an explainer about why the outreach efforts might face an uphill climb -

ABC News: 4 Reasons That Young Adults Won't Sign Up for the Affordable Care Act
The U.S. Department of Health and Human Services has released data showing that 55 percent of Americans who enrolled in plans under the Affordable Care Act (ACA) in the first three months were between the ages of 45 and 64. The report from January showed a whopping one-third of enrollees were aged 55 and older—people just shy of coverage under Medicare, and more likely to get sick or to have pre-existing health conditions. Only 24 percent of the 2.2 million who have signed up are between the ages of 18 and 34, well below the Obama administration's target of around 40 percent. A new study on the cost of insurance for young adults reveals why young adults may opt out of purchasing health insurance through the marketplace
(Pratini, 3/3).

Minnesota Public Radio: More Than Financial Penalty At Stake For Missed Health Care Deadline
Minnetonka-based health insurer Medica has launched an ad campaign to remind consumers that the deadline to obtain health insurance is more than just about avoiding a penalty. Under the federal health care law, most Americans who don't obtain insurance by March 31 will face a financial penalty. But Medica's Dannette Coleman said many consumers who buy on the individual market don't realize that in most cases if they miss that deadline, they'll have to wait nine months until January first to get covered again (Stawicki, 3/1).

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Upper-Bracket Homeowners Who Make Profits On Home Sales Begin Feeling Effect Of Health Law Tax

The controversial tax became effective Jan. 1, 2013. It kicks in for couples who make more than $500,000 in profit on a primary residence sale and single people who make more than $250,000. In other health law implementation news, media outlets report on issues that might impact small businesses, physicians and married couples.  

The Washington Post: New Tax Embedded In Affordable Care Act Affects Homeowners
A new controversial tax embedded in the Affordable Care Act affects homeowners who sell their homes for a substantial profit. Homeowners need to be aware of the new 3.8 percent net investment income tax. While this provision became effective Jan. 1, 2013, its effect is just now being felt by upper-bracket homeowners who have profitably sold their home in 2013. Homeowners planning to sell their home in 2014 are advised to factor this new tax into their sales contract pricing decisions (Jacobs, 2/28).

CBS News: Obamacare: What Every Small Business Owner Needs To Know
Change, even when positive, can create confusion and anxiety. Just ask any small business owner trying to figure out the Affordable Care Act. The Act, also called Obamacare, refers to mandated health care reform for everyone and impacts upon businesses of varying sizes differently. This has some small business employers scratching their heads. The stops and starts associated with the first wave of insurance signups have further confused the landscape. If you run a small company, this is how the Affordable Care Act may affect your bottom line (3/3).

Health News Colorado: Veterinarians Drop Insurance, Hope Employees Find Better Deal
Dropping health insurance made financial sense for the veterinarians who own University Hills Animal Hospital in Denver. Last year, the company’s share of premiums had spiked to $17,000 after rising about 10 percent each year, and plans were getting so expensive that only 11 of 35 employees had signed up. The three owners also hoped the Affordable Care Act would help many of their lower-wage workers afford insurance (McCrimmon, 2/28).

The New York Times: New Law's Demands On Doctors Have Many Seeking A Network
Dr. Sven Jonsson, a primary care physician in this rural community, is seeing a steady tide of new patients under President Obama’s health care law, the Affordable Care Act. And so far, it is working out for him. His employer, a big hospital system, provides expensive equipment, takes care of bureaucratic chores and has buffered him from the turmoil of his rapidly changing business (Goodnough, 3/2).

The Philadelphia Inquirer: Insurance No Longer May Hinder Divorce 
The Affordable Care Act is changing more than the way Americans buy health insurance. It's making it simpler for unhappily married couples to uncouple (Calandra, 3/2).

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Administration Offers Fix For Consumers Tangled Up In Health Exchange Flaws

Late last week, the Obama administration announced that some people who, because of technical issues, sought health coverage through the private market -- not the health law's online insurance marketplaces -- would still be able to get tax subsidies.

The New York Times: New Health Fix Offers Subsidies For Insurance Policies Bought Outside Exchanges
The sudden shift was the latest in a series of policy changes, extensions and clarifications by federal officials trying to help beneficiaries and minimize political damage to Democrats in this election year. Federal officials said they had agreed to provide such assistance retroactively because technical problems had prevented consumers from using online exchanges to obtain insurance and financial aid in some states (Pear, 2/28).

The Wall Street Journal: Tax Credit Still Available To Some State Health-Exchange Users
The Obama administration said consumers who have had trouble enrolling in health insurance in states running their own exchange could still be eligible for tax credits to help pay for the insurance. The Centers for Medicare and Medicaid Services issued guidelines to states late Thursday allowing them to retroactively apply federal tax credits to certain consumers who tried to sign up for insurance but have gotten stuck in state systems (Corbett Dooren, 2/28).

The Washington Post: Government Expands Help For Buying Health Insurance
In states with dysfunctional insurance marketplaces, the government will for the first time help pay for certain health plans that consumers buy on their own. And once people in those states are able to sign up through the exchanges, their insurance can be made retroactive. These rewritten rules, laid out in a three-page memo, can be used by any state but are aimed primarily at helping people in Maryland and three other states whose exchanges have not been working well. The four states are among 14 that have each created an insurance marketplace under the 2010 Affordable Care Act (Goldstein and Johnson, 2/28).

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Shoppers Confront More Glitches, Frustrations From State Health Exchanges

Whether it is long waits for marketplace helplines or news that some people in California will have to redo their applications, problems persist. News outlets offer more examples and updates with reports from Maryland, Oregon, Washington, Georgia and Colorado.

The Associated Press: Long Waits Frustrate Callers To Health Exchanges
For those trying to enroll through online health exchanges, help has long been advertised as just a phone call away. Yet the challenge in some states has been trying to get a call through at all, never mind the multiple transfers once contact has been made. Long wait times of an hour or more have been commonplace in some states, primarily those running their own health care exchanges. California, Maryland, Minnesota, Nevada and Washington are among the states in which consumers and insurance agents have complained. One consequence is that people just give up because they are unable to wait indefinitely (Witte, 3/1).

Los Angeles Times: California Says 14,500 Must Redo Obamacare Applications After Glitch
California's health insurance exchange said about 14,500 people have to redo their online applications for Obamacare coverage because of a software error. The state's announcement late Friday comes shortly after a five-day outage of the Covered California enrollment website. About 14,500 people who partially completed applications or updated them Feb. 17-19 -- just before the website went down -- have to either start over or resubmit any changes they made, the exchange said (Karlamangla, 2/28).

The Sacramento Bee: Covered California Software Glitch Affects 37,000 Health Care Applicants
Computer problems that darkened Covered California’s website last week will force as many as 14,500 customers with partially completed applications to either resubmit the changes or begin a new request, officials at the health exchange said Friday. Overall, about 37,000 Californians were affected by a software malfunction that led officials to ground the enrollment portal for five days. Those who submitted updates between Feb. 17 and Feb. 19 may have to start over (Cadelago, 2/28).

The Washington Post: Only Nine Marylanders Have Signed Up For The State's Retroactive Health Insurance
Only nine Marylanders have signed up for temporary, retroactive health insurance made possible by emergency legislation aimed at helping people who tried to get coverage through the state’s faulty online health insurance marketplace, encountered problems and were stuck with medical bills to pay (Johnson, 3/1).

The Washington Post: About 19,000 Have Paid First Premium Through Maryland Health Insurance Exchange
About 19,000 Marylanders who signed up for a private health insurance plan through the state’s new online marketplace have paid their first premium, state health officials announced Friday. Although the state announces its number of private plan enrollees each week, this is the first time officials have made public the number of enrollees who have actually paid for their insurance — the ultimate sign of commitment and one closely watched by insurance companies (Johnson, 2/28).

The Baltimore Sun: Health Exchange Mulling Scenarios for How To Move Beyond Troubled Site
After the state severed ties with the contractor that built its problem-plagued health insurance exchange, officials face the looming question of what to do with it — continue throwing money toward fixing it or replace it. Every option is potentially fraught with more technical headaches and expense (Walker and Cohn, 3/1).

Fox News: Costs Of ObamaCare Bungles Start To Add Up, With Maryland First At About $30.5M
Maryland could end up spending as much as $30.5 million as a result of a glitch in its ObamaCare website, as the Obama administration steps in to help states with problematic exchanges. Because of Maryland’s defective exchange, the state cannot determine whether customers remain eligible for Medicaid, according to a report by state budget analysts released Thursday. As a result, the state has agreed with the federal government to a six-month delay in determining eligibility, meaning that payments will continue to be made to customers who are not eligible until the system is fixed. The delay will cost the state $17.8 million in fiscal 2014 and $12.7 million in fiscal 2015, the analysts estimated (3/2).

The Seattle Times: 15,000 Applicants 'Stuck' In State's Insurance Exchange 
Five months since the launch of the Washington Healthplanfinder insurance exchange, officials say many of the website problems consumers experienced in the early weeks have been fully resolved. At the same time, they acknowledge there are still thorny issues they are working to fix (Marshall, 3/2).

The Oregonian: Cover Oregon: Carolyn Lawson, Departed IT Director, Says She's Been Unfairly Scapegoated
Carolyn Lawson, the former senior IT manager forced to resign after the Oregon's disastrous health care exchange rollout, said she's wrongfully been made the scapegoat for the technology fiasco. In her first lengthy interview since she quit the state in December, Lawson said Friday she was removed from most daily oversight of the exchange project in November 2012. Cover Oregon demanded more independence from Lawson and the Oregon Health Authority, she claims, and Cover Oregon management called the shots from that point on. Lawson said, "there is plenty of blame to go around," for the exchange's issues (Manning, 2/28).

The Oregonian: Cover Oregon Health Insurance Exchange Fiasco Spawns Problems For Low-Income Oregonians' Health Plan
Nearly 4,000 applicants for a state program that provides undocumented immigrants with pregnancy services were instead enrolled in full Oregon Health Plan coverage, contrary to federal law, thanks to problems with the Cover Oregon health insurance exchange. State officials say they discovered the problem several weeks ago and are correcting it.
The pregnancy program goof, however, is just one of many little-known problems that Oregon Health Plan members, providers, care groups and state officials have wrestled with as Oregon’s system for enrolling people undergoes chaotic change (Budnick, 3/1). 

Georgia Health News: Black Churches Play Big Role In ACA Outreach
Willie Johnson of Doraville didn’t know what to expect when he went to a recent health care information event in Stone Mountain. Johnson, a part-time restaurant worker, had no health insurance. So when he heard a spot on radio station V-103 about the event at Berean Christian Church, he decided to find out for himself. At the church, he met officials with Enroll America, a nonprofit organization seeking to help people gain coverage under the Affordable Care Act. They gave him information about the health insurance exchange that the federal government operates in Georgia. Soon afterward, Johnson, 47, enrolled in an exchange policy that he says will cost him just $30 a month (Miller, 2/28).

Health News Colorado: Lawmakers Support Comprehensive Exchange Audit
Members of the House Health, Insurance and Environment Committee voted 9 to 2 on Thursday to support the audit. Colorado Auditor Dianne Ray is already working on a narrow examination of how the exchange is spending $177 million in federal funds. If House Bill 14-1257 passes the full House, then the Senate, Ray will conduct a much more thorough examination. It will include how funds have been spent, whether the exchange is on track to be financially self-sustaining as planned by January 2015, if employee background checks are working and whether workers are safely handling private customer data (McCrimmon, 2/28).

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In Virginia, Budget Negotiators Still Wrestling With Medicaid Expansion Plan

Virginia legislators must come to terms on the state budget blueprint by the legislative session's scheduled March 8 conclusion. The expansion debate also stays hot in Utah and Arkansas.  

The Washington Post: Medicaid Expansion Complicates Va. Budget Negotiations
House and Senate budget negotiators are both incredibly close and hopelessly deadlocked as a deadline looms for reconciling rival state spending plans. Both chambers have passed two-year, $96 billion blueprints that are in step with each other on 99.9 percent of spending. House leaders say the differences — the House plan is more generous to higher education, for instance, while the Senate gives more to K-12 — are easy fixes (Vozzella, 3/2). 

Norfolk Virginian-Pilot: McAuliffe Wants "Conservative" Budget With Medicaid
Gov. Terry McAuliffe cautions against planning state spending on overly optimistic revenue assumptions and reiterates that Medicaid expansion is "the most important decision" facing this General Assembly in a Friday letter to budget negotiators. Arriving with roughly one week until the legislative session's scheduled March 8 ending, the governor's letter that's presented as encouragement instead appeared to inflame House of Delegates Republicans who disagree on Medicaid (Walker, 2/28).

The Associated Press: Battle On Two Fronts For Utah Governor's Medicaid Plan 
Utah Gov. Gary Herbert has finally announced his plan for Medicaid, but he still faces a long road for it to become reality. The first hurdle for the Republican governor will be convincing legislators, particularly those in his own party, that he's not seeking a full Medicaid expansion under the federal health law (3/1).

The Associated Press: Analysis: Arkansas Private-Option Opponents Seek Exit Plan
Heading into this year's legislative session, opponents of Arkansas' compromise Medicaid expansion vowed to push for an exit plan for a program they see as no different from the law they derided as “Obamcare.” Now, they may be the ones in need of an exit strategy. With the impasse over Arkansas' "private option" heading into its third week, opponents of the plan to use federal Medicaid funds to purchase insurance for the poor are looking for a way out of a showdown that could jeopardize the state's budget—not to mention the Republican Party's efforts to build on their recent gains (DeMillo, 3/2).

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Clinton Papers Offer Window Into Failed Health Reform Effort

Some of the 4,000 pages of previously confidential Clinton administration documents, released Friday by the National Archives, chronicle Hillary Clinton's efforts to overhaul the health system.

Politico: How The Clinton White House Bungled Health Care Reform
Bill and Hillary Clinton understood individual members of Congress just fine. They just didn't get Congress. That's the picture that emerges from the documents released by the Clinton presidential library Friday on their efforts to pass health care reform in the 1990s. For years after the effort failed, the generally accepted storyline was that they cooked up the health care plan in secret, didn't work with Congress enough and that's why it stalled. Not true, according to the documents released Friday (Nather, 2/28).

Los Angeles Times: Papers Offer Peek Into Hillary Clinton's Failed Healthcare Initiative 
As Hillary Rodham Clinton sought to reshape the nation's healthcare system in her husband's first term as president, she got all the right advice from senior aides: Consult closely with members of Congress, build bridges with business leaders, communicate clearly to nervous voters, move swiftly. The first lady and her husband ultimately failed in nearly all those efforts, nearly sinking Bill Clinton's presidency. Thousands of documents released Friday, which detail that failure as well as other policy disputes of the Clinton White House, provide new details on what remains one of the defining chapters in Hillary Clinton's career. The papers also foreshadow the challenges the Obama administration would encounter as the current president worked to pass the Affordable Care Act 16 years later (Levey, Lauter and Reston, 2/28).

The Associated Press: '90s Documents Show Clintons' Health Care Concerns
Bill Clinton's aides revealed concern early in his presidency about the health care overhaul effort led by his wife, Hillary Rodham Clinton, and later about what they saw as a need to soften her image, according to documents released Friday. Mrs. Clinton now is a potential 2016 presidential contender. The National Archives released about 4,000 pages of previously confidential documents involving the former president's administration, providing a glimpse into the ultimately unsuccessful struggles of his health care task force, led by the first lady, and other Clinton priorities such as the U.S. economy and a major trade agreement (Thomas and Elliott, 2/28).

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Capitol Hill Watch

Republicans Aim At Senate Seats Using Health Law Stances

The GOP is showing signs it intends to go even further to use the health law to win or retain Senate seats this election cycle.

The Wall Street Journal: Shifting Senate Landscape Draws New Faces
Rep. Cory Gardner of Colorado is in an enviable position, with a safe House seat and bright prospects for joining his party's leadership. So when GOP officials last year asked him to give it all up to run for the Senate, he declined. … But signs of Mr. Udall's political vulnerability grew. Like other Democrats, he drew blame for the troubled rollout of the health-care law. Criticism grew when his office questioned the number of notices the state said people received saying their policies were being canceled because they didn't comply with the standards of the new law (Hook and O’Connor, 3/2).

The New York Times: Giving Early Taste Of G.O.P. Tactics, Texans Make A Stand Against Obama
And an ad for Senator John Cornyn, Republican of Texas, titled “The Truth” accuses Mr. Obama of obfuscating on a variety of issues, including the attack on the United States Mission in Benghazi and the president’s signature health care law. … “Senator John Cornyn stands up to President Obama every day, pushes back,” concludes a narrator. “John Cornyn’s for us, for Texas.” Accusing the president of lying in an ad, said Kathleen Hall Jamieson, the director of the Annenberg Public Policy Center at the University of Pennsylvania and an expert on political discourse, is “a very strong attack”(Parker, 3/2). 

Meanwhile, as political context -

CBS News: Drawing The Line On Obamacare
There's debate now not just over Obamacare, but on how much to even talk about it in the first place. For instance, Gov. Bobby Jindal, R-La., cautions Republicans not to make it the only item in their campaigns. The Democrats are looking to shift the topic to wages and the economy. But Obamacare continues to be a hinge point of 2014 whether they like it or not, and here's how: When voters make choices some things are "nice-to-have" and some things are "must-have," which usually means a candidate has to agree on some items before you'll even consider them (Salvanto, 3/1).

Reuters: U.S. House Republican Unity Tested On Obamacare Alternative
A month after Republicans rallied around offering an alternative to President Barack Obama's healthcare law in an election-year move to broaden their appeal to voters, divisions are surfacing over the issue in the U.S. House of Representatives. House Speaker John Boehner has not committed to voting this year on legislation to replace Obama's landmark Affordable Care Act (Cowan, 2/28).

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Administration News

Prospects For Bipartisan Budget Deal Seen As Dim

As President Barack Obama prepares to release his budget proposal Tuesday, he is expected to reverse course on efforts to curb spending on Social Security. House Republicans, meanwhile, plan to release a proposal that would make sweeping changes to antipoverty programs, including Medicaid.

The Associated Press: Big Or Small, Spending-Cut Efforts Hit Roadblocks
Indeed, little-noticed but telling events over the past few weeks show lawmakers and the White House are backsliding on spending cuts. President Barack Obama, who's scheduled to release his own federal budget Tuesday, reversed course on a deeply contentious proposal that would curb cost-of-living increases in Social Security. Republicans criticized Obama for backing down but then blasted the administration as it announced it was implementing a new round of Medicare cuts that Congress included in the health care overhaul four years ago (Babington and Taylor, 3/3).

The Washington Post: House GOP Budget Will Focus On Reforming Welfare, Overhauling Social Programs
As a direct counter to President Obama's recent emphasis on the gap between rich and poor, the upcoming House Republican budget will focus on welfare reform and recommend a sweeping overhaul of social programs, including Head Start and Medicaid. The push, led by Rep. Paul Ryan, returns the GOP's attention to a policy front that animated the party in the 1990s and signals Republicans' desire to expand their pitch to voters ahead of this year's midterm elections. This new effort comes after the party spent months fixated on combating the federal health-care law and engaged in intraparty squabbles over fiscal strategy (Costa, 3/2).

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Public Health & Education

Costly New Hepatitis C Drug Raises Questions About Who Will Pay

The new hepatitis C medication presents a dilemma for Medicaid and other insurers, who must balance the cost against the large numbers of people who might benefit. A single course of treatment costs $84,000.

Kaiser Health News: There’s a Life-Saving Hepatitis C Drug. But You May Not Be Able To Afford It.
There's a new drug regimen being touted as a potential cure for a dangerous liver virus that causes hepatitis C. But it costs $84,000 -- or $1,000 a pill. And that price tag is prompting outrage from some consumers and a scramble by insurers to figure out which patients should get the drug —and who pays for it (Appleby, 3/3).

The Washington Post: Costly Hepatitis Drug Sovaldi Rattles Industry
When the Food and Drug Administration approved a medication called Sovaldi in December, it was hailed as a breakthrough in the fight against hepatitis C, a blood-borne disease that affects 3.2 million Americans and kills more people in the U.S. annually than AIDS. Then California-based Gilead Sciences, the manufacturer, announced the price: $84,000 for a 12-week course, more than what many cancer treatments cost in a year. The hefty price tag has rattled patient advocacy groups and insurance companies, who say most costly new treatments coming on the market are targeted for a smaller patient population. Putting such a premium on a drug that could help so many will be crushing, they say (Somashekhar, 3/1).

Stateline: Could New Hepatitis C Drugs Bust State Budgets?
Two new medications to treat the deadly epidemic of hepatitis C promise millions of Americans a better chance of a cure, shorter periods of treatment and fewer side effects than older drugs. They also threaten to bust state budgets and raise private insurance rates. 

The new hepatitis C medications present a dilemma for Medicaid and other insurers, who must balance the cost against the huge number of people who could benefit from the treatment. A course of treatment costs between $84,000 and $168,000 -- or $1,000 to $2,000 per pill (Ollove, 2/28).

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Plan To Revamp Medicare Drug Plans Meets Resistance

A bipartisan group of senators is criticizing the Obama administration's efforts to make significant changes to Part D drug plans.

Kaiser Health News: Administration Faces Opposition To Changes In Medicare Prescription Drug Program
Medicare's prescription drug program was controversial when it arrived, but a decade later it is widely considered to be a Washington success story. Now, though, the Obama administration is proposing a series of significant changes to fix what critics say isn't broken (Carey, 3/3). Plus: Three Key Changes Proposed For Medicare Part D (Carey 3/3).

The Hill: Key Dems Break With White House On Medicare Change
A number of powerful Senate Democrats broke with the Obama administration Friday by opposing proposed changes to Medicare's prescription drug program. Led by newly installed Chairman Ron Wyden (D-Ore.), all but four Democrats on the Senate Finance Committee criticized a suggested overhaul that would enlarge the government's role in Part D. The letter, also signed by Finance Republicans, described the strength of the current program and urged Medicare officials to abandon their plans to change it (Viebeck, 2/28).

Meanwhile, Medicare cuts in funding for home health care raise concerns in Oregon.

The Associated Press: Home Health Cuts To Hit Harder In Rural Oregon
Advocates for the home health care industry say the 14 percent cut in Medicare payments it will see over the next four years is unprecedented and could result in a loss of services for thousands of homebound seniors and disabled individuals in Oregon. The Centers for Medicare and Medicaid Services, calling upon authority afforded by the Affordable Care Act, issued the final rule in November that carries 3.5 percent cuts in payments from 2014 to 2017 to providers who support patients in their homes, ensuring they take their medications and providing certain therapies (3/2).

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Health Information Technology

Tom Daschle, With Group Of Former Senators, Focuses On Telehealth Rules

The Washington Post: Daschle, Former Senators Form Alliance To Lobby For New Telehealth Rules
About eight months ago, Daschle, now a senior policy adviser at the law firm DLA Piper, shifted his focus to “telehealth” — a system in which health-care providers examine and treat patients virtually. For instance, instead of driving miles and miles to the nearest health center, a rural patient with a minor allergic reaction might use his iPad to chat by video with an available physician to discuss treatment options. But until state and federal health-care laws evolve to address telehealth, Daschle’s vision of a national network of virtually accessible doctors is far off (Ravindranath, 3/2).

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State Watch

State Highlights: Fla. Restaurant's Health Law Surcharge

A selection of health policy stories from Florida, California, the District of Columbia, Pennsylvania and Wisconsin.

Los Angeles Times: Florida Restaurant Chain Adds Health Care Surcharge To The Tab; Will Others Follow?
A chain of restaurants in central and northern Florida have added a 1 percent surcharge to its customers’ checks to cover health care costs for its employees. Eight Gator’s Dockside restaurants have instituted the surcharge, the Associated Press reported. Customers’ bills show a fee labeled “ACA,” which stands for the Affordable Care Act that will require all businesses with 50 or more full-time workers to provide health coverage or pay a fine. For restaurants with more than 100 full-time staff members, the deadline to comply is 2015 (Hallock, 3/1).

Reuters: Florida Restaurant Chain Adds Obamacare Surcharge To Meal Bills
Diners at a Florida restaurant chain are being asked to pay a health insurance surcharge on their meal tabs to cover the cost for business owners of the Obama administration's new healthcare program. Customers at eight Gator's Dockside restaurants dotted around central and north Florida are finding a 1 percent surcharge on their bills listed as "ACA," the letters standing for the Affordable Care Act, popularly known as Obamacare (Liston, 2/28).

Miami Herald: Feds To Fine State Over Limit on Medicaid Patients' ER Visits
Florida has been limiting Medicaid patients to six emergency room visits a year even though federal officials consider such a cap illegal. As a result, the federal government intends to penalize the state by withholding a portion of Medicaid funding (Mitchell and Tillman, 3/2).

Los Angeles Times: Rate Of Babies Delivered At U.S. Hospitals Drops Sharply
U.S. hospitals are making major strides at clamping down on early deliveries of babies and instead letting Mother Nature take its course in response to growing pressure from employers, government officials and patient-safety advocates. The Leapfrog Group, an employer-backed organization that tracks hospital safety and quality, published data Monday showing a sharp decrease in early-elective deliveries since 2010 nationwide and in California (Terhune, 3/2).

The Washington Post: MetroAccess Is A Public Transit Lifeline For People With Disabilities
Mandated by the Americans With Disabilities Act, MetroAccess is vital to many of its 32,000 users, people who are not physically capable of riding Metro’s buses or trains or who might feel frightened doing so because of their disabilities. For [Denise Rush, who is blind,] and others, it’s a key to an active, fulfilling lifestyle, allowing them to avoid becoming shut-ins or burdens to their families. ... Without transportation, Rush says, she could not keep her job, and losing her job would mean losing her health insurance and possibly her home (Duggan, 3/1).

Philadelphia Inquirer: Phila. Area Blocked From New Medicare Ambulance Enrollment
Citing a "significant potential for fraud, waste, and abuse," federal Medicare officials put a moratorium on the enrollment of new ambulance operators in Philadelphia and six surrounding counties. The Philadelphia moratorium, which took effect Jan. 31, is just the second time officials at the Centers for Medicare and Medicaid Services have exercised this new power under the Affordable Care Act. It is intended to root out fraud (Brubaker, 3/2). 

Miami Herald: Jackson Memorial Hospital Expected To Lose $140 Million Under New Medicaid Law
Jackson Memorial Hospital is bracing again for big cuts -- this time, the result of a new law that will send millions of federal dollars that used to go to Miami-Dade hospitals elsewhere in the state. ... The new funding formula was a little-known part of Florida’s 2011 Medicaid reform law, a Republican-driven overhaul of the state and federal insurance program for the poor. The provision was intended to make the distribution of an estimated $1 billion a year in federal Medicaid matching funds more equitable. But its unintended consequences are now becoming clear, as the funding mechanism known as “tiering” is scheduled to take effect (McGrory, Mitchell and Tillman, 3/2).

The Kansas City Star: Healthier Lunches Law Has Unintended Consequences
It's been two years since legislation was implemented to encourage healthy eating during school lunches -- and kids are eating healthier -- but the new rules also are having some unintended consequences. Students at Wilson Junior High School [in Manitowoc, Wisconsin] had a wide assortment of healthy options as they walked through the lunch line recently...However, while the legislation requires students take a fruit and vegetable, it cannot force them to eat it — and many students choose not to. "We had very little waste before, now we have a lot of waste," [food services director Lynette] Zalec said (Bock, 3/3).

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Editorials and Opinions

Viewpoints: Frightening Seniors; Regulating E-Cigarettes; Waiting For Black Lung Drugs

The New York Times: Fear Mongering With Medicare
The Obama administration's proposed cuts to Medicare Advantage plans — the private insurance plans that cover almost 30 percent of all Medicare beneficiaries — are fair and reasonable. As it happens, they are also mandated by law. Yet Republicans, sensing a campaign issue, are telling older and disabled Americans that the administration is "raiding Medicare Advantage to pay for Obamacare." The health insurance industry, for its part, is warning that enrollees will suffer higher premiums, lower benefits and fewer choices among doctors if the cuts go into force (3/1).

The New York Times: Arizona Did Us All A Favor
The Arizona bill [vetoed by Gov. Jan Brewer], in the eyes of some, was a religious version of the Stand Your Ground law, most recently associated with Florida but used in more than 20 states. ... A more apt comparison to Arizona is to the legal movement to expand the definition of corporations as people. Lawmakers in the Grand Canyon state would have allowed businesses to use religion as a shield against secular laws they don't like. The same principle is behind the Supreme Court challenge to the birth control requirements of the new health care law. In one case, religion is an excuse for refusing service. In another, it’s a reason to oppose a package of medically recognized health care benefits. In both cases, the "sincerely held" belief, once the province of an individual citizen, now belongs to a moneymaking entity (Timothy Egan, 3/1).

The New York Times: Regulating Electronic Cigarettes
European lawmakers last week adopted strong tobacco regulations that will increase government oversight of electronic cigarettes. The rules should serve as a model for the Food and Drug Administration, which has said that it also intends to regulate the nicotine-delivery devices (3/1).

Los Angeles Times: Legal 'Standing': Obama's Executive Branch Escape Hatch
President Obama's proclaimed strategy to "bypass Congress" — most conspicuously his broad rewriting of the Affordable Care Act — has given unusual prominence to a fairly arcane legal doctrine: standing. Standing is what is preventing a potential blizzard of litigation against the president's unilateral decrees, and ironically, it's a doctrine liberal jurists have long decried (Eugene Kontorovich, 3/2).

The Wall Street Journal: The FDA's Black Lung
Government power can ruin fortunes, reputations and businesses, but at least the targets usually escape with their lives. Not so with the Food and Drug Administration, whose culture of political control is often lethal. This reality is all too familiar for the 200,000 or so Americans suffering from a terminal lung disorder as they wait, and wait, and wait for the FDA to approve a good drug that can slow the progression of their disease (3/2). 

USA Today: Obamacare Squeezes Small Businesses
The way President Obama told it in 2010, Obamacare would save small businesses money. He even predicted that businesses that provide health care would save so much — he estimated up to $3,000 per employer — that they could give their employees a raise. Another day, another broken promise (Tim Phillips, 3/1). 

The Fiscal Times: Health Care Savings To Come From Unlikely Places
Let's say that the U.S. health care industry really is embarking upon a major wave of innovation and cost cutting. Where would you expect that most of those savings occur? In hospitals? Clinics? Outpatient centers? The best bet might be in so-called "non-traditional" settings — perhaps even your local drug store. Much of the nascent movement to push health care outside of hospitals and clinics isn't being driven by the industry. It's an outgrowth of the formation of Medicare Accountable Care Organizations (ACOs), an obscure part of Obamacare that seeks to reward organizations for efficiency and high-quality care (John F. Wasik, 3/2).

Bloomberg: Busted State Obamacare Sites Have A Silver Lining
If the red states had built their own exchanges, many of them would likely also suffer the same problems -- or worse ones, given that red-state governors lacked the enthusiasm of their blue-state counterparts. Naturally, this raises some questions. What if the administration’s supporters who complained about red-state intransigence had it backward? What if the mistake was allowing states to do a job that we should have left to the federal government? There are some powerful arguments in favor of this proposition. ... So should Congress have simply had the federal government build the exchanges and be done with it? Actually, no. The architecture of the law allowed for some failures. But it also enshrined two important principles for failing well: experimentation and diversification (Megan McArdle, 3/2).

Richmond Times-Dispatch: State Budget Should Not Be Held Hostage
Another indicator that events in Richmond are emulating those in Washington with greater frequency, Virginia appears poised for another budget battle that — if not resolved — threatens to shut down state government. ... The practical effect of [Gov. Terry] McAuliffe's statements is clear: Any budget that does not include a plan to fully implement Obamacare by accepting its provision to grow the rolls of those who receive health coverage through government funding is a non-starter to him (State Sen. Ryan T. McDougle, 3/23).

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Stephanie Stapleton

Andrew Villegas

Lisa Gillespie
Shefali Luthra

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