Daily Health Policy Report

Monday, March 31, 2014

Last updated: Mon, Mar 31

KHN Original Reporting & Guest Opinion

Health Reform


Public Health & Education

Health Spending And Fiscal Battles

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

What Happens Next On The Health Law?

Kaiser Health News staff writers Julie Appleby, Mary Agnes Carey and Phil Galewitz, in collaboration with USA Today, report: "Just because open enrollment for people who buy their own health insurance formally closes March 31 doesn't mean debate over the health law will take a hiatus. After more than four years of strident rhetoric, evidence about how the law is actually working is starting to trickle in. Here are seven things to watch before the next enrollment period begins in November" (Appleby, Carey, and Galewitz, 3/31). Read the story.

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Capsules: Former Young Invincible Becomes Less So

Now on Kaiser Health News' blog, Sarah Varney, working in collaboration with NPR, reports: "When we last left Brad Stevens, he was living in Lakeport, California, a struggling massage therapist in a struggling town on the southern tip of Clear Lake. Brad has been uninsured his entire adult life .... After a bike accident which injured his shoulder and a battle with advanced thyroid cancer, Brad was anxious to enroll in some form of insurance – any kind of insurance – under the Affordable Care Act. ... The insurance broker had warned Brad about long wait times, but when he called the toll-free line for Covered California, the state’s insurance marketplace, Brad said, 'I waited four minutes. It was a piece of cake.'The operator didn’t offer to help him apply for Medi-Cal, and instead told Brad to call the social services office in Lake County. 'It wasn’t a one-stop shop'" (Varney, 3/31). See what else is on the blog.

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Insurance Agents Enroll More Than 4,000 Haitian-Americans In South Florida

The Miami Herald's Patricia Borns, working in collaboration with Kaiser Health News, reports: "While the White House has focused on enrolling the country’s Hispanic population in health plans, a group of Haitian-American insurance agents in South Florida have seized the opportunity to bring health coverage to their own communities, where they estimated seven out of 10 people are uninsured" (Borns, 3/28). Read the story.

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Political Cartoon: 'Dear President Obama'

Kaiser Health News provides a fresh take on health policy developments with "Dear President Obama" by Mark Martin.

And here's today's health policy haiku:


My sister too poor
for insurance coverage
in clueless red state

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

L.A. Times: More Than 9 Million Uninsured Gain Coverage

The newspaper's tally draws on state and federal enrollment reports, surveys by consultants and interviews with insurance and government officials. Meanwhile, insurers and others intensify efforts to sign up young customers.

Los Angeles Times: Obamacare Has Led To Health Coverage For Millions More People
President Obama's healthcare law, despite a rocky rollout and determined opposition from critics, already has spurred the largest expansion in health coverage in America in half a century, national surveys and enrollment data show. As the law's initial enrollment period closes, at least 9.5 million previously uninsured people have gained coverage. Some have done so through marketplaces created by the law, some through other private insurance and others through Medicaid, which has expanded under the law in about half the states. The tally draws from a review of state and federal enrollment reports, surveys and interviews with insurance executives and government officials nationwide (Levey, 3/30).

The Wall Street Journal: Health Insurers Make Late Push To Sign Up Young Customers
Insurers are pressing ahead with a final marketing push to bring as many young, healthy customers as possible onto their rolls and buttress a recent surge in health-law enrollments. The flood of late sign-ups that helped boost the marketplace total to six million enrollees, a key milestone for the Obama administration, has also brought some insurers an uptick among younger people. But it isn't clear if the trend is broad enough to balance out an earlier skew toward older enrollees, who are more likely to have costly ailments (Wilde Mathews and Weaver, 3/28).

Los Angeles Times: Fighting For Obamacare Through Stage IV Cancer
Michael Robertson put the bag of chemicals in an inside pocket of his sport coat, the pump in the other. He snaked the tubes between the buttons of his shirt to the port in his chest. He adjusted his tie to cover them. Then he sat down in a cavernous room in the White House complex and pulled his chair close to the table, hiding the bulges. Robertson, an aide to President Obama, was meeting with top officials from federal agencies working to implement the Affordable Care Act. He was also in treatment for stage IV colorectal cancer. A soft "bzzt" every 90 seconds alerted him to another dose and another wave of nausea. He timed the cadence of his questions and comments to the ebb and flow of the chemo. No one seemed to notice, and that's how he wanted it (Parsons, 3/29).

The Hill: GOP Senator: Administration 'Cooking The Books' On ObamaCare Enrollment
Sen. John Barrasso (R-Wyo.) said Sunday that the Obama administration was "cooking the books" on enrollment figures for ObamaCare. Appearing on "Fox News Sunday," Barrasso said he wasn’t persuaded by statistics that said that more than six million people had signed up for insurance under the healthcare law. ... Sen. Angus King (I-Maine), who has offered legislation to make fixes to ObamaCare, said that it was a great victory for so many people to have signed up for insurance, and said he wasn’t concerned about the number of young people or uninsured signing up (Becker, 3/30).

NPR: Latinos Wary Of All-Out Push To Sign Up For ACA
All throughout the country, supporters of the Affordable Care Act have worked to reach the uninsured, holding health fairs and putting ads on TV and radio. The push continues to get as many enrolled as possible, especially Latinos — the most uninsured group in the country. ... Undocumented immigrants aren't eligible for insurance under the Affordable Care Act, but Obama's deportation of nearly 2 million of them during his presidency may have soured many Latinos' opinion of him (Corley, 3/29).

Politico: Procrastinators: Obamacare Wants You
Leading up to the deadline, President Barack Obama, Vice President Joe Biden, cabinet secretaries and other surrogates have done more than 300 radio interviews, attended 45 enrollment events and appeared in videos that have collectively gotten 33 million hits over the last six weeks, according to figures released to POLITICO by a White House official (Haberkorn, 3/30).

ABC News: Obamacare Enrollment Deadline Will Test High-Profile Sales Pitch
LeBron James wants you to sign up for health coverage under Obamacare. So do Magic Johnson and Jonah Hill’s mom. Monday is (sort of) the deadline for Americans without employer-provided health coverage to sign up for insurance under the Affordable Care Act — the White House extended it so that anyone who’s begun to sign up by Monday can still complete the process by April 7 — and the final enrollment numbers will be an important test for a law intended to expand access for the uninsured. It’ll also be a test for the White House’s high-octane sales pitch, one that’s involved celebrities, YouTube videos, and paid media (Good, 3/30). 

The Fiscal Times: The Growing Puzzle Over Obamacare Enrollment
Probably the only thing harder than predicting the final enrollment figures for the Affordable Care Act is guessing the winners in the NCAA Tournament Brackets.  President Obama announced last week that more than six million people would have enrolled for insurance during the six-month enrollment period that officially ends on Monday -- despite the troubled rollout of Obamacare. Surpassing that six-million mark brings enrollment in line with a revised estimate by the nonpartisan Congressional Budget Office – albeit well below the seven-million target that was initially set by the administration (Pianin, 3/31).

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Marketplace Website Has A Rocky Day As Thousands Try To Beat Enrollment Deadline

Federal officials took the healthcare.gov marketplace offline twice to deal with problems that surfaced under the heavy use.

Politico: HealthCare.gov Experiences Double Trouble On Deadline Day 
The Obamacare enrollment website, HealthCare.gov, endured renewed technical problems on Monday, creating serious obstacles for people trying to sign up before the midnight deadline and stirring up bad memories of the botched October launch. The website was down six hours early in the day, bounced back for a while, and triggered its "virtual waiting room" to handle a traffic surge. But then another problem emerged around noon; people trying to start accounts for the first time couldn’t do so. That problem, which officials said was resolved at about 1:30 p.m., created a sense of uncertainty amid a surge of interest that seemed likely to bring signups well past the 6 million mark (Kenen and Cheney, 3/31).

The New York Times: Health Website Failures Impede Signup Surge As Deadline Nears
Tens of thousands of people around the country raced to beat Monday’s deadline to sign up for health insurance, overloading phone lines and taxing the capacity of the website for the federal insurance marketplace. The last-minute scramble created a range of emotions among consumers, from happiness and satisfaction at having insurance for the first time to frustration at being unable to get answers or assistance, or affordable coverage (Pear, 3/31).

USA Today: Glitches In Race To Meet Health Deadline
Consumers who waited until the last day to enroll for insurance on the federal HealthCare.gov were out of luck on Monday morning, and the problem still may not be fixed: The tools to set up new accounts and enroll are functioning erratically and some people can't even get onto the site to try to set up an account. Department of Health and Human Services spokeswoman Joanne Peters said the tech team monitoring HealthCare.gov identified an issue with users creating new accounts, a problem agents were reporting earlier in the day and USA TODAY found when reporters tried to create accounts (O'Donnell, 3/31). 

The Wall Street Journal: HealthCare.gov Glitch Prevents Users From Creating New Accounts
A second software glitch took HealthCare.gov offline on Monday as the site struggled to stay open during this year's final day of enrollment under the Affordable Care Act. The new problem hit around 12 p.m. EDT and was preventing users from creating new accounts and logging in with new accounts, said a person familiar with the matter. The glitch is related to the part of the system that processes peoples' identities, the person said. A user who visits the site now and tries to log in is told "HeatlhCare.gov has a lot of visitors right now" and is put into a queue. A software bug took down the site earlier on Monday for a number of hours. Despite the two problems, the site has been very busy and was handling more than 100,000 simultaneous users at one point, the person said (Ante, 3/31).

NBCNews: Obamacare Website Freezes For A Second Time
“There is a technical problem that the tech team is on,” White House spokesman Jay Carney told reporters. “There are currently 100,000 people on the system who are enrolling and there is no problem for them to enroll.” A spokeswoman said 1.2 million people had visited the site as of noon (Fox, 3/31).

The Hill: HealthCare.gov Struggles Under Surge Of Last-Minute Demand
While the administration said the problem was resolved quickly on Monday afternoon, it shows how the website is having trouble keeping up with the last minute rush of people seeking coverage before the March 31 deadline. ... “The tech team is working to resolve the issue as quickly as possible,” an official said as the problem persisted. “The Data Services Hub is still fully operational. Users already in system remain able to complete enrollment” (Easley, 3/31). 

The Washington Post: Healthcare.gov Stumbles Twice On Deadline Day
Both the onrush of new customers and the possibility of computer troubles had been anticipated by Obama adminsitration officials as the end of the six-month window approaches for people to buy new health plans under the Affordable Care Act, a 2010 reshaping the U.S. health care system. Mindful of a potential last-munite frenzy, health officials decided last week to let anyone ask for extra time — until a so-far unspecified time in April — if they attempt to enroll in a health plan by the deadline (Goldstein, 3/31).

Several news outlets reported on the heavy use of the website over the weekend.

The Wall Street Journal: Long Waits As Health Insurance Deadline Nears
Last-minute applicants for health insurance strained enrollment offices over the weekend, triggering long lines, extra security and hours of waiting across the country ahead of Monday's federal deadline. HealthCare.gov, the federal website, blocked some applicants late Friday but didn't show major technological problems as consumers rushed before the end of the 2014 open-enrollment period for obtaining insurance under the Affordable Care Act. But the system's human capacity maxed out, with too few "navigators" and other enrollment workers to steer consumers through the complex application process (Radnofsky and Corbett Dooren, 3/30).

The Hill: Record Volume For O-Care Exchanges
The federal health insurance marketplace saw record volume for a Saturday, and operators at the federal call centers struggled to keep up with the volume of calls as consumers flooded the ObamaCare exchanges ahead of Monday’s enrollment deadline. According to the Obama administration, HealthCare.Gov saw two million visits this weekend, while the call centers received 380,000 phone calls (Sink, 3/30).

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Looking Ahead At Health Law Milestones

With open enrollment for 2014 set to formally close today, analysts note that it will take years to assess whether the health law succeeds at creating stable markets for those without employer-sponsored insurance. Several look at likely victories and hurdles.

Kaiser Health News: What Happens Next On The Health Law?
Just because open enrollment for people who buy their own health insurance formally closes March 31 doesn't mean debate over the health law will take a hiatus. After more than four years of strident rhetoric, evidence about how the law is actually working is starting to trickle in. Here are seven things to watch before the next enrollment period begins in November (Appleby, Carey, and Galewitz, 3/31).

Reuters: Obamacare Hits Milestone, But Detours Ahead For Health Law
[A]s the White House and its allies declare victory, major hurdles remain. And it will take years to determine whether the law will accomplish its mission of creating stable insurance markets that can help a significant number of America's nearly 50 million uninsured gain health coverage, experts say. Republicans are counting on that uncertainty to play into their strategy for the midterm congressional elections in November  (Morgan, 3/30).

The New York Times: In New Health Care Era, Blessings And Hurdles
In a plain brown health clinic on a busy boulevard [in Louisville, Ky.], the growing pains of the Affordable Care Act are already being felt — almost too sharply for the harried staff trying to keep up with the flow of patients. ... The law still faces steep challenges in Kentucky and nationwide, not only from energized political opponents who plan to attack it until Election Day, but also from skeptical consumers who think the cost of many new plans is too high, and the choice of doctors, hospitals and prescription drugs too limited. ... Yet beneath the loud debate, the law is quietly starting to change the health care landscape (Goodnough, 3/30).

Los Angeles Times: Insurers Already Calculating 2015 Premiums As Obamacare Kicks In
Even before enrollment closes Monday, California has far exceeded its initial goals for signing up people under the Affordable Care Act. Although the sheer volume of 1.1 million policyholders is impressive for a brand new government program, the number of sicker patients is what's likely to draw the most attention. How sick they are and the size of their medical bills will be front and center in the weeks to come as insurers begin drawing up next year's insurance rates, which will become public this summer (Terhune, 3/30).

Politico Pro: Off-Exchange Enrollment Could Shore Up Risk Pools
The Obama administration’s tally of sign-ups for the federal health care law doesn’t include a key group that is likely to boost the total number of people — and the share of younger and healthier people — with Obamacare coverage. These are the people who are getting covered in new plans that live up to the new Affordable Care Act rules, but aren’t sold on the exchanges. The people buying them don’t qualify for the premium subsidies in the exchange, so they go directly to insurance companies or online brokers. ... federal health officials, insurers and health policy experts say that it’s likely to be a sizable group that tends to be more affluent and younger than the people in the exchanges (Norman, 3/29).

The Hill: ObamaCare's 4-Year Checkup 
The deadline for ObamaCare’s first-year enrollment has arrived, four years after one of the most far-reaching and divisive pieces of domestic legislation became law. It’s a historic moment and a time to take stock of a measure proponents said would provide health insurance to people who lacked it, drive down costs, take a bite out of the deficit, boost the economy and lower the amount ordinary people had to pay (Viebeck and Easley, 3/31).

The Milwaukee Journal Sentinel: Despite Concerns About Obamacare, Big Employers Not Abandoning Health Benefits
Patrick Hansen, the chief financial officer of Strattec Security Corp., has no pretensions of knowing how the Affordable Care Act will affect employers years from now. But for now, Strattec, based in Glendale, has no plans to stop offering health benefits to its employees. "We'd have a hard time recruiting," Hansen said. Opponents of the Affordable Care Act — among them Wisconsin Republicans Rep. Paul Ryan and Sen. Ron Johnson — have contended that the law will result in employers no longer offering health benefits. Now Ezekiel Emanuel, a physician and former adviser in the Obama administration when the law was making its tortuous way through Congress, is contending the same ... Most supporters of the law — and some policy analysts and economists ambivalent about it — don't see that happening (Boulton, 3/29).

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Assessing The Possible Impact Of Obamacare On Nov. Elections

A variety of news organizations analyzed what might happen in the fall, because of political campaigns built around the health law.  

Politico: The Obamacare Enthusiasm Gap
Irony alert: The Democrats’ biggest challenge this fall is to get their voters excited about a law that they asked for. Obamacare will be a huge voting issue for Republicans — that’s already clear. They’ll turn out in droves because they hate the law. What’s less clear is how Democrats will get their supporters to the polls to say, “hey, thanks for health reform” (Nather, 3/31).

Politico: Dems Try To Keep Hope Alive With ACA Mantra
According to administration officials, Democrats on Capitol Hill and other strategists who’ve been in touch with the White House, President Barack Obama’s team is sure the health care law’s problems will fade in people’s minds by November, months after the website rollout. They believe the intense attacks Republicans are using to stoke their own base won’t completely depress Democratic turnout. And they’re confident that independents will see the GOP’s 50 votes to repeal all or parts of Obamacare as a sign of Washington dysfunction (Dovere, 3/31).

The Washington Post: Democrats, Republicans Prepare For New Round Of Battles Over Health-Care Law
Supporters face an array of political, financial and legal challenges in the coming months. ... In the months and years ahead, other questions will loom: How will Americans react when they get fined next year for not having insurance? Will more states expand Medicaid under the law? And will the federal courts make future changes to the law, including barring the use of government subsidies to help pay for coverage in the federal marketplace? (Eilperin, Goldstein and Somashekhar, 3/30).

The Associated Press: Health Law Legacy Eludes Obama As Changes Sink In
As a roller-coaster sign-up season winds down, President Barack Obama's health care law has indeed managed to change the country. Americans are unlikely to go back to a time when people with medical problems could be denied coverage. But Obama's overhaul needs major work of its own if it is to go down in history as a legacy achievement like Medicare or Social Security (Alonso-Zaldivar, 3/29).

The Associated Press: GOP Challenger Is The Focus In Colo. Senate Race
The Senate race in Colorado has shot toward the top of the nation’s most competitive contests this midterm election year, giving the Democratic incumbent a tougher battle than he expected and Republicans a new pickup opportunity in their drive to win the chamber’s majority. Sen. Mark Udall responded to Rep. Cory Gardner’s surprise challenge by quickly trying to define his opponent as an extremist. ... As Gardner scrambles to raise money and assemble a campaign staff, his allies have hammered Udall’s support for President Barack Obama’s health care law (Riccardi, 3/29).

The Washington Post: Senate Democrats Struggle To Define A Message That Can Save Their Majority
Democrats are going into the 2014 midterm elections with their control of the Senate greatly imperiled and with the prospect of an Obama presidency completely hobbled in its final two years. In response, the president and his party are struggling to come up with a broad economic message that can rebut, or at least deflect, the continued GOP assaults on the president and his new health-care law (Tumulty and Kane, 3/29).

CBS News: Clock Winds Down On Enrollment But Not On Obamacare's Political Fight
March 31 has finally arrived, and with it comes the last official day for people to sign up for health insurance on the federal exchange websites.  The deadline, of course, isn't a hard one: the administration announced last week that people who started to apply for health insurance by the deadline but didn't finish the process will still be able to get coverage. Just as enrollment doesn't close for good on Monday, the fight over Obamacare will hardly be settled by the coming and going of the end of the month (Kaplan, 3/31).

Fox News: Debate Over ObamaCare Far From Over As Signup Deadline Arrives
The deadline to sign up for ObamaCare technically is Monday, but the roiling, years-long debate about enrollment numbers and practically every other aspect of President Obama’s signature health care law appears far from over in this politically charged election year. ... On Sunday, ObamaCare supporters were on television championing the law’s recent successes, particularly the late-enrollment surges, including 1.2 million visitors Saturday to the federal site. Some who have trouble signing up by Monday will also be given extra time (3/31).

Bloomberg: Obamacare Changes Illegal, McMorris Rodgers Says 
President Barack Obama is "picking and choosing" how the 2010 health-care law will be implemented and "doesn't have the flexibility" legally to do so, U.S. Representative Cathy McMorris Rodgers said. Asked if she was saying such changes to the law are illegal, McMorris Rodgers, a Republican from Washington state, replied, "Yes, I am" (Wallbank, 3/29).

Miami Herald: PolitiFact: Rick Scott's Political Committee Says Obamacare Has Led To 300,000 Health Plans Canceled
A new TV attack ad against former Gov. Charlie Crist zeroes in on Crist’s support for Obamacare.
Republican Gov. Rick Scott’s political committee, Let’s Get to Work, unveiled the ad March 24. Scott’s campaign said it will spend $2 million on the statewide ad, which started running on Thursday. The ad repeats snippets of Crist’s March 9 interview on CNN when he called Obamacare "great." ... Scott’s TV ad says, "300,000 health plans canceled," attributing the number to news reports. ... The statement has an element of truth but leaves out important details, so we rate this claim Mostly False (Sherman, 3/30).

Meanwhile, several polls give a glimpse of what voters are thinking.

The Associated Press: Poll: Obama Health Law Fails To Gain Support
Despite a late surge in sign-ups, support for President Barack Obama's health care law is languishing at its lowest level since passage of the landmark legislation four years ago, according to a new poll. The Associated Press-GfK survey finds that 26 percent of Americans support the Affordable Care Act. Yet even fewer — 13 percent — think it will be completely repealed. A narrow majority expects the law to be further implemented with minor changes, or as passed (Alonso-Zaldivar and Junius, 3/30).

Christian Science Monitor: Obamacare Launch: What Americans Like About The Law, And What They Don't 
A narrow majority of US adults say they oppose the law, which is designed to reduce the number of people who lack health insurance, according to a new Christian Science Monitor/TIPP poll conducted this week. ... The results, when viewed alongside other polls about "Obamacare," show the broad political challenge that the president and Democrats face regarding the law. Even though particular elements of the Affordable Care Act are popular – as is its broad goal of expanding access to health care – the financial math is a sticking point (Trumbull, 3/28).


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Americans' Experience With Health Law Depends On Where They Live

Some states that embraced the law, such as Oregon, have had difficulty enrolling residents because of glitch-ridden online marketplaces, while others like New Hampshire have seen unexpectedly strong enrollments despite prevailing critical views.

NPR: Obamacare Rolls Into N.H. Like A Political Campaign — And Wins
Monday is the deadline to sign up for health insurance under the Affordable Care Act, or at least to begin the process. We already know that nationwide more than six million people have enrolled. But each state has its own insurance market and its own experience with the law. In New Hampshire, polls show the law is quite unpopular. ... And yet, enrollments in the state have greatly exceeded expectations (Keith, 3/31).

Los Angeles Times: States That Have Struggled With Healthcare Sites Consider Lawsuits
Enrollments in the nation's healthcare program have nearly concluded, but for states whose insurance exchanges have been crippled by technical problems, a difficult phase is just beginning: potential legal battles and a race to overhaul their systems before federal grant money dries up. Officials in Oregon, Massachusetts and Maryland are exploring legal options as they sever contracts with those who created their sites (Reston, 3/29).

Los Angeles Times: L.A. County Grapples With Healthcare For Remaining Uninsured
One long period of Obamacare hand-wringing in Los Angeles County will end Monday, as the window for residents to enroll in mandatory healthcare coverage comes to a close. But less than 24 hours later, county elected officials will be confronted with another politically sensitive facet of the nation's healthcare overhaul: how to manage roughly a million people, many of them poor or undocumented, who will remain uninsured either because they aren't eligible or failed to enroll (Brown, 3/30).

Politico: Obamacare In Washington State: 'No Frills' Success
In contrast to the other Washington’s HealthCare.gov, this Washington’s Healthplanfinder has run fairly smoothly almost from the start. While programs elsewhere sputtered and the federal portal didn’t work at all, the state signed up more than one in every five Americans who enrolled in an Affordable Care Act plan during the first month. ... This land of a thousand baristas, high-tech giants and evergreen-scented landscapes designed a straightforward exchange, chose a contractor that delivered, and kept lawmakers, policymakers and advocates from getting in the way with their own priorities, no matter how attractive or well-meaning (Haberkorn, 3/31).

Politico: Obamacare In Oregon: A Failed Exchange
Oregon had all the right ingredients for a sparkling Obamacare success story: A Democratic doctor as governor, an eager legislature and a history of health care innovation. It ended up with Obamacare’s biggest technological disaster. CoverOregon.com, the state’s equivalent of HealthCare.gov, is the only insurance exchange in the country where people still cannot buy coverage entirely online. ... The exchange board is hunting for its third leader since December (Haberkorn, 3/31).

Marketplace: Health Care Deadline Reveals State Disparities
Monday is the deadline to sign up for healthcare under the Affordable Care Act, or risk paying a penalty. Larry Levitt, senior vice president at the Kaiser Family Foundation, says the way people are experiencing Obamacare varies across the country. Take Connecticut and Oregon, for example. Levitt says both states were enthusiastic about Obamacare, but the actual rollout in each state couldn’t be [more] different. He says for some states, it came down to how lucky they were in choosing a developer to build their online exchange. And Connecticut has a strong history of outreach to the public around health issues (Wilson, 3/31).

The Associated Press: Sebelius: Texas Opposition Hasn't Helped Sign-Ups
Political opposition in Texas to the federal health care overhaul hasn't helped enrollment numbers that lag behind expectations as next week's deadline to sign up looms, Health and Human Services Secretary Kathleen Sebelius said Friday. Texas has the highest rate of uninsured residents in the nation. As of March 1, about 295,000 people in Texas had signed up for coverage — less than half of the target of 629,000 enrollees originally set by the federal Center for Medicare and Medicaid Services (Weber, 3/28).

The Associated Press: NY State Health Exchange Reports 782,000 Enrolled
With the 2014 enrollment deadline scheduled to fall at midnight Monday, the state Health Exchange says 1.13 million New Yorkers have completed applications for insurance though fewer than 800,000 have now enrolled for specific coverage (3/29).

The Oregonian: Cover Oregon: Officials Weigh Pros, Cons Of Hiring New IT Contractor, Switching To Federal Exchange
Cover Oregon board members are set to decide in the coming weeks whether the state's troubled health insurance exchange can be rescued. Officials are weighing the benefits and drawbacks of three options: hiring a new information technology contractor, switching over to the federal government's health exchange or piggybacking on another state-based exchange. The goal is to find a technology solution that will allow Oregonians to enroll online once the 2015 open enrollment period begins Nov. 15 (Zheng, 3/29). 

The CT Mirror: At Obamacare Deadline, Rush To Enroll, Questions About What’s Next
The crowd at the Access Health CT store was so big Wednesday morning that Pedro Lopez decided to put off his plans to buy health insurance there for a few hours. But when he returned around lunchtime, the store -- run by Connecticut's health insurance exchange -- was still busy, filled with people trying to beat today's midnight insurance sign-up deadline. It had been more than a decade since Lopez had coverage, and the 43-year-old figured he could put it off a little longer. But as he turned to leave again, a buddy pointed out that if Lopez wanted insurance, he'd have to sign up by Monday (Becker, 3/31).

The San Jose Mercury News: Obamacare: Californians Flock To Community Centers, Libraries To Sign Up For Health Care
The last time Ileinna Jasso needed medical care, she went to an emergency room, emerging with a simple prescription for antibiotics -- and a $1,700 bill she couldn't afford. So the 20-year-old Gavilan College student was happy to wait in line Saturday to sign up for affordable health coverage at Berryessa Community Center, just two days before Monday's midnight deadline. More than 500 similar workshops to help people get their applications in on time are being held from Friday through Monday across California. They're drawing droves of people (Kaplan, 3/29).

The Arizona Republic: Some Specialty Care More Expensive Under ACA
[Pat Elliott] has discovered what many Affordable Care Act shoppers have learned: The least-expensive plans sold over the marketplace often limit the doctors and hospitals that consumers can choose to a narrow network of providers with whom insurance companies negotiate discounted rates. In metro Phoenix, some larger cancer and transplant hospitals don't participate in many marketplace plans at all. Elliott nearly selected a Cigna plan, only to learn her doctor wasn't in the network (Alltucker, 3/30).

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Maryland To Replace Troubled $125M Health Exchange With New System

Despite a late surge in sign-ups in the past week, Monday will mark the end of Maryland's problematic health exchange system which encountered many technical issues. The exchange will be replaced with technology used in Connecticut's system, one of the most successful in the country, The Washington Post reports.

The Washington Post: Maryland Gears Up For Health Exchange Redo
On Monday, the first enrollment period for health insurance plans made possible by the Affordable Care Act will end, so call centers in Maryland plan to stay open until midnight in a last-minute effort to boost enrollment numbers. Then on Tuesday, Maryland will begin the process of replacing its troubled exchange, which has had so many problems since its launch on Oct. 1 that officials have decided it would be better to start anew. ... The exchange’s board plans to vote Tuesday to use technology from Connecticut, which has had one of the most successful exchanges in the country, and hire the contractor that built that system, Deloitte, according to two people familiar with the decision (Johnson and Flaherty, 3/30).

The Baltimore Sun: Maryland Gears Up For End Of Health Care Enrollment 
Monday marks the end of a six-month enrollment push for Maryland's troubled health exchange, and despite a surge in the past week, it is unclear whether the state can overcome technical problems that have persisted since the Oct. 1 debut and meet its goals. As a flurry of consumers signed up for health insurance Saturday during an enrollment fair, Gov. Martin O'Malley said that he expected the next enrollment period to run more smoothly on a new platform built by Deloitte Consulting LLC, replacing the troubled existing website (Walker, 3/29).

Fox News: Maryland To Reportedly Abandon $125M ObamaCare Exchange For New System
With just days to go before open enrollment ends on March 31, Maryland officials are reportedly planning to abandon its glitch-ridden ObamaCare website and replace the health exchange with technology from Connecticut’s marketplace. The Washington Post reported late Friday that the board of the Maryland exchange will vote on changing the system that has cost at least $125.5 million at a meeting on Tuesday, the day after the end of the first enrollment period under ObamaCare. Maryland residents will still be able to use the exchange as it is being replaced with technology from the Connecticut exchange, Access Health CT, officials told The Post. The state is expected to tap consulting firm Deloitte for the overhaul (3/29).

The CT Mirror: Report: Maryland To Replace Obamacare Exchange With CT Model
Citing unnamed sources, the Washington Post reported late Friday that Maryland was going to abandon its glitch–plagued health exchange with technology from Connecticut’s marketplace, Access Health CT. Kevin Counihan, CEO of Access Health CT, said he “had not heard” about Maryland’s decision. Counihan said he’s had several conversations with Maryland officials about his concept of an “exchange in a box,” a package of technology that could be sold to other states that have had problems with their exchange portals or are currently served by HealthCare.gov., the federal exchange many states are using. Counihan said he traveled to Baltimore in February to discuss Access Health CT with Maryland officials. But he also said Maryland is considering other options, including pouring more resources into fixing its site, MarylandHealthConnection.gov,  or using the federal exchange (Radelat, 3/28).

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Artists Benefit From Health Law, But Rural Residents May Pay More

Self-employed Americans such as artists stand to gain under the health law, but rural residents may pay more for coverage because of the higher costs of delivering care in a sparsely populated area and the disproportionate number of older people. Other media outlets offer advice for consumers trying to make sense of the law.

Politico: Self-Employed Artists, Actors Benefit From ACA
[Karin] Abromaitis is among the hundreds of thousands of artists, musicians, dancers, actors and filmmakers around the country who especially stand to gain under Obamacare, either through the plans and premium subsidies available on its new insurance exchanges or from the plans employers must start offering. Typically a well-educated but lower-earning demographic — whose members are self-employed more often than not — these Americans have frequently struggled to buy insurance on their own (Winfield Cunningham, 3/31).

The Associated Press: Rural Residents Confront Higher Health Care Costs
Bill Fales wanted a new baler and a better irrigation system for the 700-acre ranch where he raises grass-fed beef cattle, but he scrapped those plans when he saw his new health insurance premiums. ... Health care has always been more expensive in far-flung communities, where actuarial insurance data show fewer doctors, specialists and hospitals, as well as older residents in need of more health care services (Wyatt, 3/30).

The New York Times: Repercussions And Reprieves At Health Insurance Enrollment Deadline
America’s health insurance marketplace closes on Monday night, the deadline for most people to obtain coverage or face a penalty. The confusion and uncertainty of the last six months appear likely to continue as consumers, including some who have never had insurance, begin using new policies for the first time. Here are answers to some frequently asked questions (Pear, 3/29).

The Wall Street Journal: 5 Things To Know About The Health Law’s March 31 Deadline
Six months after the disastrous launch of the Affordable Care Act’s online insurance marketplaces, Monday is slated to be the final day to sign up for coverage under President Obama’s signature domestic program—sort of. Here’s what you need to know about the health law’s impending deadline, and the last-minute changes that will push the date back for many consumers (Weaver, 3/30).

Los Angeles Times: Health Plan Tips For Patients Relying On Specialty Medications
Monday is the last day to begin the process of signing up for insurance under the Covered California statewide health exchange. But even for many of those already enrolled, the challenges are just beginning. Consider, for instance, the work to be done in figuring out your new health plan's coverage for prescription drugs. For people who take medications on an ongoing basis, it's especially important to closely evaluate details of a health plan's drug coverage (Zamosky, 3/30).

The Wall Street Journal: Newborns Need Health Insurance Too
Between picking out tiny clothes, setting up the crib and managing the in-laws, new parents have plenty to think about. But they can't afford to neglect health insurance for Junior, says Doug Whiteman, insurance analyst at Bankrate.com. First things first, Mr. Whiteman says: Make sure you sign up your infant for coverage within 30 days of birth. A federal rule requires insurance providers to cover children signed up within 30 days of birth retroactively to day one. Some plans may provide more flexibility (Gellman, 3/29).

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Utah's Medicaid Efforts May Pave Route For Other Red States

Gov. Gary Herbert and aides have been meeting with federal officials to find a different option. Meanwhile, news outlets look at the Medicaid expansion battles in Virginia and Florida and Republican concerns in Illinois.

The Washington Post: Why Utah Is The State To Watch On Medicaid Expansion
Utah Gov. Gary Herbert is looking for a way to join the Medicaid expansion, and that could have national implications. Herbert, whose aides have been meeting with federal officials at the Centers for Medicare and Medicaid Services since last week, told local media yesterday that he hopes to have a deal in place with the Obama administration by the summer. "There's clearly a growing understanding in the Obama administration in the need for states to have more flexibility," the Republican governor told reporters (Millman, 3/29). 

PolitiFact: McAuliffe Says Medicaid Expansion Will Save Virginia $1 Billion
Gov. Terry McAuliffe says expanding the state's Medicaid program would allow Virginia to save money by offering health coverage to 400,000 poor and disabled citizens. ... The potential savings is a key issue as the General Assembly struggles this spring to decide whether to expand Medicaid eligibility ... the analysis he cites says the state will save $420 million of that sum, regardless of whether it broadens Medicare, from other provisions in Obamacare. The research concludes that $601 million in savings over the next eight years are riding on the legislature's decision. So McAuliffe is right that there’s a lot of expansion money on the table, but he exaggerates how much. We rate his claim Half True (Madsen, 3/30).

The Richmond Times-Dispatch: Backlog Of Medicaid Applications Muddies Debate
A backlog of applications for Medicaid in Virginia has become fodder for political debate over the wisdom of expanding the program in some fashion under the Affordable Care Act. Virginia officials expect more than 40,000 applications to arrive from the new federal marketplace and strain local services offices that will review them for eligibility under the state’s health care program for the poor, elderly and disabled. The state already is coping with a 60 percent surge in applications through the state system since Oct. 1, when the launch of enrollment in the new marketplace prompted more people to seek eligibility for publicly subsidized health insurance (Martz, 3/30). 

The Associated Press: Medicaid Ads Target Virginia House Speaker
New ads funded by groups on both sides of the debate over expanding Medicaid appear to be narrowly aimed at one person: House Speaker William J. Howell. The focus on Howell underscores what is likely a pivotal role that he will play in deciding the outcome. The Democrat-controlled Senate and Democratic Gov. Terry McAuliffe supporting expanding the Medicaid rolls. But the Republican Howell, and his colleagues in the GOP-controlled house, have remained resolutely opposed (3/28).

The Richmond Times-Dispatch: Flawed Obamacare Rollout Colors Virginia Debate
House Appropriations Chairman S. Chris Jones, R-Suffolk, drew applause and laughter during the debate over the state budget in the House of Delegates last week when he announced "the Obama administration has announced another extension to Obamacare." Jones referred to the announcement that the federal government would process people who are "still in line" to buy health insurance on the new federal marketplace after the deadline for enrollment expires tomorrow night. … What the government calls flexibility, critics call reason to doubt the federal promise under the Affordable Care Act to pay for the long-term costs of a proposed expansion of health insurance to the uninsured (Martz, 3/31).

Chicago Tribune: Kirk, Rauner Question Illinois' Medicaid Expansion
Republican U.S. Sen. Mark Kirk on Sunday sharply criticized a feature of President Barack Obama’s signature health care law, contending Illinois’ expansion of Medicaid coverage deceives people into believing they have health insurance. The state’s junior senator was joined by Republican governor nominee Bruce Rauner, who warned of the potential for a "massive" budget hole down the road due to Democratic Gov. Pat Quinn’s Medicaid expansion. Still, Rauner stopped short of saying Illinois should roll back the expanded Medicaid program (Pearson, 3/30).

Health News Florida: Public Keeps Pushing For Expansion 
A campaign -- that some would call a doomed campaign -- to expand Medicaid for Florida's uninsured poor continued in Tallahassee on Thursday with a mass lobby conducted by doctors and nurses from Miami's Jackson Hospital. They went from office to office in the state capitol seeking legislative support …but got basically nowhere. Along with the 100 or so doctors and nurses who took the trip, were consumers such as Orlando resident Kathleen Voss Woolrich, who spent some of the time on her computer (Stone, 3/28).  

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Public Health & Education

Veterans Struggle With Mental Health Problems

More than half of the 2.6 million Iraq and Afghanistan veterans say they struggle with physical or mental health problems as a result of their service and feel detached from civilian life, according to a poll conducted by The Washington Post and the Kaiser Family Foundation.

The Washington Post: A Legacy Of Pain And Pride
More than half of the 2.6 million Americans dispatched to fight the wars in Iraq and Afghanistan struggle with physical or mental health problems stemming from their service, feel disconnected from civilian life and believe the government is failing to meet the needs of this generation’s veterans, according to a poll conducted by The Washington Post and the Kaiser Family Foundation. The long conflicts, which have required many troops to deploy multiple times and operate under an almost constant threat of attack, have exacted a far more widespread emotional toll than previously recognized by most government studies and independent assessments: One in two say they know a fellow service member who has attempted or committed suicide, and more than 1 million suffer from relationship problems and experience outbursts of anger — two key indicators of post-traumatic stress (Chandrasekaran, 3/29).

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Health Spending And Fiscal Battles

Health Care Spending Growth Hits Decade High

In other news, health care stocks have emerged as robust gainers in a resilient U.S. stock market.

USA Today: Health Care Spending Growth Hits 10-Year High
Health care spending rose at the fastest pace in 10 years last quarter, a development that could foreshadow higher costs for consumers this year. Expenses for health care rose at a 5.6% annual rate in the fourth quarter, the Bureau of Economic Analysis said  last week. The jump triggered a sharp upward revision in the government's estimate of consumer spending overall and accounted for nearly a quarter of the economy's 2.6% annualized growth in the last three months of 2013 (Davidson, 3/30).

The Wall Street Journal: Health-Care Stocks Lead From The Front 
This isn't your father's health-care sector. Long embraced by investors seeking to weather market downturns and recessions, the group — comprising drug companies, hospitals and health insurers, among others — has emerged as one of the healthiest gainers in a resilient U.S. stock market (Russolillo, 3/30).

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State Watch

Roundup: W.Va. Gov. Vetoes Abortion Ban; N.Y. Curbs Medical Bill Surprises

A selection of health policy stories from California, Illinois, New York, West Virginia and Wisconsin.

Charlestown (W.Va.) Gazette: Tomblin Vetoes 20-Week Abortion Ban 
Gov. Earl Ray Tomblin vetoed a bill late Friday that would have banned abortions of fetuses after 20 weeks gestation. The governor called the bill unconstitutional and a "detriment" to women's health (White, 3/28).

The New York Times: New York Curbs Medical Bills Containing Surprises
Every year, thousands of New Yorkers find themselves responsible for a surprise medical bill from a doctor, like an anesthesiologist, who becomes involved in their care but, unbeknown to the patient, is not covered by their insurance. Now a provision in the state budget agreement announced Saturday is intended to protect consumers by requiring that they be given a reasonable amount of notice when an out-of-network doctor will be treating them (Hartocollis, 3/30).

The Wall Street Journal: Bid To Raise Malpractice Cap Gets A Rider
A California law on medical malpractice awards, in place since 1975, puts a $250,000 ceiling on the amount of money that can be given for noneconomic damages. Now, lawyers and some consumer groups are mounting an effort to substantially raise the cap through California's referendum system, but they are coupling it with a popular idea that hospital doctors should undergo routine drug and alcohol testing (Lazo, 3/28).

Chicago Tribune: Cook County Health System Inks $1.8 Billion Contract 
The board running Cook County's public health system on Friday approved a contract worth up to $1.8 billion over five years to manage health care for an estimated 115,000 low-income residents as the county adapts to the federal Affordable Care Act. IlliniCare Health Plan Inc., a division of St. Louis-based Centene Corp. that already manages health care programs for the state of Illinois, was chosen to operate the CountyCare program. Through CountyCare, people receive either Medicaid or insurance subsidies via the Affordable Care Act, which has come to be known as Obamacare (Dardick, 3/29).

The Milwaukee Journal Sentinel: Health Tied To Wealth: Ozaukee Ranks First, Milwaukee Near Bottom
While overall life expectancy in the nation has increased during roughly the past two decades, the increase has been concentrated almost entirely among the one-third of society with the most wealth and the most education. For those with just a high school diploma or less, life expectancy has stayed the same or fallen, according to a report from the Council on Health Care Economics and Policy's annual conference. So not surprisingly, a new study shows that the overall healthiest county in Wisconsin also is one of the richest: Ozaukee. At the same time, the county with the worst health — Menominee — is one of the poorest in the state. And Milwaukee County, with large pockets of poverty, is right behind it (Boulton, 3/30).

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Editorials and Opinions

Viewpoints: Coburn, USA Today, WSJ, New Yorker On Obamacare Deadline

USA Today: Obamacare Deadline Comes With Humble Pie (Our View)
As Obamacare's first enrollment period ends Monday (except for those who got an extension), the president's signature initiative is behind schedule, increasingly unpopular in polls and coming up short of the numbers the administration originally targeted. So should it be junked, as Republicans have been trying to do ever since it was passed? Hardly. Thanks to both administration incompetence and Republican intransigence, the Affordable Care Act is far from the runaway success its supporters imagined when President Obama signed the law four years ago. But neither is it the unmitigated disaster that opponents contend (3/30).

USA Today: Obamacare Cuts Choices, Not Costs
Obamacare supporters are touting reports that 6 million Americans bought insurance on exchanges as evidence the plan is moving in the right direction. But these numbers are misleading. If anything, they show that Obamacare's greatest challenges are yet to come. Of these enrollees, as many as 89% were previously insured. Helping 5 million Americans re-enroll in insurance is no great achievement, particularly when many of those customers were forced to give up plans they liked. For everyone else, costs continue to skyrocket (Sen. Tom Colburn, R-Okla., 3/30). 

The Washington Post: The Insiders: Is Obamacare Working?
From an insurer standpoint, an enrollment mix where only 25 percent are in the golden 18-34 age bracket is not the definition of “success.” And if the enrollees lean toward older, sicker people, premiums are going to go up dramatically for everyone. The premiums will be higher, and the only way insurers can lower prices is to make their networks more and more restricted, limiting access and choice for millions of Americans. That’s not what success looks like (Ed Rogers, 3/28).

The New Yorker: Obamacare: Where Are We Now? 
Lots of Americans who previously couldn’t obtain insurance ... now have health coverage. ... despite all the carve-outs and delayed deadlines imposed by an anxious White House, Obamacare is up and running. Contrary to the predictions of doom, it hasn’t collapsed under the weight of its own complications. Why, then, does the over-all reform remain so unpopular? ... The Republicans, with the enthusiastic help of conservative media outlets, have done a fiendishly effective job of stigmatizing what is essentially a private-sector solution as a big-government intrusion, and a handout to the unworthy (John Cassidy, 3/28).

The New Yorker: Health Caring
As the first deadline for coverage in 2014 drew near, the Administration announced that the number of people who signed up had passed six million. ... Those gains have been achieved amid a political controversy that has at times seemed almost unprecedented but which in many ways replicates the example of two of the law’s forerunners, Medicare and Medicaid. Those programs were born together in the summer of 1965, but their paths quickly diverged. ... the core of the law is the guarantee of health care to the people who need it most. As the story of Medicaid illustrates, the hardest thing about programs to aid the poor is getting them started in the first place. Obamacare has now passed that hurdle (Jeffrey Toobin, 4/7). 

The Wall Street Journal: Is ObamaCare A Law?
Liberals keep dismissing challenges to ObamaCare, political and legal, so it's no surprise they mostly ignored last week's oral argument at the D.C. Circuit Court of Appeals that could send another case to the Supreme Court. Coming in the week the White House wheeled out its 38th rewrite of the law, Halbig v. Sebelius is even more important for the contours of executive power and the rule of law. The case asks whether the Affordable Care Act, which limits insurance subsidies to "an Exchange established by the State," also authorizes subsidies for the 36 exchanges established by the federal government. ... here the Administration is asking the court to declare that the statute unambiguously means the opposite of what the plain language says (3/30).

Chicago Tribune: Monday Is The Obamacare Deadline. Sort Of. 
Another reason the law's supposed enforcement mechanisms are so wobbly: Consumers can claim one of many "hardship exemptions," some of which require little or no proof, to sidestep the mandate and penalty. Many Americans, heads spinning from all the Obamacare changes so far, may suspect that there's another reprieve — from penalties or deadlines — in store. Who knows? Thirty-eight Obamacare asterisks are a lot of asterisks. We'd bet there are more on the way (3/31).

Los Angeles Times: How A Koch Brothers Operative Played The Sexism Card Against MSNBC 
I suggest you take a look at the masterful performance of one Jennifer Stefano, a regional director of the Obamacare-hating, Koch brothers-funded Americans for Prosperity. She appeared as a guest on Chris Hayes’ MSNBC program "All In" Wednesday night to talk, ostensibly, about AFP’s objection to the two-week Obamacare deadline extension. The conversation quickly devolved into a one-sided screaming match, with Stefano working herself into the kind of tizzy any parent of a teenager would recognize as phony. Let’s put it this way: Any interview about health policy that ends with the guest demanding “How dare you?” has the ring of a set-up (Robin Abcarian, 3/28).

Bloomberg: Republican Senate Could Work Around Obama's Veto 
If Republicans take control of the U.S. Senate in this year's elections, it will be, as Vice President Joe Biden might put it more graphically, a big deal. ... President Barack Obama has the veto pen for the last two years of his term. That glosses over the profound policy implications of a change that would affect many areas. The Affordable Care Act: The president can stop repeal of Obamacare, but a determined congressional majority can wreak havoc by using the initial budget process, known as reconciliation, which allows major changes to be made with only a majority Senate vote that isn't subject to veto (Albert R. Hunt, 3/30).

On other health issues -

NPR: Why Paper Prescriptions Are Going The Way Of Snail Mail
Charlie is like a lot of my patients. He's in his late 50s, weighs a little too much and his cholesterol and blood pressure are both too high. To lower his risk of a heart attack or stroke, he takes daily pills to control his blood pressure and lower his cholesterol. A couple of times a year, Charlie visits me to make sure the drugs are working and aren't causing problems. Caring for patients like Charlie has become easier in the last few years because of something that you might take for granted in 2014: electronic prescribing (John Henning Schumann, 3/30). 

The Hill: Yet Another Short-Term 'Doc Fix', But With Glimmers Of Hope
House leaders approved a 12-month short-term patch to prevent looming physician payment cuts that would threaten access to needed care for millions of Americans. ... While imperfect and not the permanent fix that we hoped for, the authors of the bill included a number of provisions not typically included in SGR legislation ... A number of these policies were recommended in March 2013 by the National Commission for Physician Payment Reform and hit on important areas within healthcare. Furthermore, their inclusion illustrates that the SGR patch is one of the few legislative vehicles that has bicameral and bipartisan viability (Dr. Kavita Patel and Jeffrey Nadel, 3/29).

The Washington Post: Having 'The Other Talk' With Your Kids — Not Storks, But Aging
As parents, we care for our children until they can fend for themselves. Then one day, the roles are reversed. ... Perhaps you won’t need assistance in your senior years. You would be one of the lucky ones. The fact is that about 70 percent of people 65 or older will need long-term care services at some point, according to Genworth Financial. But long before a health crisis forces the issue, you need to talk with your adult children about your later years. The problem is, many people can’t bring themselves to have that talk (Michelle Singletary, 3/28).

The New York Times: Antibiotic Use, And Abuse, On The Farms
The Food and Drug Administration’s efforts to get the voluntary cooperation of drug companies to curb the overuse of antibiotics in animal feed is off to a rousing good start. The agency announced on Wednesday that 25 of the 26 manufacturers of the antibiotics of greatest concern had agreed to modify their labels to block such usage. They account for almost all sales of these drugs (3/28).

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