Daily Health Policy Report

Thursday, March 6, 2014

Last updated: Thu, Mar 6

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Changes To Health Law Rules Include Extra Month To Enroll In 2015

Kaiser Health News staff writer Mary Agnes Carey reports: "The Obama administration on Wednesday released a broad set of regulatory changes to the health law that would give some consumers additional time to stay in plans that do not comply with all its coverage requirements and all consumers more time to enroll in coverage come 2015" (Carey, 3/6). Read the story.

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Marketing Mistakes Hurt Latino Enrollment In California

KQED’s April Dembosky, working in partnership with Kaiser Health News and NPR, reports: "It's been decades since the advertising industry recognized the need to woo Hispanic consumers. Big companies saw the market potential and sank millions of dollars into ads. The most basic do's and don'ts of marketing to Latinos in the U.S. have been understood for years. So when California officials started thinking about how to persuade the state's Latino population to enroll in health care plans, they should have had a blueprint of what to do. Instead, they made a series of mistakes" (Dembosky, 3/6). Read the story.

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Groups Make Final Push To Sign People Up For Obamacare

Kaiser Health News staff writer Phil Galewitz, working in partnership with USA Today, reports: "It's crunch time for Obamacare: With less than four weeks left to sign up for coverage this year through the health law’s insurance marketplaces, consumer groups, insurers, hospitals and state and federal officials are ratcheting up their enrollment campaigns to deliver more people — particularly young adults" (Galewitz, 3/5). Read the story.

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Capsules: Survey: Employers Less Confident Of Future Health Benefits; Insurers Take The Lead To Reach Florida Latinos

Now on Kaiser Health News' blog, Jay Hancock writes about the findings from this survey of large companies: "Big employers are pretty sure they’ll keep offering workers health care coverage. But they seem a lot less sure than they used to be, according to a survey released Thursday. Only one large company in four recently surveyed by Towers Watson and the National Business Group on Health is confident it will provide medical coverage in a decade. That’s down from 73 percent in 2007 and 38 percent in 2010" (Hancock, 3/6).

In addition, WLRN's Sammy Mack, working in partnership with KHN and NPR, reports that insurers are taking the lead in Florida with targeted health law outreach efforts: "About a third of Florida’s Hispanics are not covered by insurance, yet insurers need them to sign up. They tend to be younger and healthier than the rest of the population, so insurers want them since they may pay more into the system than they use in services. Having healthy, young people on their rolls helps insurers balance the books" (Mack, 3/6). Check out what else is on the blog.

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Political Cartoon: 'Bear-ly Covered?'

Kaiser Health News provides a fresh take on health policy developments with "Bear-ly Covered?" by Dan Piraro.

And here's today's health policy haiku:


Time to make more of those tweaks
to the health care law.

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

Administration Unveils New Round Of Health Law Rule Changes

Among the wide-ranging set of changes, the one drawing the most attention is the Obama administration's decision to allow some consumers to keep health coverage into 2017 that does not comply with the overhaul's minimum standards. Other changes include an extension of next year's enrollment period, more backup for plans in insurance exchanges dealing with high patient costs and more time for states deciding whether to run their own marketplaces.

The New York Times: Some Policies Get More Time In Health Shift
The Obama administration, grappling with continued political fallout over its health care law, said Wednesday that it would allow consumers to renew health insurance policies that did not comply with the new law for two more years, pushing the issue well beyond this fall’s midterm elections (Pear,3/5).

Los Angeles Times: Consumers Allowed To Keep Substandard Health Plans Into 2017
The Obama administration announced Wednesday that some Americans with health insurance policies that don't meet consumer standards set by the president's new healthcare law would be allowed to keep their plans into 2017, three years later than originally envisioned. The delay, which could put off the final cancellation of some health plans until after President Obama leaves office, may have limited practical impact (Levey, 3/5).

The Washington Post: Obama Administration Rewrites Some Health-Care Policies
The Obama administration announced Wednesday that it has rewritten an array of far-reaching rules under the Affordable Care Act. ... The rule changes will touch essentially every sector affected by the 2010 health-care law. It will buffer more health plans in insurance exchanges from high patient costs, give states more time to decide whether to run their own marketplaces, and spare certain unions from a fee they have resented (Goldstein and Somashekhar, 3/5).

The Wall Street Journal: Obama Gives Health Plans Added Two-Year Reprieve
But a series of delays by the administration—and decisions by states on implementing the law—have taken a toll. The latest delay came Wednesday, when federal officials said insurance companies could continue selling plans that don't meet the law's more rigorous standards until 2016 in some instances. It was the second time the administration delayed that requirement after the law's tougher standards prompted insurers to cancel millions of people's health plans last year. The latest delay averts another raft of cancellations before this year's midterm elections (Radnofsky, 3/5).

The Associated Press/Washington Post: 2-Year Extension Offered For Canceled Health Plans
The decision helps defuse a political problem for Democrats in tough re-election battles this fall, especially for senators who in 2010 stood with President Barack Obama and voted to pass his health overhaul (3/5).

Kaiser Health News: Changes To Health Law Rules Include Extra Month To Enroll In 2015
The Obama administration on Wednesday released a broad set of regulatory changes to the health law that would give some consumers additional time to stay in plans that do not comply with all its coverage requirements and all consumers more time to enroll in coverage come 2015 (Carey, 3/6).

Reuters: U.S. Health Plans That Don't Meet Obamacare Rules Can Renew For Two More Years
The Obama administration on Wednesday said it would allow health insurers to extend plans that fail to comply with its signature health law for an additional two years, a move Republicans quickly condemned as a politically motivated delay (Morgan, 3/5).

Bloomberg: Obamacare Policies Change for 2015 To Add Flexibility 
With midterm congressional elections bearing down, the government changed its regulation of Obamacare to give consumers and states more flexibility to decide on their health plans, insurers more time to sign up customers and taxpayers a chance to avoid more costs (Wayne, 3/5).

McClatchy: Canceled Health Insurance Plans Extended - Again
The administration’s second canceled-policy “fix,” following a one-year extension granted in November, was the most notable and controversial of several new executive branch tweaks made to the health law for next year. Theoretically, the move allows about 500,000 individual and 1 million small group health policies to continue through October 2017 (Pugh, 3/5).

ABC News: White House Extends ‘Keep Your Plan’ Fix for Obamacare
Facing growing opposition from his own party, President Obama announced a transition plan last fall that allowed Americans who were losing their coverage because it didn’t comply with the requirements of the Affordable Care Act to keep their plans for up to a year before being forced into coverage that meets the new standards. Today, the administration said it would extend that transition plan for two years to policies issued up to October 1, 2016, allowing consumers to renew their 2013 plans for two more years (Bruce and Good, 3/5).

NBC News: Feds Offer Two-Year Obamacare Delay For Some
Senior administration officials confirmed rumors that had been circulating for days that the administration would further extend the exception for people who object to being forced to buy new policies that meet tough new government requirements (Fox, 3/6).

CBS News: Obamacare Officials: No Concern About Mass Insurance Cancellations
By extending the policy that long -- potentially letting consumers keep plans that aren't Obamacare-compliant until the fall of 2017 -- the administration says it should avoid another wave of dropped insurance policies (Condon, 3/5).

USA Today: People May Keep Old Health Insurance Another Year
The change represented another midcourse correction for the law, which is still recovering from the flawed opening of the federal and state health care exchanges last Oct. 1 and the delay of several key provisions (Kennedy, 3/5).

Fox News: Administration Offers 2-Year Obamacare Extension For Canceled Health Plans
The Obama administration announced Wednesday that it will let people keep health insurance plans that would otherwise be out of compliance with ObamaCare for another two years, in a delay Republicans portrayed as an election-year ploy (3/5).

The Wall Street Journal: Latest Health-Law Changes Affect Consumers, Insurers, Employers
The Obama administration unveiled a slate of health-law changes Wednesday, including stretching the enrollment period for next year's plans an extra month and fine-tuning a financial backstop meant to limit insurers' losses if they end up with sicker customers than expected. Some of the shifts compensate for a series of earlier policy changes as the Obama administration responded to criticism over the glitchy launch of the Affordable Care Act and a wave of health-plan cancellations. Others, such a new threshold for out-of-pocket medical expenses, give insurers the tools to begin setting prices for 2015 plans (Weaver and Francis, 3/5).

The Washington Post: Obama Administration Permits Further Delay To Health Exchanges For Small Businesses
The Obama administration on Wednesday gave states more time to implement a key feature of the new employer health care marketplaces and gave small businesses more time to comply with some of the new coverage requirements in the law. Under the Affordable Care Act, states are required to offer a health care exchange where small businesses can enroll in and pay for insurance plans, all online. Companies in states that declined to build their own portals would be able to access a similar network run by the federal government (Harrison, 3/5).

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Groups, Insurers, Officials Mobilize For Health Law Enrollment Push

March 31 is the deadline for signing up for insurance, and young adults and minorities are among the groups being targeted.

Kaiser Health News: Groups Make Final Push To Sign People Up For Obamacare
It's crunch time for Obamacare: With less than four weeks left to sign up for coverage this year through the health law's insurance marketplaces, consumer groups, insurers, hospitals and state and federal officials are ratcheting up their enrollment campaigns to deliver more people -- particularly young adults (Galewitz, 3/5).

The Washington Post: Insurers Increase Ads To Get People To Sign Up For Health Plans Under Affordable Care Act
As the March 31 enrollment deadline approaches, insurers are increasingly urging consumers to sign up for health plans under the Affordable Care Act, even as some take swipes at the law, according to a new analysis of health-care advertising. Forty-six percent of insurer ad spending during the week of Feb. 24 went to commercials featuring the law, compared with 32 percent the week before, according to the ad tracking group Kantar Media CMAG (Eilperin, 3/5).

The Associated Press: Michelle Obama Promotes Health Insurance In Fla.
With just weeks left to sign up for health care under the Affordable Care Act, Michelle Obama zeroed in on recruiting the crucial young adult demographic during a visit to a Miami community health center Wednesday. The first lady congratulated a handful of residents who had just enrolled during an intimate event, asking one woman whether she had gotten her son to enroll (Kennedy, 3/5).

The Hill: Obama's Final Push To Boost Latino Enrollees
President Obama will participate in a town hall Thursday morning at the Newseum, in a bid to encourage Latinos to enroll in Obamacare before the March 31 deadline. The question-and-answer session will be hosted by the Asegúrate campaign, a collaboration between the nonprofit California Endowment, a private health endowment,  and major Spanish-language media outlets, including Univision and Telemundo (Sink, 3/5).

Politico: Final Obamacare Push Focusing On Latino Community
For the uninsured Latinos who live in places like El Paso, the political drama surrounding Obamacare seems very far away. They are more concerned with understanding how the Affordable Care Act benefits them. And with open enrollment ending March 31, time is running out for people like Margarita Sanchez -- or President Barack Obama -- to explain that to them (Haberkorn and Kenen, 3/5).

Kaiser Health News: Marketing Mistakes Hurt Latino Enrollment In California
It's been decades since the advertising industry recognized the need to woo Hispanic consumers. Big companies saw the market potential and sank millions of dollars into ads. The most basic do's and don'ts of marketing to Latinos in the U.S. have been understood for years. So when California officials started thinking about how to persuade the state's Latino population to enroll in health care plans, they should have had a blueprint of what to do. Instead, they made a series of mistakes (Dembosky, 3/6).

Los Angeles Times: Covered California Begins Ad Blitz In Final Enrollment Weeks
With less than a month left for enrollment in Obamacare, California's insurance exchange is applying a major dose of peer pressure. In a new TV ad blitz, recent enrollees extol the benefits of having coverage for checkups or a serious illness. A man plays soccer with his sons, a musician carries his guitar down the street. "I'm in," young, fit-looking people say. "Are you in?" the announcer asks (Karlamangla, 3/5).

USA Today: Blacks In South Urged To Enroll In Health Care Plans
The fliers, featuring a smiling African-American family, invite people to Allen Chapel A.M.E. Church each Saturday this month to learn more about the Affordable Care Act -- and hopefully to enroll in a health insurance plan. It's all part of a determined effort by community groups, churches and civil rights organizations -- particularly in the South -- to sign up more African Americans for health care under the federal law ahead of the March 31 enrollment deadline (Barfield Berry, 3/5).

Health News Colorado: Final Push For Health Sign-Ups By March 31
Patty Fontneau, CEO of Connect for Health Colorado, said exchange officials are working hard this month to let people know that now is the last chance to buy. "We are stepping up outreach efforts to help as many Coloradans as possible access coverage and tax credits in the final four weeks of open enrollment," Fontneau said in a press release. Of 84,881 people who bought insurance through Colorado's exchange, about 56 percent have so far qualified for federal subsidies to make insurance more affordable (McCrimmon, 3/5).

The Denver Post: Patients Can Get Help Navigating Health Care
Nicole King said there was a woman who came into Doctors Care in Littleton with a respiratory infection, plus jaundice and substance-abuse problems. There wasn't much they could do for her in terms of substance abuse because she was uninsured at the time. But through the Affordable Care Act, also known as Obamacare, she was able to get Medicaid (Woullard, 3/6).

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Feds To Probe Troubled State Exchanges

The Government Accountability Office, an investigative arm of Congress, will look at what went wrong with several state exchanges, including Oregon's, which failed to deliver despite large infusions of federal money. Meanwhile, a state lawmaker has sued California for refusing to allow consumers with canceled health policies to keep them, and Florida has a high rate of uninsured Latinos.

The Associated Press: U.S. Agency To Probe Health Exchanges
The investigative arm of Congress on Wednesday agreed to look into problems with state health exchange websites around the country. The U.S. Government Accountability Office accepted an initial request from a group of House Republicans seeking an audit on how $304 million in federal grants were spent on the Cover Oregon website, which has yet to enroll a single person online without special assistance (3/5).

The Oregonian: Congressional Investigators Will Probe Cover Oregon And Other States' Health Exchanges
The Congressional Government Accountability Office will audit Cover Oregon as part of a larger examination of state-based health insurance exchange projects. Oregon remains the only site in the country that doesn't let the public self-enroll, despite spending more than $210 million in federal grant money so far. U.S. Rep. Greg Walden (R-Ore) and other House Republicans requested an investigation last month. Oregon's two U.S. Senators, Democrats Jeff Merkley and Ron Wyden, echoed the request a day later. The GAO won't confine its efforts to just Oregon. It "will undertake this work as part of a broader study planned to examine states’ health exchange websites," said a March 5 letter to Walden from GAO congressional relations director Katherine Siggerud (Budnick, 3/5).

Los Angeles Times: State Lawmaker Sues California Health Exchange Over Cancellations
A Republican state lawmaker sued California’s health insurance exchange, saying it overstepped its authority by refusing to allow more than 900,000 people to keep their existing health policies (Terhune, 3/5).

Health News Colorado: Accused Embezzler Resigns From Colorado Exchange
Colorado’s health exchange has severed ties with a manager who in February was indicted in Montana on federal embezzlement charges. “Connect for Health Colorado has accepted the resignation of Christa McClure, effective today,” exchange spokeswoman Myung Oak Kim said in a written statement late Tuesday. Kim said McClure did not receive a severance package and that there are no financial concerns related to her tenure at Connect for Health (McCrimmon, 3/5).

NPR: Florida Has A High Rate Of Latinos Without Health Insurance
Florida doesn't have its own insurance exchange, and it has not expanded Medicaid. In the absence of state outreach efforts, it's up to the insurers and other groups to get the word out to Latinos (Mack, 3/6).

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Medicaid Expansion: With Arkansas 'Private' Plan Authorized For Another Year, Officials Now Focus On Possible Fixes

After surviving an effort earlier this week to defund it, supporters of the state's private option are now working on alterations that will smooth its future. Meanwhile, the back-and-forth over whether to pursue the expansion continues in Virginia and Utah.   

The Associated Press: Arkansas Officials Eye Changes to Medicaid Plan
With Arkansas’ model plan to use Medicaid funds to purchase private insurance for the poor spared for another year, backers of the nationally watched program are now focusing on changes that will be needed to keep it alive in the future. State officials and architects of the “private option” said Wednesday they’ll spend the coming weeks focusing on proposals Arkansas must submit to the federal government to alter a program that was approved last year as an alternative to expanding Medicaid under the federal health care law. The program survived a defunding attempt on Tuesday, with the House voting to reauthorize the program for another year (3/5).

PBS NewsHour: ‘Private Option’ Medicaid Expansion To Continue In Arkansas
The Arkansas experiment to use federal Medicaid dollars to help low-income people buy private health insurance plans will survive another year. This “private option” of Medicaid expansion -- which narrowly passed in the state’s House of Representatives on Tuesday after being rejected in four previous votes -- allows those below 138 percent of the poverty level to enroll in plans like Blue Cross and Blue Shield through the state’s insurance exchange. Many conservatives in the Republican-controlled legislature found that to be a much more palatable option than enrolling more people in the traditional Medicaid program, which they see as a broken and inefficient system that offers poor-quality care (Kane, 3/5).

Politico: Hillary Clinton: Obamacare Too Important To Turn Back
Hillary Clinton showed more signs of flexibility Wednesday on how Obamacare is implemented, but she insisted the law is too important to “turn the clock back.” In a question-and-answer session following a lecture at UCLA, Clinton suggested she’s open to different ways of achieving the health law’s goals. She praised Arkansas -- the state where she and her husband rose to political fame -- for carrying out a new approach to expanding Medicaid coverage, by using the federal money to buy private health insurance for more than 100,000 low-income residents (Nather, 3/5).

Norfolk Virginian-Pilot: Dems: Medicaid Expansion Means Money For Schools
Extortion. Immorality. Hypocrisy. Fiscal irresponsibility. Hostage-taking. Such words were flying Wednesday as the rhetoric got hotter than ever in the General Assembly's pitched battle over whether to expand the Medicaid health insurance program for low-income Virginians. The fight seems almost certain to delay passage of a state budget by the legislature's scheduled Saturday adjournment, setting up the possibility of a government shutdown when the new fiscal year kicks in July 1 (Sizemore and Walker, 3/6). 

The Richmond Times-Dispatch: Goodwin, 3 Ex-McDonnell Aides Urge Health Care Fix
Unusual alliances are adding pressure to the Medicaid expansion debate, with Richmond power broker William H. Goodwin Jr. and three members of former Gov. Bob McDonnell’s administration writing to House and Senate leaders urging them to expand health care to the uninsured. Former State Health Commissioner Dr. Cynthia Romero, former Secretary of Technology James D. Duffey Jr. and former Secretary of Commerce and Trade Jim Cheng wrote to House Speaker William J. Howell, R-Stafford, and Senate Democratic leader Richard L. Saslaw, Fairfax, asking them to close the Medicaid coverage gap. “We urge you to work together to find a way to close the coverage gap in health care, drawing down the federal funds that will help provide health care to the uninsured and also meet the needs of Virginia’s business community,” state the three former officials in the administration of McDonnell, a Republican who publicly opposed Medicaid expansion (Meola and Martz, 3/5).

Deseret News: Democrats Offer Full Medicaid Expansion Bill
A Democratic plan to take the full Medicaid expansion available under the Affordable Care Act surfaced Wednesday as the Legislature's GOP majority remained split over competing proposals from their ranks and Gov. Gary Herbert. SB272, sponsored by Senate Minority Leader Gene Davis, D-Salt Lake City, calls for the state to accept all of the federal money offered to provide health care coverage for Utahns who earn up to 138 percent of the federal poverty level. Davis said the bill will have a hearing Friday before the Senate Health and Human Services Committee but admits it's a long shot (Roche, 3/5). 

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White House Says Risk Corridors Will Be Budget Neutral

In news on the implementation of the health overhaul, administration officials seek to rebut Republican charges that the risk corridors will be a "bailout" for the insurance industry. Meanwhile, Gary Cohen, who helped oversee many of the rules for rolling out the law, is leaving the government.

The Hill: White House: Federal Government Won't Be Bailing Out Insurers 
The risk corridors created under ObamaCare that Republicans have decried as a "bailout" won't cost the federal government anything because they'll be implemented in a "budget neutral fashion," the Obama administration said Wednesday. The Affordable Care Act creates a temporary pool of money, known as risk corridors, to pay insurers who enroll a higher-than-expected number of sick patients through 2016 (Easley, 3/5).

CNN: Official Key To Implementation Of Obamacare Resigns
With this year's goal for enrollment in Obamacare seemingly out of grasp and the President under renewed partisan attack over the program, an official key to implementing it has resigned. Gary Cohen leads the agency that made many of the rules for the Affordable Care Act and established the Marketplaces, where Americans can buy health insurance through Obamacare, including healthcare.gov, according to a statement Wednesday announcing his departure. The Marketplaces came under fire, when they crashed massively upon rollout. Cohen will vacate the post of Director of the Center for Consumer Information and Insurance Oversight after March 31 (Brumfield and Seher, 3/6).

And in other news -

California Healthline: Obamacare Payment Pilots Are Struggling To Prove They Work. Here's Why It's OK.
When Barack Obama was merely a senator running for the White House, he told one physician association, "I support the concept of a patient-centered medical home" and would encourage the model if he ever became president. Six years later: Mission accomplished. Nearly 7,000 primary care practices have officially been accredited as PCMHs, and thousands of other providers have adopted some features of medical homes, which use a team-based approach to coordinated care. And while the movement toward medical homes might have evolved without Obama, his health reforms clearly laid the groundwork for rapid adoption. The only problem? There's still no clear evidence that the model even works (Diamond, 3/5).

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Capitol Hill Watch

House Votes To Delay Individual Mandate

The House took its 50th vote to change the health law, passing a bill that would delay the individual mandate to carry health insurance for one year. The measure will likely never be taken up in the Democrat-led Senate.

The Associated Press/Washington Post: House Backs Bill To Delay Health Care Penalty
The House on Wednesday backed a one-year delay in the penalty that individuals would have to pay for failing to sign up for health insurance, the 50th time Republicans have forced a vote to repeal, gut or change the law championed by President Barack Obama. The vote was 250-160, with 27 Democrats joining Republicans on legislation to postpone the individual mandate under the law. The measure stands no chance in the Democratic-led Senate and the White House has threatened a veto (3/5).

ABC News: House Takes 50th Vote To Change ‘Obamacare’
While the president once again makes changes to his signature legislative achievement, House Republicans continue targeting the health care law, casting their 50TH vote today to tweak it since seizing majority control in 2011. The vote passed 250 to 160 with 27 Democrats crossing the aisle to vote with the GOP majority. House Majority Leader Eric Cantor said the bill, known formally as “Suspending the Individual Mandate Penalty Law Equals Fairness Act,” would enact a one-year delay of Affordable Care Act‘s individual mandate, changing the penalty for failing to buy health insurance from $95, or one percent of income, to zero (Parkinson, 3/5).

Politico Pro: Ellmers: ACA Replacement May Be Multiple Bills
A GOP plan to replace Obamacare may be a collection of different bills rather than a single omnibus package, a Republican congresswoman said Wednesday. “We’ve got to come together on a plan, and it may actually end up being multiple bills we vote on,” Rep. Renee Ellmers of North Carolina, a member of the powerful Energy and Commerce Committee, said at a POLITICO Health Care Breakfast Briefing in Washington. Ellmers said getting Republicans to agree on one plan is like “herding cats” but that ultimately the party will examine “what has worked and what hasn’t worked” about Obamacare to devise a solution (Cheney, 3/5).

And the new chair of the Senate Finance Committee says he'll fix how Medicare pays doctors --

The Oregonian: Ron Wyden Vows Permanent 'Doc Fix' For Medicare In First Speech As Finance Chairman
Oregon Sen. Ron Wyden, in his maiden speech as chair of the Senate Finance Committee, told a hospital association this week, that he will make a major push to permanently end the recurring battles over Medicare payments to doctors. Congress has routinely overrode a 1997 law aimed at limiting physician fees as a way to control Medicare costs.  These so-called "doc fixes" have become a regular feature of annual haggling over budgets as physician groups have complained that they would face steep cuts in Medicare fees if the fixes weren't enacted. Legislation is now moving in Congress to permanently repeal the 1997 law and Wyden embraced that effort in a speech Tuesday to the Federation of American Hospitals (Mapes, 3/5).

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State Watch

Arizona Sued Over Abortion Restrictions

Abortion providers filed suit Wednesday to block new state regulations that limit the use of the most common abortion drugs. Meanwhile, two more Texas abortion clinics are closed as a result of that state's restrictions, bringing total closures to 12. 

Los Angeles Times: Suit Filed to Block New Arizona Abortion Regulations
Abortion providers have filed suit against Arizona to block a new rule that limits the use of medications to induce abortions. The rule is part of state-mandated abortion regulations that are scheduled to take effect April 1 (Carcamo, 3/5).

The Associated Press/Washington Post: Arizona Sued Over Rules Limiting Abortion Drug
Abortion providers said Wednesday that they have sued the state of Arizona to try to block new state rules limiting the use of the most common abortion drugs. The lawsuit filed in federal court in Tucson alleges that the new rules required under a 2012 law will effectively block the ability of many women to have abortions (3/5).

The Associated Press/Washington Post: 2 More Texas Clinics Closing Amid New Abortion Law
Two more Texas abortions clinics are closing because of new restrictions placed on the facilities by the Republican-controlled Legislature. Ten clinics have already closed because of a new law, which strictly limits where, when, how and from whom women can obtain abortions (3/6).

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State Highlights: Va. Mental Health Budget; Nurses' Practice In Minn.

A selection of health policy stories from Virginia, California, Minnesota, Illinois and Colorado.

The Washington Post: Budget Battle Over Mental Health Reform
Lawmakers in Richmond are deep in budget negotiations and will soon decide which parts of the mental health-care system will receive a funding boost. The House and Senate proposals have a number of differences, and what emerges will likely be a mash-up of the two (Shin, 3/5).

The Wall Street Journal: California Nursing Home Operator Files For Bankruptcy
California nursing home operator Country Villa Health Services, the target of a number of pending class-action lawsuits, has filed for Chapter 11 bankruptcy. The company, which operates 19 nursing homes and assisted living centers in Southern California, sought Chapter 11 protection on Tuesday along with more than a dozen of its health care affiliates in U.S. Bankruptcy Court in Orange County, Calif. (Fitzgerald, 3/5).

Minnesota Public Radio: Nurses Lobby For Authority To Practice Independently
As the health care industry increasingly relies on nurses to perform some work that once was exclusively assigned to doctors, some highly skilled Minnesota nurses say it's time they had the authority to practice independently. They're trying to change state law, which requires advanced practice nurses to have some supervision from physicians. Nurses say the requirement limits the treatment they can provide, and is a significant barrier to practicing in health care shortage areas. But proposed legislation that would remove physician supervision is not popular with doctors' groups (Benson, 3/5).

The Chicago Sun-Times: Aldermen Propose Paid Sick Days For All Workers In Chicago
Chicago employers large and small would be required to provide at least five paid sick days a year for their employees under an ordinance proposed Wednesday to provide a much-needed benefit for 460,000 workers without it. The plan to let employees accumulate sick days at a rate of one hour for every 30 hours worked -- up to nine a year for companies with 10 or more employees -- was introduced by nearly a dozen progressive aldermen at the behest of Women Employed, unions and other advocates for low-wage workers and health care practitioners. They argue that 42 percent of Chicago’s private sector employees do not get a single sick day and that the figure is nearly twice that for low-income workers in the food service and health care industries, which are dominated by women (Spielman, 3/5).

Health News Colorado: Aguilar To Introduce Bill To Reverse High Health Costs
As anger about high health costs escalates in Colorado, Sen. Irene Aguilar, D-Denver, plans to introduce legislation this month to create a commission charged with cutting costs. The problem of high health costs is hardly new. Aguilar, who is also a physician, has a binder full of reports going back 20 years from groups that have tried to tackle the problem both in Colorado and the U.S. What may be changing now is that under the Affordable Care Act and through Colorado’s All Payer Claims Database, consumers can see variations in health costs and those who are paying significantly higher rates are furious (McCrimmon, 3/5).

Health News Colorado: Kids On Public Health Programs To Get Continuous Care
In what advocates are calling a “home run for children’s health,” kids enrolled in public health insurance programs now will get coverage for 12 months at a time. In the past, children who qualified for Medicaid or the Child Health Plan Plus often got bounced off the programs every few months if the family’s income changed and thus lost access to reliable care. Colorado managers of those programs expect the new policy to affect about 535,000 children (McCrimmon, 3/5).

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Editorials and Opinions

Viewpoints: Revamping Health Law Regs -- Again; Arkansas Decision On Medicaid Reverberates Nationwide

Los Angeles Times: Obama Breathes Life Into Canceled Health Plans – Again
The Obama administration wrote a new chapter Wednesday in the "if you like your health plan, you can keep it" chronicles, decreeing that plans it once derided as "junk" or "substandard" can remain in effect until October 2017 -- long after the next presidential election. The point, administration officials say, is to help those in the market for individual or small-group plans make a smoother transition into Obamacare (Jon Healey, 3/5). 

The Wall Street Journal: The Endangered Senators Rule
Maybe the White House figures that if it rewrites Obamacare enough times, the media will stop paying attention. On Wednesday it ordered one more delay of the mandates for individuals and small business -- in time to give a political reprieve to Senators vulnerable in the midterm election (3/5).

The New York Times: Republicans Place The Wrong Bet
Republicans may have bet too heavily on the wrong issue going into the midterm elections. When the health care law's website wasn't working, the law itself was at its most unpopular and its most newsworthy, and the president's poll numbers were cratering, many Republicans made the calculation that they could ride the wave of woe to an overwhelming electoral victory in November. But betting on stasis is stupid. Things change (Charles M. Blow, 3/5).

Bloomberg: Arkansas Republicans Help Obamacare Dig In
It's one case, in one state, but the renewal of Medicaid expansion in Arkansas is a big deal. ... This is a big deal because it’s another indication that Medicaid expansion is almost certainly going to be a one-way street. Once states get in, they aren't going to drop out. ... That's because, over time, repeal would mean taking away people's insurance. I'm not making a prediction that Obamacare will become popular. Nor does it mean that the ACA is "working." My point is only that very few politicians want to take away benefits from a large number of voters. And, in the case of Medicaid expansion, those benefits accrue to important organized interest groups, including hospitals (Jonathan Bernstein, 3/5).

Boston Globe: Close Shave In Arkansas
Yesterday, the Arkansas House of Representatives gave approval to the state's annual budget and, after a long hard fight, included continuation of its unorthodox health insurance expansion for low-income residents under the Affordable Care Act, dubbed the "private option." Does this matter beyond Arkansas' borders? Yes. Reversal would have been the first case of a state reversing an ACA expansion, and would have emboldened opponents to seek similar reversals in other states (John McDonough, 3/5). 

The Washington Post: Virginia GOP Legislators Oppose Medicaid Expansion Despite Benefits To Their Districts
Virginia House Speaker Bill Howell (R-Stafford) is leading the campaign to block Medicaid expansion even though the largest hospital in his Fredericksburg district says it desperately needs the money to continue supporting health care for the city’s poor. Fred Rankin, chief executive of the nonprofit parent of Mary Washington Hospital, said rebuffing expansion would cost his institution $14 million a year available under the Affordable Care Act. That would threaten the hospital's support for a free clinic and community health centers that serve low-income people (Robert McCartney, 3/5).

Roanoke Times: Hazards Ahead For Hospitals Without Action
The Virginia General Assembly wasn't responsible for creating either the Affordable Care Act or the subsequent need to expand Medicaid; nonetheless, today we need the General Assembly to help us deal with the consequences of the ACA. There seems to be much discussion about who is to blame for the issues and much less discussion focused on possible solutions. The people of Virginia and our health systems in Virginia need solutions -- and soon. Today, the ACA is already draining money from Virginia. While we are sympathetic to calls for audits and improvements to the administration of Medicaid, we are hopeful that those reforms can move forward in parallel with Medicaid's expansion (Victor Iannello, 3/5).

Roanoke Times: Health Care Progress Within Virginia's Grasp
The challenges facing hospitals, physicians and the health care system are many. First and foremost are the various reductions in payments for services to beneficiaries of the federal Medicaid program that are contained in the Affordable Care Act. ... The financial stakes and the financial integrity of hospitals and health systems ... are clearly tied to the outcome of this debate. In our most recent fiscal year, our system provided more than $131 million in uncompensated and charitable care to our region. This is significant, and the reality that businesses are bearing some of this cost through their own health insurance policies by subsidizing the care for the uninsured is unsustainable. There must be a way of caring for the uninsured going forward (James A. Hartley, 3/5).

Roanoke Times: Two Challenges, One Solution
Two issues have dominated this year's General Assembly session. The debates over mental health and access to medical care have largely played out on parallel tracks at the state Capitol, but in reality they are intertwined. Budget negotiators must recognize that truth if they hope to make meaningful improvements in the commonwealth's behavioral health system (3/5).

Norfolk Virginian-Pilot: Special Session: Just Another Ploy
Virginia House Republicans opposed to extending health insurance coverage to lower-income residents reiterated their latest battle strategy at a press conference Tuesday. They want to remove the issue from state budget negotiations and, instead, take it up in a special legislative session. On the surface, this might appear reasonable. But as has been the case with House Republicans' previous tactics for opposing the return of Virginians' federal tax dollars to Virginia, upon closer inspection the rationale for their latest position unravels (3/5).

And on other health care issues --

The New York Times: Room For Debate: When The Doctor Is No Longer The Boss
The Affordable Care Act seems to have accelerated doctors' flight from private practice into large physician groups and hospital networks. Do those systems' economies of scale benefit all involved? Or are there downsides for patients, physicians or others? (3/5).

Los Angeles Times' Capitol Journal: Compromise Unlikely In Fight Over Medical Malpractice Cap
You'd think this would be a simple problem to fix: The unfair low limits on pain and suffering awards in California medical malpractice suits. But few things of genuine importance are simple in California's innately pugnacious Capitol. There's greed, ill will, stubbornness, hubris, vindictiveness, indifference (doesn't affect me), cowardice -- all the human traits that politicians bring to Sacramento from the citizenry they represent. And too often these characteristics aren't tempered with people's counter-attributes of fairness, compromise and common sense (George Skelton, 3/5).

JAMA: The Three-Fold Path To Health Savings And Better Care
With each passing month, evidence accumulates that health care spending growth has reset to a new, lower level. Preliminary data for 2013 show an increase in health care spending essentially equal to the growth of the economy -- a rate of increase not seen for some time. With each passing month, evidence accumulates that health care spending growth has reset to a new, lower level. Preliminary data for 2013 show an increase in health care spending essentially equal to the growth of the economy -- a rate of increase not seen for some time. Employment data show that December and January were the 2 slowest months in health care employment in over 25 years. As the troubles with the Affordable Care Act's (ACA's) website recede in importance, the slowing in medical spending becomes the single most important story in health care (David Cutler, 3/5).

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Stephanie Stapleton

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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.