Daily Health Policy Report

Tuesday, April 1, 2014

Last updated: Tue, Apr 1

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Health Care Marketplace

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Burnt Out Primary Care Docs Are Voting With Their Feet

Reporting for Kaiser Health News in collaboration with The Washington Post, Roni Caryn Rabin writes: “Physician stress has always been a fact of life. But anecdotal reports and studies suggest a significant increase in the level of discontent-especially among primary care doctors who serve at the frontlines of medicine and play a critical role in coordinating patient care” (Rabin, 4/1). Read the story.

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Insuring Your Health: Community Health Centers May Provide Services For Those Who Remain Uninsured

Kaiser Health News consumer columnist Michelle Andrews writes: “If you're uninsured, you may have run out of time. Yesterday was the formal deadline to sign up for health insurance on the marketplaces or face a penalty, unless you were already 'in-line' for enrollment. Still, people who missed the cutoff or couldn’t buy insurance have options to get the health care services they need. But doing so may not be simple or assured” (Andrews, 4/1). Read the column.

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Capsules: Healthcare.gov Woes Frustrate In-Person Helpers Around The Country; For California’s Uninsured, A Rush To The Finish

Now on Kaiser Health News blog, check out this collection of updates on enrollment developments from a variety of states: "Last minute health insurance shoppers nationwide turned up in record numbers online Monday, and they also showed up in person at clinics, county health departments and libraries to sign up for Obamacare on the last official day of open enrollment. Here are dispatches from public radio reporters in Ohio, Pennsylvania and Houston — three of the 36 states that are using healthcare.gov — and Minnesota, which has one of the most troubled state-run marketplaces" (4/1).

In addition, Anna Gorman reports on enrollment information from California: “Uninsured Californians flocked to shopping malls, beauty salons, clinics and libraries Monday to meet the deadline for enrolling in health coverage. The website of the state-run insurance exchange, coveredca.com, was so inundated that officials directed some consumers who began online applications to return later to complete them. The state was seeing a ‘huge surge’ in last-minute applications, with more than 150,000 people signing up in the last week, Peter Lee, executive director of the exchange said Monday. More applications were started on Sunday than any other day since Oct. 1, when open enrollment began on the nation’s insurance exchanges” (Gorman, 4/1). Check out what else is on the blog.

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For A Family With Job-Based Insurance, Premium Subsidies Fall Far Short Of Promises

Writing for Kaiser Health News, Kathie Platt explains her family’s first-hand experience with health insurance: "On Monday, the first open enrollment period for the new Affordable Care Act will close, and the opportunity to sign up for health insurance will not reopen again until November. For our family, President Barack Obama’s promise to make health insurance 'affordable and available to every single American" has not come true'" (Platt, 3/31). Read the story.

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Political Cartoon: 'No Fertilizer Needed?'

Kaiser Health News provides a fresh take on health policy developments with "No Fertilizer Needed?" by Dave Granlund.

And here's today's health policy haiku:

TRACKING THE TALLY

Numbers are starting
To come in… 7 million?
But it’s April 1.
-Anonymous

If you have a health policy haiku to share, please send it to us at http://www.kaiserhealthnews.org/ContactUs.aspx and let us know if you want to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

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Health Reform

Dust Settles As First Enrollment Period Comes To A Close

Though March 31 is increasingly viewed as a somewhat soft deadline, it's come and gone amidst last-day technical troubles. In its wake, lots of analysis and speculation about where the ultimate tally -- now estimated to have topped 7 million -- may fall, as well as how many of those new enrollees were previously uninsured and how many will pay their premiums.  

The Associated Press/Washington Post: Deadline Brings High Interest For Health Insurance
The last-minute rush was expected to significantly boost the number of Americans gaining coverage under the new law, and government officials told The Associated Press late Monday that they were on track to sign up more than 7 million Americans for health insurance by the deadline. But the months ahead will show whether the Affordable Care Act will meet its mandate to provide affordable health care coverage or whether high deductibles, paperwork snags and narrow physician networks make it a bust (4/1).

The Wall Street Journal’s Washington Wire: Obama Sees Health-Care Sign-Ups Nearing 7 Million
Last Thursday, the White House announced that more than six million people had signed up for private health coverage through state and federal insurance exchanges. That figure surpassed the nonpartisan Congressional Budget Office’s revised estimate that six million people would enroll, down from its initial forecast of seven million. Monday is the final day of enrollment under the Affordable Care Act. If an insufficient number of people sign up, or not the right mix, the law won’t work effectively because insurers may end up with too few healthier members to offset the costs of less-healthy enrollees (Favole, 3/31).

Politico: Obamacare Enrollment Period Ends With Massive Surge
The first open enrollment season of Obamacare ended at midnight Monday, a day that saw millions of Americans click onto Obamacare sign-up portals, dial into call centers and stand in long lines at assistance sites nationwide. The huge surge made it increasingly likely that enrollment would hit 7 million, the finish line that seemed out of reach during much of the often rocky six-month period. Shortly after 10 p.m., the Associated Press cited two sources that said sign-ups were “on track” to hit 7 million. Administration officials wouldn’t confirm the number but said that signs were pointing in that direction (Kenen and Cheney, 4/1).

The Wall Street Journal: New Technical Woes Hobble Health-Insurance Sign-Ups At Zero Hour
New problems in the federal health-insurance website stymied some of the hundreds of thousands of Americans trying to sign up at the last minute, prompting health plans and officials to brace for the complex task of enrolling people after Monday's official deadline. The HealthCare.gov site for 36 states that have about 33 million uninsured people went down shortly after midnight Sunday and remained unusable until about 7:45 a.m. EDT Monday, a person familiar with the matter said. It was hit by a second problem around noon EDT that prevented new users from creating accounts, while some people who already had accounts were unable to log in, this person said (Ante and Radnofsky, 3/31).

The New York Times: Health Website Failures Impede Signup Surge As Deadline Nears
A frenzied last-minute scramble to sign up for health insurance overloaded phone lines and temporarily overwhelmed the website of the federal marketplace on Monday, as hundreds of thousands of people around the country raced to beat the deadline to obtain coverage under the Affordable Care Act (Pear, 3/31).

The Washington Post: Healthcare.gov Stumbles On Deadline Day As Consumers Race To Sign Up For Insurance
The first six-month window for Americans to gain health insurance under the Affordable Care Act closed on Monday with large numbers of consumers speeding to get coverage at the last minute. Some of them encountered obstacles as HealthCare.gov, the main enrollment Web site, faltered on and off throughout the day (Goldstein and Sun, 3/31).

NPR: Cause For Hope And Frustration In the Shadow Of ACA Deadline
As the Affordable Care Act's midnight deadline draws near, there has been a surge in last-minute signups. The heavy traffic has caused both glitches in the website and optimism from some forecasters (Horsley, 3/31).

The New York Times: Last-Day Rush Causes Another Malfunction Of HealthCare.gov
For a second time on Monday, the federal website where consumers can sign up for medical coverage under President Obama’s health care law unexpectedly stopped taking applications. It is the last day of open enrollment for the year (Joachim, 3/31).

Reuters: Obamacare Website Stalls A Bit Before Enrollment Deadline
The federal website for U.S. consumers to enroll in private health insurance under Obamacare ran into problems twice on Monday because of a surge of people trying to access the site hours before a midnight deadline to sign up for coverage. Technical issues that barred access to HealthCare.gov for several hours throughout the day underscored the frantic last-minute pace of an enrollment process that could determine the ultimate success or failure of the healthcare law that represents President Barack Obama's domestic policy achievement (Morgan, 4/1).

McClatchy: White House Dismisses Senator’s Allegation That Administration ‘Cooked The Books’ On Obamacare
The White House on Monday dismissed a Republican senator’s accusation that the Obama administration was “cooking the books” by inflating the number of Americans who’ve enrolled for health care under the Affordable Care Act. Wyoming Sen. John Barrasso, R-Wyo., said on Fox News Sunday that he didn’t believe the enrollment numbers released by the administration. "I think they're cooking the books on this," said Barrasso, an orthopedic surgeon. At a briefing with reporters on Monday, White House spokesman Jay Carney dismissed Barasso’s allegation, along with the comments of other critics of the law (Wise, 3/31).

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Enrollment Dramas Ripple Through The States

As the health overhaul's first open enrollment period drew to a close, states experienced triumphs as well as tribulations -- whether they were running their own websites or using the federal exchange. News outlets offer updates from California, Florida, Maryland, Minnesota, Oregon, Wisconsin and Kansas. 

Los Angeles Times: California Gives Further Reprieve For Obamacare Sign-Ups
Overrun by last-minute demand for Obamacare coverage, California gave many consumers until April 15 to enroll as thousands of people across the nation endured long lines and website troubles. Despite the problems, the late surge in sign-ups was a substantial boost to President Obama's signature law, particularly after such a disastrous launch in October (Terhune, Levey and Karlamangla, 3/31).

Kaiser Health News: Capsules: Healthcare.gov Woes Frustrate In-Person Helpers Around The Country
Last minute health insurance shoppers nationwide turned up in record numbers online Monday, and they also showed up in person at clinics, county health departments and libraries to sign up for Obamacare on the last official day of open enrollment. Here are dispatches from public radio reporters in Ohio, Pennsylvania and Houston — three of the 36 states that are using healthcare.gov — and Minnesota, which has one of the most troubled state-run marketplaces (4/1).

Kaiser Health News: Capsules: For California’s Uninsured, A Rush To The Finish
Uninsured Californians flocked to shopping malls, beauty salons, clinics and libraries Monday to meet the deadline for enrolling in health coverage. The website of the state-run insurance exchange, coveredca.com, was so inundated that officials directed some consumers who began online applications to return later to complete them. The state was seeing a ‘huge surge’ in last-minute applications, with more than 150,000 people signing up in the last week, Peter Lee, executive director of the exchange said Monday. More applications were started on Sunday than any other day since Oct. 1, when open enrollment began on the nation’s insurance exchanges (Gorman, 4/1).

The Sacramento Bee: Californians Sprint To Beat Health Insurance Sign-Up Deadline
Laura and Jose Gomez of Sacramento say they went their entire lives without health insurance. As the federal deadline approached Monday, the parents of three were overcome with emotion after enrolling for coverage for the first time. “We feel really good right now,” said a smiling Laura Gomez, 36, as she posed for photographs at a sign-up event hosted by a health care workers union in midtown Sacramento. She had just selected a plan through Covered California, the state’s new exchange. The couple, who expect to pay about $300 a month after federal subsidies, were among hundreds of thousands of people nationwide rushing to beat the midnight cutoff for the health insurance overhaul (Cadelago, 3/31).

The San Jose Mercury News: Covered California: Applicants Flood Health Insurance Exchanges In State
In a flood of last-minute sign-ups, hundreds of thousands of Americans rushed to apply for health insurance Monday, but deadline day for President Barack Obama's overhaul brought long, frustrating waits and a new spate of website ills. It happened early and often in California, which leads the nation in enrollments since Oct. 1 and hit 1.2 million enrollees by 2 a.m. By early evening, however, insurance exchange officials were forced to raise a white flag after the website repeatedly stalled from the crush of applicants. So overwhelming were the numbers of applicants that Covered California announced the exchange would now honor any attempt to sign up before the midnight deadline, even if a person could not get to a certain stage to verify that online (Seipel, 3/31).

Health News Florida: Crunch Time Hits Uninsured, Website
Al Lopez Park in Tampa is normally an oasis of serenity on a Monday. But on the last day of open-enrollment for health insurance under the Affordable Care Act, the community center was crowded, noisy, and stressful. Hundreds of procrastinators came seeking help from navigators (Gentry, 4/1).

The Baltimore Sun: Md's Bumpy Health Insurance Enrollment Period Ends
As consumers rushed to sign up for insurance on the last day of open enrollment under the Affordable Care Act, Maryland's health exchange website slowed to a crawl and all circuits were busy at the call center. That worsened a bottleneck of consumers who have tried for months to overcome glitches on the troubled website to be able to buy a private plan or sign up for Medicaid (Cohn and Walker, 3/31).

NBC News: The Longest Wait: Maryland Residents Wait In Line For Last-Ditch Obamacare
The line started just after 6 a.m. Monday outside the Montgomery County, Md., health department office in Silver Spring, as people trying to get health insurance joined the 11th-hour deluge on the last day to sign up under the Affordable Care Act. There's a huge last-minute crush of people signing on nationally as Healthcare.gov froze under the pressure, but nowhere like in Maryland, where the state-run exchange has been a failure from the beginning, thwarting all but the most determined comers. Maryland officials embraced Obamacare with enthusiasm, and were among the first to announce they would run their own exchange. But it went downhill from there (Fox, 3/31).

The Washington Post: Gansler Renews Attack On Brown’s Handling Of Maryland Health Insurance Exchange
The latest development in Maryland’s race for governor was something you don’t see every day: A candidate handing out his rival’s campaign literature. But Attorney General Douglas F. Gansler (D) wanted to make sure reporters got a good look at the brochure of Lt. Gov. Anthony G. Brown (D) on Monday so that he could properly attack it. In the glossy piece, Brown says that under his leadership, Maryland is “leading the nation in implementing President Obama’s health reform law” (Wagner, 3/31).

The Associated Press/Washington Post: Md. Board To Discuss Future Of Health Exchange
A Maryland board is scheduled to discuss what the state will do about its badly flawed health exchange website. The Maryland Health Benefit Exchange Board of Trustees has a 5 p.m. meeting in Baltimore on Tuesday, when it could officially decide to use technology from another state that has had a more successful exchange rollout. Maryland is one of 14 states with its own exchange (4/1).

The Star Tribune: Time’s Up: It Was A Mad Dash To Beat MNsure’s Enrollment Deadline
Minnesotans rushed to sign up for health insurance Monday, as open enrollment ended and consumers closed the first, eventful chapter in an ambitious national experiment to transform health coverage. The result: long wait times at the state’s MNsure call center and a bogged-down website that prevented some people from completing enrollment. Problems arose around noon at the federal Internet hub, which helps identify Minnesotans who are eligible for public programs and tax credits. The glitches lasted most of the day and resulted in “intermittent” problems for consumers using the MNsure site, state officials said (Crosby and Dullinger, 4/1).

Minnesota Public Radio: Demand Strains MNsure Phone System On Signup Deadline Day
Monday was the deadline for the uninsured to obtain health coverage for this year — and to avoid a tax penalty. With that in mind, officials with MNsure, the agency that runs Minnesota's online insurance marketplace, expected to be swamped. Procrastinators didn't disappoint them, as MNsure's call center fielded a record 25,000 calls. The website also was slowed by high volume. But it did not buckle as it did Dec. 31, the last big deadline for enrolling in coverage (Stawicki, 4/1).

Minnesota Public Radio: Navigator Talks About The Ups And Downs Of MNSure Roll-Out
Many navigators work for non-profit organizations and they have experienced the ups and downs of MNsure since the program rolled out last fall. MPR's Phil Picardi spoke with Rebecca Lozano, who's the Outreach Program Manager at Portico Health-net in St. Paul. She is one of several trained MNsure navigators there (Picardi, 3/31).

The Oregonian: Cover Oregon Health Insurance Exchange Notches Another Political Casualty With IT Director's Resignation
Aaron Karjala, the top information-technology manager for the Cover Oregon health insurance exchange, resigned Monday, adding to the list of the exchange's political casualties. Kitzhaber on March 20 announced he'd accepted the resignation of his top healthcare administrator, Bruce Goldberg, and also urged the appointed board of Cover Oregon to remove Karjala as well as Triz delaRosa, the exchange's chief operating officer. Oregon's exchange remains the only one in the country that does not let the public self-enroll for health coverage in a single-sitting, despite more than $200 million spent so far (Budnick, 3/31).

The Oregonian: Cover Oregon Health Insurance Exchange Drops Bid To Keep Legislative Oversight Meetings Secret
For the first time, the public will be able to listen to meetings of the Cover Oregon Legislative Oversight Committee after health exchange staff barred reporters from attending a meeting last week. Thanks to a change of heart by Cover Oregon, members of the public can now tune in online or call a toll-free number to listen to the meeting, which consists of four state lawmakers speaking with Cover Oregon staff. Its next meeting starts at 10 a.m. Tuesday, April 1. The oversight committee was set up by legislation authorizing the exchange (Budnick, 3/31).

The Oregonian: Survivors Of Domestic Violence, Who Are Married, Have Until Late May To Sign Up For Health Insurance Coverage
The current deadline for open enrollment for healthcare insurance coverage in Oregon was extended through April 30. However, for survivors of domestic violence who are also married, this open enrollment period is extending to May 31. The U.S. Department of Health and Human Services recognized "the unique difficulties that these survivors of domestic violence face when attempting to file taxes,'' according to the Oregon Coalition against Domestic & Sexual Violence (Bernstein, 3/31).

The Milwaukee Journal Sentinel: Affordable Care Act's Enrollment Period Ends, For Most People
The open enrollment period to sign up for a health insurance plan through the Affordable Care Act's marketplaces officially ended on Monday, but as with many of the law's deadlines, there were some caveats. People who have started an application on the healthcare.gov website but were unable to complete the process still will be able to enroll. And adults in Wisconsin previously covered by BadgerCare Plus who are being moved to subsidized health plans sold through the federal marketplace have until May 31 to sign up. As expected, the number of people signing up for coverage jumped in the past week, and particularly in the past few days (Boulton, 3/31). 

The Kansas City Star: Affordable Care Act Endures Tense Deadline Day 
Tearful. Testy. Thunderstruck. And profoundly grateful. Monday’s last-minute applicants for 2014 coverage under the Affordable Care Act ran the emotional gamut as hundreds of thousands of people nationally flooded the balky system to buy health insurance (Stafford and Campbell, 3/31).

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Looking Forward: How To Judge The Rollout; Challenges To Come

Following the official end of the enrollment season, some outlets turn their attention to the upcoming issues surrounding the law.

Propublica: Judging Obamacare: How Do We Know If It's A Success Or Failure? 
One day very soon, the focus on Obamacare will turn from signing up new enrollees to quantifying the law's success — or failure. ... Dr. David Blumenthal of the Commonwealth Fund recently told me that any attempt to review the success of the law must go beyond those who sign up for coverage on the exchanges. It should include those who gained coverage through the expansion of state Medicaid programs for the poor, as well as young adults who are now able to stay on their parents’ health plans because of the law (Ornstein, 3/31).

The Associated Press: Q&A: Status Update As Health Law Marks A Milestone
Like so much about the government's health care overhaul, Monday's deadline to sign up for coverage in 2014 didn't turn out quite as planned: Many people still are eligible for extensions that will let them enroll. The change of plans shouldn't come as much of a surprise, given the disastrous HealthCare.gov rollout last fall, the mass policy cancellation notices that shocked even the president, and other set-in-law deadlines that turned out not to be not so firm. ... It's time for a status report as the law marks a milestone, although no one’s quite sure how to define success (Benac, 4/1).

CBS News: Obamacare Enrollment Is Over -- Now What?
Open enrollment on the Affordable Care Act marketplaces closed on Monday night, bringing an end to the most turbulent part of the four-year-old law's history. The Obama administration is hailing the enrollment process as a success, but it will take time for the dust to settle -- we have yet to hear exactly how many people have benefited from the law, or what its impact on the insurance market will be. Furthermore, the enrollment process isn't over for everyone. Here's a look at where the law stands now (Condon, 4/1).

Reuters: Obamacare Hits Milestone, But Detours Ahead For U.S. Health Law 
President Barack Obama's embattled U.S. healthcare law, having survived a rollout marred by technology failures, reaches a milestone on Monday with the end of its first enrollment wave, and with the administration likely to come close to its goal of signing up 7 million people in private health insurance. But as 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 (Morgan, 3/31).

The Wall Street Journal’s Washington Wire: Fights Over The Health Law Aren't Over
The rollout of the government website for signing up for insurance was a disaster. ... But now that the website has seemingly delivered close to – if not more than – the seven million enrollees needed by the deadline, the White House can breathe a little easier. Not for long, however. ... Now critics of the law will turn their focus on the penalties for those who didn’t sign up and any trouble with coverage or even the most modest increase in premiums. In that sense it's a front the White House – and any Democrat up for election this November – will have to keep fighting (Lee, 4/1).

Bloomberg: Obamacare Sign-Up Ends As Began With Flaws, New Challenge 
The first phase of Obamacare ended yesterday much the same way it began: The federal website drew 1.2 million visitors by noon and crashed at least twice. As the Patient Protection and Affordable Care Act moves into a new stage today, when most consumers must be insured or pay a fine, an estimated 45 million Americans remain uncovered, a continuing burden for medical providers and governments, and a constant target for Republicans seeking to upend President Barack Obama’s signature initiative in the midterm election (Chen, Talev and Wayne, 4/1).

CQ HealthBeat: End Of Open Enrollment Won't Yield Quick Answers On Uninsured Rate
As heavy traffic of up to 125,000 applicants at a time on the federal health exchange website sent users into a virtual waiting room on the last day of open enrollment, policy analysts began to speculate about how much the last-minute sign-ups would reduce the uninsured rate, and whether the trend can be sustained. Recent surveys, statements by state officials and anecdotal evidence suggest that the percentage of people without health coverage is inching downward (Adams, 3/31).

CBS News: So You Missed The Obamacare Deadline? Here's What To Do
You may be in for a rude awakening today if you're uninsured and missed yesterday's enrollment deadline for Obamacare coverage in 2014. Of course, like everything having to do with the government, there are some loopholes and ways to pick up coverage this year. But for many uninsured Americans who dragged their feet or opted against buying coverage, the decision could prove costly not only this year, but next (Picchi, 4/1).

Fox News: ObamaCare Sign-Ups Reportedly On Track To Hit 7 Million – But Will They Pay?
On the last day to sign up for ObamaCare, the health care overhaul was reportedly on track to sign up more than 7 million Americans for insurance coverage, though the number of enrollees who have paid for their insurance premiums is still unclear.  Government officials confirmed the 7 million target to The Associated Press late Monday, speaking on condition of anonymity because they were not authorized to discuss the matter ahead of an official announcement (4/1).

Fox News: Need An ObamaCare Enrollment Extension? Here’s What To Do
Last week, the Department of Health and Human Services announced a temporary reprieve for those who still have to sign up for health insurance on the federal exchange. Those having issues completing enrollment by March 31 can check a box on Healthcare.gov that indicates they in need of an extension. The Washington Post was first to report of the new feature on the federal exchange. The amount of extra time people will have to enroll is still not clear, but it’s important consumers that are requesting the leeway understand checking the box doesn’t mean they have coverage, and it is still on the individual to complete the process (Rogers, 3/31).

PBS News: At Enrollment Deadline, Affordability May Be Real Test Of Affordable Care Act
The crush of last-minute signups for health insurance at HealthCare.gov drove the website out of service for part of the day. Some applicants turned to in-person help centers around the country to enroll. Health policy analyst Susan Dentzer and Mary Agnes Carey of Kaiser Health News join Judy Woodruff to discuss what’s at stake for the Affordable Care Act (Woodruff, 3/31).

McClatchy: Many Newly Insured Still Face Health Coverage Upheaval
[New] research estimates that about half of those with subsidized coverage obtained from federal or state marketplaces will lose it within a year because of changes in their incomes or other family circumstances, such as divorce, relocation or the births of children. The same is true for about half of new Medicaid recipients, who are likely to lose program eligibility at some point over the next year for a variety of reasons, said Benjamin Sommers, an assistant professor of health policy and economics at the Harvard School of Public Health. ... Along with being a bookkeeping headache for insurers and Medicaid administrators, churning undermines the continuity of care between doctors and patients by causing patients to miss treatments and sometimes seek new caregivers. It also has a financial impact (Pugh, 3/31).

The Washington Post’s Wonkblog: How The Administration Could Miss A CBO Obamacare Target
The large media focus in the first Obamacare enrollment period has been on whether the administration would hit CBO targets for exchange enrollment. The CBO has said it expects 6 million people to enroll through exchanges in 2014 -- more than 6 million have signed up, so that target looks in reach if enough people pay their premiums. But about one-third of those exchange signups were previously uninsured people, according to the report findings. It also found about 4.5 million adults had newly enrolled in Medicaid; 9 million people, most who were previously insured, have signed up for individual plans off the exchanges; and fewer than 1 million people who had their coverage cancelled remain uninsured (Millman, 3/31).

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Poll: Obamacare Hits A New High -- Especially Among Democrats

At 49 percent public support, the health law reached a new high in the latest ABC/Washington Post poll, while criticism of Barack Obama's handling of the law's rollout- although still substantial- has eased. However, Republicans believe that they can use voter frustration over the measure in the upcoming election. 

The Washington Post: Democrats’ Support For Obamacare Surges
Democrats are rallying back behind the 2010 health-care law and boosting President Obama's ratings for handling the law's rollout, according to a new Washington Post-ABC News poll (Clement and Craighill, 3/31).

ABC News: At 49 Percent Support, Obamacare Hits A High
Public support for the Affordable Care Act narrowly notched a new high in the latest ABC News/Washington Post poll, while criticism of Barack Obama’s handling of the law’s rollout – although still substantial – has eased from its peak last fall. Views hardly are enthusiastic: With the year’s sign-up deadline upon us, Americans split on Obamacare, 49 percent in support, 48 percent opposed. But that compares with a 40-57 percent negative rating after the initial failure of the federal enrollment website last November (Langer, 3/31).

The New York Times: ‘Imperial Presidency’ Becomes A Rallying Cry For Republicans
The phrase is part of an effort by Republicans to nationalize a series of concerns about the Obama White House, and the role of government, into a pithy, compelling expression. The “imperial presidency” mantra not only captures existing voter frustration over the Affordable Care Act and turns it, Republicans believe, into a broader referendum on the president’s entire administration, but also reflects an underlying conservative philosophy about the appropriate role of government (Parker, 3/31).

CNN: Republicans Hit A Nerve When It Comes To Obamacare
Republicans are going all in, hoping that the payout is big. Like control of the Senate, big. Their big bet: Obamacare. The deadline to enroll in the Affordable Care Act for the year has come and gone. The Obama administration is touting the enrollment numbers as a successful first year, but Republicans think voter anger over the law is here to stay. And so, Republicans running for Congress and Senate continue to make it central to their campaign (Caldwell, 4/1).

Los Angeles Times: Democratic Turnout Seen As Key To Party’s Retaining Senate Control
Because of the states up for grabs this year, "we're playing defense, they're playing offense," said Joel Benenson, Obama's chief pollster. Moreover, anger at the party in power has proved a powerful motivating force to get people to the polls. With Obama in the White House and his signature healthcare law a rallying point for conservatives, Republicans can count on their core voters showing up. A recent NBC/Wall St. Journal poll found Republicans significantly more likely than Democrats to express high interest in the fall election (Memoli and Lauter, 3/31).

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Capitol Hill Watch

For 17th Time In 11 Years, Congress Passes 'Doc Fix' Measure

The legislation gives doctors temporary relief from a flawed Medicare payment formula but fails to revamp it because of disagreements over how to pay for the change. Meanwhile, House Republicans are expected to unveil a budget that resurrects their proposal to privatize Medicare but in a more politically palatable way.

The Wall Street Journal: GOP Budget Expected To Expand Medicare Proposal
House Republicans are expected to unveil a budget Tuesday that seeks to make their proposed revamp of Medicare more politically palatable, while at the same time moving to expand its reach. House Budget Committee Chairman Paul Ryan (R., Wis.) is expected to unveil a budget that would give people age 55 and younger a choice between keeping traditional government-run Medicare or receiving a subsidy to buy private health insurance, lawmakers said (Peterson, 3/31).

The Washington Post: For 17th Time In 11 Years, Congress Delays Medicare Reimbursement Cuts As Senate Passes ‘Doc Fix’
The Senate voted Monday evening to pass a so-called "doc fix" bill approved last week by the House, the 17th time that Congress has acted since 2003 to temporarily delay cuts to doctor reimbursements under Medicare due to a structural problem in the formula used to determine funding levels. Senators voted 64 to 35 to pass the bill, which delays the cuts for one year in a vote that came after House Republicans used a rare voice-vote to get the measure through the lower chamber due to uncertainty over whether the bill had sufficient support to pass (Lowery, 3/31).

The Wall Street Journal: Senate Passes 'Doc Fix' Legislation
The Senate on Monday passed a bill preventing Medicare-payment cuts to physicians for 12 months, sending the measure to the White House for President Barack Obama's expected signature. The "doc fix" legislation, already passed by the House last week, cleared the Senate on a 64-35 vote, with 46 Democrats, 16 Republicans and two Independents supporting the plan (Peterson, 3/31).

The Associated Press/Washington Post: Obama Gets Bill Giving Docs Temporary Medicare Fix
Congress once again has given doctors temporary relief from a flawed Medicare payment formula that threatened them with a 24 percent cut in their fees. A 64-35 Senate vote Monday cleared the measure for President Barack Obama’s signature, which was expected as early as Tuesday (4/1).

Politico: Senate Backs One-Year ‘Doc Fix’ Patch
The latest “doc fix” prevents a 24 percent cut in physician pay and comes after a battle on Capitol Hill over whether to permanently repeal the formula — and the politically dicey question of how to pay for that — or patch it for another year. The bill also delays for a year the ICD-10 implementation of new medical codes (Haberkorn, 3/31).

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Michigan Rep. Dave Camp Won't Seek Re-Election

House Ways and Means Committee Chairman Dave Camp, R-Mich, announced on Monday that he will retire in 2014, ending a 12-term congressional career. Camp was a powerful voice in federal health, welfare , trade policy and tax reform.

The Washington Post: Dave Camp To Retire After His Current Term
Camp said in a statement that his decision "was reached after much consideration and discussion with my family. Serving in Congress is the great honor of my professional life. I am deeply grateful to the people of the 4th Congressional District for placing their trust in me. Over the years, their unwavering support has been a source of strength, purpose and inspiration. During the next nine months, I will redouble my efforts to grow our economy and expand opportunity for every American by fixing our broken tax code, permanently solving physician payments for seniors, strengthening the social safety net and finding new markets for U.S. goods and services" (O’Keefe and Kane, 3/31).

The Wall Street Journal: Michigan Rep. Dave Camp Won't Seek Re-election In 2014
House Ways and Means Committee Chairman Dave Camp (R., Mich.) announced Monday that he won't seek re-election in 2014, ending a 12-term congressional career that made him a leading proponent of tax reform and a powerful voice in federal health, welfare and trade policy. The announcement turns the spotlight on what was already an expected change of leadership at the powerful tax-writing committee. Rep. Paul Ryan (R., Wis.) has already been seen as his likely successor as the panel's chairman after this year, when Mr. Camp's chairmanship expires under the GOP's term-limit rules. … Even if the plan dies this year, it could help frame future debates over the issue. But while Mr. Ryan has expressed enthusiasm for the Camp plan, he is considered more likely as chairman to give priority to overhauling entitlement programs such as Medicare and Medicaid (Hook and McKinnon, 3/31).

Politico: Dave Camp Won’t Seek Reelection
He is the 23rd House lawmaker to announce he or she will leave this Congress. Other prominent Republicans calling it quits include Natural Resources Chairman Doc Hastings of Washington state, Armed Services Chairman Buck McKeon of California and Intelligence Chairman Mike Rogers of Michigan. Senior Democrats forgoing reelection include Reps. Henry Waxman and George Miller of California and John Dingell of Michigan (Sherman and Bresnahan, 3/31).

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Health Care Marketplace

Expensive Hepatitis Drug Draws Huge Sales

The demand for Gilead Sciences' Sovaldi, which costs $1,000 a pill, indicates how hard it is for insurers to curb the use of life-saving medicines. Meanwhile Humana names a former Goldman Sachs executive as finance chief.

The Wall Street Journal: Sales Soar For Pricey Hepatitis Drug Sovaldi
A hepatitis C pill from Gilead Sciences Inc. that costs $1,000 a day is on track to notch among the biggest sales ever for the first year of a newly approved drug, showing just how hard it is for insurers to curb the use of pricey life-saving medicines (Rockoff, 3/31).

In other marketplace news -

The Wall Street Journal: Humana Names Brian Kane Finance Chief
Brian Kane, 41 years old, will join Humana after spending nearly 17 years at Goldman Sachs, where he was responsible for leading financing transactions for a number of companies across multiple industries. Mr. Kane's health- insurance work has included coverage of the national and government-focused managed care organizations (Kell, 3/31).

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State Watch

State Roundup: Federal Judge Lets Ariz. Abortion Rules Stand; Mich. Medicaid Expands

News organizations report on health care developments in Arizona, California, Michigan, Minnesota and Virginia.

The New York Times: Judge Won’t Block Rules On Abortion Drug In Arizona
A federal judge in Tucson has refused to block some of the strictest rules in the nation on the use of abortion drugs. The rules, which were approved by the Arizona Legislature in 2012 and will take effect on Tuesday, restrict the use of a medication to induce abortions during the early stages of pregnancy to the first seven weeks (Schwartz, 3/31).

The Associated Press: Judge Won't Block New Arizona Abortion Drug Rules
The most stringent restrictions in the nation on the use of abortion drugs were allowed to take effect Tuesday by a federal judge’s ruling in the latest in a series of court fights over Arizona abortion laws. U.S. District Judge David C. Bury on Monday refused to stop the new rules just hours before they were to take effect. Opponents of the rules said they would continue to challenge the restrictions in court (Galvan, 4/1).

Detroit Free Press: Michigan's Expanded Medicaid For 470,000 Recipients Kicks Off Today
The long-awaited Healthy Michigan plan, the state’s unique version of expanded Medicaid, opens today .... Healthy Michigan, accessible through www.HealthyMichiganPlan.org, extends publicly funded health care coverage to 470,000 Michiganders. The portal, www.michigan.gov/healthymichiganplan, was scheduled to launch at 12:01 a.m. (Erb, 4/1).

MLive: 6 Things To Know As Michigan's Expanded Medicaid Program Launches Today
Enrollment begins today for Michigan's expanded Medicaid program. State officials say they're ready to handle a "large number of people" applying for the health insurance program that's available to some 477,000 low-income Michiganders. The plan, called Healthy Michigan, is expected to cover 320,000 people in the first year (Anders, 4/1).

The Washington Post: Creigh Deeds Vows To Keep Working On Virginia's Mental Health System
Referring to newly passed reforms as "modest," state Sen. Creigh Deeds said Monday that he plans to keep the pressure on his colleagues to fix Virginia’s long-troubled mental health system. "My scars aren't going away," Deeds (D-Bath) told an audience at the National Press Club on Monday. "Believe me, I’m not done" (Shin, 3/31).

The Associated Press: Senator: 'Real Work Lies Ahead' On Mental Health
During this year’s legislative session, Deeds, who was the Virginia Democratic nominee during the 2009 gubernatorial campaign, helped push through several changes to the state’s current mental health system. Most notably, the General Assembly approved legislation that extends the time allotted for finding a bed for those under an emergency custody order to 12 hours. If no private beds can be found after eight hours, a state hospital will now be required to admit (Frommer, 3/31).

MinnPost: How Do Shuttling Snowbirds Handle Their Health Care?
After his wife died, Wade Dickey bought a house in Florida. A native Minnesotan, he spends each spring and summer in his home in New Brighton. And every fall, he heads south for the winter. ... Considering that many people at that life stage experience significant health problems, the snowbird lifestyle poses a pressing question: How do people who potentially face a number of health issues tend their care while living in two places? (Harvey, 3/31).

The California Health Report: Charitable Program Helps To Fill The Dental Care Gap
When the first storm of the season hit California’s Central Coast, the rain was no deterrent to the more than 300 people who showed up at Blanco Circle Dental Care in Salinas, seeking free treatment. They starting arriving the night before—some sleeping in cars, some sleeping in tents—waiting out the frigid February downpour in hopes of getting their teeth fixed. "There is no safety net for dental care in Monterey County," said Dr. Gary Klugman, DDS, owner of Blanco Circle and organizer of the event. After volunteering at a Dentistry from the Heart event in Santa Rosa last year, Klugman was so touched that he decided to bring the program to Salinas (Dayton, 4/1).

The California Health Report: Medi-Cal Doctors Have Yet To See Pay Boost Required By Obamacare
Everyday George Ma waits for the money the state owes him. The internist, who sees some of Los Angeles' most destitute residents and receives meager reimbursement, was supposed to get a pay boost beginning in January 2013 as part of the Affordable Care Act. But the state Department of Health Care Services and the managed-care plans it contracts with have been slow to turn over the tens of millions owed to California doctors, including Ma. The result is that the federally mandated pay boost is not having its intended effect of encouraging more primary-care doctors to accept low-income patients or accept them in larger numbers (Guzik, 3/31).

The San Francisco Chronicle: Supervisor Campos Seeks Overhaul Of S.F. Health Care Program
San Francisco Supervisor David Campos on Tuesday will introduce legislation to overhaul the city's universal health care program in an attempt to ensure that people who can't afford insurance on the state exchange can remain in the low-cost program and that employers cannot reclaim employees' unspent health care funds. The city's Healthy San Francisco program, created in 2007 as the first of its kind in the country, is not considered insurance because it doesn't cover participants when they travel outside city borders. That means it doesn't satisfy the requirements of the federal Affordable Care Act, which mandated that individuals have health insurance as of Monday or face a tax penalty (Knight, 3/31).

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Editorials and Opinions

Viewpoints: 'Thrice-Buried' Obamacare 'Looks Very Much Alive;' Ted Cruz 'Gets An Earful'

The New York Times: Obamacare Lives!
Back when rate shock, website problems and lagging enrollment were threatening to unravel the new health care law before it fully took effect, I concluded a column on Obamacare's repeated near-death experiences with the following warning to conservatives: ...  What isn't killed outright grows stronger the longer it's embedded in the federal apparatus, gaining constituents and interest-group support just by virtue of its existence even if it doesn't work out the way it was designed. ... the serious right-of-center alternatives to Obamacare have always included policies to expand coverage, and with a coverage expansion accomplished, Republicans may find themselves effectively forced in a more serious direction. ... wherever they go and whatever they do, they will have to deal with the reality that Obamacare, thrice-buried, looks very much alive (Ross Douthat,  3/31).

The New York Times: Obamacare, The Unknown Ideal
It's not my ideal; in a better world I'd call for single-payer, and a significant role for the government in directly providing care. But Ross Douthat, in the course of realistically warning his fellow conservatives that Obamacare doesn't seem to be collapsing, goes on to tell them that they're going to have to come up with a serious alternative. But Obamacare IS the conservative alternative, and not just because it was originally devised at the Heritage Foundation (Paul Krugman, 3/31).

Los Angeles Times: Ted Cruz Asks His Facebook Friends About Obamacare, Gets An Earful
The Olympiad of officials and institutions reaching out to the public via social media and not hearing what they expected has a new champion: Sen. Ted Cruz (R-Texas). Back on March 24, Cruz posted an informal survey on his verified senatorial Facebook page. It read: "Quick poll: Obamacare was signed into law four years ago yesterday. Are you better off now than you were then? Comment with YES or NO!" It's probably fair to say that he didn't expect the tsunami of "YES" votes that have shown up on the page among the 47,000 that Facebook says have been posted (Michael Hiltzik, 3/31).

Los Angeles Times: Obamacare Numbers Coming In Huge: Here's A Guide To GOP Excuse-Making
Against all odds and expectations, enrollments in health plans qualified under the Affordable Care Act are surging Monday toward -- and maybe beyond -- the 7-million figure projected by the Congressional Budget Office before Oct. 1, when the open-enrollment period began. ... The surge is creating a big problem for the "train wreck" narrative of Republican opponents of the ACA, who have been holding out hope for Obamacare's utter failure. So the excuse-making has begun (Michael Hiltzik, 3/31).

Bloomberg: What Obamacare's Numbers Don't Tell Us
[It] has proved difficult -- to put it mildly -- to expand coverage to poor people in states that reject the law. Some states may well follow New Hampshire's lead, reversing their initial opposition to the expansion of Medicaid. But if the federal government's current strategy of exemptions and semantic dodges proves unequal to the task of gaining Obamacare purchase in states such as Texas or North Carolina, its architects will need to look for an alternative. Spending $1.3 trillion in health-care subsidies for the middle class while leaving many poorer Americans with no options threatens the moral basis for the whole undertaking (4/1).

Bloomberg: Kentucky Loves Its Insurance, Just Not Obamacare
Remember, however, that it isn't just in Kentucky that the words "Obamacare" or even "Affordable Care Act" are invisible to consumers; that's the case nationwide. And that omission doesn't reflect some sort of defensive reaction to bad polling. It's the way the law was designed to work. As a result, we have no idea how many of the almost 7 million who will have signed up through the exchanges will think of themselves as Obamacare consumers; how many of the 4 to 5 million newly eligible Medicaid sign-ups will think they are; or how many of the roughly 3 million 19 to 25 year-olds on their parents’ plans will think so (Jonathan Bernstein, 3/31).

Fox News: ObamaCare And America's Youth -- Why Lessons Of 2014 Will Last A Lifetime
Quite a few Millennials peeled off from the Obama coalition because they stood to the left of the president on the health care bill itself (preferring a single payer system or at least the "public option"), not to mention issues like Afghanistan and the NSA surveillance debate. These young people are not likely to vote Republican unless they are drawn to GOP candidates who stake out strongly civil libertarian positions on issues like surveillance. But their enthusiasm for mainstream Democrats is very much in question. I have never seen persuasive evidence that media outreach and celebrity appeals can change fundamental opinions about policy and politics. Obama’s visit to "Between Two Ferns" will not be the turning point in the administration’s efforts. So what should they do to get young people involved in health reform? (Peter Levine, 3/31).

CNN: 317 Million Reasons To Love Obamacare
More than 6 million Americans signed up for Obamacare before the March 31 deadline to get private health insurance through the Affordable Care Act exchanges. This is great news for the Obama administration. But there are millions more reasons to celebrate Obamacare. Actually, at the writing of this essay, there are more than 317 million reasons — because that's the population of the United States of America and every single one of us can benefit from health care reform. How? Here's a rundown by the numbers (Sally Kohn, 3/31). 

CNN: I Got A Better Deal Through Obamacare
I signed up for health care through the Affordable Care Act last week. I did so for one reason and one reason only: it was a good deal for my family. In fact, it was a better deal than we were getting before the ACA (Paul Begala, 3/31). 

The [Minneapolis] Star Tribune: Watching MNsure From The Inside Out
Having recently retired, I decided I wanted to be a part of the process of enrolling people in MNsure, the Minnesota version of the Affordable Care Act’s online health insurance exchanges. … I found two organizations that were looking for volunteers to help with outreach and enrollment. I began phone-banking and helping with open-enrollment events in October, and I did my last shift this past Saturday. Here is some of what I saw from the inside out of the first six months of Obamacare in Minnesota, as I followed the media's reporting of the disastrous rollout of the website access points. I do not dispute any of the coverage, but only want to give a different perspective, perhaps a bit closer to those who hoped to gain a level of health security through this historic legislation (Carol C. White, 3/31). 

On other health issues -

The Wall Street Journal: The Definition Of Insanity
Every time a mass shooting happens in the U.S.—Sandy Hook, Virginia Tech, Aurora—we have the same national discussion: Why can't we identify and treat the dangerously mentally ill before they kill? Here is one infuriating answer. Inside the U.S. Department of Health and Human Services sits an agency whose assignment since its creation in 1992 has been to reduce the impact of mental illness and target services to the "people most in need." Instead the Substance Abuse and Mental Health Services Administration, known as Samhsa, uses its $3.6 billion annual budget to undermine treatment for severe mental disorders (3/31). 

Bloomberg: The Real Problem With the 'Doc Fix'
As policy-making disgraces go, last week’s House of Representatives vote for a temporary "doc fix" to avoid a cut in Medicare payments to doctors is hard to beat: It's financed in part through accounting gimmicks, and the vote was so rushed that most members of Congress didn’t even realize it had been held. A permanent fix is offered as an alternative, and it would indeed be better, but this option, too, could be much stronger (Peter R. Orszag, 3/31).

Reuters: America Is Not Broke
That's where the Republican budget comes in. For the past few years, House Republicans have passed a budget that radically reduces support for healthcare, economic opportunity and a safety net for hard times. By claiming to address an urgent "debt crisis," it dismantles the social contract that Americans have made with their government for decades. These Republican budgets replaced Medicare with a voucher to help pay for health insurance. But that voucher would fail to keep up with the rising cost of healthcare, so those expenses would just shift from the government to senior citizens. Many elderly Americans would no longer be able to afford healthcare, which was why President Lyndon B. Johnson and Congress passed Medicare in the first place. Medicaid beneficiaries fare even worse (Harry Stein, 3/31).

Reuters: How Big Pharma Is Slowing Cancer Research
Even as scientists seek to bring new cancer treatments to market, however, drug patent issues are holding back some researchers. A major hurdle is in combination drug trials that test two or more therapies at once. Pharmaceutical companies often shy away from trials that have great potential, because the drugs may not generate profits if they are used together with a generic drug or a drug patented by a different company (Carlos Moreno, 3/31).

WBUR: Project Louise: The One Thing That Will Actually Make Me Exercise
It's hard to believe that I've been doing Project Louise for three months – one-quarter of this yearlong effort. In some ways it already feels like a year since I vowed to change my eating and exercise habits; in others I feel like a rank beginner. Here’s where it seems as if I’ve barely begun: creating a real, practical, sustainable exercise routine. As coach Allison Rimm wrote last week, I jumped in with both feet to starting the project, and I'm now starting to realize that this habit of quick, impulsive beginnings has been one of my lifelong obstacles to creating lasting change (Louise Kennedy, 3/31). 

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Lisa Gillespie
Shefali Luthra

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