Daily Health Policy Report

Tuesday, April 15, 2014

Last updated: Tue, Apr 15

KHN Original Reporting & Guest Opinion

Health Reform

Health Care Marketplace


State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Doctors Overlook Lucrative Procedures When Naming Unwise Treatments

Kaiser Health News staff writer Jordan Rau, working in collaboration with The Chicago Tribune, reports: “When America’s joint surgeons were challenged to come up with a list of unnecessary procedures in their field, their selections shared one thing: none significantly impacted their incomes. The American Academy of Orthopaedic Surgeons discouraged patients with joint pain from taking two types of dietary supplements, wearing custom shoe inserts or overusing wrist splints after carpal tunnel surgery. The surgeons also condemned an infrequently performed procedure where doctors wash a pained knee joint with saline” (Rau, 4/14). Read the story.

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Insuring Your Health: Abortion Coverage Details Hard To Find On Marketplace Plans

Kaiser Health News consumer columnist Michelle Andrews writes: "When it comes to coverage of abortion services in plans sold on the health insurance marketplaces, opponents and supporters of abortion rights are in complete agreement on one thing: Coverage details need to be clearer” (Andrews, 4/15). Read the column.

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Focus On Marketplace Enrollment Overlooks Millions Who Bought Private Insurance

APRN’s Annie Feidt, working in partnership with Kaiser Health News and NPR, reports: “Want to know how many people have signed up for private insurance under Obamacare? Like the health care law itself, the answer is complicated. The Obama administration is tracking the number of plans purchased on HealthCare.gov and on the state exchanges. ... But often overlooked is that enrollment in private health plans outside the marketplaces is also booming. The federal government hasn’t been counting the number of people who buy new plans directly from insurance carriers -- and that number could be substantial" (Feidt, 4/15). Read the story.

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Patients Often Win If They Appeal A Denied Health Claim

Capital Public Radio’s Pauline Bartolone, working in collaboration with Kaiser Health News and NPR, reports: “Federal rules ensure that none of the millions of people who signed up for Obamacare can be denied insurance -- but there is no guarantee that all health services will be covered” (Bartolone, 4/14). Read the story.

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Capsules: Survey: Health Insurance Enrollment In California More Complex Than Anticipated

Now on Kaiser Health News' blog, Anna Gorman reports: "Newly insured Californians felt relieved after signing up for health coverage but encountered numerous obstacles with technology and communication during the enrollment process, according to a report released Monday by the California HealthCare Foundation. Surveyed in interviews and focus groups, consumers said they had trouble getting through to the call center, choosing a health plan and calculating their income. They also had problems with the online chat program, and many were surprised by the amount of documentation required to enroll, according to the report" (Gorman, 4/15). Check out what else is on the blog.

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Political Cartoon: 'Execute-ive Position?'

Kaiser Health News provides a fresh take on health policy developments with "Execute-ive Position?" by Lee Judge.

Here's today's health policy haiku:


Exchanging health plans
Or just health information --
All are affected.
-Stuart Portman 

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

CBO Shrinks Estimate Of Health Law Spending Based On Lower Subsidy Costs

Expanding health coverage under the health law will also slow premium growth, helping lower the total cost of the law, the nonpartisan office said.

The New York Times: Budget Office Lowers Estimate For The Cost Of Expanding Health Coverage
The insurance expansion under the Affordable Care Act will cost $1.383 trillion over the next decade, more than $100 billion less than previous forecasts, the Congressional Budget Office said Monday. The nonpartisan budget office's report, an update to projections from February, shows the law costing less than in previous estimates in part because of the broad and persistent slowdown in the growth of health care costs. The news might come as welcome to Democrats on Capitol Hill and in the White House who are struggling to defend the law in an election year (Lowrey, 4/14).

Los Angeles Times: Obamacare Cost Forecast Is Reduced 7% By U.S. Fiscal Watchdog
Lower-than-expected health insurance premiums under Obamacare will help cut the long-term cost of the program 7 percent over the next decade, according to the latest report from the Congressional Budget Office. The government's reduction of $104 billion in subsidies for those premiums was the main factor that led the nonpartisan fiscal watchdog to cut its projection of the nation's federal deficit by nearly $300 billion through 2024 (Memoli, 4/14).

The Wall Street Journal: CBO Estimates U.S. Deficit Will Shrink More Than Expected In 2014
CBO also reduced the government's projected 10-year deficit by $286 billion, to $7.6 trillion, mainly because of lower subsidies related to the health-care law. Future Medicare spending was also revised lower. The estimates come during a brief period of rapidly shrinking budget deficits, forcing both political parties to rethink their approaches to taxes and spending heading into the November midterm elections. The White House and Republican lawmakers have battled over the deficit for years, primarily through protracted debates over how much revenue to collect and how to structure government programs (Paletta, 4/14).

USA Today: CBO Lowers Estimate Of Health Care Law Costs
Net costs in 2014 are due almost entirely to subsidies paid out to those who make less than 400% of the federal poverty level who enrolled in the health insurance exchanges, as well as the Medicaid expansion in some states. The government will pay out $1.84 trillion through 2024 for health exchanges and subsidies, Medicaid, the Children's Health Insurance Program and tax credits for small employers. But the budget office expects $456 billion in penalty payments from those who do not have health insurance as well as excise taxes on high-premium insurance plans, income taxes for those who make more than $200,000 a year, and payroll taxes that come from changes in employer coverage (Kennedy, 4/14).

McClatchy: CBO Sees Lower Costs For Affordable Care Act Insurance Provisions
The Affordable Care Act’s insurance coverage provisions will be less costly to the federal budget than first projected and premiums for a key health plan are expected to rise by about 6 percent a year, the Congressional Budget Office said Monday. Updating estimates issued in February, the non-partisan CBO said the cost to the federal government for the insurance provisions is $5 billion less than thought earlier this year. From 2015 through 2024, the provisions should prove $104 billion less costly. That's 7 percent below earlier projections (Hall, 4/14).

The Fiscal Times: CBO Says Obamacare Will Cost Less Than Projected
The White House is kicking off the week with some more good news for Obamacare. The Congressional Budget Office said on Monday that the federal government will spend significantly less than expected on health insurance benefits under the new law. The CBO and the Joint Committee on Taxation said the law’s insurance coverage provisions will now cost about $1.4 trillion over the next 10 years -- about $104 billion less than previously estimated. This year alone the government will spend $5 billion less than projected. The CBO said lower spending on the health care law is helping shrink deficits overall (Ehley, 4/14).

Politico: Smaller Premium Hikes Forecast In 2014 For Obamacare
Coverage through the law will cost the federal government about $5 billion less than expected this year. And overall, the law’s 10-year cost for the coverage provisions is pegged at $1.383 trillion -- $104 billion less than prior calculations. Both figures are lower than prior estimates mostly because the CBO and JCT anticipate premium subsidies being smaller (Haberkorn and Norman, 4/14).

Other highlights from the report include that the deficit will shrink as a result of the lower health care costs and that 6 million will be the average number getting coverage in health law marketplaces --

The Associated Press: CBO: Deficits To Drift Lower On Lower Health Costs
A Congressional Budget Office report Monday said this year's deficit will now be $492 billion, $23 billion less than previously estimated. Last year’s deficit registered $680 billion, the first year in President Barack Obama’s tenure that the deficit was less than $1 trillion (4/14). 

CBS News: Report: Average Of 6 Million In Obamacare Marketplaces In 2014
Over the course of 2014, an average of 6 million Americans will have health insurance through the new Obamacare marketplaces, according to the latest estimate from the nonpartisan Congressional Budget Office (CBO). All told, the CBO said that 12 million more nonelderly people will have health insurance in 2014 than would have had it in the absence of the Affordable Care Act. That includes the 6 million in private Obamacare plans, 7 million more enrolled in Medicaid or the Children's Health Insurance Program (CHIP), and the subtraction of 1 million losing coverage on the nongroup market (Condon, 4/14).

But a survey also says premiums are going up --

Fox News: Survey Shows Obamacare Sending Premiums Rising At Fastest Clip In Decades
A recent survey of 148 insurance brokers shows that Obamacare is sending premiums rising at the fastest clip in decades. "For the last, about, five years they've been doing this survey, so this was the largest percentage increase in any quarter since they've been doing (it)," said Scott Gottlieb of the American Enterprise Institute. "But at 12 percent, 11 percent increase on average across all the states -- that puts it at the upper end of any increase we've seen for decades." That is the national average in a survey done by Morgan Stanley. … The reported hikes are for the first policies issued under Obamacare in 2014 (Angle, 4/14).

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Some Push To Sync Obamacare Deadline With Tax Day

This year's intersection of the deadlines to sign up for health insurance, as well as to file taxes, elevated the role of many tax preparers who have been educating uninsured clients about the health law. Some tax preparers contend the two deadlines should be permanently connected.

Politico Pro: Push To Keep Obamacare Deadline On Tax Day
Tax preparers got their wish: They’re helping to carry Obamacare enrollment across the finish line on Tuesday’s Tax Day. But they’re already worried about a deadline mismatch in 2015. The Obama administration effectively extended this year’s sign-up period for many Americans an extra two weeks, until April 15. That deadline’s intersection with the deadline for filing taxes elevated the role of many major tax preparers, who have been educating uninsured clients and directing them to brokers who could get them enrolled (Cunningham, 4/15).

The New York Times: Tax Preparers’ New Role: Health-Coverage Advisers
The tax system provides both the carrot and the stick for people to obtain coverage. Tax preparers like Jackson Hewitt and H&R Block say they have helped tens of thousands of people apply for tax credits to help defray the cost of private insurance bought through the exchanges. In addition, the big tax service companies and makers of tax preparation software like Intuit’s TurboTax are calculating potential penalties for those who do not have insurance (Pear, 4/14).

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Burwell Steps Into Hot Seat

Sylvia Mathews Burwell, the president's nominee to head the Health and Human Services Department, may have some goodwill, but she will still have to navigate plenty of challenges -- starting with her confirmation hearing.

Politico: Sylvia Mathews Burwell: Do’s And Don’ts
Sylvia Mathews Burwell will start her new gig with a lot of goodwill. Everyone knows she’s not the Health and Human Services secretary who fumbled the launch of Obamacare, but the competent head of the wonky Office of Management and Budget. And then, something else will break. And then, Burwell could end up the one up on Capitol Hill, taking one for the team at the next round of Obamacare hearings, just like Kathleen Sebelius used to (Nather, 4/15).

St. Louis Post-Dispatch:  Sebelius Is Gone, But The Health Care Fight Endures 
Now that Kathleen Sebelius has left her stormy post as the head of Health and Human Services, what will happen to the sweeping health care reform law that is hers and President Barack Obama’s biggest legacy? Although Sebelius’ resignation removes a symbolic target for opponents of the Affordable Care Act, and although Obama’s 2012 re-election is seen by its supporters as a final validation, the law awaits yet another voter verdict in November’s House and Senate elections (Raasch, 4/15).

Meanwhile, ABC reports on another challenge to the law in federal appeals court -

ABC News: Little-Known Legal Challenge That Could Torpedo Obamacare
While the Supreme Court considers one challenge to a provision of the Affordable Care Act (ACA), a federal appeals court located just blocks away is contemplating a separate challenge that could have much more dire consequences for the future of the law. “What you’re asking for is to destroy the individual mandate, which guts the statute,” Judge Harry T. Edwards of the U.S. Court of Appeals for the District of Columbia said to an attorney representing the challengers during a hearing on March 25. .. The conflict at the center of the Halbig case (and three other challenges across the country) has to do with tax subsidies granted to those who seek to obtain insurance from the exchanges (de Vogue, 4/14).

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Survey: Signing Up For Obamacare No Walk In The Park

California enrollees said they had trouble getting through to call centers, calculating their income and gathering the required documentation, among other difficulties, according to a survey by the California HealthCare Foundation. Meanwhile, media outlets note that Tuesday is the last chance to sign up in California, while April 22 is the deadline in Minnesota.

Kaiser Health News: Capsules: Survey: Health Insurance Enrollment In California More Complex Than Anticipated
Newly insured Californians felt relieved after signing up for health coverage but encountered numerous obstacles with technology and communication during the enrollment process, according to a report released Monday by the California HealthCare Foundation. Surveyed in interviews and focus groups, consumers said they had trouble getting through to the call center, choosing a health plan and calculating their income. They also had problems with the online chat program, and many were surprised by the amount of documentation required to enroll, according to the report (Gorman, 4/15).

Los Angeles Times: Last Chance For Obamacare Ends Tuesday For Most Californians
After many deadline extensions and grace periods, Tuesday will mark the end of the first open enrollment for Obamacare in California. California's health insurance exchange is encouraging thousands of people who have started an application to finish before midnight Tuesday (Terhune, 4/14).

The San Jose Mercury News: Obamacare: Tuesday Midnight Deadline Looms For Last-Minute Health Care Applicants
That ticking sound you're hearing isn't just the clock counting down to Tuesday's deadline to file your taxes. Californians who started but were unable to finish their applications for a health care plan by the original March 31 open enrollment deadline have until midnight Tuesday to complete the process. "People have had since October to enroll. These are the final hours," said Larry Hicks, a spokesman for Covered California, the state's health care exchange (Seipel, 4/14).

The Star Tribune: MNsure Sets April 22 Deadline To Complete Enrollment
MNsure officials have set an April 22 deadline for MinneĀ­sotans who indicated that technical problems prevented them from buying health insurance by the end of March. The deadline applies only to those who filled out an online form alerting MNsure of their troubles, but hadn’t previously created an account on the new online health insurance exchange. At least 8,200 people are known to be affected by the decision, according to a MNsure spokeswoman, but the number is expected to grow (Crosby, 4/15).

Pioneer Press: MNsure Extension Deadline For Private Insurance Buyers April 22
MNsure has told about 8,200 people who couldn't get health insurance by the end of last month that some of them might now face a sign-up deadline of April 22. In late March, the state's health insurance exchange created an online form for people to signify that they were trying to obtain coverage before the federal health law's March 31 deadline, but couldn't do so for technical reasons (Snowbeck, 4/14).

The Denver Post:  Colorado’s Private Health Insurance Enrollment Stands At 124,000
Final figures for Colorado's open-enrollment in private health insurance under the Affordable Care Act stand at about 124,000, according to state officials.That number kept climbing after the March 31 deadline, when it topped 118,000, as those who started enrollment but were unable to complete it by month's end were allowed to finish (Draper, 4/14).

Kaiser Health News: Focus On Marketplace Enrollment Overlooks Millions Who Bought Private Insurance
Want to know how many people have signed up for private insurance under Obamacare? Like the health care law itself, the answer is complicated. ... Often overlooked is that enrollment in private health plans outside the marketplaces is also booming. The federal government hasn’t been counting the number of people who buy new plans directly from insurance carriers -- and that number could be substantial (Feidt, 4/15).

And on the Medicaid expansion front -

The Associated Press: Anti-Tax Group Praises Va. House Speaker
An anti-tax group Americans for Tax Reform is applauding House Speaker William J. Howell for his opposition to Medicaid expansion, praise that comes a year after the group advocated for new leadership in the House of Delegates (4/14). 

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Health Care Marketplace

U.S. Health Care Spending, Usage Rise

Americans' spending on medicines in 2013 rose 3.2 percent to nearly $330 billion, fueling speculation that a dip in overall health care spending may be over.

Los Angeles Times: More U.S. Consumers Are Seeking Medical Care, Report Shows
A historic slowdown in U.S. health care spending in recent years may be drawing to a close. An industry report published Tuesday and healthcare experts point to a steady rise in medical care being sought by consumers seeing specialists, getting more prescriptions filled and visiting the hospital. Other factors such as millions of newly insured Americans seeking treatment for the first time and higher prices from health care consolidation could also help drive up costs (Terhune, 4/14).

Reuters:  U.S. Health Care Usage And Spending Resumes Rise In 2013 
Americans used more health services and spent more on prescription drugs in 2013, reversing a recent trend, though greater use of cheaper generic drugs helped control spending, according to a report issued on Tuesday by a leading health care information company. Spending on medicines rose 3.2 percent in the United States last year to $329.2 billion. While that was far less than the double-digit increases seen in previous decades, it was a rebound from a 1 percent decline in 2012, the report by IMS Health Holdings Inc. found Berkrot, 4/15).

And the costs for some specialty drugs increase --

The New York Times: Prices Soaring for Specialty Drugs, Researchers Find
Even as the cost of prescription drugs has plummeted for many Americans, a small slice of the population is being asked to shoulder more and more of the cost of expensive treatments for diseases like cancer and hepatitis C, according to a report to be released on Tuesday by a major drug research firm (Thomas, 4/15).

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Wal-Mart Exec Who Led Health Care Expansion Steps Down

News emerged Monday in an internal staff memo that John Agwunobi would leave his post running the retailer's health and wellness division.

The Wall Street Journal: Executive Who Led Wal-Mart Expansion Into Health Care Steps Down
The executive who led Wal-Mart Stores Inc.'s expansion into providing health services has left the company, as the retailer plans to make another push at providing care through its stores. John Agwunobi stepped down from his job running the retailer's health and wellness division after seven years at Wal-Mart, according to an internal memo sent to staff earlier this month. He will be replaced by Labeed Diab, who most recently led Wal-Mart's U.S. Midwest division (Banjo, 4/14).

Also in the news, Medtronic is dealt an unexpected ruling by a federal court --

The Wall Street Journal: Medtronic Prevented From Selling Heart Valve In U.S.
In what doctors called a surprise ruling, a federal court has barred Medtronic Inc. from selling its new artificial heart valve to most patients in the U.S., despite finding that the device is "safer" and has "a lower risk of death" than a competing device. The ruling, issued Friday by U.S. District Judge Gregory M. Sleet of Delaware, would give Edwards Lifesciences Corp. a near-monopoly on the sale of a new type of aortic heart valve that is implanted via a minimally invasive procedure, instead of through open-heart surgery. Medtronic is appealing the ruling, but for now has stopped training new doctors in how to use the devices, and told surgeons already using the valves not to schedule any new procedures, the company said (Walker, 4/14).

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Fallout Continues Around Medicare Advantage Payment Rates

The Obama administration's decision to reverse a proposed Medicare Advantage payment cut has been panned by insurance analysts and governors, among others.

The Washington Post’s Wonkblog: Medicare Reversed Payment Cuts, And Not Many Are Happy About It
Medicare’s recent reversal of a proposed payment cut to private health plans -- the second such reversal in two years -- hasn’t won a lot of rave reviews. Insurance analysts say they still anticipate lower payments to private Medicare Advantage plans in 2015. Some editorial pages and supporters have criticized the Obama administration and lawmakers for easing off on Medicare Advantage cuts ordered by the president's health-care law (Millman, 4/14). 

The Associated Press:  3 GOP Governors Blast Medicare Advantage Rates
Three Southern Republican governors are writing President Barack Obama to complain about newly announced Medicare Advantage payments. Florida Gov. Rick Scott, Texas Gov. Rick Perry and Louisiana Gov. Bobby Jindal signed the April 15 letter that says changes to Medicare Advantage payments will harm "America's seniors." The changes are blamed on the nation's health care overhaul (4/15).

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Disparity In Medicare Provider Payments In Oregon, Data Show

Information gleaned from the federal government's Medicare data dump shows that Oregon providers and provider groups were paid $508 million in 2012. However, some providers made more than others. Meanwhile the Milwaukee Journal Sentinel is reporting that arising from the data, Wisconsin Congressional members want physicians rated on quality of care. 

The Oregonian: Oregon Medicare Data Shows Disparity In Provider Payments
Medicare paid $508 million to Oregon providers and provider groups in 2012. But some providers made much more than others. New information released by the federal government shows 15 Oregon providers made more than $1 million from the government health care program set up for people 65 or older. But the typical provider made far less, with the median reimbursement coming in at $18,890. The data is broken down by provider, city, and procedure, letting consumers and researchers slice the information in different ways. The data release is the latest example of a larger transparency trend, meaning consumers have more access to health care spending data than ever, said John McConnell, a health economist who heads the Center for Health Systems Effectiveness at Oregon Health & Science University (Budnick, 4/14).

The Milwaukee Journal Sentinel: Wisconsin Congressional Members Want Physicians Rated On Quality Of Care
The government's unprecedented release of information about Medicare payments to doctors last week drew national attention, particularly spotlighting individual physicians who collected millions of dollars for treating Medicare patients in 2012. One Milwaukee eye doctor received more than $8.6 million in Medicare payments, by far the most received by an individual doctor in Wisconsin that year. A Florida doctor topped them all, receiving $20.8 million. But the information, which disclosed the total amounts of Medicare payments made to more than 880,000 physicians and other health care providers, did not include the detail needed to determine what really matters: Which doctors provide high-quality care in the most cost-effective way? (Boulton, 4/14). 

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State Watch

State Highlights: N.Y.'s Medicaid Waiver; Conn. Medicaid Application Delays Settlement

A selection of health policy stories from New York, Connecticut, Washington state, Kansas, Florida, West Virginia and California.

The Associated Press: N.Y. Gets Final Terms For $8B Medicaid Waiver
New York and federal officials report final agreement allowing the state to reinvest $8 billion in Medicaid savings to support hospital overhauls and expand primary medical care over the next five years. The goal of the Medicaid waiver is to reduce avoidable hospital use by 25 percent while helping financially struggling hospitals shift to more primary and outpatient care (4/14).

The CT Mirror: Proposed Settlement Reached In DSS Medicaid Application Delay Lawsuit
The Department of Social Services is seeking approval to hire dozens of additional workers to comply with a proposed settlement to a class action lawsuit alleging that delays in processing Medicaid applications have left poor state residents waiting months to get coverage and care. Meeting the settlement’s terms would require hiring 35 additional workers at a cost of more than $2.5 million per year, Social Services Commissioner Roderick L. Bremby wrote in a recent letter to Attorney General George Jepsen. Those positions would be in addition to 103 new positions for the department included in Gov. Dannel P. Malloy’s proposed budget for the coming fiscal year (Becker, 4/15).

The Seattle Times:  State Medicaid Audit Suggests $17.5 Million Overpaid 
The state’s Health Care Authority did not have enough oversight and control over its Medicaid managed-care program in 2010, according to a state audit of the program, which may have racked up an estimated $17.5 million in overpayments by contracted managed-care organizations to doctors, hospitals and other care providers. Overpayments are important, because total payments reported by the managed-care organizations are used to calculate future premiums paid by the state to the organizations, notes the report, which was released Monday (Ostrom, 4/14).

Kansas Health Institute:  Managed Care Program For Elderly To Expand In Kansas
It’s been about three and a half years since Linda Cranmer’s left leg was amputated a few inches below the knee. At the time, Cranmer, then 62, was living in Scranton, a small town about 20 miles south of Topeka. Eighteen months later, Cranmer was able to get into the Programs for All-inclusive Care For the Elderly program, and things began to look up for her. The Medicare- and Medicaid-funded managed care program for people who are 55 or older, low-income and close to being admitted to a nursing home has been a relatively small player in Kansas’ efforts to help frail seniors such as Cranmer avoid expensive nursing home care but is poised to take on a much larger role. But Kansas now has plans to expand the program (Ranney, 4/14).

Miami Herald:  Florida Lawmakers Will Re-Evaluate Funding Model For Safety Net Hospitals 
With the federal government making clear last week that no new Medicaid money is coming Florida’s way, legislators say it’s important they re-evaluate a new funding model that safety-net hospitals say will cost them hundreds of millions of dollars a year. “Tiering” is set to take effect in July unless the law is changed before session ends May 2. It requires counties that use local dollars to draw down more federal money for hospitals to begin sharing that money statewide (Mitchell, 4/14).

The Miami Herald:  Florida Lawmakers Consider Health Care Law Change Aimed At Jackson
A high-profile health care bill moving through the Florida House could strip the Miami-Dade County Commission of its authority to make the final decision on labor union contracts at the county’s public hospital system. The bill originally sought to create new rules for trauma centers, allow skilled nurses to practice independent of physicians, and pave the way for hospitals to use virtual healthcare services (McGrory, 4/14).

The Associated Press:  Plan Would Change How State Of Florida Pays For Mental Health Care 
The Florida Legislature is considering a plan that would change the way the state pays to treat people who need emergency mental health care, a move critics say would gut the current system to benefit large hospital systems. Under the current system, the state Department of Children and Families contracts with 117 public and private Crisis Stabilization Units around the state to provide emergency mental health treatment, paying nearly $300 a day per bed regardless of whether they are occupied. The system, which cost the state $61.3 million last year, guarantees that the crisis units have enough beds and staff to meet peak needs, supporters say (Miller, 4/14).

The Associated Press:  W.VA. Home, Long-term Care Costs Rise
An annual survey shows long-term and home health care costs in West Virginians are outpacing such costs nationally. The Cost of Care Survey released Monday by Genworth Financial shows the median hourly cost of home health aide services in West Virginia has increased 3.8 percent annually over the past five years. Nationally, the annual increase was 1.3 percent. West Virginia's median hourly rate for homemaker services increased 3.6 percent annually during the same period. Nationally, the annual increase was about 1 percent (4/14).

The California Health Report: Mental Health Courts Give Mentally Ill Offenders The Option Of Treatment
Cholena Loewenthal remembers a great childhood: success in school, lots of friends, a supportive family. But she knew something wasn’t quite right with her. She was unable to complete tasks and had difficultly focusing. Shopping was a compulsion for her. She had to buy things regardless of her financial ability. At age 18, she read a pamphlet about bipolar disease and knew she had the illness. But she didn’t get a medical diagnosis until she was 28 (Graebner, 4/15). 

The California Health Report: Strange Bedfellows Unite To Help Older Adults
In the near future, successful care for older adults will depend on bold and creative collaborations. That’s the message aging pioneer Ken Dychtwald gave last month’s Aging in America conference. Dychtwald, CEO of the consulting group Age Wave, might as well have been describing the “strange bedfellows” collaboration between two organizations often considered mortal enemies -- a county aging services agency and a managed health care plan. In San Diego County, Aging and Independence Services (AIS) has long been heralded as one of the nation’s most progressive organizations serving older adults. It acts as the local Area Agency on Aging, or AAA -- one of 59 statewide (Perry, 4/14).

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Editorials and Opinions

Viewpoints: Obamacare Dilemma -- Some People Dislike The Law But Embrace Its Provisions; Are Health Costs Falling?

Los Angeles Times: The Trade-Offs Of Obamacare's Preexisting Condition Coverage
Polls have consistently shown that even though the public opposes Obamacare, people like some of its most significant provisions. That's particularly true of the requirement that insurers ignore preexisting conditions when signing up customers for coverage. Yet that one provision, also known as guaranteed issue, is responsible for trade-offs that people bitterly oppose (Jon Healey, 4/14). 

The Washington Post: Obamacare's Victory Lap
It's all over but the shouting: Obamacare is working. All the naysaying in the world can't drown out mounting evidence that the Affordable Care Act, President Obama's signature domestic achievement, is a real success. Republican candidates running this fall on an anti-Obamacare platform will have to divert voters' attention from the facts, which tell an increasingly positive story (Eugene Robinson, 4/14).

Reuters: America: The Anecdotal Nation
In America today, anecdotes have become the new facts. Consider Obamacare. Opponents have produced ads featuring apparently ordinary Americans telling stories about the travails forced upon them by the Affordable Care Act. One ad, financed by the Koch brothers, highlighted a leukemia sufferer named Julie Boonstra, who claimed that Obamacare had raised the cost of her medications so much that she was faced with death! Pretty dramatic stuff -- except that numerous fact-checkers found she would actually save $1,200 under Obamacare. But what are you going to believe -- a sob story or a raft of statistics about the 7.5 million Americans who have signed up and the paltry 1 million folks who had policies canceled? (Neal Gabler, 4/14).  

The Washington Post: Let HHS Nominee Sylvia Burwell Explain Obamacare Lie
Senate Democrats have been desperately trying to move the national conversation away from Obamacare to just about anything else before the midterm elections -- "paycheck fairness," the minimum wage, even the Koch brothers. But President Obama’s choice of Sylvia Burwell to replace Kathleen Sebelius as secretary of Health and Human Services thrusts Obamacare right back into the national spotlight -- and with it Obama’s false promise that "if you like your health-care plan, you can keep your health-care plan" (Marc A. Thiessen, 4/14).

Bloomberg: Will Burwell Corral Health-Care Costs?
In the past several months, health-care costs outside Medicare may have accelerated, even as Medicare spending growth remains remarkably low. This is why Sylvia Mathews Burwell (who is a friend of mine) has the opportunity to be a transformational secretary of Health and Human Services. If over the next three years she can take the bold steps needed to reinforce better value in health care, she will drastically alter prospects for everything from the federal budget to state and local priorities (including education) and the take-home pay of America's workers (Peter R. Orszag, 4/14).

Bloomberg: Will Obamacare Actually Cost Us Less?
The Congressional Budget Office just announced that it's revising the projected cost of the Affordable Care Act -- downward. The reason? ... The biggest change is simply that it projects premiums will be lower, which means that it projects the government will pay out less in subsidies. And why does it think premiums will be lower? Because it didn't anticipate what the insurers did: slashing their provider networks to the bone in order to keep premiums low (Megan McArdle, 4/14).

The Washington Post: Congress Must Learn To Pay For Tax Breaks It Extends
Just in time for tax day, the Congressional Budget Office delivered a pleasant surprise. Based on current law, the national debt will grow by $286 billion less during the next decade than the CBO projected only two months ago. The main reason is a downward adjustment in the nonpartisan agency's forecast of subsidy costs for health insurance purchased on the Affordable Care Act's exchanges (4/14).

The San Jose Mercury News: Norma J. Torres: Covered California Needs More Diversity, Expertise
Covered California will be better prepared to address its challenges with customer service and low Latino enrollment if legislative leaders and the governor take much needed action to diversify and broaden the expertise of its board of directors. Although Covered California met and exceeded their expectations for the inaugural enrollment period, enrollment fell short in at least two key target markets -- Latinos and young adults. Whether Covered California has long-term success depends partly on whether it can improve its enrollment numbers for these populations (Norma J. Torres, 4/14).

JAMA Pediatrics: A New Opportunity To Define Health Care Reform For Children
The critical need is sustaining high rates of coverage for children while maintaining affordable access. The hugely popular CHIP program closed the gap of uninsured children but faces an uncertain future unless it is reauthorized in 2015. Some believe the availability of subsidized insurance through exchanges might obviate the need for a separate CHIP program, although early evidence suggests that while benefits are similar to exchange plans, exchange cost sharing may be higher and network access reduced (David M. Rubin and Kathleen Noonan, 4/14).

On other health issues -

The New York Times: Preventing Painkiller Overdoses
The Food and Drug Administration earlier this month approved a hand-held device that can quickly reverse the effects of an overdose and prevent deaths from opioid painkillers and heroin. The easy-to-use injector ... can now be used by family members or emergency responders at the scene of an overdose. ... The announcement was made in part to shift the focus of discussion from the F.D.A.’s controversial decision to approve a prescription painkiller, Zohydro ER, which contains pure hydrocodone and is released over an extended period to relieve chronic pain. An expert panel had advised the F.D.A. against approval until Zohydro ER or others like it could be made more resistant to tampering or abuse (4/14). 

WBUR: Why Zohydro Ban Is A Tough Call
U.S. District Court Judge Rya W. Zobel today disappointed anyone who expected her to quickly strike down Gov. Deval Patrick’s ban on the sale of the new pain reliever Zohydro. She declined to rule on the drugmaker’s request to quickly but temporarily lift the ban, and is continuing to consider whether to lift the ban permanently. Judge Zobel faces a difficult decision but not because Zohydro, as many media reports have said, is more potent than anything else on the market. It’s not, and we’ll get to that in a minute (Judy Foreman, 4/14).

The Wall Street Journal: Taking The Powerball Approach To Funding Medical Research
Participants anxiously await the announcement of the winning numbers, thinking to themselves, "Someone has to win, why not me? Just think of what I could do with a million dollars!" But alas, better luck next time. Powerball? Mega Millions? Unfortunately, no -- we are talking about research funding from the National Institutes of Health (Ferric C. Fang and Arturo Casadevall, 4/14). 

The New York Times: Room For Debate: DNA And Insurance, Fate And Risk
As costs for DNA sequencing drop, hundreds of thousands of Americans are undergoing the procedure to see if they are at risk for inherited diseases. But while federal law bars employers and health insurers from seeking the results, insurers can still use them in all but three states when considering applications for life, disability and long-term care coverage (4/15). 

The New England Journal Of Medicine: Therapy For Hepatitis C -- The Costs Of Success
The availability of effective, oral regimens of therapy for hepatitis C will lead to major changes in the management of this disease and probably affect both its morbidity and its mortality. ... Collectively, these regimens promise to transform hepatitis C from a condition requiring complex, unsatisfactory therapies and specialist care to one that can be effectively treated and easily managed by a general physician with few contraindications and side effects. Unfortunately, not all barriers to treatment will be lifted. The major limitation remaining will be economic. The current cost of a 12-week regimen of sofosbuvir alone is $84,000, or $1,000 per tablet. The addition of ledipasvir will add to the costs. ... The predicted costs of the new oral antiviral agents are as breathtaking as their effectiveness (Jay H. Hoofnagle and Averell H. Sherker, 4/12).

The Journal of the American Medical Association: The Changing Legal Climate For Physician Aid In Dying
While once widely rejected as a health care option, physician aid in dying is receiving increased recognition as a response to the suffering of patients at the end of life. With aid in dying, a physician writes a prescription for life-ending medication for an eligible patient. Following the recommendation of the American Public Health Association, the term aid in dying rather than "assisted suicide" is used to describe the practice. In this Viewpoint, we describe the changing legal climate for physician aid in dying occurring in several states (David Orentlicher, Thaddeus Mason Pope and Ben A. Rich, 4/14).

WBUR: Autism: Awareness Helps, But What We Really Need Is Knowledge
April is autism awareness month. Awareness is great. But what really frustrates me and other parents of children with autism isn't a lack of awareness but rather how little is actually known about the disorder (IIlyse Levine-Kanji, 4/14).

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Stephanie Stapleton

Andrew Villegas

Lisa Gillespie
Shefali Luthra

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