Daily Health Policy Report

Wednesday, April 16, 2014

Last updated: Wed, Apr 16

KHN Original Reporting & Guest Opinion

Administration News

Health Reform


Health Information Technology

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

FAQ On ACOs: Accountable Care Organizations, Explained

Kaiser Health News staff writer Jenny Gold writes: “One of the main ways the Affordable Care Act seeks to reduce health care costs is by encouraging doctors, hospitals and other health care providers to form networks which coordinate patient care and become eligible for bonuses when they deliver care more efficiently. … While ACOs are touted as a way to help fix an inefficient payment system that rewards more, not better, care, some economists warn they could lead to greater consolidation in the health care industry, which could allow some providers to charge more if they’re the only game in town. Here are answers to some of the more common questions about how they work” (Gold, 4/16). Read the story.

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Capsules: Health Law Push Brings Thousands Into Colo. Medicaid Who Were Already Eligible

Now on Kaiser Health News' blog, Eric Whitney writes: “The big marketing push to get people enrolled in health coverage between October and March resulted in 3 million people signing up for Medicaid. Hundreds of thousands of those people were already eligible and could have signed up even before the Affordable Care Act made it much more generous” (Whitney, 4/16). Check out what else is on the blog.

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Political Cartoon: 'Absence Makes The Heart Grow Fonder?'

Kaiser Health News provides a fresh take on health policy developments with "Absence Makes The Heart Grow Fonder?" by Steve Sack.

Here's today's health policy haiku: 


Call it "Department
of Apples and Oranges."
Not Census Bureau.

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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Administration News

Census Changes Will Make It Hard To Gauge Health Law's Impact

The revisions are intended to make the survey more accurate, but specific questions will be so different that the results will not be comparable to previous years.

The New York Times: Census Survey Revisions Mask Health Law Effects
The Census Bureau, the authoritative source of health insurance data for more than three decades, is changing its annual survey so thoroughly that it will be difficult to measure the effects of President Obama’s health care law in the next report, due this fall, census officials said. The changes are intended to improve the accuracy of the survey, being conducted this month in interviews with tens of thousands of households around the country. But the new questions are so different that the findings will not be comparable, the officials said (Pear, 4/15).

The Hill:  Census Overhaul Will Obscure Obamacare Effects
The Census Bureau is changing the way it calculates the number of people with health insurance, a move researchers say could obscure the true impact of ObamaCare. The bureau is overhauling the questions on its annual health insurance survey to make sure people understand that they are being asked whether they had coverage in the previous year (Viebeck, 4/15).

The Fiscal Times: Both Sides In Obamacare Fight Slam Census Bureau
The U.S. Census Bureau set [off] a mild firestorm in the health policy field on Tuesday after revealing to The New York Times that it was planning to execute a complete overhaul of the way that it measures health insurance coverage in the U.S. The new version of the decades-old survey is designed to get a better read on the number of uninsured people in the country, and is expected to produce results showing the rate as lower, in general, than the old report. The Times reported that the bureau was changing the survey so dramatically, "that it will be difficult to measure the effects of President Obama's health care law in the next report, due this fall" (Garver, 4/15).

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Health Reform

Enrollment Extensions Wind Down But Health Law Politics Getting Complicated

People wanting coverage on the federal and some state websites needed to sign up by Tuesday, and federal officials say they won't again extend the deadline. In addition, news outlets examine why it will take time to determine whether the overhaul is a success and how Republicans are treading carefully as they call for overturning a law that has provided benefits to millions of Americans.

The Wall Street Journal: Obama Administration Won't Extend Health-Insurance Enrollment
The Obama administration said on Tuesday that a midnight deadline for most people to finish health-insurance applications for private coverage this year wouldn't be extended amid signs that enrollment waits had dissipated. Aaron Albright, a spokesman for the Centers for Medicare and Medicaid Services, confirmed there would be no further changes to an extension that pushed the end of insurance enrollment until April 15 for those who were "in line" on HealthCare.gov by March 31. The federally run site is the main portal for buying insurance under the Affordable Care Act (Radnofsky, 4/15).

Los Angeles Times: Health Sign-Ups In State Draw to A Close
After website troubles sparked a two-week extension, California officials wrapped up the first open enrollment for Obamacare coverage with nearly 1.3 million consumers signed up since October for the state-run exchange. Sign-ups ahead of Tuesday's enrollment deadline appeared to run more smoothly than they did March 31, the previous cut-off date (Terhune, 4/15).

NPR: Is Obamacare A Success? We Might Not Know For A While
After months of focusing on how many people have or haven't signed up for health insurance under the Affordable Care Act, we now have a rough total (7.5 million) and everyone's keen to get to the bigger questions: How well is the law working? How many of those who signed up have paid their premiums and are actually getting coverage? How many were uninsured before they signed up? And just how big has the drop been in the number of uninsured people? (Rovner, 4/16).

Politico: Giving Anti-Obamacare Speeches To Enrollees
Anti-Obamacare Republicans home on recess are coming face to face this week with newly insured constituents. It could be an interesting encounter. No politician wants to sound eager to take government benefits away from voters — and while public opinion polls show the health care law is still controversial, millions of people are indeed getting assistance. ... The two-week recess is the first extended break from Washington for lawmakers since the 2014 open enrollment season ended and coverage for many Americans kicked in. Many people with new plans received subsidies to make their health insurance more affordable, or they became eligible for expanded Medicaid (Cunningham and Kim, 4/16).

Reuters:  Americans Increasingly Prefer Democrats On Health Care
Americans increasingly think Democrats have a better plan for healthcare than Republicans, according to a Reuters/Ipsos poll conducted after the White House announced that more people than expected had signed up for the "Obamacare" health plan. Nearly one-third of respondents in the online survey released on Tuesday said they prefer Democrats' plan, policy or approach to healthcare, compared to just 18 percent for Republicans. This marks both an uptick in support for Democrats and a slide for Republicans since a similar poll in February (Debenedetti, 4/16).

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With End-Of-Enrollment Surge Behind Them, Insurers See Health Law Positives

Politico reports that many insurers are contemplating expanding -- or initiating -- their participation in exchanges. Other news outlets examine tax day, the health law and the Internal Revenue Service.   

Politico: Insurers See Brighter Obamacare Skies
Health insurers got their first taste of Obamacare this year. And they want seconds. Insurers saw disaster in the fall when Obamacare’s rollout flopped and HealthCare.gov was a mess. But a strong March enrollment surge, along with indications that younger and healthier people had begun signing up, has changed their attitude. Around the country, insurers are considering expanding their stake in the Obamacare exchanges next year, bringing their business to more states and counties. Some health plans that skipped the new marketplaces altogether this year are ready to dive in next year (Cheney and Norman, 4/15).

Fox News: How Much Will ObamaCare Cost You In Taxes?
On this April 15, filers and accountants alike are finding a new array of taxes resulting from the president’s health care legislation. These include at least 20 ObamaCare-related tax increases totaling  $409 billion over the next ten years, according to the Joint Committee on Taxation. The new taxes are especially irksome to ObamaCare opponents, because they are imposed by a law that passed on a straight party-line vote and are being enforced by an agency that some accuse of party favoritism. "I think it's rather unfortunate that the IRS has this huge role in the Affordable Care Act because it's always controversial," said Mark Everson, a former IRS Commissioner (McKelway, 4/15).

Politico Pro: IRS Soon Becomes Point Guard For ACA
The IRS is already laser-focused on 2015, when they take the lead in carrying out Obamacare. The law’s pivotal individual mandate and subsidies kick in this year, so the IRS role will expand next filing season. A major goal? Avoid the fate of the Health and Human Services website “train wreck,” as the GOP so fondly calls it, quoting the early worries of a Democratic senator (Bade, 4/15).

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Uninsured Rate Drops More In States That Expanded Medicaid, Run Own Exchanges

News outlets also provide updates on Medicaid expansion efforts and debates in Colorado, Virginia, Missouri, Montana, North Carolina and Indiana.

Politico: Poll: Uninsured Drops In Key States
States that have expanded Medicaid and opened their own exchanges have seen a higher rate of decline in the number of uninsured, compared with other states, a new poll show. The 21 states and D.C., which have done both, saw an average decline in uninsured of 2.5 percent, according to a poll released Wednesday by Gallup. The other 29 states that didn’t enact both measure had a dip in uninsured of less than 1 percent on average (McCalmont, 4/16).

Kaiser Health News: Capsules: Health Law Push Brings Thousands Into Colo. Medicaid Who Were Already Eligible
The big marketing push to get people enrolled in health coverage between October and March resulted in 3 million people signing up for Medicaid. Hundreds of thousands of those people were already eligible and could have signed up even before the Affordable Care Act made it much more generous (Whitney, 4/16). 

The Associated Press: Va. House Republicans Reaffirm Medicaid Opposition
House Republicans say they remain resolute in their opposition to using federal Medicaid funds to provide health insurance to as many as 400,000 low-income Virginians. During a conference call with reporters Tuesday, House Speaker William J. Howell said he is optimistic that Gov. Terry McAuliffe and Democratic lawmakers would back down from their support of a proposed state budget that includes expanding Medicaid eligibility. State services could shutter if a state budget isn’t passed by July 1 (4/15).

The Richmond Times-Dispatch: Marketplace Virginia Is ‘Probably Germane’ To Budget
House Speaker William J. Howell, R-Stafford, said Tuesday that the Senate’s Marketplace Virginia proposal “probably is germane” to the state budget, but that it represents the wrong way to govern. “Probably technically it would be germane,” Howell said in a news conference call. “It’s just not good public policy to govern that way.” The Senate has yet to act on the House budget proposal during the special session that began March 24, in part because of concern that Howell would rule as not germane the Marketplace Virginia plan to extend health coverage to hundreds of thousands of uninsured Virginians using federal funds reserved for states to expand Medicaid under the Affordable Care Act (Martz and Nolan, 4/15).

Raleigh News & Observer: Legislature Won’t Adopt Medicaid Recommendation This Year, Key Legislator Says
Rep. Nelson Dollar, a member of an advisory committee on Medicaid changes, liked the idea of creating Accountable Care Organizations a whole lot more than his Senate counterpart, Louis Pate, did. Pate has said the plan that the state Department of Health and Human Services rolled out in February didn’t go far enough. ... Though he likes the basics, Dollar says not to expect legislation this year that would allow ACOs to be in place by July 2015, as DHHS had posited (Bonner, 4/15).

The St. Louis Post-Dispatch:  Adding Dental Care Contrasts With Mo. Legislature’s Opposition To Medicaid Expansion
Republican opposition in the state Senate has dimmed hopes that Missouri will expand Medicaid this year to cover the working poor. But agreements are percolating on what might be called Medicaid Expansion Lite. In the most far-reaching move, next year’s state operating budget almost certainly will restore limited dental coverage for 300,000 low-income adults whose benefits were cut in 2005. Coverage for rehabilitative therapy also might be reinstated (Young, 4/16).

Springfield (Mo.) News-Leader: Nixon Launches Pro-Medicaid Page On State Website
Democratic Gov. Jay Nixon has launched a pro-Medicaid expansion page on the official Missouri state website. At www.mo.gov/WePaidForIt, visitors see an interactive map of the U.S. showing what states have and have not expanded Medicaid. By hovering over each state, users can read how much federal tax revenue paid by Missourians is going to states that have expanded (Shorman, 4/15).

The Montana Standard: Attorney General Says Medicaid Initiative’s Fiscal Note Is Flawed
Attorney General Tim Fox has told the state Supreme Court that part of a voter-initiative petition to expand Medicaid in Montana is legally flawed, and should be rewritten to conform with the law. Fox, a Republican, said Monday he agreed with opponents of proposed Initiative 170 who say it has a “fiscal note” that overstates how much federal money Montana gets if the measure is passed, and therefore is misleading to those who would sign a petition to qualify I-170 for the November ballot. The alleged overstatement of federal money is $100 million over the next four years (Dennison, 4/15).

The Associated Press:  Decision Sought On Indiana Plan
Two of the state’s top Republican lawmakers said Tuesday that they would like to see the federal government approve an expansion of Medicaid through the state’s health care plan for low-income residents, but they added that they have little idea how soon that could happen. U.S. Rep. Larry Bucshon and state Rep. Tim Brown of Crawfordsville, who are both physicians, said they would like to see the Department of Health and Human Services approve the expansion being sought by Gov. Mike Pence through the Healthy Indiana Plan (LoBianco, 4/16).

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Exchange Fixes, Questions In Oregon, Maryland, Massachusetts

Cover Oregon severed a contract with technology consultant Deloitte as it moves into a new era of fiscal austerity, while the Maryland exchange continues to enroll consumers in coverage. The problems with Massachusetts' exchange are not expected to impact that state's current budget.

The Oregonian: Cover Oregon: New Executive Director Suspends Deloitte Contract, More Cuts Likely
Cover Oregon late last week severed one of its contracts with technology consultant Deloitte, the first of what could be a series of cost-cutting moves as the troubled operation enters a new era of fiscal austerity. Clyde Hamstreet, the consultant recently hired to take over executive director duties at Cover Oregon, said Deloitte has already accomplished its primary goal under the contract: advising the state how to proceed to finally deliver a fully functional health insurance exchange. "It was our conclusion we didn't need any more work from Deloitte," Hamstreet said. The move should save Cover Oregon about $2 million (Manning, 4/15).

The Baltimore Sun:  [Maryland] Health Exchange Continues To Enroll Consumers In Insurance
Almost 18,680 people asked for more time to sign up for insurance through the state's health exchange because they had trouble with the website during open enrollment, but exchange officials said Tuesday that many have already had their issues addressed. About 4,000 of those have been enrolled in person or on the phone by an agent hired by the exchange, many others likely have enrolled on their own online, and officials assume that some on the list are duplicates (Cohn, 4/15).

The Associated Press:  Health Website Not Expected To  Hurt State Funds
The breakdown of Massachusetts' health exchange website was not expected to have a significant impact on the state's current finances, a top state official told lawmakers Tuesday, but stopped short of giving similar assurances for the future. The website glitches forced the health connector to rely on balky manual workarounds and dramatically slowed the state's transition from its own first-in-the-nation universal health care program to the requirements of the federal Affordable Care Act (4/15).

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Vulnerable Democrats Fight Health Law Stigma

In tight races around the nation, Democrats are hoping that stories about the health law's rocky rollout are behind them, while Republicans try to make the races a referendum on the law.

Los Angeles Times: Louisiana Democrat Highlights Independence From Obama In New Ad
The aggressive tone of [Sen. Mary] Landrieu’s new ad mirrors that of her first ad last fall, which highlighted her legislative proposal to fix Obama’s health care law. Her campaign aired the ad after thousands of Louisiana residents received warnings that their health insurance policies would be canceled because they did not meet the new guidelines under the law. As a key target in the Republican quest to win back the Senate, Landrieu faces two Republican opponents in the November election and must win more than 50% of the vote to avoid a runoff (Reston, 4/15).

The Wall Street Journal: Health Law Poses A Test In New Hampshire Senate Race
New Hampshire's rollout of the Affordable Care Act has been one of the rockiest in the nation, putting Democratic Sen. Jeanne Shaheen on the front lines of Republican efforts to make the 2014 elections a referendum on the health law. Only a single insurer in the state offers policies through the new law. Ten of the state's 26 hospitals and one fifth of its primary care providers aren't in its network. Residents of Concord, the state capital, have to drive to other cities to get covered hospital care (Hook, 4/15).

The Denver Post:  GOP Claim About Sen. Mark Udall And Obamacare Ruled 'Mostly False'
A nationally lauded political-fact checking enterprise has concluded Congressman Cory Gardner's claim that Sen. Mark Udall cast the deciding vote on Obamacare was "mostly false." Republicans for months have hammered Udall on that point, but the attacks stepped up after Gardner unexpectedly jumped into the Senate race in February, turning it into one of the most closely watched contests in the country (Bartels, 4/15).

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Veracity Of Abortion Political Ads Case Going To High Court

An anti-abortion group challenged an Ohio law banning false statements by political campaigns.

The Associated Press: Court To Weigh Challenge To Ban On Campaign Lies
The Ohio law makes it illegal to knowingly or recklessly make false statements about a candidate during an election. ... The case began during the 2010 election, when the Susan B. Anthony List, an anti-abortion group, planned to launch a billboard campaign accusing then-Democratic Rep. Steven Driehaus of supporting taxpayer-funded abortion because he backed President Barack Obama’s health care overhaul (Hanenhel and Yen, 4/16).

Los Angeles Times: Supreme Court to Consider Challenge To Law Barring Campaign Falsehoods
The antiabortion group Susan B. Anthony List launched a campaign to unseat Driehaus, preparing to run billboard ads saying, "Shame on Steve Driehaus! Driehaus voted for taxpayer-funded abortion." The statement was false, Driehaus said, since under the law no federal funds can be spent to pay for abortions (Savage, 4/15).

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A Heavy Lift? Legal Challenge To Medicare's 'Two Midnight' Rule

Modern Healthcare reports that some legal experts say it will be tough to convince judges to overturn the controversial rule on classifying Medicare in-patients.

Modern Healthcare: AHA Lawsuit Over ‘Two-Midnight’ Rule Called Uphill Battle
The CMS' so-called “two-midnight” rule was intended to clarify which patients are sick enough to be admitted to the hospital by requiring doctors to certify they have good reason to expect patients to need two nights in the hospital. Only then will Medicare pay inpatient hospital rates for the patients' care. ... Monday, the American Hospital Association and a coalition of members filed two federal lawsuits challenging the rule and its reduction in payments to hospitals. ... Medicare's recovery auditors have been banned from auditing hospitals under the two-midnight policy until March 2015 (Carlson, 4/15).

Meanwhile --

Pioneer Press:  Medicare Data:  Minnesota Providers Collect Less On Average Than Peers
The federal Medicare health insurance program winds up paying the fare for many of the ambulance rides provided by the city of St. Paul. That's why the city in 2012 was one of the largest single recipients of the program's payments among nonhospital health care providers in Minnesota, according to data released this month by the federal government. Of more than 19,000 providers who in 2012 cared for Medicare patients in Minnesota, St. Paul's take of more than $2 million was the ninth-largest individual sum (Snowbeck, 4/15).

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Health Information Technology

Scientists Trying To Merge Millions Of Patient Medical Records

The attempt includes collecting and connecting terabytes of patient medical records from every patient recently treated at one of New York's major hospital centers. Meanwhile in Kansas, a council discusses ways to regulate so-called "secondary use" of patient health data.

The Washington Post: Scientists Embark On Unprecedented Effort To Connect Millions Of Patient Medical Records
Inside an otherwise ordinary office building in lower Manhattan, government-funded scientists have begun collecting and connecting together terabytes of patient medical records in what may be one of the most radical projects in health care ever attempted. The data -- from every patient treated at one of New York’s major hospital centers over the past few years -- include some of the most intimate details of a life. Vital signs. Diagnoses and conditions. Results of blood tests, X-rays, MRI scans. Surgeries. Insurance claims. And in some cases, links to genetic samples (Cha, 4/15).

Kansas Health Institute News Service:  KanHIT Work Groups To Study Secondary-Use Policies
Members of a council advising the state on how to govern the digital exchange of patient health information met again today to talk about ways to regulate the so-called "secondary use" of the data. As more medical providers feed their patient information to the two exchange networks operating in the state, the network managers are expected to receive more requests for access to the data from researchers, marketers, drug companies and others. Kansas is an "opt-out" state, which means patients may have their information shared or exchanged over the networks among their various participating medical providers unless they sign a form prohibiting it (Shields, 4/15).

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State Watch

Arizona Takes Another Abortion Restriction Step

Now the state has the authority to "surprise" inspect clinics without a warrant.

Reuters:  Bill Signed Allowing Surprise Inspections Of Arizona Abortion Clinics
Arizona Governor Jan Brewer on Tuesday signed into a law a bill allowing state health authorities to conduct surprise inspections of abortion clinics without first obtaining a warrant, handing another victory to abortion foes.  The Republican-backed bill, which gained final legislative approval from the state Senate last week, removes a provision from state law requiring a judge to approve any spot inspections conducted at the nine clinics in Arizona licensed to perform abortions (Schwartz, 4/15).

The Associated Press: Governor Signs Surprise Inspection Abortion Bill
Litigation is likely because a 2010 lawsuit settlement over a 2004 state law calls for a search warrant to be obtained before an inspection. ... Republicans say the change is needed to ensure that abortion clinics can be inspected without delays. They say the bill is an effort to keep women safe. Democrats say that removing the warrant requirement would open clinics to harassment ... [and] also say the bill is unnecessary, since only one warrant has been issued in the past four years (Galvan, 4/15).

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State Highlights: Mass. Can't Ban Painkiller, Judge Rules; Kan. And Health Care Compact Bill

A selection of health policy stories from Massachusetts, Kansas, Florida, Michigan, Connecticut, Maryland, Arizona, Hawaii, Missouri and Georgia.

The Washington Post: Massachusetts Cannot Ban FDA-Approved Painkiller, Judge Rules
A federal judge on Tuesday blocked an effort by Massachusetts Gov. Deval L. Patrick to ban sales of a controversial new painkiller in the state, saying the governor’s move was preempted by federal law and could harm people who need the drug for pain relief. In a five-page order, U.S. District Judge Rya W. Zobel sided with the drug’s California-based manufacturer, Zogenix, which had argued that Patrick had no right to bar a medication that the Food and Drug Administration has deemed safe and effective (Dennis, 4/15).

Kansas Health Institute:  Governor Urged To Veto Health Care Compact Bill
Gov. Sam Brownback would be taking a political risk by signing a bill that could eventually give state officials control of Medicare and other federal health care programs, Kansas Insurance Commissioner Sandy Praeger said Tuesday. Praeger, a Republican in the final year of her third and final term, said because the bill could “jeopardize” the benefits of the nearly 450,000 Kansans enrolled in Medicare signing it could alienate senior voters (McLean, 4/15).

The Miami Herald:  Miami Lawmakers Make One More Push To Extend Health Care To Immigrant Children
A bill to extend subsidized health insurance to the state’s youngest legal immigrants has stalled in the Florida Legislature, due largely to the initial $27.5 million price tag. But Rep. José Félix Díaz, a Miami Republican says the actual price is a lot lower: between $7 million and $15 million. He’s fighting to have the measure included in the state budget (McGrory, 4/15).

The Wall Street Journal: Detroit Reaches Deal With Police, Firefighter Retirees
Other terms in Tuesday's police and firefighters pact include a voluntary employee beneficiary association plan, known as a VEBA, funded by Detroit to handle retiree health care, instead of the city. These retirees would also keep some representation on the board of their pension system, over which the city had proposed increasing independent oversight. All of the city's creditors will still have a chance to vote on the city's plan, including more than 20,000 city workers and retirees. But Judge Rhodes will have the final say on its approval (Dolan, 4/15).

The CT Mirror: Medical Fraud In CT Costs Feds Millions Of Dollars
Reporters and lawyers have become the latest front in Washington’s war against medical fraud that, in some way, is unwinnable, even as it has resulted in the prosecution of doctors and drug companies in Connecticut and across the country. Last year, James P. Ralabate, a Stratford-based general practitioner, agreed to pay $700,000 as part of an agreement with the Justice Department to settle allegations that he and his company, Primary Care Associates, engaged in fraudulent billing at several nursing homes in Connecticut. Each year, medical fraudsters steal at least $70 billion from the federal government -- probably a lot more (Radelat, 4/15).

The Washington Post: Gansler Takes Aim At Maryland’s ‘Bad Spending Habits,’ Says He Would Save The State Money
[Democratic candidate for governor Douglas] Gansler said major savings could be realized through reforms to the state’s procurement process, better management of the state Medicaid program and reduction of the non-violent prison population, among other strategies (Wagner, 4/15).

The CT Mirror: CT Legislative Panel OKs Contract With Personal Care Attendants
A legislative committee approved a controversial first contract Tuesday between the state and the union representing nearly 11,000 personal care attendants who help the elderly and disabled remain in their homes. The workers, who originally gained bargaining rights through an executive order by Gov. Dannel P. Malloy, receive hourly raises ranging from 40 to 50 cents in 2014, and from 35 to 50 cents in 2015. The agreement provides funds for worker training and orientation and limited paid time off. Though rules governing the latter still must be negotiated, workers could be eligible for limited stipends -- but not full pay -- when taking scheduled time off (Phaneuf and Becker, 4/15).

Kansas Health Institute News Service:  Mental Health Task Force Report Released
A 16-member task force that spent much of the past year looking for ways to improve the state’s mental health system released its findings today. “I looked forward to reading this report and working to determine which of their recommendations we want to implement,” Gov. Sam Brownback said in a prepared statement. Included in the 38-page report are an assessment of the system’s shortcomings and more than 40 recommendations for expanding access to treatment (Ranney, 4/15).

The Associated Press:  Plan Would Change Payments 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 (4/15).

The Associated Press:  Arizona Bill Would Regulate Health Care Navigators
The Arizona Senate has given initial approval to a measure that would require extra licensing and background checks for health exchange navigators who help people buy coverage. The Senate gave initial approval to House Bill 2508 on Tuesday. The bill that would require navigators to get a license through the state Department of Insurance and to pass a criminal background check (4/15).

The Associated Press:  Hawaii Weighs Expanded Coverage For Infertility
Hawaii lawmakers are weighing whether insurance companies should be required to cover more treatments for infertility and to update a law that some say discriminates against unmarried women. The resolution (SCR 35) calls on the state auditor to study the social and economic effects of the proposal. "Women are starting their families later, which raises all sorts of concerns about access to procedures," said Rep. Della Au Belatti, chairwoman of the House Health committee, which advanced the resolution (Bussewitz, 4/15).

Stateline: States Battle Asthma As Numbers Grow
In a valley wedged between the Mississippi and Missouri rivers, St. Louis often finds itself beset by a stationary air mass that only a severe storm of some kind can dislodge. St. Louis is also an industrial city with high humidity, so it’s no wonder it usually makes the list of worst places for asthmatics to live. But the state has also pioneered advances in addressing asthma treatment and costs (Ollove, 4/16).

Georgia Health News: State Seeking More Choice In 2015 Health 
State officials said Tuesday that they plan to increase the number of insurers and health plan options for state employees and teachers next year. The State Health Benefit Plan (SHBP) has been a target of fierce criticism since Jan. 1. That’s when changes to its benefit design, plus the use of just one insurer, sparked widespread complaints about a lack of choice of insurance plans and higher health care costs. Now, though, the Department of Community Health is asking for proposals for a second statewide insurer to offer a high-deductible health plan, a Medicare Advantage plan for retirees, and a statewide HMO (Miller, 4/15).

Georgia Health Plans: Standalone Rural ERs Face A Serious Hurdle
Gov. Nathan Deal’s plan to help financially ailing rural hospitals, announced last month, has drawn strong praise from legislators and health industry leaders. Deal proposed a change in licensing rules to permit a struggling rural hospital, or one that recently closed, to offer downsized services that would include an emergency department. But a drawback has emerged – one that, if unchanged, may lower the chances of these freestanding ERs being built (Miller, 4/15).

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Editorials and Opinions

Viewpoints: Cooking The Census Books; Immigrants Left Off Health Law; Abortion Still A 'Tripwire'

The Wall Street Journal: Cooking The ObamaCare Stats
You can't manage what you don't measure, as the great Peter Drucker used to say, and for the White House that seems to be the goal. Out of the blue, the Census Bureau has changed how it counts health insurance—at the precise moment when ObamaCare is roiling the insurance markets (4/15). 

Bloomberg: Is Obama Cooking The Census Books For Obamacare?
The New York Times reports that the Barack Obama administration has changed the [Census] survey so that we cannot directly compare the numbers on the uninsured over time. ... This is the biggest policy debate of the last 10 years, and these data are at the heart of that debate. It is implausible that everyone involved somehow failed to notice that they were making it much harder to know the effect of this law on the population it was supposed to serve (Megan McArdle, 4/15).

USA Today: Obamacare Doesn't Help Immigrants
I can't remember the last time I had a medical check-up; I'm 20, and it's been at least five years. When I was a little kid in South Los Angeles, my mother would only take my older sister and me to the doctor when we were already sick; whether we had a fever or any other illness, every visit cost $100, including treatments. Then a neighbor informed my mom of a community clinic that offered free visits for low-income families — but only, again, if we were already sick. The clinic was our best option because as undocumented immigrants we had no insurance and weren't eligible for benefits from state programs (Miguel Molina, 4/15).

Arkansas Times: Tom Cotton Avoids Taking Stance On Private Option
The private option — the state's unique plan using Medicaid funds to purchase health insurance for low-income Arkansans — has provided coverage to 150,000 Arkansans (and counting). The funding mechanism for the private option is Obamacare, and repealing Obamacare is at the top of Rep. Tom Cotton's agenda. Repeal Obamacare, and the private option dies with it. At today's presser, I asked Cotton about this. "We would repeal Obamacare and replace it entirely with many reforms for our health care program," Cotton said. I asked whether he had a specific replacement plan which would cover all the folks who would lose their coverage if Cotton succeeded in repealing the law. He trotted out some tried-and-true Republican talking points which would do no such thing, such as allowing insurance to be sold across state lines (David Ramsey, 4/13).

The Richmond Times-Dispatch: In Health Fight, Both Sides Told What They Want To Hear
At a town hall-type meeting Monday night organized by three Republican legislators who represent rural Louisa County, speaker after speaker questioned or criticized a proposal to bring as many as 400,000 uninsured Virginians under Obamacare through a private market set up by the state. In fact, after the lawmakers reprised their wins and losses during the winter session of the General Assembly, the coverage plan was the only topic the audience wanted to talk about. The scheme — caught up in the latest budget impasse that threatens a state government shutdown unless there’s a deal by June 30, the final day of the spending cycle — would be paid for over the next four years with nearly $7 billion from Medicaid, a health care program for the poor. Welcome to the echo chamber (Jeff E. Schapiro, 4/15).

Philly.com: Corbett Medicaid Plan Puts Pennsylvanians At Breaking Point Over Cuts And Delays
With the federal public comment period ending this week on the Corbett Administration's Healthy PA proposal, Pennsylvanians delivered a loud and clear message to the Centers for Medicare and Medicaid. Healthy PA is overly complex, overly complicated and unnecessary. The best choice for Pennsylvania taxpayers and uninsured workers is to join all of our surrounding states by expanding Medicaid immediately (Antoinette Kraus, 4/16).

New Orleans Times-Picayune: Louisiana Taking Away Medicaid Lifeline For Disabled, Other Vulnerable Residents
It's well known that Gov. Jindal steadfastly opposes expanding Medicaid in the state under the Affordable Care Act, and that the Legislature voted against expansion in 2013. This is misguided, as Medicaid expansion would cover as many as 300,000 uninsured residents, with 100 percent of the costs picked up by the federal government through 2016 and at least 90 percent thereafter. But less widely known is that Medicaid in Louisiana is actually shrinking, through termination of programs and tighter eligibility requirements. In the state's view, since the Affordable Care Act's private insurance marketplace will cover people earning more than the federal poverty level, many people on Medicaid should pick up insurance on marketplace exchanges. But it's not that simple (Megan McLemore, 4/15).

The CT Mirror: Accessing Mental Health Care Still A Challenge In CT’s Rural Areas
The Affordable Care Act has brought ongoing changes in health care, but there are still issues surrounding those living with mental illness, particularly in rural areas, where there is a significant lack of mental health care available. In rural populations, the rates of depression exceed those in urban populations, and suicide rates among teenagers and adults are significantly higher in rural areas than in urban areas. As a mother and nurse living and working in rural of Connecticut, I have found that obtaining mental health services can be a time-consuming, frustrating process (Holly Atkinson, 4/15). 

Fox News: Kathleen Sebelius Quits: Can You Spell Scapegoat?
Dictionary.com offers two definitions for scapegoat: "1. A person or group made to bear the blame for others or to suffer in their place; 2. Chiefly biblical. A goat let loose in the wilderness on Yom Kippur after the high priest symbolically laid the sins of the people on its head. Lev. 16:8,10,26." Both definitions seem to fit last week's announcement of the "resignation" of Kathleen Sebelius, secretary of Health and Human Services, who presided over the disastrous rollout of the government's website, healthcare.gov, which was supposed to provide easy access for people who wished to sign up for ObamaCare (Cal Thomas, 4/15).

On other health issues -

The New York Times: Abortion Endures As A Political Tripwire
Why is there such a difference in the durability of two foundational issues of American conservatism: gay marriage and abortion? Same-sex marriage burst onto the political scene in the early 1990s, lasted through the mid-2000s, and is now quietly fading. Abortion, as a political call to arms, has been around twice as long and shows no signs of disappearing (Thomas B. Edsall, 4/15). 

The Des Moines Register: Medicare Pay Info Helps With Accountability
For the first time since the 1970s, the federal government has released data on Medicare payments to individual physicians. The media have focused on a few doctors who collected from $10 million to $20 million in 2012 from the government health insurance program for seniors. About 2,000 providers were reimbursed at least $2 million. The information certainly does raise eyebrows (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.