Daily Health Policy Report

Thursday, April 17, 2014

Last updated: Thu, Apr 17

KHN Original Reporting & Guest Opinion

Health Reform

Health Care Marketplace


State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

VA, California Panels Urge Costly Hepatitis C Drugs For Sickest Patients

Kaiser Health News staff writer Julie Appleby reports: “Doctors should consider expensive new hepatitis C drugs for patients with advanced liver disease, including those awaiting transplants, but ask most others to wait for drugs in development, the Department of Veterans said Wednesday” (Appleby, 4/17). Read the story.

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Capsules: Hospitals Get Into Doctor Rating Business; Hospital Visits Fell When Seniors Got Drug Coverage

Now on Kaiser Health News’ blog, Phil Galewitz reports about hospitals and patient ratings: “After some doctors at University of Utah Health Care noticed scathing online reviews about themselves in 2012, the hospital system decided the best way to respond was by posting its patients’ ratings of physicians on the hospital’s own website. The hospital was already randomly surveying patients about their experiences with physicians” (Galewitz, 4/17). 

Also on Capsules, Jay Hancock reports on new research regarding Medicare Part D: “Researchers at the University of Illinois and the Johns Hopkins University have made the broadest test yet of Medicare Part D prescription drug program’s promise — that covering drugs would keep seniors out of the hospital. Comparing national records from before and after 2006, when Part D kicked in, they found that drug coverage was associated with an 8 percent drop in hospital admissions and nearly as much in hospital-cost savings — an amount they calculate to be $1.5 billion a year” (Hancock, 4/16). Check out what else is on the blog.

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Adding Dental Care Contrasts With Mo. Legislature's Opposition To Medicaid Expansion

The St. Louis Post-Dispatch's Virginia Young, working in partnership with Kaiser Health News, reports: "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). Read the story.

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Political Cartoon: 'Pant-Up Demand?'

Kaiser Health News provides a fresh take on health policy developments with "Pant-Up Demand?" By Mike Peters.

Here's today's health policy haiku: 


Is it sweet revenge
to run for that Senate seat?
Ask Sebelius.

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

Health Law Strategies Emerge For Congressional Campaigns

Some Democrats are pointing to recent good news about the health law and urging candidates in tough races to embrace the overhaul. At the same time, GOP leaders say criticism of the law will resonate with voters.  

The Associated Press: Defend ‘Obamacare’ Unabashedly, Some Democrats Say
With enrollments higher than expected, and costs lower, some Democrats say it’s time to stop hiding from the president’s health care overhaul, even in this year’s toughest Senate elections. Republicans practically dare Democrats to embrace “Obamacare,” the GOP’s favorite target in most congressional campaigns. Yet pro-Democratic activists in Alaska are doing just that, and a number of strategists elsewhere hope it will spread (4/17).

The Wall Street Journal: GOP Fall Strategy: Slam Health Law
Republican leaders are telling the party's House members that persistent criticism of the federal health-care law is the best path to victory this fall regardless of how the law's implementation evolves ahead of the November elections. Leaders of the congressional wing of the party say opposition to the Affordable Care Act will resonate with the voters most likely to go to the polls, and they are encouraging House members, currently at home for a two-week recess, to keep up their attack (Crittenden, 4/16).

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Will Sebelius Run?

News outlets report that outgoing Health and Human Services Secretary Kathleen Sebelius is contemplating a run for the Senate in Kansas.

The New York Times: Sebelius Said To Weigh Run For Kansas Senate Seat
In her darkest hour last fall, Kathleen Sebelius suffered one of the deepest cuts from an old family friend who accused her of "gross incompetence" over the rollout of the Affordable Care Act and demanded that she resign as secretary of health and human services. Now she is weighing revenge. Ms. Sebelius is considering entreaties from Democrats who want her to run against that old friend, Senator Pat Roberts, Republican of Kansas (Peters, 4/16).

Reuters: Obama's Departing Health Chief Mulls U.S. Senate Run: Report 
Departing Health and Human Services Secretary Kathleen Sebelius, who took withering criticism over the botched rollout of President Barack Obama's signature healthcare law, is considering a run for the U.S. Senate in Kansas, The New York Times reported on Wednesday. Sebelius, a former Kansas governor, is weighing overtures from Democrats who want her to run for the Senate seat occupied by Republican Pat Roberts, the newspaper said, quoting unidentified Democrats (Lawder and Morgan, 4/16).

Meanwhile, an update on Louisiana Democrat Sen. Mary Landrieu's race -

CNN: Landrieu Faces Her Toughest Political Storm To Stay In Senate
Louisiana Democrat Sen. Mary Landrieu is in the middle of a storm. She is beset by well-funded forces on the right who sense the Gulf Coast Democrat's vulnerability in trying to defend a Senate seat in a red state. On the left, she is trying to avoid being pulled down by the undertow of a president whose decline in approval ratings and controversial health care reform law might not play well with her state's conservative sensibilities. ... Republicans have vowed to hang Obamacare like a proverbial albatross around the necks of vulnerable Democrats like Landrieu. For example, the conservative super-PAC Americans for Prosperity, funded by the Koch brothers, a pair of wealthy industrialists, has spent more than $3 million on ads in Louisiana highlighting Landrieu's 2010 vote for Obamacare (Abdullah, 4/16).

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Actuary Says Stats Point To Smaller Premium Increases Next Year

Also, the disparities in insurance coverage between states that embraced the health law and those that did not are more closely examined. And many Iowans will get to keep their pre-health law coverage.

USA Today: New Data Signal Smaller Jump In Health Care Costs
Statisticians working with insurers to project next year's insurance premium rates say they expect to see an average increase of about 7 percent, well below the feared double-digit increases making recent headlines. "The double-rate increases we've been hearing are probably exaggerated," says Dave Axene, a fellow with the Society of Actuaries. … Axene says that as insurers dig through the new health exchange enrollees to figure out their ages and health conditions to determine next year's premiums, he expects an overall increase of 6 percent to 8.5 percent (Kennedy, 4/16).

CBS News: Obamacare's Impact: Differences Emerge Between States
Two weeks after the close of open enrollment on the new Obamacare marketplaces, various surveys and studies released have given different estimates of the Affordable Care Act's impact on the uninsured. One clear finding, however, is the disparity between states that have more openly embraced the controversial health law and those that haven't. … States run by Republicans tended to rely on healthcare.gov and have been more likely to reject the Medicaid expansion. More data is needed to assess just how the new law is impacting health coverage across the nation. However, two studies released this week illustrate how it may affect the coverage rates in red states versus the coverage rates in blue states (Condon, 4/17).

The Fiscal Times: ACA-Friendly States Are Insuring More People
In another sign that the Affordable Care Act is working as intended, states that have embraced the president’s signature health care law are reducing their uninsured rates faster than those that have not. Gallup’s latest survey shows states that have set up their own exchanges and expanded their Medicaid programs saw their uninsured rates for those 18 and older drop to an average 13.6 percent in the first quarter of 2014. That’s about a 2.5 percent year-over-year drop (Ehley, 4/16).

Los Angeles Times: Obamacare Effects Are Bigger Than Expected, Poll Finds
President Obama's health law has led to an even greater increase in health coverage than previously estimated, according to new Gallup survey data, which suggests that about 12 million previously uninsured Americans have gained coverage since last fall. That is millions more than Gallup found in March and suggests that as many as 4 million people have signed up for some kind of insurance in the last several weeks as the first enrollment period for the Affordable Care Act drew to a close (Levey, 4/16).

The Des Moines Register: 330,000 Iowans May Keep Pre-Obamacare Insurance Plans
About 330,000 Iowans will be able to retain old health-insurance policies that fail to meet all rules of the Affordable Care Act, state leaders announced today. Iowa has decided to go along with a recommendation from the Obama administration to allow extensions of the plans through 2016 (Leys, 4/16).

And some say recent changes to the Census could make it easier to view how the health law has affected Americans, not harder --

The Washington Post: Census Bureau: Question Changes Make It Easier To Assess Health Insurance Law
Concerns, first reported in the New York Times, have arisen that changes in the phrasing of one survey’s questions may make future comparisons more difficult. Critics of the health-care law have accused the Census Bureau of working to fudge the numbers so the White House can claim more success than is merited. [The director of the Census Bureau John H.] Thompson said that Census Bureau demographers had been preparing for many years to modify the questions and that the changes should make it easier to measure the law’s impact, not harder (Morello, 4/16).

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Va. Small Business Owners Press GOP To Expand Medicaid

More than 400 have signed a letter to Virginia's House speaker asking Republicans to drop their opposition to the effort. Meanwhile, Utah's governor says he is encouraged about his state's prospects for its plan after talks with federal officials, and a Florida senator is trying to find a way around the logjam there.

The Associated Press: Va. Small Business Owners Advocate For Medicaid
A group of small business owners want Virginia House Republicans to drop their opposition to expanding publicly funded health care to low-income residents. Lee Russell, a butcher from Fredericksburg is scheduled to deliver a letter Wednesday signed by more than 400 current and former small business owners to House Speaker William J. Howell (4/16).

The Associated Press: Utah Gov.: Medicaid Negotiations Moving Forward 
Utah's low-income residents are a step closer to buying private insurance through federal subsidies, Gov. Gary Herbert said Wednesday. Herbert, who proposes a state Medicaid alternative to help insure 110,000 residents in the private market instead of the government program, said he’s encouraged by talks with federal officials earlier this week (Knox, 4/16).

Miami Herald: Sen. Bill Nelson Seeks Local Solution To Expand Medicaid In Florida
Expanding Medicaid to cover thousands of uninsured Floridians has mostly been ignored by Republicans during this year’s legislative session, but U.S. Sen. Bill Nelson, a Democrat, is making a last-ditch effort to get it done. Medicaid is a joint state-federal program, though most of the expansion called for under the Affordable Care Act would be funded by Washington (Mitchell, 4/16).

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MNsure Picks Deloitte To Revamp Exchange

Other state developments include the District of Columbia's decision to extend enrollment until April 30, New York's announcement that nearly 1 million residents enrolled in coverage  and a Georgia report that only about half of the 220,000 enrollees in that state have paid their first month's premiums.

Pioneer Press: MNsure Chooses New Vendor To Oversee Website Fixes 
For help figuring out how to fix its troubled website, MNsure is paying $4.95 million to a New York firm that has successfully created health insurance exchanges in four other states. Deloitte LLP designed and developed online insurance marketplaces that are working relatively well in Connecticut, Kentucky, Rhode Island and the state of Washington, state officials said (Snowbeck, 4/16).

Minnesota Public Radio: Deloitte Named To Revamp MNsure Exchange
MNsure's board of directors has hired a new general contractor to revamp its troubled health insurance exchange at a cost of nearly $5 million. Deloitte Consulting, Minnesota's original choice to build MNsure will oversee the $100 million project for the next nine months. MNsure interim CEO Scott Leitz says Deloitte has two key responsibilities: to advise agency leaders on how much of the current system can be salvaged for the future and to make the site operate as well as it can currently (Stawicki, 4/16).

The Associated Press: DC Extends Deadline To Enroll In Health Plans
More than 2,000 District of Columbia residents either enrolled in a health insurance plan or were found to be eligible for Medicaid after the official end of open enrollment on March 31, but a spike in call volume this week led to another extension of the deadline, officials said Wednesday. The district was one of a handful of states that joined President Barack Obama’s administration in offering a grace period into April for people who started applications but didn’t finish them by the end of March (4/16).

The Associated Press: New York Says 960,000 Enrolled In Health Exchange 
More than 960,000 New Yorkers signed up for health insurance through the state exchange, officials said Wednesday. About 94,000 of those finished applying in the two weeks after the original March 31 deadline, according to figures released by the exchange's executive director, Donna Frescatore. That leaves the program about 140,000 shy of a goal of 1.1 million enrollees by 2016, a sign of the public's "tremendous interest" in it, Frescatore said (4/16).

The Oregonian: Oracle Blasts Oregon For Spreading Cover Oregon 'False Narrative'
Oracle Corp. has accused the state of Oregon of misleading the press and the public with a "false narrative" about who's at fault for the state's health exchange technology disaster. Oracle President Safra Catz said in a letter to Cover Oregon that the state, and not Oracle, deserves blame. The state made the decision to serve as its own systems integrator (Manning, 4/16).

Georgia Health News: Georgia Exchange Applications Hit 220,000
Georgia insurers received more than 220,000 applications for health coverage in the Affordable Care Act’s exchange as of the official federal deadline of March 31, state officials said Wednesday. Insurance Commissioner Ralph Hudgens, though, said premiums have been received for only 107,581 of those policies, which cover 149,465 people. “Many Georgians completed the application process by the deadline, but have yet to pay for the coverage,” Hudgens said in a statement Wednesday (Miller, 4/16).

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Health Care Marketplace

UnitedHealth's 1st Quarter Profit Falls 7.8%

Officials blame part of the downturn on reductions in federal funding for the Medicare Advantage program and new taxes resulting from the health law.

The Wall Street Journal: UnitedHealth's Profit Falls Amid Health-Law Changes
UnitedHealth Group Inc. on Thursday said its first-quarter earnings fell 7.8%, hurt by government cuts to Medicare Advantage programs and new taxes resulting from the Affordable Care Act. The health insurer also reported an increase in members year over year but a decrease sequentially. UnitedHealth is the first major health insurer to report its results for the latest quarter, the first period to reflect the Affordable Care Act. Planned reductions in government funding for Medicare Advantage and other provisions of the health law were expected to affect the managed-care provider's performance this year. UnitedHealth reported a profit of $1.1 billion, or $1.10 a share, down from $1.19 billion, or $1.16 a share, a year earlier. Revenue rose 4.5% to $31.7 billion (Stynes, 4/17).

The Associated Press: UnitedHealth’s 1Q Profit Tumbles 8 Percent
UnitedHealth Group’s first-quarter net income slid 8 percent as funding cuts to a key product and costs imposed by the health care overhaul dented the health insurer’s performance. The Minnetonka, Minn., company said Thursday the overhaul and government budget cuts added about 35 cents per share in costs during the quarter. The federal law aims to provide coverage for millions of uninsured people, but it also trims funding for Medicare Advantage plans, changes how insurers can write their coverage and adds an industry-wide tax, which is not deductible (4/17).

Marketplace: A Bill Of Health For Insurance Companies
Big insurance companies report quarterly earnings over the next two weeks, starting with United Healthcare today. Thanks to new customers brought in by the Affordable Care Act, 2013 was a good year for health insurance companies.  The extended deadlines, which ended just this week, may provide more good news: More enrollment, more premiums, more revenue.  Now comes the hard part (Weissmann, 4/17).

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Industry Coalition Pushes For Price Transparency

A report put out Wednesday by a coalition of hospitals, insurers, doctors and consumer advocates recommends how providers can make information available about the costs of various tests and procedures. An accompanying guide tells consumers how to find it.  

The Washington Post’s Wonkblog: Price Transparency Stinks In Health Care. Here’s How The Industry Wants To Change That.
There's been much written in the past year about just how hard it is to get a simple price for a basic health-care procedure. The industry has heard the rumblings, and now it's responding. About two dozen industry stakeholders, including main lobbying groups for hospitals and health insurers, this morning are issuing new recommendations for how they can provide the cost of health-care services to patients (Millman, 4/16).

Politico Pro: Report Pushes For Pricing Transparency In Health Care
Key players in the health care industry want to help consumers find out how much they will pay for a medical visit or procedure — well before it takes place. A report released Wednesday by a coalition of hospitals, insurers, doctors and consumer advocates recommends the ways providers can make that information easily available. An accompanying guide tells consumers how to go about getting it. The documents are a response to Americans’ growing demand to be able to shop for health care much like they shop for everything else, especially as they pay an ever-larger share of health costs out of pocket (Norman, 4/16).

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Skin Docs Prescribe Costlier Drugs After Free Samples

In other news, panels recommend a costly hepatitis C drug for the sickest patients, and cancer doctors will compare the value of costly cancer drugs.

NPR: Free Drug Samples Prompt Skin Doctors To Prescribe Costlier Meds
Every "free" sample comes with a price. Dermatologists who accept free tubes and bottles of brand-name drugs are likelier to prescribe expensive medications for acne than doctors who are prohibited from taking samples, a study reports Wednesday (Doucleff, 4/16).

Kaiser Health News: VA, California Panels Urge Costly Hepatitis C Drugs For Sickest Patients
Doctors should consider expensive new hepatitis C drugs for patients with advanced liver disease, including those awaiting transplants, but ask most others to wait for drugs in development, the Department of Veterans said Wednesday (Appleby, 4/17).

Bloomberg: Cancer Doctors Plan To Compare Value Of Expensive Drugs 
The world’s largest organization of cancer doctors plans to rate the cost effectiveness of expensive oncology drugs, and will urge physicians to use the ratings to discuss the costs with their patients. The American Society of Clinical Oncology is weighing efficacy, side effects and price using an algorithm to determine the relative value of drugs, focusing first on therapies for advanced cases of lung and prostate cancer and for multiple myeloma, said Richard Schilsky, the group’s chief medical officer (Damouni and Langreth, 4/17).

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Medicare Pays Doctors Even After They're Sanctioned

A ProPublica report finds that the agency continued paying doctors, pharmacists and other health professionals even after they were charged with bilking the program. Meanwhile, a report recommends that Medicare pay hospitals less for low-risk outpatient surgeries.

ProPublica: Even After Doctors Are Sanctioned Or Arrested, Medicare Keeps Paying 
In August 2011, federal agents swept across the Detroit area, arresting doctors, pharmacists and other health professionals accused of running a massive scheme to defraud Medicare. The following month, several of those arrested —including psychiatrist Mark Greenbain and podiatrist Anmy Tran —were suspended from billing the state's Medicaid program for the poor ... But the indictment and Medicaid suspensions didn't deter Medicare from continuing to allow the doctors to treat elderly and disabled patients — and billing taxpayers for their services (Ornstein, 4/16).

Modern Healthcare: Cut Prices For Low-Risk Hospital Outpatient Surgeries: HHS Report 
Medicare should pay hospitals less for low-risk outpatient surgeries, the program's fiscal watchdog suggests in a report published this morning (Carlson, 4/17).

Kaiser Health News: Capsules: Hospital Visits Fell When Seniors Got Drug Coverage
Researchers at the University of Illinois and the Johns Hopkins University have made the broadest test yet of Medicare Part D prescription drug program’s promise — that covering drugs would keep seniors out of the hospital. Comparing national records from before and after 2006, when Part D kicked in, they found that drug coverage was associated with an 8 percent drop in hospital admissions and nearly as much in hospital-cost savings — an amount they calculate to be $1.5 billion a year (Hancock, 4/16).

Meanwhile, a conservative group says seniors will see Medicare Advantage benefit reductions even though the government reversed proposed rate cuts -

National Journal: Study: Cuts To Medicare Advantage Top $1,500 Per Senior
Obamacare's Medicare Advantage cuts will lead to benefit reductions of about $1,500 per beneficiary, according to a new analysis from a conservative think tank. The American Action Forum, founded by former Congressional Budget Office Director Douglas Holtz-Eakin, said almost all Medicare Advantage beneficiaries will feel the effect of cuts to the program. The federal Medicare agency recently backed off a proposal to make additional cuts to Medicare Advantage—the second year in a row it has proposed and then abandoned such reductions. But the AAF analysis says the reductions mandated in the Affordable Care Act will still affect benefits for most seniors who use the program (Baker, 4/17). 

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State Watch

State Highlights: N.Y. Court Ends Taxi Health Care Fund

A selection of health policy stories from New York, Maryland, Colorado and Massachusetts.

The Washington Post’s Wonkblog: New York Court Guts A Groundbreaking Health-Care Fund That Would Have Changed Taxi Drivers’ Lives
Until late last week, help seemed close. In 2012, the city's Taxi and Limousine Commission had voted to take six cents on every fare for a fund that would help with exactly these kinds of situations, providing upwards of $300 per week in assistance as soon as a driver could produce a doctor's note. The money started flowing in February, and Singh was just waiting for newly installed Mayor Bill DeBlasio to greenlight a contract for the fund's administrator, who could then begin doling out cash. And then, on Friday, Singh's hopes fizzled: A New York State Supreme Court judge struck down the TLC's rule, in a decision that may limit how independent workers -- who are exposed to the most economic risk and enjoy the fewest legal protections -- can collectively organize for benefits that are otherwise beyond their reach (DePillis, 4/16).

The Denver Post: Colorado's Monitoring Of Psychotropics Trails Other States' Efforts
Colorado lags other states that established policies years ago to reduce the use of powerful psychotropic drugs by children in foster care. Since 1992, Illinois has contracted with a medical school to review all prescriptions for children in foster care and to advise state officials on whether to allow the medication (Osher and Brown, 4/16).

The Washington Post: Gansler Calls Health Care ‘A Right’ In His Latest TV Ad For Maryland Governor
Maryland Democratic gubernatorial hopeful Douglas F. Gansler is keeping the focus on health care in his latest television ad. In the 15-second spot, Gansler, Maryland’s attorney general, tells viewers that “health care is a right” (Wagner, 4/16).

The Boston Globe: New Scrutiny For Bridgewater State Hospital After Complaints
A federally funded watchdog group has launched an investigation into the alleged abuse and neglect of inmates at Bridgewater State Hospital, interviewing staff and inmates this week about reports that guards and clinicians are illegally putting mentally ill men into physical restraints and isolation cells. Lawyers from the Disability Law Center, designated under federal law to investigate complaints about the abuse of disabled people, converged on the medium-security prison Tuesday to meet with administrators, gather records, and meet with patients, the Department of Correction confirmed Wednesday. … If Disability Law Center officials conclude they have found wrongdoing, they could file a federal lawsuit against the state to force changes (Rezendes, 4/17).

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Weekend Reading

Longer Looks: HIV Epidemic In The Deep South; Planning For Alzheimer's

Every week KHN reporter Marissa Evans finds interesting reads from around the Web. 

The New Yorker: H.I.V.'s Grip On The American South
One of the strangest things about the H.I.V. epidemic in the Deep South—from Louisiana to Alabama to Mississippi—is how easily most Americans have elided it, choosing instead to imagine that the disease is now an out-there, elsewhere epidemic. It's a plague from some anterior time, some exterior continent .... Only recently, in the face of unrelenting statistics about the convergence of H.I.V./AIDS rates in the Deep South with almost every other relevant public-health risk—from obesity to heart disease and diabetes—have many of the mega-funders taken a different tack. They are learning that the people doing the grunt work of prevention, education, and treatment often do so in an environment of fierce hardships, the most obvious of which is a lack of funding (Sarah Stillman, 4/10). 

​Health Affairs: It's Always Too Soon Until It's Too Late: Advanced Care Planning With Alzheimer's
My sister, who had gotten 700s and 800s on her SATs and graduated from Radcliffe magna cum laude, would sit in a room, subtracting by seven, judging spatial relations, and repeating dates. The slow decline on those tests didn't begin to show the behavior we saw in real life. They didn't mark the deteriorating house, the bills unpaid, and the struggle to find her way to my home. Nevertheless, she would say pridefully, defensively that there was nothing to worry about. ... On this day, though, a new doctor finally used the "A" word. ... When I got home, I told my husband that finally Jane had been told and finally she’d understand. Surely we could talk about it. Surely we could make some plans for her care. But of course the next day, she didn't remember (Ellen Goodman, 4/10).

The New Republic: Today's Obamacare Conspiracy Theory And Why You Should Be Skeptical 
Figuring out whether Obamacare is reducing the number of people without health insurance is obviously a very important question. And the preliminary data—from independent organizations like Gallup and the Rand Corporation—isn't precise. Those surveys show that more people have insurance because of the law, but they don't reliably say how many or what kind of insurance people have. That requires more comprehensive, more thorough surveys—the kind that the federal government has traditionally provided (Jonathan Cohn, 4/15). 

Matter: The Silencing Of The Deaf
Parenting is full of big decisions. But in the first year or so of Ellie's life, when other parents are focused on helping their kids to walk and talk, Christine and Derek had to think about an issue that many parents never even contemplate: They had to decide which culture their daughter should be a part of. Ellie could join their world, the hearing world, if she received cochlear implants. Yet implants don't work perfectly. ... What's more, implants might cut Ellie off from a community that, some would argue, is her birthright: the Deaf world, where lack of hearing is an identity to be celebrated, not a disability to be cured (Sujata Gupta, 4/10).

Slate/Bulletin of The Atomic Sciences: A Brief, Terrifying History Of Viruses Escaping From Labs
The public health danger posed by potentially pandemic-causing viruses escaping from laboratories has become the subject of considerable discussion, spurred by "gain of function" experiments. The ostensible goal of these experiments—in which researchers manipulate already-dangerous pathogens to create or increase communicability among humans—is to develop tools to monitor the natural emergence of pandemic strains. Opponents, however, warn in a variety of recent research papers that the risk of laboratory escape of these high-consequence pathogens far outweighs any potential advance (Martin Furmanski, 4/11).

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Editorials and Opinions

Viewpoints: Obamacare Still Has More Challenges; GOP Needs To Help Make Law Work; Census Change Is Not Obama's Decision

Los Angeles Times: No Need For A Rush To Judgment On Obamacare
The first open enrollment period under the Affordable Care Act ended this week with roughly 7.5 million people obtaining policies through the new state insurance exchanges, including more than 1.3 million at Covered California. That's an amazing and welcome result, considering how badly many of the exchanges stumbled when sign-ups began in October. Nevertheless, it's far too early to judge the success or failure of the healthcare law, given that key tests of the program's sustainability have yet to be passed (4/16). 

Des Moines Register: Focus Needs To Be Making Obamacare Work
Assuming [Sylvia Mathews Burwell] is confirmed for the position, she should avoid getting mired down in the politics of Obamacare. While she must work to gain public support for the law, her focus must be on working through the problems faced by some consumers, state agencies and businesses. She will have to continue to negotiate with states like Iowa that implemented complicated alternatives to expanding Medicaid. The next HHS director must focus on moving forward. And members of Congress need to do the same. Some politicians don't seem to understand that Obamacare isn't about one person. It's not about the president. It's not about Sebelius. And it's not about Chuck Grassley. It's about creating a health care system in this country that works for everyone, including the more than 7 million Americans who have recently gained coverage under the law (4/16).

The New York Times' Economix blog: Stealth Taxes Are Still Income Taxes
For most Americans, the individual income tax returns they have filed over the last days and weeks are not much different than they were 10 years ago. But, in fact, taxes have changed dramatically over that period, behind the scenes and in support of health reform (Casey B. Mulligan, 4/16). 

The New York Times' Taking Note: The Birth Of A Conspiracy Theory
For years now some on the right have speculated that the Obama administration is trying to politicize the national census. Yesterday, Noah Rothman argued on Mediaite that the theory was proven correct by a New York Times article about changes in the way the Census Bureau plans to ask about health insurance coverage. ... But the article that Mr. Rothman cites, by Robert Pear, doesn't support the theory. Mr. Pear reports that census statisticians had been trying to change the questions about health insurance for more than a decade (in other words, before Mr. Obama was president) because … wait for it … the old questions were not accurate (Andrew Rosenthal, 4/16). 

The Fiscal Times: Obamacare: Kill Or Cure For Health Care Job Market?
During the Great Recession and in the years that followed, the job market in the U.S. had its legs taken out from under it. Millions of jobs disappeared, across virtually every sector of the economy but one. Throughout even the worst months of the crisis, the health care sector added jobs as reliably as sunrise and sunset. Last year, however, even as the broader economy showed signs of slowly reviving itself, the health care sector began to stumble (Rob Garver, 4/17).

Newark Star-Ledger: Medicaid Recipients May Have Their Estates Billed Down The Road
Opponents have nicknamed one provision of Medicaid the "Obamacare death debt." They are referring to the Medicaid Estate Recovery Program. And while it does exist, it predates Obamacare by two decades. The Medicaid Estate Recover Program is how the federal government is repaid for money it spent on a lengthy stay in the nursing home. If someone was on Medicaid, the government can, in some instances, put a lien on his estate after his death (Kathleen O'Brien, 4/16).

On other health issues -

The Washington Post: Mental Health Care In The U.S. Needs A Check-Up 
The Affordable Care Act has significantly increased insurance coverage for mental health care. But that may not be enough to expand access to sparse mental-health-care resources. Besides, the government is already spending billions on mental illness treatment; it has an interest in making sure taxpayers get results. Rep. Tim Murphy (R-Pa.) has a bill that would do so. The Helping Families in Mental Health Crisis Act is more comprehensive than other recent efforts to reform the system and perhaps has the brightest prospects in a divided Congress (4/16). 

The Washington Post: Heed Massachusetts's Cry For Help In Opioid Regulation
Massachusetts has lost its bid to ban a new prescription opioid pain medication known as Zohydro. A federal judge ruled Tuesday that only the Food and Drug Administration can decide what medications are safe and effective enough for sale in the United States. As a matter of law, the judge, Rya Zobel, was almost certainly correct; Congress has had supremacy in this particular field ever since the 1906 Pure Food and Drug Act. As a matter of policy and morality, however, Massachusetts and its Democratic governor, Deval Patrick, were in the right (Charles Lane, 4/16). 

The Wall Street Journal: California's Malpractice Ruse
One of California's few emollients for employers is its limit on "pain and suffering" medical liability judgments, which has improved access to medical care and held down health costs. But look out: Plaintiffs lawyers abetted by Attorney General Kamala Harris are now trying to gut the cap with a ballot initiative dressed in patient-protection garb (4/16). 

The Dallas Morning News: Making Dallas A Healthy Place To Live
Dallas County provides a number of complex public health challenges that are seen by the thousands of Parkland employees as opportunities to make meaningful impact in the lives of our residents. We have one of the highest uninsured rates in the country. Dallas County’s population is becoming older and more diverse, creating the need to rethink how we deliver services and maintain cultural competency among our health care professionals. Disparities found within southern Dallas County and pockets of northern suburban areas mean we must do more to reach residents living in parts of the county known as health care deserts (Fred Cerise, 4/16).

The Fiscal Times: Medicare Advantage Isn't Reducing Health Care Costs
Bowing to election-year and industry pressures, the Obama administration this month quietly rescinded cuts to the Medicare Advantage program and boosted subsidies to insurers. If the administration, and Congress for that matter, were serious about attacking health care costs, this was a turn into a blind alley (John F. Wasik, 4/16).

Deseret News: 'Progress Indeed' In The Unusually High Medicare Charges Cases
The late Supreme Court Justice William O. Douglas famously stated, "Sunlight is the best disinfectant." Last week, the Centers for Medicare & Medicaid Services (CMS), in a historic move, applied the transparency disinfectant to the ailing Medicare program by publishing comprehensive physician payment data for the first time in nearly 35 years. Release of this information is a boon for taxpayers, a treasure trove for researchers, and a nightmare for physicians involved in demonstrably wasteful, fraudulent or abusive Medicare billing practices. It is a triumph for transparency that I applaud wholeheartedly (Dan Liljenquist, 4/17).

The New England Journal Of Medicine: Abolishing Mammography Screening Programs? A View From The Swiss Medical Board
It is easy to promote mammography screening if the majority of women believe that it prevents or reduces the risk of getting breast cancer and saves many lives through early detection of aggressive tumors. We would be in favor of mammography screening if these beliefs were valid. Unfortunately, they are not, and we believe that women need to be told so. From an ethical perspective, a public health program that does not clearly produce more benefits than harms is hard to justify (Nikola Biller-Andorno and Peter Jüni, 4/16).

The New England Journal Of Medicine: Comparative Effectiveness Questions In Oncology
The high price of cancer drugs is unsustainable, and the need for less costly alternatives is greatest in cases where the benefit of new therapies is marginal (i.e., the cost-effectiveness ratio is mostly unfavorable). The five comparisons that we highlight suggest an underappreciated consequence of the prices themselves: high prices protect a drug's market share, precluding challenges from cheaper alternatives. ... The realization that prices threaten comparative effectiveness trials of cancer drugs provides yet another challenge to the research community — but one that we believe we must be ready to confront (Sham Mailankody and Vinay Prasad, 4/17).

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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.