Daily Health Policy Report

Wednesday, April 2, 2014

Last updated: Wed, Apr 2

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Co-Op Health Insurance Plans See Early Success

Reporting for Kaiser Health News, in partnership with NPR, Eric Whitney writes: "The names of the big health insurance companies are familiar – Blue Cross, Aetna, United Healthcare. But what about CoOportunity Health, or Health Republic Insurance of New York? These are among 23 new health insurance companies that started under the Affordable Care Act. They're all nonprofit, member-owned cooperatives, and the aim is to create more competition and drive prices down" (Whitney, 4/2). Read the story.

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Obama: 'The Affordable Care Act Is Here To Stay' (Video)

Kaiser Health News posted excerpts from a Tuesday White House Rose Garden by President Barack Obama in which he touted over 7 million sign-ups for health insurance on the health law's marketplaces (4/1). Watch the video

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Capsules: As Insurance Enrollment Exceeds 7M, Obama Says Health Law ‘Here To Stay’

Now on Kaiser Health News' blog, Mary Agnes Carey writes: "The Obama administration took a victory lap Tuesday as enrollment through the health law’s exchanges topped 7 million, a goal previously thought untouchable when the website healthcare.gov sputtered and crashed as sign-ups began last fall" (Carey, 4/1). Check out what else is on the blog.

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Political Cartoon: 'Red Zone?'

Kaiser Health News provides a fresh take on health policy developments with "Red Zone?" by Pat Bagley.

And here's today's health policy haiku:


Keep the darn gov'mint
out of my Medicare, my
MA, my pass through.
- Larry Beresford

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

White House: More Than 7 Million Health Insurance Sign-Ups

The official enrollment cut-off has come and gone, and the Obama administration is claiming a big win based on the last-minute surge of interest in online insurance marketplaces. President Barack Obama viewed the number as a rebuttal of the months-long criticism over the health law.  

The New York Times: Obama Claims Victory In Push For Insurance
President Obama declared victory Tuesday in the government’s aggressive push to enroll seven million people in private health insurance plans under the Affordable Care Act, even as his senior aides braced for an escalated political battle over the law ahead of the fall’s crucial midterm elections (Shear and Pear, 4/1).

The Washington Post: More Than 7 Million Have Enrolled Under Affordable Care Act, White House Says
Even after the official cutoff, more than 100,000 people at a time were on HealthCare.gov, the online federal insurance marketplace, into the early morning hours, according to a person familiar with the details of the last-minute surge. People who have started to enroll on the federal exchange, as well as on some state exchanges, have a grace period to finish their applications (Goldstein and Eilperin, 4/1).

The Wall Street Journal: More Than Seven Million Sign Up For Health Coverage, Obama Says
Speaking in the White House Rose Garden, the president offered one of his most forceful defenses of the law in months after a surge in sign-ups Monday pushed enrollment past the seven million mark. That figure generally was viewed as unattainable after technical problems with HealthCare.gov impeded sign-ups for weeks after the Oct. 1 launch (McCain Nelson and Radnofsky, 4/1).

Reuters: Obamacare Enrollment Exceeds Seven Million Target Despite Setback 
President Barack Obama's national healthcare program signed up more than 7 million people by the end of March, the president said on Tuesday, notching a rare victory after a months-long, glitch-filled rollout of the law. Appearing in the White House Rose Garden, the president said 7.1 million people had signed up for coverage under the law, known as Obamacare, and called for Republicans to end their bid to repeal it (Mason and Felsenthal, 4/1).

NPR: Debate Over Repealing Health Care Law Is Over, Obama Says
Six months after a disastrous rollout, more than 7 million people had signed up for health insurance on the federal and state exchanges when the deadline passed on Monday (Keith, 4/2).

Los Angeles Times: Obamacare Passes First Big Test
The Affordable Care Act has passed its first big test, but the law's distribution of winners and losers all but guarantees the achievement will not quiet its political opposition. White House officials, who had a near-death experience with the law's rollout six months ago, were nearly giddy Tuesday as they celebrated an open-enrollment season that ended on a high note (Lauter and Parsons, 4/1).

Bloomberg: Obama Says 7.1 Million Health Sign-Ups Rebut Criticism
President Barack Obama’s declaration that 7.1 million health-plan enrollments serve as a rebuke to critics of his signature law won’t diminish the opposition nor stop the scrutiny of the overhaul’s effect. “The Affordable Care Act hasn’t completely fixed our long-broken health-care system, but this law has made our health-care system a lot better,” Obama told administration officials, lawmakers and other supporters in the White House Rose Garden. “The debate over repealing this law is over” (Talev, Keane and Wayne, 4/2)

Kaiser Health News: Capsules: As Insurance Enrollment Exceeds 7M, Obama Says Health Law ‘Here To Stay’
The Obama administration took a victory lap Tuesday as enrollment through the health law’s exchanges topped 7 million, a goal previously thought untouchable when the website healthcare.gov sputtered and crashed as sign-ups began last fall (Carey, 4/1).

Kaiser Health News: Obama: 'The Affordable Care Act Is Here To Stay' (Video)
Kaiser Health News posted excerpts from a Tuesday White House Rose Garden by President Barack Obama in which he touted over 7 million sign-ups for health insurance on the health law's marketplaces (4/1).

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Who Enrolled In Health Law Coverage And What Do They Bring To The Risk Pool?

The final days of open enrollment were marked by a surge that helped the Obama administration clear a key milepost. But not yet known is what this population actually looks like. Were these people previously uninsured? Did young people sign up in big enough numbers? And will the insurance model actually work?   

The Wall Street Journal: 5 Questions About Obamacare’s 7 Million Enrollees
What does the 7 million mark mean for the health law? It tells us the final days of enrollment attracted a surge of consumers and that the sometimes-panicked rush by the Obama administration to fix HealthCare.gov after a disastrous launch largely paid off. What the politically crucial milestone doesn't reveal, however, is much about whether the law will work. For instance, we still don't know whether the new marketplaces will make much of a dent in the number of uninsured people, or if the business will prove sustainable for insurers (Weaver, 4/1).

The Washington Post’s The Fact Checker: Obamacare Enrollment Numbers: What We Know And What We Don’t Know
With the enrollment period ended on March 31, it's time to do the numbers. What do we actually know about Obamacare enrollment numbers — and what is missing? (Kessler, 4/2).

The New York Times: Newly Enrolled, But Not Counted By Insurance Exchange
Millions of newly insured people are hiding in plain sight. They are the people who have bought new health insurance since the start of this year but have chosen for one reason or another to bypass the state and federal exchanges that opened last year under the Affordable Care Act. While the exact number is unknown, some health care experts estimate that it may be in the millions (Thomas, 4/1).

CBS News: Did Enough "Young Invincibles" Sign Up For Obamacare?
The lines were long at last-minute enrollment events for California's health-care exchange. The Covered California website could not keep up and logged people out as they tried to sign up. California has now enrolled more than 1.2 million people, nearly 156,000 in just the past week (Tracy, 4/1).

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Counting Will Continue After 'Official' Deadline

The counting goes on as federal and state exchange officials tally consumers who are taking advantage of various extensions to sign up late. Efforts to determine whether the overhaul is working also continue.

Politico: Enrollment Caveats Will Keep ACA Counting
For Obamacare enrollment, it’s not over even when it’s over.
With special enrollment, extra special enrollment, slightly extended state enrollment and very extended state enrollment, the sign-up tally will keep climbing beyond the 7.1 million people President Barack Obama announced Tuesday (Kenen, 4/1).

The Associated Press: It’s Not Too Late To Get Health Coverage
It’s not too late to get covered. A few routes remain open for those who missed the health care law’s big enrollment deadline. Millions may be eligible for a second chance to sign up for subsidized insurance this year. And people who get coverage after the deadline can still avoid, or at least reduce, the fine for going uninsured (4/2).

Politico: Behind The Obamacare Surprise
The administration overcame a disastrous start to actually hit 7 million enrollees. They lost two months — and all the political capital they won from the government shutdown — to a broken website that seemed to prove every one of their critics’ complaints, and fed the most negative coverage and worst polls President Barack Obama’s ever gotten. They’ve done nothing to settle the political objections, and know May 1 is going to be a whole new kind of trouble trying to educate the newly insured on how to use the plans they’ve now got. But Tuesday, in private meetings in the Oval Office and his triumphant speech in the Rose Garden, there was no missing the bounce in the president’s step (Dovere and Budoff Brown, 4/2). 

NPR: Beyond The Fog Of Spin And Doubt: What Has ACA Achieved?
The Affordable Care Act has made it possible for millions of Americans to obtain health insurance — but how successful has the law been in reforming the health care system? (Ydstie, 4/1).

The Fiscal Times: What’s Next for Obamacare? 5 Things to Watch
The White House is doing a victory lap as the Affordable Care Act’s first open enrollment period has come to a close. As of midnight last night, the administration had reportedly reached its original goal of enrolling some 7 million people on the new exchanges—a feat that seemed nearly impossible at the beginning of March when enrollment was at 5 million. Though this is certainly good news for the White House, there are still hurdles ahead of the law and many crucial questions we need to answer before we can fully assess how it’s really shaping up. Here are five things to watch (Ehley, 4/1).

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Politics Swirl Around The 7 Million Enrollment Figure

There's talk that this could already be affecting Republican strategy, though Democrats are "still wary" of the law. Meanwhile, Louisiana Gov. Bobby Jindal, in an effort to move into the 2016 presidential mix, will offer his own proposal. 

Politico: Obamacare Critics: Homina, Homina, Homina
On Tuesday, Obamacare sign-ups passed 7 million, ... the idea that the law could even come close to the original goal after such a disastrous start would have been laughable even a few weeks ago. It was also a wake-up call for Republicans and conservatives, and even the occasional liberal, who pushed the argument that the failed website challenges the idea at the heart of Obama’s agenda — that government can still solve big social problems. That’s left the critics questioning the early numbers or changing the subject (Nather, 4/2). 

The Washington Post: Bobby Jindal, With An Eye On 2016, To Unveil Plan To Replace Obama Health-Care Law
Louisiana Gov. Bobby Jindal will announce Wednesday a plan to repeal and replace President Obama’s health-care law, an effort by the Republican to insert himself into the increasingly competitive early maneuvering for his party’s presidential nomination. ... he sets forth a bevy of ideas that have run through conservative thought for years, in some cases renaming them and in other cases suggesting new variations on old themes (Costa and Goldstein, 4/2).

Politico Vulnerable Dems Still Wary Of Obamacare
After 7 million people signed up for Obamacare, an unexpectedly sunny end to a dreary enrollment process, Democrats outlined plans Tuesday to step up attacks on Republicans for wanting to repeal the health care law. But while Obama administration officials popped champagne to celebrate the enrollment figure, Democrats on the ballot this year continue to tread cautiously (Hohmann, 4/1).

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Maryland Scraps Exchange Software, Will Buy Connecticut's System

Now that the enrollment period has ended, the board that runs Maryland's troubled online insurance marketplace has opted to start over with a system that worked well in Connecticut.

Los Angeles Times: For Faulty State Exchanges, Big Decisions Loom About Healthcare Law
Although the Obama administration appears to have surpassed its goal of enrolling more than 7 million people in the new healthcare program this year, some of the states that have struggled with technology problems are headed into an intensive new phase of fixes as they try to shepherd final enrollees through the process (Reston, 4/1).

Los Angeles Times: Maryland To Overhaul Healthcare Exchange With Help From Connecticut
The board of the Maryland Health Benefit Exchange voted Tuesday night to overhaul its troubled healthcare website by adopting the smooth-running technology platform developed by Connecticut. Maryland has spent about $125.5 million operating and building its exchange, but in late February the state severed its $193-million contract with prime technology contractor Noridian Healthcare Solutions after struggling with technical problems that led to thousands of lost and stuck applications, as well as long wait times for frustrated consumers (Reston, 4/1).

The Washington Post: Board Of Md. Health-Insurance Exchange Votes To Hire Deloitte To Overhaul It
The board of Maryland’s health-insurance exchange voted Tuesday to hire Deloitte Consulting to replace most of the state’s troubled online marketplace with technology that has successfully worked in Connecticut. The change is expected to cost between $40 million and $50 million to implement, plus some hardware and software costs, according to Isabel FitzGerald, Maryland's secretary of information technology. Fitzgerald told board members that Maryland would adopt Connecticut's system, which has run as smoothly as any in the country, largely as is, with little retrofitting (Johnson and Wagner, 4/1).

The Baltimore Sun: Maryland Votes To Adopt Health Exchange Software Used In Connecticut
The board overseeing Maryland's health exchange voted unanimously Tuesday evening to scrap its dysfunctional website and adopt software developed by Deloitte Consulting and used by the more successful health exchange in Connecticut. The software is free for Maryland to use but Health Secretary Joshua M. Sharfstein will negotiate an emergency $40 million to $50 million contract with the software company to develop the site (Walker, Cohn and Cox, 4/2).

The Wall Street Journal: Maryland To Scrap Health Insurance Website
The state, under Gov. Martin O'Malley, a Democrat who quickly moved to implement the Affordable Care Act, was expected to be a leader among the 14 states running their own health insurance exchanges. Instead, Maryland's health connection website crashed soon after it launched Oct. 1 and was plagued with problems for months, crippling the ability of people to sign up for coverage (Corbett Dooren, 4/1).

The Associated Press: Md. Moves To Revamp Flawed Health Exchange
Maryland has had one of the worst exchange websites of the 14 states that developed their own: The state’s health exchange website crashed shortly after it opened Oct. 1 (4/1).

The CT Mirror: Maryland Scraps Obamacare Website For Connecticut Model
Maryland is scrapping its malfunctioning health care exchange for the technology Connecticut developed for its Obamacare website, AccessHealthCT, the state’s governor said late Tuesday. "The Health Exchange Board selected a partner with a proven track record to upgrade our website using a platform that has an established record of success," Maryland Gov. Martin O’Malley said. "We're confident that this partner will have the website upgraded by the time the next open enrollment period begins in November" (Radelat, 4/1).

And in Minnesota -

Minnesota Public Radio: Enrollment Push Helps MNsure Sign Up 169K Minnesotans By Deadline
More than 169,000 Minnesotans enrolled in health coverage through the state's health insurance marketplace through the six-month open enrollment period that ended Monday. About 60,000 people signed up in March alone. Early on, faulty software and other problems turned the enrollment process into a frustrating ordeal for thousands of state residents (Stawicki, 4/1).

The Star Tribune: As Deadline Passes, MNsure Exceeds Sign-Up Goal
After a halting start that left thousands of Minnesotans pulling out their hair in frustration, MNsure officials said Tuesday they exceeded their goals for the initial open enrollment period. "I think it's fair to say MNsure has turned a corner," interim CEO Scott Leitz said. Nearly 170,000 Minnesotans signed up for insurance coverage through MNsure, the state’s new online insurance exchange, according to preliminary figures. That's well above the 135,000 the agency set as a target last October, a few weeks before the website and call center came unglued with technical glitches that lasted through the end of the year (Crosby, 4/2).

Meanwhile, in other related news -

Kaiser Health News: Co-Op Health Insurance Plans See Early Success
The names of the big health insurance companies are familiar – Blue Cross, Aetna, United Healthcare. But what about CoOportunity Health, or Health Republic Insurance of New York? These are among 23 new health insurance companies that started under the Affordable Care Act. They're all nonprofit, member-owned cooperatives, and the aim is to create more competition and drive prices down (Whitney, 4/2).

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Fight Over Medicaid Expansion Intensifies In Virginia, Other States

The battle for the future of Medicaid in Virginia is expected to heat up, with both sides of the divide paying close attention to a proposal to expand the program through the state budget. 

The Washington Post: Hundreds Cram Into Va. Senate Hearing On Medicaid Expansion Through State Budget
Virginia’s on-again, off-again special session got rolling again Tuesday, as hundreds of lobbyists and activists on opposite sides of the state’s Medicaid battle crammed into a Senate hearing on whether to expand the program through the state budget. The hearing was the first sign of life from the Senate since last week, when the chamber went home one day into the special budget session, leaving the House and its two-year, $96 billion spending plan hanging (Vozzella, 4/1).

The Richmond Times-Dispatch: Medicaid Expansion Battle To Heat Up
The stage is set for a battle on two fronts in the General Assembly next week over expanding health insurance to hundreds of thousands of uninsured Virginians. The Senate Finance Committee will meet Monday morning to act on the state budget proposed by Gov. Terry McAuliffe last week with a two-year pilot to expand Virginia’s Medicaid program, and likely will substitute its own private insurance marketplace as an alternative. The Medicaid Innovation and Reform Commission will meet that afternoon for the first time this year to resume its effort to accelerate cost-saving changes to the state Medicaid program as a step toward possible expansion of health benefits for up to 400,000 uninsured Virginians (Martz and Nolan, 4/2).

Modern Healthcare: States Seek Contested Medicaid Alternatives, Cuts
Proposals from conservative-led states looking to expand their Medicaid coverage in alternative ways have prompted worries among healthcare providers and patient advocates that proposed changes may mean some benefits are discontinued (Dickson, 4/1).

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Capitol Hill Watch

Ryan Plan Would Repeal Health Law, Offer Private Option Medicare

The budget proposal by Rep. Paul Ryan, House Budget chairman and a possible Republican contender for the White House in 2016, would repeal the health law but maintain its savings and taxes. Beginning with those who turn 65 in 2024, it would offer seniors a fixed amount to purchase a private plan or traditional fee for service Medicare.

The New York Times: Ryan’s Budget Would Cut $5 Trillion In Spending Over A Decade
Mr. Ryan, the House Budget Committee chairman and a possible White House contender in 2016, laid out a budget plan that cuts $5 trillion in spending over the next decade. He said it would bring federal spending and taxes into balance by 2024, through steep cuts to Medicaid and food stamps, and the total repeal of the Affordable Care Act just as millions are reaping the benefits of the law (Weisman, 4/1). 

Los Angeles Times: House GOP Revives Paul Ryan’s Austere Budget, Medicare Cuts
The blueprint from Ryan, the party's former vice presidential nominee, is expected to be met with stiff opposition not only from Democrats, but also from hard-line Republicans who want deeper austerity cuts to more quickly balance the budget (Mascaro, 4/1).

The Washington Post: Paul Ryan’s Final Budget Plan Would Slash $5 Trillion In Next Decade
The 99-page plan is Ryan’s last manifesto on government austerity as head of the Budget Committee. He has emerged as the GOP’s leading light on fiscal policy in recent years, but he is term-limited as head of the budget panel and vying to become chairman of the tax-writing Ways and Means Committee next year while considering a 2016 presidential bid (O’Keefe, 4/1).

Politico: Paul Ryan’s Budget Makes Big Medicare Changes
It’s Paul Ryan’s wish list. The House GOP 2015 budget, penned by the Wisconsin Republican, will seek to shave federal spending by $5 trillion by offering changes to social welfare programs, ending government ownership of Fannie Mae and Freddie Mac and repealing Obamacare (French, 4/2).

The Wall Street Journal: Ryan Sees Budget Balancing 
House Budget Committee Chairman Paul Ryan released an election-year budget blueprint Tuesday designed to unify Republicans behind an effort to balance the federal budget in 10 years, exposing the party to Democratic attacks over its proposed cuts to Medicare and other safety-net programs (Peterson and Paletta, 4/1).

Los Angeles Times: Paul Ryan Budget Cuts Deeply – But Will It Balance As Promised? 
Ryan, the House Budget Committee chairman, relies on a combination of previously approved Obamacare savings and tax hikes, along with a new way of measuring economic growth, to reach the 10-year goal of ridding the budget of red ink. That approach does not sit well with hard-line budget hawks, and could make Ryan's job even more difficult as the House prepares to vote on the budget next week (Parsons, 4/1).

CQ HealthBeat: Ryan Budget Would Turn Medicare Into Premium Support Program
The House Republican budget proposal released on Tuesday largely repeats previous health care ideas, including turning Medicare into a premium support program but also maintaining the program’s $716 billion in savings from the 2010 health care law. The fiscal 2015 budget proposal, introduced by Budget Chairman Paul D. Ryan, would repeal most of the health care overhaul (PL 111-148, PL 111-152) and change Medicaid into a block grant program (Ethridge, 1/4).

The Associated Press: House GOP Plan Seeks Health Cuts To Balance Budget
Ryan promises to balance the government’s books with wide-ranging cuts to programs such as food stamps and government-paid health care for the poor and working class. It’s a nonstarter with Obama but polishes the GOP’s supply-side brand heading into midterm elections likely to be determined by the core voters of either party (4/2).

NBC News: What Ryan's Budget Means (And Doesn't Mean) For Medicare
Democrats have attacked the budget Republican Paul Ryan released Tuesday for trying to privatize and "voucherize" Medicare, the popular entitlement program for seniors. Republicans have countered that the proposed changes instead amount to "premium support" and offer a choice to future seniors. What are the changes that Rep. Ryan, R-Wis., has unveiled? Answer: Think of Obamacare, but with a public option attached (Murray, 4/1).

In other Medicare news -

The Associated Press: Obama Signs Bill Temporarily Fixing Medicare Fees
The $21 billion bill would stave off a 24 percent cut in Medicare reimbursements to doctors for a year and extend dozens of other expiring health care provisions, such as higher payment rates for rural hospitals. The legislation is paid for by cuts to health care providers, but fully half of the cuts won’t kick in for 10 years (4/1).

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State Watch

State Highlights: Abortion Restrictions In Mississippi, Arizona

And in Hawaii and Los Angeles, some advocacy groups are worrying about providing health insurance to migrant workers and undocumented workers.

Los Angeles Times: Abortion Restrictions Take Effect In Arizona After Judge’s Ruling
Restrictions on some types of abortions in Arizona went into effect Tuesday morning after a federal judge upheld state changes limiting a woman's access to an abortion-inducing drug. U.S. District Judge David Bury issued an order Monday afternoon rejecting a bid to block the new abortion restrictions while the state’s 2012 law is litigated. The law allowed the state to issue new rules banning the use of the most common abortion–inducing drug, RU-486, after the seventh week of pregnancy, compared with the current restriction of nine weeks (Muskal, 4/1).

Houston Chronicle: Miss. Gov Says He Will Sign 20-Week Abortion Ban 
Mississippi Gov. Phil Bryant said Tuesday that he looks forward to quickly signing a bill that would ban abortion at 20 weeks, the midpoint of a full-term pregnancy. "This measure represents a great effort to protect the unborn in Mississippi," Bryant said in a statement after House Bill 1400 passed the House 91-20 and the Senate 41-10 (Wagster Pettus, 4/1).

Los Angeles Times: Healthcare Advocates Push For Medical Services For Uninsured
Healthcare advocates Tuesday urged the Los Angeles County Board of Supervisors to set aside at least $11 million in additional funding for free medical services for low-income residents — including immigrants lacking legal status — who remain uninsured under Obamacare (Brown, 4/1). 

The Associated Press: Court: Hawaii Not Required To Pay For Migrant Care
Hawaii isn’t required to fund Medicaid for migrants from three Pacific Island nations in Micronesia to make up for a reduction in federal funding, a federal appeals court ruled Tuesday. The 9th U.S. Circuit Court of Appeals said in a ruling filed Tuesday that Hawaii has no constitutional obligation to fill a gap left in 1996 when Congress cut health care funding for migrants under the Compact of Free Association (Garcia, 4/2).

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Editorials and Opinions

Viewpoints: GOP Can No Longer Wait For Obamacare 'To Implode;' Ryan's Version Of 'Trickle-Down Economics'

The New York Times' The Conscience Of A Liberal: A Big Biden Deal
Now that Obamacare has finished with an amazing surge in signups, apparently passing the 7 million mark for the exchanges, there have been two main responses. Republicans are in full-on denial — the books are cooked! Nobody has paid! It’s only because people have been forced to do it! Benghazi! Vince Foster! Meanwhile, progressives are full of caution. It's just a start, we don't know how well this will work in the longer run, too soon to celebrate. The right-wing reaction is, of course, ludicrous. But the cautious progressives are being too cautious. This really is what Joe Biden would have called a Big Frothing Deal, or something like that. The key question you need to ask is, what would make Obamacare fail if it did fail? (Paul Krugman, 4/1). 

Bloomberg: Stop Waiting For Obamacare To Implode
But it's clear now that one scenario with a lot of purchase among conservative opponents of Obamacare -- that the law would "implode," "collapse" or "unravel" -- is highly unlikely. A quick death spiral was always a remote possibility, even if the early troubles of the exchange websites made it look a little less remote. Many congressional Republicans wanted to believe the idea, though, especially because they viewed it as one more reason they could avoid coming up with their own health-care agenda (Ramesh Ponnuru, 4/1).

Bloomberg: Want Obamacare Answers? Get In Line.
It's impossible to say for sure, of course, but I think that the people who signed up in the last few days will be systematically different from the earlier groups. ... allow me to speculate a bit about the ways that they probably differ. Start with what we know about these people: They waited until the last minute to sign up. This tells you that a lot of them will fall into one of a few groups: 1. People who are incredibly disorganized. 2. People who are so financially pinched that it was important to wait until the last minute so that they could pay eight months' worth of premiums instead of 12. 3. People who are young and healthy enough to make acquiring insurance less than urgent (Megan McArdle, 4/1).

Fox News: Real Health Care Reform: Give States The Tools, And Let Them Do The Job
They're practically the first words out of one's mouth the second a Washington reporter hears about a new health reform proposal: "How many people does your plan cover?" The basic premise of the America Next health plan I'm endorsing today is simple: "I believe the problem is not that folks are trying to avoid getting health care. The problem is they can't afford it." In short, I agree with Barack Obama. Of course, Barack Obama circa January 2008—when he uttered those words in opposition to a health insurance mandate -- represents a far cry from the Barack Obama who signed ObamaCare into law in March 2010 (La. Gov. Bobby Jindal, 4/2).

The Wall Street Journal: ObamaCare's Hidden Hit On Businesses
President Obama's promise that Americans could keep their health insurance if they liked it was the most infamous of the Affordable Care Act's sketchy sales pitches. But many of the law's most damaging aspects are less known, buried in thousands of pages of regulations (Bernie Marcus, 4/1). 

The Wall Street Journal: The ObamaCare Copperheads
Yet for months the Health and Human Services Department has refused to disclose crucial contextual data, such as how many insurance contracts are in force, the market-by-market totals and how many beneficiaries were previously covered. Regardless of your partisan sympathies, the White House's selective disclosure is a crime against transparency and accountable government. Then there are the 12 Democratic Senators up for re-election who each cast the decisive 60th vote for ObamaCare. They're acting as if the law is still a political threat, and presumably their polls say as much. The ObamaCare Dozen have tried to create an alibi by saying the plan isn't perfect but mend it don't end it. They've now proposed some concrete fixes, and they must think their constituents aren't paying attention (4/1). 

Los Angeles Times: Obama Says ACA Sign-Ups Surpass 7 Million; Twitterverse Reacts
This afternoon President Obama, with a grinning Vice President Biden behind him, announced in the White House Rose Garden that sign-ups for his signature health law had exceeded original projections. Some 7.1 million Americans have signed up for Obamacare, the president said, by far exceeding the revised projection of 6 million insured after the disastrous roll out of the HealthCare.gov website in October (Robin Abcarian, 4/1). 

And in commentaries on Rep. Paul Ryan's budget proposal -

The New York Times: Mr. Ryan’s Faith-Based Budget
Medicare would become a voucher program by 2024 for those now 55 and younger, allowing them to choose between a fixed payment for private insurance and the traditional plan. The problem with this idea, revived from past Ryan budgets, is that traditional Medicare wouldn't stay unchanged for long because it will attract the sickest patients and become so expensive that most people would be driven to the private plan. The spending cuts in that plan would quickly make it inadequate. Mr. Ryan would make exactly the same $700 billion in cuts to Medicare that Republicans have ridiculed Democrats for making to pay for health care reform. But, of course, he would repeal the health law and has no particular concern about the 13 million people who would no longer be covered under the law's Medicaid expansion (4/1). 

Los Angeles Times: Paul Ryan The Anti-Robin Hood: Robbing The Poor To Help The Rich 
Well, in a nutshell, here's Ryan and the Republicans' vision, per my colleague, Lisa Mascaro: "House Republicans will return to the core ideas from Ryan, the Budget Committee chairman, that have come to define the party's approach: Cut federal spending on Medicare, Medicaid and other programs that make up the federal safety net, while reducing top individual and corporate tax rates to 25%, which Republicans argue will spur economic growth." Holy Ronald Reagan! The Gipper may be gone, but his trickle-down economic notions are alive and well (Paul Whitefield, 4/1). 

The Wall Street Journal: The Ryan Priorities
Paul Ryan laid out his House budget outline on Tuesday, which is already more than Senate Democrats plan to do this year. Passing a budget is a core part of governing, and it's also an obligation under the 1974 Budget Act, but Democrats plan to cruise through the general election on December's budget deal and not let the voters in on their future plans for taxes and spending (4/1).

The Washington Post's Post Partisan: Paul Ryan's Unrealistic Path To Prosperity
Rep. Paul Ryan (R-Wis.), the House budget committee chairman, just released his latest "Path to Prosperity." This one is for fiscal year 2015. As many have noted, this latest iteration is similar to previous paths to prosperity unveiled by the 2012 Republican vice presidential nominee and perhaps future chairman of the powerful House Ways and Means tax-writing committee. And it kills the Affordable Care Act (ACA), which renders it a non-serious fiscal blueprint (Jonathan Capehart, 4/1).

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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.