Daily Health Policy Report

Monday, April 21, 2014

Last updated: Mon, Apr 21

KHN Original Reporting & Guest Opinion

Health Reform

Health Care Marketplace

Public Health & Education

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

15-Minute Visits Take A Toll On The Doctor-Patient Relationship

Reporting for Kaiser Health News in collaboration with USA Today, Roni Caryn Rabin writes: "Patients -- and physicians -- say they feel the time crunch as never before as doctors rush through appointments as if on roller skates to see more patients and perform more procedures to make up for flat or declining reimbursements. It’s not unusual for primary care doctors' appointments to be scheduled at 15-minute intervals. Some physicians who work for hospitals say they've been asked to see patients every 11 minutes. And the problem may worsen as millions of consumers who gained health coverage through the Affordable Care Act begin to seek care -- some of whom may have seen doctors rarely, if at all, and have a slew of untreated problems" (Rabin, 4/21). Read the story.

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Progress, Challenges As Medicaid Rolls Swell in Wash.

The Seattle Times' Lisa Stiffler, working in partnership with Kaiser Health News, reports: "Washington state has blown past its targets for signing up new Medicaid participants under the Affordable Care Act (ACA). The program’s ranks have grown roughly 25 percent in the past six months, helping fulfill one of the act’s key goals to provide health care to nearly all Americans. By the end of March, more than 285,000 adults who are newly eligible to participate in Medicaid had signed up for coverage. That's twice the number officials had hoped to reach by then, and a target they hadn't expected to hit for three more years" (Stiffler, 4/18). Read the story.

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Political Cartoon: 'Seeing Red?' By John Darkow, Columbia Daily Tribune

Kaiser Health News provides a fresh take on health policy developments with 'Seeing Red?' By John Darkow, Columbia Daily Tribune.

Here's today's health policy haiku: 


Back in October
who really thought enrollments
would top 8 million?

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

GAO Examines Efforts To Raise Funds To Boost Health Law

The investigation examined the campaign by federal officials to raise money to spur health insurance enrollment, according to The New York Times.

The New York Times: Health Law Fund-Raising Is Detailed
The Government Accountability Office provided new details on Sunday of how the Obama administration raised money from outside organizations to promote enrollment in health insurance under the health care law. Republicans said such solicitations were meant to circumvent limits on government spending imposed by Congress. But in a report to Congress, the accountability office did not give a legal opinion on the propriety of the fund-raising. Administration officials said it was legal. Under federal law, they said, the secretary of health and human services can encourage support for nonprofits that promote public health (Pear, 4/20).

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Health Law A Tough Sell, Although Millions Gain Benefits

A New York Times analysis points out that many of those helped most by the health law are the least likely to cast votes to preserve it. CNN notes that Obamacare is a tough sell for embattled Democrats, and a political analyst questions the GOP strategy to run against the law. 

New York Times: Democrats Confront Vexing Politics Over The Health Care Law
When Franklin D. Roosevelt established Social Security, he created generations of loyal Democrats. When Lyndon B. Johnson signed Medicare into law, he built on that legacy, particularly with older Americans. And when George W. Bush instituted a new prescription drug benefit for Medicare, it helped reclaim elderly voters for Republicans. But President Obama’s Affordable Care Act, the $1.4 trillion effort to extend health insurance to all Americans, is challenging the traditional calculus about government benefits and political impact (Martin, 4/19). 

The Wall Street Journal: Ted Cruz, Invoking Reagan, Angers GOP Colleagues But Wins Fans Elsewhere
Despite resistance from Senate Republicans and Democrats, he stood up before an empty Senate on Sept. 24 to argue Congress shouldn't renew government funding while the health law remained on the books. "I rise today in opposition to Obamacare," he said, launching a 21-hour monologue that included a reading of "Green Eggs and Ham." Mr. Cruz was roundly pilloried. ... While he lost his defunding attempt, he says he finds victory in the low approval ratings of Mr. Obama and his health-care law (Langley, 4/18). 

CNN: Why Are Some Democrats Running From Obamacare?
Polls have shown that voters love popular provisions calling for mandatory coverage for maternity care and extending coverage for young people up to age 26 to stay on their parents' health insurance policies. And recent figures from the Congressional Budget Office show that Obamacare will cost about $5 billion less to implement in 2014 than originally estimated. Still, some Democrats have run from the President's signature health care reform law so fast, they've practically left skid marks. The question is: Will they run back? (Abdullah, 4/18).

CNN: Will GOP’s Focus On Obamacare Pay Off In 2014 Midterms?
Nonpartisan political handicapper Stuart Rothenberg said Sunday it's hard to imagine Republicans can run entirely on a platform against Obamacare from now until the November midterm elections. "I think the cake has been baked on the (Affordable Care Act)," Rothenberg said on CNN's "State of the Union." "I don't think there are a bunch of people changing their opinions now." ... he said Republicans will need to do more this cycle than just train their fire against Obamacare (Killough, 4/20).

In Oregon, the GOP is moving to take a Senate seat using health law attacks --

Fox News: GOP's Bid To Take Senate Moves To Oregon, Which Is Ripe For Obamacare Attack
Democratic-leaning Oregon seems like an unexpected place for Republicans to advance their efforts to win control of the Senate this year. But with a strong candidate in a state with arguably the worst ObamaCare rollout in the country, Washington Republicans think they have a winning strategy. A Republican hasn't been elected to a statewide Oregon office in more than a decade. But Washington Republicans think they have the right candidate in Monica Wehby, a children's brain surgeon who's raised more than $1 million and who, like Republicans, has made her opposition to ObamaCare the centerpiece of the 2014 campaign (4/20).

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States Have Limited Time For Decision On Setting Up Marketplaces

Meanwhile, other outlets look at the deadline enrollment surge and its possible effect on health care costs.

The Associated Press: Clock Ticking For States To Adopt Health Exchanges
For the more than 30 states that defaulted to the federal government under President Barack Obama's health care law, time may be running out to decide whether to create their own state-run insurance exchanges. With the chance to apply for hundreds of millions of dollars in federal help set to expire in a few months, even Obama's home state of Illinois is expressing little interest in taking the next step. The law's disastrous rollout and lingering unpopularity have made it risky to raise the issue in a tense election year (Johnson, 4/18).

The Fiscal Times: Obamacare Signups Don’t Tell The Whole Story
Yet while the figures might be a political victory for President Obama and Democrats, health economists and experts caution that it’s too soon to celebrate. They argue that overall enrollment figures are not sufficient to properly assess the success of the law. ... Austin Frakt, the Incidental Economist’s editor- in-chief, argues that "overall enrollment is a lousy benchmark because it doesn't tell you anything about the stability of the program at the level at which it matters: state-level markets" (Ehley, 4/18).

Politico: Beyond 8 Million: Obamacare Math
The surge of people who signed up in the new health insurance exchanges surpassed both White House targets and expectations. It seemed unimaginable six months ago. But the exchanges aren’t the only way people can get covered under the Affordable Care Act. And it’s by no means the only number people will keep fighting about. ... Now that the 2014 sign-up season has ended, here’s a look at several aspects of health law coverage and the brewing disputes about how to measure them (Norman, Haberkorn and Cheney, 4/19).

The Associated Press: Late Sign-ups Improve Outlook For Obama Health Law
A surge of eleventh-hour enrollments has improved the outlook for President Barack Obama's health care law, with more people signing up overall and a much-needed spark of interest among young adults. Nonetheless, Obama's announcement Thursday that 8 million have signed up for subsidized private insurance, and that 35 percent of them are younger than 35, is just a peek at what might be going on with the nation's newest social program (Alonso-Zaldivar and Lederman, 4/19).

The Hill:  O-Care Enrollment Still Growing In Several States
Enrollment in ObamaCare's new health insurance exchanges is likely to grow past eight million, as some states are still letting people sign up for insurance beyond this year's official enrollment deadline. At least eight states and the District of Columbia are still allowing people to register for health plans, according to news reports and an April 14 analysis by consulting firm Avalere Health (Viebeck, 4/19).

The New York Times: Health Care Spending’s Recent Surge Stirs Unease
For years, because of structural changes in the health care delivery system and the deep economic downturn, the health care "cost curve" — as economists and policy makers call it — had bent. Health spending was growing no faster than spending on other goods or services, an anomaly in 50 years of government accounts. But perhaps no longer. A surge of insurance enrollment related to rising employment and President Obama’s health care law has likely meant a surge of spending on health care, leaving policy experts wondering whether the government and private businesses can control spending (Lowrey, 4/18).

And with the successes of the enrollment push, another health law program is ending.

The Washington Post: Obamacare's High-Risk Pools Are Closing For Real This Time
After three previous extensions, it looks like Obamacare’s temporary high-risk pools for the some of the country’s sickest patients are finally closing as planned. The high-risk pools were set up in each state four years ago as a bridge to Obamacare’s coverage expansion this year, when insurers can no longer deny people coverage or charge them more because of a pre-existing condition. ... Many of the PCIP patients had been undergoing treatment for cancer, diabetes and heart disease (Millman, 4/18). 

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Internet Bug Spurs Healthcare.gov To Reset Customer Passwords

USA Today: Obamacare Website Resets Passwords Over Heartbleed Bug
The Obama administration has reset the passwords of consumers who created accounts through HealthCare.gov, saying the precautionary move was necessary to protect personal information at risk through the newly discovered Heartbleed Internet bug. Those who have accounts will be prompted to create new ones the next time they visit the site, according to an announcement posted on HealthCare.gov (King, 4/19).

CNN: Heartbleed Causes HealthCare.Gov To Change Users' Passwords
The Obama administration says that although there is no immediate threat to users, all enrollees have had their password reset and now must create a new password. The threat emanates from a recently discovered online security vulnerability known as Heartbleed, which could put people's personal information at risk, from passwords and e-mails to financial information (Finnegan, 4/19).

Reuters:  Obamacare Enrollees Urged To Change Passwords Over Heartbleed Bug 
Companies from Amazon.com Inc to Google Inc. have been forced to take steps to protect against Heartbleed. ... The Heartbleed security flaw is a "catastrophic bug" believed to affect two out of every three Web servers, according to the Electronic Freedom Foundation. HealthCare.gov, a health insurance exchange for the 36 states that opted out of creating their own state insurance exchanges, was created under Obama's signature health care law, the 2010 Patient Protection and Affordable Care Act (Francescani, 4/19).

Fox News: HealthCare.Gov Users Told To Change Passwords Due To Heartbleed Risk
The full extent of the damage caused by the Heartbleed is unknown. ... The White House has said the federal government was not aware of the Heartbleed vulnerability until it was made public in a private sector cybersecurity report earlier this month. ... The Homeland Security Department has been leading the review of the government's potential vulnerabilities. The Internal Revenue Service, a widely used website with massive amounts of personal data on Americans, has already said it was not impacted by Heartbleed (4/20).

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Maryland Details Money Spent On Troubled Health Marketplace

The state spent nearly $130 million on the marketplace and more than $90 million of it on technology, according to the state's breakdown, The Washington Post reports.

The Washington Post: Md. Spent $90 Million On Health Exchange Technology, According To Cost Breakdown
Of the nearly $130 million that Maryland has spent on its troubled health insurance exchange, more than $90 million went toward technology expenses, according to a breakdown of costs released Friday. ... State officials have said the exchange is so structurally flawed that it would be cheaper to replace the system than continue to fix it. Maryland hired Deloitte Consulting this month to oversee that replacement, which is expected to cost at least $40 million to $50 million, plus software and hardware costs (Johnson, 4/18).

The Baltimore Sun:  Md. Exchange Enrolls Nearly 329,000 In Health Plans
Nearly 329,000 people have enrolled in insurance through the Maryland health exchange, officials reported Friday. As of April 15, 262,619 people have gained Medicaid coverage and 66,203 enrolled in a private plan sold on the exchange website (4/18).

The state's marketplace problems are also becoming an issue in the race to be Maryland's next governor --

The Baltimore Sun: Race For Maryland Governor Turns Negative
The first negative advertisements in the Democratic primary campaign for governor hit airwaves this week, pushing a feisty political fight that's simmered for months into prime time. ... Attorney General Douglas F. Gansler has released two television spots and a radio ad that bring his attack on the failed Maryland health exchange to more voters than ever. They implicitly criticize the leadership of front-runner Lt. Gov. Anthony G. Brown, who oversaw the state's health care reform effort for the O'Malley administration (Cox and Fritze, The Baltimore Sun, 4/19).

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Ohio Inmates Getting Medicaid; Va. Hospitals Pushing Legislature

As prison inmates in Ohio gain their freedom, state officials are trying to get many of them enrolled in health coverage for low-income people. In Virginia, where the General Assembly is at an impasse on the budget because of the dispute over expanding Medicaid, hospitals seek to convey their message about the economic costs.

Columbus Dispatch: State’s Inmates Going On Medicaid
After serving their time, many Ohio prison inmates will be released with more than street clothes and a few bucks in their pocket. They're likely to leave with health insurance. State officials are helping inmates enroll in Medicaid, as they are now eligible for coverage under Gov. John Kasich's expansion of the tax-funded health-care program (Candisky, 4/20). 

The Richmond Times-Dispatch: Community Hospitals On Front Line Of Medicaid Battle
For the second time in its 60-year history, Community Memorial Healthcenter is looking at a budget this year that's going to be written in red ink. ... The affiliation agreement announced earlier this month between Community Memorial and VCU will help the local hospital improve its bottom line and access to quality health care in the region, but it won’t solve the problem of how to make a profit at an institution with patients that are predominantly elderly, poor or uninsured. For [CEO W. Scott] Burnette and other hospital administrators, one obvious solution is for Virginia to accept billions of dollars in federal funds to expand health coverage of uninsured patients, either through Medicaid or a private insurance alternative, under the Affordable Care Act (Martz, 4/19).

And in Washington and North Carolina --

The Seattle Times: Progress, Challenges As Medicaid Rolls Swell In State
Washington state has blown past its targets for signing up new Medicaid participants under the Affordable Care Act (ACA). The program’s ranks have grown roughly 25 percent in the past six months, helping fulfill one of the act’s key goals to provide health care to nearly all Americans. By the end of March, more than 285,000 adults who are newly eligible to participate in Medicaid had signed up for coverage. That's twice the number officials had hoped to reach by then, and a target they hadn't expected to hit for three more years (Stiffler, 4/18).

North Carolina Health Report:  Minorities More Likely to Fall Into ACA Coverage Gap
In states such as North Carolina decided not to expand Medicaid under the Affordable Care Act, the percentage of minorities who remain uninsured will be higher than that of whites.  According to experts, because many minority groups are not qualifying for marketplace insurance, it will be even more difficult to improve public-health outcomes in those populations (Porter-Rockwell, 4/21).

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Clinton Papers Reveal Failed Health Law Efforts

Newly released papers offer a glimpse of how the former president's team had hoped to win over moderate Republicans as well as Democrats, and also reassure Americans that the plan wouldn't disrupt coverage if they already had it.

NBC News: Clinton Docs Offer Glimpse Into Failed Health Care Fight
Newly released documents from the Clinton White House reveal a candid assessment of the looming fight over the administration’s doomed health care plan, as advisers tried unsuccessfully to steer the sprawling legislation through Congress. A series of 1993 memos and briefing notes shows how the Clinton White House anticipated -- but was ultimately overwhelmed by -- Republican lines of attack against the health care reform effort, which collapsed under criticism through 1993 and 1994. ... Laying out an early strategy for pushing the plan through Congress, the summary memo urged tight control by an elite group of White House officials -- a strategy that ultimately drew criticism as one reason for the legislation’s demise (Dann, 4/18).

Politico: Bill Clinton's 'Keep Your Plan' Dilemma 
During an August 1994 prep session for a presidential press conference -- which was supposed to set up a health care reform vote that never happened -- Clinton and his aides discussed how to make the public feel more comfortable about a health care plan that was supposed to cover all Americans ... Just like Barack Obama did during the passage of his health care law, Clinton wanted to reassure Americans that his health care plan wouldn’t disrupt their own coverage if they already had it, according to a private White House transcript of their conversation. ... Even after Clinton raised the point, though, there was no discussion of the critical question that got Obama in trouble years later: Can the president really make that promise? (Nather, 4/18).

The Associated Press: Clinton Sought GOP Support For Health Care 
President Bill Clinton's advisers estimated early in his term that passing a health care overhaul would require a delicate balance of Democratic and Republican support, needing at least eight moderate Republicans in the Senate and 15 or more in the House to win approval, according to documents released Friday. ... A strategy memo from 1993 argued the plan would require support from enough conservative Democrats and moderate Republicans without alienating too many liberal Democrats. But the bill never cleared a House committee (Thomas, 4/18).

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Health Care Marketplace

Doctors Still Make Good Money

An annual survey shows that doctors, on average, still make at least three times the annual median household income. Media outlets also describe other trends, including the return of house calls, often as part of hospital palliative care programs, the use of scribes to help with digital records, rushed doctors' visits and a study finding that free drug samples influence doctors' prescribing practices.

The Washington Post: Doctors Still Make Good Money
In the United States, doctors on average still make at least three times the annual median household income. The lowest average income on the list of doctors for 2013 was $174,000 and in 2012, the median household income was about $51,000. Orthopedics had the highest average earnings at $413,000, and cardiologists and urologists were not far behind. Of the 25 medical specialties listed, three-quarters of them had an increase from 2012, according to the Medscape Physician Compensation Report, an annual survey of doctors around the country (Tobey, 4/18). 

The New York Times: House Calls Are Making A Comeback
A relic from the medical past — the house call — is returning to favor as part of some hospitals’ palliative care programs, which are sending teams of physicians, nurses, social workers, chaplains and other workers to patients’ homes after they are discharged. The goal is twofold: to provide better treatment and to cut costs. ... Confusion continues to exist over what palliative care is and whom it is for. Broadly, it is meant to ease symptoms and pain, and focus on quality of life for severely ill patients, who can choose between continuing or halting traditional medical treatment (Freudenheim, 4/19).

Kaiser Health News: 15-Minute Visits Take A Toll On The Doctor-Patient Relationship
Patients -- and physicians -- say they feel the time crunch as never before as doctors rush through appointments as if on roller skates to see more patients and perform more procedures to make up for flat or declining reimbursements. It's not unusual for primary care doctors' appointments to be scheduled at 15-minute intervals. Some physicians who work for hospitals say they've been asked to see patients every 11 minutes. And the problem may worsen as millions of consumers who gained health coverage through the Affordable Care Act begin to seek care -- some of whom may have seen doctors rarely, if at all, and have a slew of untreated problems (Rabin, 4/21).

NPR: Scribes Are Back, Helping Doctors Tackle Electronic Medical Records
Like many other doctors across the country, Dr. Devesh Ramnath, a Dallas orthopedic surgeon, recently made the switch from paper to electronic medical records. This meant he no longer had to just take notes when he was examining a patient — he also had to put those notes into the computer as a permanent record. ... In fact, he found he was spending an extra two to three hours every clinic just on electronic records. So he hired medical scribe Connie Gaylan. Acting a bit like a court reporter, Gaylan shadows Ramnath at every appointment. As the doctor examines a patient, Gaylan sits quietly in the corner, typing notes and speaking into a hand held microphone. Once she's finished with the records, she gives them to Ramnath to check and approve, saving him hours of administrative work and allowing him to concentrate on his patients (Silverman, 4/21).

PBS NewsHour: Do Free Samples Influence The Way Doctors Prescribe Drugs?
A new study from Stanford University's School of Medicine found that doctors who are allowed to hand out free samples of expensive drugs prescribe those drugs more often than doctors who don’t have access to free samples. Dr. Alfred Lane, senior author of the report, talks with Hari Sreenivasan about the implications of the findings (Sreenivasan, 4/20).

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Hospitals Ask Officials For Easier ACO Bonuses

Modern Healthcare:  Give ACOs A Break, AHA Tells CMS Innovation Center
The American Hospital Association is lobbying the CMS Innovation Center to make it easier for accountable care organizations to earn Medicare bonuses and delay potential penalties as the agency looks to expand the initiative (Evans, 4/18).

In the meantime, walk-in clinics aren't just benefitting the companies that own them --

The Wall Street Journal: Walk-In Urgent-Care Companies Are Providing Relief to Retail Landlords
People with relatively minor health problems -- say, the flu or a deep cut -- aren't the only ones getting relief from growing walk-in "urgent care" companies such as CityMD and PM Pediatrics. These companies also are providing a little tonic to retail landlords. ... Demand from urgent-care businesses is increasing at a time that the city's retail sector is outperforming the national market (Li, 4/20). 

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Public Health & Education

Cost Of Hep C Medicines Vexing Insurers

Forbes: Insurers Fret Hepatitis C Pill Costs More Than Obamacare
As health insurance companies reveal much anticipated first-quarter earnings, it’s the unpredictable impact from the five-figure cost of new Hepatitis C treatments that are the subject of as much Wall Street worry as the Affordable Care Act. The cost of a course of treatment has been pegged at more than $80,000. The market is large with the liver disease afflicting more than three million Americans. And there are more Hepatitis C drugs to come. ... Across the industry, the cost of Hepatitis C medications could run more than $1 billion in the first quarter alone (Japsen, 4/17).

Related, earlier KHN story: Biggest Insurer Shocked With Hepatitis C Costs (Hancock, 4/17).

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State Watch

State Roundup: Ill. Medicaid Fraud; Iowa Seeks More Caregivers; Definitive 'No' On Kan. Medicaid Expansion.

A collection of state health policy news from Florida, Georgia, Illinois, Texas, Washington state, Iowa and Kansas.

The Associated Press: Medicaid Paid $12M For Illinois Dead
The Illinois Medicaid program paid an estimated $12 million for medical services for people listed as deceased in other state records, according to an internal state government memo. The memo dated Friday, which The Associated Press obtained through a Freedom of Information Act request, says the state auditor compared clients enrolled in the Medicaid database last June with state death records dating back to 1970. Auditors identified overpayments for services to roughly 2,900 people after the date of their deaths (Johnson and Burnett, 4/18).

Des Moines Register: Demand Increasing For Paid Caregivers 
When they married 31 years ago, Dave Johnson joked that someday his younger wife, Alicia, would be pushing him around in a wheelchair. The 66-year-old Sioux City man never thought he would instead be taking care of Alicia Johnson, 53, who suffers from congestive heart failure, chronic obstructive pulmonary disease, asthma and diabetes. ... A year ago, the couple began receiving help from nurses and home health aides ... By 2020 Iowa will need 95,000 paid caregivers. The average annual turnover rate for the profession in the state is more than 60 percent, according to the Iowa CareGivers Association (Butz, 4/19).

The Associated Press:  Kansas Extending Ban On Expansion Of Medicaid
Gov. Sam Brownback has indefinitely extended a ban on expanding Medicaid in Kansas under the federal health care overhaul. Brownback on Friday signed a bill approved by the GOP-dominated Legislature to keep the ban in place (4/19).

WABE: Educators Pleased About Potential Changes To The State Health Benefit Plan
Several education organizations are pleased the state plans to increase the number of providers and health plan options for state employees next year. The announcement by the state comes after state employees raised concerns about Georgia selecting Blue Cross Blue Shield as its only insurer this year for the State Health Benefit Plan (Wirth, 4/18).

Los Angeles Times: Texas Doctors Say Hospital Revoked Their Privileges Over Abortions
Two Texas doctors who had been performing abortions for more than three decades lost their legal ability to do so at the end of March when their new hospital revoked their privileges. This week, a judge temporarily reinstated their positions. ... The abortion case, like many others in Texas at the moment, was sparked by legislation passed last year that placed significant limits on who can perform abortions and where (Dave, 4/18).

The Seattle Times:  After-Hours Clinic A Partnership Of Health-care David And Goliath
At Medical Center’s Cherry Hill hospital, the "EMERGENCY" sign glows bright in the dusk above the emergency-room entrance. Some 18,000 people sought help here last year. Right next to the sign, there’s another one on the building: "After-Hours Clinic." Operated by Country Doctor Community Health Centers, this clinic -- like Swedish’s ER -- is open evenings and weekends. This isn’t competition, but a partnership few would have predicted before the Affordable Care Act, also known as Obamacare (Ostrom, 4/20). 

The Miami Herald:  UM Law Students Dig Into Health Care Policy To Help Patient Get Life-saving Treatment
One day last January, Ariel Gonzalez was picking oranges in Okeechobee. The next, the 35-year old Mexican laborer was overcome by lower back pain from what would later be diagnosed as Stage 5 kidney disease. Medicaid usually doesn’t cover the health needs of undocumented workers like Gonzalez, but it can -- and it did -- in his case. But apparently no one knew of the potential exception. ... It took the four law students, along with two attorneys and a paralegal, 20 days to secure outpatient dialysis for Gonzalez (Borns, 4/18).

Kansas Health Institute News Service:  Governor Signs 19 Bills Into Law 
Senate Bill 311 increases the cap on economic damages in medical malpractice cases and personal injury lawsuits from $250,000 to $350,000 between now and 2022. House Bill 2552 requires that all properly submitted or "clean" claims for payment filed by Kansas Medicaid providers with managed care organizations be fully paid or denied within 30 days. Full payment or denial on all other claims is required within 90 days. Senate Bill 271 beefed up the penalties for Medical fraud by, among other things, increasing fines for violations and the severity levels of the crimes (4/18).

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Editorials and Opinions

Viewpoints: How Dems Should Run On Obamacare; A $54,000 Copter Ride

The New York Times: How To Run On Health Reform
The Republican attack machine, fueled by millions of dollars from the Koch brothers, has Democrats so rattled about the health reform law that many don’t want to talk about it. They’re happy to run on equal pay for women, or a higher minimum wage, or immigration reform — all of which provide important contrasts with a do-nothing Republican Party — but they haven’t said much about the biggest social accomplishment of the Obama administration. ... voters need to be reminded that government programs can improve life for all Americans. When one of those programs begins to do its job, its authors shouldn’t be afraid to say so (4/18).

The New York Times: Obamacare Versus The Wusses 
Not a day goes by without some prominent Republican politician or pundit insisting that the enrollment numbers are phony, that more people are losing insurance than gaining it, etc. ... I guess that what gets me is the — to use the technical term — wussiness of it all. Isn’t there any space on the right for people who sell themselves as tough-minded, who condemn Obamacare on principle but warn their followers that it’s not on the verge of collapse? Is the whole party so insecure, so unable to handle the truth, that it automatically shoots anyone bearing bad news? And the answer appears to be yes (Paul Krugman, 4/19).

Bloomberg: Obama's Good News Isn't Getting Across
The Senate leadership and White House staff have started to meet each week to develop a coordinated economic message for the fall. They have a ways to go. Politicians see the same poll numbers the news media does. In a recent Wall Street Journal-NBC News poll, the sentiment about the economy showed no positive movement. A Bloomberg national survey last month indicated more pessimism than a year before about the economy, job growth and housing. A majority said they thought health-care costs were getting worse and gave Obama negative marks on health care and the economy (Albert R. Hunt, 4/20).

The Washington Post: The Glorious Obamacare Reckoning Fades Away
On balance, Obamacare will probably remain a net negative for Dems. But with Republicans beginning to voice support for its general goals, increasingly acknowledging the law’s beneficiaries, and continuing to struggle with their stances on repeal and on the Medicaid expansions in their states, the law could turn into more of a political wash than anything else, leaving behind races that end up being about candidates, local issues, and the economy (Greg Sargent, 4/18).

The New York Times: Obamacare Bashing Or Bust
The health care law is a staggering achievement by this president and the Democrats and is likely to be viewed by history as such, but Republican opposition to it has been so vociferous and unrelenting that the president has been hard pressed to find a message that can overcome it. ... The Republican plan is simply to hold tight to last year’s disapproval and drag it forward to this year’s election. And that just might work. Democrats have so fumbled the selling of the health care law’s advantages, both moral and economic — faltering and stammering when they should have been steadfast and resolute — that they have acquiesced the debate to Republican opposition (Charles M. Blow, 4/18).

The Wall Street Journal: Courts Should Stay Out Of Political Fact-Checking 
The U.S. Supreme Court will hear oral arguments on April 22 in Susan B. Anthony List v. Driehaus, a case raising important constitutional questions about laws that purport to prohibit "false" political statements. ... The Susan B. Anthony List and the Coalition Opposed to Additional Spending and Taxes—the two advocacy organizations that are petitioners in this case—wanted to criticize Rep. Steve Driehaus (D., Ohio), for his 2010 vote in favor of the Affordable Care Act. The groups believe that the law includes taxpayer-funded abortion because (among other things) it subsidizes insurance plans that may include abortion coverage (Michael A. Carvin and Yaakov M. Roth, 4/18).

Los Angeles Times: My $54,000 Helicopter Ride
One of the benefits of the Affordable Care Act that President Obama often touts is the limit it places on medical bills: no more than $6,350 annually per insured individual ... The insurance industry's idea of an "out-of-pocket maximum," however, doesn't deliver on the promise implicit in its name ... Once you reach it, your insurer will cover 100% of the cost only of the essential health benefits covered by the plan, and out-of-network services are exempt (except for emergency treatments). That's a troubling thought, considering how many insurers are reducing the number of doctors and hospitals in their plans (Jon Healey, 4/20). 

Journal of the American Medical Association: Pediatric Euthanasia In Belgium
What the [new Belgian] law does not consider, however, is that adults choose euthanasia for reasons that go beyond pain. For adults, the decision to end their life can be based upon the fear of a loss of control, not wanting to burden others, or the desire not to spend their final days of life fully sedated. These desires might be supported by the experience they have had witnessing a loved one express a loss of dignity or because they understand what terminal sedation is and wish to refuse it. Children, however, lack the intellectual capacity to develop a sophisticated preference against palliative interventions of last resort (Andrew M. Siegel, Dominic A. Sisti and Arthur L. Caplan, 4/17). 

The New York Times: The Public Health Crisis Hiding In Our Food
The reason that nearly everyone eats way too much sodium is that our food is loaded with it, and often where we don’t taste or expect it. ... Doctors warn people with high blood pressure to go on a low-salt diet, but that’s virtually impossible in today’s world, because nearly 80 percent of the sodium that Americans eat comes in packaged and restaurant food (whether it’s a bagel, a sandwich or a steak dinner). You can’t take it out. And nearly everyone, not just people with hypertension puzzling over food labels, should be taking in less sodium. The only way to prevent millions of Americans from developing high blood pressure is for companies and restaurants to stop loading up their food with sodium (Dr. Thomas A. Farley, 4/20).

USA Today: Let Medicare Negotiate Drug Prices: Our View
Medicare's "Part B" program pays roughly $20 billion a year for the drugs patients get in doctors' offices and hospital outpatient facilities. There's room for savings in Part B, but the real drug-spending problem is Medicare's "Part D" prescription plan, which began in 2006. Part D already costs about $80 billion a year and is on track to double by 2022 as benefits improve and Baby Boomers retire. ... a significant chunk of that money is wasted on overpayments to drug companies. ... In 2006, when Democrats wanted to change the fledgling law to let Medicare use its enormous leverage to bargain with drug makers, we thought such a step was premature. Eight years later, however, the rosy stories about how well private insurers were keeping prices down turn out to have been exaggerated (4/20).

USA Today: Leave Part D Be: Opposing View
The Congressional Budget Office has repeatedly stated that allowing the government to negotiate prices in Part D would have a negligible impact on federal spending unless Health and Human Services limits access to medicines. Restricting access to medicines would not only fail to contain health care costs, it could also increase the need for other, more expensive health care services while jeopardizing patient health. Part D plans already negotiate significant discounts and rebates on medicines for patients, which is a key factor of the program's success. Even CBO has found that Part D plans have "secured rebates somewhat larger than the average rebates observed in commercial health plans" — often as high as 20% to 30% (John J. Castellani, CEO of PhRMA, 4/20).

The Washington Post: In Stem-Cell Research, Health Benefits Outweigh The Risks Of Copying Humans
For the last few years, the promising field of stem-cell research has focused on a technique that skirts various ethical concerns about the treatment of human embryos and the potential to clone whole human beings. But last week, U.S. and South Korean researchers announced that they went ahead with a different technique, successfully creating stem cells cloned from the normal skin cells of adults. Their work helps to open a new avenue in stem-cell research. But it also could be a step on the way to human reproductive cloning. Some ethical worries are reasonable, but they are not enough reason to hold back this research (4/20).

The Washington Post: Higher Taxes On Cigarettes Make Good Sense
Maryland has one of the highest state-imposed cigarette tax rates in the nation ($2 per pack) and, unsurprisingly, one of the lowest smoking rates. Virginia has the lowest cigarette tax rate in the nation (30 cents per pack); its smoking rate is almost 20 percent higher than Maryland’s. America is well past the debate about the health effects of smoking, but tobacco taxes in many states remain low, thanks largely to the influence of tobacco companies. Yet it is clear that higher cigarette taxes have a direct effect on smoking rates, and they are particularly effective in dissuading young people from taking up the habit (4/20). 

The Chicago Sun-Times: Help Arriving For Jailed Mentally Ill
CountyCare is uniquely positioned to provide coverage to individuals involved in our criminal justice system, because the expanded Medicaid population mirrors the makeup and the needs of a large portion of the people in the Cook County jail. Based on our experience, roughly 20 percent of the people entering the Cook County jail suffer from mental illness, which often coincides with substance abuse. CountyCare gives us an opportunity to provide access to healthcare to people being released from jail, which is in the interest of public health and public safety (Toni Preckwinkle and John Jay Shannon, 4/19).

The Star Tribune: What You Pay? Hard To Say When It's Health Care
In a normal economic marketplace, real “transparency” translates all of those complexities into a simple price, prominently displayed. And then the consumer, spending his or her own money, does what I did — buys some things and not others, and shops around for better deals. ... But we’ve evolved a health care system far too lacking in this genuine kind of transparency and feedback — one where people seldom spend (or withhold) their own money in response to clear prices. Instead, vast bureaucracies, public and private, allocate trillions according to arcane formulas and closed-door negotiations that try to penetrate all the complexities (D.J. Tice, 4/18).

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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.