Daily Health Policy Report

Thursday, April 24, 2014

Last updated: Thu, Apr 24

KHN Original Reporting & Guest Opinion

Health Reform

Health Care Marketplace

Health Care Fraud & Abuse

Coverage & Access

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Most States To Rely On Federal Website For 2015 Enrollment

Kaiser Health News staff writer Phil Galewitz reports: "Only two of the 36 states that relied on the federal insurance exchange this year -- Idaho and New Mexico -- plan to set up their own online marketplaces in time for the next open enrollment beginning Nov. 15" (Galewitz, 4/24). Read the story.

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In Seattle, Insurers And Hospitals Complain About New Rules

The Seattle Times' Carol Ostrom, working in partnership with Kaiser Health News, reports: "Health insurers and hospitals, usually on opposite sides, lined up together Tuesday to give Insurance Commissioner Mike Kreidler an earful about his proposed new rule for insurance-provider networks. Kreidler proposed the rule after complaints that consumers have been taken by surprise about narrower networks in insurance plans offered in the Affordable Care Act. Those networks exclude some of the region’s prominent hospitals and medical centers, meaning some consumers don’t have access to providers they expected to use" (Ostrom, 4/23). Read the story.

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Political Cartoon: 'Runner's High?'

Kaiser Health News provides a fresh take on health policy developments with "Runner's High?" by Pat Bagley.

Here's today's health policy haiku: 


Someone pays for us:
Our children and our taxes.
Who reaps the savings?
-Janice Lynch Schuster, Altarum Institute 

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 Influences Small Business Owners' Decisions

The Wall Street Journal reports that even though the mandate was delayed requiring businesses with more than 50 employees to provide coverage for their workers, the overhaul is affecting how companies are run. In addition, Fox News reports that doctors could be left with unpaid bills if enrollees don't pay their premiums, and Politico writes about a study that challenges the notion that the health law resulted in millions of canceled policies.

The Wall Street Journal: Small Businesses Find Benefits, Costs As They Navigate Affordable Care Act
Many small businesses won a reprieve from having to provide health insurance under the Affordable Care Act until 2015 or later. But the law is already having a lasting impact on how lots of owners choose to run their companies. Some owners have begun to weigh strategies that might help them avoid complying with the law later on, such as opting out of providing the required coverage and instead paying a federal penalty of $2,000 for each full-time worker after the first 30. Others have begun restructuring their businesses, reducing their employees' hours, for example, or trimming their total head counts to fewer than 50 full-time workers (Needleman and Loten, 4/23).

Fox News: Nonpayment Of ObamaCare Premiums Could Cost Doctors
While the debate continues over how many ObamaCare enrollees are actually paying their premiums, one aspect of the law temporarily rewards those who actually stop paying – and doctors may wind up bearing the cost. “This law provides a 90-day grace period for people who have subsidized ObamaCare exchange plans and stopped paying their premium," said Betsy McCaughey, health care author and former New York lieutenant governor. But the insurance companies are only obligated to cover the first 30 days of the 90-day grace period (Angle, 4/24).

Earlier, related KHN coverage: Doctors Say Obamacare Rule Will Stick Them With Unpaid Bills, (Rabin, 3/19).

Politico: Study Questions Obamacare Impact On Canceled Plans
Millions of the plans that were canceled because they did not meet Affordable Care Act requirements probably would have been canceled anyway — by the policyholders, a new study suggests. Last fall, as cancellation letters arrived in mailboxes around the country, opponents of the law cited them as evidence that President Barack Obama had lied to Americans when he promised, “If you like your health care plan, you can keep it” (Wheaton, 4/23).

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Poll Finds Dislike Of Health Law, But Lack Of Support For Its Repeal

In the run up to the midterm congressional elections, this and other polls find hope for Democratic incumbents while also probing the difficulties that continue to make the health law unpopular among many Americans. Also in the headlines, new ads from Americans for Prosperity take on the overhaul.   

The New York Times: Southerners Don’t Like Obamacare. They Also Don’t Want To Repeal It.
Despite strong dislike of President Obama’s handling of health care, a majority of people in three Southern states – Kentucky, Louisiana and North Carolina – would rather that Congress improve his signature health care law than repeal and replace it, according to a New York Times Upshot/Kaiser Family Foundation poll (Tavernise and Kopicki, 4/23).

The New York Times’ The Upshot: Health Law’s Middle-Ground Approach Leaves It Unloved
The legacy achievement of the Obama administration has also become its largest political conundrum. Many Americans disapprove of the Affordable Care Act — but for different reasons, coming from different sides. To get the law through Congress (barely), the administration chose a middle ground that relies on the private insurance system and a mandate that individuals buy insurance. To many Americans, especially conservatives, that approach involves too much government involvement. To many others, the approach involves too little; they would prefer that government insure most people directly, as it does for older people through Medicare. Obamacare, however, exists in a middle ground between the two (Kopicki, 4/23).

The New York Times’ The Upshot: Despite Poll, Problems Lurk For Democratic Incumbents In South
Other Democrats face a similar challenge: In every contest, at least 10 percent of Democratic supporters oppose the Affordable Care Act and say they wouldn’t vote for a candidate who disagrees with their stance. All four Democratic Senate candidates in these states support the law (Cohn, 4/23).

Los Angeles Times: New Senate Polls Offer Three Lessons And Some Hope For Democrats
Both Beebe and Beshear have backed expansion of healthcare coverage under the Affordable Care Act. Beshear, in particular, has attracted national attention for Kentucky’s successful introduction of the new law. Both have expanded Medicaid coverage in their states. Jindal and McCrory have opposed the law and have blocked Medicaid expansion. Jindal’s position on healthcare could be an issue in Louisiana’s Senate race. The Democratic incumbent, Sen. Mary Landrieu, attacked Republicans in a recent interview for blocking Medicaid expansion (Lauter, 4/23).

The Washington Post’s The Fact Checker: Four New Americans For Prosperity Ads Take On Obamacare
Americans for Prosperity, the limited-government group that has spent $35 million attacking Democrats over the Affordable Care Act, released four ads on Tuesday—in New Hampshire, Louisiana, Colorado and Michigan.Here’s a roundup of fact checks of these ads (Kessler, 4/24).

In other campaign news -

The Hill:  NRSC Challenges Dems To Hold O-Care Town Halls
The National Republican Senatorial Committee (NRSC) is challenging vulnerable incumbent Democrats to hold a series of town-halls on President Obama's healthcare law.  In a morning email, communications director Brad Dayspring wrote that Democrats should agree to discuss the merits of the reform law at length if they choose to call it a success (Viebeck, 4/23).

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CBO Lowers Spending Forecast For States That Expand Medicaid Coverage

The Congressional Budget Office updated its February forecast, which pegged the cost at $70 billion over the next 10 years. The new figure puts the cost at $46 billion. In other Medicaid expansion news, Virginia's charged debate on this question appears to be spilling over to other issues before the General Assembly, Louisiana rejects expansion again and Arizona Gov. Jan Brewer continues to confront opposition.    

The New York Times: Forecast Cut On Spending For Health
The Congressional Budget Office has reduced by one-third its estimate of how much more states will spend on Medicaid in the coming decade because of the Affordable Care Act. In early February, the budget office estimated that state spending on Medicaid and a related program for children would be $70 billion higher from 2015 to 2024 because of the law’s coverage provisions. In a new report, the budget office puts the cost at $46 billion (Pear, 4/23).

CQ Healthbeat:  Lower Costs Forecast For States That Expand Medicaid Coverage
Expanding Medicaid under the health law is a better financial proposition for states than previously thought, according to a left-leaning think tank that projects the 10-year cost starting in 2015 will be 34 percent lower than an earlier estimate. Revised Congressional Budget Office health cost projections released last week show expanding Medicaid would raise state spending by $46 billion from 2015 through 2024, according to Edwin Park, an analyst with the Center for Budget and Policy Priorities. The baseline CBO issued in February pegged the cost at $70 billion over a decade (Reichard, 4/24).

The Washington Post: Va. Lawmakers Fail To Override Any Of Governor’s Vetoes
The General Assembly returned to the Capitol for its annual "veto session" to consider the 60 bills McAuliffe amended and four of the five he had vetoed. (The fifth veto had been sustained during the regular session.) It took no action on the overdue state budget, which has been deadlocked by an impasse over Medicaid. But rancor over the budget and Medicaid spilled over into Wednesday's work in floor speeches (Vozzella, 4/23).

The Associated Press: Virginia Lawmakers Sustain McAuliffe Vetoes
At a news conference, Senate Democratic Leader Richard L. Saslaw of Fairfax accused Republican lawmakers who oppose Medicaid but have state-funded health insurance of being hypocritical. On the House floor, Del. Tim Hugo, R-Fairfax, accused McAuliffe of "extorting" the entire state by insisting on a budget that includes expanding Medicaid eligibility (4/23).

The Washington Post’s Wonkblog: A Year After Arizona Approved Medicaid Expansion, Brewer Still Fighting For It
Arizona Gov. Jan Brewer fought harder than any Republican governor last year to push through Obamacare's Medicaid expansion. Almost a year later, she's still fighting opposition to it on two fronts. First, she vetoed a bill Tuesday that would have capped the Medicaid program. … Even if Brewer had signed the bill, it's unlikely the law would have taken effect in Arizona. It would have had to pass review by the Centers for Medicare and Medicaid Services, which had already warned that the Arizona bill ran counter to the goals of the Medicaid program (Millman, 4/23).

The Associated Press: Louisiana: Medicaid Expansion Is Rejected Again
Lawmakers have again turned away efforts to expand the state Medicaid program under the federal health care law, with the Senate health committee voting 6 to 2 on Wednesday against an expansion (4/24).

New Orleans Times-Picayune: Louisiana Senate Committee Kills Medicaid Expansion Bill
The Louisiana Senate Health and Welfare Committee halted a chance on Wednesday (April 23) for the full body to vote on a bill that would "let Louisiana decide" on Medicaid expansion. Senate Bill 96, sponsored by Sen. Ben Nevers, D-Bogalusa, proposed a constitutional amendment mandating the state implement a program to provide health insurance to those living at or below the federal poverty line. If the proposal was adopted by voters, the state would accept billions in federal funding for Medicaid expansion under the Affordable Care Act, often called Obamacare, to provide heath care for those who make about $11,490 for a single person and $23,550 for a family of four (Lane, 4/23).

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Washington, Minnesota Tout Exchange Sign-Ups, While Oregon Official Exits

Another top official for the Cover Oregon exchange submitted her resignation this week, while a technology committee decides whether the state should participate in the federal exchange or fix the existing website with the help of a new contractor. Meanwhile, some consumers decline to buy coverage because they say they cannot afford the policies sold on the exchange.

The Associated Press: Technology Group To Decide Cover Oregon’s Future
The technology committee will decide whether Cover Oregon should ditch its glitch-filled website and replace it with the federal government’s health insurance marketplace, or try to fix the existing system with the help of a new IT contractor. The decision comes nearly seven months after Oregon’s exchange was supposed to go live so that residents could use it to compare and buy health insurance plans (4/24).

The Oregonian: Another Top Official Resigns From Cover Oregon Health Insurance Exchange
Triz delaRosa, the chief operating officer for the Cover Oregon health insurance exchange, has submitted her resignation, one month after Gov. John Kitzhaber called for her removal. DelaRosa, who'd worked for the exchange since June 2011, is just the latest political casualty of a fiasco that has already seen major turnover among managers who worked on the exchange, which continues to be the least functional in the country. On March 20, at a press conference, Kitzhaber announced that he had accepted the resignation of Bruce Goldberg, the acting Cover Oregon director who, in his prior job as Oregon Health Authority director, had overseen the construction of the exchange (Budnick, 4/23).

The Oregonian: Dennis Richardson Goes On The Attack Against Cover Oregon, Gov. John Kitzhaber
Rep. Dennis Richardson is on the lookout for Cover Oregon horror stories. Richardson, a Republican from Central Point and candidate for governor, said he wants to counterbalance what he calls "propaganda" by Democratic Gov. John Kitzhaber contained in a recent ad campaign for the state's health insurance exchange. "To counteract his use of public money to promote a failed system and a failed website, we're asking citizens to share their stories," Richardson said (Esteve, 4/23).

Minnesota Public Radio: Signups Via Minn. Health Exchange Pass 200,000
MNsure's enrollment total topped the 200,000 mark as of Tuesday, the final day that people could choose a plan on the state's health insurance marketplace. About three quarters of those who enrolled in coverage since October qualified for government-sponsored coverage such as Medical Assistance and MinnesotaCare, MNsure spokesman Joe Campbell said. About 50,000 others enrolled in private coverage. "We're thrilled with the numbers," Campbell said. "We're thrilled with where we are today” (Stawicki, 4/23).

The Star Tribune: MNsure Crosses Key Milestone: 50,000 Enrollees
More than 50,000 Minnesotans have enrolled in a private health plan through the state’s new online insurance exchange, a key benchmark that makes it more likely MNsure will be able to make its budget work, officials said Wednesday. Enrollment in private plans is an important funding source because the agency collects a premium-based fee from insurance carriers on policies sold on the MNsure exchange. After technical problems prevented people from buying insurance through MNsure in November and December, exchange officials scaled back their original goal of enrolling 70,000 people in individual and family plans by April 1 (Crosby, 4/24).

The California Health Report: Some Still Struggling To Afford Affordable Care
Chanee Houston has decided to take her chances. As the open enrollment period for health insurance under Covered California closed this month, the 26-year-old remained uninsured. The Irvine resident had considered purchasing a plan through the state’s marketplace, “but even with the financial aid they give you, it’s still kind of expensive,” she said. “I can’t spend $100 a month right now.” More than 1.4 million people enrolled in a Covered California plan before the April 15 deadline, but some residents, such as Houston, feel that the Affordable Care Act still doesn’t provide them with affordable options. Others have signed up for health plans but wonder whether they’ll be able to pay the premiums or the out-of-pocket expenses associated with seeing a doctor (Johnson, 4/23).

The Seattle Times:  Health Exchange Sign-ups Cheered By State Officials
Close to 600,000 residents enrolled in private health coverage and Medicaid in the first year of the state insurance website, and Washington state leaders gathered Wednesday to mark the performance of this key provision of the Affordable Care Act. At the gathering in downtown Seattle, U.S. Sen. Patty Murray, Gov. Jay Inslee and other state officials gave speeches worthy of Oscar recipients, thanking President Obama and the bipartisan support of local leaders, their employees and the legions of community partners that helped people enroll statewide (Stiffler and Ostrom, 4/23).

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Health Care Marketplace

Aetna Raises Earnings Outlook

In other market news, coverage continues of the cost and effectiveness of Sovaldi, a new drug to treat hepatitis C, and the related earnings gained by Gilead Sciences, its manufacturer.  

The Wall Street Journal: Aetna Raises Outlook On Strong Quarterly Growth
The company raised its full-year operating earnings forecast to $6.35 to $6.55 a share from its prior view of at least $6.25 a share. The insurer in February said it expects to lose money on its business in the Affordable Care Act marketplaces this year, with the demographics of enrollees skewing slightly more than expected toward people likely to rack up higher costs. Still, the company noted that individual insurance represents a small part of operating revenue (Rubin, 4/24).

NPR: Costly Hepatitis C Pill Shreds Drug Industry Sales Record
The launch of Sovaldi, the $1,000-a-day pill for hepatitis C, is shaping up as the most successful ever. The Food and Drug Administration approved the pill in December. And then Gilead Sciences was off to the races. The company said it sold $2.27 billion worth of Sovaldi in the quarter that ended March 31. $2.27 billion! The boffo number beat Wall Street's estimate for the quarter by more than $1 billion (Hensley, 4/23).

PBS NewsHour: New Hepatitis-C Drug Raises Hope At A Hefty Price
A new drug has a 90 to 100 percent chance of curing the Hepatitis-C virus, but costs tens of thousands of dollars for a course of treatment. The announcement by the manufacturer that it earned more than $2 billion in the year’s first quarter raises the question, who should pay when drugs are highly effective, but extremely expensive? Hari Sreenivasan reports on the profits, coverage and costs (Sreenivasan, 4/23).

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Health Care Fraud & Abuse

Amedisys To Pay $150 Million To Settle Medicare Fraud Case

Amedisys Inc., one of the nation's largest home health providers, will pay $150 million to settle claims that it exaggerated Medicare billings and had improper financial relations with referring physicians, the Department of Justice revealed. Meanwhile McClatchy is reporting that, based on an analysis of Medicare's list of banned providers, Miami is at the top for Medicare fraud.

The Associated Press: Feds: Home Health Company Paying $150 M Settlement
Amedisys Inc., a Baton Rouge-based home health company, will pay $150 million to resolve allegations that it inflated Medicare billings and had improper financial relationships with referring physicians, the U.S. Department of Justice said Wednesday. Amedisys and its affiliates make up one of the nation’s largest home health providers, operating in 37 states, Washington, D.C., and Puerto Rico, according to a Justice Department news release (4/23).

The Wall Street Journal: Amedisys To Pay $150 Million to Resolve Medicare Fraud Allegations
The Department of Justice had been investigating allegations that between 2008 and 2010, Amedisys billed Medicare for services that were medically unnecessary, and misrepresented patients' conditions to increase its payments from Medicare, the U.S. Attorney in Philadelphia said in a statement Wednesday. Based in Baton Rouge, La., Amedisys provides at-home nursing care and physical therapy in 37 states (Whalen, 4/23).

McClatchy: In Miami, There’s No Shortage Of Medicare Fraud To Keep Prosecutors Busy
If there ever was any question that Miami is the champ when it comes to health care fraud, a peek inside Medicare’s list of banned providers should settle it. Of all the people and businesses in the federal government’s “exclusions database,” Miami tops the list – and does so by a long shot, according to a McClatchy analysis. Of the medical providers in the database, 1,491 list Miami addresses. Second place: Los Angeles, with a relatively meager 522 names. They’re followed by Phoenix; Brooklyn, N.Y.; and Houston in the top five (Adams, 4/23).

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Coverage & Access

Employers Increasingly See Positives In Wellness Programs

The Associated Press: Wellness Programs Grow More Popular With Employers
More companies are starting or expanding wellness programs that aim to reduce their medical costs by improving their employees’ health. They’re asking workers to take physical exams, complete detailed health assessments and focus on controlling conditions such as diabetes. Along with that, many companies also are dangling the threat of higher monthly insurance premiums to prod workers into action (4/23).

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State Watch

Highlights: New Abortion Restrictions In Mississippi; Political Ad Calls Maryland Exchange A 'Failure'

A selection of health policy stories from Arizona, Connecticut, D.C., Kansas, Maryland, Mississippi and Missouri.

The Associated Press: Mississippi: Governor Signs Abortion Restriction
Gov. Phil Bryant signed a bill on Wednesday to ban abortion starting at the midpoint of a full-term pregnancy. Supporters say the measure will protect women’s health; opponents say it is unconstitutional (4/24).

Reuters: Mississippi Sets 20-week Limit On Abortions
Mississippi will ban abortions after more than 20 weeks of pregnancy from July, joining other conservative U.S. states that have placed restrictions on the procedure. The U.S. Supreme Court legalized abortion nationwide in 1973, but the practice still polarizes U.S. society (4/23).

The Washington Post: Gansler Calls Maryland’s Health Exchange A ‘$200 Million Failure’ In Latest TV Ad
Maryland gubernatorial hopeful Douglas F. Gansler on Wednesday released his third television ad on health care, promising to “get tough” on proposed rate hikes by insurance companies and calling the state’s online health exchange “a nearly $200 million failure.” The 30-second spot, which Gansler’s campaign said will debut Thursday in the Baltimore market, is Gansler’s latest attempt to call attention to problems with the exchange, for which he has sought to pin blame on Democratic rival Anthony G. Brown (Wagner, 4/23).

The Wall Street Journal: Creditors Seek To Force D.C. Hospital Into Bankruptcy
A group of businesses owed more than $2.5 million by Washington, D.C.’s Specialty Hospital is seeking to push the troubled health-care facility into bankruptcy. Creditors of Specialty Hospital of Washington LLC, which runs the city’s only long-term acute-care hospitals, Wednesday filed an involuntary bankruptcy petition against the facility in U.S. Bankruptcy Court in Wilmington, Del (Fitzgerald, 4/23). 

The CT Mirror: The Basics: CT’s Effort To Notify Patients Of Added Medical Fees
The state House of Representatives Wednesday passed a bill aimed at making sure patients know about extra charges they could face if they get outpatient care at medical offices owned by hospitals. The proposal, which passed unanimously, now goes to the Senate. Medical practices owned by hospitals can charge patients “facility fees” -- charges separate from doctor fees that often cost hundreds or thousands of dollars. Many patients say they didn’t realize they would face the additional charges until they got the bill (Becker, 4/23).

Kansas Health Institute News Service:  Brownback Signs Controversial Health Care Compact
Gov. Sam Brownback has signed into law a bill that might make it possible for Kansas to join a compact of states that want the power to run Medicare and Medicaid within their borders. The new law also creates the possibility that the compact states could circumvent several key provisions in the Affordable Care Act, also known as Obamacare (Ranney, 4/23).

The Arizona Republic: Health Care Nightmares Day 4: Medical Coding Leaves 87-Year-Old Facing $32,000 Bill
Eileen Schraan's doctor told her to call 911. The 86-year-old woman had complained of shortness of breath and pain in her jaw, classic heart-attack symptoms. She was loaded into an ambulance and rushed to the emergency room. Schraan was kept under observation for three days last year at Banner Baywood Medical Center in Mesa while doctors tried to determine if she'd had a heart attack. ... Results were negative. Doctors sent her home with a diagnosis of TMJ, a joint problem with her jaw. Banner coded Schraan's bills with the same TMJ diagnosis and charged her more than $32,000 (Anglen, 4/23).

The St. Louis Post-Dispatch:  Planning For The Aging Prison Population
Before long, the Missouri Department of Corrections, through its prisons, will operate one of the largest nursing home systems in the country. It already operates its own hospice program for prisoners. Since 2004, the number of older offenders incarcerated in Missouri prisons has almost doubled. Caring for the state’s aging prison population may be manageable now, but soon will not be (Dierkes, Motil and Snow, 4/24).

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Weekend Reading

Longer Looks: Terri Schiavo Case; Stem Cell Tourism In China; Fall Protection For The Elderly

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

ProPublica: MIA In The War On Cancer: Where Are The Low-Cost Treatments?
Increasingly, Big Pharma is betting on new blockbuster cancer drugs that cost billions to develop and can be sold for thousands of dollars a dose. In 2010, each of the top 10 cancer drugs topped more than $1 billion in sales, according to Campbell Alliance, a health-care consulting firm. A decade earlier, only two of them did. Left behind are low-cost alternatives ... that have shown some merit but don't have enough profit potential for drug companies to invest in researching them. The newer drugs have in some cases shown dramatic life-extending results for patients. Yet cancer remains the second-most-common cause of death in the U.S. after heart disease, killing about 580,000 people a year. Worldwide, 60 percent of all cancer deaths occur in developing countries .... That has added urgency to an active debate about whether efforts to combat cancer — and where to put scarce research dollars — need to be rethought (Jake Bernstein, 4/23).  

The New York Times: From Private Ordeal To National Fight: The Case Of Terri Schiavo 
For 15 years, Terri Schiavo was effectively a slave — slave to an atrophied brain that made her a prisoner in her body, slave to bitter fighting between factions of her family, slave to seemingly endless rounds of court hearings, slave to politicians who injected themselves into her tragedy and turned her ordeal into a national morality play. To this day, the name Schiavo is virtually a synonym for epic questions about when life ends and who gets to make that determination. It would be nice to believe that since Ms. Schiavo’s death nine years ago, America has found clear answers. Of course it has not (Haberman, 4/20).

That's Magazine: We Can Rebuild You: Stem Cell Tourism Comes To China
Consigned to a wheelchair and rapidly losing motor functions, 9-year-old Kara Anderson, who suffers from cerebral palsy, faced an uncertain future in her native US. With doctors recommending invasive surgery that would sever tendons, nerves and ligaments to help restore mobility, her family began searching overseas for alternatives. ​ ​​After months of research, her uncle David Mair, who is also CEO of a medical tourism company, suggested stem cell therapy in China. This largely experimental field of medicine uses undifferentiated (or "blank") cells that can take on the functions of depleted or damaged cell lines and repopulate within the patient’s body. While many stem cell treatments remain years, if not decades away from being approved as safe in the West, a combination of more lenient regulations and a distinctly different model of medical ethics has seen a surge of these advanced procedures in China over the past decade ​ (Oscar Holland, 4/23). 

The Atlantic:  Who Will Watch You Fall? A Radar Detection Program ​F​or ​T​he Elderly
In the next three decades, the number of Americans over 65-years-old will double. That's good news if you are the proprietor of any retirement homes, retirement villages, or retirement centers. But as many Americans opt to "age in place"—a popular term that might conjure the stagnation of a potted plant but is used in rebellion to the nursing-home-exile trope, describing continued independent living in one's own home—there will be an increasing need for affordable, large-scale systems to monitor for emergencies. The most common injury-related reason that elderly people are admitted to the hospital is that they fell over. It has been reported that almost one in one thousand of those falls results in death. Wearable devices and home-monitoring video cameras have become widely popular, but they have drawbacks in that they can be invasive or annoying. So an expert in radar imaging is on the case (James Hamblin, 4/21). 

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Editorials and Opinions

Viewpoints: Blum's Departure Is A Serious Loss; GOP Fighting Medicaid Expansion With New Tactic

Bloomberg: The Health-Care Job That Really Matters
The official who matters most when it comes to controlling U.S. health-care spending has just resigned, leaving behind a program with serious fiscal problems that badly needs further reform. No, not Kathleen Sebelius -- and the program isn't the Affordable Care Act. The official is Jonathan Blum, and the program in question is Medicare, which next year will replace defense as the largest federal expenditure after Social Security. Blum had started to get Medicare costs under better control, but there's a lot more work to do and there'll be plenty of resistance along the way (4/23).

Reuters: Why The Obamacare Fight Never Ends
With 8 million people signed up for Obamacare — and perhaps as many as 14 million covered by the law — repealing Obamacare looks like a lost cause. "This thing is working," the president announced. The fact that Obamacare is working should shut down the debate. But that's not happening. Why not? Six reasons (Bill Schneider, 4/24). 

The New York Times' Taking Note: The Real Reason Red States Won't Expand Medicaid
By now it's pretty clear that the states refusing to expand health coverage under Medicaid aren't really worried about the expense. They're motivated entirely by ideological stubbornness — "for no other reason than political spite," as President Obama said last week (David Firestone, 4/23). 

MSNBC: Medicaid Expansion Starts To Look Even Better
Here’s the deal: in some states, it's up to the governor’s office to decide whether or not to embrace Medicaid expansion. For opponents of health care, this works out fine, just so long as there’s a far-right governor who’s prepared to ignore all of the evidence and obvious benefits. But what if that governor loses? In Georgia and Kansas, there are far-right incumbent governors who are favored to win re-election, but polls suggest their races will at least be competitive. It’s no longer ridiculous to think voters in either state – or perhaps both – could elect a Democratic governor who would, of course, do the smart thing when it came to Medicaid expansion. The mere possibility has led legislators in Georgia and Kansas to push changes to state law, moving authority over the decision from the governor’s office to the legislature, just to make sure state finances, state hospitals, and the state’s struggling families will suffer now and in the future, regardless of who wins the gubernatorial races (Steve Benen, 4/23).

National Review: Conservatives And The Medicaid Expansion
But a group of states with significant Republican control, such as Michigan, Arkansas, Iowa, and, most recently, New Hampshire, are trying to chart a middle way by using seemingly conservative means to expand their states' Medicaid programs. Obamacare’s Medicaid expansion provides an opportunity for Republicans to reform the welfare state by applying conservative ideas and principles, and some GOP-led states are trying to seize this opportunity. Despite their best efforts, though, these states are hamstrung by federal regulations and control of Medicaid. The Obama administration is limiting their ability to innovate and their capacity to stake out a fundamentally different vision of welfare in the United States from the one implied in Obamacare (Andrew Evans, 4/24).

The Wall Street Journal: The Other Stealthy ObamaCare Menace
The Affordable Care Act's Independent Payment Advisory Board has been so heavily criticized for being an unaccountable body with the power to effectively ration Medicare services that many congressional Democrats no longer support it. IPAB's bureaucratic cousin—the Center for Medicare and Medicaid Innovation—deserves the same treatment (Lanhee J. Chen and James C. Capretta, 4/23). 

news@JAMA:  What Do We Know About The Affordable Care Act?
Now that the 2014 enrollment period has (finally) ended for signing up for a plan in the Affordable Care Act’s (ACA’s) health insurance exchanges, many of us policy analysts and political observers are trying to figure out what we know about the ACA’s early effects and what else we need to know to begin a reasonable assessment of the law. ... Beyond the total number, however, we know almost nothing about those who’ve enrolled, not even the most basic demographic data. This lack of information is frustrating and has led many to wonder why the administration has only chosen to dribble out favorable information while refusing to make basic facts easily available (Gail Wilensky, 4/23).

Fox News: A Doctor, Not A Bureaucrat, Should Be In Charge Of Health And Human Services
"The torch has been passed to a new generation of Americans," Jack Kennedy famously said in his 1961 inaugural address, a phrase once swollen with optimism and American pride. It may be tempting for President Obama to use this same expression now to describe Health and Human Services Secretary (Baby Boomer) [Kathleen] Sebelius handing off the HHS secretarial torch to her apparent (Generation X) replacement, Sylvia Burwell, but such a sentiment would be false optimism. It is time for a physician or an expert in health care to administer Health and Human Services, not another numbers-massaging manager, no matter how able (Dr. Marc Siegel, 4/23). 

The Fiscal Times: How To Play The Obamacare Data Game
The need for statistical data is certainly no myth. The only rational way to understand and measure complicated systems is from metrics that produce hard data. That need exists in complex systems in small applications such as data and call centers, which I managed for years, to large government bureaucracies, and especially in risk-pool management as conducted by insurers in every application. The key is to know the scope and the limits of those measurements and to understand their meaning to the whole of the operation. Otherwise, it's too easy to see just the statistics that suit one's own purposes, or to deliberately cherry-pick them to advance one's own agenda. Nowhere has this been impulse been more often displayed than with the Obama administration and Obamacare (Edward Morrissey, 4/24).

The Fiscal Times: How Medicare Data Could Revolutionize Health Care
The release this month of a mountain of data on physician payments by the Centers for Medicare and Medicaid Services (CMS) might be remembered by future historians as a major turning point in the quest to battle overpriced medical care. As a result of a court ruling, the government on April 8 made public some $77 billion in payments to nearly one million providers during 2012. In a month or so, data will be released on hospitals and clinics. An injunction making the information private since 1979 was challenged by the Dow Jones Co., publisher of The Wall Street Journal. While increasing transparency in public health care services is generally a win for patients and taxpayers alike, the numbers are meaningless without pragmatic analysis (John F. Wasik, 4/23).

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