Daily Health Policy Report

Thursday, April 3, 2014

Last updated: Thu, Apr 3

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch


Health Care Marketplace

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Top Boston Hospital Begins To Tackle Readmissions Problem

Reporting for Kaiser Health News in collaboration with NPR and WBUR, Rachel Gotbaum writes: “Beth Israel Deaconess Medical Center is a highly regarded teaching hospital in Boston, but in 2012, the hospital found out it had one of the highest rates of readmissions among Medicare patients in the country. That meant federal fines of more than $1 million—and a lot of soul searching for the staff, says Dr. Julius Yang, the head of quality for the hospital. ‘Patients coming to our hospital, getting what we believed was high quality care, were coming back at an alarmingly high rate,’ says Yang” (Gotbaum, 4/3). Read the story.

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Capsules: Why Some Don’t Pay Their Obamacare Premium: It’s Not What You Think

Now on Kaiser Health News’ blog, KQED’s Lisa Aliferis reports: “A new analysis finds that many people who signed up for a Covered California health insurance exchange plan are likely to drop the coverage for a good reason: They found insurance elsewhere. Researchers at the U.C. Berkeley Labor Center released estimates Wednesday showing that about 20 percent of Covered California enrollees are expected to leave the program because they found a job that offers health insurance. Another 20 percent will see their incomes fall and become eligible for Medi-Cal, the state’s insurance program for people who are low income” (Aliferis, 4/2). Check out what else is on the blog.

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Political Cartoon: 'Leveling The Playing Field?'

Kaiser Health News provides a fresh take on health policy developments with "Leveling The Playing Field?" by Nate Beeler.

And here's today's health policy haiku:


Sharpen your pencils
For Medicare claims data
Like Christmas for nerds.

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

Open Enrollment Is Over -- What's Ahead For The Health Law Now?

News outlets are beginning to focus on the next set of implementation chores, as well as the ways in which the law will impact the health care marketplace.  

The New York Times: What’s Next For Health Care
The first open enrollment period for health insurance under the Affordable Care Act has just ended, and consumers, insurers and federal officials now face many immediate chores and challenges that will help determine if the law works as intended. Many questions about the law’s potential impact on the health care system remain, and here are some preliminary answers (Pear, 4/2).

The Associated Press: Nonprofit Insurers Struggle In New Marketplaces
A smorgasbord of options and lower prices for consumers were two of the chief selling points for President Barack Obama as he promoted his overhaul of the nation’s health insurance industry, predicting Americans would see “competition in ways we haven’t seen before.” Companies were even started as a way to encourage innovation and competition, namely 23 consumer-run, co-op insurers created with the help of $2 billion in federal loans. But rather than promote competition, the co-ops and smaller nonprofits in some states have languished behind major insurers, attracting in some cases minuscule shares of the market (4/2).

The Fiscal Times: Obamacare Spikes Costs For Employers Who Insure Over 170 Million
The health care benefits provided by large employers for over 170  million Americans may be in jeopardy because of costs related to the Affordable Care Act. Large employers with 10,000 or more employees who provide health care insurance to the majority of Americans including employees, retirees and dependents, will see their total costs over ten years increase from $151 billion to $186 billion, or 5.9 percent more than what they would otherwise be spending. Put another way, the ACA will cost large U.S. employers between $4,800 and $5,900 per employee (Leo, 4/2). 

CQ HealthBeat: Working-Age Military Retirees Could Face Higher Health Costs
Active duty personnel and veterans won’t be shifted into the new health law marketplaces or Medicaid, a top Defense Department health official told House appropriators Wednesday. But the official said that some military beneficiaries may face higher out-of-pocket costs in the future (Adams, 4/3).

Meanwhile, the Associated Press reports on this development related to a Supreme Court challenge to the overhaul's birth control mandate  -

The Associated Press: Hobby Lobby 401(k) Invests In Birth Control Makers
The company leading the legal challenge against birth control coverage under the new health care law offers its workers a retirement plan that includes investments in companies making contraceptive and abortion drugs. Hobby Lobby Stores Inc. has a 401(k) plan featuring several mutual funds investing in pharmaceutical firms that produce intrauterine birth control devices, emergency contraceptive pills and drugs used in abortion procedures, according to Labor Department documents and a review of fund portfolios (Hananel, 4/2).

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Obama Administration Points To Official End -- April 15 -- For Enrollment Extension

The Wall Street Journal reports that this cut off will apply to the hundreds of thousands of people who started signing up for insurance on the federal health exchange but got held up during their last-minute shopping. Also in the news, the latest from California and Georgia in terms of deadlines and enrollment efforts.  

The Wall Street Journal: Health Enrollment Extension To End April 15
People who started signing up for private health coverage before the March 31 enrollment deadline will have until April 15 to finish their applications, the Obama administration said Wednesday, putting an end point on an extension that had prompted questions. The cutoff point is being set for hundreds of thousands of Americans who tried to apply for coverage at the last minute and ran into long waits at enrollment centers, on a telephone hotline or on the website HealthCare.gov because of limits on the system's capacity and a string of late technical problems (Radnofsky, 4/2).

Los Angeles Times: Many More Californians May Qualify For Obamacare After Deadline
Even with 1.2 million people enrolled by Monday's deadline, California's health exchange isn't done adding to the Obamacare rolls — and it won't be for quite some time. In the months to come, it's estimated that several hundred thousand more Californians could qualify for a special enrollment period as college students graduate, families move and workers change jobs (Terhune, 4/2).

Kaiser Health News: Capsules: Why Some Don’t Pay Their Obamacare Premium: It’s Not What You Think
A new analysis finds that many people who signed up for a Covered California health insurance exchange plan are likely to drop the coverage for a good reason: They found insurance elsewhere. Researchers at the U.C. Berkeley Labor Center released estimates Wednesday showing that about 20 percent of Covered California enrollees are expected to leave the program because they found a job that offers health insurance. Another 20 percent will see their incomes fall and become eligible for Medi-Cal, the state’s insurance program for people who are low income (Aliferis, 4/2).

Georgia Health News: Faithful Recruiters: Two From Catholic Order Joined ACA Effort
The volunteer army in the Affordable Care Act enrollment effort included two older women stationed regularly at a Macon Kmart. Sister Joan Serda and Cecelia Smaha, a layperson associate of the Sisters of Mercy, talked to hundreds of local residents about the health care law in the months leading up to Monday’s enrollment deadline. The two say they volunteered for the Get Covered America campaign because their organization’s mission includes helping people living in poverty who lack education and health care (Miller, 4/2).

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Failed State Exchanges Set Sights Too High, Say Experts

Common themes characterize several failed state exchanges, including trying to do too much the first year and having tangled lines of authority, reports CQ HealthBeat. Meanwhile, officials who oversaw those troubled marketplaces prepare to testify before congressional committees.

CQ HealthBeat: What’s The Matter With Blue State Exchanges? Experts See a Pattern
Maryland . . . Oregon . . . Massachusetts . . . Hawaii . . . Minnesota . . . it’s hard to think of a group of states with a politically stronger commitment to expanding coverage under the health law. But the marketplaces they set up to get that accomplished either malfunctioned mightily, underperformed or didn’t work at all ... Overly ambitious website designs, tangled lines of authority and incompetence and bad luck in picking contractors are among the reasons (Reichard, 4/3).

The Associated Press: Md. Panel To Get Update On Health Exchange
A legislative oversight panel on Maryland’s troubled health exchanged is holding a meeting to get an update from state officials. The Joint Oversight Committee of the Maryland Health Benefit Exchange is scheduled to meet in Annapolis on Thursday afternoon to hear details about an audit by state analysts (4/3).

The Washington Post: 7 Questions You Should Ask About Maryland’s Effort To Replace Its Troubled Health Exchange
Maryland Gov. Martin O’Malley (D) announced Tuesday that the state will replace nearly all of its troubled online health insurance exchange with technology borrowed from Connecticut, which has had one of the most successful exchanges in the country. The new system will be completed by November, officials say, in time for residents to enroll in private plans for 2015. Here are questions, and answers, about Maryland’s decision and the impact it will have on citizens seeking to benefit from the 2010 Affordable Care Act (Johnson, 4/2).

The Oregonian: Kitzhaber Adviser To Congress: Cover Oregon Health Insurance Exchange Succeeding Despite 'Bumpy' Start
An adviser to Gov. John Kitzhaber plans to tell a Congressional committee on Thursday that despite a "bumpy" start, Cover Oregon has enrolled more than 175,000 people in coverage and "those numbers grow every day." Greg Van Pelt has helped advise Kitzhaber on Cover Oregon following his retirement as CEO of Providence Health & Services last year. With several top Oregon exchange officials having either resigned or expected to resign, it's left to Van Pelt to address a Republican-led group of lawmakers probing problems at state-based health insurance exchanges (Budnick, 4/2).

Stateline: Next Steps For States And ACA
Like other states that opted to run their own exchange, Colorado spent several years and hundreds of millions in federal dollars to create an insurance marketplace specifically tailored for Coloradans. Complex legislation, multiple studies, numerous vendor contracts, dozens of public hearings and behind-the-scenes preparations led up to the launch of Colorado’s site in October. As of April 1, Colorado signed up 119,000 people for commercial insurance – a little shy of its goal of 136,000. State officials are already working on improvements for next year’s enrollment period, which starts Nov.15 and runs until Feb. 15, 2015 (Vestal, 4/3).

The Star Tribune: MNsure 'Stable, Secure And Successful,' Interim CEO To Tell Congress
MNsure's interim CEO will tell a congressional panel Thursday that Minnesota’s online health insurance exchange is “stable, secure and successful,” according to an advance copy of testimony reviewed by the Star Tribune. In testimony before two House Oversight subcommittees in Washington, D.C., on Thursday, interim CEO Scott Leitz will also acknowledge the exchange’s “rollout was rocky." MNsure is one of the six “problem-filled state exchanges” members of Congress will hear from (Mitchell, 4/2).

Pittsburgh Post-Gazette: GOP Proposal Would Regulate 'Navigators' Of Federal Health Law
A Republican-backed proposal to regulate the workers who help customers learn about insurance plans under the federal health care law appears to have traction in a [state] Senate committee. Pennsylvania would join numerous states in regulating the so-called navigators called for in the federal law. ... The Pennsylvania proposal, which has been sponsored by more than half the members of the Senate's Republican majority, would require navigators to register with the state Insurance Department and pass a criminal background check. The legislation would allow navigators to provide "general information" about enrolling in a health insurance marketplace but not to compare specific health plans (Langley, 4/3).

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New Medicaid Era Takes Different Paths In Mich., Wis.

The neighboring states opt for different approaches to Medicaid expansion. Meanwhile, in Missouri, two Republican lawmakers clash over whether to accept the health law's expansion, and the Pennsylvania governor says he is nearly ready to pull back his proposal that is languishing with federal officials.

The Washington Post's Wonkblog: Michigan And Wisconsin Highlight Divide On Medicaid Expansion
While the health care world was fixated yesterday on the end of Obamacare open enrollment, Tuesday also marked the beginning of a new Medicaid era for two neighboring states that took very different approaches to the law's expansion of coverage for low-income individuals. In Wisconsin, Republican Gov. Scott Walker pared back generous Medicaid eligibility while opening up the program to more of the state's lowest-income adults. In Michigan, Gov. Rick Snyder is using a federal waiver to implement the Affordable Care Act's expansion (Millman, 4/2).

The Associated Press/Kansas City Star: Missouri Medicaid Bill Set Aside After GOP Dispute
A bill revamping the management of Missouri's Medicaid program was set aside Wednesday after debate turned tense between two Republican senators who are at odds over whether to accept billions of federal dollars to expand health coverage for low-income adults (Lieb, 4/2).

St. Louis Post Dispatch: Republican Floats New Way To Expand Medicaid In Missouri, Runs Into Roadblock
Sen. Ryan Silvey, R-Kansas City, said Wednesday that it’s time for the Missouri Legislature to work to solve problems created by the federal Affordable Care Act instead of just hoping Congress will repeal it. Silvey contends he has a way to solve one of those problems. ... But at least so far, his plan isn’t even on the table. And critics of the health care law, led by Sen. John Lamping, R-Ladue, hope to keep it that way (Young, 4/2).

Springfield (Mo.) News-Leader: Medicaid Proposal Sparks Heated Exchange In Senate
Two Republicans dueled over Medicaid this morning, as the Senate's foremost opponent of expansion accused another senator of taking the "easy" route in rolling out a plan that would increase coverage. Sen. Ryan Silvey, R-Kansas City, has a proposal that would provide insurance for adults earning up to 138 percent of the federal poverty line but would also make extensive changes to assistance programs for the poor. ... On the floor, Sen. John Lamping, R-St. Louis County, said Republican lines such as "pragmatism" and "problem-solving" operate as code words that allow conservatives to support policies that lead to more government and more debt (Shorman, 4/2).

Philadelphia Inquirer: As Medicaid Talks Stumble, Corbett Warns Of 'Breaking Point'
Gov. Corbett said Wednesday that he might be nearing a decision on whether to pull the plug on his proposal to offer health insurance for hundreds of thousands of uninsured Pennsylvanians. In his strongest statement on the yearlong Medicaid negotiations, Corbett said he was "reaching his breaking point" with the federal government (Worden, 4/2).

The Billings Gazette: Court Clears Initiative Opposing Medicaid Expansion
The [Montana] Supreme Court on Wednesday denied an attempt to block state officials from approving petitions for an initiative prohibiting Montana from using funds or staff to administer the Affordable Care Act and forbidding the state from expanding Medicaid. The court, in a 5-0 ruling, rejected an attempt by Travis Hoffman, of Missoula; Melissa Smylie, of Great Falls; and Kim Abbott, of Helena, to disqualify Initiative 171 and prevent it from being circulated for signatures to qualify for the November ballot. Hoffmann is on Medicaid, while Smylie is on Medicaid and her child is on the Children’s Health Insurance Program. Abbott is leader of the Healthy Montana initiative (Johnson, 4/2).

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Confident From Enrollment Numbers, Obama Turns Focus To GOP Health Care And Budget Plans

President Barack Obama continued to tout the success of the health care law, using the momentum to attack the House GOP's new budget proposal, as well as providing a blueprint for the defense of the law for Democrats in upcoming elections. 

McClatchy: With 7 Million Enrolled, Obama Exudes New Confidence About Health Care Law
While further challenges remain, both politically and logistically, the unexpected success of the marketplace enrollment period helps ensure that the president's signature legislation will usher in one of the broadest expansions of national health coverage since the Medicaid and Medicare programs were launched in 1965 and the Children’s Health Insurance Program was established in 1997 (Pugh and Wise, 4/2).

Politico: Barack Obama On GOP Health Care And Economic Plans: ‘Stinkburger’ Or ‘Meanwhich’
President Barack Obama headed out on the road Wednesday still glowing from the latest Obamacare numbers and set his sights on congressional Republicans still working to obstruct his agenda. The House GOP’s new budget proposal and efforts to repeal the Affordable Care Act "should be familiar because it was their economic plan in the 2012 campaign, it was their economic plan in 2010," he said at the University of Michigan in Ann Arbor. "It's like that movie 'Groundhog Day.' Except it's not funny" (Epstein, 4/2).

Los Angeles Times: Obama, Lampooning GOP, Calls For Hike In Minimum Wage
The edgy message opened a new phase for Obama. With the rollout of his 2010 health law nearly complete, the president is now focusing on the congressional elections and on keeping the Senate in Democratic hands, a task his advisors think depends in part on his ability to draw a sharp contrast with the GOP's economic proposals (Parsons and Memoli, 4/2).

NBC News: Obama Offers A Blueprint For Democrats To Defend Health Law
President Obama's remarks on Tuesday hailing the 7 million-plus Americans who enrolled in the health-care exchanges were more than a victory lap. They also served as his blueprint to the Democrats running for re-election -- from Mary Landrieu in Louisiana and Kay Hagan in North Carolina, to Mark Udall in Colorado and Gary Peters in Michigan -- on how to defend the law in this tough political environment for their party. The question is whether these Democrats make the same arguments and borrow the same language; many of them would prefer that health care simply fade as an issue (Todd, Murray and Dann, 4/2).

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With Eyes On Upcoming Congressional Elections, Democrats See Glimmer Of Hope In Enrollment Numbers

For months, Republicans have viewed the health law as a powerful weapon against Democratic opponents, but the better-than-expected enrollment figures offered Democrats a positive counter-argument. Meanwhile, House Speaker John Boehner, R-Ohio, continues to voice dissatisfaction with his own "Obamacare" health policy.   

The New York Times: Health Enrollment Numbers Lift Democratic Hopes
After months of pummeling by Republicans and with a grim election season approaching, Democrats on Tuesday had a rare bright day. President Obama’s announcement that the new health care plan had enrolled 7.1 million Americans coincided with the release by Representative Paul D. Ryan of a new Republican budget that proposes changes in Medicare and deep cuts in spending (Weisman, 4/2).

Reuters: Obamacare Numbers Offer Glimmer Of Hope For Democrats In Elections
A rare burst of good news on President Barack Obama's healthcare program has given Democrats their first glimmer of hope in months on an issue that has helped drag the party down ahead of November's U.S. congressional elections. A better-than-expected enrollment of 7.1 million people in healthcare exchanges under Obamacare gives Democrats a positive argument to counter relentless Republican calls for repeal of the law, and could help them change the topic to the bread-and-butter economic and job issues Democrats prefer to talk about (Whitesides and Morgan, 4/2).

ABC News: Boehner Complains That Obamacare Tripled His Co-Pay
While President Obama heralds the more than 7 million health insurance signups through the Affordable Care Act, House Speaker John Boehner made it clear today he’s still ticked off about his own insurance rates going up. “I can give you hundreds of letters from my constituents who have been harmed by this law. My insurance premiums nearly doubled. My co-pays and deductibles tripled under ‘Obamacare,’” the Ohio Republican said today. Boehner has lamented his own insurance rates previously, which were forced to change along with other older government workers when the existing federal employee healthcare system moved to the District of Columbia’s new exchange, which was mandated by president’s signature law (Larotonda, 4/2).

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Jindal Offers Alternative To Health Law

Louisiana Gov. Bobby Jindal unveiled a 26-page health plan that emphasizes the role of states in keeping health costs down while giving consumers more flexibility. He also reiterates the need to repeal Obamacare.

The Washington Post: Bobby Jindal, With An Eye On 2016, Unveils Plan To Replace Obama Health-Care Law
In his 26-page plan, Jindal lays out a long critique of the health-care law and reiterates his belief that it needs to be done away with. He sets forth a bevy of ideas to replace it 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).

The Associated Press: Jindal: GOP Needs ‘Obamacare’ Alternative
Louisiana Gov. Bobby Jindal, a potential 2016 presidential candidate, on Wednesday offered a Republican alternative to President Barack Obama’s health care overhaul, saying states should play a greater role in containing health care costs while giving consumers more flexibility in choosing insurance plans. Jindal said Obama’s health care law should be “repealed in its entirety” but said Republicans need to offer a better way to reform the health care system, wading into one of the most contentious policy issues in the upcoming midterm elections (4/2).

The Wall Street Journal: Louisiana Gov. Bobby Jindal Proposes Alternative To Affordable Care Act
Republican Gov. Bobby Jindal of Louisiana, trying to distinguish himself from other potential presidential candidates, outlined a replacement for the Affordable Care Act that he said would expand health coverage to more Americans by making insurance more affordable (Reinhard, 4/2).

Politico: Bobby Jindal Dismisses Obamacare Numbers, Unveils Own Reform Plan
Jindal’s health package is predicated on a full repeal of the health care law, however. He said the longer Obamacare enrolls people, the less interested he is in accepting its massive expansion of Medicaid – an optional program that offers states billions of dollars to cover their poorest residents. Asked what he’d tell Republican colleagues who support Medicaid expansion, Jindal said his proposal wouldn’t stand in the way of states that want to expand Medicaid on their own. He pointed out that Obamacare is offering states more money to cover able-bodied adults through the expansion than to cover disabled children, who were typically eligible for the traditional Medicaid program (Cheney, 4/2).

CNN: Jindal On Obamacare Sign-Ups: So What
Louisiana Gov. Bobby Jindal, a possible contender for the 2016 Republican presidential nomination, waved off the Obama administration's jubilance over this week’s news that more than 7 million people have signed up for health insurance under the Affordable Care Act. “So what that under the threat of a government mandate they are able to get to this target of 7.1 million?” Jindal said Wednesday. Jindal was speaking to reporters at a Washington breakfast hosted by the Christian Science Monitor, where he revealed his own health care proposal that he claimed would lower costs and make insurance more affordable while giving states more control (Hamby, 4/2).

Reuters: With An Eye On 2016, Louisiana's Jindal Offers Healthcare Plan 
Louisiana Governor Bobby Jindal, who is testing the waters for the 2016 presidential race, on Wednesday unveiled a set of ideas on U.S. healthcare policy that he said could take the place of President Barack Obama's signature healthcare law. Republicans have put their call to repeal Obamacare at the center of their campaigns for November's congressional elections, but have yet to coalesce around an alternative to the health law (Debenedetti, 4/2). 

CBS News: Bobby Jindal: Republicans Can’t Just Run Against Obamacare
President Obama on Tuesday definitively declared that "the Affordable Care Act is here to stay." Yet just one day later, Gov. Bobby Jindal, R-La., rolled out a 26-page plan for replacing the controversial health care law. "We should absolutely repeal the law," Jindal said at a meeting in Washington hosted by the Christian Science Monitor. That said, he continued, "Too many Republicans in this town think that we can just run against Obamacare and we can't say anything else until November." Republicans are revving up their opposition to the health law ahead of this November, but Jindal acknowledged "it's no secret" that he's looking beyond the midterm elections and considering his own presidential prospects in 2016 (Condon and Alemany, 4/2).

The Fiscal Times: Jindal Releases Proposal To Replace Obamacare
There are some Republicans on the national stage so fixated on doing away with the Affordable Care Act that their calls to “repeal Obamacare” take on the character of a nervous tic. Few of them, though, offer any substantive proposal for what to do when about providing health care once it’s gone. On Wednesday, Louisiana Governor and possible 2016 candidate for the Republican presidential nomination, Bobby Jindal, released his “The Freedom and Empowerment Plan: The Prescription for Conservative Consumer-Focused Health Reform,” which he describes as “the foundation for true health reform – one that puts doctors and patients, not government bureaucrats, at the heart of all policy decisions” (Garver, 4/2).

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Capitol Hill Watch

Ryan Budget Plan Stirs Opposition On Both Sides Of The Aisle

The proposal from House Budget Chairman Paul Ryan, R-Wis., would cut $5 trillion over the next decade by repealing the Affordable Care Act and making sharp cuts to health care programs for the middle class and the poor. Democrats are incorporating the proposal into their midterm campaign strategy, while some Republicans, angered by the House leadership's handling of the 'doc fix' vote, are also expressing doubts.

Politico: Paul Ryan Budget Faces Bumps Amid GOP Dissent
And the simmering dispute is significant as it carries political consequences. Even the smallest group of members voting “no” can potentially put a vote in jeopardy and give a black eye to Ryan — a potential 2016 presidential contender — and Republican leadership. This is the most serious fallout from the leadership’s effort last week to pass a “doc fix” bill. In the blink of an eye last Thursday, Republican leadership used a voice vote to pass a patch of reimbursement rates for physicians who serve Medicare patients. No one had the chance to vote for or against the bill, which faced opposition from both parties (Sherman and French, 4/2).

The Associated Press: GOP Budget Slashes Spending, Aid To Poor
A budget plan stuffed with familiar proposals to cut across a wide swath of the federal budget breezed through the House Budget Committee on Wednesday, but its sharp cuts to health care coverage for the middle class and the poor, food stamps and popular domestic programs are a nonstarter with President Barack Obama (4/2).

The Washington Post: Ryan Budget Plan In Democrats’ Crosshairs
Congressional Democrats said Wednesday that the new House Republican budget plan will play a central role in Democratic midterm election strategy. … The Ryan plan released this week closely resembles the House GOP budget requests proposed and passed in recent years. The plan would cut federal spending by $5 trillion over the next decade by effectively repealing the Affordable Care Act, making deep cuts to Medicare and cutting taxes significantly for the nation’s wealthiest earners (O’Keefe, 4/2).

The Wall Street Journal’s Washington Wire: Why Democrats Like Ryan’s Budget
The DCCC Wednesday launched a new campaign called “Battleground: Middle Class” featuring ads and other efforts to attack the GOP budget proposals to revamp Medicare, replace Medicaid with state block grants, and cut spending in domestic programs throughout the budget (Hook, 4/2).

Meanwhile, in other Capitol Hill news -

Politico: Reality Hits Ron Wyden’s Idealism
The awkward episode came as Wyden was engaged in a quixotic effort to thwart a bill personally crafted by Reid and House Speaker John Boehner. The deal achieved exactly what Wyden didn’t want: a temporary patch in Medicare reimbursement rates that punted a long-term decision to another year. The measure passed the Senate over Wyden’s objection and President Barack Obama signed it into law on Tuesday (Raju and Haberkorn, 4/2).

And, on the legislative front -

The New York Times: Mental Health Groups Split On Bill To Overhaul Care
Lawmakers, patient advocates and the millions of Americans living with a psychiatric diagnosis agree that the nation’s mental health care system is broken, and on Thursday, Congress will hear testimony on the most ambitious overhaul plan in decades, a bill that has already stirred longstanding divisions in mental health circles (Carey, 4/2).

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Medicare Will Release Billing Data From Doctors

The information will include data on what services doctors used, the average amount they charged Medicare and what they were paid. Doctors have fought such disclosures in the past.

The Wall Street Journal: Medicare To Publish Trove Of Data On Doctors
Federal officials said they planned to release reimbursement information on April 9 or soon after that would show billing data for 880,000 health-care providers treating patients in the government-run insurance program for elderly and disabled people. It will include how many times the providers carried out a particular service or procedure, whether they carried it out in a medical facility or an office setting, the average amount they charged Medicare for it, the average amount they were paid for it, and the total number of people they treated (Radnofsky, 4/2).

The Associated Press: Medicare To Release Billing Data For 880K Doctors
Patients may soon get an unprecedented look at how their doctor compares to other physicians, after Medicare announced Wednesday it plans to publicly post billing data for more than 880,000 practitioners. Considered the mother lode of information on doctors, the Medicare claims database has been off-limits to the public for decades, blocked in the courts by physician groups. The American Medical Association has argued that its release would amount to an invasion of doctors' privacy. Consumer groups, insurers, employers and the news media have sought the information to help them evaluate clinicians (Alonso-Zaldivar, 4/2).

The Washington Post: Physician Data On Health Services, Payment To Be Released By Obama Administration
The Obama administration announced Wednesday it would for the first time release data about health-care services provided by doctors who participate in Medicare, in what officials hailed as a major step toward making the health-care system more transparent and accountable. As early as next week, the administration plans to release information about the number and type of health-care services delivered by more than 880,000 physicians in 2012, as well as how much Medicare paid them for the services. Together, those physicians collected $77 billion in payments through Medicare (Somashekhar, 4/2).

The New York Times: Medicare To Share Information On Pay For Physicians
Medicare said on Wednesday that it planned to make available to consumers and others detailed information on what it pays individual physicians as soon as next week, despite the long-term resistance by the American Medical Association and other group (Abelson, 4/2).

Bloomberg: Medicare To Release Doctor Payments For The First Time
Medicare, the U.S. health plan for the elderly and disabled, for the first time will release data on its payments to about 550,000 individual physicians. The U.S. Centers for Medicare and Medicaid Services informed the American Medical Association in a letter that the data would be released April 9 (Wayne, 4/3).

Politico Pro: CMS To Show What Medicare Pays Doctors
The Obama administration will open the books next week on what the government pays doctors through Medicare, a first-of-its kind data release that will provide an unprecedented view of spending in the health insurance program for seniors. CMS plans to provide a detailed account of $77 billion in payments made to more than 880,000 physicians in 2012. It will list procedures performed by individual doctors, how much they charged for them and how much they were reimbursed by the program — a total of 10 million lines of data (Norman, 4/2).

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Health Care Marketplace

Companies Continue To Shed Retiree Health Coverage

McClatchy reports on this trend. Among American workers, employer-provided retiree coverage has dropped from 29 percent in 1997 to 17.7 percent in 2010.  

McClatchy: U.S. Companies Are Chipping Away At Retiree Health Benefits
Once a mainstay of blue-collar and government jobs, retiree health benefits are steadily disappearing. Companies long offered them as a way of retaining workers. Now companies are shedding these plans and the expectations they entailed. By 2010, just 17.7 percent of American workers had employer-provided retiree health coverage, down sharply from about 29 percent in 1997, according to the Employee Benefit Research Institute, a nonpartisan study organization (Hall, 4/2).

In other news, the Associated Press reports on insurance company executive pay -

The Associated Press: Insurers Aetna, WellPoint Bulk Up Executive Pay
Health insurers enjoyed a boom year in 2013, with soaring earnings and stock prices, and some of the biggest companies shelled out millions of dollars to either keep or attract their leaders. Aetna Inc. Chairman and CEO Mark T. Bertolini saw his total compensation more than double to top $30 million last year, largely due to restricted stock and options valued at $17.6 million that the nation’s third-largest insurer gave him last August. Meanwhile, WellPoint CEO Joseph R. Swedish received $1.5 million in restricted stock for joining the second-largest insurer last year and about $3.8 million to make up for pay he forfeited leaving his old job running a multistate Catholic hospital system (4/2).

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State Watch

State Roundup: Battles Fought Over Lyme Disease, Autism and Abortion

In Texas, abortion providers file suit to block a state rule that could shut down many of the state's remaining clinics, while lawmakers in Vermont and N.Y. seek to protect doctors who prescribe long-term antibiotics for patients with lasting symptoms attributed to Lyme disease. In Kansas, a mandate to cover autism treatments is sent to Gov. Sam Brownback for his signature.

The New York Times: Abortion Providers In Texas Sue Over A Restrictive Rule That Could Close Clinics
Health clinics offering abortions in Texas filed a federal lawsuit on Wednesday to block a new state rule that could shut down more than half of the state’s remaining providers this fall, forcing women seeking an abortion in southern and western Texas to drive several hundred miles each way or go out of state (Eckholm, 4/2).

Kaiser Health News: Top Boston Hospital Begins To Tackle Readmissions Problem
Beth Israel Deaconess Medical Center is a highly regarded teaching hospital in Boston, but in 2012, the hospital found out it had one of the highest rates of readmissions among Medicare patients in the country. That meant federal fines of more than $1 million—and a lot of soul searching for the staff, says Dr. Julius Yang, the head of quality for the hospital. "Patients coming to our hospital, getting what we believed was high quality care, were coming back at an alarmingly high rate," says Yang (Gotbaum, 4/3).

The CT Mirror: Key CT Legislator Wary Of Proposed For-Profit Hospital Moratorium
Connecticut hospital officials came to the state Capitol Wednesday for their annual lobbying day with a big question mark lingering over the session: How far will lawmakers go in restricting the conversion of nonprofit hospitals to for-profits? With four of the state’s 28 nonprofit hospitals poised to be acquired by a national for-profit chain, the legislature's Public Health Committee last week advanced a bill that would place a moratorium on hospitals converting to for-profit, a concept cheered by union leaders and other critics of for-profit health care. But that proposal is expected to be revised, and on Wednesday, House Speaker J. Brendan Sharkey indicated that he would prefer a less restrictive approach (Becker, 4/3).

The New York Times: A Union Aims At Pittsburgh’s Biggest Employer
For decades, United States Steel was this city’s dominant employer, but now the biggest employer is the University of Pittsburgh Medical Center, with its 22 hospitals and 62,000 workers. … And just as labor unions famously clashed with Andrew Carnegie, UPMC faces its own labor showdown. The Service Employees International Union is seeking to organize more than 10,000 of UPMC’s service workers, and demanding that the hospital system be a leader, much like U.S. Steel once was, in raising wages (Greenhouse, 4/2).

The Wall Street Journal: Lyme Disease Dispute Draws In State Legislatures
Some patients with lasting symptoms attributed to Lyme disease believe long-term antibiotics can help. But advocates claim doctors who back the approach are hesitant to prescribe for fear of professional sanctions, given a long-roiling dispute over whether such treatment even works. Now, lawmakers in a growing number of states in the Northeast, where the tick-borne illness is particularly prevalent, are taking up the cause. Bills in Vermont and New York would protect doctors from punishment just for prescribing long-term antibiotics for patients who have lasting symptoms that they blame on a Lyme infection (Kamp, 4/2).

The New York Times: At Trial, Queens Doctor Is Accused Of Recklessly Prescribing Drugs
Among Dr. Li’s patients, prosecutors say, were drug addicts and street dealers who knew they could get a prescription, with few questions asked, for the right price. One patient was David S. Laffer, an addict who in June 2011 massacred four people while stealing narcotics from a drugstore in Medford, N.Y., on Long Island. He is now serving life without parole. Dr. Li, through his lawyer, has previously denied selling drugs to Mr. Laffer (McKinley, 4/2).

Los Angeles Times: County Urges Meningitis Vaccinations For Men Who Have Sex With Men
Citing a recently identified uptick in potentially deadly meningococcal disease, the Los Angeles County Department of Public Health recommended Wednesday that men who have sex with men get a meningitis vaccination (Brown, 4/2).

The Kansas City Star: Autism Coverage Mandate Goes To Kansas Governor
Advocates for children with autism won a breakthrough Wednesday when the Kansas Senate approved a bill mandating insurance coverage for the developmental brain disorder. The Senate voted 38-2 to pass the bill and send it to Republican Gov. Sam Brownback for his signature (Cooper, 4/2).

Modern Healthcare: Reform Update: Higher-Risk Medicare Shared Savings Program Pays Off For Some
Heartland Regional Medical Center had more to lose than most when it gambled and joined Medicare's experiment with accountable care in 2012 (Evans, 4/2).

The California Health Report: Future Uncertain For California’s Uninsured Kids
The Camacho family has six children, none of whom have health insurance. The Sacramento residents emigrated from Mexico about 13 years ago, staying without legal papers. They are among the estimated 2.6 million undocumented California residents who will largely be left out of health-care reform (Jones, 4/2).

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Weekend Reading

Longer Looks: New Doubts About Shaken Baby Syndrome; Arresting The Mentally Ill

Every week, KHN reporter Marissa Evans selects interesting reading from around the Web.

Seattle Met: The Trouble With Shaken Baby Syndrome
A number of reexamined cases in recent years—aided by new technology and debate among medical experts—have put proponents of the (Shaken Baby Syndrome) hypothesis on the defensive. Ernie Lopez, who was serving a 60-year-sentence for shaking an infant in his care to death, is now free, thanks in part to the work of retired Seattle lawyer Heather Kirkwood. So is Audrey Edmunds, a woman charged with the murder of a child in her care in the 1990s.  Yet even if they're ultimately absolved of any wrongdoing, those suspected of SBS are left to pick through the debris of their former lives: loss of employment, financial ruin, the stigma of having been labeled a child abuser.  Over the course of the past year I have contacted Washingtonians who've either been acquitted of SBS or whose cases showed sufficient reason for the possibility of exoneration. And in nearly every instance, they either refused to speak to me or asked that any identifying biographical details be left out of my account (James Ross Gardner, 4/1).

The New York Times: Police Confront Rising Number Of Mentally Ill Suspects
In towns and cities across the United States, police officers find themselves playing dual roles as law enforcers and psychiatric social workers. County jails and state prisons have become de facto mental institutions; in New York, for instance, a surge of stabbings, beatings and other violence at Rikers Island has been attributed in part to an influx of mentally ill inmates, who respond erratically to discipline and are vulnerable targets for other prisoners. "Frequent fliers," as mentally ill inmates who have repeated arrests are known in law enforcement circles, cycle from jail cells to halfway houses to the streets and back. The problem has gotten worse in recent years, according to mental health and criminal justice experts, as state and local governments have cut back on mental health services for financial reasons (Fernanda Santos and Erica Goode, 4/1). 

Salon: Report: Doctors At Oklahoma Hospital Banned From Prescribing Birth Control
Doctors affiliated with a small Catholic hospital in Bartlesville, Okla., are no longer allowed to prescribe contraception for the purposes of birth control, according to a report from the Bartlesville Examiner-Enterprise. According to the report, a meeting was held last week to inform doctors of the new directive barring them from prescribing contraceptives as birth control; according to the Examiner-Enterprise, doctors are allowed to prescribe contraceptives for non-birth control purposes, such as cramps, menstrual pain or endometriosis. ... A representative for St. John Health Systems, the Catholic health conglomerate that owns Jane Phillips Medical Center, said that the hospital's policy on contraception is "consistent with all Catholic health care organizations," but that physicians are able to prescribe medicine as they see fit (Katie McDonough, 4/1).

WBUR: The Woman Who Couldn't Stop Buying Self-Help Books
At first, I couldn’t understand why this new psychotherapy client had settled on my couch. Sure, Kaye (not her real name) was unhappy with her weight, and yet, she enjoyed an enviably healthy diet. With the aid of self-help books, she had not only taught herself to cook delicious, nutritious dishes, she'd also learned to meditate and eat mindfully. This unusually self-motivated working mother of two not only read each book from cover to cover, she practiced what the most helpful authors preached. As time went on, I came to understand that as much as self-help books helped Kaye eat more healthfully, they were effectively hindering her happiness. You see, she used self-help books the same way she used food – to stuff her feelings (Jean Fain, 3/28).

The Atlantic: Making Profits And Differences At Hospitals
Fifty years ago, healthcare was not so tightly linked to money. It has become so money-focused largely because, over the same period, healthcare spending increased from 5 percent to 18 percent of GDP, greater than any other segment of the U.S. economy. In some respects, the growing focus on money is completely natural. For one thing, someone needs to pay the bills of physicians, hospitals, health insurers, and even publicly-funded health programs. Even if healthcare workers give their time and hospitals donate the supplies, equipment, and facilities, someone ultimately pays out of pocket or in uncompensated effort for the care of every patient. The question is not so much whether money should enter into the conversation, but how prominent a role should it play, and where the loyalties of the people involved ultimately lie (Richard Gunderman, 3/27).

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Editorials and Opinions

Viewpoints: 'Pent-Up Demand' For Health Care; Too Early For That White House Victory Lap; The Fight Over Medicare Advantage

The New York Times: Measuring The Success Of Health Reform
More than seven million people have signed up for insurance on the new federal and state health exchanges, President Obama said this week. Millions more could be added to that total once insurers tally up the people who bought policies directly from them and when those who tried to apply on balky websites are able to complete the process. This is a remarkable turnaround that seemed unlikely after the health care exchanges operated by the federal government and by several states got off to a horrendous start in October and continued to suffer intermittent difficulties as late as Monday, the last official day for enrolling for coverage in 2014. The figures provide stark evidence of the pent-up demand for health insurance and the willingness of people to comply with a law that has been vilified by conservatives as a disaster for millions of Americans (4/2). 

Louisville Courier-Journal: Health Law Heading For Success
The stunning success announced Tuesday will do little to stop critics, chiefly in the Republican Party and its offshoot tea party, who have made the law also known as Obamacare a focal point of relentless political attack. In fact, the public should brace for a new onslaught of attacks as false as they are virulent —fueled by torrents of SuperPAC cash and special interest money as we enter the election season. But the public should consider some really good questions President Obama posed in remarks Tuesday as he announced the results of enrollment for health coverage by the March 31 deadline. "Why are folks working so hard for people not to have health insurance?" he asked. "Why are they so mad about the idea of folks having health insurance?" (4/3).

Time: Obamacare: Mend it, Don't End it
Indeed, there is one political thing that we know for sure: the Republicans have lost this debate substantively. The law won’t be repealed. "There is no off switch," says Professor John DiIulio of the University of Pennsylvania, who is studying the system from the bottom up in 35 states. "There are financial obligations to the people who have signed up [and receive subsidies from the government]. There are 50 different stories here. The program is different in every state. That makes it difficult to formulate a national policy response," whether it be repeal or sweeping reform. Which doesn't mean the Affordable Care Act doesn't need reform. It is a slovenly piece of legislation that will need constant modification and in some cases structural overhaul (Joe Klein, 4/3).

The Washington Post: The GOP Must Admit It Was Wrong On Obamacare
Is there any accountability in American politics for being completely wrong? Is there any cost to those who say things that turn out not to be true and then, when their fabrications or false predictions are exposed, calmly move on to concocting new claims as if they had never made the old ones? (E.J. Dionne Jr., 4/2).

The Fiscal Times: The Coming Obamacare Shock For 170 Million Americans
The public has hardly been in a celebratory or a laughing mood. Polls show that the American public remains as opposed to the ACA as ever, with 55 percent of Quinnipiac respondents disapproving of the law. Only 39 percent approve of Obama's handling of health care policy, which has until recently been a Democratic Party strength. For that matter, Obama only gets a 40 percent approval rating on the economy and jobs, to which House Minority Leader Nancy Pelosi wants the debate to turn now that the Obamacare debate "is over."  Pelosi and Obama may want to be careful with that wish casting, because the two debates are now closely related (Edward Morrissey, 4/3).

The Fiscal Times: Obamacare Got To 7 Million. Here's Its Next Big Test
Now that Obamacare enrollment has closed — with some 7.1 million enrollees, as the president crowed Tuesday — the next big test for the reform will be whether its spurs competition among health insurers to lower costs. While competition may thrive in the largest states, it may not hold true in mid-sized and smaller states, where only a handful of insurers dominate the new health care exchanges. Some radical changes may be necessary if competition is to play a role in reducing overall health spending (John F. Wasik, 4/2).

CNN: Too Early To Run Obamacare Victory Lap
Now that it's implemented, public opinion of the [health care] law is going to be tied to its success or failure. And the first year enrollment figures are only one small indicator. In other words, the Obama administration's celebration might be legitimate, but it could be premature as the long-term viability of the Affordable Care Act unfolds (Leigh Ann Caldwell, 4/2).

Huffington Post: A Tale Of Two Siblings, The ACA, And The Supreme Court
Yet there is a part of the law that is not at all working as originally envisioned, because the Supreme Court dramatically altered the structure of the ACA when it ruled that the expansion of Medicaid should be voluntary for states. Since then, political and fiscal considerations have led almost half of governors and state legislatures to choose not to expand Medicaid. The result is an insurance system that makes very little sense: An estimated 4.8 million poor Americans in states not expanding Medicaid will fall in a coverage gap this year and get no help paying for insurance, while 10.1 million people in those states who earn more than they do can get tax credits to help pay for coverage (Drew Altman, 4/1).

The Washington Post: Parting Companies And Their Employee Health Care
Hobby Lobby's case is that the Affordable Care Act confronts it with an impossible choice: paying for contraceptives that its owners' faith prohibits as abortifacients ... or dropping coverage. ... No doubt Hobby Lobby provides this insurance out of a sincere intent to fulfill [its religious duty to provide care for employees]. But I’ll bet the federal tax exemption for employer-paid health insurance plays a role, too.
Given that it benefits from this feature of the Internal Revenue Code, Hobby Lobby’s insistence on delivering health insurance to employees in precisely the manner its company conscience dictates strikes me as not only a matter of principle but also a subtle manifestation of the great American entitlement mentality (Charles Lane, 4/2). 

Bloomberg: Understanding Health-Care Spending's Ugly Spike
I’ll point you to a new piece of data that came in last week: In the fourth quarter of 2013, health-care spending seems to have grown at the fastest pace in a decade .... The timing doesn't jibe well with the theory that health-care spending is rising because of Obamacare. It's much more consistent with the theory that the slowdown was driven by the recession, or a temporary innovation hiatus, or a combination of both. This is hardly the last word, of course. But as it stands, the data suggest two things: We need to revisit our theories of why cost growth has slowed over the last few years, and we need to prepare for what this trend might do to our budget if it continues (Megan McArdle, 4/2).

Forbes: The Real Value Of ObamaCare Has Nothing To Do With Enrollment
The noisy debate over how many people have gotten health insurance under the Affordable Care Act misses the point. Yes, reducing the number of uninsured was one goal of the ACA. But only one. The law’s most enduring legacy will come from its historical—but largely unnoticed—changes in the way health care is delivered. Unlike the insurance expansion, which largely excludes Medicare, many of those delivery reforms affect seniors and younger people with disabilities. In some cases, they are remaking the care people get through Medicare. In others, they change the way care is delivered through Medicaid, which is critical for many receiving long-term services and supports (Howard Gleckman, 4/2). 

On other health issues -

USA Today: Trim Medicare Advantage Subsidies: Our View
Here we go again. Insurance companies and members of Congress are trying to scare seniors with dire warnings that new spending cuts will hurt the popular Medicare Advantage program, forcing beneficiaries to pay more for less. The final numbers are due from the Obama administration on April 7. Our advice: Take the warnings with a big grain of salt. Many of these same folks said many of these same, scary things back when health reform was being debated in 2009, insisting that cuts to Medicare Advantage in Obamacare would devastate the program (4/2). 

USA Today: Don't Harm Seniors: Opposing View
History often repeats itself, and that reality is a daunting one for seniors in Medicare Advantage. While some have argued that cuts to the popular program would do nothing to jeopardize seniors' health benefits, precedent tells us this isn't true. In 1997, Congress passed substantial cuts to Medicare Advantage, then known as Medicare+Choice. As a result, between 1999 and 2003, nearly 2.4 million seniors lost their health care coverage. That's a dangerous precedent (Karen Ignagni, 4/2). 

The New York Times' The Opinionator: An Illness, Inherited?
I spent many months, as a fetus, in a mental institution, listening to the world shuffling outside. I don't know what meds were administered to me in that developing stage. I lived in the belly of a woman I would never know. But my relationship with something dubiously entitled mental health was already established. I grew up in public care, in a series of foster placements, children's homes, adoptions, hostels; by the time I was 16 I had moved around 30 times. I had no memory of ever meeting anyone I was related to or even seeing a photograph of them. All I knew, thanks to a social worker, was that one parent had at one point been given a diagnosis of schizophrenia (Jenni Fagan, 4/2). 

USA Today: Health App Users Beware
Patients in my clinic increasingly use health apps on their mobile devices. Many of these apps track health metrics, such as weight or calories eaten, while others go a step further and help patients make sense of their symptoms or suggest diagnoses. By 2015, an estimated 500 million people worldwide will use a health app, turning the industry into a $26 billion business by 2017. Despite the promise of these apps, I'm not ready to recommend them to my patients. The sheer number of health apps is staggering, with more than 40,000 apps categorized as "health and fitness" or "medical" in Apple's app store alone (Kevin Pho, 4/2). 

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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.