Daily Health Policy Report

Wednesday, April 30, 2014

Last updated: Wed, Apr 30

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Health Care Marketplace

Medicare

Medicaid

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Some Obamacare Enrollees Emboldened To Leave Jobs, Start Businesses

KPCC’s Stephanie O’Neill, working in partnership with Kaiser Health News and NPR, reports: “Until recently, Mike Smith, 64, worked 11 hours a day, Monday through Friday and then half a day on Saturday, as a district manager for a national auto parts chain -- a schedule he’s kept for nearly 40 years. Early retirement, while certainly appealing, wasn't a viable option for him because both he and his already-retired wife, Laura, also 64, relied heavily on his job-provided health insurance. ‘At our age, with some preexisting medical conditions, it would have been very costly to buy insurance on the open market - about $3,000 a month,’ he says” (O’Neill, 4/29). Read the story.

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Who Really Pays For Health Care Might Surprise You

Kaiser Health News staff writer Jay Hancock, working in collaboration with USA Today, reports: “Eight million people have signed up for subsidized private health insurance under Affordable Care Act, President Obama said this month. Millions more obtained new coverage through the Medicaid program for the poor. Full implementation of the health law, and its wider coverage, new taxes and shifting subsidies, has renewed discussions of winners and losers, makers and moochers. Here's a corrective to common misconceptions about who pays for health care” (Hancock, 4/30). Read the story.

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Once Opposed To The Health Law, Now A Convert

The Philadelphia Inquirer's Robert Calandra, working in partnership with Kaiser Health News, reports: "Dean Angstadt fells trees for a living. He's a self-employed, self-sufficient logger who has cleared his own path for most of his 57 years, never expecting help from anyone. And even though he'd been uninsured since 2009, he especially wanted nothing to do with the Affordable Care Act. ... That refrain changed this year when a faulty aortic valve almost felled Angstadt. Suddenly, he was facing a choice: Buy a health plan, through a law he despised, that would pay the lion's share of the cost of the life-saving surgery - or die. He chose the former" (Calandra, 4/30). Read the story.

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Illinois Medicaid Moves To Managed Care

The Chicago Tribune's Peter Frost and Marcia Frellick, working in partnership with Kaiser Health News, report: "Sherry Loveless can see the promise of managed care right through her bedroom door. ... But next month, thanks to a restructuring in Illinois' Medicaid program, a renovation project is scheduled to widen the door and build a ramp that will allow her access to the outside. The nonprofit that's now in charge of Loveless' health and well-being, Community Care Alliance of Illinois, also is making it easier for her to obtain medications for her arthritis, hypertension, diabetes and chronic obstructive pulmonary disease, as well as transportation to medical appointments" (Frost and Frellick, 4/29). Read the story.  

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Health Law Presents Options, Challenges For Colorado Small Businesses

The Denver Post's Arthur Kane, working in partnership with Kaiser Health News, reports: "Jim Noon, owner of Denver cardboard box seller Centennial Container, has offered his employees health care coverage for three decades, but he isn't sure he will continue to offer the benefit after this year. ... Late last year, Noon received an early renewal offer from his insurance company that will be good through the end of the year with an 8.6 percent premium increase. To get a policy compliant with Affordable Care Act requirements — one that covers birth control, which his current plan doesn't — would have cost Noon 50 percent more, according to documents Noon provided from his broker" (Kane, 4/29). Read the story.

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Political Cartoon: 'Meep Meep?'

Kaiser Health News provides a fresh take on health policy developments with "Meep Meep?" by Jeff Darcy.

Here's today's health policy haiku: 

COULD IT BE THE FOUNTAIN OF YOUTH?

Testosterone gel
Wonder drug for aging men
Or maybe snake oil
-Anonymous 

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

Polls Try To Gauge The Health Law's Effects On Midterm Elections

A new NBC News/Wall Street Journal poll finds that more people think the overhaul is a bad idea rather than a good one. Still, another poll concluded that voters in swing districts are more supportive of fixing it instead of repealing it.  

The Wall Street Journal: Americans Want To Pull Back From World Stage, Poll Finds
But the president's standing remains perilously low just six months before the midterm congressional elections, and the poll was riddled with warning signs for his party. Support for his signature health-care law is improving slightly, a result that comes after the announcement that eight million people had picked insurance plans under the law. Still, support for the law remains weak, with 46% saying it is a bad idea and 36% saying it is a good one. "Clearly, the president has better news from his health-care law. But in general, that better news has still left people, by double-digit margins, saying it is a bad idea," said Mr. McInturff, the GOP pollster (Hook, 4/30).

NBC News: Poll: Slight Improvements But Tough Terrain Ahead For Democrats
Support for President Barack Obama and his health care law has increased in the weeks since the White House announced that eight million Americans have enrolled in the law’s health-insurance exchanges, according to a new NBC News/Wall Street Journal poll. But in spite of slight improvements from March, the poll still represent difficult terrain for Obama and the Democratic Party with six months to go until November’s midterm elections. Republican pollster Bill McInturff, who conducted the survey with Democratic pollster Peter Hart, says the results highlight the difference between “better” and “good” for Democrats (Murray, 4/29).

Los Angeles Times: Support Wanes For Repeal Of Obamacare, Surveys Suggest
Kaiser, which has surveyed public opinion about the Affordable Care Act, or Obamacare, each month, found impressions of it warming slightly from the low points of November through January. Overall, however, opinions of the law remain negative, with 46% now having a generally unfavorable view of it and 38% generally positive, the poll found. Those views are sharply divided by party, as has been the case since the law passed. A survey by Democratic pollster Stanley Greenberg found a similar division on the question of fixing the law versus repealing it. Among likely voters in competitive congressional districts, 52% say the country should “implement and fix the healthcare reform law” while 42% say they want to “repeal and replace” it, he found (Lauter, 4/29).

Fox News: New Polls Show Public Skeptical About Impact Of ObamaCare
New polls continue to show the public is skeptical about the impact of ObamaCare, particularly when it comes to costs, something analysts have long warned about. “New ObamaCare policies cost about 35 percent more and that increase can come in the form of higher premiums, higher deductibles or narrower networks," said Robert Laszewski of Health Policy and Strategy Associates. In the latest Washington Post poll, 58 percent of consumers said the new law is causing higher costs while only 11 percent said it is reducing them (Angle, 4/30).

Politico: Steny Hoyer: Obamacare Not Election’s ‘Holy Grail’
House Minority Whip Steny Hoyer predicted on Tuesday that Obamacare will not prove to be the massive political liability for Democrats that Republicans hoped ahead of the 2014 midterm elections. “I think health care at worst is going to be a neutral in this election,” said Hoyer (D-Md.) during a press conference. “This is not the holy grail of this election” (French, 4/29).

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Health Plan Execs Say Millions More Are Insured

Meanwhile, Marketplace describes how hundreds of mostly rural residents in Tennessee still wait in line all night to get free health care, while Southern California Public Radio reports on Obamacare enrollees who feel emboldened to leave their jobs to start businesses now that they can get insurance outside of their jobs.

Politico: Insurers: Millions More Have Coverage Now
A panel of health insurers agreed Tuesday that the number of insured people in the country has climbed by millions, despite arguments by some Republicans that the insured population has declined because of canceled plans. “I don’t doubt that,” said Jay Gellert, president and CEO of the California-based Health Net, when asked whether there’s any real question that the nation’s insured population has grown (Cheney, 4/29).

Kaiser Health News: Some Obamacare Enrollees Emboldened To Leave Jobs, Start Businesses
Until recently, Mike Smith, 64, worked 11 hours a day, Monday through Friday and then half a day on Saturday, as a district manager for a national auto parts chain -- a schedule he’s kept for nearly 40 years. Early retirement, while certainly appealing, wasn't a viable option for him because both he and his already-retired wife, Laura, also 64, relied heavily on his job-provided health insurance. "At our age, with some preexisting medical conditions, it would have been very costly to buy insurance on the open market -- about $3,000 a month," he says (O’Neill, 4/29).

CQ:  Health Law Brings Access to More Contraceptives, But Coverage Gaps Remain, Advocates Say
The health care overhaul law is giving teens access to a wider range of contraceptive products that will strengthen efforts to prevent unwanted pregnancy among young people, advocates say. After a period of interpreting the law’s requirement for contraceptive coverage too narrowly, insurers have begun to cover a wider range of products including expensive intrauterine devices, speakers at a forum on preventing teen pregnancy in the District of Columbia said (Reichard, 4/29).

Marketplace: Why Some Rural Patients Wait All Night To Get A Tooth Pulled
The Affordable Care Act is intended to provide insurance for America’s poorest. It was supposed to control healthcare costs by getting people to doctors for routine visits. But for many low-income -- and especially rural -- Americans, healthcare needs are still not being met. At a fairground just outside downtown Knoxville, Tennessee, hundreds of people wait in line. ... The two-day clinic, called Remote Area Medical, offers free medical services -- from dental to vision to yearly checkups (McKone, 4/29).

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Oregon, Oracle Officials Thought They Might Have A Federal Exchange Fix

Emails show that a former Oregon official believed in early October that the state's troubled exchange was just weeks away from a fix that might also be used to rescue the federal website, reports The Oregonian. Meanwhile, Fox News writes about an announcement by contractor Accenture that it will cost $121 million to get the federal exchange site ready for a second open enrollment and MNsure makes coverage retroactive for some people.

The Oregonian: Oracle, State IT Official Contemplated Cover Oregon As Rescue For Beleaguered Federal Health Insurance Exchange
The date was Oct. 19, 2013 and Oregon's health exchange website was 19 days late. Yet, state technology workers and their counterparts at Oracle were convinced they were on the right track, so much so that they discussed making their technology available to the federal government to rescue the fed's then-struggling healthcare.gov exchange site. "How is Oregon's exchange looking?  Any possibility it could be the answer to an overhaul," Oracle executive Donna-Mae Shyduik asked in an email. "I think it could be," answered Caroline Lawson, then chief information officer of the Oregon Health Authority (Manning, 4/29).

Fox News: Accenture Says ObamaCare Website Fix Will Cost $121M
The contractor hired to fix the ObamaCare exchange website announced Tuesday that it would cost $121 million to get the site ready for a second open enrollment period in 2015. In a statement posted on its website, Accenture Federal Services said the contract it had agreed with the Centers for Medicare and Medicaid Services (CMS) covers initial repair work, as well as "enhancing back-end capabilities to improve issuer payments and plan management including deploying new features." The agreement runs until January 10, 2015. Accenture was tapped to repair the glitch-laden site this past January 11 after CGI Federal, the original contractor in charge of the site, was fired (4/30).

The Pioneer Press:  MNsure Coverage To Be Retroactive In Some Cases
MNsure announced two new options Tuesday for select groups of consumers to purchase coverage in the coming weeks through the state's new health insurance marketplace. The options are intended to help people who either struggled with technical problems while trying to buy on MNsure in the past seven months or skipped the insurance exchange altogether and purchased policies directly from insurance companies (Snowbeck, 4/29).

Minnesota Public Radio: MNsure Offers Retroactive Coverage For Some
Consumers who lost out on federal health insurance subsidies because of MNsure's troubled website now have a way to recoup those discounts if they act by May 15. Many frustrated consumers stymied by MNsure's online problems ditched the health insurance marketplace and applied for health coverage directly through insurance companies. But that that made them ineligible for premium tax credits (Stawicki, 4/29).

And on other exchanges -

The Associated Press: Deadline Arrives To Enroll In Health Plan In DC
District of Columbia residents who've yet to enroll in a health insurance plan are facing a final deadline. Wednesday is the last day that people can sign up for insurance without having to pay a tax penalty under the federal health care overhaul (4/30).

The Seattle Times:  Healthplanfinder Site Fixes Potential Password Problem
The folks who run the Washington Healthplanfinder online exchange heard about several consumers who said that when they needed a new password from the website, the password was emailed to them in plain text — making it relatively easy to viewed by anyone intercepting the e-mail.  They were concerned about the security of that practice. I checked with Curt Kwak, chief information officer of the Washington Health Benefits Exchange, which operates the site, regarding their password policies (Marshall, 4/29).

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Capitol Hill Watch

With Burwell Confirmation Hearing Approaching, Many GOP Senators Say They Are Impressed With The Nominee

The first confirmation hearing for Sylvia Mathews Burwell, President Barack Obama's pick to head the Department of Health and Human Services, will be next week.

Politico: Sylvia Mathews Burwell: The Obamacare War That Wasn’t
The proxy war over Obamacare that was expected to dominate the Senate in May is looking more and more like a dud. The chamber will begin consideration next week of Sylvia Mathews Burwell’s nomination to lead the Department of Health and Human Services, the agency tasked with implementing the health care law. Initially, Republicans seemed poised to use the confirmation process to spur further attacks on Obamacare. But instead, more than a half-dozen GOP senators said in interviews that they are impressed with Burwell’s credentials (Haberkorn and Everett, 4/29).

The Hill:  House GOP Lawmakers Demand Hold On Burwell
Five House Republicans from Louisiana are demanding that their senators place a hold on President Obama's nominee to lead the Department of Health and Human Services (HHS) until the administration withdraws the individual mandate. The call for Sens. Mary Landrieu (D-La.) and David Vitter (R-La.) to act comes as Landrieu faces a tough reelection battle that has ObamaCare at the center of the debate. It is unlikely to bring any changes to the law, because Senate Democrats have the votes to confirm a new HHS head (Viebeck, 4/29).

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House Passes Bill To Loosen Health Law Rule For Insurers Who Sell To Expat Workers

The White House, however, opposes the bill on grounds that it could weaken the health law's consumer protections, although it stopped short of threatening a veto.

The Associated Press: House Passes Bipartisan Fix To Health Law
The House approved bipartisan legislation Tuesday to exempt U.S. health plans sold to expatriate workers from having to comply with requirements under the Affordable Care Act. The measure, which passed 268-150, is aimed at helping U.S. insurance companies like Cigna and MetLife that are at a competitive disadvantage with foreign firms that do not have to comply with ACA requirements such as free preventive care and a ban on lifetime coverage limits. Sixty Democrats joined most Republicans in voting "yes," while 17 Republicans opposed the legislation. There is widespread agreement on the need for a fix under the health law for U.S.-written expatriate plans that can be sold to Americans working overseas and foreigners working here or elsewhere. But senior Democrats and the White House opposed the bill that was advanced Tuesday, saying it contained deal-killing loopholes (Werner, 4/29).

The Hill:  White House Opposes Bipartisan O-Care Bill 
The White House expressed opposition to a bipartisan bill that would loosen ObamaCare's rules for expatriates and workers who frequently travel in and out of the country, but stopped short of threatening to veto the legislation. In an official statement Tuesday, the Office of Management and Budget urged Congress to make "straightforward changes" to the legislation from Rep. John Carney (D-Del.) to ensure it does not weaken ObamaCare's consumer protections (Viebeck, 4/29).

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Health Care Marketplace

WellPoint's Profits Fall On Investments In Health Law Plans

Still, the company, which is closely watched because it is a big provider of plans to individuals on the law's marketplaces, beat analysts' expectations and raised its outlook for the year. Also out are earnings statements from hospital giant HCA and Express Scripts.

The Wall Street Journal: WellPoint Profit Declines On Higher Expenses
WellPoint Inc. on Wednesday said its first-quarter profit shrank 21 percent, as the health insurer's higher expenses offset a rise in revenue. The company raised its outlook for the year, predicting adjusted earnings above $8.40 a share and operating revenue above $73.5 billion. ... WellPoint in January said the people enrolling in new health-law plans are skewing older than its previous individual consumers, but they appeared to match the less-healthy pool the company predicted when it set its prices. The insurer's experience is being closely watched because of its big position in the new government marketplaces. The Indianapolis company has been one of the biggest providers of individual plans and is selling them through the government marketplaces in more than a dozen states (Rubin, 4/30).

Reuters: WellPoint Says First-Quarter Profit Fell On Reform Costs
WellPoint Inc, the second-largest U.S. health insurer, said on Wednesday that first-quarter profit fell, largely because of investment spending related to healthcare reform and the higher administrative costs of adding new commercial customers. WellPoint, which runs Anthem and Empire Blue Cross Blue Shield plans, reported net income of $701 million, or $2.40 per share, down from $885 million, or $2.89 per share, a year earlier. As in Aetna Inc's report last week, earnings beat analysts' expectations (Humer, 4/30).

The Wall Street Journal: HCA Profit Edges Up; Health-Care Reform Has Minimal Impact
HCA Holdings Inc. said its first-quarter earnings rose 0.9 percent as the hospital operator reported stronger revenue. "We are pleased with results for the first quarter," Chief Executive R. Milton Johnson said. "As expected, health-care reform had minimal impact on the company's first quarter results; however, we remain optimistic regarding the potential long-term benefits" (Stynes, 4/29).

Reuters:  HCA Sees Encouraging Signs But No Health Reform Benefit Yet
HCA Holdings Inc on Tuesday reported quarterly earnings just shy of analysts' expectations, and its top executive said the U.S. hospital chain had not yet benefited from President Barack Obama's healthcare reform law. HCA, the largest U.S. for-profit hospital operator, said first-quarter net income rose to $347 million, or 76 cents a share, from $344 million, or 74 cents a share, a year earlier (Kelly, 4/29).

The Associated Press: Express Scripts Profit Falls In 1Q On Lower Sales
The nation’s largest pharmacy benefits manager scaled back its 2014 earnings guidance to between $4.82 and $4.94 per share, citing several customer delays which pushed back implementation of service to early 2015 from mid-2014. The company had previously forecast earnings in the range of $4.88 to $5 per share. Company shares fell 5 percent in after-hours trading (4/29).

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Medicare

Some Medicare Beneficiaries Have Trouble Getting Extended Nursing And Therapy Services

Under a 2012 court settlement, the Department of Health and Human Services agreed to relax rules that said seniors could get these services only if they continued to improve. But many providers are still unaware of the new regulations.

Reuters:  New Medicare Coverage Of Long-Term Care Off To Rocky Start
Under the 2012 settlement of Jimmo v. Sebelius, the U.S. Department of Health and Human Services agreed to relax Medicare's requirements for coverage of skilled nursing and therapy services in institutional or home care settings. Prior to the settlement, Medicare's policy was to cover skilled nursing care only when patients had demonstrated medical potential to improve. Starting this year, the key criterion for coverage is a demonstrated need for skilled care -- even if the patient isn't expected to improve. ... That should be good news for the Klaibers, a retired couple living in Marstons Mills, Massachusetts, on Cape Cod. But Diane Klaiber instead finds herself embroiled in a coverage dispute with Robert's healthcare provider that underscores the rough start for the new Medicare rules (Miller, 4/29).

In other Medicare news -

Modern Healthcare:  Health Centers In Line For Medicare Boost Under New Pay Model
Medicare will increase payments to federally qualified health centers by as much as 32% while scrapping the fee-for-service model for one that gives the facilities a bundled rate for each patient encounter. On Oct. 1 the CMS will begin transitioning some 8,900 FQHCs to a new prospective payment system under a final rule issued late Tuesday. The health centers get enhanced Medicare reimbursement for providing care to underserved populations. Some of them, however, are wary of the new payment system, which was called for in the Patient Protection and Affordable Care Act (Dickson, 4/29).

USA Today: Some Chiropractors Making Big Medicare Adjustments
More than 36,000 chiropractors were paid nearly $500 million by the federal government in 2012, making chiropractors one of the largest groups of Medicare providers. And one chiropractor in Brooklyn topped the list, receiving more than $1 million that year alone. Alexander Khavash, who works in Brooklyn out of a rented office, received nearly twice the Medicare payments than any other practitioner in his field, according to data released this month by the Department of Health and Human Services (O'Donnell, Hoyer and Alcindor, 4/29).

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Medicaid

Increased Awareness Drives Up Kansas Medicaid Enrollment

State officials say it is a result of the "woodwork effect." Meanwhile, Modern Healthcare reports that some state Medicaid managed care plans are looking for help dealing with the cost of Sovaldi, the new hepatitis C drug.  

Kansas Health Institute News Service:  Kansas Officials Say Medicaid Enrollment Growth Expected To Continue
State officials today said they expect more than 13,000 Kansans currently eligible but not enrolled in Medicaid will sign up for it by July 2015 due to greater awareness of the program from the Affordable Care Act and KanCare. Kari Bruffett, director of the Division of Health Care Finance at the Kansas Department of Health and Environment, said Medicaid enrollment so far this year already has outpaced "normal growth" patterns and that trend was expected to continue at least over the next year or more thanks to the so-called "woodwork effect” (Shields, 4/29).

In other Medicaid news --

Modern Healthcare:  Medicaid Plans Look To States For Help With Expensive Hepatitis C Drug
Medicaid managed-care plans are looking to state officials for help as they face massive outlays for the new hepatitis C drug Sovaldi, which costs $84,000 for a 12-week course of treatment (Dickson, 4/29).

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State Watch

Minn. Unseats Mass. As Top Place For Health Care

News outlets around the country reported on The Commonwealth Fund's score card, which graded states on 42 measures, including access to care, quality and costs. USA Today looked at the report's contention that states' decisions not to expand Medicaid risk widening the health care gap with states that have expanded coverage.

WBUR: Minn. Beats Mass. For Top Health Care Spot In United States
Massachusetts ranks second in the country on a health care score card out today from The Commonwealth Fund. The ranking is based on 42 measures, including access to care, preventive visits, quality of treatment, race and ethnic disparities and lifestyle issues such as smoking. Massachusetts is at or near the top on many measures, but the state received low scores for avoidable hospital use and costs in 2012. Commonwealth Fund president Dr. David Blumenthal says an abundant supply of hospital beds may be driving demand (Bebinger, 4/30).

Georgia Health News: Georgia Sinks In State-By-State Health Care Rankings
Georgia improved on several important health measures from 2007 to 2012, but its overall health care ranking among states fell from 35th to 45th in a newly released study. The Commonwealth Fund’s 2014 state health system scorecard, released Wednesday, found that all states saw meaningful improvement on at least seven of 34 indicators. Georgia improved on 13, including child vaccinations, hospital admissions for pediatric asthma, Medicare 30-day readmission rates, and infant mortality. But Georgia’s health statistics worsened in 12 areas, including its rates of uninsured adults; adults with a usual source of care; and adults without a dental visit in the past year (Miller, 4/30).

The Milwaukee Journal Sentinel: Wisconsin's Health System Ranks In Top 10 In National Report
Wisconsin ranks seventh in the country in the overall performance of its health system and has made gains in reducing infant mortality and improving care for people covered by Medicare, according to a report released by the Commonwealth Fund. But the Scorecard on State Health System Performance, which tracks how states performed on 42 measures, also shows areas where Wisconsin has made no progress, such as the percentage of adults under 65 who have lost six or more teeth. "There is room for improvement in every state, said David Blumenthal, a physician and president of the Commonwealth Fund, an organization based in New York that supports health policy research (Boulton, 4/29).

Politico Pro: Report Finds Little Health Progress In States Pre-ACA
In the five years preceding the coverage expansion of the Affordable Care Act, most states did not improve health care access, quality, costs or outcomes, according to a report released Wednesday by the Commonwealth Fund. In some cases, states took several steps backward. The report found that between 2007 and 2012, most states made no progress or did worse on two-thirds of 34 indicators. In 10 states, scores declined on more indicators than improved. Disparities persisted based on geography, race and ethnicity and income (Villacorta, 4/30).

USA Today: No Medicaid Expansion Could Create Health Care Gaps
States that have not expanded their Medicaid programs as part of the Affordable Care Act risk larger-than-ever gaps in overall health between residents of their states and those that have expanded Medicaid, a report released Wednesday shows. Nine of the top 13 states in overall health have expanded Medicaid, while three in the lowest 12 have not expanded, according to the report by the Commonwealth Fund, a non-profit group studying U.S. health care (Kennedy, 4/30).

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State Highlights: Medicaid For Former Foster Youth; Free Clinic Expands In Va.; Va. Mental Health Law Signed

A selection of health policy stories from Virginia, Arizona, Missouri and Connecticut.

Stateline: States Enroll Former Foster Youth In Medicaid
About 26,000 young adults 18 to 22 years old are released from foster care each year and left to fend for themselves without state protections. The age that a young adult in foster care loses benefits varies across the states. The new health care provision for former young people without parents in the picture grants them full Medicaid coverage until age 26 in the state where they lived when they left foster care. For states, the trickiest part may be finding these young adults (Vestal, 4/30).

The Associated Press: Free Health Clinic To Ramp Up Operations In Va. 
Now RAM organizers are hoping to help more Virginians without health care. RAM founder and former “Wild Kingdom” TV star Stan Brock announced at the Capitol on Tuesday that his organization is launching a two-year “Stop the Suffering” campaign aimed at providing more free health clinics in Appalachian states. The announcement comes as the General Assembly continues to debate whether to expand Medicaid eligibility. Like most other Southern states, Virginia has thus far rejected expansion (4/29).

The Associated Press: McAuliffe Signs Va. Mental Health Reform Bill
Virginia officials are celebrating the signing of a mental health reform bill. Gov. Terry McAuliffe ceremonially signed the bill Monday at the University of Virginia Medical Center in Charlottesville (4/29).

The Associated Press:  Congressmen Want Phoenix VA Health Chief Removed 
A trio of Arizona congressmen on Tuesday called for the head of the Phoenix Veterans Affairs Health Care Center to step down amid allegations of gross mismanagement and neglect at the facility, the latest in a string of issues at VA hospitals across the nation. The call from Republican Reps. David Schweikert, Matt Salmon and Trent Franks comes after weeks of growing outrage about lapses in veteran patient care in Phoenix. They urged hospital director Sharon Helman and her leadership team to resign, saying in a letter that "drastic changes need to be made to ensure that this never happens again” (4/29).

The Associated Press:  Former Health Care CEO Pleads Guilty To Fraud
The former CEO of a southeast Missouri health center has pleaded guilty in federal court to fraud. Cheryl Ann White was chief executive officer of the nonprofit Southeast Missouri Health Network from 2004 to 2013. Prosecutors say the 56-year-old New Madrid resident falsified federal grant applications and used health center money to pay for a roof on a building she owned. She also admitted providing insider information to a contractor who built the center's Bernie clinic and worked on several other projects (4/29).

The CT Mirror: House OKs Nursing Home Transparency, Despite GOP Talkfest
A sharply divided House of Representatives voted Tuesday night for new financial reporting rules on nursing homes that were proposed by Gov. Dannel P. Malloy at the request of a union ally, SEIU 1199 New England. The bill passed on an 86 to 57 vote, with seven Democrats joining every Republican present in opposition. The House GOP minority signaled its deep opposition to the Democratic governor’s bill and the administration's refusal to negotiate by extending the debate to nearly eight hours. The measure, which now goes to the Senate, would create a Nursing Home Financial Advisory Committee to regularly examine the financial solvency and quality of care of nursing homes (Pazniokas, 4/29).

The CT Mirror: CT Lawmakers Join War On Heroin, Painkillers
Washington has turned its attention to the epidemic of heroin addiction and overdose deaths -- including more than 250 in Connecticut last year -- but there’s a limit to what the federal government and Congress can do, especially in times of tight budget constraints. Members of the House Energy and Commerce Committee held a hearing Tuesday to review growing concerns about heroin and prescription abuse. Some wanted more funds for law enforcement and treatment, others wanted to know which programs worked best, and a few members said they worried that Congress would drop the ball on the issue (Radelat, 4/29).

The CT Mirror: Business Groups Question Malloy Health Reform Funding Plan
Gov. Dannel P. Malloy’s proposal to hire nine workers to help develop a state-level health reform initiative isn’t, in itself, especially controversial. But the way the governor wants to pay for it -- by imposing a new fee on health insurance policies -- has drawn opposition from business groups. One has warned that the state could face a lawsuit if the measure passes. At issue is how the state would come up with $3.2 million for expenses and new staff to work on a project, known as the state innovation model, or SIM (Becker, 4/29).

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Editorials and Opinions

Viewpoints: Fauxbamacare; Virginia's 'Game Of Chicken'

Vox: The Republican Replacement For Obamacare Is Fauxbamacare
Scott Brown, who's now running for Senate in New Hampshire, has found the perfect position on Obamacare. He's for it. He's just not for calling it Obamacare. In an interview with [WMUR], he called Obamacare a "disaster." Then he was asked what he's for  — and he went on to describe Obamacare. "I've always felt that people should either get some type of health care options, or pay for it with a nice competitive fee," he said. "That's all great. I believe it in my heart. In terms of preexisting conditions, catastrophic coverages, covering kids, whatever we want to do." He even said it could "include the Medicaid expansion [for] folks who need that care and coverage" (Ezra Klein, 4/29).

The New York Times' Taking Note: No Comment Necessary: Scott Brown's Take On 'Obamacare'
Like confused poll respondents, Scott Brown, the former Massachusetts Senator who's running for Senate in New Hampshire, says he thinks the Affordable Care Act is disastrous, but seems to like everything it does (Andrew Rosenthal, 4/29). 

Bloomberg: Catch Of The Day: Fauxbamacare!
The dirty secret is most Republicans don’t actually oppose the type of reform that Democrats undertook. Oh, they oppose "Obamacare," and they've managed to convince themselves that they oppose one or two of the provisions. But for the most part, what they oppose is the idea of it or, even worse, the fables they tell about it: "Death panels" and "government takeovers" and "socialism," but not the basic idea of the exchanges. That’s not to say the ACA is really a conservative plan – I think Scott Lemieux is correct in pointing out the massive differences between the actual law Democrats passed in 2010 and the ideas that Republicans previously supported, let alone the differences between the law and what Republicans actually would have been willing to pass if it was up to them (hint: nothing). That's why there is still no Republican alternative to Obamacare, and won’t be (as Paul Krugman explained today). There's just no viable policy that Republicans are willing to embrace (Jonathan Bernstein, 4/29).

The New York Times: Nurses Are Not Doctors
Earlier this month, the New York State Legislature passed a bill granting nurse practitioners the right to provide primary care without physician oversight. New York joins 16 other states and the District of Columbia in awarding such autonomy. (Most states still require nurse practitioners to work with physicians under a written practice agreement.) The bill's authors contend that mandatory collaboration with a physician "no longer serves a clinical purpose" and reduces much-needed access to primary care (Dr. Sandeep Jauhar, 4/29).

The Washington Post: McAuliffe Can't Win 'Game Of Chicken' Over Medicaid
The first law of holes is to know when to stop digging. We therefore urge Gov. Terry McAuliffe to reject The Post editorial board's Medicaid expansion shovel. In the April 25 editorial "Virginia’s game of chicken," The Post suggested that McAuliffe start "describing to Virginians the paralysis and hardships that are likely to befall the state if Republicans continue to refuse any semblance of compromise and the government shuts down." With all due respect, the strategy of digging up fears of a state-government shutdown has not worked and will not work, as indicated by recent polling on Medicaid expansion and the state budget from Christopher Newport University (Norman Leahy and Paul Goldman, 4/28). 

The Wall Street Journal: A Biotech Lesson For Big Pharma Mergers
Pfizer's $100 billion offer for rival AstraZeneca's proof that big drug makers are once again seeking out big mergers. It's a way for them to gain market leverage as governments clamp down on health-care spending. But the more interesting story—and one Big Pharma could learn from—is the bull market in young, lean biotech companies and their initial public offering (Scott Gottlieb, 4/29). 

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Lisa Gillespie
Marissa Evans

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.