Daily Health Policy Report

Monday, April 7, 2014

Last updated: Mon, Apr 7

KHN Original Reporting & Guest Opinion

Health Reform

Medicare

Capitol Hill Watch

Health Care Marketplace

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Decoding The High-Stakes Debate Over Medicare Advantage Cuts

Kaiser Health News staff writer Jay Hancock, working in collaboration with The Miami Herald, reports: "The rate change, part of the Affordable Care Act, is the next step in winding down a subsidy that pays Medicare Advantage plans substantially more than what traditional Medicare costs. Proponents say the move will end what they call an industry windfall and pressure insurers, hospitals and doctors to deliver care more efficiently. The industry, which maintains the cuts will raise costs and reduce consumer benefits, has launched a massive national counterattack, running numerous 'seniors are watching' ads, getting beneficiaries to pepper politicians with calls and letters, and lobbying the administration to back off" (Hancock, 4/7). Read the story.

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Los Angeles County Audit Finds Backlog Of Nursing Home Complaints

Kaiser Health News staff writer Anna Gorman, working in collaboration with the Los Angeles Daily News, reports: “A lack of central oversight of nursing home investigations in Los Angeles County has contributed to a backlog of hundreds of complaints, according to an audit released late Friday. The Los Angeles County Auditor-Controller determined that there were 3,044 open investigations as of March 14, including 945 that have been open for more than two years. The auditor found that there is no central management of the investigations and that surveyors within the Health Facilities Inspections Division, or HFID, do not have set deadlines for completing cases” (Gorman, 4/5). Read the story.

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When Connecting With A Dentist Doesn't Mean An Office Visit

Kaiser Health News staff writer Daniela Hernandez, working in collaboration with the Los Angeles Daily News, reports: "It’s all part of a free ‘teledentistry’ program for low-income patients in California who don’t have access to regular dental care. Often they’re stymied by high costs and a shortage of dentists who treat the poor. Many also face language barriers, lack legal immigration status, are afraid of dentists or have a poor understanding of what causes dental problems" (Hernandez, 4/7). Read the story or watch the related video by Heidi de Marco

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Capsules: Medicaid Enrollment Increased By 3 Million From October To February

Now on Kaiser Health News blog, Phil Galewitz reports on the latest Medicaid enrollment numbers: “The number of low-income people enrolled in Medicaid rose by 3 million to 62.3 million from October through February as more Americans joined the state-federal insurance program through state and federal online insurance marketplaces, according to a report released Friday by the Department of Health and Human Services” (Galewitz, 4/4). Check out what else is on the blog

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Political Cartoon: 'Having His Weigh?'

Kaiser Health News provides a fresh take on health policy developments with "Having His Weigh?" By Mike Lester.

And here's today's health policy haiku:

WHO'S GOT HEALTH COVERAGE?

A reason to count...
Take inventory... Figure
out if it's working.
-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

Survey: Number Of Uninsured Americans Hits New Low

A national survey by Gallup-Healthways finds the share of Americans without health insurance has dropped to the lowest level since before President Barack Obama took office.

The Associated Press: Survey: Health Insurance Gains Pick Up
A major new survey finds that a growing percentage of Americans gained health insurance as the initial sign-up season for President Barack Obama’s health care law drew to a close last month. Released Monday, the Gallup-Healthways Well-Being Index measured the share of adults without health insurance. That shrank from 17.1 percent at the end of last year to 15.6 percent for the first three months of 2014 (4/7). 

Los Angeles Times: Number Of Americans Without Health Insurance Reaches New Low
The share of Americans without health insurance has dropped to the lowest level since before President Obama took office, according to a new national survey that provides more evidence the healthcare law is extending coverage to millions of the previously uninsured. Just 14.7% of adults lacked coverage in the second half of March, down from 18% in the last quarter of 2013, the survey from Gallup found (Levey, 4/7).

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Despite Hitting 7M, Obamacare Faces Plenty Of Challenges

Big tests await the health law, including whether premiums and other consumer costs can be held down in the face of pent up demand and also the GOP's continuing efforts to sabotage or repeal it heading into the midterm elections.  

The Associated Press: 7M Enrolled Doesn't Guarantee Health Law's Success
Big challenges are lurking for the next enrollment season, which starts Nov. 15. Chief among them are keeping premiums and other consumer costs in check, and overhauling an enrollment process that was advertised as customer-friendly but turned out to be an ordeal. ... The source of the pent-up demand that propelled health care sign-ups beyond expectations could stem from the nation's new economic reality: a shrinking middle class and many working people treading water in low-paying jobs. Health insurance has been one of the pillars of middle-class security for decades. With fewer jobs these days that provide health benefits, there was an opening for a government program to subsidize private insurance (Alonso-Zaldivar, 4/5).

Politico: Obama’s Challenge: Don’t Blow It
Obama’s got a history of watching his victories slip away before fully capitalizing on them. Last year alone, his reelection bump disappeared into a triple whammy of low-grade spring scandals. Then, all the goodwill he had coming out of the government shutdown was eclipsed by the devastating HealthCare.gov rollout. Not only does this give him a chance to show that he and his party actually can be trusted to run government and a shot at reclaiming the narrative of his presidency, it comes just in time for the midterm elections that will determine his party’s fate in 2014 — and his own over the next three years (Dovere, 4/6). 

NPR: With Enrollee Goal Met, Obamacare Still Faces Political Trial
President Obama and his supporters had a rare opportunity to celebrate this week. A last-minute surge in people signing up for health insurance sent the total government enrollment figures over the seven-million mark. That number seemed out of reach just a few months ago, when a crash-prone website threatened to undermine the president's signature health care law. Republicans are still bent on repealing the law, but now millions more Americans have a stake in Obamacare's survival (Horsley, 4/5). 

ABC News: Obamacare: What Could Go Wrong Next?
After an unprecedented, last-minute surge, the Affordable Care Act open-enrollment period closed last week, topping out at more than 7 million enrollees. But even as a triumphant White House celebrated surpassing its enrollment goal, Republican strategists were downplaying its significance. Though Obamacare undoubtedly hit a major milestone March 31, the path ahead could still be a rocky one. Here’s a look at the challenges that remain for the president’s signature health care reform law (Dooley, 4/7).

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Medicaid Enrollment Increases By 3 Million Since Health Law Enrollment Began

The number is not yet complete because some states have not reported their numbers and it doesn't include March sign-ups.

The Wall Street Journal: Health-Care Law Helps Add 3 Million To Medicaid
The Obama administration said Friday that three million additional Americans were enrolled in Medicaid as of the end of February than were in the program before the start of the health law's open enrollment period Oct. 1, suggesting the law allowed more people to gain Medicaid coverage. Tracking new enrollment figures for Medicaid and the Children's Health Insurance Program under the health law is tricky because figures include people already in the program or those whose coverage is being renewed in addition to those eligible for Medicaid before the health law took full effect (Corbett Dooren, 4/4).

The Washington Post: Medicaid, CHIP Enrollment Grows By More Than 3 Million, CMS Data Shows
White House officials pointed to the data as growing evidence that more people are gaining coverage as a result of the Affordable Care Act. This week, the White House announced that 7.1 million people had signed up for health coverage as of March 31 on the marketplaces, marking a turnaround from the troubled beginnings of enrollment last fall (Sun and Millman, 4/4). 

Politico: Enrollment In Medicaid, Children's Health Program Grows By 3 Million
Figures released Friday by the Obama administration show that over that five-month period, a total of 11.7 million people were determined eligible for the two programs. Both numbers could rise further once all states finish reporting their data, officials said. ... The biggest change in Medicaid came in Oregon. The state has one of the nation's worst health exchange websites — which still cannot process an application entirely online — but it is operating a "fast track" program that helped to drive a 34.8 percent spike in Medicaid enrollment from September to February (Haberkorn, 4/4).

The Associated Press: Health Care Bill Helps Add 3 Million To Medicaid
Many were newly eligible because of the law's Medicaid expansion, while others already eligible but not yet enrolled came forward due to publicity around the law and its requirement for individuals to carry insurance or risk paying a fine, analysts said. It brings to around 62 million the total number of people covered under Medicaid and the Children's Health Insurance Program. The 3 million figure is incomplete because a handful of states didn't report their numbers, and it doesn't include sign-ups in March (Werner, 4/4).

Kaiser Health News: Capsules: Medicaid Enrollment Increased By 3 Million From October To February
The number of low-income people enrolled in Medicaid rose by 3 million to 62.3 million from October through February as more Americans joined the state-federal insurance program through state and federal online insurance marketplaces, according to a report released Friday by the Department of Health and Human Services (Galewitz, 4/4).

Reuters: US Reports 3 Million Medicaid Enrollments Under Obamacare
Three million lower-income Americans have enrolled in the Medicaid program for the poor so far during the rollout of U.S. President Barack Obama's healthcare reform law, the administration announced on Friday. That brings to more than 10 million the number of people who have signed up for both public and private health coverage since the Oct. 1 launch of the Patient Protection and Affordable Care Act, known as Obamacare (Morgan, 4/4).

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Support Grows In Missouri For 'Mini' Medicaid Expansion

News about Medicaid expansion efforts in Missouri and Georgia.

The Associated Press: Medicaid Asset Limit Change Sought 
Some Missouri Republicans have remained adamantly opposed to expanding Medicaid to hundreds of thousands of adults by tapping into billions of federal dollars available under President Barack Obama's health-care law. Yet support has been quietly growing among some of those same Republicans for a mini Medicaid expansion (Lieb, 4/7).

Georgia Health News: Medicaid Expansion: A Tale Of Two Southern States
In Georgia, Gov. Nathan Deal refuses to expand Medicaid, saying the state cannot afford it. The Republican-controlled General Assembly agrees with Deal and has even gone a step further. It passed legislation during the 2014 session that requires the Legislature, not just the governor, to approve any Medicaid expansion. ... Buckler, 44, of Paris, Ky., has worked all her life “waitressing and cleaning up.” She is divorced with a grown child and a teenager at home. She lost her health insurance two years ago when she hurt her hand and could no longer work for a company that cleaned away trash and debris from newly built homes.
Because she lives in Kentucky, a state that has expanded Medicaid, she’s now on the program, and seeing a doctor about her hand and waiting to find out if she needs surgery (Craig, 4/6).

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Minnesota State Lawmakers Will Decide If Online Insurance Marketplace Needs Top-To-Bottom Audit

The decision regarding a further investigation of MNsure's troubles is expected this week.

Minnesota Public Radio: Lawmakers To Decide If MNsure Gets Major Audit
A state legislative commission decides this week whether the state's new online health insurance marketplace, MNsure, should get a major, top to bottom audit. MNsure has received more than $150 million in federal grants and external reviews found poor management and serious software failures. While a change in leadership in December improved MNsure's operations many questions remain about the reasons for the site's troubled operations (Stawicki, 4/6).

In other Minnesota news -

The Star Tribune: Many in Minnesota's High-Risk Health Insurance Pool Find New Plans
Almost 62 percent of Minnesotans who had relied on the state’s safety net insurance pool have found better health care coverage on MNsure or the individual market, far exceeding goals, officials at the organization said Friday. The high-risk pool is winding down operations and will close for good at the end of the year. Under the Affordable Care Act, such pools are less necessary because insurers now are required to provide coverage even to those who are already sick. About 9,000 people remain enrolled in the program, down from about 25,000 when open enrollment began under the new health law (Crosby, 4/4).

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After Big Sign-Ups, One Insurer Works To Help Consumers Use Insurance Effectively

The Philadelphia Inquirer examines how one company is trying to make the move into insurance seamless for new buyers. Meanwhile, Fox News reports that some states are shifting costs to the feds as a means of getting health care for prison inmates.

Philadelphia Inquirer: Clients Save, Insurers Get Boost From Affordable Care Act 
There were plenty of nights during the last 33 years that Denise Schroeder of West Chester had to choose between eating dinner and paying for health insurance. ... Then she heard about the Affordable Care Act. "I thought maybe this was my saving grace," Schroeder said. Schroeder bought Independence Blue Cross' silver Keystone HMO. ... Even as people continue enrolling to buy insurance plans through mid-April, Independence is focusing on the next phase: Helping people like Schroeder learn how to use their new ACA policies. ... The company is contacting new members via regular mail, e-mail, and phone to help them get up to speed, Sunshine said. New members will be asked if they have received an identification card, if they understand their plan's benefits, and, yes, if they have made their premium payment. Sunshine said special attention will be given to people who bought Independence's best-selling silver HMO Keystone Proactive tier plan. New to the market, the plan has three tiers. Policy holders with a referral can use doctors and hospitals at any tier level. But deductibles, co-payments and coinsurances can vary dramatically (Calandra, 4/6).

Fox News: Inmates Getting Coverage Under ObamaCare, As States Shift Cost To Feds
The Obama administration often touts that people with pre-existing conditions and countless others can now get covered under ObamaCare. But there's another group that's starting to benefit from the law -- prison inmates.  Cash-strapped state and local prisons increasingly are using the Affordable Care Act to pay for their inmates' medical costs, taking advantage of a little-known provision that lets them shift some of those expenses to the federal government. Ohio, Illinois and Iowa are among the states trying to offload the rising costs of health care – which include mental health programs – by enrolling inmates into a new expanded Medicaid program when they get sick.  But it doesn't stop there (Chakraborty, 4/6).

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Medicare

Medicare Advantage Cuts Pose Political Threat

The cuts to Medicare Advantage, expected to be included in planned 2015 payments to be unveiled Monday, end what proponents call a windfall to insurers. But they have drawn protests not just from insurers but from Democrats who fear the GOP will use them as political fodder in the midterm elections.

The Wall Street Journal: Some Democrats Fight Obama Over Medicare
More than two dozen Democrats are fighting the Obama administration over planned cuts to private plans offered in Medicare, tied in part to the 2010 health overhaul, which could divide the party on health care in the run-up to this year's midterm elections. The cuts to Medicare Advantage insurers, which are expected to be included in planned 2015 payments to be unveiled Monday, have drawn increasingly vocal opposition from Democrats who fear that insurers will use the cuts to justify higher premiums or fewer options for enrollees (Peterson and Mathews, 4/6).

The Hill: Obama's New Healthcare Dilemma
Democrats are battling the White House over proposed cuts to Medicare Advantage, creating a new divide on healthcare just as the party had begun to rally around ObamaCare’s 7.1 million enrollees. The issue threatens the newfound momentum Democrats have on healthcare after a late surge of ObamaCare enrollees surprised and electrified a party that had been beaten down after months of bad news associated with the healthcare law’s rollout (Easley, 4/6).

Kaiser Health News: Decoding The High-Stakes Debate Over Medicare Advantage Cuts
The rate change, part of the Affordable Care Act, is the next step in winding down a subsidy that pays Medicare Advantage plans substantially more than what traditional Medicare costs. Proponents say the move will end what they call an industry windfall and pressure insurers, hospitals and doctors to deliver care more efficiently. The industry, which maintains the cuts will raise costs and reduce consumer benefits, has launched a massive national counterattack, running numerous "seniors are watching" ads, getting beneficiaries to pepper politicians with calls and letters, and lobbying the administration to back off (Hancock, 4/7).

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Capitol Hill Watch

Republicans Secure Health Law Coverage Change

The change involves improving coverage choices for small business. In the meantime, Senate Democratic leadership is trying to secure victories for their at-risk colleagues and Republicans look to pass a budget.

The Associated Press: GOP Seeks Coverage Choices In Health Law They Hate
House Republicans quietly secured a recent change in President Barack Obama's health law to expand coverage choices, a striking, one-of-a-kind departure from dozens of high-decibel attempts to repeal or dismember it. Democrats describe the change involving small-business coverage options as a straightforward improvement of the type they are eager to make ... No member of the House GOP leadership has publicly hailed the fix, which was tucked, at Republicans' request, into legislation preventing a cut in payments to doctors who treat Medicare patients (Espo, 4/6).

The Washington Post’s The Fact Checker: McConnell’s Stale, Inflated Claim About Health Plan Cancellations
We have explained before that, depending on the phrasing, this can be a misleading comparison. But the gap in the numbers in McConnell’s op-ed jumped out at The Fact Checker, especially because Kentucky is a rare example of a red state building an exchange that, by most accounts, has operated smoothly. What’s behind these numbers? (Kessler, 4/7).

Politico: Senate Leaders Give Floor Time To Vulnerable Dems 
At-risk senators will get to beef up their back-home cred by taking the lead on bills and amendments tailored to their campaigns. And they won’t be stuck in the back row at news conferences but will be in front of TV cameras and taking center stage during Senate debates. It’s all part of an effort to blunt a furious Republican midterm campaign centered on attacking President Barack Obama and Democrats in the Senate who supported his signature health care law (Everett and Goode, 4/6).

Bloomberg: Obamacare Can Be Repealed Even With Enrollment, Ryan Says
House Budget Committee Chairman Paul Ryan said Congress and a new president could still repeal President Barack Obama’s health-care law after 2016, rejecting Democratic arguments that the measure is irreversible. “I don’t think it can last,” Ryan said of the law in an interview yesterday with Bloomberg Television to air on “Political Capital with Al Hunt” this weekend (Wallbank, 4/5).

Politico: GOP Confident About Paul Ryan’s Budget
For a time last week, Ryan’s budget encountered problems as conservatives threatened to oppose the proposal to express frustration about a controversial parliamentary maneuver GOP leadership deployed to pass the “doc fix.” Though it seems that leadership has minimized the opposition, Republicans privately concede that they’ll most likely pass the 2015 budget by the slimmest margin in their four years in power (Bresnahan and Sherman, 4/6). 

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Health Care Marketplace

New Treatments To Help Patients With Chronic Illnesses Have Become Big Business

The New York Times reports that these types of medical advances have become a multi-billion dollar opportunity.

The New York Times: Even Small Medical Advances Can Mean Big Jumps In Bills
Traditionally, insurers lost money by covering people with chronic illnesses, because they often ended up hospitalized with myriad complications as their diseases progressed. Today, the routine care costs of many chronic illnesses eclipse that of acute care because new treatments that keep patients well have become a multibillion-dollar business opportunity for device and drug makers and medical providers (Rosenthal, 4/5).

In other marketplace news --

The Washington Post: Why Walk-In Health Care Is A Fast-Growing Profit Center For Retail Chains
CVS is fast expanding its Minute Clinics, exemplifying a trend of retailers opening health-care services to supplement traditional doctors’ offices. CVS, the largest retail clinic operator in the Washington area, has 800 clinics nationwide, and it expects to add 150 more this year and to have 1,500 clinics by 2017, or almost as many as the more than 1,600 retail clinics across the country now, according to the Convenient Care Association. Retail walk-in clinics are relatively new on the health-care landscape, dating to 2000. After several years of very slow growth coinciding with the recession and its aftermath, they are taking off again (Hamilton, 4/4).

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State Watch

State Highlights: 'Balance Billing' Protection In N.Y.; L.A. Nursing Home Complaint Backlog

A selection of health policy stories from New York, California, Hawaii and Georgia.

Bloomberg: Surprise Medical Bills Lead To Protection Laws 
Hospital patients in New York are the latest in the nation to gain legal protection against unexpected bills from doctors who won’t accept their insurance. New York this week extended patient protection laws to restrict out-of-network providers from “balance-billing” consumers for emergency care or when patients can’t choose their doctors (Chen, 4/4).

The Associated Press: Study: Asthma Has $1.3B Impact On New York
Asthma is costing New York's Medicaid system more than half a billion dollars a year, according to a report released Friday that urges the state to do more to help those affected by the respiratory illness. The study by state Comptroller Thomas DiNapoli found that Medicaid costs related to asthma were $532 million in 2013, an increase of more than 26 percent over five years (4/4). 

Kaiser Health News: Los Angeles County Audit Finds Backlog Of Nursing Home Complaints
A lack of central oversight of nursing home investigations in Los Angeles County has contributed to a backlog of hundreds of complaints, according to an audit released late Friday. The Los Angeles County Auditor-Controller determined that there were 3,044 open investigations as of March 14, including 945 that have been open for more than two years. The auditor found that there is no central management of the investigations and that surveyors within the Health Facilities Inspections Division, or HFID, do not have set deadlines for completing cases (Gorman, 4/5).

Los Angeles Times: Hawaii's Trailblazing Health Care Underscores Disparity 
Hawaiians live longer than their counterparts on the mainland. They die less frequently from common diseases, such as breast and colon cancers, even though these cancers occur more often here than in most other states. They also pay less for their care; the state's health care costs are among the lowest in the country. Hawaii's success owes much to the state's trailblazing health system and its long history of near-universal health insurance. Forty years ago, the state became the first to require employers to provide health benefits (Levey, 4/5).

The New York Times: New York’s Paid Sick Leave Law Quietly Takes Effect
Shiv Puri gathered his employees together after the lunchtime rush last week to deliver the big news: This year, the cook and kitchen staff at the Bombay Sandwich Co. on West 27th Street will receive paid sick leave for the very first time. ... His eight employees were thrilled. No surprise there. But Mr. Puri, a new business owner, was feeling pretty good, too ... The law went into effect on April 1. ... [W]ithout hoopla or hullabaloo, the city quietly became the largest in the nation to ensure that the vast majority of workers wouldn’t lose their jobs or a portion of their paychecks if they or their close relatives got sick (Swarns, 4/6).

Kaiser Health News: When Connecting With A Dentist Doesn't Mean An Office Visit
It’s all part of a free "teledentistry" program for low-income patients in California who don’t have access to regular dental care. Often they’re stymied by high costs and a shortage of dentists who treat the poor. Many also face language barriers, lack legal immigration status, are afraid of dentists or have a poor understanding of what causes dental problems (Hernandez, 4/7).

Georgia Health News: Key Part Of Hospital Provider Fee Still Unresolved
Last year, a bill that would renew a financing mechanism for the state’s Medicaid program hurtled irresistibly through the Georgia General Assembly. Gov. Nathan Deal signed it into law almost as soon as it was passed. The high priority the measure received was easy to understand. The funding mechanism, known as the hospital provider fee -- called by opponents a “bed tax’’ -- was designed to fill a nearly $500 million hole in the state’s Medicaid program (Miller, 4/4).

CBS' 60 Minutes: On The Road With The Health Wagon
[T]he Health Wagon, a mobile health clinic in a beat-up Winnebago [is] run by Teresa Gardner and Paula Meade, two nurse practitioners who navigate the hills and hollows of Appalachia, providing free medical care to the working poor. ... "Obamacare was supposed to change all of this," says Pelley. "These folks, many of whom work full time at minimum wage, make too much money in those states to qualify for Medicaid, but they don't make enough money even to buy insurance on the health care exchanges" (Pelley, 4/6).

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Editorials and Opinions

Viewpoints: Despite Enrollment Success, Health Law Has Internal Problems; Burdens For Both Parties

The New York Times: Health Care Without End
[F]or the foreseeable future, the health care debate probably isn't going to get any less intense. Instead, what we've watched unfold since 2009 is what we should expect for years, decades, a generation: a grinding, exhausting argument over how to pay for health care in a society that's growing older, consuming more care, and (especially if current secularizing trends persist) becoming more and more invested in postponing death. In the near term, this debate will go on because Obamacare has stabilized itself without fully resolving any of its internal problems (Ross Douthat, 4/5).

Los Angeles Times: Is Obamacare Too Big To Fail? 
The program still faces a series of difficult tests -- most important, keeping costs under control so insurance premiums don't soar in coming years. And the program is certain not to be universally popular with its participants. Just think: Millions of newcomers to health coverage are about to join the rest of us in those frustrating battles with insurers. But the enrollment numbers do mean that the main argument Republicans hurled against the law -- that it was doomed to collapse -- is looking weaker than ever (Doyle McManus, 4/6). 

The Washington Post: Can Democrats Change The Politics Of Health Care?
The debate over the Affordable Care Act has entered a new stage, one that will challenge Republicans and Democrats alike. But the burden still falls more heavily on the Democrats to show that the law can become something other than a political weight on vulnerable incumbents this year. With 7 million people now signed up under the health-care law, and more likely to join during future enrollment periods, the act is rapidly becoming embedded in the nation’s health-care system (Dan Balz, 4/5). 

Forbes: Get Ready For The Real Obamacare Disasters As People Start To Use It
The problems that will create the next headlines will come in three main flavors: lack of access to doctors, failures of the system to verify coverage and pay claims, and the incredibly high deductibles and copays on many of the exchange insurance policies. ... When these people first use their new coverage and a health care provider explains they owe a deductible and co-pay there is going to be a sudden and steep learning curve. Many doctor offices request immediate payment of these monies and many newly insured patients are going to be unable to make such payments. If they could afford a $6,000 deductible and 40 percent co-pays, they would have already had insurance (Jeffrey Dorman, 4/5).

The New York Times: As Vermont Goes, So Goes The Nation?
Three years ago, Peter Shumlin, the governor of Vermont, signed a bill creating Green Mountain Care: a single-payer system in which, if all goes according to plan, the state will regulate doctors' fees and cover Vermonters' medical bills. Mr. Shumlin is a Democrat, and the bill’s passage is a credit to his party. Yet a small upstart spent years building support for reform and nudging the Democrats left: the Vermont Progressive Party (Molly Worthen, 4/5).

The Richmond Times-Dispatch: Expanding Medicaid Is Crazy
Recently, Democrat Dick Saslaw said "opposing Medicaid expansion is crazy," and "the reason for opposition is hatred of a black president." Nothing says desperation like the abandonment of any coherent argument. Democrats think that voters are so ill-informed that this rhetoric will win, but I have more respect for our voters than that. With this in mind, several of the innumerable reasons Medicaid expansion would be disastrous for Virginia are listed here (Va. State Sen. Tom Garrett Jr., 4/4).

The Richmond Times-Dispatch Include Health Care In Virginia's Budget
The Affordable Care Act (ACA), otherwise known as Obamacare, is tearing our country apart; 56 percent of the public is now opposed to the ill-conceived and ineptly implemented ACA. But, despite my personal opposition to the plan, it is the law of the land. As long as it remains the law of the land, I believe it is the responsibility of state lawmakers to find a common-sense solution that makes the law as manageable as possible for our citizens (Va. State Sen. Walter A. Stosch, 4/4).

On other health care issues --

The Wall Street Journal: In Praise Of Medical Scribes
We often think that a complex problem (such as health care in the U.S.) requires a complex solution (Obamacare). Yet some important issues that are not adequately addressed with the current health-care overhaul include decreased patient and physician satisfaction, reduced access to care, and the increasing cost of care. For instance, the electronic medical record-keeping .... While the increased use of scribes will not address many important issues in health care, it would provide an inexpensive, market-based, partial solution to a number of them (Dr. Alan J. Bank, 4/6).

The New York Times: The Mentally Ill, Behind Bars
Mayor Bill de Blasio and his new correction commissioner, Joseph Ponte, have inherited a city jail system in which nearly 40 percent of the 12,000 inmates have mental illnesses -- up from about a quarter just seven years ago. Yet despite the stark shift, the system has not been redesigned to serve the complex needs of inmates with mental illnesses (4/6). 

The Washington Post: Disclosing Medicare Payment Data Could Be A Boon For The Nation
Mr. Obama’s administration has shown that it is possible to reform government significantly without a new act of Congress and without crossing constitutional boundaries. We refer to the Department of Health and Human Services' announcement that from now on it will greatly expand public disclosure of doctor-specific data on Medicare payments. This will enable the public to know, in detail, what happens to the $70 billion-plus that the program spends on physician services each year. Previously, such data had been off-limits due to supposed doctor privacy concerns (4/5). 

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
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.