Daily Health Policy Report

Monday, April 8, 2013

Last updated: Mon, Apr 8

KHN Original Reporting & Guest Opinion

Health Spending And Fiscal Battles

Health Reform

Capitol Hill Watch

Coverage & Access

Women's Health

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Worries Mount About Enrolling Consumers In Federally Run Insurance Exchanges

Kaiser Health News staff writer Jenny Gold, working in collaboration with USA Today, reports: "The plan to insure as many as 27 million Americans under the federal health law beginning this fall will be the biggest expansion of health coverage since that launch. Millions will be eligible to shop for insurance in the new online marketplaces, which open for enrollment Oct. 1 with the coverage taking effect Jan. 1" (Gold, 4/8). Read the story.

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VA Drive To Hire 1,600 Mental Health Professionals Hits Community Clinics' Supply

Reporting for Kaiser Health News in collaboration with The Washington Post, Guy Gugliotta writes: "The Department of Veterans Affairs, trying to cope with a surge in psychological needs of veterans, has vowed to hire 1,600 additional mental health care professionals by the end of June, but some experts say the pool of qualified candidates is too small and the federal effort could jeopardize already-understaffed community health organizations" (Gugliotta, 4/7). Read the story.

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Political Cartoon: 'Blind Date?'

Kaiser Health News provides a fresh take on health policy developments with "Blind Date?" by Eric Allie.

Meanwhile, here is today's health policy haiku:


Birds of a feather
Will be sick all together
Without insurance
 -Katie Benston

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 Spending And Fiscal Battles

Obama's Budget Expected To Call For Medicare Cuts

In advance of the release of President Barack Obama's fiscal blueprint on Wednesday, an adviser warned friends and foes that the plan includes things neither will like. The budget plan is expected to kick off new discussions about trimming entitlements and revamping the nation's safety net.

The Associated Press/Washington Post: Ahead Of Budget Release, Top Obama Adviser Warns Both Parties They May Not Be Happy With Plan
The White House is warning friend and foe alike: They're not going to like every part of President Barack Obama’s budget when it is released this week. White House senior adviser Dan Pfeiffer is telling Republicans their "my way or the highway" approach would spell the GOP's defeat in upcoming budget negotiations. He also is telling Obama's Democratic allies that they, too, will have to bend on the spending plan that is due Wednesday (4/8).

USA Today: Obama's Budget Revives Talk Of Entitlement Changes
A brief reprieve on imminent budget deadlines is providing Republicans and Democrats alike an opportunity to regroup for the next fiscal debate that will dominate the spring and come to a head this summer: increasing the nation's ability to borrow money to pay its bills. Negotiations to raise the debt ceiling are increasingly linked to an ongoing debate over how to revamp the nation's social safety net to help reduce the deficit (Davis, 4/7).

Medpage Today: Obama To Propose $400 Billion In Medicare Savings
About $400 billion of savings in President Obama's fiscal 2014 budget proposal will come from Medicare and other health programs, according to media reports. The money would come in the form of reduced payments to pharmaceutical companies and asking wealthier seniors to pay higher premiums, the news reports, citing a leaked budget briefing document, said Friday. Obama is set to unveil the full fiscal 2014 budget proposal to Congress on Wednesday. … One move would place greater price controls on drugs paid through Medicare Part D for beneficiaries eligible for both Medicare and Medicaid. Currently, those drugs are bought through Medicare, rather than Medicaid, where prices are lower and more restrictive (Pittman, 4/5).

Bloomberg: Obama Drops Stimulus For Benefit Cut To Woo Republicans
Less than a week after job-creation figures fell short of expectations and underscored the U.S. economy's fragility, President Barack Obama will send Congress a budget that doesn't include the stimulus his allies say is needed and instead embraces cuts in an appeal to Republicans…The Medicare insurance program for the elderly would be cut by reducing payments to health-care providers and drug companies and imposing more costs on high-income beneficiaries (Dorning, 4/8).

Meanwhile, in other fiscal news -

The Wall Street Journal: Workers Stuck In Disability Stunt Economic Recovery
The unexpectedly large number of American workers who piled into the Social Security Administration's disability program during the recession and its aftermath threatens to cost the economy tens of billions a year in lost wages and diminished tax revenues (Scism and Hilsenrath, 4/7).

California Healthline: Healthy Families Savings Goes From $13M To $137K
At a legislative hearing yesterday, state officials said the estimates for savings have been reduced for the Healthy Families transition to Medi-Cal managed care. According to the Legislative Analyst's Office, the original estimated general fund savings for the Healthy Families transition was $13.1 million in 2012-13. The estimate has shrunk to $137,000. Savings for next fiscal year -- 2013-14 -- were estimated at $52 million and that estimate has been revised to $43 million. Scott Ogus, who represented the Department of Finance at yesterday's hearing, said there were several factors contributing to the revision. Delays in implementation by the Department of Health Care Services led to caseload changes. DHCS officials have said the department slowed down some of the early phases of the transition so children would have less disruption in continuity of care (Gorn, 4/5).

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Sequestration: Scientists Protest Automatic Budget Cuts

McClatchy: Scientists Angry About Budget Cuts Come Out Of The Lab And Onto The Streets
To the ranks of civil rights and anti-war activists who've marched on Washington, get ready to add white-frocked scientists. Thousands of prominent cancer and other medical researchers will rally in the nation’s capital Monday to protest federal funding cuts that began several years ago and were accelerated by additional forced reductions beginning to take effect under the congressionally mandated process of sequestration (Rosen, 4/5).

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Health Reform

Democrats Express Dismay Over White House Health Law Implementation Delays

The Hill reports that this "friendly fire" comes as Republicans are preparing to make health care an election-year topic and Democrats are hoping for speedier progress regarding some of the measure's most popular provisions. In related news, the law's taxes and penalties, as well as the premium increases that some are predicting, continue to draw analysis.

The Hill: ObamaCare Takes Friendly Fire
Delays in implementing popular pieces of ObamaCare are hurting it with Democrats. Ahead of an election year in which Republicans promise to make healthcare an issue again, Democrats are criticizing the White House for delaying policies that could help build support for the unpopular law (Baker, 4/6).

The Fiscal Times: Two Taxes Could Decide The Fate Of Obamacare
Much of Obamacare's success hinges on whether a pair of new taxes can compel more Americans to have health insurance. For all the carrots in the 2010 law such as tax credits and subsidies, there are two big sticks ... meant to change the behavior of a projected 58 million uninsured. There are other taxes on medical devices and gold-plated insurance plans that all told will raise $1 trillion over the next decade (Boak, 4/8).

The Wall Street Journal: Some Small Businesses Opt For The Health-Care Penalty
Small-business owners across the U.S. are bracing for the health-care law that kicks in next year, fearing it will increase the cost of providing insurance to employees. But Rick Levi, a business owner in Des Moines, Iowa, is among those considering the government's escape hatch: paying a penalty to avoid the law's "employer mandate" (Maltby and Needleman, 4/7).

Modern Healthcare: Insurance Commissioners Propose Ideas To Minimize 'Rate Shock'
A group of insurance commissioners is sharing ways states can minimize the likelihood of large premium increases, particularly for young adults, as major provisions of the Patient Protection and Affordable Care Act go into effect in 2014. Several provisions of the law affecting the individual and small-group markets—such as essential health benefits, limits on age-rating factors, guaranteed issue and single risk-pool ratings—could make claims costs spike for insurers, leading to premium hikes, according to a draft paper titled "Rate Increase Mitigation Strategies" (PDF) presented today at the National Association of Insurance Commissioner's annual spring meeting in Houston (Block, 4/5).

Today's coverage also includes reports about what's happening on the state level -

Kansas Health Institute: House Tussles Over 'Mandate Lite' Health Insurance Measure
The Kansas House tied itself in knots today over a bill to allow insurance companies to market "mandate lite" health insurance policies in the state. Members voted in the morning to reject the bill but abruptly reversed themselves in the afternoon. The whole thing took hours of debate. The measure, part of a legislative package included in a conference committee report, passed the Senate on Thursday. It now goes to Gov. Sam Brownback (McLean, 4/5).

The Associated Press: Bentley Won't Enforce Federal Health Care Rules
Gov. Robert Bentley has rejected another provision of the federal health care overhaul pushed by President Barack Obama, saying Alabama insurance regulators won't enforce parts of the law aimed at protecting consumers. Bentley wrote a letter to federal officials last month saying Washington, rather than state regulators in Montgomery, should be responsible for ensuring that insurance policies sold in Alabama comply with the federal law's requirements such as covering people with pre-existing health conditions, the Montgomery Advertiser reported Saturday (4/7).

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Health Exchange Development, Enrollment Issues Trigger Concerns

Politico and Kaiser Health News provide progress reports related to the development of the health law's new online insurance marketplaces.

Politico: Exchanges, But Not As Envisioned
Delay? What delay? Even though the Obama administration is delaying a key component of federally run small-business exchanges, some states building their own exchanges say they’re on track to have the program running next year. The feds last month said the 33 exchanges it will run next year won’t allow employees whose companies use the exchanges to choose their own health plans until 2015. Instead, they’ll have to accept whatever plan their employer selects for them (Millman, 4/8).

Kaiser Health News: Worries Mount About Enrolling Consumers In Federally-Run Insurance Exchanges
The plan to insure as many as 27 million Americans under the federal health law beginning this fall will be the biggest expansion of health coverage since that launch. Millions will be eligible to shop for insurance in the new online marketplaces, which open for enrollment Oct. 1 with the coverage taking effect Jan. 1. But six months before the process begins, questions are mounting about the scope and adequacy of efforts to reach out to consumers (Gold, 4/8).

In related news, there are political concerns about "navigators" -- individuals who will help consumers with the exchanges -

The Hill: Marchant Questions 'Inflated' Salaries For ObamaCare Insurance Navigators
Rep. Kenny Marchant (R-Texas) says the new ObamaCare insurance brokers known as "navigators" are likely to cost more than they’re worth because of "inflated" salaries. Marchant's questions stem from a recently released Department of Health and Human Services (HHS) proposal outlining the specifics of the navigators, a fleet of individuals that will help Americans without employer-provided insurance figure out how to use the new healthcare exchanges set up by the Affordable Care Act (Wilson, 4/5).

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Some GOP Governors See Block Grant Opportunity In Medicaid Expansion

Politico reports that some conservatives who have long sought to convert Medicaid into a block grant program see an opening with the health law to move in this direction. Also in the news, states continue to mull how to proceed with this provision of the law.  

Politico: Obamacare Foes Using It For Medicaid Control
Conservatives who hate President Barack Obama's health law have been agitating to convert Medicaid into a no-strings-attached block grant for states since the Reagan era. That effort died -- or at least got put on indefinite hold -- with Obama's reelection. But red-state governors see another chance to ram through some of the changes they seek. Ironically, their opening was created by the health law's Medicaid expansion (Millman and Cheney, 4/7).

The Texas Tribune: The Medicaid Expansion Merry-Go-Round
Republicans who want to draw down billions in federal dollars to reform Medicaid and shore up the state's budget have been running in circles trying to find common ground between Gov. Rick Perry and the Obama administration and craft a "Texas solution." And the party-line vote in the House on Thursday to reconsider legislative guidance on Medicaid expansion from the budget -- even without an up-or-down vote on the substance -- left the issue on life support (Aaronson, 4/8).

Philadelphia Inquirer: Arkansas Wants To Privatize Its Medicaid Expansion: Is This The Start Of A Trend
How do you get recalcitrant Republicans like Pennsylvania Governor Tom Corbett to support expanding Medicaid, which is a key feature of Obamacare? The answer is to do it through privatization. That's the path Arkansas Governor Mike Beebe, a Democrat, is hoping to take. To convince the state's Republican-dominated legislature to expand Medicaid, he proposed offering coverage through private insurance companies. So far, Republican leaders in the state are going along (Field, 4/7).

Modern Healthcare: State Reform Update: Medicaid Expansion Moves Forward In Ark.
Arkansas' Medicaid expansion -- potentially a model for many other states -- has begun to advance in the legislature and supporters are optimistic about its prospects. The Arkansas Senate Public Health, Welfare and Labor Committee unanimously approved a Medicaid expansion plan Wednesday that would use federal Medicaid funds to buy coverage for beneficiaries on the coming federal health insurance exchange in the state. The legislation is based on a compromise between Democratic Gov. Mike Beebe and Republican leaders (Daly, 4/5).

The Washington Post: Health Care Law Could Backfire For Thousands On Medicaid
At a time when most states are preparing to expand their Medicaid programs in line with the new health-care law, tens of thousands of people in states with historically generous Medicaid coverage could soon be kicked off the rolls. In Wisconsin, officials want to take advantage of the law to shift nearly 100,000 low-income people from the health insurance program for the poor into subsidized private plans. ... An additional 180,000 people in five other states could lose coverage because they are in experimental versions of Medicaid that expire this year and may not be renewable under the new law (Aizenman, 4/6).

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Capitol Hill Watch

Tavenner May Gain Bipartisan Support

Politico: Marilyn Tavenner Might Be Beneficiary Of Bipartisan Nod
President Barack Obama's nominee to run the Centers for Medicare & Medicaid Services will go before the Senate Finance Committee on Tuesday with potential for bipartisan support for her confirmation. Marilyn Tavenner, who has been running the agency in an acting capacity for more than a year, appears to have risen above the volatile politics of health reform to garner support — or at least not vocal, universal opposition — on Capitol Hill (Haberkorn, 4/8).

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Coverage & Access

Military Health Care: Shallow Candidate Pool Could Hamper Mental Health Efforts

The Department of Veterans Affairs is preparing to hire 1,600 mental health professionals, but some say a shallow pool of candidates could hamper efforts, while Congress continues to resist making military health care beneficiaries pay more for their care.

Kaiser Health News: VA Drive To Hire 1,600 Mental Health Professionals Hits Community Clinics' Supply
The Department of Veterans Affairs, trying to cope with a surge in psychological needs of veterans, has vowed to hire 1,600 additional mental health care professionals by the end of June, but some experts say the pool of qualified candidates is too small and the federal effort could jeopardize already-understaffed community health organizations (Gugliotta, 4/7).

The Associated Press/Washington Post: Pentagon Presses For Higher Fees For Military Health Care Beneficiaries, Congress Resists
The loud, insistent calls in Washington to rein in the rising costs of Social Security and Medicare ignore a major and expensive entitlement program -- the military's health care system. Despite dire warnings from three defense secretaries about the uncontrollable cost, Congress has repeatedly rebuffed Pentagon efforts to establish higher out-of-pocket fees and enrollment costs for military family and retiree health care as an initial step in addressing a harsh fiscal reality. The cost of military health care has almost tripled since 2001, from $19 billion to $53 billion in 2012, and stands at 10 percent of the entire defense budget (4/8).

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New Medical Schools Aim At Doubling Number Of Primary Care Doctors

New medical schools are trying to double the number of primary care doctors in America, while MedPAC considers better pay for advanced-practice nurses and physicians assistants under Medicare.

Medscape: New Medical Schools Aim To Double Primary Care Graduates
Among the nation's newest medical schools are 2 that stand out for the career path they are emphasizing: primary care. Quinnipiac University's Frank H. Netter MD School of Medicine in North Haven, Connecticut, and the University of California–Riverside School of Medicine both will admit their first students in August. They hope to at least double the percentage of graduating physicians who typically choose primary care. A study published online December 4 in JAMA found that only 21 percent of third-year residents planned to enter internal medicine (Frellick, 4/5). 

Medpage Today: MedPAC Debates Better Pay For APRNs, Pas
Some members of the Medicare Payment Advisory Commission (MedPAC) suggested Medicare take stronger steps to recognize and reward the work of advanced practice registered nurses (APRNs) and physician assistants (PAs). Medicare payments generally follow along with states' scope-of-practice laws for APRNs and PAs, which vary widely in what they allow the lower-level providers to do and, hence, can bill Medicare for. If a particular state allows an APRN to operate independently of a physician, Medicare will pay the APRN 85 percent of what a doctor would receive for providing that service. But if the APRN must work under a physician, that doctor receives 100 percent of the payment for that service -- at the regular physician fee schedule rate -- even if the doctor didn't provide it (Pittman, 4/5).

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Women's Health

Plan B Ruling Raises Political, Practical Questions About Next Move

A federal judge's ruling on Friday that the Food and Drug Administration has to lift age restrictions on emergency contraception has set up choices for pharmacists, consumers and the Obama administration about whether this is the end of the controversy.

The Associated Press: Risk For Obama In Pursuing Legal Appeals After Judge Reverses Morning-After Pill Limits
President Barack Obama supports requiring girls younger than 17 to see a doctor before buying the morning-after pill. But fighting that battle in court comes with its own set of risks. A federal judge in New York on Friday ordered the Food and Drug Administration to lift age restrictions on the sale of emergency contraception, ending the requirement that buyers show proof they’re 17 or older if they want to buy it without a prescription (Lederman and Neergaard, 4/6).

NPR: With Plan B Ruling, Judge Signs Off On Years Of Advocacy
Federal District Court Judge Edward Korman has been overseeing the case on and off since 2005. He found, among other things, that the Food and Drug Administration "has engaged in intolerable delays ... that could accurately be described as an administrative agency filibuster" in deciding whether to approve a 2001 citizens' petition to allow nonprescription sale of the drug (Rovner, 4/6).

Los Angeles Times: Teen Contraception Decision: Doctors Say Science Trumps Politics
Science trumped politics, but politics may still present problems for teens trying to purchase emergency contraception. "A lot of stuff is going to happen over the next 30 days," said Dr. Cora Breuner, a pediatric medicine specialist at the University of Washington (Mohan, 4/6).

NBC News: Pharmacists React To 'Morning-After Pill' Ruling
Up until now, pharmacists in Washington and Illinois had been assured by the courts that they could choose not to dispense Plan B if they so chose. A federal judge ruled in February of 2012 that Washington state couldn’t force pharmacies to sell Plan B. Then in September of the same year, an Illinois appellate court affirmed a lower court’s ruling that pharmacists could not be forced by the state to sell Plan B if they had religious objections (Carroll and Mapes, 4/6). 


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State Watch

Roundup: Abortion Restriction Measure Goes To Kan. Governor's Desk

A selection of health policy stories from Kansas, California, the District of Columbia, Minnesota, Wisconsin and Washington state.

The Associated Press: Sweeping Anti-Abortion Bill Goes To Kansas Gov.
Kansas legislators gave final passage to a sweeping anti-abortion measure Friday night, sending Gov. Sam Brownback a bill that declares life begins "at fertilization" while blocking tax breaks for abortion providers and banning abortions performed solely because of the baby's sex. ... The measure's language that life begins "at fertilization" had some abortion-rights supporters worrying that it could be used to legally harass providers. Abortion opponents call it a statement of principle and not an outright ban on terminating pregnancies (Hanna, 4/6).

Los Angeles Times: Judge Denies Gov. Jerry Brown's Bid To End Prison Oversight
Lawyers representing about 33,700 California prisoners requiring mental health care contend serious shortfalls in care remain, evidenced by staff shortages in some psychiatric wards, the housing of mentally ill inmates in isolation cells and a climbing prison suicide rate. California presented reports from a team of experts, including one who became Brown's current secretary of corrections, who contend conditions, while imperfect, now meet the minimum adequate care required under the U.S. Constitution and continue to improve (St. John, 4/5).

The Associated Press: Feds Retain Control Of Calif. Prison Mental Health
A federal judge on Friday rejected Gov. Jerry Brown's bid to regain state control of inmates' mental health care, citing systematic failures to reduce prison suicides, provide timely care and hire enough staff. The decision is a blow to the Democratic governor's attempts to end nearly two decades of expensive federal lawsuits that influence nearly every aspect of California's prison system (Thompson, 4/6).

The Washington Post: Two D.C. Hospitals Vie To Establish Costly Cancer Treatment Option
Two of the region’s largest hospital systems are competing to offer a controversial cancer treatment -- joining what critics say is a nationwide medical arms race as hospitals scramble for dominance by investing millions of dollars in technology that has not been proven to be better than cheaper alternatives for some cancers (Sun, 4/7).

MPR News: With Soda Bans, NE Minn. Hospitals Are At Leading Edge Of U.S. Trend
A few months ago Dr. Maria Barrell, a family practice resident in Duluth, Minn., had a patient admitted to the hospital. The woman had recently been diagnosed with diabetes. ... Barrell had had a long talk with the patient about the negative health effects of sugar-sweetened beverages. One 12-ounce can of Mountain Dew, for example, contains almost three tablespoons of sugar. They are linked to obesity and diabetes, cardiovascular problems and a heightened risk of stroke (Kraker, 4/5). 

MPR News: Geography May Be Key In Any Deal For Fairview Health
Merger talks are swirling around Minneapolis-based Fairview Health Services and Sanford Health of North and South Dakota. Minnesota Attorney General Lori Swanson wants the public to weigh in on the situation at a hearing on Sunday at the Capitol. Meanwhile, the University of Minnesota has just revealed its own offer to acquire Fairview. The fate of Fairview is much ado about location. The urge to merge is strong in the health care sector now with less than a year to go before major provisions of the federal health care overhaul take full effect (Stawicki, 4/5). 

Milwaukee Journal Sentinel: Wisconsin's Family Care Program Sees Cost Of Caring For Average Person Decline
Something unexpected is happening within a state program for the elderly and disabled -- for three years the cost of caring for the average person in it has fallen rather than risen. The looming choice of whether to expand the Family Care program could be shifted by this ongoing trend, which runs counter to everything the public and policy-makers have been led to expect from health care costs. Overall costs in recent years have risen substantially for Family Care as many more frail elderly or disabled recipients have moved into it (Stein, 4/6). 

The Associated Press: Lavish Medical Benefits For Retirees Imperil Budgets
After this coastal city’s 1979 ladder truck finally broke down a few years ago, firefighters continued their duties by using hand ladders that reach only a couple of stories up. Without the cash to buy a proper replacement truck, Hoquiam officials went to the ballot earlier this year with a levy proposal totaling $1.2 million (Baker, 4/7).

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Editorials and Opinions

Viewpoints: Drugging Soldiers; GOP Opposition To Medicaid Expansion Strays From Party Legacy; Health Law Distorts Market

The New York Times: Wars On Drugs
Last year, more active-duty soldiers committed suicide than died in battle. ... Worse, according to data not reported on until now, the military evidently responded to stress that afflicts soldiers in Iraq and Afghanistan primarily by drugging soldiers on the front lines. ... The prescribing trends suggest that the military often uses medications in ways that are not approved by the Food and Drug Administration and do not comport with the usual psychiatric standards of practice (Richard A. Friedman, 4/6).

The New York Times: Insurance And Freedom
No, the real policy action at this point is in the states, where the question is, How many Americans will be denied essential health care in the name of freedom? I'm referring, of course, to the question of how many Republican governors will reject the Medicaid expansion that is a key part of Obamacare. What does that have to do with freedom? In reality, nothing. But when it comes to politics, it's a different story (Paul Krugman, 4/7). 

Des Moines Register: GOP Goes Against Party's Medicaid Heritage
Republicans should be aware that their opposition to Medicaid expansion is at odds with their party’s proud heritage. So is the tendency to blindly follow the instructions of a party leader and cast votes in "blocks" rather than as individuals representing their constituencies. Washington lawmakers crossed party lines and worked together to create Medicaid in 1965. ... President Ronald Reagan signed legislation in 1986 allowing states to extend Medicaid coverage to pregnant women and young children in households having incomes up to 100 percent of the federal poverty level. That was only the beginning. Three more times he signed bills to expand coverage to more pregnant women and older children (4/7).

Bloomberg: How Obamacare Will Distort The Health-Care Market
President Barack Obama and his fellow Democrats sold many Americans on the Affordable Care Act largely by emphasizing two arguments: The law would help to reduce overall health-care costs, and it would provide health insurance to those who, for financial or health reasons, cannot get it now. Unfortunately, both of these arguments are flawed. The law creates market distortions that will significantly raise premiums and costs for many Americans -- including some middle-income families. And there are less costly, less distortionary and less intrusive ways to address the problem of the uninsured (Lanhee Chen, 4/7).

The Wall Street Journal: Reflections Of A Medical Ex-Practitioner
A fundamental principle in medicine is that if you get the diagnosis wrong, you'll probably apply the wrong therapy. A corollary is that if the therapy isn't working, increasing the dose may make things worse. That's where we are with ObamaCare. There are shortcomings aplenty in the health-care field, and changes and improvements are required. But never have I seen so many good intentions leading irreversibly to hell (Ed Marsh, 4/7).

Roll Call: Affordable Care Act Offers Opportunity To Combat Pain And Drug Abuse
There is a growing national debate about two important life and death issues: the abuse of powerful pain medications and the treatment of chronic pain. The Centers for Disease Control and Prevention has classified prescription drug abuse as a deadly epidemic and the White House Office on National Drug Policy has declared the crisis to be a top public health priority. ... To address these twin crises, it is critical that Congress fund programs within the Affordable Care Act that provide powerful opportunities to improve care of persons with pain and with substance abuse disorders (Seddon R. Savage, 4/5).

Boston Globe: Seeing Patients As More Than Their Conditions
Mr. S lay patiently in his hospital bed while several medical students took turns pressing their stethoscopes to his chest, hoping to hear his sometimes elusive heart murmur. The elderly gentleman had a long cardiac history; he had been admitted to the hospital with worsening shortness of breath several days earlier. His hospital stay had been complicated and he was quite sick. However, when I gently approached him about participating in a teaching exercise designed to help medical students improve their physical exam skills, he responded with a smile, "Anything to help the next generation" (Kiran Gupta, 4/8).

The Hill: A Way Out Of The Medicare Maze
Medicare and how we pay for it has been the most vexing issue to confront President Obama and Congress as they struggle (or in some cases saunter) toward trying to put our financial house in order. Social Security has only a few moving parts that need to be fixed to give it long-term effectiveness and affordability. But fixing Medicare so it is sustainable and does not bankrupt the country, yet still gives quality healthcare to our seniors, involves addressing a complex and constantly changing matrix (Judd Gregg, 4/8).

Bloomberg: Obama Should End Political Fight Over Morning-After Pill
If anything, age restrictions on the morning-after pill are a bigger problem than they would be for pain relievers. Many doctors have explained why. The pill is most effective if taken within 24 hours of unprotected sex; there often isn’t time for users to see a doctor before going to the pharmacy. Last November, the American Academy of Pediatrics recommended that its members work around the age restriction by prescribing the drug to teens in advance. (The American Medical Association and the American College of Obstetricians and Gynecologists also support making the morning-after pill available with no restrictions.) (4/5).

The Washington Post: Johns Hopkins's And Planned Parenthood's Troubling Extremism
We know Johns Hopkins University is devoted to diversity, because it says so. Its "Diversity and Inclusion Statement." ... Unless you are a member of Voice for Life (VFL), an antiabortion group. Hopkins’s Student Government Association has denied VFL status as a recognized student group. ... Hopkins's institutional intolerance would be boring were it simply redundant evidence of academia's commitment to diversity in everything but thought. It is, however, indicative of the increasingly extreme ambitions and tactics of those operating under the anodyne rubric of "choice" (George F. Will, 4/5). 

Kansas City Star: Strong Hospitals Are Crucial To Healthy Communities
Hospitals are where people welcome new life and say final goodbyes. They are major employers, givers and receivers of charity and mainstays of communities. It's no wonder that emotions run high when change is in the works. In recent weeks, people have packed into hearings regarding three hospitals. In the case of two — Providence Medical Center in Kansas City, Kan., and St. John Hospital in Leavenworth — a formal process for sale appears to have led to a workable resolution (4/6). 

Los Angeles Times: Judge Poised To Toss Ridiculous Prime Healthcare Lawsuit
U.S. District Judge Gonzalo Curiel of San Diego has signaled that he's prepared to dismiss a bizarre lawsuit filed by Prime Healthcare Services against the Kaiser Foundation Health Plan and the Service Employees International Union. In a tentative ruling handed down Thursday, Curiel said he found no merit in Prime's claim that Kaiser and the SEIU had conspired against the Ontario hospital company (Michael Hiltzik, 4/5).

Health Policy Solutions (a Colo. news service): Sending Health Care Leaders Back To School
Every single balancing act described above that lies at the heart of every discussion we have about paying for value in health care echoes the challenges of measuring school performance. What can we learn from the struggle to make Colorado’s schools more accountable that can inform our efforts to measure and reward quality in health care? (Edie Sonn, 4/5).

HealthyCal: Federal Health Reform Involves A Series Of Trade-Offs
California has led the nation in implementing President Obama's health reform law, and Californians are among its biggest supporters. Will that support be sustained as voters learn more about how the law will work? That's a tough question. But the answer may help determine the ultimate fate of the law as its still-vague promises become reality. If Californians turn against the Affordable Care Act, the rest of the nation, which is already more skeptical, will likely be in full revolt (Weintraub, 4/7).

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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.