Daily Health Policy Report

Tuesday, April 8, 2014

Last updated: Tue, Apr 8

KHN Original Reporting & Guest Opinion


Health Reform

Capitol Hill Watch

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Obama Administration Retreats On Private Medicare Rate Cuts

Kaiser Health News staff writer Jay Hancock reports: "Under intense, bipartisan political pressure, the Obama administration backed down for the second year in a row on proposed payment cuts for insurance companies that offer private plans to Medicare members. After estimating in February that the cuts required by the Affordable Care Act as well as other adjustments would reduce would reduce what it pays insurers next year by 1.9 percent per beneficiary, the Department of Health and Human Services said Monday it would instead give Medicare Advantage plans a raise of 0.4 percent" (Hancock, 4/8). Read the story.

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Insuring Your Health: Nevada Offers Rare Bet: Year-Round Sales Of Health Plans

Kaiser Health News consumer columnist Michelle Andrews writes: "For months, consumers have been warned that they have to buy health insurance by the end of open enrollment or remain uninsured until next year. But a little noticed provision of the health law may give some consumers another chance. Insurers that sell individual plans have to offer insurance to all comers during an annual open enrollment period, which this year ended for most people on March 31. However, the health law allows insurers to sell individual plans off the exchange outside the regular open enrollment if they wish to do so, as long as they don’t discriminate against people who are sick" (Andrews, 4/8). Read the column.

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Capsules: Report: Jails House 10 Times More Mentally Ill Than State Hospitals

Now on Kaiser Health News' blog, Jenny Gold writes: "In 44 states and the District of Columbia, at least one prison or jail holds more people with serious mental illnesses than the largest state psychiatric hospital, according to a report released Tuesday by the Treatment Advocacy Center and the National Sheriffs’ Association" (Gold, 4/8). Check out what else is on the blog.

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Clients Save, Insurers Get Boost From Affordable Care Act

The Philadelphia Inquirer's Robert Calandra, working in partnership with Kaiser Health News, reports: "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. And no, that is not an exaggeration. Schroeder is a cancer survivor, and for many of those years, a working, single mom who felt lucky just to have coverage. ... With her savings account long since drained, her retirement fund exhausted, and an $880 monthly premium payment gobbling up almost half of her annual income, Schroeder, 62, could no longer make financial ends meet. Then she heard about the Affordable Care Act. 'I thought maybe this was my saving grace,' Schroeder said" (Calandra, 4/8). Read the story.

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Political Cartoon: 'Open-Door Policy?'

Kaiser Health News provides a fresh take on health policy developments with "Open-Door Policy?" by Randy Bish.

And here's today's health policy haiku:


Did the ad campaign
make a difference in rates?
Read the news stories.

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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HHS Reverses Plan To Cut Medicare Advantage Rates

Administration officials announce that they will slightly boost rates paid to insurers offering the private Medicare plans. In February they had suggested cuts to the funding, but Republican and Democratic lawmakers had opposed the suggestion.

The Wall Street Journal: Medicare Agency Says Payments To Insurers Will Rise In 2015
Federal regulators on Monday said they boosted planned payments to insurers that run private Medicare Advantage plans, issuing final rates that were higher than the cuts regulators proposed in February. The trims were opposed by many Republicans and some Democrats, creating a tough political situation for the Obama administration. These lawmakers said the result could have been higher rates or less choice for some seniors. The insurance industry launched a major lobbying campaign against the reduction (Mathews and Peterson, 4/7).

The Associated Press: Government Hikes Medicare Advantage Pay Estimate
The government has raised its payment estimate for Medicare Advantage plans months ahead of a busy election season during which cuts to the program promise to be a key focus for politicians and voters. The Centers for Medicare and Medicaid Services said Monday that 2015 payments to the plans should increase less than 1 percent overall. That compares to a drop of nearly 2 percent that the government forecast in February (Murphy, 4/7).

Kaiser Health News: Obama Administration Retreats On Private Medicare Rate Cuts
Under intense, bipartisan political pressure, the Obama administration backed down for the second year in a row on proposed payment cuts for insurance companies that offer private plans to Medicare members. After estimating in February that the cuts required by the Affordable Care Act as well as other adjustments would reduce would reduce what it pays insurers next year by 1.9 percent per beneficiary, the Department of Health and Human Services said Monday it would instead give Medicare Advantage plans a raise of 0.4 percent (Hancock, 4/8).

The Washington Post's Wonkblog: Obama Administration Reverses Proposed Cut To Medicare Plans
The reversal comes after a major lobbying effort from the health insurance industry and signals that Republicans would use the cuts to attack Democrats in this year's midterm elections. The Medicare Advantage program, according to the Avalere Health consulting firm, now covers about 16 million seniors, or 30 percent of all Medicare beneficiaries, through private health plans that can offer extra benefits, like wellness plans (Millman, 4/7).

McClatchy: Proposed Cuts To Medicare Advantage Plans Out, Payments Hikes In
Congressional Democrats, many facing tough re-election bids, had recently joined Republicans in asking that these private health plans, known as Medicare Advantage, be spared from payment cuts next year, even though they receive an average of six percent, or $8 billion, more this year to cover their enrollees than it would cost under the traditional Medicare program. The administration had proposed a two percent cut in Medicare Advantage payment rates in February as part of an Affordable Care Act initiative to help bring the payments more in line with the regular Medicare program (Pugh, 4/7).

Reuters: U.S. Government Rolls Back Proposed Medicare Advantage Cut
The Obama administration on Monday rolled back some of the more controversial cuts proposed for privately managed Medicare health plans used by the elderly following pressure from insurance companies and lawmakers. The Centers for Medicare and Medicaid Services (CMS) said that on average, reimbursement for such Medicare Advantage plans in 2015 would rise 0.4 percent, reversing what is said was a 1.9 percent average reduction proposed in February (Humer and Morgan, 4/8).

The Star Tribune: Medicare Advantage Plans Dodge U.S. Cuts
Federal officials said Monday that they have made a series of administrative adjustments to offset cuts to the Medicare Advantage program that will be required under national health care reform. The health insurance industry spent millions of dollars on lobbying and advertising to fight the cuts to Medicare Advantage, which is the private alternative to Medicare. Medicare Advantage costs the government more per patient than traditional Medicare, and the disputed cuts are designed to bring those payments closer together (Spencer, 4/7).

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AMA Won't Go To Court To Block Wednesday's Expected Release Of Medicare Physician Billing Records

The Associated Press: Medical Assn. Won’t Stop Medicare Doc Data Release
The nation’s largest doctors’ group said Monday it won’t try to block Medicare’s release of billing records for 880,000 physicians, although it continues to oppose the government’s recent decision to open up the massive data trove. An official of the American Medical Association told The Associated Press that the group won’t go to court ahead of Wednesday’s scheduled release. The official spoke on condition of anonymity because the organization’s policies allow only certain designated representatives to make on-the-record comments (4/7).

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Health Reform

Community Health Centers Face Tough Competition For Newly Insured

A center in the District of Columbia is challenged by a regional hospital system when trying to attract low-income patients who are now insured under the health law. Other media outlets report on a study showing that the chances of getting a doctor's appointment vary depending on what type of insurance a consumer has, and other implementation issues .

The Washington Post: MedStar Faces Tensions With Community Clinics Over Primary-Care Expansion In District
For a quarter-century, Mary's Center, a community health center in Adams Morgan, has served patients too poor to be treated elsewhere. Like many other safety-net providers which are required by the government to treat patients regardless of their ability to pay, the center has struggled constantly for money. So officials were looking forward to the opening of the new health insurance exchanges created by the Affordable Care Act: More patients with coverage would bolster the bottom line. To attract more young professionals and families, they decided to offer walk-in services for problems such as strep throat and sprained ankles. But in November, regional hospital giant MedStar Health opened a pair of clinics two blocks away offering just those services — and wide-screen TVs to boot  .... The tension is an unintended consequence of the health-care law, which has set off an intense competition for a growing number of privately insured patients, who tend to be the best-paying customers (Sun, 4/7).

Reuters: Doctor Appointment Availability Varies By Insurance Type
People's chances of getting a new primary care doctor vary depending on their insurance, according to a new study. Researchers calling doctors' offices and claiming to be a patient with private insurance had about an 85 percent success rate for getting appointments (Seaman, 4/7).

In other news about the health law's implementation -

The Fiscal Times: Health Insurance: 14.5 Million To Get Massive Increases
The price of health insurance premiums on plans purchased outside of the federal and state exchanges are much higher than expected, a survey of brokers found. A proprietary survey of 148 brokers conducted by Morgan Stanley analysts revealed the largest acceleration in small and individual group rates in the survey’s history, Forbes contributor Scott Gottlieb of the conservative American Enterprise Institute first noted. The survey found that the prices for off-exchange plans in the small group market increased by an average of 11 percent, while off-exchange plans on the individual market increased by an average of 12 percent. Analysts noted that the prices tended to vary by state, with some states showing increases 10 to 50 times that amount, Gottlieb wrote (Ehley, 4/8).

Politico: Obamacare's Next Obstacle: Confusion As People Use It
Obama administration officials hoping to exhale after the big finish to Obamacare's first enrollment season may need to hold their breath a while longer. All the confusion and mixed messages out there are bound to combust if people decide they were misled — an echo of the "you can keep your plan if you like it" fiasco (Villacorta, 4/7).

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Majority Of Medicaid Sign-Ups Centered In 10 States

An analysis from the Centers for Medicare & Medicaid Services found that 80 percent of the 3 million people who enrolled in Medicaid since Oct. 1 were located in 10 states. Also in the news, specific enrollment tallies from Michigan and the latest on Virginia's legislative stalemate over the expansion. 

CQ HealthBeat: Ten States Account for Vast Majority of Medicaid Sign-Ups
Ten states signed up more than 80 percent of the approximately 3 million people who enrolled in Medicaid since Oct. 1, meaning 700,000 to 1.3 million people may have joined the health program in March based on earlier trends, according to a consulting firm’s projections. The analysis was based on a Centers for Medicare & Medicaid Services report released Friday that found that sign-ups in Medicaid and the Children’s Health Insurance Program rose during the health law’s open enrollment period to buy coverage (Adams, 4/7).

The Associated Press: Medicaid Sees 46,100 Applicants After Expansion
The state says about 46,100 people have applied for Michigan’s expanded Medicaid plan since it launched last week. The Department of Community Health says that as of 12 a.m. Monday, roughly 27,000 individuals had been enrolled in Healthy Michigan, which is intended to provide health insurance for hundreds of thousands more low-income adults (4/7). 

MLive: Michigan Enrolls Nearly 27,000 In Expanded Medicaid Program In First 6 Days
Michigan has received more than 46,000 applications for the state's expanded Medicaid program in less than a week. As of midnight on Monday, the state had received 46,091 applications and enrolled 26,906 people in the Healthy Michigan plan since it launched April 1, according to the Michigan Department of Community Health. The state hadn't set specific expectations for the first week of enrollment, but it does hope to enroll about 320,000 low-income Michiganders in the program this year. A total of 477,000 people are eligible under the increased income limits (Anders, 4/7).

Roanoke Times: Senate To Vote Tuesday On Medicaid Expansion
The [Virginia state] Senate will vote today on state budget proposal that includes a private-option Medicaid expansion plan that already has been rejected by the House of Delegates, and there are no signs that the legislative stalemate will end soon. The Senate budget bill (SB 5003), advanced Monday by the Senate Finance Committee, also includes pay raises that Gov. Terry McAuliffe has proposed for state employees and school teachers. McAuliffe included the raises in the budget plan he introduced March 21, the first day of the General Assembly’s plodding special session (Sluss, 4/7).

The Richmond Times-Dispatch: Two Paths Seek Health Care Expansion; House Balks
State lawmakers traveled two paths on Monday toward expanded health coverage for uninsured Virginians, but both have the same obstacle -- the House of Delegates. The Senate Finance Committee, as expected, revived its plan for a private insurance marketplace in its version of the two-year state budget that the House adamantly opposes. Hours later, Gov. Terry McAuliffe’s administration testified that it has met the requirements of a budget agreement last year to reform Virginia’s Medicaid program before expanding it -- a contention that House members of the Medicaid Innovation and Reform Commission quickly rejected (Martz, 4/8).

In related news, how people with mental illness are faring in states that opted against the expansion --

Stateline: Nearly 4 Million Seriously Mentally Ill Still Without Insurance
Some might consider Kelly Troyer of South Carolina lucky. She isn’t one of them. Thanks to the generosity of her church and family members, she receives some treatment for the depression and post-traumatic stress disorder she suffers as a result of the sexual assault she endured in 2012. But Troyer, 45, said her lack of health insurance and other uncovered medical costs, including a hospitalization and all her medications, has forced her into personal bankruptcy. She lives in one of the 24 states that chose not to expand their Medicaid programs, offered under the Affordable Care Act. Those decisions have left about 3.7 million Americans with serious mental illness, psychological distress or a substance abuse disorder without health insurance, according to a recent report from the American Mental Health Counselors Association (AMHCA), a group that represents mental health professionals (Ollove, 4/8).

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Last-Minute Push Boosted Latino Enrollment

In the meantime, New York officials say they signed up more than 900,000 people -- with slightly more than half enrolling in Medicaid.

Modern Healthcare: Boots On The Ground Brought Out Last-Minute Latino ACA Signups
A last-minute shift to more community and local outreach along with other grass-roots marketing strategies helped state exchanges and enrollment organizations boost Latino signups just before the March 31 deadline after months of lagging enrollment in Obamacare plans (Landen, 4/7).

The Associated Press: NY State Health Exchange Reports 908,000 
The Department of Health says enrollment for individual and family coverage since October includes nearly 422,000 New Yorkers in the 16 commercial and nonprofit insurers in the exchange and nearly 487,000 in government-funded Medicaid (4/8).

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Capitol Hill Watch

House Democrats' Budget Plan Leaves Health Law And Medicare Intact

GOP Rep. Paul Ryan's plan, in the meantime, would offer seniors a choice between private or traditional Medicare plans and would repeal the health law.

The Wall Street Journal: House Democrats Offer Different Budget Path
Democrats emphasized that their budget would not reduce spending for federal safety-net programs, including Medicare and Medicaid. In the GOP budget, Mr. Ryan proposes offering seniors a choice between traditional Medicare and private plans subsidized by the government, starting in 2024. He would also transfer much of the federal government’s role in Medicaid to the states (Peterson, 4/7).

The Associated Press: House Democrats Unveil Budget Plan With Tax Hikes
Van Hollen’s plan leaves in place so-called Obamacare and leaves the current Medicare system in place, whereas Ryan would repeal the law’s benefits and set in motion a dramatic overhaul of Medicare for future retirees who are presently 55 or younger. It calls for extending refundable tax breaks for the working poor and providing them to childless workers as Obama calls for (4/7).

In other news from Capitol Hill -

Politico: Obamacare And GOP Congress Collide
This race will be a high-profile test of what offends voters more: Obamacare or the Republican Congress. Romanoff is running squarely against House Republicans’ agenda, and Coffman is banking on the hope that voters will be sufficiently outraged about Obama’s health plan to turn out on Election Day (Sherman, 4/8).

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State Watch

State Highlights: State Mental Hospitals Compared To Prisons; Johnson & Johnson Ruling; Va. Hospitals Pick New Leader

A selection of health policy stories from Virginia, Arkansas, New York and Florida.

The Associated Press: Arkansas AG Asks Court To Reconsider Drug Ruling
Arkansas Attorney General Dustin McDaniel asked the state Supreme Court on Monday to reconsider its decision tossing out a $1.2 billion judgment against drugmaker Johnson & Johnson, saying justices did “significant harm” to the state and broke from 170 years of precedent. McDaniel filed a petition for rehearing over the high court’s decision last month that the state misapplied the Medicaid fraud law in its lawsuit against New Jersey-based Johnson & Johnson and its subsidiary Janssen Pharmaceutical Inc. over the marketing of the antispyschotic drug Risperdal (DeMillo, 4/7).

Kaiser Health News: Report: Jails House 10 Times More Mentally Ill Than State Hospitals
In 44 states and the District of Columbia, at least one prison or jail holds more people with serious mental illnesses than the largest state psychiatric hospital, according to a report released Tuesday by the Treatment Advocacy Center and the National Sheriffs’ Association. ... an estimated 356,268 people with mental illnesses including bipolar disorder and schizophrenia are in prisons and jails, compared to just 35,000 in state hospitals ... That’s similar to the mental health system in 1830 (Gold, 4/8).

The Associated Press: Va. Governor Signs Mental Health Bill
A key part of Sen. Creigh Deeds’ efforts to fix Virginia’s mental health system is now law. Gov. Terry McAuliffe signed legislation Monday that extends the length of time allotted for finding a psychiatric bed for those under an emergency custody order from six hours to 12 hours (4/7).

The Washington Post: Ex-Transportation Secretary Connaughton Picked To Lead Health Care Association
A prominent hospital association has picked former governor Robert F. McDonnell’s hard-charging transportation secretary to lead the organization as it continues to push House Republicans to expand Medicaid. The selection of Sean Connaughton as the next president of the Virginia Hospital and Healthcare Association surprised and upset some people on both sides of the Medicaid debate (Vozzella, 4/7).

PolitiFact/Richmond Times-Dispatch: McAuliffe Says The Medicaid Fraud Rate In Virginia Is 0.47 Percent
The 0.47 is a computation of the percentage of Medicaid bills that were paid in 2012 for services that Virginians were ineligible to receive. Some of those errors resulted from deceit and some were simply caused by clerical errors. Neither the state nor the federal government offer a standard measurement of Medicaid fraud because much of the abuse is undetected. So the governor comes up empty. We rate his statement False (Gorman, 4/8).

The Associated Press: Bill Takes On Unlicensed Health Clinics
There is one simple way for a Florida medical clinic to avoid being licensed and undergoing an annual inspection: Don't accept insurance. A bill moving through the Legislature would close that loophole for so-called cash-only clinics, which can escape government oversight because the statutory definition of a clinic is interpreted as an operation that takes third-party insurance (4/7).

The Wall Street Journal’s Metropolis: New York Officials Restore Millions For Spinal Cord Injury Research
New York state budget officials have restored nearly $7 million in annual funding for spinal cord injury research after an influential lobby of paraplegics put pressure on Albany lawmakers and Gov. Andrew Cuomo‘s administration. The group, New Yorkers to Cure Paralysis, had tried unsuccessfully since 2010 to restore about $8.5 million in annual state funding for the research, which they argued is required to be spent by state law (Kravitz, 4/7).

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Editorials and Opinions

Viewpoints: A 'Misguided' Debate; Trying To Figure Out Who's Uninsured; The Safety Net For The Middle Class

The Washington Post: Obamacare Has Spawned A Misguided Debate
Supporters of Obamacare are celebrating that the law is not an unmitigated disaster, just a mitigated one. As enrollment closed (for most) on March 31, the system passed 7 million exchange sign-ups. What some are taking as a triumph of governmental competence was actually an emergency rescue by private-sector volunteers after a laughable failure of government to construct and run its own system. This has hardly been a confidence-builder when it comes to public faith in bureaucracy. But never mind (Michael Gerson, 4/7).

The Wall Street Journal: Off The ObamaCare Deep End
It doesn't take much for some conservatives to shout "betrayal" these days, but the latest example is especially obtuse. House GOP leaders are rushing to quell a micro-rebellion on the right for having repaired a small corner of ObamaCare's economic damage. It's going to be a long three years until there is a new President if harm reduction now constitutes health-care treason (4/7).

Bloomberg: Obamacare Isn't Failing. Now What?
Some Republicans, however, think proposing their own health-care ideas is a mistake because it distracts from the case against Obamacare. And even those who think it's important to advance alternatives are divided on a key question: How important is it that a replacement plan increase coverage? More people would have coverage under Jindal's plan than under the pre-Obamacare system. But compared to Obamacare, people would lose coverage. Does that matter? (Ramesh Ponnuru, 4/7).

Bloomberg: So Who Are The 'Uninsured,' Anyway?
Supporters of the Affordable Care Act are basically counting on its beneficiaries to make it impossible to repeal. That makes it important to know exactly how many of those beneficiaries there are. As I've written before, it's hard to know yet -- Medicaid signups will continue for the rest of the year, and while we know how many people selected a policy on the exchanges, we don't know how many of them have paid. But one number should be pretty easy to figure out: how many young people have gained insurance through their parents' policies, thanks to the Obamacare provision that allows them to stay on those policies until they are 26. And yet, that's not very easy to figure out (Megan McArdle, 4/7).

Bloomberg: It's A Fact: More People Have Health Insurance
That Gallup poll previewed in a Los Angeles Times story at the end of last month was finally published today. As expected, it finds that the percentage of Americans without insurance has plunged. As I've said before, be very careful about these polling results. This series shows the percentage of uninsured in the first quarter of 2014 at a little less than 16 percent, a drop of more than 1.5 percentage points from the end of 2013. Yet, earlier last year, Gallup also had an unexplained spike to 18 percent. My best guess is that the 2013 spike was just noise in the polling data. This drop is larger, but I wouldn't get too attached to Gallup's exact numbers or to the size of the reduction (Jonathan Bernstein, 4/7).

The New Republic: Another Day, Another Sign That Obamacare Is Working
These tracking surveys on the uninsured are far from precise. Among other things, people answering these surveys aren't always sure of their own insurance status. Nobody should treat them as gospel. But Gallup also found the most dramatic change in insurance status among low-income and minority populations, which would be consistent with implementation of a law that has its most dramatic impact on people with the least money. It's also consistent with three other pieces of information (Jonathan Cohn, 4/7).

Bloomberg: Obamacare Needs To Start Clipping Drug Coupons
Unlike coupons for, say, breakfast cereal, coupons for pricey drugs are a bit of a racket. It works like this: Your doctor says you need a drug to, say, treat your depression. Perhaps you've heard about a particular brand-name antidepressant and ask for it; your doctor says a generic version has just been approved but agrees to prescribe the brand you want. ... Your doctor, however, isn't paying the cost of the drug; your insurance company is. Insurers could simply refuse to cover brand-name drugs, but then who would buy their policies? Instead, companies discourage higher-priced medicines by charging you a higher copayment. Drugmakers know this, and they offer some patients coupons offsetting that copayment. You stick with the brand-name drug; the drugmaker gets more revenue; and your insurance company is hit with a much higher cost (4/7).

The Hill: Facts Show Faults Of Health Law
Now, in a breathtakingly deceptive declaration, the administration is touting the fact that with approximately 7 million people supposedly signed up, ObamaCare is a success. Of course, this entirely glosses over the millions of people who are in healthcare limbo as they try to figure out what their coverage is, who will provide it and at what cost. Most important, it is now rather obvious that ObamaCare is not going to insure a very large share of the previously-uninsured population. The defects of the law do not begin and end with the taking away of insurance plans from people who were previously happy with those plans. ObamaCare will also cost an extraordinary amount of money because of the new federal subsidies and mandates both in the exchanges and in the states' Medicaid programs (Judd Gregg, 4/7).

Denver Post: Obamacare Not Helping Mountain Dwellers
While many of us still think the Affordable Care Act is a terrible law, it's not because of any of the unsubstantiated inanities about how it will destroy the economy and bankrupt ordinary Americans, but because it doesn't go far enough in terms of truly socializing medicine and holding down costs like we see in Canada, Japan and England. In the mountains, we face another problem with the new health-care system: premiums under Obamacare that are hundreds of dollars more than the rest of the state (Steve Lipsher, 4/7).

Fox News: ObamaCare Is Destroying My Medical Practice
The Obama administration has been boasting about its great enrollment numbers for ObamaCare, claiming that 7.1 million people have signed up for plans through the new insurance marketplaces. But, in reality, medicine has gotten harder and harder to practice since ObamaCare became the law of the land. As a doctor who treats many patients on a daily basis, I’ve seen firsthand how difficult it can be to maneuver the new health care landscape and get patients the help they need (Dr. Manny Alvarez, 4/7).

Journal of the American Medical Association: The Changing Landscape Of Medicaid
The opportunity for each state to create an exchange was seen as a form of "conservative means to liberal ends," allowing the country to move closer to universal coverage through a state-level market-based mechanism favored by conservative policy experts. Similarly, many commentators and scholars suggested that the Medicaid expansion would be so beneficial that every state would ultimately comply. ... Yet by January 2014 only 15 states and the District of Columbia had chosen to fully comply with the ACA by creating a state-based exchange and expanding Medicaid, whereas 23 states took neither of these steps. ... These decisions have followed partisan patterns (David K. Jones, Phillip M. Singer and Dr. John Z. Ayanian, 4/6).

On other health issues -

The Washington Post: The Safety Net Catches The Middle Class More Than The Poor
Liberals are shocked (shocked!) that Rep. Paul Ryan (R-Wis.) and his co-partisans would consider cutting Medicaid, food stamps, Pell grants and other programs that serve the neediest Americans. They have accused Ryan of trying to balance the budget on the backs of the poor. But long before Ryan unveiled his "Path to Prosperity," politicians of both parties had been redistributing government spending away from the truly destitute and toward everyone else (Catherine Rampell, 4/7).

Modern Healthcare: Time For A New Test On Hospitals' Tax Exemptions
As of last year, not-for-profit hospitals are required under the Patient Protection and Affordable Care Act to meet new tax-exemption reporting requirements on their policies and practices in four areas: community health needs assessment; patient financial assistance; billing and collections; and emergency-care pricing. Unfortunately, this is the wrong way for tax-exempt hospitals to demonstrate their performance in providing special benefits to their communities. First, these four areas are far from the only important community-benefit considerations for a hospital's board and management. ... Second, and more important, the current reporting requirements represent a form of micromanagement by the federal government, focusing on process rather than results (Bruce McPherson, 4/5).

Georgia Health News: The Personal Side: Looking Into Getting Older
While recently sharing a seafood dinner, three of my old high school friends and I also shared an inventory of our medical conditions. "Old" is a relative term. We’re in our early 60s. And our annual reunion is a golf vacation in Florida, so we’re mobile enough to get around the links (and send too many Titleists splashing into lagoons). After some initial chitchat, our dinner conversation eventually got around to health (Andy Miller, 4/7).

WBUR: Project Louise: Music Makes The Heart Beat Faster
So it turns out this kid thing really works. I did not do great workouts on all three days that I promised to exercise, but I did get myself moving. Even better, having made this promise caused me to think about taking care of myself for my kids’ sake every single day. Being here for my children turns out to be a really great motivator. And – who knew? – my kids are helping with Project Louise in other ways, too. The 5-year-old got me running around outside on Sunday; it didn’t even feel like a workout, but it was. (That’s my new goal: workouts that feel more like "playouts.") And the 16-year-old has given me another boost: music to listen to while I walk or bike (Louise Kennedy, 4/7).

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Stephanie Stapleton

Andrew Villegas

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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.