Daily Health Policy Report

Wednesday, April 9, 2014

Last updated: Wed, Apr 9

KHN Original Reporting & Guest Opinion


Health Reform

Capitol Hill Watch

Health Care Marketplace

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Early Drug Claims Suggest Exchange Plan Enrollees Are Sicker Than Average

Kaiser Health News staff writer Julie Appleby, working in partnership with The Daily Beast, reports: “Offering a first glimpse of the health care needs of Americans who bought coverage through federal and state marketplaces, an analysis of the first two months of claims data shows the new enrollees are more likely to use expensive specialty drugs to treat conditions like HIV/AIDS and hepatitis C than those with job-based insurance” (Appleby, 4/9). Read the story.

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Oregon Medicaid Plan Sees High Demand

Oregon Public Broadcasting’s Kristian Foden-Vencil, working in collaboration with Kaiser Health News and NPR, reports: “Millions of Americans who didn't have health insurance last year now do, as a result of the Affordable Care Act. In Lane County, Oregon, Trillium Community Health Plan is struggling to deal with a huge influx of new patients. CEO Terry Coplin says they expected 26,000 people to sign up in the first few years. Instead, about that many signed up in the first few months” (Foden-Vencil, 4/8). Read the story.

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Capsules: Primary Care Shortage? Not For The Insured, Study Shows

WHYY’s Elana Gordon, working in partnership with Kaiser Health News, reports: “Researchers posing as nonelderly adult patients made nearly 13,000 calls to primary care practices across Pennsylvania, New Jersey and eight other states between fall 2012 and spring of last year. What they found may provide some comfort amid growing concerns of doctor shortages, especially as more people gain coverage through the Affordable Care Act, potentially straining the health system” (Gordon, 4/8). Check out what else is on the blog.

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Political Cartoon: 'Ryan's Hope?'

Kaiser Health News provides a fresh take on health policy developments with 'Ryan's Hope?' By Dave Granlund.

And here's today's health policy haiku:


For 35 years
no such data saw sunlight.
Now it's out. What's next?

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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CMS Releases Trove Of Medicare Physician Billing Data

The Centers for Medicare & Medicaid Services is making this information available for the first time in 35 years. Meanwhile, in their first run at the data, news outlets report that a small number of doctors account for a large share of Medicare costs.  

The New York Times: Sliver Of Medicare Doctors Get Big Share Of Payouts
A tiny fraction of the 880,000 doctors and other health care providers who take Medicare accounted for nearly a quarter of the roughly $77 billion paid out to them under the federal program, receiving millions of dollars each in some cases in a single year, according to the most detailed data ever released in Medicare's nearly 50-year history (Abelson and Cohen, 4/9).

The Washington Post: Data Uncover Nation's Top Medicare Billers
The Medicare program is the source of a small fortune for many U.S. doctors, according to a trove of government records that reveal unprecedented details about physician billing practices nationwide. The government insurance program for older people paid nearly 4,000 physicians in excess of $1 million each in 2012, according to the new data. Those figures do not include what the doctors billed private insurance firms (Whoriskey, Keating and Sun, 4/9).

The Wall Street Journal: Small Slice Of Doctors Account For Big Chunk Of Medicare Costs
The long-awaited data reveal for the first time how individual medical providers treat America's seniors—and, in some cases, may enrich themselves in the process. Still, there are gaps in the records released by the U.S. about physicians' practice patterns, and doctors' groups said the release of such data leaves innocent physicians open to unfair criticism (Weaver, McGinty and Radnofsky, 4/9).

Los Angeles Times: Release Of Medicare Doctor Payments Shows Some Huge Payouts
Ending decades of secrecy, Medicare is showing what the giant healthcare program for seniors pays individual doctors, and the figures reveal that more than a dozen physicians received in excess of $10 million each in 2012. The Obama administration is releasing a detailed account Wednesday of $77 billion in government payouts to more than 880,000 healthcare providers nationwide that year. The release of payment records involving doctors has been legally blocked since 1979, but recent court rulings removed those obstacles. No personal information on patients is disclosed (Terhune, Levey and Smith, 4/8).

USA Today: First Look At Medicare Data In 35 Years
Reimbursements to doctors who provide Medicare services in 2012 ranged from nearly $21 million to a single Florida ophthalmologist to the $27,000 for the average anesthesiologist, according to the first look at government payment data in 35 years. The data were released this week by the Center for Medicare Services after a court order lifted an injunction sought by the American Medical Association had been in place since 1979 (Hoyer and Kennedy, 4/9).

Politico: Medicare Pay Data Laid Bare
Yet the massive release brings what federal health officials tout as a measure of transparency to a notoriously inscrutable system. Academic researchers and the media are expected to immediately begin dissecting the information to identify potential cases of fraud or abuse as well as differences in how Medicare services are used in various parts of the country (Norman, 4/9).

The Associated Press: Medicare Database Reveals Top-Paid Doctors
Topping Medicare’s list was Florida ophthalmologist Salomon Melgen, whose relationship with Sen. Robert Menendez, D-N.J., made headlines last year after news broke that the lawmaker used the doctor’s personal jet for trips to the Dominican Republic. Medicare paid Melgen $20.8 million. AP’s analysis found that a small sliver of the more than 825,000 individual physicians in Medicare’s claims data base — just 344 physicians — took in top dollar, at least $3 million apiece for a total of nearly $1.5 billion. ... About 1 in 4 of the top-paid doctors — 87 of them — practice in Florida, a state known both for high Medicare spending and widespread fraud (Alonso-Zaldivar and Tumgoren, 4/9).

The New York Times: Doctor With Big Medicare Billings Is No Stranger To Scrutiny
The doctor who bills the most for Medicare in the country is a South Florida ophthalmologist whose offices were twice raided last year by the FBI and whose generous political contributions and cozy relationship with New Jersey Senator Robert Menendez are under investigation by federal public corruption prosecutors, a New York Times analysis of Medicare data shows (Robles, 4/9).

Bloomberg: Top Medicare Doctor Paid $21 Million in 2012, Data Shows
A doctor who treats a degenerative eye disease in seniors was paid $21 million by Medicare in 2012, twice the amount received by the next ophthalmologist on a list of 880,000 medical providers released by the government. The data on the payments was given to the public for the first time today by the Centers for Medicare and Medicaid Services. The list, a detailed account of how $77 billion in federal health-care funds were spent in 2012, showed a wide range in which some top earners were paid as much as 100 times the average for their respective fields (Chen and Pearson, 4/9).

Here's the Centers for Medicare & Medicaid Services provider data site

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Health Reform

Portrait Of Newly Insured Takes Shape

Early enrollees in the health law's marketplaces were more likely to use expensive specialty drugs and less likely to use contraceptives, according to an analysis of two months of drug claims data by Express Scripts. A Rand analysis, meanwhile, argues that most of the newly insured signed up with an employer rather than buying it through the marketplaces.

Kaiser Health News: Early Drug Claims Suggest Exchange Plan Enrollees Are Sicker Than Average
Offering a first glimpse of the health care needs of Americans who bought coverage through federal and state marketplaces, an analysis of the first two months of claims data shows the new enrollees are more likely to use expensive specialty drugs to treat conditions like HIV/AIDS and hepatitis C than those with job-based insurance (Appleby, 4/9). 

The New York Times: Study Looks At Earliest Health Law Enrollees
The health of those who enrolled in new coverage is being closely watched because many observers have questioned whether the new marketplaces would attract a large share of sick people, which could lead to higher premiums and ultimately doom the new law (Thomas, 4/9).

Los Angeles Times: Employer Insurance Increasing As Obamacare Rolls Out, Study Finds
In addition to gains in insurance coverage as a direct result of the Affordable Care Act, the number of Americans covered by employer-provided insurance also has increased in the last year, according to newly released data from the Rand Corp. As previously reported by my colleague Noam N. Levey, Rand estimated that the number of Americans with health insurance rose by about 9.3 million as of mid-March. The group’s researchers note that the number probably has increased as their survey missed much of the final surge of enrollments in the online marketplaces created by the healthcare law, also known as Obamacare (Lauter, 4/8).

NBC News: Nine Million Got New Health Insurance, Study Finds
More than 9 million Americans have gotten health insurance for the first time thanks to Obamacare, according to a new report from the Rand Corporation. Most of the people who got new insurance didn’t buy it on the Obamacare exchanges but rather signed up with an employer, the survey found. Rand says that 8.2 million people have gained insurance from an employer since September — more than 7 million of them who had no health insurance before (Fox, 4/8).

The Wall Street Journal: Health-Care Law, Economy Boost Ranks Of The Insured
Research released Tuesday shows 9.3 million Americans gained insurance coverage since the Affordable Care Act took full effect, though most who bought policies through newly established exchanges weren't uninsured and employers accounted for much of the rise in the newly covered. The figures from the nonpartisan research firm Rand Corp. are the latest findings to paint an emerging picture of the law's impact. This and other studies released recently suggest the 2010 law is meeting its goal of lowering the number of Americans without insurance (Corbett Dooren, 4/8).

Politico Pro: Health Law Could Have Ripple Effect On Other Insurance
Obamacare could make auto and workers’ compensation insurance cheaper but increase prices for medical malpractice insurance, a new RAND corporation study says. More Americans will have health coverage under the Affordable Care Act through expanded Medicaid or private coverage in the new marketplaces. And because a considerable amount of health care is paid for by liability insurers, the expanded access to health coverage could affect the way claims are filed for other types of insurance. Because patients have access to health coverage, they might become less likely to obtain treatment for health problems unrelated to an accident via other liability insurance (Cunningham, 4/9).

Also, a consumer advocacy group urges changes to make enrollment easier next time -

NPR: Lessons Learned For 2015 From This Year's Obamacare Sign-Ups
President Obama was thrilled last week when he was able to announce that more than 7 million people have signed up for insurance under the Affordable Care Act. "This law is doing what it's supposed to do," the president said in the Rose Garden. "It's working." But that's not to say it couldn't work better. Among those suggesting ways to help is the consumer group Families USA. The group's got a list of 10 specific changes it says could improve outreach and make the overall process easier for people to navigate (Rovner, 4/9).

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Va. Senate Sends Budget With Medicaid Expansion To House

A key Republican leader says, however, that the House will not take up that measure. In Georgia, protesters resume demands for Medicaid expansion, and Sen. Mary Landrieu encourages lawmakers in Louisiana to move forward on the effort there.

The Associated Press: Va. Senate Passes Budget With Expanded Medicaid
The Virginia Senate approved its version of a roughly $96 billion two-year budget Tuesday as Republicans and Democrats pointed fingers over who is responsible for a potential state government shutdown. Two weeks after the start of a special session devoted to passing a state budget, the Democratically controlled Senate approved a spending plan that includes accepting federal Medicaid funds to provide new health insurance to as many as 400,000 low-income residents (4/8).

The Richmond Times-Dispatch: Senate Passes Budget With Private Health Care Option
The Virginia Senate has approved its version of the state budget with a plan for extending health coverage to hundreds of thousands of uninsured Virginians, but the spending plan is not likely to go anywhere in the House of Delegates. The 22-15 vote on Tuesday sends the Senate budget to the House and substitutes the Marketplace Virginia plan for the two-year Medicaid expansion pilot Gov. Terry McAuliffe proposed after the General Assembly adjourned without a budget on March 8. However, House Appropriations Chairman S. Chris Jones, R-Suffolk, made clear that the Senate budget will not emerge from his committee because the House budget remains the traditional vehicle for negotiating a state spending plan (Martz and Nolan, 4/8).

The Associated Press: Protestors Demand Expansion Of Georgia Medicaid
Dozens of demonstrators gathered outside Gov. Nathan Deal’s mansion to demand that Georgia expand its Medicaid program. The protesters were part of the Moral Monday group, which has held demonstrations in several states to protest laws they consider attacks on the poor and other marginalized groups (4/8).

The Associated Press: Landrieu Asks Lawmakers To Back Medicaid Expansion
While she was visiting Baton Rouge, U.S. Sen. Mary Landrieu said she was meeting with state lawmakers to encourage them to support the expansion of Louisiana's Medicaid program. Several bills proposed in the current legislative session would allow as many as 252,000 uninsured Louisiana residents to get free, government-funded health insurance through the Medicaid expansion allowed under President Barack Obama's health care law (4/8).

In states that have moved forward with expansion, some providers are struggling to stay ahead of the patient load.

Kaiser Health News: Oregon Medicaid Plan Sees High Demand
Millions of Americans who didn't have health insurance last year now do, as a result of the Affordable Care Act. In Lane County, Oregon, Trillium Community Health Plan is struggling to deal with a huge influx of new patients. CEO Terry Coplin says they expected 26,000 people to sign up in the first few years. Instead, about that many signed up in the first few months (Foden-Vencil, 4/8).

The California Health Report: The Waiting Room: L.A. County’s Medi-Cal Backlog
As the deluge of applications for Medi-Cal through continues to flood into Covered California, local health advocacy groups and providers throughout Los Angeles County say the sizable enrollment backlog is delaying health care services for needy residents. In L.A. County, 175,000 applications for the Medi-Cal program, which was expanded under the Affordable Care Act, were still being processed as of mid-March, and some were filed as far back as October, according to Katie Murphy of Neighborhood Legal Services of Los Angeles County (NLSLA). In California, 700,000 people are still awaiting enrollment in Medi-Cal, according to the state’s Department of Health Care Services (Portner, 4/9).

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Maryland A.G. Urges Probe of State Health Exchange

Douglas Gansler, also a Democratic candidate for governor, called on Gov. Martin O'Malley to launch an independent probe of problems and management issues that related to the state's online insurance marketplace.

The Washington Post: Gansler Asks O’Malley For Independent Probe Of Maryland Health Exchange, Gets Rebuffed
Maryland gubernatorial hopeful Douglas F. Gansler on Tuesday called on Gov. Martin O’Malley (D) to appoint a special counsel to investigate problems with the state’s online health insurance exchange, in his latest attempt to call attention to its shortcomings (Wagner, 4/8).

The Baltimore Sun: Gansler Calls for Special Probe Of Health Exchange
Attorney General Douglas F. Gansler stepped up his barrage of attack's on the O'Malley administration handling of the development of the state's health insurance exchange, calling for the appointment of a special counsel to investigate the web site's failed launch. Gansler, who is running for the Democratic nomination for governor against Lt. Gov. Anthony G. Brown, called for that investigator to be given subpoena powers to examine what the attorney general called "mismanagement, malfeasance and waste" in the establishment of the failed exchange. He called for the investigator to be given 60 days to compile a report -- a schedule that could lead to its completion just before the June 24 primary if the probe started almost immediately (Dresser, 4/8).

Meanwhile, news from Washington state about what people should do if they missed the deadline --

The Seattle Times: Missed Health-insurance Signup Deadline? Here’s What To Do
It’s “follow the rules” time for folks who missed the deadline to sign up for a private health plan through Washington’s Healthplanfinder but who still want insurance. If you couldn’t finish -- or even start -- an application, you’ll need to get a special dispensation from the Washington Health Benefit Exchange to move ahead. So keep reading, and we’ll tell you how to be granted the dispensation, aka ”special enrollment period.” Your insurance -- if you are approved, follow all the steps, select a plan and pay -- should begin May 1 (Ostrom, 4/8).

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Capitol Hill Watch

Democrats And GOP Lock Horns Over Paul Ryan's Budget

Democrats and Republicans clashed Tuesday over the proposals in Paul Ryan's budget which includes $5 trillion in cuts over the next decade to several programs, including Medicaid. It also would repeal the health law.

The Washington Post: Democrats, GOP Clash As Debate Opens On Ryan Budget Plan
Ryan aims to reduce the top individual income-tax bracket to 25 percent and keep military spending on its current trajectory. About $3 trillion of his savings would come from revamping health care, first by repealing the ACA — but leaving intact taxes and savings from the law — and by altering Medicare into a program in which the elderly would receive premium supports from the federal government but buy insurance on their own (Kane and Yoder, 4/8).

The Associated Press: GOP Lawmakers Balk When Spending Cuts Turn Real
When House Republicans pass Rep. Paul Ryan’s budget for a fourth year in a row this week, they’ll go on record again in favor of big spending cuts across a wide swath of programs, including Medicaid, food and farm aid and eliminating subsidies for Amtrak and airline flights to small cities. But a budget is only a non-binding framework. It can promise the sky, but to actually fulfill its pledges requires follow-up legislation (4/8).

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Health Law: Attack Ad Fuel For Midterms

The Wall Street Journal reports on three ads that focus on health care with roots in the 2008 presidential election, while the Koch brothers have launched health law ads against Democratic senators they deem vulnerable. And many health law critics have accepted the law's subsidies.

The Wall Street Journal’s Washington Wire: Top Ten Campaign Ads: The More Things Change ...
In fact, three of the top five ads focus on health care and date from the 2008 presidential campaign, providing a bracing reminder of how little the last six years of debate about health care have done to resolve differences between the parties. The No.1 ad -- an attack on GOP presidential nominee John McCain’s health-care proposals by then-Sen. Barack Obama -- features arguments that sound very much like today’s slings and arrows (Hook, 4/9).

The Wall Street Journal’s Washington Wire: Koch Brothers Launch Health Law Ads Against Democrats Udall, Braley
The campaign arm of the Koch-backed nonprofit Freedom Partners launched on Tuesday a nearly $1.1 million ad campaign against two Democratic Senate candidates: Rep. Bruce Braley of Iowa and Sen. Mark Udall of Colorado. The campaign, which will be broadcast in both states for the next three weeks, targets the candidates’ support of the Affordable Care Act (Ballhaus, 4/8).

The Associated Press: Many ‘Obamacare’ Critics Accepted Its Subsidies
Several big corporations have reaped millions of dollars from “Obamacare” even as they support GOP candidates who vow to repeal the law. This condemn-while-benefiting strategy angers Democrats, who see some of their top congressional candidates struggling against waves of anti-Obamacare ads partly funded by these companies (4/8).

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Health Care Marketplace

CVS Caremark To Pay $20 Million To Settle SEC Charges

The Securities and Exchange Commission had alleged that CVS did not tell investors ahead of a 2009 bond offering that it had lost "significant" Medicare Part D revenue. Elsewhere, two drugmakers are ordered to pay $9 billion in damages for failing to disclose the cancer risks for Actos, a diabetes drug.

Los Angeles Times: CVS Caremark To Pay $20 Million To Settle SEC Charges
CVS Caremark Corp., the country's second-largest pharmacy chain, has agreed to pay $20 million to settle charges that it misled investors and used improper accounting techniques to artificially boost its financial earnings, the U.S. Securities and Exchange Commission announced Tuesday. … According to the SEC, CVS had conducted a $1.5-billion bond offering in 2009 but did not tell investors that it had recently lost "significant" Medicare Part D and contract revenues in its pharmacy benefits business segment (Lopez, 4/8).

The Wall Street Journal: CVS To Pay $20 Million To Settle SEC Allegations
CVS allegedly further misled investors on an earnings call that same day by maintaining there was a slight improvement in its "retention rate," the SEC claimed, saying the drugstore chain omitted changes to how it calculated the rate. The SEC also claimed the company made improper accounting adjustments that overstated the financial results for its retail pharmacy business. Those adjustments were tied to CVS's treatment for its acquisition of another drug-store chain, Longs Drugs Stores (Kell, 4/8).

Los Angeles Times: Takeda And Eli Lilly Ordered To Pay $9 Billion Over Actos Drug
A federal jury awarded a combined $9 billion in punitive damages against Takeda Pharmaceuticals U.S.A. Inc. and Eli Lilly & Co. after it found that the drug makers did not disclose cancer risks for their diabetes medicine, Actos (Li, 4/8).

And demand for robotic surgery softens --

The Wall Street Journal: Intuitive Surgical Earnings Fall As Robot Demand Softens
Intuitive Surgical, which is expected to report earnings April 22, has struggled over the past year as doctors took a more conservative approach toward performing some minimally invasive procedures. Concerns about the safety and cost-effectiveness of the company's robots have also hurt sales, analysts said (Walker and Stynes, 4/8).

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State Watch

State Highlights: R.I. Disabled Settlement's Far Reach; Ore. Long-Term Care Rates

A selection of health policy stories from Oregon, Massachusetts, California, Minnesota, Kansas, Arizona and Florida.

The Oregonian: Thousands Of Disabled Oregon Workers Could Benefit From U.S. Settlement In Rhode Island
The government's landmark Americans with Disabilities Act settlement with Rhode Island on Tuesday is expected to move people with profound disabilities out of low-paying jobs in sheltered workshops into the general workforce, a move federal lawyers are calling a blueprint for the nation. Senior lawyers in the Justice Department say the settlement will serve as a model for Oregon and other states abundant with workshops and activity programs for disabled adults that keep them segregated from the greater world of commerce. The government joined a class-action lawsuit a year ago that accuses Oregon of not doing enough to move people with developmental and intellectual disabilities into mainstream jobs. Oregon is the only state in the nation confronted by such litigation (Denson, 4/8).

The Oregonian: Oregon Long-Term Care Insurance Rates Skyrocket, Part Of A National Trend
Carriers’ rates for long-term care insurance in Oregon have shot up an average of 26 percent in recent months, suggesting people might want to consider their options, officials say. The Oregon Insurance Division has released a compilation of recent state decisions affecting nearly 30,000 people who bought the long term policies. The policies are intended to ensure proper care later in life as abilities decline and independent living becomes difficult (Budnick, 4/8).

The Boston Globe: Blue Cross Cuts Back On Painkiller Prescriptions
The state’s largest health insurer has cut prescriptions of narcotic painkillers by an estimated 6.6 million pills in 18 months as part of a campaign to curb abuse of the powerful drugs, according to executives from Blue Cross Blue Shield of Massachusetts. That estimated reduction appears to bolster the argument made by many health workers that these narcotics have been overprescribed and too easy to obtain. The drugs are cited as a gateway to heroin, which has plagued the state recently amid a startling succession of overdoses and deaths (MacQuarrie, 4/8).

NPR: Calif. Medical Center Offers Cure To Indigenous Language Barrier
Immigrants from Mexico don't always speak Spanish. Instead they speak indigenous languages. That's created huge communications problems but a hospital in Salinas has found a solution (Almanzan, 4/9).

Minnesota Public Radio: Lawmakers OK Emergency Use Of Heroin Overdose Shot; Good Samaritans Protected
First responders rushing to aid a drug overdose victim would have the power to use the antidote Narcan under a bill passed unanimously Tuesday by the Minnesota Senate. The legislation would also grant immunity to "Good Samaritans" who call for medical help when someone has overdosed. Supporters of the two-part measure refer to it as "Steve's Law." It's named after Steve Rummler of Edina, who died of a heroin overdose three years ago. A companion measure in the House is awaiting final action (Pugmire, 4/8).

The Associated Press: Kansas Lawmakers OK Tougher Medicaid Fraud Law
Kansas Attorney General Derek Schmidt is praising legislators for unanimously approving a measure to increase penalties for defrauding the state's Medicaid program. Schmidt said Monday the bill approved over the weekend also would make it easier to fine people who file false Medicaid claims. The Medicaid program is funded jointly by states and the federal government and provides health coverage for the needy and disabled (4/8).

The Associated Press: Court Extends Stay On New Arizona Abortion Rules
A federal appeals court panel on Tuesday issued an injunction blocking new Arizona abortion restrictions that are considered the most stringent in the nation, saying women likely would suffer irreparable harm if the rules are allowed to take effect. The 9th U.S. Circuit Court of Appeals issued a stay blocking the Arizona rules last week while it considered an appeal from Planned Parenthood of Arizona and abortion rights groups. The court extended the stay into a full injunction on Tuesday (Galvan and Christie, 4/8).

The Associated Press: Fla Lawmakers Look To Expand, Regulate Telehealth 
The calls may come in the middle of the night and from hospitals more than an hour away. Someone is having a stroke and is en route an emergency room in the Florida Keys, but there aren't any neurologists on call. … A Senate bill would increase the use of telemedicine in Florida and establish requirements for health providers who treat patients remotely. A companion bill is also making its way through the House, but that bill doesn't require doctors to have a Florida license -- only that they be licensed in their home state and registered in Florida (Kennedy, 4/8).

Kansas Health Institute: Prominent Kansas Insurance Agent Sanctioned For Misrepresenting ACA
In a move that may be unprecedented simply because of the subject matter involved, the Kansas Insurance Department has fined a prominent insurance agent $1,000 for publishing false and misleading information about the Affordable Care Act. Scott Day of Day Solutions LLC, which is based in Ozawkie, signed off on a "consent agreement" with the department that, in addition to the dollar penalties, called for him to publish a correction to the misleading statements he had published in Metro Voices, a publication distributed free in 500 northeast Kansas locations (Shields, 4/8).

Kansas Health Institute: County Officials Say Health Rankings Can Be Powerful Tool
Bugging people to exercise may not be the best way to encourage healthy behaviors among local residents, according to panelists who came here to discuss recently released health rankings for Kansas counties. More subtle approaches have worked in Allen, Sedgwick and Wyandotte counties, people from those communities said Monday at a forum held at Sporting Park, the home of Kansas City’s Major League Soccer team. Wyandotte County has shifted the emphasis of the Parks and Recreation Department from play to wellness, said Mark Holland, mayor of the Unified Government of Wyandotte County and Kansas City, Kan. (Sherry, 4/8).

Health News Florida: Doctors To Get 1-Time Fee Cut
Florida’s 61,000 medical doctors will get a 31-percent cut on their license renewal fee under a proposal adopted by the Florida Board of Medicine. The renewal fee for MDs who have active licenses will be reduced from the usual $360 to $250 during the calendar years 2015-16, under the proposal. MDs have to renew their license every other year (Gentry, 4/8).

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Editorials and Opinions

Viewpoints: Sebelius' Questionable Arithmetic; Rand Finds 9.3 Million Gained Insurance; New Numbers On Your Doctor

The New York Times' Economix: The Power Of Sebelius
In setting the 2015 calendar parameters for health plans and employers, Kathleen Sebelius, the secretary of health and human services, quietly did some creative but questionable arithmetic that forced taxpayers to give still more help to businesses and people who buy health insurance (Casey B. Mulligan, 4/9). 

Los Angeles Times: Rand’s Obamacare Stats: 9.3 Million New Insureds, And Counting
The long-awaited Rand Corp. study of Obamacare's effect on health insurance coverage was released Tuesday and confirmed the numbers that had been telegraphed for more than a week: At least 9.3 million more Americans have health insurance now than in September 2013, virtually all of them as a result of the law. That's a net figure, accommodating all those who lost their individual health insurance because of cancellations. The Rand study confirms other surveys that placed the number of people who lost their old insurance and did not or could not replace it -- the focus of an enormous volume of anti-Obamacare rhetoric -- at less than 1 million. The Rand experts call this a "very small" number, less than 1% of the U.S. population age 18 to 64 (Michael Hiltzik, 4/8).

WBUR: Obama Seeks To Turn The Political Tide On Health Care
Mission accomplished … or mission impossible? This question may be on the minds of skittish congressional Democrats up for re-election after the White House doubled down on making the Affordable Care Act the centerpiece of its mid-term strategy during its press-conference-cum-pep-rally last week in the Rose Garden. A schism may have opened between the White House and some of those incumbent Democrats when the cheering subsided because they know the ACA remains profoundly unpopular and is unlikely to recover by November (John Sivolella, 4/9).

The Sacramento Bee: What Needs To Be Fixed With Health Care Reform
It seems that all we hear about health reform these days is hatred or hype. As usual, the truth is more complicated. We've laid a solid foundation for a much-needed national reform, but the challenges to date run deeper than the issues with the website. Successfully creating a functional, universal health care system for our country will require being entirely clear-eyed about what has worked and what needs to be fixed with the Affordable Care Act (Micah Weinberg, 4/9).

The Richmond Times-Dispatch: Little-Known Panel A Big Obstacle In Health Fight
MIRC — it rhymes with "jerk" — is the acronym for the Medicaid Innovation and Reform Commission. It is a little-known [state] legislative panel that may be the biggest obstacle to a health care fix financed over four years with nearly $7 billion from Washington. The commission, a creation of the Republican-dominated House of Delegates, is intended as a trap from which anything resembling Obamacare and bankrolled with Medicaid dollars has no hope of escape. It's worked like a charm for about a year (Jeff E. Schapiro, 4/9).

The Dallas Morning News: Why Business Leaders Should Reject Medicaid Expansion
The argument goes like this: Texas has the highest uninsured rate in the nation. Medicaid expansion will lower the number of uninsured and alleviate the taxes and high insurance premiums Texans pay to cover the cost of treating the uninsured in hospital emergency rooms (what's called uncompensated care). In addition, the influx of billions in federal Medicaid dollars will be an economic windfall for Texas, creating thousands of taxpayer-funded jobs. The latest group to buy into this rhetoric is the Dallas Citizens Council, an organization that has called on Texas' business leaders to support Medicaid expansion under Obamacare. But the group's reasons for supporting expansion don't stand up to close scrutiny (John Davidson, 4/8).

On other health care issues -

Los Angeles Times: Coming Soon: More Ways To Get To Know Your Doctor
This week, the federal government is planning to release a massive database capable of providing patients with much more information about their doctors. The Centers for Medicare and Medicaid Services, the government agency that runs Medicare, plans to post on its website detailed information about how many visits and procedures individual health professionals billed the program for in 2012, and how much they were paid. ... It's important to remember, though, that data can sometimes be misleading. There's a big difference between, say, a hospice doctor giving almost every patient a narcotic and a podiatrist doing the same thing. ... These new tools all have limits. They won't tell you whether one doctor's patients are sicker than another's and need different therapies. They won't tell you about a doctor's bedside manner or willingness to return a phone call at 3 a.m. They won't tell you about a doctor's surgical skill (Charles Ornstein, 4/8). 

Bloomberg: Health Care By the Numbers, Finally
[Consumers], news organizations, insurance companies and others will have access to data on how much doctors charge for procedures, how often they perform them and how their practices stack up against those of their peers. ... Providers who overcharge, or who bill Medicare for more procedures than they can reasonably accomplish, will face the prying eyes not only of patients, but also of competitors with intimate knowledge of the field. The government projects that the program will lead to higher quality and lower costs in addition to less fraud. Medicare money is public money, and it must be vigorously safeguarded. For too long, criminals have been able to find both opportunity and anonymity within the system's labyrinth. Transparency, much of it driven by the Affordable Care Act, is now changing the health-care industry in profound ways. It will transform crime fighting, too (4/8).

Bloomberg: Your Diet Coke Won't Kill You 
Why is total consumption declining, and is drinking diet soda harmful to health? Although the data do suggest a change in attitudes toward diet sodas, one potentially underappreciated factor in the consumption data is the role of demographics. Consumption of diet soda is twice as high among non-Hispanic whites as among Hispanics .... Demographic shifts don't entirely explain the shift in soda drinking, however. Concern about health effects appears to be rising, too -- which is not surprising, given how much media attention has been trained on reports of harm (Peter Orszag, 4/8).

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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.