First Edition: February 10, 2014

Today's headlines include stories about the health law's coverage gap.  

Kaiser Health News: Arkansas' Medicaid Experiment, Key To Obamacare Expansion, On Ropes
Kaiser Health News staff writer Phil Galewitz reports: “The Arkansas’ experiment, known as the “private option” marks the first large-scale attempt to enroll Medicaid recipients into the same private health insurance plans that any consumer might buy in the health law’s online insurance marketplace. That’s different from how Medicaid typically works where enrollees must join state-operated programs or private managed care plans designed exclusively for the poor -- and which pay doctors less, sometimes a lot less. As a result, private option enrollees like Fant will have access to a larger network of doctors and hospitals than is usually available through Medicaid” (Galewitz, 2/10). Read the story and a related Q & A with Arkansas Gov. Mike Beebe.

Kaiser Health News: Some Middle-Class Families Find Price Of Subsidized Health Coverage ‘Awfully High’
Kaiser Health News staff writer Julie Appleby, working in collaboration with USA Today, reports: “The lure used to get uninsured Americans to sign up for health law coverage was the promise of generous premium subsidies. But the promise comes with a catch for almost 3 million people earning between three and four times the federal poverty rate: They may have to pay up to 9.5 percent of their income toward that premium before the subsidy kicks in” (Appleby, 2/10). Read the story.

Kaiser Health News: Family Planning Clinics In Calif. Squeezed By Health Law
Reporting for Kaiser Health news, in partnership with NPR, KQED’s April Dembosky writes: “An unexpected quirk in the Affordable Care Act has left birth control clinics struggling to balance their budgets in the most unlikely of places: California. Clinics that have long enjoyed state support to run as nonprofits have to rethink how to stay in business” (Dembosky, 2/10). Read the story.

Kaiser Health News also tracked weekend health policy headlines, including the discussions during Sunday talk shows of the Congressional Budget Office report on the health law and jobs (2/9) as well as reports that AOL reversed its 401(K) policy after fallout over Obamacare remarks (2/9). 

The Wall Street Journal: Millions Trapped In Health-Law Coverage Gap
The 2010 health law was meant to cover people in Mr. Maiden's income bracket by expanding Medicaid to workers earning up to the federal poverty line—about $11,670 for a single person; more for families. People earning as much as four times the poverty line—$46,680 for a single person—can receive federal subsidies. But the Supreme Court in 2012 struck down the law's requirement that states expand their Medicaid coverage. Republican elected officials in 24 states, including Alabama, declined the expansion, triggering a coverage gap. Officials said an expansion would add burdensome costs and, in some cases, leave more people dependent on government (Weaver, 2/9). 

The Wall Street Journal: Hospitals Take Financial Hit In Failed Expansion of Medicaid
State decisions to decline federal offers to expand Medicaid costs hospitals, in addition to lower-wage workers. Hospitals backed the health-care law because it promised to create new, paying customers. Instead, the failure to expand Medicaid coverage by some states not only adds fewer insured patients, it also eliminates the payments hospitals had long received to cover the cost of uninsured people they treat free (Weaver, 2/9).

Politico: ACA Enrollment: Mayors Hold The Key
The road to Obamacare enrollment runs through City Hall. The Obama administration is relying on friendly mayors to coordinate enrollment efforts, circumvent tricky state politics and put a local stamp on the vast federal law. Health and Human Services Secretary Kathleen Sebelius has stood alongside mayors in at least seven cities in the past three weeks as she has taken the sign-up message across the country and rubbed elbows with dozens of other mayors at a recent conference in Washington (Cheney, 2/9). 

The Washington Post: Accenture, Hired To Fix HealthCare.gov, Has Troubled Past
Accenture, the contractor urgently tapped to help fix the federal health-insurance Web site, is a favorite of corporate America but has a record that includes troubled projects and allegations of ethical lapses, a review of the consulting giant’s history shows. ... In North Carolina, glitches in an Accenture-configured computer system contributed to massive backlogs for food-stamp recipients, leading the Obama administration last month to threaten to withdraw the state’s food-stamp funding. Federal officials have also on occasion criticized the company’s integrity. The U.S. Postal Service Inspector General’s Office wrote in June that Accenture had “demonstrated an absence of business ethics,” and said that the agency should consider terminating the firm’s more than $200 million in contracts. ... The company denied wrongdoing in the case (Markon and Crites, 2/9).

Los Angeles Times: Corporate Backing Is Helping Obamacare Go Mainstream
Although many companies are wary of associating with the health law while it remains a political lightning rod, the Affordable Care Act is increasingly entering the mainstream as major corporations, sports teams and others integrate it into their businesses. The development — little-noticed amid the political skirmishing in Washington — may not erase widespread skepticism about the law, which has deepened in recent months, polls show. But as the law becomes embedded in American life, the Republican drive to dismantle Obamacare will almost certainly become more complicated (Levey, 2/8).

Politico: Both Parties Keep Cherry-Picking CBO Report 
As the dust is finally settling on the CBO report released Tuesday, the two parties are also finally settling on their talking points going forward - and both still maintain vastly different portraits of the same document, depictions non-partisan analysts say are misleading, at best. ... Republicans are quietly accepting that the report was largely about people working less and making that choice on their own, not literally about “2 million lost jobs.” But ... Republicans and conservative critics are already shifting to a more general argument: Even if it is just people working less, there’s no way that can be good for the economy, especially if it’s because they lose Obamacare subsidies if their income goes up. The White House and Democrats say they’re happy to argue that point — because in their view, it’s much better for Americans, and the economy, if they can switch jobs or start businesses without having to worry about losing their health insurance (Nather, 2/9).

The Washington Post: They Quit Their Jobs, Thanks To Health-Care Law
Count Polly Lower among those who quit their jobs because of the health-care law. It happened in September, when her boss abruptly changed her job description. She went from doing payroll, which she liked, to working on her boss’s schedule, which she loathed. At another time, she might have had to grit her teeth and accept the new position because she needed the health benefits. But with the health-care law soon to take effect, she simply resigned — and hasn’t looked back. ... The equivalent of about 2.5 million Americans will quit their jobs, cut their hours or stop looking for work during the next decade because of new benefits available under the health-care law, according to recent Congressional Budget Office estimates that have renewed debate over the program’s effect on the economy (Somashekhar,  2/8).

The Washington Post’s The Fact Checker: Congressional Budget Office Data Taken Out Of Context As ‘Job’ Losses Tied To Health-Care Law
The Congressional Budget Office report on the impact of the Affordable Care Act was released on Tuesday, and already we have the first attack ads. The Fact Checker devoted one column to explaining what the CBO’s report actually meant. But we have long learned that all the fact checks in the world won’t stop politicians if they think an attack line moves voters. So how do these first attacks fare? (Kessler, 2/8). 

Reuters: CMS May Require Obamacare Insurers To Accept Ryan White Payments
The U.S. Centers for Medicare and Medicaid Services (CMS), in an effort to keep insurers from denying coverage to people with HIV/AIDS, may strengthen its position on health plans accepting third-party payments, such as those under the 1990 Ryan White Act. Hundreds of people with HIV/AIDS in Louisiana trying to obtain coverage under President Barack Obama's healthcare reform are in danger of being thrown out of the insurance plan they selected in a dispute over federal subsidies and interpretation of rules about preventing Obamacare fraud, Reuters reported on Saturday. Blue Cross and Blue Shield of Louisiana, the state's largest health insurer, is rejecting checks from a federal program designed to help these patients pay for AIDS drugs and insurance premiums (Begley and Steenhuysen, 2/8).

The Associated Press/Washington Post: Vulnerable Democrats Try Straddle On Health Law
Hit with a multimillion-dollar barrage of televised attacks, Democrats in tough re-election races want credit for trying to fix the problematic parts of the health care law at the same time they claim bragging rights for its popular provisions and allege Republicans will reverse the crackdown on insurance company abuses. It’s a tricky, high-stakes political straddle by lawmakers who voted to create the law, which Republicans intend to place at the center of their campaign to win control of the Senate and hold their House majority (2/8). 

The Washington Post: With The Clock Ticking, Republicans See A Solution To Raising Debt Limit, But Not A Fight
A handful of bargaining ideas have emerged, with a proposal to restore recently cut military benefits in exchange for a one-year extension as a leading option. Other ideas, such as tying a debt-limit extension to the “doc fix,” which would alter the way doctors are reimbursed for Medicare treatments, are in the mix. One idea that gained traction over the weekend would combine the military and Medicare issues with the debt-ceiling extension, along with offsetting cuts that would prolong portions of the automatic spending decreases known as sequestration and changes to pension programs (Kane and Costa, 2/9).

The Washington Post’s The Fact Checker: Durbin’s Claim That 10 Million Now Have Health Insurance Because Of Obamacare
Durbin appears to be combining two figures released by the administration: more 3 million signing up for insurance through the federal HealthCare.gov and state exchanges and 6.3 million deemed eligible for Medicaid. Both figures are generally October through December, and so obviously have increased since then. But there are two big problems with both numbers (Kessler, 2/10). 

The Washington Post: The Koch Brothers' Group Is Getting Involved In Louisiana’s Obamacare Fight 
A major opponent of Obamacare is doubling down in Louisiana ahead of the start of that state’s 2014 legislative session. The state chapter of Americans for Prosperity — the national tea party group founded by brothers Charles and David Koch — launched on Jan. 2 and is pressing each of Louisiana’s 144 lawmakers to pledge opposition to expanding Medicaid under the law. ... The chapter is targeting federal lawmakers in its anti-expansion push, too. The group launched this year with a $600,000 ad buy against Sen. Mary Landrieu (D) over her support for Obamacare (Chokshi, 2/8).

The Associated Press: Suit Challenging Ariz. Gov's Medicaid Plan Tossed
A lawsuit challenging Arizona Gov. Jan Brewer's Medicaid expansion plan that was filed by fellow Republicans in the state Legislature was dismissed in a ruling released Saturday, handing Brewer a major victory in her battle against conservative members of her own party. Maricopa County Superior Court Judge Katherine Cooper agreed with Brewer that the lawmakers challenging the law don't have the right to sue, ... The suit was filed by the Goldwater Institute on behalf of 36 Republican legislators and several citizens, and Goldwater issued a statement saying it planned to appeal (Christie, 2/8).

The Associated Press: Republicans Debate Mini-Bailouts For Hospitals
Republican governors scored easy political points by rejecting President Barack Obama’s plan to enroll more poor people in government health insurance. Now Republican leaders in Georgia and Mississippi may be bailing out hospitals that will lose funding they would have gotten from Obama’s health care law. South Carolina’s leaders increased payments to some hospitals in a push to improve rural health, though the extra money likely placated hospital officials who might otherwise have pressured Republicans to adopt the Democratic plan (Henry and Cassidy, 2/9).

The Associated Press/Wall Street Journal: Budget Model Uncertain For State Health Exchanges
The 14 states running their own health insurance marketplaces had all their startup costs footed by the federal government, but they're supposed to pay for themselves starting next year under the federal health care reform law. In several states, it's not clear whether it will work out that way. Projected enrollments are lower than expected, meaning the insurance surcharges designed to sustain the exchanges might not generate enough revenue in the years ahead without significant changes in the financing model (2/8).

The Associated Press/Washington Post: Feds Say They Fixed Medicaid Problem For Children
A wrinkle in the HealthCare.gov website that temporarily left some children without insurance coverage has been fixed, federal officials said Friday. Children who have been denied Medicaid coverage can now be added to a subsidized plan, the Centers for Medicare and Medicaid Services said in a letter to a New Hampshire congresswoman (2/7).

The Associated Press/Washington Post: No Signs Of Compromise ON Va. Medicaid Expansion
Gov. Terry McAuliffe has plenty of allies in his efforts to expand Medicaid eligibility in Virginia, including the state’s hospitals, insurance companies, several business organizations, liberal advocacy groups, and even some Republican state senators (2/9).

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This is part of Kaiser Health News' Daily Report - a summary of health policy coverage from major news organizations. The full summary of the day's news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.