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Longer Looks: New Doubts About Shaken Baby Syndrome; Arresting The Mentally Ill; Self-Help Therapy

Kaiser Health News - Thu, 04/03/2014 - 9:43am

Every week, KHN reporter Marissa Evans selects interesting reading from around the Web.

Seattle Met: The Trouble With Shaken Baby Syndrome
A number of reexamined cases in recent years—aided by new technology and debate among medical experts—have put proponents of the (Shaken Baby Syndrome) hypothesis on the defensive. Ernie Lopez, who was serving a 60-year-sentence for shaking an infant in his care to death, is now free, thanks in part to the work of retired Seattle lawyer Heather Kirkwood. So is Audrey Edmunds, a woman charged with the murder of a child in her care in the 1990s.  Yet even if they're ultimately absolved of any wrongdoing, those suspected of SBS are left to pick through the debris of their former lives: loss of employment, financial ruin, the stigma of having been labeled a child abuser.  Over the course of the past year I have contacted Washingtonians who've either been acquitted of SBS or whose cases showed sufficient reason for the possibility of exoneration. And in nearly every instance, they either refused to speak to me or asked that any identifying biographical details be left out of my account (James Ross Gardner, 4/1).

The New York Times: Police Confront Rising Number Of Mentally Ill Suspects
In towns and cities across the United States, police officers find themselves playing dual roles as law enforcers and psychiatric social workers. County jails and state prisons have become de facto mental institutions; in New York, for instance, a surge of stabbings, beatings and other violence at Rikers Island has been attributed in part to an influx of mentally ill inmates, who respond erratically to discipline and are vulnerable targets for other prisoners. "Frequent fliers," as mentally ill inmates who have repeated arrests are known in law enforcement circles, cycle from jail cells to halfway houses to the streets and back. The problem has gotten worse in recent years, according to mental health and criminal justice experts, as state and local governments have cut back on mental health services for financial reasons (Fernanda Santos and Erica Goode, 4/1). 

Salon: Report: Doctors At Oklahoma Hospital Banned From Prescribing Birth Control
Doctors affiliated with a small Catholic hospital in Bartlesville, Okla., are no longer allowed to prescribe contraception for the purposes of birth control, according to a report from the Bartlesville Examiner-Enterprise. According to the report, a meeting was held last week to inform doctors of the new directive barring them from prescribing contraceptives as birth control; according to the Examiner-Enterprise, doctors are allowed to prescribe contraceptives for non-birth control purposes, such as cramps, menstrual pain or endometriosis. ... A representative for St. John Health Systems, the Catholic health conglomerate that owns Jane Phillips Medical Center, said that the hospital's policy on contraception is "consistent with all Catholic health care organizations," but that physicians are able to prescribe medicine as they see fit (Katie McDonough, 4/1).

WBUR: The Woman Who Couldn't Stop Buying Self-Help Books
At first, I couldn’t understand why this new psychotherapy client had settled on my couch. Sure, Kaye (not her real name) was unhappy with her weight, and yet, she enjoyed an enviably healthy diet. With the aid of self-help books, she had not only taught herself to cook delicious, nutritious dishes, she'd also learned to meditate and eat mindfully. This unusually self-motivated working mother of two not only read each book from cover to cover, she practiced what the most helpful authors preached. As time went on, I came to understand that as much as self-help books helped Kaye eat more healthfully, they were effectively hindering her happiness. You see, she used self-help books the same way she used food – to stuff her feelings (Jean Fain, 3/28).

The Atlantic: Making Profits And Differences At Hospitals
Fifty years ago, healthcare was not so tightly linked to money. It has become so money-focused largely because, over the same period, healthcare spending increased from 5 percent to 18 percent of GDP, greater than any other segment of the U.S. economy. In some respects, the growing focus on money is completely natural. For one thing, someone needs to pay the bills of physicians, hospitals, health insurers, and even publicly-funded health programs. Even if healthcare workers give their time and hospitals donate the supplies, equipment, and facilities, someone ultimately pays out of pocket or in uncompensated effort for the care of every patient. The question is not so much whether money should enter into the conversation, but how prominent a role should it play, and where the loyalties of the people involved ultimately lie (Richard Gunderman, 3/27).

Categories: Health Care

Political Cartoon: 'Leveling The Playing Field?'

Kaiser Health News - Thu, 04/03/2014 - 9:42am

 

Kaiser Health News provides a fresh take on health policy developments with "Leveling The Playing Field?" by Nate Beeler.

And here's today's health policy haiku:

 A TREASURE TROVE...

Sharpen your pencils
For Medicare claims data
Like Christmas for nerds.
-Anonymous

If you have a health policy haiku to share, please send it to us at http://www.kaiserhealthnews.org/ContactUs.aspx and let us know if you want to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

 

Categories: Health Care

First Edition: April 3, 2014

Kaiser Health News - Thu, 04/03/2014 - 7:55am

Today's headlines include reports on how Paul Ryan's budget is playing on Capitol Hill as well as news that the Obama administration is releasing a trove of data on physician services and payments.   

Kaiser Health News: Top Boston Hospital Begins To Tackle Readmissions Problem
Reporting for Kaiser Health News in collaboration with NPR and WBUR, Rachel Gotbaum writes: “Beth Israel Deaconess Medical Center is a highly regarded teaching hospital in Boston, but in 2012, the hospital found out it had one of the highest rates of readmissions among Medicare patients in the country. That meant federal fines of more than $1 million—and a lot of soul searching for the staff, says Dr. Julius Yang, the head of quality for the hospital. ‘Patients coming to our hospital, getting what we believed was high quality care, were coming back at an alarmingly high rate,’ says Yang” (Gotbaum, 4/3). Read the story.

Kaiser Health News: Capsules: Why Some Don’t Pay Their Obamacare Premium: It’s Not What You Think
Now on Kaiser Health News’ blog, KQED’s Lisa Aliferis reports: “A new analysis finds that many people who signed up for a Covered California health insurance exchange plan are likely to drop the coverage for a good reason: They found insurance elsewhere. Researchers at the U.C. Berkeley Labor Center released estimates Wednesday showing that about 20 percent of Covered California enrollees are expected to leave the program because they found a job that offers health insurance. Another 20 percent will see their incomes fall and become eligible for Medi-Cal, the state’s insurance program for people who are low income” (Aliferis, 4/2). Check out what else is on the blog.

The New York Times: What’s Next For Health Care
The first open enrollment period for health insurance under the Affordable Care Act has just ended, and consumers, insurers and federal officials now face many immediate chores and challenges that will help determine if the law works as intended. Many questions about the law’s potential impact on the health care system remain, and here are some preliminary answers (Pear, 4/2).

The Associated Press: Nonprofit Insurers Struggle In New Marketplaces
A smorgasbord of options and lower prices for consumers were two of the chief selling points for President Barack Obama as he promoted his overhaul of the nation’s health insurance industry, predicting Americans would see “competition in ways we haven’t seen before.” Companies were even started as a way to encourage innovation and competition, namely 23 consumer-run, co-op insurers created with the help of $2 billion in federal loans. But rather than promote competition, the co-ops and smaller nonprofits in some states have languished behind major insurers, attracting in some cases minuscule shares of the market (4/2).

The Wall Street Journal: Health Enrollment Extension To End April 15
People who started signing up for private health coverage before the March 31 enrollment deadline will have until April 15 to finish their applications, the Obama administration said Wednesday, putting an end point on an extension that had prompted questions. The cutoff point is being set for hundreds of thousands of Americans who tried to apply for coverage at the last minute and ran into long waits at enrollment centers, on a telephone hotline or on the website HealthCare.gov because of limits on the system's capacity and a string of late technical problems (Radnofsky, 4/2).

Los Angeles Times: Many More Californians May Qualify For Obamacare After Deadline
Even with 1.2 million people enrolled by Monday's deadline, California's health exchange isn't done adding to the Obamacare rolls — and it won't be for quite some time. In the months to come, it's estimated that several hundred thousand more Californians could qualify for a special enrollment period as college students graduate, families move and workers change jobs (Terhune, 4/2).

The Associated Press: Md. Panel To Get Update On Health Exchange
A legislative oversight panel on Maryland’s troubled health exchanged is holding a meeting to get an update from state officials. The Joint Oversight Committee of the Maryland Health Benefit Exchange is scheduled to meet in Annapolis on Thursday afternoon to hear details about an audit by state analysts (4/3).

The Washington Post: 7 Questions You Should Ask About Maryland’s Effort To Replace Its Troubled Health Exchange
Maryland Gov. Martin O’Malley (D) announced Tuesday that the state will replace nearly all of its troubled online health insurance exchange with technology borrowed from Connecticut, which has had one of the most successful exchanges in the country. The new system will be completed by November, officials say, in time for residents to enroll in private plans for 2015. Here are questions, and answers, about Maryland’s decision and the impact it will have on citizens seeking to benefit from the 2010 Affordable Care Act (Johnson, 4/2).

The Washington Post’s Wonkblog: Michigan And Wisconsin Highlight Divide On Medicaid Expansion
While the health care world was fixated yesterday on the end of Obamacare open enrollment, Tuesday also marked the beginning of a new Medicaid era for two neighboring states that took very different approaches to the law's expansion of coverage for low-income individuals (Millman, 4/2).

The New York Times: Health Enrollment Numbers Lift Democratic Hopes
After months of pummeling by Republicans and with a grim election season approaching, Democrats on Tuesday had a rare bright day. President Obama’s announcement that the new health care plan had enrolled 7.1 million Americans coincided with the release by Representative Paul D. Ryan of a new Republican budget that proposes changes in Medicare and deep cuts in spending (Weisman, 4/2).

Politico: Barack Obama On GOP Health Care And Economic Plans: ‘Stinkburger’ Or ‘Meanwhich’
President Barack Obama headed out on the road Wednesday still glowing from the latest Obamacare numbers and set his sights on congressional Republicans still working to obstruct his agenda. The House GOP’s new budget proposal and efforts to repeal the Affordable Care Act “should be familiar because it was their economic plan in the 2012 campaign, it was their economic plan in 2010,” he said at the University of Michigan in Ann Arbor. “It’s like that movie ‘Groundhog Day.’ Except it’s not funny” (Epstein, 4/2).

Los Angeles Times: Obama, Lampooning GOP, Calls For Hike In Minimum Wage
The edgy message opened a new phase for Obama. With the rollout of his 2010 health law nearly complete, the president is now focusing on the congressional elections and on keeping the Senate in Democratic hands, a task his advisors think depends in part on his ability to draw a sharp contrast with the GOP's economic proposals (Parsons and Memoli, 4/2).

The Washington Post: Bobby Jindal, With An Eye On 2016, Unveils Plan To Replace Obama Health-Care Law
In his 26-page plan, Jindal lays out a long critique of the health-care law and reiterates his belief that it needs to be done away with. He sets forth a bevy of ideas to replace it that have run through conservative thought for years, in some cases renaming them and in other cases suggesting new variations on old themes (Costa and Goldstein, 4/2).

The Associated Press: Jindal: GOP Needs ‘Obamacare’ Alternative
Louisiana Gov. Bobby Jindal, a potential 2016 presidential candidate, on Wednesday offered a Republican alternative to President Barack Obama’s health care overhaul, saying states should play a greater role in containing health care costs while giving consumers more flexibility in choosing insurance plans. Jindal said Obama’s health care law should be “repealed in its entirety” but said Republicans need to offer a better way to reform the health care system, wading into one of the most contentious policy issues in the upcoming midterm elections (4/2).

The Wall Street Journal: Louisiana Gov. Bobby Jindal Proposes Alternative To Affordable Care Act
Republican Gov. Bobby Jindal of Louisiana, trying to distinguish himself from other potential presidential candidates, outlined a replacement for the Affordable Care Act that he said would expand health coverage to more Americans by making insurance more affordable (Reinhard, 4/2).

Politico: Bobby Jindal Dismisses Obamacare Numbers, Unveils Own Reform Plan
Jindal’s health package is predicated on a full repeal of the health care law, however. He said the longer Obamacare enrolls people, the less interested he is in accepting its massive expansion of Medicaid – an optional program that offers states billions of dollars to cover their poorest residents. Asked what he’d tell Republican colleagues who support Medicaid expansion, Jindal said his proposal wouldn’t stand in the way of states that want to expand Medicaid on their own. He pointed out that Obamacare is offering states more money to cover able-bodied adults through the expansion than to cover disabled children, who were typically eligible for the traditional Medicaid program (Cheney, 4/2).

The Wall Street Journal: Medicare To Publish Trove Of Data On Doctors
Federal officials said they planned to release reimbursement information on April 9 or soon after that would show billing data for 880,000 health-care providers treating patients in the government-run insurance program for elderly and disabled people. It will include how many times the providers carried out a particular service or procedure, whether they carried it out in a medical facility or an office setting, the average amount they charged Medicare for it, the average amount they were paid for it, and the total number of people they treated (Radnofsky, 4/2).

The Associated Press: Medicare To Release Billing Data For 880K Doctors
Patients may soon get an unprecedented look at how their doctor compares to other physicians, after Medicare announced Wednesday it plans to publicly post billing data for more than 880,000 practitioners. Considered the mother lode of information on doctors, the Medicare claims database has been off-limits to the public for decades, blocked in the courts by physician groups. The American Medical Association has argued that its release would amount to an invasion of doctors’ privacy. Consumer groups, insurers, employers and the news media have sought the information to help them evaluate clinicians (4/2).

The Washington Post: Physician Data On Health Services, Payment To Be Released By Obama Administration
The Obama administration announced Wednesday it would for the first time release data about health-care services provided by doctors who participate in Medicare, in what officials hailed as a major step toward making the health-care system more transparent and accountable. As early as next week, the administration plans to release information about the number and type of health-care services delivered by more than 880,000 physicians in 2012, as well as how much Medicare paid them for the services. Together, those physicians collected $77 billion in payments through Medicare (Somashekhar, 4/2).

The New York Times: Medicare To Share Information On Pay For Physicians
Medicare said on Wednesday that it planned to make available to consumers and others detailed information on what it pays individual physicians as soon as next week, despite the long-term resistance by the American Medical Association and other group (Abelson, 4/2).

The Associated Press: GOP Budget Slashes Spending, Aid To Poor
A budget plan stuffed with familiar proposals to cut across a wide swath of the federal budget breezed through the House Budget Committee on Wednesday, but its sharp cuts to health care coverage for the middle class and the poor, food stamps and popular domestic programs are a nonstarter with President Barack Obama (4/2).

The Washington Post: Ryan Budget Plan In Democrats’ Crosshairs
Congressional Democrats said Wednesday that the new House Republican budget plan will play a central role in Democratic midterm election strategy. … The Ryan plan released this week closely resembles the House GOP budget requests proposed and passed in recent years. The plan would cut federal spending by $5 trillion over the next decade by effectively repealing the Affordable Care Act, making deep cuts to Medicare and cutting taxes significantly for the nation’s wealthiest earners (O’Keefe, 4/2).

The Wall Street Journal’s Washington Wire: Why Democrats Like Ryan’s Budget
The DCCC Wednesday launched a new campaign called “Battleground: Middle Class” featuring ads and other efforts to attack the GOP budget proposals to revamp Medicare, replace Medicaid with state block grants, and cut spending in domestic programs throughout the budget (Hook, 4/2).

Politico: Paul Ryan Budget Faces Bumps Amid GOP Dissent
And the simmering dispute is significant as it carries political consequences. Even the smallest group of members voting “no” can potentially put a vote in jeopardy and give a black eye to Ryan — a potential 2016 presidential contender — and Republican leadership.This is the most serious fallout from the leadership’s effort last week to pass a “doc fix” bill. In the blink of an eye last Thursday, Republican leadership used a voice vote to pass a patch of reimbursement rates for physicians who serve Medicare patients. No one had the chance to vote for or against the bill, which faced opposition from both parties (Sherman and French, 4/2).

Politico: Reality Hits Ron Wyden’s Idealism
The awkward episode came as Wyden was engaged in a quixotic effort to thwart a bill personally crafted by Reid and House Speaker John Boehner. The deal achieved exactly what Wyden didn’t want: a temporary patch in Medicare reimbursement rates that punted a long-term decision to another year. The measure passed the Senate over Wyden’s objection and President Barack Obama signed it into law on Tuesday (Raju and Haberkorn, 4/2).

The Associated Press: Insurers Aetna, WellPoint Bulk Up Executive Pay
Health insurers enjoyed a boom year in 2013, with soaring earnings and stock prices, and some of the biggest companies shelled out millions of dollars to either keep or attract their leaders. Aetna Inc. Chairman and CEO Mark T. Bertolini saw his total compensation more than double to top $30 million last year, largely due to restricted stock and options valued at $17.6 million that the nation’s third-largest insurer gave him last August. Meanwhile, WellPoint CEO Joseph R. Swedish received $1.5 million in restricted stock for joining the second-largest insurer last year and about $3.8 million to make up for pay he forfeited leaving his old job running a multistate Catholic hospital system (4/2).

The New York Times: Mental Health Groups Split On Bill To Overhaul Care
Lawmakers, patient advocates and the millions of Americans living with a psychiatric diagnosis agree that the nation’s mental health care system is broken, and on Thursday, Congress will hear testimony on the most ambitious overhaul plan in decades, a bill that has already stirred longstanding divisions in mental health circles (Carey, 4/2).

The New York Times: Abortion Providers In Texas Sue Over A Restrictive Rule That Could Close Clinics
Health clinics offering abortions in Texas filed a federal lawsuit on Wednesday to block a new state rule that could shut down more than half of the state’s remaining providers this fall, forcing women seeking an abortion in southern and western Texas to drive several hundred miles each way or go out of state (Eckholm, 4/2).

The New York Times: A Union Aims At Pittsburgh’s Biggest Employer
For decades, United States Steel was this city’s dominant employer, but now the biggest employer is the University of Pittsburgh Medical Center, with its 22 hospitals and 62,000 workers. … And just as labor unions famously clashed with Andrew Carnegie, UPMC faces its own labor showdown. The Service Employees International Union is seeking to organize more than 10,000 of UPMC’s service workers, and demanding that the hospital system be a leader, much like U.S. Steel once was, in raising wages (Greenhouse, 4/2).

The Wall Street Journal: Lyme Disease Dispute Draws In State Legislatures
Some patients with lasting symptoms attributed to Lyme disease believe long-term antibiotics can help. But advocates claim doctors who back the approach are hesitant to prescribe for fear of professional sanctions, given a long-roiling dispute over whether such treatment even works. Now, lawmakers in a growing number of states in the Northeast, where the tick-borne illness is particularly prevalent, are taking up the cause. Bills in Vermont and New York would protect doctors from punishment just for prescribing long-term antibiotics for patients who have lasting symptoms that they blame on a Lyme infection (Kamp, 4/2).

The New York Times: At Trial, Queens Doctor Is Accused Of Recklessly Prescribing Drugs
Among Dr. Li’s patients, prosecutors say, were drug addicts and street dealers who knew they could get a prescription, with few questions asked, for the right price. One patient was David S. Laffer, an addict who in June 2011 massacrd four people while stealing narcotics from a drugstore in Medford, N.Y., on Long Island. He is now serving life without parole. Dr. Li, through his lawyer, has previously denied selling drugs to Mr. Laffer (McKinley, 4/2).

Los Angeles Times: County Urges Meningitis Vaccinations For Men Who Have Sex With Men
Citing a recently identified uptick in potentially deadly meningococcal disease, the Los Angeles County Department of Public Health recommended Wednesday that men who have sex with men get a meningitis vaccination (Brown, 4/2).

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Categories: Health Care

Top Boston Hospital Begins To Tackle Readmissions Problem

Kaiser Health News - Thu, 04/03/2014 - 4:55am

Beth Israel Deaconess Medical Center is a highly regarded teaching hospital in Boston, but in 2012, the hospital found out it had one of the highest rates of readmissions among Medicare patients in the country. That meant federal fines of more than $1 million—and a lot of soul searching for the staff, says Dr. Julius Yang, the head of quality for the hospital.

“Patients coming to our hospital, getting what we believed was high quality care, were coming back at an alarmingly high rate,” says Yang.

The hospital was providing quality care to patients when they were in the hospital, but it turned out that focus was too narrow, says Yang.

Dr. Julius Yang runs a program that has helped Beth Israel Deaconess Medical Center improve its readmission rates. (Photo: James Derek Dwyer/BIDMC).

“In the hospital we provide a lot of structure, we provide a lot of staff. We provide a lot of expertise to manage every moment of their illness,” he says, “but as soon as they leave, the complexity of their situation probably explodes.”

Lila Gross, 84, is one of those complex patients, suffering from heart, lung and kidney problems. Gross frequently ended up in the hospital, and her daughter Geri Segel says the family always left with unanswered questions.

“She would check out of the hospital and there was no one who followed through,” says Segel. “We had a hundred questions and we had to wait for the next catastrophe to get her back in the hospital to find more answers.”

Now Lila Gross is one of 2,000 Medicare patients who is treated in Beth Israel Deaconess’ PACT program. The idea behind the program, which stands for Post-Acute Care Transitions, is to keep Medicare patients from bouncing in and out of the hospital. Studies show that about 30 percent of elderly patients return to the hospital within 30 days of being discharged.

With a $5 million federal grant, PACT nurses and pharmacists now track Medicare patients who are at high risk for readmission. Nurses call patients and their caregivers, communicate with a patient’s primary care provider and arrange for rehabilitation or visiting nurses. Pharmacists are also on hand to answer medication questions.

Siegel says having PACT nurse Susan Sorlien as an advocate for her mother means the family now knows when they should bring their mother into the hospital and when it can be avoided.

“Susan would keep touching base with my sister and myself to make sure that mom was taking everything and that we understood how to use everything and that mom was doing well,” says Segel. “When we had questions, Susan had an answer.”

So far Beth Israel Deaconess has reduced its readmission rate by 25 percent and its fines have also been reduced. According to Yang, who directs the PACT program, the hospital is now providing better care for its older patients. But there’s a catch, he says, because the hospital loses money for every bed it keeps empty.
“For a patient to come into the hospital, whether it’s a readmission or not, we collect revenue and yet we are being penalized for this,” he says.

The attempt to control costs under Obamacare focuses on hospitals because hospitals are expensive, says Ashish Jha, a professor at the Harvard School of Public Health. But the new readmissions policy alone is probably not enough to bring down those high hospital costs, he says.

“The problems with policies like these is that they are piecemeal, they are fragmented and they are little band aids,” says Jha. “I think we need a much more comprehensive approach to how we pay for healthcare.”

This story is part of a collaboration between Kaiser Health News and the WBUR-NPR show Here & Now.

Categories: Health Care

Politics Swirl Around The 7 Million Enrollment Figure

Kaiser Health News - Wed, 04/02/2014 - 9:30am

There's talk that this could already be affecting Republican strategy, though Democrats are "still wary" of the law. Meanwhile, Louisiana Gov. Bobby Jindal, in an effort to move into the 2016 presidential mix, will offer his ownn proposal. 

Politico: Obamacare Critics: Homina, Homina, Homina
On Tuesday, Obamacare sign-ups passed 7 million, ... the idea that the law could even come close to the original goal after such a disastrous start would have been laughable even a few weeks ago. It was also a wake-up call for Republicans and conservatives, and even the occasional liberal, who pushed the argument that the failed website challenges the idea at the heart of Obama’s agenda — that government can still solve big social problems. That’s left the critics questioning the early numbers or changing the subject (Nather, 4/2). 

The Washington Post: Bobby Jindal, With An Eye On 2016, To Unveil Plan To Replace Obama Health-Care Law
Louisiana Gov. Bobby Jindal will announce Wednesday a plan to repeal and replace President Obama’s health-care law, an effort by the Republican to insert himself into the increasingly competitive early maneuvering for his party’s presidential nomination. ... he sets forth a bevy of ideas that have run through conservative thought for years, in some cases renaming them and in other cases suggesting new variations on old themes (Costa and Goldstein, 4/2).

Politico Vulnerable Dems Still Wary Of Obamacare
After 7 million people signed up for Obamacare, an unexpectedly sunny end to a dreary enrollment process, Democrats outlined plans Tuesday to step up attacks on Republicans for wanting to repeal the health care law. But while Obama administration officials popped champagne to celebrate the enrollment figure, Democrats on the ballot this year continue to tread cautiously (Hohmann, 4/1).

Categories: Health Care

Who Enrolled In Health Law Coverage And What Do They Bring To The Risk Pool?

Kaiser Health News - Wed, 04/02/2014 - 9:29am

The final days of open enrollment were marked by a surge that helped the Obama administration clear a key milepost. But not yet known is what this population actually looks like. Were these people previously uninsured? Did young people sign up in big enough numbers? And will the insurance model actually work?   

The Wall Street Journal: 5 Questions About Obamacare’s 7 Million Enrollees
What does the 7 million mark mean for the health law? It tells us the final days of enrollment attracted a surge of consumers and that the sometimes-panicked rush by the Obama administration to fix HealthCare.gov after a disastrous launch largely paid off. What the politically crucial milestone doesn't reveal, however, is much about whether the law will work. For instance, we still don't know whether the new marketplaces will make much of a dent in the number of uninsured people, or if the business will prove sustainable for insurers (Weaver, 4/1).

The Washington Post’s The Fact Checker: Obamacare Enrollment Numbers: What We Know And What We Don’t Know
With the enrollment period ended on March 31, it's time to do the numbers. What do we actually know about Obamacare enrollment numbers — and what is missing? (Kessler, 4/2).

The New York Times: Newly Enrolled, But Not Counted By Insurance Exchange
Millions of newly insured people are hiding in plain sight. They are the people who have bought new health insurance since the start of this year but have chosen for one reason or another to bypass the state and federal exchanges that opened last year under the Affordable Care Act. While the exact number is unknown, some health care experts estimate that it may be in the millions (Thomas, 4/1).

CBS News: Did Enough "Young Invincibles" Sign Up For Obamacare?
The lines were long at last-minute enrollment events for California's health-care exchange. The Covered California website could not keep up and logged people out as they tried to sign up. California has now enrolled more than 1.2 million people, nearly 156,000 in just the past week (Tracy, 4/1).

Categories: Health Care

Fight Over Medicaid Expansion Intensifies In Virginia, Other States

Kaiser Health News - Wed, 04/02/2014 - 9:29am

The battle for the future of Medicaid in Virginia is expected to heat up, with both sides of the divide playing close attention to a proposal to expand the program through the state budget. 

The Washington Post: Hundreds Cram Into Va. Senate Hearing ON Medicaid Expansion Through State Budget
Virginia’s on-again, off-again special session got rolling again Tuesday, as hundreds of lobbyists and activists on opposite sides of the state’s Medicaid battle crammed into a Senate hearing on whether to expand the program through the state budget. The hearing was the first sign of life from the Senate since last week, when the chamber went home one day into the special budget session, leaving the House and its two-year, $96 billion spending plan hanging (Vozzella, 4/1).

The Richmond Times-Dispatch: Medicaid Expansion Battle To Heat Up The stage is set for a battle on two fronts in the General Assembly next week over expanding health insurance to hundreds of thousands of uninsured Virginians. The Senate Finance Committee will meet Monday morning to act on the state budget proposed by Gov. Terry McAuliffe last week with a two-year pilot to expand Virginia’s Medicaid program, and likely will substitute its own private insurance marketplace as an alternative. The Medicaid Innovation and Reform Commission will meet that afternoon for the first time this year to resume its effort to accelerate cost-saving changes to the state Medicaid program as a step toward possible expansion of health benefits for up to 400,000 uninsured Virginians (Martz and Nolan, 4/2).

Modern Healthcare: States Seek Contested Medicaid Alternatives, Cuts
Proposals from conservative-led states looking to expand their Medicaid coverage in alternative ways have prompted worries among healthcare providers and patient advocates that proposed changes may mean some benefits are discontinued (Dickson, 4/1).

Categories: Health Care

Counting Will Continue After 'Official' Deadline

Kaiser Health News - Wed, 04/02/2014 - 9:28am

The counting goes on as federal and state exchange officials tally consumers who are taking advantage of various extensions to sign up late. Efforts to determine whether the overhaul is working also continue.

Politico: Enrollment Caveats Will Keep ACA Counting
For Obamacare enrollment, it’s not over even when it’s over.
With special enrollment, extra special enrollment, slightly extended state enrollment and very extended state enrollment, the sign-up tally will keep climbing beyond the 7.1 million people President Barack Obama announced Tuesday (Kenen, 4/1).

The Associated Press: It’s Not Too Late To Get Health Coverage
It’s not too late to get covered. A few routes remain open for those who missed the health care law’s big enrollment deadline. Millions may be eligible for a second chance to sign up for subsidized insurance this year. And people who get coverage after the deadline can still avoid, or at least reduce, the fine for going uninsured (4/2).

Politico: Behind The Obamacare Surprise
The administration overcame a disastrous start to actually hit 7 million enrollees. They lost two months — and all the political capital they won from the government shutdown — to a broken website that seemed to prove every one of their critics’ complaints, and fed the most negative coverage and worst polls President Barack Obama’s ever gotten. They’ve done nothing to settle the political objections, and know May 1 is going to be a whole new kind of trouble trying to educate the newly insured on how to use the plans they’ve now got. But Tuesday, in private meetings in the Oval Office and his triumphant speech in the Rose Garden, there was no missing the bounce in the president’s step (Dovere and Budoff Brown, 4/2). 

NPR: Beyond The Fog Of Spin And Doubt: What Has ACA Achieved?
The Affordable Care Act has made it possible for millions of Americans to obtain health insurance — but how successful has the law been in reforming the health care system? (Ydstie, 4/1).

The Fiscal Times: What’s Next for Obamacare? 5 Things to Watch
The White House is doing a victory lap as the Affordable Care Act’s first open enrollment period has come to a close. As of midnight last night, the administration had reportedly reached its original goal of enrolling some 7 million people on the new exchanges—a feat that seemed nearly impossible at the beginning of March when enrollment was at 5 million. Though this is certainly good news for the White House, there are still hurdles ahead of the law and many crucial questions we need to answer before we can fully assess how it’s really shaping up. Here are five things to watch (Ehley, 4/1).

Categories: Health Care

Maryland Scraps Exchange Software, Will Buy Connecticut's System

Kaiser Health News - Wed, 04/02/2014 - 9:28am

Now that the enrollment period has ended, the board that runs Maryland's troubled online insurance marketplace has opted to start over with a system that worked well in Connecticut.

Los Angeles Times: For Faulty State Exchanges, Big Decisions Loom About Healthcare Law
Although the Obama administration appears to have surpassed its goal of enrolling more than 7 million people in the new healthcare program this year, some of the states that have struggled with technology problems are headed into an intensive new phase of fixes as they try to shepherd final enrollees through the process (Reston, 4/1).

Los Angeles Times: Maryland To Overhaul Healthcare Exchange With Help From Connecticut
The board of the Maryland Health Benefit Exchange voted Tuesday night to overhaul its troubled healthcare website by adopting the smooth-running technology platform developed by Connecticut. Maryland has spent about $125.5 million operating and building its exchange, but in late February the state severed its $193-million contract with prime technology contractor Noridian Healthcare Solutions after struggling with technical problems that led to thousands of lost and stuck applications, as well as long wait times for frustrated consumers (Reston, 4/1).

The Washington Post: Board Of Md. Health-Insurance Exchange Votes To Hire Deloitte To Overhaul It
The board of Maryland’s health-insurance exchange voted Tuesday to hire Deloitte Consulting to replace most of the state’s troubled online marketplace with technology that has successfully worked in Connecticut. The change is expected to cost between $40 million and $50 million to implement, plus some hardware and software costs, according to Isabel FitzGerald, Maryland's secretary of information technology. Fitzgerald told board members that Maryland would adopt Connecticut's system, which has run as smoothly as any in the country, largely as is, with little retrofitting (Johnson and Wagner, 4/1).

The Baltimore Sun: Maryland Votes To Adopt Health Exchange Software Used In Connecticut
The board overseeing Maryland's health exchange voted unanimously Tuesday evening to scrap its dysfunctional website and adopt software developed by Deloitte Consulting and used by the more successful health exchange in Connecticut. The software is free for Maryland to use but Health Secretary Joshua M. Sharfstein will negotiate an emergency $40 million to $50 million contract with the software company to develop the site (Walker, Cohn and Cox, 4/2).

The Wall Street Journal: Maryland To Scrap Health Insurance Website
The state, under Gov. Martin O'Malley, a Democrat who quickly moved to implement the Affordable Care Act, was expected to be a leader among the 14 states running their own health insurance exchanges. Instead, Maryland's health connection website crashed soon after it launched Oct. 1 and was plagued with problems for months, crippling the ability of people to sign up for coverage (Corbett Dooren, 4/1).

The Associated Press: Md. Moves To Revamp Flawed Health Exchange
Maryland has had one of the worst exchange websites of the 14 states that developed their own: The state’s health exchange website crashed shortly after it opened Oct. 1 (4/1).

The CT Mirror: Maryland Scraps Obamacare Website For Connecticut Model
Maryland is scrapping its malfunctioning health care exchange for the technology Connecticut developed for its Obamacare website, AccessHealthCT, the state’s governor said late Tuesday. "The Health Exchange Board selected a partner with a proven track record to upgrade our website using a platform that has an established record of success," Maryland Gov. Martin O’Malley said. "We're confident that this partner will have the website upgraded by the time the next open enrollment period begins in November" (Radelat, 4/1).

And in Minnesota -

Minnesota Public Radio: Enrollment Push Helps MNsure Sign Up 169K Minnesotans By Deadline
More than 169,000 Minnesotans enrolled in health coverage through the state's health insurance marketplace through the six-month open enrollment period that ended Monday. About 60,000 people signed up in March alone. Early on, faulty software and other problems turned the enrollment process into a frustrating ordeal for thousands of state residents (Stawicki, 4/1).

The Star Tribune: As Deadline Passes, MNsure Exceeds Sign-Up Goal
After a halting start that left thousands of Minnesotans pulling out their hair in frustration, MNsure officials said Tuesday they exceeded their goals for the initial open enrollment period. "I think it's fair to say MNsure has turned a corner," interim CEO Scott Leitz said. Nearly 170,000 Minnesotans signed up for insurance coverage through MNsure, the state’s new online insurance exchange, according to preliminary figures. That's well above the 135,000 the agency set as a target last October, a few weeks before the website and call center came unglued with technical glitches that lasted through the end of the year (Crosby, 4/2).

Meanwhile, in other related news -

Kaiser Health News: Co-Op Health Insurance Plans See Early Success
The names of the big health insurance companies are familiar – Blue Cross, Aetna, United Healthcare. But what about CoOportunity Health, or Health Republic Insurance of New York? These are among 23 new health insurance companies that started under the Affordable Care Act. They're all nonprofit, member-owned cooperatives, and the aim is to create more competition and drive prices down (Whitney, 4/2).

Categories: Health Care

White House: More Than 7 Million Health Insurance Sign Ups

Kaiser Health News - Wed, 04/02/2014 - 9:27am

The official enrollment cut-off has come and gone, and the Obama administration is claiming a big win based on the last-minute surge of interest in online insurance marketplaces. President Barack Obama viewed the number as a rebuttal of the months-long criticism over the health law.  

The New York Times: Obama Claims Victory In Push For Insurance
President Obama declared victory Tuesday in the government’s aggressive push to enroll seven million people in private health insurance plans under the Affordable Care Act, even as his senior aides braced for an escalated political battle over the law ahead of the fall’s crucial midterm elections (Shear and Pear, 4/1).

The Washington Post: More Than 7 Million Have Enrolled Under Affordable Care Act, White House Says
Even after the official cutoff, more than 100,000 people at a time were on HealthCare.gov, the online federal insurance marketplace, into the early morning hours, according to a person familiar with the details of the last-minute surge. People who have started to enroll on the federal exchange, as well as on some state exchanges, have a grace period to finish their applications (Goldstein and Eilperin, 4/1).

The Wall Street Journal: More Than Seven Million Sign Up For Health Coverage, Obama Says
Speaking in the White House Rose Garden, the president offered one of his most forceful defenses of the law in months after a surge in sign-ups Monday pushed enrollment past the seven million mark. That figure generally was viewed as unattainable after technical problems with HealthCare.gov impeded sign-ups for weeks after the Oct. 1 launch (McCain Nelson and Radnofsky, 4/1).

Reuters: Obamacare Enrollment Exceeds Seven Million Target Despite Setback 
President Barack Obama's national healthcare program signed up more than 7 million people by the end of March, the president said on Tuesday, notching a rare victory after a months-long, glitch-filled rollout of the law. Appearing in the White House Rose Garden, the president said 7.1 million people had signed up for coverage under the law, known as Obamacare, and called for Republicans to end their bid to repeal it (Mason and Felsenthal, 4/1).

NPR: Debate Over Repealing Health Care Law Is Over, Obama Says
Six months after a disastrous rollout, more than 7 million people had signed up for health insurance on the federal and state exchanges when the deadline passed on Monday (Keith, 4/2).

Los Angeles Times: Obamacare Passes First Big Test
The Affordable Care Act has passed its first big test, but the law's distribution of winners and losers all but guarantees the achievement will not quiet its political opposition. White House officials, who had a near-death experience with the law's rollout six months ago, were nearly giddy Tuesday as they celebrated an open-enrollment season that ended on a high note (Lauter and Parsons, 4/1).

Bloomberg: Obama Says 7.1 Million Health Sign-Ups Rebut Criticism
President Barack Obama’s declaration that 7.1 million health-plan enrollments serve as a rebuke to critics of his signature law won’t diminish the opposition nor stop the scrutiny of the overhaul’s effect. “The Affordable Care Act hasn’t completely fixed our long-broken health-care system, but this law has made our health-care system a lot better,” Obama told administration officials, lawmakers and other supporters in the White House Rose Garden. “The debate over repealing this law is over” (Talev, Keane and Wayne, 4/2)

Kaiser Health News: Capsules: As Insurance Enrollment Exceeds 7M, Obama Says Health Law ‘Here To Stay’
The Obama administration took a victory lap Tuesday as enrollment through the health law’s exchanges topped 7 million, a goal previously thought untouchable when the website healthcare.gov sputtered and crashed as sign-ups began last fall (Carey, 4/1).

Kaiser Health News: Obama: 'The Affordable Care Act Is Here To Stay' (Video)
Kaiser Health News posted excerpts from a Tuesday White House Rose Garden by President Barack Obama in which he touted over 7 million sign-ups for health insurance on the health law's marketplaces (4/1).

Categories: Health Care

Ryan Plan Would Repeal Health Law, Offer Private Option Medicare

Kaiser Health News - Wed, 04/02/2014 - 9:27am

The budget proposal by Rep. Paul Ryan, House Budget chairman and a possible Republican contender for the White House in 2016, would repeal the health law but maintain its savings and taxes. Beginning with those who turn 65 in 2024, it would offer seniors a fixed amount to purchase a private plan or traditional fee for service Medicare.

The New York Times: Ryan’s Budget Would Cut $5 Trillion In Spending Over A Decade
Mr. Ryan, the House Budget Committee chairman and a possible White House contender in 2016, laid out a budget plan that cuts $5 trillion in spending over the next decade. He said it would bring federal spending and taxes into balance by 2024, through steep cuts to Medicaid and food stamps, and the total repeal of the Affordable Care Act just as millions are reaping the benefits of the law (Weisman, 4/1). 

Los Angeles Times: House GOP Revives Paul Ryan’s Austere Budget, Medicare Cuts
The blueprint from Ryan, the party's former vice presidential nominee, is expected to be met with stiff opposition not only from Democrats, but also from hard-line Republicans who want deeper austerity cuts to more quickly balance the budget (Mascaro, 4/1).

The Washington Post: Paul Ryan’s Final Budget Plan Would Slash $5 Trillion In Next Decade
The 99-page plan is Ryan’s last manifesto on government austerity as head of the Budget Committee. He has emerged as the GOP’s leading light on fiscal policy in recent years, but he is term-limited as head of the budget panel and vying to become chairman of the tax-writing Ways and Means Committee next year while considering a 2016 presidential bid (O’Keefe, 4/1).

Politico: Paul Ryan’s Budget Makes Big Medicare Changes
It’s Paul Ryan’s wish list. The House GOP 2015 budget, penned by the Wisconsin Republican, will seek to shave federal spending by $5 trillion by offering changes to social welfare programs, ending government ownership of Fannie Mae and Freddie Mac and repealing Obamacare (French, 4/2).

The Wall Street Journal: Ryan Sees Budget Balancing 
House Budget Committee Chairman Paul Ryan released an election-year budget blueprint Tuesday designed to unify Republicans behind an effort to balance the federal budget in 10 years, exposing the party to Democratic attacks over its proposed cuts to Medicare and other safety-net programs (Peterson and Paletta, 4/1).

Los Angeles Times: Paul Ryan Budget Cuts Deeply – But Will It Balance As Promised? 
Ryan, the House Budget Committee chairman, relies on a combination of previously approved Obamacare savings and tax hikes, along with a new way of measuring economic growth, to reach the 10-year goal of ridding the budget of red ink. That approach does not sit well with hard-line budget hawks, and could make Ryan's job even more difficult as the House prepares to vote on the budget next week (Parsons, 4/1).

CQ HealthBeat: Ryan Budget Would Turn Medicare Into Premium Support Program
The House Republican budget proposal released on Tuesday largely repeats previous health care ideas, including turning Medicare into a premium support program but also maintaining the program’s $716 billion in savings from the 2010 health care law. The fiscal 2015 budget proposal, introduced by Budget Chairman Paul D. Ryan, would repeal most of the health care overhaul (PL 111-148, PL 111-152) and change Medicaid into a block grant program (Ethridge, 1/4).

The Associated Press: House GOP Plan Seeks Health Cuts To Balance Budget
Ryan promises to balance the government’s books with wide-ranging cuts to programs such as food stamps and government-paid health care for the poor and working class. It’s a nonstarter with Obama but polishes the GOP’s supply-side brand heading into midterm elections likely to be determined by the core voters of either party (4/2).

NBC News: What Ryan's Budget Means (And Doesn't Mean) For Medicare
Democrats have attacked the budget Republican Paul Ryan released Tuesday for trying to privatize and "voucherize" Medicare, the popular entitlement program for seniors. Republicans have countered that the proposed changes instead amount to "premium support" and offer a choice to future seniors. What are the changes that Rep. Ryan, R-Wis., has unveiled? Answer: Think of Obamacare, but with a public option attached (Murray, 4/1).

In other Medicare news -

The Associated Press: Obama Signs Bill Temporarily Fixing Medicare Fees
The $21 billion bill would stave off a 24 percent cut in Medicare reimbursements to doctors for a year and extend dozens of other expiring health care provisions, such as higher payment rates for rural hospitals. The legislation is paid for by cuts to health care providers, but fully half of the cuts won’t kick in for 10 years (4/1).

Categories: Health Care

Highlights: Abortion Restrictions In Mississippi, Arizona

Kaiser Health News - Wed, 04/02/2014 - 9:26am

And in Hawaii and Los Angeles, some advocacy groups are worrying about providing health insurance to migrant workers and undocumented workers.

Los Angeles Times: Abortion Restrictions Take Effect In Arizona After Judge’s Ruling
Restrictions on some types of abortions in Arizona went into effect Tuesday morning after a federal judge upheld state changes limiting a woman's access to an abortion-inducing drug. U.S. District Judge David Bury issued an order Monday afternoon rejecting a bid to block the new abortion restrictions while the state’s 2012 law is litigated. The law allowed the state to issue new rules banning the use of the most common abortion–inducing drug, RU-486, after the seventh week of pregnancy, compared with the current restriction of nine weeks (Muskal, 4/1).

Houston Chronicle: Miss. Gov Says He Will Sign 20-Week Abortion Ban 
Mississippi Gov. Phil Bryant said Tuesday that he looks forward to quickly signing a bill that would ban abortion at 20 weeks, the midpoint of a full-term pregnancy. "This measure represents a great effort to protect the unborn in Mississippi," Bryant said in a statement after House Bill 1400 passed the House 91-20 and the Senate 41-10 (Wagster Pettus, 4/1).

Los Angeles Times: Healthcare Advocates Push For Medical Services For Uninsured
Healthcare advocates Tuesday urged the Los Angeles County Board of Supervisors to set aside at least $11 million in additional funding for free medical services for low-income residents — including immigrants lacking legal status — who remain uninsured under Obamacare (Brown, 4/1). 

The Associated Press: Court: Hawaii Not Required To Pay For Migrant Care
Hawaii isn’t required to fund Medicaid for migrants from three Pacific Island nations in Micronesia to make up for a reduction in federal funding, a federal appeals court ruled Tuesday. The 9th U.S. Circuit Court of Appeals said in a ruling filed Tuesday that Hawaii has no constitutional obligation to fill a gap left in 1996 when Congress cut health care funding for migrants under the Compact of Free Association (Garcia, 4/2).

Categories: Health Care

Viewpoints: GOP Can No Longer Wait For Obamacare 'To Implode;' Ryan's Version Of 'Trickle-Down Economics'

Kaiser Health News - Wed, 04/02/2014 - 9:26am

The New York Times' The Conscience Of A Liberal: A Big Biden Deal
Now that Obamacare has finished with an amazing surge in signups, apparently passing the 7 million mark for the exchanges, there have been two main responses. Republicans are in full-on denial — the books are cooked! Nobody has paid! It’s only because people have been forced to do it! Benghazi! Vince Foster! Meanwhile, progressives are full of caution. It's just a start, we don't know how well this will work in the longer run, too soon to celebrate. The right-wing reaction is, of course, ludicrous. But the cautious progressives are being too cautious. This really is what Joe Biden would have called a Big Frothing Deal, or something like that. The key question you need to ask is, what would make Obamacare fail if it did fail? (Paul Krugman, 4/1). 

Bloomberg: Stop Waiting For Obamacare To Implode
But it's clear now that one scenario with a lot of purchase among conservative opponents of Obamacare -- that the law would "implode," "collapse" or "unravel" -- is highly unlikely. A quick death spiral was always a remote possibility, even if the early troubles of the exchange websites made it look a little less remote. Many congressional Republicans wanted to believe the idea, though, especially because they viewed it as one more reason they could avoid coming up with their own health-care agenda (Ramesh Ponnuru, 4/1).

Bloomberg: Want Obamacare Answers? Get In Line.
It's impossible to say for sure, of course, but I think that the people who signed up in the last few days will be systematically different from the earlier groups. ... allow me to speculate a bit about the ways that they probably differ. Start with what we know about these people: They waited until the last minute to sign up. This tells you that a lot of them will fall into one of a few groups: 1. People who are incredibly disorganized. 2. People who are so financially pinched that it was important to wait until the last minute so that they could pay eight months' worth of premiums instead of 12. 3. People who are young and healthy enough to make acquiring insurance less than urgent (Megan McArdle, 4/1).

Fox News: Real Health Care Reform: Give States The Tools, And Let Them Do The Job
They're practically the first words out of one's mouth the second a Washington reporter hears about a new health reform proposal: "How many people does your plan cover?" The basic premise of the America Next health plan I'm endorsing today is simple: "I believe the problem is not that folks are trying to avoid getting health care. The problem is they can't afford it." In short, I agree with Barack Obama. Of course, Barack Obama circa January 2008—when he uttered those words in opposition to a health insurance mandate -- represents a far cry from the Barack Obama who signed ObamaCare into law in March 2010 (La. Gov. Bobby Jindal, 4/2).

The Wall Street Journal: ObamaCare's Hidden Hit On Businesses
President Obama's promise that Americans could keep their health insurance if they liked it was the most infamous of the Affordable Care Act's sketchy sales pitches. But many of the law's most damaging aspects are less known, buried in thousands of pages of regulations (Bernie Marcus, 4/1). 

The Wall Street Journal: The ObamaCare Copperheads
Yet for months the Health and Human Services Department has refused to disclose crucial contextual data, such as how many insurance contracts are in force, the market-by-market totals and how many beneficiaries were previously covered. Regardless of your partisan sympathies, the White House's selective disclosure is a crime against transparency and accountable government. Then there are the 12 Democratic Senators up for re-election who each cast the decisive 60th vote for ObamaCare. They're acting as if the law is still a political threat, and presumably their polls say as much. The ObamaCare Dozen have tried to create an alibi by saying the plan isn't perfect but mend it don't end it. They've now proposed some concrete fixes, and they must think their constituents aren't paying attention (4/1). 

Los Angeles Times: Obama Says ACA Sign-Ups Surpass 7 Million; Twitterverse Reacts
This afternoon President Obama, with a grinning Vice President Biden behind him, announced in the White House Rose Garden that sign-ups for his signature health law had exceeded original projections. Some 7.1 million Americans have signed up for Obamacare, the president said, by far exceeding the revised projection of 6 million insured after the disastrous roll out of the HealthCare.gov website in October (Robin Abcarian, 4/1). 

And in commentaries on Rep. Paul Ryan's budget proposal -

The New York Times: Mr. Ryan’s Faith-Based Budget
Medicare would become a voucher program by 2024 for those now 55 and younger, allowing them to choose between a fixed payment for private insurance and the traditional plan. The problem with this idea, revived from past Ryan budgets, is that traditional Medicare wouldn't stay unchanged for long because it will attract the sickest patients and become so expensive that most people would be driven to the private plan. The spending cuts in that plan would quickly make it inadequate. Mr. Ryan would make exactly the same $700 billion in cuts to Medicare that Republicans have ridiculed Democrats for making to pay for health care reform. But, of course, he would repeal the health law and has no particular concern about the 13 million people who would no longer be covered under the law's Medicaid expansion (4/1). 

Los Angeles Times: Paul Ryan The Anti-Robin Hood: Robbing The Poor To Help The Rich 
Well, in a nutshell, here's Ryan and the Republicans' vision, per my colleague, Lisa Mascaro: "House Republicans will return to the core ideas from Ryan, the Budget Committee chairman, that have come to define the party's approach: Cut federal spending on Medicare, Medicaid and other programs that make up the federal safety net, while reducing top individual and corporate tax rates to 25%, which Republicans argue will spur economic growth." Holy Ronald Reagan! The Gipper may be gone, but his trickle-down economic notions are alive and well (Paul Whitefield, 4/1). 

The Wall Street Journal: The Ryan Priorities
Paul Ryan laid out his House budget outline on Tuesday, which is already more than Senate Democrats plan to do this year. Passing a budget is a core part of governing, and it's also an obligation under the 1974 Budget Act, but Democrats plan to cruise through the general election on December's budget deal and not let the voters in on their future plans for taxes and spending (4/1).

The Washington Post's Post Partisan: Paul Ryan's Unrealistic Path To Prosperity
Rep. Paul Ryan (R-Wis.), the House budget committee chairman, just released his latest "Path to Prosperity." This one is for fiscal year 2015. As many have noted, this latest iteration is similar to previous paths to prosperity unveiled by the 2012 Republican vice presidential nominee and perhaps future chairman of the powerful House Ways and Means tax-writing committee. And it kills the Affordable Care Act (ACA), which renders it a non-serious fiscal blueprint (Jonathan Capehart, 4/1).

Categories: Health Care

Political Cartoon: 'Red Zone?'

Kaiser Health News - Wed, 04/02/2014 - 9:26am

Kaiser Health News provides a fresh take on health policy developments with "Red Zone?" by Pat Bagley.

And here's today's health policy haiku:

ADVANTAGE WHOSE?

Keep the darn gov'mint
out of my Medicare, my
MA, my pass through.
- Larry Beresford

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.

Categories: Health Care

First Edition: April 2, 2014

Kaiser Health News - Wed, 04/02/2014 - 8:01am

Today's headlines include news and analysis about the 7 million insurance enrollment tally.  

Kaiser Health News: Co-op Health Insurance Plans See Early Success
Reporting for Kaiser Health News, in partnership with NPR, Eric Whitney writes: "The names of the big health insurance companies are familiar – Blue Cross, Aetna, United Healthcare. But what about CoOportunity Health, or Health Republic Insurance of New York? These are among 23 new health insurance companies that started under the Affordable Care Act. They're all nonprofit, member-owned cooperatives, and the aim is to create more competition and drive prices down" (Whitney, 4/2). Read the story.

Kaiser Health News: Obama: 'The Affordable Care Act Is Here To Stay' (Video)
Kaiser Health News posted excerpts from a Tuesday White House Rose Garden by President Barack Obama in which he touted over 7 million sign-ups for health insurance on the health law's marketplaces (4/1). Watch the video

Kaiser Health News: Capsules: As Insurance Enrollment Exceeds 7M, Obama Says Health Law ‘Here To Stay’
Now on Kaiser Health News' blog, Mary Agnes Carey writes: "The Obama administration took a victory lap Tuesday as enrollment through the health law’s exchanges topped 7 million, a goal previously thought untouchable when the website healthcare.gov sputtered and crashed as sign-ups began last fall" (Carey, 4/1). Check out what else is on the blog.

The New York Times: Obama Claims Victory In Push For Insurance
President Obama declared victory Tuesday in the government’s aggressive push to enroll seven million people in private health insurance plans under the Affordable Care Act, even as his senior aides braced for an escalated political battle over the law ahead of the fall’s crucial midterm elections (Shear and Pear, 4/1).

The Washington Post: More Than 7 Million Have Enrolled Under Affordable Care Act, White House Says
Even after the official cutoff, more than 100,000 people at a time were on HealthCare.gov, the online federal insurance marketplace, into the early morning hours, according to a person familiar with the details of the last-minute surge. People who have started to enroll on the federal exchange, as well as on some state exchanges, have a grace period to finish their applications (Goldstein and Eilperin, 4/1).

The Wall Street Journal: More Than Seven Million Sign Up For Health Coverage, Obama Says
Speaking in the White House Rose Garden, the president offered one of his most forceful defenses of the law in months after a surge in sign-ups Monday pushed enrollment past the seven million mark. That figure generally was viewed as unattainable after technical problems with HealthCare.gov impeded sign-ups for weeks after the Oct. 1 launch (McCain Nelson and Radnofsky, 4/1).

NPR: Debate Over Repealing Health Care Law Is Over, Obama Says
Six months after a disastrous rollout, more than 7 million people had signed up for health insurance on the federal and state exchanges when the deadline passed on Monday (Keith, 4/2).

Los Angeles Times: Obamacare Passes First Big Test
The Affordable Care Act has passed its first big test, but the law's distribution of winners and losers all but guarantees the achievement will not quiet its political opposition. White House officials, who had a near-death experience with the law's rollout six months ago, were nearly giddy Tuesday as they celebrated an open-enrollment season that ended on a high note (Lauter and Parsons, 4/1).

The Washington Post’s The Fact Checker: Obamacare Enrollment Numbers: What We Know And What We Don’t Know
With the enrollment period ended on March 31, it’s time to do the numbers. What do we actually know about Obamacare enrollment numbers — and what is missing? (Kessler, 4/2).

The Wall Street Journal: 5 Questions About Obamacare’s 7 Million Enrollees
What does the 7 million mark mean for the health law? It tells us the final days of enrollment attracted a surge of consumers and that the sometimes-panicked rush by the Obama administration to fix HealthCare.gov after a disastrous launch largely paid off. What the politically crucial milestone doesn’t reveal, however, is much about whether the law will work. For instance, we still don’t know whether the new marketplaces will make much of a dent in the number of uninsured people, or if the business will prove sustainable for insurers (Weaver, 4/1).

Politico: Enrollment Caveats Will Keep ACA Counting
For Obamacare enrollment, it’s not over even when it’s over.
With special enrollment, extra special enrollment, slightly extended state enrollment and very extended state enrollment, the sign-up tally will keep climbing beyond the 7.1 million people President Barack Obama announced Tuesday (Kenen, 4/1).

Politico: Behind The Obamacare Surprise
The administration overcame a disastrous start to actually hit 7 million enrollees. They lost two months — and all the political capital they won from the government shutdown — to a broken website that seemed to prove every one of their critics’ complaints, and fed the most negative coverage and worst polls President Barack Obama’s ever gotten. They’ve done nothing to settle the political objections, and know May 1 is going to be a whole new kind of trouble trying to educate the newly insured on how to use the plans they’ve now got. But Tuesday, in private meetings in the Oval Office and his triumphant speech in the Rose Garden, there was no missing the bounce in the president’s step (Dovere and Budoff Brown, 4/2). 

NPR: Beyond The Fog Of Spin And Doubt: What Has ACA Achieved?
The Affordable Care Act has made it possible for millions of Americans to obtain health insurance — but how successful has the law been in reforming the health care system? (Ydstie, 4/1).

Politico: Obamacare Critics: Hubida, Hubida, Hubida
On Tuesday, Obamacare sign-ups passed 7 million, six months after the launch of a federal website that could barely sign up anybody. There are still a lot of questions about how solid that figure is, but the idea that the law could even come close to the original goal after such a disastrous start would have been laughable even a few weeks ago. It was also a wake-up call for Republicans and conservatives, and even the occasional liberal, who pushed the argument that the failed website challenges the idea at the heart of Obama’s agenda — that government can still solve big social problems (Nather, 4/2). 

Politico Vulnerable Dems Still Wary Of Obamacare
After 7 million people signed up for Obamacare, an unexpectedly sunny end to a dreary enrollment process, Democrats outlined plans Tuesday to step up attacks on Republicans for wanting to repeal the health care law. But while Obama administration officials popped champagne to celebrate the enrollment figure, Democrats on the ballot this year continue to tread cautiously (Hohmann, 4/1).

The New York Times: Newly Enrolled, But Not Counted By Insurance Exchange
Millions of newly insured people are hiding in plain sight. They are the people who have bought new health insurance since the start of this year but have chosen for one reason or another to bypass the state and federal exchanges that opened last year under the Affordable Care Act. While the exact number is unknown, some health care experts estimate that it may be in the millions (Thomas, 4/1).

Los Angeles Times: For Faulty State Exchanges, Big Decisions Loom About Healthcare Law
Although the Obama administration appears to have surpassed its goal of enrolling more than 7 million people in the new healthcare program this year, some of the states that have struggled with technology problems are headed into an intensive new phase of fixes as they try to shepherd final enrollees through the process (Reston, 4/1).

Los Angeles Times: Maryland To Overhaul Healthcare Exchange With Help From Connecticut
The board of the Maryland Health Benefit Exchange voted Tuesday night to overhaul its troubled healthcare website by adopting the smooth-running technology platform developed by Connecticut. Maryland has spent about $125.5 million operating and building its exchange, but in late February the state severed its $193-million contract with prime technology contractor Noridian Healthcare Solutions after struggling with technical problems that led to thousands of lost and stuck applications, as well as long wait times for frustrated consumers (Reston, 4/1).

The Washington Post: Board Of Md. Health-Insurance Exchange Votes to Hire Deloitte To Overhaul It
The board of Maryland’s health-insurance exchange voted Tuesday to hire Deloitte Consulting to replace most of the state’s troubled online marketplace with technology that has successfully worked in Connecticut. The change is expected to cost between $40 million and $50 million to implement, plus some hardware and software costs, according to Isabel FitzGerald, Maryland’s secretary of information technology. Fitzgerald told board members that Maryland would adopt Connecticut’s system, which has run as smoothly as any in the country, largely as is, with little retrofitting (Johnson and Wagner, 4/1).

The Wall Street Journal: Maryland To Scrap Health Insurance Website
The state, under Gov. Martin O'Malley, a Democrat who quickly moved to implement the Affordable Care Act, was expected to be a leader among the 14 states running their own health insurance exchanges. Instead, Maryland's health connection website crashed soon after it launched Oct. 1 and was plagued with problems for months, crippling the ability of people to sign up for coverage (Corbett Dooren, 4/1).

The Associated Press: Md. Moves To Revamp Flawed Health Exchange
Maryland has had one of the worst exchange websites of the 14 states that developed their own: The state’s health exchange website crashed shortly after it opened Oct. 1 (4/1).

The Associated Press: It’s Not Too Late To Get Health Coverage
It’s not too late to get covered. A few routes remain open for those who missed the health care law’s big enrollment deadline. Millions may be eligible for a second chance to sign up for subsidized insurance this year. And people who get coverage after the deadline can still avoid, or at least reduce, the fine for going uninsured (4/2).

The Washington Post: Hundreds Cram Into Va. Senate Hearing ON Medicaid Expansion Through State Budget
Virginia’s on-again, off-again special session got rolling again Tuesday, as hundreds of lobbyists and activists on opposite sides of the state’s Medicaid battle crammed into a Senate hearing on whether to expand the program through the state budget. The hearing was the first sign of life from the Senate since last week, when the chamber went home one day into the special budget session, leaving the House and its two-year, $96 billion spending plan hanging (Vozzella, 4/1).

The Washington Post: Bobby Jindal, With An Eye On 2016, To Unveil Plan To Replace Obama Health-Care Law
Louisiana Gov. Bobby Jindal will announce Wednesday a plan to repeal and replace President Obama’s health-care law, an effort by the Republican to insert himself into the increasingly competitive early maneuvering for his party’s presidential nomination. Jindal, a former state and federal health official, said his plan is one of many policy proposals he will release in coming months, making clear that he wants to be seen as a policy-driven problem solver (Costa and Goldstein, 4/2).

The New York Times: Ryan’s Budget Would Cut $5 Trillion In Spending Over A Decade
Mr. Ryan, the House Budget Committee chairman and a possible White House contender in 2016, laid out a budget plan that cuts $5 trillion in spending over the next decade. He said it would bring federal spending and taxes into balance by 2024, through steep cuts to Medicaid and food stamps, and the total repeal of the Affordable Care Act just as millions are reaping the benefits of the law (Weisman, 4/1). 

Los Angeles Times: House GOP Revives Paul Ryan’s Austere Budget, Medicare Cuts
The blueprint from Ryan, the party's former vice presidential nominee, is expected to be met with stiff opposition not only from Democrats, but also from hard-line Republicans who want deeper austerity cuts to more quickly balance the budget (Mascaro, 4/1).

The Washington Post: Paul Ryan’s Final Budget Plan Would Slash $5 Trillion In Next Decade
The 99-page plan is Ryan’s last manifesto on government austerity as head of the Budget Committee. He has emerged as the GOP’s leading light on fiscal policy in recent years, but he is term-limited as head of the budget panel and vying to become chairman of the tax-writing Ways and Means Committee next year while considering a 2016 presidential bid (O’Keefe, 4/1).

Politico: Paul Ryan’s Budget Makes Big Medicare Changes
It’s Paul Ryan’s wish list. The House GOP 2015 budget, penned by the Wisconsin Republican, will seek to shave federal spending by $5 trillion by offering changes to social welfare programs, ending government ownership of Fannie Mae and Freddie Mac and repealing Obamacare (French, 4/2).

The Wall Street Journal: Ryan Sees Budget Balancing 
House Budget Committee Chairman Paul Ryan released an election-year budget blueprint Tuesday designed to unify Republicans behind an effort to balance the federal budget in 10 years, exposing the party to Democratic attacks over its proposed cuts to Medicare and other safety-net programs (Peterson and Paletta, 4/1).

Los Angeles Times: Paul Ryan Budget Cuts Deeply – But Will It Balance As Promised? 
Ryan, the House Budget Committee chairman, relies on a combination of previously approved Obamacare savings and tax hikes, along with a new way of measuring economic growth, to reach the 10-year goal of ridding the budget of red ink. That approach does not sit well with hard-line budget hawks, and could make Ryan's job even more difficult as the House prepares to vote on the budget next week (Parsons, 4/1).

The Associated Press: House GOP Plan Seeks Health Cuts To Balance Budget
Ryan promises to balance the government’s books with wide-ranging cuts to programs such as food stamps and government-paid health care for the poor and working class. It’s a nonstarter with Obama but polishes the GOP’s supply-side brand heading into midterm elections likely to be determined by the core voters of either party (4/2).

The Associated Press: Obama Signs Bill Temporarily Fixing Medicare Fees
The $21 billion bill would stave off a 24 percent cut in Medicare reimbursements to doctors for a year and extend dozens of other expiring health care provisions, such as higher payment rates for rural hospitals. The legislation is paid for by cuts to health care providers, but fully half of the cuts won’t kick in for 10 years (4/1).

Los Angeles Times: Healthcare Advocates Push For Medical Services For Uninsured
Healthcare advocates Tuesday urged the Los Angeles County Board of Supervisors to set aside at least $11 million in additional funding for free medical services for low-income residents — including immigrants lacking legal status — who remain uninsured under Obamacare (Brown, 4/1). 

Los Angeles Times: Abortion Restrictions Take Effect In Arizona After Judge’s Ruling
Restrictions on some types of abortions in Arizona went into effect Tuesday morning after a federal judge upheld state changes limiting a woman's access to an abortion-inducing drug. U.S. District Judge David Bury issued an order Monday afternoon rejecting a bid to block the new abortion restrictions while the state’s 2012 law is litigated. The law allowed the state to issue new rules banning the use of the most common abortion–inducing drug, RU-486, after the seventh week of pregnancy, compared with the current restriction of nine weeks (Muskal, 4/1).

The Associated Press: Court: Hawaii Not Required To Pay For Migrant Care
Hawaii isn’t required to fund Medicaid for migrants from three Pacific Island nations in Micronesia to make up for a reduction in federal funding, a federal appeals court ruled Tuesday. The 9th U.S. Circuit Court of Appeals said in a ruling filed Tuesday that Hawaii has no constitutional obligation to fill a gap left in 1996 when Congress cut health care funding for migrants under the Compact of Free Association (4/2). 

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