First Edition: February 24, 2014

Today's headlines include continuing coverage of Medicare Advantage payment rates, as well as a range of stories about the health law's Medicaid expansion and online insurance marketplaces.  

Kaiser Health News: Impact Of Medicare Advantage Cuts On Seniors Sharply Disputed
Kaiser Health News staff writer Phil Galewtiz reports: "The health insurance industry points to these examples as some of the more extreme cases of beneficiaries feeling the sting of federal funding cuts to Medicare Advantage plans that cover nearly 16 million senior citizens. They say the Obama administration's additional proposed 1.9 percent in cuts to the plans for 2015, which was announced Friday, will mean millions more will see reductions in benefits and higher out-of-pocket costs. But health policy experts and advocates for seniors say most Medicare health plans have largely kept costs and benefits stable and believe the industry is scaring seniors unnecessarily" (Galewitz, 2/23). Read the story.

Kaiser Health News: Obama Administration Proposes 1.9% Cut In Medicare Advantage Payments
Kaiser Health News staff writer Mary Agnes Carey reports: "Late Friday, the Centers for Medicare & Medicaid Services announced proposed rates that officials said could mean payment reductions of 1.9 percent for the private plans in the program. But insurers, who have led a fierce lobbying campaign against payment reductions, say the Medicare Advantage plans would sustain a far deeper cut. That's because the lower payment rates will be combined with new health law fees on health plans, a phase-out of the 'star rating' system that helped buffer the reductions for Medicare Advantage plans in prior years and Medicare cuts in the automatic federal spending cuts known as 'sequestration'" (Carey, 2/24). Read the story.

Kaiser Health News: Medicare Data Show Wide Differences In ACOs' Patient Care
Kaiser Health News staff writer Jordan Rau reports: "The release is the first public numbers from Medicare of how patient care is being affected by specific networks. These accountable care organizations, or ACOs, are among the most prominent of Medicare's experiments in changing the ways physicians and health care facilities work together and are paid. The ACOs will be able to keep some of the money they save, but they also take on some of the financial risk if their patients end up being costly" (Rau, 2/21). Read the story.

Kaiser Health News: Capsules: 40 Percent Of Enrollees Through eHealth Website Are Young Adults
Now on Kaiser Health News' blog, Julie Appleby reports: "Private online marketplace eHealth reported that the percentage of people between the ages of 18 and 34 who applied for coverage through the firm's website in the last quarter of 2013 was well above the 25 percent rate cited by the Obama administration for enrollments through sites run by the states and the federal government" (Appleby, 2/21). Check out what else is on the blog.

Kaiser Health News also tracked weekend health policy headlines, including reports about proposed Medicare Advantage rates (2/23).

Politico: Obamacare Stats Still Hard To Nail Down
The truth is, nobody has a good, real-time fix on how successful the Affordable Care Act has been in reducing the ranks of the uninsured. The Obama administration hasn't been able to say how many of the 3.3 million people who have signed up for private health insurance coverage, or of the 6.3 million who have been determined eligible for Medicaid, were actually uninsured before -; and health care experts aren't sure yet, either (Nather, 2/23).

Politico: The Politics Of Obamacare Delays
By now, the pattern is pretty clear: Obamacare deadlines don't stick. .... The unanswered question is, does the extra time create more hassles than benefits for those affected - and is the goalpost-moving worth the political headaches it creates for the Obama administration? Because undeniably, every time the Obama administration bends a deadline for the Affordable Care Act -; delaying the employer mandate for the second time, putting off parts of the enrollment launch, or giving customers just a little more time to sign up -; it fuels the perception that the administration is just winging it, and gives Republicans new fodder to accuse the White House of rewriting laws too casually. That doesn't mean the busted deadlines always matter in the real world, though (Nather, 2/21).

The Washington Post: Health Care Law's Small-Business Marketplace Not Attracting Many Small Businesses
Small-business owners, who were supposed to gain more choices and cheaper rates from the new online-health-insurance portals, have been slow to select plans through marketplaces since the rollout started last fall. In part, some say, that is because luring employers to the marketplaces has taken a back seat to fixing technical problems and recruiting individuals and families. As a result, businesses in many states have been left with an online-shopping portal that is only partially functional -; if they have one at all (Harrison, 2/23).

The Wall Street Journal: Finding the Right Health Plan, Online
Under the Affordable Care Act, just about everyone must apply for health insurance by March 31 or possibly pay a penalty. As the deadline nears, there are new tools consumers can turn to that might make finding the right plan easier and cheaper. One of them is healthplanratings.org. Run by the not-for-profit Consumers' Checkbook, the free website launched in Illinois this month. Its operators hope it will become a model for innovation in other states. ... Of course, the main place for most consumers to shop for insurance will be the federal marketplace at HealthCare.gov and state marketplaces (Johnson, 2/23).

The Washington Post's The Fact Checker: Obama's Claim That 7 Million Got 'Access To Health Care For The First Time' Because Of His Medicaid Expansion
The Fact Checker has written several times about the fuzziness of the Medicaid numbers issued by the Obama administration. But it is like playing whack-a-mole. Every time we rap someone for getting it wrong, the same problem pops up someplace else (Kessler, 2/24).

The Associated Press/Washington Post: Governors: 'Obamacare' Here To Stay
The explosive politics of health care have divided the nation, but America's governors, Republicans and Democrats alike, suggest that President Barack Obama's health care overhaul is here to stay. While governors from Connecticut to Louisiana sparred Sunday over how best to improve the nation's economy, governors of both parties shared a far more pragmatic outlook on the controversial program known as "Obamacare" as millions of their constituents begin to be covered (2/23).

The Washington Post: Virginia And Other States Wrestle With Whether To Expand Medicaid Under Affordable Care Act
It was a purely symbolic vote, but Gov. Terry McAuliffe desperately wanted it to go his way. The Democratic governor summoned at least four Republican delegates to his office one by one last week, twisting their arms to support expanding Medicaid in a floor vote the GOP was forcing just for show (Vozzella, 2/23). 

The Associated Press: Poor Floridians Fall Into Medical Expansion Gap
Roughly 1 million uninsured Floridians who repeatedly heard affordable health insurance was just around the corner for them thanks to President Barack Obama's new law are finding a harsh reality -; they're too poor to qualify.The Florida House voted last year not to expand Medicaid under the Affordable Care Act because of fears that it could eventually cost the state hundreds of millions annually, meaning those earning below the poverty line, $11,490 for an individual or $23,550 for a family of four, aren't eligible for tax credits through the online marketplace. Without those tax credits, most people living below the poverty line can't afford coverage (Kennedy, 2/23).

The Washington Post: Maryland Haws Achieved Its Health Insurance Enrollment Goal, Thanks To A Research Error
For months, it looked like Maryland would barely meet, or even miss, the first enrollment goal for its new health insurance exchange. But it turns out the goal was based on flawed data, and the state's new goal is one that it has already beat. Instead of signing up 260,000 Marylanders for private plans or Medicaid during the first enrollment period, as was the original goal, the state is only expected to get 160,000, according to a letter the exchange's interim executive director received from researchers Friday. So far, sign-ups tally nearly 190,000 (Johnson, 2/23). 

The Associated Press/Washington Post: Md. Resets Goal For Health Insurance Enrollment
Instead of signing up 260,000 Maryland residents for private insurance or Medicaid during the first enrollment period, the state is now expected to enroll 160,000 residents. So far, Maryland has signed up nearly 190,000 people. The new goal is detailed in a letter the exchange's interim director received from researchers Friday (2/23). 

Politico: Shumlin: 'Websites Get Fixed'
Vermont Gov. Peter Shumlin says the problems with the Affordable Care Act rollout are getting fixed – and that Republicans were boxing themselves in politically by focusing on failures instead of the successes. "Websites get fixed. We're fixing ours. They're fixing theirs. The federal exchange is working better," the Democratic governor said on "Fox News Sunday." ... Sitting on a panel with Wisconsin Republican Gov. Scott Walker, Shumlin said the refusal of some GOP governors – including Walker – to accept federal money was driven solely by animus towards President Barack Obama (Tau, 2/23).

The Wall Street Journal: Court Rules Against Notre Dame In Contraception Case
A federal appeals court Friday ruled against the University of Notre Dame in a legal proceeding claiming the Obama administration's contraception-coverage requirement is forcing it to violate its religious beliefs (Radnofsky and Kendall, 2/21).

The Wall Street Journal: Government Proposes Cuts To Insurers' Medicare Payments
Federal regulators proposed cuts to payments for insurers that run private Medicare plans, with some analysts saying the reductions appeared steeper than they had projected. The stakes on such changes are high for many health insurers, which count on Medicare dollars for a substantial chunk of their earnings (Mathews, 2/21).

The Associated Press/Washington Post: GOP Intent On Highlighting Health Care Woes
House Republicans intent on highlighting the woes of President Barack Obama's health care law need to look no further than their own back yards, some of which are traditionally liberal strongholds. Maryland's online health care exchange has been plagued by computer glitches since its rollout last year, reflected in abysmal enrollment numbers well below projections through January. The state's lone Republican in Congress, Rep. Andy Harris, has asked the inspector general of the federal Health and Human Services Department to investigate (2/24). 

The Associated Press: Early House Race Tests Obamacare As Election Issue
The candidates are Alex Sink, Democrat, and David Jolly, Republican, but Obamacare is on the ballot in a big way in a competitive House race in Florida that offers a preview of the nationwide campaign for Congress this fall. Republicans and their allies wouldn't have it any other way as they test the issue's potency, even though their candidate may muddle the message, and other issues like Social Security may command a bigger role in deciding the winner. ... The candidates took different paths to their March 11 matchup to serve out the term of the late Republican Rep. C.W. "Bill" Young, who died last fall (Espo, 2/22).

The Associated Press/Washington Post: Medicare Advantage Plans May Face Cuts
Cuts are on the table next year for Medicare Advantage plans, the Obama administration says. The politically dicey move affecting a private insurance alternative highly popular with seniors immediately touched off an election-year fight. The announcement gave new ammunition to Republican critics of President Barack Obama's health care law, while disappointing some Democratic senators who had called on the administration to hold rates steady. Insurers are still hoping to whittle back the cuts or dodge them altogether (2/22). 

The Wall Street Journal: Pediatrics Group Balks At Rise Of Retail Health Clinics
Retail health clinics that are popping up in drugstores and other outlets shouldn't be used for children's primary-care needs, the American Academy of Pediatrics said, arguing that such facilities don't provide the continuity of care that pediatricians do. While retail clinics may be more convenient and less costly, the AAP said they are detrimental to the concept of a "medical home," where patients have a personal physician who knows them well and coordinates all their care (Beck and Martin, 2/24). 

The Wall Street Journal: How To Bring The Price Of Health Care Into The Open
With outrage growing over incomprehensible medical bills and patients facing a higher share of the costs, momentum is building for efforts to do just that. Price transparency, as it is known, is common in most industries but rare in health care, where "charges," "prices," "rates" and "payments" all have different meanings and bear little relation to actual costs (Beck, 2/23). 

The Wall Street Journal: Palliative Care Gains Favor As It Lowers Costs
Insurers are establishing programs that give the sickest patients the chance to receive extra care for their pain, suffering and emotional needs, in a move that turns out to cut spending substantially (Rockoff, 2/23). 

The New York Times: Plan To Limit Some Drugs in Medicare Is Criticized
An alliance of drug companies and patient advocates, joined by Democrats and Republicans in Congress, is fiercely opposing an Obama administration proposal that would allow insurers to limit Medicare coverage for certain classes of drugs, including those used to treat depression and schizophrenia. Opponents warn that the proposal, if enacted, could harm patients. Federal officials say it would lower costs and reduce overuse of the drugs. The proposed rule, which would lift a requirement that insurers cover "all or substantially all" drugs in certain treatment areas, is just one of a series of changes to the drug program that are being opposed by the unlikely alliance (Thomas and Pear, 2/21).

The New York Times: Wisconsin's Legacy for Unions
[Gov. Scott] Walker's landmark law -; called Act 10 -; severely restricted the power of public-employee unions to bargain collectively ... All over the state, public executives are exercising new authority. Instead of raising teachers' salaries, the Mequon-Thiensville School District, near Milwaukee, froze them for two years, saving $560,000. It saved an additional $400,000 a year by increasing employee contributions for health care, said its superintendent, Demond Means (Greenhouse, 2/22).

The Washington Post: Work Limits May Be Easing For Va. Adjunct College Instructors; Federal Health Law At Issue
Virginia's limits on the work schedule of part-time college instructors, imposed last year to minimize health insurance expenses of public community colleges under the Affordable Care Act, appear to be easing for at least some of the adjunct professors (Anderson, 2/21). 

Los Angeles Times: Actors Draw Med School Students Into Caregiver Role
David Solomon lay in bed, a sheet draped over his legs. His darkened bedroom was silent, except for the ticking of a clock on the wall. A box of tissues sat on a bedside table; a Hebrew-and-English siddur, or prayer book, rested on his lap.The cancer that the 70-year-old cosmetics merchant had held at bay for 12 years was no longer responding to chemo. His breathing was labored, and his morphine-addled gaze wandered. It took all his effort to focus on the white-jacketed medical student who stood next to him (Brown, 2/24). 

Los Angeles Times: Mysterious Polio-Like Illnesses Reported In Some California Children
A small number of children in California have come down with polio-like illnesses since 2012 -- suffering paralysis in one or more limbs and other symptoms -- and physicians and public health officials do not yet know why.A virus may play a role, said Dr. Carol Glaser, leader of a California Department of Public Health team investigating the illnesses, which are occurring sporadically throughout the state (Brown, 2/23).