First Edition: July 24, 2014

Today's headlines include more analysis of this week's conflicting appeals courts' decisions regarding a key part of the health law.

Kaiser Health News: New Health Law Court Decisions Could Have Limited Political Impact
Kaiser Health News staff writers Mary Agnes Carey and Julie Rovner report: "Political analysts say this week's court decisions on the legality of tax subsidies for those obtaining coverage under the Affordable Care Act may not have a broad impact on this fall's midterm elections. The decisions sent a mixed legal message, complicating the political message as well. One appellate court panel ruled the subsidies cannot be provided in the 36 states relying on the federal insurance exchange; the other ruled in favor of the Obama administration, saying Congress intended that the subsidies be available regardless of whether states operated their own insurance marketplace" (Carey and Rovner, 7/24). Read the story.

Kaiser Health News: Groups Sue Tennessee Over Medicaid Enrollment Delays
Kaiser Health News staff writer Phil Galewitz reports: "The suit was filed several weeks after the Obama administration ordered Tennessee and several other states to resolve problems that have led to a backlog nationwide of more than 1 million applications for Medicaid, the state-federal health insurance program for the poor" (Galewitz, 7/23). Read the story. 

The New York Times: Court Ruling On Health Care Subsidies Risks Loss Of Coverage
The conflicting court rulings left much unresolved -; both cases will be appealed further, and additional cases challenging the subsidies in federal exchange states are still making their way through trial courts in Indiana and Oklahoma. But the ruling in Halbig v. Burwell, in which a panel of the United States Court of Appeals for the District of Columbia found that subsidies could be awarded only in states that set up their own insurance exchanges, raised the possibility that many of the 4.5 million people who were found eligible for subsidized insurance through the federal exchange would drop their new coverage (Goodnough, 7/23).

The Wall Street Journal: Key Question On Health-Law Subsidies: Were Plaintiffs Harmed?
That argument is simmering beneath court battles about the legality of insurance subsidies tied to the Affordable Care Act. Mr. Klemencic is a key plaintiff in a case in which a Washington, D.C., court Tuesday invalidated subsidies for consumers in up to 36 states, the ones relying on a federal insurance exchange. Whether challengers like Mr. Klemencic had legal standing to sue the Obama administration in the first place turns on whether he was harmed by the subsidies. The ruling struck down an Internal Revenue Service rule that said qualifying consumers could receive subsidies whether they bought coverage on a state-run insurance exchange or a federal one. A second court, in Virginia, upheld the legality of the subsidies in another ruling Tuesday (Kendall, 7/23).

The New York Times: Bolstered By Ruling, Republicans Attack Health Law
Republicans in Congress resumed their campaign against the Affordable Care Act on Wednesday with new zeal, fired up by a ruling of a federal appeals court panel that said premium subsidies paid to millions of Americans in 36 states were illegal. Republicans pointed to the ruling as evidence of problems in the law that could not easily be solved (Pear, 7/23).

The Associated Press: Study: 10M Have Gained Coverage Through Health Law
A new study estimates that more than 10 million adults gained health insurance by midyear as the coverage expansion under President Barack Obama's law took hold in much of the country. The study published Wednesday in the New England Journal of Medicine found that the share of Americans ages 18 to 64 without insurance dropped by a little more than 5 percentage points (7/23).

Politico: New England Journal Of Medicine Report: 10 Million Newly Insured
The Obama administration is touting yet another study showing that the Affordable Care Act has expanded health insurance to millions of Americans -; this one published in the New England Journal of Medicine and estimating that 10 million have gained coverage under the law. Using Gallup polling and HHS data, Harvard researchers estimate that the uninsured rate declined by 5.2 percentage points in the second quarter of this year, corresponding to 10.3 million adults gaining coverage -; although that could range from 7.3 to 17.2 million depending on how the data are interpreted. At least one researcher also has an HHS affiliation (Winfield Cunningham, 7/23).

ProPublica/NPR: Federal Health Exchange Stays Busy After Open Enrollment Ends
For months, journalists and politicians fixated on the number of people signing up for health insurance through the federal exchange created as part of the Affordable Care Act. It turned out that more than 5 million people signed up using HealthCare.gov by April 19 (Ornstein, 7/23).

The Associated Press: Medicaid Enrollees Strain Oregon
Low-income Oregon residents were supposed to be big winners after the state expanded Medicaid under the federal health care overhaul and created a new system to improve the care they received. But an Associated Press review shows that an unexpected rush of enrollees has strained the capacity of the revamped network that was endorsed as a potential national model, locking out some patients, forcing others to wait months for medical appointments and prompting a spike in emergency room visits, which state officials had been actively seeking to avoid (7/23).

Politico: GAO: Too Early To Draw Obamacare Fraud Conclusions
It's too early to draw conclusions about fraud in the Obamacare marketplaces, a congressional investigator said at a hearing focused on a report finding 11 out of 12 fake applicants were able to obtain subsidized health insurance. Republicans jumped on the report as proof that the health care law invites fraud, but the Government Accountability Office official said the sample is too small and investigators "can't draw any conclusions" until their work is complete. The investigation is ongoing, GAO's Seto Bagdoyan said, and the "intent of this sample was not to project in any way" based on this initial stage of work, but instead to identify areas of potential focus for future work (Weinger, 7/23).

USA Today: Health Care Jobs Lift Less-Educated Workers
The boom in health care jobs is skewed toward positions requiring less education, providing lower-paid workers a potential pathway to better careers, a new Brookings Institution report says. From 2000 to 2011, the number of workers in 10 large health care occupations who had less than a bachelor's degree surged 46%, vs. 39% growth for all health care jobs, the study says (Davidson, 7/24).

The Washington Post's The Fact Checker: Exemptions For Congressional Staff In 'Obamacare,' Or Hypocrisy?
This is a complicated issue which we have explored before, but we will try to keep it simple. The health-care law requires members of Congress and at least some staffers to leave the Federal Employees Health Benefit Program (FEHBP) and join the health-care exchanges (Kessler, 7/23).

The Washington Post: Paul Ryan To Unveil Anti-Poverty Plan
The new proposal, called an "Opportunity Grant," would begin on a pilot basis. It would consolidate a range of safety-net programs -; from food stamps to housing vouchers -; into a single grant offered to states. State governments, working with local officials and nonprofit and faith groups, would then distribute the money, with strict accountability standards. Medicaid, the health program for the poor, would not be included (Goldfarb, 7/22).

The Wall Street Journal: Paul Ryan To Propose Sweeping Consolidation In Antipoverty Pitch
A signature part of Mr. Ryan's past budget plans has been deep reductions in spending on Medicaid, the hybrid state and federal health care program for the poor. Mr. Ryan, in his op-ed, didn't say whether Medicaid spending would be effected by his Opportunity Grant plan (Paletta, 7/23).

The New York Times: Gilead Reports Strong Sales of Sovaldi, Putting It On Pace to Become A Blockbuster 
Sales of the new hepatitis C drug Sovaldi reached $3.5 billion in the second quarter, a huge figure that puts it on track to become one of the world's best-selling medicines but could intensify concerns about society's ability to pay for it. The sales, announced on Wednesday by Gilead Sciences, were an increase from the $2.3 billion in the first three months of the year, the first full quarter of sales since the drug's approval in December (Pollack, 7/23).

The Wall Street Journal: Hepatitis C Pill Rockets Gilead Into Big Leagues
For decades, a liver disease that would slowly kill the infected person didn't even have a name, let alone an effective medicine. Now, a new pill promising to cure most cases of the disease, eventually called hepatitis C, is believed to be the biggest new drug launch ever, catapulting maker Gilead Sciences Inc. 13% into the ranks of the top-selling pharmaceutical companies (Rockoff, 7/23).

Politico: Robert McDonald Could Soon Be Confirmed To VA
The Senate is expected to vote on the White House's nominee to lead the embattled Department of Veterans Affairs before senators leave for a five-week August recess, Sen. Bernie Sanders (I-Vt.) said on Wednesday (French, 7/23).

Politico: CDC Lab Head Quits After Anthrax Scare
The head of a laboratory at the Centers for Disease Control and Prevention in the spotlight after dozens of employees were potentially exposed to live anthrax bacteria has resigned. Michael Farrell resigned on Tuesday, CDC spokesman Tom Skinner said. Farrell had led the Bioterror Rapid Response and Advanced Technology laboratory on the agency's Atlanta campus since 2009 (Norman, 7/23).

The Wall Street Journal: Invoking Anti-Fraud Law, Louisiana Doctor Gets Rich
Over two decades, the 65-year-old internist has filed 12 lawsuits accusing health-care companies of defrauding taxpayer-funded programs such as Medicare. Five of his suits have together led the government to recover hundreds of millions of dollars. Those successful suits have also enriched Dr. LaCorte, who has received a $38 million cut under a federal law that encourages fraud reporting. Much was from a $250 million U.S. settlement with Merck & Co. in 2008 over allegations it overcharged Medicaid for Pepcid, a heartburn drug. He used part of his portion to buy a boat he named Pepsid (Loftus, 7/23).

The Washington Post: Virginia Psychiatric-Bed Registry Does Not Work As Intended, Lawmakers Told
A four-month-old psychiatric-bed registry that is supposed to provide up-to-the-minute information for Virginians who need emergency mental health treatment is being updated as seldom as once a day, state officials told a panel of lawmakers this week (Shin, 7/22).

The Associated Press: Healthy Virginians Aim Of State Panel
First lady Dorothy McAuliffe is joining a panel of public health experts intent on promoting policies to ensure a healthier Virginia. The Virginia Department of Health is convening the meeting Wednesday at the University of Virginia in Charlottesville. Called the "Excellence in State Public Health Law Conference," the meeting is intended to assess policy proposals for improving the health of all Virginians (7/23).

NPR: States Help New Mothers Get Birth Control Through Medicaid
Here's the catch: Her Medicaid plan won't pay for contraception if she tries to get it while she's still at the hospital. New York has just joined five other states in making it easier for our fictional mom to have access to the kind of family planning options she was seeking without worrying about the price tag. At first glance this is a technical issue about Medicaid reimbursements. But it is also about postpartum contraception and which women have access to it (Farrington, 7/23).