First Edition: April 7, 2014

Today's headlines include stories about the next round of health law challenges the Obama administration faces as well as the new Medicare Advantage rates scheduled to be announced today.  

Kaiser Health News: Los Angeles County Audit Finds Backlog Of Nursing Home Complaints
Kaiser Health News staff writer Anna Gorman, working in collaboration with the Los Angeles Daily News, reports: "A lack of central oversight of nursing home investigations in Los Angeles County has contributed to a backlog of hundreds of complaints, according to an audit released late Friday. The Los Angeles County Auditor-Controller determined that there were 3,044 open investigations as of March 14, including 945 that have been open for more than two years. The auditor found that there is no central management of the investigations and that surveyors within the Health Facilities Inspections Division, or HFID, do not have set deadlines for completing cases" (Gorman, 4/5). Read the story.

Kaiser Health News: Decoding The High-Stakes Debate Over Medicare Advantage Cuts
Kaiser Health News staff writer Jay Hancock, working in collaboration with The Miami Herald, reports: "The rate change, part of the Affordable Care Act, is the next step in winding down a subsidy that pays Medicare Advantage plans substantially more than what traditional Medicare costs. Proponents say the move will end what they call an industry windfall and pressure insurers, hospitals and doctors to deliver care more efficiently. The industry, which maintains the cuts will raise costs and reduce consumer benefits, has launched a massive national counterattack, running numerous 'seniors are watching' ads, getting beneficiaries to pepper politicians with calls and letters, and lobbying the administration to back off" (Hancock, 4/7). Read the story.

Kaiser Health News: When Connecting With A Dentist Doesn't Mean An Office Visit
Kaiser Health News staff writer Daniela Hernandez, working in collaboration with the Los Angeles Daily News, reports: "It's all part of a free 'teledentistry' program for low-income patients in California who don't have access to regular dental care. Often they're stymied by high costs and a shortage of dentists who treat the poor. Many also face language barriers, lack legal immigration status, are afraid of dentists or have a poor understanding of what causes dental problems" (Hernandez, 4/7). Read the story or watch the related video by Heidi de Marco. 

Kaiser Health News: Capsules: Medicaid Enrollment Increased By 3 Million From October To February
Now on Kaiser Health News blog, Phil Galewitz reports on the latest Medicaid enrollment numbers: "The number of low-income people enrolled in Medicaid rose by 3 million to 62.3 million from October through February as more Americans joined the state-federal insurance program through state and federal online insurance marketplaces, according to a report released Friday by the Department of Health and Human Services" (Galewitz, 4/4). Check out what else is on the blog. 

The Associated Press: Survey: Health Insurance Gains Pick Up
A major new survey finds that a growing percentage of Americans gained health insurance as the initial sign-up season for President Barack Obama's health care law drew to a close last month. Released Monday, the Gallup-Healthways Well-Being Index measured the share of adults without health insurance. That shrank from 17.1 percent at the end of last year to 15.6 percent for the first three months of 2014 (4/7). 

Los Angeles Times: Number Of Americans Without Health Insurance Reaches New Low
The share of Americans without health insurance has dropped to the lowest level since before President Obama took office, according to a new national survey that provides more evidence the healthcare law is extending coverage to millions of the previously uninsured.Just 14.7% of adults lacked coverage in the second half of March, down from 18% in the last quarter of 2013, the survey from Gallup found (Levey, 4/7).

The Associated Press: 7M Enrolled Doesn't Guarantee Health Law's Success
Big challenges are lurking for the next enrollment season, which starts Nov. 15. Chief among them are keeping premiums and other consumer costs in check, and overhauling an enrollment process that was advertised as customer-friendly but turned out to be an ordeal. ... The source of the pent-up demand that propelled health care sign-ups beyond expectations could stem from the nation's new economic reality: a shrinking middle class and many working people treading water in low-paying jobs. Health insurance has been one of the pillars of middle-class security for decades. With fewer jobs these days that provide health benefits, there was an opening for a government program to subsidize private insurance (Alonso-Zaldivar, 4/5).

Politico: Obama's Challenge: Don't Blow It
Obama's got a history of watching his victories slip away before fully capitalizing on them. Last year alone, his reelection bump disappeared into a triple whammy of low-grade spring scandals. Then, all the goodwill he had coming out of the government shutdown was eclipsed by the devastating HealthCare.gov rollout. Not only does this give him a chance to show that he and his party actually can be trusted to run government and a shot at reclaiming the narrative of his presidency, it comes just in time for the midterm elections that will determine his party's fate in 2014 -; and his own over the next three years (Dovere, 4/6). 

NPR: With Enrollee Goal Met, Obamacare Still Faces Political Trial
President Obama and his supporters had a rare opportunity to celebrate this week. A last-minute surge in people signing up for health insurance sent the total government enrollment figures over the seven-million mark. That number seemed out of reach just a few months ago, when a crash-prone website threatened to undermine the president's signature health care law. Republicans are still bent on repealing the law, but now millions more Americans have a stake in Obamacare's survival (Horsley, 4/5). 

Politico: Enrollment In Medicaid, Children's Health Program Grows By 3 Million 
Figures released Friday by the Obama administration show that over that five-month period, a total of 11.7 million people were determined eligible for the two programs. Both numbers could rise further once all states finish reporting their data, officials said. ... The biggest change in Medicaid came in Oregon. The state has one of the nation's worst health exchange websites -; which still cannot process an application entirely online -; but it is operating a "fast track" program that helped to drive a 34.8 percent spike in Medicaid enrollment from September to February (Haberkorn, 4/4).

The Associated Press: Health Care Bill Helps Add 3 Million To Medicaid
Many were newly eligible because of the law's Medicaid expansion, while others already eligible but not yet enrolled came forward due to publicity around the law and its requirement for individuals to carry insurance or risk paying a fine, analysts said. It brings to around 62 million the total number of people covered under Medicaid and the Children's Health Insurance Program. The 3 million figure is incomplete because a handful of states didn't report their numbers, and it doesn't include sign-ups in March (Werner, 4/4).

The Wall Street Journal: Health-Care Law Helps Add 3 Million To Medicaid
The Obama administration said Friday that three million additional Americans were enrolled in Medicaid as of the end of February than were in the program before the start of the health law's open enrollment period Oct. 1, suggesting the law allowed more people to gain Medicaid coverage. Tracking new enrollment figures for Medicaid and the Children's Health Insurance Program under the health law is tricky because figures include people already in the program or those whose coverage is being renewed in addition to those eligible for Medicaid before the health law took full effect (Corbett Dooren, 4/4).

The Washington Post: Medicaid, CHIP Enrollment Grows By More Than 3 Million, CMS Data Shows
White House officials pointed to the data as growing evidence that more people are gaining coverage as a result of the Affordable Care Act. This week, the White House announced that 7.1 million people had signed up for health coverage as of March 31 on the marketplaces, marking a turnaround from the troubled beginnings of enrollment last fall (Sun and Millman, 4/4). 

Los Angeles Times: Computer Glitches Hamper Healthcare Delivery To California's Poor
Reginald Clarke is someone Obamacare was designed to help. The 55-year-old, who was homeless for a time, now has an apartment in Gardena and a street-cleaning job that pays him $14,000 a year. ... joy turned to exasperation when Clarke's application, filed in December, was mistakenly rejected -; and then seemed to disappear from county and state computer systems. ... And while the period to apply for private insurance through the state has ended, enrollment in Medi-Cal remains open. About 800,000 applications for that coverage are pending approval statewide, according to the Department of Health Care Services in Sacramento Brown, 4/5).

The Associated Press: GOP Seeks Coverage Choices In Health Law They Hate
House Republicans quietly secured a recent change in President Barack Obama's health law to expand coverage choices, a striking, one-of-a-kind departure from dozens of high-decibel attempts to repeal or dismember it. Democrats describe the change involving small-business coverage options as a straightforward improvement of the type they are eager to make ... No member of the House GOP leadership has publicly hailed the fix, which was tucked, at Republicans' request, into legislation preventing a cut in payments to doctors who treat Medicare patients (Espo, 4/6).

The Washington Post's The Fact Checker: McConnell's Stale, Inflated Claim About Health Plan Cancellations
We have explained before that, depending on the phrasing, this can be a misleading comparison. But the gap in the numbers in McConnell's op-ed jumped out at The Fact Checker, especially because Kentucky is a rare example of a red state building an exchange that, by most accounts, has operated smoothly. What's behind these numbers? (Kessler, 4/7).

The Wall Street Journal: Some Democrats Fight Obama Over Medicare
More than two dozen Democrats are fighting the Obama administration over planned cuts to private plans offered in Medicare, tied in part to the 2010 health overhaul, which could divide the party on health care in the run-up to this year's midterm elections. The cuts to Medicare Advantage insurers, which are expected to be included in planned 2015 payments to be unveiled Monday, have drawn increasingly vocal opposition from Democrats who fear that insurers will use the cuts to justify higher premiums or fewer options for enrollees (Peterson and Mathews, 4/6).

Politico: Senate Leaders Give Floor Time To Vulnerable Dems 
At-risk senators will get to beef up their back-home cred by taking the lead on bills and amendments tailored to their campaigns. And they won't be stuck in the back row at news conferences but will be in front of TV cameras and taking center stage during Senate debates. It's all part of an effort to blunt a furious Republican midterm campaign centered on attacking President Barack Obama and Democrats in the Senate who supported his signature health care law (Everett and Goode, 4/6).

Politico: GOP Confident About Paul Ryan's Budget
For a time last week, Ryan's budget encountered problems as conservatives threatened to oppose the proposal to express frustration about a controversial parliamentary maneuver GOP leadership deployed to pass the "doc fix." Though it seems that leadership has minimized the opposition, Republicans privately concede that they'll most likely pass the 2015 budget by the slimmest margin in their four years in power (Bresnahan and Sherman, 4/6). 

The New York Times: Even Small Medical Advances Can Mean Big Jumps In Bills
Traditionally, insurers lost money by covering people with chronic illnesses, because they often ended up hospitalized with myriad complications as their diseases progressed. Today, the routine care costs of many chronic illnesses eclipse that of acute care because new treatments that keep patients well have become a multibillion-dollar business opportunity for device and drug makers and medical providers (Rosenthal, 4/5).

The Washington Post: Why Walk-In Health Care Is A Fast-Growing Profit Center For Retail Chains
CVS is fast expanding its Minute Clinics, exemplifying a trend of retailers opening health-care services to supplement traditional doctors' offices. CVS, the largest retail clinic operator in the Washington area, has 800 clinics nationwide, and it expects to add 150 more this year and to have 1,500 clinics by 2017, or almost as many as the more than 1,600 retail clinics across the country now, according to the Convenient Care Association. Retail walk-in clinics are relatively new on the health-care landscape, dating to 2000. After several years of very slow growth coinciding with the recession and its aftermath, they are taking off again (Hamilton, 4/4).

Los Angeles Times: Hawaii's Trailblazing Healthcare Underscores Disparity 
Hawaiians live longer than their counterparts on the mainland. They die less frequently from common diseases, such as breast and colon cancers, even though these cancers occur more often here than in most other states. They also pay less for their care; the state's healthcare costs are among the lowest in the country. Hawaii's success owes much to the state's trailblazing health system and its long history of near-universal health insurance. Forty years ago, the state became the first to require employers to provide health benefits (Levey, 4/5).

The New York Times: New York's Paid Sick Leave Law Quietly Takes Effect
Shiv Puri gathered his employees together after the lunchtime rush last week to deliver the big news: This year, the cook and kitchen staff at the Bombay Sandwich Co. on West 27th Street will receive paid sick leave for the very first time. ... His eight employees were thrilled. No surprise there. But Mr. Puri, a new business owner, was feeling pretty good, too ... The law went into effect on April 1. ... without hoopla or hullabaloo, the city quietly became the largest in the nation to ensure that the vast majority of workers wouldn't lose their jobs or a portion of their paychecks if they or their close relatives got sick (Swarns, 4/6).

The Associated Press: Study: Asthma Has $1.3B Impact On New York
Asthma is costing New York's Medicaid system more than half a billion dollars a year, according to a report released Friday that urges the state to do more to help those affected by the respiratory illness. The study by state Comptroller Thomas DiNapoli found that Medicaid costs related to asthma were $532 million in 2013, an increase of more than 26 percent over five years (4/4).