First Edition: April 24, 2014

Today's headlines include a number of reports about how the health law is playing in midterm election campaigns.   

The Wall Street Journal: Small Businesses Find Benefits, Costs As They Navigate Affordable Care Act
Many small businesses won a reprieve from having to provide health insurance under the Affordable Care Act until 2015 or later. But the law is already having a lasting impact on how lots of owners choose to run their companies. Some owners have begun to weigh strategies that might help them avoid complying with the law later on, such as opting out of providing the required coverage and instead paying a federal penalty of $2,000 for each full-time worker after the first 30. Others have begun restructuring their businesses, reducing their employees' hours, for example, or trimming their total head counts to fewer than 50 full-time workers (Needleman and Loten, 4/23).

Politico: Study Questions Obamacare Impact On Canceled Plans
Millions of the plans that were canceled because they did not meet Affordable Care Act requirements probably would have been canceled anyway -; by the policyholders, a new study suggests. Last fall, as cancellation letters arrived in mailboxes around the country, opponents of the law cited them as evidence that President Barack Obama had lied to Americans when he promised, "If you like your health care plan, you can keep it" (Wheaton, 4/23).

The New York Times: Southerners Don't Like Obamacare. They Also Don't Want To Repeal It.
Despite strong dislike of President Obama's handling of health care, a majority of people in three Southern states – Kentucky, Louisiana and North Carolina – would rather that Congress improve his signature health care law than repeal and replace it, according to a New York Times Upshot/Kaiser Family Foundation poll (Tavernise and Kopicki, 4/23).

The New York Times' The Upshot: Health Law's Middle-Ground Approach Leaves It Unloved
The legacy achievement of the Obama administration has also become its largest political conundrum. Many Americans disapprove of the Affordable Care Act -; but for different reasons, coming from different sides. To get the law through Congress (barely), the administration chose a middle ground that relies on the private insurance system and a mandate that individuals buy insurance. To many Americans, especially conservatives, that approach involves too much government involvement. To many others, the approach involves too little; they would prefer that government insure most people directly, as it does for older people through Medicare. Obamacare, however, exists in a middle ground between the two (Kopicki, 4/23).

The New York Times' The Upshot: Despite Poll, Problems Lurk For Democratic Incumbents In South
Other Democrats face a similar challenge: In every contest, at least 10 percent of Democratic supporters oppose the Affordable Care Act and say they wouldn't vote for a candidate who disagrees with their stance. All four Democratic Senate candidates in these states support the law (Cohn, 4/23).

Los Angeles Times: New Senate Polls Offer Three Lessons And Some Hope For Democrats
Both Beebe and Beshear have backed expansion of healthcare coverage under the Affordable Care Act. Beshear, in particular, has attracted national attention for Kentucky's successful introduction of the new law. Both have expanded Medicaid coverage in their states. Jindal and McCrory have opposed the law and have blocked Medicaid expansion. Jindal's position on healthcare could be an issue in Louisiana's Senate race. The Democratic incumbent, Sen. Mary Landrieu, attacked Republicans in a recent interview for blocking Medicaid expansion (Lauter, 4/23).

The Washington Post's The Fact Checker: Four New Americans For Prosperity Ads Take On Obamacare
Americans for Prosperity, the limited-government group that has spent $35 million attacking Democrats over the Affordable Care Act, released four ads on Tuesday-;in New Hampshire, Louisiana, Colorado and Michigan.Here's a roundup of fact checks of these ads (Kessler, 4/24).

The Associated Press: Technology Group To Decide Cover Oregon's Future
The technology committee will decide whether Cover Oregon should ditch its glitch-filled website and replace it with the federal government's health insurance marketplace, or try to fix the existing system with the help of a new IT contractor. The decision comes nearly seven months after Oregon's exchange was supposed to go live so that residents could use it to compare and buy health insurance plans (4/24).

The Washington Post: Gansler Calls Maryland's Health Exchange A '$200 Million Failure' In Latest TV Ad
Maryland gubernatorial hopeful Douglas F. Gansler on Wednesday released his third television ad on health care, promising to "get tough" on proposed rate hikes by insurance companies and calling the state's online health exchange "a nearly $200 million failure." The 30-second spot, which Gansler's campaign said will debut Thursday in the Baltimore market, is Gansler's latest attempt to call attention to problems with the exchange, for which he has sought to pin blame on Democratic rival Anthony G. Brown (Wagner, 4/23).

The Washington Post: Va. Lawmakers Fail To Override Any Of Governor's Vetoes
The General Assembly returned to the Capitol for its annual "veto session" to consider the 60 bills McAuliffe amended and four of the five he had vetoed. (The fifth veto had been sustained during the regular session.) It took no action on the overdue state budget, which has been deadlocked by an impasse over Medicaid. But rancor over the budget and Medicaid spilled over into Wednesday's work in floor speeches and Republican claims that the governor had vetoed the red-light bill to retaliate against the Democrat who opposed expansion (Vozzella, 4/23).

The Associated Press: Virginia Lawmakers Sustain McAuliffe Vetoes
The General Assembly did not take up the state's proposed $96 billion two-year budget. Republicans and Democrats remain deadlocked on whether the budget should include expanding Medicaid eligibility to about 400,000 low-income residents. State government could shut down if no budget is passed by July 1. At a news conference, Senate Democratic Leader Richard L. Saslaw of Fairfax accused Republican lawmakers who oppose Medicaid but have state-funded health insurance of being hypocritical. On the House floor, Del. Tim Hugo, R-Fairfax, accused McAuliffe of "extorting" the entire state by insisting on a budget that includes expanding Medicaid eligibility (4/23).

The Washington Post's Wonkblog: A Year After Arizona Approved Medicaid Expansion, Brewer Still Fighting For It
Arizona Gov. Jan Brewer fought harder than any Republican governor last year to push through Obamacare's Medicaid expansion. Almost a year later, she's still fighting opposition to it on two fronts. First, she vetoed a bill Tuesday that would have capped the Medicaid program. … Even if Brewer had signed the bill, it's unlikely the law would have taken effect in Arizona. It would have had to pass review by the Centers for Medicare and Medicaid Services, which had already warned that the Arizona bill ran counter to the goals of the Medicaid program (Millman, 4/23).

The Associated Press: Louisiana: Medicaid Expansion Is Rejected Again
Lawmakers have again turned away efforts to expand the state Medicaid program under the federal health care law, with the Senate health committee voting 6 to 2 on Wednesday against an expansion (4/24).

The New York Times: Forecast Cut On Spending For Health
The Congressional Budget Office has reduced by one-third its estimate of how much more states will spend on Medicaid in the coming decade because of the Affordable Care Act. In early February, the budget office estimated that state spending on Medicaid and a related program for children would be $70 billion higher from 2015 to 2024 because of the law's coverage provisions. In a new report, the budget office puts the cost at $46 billion (Pear, 4/23).

The Associated Press: Wellness Programs Grow More Popular With Employers
More companies are starting or expanding wellness programs that aim to reduce their medical costs by improving their employees' health. They're asking workers to take physical exams, complete detailed health assessments and focus on controlling conditions such as diabetes. Along with that, many companies also are dangling the threat of higher monthly insurance premiums to prod workers into action (4/23).

The Wall Street Journal: Aetna Raises Outlook On Strong Quarterly Growth
The company raised its full-year operating earnings forecast to $6.35 to $6.55 a share from its prior view of at least $6.25 a share. The insurer in February said it expects to lose money on its business in the Affordable Care Act marketplaces this year, with the demographics of enrollees skewing slightly more than expected toward people likely to rack up higher costs. Still, the company noted that individual insurance represents a small part of operating revenue (Rubin, 4/24).

NPR: Costly Hepatitis C Pill Shreds Drug Industry Sales Record
The launch of Sovaldi, the $1,000-a-day pill for hepatitis C, is shaping up as the most successful ever. The Food and Drug Administration approved the pill in December. And then Gilead Sciences was off to the races. The company said it sold $2.27 billion worth of Sovaldi in the quarter that ended March 31. $2.27 billion! The boffo number beat Wall Street's estimate for the quarter by more than $1 billion (Hensley, 4/23).

The Associated Press: Feds: Home Health Company Paying $150 M Settlement
Amedisys Inc., a Baton Rouge-based home health company, will pay $150 million to resolve allegations that it inflated Medicare billings and had improper financial relationships with referring physicians, the U.S. Department of Justice said Wednesday. Amedisys and its affiliates make up one of the nation's largest home health providers, operating in 37 states, Washington, D.C., and Puerto Rico, according to a Justice Department news release (4/23).

The Wall Street Journal: Amedisys To Pay $150 Million to Resolve Medicare Fraud Allegations
The Department of Justice had been investigating allegations that between 2008 and 2010, Amedisys billed Medicare for services that were medically unnecessary, and misrepresented patients' conditions to increase its payments from Medicare, the U.S. Attorney in Philadelphia said in a statement Wednesday. Based in Baton Rouge, La., Amedisys provides at-home nursing care and physical therapy in 37 states (Whalen, 4/23).

The Associated Press: Mississippi: Governor Signs Abortion Restriction
Gov. Phil Bryant signed a bill on Wednesday to ban abortion starting at the midpoint of a full-term pregnancy. Supporters say the measure will protect women's health; opponents say it is unconstitutional (4/24).

The Wall Street Journal: Creditors Seek To Force D.C. Hospital Into Bankruptcy
A group of businesses owed more than $2.5 million by Washington, D.C.'s Specialty Hospital is seeking to push the troubled health-care facility into bankruptcy. Creditors of Specialty Hospital of Washington LLC, which runs the city's only long-term acute-care hospitals, Wednesday filed an involuntary bankruptcy petition against the facility in U.S. Bankruptcy Court in Wilmington, Del (Fitzgerald, 4/23).