First Edition: April 25, 2014

Today's headlines include reports about a recommendation that Oregon switch its troubled health exchange from a state-run marketplace to healthcare.gov.  

Kaiser Health News: With Medical Debts Rising, Doctors Are More Aggressive About Payments
Kaiser Health News staff writer Jenny Gold, working in collaboration with NPR, reports: "The recent economic downturn and the increasing use of high-deductible insurance plans "has driven patients to want to put off paying their bills," Michael explains. Whether it's for a hip replacement or a broken bone, he frequently sees patients on the hook for a $3,000 to $5,000 deductible" (Gold, 4/25). Read the story and the related sidebar by Lexie Verdon.

Kaiser Health News: What Obamacare? Meet 4 People Choosing To Remain Uninsured
Southern California Public Radio's Stephanie O'Neill, working in partnership with Kaiser Health News and NPR, reports: "Despite a surge in enrollment in the two weeks before the April 15 deadline to enroll for insurance under the health law, many more Californians have not signed up. And they're unlikely to. Many people are uninterested in health insurance, confused or skeptical" (O'Neill, 4/25). Read the story. 

Kaiser Health News: Rural Hospitals Face Tough Choices On Computerized Records
Reporting for Kaiser Health News, in partnership with NPR, Eric Whitney writes: "One of the biggest challenges American hospitals face right now is adopting electronic medical records systems. It's costing tens of billions of dollars, eating up tons of staff time and it's especially tough for the country's 2,000 rural and small town hospitals. Rural hospitals are typically cash strapped, and people with information technology skills can be hard to find outside of big cities" (Whitney, 4/24). Read the story. 

Kaiser Health News: A Reader Asks: If Our Income Changes, Can We Change Plans?
Kaiser Health News consumer columnist Michelle Andrews answer this reader's question (4/25). Read her response.

Kaiser Health News: Capsules: Consumers In Federal High-Risk Pools Get Special Enrollment Option For Marketplace; RAND: Medicare Should Weigh Cost In Coverage Decisions
Now on Kaiser Health News' blog, Mary Agnes Carey reports on developments regarding federal high risk pools: "In a notice posted on the Pre-Existing Condition Insurance Plan website, officials said that participants in the high-risk program who have not yet purchased coverage through the health law's online marketplaces, or exchanges, can qualify for the new enrollment period. These people have until June 30 to pick a plan through the federal exchange, healthcare.gov, or their state marketplace, if their state runs one. No matter when they enroll in that time frame, benefits will be effective back to May 1, officials said. State-based marketplaces are adopting a similar special enrollment period" (Carey, 4/25). 

Also on Capsules, Lisa Gillespie reports on the RAND recommendations: "The agency that oversees the Medicare program should be able to consider the cost effectiveness of drugs and medical devices when making coverage determinations, according to a new report by the RAND Corporation" (Gillespie, 4/24). Check out what else is new on the blog.

The New York Times: Democratic Candidates Grow More Vocal In Supporting Health Law
So far, 76 percent of all Republican-sponsored general election spots in House and Senate races this year have attacked the Affordable Care Act, making the law the most mentioned issue in such ads, according to Kantar Media/CMAG, which tracks political advertising. But Democrats, who this cycle have run largely on a "fix, don't repeal" strategy concerning the law, are now gingerly experimenting, mostly in primaries and through outside groups, with ads that endorse the law and also say what could be lost if Republicans repeal it (Parker, 4/24).

Politico: Democrats Race To Embrace Obamacare In Pennsylvania Primary
Democrats vying to be the swing state's next governor are trying to one-up each other in showing their support for the law ahead of the May 20 primary -; airing ads boasting ties to the president, tweeting old OpEds proving their pro-health law bona fides and even suggesting one Democratic contender is a "frenemy" of the law (Schultheis, 4/24).

The Washington Post's The Fact Checker: The Bogus Claim That Obamacare Has Boosted The Number Of Uninsured
Rep. Tim Huelskamp is a tea party favorite who has long been a skeptic of the Affordable Care Act, aka Obamacare, but his recent remarks during a swing of town halls jumped out at The Fact Checker. He referred to "numbers" that showed that, even after all the hoopla about 8 million Americans enrolling on the exchanges, the number of uninsured in Kansas has actually risen since the law went into effect. What is he looking at? (Kessler, 4/25).

The Wall Street Journal's Washington Wire: Insurance Program For Those With Pre-Existing Ailments To End
The Obama administration said there will be no further extensions of the federal health-insurance program for people with pre-existing health conditions, and it will close Wednesday, April 30 (Radnofsky, 4/24).

The New York Times: Oregon Panel Recommends Switch To Federal Health Exchange
With encouragement from the Obama administration, an Oregon panel recommended Thursday that the state scrap the website for its beleaguered health insurance exchange and use the federal marketplace instead. State officials concluded that it would be much less expensive to use the federal site, HealthCare.gov, than to repair the one built specially for the state, Cover Oregon. The first option would cost $4 million to $6 million, while the second would cost $78 million, state officials said (Pear and Johnson, 4/24).

Los Angeles Times: Oregon Leaders To Vote On Scrapping Health Insurance Exchange
Oregon officials will vote Friday on whether to become the first state to scrap its troubled insurance exchange and switch to the federal system, after spending an estimated $248 million on an ambitious exchange that failed in spectacular fashion. Not a single insurance seeker was able to enroll online in a private plan under the Affordable Care Act in this high-tech state, which has long prided itself on healthcare innovation and whose governor is a former emergency room doctor. Cover Oregon instead was forced to resort to paper applications (La Ganga and Reston, 4/24).

The Washington Post: Obama Administration Prepares To Take Over Oregon's Broken Health Insurance Exchange
The collapse of Oregon's insurance marketplace comes as federal health officials are focusing intensely on faltering exchanges in two other states, Maryland and Massachusetts. This month, the board of the Maryland Health Connection became the first in the nation to decide to replace most of its exchange with different technology. But Maryland did not obtain required federal approval before its vote. Federal officials remain uncertain whether the state exchange has the capacity to correct its problems and have not indicated whether they will give Maryland the $40 million to $50 million it says it needs to make the switch. Massachusetts was in the vanguard of insurance exchanges, opening its own years before the 2010 federal health-care law. But the commonwealth's insurance marketplace developed severe technical problems as it tried to make adjustments to interact with the federal system (Goldstein, 4/24).

The Wall Street Journal: Oregon May Give Up on Its Troubled Health-Insurance Exchange Site
The staff of Oregon's troubled health-insurance exchange on Thursday recommended the state switch to the federal government's system for next year's open enrollment. Alex Pettit, acting chief information officer for Cover Oregon, recommended using the U.S. government's HealthCare.gov technology at a meeting Thursday. The recommendation, which is backed by Gov. John Kitzhaber, a Democrat, is set to be discussed Friday at Cover Oregon's board of directors meeting (Corbett Dooren, 4/24).

USA Today: Oregon May Dump Health Exchange For Healthcare.gov
The move comes after an advisory board recommended that the site, often called the worst in the nation, be dropped. Oregonians have signed up for health insurance through a mix of paper applications and the website, a tedious, slow process necessitated by the website's glitches. The state has spent at least $134 million on the site, plus an additional $7 million to process the paper applications because the contractor, Oracle Corp., was never able to fix the website. Federal officials immediately said they would work with states that choose to use the federal site, rather than malfunctioning state sites (Kennedy, 4/24).

Politico: State Health Exchange Still Broken, Oregon Looks To Join Feds
Oregon state officials are ready to hand off their disastrous Obamacare website to the federal government -; a concession backed by the governor that the state won't be able to operate the website on its own any time soon. Oregon is the first state to give up technological control of its Obamacare website and join the federal exchange, an irony considering how busted HealthCare.gov was six months ago (Haberkorn, 4/24).

The Associated Press: Cover Oregon Board To Decide Exchange's Future
Cover Oregon's board will decide Friday whether to approve an advisory committee's recommendation to ditch its troubled portal. Under that option, Oregon would use HealthCare.Gov for private policies but continue using its current system for Medicaid enrollments (4/25).

The Washington Post: Poll: Support For Medicaid Expansion Down Sharply In Virginia
McAuliffe (D) and a slim majority of the evenly divided state Senate have pushed this year to expand Medicaid under the federal Affordable Care Act, saying it would provide insurance to up to 400,000 needy Virginians and boost the economy. The Republican-dominated House has opposed expansion, raising doubts about the federal government's ability to pay most of the $2 billion-a-year cost and stressing the need to first rein in the existing Medicaid program (Vozzella, 4/24).

The Associated Press: Poll: Majority Oppose Va. Medicaid Expansion
A poll from Christopher Newport University's Judy Ford Wason Center for Public Policy poll released Thursday shows that Virginia voters oppose Medicaid expansion 53 percent to 41 percent. In February, the university found the majority of voters favored Medicaid expansion 56 to 38 (4/24).

NPR: How One State Convinced Its 'Young Invicibles' To Get Health Insurance
Enrolling in health insurance often doesn't make good economic sense for healthy young people, as they can end up paying a lot for very little coverage. Why are young invincibles still willing to pay? (Kestenbaum, 4/24).

The Wall Street Journal: Aetna Raises Outlook On Strong Quarterly Growth
Aetna, which is participating in the health-law exchanges in 16 states and the District of Columbia, the most of any insurer, said it had signed up about 230,000 paid members through the end of the first quarter, and was projecting it could have around 450,000 by the close of the year after a surge at the end of the enrollment period. The company said it expected to seek premium increases for next year's exchange business that could range from "low single digits to over double digits" (Mathews and Rubin, 4/24).

The Associated Press: Aetna's 1Q Profit Jumps 36 Pct, Forecast Climbs
Its results breezed past analysts' expectations, and Aetna shares jumped more than 5 percent Thursday after it detailed a starkly different quarter compared with competitor UnitedHealth Group, which dragged down other health insurance stocks last week after it said first quarter earnings fell 8 percent (4/24).

The Washington Post's Wonkblog: Aetna: Late Obamacare Changes Account For Half Of 2015 Premium Increases
Major health insurers are starting to report their first quarter of financial results under Obamacare's new market rules, giving us some perspective on how they're seeing the law's new insurance marketplaces playing out (Millman, 4/24).

USA Today: Some Top Medicare Beneficiaries Spend Heavily To Lobby
he 10 drug companies that make the most money from doctors using their products on Medicare patients spent more than $236 million to lobby Congress and the executive branch between 2009 and 2013, according to lobbying records compiled by the Center for Responsive Politics and new federal data. Those efforts came as lawmakers crafted the sweeping Affordable Care Act and as federal regulators have sought new ways to contain costs in Medicare, the federal insurance program for seniors (Kennedy, 4/24).

The New York Times: Alternative to Pap Test Is Approved By F.D.A.
The Food and Drug Administration on Thursday approved the first alternative to the long-used Pap test as a primary screening method for cervical cancer, in the face of opposition from some women's groups and health organizations. … But a coalition of 17 consumer, women's and health groups opposed the approval, arguing that the new screening method had not been adequately tested and could upend a practice that has successfully prevented cervical cancer for decades (Pollack, 4/24).

The New York Times: A Fight To Keep College Athletes From The Pain of Injury Costs
In the sprawling battle to reform the N.C.A.A., medical care for injured athletes has emerged as a key front, a particularly sensitive subject that has become more important with increased awareness about head injuries. … It is unusual for an athlete to lose a scholarship after an injury, but those worst-case scenarios are part of the reason Huma has helped lead a recent push to unionize Northwestern's scholarship football players. Under N.C.A.A. rules, players can still lose their scholarships after being hurt, often pay for their own insurance and are generally responsible for long-term health care for injuries sustained on the playing field (Strauss, 4/24).

Los Angeles Times: State To Provide $75 Million In Mental Health Grants
State Treasurer Bill Lockyer announced the approval Thursday of $75.3 million in grants that aim to stabilize residents with severe mental illness before they land in jail or suffer multiple hospitalizations. The 20 grants will go to 28 counties for new or expanded services. They will add 827 residential mental health beds and crisis "stabilization" beds, and pay for more than three dozen vehicles and five dozen staff members for mobile support teams, which often accompany local law enforcement to defuse tense situations and direct those in need to care (Romney, 4/24).

The New York Times: NYU Langone Reopens Emergency Room That Was Closed by Hurricane Sandy
A striking sight appeared earlier this week outside the emergency room of NYU Langone Medical Center: an ambulance. Then another. And then many more. The emergency chairman, Dr. Lewis Goldfrank, watched a procession of stretchers throughout the day as if he was welcoming long-lost friends. Other doctors came around so they could witness it for themselves. The occasion was so moving that Dr. Steven Hofstetter, a surgeon, felt that one Yiddish expression for feeling pride was not enough. So he used two (Hartocollis, 4/24).