First Edition: May 20, 2014

Today's headlines include the latest reports on various states' challenges related to expanding the Medicaid program.

Kaiser Health News: Patients Lose When Doctors Can't Do Good Physical Exams
Reporting for Kaiser Health News, in collaboration with The Washington Post, Sandra G. Boodman writes: "Doctors at a Northern California hospital, concerned that a 40-year-old woman with sky-high blood pressure and confusion might have a blood clot, order a CT scan of her lungs. To their surprise, the scan reveals not a clot but large cancers in both breasts that have spread throughout her body" (Boodman, 5/20). Read the story.

Kaiser Health News: Insuring Your Health: What Happens To A Consumer Who Gets Exchange Plan Buyers' Remorse?
Kaiser Health News consumer columnist Michelle Andrews answers questions from reader who are confused about the health law (5/20). Read her responses.

Kaiser Health News: Capsules: Study: Limited Competition Raised Obamacare Prices
Now on Kaiser Health News' blog, Jay Hancock reports: "Many insurers only dipped a toe into the Affordable Care Act's online marketplaces for their first year. Cigna, one of the country's largest insurers, offered 2014 plans to individuals in fewer than half a dozen states. Humana is only in a little more than a dozen states. The biggest health insurer, UnitedHealthcare, didn't offer any policies through the federally run online portal and only a few elsewhere. The result: substantially higher premiums than otherwise would have been the case, according to a new paper" (Hancock, 5/19). Check out what else is on the blog.

Politico: Free Preventive Care Can Still Cost
"Free" preventive health care is one of Obamacare's chief selling points. But as millions of newly covered people begin to seek that benefit, some are still getting stuck with bills. The Affordable Care Act requires insurers to pay the full cost of services like cholesterol checks, women's birth control, immunizations, colonoscopy screenings and a host of other items. It also covers "well visits" for children and adults -; periodic checkups not triggered by a particular health complain (Norman, 5/19).

The Washington Post: Pence Promotes Alternative Health Care Proposal
The Republican governor introduced his state proposal that he says would act as an alternative to Medicaid. In a speech to the American Enterprise Institute, Pence said his plan would help expand health coverage for low-income residents but provide more flexibility to allow people to manage their own health care needs (5/19).

The Washington Post: Virginia Budget Situation Worsens
The dire budget news seemed only to drive the House and Senate further apart, as each side used the bleak financials to bolster its case for or against Medicaid expansion. The central sticking point in the budget impasse is whether to open the health-care program for the poor to an additional 400,000 Virginians. Senate budget leaders, who like McAuliffe support expansion, say the shortfall shows how much Virginia needs the federal Medicaid money, which initially would amount to $5 million a day. But House budget leaders, already skeptical that Virginia can afford expansion, says the bleak financials are another reason to keep it at bay (Vozzella, 5/19).

The Associated Press: $300 Million Budget Gap Possible For Va. Budget
Republican and Democrats haven't been able to pass a roughly $96 billion biennial budget for several weeks because of disagreements over whether to expand Medicaid eligibility to as many as 400,000 low income residents. McAuliffe and most Democrats favor expanding eligibility, most Republicans do not. Republicans said Monday they've always had a sense of urgency about passing a state budget. But they said the projected shortfall bolsters their case for passing a budget without Medicaid expansion, saying more reforms of current Medicaid spending are needed first (5/19).

The Wall Street Journal's Washington Wire: California's Medicaid Conundrum
Two recent articles on California's fiscal situation illustrate the mixed messages coming from some states, which face rising costs from expanding Medicaid under the Affordable Care Act even as they grapple with a reduced, and frequently fickle, tax base. … Some states opted to expand Medicaid under the health-care law, raising costs and budgetary pressures at a time of volatile tax revenue. In some cases, the result has been cognitive dissonance. California Gov. Jerry Brown was quoted in Thursday's Journal saying: "We can't spend at the peak of the revenue cycle-;we need to save that money, as much of it as we can." But two days earlier, Mr. Brown had expressed pride in the "huge social commitment" that health-care expansion represented in his state-;even as it caused a billion-dollar overspend (Jacobs, 5/19).

The Associated Press: For Obama, A 2nd-Term Focus On Following Through
Republicans and Democrats alike have voiced anger over troubling allegations of preventable deaths and treatment delays at VA hospitals around the country. While Obama is so far standing by VA Secretary Eric Shinseki, officials say there is urgency in getting the matter under control. As it seeks to shore up its response, the White House is turning to the same playbook it used during the health care enrollment debacle, when Obama dispatched longtime aide Jeffrey Zients to the Health and Human Services Department to oversee efforts to fix the woeful HealthCare.gov website. Obama made a similar move last week, temporarily assigning deputy chief of staff Rob Nabors to the VA to lead an internal review of agency policies (5/20).

The Wall Street Journal: White House Defends VA Nominee Murawsky
The White House on Monday defended President Barack Obama's nominee for a high-ranking Department of Veterans Affairs position, as the administration scrambles to control the fallout from wide-ranging allegations of misconduct at the VA. Just days after the forced resignation of Robert Petzel, undersecretary for health at the VA, White House Press Secretary Jay Carney faced questions about its nominee to replace him, Jeffrey Murawsky, who has served for more than a decade in the VA system. Mr. Murawsky currently oversees a hospital network that includes a Chicago-area VA hospital which allegedly used unauthorized appointment waiting lists that made official wait times seem to fall within VA targets (Kesling, McCain Nelson and Lee, 5/19).

USA Today: Bundled Payments Could Cut Medicare Fraud, Experts Say
Health and policy experts are pushing for a system that pays doctors a lump sum for medical care or allows them to share in savings, saying it will save millions of dollars over current fee-for-service payments that can lead to fraud and over-use of medications. In the new system, doctors would not be entitled to extra pay should they prescribe costlier medication (Kennedy, 5/19).

The Associated Press: Nunn Skirts Question On Health Care Vote
Democratic Senate hopeful Michelle Nunn in Georgia declined to answer questions Monday about whether she would have voted for President Barack Obama's health care overhaul, as candidates in six states went through the final paces of bruising primary campaigns for congressional and statewide offices. Seven Georgia Republicans -; all of whom have called for repeal of the law Republicans deride as "Obamacare" -; are in their own scramble ahead of a Tuesday primary vote that is expected to whittle the field to two runoff candidates (5/19).

Los Angeles Times: L.A. County Supervisorial Candidates Lay Out Visions For Healthcare
But whoever emerges from the field of 11 candidates competing in two districts will have to take a big-picture approach when they assume office in December if they hope to help the county navigate federal healthcare reforms. In separate interviews, District 1 candidate Hilda Solis and District 3 contenders John Duran, Sheila Kuehl and Bobby Shriver described their visions for the second-largest public healthcare system in the nation, with four hospitals and 19 regional clinics (Brown, 5/18). 

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