First Edition: March 3, 2014

Today's headlins include stories detailing ongoing challenges with state-run exchanges as well as previews of what's next regarding the federal budget process.

Kaiser Health News: Administration Faces Opposition To Changes In Medicare Prescription Drug Program
Kaiser Health News staff writer Mary Agnes Carey, working in collaboration with USA Today, reports: "Medicare's prescription drug program was controversial when it arrived, but a decade later it is widely considered to be a Washington success story. Now, though, the Obama administration is proposing a series of significant changes to fix what critics say isn't broken" (Carey, 3/3). Read the story and the related sidebar detailing the proposed changes (3/3).

Kaiser Health News: There's a Life-Saving Hepatitis C Drug. But You May Not Be Able To Afford It.
Kaiser Health News staff writer Julie Appleby, working in collaboration with The Daily Beast, reports: "There's a new drug regimen being touted as a potential cure for a dangerous liver virus that causes hepatitis C. But it costs $84,000 -- or $1,000 a pill. And that price tag is prompting outrage from some consumers and a scramble by insurers to figure out which patients should get the drug -;and who pays for it" (Appleby, 3/3). Read the story.

Politico: Obamacare's Under-The-Radar Sales Push 
President Barack Obama and Vice President Joe Biden spent their week pushing Obamacare -; but most of the country probably didn't notice. The final month of the White House enrollment campaign isn't about daily events in Washington or speeches aimed at a national audience. Instead, Obama, Biden, First Lady Michelle Obama, cabinet members and senior administration officials are showering attention in very targeted ways on African Americans, Latinos, young people and the top 25 cities with the most uninsured Americans (Budoff Brown, 3/1).

The Associated Press: This Month's Big Deadline: What You Need To Know
The big deadline is coming March 31. By that day, for the first time, nearly everyone in the United States is required to be signed up for health insurance or risk paying a fine. Here's what you need to know about this month's open enrollment countdown (Cass, 3/2).

The New York Times: New Law's Demands On Doctors Have Many Seeking a Network
Dr. Sven Jonsson, a primary care physician in this rural community, is seeing a steady tide of new patients under President Obama's health care law, the Affordable Care Act. And so far, it is working out for him. His employer, a big hospital system, provides expensive equipment, takes care of bureaucratic chores and has buffered him from the turmoil of his rapidly changing business (Goodnough, 3/2). 

The Washington Post: New Tax Embedded In Affordable Care Act Affects Homeowners
A new controversial tax embedded in the Affordable Care Act affects homeowners who sell their homes for a substantial profit. Homeowners need to be aware of the new 3.8 percent net investment income tax. While this provision became effective Jan. 1, 2013, its effect is just now being felt by upper-bracket homeowners who have profitably sold their home in 2013. Homeowners planning to sell their home in 2014 are advised to factor this new tax into their sales contract pricing decisions (Jacobs, 2/28).

The New York Times: New Health Fix Offers Subsidies For Insurance Policies Bought Outside Exchanges
The Obama administration said Friday that it would allow some people to receive federal subsidies for health insurance purchased in the private market outside of health insurance exchanges. The sudden shift was the latest in a series of policy changes, extensions and clarifications by federal officials trying to help beneficiaries and minimize political damage to Democrats in this election year. Federal officials said they had agreed to provide such assistance retroactively because technical problems had prevented consumers from using online exchanges to obtain insurance and financial aid in some states (Pear, 2/28).

The Wall Street Journal: Tax Credit Still Available To Some State Health-Exchange Users
The Obama administration said consumers who have had trouble enrolling in health insurance in states running their own exchange could still be eligible for tax credits to help pay for the insurance. The Centers for Medicare and Medicaid Services issued guidelines to states late Thursday allowing them to retroactively apply federal tax credits to certain consumers who tried to sign up for insurance but have gotten stuck in state systems (Corbett Dooren, 2/28).

The Washington Post: Government Expands Help For Buying Health Insurance
In states with dysfunctional insurance marketplaces, the government will for the first time help pay for certain health plans that consumers buy on their own. And once people in those states are able to sign up through the exchanges, their insurance can be made retroactive. These rewritten rules, laid out in a three-page memo, can be used by any state but are aimed primarily at helping people in Maryland and three other states whose exchanges have not been working well. The four states are among 14 that have each created an insurance marketplace under the 2010 Affordable Care Act (Goldstein and Johnson, 2/28).

The Associated Press: Long Waits Frustrate Callers To Health Exchanges
For those trying to enroll through online health exchanges, help has long been advertised as just a phone call away. Yet the challenge in some states has been trying to get a call through at all, never mind the multiple transfers once contact has been made. Long wait times of an hour or more have been commonplace in some states, primarily those running their own health care exchanges. California, Maryland, Minnesota, Nevada and Washington are among the states in which consumers and insurance agents have complained. One consequence is that people just give up because they are unable to wait indefinitely (Witte, 3/1).

Los Angeles Times: California Says 14,500 Must Redo Obamacare Applications After Glitch
California's health insurance exchange said about 14,500 people have to redo their online applications for Obamacare coverage because of a software error. The state's announcement late Friday comes shortly after a five-day outage of the Covered California enrollment website. About 14,500 people who partially completed applications or updated them Feb. 17-19 -- just before the website went down -- have to either start over or resubmit any changes they made, the exchange said (Karlamangla, 2/28).

The Washington Post: Only Nine Marylanders Have Signed Up For The State's Retroactive Health Insurance
Only nine Marylanders have signed up for temporary, retroactive health insurance made possible by emergency legislation aimed at helping people who tried to get coverage through the state's faulty online health insurance marketplace, encountered problems and were stuck with medical bills to pay (Johnson, 3/1).

The Washington Post: About 19,000 Have Paid First Premium Through Maryland Health Insurance Exchange
About 19,000 Marylanders who signed up for a private health insurance plan through the state's new online marketplace have paid their first premium, state health officials announced Friday. Although the state announces its number of private plan enrollees each week, this is the first time officials have made public the number of enrollees who have actually paid for their insurance -; the ultimate sign of commitment and one closely watched by insurance companies (Johnson, 2/28).

The Washington Post: Medicaid Expansion Complicates Va. Budget Negotiations
House and Senate budget negotiators are both incredibly close and hopelessly deadlocked as a deadline looms for reconciling rival state spending plans. Both chambers have passed two-year, $96 billion blueprints that are in step with each other on 99.9 percent of spending. House leaders say the differences -; the House plan is more generous to higher education, for instance, while the Senate gives more to K-12 -; are easy fixes (Vozzella, 3/2). 

Politico: How The Clinton White House Bungled Health Care Reform
Bill and Hillary Clinton understood individual members of Congress just fine. They just didn't get Congress. That's the picture that emerges from the documents released by the Clinton presidential library Friday on their efforts to pass health care reform in the 1990s. For years after the effort failed, the generally accepted storyline was that they cooked up the health care plan in secret, didn't work with Congress enough and that's why it stalled. Not true, according to the documents released Friday (Nather, 2/28).

Los Angeles Times: Papers Offer Peek Into Hillary Clinton's Failed Healthcare Initiative 
As Hillary Rodham Clinton sought to reshape the nation's healthcare system in her husband's first term as president, she got all the right advice from senior aides: Consult closely with members of Congress, build bridges with business leaders, communicate clearly to nervous voters, move swiftly. The first lady and her husband ultimately failed in nearly all those efforts, nearly sinking Bill Clinton's presidency. Thousands of documents released Friday, which detail that failure as well as other policy disputes of the Clinton White House, provide new details on what remains one of the defining chapters in Hillary Clinton's career. The papers also foreshadow the challenges the Obama administration would encounter as the current president worked to pass the Affordable Care Act 16 years later (Levey, Lauter and Reston, 2/28).

The Associated Press/Washington Post: Big Or Small, Spending-Cut Efforts Hit Roadblocks
Indeed, little-noticed but telling events over the past few weeks show lawmakers and the White House are backsliding on spending cuts. President Barack Obama, who's scheduled to release his own federal budget Tuesday, reversed course on a deeply contentious proposal that would curb cost-of-living increases in Social Security. Republicans criticized Obama for backing down but then blasted the administration as it announced it was implementing a new round of Medicare cuts that Congress included in the health care overhaul four years ago (3/3).

The Washington Post: House GOP Budget Will Focus On Reforming Welfare, Overhauling Social Programs
As a direct counter to President Obama's recent emphasis on the gap between rich and poor, the upcoming House Republican budget will focus on welfare reform and recommend a sweeping overhaul of social programs, including Head Start and Medicaid. The push, led by Rep. Paul Ryan, returns the GOP's attention to a policy front that animated the party in the 1990s and signals Republicans' desire to expand their pitch to voters ahead of this year's midterm elections. This new effort comes after the party spent months fixated on combating the federal health-care law and engaged in intraparty squabbles over fiscal strategy (Costa, 3/2).

The Washington Post: Daschle, Former Senators Form Alliance To Lobby For New Telehealth Rules
About eight months ago, Daschle, now a senior policy adviser at the law firm DLA Piper, shifted his focus to "telehealth" -; a system in which health-care providers examine and treat patients virtually. For instance, instead of driving miles and miles to the nearest health center, a rural patient with a minor allergic reaction might use his iPad to chat by video with an available physician to discuss treatment options. But until state and federal health-care laws evolve to address telehealth, Daschle's vision of a national network of virtually accessible doctors is far off (Ravindranath, 3/2).

The Wall Street Journal: Shifting Senate Landscape Draws New Faces
Rep. Cory Gardner of Colorado is in an enviable position, with a safe House seat and bright prospects for joining his party's leadership. So when GOP officials last year asked him to give it all up to run for the Senate, he declined. … But signs of Mr. Udall's political vulnerability grew. Like other Democrats, he drew blame for the troubled rollout of the health-care law. Criticism grew when his office questioned the number of notices the state said people received saying their policies were being canceled because they didn't comply with the standards of the new law (Hook and O'Connor, 3/2).

The New York Times: Giving Early Taste Of G.O.P. Tactics, Texans Make A Stand Against Obama
And an ad for Senator John Cornyn, Republican of Texas, titled "The Truth" accuses Mr. Obama of obfuscating on a variety of issues, including the attack on the United States Mission in Benghazi and the president's signature health care law. … "Senator John Cornyn stands up to President Obama every day, pushes back," concludes a narrator. "John Cornyn's for us, for Texas." Accusing the president of lying in an ad, said Kathleen Hall Jamieson, the director of the Annenberg Public Policy Center at the University of Pennsylvania and an expert on political discourse, is "a very strong attack"(Parker, 3/2). 

NPR: FDA To Increase Access To Generic Morning-After Pills
The Food and Drug Administration has decided to allow generic versions of the most popular form of emergency contraceptive pills to be sold over the counter, without age restrictions, after all. ... in approving [last July] the product for sale without prescription, the FDA also granted Teva Pharmaceuticals, the drug's maker, an additional three years of protection from generic competition because it conducted an additional market study on the product's use by teenagers. ... In something of a compromise, the FDA now says the generic versions of the product must still say on their labels that they are intended for "women 17 years of age or older," but they may be sold directly from retail shelves without a requirement to produce proof of age (Rovner, 3/2).

The Washington Post: Costly Hepatitis Drug Sovaldi Rattles Industry
When the Food and Drug Administration approved a medication called Sovaldi in December, it was hailed as a breakthrough in the fight against hepatitis C, a blood-borne disease that affects 3.2 million Americans and kills more people in the U.S. annually than AIDS. Then California-based Gilead Sciences, the manufacturer, announced the price: $84,000 for a 12-week course, more than what many cancer treatments cost in a year. The hefty price tag has rattled patient advocacy groups and insurance companies, who say most costly new treatments coming on the market are targeted for a smaller patient population. Putting such a premium on a drug that could help so many will be crushing, they say (Somashekhar, 3/1).

Los Angeles Times: Florida Restaurant Chain Adds Healthcare Surcharge To The Tab; Will Others Follow?
A chain of restaurants in central and northern Florida have added a 1% surcharge to its customers' checks to cover healthcare costs for its employees. Eight Gator's Dockside restaurants have instituted the surcharge, the Associated Press reported. Customers' bills show a fee labeled "ACA," which stands for the Affordable Care Act that will require all businesses with 50 or more full-time workers to provide health coverage or pay a fine. For restaurants with more than 100 full-time staff members, the deadline to comply is 2015 (Hallock, 3/1).

The Washington Post: MetroAccess Is A Public Transit Lifeline For People With Disabilities
Mandated by the Americans With Disabilities Act, MetroAccess is vital to many of its 32,000 users, people who are not physically capable of riding Metro's buses or trains or who might feel frightened doing so because of their disabilities. For [Denise Rush, who is blind,] and others, it's a key to an active, fulfilling lifestyle, allowing them to avoid becoming shut-ins or burdens to their families. "This is our connection to the outside world," she says. "We don't have to sit in the dark and just wait and hope someone comes and takes us somewhere." Without transportation, Rush says, she could not keep her job, and losing her job would mean losing her health insurance and possibly her home (Duggan, 3/1).