First Edition: April 28, 2014

Today's headlines include a number of stories examining the impact of the health law in various states.   

Kaiser Health News: Health Plans Scramble To Calculate 2015 Rates
Kaiser Health News staff writer Jay Hancock, working in collaboration with The Washington Post, reports: "With the results sure to affect politics as well as pocketbooks, health insurers are already preparing to raise rates next year for plans issued under the Affordable Care Act. But their calculation about how much depends on their ability to predict how newly enrolled customers – for whom little is known regarding health status and medical needs -- will affect 2015 costs" (Hancock, 4/28). Read the story.

Kaiser Health News: Low T Business Is Booming, Despite Questions About Risks
Kaiser Health News staff writer Sarah Varney, working in collaboration with NPR, reports: "t is perhaps the biggest men's health craze since Rogaine or Viagra: so-called low testosterone clinics, which have rapidly grown in cities and suburbs all across the country. But these "low T" clinics have also drawn the ire of leading urologists and endocrinologists who question the clinics' safety" (Varney, 4/28). Read the story.

Kaiser Health News: Capsules: Oregon Raises White Flag Over Its Health Exchange; Study: Costly Breast Cancer Treatment More Common At For-Profit Hospitals; First-Aid Training For Mental Health Could Aid At-Risk Veterans
Now on Kaiser Health News' blog, Oregon Public Radio's Kristian Foden-Vencil reports on Oregon's decision to switch to the federal health exchange: "Oregon has been "all in" on health reform. Its embrace of the Affordable Care Act includes a very successful Medicaid expansion, a $2 billion federal experiment to show the state can save money by managing patients' care better, and, of course, the state's own online marketplace to sell Obamacare insurance. But that last point has been a huge problem. The Cover Oregon board decided on Friday to ditch its troubled website and join up with the federal Healthcare.gov exchange instead" (Foden-Vencil, 4/28). 

Also on the blog, Roni Caryn Rabin reports on a study regarding breast cancer treatment costs: "Older breast cancer patients who received radiation treatment after surgery were more likely to undergo a more expensive and somewhat controversial type of radiation called brachytherapy if they got their care at for-profit rather than nonprofit hospitals, a new study reports (Rabin, 4/28). 

In addition, Lisa Gillespie writes about mental health first aid: "When done right, first aid quickly identifies a problem and triages patients so the more urgent cases get treated first and followed up on. Now, with federal aid, that same strategy will apply to the pressing problem of veterans' mental health. A push for new funding -; and the use of existing funds -; may soon make more resources available to help identify vets who need help with depression or other mental illness through the National Council for Behavioral Health's Mental Health First Aid training" (Gillespie, 4/25). Check out what else is on the blog. 

The New York Times: Health Law's Pay Policy Is Skewed, Panel Finds
Federal policies to reward high-quality health care are unfairly penalizing doctors and hospitals that treat large numbers of poor people, according to a new report commissioned by the Obama administration that recommends sweeping changes in payment policy (Pear, 4/27). 

Politico: Behind The Scenes, Much Of Healthcare.Gov Is Still Under Construction
The Obamacare website may work for people buying insurance, but beneath the surface, HealthCare.gov is still missing massive, critical pieces -; and the deadline for finishing them keeps slipping. As a result, the system's "back end" is a tangle of technical workarounds moving billions of taxpayer dollars and consumer-paid premiums between the government and insurers. The parts under construction are essential for key functions such as accurately paying insurers. The longer they lag, experts say, the likelier they'll trigger accounting problems that could leave the public on the hook for higher premium subsidies or health care costs (Cheney, 4/26).

The Washington Post: Deltek: What Contractors Can Learn From The Rollout Of The State Exchanges
The open enrollment period for federally mandated health insurance is now closed, and it's a fitting time to look back on how the state health insurance exchanges performed. Much attention was paid to the difficult rollout of the federal exchange; however, the state exchanges -; with rollouts that ranged from smooth to catastrophic -; are also worth examining (Dixon, 4/27).

The Washington Post: Few Have Sought Exemption From Health-Care Mandate That They Have Insurance Or Pay Fine
The government left the door wide open for millions of Americans to be excused from the Affordable Care Act's requirement that most people must carry health insurance or pay a fine, but so far relatively few have asked for such a pardon. About 77,000 families and individuals have requested exemptions from the health-care law's so-called individual mandate, according to internal government documents obtained by The Washington Post. As of April 20, officials had approved tens of thousands of exemption requests and rejected none (Somashekhar, 4/25).

The New York Times: In Poorest States, Political Stigma Is Depressing Participation In Health Law
Inside the sleek hillside headquarters of Valley Health Systems, built with a grant from the health care law, two employees played an advertisement they had helped produce to promote the law's insurance coverage for young, working-class West Virginians. The ads ran just over 100 times during the recent six-month enrollment period. But three conservative groups ran 12 times as many, to oppose the law and the local Democratic congressman who voted for it. This is a disparity with consequences. Health professionals, state officials, social workers, insurance agents and others trying to make the law work for uninsured Americans say the partisan divisions and attack ads have depressed participation in some places. They say the law has been stigmatized for many who could benefit from it, especially in conservative states like West Virginia that have the poorest, most medically underserved populations but where President Obama and his signature initiative are hugely unpopular (Calmes, 4/26).

The New York Times: New York Will Keep Affordable Care Act Health Plans Restricted
New York State health officials said on Friday that they would not require out-of-network coverage on Affordable Care Act health plans next year, a decision likely to disappoint customers who have complained that they can no longer use their favorite doctors and hospitals. Restricting consumers to a fixed network of doctors and hospitals, called in-network coverage, helps keep costs down, and for the first year, none of the 16 insurance companies in New York's exchange deviated from that model (Hartocollis, 4/25).

The Washington Post: Gansler Hopes To Wield Maryland Health Exchange Woes As A Club Against Brown
Maryland gubernatorial hopeful Douglas F. Gansler is pounding his chief rival, Lt. Gov. Anthony G. Brown, over the state's deeply troubled online health exchange, convinced that the tactic will help him gain ground in the polls ahead of the all-important Democratic primary in June. Gansler, the state attorney general, brought up the health-care "debacle" barely three minutes into his introductory comments at a candidates forum last week. He has highlighted the "mess" in three television ads -; the latest debuted Thursday -; and in one lengthy radio spot. And he has set up a Web site questioning when Brown will "come clean" about the exchange's shortcomings (Wagner, 4/26).

Los Angeles Times: Oregon Scraps State Health Insurance Exchange
Oregon officials voted unanimously Friday to jettison the state's disastrous health insurance exchange and switch to the federal system, admitting disappointment and defeat in an arena where the state had been a trailblazer (La Ganga, 4/25).

The Wall Street Journal: Oregon To Use Healthcare.gov Technology For State Insurance Exchange
An Oregon state board unanimously agreed to a plan Friday to use the federal government's technology to run the state's health insurance exchange. The board overseeing the state's Cover Oregon health insurance exchange adopted a staff recommendation to use the technology behind the federal government's HealthCare.gov website. Gov. John Kitzhaber, a Democrat, has said he supports the decision (Corbett Dooren, 4/25).

The Washington Post: Cover Oregon Officially Admits Enrollment Site Is Broken Beyond Repair
The Oregon board overseeing the state's deeply flawed health insurance exchange unanimously approved the Obama administration's plan Friday to take over the marketplace, making Oregon the first state to drop its enrollment Web site for HealthCare.gov. Directors of the exchange, Cover Oregon, voted Friday to drop its enrollment Web site, which hadn't fully recovered from a failed launch Oct. 1. Oregon, which was awarded $305 million in federal grants to build the exchange, remains the only state not allowing full online enrollment in Affordable Care Act health plans (Millman, 4/25).

Politico: Trio of Democrats Stuck In Medicaid Morass
In Missouri, Montana and Virginia Democratic governors and Republican Legislatures have battled each other to stalemates, preventing hundreds of thousands of low income people from getting covered under the president's health law and fueling the ongoing Obamacare battles leading up to the 2014 elections. Each of these three governors has made Medicaid a central plank of his agenda, and each has slammed into a wall of Republican resistance, failing where their 17 counterparts -; and even nine Republican governors -; have succeeded (Cheney and Haberkorn, 4/27).

The Associated Press: Pennsylvania Awaits Ruling On Medicaid Expansion
Pennsylvania Gov. Tom Corbett has softened his rhetoric while he awaits a federal decision on his request to link a work requirement to benefits under the Medicaid expansion. It's an issue that has flared up in his hotly contested re-election campaign (4/27). 

The Associated Press: Nonprofit Builds Different Kind Of Insurance Firm
Maryland hadn't had a health insurance co-op for 20 years. Then Dr. Peter Beilenson came along. Although Beilenson -; who has held a number of prominent health positions -; describes himself as a staunch advocate for a single-payer health care system, he said he felt compelled to start an insurance company that broke the mold (4/27). 

USA Today/Louisville Courier Journal: Health Care's Appalachian Spring: Obamacare Comes To An Old Battlefield In The War On Poverty
When Eula Hall is asked about Obamacare, you expect this veteran of the war on poverty, who lives in the sickest county in one of the sickest states, to sing hosannas. Instead, she hedges. "I'm glad people without insurance are getting it, but I'm a skeptic," she says of the law. "I can't have high hopes." Hall, a beloved figure who's tended the poorest of the sick at the Mud Creek Clinic here for four decades, shakes her old grey head. "We'll have to wait and see." Her ambivalence, which largely epitomizes Floyd County's reaction to Obamacare, contrasts with some outsized expectations. ... Four months after it took effect, Obamacare here is a neither a train wreck nor a cure-all. It's a work in progress, widely misrepresented and misunderstood. Some people have been helped, some hurt, and many others affected not at all (O'Donnell, Hampson, Kenning and Ungar, 4/26).

USA Today/Louisville Courier Journal: Scenes From Floyd County, Kentucky: A Closer Look At The Affordable Care Act's Impact In Eastern Kentucky
Here's how Paul Deskins, who runs an auto dealership with his son Terry near the Floyd County line, describes his attitude toward the Affordable Care Act's employer health insurance mandates: "We were hoping that Obama thing would go away." Of the many groups affected by Obamacare, small business owners -; those with at least 50 full-time employees -; are among the most aggrieved by the law's requirement to provide their workers with insurance. ... Nearly four of 10 adults in Floyd County, Ky., have lost at least six teeth because of decay or gum disease. Statewide, more than half of adults have had at least one tooth pulled, and a quarter of those over 65 have lost all their teeth. When it comes to dental care, the Affordable Care Act's reach is limited (4/27).

The Wall Street Journal: Health Care May Be Hazardous To Your Credit
It can happen after a job loss, caring for a sick loved one or amid routine confusion over who owes what. A medical bill goes unpaid and ends up in collections, staining your credit for years-;even if you pay or settle the debt. When a bill is beyond past due, some health-care providers sell it to debt collectors, who take a percentage of what they recover. That's typically when the credit-reporting companies have information to act on (Gerencher, 4/27). 

The New York Times: One Therapist, $4 Million In 2012 Medicare Billing
A few miles from the Coney Island boardwalk in Brooklyn stands an outpost of what, on paper, is a giant of American medicine. Nothing about the place hints at the money that is said to flow there. But in 2012, according to federal data, $4.1 million from Medicare coursed through the office in a modest white house on Ocean Avenue (Creswell and Gebeloff, 4/27). 

Politico: Health Care Wonks Turn To 2016
Even before the midterm election that's likely to turn heavily on Obamacare, health care wonks from both parties are already thinking ahead, taking the first early cracks at health care ideas the next White House candidates can use. But the challenges will be starkly different for the two parties (Nather, 4/26).

The Washington Post: Boehner Takes Over Response To Obama, Focuses On Jobs And Health Care
President Obama's record is "littered" with promises -; ranging from an economic stimulus plan to a new health-care law -; that have not panned out, Speaker John A. Boehner (R-Ohio) charged Saturday as he touted measures passed in recent months by the House meant to spur job creation. Boehner spoke during the Republican response to Obama's Saturday morning radio address, a forum usually reserved for rank-and-file lawmakers or GOP governors (O'Keefe, 4/26).

The Washington Post: Specialty Hospital Of Washington Could Be Forced Into Bankruptcy By Creditors
Creditors who say they are owed millions of dollars hope to force two D.C. hospitals into bankruptcy, threatening the city's only facilities dedicated to the long-term care of those suffering from serious and complex maladies (DeBonis, 4/26).

The Wall Street Journal: Waits For Phoenix VA Appointments Drove Sick To ER, Ex-Employee Says
Waits to see primary-care doctors in the Phoenix VA Health Care System were lengthy enough to force some patients to seek help at the emergency room, according to a former employee whose allegations are part of an investigation by the VA's inspector general. Sam Foote, a doctor who retired in 2013 from the Phoenix VA after 24 years, has lodged a number of complaints with the agency's independent inspector general. He has alleged in public appearances and interviews on Thursday and Friday that as many as 40 patients may have died before ever seeing their main doctor (Kesling and Phillips, 4/25).

Los Angeles Times: Senator: Hospitals Reducing Treatment Errors, But Problems Remain 
Calling hospital errors "heartbreaking," U.S. Sen. Barbara Boxer (D-Calif.) on Friday released a report detailing how some California hospitals are reducing medical mistakes that can cause infections, incorrect administration of drugs, falls and other complications. Many medical centers are preventing errors, she said, but others still need to demonstrate they are serious about addressing the problem. According to some researchers, Boxer said, between 210,000 and 440,000 Americans die as a result of medical errors each year -- making medical errors the third leading cause of death in the nation, behind heart disease and cancer (Brown, 4/25).

Los Angeles Times: More Scrutiny For UCLA's School Of Medicine
In the wake of a $10-million payout to a whistleblower, UCLA's School of Medicine is drawing more scrutiny over its financial ties to industry and the possibility that they compromised patient care. A new study in this month's Journal of the American Medical Assn. raised a red flag generally about university officials such as Eugene Washington, the dean of UCLA's medical school who also serves on the board of healthcare giant Johnson & Johnson. The world's biggest medical-products maker paid Washington more than $260,000 in cash and stock last year as a company director (Terhune, 4/25).