First Edition: May 27, 2014

Today's early morning highlights from the major news organizations, including reports about the health law's effect on unions and hospitals and a new IRS ruling designed to keep employers from dumping workers onto the law's online marketplaces.

Kaiser Health News: Safety Net Hospitals Already Seeing More Paying Patients -; And Revenue
Kaiser Health News staff writer Phil Galewitz, working in collaboration with USA Today, reports: "One of the biggest beneficiaries of the health law's expansion of coverage to more than 13 million people this year has been the nation's safety-net hospitals, which treat a disproportionate share of poor and uninsured people and therefore face billions of dollars in unpaid bills. Such facilities had expected to see a drop in uninsured patients seeking treatment, but the change has been faster and deeper than most anticipated-; at least in the 25 states that expanded Medicaid in January, according to interviews with safety-net hospital officials across the country" (Galewitz, 5/27). 

Kaiser Health News: States Consider Using Medicaid To Pay College Health Plan Premiums
KHN's consumer columnist Michelle Andrews writes: "Some students headed for college this fall will get top-drawer health coverage at little or no cost, and Medicaid will pick up the tab by paying the premium for the college's student health plan" (Andrews, 5/27). 

Kaiser Health News: Too Early To Calculate Success Of ACA Marketplaces
Reporting for Kaiser Health News, in partnership with NPR and Colorado Public Radio, Eric Whitney writes: "Over $7 billion of taxpayer money went into creating the health law's insurance marketplaces, and about 8 million people signed up. But some experts say it's actually still too early to declare these markets a success or failure. So, what can we say about what the public is getting for its money?" (Whitney,5/27). 

The Wall Street Journal: New Costs From Health Law Snarl Union Contract Talks
Disputes between unions and employers over paying for new costs associated with the Affordable Care Act are roiling labor talks nationwide. Unions and employers are tussling over who will pick up the tab for new mandates, such as coverage for dependent children to age 26, as well as future costs, such as a tax on premium health plans starting in 2018. The question is poised to become a significant point of tension as tens of thousands of labor contracts covering millions of workers expire in the next several years, with ACA-related cost increases ranging from 5% to 12.5% in current talks (Maher and Trottman, 5/26).

The New York Times: Hospitals Look To Health Law, Cutting Charity
Hospital systems around the country have started scaling back financial assistance for lower- and middle-income people without health insurance, hoping to push them into signing up for coverage through the new online marketplaces created under the Affordable Care Act. The trend is troubling to advocates for the uninsured, who say raising fees will inevitably cause some to skip care rather than buy insurance that they consider unaffordable (Goodnough, 5/25).

The New York Times: I.R.S. Bars Employers From Dumping Workers Into Health Exchanges
Many employers had thought they could shift health costs to the government by sending their employees to a health insurance exchange with a tax-free contribution of cash to help pay premiums, but the Obama administration has squelched the idea in a new ruling. Such arrangements do not satisfy the health care law, the administration said, and employers may be subject to a tax penalty of $100 a day -; or $36,500 a year -; for each employee who goes into the individual marketplace. The ruling this month, by the Internal Revenue Service, blocks any wholesale move by employers to dump employees into the exchanges (Pear, 5/25).

The New York Times: Insurers Once On The Fence Plan To Join Health Exchanges In '15
In a sign of the growing potential under the federal health care law, several insurers that have been sitting on the sidelines say they will sell policies on the new exchanges in the coming year, and others plan to expand their offerings to more states. ... In New Hampshire, for example, where Anthem Blue Cross is the only insurer offering individual coverage on the state exchange, two other plans, both from Massachusetts, say they intend to offer policies next year. ... UnitedHealth Group and Cigna, which were notable in their caution about the exchanges last year, are expected to enter more markets this year. In Washington State, United is among four new insurers that have told state regulators they are interested in offering plans in 2015 (Abelson, 5/25).

The Associated Press: Big Insurance Rate Hikes In The Future?
The wild hikes in health insurance rates that blindsided many Americans in recent years may become less frequent because of the health care overhaul. Final rates for 2015 won't be out for months, but early filings from insurers suggest price increases of 10 percent or more. That may sound like a lot, but rates have risen as much as 20 or 30 percent in recent years. The rates that emerge over the next few months for 2015 will carry considerable political weight, since they will come out before Republicans and Democrats settle their fight for Congressional control in next fall's midterm elections. Republicans are vowing to make failures of the law a main theme of their election push, and abnormally high premiums might bolster their argument (Murphy, 5/26).

The Associated Press: Health Law: Embrace, Avoid Or In Between For Dems
Democratic candidates are trying to figure out whether to embrace or avoid President Barack Obama's health care overhaul -; or land somewhere in between. The president says his party shouldn't apologize or go on the defensive about the Affordable Care Act. Candidates aren't so sure (Barrow and Lederman, 5/25).

The Associated Press: Medicaid Surge Triggers Cost Concerns For States
From California to Rhode Island, states are confronting new concerns that their Medicaid costs will rise as a result of the federal health care law. That's likely to revive the debate about how federal decisions can saddle states with unanticipated expenses. Before President Barack Obama's law expanded Medicaid eligibility, millions of people who were already entitled to its safety-net coverage were not enrolled. Those same people are now signing up in unexpectedly high numbers, partly because of publicity about getting insured under the law. For states red or blue, the catch is that they must use more of their own money to cover this particular group (Alonso-Zaldivar, 5/26).

The Washington Post: Health Care Law's Small-Business Exchange Right On Track -; With One Glaring Exception
Six months have passed since the Obama administration announced that the launch of the health care law's online insurance marketplace for small businesses would be delayed until November, more than a year after its originally scheduled start. So, how is the work coming? Six months from now, can small employers across the country expect to finally sign on to a fully functioning health insurance exchange? So far, the answer seems to be yes -; with an asterisk (Harrison, 5/26).

Los Angeles Times: Insurance Plan For Farmworkers Falls Short Of Obamacare Rules
Years ago, legendary activist Cesar Chavez helped create the first health insurance plan for farmworkers who toiled for meager wages in California's fields. ... But like many other insurance plans around the country, it doesn't fully meet requirements set by President Obama's healthcare law. Unless supplemental insurance is purchased, the farmworkers say, 10,700 people could lose coverage. Some Democrats want taxpayers to pick up the $3.2 million tab for the extra insurance so the healthcare plan can keep operating. But the proposed subsidy has sparked concern about Democrats trying to prop up one union's healthcare coverage when other insurance plans have also struggled to meet new federal requirements (Megerian, 5/26).

The Associated Press: Poll: Sign-Ups Rise But Little Love For Health Law
A new Associated Press-GfK poll finds that public opinion continues to run deeply negative on the Affordable Care Act, Obama's signature effort to cover the uninsured. Forty-three percent oppose the law, compared with just 28 percent in support. The pattern illustrates why the health care law remains a favored target for Republicans seeking a Senate majority in the midterm elections (Alonso-Zaldivar and Agriesta, 5/23).

The New York Times: Obama, Honoring the Fallen, Says V.A. Problems Must Be Faced
President Obama, just back from a surprise visit to the troops in Afghanistan, honored America's fallen warriors in a solemn Memorial Day ceremony on Monday and acknowledged the need to confront the widening scandal at the nation's veterans hospitals. "As we've been reminded in recent days, we must do more to keep faith with our veterans and their families to make sure they get the care and benefits and opportunities that they've earned and that they deserve," Mr. Obama said to a military audience gathered under balmy sunshine in an amphitheater at Arlington National Cemetery (Lander, 5/26).

USA Today: Obama Honors Veterans 'Who Gave Their All'
Obama did not specifically mention the VA controversy during his speech, but did note the obligation that the nation owes its veterans. He said, "we must do more to keep faith with our veterans and their families, and ensure they get the care and benefits and opportunities that they've earned and that they deserve" (Jackson, 5/26).

USA Today: Long Appeals Leave Older Vets Without Benefits For Years
Cases involving the appeal of veterans benefits rulings take almost 19 months to resolve, Department of Veterans Affairs records show, and advocates say the crush of new claims is hurting older veterans. At least 350,000 veterans of wars before those in Iraq and Afghanistan have outstanding appeals of benefits decisions, according to VA records (Kennedy, 5/26).

The Wall Street Journal: Veterans Groups, Sen. Richard Burr Trade Barbs Over VA
Veterans' groups traded furious charges with a senior Republican senator during the Memorial Day weekend, escalating and hardening a fight over how to fix problems in a veterans' health-care system facing allegations of misconduct. ... The clash began Friday, when Sen. Richard Burr (R., N.C.) posted an open letter to veterans criticizing some veterans' groups for failing to call for the resignation of Veterans Affairs Secretary Eric Shinseki after accusations that staffers at VA hospitals used secret bookkeeping to try to cover up delays in patient care. ... Two top executives at the VFW in a statement Monday called Mr. Burr's letter "an absolutely disgusting ambush style of politics" and "clearly one of the most dishonorable and grossly inappropriate acts that we've witnessed in more than forty years of involvement with the veteran community" (Tracy, 5/26).

Politico: Veterans' Groups Rip Richard Burr Over VA
Leading veterans groups are lashing out against Sen. Richard Burr (R-N.C.) for an open letter he wrote scolding the organizations for not doing more to condemn Secretary of Veterans Affairs Eric Shinseki. Calling Burr's letter a "monumental cheap shot" and a "disgusting ambush style of politics," Veterans of Foreign Wars' commander in chief William A. Thien and John E. Hamilton, the adjutant general, said on Monday that Burr should be ashamed of his conduct (Gold, 5/26).

The Washington Post: In VA Crisis, A General's Deliberate Style Clashes With Impatience Of Young Veterans
In other wars, in other eras, Eric K. Shinseki might have been an ideal fit to lead the Department of Veterans Affairs through a crisis. He's run some of Washington's biggest and most complex bureaucracies. He knows what it's like to fight back from life-changing war wounds, having lost half a foot to a land mine in Vietnam. He prefers to stay out of politics and work on problems quietly and in the background. ... The question facing President Obama as he seeks to contain yet another widening VA scandal is whether quiet and resolute professionalism still works in an age of noisy disputation (Jaffe, 5/26).

The Wall Street Journal: Veterans Allowed More Care At Non-VA Facilities Amid Criticism Of Agency
The Department of Veterans Affairs began a program Thursday to increase capacity at clinics throughout the VA system and push to allow veterans to have greater access to health care outside the VA system, the department announced Saturday, revealing few details of the program. In response to President Barack Obama's May 21 announcement touting outreach efforts for veterans on appointment wait lists, the head of the VA, Secretary Eric Shinseki, directed the Veterans Health Administration to review scheduling processes and build a plan to cut wait times (Kesling, 5/24).

Los Angeles Times: VA Says More Veterans May Use Private Medical Services
Veterans Affairs Secretary Eric K. Shinseki said in a brief statement that as part of an expansion of services, veterans will be able to seek care at private clinics and hospitals in areas where the department's capacity to expand is limited. In such situations, the VA "is increasing the care we acquire in the community through non-VA care," Shinseki said. The agency will provide more specifics on these options in the next few days, said Victoria Dillon, a department spokeswoman. It is unclear how much this service expansion will cost (Richter and Simon, 5/24).

The Wall Street Journal: VA's Budget, And Rolls, Have Boomed
The Department of Veterans Affairs, the agency caught in a political firestorm over its medical care for veterans, has seen its funding grow faster than any other government department in recent years. Since 2000, annual spending has tripled to $63 billion to meet a surge in health-care and other costs. That is on top of the more than $85 billion the VA is set to receive this year for automatic payments such as disability benefits and pensions, a tally that has more than tripled since 2000 (Paletta, 5/23).

The Wall Street Journal: VA Goal To Slash Wait Times Was 'Unrealistic,' Aide Said
A goal to cut wait times for appointments by more than half at Department of Veterans Affairs hospitals was "unrealistic" and may have been a mistake, a top VA official said in a closed-door meeting with two veterans' groups days before the official was forced to step down. Robert Petzel, the undersecretary for health at the Department of Veterans Affairs until a week ago, directed in 2011 that goals for many wait times in the VA system be cut to 14 days from 30. That possibly set off efforts by employees to game the appointment system, a Government Accountability Office official said on Friday (Kesling and Nissenbaum, 5/23).

Los Angeles Times: Lawmakers Call For Criminal Investigation Of Veterans Affairs Facilities
The Justice Department should enter the investigation of whether Veterans Affairs employees have falsified records to cover up long waits at VA medical facilities, Democratic and Republican lawmakers said Sunday. "Only the Department of Justice and the FBI have the resources, the expertise and the authority to do a prompt and effective criminal investigation of the secret waiting lists, potential destruction of documents, falsification of records, in effect, the cooking of books and covering up that may have occurred," Sen. Richard Blumenthal (D-Conn.), a member of the Senate Veterans Affairs Committee, said on CBS' "Face the Nation." Rep. Adam Kinzinger (R-Ill.), a veteran of the wars in Afghanistan and Iraq, agreed. The "Department of Justice needs to get involved," he said on the same program (Simon, 5/25).