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Surprises And Standing: Breaking Down Today's Supreme Court Arguments

Supreme Court justices heard oral arguments Wednesday in a case challenging some of the health law's insurance subsidies, but not before considering whether the plaintiffs had standing in the case. KHN's Mary Agnes Carey and Julie Rovner discuss surprises from the hearing. (3/4)

Political Cartoon: 'Take A Walk?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Take A Walk?'" by Steve Sack, Minneapolis Star Tribune.

Here's today's health policy haiku:


No surprise charges!
Network confusion must end
Squelch "balance billing"

If you have a health policy haiku to share, please Contact Us and let us know if you want us to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

Health Law Issues And Implementation

Supreme Court Scene: Justices Appear Divided But Offer Few Clues About How They Will Rule

The arguments went into overtime and ideological differences were evident. The next step for the nine justices is to meet Friday to cast initial votes on a decision in King v. Burwell. The court's ruling, however, is not expected until June.

The Washington Post's Wonkblog: Five Key Takeaways From The Supreme Court’s Obamacare Hearing Today
Based on oral arguments this morning, the latest Supreme Court showdown over Obamacare could lead to another narrow ruling determining the fate of the health-care program. Here are five important takeaways from the hearing in King v. Burwell, a challenge an IRS rule providing financial assistance to millions purchasing health insurance through federal-run exchanges offered in states that did not create their own online marketplaces. (Millman, 3/4)

Politico: Obamacare At The Supreme Court: Round 2
Obamacare returned to a divided Supreme Court Wednesday; this time the justices must figure out whether an obscure phrase in the massive law means that health-insurance subsidies should only go to people living in states that embrace the law.During 90 minutes of oral argument, the justices gave few hints about how they’ll determine the fate of the president’s health care law. But Justice Anthony Kennedy, the perennial swing justice, suggested that ruling against the White House would be an implicit approval of the federal government putting a gun to the states’ heads about insurance. (Haberkorn, 3/4)

McClatchy: Supreme Court Scrutinizes Health Care Law
At issue is the legality of the subsidies for an estimated 7.5 million subscribers in the 34 states that chose not to run their own health insurance exchanges, leaving it to the federal government. Critics argue the law as written only permits the subsidies to go to people who use state-run exchanges. The administration says the subsidies were intended to be available in all states.(Doyle, 3/4)

Kaiser Health News: Arguments On Health Law Provide Few Clues About Supreme Court Decision
Unlike in 2012, the current case, King v. Burwell, doesn’t challenge the constitutionality of the law’s centerpiece that requires most Americans to have health insurance or pay a penalty. In a 5-4 ruling, the court that year decided the law could continue, albeit with a twist: states could elect not to expand Medicaid. But the latest case does challenge another piece that’s pivotal to making the law work: Whether tax credits to help moderate-income Americans afford coverage can be provided in the three dozen states where the marketplace is being run by the federal government. (Rovner, 3/4)

The Wall Street Journal: Justices Divided At Health-Law Argument
The Supreme Court sparred Wednesday over a lawsuit that could gut the Affordable Care Act across most of the nation, going overtime in arguments that suggested the law’s fate likely rests with two justices. The outcome of the case, a challenge to the insurance subsidies in the 2010 health law, appeared to turn on the views of Justice Anthony Kennedy and Chief Justice John Roberts . Justice Kennedy, in the biggest surprise from the session, suggested the challengers’ theory could face a constitutional roadblock, since it assumes Congress was trying to strong-arm the states into carrying out a federal policy. Chief Justice Roberts, who joined liberals to uphold most of the health law in 2012, was uncharacteristically quiet through most of the argument, leaving observers guessing. (Bravin and Kendall, 3/4)

Los Angeles Times: Supreme Court Appears Split In Challenge To Affordable Care Act
Chief Justice John G. Roberts Jr., who helped rescue the law three years ago, gave no hint about how he might rule this time. And Justice Anthony M. Kennedy, another possible swing vote, voiced some reservations about the challenge, but also said he was troubled by how the Obama administration had implemented the law. (Savage and Levey, 3/4)

NPR: Justices Roberts And Kennedy The Key Votes In Health Law Case
With yet another do-or-die test of Obamacare before the U.S. Supreme Court on Wednesday, the justices were sharply divided. By the end of the argument, it was clear that the outcome will be determined by Chief Justice John Roberts and Justice Anthony Kennedy. The chief justice said almost nothing during the argument, and Kennedy sent mixed signals, seeming to give a slight edge to the administration's interpretation of the law. Judging by the comments from the remaining justices, the challengers would need the votes of both Roberts and Kennedy to win. (Totenberg, 3/4)

The Washington Post: Supreme Court Justices Split In Key Challenge To Obamacare Subsidies
Supreme Court justices split along ideological lines Wednesday in a dramatic but collegial showdown in the latest legal battle over the Affordable Care Act, with the outcome difficult to predict. If President Obama could draw hope from the 1 hour and 25 minutes of debate about his signature domestic achievement, it would be because of Justice Anthony M. Kennedy. Three years ago, Kennedy was among the four dissenters who would have found the entire act unconstitutional. But Wednesday, with his comments and questions seeming to cut both ways, he appeared to be back in play. (Barnes, 3/4)

USA Today: First Take: Roberts, Kennedy Hold The Key To Obamacare
On Wednesday, as justices on the left and right pounced on both of the polished litigators before them — Michael Carvin for the opponents, Solicitor General Donald Verrilli for the government — Roberts maintained an almost stony silence. If he had decided how to vote on the case, he didn't want anyone to know. About the most noteworthy thing the chief justice said was a reference to that last case, which focused on the law's mandate that individuals buy insurance or pay a penalty. When liberal justices sought to tie Carvin to arguments he made in 2012, Roberts said, "We've heard talk about this other case. Did you win that other case?" As the laughter in the courtroom subsided, Roberts added, "So maybe it makes sense that you have a different story today." (Wolf, 3/4)

CNN: Obamacare At The Supreme Court: Justices Again Divided Over Landmark Health Law
The IRS -- which is charged with implementing the law -- interprets the subsidies as being available for all eligible individuals in the health exchanges nationwide, in both exchanges set up by the states and the federal government. In Court , Solicitor General Donald B. Verrilli, Jr. defended that position. He ridiculed the challengers argument saying it "revokes the promise of affordable care for millions of Americans -- that cannot be the statute that Congress intended." But he was immediately challenged by Justice Antonin Scalia. (de Vogue, 3/4)

The Associated Press: Fate Of Health Law Subsidies Rests With Two Justices
The justices will gather in private Friday to cast their votes in the case. The outcome after Wednesday's argument appears to be in the hands of two conservative justices — one who voted with the court's four liberals to uphold the law in 2012 and the other who joins the liberals more often, but who would have killed the whole thing three years ago. (Sherman, 3/5)

Each Side Claims Victory In Supreme Court Health Law Arguments

Suspense grows over how the Supreme Court justices will rule, with each side claiming confidence that their arguments won over the court -- but how a couple of justices will see the issue remains in the air.

Politico: Obamacare Saved? Not So Fast
Obamacare supporters were cheered Wednesday by Justice Anthony Kennedy’s tough grilling of the lead attorney in the latest lawsuit — and the law’s opponents came away nervous. That doesn’t mean the suspense is over and Kennedy will be the deciding vote to save the law. There’s still enough uncertainty about the outcome of King v. Burwell to guarantee that the survival of Obamacare will be in doubt until the Supreme Court rules at the end of June. (Nather, 3/4)

The Washington Post: Both Sides Claim Victory In Latest Challenge To The Affordable Care Act
Though both sides said they thought the arguments before the court had gone well, lawyers supporting the Obama administration seemed a bit more confident that the justices will ultimately uphold the controversial federal tax subsidies for health care at the heart of Wednesday’s oral arguments. ... The lawyers who actually made the arguments on Wednesday, from the Justice Department, declined to comment, though White House spokesman Josh Earnest said the administration was “quite pleased” with Verrilli’s performance. When his turn at the microphone came, Washington lawyer Michael A. Carvin, who argued for the plaintiffs, said he is “hopeful and confident that the court will recognize the merits of our statutory interpretation and not let the IRS rewrite the plain language” of the Affordable Care Act. (Markon, 3/4)

The New York Times: At Least One Justice Is In Play As Supreme Court Hears Affordable Care Act Case
The court’s four liberal members voiced strong support for the administration’s position. But Chief Justice John G. Roberts Jr., who cast the decisive vote to save the law in 2012, said almost nothing on Wednesday, and did not indicate his position. In a pleasant surprise for the administration, however, Justice Anthony M. Kennedy, who was in dissent in 2012, made several comments indicating that his vote was in play. (Liptak, 4/3)

The Wall Street Journal: Health Law Backers And Opponents Are Both Cautiously Optimistic
Supporters of the Affordable Care Act struck a confident tone after Wednesday’s oral arguments, saying they don’t expect the Supreme Court will strike down subsidies to millions of Americans who got health insurance. But the same cautious optimism was also expressed by critics of the health law, who said the plaintiffs’ argument is so rock-solid that the justices should decide subsidies provided on, the federal exchange, are illegal. (Armour and Wilde Mathews, 3/4)

Ruling Against Obamacare Would Have Broad But Disparate Impact

A decision to strike down the premium subsidies in states that rely on the federal marketplace would affect a wide variety of stakeholders, including hospitals and groups such as Latinos who have been the focus of enrollment efforts.

The Wall Street Journal: Supreme Court Ruling On Health Law Would Have Disparate Impact
If the Supreme Court overturns a key facet of the Affordable Care Act, it could leave the law functioning as designed in some states, while grinding it largely to a halt in others. That divide comes into focus through the case’s potential impact on a group of people The Wall Street Journal has been tracking to document the law’s impact. Some are likely to be unaffected by a ruling striking down the subsidies. Others could see the law’s effects on their lives unravel. (Wilde Mathews and Radnofsky, 3/4)

NPR: A Ruling Against Obamacare Would Have Broad Implications
The Supreme Court heard arguments Wednesday in a case that could end Obamacare subsidies for policyholders in a majority of states, including Texas, Florida, Illinois, Pennsylvania and Ohio. If the court sides with the plaintiffs, it would mean millions of people could no longer afford health insurance. The challenge to the Obamacare subsidies comes in the case King v. Burwell. The plaintiffs point to a passage in Affordable Care Act that suggests that the federal government can only offer premium subsidies in Obamacare exchanges established by the states. (Ydstie, 4/4)

Reuters: U.S. Hospitals Optimistic They'll Dodge Bullet With Obamacare Ruling
U.S. hospital executives said on Wednesday they were optimistic they will avoid the toughest consequences of a Supreme Court decision on whether millions of Americans can continue to purchase subsidized health benefits under Obamacare. The high court heard oral arguments in the case challenging the federal tax credits that help residents in at least 34 states afford medical benefits under President Barack Obama's healthcare law (Humer and Berkrot, 3/4)

CNN: White House Purposely Has No Obamacare Plan B
The Obama administration says it's doing nothing to stave off the potential disaster that would ensue if the Supreme Court upends Obamacare and millions of Americans face losing affordable health insurance. What might look like administration negligence is actually a carefully tuned strategy to raise the stakes at the Supreme Court, where on Wednesday justices will hear arguments on a central Obamacare provision that allows federal subsidies for insurance. (Liptak, 3/4)

Challengers' 'Legal Standing' Explored During Court Arguments

Although the justices asked about whether the plaintiffs had standing -- the legal right to challenge the law -- it does not appear that either side has concerns about the issue. Other reports examine some of the other legal issues and the background of the case.

The Associated Press: Health Care At The High Court: 5 Ways This Time Is Different
The never-ending political fight over health care hit the Supreme Court Wednesday, and insurance coverage for millions of Americans is on the line. Didn't we do this already? Yes, but foes of President Barack Obama's signature law hope this time the justices will gut "Obamacare." The law's defenders say it's a trumped-up attack. Still sound familiar? Actually, a lot has changed since the Supreme Court's big health care decision of 2012. (Cass, 3/4)

The New York Times: Challenge To Health Overhaul Puts Obscure Think Tank In Spotlight
In the orbit of Washington think tanks, the Competitive Enterprise Institute is an obscure name with a modest budget that belies its political connections to conservative titans like the Koch brothers. But the institute, a libertarian research group, enjoyed a coming-out of sorts on Wednesday, as the lawsuit that it organized and bankrolled — challenging the Affordable Care Act — was heard by the Supreme Court. The case has the potential to end federal insurance subsidies for some 7.5 million people in 34 states. (Lichtblau, 3/4)

USA Today: Obamacare Protests Resemble Campaign Rallies
If the scene outside the Supreme Court on Wednesday resembled dueling campaign rallies — and it did — that was because many people's views on the hotly contested Obamacare case argued inside fall along partisan lines. On one side were workers for conservative and free-market groups trying to outshout those on the other side from union and health care advocacy groups who tried to sing over the pointed rhetoric coming from "Tea Party Patriots" and others. (O'Donnell, 3/4)

Subsidy Recipients, Insurers Watch High Court Anxiously

In Minnesota, officials at UnitedHealthcare and Medica worry about losing millions of customers if the Supreme Court rules against some subsidies, while residents of states reliant on the federal health insurance exchange, such as Michigan and Georgia, say they would be unable to afford coverage without tax credits.

The Minneapolis Star-Tribune: UnitedHealth, Medica Among Insurers With Stake In Health Subsidy Decision
Dannette Coleman, vice president for individual health insurance sales at Minnetonka-based Medica, does not mince words about a possible Supreme Court decision that would outlaw tax credits in 34 states that did not sponsor insurance exchanges under the Affordable Care Act (ACA). “It would be a public policy nightmare,” she said. ... If a majority of the justices agree, the nation’s health insurers, including Medica and Minnetonka-based UnitedHealthcare, will lose millions of policyholders. (Spencer, 3/5)

The Detroit Free Press: Michiganders React To Health Care Challenge
Kathe Koja is a self-employed writer and event producer; Vanita Johnson, a security guard. Both are among the hundreds of thousands of Michiganders who receive federal subsidies without which they could not afford health insurance. "It's essential," said Koja, 55, of Berkely, who with her husband pays about $200 a month for a $700-per-month Blue Cross Blue Shield of Michigan silver plan. "Without the subsidy, we're dead in the water. I can't put it any blunter than that." Johnson, 48, of Highland Park: "It basically means life or death." (Spangler, 3/4)

Co-Op Signs Up 39 Percent Of Colorado Obamacare Enrollees

In Missouri, meanwhile, a GOP lawmaker wants to bar health insurance subsidies to residents of his state regardless of how the Supreme Court rules. And budget pressures on Florida hospitals have fueled new discussions of Medicaid expansion, while Kansas Gov. Sam Brownback softens his stance on the program's expansion.

The Denver Post: Colorado's 2 Nonprofit Health Plans Signed Up 3 Of Every 4 Enrollees
Colorado's nonprofit health insurance cooperative, Colorado HealthOP, signed up 39 percent of individuals enrolling for health insurance for 2015 through the state exchange. Connect for Health Colorado reported it enrolled almost 140,000 people in private insurance plans. The nonprofit Colorado HealthOP garnered almost 55,000 of those after significantly lowering its premiums in the second year of the state exchange. (Draper, 3/4)

Health News Colorado: Exchange Managers Get Bonuses Even As Customers Struggle To Sign Up
Colorado health exchange managers have given $226,720 in bonuses since 2012 and the budget calls for $105,870 more this year. The bonuses — including a hefty one this year for the technology chief — have come as IT and sign-up glitches have dogged the exchange, forcing millions of dollars in cost-overruns and complicating sign-ups for thousands of people who were trying to buy private health insurance. (Kerwin McCrimmon, 3/4)

The Associated Press: Officials: Ruling In Health Care Case Won't Affect Oregon
Oregon's health insurance marketplace is a state-based exchange and would not be affected by the U.S. Supreme Court case against president Barack Obama's health care law, state officials say. The Supreme Court heard arguments in the case Wednesday. The lawsuit seeks to limit financial assistance to people who live in states that created their own health insurance marketplaces. (Wozniacka, 3/4)

The Associated Press: Missouri Republican Wants To Bar Health Insurance Subsidies
While the U.S. Supreme Court heard arguments on whether premium health care insurance subsidies could be used in states that did not set up their own exchange, one Republican lawmaker told a Missouri Senate panel Wednesday that the state should bar such subsidies on its own. Congressional action is needed to fully dismantle the Affordable Care Act, but the bill would be a first step, Sen. Bob Onder said. The Lake St. Louis Republican also said President Barack Obama's administration was acting "lawlessly" in continuing to offer subsidies in states, including Missouri, which are using the federal government's website. (French, 3/4)

Tampa Bay Times: Under New Budget Pressures, Florida Senate Debates Medicaid Expansion
A potential budget crisis is fueling a new conversation about Medicaid expansion in Florida. The issue was a non-starter in 2014, largely because House Republicans oppose expanding Medicaid as envisioned under the Affordable Care Act. But Florida now risks losing a separate pot of federal money known as the Low Income Pool that helps hospitals like Tampa General Hospital treat uninsured patients. Senate President Andy Gardiner, R-Orlando, said the potential $1.3 billion loss in funding has given lawmakers a reason to reconsider Medicaid expansion. "We have an obligation to look at this issue," Gardiner said. (McGrory, 3/4)

The Associated Press: Bill Seeking Freeze In Medicaid Plan Sign-ups Advances
A Senate panel has advanced legislation requiring Arkansas to seek federal approval to freeze enrollment in the state's compromise Medicaid expansion, despite state officials saying such a move isn't possible. The Senate Public Health, Welfare and Labor Committee on Wednesday endorsed a bill requiring the state to seek federal approval by the end of the year to halt enrollment in the "private option." Under the private option, Arkansas is using federal Medicaid funds to purchase private insurance for the poor. (3/4)

Lawrence (Kan.) Journal-World: Brownback Softens Stance On Medicaid Expansion
Gov. Sam Brownback suggested Wednesday that he might consider proposals to expand Medicaid under the Affordable Care Act, provided the Legislature can identify a way to pay for it. "I’ve been pushing that anything we do on Medicaid expansion has to be 100-percent paid for," Brownback said during impromptu remarks to the Kansas Association of Insurance Agents, who met at the Statehouse on Wednesday. ... Brownback's comments, which came in response to a question from one of the insurance agents, stood in stark contrast to his remarks on the campaign trail last year when he said he strongly opposed the federal health care law, also known as Obamacare, and criticized his Democratic opponent Paul Davis for supporting it. (Hancock, 3/4)

NBC News: Newly Insured? 8 Things to Know About The Affordable Care Act
Before the Affordable Care Act (ACA) was fully implemented in 2014, there were 30 million African Americans who lacked any kind of health insurance coverage in this country. The law hopes to bridge that gap with affordable and accessible coverage, which is now a mandate. (King Collier, 3/4)

Meanwhile, small employers prepare for new tax reporting requirements under the ACA -

The Wall Street Journal: Small Business Owners Scramble To Prepare For New Tax Form
Small employers are facing an unexpectedly onerous task: tallying their individual employees’ monthly health-care costs. Starting in 2016, under the Affordable Care Act, employers with 50 or more full-time workers are required to file new tax forms laying out what individual employees are being charged for their employer-sponsored plans. The Internal Revenue Service released the new forms on Feb. 8. (Loten, 3/4)

Capitol Hill Watch

Passing Obamacare Alternative Would Be Politically Tricky

While Republicans say they are weighing ways to help people who might be hurt should the Supreme Court reject federal exchange subsidies, USA Today writes that building GOP consensus to pass legislation would be extremely difficult. Meanwhile, The Washington Post explores how the debate over four words in the Affordable Care Act shows Congress can sometimes be sloppy when it writes legislation.

USA Today: GOP Weighs Obamacare Alternatives
With Republicans in control of Congress and a fresh challenge to President Obama's health care law before the Supreme Court, the GOP is under renewed pressure to present a legislative alternative to Obamacare if the court rules against the law. "We're meeting together on a regular basis," said Sen. John Barrasso, R-Wyo., a physician and member of the Senate leadership who is part of a group of GOP lawmakers working on an alternative. "What we've been saying is Republicans are going to protect the people hurt by the law, but not protect the law." ... [But] Joseph Antos, a health care expert at the American Enterprise Institute, a conservative think tank, said building GOP consensus on health care will be difficult. (Davis, 3/4)

CQ Healthbeat: Tweaks Possible For Law Allowing Veterans Private Health Care
Some in Congress are weighing whether to tweak a seven-month old law allowing veterans facing delays in getting medical care to go outside the Department of Veterans Affairs system, or to pressure the VA to interpret the statute differently. The law, prompted by instances in which local VA officials lied about wait times, allows veterans to get treatment outside the VA if they can’t get an appointment within 30 days or if the patient's home is more than 40 miles from the closest VA facility. Several lawmakers at a Wednesday joint hearing of the House and Senate committees overseeing veterans’ affairs expressed concerns about the agency’s implementation of the law. (Adams, 3/3)

State Watch

State Highlights: Mass. Insurer Expands Quality-Based Doctor Pay System; Missouri House Advances Med-Mal Lawsuit Caps

A selection of health policy stories from Massachusetts, Missouri, California, Montana, Washington, Georgia, Connecticut, Kansas, North Carolina, Texas and Utah.

The Boston Globe: Blue Cross Vastly Expands Quality-Based Payment Systems
The Massachusetts health care industry’s traditional system of paying doctors for every office visit, test, and procedure may be nearing its end. The state’s largest health insurer, Blue Cross Blue Shield of Massachusetts, will vastly expand its system that pays doctors based on how well they care for patients — not just for the number they see and volume of services they provide. (Dayal McCluskey, 3/5)

The Associated Press: Missouri House Endorses Lawsuit Caps For Medical Malpractice
The Missouri House is moving forward with a measure to limit the amount of noneconomic damages that can be awarded to victims of medical malpractice. The House gave initial approval Wednesday to a bill to reinstate limits on how much juries can award in some types of damages such as pain and suffering in medical malpractice cases against health care providers. (3/4)

Los Angeles Times: Superbug Outbreak Extends To Cedars-Sinai Hospital, Linked To Scope
In the latest superbug outbreak, Cedars-Sinai Medical Center discovered that four patients were infected with deadly bacteria from a contaminated medical scope, and 67 other people may have been exposed. The Los Angeles hospital said Wednesday that it began investigating the possibility of patient infections after a similar outbreak at UCLA's Ronald Reagan Medical Center that sickened seven patients, including two who died. The widening problem is certain to ratchet up the pressure on the Food and Drug Administration, already under fire for ignoring warnings about these medical instruments. (Terhune, 3/4)

The Associated Press: Short-term Mental Health Measures Advance In Legislature
Three Republican-sponsored bills to bolster short-term mental health care have passed through the Montana House with unanimous support, but cover only a fraction of what the governor proposed in January. Republican Rep. Ron Ehli of Hamilton says the plans push mental health care toward hometown treatment and would send fewer patients and inmates to the Montana State Hospital in Warm Springs. The measures do not include long-term care, staff enhancements, preventative measures, and specific forensic and dementia units included in the $20 million mental health package that Democratic Gov. Steve Bullock recommended in his budget proposal. (Noon, 3/4)

Los Angeles Times: Lawmakers Announce Renewed Push For Medi-Cal Funding
California lawmakers and advocates are gearing up for a new chapter in the battle over the state's healthcare program for the poor. They announced new legislation on Wednesday that would pump more money into Medi-Cal, which has expanded to cover more residents even while suffering from recession-era funding cuts. (Megerian, 3/4)

The Wall Street Journal: Push To Expand Paid-Leave Law In Connecticut
Advocates of Connecticut’s paid-sick-leave law hope a hearing Thursday begins the process of extending its benefits to more workers, reigniting a debate over whether such measures hurt the state’s business climate. Connecticut became the first state in the nation in 2011 to pass a law requiring businesses with 50 or more employees to offer five paid days off for illnesses. Gov. Dannel Malloy, a Democrat, hailed it as one of his biggest legislative achievements during his re-election campaign last year. (DeAvila, 3/4)

The Kansas Health Institute News Service: Bill Would Give Parents More Leeway To Refuse Medication For Kids
In Kansas, when parents or guardians decline to provide their children treatment the medical community deems necessary, the state can use medical neglect statutes to compel treatment unless that treatment would run counter to religious beliefs determined to be legitimate by a judge. A bill that overwhelmingly passed the Kansas Senate could alter that. Sen. Forrest Knox, a Republican from Altoona, said he introduced Senate Bill 157 to keep schools from forcing parents to medicate children with behavior-control drugs like Ritalin, which is used to treat attention deficit hyperactivity disorder. (Marso, 3/4)

The Charlotte Observer: As Negotiations Continue, Carolinas HealthCare Offers Guidance For Patients Covered By UnitedHealthcare
Three days after their contract expired, Carolinas HealthCare System and UnitedHealthcare are giving patients contradictory information about how their medical expenses will be covered. Since Sunday, when negotiators failed to reach an agreement, UnitedHealthcare has told members they're considered "out-of-network," which means they'll pay more, if they use Carolinas HealthCare hospitals or doctors in the Charlotte area. Exceptions are for patients with emergencies or who are in the midst of treatment (such as chemotherapy or pregnancy) and get "continuity of care approval." (Garloch, 3/4)

The Associated Press: Nurse Who Survived Ebola Sues Dallas Hospital System
The Dallas hospital that treated the first patient to be diagnosed in the U.S. with Ebola lied to Congress when it said its staff was trained to handle the deadly virus, a nurse who contracted the disease contends in a lawsuit filed Monday. Nina Pham, who was an intensive care unit nurse at Texas Health Presbyterian Hospital Dallas, says after being told last fall that she would be treating a patient suspected of having Ebola, “the sum total” of information she was given to protect herself was “what her manager ‘Googled’ and printed out from the Internet.” (3/4)

ABC 4 UTAH: Growing Gap Between Number Of Latino Docs And Growing Latino Population
In ten years, 2025, there will be a 90,000 doctor shortage in the US. This according to a report from an association of medical schools. That means longer wait times like weeks or even months to see a doctor and for the Latino population, that rate is even worse. According to a UCLA report, there are 51 million Latinos in the country, but only 15 Latino doctors per 100,000 Hispanics. (Crow, 3/4)

Weekend Reading

Longer Looks: King V. Burwell, Medical Records and Antibiotic Resistance

Each week, KHN's Shefali Luthra finds interesting reads from around the Web.

The Atlantic: The End Of Obamacare?
Under the Affordable Care Act, otherwise known as Obamacare, the states were invited to create exchanges, or online marketplaces, where uninsured individuals must buy insurance plans. In the states that opted not to create one—either for logistical reasons or out of political opposition to the law—consumers were told to use an exchange created by the federal government through Florida is one of these states. (Olga Khazan, 3/4)

The Wall Street Journal: The Next Marketing Frontier: Your Medical Records
Dr. Treadwell isn’t the only one who is pleased with the alerts. So is Merck & Co., which pays for the notifications sent to Dr. Treadwell and 20,000 other health-care providers. Medical-record software startup Practice Fusion Inc., which sells the alerts and displays them through its software, said that during a four-month study period ending in August, it observed a 73% increase in vaccinations—amounting to 25,000 additional treatments—compared with a control group. The company didn’t disclose its fees for delivering sponsored alerts but said it doesn’t take a cut of sales that result. (Elizabeth Dwoskin, 3/3)

The New York Times Magazine: Obamacare Goes To The Supreme Court
On Wednesday morning, the United States Supreme Court will hear arguments in King v. Burwell, the case that could decide the fate of the Patient Protection and Affordable Care Act, the landmark “Obamacare” legislation passed by Congress in 2010. Emily Bazelon, a staff writer for the magazine, and Adam Liptak, The Times’s Supreme Court correspondent, have been exchanging emails about what’s at stake in the case and how the court might approach its decision. (Emily Bazelon and Adam Liptak, 3/3)

Pacific Standard: Our C-Section Rate Won't Budge—Is It Because We Don't Trust Women's Hormones?
For the third year in a row, the Centers for Disease Control and Prevention reports that the number of women who give birth by Caesarean section in the United States is hovering at around one-third of births. That's a 60 percent increase in 15 years, and a public health crisis. Why hasn't the number budged? Last year, it seemed that every professional organization publicly agreed (the obstetricians here, the nurses here, and the nurse-midwives here) that this is a problem and took responsibility for their part. They blamed, in a word, over-treatment. (Jennifer Block, 3/3)

Vox: The Accidental Case Against Obamacare
Unlike the last time conservatives took Obamacare to the Supreme Court — when the Republican party, major activists, and 26 attorneys general joined forces — the new challenge has a more surprising backstory for a big case. It is the result of the key players working loosely, overcoming lawsuit fatigue in conservative circles, pushing an argument that seems more technical than substantive, and even a bit of luck. (Sarah Kliff, 3/2)

Vox: Congress Could Help Solve Antibiotic Resistance. This Congresswoman Explains Why It Won't.
Rep. Louise Slaughter, the only microbiologist in Congress, has been leading the push to stop the overuse of antibiotics on farms through the Preservation of Antibiotics for Medical Treatment Act (PAMTA). This is a hugely important aim: 80 percent of antibiotics in the US are used on animals. So far, Slaughter has met resistance at every turn. PAMTA has been re-introduced four times since she took it over in 2007, repeatedly dying on the house floor. (Julia Belluz, 2/28)

Editorials And Opinions

Viewpoints: Health Challenge Appears Flimsy; Issue Of Coercion; Kennedy's Role

A selection of opinions on health care from around the country.

USA Today: Let Obamacare Live: Our View
For the second time in Obamacare's short five-year life, the Supreme Court has a chance to kill or cripple the law in a way that political opponents have not been able to do despite endless attempts. The court heard arguments in the case Wednesday, and the evidence suggested that this latest challenge is even more flimsy than the one the court wisely rejected in 2012. (3/4)

USA Today: Law Means What It Says: Opposing View
The King v. Burwell challenge to the Affordable Care Act at the Supreme Court presents a straightforward case of statutory interpretation. The question is whether the law authorizes the issuance of tax credits in exchanges established by the federal government. The statute is clear on this point. Tax credits are available in exchanges "established by the state," and the federal government is not a state. Were there any doubt on this point, the law defines "state" to mean one of the 50 states and the District of Columbia. The Department of Health and Human Services is not a state. (Jonathan H. Adler, 3/4)

Bloomberg: Four Ways Obamacare Can Survive The Supremes
The chances of Obamacare surviving its latest legal challenge seem much brighter after Wednesday's oral argument at the Supreme Court. ... The justices' questions offer some support for the law's supporters. At this point the government has four paths to victory; the challengers have only one. (Timothy Jost, 3/4)

The Wall Street Journal: Federalism And ObamaCare
A closely divided Supreme Court heard arguments in the challenge to ObamaCare’s illegal subsidies on Wednesday, and the session spun off in an unexpected and provocative direction: To wit, several Justices suggested that the Affordable Care Act as drafted would unconstitutionally coerce the states. ... One problem is that coercion precedents like South Dakota v. Dole (1987) involve situations in which the states were given an initial choice to cooperate, or not. Then the federal government later sought to fundamentally change the terms of a longstanding bargain by threatening to withhold spending, take it or leave it. ... That is not the same as this case. If Governors decline to establish an exchange, their citizens are not entitled to benefits, but that is not coercion. That is the very trade-off that is supposed to encourage states to participate. (3/4)

The Wall Street Journal: A State Reply To Justice Kennedy
In the hours since oral arguments, much of the talk has centered around Justice Anthony Kennedy ’s suggestion that “from the standpoint of the dynamics of Federalism . . . there is something very powerful to the point that if [the challenger’s] argument is accepted, the States are being told either create your own Exchange, or we’ll send your insurance market into a death spiral.” In other words, Justice Kennedy was asking, if Congress did in fact condition ObamaCare’s tax credits on a state having set up an exchange, does that amount to an unconstitutional coercion of the states? In short: no. (Scott Pruitt, 3/4)

The Washington Post's PostPartisan: Will Anthony Kennedy Save The Day For The Obama Administration?
With all the usual caveats — it’s dangerous to read too much into random comments at oral argument, justices are apt to change their minds — that seems to be the better bet emerging from the argument Wednesday in King v. Burwell. Kennedy isn’t the most obvious candidate to back the administration. After all, he voted to strike down the individual mandate to purchase health insurance during the law’s last big test. (Ruth Marcus, 3/4)

The Washington Post: Obamacare’s Rescuer?
Based on that history, many thought [Justice Anthony] Kennedy would seize on the second chance to thwart Obamacare that is being presented by King v. Burwell — a challenge to the law’s crucial tax-credit insurance subsidies now before the court. The betting was that [Chief Justice John] Roberts would again be the Obama administration’s best hope for a fifth vote. During oral arguments Wednesday, though, Kennedy sounded astonishingly reluctant to do the deed. (Charles Lane, 3/4)

Los Angeles Times: Obamacare Opponents Make Out-Of-Context Pitch To The Supreme Court
The false premise is that lawmakers intended to withhold subsidies from states that did not set up their own insurance exchanges as a way to strong-arm them into doing the work. I laid out the actual history of the act in a post last year, but the short version is that such a plan was never even discussed. The closest Congress came to doing so was a preliminary proposal in the Senate that would have withheld subsidies from states that didn't enact more consumer-friendly insurance regulations, but that idea was dropped by the time the measure reached the Senate floor. (Jon Healey, 3/4)

Los Angeles Times: Obamacare Challengers' Ridiculous Claims Head To The Supreme Court
There are numerous reasons why the court should reject the plaintiffs' phony narrative about the new exchanges that Congress required in every state. One of the best, though, is that a ruling in the plaintiffs' favor would retroactively penalize states and their residents for choosing to let Washington run their exchanges when the consequences couldn't have been foreseen. (3/4)

The New York Times: The Supreme Court And The Fate Of American Health Care
In 2012, the chief justice of the United States, John Roberts Jr., saved the Affordable Care Act by a single, surprising vote. On Wednesday morning, the chief justice was again expected to hold the decisive vote as the Supreme Court heard extended oral argument in the latest assault on President Obama’s signature health care law. The case, King v. Burwell, will determine the fate of legislation that has transformed the American health care system. But the argument provided few solid clues to how the justices will rule. The chief justice remained virtually silent for the entire argument, while most of the others took predictable positions in questioning the government or the challengers. (3/4)

Bloomberg: Obamacare Is On Roberts's Shoulders, Again
Three years ago, in the first Affordable Care Act case before the U.S. Supreme Court, Chief Justice John Roberts invented a legal doctrine that he memorably called the “gun to the head.” During oral arguments on Wednesday in the second ACA case, Justice Anthony Kennedy aimed the gun at Roberts. Roberts originally used the doctrine to gut the ACA’s extension of Medicare to unwilling states. Kennedy, by contrast, used it to try to pressure Roberts to save Obamacare by suggesting that Congress couldn’t lawfully deny tax subsidies to states that failed to create their own insurance exchanges. (Noah Feldman, 3/4)

Bloomberg: The Heart Of The Obamacare Case
Beyond the technicalities of guns to the head and standing, a profound issue lies at the heart of the King v. Burwell case that the U.S. Supreme Court heard Wednesday -- and for a few shining moments, the justices debated it. That question can actually be put rather simply: What should happen when Congress writes a law with some internal incoherence? Should the courts assign a sensible meaning to the statute that makes everything come out right? Or should they follow the strict words of the law, and let the chips fall where they may? (Noah Feldman, 3/4)

Bloomberg: Government Wants Obamacare Ruling Now
Justice Ruth Bader Ginsburg opened the King v. Burwell argument Wednesday in the U.S. Supreme Court by asking whether the challengers are actually being injured by the Affordable Care Act and have standing to bring the case. Then something weird happened. Even though the lawyer for the challengers couldn’t definitively say his clients had standing, Solicitor General Don Verrilli seemed not to want the court to dismiss the challenge to Obamacare on that ground. ... what would happen if the case were dismissed on standing grounds: It would come back later, with different plaintiffs. That would be fine -- unless Jeb Bush or another Republican is president and a new solicitor general won’t defend the statute as Barack Obama's administration reads it. The government might not want to wait for another round -- even if it means cutting corners on standing. (Noah Feldman, 3/4)

Bloomberg: Obamacare Case Is Not Life Or Death
This morning, someone on Twitter explained that this case really is different because if the Supreme Court rules the wrong way, thousands of people will die. I find this explanation wholly unconvincing, for two reasons. First of all, this is not somehow different from other controversial cases in the court's past. (Megan McArdle, 3/4)

The New York Times' The Upshot: Even With An Unfavorable Court Ruling, Much Of Obamacare Would Live On
The case before the Supreme Court this week will not wipe Obamacare off the books. Unlike the case the court considered in 2012, which could have erased the Affordable Care Act entirely, this one concerns the application of only one provision of the law, and only to certain states. A ruling for the plaintiffs in the case, King v. Burwell, would carry huge consequences in many states, but 15 million of the people estimated to get insurance under the law would still get it, according to an Urban Institute estimate. (Margot Sanger-Katz, 3/4)

The New York Times' The Upshot: The Supreme Court Has The Power To Deepen A National Health Divide
The Supreme Court has the potential to radically reshape the Affordable Care Act, creating a result profoundly different from that imagined by President Obama and the law’s drafters in Congress. Three years ago, the court essentially limited the law’s ability to expand health insurance to low-income Americans in red states. A case it is considering on Wednesday might result in taking away insurance access for middle-income people, too. (Margot Sanger-Katz, 3/4)

The Wall Street Journal's Washington Wire: If Health Insurance Subsidies Are Struck Down, States Will Need Time
In op-eds published in The Wall Street Journal and the Washington Post this week, Republicans sketched out fallback positions, suggesting actions that Congress could take if the Supreme Court rules for the plaintiffs challenging the legality of health insurance subsidies in states with federally run marketplaces. But the odds are very low that Democrats and Republicans in Congress and President Barack Obama could agree on any health-care legislation, much less come to consensus on what Senate Majority Leader Mitch McConnell has called a “mulligan” and a “do-over” for the Affordable Care Act. If the court rules for the plaintiffs in King v. Burwell, action is not likely to come from Congress but in the 34 states where about 7.5 million people would lose insurance subsidies. (Drew Altman, 3/4)

USA Today: Lives At Stake Before Top Court
I'm a nurse caring for kidney transplant patients over the course of my 12-hour work days. Tough choices my patients have faced and the loss of my own mother-in-law to treatable conditions motivated me to join other healthcare workers in filing an amicus legal brief in a watershed case coming before the U.S. Supreme Court next week, King v Burwell. (Michelle Boyle, 3/4)

USA Today: Obamacare On SCOTUS Chopping Block
Critics complain [a ruling for the challengers by the Supreme Court] would eliminate subsidies in states, making the cost of Obamacare coverage transparent to enrollees. But those enrollees will be able to switch to lower-cost "catastrophic" plans — if the Obama administration allows it. To date, the administration has adamantly refused to say whether it would take even this small step to help affected enrollees. More important, transparency is a good thing. If enrollees don't want to pay the full cost of Obamacare coverage, that tells us something very important about Obamacare (Michael F. Cannon, 3/4)

USA Today: GOP's Obamacare-Lite Needs To Die, Too
With the Supreme Court hearing another challenge to ObamaCare Wednesday, Republicans are scrambling to craft their replacement plan. The leading contender is the "Patient Choice, Affordability, Responsibility, and Empowerment Act" — the Patient CARE Act — authored by Senators Orrin Hatch and Richard Burr and Congressman Fred Upton. They have heralded the plan as a "common-sense" proposal which includes "patient-focused" reforms without ObamaCare's "Washington mandates." But despite its authors' good intentions and their exemplary work in other policy areas, it will do little to fix America's broken health care system. At best, it will be ObamaCare-lite. At worst, it will be ObamaCare by another name. And in either case, it will not fix health care. (Nancy Pfotenhauer and Nathan Nascimento, 3/4)

The Washington Post's The Fix: No Matter What The Supreme Court Decides, Opinions On Obamacare Won’t Change
Obamacare is back in the news today as the Supreme Court hears oral arguments in King v. Burwell, a case that could invalidate subsidies in states that use the federal insurance exchange -- a development that could unravel the entire law. No one knows for sure how the Court will rule on this second major challenge to the Affordable Care Act -- it ruled in 2012 that the individual mandate was constitutional -- but there is one thing we do know: No matter what the Court decides, it won't change public opinion on the law. (Cilllizza, 3/4)

The Washington Post: The Supreme Court Cannot Hide On Obamacare
The Supreme Court, it would seem, did not want you to see what it was up to on Wednesday. The robed nine were hearing oral arguments in King v. Burwell , a legal effort by conservatives to dismantle Obamacare and probably the most politically charged case to appear before the high court since Bush v. Gore. But, as always, there was no video of the proceedings and, curiously, the court chose not to release same-day audio of the argument, as it did in Bush v. Gore and has done in other high-profile cases since then. (Dana Milbank, 3/4)

The Washington Post's The Volokh Conspiracy: Avoiding Constitutional Avoidance
From questioning today in King v. Burwell, there is quite a buzz that Justice Kennedy appears concerned about whether interpreting the ACA to deny subsidies to citizens of states with federal exchanges would unconstitutionally coerce states to set up their own exchanges. The alleged coercion would result from the damage caused to the insurance markets of these states by the other mandates in the ACA — for example, by “community rating” that restricts the ability of insurance companies to set their rates according to actuarial risk, and “guaranteed issue,” that is, preventing carriers from refusing insurance based on pre-existing conditions. The concern is that, because these provisions absent a subsidy would cause a “death spiral” in those states, states would be unconstitutionally coerced to setting up their own exchanges lest their insurance markets be destroyed. Therefore, it is contended, under the doctrine of “constitutional avoidance,” the ACA should be interpreted to avoid this unconstitutional result and allow the IRS regulation to stand so subsidies will flow to the states. (Randy Barnett, 3/4)