KHN Morning Briefing

Summaries of health policy coverage from major news organizations.

Kaiser Health News Original Stories

What’s At Stake As Health Law Lands At Supreme Court Again

With a $400 tax credit, Julia Raye of North Carolina has been able to afford health insurance and keep her diabetes under control. She is one of 8.2 million people who could lose that subsidy in a case that goes before the U.S. Supreme Court Wednesday. (Sarah Varney, 3/3)

Political Cartoon: 'Gurney Journey?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Gurney Journey?'" by Lisa Benson.

Here's today's health policy haiku:


Hayfork folks travel
Far and wide for good health care
Long bus rides await.

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

The Health Law's Future And Four Little Words

News outlets preview and analyze the key issues that will be in play as the Supreme Court hears oral arguments in King v. Burwell, the legal challenge to the health law's insurance subsidies.

The Wall Street Journal: How The Supreme Court Case Could Affect The Health Law
The blockbuster case before the Supreme Court is version 2.0 of a legal battle that could cripple the Affordable Care Act overhaul of the nation’s health care system. But in important ways, the new case is different from what came before the court three years ago. The case, King v. Burwell, leaves the Constitution aside and focuses instead on interpreting small snippets of language contained in the sprawling health-care law. The justices, who will hear argument on Wednesday, are deciding the meaning of words Congress chose when authorizing the government to provide tax credits for insurance purchases by middle- and low-income individuals. The subsidies are considered a crucial pillar of the law because they make health coverage more affordable for millions of Americans. (Kendall, 3/2)

The Wall Street Journal's Law Blog: Obamacare On Trial: A Preview Of King V. Burwell
The Supreme Court on Wednesday is set to hear arguments in King v. Burwell, the latest case tied to the health-care law. The dispute involves the validity of insurance subsidies for people in more than 30 states who use the federal exchange, At issue is wording in the Obamacare law stipulating that tax credits are available for people who enroll “through an exchange established by the state.” The parties disagree on whether the language allows the Obama administration to offer subsidies nationwide. At stake are subsidies for more than six million Americans but also the fate of the health law itself. (Gershman, 3/2)

The Washington Post's Wonkblog: Why It Would Be Hard For Obamacare To Recover From A Supreme Court Loss
Without the subsidies, the situation would quickly become pretty chaotic for insurers, who've largely benefited from the law so far. Most of the uninsured would no longer be subject to Obamacare's individual mandate requiring people to have health insurance because they wouldn't then have access to "affordable" coverage, as the Affordable Care Act defines affordability. But all of the law's other features that increase the cost of health insurance, such as guaranteed coverage regardless of preexisting conditions, would remain in place. The history of similar state-level health reform efforts that enacted these consumer protections without the mandate and financial assistance shows health insurance rates skyrocketed and healthier people dropped out of the insurance markets. (Millman, 3/2)

The New York Times: Lawyer Put Health Act in Peril by Pointing Out 4 Little Words
The first lawsuits challenging the Affordable Care Act were still in the early stages, but conservative lawyers were already working on a backup plan in December 2010 if the first line of attack failed. It was Thomas M. Christina, an employment benefits lawyer from Greenville, S.C., who found a new vulnerability in the sprawling law. “I noticed something peculiar about the tax credit,” he told a gathering of strategists at the American Enterprise Institute. (LIptak, 3/2)

Politico: Obamacare Case: All Eyes On 2 Justices
The future of Obamacare again falls on the shoulders of John Roberts and Anthony Kennedy. As the Obama administration and Obamacare opponents prepare for another Supreme Court showdown Wednesday, both sides are tailoring their arguments to win over the chief justice, who cast the saving vote for the Affordable Care Act in 2012, and Kennedy, the perennial swing vote on the Supreme Court. (Haberkorn and Gerstein, 3/3)

Kaiser Health News: ACA Heads Back To Supreme Court
The Affordable Care Act is headed back to the Supreme Court. At stake are millions of subsidies that help people in more than three-dozen states afford health care coverage. Mary Agnes Carey and Julie Rovner, discuss the case. (3/3)

A second health law challenge is also making its way through the system -

The Fiscal Times: The Other Obamacare Lawsuit Moving Through The Courts
The Supreme Court hears oral arguments on Wednesday in King v. Burwell, the controversial case that could devastate the health care marketplace in 34 states and destroy the system envisioned by the Affordable Care Act. However, the high-profile assault on the law isn’t the only case working its way through the courts. Last July, after months of threats and a lengthy struggle to find a willing attorney, the House of Representatives filed suit against the Obama administration. It claimed the president’s move to change the effective date of part of the ACA was an unconstitutional infringement on the power of the Congress to write the laws. (Garver, 3/2)

Meanwhile, the Supreme Court is saying no to requests for a speedy release of the transcript of these proceedings -

Legal Challenge To Obamacare Subsidies Worries Consumers

As attention is focused on the high court's consideration of King v. Burwell, news outlets also take a look at the people who will be affected if the justices rule against the subsidies.

The Wall Street Journal: What The Supreme Court Challenge Means For The Health-Care Law
Kim Jones, a substitute teacher, worries she will lose her health insurance if the Supreme Court strikes down a core provision of the Affordable Care Act in her state. Lou Moshakos, the head of a restaurant company in nearby Raleigh, is also waiting for the court, but with a sense of optimism. A weakened law might remove the threat of fines if he doesn’t provide insurance for his waiters. (Armour, 3/2)

Los Angeles Times: Challenge To Health Law Stokes Fears
[Samantha] Allen, 30, is one of millions of Americans who have come to rely on the insurance aid in the law. Few of them will be in the courtroom Wednesday when the Supreme Court takes up a legal challenge to the subsidies, but perhaps no one has more at stake. An estimated 7 million people could lose assistance if the court backs the challengers. The lawsuit — spearheaded by conservative and libertarian activists — argues that a strict reading of the statute makes subsidies available only in the handful of states like California that established their own insurance marketplaces through the law. (Levey, 3/2)

Kaiser Health News: What’s At Stake As Health Law Lands At Supreme Court Again
It’s been a bitterly cold winter in the Blue Ridge Mountains for Julia Raye and her 13-year-old son, Charles. But despite the punishing weather, 2015 has been looking good: Raye is finally able to afford insulin and the other medications she needs to keep her diabetes under control. She’s a self-employed auditor who relies on a $400 per month government subsidy to afford the private health plan she bought on, the online federal marketplace for health insurance. Before the Affordable Care Act made tax credits available to low- and moderate-income workers, Raye was uninsured. Back then, just one of her diabetes medications cost her $320. (Varney, 3/3)

The Wall Street Journal: What’s At Stake In The Health-Law Case
On Wednesday, the Supreme Court will hear oral arguments in King v. Burwell, a case that could change the future of the federal health law. The 2010 Affordable Care Act requires most Americans to carry health insurance or pay a penalty, prohibits insurers from rejecting customers based on their medical history and provides tax credits to help many lower-income Americans who don’t get insurance from the government or an employer to help them pay premiums for insurance plans sold through online marketplaces. ... Both sides agree that if the Supreme Court voids the credits in much of the country, the law would rapidly become unworkable. (Radnofsky, 3/2)

NAACP Joins Fight To Expand Medicaid In N.C.

Medicaid also makes news in Texas, where some lawmakers set a marker for what they want from an expansion while others there decry the program's larger cost.

WRAL: NAACP Renews Push For Medicaid Expansion
With the Affordable Care Act headed for the U.S. Supreme Court this week, the NAACP and Democratic state lawmakers are renewing calls for North Carolina to accept the law's Medicaid expansion. ... [If the court strikes down the subsidies] it could mean the end of coverage subsidies for around half a million North Carolinians, warned Rep. Rosa Gill, D-Wake, at a news conference Monday morning. "It could be devastating to the Carolinas," Gill said. "Insurance companies, medical professionals and others may lose their financial stability." Yet, Gill and state NAACP President Rev. William Barber say the state should accept the federal Medicaid expansion provided under another section of the ACA. (Leslie, 3/2)

Houston Chronicle: Texas Senate Lays Out Prerequisites For Medicaid Expansion
The Texas Senate on Monday gave the federal government what amounted to an ambitious list of preconditions for any negotiations about expanding Medicaid in the state, demanding President Barack Obama loosen regulations and make recipients here work and pay premiums and missed-appointment fees before any widening of eligibility is considered. In a letter to the White House, Lt. Gov. Dan Patrick and the Senate Republican Caucus said growth in the nearly $30 billion Texas Medicaid program, which is jointly funded by the state and federal governments, is on a "clearly unsustainable" path that is limiting many other needs. (Rosenthal, 3/2)

Dallas Morning News: Texas Lt. Gov. Dan Patrick, 20 GOP Senators Demand Leeway On Medicaid
For Texas Independence Day on Monday, Lt. Gov. Dan Patrick and the Senate’s 20 Republicans vented their frustration over Medicaid’s costs and federal requirements. Patrick complained about “overreaching federal mandates” and demanded the leeway to “manage our own Medicaid.” He and the chamber’s Republicans sent President Barack Obama a letter demanding flexibility to revamp Texas’ version of Medicaid, a state-federal health insurance program for the poor, elderly and disabled. (Garrett, 3/2)

And some question why the Obama administration shifted money around to pay for the health law's federal insurance marketplace --

Capitol Hill Watch

Both Sides Tailor Talking Points To Sway Justices

Leading Republicans say they have a plan if the Supreme Court voids health insurance subsidies, although they have offered no details, because they believe that will make it easier for the court to strike down the credits. Likewise, the Obama administration insists it has no plan.

The Wall Street Journal's Washington Wire: Three House Chairmen Look Beyond Obamacare
Leading House Republicans stopped short of endorsing a short-term extension of the health law’s tax credits if the Supreme Court voids them in much of the country. The three committee chairmen tasked with organizing the House GOP response to a decision this June said in a Wall Street Journal op-ed that they want to retain a number of the law’s provisions if the court sides with plaintiffs in a case that will be heard Wednesday and could gut the law as it stands. (Radnofsky, 3/3)

The Associated Press: GOP: Our Plans Would Help People Losing Health Subsidies
Congressional Republicans sent a message Monday that they hope the Supreme Court and voters will hear: They have ideas to keep the country’s health care system from crumbling if the justices obliterate a bedrock feature of President Barack Obama’s heath care law. The plans — one set from three GOP House chairmen, another from three top Republican senators — were far from legislative proposals, lacked detail and left many unanswered questions. They were released in the run-up to Wednesday’s oral arguments before the Supreme Court in a case in which Republicans and conservatives are challenging federal subsidies that help millions of Americans afford health coverage under Obama’s 2010 law. (3/2)

The Hill: Republicans To High Court: We Have ObamaCare Plan
The effort is intended to make it easier for the court to strike down the subsidies, since Republicans believe the court is more likely to rule in their favor if it believes a plan is in place to limit the fallout. It’s the same reason Republicans have seized on statements from the White House and Health and Human Services Secretary Sylvia Matthews Burwell that officials have “no plans” in case of a plaintiff victory. “What Burwell does not have — any plan — Republicans do have,” Sen. Bill Cassidy (R-La.) told The Hill on Monday. Senate Republicans have recently tried to unite their party around a fallback plan in which people could receive temporary government help to keep their subsidies. (Ferris, 3/3)

The Hill: Obama: No 'Plausible' Basis For SCOTUS Ruling Against ObamaCare
President Obama said his administration is not preparing a backup plan in case the Supreme Court rules against ObamaCare because he believes there is no “plausible legal basis” for such a ruling. In his first public remarks on the high-stakes case, Obama stuck with his health secretary’s previous remarks that the administration is not concerned about how to protect the subsidies at the heart of his healthcare law. (Ferris, 3/2)


Groups That Rate Hospitals Often Disagree On Rankings

A study in Health Affairs examined four hospital rating systems for consumers and found their results often diverged.

The Wall Street Journal: What Are the Best Hospitals? Rankings Disagree
What makes a top hospital? Four services that publish hospital ratings for consumers strongly disagree, according to a study in the journal Health Affairs. No single hospital received high marks from all four services—U.S. News & World Report, Consumer Reports, the Leapfrog Group and Healthgrades—and only 10% of the 844 hospitals that were rated highly by one service received top marks from another, the study published Monday found. (Beck, 3/2)

The New York Times: Hospital Rating Systems Differ On Best And Worst
Four popular national rating systems used by consumers to judge hospitals frequently come to very different conclusions about which hospitals are the best — or worst — potentially adding to the confusion over health care quality, rather than alleviating it, a new study shows. The analysis, published on Monday in the academic journal Health Affairs, looked at hospital ratings from two publications, U.S. News & World Report and Consumer Reports; Healthgrades, a Denver company; and the Leapfrog Group, an employer-financed nonprofit organization. (Abelson, 3/2)


Workers' Costs Grow Despite Slowed Health Spending

A new report indicates that employees face higher medical bills as a result of increasing insurance premiums and out-of-pocket medical expenses. Another finds that drug coverage in Obamacare plans is often stingier than in employer coverage.

Los Angeles Times: Employees Not Benefiting From Slower Growth In Health Care Costs
American workers already struggling with stagnant wages are being saddled with higher medical bills even as employers reap the benefits of a sustained slowdown in the growth of healthcare costs, a new report indicates. While employees' insurance premiums and out-of pocket medical expenses shot up 21% from 2007 to 2013 to an average of $3,273 a year, employers' total healthcare costs rose only 14.5%. (Levey, 3/2)

Politico Pro: Study: Drug Coverage Less Generous In Obamacare Plans
Prescription drug coverage in Obamacare plans varies widely but is stingier than typical employer-sponsored coverage, according to a study published Monday in Health Affairs. Co-pays, coinsurance and high deductibles, especially in bronze and the most popular silver plans, mean that many enrollees are on the hook for a larger share of their drug costs, even though the monthly premiums are often lower than for coverage they might get through work, the researchers report. (Norman, 3/2)

Meanwhile, a onetime patient safety advocate pays $1 million to settle allegations he took kickbacks to promote a product -

State Watch

State Highlights: Budget Proviso Would Delay KanCare Home Health Expansion; NYC's Rikers' Health Care Contract

A selection of health policy stories from Kansas, New York, North Carolina, Texas, Ohio, Georgia and Oregon.

Kansas Health Institute News Service: Proposal Would Delay KanCare Health Home Expansion
The Senate Ways and Means Committee has adopted a budget proviso that’s expected to delay the implementation of “health homes” for KanCare patients with chronic illnesses such as asthma and diabetes. The proviso, drafted by Sen. Jim Denning, a Republican from Overland Park, stipulates that no state money shall be spent on KanCare health homes for chronic conditions without the Legislature’s explicit consent in fiscal years 2015, 2016 and 2017 — through June 30, 2017. (Ranney, 3/2)

North Carolina Health News: N.C. Docs Face Retroactive Medicaid Rate Cut
In the 2014 state budget passed last August, state lawmakers inserted what could be considered a poison pill for Medicaid providers: a 3 percent pay cut that for specialists could be effective retroactively to January 2014. Primary care providers such as pediatricians, internists and family doctors will see the same pay cut, effective back to Jan. 1, 2015. But the cut is only now being implemented. (Hoban, 3/3)

NPR: Abortion Restrictions Complicate Access For Ohio Women
Ohio may not have gotten the national attention of say, Texas, but a steady stream of abortion restrictions over the past four years has helped close nearly half the state's clinics that perform the procedure. "We are more fully booked, and I think we have a harder time squeezing patients in if they're earlier in the pregnancy," says Chrisse France, executive director of Preterm. It's one of just two clinics still operating in Cleveland, and its caseload is up 10 percent. (Ludden, 3/3)

Editorials And Opinions

Viewpoints: Health Law 'Off-Ramp'; GOP's Tough Choices; Negotiating Medicare Drug Prices

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

The Wall Street Journal: An Off-Ramp From ObamaCare
On Wednesday the Supreme Court will take on yet another legal challenge to the president’s health-care law, when the justices hear oral arguments in King v. Burwell. If the court rules against the administration, as any fair reading of the law would demand, millions of individuals and families will hit a major roadblock: They’ll be stuck with health insurance designed by Washington, D.C., that they can’t afford. Americans should have an off-ramp from ObamaCare—a legislative alternative that leads them away from an expensive health-care wreck and toward a patient-centered system. (Rep. John Kline, R-Minn., Rep. Paul Ryan, R-Wis., and Rep. Fred Upton, R-Mich, 3/2)

The Wall Street Journal: The Plain Text Of ObamaCare
The Obama Administration’s abuse of executive power—dispensing with its duty to faithfully execute statutes to become a law maker unto itself—has become the most consequential dispute across the three branches of government. The Supreme Court rejoins this debate on Wednesday with oral arguments in the challenge to the White House’s illegal Affordable Care Act subsidies. Unlike the 2012 ObamaCare cases, King v. Burwell is not a challenge to the constitutionality of the health law. To the contrary, the plaintiffs are asking the Justices to vindicate the law’s plain text and uphold the statute that Congress passed in 2010, rather than the version the Administration rewrote. (3/2)

The New York Times' The Upshot: A Polarized Court, Weighing A Reversal Of The Safety Net
The Supreme Court has become a more partisan institution in recent decades, more closely resembling the other branches of government than it once did. This week will start to show just how partisan the court has become. On Wednesday, it will hear arguments in the latest challenge to the health care law, a case that has received less attention than the 2012 challenge did but also is of great consequence. Of the 10 million people who have health insurance thanks to the law, the court could effectively take it from about five million of them. There are few if any historical precedents for a rollback of the social safety net as large as this one would be. (David Leonhardt, 3/3)

Bloomberg: Republicans And An Obamacare Apocalypse
If you liked the fiasco in the House of Representatives late Friday -- as its leaders scrambled to avoid a shutdown of the Department of Homeland Security -- Republicans are setting things up for an even bigger imbroglio. This time, health care is on the line. (Jonathan Bernstein, 3/2)

Bloomberg: Hurting Obamacare Hurts Conservatives
If the U.S. Supreme Court rules against the government in the latest challenge to Obamacare, conservatives will have done more than undercut the Affordable Care Act. They will also have crippled a cause they have long supported: weakening the link between health insurance and employment. (Christopher Flavelle, 3/3)

The Washington Post: Morning Plum: Republicans Won’t Have Any Contingency Plan If Court Guts Subsidies For Millions
With the Supreme Court set to hear oral arguments this week in the lawsuit that could do severe damage to the Affordable Care Act, some Republican lawmakers are working hard to convey the impression that they have a contingency plan for the millions who will likely lose subsidies — and coverage — if the Court rules with the challengers. Senators Orrin Hatch, Lamar Alexander, and John Barrasso have published a Washington Post op ed with an oh-so-reassuring title: “We have a plan for fixing health care.” ... Yet even if this game works on the Justices in the short term, any eventual failure to come through with any contingency plan could saddle Republicans with a political problem, perhaps even among GOP voters. (Greg Sargent, 3/2)

The Washington Post's The Volokh Conspiracy: Lobbying The Chief Justice (Again)
Now that we have reason to believe that the Chief Justice Roberts did change his vote after the progressive onslaught, the left has been encouraged to think that its pressure worked, and might work again in King v. Burwell. But this time, they aren’t waiting until after oral argument to launch their political lobbying campaign. Instead, in advance of oral argument, they are making a preemptive appeal to the Chief Justice with varying degrees of subtlety. (Randy Barnett, 3/2)

The Washington Post's The Volokh Conspiracy: Have The Practical Effects Of A Plaintiffs’ Victory In King Been Exaggerated? (And Does It Matter?)
An analysis produced by the Urban Institute estimates a ruling for the plaintiffs would result in 8.2 million more uninsured and substantial premium increases. Several amicus briefs filed in support of the federal government paint even more dire scenarios. Such scenarios generally assume that the political process fails to respond to a court decision recognizing that the PPACA’s text only authorizes tax credits in state-established exchanges. Yet it’s possible that Congress will swing into action, that states will reconsider whether to create exchanges, and even that the administration, when push comes to shove, discovers ways to ease the effects of ending illegal subsidies. (Jonathan H. Adler, 3/3)

Los Angeles Times: Costco-Visa Deal Shows Why Medicare Should Negotiate Drug Prices
Costco's deal to replace American Express with Visa as its exclusive credit-card company highlights an economic principle that should surprise no one. Consumers benefit when a business uses its market power to negotiate lower prices and passes along the savings to customers. Conservatives have championed such market forces for decades, arguing that if government regulators just got out of the way of businesses, consumers would be the big winners. That is, unless we're talking about drug prices. Medicare, the federal healthcare program, is prohibited by law from haggling with makers of prescription drugs over the prices paid by its 54 million beneficiaries. (David Lazarus, 3/2)

The Wall Street Journal: The Diseases We Spend Our Health Dollars On
People worry a lot about their health-care costs, such as the share they pay of their health premium or the size of their deductible. But they tend to have a harder time getting their heads around the measures experts use to talk about the national health-cost problem .... But there is good news for those who want to understand more. The Bureau of Economic Analysis (BEA) has made a real contribution to making health spending more comprehensible by analyzing health spending and price growth by common diseases and diagnoses such as cancer, heart disease, diabetes, and even the common cold. Doing that makes the problem of health-care costs much more understandable for everyone. (Drew Altman, 3/3)

The New York Times' The Upshot: If Patients Only Knew How Often Treatments Could Harm Them
If we knew more, would we opt for different kinds and amounts of health care? Despite the existence of metrics to help patients appreciate benefits and harms, a new systematic review suggests that our expectations are not consistent with the facts. Most patients overestimate the benefits of medical treatments, and underestimate the harms; because of that, they use more care. (Austin Frakt and Aaron E. Carroll, 3/2)

Bloomberg: The Politics Of Aging
Who will take care of all the old people? That's the theme of Nicholas Eberstadt's latest piece on demographics, which I highly recommend to all of you. The core problem of the welfare state is that it relieves people of the need for family to take care of them, but it does not relieve society of the need for caretakers. ... And, of course, there is the question of who will provide the actual hands-on care that people need. Here, the usual solution proposed is immigration. There are a couple of problems with that. ... But there's another problem, which is that old people are often vulnerable. This is why stories of abuses in nursing homes are so common; it is not that the state doesn't care about the people in its charge, but that "the state" does not actually provide the care -- individual people do, some of whom are badly motivated. (Megan McArdle, 3/2)

The New York Times: Are You Really Allergic To Antibiotics?
Allergic reactions to antibiotics can be severe, including symptoms ranging from hives and wheezing to anaphylactic shock. People with such allergic reactions are right to steer clear. The problem is that many, and probably most, people who say they’re allergic to antibiotics actually aren’t. For penicillin, the most commonly reported allergy, many studies have estimated that up to 90 percent of claims of allergies are not legitimate. (Victoria Dooley, 3/3)