KHN Morning Briefing

Summaries of health policy coverage from major news organizations.

Kaiser Health News Original Stories

Obamacare Processing Center In Missouri Paid 13,000 Hours Of Overtime

The St. Louis Post-Dispatch filed Freedom of Information Act requests after whistleblowers alleged that workers at the Wentzville, Mo. center played games, read or worked very slowly because they had so little to do beginning in fall, 2013 after the facility opened. Serco Inc. said that it paid workers overtime in spring and summer of 2014 because of the large number of backlogged applications as a result of healthcare.gov’s computer problems. (Chuck Raasch, St. Louis Post-Dispatch , 4/21)

What’s At Stake In The Supreme Court Obamacare Case

Despite political opposition to the Affordable Care Act, more than 186,000 people in Louisiana signed up for health insurance through healthcare.gov. The vast majority of those received subsidies, which could be lost in the King v. Burwell case before the Supreme Court. (Jeff Cohen, WNPR, 4/21)

Political Cartoon: ‘Down To A Science?’

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: ‘Down To A Science?’" by David Fitzsimmons, The Arizona Daily Star.

Here's today's health policy haiku:

SETTLING UP

I've got Sovaldi
for my Hep C, but who pays?
I hope it's not me.

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

Facing Pressure From Federal Officials, Texas Gov. Renews Opposition To Medicaid Expansion

Gov. Greg Abbott also says he supports the Florida governor's threat of a lawsuit against the Obama administration in a similar dispute. In other Medicaid news, Montana's legislature sends its expansion bill to the governor, and Alaska's governor says he will call the legislature back if lawmakers do not deal with the issue of expansion in the current session.

The Texas Tribune: With Hospital Funds In Question, Abbott Holds Firm Against Medicaid Expansion
Following news that billions of federal dollars for hospitals could be in jeopardy if the state does not expand its public health insurance program to cover more low-income Texans, Gov. Greg Abbott reiterated his opposition to Medicaid expansion — a tenet of President Obama’s signature health care law — and accused the administration of "coercive tactics against the States." (Walters, 4/20)

The Hill: ObamaCare Court Fight Escalates
The fight over ObamaCare’s Medicaid expansion escalated Monday, as Texas’s Republican governor backed a lawsuit from Florida against the Obama administration. ... The administration says some Florida hospital funding will not be extended in its current form past the June expiration date, arguing that the money should not go toward costs that would otherwise be covered by an expansion of Medicaid under ObamaCare. ... Aaron Albright, a spokesman for CMS, said the principles given to Florida apply in Texas and other states as well. “We will also use these principles in considering similar proposals in other states, but discussions with each state will also take into account state specific circumstances,” he said. CMS communicated that message directly to Texas in a call on Thursday. (Sullivan, 4/20)

Orlando Sentinel: Gov. Scott Lawsuit Over Medicaid Expansion Gets Texas Backing
Gov. Rick Scott received the backing of Texas Gov. Greg Abbott on Monday over his intention to sue the federal government for allegedly “coercing” Florida to accept Medicaid expansion. "I commend Governor Rick Scott’s decision to take legal action to protect these important constitutional principles. Texas will support Florida in its litigation against the federal government. Medicaid expansion is wrong for Texas. Florida’s approach should be determined by Floridians, not coerced by federal bureaucrats,” Abbott said in a released statement. (Rohrer, 4/20)

Modern Healthcare: CMS Takes Tougher Medicaid Stance To Texas
Texas officials and the Obama administration are nearing a showdown over Medicaid expansion that threatens billions of dollars of federal funding that helps healthcare providers care for low-income Texans and improve the quality of care. Texas' five-year Medicaid waiver is on track to end in September 2016. Under the waiver, the state draws $6 billion a year that's split into two pools—one for uncompensated care and another (known as the Delivery System Reform Incentive Payment, or DSRIP, program) to encourage providers to increase the quality and cost effectiveness of care by creating innovative programs. The CMS notified state health officials in a call last week that the agency intends to use the same principles outlined in a recent letter to Florida regarding the future of that state's assistance for treating low-income patients. (Dickson, 4/20)

The Great Falls (Mont.) Tribune: Medicaid Expansion On Way To Governor's Desk
Saturday morning the Montana Senate gave final approval to Medicaid expansion with a 28-21 vote. The bill, sponsored by Sen. Ed Buttrey, R-Great Falls, now heads to the governor's desk. Gov. Steve Bullock praised passage of Buttrey's HELP (Montana Health and Economic Livelihood Partnership) Act He said the partisan fighting that sank the bill during the 2013 session threatened to do so again but "Democrats and responsible Republicans stuck together and shepherded the bill to final passage." (Inbody, 4/18)

Louisiana Lives At Stake In King V. Burwell

A reporter profiles some of those who would lose their subsidies and their health coverage if the Supreme Court were to strike down subsidies in federal exchange states. In Colorado, meanwhile, an exchange oversight committee gears up and in Missouri, an Obamacare processing center where workers once complained of little to do paid more than 13,000 hours of overtime last spring and summer.

Kaiser Health News: What’s At Stake In The Supreme Court Obamacare Case
The Affordable Care Act mandates that all Americans get health coverage or pay a penalty. To help people pay for that insurance, the federal government subsidizes insurance premiums for millions of Americans. In just a couple of months, the Supreme Court will rule in a major case concerning those subsidies. The question is whether the law allowed for them across the country or just in the minority of states that set up their own insurance exchanges. A decision to take away those subsidies could leave millions without insurance. ... Louisiana is a state where a lot of people could be affected. ... We traveled to the state to interview many of these people who could lose subsidies if the Supreme Court rules against them. (Cohen, 4/21)

The Denver Post: Connect For Health Colorado's Oversight Committee Gears Up To Provider Greater Legislative Scrutiny
The legislative oversight committee for the state health insurance exchange heard Wednesday from brokers, agents and consumers about the good, the bad and the ugly aspects of the two-year-old marketplace. Even as the oversight committee heard testimony from some of those directly affected by operational problems and successes at the exchange, the Senate passed a bill allowing the committee to change its name and to meet 10 times after the legislative session ends. (Draper, 4/20)

The St. Louis Post-Dispatch: Wentzville Obamacare Contractor Paid 13,000 Hours Of Overtime
The contractor who runs the Affordable Care Act application processing facility in Wentzville paid more than 13,000 hours of overtime to catch up with a backlog created by computer problems after the initial sign-up period, according to documents obtained under the Freedom of Information Act. From May 1 through Aug. 15 last year, workers in the Wentzville facility logged 13,228.25 hours of overtime to process “backlogged inconsistency work,” according to a report by Serco Inc., the contractor running the facility for the federal Centers for Medicare and Medicaid Services, or CMS. (Raasch, 4/20)

Capitol Hill Watch

Lines Are Drawn In Capitol Hill Budget Negotiations

Medicare is among the flashpoints in the negotiations between House and Senate Republican negotiators as they try to reach agreement on a budget blueprint for next year and further into the future.

McClatchy: Congress Starts Work On Slashing Trillions From Federal Budget
The two GOP budget resolutions envision deep spending cuts above $5 trillion over 10 years to get to a balanced budget. The president’s budget proposal doesn’t balance, boosts spending on education and infrastructure and is paid for with a $320 billion tax hike on the rich that will never get past a Republican Congress. Similarly, GOP plans envision repealing the Affordable Care Act, something the president is sure to veto. (Hall and Douglas, 4/20)

All the while, President Barack Obama will invite lawmakers from both parties to the White House -

The Associated Press: Obama Plans Reception For Overhaul Of Medicare Payment Plan
President Barack Obama has invited Democratic and Republican lawmakers to the White House for a reception thanking them for their work on legislation permanently changing how Medicare pays doctors. The event will be held Tuesday in the Rose Garden. Obama signed the legislation on Friday, marking a rare bipartisan achievement and ending years of last-minute fixes. Obama said then that he wanted to act quickly without ceremony to allow for the new payments. He said he would have lawmakers to the White House this week. (4/20)

New Draft Of Long-Awaited 'Cures' Bill Nears Completion

The measure, which has bipartisan support on the House Energy and Commerce Committee, is focused on spurring new medical treatments.

The Hill: Details Could Come Wednesday For New 'Cures' Bill
Senior members of the House Energy and Commerce Committee are close to completing a new draft of their long-awaited 21st Century Cures bill, which could be released as early as Wednesday. Committee chairman Fred Upton (R-Mich.) and ranking member Diana DeGette (D-Colo.) are expected to release the latest draft of the legislation after a joint trip to Upton’s home state of Michigan to promote their initiative, which aims to speed up the development of new medicines and treatments. (Ferris, 4/20)

CQ Healthbeat: House Members Close To Narrowing Down 'Cures' Package
The biggest piece of health care legislation still to be decided by Congress this year could begin taking shape as soon as this week, when House lawmakers narrow down the list of provisions to be included in a bill aimed at spurring new medical treatments. The so-called 21st Century Cures initiative was introduced in draft form earlier this year by House Energy and Commerce Chairman Fred Upton, R-Mich., after dozens of roundtable discussions and hearings. The hefty document was essentially a compendium of any provision that an interest group requested that had any support in Congress. (Zanona, 4/20)

In other action on Capitol Hill -

The Washington Post: Pressure Mounts For Loretta Lynch Vote, But No Deal Yet
The Senate wrapped up its business last week with high hopes that a solution might be at hand to break an impasse that has delayed a confirmation vote for attorney general nominee Loretta Lynch for more than six weeks. By the end of Monday's Senate business, no such deal was in place. But senators of both parties said an agreement was close at hand and could be announced on Tuesday. Democrats have filibustered a bill cracking down on human trafficking due to abortion restrictions embedded within it, and Republicans have vowed not to move forward with Lynch's confirmation until the trafficking bill is dealt with. After weeks of gridlock, leaders of both parties sounded optimistic on Thursday that a deal could be hashed out over the weekend. (DeBonis, 4/20)

The Washington Post: House Republicans Take Issue With Another D.C. Law
After months of fiery rhetoric and even a threat to jail the mayor, conservative House Republicans on Tuesday are poised to take yet another swipe at the District’s liberal leaders by trying to throw out a new law. For the first time in 23 years, a powerful House committee has scheduled a vote to upend a D.C. law that bans employers from discriminating based on reproductive health decisions. Some conservatives have interpreted the bill to mean that employers in the District, including religious organizations, could eventually be required to provide coverage for contraception and abortions. (Davis, 4/20)

St. Louis Public Radio: Blunt Wants To Boost Funding For NIH
U.S. Sen. Roy Blunt says that he wants to use his key position on the Senate Appropriations Committee to boost funding for research. The Republican senator recently became the chairman an Appropriations subcommittee that controls federal funding for the National Institutes of Health. He said during a visit to Washington University’s Alzheimer’s Research Center that he wants to make funding for the agency a priority. (Rosenbaum, 4/21)

Marketplace

Cardinal Health To Pay $26.8 Million To Settle FTC Drug Inflation Charges

Also in news, the Wall Street Journal's Pharmalot blog reports that Teva Pharmaceutical agreed to pay $512 million to settle a pay-to-dely case.

The Wall Street Journal: Cardinal Health To Pay $26.8 Million To Settle Allegations It Inflated Prices
Cardinal Health Inc. agreed to pay $26.8 million to settle U.S. accusations that the drug distributor inflated the prices for radiopharmaceutical drugs used to diagnose illnesses such as heart disease. Cardinal Health said that as part of the settlement, it didn’t admit or deny any wrongdoing and that it doesn’t believe it violated the law. According to the company, it voluntarily agreed to the settlement to avoid the costs and inherent unpredictability associated with litigation. (Stynes, 4/20)

The Associated Press: Cardinal Health Paying $26.8M In FTC Settlement
Cardinal Health will pay $26.8 million as part of a settlement with the Federal Trade Commission over charges it monopolized the sale in 25 markets of diagnostic drugs known as low-energy radiopharmaceuticals. The charges allege that the pharmaceutical and medical-products distributor forced hospitals and clinics to pay inflated prices for the drugs, used to diagnose a range of conditions, including heart disease. (4/20)

Modern Healthcare: Cardinal To Pay $26.8M For Alleged Monopolization Of Radiopharmaceuticals
Cardinal Health has agreed to pay $26.8 million as part of a settlement with the Federal Trade Commission that sparked disagreement among the commissioners about the agency's appropriate role. The settlement resolves allegations that Cardinal illegally monopolized the sale of low-energy radiopharmaceuticals in 25 markets. The settlement announced Monday is the second-largest in FTC antitrust history. (Schencker, 4/20)

A health insurance start-up joins the rare group of "unicorns" -

The New York Times' DealBook: Oscar, A Health Insurance Start-Up, Valued At $1.5 Billion
Sixteen months after going live, the insurance company Oscar has joined the elite group of start-ups known as unicorns, or those with billion-dollar valuations. The company plans to announce on Monday that it has raised $145 million from a group led by the billionaire Peter Thiel and his Founders Fund venture capital firm. Other investors in the round included the Hong Kong billionaire Li Ka-shing’s Horizon Ventures, the Wellington Management Company and Goldman Sachs. (de la Merced, 4/20)

News outlets also offer financial status checks on the health care sector -

Marketplace: Why Health Stocks Are Doing So Well
It’s a great time to own health stocks. In fact, over the past five years, the sector has outperformed most other industries. What’s driving the surge? Wunderlich Securities analyst Art Hogan says it’s easy as saying "ACA." (Gorenstein, 4/20)

Modern Healthcare: Higher Medical, Drug Costs Could Slow Down Insurers' Profit Run
Rising medical and prescription drug costs could crimp the health insurance industry's strong revenue and profit growth. The Altarum Institute's Center for Sustainable Health Spending estimated that spending on hospital care jumped 9% from February 2014 to February 2015. That's a “giant” increase, said Paul Hughes-Cromwick, a senior health economist at Altarum. By contrast, hospital spending climbed only 3.1% from February 2013 to February 2014. (Herman and Evans, 4/20)

Public Health And Education

Mammogram Age Guidelines Say Optional In 40s, Definitely By 50

A government task force's recommendations will affirm controversial guidance issued in 2009 that women who are 50 or older should get a mammogram every two years, but that the screenings may do more harm than good for younger women.

The Associated Press: Task Force: Mammograms In 40s A Choice, But Don’t Skip At 50
Women should get a mammogram every two years starting at age 50 — and while routine screening brings little benefit in the 40s, beginning it that early should be a personal choice, a government task force said Monday. Also, there’s not enough evidence to tell if new 3-D mammograms are the best option for routine screening, or if women with dense breasts need extra testing to find hidden tumors, the U.S. Preventive Services Task Force concluded. (Neergaard, 4/21)

NPR: Federal Panel Revisits Contested Recommendation On Mammograms
In 2009, I was among the scrum of reporters covering the controversial advice from the U.S. Preventive Services Task Force that women in their 40s think twice about regular mammograms. The task force pointed out that the net benefits in younger women were small and said women should weigh the pros and cons of screening before making a decision. (Hobson, 4/20)

Meanwhile, two labs are teaming up with researchers to share data to help target the BRCA1 and BRCA2 genes that can cause breast and ovarian cancers. And a start-up company says it can detect the genes from an inexpensive saliva test -

USA Today: BRCA Gene Datashare Will Help Detect Cancer Risk
A first-of-its-kind genetic datashare program is being launched to zero in on patients with unclear BRCA test results — and save more women from the devastation of breast and ovarian cancer. U.S.-based Quest Diagnostics announced Tuesday that it is pairing with Inserm, the French public health institute, to launch BRCA Share. The goal: provide scientists and labs around the world with open access to BRCA1 and BRCA2 genetic data and improve the ability of diagnostic labs to predict which individuals are at risk of developing hereditary breast and ovarian cancers. (Miller, 4/21)

The New York Times: New Genetic Tests For Breast Cancer Hold Promise
A Silicon Valley start-up with some big-name backers is threatening to upend genetic screening for breast and ovarian cancer by offering a test on a sample of saliva that is so inexpensive that most women could get it. At the same time, the nation’s two largest clinical laboratories, Quest Diagnostics and LabCorp, normally bitter rivals, are joining with French researchers to pool their data to better interpret mutations in the two main breast cancer risk genes, known as BRCA1 and BRCA2. Other companies and laboratories are being invited to join the effort, called BRCA Share. (Pollack, 4/21)

Administration News

FDA Moving 'Full Steam Ahead' On Rules To Cut Teens' Use Of E-Cigarettes

The acting administrator says strengthening tobacco regulations is one of his top priorities. Also, a bipartisan bill introduced in the Senate would give the FDA more authority to regulate cosmetics.

The Hill: New FDA Head: 'Full Steam Ahead' On E-Cig Rules
The acting head of the Food and Drug Administration (FDA) said Monday that the agency is moving “full speed ahead” with its efforts to crack down on the use of e-cigarettes. Two weeks into his tenure, Dr. Stephen Ostroff said strengthening tobacco regulations is one of his top priorities. He pointed to alarming new federal data that showed the use of e-cigarettes among middle and high school students has tripled in the last year — a trend that landed on the front page of nearly every national newspaper. (Ferris, 4/20)

The New York Times: Bill Would Give F.D.A. More Muscle On Cosmetics
For decades, the Food and Drug Administration has had fewer than a dozen pages of instructions for how to regulate the millions of lipsticks, moisturizers and other cosmetics sold each year. Now, a new bipartisan bill, co-sponsored by Senators Dianne Feinstein, Democrat of California, and Susan Collins, Republican of Maine, proposes to give the F.D.A. broader oversight, including the authority to force recalls of dangerous products. (Abrams, 4/20)

State Watch

Georgia Owes The Feds $100M In Inappropriate Medicaid Payments To Nursing Homes

In other state Medicaid news, a growing population of inmates is signing up for the program; New Jersey is awaiting an analysis of its backlog of applicants; Iowa's privatization effort draws scrutiny; and federal officials end a psychiatric hospital pilot program that will have ramifications in Alabama.

National Journal: States Enrolling Newly-Eligible Inmates In Medicaid
Thanks to Obamacare, there's a growing population enrolling in Medicaid upon their first opportunity: prisoners. Under the Affordable Care Act, a large proportion of incarcerated adults have become eligible for Medicaid in states that have expanded their Medicaid program. They can't receive Medicaid benefits while behind bars, but many states are now working to ensure they are enrolled immediately upon reentering society. Doing that, the thinking goes, will help prevent costly emergency health care and, potentially, decrease recidivism rates. (Owens, 4/21)

The Associated Press: New Jersey Awaits Report On Backlogged Medicaid Program
New Jersey's Human Services Department chief told lawmakers Monday that the state expects to get an analysis of its Medicaid program in May that should help with development of a computer-based program to reduce a backlog of applicants. Acting Commissioner Elizabeth Connolly said at an Assembly budget hearing that the KPMG report, at a cost of $850,000, will be used by Xerox to develop the new process. (Catalini, 4/20)

The Associated Press: Iowa's Medicaid Privatization Draws Scrutiny
Gov. Terry Branstad’s plan to privatize the state’s Medicaid program is moving forward, though critics are raising questions about how the shift will impact patients. Earlier this year, the state began an effort to shift Medicaid administration to two or more managed care organizations, to which Iowa will pay a fixed amount per enrollee to provide health coverage. State officials predict cost savings and say patients will still have access to quality health care. But Democratic Senate President Pam Jochum, of Dubuque, said this week that she is not convinced. (4/20)

Al.com: Program's End Will Cut Psychiatric Beds For Adults On Medicaid
A pilot program that paid private psychiatric hospitals to treat adults on Medicaid ended abruptly last week, two months earlier than expected, which could leave south Alabama with a shortage of treatment beds. AltaPointe Health Systems has been receiving about $2 million annually since 2012 to treat adult Medicaid patients in its two inpatient hospitals, BayPointe and EastPointe, according to CEO Tuerk Schlesinger. Freestanding psychiatric hospitals have historically been excluded from Medicaid, and cannot receive payment for treating adults in the program unless they participated in the pilot program. The Centers for Medicare & Medicaid Services notified AltaPointe and other hospitals last week that money for the program ran out, Schlesinger said. (Yurkanin, 4/20)

State Highlights: Scope-Of-Practice Bills Trigger Turf Battles; Fla. Sends Hospital-Funding Plan To Feds

News outlets cover health care issues in Texas, Florida, Delaware, Minnesota, California, Indiana, New York and Montana.

The Texas Tribune: Bills On Medical Authority Spark More Doc Fights
Every two years, it seems, lawmakers are asked to recalibrate a few delicate balances between groups of health professionals trying to keep others from encroaching into their business. More than a dozen bills this year — some moving, some apparently stuck — would give professionals like nurse practitioners and physical therapists more autonomy to operate independently from medical doctors. Others would expand the range of medical professionals like optometrists, allowing them to prescribe painkillers, or create new classes of non-doctor medical professionals, like dental hygiene practitioners. (Walters, 4/21)

The Associated Press: Florida Sends Feds Formal Hospital Funding Proposal
Florida is submitting a proposal to the federal government based on a Senate plan to extend funding for hospitals that treat low-income patients. The proposal would extend funds through June 2017. It also distributes the $2 billion funding more broadly and includes money for Florida medical schools, county health departments and federally qualified health centers. (4/20)

Tampa Bay Times: Politicking, Negotiations Continue Over Low Income Pool
Florida has officially petitioned the federal government to renew a $2.2 billion program for hospitals that treat low-income patients, the state Agency for Health Care Administration said Monday. State health officials are asking the U.S. Centers for Medicare and Medicaid Services (CMS) to continue the so-called Low Income Pool program through June 30, 2017. They have submitted a plan created by the Florida Senate that would distribute the funds more broadly than in the past. ... The uncertainty surrounding the Low Income Pool has brought the budget building process to a virtual halt in Tallahassee. It has also become part of a larger debate on whether to extend subsidized health care coverage to more than 800,000 low-income Floridians. (McGrory, 4/20)

The Associated press: Nemours Foundation Sues United Healthcare Of Delaware
The foundation that owns the Alfred I. du Pont Hospital for Children in Wilmington filed a federal lawsuit against United Healthcare of Delaware on Monday over pediatric care provided to children covered by Medicaid and another state-subsidized health care program. Despite termination of the hospital's in-network agreement, Nemours says it has an obligation and responsibility under the agreement, as well as state law, to continue to treat United's members under certain conditions and for certain periods of time. But Nemours claims that the Medicaid rate it has been receiving from United for those services is not adequate, and that it has not been paid in full for providing medically necessary services, including emergency care, to United members, including those on Medicaid and Delaware Healthy Children Program. (Chase, 4/20)

California Healthline: Youth Immigrants Face Health Risks
Immigration status affects the health of young immigrants in California, according to a new study from UCLA... The report found that [h]alf of immigrant youth delay getting needed medical care, mostly because of cost or lack of insurance. (Gorn, 4/20)

The Sacramento Bee: Religion Complicates California Vaccine Debate
Most states allow for a religious vaccine exemption. Since California does not have a religious exemption distinct from the personal belief exemption, doing away with the personal belief exemption, as SB 277 would do, also would bar parents from invoking religion to skip shots. (White, 4/20)

Tampa Bay Times: Also Under Consideration: Health Care Bills That Aren't Medicaid Expansion
While a contentious debate over Medicaid expansion has overshadowed much of the 2015 legislative session, it isn't the only health care issue under consideration. A proposal that would allow doctors to make better use of digital communications technology is gaining steam late in the session, as are bills seeking to expand the prescribing powers of nurses and encourage medical tourism. Lawmakers are also advancing a plan that would broaden the list of vaccines that pharmacists and pharmacy interns can administer (HB 279/SB 792). (McGrory, 4/20)

The Associated Press: Indiana Governor Extends Needle Exchange Program To Curb HIV
Indiana Gov. Mike Pence on Monday extended a needle exchange program in a rural, southern Indiana county to help combat an HIV outbreak, even though he generally opposes such programs. Pence approved the 30-day extension of a March 26 executive order that declared a public health emergency in Scott County, about 30 miles north of Louisville, Kentucky. Republican Pence opposes such programs as part of a statewide anti-drug policy but said the efforts to fight the outbreak must continue. (Schroeder, 4/20)

The Associated Press: NY Blueprint Lists Steps To End AIDS Scourge
Experts and advocates in New York, a state hit hard early in the AIDS epidemic, have drafted a blueprint for reducing new HIV infections and related deaths to the point of nearly ending them in five years. The plan, requested by Gov. Andrew Cuomo, expands steps already reducing deaths and newly diagnosed infections statewide to fractions of what they once were. (4/21)

Kaiser Health News: Cash-And-Carry Health Insurance For Some In Los Angeles
The largest publicly run health plan in the nation, L.A. Care, will allow customers who do not have traditional bank accounts to pay their health insurance premiums with cash. One in four Americans who were previously uninsured and eligible for federal insurance subsidies do not have a bank account, relying instead on pre-paid debit cards, money orders and cash to pay bills, according to a study by Jackson Hewitt Tax Service. (Varney, 4/20)

Los Angeles Times: Abortion Restrictions Relying On 'Junk Science,' Rights Advocates Say
In Montana, the Legislature has approved and sent to the governor a bill that would require a fetus to be anesthetized before an abortion is performed so it would not feel pain. In Arizona and Arkansas, doctors are now required to tell women that drug-induced abortions can be "reversed" mid-procedure, even though the American Congress of Obstetricians and Gynecologists says the reversal claims are "not supported by the body of scientific evidence." (La Ganga, 4/20)

Editorials And Opinions

Viewpoints: Doctors' Attack On Dr. Oz; Calif.'s Vaccine Bill; No Tax Day Hysteria

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

Los Angeles Times: A Physicians' Attack On Dr. Oz Explodes Into A New Controversy
Sometimes a cogent attack on a worthy target ends up making the target stronger. That may be happening with last week's letter signed by 10 physicians urging Columbia University to sever its ties with Dr. Mehmet Oz, who has made a fortune promoting quack nostrums to his huge television audience. Oz's TV producers say he'll be devoting a large portion of a forthcoming "Dr. Oz" show, probably Thursday's, to a counterattack. Of the doctors behind the letter, the producers say, "We plan to show America who these authors are, because discussion of health topics should be free of intimidation." (Michael Hiltzik, 4/20)

The New York Times: Vaccine Phobia In California
California is in the midst of a dispute between parents who want to exempt their children from some or all of the vaccinations required for admission to public and private schools and a medical establishment that believes, with good reason, that vaccines can protect the students from the harm caused by infectious diseases and reduce the risk of transmitting the diseases from schools to the broader community. A sensible bill pending in the Legislature would eliminate exemptions based on a parent’s “personal belief” that the vaccines might harm a child and allow exemptions only for students with medical conditions that would make vaccination unsafe. (4/20)

Bloomberg: Lower Health Costs Won't Cure All
It was a sure bet that if health-care costs fell after the Affordable Care Act was passed, we’d see people writing articles about how the law had finally gotten health-care costs under control. And so it has come to pass, and so a number of readers have written me to ask whether this is actually true. The short answer is that I’m far from convinced. (Megan McArdle, 4/20)

The Wall Street Journal: At Tax Time, No Public Backlash Over Obamacare’s Individual Mandate
Tax season has come and gone with no great outbreak of protest about the Affordable Care Act’s least popular provision: the individual mandate. ... The one-two punch of the mandate and repayments at tax time might have produced a public backlash–but it has not. One reason may be that the public was prepared–that between news media coverage of these issues and government officials and organizations involved in enrollment outreach talking about them often enough that paying the penalty or making a repayment was not “news” when tax season arrived. The government also offered a special extended enrollment period to people who were facing the penalty but didn’t know about it and were still uninsured. Even though a very modest number of people took advantage of it this, it may also have helped to diffuse the issue. (Drew Altman, 4/21)

Alaska Dispatch News: Before Expanding Medicaid, Alaska Should Ask Some Hard Questions
Cost-shifting is standard terminology in health care finance classes. Simply put, it means rolling up the uncompensated costs of care into the price or insurance premium of those who actually pay for health care. ... The reality is that cost-shifting is a more efficient way to pay for the uninsured than Medicaid. Filtering your health care dollars through a government agency will peel off a significant percentage of your dollars to pay for government overhead but will not reduce the cost of health care, increase access, or increase health care outcomes. (Brent A. Fisher, 4/19)

Al.com: Clock's Ticking On Medicaid
Access to quality and affordable healthcare should be a right and not a privilege. To date, 29 states, including the District of Columbia, have made the critically important decision to expand Medicaid. I urge the State of Alabama to expand Medicaid without delay. Alabama's reluctance to expand Medicaid has placed access to quality health care out of reach for too many of our state's working poor families and individuals. (Rep. Terri Sewell, D-Ala., 4/20)

Des Moines Register: Iowa Medicaid Plan Is Full Of Empty Promises
Under the governor’s plan for Medicaid modernization, the state and federal governments will spend more than $4 billion to manage and implement health services for Iowans on Medicaid. This is one-half of the state’s entire budget. The governor has claimed that the state will save $51 million in the first six months of managed care. These savings must be devoted to ensuring that the transition to managed care is carefully planned, taxpayer money is effectively spent and services are maintained. ... To date, the governor has not explained to Iowans how he intends to make the managed care companies accountable and responsible. This should alarm us all. (Jane Hudson, 4/20)

Forbes: AARP's New Evidence That Medicare's Hospital Observation Rules Are a Mess
Of all the complex rules that plague fee-for-service Medicare, few are harder to understand and potentially more important for seniors than observation status. By now, many older adults have heard the phrase. But they are still not clear what it means. A new study by AARP sheds some light on the consequences for seniors of hospital observation stays. But they turn out to be a muddle, in part because Medicare pays for hundreds of millions of dollars of skilled nursing facility care that probably should be billed to patients. The AARP study, written by Keith Lind and Claire Noel-Miller of AARP’s Public Policy Institute and Lan Zhao and Claudia Schur of the consulting firm Social & Scientific Systems, finds the rules are a complex mess, and it is impossible for patients to predict whether an observation stay is financially more or less beneficial than an admission. (Howard Gleckman, 4/20)