KHN Morning Briefing

Summaries of health policy coverage from major news organizations.

Kaiser Health News Original Stories

Political Cartoon: ‘Plea Bargain?’

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: ‘Plea Bargain?’" by Adam Zyglis, The Buffalo News.

Here's today's health policy haiku:


Tax-time confusion
Avoid paying penalty
Special enrollment

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Health Law Issues And Implementation

White House Crafts Health Law Arguments To Appeal To Conservative Justices

When the Supreme Court hears arguments in King v. Burwell, the Obama administration lawyers will highlight states' rights issues in their attempts to draw support from key justices. Meanwhile, news outlets continue to examine the impact that the court's ruling could have on the law's future and the insurance marketplace.

Los Angeles Times: Obamacare Defense Is Tailored For Key Supreme Court Justices
With President Obama's healthcare law once again facing possible unraveling at the hands of the Supreme Court, the administration and its allies have developed a novel argument tailor-made to appeal to conservative justices: states' rights. The high court is set to hear arguments March 4 to determine the legality of Affordable Care Act subsidies for approximately 7 million Americans who receive coverage from federally run health insurance marketplaces, also known as exchanges. (Savage, 2/26)

Politico: Supreme Court Ruling Could Upturn Obamacare Politics
What Obamacare gave, the Supreme Court could take away. The Supreme Court next Wednesday hears a case that could end Obamacare subsidies in 34 states that use If the justices rule that the subsidies are illegal through the federal exchange, they would largely unravel President Barack Obama’s health care law, which has helped millions of Americans get insured. (Nather and Haberkorn, 2/26)

Los Angeles Times: The Conservative Ruling That Might Save Obamacare
The Pennhurst State School and Hospital outside Philadelphia was once one of America’s most notorious institutions. During much of the 20th century, it was where the state of Pennsylvania confined thousands of children and adults with mental and physical disabilities, some in horrific conditions. The long legal battle to close the facility made Pennhurst a landmark in the historic campaign to expand the rights of Americans with disabilities. (Levey, 2/25)

The Hill: Insurance Group Raises Alarms About Looming ObamaCare Case
The Obama administration should allow insurance companies to raise their rates, if the Supreme Court decides to gut a central piece of the Affordable Care Act this summer, a national insurance group said Wednesday. In a letter to the Department of Health and Human Services, the American Academy of Actuaries warns that the challenge before the high court threatens the financial health of insurance companies. (Ferris, 2/25)

Kaiser Health News: Supreme Court Insurance Subsidies Decision Could Trigger Price Spikes
Making health insurance available and affordable to millions of people who buy their own coverage was a key goal for backers of the federal health law known as Obamacare. But if the Supreme Court strikes down the insurance subsidies of millions of Americans who rely on the federal insurance marketplace, it could leave many worse off than they were before the law took effect, say experts. (Appleby, 2/26)

Modern Healthcare: Supreme Court Ruling Carries Implications For Regulatory Boards
State professional regulatory boards may seek out more state supervision or even change their membership makeup because of a U.S. Supreme Court decision Wednesday against a North Carolina dental board accused of illegally suppressing competition. The court ruled Wednesday that the North Carolina dental regulatory board, composed mostly of dentists, illegally suppressed competition when it told non-dentists to stop offering teeth-whitening services. (Schencker, 2/25)

More Than 1 Million Americans Switched Health Plans During Enrollment Season

Federal officials said Wednesday that this development came as a surprise. The finding was announced as part of new enrollment data, including the latest tally -- 8.84 million -- of people who selected or were automatically enrolled in coverage as of Feb. 22.

The Wall Street Journal: More Than 1 Million People Pick New Health Law Plans
About 1.2 million people who bought coverage on in 2014 dropped their health plan and picked a new one through the site for 2015, the Obama administration said Wednesday. The extent of people’s willingness to consider shifting to a different insurance carrier came as a surprise to federal officials, said Andy Slavitt, a former top executive at UnitedHealth Group who is now principal deputy administrator at Centers for Medicare and Medicaid Services and will become acting administrator on Monday. (Radnofsky, 2/25)

USA Today: More Shopped Than Auto-Enrolled On
More than 8.8 million consumers selected a plan or were automatically re-enrolled through from Nov. 15, 2014, to Feb. 22, Department of Health and Human Services Secretary Sylvia Burwell said Wedneday. HHS extended the deadline from Feb. 15 to Feb. 22 to accommodate people who couldn't get through to the federal call center or on the website by midnight on Feb. 15. (O'Donnell and Unger, 2/25)

Utah Gov.'s Medicaid Expansion Plan Loses Momentum

Though the plan got the nod of the state Senate, the Republican House Speaker said the GOP-controlled House will not consider it because it doesn't have enough support. News outlets also offer the latest Medicaid expansion news from Nebraska and Oregon.

The Associated Press: Governor's Medicaid Expansion Plan May Have Hit Dead End
Gov. Gary Herbert's trimmed-down plan for expanding Medicaid appears to have hit a dead end at the state Capitol. Hours after the Republican governor's plan earned key approval in the state Senate, Republican House Speaker Greg Hughes said Wednesday afternoon that the GOP-dominated House will not consider the governor's plan because it has no support. (Price, 2/26)

The Associated Press: Nebraska Eyes Medicaid 'Redesign' Bill To Close Coverage Gap
Lawmakers who want to close Nebraska's health care coverage gap are taking a new approach after two previous attempts to expand Medicaid failed. Sen. Kathy Campbell presented her Medicaid "redesign" bill Wednesday to a legislative committee, saying it would help the state uncover more efficient ways to provide health coverage while giving Nebraska officials flexibility to design a state-specific plan. (Shulte, 2/26)

The Associated Press: Judge Orders Oracle To Keep Hosting Oregon's Medicaid System
An Oregon judge has ordered technology giant Oracle Corp. to continue hosting Oregon's Medicaid health insurance system for low-income Oregonians even after the company's contract expires this weekend. Marion County Circuit Judge Courtland Geyer ruled Wednesday that Oracle should host Medicaid for another year. He granted the preliminary injunction until February 2016. (Wozniacka, 2/26)

Meanwhile, on the topic of health exchanges -

Americans Worried Over Obamacare Seek Professional Tax Help

News outlets also offer more details about Americans who are filing their taxes and finding out that they will have to repay the federal government a portion of the subsidies that helped them afford coverage. And Republicans in West Virginia are backing a proposal that would make it a crime to enforce Obamacare.

The Boston Globe: Worries About Health Care Law Leads Tax Filers To Seek Professional Help
Worries about how the Affordable Care Act may affect 2014 returns could drive more filers to spend hundreds of dollars to get professional help from accountants and preparation services, tax specialists said. The tax code changes tied to the federal health care law take effect this year. That has triggered television, radio, and newspaper ads suggesting that filers need to brace for complications and may need specialized tax help. (Fernandes, 2/26)

Fox News: H&R Block Analysis: Most Obamacare Customers Paying Back Portion Of Subsidies
ObamaCare customers who received health insurance subsidies last year are getting an unpleasant surprise this tax season -- with many finding they have to repay hundreds of dollars. An analysis by tax-preparer H&R Block found that to date, 52 percent of those who enrolled in Affordable Care Act coverage are paying back part of their premium tax credits. (2/25)

The Charleston Gazette: GOP-backed Bill Would Make It Criminal To Enforce ACA In W. VA.
In another salvo against the federal Affordable Care Act, some Republicans in West Virginia’s House of Delegates want to make it a crime for state and federal officials to enforce the health-care law. Under the GOP-backed bill (HB2509), federal employees would face felony charges, while state workers would be arrested for a misdemeanor offense, if they try to administer any federal regulations under the Affordable Care Act. The legislation also declares the federal health-care law “invalid” in West Virginia. (Eyre, 2/25)

Mass. Gov. Forces 4 Resignations From Health Connector Board

Among the resignations was that of Jonathan Gruber, the MIT economist and Obama administration health law adviser who became notorious for making statements about "the stupidity of the American voter."

Politico: Jonathan Gruber Among 4 Ousted From Massachusetts Obamacare Board
At least Jonathan Gruber is not alone in his latest indignity. The MIT economist and Obamacare adviser now notorious for opining on the “stupidity of the American voter” is out of his job on the board of the Massachusetts exchange in an unexpected power play by the new Republican governor. Three other respected health experts with much lower public profiles were also removed. (Wheaton, 2/25)


What Ails You? New Tool Sheds Light On Health Care Prices

The website, named Guroo, lets consumers search for prices for 70 medical services across 41 states and the District of Columbia to help inform their decisions on where to seek health care.

Kaiser Health News: Attention, Shoppers: Prices For 70 Health Care Procedures Now Online!
Buying health care in America is like shopping blindfolded at Macy’s and getting the bill months after you leave the store, economist Uwe Reinhardt likes to say. A tool that went online Wednesday is supposed to give patients a small peek at the products and prices before they open their wallets. Got a sore knee? Having a baby? Need a primary-care doctor? Shopping for an MRI scan? shows the average local cost for 70 common diagnoses and medical tests in most states. That’s the real cost — not “charges” that often get marked down — based on a giant database of what insurance companies actually pay. (Hancock, 2/25)

Modern Healthcare: Insurers Reveal What Health Care Providers Are Paid
Healthcare consumers have a new tool to compare prices using data from some of the largest U.S. health insurers, but comparison shopping will remain a challenge for most. On Wednesday the Health Care Cost Institute, a not-for-profit healthcare research organization, launched the first of two websites conceived to help consumers navigate prices for medical services. The website—named Guroo—allows consumers to search for average prices for 70 services across more than 300 hundred cities, 41 states, coastal California and the District of Columbia. (Evans, 2/25)

In other cost-related news, the Associated Press offers consumers these insights -

The Associated Press: 5 Tips For Handling Early-Year Medical Expenses
Deductibles topping $3,000 are common among plans sold on the health care overhaul's public insurance exchanges, which provide coverage for millions. Companies also have been raising deductibles for years on employer-sponsored health plans, the most common form of coverage in the United States. Plus cost-sharing requirements for Medicare prescription drug coverage renew every year. (2/25)

Health IT

Providers Get More Time To Meet Electronic Records Deadline

Doctors and certain other providers got a three-week extension to attest they can "meaningfully use" their digital records systems. Meanwhile, tests show a new electronic billing system for health services is ready to implement even as doctors and hospitals push for more time.

CQ Healthbeat: Electronic Health Record Deadlines Extended 3 Weeks For Doctors
Amid complaints that doctors are facing a "regulatory tsunami," the Centers for Medicare and Medicaid Services will ease certain deadlines regarding electronic health records. CMS on Wednesday said the deadline for doctors and certain other providers of health care to attest that their medical records systems meet meaningful use standards has been pushed to March 20 from Feb. 28. Physicians who accept Medicare payments must undergo certification every year to receive incentive money and avoid reductions in payments. (Young, 2/25)

CQ Healthbeat: Test Shows ICD-10 Billing System Is Ready, CMS Says
A test run indicates that a new electronic billing system for health services can be implemented in the United States, the Centers for Medicare and Medicaid Services on Wednesday, even as some doctors continued to push for relief from an October deadline for implementing the co-called ICD-10 codes. About 660 providers, billing agencies and equipment suppliers submitted almost 15,000 test claims using the ICD-10 codes between Jan. 26 and Feb. 3, CMS said. (Young, 2/25)

Modern Healthcare: Predictive Analytics Play New Role In Fraud Detection, But Critics Want More
The CMS has either identified or prevented more than $210.7 million in healthcare fraud in one year using predictive analytics. But critics want to see the agency do much more with its new digital tools. Work done in detecting credit card fraud points the way to the possibility of greater savings in healthcare from predictive analytics. But stumbling blocks remain, including the greater complexity of healthcare data compared with simpler credit card transaction data, analytics experts caution. (Tahir, 2/25)

And technology and training are reducing nurses' injuries at VA hospitals -

NPR: At VA Hospitals, Training And Technology Reduce Nurses' Injuries
Bernard Valencia's room in the Jerry L. Pettis Memorial Medical Center in Loma Linda, Calif., illustrates how hospitals across the country could fight a nationwide epidemic. As soon as you enter the room, you can see one of the main strategies: A hook hangs from a metal track that runs across the ceiling. This isn't some bizarre way of fighting hospital-acquired infections or preventing the staff from getting needle sticks. The contraption is a ceiling hoist designed to lift and move patients with a motor instead of muscle. (Zwerdling, 2/25)

State Watch

State Highlights: Miss. Blazes Telemedicine Trail For Other States

A selection of health policy stories from Iowa, Mississippi, Minnesota, Maryland, Kansas, New Jersey, Delaware, Colorado, California, North Carolina and Vermont.

The Associated Press: Iowa Details Plan To Use Private Firms To Manage Medicaid
Turning Iowa's Medicaid program over to private operators will save money and improve service, a top state official said Wednesday, but lawmakers questioned how it would impact people enrolled in the program. Department of Human Services Director Chuck Palmer told the Legislature's Health and Human Services Appropriations Committee that the state is moving forward with a plan to shift the Medicaid program to two or more managed care organizations, to which Iowa will pay fixed amount per enrollee to provide health coverage. (2/25)

Politico: Mississippi Emerges As Leader In Telemedicine
Mississippi has a sickly reputation. The Magnolia State ranks at or near the bottom in most health rankings: worst infant mortality and most kids born with low birth weight; second-to-highest rate of obesity and cancer deaths; second from the last in diabetes outcomes. (Pittman, 2/26)

The Baltimore Sun: Audit Critical Of Medicaid Procurement
State auditors say Maryland's health department did not follow proper procedure when it hired a contractor to replace the system used to process Medicaid payments. The department later had to suspend work with the company. In a report released Wednesday, auditors said the Department of Health and Mental and Hygiene did not follow the procurement process, and kept information that raised red flags about the contractor from the state Board of Public Works, which approved the five-year, $171 million contract. (McDaniels and Cohn, 2/25)

The Associated Press: Kansas Senate Rejects Bill Controlling Mental Health Drugs
A proposal for controlling Kansas' costs for expensive mental health drugs in its Medicaid program failed Wednesday in the state Senate because some members worried that patients wouldn't get the medications they need. The Senate voted 25-15 against a bill repealing a 2002 law that prohibits restrictions in Medicaid on prescriptions for treating mental illnesses, such as a list of preferred drugs for doctors, or a requirement that the program sign off before a prescription is made. The state's $3 billion-a-year Medicaid program provides health coverage for 368,000 needy and disabled state residents. (Hanna, 2/25)

The Baltimore Sun: Supporters Of Mental Health, Drug Providers Rally For Funds
Shouting the slogan "keep the doors open," several hundred supporters of Maryland's mental health and drug treatment programs rallied outside the State House in Annapolis Wednesday to protest proposed cuts in the budget for compensating care providers. Mental illness patients, recovering drug addicts and parents of children with those problems were among the speakers as members of the Behavioral Care Coalition gathered to seek the restoration of about $23 million. Those funds were trimmed from such programs under the Hogan and O'Malley administrations as a means to close a revenue shortfall. (Dresser, 2/25)

NJ Spotlight: Christie's Proposed Health Budget Slashes $148M From Hospital Charity Care
New Jersey hospitals will be getting a lot less money from the state government to deliver charity care to uninsured people under Gov. Chris Christie’s proposed 2015-2016 budget. Administration officials say there’s a good reason for the cuts: the Affordable Care Act has dramatically reduced the ranks of the uninsured. But hospitals contend that it’s too soon to know how much they’ll be getting from the ACA or if that money will offset the proposed reductions. (2/25)

The Associated Press: Delaware Legislators Pan Medicaid Efforts To Reduce Waste
Legislative budget writers grilled Delaware Medicaid officials Wednesday on delays in a program aimed at reducing waste, fraud and abuse, and about the lack of access by thousands of Medicaid enrollees to the state's only children's hospital. With the state facing a tight budget year and the Joint Finance Committee trying to balance a $3.9 billion operating budget proposed by Gov. Jack Markell, co-chair Sen. Harris McDowell III wondered why the Department of Health and Social Services has lagged on reducing fraud and waste in the state's $1.9 billion Medicaid program. (Chase, 2/25)

The Associated Press: Justices: Dentists Unfair To Limit Teeth-Bleaching Providers
The Supreme Court ruled Wednesday that a state regulatory board made up mostly of dentists violated federal law against unfair competition when it tried to prevent lower-cost competitors in other fields from offering teeth-whitening services. By a 6-3 vote, the justices rejected arguments from the North Carolina State Board of Dental Examiners that it was acting in the best interests of consumers when it pressured nondentists to get out of the lucrative trade in teeth-whitening services. (2/25)

The New York Times: Vermont Tackles Heroin, With Progress In Baby Steps
In 2014, Gov. Peter Shumlin devoted his State of the State address to what he called a “full-blown heroin crisis” in Vermont. The State Legislature enacted many of his initiatives, including giving one-time grants to addiction clinics to help them reduce the size of their waiting lists. The Central Vermont Addiction Medicine clinic here used its share of the grant to extend the hours of its lone doctor. Counselors reached out to people on the waiting list, moving active needle-users like Mr. Kenney and pregnant women to the top. (Seelye, 2/25)

Weekend Reading

Longer Looks: The Next Health Agenda, OxyContin And Shrinking Hospitals

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

Vox: After Obamacare: The Next Democratic Health Agenda
The architects of the Affordable Care Act got millions of Americans to sign up for coverage. Now they're quietly crafting the next Democratic health-care agenda: lowering costs. A half-dozen key Democratic policy influencers, from the head of Hillary Clinton's 2008 policy team to former Obama administration officials, are starting to plan for a post-Obamacare Washington. In recent interviews, they describe twin goals — improving quality of care while making it cheaper — that will require building a coalition quite different from the one that supported health reform in 2010. (Sarah Kliff, 2/23)

Pacific Standard: Poison Pill
After more than seven years of battling the evasive legal tactics of Purdue Pharma, 2015 may be the year that Kentucky and its attorney general, Jack Conway, are able to move forward with a civil lawsuit alleging that the drugmaker misled doctors and patients about their blockbuster pain pill OxyContin, leading to a vicious addiction epidemic across large swaths of the state. A pernicious distinction of the first decade of the 21st century was the rise in painkiller abuse, which ultimately led to a catastrophic increase in addicts, fatal overdoses, and blighted communities. But the story of the painkiller epidemic can really be reduced to the story of one powerful, highly addictive drug and its small but ruthlessly enterprising manufacturer. (Mike Mariani, 2/23)

The Atlantic: Legally Married, But Their Boss Disagrees
Fifteen states have no law requiring insurance coverage for same-sex partners, and in those states, businesses can choose not to offer same-sex spousal health coverage. Massachusetts is not one of those states, however: According to the Kaiser Family Foundation, in the 37 states with legal gay marriage, “employees’ same-sex spouses should have the same eligibility as opposite-sex spouses for dependent health coverage.” The U.S. Supreme Court ruled in June that states that recognize same-sex marriage must also treat gay spouses the same as straight spouses when it comes to federal benefits and taxes. (Olga Khazan, 2/20)

Modern Healthcare: Hospitals Closing, Shrinking As Outpatient Care Grows
As hospitals increasingly lose patients to medical care delivered in clinics and home settings, hospital operators are escalating their efforts to shrink capacity. Hospitals are operating with fewer beds or closing outright, in some cases to make way for new ambulatory-care centers. In Lakewood, Ohio, where chronic conditions such as heart disease and diabetes are just as prevalent as in the rest of the country, the city is about to close its only hospital, whose 200 beds are typically half empty. (Melanie Evans, 2/21)

Editorials And Opinions

Viewpoints: How Dr. Seuss, Other Angles, Might Figure In High Court Review Of ACA Challenge; Obamacare Tax Complications

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

The Wall Street Journal: A First Step On The Way Out Of ObamaCare
The Supreme Court case King v. Burwell being argued March 4 is one of profound national importance. It challenges the legality of 75% of ObamaCare—the subsidies that the federal government has been paying to health insurers on behalf of enrollees in the 37 states that chose not to participate in ObamaCare. Like most conservatives, I am hopeful about the court’s decision, expected in June. (Ben Sasse, 2/25)

Bloomberg: How The Supreme Court Could Save Obamacare Again
Could the U.S. Supreme Court allow the Affordable Care Act to survive its latest legal challenge because the plaintiffs in the case before it haven’t been injured by the law? It’s possible. The more probable result is still that the court will reach a decision on the merits of the case and eliminate the insurance subsidies necessary to make the law work in many states. But if Chief Justice John Roberts wants to avoid the criticism that the Roberts court is the most activist conservative court in history, he could plausibly use the standing argument to avoid a decision -- especially if he could get cover from the archconservative Justice Antonin Scalia, who more or less invented the constitutional doctrine of standing in a 1992 case argued successfully by -- you guessed it -- then-Deputy Solicitor General John Roberts. (Noah Feldman, 2/25)

Bloomberg: How Dr. Seuss Could Save Obamacare
What does a red grouper have to do with the Affordable Care Act? Maybe a lot. The U.S. Supreme Court ruled Wednesday on a quirky case in which it had to decide whether the fish counted as a “tangible object” under the Sarbanes-Oxley Act. The decision broke down in a particularly strange way across the usual liberal-conservative lines. Reading the tea leaves -- or maybe the fish entrails -- it's possible to get some clues about how the court will interpret the ACA in the major case it will hear March 4. (Noah Feldman, 2/25)

The Wall Street Journal's Washington Wire: How Obamacare’s Tax Complications Are Playing Out
The administration’s enrollment strategy seems inclined toward leniency—for the policy reason of trying to enroll as many individuals as possible and for the political reason of avoiding actions that could make the law more unpopular. Some advocates of a longer enrollment period have cited the ability to “diminish hostility” toward the law as one reason to allow Americans a second bite at the enrollment apple. (Chris Jacobs, 2/25)

The Wall Street Journal: Jeb Bush Was Right To Try To Save Terri Schiavo
The usual media suspects are excoriating Jeb Bush —again—for trying to help save my sister Terri Schiav o’s life. An article last month in the Tampa Bay Times, “The Audacity of Jeb Bush,” later quoted in a New Yorker article titled “The Punisher,” accused the former Florida governor of going “all in on Schiavo” and running roughshod over Florida state law. (Bobby Schindler, 2/25)

The Washington Post: Neuroscience Is Coming To The Law. Can We Keep Politics Out Of It?
Neuroscience is appearing everywhere. And the legal system is taking notice. The past few years have seen the emergence of “neurolaw.” A spread in the NYT Magazine, a best-selling NYT book, a primetime PBS documentary, the first Law and Neuroscience casebook, and a multimillion-dollar investment from the MacArthur Foundation to fund a Research Network on Law and Neuroscience have all fueled interest in how neuroscience might revolutionize the law. The potential implications of neurolaw are broad. (Francis Shen and Dena Gromet, 2/25)

Los Angeles Times: Los Angeles Has The Right DNA To Become Biotech Hub
California is home to two major biotechnology hubs — San Francisco and San Diego — but Los Angeles has been left behind. The paradox is that universities in Los Angeles County produce more than 5,000 graduates in biotechnology-related fields each year, compared with 2,800 in San Francisco-Oakland-Fremont. However, it's San Francisco that attracted $1.15 billion in biotechnology investment in 2013, compared with a paltry $45 million here. No wonder, then, that so many of our graduates head north. (C.L. Max Nikias, 2/25)

The New York Times' Taking Note: A Plot To Keep Teeth Whitening Expensive
The Supreme Court made the right call today by ruling against a state dental board that tried to limit competition from salons, spas and other businesses. The case pitted the North Carolina State Board of Dental Examiners against the Federal Trade Commission, which accused the board of violating federal antitrust law. It had been sending letters to teeth whitening businesses ordering them to stop offering the service, on the grounds that they were not licensed dentists. These letters served to reduce competition and, therefore, raise the cost of teeth whitening. (Vikas Bajaj, 2/25)