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Morning Briefing

Summaries of health policy coverage from major news organizations

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Tuesday, Mar 3 2015

麻豆女优 Health News Original Stories 5

  • What鈥檚 At Stake As Health Law Lands At Supreme Court Again
  • Health On The Hill: ACA Heads Back To Supreme Court
  • Fate Of 500,000 North Carolinians Tied To High Court Case
  • Some Dementia Can Be Treated, But My Mother Waited 10 Years For A Diagnosis
  • HHS Shifts Money From Cancer, Global Health To Pay For Health Insurance Exchange

Note To Readers

Health Law 3

  • The Health Law's Future And Four Little Words
  • Legal Challenge To Obamacare Subsidies Worries Consumers
  • NAACP Joins Fight To Expand Medicaid In N.C.

Capitol Watch 1

  • Both Sides Tailor Talking Points To Sway Justices

Quality 1

  • Groups That Rate Hospitals Often Disagree On Rankings

Marketplace 1

  • Workers' Costs Grow Despite Slowed Health Spending

State Watch 1

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

Editorials And Opinions 1

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

From 麻豆女优 Health News - Latest Stories:

麻豆女优 Health News Original Stories

What鈥檚 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 )

Health On The Hill: ACA Heads Back To Supreme Court

Justices to decide if subsidies that help millions afford health insurance are available to residents of more than three dozen states. ( 3/3 )

Fate Of 500,000 North Carolinians Tied To High Court Case

The U.S. Supreme Court hears a challenge Wednesday to the insurance subsidies available through the federal health insurance exchange used by North Carolina residents. ( Ann Doss Helms, Charlotte Observer , 3/2 )

Some Dementia Can Be Treated, But My Mother Waited 10 Years For A Diagnosis

For many physicians, normal pressure hydrocephalus, or NPH, doesn鈥檛 come to mind when they see people with cognitive and gait problems, although it is one of the few treatable causes of dementia. ( Roni Caryn Rabin , 3/3 )

HHS Shifts Money From Cancer, Global Health To Pay For Health Insurance Exchange

Some House Republicans question the transfer of funds, but HHS says the shifts are legal and necessary to operate a marketplace, which is relied upon by 37 states. ( Phil Galewitz , 3/3 )

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Summaries Of The News:

Health Law

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 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鈥檚 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 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, HealthCare.gov. At issue is wording in the Obamacare law stipulating that tax credits are available for people who enroll 鈥渢hrough an exchange established by the state.鈥 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)

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 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. 鈥淚 noticed something peculiar about the tax credit,鈥 he told a gathering of strategists at the American Enterprise Institute. (LIptak, 3/2)

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)

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 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鈥檛 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鈥檚 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 -

The Supreme Court is saying no to calls for the speedy release of the audio of Wednesday's high-stakes argument about tax subsidies that are critical to President Barack Obama's health overhaul. (3/2)

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.

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鈥檛 provide insurance for his waiters. (Armour, 3/2)

[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 鈥 spearheaded by conservative and libertarian activists 鈥 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)

It鈥檚 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鈥檚 a self-employed auditor who relies on a $400 per month government subsidy to afford the private health plan she bought on healthcare.gov, 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)

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鈥檛 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.

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)

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)

For Texas Independence Day on Monday, Lt. Gov. Dan Patrick and the Senate鈥檚 20 Republicans vented their frustration over Medicaid鈥檚 costs and federal requirements. Patrick complained about 鈥渙verreaching federal mandates鈥 and demanded the leeway to 鈥渕anage our own Medicaid.鈥 He and the chamber鈥檚 Republicans sent President Barack Obama a letter demanding flexibility to revamp Texas鈥 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 --

In their latest attack on the Affordable Care Act, House Republicans are questioning why the Obama administration transferred money last year from the National Institutes of Health and the Centers for Disease Control and Prevention to pay for the operation of the federal health insurance marketplace. (Galewitz, 3/3)

Capitol 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.

Leading House Republicans stopped short of endorsing a short-term extension of the health law鈥檚 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鈥檚 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)

Congressional Republicans sent a message Monday that they hope the Supreme Court and voters will hear: They have ideas to keep the country鈥檚 health care system from crumbling if the justices obliterate a bedrock feature of President Barack Obama鈥檚 heath care law. The plans 鈥 one set from three GOP House chairmen, another from three top Republican senators 鈥 were far from legislative proposals, lacked detail and left many unanswered questions. They were released in the run-up to Wednesday鈥檚 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鈥檚 2010 law. (3/2)

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鈥檚 the same reason Republicans have seized on statements from the White House and Health and Human Services Secretary Sylvia Matthews Burwell that officials have 鈥渘o plans鈥 in case of a plaintiff victory. 鈥淲hat Burwell does not have 鈥 any plan 鈥 Republicans do have,鈥 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)

If the Supreme Court rules against the Obama administration in the latest legal challenge to Obamacare, a group of Republicans say they have a plan to prevent millions from losing their subsidized health care coverage. (Ehley, 3/2)

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 鈥減lausible legal basis鈥 for such a ruling. In his first public remarks on the high-stakes case, Obama stuck with his health secretary鈥檚 previous remarks that the administration is not concerned about how to protect the subsidies at the heart of his healthcare law. (Ferris, 3/2)

Quality

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.

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鈥擴.S. News & World Report, Consumer Reports, the Leapfrog Group and Healthgrades鈥攁nd 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)

Four popular national rating systems used by consumers to judge hospitals frequently come to very different conclusions about which hospitals are the best 鈥 or worst 鈥 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)

The quality of hospitals is apparently in the eye of the beholder. A Health Affairs study published Monday examined four popular hospital rating systems and found that their assessments rarely agreed on much 鈥 to the likely detriment of the consumers they aim to help. (Norman, 3/2)

Earlier, related KHN coverage:聽聽(Rau, 3/18/13)

Marketplace

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.

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)

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

Dr. Chuck Denham, once a leading voice for patient safety, will pay $1 million to settle civil allegations that he took kickbacks to promote a drug company's product in national health quality guidelines, the Justice Department announced Monday. (Allen, 3/2)

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.

The Senate Ways and Means Committee has adopted a budget proviso that鈥檚 expected to delay the implementation of 鈥渉ealth homes鈥 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鈥檚 explicit consent in fiscal years 2015, 2016 and 2017 鈥 through June 30, 2017. (Ranney, 3/2)

New York City lawmakers are taking a hard look at the quality of health care inmates receive at the Rikers Island jail complex and whether the city should renew a $126.6 million contract with a private health provider. (3/3)

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)

Nearly every day for the past seven years, after dropping her daughter off at school, Maria Medina has driven to the home of Renee Lopez, a woman to whom she bears no relation but has come to know almost as well as family. (Walters, 3/3)

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)

More than 96 percent of the veterans who sought care from the eight facilities in the VA Portland Health Care System in December completed their appointments in 30 days or fewer, according to the latest figures from the federal Department of Veterans Affairs. (Francis, 3/2)

The Department of Community Health has tapped a current official to become the state鈥檚 new Medicaid chief. Linda Wiant has served as pharmacy director for Georgia Medicaid since August 2011. (Miller, 3/2)

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.

On Wednesday the Supreme Court will take on yet another legal challenge to the president鈥檚 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鈥檒l be stuck with health insurance designed by Washington, D.C., that they can鈥檛 afford. Americans should have an off-ramp from ObamaCare鈥攁 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 Obama Administration鈥檚 abuse of executive power鈥攄ispensing with its duty to faithfully execute statutes to become a law maker unto itself鈥攈as 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鈥檚 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鈥檚 plain text and uphold the statute that Congress passed in 2010, rather than the version the Administration rewrote. (3/2)

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)

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)

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)

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 鈥 and coverage 鈥 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: 鈥淲e have a plan for fixing health care.鈥 ... 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)

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鈥檛 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)

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鈥檚 text only authorizes tax credits in state-established exchanges. Yet it鈥檚 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)

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)

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)

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)

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)

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鈥檙e allergic to antibiotics actually aren鈥檛. 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)

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