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Automated Benefit Services is preparing teams for participation in the American Heart Association (AHA) annual HeartChase fundraising event, which takes place April 5, 2014, in Mount Clemens, Michigan.

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Users of ABS online services will soon enjoy an expansion of features and functionality provided by new web-based secure services portals scheduled to begin rolling out this year.

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Health flexible spending accounts (FSAs) are becoming more flexible. New federal guidance permits employers to allow workers to carry over unused amounts of up to $500 for expenses in the next year and still contribute up to $2,500 annually.

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Since 2009, the US Department of Health and Human Services (HHS) has required the use of a Business Associate Agreement (BAA) in order to establish “rules of conduct” in handling electronic Private Health Information (ePHI) when any Covered Entity (health insurance carrier and plan sponsor) utilizes the services of an outside vendor.

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  • Progress, Challenges As Medicaid Rolls Swell in Wash.

    Washington state has blown past its targets for signing up new Medicaid participants under the Affordable Care Act (ACA).

    The program’s ranks have grown roughly 25 percent in the past six months, helping fulfill one of the act’s key goals to provide health care to nearly all Americans.

    By the end of March, more than 285,000 adults who are newly eligible to participate in Medicaid had signed up for coverage. That’s twice the number officials had hoped to reach by then, and a target they hadn’t expected to hit for three more years.

    But with enrollment success comes the challenge of serving more people in a $10 billion program that’s already stretched thin in places.

    Some of the new enrollees haven’t seen a doctor in years and need help navigating the health-care morass. Medicaid patients already struggle to get care in parts of the state and for certain medical specialties.

    And while the hope is that more efficient, better care for all will drive down medical costs, they could still rise as more people are being helped.

    Medicaid advocates acknowledge the hard work ahead but are committed to it.

    “It’s the right thing to do,” said MaryAnne Lindeblad, Medicaid director at the state Health Care Authority, which oversees Washington Apple Health, the local name for the Medicaid program.

    “Health care should be a right, not a privilege,” she said. “From that perspective, all folks ought to have access to a basic package of health-care services. It shouldn’t be based on income or need.”

    Washington is one of 26 states where lawmakers voted to expand Medicaid coverage beginning Jan. 1 of this year. As part of the Affordable Care Act, federal funding will support that expansion.

    Before then, Medicaid was available to low-income children and elderly people, pregnant women, people with certain disabilities, foster kids and as a temporary aid to the neediest families.

    Poor, childless adults younger than 65 essentially were out of luck and had to rely on charity care.

    Now people earning up to 138 percent of the federal poverty level can get free health and dental care. That covers individuals earning up to nearly $16,000 a year or a family of four making $32,500. Low-income people with higher wages must buy private insurance, though they would receive subsidies to reduce the cost.


    For Heather Hawley, health care has been a luxury beyond her financial means.

    The 28-year-old SeaTac resident has worked in call centers, but the jobs rarely have included benefits, or the pay has been too low to afford insurance premiums. She has asked about government-funded health care, but nothing was available.

    “You have to have a lot of kids,” she said. “And I’m not going to have kids just to get health benefits through the state.”

    Hawley was laid off more than a year ago when her job answering calls for a bank’s reverse-mortgage program ended. She lives with her mom to save money.

    “It’s tough times right now,” Hawley said. “There are so many people looking for the same job.”

    Hawley has a promising lead with a department-store call center, but the benefits wouldn’t kick in for three months.

    So she was thrilled to qualify now for Medicaid. She doesn’t have chronic health issues but wanted a backup plan beyond the emergency room, the default option for many uninsured people.

    Two years ago, Hawley rushed to the ER when a bout of food poisoning resulted in her needing IV fluids. In December she was sick with bronchitis. It was a Saturday when her coughing got bad, Hawley said, and the ER “was the only place I could think of going.”

    She was billed for the ER visits but doesn’t recall the amount and believes the bills have been sent to collection agencies.

    The state and health-care providers hope to save money through Medicaid expansion by giving people like Hawley more cost-effective alternatives.

    With better medical access, Medicaid supporters reason, people will seek more preventive medicine, such as vaccinations, and treat minor illnesses before they become severe. They’ll manage chronic conditions like high blood pressure and diabetes, forestalling emergency trips.

    That should reduce the amount of free charity care hospitals provide, costs often passed on to insured patients through higher prices.

    ER visits

    While reducing ER visits may be one goal, a recent study from Oregon found that people newly enrolled in Medicaid actually used the ER more than other adults, potentially undermining one argument for savings. Some experts suggested the ER visits increased because the patients struggled to find doctors willing to take Medicaid insurance.

    But a Washington state project that sought to reduce ER use by Medicaid recipients cut nearly $34 million in costs last year. And Washington leaders predicted expanding Medicaid would save the state $300 million in the first 18 months, mostly because of an influx of federal funding to cover health costs previously paid by the state.

    That federal funding is a result of an ACA provision in which the feds pay 100 percent of the costs of newly eligible enrollees in states that expand Medicaid. Up to now, most Medicaid costs in Washington were split 50-50 with the federal government.

    The 100 percent lasts three years, then ratchets down to 90 percent by 2020.

    Meanwhile, the intensive enrollment outreach also recruited Medicaid-qualified people who hadn’t joined — an effect state officials had expected.

    Some 138,000 of Washington’s new enrollees fall into this category, and their care will be matched at a lower rate — likely 50 percent — adding to the state’s financial burden. Last year, medical assistance for Medicaid enrollees cost on average $321 per person, per month.

    Even with the higher match, 24 states have chosen not to expand Medicaid.

    Savings to states

    Studies show the expansion will save states money, in part by shifting costs to the federal budget, said Alan Weil, executive director of the nonpartisan National Academy for State Health Policy.

    Academics and policymakers are interested in a more challenging question: Will Medicaid save money by reducing health costs?

    But even before that answer emerges, Weil said, “we have a lot of evidence that people who have health insurance fair better, they’re healthier and live longer, and they’re more productive.”

    Elizabeth Winders, manager of Medicaid programs at HealthPoint, a nonprofit with King County clinics, recalled one woman who hobbled on crutches into its Tukwila clinic. The woman had an accident, but wasn’t insured because her employer’s plan was too expensive. She had gone to the ER but couldn’t get needed follow-up care from a specialist. Her injury persisted and she lost her job.

    When she enrolled in Medicaid, the woman told Winders: “ ‘This is going to change my life. I’m going to recover and get a new job. It’s hard to go to an interview on crutches and be someone they want to hire.’ ”

    But even with Medicaid, the woman might have had trouble seeing a specialist.

    Medicaid insurance generally pays doctors at a lower rate than Medicare and private insurance. To recruit and maintain Medicaid physicians, the ACA temporarily boosts the rate for primary-care doctors and services up to the level of Medicare.

    Medicaid payments were so low that it required a 70 to 90 percent increase to reach Medicare rates, said Lindeblad, of the state Health Care Authority. The difference is being paid out of the federal budget.

    The boost didn’t include specialists such as dermatologists and orthopedists.

    22 cents on the dollar

    The low reimbursements mean the specialists are earning 18 to 22 cents for every dollar they charge, said Sallie Neillie, executive director of Project Access Northwest, which helps uninsured and Medicaid patients find doctors. That’s compounded by uninsured and Medicaid patients being more likely to miss their appointments, she said.

    State officials say they believe the Medicaid patients for the most part are finding care, and Molina Healthcare, a large Medicaid insurance provider, says it is increasing its network of primary-care doctors.

    The state has crafted a multifaceted Health Care Innovation Plan designed to make health care more efficient and cost effective for those privately insured and those on government programs. A recent audit found that with better oversight of insurers covering Medicaid patients, the state could save by reducing overpayments.

    Programs like Project Access Northwest offer a model for improving efficiency. The group assigns case managers to ensure patients get needed lab work, helps them get to appointments, and makes sure they do prescribed follow-up treatment.

    Efforts to increase access include a greater use of nurse practitioners, giving scholarships for doctors who will practice in underserved areas, and opening more clinics targeted to low-income patients.

    Because the greater goal isn’t simply an insurance card in every wallet. “People don’t want health insurance and health care,” said Sallie Thieme Sanford, a law and health services professor at the University of Washington. “They want to be healthy.”

  • At 8 Million Sign-Ups, Health Law Enrollment Surpasses Target

    President Barack Obama hailed the latest tally of people who gained insurance as a result of the health law. News outlets also look inside this latest round of data to find out what information the administration is providing and what is still to come.   

    The New York Times: Enrollments Exceed Obama’s Target For Health Care Act
    President Obama announced Thursday that eight million people have signed up for health insurance under the Affordable Care Act, including what the White House said were a sufficient number of young, healthy adults, a critical milestone that might counter election-year attacks by Republicans on the law’s success and viability. The total number of enrollees exceeds by a million the target set by the administration for people to buy insurance through government-run health care exchanges. In particular, the number of young people signing up appears to have surged during the final weeks of enrollment (Landler and Shear, 4/17).

    The Washington Post: Obama Hails 8 Million Enrollees For Insurance Under Federal Health-Care Law
    Speaking at an impromptu news conference, the president described how the law has helped make a difference for ordinary citizens such as a young woman in Pennsylvania with a self-employed husband and two young children who managed to get insurance despite being diagnosed with breast cancer. … Armed with those enrollment numbers, Obama challenged the political dynamic that has grown up around the law and that has unnerved some members of his party. Problems with the law have become a central theme in the Republicans’ efforts to wrest control of the Senate this fall (Eilperin and Nakamura, 4/17).

    NPR: Obama: Affordable Care Act Enrollment Hits 8 Million
    The latest figures represent a turnaround from the disastrous debut of the HealthCare.gov website last year. The president said it was "well past time" for Republicans to quit trying to repeal the program, something he said they have voted on "some 50 times" (Neuman, 4/17).

    Politico: Obama Spikes The Football
    But the final enrollment numbers, along with other recent survey findings, are strong enough to give the Obama administration a cushion against some of the most common criticisms of the enrollment trends. Here are the takeaways from Thursday’s announcement (Nather, 4/17).

    Los Angeles Times: Obamacare Enrollments Hit 8 Million
    The total exceeded the initial forecast by 1 million people and capped a notable comeback after a disastrous debut last fall gave rise to predictions the law would collapse in its maiden year. The health law, often called Obamacare, instead has brought about the largest increase in insurance coverage in the United States in the half a century since Medicare and Medicaid were created (Levey and Terhune, 4/17).

    Kaiser Health News: Obama Sharply Criticizes Republicans As He Announces 8 Million Have Enrolled
    Enrollment in private health insurance on federal and state marketplaces has surged in recent weeks and now totals 8 million, a feisty President Barack Obama said Thursday. "This thing is working,” Obama said at a White House news conference in which he lambasted Republican critics of the health law, especially those in states that did not expand Medicaid eligibility, as the law allows.  … The actual number of people affected [by the refusal to expand Medicaid] is 5.7 million, the administration said (Galewitz and Hernandez, 4/17).

    Bloomberg: Obamacare Enrollment Got Younger In Late Surge, Officials Say 
    People who waited until the last minute to sign up for Obamacare were significantly younger than those first in line, as the percentage of enrollees younger than 35 jumped in the last month, officials said. About 35 percent of Americans who signed up for a private plan using new insurance exchanges were in the young adult age group, state insurance commissioners said after a meeting with President Barack Obama and his top staff (Wayne, 4/17).

    The Wall Street Journal: Obama Says Health-Insurance Enrollees Reach 8 Million
    Some 35% of those who signed up through the federal health-insurance exchange were in the coveted under-35 demographic, Mr. Obama said. The participation of younger, relatively healthy people is needed to balance out the cost of medical claims from older and sicker ones. The announcement contained few other new details about enrollment. Republicans quickly pointed to missing information—such as the number of people who had actually gained coverage after being uninsured, as opposed to those replacing an existing policy—to suggest the figures could be overblown as a measure of success (Radnofsky and McCain Nelson, 4/17).

    The Washington Post's Wonkblog: Here's How We Got To 8 Million Obamacare Signups
    Last summer, the administration had hoped that 40 percent of exchange enrollees would be between 18 and 34, based on the Congressional Budget Office's estimates that 7 million people in all would enroll in 2014. Instead, the administration got 28 percent, which the White House and supporters very eagerly pointed out Thursday was nearly identical to youth enrollment in the first year of the Massachusetts health-care law that Obamacare was based on (Millman, 4/17).

    The Associated Press: Late Sign-Ups Improve Outlook For Obama Health Law
    A surge of eleventh-hour enrollments has improved the outlook for President Barack Obama's health care law, with more people signing up overall and a much-needed spark of interest among young adults. … Still to be announced is what share of those enrolled were previously uninsured — the true test of Obama's Affordable Care Act — and how many actually secured coverage by paying their first month's premiums (Alonso-Zaldivar and Lederman, 4/18).

    McClatchy: Health Care Enrollment Hits 8 Million, Obama Says
    More than 8 million Americans have signed up for health insurance through the Affordable Care Act, a triumphant President Barack Obama announced Thursday. Obama hailed the number -- which exceeds expectations -- and said that 35 percent of those who enrolled through the federal marketplace are under the age of 35, a coveted demographic that is cheaper to insure. He argued that the law has also helped tame soaring health care costs, saying that since the law took effect, health care spending has risen more slowly than at any time in the past 50 years (Clark and Wise, 4/17).

    Kaiser Health News: Obama Announces 8 Million Have Enrolled In Marketplace Plans (Video)
    Kaiser Health News posted this video of Thursday’s White House news conference on enrollment figures. President Barack Obama also announced that 35 percent of people who enrolled on the federally run healthcare.gov marketplace are under age 35 (4/17).

  • Sign-Up Figures Trigger New Round Of Health Law Political Spin

    President Barack Obama uses the new enrollment numbers to urge Democrats to be proud of the health law and call on Republicans to back off in their push to repeal the measure. GOP leaders, though, did not appear to soften their positions.

    CNN: Obama: Republicans 'Were Wrong' About Obamacare
    President Barack Obama called on his fellow Democrats to "forcefully defend and be proud" of the fact that millions of people have signed up for health care insurance through the federal marketplaces, and faulted Republicans who are still angling to repeal the Affordable Care Act. "I don't think we should apologize for it. I don't think we should be defensive about it. I think there is a strong, good, right story to tell," Obama said Thursday during a rare appearance at the daily White House news conference (Killough, 4/17).

    Politico: Obama Tells Democrats: Defend My Law
    President Barack Obama has laid out the blueprint he thinks his party should follow on Obamacare as the midterms approach: "forcefully defend and be proud" of the law — and then move on, hitting Republicans for Washington dysfunction and inaction on the economy. The question now is whether Democrats will listen (Dovere and Budoff Brown, 4/18).

    The Associated Press: President Defending Health Law Good For Some Dems
    President Barack Obama’s full-throated defense of his health care overhaul seems perfectly timed for Democrats who want their party to embrace the law more enthusiastically. At a White House news conference Thursday, Obama noted that health insurance enrollments under the new law are higher than expected, and costs are lower. If Republicans carried out their pledge to repeal the law, he said, it "would increase the deficit, raise premiums for millions of Americans and take insurance away from millions more" (Babington and Alonso-Zaldivar, 4/17).

    Reuters: Obama Says Health Law Is Working, Private Insurance Enrollment At 8 Million
    President Barack Obama delivered a vigorous defense of his signature healthcare law on Thursday, saying private insurance enrollment under it has reached 8 million people and faulting Republicans for failing to agree with him that "this thing is working. I've said before this law won't solve all the problems in our healthcare system. We know we've got more work to do. But we now know for a fact that repealing the Affordable Care Act would increase the deficit, raise premiums for millions of Americans and take insurance away from millions more," Obama told reporters at the White House (4/17).

    USA Today: Obama On Health Law: 'This Thing Is Working'
    Opponents of the law say they're still waiting to hear how many people pay for their policies, if enough healthy people have enrolled to make the exchanges financially workable in the future and how many of the enrollees use a month's worth of benefits to cover medical procedures they couldn't afford before but then discontinue paying for their insurance. Obama spoke shortly after meeting with a group of state insurance commissioners, some of whom reported that the president cited a rush of young people — under age 35 — signing up late (Jackson and Kennedy, 4/17).

  • Physician Groups Deciding How To Spend Health Care Dollars

    The New York Times: Cost Of Treatment May Influence Doctors
    Saying they can no longer ignore the rising prices of health care, some of the most influential medical groups in the nation are recommending that doctors weigh the costs, not just the effectiveness of treatments, as they make decisions about patient care. The shift, little noticed outside the medical establishment but already controversial inside it, suggests that doctors are starting to redefine their roles, from being concerned exclusively about individual patients to exerting influence on how health care dollars are spent (Pollack, 4/17).  

    Earlier, related KHN story: Doctors Overlook Lucrative Procedures When Naming Unwise Treatments (Rau, 4/14).

  • Are Exchanges More Appealing To Insurers Now?

    Elsewhere, in Colorado, new fees on consumers and insurance plans would raise $13 million to help run that state's exchange next year.

    Modern Healthcare: Exchanges Look More Appealing To Insurers Second Time Around 
    Health insurers appear to be increasingly bullish on the fledgling state and federal exchanges, in spite of disastrous rollouts in many of the online marketplaces last fall (Demko, 4/17).

    The Denver Post: Colorado Health Exchange Proposes Insurer Fee to Raise $13 Million 
    Colorado's new health exchange will decide this summer whether to assess a fee to insurance companies for each policy they provide exchange users. The assessment could be up to $1.80 per policy, and if approved by the exchange board would be in effect to help pay exchange operating costs next year and in 2016, according to Connect for Health Colorado CEO Patty Fontneau (McGhee, 4/18).

    Health News Colorado: Fee To Fund Exchange Would Hit All Coloradans With Health Insurance
    A $13 million fee on all Coloradans with health insurance would pay half the operating costs at the state health exchange next year and in 2016 under the newest financial projections. The proposed fee would affect at least 875,000 people and includes Coloradans who get their insurance through their employers or outside the exchange. Exchange managers announced earlier this week that they sold private health plans to 124,000 people through the end of March (McCrimmon, 4/17).

    Meanwhile, in Medicaid expansion news --

    Bangor Daily News: Maine Legislature Approves Late, Last-Ditch Push For Medicaid Expansion
    The Maine Legislature on Thursday night approved a Medicaid expansion plan for the third time since March, though the bill is likely doomed to the same fate as its predecessors -- death by gubernatorial veto. The House of Representatives gave the bill final approval with a vote of 94-51. The Senate gave final approval after a 19-14 vote. ... [House Speaker Mark] Eves’ amendment offered a new twist on the 16-month-old Medicaid expansion debate by promoting a plan to use millions of federal Medicaid dollars to buy private insurance plans for tens of thousands of newly eligible low-income Mainers (Moretto, 4/17).

  • California Officials Announce Enrollee Tally, Note Last-Minute Surge

    Covered California, the state's online health insurance marketplace, signed up 200,000 people for coverage during the two-week deadline extension -- bringing the state's total to 1.4 million. The state's initial goal was about 815,900 for the six-month enrollment period that began Oct. 1, 2013.  

    Los Angeles Times: Obamacare Enrollment Nears 1.4 Million In California Exchange
    Covered California signed up more than 200,000 consumers for Obamacare coverage after extending its enrollment deadline by two weeks, bringing the statewide total to nearly 1.4 million people. The health insurance exchange gave people until Tuesday to finish enrolling after the state website faltered at the end of March from a crush of last-minute applicants (Terhune, 4/17).

    The Associated Press: California Health Care Sign-Ups Exceed Projections
    A late surge of sign-ups pushed California's health insurance exchange nearly 100,000 enrollees beyond the original projections of the Obama administration, state officials announced Thursday. Nearly 1.4 million Californians selected a private policy through the state's exchange by Tuesday's open enrollment extension, and 88 percent were eligible for subsidies to reduce their monthly premiums (Lin, 4/17).

    The San Francisco Chronicle: Covered California Enrollment Numbers Surpass Goals
    More than 205,000 Californians signed up for health insurance through Covered California in the final extended two weeks of enrollment that ended April 15, bringing the total number of enrollees in the state health exchange to about 1.4 million people. The state had set an enrollment goal of about 815,900 for the six-month enrollment period, which began Oct. 1. When the numbers for people who signed up for coverage for Medi-Cal, the state-federal health program for the poor, are included, the total exceeds 3 million people. The state expanded its Medi-Cal program as part of the federal health law, often referred to as Obamacare (Colliver, 4/17).

    The San Jose Mercury News: Obamacare Sign-Ups Beat Projections In U.S., California
    Good news on two fronts for President Barack Obama's health care law surfaced Thursday after health plan enrollment numbers reported by California and the White House wildly exceeded expectations. Obama announced that 8 million Americans had signed up for plans, 1 million more than projected. Meanwhile, a concerted, late-stage effort by California's health insurance exchange to expand outreach efforts, particularly in Latino communities, helped boost private health insurance sign-ups in the Golden State to almost 1.4 million (Seipel, 4/17).

  • Sebelius Says No To Kansas Senate Run

    Despite recent appeals from Democrats for outgoing Health and Human Services Secretary Kathleen Sebelius to run against Sen. Pat Roberts, R-Kan., she has declined. Meanwhile, The New York Times reports that political attack ads are now trying to offer positive alternatives.

    The New York Times: Sebelius Says She’s Not Interested In Senate Run
    Kathleen Sebelius, the soon-to-be former secretary of the Health and Human Services Department, said through a spokeswoman on Thursday that she was not interested in running for the Senate in Kansas, despite recent entreaties from Democrats (Peters, 4/17).

    CBS News: Kathleen Sebelius In The Senate? Not Likely
    When Kathleen Sebelius steps down from her post as Health and Human Services secretary in a few weeks, she may best be remembered for presiding over the disastrous HealthCare.gov rollout. But in addition to running a major federal agency for five years, Sebelius has an impressive record as a state leader in Kansas. Given that history, it's understandable that she may have toyed with the idea of running against Sen. Pat Roberts, R-Kansas, as the New York Times reported this week (Condon, 4/18).

    The New York Times: Political Attack Ads, Often Negative, Try Instead To Accentuate The Positive
    An ad by the group supporting Representative Steve Southerland II, Republican of Florida, focuses on his record of fighting President Obama’s health care law before it concludes, “Thank Steve Southerland for fighting to keep our health care decisions in our hands.” The shift is the product of several factors -- the renewed hope that positive commercials can break through the advertising clutter; lessons of the 2012 presidential race, when Mitt Romney and outside Republican groups largely failed to offer an alternate message to an onslaught of negative spots; and the increasing prevalence of stock footage made public by campaigns that makes producing positive ads easier (Parker, 4/17).

    The Wall Street Journal’s Washington Wire: N.C. Sen. Hagan’s First Ad Takes On GOP’s Thom Tillis
    Democratic Sen. Kay Hagan’s re-election campaign launched its first ad of the cycle on Thursday, targeting remarks by leading GOP candidate Thom Tillis, the speaker of the North Carolina House, about the Affordable Care Act as well as his handling of a sex scandal involving staffers in 2012. The 60-second radio spot, which will air statewide, quotes Mr. Tillis calling the health care law “a great idea.” It also says that Mr. Tillis supported creating a state health exchange in North Carolina. The ad’s voice-over asks: “So Thom Tillis thinks he can attack Kay Hagan over something he called a great idea? Watch close. Seems Thom Tillis wants it both ways” (Ballhaus, 4/17)

  • Obama Presses Scrutiny Of 2015 Health Insurance Rates

    The president made his appeal to state insurance commissioners at a meeting Thursday. Elsewhere, consumer spending related to the health law jumps, the GOP again demands to know the White House's involvement in the healthcare.gov rollout, and hospitals try their hand as insurers.

    The Seattle Times: Kreidler: 'Robust Discussion' With Obama On Health Coverage
    President Obama, in a meeting with state insurance commissioners Thursday, made it clear that he expects careful scrutiny of rates for 2015 health-insurance plans, according to Washington Insurance Commissioner Mike Kreidler. Kreidler was among more than 40 commissioners who met for an hour in the State Dining Room with the president, Vice President Joe Biden, outgoing Health and Human Services Secretary Kathleen Sebelius, Medicare administrator Marilyn Tavenner and other top health officials (Ostrom, 4/17).

    NPR: Following Enrollment Deadline, Health Care Focus Turns To States
    President Obama met Thursday with insurance company executives and a separate group of insurance regulators from the states, discussing their mutual interest in administering the new health care law (Horsley, 4/17).

    Bloomberg: Obamacare Spurs Jump In Consumers' Health Spending Economy
    Nancy Beigel has known since September that she would need hernia surgery. She couldn’t afford it on her $11,000 yearly income until she became eligible for Medicaid in January through President Barack Obama’s signature health care law. The law is prompting Beigel and others to spend more at the doctor’s office and pharmacy, and the impact is reflected in the latest data on consumer spending (Smialek, 4/17).

    Fox News: GOP Steps Up Demand For Documents On White House Role In Botched Health Care Rollout
    Republican Rep. Darrell Issa is ratcheting up pressure on President Obama's top aides to turn over more documents revealing the extent of the White House's direct involvement in the botched rollout of the health insurance exchanges, according to a letter to White House Counsel Kathryn Ruemmler obtained exclusively by Fox News. In the letter transmitted to Ruemmler at the White House Thursday morning, Issa asserts "senior White House officials -- as well as the President -- appear to have been far more personally involved in decision-making related to healthcare.gov than the White House previously represented. Documents obtained by the Committee show the significant involvement of senior White House officials in the rollout of healthcare.gov” (Henry, 4/17).

    Fox News: Hospitals Trying Their Hand At Insurance Provider Business
    As doctors, businesses and individuals around the country are adapting to the sweeping changes enacted under the Affordable Care Act, some hospitals are getting in on the provider game. Self-insurance plans are cropping up at hospitals that put the financial risks on employers for providing benefits to their workers.. Hospital officials say they can offer competitive pricing as providers to small business owners as many predict higher premium costs in the coming years. Self-insured products are often offered with employers pooling together, creating large insurance pools and spreading that risk (and thus, mitigating costs) across companies (Rogers, 4/17).

    And, a Christian broadcaster wins an injunction against the health law's conception coverage mandate --

    The Associated Press: Christian Broadcaster Wins Health Care Injunction
    Christian radio broadcaster James Dobson has won a temporary injunction preventing the federal government from requiring his ministry to include the morning-after pill and other emergency contraception in its health insurance. A federal judge in Denver issued the injunction Thursday (4/17).

  • UnitedHealth Cites Health Law, Costly Hepatitis Drug In Reporting Lower Earnings

    The health law's effect was mixed, officials said, because the company did not participate in many of the online marketplaces, but it did see more customers for its Medicaid plans. Officials are considering a bigger role in the marketplaces next year.

    The New York Times: Health Law Bellwether, UnitedHealth Posts Lower Profit
    The UnitedHealth Group, one of the nation's largest health insurers, reported lower earnings on Thursday, attributing its weak results in part to the federal health care law. It said profits were also weighed down by an expensive new drug to treat hepatitis C that costs $1,000 a pill (Abelson, 4/17).

    The Wall Street Journal: UnitedHealth's Profit Falls Amid Health-Law Changes
    UnitedHealth said the health law pushed down earnings by around 30 cents a share, including via taxes and cuts to government payments for Medicare Advantage, which is the private version of the federal benefit program. The company also said it lost around 90,000 customers from its business selling insurance to individual consumers, as it chose to play a very limited role in the law's public marketplaces where consumers shop for coverage. But the law also helped drive an increase of 255,000 people in UnitedHealth's Medicaid plans. … The company also highlighted more than $100 million in costs tied to hepatitis C treatment in the first quarter across its Medicaid, commercial and Medicare segments (Stynes and Mathews, 4/17).

    Kaiser Health News: Capsules: Biggest Insurer Shocked With Hepatitis C Costs
    UnitedHealth Group spent $100 million on hepatitis C drugs in the first three months of the year, much more than expected, the company said Thursday. The news helped drive down the biggest insurance company's stock and underscores the challenge for all health care payers in covering Sovaldi, an expensive new pill for hepatitis C (Hancock, 4/17). 

    Related earlier coverage: There’s a Life-Saving Hepatitis C Drug. But You May Not Be Able To Afford It. (Appleby, 3/3).

    The Associated Press: UnitedHealth's 1Q Profit Tumbles 8 Percent
    UnitedHealth Group's first-quarter net income slid 8 percent as funding cuts to a key product and costs imposed by the health care overhaul dented the health insurer's performance. The Minnetonka, Minn., company said Thursday the overhaul and government budget cuts added about 35 cents per share in costs during the quarter (Murphy, 4/17).

    The Star Tribune: UnitedHealth Sees Impact Of Health Law; Profit Falls 8%
    UnitedHealth Group Inc. pointed a finger at the new U.S. health law and cuts to Medicare payments on Thursday as it worked through a difficult first quarter. The Minnetonka-based company said earnings were down 8 percent during the quarter, as it felt the full brunt of the Affordable Care Act for the first time. Yet despite a somewhat downbeat tone from executives in a morning conference call with analysts, UnitedHealth maintained its previously stated outlook for the rest of 2014 (Crosby and Ramstad, 4/17).

    The Washington Post’s Wonkblog: The Nation’s Largest Insurer Thinks Obamacare Exchanges Are Doing Just Fine
    After taking a pretty cautious approach to the launch of the health insurance marketplaces in 2014, the nation's largest insurer said it's looking to expand its Obamacare footprint in 2015. UnitedHealth Group, which is participating in just five public exchanges this year, said it's likely to join more insurance marketplaces in 2015 but didn't offer specifics (Millman, 4/17).

  • Viewpoints: The Number Keeps Rising; New Fears About Census Fracus; Patients Lose As Insurers 'Play Games'

    The Washington Post: The Affordable Care Act Comes In With Better-Then-Expected Numbers
    Obamacare's critics have had a bad week. On Thursday, President Obama announced that 8 million people have enrolled in new health insurance plans through the Affordable Care Act's marketplaces, and a significant portion of them are young Americans. Yes, we need to learn more about the numbers. And yes, a lot needs to happen to complete the ACA’s phase-in. The debate about how well the law is working is not over. But the initial figures are encouraging, and Mr. Obama is right to insist that continued Republican demands for repeal are unproductive and unwise (4/17). 

    The Wall Street Journal: What Sweden Can Teach Us About ObamaCare
    President Obama has declared the Affordable Care Act a success—a reform that is "here to stay." The question remains, however: What should we expect to come out of it, and do we want the effects to stay? If the experiences of Sweden and other countries with universal health care are any indication, patients will soon start to see very long wait times and difficulty getting access to care (Per Bylund, 4/17). 

    The Wall Street Journal: None Dare Blame ObamaCare
    The White House and its media phalanx are claiming the Census Bureau fracas is nothing more than a search for a conspiracy where none exists. Yet revising its health insurance survey design will make it harder to measure ObamaCare's performance over time, and now we've learned that the choice to do so is even worse than we first wrote (4/17). 

    The Washington Post: Is Cantor The Key To Medicaid Expansion In Virginia?
    Seventh District Republican Rep. Eric Cantor has helped lead the fight against Obamacare. But the Republican majority leader’s continued tenure in the House of Representatives may be the key to allowing Democratic Gov. Terry McAuliffe to win the Medicaid expansion envisioned by the very law Cantor opposes. While counterintuitive, let’s examine this political logic (Norman Leahy and Paul Goldman, 4/17). 

    Los Angeles Times: When Health Insurers Play Games, Patients Lose
    Dr. Theodore Corwin, a plastic surgeon in Thousand Oaks for the last 30 years, has had run-ins with insurers before, but never one so aggravating — and pointless — as this. A 26-year-old woman recently came to his office complaining of back, neck and shoulder pain, as well as numbness in her hands and arms, resulting from her unusually ample bust. She's 5-foot-6, not overweight, Corwin said. She wanted a breast reduction. "There seemed to be no question that her pain and numbness was caused by her carrying this excessive weight," Corwin told me. "It seemed like a straightforward diagnosis." It wasn't, at least in the eyes of the young woman's insurer, UnitedHealthcare. Its response to both a policyholder and her doctor speaks volumes about the seeming priorities of our for-profit healthcare system (David Lazarus, 4/17).

    Los Angeles Times: Reproductive Services: The Hoag Hospital Compact
    When Hoag Hospital, which has facilities in Irvine and Newport Beach, announced it was establishing a partnership with St. Joseph Health System, community groups say they were promised that the hospital would continue to provide the same services it always had. But soon after — and not all that surprisingly, given that St. Joseph is Catholic-run — Hoag declared that it would stop providing elective abortions (4/17).

    Bloomberg: Good News For Paul Ryan's Medicare Plan
    It didn't attract much attention, but the Congressional Budget Office has changed the way it looks at the Republican plan for Medicare -- and its new look at the issue is good news for the plan's chief sponsor, House Budget Committee Chairman Paul Ryan (Ramesh Ponnuru, 4/17).

    Fox News: ObamaCare Proxy War? Republicans Could Use Burwell Nomination As Leverage
    A 96-love Senate confirmation vote to run the White House budget office might not mean much -- when the person who secured that support is now up to run the Department of Health and Human Services. And by fiat, ObamaCare. Such is the lot facing Sylvia Mathews Burwell, whom President Obama tapped to succeed outgoing HHS Secretary Kathleen Sebelius (Chad Pergram, 4/17).