THE GAZETTE ONLINE AND PRINTABLE VERSIONS AVAILABLE AT HTTP://AHCA.BULLETINNEWS.COM

DATE: FRIDAY, APRIL 11, 2014 8:00 AM EDT

TODAY’S EDITION

AHCA/NCAL in the News Medicare News Analysis: Physicians Charged With Medicare Fraud Got $17 HHS Releases Medicare Payment Data...... 8 Million In 2012...... 1 Coverage Of Medicare Payment Data Release Continues...... 8 Affordable Care Act/Health Reform Implementation Prime Healthcare Services Denies Medicare Misdeeds...... 8 HHS Secretary Sebelius To Resign, Ending Tenure Marked By Columnist Argues Retirees Did Not Pay For Most Of Their ACA’s Rocky Rollout...... 1 Medicare, Social Security Benefits...... 9 Enrollment On ACA Exchanges Tops 7.5 Million...... 3 Medicaid News IRS Getting Ready To Enforce Individual Mandate...... 4 CMS Warns Jindal Administration Over LSU Plan...... 9 Poll Suggests ACA Motivating Factor In Midterm Elections...... 4 Maine Medicaid Restrictions Linked To Lower Use Of House Republicans Said To Be Working On ACA Alternative. .... 4 Painkillers...... 9 Scott Brown Expected To Attack ACA In New Hampshire Senate Campaign...... 5 Industry News State Exchanges Plan For Future...... 5 Analysis: Average SNF Bed Cost $73,300 In 2013...... 9 Ohio, Florida Report Expanded Medicaid Enrollment Numbers. .. 6 Pilot Program For Alzheimer’s Caregivers Could Save Kansas Republican Insurance Commissioner Candidates Minnesota $966M...... 9 Support Anti-ACA Compact...... 7 Los Angeles Public Health Supervisor Reassigned...... 9 Hospitals Finding Themselves Excluded From Exchange- Analysis: US Dementia Treatment Inadequate...... 9 Offered Health Plan Provider Networks...... 7 SGR Patch Legislation Included Provision Removing ACA’s Assisted Living News Small Business Deductible Limits...... 7 California Legislative Committees Push Assisted Living Blog Considers RAND Study Of Expansion Of Employer Health “Overhaul.” ...... 9 Insurance...... 7 VA Medical Center Calls For ALF Construction...... 9 Commentary Considers ACA...... 7

AHCA/NCAL IN THE NEWS AFFORDABLE CARE ACT/HEALTH Analysis: Physicians Charged With Medicare REFORM IMPLEMENTATION Fraud Got $17 Million In 2012. The Hill (4/11, HHS Secretary Sebelius To Resign, Ending Easley, Viebeck, 237K) reported in its “Healthwatch” blog that that “Washington’s leading post-acute-care lobby shop,” the Tenure Marked By ACA’s Rocky Rollout. News American Health Care Association, promoted former Vice broke late Thursday night that HHS Secretary Kathleen President Elise Smith to Senior Fellow for Health Policy and Sebelius would announce her resignation Friday, ending a Post-Acute Care. tenure that spanned two terms of Barack Obama’s presidency, during which she oversaw the passage and implementation of his signature domestic achievement: the Affordable Care Act. The ACA was the main focus of her time as Secretary, and its rocky rollout in the fall of last year led to many calls for her resignation. However, as several outlets open enrollment ended, it would be the right time to transition note in their early coverage of her stepping down: she is the department to new leadership.” leaving on a high note, as enrollment under the law has just In a report carried by hundreds of papers across the hit the important seven million milestone and continues to country, the AP (4/11, Pace) notes that Sebelius’ resignation grow. “comes just over a week after sign-ups closed for the first Due to late confirmation of the news, the three year of insurance coverage” under the ACA, enrollment broadcast network broadcasts dedicated just one minute, through which has now exceeded 7.5 million. Still, as the total, to Sebelius’ resignation. But their brief segments were article notes, “even with the late surge in sign-ups, the law indicative of the tone of the broader coverage, with all three remains unpopular with many Americans.” On its website, calling the launch of the Affordable Care Act under her tenure CNN (4/11, Acosta, Botelho, 77.95M) adds that despite her “rocky.” ABC World News (4/10, story 6, 0:15, Sawyer) said contentious tenure, the “decision to resign was on her own “she led the rocky introduction of Obamacare,” the CBS accord.” Evening News (4/10, story 3, 0:15, Pelley, 5.08M) said she Among the print and online outlets --a good portion of “has been under fire over the rocky roll-out,” and NBC Nightly them out of the beltway-- offering similar accounts of News (4/10, story 5, 0:30, Williams, 7.86M) said she is Sebelius’ resignation, complete with postmortems on her leaving “after five years on the job and following the rocky roll- helming of HHS, are the Washington Post (4/11, Hamburger, out of President Obama’s healthcare law.” Sullivan, 4.22M) “Post Politics” blog, the Los Angeles Times Vastly more extensive, print, wire, and online outlets (4/11, Parsons, 3.46M), the Washington Times (4/11, Boyer, were able to take a deeper look at Sebelius’ time atop the 455K), Reuters (4/11, Rampton), McClatchy (4/11, Pugh, Department of Health and Human Services and consider the Wise, Helling, Subscription Publication, 23K), the Huffington implications of her exit. Still, the main focus of the accounts Post (4/11, Alman, 11.54M), a second piece in the Huffington remained challenges with the ACA’s rollout, as evidenced by Post (4/11, Buxton, 11.54M), NBC News (4/11, Todd, the titles and subtitles of stories gracing the front pages of the Johnson, 7.5M), CNBC (4/11, 31.28M), FOX News (4/11, nation’s major papers. The New York Times (4/11, A1, Shear, 74.23M), Politico (4/11, Kenen, 73K), The Hill (4/11, Viebeck, Subscription Publication, 9.65M) titles its above-the-fold Sink, 237K) “Healthwatch” blog, the National Journal (4/11, report: “Sebelius Resigns After Troubles Over Health Site.” Baker, Subscription Publication, 561K), the Daily Caller (4/11, And under its front-page headline, USA Today (4/11, A1, Munro, 408K), the Washington Examiner (4/11, Crabtree, Schouten, Kennedy, Madhani, 5.82M) notes in bold, 335K), Forbes (4/11, Schoen, 6.28M), TIME (4/11, Miller, “Sebelius criticized over website launch.” 24.1M), the NPR (4/11, Peralta, 519K) “The Two-Way” blog, On its front page, the Washington Post (4/11, A1, the New Orleans Times-Picayune (4/11, Alpert, 678K), the Eilperin, Goldstein, 4.22M) notes that when Sebelius steps New York Daily News (4/11, Friedman, 4.36M), the Topeka down Friday, it will mean an end “to the secretary’s (KS) Capital-Journal (4/11, 177K), MedPage Today (4/11, tumultuous five-year tenure.” The article says she came to Friedman, 205K), Modern Healthcare (4/11, Demko, the position “as a well-regarded former governor of Subscription Publication, 224K), the US News & World conservative Kansas,” but eventually “came under intense fire Report (4/11, Metzler, 645K), The Wire (4/11), and The New in the fall during the botched rollout of the Affordable Care Yorker (4/11, Davidson, 5.3M). Act.” Still, the piece recognizes her efforts to tout the Cable news programs reporting on Sebelius’ President’s healthcare law, calling her a “tireless promoter” resignation Thursday night included CNN’s The Lead with who held “43 local events and more than 100 local interviews Jake Tapper (4/10, 9:31 p.m. EST, 568K), MSNBC’s Rachel over the past several months.” Maddow Show (4/10, 9:34 p.m. EST, 548K), MSNBC’s All In The Los Angeles Times (4/11, Levey, Parsons, 3.46M) with Chris Hayes (4/10, 8:19 p.m. EST, 510K), Fox News reports that Administration officials stress “Sebelius was not Insider’s The Kelly File (4/10, 9:24 p.m. EST, 1.33M), and pressured to resign,” despite what the paper calls “the FOX News’ On The Record with Greta van Susteren (4/10, disastrous launch of the health law’s online insurance 7:50 p.m. EST, 1.65M). marketplaces last fall.” Obama To Nominate OMB’s Burwell To Succeed On its front page, the Wall Street Journal (4/11, A1, Sebelius. Much of the coverage of Sebelius’ resignation Radnofsky, Lee, Subscription Publication, 5.51M) says that mentioned that President Obama has already indicated who Sebelius informed the President of her decision to step down he wants to succeed her. However, several outlets offered in mid-March, as a White House official explained, “At that pieces focusing on the choice: current OMB Director Sylvia time, Secretary Sebelius told the president that she felt Mathews Burwell. Much of this coverage highlights Burwell’s confident in the trajectory for enrollment and implementation credentials, as well as the potentially tough confirmation of the Affordable Care Act, and that she believed that once battle she faces. The New York Times (4/11, Shear, Subscription Publication, 9.65M) says in its account, Burwell 2 “has spent much of the past year mired in Washington’s fiscal Gang, Wilson, 414K), the Louisville (KY) Courier-Journal fights, including the standoff that led to a 15-day government (4/11, Carroll, 468K), Huffington Post (4/11, Alman, 11.54M), shutdown in early October,” and if confirmed would “take over FOX News (4/11, 74.23M), and a second piece from FOX one of the largest and most unwieldy parts of the federal News (4/11, Ashburn, 74.23M). bureaucracy.” Beyond the reaction of lawmakers through media like The Wall Street Journal (4/11, Paletta, Subscription Twitter, pundits took to the web to offer long-form analyses of Publication, 5.51M) reports that a senior Administration the news. For example, David Graham considers for the official said Burwell was the only candidate the President Atlantic (4/11, Graham, 8.78M) “What Kathleen Sebelius’s considered, seeing her strong management skills as essential Exit Means for Obama—and Obamacare.” In Politico (4/11, in a new HHS chief. Her 96-0 confirmation as OMB director Nather, 73K), David Nather reckons that the healthcare.gov last April, during a time when many nomination fights were “fiasco” will “taint Kathleen Sebelius’ legacy.” And Susan contentious, was also a factor. Page, in an analysis for USA Today (4/11, Page, 5.82M), Politico (4/11, White, Epstein, 73K) says “the theory says that Sebelius “exits, battered and blamed.” among senior Democrats is that Burwell will be both hard for Additional analyses in this vein are offered by TIME Republicans in the Senate to reject...and hard for them to (4/11, 24.1M), the Washington Examiner (4/11, Crabtree, demonize once she’s in the job.” They say her “relationships 335K), Bloomberg News (4/11, Wayne, Goldman, Armstrong, with Republicans on the Hill should help ease her 2.76M), a second piece from Bloomberg News (4/11, confirmation, though administration officials are aware that Dorning, Linskey, 2.76M), NBC News (4/11, Fox, 7.5M), and Republicans will use the hearings as an opportunity to score Politico (4/11, Dovere, Brown, 73K). points” on the ACA. Finally, several outlets offer pure commentary. In a Additional pieces introducing Burwell as the nominee to highly critical editorial, the Wall Street Journal (4/12, succeed Sebelius are carried by the Washington Post (4/11, Subscription Publication, 5.51M) says that Secretary Millman, 4.22M) “Wonkblog,” Bloomberg News (4/11, Sebelius’ resignation does not demonstrate accountability for Sobczyk, Linskey, 2.76M), Vox (4/11, Kliff), the Roll Call problems with the law she oversaw, but rather shows a (4/11, Dennis, Subscription Publication, 76K) “#WDGB” blog, tendency to avoid responsibility. the Congressional Quarterly (4/11, Bettelheim, Subscription Gerald Seib predicts in his Wall Street Journal (4/11, Publication, 967), Kaiser Health News (4/11, Carey, 2K), the Subscription Publication, 5.51M) column that though Sebelius Washington Examiner (4/11, Klein, 335K), the Charleston has become the public face of the ACA, her departure will not (WV) Gazette (4/11, 144K), the West Virginia MetroNews end the debate over the law. The problems with the law’s (4/11, Jenkins, 5K), and the Chicago Sun-Times (4/11, introduction, he argues, were due to its complexity and a Sweet, 1.1M). series of tight deadlines, and until its success or failure can Lawmakers, Stakeholders, Pundits React To be seen over the longer term, the arguing will continue. Sebelius’ Resignation. Though news of Sebelius’ However, Ezra Klein writes at Vox (4/11) that Sebelius resignation broke late, several pundits and stakeholders can leave because “Obamacare has won.” While the managed to broadcast their reactions to the news. The Wall demands last year “that Sebelius to step down – or be fired – Street Journal (4/11, Peterson, Subscription Publication, were as deafening inside” the White House as outside it, the 5.51M) says Republicans used the announcement as an enrollment successes reported this month have vindicated opportunity to again criticize the ACA. Senate Minority Leader the law and Sebelius. McConnell said, “Regardless of the Administration’s public In her column for Kansas City (MO) Star (4/11, 1.48M), explanation for the secretary’s exit, Obamacare has been a Barbara Shelly asks readers to give Sebelius “credit” because rolling disaster and her resignation is cold comfort to the “she survived the furnace” of countless Congressional millions of Americans who were deceived about what it would hearings, calls for her resignations, and a heavy workload. mean for them and their families.” Sen. Charles Grassley (R- Doug MacEachern, in his column for the Arizona IA) said, “Anybody put in charge of Obamacare would be set Republic (4/11, 1.45M), blames the President for Sebelius’ up to fail.” “ineptitude.” Jim Treacher also calls Sebelius “inept” in a The Politico (4/11, Cheney, 73K) characterizes the piece for the Daily Caller (4/11, 408K). “reaction of GOP lawmakers” as ranging from “muted thanks to outright disdain.” For example, House Majority Leader Eric Enrollment On ACA Exchanges Tops 7.5 Cantor (R-VA) tweeted, “I thank Secretary Sebelius for her Million. Though news of HHS Secretary Kathleen service. She had an impossible task: nobody can make Sebelius’ resignation dominated headlines after it broke late Obamacare work.” Additional accounts of initial reactions to Thursday, the Secretary first garnered significant coverage the news are offered by the National Journal (4/11, Novack, earlier in the day for an announcement she made during a Subscription Publication, 561K), the Tennessean (4/11, 3 Senate Finance Committee hearing. As USA Today (4/11, mandate. The law requires most individuals to have some Kennedy, 5.82M) reports, Sebelius told the panel that form of health insurance or pay a penalty. However, the IRS enrollment on the Affordable Care Act’s exchanges had hit at still must choose how it will enforce the provision. least 7.5 million. She said, “Last week, we announced that 7.1 million Americans have signed up for private insurance Poll Suggests ACA Motivating Factor In through the Marketplace. As of this week, 400,000 additional Midterm Elections. USA Today (4/11, Page, 5.82M) Americans have signed up – and we expect that number to reports on the results of a new USA Today-Pew Research continue to grow.” poll that shows an overwhelming majority of Americans The Wall Street Journal (4/11, Dooren, Subscription considering a politician’s stance on the Affordable Care Act is Publication, 5.51M) reports that after mentioning the either “important” or “very important.” More than 80% rated it marketplace figures, Sebelius predicted the numbers would as one of the two highest categories of concern, with 54% continue growing, saying, “I can tell you that those numbers considering it very important. Twice as many people who are going to be much more significant by the time we tally the identified themselves as being in the latter category newcomers.” disapprove of the healthcare law. The poll provides insight The Los Angeles Times (4/11, Rothberg, 3.46M) into public opinion leading up to midterm elections that are reports that Sebelius also spoke fondly of the law, saying, expected to be contentiously fought between parties that “During these past six months, millions have obtained the have very different opinions about the ACA. The data imply security and peace-of-mind of affordable health coverage. that the law may affect turnout in November and “is more Many of the people I’ve met have told me that they’ve been likely to motivate opponents than supporters to vote.” able to get covered for the first time in years. And some have The Hill (4/11, Trujillo, 237K) reports in its insurance for the first time in their entire lives.” “Healthwatch” blog that the survey polled “1,010 people from However, Bloomberg News (4/11, Wayne, 2.76M) adds April 3-6 and has a 3.6-percentage-point margin of error.” that Republicans are pushing back against the new figures. Rutgers-Eagleton Poll: New Jerseyans Divided For example, Utah Senator Orrin Hatch called the figure a Over ACA. NJBIZ (4/10, Bader, George, 27K) reports on a “false metric,” asking Sebelius “about how many people who different poll that shows New Jersey residents having mixed signed up under the law previously lacked health insurance.” feelings toward the Affordable Care Act. The Rutgers- She responded, “I do not have data to give you right now in Eagleton Poll found 26% fully supportive, 29% somewhat terms of who exactly was previously uninsured. We are supportive, 12% somewhat opposed, and 28% strongly collecting that.” opposed. Moreover, the Washington Post (4/10, Somashekar, Millman, 4.22M) “Post Politics” blog points out that the new House Republicans Said To Be Working On figures do “not reflect the number of people who have paid ACA Alternative. NBC News (4/11, Russert, 7.5M) their first month’s premium.” reports that, according to House Speaker John Boehner (R- Additional coverage of the new 7.5 million sign-up OH), Republicans are working to create an alternative to the figure, as well as Sebelius’ testimony Thursday, is offered by Affordable Care Act. Although he did not provide details the AP (4/11, Werner), Reuters (4/11, Morgan), McClatchy about what is currently being considered, he hinted that it (4/11, Pugh, Subscription Publication, 23K), CNN (4/11, would reflect Republican proposals predating the ACA’s Acosta, 77.95M), MSNBC (4/11, Whitaker, 45.1M), Politico passage. NBC describes such proposals: “the GOP’s loose (4/11, Haberkorn, 73K), the National Journal (4/11, Novack, plan was a collection of standard Republican principles: small Subscription Publication, 561K), The Hill (4/11, Viebeck, business tax credits to businesses that offered healthcare, 237K) “Healthwatch” blog, the Congressional Quarterly (4/11, measures to allow young people to stay on their parent’s plan Ethridge, Subscription Publication, 967), a second piece in till age 25, medical malpractice reforms and a boost in high the Congressional Quarterly (4/11, Reichard, Subscription risk pools.” Publication, 967), the Christian Science Monitor (4/11, Citing an April 9 article in the Washington Examiner Trumbull, 566K), Modern Healthcare (4/11, Demko, (4/11, Drucker, 335K), National Journal (4/11, Subscription Subscription Publication, 224K), the Washington Examiner Publication, 561K) questions if Sen. Marco Rubio and Rep. (4/11, Mali, 335K), Vox (4/11, German), and the PBS (4/11, Paul Ryan really are working on a Republican alternative to Barajas, 1.22M) “The Rundown” blog. the Affordable Care Act. The Journal notes, “the more entrenched the current law becomes, the harder it will be to IRS Getting Ready To Enforce Individual repeal.” Mandate. FOX News (4/10, 74.23M) reports that the IRS Grover Norquist and Patrick Gleason, in a U-T San is preparing to enforce the Affordable Care Act’s individual Diego (4/10, 648K) opinion piece, support an ACA alternative

4 recently proposed by several conservative members of State Exchanges Plan For Future. With the Congress from California. inaugural open-enrollment period over and extended enrollment times winding down, state-run health insurance Scott Brown Expected To Attack ACA In New exchanges across the country are planning for their futures, Hampshire Senate Campaign. The Boston Globe with bug-fixing and financial stability in mind. (4/10, O'Sullivan, 1.62M) reports that ex-Massachusetts Sen. In Oregon, the AP (4/11, Wozniacka) reports that Cover Scott Brown (R) is planning to run for the Senate seat Oregon announced it has officially reduced the future of the currently held by Sen. Jeanne Shaheen (D-NH). Although he exchange to two options: “switching to the federal exchange, must first win the GOP primary, “Brown has sought to lash or staying with the current technology and hiring a new Shaheen to her support for the 2010 federal health care law.” contractor to fix it.” That means that the state will not be The AP (4/10) reports that Brown, set to announce his considering the possibility of utilizing technology from a more New Hampshire bid today, “is using a variation of the state’s successful state exchange. The Oregonian (4/11, Budnick, ‘Live Free or Die’ motto to argue against President Barack 992K) summarizes the exchange’s two options as “fix it or go Obama’s health care overhaul law.” According to “excerpts of federal.” The Salem (OR) Statesman Journal (4/10, Yoo, remarks provided by his campaign,” Brown will say in his 104K) reports that Cover Oregon has hired “turnaround firm” announcement speech that the ACA “forces people to ‘live Hamstreet & Associates to give the exchange leadership as it free or log on.’ ‘Along with our money and our health plans, accepts the resignation of Acting Director Dr. Bruce for a lot of us, it feels like we’re losing our liberty, too. Goldberg. The Oregonian (4/11, Manning, 992K) provides an Obamacare forces us to make a choice, live free or log on — overview of the job in front of Hamstreet, namely creating a and here in New Hampshire, we choose freedom,’ Brown working health insurance exchange before the November 15 planned to tell supporters.” start of the next open enrollment period. Also reporting on Reuters (4/11, Malone) reports that Brown’s incipient Cover Oregon’s woes and possible fixes are the Portland campaign has thus far focused on the Affordable Care Act. (OR) Business Journal (4/11, Subscription Publication, 26K) Polls show Brown gaining ground on the incumbent, though it and Oregon Public Broadcasting (4/11, Foden-Vencil, 4K). is too early to know if the trend will continue. In Massachusetts, the Boston Herald (4/11, Szaniszlo, FOX News (4/10, 74.23M) notes that “Brown won a 783K) reports that Health Connector leader Sarah Iselin special election in Massachusetts in 2010 before losing his acknowledged the challenges involved in getting the seat to Democrat Elizabeth Warren two years later.” exchange working in time for open enrollment, saying “The Group Runs Ads Lauding Senator’s ACA Support. clock is ticking and we’ve got a lot of work to do.” The Lowell The National Journal (4/10, Drusch, Subscription Publication, (MA) Sun (4/11, Murphy, 142K) reports that the 561K) reports that super PAC Put Alaska First is running an Administration of Gov. Deval Patrick is “tempering ad in favor of Sen. Mark Begich (D-AK) that touts his support expectations in advance of the scheduled relaunch of its of the Affordable Care Act. The ad differs from other ads exchange site this fall.” being run by outside groups around the country that attack In California, the Huffington Post (4/10, Miles, 11.54M) politicians for the same reason. uses Covered California as an eponymous example of “How The Huffington Post (4/11, Siddiqui, 11.54M) reports Obamacare Leaves Some People Without Doctors.” The that the ad will run statewide in a $130,880 run. largest insurers on the exchange have networks that exclude Supreme Court To Consider Laws Banning False some providers. For example, the Huffington Post focuses on Statements In Campaigns. US News & World Report (4/10, Noam Friedlander, whose insurance through the exchange 645K) reports on an upcoming Supreme Court case that will did not stop her from having to pay “$16,000 out of pocket.” evaluate the constitutionality of laws prohibiting false In Washington state, the Daily News (WA) (4/11, statements in conjunction with political campaigns. The case, Toledanes, 72K) reports that consumers who experienced Susan B. Anthony List v. Driehaus, is based on an Ohio law difficulty using the state website during open enrollment have that made billboard companies afraid to run an ad by the List, additional time to sign up for health insurance. a pro-life advocacy group, on the grounds that it could open In Vermont, the AP (4/11, Garbitelli) reports that them up to legal action by Rep. Steve Driehaus (D-OH). The Commerce Secretary Lawrence Miller has been tasked with ad, and nearly-identical versions run in other parts of the “overseeing the overhaul of the health care insurance system country, claim their respective subjects “voted for taxpayer- statewide.” Part of her job will involve transitioning the state’s funded abortion” by supporting the Affordable Care Act. The health programs from an exchange-based system to the high court previously ruled to overturn a law prohibiting false country’s first single-payer system. The transition is statements about military service, scheduled for 2017.

5 In Minnesota, the Minneapolis Star Tribune (4/11, to 450,000. KTNV-TV Las Vegas (4/11, Lopardi, 19K) also Crosby, Meitrodt, 1.48M) reports that consulting giant Deloitte reports on the exchange. “has agreed to general contract terms to help MNsure begin Southern California Public Radio (4/10, O'Neill, 85K) fixing underlying issues with its massive computer system.” reports that enrollment in Covered California is “charging Deloitte was considered as a lead contractor in the original ahead” with less than a week to go until the end of extended bidding process, but the company wanted more money than open enrollment. More than 1.2 million applications were the state was then willing to pay. The St. Paul (MN) Pioneer processed through the marketplace during the standard Press (4/11, Belden, 656K) also reports on MNsure. October 1-March 31 open enrollment, and an additional The Washington Business Journal (4/11, Subscription 70,000 have come during extended time. Publication, 119K) reports that DC Health Link is working on Similarly, the Connecticut Post (4/11, Cuda, 252K) a plan to secure long-term funding beyond the 2015 cutoff of reports that around 3,500 consumers in the Nutmeg state Federal support. Specifically, city officials “are proposing an have availed themselves of the state’s extension to open estimated 1 percent assessment on all health carriers enrollment, adding to the 200,000 who enrolled during the operating in D.C. to fund the exchange.” It is believed that the regularly scheduled period. fee may result in higher consumer premiums. The Idaho Statesman (4/10, 222K) reports that Blue In Hawaii, the Honolulu Star-Advertiser (4/11, Consillio, Cross of Idaho received a total of roughly 45,000 insurance 402K) reports that Hawaii Health Connector has proposed applications through Your Health Idaho. shifting to the Hawaii Department of Human Services WSJournal Says New Hampshire Exchange responsibility for “determin[ing] whether applicants can Problems Expose ACA Flaws. The Wall Street Journal receive tax credits to help pay for health insurance.” The (4/11, Subscription Publication, 5.51M) says in an editorial beleaguered exchange is evaluating a range of options for that though Sen. Jeanne Shaheen has been a vocal ensuring its long-term success and stability. supporter of the Affordable Care Act, she is now seeking help The Denver Post (4/11, Kane, 940K) reports in an from HHS in its implementation as she seeks re-election in analysis piece that Colorado’s exchange ranks 11th in terms New Hampshire. Just one insurer, Anthem Blue Cross and of states with the higher proportion of Medicaid enrollees Blue Shield, has opted to participate in the state’s exchange, compared to private insurance. creating a potential monopoly in a state that used to have a Exchanges Report New Enrollment Data. Several competitive insurance industry. HHS has since granted state exchanges reported the latest enrollment numbers Massachusetts-based Minuteman Health, a non-profit, nearly yesterday, providing a more complete picture of the state- $67 million to begin operations in New Hampshire. The level implementation of the Affordable Care Act. Although Journal says HHS should instead deregulate. states have previously announced enrollment, today offers the most comprehensive understanding to date of how many Ohio, Florida Report Expanded Medicaid state residents are taking advantage of extended deadlines to Enrollment Numbers. In Ohio, the AP (4/10) reports open-enrollment. that “more than 106,000 Ohioans have signed up for In Delaware, the AP (4/11) reports that officials Medicaid under an expansion of the taxpayer funded health yesterday announced that 11,335 people had enrolled in the program.” The Toledo (OH) Blade (4/10, Troy, 241K) reports state exchange. The enrollment number exceeds the most on continuing political controversy over the state’s expansion. recent signup target: “State officials initially had hoped to The AP (4/10) reports that, despite not expanding the enroll 35,000 of the roughly 90,000 uninsured Delawareans eligibility for its Medicaid program, Florida has seen for coverage under the ACA, but federal officials set a much increasing enrollment since the launch of the Affordable Care lower benchmark of 8,000 last fall.” The Wilmington (DE) Act. Since October, 245,000 people have enrolled in News Journal (4/10, Miller, 288K) also reports on the Medicaid, bringing the total beyond the three million mark. enrollment announcement. Pennsylvania Medicaid Expansion Battle Enters Alabama Live (4/11, Oliver, 75K) reports that the latest Next Stage. The Congressional Quarterly (4/11, Adams, “unofficial, off-the-record, tally” of enrollment in Alabama’s Subscription Publication, 967) reports that the debate over exchange suggests enrollment has reached 90,910. The Medicaid expansion is intensifying, as the comment period for state’s goal was 89,000. an expansion proposal closed early this morning. A In Nevada, the Las Vegas Review-Journal (4/11, spokesman for Gov. Tom Corbett (R) said today “the formal Robison, 437K) reports that an additional 7,000 people have negotiations start.” started applications in the Silver State Health Insurance Opinion Writers Debate Medicaid Expansion. Exchange in the special enrollment period that started on the Several sources of commentary offer their respective first of the month. That brings the total number of applications

6 opinions on expanded-eligibility Medicaid programs, as will be looking more closely at the role of narrow networks in envisioned by the Affordable Care Act. 2015.” In an opinion piece for the Washington Examiner (4/11, de Rugy, 335K), Veronique de Rugy complains about SGR Patch Legislation Included Provision Medicaid’s cost to state governments and the quality of care it Removing ACA’s Small Business Deductible offers beneficiaries: “state legislators should ask themselves Limits. The New York Times (4/11, Mandelbaum, 9.65M) whether the expansion is really worth the future cost to “You’re the Boss” blog runs a piece that says the recently- taxpayers in their states and whether it is really fair to throw passed “doc fix” legislation had “a separate provision that more low-income Americans into costly substandard health removed restrictions on deductibles in small-business health care.” plans.” The legislative change is seen as “largely symbolic,” Anna Galland, from the liberal advocacy group because HHS already issued regulations making a similar MoveOn, writes an op-ed in the Huffington Post (4/11, change. The Affordable Care Act required plans to meet Galland, 11.54M) “Blog” in which she calls on people to “go minimum standards of care and to limit deductibles. However, on offense” to defeat “the Republican Medicaid blockade.” achieving both goals proved difficult for insurers. Dan Liljenquist, writing in Deseret (UT) News (4/11, 610K), offers his opinion that Utah’s approach to Medicaid is Blog Considers RAND Study Of Expansion Of “a quiet success.” Liljenquist used to be a state senator and a Employer Health Insurance. The Washington Post US Senate candidate. (4/10, 4.22M) “Wonkblog” questions the level of surprise The presidents of several Missouri chambers of warranted by a RAND Corporation study that attributed a commerce jointly write an opinion piece for the St. Louis Post- “drop in the uninsured rate over the past six months mostly to Dispatch (4/11, 1.02M) that calls on lawmakers to support gains in employer coverage,” not the expansion of health “Medicaid transformation.” Jim Anderson, Jim Heeter, Dan insurance under the Affordable Care Act and the individual Megan, and Joe Reagan point to statistics that show a strong mandate’s legal requirement for coverage. While some positive correlation between employee health and business influential analysts anticipated a drop in employer-provided productivity and success. health coverage due to the law, others correctly predicted the An editorial in the Portland (ME) Press Herald (4/11, opposite. 352K) calls on state legislators to override Gov. LePage’s (R) veto of Medicaid expansion. Commentary Considers ACA. A handful of opinion pieces Friday weigh in on various aspects of the Affordable Kansas Republican Insurance Commissioner Care Act. Paul Krugman, in his column for the New York Candidates Support Anti-ACA Compact. The Times (4/11, Krugman, Subscription Publication, 9.65M), Kansas City (MO) Star (4/10, Mann, 1.48M) reports that four accuses Republicans of having “delusions of disaster” when it Republican candidates for Kansas Insurance Commissioner comes to the Affordable Care Act. They are so sure, he agreed yesterday that they would support “a compact with writes, “that the Affordable Care Act is doomed to utter failure, other states hoping to become exempt from the federal health so failure is what they see, never mind the facts on the care overhaul.” State lawmakers are currently considering a ground.” As it turns out, he concludes, it’s that the law is bill that “would give the state all of the federal funding for the succeeding that turns out to be the GOP’s “real Obamacare Affordable Care Act, Medicare, Medicaid and the Children’s nightmare.” Health Insurance Program, and grant the state authority to Joe Klein, in a piece for TIME (4/11, 24.1M) website, determine how that money is spent and which rules, makes a similar point, highlighting several times in which regulations and policies are followed.” “neoconservatives” push the “Obamacare Disaster!” narrative in print, online, and on radio and television. Hospitals Finding Themselves Excluded From However, in an editorial, the Washington Examiner Exchange-Offered Health Plan Provider (4/11, 335K) argues that those who believe the “debate” over Networks. The US News & World Report (4/10, 645K) the Affordable Care Act to be over will be disproved when reports that “several hospitals nationwide suddenly have Republicans dominate in November’s midterm elections. found themselves excluded from exchange-offered health In a piece entitled, “How Will Boomer, Gen-X, Millennial plan provider networks.” Matthew Eyles, executive vice Doctors Respond To Health Care Changes?” Forbes (4/10, president with consulting firm Avalere Health, explained, 6.28M) contributor Robert Pearl explores how physicians will “There is enough anecdotal evidence to say this is a trend. It respond to the changes brought to the American healthcare is part of a broader strategy by payers to get ahead of the system by the Affordable Care Act. While noting that, “not all costs.” Meanwhile, “the federal government has signaled it generational generalities are foolproof,” Pearl applies 7 information about each of the three generations to the law’s tag 40 times cheaper and works equally well, according to implementation. He concludes, “Whether health care reform studies.” Bloomberg News adds, “The government hopes the proves successful or not may depend on how physicians newly public data on physician payments will help control across the U.S. collaborate.” costs in the $604 billion Medicare system by pressuring Additional commentary is offered by the Foster’s Daily doctors to be more concerned about the price of the drugs Democrat (4/11, 68K), Bloomberg BusinessWeek (4/11, they use, said Jonathan Blum, principal deputy director of” 4.91M), the Washington Times, Forbes (4/11, 6.28M), and CMS. In response to “a question about the choice between the New Orleans Advocate (4/11). Lucentis and the cheaper version, called Avastin [bevacizumab],” he said, “Under the current statutory MEDICARE NEWS framework we work under, we cannot encourage or require physicians to use lower-cost drugs that are available.” HHS Releases Medicare Payment Data. In The Memphis (TN) Commercial Appeal (4/10, 414K) continuing coverage, McKnight’s Long-Term Care News reports that physicians “suggest the reimbursement figures in (4/11, 921) reports on Wednesday’s Medicare physician the database were inflated in part by Medicare billing payment data release, providing a link to the complete data methods.” In some cases, “one doctor’s provider identification set (4/10, 123K). code is used to bill on behalf of all the doctors in the practice.” However, “Congress’ reaction to the data release has been Coverage Of Medicare Payment Data Release generally supportive of the Obama administration, even Continues. Modern Healthcare (4/11, Robeznieks, among Republicans.” The Bangor (ME) Daily News (4/10, Subscription Publication, 224K) reports, “This has been a 166K)also covers the story. fraught week for physicians as the CMS let loose a database Opinion. In an editorial, the Baltimore Sun (4/11, of Medicare payments that allows the media and the public to 925K) praises the release of the Medicare payment data, but scour the numbers for signs of fraud and abuse by individual argues that “it’s frustrating that it’s taken this long” for the data providers.” However, physicians’ “responses to the release to be released. The Sun adds, “In releasing the data, U.S. had much to do with their own circumstances, and some are Health and Human Services Secretary Kathleen Sebelius even welcoming it.” described it as a ‘new window into health care spending and The Chicago Tribune runs a 1,900-word story on Illinois’ physician practice patterns.’” According to the Sun, “If so, it’s biggest Medicare billers. The Tribune also adds, “The data a window that needs to be made more clear.” dump ‘has significant shortcomings regarding the accuracy The New York Times (4/11, Subscription Publication, and value of the medical services rendered by physicians,’ 9.65M) says in an editorial that the case of Salomon Melgen, said AMA President Dr. Ardis Dee Hoven,” who added, the Florida ophthalmologist who received $21 million in “Releasing the data without context will likely lead to Medicare reimbursements in 2012 and who gave $700,000 to inaccuracies, misinterpretations, false accusations and other the Democratic-linked Majority PAC that same year, is at the unintended consequences.” intersection of political and Medicare malfeasance. Melgen’s A separate Modern Healthcare (4/11, Carlson, funds went mainly to help re-elect Sen. Robert Menendez, “a Subscription Publication, 224K) story reports, crony of Dr. Melgen,” and the Times says there can be little “Ophthalmologists are among Medicare’s highest paid doubt that “there is a quid pro quo in these payments? Yet it specialists – a finding already drawing scrutiny from remains invisible to those tearing down campaign finance policymakers and watchdogs worried about waste and limits.” overuse.” However, physicians’ “advocates say the data In a syndicated column published in the Raleigh (NC) shouldn’t be interpreted as eye doctors getting rich off” of News & Observer (4/10, 504K), Froma Harrop argues that Medicare. According to Modern Healthcare, “A closer the data “show why we need more government in health inspection of the data reveals that many of the highest-paying care.” Harrop writes, “A free flow of information about where codes for eye doctors relate to the use of Lucentis health care dollars are going offers a lighted path to restrain [ranibizumab injection], a branded injectible drug for macular the growth in federal spending.” degeneration that costs $2,000 a dose.” Prime Healthcare Services Denies Medicare Bloomberg News (4/11, Chen, Cortez, 2.76M) also reports on this issue in a 1,000-word article titled “Eye Misdeeds. The Victorville (CA) Daily Press (4/11, Doctors Say Medicare Pay List Unfairly Demonizes Them.” Johnson, 3K) reports that Prime Healthcare Services The Medicare program “paid at least $915 million to continues to deny allegations that the Ontario-based ophthalmologists whose patients used Lucentis in 2012 rather company “inflated billings and defrauded the federal than a similar medicine, also from Roche, that carries a price government of millions of dollars.” One of several specific 8 allegations of misconduct is that “Prime founder Dr. Prem Pilot Program For Alzheimer’s Caregivers Reddy instructed hospital personnel during a Dec. 13 meeting Could Save Minnesota $966M. The Kaiser Health on how to alter patient records in such a way to collect more News (4/10, Gillespie, 2K) “Capsules” blog reported that money from Medicare.” according to a study published in the April issue of the journal Columnist Argues Retirees Did Not Pay For Health Affairs, “a five-year pilot program offered to 228 participating [Alzheimer’s disease] caregivers in urban and Most Of Their Medicare, Social Security rural areas” in Minnesota “could save $966 million by 2025 if Benefits. Catherine Rampell, in her column for the it were implemented state-wide.” Savings in costs were Washington Post (4/11, 4.22M), attempts to dispel the primarily realized by keeping patients with Alzheimer’s at common notion that Medicare and Social Security recipients home in their community. The study “authors found that five have paid for the benefits, arguing that most beneficiaries percent more people would stay in these settings if the “receive much more out of the entitlement system than they project was expanded, and 19.3 percent fewer people with paid into it.” She cites a study by the Urban Institute for “the dementia would die in an institution.” average worker who turned 65 in 2010.” The study found that these people “will, more or less, break even on Social Los Angeles Public Health Supervisor Security.” For Medicare, beneficiaries generally receive “two Reassigned. Kaiser Health News (4/11, Gorman, 2K) to six times” what they paid. She argues that retirees reports in collaboration with the Los Angeles Daily News that therefore did not pay for their benefits, but for their parents Los Angeles County Department of Public Health supervisor benefits. She argues that such expenses need to be Ernest Poolean has been transferred from overseeing controlled in order to preserve funds “for other worthy, nursing home inspections to another position. According to a traditionally liberal causes — education, infrastructure, memo circulated yesterday, he will be taking a position at the children, the deeply poor.” Baldwin Park headquarters. MEDICAID NEWS Analysis: US Dementia Treatment Inadequate. McKnight’s Long-Term Care News (4/11, 921) reports that CMS Warns Jindal Administration Over LSU according to a recent analysis published in Health Affairs, the US dementia treatment strategy is inadequate. After Plan. The AP (4/11) reports that CMS officials notified observing seven other nations, investigators found that “all Louisiana Gov. Bobby Jindal (R) that the agency will seven countries have stronger plans for early-stage “withhold $307 million in Medicaid money from the state if no transitions (such as connecting the newly diagnosed with agreement is soon reached on whether the state’s financing services) than late-stage transitions (such as moving from plans for the privatized LSU hospitals meet federal home to residential care).” guidelines.” Maine Medicaid Restrictions Linked To Lower ASSISTED LIVING NEWS Use Of Painkillers. The AP (4/11, Davis) reports that Maine’s restrictions on Medicaid coverage for opioid California Legislative Committees Push painkillers “have sharply reduced the number of people Assisted Living “Overhaul.” Senior Housing News obtaining highly addictive medications blamed for drug abuse (4/10, 503) reports in continuing coverage that two separate and deaths around the nation.” Restrictions implemented last California committees passed legislation for an assisted living year contributed to “a 17 percent drop last year in how many “overhaul.” patients take opioid painkillers such as OxyContin and Vicodin” versus the previous year. VA Medical Center Calls For ALF Construction. Newsday (4/11, Issler, 1.5M) reports Northport Veterans Affairs (VA) Medical Center officials have requested that INDUSTRY NEWS developer Communities for Veterans build an assisted living Analysis: Average SNF Bed Cost $73,300 In facility on hospital grounds. According to Chief of Engineering and project leader Ronald Brattain, such a facility would 2013. McKnight’s Long-Term Care News (4/11, Mullaney, provide a necessary service to Long Island veterans and 921) reports a recent Irving Lenin Associates report indicates provide them independence. the average skilled nursing facility bed cost $73,300 last year. This represents a 21% increase from 2012. The “significant jump” surprised Irving Levin analysts. 9 Copyright 2014 by Bulletin News, LLC. Reproduction without permission prohibited. Editorial content is drawn from thousands of newspapers, national magazines, national and local television programs, and radio broadcasts. The Office of the AHCA/NCAL Gazette is published five days a week by BulletinNews, which creates custom news briefings for government and corporate leaders. We can be found on the Web at BulletinNews.com, or called at (703) 483-6100.

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