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

DATE: MONDAY, APRIL 7, 2014 8:00 AM EDT

TODAY’S EDITION AHCA/NCAL in the News Commentary Considers ACA...... 7 Research Team Develops New Nursing Home Care Quality Scholar Says Jindal Pitching Old GOP Healthcare Measure...... 1 Junker...... 8 Scholar Says Vermont’s Healthcare, Progressive Party Are Affordable Care Act/Health Reform Implementation Instructive For Nation...... 8 HHS: Nearly Three Million People Added To Medicaid Rolls Since ACA Launched...... 2 Medicare News Sebelius Due To Testify On 2015 Budget For Senate House Democrats Urge HHS To Rethink ACA’s Cuts To Committee...... 2 Medicare Advantage...... 8 For Americans Who Have Not Signed Up For Insurance, Next Obama Criticizes Ryan Budget Plan In Weekly Address...... 9 Chance Likely This Fall...... 3 Advocates Tell CMS Not To Expand Competitive Bidding Facing ACA Deadline, More Young People Signed Up In Program...... 9 March...... 3 AMGA Representatives Say Push For Permanent Fix To SGR House Republicans Quietly Sought Expansion OF ACA Will Continue...... 9 Coverage Choices...... 3 Industry News Strategists Say Senate Democrats Need To Shift From ACA To Report: More Nursing Homes Need Tornado Shelter Economy In Election...... 3 Specifications...... 9 Pelosi Dismisses Gibbs Claim That ACA’s Employer Mandate Federal Suit Holds Nursing Home Responsible For Hep C Will Be Scrapped...... 4 Outbreak...... 10 Paul Ryan Confident ACA Can Still Be Repealed...... 4 Report: Los Angeles County Health Department Had No State Exchanges Consider Fixes...... 4 “Central Oversight.” ...... 10 Medicaid Expansion Debates Remain Largely Unchanged...... 6 Medicare Extends Policies To People In Same-Sex Marriages. 10 Kentucky Jail Signs Up Exiting Inmates Under ACA’s Expanded Groundbreaking Ceremony Held For Future ALF...... 10 Medicaid...... 6 Legislators Push Bill Tightening Nursing Home In California, 800,000 Medi-Cal Applicants Caught In Computer Regulations...... 10 System Mismatch...... 7 Minnesota Home To Replace Dormitories With Cottages...... 10 ACA Leads To Closing Of New Jersey Low-Cost Health Ryan Budget Would Make Changes To Medicaid...... 10 Insurance Program For Kids...... 7 Investigation Into Louisiana’s Canceled Medicaid Contract Fact Checker Examines Obama’s Claim ACA Opponents Have Slow...... 10 Spent “Billions.” ...... 7 MHCA Hosts Annual Golden Age Games...... 10 Blog Examines CBO’s Original ACA Enrollment Projection...... 7 Construction Begins To Replace Nursing Home...... 10 Author Offers Tips To “Get The Most” Out Of ACA Plans...... 7 New Media Venture Launches Feature Explaining ACA...... 7

151K) reported that several researchers believe they have AHCA/NCAL IN THE NEWS developed “a way to measure how tightly nursing homes supervise their doctors,” which could possibly improve results Research Team Develops New Nursing Home for nursing home residents. They defined the metric with three broad categories, including “credentialing, formal Care Quality Measure. Provider Magazine (4/5, Myers, attachment to a nursing home, and oversight of the doctors,” which they published in last month’s Journal of the American The New York Times (4/5, Pear, Subscription Medical Directors Association. According to AHCA head of Publication, 9.65M) reported the government’s numbers “are quality initiatives David Gifford, “We take these studies consistent with estimates by independent experts,” but they seriously. And if the evidence supports more emphasis on “do not include people who signed up last month, following a credentialing, then we will certainly look to fold that into our huge publicity campaign by President Obama and other best practices training.” officials.” (4/5, Sun, Millman, 4.22M) AFFORDABLE CARE ACT/HEALTH reported that state increases showed “a wide variation.” Arizona, for example, increased its enrollment by almost REFORM IMPLEMENTATION three percent, while Oregon posted an increase of almost 35%. Other big enrollment gains among states that expanded HHS: Nearly Three Million People Added To their programs were made in West , , and Medicaid Rolls Since ACA Launched. Over the Arkansas. Without expansion, “Florida had the biggest weekend through Monday, several major outlets carried news increase – 8.2 percent. Montana ranked second with a 6.9 that through the month of February, nearly three million percent increase, and Idaho was third with a 6.6 percent people enrolled in Medicaid or the Children’s Health jump.” Insurance Program (CHIP). As USA Today (4/7, O'Donnell, The Miami Herald (4/5, Chang, 822K) reported the 5.82M) explains, this increase was “probably spurred by the Florida’s enrollment was up by 245,000 people, “despite the Affordable Care Act deadline of March 31 and improvements Florida Legislature’s refusal to expand Medicaid.” in state and federal insurance exchanges.” According to the Among states that expanded their programs, Politico article, HHS Secretary Kathleen Sebelius “used the numbers (4/4, Haberkorn, 73K) reported that West Virginia had a to tout the benefits of expanding Medicaid” under the 33.5% gain, Vermont had a 32.3% gain, while Colorado was Affordable Care Act, writing in a blog post, “There’s no up 22.8%. Kaiser Family Foundation Medicaid expert Diane deadline for states to expand, so we’re going to keep working Rowland said of the gains, “Medicaid enrollment is going in with the remaining states as they decide to come on board. the right direction, and state people are signing up and Not only is expanding Medicaid coverage helping many enrolled. ... This isn’t over because it is a whole year’s people gain health coverage, it’s a good deal for states.” experience.” The AP (4/5, Werner) noted that the Medicaid total The Wall Street Journal (4/5, Dooren, Subscription combined with the more than seven million people who used Publication, 5.51M) noted that Sebelius said Friday in a blog healthcare exchanges to find private insurance “allows post that she expects higher numbers after March enrollment Administration officials to boast that the nation’s new health figures come in. care program has already covered 10 million uninsured Addition coverage was offered by the Washington Americans even in the face of unflagging Republican Times (4/4, Howell, 455K), the National Journal (4/4, Novack, opposition.” In the blog post Friday, Sebelius added that there Subscription Publication, 561K), Forbes (4/4, 6.28M), the was “more work...left to do” on Medicaid, which does not Kaiser Health News (4/4, Galewitz, 2K) “Capsules” blog, NBC have a sign-up deadline. The AP notes that “the News (4/4, Fox, 7.5M), CNN (4/4, Luhby, 77.95M), CNBC Congressional Budget Office has estimated that 8 million (4/4, Mangan, 31.28M), and Modern Healthcare (4/4, Demko, Americans will sign up for Medicaid” by year’s end. Subscription Publication, 224K). Bloomberg News (4/5, Chen, 2.76M) reported that HHS In state-specific coverage, the AP (4/4, Chereb) said about 19% of the population, or 61 million people, were reported that in Nevada, the program grew “nearly 118,000 enrolled in Medicaid through February, with a monthly from a year ago,” and the Tacoma (WA) News Tribune (4/6, enrollment increase of 5.2% from pre-ACA averages. In the Shannon, 338K) reports from Washington state. 26 states that expanded their programs, enrollment was up Sebelius Due To Testify On 2015 Budget For by 8.3%, “compared with 1.6 percent in states that didn’t.” Sebelius said the Administration would “keep working with the Senate Committee. The Hill (4/4, Cox, 237K) reported remaining states as they decide to come on board.” in its “Floor Action” blog that HHS Secretary Kathleen Reuters (4/5, Morgan) reported the Administration said Sebelius is scheduled to testify Thursday before the Senate the number of people who qualified for both Medicaid and the Finance Committee on President Obama’s budget proposal Children’s Health Insurance Program since October and for 2015, although “Republicans senators are likely to grill her through February was 11.7 million, with total enrollment up in about ObamaCare.” The post notes that Republicans that period in 46 states to 61 million from 58 million. Some continue to press for a repeal, “even though the President states didn’t report data. 2 announced this week that his goal of signing up 7 million Several Insurers Allowing Health Plan Sign Ups people was exceeded Monday.” Through April. Bloomberg News (4/7, Chen, 2.76M) reports that insurers in “at least 14 states,” including Health Net Inc., For Americans Who Have Not Signed Up For “will let consumers who missed open enrollment sign up for Insurance, Next Chance Likely This Fall. The AP health plans in April.” The article says this move “may help (4/5, Cass) reported that “Americans thinking about buying attract younger customers.” health insurance on their own later this year, or maybe switching to a different insurer, are probably out of luck.” With House Republicans Quietly Sought Expansion only a few exceptions, insurance companies have largely OF ACA Coverage Choices. The AP (4/7, Espo) stopped selling individual plans. The AP says the Affordable reports that House Republicans, at the urging of business Care Act “allows insurers to keep selling all year,” yet “it also organizations, have “quietly secured a recent change in creates the conditions prompting them to stop.” That includes President Barack Obama’s health law to expand coverage limiting the number of people enrolling only after they become choices.” The article calls this “a striking, one-of-a-kind sick, which Kaiser Permanente noted would “would make departure from dozens of high-decibel attempts to repeal or insurance unaffordable for everyone.” Enrollment for 2015 dismember” the ACA. While Democrats “describe the change won’t begin until November. The AP calls the sudden dearth involving small-business coverage options as a of available plans “a little-noticed consequence” of the ACA. straightforward improvement of the type they are eager to ACA Faces “Big Challenges” Ahead Of Next Open make, and Obama signed it into law,” Republicans “are loath Enrollment Period. In an analysis piece, the AP (4/5, to agree, given the strong sentiment among the rank and file Alonso-Zaldivar) discusses the “big challenges” the that the only fix the law deserves is a burial.” The AP noted Affordable Care Act faces ahead of the “next enrollment that several lobbyists and GOP aides “said the provision season, which starts Nov. 15.” Most important, according to reflects a calculation that no matter how hard the party tries, the piece, are “keeping premiums and other consumer costs the earliest the law can be repealed is after Obama leaves in check,” and “overhauling an enrollment process that was office in 2017,” and in the meantime, “small-business owners advertised as customer-friendly but turned out to be an need all the flexibility that can get to comply with it.” ordeal.” In a nearly-1,500 word analysis piece for Politico (4/7, Strategists Say Senate Democrats Need To 73K), Edward-Isaac Dovere describes the “challenge” facing Shift From ACA To Economy In Election. CBS President Obama now that he has “clocked a huge win by News (4/5, Alemany, 5.21M) reported on its website with hitting his target 7 million Obamacare enrollment.” Noting that embedded video on what some campaign strategists are Obama has “a history of watching his victories slip away advising Senate Democrats to do on the campaign trail with before fully capitalizing on them,” Dovere cautions him: “Don’t the Affordable Care Act and how some of those Democrats blow it.” are handling their campaigns so far. Some strategists and Scott Horsley made a similar assessment of the pollsters say the ACA “could be the deciding issue of the “political trial” Obama “still faces” despite hitting the seven midterms if Democrats allow it to be,” yet “perhaps more million milestone on NPR’s (4/5, Horsley, 519K) “Weekend importantly...red state Democrats must succeed in shifting the Edition” on Saturday. focus from health care to the economy and jobs.” The report also examines how some Democrats, such as Kentucky’s Facing ACA Deadline, More Young People Alison Lundergan Grimes and others, “have been publicly Signed Up In March. The Washington Post (4/4, distancing themselves from Mr. Obama on the campaign Millman, 4.22M) “Wonkblog” reported that more young people trail,” while candidate such as Sen. of did indeed sign up for health insurance at higher rates in Louisiana have “defended Obamacare.” March as the deadline mandated by the Affordable Care Act Modern Healthcare (4/4, Hollander, Subscription approached, based on data from five states and the District of Publication, 224K) carries a similar assessment, under the Columbia. Data for 36 states is yet to come from HHS, while headline “Vulnerable Dems Wary Of Trumpeting ACA On “nine other state-based exchanges also haven’t yet provided Campaign Trail.” an age breakdown for March enrollment.” The numbers also However, The Hill (4/6, Balluck, 237K) reports in its don’t include “young adults who enrolled in coverage outside “Ballot Box” blog that White House senior adviser Dan Pfeiffer the exchanges.” The post notes that the online broker on CBS’ Face The Nation “rejected the suggestion that eHealthInsurance “recently reported that 45 percent of its Republicans will take control of the Senate in the midterm shoppers since Jan. 1 are between 18 and 34 years old.” elections, saying that the GOP argument to repeal ObamaCare is a ‘political loser.’” Pfeiffer said, “I’d say we

3 believe we’re going to keep the Senate,” and later added, “I Mississippi Senate Hopeful McDaniel Vows To do think that the Republican argument for repeal is a political “Kill” ACA If Elected. The Hill (4/5, Devaney, 237K) loser. What they’re arguing now is that the seven million reported that Mississippi state Sen. Chris McDaniel, “the Tea people who signed up through the exchanges and the Party candidate who is challenging Sen. Thad Cochran” for millions more who got it from Medicaid and other ways, the Republican nomination, “promised to ‘kill’ ObamaCare if they’re going to take health care away from all of those he gets elected in November.” At a conservative event people.” Saturday, he said, “We are not going to stand with an eye Obama To Speak On Economy Twice This Week. toward trying to place a Band-Aid on ObamaCare. We’re not The Hill (4/7, Shabad, 237K) “Blog Briefing Room” reports going to fix it. We’re going to kill it.” that in an attempt to “pivot the political discussion away from” the Affordable Care Act, President Obama “will host two State Exchanges Consider Fixes. Last Thursday’s events on the economy this week.” Congressional hearing into continuing problems with six state-run health insurance exchanges continued to play Pelosi Dismisses Gibbs Claim That ACA’s prominently into the news over the weekend as officials from Employer Mandate Will Be Scrapped. The the respective states publicly considered how best to fix their Washington Post (4/7, Blake, 4.22M) reports in its “Post deficiencies. Additionally, other state exchanges have been Politics” blog, which also appears in today’s print edition of working to complete extensions to open enrollment and the paper, that House Minority Leader Pelosi (D-CA) on address other issues. Sunday suggested “that former top Obama aide Robert In Minnesota, the Minneapolis Star Tribune (4/6, Gibbs’s comment that the employer mandate portion of the Meitrodt, 1.48M) reports that its examination of reports, Affordable Care Act won’t survive might be related to Gibbs’s audits, and government emails shows that state leaders had business interests.” Appearing on CNN’s State Of The Union “many” warnings that the debut of their $100 million MNsure (4/6, Crowley) on Sunday, she said, “I don’t know who his health insurance exchange would falter, and it did, with clients are or what his perspective is. But we are celebrating “frequent website crashes and ongoing errors that have the fact that we have over seven million who have signed up.” angered thousands of would-be enrollees.” The Star Tribune The Politico (4/6, Glueck, 73K) “Politico Live” blog says that Gov. Mark Dayton was told 12 days before the reports that Pelosi explained the mandate saying the “various launch that no one could say whether the website “would provisions of the law...are ‘all integral,’” adding, “This is an actually work,” and that a third of its 270 known bugs “were initiative that has strong pillars in it that relate to each other.” so severe that no stopgap fixes were possible.” The Star As the Daily Caller (4/6, Bordelon, 408K) puts it, Pelosi Tribune also reports that state officials “did not know that “denied there was any chance of the Obamacare employer online enrollment could be postponed” beyond Oct. 1 “without mandate being scrapped.” Additional coverage is offered by penalty, an option federal officials disclosed in response to the New York Daily News (4/7, Edelman, 4.36M) and The Hill Star Tribune inquiries.” CMS said the state could have met its (4/7, Goad, 237K) “Regwatch” blog. obligation “through paper applications.” The Minneapolis Star Tribune (4/4, Crosby, 1.48M) and the Minneapolis-St. Paul Paul Ryan Confident ACA Can Still Be (MN) Business Journal (4/4, Reilly, Subscription Publication, Repealed. The Washington Post (4/4, Blake, 4.22M) 56K) also reported on the exchange. reported in its “Post Politics” blog that House Budget The Hawaii Reporter (4/7, Zimmerman, 8K) reports that Committee Chairman Paul Ryan (R-WI) said in an interview Tom Matsuda, interim director of Hawaii Health Connector, taped for Bloomberg News’ “Political Capital With Al Hunt” spoke to Congress about the exchange’s low enrollment and that “it would be too costly for Republicans to reinstate some high cost-per-enrollee. The exchange has spend most of its of the more popular provisions of Obamacare if and when the $204 million budget and enrolled only 7,242 individuals. law is repealed, but that Republicans should look for Projections when the exchange launched estimated tens-or- alternatives.” He said that included “the most popular parts of hundreds of thousands of enrollments by this point. The Obamacare,” such as “requiring coverage for pre-existing Honolulu Star-Advertiser (4/7, Consillio, 402K) quotes from conditions” and “keeping kids on their parents’ insurance until Matsuda’s testimony: “The Connector’s total enrollment, to they are 26 years old.” date, is low especially as compared to other state-based In an 1,100-word story based on the interview, marketplaces.” Another Honolulu Star-Advertiser (4/7, Bloomberg News (4/4, Wallbank, 2.76M) says Ryan is DePledge, 402K) article reports on Matsuda’s appearance confident the ACA could still be repealed despite the law before the panel and KHON-TV Honolulu (4/6, Matthews, hitting seven million enrollees last week. In fact, he said, “I 30K) reports on the exchange’s small business enrollment. don’t think it can last.” In Oregon, the AP (4/4) reported on a new study into the state’s exchange that says switching “to the federally run 4 marketplace would be the least expensive fix for the glitch- comments exceeding 4,000, an analysis found only 15 that filled system.” The analysis, conducted by Deloitte were positive. The rest ranged from the blunt “It Development LLC, found a switch to healthcare.gov would Sucks!!!!!!!!!!!!!!!!!!!!!!!!!!” to the more informative “This is the require between $4 million and $6 million and take five to 4th day I have tried to access this site and apply ... still have eight months, whereas “fixing the existing website would cost not even been able to create an account.” $25.5 million to $57 million in development and maintenance In Idaho, the AP (4/7) reports that state residents who costs just this year – not counting 2015 costs.” The were unable to sign up for health insurance before the March Oregonian (4/4, Budnick, 992K) described the report as part 31 deadline will now have until April 15 to complete their of “a highly secretive effort by exchange officials and Gov. applications. The Idaho Statesman (4/4, 222K) also reported John Kitzhaber to decide how to proceed with the exchange, on the shifted deadline. which remains the only one in the country that does not allow In Rhode Island, the Providence (RI) Business News consumers to self-enroll in a single sitting.” Another AP (4/5, (4/7, Anderson, 42K) reports that, despite solid enrollment in Cooper) story reported that the problems with the state’s the individual market, the state’s exchange has failed to exchange have opened up partisan lines of attack on the attract a large number of businesses, enrolling only 175 Governor’s Administration. Other outlets reporting on the during the inaugural open enrollment period. Another article state’s exchange are the Salem (OR) Statesman Journal in the Providence (RI) Business News (4/7, Daddona, 42K) (4/4, Yoo, 104K), the Bend (OR) Bulletin (4/4, Clevenger, also discusses the exchange. Similarly, reporting from the 94K), and The Oregonian (4/7, Brettman, 992K). Centennial State, the Northern Colorado Business Report In Vermont, the Barre Montpelier (VT) Times Argus (4/4, Armbrister) reported that “the state’s focus is turning to (4/4, Goswami, 20K) reported that state officials signed a another tough issue: How to lure reluctant small businesses contract with lead exchange contractor CGI to establish a to the new health insurance program.” timeline for repairs. CGI must provide “change of In Connecticut, the New Haven (CT) Register (4/4, circumstance” functions by May 21 and a working small Stuart, 215K) reported that House Minority Leader Lawrence business exchange by July 2 or else face penalties in addition Cafero (R) complained about the state’s exchange, saying to the $5 million already claimed by the state. VTDigger (4/6, “Behind all the hype surrounding the last minute surge in True, 1K) also reported on the exchange. enrollments are the facts. Connecticut fell short of its stated In California, the Los Angeles Times (4/4, Karlamangla, goals.” 3.46M) reported on the high pace of signups during the final The Las Vegas Review-Journal (4/5, Robison, 437K) week of open enrollment. In spite of official explanations of offered a 2,700-word feature on how the Affordable Care Act “high demand,” the Times focuses on the importance of the is faring in Nevada, offering an overview of the “winners and Affordable Care Act’s individual mandate penalties in losers” so far. motivating people to become insured. The Fresno (CA) Bee Opinion Pieces Discuss State Exchanges. (4/4, Ibarra, 352K) reported that insurance application Columnist David Sarasohn writes in The Oregonian (4/6, counselors are facing pressure to complete the applications 992K) that Maryland’s decision to scrap its health insurance of people who were unable to meet the March 31 deadline. exchange website and adopt the technology used in Covered California has given such consumers until April 15 to Connecticut’s exchange shows that Oregon is “not the only complete their applications. Other outlets reporting on state that has technical problems, and there are alternatives Covered California include the Santa Cruz (CA) Sentinel (4/7, to trying to make our disastrous website work. Even the Gumz, 151K), another Santa Cruz (CA) Sentinel (4/5, Gumz, ancient Greeks realized that there’s a point where you give 151K) article, and the Marin (CA) Independent Journal (4/5, up on the Oracle.” In Oregon, meanwhile, a “high-level Seipel, 88K). technical solutions committee, including the chief information In Maryland, the Baltimore Sun (4/7, Cohn, Walker, officers of the state’s major health providers, promises a new Cox, 925K) reports that, as the exchange replaces its current direction as soon as this week.” Cover Oregon remains “the technological platform, “lawmakers and information only state where applicants for health insurance under the technology experts are raising new concerns about whether Affordable Care Act can’t complete the process on line.” there is enough oversight to prevent a second failure.” An editorial in the Frederick (MD) News-Post (4/7, WTOP-FM Washington (4/5, Murillo, 172K) reported that the 102K) assailed the “incompetence of state government Maryland Health Benefit Exchange managed to enroll more leaders” for their involvement in the deeply flawed Maryland people than expected, despite a “broken” website. The exchange. Frederick (MD) News-Post (4/4, Borda, 102K) reported on Columnist Rob Otos, in the St. Paul (MN) Pioneer continuing problems with the exchange. The Baltimore Sun Press (4/5, 656K), argued that Minnesota’s health insurance (4/7, Campbell, 925K) reports on comments left by user’s of exchange should be funded through user fees. the “glitch-riddled exchange.” Out of a total number of 5 Medicaid Expansion Debates Remain Largely In Mississippi, the AP (4/7, Mitchell) reports that small Unchanged. Although several state legislatures are hospitals are facing a “financial crisis” that has been considering proposals for Medicaid expansion under the exacerbated by the state’s decision not to participate in auspices of the Affordable Care Act, there is little change Medicaid expansion. from last week, with proponents and opponents equally Commentary Supports Expansion. Several local entrenched. newspapers ran opinion pieces supporting expansion over The Hill (4/4, Viebeck, 237K) reported in its the weekend. “Healthwatch” blog that the Obama Administration pointed to Scott Stroud, in a Tennessean (4/5, 414K) op-ed, recent enrollment numbers to encourage more states to pass criticized Tennessee Gov. Bill Haslam for failing to produce a legislation expanding Medicaid eligibility in accordance with clear Medicaid expansion plan. Stroud noted, “health care for the Affordable Care Act. the poor isn’t a big winner politically, but it might be the right The Pittsburgh Post-Gazette (4/6, Toland, Giammarise, thing to do.” 677K) reports that some advocates describe Medicaid as “a Jonathan P. Baird, an administrative law judge, predicts better fit for low-income households than private insurance.” that more and more states will participate in Medicaid One reason for the assertion is the former program’s expansion as the benefits become more widely known in his coverage of medical rides. Some states are seeking to Concord (NH) Monitor (4/7, 38K) column. participate in Medicaid expansion through private insurance, RyLee Curtis, writing in the Deseret (UT) News (4/7, but some people have pointed out there are fundamental 610K), calls on Utah’s lawmakers to support expansion, differences between Medicaid and alternatives. concluding “the 57,000 Utahns who are affected by Utah’s In Virginia, the Washington Times (4/7, Sherfinski, slow progress can’t wait any longer.” 455K) reports that the debate over Medicaid expansion in the Colleen M. Grogan, a professor in the School of Social state has reached an “impasse,” even as it holds up the Service Administration at the University of Chicago, writes in commonwealth’s budget. The Newport News (VA) Daily an op-ed published in the Milwaukee Journal Sentinel (4/6, Press (4/7, 206K) reports that the Virginia General Assembly 893K) that “powerful factors are pushing even Republican-led will meet again today in an effort to break the gridlock. The states toward expansion” of Medicaid, adding that “in Hampton Roads (VA) Virginian-Pilot (4/7, Walker, 422K) also Southern states where non-expansion leaves up to two-thirds reports on the debate in Virginia. of the poor without coverage, majority public support is The Newark (NJ) Star-Ledger (4/4, O'Brien, 694K) especially strong – including in Virginia, North Carolina, South reported that New Jersey’s expanded Medicaid program has Carolina, Georgia, Alabama, Mississippi, Louisiana and a serious backlog following a high rate of enrollment: “new Florida.” Moreover, “in all but 11 sparsely populated states in applications during January and February alone totaled just the Inner West, more than 45% of the public supports over 30,000, however, only 4,878 of those – or just one out of Medicaid expansion.” She adds, “Social injustices aside, every six – made it all the way through the process.” these states will face fiscal strains and lose jobs and profits.” In Missouri, the Kansas City (MO) Star (4/4, Hancock, Grogan and a colleague estimated the state-level support 1.48M) reported that the issue of Medicaid expansion has from national surveys done by the Kaiser Family Foundation. split members of the state GOP. The AP (4/7, Lieb) reports Kentucky Jail Signs Up Exiting Inmates Under that, despite the politically contentious expansion proposal, USA Today (4/7, there is bipartisan support for what the AP terms a “mini ACA’s Expanded Medicaid. Medicaid expansion” that “would double the amount of assets Kenning, 5.82M) runs a Louisville Courier-Journal story, people could have without being disqualified for Medicaid reporting that the Louisville Metro Department of Corrections coverage.” “last week began holding daily sign-ups for exiting inmates” In Kansas, the Wichita (KS) Eagle (4/7, Lowry, 313K) who qualify “for the newly expanded Medicaid under the reports that the state legislature approved a bill that would Affordable Care Act.” The effort is “part of a growing push “indefinitely halt the expansion of Medicaid in Kansas.” The nationwide by prisons and jails trying to take advantage of state’s Governor “has repeatedly said that he has not made a expanded health care to curb rapidly rising medical costs in a final decision about expansion.” The Kansas Health Institute setting where many are poor, unhealthy and uninsured.” (4/4) also reported on Medicaid in the state. However, the idea “doesn’t sit well with some Affordable Care In Alaska, the Fairbanks (AK) News-Miner (4/5, Buxton, Act critics.” Senate Minority Leader McConnell said that 44K) reported over controversy after a Republican canceled a “signing up those leaving jail or prison will add burdens to an hearing to consider a Democratic proposal to expand the already strained Medicaid program that is hard pressed to state’s Medicaid program. Gov. Sean Parnell (R) has said he find enough doctors willing to accept Medicaid patients.” will veto any such bill. 6 Other States Using Expanded Medicaid Programs some slack here” because “opponents of the law have spent To Cover Prison Inmates. Fox News (4/4, Chakraborty, significantly more than proponents to discredit the Affordable 74.23M) reported on its website that prison inmates are Care Act.” Still, it concluded, “next time, Mr. President, stick to benefiting from the Affordable Care Act as “cash-strapped ‘half a billion’ rather than billions.” state and local prisons” use the law “to pay for their inmates’ medical costs, taking advantage of a little-known provision Blog Examines CBO’s Original ACA Enrollment that lets them shift some of those expenses to the federal Projection. The Washington Post (4/7, Kessler, 4.22M) government” through expanded Medicaid programs. Fox “Fact Checker” blog offers a “technical note” on the CBO’s News reports that “it doesn’t stop there. The states also are estimate that “7 million people would be enrolled in the working to enroll them even before they’re released from exchanges” this year. Notably, the blog points out that prison, so they have coverage when they get out.” The report according to the CBO analysis, “each of those 3 million or so says the Illinois, Indiana, and Ohio “are among the states people who signed up for coverage in the past few weeks trying to offload the rising costs of health care – which include would really only count as two-thirds a person.” mental health programs.” Advocates “say this reduces Over the weekend, two cable news programs – FOX recidivism,” while opponents “argue that federal taxpayer News’ Huckabee (4/6) and FOX News’ Fox Report (4/6, dollars shouldn’t be used to foot the multibillion dollar bill.” 1.66M) – offered continuing coverage of the ACA’s enrollment figures so far. In California, 800,000 Medi-Cal Applicants Caught In Computer System Mismatch. The Los Author Offers Tips To “Get The Most” Out Of Angeles Times (4/6, Brown, 3.46M) reports that about ACA Plans. Author Lisa Zamosky offers tips for ACA 800,000 Medi-Cal applicants in California have waited consumers to “get the most out of” their new health insurance months to be approved for healthcare coverage after their plans in a piece for the Los Angeles Times (4/7, 3.46M). Most applications got caught between “a new state computer importantly, she cautions, “Know what your policy covers and system that for months didn’t communicate properly with what it doesn’t.” county computers” about eligibility. As a result, “some patients are putting off trips to the doctor and drugstore – or New Media Venture Launches Feature paying full price for care they can’t delay.” Los Angeles Explaining ACA. Vox.com, a new website designed to County can now link its public social services computers to help readers “understand the news,” officially launched the state’s system, “but workers still face a daunting backlog Sunday night. Spearheaded by former Washington Post of applications – and new software glitches have exacerbated blogger Ezra Klein, Vox features an extensive “Obamacare” the problem.” The state’s Department of Health Care section, with 26 “cards” answering frequently asked Services acknowledged that the additional 1.9 million added questions. Healthcare journalist Sarah Kliff, also formerly of to Medi-Cal and “new computer systems” have hurt its ability the Washington Post, “curated” the Q&A, answering inquires “to complete eligibility reviews in a timely and accurate ranging from the simple, like “What is Obamacare? “ to the manner.” more complex, like, “What happens to poor people in non- Medicaid expansion states?” ACA Leads To Closing Of New Jersey Low- Cost Health Insurance Program For Kids. The Commentary Considers ACA. Over the weekend Newark (NJ) Star-Ledger (4/7, Livio, 694K) reports that the through Monday, several outlets carried opinion pieces Affordable Care Act has “effectively killed FamilyCare weighing in on the Affordable Care Act. Advantage, a low-cost option for kids in New Jersey created Mark Zandi, chief economist of Moody’s Analytics, in an six years ago for parents who earned too much to qualify for op-ed for the Philadelphia Inquirer (4/7, 1.64M) offers several Medicaid and other subsidized programs but too little to buy ways the Affordable Care Act is working well. Chief among on a policy on their own.” these, he argues, is its apparent role in “cutting health costs.” Discussing the importance of keeping health spending in Fact Checker Examines Obama’s Claim ACA check. he concludes, “Obamacare probably won’t get us all Opponents Have Spent “Billions.” The the way there, but when all is said and done it stands a good Washington Post (4/4, Kessler, 4.22M) “Fact Checker” blog chance of getting us a lot closer.” looked into President Obama’s claim, made from the Rose Marc Caputo, in a column for the Miami Herald (4/7, Garden last week, that critics spent “billions of dollars” on 822K), offers several “reasons to be skeptical” about the 7.1 anti-Affordable Care Act commercials. Acknowledging that his million enrollment figure the White House touted last week, numbers are a bit “inflated,” the blog “cut[s] the president pointing out that “like insurance, politics is a numbers game.”

7 Paul Waldman, in a piece for the Washington Post (4/7, repeal and the loss of benefits” and to explain their “mend it, 4.22M) “Plum Line” blog, criticizes the GOP’s latest “scheme don’t end it” catchphrase before the election. Balz added that to manufacture Obamacare ‘horror stories,” this one featuring Democrats’ ability to do that “will determine whether the “the worker whose hours are being cut back so their boss politics of health care will shift by Election Day in November” won’t have to comply with the ACA’s employer mandate.” and perhaps lift “a political weight on vulnerable incumbents The Post (4/6, 940K) said in an editorial that the this year.” Affordable Care Act made it through its first enrollment Additional commentary was carried by Forbes (4/5, milestone, which is good news for the law and for the country, 6.28M), another piece in Forbes (4/4, 6.28M) , the Boulder but it cautions that there are many challenges ahead. Some (CO) Daily Camera (4/4, 112K), the Daily Caller (4/7, 408K), of those include whether people will pay for their premiums, FOX News (4/3, 74.23M), another post for FOX News (4/4, how many of them will prove to have been uninsured, and 74.23M), the Wausau (WI) Daily Herald (4/6, 71K), the Clark whether costs will smooth with enough young and healthy County (WA) Columbian (4/6, 95K), the Fort Wayne (IN) people signing on. The editorial argues that healthcare reform Journal-Gazette (4/6, 172K), the Denver Post (4/7, 940K), is a long process that will require Americans to be both and the Miami Herald (4/7, 822K). patient and persistent to slow the medical cost trajectory while opening access to all. Louisiana Scholar Says Jindal Pitching Old Ross Douthat wrote in his New York Times (4/6, GOP Healthcare Junker. Robert Mann, an author and Subscription Publication, 9.65M) column that the healthcare former US Senate and gubernatorial staff member and a debate in the US is anything but finished, even though professor at the Manship School of Mass Communication at “Republican predictions of a swift Obamacare unraveling look Louisiana State University, writes in an op-ed for the New a bit like Republican predictions of a Romney landslide.” Orleans Times-Picayune (4/5, 678K) under the title, “Bobby Instead, Douthat predicts that “for years, decades, a Jindal’s Healthcare Jalopy.” Mann says he had predicted “lots generation,” the US will be in “a grinding, exhausting of innovation and policy experimentation” soon after Gov. argument over how to pay for health care in a society that’s Jindal took office in 2007, but he “couldn’t have been more growing older, consuming more care, and (especially if wrong.” Instead, “after more than six years as governor,” current secularizing trends persist) becoming more and more Jindal “has no major innovative idea to his name” and has invested in postponing death.” He also argues that “in the even delegated policy development to a Virginia think tank for near term, this debate will go on because Obamacare has a possible presidential run. What he’s pitching for healthcare stabilized itself without fully resolving any of its internal is “just a high-mileage contraption cobbled together with used problems,” which Douthat thinks will lead to “endless parts that Republicans have been selling for years.” Mann arguments” in 2020 “about a reform of the reform of the adds that “Jindal’s plan is really about caring for the health of reform.” his presidential ambitions.” Columnist Doyle McManus wrote in the Los Angeles Times (4/6, 3.46M) that the number of newly insured Scholar Says Vermont’s Healthcare, Americans represents “a significant political victory for Progressive Party Are Instructive For Nation. Democrats,” making Republicans’ promise of repealing the Molly Worthen, an author and assistant professor of history at Affordable Care Act “highly unlikely.” That, however, “doesn’t the University of North Carolina Chapel Hill wrote in an op-ed mean Obamacare is guaranteed to succeed,” and McManus for the New York Times (4/6, Subscription Publication, 9.65M) says talk must turn now to “how to improve it.” He finds a that Vermont “is now on the way to single-payer health care, Democratic proposal for a so-called catastrophic “copper” and a third party deserves much of the credit.” She explains policy interesting and explores that in depth as a way to lower Green Mountain Care and how the Vermont Progressive up-front premium costs, expand available choices, and Party “spent years building support for reform and nudging possibly “drive down costs overall, by increasing the number the Democrats left.” She notes that that the Progressives in of willing consumers and competition.” In contrast, Vermont face a unique environment, yet “their example offers Republicans haven’t provided “a fully fleshed-out hope that the most frustrating dimensions of our political replacement” for the ACA, “and that’s a prescription for culture can change, despite obstacles with deep roots in irrelevance.” American history.” Dan Balz wrote in the Washington Post (4/6, 4.22M) column that Republican hopes for dismantling the Affordable EDICARE EWS Care Act are “increasingly difficult” and they know that, M N although it will be tempting to feast on it for midterms House Democrats Urge HHS To Rethink ACA’s elections. Balz argued that Democrats as a result bear a heavier burden to both “feel just as strongly about the risks of Cuts To Medicare Advantage. The Wall Street 8 Journal (4/7, Peterson, Mathews, Subscription Publication, With Ryan Shift On Medicare In Budget, Democrats 5.51M) reports that some Democrats in Congress object to Change Attack Messaging. The Hill (4/5, Wasson, 237K) upcoming cuts to Medicare Advantage called for in the reported in its “On The Money” blog that Congressional Affordable Care Act, warning they could put upward pressure Democrats have had to rethink their attack messaging on already rising health insurance premiums. The Journal against Ryan’s budget because he changed the plan and notes that 22 House Democrats signed a letter to HHS blunted an attack they had used before. Democrats have Secretary Kathleen Sebelius opposing the planned cuts. argued for three years that the Ryan plan “ends the Medicare Republican Rep. Greg Walden of Oregon criticized the move, guarantee, shifting rising costs onto seniors,” but Ryan writing, “Democrats are acting like bank robbers who want to changed up the plan to allow Republicans to say they are give the money back after getting caught.” According to “lowering costs for seniors while preserving traditional Walden, Democrats “gutted Medicare to pay for Obamacare.” Medicare.” The Hill (4/7, Easley, 237K) “Healthwatch” blog calls the battle over the ACA’s Medicare Advantage cuts Obama’s Advocates Tell CMS Not To Expand “new healthcare dilemma.” Competitive Bidding Program. Modern Healthcare Insurers Warn Seniors Over Looming Medicare (4/4, Dickson, Subscription Publication, 224K) reported on Advantage Cuts. The Minneapolis Star Tribune (4/7, advocacy by “devicemakers and lawmakers” to convince “the Spencer, 1.48M) details “a multimillion-dollar lobbying CMS to not move forward with plans to expand Medicare’s strategy designed to curtail proposed cuts to Medicare competitive bidding program for durable medical equipment.” Advantage, the private health plans sold as alternatives to CMS estimates its current competitive bidding program “has traditional Medicare.” The Star Tribune says insurers saved Medicare $400 million the first two years of operation “characterize their lobbying blitz as a wake-up call to 16 and projects it will save another $17.2 billion for beneficiaries million elderly Americans who could lose easy access to care, and $25.8 billion for the Medicare program over the next 10 be forced to change doctors or face higher premiums” years.” because the ACA “requires government reimbursements to Medicare Advantage to come more in line with traditional AMGA Representatives Say Push For Medicare payments.” On the Other hand, the Star Tribune Permanent Fix To SGR Will Continue. Modern notes that the Kaiser Family Foundation says, “for now, grim Healthcare (4/7, Robeznieks, Subscription Publication, 224K) predictions ‘are not panning out,’” and, “despite last year’s reports that “representatives of the nation’s largest physician cuts, Medicare Advantage enrollment is still growing rapidly; group practices are saying a permanent fix to Medicare’s oft- health insurance companies are not abandoning the market postponed caps on physician pay isn’t dead yet—even if it’s in significant numbers, and premiums have risen” only barely breathing at this point.” According to Modern “slightly.” Healthcare “Lobbyists for the American Medical Group The Miami Herald (4/7, Hancock, 822K) carried a Association...predicted Congress will spend the next year Kaiser Health News report on how the Medicare Advantage looking for ways to cover the more than $130 billion cost of would affect consumers, noting that supporters “say the move repealing the Medicare sustainable growth-rate formula.” At will end what they call an industry windfall and pressure the AMGA annual meeting, AMGA Vice President for Public insurers, hospitals and doctors to deliver care more Policy Chet Speed said, “Our thinking is nothing will happen efficiently.” on SGR relief until March 31 (2015) at the earliest.” Obama Criticizes Ryan Budget Plan In Weekly NDUSTRY EWS Address. The AP (4/6, Gentilviso) reported President I N Obama said in his weekly address that House Budget Report: More Nursing Homes Need Tornado Chairman Paul Ryan’s budget “would shrink opportunity and McKnight’s Long-Term Care make it tougher for hard-working Americans to get ahead.” Shelter Specifications. The President said Ryan’s plan “gives massive tax cuts to the News (4/5, Mullaney, 921) wrote a recently-released National rich while cutting programs like education and research that Institute of Standards and Technology (NIST) report indicates spur job growth.” CNN (4/5, 77.95M) reported on its website a tornado that destroyed a Missouri nursing home three years that the President said, “Our economy doesn’t grow best from ago highlights the long-term care industry’s need for specially the top down; it grows best from the middle out. That’s what designed shelter areas. It calls for all buildings to develop my opportunity agenda does, and it’s what I’ll keep fighting tornado shelter specifications for tornado shelters in all for.” The ABC News Radio (4/5) and Voice of America (4/5, tornado hazard zones. 21K) websites also reported on the President’s remarks.

9 Federal Suit Holds Nursing Home Responsible reported that Margaret Graves Hall has begun construction of For Hep C Outbreak. McKnight’s Long-Term Care cottages to replace its “aging residence hall.” Construction News (4/5, Mullaney, 921) reported a Federal lawsuit filed begins next week and “will provide homes for adults with Wednesday holds an HCR ManorCare nursing home developmental disabilities who now live in a dormitory-style responsible for a hepatitis C outbreak resulting from building on the neighborhood campus.” “negligent care.” The outbreak infected 44 total people and Ryan Budget Would Make Changes To the North Dakota Department of Health is carrying out a full Vox (4/7, Kliff) reports on Rep. Paul Ryan’s (R- investigation. The home called the suit “premature,” noting Medicaid. that the outbreak’s cause had not yet been determined. WI) budget proposal’s changes to the Medicaid system. Ryan’s budget would convert Medicaid into a block grant Report: Los Angeles County Health program, which would result in lower total funding for the Department Had No “Central Oversight.” Kaiser program over time compared to current budget projections. Health News (4/6, Gorman, 2K) reported an audit released Vox cites a recent study that found the Medicaid changes Friday notes a backlog of complaints in Los Angeles county “would mean between 14 and 20 million fewer people following “a lack of central oversight of nursing home receiving Medicaid by 2022.” investigations.” The Los Angeles County Auditor-Controller Investigation Into Louisiana’s Canceled found 3,044 open investigations, 945 of which had been open for over two years. The auditor found no central investigation Medicaid Contract Slow. The New Orleans Advocate management within the Health Facilities Inspections Division (4/7, Shuler) reports on the status of Client Network Services. and no established deadlines for completing cases. These The company’s lucrative contract with Louisiana to provide findings result from an investigation that the health support for Medicaid was canceled by Gov. Jindal’s department allegedly ordered inspectors to close cases Administration shortly after it was revealed that the company without completing their investigations. was the target of a grand jury investigation. However, in the intervening year, there have been neither signs of an Medicare Extends Policies To People In Same- advancing investigation nor efforts to replace the fired Sex Marriages. McKnight’s Long-Term Care News (4/5, contractor with another company. Mullaney, 921) reported that HHS announced Thursday that MHCA Hosts Annual Golden Age Games. seniors married to somebody of the same gender now qualify KQTV-TV St. Joseph, MO (4/5, Watkins, 1K) reported that on for premium-free Medicare Part A. Special enrollment period Friday the Missouri Health Care Association held its annual requests are also being processed for Parts A and B and Golden Age Games at Missouri Western State University. It many parties will be eligible for reduced late enrollment involved competitions among nursing home residents penalties. throughout the state’s northwestern region. Groundbreaking Ceremony Held For Future Construction Begins To Replace Texas Florida ALF. WTLV-TV Jacksonville, FL (4/5, Clark, 39K) Nursing Home. The AP (4/6) reported construction of a reported on its website that a groundbreaking ceremony was new West, TX, nursing home has begun following the held before the planned construction of a new Ponte Vedra, destruction of the previous home in “a deadly fertilizer plant FL, assisted living facility. It will be called the Palms at Ponte blast last year.” The Waco (TX) Tribune-Herald (4/6, 99K) Vedra. also reported on this story. California Legislators Push Bill Tightening Copyright 2014 by Bulletin News, LLC. Reproduction The Modesto (CA) Bee Nursing Home Regulations. without permission prohibited. Editorial content is drawn from (4/5, Carlson, 210K) reported several Democratic California thousands of newspapers, national magazines, national and legislators are proposing bills enhancing residential elder care local television programs, and radio broadcasts. The Office facility oversight. This week the state bills go to policy of the AHCA/NCAL Gazette is published five days a week by hearings in the Assembly and Senate. They call for annual BulletinNews, which creates custom news briefings for inspections and facilitate shutting down the worst facilities, government and corporate leaders. We can be found on the along with increasing fines, requiring staff training, and Web at BulletinNews.com, or called at (703) 483-6100. mandating online access to enforcement records. Minnesota Home To Replace Dormitories With Cottages. The Northfield (MN) News (4/6, Smith, 14K) 10