Advocates, Opponents Mark Third Anniversary Of ACA.

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Advocates, Opponents Mark Third Anniversary Of ACA. Thursday is the third anniversary of the passage of the Affordable Care Act, and several outlets carry reports marking this occasion. Many carry analyses and accounts of the law's implementation and implications, as well as opponents' continued attempts to repeal it.         For example, the National Journal  (3/21, Sanger-Katz, Subscription Publication) marks the third anniversary of the Affordable Care Act with a piece measuring the law's "attempt to broadly transform the health care system." According to the article, both "advocates and opponents have been seizing on the anniversary to offer their assessments of the law." For example, Monday, HHS "took credit for the more than 100 million Americans who have received at least one free preventive health service," and Secretary Kathleen Sebelius "started a Twitter stream (@acaturns3) where advocates can cheer." Still, "experts say it's much too early to know how well the Affordable Care Act is meeting its dual goals of expanding health insurance coverage and reducing the growth of health care prices are working in practice."         As ACA Turns Three, Opponents Still Hoping For Repeal. In an article marking the third anniversary of the Affordable Care Act's passage, the Washington Times  (3/21, Howell) reports that while Republicans "say they are still gathering support to dismantle it," there are "few signs they'll be successful." For example, "the Senate last week voted down the latest Republican repeal effort," leaving "congressional Republicans to try to poke smaller holes where they think they can gain the most Democratic support." Along these lines, the article notes that Republicans like Senators John Barrasso and Orrin Hatch have been offering "piecemeal legislation" to "strip away parts of the law."         For example, The Hill  (3/21, Viebeck) "Healthwatch" blog reports that Representatives Richard Hudson (R-NC) and Robert Pittenger (R-NC) have introduced a bill "to toss the requirement that businesses automatically enroll new workers in the company health plan," and the measure "is winning praise from industry." In a statement, the "lawmakers warned that the auto-enroll provision would bury employers of 200 workers or more in paperwork - a particular threat for industries that experience high employee turnover." US retailers, including the National Restaurant Association, "quickly backed the bill along with the restaurant industry, which said auto-enroll would lead to 'financial hardship' and 'confusion.'"         Poll Shows Public Has Poor Understanding Of ACA. Notably, several outlets report on a poll released Wednesday, which found that despite being around for three years, many Americans remain in the dark about many of the ACA's provisions. The Los Angeles Times  (3/20, Levey) reports that a new survey from the Kaiser Family Foundation found that three years after President Obama signed the Affordable Care Act, the law "remains largely a mystery to most Americans." Nearly "six in 10 Americans say they still don't have enough information to understand how the Affordable Care Act will affect them. Ignorance about the law is even higher among Americans who stand to benefit most, with more than two-thirds of people without health insurance reporting they don't have enough information."         The Hill  (3/21, Baker) "Healthwatch" blog reports that the poll "shows that the public still doesn't understand what's in the healthcare law - and what voters do know is mostly negative." Further, "The findings indicate that Republicans have done a far better job defining the healthcare law than Democrats: the more popular a provision is, the less likely people are to realize it's included in the ACA."         CQ  (3/21, Norman, Subscription Publication) reports that for example, "Few people are also taking note of their home states' decisions on whether or not to set up their own health insurance exchanges or expand their Medicaid programs to include low-income adults, the poll found. The one thing about the law most people do appear to understand is that they will be required to have health insurance," a provision which remains unpopular. According to the article, "the findings underline the challenges faced by the Department of Health and Human Services, the states and advocates as they ramp up efforts to enroll millions of uninsured people in private plans and Medicaid programs through health insurance exchanges beginning in October."         The NPR  (3/21, Rovner) "Shots" blog reports that the elements that remain popular "across party lines" include "things like providing tax credits to small businesses to help employees afford insurance, closing the Medicare prescription drug 'doughnut hole,' and creating health insurance marketplaces where individuals and small businesses can buy coverage." Still, "the law as a whole remains controversial, with only 37 percent saying they view it favorably. Forty percent view it unfavorably, and 23 percent declined to offer any opinion."         Notably, the Kaiser Health News  (3/21, Gold) "Capsules" blog notes that "two-thirds of uninsured adults - the very people the law sets out to help - say they still don't know what it means for them."

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Legislation and Policy ACA Implementation Brings "Scope-Of-Practice" Battles To Forefront. Politico  (3/21, Smith, Cheney) reports that as the Affordable Care Act nears full implementation, "State legislatures are wrestling with all kinds of 'scope-of-practice' issues - turf battles over who can provide what kind of health care, under whose supervision and for what kind of payment." These battles "are sharp and numerous, particularly regarding primary care." Due to the widely-acknowledged "primary care shortage," the main focus of these "scope of practice" bills is "the relationship between primary-care doctors and nurse practitioners." Small Business Owners Express Uncertainty About ACA. The Washington Post  (3/21, Harrison) reports, "Nearly three years after the health-care law was passed, federal regulators have only recently begun to define its terms," and, as a result, "the picture remains anything but clear for small-business owners." According to the Post, "many employers have seen their premiums rise or plans disappear as insurers prepare for the coming changes. One in eight small-business owners who responded to a survey by the" NFIB "said their health insurance providers had notified them that their plans would be terminated," while "a study released last week by Adecco, a human resources consulting firm, showed that nearly a third of employers said they stopped hiring or cut their workforce because of the law." The Post story includes comments from a number of small business owners who express uncertainty about the law Minnesota Governor Signs State-Based Exchange Into Law. The AP  (3/21) reports that on Wednesday, Minnesota Governor Mark Dayton signed the state's health insurance exchange into law, ensuring that "Minnesotans will be able to buy health insurance online through a state-based marketplace called MNsure, starting in 2014." According to the article, "House lawmakers passed the legislation last week, with all but one Democrat supporting it and Republicans opposed. The Senate passed the bill Monday on a straight party-line vote."         The St. Paul Pioneer-Press  (3/21, Snowbeck) reports that supporters call the law "the state's most sweeping coverage reform in 50 years." As the piece explains, "About 1.3 million state residents are expected to use the online marketplace for obtaining health insurance by 2016."         The Minneapolis Star Tribune  (3/21, Brooks) reports, "The governor was flanked by dozens of DFL lawmakers at the bill signing and not one Republican, a sign of the ferocious partisan battles that marked the exchange's two-month journey through the DFL-controlled Legislature."         Also reporting are the Worthington (MN) Daily Globe  (3/21, Davis), the Minneapolis/St. Paul (MN) Business Journal  (3/21, Grayson), and Minnesota Public Radio  (3/21). Proposed Expansion Of Healthy Indiana Plan Gets Mixed Reactions At Hearing. The AP  (3/21, Kusmer) reports Indiana Gov. Mike Pence is seeking Centers for Medicaid and Medicare Services "approval to use the Healthy Indiana Plan to expand Medicaid in this state." While "Hospital officials praised Indiana's medical savings accounts" during a hearing, "critics noted HIP isn't available to everyone and even when it is, it can prove too costly for some low-income Indiana residents needing medical care." States Taking Action To Keep Compounding Pharmacies In Check. The Washington Post  (3/21, Sun) reports says that about a dozen states are "cracking down on specialty pharmacies, conducting surprise inspections and weighing proposals to require companies to obtain special permits to mix sterile drugs. The moves are in response to last fall's deadly meningitis outbreak, which was linked to tainted steroid shots made by a Massachusetts pharmacy." States are now "considering legislation that would require stricter licensing requirements for specialty pharmacies, known as compounders." Also, "New York regulators have issued a temporary ban on sales by Illinois-based Pharmedium Services, one of the largest compounding pharmacies in the country." In Iowa, "the pharmacy board is inspecting more than 600 out-of-state pharmacies that ship medications" into the state. Public Health and Private Healthcare Systems CMMI's Gilfillan Discusses Efforts With Senate Finance Committee. Reuters  (3/20, Morgan) reports that Dr. Richard Gilfillan, director of HHS' Center for Medicare and Medicaid Innovations, told the Senate Finance Committee Wednesday that his office is awaiting results from many of their initiatives, funded under the Affordable Care Act. He said, "We're all eager to see the results of these models. But we need to be realistic. This change is difficult. Some models will work and some will not. It will take time to see the improvements we are after." He continued, "We'll be able to start sharing interim results with Congress within the year and start giving recommendations for payment or peer changes within the next two years."         CQ  (3/21, Ethridge, Subscription Publication) reports that Gilfillan told the Senate Finance Committee Wednesday that his agency is "rapidly expanding its model programs that could show how to reduce health costs, ranging from better prenatal care to post-acute care." CMMI received $10 billion under the Affordable Care Act to "work on model programs to improve delivery of care and lower health care costs." According to the article, "Lawmakers of both parties generally praised the center's efforts, which include programs to set up accountable care organizations, provide home-based primary care to chronically ill beneficiaries, and reduce hospital readmissions." Still, some Republicans, including Senator Orrin Hatch of Utah, raised concerns about the office.         The Hill  (3/21, Baker) "Healthwatch" blog reports further on Hatch's concerns about the office, which he claimed "is wasting money on high salaries and expensive perks." For example, Hatch said that he has "heard that … staffers have state-of-the-art workspaces, including very expensive treadmill desks." He continued, "In a post-sequester world, where White House tours are being canceled and Easter egg hunts are being threatened, you can imagine why the American people would take a very cynical view about federal employees being furnished with thousand-dollar treadmill desks." Study Finds Preferred-Pharmacy Plans May Violate CMS Requirement. Bloomberg News  (3/21, Wayne) reports that, according to an analysis today by the National Community Pharmacists Association, "preferred-pharmacy plans that promise lower prices for people who agree to buy their prescription drugs from certain stores may be costing the U.S. Medicare program more money to support." The group found that, "while Medicare patients get reduced co-payments in the plans," the insurers are "shifting the burden of those discounts onto the federal government." Bloomberg adds that "such price discrepancies, if found to be accurate, may violate a CMS requirement that discount programs not increase total payments from Medicare to the insurers." Several States Considering Private Alternative To Medicaid Expansion. Coverage of the "private option" for Medicaid expansion is heating up, moving beyond Arkansas, where the original compromise originated, to Florida, Texas, and beyond.         Providing a national overview, CNN Money  (3/21, Luhby) reports that as an alternative to expanding Medicaid under the Affordable Care Act, some Republican-led states "are warming up to the idea of using federal funds to buy private insurance for the poor." Lawmakers "in Ohio, Louisiana and Florida - and in Arkansas, which has a Democratic governor and a Republican legislature" are now considering this option. Further, "The U.S. Department of Health and Human Services is open to the idea, saying it wants to be flexible and work with states to design plans that fit their needs."         Florida Weighing Private Options For Medicaid Expansion. The AP  (3/21) reports that Florida state Senator Aaron Bean "wants to turn down roughly $51 billion in federal funds from the Affordable Care Act" to expand Medicaid, and instead find an alternative, he says, "that we can say yes to." Bean told the Senate Health Policy Committee on Wednesday that his plan "would potentially rely on state dollars and cover about 600,000 people," and that "the rest will qualify for subsidies under the state health exchange to purchase private insurance."         WJXT-TV  Jacksonville, FL (3/21) notes that with this plan, "Bean appears to be bucking another plan that Senate Appropriations Chairman Joe Negron, R-Stuart, is expected to formally introduce Thursday. The plan, dubbed 'Healthy Florida,' would use federal money to provide private health insurance to people who otherwise would qualify for the Medicaid expansion."         The Miami Herald  (3/21, Mitchell) reports that this alternative to Medicaid expansion will get its first hearing Thursday. Negron's plan "would expand the state's Florida Healthy Kids program to cover qualifying adults 18 and over. People in the expanded plan would be required to pay small premiums and co-pays, and they would have access to health reimbursement accounts to help cover out-of-pocket expenses."         The South Florida Sun-Sentinel  (3/21, Haughney, Gibson) notes that "there are still a lot of unanswered questions about" the plan, nicknamed "Negron-care." Notably, it is uncertain whether "the House – and the federal government - will agree to it."         The Capitol News Service (FL)  (3/21, Ray) calls Negron's plan "an attempt to break a stalemate between the House and the Governor's office."         The Palm Beach (FL) Post  (3/21, Kennedy) reports that "Florida clergy turned to the Bible for support Wednesday in joining health care advocates and leading Democrats in decrying the House and Senate's opposition to Medicaid expansion." House Democratic Leader Perry Thurston "opted for a more secular – and direct - approach in ridiculing Republican lawmakers who refuse to expand Medicaid eligibility to 138 percent of poverty." The Capitol News Service (FL)  (3/21) also reports on the clergy's call for expansion.         Costs Associated With Arkansas' Medicaid Expansion Plan Questioned. On its "Wonkblog," the Washington Post  (3/21, Kliff) reports that, "a few weeks ago, Arkansas put forward an unusual plan to expand Medicaid: It would use the health law dollars to buy private insurance for some 210,000 Arkansans expected to be covered under the program." The approach, which is being considered by about a half-dozen states, "could end up covering millions of Americans and may win over some of Obamacare's staunchest opponents." However concerns remain about how much the Arkansas plan would cost. The remainder of the article is denoted to analyzing whether Arkansas's "Obamacare math" will "add up."         Similarly, the Arkansas Times  (3/20, Ramsey) reports that the Arkansas chapter of Americans for Prosperity(AFP) "sent out a tweet today expressing opposition to expansion even under the so-called 'private option' that many Republican lawmakers have shown interest in." In a clarification, AFP Director Teresa Oelke tweeted "that AFP was still 'waiting for details.'" The Times notes that, "thus far, conservatives both locally and nationally have been relatively quiet on the new 'private option' plan."         Think Tank Outlines Private Alternative For Texas Medicaid Program. The Texas Tribune  (3/21, Aaronson) reports, "In a report released Wednesday, the Texas Public Policy Foundation detailed how Texas could use a federal block grant to cut costs and fundamentally reform Medicaid, the state's health program for the poor, without expansion." The report, titled "Save Texas Medicaid: A Proposal for Fundamental Reform," the think tank suggests "the use of a block grant to let the state subsidize private health savings accounts, so that Medicaid recipients can pay for health services." The article notes that other states, notably Arkansas, have begun to reach compromises along these lines.         The Dallas Morning News  (3/21, Garrett) "Trail Blazers Blog" reports further that the report "suggests that Texas ask Congress to pass a law pulling Texas out of Medicaid and giving it a capped amount of federal funds. The federal government's annual contribution would be linked to medical inflation and changes in the number of Texans below the federal poverty level." Kaiser Permanente Hailed As Future Of Healthcare. The New York Times  (3/21, Abelson, Subscription Publication) reports that, "when people talk about the future of health care, Kaiser Permanente is often the model they have in mind" as the organization, "which combines a nonprofit insurance plan with its own hospitals and clinics, is the kind of holistic health system that President Obama's health care law encourages." The Times also notes Kaiser's "sophisticated electronic records and computer systems that - after 10 years and $30 billion in technology spending - have led to better-coordinated patient care, another goal of the president." However, "even with all of its effort, its chairman and chief executive, George C. Halvorson, acknowledges Kaiser has yet to achieve the holy grail of delivering that care at a low enough cost." Senior Market News UCLA Researchers Urge Patient-Centered Care At End Of Life. On its "Booster Shots" blog, the Los Angeles Times  (3/20, Macvean) reports that UCLA researchers say "finding out what dying patients want and treating them accordingly leads to happier patients who are in less pain and who use fewer healthcare dollars." Dr. Jonathan Bergman, a Robert Wood Johnson clinical scholar at UCLA, "and colleagues wrote an article advocating for patient-centered care at the end of life in the journal JAMA Surgery." The authors claim that "people who are dying often receive care that is poorly coordinated and not in line with the patient's values or goals," but "when a patient's desires are taken into account, death is less likely to occur in an intensive care unit, physical distress is reduced, and death comes no sooner." Also in the News AMA Finds Many Patients Fail To Understand Health Information. Medscape  (3/21, Gammon) reports on a presentation at the American Pharmacists Association Annual Meeting in Los Angeles saying that "half of patients in the United States don't understand the health information they receive, according to an estimate by the American Medical Association (AMA)." One reason is that "the average American reads at an eighth-grade level, whereas most healthcare information, including labels on prescriptions, is written for college graduates." The presenter suggested that physicians and pharmacists need to work on ways to explain medical conditions, medications and other treatments to less educated patients. Wednesday's Lead Stories  • Senators Introduce Bill To Block ACA Tax On Insurers.  • Administration Officials Admit ACA Implementation Will Be Complicated.  • Hospitals, Insurers At Loggerheads Over Rising Costs.  • Another Thirteen Indicted In Medicare, Medicaid Fraud Case In Detroit.