First Edition: January 5, 2015

Kaiser Health News: As Caregiving Shifts To The Home, Scrutiny Is Lacking
California’s frail elderly and disabled residents increasingly are receiving care in their own homes, an arrangement that saves the government money and offers many people a greater sense of comfort and autonomy than life in an institution. Yet caregivers are largely untrained and unsupervised, even when paid by the state, leaving thousands of residents at risk of possible abuse, neglect and poor treatment, a Kaiser Health News investigation found. (Gorman, 1/5)

Kaiser Health News: How A State's Choice On Medicaid Expansion Affects Hospitals
In negotiating the creation of the Affordable Care Act, hospitals took a big gamble, with the expectation that they would soon have millions of new Medicaid customers. In states that expanded Medicaid, the bet paid off. (Varney, 12/29)

Kaiser Health News: When Home And Health Are Just Out Of Reach
Donna Giron is frail. She has Crohn’s disease and uses a wheelchair to get around because walking exhausts her. But she doesn’t want to be in the nursing home where she has lived since May. Giron, 65, is looking to rent a small house in the industrial town in the Cleveland suburbs where she grew up. Using federal funds from a special project, thousands of elderly and disabled nursing home residents have been able to move into their own homes in recent years. The experimental project has reached people in 44 states, including more than 5,400 in Ohio. It connects people to the medical and living support they need to move into private homes, so that they can live independently. (Tribble, 1/5)

Los Angeles Times: Obamacare's Guaranteed Health Coverage Changes Lives In First Year
Like many working Americans, Lisa Gray thought she had good health insurance. That was until she was diagnosed with leukemia in mid-2013, and the self-employed businesswoman made a startling discovery: Her health plan didn't cover the chemotherapy she needed. "I thought I was going to die," Gray, 62, said recently, recalling her desperate scramble to get lifesaving drugs. Through a mix of temporary measures, doctors and patient advocates managed to keep Gray stable for a few months. But it was a new health care plan through the Affordable Care Act that Gray credits with saving her life. (Levey, 1/4)

The Wall Street Journal: Affordable Care Act Creates A Trickier Tax Season
The law’s requirement that most Americans carry health insurance means all filers must indicate on federal tax forms whether they had coverage last year and got tax credits to help pay for it. Those who didn’t have coverage could face a fine ... Meanwhile, millions of Americans who got subsidies under the law may find they are getting smaller-than-expected refunds or owe the IRS because credits they received to offset their insurance premiums were too large. As many as half of the roughly 6.8 million Americans who got subsidies may have to refund money to the government, based on one estimate by tax firm H&R Block Inc. (Armour and Radnofsky, 1/1)

USA Today: Dilemma Over Deductibles: Costs Crippling Middle Class
Physician Praveen Arla is witnessing a reversal of health care fortunes: Poor, long-uninsured patients are getting Medicaid through Obamacare and finally coming to his office for care. But middle-class workers are increasingly staying away. ... "They're really worried about cost." It's a deep and common concern across the USA, where employer plans cover 60% of working-age Americans, or about 150 million people. Coverage long considered the gold standard of health insurance now often requires workers to pay so much out-of-pocket that many feel they must skip doctor visits, put off medical procedures, avoid filling prescriptions and ration pills — much as the uninsured have done. (Ungar and O'Donnell, 1/1)

USA Today: Some Businesses Use Part-Time To Meet Health Law
Many businesses in low-wage industries have hired more part-time workers and cut the hours of full-timers recently to soften the impact of new health law requirements that take effect Thursday, some consultants say. The strategies have had only a modest impact on job growth, which has accelerated substantially this year, but could take a somewhat bigger toll next year as firms gear up for an expanded health care mandate in 2016. ... Businesses in low-wage sectors, such as restaurants, retail and warehousing, are feeling bigger effects because health insurance represents an outsize share of their total employee costs, says Rob Wilson, head of Employco, a human resources outsourcing firm. (Davidson, 12/30)

The New York Times: Health Insurance Enrollment Strongest In Federal Marketplace
The Obama administration on Tuesday reported a big increase in new customers signing up for health insurance in Florida, Texas and other states using the federal insurance marketplace. But in states running their own insurance exchanges, the numbers were more modest. ... The report showed the importance of subsidies to people seeking coverage under the Affordable Care Act. Officials said that 87 percent of those selecting health plans for next year in the federal exchange had qualified for subsidies that would reduce their premiums. (Pear, 12/30)

The Washington Post: At Least 7.1M Signed Up For 2015 Obamacare Plans So Far
As of Dec. 26, 6.5 million people signed up for coverage in federally run exchanges — that includes new enrollments, people actively re-enrolling and existing customers who allowed their coverage to automatically renew, according to the Department of Health and Human Services' weekly enrollment update. A second HHS report, which provides the most comprehensive look at the new enrollment period so far, found that 633,000 people selected coverage in the 14 states running their own health insurance marketplaces as of Dec. 15. That's in addition to those who signed up through the federal exchanges, for a total of roughly 7.1 million. (Millman, 12/30)

Politico: Regrets On Obamacare? Sebelius Has Very Few
During the worst days of the Obamacare rollout last year, Kathleen Sebelius kept her spirits up by thinking about … Medicare. As the Obamacare website was crashing and conservative interest groups were shining the spotlight on canceled health plans, the embattled Health and Human Services secretary flashed back to the fierce battles over the creation of Medicare in the 1960s, when the American Medical Association fought its passage ... Now, she says, when the AMA speaks out about Medicare, it’s when the doctors are trying to prevent their Medicare payments from being cut. The lesson for future political leaders who might be thinking about the next ambitious social programs? Don’t shy away from them. (Nather, 12/29)

Los Angeles Times: Since Obamacare, L.A. County ER Visits Show Hospitals In 'State Of Flux'
A key measure of hospital emergency room use in Los Angeles County shows continued growth during the first six months of Obamacare, but also points to shifting patterns of where patients are choosing to receive urgent medical treatment. With the healthcare expansion last year, many are watching how the Affordable Care Act affects emergency room use. (Karlamangla and Menezes, 1/1)

The New York Times: Success Of Kentucky’s Health Plan Comes With New Obstacles
In many ways, Kentucky, a poor state with a starkly unhealthy populace, has become a symbol of the Affordable Care Act’s potential. Largely because the state chose to expand Medicaid, the drop in the uninsured rate has been among the sharpest in the nation. Hospital revenues are up, health care jobs are multiplying and far more Kentuckians are getting preventive checkups and screenings, according to state officials. (Goodnough, 12/29)

The Associated Press: Idaho Health Care Call Center To Lay Off 1,500
A technology company says it will lay off more than 1,500 employees at a Boise call center where workers handle questions about the federal health care law. The Idaho Statesman reports that Maximus Inc. has hired, laid off and rehired hundreds of employees at the call center since 2013. (1/3)

The New York Times: Republicans Say They’ll Act Fast To Push Agenda
Republicans hope to strike early with measures that are known to have bipartisan support. The House is set to pass legislation this week expediting the Keystone XL pipeline; the Senate is making it the first order of business as well. The House will also take up a measure that would change the new health care law’s definition of full-time workers to those working 40 hours rather than the current 30 hours — another proposal that has drawn backing from Republicans and Democrats in the House and Senate. (Hulse, 1/4)

The Wall Street Journal: GOP Opts For Middle Ground On Legislation
As the new Congress convenes this week, Republicans in charge of both chambers have a challenging task: push through bills on some of the most contentious issues — health, energy and spending — without inflaming tensions on both the left and right that have in the past ground legislating to a halt. Republicans plan to start with narrowly focused legislation, such as approving a long-disputed pipeline project and adjusting the federal health law’s requirement that companies provide health insurance for employees who work as little as 30 hours a week. Bigger-ticket measures to reduce government spending and overhaul the tax code are expected to follow. (Hughes, 1/4)

Politico: GOP Searches For Elusive Obamacare Fix
Republicans have been vowing to repeal Obamacare for nearly five years. But 2015 could be the year that Republicans finally define how they would replace it. ... The GOP conversations so far are preliminary, and a breakthrough isn’t imminent. Various Republican proposals have been put forth over the years, but forging agreement requires bridging deep ideological differences among Republicans about the scope of a plan, the role and responsibility of the federal government in health care, and how much to money to spend. (Haberkorn, 1/3)

The Associated Press: New GOP Senate Chairmen Aim To Undo Obama Policies
Republican senators poised to lead major committees when the GOP takes charge are intent on pushing back many of President Barack Obama's policies, ... Tennessee's Lamar Alexander, 74, is a former education secretary under President George H.W. Bush, governor and president of the University of Tennessee. … He's called the health care law a "historic mistake" and supports repealing it. He's also said modernizing the National Institutes of Health and Food and Drug Administration is a necessity, and he is seeking to examine the FDA's process for drug and device review. (Ohlemacher and Cassata, 1/3)

The Washington Post: New Senate Majority Leader’s Main Goal For GOP: Don’t Be Scary
Mitch McConnell has an unusual admonition for the new Republican majority as it takes over the Senate this week: Don’t be “scary.” The incoming Senate majority leader has set a political goal for the next two years of overseeing a functioning, reasonable majority on Capitol Hill that scores some measured conservative wins, particularly against environmental regulations, but probably not big victories such as a full repeal of the health-care law. McConnell’s priority is to set the stage for a potential GOP presidential victory in 2016. (Kane, 1/4)

The Washington Post: Republicans In State Governments Plan Juggernaut Of Conservative Legislation
The unprecedented breadth of the Republican majority — the party now controls 31 governorships and 68 of 98 partisan legislative chambers — all but guarantees a new tide of conservative laws. ... there will be exceptions to the coming conservative juggernaut. Despite conservative opposition to Obamacare, some Republicans are debating whether and how to accept federal Medicaid expansion. Republican governors of Wyoming, Utah, Idaho, North Carolina and Tennessee have said they will try to persuade their legislators to accept federal funding, while Democratic governors in Montana and Pennsylvania will work with Republican-controlled legislatures in a similar vein. (Wilson, 1/2)

The Associated Press: GOP Legislators Thwart Bids To Expand Medicaid
Governors across the political spectrum are hitting a roadblock in their bids to expand Medicaid with federal funds: Republican legislators who adamantly oppose "Obamacare." While some of these governors themselves have criticized the president's health care law in general, they've come to see one component — Medicaid expansion — as too generous to reject. But they're battling conservative lawmakers who say it's better to turn down billions of federal dollars than to expand Medicaid under the 2010 law. (Babington, 1/1)

Los Angeles Times: Arizona Gov. Jan Brewer Dealt Legal Blow Over Medicaid Expansion Plan
Arizona Gov. Jan Brewer was dealt a significant legal defeat Wednesday when the Arizona Supreme Court ruled that a lawsuit challenging her controversial Medicaid expansion plan could move forward. (Baxter, 12/31/14)

Los Angeles Times: No Plans For California To Make Up For Expiring 'Medicaid Fee Bump'
California officials have no plans to make up for an expiring federal pay incentive designed to entice doctors to treat low-income patients. The end of the subsidy with the start of the new year could result in steep pay cuts for many doctors participating in the Medicaid system for needy Californians. (Brown, 12/31/14)

The Washington Post: CareFirst Is Ordered To Spend $56M On Community Health Needs By D.C. Regulators
D.C. insurance regulators on Tuesday ordered the Washington region’s largest health insurer to spend $56 million on community health needs in the District, calling the billion-dollar cash reserves of CareFirst BlueCross BlueShield legally “excessive.” The order, signed by acting insurance commissioner Chester A. McPherson, is a landmark moment in a decade-long battle over the reserve holdings belonging to a nonprofit subsidiary of CareFirst. The company has long said the reserve is a prudent hedge against possible catastrophes. (DeBonis, 12/30)

The Wall Street Journal: Tending To Unmet Dental Needs, A Root Of Elder Hunger
For many homebound seniors, the biggest challenge to staving off hunger and getting needed nutrition isn’t having money to buy food or the physical or cognitive ability to prepare it. It is simply being able to chew. In one of the first programs of its kind in the U.S., nonprofit food-delivery service Citymeals-on-Wheels recently joined with Columbia University College of Dental Medicine to conduct a pilot study of meal recipients’ oral health. Funded with a $50,000 grant from the National Institutes of Health, the research has included both phone interviews and dental house calls to low-income seniors, many of whom haven’t seen a dentist in years—sometimes decades. (Wilson, 1/1)

NPR: Rural Doctor Launches Startup To Ease Pain Of Dying Patients
Dr. Michael Fratkin is getting a ride to work today from a friend. "It's an old plane. Her name's 'Thumper,' " says pilot Mark Harris, as he revs the engine of the tiny 1957 Cessna 182. Fratkin is an internist and specialist in palliative medicine. He's the guy who comes in when the cancer doctors first deliver a serious diagnosis. He manages medications to control symptoms like pain, nausea and breathlessness. And he helps people manage their fears about dying and make choices about what treatments they're willing — and not willing — to undergo. (Dembosky, 1/3)

The Washington Post: Dying And Profits: The Evolution Of Hospice
The influx of for-profit companies into the hospice field has benefited patients, advocates say, because the commercial companies made big investments in technology, focused on efficiency and made care more accessible. But a Washington Post analysis of hundreds of thousands of U.S. hospice records indicates that, as those companies transformed a movement once dominated by community and religious organizations into a $17 billion industry, patient care suffered along the way. On several key measures, for-profit hospices as a group fall short of those run by nonprofit organizations. (Whoriskey and Keating, 12/26)

The Associated Press: Mental Health Advocates Seek Relief For Autistic Va. Inmate
Mental health and civil liberties advocates are urging Gov. Terry McAuliffe to intervene in the case of a Virginia inmate with autism who faces trial Wednesday for allegedly assaulting a correctional officer. (1/4)