First Edition: April 11, 2014

Today's headlines include details of the resignation of Health and Human Services Secretary Kathleen Sebelius as well as coverage of her likely successor,  Sylvia Mathews Burwell.

Kaiser Health News: Sebelius Resigns; Obama To Name OMB Chief Burwell To Head HHS
Kaiser Health News staff writer Mary Agnes Carey reports: “After a five-year tenure that included the flawed rollout of the health care law and stormy relations with Capitol Hill Republicans, Department of Health and Human Services Secretary Kathleen Sebelius is resigning, a White House official said late Thursday” (Carey, 4/10). Read the story.

Kaiser Health News: L.A. County Nursing Home Inspections Chief Reassigned
Kaiser Health News staff writer Anna Gorman, working in collaboration with the Los Angeles Daily News, reports: “The Los Angeles County Department of Public Health supervisor in charge of nursing home inspections has been moved to another job days after the release of a highly critical audit of his division. Ernest Poolean, who has been a county employee since 1968 and became the head of the Health Facilities Inspection Division in 2011, has been reassigned to the Baldwin Park headquarters, according to a memo sent to the staff Thursday” (Gorman, 4/10). Read the story.

Kaiser Health News: A Reader Asks: Do I Face A Penalty If My Kids’ CHIP Coverage Starts In April?
Kaiser Health News consumer columnist Michelle Andrews answers this reader’s question (4/11). Read her response.

Kaiser Health News: Letters To The Editor: The Health Insurance Affordability Gap; What’s Ahead For The Health Law; Doctor Burnout; Medicare Advantage Payment Rates
Here’s a collection of comments from Kaiser Health News readers to a range of recent stories (4/10). Read what our readers think.

The New York Times: Sebelius Resigns After Troubles Over Health Site
Kathleen Sebelius, the health and human services secretary, is resigning, ending a stormy five-year tenure marred by the disastrous rollout of President Obama’s signature legislative achievement, the Affordable Care Act. Mr. Obama accepted Ms. Sebelius’s resignation this week, and on Friday morning, he will nominate Sylvia Mathews Burwell, the director of the Office of Management and Budget, to replace her, officials said (Shear, 4/10).

The Washington Post: Kathleen Sebelius To Step Down As HHS Secretary, OMB Director Will Take Her Place
Sebelius entered the Cabinet in 2009, three months into Obama’s presidency, as a well-regarded former governor of conservative Kansas. She is leaving after months of intense criticism over the botched rollout in the fall of the insurance marketplace. During the firestorm, Obama made clear to his aides that he would not seek the resignation of his health secretary, and her departure is timed to brighter news for the White House as enrollment soared late last month. Still, some White House allies said Thursday night that the troubled launch of HealthCare.gov had heightened tensions between Sebelius and the president’s staff members, who had become increasingly mistrustful of the department she led (Eilperin and Goldstein, 4/10).

Los Angeles Times: Health Chief Kathleen Sebelius, Who Oversaw Obamacare Rollout, Resigns
Sebelius was not pressured to resign, the official said. But she leaves after presiding over the disastrous launch of the health law's online insurance marketplaces last fall. That failure threatened to unravel what was supposed to be Obama's signature domestic policy achievement and has endangered Democrats who face elections in November (Levey and Parsons, 4/10).

The Wall Street Journal: Kathleen Sebelius To Resign Health Post
She informed Mr. Obama in early March of her decision to resign, a White House official said. "At that time, Secretary Sebelius told the president that she felt confident in the trajectory for enrollment and implementation of the Affordable Care Act, and that she believed that once open enrollment ended it would be the right time to transition the department to new leadership," the official said (Radnofsky and Lee, 4/10).

The Associated Press: Sebelius, A Lightning Rod For Critics, Resigns 
The opening weeks of the enrollment period were marred by website woes, straining ties between Sebelius and officials in the West Wing. Though the administration rebounded strongly and exceeded expectations by enrolling 7.1 million people by the March 31 deadline, the comeback wasn’t enough to tamp down Republican criticism of Sebelius or boost the public’s perception of the federal health care overhaul (4/11).

USA Today: HHS Secretary Kathleen Sebelius Resigns
In recent months, Sebelius has faced heavy scrutiny after the troubled launch of the federal online insurance marketplace and has been deluged with Republican attacks over the costs of the Affordable Care Act. During the first difficult weeks of the federal marketplace, Sebelius proved to be an unsteady administration spokeswoman for the health care law (Schouten, Kennedy and Madhani, 4/10).

Politico: Website Fiasco Will Taint Kathleen Sebelius’ Legacy
Kathleen Sebelius waited as long as she could. She waited until the Obamacare enrollment season was over, and the once-broken website was so firmly back on track it held up under the last-minute surge. She even waited for one last high point: her announcement at a Senate Finance Committee hearing Thursday that sign-ups had risen to 7.5 million, thanks to the extra time the Obama administration had granted to people who said they couldn’t finish their enrollments on time (Nather, 4/10).

The Wall Street Journal: Health Law Draws Fresh GOP Fire as Sebelius Resigns
Republicans seized on news of Health and Human Services Secretary Kathleen Sebelius's resignation as a fresh opportunity to push for further-reaching changes to President Barack Obama's embattled health-care law, while Democrats praised her for her commitment under fire. In the four years since it was passed, widespread congressional anger and frustration over the Affordable Care Act was often trained on the secretary as she oversaw its implementation. On Thursday, critics largely avoided personal attacks on Mrs. Sebelius, 65 years old, and instead sought to use her resignation to shift attention back to the law's problems and advocate for its repeal (Peterson, 4/10).

Politico: Republicans Pile On At News Of Sebelius’s Exit
The reaction of GOP lawmakers to news of HHS Secretary Kathleen Sebelius’s resignation played on a very narrow band Thursday evening: Muted thanks to outright disdain. Capitol Hill Republicans have long bludgeoned Sebelius for her role overseeing the failed rollout of Obamacare’s enrollment website, HealthCare.gov. Their response to her exit started coming in immediately (Cheney, 4/10).

Politico: Sebelius Exit Opens New Obamacare Front
Democrats will be hoping Health and Human Services Secretary Kathleen Sebelius’s resignation — kept tightly under wraps since the one-on-one meeting in early March when she gave Obama the news — will finally force the president closer to the offensive, aggressive position on Obamacare that they’d been begging for (Dovere and Budoff Brown, 4/11).

The New York Times: Budget Chief Is Obama’s Choice As New Health Secretary
On Friday, President Obama is to nominate Ms. Burwell, currently director of the White House Office of Management and Budget, to take over one of the largest and most unwieldy parts of the federal bureaucracy as secretary of health and human services. If confirmed, Ms. Burwell would replace Kathleen Sebelius, who is resigning (Shear, 4/10).

The Washington Post’s Wonkblog: Meet The Nominee To Lead HHS
Sylvia Mathews Burwell is about to become the biggest name in health care after news broke Thursday night that she will be the nominee to replace the resigning Health and Human Services Secretary Kathleen Sebelius. … Burwell has extensive administration experience that includes budget oversight for major entitlement programs, like Medicare and Medicaid. Last summer, Burwell and White House chief of staff Denis McDonough led negotiations with a group of Senate Republicans who hoped to forge a grand bargain with the administration to raise taxes and rein in spending on health and retirement programs (Millman, 4/10).

Politico: Sylvia Mathews Burwell’s Next Marathon
Intentionally or not, Burwell, who served every single day of the Clinton administration, now finds herself facing another test of endurance and determination: replacing Kathleen Sebelius as secretary of Health and Human Services, the department responsible for implementing Obamacare, in a midterm election year (White and Epstein, 4/10).

The Wall Street Journal: Who Is Sylvia Burwell, HHS Secretary Sebelius’ Expected Replacement
Ms. Burwell, a veteran of the Clinton White House and Treasury Department who has held senior roles at the Bill & Melinda Gates Foundation and the Walmart Foundation, will face close scrutiny because the agency she has been tapped to run oversees some of the most polarizing and expensive parts of the federal budget. A senior administration official said Ms. Burwell, 48 years old, was the only person Mr. Obama considered, saying he placed a premium on her management skills, which was one thing he wanted in Mrs. Sebelius' replacement (Paletta, 4/10).

Los Angeles Times: Health Official Says 7.5 Million Americans Now Signed Up For Obamacare
Sebelius' announcement marks a 400,000-person uptick since Obama announced last week that 7.1 million Americans had signed up for coverage through marketplaces on the final day of open enrollment. The administration's original tally didn't include Americans who, because of issues signing up, received an extension until April 15 (Rothberg, 4/10).

The Wall Street Journal: Health Insurance Enrollment Has Hit 7.5 Million, Sebelius Says
Mrs. Sebelius provided the new figures in testimony before the Senate Finance Committee about the agency's 2015 budget request. Last week the White House announced that at least 7.1 million Americans signed up for health insurance through the end of March, which is when open enrollment for health plans created by the Affordable Care Act formally ended. The federal government and states running their own health-insurance exchanges are continuing to complete enrollments for people who started their insurance applications on or before March 31 (Corbett Dooren, 4/10).

Politico: Kathleen Sebelius: 7.5 Million Signed Up In Obamacare Exchanges
At least 7.5 million people have signed up for health coverage through the Obamacare exchanges, and the number is still rising, HHS Secretary Kathleen Sebelius said Thursday. President Barack Obama had said that 7.1 million Americans enrolled as of April 1, but that tally didn’t count all the last-minute enrollment surge numbers from state-run exchanges or the people allowed to complete signup after March 31 (Haberkorn, 4/10).

The Associated Press: Cover Oregon Narrows Exchange Future To Two Options
Officials with Oregon’s troubled health insurance exchange say they’ve narrowed the options for the site’s future to two: switching to the federal exchange, or staying with the current technology and hiring a new contractor to fix it. Cover Oregon’s interim chief information officer Alex Pettit told board members Thursday that a third option — transferring technology from another state — would be too expensive and take too long (4/10).

Politico: Vulnerable Democrats Wait Out Obamacare Hits
Conservative outside groups have pummeled Senate Democrats over their support for Obamacare, spending millions on attack ads from Louisiana to Montana. But many of the most endangered Democratic incumbents have decided it’s better to wait out the barrage than to respond in-kind (Raju, 4/11).

The Wall Street Journal: Sensitive Market Data Leaked After Government Phone Call
Market-sensitive information vitally important to health-insurance companies has once again reached Wall Street before the public, and this time it appears to have come from the government itself. On Dec. 3, an official with the agency in charge of Medicare spending held a conference call for industry officials. During the call, he provided data suggesting that federal funding for private Medicare plans would likely fall more than expected. Word soon reached Wall Street, prompting a selloff in insurance shares (Mathews and Mullins, 4/10).

The New York Times: House-Passed Budget Shows Parties’ Divergence
The move underscored the different universes the two parties occupy as election season heats up. Democrats see the budget, which passed on Thursday in a 219-to-205 vote, as a political millstone, with brutal cuts to popular government programs, sweeping and controversial changes to Medicare, and tax cuts for the rich. Republicans consider it a modest step (Weisman, 4/10).

Los Angeles Times: GOP-Led House Approves Tough Paul Ryan Budget, But Debate Continues
With little drama Thursday, House Republicans easily approved a largely symbolic budget proposal from Rep. Paul Ryan (R-Wis.), closing out a floor debate over spending priorities and opening a new front on the midterm campaign trail. … Ryan's proposal would overhaul Medicare for the next generation of seniors, boost defense spending beyond Obama's levels and slash most other domestic spending on college aid, food stamps and basic government investments. Tax rates for the wealthy would be cut to a top rate of 25% (Mascaro, 4/10).

The Wall Street Journal: Republican Budget Plan Narrowly Passes House
Under Mr. Ryan's plan, the average annual growth in federal spending would slow to 3.5% from its current path of 5.2%. To eliminate the annual federal budget deficit, the budget would reduce spending by $5.1 trillion over 10 years and overhaul social safety-net programs, including Medicare and Medicaid. The Ryan plan also would repeal the Affordable Care Act, but it incorporates some $700 billion in Medicare savings and $1 trillion in revenues generated under the 2010 health law (Peterson, 4/10).

Politico: House Passes Ryan Budget
The House approved a fiscal 2015 budget on Thursday that would cut federal spending by $5 trillion and significantly revamp social welfare programs. The measure, which cleared the House 219-205, is essentially a political document that has no chance of being passed in the Democratic-controlled Senate. House Budget Committee Chairman Paul Ryan (R-Wis.) is expected to relinquish his gavel at the end of this Congress and his final budget is seen as more of an outline of Republican priorities, including the repeal of Obamacare (French, 4/10).

The Texas Times/New York Times: Doctors Shun Insurance, Offering Care For Cash
For 12 hours a day, the waiting room at Dr. Gustavo Villarreal’s family practice is packed with patients who pay a flat $50 fee for the convenience — or necessity — of a walk-in, quick-turn doctor’s visit. Efforts at both the state and federal level are underway to decrease Texas’ sky-high rate of residents without health coverage. But in a city where nearly a third of the population lives below the poverty line, Dr. Villarreal does not accept health insurance. Instead, he has switched to a cash-based model, eschewing the laborious practice of filing out insurance forms in order to get paid (Ura, 4/10).

Los Angeles Times: Assembly Backs Permanently Allowing Over-The-Counter Sale Of Syringes
The Assembly approved a measure Thursday that would permanently extend a provision allowing pharmacists to sell syringes without a prescription. Assemblyman Phil Ting (D-San Francisco), the bill's author, said expanding access to sterile needles is "the best way to stop the spread of some very deadly diseases." Public health experts say the use of shared needles among intravenous drug users contributes to the spread of HIV, hepatitis B and hepatitis C (Mason, 4/10).

The Associated Press: Maine Medicaid Rules Reduce Narcotic Prescriptions
Maine’s severe restrictions on opioid painkillers for Medicaid patients, requiring many to instead seek alternative pain management treatment for the past year, have sharply reduced the number of people obtaining highly addictive medications blamed for drug abuse and deaths around the nation (4/10).

The Associated Press: Nemours Foundation Sues United Healthcare Entities
The foundation that owns the Alfred I. du Pont Hospital for Children in Delaware and various pediatric physician practices in the region is suing United Healthcare entities in three states for unpaid bills. Lawyers for the Nemours Foundation filed lawsuits in federal court in Delaware on Wednesday against United Healthcare of Pennsylvania, United Healthcare of the Mid-Atlantic, and United Healthcare Community Plan of New Jersey (4/10).

The Associated Press: Judge: California Mistreating Mentally Ill Inmates
A federal judge ruled Thursday that California’s treatment of mentally ill inmates violates constitutional safeguards against cruel and unusual punishment through excessive use of pepper spray and isolation. U.S. District Court Judge Lawrence Karlton in Sacramento gave the corrections department time to issue updated policies on the use of both methods but did not ban them (4/10).

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