First Edition: April 21, 2014

Today's early morning highlights from the major news organizations, including a GAO report on how the Obama administration raised money from outside groups to promote the health law.

Kaiser Health News: 15-Minute Visits Take A Toll On The Doctor-Patient Relationship
Reporting for Kaiser Health News in collaboration with USA Today, Roni Caryn Rabin reports: "Patients – and physicians – say they feel the time crunch as never before as doctors rush through appointments as if on roller skates to see more patients and perform more procedures to make up for flat or declining reimbursements. It’s not unusual for primary care doctors’ appointments to be scheduled at 15-minute intervals. Some physicians who work for hospitals say they’ve been asked to see patients every 11 minutes. And the problem may worsen as millions of consumers who gained health coverage through the Affordable Care Act begin to seek care — some of whom may have seen doctors rarely, if at all, and have a slew of untreated problems" (Rabin, 4/21). Read the story.

Kaiser Health News: Progress, Challenges As Medicaid Rolls Swell in Wash.
The Seattle Times' Lisa Stiffler, working in partnership with Kaiser Health New, reports: "Washington state has blown past its targets for signing up new Medicaid participants under the Affordable Care Act (ACA). The program’s ranks have grown roughly 25 percent in the past six months, helping fulfill one of the act’s key goals to provide health care to nearly all Americans. By the end of March, more than 285,000 adults who are newly eligible to participate in Medicaid had signed up for coverage. That’s twice the number officials had hoped to reach by then, and a target they hadn’t expected to hit for three more years" (Stiffler, 4/18). Read the story.

The New York Times: Health Law Fund-Raising Is Detailed
The Government Accountability Office provided new details on Sunday of how the Obama administration raised money from outside organizations to promote enrollment in health insurance under the health care law. Republicans said such solicitations were meant to circumvent limits on government spending imposed by Congress. But in a report to Congress, the accountability office did not give a legal opinion on the propriety of the fund-raising. Administration officials said it was legal. Under federal law, they said, the secretary of health and human services can encourage support for nonprofits that promote public health (Pear, 4/20).

Politico: Beyond 8 Million: Obamacare Math
The surge of people who signed up in the new health insurance exchanges surpassed both White House targets and expectations. It seemed unimaginable six months ago. But the exchanges aren’t the only way people can get covered under the Affordable Care Act. And it’s by no means the only number people will keep fighting about. ... Now that the 2014 sign-up season has ended, here’s a look at several aspects of health law coverage and the brewing disputes about how to measure them (Norman, Haberkorn and Cheney, 4/19).

The New York Times: Democrats Confront Vexing Politics Over The Health Care Law
When Franklin D. Roosevelt established Social Security, he created generations of loyal Democrats. When Lyndon B. Johnson signed Medicare into law, he built on that legacy, particularly with older Americans. And when George W. Bush instituted a new prescription drug benefit for Medicare, it helped reclaim elderly voters for Republicans. But President Obama’s Affordable Care Act, the $1.4 trillion effort to extend health insurance to all Americans, is challenging the traditional calculus about government benefits and political impact (Martin, 4/19). 

The Wall Street Journal: Ted Cruz, Invoking Reagan, Angers GOP Colleagues But Wins Fans Elsewhere
Despite resistance from Senate Republicans and Democrats, he stood up before an empty Senate on Sept. 24 to argue Congress shouldn't renew government funding while the health law remained on the books. "I rise today in opposition to Obamacare," he said, launching a 21-hour monologue that included a reading of "Green Eggs and Ham." Mr. Cruz was roundly pilloried. ... While he lost his defunding attempt, he says he finds victory in the low approval ratings of Mr. Obama and his health-care law (Langley, 4/18). 

CNN: Why Are Some Democrats Running From Obamacare?
Polls have shown that voters love popular provisions calling for mandatory coverage for maternity care and extending coverage for young people up to age 26 to stay on their parents' health insurance policies. And recent figures from the Congressional Budget Office show that Obamacare will cost about $5 billion less to implement in 2014 than originally estimated. Still, some Democrats have run from the President's signature health care reform law so fast, they've practically left skid marks. The question is: Will they run back? (Abdullah, 4/18).

The Associated Press: Clock Ticking For States To Adopt Health Exchanges
For the more than 30 states that defaulted to the federal government under President Barack Obama's health care law, time may be running out to decide whether to create their own state-run insurance exchanges. With the chance to apply for hundreds of millions of dollars in federal help set to expire in a few months, even Obama's home state of Illinois is expressing little interest in taking the next step. The law's disastrous rollout and lingering unpopularity have made it risky to raise the issue in a tense election year despite Obama's announcement Thursday that 8 million Americans have signed up for subsidized private insurance (Johnson, 4/18).

USA Today: Obamacare Website Resets Passwords Over Heartbleed Bug
The Obama administration has reset the passwords of consumers who created accounts through HealthCare.gov, saying the precautionary move was necessary to protect personal information at risk through the newly discovered Heartbleed Internet bug. Those who have accounts will be prompted to create new ones the next time they visit the site, according to an announcement posted on HealthCare.gov, a federal website managed by the U.S. Centers for Medicare & Medicaid Services. Government officials say there's no evidence that anyone's personal information has been compromised (King, 4/19).

The Washington Post: Obamacare’s High-Risk Pools Are Closing For Real This Time
After three previous extensions, it looks like Obamacare’s temporary high-risk pools for the some of the country’s sickest patients are finally closing as planned. The high-risk pools were set up in each state four years ago as a bridge to Obamacare’s coverage expansion this year, when insurers can no longer deny people coverage or charge them more because of a pre-existing condition. ... Many of the PCIP patients had been undergoing treatment for cancer, diabetes and heart disease (Millman, 4/18). 

The Washington Post: Md. Spent $90 Million On Health Exchange Technology, According To Cost Breakdown
Of the nearly $130 million that Maryland has spent on its troubled health insurance exchange, more than $90 million went toward technology expenses, according to a breakdown of costs released Friday. ... State officials have said the exchange is so structurally flawed that it would be cheaper to replace the system than continue to fix it. Maryland hired Deloitte Consulting this month to oversee that replacement, which is expected to cost at least $40 million to $50 million, plus software and hardware costs (Johnson, 4/18).

The New York Times: Health Care Spending’s Recent Surge Stirs Unease
For years, because of structural changes in the health care delivery system and the deep economic downturn, the health care "cost curve" — as economists and policy makers call it — had bent. Health spending was growing no faster than spending on other goods or services, an anomaly in 50 years of government accounts. But perhaps no longer. A surge of insurance enrollment related to rising employment and President Obama’s health care law has likely meant a surge of spending on health care, leaving policy experts wondering whether the government and private businesses can control spending (Lowrey, 4/18).

The Washington Post: Doctors Still Make Good Money
In the United States, doctors on average still make at least three times the annual median household income. The lowest average income on the list of doctors for 2013 was $174,000 and in 2012, the median household income was about $51,000. Orthopedics had the highest average earnings at $413,000, and cardiologists and urologists were not far behind. Of the 25 medical specialties listed, three-quarters of them had an increase from 2012, according to the Medscape Physician Compensation Report, an annual survey of doctors around the country (Tobey, 4/18). 

The New York Times: House Calls Are Making A Comeback
A relic from the medical past — the house call — is returning to favor as part of some hospitals’ palliative care programs, which are sending teams of physicians, nurses, social workers, chaplains and other workers to patients’ homes after they are discharged. The goal is twofold: to provide better treatment and to cut costs. ... Confusion continues to exist over what palliative care is and whom it is for. Broadly, it is meant to ease symptoms and pain, and focus on quality of life for severely ill patients, who can choose between continuing or halting traditional medical treatment (Freudenheim, 4/19).

The Wall Street Journal: Walk-In Urgent-Care Companies Are Providing Relief to Retail Landlords
People with relatively minor health problems—say, the flu or a deep cut—aren't the only ones getting relief from growing walk-in "urgent care" companies such as CityMD and PM Pediatrics. These companies also are providing a little tonic to retail landlords (Li, 4/20).

NBC News: Clinton Docs Offer Glimpse Into Failed Health Care Fight
Newly released documents from the Clinton White House reveal a candid assessment of the looming fight over the administration’s doomed health care plan, as advisers tried unsuccessfully to steer the sprawling legislation through Congress. A series of 1993 memos and briefing notes shows how the Clinton White House anticipated -- but was ultimately overwhelmed by -- Republican lines of attack against the health care reform effort, which collapsed under criticism through 1993 and 1994. ... Laying out an early strategy for pushing the plan through Congress, the summary memo urged tight control by an elite group of White House officials – a strategy that ultimately drew criticism as one reason for the legislation’s demise (Dann, 4/18).

Politico: Bill Clinton's 'Keep Your Plan' Dilemma
During an August 1994 prep session for a presidential press conference — which was supposed to set up a health care reform vote that never happened — Clinton and his aides discussed how to make the public feel more comfortable about a health care plan that was supposed to cover all Americans ... Just like Barack Obama did during the passage of his health care law, Clinton wanted to reassure Americans that his health care plan wouldn’t disrupt their own coverage if they already had it, according to a private White House transcript of their conversation. ... Even after Clinton raised the point, though, there was no discussion of the critical question that got Obama in trouble years later: Can the president really make that promise? (Nather, 4/18).

The Associated Press: Clinton Sought GOP Support For Health Care
President Bill Clinton's advisers estimated early in his term that passing a health care overhaul would require a delicate balance of Democratic and Republican support, needing at least eight moderate Republicans in the Senate and 15 or more in the House to win approval, according to documents released Friday. ... A strategy memo from 1993 argued the plan would require support from enough conservative Democrats and moderate Republicans without alienating too many liberal Democrats. But the bill never cleared a House committee (Thomas, 4/18).

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