First Edition: April 14, 2014

Today's headlines include continuing coverage of the announcement that Kathleen Sebelius will leave her post as secretary of the Department of Health and Human Services and the challenges that her likely successor will face. 

Kaiser Health News: Waiting – And – Waiting On The Nursing Home Inspector
Kaiser Health News staff writer Anna Gorman, working in collaboration with the Los Angeles Daily News, reports: "The case is just one example of hundreds in Los Angeles County and thousands statewide in which investigations by nursing home regulators have remained incomplete for months, sometimes years. There were 3,044 open cases in the county as of mid-March, 945 of which date back two years or more, according to an audit released last week by the Los Angeles County Auditor-Controller" (Gorman, 4/14). Read the story. 

Kaiser Health News: Obama Hails Sebelius' 'Extraordinary Service' (Video)
Kaiser Health News posted video clips of Friday’s remarks by President Barack Obama and Health and Human Services Secretary Kathleen Sebelius (4/11). Watch the videos.

Los Angeles Times: Sebelius Praises Obamacare, Concedes Rollout Was Botched Outgoing Health and Human Services Secretary Kathleen Sebelius said Sunday that the health insurance exchanges that are now up and running across the country have given uninsured Americans a true choice of insurance plans with price comparisons. “People have competitive choices and real information for the first time ever in this insurance market,” Sebelius said in an interview on NBC's "Meet The Press" (Savage, 4/13).

The Wall Street Journal: Sebelius Exits Without Regret, Despite 'Awful' Period
Outgoing Health and Human Services Secretary Kathleen Sebelius described the period last fall when HealthCare.gov was crippled by technical problems as "awful," but said she had no regrets as she prepares to leave her job. In an interview with NBC News that aired Sunday, Mrs. Sebelius said she would ask different questions about the readiness of the website if she could have a do-over (McCain Nelson, 4/13). 

Politico: Sebelius Says Departure Was Her Choice
Outgoing Health and Human Services Secretary Kathleen Sebelius says her departure after Obamacare’s first, rocky open enrollment period was her own choice and that it was “a logical time to leave.” “The president and I began to talk, you know, after the first of the year,” Sebelius told NBC’s Andrea Mitchell in an interview that aired Sunday on “Meet the Press. “And I went back to him in early March and said, ‘You know, I'm really optimistic we’re going to meet the targets and the enrollment is good, the site is working well. I think once we finish this first chapter you really should begin to look for the next secretary who can be here through the end of your term.’ And that really wasn't a commitment I was willing to make. And he knew that” (Titus, 4/13).

The Associated Press: Sebelius: Health Care Launch 'Terribly Flawed'
Outgoing Health and Human Services Secretary Kathleen Sebelius says the administration's own predictions that the new health care law's online sign-up system would be ready by Oct. 1 were "just flat out wrong." Sebelius told NBC's "Meet the Press" in an interview airing Sunday the health care website's launch was "terribly flawed and terribly difficult." She says that eight-week period was her low point of her tenure (4/13).

The New York Times: Sebelius’s Slow-Motion Resignation From the Cabinet
The White House frustration with Ms. Sebelius crystallized by Thanksgiving, as it became clear in Washington that she would eventually have to go. Republicans were brutalizing her at congressional hearings. The health care website’s problems were consuming the White House. ... But three things put off Ms. Sebelius’s departure: Mr. Obama’s fear that letting people go in the middle of a crisis would delay fixing the website; his belief that ceremonial firings are public concessions to his enemies; and the admiration and personal loyalty that Mr. Obama still felt for Ms. Sebelius and her advocacy for his chief domestic legacy (Shear, Calmes and Pear, 4/11).

Politico: The Kathleen Sebelius Sendoff: Everybody Wins
The White House isn’t just celebrating the big Obamacare recovery and the 7.5 million signups for health coverage. They’re also breathing a quiet sigh of relief that they were able to ride out another huge political problem: how to let Kathleen Sebelius quietly slip out the door. ... The idea that Sebelius can still claim full credit for the health care law’s achievements isn’t going to fly with a lot of the public. Obamacare opponents — and some angry Democrats — insist that Sebelius had to go. She was, after all, the Health and Human Services secretary who let the broken website go live — and define Obama’s signature program with an image of incompetence. But now, because of the timing, some liberals could actually push back against the “Sebelius leaves because of failed website” storyline. What failure, many of them asked on Friday? She helped bring health care to more than 7 million people (Nather, 4/11).

Politico: Whitehouse: HHS Swap Probably 'A Good Thing'
Sen. Sheldon Whitehouse on Sunday praised the leadership changes at the Department of Health and Human Services as the Obama administration emerges from the first, rocky enrollment period under the Affordable Care Act. The Rhode Island Democrat commended outgoing HHS Secretary Kathleen Sebelius, even as some Democrats were privately frustrated by her management, And he suggested a " new face” was likely a positive step (Titus, 4/13).

Politico: Blackburn: Sebelius Resignation Won't Stop Obamacare Fight
The Obamacare fight isn't going anywhere, Republican Rep. Marcia Blackburn of Tennessee said Sunday. The resignation of Kathleen Sebelius, the health and human services secretary, won't stop Republicans for continuing to hammer the Affordable Care Act. Blackburn argued that it will likely heighten criticism (Summers, 4/13).

The Wall Street Journal: Obama Announces New Health Secretary Nominee
President Barack Obama's decision to place Sylvia Mathews Burwell atop the federal health agency sets up a fresh Senate fight over his signature domestic achievement, and poses a test for a relatively unknown but experienced White House official. In announcing Ms. Burwell's nomination Friday to succeed Health and Human Services Secretary Kathleen Sebelius, Mr. Obama hit refresh on a post that symbolized the fraught rollout of the Affordable Care Act. Republicans prepared to use Ms. Burwell's Senate confirmation as a new opportunity to showcase what they see as the law's flaws, a central issue in this year's midterm elections (Lee, Peterson and Paletta, 4/11).

Los Angeles Times: Obama Names Budget Chief As New Health Secretary 
With Burwell, who was unanimously confirmed by the Senate to her current post, the White House hopes to ensure the continued rollout of the healthcare law offers Republicans no more ammunition to attack it. Obamacare has shaped up to be one of the major issues in the midterm elections. Burwell's confirmation hearings, however, are likely to be boisterous, as Republicans dissect what they see as the healthcare law's failures and grill a nominee in line for a job the GOP calls the "chief implementer of Obamacare" (Parsons and Memoli, 4/11).

The Washington Post: For HHS Hot Seat, Obama Chooses Burwell, A Budget 
After the political tumult and technical defects that have hindered the Affordable Care Act, Obama selected a trusted budget wonk with a reputation for management acumen and a rapport with lawmakers on Capitol Hill. By choosing someone he twice called a “proven manager” in his announcement Friday, Obama signaled his need for a set of steady hands to shepherd his signature domestic initiative through the end of his tenure. Even though the administration met a first-year insurance enrollment goal, many potential obstacles lie ahead before the health-care law is fully implemented (Eilperin and Goldstein, 4/11).

The Associated Press: New 'Face,' But Some Old Problems For 'Obamacare'
Senate Finance Committee Chairman Ron Wyden, D-Ore., who will hold confirmation hearings for Burwell, said there's an opportunity for her to move the health care debate beyond stalemate. While a political truce is unlikely over Obama's health overhaul, Wyden ticked off a list of other issues where Republicans and Democrats might be able to find compromise. Among them: revamping the way Medicare pays doctors, providing coordinated care for patients with chronic illnesses and using data to encourage delivery of quality health care at lower cost (Alonso-Zaldivar, 4/12).

The Washington Post: Here Are The Biggest Problems For Obamacare’s Next Leader
If Sylvia Mathews Burwell is confirmed as the next secretary of Health and Human Services, it puts her in charge of a sprawling health-care overhaul that's still gaining its footing and is under constant attack from opponents. The Obama administration is celebrating the more than 7.5 million people who have signed up for coverage in Obamacare health insurance marketplaces, but there are big implementation challenges for the next HHS leader. Here are the major challenges the next HHS chief will face (Millman, 4/11).

USA Today: Burwell Hearings To Be Debate Over Health Care
Confirmation hearings for the next secretary of health and human services are likely to be more about the health care law than nominee Sylvia Mathews Burwell. Republicans are serving notice that they will use the Burwell hearings to spotlight what they call problems with the health care law, including canceled policies, higher premiums, and delay of some provisions (Jackson, 4/13). 

Politico: Sylvia Mathews Burwell Pick Complicates Democrats’ Plans
Senate Democrats planned to spend the spring ramping up their election-year message on income inequality — not relitigating Obamacare. Change of plans. Republicans hope to turn Sylvia Mathews Burwell’s nomination to run the Department of Health and Human Services — announced by President Barack Obama on Friday — into a proxy war over Obamacare (Kim and Everett, 4/11). 

The New York Times: In New York, Hard Choices On Health Exchange Spell Success
In contrast with the early stumbles in most of the country, New York State, almost from the start, has provided a textbook lesson in how to make the Affordable Care Act work. But it has done so by making some tough decisions. New York has signed up more than 900,000 people for commercial or government plans, lured 16 insurance companies onto its exchange, provided subsidies for most customers and reduced premiums across the board (Hartocollis, 4/13).

Los Angeles Times: For The Working Poor, New Health Premiums Can Be A Burden
For nearly two decades, Barbara Garnaus maintained a modest, delicate life balance: keeping her part-time Orange County school district job and juggling her bills and credit card debt. Now 63, living alone, she counts every dollar, has no cellphone and commutes an hour in traffic so she can keep an affordable apartment in Laguna Woods (Karlamangla, 4/13).

The Associated Press: Medicaid Expansion Debate Good For Insurers
Some of the biggest health insurance companies in the country are poised to benefit from the debate over expanding Medicaid in Virginia, regardless of its outcome. If Gov. Terry McAuliffe and the Democratically controlled Virginia Senate prevail, the state will expand Medicaid eligibility to about 400,000 low-income residents. The money to insure them — hundreds of millions of dollars a year — will be paid by the federal government to private insurance companies. Understandably, those insurers strongly favor this option (4/13).

The Washington Post: Va. Republicans Aren’t Blinking In Showdown Over Medicaid Expansion
Virginia Republicans were supposed to be squirming by now. For months, their opposition to expanding Medi¬caid under the Affordable Care Act has put them at odds with some traditional allies in the business world. Hospitals, the state chamber of commerce and corporate leaders have been calling, writing, visiting and buttonholing, pushing what they call “the business case” for expanding coverage to thousands of uninsured under the health-care law, with the federal government promising to pay most of the cost. Gov. Terry McAuliffe and other Democrats who favor expansion have been betting on that pressure to sway Republicans, particularly in rural areas where hospitals are often the largest employer and are ¬eager for the financial girding that the coverage expansion would provide (Vozzella, 4/13).

The Associated Press: With New Law, Insurers Target Diabetics
Insurers are calling diabetics when they don’t pick up prescriptions or miss appointments. They are arranging transportation to get them to the doctor’s office and some are even sending nurses on house calls in an effort to avoid costly complications that will have big impact on their bottom lines. Before the Affordable Care Act, some diabetics struggled to find insurance because of their pre-existing condition. But the new law no longer allows companies to refuse them or charge more, making early intervention even more critical (4/13).

The Wall Street Journal: Odd-Hour Workers Face Loss Of Employer Health Plans
Ms. Caspersen, a waitress at Virtues Restaurant in the Summa Akron City Hospital, falls into part of the workforce that may feel the strongest effects of the Affordable Care Act: workers whose hours change on a weekly or seasonal basis. Thousands of these so-called variable-hour employees—many of whom work on college campuses that don't operate during summer months—could lose their benefits as employers use new formulas to classify workers as full time or part time. The distinction determines which employees are entitled to company-sponsored health coverage (Weber, 4/13).

The Wall Street Journal: Discord Over What To Pay The Doctor
Access to preventive care at no charge to the patient is a key tenet of the federal health law. But questions about what qualifies as "preventive" are causing discord between doctors and patients, particularly when it comes to the traditional annual checkup. Some patients, anticipating free visits to address all their health issues—past, present and potential—are upset to find that only some of that qualifies as preventive care, exempt from deductibles and copays (Beck, 4/13). 

The Washington Post: These Maps Tell You Everything That’s Wrong With Our Drug Pricing System
The kind of health care you get and how much it costs depends a lot on where you live. Take, for example, the way that doctors across the U.S. treat a chronic eye disease, known as wet age-related macular degeneration, that among older people had long been a leading cause of blindness. There is no evidence that the disease varies from place to place. But as recent Medicare data show, the way that doctors’ treat it does, and those choices have huge effects on the U.S. and personal budgets (Rich and Whoriskey, 4/11).

The Associated Press: ‘Obamacare’ Under Attack As Conservatives Eye 2016
Republicans eyeing the 2016 White House race battered President Barack Obama’s health care law and nicked each other Saturday, auditioning before a high-profile gathering of conservatives that some political veterans said marked the campaign’s unofficial start. A speaking program packed with potential presidential candidates weighed in on the House Republicans’ controversial budget, the party’s struggle with Hispanics, the GOP’s future and the upcoming midterm elections while taking turns on a conference room stage facing hundreds of conservative activists gathered in New Hampshire’s largest city (4/12).

The Associated Press: Gingrich Blasts ‘Ideologues’ Behind Health Law
Newt Gingrich isn’t holding back in his criticism of the Cabinet secretary and others behind the troubled rollout of the health care law. The former House speaker and Republican presidential candidate says Health and Human Services Secretary Kathleen Sebelius (seh-BEEL’-yuhs) and other Democrats are “nut-cake ideologues” and less than competent (4/12).

Los Angeles Times: Democrats Hoping To Succeed Rep. Waxman Square Off In Pacific Palisades
Not surprisingly, the four candidates displayed similar views on most issues: Protect the environment, improve public education, boost the minimum wage and take other steps to ease the income diversity between the rich and the poor. All said they would like to see the Affordable Health Care Act improved upon by extending Medicare to all Americans and not remain limited to those over 65. Miller also called for finding ways to cut medical costs so healthcare dollars can be spent more efficiently. Savings also could be funneled to other needs, such as education, he said (Merl, 4/13).

The Associated Press: Abortion In Cases Of Rape: New Rifts In Old Debate
Poll after poll over many years has shown that Americans overwhelmingly support legal access to abortion for women impregnated by rape. Yet the issue remains divisive, as demonstrated by two current rifts — one involving U.S. aid policy overseas, the other highlighting strategy differences within the U.S. anti-abortion movement. The National Right to Life Committee recently voted to cut ties with one of its most zealous state affiliates, Georgia Right to Life. The move, which angered many anti-abortion activists nationwide, came after the affiliate defied instructions to endorse an anti-abortion bill in Congress because it included exceptions for rape and incest (Crary, 4/12).

The New York Times: Surge In Prescriptions For Opioid Painkillers For Pregnant Women
Of 1.1 million pregnant women enrolled in Medicaid nationally, nearly 23 percent filled an opioid prescription in 2007, up from 18.5 percent in 2000, according to a study published last week in Obstetrics and Gynecology, the largest to date of opioid prescriptions among pregnant women. Medicaid covers the medical expenses for 45 percent of births in the United States (Saint Louis, 4/13). 

Los Angeles Times: California's Medical Prison Beset By Waste And Mismanagement 
California's $840-million medical prison — the largest in the nation — was built to provide care to more than 1,800 inmates. When fully operational, it was supposed to help the state's prison system emerge from a decade of federal oversight brought on by the persistent neglect and poor medical treatment of inmates. But since opening in July, the state-of-the-art California Health Care Facility has been beset by waste, mismanagement and miscommunication between the prison and medical staffs (St. John, 4/12).

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