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Headlines in Health Policy

A roundup of recent news about health coverage, health delivery system reform, and more.

Medicaid
Maine's Highest Court Orders Rollout of Medicaid Expansion

Maine's highest court on Thursday blocked the latest attempt by Gov. Paul LePage to restrain Medicaid expansion, although the legal battle appeared set to continue. Maine's Supreme Judicial Court said two lower-court rulings ordering the state to begin executing the voter-approved Medicaid expansion stand, and that there are still issues for the lower court to resolve. Backed by nearly 60 percent of Maine voters last November, the Medicaid expansion would cover more low-income adults, while making the state the 32nd to adopt a key plank of the Affordable Care Act. Mr. LePage has argued Maine was being asked to implement the program without funding from the legislature, and his administration wanted the expansion put on hold pending legal appeal. (Jon Kamp, Wall Street Journal)

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Ohio Gov. Kasich Stumps Again in Support of Medicaid Expansion

Four years after going out on a limb to get Medicaid expansion enacted in Ohio, outgoing Republican Gov. John Kasich is worried about the future of the program. So he is now defending it — through a study and through the stories of people who have benefited from the coverage expansion. Ohio Medicaid Director Barbara Sears says the analysis shows Medicaid expansion has cut in half the number of uninsured Ohioans. Ninety-six percent of people in the program with opioid addiction got treatment, and 37 percent of smokers were able to quit. One-third reported improved health, including better access to medical care for high blood pressure and diabetes. ER visits went down 17 percent, and there was a 10 percent increase in the number of people seeing primary care doctors. And most recipients said Medicaid expansion made it easier to find work, earn more money, and care for their families. (Karen Kasler, National Public Radio)

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Kentucky Governor Loses Another Round in Medicaid Fight

Kentucky's Republican governor lost another round Monday in a legal fight over his efforts to revamp the state's Medicaid program to require poor people to get a job to keep their benefits. The latest setback for Gov. Matt Bevin came in his home state when a federal judge dismissed his lawsuit that sought a ruling validating the Medicaid changes. U.S. District Judge Gregory Van Tatenhove sided with a group of Medicaid recipients who were named as defendants in Bevin's lawsuit. The judge signaled that the legality of Bevin's Medicaid plan would be sorted out in a separate case in Washington, D.C. (Bruce Schreiner, Associated Press)

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Mississippi to Test Limits of Medicaid Work Requirements

The Trump administration is facing a key test with Mississippi's Medicaid program as the state seeks permission to be the first ever to impose work requirements without expanding Medicaid under Obamacare.  Already one of the poorest states in the nation, advocates say work requirements for "able-bodied" beneficiaries could decimate the health coverage that tens of thousands of residents depend on. While the administration touts state flexibility and has already approved work requirements in Medicaid expansion states, there could be far reaching practical and political consequences for approving them in Mississippi. (Nathaniel Weixel, The Hill)

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Affordable Care Act
For McCain, A Life of Courage, Politics Came Down to One Vote

For John McCain, a lifetime of courage, contradictions, and contrarianism came down to one vote, in the middle of the night, in the twilight of his career. The fate of President Donald Trump's long effort to repeal Barack Obama's health care law hung in the balance as a Senate roll call dragged on past 1 a.m. on a July night in 2017. Then came McCain — 80 years old, recently diagnosed with brain cancer, his face still scarred from surgery, striding with purpose toward the well of the Senate. The Arizona Republican raised his right arm, paused for dramatic effect and flashed a determined thumbs-down, drawing gasps from both sides of the aisle. Trump's health care bill was dead. McCain's lifelong reputation as free thinker, never to be intimidated, was very much alive. (Nancy Benac, Associated Press)

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GAO Report: Administration Needs to Step Up on 'Obamacare'

A congressional watchdog said Thursday the Trump administration needs to step up its management of sign-up seasons under former President Barack Obama's health care law after mixed results last year in the throes of a failed GOP effort to repeal it. On one hand, the Government Accountability Office found problems with consumer counseling and advertising and recommended such basic fixes as setting enrollment targets. On the other, it credited administration actions that did help people enroll, such as a more reliable HealthCare.gov website and reduced call center wait times. (Ricardo Alonso-Zaldivar, Associated Press)

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Health Care Politics
Why 'Medicare for All' Is Playing Poorly in Democratic Primaries

Most of the prominent Democrats eyeing 2020 presidential bids—including Sens. Kirsten Gillibrand of New York, Cory Booker of New Jersey, and Elizabeth Warren of Massachusetts—champion the idea of "Medicare for all," suggesting it's become almost a litmus test for the party's base. But the notion of government-funded health care has proved a tough sell to Democratic voters in swing districts that will determine control of the House. Many Democratic candidates who made that a centerpiece of their campaigns in key districts this year lost their primaries, in some cases getting clobbered by rivals who offered vaguer health care plans or backed a more incremental approach. Democratic primary voters in battleground districts in Iowa, Texas, Kansas, and New York passed over candidates who emphatically supported single payer. (Paul Demko, Politico)

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Costs
What Does Knee Surgery Cost? Few Know, and That's a Problem

The price we pay for health care often has little connection to what it actually costs. One hospital decided to investigate. Gundersen Health System set out to tally how much it cost to perform knee-replacement surgery. For nearly a decade, Gundersen Health System's hospital in La Crosse, Wis., boosted the price of knee-replacement surgery an average of 3 percent a year. By 2016, the average list price was more than $50,000, including the surgeon and anesthesiologist. Yet even as administrators raised the price, they had no real idea what it cost to perform the surgery — the most common for hospitals in the U.S. outside of those related to childbirth. They set a price using a combination of educated guesswork and a canny assessment of market opportunity. The actual cost? $10,550 at most, including the physicians. (Melanie Evans, Wall Street Journal)

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Prescription Drugs
Trump's Plan on Drug-Pricing Transparency Takes Step Forward

White House staff are reviewing a proposal that may require pharmaceutical companies to be more transparent about their pricing, a key piece of President Donald Trump's plan to lower drug costs. The Office of Management and Budget (OMB) has received a proposed regulation by the Department of Health and Human Services (HHS) that deals with drug-pricing transparency in the U.S. Medicare and Medicaid systems. OMB typically reviews regulations before they're made public. The Senate, meanwhile, is debating a spending bill for HHS. Senators Chuck Grassley, an Iowa Republican, and Dick Durbin, an Illinois Democrat, have proposed an amendment that would fund requiring drugmakers to post prices on direct-to-consumer advertising. The senators say the amendment would bring more transparency. (Anna Edney, Bloomberg News)

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