Six GOP governors now back Medicaid expansion - Health law enforcers lacking at IRS - W.H.: CBO's Obamacare analysis 'oversimplified' - Republicans want sequester avoidance deal to their liking Presented by

THE DIRTY HALF-DOZEN? SIX GOP GOVERNORS NOW BACK MEDICAID EXPANSION — Michigan Gov. Rick Snyder became the latest on Wednesday, lining up with a phalanx of health industry representatives and breaking with GOP anti-Obamacare orthodoxy. Snyder’s move adds to the pro-expansion momentum created earlier this week when Ohio Gov. John Kasich offered forceful support. But Snyder will fail unless he gets a little help from his friends in Lansing. Republican lawmakers there embarrassed him when he sought to build a state-based insurance exchange last year, killing his proposal without even bringing it to the floor for a vote. But members’ reaction to his expansion bid was muted — some promises for study, some boilerplate concern about the potential for unsustainable costs and even some outright support. As far as Snyder is concerned, no one said “no.” http://politico.pro/11Mex50

--Snyder’s office estimates that about 470,000 people would ultimately join Medicaid by 2022 under his proposal. He also estimates that it will result in savings, all of which he said would be set aside to be used in a few years, when federal support from the expansion drops from 100 percent to 90 percent. http://1.usa.gov/XVYVVc


HEALTH LAW ENFORCERS LACKING AT IRS — Obamacare critics liked to warn of a fearsome army of tax collectors roaming the country enforcing the health law to the letter. Turns out, that army may not exist — and its absence could create headaches for the administration as implementation reaches its peak. Pro’s Paige Winfield Cunningham reports that funding for 856 full-time workers dedicated to the health law wasn’t renewed in this year’s budget, just when they’re needed most. “The health care law includes at least 42 provisions that will either add to or amend the tax code — and at least eight of those will require the IRS to build new processes that don’t currently exist,” according to the Treasury inspector general. http://politico.pro/XlEmTV

Welcome to Thursday PULSE, where we’re a little miffed that your PULSEr’s hometown Knicks were laughed off the court of the Verizon Center last night with a woeful fourth-quarter performance against the Washington Wizards. On the bright side, pitchers and catchers report next week… http://bit.ly/SfbsWP

“It’s not in my past to presume, PULSE can keep on moving in both directions.”

WHITE HOUSE CALLS CBO’S OBAMACARE ANALYSIS ‘OVERSIMPLIFIED’ — Spokesman Jay Carney leveled the claim during his daily press briefing when asked about the agency’s estimate that 7 million people would lose their employer-based coverage over the next decade. That estimate is up from the 4 million CBO projected last year. After he rejected the report’s conclusion, Carney said HHS could elaborate on his claim. “The bottom line here is that no matter where you live, on Jan. 1, 2014, an insurance marketplace will be up and running, and consumers will have more access to quality, affordable health insurance coverage,” he said. HHS officials did not respond to a request for comment.

MORE ON MEDICAID EXPANSION:

--GOV. BENTLEY NIXES EXPANSION FOR ALABAMA – Leave it to the most conservative state (per Gallup: http://bit.ly/XrQbrw) to rain on the pro-expansion parade. The Republican governor offered a budget that excluded funding for expansion, and his office said he still has “serious concerns” about the “long-term costs” of adding thousands of Alabamans to the Medicaid rolls. The expansionless budget: http://1.usa.gov/YE4RF6

--EXPANSION BAD NEWS FOR CONNECTICUT PARENTS? — Connecticut is fully on board with the Affordable Care Act, but the Connecticut Mirror reports that Medicaid expansion might actually cut into the coverage some state residents receive. That’s because under the state’s current Medicaid rules, parents earning up to 185 percent of the federal poverty level are eligible for Medicaid. But the ACA’s Medicaid expansion only covers adults earning up to 138 percent of the federal poverty level. A budget rolled out by Gov. Dannel Malloy on Wednesday would cut off Medicaid eligibility for anyone earning above the 138-percent threshold and direct them instead to new health insurance exchanges due to go online next year. http://bit.ly/WONDWC; Gov. Malloy’s FY 2014-15 budget proposal: http://1.usa.gov/Wv8FtC

--ARKANSAS GOVERNOR EYEING EXPANSION COMPROMISE? – Some buzz in Arkansas suggests Democratic Gov. Mike Beebe is looking for the same sort of Medicaid expansion flexibility that Ohio Gov. John Kasich asked for Monday, when he endorsed expansion. An Arkansas Times blogger suggests that Beebe wants to give people earning from 100 percent to 138 percent of the poverty level a choice between Medicaid or an insurance exchange: http://bit.ly/X5i9v0

--WASHINGTON GOVERNOR PRESSES FOR EXPANSION – The Associated Press reports that Washington Gov. Jay Inslee is pushing Republicans in his state to join him and back Medicaid expansion. http://bit.ly/WPqGmb

--INDIANA GOV: EXPANSION ON MY TERMS ONLY – And Gov. Mike Pence’s terms include the ability for Indianans to enroll in Healthy Indiana, a plan that already exists in the state. The AP reports that Pence made his demand in a phone call with HHS Secretary Kathleen Sebelius this week. http://bit.ly/12u8KkH

REPUBLICANS WANT SEQUESTER AVOIDANCE DEAL TO THEIR LIKING — Republicans want to avert the sequester — but only on their terms. POLITICO’s Jake Sherman reports that unless Democrats are willing to bend to a few GOP demands, House Speaker John Boehner is ready to let the automatic cuts hit on March 2. Among the proposals Republicans want on the table: upping the Medicare eligibility age to 67 and restructuring premiums to raise a combined $145 billion, wringing $10 billion from Medicaid provider taxes, repealing some social services block grants and reforming medical liability. http://politi.co/TMu3dF

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SUPREME COURT SHOOTS DOWN NURSING HOME OPERATOR STAY REQUEST — Remember the saga of the nursing home operator seeking help from the Supreme Court to overturn a lower-court order to rehire 700 workers? Well, the high court shot them down Wednesday after Justice Antonin Scalia referred the matter to the full court. At issue was an order sought and won by the National Labor Relations Board to force the operator, HealthBridge Management, to rehire 700 workers involved in a labor dispute. But a recent district court decision that called into question President Obama’s power to make recess appointments to NLRB called into question the board’s decisions. The Supreme Court, though, wasn’t buying it. ICYMI, the basis of the dispute: http://politico.pro/XPpzko

--HealthBridge’s response to the ruling: “While we are disappointed in the decision, HealthBridge managed health care centers intend to comply with the district court’s order. As always, our primary concern is with the care and wellbeing of our patients. Throughout this process our guiding principle has been to provide the highest standard of care and safety to our patients.”

FRC SHOOTER DIDN’T HAVE ABORTION ON HIS MIND — Looks like abortion and contraception politics had little to do with the shooting last year that wounded a security guard at the D.C. headquarters of the Family Research Council. Reuters reported Wednesday that the shooter, Floyd Corkins, said in a plea agreement that he was targeting organizations that oppose gay marriage, and he had brought 15 Chick-fil-A sandwiches with him to smear in the faces of his victims. Creepy? Yes. Health-related? No. http://nyti.ms/11XcFBX

THREE MORE MEMBERS NAMED TO LONG-TERM CARE COMMISSION — House Minority Leader Nancy Pelosi announced Wednesday that she’s appointed three members to a long-term care commission established as part of the fiscal cliff deal hatched in December. Her appointees: Bruce Chernof, president of the SCAN Foundation; Judith Stein, executive director of the Center for Medicare Advocacy; and George Vradenberg, a longtime business executive who has contributed to Alzheimer’s Disease research. Earlier in the day, Senate Majority Leader Harry Reid named Georgetown professor Judy Feder, SEIU United Long Term Care Workers' Union President Laphonza Butler and Dr. Javaid Anwar of Nevada to the commission.

ALTARUM ISSUES NEW HEALTH CARE DATA SET — The Altarum Institute is out with its latest monthly assessment of the health care workforce, spending and price. In January, health care employment rose 23,000, just below the two-year average, driven largely by a 28,000-job gain in ambulatory care and an 8,000-job decline in nursing and residential care. Meanwhile, health care prices were up 1.7 percent in December 2012 from the same month a year earlier, the lowest year-over-year increase since 1998. And health spending in December 2012 rose 4 percent from December 2011, slightly below the 4.3 percent increase recorded for all of last year. The spending brief: http://bit.ly/UAP9gx; The price brief: http://bit.ly/WRozex; The workforce brief: http://bit.ly/11MrCLN

ADVOCATES AND RESEARCH INSTITUTIONS WARN OF SEQUESTER IMPACT — United for Medical Research is out with a new analysis suggesting that the sequester — and the automatic 5.1 percent cut to NIH funding — would cost 20,500 life sciences jobs and cost $3 billion in economic output. The losses would be most pronounced in California — to the tune of about 3,000 jobs — followed by Massachusetts, New York and Texas. United for Medical Research is a collection of powerful research institutions and advocacy groups — from the American Cancer Society to MIT to the Biotechnology Industry Organization — urging increases in NIH funding. http://bit.ly/UVTuJ5

WHAT WE’RE READING, By Brett Norman

Sen. Robert Menendez went to bat with CMS officials over their finding that a major campaign supporter — the Florida eye doctor Salomon Melgen, at the center of a Senate ethics investigation of Menendez — had overbilled the government by $8.9 million, The Washington Post reports. http://wapo.st/11NjKJV

CMS leaked to USA Today an announcement that seniors have saved $5.7 billion since January 2011 because of the ACA’s provisions to close the doughnut hole. http://usat.ly/VF1bAo

The Washington Post’s Sarah Kliff reports on the coalition of Obamacare supporters and opponents who came together behind Ohio Gov. John Kasich’s push for Medicaid expansion. http://wapo.st/11WEwlN

An editorial at National Review puts Kasich on the “dishonor role” of Republican governors taking “free money” for the Medicaid expansion under Obamacare. http://bit.ly/11TWWU5

The Kaiser Family Foundation has a detailed analysis of the federal health care law’s reforms that will change premiums for young people. http://bit.ly/UzfQST

California Healthline’s Dan Diamond tells the back story of how a pharmacy chain — Walgreens — got into the ACO business. http://bit.ly/YDuuWB

The CEO of a hospital chain under investigation for its Medicare billings shared his controversial strategies with doctors at Knapp Medical Center in Texas, and California Watch has it on tape. http://bit.ly/XOXVE4

Mayor Michael Bloomberg and two private equity executives are pledging $25 million over three years in research to cure Lou Gehrig’s disease, The New York Times reports. http://nyti.ms/UCncFo

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