Daily Health Policy Report

Friday, August 1, 2014

Last updated: Fri, Aug 1

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Medicare

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Florida's Largest Health Insurer Is Raising Exchange Rates An Average Of 17.6 Percent

Kaiser Health News staff writer Phil Galewitz reports: “Florida Blue, the state’s largest health insurer, is increasing premiums by an average of 17.6 percent for its Affordable Care Act exchange plans next year, company officials say. The nonprofit Blue Cross and Blue Shield affiliate blames higher health costs as a result of attracting older adults this year who previously lacked coverage and are using more services than expected” (Galewitz, 8/1). Read the story.

This Story: Print | Link to | Top

Good News On California ACA Rates. But Why?

KQED’s Lisa Aliferis, working in partnership with Kaiser Health News and NPR, reports: “After years of double-digit rate hikes in health insurance premiums, California will see average increases of 4.2 percent in 2015 for people who purchase insurance through the Covered California exchange, the state's Obamacare marketplace. It’s good news for consumers, but two of the top insurance officials in the state disagree about why it’s happening” (Aliferis, 8/1). Read the story.

This Story: Print | Link to | Top

Health On The Hill: House Panel Focuses 'Microscope' On Marketplace Open Enrollment

House members examined concerns raised in a GAO report about the healthcare.gov website during a subcommittee hearing Thursday. Kaiser Health News’ Mary Agnes Carey and CQ Roll Call's Melissa Attias discuss the action (7/31). Listen to the audio or read the transcript.

This Story: Print | Link to | Top

A Reader Asks: With Job-Based Coverage, Can I Still Qualify For Cost-Sharing Subsidies

Kaiser Health News’ consumer columnist Michelle Andrews explains that if the insurance offered through an employer is considered affordable, you can’t qualify for the health law’s program to provide financial help to cover costs such as deductibles and co-payments (8/1). Read her response.

This Story: Print | Link to | Top

Capsules: Unfavorable Views Of Health Law Spike In July: Poll; Covered California Rates Up Modest 4.2 Percent

Now on Kaiser Health News’ blog, Jordan Rau reports on new poll findings: “The health law’s unpopularity among the public rose sharply in July with a surge of disapproval from people who had been agnostic about it in recent months, a poll released Friday shows. The law is as unpopular as it has been since it was enacted four years ago” (Rau, 8/1). 

Also on the blog, Capital Public Radio’s Pauline Bartolone reports on Covered California’s rates: “Covered California says health care premiums will go up modestly for most people buying coverage on the state exchange next year by an average of 4.2 percent” (Bartolone, 8/1). Check out what else is on the blog.

This Story: Print | Link to | Top

Political Cartoon: 'Frank N' Sense?'

Kaiser Health News provides a fresh take on health policy developments with "Frank N' Sense?" by Steve Sack.

Meanwhile, here's today's haiku:

SHAKING UP GRADUATE MEDICAL EDUCATION

Redistribution
Evidence of need be damned!
Bitter medicine
-Chris Koller 

If you have a health policy haiku to share, please send it to us at http://www.kaiserhealthnews.org/ContactUs.aspx and let us know if you want to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

This Story: Print | Link to | Top

Health Reform

Administration: Next Enrollment Season Will Have 'Bumps'

In a House hearing, the number two official at the Centers for Medicare & Medicaid Services responds to a critical GAO report and says while improvements to the federal online exchange are being made, it still "won't be perfect."

The New York Times: Work To Bolster Health Website Is Raising Cost, Officials Say
Obama administration officials said Thursday that the cost of the federal health insurance exchange was growing because they were assigning new work to contractors in an effort to prevent a repetition of the problems that crippled HealthCare.gov last fall. Andrew M. Slavitt, the No. 2 official at the Centers for Medicare and Medicaid Services, told Congress that the agency was changing requirements for its contracts to expand the scope of work that must be done (Pear, 7/31). 

Politico: Questions Linger About Obamacare Website, Year 2
HealthCare.gov is expected to enroll millions of new people in Obamacare this fall and re-enroll millions more who signed up the first time around. It's likely a more demanding task than the one that it buckled under last year. Will it be up to the task? A top federal health official says yes — with some "bumps." A top federal government investigator says maybe (Norman and Haberkorn, 7/31). 

The Fiscal Times: Healthcare.Gov Not Fully Ready For Round Two
Remember when HealthCare.gov was plagued with so many problems last fall that people could barely sign up? Well, after nearly a year of significant repair efforts pushing the website’s price tag to roughly $840 million, HealthCare.gov still "won't be perfect" and isn't "fully ready" for next year's open enrollment, officials said Thursday. During a House Energy and Commerce Committee hearing lawmakers grilled officials from the Centers for Medicare and Medicaid Services about the website, the costs it has incurred over the last year, and its readiness for next year’s enrollment process (Ehley, 7/31). 

CBS: There Will Be Some Bumps in Obamacare Enrollment This Year: Official
A top official at the Centers for Medicare and Medicaid Services (CMS) told House members Thursday that there will likely be more "bumps" next year in enrollment in the federal health exchange set up under Obamacare. "It won't be perfect," said Andrew Slavitt, who was recently appointed to join CMS -- the Health and Human Services agency that administers Obamacare -- as its principal deputy administrator (Bessler, 7/31).

Reuters: Next Obamacare Enrollment Period Faces Bumps: U.S. Official
U.S. consumers who purchase private health coverage through the federal Obamacare website HealthCare.gov are likely to find only modestly higher premiums but may still have technical problems signing up, a top health official said on Thursday. "It won't be perfect," Andrew Slavitt, a newly appointed principal deputy administrator at the Centers for Medicare and Medicaid Services (CMS), told lawmakers at hearing before a House of Representatives oversight committee. ... However, Slavitt said the three-month 2015 open enrollment period that begins Nov. 15 will be under vastly different circumstances from HealthCare.gov's botched launch last October, when the website was overwhelmed by technical problems for weeks (Morgan, 7/31).

Kaiser Health News: Health On The Hill: House Panel Focuses 'Microscope' On Marketplace Open Enrollment
House members examined concerns raised in a GAO report about the healthcare.gov website during a subcommittee hearing Thursday. Kaiser Health News' Mary Agnes Carey and CQ Roll Call's Melissa Attias discuss the action (7/31). 

Additionally -

CQ Healtbeat:  Health Law Reporting Could Spell Tax Season Headaches For Newly Insured
Tax preparers are anticipating confusion next year over new filing requirements stemming from the health care law following last week's release of draft forms by the Internal Revenue Service. The drafts posted on July 24 include a new form for recipients of federal subsidies to buy coverage through insurance exchanges and a modified income tax return that includes a line for individuals to indicate whether they met the law’s coverage requirements. The accompanying instructions will be released separately and are not expected for another month or so, leaving an incomplete picture of exactly how the process will work. Even without all the details, however, the novelty and complexity of the forms are expected to pose a challenge to low and moderate income families receiving subsidies under the 2010 overhaul, according to tax preparation firms (Attias, 7/31).

This Story: Print | Link to | Top

Critics Ask Supreme Court To Take Case About Health Law Subsidies

The appeal comes after the Fourth U.S. Circuit Court of Appeals in Richmond, Va., upheld the administration's use of subsidies on the federal insurance marketplaces. The D.C. appeals court has ruled against the administration on the issue, and critics hope the high court will step in to resolve the matter.

Los Angeles Times: Lawyers Challenging Health Subsidies Seek Quick Supreme Court Ruling
Lawyers challenging President Obama's healthcare law filed a quick appeal with the Supreme Court on Thursday, urging justices to take up the issue this fall and throw out insurance subsidies for nearly 5 million Americans. "The monumental significance of this legal issue requires the court's immediate, urgent attention," they said in a filing. "The longer the lawless IRS rule is in effect, the greater the upheaval when it is ultimately vacated" (Savage, 7/31). 

The Wall Street Journal: Health-Law Opponents Seek Supreme Court Review
Opponents of health-insurance subsidies tied to the Affordable Care Act moved quickly Thursday to get an appeal in front of the Supreme Court. The challengers, Virginia residents who objected to the subsidies, filed a petition with the high court just nine days after the Fourth U.S. Circuit Court of Appeals in Richmond, Va., upheld an Obama administration regulation that said subsidized insurance was available to qualifying consumers nationwide. That appeals court decision was one of two issued on the same day in mid-July that reached conflicting conclusions on the legality of the administration's approach. A federal appeals court in Washington ruled against the government, siding with a different group of challengers who argued language in the 2010 health-care law prohibited subsidies for those who buy insurance on a federal exchange, instead of one run by a state (Kendall, 7/31). 

Politico: Supreme Court Asked To Hear Obamacare Subsidies Case
The four Virginians whose challenge to Obamacare subsidies suffered a defeat last week are now asking the Supreme Court to hear the case. Their lawsuit was dismissed by the U.S. Court of Appeals for the 4th Circuit, which ruled that the Obama administration can legally award the subsidies through federally run insurance exchanges — not just those run by the states themselves. The individuals behind King v. Burwell say the subsidies are being improperly awarded through Virginia’s federally run exchange (Winfield Cunningham, 7/31). 

NBC: Obamacare Challengers Urge Quick U.S. Supreme Court Review
Challengers of a key provision of the Obama healthcare law Thursday asked the U.S. Supreme Court to take up the case and decide quickly whether people who buy their health insurance on state exchanges qualify for a federal subsidy. Two federal courts reached opposite conclusions on that issue (Williams, 7/31).

Fox News: Obamacare May Be Headed to Supreme Court – Again
President Obama's federal health care law may be headed to the Supreme Court – again. The high court has been asked to review a July 22 ruling by the Fourth Circuit Court of Appeals that declared constitutional all federal subsidies granted to enrollees of the health care system (7/31).

The Hill: High Court Asked to Rule On Obamacare Subsidies
The Supreme Court on Thursday was asked to decide whether some of the subsidies distributed under ObamaCare are illegal. Lawyers petitioned the high court over last week’s decision in King v. Burwell, which found that the government has the power to distribute subsidies for health insurance in the federal exchange HealthCare.gov. (Al-Faruque, 7/31).

Reuters: Obamacare Subsidy Case Could Be Reviewed By U.S. Supreme Court
The U.S. Supreme Court has been asked to review a case about whether the federal government can subsidize health insurance for millions of Americans, a party involved in the lawsuit said on Thursday. The petition requests the U.S. high court decide the issue after two lower U.S. court rulings created uncertainties last week regarding the legitimacy of subsidies for individuals enrolled on federally run exchanges under the Affordable Care Act, or Obamacare. The Competitive Enterprise Institute, which is coordinating and funding the cases, filed the petition, according to the not-for-profit's website (7/31).

Modern Healthcare: ACA Subsidy Case Being Appealed to U.S. Supreme Court
Plaintiffs who lost in the 4th Circuit U.S. Court of Appeals ruling over the legality of health insurance subsidies being paid to those who bought plans on non-state exchanges have formally asked the Supreme Court to take up the case. Last week, three judges in the 4th Circuit ruled in King v. Burwell that health insurance subsidies granted through the Patient Protection and Affordable Care Act were legal in both state and federal exchanges. The decision came mere hours after the D.C. Circuit Court in Washington produced a contradictory decision in Halbig v. Burwell. The Halbig ruling said the letter of the law forbade tax subsidies for exchanges not operated by states (Herman, 7/31).

On the issue of the House Republicans' lawsuit against President Obama over the health law-

The Wall Street Journal’s Law Blog: A Primer On Boehner V. Obama
The House of Representatives on Wednesday voted 225-201 to authorize Republican Speaker John Boehner to bring a lawsuit against the Obama administration accusing the president of overstepping his legal authority. Here are answers to some frequently asked questions about the unprecedented constitutional battle unfolding in Washington (Gershman, 7/31). 

Meanwhile, Supreme Court Justice Ruth Bader Ginsburg talks about some recent health-related decisions-

Yahoo: Ruth Bader Ginsburg On Hobby Lobby Dissent
Justice Ruth Bader Ginsburg, fresh off a bruising loss in the Hobby Lobby birth control case last month, told Yahoo Global News Anchor Katie Couric in an exclusive interview that she believes the male Supreme Court justices who voted against her have a "blind spot" when it comes to women. "Do you believe that the five male justices truly understood the ramifications of their decision?" Couric asked Ginsburg of the 5-4 Hobby Lobby ruling, which cleared the way for employers to deny insurance coverage of contraceptives to female workers on religious grounds. "I would have to say no," the 81-year-old justice replied. Asked if the five justices revealed a "blind spot" in their decision, Ginsburg said yes (Goodwin, 7/31).

The Associated Press: Ginsburg: Court Right To Void Clinic Buffer Zones
Justice Ruth Bader Ginsburg is defending a rare Supreme Court decision that put her at odds with women's rights groups. Ginsburg said the court's unanimous ruling in June that struck down the 35-foot, protest-free zone on sidewalks outside Massachusetts abortions clinics was a good decision that balanced the rights of access to the clinics and speech of abortion opponents. (Sherman, 8/1).

This Story: Print | Link to | Top

Health Law Negatives Reach An All-Time High

According to the Kaiser Family Foundation's monthly tracking poll, negative views of the health law reach a high point, erasing six months of gradual improvements in popularity. (KHN is an editorially independent program of the foundation.)  

The Washington Post’s Wonkblog: Suddenly, Obamacare Is More Unpopular Than Ever
Even after survey after survey has recently shown a major drop in the nation's uninsured rate, Obamacare just had its worst month in a key health-care poll. Kaiser Family Foundation, which has done arguably the best and most consistent polling on the health-care law in the past four-plus years, found that public opinion on the law sank to a record low in July. More people than ever (53 percent) last month said they viewed the law unfavorably, an increase of 8 percentage points since June — one of the biggest opinion swings ever (Millman, 8/1). 

Kaiser Health News: Capsules: Unfavorable Views Of Health Law Spike In July: Poll
The health law’s unpopularity among the public rose sharply in July with a surge of disapproval from people who had been agnostic about it in recent months, a poll released Friday shows. The law is as unpopular as it has been since it was enacted four years ago (Rau, 8/1).

The Hill: Negative Views of O-Care At Highest
Negative views of ObamaCare abruptly hit an all-time high this month, erasing six months of gradual increases in the law's popularity. Fifty-three percent now see the Affordable Care Act in a negative light compared with 45 percent last month, according to a monthly tracking poll by the Kaiser Family Foundation. (Viebeck, 8/01).

This Story: Print | Link to | Top

Going Against Trends, Covered California Premiums To Rise Just 4.2% In 2015

While many other states are experiencing double-digit increases, California's modest premium boost is viewed as good news for the health law.   

Los Angeles Times: Obamacare Premiums To Rise A Modest 4.2% In 2015
Defying an industry trend of double-digit rate hikes, California officials said the more than 1.2 million consumers in the state-run Obamacare insurance exchange can expect modest price increases of 4.2% on average next year. On Thursday, Covered California announced the results of its negotiations with Anthem Blue Cross, Kaiser Permanente and other major insurers, an important yardstick for President Obama's Affordable Care Act (Pfeifer, Terhune and Karlamangla, 7/31).

The Wall Street Journal: California Sees Health-Law Premiums Rising 4.2% In 2015
Premiums for health-law plans in California will go up 4.2% on average next year, an increase that the state's insurance marketplace said was limited partly due to the large and relatively healthy pool of enrollees it had attracted. Nationally, 2015 rate changes for plans sold through marketplaces created under the Affordable Care Act will vary widely, with a mix of increases and some declines. But California is seen as a bellwether. According to federal statistics released May 1, the state had about 1.4 million of the 8 million total people who selected a marketplace plan during the open-enrollment period for 2014 coverage (Wilde Mathews, 7/31).

Kaiser Health News: Good News On California ACA Rates. But Why?
After years of double-digit rate hikes in health insurance premiums, California will see average increases of 4.2 percent in 2015 for people who purchase insurance through the Covered California exchange, the state's Obamacare marketplace. ... It’s good news for consumers, but two of the top insurance officials in the state disagree about why it’s happening. Covered California's executive director and other analysts pointed to specific factors for this moderate increase. For starters, enrollment was very strong in 2014, more than a million people. In addition, healthy people signed up, spreading the risk. But the state's insurance commissioner, Dave Jones, sees a different force in play. He believes that a statewide ballot measure, Proposition 45, has insurers scared (Aliferis, 8/1). 

The San Jose Mercury News: Obamacare: New California Rates Increase Only 4.2 Percent
Most consumers who bought health care plans through Covered California, the state's health-insurance exchange, will see low rate hikes in 2015, while some will see no increase or even a decrease, exchange officials said Thursday. The average California rate hike of the plans created by the nation's health care law will be 4.2 percent, but some plans will offer average rates that are 8.5 percent lower. By comparison, state exchanges in Washington state and New York have reported average rate increases of 9.6 percent and 13 percent, respectively (Seipel, 7/31).

Kaiser Health News: Capsules: Covered California Rates Up Modest 4.2 Percent
Covered California says health care premiums will go up modestly for most people buying coverage on the state exchange next year by an average of 4.2 percent (Bartolone, 8/1).

And in the news from Florida -

Kaiser Health News: Florida's Largest Health Insurer Is Raising Exchange Rates An Average Of 17.6 Percent
Florida Blue, the state’s largest health insurer, is increasing premiums by an average of 17.6 percent for its Affordable Care Act exchange plans next year, company officials say. The nonprofit Blue Cross and Blue Shield affiliate blames higher health costs as a result of attracting older adults this year who previously lacked coverage and are using more services than expected (Galewitz, 8/1). 

This Story: Print | Link to | Top

Medicaid Expansion Offers Financial Boost For Hospitals

Second quarter earnings reports highlight how health law provisions are helping increase hospital companies' profits.

Reuters: U.S. Hospitals Get Lift From Surge In Medicaid Sign-Ups
U.S. hospitals are getting a stronger-than-expected benefit from a new influx of low-income patients whose bills are paid by the government's Medicaid program, raising their profit forecasts as a result. The growing numbers of Medicaid patients helped hospital operator HCA Holdings Inc, the largest for-profit chain, post stronger earnings in the second quarter than initially forecast. Notably fewer uninsured patients came through its doors, HCA said, as millions of Americans signed up for private health insurance under President Barack Obama's healthcare law. But a second, unexpectedly strong boost came from a surge in Medicaid enrollment, which is expanding under the law known as Obamacare (Kelly, 7/31).

Philadelphia Inquirer: Obamacare’s Been Great For Health Care Business
If Obamacare is a government takeover of health care, you could hardly tell it from recent reports from the private health care sector. Much of it is booming. Among hospitals, the largest for-profit chain, HCA Holdings, Inc., raised its financial forecast last week to reflect a 6.6% drop in the number of patients it treats who don’t have insurance. The drop is even more dramatic, 48%, in four states that expanded their Medicaid programs. LifePoint Hospitals, Inc., another chain, raised its forecast to reflect an increase of as much as $13 million in second quarter earnings, about 40% more than it had expected, due in large part to a drop in the number of uninsured patients  (Field, 8/1).

A new report in Pennsylvania points to the benefits of Medicaid expansion for a number of people and businesses.

Pittsburgh Post-Gazette: Report Argues For Pennsylvania Medicaid Expansion
A new report by two groups favoring an expansion of Pennsylvania’s Medicaid program says more than half of the 481,000 uninsured Pennsylvanians hold jobs and would benefit if the state expanded its Medicaid program. Many of these residents have jobs that don't provide health insurance, or pay enough to buy it, such as home health aides, cashiers or janitors, the report says. Together, they represent 59 percent of Pennsylvania's uninsured, while another 22 percent comprise students, nonworking spouses, people with disabilities and those who have left the workforce, according to the report by Pennsylvania Health Access Network and Families USA (Twedt, 8/1).

Also in the news, health exchanges -

Chicago Tribune: Problem Solver: Woman Tries To Cancel Exchange Insurance, Gets No Response
Erin Carver had no trouble signing up for health insurance through the federal health insurance marketplace created under the Affordable Care Act. Canceling her policy, however, has been a bear. The Wheaton resident signed up online in late November, whizzing through prompts before choosing a Blue Cross and Blue Shield Choice Gold Plan. Her policy started Jan. 1, and she had no issues with the coverage. A stroke of good fortune in April resulted in a new job, which included a company-sponsored health insurance plan. Her new insurance, through her employer, started May 1. As luck would have it, it was also administered by Blue Cross and Blue Shield of Illinois. On May 6, Carver emailed Blue Cross and asked to cancel her Obamacare plan because she no longer needed it. Two days later, Blue Cross emailed back (Yates, 7/28).

This Story: Print | Link to | Top

Capitol Hill Watch

Senate Clears $16.3 Billion Plan To Overhaul Vets Health Care System

The measure, which was approved by the House Wednesday, will now move to the White House for President Barack Obama's signature.

NPR: Congress Approves $16.3 Billion VA Health Care Bill
With a 91-3 vote in the Senate Thursday, Congress has passed a massive $16.3 billion bill to address problems with health care for veterans and other problems with the Department of Veterans Affairs. The bill now moves forward to the White House for President Obama's signature. The House voted overwhelmingly to approve the bill on Wednesday (Mullins, 7/31). 

The Associated Press: Congress Sends VA Overhaul To White House
The legislation is a response to reports of veterans dying while awaiting appointments to see VA doctors and cover-ups of the delays at several of the VA's 1,000 hospitals and outpatient clinics. The bill devotes $10 billion in emergency spending over three years to pay private doctors and other health professionals to care for qualifying veterans who can't get timely appointments at VA hospitals or clinics or who live more than 40 miles from one of them. It includes $5 billion for hiring more VA doctors, nurses and other medical staff and $1.3 billion to open 27 new VA clinics across the country (Daly, 7/31). 

The Wall Street Journal: Senate Passes $17 Billion Bill To Help Pay For VA Overhauls
Although the legislation passed the Senate handily, there were still dissenters who objected, in large part to the cost. Some of those objections stemmed from a Congressional Budget Office estimate that the measure would add some $10 billion to the deficit over the next decade. One of the dissenting senators was Bob Corker (R., Tenn.), who said the bill was rushed through Congress before legislators had time to work with the new VA secretary to determine needed, yet cost-effective, reforms. The new bill isn't fiscally responsible, he said (Kesling, 7/31). 

The Washington Post: Senate Sends VA, Transportation Bills To Obama On Eve Of Summer Recess
On veterans affairs, senators voted 91 to 3 to approve legislation injecting more than $16 billion into VA to help deal with extensive treatment delays and a recent record-keeping scandal. Republican Sens. Bob Corker (Tenn.), Tom Coburn (Okla.) and Jeff Sessions (Ala.) voted no because the legislation lacked spending cuts to match the new funding (Hicks and Halsey, 7/31). 

Politico: Senate Sends VA Reform Bill To Obama
The legislation was approved as Robert McDonald prepares to take control of the VA. There has been an acting head in charge of the agency since Eric Shinseki resigned as secretary in May (French, 7/31). 

CBS: VA Reform Bill Clears Senate, Awaits Obama’s Signature
A bill to reform the beleaguered Veterans Affairs health care system cleared the Senate by a wide bipartisan vote on Thursday evening. The law now heads to President Obama's desk just before lawmakers depart for their August recess. The $16.3 billion proposal, which passed by a margin of 91-3, includes $10 billion to allow veterans who are unable to receive a timely appointment within the VA system to seek care from outside providers. (Miller, 7/31).

Reuters: U.S. Senate Passes $16.3B Veterans Health Bill
The 91-3 vote sends the measure to President Barack Obama to be signed into law just before Congress starts a five-week summer recess. The plan, which contains $10 billion in new emergency spending that is not offset by any budget savings, aims to clear months-long waiting lists for healthcare appointments at VA hospitals and clinics across the country. It allows veterans access to private doctors at the department's expense if they are forced to wait more than 30 days for an appointment or live more than 40 miles (65 km) from a VA facility (Lawder, 7/31).

In other news related to veterans' health care -

Detroit Free Press: Federal Counsel Says VA Didn't Fully Investigate Ann Arbor Claims
A top Veterans Affairs official who retired after his division was criticized for downplaying whistle-blower claims refused to reopen an investigation into complaints at the VA facility in Ann Arbor, despite allegations that sterile conditions there may have been compromised. In a letter to President Barack Obama, Carolyn Lerner, who heads the U.S. Office of Special Counsel, said the VA's Office of Medical Inspector (OMI) wasn't "fully responsive" to complaints made at the VA Ann Arbor Healthcare System about personnel wearing potentially contaminated clothing, and construction going on near a sterile supply room without an appropriate barrier (Spangler, 7/31).

This Story: Print | Link to | Top

Senate Bill Introduced To Maintain Medicaid Primary Care Pay Boost Through 2016

In other news, House Energy and Commerce Committee Democrats unveiled legislation to extend funding for the Children's Health Insurance Program for four years.   

Medscape: Bill Would Keep Medicaid Raise For Primary Care Through 2016
On July 30, 2 senators introduced a bill that would extend a Medicaid raise for primary-care physicians another 2 years through 2016 and make more clinicians eligible for the extra money. Given that the temporary pay hike was authorized by the Affordable Care Act (ACA), the bill's prospects are cloudy in the House, controlled by Republicans who want to junk the healthcare reform law, even if the Senate were to pass it. The ACA allocated funds to boost historically paltry Medicaid rates to Medicare levels in 2013 and 2014 for evaluation and management (E/M) services and vaccine administration (Lowes, 8/1).

Related KHN coverage: 6 States, D.C. Extending Medicaid Pay Raise Next Year To Primary Care Doctors (Galewitz, 7/31).

CQ Healtbeat: Democrats Offer Bill Extending CHIP Funding Through 2019
The top Democrats on the House Energy and Commerce Committee unveiled legislation Thursday that would extend funding of the Children’s Health Insurance Program for four years. Without such legislation, no new funding will be available for CHIP after September 2015, said Frank Pallone Jr. of New Jersey and Henry A. Waxman of California. Waxman is ranking member of the full committee and Pallone ranking member of its health subcommittee. The bill also gives states the option to permanently use “express lane eligibility,” to reduce administrative burdens involved in the enrollment process. That authority is set to expire next year (Reichard, 7/31).

This Story: Print | Link to | Top

Medicare

Medicare Drug Premiums To Rise $1 A Month In 2015

The modest increase of the monthly premium to $32 comes even as officials are concerned about the impact of expensive specialty drugs, such as Sovaldi, which cures hepatitis C but costs $1,000 a pill.

The Associated Press: Medicare Drug Premiums To Rise For 2nd Year
Medicare says premiums for prescription drug plans will rise in 2015 for the second year in a row. Officials said Thursday that Medicare's average monthly drug premium will rise next year to $32. The modest increase of $1 a month comes amid worries over the future impact of costly new medications. Sovaldi, for example, cures hepatitis C but costs $1,000 a pill (7/31).

The Hill: Part D Premiums Stay Low Despite Fears Of Rising Drug Prices
Medicare Part D premiums are expected to stay pretty flat in the next few years, according to a new report, despite concerns with rising cost of specialty drugs. The Centers for Medicare and Medicaid Services said it estimates the premium for a basic Medicare Part D plan will only go up $1 next year to a total of $32. For the past four years the average premiums for Medicare Part D plans have been between $30 and $31. (Al-Faruque, 7/31).

This Story: Print | Link to | Top

State Watch

State Highlights: Time Of Turmoil For Georgia Hospitals

A selection of health policy stories from Gerogia, Wisconsin, Texas, Oregon, Florida, Michigan, Massachusetts, Connecticut and North Carolina.

Georgia Health News: Time Of Change –– And Crisis – In The Hospital World
The financial turmoil rocking Georgia’s hospitals shows no signs of fading. Just this week, Emory-Adventist Hospital announced it would close by the end of October. By doing so, the Smyrna hospital would become the fifth Georgia hospital to close within the past two years. And unlike the previous four, it is in the affluent Atlanta suburbs, not a struggling rural area. Emory-Adventist officials said Wednesday that the hospital “is no longer sustainable in today’s dramatically changed health care environment.’ Other hospitals in better financial shape are seeking to position themselves for tough times ahead. Some are partnering with other health systems, seeking to broaden their services and increase their scale. Why all the activity? (Miller, 7/31).

The New York Times: Wisconsin Justices Uphold Union Limits, A Victory For The Governor
Some labor leaders said that Mr. Walker’s measure all but eviscerated many public sector unions, leaving members wondering exactly what bargaining ability they were getting for their dues, which under the law can no longer be automatically withdrawn from their paychecks. Act 10 limited bargaining rights to pay raises within the rate of inflation. And with higher contributions from workers for their health care and pensions under the law, some union members said they could no longer afford dues. One Wisconsin union said it had lost as much as 60 percent of its membership (Davey, 7/31). 

Texas Tribune: Rule Changes Address Contraceptive Devices
Texas women who receive state-financed health services may be able to more easily access contraceptive products like intrauterine devices and hormonal implants beginning Friday, when rule changes to the state’s Medicaid program and the Texas Women’s Health Program take effect. Under the new rules implemented by the state's Health and Human Services Commission, physicians who participate in the two programs will be able to order long-acting reversible contraception (LARC) products from three pharmacies in Texas instead of having to purchase them from a drug wholesaler (Ura, 7/31).

The Associated Press: Oregon Medicaid Targets Expensive Hepatitis Drug
An Oregon Medicaid committee on Thursday significantly scaled back access to an effective — but expensive — new drug used to treat hepatitis C. The decision allows only a narrow set of Medicaid patients to be treated with the $1,000-per-pill drug known as Sovaldi, made by Gilead Sciences Inc. (Cooper, 7/31).

Miami Herald: Florida Mental and Behavioral Health Care Providers Get Funding Boost From Affordable Care Act
Eight health centers in Florida, including one in Miami Beach and another in Broward County, are to receive almost $2 million in Affordable Care Act funding to help care for people with mental and behavioral health issues. The grants, announced on Thursday by the Department of Health and Human Services, are part of $54.6 million in ACA funding intended to help 221 health centers around the country establish or expand such care for about 450,000 patients (Madigan, 7/31).

The Associated Press: Michigan Gets $1 Million in Mental Health Funding
The federal government has awarded Michigan $1 million for mental health services. Health and Human Services Secretary Sylvia M. Burwell announced Thursday that the state will receive the Affordable Care Act funding to support four health centers. The money will be used to establish or expand behavioral health services for more than 5,000 Michigan residents (7/31).

The Boston Globe: Substance Abuse Bill Keeps Coverage For Inpatient Care
The Legislature on Thursday was poised to approve a bill intended to address the state’s opioid addiction crisis, including controversial provisions that curtail insurers’ ability to deny coverage for addiction treatment. The bill requires coverage for at least 14 days of inpatient detoxificiation and post-detox care, bars insurers from determining whether any addiction treatment -- inpatient or outpatient -- is medically necessary, and removes the requirement to obtain “prior authorization” from an insurer before entering substance use treatment (Freyer and Abutaleb, 7/31).

WBUR: Mass. Substance Abuse Bill Responds To Tide Of Sadness And Fear
In response to stories that seem to be on the rise in communities across the state — stories of parents trying to revive children after a heroin overdose, of young people seeking treatment their insurance plan won’t cover, and of babies born addicted to opiates — state lawmakers on the last day of their formal session approved a bill they say will help save the lives of those addicted to heroin, prescription painkillers and alcohol. The measure, among several major bills passed just after midnight Friday, requires insurers pay for any care a doctor decides is medically necessary. Insurers say this and other requirements included in the bill are a mistake. In outlining the House and Senate compromise on the substance abuse bill Thursday afternoon, Sen. John Keenan of Quincy talked about his father (Bebinger, 7/31).

The CT Mirror: Ten Things John Mckinney Thinks About Health Care
John P. McKinney, the state Senate minority leader, has pitched himself as the Republican candidate for governor with experience putting together budgets and doing the work needed to govern. In his 16 years in the Senate, McKinney hasn’t been deeply identified with health care issues, although he was a key critic of plans to expand and renovate UConn’s John Dempsey Hospital using state funds. He also pushed for a tax incentive program to encourage people to get preventive care. As governor, he said, he'd side more with consumers on insurance-related matters, privatize social services and ask state employees to accept less costly health insurance. He's critical of Obamacare, but didn't cite any specific ways he'd change how Connecticut handles it (Becker, 8/1).

North Carolina Health News: Autism Insurance Bill Likely To Die In Session’s Final Days
A bill that would allow children with autism to get health insurance coverage for treatment that passed the House over a year ago looks like it won’t make it across the finish line in the current General Assembly session. The bill, which would require treatment called applied behavioral analysis to be covered by insurers, was passed by the House of Representatives in May of last year. Advocates looking to convince lawmakers to pass the autism insurance measure roamed the halls of the General Assembly to speak to legislators early in July. Applied behavioral analysis has been shown by research to be one of the most effective treatments in helping children with the disorder to be “mainstreamed” into schools and society (Hoban, 7/31).

North Carolina Health News: Hospitals, Adult Care Homes Big Losers In Budget
Hospital and adult care home operators are all reacting to the $21.1 billion North Carolina budget presented late Wednesday and passed by the Senate late Thursday evening, which contains cuts to those facilities, even as the state’s hospitals have taken cuts for the past several budget cycles. Lawmakers have said they were determined to bring the state’s Medicaid budget under control. The program – which pays for care for more than 1.6 million low-income children, pregnant women, low-income seniors and people with disabilities – has been blamed for claiming an ever-increasing part of the state budget (Hoban, 8/1).

This Story: Print | Link to | Top

Health Policy Research

Research Roundup: Expensive Cancer Therapies; Missed Hospital Handovers; Children's Mental Health Needs

Each week, KHN compiles a selection of recently released health policy studies and briefs.

Health Affairs: Site-Neutral Payments
Medicare uses more than a dozen different payment systems to set payment rates for the medical items and services the program covers for beneficiaries. The location where a beneficiary receives a service determines which payment system applies. Each system has its own methodology for rate-setting reflecting costs of operating the setting and the different patient populations served in each. ... Recently, the Centers for Medicare and Medicaid Services (CMS) and the Medicare Payment Advisory Commission (MedPAC) have been exploring options to eliminate this differential payment for certain services. This brief explains the origins of these differential payments and the debate over approaches that have been proposed for developing so-called site-neutral payments (Cassidy, 7/24).

JAMA Otolaryngology–Head & Neck Surgery: Unintended Consequences Of Expensive Cancer Therapeutics—The Pursuit Of Marginal Indications And A Me-Too Mentality That Stifles Innovation And Creativity
The use of expensive therapies with marginal benefits for their approved indications and for unproven indications is contributing to the rising cost of cancer care. We believe that expensive therapies are stifling progress by (1) encouraging enormous expenditures of time, money, and resources on marginal therapeutic indications and (2) promoting a me-too mentality that is stifling innovation and creativity. ... We discuss the economic realities that are driving this process and provide suggestions for radical changes to reengineer our collective cancer ecosystem to achieve better outcomes for society (Fojo, Mailankody and Lo, 7/28).

JAMA Internal Medicine: Morning Handover Of On-Call Issues
Handover is the process of transferring pertinent patient information and clinical responsibility between health care practitioners. Few studies have examined morning handover from the overnight trainee to the daytime team. ... A prospective, point-prevalence study was conducted in the general internal medicine wards of 2 tertiary care academic medical centers in Toronto, Ontario, Canada, in 2012 and 2013. Participants included on-call third-year medical students and first- and second-year residents. ... We identified 141 clinically important overnight issues during 26 days of observation. The on-call trainee omitted 40.4% of clinically important issues during morning handover and did not document any information in the patient’s medical record for 85.8% of these issues. ... running the list patient-by-patient (ie, the entire team discusses each patient) and using a dedicated handover location positively correlated with handover of an issue taking place (Devlin et al., 7/21).

Employee Benefit Research Institute: Lifetime Accumulations And Tax Savings From HSA Contributions
In 2013, enrollment in HSA-eligible health plans was estimated to range from 15.5 million to 20.4 million policyholders and their dependents. Nearly 11 million accounts holding $19.3 billion in assets as of Dec. 31, 2013 were also estimated. ... HSAs provide account owners a triple tax advantage. Contributions to an HSA reduce taxable income. Earnings on the assets in the HSA build up tax free. And distributions from the HSA for qualified expenses are not subject to taxation. Because of this triple tax preference, some individuals might find using an HSA as a savings vehicle for health care expenses in retirement more advantageous from a tax perspective than saving in a 401(k) plan or other retirement savings plan. This paper examines the amount of money an individual could accumulate in an HSA over his or her lifetime. It also examines lifetime tax savings from HSA contributions. Limitations of an HSA are also discussed (Fronstin, 7/28).

The Kaiser Family Foundation: Financial And Administrative Alignment Demonstrations For Dual Eligible Beneficiaries Compared: States With Memoranda Of Understanding Approved By CMS
Using new authority in the Affordable Care Act, the Centers for Medicare and Medicaid Services (CMS) is launching demonstrations that seek to improve care and control costs for people who are dually eligible for Medicare and Medicaid. These three year demonstrations, implemented beginning in July 2013, are introducing changes in the care delivery systems through which beneficiaries receive medical and long-term care services. The demonstrations also are changing the financing arrangements among CMS, the states, and providers. As of July 2014, CMS has finalized memoranda of understanding (MOUs) with 12 states to implement 13 demonstrations .... This issue brief compares key provisions of the approved demonstrations (Musumeci, 7/24).

UCLA Center for Health Policy Research: Three Out Of Four Children With Mental Health Needs In California Do Not Receive Treatment Despite Having Health Care Coverage
More than 300,000 California children ages 4 to 11 have mental health needs, yet only one-fourth of them received mental health care in 2007 and 2009. Health insurance coverage and a usual source of care typically facilitate mental health service use; however, this is not the case for children with mental health needs. This policy brief identifies children at risk for mental health needs and highlights some barriers to their receiving mental health services (Padilla-Frausto et al., 7/24).

Here is a selection of news coverage of other recent research:

Reuters: Too Few U.S. Youth Getting Vaccine For Sexually Transmitted Virus: CDC
More U.S. adolescents are receiving vaccines against the sexually transmitted virus that causes cervical and other types of cancer but vaccination rates for the infection remain too low, federal health officials said on [July 24]. In 2013, 37.6 percent of girls ages 13-17 got the recommended three doses of the vaccine against human papillomavirus (HPV), the Centers for Disease Control and Prevention said. That was up from 33.4 percent in 2012 but far short of the CDC's goal of an 80 percent vaccination rate, data showed (Beasley, 7/25).

Reuters: Medication Errors May Be Common After Hospital Discharge
More than half of heart patients in a new U.S. study made mistakes taking their medications or misunderstood instructions given to them after being discharged from the hospital. Those with the lowest "health literacy" were among the most likely to make the risky errors, highlighting the importance of healthcare professionals making sure their instructions are clear and of patients being sure they understand what they need to do after they get home, the study authors say (Storr, 7/21).

MinnPost: Pre-Diabetes Diagnosis Has Little Value, Experts Say
Millions of people are being needlessly diagnosed with "pre-diabetes," putting them at risk of receiving "unnecessary" medical treatment and creating "unsustainable burdens" for health care systems, according to a commentary published last week in the journal BMJ. Written by Dr. Victor Montori, an endocrinologist who specializes in diabetes at the Mayo Clinic in Rochester, and Dr. John Yudkin, an emeritus professor of medicine at University College London, the commentary describes the dubious origins of the "pre-diabetes" label and its unreliable role as a predictor of who will go on to develop diabetes (Perry, 7/22).

Reuters: Tools For Planning End Of Life Care Are Varied And Untested, Study Says 
Many tools exist to help introduce people to the subject of advanced care planning, but they vary widely in what they offer and how accessible they are, according to a new research review. The authors found the tools that are most readily available often have not been vetted by formal studies, and the ones that have are often not accessible to the public or are specific to certain diseases (Doyle, 7/29).

JAMA: AAP: Toxic Stress Threatens Kids’ Long-Term Health
Now, emerging data on how early exposure to adversity can impair long-term health and development have led the American Academy of Pediatrics (AAP) and other thought leaders to call for more effective and aggressive intervention for children in distress. In June, the AAP convened a symposium on the long-term dangers of childhood toxic stress—early exposure to chronic unmitigated stress—and urged pediatricians, policy makers, and federal agencies to develop a stronger national response. To facilitate these efforts, the AAP announced it will launch the Center on Healthy, Resilient Children to help pediatricians and others identify toxic stress in children and connect them with appropriate resources (Kuehn, 7/30).

This Story: Print | Link to | Top

Editorials and Opinions

Viewpoints: Did HHS Ignore Warnings About Healthcare.gov?; Expand Medicare For All; Restaurant Calorie Labeling

The Wall Street Journal's Washington Wire: Were GAO Warnings About HealthCare.Gov Unheeded?
A Government Accountability Office report on last fall's HealthCare.gov debacle, released Wednesday in advance of a House Energy and Commerce subcommittee hearing Thursday, details what went wrong. But the bigger questions involve the culture that led administration officials to ignore–and even publicly repudiate–the warning signs that the GAO flagged well before the federal health exchange Web site crashed last October (Chris Jacobs, 7/31).

Los Angeles Times: In California, Good Vital Signs For Obamacare
Two pieces of news this week illustrated how much progress California is making on one of the main goals of the 2010 federal healthcare law, extending coverage to the uninsured. A new survey from the Kaiser Family Foundation estimated that the percentage of uninsured Californians has been cut in half thanks to the expansion of free and subsidized coverage for low- and moderate-income residents. And Covered California, the state's new insurance market, announced a surprisingly small increase in the average premiums its customers will face next year. As encouraging as these signs are, though, it's still too early to declare the Affordable Care Act a success (7/31).

Miami Herald: Medicaid Expansion Should Be A No-Brainer
The Florida Medical Association, the politically powerful lobbying organization that represents the state's doctors, recently approved a resolution endorsing Medicaid expansion for Florida’s low-income uninsured. What’s mind-boggling is why the FMA didn’t take a stance earlier, like perhaps during the last two legislative sessions, to convince the reluctant governor and legislative leaders to accept federal funding for the expansion (Paula Dockery, 7/30).

CNN: Expand Medicare For All Americans
But despite Monday's cautiously optimistic report on Medicare's solvency, a sustainable and comprehensive health care system requires covering everybody. Expanding Medicare for all is the fairest, most effective and straightforward way to ensure universal coverage in America. With Medicare, seniors have greater access to care. Yet most people deal with an overly complex system that fails to provide the same benefits our seniors receive. Even after the passage of Obamacare, unacceptable burdens remain (Vijay Das, 7/30).

The Wall Street Journal's Washington Wire: 3 Takeaways From the Medicare Trustees Report
The annual report from the Social Security and Medicare trustees predicted that Medicare will be solvent until 2030, four years later than the trustees predicted last year. That’s thanks to the recent slowdown in Medicare spending and a stronger economy that yields higher revenue through payroll tax contributions to the Medicare trust fund (Drew Altman, 8/1).

The New York Times: When Wheelchairs Are Cool
I've never pretended to be in a wheelchair to curry favor, of course, but I've often felt that I can play the disability card for all it's worth. I have, I confess, used it to hustle my kids through Disney lines, even though I knew full well that I wasn't actually going to get on the ride myself (Ben Mattlin, 7/31).

Journal of the American Medical Association: Potential Benefits Of Calorie Labeling In Restaurants
Provisions in the 2010 Affordable Care Act will require chain restaurants with 20 or more US locations to display calorie information on their menus, including drive-through menu boards. The US Food and Drug Administration released preliminary regulations in April 2011, and the long-delayed final regulations are expected soon, perhaps as early as summer 2014. The documented effects of menu labeling on consumer and restaurant industry behavior suggest that menu labeling will likely encourage some consumers to eat more healthfully some of the time, and the policy is likely an important first step toward improving the public’s eating habits (Jason P. Block and Christina A. Roberto, 7/31).

Journal of the American Medical Association: Interstate Medical Licensure
The Interstate Medical Licensure Compact is a streamlined process that would allow physicians to rapidly become licensed to practice medicine in multiple states. If the compact were to be approved by state legislators and incorporated into the laws of most, if not all, states, it could catalyze many substantial changes in medical practice. The potential benefits include easing the physician shortage in rural and other underserved areas and speeding the growth of telemedicine. Telemedicine, whether by telephone, e-mail, videoconference, or online, has increasing uses in medicine (Robert Steinbrook, 7/28).

This Story: Print | Link to | Top


EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Marissa Evans
Lisa Gillespie
Shefali Luthra

The Kaiser Daily Health Policy Report is published by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. (c) 2014 Kaiser Health News. All rights reserved.