Daily Health Policy Report

Tuesday, January 14, 2014

Last updated: Tue, Jan 14

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Women's Health

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Some Medical Schools Shaving Off A Year Of Training

Reporting for Kaiser Health News, in collaboration with The Washington Post, Sandra G. Boodman writes: "For Travis Hill, it was an offer too good to refuse. Last year when the 30-year-old neuroscientist was admitted to a new program at New York University that would allow him to complete medical school in only three years and guarantee him a spot in its neurosurgery residency, he seized it. Not only would Hill save about $70,000 -- the cost of tuition and living expenses for the fourth year of medical school -- he would also shave a year off the training that will consume the next decade of his life" (Boodman, 1/14). Read the story.

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Insuring Your Health: Health Law Adds Coverage For Services Needed By People With Developmental Disabilities

Kaiser Health News consumer columnist Michelle Andrews writes: "A little remarked upon requirement in the health law expands treatments for people with cerebral palsy, autism and other developmental disabilities. But some advocates and policy experts are concerned that insurers may find ways to sidestep the new requirement. The health law requires that individual and small group plans sold on or off the health insurance marketplaces cover 10 essential health benefits, including 'rehabilitative and habilitative services and devices'" (Andrews, 1/14). Read the column

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Emergency Rooms Are Front Line For Enrolling New Obamacare Customers

Kaiser Health News staff writer Sarah Varney, working in collaboration with NPR, reports: "Angela Felan is sitting in the emergency department waiting room at O’Connor Hospital for the second time in a week. A blue surgical mask covers her nose and mouth, and her hoodie sweatshirt is pulled snug over her head. She first came into the emergency room a few days ago with what she thought was bronchitis. The doctor prescribed an inhaler that cost her $56. She works part-time in retail and hasn’t had insurance for at least a decade because she can't afford it" (Varney, 1/14). Read the story.

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Nearly A Quarter Of Health Marketplace Enrollees Are Young Adults

Kaiser Health News staff writer Phil Galewitz reports: "Nearly a quarter of the 2.2 million people who have enrolled in health coverage in the health law's insurance marketplaces are young adults — the population that's hardest to reach and yet most vital for the financial stability of the new exchanges, the Obama administration announced Monday" (Galewitz, 1/13). Read the story

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Capsules: New York Consumers Frustrated By Insurance Delays

Now on Kaiser Health News’ blog, WNYC’s Fred Mogul, working in partnership with KHN and NPR, reports: "Last weekend, Rob Cuillo had a severe stomach bug, and he began thinking it might be time for a trip to the emergency room near his home on Long Island. … But then he remembered he hadn’t received his insurance card from Empire Blue Cross. He had enrolled in the plan through the New York State of Health, the state exchange for purchasing coverage under the Affordable Care Act" (Mogul, 1/14). Check out what else is on the blog.

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Political Cartoon: 'Traffic Study?'

Kaiser Health News provides a fresh take on health policy developments with "Traffic Study?" by Signe Wilkinson.

And here's today's health policy haiku:  


How many young folks
need to dive in the deep end
of exchange risk pools?

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.

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Health Reform

Insurance Sign-Ups Skew Older, Spurring Cost Concerns

Halfway through the six-month enrollment period for private insurance under the health care law, just one in four adult enrollees are between ages 18 and 34, the crucial demographic group whose participation rates are key to keeping monthly premiums affordable. Administration officials say they are confident that a greater proportion of young people will enroll by the end of March.

The New York Times: Older Pool of Health Care Enrollees Stirs Fears on Costs
People signing up for health insurance through the Affordable Care Act’s federal and state marketplaces tend to be older and potentially less healthy, officials said Monday, a demographic mix that could threaten the law’s economic underpinnings and cause premiums to rise in the future if the pattern persists (Shear and Pear, 1/13). 

Los Angeles Times: More Than 2.1 Million Sign Up For Obamacare Health Coverage
More than 2.1 million Americans signed up for health insurance in the last three months of 2013 through new online marketplaces created by President Obama's healthcare law as a December surge in enrollment helped the initiative recover from its disastrous launch. But the enrollment numbers — released in a government report Monday — lagged behind the Obama administration's target of 3.3 million sign-ups by the end of December (Levey, 1/14). 

Kaiser Health News: Nearly A Quarter Of Health Marketplace Enrollees Are Young Adults
Nearly a quarter of the 2.2 million people who have enrolled in health coverage in the health law's insurance marketplaces are young adults — the population that's hardest to reach and yet most vital for the financial stability of the new exchanges, the Obama administration announced Monday (Galewitz, 1/13).

The Washington Post: Health-Insurance Sign-Ups By Young Adults Are Off Pace Seen As Key To New Law’s Success
Young adults account for slightly less than one-fourth of the Americans who signed up for health plans during the initial three months of federal and state insurance marketplaces — fewer so far than the government has said will be needed to make the economics of the new exchanges work. The figures, part of a monthly progress report on the marketplaces that was issued Monday, offer the first glimpse into whether the health plans available under the Affordable Care Act are becoming provinces of the old and sick or are managing to attract young, healthy people who have not previously considered insurance worthwhile (Goldstein and Somashkehar, 1/13). 

The Wall Street Journal: Health Sign-Ups Skew Older, Raising Fears Over Costs
One-third of health plan enrollees in new insurance marketplaces are 55 or older, the Obama administration said Monday, a figure that insurers said makes the pool older than they would need to sustain their coverage at current premiums. Administration officials said they are pushing to enroll more young people before a March 31 deadline for most people to get coverage for this year, and some cushions built into the law mean it won't necessarily face trouble right away even if the 2014 pool of enrollees skews older (Radnofsky and Weaver, 1/13).

The Associated Press: Health Care Signups: More Older Americans So Far
Younger people went for President Barack Obama at election time, but will they buy his health insurance? New government figures show it's an older, costlier crowd that's signing up so far for health insurance under Obama's health care law. Enrollments are lower for the healthy, younger Americans who will be needed to keep premiums from rising (Alonso-Zaldivar, 1/14).

USA Today: Most Insurance Enrollees Older Than 45, Records Show
More than half of the almost 2.2 million people who bought health insurance on federal and state exchanges in the past three months are older than 45, records released Monday show. If that trend holds, it could skew the health insurance market as older policyholders that use more health care are not balanced by younger policyholders who tend to use less health care. In effect, the younger policyholders subsidize older ones (Kennedy, 1/13).

Politico: Young Adults Make Up One-Fourth Of Obamacare Enrollees
Just under a quarter of Obamacare sign-ups so far have been in the critical 18-to-35-year-old age range, the Obama administration revealed Monday, the first time officials have given demographic data about health plan enrollees. The administration had set a goal of around 38 percent to 40 percent of the enrollees in that age bracket by the time the sign-up season ends March 31 (Cheney and Millman, 1/14).

CBS News: Obamacare Sign-Ups Among Young Adults Off To Slow Start
About one-quarter of those who signed up for Obamacare by the end of 2013 were between the ages of 18 and 34, the Obama administration reported Monday, falling below what experts have called the ideal proportion of young adults in the new health insurance marketplace. However, administration officials said they are comfortable with the proportion of young enrollees so far, and they expect Obamacare enrollment in the key demographic group to accelerate in the second half of the six-month open enrollment period (Condon, 1/13).

Fox News: Insurers Raise Cost Concerns After ObamaCare Demographic Data Released
Insurers have raised concerns that too few young people are signing up for health insurance through the ObamaCare exchanges after newly released statistics showed that less than a quarter of people who have enrolled are between the ages of 18 and 34 (1/14).

McClatchy: Young Adult Enrollment In Health Care Marketplaces Lags
Halfway through the six-month enrollment period for private marketplace health insurance, just one in four new adult enrollees are between ages 18 and 34, the crucial demographic group whose participation rates are key to keeping monthly premiums affordable under Obamacare. In the first release of extensive demographic data about the new enrollee population, the Obama administration said Monday that 55 percent, or roughly 1.2 million of the nearly 2.2 million people who’ve selected a federal or state marketplace plan, are generally older adults, ranging in age from 45 to 64. About 517,000, or 24 percent, of the new enrollees were young adults ages 18 to 34 (Pugh and Kumar, 1/13).

Marketplace: Obamacare Stats Show Young Folks Are Signing Up
Today, the Department of Health and Human Services announced that nearly 2 million people enrolled for health insurance through the federal and state exchanges in December. That includes a dramatic increase in the number of young people signing up. That number of so-called 'young invincibles' is higher than some had predicted. And in a conference call today, HHS officials said that about one in four of all the consumers on the exchanges are between the ages of 18-34. Ideally, you want to see a higher rate, about 40 percent, of exchange customers in that age range. The data raises a bunch of questions (Gorenstein, 1/13).

The Fiscal Times: Four New Mysteries in the Obamacare Enrollment Numbers
The White House is still lagging to meet self-imposed enrollment targets. And young people are not signing up at the pace the White House needs, no matter how CMS claims that they’re on track to meet their goals. Now that we know the December data, here are four mysteries in the Obamacare numbers (Francis, 1/14).

The Fiscal Times: White House Claims It Will Reach Obamacare Goal
Nearly a quarter of the 2.2 million Americans who have signed up for Obamacare so far are young people, ages 18-34, the demographic most important to the success of the president’s healthcare law. It’s not clear yet, however, how many have actually paid their premiums. A new White House report released Monday shows some 489,460 Americans ages 18-34 have signed up for health insurance through the state and federal exchanges since Obamacare's launch on Oct 1. Though White House officials say they are encouraged by the new numbers, they are well below the administration’s goal of enrolling 2.7 million young Americans which are needed to subsidize the cost of older, sicker Americans (Ehley, 1/13).

CQ HealthBeat: HHS Optimistic About Exchange Sign-Ups Among Young, But Enrollment Still Key
Federal officials reported Monday that nearly 2.2 million Americans through Dec. 28 selected health plans from federal and state insurance exchanges. The officials said they are pleased with the sign-up rate by the key demographic group of young Americans, even though so far the percentage of young adults is lower than what the Obama administration has said will be needed by the time that open enrollment ends on March 31 (Reichard, 1/13).

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State-Specific Numbers Highlight December Enrollment Surge

Various news outlets report on the enrollment totals through December -- and some demographic data -- for Alabama, Wisconsin, Connecticut, Georgia, California, Illinois and others.

The Associated Press: More Alabamians Signing Up For Health Insurance
The number of Alabamians signing up for the federally operated health insurance marketplace jumped significantly in the past month, with more than 28,600 signed up through late December. Enrollment under the federal health care law started Oct. 1 (1/13).

The Milwaukee Journal Sentinel: 40,752 State Residents Enrolled In Obamacare Through December
Enrollment in health plans sold on the federal insurance marketplace jumped last month, with a total of 40,752 people in Wisconsin having picked a plan through December, according to figures released Monday by the U.S. Department of Health and Human Services. The number of people who have picked a plan in Wisconsin was up from 5,303 at the end of November (Boulton, 1/13). 

The CT Mirror: CT Exchange's Private Insurance Customers Skew Older, Male
Sixty percent of the people who signed up for private health plans through Connecticut's health insurance exchange are 45 and older, according to figures released by the federal government Monday. That's more than twice the share of people in the coveted under-35 age brackets. Twenty-one percent of enrollees are age 18 to 34. The figures also show that Connecticut stands out as one of just two states with more men than women signing up for private plans through the exchanges (Becker, 1/13).

Georgia Health News: Georgia Exchange Enrollment Jumped In December
More than 58,000 Georgians signed up for health coverage in the insurance exchange by Dec. 28, a nearly tenfold jump from the enrollment figure a month before, according to a federal report released Monday. The increase reflected a more functional federal website for people to navigate, and came ahead of the deadline of late December to sign up for insurance to begin Jan. 1. Thirty percent of the Georgia enrollees are under age 35, a key statistic in determining whether the Affordable Care Act’s exchange will work. Insurance experts say for the exchange to work and be economically viable for insurers, there must be enough young and healthy enrollees in the exchange to balance the risk from older and sicker enrollees (Miller, 1/13).

The San Jose Mercury News: California Continues To Lead U.S. In Numbers Of Health Insurance Enrollments
The frenzy in December to sign up for insurance under the nation's new healthcare law accounted for a staggering 83 percent of the new policies written before the deadline to start coverage this month, according to numbers released Monday by the federal government. And in California, that brisk pace continues as the next deadline -- for medical insurance coverage starting Feb. 1 -- approaches on Wednesday, said officials with the state's healthcare exchange. Covered California is confident that the momentum highlighted in the latest U.S. Department of Health & Human Services report will continue (Seipel, 1/13).

Chicago Tribune: Health Insurance Enrollment Surges In Illinois
A little more than 61,100 Illinoisans selected new health insurance policies created under President Barack Obama's health care law through Dec. 28, as a last-minute surge in enrollment helped the marketplaces recover from an embarrassing Oct. 1 launch. The Illinois enrollments are up nearly ninefold from November (Frost and Levey, 1/14). 

The Chicago Sun-Times: Big Increase Of Enrollees In Obama’s Health Care Plan
In a significant jump, 61,111 Illinois residents had chosen an insurance plan through President Barack Obama’s health care law by the end of December, according to the latest enrollment numbers released by the federal government Monday. That marks nearly a ninefold increase in December over the first two months, when 7,043 Illinois residents had selected a new plan created by the Affordable Care Act between Oct. 1 and Nov. 30 (Thomas, 1/13).

The Philadelphia Inquirer: Obamacare Signups Up Fivefold In One Month
The number of Americans who selected plans through the Obamacare exchanges surged nearly five-fold in December, administration officials said Monday ... 81,320 Pennsylvanians selected coverage through the federal exchange through the end of December, a more than sevenfold increase from the month before. In New Jersey, 34,751 selected plans, up more than 10 times (Sapatkin, 1/13).

The Texas Tribune: Enrollments Grow in TX, Where Uninsured Rates Are High
Texas enrollments in the online insurance marketplace created under the Affordable Care Act rose nearly eightfold in December, according to 2013 figures that the U.S. Department of Health and Human Services released Monday (Walters, 1/13).

The Miami Herald: Women And Older Americans Lead The Way In Obamacare Signups -- In Florida And The Nation
About 36 percent of Floridians who selected a plan, or more than 56,000 people, were between 55 and 64. Florida also saw women participate in greater numbers, making up about 55 percent of enrollees who selected a plan, or 86,000 people (Chang, 1/13).

St. Louis Post-Dispatch: More Than 33K Missourians Now Have Coverage Through HealthCare.gov
More than 33,000 Missourians enrolled in a health insurance plan through the federal HealthCare.gov marketplace as of Dec. 28, according to new data released Monday by the Department of Health and Human Services.

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State Legislators Contemplate Flaws In New York's Online Insurance Marketplace

Testimony during a New York State Senate hearing Monday explored problems that have emerged during the rollout of New York State of Health. News outlets also reported the latest related developments from Maryland and California. 

The New York Times: Mixed Reports On State Health Exchange
New York is enrolling a significant number of young subscribers on its health insurance exchange, but many of those already enrolled have raised questions about rules that limit which doctors they can see, or are having problems finding out if their doctors are covered, according to testimony at a State Senate hearing on Monday (Hartocollis, 1/13).

The Associated Press/Wall Street Journal: Legislators Cite Flaws In NY Health Exchange
State legislators cited problems Monday with the rollout of the federal health overhaul in New York, with constituents complaining about lost insurance coverage, higher premiums and confusion and limitations of medical networks. Nearly 300,000 New Yorkers have been enrolled in private insurance or Medicaid since October with the average cost 53 percent lower than comparable individual insurance coverage, Donna Frescatore, executive director of the state's new health marketplace, New York State of Health, testified at a Senate oversight hearing (1/13).

Kaiser Health News: Capsules: New York Consumers Frustrated By Insurance Delays
Last weekend, Rob Cuillo had a severe stomach bug, and he began thinking it might be time for a trip to the emergency room near his home on Long Island. … But then he remembered he hadn’t received his insurance card from Empire Blue Cross. He had enrolled in the plan through the New York State of Health, the state exchange for purchasing coverage under the Affordable Care Act (Mogul, 1/14).

The Washington Post: Brown Says Health Exchange Problems Were Not Conveyed To Him But Still Accepts Blame
The day before he was to testify about an emergency bill that would help those who were unable to sign up for health insurance through the state’s exchange, Maryland Lt. Gov. Anthony G. Brown (D) said Monday that he was kept in the dark about the severity of the problems that led to the calamitous debut of the state’s online health marketplace (Johnson and Wagner, 1/13). 

Los Angeles Times: State Tells Cigna To Stop Using Covered California Exchange Name
California Atty. Gen. Kamala Harris told insurance giant Cigna Corp. to stop selling health plans bearing the name of California's health exchange because it was deceptive. Cigna opted out of participating in the Covered California exchange when it launched last year. But the company continued selling policies outside the exchange and labeled some of them "Covered California" plans (Terhune, 1/13).

And, in news related to the federal online insurance marketplace -

The Washington Post: CMS Replaces Executives Who Departed After Healthcare.gov Troubles
In a letter to employees, CMS Administrator Marilyn Tavenner said the agency promoted Tim Love to serve as chief operating officer and appointed Dave Nelson as its new chief information officer (Hicks, 1/13).

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Medicaid Expansion Battles Resume In State Capitols

Aided in some cases by a new cast of elected officials, groups pushing for Medicaid expansion hope to reopen the debate in state legislative sessions beginning in Maine, Virginia, Louisiana, Kansas and Georgia.

The Washington Post: Maine Session Preview: Rehashing A Medicaid Fight
Maine Democrats hope to reopen a debate on expanding Medicaid in that state this legislative session, which began on Wednesday. But expect Gov. Paul LePage (R) to put up a fight. The Democrat-controlled legislature is expected to take up the expansion, under President Obama’s health-care law, despite two vetoes from LePage. And both sides return to the fight with new ammunition (Chokshi, 1/13).

The Associated Press: Va. Gov. McAuliffe Sets Priorities Before Lawmakers
Days after taking office, Democratic Gov. Terry McAuliffe of Virginia told the General Assembly on Monday evening that Medicaid eligibility should be expanded in the state. In addressing the lawmakers, McAuliffe said the state can't afford to forgo $2.1 billion a year in federal funds by not expanding Medicaid under the federal health care law to about 400,000 Virginians (Suderman, 1/13).

The Associated Press: Medicaid Expansion Debate To Resume In Louisiana
Efforts to provide government-subsidized health insurance to thousands through an expansion of Louisiana's Medicaid program will again be pushed in the upcoming legislative session. Former Health and Hospitals Secretary David Hood said Monday he'll be involved with a coalition of Medicaid expansion supporters seeking to persuade state lawmakers who rejected the idea last year (Deslatte, 1/13).

The Associated Press: Kan. Group Working On Medicaid Plan, But GOP Wary
The Kansas Hospital Association is working on an alternative to expanding Medicaid under the federal health care overhaul, but Gov. Sam Brownback and other top Republican leaders remained wary as the GOP-dominated Legislature opened its annual session Monday. Cindy Samuelson, a Kansas Hospital Association vice president, said the group is not yet sure what form the proposal will take (Hanna, 1/13).

Georgia Health News: Protestors Demand Medicaid Expansion
An estimated 200 people gathered Monday at the state Capitol in perhaps the most vocal protest yet of Gov. Nathan Deal’s rejection of Medicaid expansion in Georgia. Georgia’s Moral Monday Coalition, an offshoot of a movement started in North Carolina, landed on the steps of the Capitol on Monday afternoon when protesters braved off-and-on rain showers to urge Deal to expand Medicaid. The Moral Monday movement, a grass-roots coalition of civil rights groups, churches, labor unions and health care groups, targets public policy issues that negatively affect poor and working-class people. Though the group is known for nonviolent civil disobedience tactics in North Carolina, the Georgia protest on Monday was vocal but calm. It was the first of many planned for the 2014 General Assembly session, and the organizers said they will follow the lead of their colleagues in Raleigh if Deal and the state’s GOP leadership ignore them (Craig, 1/13).

Health Policy Solutions (a Colo. news service): Health Guide Calls Medicaid Application Process A 'Train Wreck'
A health coverage guide from Jefferson County testified during an exchange board meeting on Monday and said that working with Connect for Health service agents has been relatively smooth, but that Colorado's mandatory Medicaid application has been a "train wreck."… [Leslie] Wilson-Langsdon said she and her team have been reaching out to people who need health insurance at places from libraries to human services offices. She estimates that in December alone, they met with about 700 people, but fewer than 100 managed to enroll (Kerwin McCrimmon, 1/13).

Meanwhile, The Washington Post's Fact Checker assesses Sen. Mark Rubio's claim that the health law's federal funds for Medicaid expansion will not last.

The Washington Post's The Fact Checker: Rubio's Claim That Medicaid Funds Will 'Go Away'
Sen. Rubio made this comment while defending a proposal to "streamline most of our existing federal anti-poverty funding into one single agency," which would distribute funds as a cash grant to states for their own "creative initiatives that address the factors behind inequality of opportunity." Rubio was asked what would happen if states simply opted out of providing programs for the poor, as nearly half the states have done with the Medicaid expansion envisioned in the Affordable Care Act, a.k.a. Obamacare. Rubio countered that his plan would be funded. "It wouldn't be something where states are told you get the money for a few years then we’ll back away," he said. Is this really how the Medicaid expansion is funded? A bait and switch? ... Rubio has little basis to make such a sweeping statement (Kessler, 1/14).

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For Many Working Low-Income Residents, Health Law's Promise Is Still Unaffordable

Stateline examines the difficulty for many working families to buy insurance while KHN checks how efforts to enroll the uninsured are going at a California hospital. Other news coverage on health law outreach and enrollment looks at narrow networks in some plans and an effort in Connecticut to attract consumers.

Stateline: Affording The Affordable Care Act
The promise of the Affordable Care Act is right there in its title: Affordable. Yet, anti-poverty agencies across the country fear that even with the federal financial assistance available under the law, health insurance will remain unaffordable for significant numbers of low-income Americans. "For those with very low wages trying to raise kids, after paying for housing, electricity, food, transportation, and child care, asking people to pay another $50 or $100 a month, that's just out of reach," said Sireesha Manne, a staff attorney at the New Mexico Center on Law and Poverty (Ollove, 1/14).

The Washington Post's WonkBlog: Obamacare's Narrow Networks Are Going To Make People Furious – But They Might Control Costs
Just the name itself, a narrow network, sounds like a miserable, restrictive health plan that you would just as well avoid. But health-care experts love narrow networks, pointing out that they underpin some of the country's most successful health plans (Kliff, 1/13).

Kaiser Health News: Emergency Rooms Are Front Line For Enrolling New Obamacare Customers
Angela Felan is sitting in the emergency department waiting room at O'Connor Hospital for the second time in a week. A blue surgical mask covers her nose and mouth, and her hoodie sweatshirt is pulled snug over her head. She first came into the emergency room a few days ago with what she thought was bronchitis. The doctor prescribed an inhaler that cost her $56. She works part-time in retail and hasn't had insurance for at least a decade because she can't afford it. "And unfortunately, even not having insurance is just as expensive," she says (Varney, 1/14). 

The CT Mirror: Uninsured Connecticut: Obamacare Comes To Hartford
In their quest to help people sign up for insurance offered under the federal health law, the staff at Charter Oak Health Center have talked to more than 3,000 people. But a few stand out, like the man who was so happy to have insurance -- for $49 a month -- he was shouting on the way out. Or the young man with bad eyes who couldn't afford glasses but would, as of Jan. 1, qualify for Medicaid. "He can get those much-needed glasses, and he was so freaking happy," said Jesse Grant, the health center's outreach enrollment case manager and self-appointed promoter of Obamacare to just about anyone who will listen (Becker, 1/14).

Meanwhile, a new study assesses efforts to curb enrollment in some states.

USA Today: Study: Navigator Laws Limit Health Exchange Outreach
States that have not expanded Medicaid as part of the Affordable Care Act and also passed laws limiting the ability of health care "navigators" to advise customers have compromised their residents' ability to gain access to health care, a new study released Tuesday shows (Kennedy, 1/14).

NBC News: State Efforts To Block Obamacare Are Working, Study Finds
States whose governments are hostile to Obamacare are also hindering efforts to get people signed up for health insurance, according to a study released Tuesday. Laws restricting outreach and enrollment efforts have handicapped community health centers that are a key component of plans to get health insurance to millions of Americans who lack it, researchers at George Washington University found. "This is the first study to attempt to measure the impact of restrictive state policies," said Sara Rosenbaum, who led the team at GW’s Department of Health Policy that did the study. "The navigator laws are having a real effect" (Fox, 1/14).

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Capitol Hill Watch

Lawmakers Introduce $1T Spending Bill With Health Law Prevention Fund Cuts

The $1 trillion spending bill that lawmakers introduced Monday cuts $1 billion from the health law's Prevention and Public Health Fund and holds down funding for other health law programs to 2013 levels, but leaves it otherwise untouched. The package also funds the National Institutes of Health, but at lower levels than approved by Congress in 2013 and continues a ban on the federal government paying for abortions in the District of Columbia.

The New York Times: House and Senate Negotiators Agree on Spending Bill
House and Senate negotiators reached accord on a trillion-dollar spending plan that will finance the government through September, reversing some cuts to military veterans’ pensions that were included in a broader budget agreement last month and defeating efforts to rein in President Obama’s health care law. … Republicans do get to point to some conservative victories. The bill would cut $1 billion from the Affordable Care Act’s Prevention and Public Health Fund, which Republicans have long targeted, fearing the administration would use it to bolster the law’s online insurance exchanges. … Otherwise, the bill’s winners and losers seem to follow no patterns. The National Institutes of Health, long a congressional favorite, would get $29.9 billion, down $714 million from the level approved by Congress for 2013. In all, the N.I.H. would end up with only $1 million more than it did last year after the across-the-board spending cuts, known as sequestration, severely curtailed its research grants (Weisman, 1/13).

The Washington Post: Lawmakers Unveil Massive $1.1 Trillion Spending Bill In Bipartisan Compromise
Given barely a month to complete work on the package, [Senate Appropriations Committee Chairwoman Barbara Mikulski, D-Md.] and [House Appropriations Committee Chairman Harold Rogers, R-Ky.,] were able to overcome early partisan disputes over funding for the Affordable Care Act, Obama’s signature legislative achievement, and payments due to the International Monetary Fund, a frequent target of conservatives. … The measure also continues a ban on the use of federal funding to perform most abortions, including abortions in the District and for federal prisoners. But Republicans agreed to jettison other contentious proposals, including a ban on new federal regulations for greenhouse gases and the “global gag rule,” which sought to prohibit U.S. funding for organizations that give women information about abortion (Montgomery and O’Keefe, 1/13).

The Wall Street Journal: House, Senate Negotiators Seal $1 Trillion Spending Deal
Negotiators dropped many of the policy riders Republicans had pushed to reverse or block administration policies on environmental regulation, abortion and other issues. However, the bill didn't include funding for administration priorities conservatives opposed, such as construction of high speed rail. The bill held funding for the agency responsible for implementing the 2010 health care law at 2013 levels, and cut $1 billion from a related public-health fund (Hook, 1/13).

USA Today: Lawmakers Release $1 Trillion Spending Bill
The "omnibus" spending bill is a sweeping piece of legislation that includes all 12 of the annual bills that provide funding for all discretionary federal spending. It does not include mandatory spending on entitlement programs like Social Security and Medicare (Page, 1/13).

Politico: $1.1 Trillion Spending Bill Unveiled
Under pressure from Republicans, the measure keeps a tight rein on new funding for Wall Street regulators and effectively freezes appropriations for President Barack Obama’s health care program at the reduced, post-sequester level (Rogers, 1/13).

The Hill: Spending Bill Rolls Back Funding For Controversial Obamacare Program
House Appropriations Committee Chairman Hal Rogers (R-Ky.) on Monday trumpeted funding cuts to some of the GOP’s most despised Obamacare programs in the newly unveiled $1 trillion omnibus spending bill (Easley, 1/13).

Politico: No Appetite For Another Obamacare Fiscal Battle
The debt limit will have to be hiked sometime between late February and early June, depending on various government estimates. But congressional Republicans from across the ideological spectrum are already skeptical of trying to extract concessions from Democrats on the Affordable Care Act — a dynamic that triggered an unpopular government shutdown last fall (Kim, 1/13).

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Capitol Hill Staffers Worry Over Health Coverage, Survey Finds

A report released by the Congressional Management Foundation concluded that there is significant concern among congressional aides since the health law moved them off of their traditional federal coverage.  

The Washington Post: Survey: Strong Concern About Health Coverage Among Congressional Staffers
The vast majority of congressional staff directors think their employees are worried about their health benefits after a GOP amendment to the Affordable Care Act forced them off their normal federal-worker plans, according to a survey released Monday (Hicks, 1/13).

Politico: Survey: Obamacare Worries Hill Aides
A vast majority of top congressional aides say in a new survey that they are concerned about the effects of Obamacare on their staff, ticking off worries about changes to their benefits, higher costs and whether they’ll have access to local health care providers. Ninety percent of staffers surveyed for a report released Monday by the Congressional Management Foundation said they are concerned about benefit changes under the health care law, while 86 percent are anxious about the financial hit and 79 percent cited worries to access (Kim, 1/13).

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Rep. Miller, Close Obamacare Ally, To Retire

Rep. George Miller will retire at the end of his term, he announced Monday. The California Democrat is a close ally of House Minority Leader Nancy Pelosi and the health law.

The New York Times: California Democrat To Retire From House
Representative George Miller, Democrat of California, announced Monday that he would retire at the end of his term, after 40 years in Congress. … “Now, I look forward to one last year in Congress fighting the good fight," Mr. Miller said in a statement on Monday. He added that he had a “tall agenda” remaining as he serves out his 20th term. He hopes to extend long-term unemployment insurance benefits; raise the minimum wage to at least $10.10 per hour by 2016; further carry out President Obama’s signature health care law, and push through a broad overhaul of immigration laws -- all key Democratic goals for the coming session (Parker, 1/13).

Los Angeles Times: San Francisco Area Rep. George Miller To Retire From Congress
Rep. George Miller, a San Francisco Bay area liberal and dean of the California congressional delegation, announced Monday that he will retire when his term ends, closing a 40-year career on Capitol Hill. The veteran Democrat’s departure will leave just one lawmaker, Rep. Henry Waxman (D-Los Angeles), in the House who was elected in the Watergate class of 1974 to serve continuously in the chamber since then. Also, Miller's retirement will further shake up the state’s 53-member delegation that underwent a large turnover in 2012 due to a spate of retirements and defeats (Simon, 1/13).

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Women's Health

SCOTUS Won't Hear Appeal On Arizona Abortion Ban

The Supreme Court won't hear an appeal from Arizona seeking to reinstate an abortion law there that disallowed most abortions after 20 weeks of pregnancy. It's the third time this term the Court has refused to hear an appeal of an abortion-related case.

The New York Times: Supreme Court Won’t Hear Arizona Appeal on Abortion Ban
The Supreme Court on Monday declined to hear an appeal from Arizona officials seeking to revive a state law that barred most abortions after 20 weeks of pregnancy. The justices offered no reasons for turning down the appeal, as is their custom (Liptak and Santos, 1/13).

Los Angeles Times: With Arizona Case, Supreme Court Postpones Major Abortion Ruling
The Supreme Court's refusal Monday to revive an Arizona law that largely banned abortions after 20 weeks put off for at least another year a clear constitutional ruling on whether conservative states may adopt new restrictions on women seeking to end their pregnancies. The decision, marking the third time this term that justices have declined to take up an abortion case, suggested the closely split court is not anxious to jump into the divide between red states and blue states over abortion rights (Savage and Serrano, 1/13). 

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State Watch

State Highlights: Mass. Health Care System Eyes New Expansion

A selection of health policy stories from Massachusetts and California.

The Boston Globe: Partners Promises A New Model For Care
Facing challenges in their home state, top executives of Boston-based Partners HealthCare System told a national audience of investors Monday that they will create a bold “new medical model” by integrating hospitals and their medical services with insurance products and by drawing patients from across the country. Speaking at the J.P. Morgan Healthcare Conference, Partners’ chief executive, Gary L. Gottlieb, said his organization, which owns Harvard-affiliated Massachusetts General and Brigham and Women’s hospitals in Boston, plans to improve medical care and lower costs by further expanding its network of community hospitals and primary care physicians in Eastern Massachusetts (Weisman, 1/14).

California Healthline: In State Budget, Inaction Can Be Action
The California Budget Project's appraisal of the governor's 2014 proposed budget finds the plan lacking in addressing several health care issues. In his projections for state revenue and spending in the coming year, Gov. Jerry Brown (D) said the outlook was financially brighter but many health care budget cuts made in previous years were not addressed. According to Chris Hoene, executive director of the California Budget Project, a not-for-profit nonpartisan budget analysis organization based in Sacramento, that just doesn't make good fiscal sense. … A 10 percent Medi-Cal rate cut was passed two years ago as an emergency budget reduction when the state faced a tsunami of red ink. Now that the fiscal waters have calmed, Hoene said, it's important to make sure the state is ready for this year's Medi-Cal expansion, when one million to two million Californians will join the system and will need providers to care for them (Gorn, 1/13).

California Healthline: New Stewardship Responsibilities, Costs Probed For Drug, Needle Manufacturers
The question of what to do with toxic waste from the health care industry -- medications, used needles and other detritus -- is generating proposals for new county and state regulations in California, some of which place the burden on drug makers and needle manufacturers. Two bills in the California Legislature seek statewide regulations on the proper disposal of unused drugs and disposable needles, syringes and lancets -- collectively known as "medical sharps” (Lauer, 1/13).

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Editorials and Opinions

Viewpoints: 'Celebrating' Enrollment Numbers; Maryland's Website 'Debacle;' Abortion Battle Moves Again To High Court

Bloomberg: Everyone Can Celebrate New Obamacare Numbers
Today the federal government released the most comprehensive data yet about who signed up for Obamacare through Dec. 28. There's reason to cheer for both the law's supporters and its detractors. ... Today's numbers don't settle the question of whether the administration will hit its goals for enrollment in the exchanges, measured either in raw numbers or demographic breakdown. But they show that those goals are within reach (Christopher Flavelle, 1/13).

The Washington Post: Maryland's Health Web Site Debacle: A Scandal Of Incompentence
No one can look at The Washington Post's exhaustive investigation into the construction, rollout and crash of the Maryland health insurance exchange and walk away with any measure of confidence in government. How could this epic bungling have happened in a state that often oozes self-satisfaction with its progressive policies, led by a governor who considers himself a 2016 presidential contender? (Petula Dvorak, 1/13).

The Wall Street Journal: A Legal Poison Pill For ObamaCare
The  Obama administration is in the habit of selectively enforcing the law. It has justified this practice as an expedient to bypass congressional "dysfunction" and preserve the president's signature achievement, the Affordable Care Act. Yet that strategy may backfire on both counts. The administration's nonenforcement gambit promises only to prolong the current legislative stalemate while preparing the way for a broader rollback of the ACA (Brian Callanan, 1/13).

The New York Times: Abortion Rights: Uphold Buffer Zones
Abortion is one of the most emotionally fraught issues in American society, and public discussion often turns into an attack on the women who choose to exercise their constitutionally protected rights. ... On Wednesday, in McCullen v. Coakley, the Supreme Court is scheduled to consider whether [a Massachusetts law that creates a buffer zone around abortion clinics] violates the protesters' free speech rights under the First Amendment. While that is the legal question before the court, the broader issue at stake is protecting women's access to abortion, which is under assault around the country by lawmakers and protesters alike (1/13).

The New York Times: Abortion Rights: A Good Ruling Stands
The Supreme Court made a good call, announced on Monday, not to review a 2013 ruling by the United States Court of Appeals for the Ninth Circuit, which struck down Arizona's 20-week abortion ban as unconstitutional. For women in Arizona, the appellate ruling is critically important in protecting their reproductive rights (1/13).

Politico: R&D Funding Is The Best Medicine
American innovation, badly damaged last year by federal budget tightening and the across-the-board cuts known as sequestration, appears to be getting partial relief with the bipartisan budget deals struck last month and Monday night. The progress is praiseworthy, but it will not counteract the decades-long decline in federal funding for research and development that is so essential to our economic future and critical to accelerating treatments for today’s major health care challenges, including Alzheimer’s, diabetes, heart disease and cancer (Dr. Paul Stoffels and Alan I. Leshner, 1/13).

Bloomberg: Right, Wrong And Rubio On Poverty
The way to defeat poverty in America, Republican Senator Marco Rubio says, is to let the states lead the fight. ... A more fundamental rejoinder to Rubio’s plan is that the nature and causes of poverty don’t vary from state to state nearly as much as the political will to alleviate it does. The best illustration of this is the expansion of Medicaid under the Affordable Care Act: Only half the states have agreed to take new federal money to provide Medicaid for more people. That level of disregard for the vulnerable doesn't bode well for letting states control more such programs (1/13).

Bloomberg: Is There A Right Way To Have Cancer?
Cancer is one of those subjects like diet or child-rearing where everyone seems to have a strong opinion about the right way to do things. In [Lisa Bonchek] Adams's case, two prominent columnists -- Emma Keller of the Guardian and her husband, Bill Keller of the New York Times -- wrote articles that, while hedged with all sorts of qualifications, made it clear that they didn't condone her approach. The Internet exploded with disapproval of their disapproval (Virginia Postrel, 1/13).

WBUR: Project Louise: Flunking The Fitness Test And Getting Down To Work
It's still a bit early to declare that I’m getting into a groove, but … well, I think I can at least see the groove from here. Project Louise had a busy week: an official "fitness assessment" with my new trainer, Rick DiScipio, followed a couple of days later by my first training session with him; a two-hour meeting with my strategy coach, Allison Rimm, to outline my strategic vision and "set an intention" for the coming year; a "hot yoga" session that my friends Sara and Susan talked me into (spoiler alert: I only thought I was going to die – but you'll have to wait a week to hear more about that); and, yay me, not one but three separate visits to the gym, complete with aerobic workouts (Louise Kennedy, 1/13).

WBUR: Beyond Blame: Yes, Too Many C-Sections, But No, Not Bad Moms
I am not a bad mother because I had a Cesarean section. If you had one, neither are you. ... I hated hearing from moms who felt like we belittled their experience by suggesting that there are too many C-sections. Our point in the series was to alert everyone to the range of C-section rates and to help mothers be more aware of the factors that lead to a C-section (Martha Bebinger, 1/13).

Health Policy Solutions (a Colo. news service): Conversations With Consumers Provide Insights On New Marketplace
Health Coverage Guides are playing a critical, impartial role in helping Coloradans navigate what we all know is one of the most challenging decisions one can make: What is the right health insurance for me? Many consumers after a session with a Health Coverage Guide expressed that they were relieved to have a trained professional walk them through the process of browsing and applying for coverage. "People get confused about the process until they talk with a guide," said a guide in northern Colorado (Lisa Ritland, 1/14). 

Health Policy Solutions (a Colo. news service): Colorado Providers – Importers Or Exporters Of Services?
Beginning in 2014, large national employers including Wal-Mart and Lowes, will begin offering their employees the opportunity to travel to national Centers of Excellence (CoE’s) for total hip and total knee replacements. If the employee travels to the CoE for care, they will have no out of pocket costs for any of their treatment and all travel and meal expenses, for the employees and a "helper/companion", will be paid for by the employer. There are no Colorado providers on this CoE list and, as a result, Colorado will begin exporting some of its most profitable medical procedures beyond its borders beginning next month (Bob Kershner, 1/14). 

Health Policy Solutions (a Colo. news service): There's More Than One Way To Slice An Apple – And Calculate Readmissions
Hospitals have access to their own readmission data, but that's typically where their information ends. The Colorado All Payer Claims Database now has new ways of looking at readmissions that will give hospitals and health systems deeper insights into readmissions across the state and in their own facilities like never before. Separate Medicaid and commercial insurance readmission rates are also now publicly available for comparison across Colorado – giving us the ability to break down readmissions by coverage type, service line and geography. This level of data transparency is a critical part of eliminating unnecessary hospital readmissions for a safer, healthier, and less expensive health care system (Kristin Paulson, 1/14).

Journal of the American Medical Association: Medicare Physician Payment Reform
There are several reasons physician payment reform legislation is moving forward now. One widely cited reason is the much lower budgetary cost of a permanent fix: since last year, the 10-year cost of replacing the current SGR declined by more than half, from $297 billion to $117 billion .... The other, perhaps less appreciated reason is that support among physician groups is growing for alternatives to both the short-term SGR patches and RBRVS. Many primary care and specialty groups have been developing and in some cases implementing the kinds of payment reforms (Drs. Mark McClellan, Kavita Patel and Darshak Sanghavi, 1/13).

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Stephanie Stapleton

Andrew Villegas

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.