Daily Health Policy Report

Wednesday, January 15, 2014

Last updated: Wed, Jan 15

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Women's Health

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

HHS Extends Coverage For Patients In Federal High-Risk Pools

Kaiser Health News staff writer Mary Agnes Carey reports: "The tens of thousands of people with a history of serious illnesses who are enrolled in high-risk insurance pools created under the health care law will have an additional two months -- until March 31 -- before they lose that coverage, the Department of Health and Human Services announced Tuesday" (Carey, 1/14). Read the story

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Capsules: Oregon Seeks Tax Credits For Those Who Bypassed Exchange; WellPoint Optimistic On Exchanges Despite Slow Start; New Attack On Obamacare Filed In Missouri Legislature

Now on Kaiser Health News' blog, Marissa Evans and Mary Agnes Carey report on developments related to Oregon and the state's health exchange: "Two officials from the Oregon governor’s office were on a mission in D.C. Tuesday — trying to get a federal go-ahead to compensate individuals who purchased insurance on their own because of the breakdown of the state's health care exchange" (Evans and Carey, 1/15). 

In addition, Jay Hancock reports on Wellpoint's optimism: "WellPoint Inc. and its Anthem Blue Cross plans made one of the biggest bets on selling insurance to individuals and families through the health law’s online exchanges. No regrets, CEO Joseph Swedish said Tuesday, despite the balky beginning. … Speaking at a San Francisco conference organized by investment house J.P. Morgan, Swedish gave no sign-up figures for the marketplaces. WellPoint had 35.6 million total members at the end of the year, he said" (Hancock, 1/14).

Also on Capsules, The St. Louis Post-Dispatch's Virginia Young reports: "Missouri would strike another blow against the federal Affordable Care Act under a bill filed by state Sen. John Lamping, R-Ladue. The bill would suspend insurance companies’ state licenses if they accepted subsidies offered by the federal government to help pay health insurance premiums for low- and middle-income Missourians. Lamping contends the subsidies are illegal and eventually will be thrown out by a federal court. By rejecting them, he said, Missouri could remove the trigger in the federal law that, beginning in 2015, will assess penalties against large employers that don’t provide health insurance" (Young, 1/15). Check out what else is on the blog.

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Letters To The Editor: Medigap Coverage And Medicare Costs; The Complicated Nature Of Deductibles; Do People Know How Much 'Good' Insurance Costs?

Here's what Kaiser Health News’ readers are telling us about some of our recent stories (1/14). Check out the comments

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Political Cartoon: 'Giving The Devil His Due?'

Kaiser Health News provides a fresh take on health policy developments with "Giving The Devil His Due?" by Chip Bok.

And here's today's health policy haiku:  


States begin to ask
can exchanges be exchanged
for something better?

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

Enrollment Deadline Extended For People In High-Risk Pools

A special insurance program for about 30,000 people with a history of cancer, heart disease and other serious illnesses will be extended for an additional two months so enrollees can continue treatments while they search for other coverage, the Obama administration announced Tuesday.

Kaiser Health News: HHS Extends Coverage For Patients In Federal High-Risk Pools
The tens of thousands of people with a history of serious illnesses who are enrolled in high-risk insurance pools created under the health care law will have an additional two months -- until March 31 -- before they lose that coverage, the Department of Health and Human Services announced Tuesday (Carey, 1/14).

The New York Times: Program to Cover Major Illnesses Is Extended
A special health insurance program for people with cancer, heart disease and other serious illnesses will be extended for two additional months, through March, so patients can continue treatment while they search for other coverage, the Obama administration said Tuesday. About 30,000 people are now in the program, known as the Pre-Existing Condition Insurance Plan (Pear, 1/15).

The Wall Street Journal: White House Extends High-Risk Insurance Program
The Obama administration said Tuesday it was extending for an additional two months a federal insurance program to cover up to 30,000 people with existing medical conditions who had yet to gain insurance through private health plans. The Department of Health and Human Services said it was postponing the closure of the program until March 31 (Radnofsky, 1/14).

Fox News: White House Pushes Back ObamaCare Enrollment Deadline For Pre-Existing Conditions
The Obama administration announced Tuesday that it was delaying the deadline for people with pre-existing conditions to enroll in ObamaCare. The Department of Health and Human Services (HHS) said Tuesday that it was moving the deadline to March 15 from January 31, the originally scheduled end of the enrollment period.  "As part of our continuing effort to help smooth consumers' transition into Marketplace coverage, we are allowing those covered by (the Pre-Existing Conditions Insurance Plan) additional time to shop for new coverage while they receive the ongoing care and treatment they need," HHS spokeswoman Joanne Peters said in a statement (1/15).

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Md. Continues To Wrestle Health Exchange Glitches

Even as one cabinet member told Maryland lawmakers Tuesday that the troubled system may need to be abandoned or overhauled, Gov. Martin O'Malley issued a statement saying the state would keep the online marketplace operating and work on improvements and fixes. News outlets also provide the latest developments from Oregon, Colorado and Minnesota.   

The Washington Post: Md. Health Secretary: State Exchange Site Glitches Could Force Overhaul Or Abandonment
Maryland’s health exchange Web site is still riddled with glitches and might need to be completely overhauled — or even abandoned — once the first round of enrollment ends March 31, a member of Gov. Martin O’Malley’s Cabinet told lawmakers Tuesday. Until then, state officials say they have come up with a system of temporary fixes aimed at getting as many Marylanders as possible signed up for health coverage before the deadline. That has included hiring dozens of people to staff call centers and, in some cases, resorting to paper applications (Johnson, 1/14).

The Baltimore Sun: Maryland To Stick With Own Health Care Site
As legislators grilled Lt. Gov. Anthony G. Brown on Tuesday over the dismal debut of Maryland's health insurance exchange, the O'Malley administration stood by the website and said it will not switch to the federal version. Rejecting calls to shut down the state's bug-ridden website, Gov. Martin O'Malley's office issued a statement saying the state would keep it running while working to improve it for at least the next 21/2 months (Dresser, 1/14).

The Wall Street Journal’s Washington Wire: Maryland Won’t Switch Over To Healthcare.gov
Maryland says it won’t switch to the federal health insurance website Healthcare.gov while kinks are worked out of the state’s website. In a written statement Tuesday, Gov. Martin O’Malley’s office said it “evaluated the feasibility” of using some functions of the federal exchange but said the “risks associated with the transition to the federal site would outweigh the benefits” (Corbett Dooren, 1/14).

Kaiser Health News: Capsules: Oregon Seeks Tax Credits For Those Who Bypassed Exchange
Two officials from the Oregon governor’s office were on a mission in D.C. Tuesday — trying to get a federal go-ahead to compensate individuals who purchased insurance on their own because of the breakdown of the state's health care exchange (Evans and Carey, 1/15).

The Star Tribune: MNsure’s Troubles Are Leaving The Poor Stranded
It’s early on a Monday, and Comopsia Stanley is making a series of calls in rapid succession, stopping only to wipe tears from her reddened eyes. Her diabetic son, Demarco, 11, is down to just a day’s supply of insulin, and Stanley is trying desperately to determine if her online application for Medical Assistance through MNsure has been approved so she can buy more. Each call is more frantic than the last. “What do you want?” Stanley, 36, pleads with an Anoka County social service worker. “Do you want my son to die?” The messy rollout of MNsure, the state’s troubled online insurance exchange, just got messier for thousands of low-income Minnesotans (Serres, 1/15). 

The Denver Post: Audit Of Colorado’s Health-Care Exchange Program Underway
A Republican lawmaker's request to audit Colorado's state health care exchange was viewed favorably Tuesday because an audit already is underway. Rep. Jared Wright of Fruita requested the audit late last year when reports surfaced that enrollments had fallen short of projections, there were problems with the website, and the CEO of Connect for Health Colorado asked for a raise and bonus. That request was later withdrawn (Bartels, 1/15).

And from the insurance industry's perspective -

Kaiser Health News: Capsules: WellPoint Optimistic On Exchanges Despite Slow Start
WellPoint Inc. and its Anthem Blue Cross plans made one of the biggest bets on selling insurance to individuals and families through the health law’s online exchanges. No regrets, CEO Joseph Swedish said Tuesday, despite the balky beginning. … Speaking at a San Francisco conference organized by investment house J.P. Morgan, Swedish gave no sign-up figures for the marketplaces. WellPoint had 35.6 million total members at the end of the year, he said (Hancock, 1/14).

Modern Healthcare: Insurers Show Measured Optimism For Exchange Enrollment
Health insurers are expressing measured optimism for enrollment in the coverage they're selling on the health insurance exchanges after quietly grumbling for weeks that the fumbled rollout was undermining their business plans. Some health insurance executives expressed some modest bullishness on the exchanges Tuesday at the JP Morgan Healthcare conference in San Francisco, even though a day earlier HHS revealed that the enrollees so far are skewing older than many had hoped (Kutscher, 1/15).

In other related news -

The Washington Post: QSSI To Stay On As Healthcare.gov’s General Contractor
The Obama administration has decided to retain Quality Software Services Inc. as its general contractor for HealthCare.gov, even as it has hired a new contractor to do most of the work on the Web site. In a joint statement Tuesday, Optum/QSSI and the Centers for Medicare and Medicaid Services said they would keep working together to ensure the online federal health insurance marketplace works well for consumers. On Saturday, CMS signed a contract with the global consulting firm Accenture to serve as the site's primary contractor in the coming year (Eilperin, 1/14).

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Coverage, Payment Confusion Persists For Insurers, Consumers

The CT Mirror details how coverage delays are affecting consumers while the Sacramento Bee reports on how some insurers on California's health exchange have pushed back the due date for premium payments while others are not.   

The CT Mirror: Connecticut Regulators Losing Patience With Anthem Coverage Delays
David Gilbert says he sent his $825 check to Anthem Blue Cross and Blue Shield in early December. It was supposed to ensure that the Voluntown man would have health insurance by the start of this year. But two weeks into 2014, Gilbert, 63, is still waiting for proof that he has insurance. An Anthem representative told him his check had been received, but as of Monday it hadn’t been cashed. That means Gilbert has been unable to get an insurance ID card, which he needs for a referral to an orthopedist (Becker, 1/14).

The Sacramento Bee: Amid Confusion, Some California Health Insurance Deadlines Are Pushed Back
Beset by processing delays and customer confusion, two providers operating in the state’s new health insurance exchange have pushed back their due dates for premium payments. On Tuesday, officials with Anthem Blue Cross of California said the company was pushing back its payment deadline to Jan. 31. Kaiser Permanente set its new payment date for Jan. 22. Meanwhile, the state exchange said its deadline would remain midnight tonight for those whose coverage with nine other participating insurers begins Jan. 1. Midnight tonight is also the deadline for customers to enroll in coverage that begins Feb. 1 (Cadelago, 1/15).

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Alabama, S.D. Governors Defend Decisions Not To Expand Medicaid

Alabama Gov. Robert Bentley, a physician, began the state legislative session by presenting better education and jobs as the best strategies to help residents escape poverty. South Dakota Gov. Dennis Daugaard, meanwhile, said his goal is to seek federal approval to cover only South Dakotans earning below 100 percent of the federal poverty line — $10,890 per year for a single person.

The Associated Press: Bentley Defends Decision Not To Expand Medicaid
Gov. Robert Bentley began the election-year session of the Alabama Legislature by defending his decision not to expand the state Medicaid program and by presenting better education and more jobs as the best strategy for escaping poverty. In his State of the State speech Tuesday night, the Republican governor acknowledged that Alabama is one of the poorest states in America, with one in four children living in poverty. ... Bentley is a physician, but like other Republican governors in the South, he chose not to expand Alabama's Medicaid program under the federal health care law (Barrow and Rawls, 1/14).

Sioux Falls Argus Leader: [S.D.] Governor Weighs Medicaid Options But Urges Patience
Gov. Dennis Daugaard is looking for alternative ways for South Dakota to expand Medicaid under the federal Affordable Care Act, instead of the full expansion he’s said no to so far. But he’s not looking very quickly. While states such as Arkansas and Iowa have negotiated deals with the federal government to pursue flexible approaches to Medicaid expansion, Daugaard hasn’t shown the same urgency. ... Daugaard’s goal is to get approval to cover only South Dakotans earning below 100 percent of the federal poverty line — $10,890 per year for a single person, or $22,350 for a family of four. The federal health care law calls for states to expand Medicaid up to 133 percent of the federal poverty line. That’s $15,282 for a single person or $31,322 for a family of four (Montgomery 1/15).

Meanwhile, low-income Ohioans who applied through healthcare.gov for Medicaid or the Children's Health Insurance Program are being told they must reapply through the state.

Columbus Dispatch: Thought Healthcare.gov Signed You Up For Medicaid? Better Think Again
Tens of thousands of low-income Ohioans who applied through HealthCare.gov for Medicaid or the Children’s Health Insurance Program are being told they must reapply for that insurance coverage through the state. Turns out that applicants who used the federal enrollment website and were told they qualified for the tax-funded coverage actually were not signed up because of lingering computer problems, according to federal and state officials (Candisky, 1/14).

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State Officials Seek Ways To Undermine Obamacare

Lawmakers in some states continue to look for ways to stop implementation of the health law, making proposals to ban state employees from carrying out the law, forbidding state officials from taking federal money to implement it, and suspending the state licenses of insurers who take federal subsidies meant to defray the premiums of poor and middle-class consumers.

Reuters: South Carolina Lawmakers Take Aim At Health Care Law
South Carolina lawmakers say they have found a way to stop implementation of the U.S. Affordable Care Act in their state, an effort that could provide a template for other Republican-led legislatures looking to derail the federal program. The proposed measure would ban state agencies from helping carry out President Barack Obama's signature health care reform law and prevent federal money flowing through state coffers from being spent on it, said Republican state Senator Tom Davis (McLeod, 1/14).

St. Louis Post-Dispatch/Kaiser Health News: Capsules: New Attack On Obamacare Filed In Mo. Legislature 
Missouri would strike another blow against the federal Affordable Care Act under a bill filed by state Sen. John Lamping, R-Ladue. The bill would suspend insurance companies’ state licenses if they accepted subsidies offered by the federal government to help pay health insurance premiums for low- and middle-income Missourians. Lamping contends the subsidies are illegal and eventually will be thrown out by a federal court. By rejecting them, he said, Missouri could remove the trigger in the federal law that, beginning in 2015, will assess penalties against large employers that don’t provide health insurance (Young, 1/15).

And county officials in Virginia want Congress to redefine a so-called Cadillac plan and how it is taxed -

The Washington Post: Fairfax County Decides To Push Congress To Make Changes To Health-Care Law
Fairfax County officials are moving to persuade Congress to change how so-called “Cadillac” health plans are defined under the Affordable Care Act, part of a spreading concern about projected tax penalties under the law that would not take effect until 2018. On Tuesday, the Fairfax County board of supervisors voted to explore ways to push for changes in a section of the law that they argued unfairly punishes employers in more expensive areas of the country where health insurance premiums are higher (Olivo, 1/14).

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In States Opposed To Health Law, Many Low-Income Residents Are Left Out

Politico examines the stark differences in the impact of the Affordable Care Act between Republican-led states fighting it and others that have accepted the health overhaul. Meanwhile, USA Today finds that even with the law, many consumers will face troubling medical debt.

Politico: State Fights Creating 2 Obamacares
Determining who has health insurance under Obamacare is almost as simple as figuring out which political party runs a state. Republican-led states like Texas that have refused Obamacare every step of the way have left hundreds of thousands of people without health care, while Democrat-led states like Kentucky that have embraced key portions of the law have seen a dramatic expansion in people signed up for private health plans and expanded Medicaid coverage (Norman, 1/14).

The Richmond Times-Dispatch: Advocates Say 195,000 Virginians In Health Care 'Coverage Gap'
Alyson Cardin had a choice -- pay $300 a month for medication to control her seizures or buy groceries for her three children. "Feeding my children was simply more important," said Cardin, 37, a divorced waitress in Giles County. So Cardin stopped taking her medication and experienced a seizure while driving with one of her children. She lost control, hit another car, and ended up in a hospital emergency room. Hers is one story from the "coverage gap" that has swallowed an estimated 195,000 Virginians who earn too much to qualify for Medicaid but too little to be eligible for federal subsidies to buy health insurance in the new federally run marketplace (Martz, 1/15).

USA Today: Medical Debt Will Persist Despite Health Law
Millions of Americans will get health insurance through the Affordable Care Act that will protect them from potentially ruinous medical expenses, but a new USA Today analysis shows the health plans they can choose still leave them vulnerable to thousands in deductibles and other out-of-pocket costs each year (O’Donnell and Overberg, 1/14).

In other implementation news --

NPR: Why The Youth Gap On Obamacare Exchanges Could Be A Yawner
The dust is settling a bit after the administration released details Monday about who signed up for health insurance on the exchanges during the chaotic three months after they launched Oct. 1. Just about everybody was watching to see how many young people piled in. ... The administration ultimately hopes that about 40 percent of the people who get insurance through the exchanges will be young adults. ... [B]ut people ages 18 to 34 came in at just 24 percent of the total sign-ups. Big deal? Maybe. Maybe not (Hensley, 1/14).

The Fiscal Times: 3 Predictions On How Docs Will Treat You Under Obamacare
The White House contends that Obamacare will reduce the number of uninsured, reign in health care costs, cut the deficit and improve the quality of health care. Opponents of the law argue that it's simply another costly entitlement program that won't control costs and will lower quality of care all while incurring hundreds of billions in new costs. To get an idea of what the act of receiving health care will be like in the next five to 10 years with Obamacare as the law of the land, we reached out to experts who fell into one of three camps. One predicts disaster, another predicts success, and another doesn’t believe the Affordable Health Care Act will change much of anything (Francis, 1/15).

Bloomberg: Obamacare Packing Medical Offices Spurs Deal Surge
Obamacare and an aging U.S. population are spurring purchases of medical office buildings, with investors sending prices to a record on bets that Americans' demand for health services will increase. Sales of properties leased by doctors and other health-care providers reached $6.67 billion in 2013, the second-highest total in 13 years of data-keeping by Real Capital Analytics Inc (Louis, 1/14).

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Health Law Attack Ads Pressure Democratic Congressional Candidates

An onslaught of ads targets vulnerable Democrats for their support of the overhaul. Health law opponents, notably the Americans for Prosperity group, which is in part financed by the Koch brothers, have spent an estimated $20 million on television advertising. A conservative Hispanic advocacy group is also planning its own round of ads. 

The New York Times: Ads Attacking On Health Law Stagger Outspent Democrats
Democrats are increasingly anxious about an onslaught of television ads hitting vulnerable Senate and House candidates for their support of the new health law, since many lack the resources to fight back in the early stages of the midterm campaign. Since September, Americans for Prosperity, a group financed in part by the billionaire Koch brothers, has spent an estimated $20 million on television advertising that calls out House and Senate Democrats by name for their support of the Affordable Care Act (Hulse, 1/15).

The New York Times' The Caucus: Conservative Group To Air Ads Attacking Health Law In Michigan And Iowa
One of the country's most well-funded conservative groups is betting that public anger against President Obama's signature health initiative is broad and deep enough to expand the field of competitive Senate races this November. The group, Americans for Prosperity, will begin a $1.8 million television advertising campaign on Tuesday attacking Democratic Senate candidates in Iowa and Michigan, states that went for Mr. Obama in 2012. The campaign, further bolstered by radio and Internet expenditures, will also include an advertisement thanking Representative Steve Daines, a Republican Senate candidate in Montana, for his efforts opposing the health care act (Confessore, 1/14).

The Wall Street Journal’s Washington Wire: Ads Attack Democratic Candidates In Iowa, Michigan
Americans for Prosperity, the well-funded conservative group that has shelled out millions attacking Democrats in states President Barack Obama lost, is turning its attention to a pair of states the president won. The group kicked off a $2 million advertising blitz Tuesday that centers on ads criticizing Democratic Senate candidates in Iowa and Michigan for supporting Mr. Obama’s new health law. The campaign also includes ads thanking Rep. Steve Daines, the Republican Senate candidate in Montana, for opposing the law (O’Connor, 1/14).

Politico: Hispanic Group Offers Anti-ACA Ad
A conservative Hispanic advocacy group will launch a new round of ads Wednesday targeting a vulnerable House Democrat over Obamacare — an effort that highlights the problems that it says Latinos have faced with the health care law. The ad from the LIBRE Initiative goes after Rep. Joe Garcia (D-Fla.) and stars a Latina doctor in southern Florida who cites a handful of concerns she has about the Affordable Care Act — such as higher premiums and canceled insurance policies (Kim, 1/14).

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Capitol Hill Watch

Health Law's Prevention Funds Diverted To Other Programs In $1T Spending Bill

New details emerge about the cut to the health law's Prevention and Public Health Fund in the $1 trillion spending bill, but a jobless benefits extension in Congress stalls.  In the meantime, a mental health plan pushed by President Obama will get spending bill funds.

The New York Times: $1.1 Trillion Bill To Avoid Federal Shutdown Covers Many Local Interests
A billion-dollar public health fund created by the Affordable Care Act survived in name only. Republicans made sure that every cent of the money was parceled out to programs that are not connected to the health law (Lipton and Weisman, 1/14).

Politico Pro: Budget Bill Yields Another ACA Scramble
The deal to fund the government leaves Obamacare high and dry, raising questions about how the Obama administration will fund ongoing repair efforts and development costs for the misbegotten signup portal. The omnibus bill unveiled Monday night doesn’t provide another dime for the Affordable Care Act and it walls off one of the key pots the administration has turned to in the past -- the Prevention and Public Health Fund, established by Sen. Tom Harkin (D-Iowa). That money will go to disease prevention programs, not Obamacare implementation (Norman, 1/14).

CQ HealthBeat: Obama Mental Health Plan Would Be Funded Under Obamacare
Mental-health initiatives that the Obama administration proposed in the wake of the deadly elementary school shooting in Newtown, Conn., will receive sought-after funding if the omnibus spending bill released late Monday is signed into law (Attias, 1/14).

Los Angeles Times: Spending Bill Is On Track But Jobless Benefits Stall In Congress
A $1-trillion spending bill was headed for swift approval in the House by Wednesday, but legislation to extend unemployment insurance stalled in the Senate amid partisan bickering, dashing hopes for a quick deal to resume jobless benefits (Mascaro, 1/14).

The Washington Post: Unemployment Benefits Won’t Be Extended Until At Least Late January As Senate Deadlocks
With a total price tag of about $12 billion, the Republican proposal offered savings by eliminating the ability of the unemployed to receive both federal disability payments and jobless aid. Also included was a provision to extend portions of automatic spending cuts but walling off the military and Medicare providers to increased cuts. The proposal was similar in some respects to Reed’s latest, but he suggested it was also “robbing Peter to pay Peter” because some of the proposed spending cuts would hit programs that would assist the poor (Kane, 1/14).

The New York Times: Unemployment Extension Is Stalled, With 2 Proposals Defeated In The Senate
The first vote failed, 52 to 48, on a measure proposed by the Democratic leadership that would have extended benefits for 11 months. The extension would have been largely financed by continuing a 2 percent cut to Medicare health providers for an additional year, through 2024. The second vote, on the original bill, which would have extended benefits for three months at a cost of $6.4 billion, failed 55 to 45 (Parker, 1/14).

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Bill Seeks Team-Based Approach To Caring For Medicare Patients With Chronic Illness

Sen. Ron Wyden plans to unveil a bill to encourage team-based care in the program for older and disabled Americans. In the meantime, Medicare readies to deliver payment data for individual doctors on a "case-by-case" basis.

Modern Healthcare: Lawmaker’s Bill Encourages Team-Based Care For Chronically Ill Medicare Patients
Sen. Ron Wyden and three other lawmakers are expected to introduce bipartisan legislation Wednesday intended to remove obstacles they say prevent Medicare providers from focusing on chronically ill patients (Zigmond, 1/15).

Medpage Today: Medicare To Release Doc Pay Data This Spring
Medicare will begin releasing payment data for individual physicians on a "case-by-case basis" as soon as this spring, the Centers for Medicare and Medicaid Services (CMS) announced Tuesday. … The agency will evaluate requests for individual physician payment information starting in mid-March -- 60 days after the publication of a Federal Register notice explaining the policy, Blum said (1/14).

And insurers aren't waiting for proposed cuts to pressure lawmakers to preserve money for private Medicare plans --

Politico: Insurance Industry Ad Blitz To Preempt Medicare Cuts
This time around, the insurance industry isn’t even waiting for the Obama administration to threaten cuts to private Medicare plans: It’s launching a peremptory strike. America’s Health Insurance Plans announced an all-out advertising campaign Tuesday. Maintaining the same "Seniors are Watching" theme of more general ads last fall, the new seven-figure campaign is the group’s biggest mobilization to date for Medicare Advantage, a spokesman said. It comes in advance of an annual notice that sets the plans’ payment rates for the upcoming year and is focused on that issue (Norman, 1/14).

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Women's Health

High Court To Hear Arguments In Abortion Clinic Buffer Zone Case

The arguments, which pit anti-abortion protestors' freedom-of-speech rights against women's health providers' public safety concerns, will be heard on Wednesday.

Reuters: Supreme Court Takes Up Abortion Protest Case
The U.S. Supreme Court on Wednesday will wade into a divisive case that pits the free speech rights of anti-abortion protesters against public safety concerns raised by women's healthcare providers. The nine justices will hear a one-hour argument over a challenge to a Massachusetts law aimed at ensuring access for patients at clinics that offer abortions (Hurley, 1/15).

NPR: Supreme Court Considers Legality Of Abortion Clinic Buffer Zones
The U.S. Supreme Court hears arguments Wednesday in a case testing the constitutionality of buffer zones at abortion clinics. Fourteen years ago, the court upheld Colorado's 8-foot "floating" buffer zones around individuals to protect patients and staff entering and exiting these clinics. Since then, buffer zones have prevented demonstrators from closely approaching patients and staff without permission. But the issue is back before a different and more conservative Supreme Court (Totenberg, 1/15).

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State Watch

State Highlights: Tough Road Ahead For Ga. Medical Malpractice Bill

A selection of health policy stories from Minnesota, Georgia, California, Ohio, Wisconsin, Texas and North Carolina.

Georgia Health News: Medical Malpractice Bill Faces Long Odds
State Sen. Brandon Beach (R-Alpharetta) faces an uphill climb in his effort to revamp the medical malpractice system in Georgia. Beach has been pushing his malpractice reform bill for two years, but experts say SB 141 is not likely to pass in 2014. House Speaker David Ralston (R-Blue Ridge) told the Atlanta Business Chronicle there is not enough time to consider the legislation during this year’s abbreviated session of the Georgia General Assembly. The session will end early because party primaries will be held in May — two months earlier than in recent election years (Craig, 1/14). 

The San Francisco Chronicle: Ballot Drive Seeks Cap On Health Costs, CEO Pay
SEIU-United Healthcare Workers says its proposed measures represent the nation's most wide-ranging and aggressive ballot efforts to control hospital costs. They include one measure that would prohibit hospitals from charging more than 25 percent above the actual cost of providing patient care, and another that would bar the executives of not-for-profit hospitals from earning more than $450,000 a year. Proponents of the measures say the overwhelming number of hospital beds -- more than 75 percent of those in California -- are in such not-for-profit hospitals, which include giants like Kaiser Permanente and Sutter Health. Supporters must gather 505,000 valid signatures of registered voters for each measure to qualify for the November ballot (Marinucci, 1/14). 

The Wall Street Journal: Splintered System Often Fails Mentally Ill With Low IQs
In most states, including California, mental-health treatment is overseen by counties, while state officials coordinate developmental-disability services. The splintered system makes it extremely hard to coordinate treatment, and few professionals are trained to even identify coexisting conditions (Ansberry, 1/14).

Minnesota Public Radio: Primary Care Shortage Raises Profile Of Nurses With Advanced Degrees
A Twin Cities foundation will invest $10 million in a University of Minnesota program that develops highly trained nurses. Minnesota's primary care shortage is raising the profile of nurses who have earned advanced degrees in the field. With that in mind, the Bentson Foundation is funding the U of M's Doctor of Nursing Practice program. By doing so, the foundation aims to help supply Minnesota with more nurses who have doctorate-level training in family medicine, geriatrics and other specialties (Benson, 1/14).

The New York Times: After Flurry of Changes, Some States Ease Up
The lowered ambition amounts, in some cases, to a declaration of victory, as is the case with abortion restrictions in Ohio and providing driver’s licenses to illegal immigrants in California. But it also reflects political concerns among some legislators and governors up for election that they at times claimed an unfounded mandate with this aggressive period of legislating, according to analysts and elected officials. For the past three years, under the hand of a Republican governor and a Republican legislature, Ohio has forged an ambitious, if occasionally unorthodox, conservative agenda, enacting laws to limit the availability of abortion, cut taxes and restrict the power of unions, while also bolstering some programs for the needy. But for now at least, lawmakers are looking at consensus legislation, such as requiring parental notification for children getting opiate prescriptions rather than restricting bargaining rights of public workers (Nagourney, 1/15).

The Milwaukee Journal Sentinel: Poor Care Called Factor In Four Deaths At Mental Health Complex
An independent doctor, hired last spring to examine six 2012 deaths at the Milwaukee County Mental Health Complex, found that medical treatment there was so poor, the place should be closed. The doctor, who had access to medical files and other internal documents, found that significant failures in medical care contributed to the deaths of four of the six patients. In the other two cases, he found problems but said "their treatment was at least adequate” (Kissinger, 1/14).

The New York Times: Suing To End Life Support For Woman and Fetus
Lawyers for the husband of a pregnant woman being kept on life support at a Fort Worth hospital against her family’s wishes sued hospital officials on Tuesday, asking a judge to order the doctors to remove her from the machines and declare the Texas law at the center of her case unconstitutional (Fernandez, 1/15).

Los Angeles Times: Case Of Brain-Dead Pregnant Woman Goes To Texas Court
The husband of a brain-dead, pregnant woman filed papers in court Tuesday, accusing a Texas hospital of "cruel and obscene mutilation of a deceased body," and demanded that his wife be removed from a ventilator immediately. Erick Munoz, who found his wife, Marlise, collapsed on their kitchen floor on Nov. 26, has accused John Peter Smith Hospital in Fort Worth of misinterpreting a state law that prohibits hospitals from suspending "life sustaining treatment" on patients who are pregnant, according to the filing (Morin, 1/14). 

The Star Tribune: Bill Takes Aim At Minnesota's Problem Nurses
Minnesota health professionals who fail a state program monitoring them for drug abuse and mental illness would automatically be suspended from practicing under a proposal introduced Monday in the Legislature. The sponsor of the bill, Rep. Tina Liebling, DFL Rochester, said it is likely the first of many proposed changes to the state’s oversight of problem nurses. In November, the Star Tribune reported that some nurses continued to practice despite being discharged from the Health Professionals Services Program (HPSP) for abusing drugs or alcohol, or for stealing drugs from their workplaces. Legislators convened a hearing later that month where Minnesota Nursing Board officials expressed frustration that they could not immediately suspend nurses terminated from state monitoring (Stahl, 1/15).

North Carolina Health News: Medicaid Budget Impossible To Forecast Due To Ongoing DHHS Computer Woes
After months of negative publicity about computer glitches in her department, Health and Human Services Sec. Aldona Wos apologized for a massive data-privacy breach that occurred at the end of December, when the state Medicaid program sent the wrong registration cards to more than 48,000 child Medicaid recipients (Hoban, 1/14).

Raleigh News & Observer: Obamacare Website Fixer Has Thing For Tax Havens 
The head of the state’s health agency apologized Tuesday for errors that resulted in violations of federal privacy rights of nearly 50,000 children. ... The department has been juggling crises in the last month. In December, the agency mailed 48,752 children’s Medicaid insurance cards, which include their names, dates of birth and Medicaid identification numbers, to the wrong addresses. A few weeks earlier, the U.S. Department of Agriculture threatened to sanction the state for lengthy delays in processing thousands of food stamp applications (Bonner, 1/14).

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Editorials and Opinions

Viewpoints: House GOP Moves Away From Health Law Repeal Demands; Defeating Polio; Health Website Insults Hispanics

The New York Times: Finally, Congress Does Its Job
Assuming hard-right members of the House don’t manage to block it, a $1 trillion appropriations bill is about to be approved by both chambers for the rest of the 2014 fiscal year, through the end of September. ... Republican moderates, politically burned by the government shutdown last fall, joined Democrats in fending off almost all of the Tea Party’s demands. Right-wing Republicans failed to prevent any money from being spent on implementing the health care law, or enforcing power-plant regulations, or reforming financial practices under the Dodd-Frank law (1/14). 

The New York Times: Eradicating Polio Everywhere
It has been three years since the last new case of polio was reported in India. The country can now be declared polio-free. India’s victory is an important milestone in the global effort to eliminate polio. In 2013, just 250 people were paralyzed by polio. But the viral disease remains a threat. The World Health Organization reported 359 new polio cases as of Dec. 10, 2013, up from 213 in December 2012. And the number of countries where polio is present rose to eight from four between December 2012 and December 2013, with polio spreading out of Nigeria into the Horn of Africa and from Pakistan into the Middle East. Violent conflict and distrust of vaccination programs are to blame (1/14). 

The Washington Post's The Plum Line: As Republicans Kill UI, A Battle Looms Over Safety Net
This is a reminder that the safety net is going to be front and center in many races this fall, even in red states. To read much of the commentary, you’d think Dems have two choices: either sink under the weight of Obamacare, or run away from it. As Charlie Cook put it, Dems are talking about inequality to "shift the focus" from Obamacare, because it has become a "sore subject." That’s true in some ways, but the nuances of what Dems are up to are worth appreciating (Greg Sargent, 1/14). 

The Wall Street Journal: Speechless In Massachusetts
A hallmark of the John Roberts Supreme Court has been its support for the First Amendment, and the Justices have another chance to advance free speech on Wednesday when they hear a case challenging one of their historic mistakes. In McCullen v. Coakley, 76-year-old Eleanor McCullen wants to stand outside clinics to change the mind of women who may want an abortion. She is challenging a 2007 Massachusetts law that says only patients and clinic employees can stand within a 35-foot radius of the entrance of a "reproductive health facility." Violators can be fined up to $500 for a first offense, and repeat offenders punished with fines up to $5,000 and two and a half years in jail (1/14). 

The Sacramento Bee: Ask Emily: Obamacare's Other Story: Medi-Cal Has Its Own Glitches
State officials have been crowing that more than 400,000 Californians have enrolled in plans through the state’s health insurance exchange, Covered California. However, another important statistic is getting lost in the exchange hubbub, and it has to do with Medi-Cal, the state's publicly funded Medicaid program that insures low-income residents. Medi-Cal is huge. ... like the folks who have wrestled with the Covered California website or waited on hold for hours without getting an answer to their question, some Medi-Cal applicants say they are hitting roadblocks that are preventing them from obtaining coverage (Emily Bazar, 1/15).

USA Today: Obamacare Insults Hispanics
Hispanic Americans have a rocky relationship with the Affordable Care Act. After years of planning, the Spanish-language version of HealthCare.gov opened two months late and was only officially launched in January. But that was the least of the website's problems. The finished product turned out to be more punchline than health care portal. The glitchy "Spanglish" site is not only a technical disaster; it's also an embarrassment to the Spanish-language and a sign of disrespect to the Hispanic-American community, for whom much is at stake in the health care debate (Daniel Garza, 1/14). 

Journal of the American Medical Association: Implications Of New Insurance Coverage For Access To Care, Cost-Sharing, And Reimbursement
Whether the goal of the ACA in providing access to care for millions of uninsured US citizens is realized depends largely on the current primary care system to treat newly insured patients. The reimbursement and regulatory structure of the US health care delivery system makes decisions about accepting new patients particularly complicated for physicians, other clinicians, and practices. ... How, how much, and how long clinicians and practices will be paid for their services under Medicaid and the exchanges will be important considerations. It may well be that the ACA’s temporary reimbursement increases coupled with high cost-sharing insurance products and payments tied to quality measurement are simply not an attractive enough business proposition (A. Everette James III, Dr. Walid F. Gellad and Dr. Brian A. Primack, 1/14).

The Fiscal Times: Opening Up the Black Box Of U.S. Health Care Prices
What if you could compare hospital and doctor's fees the way you could shop for something online? For those expenses you pay out of pocket, it would make a huge difference. In theory, providers would compete to offer the highest-quality service at the lowest cost and would likely be "star" rated by consumers the way they are on hundreds of online sites. That begs a critical question: Will the 2.2 million Americans who signed up for insurance through the Affordable Care Act – including some 1.8 million added just last month – be more demanding consumers? (John F. Wasik, 1/15).

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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.