Daily Health Policy Report

Thursday, January 16, 2014

Last updated: Thu, Jan 16

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Women's Health

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Congress Is Poised To Change Medicare Payment Policy. What Does That Mean For Patients And Doctors?

Kaiser Health News staff writer Mary Agnes Carey reports: "After years of legislative wrangling and last-minute patches, expectations are high among physician groups, lawmakers and Medicare beneficiaries that Congress could act this year to permanently replace the current Medicare physician payment formula. While committees in both chambers have approved their own 'doc fix' proposals, the approaches have yet to be reconciled, and none have identified how they would pay for a repeal" (Carey, 1/16). Read the story.

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Check Your Blood Pressure, (Unwittingly) Sell Your Contact Information

KQED’s April Dembosky, working in partnership with Kaiser Health News and NPR, reports: "Health insurance companies are on the prowl for more customers. There are still three months to go for people to enroll in health plans under the Affordable Care Act, but insurers don’t want to rely solely on state or federal websites to find them. Some are finding a path to new customers by partnering with companies that operate health-screening kiosks –- those machines in supermarkets and drug stores where people check their blood pressure or weight" (Dembosky, 1/15). Read the story.

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Capsules: State Snapshots Of Obamacare Enrollment Numbers

Now on Kaiser Health News' blog, a roundup of enrollment numbers from various states: "Enrollment in the health law’s marketplaces surged in December, and the administration’s report on the numbers made headlines on Monday — but the national story isn’t the whole story. Health care is delivered in 50 different state markets, and each state is implementing the health law with varying degrees of success and failure, enthusiasm and hostility. Reporters at NPR member stations around the country dove into the data the Obama administration released and delivered these dispatches" (1/16).

Also on the Capsules, Roni Caryn Rabin reports on the variation in costs for labor and delivery: "Hospital charges for labor and delivery vary so widely from one California medical center to another that some facilities charge women eight to 11 times more than others, according to a new study. Comparing nearly 110,000 uncomplicated births and Caesarean sections, researchers found the lowest charge for a vaginal birth involving an average woman was $3,296, while the highest was $37,227" (Rabin, 1/16). Check out what else is new on the blog.

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Political Cartoon: 'Moving The Goalposts?'

Kaiser Health News provides a fresh take on health policy developments with "Moving The Goalposts?" by Eric Allie.

And here's today's health policy haiku:  


Magic Johnson part
of health care law full court press
to spur enrollment. 

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

Federal Judge Upholds Health Law's Subsidies

Critics of the overhaul argued that, as passed by Congress, the statutory language limited the use of subsidies to purchase health insurance only to consumers in states that are running their own online marketplaces -- not to those who are shopping for health plans on the federal exchange. The judge's ruling, which upholds a central element of the health law, is a victory for the Obama administration.

The New York Times: Federal Judge Upholds Health Care Subsidies
A federal judge rejected a legal challenge on Wednesday to a central part of President Obama’s health care law, ruling that millions of low- and moderate-income people could obtain health insurance subsidies regardless of whether they bought coverage through the federal insurance exchange or in marketplaces run by the states (Pear, 1/15).

Los Angeles Times: Obamacare Critics Lose Major Lawsuit
A federal judge Wednesday emphatically rejected a last-ditch challenge to President Obama’s healthcare law, ruling that the Affordable Care Act allows low-income Americans to get government subsidies to buy health coverage no matter what state they live in. Critics of the law argued that the statute, passed by Congress in 2010, limited these subsidies to consumers in states that operate their own insurance marketplaces. Only 14 states do that; the remaining 36 rely on the federal government to run their marketplaces, or exchanges (Levey, 1/15).

The Wall Street Journal: Judge Rejects Challenge To Health-Care Law Subsidies
A federal judge on Wednesday upheld the legality of subsidies at the core of the federal health-care law, turning aside one of the principal remaining court challenges to the law. The decision hands a victory to the Obama administration, which has been fighting in court to defend the Affordable Care Act since it passed in March 2010. The Supreme Court in June 2012 upheld the law's requirement for most Americans to carry health insurance or pay a tax penalty (Kendall, 1/15).

The Washington Post: Judge Upholds Health Law Subsidies
A federal judge in the District rejected a lawsuit Wednesday that would have gutted President Obama’s health-care law by preventing the government from giving out subsidies to people buying health insurance in dozens of states. The federal subsidies are critical to the law because they reduce monthly premiums, in some cases drastically, for the vast majority of people buying coverage on new online insurance marketplaces. Starting this year, most Americans must have health insurance or face a fine (Somashekhar, 1/15).

Politico: Obamacare Tax Credit Suit Rejected
The four individuals who brought the lawsuit, Halbig v. Sebelius, had argued that the IRS overstepped its legal authority by allowing federal-run exchanges to provide tax credits for people who purchase health insurance. They contended that the Affordable Care Act only allows for state-run exchanges to access such credits and that Congress purposefully designed the law that way to incentivize states to run their own insurance marketplaces (Millman, 1/15).

Reuters: U.S. Judge Upholds Subsidies Pivotal To Obamacare
A judge on Wednesday upheld subsidies at the heart of President Barack Obama's healthcare overhaul, rejecting one of the main legal challenges to the policy by conservatives opposed to an expansion of the federal government. A ruling in favor of a lawsuit brought by individuals and businesses in Texas, Kansas, Missouri, Tennessee, West Virginia and Virginia would have crippled the implementation of the law by making health insurance unaffordable for many people (Ingram, 1/15).

McClatchy: U.S. District Court Tosses Case Challenging Health Law Tax Credits
The U.S. District Court for the District of Columbia on Wednesday dismissed one of the last major legal challenges to the Affordable Care Act. The case, Halbig vs. Sebelius, argued that the health law only allows the federal government to provide premium tax credits - the subsidies that help low- and moderate-income people purchase health coverage - in states that use the federally run marketplace. That's because a section of the ACA says the tax credits can only be applied to coverage purchased "through an exchange established by the state (Pugh, 1/15). 

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Questions Surround Future Of Some Troubled State Exchanges

State insurance exchanges in Maryland, Oregon and Colorado are under the microscope and drawing criticism. Meanwhile, Republican state lawmakers in Tennessee and Texas propose legislation to undermine the health law in those states. And a cybersecurity official at the Department of Health and Human Services tells congressional investigators that testing of healthcare.gov, the federal online exchange, was inadequate.

The Washington Post: Countdown Begins For Marylanders To Get Retroactive Private Health Insurance
Maryland health exchange workers are focusing the next few days on calling and emailing thousands of uninsured people to see if they need coverage for this month and to let them know they have until Tuesday at 5 p.m. to sign up for private health insurance that would be retroactive to Jan. 1. To qualify, Marylanders must prove that they tried unsuccessfully to get health insurance through the state’s marketplace before the new year began, and they must be willing to pay premiums for January and February before Feb. 15. For those that get in, the insurance will cover medical expenses incurred this year (Johnson, 1/15).

The Washington Post: Maryland Senate Committee To Again Question State Official About Health Exchange Problems
The chairman of the Maryland Senate Finance Committee, after expressing frustration with not being informed of brewing problems with the state’s health exchange, has asked state officials to now provide updates on the status of the exchange every two weeks. Sen. Thomas M. Middleton (D-Charles) also asked Joshua M. Sharfstein, secretary of health and mental hygiene, to appear before the committee for a second time this month and again answer questions about what went wrong in the rollout of the state’s health exchange Web site. That briefing is expected early next week (Johnson, 1/15).

Fox News: Problems In State Health Care Exchanges May Reflect Glitches In Federal System
With all the focus on the federal health care exchange, some of the problems in state exchanges have gotten less attention. But they may offer a glimpse of future problems in the federal system. Vicki Rapoport is the face of the breakdown in state exchanges -- in her case, Maryland. "To me it's very personal," she says, "and it's very frustrating because the system has failed me” (Angle, 1/16).

The Denver Post: Audit Of Colorado’s Health-Care Exchange Proposal 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).

The Lund Report: Kitzhaber Hires Cover Oregon Examiner As Doubts Build On Fate Of Exchange
Gov. John Kitzhaber told reporters Thursday that the state has hired an independent examiner to critically analyze the mistakes of contractor Oracle Corp and the state in rolling out Cover Oregon, while he and other Democratic officials have skirted discussion of whether the insurance exchange can survive its botched roll out. Kitzhaber said 170,000 Oregonians now have health coverage thanks to the Affordable Care Act (Gray, 1/10).

The Oregonian: Cover Oregon: Lawmakers Praise Hard Work, Question Its Future
Rep. Jason Conger, R-Bend, said Wednesday it may be "time to throw in the towel" on the state's nonfunctioning healthcare exchange website. "This is the most incredible train wreck I've ever seen," Conger said about Cover Oregon. "I don't believe anymore that it's going to happen tomorrow, next week or next month. Maybe it's time to declare a loss and stop throwing good money after bad." In response, Cover Oregon Interim Director Bruce Goldberg said only: "I share your frustration and embarrassment” (Budnick, 1/15).

The Dallas Morning News: Democrats In Congress Oppose Texas’ Proposed Rules For Obamacare ‘Navigators’
Texas Democrats in Congress slammed proposed state rules requiring extra training for Obamacare navigators Wednesday, and they’ve asked Attorney General Eric Holder to intervene. Navigators help consumers sign up for health insurance through online exchanges set up under the Affordable Care Act. Federal rules require navigators to have 20 to 30 hours of training. Rules proposed by the Texas Department of Insurance would add 40 more hours, require criminal background checks, and charge a fee of up to $800 for certification (Swartsell, 1/15).

The Associated Press: Legislation Proposed By GOP Lawmakers Would Make Health Care Exchanges Illegal In Tenn.
Health insurance exchanges established under President Barack Obama's signature law would be illegal under legislation proposed Wednesday by Republicans aiming to prevent state agencies from carrying out the mandates of the health overhaul. Sen. Mae Beavers of Mt. Juliet and Rep. Mark Pody of Lebanon held a news conference to announce the measure that seeks to prohibit any cooperation by the state or its agencies in implementing or administering the federal law (Johnson, 1/15).

The Associated Press: Cybersecurity Chief Had Qualms Over Health Website
The top cybersecurity officer for the Health and Human Services Department said he was concerned about potential vulnerabilities ahead of the launch of the Obama administration's health care website. But Kevin Charest told congressional investigators he was unable to get answers to his questions from others inside the department. He concluded that the testing of the site was substandard (Alonso-Zaldivar, 1/16).

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Docs, Hospitals Cope With 'Trickle' Of Newly Insured Patients -- But Questions Continue About The Actual Number

As the Wall Street Journal reports that one of the biggest issues right now is making sure these newly insured people have insurance cards, other news outlets detail reports and questions about the number of enrollees.  

The Wall Street Journal: Two Weeks Into Health Law’s Rollout, Few Problems, Few Patients
Two weeks into the full rollout of the Affordable Care Act, hospitals and doctors say they are coping with the trickle of new patients relatively smoothly, but one of the biggest issues is making sure enrollees get insurance cards. The 2010 health law represented the biggest expansion of insurance coverage in a generation. Nonetheless, the number of people signing up so far for private coverage or Medicaid under the law is still a tiny fraction of all Americans with health insurance, partly because computer snafus hindered early enrollment (Corbett Dooren and Beck, 1/16).

The Washington Post’s The Fact Checker: Warning: Ignore Claims That 3.9 Million People Signed Up For Medicaid Because Of Obamacare
There is much less to the Medicaid figure than meets the eye. (The exchange figure has been updated recently, to 2.2 million, but not the Medicaid figure.) Indeed, there has been vast confusion about what this figure means, especially in the news media. The Fact Checker cited the 3.9 million figure in a few recent columns, but prodded by an interesting analysis by Sean Trende at Real Clear Politics, we decided to take a closer look (Kessler, 1/16).

Kaiser Health News: Capsules: State Snapshots Of Obamacare Enrollment Numbers
Enrollment in the health law’s marketplaces surged in December, and the administration’s report on the numbers made headlines on Monday — but the national story isn’t the whole story. Health care is delivered in 50 different state markets, and each state is implementing the health law with varying degrees of success and failure, enthusiasm and hostility. Reporters at NPR member stations around the country dove into the data the Obama administration released and delivered these dispatches (1/16). 

In the background, insurance companies appear optimistic about the health law's future -

The Washington Post’s Wonkblog: Don’t Believe The Hype: Health Insurers Think Obamacare Is Going To Be Fine
Obamacare's troubled rollout hasn't scared insurers out of the marketplace. Instead, speaking to thousands of health-care investors gathered in San Francisco, plan executives describe the Affordable Care Act as, at worst, a fixable mess and, at best, a major growth opportunity. The executives' commentary was a reminder that the health-care industry doesn't set its watch by the election cycles which dominate Washington. They expected Obamacare to be a bit of a mess in 2014 -- but they're in it for the long haul (Kliff, 1/15).

CQ HealthBeat: Despite Near-Term Hitches, Insurance CEO Expect Gains From Government Health Plans
The rough startup of the new health care exchanges has not dampened the enthusiasm of leaders of the nation’s largest insurance companies for working with government programs to build up their businesses (Young, 1/15).

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Insurers Again Extend Payment Deadlines For Jan. 1 Coverage On Exchanges

News outlets in California offer examples of companies that are giving new customers more time to pay their first month's premiums, while in Connecticut, one insurer is beginning to get a handle on the crush of enrollment.

Los Angeles Times: Anthem Blue Cross, Kaiser Permanente Extend Payment Deadlines Again 
Amid further delays for consumers, California's two largest health insurers extended payment deadlines once more for people who signed up for Jan. 1 coverage through the Covered California exchange. Anthem Blue Cross, a unit of industry giant WellPoint Inc., said it is giving new enrollees until Jan. 31 to pay their first month's premium. Kaiser Permanente, the state's largest HMO, extended the deadline to Jan. 22 (Terhune, 1/15).

The San Jose Mercury News: Health Net Agrees To Extend Two Payment Deadlines Until Jan. 31
Responding to the crush of health insurance applications, a third major health insurer whose plans are sold on Covered California, the state's health care exchange, has agreed to extend to Jan. 31 two payment deadlines for its policies. On Wednesday, Health Net said it would delay until month's end the payment deadline for anyone who bought a Health Net plan through the exchange in late December for coverage that began Jan. 1. The previous deadline was Wednesday (Seipel, 1/15).

The CT Mirror: Anthem Still Lags But Making Progress Processing Payments
As of Tuesday, Anthem Blue Cross and Blue Shield had processed the payments of 45 percent of Connecticut members slated to begin coverage Jan. 1 and expects the number to "rise rapidly," Gov. Dannel P. Malloy said Wednesday. Anthem has struggled to set up coverage for customers whose plans were scheduled to begin Jan. 1, with a backlog in processing payments that's left many Connecticut customers wondering if they have insurance and unsure how to handle doctor visits or prescription refills. Malloy said it was "a disappointment" that Anthem’s parent company, Wellpoint, had not been prepared to handle the enrollment of customers who signed up for insurance as part of the federal health law commonly known as Obamacare (Becker, 1/15).

Meanwhile, Politico Pro notes that next Tuesday insurers are expected to reveal to the Centers for Medicare & Medicaid Services how many checks they've received in the mail - 

Politico Pro: Deadlines Keep Coming — And Moving — For Obamacare
Tangled Obamacare due dates got even messier this week as the deadline for February enrollment came Wednesday and more payment deadlines for January coverage were pushed toward the end of the month. But clarity is at least on the horizon for one critical detail: the true number of people who have signed up and then paid their first premiums. Next Tuesday, insurers are due to disclose to CMS how many of the people who signed up for their plans actually sent in checks for that initial premium. The reports will determine how millions of dollars in subsidies are apportioned by the government to each company. Insurers will only receive these premium tax credits for enrollees who have paid their share of their plan (Cheney and Norman, 1/15).

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Magic Johnson, Alonzo Mourning To 'Jump Start' Efforts To Urge Young People To Sign Up For Insurance Coverage

This and other related marketing attempts are meant to spark young people's interest in obtaining health coverage before enrollment ends March 31. 

USA Today: White House Jump Starts Health Exchanges With Celebrities
After a month of marketing the federal exchange site as "not broken anymore," the White House has tossed the ball to Magic Johnson and Alonzo Mourning in new ads touting health insurance to begin running Thursday. Both men offered up their help for free, said Julie Bataille, communications director at the Centers for Medicare and Medicaid Services. Their ads will spark a full-court press effort to get young people -- in particular, young men -- to sign up for health insurance before enrollment ends March 31 (Kennedy, 1/16).

CQ HealthBeat: White House Allies Plan Young Adult Sign-Up Day
A new TV advertisement featuring basketball legend Magic Johnson endorsing the health care law. Paid Internet ads targeting young people on ESPN.com and Hulu. A fresh video on the comedy website Funny or Die. Those are some of the ways that the Obama administration is trying to urge Americans, particularly young adults, to sign up for health care coverage in the last two months of the law’s sign-up period (Adams, 1/15).

Fox News: White House Taps Magic Johnson, Alonzo Mourning To Promote Obamacare
The Obama administration has turned to two basketball legends in the hope of driving young people to enroll in Obamacare before the March 31 deadline. USA Today reported that Magic Johnson and Alonzo Mourning will appear in ads touting healthcare.gov that will begin airing Thursday and be broadcast during NBA games on ESPN, ABC, TNT and NBATV. Centers for Medicare and Medicaid Services spokeswoman Julie Bataille told USA Today that both men offered to appear in the ads for free (1/16).

The Associated Press: State Tries To Connect Health Care, Rock 'N Roll
The people who run Washington’s new health care exchange are hoping rock 'n roll will inspire more young people to sign up for insurance. On Wednesday, they announced a partnership with a major concert producer to publicize the value of health insurance at rock concerts including the popular Sasquatch Music Festival (1/15).

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Facing Medicare Funding Cuts, Virginia Hospitals Push For Medicaid Expansion

Expanding the program for low-income residents would help bring new revenue to the hospitals. Meanwhile, supporters of Medicaid expansion offer a new proposal in Nebraska and a young man in Utah diagnosed with cancer faces treatment problems because he lost his Medicaid coverage.

The Richmond Times-Dispatch: High Stakes For Hospitals In Medicaid Fight
Bon Secours Virginia Health System faces $55.6 million in cuts in federal Medicare payments in the next two years. But the nonprofit health system, which operates four hospitals in the Richmond area and three in Hampton Roads, could more than offset those losses with an estimated $134.7 million in revenues if Virginia expands its Medicaid program. ... The stakes in the state political debate over Medicaid expansion are becoming starker for Virginia hospitals, which are counting on new revenue from patients who are now uninsured to offset cuts in Medicare reimbursements and subsidies for indigent care. The Virginia Hospital and Healthcare Association has compiled estimates for 107 hospitals in the state (Martz, 1/16).

The Associated Press: Nebraska Lawmakers Unveil New Medicaid Plan
Nebraska would use the state Medicaid program and private health insurers to cover tens of thousands of uninsured, low-income residents, including those who have fallen into the so-called "coverage gap," under a new proposal unveiled Tuesday. Supporters of expanded Medicaid introduced the "Wellness in Nebraska Act" -- dubbed WIN -- as they prepared for another attempt to expand coverage under the federal health care law (1/15).

Salt Lake Tribune: Teen Battling Cancer Awaits Utah Medicaid Expansion
Within months of graduating from high school, landing an auto collision repair job and moving into his own apartment, Joshua Kahn was diagnosed with cancer. Hodgkin’s lymphoma is highly treatable and the chemotherapy started last fall was going well for the St. George teen. But on Dec. 1, Kahn turned 19 and was cut from Medicaid, putting a halt to his treatment. In Utah, adults who don't have children -- no matter how poor -- don’t qualify for the low-income health program unless they are disabled. Kahn’s mother, Julia Buckner, said her son’s situation highlights the injustice of Utah’s dithering over an optional expansion of Medicaid through the Affordable Care Act. ... The hospital has arranged a payment plan to allow Kahn to finish his first round of chemo. But without insurance he's unable to get a PET scan to determine whether he needs further treatment or radiation (Stewart, 1/15).

The Lund Report: Health Share Of Oregon Boasts 25,000 New Enrollees
Oregon's largest coordinated care organization expected to get 20,000 to 23,000 new members in the first year after the state's Medicaid expansion kicked in. Just days into the new year, chief operating officer Susan Kirchoff announced that it had already exceeded that projection (McCurdy, 1/8).

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Companies Find Ways To Keep Offering 'No Frills' Health Plans To Employees

The Wall Street Journal reports that, as long as companies offer at least one plan that complies with the health law's requirements, they are free to also offer employees choices that don't. Also in the news, Obama administration data analysts are watching health care habits and patterns, and other health companies are seeing business opportunities in sharing the information they collect, too.

The Wall Street Journal: Bare-Bones Health Plans Survive Through Quirk In Law
The health-care overhaul was supposed to eliminate insurance plans that offer skimpy coverage at cut rates. But a quirk in the law stands to help some companies keep them going for years to come. AlliedBarton Security Services … has offered a modestly updated version of its so-called mini-med plan to employees this year and it intends to do so in 2015 as well, even though the cheap coverage fails to meet requirements of the Affordable Care Act. What makes the no-frills plan attractive is that it will save money for AlliedBarton and for its security-guard employees who don't incur substantial medical bills, many of whom want a low-cost option, according to the company. What makes it possible under the health law: As long as companies offer at least one plan that complies with the law's requirements, they are free to keep offering ones that don't (Francis, 1/16).

The Wall Street Journal’s Washington Wire: Obama Data Analysts Study Health-Care Habits Under Obamacare
A group of data analysts who helped President Barack Obama win two terms in the White House are now partnering with a coalition of health-care providers in Camden, N.J., to study how people’s consumption habits change under the new health law. BlueLabs, a company formed last year by members of the Obama data team, is partnering with the Camden Coalition of Healthcare Providers to compile information tracking the treatment patterns of people who enroll in Medicaid or the new insurance marketplaces under the Affordable Care Act. For example, the team will gather data on how frequently the newly insured go emergency rooms or outpatient health centers and compare that with their previous behavior (O’Connor, 1/15).

Kaiser Health News: Check Your Blood Pressure, (Unwittingly) Sell Your Contact Information
Health insurance companies are on the prowl for more customers. There are still three months to go for people to enroll in health plans under the Affordable Care Act, but insurers don’t want to rely solely on state or federal websites to find them. Some are finding a path to new customers by partnering with companies that operate health-screening kiosks –- those machines in supermarkets and drug stores where people check their blood pressure or weight (Dembosky, 1/15). 

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Capitol Hill Watch

Wyden's Medicare Proposal Portends New Powerful Post

Sen. Ron Wyden, D-Ore., the likely next Senate Finance Committee chairman, is flexing his political muscles by proposing a change to how Medicare treats and pays for care for chronically ill patients. Wyden is in line to take over chairmanship of the committee when Sen. Max Baucus is confirmed as U.S. ambassador to China.

The Washington Post: Wyden Bringing His Ambitious Agenda To A Powerful New Post
Sen. Ron Wyden is one of the Senate’s most ambitious dreamers, the prolific author of grand bipartisan plans to improve the health care system and rewrite the tax code. He often wins fervent praise from reformers -- but rarely much political support. That may be about to change. Next month, Wyden (D-Ore.) is expected to take control of the storied Senate Finance Committee. Its current chairman, Sen. Max Baucus (D-Mont.), has been nominated to serve as U.S. ambassador to China. So Wednesday, when Wyden unveiled his latest bill, a standing-room-only crowd of lobbyists, aides and reporters packed the Capitol Hill hearing room, hoping to learn which of Wyden’s many controversial ideas would rise to the top of his newly influential agenda (Montgomery, 1/15).

USA Today: Sen. Wyden Unveils Medicare Reform Bill
Democratic Sen. Ron Wyden, who's likely to lead one of the Senate's most powerful committees soon, unveiled an ambitious bipartisan bill Wednesday that would overhaul the way older Americans receive care under Medicare and rein in the program's soaring costs. Wyden, in line to become the next chairman of the Senate Finance Committee, introduced the measure on Capitol Hill along with three co-sponsors -- Sen. Johnny Isakson, R-Ga., and Reps. Peter Welch, D-Vt., and Erik Paulsen, R-Minn (Chebium, 1/15).

The Associated Press: Chronic Care Overhaul Proposed For Medicare
They're calling it the Better Care Program. Teams of doctors, nurses and social workers would get a flat fee per Medicare patient, with fewer strings attached. The goal is to improve care coordination, benefiting the patient while moving Medicare away from paying piecemeal for tests and treatments. The legislation is being sponsored by Sen. Ron Wyden, D-Ore., expected to take over leadership of the Finance Committee, which oversees Medicare. Joining Wyden are Sen. Johnny Isakson, R-Ga., and Reps. Erik Paulsen, R-Minn., and Peter Welch, D-Vt. Wyden is calling it "chronic disease reform" (Alonso-Zaldivar, 1/15).

The Hill: Reforms Proposed For Chronically Ill In Medicare
A bipartisan group of lawmakers is proposing a series of reforms to improve how Medicare treats its sickest and most expensive patients. New legislation from Sens. Ron Wyden (D-Ore.) and Johnny Isakson (R-Ga.) and Reps. Erik Paulsen (R-Minn.) and Peter Welch (D-Vt.) would attempt to improve care for chronically ill seniors by revamping how their providers are paid (Viebeck, 1/15).

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Women's Health

Supreme Court Appears Split On Abortion Protester 'Buffer-Zone'

Several justices expressed skepticism about the constitutionality of a Massachusetts law that prohibits protesters within a 35-foot buffer zone around abortion clinic entrances. Chief Justice John Roberts is likely to cast the deciding vote.

The Boston Globe: Justices Question Mass. Abortion Clinic Buffer Zones
In a case watched closely across the country, justices of the U.S. Supreme Court expressed skepticism Wednesday about a Massachusetts law that creates buffer zones outside abortion clinics to restrict demonstrations, questioning whether it goes too far and infringes on the free speech of activists who approach women seeking abortions. The 2007 state law aims to keep protesters at least 35 feet from the entrances of abortion clinics to quell aggressive demonstrations that have congested sidewalks and prevented people from entering the clinics. But some justices raised questions about the size of the zone and asked whether the state could find another way to address safety concerns and prevent abortion opponents from impeding access to clinics without limiting their free speech (Valencia, 1/15).

The New York Times: Justices Seem Split On Abortion Clinic Buffer Zones, But Crucial Voice Is Silent
The Supreme Court appeared evenly divided on Wednesday as it heard arguments in a First Amendment challenge to a Massachusetts law that created buffer zones around abortion clinics in the state. But a significant piece of data was missing: Chief Justice John G. Roberts Jr., who almost certainly holds the crucial vote, asked no questions. His earlier opinions suggest, however, that he is likely to provide the fifth vote to strike down the law (Liptak, 1/15).

Politico: Justices Skeptical About Mass. Abortion Clinic 'Buffer Zone'
Opponents of the law, including a woman who regularly tries to conduct “sidewalk counseling” outside a Boston clinic and who brought this case, say the exemption for employees creates an unconstitutional imbalance in speech. The woman, Eleanor McCullen, said her anti-abortion speech is limited while the speech of those who support the clinic is not (Haberkorn and Gerstein, 1/15).

The Washington Post: Supreme Court Justices Question Size Of Buffer Zones Around Mass. Abortion Clinics
Several justices made clear in their questioning that they think the law’s restrictions on who can come within a 35-foot space around a facility’s entrance unfairly target those who want to hand out leaflets or speak to the women planning abortions. But predicting outcomes is difficult because the justice who probably is key to the court’s ultimate decision kept his own counsel. Chief Justice John G. Roberts Jr., normally an active participant in the court’s major cases, did not pose a single question to the three lawyers who argued the case. ... If the Massachusetts limit is in trouble, a bigger question would be whether the court is ready to reverse an earlier ruling that upheld an eight-foot no-contact zone in a 2000 abortion protest case from Colorado. The decision brought forceful dissents from Scalia, Kennedy and Justice Clarence Thomas, and complaints since from First Amendment activists (Barnes, 1/15).

Reuters: U.S. Supreme Court Skeptical On Abortion Clinic Buffer-Zone Law
U.S. Supreme Court justices expressed doubt on Wednesday about a Massachusetts law that mandates a protective buffer zone around abortion clinics to allow patients unimpeded access, indicating they may strike it down as unconstitutional as demanded by anti-abortion protesters. Challenging the 2007 law, anti-abortion activists say it violated their freedom of speech rights under the First Amendment of the U.S. Constitution by preventing them from standing on the sidewalk and speaking to people entering the clinics (Hurley, 1/15).

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State Watch

State Highlights: Some Hospitals Aim For Wealthier Patients

A selection of health policy stories from North Carolina, California, Michigan and Missouri.

The New York Times: Public Hospitals Hope To Attract More Upscale Patients Under Affordable Care Act
But to the Health and Hospitals Corporation, the city’s public hospital agency, it is not merely another insurance plan. The corporation created MetroPlus, and sees it as a powerful opportunity to attract a different class of patients -- somewhat higher-income, more educated and more stable -- to a system whose historic mission has been to serve the poor, and whose finances have been straining. … Around the country, a number of public health systems and charity hospitals serving large numbers of poor patients see the health exchanges, created by the states under the act, as a way to widen their customer base. In Los Angeles, L.A. Care, a publicly run health plan, has enrolled about 8,000 people so far via the California exchange. The Henry Ford Health System in Detroit, which has roots in organized labor and the auto industry, has signed up about 4,000 people in its exchange plans (Hartocollis, 1/15). 

The Associated Press: N.C. Medicaid Advisory Panel Takes Public Comment
Influential players in North Carolina's medical community lined up Wednesday behind a proposal that largely retains the current Medicaid payment method but shifts slightly the risk for cost overruns to providers. The North Carolina Medical Society and North Carolina Hospital Association also joined other advocates for medical professionals and consumers at a public hearing opposing a more dramatic overhaul through managed care pushed earlier by Gov. Pat McCrory's administration (Robertson, 1/15).

Raleigh News & Observer: Health Care Providers Support Medicaid Changes That Stop Short Of Managed Care
State hospitals, doctors and pharmacies united Wednesday in support of Medicaid changes that stop short of full managed care but would reward them for quality, cost-conscious care. An advisory committee on state Medicaid changes heard from nearly 50 speakers Wednesday as it gathered more information on potential changes to the government health insurance program for low-income children and their parents, the elderly and disabled (Bonner, 1/15).

The Associated Press: Panel OKs Higher Heath Costs For Michigan Workers
The Michigan Civil Service Commission voted Wednesday to impose higher health care costs on about 32,000 unionized Michigan government workers. Roughly 70 percent of Michigan's 47,000 employees have union representation. The commission voted 3-1 at its meeting in Lansing to accept wage increases and health benefit terms that an impasse panel had recommended. Commissioners postponed the decision Dec. 18 after deadlocking 2-2 on an alternate proposal that excluded some health care cuts (1/15).

St. Louis Today: Missouri Legislators Weigh Coverage Of Anti-Cancer Drugs
Treating cancer with a pill is more convenient and has fewer side effects than intravenous chemotherapy, cancer patients and their advocates say. Now, they hope to make it more affordable as well. A bill filed in the Missouri Legislature would bar insurance companies from charging higher out-of-pocket costs for oral anti-cancer medications than for intravenous medications (Young, 1/16).

The California Health Report: Blue Zoning For Better Health
Healthy choices aren’t always easy, but three California cities may be having some success in nudging residents towards better eating and exercise habits. Three years ago in Redondo Beach, Manhattan Beach and Hermosa Beach restaurants began offering lower calorie menu choices. They promoted salads and fruit over French fries and grocery stores highlighted healthy foods. Schools also set up “walking school buses”; cities added bike paths. Smoking bans were extended. The changes are part of the Blue Zones project, adopted by the Beach Cities Health District (Renner, 1/16).

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Weekend Reading

Longer Reads: Connecting With Patients; Children With Chronic Disease

Every week reporter Ankita Rao selects interesting reading from around the Web.

NPR: 5 Simple Habits Can Help Doctors Connect With Patients
I'd never [before] been encouraged to sit at a patient's bedside — to stop hurrying for even a moment. Our medical teachers put a premium on accuracy and efficiency, which became conflated with speed. Everything had to be fast. In 2014, doctors still value speed and technical accuracy, but we also do more to consider the quality of care we give and whether patients are satisfied with it. Those goals aren't just the right thing to do. There are often financial strings attached to getting them right (John Henning Schumann, 1/11).

MedPage Today: 10 Questions: Lucian Leape, MD
What's the biggest barrier to practicing medicine today? That's just one of the 10 questions the MedPage Today staff is asking clinicians, researchers, and leaders in their community to get their personal views on their chosen profession. Here's the answer to that question and the other nine from Lucian Leape, MD, of the Harvard School of Public Health. Leape graduated with honors from Harvard Medical School in 1959 and later trained in general and thoracic surgery at the Massachusetts General Hospital and pediatric surgery at Boston Children's Hospital. Leape is recognized as a leader of the patient safety movement. He published the seminal article "Error in Medicine" in the Journal of the AmeriĀ­can Medical Association in 1994 (David Pittman, 1/12).

The Atlantic: Where Does Obesity Come From
A new article by John Cawley in NBER Reporter, "The Economics of Obesity," poses an interesting question right at the top. Why study obesity like an economic problem, anyway? There are two broad answers. The first is simply methodological. Understanding the causes and consequences of obesity is hard because scientists like randomized experiments -- e.g.: give one group drug X, give another group a placebo, and observe the difference. But this is almost impossible to do with weight. It's unethical to randomly make participants obese just to watch what happens to them. So, it's useful to study compare data and try to find out how income and obesity are actually related. Essentially: To study weight like an economist (Derek Thompson, 1/14).

The New Yorker: Lives Less Ordinary
Gwen Lorimier is eleven years old and has been in and out of hospitals all her life. When she was one and a half, she was given a diagnosis of a rare disorder of the mitochondria, the tiny structures within cells that generate most of the body's energy. Viewed under a microscope, her muscle fibers, rather than being neatly arranged in rows, are frayed and disorganized. In cases like Gwen's, the condition takes an especially hard toll on the liver, the gastrointestinal tract, and other organs and tissues that require large amounts of energy. But when we first met, in the dark-wood surgery library at Boston Children's Hospital, Gwen showed no outward traces of being sick. She has long chestnut hair, a bright face, and horn-rimmed reading glasses, and she was animated and uncannily sharp. When we sat down to talk, she glanced at her parents, Kim and Sue, to let them know that she was in charge of the conversation (Jerome Groopman, 1/20).

Modern Healthcare: Kindred Seeks To Shake Up Post-Acute Care Continuum
Kindred Healthcare, the nation's largest provider of post-acute care, traditionally focused its business on running skilled-nursing facilities. Just three years ago, SNFs accounted for nearly 47% of the publicly traded company's total business. Fast forward to 2013, when the Louisville-based firm completed the first phase of a repositioning strategy that will reduce its SNF operations to about 21% of total business this year. Since 2010, it has steadily expanded its home health and rehabilitation services divisions through acquisitions of smaller providers. The goal is to develop a coordinated model for acute and post-acute care that experts say represents the future for post-acute providers (Steven Ross Johnson, 1/11).

The New York Times: His Heart, My Sleeve: Writing About My Brother
On my 40th birthday, I began writing an essay about my brother, Robert, who, for the previous 16 years, had been in and out of mental hospitals. My intention was to write about his life as a patient, and also about the life he'd led before, when he was a bright, gifted young man who showed no signs, until his first breakdown at the age of 19, that any mental problems were likely or inevitable. When I began to write, though, I found I was writing as much about what it was like to be the brother of someone afflicted with mental illness as I was about Robert. I wrote about my frustrations in trying to get decent care and treatment for him, and I wrote -- more -- about my feelings of guilt. ... To publish the essay, I quickly came to believe, would be to exploit the misery of his life in order to advance my life as a writer. I abandoned the project and decided to stick with fiction (Jay Neugeboren, 1/13).

Health Affairs: Speaking Up About The Dangers Of The Hidden Curriculum
A medical student’s fear of raising questions endangered a patient. Here, as a resident, he explores the dangers of this "hidden curriculum" with his advisers. ... Andrea had suffered a minor vaginal laceration, a common complication that many women experience during labor. The resident turned to close the tear, calling me back to the foot of the bed to deliver the placenta (that is, to remove the placenta from the uterus as a part of standard postdelivery care). I paused for several seconds. I'd never delivered one before, I eventually said aloud. I’d only observed. ... The cord came out smoothly at first ... until suddenly, without warning, the cord went slack. I glanced down in disbelief at its torn edge, dangling from my hand. Jets of blood sprayed across my gown. "Oh my God," the resident said from behind me. She looked into my eyes. "You tore the cord" (Joshua M. Liao, Eric J. Thomas and Sigall K. Bell, 1/14).

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Editorials and Opinions

Viewpoints: Mass. Abortion Debate Comes Down To 35 Feet; Tampa Mayor Leads Charge To Get Young People Signed Up For Health Care

The New York Times' Taking Note: On Abortion-Free Speech Case, Justices Pull Out Tape Measure
The First Amendment protects the speech of short, elderly women and large and intimidating men equally, but you would be forgiven for thinking otherwise after oral arguments before the Supreme Court Wednesday morning. The case was McCullen v. Coakley, a challenge to a Massachusetts law setting a 35-foot buffer zone around reproductive-health clinics where abortions are performed (Jesse Wegman, 1/15). 

USA Today: Uphold Abortion Clinic 'Buffer Zone': Our View
For years, authorities in Massachusetts were unable to stop harassment and violence outside clinics where abortions were performed. Injunctions, arrests and prosecutions didn't stop activists from screaming in patients' faces, physically impeding them from entering clinics or surrounding cars trying to enter parking lots (1/15). 

USA Today: Overturn 'Buffer Zone' Law: Opposing View
Free speech is perhaps our most cherished civil liberty. Without free speech — especially free speech on key cultural, political and religious issues — the United States is no longer the pluralistic republic envisioned by our Founders. Given free speech's primary constitutional importance, it should be restricted only to advance the most compelling government interests, in the least restrictive way possible (Jay Sekulow, 1/15). 

Bloomberg: Is Your Abortion My Free Speech?
To pro-life protesters, however, the [Massachusetts'] law is blatantly aimed to make their speech less effective by moving them 35 feet back from clinic entrances. From that distance, they say, their message of love and compassion -- often reinforced by graphic images of bloody fetuses -- will be harder to communicate to women entering the clinics. The truth is that the buffer zone will apply to both anti- and pro-abortion protesters, but pro-life protesters have a much stronger interest than do pro-choice advocates for being in close proximity to clinics. To some degree, at least, the law stacks the deck against them (Noah Feldman, 1/15).

Los Angeles Times: Pregnant And Dead In Texas: A Bad Law, Badly Interpreted
Marlise Munoz is dead. Yet her body is in a hospital intensive care unit, maintained on a ventilator. Why? The 33-year-old paramedic and mother of one from Fort Worth, Texas, apparently suffered a fatal pulmonary embolism in her home Nov. 26. ... doctors soon determined that Munoz had suffered brain death, "irreversible cessation of all spontaneous brain function." She was dead. Her husband, accordingly, asked that all the machines be stopped. ... The Texas Advance Directives Act, Section 166.049, provides that "a person may not withdraw or withhold life-sustaining treatment under this subchapter from a pregnant patient." The Texas law, like similar laws in other states, is almost always applied when the woman is incapacitated and terminally or irreversibly ill. It does not, however, on any reading, apply to a pregnant patient who has died (Arthur L. Caplan and Thaddeus M. Pope, 1/16). 

Reuters: The Fierce Fight Over How To Die
There has been an ugly and sad pile-on by two people who ought to know better and a young woman fighting against cancer. It started — as these things can — in the blogosphere, where Lisa Bonchek Adams, mother of three and terminal cancer patient, has been chronicling her battles in sometimes raw detail. Her tweets are full of pain, literal and emotional. Apparently, her revelations have proved too much for journalists Emma Gilbey Keller and Bill Keller. In a post on theguardian.com, Ms. Keller suggested that Adams has gone over the line. "Should there be boundaries in this kind of experience?" Keller wrote. "Is there such a thing as TMI? Are her tweets a grim equivalent of deathbed selfies?" (Anne Taylor Fleming, 1/15).

The Washington Post: Exemptions From 'Contraception Mandate' Threaten Religious Liberty
Can my employer make me pay the cost of practicing his religion? In the coming months, the U.S. Supreme Court will decide two cases involving just this issue. The cases are about the Affordable Care Act’s "contraception mandate" — the law’s requirement that employer health plans cover Food and Drug Administration-approved contraceptives without out-of-pocket expense, including co-payments, co-insurance or deductibles. The employers in these two cases are among scores of profit-making businesses that are claiming a religious right under a federal statute to be excused from this requirement because the use of contraceptives violates their owners’ religious beliefs (Frederick Mark Gedicks, 1/15). 

Tampa Bay Times: Closing The Obamacare Youth Gap
Considering the antagonism to the Affordable Care Act among politicians in Republican-controlled states such as Florida, it is encouraging that the Obama administration has succeeded in getting millions of Americans signed up for new health insurance. But for health care reform to succeed more young people need to get coverage through the online marketplaces. This is where government can help with outreach and public information, and Tampa Mayor Bob Buckhorn is showing others how it can be done. ... The Tampa mayor announced Monday during a visit from Health and Human Services Secretary Kathleen Sebelius that navigators will be available at nine of the city's recreation departments to help people enroll through the online marketplaces. Also, the city's firefighters and rescue workers will be equipped with information on health coverage options when responding to emergency calls (1/15).

Bangor Daily News: Medicaid Expansion: A 'No Brainer' For Mainers
Some argue that covering more of Maine’s poor with MaineCare will result in unnecessary ER visits by the newly insured. While this may occur early in the process of expanding coverage, once people have access to a primary care medical home, the rates of ER use and avoidable hospitalizations should drop. That has been the experience in Massachusetts, where a similar law has been in place for several years. And we know from studies that people who get regular preventive care and proper management of chronic diseases have better health outcomes at lower costs (Robert Allen and Noah Nesin, 1/15).

WBUR: Want Better, Cheaper, More Seamless Health Care? Ask Me How
Now, as an adult and a doctor reflecting back on those times, I can say with certainty that my family’s primary care provider never spoke with our dentist and eye doctors about our health and wellness. My mother’s OB-GYN never communicated directly to our pediatrician about her care or anticipated my needs as a new infant. Fragmented, clunky and often disempowering, that was our health care system then in many ways. And it still is now (dR. Myechia Minter-Jordan, 1/15).

JAMA: Do Employee Wellness Programs Improve Health And Reduce Spending?
For some time, Wellness Programs have been growing in popularity across the United States. At this point, it appears that about half of employers with more than 50 employees offer them. But almost all really large employers, those with at least 50 000 employees, do so (Dr. Aaron Carrroll, 1/15).

The New England Journal Of Medicine: After the False Start — What Can We Expect from the New Health Insurance Marketplaces?
The huge share of the gross domestic product that is financed through health insurance and the extreme difficulty that consumers have in discerning value in health plans make last fall's disastrous rollout particularly unfortunate. Yet many ACA supporters seem almost blind to the need for better public management. The federal and state-based marketplaces have encountered multiple obstacles: delays in contracting for technical assistance, inadequate pay scales and cumbersome hiring processes, political opposition and court challenges, delays in issuing controversial federal guidance, a shortage of relevant expertise, tension between new exchanges and existing state agencies, and the inescapable challenge of implementing such complex legislation (Jon Kingsdale, 1/15).  

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Andrew Villegas

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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.