Daily Health Policy Report

Friday, January 17, 2014

Last updated: Fri, Jan 17

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Public Health & Education

Health Care Marketplace

Health Care Fraud & Abuse

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Health On The Hill: Explaining Healthcare.gov's Problems

Kaiser Health News staff writer Mary Agnes Carey and CQ Roll Call's Melissa Attias discuss Thursday events in which Gary Cohen, the head of the federal online marketplace, answered questions on Capitol Hill about the rocky rollout of healthcare.gov (1/16). Read the transcript or listen to the audio.

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Signing Up The Homeless, One At A Time

Kaiser Health News staff writer Anna Gorman, working in collaboration with USA Today, reports: “On a recent winter morning, health outreach worker Christopher Mack walked through the streets and alleys of the city’s Skid Row, passing a man pulling a rusty shopping cart and a woman asleep on a crumpled blue tarp. The smell of marijuana wafted through the cold air. ‘Do you have health insurance?’ Mack, a towering man with long dreadlocks, asked one woman. ‘Do you go to the doctor?’ he asked another. Homeless men and women who didn’t qualify for insurance in the past now have the chance to sign up, and Mack – who was once homeless himself -- is there to help” (Gorman, 1/17). Read the story.

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A Reader Asks: Do Couples Have To Buy The Same Level Health Plan?

Kaiser Health News consumer columnist Michelle Andrews reports family members can opt for separate plans and still qualify for premium subsidies, but they need to consider some other important details (1/17). Read her response.

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Washington State Goes After The Young And Uninsured

The Seattle Times' Lisa Stiffler, working in partnership with Kaiser Health News, reports: "Worried that too few young people are signing up for health insurance, Washington state officials are stepping up their efforts to get buy-in from the crucial demographic. On Wednesday, they launched a campaign with Live Nation, a global concert promoter, in the hope that young adults will accept a dose of health-care education along with performances by their favorite artists. The goal of the Live Nation partnership is to tell young adults, 'there's a new way to get insurance, and there are ways to address some of the cost concerns that they’ve had in the past,' Marchand said" (Stiffler, 1/17). Read the story.  

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Political Cartoon: 'Burning Questions?'

Kaiser Health News provides a fresh take on health policy developments with "Burning Questions?" by Joel Pett.

And here's today's health policy haiku:  


Fifty years ago
surgeon general said it
was bad... it was true.

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

Healthcare.gov's Back-End System Still Being Built

A top Obama administration official told Congress Thursday that the automated system to send payments to insurance companies is still under construction and didn't offer a completion date, media outlets report.

Politico: HHS Feared Contractor Would Derail Obamacare
The White House spent December talking up its revamped and repaired healthcare.gov website after the disastrous rollout. But health officials worried that the underperforming contractor could still derail Obamacare and destabilize the insurance industry, according to a new federal document. The concerns grew so acute that they decided to seek a new contractor (Cheney, 1/17).

Kaiser Health News: Health On The Hill: Explaining Healthcare.gov's Problems
Kaiser Health News staff writer Mary Agnes Carey and CQ Roll Call's Melissa Attias discuss the congressional testimony of Gary Cohen, who oversees the federal online marketplace, about healthcare.gov's rocky rollout  (1/16).

The Wall Street Journal’s Washington Wire: Under Construction: Healthcare.gov’s Payment System
An Obama administration official told Congress Thursday that the “back-end” of healthcare.gov is still being built and he didn’t forecast a completion date. An automated system to send payments to insurance companies isn’t finished, said Gary Cohen, the director of the Center for Consumer Information and Insurance Oversight, an office in the federal Medicare agency that oversees the troubled website for buying health insurance (Corbett Dooren, 1/16).

CBS News: High Security Risk Found After Healthcare.gov Launch
A top HealthCare.gov security officer told Congress there have been two, serious high-risk findings since the website’s launch, including one on Monday of this week, CBS News has learned. Teresa Fryer, the chief information security officer for the Centers for Medicare and Medicaid Services (CMS), revealed the findings when she was interviewed Tuesday behind closed doors by House Oversight Committee officials ...The Department of Health and Human Services (HHS) responded to questions about the security findings in a statement that said, "in one case, what was initially flagged as a high finding was proven to be false. In the other case, we identified a piece of software code that needed to be fixed and that fix is now in place ... " (Attkisson, 1/16).

CQ HealthBeat: Administration IT Leaders More Upbeat About Exchange Security, But GOP Dubious
Three administration witnesses said Thursday that the federal health exchange website has strong security protocols in place and has not had a successful security attack, but House Republicans did not buy their reassurances (Ethridge, 1/16).

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GOP Asks Oregon For Details On Its Health Insurance Exchange

The Republican National Committee has filed a public records request with the Oregon health insurance exchange seeking information about the marketplace's troubled rollout and about compensation for its executives. It plans other requests in Hawaii, Minnesota and Maryland.

The Associated Press: National GOP Requests Oregon Health Exchange Records
The Republican National Committee said it has filed a public records request seeking information about Oregon's troubled health insurance exchange — a sign the GOP sees the Cover Oregon challenges as a chance to make gains. In a letter dated Tuesday, the RNC requested information about compensation and vacation time for two senior officials: Cover Oregon director Rocky King and former Oregon Health Authority Chief Information Officer Carolyn Lawson. King is on leave from the agency and does not plan to return. Lawson has stepped down (Cooper, 1/16).

The Oregonian: National GOP Seeks To Turn Up Heat On Cover Oregon With Request For Documents
The Republican National Committee, which is continuing to press health care as the issue of the 2014 elections, says it is filing a public records request for information regarding the compensation of the officials who ran the troubled Cover Oregon website. RNC spokesman Michael Short said the party is also filing similar requests in Hawaii, Minnesota and Maryland --  states that are also under Democratic control.  Short referred to Gov. John Kitzhaber, Sen. Jeff Merkley and Rep. Kurt Schrader, all Oregon Democrats who are up for re-election this year, and said the "national party is getting involved to hold these elected leaders responsible for this disaster" (Mapes, 1/16).

St. Louis Public Radio: Month One Of Health Coverage Under The Affordable Care Act
As of January 1st, the first Americans enrolled in health insurance via the Affordable Care Act began receiving coverage. According to Professor Sidney Watson of the Saint Louis University Health Law Policy Center, a little more than 33,000 Missourians have signed up for plans through the federal Marketplace so far, leaving another 467,000 Missourians eligible to enroll. Almost 26,000 Missourians have enrolled in Medicaid (Phillips, 1/16).

In other exchange news -

Health News Florida: Glitch Hits FL Blue Enrollees
Florida Blue may have bitten off more than it can chew with its new plans under the Affordable Care Act. The company's customer-service apparatus and computer system appear to be overwhelmed and unable to cope (Gentry, 1/16).

Philly.com: State Health Insurance Marketplaces Boost Outreach Efforts
Health insurance exchanges in five states with strong enrollment growth are ramping up efforts to reach even more uninsured Americans before the end of the Affordable Care Act's open enrollment period on March 31. The March 31 deadline is for people who want health coverage for 2014 (Pallarito, 1/16).

The Baltimore Sun: Hearings Into Exchange To Continue, Blunders 'Might Be About Incompetence'
Sen. President Thomas V. Mike Miller said the investigations into how the state bungled its $107 million health exchange would continue until lawmakers are satisfied. … Miller said that [Sen. Thomas "Mac" Middleton, chair of the Finance Committee] will be getting daily briefings on progress to repair the exchange, which as of last week had enrolled less than 25,000 of the 150,000 people state officials hoped to get into private insurance plans. (Cox, 1/16).

The CT Mirror: 80 Percent Of Connecticare Customers Paid; The Rest Get An Extension
The deadline for ConnectiCare Benefits customers to pay their January premiums was Wednesday, but the company said Thursday that it will continue to accept payments through Jan. 20. So far, the company has processed payments from more than 80 percent of people who signed up for ConnectiCare coverage through the state's health insurance exchange, according to Michelle Zettergren, the company's senior vice president and chief sales and marketing officer. ... About a third of the people buying private insurance through the state’s exchange have picked ConnectiCare plans (Becker, 1/16).

The CT Mirror: Is Connecticut's Obamacare Insurance Age Mix A Problem?
Twenty-one percent of the customers buying private coverage through Connecticut's health insurance exchange are in the coveted 18-to-34 age brackets, and one member of the exchange's board worries that it's not higher. "Is there something that we can do other than sit here and kind of feel badly about the [age] mix?" Paul Philpott, a member of the exchange's board of directors, asked during a meeting Thursday. Of those buying insurance through Access Health CT, the state's exchange, 59 percent are 45 and older, including 36 percent who are 55 and older. As of Wednesday, 43,840 people had signed up for private insurance through Access Health (Becker, 1/16).

The Boston Globe: Pressure Mounts To Fix Mass. Health Site
Health policy analysts are calling for greater urgency in fixing the state's broken insurance website, after a report released this week showed Massachusetts far behind in signing people up for new plans under the Affordable Care Act. But, they said, the state is primed to quickly improve its standing compared with other states if it can get the technology working (Conaboy, 1/17).

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Tricky Politics Affecting Arkansas, Arizona Medicaid Expansions

An Arkansas special election, which was held to replace a Democratic senator who was forced to step down over ethics violations, centered on questions about the state plans to expand Medicaid. It resulted in a Republican win and takes away one vote from the "private option" expansion plan lawmakers approved last year. News outlets also provide updates from Georgia, Arizona and New Hampshire.   

The Washington Post: Medicaid Expansion Takes A Hit In Arkansas
A Democratic state senator forced to step down last year over ethics violations will be replaced by a Republican after a special election Tuesday that dealt a serious blow to Arkansas Gov. Mike Beebe’s (D) push to expand Medicaid. Republican John Cooper defeated Democrat Steve Rockwell in a northeast Arkansas district based in Jonesboro in a race that had centered on whether to expand Medicaid to cover those making less than 138 percent of the federal poverty line (Wilson, 1/16). 

The Associated Press: Special Election Bodes Ill For Health Plan
Republican John Cooper’s victory in Tuesday’s special election gives Republicans a 22-13 majority in the Senate and takes away a key vote for the “private option” Medicaid expansion lawmakers approved last year. ... Under the private option plan, Arkansas is using federal Medicaid money to purchase private insurance for thousands of low-income residents (DeMillo, 1/16).

The Arizona Republic: Has Arizona GOP Rift Over Medicaid Healed?
Last year’s legislative session ended on a sour note, as the fight over Medicaid expansion extended to threats to replace Arizona House and Senate leaders and highlighted a rift in the state Republican Party. This year’s session began with the good cheer and bonhomie typical of opening day, ... Most legislators say that bygones are bygones and that they expect Republicans to work together. But, at the same time, the Republicans who broke from the caucus position opposing Medicaid expansion have been censured by local precinct committees (Pitzl, 1/16).

Georgia Health News: Legislators Share Thoughts On Medicaid Expansion
While describing how Georgia’s economy has escaped its “deep freeze,’’ Gov. Nathan Deal again showed no signs of thawing on the idea of expanding Medicaid. “The Affordable Care Act is anything but affordable and is costing our state $327 million this year,’’ Deal told lawmakers Wednesday in his State of the State speech, which touted an improved state economy. Expansion of Medicaid as called for under the ACA would cost the state even more, Deal added. “We will not allow ourselves to be coerced into expansion” (Miller, 1/16).

In other news related to Medicaid and the health law -

Stateline: ACA Spurs State Shift in Long-Term Care 
In New Hampshire, Medicaid pays for in-home care for nearly all of its developmentally disabled residents. For frail elders, the opposite is true. Most wind up in nursing homes. To remedy this imbalance, New Hampshire is taking advantage of Affordable Care Act funding for a program aimed at removing existing barriers to providing long-term care in people’s homes and communities. Known as the Balancing Incentive Payments Program, it is one of several ACA provisions designed to keep as many people as possible out of costly institutions (Vestal, 1/17).

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Shortage Of Mental Health Services Underscored By Health Law

The impact of the health law on individuals needing mental health services, as well as on small businesses and the homeless are explored by various media outlets.

The Wall Street Journal: For The Mentally Ill, Finding Treatment Grows Harder
Last year, according to the U.S. Department of Health and Human Services, almost 91 million adults lived in areas like here where shortages of mental-health professionals made obtaining treatment difficult. A departmental report to Congress earlier this year said 55% of the nation's 3,100 counties have no practicing psychiatrists, psychologists or social workers, a combination of budget cuts and doctors leaving the profession. … Such shortages are expected to only grow now, as the federal health-care law goes into effect and allows more people to seek help. Indeed, according to the National Association of State Mental Health Program Directors, some 6.8 million uninsured people with a mental illness will gain coverage after federal and state health insurance exchanges implement the new law (Fields and Corbett Dooren, 1/16).

Bloomberg: Obamacare Small-Business Plan Lags Behind In Face Of Cost
Enrollment in Obamacare health plans for small businesses is off to a slow start, leaving in doubt whether the U.S. program can attract enough customers to satisfy insurers. Greeted by higher premiums, less generous coverage and more paperwork, small businesses that offer health coverage to employees are choosing to renew existing plans rather than buy them through President Barack Obama’s program (Wayne, 1/17).

Kaiser Health News: Signing Up The Homeless, One At A Time
On a recent winter morning, health outreach worker Christopher Mack walked through the streets and alleys of the city’s Skid Row, passing a man pulling a rusty shopping cart and a woman asleep on a crumpled blue tarp. The smell of marijuana wafted through the cold air. ‘Do you have health insurance?’ Mack, a towering man with long dreadlocks, asked one woman. ‘Do you go to the doctor?’ he asked another. Homeless men and women who didn’t qualify for insurance in the past now have the chance to sign up, and Mack – who was once homeless himself -- is there to help (Gorman, 1/17).

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Capitol Hill Watch

Senate Clears $1.1 Trillion Spending Bill

The measure, which already passed the House and is expected to be signed by President Barack Obama, will fund the government until Oct. 1. It provides targeted increases for various programs, including biomedical research.

The Washington Post: Senate Sends Obama A Bill To Fund The Government Until October
Congress gave final approval Thursday to a $1.1 trillion spending bill that eases sharp budget cuts known as the sequester and guarantees that the nation will not endure another government shutdown until at least Oct. 1. … The Senate voted 72 to 26 to approve the measure Thursday evening after Republicans persuaded Sen. Ted Cruz (R-Tex.) to drop a last-minute push to force another showdown over the Affordable Care Act, reprising the fight that closed the government for 16 days last fall. The House overwhelmingly passed the spending bill earlier this week. President Obama is expected to sign it by Saturday to prevent agency offices, museums and national parks from locking their gates when the current temporary funding measures expires (Montgomery, 1/16).

The Wall Street Journal: Senate Passes $1.012 Trillion Spending Bill On A 72-26 Vote
It provides targeted increases for biomedical research, pre-school education and infrastructure programs that are top Democratic priorities. But overall it provided far less than President Barack Obama requested and kept spending lower than levels that prevailed in 2009, when he took office (Hook, 1/16).

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House Approves Bill That Would Require Weekly Detailed Reports On How Health Exchanges Are Working

The measure is part of the GOP effort to maintain focus on the troubled overhaul.  

The Associated Press/USA Today: House Passes Bill Requiring Weekly Health Care Numbers
The House on Thursday backed a bill that would require the Obama administration to report weekly on how many Americans have signed up for health care coverage as Republicans maintain an election-year spotlight on the troubled law (1/16).

Politico: House Passes Health Exchange Disclosure Bill
The Republican-led House has approved legislation 259-154 requiring weekly, detailed reports on how the Obamacare insurance exchanges are working, a direct jab at the Obama administration over the massive failures that upended early enrollment on HealthCare.gov. The bill garnered 33 Democratic votes, fewer than the 67 Democrats who backed another health law-related measure last week focusing on the security of personal information on the federal- and state-run exchange websites. The two bills would add disclosure requirements to the Affordable Care Act rather than repeal any provision, making both more palatable to moderate Democrats facing tough reelection battles this year. Still, neither piece of legislation is expected to advance in the Senate (Cunningham, 1/16).

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Sen. Coburn, Watchdog Of Federal Spending, Is Retiring; Ed Gillespie Launches Senate Campaign In Va. On Opposition To Health Law

Coburn is leaving his Oklahoma seat two years early. Meanwhile, Gillespie, a Republican, is seeking to unseat Sen. Mark Warner, D-Va.

Los Angeles Times: Oklahoma Sen. Tom Coburn Says He'll Retire At End Of Year
Republican Sen. Tom Coburn said late Thursday that he will leave Congress at the end of this session, two years before his term expires (Mascaro and Memoli, 1/16).

The Washington Post: Battle Lines Drawn In Va. Senate Race As Ed Gillespie Launches Bid Against Mark Warner
Longtime Republican operative Ed Gillespie made his campaign against Sen. Mark R. Warner official Thursday, launching a bid to unseat the popular Democrat by casting him as a fiscally reckless supporter of the Affordable Care Act (Pershing, 1/16).

Politico: Ed Gillespie Formally Announces Senate Run
He also took some early hits at Warner, criticizing his vote for Obamacare and past support for tax increases. The health care law "kills jobs and costs families the insurance and doctors they like" and should be "replaced," Gillespie said. "Sen. Warner cast the deciding vote" for Obamacare, he said. "If I were a Virginia senator, it would not be law today" (Schultheis, 1/16).

And in other congressional political news -

The Washington Post's The Fact Checker: Pelosi Vs. Barrasso: A Tale Of Two Obamacare Talking Points
Washington is often a big echo chamber. Or maybe a double echo chamber, in which the two parties talk past each other. But in checking a recent statement by Sen. John Barrasso (R-Wy.), The Fact Checker encountered an odd situation. Barrasso criticized House Democratic leader Nancy Pelosi for a comment she made in 2010—which, depending on how you read it, is a mixed-up factoid that is actually supported by the data he cited (Kessler, 1/17).

CNN: Dem Group Praises Democrat For Blasting Obamacare Rollout
A group that backs House Democratic incumbents and candidates released a new ad Thursday that praises a Democratic congresswoman for blasting the "stunning ineptitude" of the Affordable Care Act rollout. "Rep. Ann Kirkpatrick blew the whistle on the disastrous healthcare website, called it 'stunning ineptitude,' and worked to fix it," the narrator says in the ad. The spot was released by House Majority PAC, a group that's trying to help Democrats retake control the House of Representatives (Killough, 1/16).

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Public Health & Education

Surgeon General: Smoking Linked To More Than 30 Diseases, Conditions

The report, which finds that smoking causes even more physical and financial damage than previously estimated, was released 50 years after the first report tied cigarettes to diseases.

USA Today: Smoking Causes Diabetes, Colon Cancer, New Report Says
A new report from the surgeon general finds that smoking causes even more physical and financial damage than previously estimated, killing 480,000 Americans a year from diseases that include diabetes, colorectal cancer and liver cancer. The report, released today, represents the first time the surgeon general has concluded that smoking is "causally linked" to these diseases (Szabo, 1/17).

The Wall Street Journal: Cigarettes Tied To More Deaths, Types Of Illness
That's a substantial increase over the government's previous estimate of 443,000 deaths, despite the fact that fewer Americans are lighting up and those who do smoke are lighting up less often. Cigarettes are a causal factor in 10 diseases and conditions they hadn't previously been definitively linked to, including diabetes, colorectal cancer, arthritis and erectile dysfunction, the report said—bringing the total number to more than 30 (Esterl, 1/17). 

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Health Care Marketplace

Report Card: E.R. Docs Give Low Grades To Nation's Emergency Care Infrastructure

A new report from an ER physician group measured "access to care, quality and patient safety, liability, injury prevention and disaster preparedness," offering a snapshot of national and state policies affecting emergency medicine.

Reuters: Doctors Say Pressure On ERs May Rise, Give U.S. Failing Grade
People seeking urgent medical could face longer wait times and other challenges as demand increases under Obamacare, U.S. emergency doctors said in a report on Thursday that gives the nation's emergency infrastructure a near failing grade. In its latest "report card," the American College of Emergency Physicians said such reduced access earned the nation a "D+"  ... While the report does not measure the actual quality of care provided, it does offer a snapshot of national and state policies affecting emergency medicine as seen by providers (Heavey, 1/16).

Los Angeles Times: California Gets F In Speedy Treatments At ERs From Advocacy Group
An updated national report on U.S. emergency medical care has again awarded California an F for lacking access to speedy treatment, noting that the state has the fewest hospital emergency rooms per capita — 6.7 per 1 million people — in the nation. The America's Emergency Care Environment report card, which gauges how well states support emergency care, was released Thursday by the advocacy group American College of Emergency Physicians (Brown, 1/16).

The Seattle Times: Emergency Doctors’ Report Faults Washington State
Washington trails all but two other states in providing hospital beds for mentally ill patients, according to a report released Thursday. The state is also among the least prepared for a public-health disaster, but it does lead the country in high seat-belt use and low infant-mortality rates, according to the [report] (Rosenthal, 1/16). 

The Dallas Morning News: Report Card: Texas Bombs Another National Health Care Test – This Time For Emergency Services
Texas is again sinking to the bottom of the barrel on a national health care measure. The state ranks 38th in the nation – down from 29th five years ago – for failing to support emergency patients. ... The report cited high rates of under-insured folks and low Medicaid fee levels for doctor-office visits as factors (Moffeit, 1/16). 

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Health Care Fraud & Abuse

Feds File Record Number Of Health Care Fraud Cases Last Year

The Associated Press: Health Care Fraud Cases Hit High Last Year
Federal prosecutors filed a record number of health care fraud cases last fiscal year, perhaps reflecting the greater emphasis the government has placed on combatting the crime costing taxpayers billions of dollars per year. According to Justice Department statistics obtained through a Freedom of Information Act request by a Syracuse University-based nonprofit group that tracks federal spending, staffing and enforcement activities, prosecutors pursued 377 new federal health care fraud cases in the fiscal year that ended in October. That was 3 percent more than the previous year and 7.7 percent more than five years ago (Suhr, 1/16).

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State Watch

State Highlights: Battle Over Medical Care In Texas Jails

A selection of health policy stories from Texas, North Carolina, California, Virginia, Missouri and Massachusetts

The Texas Tribune: Sheriff And Judge In Battle Over Medical Care In Jail
In November, David Conis Jr. sat in a Henderson County courtroom, vomiting repeatedly because of his vacillating blood-sugar levels, terrified that he was facing a diabetic coma. ... Henderson County state district Judge Carter Tarrance, concerned that the county jail was not providing adequate care, sent Conis to a local clinic and ordered the jail to follow the doctor’s instructions (Grissom, 1/17).

JAMA: Expediting Medicaid Coverage For Prison Inmates
As many state Medicaid programs expand through the Affordable Care Act (ACA), a new survey indicates that some state prisons could improve prisoners’ health care and lower state spending by revising policies on prisoner enrollment in the state-federal health plan. The survey, published online today in the American Journal of Public Health, evaluated Medicaid policies from December 2011 to August 2012 at 42 state prison systems (Voelker, 1/16).

Raleigh News & Observer: Doctors Sue NC Over Medicaid Billing System
Doctors are suing the state, a software vendor and consultants over the troubled Medicaid claims system, saying that complications and errors resulted in financial losses and harm to patients. ... Seven medical practices filed the suit Thursday in Wake County Superior Court. They ask to be certified as a class, saying a majority of the state’s 70,000 Medicaid providers suffered damages that should be recovered. NC Tracks’ flaws have been chronicled in state audits, news reports and medical workers’ comments at legislative hearings. The NC Tracks system was trouble almost as soon as the state started using it on July 1 (Bonner, 1/16).

Los Angeles Times: California Hospitals Charge $3,000 To $37,000 For Childbirth, Study Says
Amid growing scrutiny of hospital billing, a new study finds that California hospitals charged mothers $3,296 to $37,227 for a routine delivery. For women having a cesarean section, the UC San Francisco study found patients were billed $8,312 to nearly $71,000. Few of the patients in the study released Thursday had serious health issues, and most were discharged within six days of admission (Terhune, 1/16).

The Washington Post: In Wake Of Son’s Death, Creigh Deeds Makes Case For Reforms But Meets With Resistance
In a meeting Thursday of a mental-health subcommittee in the Virginia Senate, Deeds made a passionate case for his legislation without delving into the personal tragedy he suffered only two months ago. … The senator is hoping to extend the period of emergency custody to 24 hours from the current four to six. James L. Agnew, the sheriff in Goochland County, warned that it would strain small law enforcement agencies to watch over mentally ill persons for so long (Weiner, 1/16).

The Associated Press: Mo. Senator Files Medicaid Overhaul Plan
Private insurers would gain a greater role in Missouri's Medicaid program and patients could get rewarded financially for holding down their medical costs under a plan introduced Thursday by a key Republican senator. The legislation by Sen. Gary Romine follows many of the recommendation of a special Medicaid study panel he led, which sought to revamp the health care program for the poor without expanding eligibility (Lieb, 1/16).

The Boston Globe: Partners Defends Plan To Expand
Partners HealthCare, under growing pressure from regulators to abandon expansion plans, will file a forceful rebuttal Friday arguing that its proposed merger with South Shore Hospital and a related doctors’ group would save about $27 million a year in health care costs. The largest Massachusetts hospital and physician network contends that a state commission’s preliminary report criticizing the deal as costly and anticompetitive uses flawed reasoning and contains “inexplicable omissions.’’ The commission’s analysis concluding that the merger would give Partners too much market power is absurd, the rebuttal charges (Kowalczyk, 1/17). 

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Health Policy Research

Research Roundup: Nursing Home Transitions; The Impact Of Raising Medicare Premiums

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

Journal of the American Geriatrics Society: Hospitalization Of Elderly Medicaid Long-Term Care Users Who Transition From Nursing Homes
To compare hospitalizations of dually eligible older adults who had an extended Medicaid nursing home (NH) stay and transitioned out to receive Medicaid home- and community-based services (HCBS) with hospitalizations of those who remained in the NH. ... Being a NH transitioner increased the hazard of experiencing a potentially preventable hospitalization by 40% over remaining in the NH. NH transitioners had a 58% greater risk of experiencing any type of hospitalization than NH stayers. ... Most of the attention in long-term care transition programs has been focused on NH readmission, but programs encouraging NH transition should recognize that individuals may be at greater risk for hospitalization after returning to the community (Wysocki et al., 1/2). 

The George Washington University School of Public Health: Assessing The Potential Impact Of State Policies On Community Health Centers' Outreach And Enrollment Activities 
This nationwide analysis of community health centers' early outreach and enrollment experiences under the Affordable Care Act (ACA) finds that all health centers are engaged in a significant and sustained effort to identify and assist eligible patients and community residents in obtaining health insurance coverage. ... But in states with restrictive policies toward ACA implementation (defined as both opting out of the Medicaid adult expansion and adopting Navigator laws), health centers are confronting significantly greater outreach and enrollment challenges compared to health centers in states that have fully implemented the law through Medicaid expansion and without outreach and enrollment restrictions (Shin et al., 1/14).

JAMA Surgery: Failure To Rescue In Safety-Net Hospitals
While many uninsured persons will obtain coverage under the Patient Protection and Affordable Care Act, historical lack of resources and the introduction of value-based payments may adversely affect some hospitals. We found that hospital safety-net burden was an independent predictor of [the mortality rate among surgical patients with complications] after controlling for hospital and patient factors. Hospitals with a high safety-net burden (HBHs) were more likely to be large teaching facilities with sophisticated internal medicine services and high technology but had lower proportions of RNs among nurses, electronic medical record implementation, and a positron emission tomographic scanner. ... Although we cannot precisely identify the cause of this disparity, it may relate to culture, teamwork, or the way in which resources are mobilized and used to provide care for patients with complications in a timely fashion (Wakeam et al., 1/15).

JAMA Surgery: Association Of High-Volume Hospitals With Greater Likelihood Of Discharge To Home Following Colorectal Surgery
Patients having colorectal surgery at high-volume hospitals are significantly more likely to recover and return home after surgery than individuals having operations at low-volume hospitals. This study is the first step in a process of identifying which features of high-volume hospitals contribute toward desirable outcomes. Efforts to identify the reasons for improved recovery at high-volume hospitals can help lower-volume hospitals adopt beneficial practices (Balentine, 1/15).

The Kaiser Family Foundation: Raising Medicare Premiums For Higher-Income Beneficiaries: Assessing The Implications
Some recent proposals to address concerns about federal spending have included recommendations to reduce the growth in Medicare spending by increasing beneficiaries’ contributions towards their health care costs. ... there is some possibility that such changes could lead some higher-income beneficiaries to drop out of Medicare Part B and instead self-insure, which could result in higher premiums for all others who remain on Medicare if the dropout group is large and relatively healthy. ... given the relatively low incomes of most people on Medicare, a significant amount of savings from this proposal is only possible by going relatively far down the income scale to reach a sizeable share of beneficiaries—at which point the affordability of these additional costs could be called into question (Cubanski, Neuman, Jacobsen and Smith, 1/13).

Employee Benefit Research Institute/Greenwald & Associates: Views On Employment-Based Health Benefits: Findings From The 2013 Health And Voluntary Workplace Benefits Survey
Enactment of the Patient Protection and Affordable Care Act of 2010 (PPACA) has raised questions about whether employers will continue to offer health coverage to their workers in the future. Yet, the importance of benefits in choosing a job remains high, and health insurance in particular continues to be, by far, the most important employee benefit to workers. Most workers are satisfied with the health benefits they have now and do not prefer to change the mix of benefits and wages. Choice of health plans is important to workers, and they would like more choices, but workers express confidence that their employers or unions have selected the best available health plan (Fronstin and Helman, December 2013).

Journal of Infectious Diseases: Prevalence Of Hepatitis C Virus Infection In US Hispanic/Latino Adults
Prevalence of hepatitis C virus (HCV) antibody has been reported in Mexican Americans, but its prevalence in other US Hispanic/Latino groups is unknown. We studied 2 populations of US Hispanic/Latino adults; 3210 from the National Health and Nutrition Examination Survey (NHANES) 2007–2010 and 11,964 from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Age-standardized prevalence ... differed significantly by Hispanic/Latino background in HCHS/SOL (eg, 11.6% in Puerto Rican men vs 0.4% in South American men). These findings suggest that the HCV epidemic among US Hispanics/Latinos is heterogeneous (Kuniholm et al., 1/14).

All-Payer Claims Database Council/Robert Wood Johnson Foundation: The Basics Of All-Payer Claims Databases
Over the past 10 years, a growing number of states have established state-sponsored all-payer claims database (APCD) systems to fill critical information gaps for state agencies, to support health care and payment reform initiatives, and to address the need for transparency in health care ... States working collectively on common issues can leverage solutions more effectively than each state working independently. Areas for continued collective action include development of national standards, both in data and measures. Now and in the future, state APCDs provide the unique data to support the development of comparable information about the cost, effectiveness, and performance of the health care delivery system at the local, state and national levels (Porter et al., 1/14).

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

Examiner: Minorities And The Poor Receive Delayed Thyroid Cancer
A new UCLA study has found that, compared to Caucasian patients and those in higher economic brackets, minority patients and those of lower socioeconomic status are far more likely to have advanced thyroid cancer when they are diagnosed with the disease. The study, which comprised almost 26,000 thyroid cancer patients was published in the January edition of the Journal of Endocrinology and Metabolism (Wulffson, 1/9).

MedPage Today: Results Mixed For Patient-Centered Medical Homes
An analysis of patient-centered medical home (PCMH) studies showed sparse levels of improvement in overutilization and patient satisfaction, but stakeholders say the delivery model is still the right direction to move in. A review of 20 peer-reviewed and industry reports about the effect of PCMHs found eight studies (40%) reported fewer hospital admissions and three (15%) showed fewer 30-day readmissions. Only five (25%) reported improved access to care, the Patient-Centered Primary Care Collaborative (PCPCC) said. Meanwhile, four (20%) showed increase in patient satisfaction and six (30%) showed an increase in preventive services, the PCPCC, a Washington-based advocacy group for PCMHs, said in an analysis of the model's costs and quality. The report looked at studies released or published between August 2012 and December 2013 (Pittman, 1/14).

Medscape: Mental Disorders Substantially Underestimated In Adults
The number of middle-aged and older adults who have psychiatric disorders is substantially and consistently under-reported, especially when compared with physical disorders, new research suggests. An analysis of more than 1000 adult participants from the Baltimore Epidemiologic Catchment Area (ECA) study, which included interviews going back 24 years, showed that those who had reported a mental disorder in previous assessments under-reported by 2- to 12-fold this information at later recall (Brauser, 1/14).

Medscape: Five Things To Stop Doing In The ICU To Limit Waste
Four critical care provider groups have announced a list of measures to limit wasteful procedures in the intensive care unit (ICU) in an attempt to control spiraling healthcare costs. "It should be clear to everyone in the audience that rationing is unavoidable," said committee chair Scott Halpern, MD, assistant professor of internal medicine at the University of Pennsylvania in Philadelphia. "You cannot reconcile boundless needs to bounded funds." Dr. Halpern presented the list here at the Society of Critical Care Medicine 43rd Critical Care Congress (Harrison, 1/13).

Medscape: Grocery Store Coupons Encourage Unhealthy Eating
Grocery stores in the United States could be doing a better job of promoting healthful eating by changing the types of online coupons they offer their customers, a new study suggests. An analysis of over 1000 online coupons from 6 national grocery chains finds that the vast majority of the coupons were for discounts on snack foods, candies, desserts, prepared meals, cereals, and beverages, and very few were for fruits or vegetables (Tucker, 1/13).

Reuters: Many Younger U.S. Adults Skipping Flu Shots: Report
Just over a third of U.S. adults ages 18 to 65 got the flu shot during the 2012-2013 flu season, according to an analysis released on Tuesday, and if that trend holds for the current flu season, many adults may be at risk (Steenhuysen, 1/14).

Reuters: Minority Children Use Appropriate Car Seats Less Often
Many kids are not put in car seats and booster seats as recommended, studies have shown. A new report suggests use may be particularly low among non-white children. "We expected that differences in family income, parental education, and sources of information would explain the racial disparities in age-appropriate restraint use and they did not," lead author Dr. Michelle L. Macy told Reuters Health by email (Doyle, 1/13).

Los Angeles Times: Survivors Of Traumatic Brain Injuries More Likely To Die Young
People who suffer traumatic brain injuries face an elevated risk of death from suicide or accidents for years to come, according to a new study based on four decades of data on hundreds of thousand of patients in Sweden. Those who survived the immediate aftermath of moderate and severe traumatic brain injuries were three times more likely than people without such injuries to die prematurely, defined by the researchers as before age 56. Experts said the study was likely to spur calls for long-term monitoring of some brain injury patients. By virtue of its size and scope, the analysis, published Wednesday in JAMA Psychiatry, puts an authoritative stamp on a growing body of evidence that impacts to the brain can be deadly in ways that are not easily apparent (Zarembo, 1/15).

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Editorials and Opinions

Viewpoints: Is Overhaul Really A 'War' On The Young?; War On Poverty Requires Spending; Maternity Leave In America

The New York Times: Health Care Reform Survives A Lawsuit
A long-shot lawsuit that could have damaged the effectiveness of health care reform got a well-deserved brushoff from a federal district judge on Wednesday. The suit was brought with the help of conservative legal groups and cheered on by Congressional Republicans eager to disable the Affordable Care Act (1/16).

The New York Times' Economix: The Real Health Care 'War' On The Young
A common theme among critics of Obamacare has been that it basically is a war on the young and especially on men. ... But the authors cited above do not base their case on purely technical, economic grounds. Language such as "the greatest generational theft in world history" or "a war on the bros" is meant to generate moral outrage. A case in point is the gender neutrality baked into the community rating required by Obamacare, which has unleashed this so-called war (Uwe E. Reinhardt, 1/17). 

Los Angeles Times: Maternity Leave In America: How Do We Stack Up?
When I was waddling through the L.A. Times newsroom last fall very pregnant, the issue that weighed most on me had little to do with my actual baby bump. It was whether I could afford to take all the time I needed to bond with and care for my daughter in her very early development and still support my family financially. When it comes to maternity leave, the U.S. is by no means a leader (Michelle Maltais, 1/16). 

The Wall Street Journal: The FDA Nixes A Pathbreaking Drug For MS
Alemtuzumab is used today as an intravenous treatment for a form of leukemia. But 20 years of research centered at Cambridge University also has shown that the action of this drug—depleting immune cells that become misdirected and attack one's own body—is effective in treating multiple sclerosis. ... The primary reason FDA reviewers gave for rejecting Lemtrada was that the studies demonstrating the drug's efficacy did not conform to the agency's standard requirement of double-blind, placebo-controlled drug trials—where some patients, unbeknownst to themselves and their doctors, receive placebo treatments. There are excellent reasons for the standard approach, but only up to a point. Lemtrada and many established MS treatments have immediate side effects, such as nausea and headaches, that are well known to doctors and patients. A double-blind trial would not really be blind (Christopher Demuth Sr. and Christopher Demuth Jr., 1/16). 

Bloomberg: To Fight Poverty, Conservatives Will Have To Spend
There’s a simple way to tell whether the Republican Party's newfound commitment to fighting poverty is more than rhetoric: Follow the money. ... The party promised its anti-tax wing no tax increases and lower tax rates. It promised older voters that Medicare and Social Security would not change for those over age 55. It promised defense hawks that sequestration cuts to military spending would be reversed. And it promised its Tea Party allies that it would cut trillions from government spending and balance the federal budget. The only way to square all those promises is through draconian cuts to programs for the poor (Ezra Klein, 1/16).

WBUR: Health Care Spending Is Down, Why Aren't Our Premiums?
Happy New Year and welcome, most of you, to another year of sometimes-painful health insurance premium increases. Does this have to happen again? I ask because health care spending is down — or is at least not rising as fast as our premiums. We have proof for 2012 in two recent reports (Martha Bebinger, 1/16).

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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.