Daily Health Policy Report

Tuesday, January 21, 2014

Last updated: Tue, Jan 21

KHN Original Reporting & Guest Opinion

Health Reform

Administration News

Health Care Marketplace


Women's Health

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

As HHS Moves To End Overload Of Medicare Claims Appeals, Beneficiaries Will Get Top Priority

Reporting for Kaiser Health News, in collaboration with The Washington Post, Susan Jaffe writes: “Medicare beneficiaries who have been waiting months and even years for a hearing on their appeals for coverage may soon get a break as their cases take top priority in an effort to remedy a massive backlog” (Jaffe, 1/21). Read the story.

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Michigan Republicans Rethink Medicaid Expansion

Reporting for Kaiser Health News, in partnership with NPR, Eric Whitney writes: "Nationally, Republican party leaders say their number one campaign issue for the midterm elections is opposition to Obamacare. But at the same time, a growing number of Republican states are now embracing a major provision of the law – expanding Medicaid, the government-funded health benefit program for the poor. The Supreme Court made doing that optional for states in 2012 and most Republican-led states said 'no.' But now, some states like Ohio, Iowa and Michigan are forging compromises with the White House on Medicaid" (Whitney, 1/20). Read the story.

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Consumers Expecting Free 'Preventive' Care Sometimes Surprised By Charges

Kaiser Health News consumer columnist Michelle Andrews writes: “The new health-care law encourages people to get the preventive services they need by requiring that most health plans cover cancer screenings, contraceptives and vaccines, among other things, without charging patients anything out of pocket. Some patients, however, are running up against coverage exceptions and extra costs when they try to get those services. Advocates and policy experts agree that more federal guidance is needed to clarify the rules” (Andrews, 1/21). Read the column

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Capsules: Wyden Plan May Be Vision Of Future Medicare Reforms; Is The Health Law’s Insurance Website Not Spanish Friendly?

Now on Kaiser Health News’ blog, Mary Agnes Carey reports on Sen. Ron Wyden's plan for Medicare: "If Congress is ever going to overhaul Medicare, it will almost certainly have to happen this way. Sen. Ron Wyden, the Oregon Democrat widely expected to be the next Senate Finance Committee chairman, last week led a bipartisan group of lawmakers, health care experts and seniors' advocates backing a plan to better coordinate care given to Medicare beneficiaries" (Carey, 1/21).

Also on Capsules, listen to the audio of KHN’s Daniela Hernandez and CNET en Espanol’s Laura Martinez on NPR’s Tell Me More Friday morning to talk about how Spanish speakers are struggling with the federal website to buy health insurance (1/17). Check out what else is on the blog.

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Miami Children’s Hospital Part Of A Trend: Revealing Some Price Information

The Miami Herald's Daniel Chang, working in partnership with Kaiser Health News, reports: "As health insurance companies shift more financial responsibility onto consumers through higher deductibles, co-payments and co-insurance rates, hospital executives are feeling pressure to reveal their most closely-held secret: prices. Last week, Miami Children’s Hospital became one of the first in South Florida to give consumers more information — but not exactly the prices — they need to estimate their out-of-pocket costs, an increasingly important factor when deciding where to seek medical care" (Chang, 1/19). Read the story.

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Political Cartoon: 'Generation Text?'

Kaiser Health News provides a fresh take on health policy developments with "Generation Text?" by John Cole.

And here's today's health policy haiku:  


A red state puzzle: 
How to expand Medicaid
but not boost health law.

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

Even As Exchange Enrollment Numbers Appear Sluggish, Medicaid Expansion Sign-Ups Surge In Many States

The New York Times also notes that many of these new Medicaid beneficiaries are people who have not had insurance before. Meanwhile, news outlets continue to track developments regarding how governors continue to wrestle with Medicaid decisions -- including those in Virginia, Michigan and Maine. Also in the news, a problem with Maryland's Medicaid enrollment.  

The New York Times: Peace Of Mind Is First Benefit For Many Now Getting Medicaid
As health care coverage under the new law sputters to life, it is already having a profound effect on the lives of poor Americans. Enrollment in private insurance plans has been sluggish, but sign-ups for Medicaid, the federal insurance program for the poor, have surged in many states. Here in West Virginia, which has some of the shortest life spans and highest poverty rates in the country, the strength of the demand has surprised officials, with more than 75,000 people enrolling in Medicaid. While many people who have signed up so far for private insurance through the new insurance exchanges had some kind of health care coverage before, recent studies have found, most of the people getting coverage under the Medicaid expansion were previously uninsured (Tavernise, 1/20).

Politico: State Week: Medicaid Expansion Prominent In Governors’ State Of The State
With legislatures geared up, State of the State season is under way in capitals across the country. These addresses are a chance for governors to foreshadow the year ahead and hint at which policy decisions they might pursue. Medicaid expansion remains a live grenade in dozens of statehouses, and Republican governors are using their speeches to reassert themselves on the issue and kick off another year of fierce policy debate. Here’s the latest from the states (Cheney, 1/21).

The Washington Post: Terry McAuliffe’s Push To Expand Medicaid Rankles The GOP Lawmakers He Seeks To Woo
Gov. Terry McAuliffe intends to wrest the power to expand Medicaid away from a legislative commission and put it in his own hands, one of several moves threatening to undermine the new governor’s courtship of the GOP-controlled General Assembly. McAuliffe (D) announced Monday that he will seek that authority through a proposed budget amendment if the Medicaid Innovation and Reform Commission does not agree within the next 60 days to enroll 400,000 more Virginians into the federal-state health-care program for the poor (Vozzella, 1/20). 

The Associated Press/Washington Post: McAuliffe Wants Authority To Expand Medicaid
Gov. Terry McAuliffe wants lawmakers to give him the authority to expand Medicaid eligibility on his own if a state commission doesn’t act by the end of the 2014 legislative session. The Democratic governor has made expanding the publicly funded health insurance program for the poor and disabled to an additional 400,000 Virginians a top issue for his new administration. But the proposal is staunchly opposed by Republicans in the GOP-controlled House (1/20). 

The Washington Post: Maryland Welcomes Wrong People To Medicaid
As many as 383 Medicaid enrollees in Maryland received welcome packets in the mail this month that contained the names and birth dates of strangers, health officials announced Sunday evening. They blamed the mix-up on a “programming error” caused by the chief IT contractor hired to build a health-insurance marketplace for the state. Officials at the Maryland Department of Health and Mental Hygiene said they learned of the problem Friday after a customer contacted a Medicaid enrollment broker and reported receiving the wrong packet in the mail (Johnson, 1/19).

The Associated Press/Washington Post: Programming Error Affects Md. Medicaid Packages
Maryland health officials are blaming a programming error for causing some Medicaid enrollment packages to be sent to the wrong address. The state Department of Health and Mental Hygiene attributed the error Sunday to Noridian, the prime contractor for the Maryland Health Benefit Exchange (1/19). 

The Baltimore Sun: As Many As 1,000 Marylanders’ Medicaid Enrollment Packets Sent To Wrong Address
The troubled Maryland health exchange is facing another setback after a programming error sent Medicaid enrollment packets for as many as 1,078 customers to the wrong addresses, it announced on Sunday. The packets included the names, dates of birth and Medicaid ID numbers of the customers, but they did not include Social Security numbers or financial or medical information, the Department of Health and Mental Hygiene announced (Campbell, 1/19).

Kaiser Health News: Michigan Republicans Rethink Medicaid Expansion
Nationally, Republican party leaders say their number one campaign issue for the midterm elections is opposition to Obamacare. But at the same time, a growing number of Republican states are now embracing a major provision of the law – expanding Medicaid, the government-funded health benefit program for the poor. The Supreme Court made doing that optional for states in 2012 and most Republican-led states said “no”. But now, some states like Ohio, Iowa and Michigan are forging compromises with the White House on Medicaid (Whitney, 1/20).

Modern Healthcare: Despite Governor’s Staunch Opposition, Maine Lawmakers Continue To Push For Medicaid Expansion
Although Republican Gov. Paul LePage continues to be a stalwart opponent to expanding Medicaid, providers in Maine are still pushing to make their state the 26th state to do so under the Affordable Care Act. Some Maine lawmakers want to go much further and push the state toward a single-payer system. LePage, a conservative Republican, cites a new feasibility study—which found that Medicaid expansion could cost the state up to $3.2 billion over the next 10 years—as reason to find other solutions to the state's healthcare access problems (Robeznieks, 1/20).

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Trials, And A Few Unexpected Triumphs, For Insurance Exchanges

A procurement document posted on a federal website gives the newest Obamacare contractor until mid-March to build the back end of healthcare.gov, predicting dire consequences if the work is not completed on time. Other media outlets report exchange developments from Maryland, Massachusetts, Missouri, North Carolina, Oregon, Wisconsin, Georgia and Minnesota.

The Hill: Document: ObamaCare Contractor Faces Mid-March Deadline Or Disaster 
If the ObamaCare contractor brought on last week to fix the back-end of the HealthCare.gov portal doesn't finish the build-out by mid-March the healthcare law will be jeopardized, according to a procurement document posted on a federal website. It says insurers could be bankrupt and the entire healthcare industry threatened if the build out is not completed (Easley, 1/18).

The Associated Press: In Mass., Website Woes Frustrate Health Care Push
Massachusetts has long held a special status in the debate about President Obama's health care law. It was a 2006 Massachusetts law that provided the inspiration for the 2010 national law, and Massachusetts already had near-universal coverage before the federal law took effect. Now the state that gave birth to a sweeping expansion of health coverage nationally is trying to knit the two laws together and struggling to make sure no resident falls through the insurance net (LeBlanc, 1/20).

North Carolina Health News: North Carolina Obamacare Enrollment One Of Nation's Highest
North Carolina's enrollment in the Affordable Care Act federal insurance exchange reached a level in December that was surprising given the state's prior poor performance in signing people up. According to federal statistics released last week, North Carolina had 107,778 people signed up by Dec. 28, up from a total of only 8,970 who had signed up by the end of November (Hoban, 1/20).

The Baltimore Sun: Consumers Trading Up For Better, Cheaper Health Insurance
Barbara Gruber has never been happier to pay a bill. From CareFirst BlueCross BlueShield, the bill confirmed that the 55-year-old Mount Washington woman had new, affordable health insurance. She bought it on the Maryland Health Connection, the online exchange for the uninsured that was created to comply with the federal Affordable Care Act. But Gruber, like many buying insurance on the exchange, was not without coverage before. … The state cannot say how many Marylanders were switching from existing policies when they bought insurance on the exchange (Cohn, 1/19).

The Oregonian: Cover Oregon: Health Exchange Failure Predicted, But Tech Watchdogs' Warnings Fell On Deaf Ears
Amid the idealistic fervor of Oregon's effort to build a game-changing health insurance exchange, Ying Kwong did not believe the hype. In one of a series of revealing emails, the Cornell-educated technology analyst at Oregon's Department of Administrative Services wrote last May that Cover Oregon's managers were being "intellectually dishonest" in claiming the project would be ready Oct. 1 (Budnick, 1/18).

Fox News: 'Parallel Universe': Woman Spends 6 Weeks Trying To Disenroll From Obamacare
Think it's hard to enroll in ObamaCare? Try getting out of it.  Missouri resident Lesli Hill learned the hard way that terminating an Affordable Care Act plan can be far more difficult than navigating the website to buy one. She spent six weeks being bounced from operator to operator, calling the help line, using the online chat, blasting out emails to anyone who would listen, before ultimately driving to Kansas City last week to enlist her insurance company's help. Only then was she able to break through the bureaucratic logjam, and cancel her policy (Berger, 1/20).

The Milwaukee Journal Sentinel: Obamacare Sign-Ups Skew Older, But Don't Sound Alarm Yet, Experts Say
News of the small percentage of young people who have signed up so far for health plans through the federal and state marketplaces brought ominous predictions last week of higher rates next year. The predictions warrant some skepticism. "At this point, everything is an educated guess, and maybe just a guess," said Dave Osterndorf, chief health actuary for consulting firm Towers Watson (Boulton, 1/19).

Georgia Health News: Where Does Ga. Stand In Exchange Enrollment?
Georgia's enrollment in the insurance exchange in December reached a level that was almost surprising, given the state's anemic figure of a month before. The state had 58,611 sign up by Dec. 28, according to federal statistics released this week, up from 6,859 a month before. "We're starting to see real enrollment momentum after such a rocky start,’" Cindy Zeldin of Georgians for a Healthy Future said Monday, referring to the problem-plagued rollout of the federal exchange website in early fall (Miller, 1/17).

The Star Tribune: Republicans Lean On MNsure To Make Case Against Dayton
Minnesota Republicans searching for a way to defeat DFL Gov. Mark Dayton are seizing on an issue they believe could help upend his bid for a second term — the tumultuous rollout of the state's health insurance exchange. Republicans are escalating attacks on Dayton as troubles with the MNsure exchange threaten to drag into the campaign season. Last week, the Republican National Committee filed a massive data request seeking details on enrollment information and the hiring and abrupt resignation of MNsure's former director, April Todd-Malmlov (Helgeson, 1/19).

The Star Tribune: Health Beat: A Mother's Harrowing Tale With MNsure
Comopsia Stanley was anxious as she watched the middle-aged man in a parka stride across the parking lot toward her car. Was this actually the same man with the soft voice who, just hours earlier, had called and promised to buy insulin for her diabetic son after reading about her family in the newspaper? Was this the man who had asked to meet here, outside a Home Depot in St. Louis Park? (Serres, 1/18).

Minnesota Public Radio: A Clue To MNsure's Problems Found In A Similar Software Precursor
Before MNsure, the state's new online health insurance marketplace, there was HealthMatch, an expensive, problem-plagued software project that foreshadowed MNsure's trouble a decade ago. "It was a complete failure," said longtime state Rep. Tom Huntley, a DFLer from Duluth. "We hired a company to manage it and set it up...and nothing ever happened." The HealthMatch project dragged on for five years, and consumed more than $20 million of taxpayer money to develop software that was never usable (Stawicki, 1/20).  

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As Some States Look To Kill Obamacare, Maryland Bill Would Boost Enrollees

While legislators in at least seven states contemplate measures to stop implementation of the health law, Maryland's Senate advanced a bill to provide insurance to those who were unable to enroll in that state’s troubled health exchange website.

The Wall Street Journal: Bills Proposed In Several States Would Nullify Affordable Care Act 
The nullification trend in statehouses seems to be spreading. ... The latest target is the Affordable Care Act. Conservative lawmakers in at least seven states have proposed laws that would prohibit state agencies and officials from helping the federal government implement the federal healthcare law and would authorize the state’s attorney general to sue violators (Gershman, 1/17).

The Associated Press/Washington Post: Md. Senate Advances Bill On Health Exchanges
The Maryland Senate has advanced a measure to provide insurance for people who were unable to enroll in the state’s health exchange website due to computer problems. The Senate voted 36-8 late Monday to adopt a favorable report on the measure. That sets the stage for a vote Tuesday to send the bill to the House (1/20).

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Studies Providing Mixed News On Effects Of Health Law

Separate Rand and McKinsey studies examined how coverage will be affected by cost and accessibility of plans on the exchanges. Also, USA Today looked at the less-explored phenomenon of co-ops.

The Washington Post: Study: Allowing People To Stay In Existing Insurance Plans Unlikely To Disrupt Exchanges
Plans to allow people to keep their individual health insurance policies, even if they don’t meet the requirements of the health-care law, are unlikely to threaten the short-term viability of the new health insurance marketplace, according to a new Rand Corp. study. The study, released Tuesday, examines the impact of President Obama’s decision in November to allow consumers to keep their insurance plans, even if those plans don’t meet the requirements of the Affordable Care Act (Sun, 1/21).

Modern Healthcare: Continuing Bare-Bones Plans Won't Cause Insurance Exchange 'Death Spiral,' RAND Study Says
The most detrimental policy move would be to allow new enrollees into noncompliant plans, the study found. It would increase premiums for exchange plans by 10% and decrease enrollment by 3.2 million nationwide. ... The other moves, though, would have a “far smaller” impact, researchers said. ... Some insurance executives appear to be more concerned about the policy changes than others. Humana issued a financial filing warning that more members than it expected are choosing to stay with their current plans (Kutscher, 1/20).

The Wall Street Journal: Exchanges See Little Progress On Uninsured
Early signals suggest the majority of the 2.2 million people who sought to enroll in private insurance through new marketplaces through Dec. 28 were previously covered elsewhere, raising questions about how swiftly this part of the health overhaul will be able to make a significant dent in the number of uninsured. Insurers, brokers and consultants estimate at least two-thirds of those consumers previously bought their own coverage or were enrolled in employer-backed plans (Weaver and Mathews, 1/17).

Marketplace: Who's Enrolling For Health Insurance? Not The Uninsured
Citing a new survey from McKinsey & Co., the Wall St. Journal reports that ... 52 percent said plans were cost prohibitive. Many healthcare observers expect previously uninsured people to sign up for plans prior to the March 31st enrollment deadline. Even if they don’t, PricewaterhouseCoopers Ceci Connolly says insurers are well aware the new healthcare law is just beginning (Gorenstein, 1/20).

USA Today: Co-Ops The Underdog In Health Insurance Marketplace
Consumer-run health insurance cooperatives, which were included in the Affordable Care Act to stimulate competition and lower prices, have been stymied by the insurance industry and a lack of publicity, industry and health care experts say. The consumer-operated and run insurance companies, called co-ops, are often funded by government loans. Cooperatives can sell their policies through the state and federal health insurance exchanges where Americans can buy coverage (Kennedy, 1/19).

Meanwhile --

The Boston Globe: With Health Law, Less-Easy Access In N.H.
To keep premiums affordable, Anthem Blue Cross and Blue Shield of New Hampshire, the only insurer in the state offering coverage in the new insurance marketplace, radically reduced the hospitals in its network. Petro’s local provider did not make the cut. Petro’s case reflects how Obama’s health law has upset the previous balance in the insurance landscape. As new coverage begins this month, most policies sold through the insurance marketplaces offer some type of restricted hospital network in exchange for lower premiums (Jan, 1/20).

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Cost Of Care, Diabetes Are Top Latino Health Concerns

Worries about being able to afford care and about diabetes were among the biggest health concerns among Latinos -- whether they were born in the U.S. or immigrated here, according to the latest survey by NPR, the Robert Wood Johnson Foundation and the Harvard School of Public Health. Other media outlets explore the limited options of those living in this country illegally. 

NPR: Taking The Pulse Of Latino Health Concerns
Latino immigrants to the U.S. say the quality and affordability of health care is better in the U.S. than the country they come from, according to the latest survey by NPR, the Robert Wood Johnson Foundation and the Harvard School of Public Health. But many report having health care problems. More than a third of immigrant respondents (31 percent) said they'd had a serious problem with being able to pay for health insurance in the past 12 months. ... the health issue that Latinos said is most concerning for them and their families — whether they were born in the U.S. or immigrated here — is diabetes (Neighmond, 1/21).

Los Angeles Times: Immigrants Without Legal Status Remain Mostly In Healthcare Limbo 
When Alva Alvarez gets sick, she buys over-the-counter medicine from the grocery and takes as much as she can until she feels better. The mother of five resorts to this because she can't afford a visit to the doctor to figure out what's ailing her. Although scenarios like this are supposed to disappear as millions of Americans become newly insured under the national healthcare law, Alvarez's situation isn't likely to improve and could get worse. The San Bernardino resident represents the biggest — and mostly invisible — group of people left out of the Affordable Care Act: immigrants in the country illegally (Karlamangla, 1/19).

The New York Times: Nonprofit Clinic Offers ‘Bridges of Health’ To Philadelphia’s Illegal Immigrants
Like many other immigrants, Mery Martinez has no legal status in the United States, no health insurance and no money. But she does have leukemia, and has been struggling to find treatment for the disease ... With rising anxiety, and a rash that she attributed to her illness, Ms. Martinez walked into a clinic last week run by Puentes de Salud, a nonprofit group of doctors, nurses and medical students that provides primary care to Philadelphia’s undocumented, uninsured and impoverished Latino immigrants. A co-founder, Dr. Steve Larson, said the organization distinguished itself from other community-health groups by addressing the underlying causes of illness, like poor nutrition, illiteracy or urban violence (Hurdle, 1/19).

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Administration News

Supreme Court Today Hears Case On Medicaid Home Health Workers' Right To Form Public Employee Union

The case involves workers in Illinois who serve Medicaid patients at home. The state says allowing a union helps provide a more stable workforce, but opponents argue that the move was a "political payback" by state Democrats.

Los Angeles Times: Supreme Court To Hear 1st Amendment Challenge To Labor Unions
The Supreme Court will hear a 1st Amendment case this week involving Chicago-area in-home care providers that could end up dealing a major blow to public-sector labor unions. Illinois, California, Maryland, Connecticut and other states have long used Medicaid funds to pay salaries for in-home care workers to assist disabled adults who otherwise might have to be put in state institutions. The jobs were poorly paid and turnover was high. Over the last decade, more than 20,000 of these workers in Illinois voted to organize and won wage increases by joining the Service Employees International Union. But the National Right to Work Foundation, an anti-union advocacy group, sued Gov. Pat Quinn and the SEIU, accusing the state and union of conspiring to relabel private care providers as state employees so they could collect more union fees (Savage, 1/20). 

The Washington Post: Unions Circling The Wagons On Court Case
It was a "win-win-win" situation when home-care providers in Illinois unionized, says the lawyer who will represent the state and the public-employee union in Supreme Court arguments this week. Pay and benefits increased for the employees, the state negotiated with a unified and more stable workforce, and clients found that workers were more willing to stay in the demanding jobs, Washington lawyer Paul Smith said. Actually, says Patrick Semmens of the National Right to Work Committee, the whole thing was simply a “political payback” to the powerful public-employee unions (Barnes, 1/19). 

NPR: A Union For Home Health Aides Brings New Questions To Supreme Court
The U.S. Supreme Court hears arguments Tuesday in an Illinois case that could drive a stake through the heart of public employee unions. At issue are two questions: whether states may recognize a union to represent health care workers who care for disabled adults in their homes instead of in state institutions; and whether non-union members must pay for negotiating a contract they benefit from (Totenberg, 1/21).

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Health Care Marketplace

As Specialists Become 'Entrepreneurial,' Patients' Costs Soar

The New York Times: Patients’ Costs Skyrocket; Specialists’ Incomes Soar
Ms. Little’s seemingly minor medical problem — she had the least dangerous form of skin cancer — racked up big bills because it involved three doctors from specialties that are among the highest compensated in medicine, and it was done on the grounds of a hospital. Many specialists have become particularly adept at the business of medicine by becoming more entrepreneurial, protecting their turf through aggressive lobbying by their medical societies, and most of all, increasing revenues by offering new procedures — or doing more of lucrative ones (Rosenthal, 1/18).

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Insurance Execs Offer Views On Health Costs, Reform

Former Kaiser Permanente CEO George Halvorson and Blue Shield of California CEO Paul Markovich share their perspectives on where Obamacare is headed and how the nation can curb health care spending.

PBS NewsHour: Former Health Care CEO Argues America's Medical System Rewards Bad Outcomes
Judy Woodruff talks to George Halvorson, former CEO of Kaiser Permanente and author of "Don't Let Health Care Bankrupt America," who argues we spend too much money on care that doesn't deliver optimal benefits. How can the U.S. alter its approach to serve all Americans more cost-effectively and with better outcomes? ... We need to have the health care business system focus on improving care (Woodruff, 1/17).

Los Angeles Times: How I Made It: Blue Shield Of California CEO Paul Markovich 
As chief executive of Blue Shield of California, Paul Markovich leads one of the country's largest nonprofit health insurers, and he is a major player in the state's rollout of Obamacare. ... Markovich doesn't have to go far to hear complaints nowadays. Frustrated customers are venting about poor customer service in the transition to new health plans as part of the Affordable Care Act. Blue Shield recently apologized for its "unacceptable" performance. "Exchanges and health plans in California and across the country have been overwhelmed by last-minute volume and deadline extensions, which is causing serious delays," Markovich said. "I believe we will work through all of this soon and ultimately make the Affordable Care Act a success" (Terhune, 1/19).

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HHS To Start With Beneficiaries Backlog In Medicare Claims Appeals

The Department of Health and Human Services moves to break up a big backlog of Medicare claims appeals, with beneficiary hearings taking precedent. In the meantime, The Fiscal Times looks at overpayment in private Medicare Fee-For-Service plans.

Kaiser Health News: As HHS Moves To End Overload Of Medicare Claims Appeals, Beneficiaries Will Get Top Priority
Medicare beneficiaries who have been waiting months and even years for a hearing on their appeals for coverage may soon get a break as their cases take top priority in an effort to remedy a massive backlog (Jaffe, 1/21).

The Fiscal Times: Medicare Execs Are Overpaying $35 Billion a Year … And They Don’t Seem to Care
Medicare’s Private Fee-For-Service Plans, just one of the many entitlement programs run by the Centers for Medicare and Medicaid Services, overpaid billers by $34.6 billion dollars in 2013, according to its own estimates. With an “improper payments” rate of 10.1 percent of outlays, Medicare FFS is one of numerous government programs that wastes tens of billions of taxpayer dollars annually yet does little to recover any of that cash. The agency’s contractors are reasonably good at recouping overpayments when they are identified. They had an 83 percent recovery rate in 2013, according to the annual report released by the Department of Health and Human Services (Garver, 1/21).

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Women's Health

Abortion Rights Fight Central To Midterm Election Races

Abortion rights have yet again become a central issue in midterm elections while an order of nuns finds itself in the center of the health law's contraception coverage mandate.

The New York Times: Parties Seize On Abortion Issues In Midterm Race
When the Republican National Committee gathers for its winter meeting here on Wednesday, the action will start a few hours late to accommodate anyone who wants to stop first at the March for Life, the annual anti-abortion demonstration on the National Mall. And if they need a lift to the meeting afterward, they can hop on a free shuttle, courtesy of the Republican Party (Peters, 1/20). 

Los Angeles Times: Obamacare Lawsuit Forces Order Of Nuns Into The Public Eye
Except for their soliciting of donations, the members of the "begging order," as it's sometimes known, have largely stayed out of the spotlight. But that changed in September when the order became one of the plaintiffs in a lawsuit filed against the so-called contraceptive mandate of the Affordable Care Act, placing them at the center of a debate over health care and religious freedom (Hamedy, 1/18).

And in North Carolina --

The New York Times: North Carolina: Judge Blocks Ultrasound Requirement
A federal judge on  Friday declared unconstitutional the state’s ultrasound requirement for women seeking abortions, saying it violated the First Amendment by requiring doctors to display a fetal image and describe it even to women who covered their eyes and ears (Eckholm, 1/18).

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State Watch

State Highlights: R.I. Gov. Plans $43M In Medicaid Cuts

A selection of health policy stories from Rhode Island, California, Massachusetts, Virginia, Florida, Wisconsin, Missouri and Minnesota.

Providence Journal: Chafee’s $43-Million Cut In Medicaid Program Touches Many Sectors Of Health Care In Rhode Island
Rhode Island enthusiastically embraced the expansion of its Medicaid program allowed by the Affordable Care Act. But at the same time, Medicaid is where Governor Chafee has turned to make the biggest cuts as he seeks to close a $150-million budget hole. Chafee’s budget would slash $43 million from Medicaid, the health plan for the poor, in the fiscal year that ends June 2015. It’s the only expenditure cut that even gets into the double digits (Freyer, 1/17).

Los Angeles Times: New Mexico Judge Affirms Right To 'Aid In Dying'
Now, a New Mexico judge has ruled that terminally ill patients like Riggs have the right to "aid in dying" under the state constitution. "Such deaths are not considered 'suicide' under New Mexico's assisted suicide statute," ruled Judge Nan G. Nash of the 2nd District Court in Albuquerque last week. The state's assisted suicide law classifies helping with suicide as a fourth-degree felony (Hamedy, 1/19).

The Boston Globe: State Protections Still Awaited For Long-Term Care
More than a year after Massachusetts passed legislation aimed at curbing the rapidly rising cost of insurance for long-term care, regulators have yet to adopt new rules that would help protect consumers as they buy products to cover nursing homes and similar services. Regulations were scheduled to be in place by Oct. 31, but the Division of Insurance missed the deadline and recently extended the process to July 1. The state’s insurance commissioner, Joseph G. Murphy, said he does not plan to approve premium increases while his agency finalizes rules, but other protections, such as making it harder for companies to deny coverage, will be further delayed (Fernandes, 1/21).

The Washington Post: Mental Health Advocates Try To Seize The Moment In Va.
They were not as easy to pick out as the gun rights advocates with the bright orange stickers that read “Guns Save Lives” or the medical marijuana legalization supporters. But close to 200 advocates for the mentally ill wound their way through the Virginia General Assembly Building on Monday to try to make the most of a moment they know may not last (Shin, 1/20). 

The Wall Street Journal: Circumcision Coverage Comes Into Focus
Saleem Islam, a pediatric surgeon in Gainesville, Fla., was surprised a few years ago when he started receiving a steady stream of referrals for older boys from low-income families to be circumcised. … Like a dozen other states, Florida ended Medicaid coverage of routine circumcisions for newborns after the American Academy of Pediatrics issued a lukewarm statement on the practice in 1999. While the organization concluded that removing the penis's foreskin has potential benefits, it found the data were insufficient to recommend it as a routine procedure (Campo-Flores, 1/20). 

The Associated Press: Report: Wis. Hospitals Improve Quality, Save Money
More than 100 Wisconsin hospitals have been collaborating to improve the quality of health care, and their efforts have paid off with a decrease in costly outcomes such as readmissions and hospital-associated infections, according to a report released Tuesday. Hospital officials around the state have spent the past few years stepping up efforts to share knowledge and best practices associated with patient care (Ramde, 1/21).

St. Louis Today: Nixon Wants To Renovate Hospital For Nursing Classes
After Rachael Schulte spent three years watching her name inch up the wait list for Lincoln University’s nursing program, she finally started her first semester this year. Needless to say, it was a big deal. It’s an even bigger deal that the 26-year-old -- and other nursing students like her -- could have access to a soon-to-be emptied hospital for classes (Stucket, 1/21).

Minnesota Public Radio: Report: Not All Minnesotans Have The Same Opportunity To Be Healthy
The Minnesota Department of Health this week released a draft version of a report to the Legislature that recommends revamping the state's approach to health at all levels of government to eliminate health disparities between racial and ethnic groups. The 64-page document cites state policies that it found have prevented African-Americans, American Indians and members of other minority groups from enjoying the same quality of health as whites. Health Department officials say the report's authors deliberately decided to "lead with race" as a strategy for meeting the challenges of health inequities head on (Benson and Collins, 1/17).

WBUR: Launching A Grand Experiment In Massachusetts: Pricing Health Care  
There’s a grand experiment underway in Massachusetts and we are all, in theory, part of it. Here’s the question: Can we price childbirth, MRIs and stress tests, and will patients armed with health care prices change when and where they “buy” care? One of the first steps in this experiment is a new requirement that hospitals and doctors tell patients who ask how much things cost. It took effect January 1 as part of the state’s health care cost control law and we set out to run a test (Bebinger, 1/21). 

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Editorials and Opinions

Views On Health Law: 'Good Start' On Enrollment; Is Reinsurance A 'Bail-Out' Or Transfer Of Industry Funds?

The New York Times: A Good Start For Health Care Sign-Ups
Enrollments in health insurance plans through state and federal exchanges are rising rapidly, especially among young adults, making it likely that the Affordable Care Act will achieve a large and stabilizing mix of enrollees by the end of the open enrollment period on March 31 (1/17).

Bloomberg: Stop Obamacare’s Outrageous Bailouts
The Patient Protection and Affordable Care Act has already achieved "preliminary sustainability," an official recently told the National Journal. And what’s making the program sustainable? The prospect of a massive taxpayer bailout. The bailout would come from the law's "risk corridor" provisions. If insurers pay out more than 108 percent of the premiums they collect from customers in Obamacare’s exchanges, taxpayers are on the hook for about 75 percent of the extra cost. If the insurers make profits that are more than 108 percent of their collections, they have to pay back a similar proportion (Ramesh Ponnuru, 1/20).

The New Republic: Obamacare's a "Bailout" Now? Conservative Critics Are Getting Desperate
Conservatives used to say Obamacare is socialized medicine. Now they say it is a "government bailout" of insurers. The new claim is just as misleading and cynical as the old one. ... no insurer will be sure about its beneficiaries for many months, until the open enrollment period ends and the newly insured have a few months in which to file claims. That makes it impossible to know what kinds of losses, if any, insurers will take. But even if the losses are significant, the taxpayers won't be in for another Wall Street-style bailout. For one thing, the reinsurance money comes from the insurers themselves, who pay a tax on each beneficiary. It's basically a transfer of funds, from all carriers to those those companies inside the Obamacare marketplaces that end up with unusually unhealthy members. In this sense, it’s an insurance policy for the insurers—and one they more or less finance on their own (Jonathan Cohn, 1/15).

The Wall Street Journal: The Young And The Obamacare-less
ObamaCare's defenders say its troubles are over as more people sign up and, by the way, stop griping because the law is here to stay. Much evidence says otherwise, to the extent that the embroidered information the White House is willing to release counts as evidence. Lifting the veil of secrecy last week, the feds revealed that 2.2 million people nationwide had selected a plan through December. ... But even assuming an implausible 100% success rate, the exchanges are still well behind the original target of seven million, much less the 20 million or so necessary to ensure a viable insurance market. This is a failure by President Obama's own standard (1/20).

The Washington Post: Congress Needs To Keep A Lid On Medicare Spending
Even in the $1 trillion appropriations bill that passed Congress last week, a bipartisan achievement in a fractured Capitol, Republicans couldn't resist forcing through a gratuitous shot at the Affordable Care Act , defunding for now one of its most promising elements. This shouldn't become a habit. The Independent Payment Advisory Board (IPAB) has been called a "death panel," but it isn't. The group of health-care experts, appointed by the president in consultation with both parties in Congress, will be charged with making sure that Medicare spending doesn't blast through generous growth caps (1/19).

The Oregonian: Cover Oregon Mess Requires Stronger Response
Credibility has been a critical element of Gov. John Kitzhaber's third-term narrative. Before trying to sell habitually skeptical Oregonians on tax reform and other eat-your-spinach proposals, the thinking goes, it's necessary to foster trust through the determined exercise of responsible governance. Kitzhaber made a large deposit in the credibility bank last year with his leadership on public pension reform, but he's watched much of that advantage melt away over the past few months thanks to the Cover Oregon fiasco, which raises questions not only about those with more direct involvement, but also about the governor himself (1/20).

The Washington Post: Medicaid Expansion Is Right For Virginia
Virginia is one of the richest states in the nation but one of the stingiest in providing health coverage for the poor. Owing to its restrictive eligibility standards, it ranks 48th among states in per capita spending for Medicaid, the federally subsidized health program for the poor and disabled, according to the Virginia Health Care Foundation. About a million people — almost one in eight adult Virginians — lack health insurance. ... Republicans in Richmond, who have advanced no competing plan to provide quality health care for those people, should consider whether leaving available federal funds on the table really advances the interests of Virginians (1/18).

The Washington Post: Exemptions From The 'Contraception Mandate' Threaten Religious Liberty
Exempting ordinary, nonreligious, profit-seeking businesses from a general law because of the religious beliefs of their owners would be extraordinary, especially when doing so would shift the costs of observing those beliefs to those of other faiths or no faith. The threat to religious liberty, then, comes from the prospect that the court might permit a for-profit business to impose the costs of its owners' anti-contraception beliefs on employees who do not share them — by forcing employees to pay hundreds of dollars or more out of pocket each year for what should be covered under the law (Frederick Mark Gedicks, 1/15).

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Viewpoints: High Court's Scrutiny Of Home Health Workers Law; Patient 'Dumping' On LA's Skid Row; Hospital Fund Raising

The Washington Post: The Fight For Homecare Workers
On Tuesday the Supreme Court will hear arguments in Harris v. Quinn, ... It was brought by the National Right to Work Legal Defense Foundation (NRTW), whose mission is to use "strategic litigation" to "eliminate coercive union power and compulsory unionism abuses," in this case on behalf of several personal assistants who provide in-home services to persons with disabilities under Illinois's Medicaid program. ... Taking away home health-care workers’ collective bargaining rights would destroy the careful balance at least seven states have created to deal with aging populations and increased health-care costs (Moshe Z. Marvit, 1/20).

The Wall Street Journal: The Court And Union Coercion 
Illinois uses Medicaid to subsidize home care for the disabled, which the governors used as the legal excuse to redefine home-care workers as state employees and provide the SEIU with some 20,000 new dues-paying members. ... In Knox v. SEIU in 2012, the Justices ruled that forced unionization deserves a high level of First Amendment scrutiny. "Mandatory associations are permissible only when they serve a 'compelling state interes[t] . . . that cannot be achieved through means significantly less restrictive of associational freedoms.'" Let's hope the High Court follows this logic to find Illinois's forced unionization unconstitutional (1/20). 

Los Angeles Times: No Excuse For 'Patient Dumping' In L.A.'s Skid Row
It's hardly news that some hospitals have engaged in "patient dumping," the egregious practice of discharging homeless patients and simply dropping them off on the streets of skid row. Patient dumping made headlines in Los Angeles nearly a decade ago when reports of homeless people in hospital gowns and socks wandering skid row — or, in the case of a paraplegic man with a colostomy bag, crawling ... Given the universal denunciation of patient dumping from all corners of the city at that time, it's extremely troubling to learn that it is occurring on skid row again. Or perhaps it never completely went away (1/20). 

Los Angeles Times: Doctors And Hospitals Posing As Charity Cases? It’s Nauseating
Obamacare was intended, in part, to rein in sky-high healthcare costs. Yet some doctors and hospitals are responding to the reform law with outstretched palms and brother-can-you-spare-a-dime pleas for more money from patients. ... Dr. David Reuben, head of UCLA's Division of Geriatrics, defended the fundraising effort (David Lazarus, 1/20).

Fiscal Times: Medicare Execs Are Overpaying $35 Billion a Year … And They Don’t Seem to Care
Medicare's Private Fee-For-Service Plans, just one of the many entitlement programs run by the Centers for Medicare and Medicaid Services, overpaid billers by $34.6 billion dollars in 2013, according to its own estimates. With an "improper payments" rate of 10.1 percent of outlays, Medicare FFS is one of numerous government programs that wastes tens of billions of taxpayer dollars annually yet does little to recover any of that cash (Rob Garver, 1/21).

The New York Times: Sex And The Single Senior
What is happening in retirement communities, assisted living facilities and nursing homes? You might imagine quiet reading, crossword puzzles, bingo, maybe some shuffleboard. Think again. Think about sex — unsafe sex. The Department of Health and Human Services released a little-noticed report on Medicare a few months ago that had this startling statistic: In 2011 and 2012, 2.2 million beneficiaries received free sexually transmitted disease screenings and counseling sessions. And more than 66,000 received free H.I.V. tests (Dr. Ezekiel J. Emanuel, 1/18).

The Kansas City Star: Health Scare Can Give New Perspective On Life
The Tikker is a rather understated wristwatch, with a plain, digital face and a simple band that comes in black or white. But it is fancy. It ticks down to death. The goal of the watch — which uses age and habits to establish a user’s estimated time of death, and then counts down to it — is to remind people that their time is limited, and that it’s not worth it to sweat the small stuff. … As Colting notes, individuals who have battled potentially terminal diseases or narrowly escaped death often describe a marked shift in perspective, a change in how they view the world, how they prioritize things (Dugan Arnett, 1/20).

The Boston Globe: When The Writer Becomes The Patient
Should I have gotten the mammogram that started all this hand wringing? Medical researchers are still trying to answer that question. A study in the December 2013 issue of JAMA Internal Medicine found that a woman in her 40s, after a decade of annual mammograms, is between 7 and 100 times more likely to be needlessly treated than to be spared a breast cancer death. But that’s a big range. I’ve met women with my diagnosis who chose more extensive treatment than I did, and some who chose less. We are all pulling from the same data, and presumably we want the same outcome — a long and comfortable life, with little regret. But we vary greatly in our tolerance for risk-taking, our trust of technology, our appetite for medical intervention (Karen D. Brown, 1/20).

Los Angeles Times: The Global Grip Of Cigarette Smoking
Fifty years ago this month, U.S. Surgeon General Luther Terry announced the bombshell conclusions of a new report to a crowded room of journalists: Cigarette smoking causes lung cancer, is associated with other deadly illnesses and warrants remedial action. That 1964 surgeon general's report on smoking and health spurred profound and lasting changes in tobacco use and policies in the United States, but its call to action has gone unfulfilled internationally. In the intervening decades, smoking has expanded in developing countries and has had devastating consequences for the world's poor (Thomas J. Bollyky, 1/21).

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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.