Daily Health Policy Report

Thursday, January 23, 2014

Last updated: Thu, Jan 23

KHN Original Reporting & Guest Opinion

Health Reform

Administration News

Health Care Marketplace

Women's Health

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

In Western N.C., Getting Health Coverage Means Getting Creative

Kaiser Health News staff writer Jenny Gold reports: "In the mountains of Western North Carolina, health insurance navigator Julia Buckner spends hours driving around what she calls 'God's Country' — miles and miles of mountains, rivers and winding roads. Her job - and her passion - is to help the rural residents of some of the poorest counties in North Carolina sign up for coverage through the Affordable Care Act" (Gold, 1/22). Read the story.

This Story: Print | Link to | Top

Texas Imposes Additional Rules On Health Insurance Navigators

The Texas Tribune's Becca Aaronson, working in partnership with Kaiser Health News, reports: "The Texas Department of Insurance has issued state regulations for health care 'navigators,' the workers who assist people seeking health insurance in the federal marketplace created by the Affordable Care Act. The rules address some of the criticisms aired recently by Democrats and health care advocates, while also broadening the definition of 'navigator' to allow additional organizations — not just those that received federal grants — to hire and train navigators (Aaronson, 1/22). Read the story.  

This Story: Print | Link to | Top

Political Cartoon: 'DeLoreain't?'

Kaiser Health News provides a fresh take on health policy developments with "DeLoreain't?" by Milt Priggee.

And here's today's health policy haiku:


Wait, is this Buzzfeed?
No, it's still Kaiser Health News,
guess they need more clicks.

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.

This Story: Print | Link to | Top

Health Reform

Survey Finds Modest Drop In January Uninsured Rate

The Gallup-Healthways Well-Being Index found that the uninsured rate for U.S. adults dropped by 1.2 percentage points in January as the health law's coverage expansion took effect, with the biggest change seen among unemployed people and nonwhites.

The Associated Press/Washington Post: Poll Finds Drop In Uninsured Rate
The nation’s uninsured rate dropped modestly this month as the major coverage expansion under President Barack Obama’s health care law got underway, according to a closely watched survey released Thursday. The Gallup-Healthways Well-Being Index found that the uninsured rate for U.S. adults dropped by 1.2 percentage points in January, to 16.1 percent. The biggest change was for unemployed people, a drop of 6.7 percentage points. That was followed by a 2.6 percentage-point decline for nonwhites. Traditionally both groups are far more likely to be uninsured than the population as a whole (1/23).

Politico: Survey: Uninsured Rate Falls
The rate of uninsured Americans has dropped in the early stages of 2014, dipping in the less than one month since coverage from the Obamacare exchanges took effect. So far in January, 16.1 percent of Americans are uninsured, down from 17.3 percent in December before the exchange coverage began for those who signed up for Jan. 1 health insurance, according to a Gallup poll out Thursday. That’s down from a high of 18.6 percent earlier in 2013 and the lowest registered rate since December 2012 (Kopan, 1/23).

The Hill: Survey: Rate Of Uninsured Drops To Lowest Point In A Year
The amount of people who lack health insurance has dropped to its lowest level in more than a year, according to a poll.  According to the Gallup-Healthways Well-Being Index released Thursday, the U.S. uninsured rate has dropped to 16.1 percent — down from 17.3 percent in December. Gallup noted that number is slightly lower than any time since December, 2012 (Trujillo, 1/23).

This Story: Print | Link to | Top

In Calif., Anthem Leads In Enrollment; Md. Glitches Blamed On IBM Software

News outlets report on how state health exchanges and enrollment outreach efforts are proceeding.

Los Angeles Times: Anthem Still Tops California Exchange Enrollment; Kaiser Drops Back
At the halfway mark, industry giant Anthem Blue Cross is holding on to a slim lead among health insurance providers with a 31% share of California's exchange market. The Covered California exchange released enrollment figures Tuesday for its 11 health plans from Oct. 1 to the end of December. Open enrollment under the Affordable Care Act runs through March 31. Anthem, the state's largest for-profit health insurer and a unit of WellPoint Inc., has signed up 155,146 people (Terhune, 1/22).

The Wall Street Journal: IBM Software Blamed For Health Exchange Woes
Software from International Business Machines Corp. has been singled out for technical problems affecting both the Maryland and Minnesota online health exchanges. Officials from both states have blamed IBM's Cúram, used to determine consumers' eligibility for health-insurance coverage, for a number of website performance issues, including losing consumer applications (Boulton, 1/23).

Fox News: Administration Fears Part Of Health Care System So Flawed It Could Bankrupt Insurance Companies
To justify a no-bid contract with Accenture after firing CGI as the lead contractor, the administration released documents from the Department of Health and Human Services and the Center for Medicare and Medicaid Services that offered a rare glimpse of its worst fears, saying the problems with the website puts "the entire health insurance industry at risk" ... "potentially leading to their default and disrupting continued services and coverage to consumers (Angle, 1/22).

The Baltimore Sun: Emergency Stop-Gap Insurance Plan Clears Committee Vote
The emergency plan to provide state insurance to people stuck because of Maryland's faulty health exchange cleared another hurdle Wednesday as a committee voted to send it to the floor of the House of Delegates. The proposal to let people join the state's high-risk pool, known as the Maryland Health Insurance Program, passed the House Health and Government Operations Wednesday afternoon, the day after the Senate approved it (Cox, 1/22).

Kaiser Health News: In Western N.C., Getting Health Coverage Means Getting Creative
In the mountains of Western North Carolina, health insurance navigator Julia Buckner spends hours driving around what she calls 'God's Country' — miles and miles of mountains, rivers and winding roads. Her job - and her passion - is to help the rural residents of some of the poorest counties in North Carolina sign up for coverage through the Affordable Care Act (Gold, 1/22).

The Associated Press: Idaho Exchange Officials Don’t Know If 20,000 People Who Signed Up For Obamacare Were Previously Uninsured
Idaho insurance exchange officials don’t know if the 20,000 people signed up for coverage effective Jan. 1 hail from the ranks of the uninsured, or if they previously had coverage but switched to exchange policies because they’re now eligible for financial assistance. Your Health Idaho board chairman Stephen Weeg and director Amy Dowd gave their first report to the Idaho Legislature on Tuesday (1/22).

Minnesota Public Radio: Independent Report Slams MNsure Leaders, Says State Should Consider Scrapping System
An independent consultant has issued a damning report of the state's troubled online insurance marketplace. MNsure's management structure is "non-existent" according to Optum, a subsidiary of Minnetonka-based UnitedHealth Group, which recently performed a week-long analysis of the more than $100 million website. MNsure executives have been making decisions in a "crisis mode," the report states (Richert and Stawicki, 1/22).

Pioneer Press: MNsure Won’t Meet Goals, Report Says, And Revamp On Table
While limping along in the short-run with its troubled website, MNsure must quickly pick a strategy for making long-term software fixes and get beyond the recent "crisis mode" that has dominated program management, according to a consultant's report released Wednesday. Some improvements can be made in the coming weeks, but the website can't be completely fixed by the March 31 deadline for people to obtain health insurance, according to a report from Optum, a unit of Minnetonka-based UnitedHealth Group (Snowbeck, 1/22).

MinnPost: Few Quick Fixes For MNsure Problems, Optum Report Finds
Optum’s “end-to-end” review of MNsure concludes that there are few quick fixes to many of the stubborn technical issues plaguing the exchange. That finding will translate into continued problems for the exchange and for consumers (Nord, 1/22).

The Star Tribune: Optum: MNsure Managed By 'Crisis Mode,' IT System In Disarray
Minnesota’s new insurance exchange is beset with severe problems that include IT systems in disarray, a woefully understaffed call center and management that can’t get out of “crisis mode,” according to consultants hired to examine MNsure. The software underlying the insurance marketplace might be so badly flawed that MNsure should scrap parts of it, the Wednesday report concluded. The consultants, from UnitedHealth Group’s Optum division, also pointed out significant issues in how MNsure has been managed (Crosby, 1/23).

Health News Colorado: Sign-Ups For Private Insurance Top 63,000 As Exchange Faces State Audit
A state audit of Colorado’s health exchange has begun and managers say they expect it will show a clean financial bill of health. “We’ve already gotten our first communications from them (state auditors),” said Patty Fontneau, CEO and executive director for Connect for Health Colorado. She said auditors have requested 16 items (McCrimmon, 1/22).

The Milwaukee Journal Sentinel: Health Systems, Others Help People Sign Up For Insurance On Marketplace
Froedtert Health and the Medical College of Wisconsin have trained 10 of their financial counselors to help people enroll in the health plans available through the federal marketplace. As of Friday, 25 people had signed up for coverage. The number — more than three months after the launch of the federal marketplace — suggests the work ahead in reaching people who may be eligible for federal subsidies to buy health insurance through the Affordable Care Act (Boulton, 1/22). 

This Story: Print | Link to | Top

Big Jump In Medicaid Signups Reported

More than 6.3 million people were found eligible for Medicaid and the Children's Health Insurance Program since October, but it is unclear how many are newly insured since recipients must re-enroll each year. Meanwhile, Health and Human Services Secretary Kathleen Sebelius urges mayors to push their states to expand the program. News outlets also look at developments in Virginia and Florida.

Politico: Big Jump Seen In Medicaid Signups
More than 6.3 million people have been determined eligible for Medicaid and Children’s Health Insurance Program coverage since the October start of open enrollment, the Obama administration announced Wednesday — but it’s still impossible to say how many are newly insured because of Obamacare. At least 2.3 million people were found eligible for Medicaid and CHIP in December alone, the same month that enrollment in private health plans also spiked sharply, according to the latest figures from the Centers for Medicare & Medicaid Services. These determinations include people who renewed coverage or were previously eligible for coverage but had not enrolled (Millman, 1/22).

Reuters: 6.3 Million Eligible For Medicaid Since Obamacare Launch: U.S. Agency
More than 6.3 million Americans were deemed eligible for government healthcare plans for the poor since the October 1 launch of President Barack Obama's healthcare law through December, federal officials reported on Wednesday. The swelling rolls for Medicaid and the Children's Health Insurance Program (CHIP) reflect both an expansion of Medicaid under Obama's Affordable Care Act (ACA) and what healthcare policy analysts call an "out-of-the-woodwork effect," in which people who heard about Obamacare sought to obtain health insurance and discovered that they had qualified for Medicaid even before the law expanded eligibility (1/22).

CQ HealthBeat: Medicaid Eligibility Determinations From State Agencies Up In December
Almost 2.3 million people were determined eligible for Medicaid or the Children’s Health Insurance Program in December, in addition to the 1.7 million people in November. The report does not say how many of these people were eligible under Medicaid rules that go back years and how many benefit from new rules expanding eligibility under the health care law to more adults (Adams, 1/22).

The Hill: Sebelius To Mayors: Urge Your States To Accept Medicaid Expansion
Health and Human Services (HHS) Secretary Kathleen Sebelius urged U.S. mayors on Wednesday to push their state legislatures to expand Medicaid under ObamaCare. Speaking to a room of about 25 mayors at the Winter Meeting of the U.S. Conference of Mayors, Sebelius said those in attendance were “the pragmatic CEOs” that could help tip the balance in states that have so far refused to expand Medicaid under the Affordable Care Act by making their community's case for expanded coverage to state legislators (Easley, 1/22).

The Washington Post: Medicaid Expansion In Va. Gets A Boost
Democratic Gov. Terry McAuliffe’s key priority this year, expanding Medicaid in Virginia under the Affordable Care Act, got a boost Wednesday with a new estimate showing that the program would save far more money than previously thought. The expansion, along with other savings expected under the federal health-care law, is now expected to save Virginia more than $1 billion through 2022, according to William A. Hazel Jr., Virginia’s secretary of health and human resources. Previously, the new programs were projected to cost the state $137 million over that period (Weiner, 1/22).

The Associated Press/Washington Post: Revised Estimate Shows Lower Medicaid Costs
Democratic Gov. Terry McAuliffe’s administration says the state would save money instead of spending it by implementing the new federal health care law. The administration told lawmakers Wednesday that a 2012 estimate, which predicted the cost of the implementing the new law through 2022 would be $137 million, was now incorrect (1/22).

The Richmond Times-Dispatch: Va. Now Projects Medicaid Savings Of $1 Billion Through 2022
Expanding Virginia’s Medicaid program to about 250,000 uninsured Virginians initially would produce savings of $1 billion through 2022, according to new estimates produced by the state Medicaid office. The estimate represents a swing of more than $1 billion from a Medicaid analysis a year ago, when state health officials estimated a net cost to the state of $137.5 million over the nine-year period. In 2010, the estimated cost of expansion to the state exceeded $2.1 billion over 10 years. The new numbers were presented to Gov. Terry McAuliffe on Tuesday and to key legislators, including the chairmen of the House Appropriations and Senate Finance committees, on Wednesday (Martz, 1/23).

The Associated Press: Decision Not To Expand Medicaid Could Cost Florida Businesses $253 Million
The decision by state lawmakers not to expand Medicaid could cost Florida businesses as much as $253 million a year in tax penalties, according to a new report released Wednesday. Companies with 50 or more employees face Internal Revenue Service penalties if workers get subsidized health insurance through the new exchange under the Affordable Care Act. But they don't face a tax penalty if workers get subsidized coverage through Medicaid (1/22).

This Story: Print | Link to | Top

Target To Drop Part-Time Workers' Health Policies, Join Other Companies Changing Benefits After ACA Rollout

Experts predict that more employers with large numbers of part-time workers will follow as they attempt to keep costs low.

Los Angeles Times: Target To Drop Health Policies For Part-Time Workers
Target Corp. became the latest major company to say it will stop offering healthcare coverage for part-time workers, and experts said it won't be the last. … Target joins a growing list of retailers and restaurants that are making changes to their health benefits as the rollout of President Obama's healthcare law continues. Home Depot Inc. in September said it would drop coverage for part-time workers in January, a change that would affect roughly 5% of its workforce. Walgreens Co. switched its more than 160,000 employees to employer-sponsored coverage through a private health exchange. Experts predict more employers in industries with large numbers of part-time workers will make similar decisions to keep costs low (Lopez and Hsu, 1/22).

The Washington Post: Target Is Dropping Insurance For Some Because Of Obamacare. That Could Be Good News For Workers. 
Target made a very big announcement this week ---one that, for the first time in a while, had nothing to do with credit card breaches. The Fortune 500 company said Tuesday that it would stop providing health-care benefits to its part-time workers, instead directing them to purchase coverage through the health law's exchange. This adds Target to a growing list of companies that have dropped health benefits for part-time workers --including Home Depot and Trader Joe's -- pointing a finger squarely at Obamacare. Like companies before it, Target has framed the change, which begins April 1, as not so bad for employees, arguing that the decision could instead prove advantageous (Kliff, 1/22).

The Fiscal Times: More Companies Dump Employee Insurance For Obamacare
This week, another major U.S. retailer—Target—announced that it will be cutting health coverage for its part-time workers in response to changes stemming from the president’s health care law. The Minneapolis-based company now joins the likes of Home Depot and Trader Joes, among others, that have decided to dump part-time employee coverage to save on health care costs. “Health-care reform is transforming the benefits landscape and affecting how all employers, including Target, administer health benefits coverage,” Jodee Kozlak, Target’s executive vice president of human resources, said in a post on the company’s website (Ehley, 1/23).

This Story: Print | Link to | Top

Checking The Facts: Policy Cancellations And Healthcare.gov Enrollment

The Washington Post examines the landmines associated with these statistics. Meanwhile, Bloomberg reports on a new lawsuit in which a man claims Humana raised his premiums and then refused to honor his request to cancel the policy.  

The Washington Post’s The Fact Checker: The Phony Ratio Comparing Insurance Cancellations To Health Plans On Healthcare.gov
Caitlin Dunn, a spokeswoman for [Sen. Rob] Portman, immediately fessed up and said the senator had made a mistake. "Senator Portman knew the updated numbers (2.2 million sign ups versus about 5 million cancellations), but misspoke given that the ratio had previously been 10-20:1 when the process began," she said. "We don’t have any alternate data." We do not play gotcha when politicians explain that they made a mistake, especially if they had been speaking on live television. But Portman's error points out a fallacy of even trying to cite such a statistic (Kessler, 1/23).

Bloomberg: Humana Sued By Man Claiming It Wouldn't Cancel Policy
Humana Inc. (HUM) was sued by a Missouri man who claimed the insurer raised premiums for him and other customers and then failed to respond to requests to cancel policies, allegedly to increase revenue under the Affordable Care Act in what may be the first such lawsuit (Gullo and Rosenblatt, 1/23).

Also in the news, risks ahead for hospitals -  

St. Louis Post-Dispatch: Hospitals See Risk Of Newly Insured
The vast majority of people shopping on the new health insurance marketplace are selecting lower-tier plans, leaving them vulnerable to more costs than they may be expecting. Yet the risk won't be carried solely by consumers. Some worry that hospitals will be stuck with the bills because of high deductibles and cost-sharing (Kulash, 1/23).

This Story: Print | Link to | Top

Administration News

Looking Ahead: The President's State Of The Union Address Talking Points

The Washington Post: Obama's 7 State Of The Union Talking Points. No. 1: Defending Obamacare
When President Obama brings up health care during his State of the Union address on Jan. 28, he will make one issue clear (yet) again: He will defend the Affordable Care Act against any and all political attacks this year. Unlike some other initiatives such as immigration, Obama will not ask Congress for anything, focusing instead on the law's ongoing implementation as the top priority. While the Oct. 1 botched rollout of Healthcare.gov represented a significant blow to both the White House and Democrats more broadly (especially those on the ballot this November), the high-profile speech gives Obama the chance to tout the law's benefits and shore up the political fortunes of the men and women who backed it (Eilperin, 1/22).

This Story: Print | Link to | Top

Health Care Marketplace

Aetna CEO: Americans Have 'Unsustainable Attitude' About Increasing Health Care Costs

Bloomberg: Aetna CEO Says Out-Of-Control Health Costs Demand Change In U.S.
Medical expenses remain out of control in the U.S., where Americans have an “unsustainable attitude” that ignores the increasing cost of health care, the chief executive officer of insurer Aetna Inc. (AET) said. While the rise in medical costs has slowed since the last recession, the U.S. still needs to switch to a “fundamentally different” system that pays for the quality of care rather than the quantity, Mark Bertolini said in a Bloomberg Television interview from Davos, Switzerland (Nussbaum, 1/22).

This Story: Print | Link to | Top

Women's Health

Abortion Opponents Mark Roe V. Wade Anniversary With D.C. Protest

The annual March for Life rally was held amidst frigid temperatures on the National Mall, marking the decision's 41st anniversary.

The New York Times: Abortion Opponents March In Washington On Anniversary Of Roe V. Wade Decision
Thousands of abortion opponents descended on Washington for the annual March for Life rally on Wednesday on the 41st anniversary of the decision in Roe v. Wade, the landmark Supreme Court case that legalized abortion. Despite wind chills in the single digits and crunchy snow underfoot, a crowd spanning several blocks huddled on the National Mall to hear speakers such as Representative Eric Cantor of Virginia, the Republican House majority leader, before marching past the Capitol to the Supreme Court (Southall, 1/22).

The Washington Post: Thousands Brave Cold For Abortion Protest In DC
Thousands of abortion opponents confronted wind chills in the single digits Wednesday to rally and march on Capitol Hill to protest legalized abortion, with a signal of support from Pope Francis. The annual “March for Life” is held every January on the anniversary of the Supreme Court’s landmark 1973 decision that declared a constitutional right to abortion. The event draws many Catholic high school and college students from across the country for a series of events and prayer vigils that led up to a rally and march on the snow-covered National Mall (1/22).

This Story: Print | Link to | Top

State Watch

State Highlights: Minn. Improves Hospital Safety

A selection of health policy news from Minnesota, Georgia, Kansas, Ohio, Pennsylvania, Maryland, Iowa and Virginia.

Pioneer Press: Minnesota: Hospitals Make Some Gains Reducing ‘Adverse Events’
State officials and hospital leaders in Minnesota are claiming success in a 10-year effort to reduce bed sores, medication errors and more than two dozen other adverse events that can harm patients as they're being treated in medical centers. The number of deaths and disabilities that can be linked to the adverse events -- which include everything from burns and device malfunctions to operations on the wrong body part -- continue to trend downward, according to reports being released Thursday by the Minnesota Department of Health (Snowbeck, 1/23).

Minnesota Public Radio: Patient Hospital Safety Improves, But Falls Remain A Problem
The number of deaths and harmful events linked to preventable hospital errors has largely declined in the past decade, according to a new report from the Minnesota Department of Health. Department officials, who have tracked so-called "adverse health events" since 2003, called the trend encouraging. Still, the pace of progress has been slower than many health care leaders would like (Benson, 1/23).

The Star Tribune: Hospitals Report Fewer Preventable Mistakes
Efforts to eliminate preventable hospital errors in Minnesota have taken on the appearance of the old arcade game Whac-A-Mole. Just as the state’s hospitals reduce deaths or disabilities attributed to one type of mistake, another pops up. In the latest adverse-event report, released Thursday, Minnesota’s hospitals showed substantial progress in reducing the number of painful and disabling pressure ulcers that patients suffer because of immobility in hospital beds. They also reduced the number of surgical errors such as procedures on the wrong body part. But increases in patient deaths or disabilities because of falls or medication errors countered the progress in other areas (Olson, 1/23).

The Associated Press: Pennsylvania Gets 2015 Extension On CHIP-to-Medicaid Switch
About 30,000 low-income families whose kids are covered by Pennsylvania’s health insurance program for children have until 2015 to switch them to Medicaid, Gov. Tom Corbett’s administration said Wednesday. The deadline for states had been 2014, but Corbett’s office said the extra time for Pennsylvania families to switch their children from the Children’s Health Insurance Program was allowed by the federal government (Levy, 1/22).

The Associated Press: Defending Kansas Abortion Laws Top $1M
Kansas has paid private law firms slightly more than $1 million to defend anti-abortion laws enacted during the past three years, the attorney general's office confirmed Wednesday. Kansas has enacted a raft of new restrictions since Republican Gov. Sam Brownback, a strong abortion opponent, took office in January 2011. Abortion providers have responded with multiple federal and state lawsuits (Hanna, 1/22).

The Associated Press: Ohio Dems’ 2014 Ticket To Highlight Women’s Health
Ohio Democrats seeking statewide office this fall on Wednesday coupled criticism of Republican-backed abortion restrictions with a pledge to make women's health issues a priority in the 2014 campaign. The party's full 2014 slate appeared together for the first time to accept endorsements from Planned Parenthood (Smyth, 1/22).

Georgia Health News: Rise Of The ACO: Emory, Blue Cross Team Up 
A partnership of health care heavyweights was created Wednesday as Emory Healthcare and Blue Cross and Blue Shield of Georgia announced a collaboration to improve quality and contain costs. The two entities will form an “accountable care organization” that will seek to enhance the care experienced by patients in the Atlanta region. ACOs are networks of hospitals and doctors -- and sometimes insurers -- that arose as a central feature of the federal health reform law of 2010, also known as the Affordable Care Act (Miller, 1/22).

The Baltimore Sun: Health Disparities Costing Black, Hispanic Men, Study Says
Black and Hispanic men are shouldering more medical costs because of health inequalities and they, their families and society are suffering from the burden, according to a new study from Johns Hopkins University's Bloomberg School of Public Health. Health disparities among African American men and Hispanic men cost the economy more than $450 billion between 2006 and 2009, the study found. Black men incurred about three quarters of the costs (1/22).

Des Moines Register: Wellmark Adds Physicians Groups To Cost-Effective Care Pacts
Iowa’s largest health insurer has started signing up large doctors groups to a new kind of contract that will reward them for providing cost-effective care. Wellmark Blue Cross and Blue Shield has signed Accountable Care Organization contracts this month with the Iowa Clinic, based in West Des Moines, the McFarland Clinic of Ames and Family Health Care of Siouxland, based in the Sioux City area (Leys, 1/22).

The Richmond Times-Dispatch: Mental-Health Proposal Would Allow 24-Hour Detention For Evaluation
Legislation to allow people to be held involuntarily for up to 24 hours for emergency psychiatric evaluation is on its way to a Senate committee over the objections of Virginia sheriffs. The legislation, sponsored by Sen. R. Creigh Deeds, D-Bath, also would mandate creation of a Web-based psychiatric bed registry and require the state to intervene if local emergency workers are unable to find appropriate beds for people who pose a danger to themselves or others. A Senate Education and Health subcommittee voted 3-2 on Wednesday to endorse the measure, which incorporates legislation sponsored by four other senators to improve the state’s system of responding to mental health crises (Martz, 1/23).

This Story: Print | Link to | Top

Weekend Reading

Longer Looks: Leaving Antidepressants; The Lack Of Tech-Savvy Doctors

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

The Atlantic: Why Aren't Doctors More Tech-Savvy
Whenever I feel like taking a trip back in time, I save myself the trouble of building a time machine and instead just head over to a doctor's office. For a Millennial, or really anyone who lives a modern lifestyle, getting medical care is a rare departure from an otherwise technology-fueled existence. … Few of my doctors use email to communicate with patients, so medication refills, questions about side-effects, or reminders about appointments all require elaborate phone tag. This hassle is exacerbated by the fact that healthcare is one of the few consumer-focused industries where being a few minutes late is a sin so grave that it’s punished with a total cancellation of the appointment, and sometimes even the forfeiture of the fee (Olga Khazan, 1/21).

Medscape: Atul Gawande On The Secrets Of A Puzzle-Filled Career
Atul Gawande, MD, MPH, wears many hats, including that of a surgeon, researcher, journalist, and author. In this segment of Medscape One-on-One, Dr. Gawande talks with Eric J. Topol, MD, about what inspires him, his plans for the future, and why he's secretly a frustrated rock singer (Dr. Eric J. Topol and Dr. Atul Gawande, 12/6).

KevinMD: Balancing The Physician Work Force: It Takes More Than Money
Here we go again. There is yet another round of evidence of how the physician workforce hole we've dug for ourselves keeps getting deeper, but there has been still no substantive payment reform on the government side (Medicare/Medicaid) or the private payer side. … No, money is not the complete solution to balance the U.S. physician workforce. However (and I'm not making this up), when I worked with administrators at CMS (Center for Medicare and Medicaid Services) during my innovation advisor year, a high-placed official actually and seriously asked me, "Do you think if primary care physicians were paid more that more medical students would choose primary care?" It took all of my limited self-control to not laugh, scream, or cry (Dr. Richard Young, 1/20).

The New Yorker: The Prisoner Of Stress
People don't ordinarily self-medicate by writing a book, but "My Age of Anxiety" (Knopf) is an attempt at recovery by a man whom modern psychiatry has failed. The man is Scott Stossel, a successful journalist (he is currently the editor of The Atlantic), now in his forties, who has suffered all his life from an acute anxiety disorder. … The idea that anxiety is central to the human condition can also mean that our mental life is characterized by psychic conflict, and anxiety is the symptom of that conflict. This is, roughly, the psychoanalytic view. ... The notion that disorders such as anxiety and depression are caused by stuff out there in the environment, that they are like the diseases we catch from germs and viruses and are not symptoms of internal conflicts, was important to the success of an industry that was poised to take off: Big Pharma (Louis Menand, 1/27).

Al Jazeera: Waking Up From Sadness: Many Find Trouble Getting Off Antidepressants
While getting onto antidepressants is as simple as getting an increasingly common prescription and popping a pill, weaning off the drugs can seem insurmountable, if not impossible ... “People can get started on the drugs for anxiety, obesity, menopause. You see people prescribe the drugs for anything under the sun,” said Dr. Peter Breggin, an expert in psychiatric withdrawal with a private psychiatry practice in Ithaca, N.Y. “I think they’re among the most difficult drugs to come off — harder to come off than alcohol and opiates.” ... Experts disagree about the solution to what appears to be the overprescription of antidepressants to women at the primary-care level (Rebecca White, 1/22).

This Story: Print | Link to | Top

Editorials and Opinions

Viewpoints: Target Has The Right Idea For Part-Timers; Health Law 'Beyond Rescue;' Fighting Back To Secure The Right To Abortion

Los Angeles Times: Is Target Right To Send Its Part-Timers To Obamacare? Probably.
The big noise on the health insurance front today was sounded by Target, which announced via a corporate blog that it's ending health insurance for its part-time workers. Instead of signing up for a company plan, they're encouraged to use the health care exchanges set up through the Affordable Care Act. ... Target is suggesting that most of the affected workers will do better under the exchange system than they were with company-sponsored insurance. Target is probably right (Michael Hiltzik, 1/22). 

The Washington Post: Obamacare's Contingency Plan Isn't A Bailout
It was unrealistic to expect the system to work flawlessly immediately upon implementation. In fact, the law’s authors anticipated that and put safeguards in place. One spreads risk among insurance companies by transferring money from those that see relatively low claims costs to those that see relatively high costs. Another helps pay very high medical bills from individual patients. ... Critics, though, are describing the possibility that these stabilizers will have to kick in as a bailout. Some have even called to repeal them. ... Spreading risk is insurance, not a bailout. Smart contingency planning is not a bailout (1/22). 

Bloomberg: Do Conservatives Want To Bail Out Obamacare?
In my Bloomberg View column this week, I argued that Republicans should work to pass a law to prevent the abuse of Obamacare’s "risk corridors." Designed properly, risk corridors can be a useful way to spread risk among the insurers who participate in an exchange: The ones who have relatively healthy customers, and thus profits, can subsidize the ones with relatively sick customers, and losses. If almost all the participants are losing money, though, the exchange as a whole isn’t working, and taxpayers generally shouldn’t have to cover the insurers' losses (Ramesh Ponnuru, 1/22).

The Wall Street Journal: Obamacare's Missing Uninsured
The Affordable Care Act would right a great social wrong. Or so we were told. But reality is again intruding on the Obama administration's narrative. This newspaper reported Saturday that between 65 percent and 80 percent of those who have signed up for health insurance through the federal or state Obamacare exchanges previously had coverage, according to insurers. A survey by McKinsey & Co. suggested that only 11 percent of those who purchased plans through the exchanges were previously uninsured (Karl Rove, 1/22). 

Bloomberg: Resolved: Obamacare Is Now Beyond Rescue
In a nutshell, Obamacare has so far fallen dramatically short of what was expected -- technically, and in almost every other way. Enrollment is below expectations: According to the data we have so far, more than half of the much-touted Medicaid expansion came from people who were already eligible before the health-care law passed, and this weekend, the Wall Street Journal reported that the overwhelming majority of people buying insurance through the exchanges seem to be folks who already had insurance. Coverage is less generous than many people expected, with narrower provider networks and higher deductibles. The promised $2,500 that the average family was told they could save on premiums has predictably failed to materialize. And of course, we now know that if you like your doctor and plan, there is no reason to think you can keep them. Which is one reason the law has not gotten any more popular since it passed (Megan McArdle, 1/21).

The New York Times: The Luck Of The Pontiff
The president's visit, which is scheduled for March, comes at an interesting intersection in the two men's careers. Pope Francis can currently do no wrong, and Barack Obama can do no right. Recently, his administration decided to move its Vatican Embassy into a more secure building, and the outcry was so intense that you'd think Obama had ordered a re-creation of the Sack of Rome. "A slap in the face to the 78 million Catholics in the United States," one congressman screeched. "Why would our president close our Embassy to the Vatican?" twittered Jeb Bush. "Hopefully, it is not retribution for Catholic organizations opposing Obamacare." As political tweets go, this is a keeper on two counts. First, we can once again marvel at Republican politicians' ability to insert the Affordable Care Act into everything (Gail Collins, 1/22).

The New York Times: The First Amendment Protects Abortion Providers, Too
On Friday a district court judge in North Carolina issued a ruling that blocked the state's ultrasound law from going into effect -- a move worth celebrating on the 41st anniversary of Roe v. Wade, and at a time when Republican-led states are rushing to enact aggressive new abortion restrictions. Enacted in 2011 over the veto of then-Gov. Beverly Perdue, a Democrat, and similar to other restrictions lately enacted around the country, this atrocious provision sought to force women seeking an abortion to undergo a "narrated" ultrasound. Judge Catherine Eagles said that the law, which requires abortion-providers to display the ultrasound while describing the images in detail, violates the physician's free speech rights (Dorothy J. Samuels, 1/22). 

Politico: 2014: The Year The Pro-Choice Crowd Fights Back
Sure, 2013 was not a great year for reproductive freedom -- 53 anti-choice measures were adopted at the state level, and we narrowly averted a federal government shutdown when House Republicans demanded that bosses have control over their employees' birth control coverage (though we later had a shutdown, anyway). But 2013 also showed record-high public support for the rights enshrined in Roe v. Wade: Twice as many pro-choice measures as the prior year were enacted at the state level, and voters turned out to vote into office a pro-choice governor in Virginia and soundly defeat the first municipal ballot measure to ban abortion after 20 weeks. In 2013, we saw a movement starting to embody the old adage that the best defense is a good offense (Ilyse Hogue, 1/21).

The Washington Post: Antiabortion Movement Faces A Cold Reality
James Dobson's Focus on the Family asked Christians to pray for rain to fall on Barack Obama in 2008 when he accepted the presidential nomination. Various religious conservatives have said that hurricanes, earthquakes and other meteorological phenomena were divine punishment of wayward humans. So what are we to make of Wednesday’s March for Life on the Mall in Washington? The temperature was 12 degrees at the start of the annual antiabortion event, the wind chill below zero, and participants were trudging about in snow and ice from the previous day's storm (Dana Milbank, 1/22). 

JAMA: The Public Health Challenge Of Drug Overdose
The surge in prescription opioid overdoses is a leading national public health crisis, says the U.S. Centers for Disease Control and Prevention, one with a toll of more than 15 000 deaths in the United States each year. Since 1999, deaths from overdose of prescription opioids have increased 4-fold among US women and by 265 percent among US men. As in the fable of the blind men and an elephant, there are many different ways to look at this epidemic -- and just as many ideas on how to address it (Dr. Joshua Sharfstein, 1/22).

The New England Journal of Medicine: Choosing Wisely -- The Politics and Economics Of Labeling Low-Value Services
With its Choosing Wisely campaign, the American Board of Internal Medicine (ABIM) Foundation boldly invited professional societies to own their role as "stewards of finite health care resources." ... On the surface, the creation of low-value–service lists suggests that physicians are willing to make recommendations to improve health care value even against their own financial interests. The services included on the lists, however, vary widely in terms of their potential impact on care and spending. ... Strikingly, no major procedures -- the source of orthopedic surgeons' revenue -- appear on the list, though documented wide variation in elective knee replacement and arthroscopy among Medicare beneficiaries suggests that some surgeries might have been appropriate for inclusion. Other societies' lists similarly include low-impact items (Dr. Nancy E. Morden, Carrie H. Colla, Dr. Thomas D. Sequist and Meredith B. Rosenthal, 1/22).

This Story: Print | Link to | Top

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.