Daily Health Policy Report

Friday, January 24, 2014

Last updated: Fri, Jan 24

KHN Original Reporting & Guest Opinion

Health Reform

Health Care Marketplace


Administration News

Women's Health

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Capsules: An Obamacare Report Card

Now on Kaiser Health News' blog, Jenny Gold was on Boston's WBUR's On Point Thursday to talk about the latest developments with the health law — how many people have signed up and what they’re encountering in the process (1/24). Listen to audio of the conversation below or download it here or check out what else is on the blog.

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Philadelphia-Area Blues Struggle To Match Customer Service To Demand

The Philadelphia Inquirer’s Robert Calandra and Stacey Burling, working in partnership with Kaiser Health News, report: "Paige Wolf has been buying health insurance from Independence Blue Cross for years. So when the self-employed public relations professional learned that she could buy a top-of-the-line platinum plan for less than her old policy, she was ecstatic. But her good fortune turned to frustration when the Center City woman didn't receive an invoice for her new plan. She went on Independence's Facebook page to vent. Then she received an e-mail scan of an overdue notice for her January bill, with her doctor's address on it, not hers" (Calandra and Burling, 1/24). Read the story.

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Political Cartoon: 'Friends With Benefits?'

Kaiser Health News provides a fresh take on health policy developments with "Friends With Benefits?" by Mike Lester.

And here's today's health policy haiku:


Huckabee brought it
up… now everyone's asking:
Who's Uncle Sugar?

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

Judge Bars Missouri's Limits On Health Law Navigators

A federal district judge ruled Thursday that Missouri officials were illegally obstructing the activities of insurance guides funded by the federal government to help consumers enroll in coverage under the health law. More than a dozen Republican-led states have imposed additional requirements on the guides, also known as navigators.

The New York Times: Missouri Obstructing Health Law, Judge Rules
A federal district judge declared Thursday that the State of Missouri was illegally obstructing the activities of insurance counselors appointed by the federal government to inform consumers of their options under the Affordable Care Act (Pear, 1/23).

The Wall Street Journal: Court Says Missouri Can't Block Health-Law Helpers
A federal court has temporarily blocked Missouri officials from restricting organizations in the state from helping people sign up for health insurance as part of the federal health-overhaul law. The U.S. District Court for the Western District of Missouri granted an injunction Thursday blocking the Missouri insurance department from enforcing a state law passed last year that limited the activities of people seeking to enroll the uninsured through new insurance exchanges (Radnofsky, 1/23).

Los Angeles Times: Obamacare Notches Legal Victory In Missouri
Supporters of President Obama’s health law scored a legal victory in Missouri on Thursday as a federal judge blocked the state from enforcing new rules limiting the ability of community organizations to help consumers sign up for coverage under the law. Missouri is among many Republican-leaning states that have put restrictions on these groups, including a requirement that they get licenses before they can help with the enrollment process. Proponents of the restrictions maintain that they protect consumers (Levey, 1/23).

The Associated Press/Washington Post: Judge Stops Mo. Law On Health Navigator Licensing
A federal judge granted a preliminary injunction Thursday against Missouri’s law requiring a state license to serve as a navigator to help consumers sign up for coverage through the new health insurance marketplace. U.S. District Judge Ortrie D. Smith’s ruling also denied the state’s motion to dismiss the lawsuit. It wasn’t clear if the state would appeal. Missouri attorney general’s office spokeswoman Nanci Gonder said in a written statement that the office was reviewing the ruling (1/23).

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Medicaid 'Death Debt' Causes Some To Step Away From Coverage

A little-known aspect of Medicaid allows states, in certain cases, to recoup medical costs by claiming deceased people's homes, which is causing some people to avoid coverage, even those who are newly eligible under the health law's expanded eligibility.  

The Washington Post: Little-Known Aspect Of Medicaid Now Causing People To Avoid Coverage
Add this to the scary but improbable things people are hearing could happen because of the new federal health-care law: After you die, the state could come after your house. The concern arises from a long-standing but little-known aspect of Medicaid, the state-federal program that provides health coverage to millions of low-income Americans. In certain cases, a state can recoup its medical costs by putting a claim on a deceased person’s assets. This is not an issue for people buying private coverage on online marketplaces. And experts say it is unlikely that the millions of people in more than two dozen states becoming eligible for Medicaid under the program’s expansion will be affected by this rule. But the fear that the government could one day seize their homes is deterring some people from signing up (Somashekhar, 1/23).

Fox News: ObamaCare Death Debt? States Can Seize Assets To Recoup Medicaid Costs
Tom Gialanella, 56, was shocked to find out he qualified for Medicaid under ObamaCare. The Bothell, Wash., resident had been able to retire early years ago, owns his home outright in a pricey Seattle suburb and is living off his investments. He wanted no part of the government's so-called free health care. "It's supposed to be a safety net program. It's not supposed to be for someone who has assets who can pay the bill," he said.  And after reading the fine print, Gialanella had another reason to flee Medicaid -- the potential death debt (Springer, 1/23).

Other implementation policy headlines include a Reuters report that some niche government plans will not face a 2014 penalty for not meeting the health law's essential benefits requirements, a Marketplace story detailing how rural health care options are limited and Politico Pro's report on the paths businesses see under Obamacare -  

Reuters: No Obamacare Penalty For Few In Some Niche Government Plans
The Obama administration on Thursday said people enrolled in some small, government-sponsored healthcare plans will not face a penalty under Obamacare in 2014, even though their coverage does not meet the healthcare reform law's minimum requirements. In proposed rules released by the Internal Revenue Service, the administration said narrowly defined government coverage including programs limited to family planning or tuberculosis-related services through Medicaid do not meet minimum essential coverage standards (1/23).

Marketplace: Rural Americans Have Fewer - And Costlier - Healthcare Options
When you think of the healthcare marketplace, you think of options and choices. But since the rollout of the Affordable Care Act, one thing's been clear: Options are not a given. Alabama is among a dozen or so states where every county has just one--or maybe two-- insurers. Experts are noticing a pattern: Folks in rural towns seem to have the fewest choices, and the costliest plans (Douban, 1/23).

Politico Pro: Like Target, Businesses Plotting Obamacare Paths
Target became the latest big company to follow the old drill: drop health coverage for some workers, blame Obamacare and watch Republicans pounce. Home Depot and Trader Joe’s made similar changes to their health plans last year, and UPS limited coverage for spouses. Each time, it drew ugly headlines for the health care law. While each situation was a little different, the initial conclusion that Obamacare was leaving consumers worse off starts to gets squishy when the details are unpacked. But an impression was created (Nather and Cunningham, 1/23).

Also in the news -  

Fox News:  Fox News Poll: ObamaCare Support Hits Record Low
A record high number of voters now oppose the 2010 Affordable Care Act and a record low number supports it, according to the latest Fox News poll. In addition, a majority thinks the new law will increase their health care costs, while few think it will improve their quality of care. The new poll finds 59 percent of voters oppose the health care law, up from 55 percent who opposed it six months ago (June 2013).  The increase in opposition comes from both independents and Democrats (Blanton, 1/23).

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Mayors Also Have A Stake In The Medicaid Expansion's 'Promise And Pitfalls'

This health law topic is high on the agenda of this week's U.S. Conference of Mayors meeting in Washington. Meanwhile, Utah's Gov. Gary Herbert said he will pursue some form of the expansion. Also in the news, related developments in Montana and Missouri.   

Marketplace: The Promise And Pitfalls Of Expanded Medicaid
The U.S. Conference of Mayors is meeting this week in Washington, and among the many things on the agenda is the rollout of Obamacare. Under the Affordable Care Act, many states have made it easier to get Medicaid, a move that will affect cities, experts say. "It kind of casts a wider net of eligibility," says Tom Carroll, a healthcare services analyst with Stifel Nicolaus. And that has boosted enrollment. One in five Americans is enrolled in Medicaid (Gura, 1/23).

The Associated Press: 'Nothing' Not An Option For Utah On Medicaid, Gov. Says
Utah will pursue ... some form of Medicaid expansion, but specifics on the decision will be announced at a later date, Gov. Gary Herbert said Thursday. Herbert announced at his monthly televised news conference on Thursday that "doing nothing" to expand the program was off the table (1/23).

Salt Lake Tribune: Utah Guv: Medicaid Will Expand
Utah will expand Medicaid to cover more of the state's uninsured, Gov. Gary Herbert said Thursday. "Doing nothing ... I’ve taken off the table. Doing nothing is not an option," the Republican governor said at his monthly news conference ... Herbert did not indicate which of two expansion strategies endorsed by a legislative Health Reform Task Force he prefers — or whether he has another in mind. He said he will make his decision during the legislative session that begins next week (Stewart and Gehrke, 1/23).

The Missoulian: Medicaid Expansion Backers Resubmit Initiative To Address Legal Snag
Backers of a proposed 2014 voter initiative to expand Medicaid coverage to at least 70,000 low-income Montanans have hit another delay, after Attorney General Tim Fox this week noted a legal problem with the measure. Fox's warning about problems with the initiative's effective date prompted backers to resubmit a new version late Wednesday, delaying for another few weeks their efforts to get the initiative on the 2014 November ballot (Dennison, 1/23).

The Associated Press: Advocates Resubmit Medicaid Expansion Proposal
The new version of the [Montana] proposal is under review by the Legislative Services Division, Secretary of State spokeswoman Terri McCoy said. When that is completed, it goes to Fox, who has 30 days to conduct a legal review. That will leave initiative backers with a shortened timeline to gather signatures, which are due June 20. The backers must gather 24,175 signatures, which is 5 percent of the voters in the state (Volz, 1/23).

The Kansas City Star: Push To Expand Medicaid Gains An Ally In Kit Bond
Proponents of expanding Medicaid in Missouri just landed an influential — and unlikely — new ally. Republican and former U.S. Sen. Kit Bond has been hired as a lobbyist by the Missouri Chamber of Commerce and Industry. ... He's also been an outspoken critic of the federal health insurance law. During a 2010 interview with the conservative magazine Newsmax, Bond said the financial burden on state budgets of expanding Medicaid would be "horrific" (Hancock, 1/23).

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Covered California Gets Federal Grant To Improve Customer Service, Boost Enrollment

Also in the news, reports about state exchange challenges and difficulties in Nevada, Texas, Maryland, Hawaii and Minnesota.  

Los Angeles Times: Covered California Gets Federal Money To Improve Service, Enrollment
California's health exchange said it would use an additional $155 million in federal grant money to address customer service woes and to boost low enrollment among the key market of uninsured Latinos. The Covered California exchange announced the injection of money from the Obama administration Thursday as it faced growing criticism for dismal service and a disappointing sign-up rate among Latinos (Terhune, 1/23).

The Associated Press: Calif. Health Exchange Criticized For Sign-Ups
After celebrating its enrollment numbers earlier this week, California's health-insurance exchange came under heavy criticism Thursday for its lackluster efforts to sign up Latinos and for continued paperwork problems that have left untold numbers of consumers in limbo. Members of Covered California's board of directors also questioned some of the exchange's spending priorities (Verdin, 1/23).

The Associated Press: Nevada Health Exchange Glitch Delays Insurance Cards
One month since enrolling, (Gary) Smith is one of several Nevadans who were unable to get insurance cards in January despite paying through the Nevada Health Link insurance exchange website. The program — which blamed a glitch for Smith’s problems — could not provide an exact number of how many Nevadans were affected, only saying that it affected “a small group of people” (1/23).

NPR: Texas Issues Tough Rules For Insurance Navigators
Texas has imposed strict new regulations on the insurance helpers, or navigators, who work in the community to enroll people in health plans under the Affordable Care Act. The navigators must register with the state, undergo a background check and fingerprinting, and complete 20 hours of additional training — beyond the 20 to 30 hours of federal training they've already received (Feibel, 1/23).

The Associated Press/Washington Post: O’Malley Calls For Minimum Wage Hike In Speech
Maryland Gov. Martin O’Malley used his final State of the State speech on Thursday to urge lawmakers to raise the state’s minimum wage and to assure residents his administration would keep working on the troubled health care exchange. … However, the governor noted ongoing problems with the health care exchange. The troubled rollout has been frustrating for state officials who aspired to make Maryland a model for health care reform implementation. O’Malley described the glitch-ridden exchange website as “a source of great frustration, especially for those Marylanders who were looking forward to obtaining health care for the very first time in their lives” (1/23).

The Associated Press: House Bills Aim To Fix Hawaii’s Health Care Exchange; 1 Would Make Exchange A State Entity
Leaders of two key committees in the Hawaii House on Thursday introduced a package of bills to help fix the state's troubled health care exchange. One measure would make the Hawaii Health Connector a state entity, and another would change the composition of the exchange's board (McAvoy, 1/23).

Kaiser Health News: Capsules: An Obamacare Report Card
Kaiser Health News staff writer Jenny Gold was on Boston’s WBUR’s On Point Thursday to talk about the latest developments with the health law — how many people have signed up and what they’re encountering in the process (1/24).

MinnPost: MNsure Leaders Face Big Decisions, Bleak Projections
MNsure leaders now face some big — and expensive — decisions, after hearing a blunt assessment of the health exchange's continuing operational problems and bleak projections about its enrollment and finances. The biggest decision: whether to stick with making small step-by-step improvements, or blow up the whole thing and start over (Nord, 1/23).

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Health Care Marketplace

Moody's Downgrades Outlook For Health Insurers

The credit-rating firm downgraded the outlook for health insurers from stable to negative, citing the health law's troubled rollout. Meanwhile, Aetna CEO Mark Bertolini predicted that companies would soon spend billions on consumer advertising. And The New York Times explores allegations that Health Management Associates, a for-profit hospital chain based in Naples, Fla., pursued strategies to increase admissions, regardless of whether a patient needed hospital care.

The Washington Post: Moody's Downgrades Outlook For Health Insurers
Major credit-rating firm Moody’s on Thursday downgraded the outlook for health insurers from stable to negative, citing the new health-care law’s botched rollout as a significant factor. Moody’s highlighted the relatively low sign-up rate among young adults and a slew of last-minute regulatory changes by the Obama administration as posing risks to health insurers selling policies on the new exchanges (Kliff and Somashekhar, 1/23). 

The Fiscal Times: Moody's: Obamacare Uncertainty Hurting Health Insurer Outlook
Obamacare's rocky rollout is creating uncertainty for the insurance industry and rating agencies are taking note. Moody’s Investors Service on Thursday announced that it has changed its outlook on the entire sector from "stable" to "negative" due to uncertainty surrounding the president's health care law. "While we've had industry risks from regulatory changes on our radar for a while, the ongoing unstable and evolving environment is a key factor for our outlook change," Moody’s Senior Vice President Stephen Zaharuk said in a statement (Ehley, 1/23).

CQ HealthBeat: Health Insurer Outlook Downgraded By Moody's, Citing Exchange's Older Enrollees
Moody’s Investors Service announced Thursday that it has downgraded its outlook of the U.S. health insurance sector from stable to negative, pointing to aspects of the health care law’s implementation as "most challenging" to insurers' credit profile. In its report, the ratings agency said it's been following issues surrounding key pieces of the in the lead-up to 2014. But "the unstable and evolving regulatory environment under which the sector is operating" is new and a key reason for the shift, Moody's said, citing new regulations and announcements from the White House (Attias, 1/23).

The Wall Street Journal: Aetna CEO Predicts Surge In Marketing Spending Among Health Insurers
Aetna Inc. Chief Executive Mark Bertolini on Friday said that the evolution of the U.S. health-insurance market will soon push insurers to spend billions more on marketing to consumers. As more consumers begin to shop for their own health insurance via private and government-run exchanges, Mr. Bertolini said insurers will have little choice but to raise their budgets significantly to reach them. He said that he hoped to increase Aetna's marketing spend by five times in the years ahead (Berman, 1/24).

The New York Times: Hospital Chain Said To Scheme To Inflate Bills
Every day the scorecards went up, where they could be seen by all of the hospital’s emergency room doctors. Physicians hitting the target to admit at least half of the patients over 65 years old who entered the emergency department were color-coded green. The names of doctors who were close were yellow. Failing physicians were red. The scorecards, according to one whistle-blower lawsuit, were just one of the many ways that Health Management Associates, a for-profit hospital chain based in Naples, Fla., kept tabs on an internal strategy that regulators and others say was intended to increase admissions, regardless of whether a patient needed hospital care, and pressure the doctors who worked at the hospital (Creswell and Abelson, 1/23).

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GAO: Most Medicare Advantage Plans Meet Medical Expense Standard

The federal health law requires the plans to pay out at least 85 percent of their premium dollars on medical expenses, or refund the excess revenue to the government.

Modern Healthcare: Medicare Advantage Plans Spent 86.3% Of Revenue On Medical Expenses In 2011: GAO Report
A new report from the Government Accountability Office suggests that most Medicare Advantage carriers won't struggle to meet the 85% medical-loss ratio imposed on the private Medicare plans starting in 2014 under the Patient Protection and Affordable Care Act. If plans fail to spend enough money on medical costs, they'll be required to refund excess revenue to the federal government (Demko, 1/23).

And in other Medicare news, a look at why the government's announcement that it would release physician payment data is getting criticism -

ProPublica: Some Predictions On How Medicare Will Release Physician Payment Data
The federal government's announcement last week that it would begin releasing data on physician payments in the Medicare program seems to have ticked off both supporters and opponents of broader transparency in medicine. For their part, doctor groups are worried that the information to be released by the Centers for Medicare and Medicaid Services will lack context the public needs to understand it (Ornstein, 1/23).

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Administration News

White House Health Care Adviser To Leave His Post

White House coordinator for health reform Chris Jennings resigned after six months, citing personal reasons and family considerations.  

The Washington Post: Chris Jennings, White House Adviser On Health Care, Steps Down
Chris Jennings, the White House’s coordinator of health reform, has resigned six months after he was recruited to try to iron out the implementation of major aspects of the Affordable Care Act. Jennings said in an interview Thursday that he decided to leave after he landed in the hospital last month with a health scare after working the long, intense hours typical of senior White House aides (Goldstein and Eilperin, 1/23).

The Wall Street Journal’s Washington Wire: Chris Jennings Leaves White House Health Post
Mr. Jennings, a Clinton administration veteran who had been running his own health-policy consulting business, was tapped by the Obama administration in the summer to help with the rollout of the federal health law. He joined a team that had been headed by Jeanne Lambrew, a former public affairs and health policy professor (Radnofsky, 1/23).

Politico: Obama Health Care Adviser Chris Jennings Resigns
A senior health care adviser to President Barack Obama is departing the White House for personal reasons, an administration official said Thursday. Chris Jennings, a respected policy expert who also worked in the Clinton administration, has resigned “due to a recent health care scare and other serious family considerations,” the official said. The White House brought Jennings on board in July as part of a staff ramp-up ahead of the Oct. 1 rollout of HealthCare.gov, citing his deep understanding of the health policy, his knowledge of Capitol Hill and his ability to work across party lines. He served as a point of contact to the insurance industry (Brown, 1/23).

The Hill: Senior Healthcare Adviser Leaves Obama
Senior White House healthcare adviser Chris Jennings is departing the White House staff, an aide confirmed on Thursday. Jennings, who returned to the White House in July to assist with the launch of the federal health insurance marketplace, is a veteran Washington hand and served as former President Clinton's chief healthcare adviser. Before returning to the White House, Jennings ran a top health policy consulting business (Sink, 1/23).

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Women's Health

Huckabee Takes Aim At Health Law's Birth Control Requirement

The former Arkansas governor's comments, offered as part of a speech to the Republican National Committee's winter meeting, drew harsh responses from Planned Parenthood and Democratic Party committees.

The New York Times: Huckabee Criticizes Required Coverage of Birth Control
Former Gov. Mike Huckabee of Arkansas minced no words on Thursday in criticizing requirements that health insurance pay for birth control. The reasoning behind the idea, he said, was that women “cannot control their libidos or their reproductive systems without the help of the government.” He blamed Democrats, who, he said, “want to insult the women of America into making them believe that they are helpless without Uncle Sugar coming in and providing them with a prescription each month for birth control” (1/24).

Politico: Mike Huckabee Hits Dems On Women, Pill, ‘Libido’
Huckabee’s comments sparked a firestorm on Twitter and on cable news, and Democrats were quick to seize on the remarks. Planned Parenthood and several Democratic party committees blasted out statements, while White House Press Secretary Jay Carney said the comments sounded “offensive to me and to women” (Glueck, 1/23).

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State Watch

State Highlights: Hearing Friday On Battle Over Texas Woman On Life Support

A selection of health policy stories from Texas, Kansas and Oregon.

NPR: Life-Support Battle Over Pregnant Texas Woman In Court Friday
The case of the Texas woman, 22-weeks pregnant and being kept on life-support machines at a Forth Worth hospital against her husband's wishes, goes before a judge in North Texas on Friday. Marlise Munoz has been on respirators and ventilators since she was found unconscious in her home in November, when she was 14 weeks pregnant (Silverman, 1/24).

Kansas Health Institute: Mental Health Program Hailed As Way To Reduce Medicaid Costs
After navigating the brightly illuminated aisles of the Raytown Wal-Mart, Lance Sharples wheeled a grocery cart to the checkout line one night last week, … One of the program goals is to stop the revolving door at hospital emergency rooms among persons with mental health and substance abuse problems. Medical experts generally consider it more cost-effective to manage chronic or preventable conditions before patients seek care in emergency rooms. Last month, a Missouri Senate committee hailed the ReDiscover program as an example of how to reduce Medicaid costs (Sherry, 1/23).

The Oregonian: Oregon Far Behind In Community Mental Health Services, Federal Report Finds
Oregon lags far behind where it needs to be in providing community treatment to people with serious mental illness, while it continues to support more costly restrictive inpatient settings, a new federal Justice Department report says. The share of dollars Oregon spent on the state hospital and residential treatment centers actually increased in 2013 -- from 69 percent to 74 percent of the state's mental health funding for adults -- while spending dropped for community-based services. "It's the opposite of what our investigation was designed to address,'' Oregon's U.S. Attorney Amanda Marshall said Thursday (Bernstein, 1/23).

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Health Policy Research

Research Roundup: Patient Safety Measure Results 'Disappointing'

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

The New England Journal of Medicine: National Trends In Patient Safety For Four Common Conditions, 2005–2011 
Patient safety poses serious challenges to the health care system in the United States. Since 2001, nationwide efforts have focused on reducing in-hospital adverse events ... We used the Medicare Patient Safety Monitoring System (MPSMS), a large database of information abstracted from medical records of a random sample of hospitalized patients ... from 2005 to 2011, rates of in-hospital adverse events declined significantly among patients with acute myocardial infarction or congestive heart failure but not among patients with pneumonia or conditions requiring surgery. Although this suggests that national efforts focused on patient safety have made some inroads, the lack of reductions across the board is disappointing (Wang et al., 1/22).

Employee Benefits Research Institute: The Cost Of Spousal Health Coverage
In 2011, policyholders spent an average of $5,430 on health care services, compared with $6,609 for spouses. ... this analysis concludes that the cost of spousal health care coverage is higher than that for policyholders, and non-working spouses cost more than working spouses. ... While "first-mover" firms may save money in the short run by eliminating working spouses from their plan, they may in time gain the responsibility for covering employees who were previously covered as a spouse under another plan, now left without that coverage by other employers implementing the same strategy. ... employers with net reductions in covered spouses may experience a worsening in average risk, resulting in higher spending than expected (Fronstin and Roebuck, 1/23).

Annals of Internal Medicine:  Insurance Status and the Transfer of Hospitalized Patients: An Observational Study
There is little objective evidence to support concerns that patients are transferred between hospitals based on insurance status. ... Design: Data analyzed from the 2010 Nationwide Inpatient Sample. ... All patients aged 18 to 64 years discharged alive from U.S. acute care hospitals with 1 of 5 common diagnoses ... In adjusted analyses, uninsured patients were significantly less likely to be transferred than privately insured patients for 4 diagnoses: biliary tract disease, chest pain, septicemia, and skin infections. Women were significantly less likely to be transferred than men for all diagnoses (Hanmer et al., 1/20).

Annals of Asthma, Allergy and Immunology: Depressive Symptoms And The Incidence of Adult-Onset Asthma in African American Women
Of 31,848 participants [in the Black Women's Health Study] followed from 1999 to 2011, 771 reported incident asthma. Depressive symptoms were ascertained on 1999 and 2005 follow-up questionnaires with the Center for Epidemiological Studies–Depression Scale (CES-D). ... A positive association was observed between CES-D score and the incidence of adult-onset asthma. If the hypothesis is confirmed, depression could contribute substantially to the burden of asthma in adults (Coogan et al., 1/21).

JAMA Surgery:  Positive And Negative Volume-Outcome Relationships In The Geriatric Trauma Population
In trauma populations, improvements in outcome are documented in institutions with higher case volumes. However, it is not known whether improved outcomes are attributable to the case volume within specific higher-risk groups, such as the elderly ... This retrospective cohort study using a statewide trauma registry was set in state-designated levels 1 and 2 trauma centers in Pennsylvania. It included 39,431 eligible geriatric trauma patients (aged >65 years). ... Higher rates of in-hospital mortality, major complications, and failure to rescue were associated with lower volumes of geriatric trauma care and paradoxically with higher volumes of trauma care for younger patients (Matsushima et al., 1/22).

The Kaiser Family Foundation: Explaining Health Care Reform: Risk Adjustment, Reinsurance, and Risk Corridors
The Affordable Care Act's risk adjustment, reinsurance, and risk corridors programs are designed to work together to mitigate the potential effects of adverse selection and risk selection. ... Specifically, risk adjustment is designed to mitigate any incentives for plans to attract healthier individuals and compensate those that enroll a disproportionately sick population. Reinsurance compensates plans for their high-cost enrollees, and by the nature of its financing provides a subsidy for individual market premiums generally over a three-year period. And, risk corridors reduce the general uncertainty insurers face in the early years of implementation when the market is opened up to people with pre-existing conditions who were previously excluded (1/22).

The Kaiser Family Foundation: Coverage For Abortion Services And The ACA
The Patient Protection and Affordable Care Act (ACA) makes significant changes to health coverage for women by expanding access to coverage and broadening the health benefits that many will receive. ... This brief summarizes the major coverage provisions of the ACA that are relevant for women of reproductive age, reviews current federal and state policies on Medicaid and insurance coverage of abortion services, and presents national and state estimates on the availability of abortion coverage for women who are newly eligible for Medicaid or private coverage as a result of the ACA (Salganicoff, Beamesderfer and Kurani, 1/21).

Brookings Institution: Can Canadian-Style Healthcare Work In America? Vermont Thinks So.
In general, single payer health care means that all medical bills are paid out of a single government-run pool of money. Under this system, all providers are paid at the same rate, and citizens receive the same health benefits, regardless of their ability to pay. There are a number of proposed benefits to a single payer system. Currently, providers must follow different procedures with each of many insurance companies to get paid, creating an enormous amount of administrative work. ... Additionally, a single payer system provides universal access to health insurance, which eliminates the problem of the uninsured. However, Vermont's innovative proposal still leaves room for further improvement. Specifically, a single payer system alone does not address "fee-for-service" reimbursement for providers, which may encourage overuse and does not recognize quality and value (Sanghavi and Bleiberg, 1/22). 

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

NBC News: Doctors' Dress Code Aims To Halt Nasty Germs
Short sleeves, bare hands and forearms and white coats that are laundered at least once a week — if not more often — are the keys to keeping nasty bugs such as Staphylococcus aureus from hitching a ride on a doctor's wrist. Neckties are questionable. Watches and rings have to go. It's not clear what to do about name tags, lanyards, necklaces and cell phones, but when in doubt, it's best to clean the offending items — or get rid of them. That's according to new guidance on hospital attire released Monday by the Society for Healthcare Epidemiology of America, or SHEA (Aleccia, 1/20).

Reuters: Many Hospitalized Older People Need Decision Help
When the time comes for making critical medical decisions while in the hospital, a new study says older people often rely on family members or other surrogates to make those calls. Researchers found that about half of the older patients they tracked needed help making decisions within two days of being admitted to the hospital (Seaman, 1/21).

CNBC: Employers Face Tax Hit In States With No Medicaid Expansion
The decision by 25 states not to expand Medicaid coverage under Obamacare could cost some employers more than $1.5 billion in new taxes starting next year, a new analysis reveals. That tax hit might come as a shock to many of those businesses unaware of their exposure to the penalty—which will kick in if their employer-offered health plan is deemed too expensive and workers then buy private, subsidized Obamacare insurance (Mangen, 1/21).

MedPage Today: Few Docs Ready For Stage 2 'Meaningful Use'
Roughly one physician in eight has an electronic health record (EHR) system capable of supporting most requirements for Stage 2 of the "meaningful use" program, a government survey found. Only 13% of office-based physicians reported an intention to participate in the EHR incentive program and had a system meeting 14 of the 17 Stage 2 core objectives, according to a report released this week from the CDC's National Center for Health Statistics (NCHS) (Pittman, 1/17).

MedPage Today: Medical News: Evidence Not A Factor
Three doctors now in training at Harvard and the NIH -- Senthil Selvaraj, MD, Durga S. Borkar, MD, and Vinay Prasad, MD -- looked at what clinical studies the top five U.S. newspapers by circulation covered. They then mapped those against trials that appeared in the top five clinical journals, ranked by impact factor. Their findings? "Newspapers were more likely to cover observational studies and less likely to cover [randomized control trials] than high impact journals. Additionally, when the media does cover observational studies, they select articles of inferior quality. Newspapers preferentially cover medical research with weaker methodology" (Oransky, 1/21).

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Editorials and Opinions

Viewpoints: Consumers Awakening To Health Law's 'Perverse Incentives;' Medicaid Expansion Could Help Dems In Mid-Term Elections; New 'Devious Tactic' In Smoking

The Wall Street Journal: The ObamaCare Carnival Of Perverse Incentives
With fewer glitches to deter them, millions of Americans are now logging on to the ObamaCare health-insurance-exchange websites. When they get there, many are discovering some unpleasant surprises: The deductibles are higher than what most people are used to, the networks of doctors and hospitals are skimpier (in some cases much skimpier), and lifesaving drugs are often not on the insurers' formularies. Even after the government's income-based subsidies are taken into account, the premiums are often higher than what people previously paid (John C. Goodman, 1/23). 

The Washington Post's The Plum Line: Why The Medicaid Expansion Matters So Much To Dems
With Democrats on defense across the board in Senate races, their hopes in 2014 could rest heavily on their ability to turn out their base — which is to say, voters who are less likely to go to the polls in midterm elections. ... One thing that could play a key role in that effort: the Medicaid expansion (Greg Sargent, 1/23). 

Bloomberg: Will Obamacare's Medicaid Expansion Continue?
What are Republican gubernatorial candidates saying about Medicaid expansion in states where Democratic governors have implemented it? ... And the answer? Nada. Zip. Nothing. None of these Republicans is pledging to repeal the Medicaid expansion put in place by a Democratic governor. Indeed, most of them don’t mention Obamacare at all, and only one even mentioned health care. I’m sure that most -- if they want to win a Republican nomination! -- would support Obamacare repeal, if asked. But that’s different from making repeal an actual priority (Jonathan Bernstein, 1/23).

The New York Times' Opinionator: Should Pope Francis Rethink Abortion?
Pope Francis has raised expectations of a turn away from the dogmatic intransigence that has long cast a pall over the religious life of many Roman Catholics. His question "Who am I to judge?" suggested a new attitude toward homosexuality, and he is apparently willing to consider allowing the use of contraceptives to prevent sexually transmitted diseases. But his position on what has come to be the hierarchy's signature issue — abortion — seems unyielding. "Reason alone is sufficient to recognize the inviolable value of each single human life," he declared in his recent apostolic exhortation, "Evangelii Gaudium," adding: "Precisely because this involves the internal consistency of our message about the value of the human person, the church cannot be expected to change her position on this question" (Gary Gutting, 1/23). 

The New York Times: Even More Addictive Cigarettes
It was a shock to learn from the latest surgeon general's report that, because of changes in the design and composition of cigarettes, smokers today face a higher risk of lung cancer and chronic obstructive pulmonary disease than smokers in 1964, despite smoking fewer cigarettes. It is equally shocking to learn now that some of today's cigarettes may be more addictive than those smoked in past years, most likely because the manufacturers are designing them to deliver more nicotine to the lungs to induce and sustain addiction. That devious tactic requires a strong response by regulators (1/23). 

The New York Times: Quick Work On Paid Sick Leave
Mayor Bill de Blasio, swiftly delivering on a campaign promise, joined the City Council speaker, Melissa Mark-Viverito, last week in offering a bill to revise New York City’s law on paid sick leave. Their bill is broader than one that passed last year after much delay and political spatting. It's also better (1/23). 

Tampa Bay Times: Drug Database Needs Privacy Protections
Florida's prescription drug database is a valuable weapon in curbing the public damage from drug-related deaths, narcotics tourism and criminal trafficking. But it should not be used by law enforcement as a stocked pond for fishing expeditions. The Legislature needs to strengthen privacy protections without taking this tool away from law enforcement. And Florida Attorney General Pam Bondi, who has been so concerned about citizens' privacy with the implementation of the Affordable Care Act, should see the value in that (1/23).

Los Angeles Times: Mike Huckabee Mansplains Women’s Libidos And Contraception At RNC
I am genuinely starting to feel sorry for the Republican Party, which has become so adept at shooting itself in the foot over women's issues that it should probably put a moratorium on discussing them for a while. The Democrats' accusation that the GOP has waged a "war on women" has so rattled the party that its pooh-bahs cannot think straight. They keep making the same mistakes over and over. Insanity! (Robin Abcarian, 1/23). 

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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.