Daily Health Policy Report

Monday, January 27, 2014

Last updated: Mon, Jan 27

KHN Original Reporting & Guest Opinion

Administration News

Health Reform

Health Care Marketplace

Medicare

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Florida County With Highest Uninsured Rate Sees Little Impact From Obamacare

Kaiser Health News staff writer Phil Galewitz, working in collaboration with USA Today, reports: "In the city that calls itself “America's Sweetest Town,” the smell of burning sugar cane pierces the 80 degree January air. Steam billows from the 12-story U.S. Sugar Corp. factory that dominates the landscape and the economy in this region, halfway between the Gulf of Mexico and the Atlantic Ocean. Some describe the aroma as sweet, others as sour -- a metaphor of sorts for the Affordable Care Act and its impact on this South Florida county that has the state’s highest uninsured rate" (Galewitz, 1/27). Read the story.

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The Clubfoot Correction: How Parents Pushed For A Better Treatment

Kaiser Health News staff writer Jenny Gold, working in collaboration with NPR, reports: "Mary Snyder found out during her pregnancy at her 19-week ultrasound that her baby had clubfoot; both of Alice’s feet were completely turned inward, forming the twisted U-shape typical of clubfoot. The condition is one of the most common birth defects, affecting about one out of every thousand babies, but that was little comfort to Snyder" (Gold, 1/27). Read the story.

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Capsules: HHS Releases Poverty Guidelines For 2014

Now on Kaiser Health News' blog, Jordan Rau writes: "The federal government has released slightly higher poverty level guidelines for 2014, but those won’t alter the income thresholds that are being used now to determine what kind of financial assistance is available to buy insurance under the health law" (Rau, 1/27). Check out what else is new on the blog

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Local Governments In Texas Pursue Marketplace Signups

The Texas Tribune's Becca Aaronson, working in partnership with Kaiser Health News, reports: "To coordinate education and outreach efforts associated with the Affordable Care Act, the Houston Department of Health and Human Services is taking an approach that mirrors how the Federal Emergency Management Agency might react to a catastrophe. The Enroll Gulf Coast initiative has set up an 'incident command structure' to synchronize the activities of 13 organizations in Harris and 12 nearby counties. An 'intelligence committee' created heat maps showing the ZIP codes with the region’s highest number of uninsured residents and 'access' points, like community centers and libraries, to connect with people in those neighborhoods. Meanwhile, an 'operations committee' uses that information to host canvassing and health insurance enrollment events in targeted neighborhoods. The groups also share an online dashboard to input data and track their coordinated enrollment efforts in real time" (Aaronson, 1/ 27). Read the story.  

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Political Cartoon: 'An Apple A Day?'

Kaiser Health News provides a fresh take on health policy developments with "An Apple A Day?" by Steve Kelley and Jeff Parker, from "Dustin."

And here's today's health policy haiku:

TIME TO DECIDE...

Expand Medicaid?
While fighting Obamacare!
Take money and run
-Team Haiku, Altarum 

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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Administration News

How Will The President Handle Obamacare In State Of The Union?

The White House press secretary said that the law "is absolutely worth" any past or future political repercussions.

Politico: State Of The Union 2014: The Search For A Non-Awkward Obamacare Shout-Out
This time, President Barack Obama is going to have to actually talk about Obamacare in his State of the Union address. No more touch-the-base-and-keep-running treatments, the way he’s handled it the past couple of years. This time, he’ll be expected to linger on base a bit, at least long enough to acknowledge the launch of the biggest domestic achievement of his presidency — and do it in the least awkward way possible. That’s the consensus of Democratic strategists, health care experts, pollsters and crisis-management experts, all of whom will have reasons to listen closely (Nather, 1/27).

The Associated Press: Carney: Obamacare Worth It, No Matter Political Consequences
Days before President Obama is set to deliver the annual State of the Union during, White House Press Secretary Jay Carney told ABC News that passing and implementing the president's signature health care law is worth any political consequences, including losing the Democratically-controlled Senate to the Republicans. "This is not about politics. So the answer is, it is absolutely worth it, no matter what happens politically," Carney said when asked about the possibility of losing the Senate during an interview at the White House for "This Week" (Bell, 1/26).

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Health Reform

Some Consumers Find Surprises As They Explore Health Law Plans

Many plans offered on the health marketplaces will take a chunk out of consumers' wallets, Politico reports. Meanwhile, The Associated Press examines a dilemma for some parents who find their children qualify for Medicaid and can't go on the same plan as their parents.

Politico: Deductibles May Create Obamacare Surprises
Skimpy, pre-Obamacare insurance plans are being phased out, but some of the more comprehensive plans being sold in the new marketplaces carry hefty deductibles consumers have to pay before all their benefits kick in. ... Granted, they're just one part of what people end up paying, and the health law caps out of pocket spending. And not every new health plan carries higher deductibles than the old, individual market plans, despite claims by some Republicans hostile to the law. But deductibles -- the amount a customer must generally spend before their policy kicks in -- can still take a big unexpected chunk out of shoppers' wallets (Winfield Cunningham, 1/26).

The Associated Press: Health Overhaul Law Gets Tricky When Kids Might Be Eligible For Medicaid But Parents Are Not
Families shopping for health insurance through the new federal marketplace are running into trouble getting everyone covered when children are eligible for Medicaid but their parents are not. Children who qualify for Medicaid, the safety-net program for the poor and disabled, can't be included on subsidized family plans purchased through the federal marketplace, a fact that is taking many parents by surprise and leaving some kids stuck without coverage (Ramer, 1/26).

Kaiser Health News: Capsules: HHS Releases Poverty Guidelines For 2014
The federal government has released slightly higher poverty level guidelines for 2014, but those won't alter the income thresholds that are being used now to determine what kind of financial assistance is available to buy insurance under the health law (Rau, 1/27).

The Fiscal Times: Confusion Over Deadlines Jeopardizes Obamacare
As the enrollment deadline approaches for Obamacare, The White House is counting on a surge of sign ups. But more than half of Americans have no idea when that deadline is, and even more are shrugging it off because they believe it will be extended. Despite the administration's outreach efforts, a new Bankrate survey shows 55 percent still aren't aware of the March 31 health care sign up deadline through the exchanges. Nearly 25 percent believe it already passed on January 1, and 11 percent think they still have until December 31, 2014 to sign up -- nine months late (Ehley, 1/27).

The Wall Street Journal: New Benefits Come With Obamacare
Coverage for pregnancy and childbirth? Check. Mental-health care? Prescription drugs? Check and check. People who buy health insurance as on their own are seeing big changes as their coverage gets more comprehensive this year. The Affordable Care Act, also known as Obamacare, requires that all new plans offered in 2014 cover a set of "essential health benefits," some at no cost to enrollees. The benefits are modeled after those typically offered by large employers and fall into 10 broad categories (Gerencher, 1/26).

Bloomberg: Economists See Little Effect On Hiring From U.S. Health-Care Law
The vast majority of U.S. companies said the implementation of the Obama administration's health-care law will have no effect on their businesses or hiring plans, according to results of a poll issued today. About 75 percent of those surveyed said the Affordable Care Act hasn't influenced their planning or expectations for 2014, according to data from the National Association for Business Economics. Twenty-one percent of 64 respondents said that the law would have a negative impact on business conditions and 5 percent said it will be positive (Torres, 1/27).

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Getting Obamacare To Harder-To-Reach Groups

Reaching underserved populations who are newly qualified for coverage remains a major concern and challenge to advocacy groups like Families USA. For insurers and government officials, the target is healthy people who will help balance new risk pools.

Politico: Direct Sign-Up For Obamacare Subsidy Enrollees Still Bumpy
Nearly two-thirds of the way through the Obamacare sign-up season, most insurers are still having trouble with direct enrollment of individuals who qualify for subsidies. Upgrades have been promised to the feature of healthcare.gov designed to facilitate this process, and carriers and brokers are trying to stay optimistic that they’ll come in time to help enroll a rush of applicants ahead of the March 31 deadline for 2014 coverage. “They’ve made a lot of progress, but there’s still a lot to do. We’re told all of the critical changes will be completed during this open enrollment period,” said Michael Mahoney, a senior vice president with GoHealth, a private online insurance brokerage that is selling exchange plans (Norman, 1/24).

Politico: Getting Obamacare To The Hardest-To-Reach Americans
While Obamacare’s botched rollout made enrollment difficult for many Americans, certain groups continue to face coverage barriers that extend far beyond a troubled website. In fact, the individuals involved -- from homeless people and recently paroled inmates to former foster-care children -- often aren’t even aware they are eligible for benefits. Reaching underserved populations who are newly qualified for coverage under the law’s Medicaid expansion remains a major concern and challenge, according to advocates speaking Saturday at the Families USA Health Action conference in Washington, D.C. (Kalter, 1/26).

NPR:  The Healthy, Not The Young, May Determine Health Law's Fate
Now that the problems with the balky HealthCare.gov website are largely fixed, the Obama administration is finally feeling comfortable enough to launch some of the outreach it planned for last fall. Its top target: young adults, specifically those between 18 and 35. ... But people have started to wonder just how critical those young people really are to making the health exchanges operate smoothly. "There's been this incredible focus on reaching young invincibles and getting them to sign up for insurance," says Larry Levitt, senior vice president of the Kaiser Family Foundation. "But it turns out the invincible part is actually much more important than the young part" (Rovner, 1/24).

The Philadelphia Inquirer: Spreading The Word That ACA Works
Janice Churchill went to Bright Hope Baptist Church on Martin Luther King Day to proclaim the word. … If Congreso de Latinos Unidos is any indication, people in those communities are already snapping up low-cost ACA plans (Calandra, 1/26).

 

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State Lawmakers Consider Legislative Fixes For Health Insurance Exchange Problems

Lawmakers in Maryland and Oregon consider legislation that would help residents sign up for health insurance coverage -- in some cases after deadlines to sign up have passed. In the meantime, the Obama administration reports more than 3 million people have signed up for coverage under the health law.

The Associated Press/Washington Post: Maryland House To Review Insurance, Cyberbullying Bills
Maryland’s House of Delegates will likely vote Tuesday on a plan to help residents who have struggled with the state’s health insurance exchange online. The bill would let customers sign up for retroactive coverage in the Maryland Health Insurance Plan, a separate safety net plan. Private insurance companies in the health exchange opened similar retroactive coverage options, but a deadline to register was last week (1/27).

The Oregonian: Cover Oregon: Legislature To Consider Fixes As Lawmakers Question Costs, Politics
Lawmakers frustrated with the Cover Oregon mess will take up bills in next month’s legislative session to help more Oregonians enroll and to help the state better track contractors. One bill would extend coverage for high-risk Oregonians in a state insurance pool, extend whistleblower protections to Cover Oregon employees and allow the governor to remove all Cover Oregon board members in a single year. The bill, sponsored by Rep. Shemia Fagan, D-Clackamas, would also direct Cover Oregon to seek a federal waiver to extend the enrollment deadline by a month to April 30, and to seek federal tax credits for small businesses (Zheng, 1/24). 

The Oregonian: Cover Oregon's Private Insurance Enrollment Tops 30,000, More Than 200,000 Signed Up Overall
Oregonians continue to enroll in health insurance in 2014 despite difficulties with Cover Oregon. According to the state's latest numbers, more than 30,000 people have signed up for private insurance through the health exchange, and more than 170,000 have signed up for the Medicaid-funded Oregon Health Plan The numbers place Oregon in the middle of the pack despite problems with the health exchange website that have forced people to go through a makeshift manual processing system (Budnick, 1/24).

McClatchy: Federal And State Marketplace Enrollment Nears 3 Million
With just over two months remaining in a six-month open enrollment period, nearly three million people have now signed up for health insurance on the federal and state insurance marketplaces, the Obama administration reported Friday. The estimate means that roughly 800,000 people nationwide have enrolled in individual coverage in January with one more week remaining. The numbers indicate that interest in coverage remains strong following a massive enrollment surge in December when people scrambled to sign up for coverage that began on New Years Day (Pugh, 1/24).

Kaiser Health News tracked the coverage Friday when the Obama administration released the most recent health law enrollment tallies.

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States Use Waivers To Expand Medicaid Their Way

Also in the news is the Missouri Chamber of Commerce's hiring of retired Republican Sen. Kit Bond to help the state's Democratic governor lobby GOP state lawmakers to expand Medicaid.

Stateline: Medicaid Waivers' Role In Innovation, Coverage Expansion
When the U.S. Supreme Court in 2012 ruled that states could decide for themselves if they would expand Medicaid eligibility, many thought states were left with a yes or no proposition. Simple. Except nothing is ever simple when it comes to either the Affordable Care Act or Medicaid, the federal-state partnership that provides health care to America’s poor. Some states want to expand Medicaid, but in their own way. Lucky for them, there is a process that enables them to do so (Ollove, 1/27).

St. Louis Public Radio: Bond To Lobby For Missouri To Expand Medicaid
Retired U.S. Sen. Christopher “Kit” Bond, R-Mo., is jumping into the Jefferson City debate over Medicaid expansion – and he’s on the side of  Gov. Jay Nixon and other expansion supporters. Bond, a former two-term governor, has been hired as a lobbyist by the Missouri Chamber to try to persuade fellow Republicans in the General Assembly to drop their opposition and agree to take the federal aid which would cover all the expansion’s costs for three years and at least 90 percent thereafter (Mannies, 1/24).

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The View From Two Counties With Soaring Uninsured Rates

The Texas Tribune looks at how Houston officials are using techniques honed in hurricanes and other public emergencies to try to enroll the uninsured. Kaiser Health News looks at the health law's impact on the county in Florida that has the state's highest uninsured rates.

The Texas Tribune/The New York Times: Local Governments Pursue Obamacare Enrollment
While no one believed carrying out the Affordable Care Act in Texas would be easy, a series of additional obstacles has impeded efforts to help the 6.2 million uninsured Texans find health coverage. The launch of the federal marketplace, healthcare.gov, was a technical disaster. The state's Republican leadership, saying Medicaid is broken, has refused to expand the program for impoverished adults. And last week, the Texas Department of Insurance issued state regulations that added further training and other requirements for the navigators hired and trained by recipients of federal grants to help people enroll in the health marketplace. Still, government officials and community-based organizations are working together to incorporate new rules, maximize their resources and educate uninsured Texans on how to take advantage of the federal law (Aaronson, 1/26).

Kaiser Health News: Florida's Decision Hurts County With Highest Uninsured Rate
In the city that calls itself "America's Sweetest Town," the smell of burning sugar cane pierces the 80 degree January air. Steam billows from the 12-story U.S. Sugar Corp. factory that dominates the landscape and the economy in this region, halfway between the Gulf of Mexico and the Atlantic Ocean. Some describe the aroma as sweet, others as sour -- a metaphor of sorts for the Affordable Care Act and its impact on this South Florida county that has the state's highest uninsured rate (Galewitz, 1/27).

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For Health Law, Poll Finds Some Negatives Have Eased, But Most Americans Still Say Things Aren't Going Well

A new Associated Press-GfK poll finds that 71 percent of Americans who have tried to sign up for health coverage, or live with someone who tried, had difficulties with the insurance marketplaces. Meanwhile, some GOP leaders are seeking a policy alternative to replace the overhaul.  

The Associated Press: AP-GfK Poll: Negative View Of Health Rollout Eases
Memo to the White House: The website may be fixed, but President Barack Obama's new health insurance markets have yet to win over most consumers. Negative perceptions of the health care rollout have eased, a new Associated Press-GfK poll finds. But overall, two-thirds of Americans say things still aren't going well. Of those who've tried to sign up, or who live with someone who has, 71 percent have encountered problems. But the share reporting success jumped to 40 percent from a meager 24 percent in December (Alonso-Zaldivar and Agiesta, 1/27). 

Reuters: Republicans Seek Own Policy Cure To Replace Obamacare
Top Republicans are saying they can no longer just be the party of "No" on Obamacare: They need to come up with an alternative healthcare policy. While many Americans are skeptical of President Barack Obama's healthcare overhaul, they also tell lawmakers they worry about keeping their costs from getting out of control. For those voters, a party that offers a platform to repeal the 2010 law without anything to replace it may not be very attractive (Cornwell, 1/24).

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High Court Gives Temporary Contraception Coverage Exemption To Nuns

The Little Sisters of The Poor doesn't want to have an outside administrator for its health plan, which covers employees of their nursing facilities.

CQ HealthBeat: Supreme Court Gives Catholic Nonprofit Reprieve From Contraception Mandate
The Supreme Court sided with a nonprofit Catholic organization over the Obama administration on Friday in agreeing to provide the group with at least a temporary reprieve from the 2010 health care law’s requirement that it make contraceptives available to its employees (Gramlich, 1/24).

ABC News: Supreme Court Allows Nuns To Opt Out Of Contraceptive Mandate For Now
The government argued that all the Little Sisters had to do was sign a form and provide a copy of it to the third-party administrator of their self-insured group health plan. But the Little Sisters had argued that even having to sign the form violated their religious freedom. The court said it was issuing the order but that it should not be "construed as an expression of the Court's views on the merits" (de Vogue, 1/24).

CNN: Charity Gets Win For Now Over Obamacare On Contraception
The high court order, which also covers the charity's insurance administrator, will remain in effect while lower courts continue to wrangle with the merits of the primary challenge to the federal health law mandates on contraception. ... Although the high court order applies specifically to the Little Sisters of the Poor and its administrator, Christian Brothers Services, it will likely have the practical effect of keeping the government from forcing other religious non-profits that raised similar objections to comply with the mandates (Mears, 1/25).

Kaiser Health News also followed the headlines Friday when the court announced this temporary reprieve.

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Health Care Marketplace

Federal Judge Rules Idaho Hospital Must Unwind Merger With Physicians Group

The court supported a case brought by the Federal Trade Commission that argued the merger reduced competition in the local marketplace.

The Wall Street Journal: FTC Wins Challenge Against Idaho Hospital Deal
A federal judge ruled Friday that an Idaho hospital system must unwind its acquisition of the state's largest independent doctor group, a decision that could have significant implications as health care providers nationwide increasingly seek to join forces. The ruling handed another victory to the Federal Trade Commission, which in recent years has renewed its efforts to police health care mergers it sees as anticompetitive. The commission has won a string of rulings against mergers between competing hospitals. The Idaho case was considered a key test for the FTC because the agency was seeking to stop a different type of transaction, the acquisition of a physician group (Kendall, 1/24).

Bloomberg: Hospital Antitrust Case Won By U.S. Over Doctor Group
Idaho's largest hospital chain and physician group must unwind their merger, a federal judge ruled, siding with U.S. regulators seeking to broaden antitrust enforcement in health-care acquisitions. The combination of St. Luke's Health System Ltd. and the Saltzer Medical Group would raise prices for consumers even though it would improve patient care, U.S. District Judge B. Lynn Winmill in Boise, Idaho said today, ruling in a pair of cases brought by the Federal Trade Commission and local hospital (Zajac and McLaughlin, 1/24).

Modern Healthcare: Judge Rules St. Luke's Must Give Up Saltzer Medical Group
Health care providers and antitrust experts have watched the case closely because it's the first time that the federal courts have decided a Federal Trade Commission case against a physician practice deal. The decision comes as health care systems across the U.S. have been rapidly scooping up medical groups to create integrated delivery networks to prepare for population health management. St. Luke's Boise-based competitors St. Alphonsus Health System and Treasure Valley Hospital filed suit in 2012 to block the deal, arguing that it would give St. Luke's too much power with payers (Kutscher, 1/24).

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Medicare

When Cut From Medicare Advantage Plans, Doctors Face Dilemma About Patients

In the meantime, Medicare is trying to crack down on habitual overcharging by some doctors.

The Washington Post: Doctors Cut From Medicare Advantage Networks Struggle With What To Tell Patients
Thousands of primary-care doctors and specialists across the country have been terminated from privately run Medicare Advantage plans, sparking a battle between doctors who say patient care is being threatened and insurers that insist they have to reduce costs and streamline their operations. Medical associations, which describe the dismissals as the largest in the program’s history, say the cuts are forcing some patients to leave their doctors in mid-treatment  (Cha, 1/25).

Earlier, related KHN story: Judge's Medicare Advantage Order Could Have National Impact (Jaffe, 12/6/13). 

The New York Times: Doctors Abusing Medicare Face Fines And Expulsion
The Obama administration is cracking down on doctors who repeatedly overcharge Medicare patients, and for the first time in more than 30 years the government may disclose how much is paid to individual doctors treating Medicare patients. Marilyn B. Tavenner, the administrator of the Centers for Medicare and Medicaid Services, said that “recalcitrant providers” would face civil fines and could be expelled from Medicare and other federal health programs. In a directive that took effect on Jan. 15 but received little attention, Ms. Tavenner indicated that the agency was losing patience with habitual offenders. She ordered new steps to identify and punish such doctors (Pear, 1/26).

And, for patients:

The Wall Street Journal: The Pitfalls Of Applying For Medicare 
Roughly 3.65 million Americans will turn 65 this year and become eligible for Medicare. But be warned: There's nothing simple about signing up for the government's health-care insurance program. "Medicare is complicated," says Paula Muschler, operations manager of the Allsup Medicare Advisor, a Medicare advisory-services company. "There is a lot seniors can do either right or wrong that can have a lasting impact on their health-care costs for the rest of their lives." ... Get a Medicare adviser, who, like a lawyer or a financial planner, can put you on the right track to finding the package that works best for your health and your pocketbook (Waters, 1/26).

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State Watch

State Highlights: N.Y. Revises Its Request For Medicaid Adjustment

A selection of health policy stories from New York, Washington state, California, Virginia, Idaho, Connecticut and Georgia.

The Associated Press/Wall Street Journal: Feds Urge More Talks On N.Y. Medicaid Application 
New York has revised its request for a $10 billion Medicaid adjustment, which would allow using that money in related health care programs, after federal officials concluded capital investment and some other programs are ineligible. The application was first filed 18 months ago, prompting Gov. Andrew Cuomo and Health Commissioner Dr. Nirav Shah last week to publicly blame the federal delay for threatening financially distressed New York hospitals (1/26).

The Washington Post: Medical Advocates Decry Insurance Rules In Wash. State On Waiting Period For Transplants
Newly insured consumers in Washington state who purchased health plans through the online exchange might find a surprise when they comb through the fine print in their policies: They’ll have to wait 90 days from when their insurance begins before coverage for transplants will kick in. The waiting period, a holdover from the days when insurers were able to impose restrictions on coverage for all sorts of preexisting conditions, has become the latest flash point in the often tense negotiations between insurers, regulators, doctors and consumers over the design of the new individual and small-group health plans that went into effect Jan 1 (Cha, 1/26).

Los Angeles Times: Brain-Dead, Pregnant Texas Woman Taken Off Life Support
After a bitter legal battle that became a touchstone in the abortion debate, a pregnant, brain-dead woman was removed from life support Sunday as a Texas hospital agreed to comply with a court order. Marlise Munoz's body was to be turned over to her family, said attorneys for her husband, Erick Munoz. She had been on life support for about two months at John Peter Smith Hospital in Fort Worth after falling unconscious in her home Nov. 26 with a possible blood clot in her lung. At the time, she was 14 weeks pregnant (Pearce, 1/26).

NPR: Silencing Many Hospital Alarms Leads To Better Health Care
Alarms are good and necessary things in hospital care, except when there are so many of them that caregivers can't keep track of the ones that signal a crisis that requires immediate attention. Then it may be that less technology can actually be more effective (Knox, 1/27).

Los Angeles Times: Judge Kills Measure For Separate L.A. Health Department
A judge has preemptively struck down a ballot measure that would force the city of Los Angeles to launch its own health department separate from the county's. Los Angeles County Superior Court Judge Michael P. Linfield ruled Friday that the measure scheduled for the June ballot would conflict with state law if passed and would "impermissibly interfere with essential government functions." The measure was advocated by the nonprofit AIDS Healthcare Foundation, which is a major provider of AIDS- and HIV-related health services for the county's health department, but has also frequently butted heads with county leaders (Sewell, 1/24).

Politico: Creigh Deeds Talks Of Son’s Attack
Virginia state Sen. Creigh Deeds says he hopes his son’s death will be used to help address “inequity” in the way the country views mental health issues. Deeds, who was stabbed multiple times by his bipolar son, Gus, on Nov. 19, 2013, told CBS’s “60 Minutes” that the health system had failed his family (Drusch, 1/26). 

The Richmond-Times Dispatch: Questions Remain After Inquest In Deeds Case
The message to the community services board was “we’re not taking routine admissions today,” said Dr. Jack Barber, who also is medical director for the Virginia Department of Behavioral Health and Developmental Services. That wasn’t the only apparent breakdown in communication between the state and local community services board that emerged Friday from the grueling inquest conducted by the House Courts of Justice subcommittee on mental health. The subcommittee, led by Chairman Benjamin L. Cline, R-Rockbridge, and Del. Robert B. Bell, R-Albemarle, has tried to conduct its own investigation of what happened to Deeds, who attacked his father, Sen. R. Creigh Deeds, D-Bath, and killed himself, 13 hours after being released from emergency custody for a mental evaluation that determined him to be a threat to himself or others (Martz, 1/25).

The Associated Press: Mental Health Care Providers Blast Private Manager
Mental health professionals blasted a private company now managing behavioral health care for low-income Idaho residents, saying the contract is plagued with problems and hours-long delays that not only make the process more difficult but could put their clients at risk. A joint House and Senate Health and Welfare Committee meeting Friday provided a venue to criticize Optum, a Minnesota-based health care services management company whose parent company is UnitedHealth Group (Miller, 1/24).

The CT Mirror: Malloy Proposes Mental Health Funding Boost, Police Training
Gov. Dannel P. Malloy is proposing to fund more supportive housing and other services for people with mental illness, boosting annual mental health spending by $4.25 million in the next fiscal year and by another $3 million the year after. The governor also wants to require police to receive training on how to respond to situations involving people with mental illness and to fund an anti-stigma campaign to make people unashamed to seek help.The proposals, which Malloy will issue formally when the legislative session begins Feb. 5, are meant to complement changes to the state’s mental health system made last year in response to the massacre at Newtown’s Sandy Hook Elementary School (Becker, 1/24).

Georgia Health News: Health Plan Critics See Cause For Hope 
A leader of a group of state employees and teachers critical of their health plan choices said Friday that she welcomed Gov. Nathan Deal’s suggestion that their options may increase next year. Ashley Cline, creator of a Facebook group that has been a forum for complaints about the 2014 changes in the State Health Benefit Plan, told GHN that the governor’s comments represent progress. A main criticism of the plan is that it offers only one insurer: Blue Cross and Blue Shield of Georgia. "We’re going in the right direction" if more options are a future possibility, Cline said (Miller, 1/24).

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Editorials and Opinions

Viewpoints: Health Overhaul Helps Ease Inequality Issues; Nuns Triumph Over Health Law; Deinstitutionalization's Mental Health Legacy

The Washington Post: Making Progress On Inequality
Intense as it is, the current debate over rising income inequality is hardly new. ... The good news is that there's more good news than one might expect. ... In addition to avoiding making things worse, the country has adopted, at least in part, several of the policy improvements we thought made sense eight years ago. Most prominent among these was President Obama's health-care reform, which, for all its problems, promises to ease the health-care cost squeeze on middle- and lower-income Americans (1/25). 

The Washington Post: No, Obamacare Isn't A 'Bailout' For Insurers
The term "bailout" is back. Specifically, Republicans are calling a feature of the Affordable Care Act — the risk corridor funds designed to share losses if insurance companies have greater than expected losses — a "bailout." ... Usually bailouts are put into place to prevent a situation in which the failure of one firm leads to problems or a collapse for the economy as a whole. ... So should the Affordable Care Act's risk corridors be considered "bailouts"? (Mike Konczal, 1/25).

The Wall Street Journal: A Victory For The Little Sisters
The New Year's Eve emergency injunction protecting the Little Sisters of the Poor from ObamaCare's birth-control mandate was unusual enough. The Supreme Court rarely grants such relief, and the order was issued by liberal Justice Sonia Sotomayor. But the permanent stay pending appeal, issued late Friday by the full Supreme Court with no recorded dissent, was rarer still—and a rebuke to the Obama Administration's bullying conception of religious liberty (1/26). 

The Washington Post: In Virginia, Ideology Trumps Facts On Medicaid
Whether Virginia opts to expand Medicaid or not, poor and uninsured patients will continue to seek medical care, and many of them will do so at state expense. It is a triumph of ideological purity over budgetary prudence for lawmakers in Richmond to insist on spurning federal funds that would only relieve the burden on taxpayers and, in the process, provide a safety net for up to 400,000 Virginians who lack insurance coverage (1/24).

The Star Tribune: MinnesotaCare May Be Undercut By Federal Policy
The administration can ill afford more questions about the law's rollout, particularly in states such as Minnesota, where the health care community has embraced the ACA's potential. That's why it's critical that the administration move quickly to prevent federal payment policies from penalizing Minnesota for modernizing its pioneering MinnesotaCare program and having some of the nation's most affordable insurance premiums on its new MNsure marketplace. The decline in expected federal revenue is a key reason why the net state cost of MinnesotaCare is expected to increase by $517 million for 2016-17, compared with estimates from the last legislative session (1/24).

USA Today: How Americans Can Kill Obamacare, Legalize Pot 
In his excellent book, Two Cheers For Anarchism, Professor James Scott writes: "One need not have an actual conspiracy to achieve the practical effects of a conspiracy. More regimes have been brought, piecemeal, to their knees by what was once called 'Irish Democracy,' the silent, dogged resistance." ... That seems to be happening right now, in two very different areas. In one area, we have the refusal of people to sign up for Obamacare in anything like the numbers that were predicted, or needed to make it work. ... Meanwhile, on the marijuana front, the people of states like Colorado are engaging in an odd, 21st century variety of nullification (Glenn Harlan Reynolds, 1/26). 

And on other issues -

The New York Times: How Long Have I Got Left?
As soon as the CT scan was done, I began reviewing the images. The diagnosis was immediate: Masses matting the lungs and deforming the spine. Cancer. In my neurosurgical training, I had reviewed hundreds of scans for fellow doctors to see if surgery offered any hope. I'd scribble in the chart "Widely metastatic disease — no role for surgery," and move on. But this scan was different: It was my own. ... One would think, then, that when my oncologist sat by my bedside to meet me, I would not immediately demand information on survival statistics. But now that I had traversed the line from doctor to patient, I had the same yearning for the numbers all patients ask for (Dr. Paul Kalanithi, 1/24). 

The New York Times: For The Mentally Ill, It's Worse
On the one hand, many mentally ill people were able to lead fuller, richer lives thanks to the deinstitutionalization movement. But as [Susan] Sheehan's book illustrates, there were also many people for whom the drugs did not have a pronounced effect — or who stopped taking the drugs as soon as they left the hospital. Yet there were no longer enough hospital beds for them, hence the need for hospitals to drug them up and move them out (Joe Nocera, 1/24).

USA Today: Abortion Buffer Zone Harms Women
Eleanor McCullen stands on Boston sidewalks to let women know that they have alternatives to abortion. She makes her offers in normal conversational tones, speaking with eye contact and a smile. Unfortunately, she is now forced to call out her message from behind lines painted on the ground. ...  If we are serious about protecting a woman's "right to choose," then we ought to protect her right to engage in conversation about alternative choices on the public sidewalk (Mary Ann Glendon, 1/26).

The New York Times: A Formula For Repelling Women Voters
Yet the ideological tide rolls on. States dominated by Republicans continue to enact new abortion restriction. The Republican National Committee last week heard Mike Huckabee, the former governor of Arkansas, suggest that Democrats favor universal access to free contraception because they think women "cannot control their libido" without the help of "Uncle Sugar." And this week, the Republican-led House is expected to pass the deceptively named No Taxpayer Funding for Abortion Act (1/26).

The Washington Post: New Health Center Offers Convenience, Affordability, Respect In Poor D.C. Community
Vanessa Herndon, 59, wasn't sure what to expect Thursday when she became one of the first patients to take advantage of the spanking new, four-story health center in one of the District's poorest, most neglected neighborhoods. Herndon was thrilled that the clinic was within walking distance of her apartment, but she has had many bad experiences with doctors and hospitals. This time, she came away impressed and grateful (Robert McCarthy, 1/25). 

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
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.