Daily Health Policy Report

Friday, January 3, 2014

Last updated: Fri, Jan 3

KHN Original Reporting & Guest Opinion

Health Reform

Medicaid

Capitol Hill Watch

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Obamacare Comes To Skid Row

Kaiser Health News staff writer Sarah Varney, working in collaboration with NPR, reports: “If you were led blindfolded from Los Angeles’ grand city hall a few blocks east, you would know when you entered Skid Row. There is the pungent smell of urine and burning marijuana smoke, and the sound of music and easy laughter. A carnival rising out of misery. This is the chaos that Chris Mack plunges into on most days. Once homeless himself, Mack is an outreach worker for the JWCH Institute’s Center for Community Health, a free clinic that sits at the heart of Skid Row” (Varney, 1/2). Read the story

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Many Spanish Speakers Left Behind In First Wave Of Obamacare

Kaiser Health News staff writer Daniela Hernandez reports: “In Silicon Valley, the executives and engineers who’ve helped build the Apple, Google and Facebook empires earn high salaries and enjoy a slew of perks, including stellar health benefits. The clients of the Ravenswood Family Health Center, a community clinic in East Palo Alto just two miles away from Facebook’s sprawling headquarters, live in a very different Silicon Valley. They’re the gardeners, nannies, factory workers and service staff who keep Silicon Valley homes and offices humming, the lawns manicured and the families comfortable” (Hernandez, 1/3). Read the story

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A Reader Asks: If I Don’t Use All My Subsidy Credit, Will I Get It When I Do My Taxes?

Kaiser Health News consumer columnist Michelle Andrews answers this question from a reader (1/3). Read her response

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Six Things That May Move Public Perception Of Obamacare

Kaiser Health News staff writer Phil Galewitz reports: “Now, though, most of its major provisions are in effect, and arguments may hinge less on ideology and more on how the law is actually working for millions of people – for instance, how many get coverage through online marketplaces; whether they’re able to see doctors when they need them; how they rate that care; and perhaps most important, whether having that coverage improves their lives in tangible ways. … No question that partisans on both sides will keep spinning, especially in the run-up to the 2014 midterm elections. To help make sense of the challenges ahead, here are six things that are likely to be important measuring sticks of the law in 2014 and beyond” (Galewitz, 1/3). Read the story

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Capsules: Missouri Governor Pushes GOP-Led Legislature On Medicaid Expansion; 'Good Behavior' More Than A Game To Health Care Plan; New Year Brings In Many Key Provisions Of Health Law

Now on Kaiser Health News’ blog, the St. Louis Post-Disptach’s Virginia Young, working in partnership with KHN, reports on Missouri’s Medicaid expansion: “Missouri Gov. Jay Nixon, a Democrat, is intensifying his effort to persuade Republican lawmakers to expand Medicaid with a pitch that uses some of the same themes that Republicans favor. At a news conference in his Capitol office this week, Nixon praised states such as Iowa and Arkansas for designing “common-sense, market-based approaches” that encourage personal responsibility on the part of Medicaid participants” (Young, 1/2).

Also on Capsules, Oregon Public Broadcasting’s Kristian Foden-Vencil reports on how one health plan is working with elementary schools to encourage good health: “Behaving well in elementary school could reduce smoking in later life. At least, that’s what Trillium Community Health Plan hopes, and it’s putting money behind the idea. Danebo Elementary in Eugene, Ore., is one of 50 schools receiving money to teach classes while integrating something called the 'Good Behavior Game.' Teacher Cami Railey sits at a small table, surrounded by four kids. She’s about to teach them the 's' sound and the 'a' sound. But first, as she does every day, she goes over the rules” (Foden-Vencil, 1/2).

In addition, you can watch a video of KHN’s Julie Appleby on PBS NewsHour Thursday discussing the status of the health law rollout as of Jan. 1. Check out what else is on the blog.

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Political Cartoon: 'A Cautionary Tail?'

Kaiser Health News provides a fresh take on health policy developments with "A Cautionary Tail?" by Chris Wildt.

Here's today's health policy haiku:  

IF A TREE FALLS IN THE FOREST...

If you go to the
doctor, and your health plan works,
will it make the news?
-Anonymous 

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

For The Health Law, Are The First Days The Hardest Ones?

News outlets take a look at how the health law's implementation is working out on the ground during these first days of January.  

The Wall Street Journal: Consumers Hit Snags As Health Law Kicks In
Consumers began test-driving insurance coverage under the federal health-care law Thursday, seeking care at pharmacies and clinics, and in some cases running into hiccups as their policies took effect. Doctors' offices, hospitals and pharmacies said they saw a limited number of people with the new insurance, which kicked in at the beginning of the year (Mathews, Martin and Weaver, 1/2).

Politico: Quiet Start To Noisy Health Law
For a law that’s inspired a lot of noise, the start of Obamacare coverage has been quiet. The health care industry is still trying to diagnose the depth of any implementation issues with the president’s health care program since coverage took effect Jan. 1. Providers, insurers and patient advocates say it’s too early to know whether people are rushing to get care or running into problems when they try to use their new insurance for the first time (Millman, 1/2).

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State Insurance Exchanges Continue To Struggle Even After New Year Deadline

The Washington Post Fact Checker takes a closer look at the health law enrollment target the Obama administration is now backing away from. In the meantime, many states continue to confront insurance exchange challenges even after the crush of customers looking to get coverage to start in January.

The Washington Post's The Fact Checker: The White House's Claim That 7 Million Enrolled In Obamacare 'Was Never Our Target Number'
The White House this week crowed about the fact that, as of the end of the year, 2.1 million Americans have signed up for insurance either through the federal health care exchange or state-run exchanges. The message was that the Affordable Care Act Web site, which had a troubled launch, was turning a corner. At the same time, the administration has backed away from the idea that it suggested that it had a "target" of 7 million enrollees when the enrollment period for 2014 ends in March. As [White House aide Phil] Schiliro put it, "that was never our target number." Let's explore this figure and the administration's enrollment claims (Kessler, 1/3). 

The Associated Press: Health Care Glitch Affects 18K W. Virginia Residents
A state official says a glitch in the federal health insurance marketplace has affected about 18,000 West Virginians trying to sign up for coverage under the Affordable Care Act. Jeremiah Samples of the state Department of Health and Human Resources tells the Charleston Gazette the federal exchange is having problems transferring account information to and from West Virginia's system. He says some other states are having the same problem (1/2).

The Oregonian: Cover Oregon Director Rocky King Resigns Citing Medical Reasons
Rocky King, Cover Oregon's executive director, gave notice of his resignation on Jan. 1, clearing the way for a permanent replacement. King announced his medical leave on Dec. 2, after which Oregon Health Authority Director Bruce Goldberg took over the post on an interim basis. King at the time cited an undisclosed medical condition that had already cost him significant time off work in the previous two years (Budnick, 1/2). 

The CT Mirror: Obamacare Coverage Starts, But Some CT Customers Are Still Waiting
More than 34,000 state residents were slated to begin new private insurance plans Wednesday as part of the federal health law. But as the new year began, many people who bought policies through the state's health insurance exchange still hadn't received their first premium bills, which must be paid by Jan. 10 to get coverage this month. John Calkins, a Watertown insurance agent, is among those getting calls from clients who are "panicking a little bit" (Becker, 1/2).

Minnesota Public Radio: Even After January Coverage Deadline, MNsure Struggles
MNsure's serious problems continue even after Tuesday night's deadline for Minnesotans to sign up for coverage that would take effect Wednesday, Jan. 1. In theory, the end of the deadline rush might have resulted in a let-up in traffic on the site. But people hoping to access MNsure's website on Thursday were stymied for most of the business day (Catlin, 1/2).

The Star Tribune: Login Snag Prompts MNsure Website To Go Offline
Glitches and hitches continue to mar the MNsure website, even as the first of several enrollment deadlines for the state's new online insurance exchange has come and gone. The website went down Thursday about noon with a problem in the login area, MNsure spokesman John Schadl said. Consumers found a message that said: "Application and account services are currently unavailable. We are actively working on a resolution and ask that you visit us at a later time. We apologize for the inconvenience" (Crosby, 1/3).

California Healthline: Exchange Applications Hit Million Mark
Covered California signed up roughly 400,000 people for health insurance through Dec. 22, according to a preliminary estimate of enrollment numbers by Peter Lee, executive director of Covered California. The exchange topped the million mark for enrollment applications in the first three months of open enrollment with an official total of 1,064,872 applications through Dec. 28. The official release of complete December enrollment data is expected in mid-January (Gorn, 1/2).

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Confusion For People Who Enrolled In Medicaid On Healthcare.gov

Some people who applied early in the open enrollment period may not actually be signed up for the program and may be flummoxed by federal robocalls encouraging them to apply again directly to state agencies. Also, news outlets offer updates from Missouri, Pennsylvania and Maryland.  

CQ HealthBeat: Federal Robocalls Urge Medicaid Applicants On Healthcare.Gov To Reapply For Coverage
Most consumers who applied for Medicaid coverage through healthcare.gov soon after the open enrollment period began on Oct. 1 under the health law still have not started receiving health benefits, said state Medicaid officials in two states and a National Association of Medicaid Directors official. People who have applied for Medicaid through healthcare.gov may be confused by federal robocalls that are now encouraging them to apply again through state agencies (Adams, 1/2).

Kaiser Health News: Capsules: Missouri Governor Pushes GOP-Led Legislature On Medicaid Expansion 
Missouri Gov. Jay Nixon, a Democrat, is intensifying his effort to persuade Republican lawmakers to expand Medicaid with a pitch that uses some of the same themes that Republicans favor. At a news conference in his Capitol office this week, Nixon praised states such as Iowa and Arkansas for designing “common-sense, market-based approaches” that encourage personal responsibility on the part of Medicaid participants (Young, 1/2).

The Associated Press: Pa. Issues Warning Over Medicaid File Problems
Pennsylvanians who applied for health insurance through the federally run website Healthcare.gov and were found to be eligible or potentially eligible for Medicaid were cautioned Thursday by Gov. Tom Corbett’s office that they may not have coverage yet.  An administration spokesman said the federal government continues to have trouble transferring the electronic files of more than 25,000 applications to the state’s Department of Public Welfare (Levy, 1/2).

The Baltimore Sun: State Leaders Embrace Medicaid Expansion
Nearly two out of every three people signing up for health care coverage so far on Maryland's troubled insurance exchange qualified for Medicaid — helping the state top its goal for the program's enrollment. Enrolling more lower-income residents in the state and federal insurance program has been embraced by state leaders as a success amid all the exchange's difficulties (Cohn, 1/2).

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Making Lists: Parts Of The Health Law To Note

A variety of lists detail important provisions of the overhaul and how they might impact the public's feelings about it.   

Kaiser Health News: Six Things That May Move Public Perception Of Obamacare
Now, though, most of its major provisions are in effect, and arguments may hinge less on ideology and more on how the law is actually working for millions of people – for instance, how many get coverage through online marketplaces; whether they’re able to see doctors when they need them; how they rate that care; and perhaps most important, whether having that coverage improves their lives in tangible ways. … No question that partisans on both sides will keep spinning, especially in the run-up to the 2014 midterm elections. To help make sense of the challenges ahead, here are six things that are likely to be important measuring sticks of the law in 2014 and beyond (Galewitz, 1/3).

Medpage Today: 6 Things Docs Should Know About The ACA
MedPage Today reached out to a handful of experts to see what they think doctors should know and be aware of as the law's coverage expansion starts. 1. Many new plans will carry extremely high deductibles: Consumers who purchased coverage through the ACA's health insurance exchanges or marketplaces quickly found the cheapest option for them in many cases was "bronze"- or "silver"-level plans. However, those plans have the highest amount of cost-sharing via deductibles and copayments (Pittman, 1/2).

Politico Pro: 5 Key Questions About The Legal Issues Of The Contraception Mandate
The contraceptive coverage issue is already heading to the Supreme Court in two cases brought by for-profit companies. But dozens of religious-affiliated groups, from universities to social welfare organizations, have also petitioned federal courts to eliminate the requirement as well. In all, more than 90 legal challenges have been filed around the country. A Supreme Court decision against the contraceptive rule, whether in a case brought by a religious-affiliated plaintiff or for-profit company, would undercut but not cripple the ACA. Here are five questions and answers on the latest developments (Haberkorn, 1/3).

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Who The Health Law's First Wave Left Behind, And Who It Embraced

Health law coverage includes how the measure's implementation impacts a variety of different populations, as well as other key policy issues.

Kaiser Health News: Obamacare Comes To Skid Row
If you were led blindfolded from Los Angeles’ grand city hall a few blocks east, you would know when you entered Skid Row. There is the pungent smell of urine and burning marijuana smoke, and the sound of music and easy laughter. A carnival rising out of misery. This is the chaos that Chris Mack plunges into on most days. Once homeless himself, Mack is an outreach worker for the JWCH Institute’s Center for Community Health, a free clinic that sits at the heart of Skid Row (Varney, 1/2). 

Kaiser Health News: Many Spanish Speakers Left Behind In First Wave Of Obamacare
In Silicon Valley, the executives and engineers who’ve helped build the Apple, Google and Facebook empires earn high salaries and enjoy a slew of perks, including stellar health benefits. The clients of the Ravenswood Family Health Center, a community clinic in East Palo Alto just two miles away from Facebook’s sprawling headquarters, live in a very different Silicon Valley. They’re the gardeners, nannies, factory workers and service staff who keep Silicon Valley homes and offices humming, the lawns manicured and the families comfortable (Hernandez, 1/3). 

The Associated Press: Adding A Baby To A Health Plan Not Easy
There's another quirk in the Obama administration's new health insurance system: It lacks a way for consumers to quickly and easily update their coverage for the birth of a baby and other common life changes. With regular private insurance, parents just notify the health plan. Insurers will still cover new babies, the administration says, but parents will also have to contact the government at some point later on (Alonso-Zaldivar, 1/3).

Los Angeles Times: Compromise Remains Elusive On Health Law’s Contraceptive Coverage
The intensifying Supreme Court clash over whether birth control should be required under President Obama's signature healthcare law has revealed just how deep divisions remain between administration officials and Catholic leaders over where to draw the line between religious freedom and women's reproductive rights (Savage and Levey, 1/2).

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Koch-Backed Group Launches Ads Against Senators Who Supported Health Law

Americans For Prosperity, a group backed by the billionaire Koch brothers, said it will spend $2.5 million for TV ads targeting three vulnerable Democrats who supported the health care law -- Sens. Kay Hagan of North Carolina, Mary Landrieu of Louisiana and Jeanne Shaheen of New Hampshire. Other groups are using dueling personal stories to try to sway public opinion.

The New York Times: New Ad Campaign Criticizes Senators For Support Of Health Law
A conservative advocacy group backed by the billionaire Koch brothers said Thursday it will spend $2.5 million on television advertisements targeting three vulnerable Democratic senators who supported President Obama’s health care law. Americans for Prosperity, which last year spent more than $16 million on television ads attacking the law popularly called “Obamacare,” is running the ads against Senators Kay Hagan of North Carolina, Mary L. Landrieu of Louisiana and Jeanne Shaheen of New Hampshire, all Democrats who face tough re-election fights this year. They will air on cable and broadcast networks in the three states (Stolberg, 1/2). 

Politico: Americans For Prosperity Launches Obamacare Blitz
The deep-pocketed Americans for Prosperity on Thursday morning unveiled a major Obamacare air offensive against three Democratic senators up for reelection in November. The group will begin airing 30-second ads this week targeting Sens. Mary Landrieu of Louisiana, Kay Hagan of North Carolina and Jeanne Shaheen of New Hampshire. The total ad buy is north of $2.5 million and the spots will run for three weeks in each state’s major media markets, AFP said (Everett, 1/2). 

Los Angeles Times: Next Phase Of The Obamacare Battle: Dueling Personal Stories
Those sorts of dueling stories are the next phase of the battle over Obamacare, and the question of which version Americans will find most compelling could tip the balance in a dozen or so Senate races this year that will determine the balance of power in Washington (Reston, 1/2).

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Insurers Express Concerns About Health Law Fixes

Some insurers are pushing for a nationwide, as opposed to state-by-state, approach to policy fixes to the Affordable Care Act. Many also report that enrollment data errors remain a problem, despite assurances by the Obama administration.

Modern Healthcare: Payers At Odds Over Implementing Obamacare Policy Fixes
Some payers are pushing for nationwide implementation, rather than a state-by-state approach, to Patient Protection and Affordable Care Act policy fixes HHS suggested in December. Others, however, argue for maintaining the status quo to avoid further complications for insurers. The fixes are designed to offset financial losses plans may face after the Obama administration announced it is allowing people to keep plans that do not comply with the benefit standards in the act (Dickson, 1/2).

CQ HealthBeat: Insurers Say Enrollment Data Errors Still A Problem, Despite Officials’ Assurances
Insurance companies continue to find that enrollment information for consumers who sign up for coverage through healthcare.gov is not always being sent on to the insurers, even though federal officials said they have fixed the issue. With enrollment growing, the number of missing enrollment reports could be increasingly problematic (Adams, 1/2).

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Medicaid

Medicaid Expansion Boosted Emergency Room Visits In Oregon, Study Finds

A new study of a 2008 expansion of Oregon's Medicaid program showed those with new coverage used emergency rooms 40 percent more often than other adults, throwing some water on the long-held argument that expanding Medicaid coverage lowers ER usage and boosts primary care visits.

NPR: Medicaid Expansion Boosted Emergency Room Visits In Oregon
Giving poor people health insurance, the belief was, would decrease their dependence on hospital emergency rooms by providing them access to more appropriate, lower-cost primary care. But a study published in the journal Science on Thursday finds that's not the case. When you give people Medicaid, it seems they use both more primary care and more emergency room services (Rovner, 1/2). 

The Oregonian: Oregon Study Finds That Medicaid Coverage Increases Emergency Room Visits
Advocates of universal health coverage have long argued that better access to primary care will lead to a reduction in costly emergency room visits. But a new study conducted in Oregon has found the reverse is true. Researchers poring through hospital administrative records found that expansion of the Medicaid-funded Oregon Health Plan in 2008 led to a 40 percent increase in emergency department usage by people in the 15 months after they enrolled, according to a study released Thursday in the journal Science (Budnick, 1/2).

Los Angeles Times: Expanding Medicaid Increases ER Visits In Oregon Study
An Oregon Medicaid expansion program found that low-income adults who were covered by government health insurance had visited hospital emergency rooms 40 percent more often than other adults. The study, published online Thursday in the journal Science, comes at a time when many states are expanding Medicaid as part of the Affordable Care Act, or Obamacare. While federal and state policymakers have argued that expanding Medicaid would reduce costly and inefficient use of hospital emergency rooms by increasing access to primary healthcare, the Science study suggests this is not the case (Morin, 1/2).

The New York Times: Emergency Visits Seen Increasing With Health Law
Supporters of President Obama’s health care law had predicted that expanding insurance coverage for the poor would reduce costly emergency room visits because people would go to primary care doctors instead. But a rigorous new experiment in Oregon has raised questions about that assumption, finding that newly insured people actually went to the emergency room a good deal more often (Tavernise, 1/2).

The Washington Post's Wonkblog: Study: Expanding Medicaid Doesn’t Reduce ER Trips. It Increases Them. 
As the health care law expands Medicaid to cover millions more Americans, a new Harvard University study finds that enrollment in public program significantly increases enrollees' use of emergency departments. The research, published Thursday in the journal Science, showed a 40 percent increase in emergency department visits among those low-income adults in Oregon who gained Medicaid coverage in 2008 through a state lottery. This runs counter to some health-care law supporters' hope that Medicaid coverage would decrease this type of costly medical care, by making it easier for low income adults to see primary care providers (Kliff, 1/2). 

The Wall Street Journal: Putting The Uninsured On Medicaid Doesn't Cut ER Visits
Some supporters of President Barack Obama's health care overhaul say that putting uninsured Americans on Medicaid will reduce costly emergency-room visits by giving them more access to care in other settings. But a new study found the reverse: A group of 10,000 low-income Oregon residents who recently obtained Medicaid coverage visited ERs 40 percent more often than those without insurance (Beck, 1/2).

The Associated Press: Study Finds Medicaid Expansion Drove Up ER Visits
A new study has found that people enrolled recently in Medicaid went to the emergency room 40 percent more frequently than others, often seeking help for conditions that could be treated less expensively in a doctor's office or an urgent care clinic (Cooper, 1/2).

Marketplace: How Obamacare Will Change The Emergency Room
A new report looking at the Oregon Medicaid program compares emergency room use between the uninsured and people with Medicaid -- the health care program for primarily low income and disabled people. And the report already has pundits worked up, especially with 9 million Americans projected to newly sign up for Medicaid this year under the Affordable Care Act. The reason this is so hot -- at least politically -- is because the report over turns conventional health care thinking (Gorenstein, 1/2).

Medpage Today: Medicaid Growth Burdens EDs
A sudden influx of patients insured through Medicaid was associated with a 40 percent increase in emergency department visits, researchers found. Under a lottery-based Medicaid program in Oregon, Medicaid enrollment increased the probability of visiting an emergency department by 7 percentage points and increased the number of emergency department visits by 40 percent relative to a control mean of 1.02 visits, according to Sarah Taubman, ScD, of the National Bureau of Economic Research in Cambridge, Mass., and colleagues (Petrochko, 1/2).

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Capitol Hill Watch

House Plans Vote On Security Requirements For Health Insurance Exchanges

In what will likely be the GOP's first effort in 2014 to undercut the health law, House Majority Leader Eric Cantor, R-Va., said Thursday he plans to bring up the measure next week.

Politico: Eric Cantor Plans Vote On Obamacare
House Majority Leader Eric Cantor said Thursday that he plans to schedule a vote next week on a measure placing more security requirements on the new Obamacare insurance exchanges. He said he’ll draw from legislation that's been introduced by Reps. Diane Black of Tennessee, Kerry Bentivolio of Michigan and Gus Bilirakis of Florida (Cunningham, 1/2). 

Roll Call: House Will Vote On Obamacare Security Bill Next Week
House Republicans will kick off the second session of the 113th Congress next week by voting on another bill to undercut the president's health care law. In a memo sent to Republican colleagues on Thursday, Majority Leader Eric Cantor, R-Va., announced that the chamber would take up a measure next week to "strengthen security requirements" on the error-plagued HealthCare.gov website and "require prompt notification in the event of a breach involving personal information" (Dumain, 1/2).

CBS News: Obamacare Reform Tops House GOP's Post-Holiday Agenda
Republicans appear ready this year to focus on Obamacare’s shortcomings, and ways to patch over them, rather than make more attempts to repeal the law. A month ago, when asked whether the House would vote on an Obamacare alternative in 2014, all House Speaker John Boehner, R-Ohio, had to say was, "We'll see." Later in the month, Boehner made clear he wasn't interested anymore in listening to conservative groups that convinced the GOP to shut down the government over Obamacare. "They've lost all credibility," he said, getting clearly angry. Outside groups opposed to Obamacare, however, are still waging an aggressive campaign against the law that conservatives hope will pay off in November’s midterm elections (Condon, 1/3).

CNN: GOP-Led House Will Kick Off 2014 Like It Spent Most Of 2013
The GOP-led House of Representatives will kick off 2014 – a midterm election year – addressing an issue it spent much of last year debating: Obamacare. House Majority Leader Eric Cantor announced Thursday the House's first order of business when it returns next week from its extended holiday break would be a vote on legislation to address potential security risks for personal information collected on the Obamacare website, HealthCare.gov (Walsh, 1/2).

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State Watch

State Highlights: Moving Americans Out Of Nursing Homes; Kansas To Get Medicaid Bonus

A selection of health policy stories from the District of Columbia, Kansas, Virginia, Georgia, North Carolina and California.

The Washington Post: D.C. Program Reflects National Trend Toward Moving Older Americans Out Of Nursing Homes
For 60 years, Bobbie Jones, 88, had lived in the same Petworth rowhouse where she raised four children -- including one born in an upstairs bedroom -- and became a grandmother to 10 and a great-grandmother to nine. But last year, a stroke and a fall landed her in the hospital and then in a nursing home. In the past, a nursing home might have wound up being where she lived out the rest of her days. But through a new program that helps District residents receive care in their homes and communities, Jones was able to go home. She is among 58 people who have been relocated since the D.C. Office on Aging launched its Nursing Home Transition Program in April (Bahrampour, 1/2). 

Kansas Health Institute: Kansas To Get $10.8 Million Medicaid Bonus From Feds
Kansas will get $10.8 million in additional Medicaid money from the federal government as a bonus for enrolling more children from low-income homes in state-federal health insurance programs. The award was announced today by officials at the federal Centers for Medicare and Medicaid services. It is part of more than $307 million in bonuses to be paid out to 23 states (1/2).

The Richmond Times-Dispatch: McDonnell Names Mental Health Task Force
Gov. Bob McDonnell has named a task force that will meet for the first time next week to examine the gaps in Virginia's fragmented mental health system and recommend ways to fill them. The 36-member task force will convene Tuesday, less than two months after the son of state Sen. R. Creigh Deeds, D-Bath, attacked his father and then took his own life just 13 hours after being released from an expired emergency custody order (Martz, 1/3).

Georgia Health News: Doctor Shortage Remains Acute In Rural Areas 
Georgia's physician shortage continues to limit patients' access to care, especially in rural areas, a recently released report indicates. But the report by the Georgia Board for Physician Workforce also highlights some promising trends on doctors practicing in Georgia. The state ranked 39th in the ratio of doctors per 100,000 population in 2010, the latest year for which data are available. That’s a slight improvement from Georgia’s 40th-place ranking in 2008 (Miller,1/2).

Charlotte Observer: Doctors Allege For-Proft Owner Of Two Local Hospitals Committed Medicare Fraud And Offered Kickbacks
Echoing other complaints across the country, two Charlotte-area emergency room doctors allege the for-profit company that owns hospitals in Mooresville and Statesville offered them illegal kickbacks to order unnecessary tests and admit more patients to increase corporate revenues (Garloch, 1/2).

WRAL: Chapel Hill Doctor Becomes Cheerleader For Health Law
Although still too early to gauge the impact of the Affordable Care Act on the nation's health care system, one Chapel Hill physician says the law will be a game-changer for his patients. ... Dr. Sam Weir said the goals of the law will mean a lot to UNC Family Medicine Center, where about 2,000 patients -- 11 to 12 percent of the clinic's total -- have no insurance  (Browder, 1/2).

California Healthline: Los Angeles, Orange Counties Grapple With Shortage Of Nursing Instructors
Difficulty in recruiting nursing instructors may be a harbinger of an inadequate supply of nurses in the future, experts said. There are about 408,000 registered nurses statewide, according to the California Institute for Nursing and Health Care. For registered nursing, the projected rate of growth in employment between 2010 and 2020 is 26 percent, according to the U.S. Dept. of Labor Bureau of Labor Statistics -- faster than the 14 percent average growth rate for all occupations (Stephens, 1/2).

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Health Policy Research

Research Roundup: A Primer On Medicaid Expansion; Health Costs Of Smokers, Churn In The Individual Insurance Market

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

Annals Of Internal Medicine: Health Policy Basics: Medicaid Expansion
Medicaid is the largest single source of health insurance coverage in the United States, providing insurance for more than 62 million persons and families in 2013. The Patient Protection and Affordable Care Act sought to expand Medicaid eligibility to nearly all low-income persons with incomes up to 138% of the federal poverty level. However, the U.S. Supreme Court ruled that states' expansion would be optional. Although more than half of the states and the District of Columbia have opted to expand Medicaid starting in 2014, many states continue to oppose increasing access to the program. This article will discuss the basic provisions of the expansion and the benefits and challenges patients and physicians may face as Medicaid grows (Crowley and Golden, 12/24).

JAMA Internal Medicine: Preoperative Consultations For Medicare Patients Undergoing Cataract Surgery
Low-risk elective surgical procedures are common, but there are no clear guidelines for when preoperative consultations are required. Such consultations may therefore represent a substantial discretionary service. ... Cohort study using a 5% national random sample of Medicare part B claims data including a cohort of 556,637 patients 66 years or older who underwent cataract surgery from 1995 to 2006. ... The frequency of preoperative consultations increased from 11.3% in 1998 to 18.4% in 2006..... Variation in frequency of consultation across hospital referral regions was substantial, even after accounting for differences in patient-level, anesthesia provider–level, and facility-level characteristics. ... Referrals for consultation seem to be primarily driven by nonmedical factors (Thilen et al., 12/23).

JAMA Surgery: Smoking Status And Health Care Costs In The Perioperative Period
Cigarette smoking increases complication risk in surgical patients, but the potential effects of smoking status on perioperative health care costs are unclear. ... This population-based, propensity-matched cohort study, with cohort membership based on smoking status (current smokers, former smokers, and never smokers) was performed at Mayo Clinic in Rochester ... Compared with never smokers, health care costs during the first year after hospital discharge for an inpatient surgical procedure are higher in both former and current smokers, although the cost of the index hospitalization is not affected by smoking status (Warner et al., 1/1).

JAMA Psychiatry: Race/Ethnicity And Geographic Access To Medicaid Substance Use Disorder Treatment Facilities In The United States
Although substance use disorders (SUDs) are prevalent and associated with adverse consequences, treatment rates remain low. ... We used data from the 2009 National Survey of Substance Abuse Treatment Services public use file and the 2011-2012 Area Resource file to examine sociodemographic factors associated with county-level access to SUD treatment facilities that serve Medicaid enrollees. ...  Approximately 60% of US counties have at least 1 outpatient SUD facility that accepts Medicaid, although this rate is lower in many Southern and Midwestern states. ... The potential for increasing access to SUD treatment via Medicaid expansion may be tempered by the local availability of facilities to provide care, particularly for counties with a high percentage of black and/or uninsured residents and for rural counties (Cummings, Wen, Ko and Druss, 12/25).

JAMA Psychiatry: Comorbidity Of Severe Psychotic Disorders With Measures Of Substance Use
Although early mortality in severe psychiatric illness is linked to smoking and alcohol, to our knowledge, no studies have comprehensively characterized substance use behavior in severe psychotic illness. In particular, recent assessments of substance use in individuals with mental illness are based on population surveys that do not include individuals with severe psychotic illness. ... We assessed comorbidity between substance use and severe psychotic disorders in the Genomic Psychiatry Cohort. ... Relative to the general population, individuals with severe psychotic disorders have increased risks for smoking, heavy alcohol use, heavy marijuana use and recreational drug use.... Of specific concern, recent public health efforts that have successfully decreased smoking among individuals younger than age 30 years appear to have been ineffective among individuals with severe psychotic illness (Hartz et al., 1/1).

The Kaiser Family Foundation: Data Note: How Many People Have Nongroup Health Insurance?
The implementation of the Affordable Care Act (ACA) has focused attention on the composition of the nongroup market: how it looked before the new regulatory provisions take effect and how it will change afterwards. ... The pre-reform nongroup market is complicated. It was fairly small, serving less than 5 percent of the nonelderly population, with a much smaller population relying on the nongroup market as their only source of coverage. In addition, the nongroup market experiences substantial turnover. ... The turnover in, and varied populations served by, the pre-reform nongroup market have posed challenges for analysts and others trying to understand the changes occurring under the ACA. The number of people who have and keep nongroup coverage as their primary source of protection is considerably smaller than the number of people in the market at any given point in time. A considerably larger number of people have nongroup coverage sometime during a year, but many have short tenures and may or may not experience any of the changes underway. Looking forward, the size of the market is predicted to grow dramatically as millions of uninsured people, many assisted by new premium tax credits, obtain and retain nongroup coverage (Claxton, Levitt, Damico and Rae, 1/3).

American Journal of Critical Care: Association Of Sleep And Fatigue With Decision Regret Among Critical Care Nurses 
Fatigued nurses are more likely than well-rested nurses to make faulty decisions that lead to decision regret, a negative cognitive emotion that occurs when the actual outcome differs from the desired or expected outcome. ... Nurses with decision regret reported more fatigue, more daytime sleepiness, less intershift recovery, and worse sleep quality than did nurses without decision regret. Being male, working a 12-hour shift, and clinical-decision satisfaction were significantly associated with decision regret (Scott, Arslanian-Engoren, Engoren, Jan. 2014).

Journal of General Internal Medicine: National Study Of Health Insurance Type And Reasons For Emergency Department Use
This was a cross-sectional analysis of the 2011 National Health Interview Survey. Adults whose last ED visit did not result in hospitalization (n = 4,606) were asked structured questions about reasons for seeking ED care. We classified responses as 1) perceived need for immediate evaluation (acuity issues), or 2) barriers to accessing outpatient services (access issues). ... Relative to those with private insurance, adults with Medicaid and those with Medicare were similarly likely to seek ED care due to an acuity issue. Adults with Medicaid and Medicaid + Medicare (dual eligible) were more likely than those with private insurance to seek ED care for access issues. ... Policymakers should focus on increasing access to alternate sites of care, particularly for Medicaid beneficiaries, as well as strategies to increase care coordination that involve ED patients and providers (Capp et al., 12/2013).

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

The New York Times: Common Knee Surgery Does Very Little For Some, Study Suggests
A popular surgical procedure worked no better than fake operations in helping people with one type of common knee problem, suggesting that thousands of people may be undergoing unnecessary surgery, a new study in The New England Journal of Medicine reports. The unusual study involved people with a torn meniscus, crescent-shaped cartilage that helps cushion and stabilize knees. Arthroscopic surgery on the meniscus is the most common orthopedic procedure in the United States, performed, the study said, about 700,000 times a year at an estimated cost of $4 billion (Belluck, 12/25).

MedPage Today: USPSTF Finalizes Lung Screening Recs
Annual low-dose CT screening for lung cancer is recommended for high-risk individuals, the U.S. Preventive Services Task Force (USPSTF) announced. The final grade B recommendation [is] for adults ages 55 through 79 with a 30 pack-year history of smoking or who have quit in the past 15 years ... The draft had included in the clinical considerations section a recommendation against screening individuals with significant comorbidity, especially those nearing the age cutoff of 80. The final recommendation, published online Monday in Annals of Internal Medicine, ... repeated it again in the main body of the document (Phend, 12/30/13).

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Editorials and Opinions

Viewpoints: Stop 'Bailout' Of Obamacare; Health Law Not To Blame For All Insurance Woes; 'Theft' Of Medicare Advantage Money

The Washington Post: Stop The Bailout — Now 
Shrinking revenues and rising costs could bring on the "death spiral" — an unbalanced patient pool forcing huge premium increases (to restore revenue) that would further unbalance the patient pool as the young and healthy drop out. End result? Insolvency — before which the insurance companies will pull out of Obamacare. Solution? A huge government bailout. It's Obamacare's escape hatch. And — surprise, surprise — it's already baked into the law. Which is why the GOP needs to act (Charles Krauthammer, 1/2).

The Washington Post: The Affordable Care Act Is Here To Stay
Opponents of the law can hardly advocate going back to a system in which those who really need insurance can't get it. What they can do, and surely will, is make lots of noise by pretending that any problem with anyone's health insurance is due to the Affordable Care Act. Before Obamacare, millions of Americans had their policies canceled by the insurance companies every year. Millions more had their premiums raised, their coverage reduced or both. Now when these things happen, critics will try to blame the new law. ... The real problem with the ACA, and let's be honest, is that it doesn't go far enough (Eugene Robinson, 1/2).

The Washington Post's The Plum Line: The Three Stages Of Obamacare Acceptance
Now that Obamacare is clearly moving forward, Republicans are adjusting to a new reality: it may no longer be a realistic option to simply wait until the law collapses under its own weight and vanishes entirely. GOP lawmakers are increasingly discussing a range of responses, from proposing profound changes to finally embracing a comprehensive alternative. Which raises a question: Is it possible to envision a future in which Republicans and Democrats do enter into real negotiations over the future of the law and the health system, in which each side gets some changes it wants, in exchange for accepting some of the other's proposed changes? (Greg Sargent, 1/2). 

The New York Times: No Burden on Religion
Adding a level of absurdity to the controversy, Little Sisters of the Poor’s insurance plan qualifies as a self-insured "church plan" under an insurance statute known as Erisa. The Justice Department has conceded that it has no authority to compel a third-party administrator of such a plan to provide contraceptive coverage. In this case, contraceptives would not be made available even indirectly to the nuns' employees. Like the cases of the private employers, the suit by the nuns' group boils down to an unjustified attempt by an employer to impose its religious views on workers (1/2).

The New York Times' Economix: Medicare Advantage And The 'Theft' Of $156 Billion
A theft of $156 billion should catch one's attention, especially if government is the thief. It warrants a closer look. For starters, what is the time frame of this $156 billion "theft"? Greater clarity on this point would have been helpful, lest readers think that this is an annual figure. In fact, it is the sum of projected future annual cuts off projected future total payments to Medicare Advantage plans over the decade 2013-2022 (see line 8 of Table 2, page 5 in this Congressional Budget Office projection). That point aside, what the Affordable Care Act has done to the Medicare Advantage plans lies, like beauty, in the eyes of the beholder (Uwe E. Reinhardt, 1/3).

Forbes: New Oregon Data: Expanding Medicaid Increases Usage Of Emergency Rooms, Undermining Central Rationale For Obamacare
For years, it has been the number one talking point of Obamacare supporters. People who are uninsured end up getting costly care from hospitals' emergency rooms. "Those of us with health insurance are also paying a hidden and growing tax for those without it—about $1,000 per year that pays for [the uninsureds'] emergency room and charitable care," said President Obama in 2009. Obamacare, the President told us, would solve that problem by covering the uninsured, thereby driving premiums down. A new study, published in the journal Science, definitively reaches the opposite conclusion. In Oregon, people who gained coverage through Medicaid used the emergency room 40 percent more than those who were uninsured (Avik Roy, 1/2).

NBC News: How Not To Argue Against Medicaid Expansion
There are, by everyone's estimation, several hundred thousand folks in Mississippi who would benefit from Medicaid expansion. According to [Gov. Phil] Bryant, the state could help them, but he doesn't want to – because in his mind, Congress might repeal the health care law at some point in the future, and the state wouldn't be able to afford to pick up the slack. But even by GOP standards, it's impossible to take this seriously. For one thing, it's pretty obvious Congress isn't going to repeal the law, as even the most right-wing lawmakers on Capitol Hill are grudgingly conceding. For another, even in the extraordinarily unlikely event that the law is repealed sometime after 2017, Mississippi could simply revert back to its current policy once the federal well runs dry (Steve Benen, 1/2).

Journal of the American Medical Association: Realizing The Promise Of The Affordable Care Act—January 1, 2014
Never has the landscape of US health care changed so dramatically in a single day as on January 1, 2014. The challenges facing the HealthCare.gov website notwithstanding, the implementation of key provisions of the ACA will proceed apace in the upcoming year. Whether one cheers or jeers the transformational events of January 1, 2014, the US health care system will never be the same again (John E. McDonough and Dr. Eli Y. Adashi, 1/2).

Politico Magazine: Not One Penny In New Debt For Obamacare
There has been much acrimony and infighting within the Republican Party of late. But in the coming year, there are many upcoming battles that should be able to unite the party, most prominently, the effort to repeal the Affordable Care Act, more commonly known as Obamacare. Republicans agree that Obamacare must be repealed and replaced with policies that eliminate the burdensome interventions that drive up the cost of healthcare. And as the national debt continues to soar over $17 trillion, there must be an immediate push to reduce the size of government. That means there is no better opportunity to unite in the fight against both Obamacare and the growing national debt than with the upcoming debt-ceiling deadline in February (Ryun, 1/2).

And on other issues -

Los Angeles Times: The Gap In Medical Education
Since its inception more than a century ago, modern medical education has undergone a series of quiet revolutions, stretching and scaling to accommodate advances in biomedical science. Yet this comprehensive expansion in one critical area masks a relative neglect of another. Despite their staggering scope — spanning genetics to geriatrics, and everything in between — medical curricula today largely omit training on health policy (Rahul Rehki, 1/3). 

Los Angeles Times: Polio's War Foothold
Once virtually eradicated, polio again stalks the Horn of Africa, the Middle East and South Asia. The innocent victims are mostly young children. The perpetrators are insurgents and indifferent governments. The polio resurgence is preventable and it is time to pull out an old but proven technique to halt its spread: Days of Tranquility (Nancy A. Aossey and William Garvelink, 1/3). 

Bloomberg: Make Those Cows Pay For Their Penicillin
America's animals take more drugs than its people do. About 80 percent of the 51 tons of antibiotics consumed each day in the U.S. are used in agriculture and aquaculture. Such unrestrained use of the drugs may help farmers grow bigger cattle, but it has a drastic side effect: It prods bacteria to evolve defenses, so that the drugs don’t work so well when given to people (or fish or animals, for that matter) suffering from bacterial infections. The loss of these drugs as medical weapons is also astoundingly expensive. The current stock’s potential to prolong human life is worth upward of $60 trillion, according to a new report in the New England Journal of Medicine. And so it is welcome news that the authors of that report also have a novel way to protect this pharmaceutical treasure: Impose a fee on all uses of antibiotics outside of human medicine. Their market-based strategy is worth a try (1/2).

The Star Tribune: Let's Have A Full Debate On Medicaid Costs, Changes
Gov. Mark Dayton made a compassionate and politically savvy decision this week when he asked state officials to delay for a year cost-saving changes that would have phased in reduced home and nursing care for about 3,300 Minnesotans in 2014. ... It also gives the 2014 Legislature time to reconsider the long-delayed changes — expected to save about $50 million over the next four years — that were passed with bipartisan support in 2009 as legislators and then-Gov. Tim Pawlenty grappled with sobering budget deficits and soaring Medicaid costs (1/2).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Ankita Rao
Marissa Evans

The Kaiser Daily Health Policy Report is published by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. (c) 2012 Kaiser Health News. All rights reserved.