Daily Health Policy Report

Thursday, January 30, 2014

Last updated: Thu, Jan 30

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

The Health Law's '3 Rs' For Insurers: A Bailout Or Necessary Safeguards?

Kaiser Health News staff writer Mary Agnes Carey reports: "Three provisions in the health law that proponents say are designed to help insurers manage the financial risk of taking all comers while keeping premiums affordable are under fire on Capitol Hill, with Republicans labeling them as giveaways to the health insurance industry" (Carey, 1/30). Read the story.

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Capsules: Health Law A Tough Sell To Uninsured; Study: Little Evidence Of Better Care At Expensive Hospitals; WellPoint Discloses Big Sign-Ups Through Health Exchanges; Parsing The President’s 9 Million Enrollees

Now on Kaiser Health News' blog, Jordan Rau reports on a new tracking poll that finds that the people the health law was designed to help the most are becoming more critical of it: "This month’s tracking poll from the Kaiser Family Foundation found that 47 percent of the uninsured said they hold unfavorable views of the law while 24 percent said they liked it. These negative views have increased since December, when 43 percent of the uninsured panned the law and 36 percent liked it. (KHN is an editorially independent program of the Foundation)" (Rau, 1/30). 

Also on Capsules, Rau writes about a study examining quality of care at expensive hospitals: "The actual prices insurers pay hospitals are closely guarded secrets in health care. That has made it hard for health researchers to study one of the most important issues: whether patients get better treatments from more expensive hospitals. Hospital list prices, which Medicare published last year, provide no indication about how much hospitals actually are compensated by private insurers" (Rau, 1/29). 

In addition, Jay Hancock reports that WellPoint disclosed higher-than expected early membership growth through the health law's new exchanges: "The biggest player in the Affordable Care Act's online insurance marketplaces delivered encouraging news to Obamacare supporters Wednesday" (Hancock, 1/29). 

And Julie Appleby parses the 9 million Obamacare enrollment number: "That total is important to supporters as a sign that the law is working — and as an indication of the difficulties Republicans would face to rescind the law or roll back certain provisions. Critics have pointed out that 9 million isn't a huge number — and that some of those people, perhaps even many of them, were previously insured" (Appleby, 1/29). Check out what else is on the blog.

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Political Cartoon: 'Man's Best Friend?'

Kaiser Health News provides a fresh take on health policy developments with "Man's Best Friend?" by Bruce Bolinger.

And here's today's health policy haiku:


Doc looks at my cut,
He reaches for a bandage,
Nurse, what CPT?
-Sonya Nasim

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

WellPoint Is Bullish On Enrollment Trends

Health insurer WellPoint, the biggest player in the health law's online marketplaces, reported Wednesday that it has enrolled 500,000 people nationwide and their demographics match the company's projections.

Los Angeles Times: WellPoint Enrolls 500,000 In Obamacare Policies, Upbeat About Trends
Health insurance giant WellPoint Inc. has signed up 500,000 people for Obamacare policies across the country, and it struck an upbeat tone about early enrollment trends under the healthcare law. WellPoint, which runs Anthem Blue Cross plans in California and 13 other states, said new enrollees tend to be older than current customers but that enrollment is in line with its projections and pricing for the new policies (Terhune, 1/29).

The Wall Street Journal: WellPoint Says Health-Law Customers Match Projections
The insurer's experience is being closely watched because of its big position in the new government marketplaces. The Indianapolis-based company has been the biggest provider of individual plans and is selling them through the government marketplaces in 14 states, including New York and California (Mathews, 1/29).

Kaiser Health News: Capsules: WellPoint Discloses Big Sign-Ups Through Health Exchanges
The biggest player in the Affordable Care Act's online insurance marketplaces delivered encouraging news to Obamacare supporters Wednesday (Hancock, 1/29).

Reuters: WellPoint Says Health Exchange Applicants Hit Expectations
U.S. health insurer WellPoint Inc. said on Wednesday the applicants for the new Obamacare health plans are of the age and demographics it had expected, indicating that medical costs will not soar beyond the prices it charges. WellPoint, which released lower fourth-quarter results on Wednesday, said that based on age, insurance plan selection, income levels, gender and available pharmacy data, it believes it has set the right premium rates for these new customers (Humer, 1/29).

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For Some State Legislatures, Medicaid Expansion Will Be A Hot 2014 Topic

News outlets also report on the continuing debate over how to proceed in Virginia and Nebraska.  

The Washington Post’s WonkBlog: The Four Most Important States To Watch On Obamacare's Medicaid Expansion
With state legislatures kicking off their 2014 sessions, the Medicaid expansion is back in play. Twenty-six states had signed onto the Medicaid expansion at the start of this year -- and that leaves nearly half the country deciding whether to make a go of it in the future. In some states, there's little discussion of the Medicaid expansion. There are states that rejected it in 2013 and will probably reject it in 2014. But in a handful of states, there's a debate slowly starting about the best way to move forward in this area. Here are a few states that Wonkblog will be keeping an eye on in coming months (Kliff, 1/29).

The Richmond Times-Dispatch:  VCU, U.Va. Health Systems Urge State To Expand Medicaid
The Virginia Commonwealth University and University of Virginia health systems say their ability to serve low-income patients and educate future doctors could be in jeopardy if the state fails to expand its Medicaid program to serve 250,000 uninsured Virginians who otherwise may end up in their emergency rooms. Officials for the academic medical centers estimated Wednesday that the state would save more than $1 billion over nine years if Virginia expands Medicaid this year and warned that they face more than $400 million in reduced federal subsidies for indigent care from mid-2016 to mid-2022. “The reductions in all of this create a critical shortfall, and filling the shortfall is of paramount importance if our academic health centers are going to remain true to our mission,” said Dr. Sheldon M. Retchin, chief executive officer of VCU Health System and senior vice present for health sciences, in a presentation to the House Appropriations Committee (Martz, 1/30).

The Associated Press: Backers Of Expanded Medicaid In Nebraska Pack Legislative Hearing To Push For New Proposal
A new bill to expand Medicaid drew support Wednesday from Nebraska health care providers and advocates for the poor but faced opposition from conservative taxpayer groups and Gov. Dave Heineman's administration. Supporters packed a legislative hearing at the Capitol and spoke for more than three hours in favor of the proposal, an optional piece of the federal health care law (Schulte, 1/29).

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Minn. Workers Got Bonuses For Work On Troubled Exchange; Colo. Reports Robust Jan. Enrollment

The Minneapolis Star Tribune reports on the bonuses awarded to 14 managers before the insurance website went live. In other state marketplace news, Colorado officials say about 67,000 people and businesses signed up for coverage this month. Exchanges also make news in Maryland, Massachusetts and Oregon.

The Star Tribune: 14 MNsure Managers Got Bonuses For Work On Balky Website
As the state rolled out its troubled health insurance exchange, MNsure managers received bonus pay totaling $26,354 for work done in the three months leading up to the Oct. 1 launch. In all, 14 managers were awarded lump-sum payments that ranged from 1.5 to 2.5 percent of their annual salaries, according to state data. It was based on work done from July 1 to Sept. 30. Former Executive Director April Todd-Malmlov, who resigned in December in the midst of the problems, did not receive a bonus (Crosby, 1/30).

Health News Colorado: January Health Sign-Ups Robust, Board Wants Better Data
January sign-ups for Colorado's health exchange have been more robust than managers expected with a total of about 67,000 individuals or small business employees signed up for private health exchange through late January. Managers for Colorado's exchange, Connect for Health Colorado, expected January sign-ups to slow considerably after a big rush to buy health insurance in December. But about 15,000 additional Colorado customers have bought private health plans this month, managers said  (McCrimmon, 1/29).

Health News Colorado: Insurance Upstart Captures 10 Percent Of Exchange Market
The Colorado HealthOP, a new member-run health insurance co-op, said nearly 7,500 patients have signed up so far for its new health insurance plans. "It's really a vote of confidence for a consumer-operated health plan. People are interested in taking control of their health and health care, and are hungry for a different model," said Julia Hutchins, CEO of the HealthOP. The HealthOP is the only insurance carrier in Colorado to release its enrollment numbers since Colorado's exchange opened on Oct. 1 (McCrimmon, 1/29).

The Associated Press/Washington Post: O’Malley To Sign Bill On Health Exchange Problems
A measure to help people get health insurance retroactive to Jan. 1, if problems with a state website kept them from doing so, will be taking effect. Gov. Martin O’Malley is scheduled to sign emergency legislation on Thursday in Annapolis to put it into effect immediately (1/30).

WBUR: State's Health Care Website Draws Criticism
Anna Eves paid $1,065 in late December for private insurance through the Connector. In January, the bank confirmed that the Connector had cashed her check, but she had not received any information about an insurance plan, so she called the Connector. "The girl there said, 'Yep, we got your check, but you're not covered,'" Eves said. ... Now even longtime supporters of Massachusetts’ landmark effort to cover uninsured residents say the state’s performance is unacceptable (Bebinger, 1/30).

The Lund Report: Parrish And Shields Want Lawmakers Insured Through Cover Oregon
In a short but busy February legislative session, state legislators would get their insurance through Cover Oregon under one proposed bill while legislators have introduced a second bill designed to prevent future government debacles like the one that befell this fall's rollout of the state health insurance exchange (Gray, 1/28).

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Study Finds Health Law May Reduce Income Inequality

New research suggests the health law will boost the economic fortunes of people on the bottom one-fifth of the income ladder while slightly reducing average incomes for those above. Other stories look at a health plan cost calculator designed for the chronically ill, the debate over insurance risk corridors and union displeasure with the law.

The Associated Press: Big Impact On Income Gap Is Health Law’s New Angle
Maybe the health care law was about wealth transfer, after all. New research shows that the Affordable Care Act will significantly boost the economic fortunes of those in the bottom one-fifth of the income ladder while slightly reducing average incomes on the rungs above (Alonso-Zaldivar, 1/29).

Health News Colorado: Health Cost Calculator Aims To Help Chronically Ill, Disabled
Chronically ill and disabled patients who need a lot of medications and care from doctors should be careful about which health plans they pick. Insurance that appears more affordable on the surface may in fact force patients who need a great deal of care to pay costly out-of-pocket expenses. That’s the warning from the national patient advocacy group, the National Health Council, which has created a new cost calculator on its website, Putting Patients First (McCrimmon, 1/29).

Kaiser Health News: The Health Law's '3 Rs' For Insurers: A Bailout Or Necessary Safeguards?
Three provisions in the health law that proponents say are designed to help insurers manage the financial risk of taking all comers while keeping premiums affordable are under fire on Capitol Hill, with Republicans labeling them as giveaways to the health insurance industry (Carey, 1/30).

Fox News: Labor Unions 'Bitterly Disappointed' With Proposed Obamacare Regulations
Leaders of major labor unions are pushing back against proposed regulatory changes that could affect some union-sponsored health plans under ObamaCare, arguing the proposals do nothing to help workers suffering under the law. In a letter to Senate Majority Leader Harry Reid, D-Nev., and House Minority Leader Nancy Pelosi, D-Calif., the presidents of two high-profile labor unions said they are "bitterly disappointed" with the administration's proposed rules, The Hill reported. Terry O'Sullivan, president of the Laborers’ International Union of North America, and D. Taylor, president of Unite Here said the administration has failed to address their concerns about union plans and that ObamaCare threatens to lower the standard of living for the working class (1/30).

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Questions Linger About 9 Million People Said To Get Insurance Through Health Law

In his State of the Union address, the president touted successes in signing people up for private insurance or Medicaid. But critics say that the number is lower than expected, and no one yet knows how many of them were previously uninsured.

Marketplace: State Of The Union: Fact Checking Obama On The ACA
"More than 9 million Americans have signed up for private health insurance or Medicaid coverage," President Obama said during last night's State of the Union address. In a speech that touched on income inequality, wages, jobs, and the U.S. middle class, Obama touted his signature domestic policy achievement. But is that 9 million figure accurate? (Gorenstein, 1/29).

Kaiser Health News: Capsules: Parsing The President's 9 Million Enrollees
That total is important to supporters as a sign that the law is working — and as an indication of the difficulties Republicans would face to rescind the law or roll back certain provisions. Critics have pointed out that 9 million isn't a huge number — and that some of those people, perhaps even many of them, were previously insured (Appleby, 1/29).

The Wall Street Journal: Obama Travels To Promote State-Of-The-Union Message
Republicans, who complain Mr. Obama is going too far by carrying out some of his ideas through executive order instead of legislation, offered no signs Tuesday night of embracing the president's economic agenda. Many are still intent on criticizing the health law, which so far has made six million people eligible for Medicaid and prompted the enrollment of three million people through private-insurance plans and given the GOP something to rally against. "He doesn't recognize that he is actually part of the problem in terms of incredibly slow economic growth," Rep. Peter Roskam (R., Ill.), the House GOP deputy whip, told a Chicago radio station on Wednesday (Lee and Nicholas, 1/29).

The Washington Post: Affordable Care Act 'Success Story' At State Of The Union Needed Extra Help To Sign Up
A few weeks ago, Rep. Donna F. Edwards (D-Md.) invited a guest to President Obama's State of the Union address: Lorita Katherine Waltz, a 49-year-old nurse from Prince George's County who the congresswoman considers an Affordable Care Act "success story." But Waltz's family did not become enrolled in a new insurance plan until Tuesday — the day of the president's address — after weeks of trying and only with help from state leaders (Johnson, 1/29).

The Fiscal Times: Editing Obamacare: The GOP Tries a Different Tack
President Obama lashed out at Republicans in his State of the Union address Tuesday night for continuing to wage war on his health care law instead of offering solutions to fix it. "Let’s not have another forty-something votes to repeal a law that’s already helping millions of Americans," the president said. "The first forty were plenty.  We got it." That statement may be one of the rare areas where the GOP is actually starting to agree with the president. Earlier this week, three Senate Republicans unveiled the GOPs first-ever real proposal to replace Obamacare (Ehley, 1/30). 

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Poll: Health Law Support Declining Among The Uninsured

The Kaiser Family Foundation's monthly tracking poll found that 47 percent of the uninsured said they have unfavorable views of the law -- an increase since December. Most were also unaware of many of the law's benefits.

The Washington Post: Health-Care Law Loses Support Among Uninsured, Poll Shows
Support for the health-care law declined among the uninsured this month, just as many of the program’s key provisions went into effect, according to a new poll examining Americans’ knowledge and views of the Affordable Care Act. Large numbers of the uninsured are also unaware of some of the law’s benefits, such as subsidies to help low- and middle-income people pay monthly health insurance premiums, according to the Kaiser Family Foundation survey. Fifty-three percent of uninsured Americans are unaware of the law’s bar on insurance companies rejecting people with preexisting conditions (Somashekhar, 1/30).

Kaiser Health News: Capsules: Health Law A Tough Sell To Uninsured
This month’s tracking poll from the Kaiser Family Foundation found that 47 percent of the uninsured said they hold unfavorable views of the law while 24 percent said they liked it. These negative views have increased since December, when 43 percent of the uninsured panned the law and 36 percent liked it. (KHN is an editorially independent program of the Foundation) (Rau, 1/30).

A Gallup poll found that more than half of the uninsured plan to get coverage through a government exchange -

The Hill: More Uninsured Plan To Get Health Insurance Through Exchanges
More than half of people who lack health insurance in the United States say they plan to get it through a government exchange, a Gallup poll released Thursday found.  According to the poll, 56 percent of the uninsured plan to get health insurance through ObamaCare (Shabad, 1/30).

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Capitol Hill Watch

The Health Law Factors Heavily Into Senate Political Calculations

Vulnerable Senate Democrats may seek chances to vote on efforts to fix the overhaul, CQ HealthBeat reports; while the New York Times examines where GOP candidates need to win.  

CQ HealthBeat: Senate Democrats Might Vote On Fixes In The Health Care Law
Senate Democrats, who have the most to lose from the lingering negative feelings about the health care law, may have the chance to cast votes on fixing the overhaul this year. The votes would give vulnerable Democrats the opportunity to go on the record as trying to help constituents who have been affected by the law’s requirements or its troubled rollout (Ethridge, 1/29).

The New York Times: Unpopularity Of The House Could Turn Senate Races
Republicans start this election year with the strongest hand they have had since 2010: a Democratic president with weak approval ratings, an economy still struggling to spread the benefits of a slow recovery, the disastrous rollout of President Obama’s health care law, contested races for six Democratically held Senate seats in states carried by Mitt Romney, and the historical pattern that the party controlling the White House loses seats in a second midterm. But to take control of the Senate, Republicans need to net six seats, and they will probably need to do it with candidates currently serving in House seats in Montana, Louisiana, Arkansas, West Virginia and Georgia (Weisman, 1/29).

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State Watch

State Highlights: N.Y. Insurer Will Reinstate Young Adult Coverage

A selection of health policy stories from New York, California, Virginia, South Carolina, Connecticut, Florida, Kansas, Minnesota, Michigan, Georgia and Colorado.

The Associated Press/Wall Street Journal: NY Insurer Agrees To Reinstate Offspring Coverage
A New York insurer has agreed to reinstate health coverage for up to 8,300 young adults who were dropped from their parents' policies before they turned 30. Under an agreement with the state attorney general, EmblemHealth Inc. also said it will pay approximately 175 claims for about $90,000 for unreimbursed medical treatment. While federal law authorizes keeping children on their parents' health insurance until they turn 26, New York requires insurers to offer that continuing coverage until age 30. The agreement signed this week also requires EmblemHealth to pay the attorney general $100,000 as a civil penalty (1/29).

The Washington Post: San Francisco Thinks Obamacare Can Cut Costs, Crime Rates
Across the country, an estimated 90 percent of those in county jails don’t have health insurance. About the same number would qualify for subsidized health-care coverage under the Affordable Care Act. And those prisoners are more susceptible to chronic illnesses that, without treatment once they are freed, cost millions in emergency room visits. Now, the San Francisco Sheriff’s Department thinks it can help cut costs -- and reduce recidivism rates -- by signing up many of the 31,000 people it books in jail every year for coverage under Obamacare (Wilson, 1/29).

The Washington Post: Virginia House Panel Backs Proposal On Finding Psychiatric Beds
In Virginia, a proposal to give mental health workers more time to find beds for people who need immediate psychiatric care cleared a House subcommittee Wednesday, as lawmakers move swiftly to respond to an attack on Sen. R. Creigh Deeds by his son. A House Courts of Justice subcommittee cleared several proposals, including one to extend the current time limit of six hours to find psychiatric beds for individuals in crisis by two hours, and if a bed cannot be found by that deadline, to require state facilities to provide a bed of last resort (Shin, 1/29). 

The New York Times: New York State Recommends Expanding License Of Health Agency With Checkered Past
It was a medical scheme that shocked the public conscience when it came to light in 2001: Two dozen mentally ill residents of a Queens adult home were forced to have unnecessary prostate surgery that generated tens of thousands of dollars in government fees (Bernstein, 1/29).

The Associated Press: S.C. Medicaid Agency Posts Hospitals Financial Data
South Carolina's Medicaid agency on Monday introduced an easy-to-navigate website showing the financial data of the state's 60 hospitals that will eventually allow patients to comparison shop for health care. The agency's multi-stage project is aimed at bringing transparency to healthcare costs, ultimately driving costs down, by posting data online so that it's easy to access and interpret, said Director Tony Keck (1/29).

The CT Mirror: Free Dental Clinic Coming To Hartford After All
Although it seemed unlikely months ago, the Connecticut Mission of Mercy free dental clinic is coming to Hartford this spring, with plans to provide free care to more than 2,200 people. Organizers had tried in the past to hold a clinic in Hartford but couldn’t find a venue they could afford. But after news coverage and intervention from city officials and a U.S. senator, clinic organizers reached an agreement with the publicly owned XL Center to rent the facility at a discounted rate (Becker, 1/29).

Health News Florida: Scott Wants More Cancer Centers
Cancer hospitals vying to earn National Cancer Institute designation would get $60 million next year under a budget proposal being released by Florida Gov. Rick Scott today. Scott, who is running for a second term as governor, made Tampa’s Moffitt Cancer Center the final stop of his “It’s Your Money Tax Cut Budget” tour on Tuesday (Shedden, 1/29).

Kansas Health Institute: Corrections Department Plan Would Help County Jails Gain Access To Medicaid
The Kansas Department of Corrections is working with local law enforcement officials on a plan that would help county jail keepers bill Medicaid for a portion of their inmates' health care costs. The move could save Kansas jails between $1.2 million and $2.4 million a year, said Viola Riggin, director of health care services at the Kansas Department of Corrections (Ranney, 1/29).

Minnesota Public Radio: 'Structural Racism' Blamed For Some Of State's Severe Health Disparities
Minnesota's infant mortality rate is among the best in the country. Dig a little deeper, though, and the data reveal African-American babies are twice as likely as white babies to die in their first year. That disparity is the worst in the country. It's one of many examples where Minnesota's overall good health is not shared equally by all (Benson and Yuen, 1/30).

Detroit News: Detroit Deadliest City For Kids Due To Prematurity, Violence
Children are dying in Detroit at a greater rate than in any U.S. city its size or larger, a Detroit News study shows. Mostly, they die of conditions resulting from prematurity — the top killer of Detroit kids — and violence, which ranks second. “This is a public health emergency in the city of Detroit,” said Dr. Herman Gray, executive vice president of pediatric health services for the Detroit Medical Center and former president of DMC Children’s Hospital of Michigan. “We are losing our future in really socially unacceptable ways” (Bouffard, 1/30).

Georgia Health News: Flight Plan: State Wants Air Ambulances For Rural Region
Gov. Nathan Deal’s budget proposal for fiscal year 2015 contains a surprising health care item: $13 million to fund air ambulance service in 14 southwest Georgia counties. If the funding is approved by the General Assembly, it will the first time the state has ever operated an ambulance service -- either by air or by ground. In Georgia, trauma transport typically is handled by counties, hospitals or private emergency medical services (EMS) companies. Currently, all air ambulance service in the state is provided by private carriers (Craig, 1/29).

Health News Colorado: Remote Care, Monopolies And Pricy Injuries Hike Resort, Rural Health Costs
Blame the helicopters. One of Colorado’s least populated counties leads the state in health costs per person, according to new 2012 data from Colorado’s All Payer Claims Database (APCD). Mineral County in southern Colorado is home to just one town, Creede. It also has beautiful public lands that were ravaged by wildfires last summer and a population of about 700 that skews older and therefore sometimes sicker. Geographically isolated by canyons and mountain passes, the people of Mineral County face long trips if they need to be hospitalized (McCrimmon, 1/29).

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Weekend Reading

Longer Looks: Doctor Guilt; An Abortion Provider's Hidden Record

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

The Atlantic: When Doctors Make You Feel Guilty
Okay, I know I'm a health writer, but I really don't like going to the doctor. Part of it is an unshakeable, irrational certainty that they will find something horribly wrong with me that I'd rather not know about, and part of it is a rational certainty that they will find something mildly wrong with me that is my fault and chastise me for it—drinking too much, not exercising enough, whatever. One should be able to talk to one’s doctor about these things—the aspects of one's lifestyle that maybe aren't so great. ... But in 2009, a study by researchers at the University of California, San Diego found that half of the patients surveyed had experienced shame as a result of something a doctor said to them. In a new study, forthcoming in Basic and Applied Social Psychology, the researchers expand on that work to figure out why people react either positively or negatively to doctor-induced guilt (Julie Beck, 1/22).

The New Yorker: A Botched Operation
May of 1990, several hundred physicians gathered in a conference hall at an Atlanta hotel, as uniformed guards stood at the door. … It was the annual gathering of the National Abortion Federation, or N.A.F., a professional association with a beleaguered membership. ... There was at least one younger face at the conference: Steven Chase Brigham. A handsome, genial man in his mid-thirties, with a square jaw and sandy brown hair, Brigham was a recent graduate of Columbia University's medical school. Articulate, well dressed, and polite, he seemed unusually relaxed and upbeat for an abortion provider. "You sort of notice the newbies, and he seemed like a very personable young man," Dr. Suzanne Poppema, a former director of N.A.F., recalls. ... Dr. Curtis Boyd, one of N.A.F.'s founders, says, "He knew all the right things to say. He's very charming." By the mid-aughts, Brigham was the owner of a large chain of abortion clinics, American Women's Services (Eyal Press, 2/3).

The New York Review Of Books: On Breaking One's Neck
I am a senior physician with over six decades of experience who has observed his share of critical illness—but only from the doctor's perspective. That changed suddenly and disastrously on the morning of June 27, 2013, ten days after my ninetieth birthday, when I fell down the stairs in my home, broke my neck, and very nearly died. Since then, I have made an astonishing recovery, in the course of which I learned how it feels to be a helpless patient close to death. I also learned some things about the US medical care system that I had never fully appreciated, even though this is a subject that I have studied and written about for many years. … What did this experience teach me about the current state of medical care in the US? Quite a lot, as it turns out (Arnold Relman, 2/6).

60 Minutes: Nowhere To Go: Mentally Ill Youth In Crisis
Last November 19th, Virginia State Senator Creigh Deeds was slashed and stabbed repeatedly by his own son. Gus Deeds was 24 years old and had been struggling with mental illness. He and his father had been in an emergency room just hours before the attack but didn’t get the help that they needed. The story of what went wrong with his medical care exposes a problem in the way that America handles mental health. ... In the decades after the 1960s most large mental institutions were closed. It was thought that patients would get better treatment back in their communities. But adequate local facilities were never built. The number of beds available to psychiatric patients in America dropped from more than half a million to fewer than 100,000. That leaves many kids in crisis today with one option: the emergency room (Scott Pelley, 1/26).

The Wall Street Journal: Agonizing Choices For Lives Saved By Miracle Drugs
Sixteen-year-old Megan Crowley lay facedown on an operating table last June as her surgeon tried to straighten her spine, badly contorted by a genetic disease that nearly killed her as a little girl. The doctor had warned Megan that she stood a 5% chance of dying from the risky surgery, but she eagerly chose it anyway. Her 15-year-old brother Patrick, stricken with the same rare disease, refused the procedure and awaited news of her at home. ... Megan's and Patrick's choices are the kind of agonizing ones now confronting a generation of Americans like them whom biotech breakthroughs have kept alive—but haven't fully cured. The two have Pompe disease, which progressively weakens muscles. Until about a decade ago, heart failure killed most babies with Pompe within a few years (Geeta Anand, 1/24).

The New York Times: Playing With Toys And Saving Lives
How do [Third World hospitals] normally get medical equipment?  For the most part, they don’t — some public hospitals can't even afford IV tubing or gloves.  Often, they get donations from rich-country hospitals, which give away last year's technology. But these machines tend not to last long. They might need parts that are only available a continent away, or no one knows how to repair them.  Sometimes it's just that the electricity has gone out — or there was no electricity to begin with. Equipment destined for a productive life in a third-world hospital is equipment adapted for local circumstances, rugged, fixable locally, with available parts (Tina Rosenberg, 1/29).

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Editorials and Opinions

Viewpoints: Obama Drops 'Grand Bargain' Talk; Mitch McConnell In Tough Spot On Health Law

Los Angeles Times: Missing From SOTU: 'Grand Bargain,' Buffet Rule – And King Canute
What didn’t make the cut? ... A "grand bargain": For three years, Obama pursued a big fiscal deal that would have traded higher taxes (a Democratic goal) for cuts in long-term spending on Medicare, Medicaid and Social Security (a Republican goal). But with the federal deficit slowly shrinking, members of Congress in both parties are even less enthusiastic about tackling that kind of difficult compromise than before. Obama didn't even try to sell them on it this time. It's over (Doyle McManus, 1/29). 

The Washington Post: Hitting Mitch McConnell Over Health Care In Kentucky
In yesterday's speech, President Obama gave a shout-out to Kentucky Governor Steve Beshear, citing his tireless efforts to expand Obamacare coverage to his own constituents in a deep red state. As enrollment mounts, Mitch McConnell has refused to directly answer questions about Kentuckians befitting from the law. Counter-intuitively, some Kentucky Dems believe McConnell will ultimately face a reckoning on this issue (Greg Sargent, 1/29). 

Los Angeles Times: The Pope, The Pill And The Court
Last week, the Supreme Court ruled that a group of Colorado nuns will not be required to offer contraceptive coverage to employees while pursuing its legal challenge to the Affordable Care Act. The nuns' action highlights the misunderstandings and theological errors behind the Vatican's condemnation of what it terms "artificial contraception." And it also overlooks an important medical point: The nuns might have something to gain from taking oral contraceptive (Dr. Malcolm Potts, 1/30). 

USA Today: Give Little Sisters Of The Poor A Break
Personally, I support the mandate. The government has a compelling interest in providing free birth control. But there are ways to provide it that don't involve harassing nuns. Why not just use the more than 50 family planning clinics in Colorado, where the nuns are based? The government should leave the Little Sisters alone (Kirsten Powers, 1/28).

The Washington Post: Four Words In The ACA Could Spell Its Doom
Someone you probably are not familiar with has filed a suit you probably have not heard about concerning a four-word phrase you should know about. The suit could blow to smithereens something everyone has heard altogether too much about, the Patient Protection and Affordable Care Act (hereafter, ACA). Scott Pruitt and some kindred spirits might accelerate the ACA’s collapse by blocking another of the Obama administration’s lawless uses of the Internal Revenue Service. Pruitt was elected Oklahoma’s attorney general by promising to defend states’ prerogatives against federal encroachment, and today he and some properly litigious people elsewhere are defending a state prerogative that the ACA explicitly created. If they succeed, the ACA’s disintegration will accelerate (George F. Will, 1/29). 

Lincoln (Neb.) Journal Star: A Better Medicaid Plan
At this point in the ongoing war over the Affordable Care Act, some people — too many people — are suffering from ACA derangement syndrome. They simply hear the word "Obamacare" and they point their thumb up, or they point it down. The legislative bill introduced by Sen. Kathy Campbell that would expand Medicaid coverage in Nebraska deserves a better fate. People should actually consider whether the bill would improve health care in Nebraska (1/28). 

JAMA: What's Happening As Obamacare Coverage Debuts
With all of the ink that has been devoted to the Affordable Care Act (ACA), especially since the October 1 launching of the state and federally run insurance exchanges, remarkably little is being reported about what’s happening now that coverage for those newly enrolled in private insurance or Medicaid has begun (Gail Wilensky, 1/29).

And in other news-

The Fiscal Times: Medicare Opens A New Door To The Era Of Big Data
If there's a way of unlocking the black box that is U.S. medical pricing, it may come from an unlikely source: Medicare. The agency that oversees the federally run insurance system – the Centers for Medicare and Medicaid Services (CMS) – quietly announced recently that it would "evaluate requests for individual physician payment information." The final rules have yet to be written, but that bureaucratese, in plain English, could mean you'll eventually be able to see what doctors are actually charging – or at least what they are reporting to Medicare (John F. Wasik, 1/29).

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Stephanie Stapleton

Andrew Villegas

Lisa Gillespie
Shefali Luthra

The Kaiser Daily Health Policy Report is published by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. (c) 2014 Kaiser Health News. All rights reserved.