Daily Health Policy Report

Tuesday, January 7, 2014

Last updated: Tue, Jan 7

KHN Original Reporting & Guest Opinion

Health Care Marketplace

Health Reform

Capitol Hill Watch



State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Nonprofit Health Centers Go Into For-Profit Insurance Business

Kaiser Health News staff writer Phil Galewitz, working in collaboration with USA Today, reports: "The nation's 1,200 nonprofit community health centers receive strong federal support to treat millions of uninsured residents, but still face financial challenges. Some are responding with an unusual strategy -- starting for-profit insurance plans. In 2008, the Jessie Trice Community Health Center in Miami invested $120,000 to start Prestige Health Choice, a for-profit Medicaid health plan that the state pays a flat monthly fee per enrollee to provide care. Fourteen other community health centers also participated" (Galewitz, 1/7). Read the story.

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Health Law Inspires Hope But Also Worry Among Those With HIV

Kaiser Health News staff writers Anna Gorman and Ankita Rao, working in collaboration with USA Today, report: "The Affordable Care Act provides an unprecedented opportunity to reach the more than 1 million people nationwide living with HIV. The law requires private insurers to cover them and others with pre-existing conditions and bars companies from charging patients more because of their illness. HIV-positive patients can also buy coverage through insurance marketplaces, often with the help of federal subsidies. And the law allows states to expand their Medicaid programs to cover low-income HIV patients who were not previously" (Gorman and Rao, 1/7). Read the story.  

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Readers Ask: Are Premium Subsidies Permanent; Do I Have To Meet An Asset Test For Medicaid?

Kaiser Health News consumer columnist Michelle Andrews answers questions about provisions of the health law (Andrews, 1/7). Read her responses.

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Capsules: Detailed Report Delivers Good News On Health Costs, But Will It Last?; How Much Does A New Hip Cost? Even The Surgeon Doesn't Know

Now on Kaiser Health News' blog, Jay Hancock reports on the latest health cost figures: "Definitive 2012 numbers show continued, historically low increases in medical prices and the use of medical services. Health spending rose 3.7 percent, up slightly from 2011 but far below the 8 percent increases of the early 2000s, according to figures released Monday by the Centers for Medicare & Medicaid Services” (Hancock, 1/6). 

Also on the blog, Jenny Gold reports on a new survey that examines what orthopedic surgeons know and don’t know about how they contribute to health spending: "They were only able to correctly estimate the cost of a device 21 percent of the time, according to a survey of 503 physicians at seven major academic medical centers published this week in Health Affairs. Their guesses ranged from 1.8 percent of the actual price to 24.6 times the actual price. Researchers could not release the actual costs, because they signed nondisclosure agreements with the hospitals" (Gold, 1/6). Check out what else is new on the blog.

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Political Cartoon: 'First, Do No Harm?'

Kaiser Health News provides a fresh take on health policy developments with "First, Do No Harm?" by Chip Bok.

Here's today's health policy haiku:  


It took a huge freeze
To move the conversation
Off Obamacare.

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 Care Marketplace

Health Care Spending Grew At Record Slow Pace

Americans' spending on health care rose a relatively modest 3.7 percent in 2012 -- slower than the growth of the overall economy -- dropping from 17.3 percent of U.S. spending to 17.2 percent, according to an annual report from the Centers for Medicare & Medicaid Services.

The New York Times: Another Modest Rise For Health Costs
As a share of the economy, health spending declined slightly, to 17.2 percent in 2012, from 17.3 percent in the prior year. For decades, health spending has grown faster than the economy, taking a bigger bite out of workers' wages and the federal budget. Health spending averaged about $8,900 a person in 2012, according to the annual report issued Monday by the government (Pear, 1/6).

Kaiser Health News: Capsules: Detailed Report Delivers Good News On Health Costs, But Will It Last?
Definitive 2012 numbers show continued, historically low increases in medical prices and the use of medical services. Health spending rose 3.7 percent, up slightly from 2011 but far below the 8 percent increases of the early 2000s, according to figures released Monday by the Centers for Medicare & Medicaid Services (Hancock, 1/6). 

NPR: Health Care Costs Grew More Slowly Than The Economy In 2012
Health care spending grew at a record slow pace for the fourth straight year in 2012, according to a new government report. But the federal officials who compiled the report disagree with their bosses in the Obama administration about why (Rovner, 1/6).

Los Angeles Times: U.S. Health Care Costs Keep Rising But At Slower Pace
The relentless rise in health care spending -- which had threatened government budgets and helped pave the way for President Obama's health law -- continued to moderate in 2012, the fourth year of a historic slowdown, newly released federal data show. … For only the third time in the last 15 years, health spending grew more slowly than the overall economy as measured by the non-inflation-adjusted U.S. gross domestic product. That meant that health care shrank slightly as a share of the U.S. economy, from 17.3 percent in 2011 to 17.2 percent in 2012 (Levey, 1/6).

The Washington Post's Wonkblog: Good News! Health Spending As A Share Of The Economy Is Shrinking.
The share of the economy devoted to health care fell in 2012, according to federal data released Monday. The decline -- the largest in more than a decade -- comes after four years of unprecedentedly slow growth in health care spending. And it has economists puzzling, yet again, over whether the slackening merely reflects the short-term impact of the recession or shows a larger, more structural change in the medical industry (Kliff, 1/6).

The Wall Street Journal: Health Care Spending Grew at Modest Pace in 2012
Economists say health care costs are the biggest driver of the nation's long-term fiscal problems, and until the economic shocks of 2008 those costs seemed to be growing unstoppably. Since 2010, however, health spending has risen roughly in line with economic growth, and in 2012 it accounted for 17.2 percent of gross domestic product, down from 17.3 percent in 2011 (Schatz and Morath, 1/6).

USA Today: Growth Of Spending On Health Continues To Slow
The researchers would not comment on 2013 or trends moving forward, saying they have to wait for the data. However, they did explain why the growth spending rate seems to be stabilizing after the recession years. Anne Martin, lead author on the report, said that both consumers and employers make decisions about health care based on what's happening at the time, but those decisions can affect costs for years to come (Kennedy, 1/6).

Reuters: U.S. Health Spending Rose 3.7 Percent In 2012 As Economy Dragged
U.S. health care spending rose 3.7 percent in 2012 to $2.8 trillion, the fourth year in a row in this range as the slow economic recovery tempered private insurance use, drug prices fell and the government held back payment increases for doctors, the Obama administration said on Monday (1/6).

Bloomberg: Obamacare Tested By Recession's Effect On Health Care
The U.S. recession remained a drag on health-care spending three years after it ended as a net of 9.4 million people lost private insurance coverage before key provisions of Obamacare had begun, a government report showed (Wayne, 1/7).

CQ HealthBeat: Health Spending Dips Below GDP Growth -- But No Huzzahs For Health Law
National health spending growth remained unusually low in 2012 -- even taking the rare turn of dipping below Gross Domestic Product growth -- but government economists aren't making return trips to the liquor store to lay in new supplies of champagne (Reichard, 1/6).

ABC News: Health Spending Growth Slows, But Obamacare Impact 'Minimal'
For the fourth year in a row, Americans' spending on health care grew at one of the slowest rates ever recorded. National health expenditures in 2012 increased just 3.7 percent over the year before -- a rate relatively stable since 2009 and at historic lows, according to new analysis from the Centers for Medicare and Medicaid Services. All told the country spent $2.8 trillion on health care, or $8,900 per person, last year, gobbling up 17 percent of the economy (Dwyer, 1/7).

In other news related to medical pricing --

Kaiser Health News: Capsules: How Much Does A New Hip Cost? Even The Surgeon Doesn't Know 
They were only able to correctly estimate the cost of a device 21 percent of the time, according to a survey of 503 physicians at seven major academic medical centers published this week in Health Affairs. Their guesses ranged from 1.8 percent of the actual price to 24.6 times the actual price. Researchers could not release the actual costs, because they signed nondisclosure agreements with the hospitals (Gold, 1/6).

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Health Reform

Texas Hospital Officials Criticize Proposal To Limit Obamacare Navigators

Texas hospital officials and Democrats complained about proposed state legislation to impose greater training requirements and fees on navigators, while a Florida group gets a grant for outreach to Hispanics. Meanwhile, California exchange officials extended the payment deadline for January premiums because of continuing glitches, and a Minnesota auditor probes the troubled launch of the MNsure website.

The Dallas Morning News: Hospital Officials, Advocates Lament Proposed Limits On Obamacare 'Navigators'
Hospital officials, Democratic lawmakers and advocates for the poor complained Monday that the state’s proposed rule on health insurance "navigators" could cripple efforts to educate Texans about their coverage options. At a final hearing and in written comments submitted by Monday’s deadline, critics called the Texas Department of Insurance’s proposed licensing and training requirements an over-reaction -- and a poorly written one, at that. They pleaded for Insurance Commissioner Julia Rathgeber to refine her rule so it would pinpoint, but not impair, the people hired under federal grants to help people sign up for insurance through the Affordable Care Act (Garrett, 1/6).

Texas Tribune: Democrats Say Navigator Rules Are Politically Motivated
Saying that proposed state rules for the federal navigator program are politically motivated and would create unnecessary training requirements and registration fees, Democratic legislators on Monday pushed Texas Department of Insurance officials to justify their plan (Aaronson, 1/6).

Los Angeles Times: Hiccups Persist In California Health Insurance Exchange
Paperwork and computer glitches are still tripping up some eager consumers who are seeking coverage through California's insurance exchange and its 11 health plans. On Monday, the Covered California exchange said that all the applications it received online for coverage starting Jan. 1 have been sent to participating insurers, but that it is still sorting through an unspecified number of paper applications for that time period. In light of that delay, last weekend the state exchange extended the payment deadline for January premiums by nine days to Jan. 15 (Terhune, 1/6).

The Star Tribune: State Auditor Plans A Full-Throttle Investigation Of Mnsure Launch
With Minnesotans still experiencing problems with the MNsure website, the state’s legislative auditor said Monday he is planning a full-throttle investigation, starting with the vendors that received tens of millions of dollars to build the state’s new health insurance exchange. Jim Nobles said the first phase will focus on whether the IT contractors delivered on their promises and whether the state kept a close enough eye on their work. "It’s fine to question the performance of the contractor," Nobles said in an interview. “We’ll do that. But one of the worst things you can do in managing these contracts is to stand on the sidelines with the hope that things will go well. You've got to be actively managing and verifying" (Crosby, 1/6). 

Minnesota Public Radio: Minn. Legislative Auditor Investigating MNsure Contracts
Minnesota's legislative auditor is launching a wide-ranging inquiry into how the state handled contracts with several vendors that helped build MNsure, the state's new online health insurance marketplace. The review will examine whether the state adequately managed contracts with IBM Curam, Maximus and other vendors, and whether the contractors delivered what they said they would, Legislative Auditor Jim Nobles said. The legislative auditor's office is required to look at how the state spends federal dollars, which have funded MNsure. But Nobles said a recent letter from Gov. Mark Dayton to the CEO of IBM that details the failures of software with a $3.9 million price tag has raised serious concerns about how the contracts were managed (Richert, 1/6).

Miami Herald: Broward Group Gets Grant To Help Reach Hispanics About Health Care
As the Obama administration continues trying to reach Hispanics who may be eligible for benefits under the Affordable Care Act, U.S. Rep. Debbie Wasserman Schultz on Monday announced a $440,000 grant to Hispanic Unity of Florida (Borns, 1/6).

The Oregonian: Health Insurance Consumers Cite Delays, Lack Of Information On Enrollment
Nearly a week after new health insurance coverage was supposed to kick in for many Oregonians, delays in processing applications have left thousands in the dark about whether they've been successfully enrolled. The delays are mainly centered on people who applied through Oregon's health exchange, Cover Oregon, to obtain new subsidies under the Affordable Care Act. But even some people who enrolled directly with insurers are facing delays, creating stress and potential unnecessary costs. Meanwhile, about 6,000 paper applications to the Medicaid-funded Oregon Health Plan have not been processed, officials say (Budnick, 1/6).

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Maryland's Troubled Exchange Spurs Political Debate

Democratic and Republican critics of Maryland's dysfunctional exchange urged state officials to consider alternatives to the current online insurance marketplace. The issue has also become campaign fodder for gubernatorial candidates.   

The Wall Street Journal's Washington Wire: Maryland Congressman: Can We Switch To Federal Health Site?
A Maryland congressman has asked the state whether it’s feasible to consider temporarily switching to the federal Healthcare.gov site while the state continues work fixing its own health insurance site. Rep. John Delaney (D., Md.) said he’s concerned the state isn’t keeping pace with enrollment goals. As of Dec. 28, 18,257 people enrolled in private health plans through Maryland’s insurance exchange, which Mr. Delaney says is 12% of the state’s enrollment goal of 150,000 for private health plans. Nationwide, about 2.1 million have enrolled in private health plans, which represents about 30% of a White House goal of seven million (Corbett Dooren, 1/6).

The Associated Press: Critics Urge Moving Away From Maryland Exchange 
Democratic and Republican critics of Maryland's troubled health exchange urged state officials on Monday to consider other options to signing up state residents for health care plans (1/16).

The Washington Post: Democratic Hopeful Mizeur Decries 'Failure Of Leadership' On Maryland's Health Exchange
Democratic gubernatorial hopeful Heather R. Mizeur on Monday called the rollout of Maryland’s online health insurance exchange a "debacle" and said the General Assembly needs to "step in and make it right." "Our current situation has been a twin failure of leadership being asleep at the wheel when the program was being designed and then overpromising that everything was fixed when it wasn't," said Mizeur, a state delegate from Montgomery County (Wagner, 1/6).

The Washington Post: Governor Candidate David Craig: Md. Should Stop Promoting Its Troubled Health Exchange
A leading Republican candidate for Maryland governor wants the state to stop spending millions of dollars marketing and promoting its problem-plagued health insurance marketplace and instead point residents directly to private insurance carriers and other options. Harford County Executive David R. Craig (R) released a plan on Monday that calls on the administration of Gov. Martin O’Malley (D) to obtain a waiver from the U.S. Department of Health and Human Services to divert money away from promoting the state’s health exchange and toward a "public awareness campaign informing consumers of their right to obtain health insurance directly through carriers" (Johnson, 1/6).

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Study Debunks Concern That People Would Move Across State Lines To Get Medicaid

This concern has been a part of the debate over the health law's Medicaid expansion. Meanwhile, in Kansas, a new push is underway.

Reuters: Americans Unlikely To Move To Get Better Better Medicaid Benefits: Study
Americans are unlikely to move to another state to obtain better medical coverage, according to a Harvard study released on Monday that debunks fears expanded Medicaid in some states under the U.S. Affordable Care Act will trigger big and costly migrations (Valdmanis, 1/6).

Kansas Health Institute (news service): Kansas Hospitals Leading New Push For Medicaid Expansion
Many uninsured Kansans who Congress assumed would get coverage under the health reform law are instead falling in to what is being called the “Medicaid gap.” They make too much money or don’t meet other criteria to qualify for the state’s Medicaid program – called KanCare – but don’t earn enough to be eligible for federal tax credits to offset the cost of private insurance. ... The Kansas Hospital Association and a growing coalition of more than 50 organizations are preparing to push Gov. Sam Brownback and leaders in the Republican-controlled Legislature to change their minds (McLean, 1/6).

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Health Law Expected To Trigger Industry Hiring Spree

On one hand, insurance enrollment figures may be short of the numerical goals that were set earlier in the process, but some people still are predicting that health providers will ramp up hiring in response to new demand created by the overhaul.

Fox News: Obamacare Enrollment Figures Still Far Short Of Administration's Own Goal
While the Obama administration is congratulating itself for signing up 2.1 million people in private plans on state and federal health care exchanges, some analysts say it's a little early to uncork the champagne. Robert Laszewski of Health Policy and Strategy Associates says, "ObamaCare has proven that it can enroll the sick people. To only have 2 million people enrolled out of 20 million uninsured, plus all the canceled policies, indicates you only got a very small group of people enrolled." That's not even enough, he and others argue, to make up for the policies that were canceled because they didn't meet the requirements of ObamaCare (Angle, 1/7).

The Atlanta Journal Constitution: Expect Health Care Providers To Ramp Up Obamacare Hiring
One thing’s for sure when it comes to the impact of the Affordable Care Act: Health care and related industries are going to be on a hiring spree in the years to come to meet the demands of the law. While critics say the law will cause companies to cut jobs or work hours so they will not be penalized for not offering health care coverage – actions that are already under way based on anecdotal reports - other observers say the law will create scores of jobs. Health care providers will need more nurse practitioners and physician assistants, and companies that are required to offer insurance to employees will need more human resources staffers to keep track of their compliance (Seward, 1/6).

And, of course, the fact checking continues -

The Washington Post’s The Fact Checker: Harry Reid’s Claim That Under Obamacare 9 Million People ‘Have Health Care That Didn’t Have It Before’
There have been lots of numbers tossed around about enrollment under the Affordable Care Act, a.k.a. Obamacare, but Reid’s figure certainly jumped out at us, given the administration is backing away from its initial target of 7 million enrollees on the exchanges (Kessler, 1/7).

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Tanning Tax, Among Others, Kicking In

News outlets covered several elements of the tax features of the health law.

Politico: The 2014 Obamacare Tax Wave
Tanning salons, colonoscopy scopes and prescription drugs like Xanax -- they're all items hit by taxes in recent years to fund President Barack Obama's health care law. Starting in 2014, the Obamacare tax man is coming for insurance companies -- who contend a good chunk of these costs will be passed on to consumers in the form of higher premiums. And with those now in effect, almost all of the taxes that will be used to offset the cost of Obamacare are in place (Bade, 1/6).

The CT Mirror: Obamacare Q&A: More Deadlines, Tax Credits And Being Uninsured For Part Of The Year
[Y]ou can't get the tax credit for a plan sold outside the exchange. ... Under the federal health law, people whose income falls below a certain level (400 percent of the poverty level) are eligible for federal financial assistance to buy insurance. That comes in the form of a tax credit. You can choose to get it in a lump sum when you file your taxes, or you can have the federal government pay some or all of the tax credit to your insurance company each month, reducing the amount you have to pay in premiums  (Levin Becker, 1/7). 

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Capitol Hill Watch

Sen. Johnson's Suit On Obamacare Blasted By Fellow Republican

Rep. Jim Sensenbrenner, R-Wis., is attacking the lawsuit filed Monday by Sen. Ron Johnson, also a Republican from Wisconsin, that seeks to change how the health law is applied to Congress and to cut off federal government payments.

Reuters: U.S. Senator Sues Over Healthcare Subsidy For Congress
U.S. Senator Ron Johnson filed a lawsuit on Monday challenging the way President Barack Obama's healthcare law is being applied to Congress, part of a larger Republican strategy to draw attention to what they see as critical flaws in Obama's signature domestic policy. Johnson, of Wisconsin, is challenging a U.S. agency decision allowing the federal government to keep paying part of the costs of health insurance for U.S. lawmakers and their staffs who must buy coverage through the Obamacare marketplaces (Cornwell and Chiacu, 1/6).

CNN: Republican Senator Takes Obamacare Grievance To Court
The law essentially says that the only health coverage available to members of Congress and their staff through their job must come from the newly created Obamacare insurance exchanges. But the wording in the law is broad and the Office of Personnel Management had to issue a rule to determine how it would apply. That rule, Johnson alleges, subverted the law and opened up loopholes by allowing each member of Congress to determine which workers on their staff would be forced into the exchange and by giving thousands of dollars in employer-sponsored health benefit to help pay for the exchange policies (Desjardins and Merica, 1/6).

The Wall Street Journal's Washington Wire: Sen. Ron Johnson: Obamacare Suit Not A 'Stunt'
Sen. Ron Johnson and Rep. Jim Sensenbrenner, both Wisconsin Republicans, both want the Affordable Care Act repealed. But the lawmakers disagreed Monday about a lawsuit (PDF) Mr. Johnson filed related to the law. ... Mr. Sensenbrenner issued a statement on his website blasting the lawsuit, calling it an "an unfortunate political stunt." Mr. Sensenbrenner said .... Asked about Mr. Sensenbrenner’s statement during a press conference, Mr. Johnson replied: "I'm disappointed. I'm a little puzzled by his reaction." Mr. Johnson continued, "I don't in any way shape or form believe this is trivial, that this is frivolous, this is a stunt. I believe it's a very important Constitutional question" (Corbett Dooren, 1/6).

The Milwaukee Journal Sentinel: Sen. Ron Johnson's Obamacare Lawsuit Widens GOP Rift
Johnson's filing further stirred a rift within his own party over how Republicans should attack the health care law. Rep. Jim Sensenbrenner, a fellow Wisconsin Republican and ardent Obamacare critic, ... who even before Johnson filed his suit called the litigation "an unfortunate political stunt" that "focuses on trivial issues," amplified his criticism Monday. Sensenbrenner noted that having employers help pay for health insurance is a common benefit. Ending the practice would cause top congressional staff to leave, and those aides would be replaced with recent college graduates who were still on their parents' insurance plans, Sensenbrenner said (Marley, 1/6).

CBS News: Republican Senator Suing Administration Over Obamacare
[Meanwhile,] Johnson’s colleague, Sen. Rand Paul, R-Ky., also voiced frustrations with his own attempts to sign up for coverage. He says he's unsure whether he actually has insurance, and that things were particularly problematic when he tried to get his son signed up and received a Medicaid card (Kaplan, 1/6).

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Medicare Seeks To Tighten Drug Program Rules To Fight Fraud

Draft regulations issued Monday would overhaul the prescription drug program and could save up to $1.3 billion over five years. 

The Hill: New Healthcare Regs Target Medicare Fraud
Hundreds of pages of draft regulations issued Monday would overhaul the federal Medicare Advantage and Part D prescription drug programs, tackling fraud and saving an estimated $1.3 billion over five years, the Obama administration said. The U.S. Centers for Medicare and Medicaid Services (CMS) contends the sweeping proposed rule would strengthen consumer protections, while both cutting costs and improving care for enrollees in the programs (Goad, 1/6).

ProPublica: In A Major Shift, Medicare Wants Power To Ban Harmful Prescribers
Medicare plans to arm itself with broad new powers to better control — and potentially ban — doctors engaged in fraudulent or harmful prescribing, following a series of articles by ProPublica detailing lax oversight in its drug program (Weber and Ornstein, 1/6). 

CQ HealthBeat: CMS Proposes Rule Cutting Protected Formulary Drugs
The Centers for Medicare and Medicare Services is proposing a rule that would no longer require certain drugs to be included on the formularies of plans providing prescription drug coverage to Medicare beneficiaries. Under the proposed criteria, CMS would require formulary inclusion of all medications in the antineoplastic, anticonvulsant, and anti-retroviral drug classes, with certain exceptions (1/6).

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Barriers Persist To New Approaches To Medical Liability, Studies Find

Issues of medical liability and tort reform, as well as how they interact with rising health care costs, continue to draw news media interest.

MedPage Today: Tort Reform Alternatives Face Hurdles
Many barriers exist to implementing approaches to medical liability that could serve as alternatives to federal tort reform, a series of studies funded by the Agency for Healthcare Research and Quality (AHRQ) found. Physicians can be hesitant to admit medical errors and misdiagnosis; insurers are leery of supporting early notification of errors; and barriers are created by existing state malpractice laws, according to research published as a series in Monday's Health Affairs (Pittman, 1/6).

PBS NewsHour: Could Malpractice Reform Save The U.S. Health Care System?
It's a scenario most people have considered at least once. Patient A is hoisted onto Dr. B's operating table. Knife slips and causes massive injury -- and unlimited pain and suffering -- to Mr. A. Should the resulting monetary compensation be unlimited, as well? ... An essay published Monday in the journal Health Affairs argues that it might be time for the government to step in. More specifically, lead author Dr. William Sage proposes that doctors and the federal government should strike a deal (Corapi, 1/6).

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State Watch

State Highlights: States' Troubled Health Law Websites Fall Hardest On Poor

A selection of health policy stories from Virginia, Florida, Texas, Georgia and California.

The New York Times: Faulty Websites Confront Needy In Search Of Aid
While the nation's attention was focused on the troubled rollout of the federal health care site under the Affordable Care Act, the problems with the unemployment sites have pointed to something much broader: how a lack of funding in many states and a shortage of information technology specialists in public service jobs routinely lead to higher costs, botched systems and infuriating technical problems that fall hardest on the poor, the jobless and the neediest (Robles, 1/7).

The Roanoke Times: State Sen. Creigh Deeds To Push For Mental Health Reform
Deeds, D-Bath County, said Monday that he has been overwhelmed by the outpouring of support he has received since Nov. 19, when his son, Austin “Gus” Deeds, shot himself after a violent confrontation at the senator’s Millboro home. But he has been more moved by stories of people with harrowing experiences dealing with the state’s fragmented mental health system. “I’m not by myself in this,” Deeds said in a telephone interview Monday evening. ... Deeds said his son had a history of mental illness and was twice committed for psychiatric treatment in 2011. “My son was 18, he was an adult,” Deeds said. “I couldn’t make him keep appointments. … I couldn’t make him take medicine,” (Sluss, 1/6).

The Richmond Times-Dispatch: Deeds Submits Mental Health Bills After Tragedy
Sen. R. Creigh Deeds, D-Bath, has joined an escalating legislative debate sparked by his own family tragedy. Deeds has quietly filed three bills aimed at closing gaps in Virginia’s fragmented mental health system -- including one to allow a 24-hour window for holding someone involuntarily under an emergency custody order instead of the maximum of six hours now allowed under state law. He also broke a six-week silence in a telephone interview with The Roanoke Times on Monday that shed light on the mental illness afflicting his 24-year-old son, Austin C. "Gus" Deeds, who stabbed his father repeatedly Nov. 19 outside their Millboro home and then shot himself to death, just 13 hours after being released from an emergency custody order for a mental health evaluation (Martz, 1/7).

The Washington Post: Deeds Returns To Richmond Determined To Reform Mental Health System
State Sen. R. Creigh Deeds, determined to rebound from a personal tragedy that left him gravely injured and his son lost to suicide, returns to the Capitol this week on a mission to fix the state's mental health system. Deeds (D-Bath) has proposed two bills intended to address what went horribly wrong in November, when his 24-year-old son, Austin, known as "Gus," stabbed the senator and then fatally shot himself (Vozzella, 1/6).

Politico: Shifting Strategies For State Abortion Battles In 2014
Conservative states that ran into legal trouble passing some of the most restrictive abortion laws in the nation last year have shifted their approach for 2014: smaller instead of sweeping. Rather than bans that directly challenge Roe v. Wade, many states are again going for more incremental measures that address the physical space requirements of clinics, physicians' qualifications and the use of certain procedures. The move is hardly a retreat, abortion opponents say, but rather a strategic decision that they expect could be nearly as effective in less time. Compared to broader moves, restrictions that are more narrowly drawn often pass judicial muster (Villacorta, 1/6). 

Kaiser Health News: Nonprofit Health Centers Go Into For-Profit Insurance Business
As Florida shifts nearly all of its 3 million Medicaid recipients into private managed care plans this year, Prestige expects to triple its enrollment to more than 300,000 members. That could lead to more profits for Jessie Trice and the other health centers. Through Prestige, they are also less reliant on policies set by other insurers, and gain more control over how Medicaid funds are spent (Galewitz, 1/7).

The Dallas Morning News: Federal Judges Question Whether Texas Abortion Law Has Forced Clinics To Close
Appellate judges challenged lawyers Monday over provisions of Texas’ new abortion law and whether they have unduly caused the closure of about a dozen abortion clinics. The three-judge panel of the 5th U.S. Circuit Court of Appeals bore down in particular on the shuttering of the only two abortion clinics in the Rio Grande Valley. The lack of facilities is now requiring women seeking an abortion to travel about 150 miles to a Corpus Christi clinic. State Solicitor General Jonathan Mitchell defended the law, saying the state has a right to regulate medical practices as a way to promote women's health (Hoppe, 1/7).

Georgia Health News: No Performance Bonus This Year For Kids' Enrollment 
After two years of receiving a bonus, Georgia is not included in the latest round of federal performance awards for enrolling eligible children in government health insurance programs. The federal Centers for Medicare & Medicaid Services (CMS) said last week that 23 states earned a bonus for fiscal 2013, funded under legislation that reauthorized the Children's Health Insurance Program (CHIP). A year ago, Georgia received a bonus of $1.9 million, after gaining almost $5 million for fiscal 2011, the first year that the state received an award (Miller, 1/6).

California Healthline: New Overtime Law Has Far-Reaching Effects On Home Health Care Industry
The basic tenet of a new home health care law seems straightforward and unassailable: Workers who work more than nine hours at a time are entitled to overtime pay. But it may not be as simple as that. Many in the home health industry say the practical application of overtime will spell the end of live-in care and could actually result in lower earnings for home health workers. On Jan. 1, the Domestic Worker Bill of Rights (AB 241), created by Assembly member Tom Ammiano (D-San Francisco), took effect. It regulates the number of consecutive hours for home health care workers and requires overtime pay for long work shifts (Gorn, 1/6).

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Editorials and Opinions

Viewpoints: Slowing Health Costs; Possibility Of Medicaid Deal In Virginia; A New Name For Brain Death

The Wall Street Journal: ObamaCare Is Slowing Health Inflation
For decades a common refrain was that the rapid rise in health spending hurt the competitiveness of American businesses and ate into workers' take-home pay. Businesses and politicians from both sides of the aisle agreed that something had to be done to slow the growth of health-care costs. New data Monday from the Centers for Medicare and Medicaid Services show that we are making important progress. From 2010 to 2012, health spending grew at an annual rate of just 1.1% in real per capita terms—the lowest rate in the 50 years we have been collecting these data, and a small fraction of the 6% rate that inaugurated the past decade (Jason Furman, 1/6). 

The Fiscal Times: Has The U.S. Found A Cure For Rising Health Costs?
Something big has been happening in U.S. health care, and it isn't President Obama’s reform law: Since 2009, health care costs have risen between 3.6 and 3.8 percent a year, the slowest rates on record. That trend continued for a fourth straight year in 2012, as spending increased a relatively modest 3.7 percent, according to a report released Monday by Medicare actuaries. For the first time since 1997, spending on health care as a share of gross domestic product edged lower, dropping to 17.2 percent from 17.3 percent in 2011. That still represents a greater share of the economy than in other developed countries, but it offers hope that the U.S. may be getting a much-needed handle on those spiraling costs (Yuval Rosenberg, 1/7).

The Washington Post's The Plum Line: The Benghazi-Fication Of Obamacare
Back in October, conservatives had convinced themselves that the law was going down in flames. But now that it looks to be basically functional (if far from perfect) conservatives are fumbling for any reason at hand to delegitimize the law. Going by past history, the answer will be to turn it into a conservative pet rock: like Benghazi and the IRS stories, an initially suspicious happening which turns out to be a non-scandal or an example of run-of-the-mill governing incompetence, but lives on forever as a Watergate level episode in the conservative fever swamps (Ryan Cooper, 1/6). 

The Washington Post: Don't Bet Against A Medicaid Deal In Richmond
Right now, the smart money in Richmond is betting that incoming governor Terry McAuliffe will fail to deliver on his campaign promise to expand Medicaid. This past weekend, Republican House Speaker Bill Howell said again that "Medicaid should not be expanded." ... Our view: Do the supposedly dumb thing and bet against the smart money (Norman Leahy and Paul Goldman, 1/7).

The Wall Street Journal: Millionaires On Medicaid
Expanding Medicaid coverage to an estimated nine million more Americans—as mandated by the Affordable Care Act—reinforces the idea that Medicaid only serves the poor. That perception is not accurate. And it distracts from a looming budgetary threat to the program: long-term care. More than two-thirds of annual spending on long-term care for the elderly is paid by state and federal governments, $60 billion of which flows from Medicaid. With 10,000 baby boomers reaching retirement age every day for the next 19 years, the Congressional Budget Office projects that spending on long-term care will more than double by 2050—to 3% of GDP from 1.3% (Mark Warshawsky, 1/6). 

The Fiscal Times: The New Double Standards in Obamacare's Medicaid
This concept of forcing seniors over the age of 65 and the disabled to “spend down” their life savings to the last $2,000 for individuals and $4,000 for couples to qualify for Medicaid – or having to resort to devious methods of hiding or sheltering some of those savings from the government’s eye -- always seemed a bit harsh and degrading to me. ... Still, the dreaded "spend down" rule seemed essentially fair to me. After all, why should middle-income or even wealthy seniors sitting on piles of savings and investments but receiving little in outside income be allowed to tap into a social safety net designed to assist poor children, pregnant women, disabled adults, and low-income seniors? But that was until last week, when the Obama administration launched a nationwide Medicaid expansion under the Affordable Care Act (Eric Pianin, 1/6).

USA Today: A Globetrotter's View Of Obamacare
Last month, after two weeks of trying, I signed up with my two sons for an Obamacare family health insurance plan. The achievement felt huge. I had survived a bureaucratic assault course. ... Yes, I was frustrated. But it felt like déjà vu. It was only my latest frustration in dealing with the U.S. health care system, whose complexity and lack of transparency set it apart from systems in other wealthy industrialized nations. The answer is not to change the system. The answer is to fix it (Louise Branson, 1/5). 

WBUR: Dr. Tim's 'Truth About Obamacare' Podcast: Jan. 1 As Rubicon?
What just happened? That is, Jan. 1. 2014, has long been the date most commonly mentioned as the moment when Obamacare really kicks in. So now that 2014 is launched, what has really changed? Dr. Timothy Johnson, retired medical editor for ABC News and author of "The Truth About Getting Sick in America," focuses on that question in his latest 'Truth About Obamacare' podcast, above (Carey Goldberg, 1/6). 

And on other issues -

Los Angeles Times: Boeing's Hollow Victory
The narrowly approved contract agreement between Boeing and its Washington state workforce will be hailed by some as a victory for the canny, hardball brinkmanship of Boeing's management and the knuckle-under economic pragmatism of the International Machinists Union. But the steep cutbacks in retirement and health benefits that tens of thousands of Boeing workers were forced to swallow have far larger implications for middle-class America (Hedrick Smith, 1/7). 

Los Angeles Times: Blurring The Line Between Life And Death
Brain death needs a new name, some doctors and bioethicists say. Perhaps it should be called "death via cessation of brain function." Then, perhaps, the public might better understand that it's not just a serious coma or a severe brain injury or a persistent vegetative state. It's the end of life (1/6). 

Journal of the American Medical Association: Care Partners And Online Patient Portals
Many chronically ill and older people also have loved ones who, distinct from caregivers, serve as "care partners." These care partners do not provide day-to-day care or serve as surrogate decision makers but do help navigate health care—facilitating communication with physicians, discussing complex issues requiring shared decision making, and assisting with challenging self-management tasks. ... Health care systems today do not optimally identify or engage these individuals and frequently even push them away by creating barriers to obtaining patient information .... There is potential for improving care if care partners and families can be more effectively engaged (Dr. Urmimala Sarkar and Dr. David W. Bates, 1/6).

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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.