Daily Health Policy Report

Thursday, January 9, 2014

Last updated: Thu, Jan 9

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Health Care Marketplace

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Study: Supplemental Plans Raise Medicare Costs 22 Percent

Kaiser Health News staff writer Jay Hancock reports: "Supplemental 'Medigap' plans shield millions from Medicare's deductibles and other out-of-pocket costs. Pay a flat Medigap premium to a private insurer such as UnitedHealthcare or Humana and you might have little or no out-of-pocket expense for doctor visits, hospitalization or other Medicare services. Naturally many worry that the all-you-can-eat model inflates Medicare's costs by encouraging consumers to seek -- or doctors to order -- potentially unnecessary procedures. Now economists at the University of Texas and the University of Chicago have taken what some call the closest look yet at the relationship between Medigap coverage and Medicare spending" (Hancock, 1/9). Read the story.

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Capsules: New Customer Service Data Available On California Medical Groups; Report: Effort To Curb Costs Should Be 'Led By The States'; More Shoppers, Including Young Ones, Showing Up At Health Exchanges

Now on Kaiser Health News’ blog, Anna Gorman reports that California is now making available information based on patients surveys about physician groups: "Californians looking for more information about their doctors can now turn to a statewide website that includes new data on 170 physician groups. The website rates medical groups based on patients’ survey responses on access, care and customer service. Patients can compare doctor groups on such criteria as how easy it was to get appointments, how helpful the office staff was and how effectively the doctors communicated" (Gorman, 1/9).

In addition, Julie Appleby writes about a report finding that states should lead cost-cutting efforts:"Governors and other state leaders have the leverage to slow rising health costs and should not wait for action by the federal government, a commission chaired by two former governors said in a report Wednesday. State leaders can use their clout as large purchasers of health care as well as regulators to set goals for health spending and quality, said the report by the State Health Care Cost Containment Commission" (Appleby, 1/9).

Also on the blog, Ankita Rao reports on who is shopping on the health exchanges: "Seventeen percent of people potentially eligible for coverage visited the marketplaces when they opened in October, according to a survey of 622 people conducted by The Commonwealth Fund. That encompasses people going to both the finicky healthcare.gov run by the federal government for 36 states and those who went to the marketplaces run by 14 states and the District of Columbia. By the end of December — after government officials announced a fix to some of the website glitches — that number had risen to 24 percent" (Rao, 1/9). Check out what else is on the blog.

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Doors To Treatment Opening For Poor Illinoisans Struggling With Mental Illness

Reporting for The Chicago Tribune, in partnership with Kaiser Health News, Judith Graham reports: "Five years ago, Joseph Hale didn't care whether he lived or died. He was unemployed, hooked on drugs and deeply depressed. Help came after Hale swallowed a bottle of pills and landed in South Shore Hospital. There, an outreach worker persuaded him to seek help at a local mental health agency. Within a few months, Hale was living in a men's residence, going to group therapy every day, and beginning to feel secure for the first time in his life" (Graham, 1/9). Read the story.

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Political Cartoon: 'Relapse?'

Kaiser Health News provides a fresh take on health policy developments with "Relapse?" by Joe Heller.

And here's today's health policy haiku:  

RETURNING TO THE SCENE?

More votes on health law?
Really? Weren't all those others
enough? Maybe not.
-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

More Insurers Extend Premium Payment Deadlines

The relaxed timetables reflect efforts by the insurance industry, as well as the Obama administration, to "coax" people towards "cementing" their 2014 coverage, reports Bloomberg News. In addition, a Commonwealth survey finds more people are shopping on the new health insurance marketplaces. News outlets also report developments from Minnesota, California, Oregon, Connecticut, Massachusetts and Michigan.

Bloomberg: Obamacare Customers Given More Time To Pay Insurers
Two of the largest U.S. health insurers are giving Obamacare customers more time to pay their initial premiums as the industry tries to coax millions of people to take the final step in cementing coverage for 2014. WellPoint Inc. (WLP), the second-biggest U.S. health insurer, said it’s allowing consumers until Jan. 15 to pay, five extra days than planned. Health Care Service Corp., which runs Blue Cross plans in Texas, Illinois and three other states, extended its deadline to Jan. 30, saying it wanted to avoid confusion (Nussbaum, 1/8).

Kaiser Health News: Capsules: More Shoppers, Including Young Ones, Showing Up At Health Exchanges
Seventeen percent of people potentially eligible for coverage visited the marketplaces when they opened in October, according to a survey of 622 people conducted by The Commonwealth Fund. That encompasses people going to both the finicky healthcare.gov run by the federal government for 36 states and those who went to the marketplaces run by 14 states and the District of Columbia. By the end of December — after government officials announced a fix to some of the website glitches — that number had risen to 24 percent (Rao, 1/9).

Pioneer Press: MNsure Problems Prompt State To Seek Help From UnitedHealth
MNsure has asked a division of Minnetonka-based UnitedHealth Group to conduct an end-to-end review of problems with the health insurance exchange website. Meanwhile, health exchange leaders plan to make more paper applications available as a contingency for website users who continue to encounter stubborn technology problems when trying to obtain coverage through the state-run insurance marketplace (Snowbeck, 1/8). 

MinnPost: Lead Vendor Tells Oversight Committee That MNsure Took Control Of Project Last February
The lead vendor contracted to build Minnesota’s struggling health insurance exchange says it was stripped of much of its job by MNsure officials beginning last February, according to a report for the Legislature's oversight committee (Nord, 1/8).

The Star Tribune: MNsure Asks UnitedHealth Group Subsidiary Optum For Website Help
UnitedHealth Group Inc.’s data services subsidiary Optum, which came to the rescue of the federal health insurance exchange in November, is now stepping in to help resolve continuing problems with MNsure. About 15 Optum staffers arrived Wednesday morning at MNsure, the state’s insurance exchange, for a two-day assessment of the agency’s website and call center operations. Their goal: to help officials pinpoint how and why some consumers are getting hung up in the system, which is expected to eventually help more than 1 million Minnesotans choose and pay for health coverage (Crosby, 1/9).

Minnesota Public Radio: MNsure Interim CEO: More Work Needs To Be Done
Despite ongoing efforts to fix the state's new health insurance website, only a handful of problems have been fixed, MNsure's top official said Wednesday. The comments from interim CEO Scott Leitz came after a team of IBM's tech whizzes have been working in St. Paul for nearly a month to help fix the problem-plagued MNsure website. They also follow a planned, two-day maintenance shutdown of the website last weekend (Richert, 1/8).

The Wall Street Journal’s CIO Journal: Minnesota Governor Blasts IBM For State Health Exchange Troubles
Minnesota Governor Mark Dayton blamed IBM Corp. for software problems that have stalled thousands of insurance purchases on the state’s online health exchange. The exchange, MNsure, said it is bringing in UnitedHealth Group Inc.-owned contractor Optum to review operations. But MNsure may have to accept some of the blame after taking systems integration duties from the site’s general contractor just eight months before launch (Boulton, 1/8).

California Healthline: Most Small Health Plans Aren’t Thriving In Covered California. Meet Two Exceptions
CCHP's early, obvious success is testament to Covered California's potential to drive improvements in access and coverage, especially by introducing new market competitors. But for other small health plans -- who were hoping the insurance exchange would be a vehicle to pick up new members-- it hasn't been a smooth ride. One small health plan dropped out. Another was kicked out. And a third is openly hunting for business. That's in sharp contrast to the experience of the four largest plans on the exchange -- Anthem, Blue Cross, Health Net, and Kaiser -- which are hoovering up new members, based on the most recent data available (Diamond, 1/8).

The Oregonian: Cover Oregon: Moda Dominating Health Exchange's Early Sales
Moda Health is dominating insurance plans sold through Oregon's health exchange, selling a staggering 70 percent of policies. Of 13,693 plans sold through Cover Oregon as of Jan. 4, Moda sold 9,611 of them, according to Cover Oregon. Among major insurers, the subsidiary of Cambia Health known as Bridgespan is bringing up the rear with just 9 policies sold (Budnick, 1/8).

The CT Mirror: Amid Obamacare Coverage Woes, More Insurers Extend Payment Deadline
As Connecticut residents continue to face problems getting their new health care coverage set up, two more insurance companies selling plans through the state’s exchange have extended their payment deadlines for January coverage. ConnectiCare Benefits will accept January premium payments through Wednesday, Jan. 15, five days beyond the previous deadline, for people who signed up for coverage through Access Health CT, the state's health insurance exchange. Anthem Blue Cross and Blue Shield announced the same deadline change Tuesday (Becker, 1/8).

Detroit Free Press: Groups Aim To Make Clear: Metro Detroiters Can Still Sign Up For Health Care
With the promise of expanded Medicaid ahead and glitches at www.healthcare.gov being ironed out, insurers and health care providers are stepping up efforts to enroll uninsured metro Detroiters in health coverage. ... [The Detroit Medical Center] is leading a partnership of about five dozen community organizations trying to boost health coverage under the Affordable Care Act. The partnership, which includes health providers, nonprofit organizations and several churches, is finalizing a schedule of community events over the next two months to raise awareness about upcoming deadlines. A public campaign kickoff is scheduled for Friday (Erb, 1/8).

The Boston Globe: Mass. Health Connector Fraught With Uncertainty
Once a national model, the Connector has frustrated consumers for months. Its new website, overhauled to comply with the federal Affordable Care Act, has locked users out of their accounts and delivered confusing error messages. But, as Kamel’s story shows, the Connector’s troubles go beyond a bad website, to inconsistent enrollment data and poor communication, leaving some users uncertain about the status of their coverage. The Connector’s new website has performed so poorly that the state has all but abandoned attempts to fix it. The agency’s staff is expected to report Thursday to its board about options for holding the vendor, CGI, accountable (Conaboy, 1/9).

And on the Medicaid expansion front -

The Associated Press: Hundreds Demand Expansion Of Medicaid
Hundreds gathered at the Maine Statehouse on Wednesday urging lawmakers to expand Medicaid under the federal health care overhaul as the Democratic-controlled Legislature began its work for the new session. The presence of the roughly 350 people calling for Medicaid expansion foreshadows what's certain to be another fiery debate in the Legislature on the bill this session, during which lawmakers will also try to fill a $75 million gap in the state budget and debate measures aimed at cracking down on welfare abuse (Durkin, 1/9).

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As Workers' Insurance Costs Rise, Bosses (Sometimes Wrongly) Blame Obamacare

A new study shows how employers are cost-shifting. And Democratic politicians are pointing fingers for Obamacare's website woes.

CBS News: Obamacare Blamed For Increases In Insurance Costs
The troubled rollout of Obamacare has made it so unpopular it is now being blamed for health insurance problems it had nothing to do with, according to a new report. Nearly half of upper-middle-income Americans (those with annual household incomes between $50,000 and $74,999) who have employer-based health insurance say the Affordable Care Act has had a negative effect on their health insurance. This is likely because 46 percent of this demographic reports paying more for insurance and also being hit with higher out-of-pocket expenses ... [b]ut analyst Doug Whiteman said this may be a case of companies passing along more of the health insurance costs to employees and using Obamacare as an excuse (Von Hoffman, 1/8).

The Hill: CFOs Blame Obamacare As They Pass Along Costs
Only 8 percent of CFOs have constrained hiring as a result of Obamacare, and only 4 percent have shifted toward part-time staffing, the survey found. These figures cast doubt on arguments by Republicans that the law is exacerbating unemployment and shifting full-time workers into part-time schedules. ... Ten percent of CFOs have added coverage for staff that was not previously eligible, and 10 percent have reduced the scope or value of their health care benefits. Another 13 percent said they have reduced their earnings forecasts as a result of the law (Viebeck, 1/8).

CBS News: Newspaper Blames Obamacare For 401(K) Cuts
San Diego Tribune CEO John Lynch recently told employees that the company is suspending matches to the company's 401(k) plan partly because of "significant additional expense due to Obamacare." But the San Diego Union-Tribune isn’t just any business -- it’s been described as a mouthpiece for developer and financier Douglas Manchester, a major Republican party contributor, according to watchdog Media Matters (Picchi, 1/8).

Meanwhile --

Politico: Democrats Blame Big Business For Botched Rollout
Facing an onslaught of constituent frustration over problems with online exchanges, several Democrats have started pointing fingers at the companies and senior executives in their home states that have contracts to get the health care websites up and running. ... Case in point: Sen. Jeff Merkley. The Oregon Democrat called out software developer Oracle and its president and Chief Financial Officer Safra Catz by name in town hall meetings and to local media over the Christmas recess. He said they’re responsible for the state’s “Cover Oregon” website problems (Palmer and Haberkorn, 1/9).

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Chamber Of Commerce Details Updated Strategy For Health Law Trouble Spots

The Chamber's President and CEO Thomas Donohue vowed first and foremost to fight against the overhaul's employer mandate, but noted that in other cases the organization will work to fix flaws rather than repeal the measure.  

Fox News: Chamber Of Commerce Vows To Fight Obamacare Employer Mandate In 2014
The head of the U.S. Chamber of Commerce vowed Wednesday to fight Obamacare's so-called employer mandate and other "onerous" provisions in the year ahead, even as the pro-business group acknowledged the bill as a whole cannot be repealed in the current climate.  The agenda was outlined by Commerce President and CEO Thomas Donohue, in his annual Washington address. Though the law's requirement on mid-sized and large businesses to provide health coverage to workers was delayed by a year, Donohue said the Chamber still plans to lobby against that mandate in 2014 (1/8).

Modern Healthcare: U.S. Chamber Looks To Fix, Not Repeal Obamacare
The U.S. Chamber of Commerce has accepted that the Patient Protection and Affordable Care Act is here to stay and, rather than continue calling for its complete repeal, will work this year to change what it sees as flaws in the 2010 law, the business group's president and CEO said Wednesday. Outlining the chamber's 2014 priorities, Thomas Donohue, the group's president and CEO, sounded realistic about the statute that his organization had once wanted Congress to repeal and that Donohue said posed the single greatest threat to the future of American enterprise (Zigmond, 1/8).

CQ HealthBeat: U.S. Chamber Address Labels Entitlements The 'Big, Smelly Elephant In The Room'
Tom Donohue saved the most vivid image of his annual address on U.S. Chamber of Commerce priorities for Medicare, Medicaid and Social Security Wednesday, calling entitlements "the big smelly elephant in the room" that President Barack Obama and members of Congress don’t want to talk about (Reichard, 1/8).

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Capitol Hill Watch

As House Readies First 2014 Vote On Health Law, Sen. Cruz Renews His Attack On The Overhaul

The House Republican leadership seems intent this year on keeping the pressure on the health law, Politico reports. Meanwhile, in an interview with the Wall Street Journal, Cruz says Republicans must use "every leverage point available" to get rid of the law.

Politico: House Back To Obamacare Votes In Week 1
House Republicans are back in town — and immediately getting back to the business of anti-Obamacare votes. It's a notable change from the opening week of Congress in the past two years, when Republicans had somewhat relaxed their Obamacare game. In 2012, they were waiting for the Supreme Court to rule on the law and in early 2013 they'd just watched President Barack Obama win reelection — after which Speaker John Boehner temporarily declared the Affordable Care Act "the law of the land." The repeal vote last year didn't come until May, and only after freshman Republicans clamored for it (Cunningham and Kim, 1/8).

The Wall Street Journal: Cruz Vows to Step Up Attack on Health Law
In an interview, [Sen. Ted Cruz] lambasted Senate Republicans for a lack of courage, compared himself to Ronald Reagan and vowed to "fight even harder … to repeal every word of Obamacare." Republicans must use "every leverage point available" to uproot the law, he said in a 45-minute discussion in which he mentioned Obamacare more than 40 times, calling it "a disaster" and "the No. 1 job killer in the country" (King Jr., 1/8).

In other Capitol Hill news -

Politico: Darrell Issa Accuses Sebelius Of 'False' Testimony
House Oversight Chairman Darrell Issa continued his intense push to highlight security risks of HealthCare.gov, accusing HHS Secretary Kathleen Sebelius of giving "false and misleading" testimony to Congress. In a letter Wednesday to Sebelius, he accused the secretary of making false statements on several points based on what he characterized as contradictory testimony by the agency's security testing contractors and CMS's chief information security officer, Theresa Fryer (Norman, 1/8). 

The Hill: NRSC: Obamacare Hurting Firefighters, Senate Dems To Blame
ObamaCare may create headaches for volunteer fire departments — and the National Republican Senatorial Committee wants to pin the blame on the Senate Democrats who voted for the law. The NRSC will send out press releases later this morning slamming more than a dozen Democratic senators and candidates for backing the law, which they say is endangering volunteer fire departments (Joseph, 1/9).

The New York Times: Two House Democrats Announce Retirement
While [New York Rep. Carolyn] McCarthy's seat is likely to stay in Democratic hands, [Rep. Mike] McIntyre’s district, which includes Wilmington and other parts of eastern North Carolina, is an almost certain pickup for Republicans. After 18 years in Congress, Mr. McIntyre said in a news release, he is ready for a "new chapter" in his life. Republicans saw evidence of Democrats' vulnerability over the health care law in Mr. McIntyre's announcement, which comes on the heels of a decision by Representative Jim Matheson, Democrat of Utah, to retire from the House. Yet Mr. McIntyre and Mr. Matheson both voted against the Affordable Care Act (Wheaton, 1/8).

Politico: Battling Cancer Again, Coburn May Cut Short His Term
Sen. Tom Coburn doesn't seem like a typical cancer patient. The Oklahoma Republican often arrives in his office two hours before his aides, sometimes as early as 4 a.m. He attends virtually all of his committee hearings. And in the evenings, he either dines with his senator buddies at Capitol Hill establishments or attends his weekly meetings of Christian conservatives at the infamous C Street house. But for the past several months, the 65-year-old Coburn has privately been undergoing intensive treatment for a recurrence of prostate cancer (Raju, 1/8).

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Health Care Marketplace

Take Over By Community Health Approved By Health Management Associates Shareholders

The Wall Street Journal: Health Management Shareholders Approve Takeover By Community Health
Health Management Associates Inc. shareholders voted to approve the hospital operator's $3.9 billion takeover by Community Health Systems Inc., overcoming opposition from some investors. The pact, which is expected to be completed by the end of the month, would create the largest U.S. hospital company by number of hospitals and No. 2 by revenue (Pollock and Stynes, 1/8).

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State Watch

Bipartisan Commission: States Should Lead Efforts To Cut Health Costs

State leaders have significant power to curb rising health care costs and they should lead the effort, advises a commission co-chaired by two former governors. Meanwhile, a Massachusetts state report concludes that more than a third of health-care spending in that state each year may be wasteful.

Health Policy Solutions (a Colo. news service): Fight To Cut Health Costs Depends On States
States have significant power to cut health care costs and they should use it, a commission co-chaired by former Gov. Bill Ritter declared on Wednesday. The Miller Center at the University of Virginia unveiled the group’s report, Cracking the Code on Health Care Costs, at the National Press Club in Washington. The bipartisan members of the State Health Care Cost Containment Commission pressed states to reverse unsustainable growth in health costs that threaten to strangle the U.S. economy (Kerwin McCrimmon, 1/8).

Kaiser Health News: Report: Effort To Curb Costs Should Be 'Led By The States'
Governors and other state leaders have the leverage to slow rising health costs and should not wait for action by the federal government, a commission chaired by two former governors said in a report Wednesday. State leaders can use their clout as large purchasers of health care as well as regulators to set goals for health spending and quality (Appleby, 1/9).

The Wall Street Journal: Massachusetts Wastes Third Of Health Spending, Report Says
More than a third of health-care spending may be wasteful in Massachusetts, where costs are among the highest in the nation, a state report released on Wednesday said. Main drivers of excess spending included patients returning to hospitals for preventable reasons and emergency-room visits that better primary care could have warded off, the state's Health Policy Commission concluded, citing 2012 data. The commission estimated between $14.7 billion and $26.9 billion in wasteful spending that year, representing between 21% and 39% of total health expenditures (Kamp, 1/8).

WBUR: Mass. Health Numbers: Over $14B Wasted, Teaching Hospitals Huge
Health wonk heaven! The state’s new Health Policy Commission has just released its full report on Massachusetts health costs, ... Here are a few data points from the report that struck me: ... Even after adjusting for the varying complexity of needs of patients treated by each hospital and for different regional wage levels, hospitals with higher levels of operating expenses spent 23 percent more to provide the same services than those with lower levels of operating expenses (Goldberg, 1/8).

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State Highlights: Mass. Launches New Electronic Health Records Updates

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

Los Angeles Times: Gov. Jerry Brown To Propose Billions In New Spending
When he unveils his new budget plan Thursday, Gov. Jerry Brown will propose billions of dollars in new spending on schools, health care, social services and environmental programs as California reaps the benefits of an economic turnaround. … The proposed budget includes $670 million more for Medi-Cal, the state's public health care program, which is expanding as part of President Obama's federal overhaul. The program is expected to serve a quarter of California's residents next year (Megerian and York, 1/8).

The Associated Press: Mass. Updates Electronic Medical Records System
Massachusetts has launched the next phase of an electronic medical records system designed to make it easier for doctors to pull up a patient's medical history with the click of a button. State officials say the Mass HIway Health Information Exchange will for the first time let health care providers locate, request, and retrieve medical records from other participating health care providers across the state on a secure, interconnected system (1/8).

WBUR: Mass. Opens Road To Sharing Medical Records
The HIway is a network of hospitals and physician groups -- 57 so far -- that have agreed to share the records of those patients who've given their permission to do so. Gov. Deval Patrick launched the HIway in 2012, sending some of his records from Massachusetts General Hospital to Baystate Medical Center in Springfield. Now the program can bring in, as well as push out, records, as Dr. John Halamka, the chief information officer at Beth Israel Deaconess Medical, demonstrates (Bebinger, 1/8).

Kaiser Health News: Capsules: New Customer Service Data Available On California Medical Groups
Californians looking for more information about their doctors can now turn to a statewide website that includes new data on 170 physician groups. The website rates medical groups based on patients’ survey responses on access, care and customer service. Patients can compare doctor groups on such criteria as how easy it was to get appointments, how helpful the office staff was and how effectively the doctors communicated (Gorman, 1/9).

Los Angeles Times: New California Physician Group Ratings Unveiled By Consumer Reports
Californians searching for a doctor have new ratings from Consumer Reports on 170 physician groups statewide. The scores released Wednesday are intended to help consumers see how different medical offices measure up on providing care and dealing with patients (Terhune, 1/8). 

The New York Times: In Annual Speech, Vermont Governor Shifts Focus To Drug Abuse
In a sign of how drastic the epidemic of drug addiction here has become, Gov. Peter Shumlin on Wednesday devoted his entire State of the State Message to what he said was "a full-blown heroin crisis" gripping Vermont (Seelye, 1/8).

The Washington Post: Deeds Returns To The Virginia Senate Seven Weeks After His Son's Attack And Suicide
In one of his rare public comments since the November tragedy, Deeds told his local paper via email that he would make it his life's work to correct the systemic flaws that he blames for his son's death. He has already proposed two bills intended to do just that. One would lengthen the time authorities can hold someone subject to a court order while searching for a psychiatric placement. The other would create an online registry that would provide real-time data on the availability of psychiatric beds (Vozzella, 1/8). 

Kaiser Health News: Doors To Treatment Opening For Poor Illinoisans Struggling With Mental Illness
Five years ago, Joseph Hale didn't care whether he lived or died. He was unemployed, hooked on drugs and deeply depressed. Help came after Hale swallowed a bottle of pills and landed in South Shore Hospital. There, an outreach worker persuaded him to seek help at a local mental health agency. Within a few months, Hale was living in a men's residence, going to group therapy every day, and beginning to feel secure for the first time in his life (Graham, 1/9).

The Texas Tribune: Providers Face Obstacles In New Women's Health Program
Since ousting Planned Parenthood clinics from the Women's Health Program, which provides cancer screening, well-woman exams and contraception for low-income women, state leaders have made a concerted effort to recruit physician groups to fill the void.  They also widened the services covered, adding testing and some limited treatment for sexually transmitted diseases (Aaronson, 1/9).

Georgia Health News: New Laws On Health? Probably Not Many This Year
A safe prediction for the upcoming session of the Georgia General Assembly is that dozens of bills involving health care will be up for consideration. That's the case every year under the Gold Dome. But given the likelihood this year of a short session, ending in mid-March, it's also a good bet that many health bills will be sidetracked or stalled before they come to a vote. (Miller, 1/8).

The California Health Report: For Homeless Women, Health Insurance Not Enough
More than 1.4 million California residents will be newly eligible for Medi-Cal under the ACA, including up to 55,000, or 53 percent, of chronically homeless people. The expansion includes dental care, and treatments for mental illness and basic substance abuse, services that the homeless population needs desperately. Homeless women present additional challenges to shelters and clinics: many are victims of sexual assault, need preventative treatments like mammograms, and require childcare in order to get to doctors’ appointments. So for the ACA to really work, housing providers, clinics and policymakers will have to work together to coordinate care (Amandolare, 1/9).

California Healthline: Blue Shield Disagrees With Jones’ Assessment Of Premium Rate Hike
California Insurance Commissioner Dave Jones yesterday strongly condemned a recent rate hike by Blue Shield of California. The 9.8 percent rate hike will affect about 81,000 grandfathered individual market policies, according to Jones. … Jones said the rate hike doesn't measure up based on a number of criteria, including overblown assumptions about growth in utilization of services, he said. … In a written statement, Blue Shield's vice president of corporate communications Stephen Shivinsky said the DOI numbers don't add up (Gorn, 1/8).

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Weekend Reading

Longer Reads: Hospice Drains Medicare; False Obamacare 'Horror Stories'

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

The Washington Post: Hospice Firms Draining Billions From Medicare
Hospice patients are expected to die: The treatment focuses on providing comfort to the terminally ill, not finding a cure. To enroll a patient, two doctors certify a life expectancy of six months or less. But over the past decade, the number of "hospice survivors" in the United States has risen dramatically, in part because hospice companies earn more by recruiting patients who aren't actually dying, a Washington Post investigation has found. Healthier patients are more profitable because they require fewer visits and stay enrolled longer (Peter Whoriskey and Dan Keating, 12/26).

Earlier, related KHN coverage: Growing Hospice Care Costs Bring Concerns About Misuse (Rau, 6/27/11).

The Weekly Standard: The Genealogy Of Obamacare
Despite its clunky rollout, Obamacare continues to move forward. ... [but] there are more problems to come, symptoms of a deeper malady inherent in the law: It is ill-suited to our Madisonian system. Obamacare seeks to micromanage a vast sector of the American economy, when our government was designed purposely to prevent that sort of control. When central planners during the New Deal ignored the limitations placed on our pluralistic government, the results were disappointing and often perverse. ... In exchange for cooperation in administering subsidies and providing the uninsured with government-approved health insurance, Obamacare essentially guarantees the stakeholders a permanent place in the nation’s health care architecture. To bring this promise to fruition, Obamacare must then regulate the minutest details (Jay Cost, 1/8).

Health Insurance: Anatomy Of An Obamacare 'Horror Story'
For months, health reform's opponents have been feasting on tales of Obamacare's innocent victims -- Americans who lost their insurance because it doesn't comply with the ACA's regulations, and now have to shell out more than they can afford – or go without coverage. Trouble is, many of those stories just aren't true. Yesterday I posted about a Fort Worth Star Telegram article that leads with the tale of Whitney Johnson, a 26-year-old new mother who suffers from multiple sclerosis (MS). Her insurer just cancelled her policy, and according to Johnson, new insurance would cost her over $1,000 a month. ... Under the ACA, no 26-year-old could be charged $1,000 monthly – even if she has MS. Obamacare prohibits insurers from charging more because a customer suffers from a pre-existing condition. This rule applies to all new policies, ... At that point, I knew that something was wrong (Maggie Mahar, 1/3).

Cincinnati Magazine: Last Words
Spurred on by the suicide of her 21-year-old son, Brian Case, in 1999, [Jean] Baker, who lives in Houston, became a teacher for special needs children. She has also written a book—Schizophrenia: Evolving from My Son's Suicide to the Classroom—and works as an outspoken advocate for kids with mental illness. Still, she’s always looking for more ways to translate her son’s tormented life and death into something of permanence. "There had not been any accounting of his passing," she says. "They didn't even put it in the newspaper in the town where he died." Last spring, she found another way to make Brian's death count for something. Tuning in to Talk of the Nation on National Public Radio, she caught an interview with John Pestian, a clinical scientist at Cincinnati Children’s Hospital Medical Center who is leading a project that is attempting to use computer technology to identify people who are suicidal (Linda Vaccariello, 1/2).

Slate: Growing Up Unvaccinated
I am the '70s child of a health nut. I wasn't vaccinated. I was brought up on an incredibly healthy diet: no sugar till I was 1, breastfed for over a year, organic homegrown vegetables, raw milk, no MSG, no additives, no aspartame. My mother used homeopathy, aromatherapy, osteopathy; we took daily supplements of vitamin C, echinacea, cod liver oil. … As healthy as my lifestyle seemed, I contracted measles, mumps, rubella, a type of viral meningitis, scarlatina, whooping cough, yearly tonsillitis, and chickenpox. In my 20s I got precancerous HPV and spent six months of my life wondering how I was going to tell my two children under the age of 7 that Mummy might have cancer before it was safely removed. So the anti-vaccine advocates’ fears of having the “natural immunity sterilized out of us” just doesn’t cut it for me (Amy Parker, 1/6).

The New York Times: Why Everyone Seems To Have Cancer
Every New Year when the government publishes its Report to the Nation on the Status of Cancer, it is followed by a familiar lament. We are losing the war against cancer. Half a century ago, the story goes, a person was far more likely to die from heart disease. Now cancer is on the verge of overtaking it as the No. 1 cause of death. Troubling as this sounds, the comparison is unfair. Cancer is, by far, the harder problem — a condition deeply ingrained in the nature of evolution and multicellular life. ... The rhetoric about the war on cancer implies that with enough money and determination, science might reduce cancer mortality as dramatically as it has with other leading killers — one more notch in medicine’s belt. But what, then, would we die from? (George Johnson, 1/4).

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Editorials and Opinions

Viewpoints: Don't Blame Insurers For Health System Problems; Obama's 'Management Failure;' Texas Abortion Case Heads To Court

Bloomberg: What Liberals Don't Get About Single Payer
[The] problem with the Affordable Care Act isn't the insurance industry. In fact, the main benefits of nationalized health care can be achieved in systems with hundreds, even thousands, of for-profit insurers. ... The dirty truth about American health care is that it costs more not because insurers are so powerful, but because they're so weak. ... It's health-care providers -- not insurers -- who have too much power in the U.S. system. As a result, they have the most to lose if health-care prices fall. But, as is often the case, political power flows in part from popularity. So politicians who routinely rail against for-profit insurers are scared to criticize -- much less legislate against -- for-profit hospitals, doctors or device manufacturers (though drug companies come in for a drubbing now and then). These are the people who work every day to save our lives, even if they make us pay dearly for the privilege (Ezra Klein, 1/8).

The Washington Post: Will Health Costs Continue Slowing?
Call it the $2.8 trillion enigma. That's the amount Americans spent on health care in 2012. The good news is that health spending slowed unexpectedly for the fourth consecutive year. The enigma is that no one really knows why. Despite many theories, there's no expert consensus. Runaway health spending is a huge national problem. It has squeezed take-home pay (employers channel more compensation to health insurance and less to salary) and is crowding out other programs — schools, defense, regulation, police — at the federal and state levels. If the slowdown is temporary, then all these problems remain. But if there's a permanent shift, then the nation's economic and budget outlook has significantly improved (Robert J. Samuelson, 1/8). 

The Washington Post: Despite What Critics Say, Obamacare Is Working
Despite the treasured right-wing talking points, it's increasingly clear that Obamacare is a success. Moreover, in places where Obamacare is not succeeding, it's also clear that the right wing is to blame. Well, it's clear to any who look at the state-by-state numbers of the newly insured. A whole lot of Americans will have to look, however, for the program's success to redound to Democrats’ advantage (Harold Meyerson, 1/8). 

The Wall Street Journal: Obama The Management Failure
The prime example of the president's management gap has been ObamaCare. By handing off the framing of the legislation to Congress, Mr. Obama repeated the rookie mistake he made with the stimulus bill, which became a bloated porkfest. The health-care program that emerged from Capitol Hill with no Republican support is a Rube Goldberg monstrosity, an administrative nightmare. Given ObamaCare's complexity, a seasoned executive would have bird-dogged every stage of its creation and rollout, with obsessive attention to the testing of the sign-up computer programs, the public's first encounter with his signature initiative. There would be go/no-go inflection points and backup timetables, cold-eyed performance reviews and abrupt dismissals. And, in the worst case, a plan to put everything on hold for a year to sort out all the problems (Edward Kosner, 1/8). 

The Wall Street Journal: ObamaCare's Rude Awakening For The Young
President Barack Obama won PolitiFact's 2013 "Lie of The Year" for claiming, that "if you like your health care plan, you can keep it." Instead of being ashamed, members of his administration appear to have been inspired by the award. Take the statement by Department of Health and Human Services' National Press Secretary for Health Care, Joanne Peters. On Jan. 2, the Journal quoted her as saying ObamaCare "is making health insurance more affordable for young adults" (Karl Rove, 1/8). 

Bloomberg: Democrats And Republicans Are Both Wrong On Obamacare Politics
Top Republicans privately recognize that repeatedly trying to repeal the Affordable Care Act is no longer a winning strategy. For Democrats, there is the risk that new problems will emerge within a program that still lacks strong leadership. They may also find that history doesn't support their calculation that the health-care law will redound to their political advantage as more benefits kick in (Albert R. Hunt, 1/8). 

JAMA: The End Of The Beginning For The Affordable Care Act
It's now halftime for the launch of the Affordable Care Act (ACA). People seeking coverage to begin on January 1 had to enroll between October 1 and the end of 2013, but they can continue enrolling until March 31, when the open enrollment period for 2014 ends. As Winston Churchill might have described it, it's the "end of the beginning" (Larry Levitt, 1/8).

And on other issues -

The New York Times: Abortion Restrictions In Texas And Beyond
The tenuous state of women's basic right to make their own childbearing decisions was made clear on Monday when a federal appeals court in New Orleans heard arguments on a new abortion restriction enacted in July in Texas — one that requires doctors who perform abortions to have admitting privileges at a nearby hospital (1/8). 

USA Today: 23andMe's Rush To Market Irresponsible
Pretty soon, you'll be able to swab your nose or mouth at home and be able to find out whether you have the flu, instead of having to trek, with fever and chills, all the way to the doctor's office. ... Home health testing is the future. You can already find out whether you are ovulating, measure your blood alcohol level, test yourself for the presence of illegal drugs, check your cholesterol or blood sugar, even find out whether you might have HIV or hepatitis C, all in the comfort of your own home and all approved by the Food and Drug Administration. But as the company 23andMe has recently shown us, there is a responsible way to approach home health testing and a sketchy way — which can serve as a lesson for future home-testing entrepreneurs (Katherine Chretien, 1/8). 

USA Today: Our View: War On Smoking, At 50, Turns To Teens
The war on smoking, now five decades old and counting, is one of the nation's greatest public health success stories — but not for everyone. As a whole, the country has made amazing progress. In 1964, four in ten adults in the U.S. smoked; today fewer than two in ten do. But some states — Kentucky, South Dakota and Alabama, to name just a few — seem to have missed the message that smoking is deadly (1/8). 

USA Today: High Cigarette Tax Hurts The Poor: Opposing View 
Kentucky is a woefully unhealthy state. Even Bluegrass residents admit that their smoking rate — the nation's highest — significantly contributes to this sickly state of affairs. Still, the claim that the remedy to such an unhealthy vice is to tax it out of existence has many Kentuckians scratching their heads (Jim Waters, 1/8).

Medpage Today: A New Year: Time To Get Lean!
"Lean" is not about the stats! It is a philosophy to reduce variation and to make customer-focused, data-driven decisions. What does "lean" mean? Lean principles are found in: The approaches of Kaizen, a Japanese term embodied by efforts at continuous improvement. Six Sigma, a methodology with tools to improve capabilities of business processes. The DMAIC (Define, Measure, Analyze, Improve, Control) process, an incremental process improvement via structured problem solving. When translated to health care, the principles can reduce denials, improve patient satisfaction and staff morale, and, most importantly, eliminate bottlenecks in practice operations (Rosemarie Nelson, 1/8).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Marissa Evans
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.