Daily Health Policy Report

Friday, October 11, 2013

Last updated: Fri, Oct 11

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Public Health & Education

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Looking For Washington's Best Hospital? Here's A Little Advice

Kaiser Health News staff writer Jordan Rau, working in collaboration with Washingtonian, reports: "What is the best hospital in Washington, D.C.? It's not as easy to figure out as you might think. Over the past two decades, a cottage industry of nonprofits and companies has sprung up that offers grades and rankings on the quality of hospitals. Because of the proliferation in ratings, two-thirds of the hospitals in the Washington area have won at least one distinction from a major rating group or company" (Rau, 10/11). Read the story.

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A Reader Asks: My Coverage Is Intermittent. Can I Do Better On The Marketplace?

Kaiser Health News consumer columnist Michelle Andrews answers a question from a contract worker looking for more consistent coverage (Andrews, 10/11). Read the column.

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California Working Overtime To Enroll Consumers On Marketplace -- And To Train People To Help

Kaiser Health News staff writer Sarah Varney reports: "Luisa Blue, head of the local Service Employees International Union in San Jose, has five more months to spend a million dollars. The union received a grant from Covered California, the state’s health insurance marketplace and is using some of the money to call people in their homes at night and on the weekend, as part of a massive education effort" (Varney, 10/11). Read the story.

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Mississippi Consumers Try And Try Again To Use Healthcare.gov

Mississippi Public Broadcasting's Jeffrey Hess, working in partnership with Kaiser Health News and NPR, reports: "In Mississippi ... consumers continue to face long delays and other technical difficulties as they try to log on and shop for affordable coverage. ... 'Why keep trying?' asked Meredith Stark, 29, a hotel desk clerk in the northeast Mississippi town of Blue Springs. 'Because this is something we need. We have a right to life, liberty and pursuit of happiness. And, I am sorry, but not having health insurance denies life'" (Hess, 10/11). Read the story.

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Capsules: Healthcare.gov Offers New Shopping Feature — Sort Of; Good News About Saving For Retirement Health Costs

Now on Kaiser Health News' blog, Phil Galewitz reports on the new shopping feature available on the federal government's health care website: "With consumers in 36 states struggling to access a federal exchange website to compare health plans, the Obama administration launched a new online tool Thursday that lets users see premium estimates by state, health plan and two age categories" (Galewitz, 10/11).

Also on the blog, Ankita Rao reports on a new study regarding planning for retirement health care costs: "A new report from the Employee Benefit Research Institute found that Medicare beneficiaries, who are 65 years or older, would need to save six to 11 percent less in 2013 than they did in 2012" (Rao, 10/10). Check out what else is on the blog.

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Political Cartoon: 'Sick Of Waiting?'

Kaiser Health News provides a fresh take on health policy developments with "Sick Of Waiting?" by David Fitzsimmons.

Here's today's health policy haiku:


Like the proverb says
If at first you don't succeed 
Try, try, try, try, try

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

Blame For Healthcare.gov's Bugs Placed On Design Element

As outside experts offered opinions about the reasons for the problems in the federal health insurance exchange, administration officials asked consumers for patience while the system undergoes repairs. Meanwhile, House and Senate Republicans launched investigations into the difficulties.

The Wall Street Journal: Healthcare.Gov's Flaws Found, Fixes Eyed
Government officials are considering rebuilding some parts of the federally run health-insurance marketplace that have been identified as the key flaws that blocked many consumers from getting coverage. Much of the problem stems from a design element that requires users of the federal site, which serves 36 states, to create accounts before shopping for insurance, according to policy and technology experts. The site, healthcare.gov, was initially going to include an option to browse before registering, but that tool was delayed, people familiar with the situation said (Weaver and Radnofsky, 10/10).

The Associated Press: Questionable Design Blamed For Health Website Woes
A decision by the Obama administration to require that consumers create online accounts before they can browse health overhaul insurance plans appears to have led to many of the glitches that have frustrated customers, independent experts say. Most e-commerce websites—as well as medicare.gov—are not designed to require those merely browsing to set up accounts. But it’s one of the first steps on healthcare.gov (10/10).

Reuters: New 'Deadline' For Fixing Obamacare Glitches Seen In Mid-November
The U.S. administration has a little over a month to fix the technology problems crippling its online health insurance marketplace, or jeopardize the goal of signing up millions of Americans in time for benefits under President Barack Obama's healthcare law, experts said on Thursday. Problems with the federal marketplace's entry portal serving 36 states, the website Healthcare.gov, continued for a 10th day on Thursday despite signs of gradual improvement, keeping a brake on the ability of consumers to shop for federally subsidized health coverage (Morgan, 10/10).

ABC News: Obamacare Officials Defend Online Exchanges
Obamacare officials are defending their health insurance exchanges today after an online poll suggested that few Americans are happy with the newly launched program. As many as 20 million Americans have gone online to check out their new insurance options since Oct. 1, according to the Associated Press-GfK poll. But just 27 percent of those surveyed between Oct. 3 and 7 said the launch had gone "extremely," "very" or "somewhat well." Forty percent of Americans polled said the launch had gone "not too well" or "not well at all," according to the poll, and another 30 percent said they didn’t know enough to say (Moisse, 10/10).

Politico: Democrats – So Far – Confident That Obamacare Web Site Can Be Fixed
Democrats are cutting President Barack Obama some slack on the clunky Obamacare website — for now. Problems with the HealthCare.gov signup site have been so massive that most people who try to sign up can’t get to step one. The troubled rollout is about the last thing Democrats need while they’re trying to fend off the Republican efforts to defund or delay the president’s signature health law (Nather, 10/11).

Politico: GOP To Obamacare Contractors: What Happened?
Republican lawmakers are demanding answers from the White House about the technical flaws that have crippled Obamacare’s online enrollment system in its opening week. Top House watchdog Rep. Darrell Issa and others say the troubled reality doesn’t jibe with the rosy predictions administration officials and contractors were making ahead of the Oct. 1 launch of HealthCare.gov, the online portal most of the country will use to enroll new Obamacare coverage programs (Cheney, 10/10).

Fox News: Republicans Investigating ObamaCare Website Glitches
House Oversight Committee Chairman Darrell Issa, R-Calif., and Sen. Lamar Alexander, R-Tenn., sent a letter Thursday to Health and Human Services Secretary Kathleen Sebelius demanding answers to a series of questions about the technical failures. The lawmakers are seeking details on the number of people who have successfully enrolled in the health insurance exchanges and information about all of the technical problems that have prevented enrollment and the cost of fixing those problems, according to a news release. "We are concerned by recent comments to the media that the system suffers from architectural problems that need design changes," the lawmakers wrote. "We seek information about these problems as well as whether you still expect individuals to suffer a tax penalty if they do not purchase government-approved health insurance” (10/11).

The Hill: Senator: ObamaCare ‘About As Clear As Mud’
The public is confused about ObamaCare because the administration is “burying” important details, a Republican senator charged Thursday. Sen. Lamar Alexander (Tenn.), the top Republican on the Senate health committee, criticized the administration's handling of ObamaCare regulations, noting that some were released through informal channels, while others had to be unearthed by reporters (Goad, 10/10).

Kaiser Health News: Capsules: Healthcare.gov Offers New Shopping Feature — Sort Of
With consumers in 36 states struggling to access a federal exchange website to compare health plans, the Obama administration launched a new online tool Thursday that lets users see premium estimates by state, health plan and two age categories (Galewitz, 10/11).

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Unlike The Federal Exchange, State Online Insurance Marketplaces Have Had More Luck Addressing Issues

News outlets report on how the exchanges are working and how consumers are responding in Pennsylvania, Florida, Mississippi, Hawaii, Minnesota and California.  

The Wall Street Journal: New State Health Exchanges Have Largely Fixed Glitches
New state-run health-insurance exchanges have largely fixed their technical problems, marking a sharp contrast with the federal government more than a week after the centerpiece of the Affordable Care Act opened for business (Schatz, Dawsey, Dooren, 10/10).

The New York Times: Blue Cross Plans Jump To An Early Lead
On the first day that people could buy coverage under the federal health care law last week, the chief executive of Independence Blue Cross in Philadelphia had just learned that his company’s plans were the area’s least expensive available through the new state exchanges. "We were thrilled," said Daniel J. Hilferty, the nonprofit insurer’s chief executive (Abelson, 10/10).

The New York Times: In Florida, Opposition By The State And Snags In Signing Up On The Web
Be it gold, silver or bronze level, there are two ironclad requirements for buying health insurance in Florida on the federal online exchange: patience and persistence. … First the State Legislature roundly rejected the law, refusing to create a state insurance exchange and punting it to the federal government to run the new insurance market. It also rejected $51 billion in federal funds that was available over 10 years to expand Medicaid coverage for the state’s poor. As the day neared for consumers to enroll in insurance plans, state officials announced that so-called navigators — a group assigned to help people sign up — would be barred from state health offices just like all other outside groups. But blame this week shifted to the federal government (Alvarez, 10/10).

Health News Florida: HealthCare.Gov: Waiting, Hoping
Florida's online health insurance Marketplace has been open for business since Oct. 1. But more than a week later, people are still having trouble with HealthCare.gov, the website consumers use to shop for health plans (Watts, 10/10).

Kaiser Health News: Mississippi Consumers Try And Try Again To Use Healthcare.gov
Mississippi Public Broadcasting's Jeffrey Hess, working in partnership with Kaiser Health News and NPR, reports: "In Mississippi, one of 34 states letting the federal government operate the online health insurance marketplace created by the health law, consumers continue to face long delays and other technical difficulties as they try to log on and shop for affordable coverage" (Hess, 10/11). Read the story.

The Associated Press: Hawaii Relaunching Obamacare Exchange After Not Selling Any Health Insurance Due To Software Problems
Hawaii’s health insurance marketplace is hoping to turn around a stalled start by providing plans and pricing to consumers by Oct. 15 — but there are no guarantees, its executive director said Wednesday. Coral Andrews, executive director of Hawaii Health Connector, told state lawmakers Wednesday that getting the marketplace running properly has been a fluid situation, with circumstances changing every day (10/10).

CQ HealthBeat: Hawaii Plans Exchange Restart On Oct. 15
The Aloha State’s health care exchange leaders have apologized to residents who flocked to its marketplace last week only to find that it wasn’t working and say they are determined to get the website fully up and open for business by Oct. 15 (10/10).

Minnesota Public Radio: MNsure Working To Reduce Help Center Wait Times
Callers to the help center for the state's new online insurance marketplace are waiting on hold for an average nine minutes, longer than originally projected, MNsure officials said today. This summer, MNsure officials said callers could expect to wait about two minutes and no more than five. But anyone who has tried the call center recently likely heard a recorded message about high call volume, followed by a bland instrumental track from soprano sax player Kenny G. MNsure Executive Director April Todd-Malmlov said MNsure is making changes to the website in hopes of easing call volumes (Stawicki, 10/10).

The New York Times: Health Act Embraced In California
There are radio and television commercials galore, along with Twitter and Facebook posts and scores of highway billboards. There are armies of outreach workers who speak Spanish, Tagalog, Cambodian, Mandarin and Cantonese, all flocking to county fairs, farmers markets, street festivals and back-to-school nights across the state. There are even dinner parties in Latino neighborhoods designed to reach one family at a time (Medina, 10/10).

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Consumers Still Have Questions About How They Will Fare Under Health Law

The Los Angeles Times and Kaiser Health News answer health law inquiries.

Los Angeles Times: Obamacare Q & A: Will My Plan Skyrocket? How Will The Unemployed Pay?
During its first week, California's insurance exchange received nearly 60,000 calls from consumers and about 1 million Web visitors. Despite numerous technical glitches, federal officials say 8 million people logged on last week to their online exchange for 36 states not running their own marketplace. This rollout has prompted many questions from people about what President Obama's Affordable Care Act will mean for them.  Here are some answers (Terhune, 10/10).

Kaiser Health News: A Reader Asks: My Coverage Is Intermittent. Can I Do Better On The Marketplace?
Kaiser Health News consumer columnist Michelle Andrews answers a question from a contract worker looking for more consistent coverage (Andrews, 10/11).

Helpful resource page from KHN: What Obamacare Means For You

Meanwhile, in news related to health law policies playing out in the marketplace -

Bloomberg: Enrolling In The Ultimate Obamacare ETF
It just may be the ultimate play on Obamacare. The $55 million SPDR S&P Health Care Services exchange-traded fund (XHS) holds insurers, hospitals, clinics, rehab centers and nursing homes -- all of which are about to get more paying customers from an injection of billions of dollars a year in a variety of new taxes (Balchunas, 10/10).

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Capitol Hill Watch

No Deal Yet, But GOP Offer On Debt Limit Raises Hopes

Speaker John Boehner’s offer represented give on the part of Republicans, who had been insisting on cuts to the federal health care law as the price for reopening government and extending the debt limit. While Boehner proposed moving only to raise the debt limit, discussions broadened to include efforts to reopen the government in exchange for entitlement cuts. In the past, President Barack Obama has refused to consider those unless Republicans agree to raise revenues.

The New York Times: No Quick Deal, But Offer By G.O.P. On Debt Shifts The Tone
Many House Republicans, leaving a closed-door party caucus earlier Thursday that at times grew contentious, said they would support their leadership’s short-term debt limit proposal. But they said they would do so only if Mr. Obama agreed to negotiate a broader deficit reduction deal, with big savings from entitlement programs. The president has insisted he will not agree to significant reductions in projected Medicare and Medicaid spending — even his own tentative proposals — unless Republicans agree to raise revenues by curbing tax breaks for corporations and wealthy individuals. And Mr. Boehner in recent days reaffirmed the party’s anti-tax stance, which suggests that future talks could founder (Calmes and Parker, 10/10).

Los Angeles Times: GOP Plan To Extend Debt Limit Raises Hope Of End To Impasse
The president's healthcare law, which Republicans spent weeks trying to block or delay as a condition of approving any funding bills this fall, was "not discussed," Rogers said. The House could vote as early as Friday, but both houses planned weekend sessions. The Treasury Department says the debt ceiling needs to be raised by Oct. 17 (Mascaro and Memoli, 10/10).

The Associated Press/Washington Post: No Deal Yet, But House GOP, White House Seek End To Debt Limit, Government Shutdown Battles
Boehner’s offer represented give on the part of Republicans, who had been insisting on cuts to Obama’s 2010 health care law and other programs as the price for reopening government and extending the debt limit. But they claimed victory on one front, noting that they were in negotiations with a president who had said repeatedly there would be none until the government was open and default prevented. The speaker’s plan — and positive though unenthusiastic words about it from White House spokesman Jay Carney — seemed to spark a good day in the financial world (10/11).

The Washington Post: Competing Plan Emerges In Senate To End Shutdown, Raise Debt Limit For 3 Months
The package was being assembled by Sen. Susan Collins (R-Me.) and has attracted the interest of Senate Democrats, sparking the first bipartisan negotiations since the stand-off began in early September. … Senate Democrats were intrigued by Collins’ proposal, but unhappy with its demand for Democratic concessions. Those include repeal of a tax on medical devices needed to fund the new health care initiative and new income verification procedures for people who receive tax subsidies to buy health insurance on the law’s new exchanges (Montgomery, 10/10).

The Wall Street Journal: Obama, GOP Open Talks Over Temporary Debt Fix
A new poll shows that Republicans are bearing the brunt of public outrage over the budget impasse. The Wall Street Journal/NBC News poll found 53% of Americans blamed the GOP for the shutdown, compared with 31% who blamed Mr. Obama. The Republican Party's image has slumped to its lowest level in Journal/NBC polling, which dates to 1989, with more than twice as many people holding a negative image of the GOP as a positive one. Until now, Mr. Obama had refused to negotiate until the government was reopened and the debt ceiling raised. Republicans, in turn, said those steps must be paired with a deficit-reduction plan and changes to the 2010 health care law that they knew Mr. Obama wouldn't accept. While Republicans on Thursday initially proposed moving only to raise the debt limit, discussions broadened to include efforts to reopen the federal government (Hook and O’Connor, 10/10).

CNN: Republican Congressman: Defunding Obamacare Is 'Off The Table'
There are reportedly enough votes to pass a “clean” funding bill to refill federal coffers – one that would not include big Republican demands that the president’s signature healthcare initiative be defunded or delayed. In an op-ed for USA Today, Republican Rep. James Lankford wrote, "Republicans have asked for two things on Obamacare and one thing on the debt ceiling." Lankford did not mention defunding Obamacare. "That's currently off the table now," Lankford said in an interview on "The Lead with Jake Tapper," referring specifically to the debt ceiling deal (10/10).

The New York Times: Ryan Is Again In The Forefront For The G.O.P.
Mr. Ryan, 43, has immense credibility with conservatives for his "Path to Prosperity" budget, which proposed politically risky Medicare changes and deep tax cuts. Moderates see Mr. Ryan, who has broken with some conservatives over immigration, as a lawmaker with some flexibility. In many respects, his standing exceeds that of the party’s titular leader, Speaker John A. Boehner. Perhaps most important, Democrats believe that when Mr. Ryan drafts a plan, he can actually deliver the votes. They hold no such confidence in Mr. Boehner (Weisman, 10/10).

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Public Largely Blames GOP For Shutdown While Health Law Grows More Popular, Poll Shows

A Wall Street Journal/NBC News poll finds sharp drop in support for a Republic position on government shutdown and health law. Meanwhile, The New York Times explores how some of the most vocal elements of the conservative wing of the GOP are splintering over the House strategy to tie defunding of the health law to the federal budget.

The Wall Street Journal: Poll Finds GOP Blamed More For Shutdown
At a time of weak confidence in the economic recovery, the government impasse in Washington has delivered an unusually sharp blow to public faith in the elected leaders and their stewardship over the economy, the poll found. Participants in the poll gave the Republican Party overall its lowest marks in the history of Journal polling, which goes back to 1989: More than twice as many hold a negative view of the GOP as a positive one. By contrast, the number of Americans viewing the Democratic Party positively or negatively was nearly equal, at about 40% (King, 10/10).

NBC News: NBC/WSJ Poll: Shutdown Debate Damages GOP
Yet what is perhaps even more worrisome for the GOP is the “boomerang” effect: As the party has used the shutdown and fiscal fight to campaign against the nation’s health-care law and for limited government, the poll shows those efforts have backfired. For one thing, the health-care law has become more popular since the shutdown began. Thirty-eight percent see the Affordable Care Act (or “Obamacare”) as a good idea, versus 43 percent who see it as a bad idea – up from 31 percent good idea, 44 percent bad idea last month. In addition, 50 percent say they oppose totally eliminating funding for the law, even if it that means a partial shutdown of the government. That's up from 46 percent who said they opposed that move in a Sept. 2013 CNBC poll (Murray, 10/10).

The Hill: Poll: ObamaCare Gains Popularity Amid Shutdown
President Obama's healthcare law has gained popularity as Republicans have looked to strip and defund parts of it, leading to a government shutdown, according to a NBC-Wall Street Journal poll. The survey released Thursday found 38 percent of people believe ObamaCare is a good idea, a 7-point jump since last month. That includes 31 percent of people who feel strongly about their views (Trujillo, 10/10).

The New York Times: Kochs And Other Conservatives Split Over Strategy On Health Law
Under attack for the government shutdown, some of the most vocal elements of the conservative wing of the Republican Party are publicly splintering, a sign of growing concerns among even hard-core conservatives that the defeat-health-care-at-any-cost strategy may have backfired (Lipton and Confessore, 10/10).

In other political news on the health law --

CNN: Ted Cruz Says He's For Health Care Reform, Just Not Obamacare
Sen. Ted Cruz really does want healthcare reform, just not Obamacare, the Texas Republican said Thursday night. The conservative firebrand and self-made arch-foe of the Affordable Care Act was on CNN’s "Crossfire" to defend the tactics he proposed that helped drive the United States to a government shutdown. And those tactics seem to be working by Cruz's standards (Koenig, 10/10).

Bloomberg: Obamacare Foes Using Shutdown Echo South's Nullifiers
The Tea Party-inspired drive to derail Obamacare is anchored in a place where opposition to the federal government is as old as the nation: the American South. The current fight, a budget standoff that threatens the creditworthiness of the U.S, has vestiges of the secession from the union that started in South Carolina and led to the Civil War (Tackett, 10/11).

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Public Health & Education

Gov't. Shutdown Creates Difficult Issues At NIH

The National Institutes of Health is trying to cope with the effects of the government shutdown on patients and medical research. 

The Associated Press: NIH Admits A Dozen Critically Ill Despite Shutdown
A few desperately ill patients have managed to get into clinical trials at the National Institutes of Health's famed hospital, even though the government's partial shutdown has others being turned away, the agency said Wednesday. Normally, about 200 new patients every week enroll in studies at the NIH's research-only hospital, often referred to as the "house of hope" because so many of those people have failed standard treatments (Neergaard, 10/9).

NPR: Shutdown Imperils Costly Lab Mice, Years Of Research
The government shutdown is likely to mean an early death for thousands of mice used in research on diseases such as diabetes, cancer and Alzheimer's. Federal research centers including the National Institutes of Health will have to kill some mice to avoid overcrowding, researchers say. Others will die because it is impossible to maintain certain lines of genetically altered mice without constant monitoring by scientists. And most federal scientists have been banned from their own labs since Oct. 1 (Hamilton, 10/10).

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State Watch

State Highlights: Calif. Gov. OK's Extension Of Autism Treatment Coverage

A selection of health policy stories from California, Kansas, Georgia, North Carolina and Ohio.

Los Angeles Times: Gov. Brown Extends Insurance Coverage For Autism Treatment
Gov. Jerry Brown has approved a 2 1/2-year extension of a program that requires insurance coverage for early autism treatment. Since its creation in 2011, the program has helped more than 12,500 Californians, according to Senate leader Darrell Steinberg (D-Sacramento), the author of the bills creating and extending the program (McGreevy, 10/10).

Los Angeles Times: Gov. Brown Orders Swift Response To Mental Hospital Crimes
Gov. Jerry Brown on Thursday signed legislation aimed at protecting victims of sex crimes in state hospitals and developmental centers. SB 651 by Senator Fran Pavley (D-Agoura Hills) mandates that victims of suspected abuse in the hospitals and centers for the developmentally disabled receive immediate examinations by trained investigators at independent facilities to collect evidence (McGreevy, 10/10).

Kansas Health Institute: Pilot Project Aims To Reduce Billing Errors At Local Health Departments
A new pilot program aimed at improving billing and collections at local health departments is beginning at a critical time: just as tens of thousands of Kansans are expected to get insurance coverage under the Affordable Care Act (ACA). Currently, billing errors are costing many local health departments when it comes to collecting payments from private insurance companies and the Medicaid program (Cauthon, 10/10).

Georgia Health News: A Change In Services And A Medicaid Pay Hike
A state health agency board gave initial approval Thursday to offering care coordination services to 450,000 Medicaid beneficiaries who have disabilities or are elderly. The proposal for the “aged, blind and disabled’’ population comes as part of the state’s move to improve care and reduce spending. This beneficiary category represents roughly 28 percent of Medicaid enrollees in Georgia, but it accounts for 60 percent of the overall costs of the program (Miller, 10/10).

Raleigh News & Observer: Auditor Challenges DHHS NC Tracks Explanations
State Auditor Beth Wood sent legislators a letter Thursday saying state Department of Health and Human Services officials offered incomplete information about the Medicaid bill paying system called NC Tracks. ... Agency officials and legislators spent hours talking about NC Tracks because it’s been a big problem for health care providers. Some have months of bills awaiting payment (Bonner, 10/10).

Winston-Salem Journal: Wood Defends Work, Rebuts Wos’ Claim On DHHS 
Beth Wood also said in a separate letter to a legislative oversight committee that DHHS officials, including Secretary Aldona Wos, provided incomplete information during a hearing Tuesday that grew testy at times. ... An article by N.C. Health News, a nonprofit group, raised questions about the completeness of the state Auditor’s Office report issued Jan. 31 on the state’s $13 billion Medicaid program. The group based its report on DHHS reports and filings acquired through public records requests (Craver, 10/10).

Los Angeles Times: Santa Clara University Drops Insurance For Elective Abortions
Santa Clara University, a Catholic institution in the Silicon Valley area, is dropping coverage for elective abortions under health insurance for its faculty and staff members, officials said. The move is part of what seems to be a trend among Catholic campuses seeking to uphold their religious beliefs against abortion while employing and enrolling many non-Catholics. Loyola Marymount University in Los Angeles took a similar step this week but, in a compromise, is allowing employees to buy coverage for elective abortions through an insurance plan not administered or subsidized by the school (Gordon, 10/10).

California Healthline: California Hospital Group Proposes Ballot Initiative for Medi-Cal Provider Fee
The California Hospital Association on Wednesday filed a ballot initiative for the November 2014 ballot that would set the percentage the state gets from a fee levied on hospitals and designate how the money is to be spent. The action, which required notification to the state Attorney General's Office, would lock in place current practices and is not the result of any disagreement with the Legislature, said Jan Emerson-Shea, association vice president (Norberg, 10/10).

Columbus Dispatch: Bill To Reform, Not Expand, Medicaid Introduced
After hearings this summer and work on the issue dating back to 2009, Sen. Dave Burke rolled out a Medicaid reform bill yesterday that would require monthly per-member costs to increase by no more than 3 percent, down from the current projections of 4.6 percent. If the system can hit the 3 percent mark — a bill introduced this past summer set it at 3.5 percent — Burke said Medicaid in Ohio would save $8.6 billion through 2020, $5.5 billion of which would be federal money. He noted that Medicaid spending has grown from 31 percent of the state budget in 2000 to 49 percent in 2015. The bill does not specify how to reach those savings (Siegel, 10/11).

The CT Mirror: Seven Things To Know About HUSKY And Obamacare
The scope of the changes to Connecticut's Medicaid program is likely to be smaller than in many other states, because this state got a head start, expanding Medicaid shortly after the health law passed in 2010. Still, Connecticut’s Medicaid program, known as HUSKY, will expand further as of Jan. 1, and existing members will see some changes. And even people who are seeking private coverage through Access Health CT, the state’s health insurance exchange, might find that their children could end up in HUSKY. Here are some key things to know about how the law commonly known as Obamacare affects Medicaid in Connecticut (Becker, 10/11).

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Health Policy Research

Research Roundup: Medicare Part D In 2014; Barriers To Mental Health Care

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

Kaiser Family Foundation/Georgetown University/NORC: Medicare Part D: A First Look At Plan Offerings In 2014
Medicare Part D continues to be a marketplace with an array of competing plans offered at a wide range of premiums and benefit designs.  In 2014, Medicare beneficiaries will have a choice of 35 stand-alone PDPs, on average, up by four from 2013. ... Beneficiaries receiving Low-Income Subsidies (LIS) will have access to a modestly higher number of plans for no monthly premium in 2014 compared to 2013 ... Notable trends for 2014 include a growing share of PDPs using preferred pharmacy networks and adopting more formulary cost-sharing tiers. For example, a majority of PDPs now use preferred pharmacy networks where cost sharing is lower when enrollees use preferred pharmacies and higher outside the preferred network (Hoadley, Cubanski, Hargrave and Summer, 10/10).  

Health Affairs: Access And Cost Barriers To Mental Health Care, By Insurance Status, 1999–2010 
Although access to specialty care remained relatively stable for people with mental illnesses, cost barriers to care increased among the uninsured and the privately insured who had serious mental illnesses. The rise in cost barriers among those with private insurance suggests that the current financing of care in the private insurance market is insufficient to alleviate cost burdens and has implications for reforms under the Affordable Care Act. People with mental health problems who are newly eligible to purchase private insurance under the act might still encounter high cost barriers to accessing care (Rowan, McAlpine and Blewett, 10/7).

Health Affairs/Rand: Accountable Care Organization Formation Is Associated With Integrated Systems But Not High Medical Spending
Medicare's approximately 250 accountable care organizations (ACOs) care for a growing portion of all fee-for-service beneficiaries across the United States. We examined where ACOs have formed and what regional factors are predictive of ACO formation. ... We found wide variation in ACO formation, with large areas, such as the Northwest, essentially empty of ACOs, and others, such as the Northeast and Midwest, dense with the organizations. Key regional factors associated with ACO formation include a greater fraction of hospital risk sharing (capitation), larger integrated hospital systems, and primary care physicians practicing in large groups. Area income, Medicare per capita spending, Medicare Advantage enrollment rates, and physician density were not associated with ACO formation (Auerbach et al., 10/7). 

Health Affairs: Trends Underlying Employer-Sponsored Health Insurance Growth For Americans Younger Than Age Sixty-Five
During [2007-2011], per capita spending on employer-sponsored insurance grew at historically slow rates, but still faster than per capita national health expenditures. Total per capita spending for employer-sponsored insurance grew at an average annual rate of 4.9 percent, with prescription spending growing at 3.3 percent and medical spending growing at 5.3 percent. Out-of-pocket medical spending increased at an average annual rate of 8.0 percent, whereas out-of-pocket prescription drug spending growth was flat. Growth in the use of medical services and prescription drugs slowed. Medical price growth accelerated, and prescription price growth decelerated (Herrera et al., 10/7). 

Urban Institute/Robert Wood Johnson Foundation: Eligibility For Assistance And Projected Changes In Coverage
Among states not currently planning to expand Medicaid eligibility, the share of the uninsured eligible for assistance ranges from 34 to 53 percent. In contrast, the share of the uninsured eligible for assistance ranges from 59 to 81 percent among the states that are currently committed to expanding Medicaid under the ACA. Second, we estimate the decrease in the uninsured population under the ACA in each state. Among states not currently expanding Medicaid, we predict the number of uninsured would decrease 28 to 38 percent. Eight states committed to expansion would see the number of uninsured decline by more than half (Buettgens, Kenney, Recht and Lynch, October 2013).

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

Reuters: Are Blood Clots After Surgery A Sign Of Hospital Quality
Some policymakers have suggested using the number of patients that form blood clots after surgery as a measure of a hospital's quality. But a new study questions that idea. Researchers found high-quality hospitals and those that regularly check for the complications tend to have higher rates of blood clots than low-quality hospitals and those that don't look for clots as often (Seaman, 10/7).

Modern Healthcare: ACOs More Likely To Be In Markets With Hospital, Doctor Consolidation, Study Finds
In five markets around the country, accountable care organizations were providing care to more than half the Medicare patients in the traditional fee-for-service program, a new study found. In addition, ACOs were more likely to be found in markets with greater consolidation by hospitals and doctors (Evans, 10/7).

Reuters: Sicker Medicaid, Medicare Emergency Patients Less Profitable
When a patient with private health insurance seeks outpatient care at the emergency room, the sicker he or she is, the more money the hospital stands to make, a new study shows. But the opposite is true for patients with Medicaid or Medicare insurance: the sicker the patient, the less profitable he or she is to the hospital, Dr. Philip Henneman of the Tufts University School of Medicine in Boston and his colleagues report in the Annals of Emergency Medicine (Harding, 10/10).

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Editorials and Opinions

Viewpoints: Health Law's Threat To Privacy; 'Catastrophic' Debut Of Marketplaces Should Signal Need For Delay; In Budget Impasse Can Either Side Accept A Compromise?

USA Today: Obamacare Data Hub Looms As Privacy Threat
Every day, personal information is the subject of hundreds of thousands of hacking attempts from all over the world. From nation states to crime rings, knowing and exploiting your information is big business. On October 1, a major component of Obamacare made you even more vulnerable to devastating attacks on your personal information and the administration is doing too little about it (Rep. Mike Rogers, R-Mich., 10/10).

The Wall Street Journal: ObamaCare And The Part-Time Economy
There are times when the Obama administration makes statements so disconnected from economic reality that you wonder if any White House official has talked with anyone in business. A case in point: the administration's mantra that ObamaCare's definition of full-time employment as 30 or more hours per week had no effect on employers' hiring practices (Andrew Puzder, 10/10). 

The Wall Street Journal: Now Is the Time To Delay ObamaCare
The Obama administration has an implementation problem. More than any administration of the modern era they know how to talk but have trouble doing. They give speeches about ObamaCare but when it's unveiled what the public sees is a Potemkin village designed by the noted architect Rube Goldberg. ... That gets us to the real story of last week, this week and the future, ... and that is the utter and catastrophic debut of ObamaCare. Even for those who expected problems, and that would be everyone who follows government, it has been a shock. They had 3½ years to set it up! They knew exactly when it would be unveiled, on Oct. 1, 2013. On that date, they knew, millions could be expected to go online to see if they benefit (Peggy Noonan, 10/10). 

Fox News: My ObamaCare Surprise
Last week at a conference on the new health care law I got a big surprise. While Washington politicians are in a never-ending fight over President Obama's health care reform many of the nation's top insurance companies, brokers and major employers have long ago moved beyond the bitter debate in Washington. Even more than other Americans, they can't understand a government shut down over the plan. Unlike Americans who tell pollsters they don't like the new law and find it confusing, the business professionals dealing with the day-to-day reality of the new health insurance landscape accept the Affordable Care Act as straight forward approach to begin cutting the rising cost of health care for people and companies (Juan Williams, 10/10).

Health Affairs: Calm Down, America: ObamaCare Is Far From A Revolutionary Change In Our Health System
Three and half years after passage of President Obama’s Patient Protection and Affordable Care Act (ACA), the law is about to reach an important milestone. On January 1, 2014, millions of Americans will no longer be uninsured and a new system for obtaining coverage will be put in place throughout the country. Yet controversy remains about how the law will impact individuals, businesses, and the US health system. Opponents call it revolutionary. They declare it "socialized medicine" and a "government takeover of the health care system." The truth is the law will have limited impact on how most Americans receive medical care and pay for it. Far from a radical change, the ACA (or "Obamacare") builds on parts of our health care system that have evolved over the last half-century (Stuart Altman and Harry Selker, 10/10). 

The New York Times: An Inadequate Offer From The House
For now, House leaders seem to have dropped their demand to tie the reopening of government to ending health care reform. But as they shift back to the longer-running dispute over spending, they still want to use the continuing shutdown as their weapon to extract more cuts from the budget without any revenue increases (10/10). 

Los Angeles Times: In Government Shutdown, Can Either Side Take Yes For An Answer?
Have Democrats left themselves room to accept anything short of complete capitulation by the GOP? In the Senate, Susan Collins (R-Maine) suggested a shutdown-ender that would give agencies more flexibility to spend dollars than they received under the across-the-board sequester cuts enacted in 2011. Her proposal also would end the tax on medical devices, a change in the 2010 Patient Protection and Affordable Care Act (a.k.a. Obamacare) that many Senate Democrats support. ... In the House, Budget Committee Chairman Paul D. Ryan (R-Wis.) is trying to rally support behind temporarily funding the government and raising the debt limit in exchange for a binding agreement to negotiate lower deficits and entitlement changes. ... Democrats say they're willing to negotiate over whatever issues Republicans want to negotiate. They're just not willing to do so "at the point of a gun." In other words, they want the government funded and the debt ceiling raised, at least temporarily, before they sit down to talk (Jon Healey, 10/10).

Los Angeles Times: Shutdown/Debt Limit: Boehner's Non-Deal Deal
They're refusing to reopen the government unless President Obama agrees to "reforms" on Medicare and Social Security. In other words, they want to sacrifice the health and sustenance of America's seniors to end the shutdown. Rolling back Obamacare, which was the putative rationale for the shutdown and the debt-limit standoff, no longer appears to be on the table. Support for the GOP position, and the party in general, is collapsing to a record low, and it wasn't too great to begin with (Michael Hiltzik, 10/10).

The Washington Post: Boehner Is Playing To Win
By taking up the Obamacare battle, and by sticking with it long after sane people realized that the program would not be defunded or delayed, Boehner displayed a fortitude that conservatives felt he lacked in the "fiscal cliff" fight last December. If what the House GOP wanted was a Pickett's Charge, Boehner showed that he was willing to lead it. Boehner may have calculated that Obama would negotiate — if not over Obamacare, then about spending and entitlements. The president's uncompromising stance against hostage-taking meant Boehner had to follow through on the threat of a government shutdown — and meant that the GOP would shoulder most of the blame for an episode of dysfunction. It also meant, however, that Boehner would get to stand before the cameras every day and show his defiance of Obama, which makes House Republicans swoon (Eugene Robinson, 10/10).

Bloomberg: John Boehner's Dangerous Choice
The U.S. cannot under any circumstances afford a default. The last time political dysfunction in Washington led us to the brink, during the 2011 debt-ceiling fiasco, Standard & Poor’s downgraded U.S. credit for the first time in history. ... The U.S. also cannot under any circumstances afford to normalize political extortion. In retrospect, Obama erred in 2011 by agreeing to Republican demands for vast spending cuts in return for raising the debt ceiling. That deal was a precedent-breaker; no previous increase in the debt limit had been subject to similar conditions. Obama must now make sure it was not also a precedent-setter. If determined factions are able to achieve their ends by preventing the normal operations of the government and threatening economic chaos, then the nation’s 237-year democratic project will unravel (10/10).

The New York Times’ Economix: The Dubious Case For Professional Licensing
The original version of the [California] bill, S.B. 491, would have allowed qualified nurse practitioners to offer a defined scope of primary care services in independent primary care practices, without supervision by a licensed physician. That is already permitted in 17 states. The politically powerful AARP had endorsed that version of S.B. 491, a free-market approach that Friedman would have enthusiastically endorsed as well. Not so the California Medical Association, which vehemently opposes the proposed intrusion on the medical profession’s economic turf (Uwe E. Reinhardt, 10/11).  

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Stephanie Stapleton

Andrew Villegas

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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.