Daily Health Policy Report

Tuesday, October 15, 2013

Last updated: Tue, Oct 15

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Health Reform



State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Pay For Hospital CEOs Linked More To Technology, Patient Satisfaction Than Quality, Study Finds

Kaiser Health News staff writer Jordan Rau reports: "What do hospital boards value in a chief executive? A new study of CEO pay at nonprofit hospitals finds that executives at institutions that have a lot of fancy medical technology and high patient satisfaction are paid more than their peers. But running a hospital that scores well on keeping more patients alive or providing extensive charity care does not translate into a compensation bump" (Rau, 10/14). Read the story.

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Insuring Your Health: Health Insurance Co-Ops Offer New Option For Some Marketplace Shoppers

Kaiser Health News consumer columnist Michelle Andrews writes: "Many consumers who shop for coverage on the state health insurance marketplaces this fall have a new option to consider: a health insurance co-op. The nonprofit, member-run "consumer oriented and operated plans," or co-ops, were created under the federal health law to enhance competition on the marketplaces and give consumers affordable choices that emphasize patient-focused, coordinated care. Whether these plans will offer a markedly different consumer experience compared to traditional insurance coverage or do a better job helping members get and stay healthy remains to be seen. Co-op managers say that, at a minimum, the plans' governance structure ensures that consumers' voices will be heard" (Andrews, 10/15). Read the column.

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Seniors Cautioned To Pay Close Attention To Details As Enrollment Begins In Medicare Plans

Reporting for Kaiser Health News, in collaboration with USA Today, Susan Jaffe writes: "The seven-week enrollment period for next year's Medicare prescription drug and managed-care plans begins Tuesday, but seniors shouldn't simply renew their policies and assume the current coverage will stay the same. There’s a likely payoff for those who pay close attention to the details" (Jaffe, 10/15). Read the story.

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South Floridians' Biggest Question About Marketplace Plans: Will They Be Affordable?

The Miami Herald's Patricia Borns, working in partnership with Kaiser Health News, reports: "One 47-year-old cancer survivor thinks the Affordable Care Act could save her life. But a 28-year-old real estate agent sees the law requiring health insurance for everyone as a safeguard he doesn’t need. And for an immigrant nursery worker in southern Miami-Dade County, health insurance is a luxury she never thought she could afford — and is afraid she still can't" (Borns, 10/14). Read the story.

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Capsules: Obamacare Enrollees Become Urban Legend; How Consumers Are Navigating The Marketplaces; Colorado Insurance Exchange Week One: Few Enrollments, Lots Of Interest

Now on Kaiser Health News' blog, The Miami Herald's Patricia Borns and Daniel Chang, working in partnership with KHN, report on the new enrollees: "Will the Floridians who have enrolled for Obamacare please stand up? Nearly two weeks after the federal government launched the online Health Insurance Marketplace at healthcare.gov, individuals who have successfully used the choked-up website to enroll for a subsidized health insurance plan have reached a status akin to urban legend: Everyone has heard of them, but very few people have actually met one" (Borns and Chang, 10/15).

In addition, Eric Whitney reports on the Colorado exchange's first week: "Despite a relatively low number of people buying coverage in its first week, the board in charge of Colorado’s health insurance exchange is generally pleased with how it’s running. Connect for Health Colorado, which is branding itself as C4HCO, says it had 162,941 unique visitors to its website October 1-7. Of those, 226 purchased health coverage for themselves and dependents, totaling 305 covered lives" (Whitney, 10/15).

Also on Capsules, watch the video of KHN's Julie Appleby on C-SPAN's Washington Journal Monday discussing consumer issues with the new online insurance marketplaces that launched Oct. 1 (10/14). Check out what else is on the blog.

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Political Cartoon: 'Roll Call?'

Kaiser Health News provides a fresh take on health policy developments with "Roll Call?" by Clay Bennett.

Here's today's health policy haiku:


When senators talk 
about the belly-button?
It's a tax, silly. 

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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Capitol Hill Watch

Senate Leaders Close In On Deal That Leaves Health Law Intact

The agreement could include a one-year delay in the health law's reinsurance tax, as well as a measure to tighten income verification standards for qualifying for health insurance subsidies.

The New York Times: Senators Near Fiscal Deal, But The House Is Uncertain
But while both Senator Mitch McConnell of Kentucky, the Republican leader, and Senator Harry Reid of Nevada, the Democratic leader, praised the progress that was made in the Senate, it was already clear that the most conservative members of the House were not going to go along quietly with a plan that does not accomplish their goal from the outset of this two-week-old crisis: dismantling the president’s health care law. … Senate Republicans had pushed for an agreement that included a provision to delay or repeal a tax on medical devices, but that became a sticking point in the negotiations and will almost certainly be excluded from the final deal, Senate aides said. But the deal is likely to include a one-year delay of another tax associated with the Affordable Care Act known as the reinsurance tax, which employers pay. … Another Republican-backed measure likely to be in the deal would require tighter income verification standards for people who receive subsidies under the new health care law. Under the new guidelines, the Health and Human Services secretary would have to certify that the department can verify income eligibility (Shear and Peters, 10/14).

The Washington Post: Senate Leaders Within Striking Distance Of Deal To End Shutdown, Raise Debt Limit
The emerging agreement would extend the Treasury Department’s borrowing authority until Feb. 7, reopen the government and fund federal agencies through mid-January, according to aides and lawmakers familiar with the negotiations. … The framework under consideration includes only minor changes to President Obama’s signature health-care law, falling well short of defunding it or delaying major provisions as conservative Republicans initially sought. Instead, Republicans would get only new safeguards to ensure that people who receive federal subsidies to purchase health insurance under the law are eligible to receive them. But talks were hung up over another provision, aides and lawmakers said: a demand by Democrats to delay the law’s “belly button tax,” a levy on existing policies that is set to add $63 per covered person — including spouses and dependents — to the cost of health insurance next year (Montgomery and Helderman, 10/14).

The Wall Street Journal: Senate Leaders In Striking Distance Of A Deal
The proposed agreement's framework included no major alterations to the 2010 health-care law that Mr. Obama championed and congressional Republicans have tried to curtail. However, lawmakers appeared to be weighing some minor changes, including new procedures to verify the incomes of some people receiving government subsidies for health-insurance costs. Lawmakers also appeared to be considering delaying for a year a fee of $63 per insured person levied on those who offer policies, including employers, unions and insurance carriers. The likely beneficiaries of the fee would be traditional insurance carriers, which are required to sell policies to everyone, regardless of medical history, and so could see customers incur major bills. Large employers and unions that provide coverage say the levy is unfair and they can't afford it, and have fought for an exemption (Peterson and Hook, 10/15).

Los Angeles Times: Senate Leaders Close In On Deal To End Budget Standoff
The proposal would not make significant changes in President Obama's healthcare law. But it could include a pair of tweaks: the delay of a new tax opposed by labor unions and an income verification requirement for customers who buy insurance through the new online marketplaces (Mascaro, Memoli and Bennett, 10/14).

The Associated Press/Washington Post: Senate Leaders Nearing Agreement To Fully Reopen Government, Avoid Threat Of Default
The plan is a far cry from the assault on "Obamacare" that tea party Republicans originally demanded as a condition for a short-term funding bill to keep the government fully operational. It lacks the budget cuts demanded by Republicans in exchange for increasing the government’s $16.7 trillion borrowing cap. Nor does the framework contain any of a secondary set of House GOP demands, like a one-year delay in the health law’s mandate that individuals buy insurance. Instead, it appeared likely to tighten income verification requirements for individuals who qualify for Obamacare subsidies and may repeal a $63 fee that companies must pay for each person they cover under the big health care overhaul beginning in 2014 (10/15).

The Wall Street Journal's Washington Wire: Belly-Button Tax: In Or Out Of Budget Deal?
The $63 levy on each person covered in a health plan goes into a fund to compensate insurance carriers who end up paying big medical bills for new customers who buy on the government exchanges. The levy is applied to spouses and dependents as well as policy holders, earning it the nickname "the belly-button tax." It’s paid by every company that provides insurance — big businesses, organized labor, and insurance carriers. The likely beneficiaries of the compensation fund, though, are just the traditional insurance carriers, who will become required to sell coverage to everyone, regardless of their medical history (Radnofsky, 10/14).

The Hill: Unions Poised To Win Delay Of ObamaCare Tax In Budget Deal
Labor unions are poised to score the delay of an ObamaCare tax in the bipartisan budget deal emerging in the Senate. The bargain under negotiation would make small adjustments to the healthcare law, including delaying the law's reinsurance fee for one year (Viebeck, 10/14).

Politico: Medical Device Makers Flex Muscle, Arm Way Into Debt Limit Fight
Several key lawmakers advocating a medical device tax repeal deal to end the current fiscal standoff could be rewarded by more than just a peacemaker reputation. The olive branch they’re offering could boost their campaign coffers (Blade, 10/14).

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Health Reform

Data Suggest State-Run Online Insurance Marketplaces Making Progress

Meanwhile, headlines across the country offer updates on specific state exchanges in California, Florida, Michigan, Oregon, Connecticut, Maryland, Minnesota and Colorado.

The Wall Street Journal: State-Run Health Exchanges Gain Some Traction
At least 38,000 people have signed up for new health plans in the state-run insurance exchanges that opened Oct. 1, while more than 100,000 have completed applications and are close to finishing the process, according to state data (Schatz, 10/14).

Los Angeles Times: Online Firms To Help Enroll People In Obamacare, But Not In California
The nation's biggest online seller of health insurance has joined forces with the federal government to enroll people across the country in Obamacare, but EHealth Inc. won't be signing up any Californians (Terhune, 10/14).

The Sacramento Bee: Covered Calif.: Doctor, Hospital Directory Release Premature
Officials with the state's health insurance marketplace acknowledged prematurely releasing an online directory of doctors and hospitals on Tuesday, a week after opening enrollment for its version of the federal health care overhaul. Covered California removed the directory within a day of release after discovering it was plagued by inaccuracies and sluggish performance. The search tool was designed to allow customers to determine whether their providers were included in health plans offered by the exchange. In an interview with The Sacramento Bee Editorial Board Monday, Covered California Executive Director Peter V. Lee said the directory never should have been launched (Cadelago, 10/14).

The Sacramento Bee: Opt-Out Efforts Won’t Play In California, Insurance Chief Says
The chief of California's health insurance marketplace said he has no concerns about advertising campaigns designed to derail the federal health care law, arguing there is no "echo chamber" for such efforts in the Golden State. Covered California Executive Director Peter V. Lee has been crisscrossing the state for roughly two dozen town hall meetings and said he has been heckled just once - by an individual speaking out against U.S. intervention in Syria (Cadelago, 10/14).

The Miami Herald/Kaiser Health News: South Floridians' Biggest Question About Marketplace Plans: Will They Be Affordable?
One 47-year-old cancer survivor thinks the Affordable Care Act could save her life. But a 28-year-old real estate agent sees the law requiring health insurance for everyone as a safeguard he doesn’t need. And for an immigrant nursery worker in southern Miami-Dade County, health insurance is a luxury she never thought she could afford — and is afraid she still can't" (Borns, 10/14).

The Miami Herald/Kaiser Health News: Capsules: Obamacare Enrollees Become Urban Legend
Will the Floridians who have enrolled for Obamacare please stand up? Nearly two weeks after the federal government launched the online Health Insurance Marketplace at healthcare.gov, individuals who have successfully used the choked-up website to enroll for a subsidized health insurance plan have reached a status akin to urban legend: Everyone has heard of them, but very few people have actually met one (Borns and Chang, 10/15).

The Associated Press: Health Plan Sign-Ups On The Rise In Michigan
Amid the problems and political finger-pointing since the launch of online health care exchanges, Adnan Hammad sees progress. The community health director at Dearborn-based nonprofit organization ACCESS said his staff has helped hundreds of people enroll in plans under the federal health care overhaul and educated thousands about the available options (10/14).

The Oregonian: Cover Oregon: Public Site Glitch Fixed So Browsers Can View Plan Details
Oregon's health insurance exchange has fixed a glitch that removed plan details from its public Cover Oregon website. Now plan details are up including information on copays, co-insurance and preventive coverage. Previously, the lack of information highly limited the website's usefulness for people hoping to buy their own policies on the individual market. The public browse-only website amounts to the state's backup plan as it tries to fix a larger glitch blocking enrollment on a separate website used by agents and application assisters. That site has had problems accurately determining whether a person is eligible for tax credits or other government assistance, such as the Medicaid-funded Oregon Health Plan. Cover Oregon officials had hoped to allow consumers to enroll themselves by Oct. 15, but now that function may not be available until November (Budnick, 10/14).

The CT Mirror: CT’s Newest Insurer Emphasizes Its Differences. Will That Win Customers?
In the quest to build an insurance company from scratch, Kenneth Lalime sees opportunity in mistaken phone calls. The new insurer Lalime runs is called HealthyCT, and it’s not uncommon for people to call trying to reach the state’s health insurance exchange, which is called Access Health CT. So the people who answer the phones at HealthyCT can transfer callers to Access Health, or they can answer questions themselves. Lalime hopes callers will remember that HealthyCT was helpful. Mistaken identity is just one of the quirks of being “the new guy on the block” at a time of major change for the health care and insurance industries (Becker, 10/14).

The Baltimore Sun: Maryland’s Obamacare Health Exchange Hit With Problems
As the nation prepared for the launch of federal health reforms, Maryland was lauded as a leader in adopting the president's signature program. Obama used a community college in Maryland as a backdrop to promote his plan — and to praise Maryland as a model (Cohn, 10/14).

The Baltimore Sun: Md. Insurance Exchange Shoppers Trend Young, Female, Officials Say
Young people are showing interest in buying insurance through Maryland Health Connection, the state marketplace created as part of federal health care reform, with those under 35 making up a third of those exploring the organization's website, officials said Friday. Users in the 25-29 and 30-34 age groups make up the largest and second-largest shares, respectively, of the 25,000 people who have created profiles on the marketplace's website, MarylandHealthConnection.gov, despite persistent technical difficulties (Dance, 10/11).

Minnesota Public Radio: MNsure After 2 Weeks: How’s It Working?
Elana Gravitz, Program Manager at Hennepin County Human Services Department sums up how many community organizations view MNsure, with a quick assessment: "Sometimes it works," she said. "Sometimes it doesn't work." MNsure officials say the on-again, off-again problems stem from the federal data hub, that insurance marketplaces such as MNsure must use to verify a person's income through the IRS. In recent weeks, the hub has been overwhelmed. But when it is working, Gravitz said, it automates the otherwise cumbersome enrollment process in Medicaid. "It's a great thing for the county," she said. "What it means is that eventually as the system gets smoother and smoother, we'll be able to have the workers spend the time with clients that have more complex issues and questions than the folks who have more straightforward cases might be able to take care of things on their own” (Stawicki, 10/15).

Kaiser Health News: Colorado Insurance Exchange Week One: Few Enrollments, Lots Of Interest
Connect for Health Colorado, which is branding itself as C4HCO, says it had 162,941 unique visitors to its website October 1-7. Of those, 226 purchased health coverage for themselves and dependents, totaling 305 covered lives (Whitney, 10/15). 

Health Policy Solutions (a Colo. news service): Thousands Look, 226 Buy During Exchange Debut
Colorado’s new health exchange has attracted thousands of visitors since its launch on Oct. 1, but only 226 pulled the trigger and bought insurance as Obamacare officially launched. High traffic to the Connect for Health Colorado website caused technology glitches that prevented many people from being able to create accounts immediately after the exchange launched. Those problems continued through last week and prompted two unscheduled shutdowns to reboot the exchange’s software, technology managers said. Even so, as of Friday, about 28,000 people have created accounts and about 204,000 unique visitors have surfed the site that offers health plans to individuals and small businesses, managers said. They say the system overloads that prevented people from creating accounts are now largely resolved (Kerwin McCrimmon, 10/14).

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Ohio Board Readies Decision On State's Medicaid Expansion

A seven-member state committee holds the fate of Ohio's Medicaid expansion in its hands as it prepares to vote on the proposal, and no one is talking about how they plan to vote.

Columbus Dispatch: Medicaid Expansion Still Up In Air On Controlling Board 
Two paths are emerging for Republican Gov. John Kasich to secure the fourth vote he needs on the seven-member Controlling Board to expand Medicaid. The administration has six days before it formally will ask the oversight panel to approve $2.56 billion in federal money to cover 275,000 more poor Ohioans under Medicaid (Varden, 10/15).

Cincinnati Enquirer: Fate Of Ohio Medicaid In Hands Of Seven Men
The fate of Medicaid expansion in Ohio, and the source of health care for up to 366,000 uninsured Ohioans, rests in the hands of seven men on a statehouse committee. ... The Enquirer interviewed each of the seven members of the Controlling Board last week. Most were coy about whether they plan to vote in favor of accepting federal money to expand Medicaid (Thompson, 10/15).

Stateline: Ohio Governor To Bypass Legislature On Medicaid Expansion
Kasich, one of only 10 Republican governors to support the Affordable Care Act’s Medicaid expansion, has been unable to convince the GOP-controlled General Assembly to go along with his plan. Late last Friday (Oct. 11) his office announced that the state Medicaid agency had asked a seven-member bipartisan panel to approve the spending proposal instead (Vessel, 10/14).

In Virginia, a state senator says the state should consider alternative ways to expand Medicaid --

The Richmond Times-Dispatch: Stosch Suggest Looking For Alternatives
Sen. Walter A. Stosch, R-Henrico, chairman of the Senate Finance Committee, said last week that he wants to consider approaches used by other states in the face of political opposition to extending Medicaid coverage to childless adults, parents, and others below or barely above the poverty line. "I believe it’s time to start to look at alternatives to expansion," he said, citing market-based approaches in states such as Iowa and Arkansas to take advantage of billions of dollars in federal spending without expanding the program for the poor, elderly and disabled. Stosch is the author of budget language this year that created the Medicaid Innovation and Reform Commission and gave it the power to determine that Virginia had made sufficient reforms to its existing Medicaid program to allow expansion under the Affordable Care Act (Martz, 10/15).

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Forms Not Ready For Those Seeking Exemption From Health Law Mandate

News outlets also report that e-brokers cannot offer exchange plans right away, and that some people may try to use the online marketplaces to mislead consumers.

Politico: Exemptions Pose Another Big Hurdle For Obamacare
Think you’re exempt from Obamacare’s individual mandate? Good luck proving it. The health law’s least popular component — the requirement to obtain insurance or face a tax penalty — also features a lengthy list of exceptions for people facing certain hardships like foreclosure, domestic violence or homelessness. Members of certain religious sects or Native American tribes also are exempt (Chaney, 10/15).

Politico: Online Insurance Plan Brokers Must Wait
The federal agency in charge of the exchanges signed agreements this summer with several e-brokers to sell health plans in the 36 states where the feds are running the new individual marketplaces. But the online brokers, eager to tap into a new market of people who’ll qualify for federal subsidies, learned shortly before the Oct. 1 launch that they wouldn’t be able to offer exchange plans right away. The brokers say CMS didn’t act fast enough to let them integrate their websites with the IT systems supporting the federal insurance marketplaces. They hope to get everything linked up with the feds in the coming weeks (Millman, 10/14).

The Associated Press/Washington Post: Regulators Say Some Insurance Brokers Mislead Those Seeking Subsidized Health Policies
This month’s glitch-filled rollout of the health insurance marketplaces created by federal law is a business opportunity for brokers and agents, but regulators warn that it also opened the door for those who would seek to line their pockets by misleading consumers. New Hampshire’s insurance commissioner sent a cease-and-desist letter last week to an Arizona company he accused of building a website to mislead health care shoppers into thinking it was the official marketplace. The site was taken down Friday (10/14).

The Wall Street Journal: Health Law Stirs Up Lending
Small businesses are griping that the new U.S. health-care law is difficult to understand. Now some may have another complaint: If they don't have a handle on the law's cost and impact, they may have a harder time getting a loan. To qualify for some loans, especially for growth capital, more companies are being required to provide assurances that they will be in compliance with the Affordable Care Act by 2015. The law will require businesses with 50 or more full-time employees to offer health insurance to their full-timers or face penalties (Murphy, 10/14).

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Confusion, Anger And Criticism Mark Some Obamacare Attitudes

The public is still puzzled, tea party groups seeth with anger over the piecemeal chipping away of the health law and Sen. Mary Landrieu stands out among colleagues from the South for supporting the law. Meanwhile, a former Obama administration spokesman reveals criticism over the insurance exchange launches.

Politico: Tea Party Groups Still Want Obamacare Gutted
You go through a whole government shutdown so you can kill Obamacare dead, and all you get is a little more due diligence before people can get their subsidies? Tea party groups are furious over the prospect that Congress is drifting toward a government funding-debt ceiling deal that might just take the usual one or two tepid dings out of President Barack Obama’s signature health care law, just like Congress has in previous fights (Nather, 10/15).

The Associated Press: Southern Democratic Senator Embraces Health Care Law Amid Showdown, But Her Colleagues Don't
In the tempest over shutdown politics, Louisiana Sen. Mary Landrieu stands out among Southern Democratic candidates with her embrace of the three-year-old health care law at the core of Capitol Hill dysfunction. A third-term senator who faces a tough re-election fight next year, Landrieu called Republicans "reckless and irresponsible and radical" for using the federal budget and looming vote to raise the debt ceiling as leverage for demands to scrap President Barack Obama's signature law (Barrow, 10/14).

CNN: Former Obama Spokesman: Fire Those Who Botched Obamacare Website 
The man who was once tasked with defending the Obama White House and its biggest legislative achievement was not impressed Monday with how Obamacare’s online insurance exchanges have been implemented. "This is excruciatingly embarrassing for the White House and for the Department of Health and Human Services," former White House spokesman Robert Gibbs said on MSNBC's "NOW with Alex Wagner." "This was bungled badly. This was not a server problem; just too many people came to the website. This is a website architecture problem" (10/14).

The Associated Press: Health Overhaul Supporters Hope Confusion Ends
It's been more than three years since President Barack Obama signed the health care law, more than one year since the Supreme Court upheld its central tenet and two weeks since the health exchanges opened nationwide, but supporters still face a surprising predicament: a confused public (Lobianco, 10/14).

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Hospital Chiefs Earn Big Bucks For 'Glitzier' Medicine

A JAMA Internal Medicine study found that quality of patient care at a facility is less likely to be reflected in the CEO's pay than other factors.

Kaiser Health News: Pay For Hospital CEOs Linked More To Technology, Patient Satisfaction Than Quality, Study Finds
What do hospital boards value in a chief executive? A new study of CEO pay at nonprofit hospitals finds that executives at institutions that have a lot of fancy medical technology and high patient satisfaction are paid more than their peers. But running a hospital that scores well on keeping more patients alive or providing extensive charity care does not translate into a compensation bump (Rau, 10/14).

The Associated Press: Hospital CEO Pay, Patient Outcomes Not In Sync
CEOs were paid more at hospitals that got high patient satisfaction scores; used more high-tech equipment including advanced imaging machines; had more beds and were located in large urban areas. But pay wasn't reflected in 30-day outcomes for patients with heart attacks, heart failure, or pneumonia in 2008, including deaths and readmissions. Those are among publicly reported outcome measures used by the federal Centers for Medicare & Medicaid Services and others (Tanner, 10/15).

Reuters: Hospital CEO Pay Not Tied To Quality Of Study
"I was hoping I'd see even some modest relationship with quality performance," said Dr. Ashish Jha. "I think we were a little disappointed." Jha worked on the study at the Harvard School of Public Health in Boston. He and his colleagues combined data from tax returns, hospital surveys and performance and cost reports (Pittman, 10/14).

Bloomberg: U.S. Nonprofit Hospital CEO Annual Pay Averages $600,000
Heads of U.S. nonprofit hospitals earn an average of almost $600,000 a year, compensation that isn’t tied to quality measures such as mortality rates, a Harvard University study found. The chief executive officers paid the most oversee larger, urban hospitals that are usually teaching institutions and have a median salary of more than $1.66 million, according to research published today in JAMA Internal Medicine (Ostrow, 10/14).

Medpage Today: Hospital CEO Pay Not Tied To Quality
Not surprisingly, executive pay was higher for those heading up larger hospitals ... at teaching hospitals ... and in urban settings. Shepherding a hospital in a small rural town, for instance, was worth $195,553 less than being responsible for an urban facility (Pittman, 10/14).

Modern Healthcare: Hospitals With Expensive Tech, High Patient Satisfaction Have Highest-Paid CEOs
In an accompanying commentary that appears in the same issue of JAMA Internal Medicine, Dr. Warren Browner, CEO of California Pacific Medical Center in San Francisco, wrote he wasn't surprised by the study's findings that “bigger, glitzier, more prestigious hospitals,” paid more compared to other facilities. However, Browner took issue with some of the study's findings. He wrote that researchers leapt to conclusions about causality without considering the full range of variables (Selvam, 10/14).

Earlier, related KHN story: Hospital CEO Bonuses Reward Volume And Growth (Hancock, 6/16)


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Medicare Open-Enrollment Begins: Seniors Should Carefully Consider New Options

Officials are cautioning seniors to stay away from the health law's new online marketplaces -- as open-enrollment season begins for Medicare managed care and prescription plans.

Kaiser Health News: Seniors Cautioned To Pay Close Attention To Details As Enrollment Begins In Medicare Plans
The seven-week enrollment period for next year's Medicare prescription drug and managed-care plans begins Tuesday, but seniors shouldn't simply renew their policies and assume the current coverage will stay the same. ... Among the top ten most popular drug policies, monthly premiums for 2014 are changing dramatically (Jaffe, 10/15).

The New York Times: Beneficiaries of Medicare Left Confused By Exchanges
In fact, people with Medicare generally cannot buy insurance through the exchange. Policies sold there duplicate many benefits provided by Medicare, and it is illegal for insurance companies, agents and brokers to sell such polices to people known to have Medicare, federal officials said Monday (Pear, 10/14).

Related, earlier KHN story: FAQ: Seniors On Medicare Don’t Need To Apply To The Health Law Marketplaces (Carey, 9/23)

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State Watch

State News: Insurer Drop-Out To Affect 22,000 On N.Y. Medicaid Managed Care

A selection of health policy stories from New York and Texas.

The Associated Press/Wall Street Journal: Excellus Dropping Out Of Medicaid Managed Care
Excellus BlueCross BlueShield says it's dropping out of public health insurance programs for the poor and disabled. The insurer has notified doctors and other providers it's withdrawing from the Medicaid managed care and Family Health Plus programs because it expects to lose about $100 million on those programs this year. The move will affect more than 22,000 central New Yorkers (10/15).

The Texas Tribune: On Dental Claims, State's Bark Worse Than Its Bite
Texans discovered nearly two years ago that the state was spending more on orthodontic claims in its Medicaid program than the other 49 states combined, but recovery of millions in purportedly misspent Medicaid money has moved slowly (Aaronson, 10/15).

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Editorials and Opinions

Viewpoints: 'False Hysteria' Over Health Law's Part-Time Criteria; Marketplaces 'Flunk' Initial Test; Ben Carson's Surprising Assessment

The New York Times: Economix: The Hurdles To Success For The Affordable Care Act
The Affordable Care Act, or Obamacare, has had a difficult launching, but the more serious challenges for the law relate not to glitch-filled Web sites but rather to its possible long-term effects on the United States economy. The law is not likely to last if it imposes a severe drag on growth and job creation, or involves large costs obscured by the legislative gimmicks used to shape the scoring of the bill by the Congressional Budget Office. Indeed, Casey B. Mulligan has discussed the negative effects of the legislation on the American labor market in a series of posts on Economix, while the policy expert Charles Blahous explains in detail why the "fiscally reckless" legislation will aggravate the already difficult federal and state fiscal situations (Philip Swagel, 10/14). 

The Wall Street Journal: The False Hysteria Over 'Part-Time Nation'
Conservative politicians, business owners and even union leaders claim that the health law is forcing employers to shift many of their workers to part-time status. It has become a central thrust of current opposition to the law. And unlike complaints about "death panels" or "socialized medicine," this worry is grounded in actual provisions of the law, and it would be a serious concern for anyone who cares about working Americans. There is only one problem: All the evidence indicates that it is not true (Ezekiel Emanuel and Andrew Steinmetz, 10/13).

Bloomberg: Obamacare Needs A Drop Dead Rate
Exactly how bad are things on the federal health-care exchanges? The working assumption among most journalists, including me, is that they would be fixed in a few weeks -- that is, by the end of this week. …Insurers began warning in 2012 that they were worried about these systems making their delivery dates, a concern that the Government Accountability Office echoed in June. Now we know why: The systems weren't on track to meet their delivery dates (Megan McArdle, 10/14).

Los Angeles Times: Government Shutdown: Obamacare Dodges A Bullet
The bullet, of course, is the disastrous rollout of the government's sign-up website for federal health insurance exchanges, which has prevented countless Americans from signing up for health coverage. The dodge was graciously provided by the House Republican caucus, which chose to distract the public's attention with its quixotic effort to "defund" the Affordable Care Act by shutting down the government, thus placing the workaday financial pain facing millions of America's at the top of the news cycle. Thanks, Sen. Ted Cruz, R-Texas! (Michael Hiltzik, 10/14).

ProPublica: How The Feds Could Fix Their Glitchy Health Care Exchange
There’s been a lot of talk in recent days about how the glitchy rollout of the federal health insurance marketplace may not mean much IF the developers of healthcare.gov are able to turn it around in the next month.  To prove the point, health policy experts point to the 2006 start of Medicare Part D, the prescription drug program for seniors and the disabled, which was also bumpy (Charles Ornstein, 10/11).

The Milwaukee Journal Sentinel: Despite Initial Problems, Obamacare Is Still A Step Forward
Under a plan by Gov. Scott Walker, those 92,000 people will lose their state BadgerCare Plus coverage on Jan. 1 and be pushed on to the new federal health insurance exchange. The exchange is aimed at giving people a way to find affordable insurance through the private sector. Subsidies are available for people who meet income guidelines. The problem is they are supposed to use the federal government's website to sign up, and that hasn't worked. While the feds say they're working to fix the problems, the fear is that some of those losing BadgerCare coverage won't line up new insurance in time. That would be a real shame, because the health exchanges are the only way right now that some of those people will be able to afford insurance (10/14).

The Boston Globe: Obamacare Flunks First Test
Anyone who thinks this disaster derives from a lack of time or money is on another planet. The Affordable Care Act was signed into law by President Obama more than three years ago. This timeframe only underscores the ineptitude of the bureaucrats now entrusted with managing the largest and most intrusive federal program in history. As for cash, it appears that HHS spent over $600 million for the online system -- more than it took to get Facebook started. Aside from the government-wide sequester, Republicans have been singularly unsuccessful in starving Obamacare of funds for implementation. No, this is a disaster of Obama’s own making, and it’s due to what the outgoing Social Security administrator calls “plain old incompetence and arrogance” (John E. Sununu, 10/14). 

Raleigh News & Observer: NC's Failure To Expand Medicaid Takes Its Toll
But while they were on a roll in the last session, bashing public school teachers, cutting unemployment for jobless North Carolinians and cutting education in general along with other worthwhile programs, GOP lawmakers and [Gov.] McCrory said no to more Medicaid participants. The problem, they said, was that the federal government would probably go back on its promise to pick up the cost. There was no basis for that suspicion. The federal government has paid its share of Medicaid for decades (10/14).

Toledo Blade: Expand Ohio Medicaid
When the Republican-controlled General Assembly isn’t making life harder for most Ohioans, it isn’t doing much of anything else. GOP Gov. John Kasich is right to work around lawmakers of his own party who have rejected his sensible proposal to expand the state Medicaid program of health insurance for working-poor Ohioans and their families (10/14).

WBUR: Lingering Health Law Questions Jon Stewart Wants To Know
Last week Jon Stewart hosted Secretary of Health and Human Services Kathleen Sebelius on The Daily Show. During the interview, he kept returning to the same question: Why was the piece of the Affordable Care Act that requires businesses to provide health insurance delayed for one year, but the piece requiring individuals to obtain health insurance (the "individual mandate") was not delayed? ... The employer mandate was delayed not for the purpose of giving businesses a reprieve from paying for insurance, but to give them a reprieve from the burden of reporting to the I.R.S. Not only is extensive reporting required, the IRS still had not released regulations for the reporting (Georgia Feuer, 10/15).

The Milwaukee Journal Sentinel: Dr. Ben Carson Links Obamacare To Slavery
Dr. Ben Carson has spoken on many conservative platforms and he has criticized the Affordable Care Act in the past but on Friday, he went too far by comparing Obamacare to slavery -- and he should be called out for it. Carson is a smart man, but whenever people use stretches like this to make a point, I wonder if they really know their history. Does he know about the lynchings? Jim Crow laws? How blacks were denied opportunities to read and how they were forced to do manual labor for free? Does he know how black men were stripped of their manhood in front of their families and how their children were sold to the highest bidder? No Carson, Obamacare is not any of these things (James Causey, 10/14).

In other topics --

Los Angeles Times: Discovering The Epidemic Of Overtreatment
Similar populations living in different regions of the United States get exposed to wildly different amounts of medical care. If that sounds like an old story, it is. It's now four decades old. But it is an important story to reflect on as we consider the path forward for our medical care system (Dr. H. Gilbert Welch, 10/15).

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Shutdown Commentaries: Compromise May Take Nick Out Of Health Law; 'The Party Of Gimme'

The New York Times: The Senate Tries To End The Crisis
But the tentative agreement includes two problematic provisions related to health care reform. One would require the Department of Health and Human Services to verify that people receiving subsidies for insurance have incomes low enough to qualify. The other would delay for a year an insurance-company tax imposed by the health care law, which gives the tax proceeds to insurance companies covering high-risk patients through state exchanges, reducing their financial burden (10/14).

The New York Times' Taking Note: The Party Of Gimme
Republicans insisted on winning something in exchange for performing those two necessary acts [of reopening the government and staving off a default]. Democrats refused to let that happen, informing Republicans that if they wanted to negotiate, it would require both sides to give up something substantial. Preventing default doesn't count. It's amazing that after weeks of listening to President Obama make clear this principle, Republicans still don't get how important it is. In the days before the shutdown, Democrats rejected every demand the House made to damage health care reform in exchange for keeping open the government. Eventually, the House dropped its health-law demands, but remained locked into the notion that they had to get something out of this crisis, to "put points on the board," in Speaker John Boehner's extremely unfortunate phrase (David Firestone, 10/14).

Los Angeles Times: A Health Care History Lesson For The GOP
Two different narratives have been at play in Washington lately to explain what caused the government shutdown. In the first, House Republicans are to blame for trying to hold Democrats and the president hostage over a law that was duly passed by Congress. In the other, Democrats are to blame for their rigid refusal to compromise on Obamacare. But there's a part of the story that seemingly has been lost in history: Democrats have already compromised on health care reform by adopting Obama/RomneyCare in the first place (Jane Mansbridge, 10/15).

The Wall Street Journal: Strange Political Devices
Democrats are smelling blood amid the latest polls, and one of their political goals is getting the GOP to ease the sequester caps. ... [S]ome conservatives have become so politically disoriented by this debate that they are now opposing tax cuts too. The issue is the tax on medical devices that is one of the smaller funding sources for Obamacare. There's bipartisan sentiment for repealing it, but some conservatives are now saying no. Repeal would amount to "corporate cronyism," said Michael Needham of the Heritage Action political committee. ... A think tank that really believes that repealing a punitive tax on business is "corporate cronyism" isn't conservative and it certainly isn't thinking (10/13).

The Washington Post: Obama Can't Waste This Moment
Democrats have been much tougher in this round of negotiations than they were in the past not only because the GOP vastly overreached in trying to gut Obamacare, but also because they know how important it is to insist that budget cutting and deficit reduction not be the sole priority of the political class. Rep. Paul Ryan (who was, by the way, the other member of the Republican ticket that lost last year, partly because of his budget ideas) hoped to steer the talks in this direction. But Democrats have made it clear that it's not 2011 anymore (E.J. Dionne Jr., 10/13).

Politico: A Subtle Solution To Debt Dilemma
There is a logical compromise staring both parties in the face. ... In exchange for raising the debt ceiling and opening the federal government, Obama should offer to cap the annual growth in federal health care spending at inflation, plus 1 percent or 2 percent. ... The key is that such a deal would give both sides what they want. Obama keeps his health care law, and Republicans get to say they prevented it from bankrupting the country. And after all, if Obamacare's boosters are correct that the law will significantly restrain future health spending, it’s a compromise that will cost the president nothing. If, on the other hand, the ACA cost projections prove overly optimistic, then legislators will have to tweak the law -- and Medicare and Medicaid -- to impose additional spending discipline (Charles J. Wheelan and Russell J. Muirhead, 10/14).

Politico: The Case For Hostage Taking
There is little incentive for Democrats to trade significant entitlement reform for tax increases when mandatory spending increases outlays without the need to pass legislation with a majority of Congress. Once the money is spent, the GOP can only borrow to delay tax increases or acquiesce and increase taxes now. Republicans’ focus on defunding or scaling back Obamacare -- an unpopular entitlement program -- rather than entitlements generally, namely Social Security and Medicare, has raised questions about their true objective. But critics forget that spending is fungible. For any level of taxation, growth in one program crowds out spending on other programs. Cost reduction is simply a matter of priorities. Republicans value preserving Medicare and avoiding tax increases over expanding Obamacare (Edward Conard, 10/14).

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Stephanie Stapleton

Andrew Villegas

Lisa Gillespie
Shefali Luthra

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