Daily Health Policy Report

Thursday, October 17, 2013

Last updated: Thu, Oct 17

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Health Reform

Administration News


State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Options For Consumers When COBRA Coverage Runs Out

Kaiser Health News consumer columnist Michelle Andrews answers this reader's question: "Can COBRA health insurance coverage be extended beyond 36 months?" (10/17). Watch the video or read the transcript.

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Miami Leads Nation In Medicare Drug Spending

The Miami Herald's Daniel Chang, working in partnership with Kaiser Health News, reports: "Elderly Miami residents on Medicare filled more prescriptions for drugs in 2010 than seniors elsewhere in the country, and they were more than twice as likely as residents in Rochester, Minn., to fill at least one prescription for medications that have been identified as high-risk for patients over age 65, such as skeletal muscle relaxants, long-acting benzodiazepines, and highly sedating antihistamines" (Chang, 10/16). Read the story.

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Capsules: Washington Exchange Signups Nearly Triple In Week Two; Shutdown Not Hurting Seniors' Ability To Get Medicare Plan Info; State Medicaid Decisions Cost Community Health Centers; Minn. Reports 3,700 Enrollments Underway, But A Rocky Road For Consumers

Now on Kaiser Health News' blog, The Seattle Times' Amy Snow Landa, working in partnership with KHN, reports on the Washington state insurance exchange: "About 25,000 Washington state residents have enrolled in health plans through the state’s online insurance exchange marketplace during its first two weeks. That figure is nearly triple the 9,500 residents who completed their enrollment during the first week that the exchange, called Washington Healthplanfinder, was open for enrollment" (Landa, 10/16).

In addition, Susan Jaffe reports on Medicare plan information during the government the shutdown: "The government may still be shut down — for now — and federal websites still caution visitors that information may not be up to date while the government is closed. But Medicare beneficiaries do not have to worry about getting accurate details from the plan finder website during the current open enrollment season, officials said" (Jaffe, 10/16).

MPR's Elizabth Stawicki, working in partnership with KHN, reports on Minnesota's exchange tally: "Officials from MNsure, the online health insurance marketplace in Minnesota, provided the first public glimpse into how many Minnesotans have not only created accounts on the new health insurance site, but also committed to choosing a plan and paying for coverage. MNsure officials say about 3,700 visitors to the site are in the enrollment process — they’ve taken the step of selecting coverage through MNsure and are in the payment process if their plans require payment" (Stawicki, 10/17).

Also on Capsules, Phil Galewitz reports on how state Medicaid decisions impact community health centers: "A new study by George Washington University researchers estimates that 518 health centers in the more than two dozen states not expanding Medicaid will lose out on $555 million next year because their uninsured patients won’t get Medicaid or federally subsidized coverage in the new online health insurance marketplaces" (Galewitz, 10/16). Check out what else is on the blog.

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Political Cartoon: 'Taken To Tusk?'

Kaiser Health News provides a fresh take on health policy developments with "Taken To Tusk?" by Joel Pett.

Here's today's health policy haiku:


The law broken down
for younger generation
can make one feel old.

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

Health Law Mostly Untouched By Agreement To End Shutdown, Increase Debt Limit

Republican foes of the overhaul came out of the confrontation with only a tweak to income verification rules for those seeking subsidies to buy coverage on the new health insurance exchanges. The agreement created a new budget deadline, however, requiring lawmakers to return to the table to reach a long-term deficit reduction agreement by Dec. 13.

The New York Times: Republicans Back Down, Ending Crisis Over Shutdown and Debt Limit
Congressional Republicans conceded defeat on Wednesday in their bitter budget fight with President Obama over the new health care law as the House and Senate approved last-minute legislation ending a disruptive 16-day government shutdown and extending federal borrowing power to avert a financial default with potentially worldwide economic repercussions. … The shutdown sent Republican poll ratings plunging, cost the government billions of dollars and damaged the nation’s international credibility. Mr. Obama refused to compromise, leaving Republican leaders to beg him to talk, and to fulminate when he refused. For all that, Republicans got a slight tightening of income verification rules for Americans accessing new health insurance exchanges created by the Affordable Care Act (Weisman and Parker, 10/16).

Los Angeles Times: Government Crisis Is Averted – For Now
Republicans had sought the confrontation in hopes that a shutdown and the threat of default would give them leverage to extract concessions from Obama on his signature healthcare law. In the end, the compromise negotiated by Senate Majority Leader Harry Reid (D-Nev.) and Minority Leader Mitch McConnell (R-Ky.) made no significant changes in the Affordable Care Act. … The bill includes one change in the healthcare law: It requires the government to verify the income of those Americans who receive financial help in buying insurance through the new online healthcare marketplaces. Democrats did not object to the provision; they said it largely repeated language already in the law (Mascaro, Memoli and Bennett, 10/16).

The Washington Post: Obama Signs Bill To Raise Debt Limit, Reopen Government
An agreement struck by Senate Majority Leader Harry M. Reid (D-Nev.) and Minority Leader Mitch McConnell (R-Ky.) ended a stalemate created last month, when hard-line conservatives pushed GOP leaders to use the threat of shutdown to block a landmark expansion of federally funded health coverage. … Senate Budget Committee Chairman Patty Murray (D-Wash.) was to have breakfast Thursday morning with her House counterpart, Rep. Paul Ryan (R-Wis.), to start a new round of talks aimed at averting another crisis. Obama repeated his vow to work with Republicans to rein in a national debt that remains at historically high levels (Montgomery and Helderman, 10/17).

The Associated Press/Washington Post: Government Reopens After Congress Ends 16-Day Shutdown And Dodges Defaults On Debts
Obama and his Democratic allies on Capitol Hill were the decisive winners in the fight, which was sparked by tea party Republicans like Sen. Ted Cruz of Texas, who prevailed upon skeptical GOP leaders to use a normally routine short-term funding bill to “defund” the 2010 health care law known as Obamacare (10/17).

The Wall Street Journal: Congress Passes Debt, Budget Deal
The deal was opposed by the conservative political groups Heritage Action and Club for Growth, which both urged Republicans to vote against it because it did nothing significant to roll back the health law. But conservative Republicans let the deal move forward without delay in the Senate, while vowing to fight on in future battles. Sen. Ted Cruz (R., Texas), a leader in the conservative's "defund Obamacare" strategy, blamed the defeat on party leaders. "Once again, it appears the Washington establishment is refusing to listen to the American people," he said outside the Senate chamber, as Senate leaders announced the deal inside. A key question is whether wounds from the fight will change the political and policy dynamics when Congress tries to meet the January deadline for funding the government for the remainder of fiscal 2014 and the February deadline for again raising the debt limit (Hook and Peterson, 10/17).

Politico: ACA Backers OK With Income Verification In Debt Deal
Republicans are getting a single Obamacare crumb in the spending deal — an income verification measure that Democratic proponents of the law are willing to swallow. It’s the only tweak to the Affordable Care Act in the agreement forged by Senate Majority Leader Harry Reid and Minority Leader Mitch McConnell to end the shutdown and lift the debt ceiling. The requirement stipulates that the HHS secretary certify there’s a way to check that Americans collecting income-based health insurance subsidies are eligible, essentially that they are earning what they claim (Cunningham, 10/17).

Politico: Budget Negotiations Begin
A key element of the deal reached to reopen the government and hike the debt ceiling is that both chambers must go to a budget conference. The conference committee will be tasked with agreeing to budget numbers and crafting a bipartisan deal to address long-term deficit reduction. … The committee will include ten Senate Republicans and twelve Senate Democrats, Murray said. The conference committee has until Dec. 13 to reach an agreement (Gibson, 10/16).

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Examining The Budget Deal's Political Dynamics

News outlets sort through the players in this drama to find winners and losers -- as well as how some lawmakers and advocates will move forward. 

The New York Times: News Analysis: Losing A Lot To Get Little
For the Republicans who despise President Obama’s health care law, the last few weeks should have been a singular moment to turn its problem-plagued rollout into an argument against it. Instead, in a futile campaign to strip the law of federal money, the party focused harsh scrutiny on its own divisions, hurt its national standing and undermined its ability to win concessions from Democrats. Then they surrendered almost unconditionally (Peters, 10/16).

The Dallas Morning News: Ted Cruz Left With Few Friends After Obamacare Fight Fails, Government Shutdown Ends, Debt Limit Rises
It might be time for Ted Cruz to get a dog. Because as the saying goes, if you want a friend in Washington, that’s what you do. And by the time Cruz’s crusade to defund Obamacare finally crashed to a halt Wednesday, the Texas senator had precious few friends left. The government shutdown alienated colleagues in both parties. It generated fresh animosity toward the tea party and a flurry of recriminations toward Cruz. Voter support for the Republican Party plunged. And the health care law survived unscathed (Gillman, 10/17).

The Hill: Rubio: The Fight Over Obamacare ‘Has Just Begun’
Sen. Marco Rubio (R-Fla.) vowed to continue to fight ObamaCare as lawmakers negotiate long-term budget deals in the coming months. ... Rubio, along with Sens. Mike Lee (R-Utah) and Ted Cruz (R-Texas), argued this summer that the vote on increasing the debt ceiling was the “last, best chance” Republicans had to stop President Obama’s signature healthcare law (Cox, 10/16).

CBS News: How One Man's Anti-Obamacare Strategy Led U.S. To The Brink Of Default
Texas Republican Sen. Ted Cruz has become the public face of the government shutdown. But you've probably never even heard of the 31-year-old conservative activist The Wall Street Journal calls "the strategist behind the shutdown." "The American people are overwhelmingly saying we need to stop Obamacare," said Michael Needham, the CEO of Heritage Action. It is the political arm of the nation's largest conservative think tank. Months ago, he and fellow activists devised a plan to try defund or delay Obamacare by blocking federal spending, even if it led to a government shutdown (Reid, 10/16).

Politico: Michael Needham: Obamacare Repeal In 2017
The CEO of conservative advocacy group Heritage Action said Wednesday that “everybody understands” that repealing Obamacare won’t happen until 2017. “Well everybody understands that we’re not going be able to repeal this law until 2017 and that we have to win the Senate and we have to win the White House,” Michael Needham said on Fox News’s “America’s Newsroom.” However, Needham said he admired the House Republicans for their strategy to defund Obamacare and hit the Senate for hindering those efforts (McCalmont, 10/16).

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With Budget Battle Now On The Back Burner, GOP Will Step Up Health Law Scrutiny

Difficulties with healthcare.gov and questions about the contractors that built it will be high on the list of issues receiving scrutiny.

Politico: Shutdown Over, Congress Turns To Obamacare 'Train Wreck'
With the shutdown over and a default averted, Washington has another train wreck to sift through: the Obamacare rollout. Republican critics have plenty to investigate, starting with the $400 million website that doesn’t work and the federal contractor that built it, while asking a more fundamental question: Will it be fixed in time for people to get health coverage early next year (Norman, 10/17).

CBS News: Congress Wants Explanation For Obamacare Site Glitches
Here's where the problem lies: When applicants try to log on to the website healthcare.gov, they are asked to verify their identities before they can shop for health insurance. That proof-of-identity process has turned out to be an impassible roadblock for many users. Now Congress is investigating why. The House Energy and Commerce Committee is asking the administration and the website's private contractors if the problems are in their hardware systems or in the software. CGI Federal, the company that won an $88 million contract to be the prime architect of the website, has repeatedly assured Congress the site would be ready when Obamacare went into effect. "CGI Federal is confident in its ability to deliver successfully on its contract," company Senior Vice President Cheryl Campbell declared last month (Andrews, 10/16).

CQ HealthBeat: Federal Exchange Woes May Take Center Stage As Hill Threat To Health Law Fades
Irony of ironies. Having survived months of attacks from Republicans on Capitol Hill unscathed, is the health law, or at least a big part of it, about to grind to a halt anyway because of technical trouble with the federal exchange? That marketplace was supposed to begin serving Americans in 36 states when it launched 15 days ago. But many of its would-be customers can’t push through its virtual front doors (Reichard, 10/16).

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Health Reform

Two Weeks In, Healthcare.gov Still Confronts Technical Difficulties

The volume of visits to the site, as well as the platform's design, are being blamed for the problems. Some experts see the necessary fixes as being projects that could take months to complete.

USA Today: Health Care Exchange Still Plagued By Problems
Two weeks into the launch of the federal health insurance exchange, the website is still plagued with problems, leading critics to wonder if the problem is worse than it appears. There are two key issues at the core of the problem, said Dan Schuyler, a director at Leavitt Partners, a health care group. One is the volume, which Health and Human Services estimates at 14.6 million unique visitors, and the second is the platform's design (Kennedy, 10/16).

Politico: Two Weeks In, Obamacare Website Still Broken
The Obamacare enrollment website remains badly broken despite two weeks of intensive round-the-clock efforts at repairs. HHS isn’t making any predictions about how long it will take to fix it — or rebuild it. But advocates, lobbyists and industry officials are talking about it as a months-long repair effort (Chaney, Millman and Haberkorn, 10/16).

Reuters: Insight: As Obamacare Tech Woes Mounted, Contractor Payments Soared
As U.S. officials warned that the technology behind Obamacare might not be ready to launch on October 1, the administration was pouring tens of millions of dollars more than it had planned into the federal website meant to enroll Americans in the biggest new social program since the 1960s. A Reuters review of government documents shows that the contract to build the federal Healthcare.gov online insurance website - key to President Barack Obama's signature healthcare reform - tripled in potential total value to nearly $292 million as new money was assigned to the work beginning in April this year (Begley, 10/17).

NPR: If A Tech Company Had Built The Federal Health Care Website
HealthCare.gov was meant to create a simple, easy way for millions of Americans to shop for subsidized health care. Instead, in a little two more than weeks, it has become the poster child for the federal government's technical ineptitude. A dysfunctional contracting system clearly bears some of the blame. But entrepreneurs in Silicon Valley likely would have approached the project differently from the start (Henn, 10/17).

Fox News: Obamacare Sign-Up Numbers Begin To Emerge, Show Slow Start Amid Website Problems
One private-sector analysis showed that, during the first week, less than 1 percent of those who tried to register were able to enroll in a health care plan. The review was released by Kantar US Insights, based on the findings of the Millward Brown Digital research firm. It showed 9.47 million unique visitors to the federal site during the first week, including 3.72 million who tried to register, 1 million successfully registering and 36,000 who completed enrollment. The administration is not yet producing its own figures (10/17).

Meanwhile, California Healthline attempts to ask and answer some important related questions -

California Healthline: Should Obamacare Be Delayed – And More To The Point, Can It?
Under the mandate, millions of Americans who were expected to use the exchanges to obtain health insurance will face fines if they haven't purchased coverage by Feb. 15, raising the question of whether the mandate or other Obamacare provisions should be postponed -- an uncomfortable position for an administration already trying to implement a politically divisive law. But at this late date, what parts of the ACA can legally be delayed? (Diamond, 10/16).

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State Exchanges Wrestle With Provider Directories, Search Tools

News outlets report on some of the challenges and sign-up tallies for state-based online insurance marketplaces in California, Minnesota, Washington and Maryland. Also in the news, progress updates regarding outreach efforts and small businesses that are attempting to use the exchanges.

The New York Times: Search Tools Wanting On Many Exchanges
Since the new health insurance exchanges opened for business on Oct. 1, millions of people who have visited the online sites have been unable to enroll because of technical problems and software glitches. But many people who are getting through the log-in process are encountering a different set of problems when they try to determine whether policies sold through the exchanges will provide the doctors, hospitals or drugs they need. Most of the 15 exchanges run by states and the District of Columbia do not have provider directories or search tools on their Web sites — at least not yet — so customers cannot easily check which doctors and hospitals are included in a particular plan’s network. Most allow customers to search for providers by linking to the insurers’ Web sites, but the information is not always accurate or easy to navigate, health care experts say (Goodnough, 10/16).

Los Angeles Times: Covered California Removes Glitchy Online Directory Of Doctors
Checking up on a doctor is becoming a major snag for Obamacare shoppers in California. Three weeks into open enrollment, the state's insurance exchange, Covered California, has pulled its online directory of medical providers after acknowledging there are serious problems with the information. The California Medical Assn. says it found mistakes such as obstetricians labeled as ophthalmologists and the wrong doctors described as fluent in Russian and Farsi (Terhune, 10/16).

The Associated Press: MNsure Signs Up 3,700 So Far For Health Insurance
Minnesota’s health insurance exchange on Wednesday released its first data on enrollment, showing that two weeks into its launch more than 3,700 people have signed up for health insurance coverage. It’s a relatively slow start to the state’s delivery system for increasing insurance coverage rates under the federal health overhaul (10/16).

The Star Tribune: MNsure Reports More Than 12,000 Accounts Created
While more than 12,000 Minnesotans have created MNsure accounts, fewer than one-third of those have completed enrollment in health plans, state officials said Wednesday. The meager sales figures didn’t alarm MNsure officials — not when Minnesotans still have two months to secure coverage for the start of 2014. But they do reflect the turbulent first two weeks of an online health insurance marketplace that aspires to extend health benefits to as many of the state’s 490,000 uninsured residents as possible. The gap between accounts created and health plans purchased so far may reflect the number of people who have just been “window shopping,” as MNsure spokesman John Reich put it, and who need time to make the weighty decision of buying insurance (Olson, 10/16).

The New York Times: States Report Health Insurance Application Numbers
Minnesota’s state-run health insurance exchange reported Wednesday that 5,569 households had completed applications for coverage in the first two weeks of operation, representing 11,684 people. The exchange portal has run relatively smoothly after struggling with technology problems for a few days after it opened on Oct. 1, said April Todd-Malmlov, the executive director. … Separately, California said Tuesday that about 94,500 applications for health insurance had been started through its exchange between Oct. 1 and Oct. 12. But exchange officials would not say how many applications had been completed in that period (Goodnough, 10/16).

Kaiser Health News: Capsules: Washington Exchange Signups Nearly Triple In Week Two
About 25,000 Washington state residents have enrolled in health plans through the state’s online insurance exchange marketplace during its first two weeks. That figure is nearly triple the 9,500 residents who completed their enrollment during the first week that the exchange, called Washington Healthplanfinder, was open for enrollment (Landa, 10/16).

The Baltimore Sun: Maryland ‘Stumbled Out Of The Gate’ With Health Exchanges, Brown Says
Lt. Gov. Anthony G. Brown, who was tapped to oversee health care reform in Maryland, spoke for the first time Wednesday about the bumpy rollout of the effort's centerpiece, the marketplace for the uninsured. He said he was "not satisfied” (Cohn, 10/16).

And what about small businesses -

The Associated Press/Washington Post: Small Businesses Give Health Exchanges Mixed Reviews, But More than Expected Are Signing Up
More small businesses than expected are signing up for health insurance on state exchanges that opened this month. The insurance markets began operating Oct. 1 under the health care law. They were designed to offer low-cost insurance for individuals and small businesses. Many business owners have been pleasantly surprised by the rates and coverage, according to accounts from owners and state officials. But some owners are disappointed and plan to buy insurance privately (10/16).

Meanwhile, outreach continues -

Marketplace: Mining Data For A Map To The Uninsured
Last month, just before the health exchanges opened, reality kicked in for Elizabeth Buck. “We have a huge number of uninsured in Camden, about 15,000. And we have this short window of time to enroll residents,” she says. So Buck, who is overseeing ACA enrollment for the non-profit Camden Coalition of Healthcare Providers, poked her head into Aaron Truchil’s office. Buck wanted Truchil, the coalition’s data whiz, to convert the hospital data the coalition has collected for a decade into something she could use to find Camden’s uninsured, nearly 20 percent of the city’s population. Twenty-four hours later, Truchil produced a color coded map, broken down by neighborhood, shading sections of the city with high concentrations of the uninsured a deep red (Gorenstein, 10/16).

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Medicaid Expansion Still In Play In Ohio, New Hampshire

Some Ohio lawmakers push back against Gov. John Kasich's move to bypass the legislature to expand Medicaid, and New Hampshire legislators plan to meet next month to hammer out what leaders hope will be a bipartisan deal to expand the state-federal program for the poor. Meanwhile, likely Virginia voters support expansion 51 percent to 42 percent with the divide falling along party lines, according to a new poll.

The Associated Press: House Leader Questions Governor's Medicaid Request
The Ohio House speaker said he has concerns about whether the governor's move to get Medicaid expansion funding through a legislative panel and bypass the full General Assembly violates the Ohio Constitution. House Speaker William Batchelder told reporters Wednesday that he and more than 30 representatives have noted their concerns in a letter that will be part of the House's daily record (Sanner, 10/16).

The Washington Post: New Hampshire Will Hold Special Session On Medicaid Expansion
New Hampshire legislators will meet next month to hammer out what leaders hope will be a bipartisan agreement to expand Medicaid after the state's Executive Council voted Wednesday to allow Gov. Maggie Hassan (D) to call a special session (Wilson, 10/17).

The Richmond Times Dispatch: Poll Shows Divide On Medicaid
More likely Virginia voters support expanding Medicaid than not, with deep divides along party lines. Overall, likely voters support expansion 51 percent to 42 percent, with 86 percent of Democrats in favor and 76 percent of Republicans opposed, according to a poll released Wednesday by the Wason Center for Public Policy at Christopher Newport University. Independents oppose expansion 51 percent to 42 percent (Meola, 10/17).

The Texas Tribune: Without Medicaid Expansion, 1 Million Texans Lack Insurance Options
Texas has the greatest number of poor, uninsured adults who will fall in a "coverage gap" created by states that chose not to expand Medicaid eligibility under the Affordable Care Act, according to a report released Wednesday by the Kaiser Family Foundation. One million of the 5.2 million Americans who won't have health insurance options available under the new law reside in Texas, according to the report (Aaronson, 10/16).

CQ HealthBeat: Some States Get Delayed Info On New Medicaid Enrollees
The flow of information between Obama Administration officials and state Medicaid agencies inched forward on Wednesday as states began receiving overdue demographic data from the federal exchange website for residents who might qualify for Medicaid. With enrollment in the health law marketplaces in its third week, state officials are waiting for the information they need to figure out how many people who apply through healthcare.gov might qualify for Medicaid (Adams, 10/16).

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State Medicaid Decisions Hurt Community Health Centers Serving Neediest

Community health centers in states that have rejected the Medicaid expansion under the health law will lose out on a half billion dollars in new revenue in 2014 that could hamper their ability to serve millions of uninsured people seeking care, according to a study from George Washington University.

Kaiser Health News: Capsules: State Medicaid Decisions Cost Community Health Centers
A new study by George Washington University researchers estimates that 518 health centers in the more than two dozen states not expanding Medicaid will lose out on $555 million next year because their uninsured patients won't get Medicaid or federally subsidized coverage in the new online health insurance marketplaces (Galewitz, 10/16).

Stateline: Neediest Health Centers to Get Least ACA Funding
Community health centers in states that have rejected Medicaid expansion under the Affordable Care Act will forgo more than half a billion dollars in new revenue in 2014, according to a new report from the George Washington University School of Public Health and Health Services. In 2014, the study estimates, community health centers in the 25 states that have chosen to expand Medicaid will gain an estimated $2 billion in Medicaid money from newly eligible patients. By contrast, the 25 states that have opted out will miss out on an estimated $555 million. "Health centers in opt-out states can be expected to struggle, falling further behind their expansion state counterparts in terms of service capacity, number of patients served (both insured and uninsured), and in their ability to invest in initiatives that improve the quality and efficiency of health care," the report states (Vestal, 10/17).

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Administration News

Sebelius Says She Won't Resign, Asks Public To Try Exchanges Again

Health and Human Services Secretary Kathleen Sebelius doesn't intend to resign over the health law's shaky rollout of insurance exchanges, despite GOP pressure. In the meantime, she is also calling on the public to renew their attempts at buying coverage on the exchanges.

The New York Times: Sebelius Stands Firm Despite Calls To Resign
Kathleen Sebelius, the secretary of health and human services, has no intention of bowing to Republican demands that she resign after the troubled rollout of President Obama's health care law, people close to her said Wednesday. And the White House expressed "full confidence" in her (Pear, 10/16).

The Associated Press: HHS Chief Urges Consumers Enroll In Health System
Health and Human Services Secretary Kathleen Sebelius said Wednesday that while online enrollment in the new federal health care system has not been without technical problems, anyone who had difficulties should try again. The system has improved and work continues on it, she said, while no one has lost an opportunity for health care coverage (Cornwell, 10/16).

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Hospitals Try New Tactics To Reduce Hospital Falls

The nation's medical workforce grapples with preventing falls in the hospital to improve patient safety. In the meantime, seniors in some places of the country are more likely to fill prescriptions for high-risk drugs, and Miami's seniors lead the nation in filling Medicare prescriptions.

NPR: To Reduce Patient Falls, Hospitals Try Alarms, More Nurses
A bad fall in the hospital can turn a short visit into a long stay. Such falls featured in congressional discussions about patient safety, and in a new study in the Journal of Patient Safety about medical errors. Falls are one part of a multistate clash between nurses and hospitals over how to improve the safety of hospitalized patients. In Washington state, hospitals are required to report falls that happen on their watch to the state health department (Ryan, 10/16).

The Associated Press: Geography Affects What Drugs Seniors Prescribed
Where seniors live makes a difference not only in how much health care they receive but also the medications they're prescribed - as some miss out on key treatments while others get risky ones, new research shows. More than 1 in 4 patients on Medicare's prescription drug plan filled at least one prescription for medications long deemed high-risk for seniors, according to the study released Tuesday by the Dartmouth Atlas Project (Neergaard, 10/16).

The Miami Herald/Kaiser Health News: Miami Leads Nation In Medicare Drug Spending
Elderly Miami residents on Medicare filled more prescriptions for drugs in 2010 than seniors elsewhere in the country, and they were more than twice as likely as residents in Rochester, Minn., to fill at least one prescription for medications that have been identified as high-risk for patients over age 65, such as skeletal muscle relaxants, long-acting benzodiazepines, and highly sedating antihistamines (Chang, 10/16).

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State Watch

State News: Texas To Close High-Risk Pool; Baltimore Probes Complaint Against Aetna

A selection of health policy stories from Massachusetts, Texas, California, Oregon, Missouri and Maryland.

The Texas Tribune: Texas Prepares To Shutter High-Risk Insurance Pool
At year's end, Texas will shut down its high-risk insurance pool for some of the state's sickest residents, pushing participants to find private coverage in the federal health insurance marketplace created under the federal Affordable Care Act. And patient advocates say those participants should focus on making the transition sooner rather than later to ensure that they don't experience a lapse in coverage or lose access to current health care providers and services (Maly, 10/17).

California Healthline: Brown Vetoes Pricing Transparency Bill
A bill requiring health plans and insurers selling to large employers to disclose broad data relating to pricing and premium increases was vetoed by Gov. Jerry Brown (D), who said his own administration is working toward coming up with just such a program to promote transparency. The bill, SB 746 authored by state Sen. Mark Leno (D-San Francisco), would have required insurers selling to large employers to provide detailed reports to the state explaining pricing and justifying premium increases. Additionally, it would have required insurers contracting with two or fewer medical groups to provide information on cost increases, as well as claims data to large purchasers who request it (Norberg, 10/16).

The Lund Report: Physician Assistants, Nurse Practitioners Get Reprieve From Federal Government
Advocates, working together with their political allies, stopped the federal government from implementing a new rule that could have inhibited the elderly from getting access to wheelchairs, nebulizers, walkers and other medical equipment. Starting Oct. 1, the Centers for Medicare and Medicaid Services had intended to require nurse practitioners and physician assistants to secure a physician's signature before ordering such medical equipment (Lund-Muzikant, 10/16).

Modern Healthcare: Big Shifts Seen In Mass. Insurance Market After Rules Limit Consumer Options
As millions of Americans began to shop in newly created markets for health insurance, a new study of health plan choice in Massachusetts found major shifts in its health insurance market after the state set new rules that limit consumer options. The results may be significant for states that have some regulatory authority over health insurance markets created under the Patient Protection and Affordable Care Act, according to the study's authors and health policy experts (Evans, 10/16).

St. Louis Beacon: Community Awareness Needed To Encourage Blacks To Embrace Mental Services
La’Shay Williams, a graphic artist, likes nothing better than spending time creating fancy brochures, colorful outfits or even a striking mural that attests to the peace she feels since shaking off the taunting voices of demons in her head. … Her refusal to seek help from a mental-health professional is common among African Americans, according to Darrell L. Hudson, an assistant professor at the Brown School at Washington University (Joiner, 10/16).

The Baltimore Sun: City Investigates Complaint That Health Care Provider Didn’t Contract With Women-, Minority-Owned Businesses
Baltimore City officials are investigating a complaint filed Wednesday by two minority- and women-owned businesses against health care giant Aetna for not using their services despite a contractual agreement to do so. Thomas B. Corey, chief of Baltimore's Minority & Women's Business Opportunity Office, said he will research why Aetna did not use the subcontractors, CASI Inc. and JUL Enterprise, despite committing to when it applied for the city contract (Wenger, 10/16).

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Weekend Reading

Longer Looks: Making RomneyCare Work For Other States

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

The Boston Globe: Exporting Romneycare
Had any of the several hundred VIPs funneling into Faneuil Hall assumed they were headed to a run-of-the-mill legislative bill signing, the two banners greeting them inside would have instantly disabused them of the notion: "MAKING HISTORY IN HEALTH CARE" they read in foot-high letters. And on this day, the boast just happened to be true. It was April 12, 2006, and Governor Mitt Romney was going to sign the nation's first universal health care program — known as Romneycare — into law. … Not even Massachusetts health reform’s staunchest supporters would argue the system is perfect. We had the highest health care costs before reform, and we still do. That’s no small thing. But the law is fulfilling its primary mission of expanding access. ... So far, Romneycare has brought health insurance to 439,000 previously uninsured people in Massachusetts. The big question now is whether Obama-care can do something similar for the more than 47 million uninsured Americans everywhere else (James Cronin, 10/13).

The Atlantic: How Primary Care Can Handle 15 Million Newly Insured Patients
As debate about Obamacare rages, some proportion of the 48 million uninsured Americans are gradually enrolling in health insurance, some for the first time in their lives. But then what? Will health care spending rise as a result of this coverage expansion? Are we just adding more people to the rolls of an already overburdened system? Answering these questions requires focusing on the linchpin of the United States' health system: primary care. Our concept of primary care is undergoing a historic reinvention (Dave Chokshi, 10/15).

The New York Times: The Dangers Of Pseudoscience
It is precisely in the area of medical treatments that the science-pseudoscience divide is most critical, and where the role of philosophers in clarifying things may be most relevant. Our colleague Stephen T. Asma raised the issue in a recent Stone column (“The Enigma of Chinese Medicine”), pointing out that some traditional Chinese remedies (like drinking fresh turtle blood to alleviate cold symptoms) may in fact work, and therefore should not be dismissed as pseudoscience. This, however, risks confusing the possible effectiveness of folk remedies with the arbitrary theoretical-metaphysical baggage attached to it. There is no question that some folk remedies do work. The active ingredient of aspirin, for example, is derived from willow bark, which had been known to have beneficial effects since the time of Hippocrates. There is also no mystery about how this happens: people have more or less randomly tried solutions to their health problems for millennia, sometimes stumbling upon something useful. What makes the use of aspirin “scientific,” however, is that we have validated its effectiveness through properly controlled trials, isolated the active ingredient, and understood the biochemical pathways through which it has its effects (Massimo Pigliucci and Maarten Boudry, 10/10).

The Boston Globe: First Responders Still In Grip Of Marathon’s Horror
The trigger can be unpredictable, but when the flashbacks come, they feel like spasms, rippling through her mind and body, rending her as she relives that day with harrowing clarity. They take Nicole Fluet McGerald back behind the thin canvas walls of the medical tent, where she hears the thud of the two Boston Marathon bombs. She feels sealed in, trapped, an easy target. She braces for a third blast, expecting to die. … Six months after the Marathon bombings, the terror of that long, frantic afternoon on Boylston Street still haunts many of those who treated the wounded (David Abel, 10/15).

ProPublica: Health Care Sign-Ups: This Is What Transparency Looks Like
Since the federal health insurance exchange has launched, top federal officials have told interviewers that they do not know how many people have been able to enroll using the healthcare.gov website. In an interview with the Associated Press on Oct. 4, President Obama said: "Well, I don't have the numbers yet." Then, appearing on the Daily Show on Oct. 8, the Health and Human Services Secretary Kathleen Sebelius said she didn’t have the information either. "I can't tell you because I don’t know." Some states, including California, New York and Colorado, are running their own health insurance marketplaces for their residents. But the Centers for Medicare and Medicaid Services (CMS) is handling enrollment for 30-plus states, including Texas, Georgia and Florida, which decided not to set up their own exchanges (Charles Ornstein, 10/14).

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Editorials and Opinions

Viewpoints: 'Surrender' By Republicans; 'Myth' Of Income Verification; 'This Fight Didn't End'

The New York Times: The Republican Surrender 
The health care reform law will not be defunded or delayed. No taxes will be cut, and the deal calls for no new cuts to federal spending or limits to social welfare programs. The only things Republicans achieved were billions of dollars in damage to the economy, harm to the nation’s reputation and a rock-bottom public approval rating (10/16). 

Los Angeles Times: The 'Income Verification' Myth Buried In The Shutdown Deal
The glittering new deal to end the government shutdown and debt-ceiling crisis has one tiny little sop to the Republicans. Let's hope they don't break their arms patting themselves on the back about it. The sop is a provision to tighten "income verification" for people applying for federal subsidies for health insurance under the Affordable Care Act. We reported on this provision earlier this week. Here's a little more background. Bottom line: the problem that the new "tightening" is supposed to resolve doesn't even exist (Michael Hiltzik, 10/16). 

USA Today: After Debt Deal, What Now? 
Yes, today's GOP is far less inclined to compromise. Yet all but the most intransigent Tea Party Republicans recognize that the doomed effort to defund Obamacare was, in the words of Sen. John McCain, R-Ariz., a "shameful chapter." Republicans might be cautious about acting for fear of attracting far-right opponents in party primaries. Even so, as the 16-day shutdown lurches to its entirely predictable conclusion, they know that the best interests of the Republican Party are in getting out of the place they're occupying (10/16).

USA Today: Rep. John Fleming: 'This Fight Didn’t End Last Night' 
The battle unified Republicans in repeated efforts to keep government open while shutting down Obamacare. The sequester caps, so hated by Democrats, remain intact. Obamacare's problematic rollout has been highlighted. And the president's move to take the nation to the brink of default will not achieve his political goal of taking back the House. Not only were attempts at defunding Obamacare worth the effort, they remain far from over. While the political debate has ended for the moment, like any prizefight there are many rounds, and this fight didn't end last night. Washington liberals have so much invested in Obamacare, they don't dare admit its failures (Rep. John Fleming, 10/17). 

The New York Times: The Myth Of The Medical-Device Tax 
In the last few days of negotiations in Congress, repeal of the Affordable Care Act’s tax on medical devices emerged as a key Republican demand. The medical-device industry waged an intense lobbying campaign -- even garnering the support of many Democrats who favored the law -- arguing that the tax would stifle innovation and increase health care costs (Topher Spiro, 10/16).

Los Angeles Times: How To Build A Better Flu Vaccine
The Spanish flu pandemic of 1918-19 killed 583,135 Americans, according to public health authorities at the time. Although we no longer suffer such a high rate of flu deaths, during a non-pandemic season, flu still kills on average thousands each year in this country. From the 1976-77 season to the 2006-07 season, flu-associated deaths ranged from a low of about 3,000 to a high of about 49,000, according to the national Centers for Disease Control and Prevention (Henry I. Miller, 10/17). 

The Wall Street Journal: ObamaCare’s Black Box 
The White House set low expectations for the Affordable Care Act's October 1 debut, so anything remotely competent should have seemed like a success. But three weeks on, the catastrophe that is Healthcare.gov and the 36 insurance exchanges run by the federal government is an insult to the "glitches" President Obama said were inevitable. This isn't some coding error, or even the Health and Human Service Department's usual incompetence. The failures that have all but disabled ObamaCare are the result of deliberate political choices, which HHS and the White House are compounding with secrecy and stonewalling (10/16). 

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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.