Daily Health Policy Report

Monday, October 28, 2013

Last updated: Mon, Oct 28

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Administration News



State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Prevention For Profit: Questions Raised About Some Health Screenings

Kaiser Health News staff writer Jenny Gold, working in collaboration with NPR, reports: "For less than $200, Riggs is getting six different screenings for stroke, heart disease and osteoporosis. Life Line says they've checked 8 million Americans this way at churches and community centers, and up to 10 percent of them are found to have some sort of abnormality. But several of the tests performed by Life Line are on a list of procedures for healthy people to avoid" (Gold, 10/28). Read the story.

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Pennsylvania Governor Talks Up Plan To Expand Medicaid His Way

WHYY's Elana Gordon, working in partnership with Kaiser Health News and NPR, reports: "As part of the Affordable Care Act, states have the option to give coverage to low-income adults, with the federal government picking up most of the tab. Only about half the states so far have planned to do that, starting Jan. 1, and Pennsylvania has, so far, not been among them" (Gordon, 10/25). Read the story.

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Zients Vows Healthcare.gov Will Work Smoothly By End Of November

Kaiser Health News staff writer Phil Galewitz reports: "The troubled federal health insurance exchange will be fixed by the end of November -- two weeks before the Dec. 15 enrollment deadline for coverage to take effect in January, Obama administration officials said Friday" (Galewitz, 10/25). Read the story.

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Political Cartoon: 'Nerd Is The Word?'

Kaiser Health News provides a fresh take on health policy developments with "Nerd Is The Word?" by Joe Heller.

Here's today's health policy haiku:


On healthcare.gov
The "hub" was the part that worked
until Sunday crash.

If you have a health policy haiku to share, please send it to us at http://www.kaiserhealthnews.org/ContactUs.aspx and let us know if you want to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

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Health Reform

Website Problems Cast New Doubts On Obama's Vision

President Barack Obama has struggled throughout his presidency to convince the American public that the government can be used to address seemingly "intractable" problems and make transformational changes, but the recent difficulties with healthcare.gov could amount to a serious test to this philosophy.

The New York Times: Health Site Woes Undermine Obama's Vow On Government
The breakdown of the federal HealthCare.gov Web site could emerge as a test of Mr. Obama’s philosophy, with potentially serious implications for an agenda that relies heavily on the belief in a can-do bureaucracy. Michael Dimock, the Pew center’s director, said that the longer the problems persist, the more they could bolster what he called the “almost American value that government is inefficient” (Shear, 10/26).

The Washington Post: HealthCare.gov Doesn't Help Obama's Argument For Greater Government
President Obama has faced a persistent challenge in office. The advocate of big, bold actions to address large and seemingly intractable problems, he has struggled to convince the public that government is equipped to carry out such transformational changes. The rollout of the Affordable Care Act has highlighted that challenge, and the administration’s response has no doubt set the president back. He and Health and Human Services Secretary Kathleen Sebelius were slow to acknowledge the scope of the problems with HealthCare.gov, and overall the administration has hardly lived up to its pledge to be the most transparent in history (Balz, 10/26).

Bloomberg: Obamacare Website Flaws Imperil President’s Activist Agenda
The rocky debut of the insurance exchanges at the heart of President Barack Obama’s health-care law poses risks to his political agenda and the activist role for government that he has championed for his second term.White House officials say they expect a surge in online enrollment to begin in mid-November, meaning the administration may have only about three weeks to fix the flaws before negative public perceptions about the new program begin to harden (Dorning, 10/26).

Meanwhile, news outlets also report on how the technical issues could undermine the enrollment of the sought-after young and healthy people while, at the same time, these hiccups may be a distraction from other health law problems, such as sticker shock.

The New York Times: Health Site's Woes Could Dissuade Vital Enrollee: The Young And Healthy
The economists and policy wonks behind the Affordable Care Act worry that the technical problems bedeviling the federal portal could become much more than an inconvenience. If applicants like Mr. Jackson decide to put off or give up on buying coverage, rising prices and even a destabilized insurance market could result. The enrollment of people like Mr. Jackson, who is 32, is vital for the health care law — and, for that matter, the entire health care system — to work (Lowrey, 10/27).

Politico: Obamacare Headaches: More Than The Website
The range of issues and potential issues runs the gamut, from the truly glitchy — the small and likely solvable — to much more serious threats to the viability of the health exchanges at the heart of Obamacare (Norman and Allen, 10/28).

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Administration Announces Website Will Be Fixed By November

Even as U.S. officials and the contractors they hired delve into the online marketplace's problems, issues arise in paper and phone applications too. Meanwhile, the familiar photo on the website is gone.

The Washington Post: HealthCare.gov Fixes Won't Be Done Until End Of November, Adviser Says
The Obama administration announced Friday that it was putting a private firm in charge of fixing its faulty health insurance Web site and set the end of November as a target date for working out all the bugs, the first indication of how long repairs may take. One day after contractors on the project publicly suggested that the federal government inadequately tested the site before its Oct. 1 launch, administration officials said that one of those contractors — Columbia-based Quality Software Services Inc., or QSSI — would take over management of HealthCare.gov (Somashekhar and Sun, 10/25).

Kaiser Health News: Zients Vows Healthcare.gov Will Work Smoothly By End Of November
The troubled federal health insurance exchange will be fixed by the end of November -- two weeks before the Dec. 15 enrollment deadline for coverage to take effect in January, Obama administration officials said Friday (Galewitz, 10/25).

CQ HealthBeat: Zients: Website Will Work Smoothly By End Of November – Under New Management
Federal officials on Friday handed over the task of overseeing changes to the federal insurance exchange website to a contractor that was part of the team that developed healthcare.gov. The administration expects the site to work well by the end of November. Quality Software Services, Inc., is taking over for the Centers for Medicare and Medicaid Services as manager of the project (Adams and Reichard, 10/25).

McClatchy: Obama Administration Says It Will Take Another Month To Fix Health Care Website
A management expert pulled in to help the White House fix the website said a review has identified the problems but that it's going to take several weeks to address them. "It will take a lot of work and there are a lot of problems that need to be addressed, but let me be clear: Healthcare.gov is fixable," said Jeff Zients, a management expert who earlier this week was asked to review the troubled program run by the Department of Health and Human Services (Clark,10/25).

Los Angeles Times: U.S. Hires Contractor To Fix Healthcare Website
Jeffrey Zients, the management consultant enlisted to assess the situation, acknowledged that dozens of unresolved problems remained, including software flaws — contradicting administration officials' early claims that unexpected traffic volume was the main cause of the frequent error messages, frozen screens and other problems. Still, Zients said the site would be running smoothly for the "vast majority" of users by the end of next month (Hennessey and Clemons, 10/25).

The Star Tribune: UnitedHealth Unit Chosen To Fix Health Care Website
The government on Friday named a UnitedHealth Group Inc. subsidiary as "general contractor" to oversee the troubled federal website designed to sign up Americans for health insurance under national health care reform. Quality Software Services Inc., known as QSSI, will "oversee the entire operation" of Healthcare.gov, a government spokeswoman said. The Maryland software company, acquired by Minnetonka-based UnitedHealth’s Optum business unit in 2012, designed the website's data services hub, one of the functions that has worked well since the problem-plagued system went online Oct. 1. QSSI now becomes responsible for prioritizing the site's worst problems and getting them fixed (Spencer, 10/26).

The New York Times: Promised Fix For Health Site Could Squeeze Some Users
Such a condensed time frame raises the question of how hundreds of thousands of people whose current policies do not comply with the health law will obtain new coverage in time, and how millions who may qualify for subsidies will enroll. Some experts predicted a groundswell of demands from Congress and elsewhere to delay the deadlines (Pear and LaFraniere, 10/25).

Politico: 'Glitches' Hit Obamacare Paper, Phone Applications Too
With the supposedly state-of-the-art $600 million HealthCare.gov portal malfunctioning, President Barack Obama is urging Americans to go ahead and try to get health coverage by mailing in a paper application, calling the helpline or seeking help from one of the trained "assisters." But the truth is those applications — on paper or by phone — have to get entered into the same lousy website that is causing the problems in the first place. And the people processing the paper and calls don't have any cyber secret passage to duck around that. They too have to deal with all the frustrations of HealthCare.gov — full-time (Winfield Cunningham, 10/26).

Politico: Healthcare.gov Smiling Face Vanishes
The website for the problem-plagued health care exchanges has a new look, and gone is the smiling face of an unidentified woman from the homepage. Since its roll out, the website had featured a smiling young woman, who became known as the "Obamacare girl," and whose identity people tried unsuccessfully to uncover (Kopan, 10/28).

CNN: HealthCare.Gov Homepage Gets Makeover
An image of a young woman who became known as the "Obamacare girl" is no longer on the homepage of the federal government's health care site. In the process of changing the homepage of HealthCare.gov to highlight the different enrollment options now being offered, the image of the woman, who has become a symbol of the online federal exchange, was set aside, said an official with Centers for Medicare and Medicaid, or CMS (Bohn, 10/27).

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Verizon Data Failure Takes Down Health Insurance Websites

Computer servers hosting a key part of the health law's infrastructure relied upon by all 14 state-run health websites, as well as by the federal website that serves 36 states, failed Sunday. Terremark, a unit of Verizon that operates the servers, could not immediately give officials a timeline for fixing the problems.

Bloomberg/The Washington Post: Obamacare Insurance Web Sites Limited By Verizon Data Hub Failure
Computer servers hosting a key piece of Obamacare’s insurance enrollment program failed today, leaving federal and independent state exchanges unable to provide most services. The data services hub, a system that supplies tax information and other data to Web sites run by the U.S. and 14 states to sell medical coverage, was unavailable after a malfunction at the data center that hosts it (Wayne, 10/27).

The Wall Street Journal: Data Center Outage Hits Health Care Website
The federal data hub relied on by all 14 state-run health care insurance exchanges and 36 exchanges run by the federal government was not working Sunday because the company hosting the hub lost its network connectivity, the Obama administration said. The outage means people trying to sign up online for health care insurance in all 50 states could not complete the process. Terremark, a unit of Verizon Enterprise Solutions that operates the data center that hosts the federal data hub as well as the HealthCare.gov site, couldn't immediately give the Department of Health and Human Services a timeline for fixing the problem, which was affecting customers other than the federal government, HHS spokeswoman Joanne Peters said (Radnofsky, 10/27).

Reuters: Data Center Glitch Is Latest Problem In 'Obamacare' Rollout
A data center critical for allowing uninsured Americans to buy health coverage under President Barack Obama's healthcare law went down on Sunday, halting online enrollment for all 50 states in the latest problem to hit the program's troubled rollout. The data center operated by Verizon's Terremark experienced a connectivity issue that caused it to shut down, affecting the federal government's already problem-plagued online marketplace Healthcare.gov and similar sites operated by 14 states and the District of Columbia, according to the U.S. Department of Health and Human Services (HHS) (Morgan and Begley, 10/27).

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IRS Offers Preliminary Glimpse Of How Many People Were Able To Use Healthcare.gov

According to the Internal Revenue Service, the federal government has delivered 330,000 premium subsidy calculations to people who have gotten far enough to find out whether they qualify for health insurance subsidies. Meanwhile, CNN looks deeper into some of the numbers currently being quoted.  

The Washington Post: IRS Offers Hint At How Many Americans Have Been Able To Use Healthcare.Gov Successfully
Despite the technical problems plaguing many of the new health insurance Web sites, the federal government has delivered 330,000 premium subsidy calculations to people who have gotten deep enough into the system to find out whether they qualify for financial help, the Internal Revenue Service said Saturday. The disclosure offers a hint of how many people might be successful in using the online marketplaces, which opened Oct. 1 amid widespread technical difficulties that prevented many people from accessing them (Kliff and Somashekhar, 10/26).

Fox News: IRS Releases Preliminary Report On Obamacare Inquiries
The IRS on Saturday reported handling more than 330,000 requests from Obamacare exchanges to calculate whether Americans are eligible for federal tax credits when purchasing insurance through the program. The release provides some indication on how many people are attempting to buy insurance through the exchanges in their first four weeks of operation and how many are seeking federal financial assistance (10/26).

CNN: The Hidden Truth Behind Early Obamacare Numbers: It's Not What It Seems
Officials announced Thursday that 700,000 people have applied for insurance plans in both the 36 states that are using a federally run health care exchange and the 14 states running their own exchanges. But don't apply that 700,000 application figure to the 7 million enrollment goal. For starters, there's no guarantee that all 700,000 will ultimately enroll in a health insurance plan. And those 700,000 applications include Medicaid enrollments (Wolf and Aigner-Treworgy, 10/27).

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Analyses: Tracking The Development Path For Healthcare.gov; Analyzing The Evolution Of The Insurance System

The Wall Street Journal reports that a "lack of direction" may have been in play as the federal health exchange was being developed while CBS News offers a long look at how the health insurance system became what it is today.

The Wall Street Journal: Federal Health Site Stymied By Lack Of Direction
A team of young policy experts energized by President Barack Obama's health law toiled for three years in a Bethesda, Md., office building to draw up specifications for the federally run insurance marketplace. Forty miles away at the Centers for Medicare & Medicaid Services' Baltimore headquarters, longtime agency computer experts with different bosses oversaw building the site's software and hardware components. And in Washington, White House advisers worked to preserve the law through treacherous politics, sometimes stalling final decisions about the site, HealthCare.gov, to avoid controversy ahead of the 2012 presidential election (Weaver and Radnofsky, 10/27).

CBS News: The Road To Obamacare: How Did We Get Here?
Fifty-five percent of Americans get health insurance through their employer. Many are surprised to learn that this system is not the result of some well-designed plan by policy experts who weighed its implications and selected it as the best option. Rather, it's an accident of history that has carried on into the 21st century (Tartakovsky, 10/25).

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State Exchange Updates: Football Marketing, Slow Starts And Calif.'s Litmus Test

News outlets provide updates on state health insurance exchanges in Kentucky, Maryland, Minnesota and California, the state that many believe will provide a litmus test on how, and if, the state-based exchanges can work elsewhere.

Bloomberg: Democratic Governor Beshear Says The U.S. Health Law Will Work
The U.S. health care law will work after the administration of President Barack Obama fixes the program's website, [Democratic] Kentucky Governor Steve Beshear said. … Since opening for business Oct. 1, the healthcare.gov Web portal to the federal exchange serving 36 states has been plagued by delays, error messages and hang-ups that have prevented customers from enrolling in a health insurance plan (Shield and Dougherty, 10/28).

The Baltimore Sun: State Insurance Exchange Paid Ravens $130K For Advertising
For $130,000, Maryland health officials are getting the word out on health reform to Ravens fans listening to the radio or visiting the team website. To catch the promotions in the stadium, though, don’t blink. Maryland Health Connection, the insurance marketplace created as part of federal health reform, is being featured in dozens of 30-second radio commercials, including one apiece on WBAL Radio and 98 Rock during each game broadcast (Dance, 10/25).

California Healthline: Exchange Officials Address 'Glitchy' Start
Covered California's board yesterday met for the first time and reviewed the Oct. 1 launch of the exchange. Across the country and in California many people were frustrated by long waits and some confusion with the rollout of the first six-month-long enrollment period. Given the size of the undertaking, some difficulty with the launch was to be expected, said board member Robert Ross. … Overall, given the high volume of interest in the exchange and the huge amount of information exchange workers were able to deliver, the launch did well, said Covered California executive director Peter Lee (Gorn, 10/25).

The San Jose Mercury News: Covered California's Executive Director Faces Fiery Test 
Now, Peter V. Lee, as executive director of Covered California, the state's new health exchange, has the daunting task of executing a key part of the new federal health care law in the nation's most populous state. And if the law succeeds here, many health care experts agree, it will likely succeed in other states. Lee, 54, is a man of boundless enthusiasm and passion for health reform who says he welcomes the challenge. Yet in the weeks since the Oct. 1 nationwide debut of the health exchanges, his critics say he too often has taken on a cheerleading role and downplays the problems facing Covered California (Seipel, 10/27).

The San Francisco Chronicle: State Health Care Website Recovering From Glitches
Since its debut Oct. 1, Covered California, the state's online marketplace developed independently of the federal government's site, experienced slowness in the early days, endured trouble with its online directory of doctors and hospitals, and had to be taken offline several times. But the state marketplace's woes are far less troubling than the problems that have plagued HealthCare.gov, which was so dysfunctional that most Americans have been unable to complete their applications through the site (Colliver, 10/25).

Minnesota Public Radio: Gov. Dayton Defends MNsure From Critics, Potential Challengers
MNsure is barely three weeks old, and, like President Obama, Gov. Mark Dayton has found himself defending the state's new health insurance marketplace against heavy criticism that their respective exchanges are not working. Compared to the federal insurance site that 36 states are using, Minnesota's homegrown exchange is in good shape, Dayton said recently. "Fortunately, we decided to go our own route in Minnesota and the Legislature has supported that," he told reporters. "I think the MNsure beginning has been not perfect. But given the complexity and scope of the project, I think it's performed phenomenally well” (Richert, 10/25).

State news outlets also report on the federal health exchange  -

WFAA: Thousands Line Up In Dallas For Health Insurance Info 
A statewide education and outreach event focusing on the new Affordable Care Act drew more than 10,000 people to the Dallas Convention Center on Saturday. The Be Covered Texas event was hosted by Blue Cross and Blue Shield of Texas and more than 30 community partners to provide health services and health care information (Panicker, 10/26).

The Philadelphia Inquirer: User, Marketplace Website Face Off
Holly Phares was a mouse click away from becoming the first, and she was psyched. … Since the health-insurance marketplace opened Oct. 1, RHD has not enrolled one client using the federal Healthcare.gov website (Calandra, 10/27).

Miami Herald: As Obamacare Site Stalls, Consumers Get Dubious Pitches
"Obamacare Enrollment Center," announced the banner hanging from the pulpit. It even bore the "O" logo from President Obama's campaign. But the self-proclaimed "Obamacare Enrollment Team" that rolled into Florida's capital this week has no official connection with the president or his signature health law (Mitchell, 10/27).

Meanwhile, on the navigator front -

Georgia Health News: Insurance Industry Veteran Upbeat On Navigator Role
For Harold Weber, an Athens resident who worked in the health insurance industry for 30 years, the most important aspect of the Affordable Care Act is its approach. Weber watched the rise and fall of HMO plans in the 1990s and believes the ACA will finally succeed where others failed. "The unaffordable aspect of insurance is never going to go away," he said. "It took longer than we thought, but we're facing this question again." That's why he applied to be one of Georgia's 100 ACA health care navigators. He wants to be part of the solution (Crist, 10/26).

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States Report Medicaid Surge As Result Of Health Law Rollout

Several media outlets examine how some states are signing up tens of thousands of new Medicaid enrollees in the first month of the health law's rollout, while enrolling fewer people in private insurance policies. In addition, Pennsylvania Gov. Tom Corbett touts his alternative to Medicaid expansion using private insurance.

The Wall Street Journal: States Report Medicaid Surge After Health-Law Rollout
Some states are signing up tens of thousands of new Medicaid enrollees in the initial weeks of the health law's rollout, while placing far fewer in private health insurance—a divergence that suggests Medicaid expansion may be a larger part of the law than expected. In one sense, the Medicaid figures are good news for the Affordable Care Act's advocates, who hoped the law would reduce the number of Americans without health insurance (Schatz and Dooren, 10/27).

Kaiser Health News: Pennsylvania Governor Talks Up Plan To Expand Medicaid His Way
Pennsylvania Gov. Tom Corbett may have kept an eye this week on his fellow Republican governor in Ohio, John Kasich, as Kasich bypassed his own Republican legislature to expand the state’s Medicaid program. As part of the Affordable Care Act, states have the option to give coverage to low-income adults, with the federal government picking up most of the tab. Only about half the states so far have planned to do that, starting Jan. 1, and Pennsylvania has, so far, not been among them (Gordon, 10/25).

CBS News: Medicaid Enrollment Spike A Threat To Obamacare Structure?
As the Obamacare website struggles, the administration is emphasizing state-level success. President Obama said Monday, "There's great demand at the state level as well. Because there are a bunch of states running their own marketplaces." But left unsaid in the president's remarks: the newly insured in some of those states are overwhelmingly low-income people signing up for Medicaid at no cost to them. Matt Salo, executive director of the National Association of Medicaid Directors, said, "We're seeing a huge spike in terms of Medicaid enrollments” (Crawford, 10/25).

Related, earlier KHN coverage:

Kaiser Health News: In Some States, Most Early Marketplace Enrollees Qualify For Medicaid
Shoppers applying for private health coverage through the marketplace have to pay their first monthly premium before they are fully enrolled. Their first payment must be made by Dec. 15 for coverage to take effect Jan. 1. Most are expected to be eligible for some tax credits, up front, to help pay the monthly premiums.

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So Far, Health Law Not Hurting Insurer Stock Prices

Health insurance stocks don't seem to be hurt by implementation of the health law. In fact, share prices for the top five publicly traded firms have risen faster than the larger market. Elsewhere, The New York Times examines options for buying insurance outside the federal or state marketplaces, and some coverage is getting pricier.

The New York Times: Insurers' Stocks, Unhurt By The Dawn Of The Health Care Law
Yet from the financial perspective of the health care industry, Obamacare, as the law is often known, doesn't seem much of a hindrance. In fact, it may even turn out to be positive. Consider the situation of health insurance providers. Because they face new regulations intended to broaden coverage and limit profit-taking, some analysts have been concerned that profits will suffer. But in the run-up to the Affordable Care Act, stock market prices have told a different story. Over the last 12 months, shares of the top five publicly traded health insurance companies -- Aetna, WellPoint, UnitedHealth Group, Humana and Cigna -- have increased by an average of 32 percent, while the Standard & Poor's 500-stock index has risen by just 24 percent (Bernasek, 10/26).

The New York Times: Health Insurance Options Aren't Limited To Government Exchanges
Of course, the main attraction of the exchange is that plans sold there may come with subsidies that can substantially lower your monthly premiums. (Premium credits are for people making up to $46,000 for an individual and up to $94,000 for a family of four.) Web-based brokers, like eHealth, are supposed to be able to help consumers enroll in subsidy-eligible plans by connecting to the federal marketplace to verify the consumer's income, under government guidelines issued last spring. But that isn't happening yet at eHealth, in part because the company is still testing its system, said a spokesman, Nate Purpura (Carrns, 10/25).

Los Angeles Times: Some Health Insurance Gets Pricier As Obamacare Rolls Out 
Thousands of Californians are discovering what Obamacare will cost them -- and many don't like what they see. These middle-class consumers are staring at hefty increases on their insurance bills as the overhaul remakes the health care market. Their rates are rising in large part to help offset the higher costs of covering sicker, poorer people who have been shut out of the system for years. Although recent criticism of the health care law has focused on website glitches and early enrollment snags, experts say sharp price increases for individual policies have the greatest potential to erode public support for President Obama's signature legislation (Terhune, 10/27).

Earlier, related KHN coverage: Thousands Of Consumers Get Insurance Cancellation Notices Due To Health Law Changes (Gorman and Appleby, 10/21).  

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Health Law Broadens Coverage Possibilities For Many People With HIV, AIDS

Stateline reports how the health law will broaden benefits for many of the 1.1 million Americans infected with HIV, especially those who live in the 25 states that are expanding Medicaid. Meanwhile, the Obama administration stresses that information an individual submits to sign up for health coverage cannot be used to enforce immigration law. 

Stateline: How The ACA Will Affect People With HIV And AIDS
The Affordable Care Act will broaden health care coverage for many of the 1.1 million Americans infected with HIV, especially those who live in the 25 states and the District of Columbia that have opted to expand Medicaid. In those states, the larger Medicaid programs will cover about 60 percent of the mostly uninsured patients currently receiving help from federal-state HIV programs. As a result, state officials who run so-called Ryan White programs that provide health care and other services for HIV-infected residents are preparing for a major shift in the type of benefits they offer and possibly the level of future investment (Vestal, 10/28).

The Associated Press: U.S. Says Healthcare Info Off Limits In Civil Immigration Cases
The Obama administration is stressing that information submitted while signing up for coverage under the new healthcare law will not be used to enforce immigration law. That's always been the practice, but lingering fear among some immigrants that personal details could be used against them led the U.S. Immigration and Customs Enforcement agency to clarify (10/27).

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Delaying Coverage Mandate Not A Simple Idea

News outlets examine the political and policy issues involved in delaying the health law's requirement that almost everyone have health insurance.

Politico: Delay Obamacare? Not As Easy As You Think
More and more Democrats worried about the 2014 election are beginning to join the Republican call to delay the Obamacare enrollment season. But it’s not as easy as bumping things back a few days on the calendar. Insurance companies would raise a ruckus because they set their prices based on customers enrolling before April. The Obama administration doesn’t want to push the successful enrollment stories until any later than they have to. And neither want to give procrastinators another reason to wait to sign up (Haberkorn, 10/25).

Roll Call: Manchin’s Obamacare Mandate Delay Could Create Political Peril
Democratic Sen. Joe Manchin III has quickly become a favorite of Republicans with his quest to delay the individual mandate to buy health insurance under Obamacare. Though that effort doesn’t seem to have much traction, it’s one that could start giving vulnerable Democrats heartburn (Lesniewski and Shiner, 10/25).

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Capitol Hill Watch

Republicans Eye Health Law Opportunities To Make Midterm Inroads

Republicans are set to pounce on the health law's rollout problems as a way to make inroads in 2014's midterm elections. Among the strategies they are considering is leaving the law out of budget negotiations but voting again in the House to delay the law. They plan further hearings to question officials on the rollout issues, and some are calling for Health Secretary Kathleen Sebelius' resignation.

The Associated Press: Obama's Troubled Health Rollout May Be Problem With Kind Of Staying Power That GOP Has Sought
For nearly five years, Republicans have struggled to make a scandal stick to President Barack Obama’s White House. One by one, the controversies -- with shorthand names such as Solyndra, Benghazi, and Fast and Furious -- hit a fever pitch, then faded away. But some Republicans see the disastrous rollout of Obama’s health law as a problem with the kind of staying power they have sought (Pace and Benac, 10/27).

The Associated Press: Republicans Ready To Question Sebelius About Troubled Rollout Of Obama's Health Care Law
Republicans plan to seek answers from Health and Human Services Secretary Kathleen Sebelius on the Obama administration's troubled start for its health care website to buy insurance, and are raising concerns about the privacy of information that applicants submit under the new system. GOP lawmakers said Sunday that the Obama administration will face intense scrutiny this week to be more forthcoming about how many people have actually succeeded in enrolling for coverage in the new insurance markets (Thomas, 10/28).

The Washington Post: QSSI, Contractor Chosen To Fix HealthCare.gov, Faced Questions From Lawmakers Last Year
The company chosen by the Obama administration to oversee the repair of the new federal health insurance Web site faced questions from lawmakers a year ago about whether it was an appropriate choice for earlier work on the site, given that it is owned by the country's largest health insurance company. ... Republican lawmakers including Sen. Orrin G. Hatch (Utah), Sen. Charles E. Grassley (Iowa), Rep. Darrell Issa (Calif.) and Rep. Fred Upton (Mich.) sent letters to UnitedHealth Group and HHS asking how QSSI had been chosen, given what they viewed as a potential conflict of interest. The lawmakers were concerned that QSSI might have access to information or would build the technology in a way that would give UnitedHealth's insurance business an advantage (Yang, 10/25).

CBS News: HHS Secretary Sebelius: Should She Stay Or Should She Go?
Sen. Joe Manchin, D-W.V., is a conservative Democrat who has voiced his share of complaints about the troubled rollout of Obamacare's online insurance marketplace. He's criticized the website problems that have stymied consumers shopping for health insurance on HealthCare.gov, the federally administered website that allows people in 36 states to comparison-shop health insurance plans. He's even called for a one-year delay of the IRS penalty for people who neglect to purchase insurance. Yet despite his criticism, he doesn't think Health and Human Services Secretary Kathleen Sebelius, whose agency bears ultimate responsibility for overseeing the law's implementation, should be forced out of her job as a result of the rocky start (Miller, 10/27).

Politico: Lawmakers Consider Sebelius Resignation, Obamacare Blame
Rep. Darrell Issa said Sunday that if Health and Human Services Secretary Kathleen Sebelius can't reorganize her agency to meet President Barack Obama's health care agenda, then "she shouldn't be there." "The president has been poorly served in the implementation of his own signature legislation," the Republican congressman from California said on "Face the Nation" on CBS. "If Kathleen Sebelius can't reorganize to meet his agenda, then she shouldn't be there." "Why didn't she know that the president's signature legislation was in trouble?" he added (Emma, 10/27).

The Wall Street Journal: Issa Calls For Sebelius To Resign If Fixes Aren’t Made
A leading House Republican said the nation's top health official should step down if problems with President Barack Obama’s new health-care plan aren't quickly resolved. Rep. Darrell Issa (R., Calif), chairman of the House Oversight and Government Reform Committee, said on CBS's "Face the Nation" Sunday that if technical issues plaguing the new online health-insurance marketplaces aren’t fixed, Secretary of the Department of Health and Human Services Kathleen Sebelius "shouldn’t be there." ... Sen. Jeanne Shaheen (D., N.H.) disagreed. "There’s going to be plenty of time to place blame for who’s responsible" later, she said on the news program (Patterson, 10/27). 

The Associated Press: In A Twist, Republican Senators Fight To Keep Tax Increase As Part Of New Health Law
Republicans in Congress don't usually fight for tax increases, especially ones that are part of President Barack Obama's health care law. But GOP senators balked when Democrats proposed delaying a new temporary fee on everyone covered by health insurance. So employers, insurance companies and other health plan sponsors are in line to pay $63 a person next year for everyone who has coverage. The temporary fee covers all workers, spouses and dependents covered by health insurance (Ohlemacher, 10/28).

The Fiscal Times: GOP Budget Strategy Takes Obamacare Off The Table
After having been singed by the 16-day government shutdown and the potential default, Republican lawmakers and their staff are finding that being less aggressive should be to their advantage. Unlike the events leading up to the partial closure, they see less of a need to insist on defunding Obamacare as a precondition for a budget agreement, even if the problematic rollout of the health insurance program has confirmed their objections to it (Pianin and Boak, 10/28).

Politico: GOP May Vote Again To Delay Obamacare 
Energy and Commerce Committee Chairman Fred Upton (R-Mich.) hinted Friday that the House might vote to delay the sign-up date for Obamacare. The current enrollment period lasts through March. Upton's committee had a high profile hearing Thursday with the contractors who built the troubled Obamacare website. Next week, Upton's panel will hear from Health and Human Services Secretary Kathleen Sebelius. "Since we had our hearing … there's a number of members -- Republican and Democrat -- that are calling for a further delay in terms of signing things up," Upton said during a taping of C-SPAN's "Newsmakers." "We're going to take a good look at that, and we'll see where we are, maybe having some announcement next week or so, maybe a little longer than that" (Sherman, 10/25). 

Bloomberg: Cruz Says Obamacare Fight Elevated Debate
Republican Senator Ted Cruz, who incited a standoff over Obamacare culminating in a 16-day U.S. government shutdown, told party activists in Iowa that fighting the health law will pay dividends in the 2014 midterm elections (McCormick, 10/26).

Fox News: Unabashed Cruz In Iowa Defends Self On ObamaCare Fight, Against GOP Establishment
Texas Republican Sen. Ted Cruz is charging ahead with his argument that attempts to dismantle ObamaCare needed to be part of the recent Washington budget negotiations and is firing back at the GOP establishment and others who say his tactics led to an unnecessary, partial government shutdown. Cruz, who appears poised for a presidential bid, told hundreds at a GOP fundraiser in Iowa on Friday that efforts he led to "defund" ObamaCare will carry the fight through the 2014 congressional and 2016 White House races (10/26).

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Administration News

Obama To Talk Health Law Importance In Boston As Sebelius Testifies

President Obama will try to bolster the health law Wednesday when he travels to Boston to talk about the law while HHS Secretary Kathleen Sebelius testifies on Capitol Hill about healthcare.gov's problems. In the meantime, the White House is busy trying to rally support for the law from congressional Democrats.

CNN: Obama To Talk Obamacare On Wednesday In Boston 
On the same day Health and Human Services Secretary Kathleen Sebelius is to testify on Capitol Hill about the Obamacare website problems, President Barack Obama will travel to Boston to talk about the importance of the law, a White House official confirmed to CNN on Sunday. Obama on Wednesday is expected to discuss the ongoing efforts to fix the problems plaguing the HealthCare.gov website, the official said. The administration has touted Massachusetts' health care law as the model for the Affordable Care Act. Officials point to that state's experience showing how many consumers sign up for insurance only as a deadline approaches. They point out that today, 97 percent of Massachusetts residents have insurance (Bohn, 10/27).

The Washington Post: White House Tries to Rally Congressional Democrats In Support Of Obamacare
By the time President Obama acknowledged on Monday that his signature health-care program had serious problems, it was clear that the political stakes had escalated for the White House. And so that evening, Obama gathered some of the top political advisers from his first term for a strategy session on a range of topics. The president himself spent little time on how to handle the political fallout, arguing that fixing the problems of HealthCare.gov, the Web site at the heart of the troubles, would take care of that challenge (Eilperin, 10/26).

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Questions About Medical Necessity For Some Surgeries, Screenings

The Washington Post looks at the dramatic increase in spinal fusion surgeries and whether all are necessary, while Kaiser Health News examines screenings for stroke and heart disease, some of which are not recommended for healthy people. The New York Times examines how the Food and Drug Administration's recommendation to limit prescriptions for narcotic painkillers was years in the making.

The Washington Post: Spinal Fusions Serve As Case Study For Debate Over When Certain Surgeries Are Necessary
By some measures, Federico C. Vinas was a star surgeon. He performed three or four surgeries on a typical weekday at the Daytona Beach, Fla., hospital that employed him, and a review showed him to be nearly five times as busy as other neurosurgeons. The hospital paid him hundreds of thousands in incentive pay. In all, he earned as much as $1.9 million a year. Yet given his productivity, some hospital auditors wondered: Was all of the surgery really necessary? (Whoriskey and Keating, 10/27).

Kaiser Health News: Prevention For Profit: Questions Raised About Some Health Screenings
For less than $200, Riggs is getting six different screenings for stroke, heart disease and osteoporosis. Life Line says they've checked 8 million Americans this way at churches and community centers, and up to 10 percent of them are found to have some sort of abnormality. But several of the tests performed by Life Line are on a list of procedures for healthy people to avoid (Gold, 10/28).

The New York Times: FDA Shift On Painkillers Was Years In The Making
When Heather Dougherty heard the news last week that the Food and Drug Administration had recommended tightening how doctors prescribed the most commonly used narcotic painkillers, she was overjoyed. Fourteen years earlier, her father, Dr. Ronald J. Dougherty, had filed a formal petition urging federal officials to crack down on the drugs (Meier and Lipton, 10/27).

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UnitedHealthcare Cuts Doctors From Medicare Advantage Plans

UnitedHealthcare is dropping 10 to 15 percent of its doctors from Medicare Advantage plans around the nation, a move that will force some seniors to find new doctors or change plans.

The Columbus Dispatch: Medicare Insurer UnitedHealthcare Cuts Doctor Network 
UnitedHealthcare is dropping an undisclosed number of doctors from its Medicare Advantage provider network in Ohio, which will force some senior citizens to find new physicians or change plans, according to a physician-advocacy group. "This is one of the most significant (provider) network narrowings we've ever seen in the Medicare Advantage world," said Todd Baker, director of professional relations with the Ohio State Medical Association. He said physicians have been receiving termination letters from UnitedHealthcare for about six weeks (Sutherly, 10/26). 

The Newark Star-Ledger: UnitedHealthcare Drops 10-15 Percent Of Its Doctors In Medicare Advantage Plans 
UnitedHealthcare this month began terminating contracts with physicians across the nation who participate in the Medicare Advantage plans, alarming doctors who say the move will disrupt their relationships with patients and make care harder to find. A UnitedHealthcare spokeswoman said the company is dropping 10 to 15 percent of its physicians nationwide, although she declined to say how many are affected in New Jersey. Doing so will save money and improve care, spokeswoman Mary McElrath-Jones (Livio, 10/26). 

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State Watch

State Highlights: Vt. Readies Universal Health Care Launch; Fla. Adds Four Contractors To Medicaid Managed Care

A selection of health policy stories from Vermont, Maryland, Florida and Kansas.

The Associated Press: As Health Marketplaces Open, Vt. Eyes Bigger Goal
As states open insurance marketplaces amid uncertainty about whether they're a solution for health care, Vermont is eyeing a bigger goal, one that more fully embraces a government-funded model. The state has a planned 2017 launch of the nation's first universal health care system, a sort of modified Medicare-for-all that has long been a dream for many liberals (Gram, 10/26).

Health News Florida: FL Adds Medicaid Managed Care Contracts
A report from analyst firm Stifel says Florida has added four more Medicaid managed care contracts in addition to the two insurers, Centene and WellCare, that were awarded contracts in September. In October, the state gave contracts to Aetna, Amerigroup, UnitedHealth and Molina (Watts, 10/25).

Kansas Health Institute: Website Launched Giving Free Access To Wealth Of Health Data
The Health Care Foundation of Greater Kansas City has rolled out a new website designed to be a comprehensive source of health information for a six-county region in Missouri and Kansas. The website KCHealthMatters.org has about 150 data indicators, and it allows users to analyze information down to the census tract (Sherry, 10/25).

The Baltimore Sun: Group Marches For Health Care For All 
The federal Affordable Care Act is expected to provide access to medical coverage to hundreds of thousands of Maryland's uninsured, but one group said that doesn't go far enough. The group, Healthcare is a Human Right-Maryland, led a rally Saturday in Baltimore to push for single-payer coverage similar to that in countries such as Canada and Sweden, where the government runs most of the health system and there are no insurance companies (Walker, 10/26).

Minnesota Public Radio: In Rochester, Squeezed By Health Care Costs Despite The Overhaul
When insurance companies decide where to sell health plans, they look closely at what it will cost them. And in Rochester, health care is more expensive than anywhere else in Minnesota because the Mayo Clinic sets the region's prices. That's the reality facing southeast Minnesota. Despite the federal Affordable Care Act and the new MNsure health coverage marketplace, Rochester stands as the one part of the state where prices are high and options are few (Baier, 10/28).

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Editorials and Opinions

Commentary On Health Law Rollout: Coverage Is 'More Expensive, More Subsidized And More Comprehensive;' Politics Kept Congress From Setting Up Simpler Medicare-Style Insurance

The New York Times: But What if Obamacare Works?
One way to understand what is being offered is to think in terms of three "mores." Insurance à la Obamacare will be more expensive, more subsidized and more comprehensive than what was previously available on the individual market. This may not be obvious if you're struggling to log on to HealthCare.gov. But some of the state-level exchange Web sites are working well enough to enable illuminating window shopping (Ross Douthat, 10/26).

The New York Times: The Big Kludge
Why did this thing have to be so complicated in the first place? ... Imagine, now, a much simpler system in which the government just pays your major medical expenses. In this hypothetical system you wouldn’t have to shop for insurance, nor would you have to provide lots of personal details. The government would be your insurer, and you’d be covered automatically by virtue of being an American. Of course, we don’t have to imagine such a system, because it already exists. It’s called Medicare, it covers all Americans 65 and older, and it’s enormously popular. So why didn’t we just extend that system to cover everyone? The proximate answer was politics (Paul Krugman, 10/27). 

The New York Times: Roll Out The Health Care
The Democrats are depressed. The Republicans enjoy pointing out that the Obamacare rollout has been a mess. But they obviously can't pretend to be upset that people are finding it hard to sign up for a program their party wanted to kill, eviscerate and stomp into tiny pieces, which would then be fed to a tank of ravenous eels. Well, actually, they can (Gail Collins, 10/26).

Politico: Obamacare Vital Signs Not Just Numbers
Obviously, the website must be fixed soon, or the ACA will be in deep trouble. If it is not fixed, the political fallout will worsen, and one of the ACA’s gateways to coverage, the federal exchange, will remain dysfunctional. But assuming the website is repaired fairly soon, the public’s judgment about Year One will be based much more on whether people believe the coverage they get is a good deal than on early website numbers or projections made in Washington for first-year enrollment (Drew Altman, 10/27).

Bloomberg: Obamacare’s Excellent Prognosis
Obamacare is in trouble. The federal website for buying insurance is a disaster, half the states have refused to expand Medicaid, and whether the whole thing will actually save money is still uncertain. Big as these problems are, however, the project’s potential value is as great as ever, and its odds of success remain high. Bet against it at your peril (10/25).

The Washington Post: Sebelius On National Damage-Control Tour Over Obamacare Web Site
Her many friends note that it isn't as though [Health Secretary Kathleen] Sebelius herself wrote the code for HealthCare.gov or even ran the tests. But given the stakes, the unhappy history of previous government tech launches and the disconnect between her promises that everything was on track and the reality that it wasn't? Those do add up to a communications disaster with her name on it (Melinda Henneberger, 10/25).

Los Angeles Times: Trying To Knock Out Obamacare On A Technicality
The Pacific Legal Foundation, a Sacramento-based advocacy group for limited government, is seeking a do-over of sorts on the legality of the individual mandate: the law's requirement that virtually all adult Americans carry comprehensive health insurance starting in 2014. The Supreme Court tackled that question head-on in 2012, ruling that the mandate amounted to a tax that Congress had the authority to impose. On the surface, that ruling appeared to negate all the lawsuits that Obamacare opponents had filed against the mandate, including the one that the Pacific Legal Foundation had filed on behalf of Matt Sissel, an artist in Washington state who did not want to have to buy health insurance. But the foundation amended Sissel's complaint with a new angle: Instead of arguing that Congress had exceeded its authority, it contended that the law violated the constitutional requirement that revenue measures start in the House of Representatives (Jon Healey, 10/25).

Los Angeles Times: Obamacare's Next Hurdle
One of these weeks, now that the Obama administration has recruited a SWAT team of computer whizzes, Healthcare.gov will recover from its shambolic debut and turn into, well, just another website. After all, it's only a website, and websites can be fixed. But that's when a far more interesting chapter in the life of Obamacare will begin. We're about to witness a massive experiment in federalism to see whether the Affordable Care Act can succeed in two very different kinds of states: those where governments are actively working to help the law succeed, and those where they're working to make it fail (Doyle McManus, 10/27).

The Wall Street Journal: 'Cover Oregon' Doesn't Have Me Covered
Despite official statements in recent days, the problems at the federal and state health insurance exchanges are far from merely "technical." Based on my experience trying to navigate the utter confusion at the "Cover Oregon" health exchange over something as simple as determining one's income and eligibility for tax credits, I wonder if they'll ever get ObamaCare working. And I'm someone who would love to sign up for one of the plans (David Kline, 10/25). 

The Wall Street Journal: Running Away From ObamaCare
What do Sens. Mary Landrieu of Louisiana, Mark Begich of Alaska, Kay Hagan of North Carolina and Mark Pryor of Arkansas have in common, besides being Democrats up for re-election next year in states that President Obama lost in 2012? Each has come out in favor of extending ObamaCare's enrollment period or delaying the individual mandate requirement to purchase health insurance or pay a penalty. West Virginia's Joe Manchin, who is not facing re-election next year, was the first Democrat to break ranks, but others clearly see the issue as a way to distance themselves from the unpopular law (Jason L. Riley, 10/25).

The Wall Street Journal: Comparison Shopping For Knee Surgery
Here we go again. The Affordable Care Act intends to transform the health-care system, extend coverage, reduce costs and increase quality—all without asking anything of the patients. Consumers will pay with higher taxes, of course, but otherwise will face no incentives to make wise choices, compare price with performance or shop for value. Doctors, hospitals, insurers and, most of all, the government will do that for them, which is hardly reassuring. This reflects what I call the "impossibility theorem" in health care (James C. Robinson, 10/27). 

The Seattle Times: After Affordable Care Act Launch, Competence Is The New Sexy
Let us now praise competence. … While we're at it, let us demand an explanation for incompetence — and some accountability to go along with it. It is unconscionable and unbelievable that the nation where Amazon.com was born, the nation that pioneered online retailing, cannot cobble together a website to sell health-care insurance (Leonard Pitts Jr., 10/27).

The Star Tribune: Obamacare: The Good, The Bad And The GOP
I sincerely hope the exchanges are successful. But it won’t be easy. In the 1990s, the Minnesota Employees Insurance Program attempted to offer health insurance to employers with as few as two employees. MEIP lasted for four years before going broke because the pool increasingly was made up of high-cost enrollees. The current exchanges have safeguards to defend against that sort of death spiral, but they still need healthy people to sign up (Bryan Dowd, 10/27). 

The Star Tribune: Companies Hope To Cash In On Health Insurance
“You’ve probably heard of this new act where everybody needs to have health insurance by 2014 or pay a penalty and you’re wondering how, where or what, and you’re probably wondering how much is this going to cost me?” he said. I thought it was an ad for MNsure, but then Steve-O said, “your first step to finding out is caretaxcredit.com. Find out in seconds if you can get financial help with purchasing insurance.” It turns out that the pitch was another example of how companies are looking to take advantage of the confusion swirling around the debut of the Affordable Care Act (Ale Matos, 10/26).

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Viewpoints: Sen. Sanders Says Don't Cut Entitlements Before Making Corporations Pay Taxes; Rep. Smith Argues That If Entitlements Are Tamed, Other Priorities Will Suffer

Los Angeles Times: The Right Way To Make A Federal Budget
Instead of talking about cuts in Social Security, Medicare and Medicaid, we must end the absurdity of corporations not paying a nickel in federal income taxes. A 2008 report from the Government Accountability Office found that was the case with 1 in 4 large U.S. corporations. At a time when multinational corporations and the wealthy are avoiding an estimated $100 billion a year in taxes by stashing money in tax havens like the Cayman Islands, we need to make them pay taxes just as middle-class Americans do (Sen. Bernie Sanders, I-Vt., 10/28). 

Politico: Entitlement Reform To Boost Research And Development
We must set priorities and get our nation’s spending under control. To accomplish this we must reform entitlement programs. If we don’t, experts warn, future funding for other budget priorities, including scientific research, could be in jeopardy (Rep. Lamar Smith, R-Texas, 10/25).

Roll Call: Home Health Patients Must Be Protected From Medicare Cuts
As colleagues in the U.S. House dedicated to protecting the health care needs of our senior and disabled constituents, we agree that access to clinically appropriate care in the most cost effective setting is of utmost importance in properly caring for our nation’s growing Medicare population. Home health care is a vital solution to improving patient health while also decreasing costs. Home health allows patients to receive low-cost care in the safety of their homes, which reduces Medicare expenditures in more expensive institutional care settings. That’s why we believe Medicare should support and encourage the delivery of home health care (Reps. Doris Matsui and David B. McKinley, 10/25).

Reuters: The Most Dangerous Mistake You Can Make During Flu Season
Flu is a highly infectious disease that is caused by a virus. It spreads rapidly through droplets coughed or sneezed into the air by an infected person. It is common, unpleasant and potentially fatal. Flu vaccines provide effective, though not universal, protection against the flu. But despite public awareness campaigns in the United States and Europe, many people persist in the mistaken belief that antibacterial drugs — like amoxicillin and azithromycin — are the best treatment for flu. And many doctors simply surrender when patients demand them, ignoring the scientific and medical truth: when treating the flu, antibacterial drugs just don’t work (Jonathan Grant and Jirka Taylor, 10/25).

USA Today: Curbing Antibiotics On Farms Taking Too Long: Our View
Want to ensure that miracle drugs can no longer perform miracles? Then do what some physicians and industrial livestock farmers have done for years: Overprescribe antibiotics to people, and use them cavalierly in farm animals to promote growth or prevent infections before they even occur (10/27).

USA Today: Farming Is Not A Public Health Risk: Opposing View
Most large modern farms have a veterinarian intimately involved in the health care of these babies and mamas. They ensure that medicines are used appropriately to save the most lives possible. Sometimes, this means giving antibiotics to animals that look healthy, preventing a deadly outbreak of disease. To avoid being prey, animals have natural instincts that make them very slow to show illness. Therefore, at the first hint of a problem we may medicate an entire barn. I do not support antibiotics used for growth promotion. Currently, the Food and Drug Administration (FDA) is phasing out the use of medically important antibiotics for growth promotion. Antibiotics used for this purpose already represented a small percentage (less than 13%) of antibiotics used on-farm. Nevertheless, farmers and veterinarians agreed to curtail this practice (Scott Hurd, 10/27).

Bloomberg: A Prescription To End Painkiller Abuse
In proposing to strengthen the rules on prescribing opioid painkillers, the Food and Drug Administration is certainly making the right call. Tighter restrictions are needed to stem the fast-growing crisis of addiction and overdose from drugs containing the narcotic hydrocodone. ... These drugs are too big a problem, however, to be solved by this one change. ... What’s also needed is better monitoring of all prescriptions through electronic databases, so that doctors and pharmacists can tell whether a patient is looking to fill prescriptions for hydrocodone-combination drugs from more than one doctor (10/25).

Journal of the American Medical Association: Can Mobile Health Technologies Transform Health Care?
[Mobile health] technologies have the potential to change every aspect of the health care environment and to do so while delivering better outcomes and substantially lowering costs. For consumers, mHealth offers the promise of improved convenience, more active engagement in their care, and greater personalization. For clinicians, mHealth could lead to reduced demands on their time and permit them to instead refocus on the art of medicine. Much remains to be done to drive this transformation. Most critically needed is real-world clinical trial evidence to provide a roadmap for implementation that confirms its benefits to consumers, clinicians, and payers alike (Drs. Steven R. Steinhubl, Evan D. Muse and Eric J. Topol, 10/24).

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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.