Daily Health Policy Report

Tuesday, October 8, 2013

Last updated: Tue, Oct 8

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch


Public Health & Education

Health Care Marketplace

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Costliest 1 Percent Of Patients Account For 21 Percent Of U.S. Health Spending

Reporting for Kaiser Health News, in collaboration with The Washington Post, Sandra G. Boodman writes: "A 58-year-old Maryland woman breaks her ankle, develops a blood clot and, unable to find a doctor to monitor her blood-thinning drug, winds up in an emergency room 30 times in six months. A 55-year-old Mississippi man with severe hypertension and kidney disease is repeatedly hospitalized for worsening heart and kidney failure; doctors don't know that his utilities have been disconnected, leaving him without air conditioning or a refrigerator in the sweltering summer heat. A 42-year-old morbidly obese woman with severe cardiovascular problems and bipolar disorder spends more than 300 days in a Michigan hospital and nursing home because she can't afford a special bed or arrange services that would enable her to live at home" (Boodman, 10/7). Read the story.

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Insuring Your Health: Consumers Shopping For Health Policies Outside The Marketplaces May Be Confused By Mix Of Plans Offered

Kaiser Health News consumer columnist Michelle Andrews writes: "The state health insurance marketplaces that opened Oct. 1 give consumers who are looking for coverage on the individual market a whole new way to shop for health plans. At the same time, health insurance brokers and insurers will also continue to sell plans directly to customers. Sorting out who’s selling what can be confusing" (Andrews, 10/8). Read the column.

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Capsules: Report: Even States Not Expanding Medicaid Will See Surge In Spending, Enrollment; Addressing A Dangerous Epidemic: Abuse Of Painkillers And Other Prescription Drugs; Why Some Veterinarians Have a Bone To Pick With Obamacare

Now on Kaiser Health News' blog, Phil Galewitz reports on a new 50-state Medicaid budget survey: "Enrollment is expected to surge by nearly 12 percent next year in states expanding the program under the health law, but even states that will not expand eligibility project a 5 percent jump in the number of people enrolled in the state-federal health insurance program for the poor, according to a new report issued Monday" (Galewitz, 10/7).

Also on the blog, Ankita Rao reports on state efforts to curb abuse of painkillers and other prescription drugs: "About 50 Americans die every day from a prescription drug overdose — a tally that, in most states, turns out to be more than deaths from car accidents. In a new report, 'Prescription Drug Abuse: Strategies to Stop the Epidemic,' researchers at the Trust for America’s Health found that rates of overdose and addiction doubled since 1999 in most states. In West Virginia — the state with the highest number of drug overdose deaths — the rate was six times higher than fourteen years ago" (Rao, 10/7).

In addition, Galewitz also reports on an emerging issue between veterinarians and the health law: "The law's 2.3 percent medical device tax, which started this year, was meant to have device manufacturers and their buyers contribute to the cost of expanding health coverage because they would benefit from having more business from insured patients. But some devices used on humans are also used for animals, including ultrasound machines, laboratory and X-ray equipment. So as a result, veterinarians have to pay the extra tax as well" (Galewitz, 10/8). Check out what else is on the blog.

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Pennsylvania Blues Plan Offers Consumers Choice Of 'Health-Care Tiers'

The Philadelphia Inquirer's Harold Brubaker, working in partnership with Kaiser Health News, reports: "With two new HMO plans introduced last week on the federal insurance exchange, Independence Blue Cross (IBC) is offering Philadelphia-area consumers a road map to cut out-of-pocket health-care costs. The trick for consumers who sign up for Blue Cross' HMO Proactive plans is to choose hospitals, primary-care physicians, and specialists in the least expensive of IBC's three price tiers of health-care providers. IBC is the largest health insurer in the Philadelphia area, serving more than two million people" (Brubaker, 10/8). Read the story.

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Political Cartoon: 'You Can Bank On It?'

Kaiser Health News provides a fresh take on health policy developments with "You Can Bank On It?" by Nick Anderson.

Here's today's health policy haiku:


How serious are
problems with Healthcare.gov?
Depends who's talking!

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

Software Crash Viewed As Root Cause Of Exchange Delays

The New York Times reports that a major software component crashed under the pressure posed by millions of visitors last week to the federal online insurance marketplace. Still, other technical issues beyond traffic also are at work, and some insurers say they are getting faulty and incomplete data from the new U.S.-run health exchange.

The New York Times: Health Exchange Delays Tied To Software Crash In Early Rush
The technical problems that have hampered enrollment in the online health insurance exchanges resulted from the failure of a major software component, designed by private contractors, that crashed under the weight of millions of users last week, federal officials said Monday (Shear and Pear, 10/7).

The Hill: Obamacare Crash Not Just Traffic
Problems plaguing online enrollment in Obamacare are not just due to high traffic, but are being compounded by structural problems at healthcare.gov, the federal government portal where people can shop for medical insurance. The Obama administration is now scrambling to fix technical troubles that contributed to a bruising debut last week for the new insurance marketplaces (Baker and Viebeck, 10/8).

Bloomberg: Insurers Getting Faulty Data From U.S. Health Exchanges
Insurers are getting faulty and incomplete data from the new U.S.-run health exchange, which may mean some Americans won’t be covered even after they sign up for an insurance plan. While it’s not clear how widespread the problem is, the reports from industry consultants are the first hint that the technical troubles faced by consumers trying to enroll in health plans under the Affordable Care Act may also be hitting the insurers (Armstrong and Nussbaum, 10/8).

The Associated Press/Washington Post: Insurers, Others Say There's Still Time To Fix Online Glitches In 'Obamacare'
The federal government’s biggest foray into online commerce has left millions of tech-savvy Americans thoroughly bewildered. But the insurance industry and others experienced with rolling out new programs say there’s still enough time to fix the glitches with President Barack Obama’s health care law before uninsured people start getting coverage on Jan. 1 (Alonso-Zaldivar, 10/8).

Politico: Obamacare Exchange Websites Still Full Of Glitches And Errors
The second week of Obamacare enrollment started a lot like the first: with error messages. Glitches continued crippling online enrollment in new Obamacare exchanges on Monday, despite assurances by the White House that the consumer experience would markedly improve this week (Cheney and Millman, 10/7).

USA Today: Health Care Exchanges Working Out Kinks A Week Later
A week after the launch of the health insurance exchanges that are the centerpiece of the health care law, the federal and state-run sites are working out the bugs. Technical difficulties are keeping many people from enrolling or even from setting up accounts. Though consumers, including Busch, are frustrated, administration officials and state spokespeople say the sites were overwhelmed by demand, problems are being addressed, and there will be plenty of time for people to sign up once the bugs are worked out (O’Donnell and Kennedy, 10/8).

The Associated Press: Health Secretary Sebelius To Visit Florida Today Amid Obamacare Web Delays
The Obama administration promised "significant improvements" in accessing the federal health overhaul website this week, after taking down the system for maintenance over the weekend. But many in Florida were still unable to enroll at the start of week two (10/8).

CQ HealthBeat: Does Big Exchange Turnout Include The Young And Healthy
A constant thread through analysts' comments about the early interest in health insurance exchanges is that there are many more shoppers than anyone expected. Does that mean many young and healthy people are shopping? Insurance industry sources aren't embracing that theory yet. And a definitive answer probably won’t come before January, they add (Reichard, 10/7).

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California's Exchange Undergoes A Weekend Tune-Up; Maryland Officials Say Site Is Improving, But Challenges Remain

In addition, news outlets offer progress reports on state-based health exchanges in Minnesota, Washington and Michigan as well as how the federal exchange is working for other states that opted not to run their own online insurance marketplace.

Los Angeles Times: California Health Exchange Looks To Speed Up Enrollment In Week 2
After a weekend tune-up, California's health insurance exchange will try to overcome first-week glitches that frustrated many consumers trying to sign up under Obamacare. The state marketplace, called Covered California, shut down its online enrollment system Saturday night through early Monday morning for what it described as "regular maintenance" (Terhune, 10/7).

Healthy Cal: Dialing In to Health Insurance
Almost as plentiful as the options for health insurance through Covered California are the ways in which a consumer may access information and sign up for coverage. A website at CoveredCa.com is supposed to make exploring and selecting a plan easy; community clinics and other health care organizations provide in-person applications; and the state has employed thousands of assisters to offer help for those not quite comfortable with the process of acquiring health insurance. While there’s been an emphasis on the usability of Covered California’s web portal – the site had 5 million hits by 3 p.m. on the first day live – and the accessibility provided by assisters, one of the options for applying for coverage that is available to the public may be sitting on a table at home or resting in a purse or pocket. The good ol’ telephone (Fulton, 10/7).

The Associated Press/Washington Post: Online Health Marketplace Improving In Md., But Some Technical Issues Still Being Dealt With
Officials say more than 13,000 residents have created accounts on Maryland’s online marketplace for health insurance. But technical issues remain in using Maryland Health Connection, the state-based health insurance marketplace, officials said Monday (10/7).

The Wall Street Journal's Washington Wire: Maryland Says It Has 326 Enrollees In Health Exchange
That number is one of the few trickling out about enrollment in the new health-insurance exchanges created by the 2010 Affordable Care Act, or Obamacare. The federal government, which is operating exchanges on behalf of 36 states, hasn’t given enrollment numbers yet for its HealthCare.gov exchange, which, as The Wall Street Journal reported today, has been plagued by design and software problems (Landers, 10/7).

The Baltimore Sun: More Than 300 Marylanders Enroll In Health Plans In Six Days
Since it launched last week, the state's new health insurance exchange has been used by 326 Marylanders to enroll in plans, while thousands of others created accounts to start shopping, despite persistent technical problems. A new report released Monday outlining the performance of Maryland Health Connection in its first six days showed steady interest from Marylanders looking for health insurance (Walker and Cohn, 10/7).

The Wall Street Journal's Washington Wire: Minnesota Health Exchange Reports ID Problems
A Minnesota official said the state’s insurance website, MNsure, is being hampered by new troubles with the federal government’s identify verification system that’s needed to create an account to buy health insurance. April Todd-Malmlov, MNsure’s executive director, didn’t elaborate on what the exact problem was but said late Monday that it "appears to be a different issue" than one that prevented many consumers from setting up an account late last week. She said MNsure staff is currently trying to figure out the details of the new problem with the federal government but said it appears related to a system update installed over the weekend meant to fix the original glitches (Dooren, 10/7).

Pioneer Press: MNsure Health Exchange Draws Praise, Confusion
With health insurance policies she's purchased in the past, Robyn Skrebes has been frustrated with flimsy coverage that left her with unexpected out-of-pocket costs. So she felt confident Monday buying a policy for next year through the website of MNsure, the state's new health insurance exchange (Snowbeck, 10/7).

Minnesota Public Radio: MNsure's Intermittent Problems Continue For Some Users
Days after Minnesota's online insurance marketplace had a less-than trouble-free launch, MNsure officials are betting that consumers will have a smoother experience this week. But the site is not in the clear yet. Intermittent problems with account creation continue for users of the online health insurance marketplace, and weekend fixes to a key federal component of the system appeared to trigger a new set of problems. "This is having a little bit of an impact on us," MNsure executive director April Todd-Malmlov. "We are working with the federal government right now to evaluate that. This issue appears to be minor so we do anticipate that we will be able to get this fixed with them quickly (Stawicki, 10/7).

The Star Tribune: New MNsure Site Fixes Old Problems But Another Arises
Despite the latest glitch, Todd-Malmlov said the insurance website continues to draw interest. The site drew 4,300 unique visitors on Monday. Nearly 6,000 people have created MNsure accounts since the site went live last week and started offering health insurance as a state exchange under the federal Affordable Care Act, often called Obamacare. Of those, 163 accounts were created by employers, who will presumably offer health ¬≠coverage to their workers. “People are getting through,” Todd-Malmlov said. “We are very excited to see the number of accounts ¬≠increasing.” Challenges remain. American Indians are still discouraged from using the site for now because of problems interfacing with federal databases to verify their unique eligibility for certain subsidies and benefits. Plans to keep the state site open 24 hours a day have been shelved for now as well (Olson, 10/7).

The Associated Press: State Health Care Exchange Signs Up 9,452 In First Week
More than 9,400 people in Washington state have signed up for insurance for either themselves or their families in the first week of the state’s new health exchange open enrollment period, according to numbers released Monday. Numbers from the Washington Health Benefit Exchange show that 9,452 enrollments have been completed since the exchange went live Oct. 1 (La Corte, 10/8).

Detroit Free Press: Consumers Struggle To Sign Up For Health Care On Michigan Exchange
After more than a year revving up for the Oct. 1 launch of the Michigan Health Insurance Marketplace only to face error messages and other computer glitches during the first few days, field workers charged with assisting consumers are reworking plans and urging patience (Erb, 10/7).

St. Louis Beacon: Health Insurance Exchange Costs May Please Young Adults
When Alexis Young, a graduate student and part-time health researcher, began looking at her own insurance exchange options, she didn’t experience nearly as much sticker shock as she had expected…Contrary to some of the hype from critics of the Affordable Care Act (sometimes called Obamacare), expenses for these two plans suggest that young adults will have access to health care at reasonable prices (Joiner, 10/8).

The Associated Press: Nebraska Health Care Enrollment Inches Forward
Nonprofit groups were still working Monday to sign Nebraskans up for health insurance through the new federal marketplace, despite computer problems that have lasted for nearly a week. The nonprofit group Community of Nebraska reported that some residents were able to create accounts within the new federal website, healthcare.gov (Schulte, 10/7).

The Kansas City Star: Here Are The Obamacare Plans And Prices Offered To KC Area Buyers
Uninsured and insured alike want to know: What will it cost to buy health insurance on the new Health Insurance Marketplace established by the Affordable Care Act? The answers depend on individual circumstances, such as age, family and income, as well as plan choices and geographic location (Stafford, 10/8).

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HHS Sec. Sebelius: 'I Don't Know' How Many Have Enrolled

Health and Human Services Secretary Kathleen Sebelius said on The Daily Show Monday that she doesn't know how many people have enrolled in health insurance exchanges, but that "hundreds of thousands" of accounts have been created and that officials will give monthly reports on enrollment.

Fox News: HHS Secretary Sebelius: 'I Don't Know' How Many Have Signed Up For ObamaCare
Secretary of Health and Human Services Kathleen Sebelius admitted Monday night that she did not know how many people had signed up to take part in the online health insurance exchanges provided for by Obamacare, but then claimed that "hundreds of thousands" of accounts had been created. Appearing on "The Daily Show with Jon Stewart," Sebelius was asked point-blank by the host if she knew how many Americans had enrolled in the exchanges. Sebelius responded, "Fully enrolled, I can't tell you, because I don't know. We are taking applications on the web, on the phone, we'll be giving monthly reports, but I can tell you we've had not only lots of web hits, hundreds of thousands of accounts created” (10/8).

The Hill: Sebelius: 'I Don’t Know' Number Of ObamaCare Enrollees
The Obama administration's top health care official said Monday that she does not know how many people have signed up for health insurance through Obamacare. In an interview on "The Daily Show," Health and Human Services Secretary Kathleen Sebelius declined to say how many people have enrolled in health insurance through healthcare.gov (Baker, 10/7).

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Despite Sales Efforts, Polls Show Continued Obamacare Doubts

Even as states like California push the health law exchanges, bolstered by a growing list of celebrity pitchmen, surveys of some groups -- among them, physician practices and likely Virginia voters -- show continued doubts about the marketplaces.

The Washington Post: California Aggressively Pushes Health-Care Law
Fliers and tablet computers in hand, a small team of outreach workers from a local nonprofit health clinic blanketed a shopping strip east of Los Angeles, spreading the word about the state’s expanding health insurance landscape under Obamacare. Stopping passersby on the sidewalk as they ducked in and out of the row of discount stores and easy-credit furniture shops at the Valley Mall, the workers assured them that the changes would put health insurance within the reach of more Californians. The mostly Latino shoppers seemed intrigued, but they also were skeptical. They worried about the penalties imposed on those without insurance. They worried about the cost of policies. And they did not know where and how to sign up (Fletcher, 10/7).

ABC News: More Celebrities Stage Star-Studded Effort to Sell Obamacare
In the week since the launch of the law's state health insurance exchanges, a steady stream of celebrity advocates (think Lady Gaga, Connie Britton, Olivia Wilde, Taye Diggs, Kate Bosworth, Sarah Silverman and Justin Long) have taken to social media platforms like Twitter and Instagram to encourage Americans to #GetCovered (to use their preferred hashtag) (Konstantinides, 10/8).

Politico: Politico Poll: Virginians Not Pleased With ACA Rollout
Forty percent of likely Virginia voters rate the implementation of the health law as "poor" and another 18 percent describe it as just "fair," according to a new POLITICO poll, conducted this weekend by the Democratic firm Public Policy Polling and the Republican firm Harper Polling using automated survey methodology. Twenty-five percent of those surveyed say the rollout has been "good." The findings suggest the technical problems with the health law rollout have permeated public consciousness in the state, which is relying on the federal exchange’s infrastructure. Just 11 percent rate implementation as "excellent." The partisan split over the health law was as sharp as ever, with 89 percent of Republicans polled calling Obamacare implementation "poor" or "fair" and 81 percent of Democrats calling it "excellent" or "good" (Cheney, 10/7).

Medpage Today: Docs Skeptical Of ACA Exchanges, Survey Shows
A majority of physician practices (55.5 percent) hold an "unfavorable" or "very unfavorable" view of the impact the Affordable Care Act's (ACA) health insurance exchanges will have on them, a survey of more than 1,000 group practices showed. Almost as many (40.2 percent) said they were still evaluating their options or planning not to participate with insurance products sold on the exchanges, according to a survey that the Medical Group Management Association (MGMA) released Monday at its annual meeting (Pittman, 10/7).

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Report: Even States Opting Out Of Medicaid Expansion Will See Enrollees, Costs Rise

Media outlets reported on a Kaiser Family Foundation study that projected a 5 percent jump next year in the number of people enrolled in the state-federal insurance program for the poor, even in states that will not expand eligibility. Meanwhile, PBS NewsHour examines the impact on the uninsured of state decisions not to participate in the health law's Medicaid expansion.

Kaiser Health News: Capsules: Report: Even States Not Expanding Medicaid Will See Surge In Spending, Enrollment
Enrollment is expected to surge by nearly 12 percent next year in states expanding the program under the health law, but even states that will not expand eligibility project a 5 percent jump in the number of people enrolled in the state-federal health insurance program for the poor, according to a new report issued Monday (Galewitz, 10/7).

CQ HealthBeat: Minor Medicaid Enrollment Growth Precedes Big Increase In 2014
The growth in Medicaid enrollment slowed to 2.5 percent in fiscal 2013, the lowest rate of growth in six years, just before enrollment is expected to swell, according to a new report by the nonpartisan Kaiser Family Foundation. Enrollment growth in 2014 is expected to balloon by 8.8 percent on average, said the report, which was prepared with the help of Health Management Associates (Adams, 10/7).

PBS NewsHour: States Taking Medicaid Opt-Out Option Leave 'Larger Impact Than Expected'
As the effects of the shutdown take hold, longer-term fights over safety net programs continue. Jeffrey Brown talks to Jacob Hacker of Yale University and Stephen Parenti of the University of Minnesota about how states opting out of the Affordable Care Act's Medicaid expansion have stranded some uninsured Americans (Brown, 10/7).

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Veterinarians Complain About One Impact Of The Health Law While Seniors Look Forward To Lower Drug Spending

The vets say a new tax aimed at helping pay for changes from the health overhaul is hurting them, according to KHN. Meanwhile, Healthy Cal looks at closing of the prescription drug coverage gap. CNN also explores the arguments over the law's effect on overall health spending.

Kaiser Health News: Capsules: Why Some Veterinarians Have a Bone To Pick With Obamacare
The law's 2.3 percent medical device tax, which started this year, was meant to have device manufacturers and their buyers contribute to the cost of expanding health coverage because they would benefit from having more business from insured patients. But some devices used on humans are also used for animals, including ultrasound machines, laboratory and X-ray equipment. So as a result, veterinarians have to pay the extra tax as well (Galewitz, 10/8).

CNN: Is Obamacare Slowing Health Care Spending?
Myth: Obamacare has slowed health care spending growth. Reality: President Obama likes to stress that health care spending has fallen to record lows in recent years thanks in part to Obamacare. It's true that after years of skyrocketing increases, America's health care spending growth has slowed to record lows. The Office of the Actuary in the Centers for Medicare and Medicaid Services reported earlier this year that national health spending grew by 3.9% each year from 2009 to 2011, the lowest rate of growth since the federal government began keeping such statistics in 1960, according to the Kaiser Family Foundation. But is Obamacare the reason? (Luhby, 10/7). 

Healthy Cal: Alzheimer's Advocates Look To ACA For Better Coverage
Ruth Gay, the director of public policy and advocacy for the Northern California Alzheimer's Association, said her agency has been watching closely as the Affordable Care Act progresses. Benefits for the elderly so far include better prescription care coverage, which started this year. ... "For a lot of seniors that doughnut hole is a big piece we were interested in – many of them were hitting it very early on," Gay said. The doughnut hole Gay is referring to is a gap in prescription coverage under Medicare Plan D. In 2013, patients on Medicare Plan D can accrue up to $2,970 in out-of-pocket and insurance payments before they go into the "doughnut hole." The ACA is slowly eliminating the doughnut hole (Anderson, 10/7).

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Capitol Hill Watch

Senate Democrats Ponder 'Clean' Debt Limit Bill; GOP Holds Obamacare Ground

Democratic leaders in the Senate are mulling passing a "clean" bill -- one with no other policy changes -- that would increase the nation's debt limit. House Republican leadership continues to refuse any proposal that doesn't strike some parts of the new health law. In the meantime, talk about the government shutdown sometimes ignores the health law's role in it.

The New York Times: Senate Leaders Mull Raising Debt Ceiling In Challenge To House
Senate Democratic leaders will move forward this week on a measure to raise the government's legal borrowing limit without any policy strings attached, answering House Republicans' taunts that Democrats would not force their politically vulnerable senators to cast that difficult vote. … Mr. Boehner told the ABC News program "This Week" that the House could not pass federal financing for the fiscal year that began last Tuesday without measures limiting Mr. Obama's health insurance law, the Affordable Care Act. House Democrats and some moderate Republicans say that a bipartisan majority does exist, but that Mr. Boehner refuses to defy Tea Party conservatives and hold a vote on the Senate-passed measure (Weisman and Calmes, 10/7).

Politico: Is Obamacare Still The Point?
Suddenly, even as everyone in Washington focuses on the government shutdown and debt ceiling standoff, fewer than ever want to talk about the issue that launched those fights in the first place: Obamacare. President Barack Obama and his aides are painting GOP leaders as hostage takers and suicide bombers over their shutdown and debt ceiling strategy. House Republicans are pushing the idea that Obama and Democrats are intransigents who refuse to engage in civil discourse on a solution. Senate Democrats are hammering Speaker Boehner with the president's call for a House vote on a clean funding bill. And everyone wants to talk about how shutdown pain is hitting home for ordinary Americans (Epstein, 10/7).

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Cost Issues: Expensive Patients; Payoff From Delaying Aging; Approving New Treatments

Cost and quality issues in the news include research about the costliest U.S. patients, the potential that delaying aging instead of treating disease could have on extending life, and examining how the U.S. compares to other countries on approving new medical treatments.

Kaiser Health News: Costliest 1 Percent Of Patients Account For 21 Percent Of U.S. Health Spending
A 58-year-old Maryland woman breaks her ankle, develops a blood clot and, unable to find a doctor to monitor her blood-thinning drug, winds up in an emergency room 30 times in six months. ... These patients are among the 1 percent whose ranks no one wants to join: the costly cohort battling multiple chronic illnesses who consumed 21 percent of the nearly $1.3 trillion Americans spent on health care in 2010, at a cost of nearly $88,000 per person. Five percent of patients accounted for 50 percent of all health-care expenditures (Boodman, 10/7).

NPR: Delaying Aging May Have A Bigger Payoff Than Fighting Disease
Curing cancer and eliminating heart disease has been the holy grail of medical research. But there could be even greater benefits if aging itself could be delayed, a study finds. This is not quite as farfetched as it sounds. While the anti-aging "cures" being marketed these days are largely snake oil, in the laboratory scientists have managed to extend the lives of laboratory animals. And they have a better understanding of the mechanisms of biological aging (Jaffe, 10/7).

Reuters: Americans: Don’t Weigh Costs Of New Treatments
Most Americans don't want the government to decide if medical treatments are economical before letting patients use them, a new survey suggests. In some places, such as the UK and Germany, governments do have that power. Before patients can use a new drug, for instance, the government studies how well it works. It also sees what the drug costs compared to other drugs before deciding to make it available (Pittman, 10/7).

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Public Health & Education

Report: States Lax In Taking Steps To Curb Prescription Drug Abuse

The number of deaths attributed to the abuse of painkillers and other prescription drugs has risen sharply in recent years.    

Kaiser Health News: Capsules: Addressing A Dangerous Epidemic: Abuse Of Painkillers And Other Prescription Drugs
About 50 Americans die every day from a prescription drug overdose — a tally that, in most states, turns out to be more than deaths from car accidents. In a new report, 'Prescription Drug Abuse: Strategies to Stop the Epidemic,' researchers at the Trust for America’s Health found that rates of overdose and addiction doubled since 1999 in most states. In West Virginia — the state with the highest number of drug overdose deaths — the rate was six times higher than fourteen years ago (Rao, 10/7).

McClatchy: Report: States Lack Strategies To Curb Prescription Drug Overdoses
Prescription-drug overdose deaths have risen sharply in recent years, and a majority of states are not implementing the best strategies to curb them, according to a new report from a health-care advocacy group. The report from the Washington-based Trust for America’s Health, which was released Monday, found that 28 states – including Alaska, Pennsylvania and Texas – and the District of Columbia had put in place six or fewer out of 10 promising strategies to lessen prescription drug overuse (Helblig, 10/7).

Medpage Today: Rx Drug Abuse Up, States Lax In Curbing It
Most states are doing little to help curb prescription drug abuse even as the number of prescription drug overdose deaths has doubled in 29 states since 1999, according to a report released Monday. A total of 28 states and the District of Columbia met six or fewer indicators showing they had implemented strategies to prevent prescription drug abuse, the report from the Trust for America's Health said. Meanwhile, prescription drug overdose deaths have tripled in 10 states and quadrupled in four states since 1999; nationally, prescription drug-related deaths now outnumber those from heroin and cocaine combined (Pittman, 10/7).

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Health Care Marketplace

Supreme Court Justices Seek Administration Views In Medical Device Case

Reuters: Justices Seek Obama Administration Views In Medical Device Case
The Supreme Court on Monday sought the legal views of the Obama administration in a medical device manufacturer's appeal of a ruling that the company can be sued by a man who was left paralyzed after using one of its products (Hurley, 10/7).

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State Watch

State Highlights: Mass. Law Shines Light On Health Care Prices

A selection of health policy stories from California, Massachusetts, Connecticut and North Carolina.

WBUR: New Era In Mass.: Price Tags For Health Care
"How much will my MRI cost?" It sounds like a simple question. But before Oct. 1, it was very difficult to get an answer. Now, Massachusetts is pulling back the curtain on what has been a largely secret world of health care prices. A new state law says health insurers must be able to tell members, in advance, how much a test, treatment or surgery will cost. The idea is to help patients become health care shoppers — especially patients who have to pay a lot out of pocket before their insurance kicks in (Bebinger, 10/8).

The Associated Press: Health Care Delivery Now A Focus
While Connecticut embraced setting up a health insurance exchange and expanding Medicaid eligibility faster than many other places, the state has lagged behind when it comes to modernizing how health care is delivered to patients. But with the new health care overhaul law and a growing push in the state to cut costs while improving patient care, Connecticut is now moving toward a streamlined and better-coordinated, patient-centered system of medical treatment (Haigh, 10/7).

The New York Times: Jesuit Campus To End Coverage For Elective Abortions
The trustees of Loyola Marymount University, a Jesuit university in Los Angeles, voted Monday to eliminate coverage for elective abortions from the health care plans offered to faculty and staff members in 2014 (Lovett, 10/7).

North Carolina Health News: McCrory Administration Officials Suppressed Insight Into Medicaid
For months, members of the McCrory administration have maintained that the state's Medicaid program is "broken." But in the first of a two-part investigation, North Carolina Health News shows McCrory officials sat on information that would have depicted the state’s much-lauded Medicaid program in a better light (Hoban, 10/8).

California Healthline: Governor Agrees To Finish State Makeover Of Long-Term Care Ombudsman's Office
On Thursday, Gov. Jerry Brown (D) signed into law legislation (SB 609) to strengthen the enforcement power of the Office of the State Long-Term Care Ombudsman. It's the second bill in two years to change the ombudsman program, both of them authored by Sen. Lois Wolk (D-Davis). SB 609 will hike penalties for any long-term care providers who interfere with investigations by the ombudsman's office (Gorn, 10/7).

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Editorials and Opinions

Viewpoints: Whether Americans Will Like Health Law Is Open Question; GOP Has 'Nothing To Show' For Shutdown; Sebelius Says Demand Derailed Marketplace's Debut

The New York Times: Nazis, Lynching And Obamacare
How absolutely bonkers. And yet how unsurprising. We're awash these days in metaphors as overworked as our political debate is overwrought, and it's impossible not to wonder how much one contributes to the other. When nuance and perspective exit the language, do they exit the conversation as well? When you speak in ludicrous extremes, do you think that way, too? Obamacare has proved to be not just ideologically divisive but linguistically fertile. There's seemingly no event or passage in American history to which it can't be compared (Frank Bruni, 10/7).

Los Angeles Times: Obamacare's Next Round
Many conservatives and liberals talk about the entitlement ratchet as if it's an iron law of the universe. But there's precedent for bad ideas — even entitlements — being modified or undone. In the 1990s, for example, Washington reformed welfare. In the 1980s, Congress dropped catastrophic health insurance like a hot rock. And we shouldn't assume that a majority of Americans will like Obamacare once they get to know it. Its list of unintended consequences is already long and still growing (just ask the administration officials listening to complaints from organized labor). If the program lives down to the promise of its website — already arguably the biggest IT disaster in American history — then you can be sure it won't be popular (Jonah Goldberg, 10/8).

Los Angeles Times: In Shutdown War, Democrats May Be Losing The PR Battle
Republicans continued to criticize President Obama and Senate Democrats on Monday for refusing to negotiate over the partial government shutdown that the House GOP instigated last week. And so far, Senate Majority Leader Harry Reid (D-Nev.) has also refused to entertain any of the rifle-shot continuing resolutions that Republicans have pushed through the House, which would have reopened such popular programs as the Federal Emergency Management Agency and the National Institutes of Health. The question is, how long can Democrats ignore the GOP's calls for deal-cutting before the public stops blaming Republicans for picking the fight and starts blaming Democrats for prolonging it? (Jon Healey, 10/7).

The Washington Post: Obamacare Is Here. Get Used To It.
While Republicans were throwing their silly tantrum, Obamacare became a fact. There is no turning back. The point of no return was reached when millions of people crashed the Web sites of the new Affordable Care Act exchanges while trying to buy health insurance. Republicans can fight rear-guard battles if they want, but last Tuesday they lost the war. All they can do at this point is harm the nation — and their political prospects (Eugene Robinson, 10/7).

The Washington Post: A Face-Saving Plan To End The Obamacare Shutdown Statement
Even the president has acknowledged that there are bound to be glitches in implementing an initiative as large and complicated as Obamacare. So why not agree now to a thorough review of the program once we have some experience with it? The process could begin after two years with a rigorous evaluation by a respected group of independent experts such as the Institute of Medicine. By the end of 2015, the institute could forward its findings to a special joint committee of Congress, reflecting the partisan makeup of the new Congress. The panel would have the authority to propose any legislative changes it deems necessary, including outright repeal, within 90 days of receiving the advisory group’s report. The committee’s proposal would be filed with both houses of Congress, which under an expedited procedure could either accept or reject it without amendment. If approved by both House and Senate, the legislation would go to President Obama for his signature or veto (Steven Pearlstein, 10/7).

The Washington Post: The House GOP Has Nothing To Show For Its Government Shutdown
Derail the hated Obamacare? ... That was the GOP's ostensible purpose for this travesty of misgovernment, but the online insurance markets created by that law opened on schedule last week and continue to operate. In fact, the Republicans managed only to distract attention from the computer glitches that would have gobbled up all the news attention if the government weren't shut. In a revealing moment Sunday on ABC's "This Week," host George Stephanopoulos replayed a clip from last year in which House Speaker John A. Boehner (R-Ohio) explained the foolishness of the tactic that he is now, a year later, pursuing (10/7). 

Politico: Fact Checkers Can Help Keep ACA Debate Honest
Although the federal government is currently shut down as a result of Republican efforts to defund the Affordable Care Act, many important debates over health policy going forward will take place at the state level. Unfortunately, continuing public confusion over the law is likely to be exploited by opportunistic politicians if they aren't fact-checked aggressively by the press (Brendan Nyhan and Jason Reifler, 10/7).

Bloomberg: Boehner's Mess and Democrats' Obligations
At this point, arguing over whether this situation is of Boehner’s own making is counterproductive. The priority now is getting out of it. Obama cannot afford to allow the debt ceiling to be ransomed as he did in 2011, and his desire to appease an opponent in free fall is unlikely to be acute. Nonetheless, there are modest concessions -- rhetorical and real, such as agreeing to rescind the $3 billion a year tax on medical devices that was part of the health-care law -- that he can offer. Boehner should then promptly bring legislation to the House floor to fund the government and lift the debt ceiling to cover spending already authorized by Congress (10/7).

The San Francisco Chronicle: Obama Sold Voters Bill Of Goods On Health Care
Now that the Affordable Care Act exchanges are open for business, voters are finding that the biggest problem with Obamacare isn't that some Web sites crashed last week but that the Obama promise of big savings for the average family was too good to be true. Now that the exchanges are open for business, people who already have individual coverage have something new to not like: sticker shock. The Affordable Care Act isn't affordable after all (Debra J. Saunders, 10/7). 

USA Today: Kathleen Sebelius: HealthCare.Gov Simple, User- Friendly
When the Health Insurance Marketplace opened last week, demand was so high, it exceeded even optimists' expectations. On the first day alone, HealthCare.gov had nearly eight times more concurrent users than Medicare's site (one of the federal government's most highly trafficked) during open enrollment peak levels (Kathleen Sebelius, 10/7).

USA Today: Exchange Launch Turns Into Inexcusable Mess: Our View
Over the first four days the new online health insurance exchanges were open last week, more than 8 million people visited them, according to the Obama administration. At the very least, this casts doubt on the Republican claim that Americans hate Obamacare and want it repealed. It seems millions of people desperately want the coverage the law will allow them to get, regardless of their medical histories. Alas, the administration managed to turn the experience for most of those visitors into a nightmare. Websites crashed, refused to load, or offered bizarre and incomprehensible choices. Even though the system was shut down for repairs over the weekend, Monday's early reports continued to suggest an epic screw-up. Why have things gone so wrong? (10/7).

The Kansas City Star: Maybe Obamacare Exchanges Are Asking Too Many Questions
News accounts about the problems with the federal health care exchange are saying that people who manage to get into the site at all are getting hung up at the point where they are asked to provide information and register. But state-designed exchanges, which are working much better, allow consumers to browse among the sites without providing information (Barbara Shelly, 10/7). 

The Milwaukee Journal Sentinel: Obamacare: Not Quite Open For Business
A week on, the exchanges are working a little better, but still don't work nearly well enough. The government planned to take healthcare.gov offline again to do more work on the site after a crush of visitors overwhelmed its servers since the federal site was launched a week ago. The government said about 8.6 million people had tried to log in during the first four days the site was open. Democrats, who conceived and saw that Obamacare became law, would have you believe that these problems are good news. The traffic illustrates the vast interest in the program, they say. And yes, there is broad interest in Obamacare; millions of Americans don't have insurance. But the problem with the online marketplaces may be more complicated than unexpected demand (which should have been expected) (10/7).

And on other topics --

Los Angeles Times: '60 Minutes' Shameful Attack On The Disabled
Is it possible for a major news organization to produce a story about the Social Security disability program without interviewing a single disabled person or disability advocate? That's the experiment "60 Minutes" conducted Sunday. The result was predictably ghastly. The news program's theme was that disability recipients are ripping off the taxpayer. Anchor Steve Kroft called the program "a secret welfare system ... ravaged by waste and fraud." His chief source was Sen. Tom Coburn, an Oklahoma Republican with a documented hostility to Social Security. Coburn has a report on the disability program's purported flaws due out Monday. Good of "60 Minutes" to give him some free publicity (Michael Hiltzik, 10/7).

Bloomberg: Are Hospitals More Efficient Than They Seem?
Hospitals have been criticized, including by me, as wildly inefficient. Yet two new pieces of evidence suggest that the hospital market may be more efficient than conventional wisdom suggests. Hospitals practice medicine in drastically different ways, and the higher-spending ones don't seem to generate any better results than those that spend less. Because of third-party insurance and other distortions, though, the market doesn't punish the inefficient hospitals. That has been the traditional critique (Peter Orszag, 10/7).

The Seattle Times: Washington Must Treat The Mentally Ill
A compelling fiscal and moral case can be made that the chronic neglect of Washington's mental-health system has reached "epidemic" proportions. That word leaps out of recent stories by Seattle Times reporter Brian M. Rosenthal about the inhumane "boarding" of psychiatric patients in hospital emergency rooms (10/7).

JAMA: Using Detection Of Postsurgical Blood Clots As A Quality Measure May Be Misguided
Sometimes good intentions have unintended consequences. Take, for example, using rates of blood clots ... after surgery as a quality measure, with higher rates theoretically pointing to suboptimal preventive measures (Mike Mitka, 10/7).

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Stephanie Stapleton

Andrew Villegas

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Shefali Luthra

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