Daily Health Policy Report

Wednesday, October 9, 2013

Last updated: Wed, Oct 9

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

FAQ: Dental And Vision Care Part Of 'Essential Benefits' For Kids

Kaiser Health News staff writer Marissa Evans reports: "One part of the Affordable Care Act is intended to improve dental coverage for children, an extension of effort by public health advocates that followed the 2007 death of a Maryland boy named Deamonte Driver, who was killed by a bacterial infection that spread from an abscessed tooth to his brain" (Evans, 10/9). Read the story.

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Problems Continue For Some Users On Minnesota's Health Insurance Exchange

Minnesota Public Radio's Elizabeth Stawicki, working in partnership with Kaiser Health News and NPR, reports: "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" (Stawicki, 10/8). Read the story.

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Capsules: N.Y. Exchange Says 40,000 Have Applied For Coverage; 28K Sign Up For Health Coverage Through California's Exchange; Navigating The Marketplaces: Reader Questions Answered

Now on Kaiser Health News' blog, Phil Galewitz reports on the latest numbers from New York’s health exchange: "New York's online insurance exchange on Tuesday said more than 40,000 people have completed applications for coverage so far, though not all have chosen a health plan. Officials from the exchange, called NY State of Health, said these applicants were found eligible to buy a health plan" (Galewitz, 10/9).

In addition, Anna Gorman checks in on applications for health coverage on the California exchange: "More than 16,000 applications on behalf of 28,700 people have been completed through the state’s insurance marketplace, Covered California, officials announced Tuesday. Executive Director Peter Lee said 16,311 applications, some representing several family members, were completed between Oct. 1 and Oct. 5 and another 27,305 are in process. Lee did not specify how many of the applicants would receive coverage through the state-based exchange or how many qualified for Medi-Cal, the state's Medicaid program" (Gorman, 10/8).

Also on Capsules, Julie Appleby joined yesterday with the Washington Post's Sarah Kliff and Consumers' Checkbook's Robert Krughoff in an online chat to answer readers' questions about enrollment in the health law's new insurance marketplaces. Read the transcript and check out what else is on the blog.

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Political Cartoon: 'What's My Line?'

Kaiser Health News provides a fresh take on health policy developments with "What's My Line?" by RJ Matson.

Here's today's health policy haiku:


Time to reassess
why consumers must log in
to see plan pricing?

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

Shoppers On Fed's Insurance Website Still Face Problems

News outlets report on the glitches still plaguing the website, healthcare.gov., in its second week of operation. White House officials say fixes are being made, although they have been unable to say how many consumers have enrolled in plans through the website.

The Washington Post: Many Remain Locked Out Of Federal Health-Care Web Site
Major insurers, state health-care officials and Democratic allies repeatedly warned the Obama administration in recent months that the new federal health-insurance exchange had significant problems, according to people familiar with the conversations. Despite those warnings and intense criticism from Republicans, the White House proceeded with an Oct. 1 launch (Eilperin, Goldstein and Somashekhar, 10/8).

The Associated Press/Washington Post: Inability To Browse Health Plans Without First Creating Accounts Seen As Adding To Online Woes
A decision by the Obama administration to require that consumers create online accounts before they can browse health overhaul insurance plans appears to have led to many of the glitches that have frustrated customers, independent experts say. Most e-commerce websites — as well as medicare.gov — are not designed to require those merely browsing to set up accounts. But it’s one of the first steps on healthcare.gov (10/8).

Politico: Once You Get Into ACA Website, It's Hard To Get Out
Once you finally make it into HealthCare.gov, it’s not clear how you get out. For those who’ve busted through glitches on the federal Obamacare insurance website to create an account, there’s no clear, obvious way for consumers to delete the accounts if they choose — at least not in the current incarnation (Millman and Cheney, 10/9).

Politico: With Obamacare Still Suffering Tech Issues, White House Hopes For Turnaround
A senior Obama administration official said Tuesday that several days of "hardware and software fixes" have put a turnaround in sight for Obamacare’s new enrollment system. But he gave no timeline for when users should expect a glitch-free experience on the HealthCare.gov website, which has been limping into its second week of technical failures (Norman, 10/9).

Health News Florida: ‘Working Around The Clock’
Health and Human Services Secretary Kathleen Sebelius, who swooped into Tampa for a 90-minute visit on Tuesday, said "today is better than yesterday" for the still-balky Health Insurance Marketplace. Each day the online enrollment site, Healthcare.gov, will work better than the day before, she said (Gentry, 10/9).

Richmond Times Dispatch: Data On Early Health Plan Enrollments Elusive
A week after the launch of the federal Affordable Care Act marketplaces, it’s still not clear how many Virginians have been able to successfully enroll in a health plan. A spokesman for Anthem Blue Cross Blue Shield said the company has begun to receive federal confirmation of people enrolled in its HealthKeepers plans offered through the Virginia marketplace. But one of the key organizations employing workers to help people enroll in plans didn’t have any hard numbers (Smith, 10/9).

CQ HealthBeat: Insurers Keep Lips Zipped Amid Mounting Exchange Woes
Despite the myriad reports of malfunctions during the first week of enrollment in the health law exchanges, insurance industry executives — publicly at least — are keeping calm, carrying on, and shying away from criticizing the Obama administration (Reichard, 10/8).

CQ HealthBeat: Faltering Start To Health Exchanges Brings Louder Calls For Law's Delay
Consumers continue to have difficulty enrolling in the health care law’s federally administered insurance exchanges, as Republicans pressure the administration for hard figures and call for delaying part of the law. One week after the exchanges’ Oct. 1 opening, administration officials say the consumer experience is improving and wait times have been reduced (Ethridge, 10/8).

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State Health Exchanges Running More Smoothly Than Federal Marketplace

The New York Times reports that, while difficulties continue for consumers in the 30 states that are using the federal government's online health insurance marketplace, those who live in states that have chosen to operate their own are faring better. Other media outlets offer sign up tallies and other updates from New York, California, Connecticut, Oregon, Minnesota and Wisconsin.   

The New York Times: Uninsured Find More Success Via Health Exchanges Run By States
The experience described by Ms. Skrebes is in stark contrast to reports of widespread technical problems that have hampered enrollment in the online health insurance marketplace run by the federal government since it opened on Oct. 1. While many people have been frustrated in their efforts to obtain coverage through the federal exchange, which is used by more than 30 states, consumers have had more success signing up for health insurance through many of the state-run exchanges, federal and state officials and outside experts say (Pear and Goodnough, 10/8).

Kaiser Health News: Capsules: N.Y. Exchange Says 40,000 Have Applied For Coverage
New York's online insurance exchange on Tuesday said more than 40,000 people have completed applications for coverage so far, though not all have chosen a health plan. Officials from the exchange, called NY State of Health, said these applicants were found eligible to buy a health plan (Galewitz, 10/9).

The Associated Press/Wall Street Journal: NY Reports 40,000 Enroll For Health Insurance
State officials say 40,000 New Yorkers have signed up for health insurance in the first week of operation for the new state-run marketplace that includes low-cost plans. The NY State of Health says its website has quadrupled capacity since opening enrollment Oct. 1, resolving the issues that initially kept many consumers from advancing past the home page, and says it is running smoothly (10/9).

Kaiser Health News: Capsules: 28K Sign Up For Health Coverage Through California's Exchange
More than 16,000 applications on behalf of 28,700 people have been completed through the state’s insurance marketplace, Covered California, officials announced Tuesday. Executive Director Peter Lee said 16,311 applications, some representing several family members, were completed between Oct. 1 and Oct. 5 and another 27,305 are in process. Lee did not specify how many of the applicants would receive coverage through the state-based exchange or how many qualified for Medi-Cal, the state's Medicaid program (Gorman, 10/8).

Los Angeles Times: California Health Insurance Enrollment Site Touts Robust Activity
Seeking to rebut mounting criticism over the rollout of Obamacare nationwide, California's insurance exchange boasted that nearly 29,000 people applied for coverage last week under the federal healthcare law. Covered California, the state's new marketplace, said it released the data earlier than planned to counter "misinformation" and reports about widespread glitches preventing people from signing up. Peter Lee, the exchange's executive director, defended the law and cited the personal stories of Californians who had successfully sought coverage (Terhune, 10/8).

Bloomberg: California Obamacare Sign-Ups Exceed 28,000 In First Week
California said 28,699 people were signed up in the state’s health-insurance exchange in the first week, while New York had more than 40,000 sign up. The numbers for California, the largest U.S. state by population, were for the Oct. 1 to Oct. 5 period and exceeded expectations, Peter V. Lee, executive director of Covered California, said at a news conference today in Sacramento. New York, the third most-populous state, said in a statement that its pace of sign-ups shows the exchange is “working smoothly” (Vekshin, 10/8).

The Sacramento Bee: California Insurance Exchange Reports 16K Finalized Applications
The head of California's health insurance marketplace announced Tuesday that 16,311 households completed applications in the first week of enrollment. Covered California Executive Director Peter V. Lee said the response Oct. 1-5 underscores the demand for health insurance in the state. Some 27,305 households have partially completed applications. In addition, more than 430 small businesses have signed up. Actual enrollment figures will not become available until customers start paying for and then receiving insurance benefits come Jan. 1 (Cadelago, 10/8).

San Jose Mercury News: California Health Insurance Exchange Reports Nearly 1 Million Visitors In First Week; 16,311 Households Sign Up
Almost one week after opening the state's health insurance exchange, officials with Covered California on Tuesday called the response "nothing short of phenomenal.'' At a morning news conference in Sacramento, Covered California Executive Director Peter Lee reported that 16,311 households had completed applications for health insurance, while 27,305 others had established accounts and partially completed their applications. "We started strong the first week,'' Lee said. "The response of consumers has underscored the demand” (Seipel, 10/8).

The Associated Press: Health Marketplace Draws Younger Conn. Residents
Nearly one-third of enrollees in Connecticut's health insurance marketplace are between 18 and 34 years old, early data show. The numbers represent "a very good start," said Kevin Counihan, CEO of the marketplace, called Access Health CT (10/8).

The CT Mirror: Nearly A Third Of Initial Access Health Applicants Are Under 35, CEO Says
Nearly a third of the initial applicants to Access Health CT, the state’s new health insurance marketplace, are under 35, CEO Kevin Counihan said Tuesday. And of all the applicants, most have selected the so-called silver or gold plans, which have higher premiums and cover a larger share of medical costs than the lower-cost bronze plan options (Becker, 10/8).

The Oregonian: Oregon’s Health Insurance Exchange Still Can’t Enroll, Check Tax Credits; Browsers Welcome
Oregon's new health exchange, Cover Oregon, remains unable to enroll people for health insurance even with agents and application assisters that were given early access to the site. Most people, those with insurance through an employer or Medicare, won't be affected by the delays to the website. But for those who buy their own policies on the individual market and who hope to qualify for new tax credits to reduce premiums, the website wasn't able to help them as open enrollment began last week. The exchanges are the focal point of the 2010 Patient Protection and Affordable Care Act (Budnick, 10/7).

Kaiser Health News: Problems Continue For Some Users On Minnesota's Health Insurance Exchange
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 (Stawicki, 10/8).

Minnesota Public Radio: MNsure Account Verification Problems To Be Fixed, Officials Say
A technical problem that has prevented many Minnesotans from enrolling in the state's new health insurance marketplace should be resolved tonight, MNsure officials said Tuesday. The problem had to do with a connection with a federal database used to identify whether site users are who they say they are. For the last few days, it has prevented people from creating an account and enrolling in an insurance plan. MNsure has been working with the federal government to find a solution. Executive Director April Todd-Malmlov said she hopes the latest fix will solve the identity verification problems once and for all (Richert, 10/8).

In other news, here are two reports about the push to sign people up and raise public awareness -

The Milwaukee Journal Sentinel: People Signed Up For Obamacare At Milwaukee Health Department: Zero
As of noon Tuesday, Arise Health Plan had sold nine health plans on the new marketplace in Wisconsin set up under the Affordable Care Act. This was a full week after the launch of the marketplace — and the problems that have rendered the marketplaces in Wisconsin and other states largely inoperable in their first week still have not been fully worked out. Arise, a subsidiary of WPS Insurance Corp. in Madison, though, was beginning to see an increase in sales Tuesday, said Ellen Foley, a company spokeswoman (Boulton, 10/8).

Los Angeles Times: L.A. County Officials Vote To Create Obamacare Marketing Plan
Because of the vast number of uninsured people living in Los Angeles County, it is going to be one of the primary places in the nation to measure the effectiveness of Obamacare. On Tuesday, county leaders voted to create a marketing plan to inform residents of their options under the Affordable Care Act (Mehta, 10/8).

Meanwhile, the Columbus Dispatch reports on movement regarding the state's Medicaid expansion circumstances -

Columbus Dispatch: Kasich Medicaid-Expansion Plan Puts Heat On GOP Legislators
If Gov. John Kasich moves ahead with Medicaid expansion via an executive order, legislators could be pressed to approve the funding or face bankrupting the massive health-care system in Ohio. Speculation is rampant that on Oct. 21, Kasich will ask the seven-member legislative-spending oversight panel to give him the authority to spend federal money to cover an estimated 275,000 low-income Ohioans under Medicaid (Siegel, 10/8).

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How Obamacare Affects Children, Prisoners

Media reports explore how the health law requires that dental and vision care benefits for children be included in policies sold through new online insurance marketplaces and how the law may shift prisoners' health care costs from local jurisdictions to the federal government. Other outlets track congressional oversight of the IRS' role in enforcing the law's requirement that most people carry insurance.

Reuters: Congressional Panel To Review U.S. IRS Progress On Health Care Law
The U.S. Internal Revenue Service executive in charge of enforcing President Barack Obama's new health care law will be the lone witness on Wednesday before a congressional panel run by Republicans resolutely opposed to the law. As if that were not daunting enough, Sarah Hall Ingram also likely will be questioned by Republicans about her previous IRS job (Temple-West, 10/8).

Kaiser Health News: FAQ: Dental And Vision Care Part Of 'Essential Benefits' For Kids
One part of the Affordable Care Act is intended to improve dental coverage for children, an extension of efforts by public health advocates that followed the 2007 death of a Maryland boy named Deamonte Driver, who was killed by a bacterial infection that spread from an abscessed tooth to his brain (Evans, 10/9).

The Washington Post: Google Wants To Make You Immortal (And Obamacare Will Pay For It)
Google unveiled its new anti-aging initiative, Calico, to much fanfare last month. The exclusive story of "Can Google Solve Death?" was splashed across the cover of TIME magazine while tech bloggers scrambled to figure out the true meaning of Google's "strange or speculative" new venture. To hear Google execs tell the story, Calico aims at nothing less than extending human life spans by 100 years or more. Given enough time, Google might even defy the aging process and make us immortal. And, the brilliance of all this is that President Obama’s Affordable Care Act may end up making this possible within our lifetime (Basulto, 10/8).

CBS News: Scams Take Advantage Of Obamacare Confusion
You should be on your guard -- and be ready to mentor other, less-informed friends and family in ways to avoid fraud and scams as well. As personal finance blog Wisebread recently wrote, there are a slew of ways that criminals are trying to profit from people's ignorance and fear. Here are some things to watch out for (Johnson, 10/9).

Fox News: Obamacare To Shift Costs Of Some Prisoner Health Coverage From States To Feds
The Eighth Amendment guarantees adequate medical care for prisoners -- often an expensive undertaking because many battle addiction and have serious mental health issues. Currently, counties and states pay for that care. But in January, when the Affordable Care Act expands Medicaid coverage to men living below the poverty line, the cost of this care shifts to the feds. "That's one of the reason why you're seeing a lot of Republican governors support the Medicaid expansion because for them, it's a fiscal windfall," said Avik Roy, a senior fellow with the Manhattan Institute for Policy Research. "They will be able to offload these costs to the federal government that currently they're paying for." State and county prisoners who need acute care outside a prison facility can also have that cost reimbursed by Medicaid (Chrise, 10/9).

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Capitol Hill Watch

In Budget Battle, Both Sides Dig In, But They Open Door To A Short-Term Deal To Allow For Negotiations

As the standoff continues between Capitol Hill Republicans and President Barack Obama over the government shutdown, the debt ceiling and GOP efforts to defund or delay the health law, Politico poses the question: what would be on the table if leaders did start talking. 

Politico: Obamacare Negotiations: What Would They Discuss?
Even if President Barack Obama and Republican and Democratic leaders suddenly started talking about Obamacare, there would be a problem: They just don't have that much to talk about. Obama says he's willing to talk about his health care law, after the crisis is over. "If you disagree with certain aspects of it, tell us what you disagree with, and let’s work on it," Obama said at a press conference Tuesday afternoon. But the kinds of piecemeal changes that wouldn't cripple Obamacare — like repealing the medical device tax — wouldn’t satisfy tea party Republicans (Nather, 10/9).

The New York Times: Lift 'Threats,' Obama Insists, Spurning Talks
But he raised the possibility of reopening the government and raising the debt limit in the short term to allow negotiations, a development Republicans saw as positive. "If they can't do it for a long time, do it for the period of time in which these negotiations are taking place," he said. … Eight days since House Republicans refused to finance the government because Mr. Obama would not defund or delay the new health care law, and nine days before the Treasury Department says it will reach the legal limit to borrow money for existing bills and obligations, the two parties showed no movement toward an accord. Both sides dug in deeper, even as polls showed that Americans are fed up with Republicans, Democrats and the president — but more so with Republicans. The Senate held a rare all-hands-on-deck debate, but aired familiar partisan arguments (Calmes and Parker, 10/8).

The Associated Press: Obama Claims GOP Extortion, Boehner Vows No Surrender Amid Hints Of Short-Term Budget Truce
President Barack Obama and House Speaker John Boehner are increasing the pressure on each other to bend in their deadlock over the federal debt limit and the partial government shutdown. Even as they do, there are hints they might consider a brief truce. With the shutdown in its ninth day Wednesday and a potential economy-shaking federal default edging ever closer, neither side was showing signs of capitulating. Republicans were demanding talks on deficit reduction and Obama’s 2010 health care law as the price for boosting the government’s borrowing authority and returning civil servants to work, while the president wanted Congress to first end the shutdown and extend the debt limit (Fram, 10/9).

Politico: Conservatives Want To Keep The Focus On Obamacare
The most conservative House Republicans are starting to worry that the growing focus on the debt ceiling could overshadow their top priority: gutting Obamacare. The health care law has always been at the center of the fight over government funding. But the debt ceiling fight, which is already rattling financial markets, could touch on a broader range of policies, including tax and entitlement reform, the Keystone XL pipeline and broader efforts to slash the deficit (Gibson, 10/8).

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Gov't Shutdown Triggered By Capitol Hill Causes Damage To Public Health

The Centers for Disease Control and Prevention calls in furloughed scientists after a salmonella outbreak in California sickened people in 18 states.

The Associated Press: Government Efforts To Protect Health And Safety Are Slowed Or Halted As Shutdown Lingers
The government shutdown has slowed or halted federal efforts to protect Americans' health and safety, from probes into the cause of transportation and workplace accidents to tracking foodborne illness. The latest example: an outbreak of salmonella in chicken that has sickened people in 18 states. The federal Centers for Disease Control and Prevention said Tuesday that it was recalling some of its furloughed staff to deal with the outbreak, which has sickened more than 270 people. Before then, the CDC had only a handful of scientists working on outbreak detection, severely hampering its ability to track potentially deadly illnesses (Jalonick, 10/8).

JAMA: Federal Shutdown Causing Immediate And Lasting Damage To US Public Health, Science
With disease trackers from the Centers for Disease Control and Prevention (CDC) sidelined by the US government shutdown, pediatricians and other physicians are going without essential information about outbreaks of influenza, pertussis, and other infectious diseases in their area (Kuehn, 10/8).

The Wall Street Journal: Government Shutdown Delays Medical Supplier's Bankruptcy Exit
Blaming the government shutdown, lawyers for the Centers for Medicare and Medicaid Services persuaded a bankruptcy judge on Monday to delay a court hearing that could have allowed a California medical supplier to get out of Chapter 11 protection (Stech, 10/8).

Modern Healthcare: Shutdown Dims Hope Of Doc-Pay Fix, MGMA Attendees Told
If Congress manages to get the government restarted and avert the debt ceiling crisis, lawmakers may have just enough time to renew their 10-year tradition of "kicking the can" on finding a replacement for the Medicare sustainable growth-rate payment formula (Robeznieks, 10/8).

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Hill GOP Blasts Coverage Costs, Seeks Numbers Of Obamacare Enrolees

The GOP on Capitol Hill is continuing targeted attacks on the health law.

The Hill: Critics Blame Cost Hikes On ObamaCare
Senate Finance Committee Republicans released a compilation of posts to the healthcare.gov Facebook account in which users argued that the law was markedly increasing the cost of their individual coverage. ... The Affordable Care Act requires healthcare plans to offer a basic level of coverage, a change the administration acknowledges will raise premiums for some patients. But experts say it will take until 2014 and beyond before analysts can fully assess the law's impact on total out-of-pocket insurance costs (Viebeck, 10/8).

The Hill: GOP Demands ObamaCare Enrollment Numbers
House Republicans are asking for the number of people who enrolled in ObamaCare's federal exchanges in their first week amid a rash of technical challenges. Republicans on the House Energy and Commerce Committee asked for a full accounting of initial enrollment figures in a letter to the Department of Health and Human Services (HHS) Tuesday (Viebeck, 10/8).

In state political news related to the health law -

Politico: Chris Christie Makes Point On Obamacare
Republican Gov. Chris Christie said Tuesday that he doesn't like Obamacare but that he found a way to deal with it in New Jersey, another signal that he sees the government shutdown as an opportunity to contrast himself with feuding parties in Washington. "I don’t agree with the law, but we’ve complied with it, and that’s the job you have as governor," Christie said at a gubernatorial debate at William Paterson University in Wayne. "You don’t always agree with every law you have to enforce, but I’ve enforced this one, and I’m proud of our record on health care" (Titus, 10/8).

Dallas Morning News: Documents: Think Tank Supplied Blueprints For Texas To Fight Obamacare
A major conservative think tank supplied the blueprints for Texas bills aimed at fighting Obamacare, according to documents ordered released by the attorney general. The Center for Media and Democracy, a Wisconsin-based government watchdog group, requested the documents from Rep. Stephanie Klick, R-Fort Worth. They were sent to her by the American Legislative Exchange Council, known as ALEC, in July. As the federal government remains shuttered over an Obamacare impasse, the released documents highlight a push by a broad coalition of conservatives to dismantle the health care law at both the federal and state levels. ALEC has acknowledged its work against the law. But Brendan Fischer, general counsel with the Center for Media and Democracy, said it was the first time his group had seen the model bills created by ALEC’s health and human services task force (Barer, 10/8).

McClatchy: Americans Want Compromise – But Not On Obamacare
People want compromise--but not on health care. A new Pew Research Center poll found that while most people are frustrated about the first government shutdown since 1996, they are not willing to give ground on the Affordable Care Act, or Obamacare.Disagreement over the act's future has divided Democrats, who support the law, and Republicans, who want it changed or repealed. "On the core issue dividing Republicans and Democrats in Washington – whether cuts or delays to the 2010 health care law should be part of any budget deal – there is little support for compromise among members of either party," Pew found (Lightman, 10/8).

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State Watch

State Highlights: Maine To Allow Foreign Mail-Order Rx Drug Orders

A selection of health policy stories from Maine, North Carolina, Missouri, California, Washington, Kansas and Florida.

The Wall Street Journal: Maine to Allow Prescription-Drug Imports
The hunt for cheaper prescription drugs long has led consumers to reach beyond U.S. borders, but under a Maine law set to take effect Wednesday, their search now will have the state's blessing. The law, the first of its kind, sanctions the direct purchase of mail-order drugs from some foreign pharmacies. It has ignited a court battle with the pharmaceutical industry and set the stage for a broader fight over access to less-costly medication (Levitz and Martin, 10/8).

The Associated Press: Lawmakers Want Quicker Fix To NC Medicaid Billing
North Carolina state lawmakers and medical workers on Tuesday demanded quicker resolution of problems within the state's new Medicaid billing system as complaints mount about overdue claims payments and unhelpful call center workers (Robertson, 10/8).

North Carolina Health News: Audit Edits Eliminated Defense Of Medicaid Program
As last year's audit of the Medicaid program widened in scope, the state auditor critiqued the performance of a highly regarded program that manages low-income patients. Those criticisms stood, uncontested, in the final report (Hoban, 10/9).

The Kansas City Star: Missouri Just Says 'No' To Tracking Drug Prescriptions
The anti-drug movement's slogan used to be "Just say no." Missouri lawmakers have managed to give it a new twist by repeatedly saying no to tracking prescriptions of controlled drugs. Missouri is now the only state in the nation that doesn't have such a system (Bavley, 10/8).

Los Angeles Times: Loyola Marymount Drops Health Coverage For 'Elective' Abortions
Amid a debate about the role of Catholic colleges in a secular society, Loyola Marymount University this week decided to drop staff health insurance coverage for "elective" abortions and instead offer employees a separate, unsubsidized plan to cover those procedures. The move was seen on campus as a compromise between traditionalist alumni and faculty -- who think the university should have nothing to do with abortion -- and a more liberal group who contend LMU should not impose religious doctrine on the large number of non-Catholics it enrolls and employs (Gordon, 10/8).

The Seattle Times: 'Boarding' Mentally Ill Becoming Epidemic In State
Matthew Jones stripped off his clothes, kicked over a trash can and ran into Kirkland’s Juanita Beach Park. He wanted to swim across Lake Washington, find Bill Gates and kill him. Police intercepted the distraught 35-year-old on a dock and brought him to nearby EvergreenHealth hospital, where officials classified him as dangerously mentally ill and ordered he be detained, against his will, to be treated (Rosenthal, 10/8).

Kansas Health Institute: Kansas’ Drug Monitoring Program Credited With Helping Keep Overdoses Low
Kansas has among the lowest rates of drug overdose in the country, likely due in part to its prescription drug monitoring program, according to a new report. Less than 1 per 10,000 Kansans died of overdoses in 2010 -- the majority of which nationwide are from prescription drugs -- ranking eighth lowest among states, according to a report released this week by the non-profit Trust for America’s Health (Cauthon, 10/8).

Miami Herald: University Of Miami Hospital Overbilled Medicare $3.7 Million, Audit Says
The University of Miami Hospital will have to refund $3.7 million to Medicare after a federal audit of the hospital's billing practices found the hospital overbilled in 2009 and 2010, according to a report released Tuesday by the U.S. Department of Health and Human Services Office of Inspector General (Chang, 10/8).

California Healthline: Governor Signs Physical Therapy Bill
The long-standing requirement that patients must get a physician's referral first to receive treatment from a physical therapist was eliminated Monday in a bill signed into law by Gov. Jerry Brown (D). Assembly member Bob Wieckowski (D-Fremont) said his bill, AB 1000, allows patients to get treatment without unnecessary delay. "With this historic compromise, we are putting patients first," Wieckowski said in a statement. The new law allows a patient to see a physical therapist for 12 visits or 45 days before having to go to a physician for an examination (Norberg, 10/8).

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Editorials and Opinions

Viewpoints: Rep. Ryan Says Entitlements Hold The Key To An Agreement; Health Law's Impact On Smokers; WSJ On Medicaid Expansion

The New York Times: First End The Crisis, Then Talk
Once those threats are removed, however, there is plenty to discuss: how to replace the sequester cuts, which are already devastating domestic programs and are about to get much worse for defense spending; how to use fiscal policy to stimulate the creation of jobs and fix the nation's infrastructure; how to repair a broken tax system, reduce long-term debt, and ensure that social welfare programs remain healthy (10/8).

The Wall Street Journal: Here's How We Can End This Stalemate
So the president has negotiated before, and he can do so now. In 2011, Oregon's Democratic Sen. Ron Wyden and I offered ideas to reform Medicare. We had different perspectives, but we also had mutual trust. ... Over the next 10 years, the Congressional Budget Office predicts discretionary spending—that is, everything except entitlement programs and debt payments—will grow by $202 billion, or roughly 17%. Meanwhile, mandatory spending—which mostly consists of funding for Medicare, Medicaid and Social Security—will grow by $1.6 trillion, or roughly 79% (Rep. Paul Ryan, R-Wis., 10/8).

The Washington Post: Divided Government Requires Bipartisan Negotiation
For three years, Congress and the White House have been building to this moment. Not the debt limit or Obamacare specifically, but this clarifying moment of Washington dysfunction. … President Obama has often chosen to unilaterally circumvent the law under the guise of executive authority. Most recently, that was demonstrated in July with his delay of Obamacare mandates for corporations, but it has been a hallmark of this presidency (Rep. Eric Cantor, R-Va., 10/8).

The Washington Post: What Wisconsin Can Teach Washington
Working with the state legislature, we took a $3.6 billion budget deficit and turned it into a budget surplus of more than half a billion dollars. ... We enacted long-term structural reforms that include allowing schools to bid out health insurance, local governments to stop overtime abuse and the state to collect reasonable contributions for health insurance and pensions — all of which saved millions (Gov. Scott Walker, 10/8).

And on the issue of the health law --

The Wall Street Journal: Obamacaid 
Democrats do have one lament about implementation: Some states are opting out of the Medicaid expansion. Medicaid, the joint state-federal safety net intended for the poor, already covers more than one of five Americans and pays for two of five U.S. births. ... The feds are dangling the promise of paying for all the costs of the new beneficiaries, at least for the next three years. This subsidy honeypot can't last forever, and Governors are right to worry about taking on fiscal obligations ...The Beltway boys and their allies in the hospital industry that are ravenous for more federal revenue are stunned that their bribery failed (10/8).

Richmond Times-Dispatch: Medicaid Expansion Opportunity To Change Lives
The vast majority of Virginia adults who would gain health insurance under the Medicaid expansion are in low-paying jobs that don't come with health insurance. Their pay is too low to afford private insurance but too high to qualify for Medicaid under current rules. Others who would benefit include returning veterans, low-income workers and workers who are in between jobs. Medicaid also provides low-wage workers with financial security by reducing the risk of medical debt (Kathy May, 10/9).

The New York Times' Public Editor's Journal: 'Obamacare' – With or Without Quotation Marks
A Times reader, Tom Bird, of East Lansing, Mich., raised a timely issue, given all that's happening in Washington. He wrote that other news organizations, including The Associated Press, are putting the expression "Obamacare" in quotation marks, "signifying that it is not a neutral expression, but instead is political rhetoric that is being used in a partisan way." And he added, "When will The Times wake up?" (Margaret Sullivan, 10/8). 

The Washington Post: Questions And Answers About The Health-Care Law
Okay, so the rollout of the health insurance marketplaces created under the Affordable Care Act didn't go so smoothly. Technical glitches and heavy traffic occurred almost right away. Nonetheless, interest in the exchanges hasn't waned. As open enrollment continues, many people will have questions about the marketplaces (Michelle Singletary, 10/8).

The Washington Post's Right Turn: And Then There Is Obamacare
Although Republicans have done a bang-up job of blurring the issue and diverting the public's attention, Obamacare remains a problem for Democrats and a burden for their incumbents up for reelection in 2014. If the Republicans could get away from the unpopular shutdown fight and focus fully on Obamacare, they might benefit from three factors that threaten the president's signature legislation (Jennifer Rubin, 10/8).

Forbes: Three Key Questions For Obamacare's Rollout
President Obama’s signature health law achieved a major milestone on Oct. 1, when its subsidized insurance exchanges went online. But Obamacare is already reshaping the health insurance landscape. If you want to track how well the law is working, keep an eye on three aspects of it (Avik Roy, 10/9).

The Seattle Times: Obamacare Is Here, GOP, Ready Or Not
The other day as GOP spokeswoman Cathy McMorris Rodgers of Spokane was on cable flailing away at Obamacare again — "People are panicked," she said, "the wheels are falling off!" — it turned out people really were a little panicked. To get in on it. ... More than 9,400 Washington state residents enrolled in the first days, most of whom were previously uninsured (Danny Westneat, 10/8).

Reuters: How Obamacare Burns Smokers
[I]nsurers participating in the exchanges can charge a premium of up to 50 percent for smokers. But the penalty doesn't stop there: The premium subsidies that Obamacare makes available for the poor and lower-middle class are based on a formula that subsidizes an individual or family so that they do not have to pay more than a certain percentage of their income — out of their pockets– for their insurance. However, under the law, those subsidies cannot be applied at all to pay the 50 percent smokers' premium. The loss of that subsidy can be a big deal (Steven Brill, 10/8).


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Stephanie Stapleton

Andrew Villegas

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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.