Daily Health Policy Report

Friday, November 1, 2013

Last updated: Fri, Nov 1

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Administration News

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

A Reader Asks: If My Son Gets Insurance From The Indian Health Service, Is He Fulfilling His Health Law Requirements?

Kaiser Health News consumer columnist Michelle Andrews answers this reader's question (11/1). Read her response.

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As Robot-Assisted Surgery Expands, Are Patients And Providers Getting Enough Information?

Kaiser Health News staff writer Marissa Evans reports: "The use of robotic surgical systems is expanding rapidly, but hospitals, patients and regulators may not be getting enough information to determine whether the high tech approach is worth its cost. Problems resulting from surgery using robotic equipment—including deaths—have been reported late, inaccurately or not at all to the Food and Drug Administration, according to one study" (Evans, 11/1). Read the story

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Why State Exchange Sites Worked While The Federal Site Faltered

The Seattle Times' Patrick Marshall, working in partnership with Kaiser Health News, reports: "When President Obama addressed massive problems with the federal health-insurance exchange website last week, he couldn't cite any actual enrollments in health plans offered through the site. At the same time, several states running their own exchanges have exceeded federal-enrollment targets, including California, Connecticut, Kentucky, New York, Rhode Island and Washington. As of Oct. 28, Washington’s online site — the Washington Healthplanfinder — had enrolled 48,995 people" (Marshall, 10/32). Read the story.

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Florida Insurer Says It Didn't Drop Customers, Just Insurance Plans

The Miami Herald’s Daniel Chang, working in partnership with Kaiser Health News, reports: "This month, Florida Blue, the state’s largest and oldest health insurer, notified 300,000 members that when their plans expire in 2014 they must enroll in new plans that comply with requirements of the ACA that insurers offer coverage to everyone, regardless of pre-existing conditions, and that plans cover 10 ‘essential health benefits’’ such as hospitalization, prescription drugs and maternity care" (Chang, 10/31). Read the story.

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Capsules: Healthcare.gov Troubles Don't Change Public's View Of Health Law, Poll Finds; Health Insurance Sign Ups Are New Service At Annual Free Clinic In L.A.

Now on Kaiser Health News’ blog, Jordan Rau reports on findings from a new tracking poll: "The public has a dim view of how the government has rolled out the health care law so far, but those stumbles have not changed people’s overall opinions of the law itself, a new poll finds. The Kaiser Family Foundation poll found that 48 percent of people think the federal government has done a poor job of implementing the law, and another 32 percent give the government an ‘only fair’ review. (KHN is an editorially independent program of the foundation.) Only 14 percent gave the federal government good or excellent reviews for the rollout of the law.  The public was slightly less critical about state government management of the law, but even there, 63 percent said their state had done either a poor or ‘only fair’ job" (Rau, 11/1).

Also on Capsules, Anna Gorman reports on what's new at L.A.'s annual free health clinic event: "The Care Harbor L.A. event, in its fifth year, expects to treat about 3,750 people over four days. But this year is different because many of those in attendance will be eligible for insurance through the federal health law, said Howard Kahn, chief executive officer of L.A. Care Health Plan" (Gorman, 11/1). Check out what else is on the blog.

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Political Cartoon: 'Dress Code?'

Kaiser Health News provides a fresh take on health policy developments with "Dress Code?" by Mike Luckovich.

Here's today's health policy haiku:


Dreamt of the health law,
Mixed up, messy and complex --
Like most of my dreams.
-Larry Beresford

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

Insurers Seek To Explain The Factors Behind Wave Of Health Plan Cancellations

The top trade group for health insurers, among others, is attempting to explain the "why" behind these recent developments.  

The Wall Street Journal's Washington Wire: Q&A: Explaining The Widespread Health-Plan Cancellations
As many as 10 million Americans are expected to have their health plans terminated by their insurers effective Jan. 1 or after. Here’s a look at who’s affected, why and options for staying covered (Needleman and Martin, 10/31).

The Hill: AHIP Seeks To Explain Health Plan Regs
The top trade group for health insurance companies is seeking to explain why some policies on the individual market are being canceled ahead of 2014. In a memo to reporters, America's Health Insurance Plans (AHIP) said that many health plans purchased individually must be cancelled because they've been changed or purchased since 2010, the year ObamaCare was enacted (Viebeck, 10/31).  

Reuters: Canceled U.S. Health Plans Are Disruptive Part Of Reform: Cigna CEO
The hundreds of thousands of Americans whose individual insurance policies will be canceled as Obamacare takes full effect next year are experiencing a disruptive element of healthcare reform, the head of health insurer Cigna said on Thursday. In the past week, reports of pending plan cancellations have become a political problem for President Barack Obama, who promised years ago as he was pushing to pass the healthcare law that Americans who liked their health plans could keep them (Humer, 11/1).

The Miami Herald/Kaiser Health News: Florida Insurer Says It Didn't Drop Customers, Just Insurance Plans
This month, Florida Blue, the state’s largest and oldest health insurer, notified 300,000 members that when their plans expire in 2014 they must enroll in new plans that comply with requirements of the ACA that insurers offer coverage to everyone, regardless of pre-existing conditions, and that plans cover 10 ‘essential health benefits’’ such as hospitalization, prescription drugs and maternity care" (Chang, 10/31).

The Associated Press: 150,000 In Ore. To Face Health Plan Cancellation
About 150,000 Oregonians enrolled in individual health care plans will see their plans cancelled by the end of the year because the plans don't provide the minimum level of coverage required under the new health care law, Oregon officials said on Wednesday. Some of those facing cancelations could see a break in coverage if they don't enroll in a new plan on the state's problem-plagued online exchange by Dec. 15, the state's Insurance Division spokeswoman Cheryl Martinis said (Wozniacka, 10/31). 

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A Central Health Law Question: Who Is Getting Covered? Who Is Getting Canceled?

The Associated Press reports that some of the newly insured will now become the faces of healthcare.gov, while The New York Times tells three stories about people who won't be able to keep their coverage.

The Associated Press/Washington Post: Still All Smiles: New Insured Who Became Latest Faces Of Health Overhaul Defend Their Choice
It didn’t take long for the friendly-looking young woman whose face was splashed across HealthCare.gov to spiral from smiling stock photo to laughingstock. As it scrambles to correct problems with the website, the Obama administration is now asking people who have successfully purchased health insurance to let their pictures be used instead (11/1).

The New York Times: When Insurers Drop Policies: Three Stories
Each, in a different way, represents the relatively small part of America that the Obama administration did not talk about while campaigning for the Affordable Care Act: people who have health insurance that they like, but who will be unable to keep it under the law. Now that new insurance marketplaces are opening, insurance companies are canceling millions of individual plans that fail to meet minimum standards. The dropped plans have become the political talking point of the moment — and, according to many Republicans, a symbol of the president’s flawed ambitions (Thomas and Abelson, 10/31).

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Most Uninsured Signing Up On Health Website Are Going To Medicaid

The Washington Post reports that nine out of 10 new enrollees are in Medicaid. Meanwhile, White House documents turned over to investigators in the House show only six people enrolled on the day the troubled website launched.

The Washington Post: In First Month, The Vast Majority Of Obamacare Sign-Ups Are In Medicaid
The first month of the new health law's rollout reveals an unexpected pattern in several states: a crush of people applying for an expansion of Medicaid and a trickle of sign-ups for private insurance. This early imbalance — in some places, nine out of 10 enrollees are in Medicaid — has taken some experts by surprise. The Affordable Care Act, which expanded Medicaid to cover millions of the poorest Americans who couldn't otherwise afford coverage, envisions a more even split with an expanded, robust private market (Kliff, 10/31).

The Washington Post: Obamacare's Launch Looked Even Worse From The Inside
Healthcare.gov had tallied exactly six successful enrollments by the morning of Oct. 2, new documents released by the House Oversight Committee show. By the end of Oct. 2, the health law Web site that serves 36 states had received 248 insurance enrollments (Kliff, 10/31).

Politico: Six Enrolled On Health Site On Day 1
Only six people enrolled in health insurance via the Obamacare exchanges on the website’s first day, newly released documents reveal. "War room notes" obtained by the House Oversight and Government Reform Committee and posted by CBS News from the morning of Oct. 2, the day after the exchange site opened, show that amid ongoing problems with the site, just six people had completed enrollment as of that morning (Kopan, 11/1).

NBC News: Only 6 Able To Sign Up On Healthcare.Gov’s First Day, Documents Show
The six enrollments that had been completed by the morning of Oct. 2 were spread across Blue Cross Blue Shield North Carolina, Blue Cross Blue Shield Kansas City, CareSource and Healthcare Service Corp., the documents say. Notes from an Oct. 2 "PM" meeting say that that "direct enrollment is still not working," and "consumer access issues are occurring; some estimates show 40,000 people in the waiting room." At the time of that report approximately 100 enrollments had been completed (Thorp, 10/31). 

CBS News: Obamacare Enrollments Got Off To Very Slow Start, Documents Show
For 31 days now, the Obama administration has been telling us that Americans by the millions are visiting the new health insurance website, despite all its problems. But no one in the administration has been willing to tell us how many policies have been purchased, and this may be the reason: CBS News has learned enrollments got off to an incredibly slow start. Early enrollment figures are contained in notes from twice-a-day "war room" meetings convened within the Centers for Medicare and Medicaid Services after the website failed on Oct. 1. They were turned over in response to a document request from the House Oversight Committee (Attkisson, 10/31).

Reuters: Enrollment In Obamacare Very Small In First Days: Documents
Enrollment in health insurance plans on the troubled Obamacare website was very small in the first couple of days of operation, with just 248 Americans signing up, according to documents released on Thursday by a U.S. House of Representatives committee (Cornwell and Morgan, 10/31). 

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Details Emerge About Key Fixers In 'Tech Surge' To Address Website Issues

News outlets report that the administration's so-called "tech surge" has been somewhat mysterious, but it's becoming clear that the administration has enlisted engineers from a number of major companies.

The Associated Press/Washington Post: Oracle, Red Hat Join In Effort To Fix Problems Crippling Obama's Healthcare Site
The Obama administration has recruited engineers from several prominent technology companies to help fix the problems preventing people from signing up for government-mandated health insurance. Oracle and Red Hat are pitching in as well as Michael Dickerson, an engineer on leave from Google, according to a blog post Thursday by Julie Bataille, a spokeswoman for the Centers for Medicare & Medicaid Services (10/31).

Bloomberg: Google, Oracle Workers Enlisted For Obamacare 'Tech Surge'
Google Inc., Red Hat Inc., Oracle Corp. and other technology companies are contributing dozens of computer engineers and programmers to help the Obama administration fix the U.S. health-insurance exchange website. The help is arriving as the government's main site for medical coverage remains plagued by repeated outages a month after its Oct. 1 debut (Wayne, 11/1). 

PoliticoPro: Obamacare 'Tech Surge' Has D.C. Ties
The clandestine Obamacare "tech surge" details unveiled by the administration Thursday have one thing in common — ties to Washington. Centers for Medicare & Medicaid Services spokeswoman Julie Bataille described "dozens" of experts rounded up to help with the HealthCare.gov repairs, but she mentioned only four, all familiar to either the Obama administration or federal IT. Google engineer Michael Dickerson has joined the team, she said, along with Presidential Innovation Fellow Greg Gershman, Oracle and Red Hat (Meyers, 10/31).

CQ HealthBeat: Few Clues Released In Mystery Over Tech 'Surge'
In the 11 days since it announced a "tech surge" to fix the federal insurance exchange website, the Obama administration has given few details about the number of people involved, what federal agencies or companies they come from, their names, and whether they are volunteers or are being paid by the federal government (Reichard, 10/31). 

The Fiscal Times: 4 Fixes Designers Would Make To Obamacare Exchanges
Set the political fallout from the rollout aside, and Obamacare is still the law of the land. People without insurance still must obtain it by March or face penalties. Sebelius has pledged to fix the site, but it remains to be seen how the site should be fixed in order to make it more user friendly, and how customer service should be improved. To get a idea of how to make the Obamacare exchanges more user-friendly, I reached out to customer service consultants to get their take on how to improve the customer’s experience. These consultants found numerous problems with the site, and suggested a number of ways that it could be improved (Francis, 11/1).

Concerns about security lapses also continue -

The Wall Street Journal: Data Security Added To Worries About Website
Concerns about the security of personal information on the HealthCare.gov website are getting closer attention in Washington, potentially adding to the list of problems with the new federal health-insurance exchange. The House Oversight and Government Reform Committee, led by Rep. Darrell Issa (R., Calif.), on Thursday subpoenaed information about the website from the Obama administration, including on whether the site was well-protected from hackers (Corbett Dooren and Schatz, 10/31).

The Hill: O-Care Contractor Cited For Security Lapses
A contractor heavily involved in repairing HealthCare.gov was previously criticized for endangering the personal data of more than 6 million government beneficiaries through insufficient security controls. Lax data safety at Quality Software Services, Inc. (QSSI) was deemed a "high" risk in a June probe by federal investigators that revealed the company had failed to stop its employees from connecting unauthorized USB devices to highly sensitive Medicare systems (Viebeck, 10/31). 

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Some States See Enrollment Success Even As Others, Federal Insurance Exchange Struggle

Even as the federal and some state-based insurance marketplaces falter, enrollment numbers in some state-based exchanges are exceeding expectations -- including nearly 49,000 in Washington state alone. But some places, like Oregon, are dealing with technical problems that are forcing officials there to hand-process applications.

The Seattle Times/Kaiser Health News: Why State Exchange Sites Worked While The Federal Site Faltered
When President Obama addressed massive problems with the federal health-insurance exchange website last week, he couldn't cite any actual enrollments in health plans offered through the site. At the same time, several states running their own exchanges have exceeded federal-enrollment targets, including California, Connecticut, Kentucky, New York, Rhode Island and Washington. As of Oct. 28, Washington’s online site -- the Washington Healthplanfinder -- had enrolled 48,995 people (Marshall, 10/32).

California Healthline: Opening Month Numbers Indicate Intense Interest In Calif. Exchange
Covered California yesterday released its total number of calls and Internet inquiries for the first four weeks of the opening enrollment period for the state's health benefit exchange. The numbers were impressive. Open enrollment began Oct. 1 at Covered California. According to figures released yesterday: The exchange had 2,154,572 "unique visits" on its website. … The three Covered California call centers logged 210,061 phone calls with an average duration of more than 15 minutes a call. 179,562 applications to join the exchange have been started (Gorn, 10/31).

The Oregonian: Cover Oregon: Health Insurance Exchange Ramps Up Manual Enrollment As Website Still Doesn't Work 
Technical problems won't prevent people who need it from getting health coverage by Jan 1, officials said, citing new hires by Cover Oregon to process applications by hand. The hand-processing began in mid-October. But officials for Oregon's new health exchange said Thursday they're hiring 60 temporary workers to join more than 20 exchange workers already processing paper applications. The exchange is training more employees and talking to other state agencies about additional help (Budnick, 10/31).

The California Health Report: Covered California Turns To Facebook To Reach The Masses
Health care advocates have targeted various groups with information in assorted languages and officials stationed at health clinics around the state. But to reach the masses, Covered California folks say one of their strongest tools has been social media -- especially Facebook. "It's a pretty planned and intentional effort," said Sarah Sol, spokeswoman with Covered California. With featured posts including "Ask the Expert," "People Like Me" and questions and answers, the site is filled daily with conversation between potential subscribers, Covered California officials and more (Bookwalter, 11/1).

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As Healthcare.gov Falters, Navigators And Marketing Efforts Forced To The Sidelines

Navigators, who had planned to be working hard on online enrollments by now, are forced to try paper insurance applications or trying to answer consumers' questions about why they can't enroll. At the same time, a marketing blitz planned by health law advocates is on hold until the website works better.

The Wall Street Journal: Health-Site Flaws Put Navigators On Front Lines
Christine Kaufmann and thousands of other people hired to help consumers sign up for health insurance on the new exchanges this fall knew they would be busy. But problems with the federally run website have placed these "navigators" on the front lines, facing a deluge of questions and resorting to pen-and-paper applications to enroll consumers (Martin, 10/31).

Politico: Obamacare Marketing Push On Hold
Team Obamacare is sitting on hundreds of millions of dollars of essentially frozen assets — yet another consequence of the failed launch of healthcare.gov. There's no point in an ad blitz directing people to sign up on a website that doesn't work. And while advocacy groups say they had always planned to spend more money on the back end to boost enrollment in lagging states at the end of this year and early next year, they didn't count on the opening month fizzle (Palmer and Allen, 10/31).

Meanwhile, in states opposed to health law, helping consumers often falls to local officials. 

The Associated Press: Houston Launches Major Effort To Roll Out Federal Health Plan Despite Political Opposition
But this is no hurricane. Instead, it is Houston's offensive to reach more than 1 million people across 600 square miles who don't have health insurance and connect them with the new federal health insurance program that began accepting applications this month. The push is happening in one of the nation's reddest states, an example of the gap between the vitriolic political opposition to President Barack Obama's signature initiative in some conservative bastions and the actual response to it by local officials (Plushnick-Masti, 10/31).

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Health Law Policy Issues: Abortion And Maternity Coverage Raising GOP Concerns

News organizations look at a variety of policy issues that affect the health law.

NPR: Which Plans Cover Abortion? No Answers On HealthCare.gov
As if the rollout of the federal health law didn't have enough problems, abortion is back in the spotlight. How the various health plans in the exchanges would or would not pay for abortion was one of the very last issues settled before the bill was passed in 2010. Now abortion's invisibility on the federal HealthCare.gov website has some people pretty upset (Rovner, 11/1).

The Washington Post: Does Obama's Health-Care Law Make Men Pay For Maternity Care? Breaking Down The Facts.
It was one of the lighter moments in a House hearing Wednesday in which Health and Human Services Secretary Kathleen Sebelius testified about the government's problem-ridden health insurance exchange. Rep. Renee L. Ellmers (R-N.C.) said the health-care law was forcing many Americans to pay for benefits they would never need, such as maternity coverage. "To the best of your knowledge, has a man ever delivered a baby?" Ellmers asked. The back-and-forth focused attention on a key part of the law: Starting next year, individual plans must provide a minimum package of essential benefits — including maternity care — to everyone (10/31).

NPR: For The Young And Healthy, Health Insurance Is A Hard Sell
Getting young, healthy people to sign up for health insurance is seen as critical to the success of the Affordable Care Act. It's precisely those people who will help offset the cost of the older, sicker ones. But while cheap health insurance and subsidies based on income are intended to make the program appealing to the young, what if they haven't even heard of the health care law? Or don't want to buy even an inexpensive policy? (Glinton, 11/1).

The Washington Post's The Fact Checker: Obama's Claim That The Massachusetts Enrollment Experience Is Relevant To Obamacare
The president traveled to Boston this week to tout his troubled health care law, to the very spot where his erstwhile rival, former governor Mitt Romney (R), has signed into law his own universal health care law with an individual mandate. He cited the experience in Massachusetts to point out that enrollment in Massachusetts started off slowly and increased substantially just before key deadlines. The administration has not released enrollment numbers, but presumably it is preparing Americans for relatively low numbers at first. But is this really a case of apples and apples—or apples and oranges? (Kessler, 11/1).

CBS News: Despite Major Obamacare Problems, A "Death Spiral" Is Unlikely
The government will have to fix HealthCare.gov to hold up the new marketplace, but there are other elements in the law that will prevent the "death spiral" from kicking in. The system of subsidies for consumers on the market, along with mechanisms like "reinsurance" and "risk corridors" designed to stabilize the market, should keep premiums from spiraling out of control (Condon, 11/1).

Fox News: One Insurer On The Exchange: What Does That Mean For Prices?
Creating a competitive marketplace with multiple insurance providers for consumers to choose from was an often-touted benefit of the Affordable Care Act's insurance exchanges, but for some residents, that pool of competition is a lonely one provider. Many insurance offerings are done by region, says Cynthia Cox from the Kaiser Family Foundation, and there are different ways to measure the number of insurers in each state. Some states, like Texas she says, have the same insurer offering individual and multi-state plans from Blue Cross Blue Shield of Texas (Rogers, 10/31).

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Democrats Feeling Health Law Anxiety Over Troubled Start

Democrats are worried the health law's problems could hurt them politically as Senate Democrats push Obama administration officials to ease their anxiety and fix implementation of the law.

The New York Times: Troubled Start for Health Law Has Democrats Feeling Anxious
Already under fierce attack from Republicans over the new health care law, President Obama now faces broad and mounting Democratic concerns that the troubled start of the insurance program will cut into the political benefit the party received from the government shutdown and cost Democratic candidates in next year's midterm elections (Weisman, 10/31).

Politico: Senate Dems Vent To W.H. On Obamacare
Anxious Senate Democrats gave senior White House officials an earful over the bungled rollout of the health care law, pushing the Obama administration to rectify problems that have become a political liability for their party. At a private lunch briefing Thursday in the Capitol, senior administration officials heard concerns over the law’s new website, frustration about the cancellation of some insurance policies and fears that the White House’s poor messaging failed to convey how Obamacare will actually work. While the mood was cordial, senators said, the questions were pointed and the anxiety was palpable (Raju, Everett and Haberkorn, 10/31).

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Ads Seek To Refocus Obamacare Debate; Dems Point To GOP's 'Sabotage' Campaign

Health law opponents are using President Barack Obama's promise that Americans could keep their health plan if they like it against him in a series of new ads. Meanwhile, Politico examines the effect of the long-running Republican effort to derail the law.

The New York Times: Conservative Group Tests New Attack On Health Law
A promise President Obama may come to regret -- "If you like your health care plan, you can keep it" -- is the centerpiece of the latest web video attacking the Affordable Care Act, released Thursday by Americans for Prosperity, the conservative advocacy group that is working to undo the health law. The video, titled "America's Broken Promise," features a mash-up of clips of Mr. Obama's statements and newscasters questioning his assertion, as foreboding music plays in the background (Stolberg, 10/31).

Politico: The Obamacare Sabotage Campaign
The opposition was strategic from the start: Derail President Barack Obama's biggest ambition, and derail Obama himself. Party leaders enforced discipline, withholding any support for the new law -- which passed with only Democratic votes, thus undermining its acceptance. Partisan divisions also meant that Democrats could not pass legislation smoothing out some rough language in the draft bill that passed the Senate. That left the administration forced to fill far more gaps through regulation than it otherwise would have had to do, because attempts -- usually routine -- to re-open the bill for small changes could have led to wholesale debate in the Senate all over again (Purdum, 11/1).

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Capitol Hill Watch

Lawmakers Don't Have To Say Which Staffers Have To Use Health Exchange

Members of Congress can choose who -- if any -- among their staffs go on the health law's insurance exchange.Sen. David Vitter, R-La., objects to the fact that they don't have to announce those decisions.

The Associated Press: Congress Governs Self Under 'Obamacare,' With Discretion, Coyness About who Is Covered And How
For House members and senators, it's about a section of the law that may -- or may not -- require lawmakers to toss some staffers off of their federal health insurance and into the Affordable Care Act's exchanges. The verdict from congressional officers is ultimately that lawmakers, as employers, have discretion over who among their staffs gets ejected, and who stays. And they don't have to say who, how many or why (Kellman, 11/1).

Politico: David Vitter Blasts Obamacare 'Loophole' 
Sen. David Vitter wants members of Congress to disclose whether they've exempted their staffs from joining the Obamacare exchanges. The Louisiana Republican is upset that lawmakers are being given discretion to decide which staffers will be pushed onto the District of Columbia's health insurance exchange and which will be able to keep their current health insurance plans. He said that amounted to a "loophole" (Gibson, 10/31).

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Administration News

New IRS Rule Gives Consumers A Break On FSA Accounts

The Treasury Department and Internal Revenue Service will allow Flexible Spending Account holders to carry over as much as $500 from one year to the next without a penalty.

Los Angeles Times: IRS Eases Rules On Healthcare Flexible Spending Accounts
Workers faced with forfeiting unused money in their flexible spending accounts for healthcare expenses may be getting some relief under a new federal rule. The U.S. Treasury Department and Internal Revenue Service changed the use-it-or-lose-it rule for flexible spending arrangements, or FSAs, to allow account holders to carry over as much as $500 from one year to the next without penalty (Terhune, 10/31).

The Wall Street Journal: Consumers Can Roll Over $500 In An FSA
The Obama administration loosened rules governing health-care savings accounts known as flexible-spending arrangements, or FSAs, allowing consumers to roll over as much as $500 in unused funds each year. The change—likely to be popular with consumers—modifies the use-it-or-lose-it rule that has governed the tax-advantaged accounts for decades (McKinnon, 10/31).

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State Watch

Federal Appeals Court Reinstates Texas Abortion Law

A federal appeals court gave the OK for Texas to reinstate a controversial abortion law while its legal fate is being decided and reversed a decision issued earlier this week blocking the law, which now goes back into effect immediately. It requires doctors performing abortions to have admitting privileges at nearby hospitals and limits medication-induced abortions.

The New York Times: In Reversal, Court Allows Texas Law on Abortion
Only three days after a federal judge blocked a new Texas law that threatened to shut down many of the state’s abortion clinics, the United States Court of Appeals for the Fifth Circuit, in New Orleans, reversed the decision, saying the rule should take effect while the case is argued in the months to come (Eckholm, 10/31).

NPR: Appeals Court Gives Texas OK To Enforce Abortion Law
A federal appeals court has granted a Texas request to reinstate restrictions on abortion providers after a lower court blocked the state from fully implementing the new law. The stay follows a ruling by District Judge Lee Yeakel on Monday -- a day before the law was to have gone into effect. It requires doctors performing abortions to have admitting privileges at a hospital within 30 miles of the clinics they practice in (Neuman, 10/31).

Los Angeles Times: Strict Texas Abortion Law Takes Effect
A federal appeals court allowed most of Texas' new abortion restrictions to take effect immediately, lifting an injunction Thursday that had suspended much of the law. The decision came three days after U.S. District Judge Lee Yeakel in Austin blocked restrictions that he found unconstitutional, including one that requires doctors at abortion clinics to have admitting privileges at nearby hospitals and another that limits medication-induced abortions (Hennessy-Fiske, 10/31).

USA Today: Court Reinstates Most Of Texas' New Abortion Restrictions
A federal appeals court reinstated most of Texas' tough new restrictions on abortions Thursday in a ruling that means as many as a dozen clinics around the state will not be able to continue performing procedures. The restrictions could take effect Friday, stopping abortion procedures in at least one-third of the state's licensed health centers, according to opponents of the law (Welch, 10/31).

Houston Chronicle: Appeals Court Allows Abortion Restrictions To Begin
A federal appeals court ruling Thursday gives Texas the green light to start enforcing a new abortion restriction that a lower court judge said posed an undue burden on women. The decision by the U.S. 5th Circuit Court of Appeals was a huge victory for Attorney General Greg Abbott and Texas abortion opponents, temporarily lifting an injunction that prevented the provisions from going into effect (Rauf, 10/31).

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State Highlights: Patients Crowd Free Clinic Event In Calif.; Mass. Bill Aims At Lowering Retiree Health Costs

A selection of health policy stories from California, Massachusetts and Pennsylvania.

Los Angeles Times: Patients Pour Into LA Sports Arena For Free Medical, Dental Care
An army of doctors, nurses, dentists and other health workers on Thursday began providing free care to a steady stream of patients at the annual Care Harbor clinic at the Los Angeles Memorial Sports Arena. Care Harbor founder Don Manelli estimated that 700 to 800 people would receive free care by the end of the day Thursday. In all, the clinic expects to serve about 4,000 Angelenos--many of whom don't have insurance, or don't have coverage for services like dentistry or vision care (Brown, 10/31). 

Kaiser Health News: Capsules: Health Insurance Sign Ups Are New Service At Annual Free Clinic In L.A.
The Care Harbor L.A. event, in its fifth year, expects to treat about 3,750 people over four days. But this year is different because many of those in attendance will be eligible for insurance through the federal health law, said Howard Kahn, chief executive officer of L.A. Care Health Plan (Gorman, 11/1).

The Associated Press: Bill Calls For Changes In Mass. Retiree Benefits 
Lawmakers are reviewing Gov. Deval Patrick's proposal to rein in health care costs for retired public employees by raising the retirement age and service requirements and reducing what the state pays for many workers' premiums. Supporters and critics crowded the Statehouse Thursday as the Legislature's Public Service committee heard testimony on a bill the administration projects would save up to $20 billion over the next 30 years (Leblanc, 10/31). 

California Healthline: Inland Empire Clinics Work To Ease Demand On Hospital EDs
Efforts in the Inland Empire to steer patients toward primary clinics and away from emergency departments appear to be alleviating some of the strain placed on county hospitals in recent years. EDs in Riverside and San Bernardino counties -- which were hit particularly hard by the economic recession -- grappled with increasing demand by uninsured patients, limited capacity and ever-increasing wait times. Preparations for the Affordable Care Act, including strengthening county networks of safety-net clinics, seem to have had a positive impact on hospitals, according to Inland Empire sources (McSherry, 10/31).

The Associated Press: Pa. Democrat To Hold Town Hall On Health Care Law 
A freshman Democrat representing northeastern Pennsylvania's biggest cities and some anthracite coal towns will hold a town hall meeting on the federal health care law in the wake of an uproar over its website woes and insurers discontinuing plans that don't meet the law's standards. U.S. Rep. Matt Cartwright was to appear Friday in Pottsville (11/1). 

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Health Policy Research

Research Roundup: States Struggling With Medicaid Expansion "Complex Issues"

Each week, KHN compiles a selection of recently released health policy studies and briefs.

Annals of Emergency Medicine: Anticipated Changes In Reimbursements For US Outpatient Emergency Department Encounters After Health Reform 
We conducted a secondary analysis of data (2005 to 2010) from the Medical Expenditure Panel Survey. ... Comparisons were made between 2 groups to reflect likely movements in insurance status after the Patient Protection and Affordable Care Act implementation: (1) the uninsured who will be Medicaid eligible afterward versus Medicaid insured, and (2) the uninsured who will be Medicaid ineligible afterward versus the privately insured. ... Assuming historical reimbursement patterns remain after Patient Protection and Affordable Care Act implementation, outpatient ED encounters could reimburse considerably more for both the previously uninsured patients who will obtain Medicaid insurance and for those who move into private insurance products through health insurance exchanges (Galarraga and Pines, 10/30).

JAMA Internal Medicine: Public Preferences About Secondary Uses Of Electronic Health Information Importance
We surveyed 3336 adults (368 Hispanic, 500 non-Hispanic African American and 2268 non-Hispanic white); participants were randomized to 6 of 18 scenarios describing secondary uses of electronic health information ... marketing uses, quality improvement uses, drug company users and public health department users were associated with less willingness to share health information than research uses and university hospital users. Hispanics and African Americans differentiated less than whites between uses. ... Participants cared most about the specific purpose for using their health information, although differences were smaller among racial and ethnic minorities. The user of the information was of secondary importance and the sensitivity was not a significant factor (Grande et al., 10/28). 

Health Affairs: Navigators And Assisters
Trained counselors and organizations are helping consumers enroll in health plans through the Affordable Care Act's new insurance Marketplaces. ... With the rough launch of the Marketplaces making it difficult for people to shop for plans and enroll online, navigators and assisters are more important than ever. Much of the job educating and enrolling people will be on a one-on-one basis, a time-intensive and costly effort that will be more difficult in states that are hostile to the law. In addition to navigators and assisters, HHS is relying in part on not-for-profit organizations that have pledged to provide outreach and education on the Affordable Care Act. ... The battle over state laws imposing additional requirements on navigators will likely play out over the next several months as navigators and assisters begin their work (Goodell, 10/31)

National Association of Medicaid Directors: NAMD Snapshot, Open Enrollment, Week 4
During the fourth week of open enrollment, the state experience remained varied depending on the type of Marketplace operating in the state and whether the state is planning to expand Medicaid eligibility January 1, 2014. ... All states described a range of complex issues in their efforts to integrate with the Marketplaces, with the specifics dependent on the use of a Federal or state model. Beyond these variables, all states continued to develop or refine a number of complex aspects of their eligibility and enrollment systems, reporting mechanisms and tools for interfacing with consumers and stakeholders. Medicaid agencies are all working to comply with the January 1, 2014 effective date for using Modified Adjusted Gross Income to determine eligibility for certain Medicaid applicants as well as ensuring their systems provide the experience for applicants and enrollees (10/29).

British Medical Journal: Non-Publication Of Large Randomized Clinical Trials: Cross Sectional Analysis
PubMed, Google Scholar, and Embase were searched to identify published manuscripts containing trial results. ... Of 585 registered trials, 171 (29%) remained unpublished. These 171 unpublished trials had an estimated total enrollment of 299 763 study participants. ... Non-publication was more common among trials that received industry funding (150/468, 32%) than those that did not (21/117, 18%), P=0.003. Of the 171 unpublished trials, 133 (78%) had no results available in ClinicalTrials.gov. ... Among this group of large clinical trials, non-publication of results was common and the availability of results in the ClinicalTrials.gov database was limited. A substantial number of study participants were exposed to the risks of trial participation without the societal benefits that accompany the dissemination of trial results (Jones et al., 10/29).

UCLA Center for Health Policy Research: Migration and Health: Mexican Immigrants In The U.S.
The results of this report indicate that the Mexican population has a lower prevalence of chronic diseases such as cancer, hypertension, asthma and cardiovascular disease, compared to other ethnic or racial groups, which, in part, could be associated with its younger age structure. However, it is also possible that the prevalence of diseases is higher than that recorded in the statistics, precisely because there is underdiagnosis related to immigrants’ limited health insurance coverage, greater financial difficulties to cover the costs involved, fear about immigration status, or with health literacy problems and difficulty navigating a health care system that is increasingly more complex and automated. ... In 2014 the Affordable Care Act will integrate millions of newly insured Latinos, including many lawful permanent resident (LPR) Mexican immigrants, into the health system. ... However, the exclusion of undocumented immigrants from Medicaid, health insurance subsidies, and even the health insurance exchanges under the ACA will leave millions of Mexican immigrants without coverage (Ramirez et al., 10/1).

Here is a selection of news coverage of other recent research:

MedPage Today: Paying Kidney Donors Can Save $$, Help Patients
Paying living donors for their kidneys would reduce the number of end-stage renal disease (ESRD) patients on dialysis and transplant wait lists, and save the healthcare system money, researchers in Canada concluded. Using decision analysis modeling, they estimated that a $9,648 ($10,000 Canadian) payment per living donor would increase the number of kidneys available for transplant by 5%, with an incremental cost savings of around $328 ($340 Canadian) per patient, ... researcher Lianne Barnieh, PhD, of the University of Calgary, and colleagues wrote online in the Clinical Journal of the American Society of Nephrology (Boyles, 10/25).

Reuters: JAMA Study Questions FDA's Shorter Drug Approval Times
New drugs that receive expedited review by the Food and Drug Administration are being tested on fewer patients, leaving many safety questions unanswered even after they are approved, a study released on Monday in the Journal of the American Medical Association found. Study authors Thomas Moore of the Institute for Safe Medication Practices and Dr Curt Furberg, a professor at Wake Forest School of Medicine, examined the development times, clinical testing and risks associated with 20 new drugs approved in 2008. Eight were given expedited review and 12 standard review (Clarke, 10/28).

MedPage Today: Futile Measures Deprive Others Of ICU Care
Patients in the intensive care unit (ICU) who are unlikely to benefit from the care they're getting may be receiving treatment at a cost to other patients who would actually gain from an ICU bed, researchers said here. In a single-center analysis, there were several instances of emergency department (ED) boarding and delays or failures in transferring patients from other hospitals when the ICU was full and "futile" patients were receiving care there, Thanh Huynh, MD, of the University of California Los Angeles, reported at the CHEST meeting here (Fiore, 10/29).

Reuters: Patients Might Benefit From Health Literacy Tests
Doctors often assume they're explaining things in a way patients understand. When patients are confused, doctors don't always realize it. A new study shows patients might benefit from having their "health literacy" tested. Researchers at a large Arizona healthcare center looked at how a short health literacy test would affect the way patients felt about their treatment. They found it did no harm and may have helped to improve patient satisfaction (Jegtvig, 10/25).

Stateline: Study Finds Aging Inmates Pushing Prison Health Care Costs
State spending on prisoner health care increased in 42 states between 2001 and 2008, with a median growth of 52 percent, according to a new report from The Pew Charitable Trusts. The primary driver of the cost spike is bigger and older prison populations. "Health care is consuming a growing share of state budgets, and corrections departments are not immune to this trend," said Maria Schiff, director of the State Health Care Spending Project, an initiative of Pew and the John D. and Catherine T. MacArthur Foundation (Vestal, 10/29).

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Editorials and Opinions

Viewpoints: Policies Being Canceled Were Once Considered Substandard; That Insurance 'Was Working For People'

Los Angeles Times: Remember When People Hated Their Health Insurance Plans?
The weirdest thing about the ongoing conniption about the cancellation of people's health insurance plans -- supposedly as a result of Obamacare -- is the notion that these are plans people liked, even loved. When did that happen? It wasn't so long ago -- months, even weeks -- when the health insurance companies were being roundly cursed for their ruthless mistreatment of individual health plan customers. Constant rate hikes. Cancellations after policyholders got sick. Endless hoops to jump through to file a claim or appeal a rejection (Michael Hiltzik, 10/31). 

Los Angeles Times: The Good Reasons Behind Those Obamacare Policy Cancellations
One of the (many) criticisms being leveled at the 2010 healthcare law is that it has caused insurers to cancel the policies covering thousands of Americans. The two main themes here are that President Obama lied when he said people would be able to keep their health plans, and that many insured Americans are being forced to trade low-cost policies for expensive ones. Little is being said, however, about why those policies are being canceled and whether that's a good thing (Jon Healey, 11/1).

The Wall Street Journal: A President Manqué
Some of us have been saying for years that the law was a bad idea in part because it was designed to force the cancellations of millions of insurance policies. This has now turned out to be true. And in Massachusetts Mr. Obama tweaked his former unqualified promise to say that his guarantee applied only to "the vast majority of people," adding that the terminations were "a central premise of the Affordable Care Act from the very beginning." ... But the insurance was working for people, which is why they bought the policies. If the federal exchanges really were better, Mr. Obama wouldn't have needed to outlaw the old product and compel everyone to buy the new, government-approved version (10/31).

The Washington Post: Obamacare Laid Bare
Every disaster has its moment of clarity. Physicist Richard Feynman dunks an O-ring into ice water and everyone understands instantly why the shuttle Challenger exploded. This week, the Obamacare O-ring froze for all the world to see: Hundreds of thousands of cancellation letters went out to people who had been assured a dozen times by the president that "If you like your health-care plan, you'll be able to keep your health-care plan. Period." The cancellations lay bare three pillars of Obamacare: (a) mendacity, (b) paternalism and (c) subterfuge (Charles Krauthammer, 10/31).

Los Angeles Times: Obamacare Debate: Will Costlier Insurance Plans Hurt The Middle Class
Forget Obamacare's website glitches. The outrage over the bungled Healthcare.gov launch has given way to sticker shock over the new insurance plans that force individuals to pay significantly more for comprehensive coverage (Alexandra Le Tellier, 10/31).

Los Angeles Times: Inept Techies And Sneaky Insurers Are The Bane Of Obamacare
In their quest to gut Obamacare, Republicans have been given a big boost by two groups that were supposed to provide the new healthcare exchange a proper rollout: the contractors who built healthcare.gov and the insurance companies who still dominate the American healthcare system (David Horsey, 10/31). 

The Washington Post: There's Time To Fix The Affordable Care Act
It takes chutzpah, or perhaps just an extraordinary lack of self-awareness, to argue vehemently that a program should not be implemented — and, when it is, complain it isn't being implemented well enough. But that seems to be the new Republican position: We want the Affordable Care Act, and we want it now (Eugene Robinson, 10/31).

The Washington Post: Obama Switched Stories To Sell Obamacare
For several days it's been bugging me. Didn't the president once argue with Republicans about the point now at issue, namely that his bill would force individuals out of the plans they wanted to keep? Maybe I had imagined it. Then it hit me — the 2010 health-care summit! Yup, there it is in the archives of the White House Web site (Jennifer Rubin, 10/31). 

The Washington Post: What Obamacare Has Cost Democrats
In one of the few political jokes attributed to a physicist, Ernest Rutherford once described a public official as being "like a Euclidean point: he has position without magnitude." With a change of pronoun, he could have been describing Health and Human Services Secretary Kathleen Sebelius, who ignored internal warnings about flaws in HealthCare.gov, botched its rollout, minimized her involvement and blamed her contractors. Now, in congressional testimony, she has accepted responsibility without the inconvenience of accountability or the demonstration of competence (Michael Gerson, 10/31). 

The Baltimore Sun: Obama, And Obamacare, Falter Under Divided Government
It turns out that many private insurers have notified their purchasers they will be losing their existing plan because it didn't meet the new federal law's requirements. President Obama accused them of "being grossly misleading" if they were "peddling the notion that insurers are cancelling people's plan without mentioning that almost all the insurers are encouraging people to join better plans" with the same or another carrier at the new public marketplaces, sometimes at cheaper prices. That contention is not likely to assuage the hordes of previously insured Americans who took at face value President Obama's categorical assurance that no one would take away their plan "no matter what." Once again, a politician's campaign promise will have fallen flat to those ears (Jules Witcover, 11/1).

USA Today: Dems May Have To Admit Obamacare Tax Increase
Ten Senate Democrats, all in vulnerable seats, have proposed extending the healthcare law's enrollment period because people still can't sign up at Healthcare.gov. More precisely, they seek to delay collecting the tax penalty for failing to buy insurance under Obamacare's individual mandate. However, this congressional retreat raises a difficult political question for the president and congressional Democrats: They must now admit that Obamacare's individual mandate is actually a tax, something they've resisted doing in public for years (Randy Barnett and Josh Blackman, 10/31).

Health Policy Solutions (a Colo. news service): Opposition To Affordable Care Act Could Have Consequences For Millions
National and, more important, state opposition to the ACA has led to implementation roadblocks, limited outreach and education and a health-insurance coverage gap that will leave more than 5 million Americans under the federal poverty level without health insurance. Access to health care and the effectiveness of the Affordable Care Act for many Americans could be determined by which state they live in – and the degree to which it worked to implement the ACA (Bob Semro, 10/31).

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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.