Daily Health Policy Report

Thursday, November 15, 2012

Last updated: Thu, Nov 15

KHN Original Reporting & Guest Opinion

Health Reform

Administration News

Capitol Hill Watch

Health Care Marketplace

Campaign 2012


State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

States Count Down To Decisions On Health Exchanges

Kaiser Health News staff writers Phil Galewitz and Alvin Tran report: "With a federal deadline looming Friday, 10 states remain undecided about whether to build state-based online insurance markets designed to help millions of people buy health coverage starting next October" (Galewitz and Tran, 11/14). Read the story.

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Computer Issues May Hamper Online Markets

Kaiser Health News staff writer Julie Appleby reports: "New online insurance markets set to begin selling health coverage to consumers next October may be hampered by delays in launching a key computer program, according to state consultants and insurance regulators. State regulators learned late last week that an electronic system most insurers will use to submit their policies for state and federal approvals won’t be ready for testing next month, as originally planned. The lag is being blamed on the wait for several regulations from the Obama administration, which are needed to update the software" (Appleby, 11/14). Read the story.

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Capsules: Hospitals, Home Health Care Services Lobby Against Cuts; Progressive Group Recommends $385 Billion In Health Cuts; Providers File The Bulk Of Medicare Appeals; Employer Health Costs Rise 4 Percent, Lowest Boost Since 1997

Now on Kaiser Health News' blog, Mary Agnes Carey reports on health industry lobbying related to the deficit deal: "As lawmakers and President Barack Obama discuss possible changes to federal entitlement programs as part of a larger deal to avoid the fiscal cliff, expect provider groups to make their case loud and clear: Don't cut us" (Carey, 11/15).

In addition, Phil Galewitz reports on a budget deficit cutting plan advanced by the Center for American Progress: "Hospitals, drug companies, nursing homes and health plans would lose billions in Medicare funding over the next decade under a budget deficit cutting plan recommended by the Center for American Progress, a left-leaning think tank which has close ties to President Barack Obama and former President Bill Clinton" (Galewitz, 11/14).

Also on Capsules, Susan Jaffe writes about Medicare appeals: "Hospitals, physicians, medical equipment suppliers and other providers also filed 85 percent of the cases decided by the administrative law judges in fiscal year 2010. Some providers get plenty of practice, with 96 'frequent filers' responsible for one-third of the 40,682 appeals submitted to the judges, the IG found" (Jaffe, 11/15).

And Jay Hancock reports on employer health costs: "Furnishing new evidence of slower growth in health costs, consulting firm Mercer said Wednesday that employers spent 4.1 percent more on health benefits this year than in 2011. It was the smallest increase in 15 years" (Hancock, 11/14). Check out what else is on the blog

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Political Cartoon: 'Good Heavens!'

Kaiser Health News provides a fresh take on health policy developments with "Good Heavens!" By Chris Wildt.

Meanwhile, here is today's health policy haiku:


The health law did it --
It's because of those 'gifts' ...
That's what Romney says.

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

Health Exchange Status Check: Will States, Feds Be Ready?

States face a Friday deadline to indicate whether they plan to establish their own online health insurance markets, or allow the federal government to do it.  Meanwhile, debate continues about whether delays in updating essential software and other glitches could hamper the start of enrollment in the markets beyond the Oct. 1, 2013 target specified in the health law.

Kaiser Health News: States Count Down To Decisions On Health Exchanges
With a federal deadline looming Friday, 10 states remain undecided about whether to build state-based online insurance markets designed to help millions of people buy health coverage starting next October (Galewitz and Tran, 11/14). 

Kaiser Health News: Computer Issues May Hamper Online Markets
New online insurance markets set to begin selling health coverage to consumers next October may be hampered by delays in launching a key computer program, according to state consultants and insurance regulators. State regulators learned late last week that an electronic system most insurers will use to submit their policies for state and federal approvals won't be ready for testing next month, as originally planned. The lag is being blamed on the wait for several regulations from the Obama administration, which are needed to update the software (Appleby, 11/14). 

CQ HealthBeat: Top HHS Official: Exchanges Will Be Ready To Go By October
Health insurance exchanges in the states will be up and running by the time enrollment begins in October 2013, a top Health and Human Services official vowed Wednesday, just two days before the deadline for states to declare whether they will operate their own exchanges. Michael Hash, director of the HHS Office of Health Reform, also said that on Jan. 1, the department will announce those states that have been approved to run their own exchanges. By Friday, states that want to operate the new marketplaces on their own must let HHS know, although under a new timeline announced last week they have another month to submit additional required paperwork (Norman, 11/14).

The New York Times: Health Law Has States Feeling Tense Over Deadline
The days since President Obama won re-election have been marked by tension and angst in Republican-led states like Iowa, where Gov. Terry Branstad has waited until the last minute to decide whether to create a crucial tool for people to get medical coverage under Mr. Obama's health care law (Goodnough and Cooper, 11/14).

McClatchy: States Face Friday Deadlines On Health Insurance Exchanges
With the prospect of outright repeal all but gone, the nation’s health care overhaul is proceeding, and states that once resisted the politically divisive law now must decide how to implement its most innovative aspect: the online health-insurance shopping malls known as exchanges. Beginning next year, the law requires states to establish Internet marketplaces in which individuals can compare and purchase private health insurance or, if eligible, enroll in public Medicaid coverage. States that want to run their own exchanges without federal involvement have until Friday to notify the Department of Health and Human Services, but they get until Dec. 14 to provide the details (Pugh, 11/14).

Modern Healthcare: Setting Up Exchanges May Be Tough For Latecomers, Experts Say
States that have waited until after the Nov. 6 federal election to decide to pursue an insurance exchange face an "enormous lift" that could limit the number that will operate such a marketplace, according to exchange experts. A leader of the Maryland exchange, which state officials have spent two years designing and building, questioned the ability of states to begin planning now and start enrolling beneficiaries by October 2013 (Daly, 11/14).

In related news, GOP governors are asking for more time and information before they have to make decisions about whether to carry out key provisions of the health law -  

Los Angeles Times: Republican Governors Want More Time To Implement Healthcare Law
In a letter to the president Wednesday, Virginia Gov. Bob McDonnell and Louisiana Gov. Bobby Jindal, the current and incoming chairmen of the Republican Governors Assn., said governors do not have enough information to assess whether they should operate their own insurance exchanges in 2014 or leave the job to the federal government (Levey, 11/14).

CQ HealthBeat: GOP Governors Press Obama On Exchanges And Medicaid
Republican governors meeting in Las Vegas on Wednesday sent a letter to President Barack Obama asking for answers to their questions about the health care law, requesting greater flexibility in the state-run exchange deadline and seeking a meeting on Medicaid. "States are struggling with many unanswered questions and are not able to make comprehensive, far-reaching decisions prudently," said the letter, signed on behalf of the Republican Governors Association by outgoing chairman Bob McDonnell of Virginia and incoming chairman Bobby Jindal of Louisiana (Adams, 11/14).

CQ HealthBeat: Fed Decision On Partial Medicaid Expansion May Wait Until Summer, Salo Predicts
State officials may have to wait until summer to get a key piece of information they need to help them decide whether to expand their Medicaid programs under the health law — whether the Obama administration will permit a partial expansion, a top state Medicaid representative predicted Wednesday. States have precious little time to gear up for the 2014 start of coverage expansion, but the administration could delay a decision on partial expansion until July, Matt Salo, executive director of the National Association of Medicaid Directors, told business executives at a Washington, D.C. meeting of the National Business Coalition on Health and in an interview afterward (Reichard, 11/14).

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Who's In? Who's Out? Who's Yet To Decide?

With the deadline looming, news outlets report on the positions states are taking regarding the establishment of state-based health insurance exchanges.  

The Associated Press: Calif. Health Board OKs Plan For Insurance Exchange
The board overseeing California's efforts to establish an insurance marketplace for providing affordable health care approved its operational blueprint Wednesday, an essential step toward meeting a key deadline under the federal health care reform law. The governor's office is expected to forward the plan to the Obama administration on Friday, the deadline for states to notify the federal government about whether they plan to establish health care exchanges (Verdin, 11/14).

The Associated Press: Branstad: Too Much Still Unknown On Health Insurance Exchange
Gov. Terry Branstad plans to tell the federal government Friday that Iowa still doesn't have enough information to move forward with a state-based insurance marketplace under the new federal health care law, a spokesman said Wednesday. The federal government has imposed a Friday deadline for states to confirm whether they will create their own health exchanges for consumers and small businesses (11/15).

The Associated Press: New Mexico Moves Ahead With Health Exchange
Gov. Susana Martinez's administration is moving ahead to establish a state-run clearinghouse to help small businesses and tens of thousands of individuals find affordable health insurance they currently lack. A fight over the exchange, however, could break out in next year's Legislature (Massey, 11/14).

The Associated Press: Mike Chaney Sends Mississippi Plans For Insurance Exchange To Feds
Mississippi's insurance commissioner is going ahead with a state health insurance exchange, over objections from Gov. Phil Bryant, a fellow Republican. Commissioner Mike Chaney sent a letter Wednesday to the U.S. Department of Health and Human Services saying Mississippi will run its own exchange. He said the state will submit the full plan by Friday (Amy, 11/14).

The Associated Press: Pence Eyes Health Plan Link
Gov.-elect Mike Pence has ruled out building a state-run health insurance exchange but appears to be leaving open the option of running a joint venture with the federal government as a critical decision deadline draws near. State leaders have until Friday to declare whether they will manage their own programs for providing insurance plans under the federal health care law (LoBianco, 11/15). 

Anchorage Daily News/McClatchy: Alaska Rejects State-Run Health Insurance Exchange
Gov. Sean Parnell announced in July that Alaska would not create a state-run health insurance exchange, and he is sticking by that, Parnell spokeswoman Sharon Leighow said Tuesday. Under the federal Affordable Care Act, each state is supposed to have an exchange, a marketplace where residents can shop for private health insurance and apply for federal subsidies to help pay for it, if they are eligible. States can create the exchanges on their own, or do it in partnership with the federal government, or leave the whole project to the U.S. Department of Health and Social Services (Shinohara, 11/15).

Bloomberg: Florida Governor Scott Drops Opposition To Health Law
Florida Governor Rick Scott dropped his opposition to President Barack Obama's health overhaul, saying he wants to negotiate on the issue that began his political career. "I don't think anyone involved in trying to improve health care should say, 'no, no, no,'" Scott, a 59-year-old Republican, told the Associated Press. "Let's have a conversation." Scott's conversion came one week after Election Day, when Florida voters supported Obama's re-election and struck down a constitutional amendment aimed at making it harder to implement the health law (Bender, 11/14).

The Arizona Republic: Brewer's Decision Looms On Health-Care Act
With the nation's health-reform law firmly in place, Gov. Jan Brewer must declare this week whether Arizona will play a pivotal role in the sweeping health-care overhaul or hand over that duty to the federal government. Arizona and other states must decide by Friday whether to establish an Internet-based marketplace for consumers and small businesses to purchase health insurance or cede that authority to the federal government. ... So far, Brewer has not tipped her hand (Alltucker, 11/14).

Politico Pro: Walker Cites 'Significant Concerns' About Wisconsin Exchange
Scott Walker said here Wednesday that Wisconsin will announce on Friday whether it will set up its own health exchange — but he's already voicing some serious worries about the consequences if it does. Weighing options he sees as flawed and insisting that he remains undecided, the governor sounded torn and conflicted during a news conference at the Republican Governors Association (Hohmann, 11/15).

North Carolina Health News: NC Health Benefits Exchange In Holding Pattern
As deadlines loom for states to tell the federal government their plans for implementing the Affordable Care Act (known as Obamacare), big questions still remain about how the law will look in North Carolina. The most immediate question is what choice the state will make for running a health benefits exchange – an online marketplace where state residents can go to shop for insurance options…. States that choose not to run their own exchanges will be defaulted to a federally run exchange, something many North Carolina legislators have said they would prefer not happen. During the 2011 session, the state House of Representatives passed a bill expressing that intent, but the bill did not make it through the state Senate (Hoban, 11/14).

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Administration News

Obama Pledges 'Substantive Changes' To Medicare As Part Of Budget Deal

President Barack Obama told some of the nation's top CEOs Wednesday that he was committed to "substantive changes" to Medicare and other entitlement programs, but Senate Democrats are warning him not to cave on entitlements as negotiations with congressional leaders move forward. Also in the mix, health care providers lobby to counter possible Medicare cuts.

The Wall Street Journal: At President's Meeting With Executives, Some Push, Pull And Give
President Barack Obama's meeting with top chief executives Wednesday included a frank exchange about the White House's chilly relationship with business executives and firm support for tackling the country's fiscal problems, several people familiar with the gathering said. … He also communicated to the chief executives, in a tone several described as persuasive, that he was committed to substantive changes in Medicare and other entitlement programs, which make up a large portion of federal spending and are projected to grow quickly in the next few decades as more Americans retire (Paletta and Linebaugh, 11/14).

Politico: Senate Liberals To Obama: 'Don't Buckle' On Cliff
Liberal Democrats in the Senate are warning President Barack Obama not to cave on taxes and entitlements in deficit talks set to begin this week, a move that could complicate efforts by the White House to win the backing of GOP leaders. West Virginia's Jay Rockefeller and Tom Harkin of Iowa are circulating a letter among their Democratic colleagues that calls on the president to stand firm on revenue, entitlement programs and spending cuts. They're hoping to get as many as 30 Senate Democrats to sign on, Rockefeller said (Sloan and Raju, 11/14).

Kaiser Health News: Capsules: Hospitals, Home Health Care Services Lobby Against Cuts
As lawmakers and President Barack Obama discuss possible changes to federal entitlement programs as part of a larger deal to avoid the fiscal cliff, expect provider groups to make their case loud and clear: Don't cut us (Carey, 11/15).

In addition, the Medicare NewsGroup examines how Medicare fits into "fiscal cliff" negotations and in the spending cuts known as sequestration -

The Medicare NewsGroup: What Part Does Medicare Play In The Fiscal Cliff Discussions?
Policymakers have begun discussing a potential package of deficit-reduction measures to stop the nation from going over the "fiscal cliff," a series of mandatory budget cuts and tax increases scheduled to take effect starting in January 2013. These deficit-reduction measures could potentially include various cuts and/or alterations to Medicare, and there is growing speculation about how Congress will change the program to contain federal spending. Conversations are now underway as President Obama is set to meet with Congressional leaders on Friday (11/15).

The Medicare NewsGroup: What Does Sequestration Mean To Medicare?
Unless Congress passes an alternate deficit-reduction package, Medicare provider payments will be cut by 2 percent beginning in fiscal year 2013 as part of the spending reductions required by the Budget Control Act of 2011. The cuts will be applied to provider payments for services administered under Medicare Hospital Insurance (Part A) and Medicare Medical Insurance (Part B) and contractual payments to Medicare Advantage Plans (Part C) and Medicare Prescription Drug Plans (Part D), according to the Congressional Budget Office (CBO). … That means about 90 percent of Medicare spending is limited to 2 percent in cuts, and 8 percent is completely exempt from sequestration. The remaining 2 percent of Medicare spending would be subject to a 7.6 percent cut in 2013 because it falls under non-exempt nondefense mandatory programs (11/15).

Headlines also focus on a plan to trim health costs from a think tank close to the White House -

Kaiser Health News: Capsules: Progressive Group Recommends $385 Billion In Health Cuts
Hospitals, drug companies, nursing homes and health plans would lose billions in Medicare funding over the next decade under a budget deficit cutting plan recommended by the Center for American Progress, a left-leaning think tank which has close ties to President Barack Obama and former President Bill Clinton (Galewitz, 11/14).

The Boston Globe: New Plan Offered To Cut Cost Of Medicare
With Congress and President Obama poised to enter yet another budget battle, the Center for American Progress released a new plan Wednesday that the organization says will stem the rising cost of health care without hurting seniors. The plan would cut $385 billion from the federal budget over a decade through a series of proposals that target waste in the health care system and modernize Medicare (Jan, 11/15).

Some lawmakers do not view Medicaid as off limits -

CQ HealthBeat: Fiscal Cliff Negotiators Eye Tens Of Billions In Medicaid Savings, Medicaid Expert Says
Lawmakers eying possible Medicaid cuts in negotiations addressing the tax hikes and spending cuts known as the fiscal cliff have limited options to achieve the level of savings they are discussing, among them a delay in the start of the health care law, a leading Medicaid expert said Wednesday (Reichard, 11/14).

Politico Pro: CAP: States Won't Expand Medicaid If It's Cut In Fiscal Cliff Talks
Cutting Medicaid as part of the fiscal cliff discussions could discourage states from expanding the program under the health reform law, according to some of the law's strongest supporters. "With the Supreme Court decision on the Affordable Care Act, I think there are governors out there, even Democratic governors, who would take a very strong signal if all of a sudden the federal government was taking back money from Medicaid," Neera Tanden, president of the Center for American Progress and one of the law's crafters, said Wednesday at a briefing on health care savings with reporters. Governors are going to be deciding over the next several months whether to expand Medicaid under the ACA — an option provided to them after the Supreme Court ruled that the expansion could not be mandatory, as it was written in the law (Haberkorn, 11/14).

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Capitol Hill Watch

Pelosi Opts To Stay House Democratic Leader; GOP Selects Woman To House Leadership Team

Meanwhile, some Republicans are pushing for creation of a new health committee in the House.

Los Angeles Times: Pelosi Decides To Remain House Democratic Leader
In 2007, she became speaker — and the first Californian to head the House — overseeing passage of the most far-reaching healthcare overhaul since the creation of Medicare, an economic stimulus program, and the revamping of financial regulations, often with little or no Republican support. But while she — and her Democratic majority — ruled the House, she became a favorite Republican campaign target as evidence of what's wrong with Washington (Simon, 11/14).

The Wall Street Journal: House GOP Elevates Woman To Key Post
House Republicans turned aside an effort by a group of conservative lawmakers to elevate their favored candidate to a top leadership position, choosing instead a female lawmaker who some in the party thought could help close the gap with women voters. The selection of Rep. Cathy McMorris Rodgers of Washington state comes after last week's presidential and Senate elections showed the party faces a challenge in reaching women (Bendavid and O’Connor, 11/14).

Medpage Today: Doc May Be Top Dem On House Health Panel
The lone Democratic physician with a vote in the House of Representatives is being mentioned as the likely minority leader for a powerful health subcommittee next year. Rep. Jim McDermott, MD (D-Wash.), is next in seniority to lead Democrats on the House Ways and Means Health Subcommittee after the defeat of longtime congressman Pete Stark (D-Calif.). … Subcommittee chairs are decided upon by the committee's membership, and nothing is final yet. Yet McDermott does have seniority and has been active in health affairs both on Ways and Means and the full House, McDermott spokesman Kinsey Kiriakos told MedPage Today (Pittman, 11/14).

CQ HealthBeat: New Health Care Committee In House Sought By Three Republicans
Three House Republicans want to create a new committee that would have complete jurisdiction over health care issues, calling it the best opportunity for repealing the 2010 health care law. Reps. Doc Hastings of Washington, Reid Ribble of Wisconsin and Rob Woodall of Georgia plan to offer an amendment to create the committee at the Republican organizing conference Thursday. Because Democrats retained control of the Senate and the White House, the lawmakers say, Republicans must make the most of their control over the House (Ethridge, 11/14).

Politico Pro: Some House Members Want One Health Supercommittee
Several House Republicans are pushing for an entirely new committee to consolidate all health care matters under one roof, but the effort is likely to be stymied by GOP committee heads who don't want to cede jurisdictional territory. Rep. Doc Hastings (R-Wash.), who circulated a letter with two colleagues Wednesday, says a new, centralized committee dealing solely with health care matters would make it easier to work on Medicare, Medicaid and oversight of the health care law's rollout — instead of leaving health care jurisdiction scattered among eight different committees and multiple subcommittees. Hastings also said that such a committee would enable Republicans to plan how to repeal the federal health law — in 2017 when President Barack Obama leaves office (Cunningham, 11/14).

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Sebelius Subpoenaed To Answer Questions On Health Law Promotion

The GOP-controlled House Ways and Means Committee has subpoenaed Health and Human Services Secretary Kathleen Sebelius to answer questions over how the administration is promoting the health law.

Los Angeles Times: Sebelius Subpoenaed Over Efforts To Promote Health Care Reform
Despite last week's election, House Republicans kept up their attack on the Obama administration’s 2010 health care law Wednesday, as the House Ways and Means Committee subpoenaed Secretary of Health and Human Services Kathleen Sebelius for information about the administration’s efforts to promote the Affordable Care Act (Levey, 11/14).

Politico: Ways And Means Issues Subpoena For Kathleen Sebelius
The House Ways and Means Committee has subpoenaed Health and Human Services Secretary Kathleen Sebelius, demanding that she reveal details of how the agency is promoting the health reform law, according to the committee. The election may have iced efforts to repeal the law on the whole, but House Republicans are indicating they're full speed ahead on intense oversight of how the Obama administration is enacting the legislation (Haberkorn, 11/14).

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FDA Chief Urges Greater Oversight Of Drug Compounders; Republicans Skeptical

Members of the House Energy and Commerce Committee Wednesday questioned Food and Drug Administration head Margaret Hamburg and the co-owner of a compounding pharmacy linked with a deadly meningitis outbreak. Hamburg called for Congress to give the FDA greater oversight of compounding pharmacies, which was met with skepticism by Republican lawmakers.

NPR: Lawmakers Clash With FDA Over Meningitis Outbreak
Members of a House subcommittee clashed repeatedly Wednesday with U.S. Food and Drug Commissioner Margaret Hamburg over the outbreak of meningitis caused by contaminated steroid injections (Stein, 11/14).

The New York Times: FDA Chief Seeks Expanded Authority To Improve Safety Of Drug Compounders
The commissioner of the Food and Drug Administration on Wednesday called on Congress to empower the agency to better police compounding pharmacies like the one at the center of a national meningitis outbreak. But Republican lawmakers pushed back, arguing that the agency has enough authority, leaving it unclear whether the House would support efforts to increase oversight (Tavernise, 11/14).

Politico: Lawmakers Lambaste FDA Chief Over Fatal Outbreak
Appearing under subpoena before a House panel, the co-owner of the compounding pharmacy linked to the meningitis outbreak that has killed more than 30 people took the Fifth Amendment and refused to answer questions Wednesday (Norman, 11/15).

Reuters: U.S. Congress Takes Aim At FDA Over Meningitis Outbreak
Members of a congressional committee investigating the deadly U.S. meningitis outbreak accused the Food and Drug Administration on Wednesday of failing to prevent the crisis by moving too slowly against a Massachusetts pharmacy. Tainted steroids from the pharmacy, New England Compounding Center (NECC), have so far killed 32 people and sickened 461 in 19 states, according to updated figures from the U.S. Centers for Disease Control and Prevention (Morgan and Berkrot, 11/14).

Medpage Today: Lawmakers Grill FDA Chief Over Compounders
Democratic lawmakers voiced support for giving the FDA greater authority to regulate such pharmacies. But the agency may be slow to gain that power -- if it does at all -- as Republican leaders voiced a more cautious approach, saying the FDA may already have all the authority it needs to have prevented the current outbreak, which has killed 32 people. Hamburg told the House Energy and Commerce Committee that her agency's authority over compounders is unclear (Pittman, 11/14).

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Health Care Marketplace

Employer Health Costs Rise 4.1% -- Slowest Growth In 15 Years

Employer health costs rose just 4.1 percent nationally in 2012 -- the slowest rate of growth in 15 years -- as employers offer more high-deductible plans and increase employee cost-sharing, a new report from consulting firm Mercer has found.

Los Angeles Times: More Employers Embrace High-Deductible Health Plans To Pare Costs
With open enrollment for benefits in full swing, U.S. workers are seeing more high-deductible health plans from cost-conscious employers. A new report finds that 36 percent of large employers offered consumer-directed, high-deductible health plans in 2012, up from 14 percent five years ago. Enrollment in those plans has risen to 16 percent of all covered employees, compared with 5 percent in 2007, according to benefits consultant Mercer (Terhune, 11/14).

Kaiser Health News:  Employer Health Costs Rise 4 Percent, Lowest Boost Since 1997
Furnishing new evidence of slower growth in health costs, consulting firm Mercer said Wednesday that employers spent 4.1 percent more on health benefits this year than in 2011. It was the smallest increase in 15 years (Hancock, 11/14).

Richmond Times-Dispatch: Employee Health Costs In Virginia Up 6.9 Percent, Survey Finds
Employee health benefit costs in Virginia rose 6.9 percent in 2012, a higher percentage increase than from last year. But Virginia employers expect employee health plan costs to increase only 5.8 percent in 2013. The figure would be higher but employers are managing costs by taking steps such as raising deductibles, co-pays and co-insurance. The findings are in the Mercer 2012 National Survey of Employer-Sponsored Health Plans, which looks at employee health benefit cost trends and forecasts. Nationally, employee health benefit costs are still going up, but the rate of increase in the U.S. slowed in 2012. Companies on average paid 4.1 percent more per employee for health benefits than in 2011 (Smith, 11/14).

Milwaukee Journal Sentinel: Cost Of Providing Health Benefits Rises 4.1%, Lowest In 15 Years
The cost to employers of providing health benefits increased at the lowest rate in 15 years, rising 4.5 percent in the Milwaukee area and 4.1 percent nationally this year, according to an annual survey by Mercer, a benefits consulting company. Employers in the Milwaukee area will spend an average of $11,867 per worker on health benefits this year. The estimated increases -- which include the employee's share of the premium -- were after changes in health plan designs, such as raising deductibles and co-pays (Boulton, 11/14).

The Oregonian: Many Local Employers Asking Workers To Pay More For Health Benefits In 2013, Survey Finds
Local employers say they'll make changes to health benefits to curb cost increases by nearly half, often by shifting costs to employees, according to a new survey. A survey of 64 employers in Oregon and Southwest Washington by human resources consultant Mercer revealed that employers thought their insurance costs would increase 3.6 percent in 2013. However, making no changes to their plan design or vendor, costs would increase 6.8 percent, they estimated. In 2012, health benefit costs increased 5.6 percent, employers said. About 41 percent said they will ask employees to shoulder more of their plan's costs in 2013 by raising deductibles, copays or out-of-pocket maximums or by increasing the workers' share of premium contributions (Hunsberger, 11/14).

Meanwhile, The Associated Press reports on new caps for employee health accounts -

The Associated Press: Limit Debuts In 2013 For Employee Health Accounts
Flexible spending accounts that set aside pre-tax wages for health care costs will have a cap in 2013 that workers need to keep in mind as they plan for next year. Benefits-related open enrollment periods, the lone chance employees generally have each year to set up these accounts, are winding down for many companies (11/14).

In other news about insurance coverage and access to health care -

The Wall Street Journal: After Divorce, Many Women Lose Health Insurance
Shedding light on the issues of divorce and health care, a new University of Michigan study estimates that 65,000 American women become uninsured each year as a result of marital dissolution. Indeed, among married women who had health insurance and then divorced, 17 percent were uninsured six months later. There was also a big shift among divorced women from private insurance to public insurance, such as Medicaid. After divorce an estimated 115,000 women each year lose private coverage, the study reported, but many are bailed out by government programs (Akst, 11/14).

The Associated Press/Washington Post: Census: Fuller Poverty Picture Finds 49.7M Are Poor, Factoring In Medical And Work Expenses
The ranks of America’s poor edged up last year to a high of 49.7 million, based on a new census measure that takes into account medical costs and work-related expenses (11/14).

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Campaign 2012

Romney Says Loss The Result Of Obama's 'Gifts' To Certain Constituences

Certain provisions of the 2010 health law were the key "gifts" GOP presidential hopeful Mitt Romney said were to blame for his loss. Other Republican leaders, including Louisiana Gov. Bobby Jindal fiercely rebuffed Romney's comments.   

The New York Times' The Caucus: Romney Blames Loss On Obama's 'Gifts' To Minorities And Young Voters
Saying that he and his team still felt "troubled" by his loss to President Obama, Mitt Romney on Wednesday attributed his defeat in part to what he called big policy "gifts" that the president had bestowed on loyal Democratic constituencies, including young voters, African-Americans and Hispanics. … The president's health care plan, he said, was also a useful tool in mobilizing black and Hispanic voters. Though Mr. Romney won the white vote with 59 percent, according to exit polls, minorities coalesced around the president in overwhelming numbers: 93 percent of blacks and 71 percent of Hispanics (Parker, 11/14).

Los Angeles Times: Romney Attributes Loss To 'Gifts' Obama Gave Minorities
Romney's frank analysis echoed his secretly taped comments at a May fundraiser, where he told a small group of donors that 47% of the electorate was unlikely to vote for him because they paid no income taxes and were dependent on government. It followed his running mate Paul D. Ryan's assertion that Obama's win stemmed from turnout among "urban" voters. … Young voters, Romney said, were motivated by the administration's plan for partial forgiveness of college loan interest, the extension of health coverage for students up to age 26 on their parents' insurance plans and free contraception coverage under Obama's healthcare plan, which he credited with ushering greater numbers of college-age women into Obama's coalition (Reston, 11/14).

The Washington Post: Romney: Obama's Gift Giving Led To Loss
Mitt Romney is blaming his loss in the presidential election on "Obamacare" and other "gifts" he says President Obama handed out to African Americans, Hispanics and other core supporters, according to news reports Wednesday. The defeated Republican candidate told donors in a conference call that Obama targeted those demographics, along with young voters and women, through programs such as health-care reform and "amnesty" for children of illegal immigrants, according to articles posted online by the New York Times and Los Angeles Times (Markon and Tumulty, 11/14).

The Hill: Romney: 'Gifts' In Obama's Health Care Law Helped Him Win
Mitt Romney suggested Wednesday that President Obama won a second term largely because of policies in his healthcare law. In comments to a group of donors, Romney said he lost in part because of the "gifts" Obama had given to certain demographic groups — and a lot of the specific gifts he mentioned came in the form of healthcare benefits. "You can imagine for somebody making $25,000 or $30,000 or $35,000 a year, being told you're now going to get free health care, particularly if you don't have it, getting free health care worth, what, $10,000 per family, in perpetuity, I mean, this is huge. Likewise with Hispanic voters, free health care was a big plus," Romney said, according to the New York Times (Baker, 11/14).

CNN: Jindal Slams Romney For 'Gifts' Comment About Minorities, Young Voters
Republican Gov. Bobby Jindal of Louisiana fiercely shot back at Mitt Romney's claim Wednesday that President Barack Obama outmatched the 2012 Republican presidential nominee by offering "gifts" to African-Americans, Hispanics and young voters. "I absolutely reject that notion," Jindal, who was a surrogate for Romney's campaign, said at the Republican Governors Association conference in Las Vegas. ... Romney, who lost to Obama by 126 electoral votes, said the president courted voters by offering policies - some of them this election year - that appealed to key constituencies. "With regards to the young people, for instance, a forgiveness of college loan interest, was a big gift," Romney said, according to The New York Times. "Free contraceptives were very big with young college-aged women," he continued. "And then, finally, Obamacare also made a difference for them, because as you know, anybody now 26 years of age and younger was now going to be part of their parents' plan, and that was a big gift to young people Killough and Bohn, 11/14).

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The Latest Fraud Target: Medicaid Personal-Care Programs

The Center For Public Integrity/The Washington Post: Blistering Inspector General Report Says Feds Are Failing To Fight Medicaid Home Care Fraud
A Health and Human Services Office of the Inspector General (OIG) report scheduled to be released today faults the Centers for Medicaid and Medicare Services (CMS) for inadequate oversight of personal care services programs, whose costs are shared by states and the federal government, as is the norm for Medicaid. The report, which brings together six years of OIG investigations and 23 reports on the topic, describes a program hindered by poor claims documentation, insufficient monitoring of claims data for fraud and waste, and a crazy-quilt of varied requirements for personal care workers in different states (Eaton, 11/14).

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State Watch

State Roundup: Medicaid Overruns Drive Budget Problems

News outlets report on health news in California, Connecticut, Colorado and Florida.

Los Angeles Times: 11% Of Children In California Are Uninsured, Study Says
Children in California are more likely to be uninsured than children nationwide, with 1.1 million lacking health coverage in 2011, according to a new study by the Keck School of Medicine of USC. About 11 percent of children lacked insurance last year -- and they were less likely to seek medical care than those with coverage, the authors reported. The study, released Wednesday by the California HealthCare Foundation, detailed children's insurance trends over a 10-year period (Gorman, 11/14).

CT Mirror: Malloy's Budget Chief Confirms $365M State Deficit
The state budget is $365 million in the red, nearly double the level needed to compel Gov. Dannel P. Malloy to prepare a plan to lower the deficit, the governor's budget chief told legislators Wednesday. Office of Policy and Management Secretary Benjamin Barnes also confirmed in his testimony to the Appropriations Committee that huge cost-overruns in the state's Medicaid program, coupled with declining revenues, are driving the shortfall. "All told, these changes result in a projected deficit of $365 million" in the current fiscal year, wrote Barnes, whose next official budget estimates are due to Comptroller Kevin P. Lembo Tuesday. "Assuming they are certified by the comptroller on Dec. 1, (they) will require that the governor submit a deficit-mitigation plan to the General Assembly before the end of the calendar year" (Phaneuf and Becker, 11/14).

San Francisco Chronicle: Patients Allowed To Sue Nursing-Home Owners
The state Supreme Court on Wednesday allowed a group of patients to sue the owner of 16 nursing homes in Alameda County for allegedly violating California's nurse-staffing standards. The rules require long-term skilled-nursing facilities to provide each patient with 3.2 hours of nursing care per day. The patients claim homes owned by Covenant Care failed to meet those standards at least 35 percent of the time over a four-year period that started in December 2006 (Egelko, 11/14).

The Miami Herald: Health Care Reform Could Impact Clinics
With the Affordable Health Care Act set to go into effect in 2014, a group of community and medical leaders gathered Wednesday at the Jefferson Reaves Sr. Health Clinic in Overtown to talk about the act's potential impacts on community clinics. A panel of public health care experts, meeting as part of a World Diabetes Day forum, said centers like Jefferson Reaves are likely to face an influx of newly insured patients and a shortage of primary care doctors as the federal legislation kicks in. "The Affordable Health Care Act is going to change the world of community health centers enormously," said Dr. Robert Schwartz, professor and chairman of the family medicine and community health department at the University of Miami's Miller School of Medicine (Burch, 11/14).

Health Policy Solutions (a Colo. news service): Governor's Panel Finds Broad Support For Keeping Elderly, Disabled At Home
Elderly people and disabled Coloradans should be able to receive better care in their homes, according to new recommendations from TBD Colorado, a nonprofit advisory board that Gov. John Hickenlooper created to survey Coloradans over the past year to develop a bipartisan policy agenda. The recommendations also call for more focus on children’s health -- including healthier food and more physical education classes in schools -- along with integrated physical and behavioral health care for Medicaid patients. ... While there are much harder problems to tackle, potential legislation to keep needy people out of nursing homes proved to be the most popular agenda item to surface after meetings with more than 1,200 Coloradans in 100 communities (Kerwin McCrimmon, 11/14).

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Weekend Reading

Longer Looks: Learning To Laugh In The Doc's Office

Every week Shefali S. Kulkarni selects interesting reading from around the Web.

The Los Angeles Times: For Dentist With Student Debt, Repaying Is Like Pulling Teeth
His jaw clenched beneath a blue surgeon's mask, Opanin Gyaami jerks his right arm and pulls out a prize: the decayed tooth of patient Larry Butler, also known as state prison inmate J22312. By the time he is done, Gyaami's smock and mask are spotted with the inmate's blood. He gently pats Butler on the shoulder and wishes him well. The 71-year-old dentist reports to the state prison in Vacaville day after day, long past retirement age. He wishes he could have hung up his drill and forceps years ago, but he's still paying off a student loan. After borrowing $50,000 in the 1980s and ignoring payment notices, Gyaami owes more than $500,000 with penalties and interest. The Justice Department took him to court and is seizing $3,000 from his paycheck each month. ...By the time Gyaami graduated from Loma Linda University in 1983 with a degree in dentistry, he had taken out five loans to pay for his education, including $50,000 from the federally guaranteed Health Education Assistance Loan program. The special loan program, offered from 1978 to 1998, lent $4 billion to 157,000 aspiring doctors, dentists, podiatrists, chiropractors and other health professionals. The Department of Health and Human Services, which oversaw the loan program, reports that 935 of the borrowers are in default, owing $115 million collectively (Stuart Pfeifer, 11/12).

The Miami Herald: Baby Boomers: The Hooked Generation?
(A) 66-year-old Fort Lauderdale man, who asked that his real name not be used, is the new face of addiction: a baby boomer long past the typical youthful phase of experimentation. He's clean now, but as a member of Narcotics Anonymous, he says he meets plenty of older recovering addicts just like him. Local and national figures show that more people in their 50s and 60s are abusing illegal and prescription drugs. While the use of illicit drugs remains relatively uncommon among people 65 and older, the number of illicit drug users 50 to 59 years old tripled between 2002 and 2011, from 900,000 to 2.7 million, according to the National Institutes of Health. The increase even prompted the NIH to post its first consumer alert on its website, NIHSeniorHealth. More older adults are also seeking treatment for substance abuse. Drug-related hospitalizations and visits to emergency rooms were up 116 percent in the 55-to-64 age group from 2004 to 2010 (Ana Veciana-Suarez, 11/13).

The Daily Beast: A Proactive New Response To The Service-Member Suicide Crisis
"There are only two kinds of people that understand Marines," said U.S. Army Gen. William Thornson: "Marines and the enemy. Everyone else has a second-hand opinion." Working with the Corps to try and help stem its suicide crisis, I have come to learn that there is some truth to that claim—but if we can't bridge that gap, things aren't going to change. ... A few years ago, I was approached to do some short-term anonymous counseling at the Marine Corps Recruit Depot in San Diego. Being a psychotherapist, I was fascinated by the military and wanted the opportunity to work with its members. I put my private practice on hold for a couple of months and headed to the base with hopes of giving back. But by the end of my second week, not a single Marine had approached me. It didn't take long for me to realize that the likelihood of them voluntarily coming in for help was very slim. These are men and women that carry enormous pride, and asking for help can be seen as a sign of weakness. Plus, accessing mental-health services has the potential of hurting one's chance for promotion (Marjorie Morrison, 11/14).

American Medical News: How To Create A Positive Practice Environment
Before seeing a patient, family physician James W. Ferguson, MD, reviews the individual's medical chart and quickly runs through a few jokes. He's not trying to perform a stand-up routine for patients. He just wants to make them laugh a little. "We need some humor in medicine," said Dr. Ferguson, who has run a solo practice in East Islip, N.Y., for 30 years. "We need to lighten up and show that we're more than doctors. We're humans." Using humor with patients strengthens the physician-patient relationship, health professionals say. It makes physicians more approachable. And it can relieve patients' anxiety about the medical visit. Just as important, incorporating humor can rejuvenate physicians who experience burnout due to the challenges of their job, said Mark Greenawald, MD, associate dean for student affairs at Virginia Tech Carilion School of Medicine in Roanoke (Christine S. Moyer, 11/12).

The New York Times: The Problem Is Clear: The Water Is Filthy
Seville, with a population of about 300, is one of dozens of predominantly Latino unincorporated communities in the Central Valley (of California) plagued for decades by contaminated drinking water. It is the grim result of more than half a century in which chemical fertilizers, animal wastes, pesticides and other substances have infiltrated aquifers, seeping into the groundwater and eventually into the tap. An estimated 20 percent of small public water systems in Tulare County are unable to meet safe nitrate levels, according to a United Nations representative. In farmworker communities like Seville, a place of rusty rural mailboxes and backyard roosters where the average yearly income is $14,000, residents like Rebecca Quintana pay double for water: for the tap water they use to shower and wash clothes, and for the five-gallon bottles they must buy weekly for drinking, cooking and brushing their teeth. It is a life teeming with worry: about children accidentally sipping contaminated water while cooling off with a garden hose, about not having enough clean water for an elderly parent's medications (Patricia Leigh Brown, 11/13).

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Editorials and Opinions

Viewpoints: Obama Must Tell Allies That Entitlements Can't Be Excluded From Fiscal Deal; Medical Device Tax Will Thwart Innovation

The Washington Post: Entitlement Reform Must Be On The Table
As bipartisan negotiations over avoiding the "fiscal cliff" draw nearer, many of President Obama's core Democratic supporters are urging him to fix the debt through defense cuts and tax increases rather than by tackling Social Security, Medicare and other federal entitlement programs. It's a reprise of progressive resistance to the entitlement trims Mr. Obama contemplated during the abortive debt-reduction negotiations with House Speaker John A. Boehner (R-Ohio) last year. This time, though, the Democratic base is claiming vindication in the just-completed election. ... Any serious debt-reduction plan has to include revenue and defense cuts. But no serious one can exclude entitlements (11/14).

The Wall Street Journal: Stage Set For Next Act In Fiscal Drama
The plot is similar too: Mr. Obama and his Democratic allies in Congress want to raise tax rates on those with annual incomes over $250,000. Republicans don't. Everyone says they want to restrain the growth of spending on government benefit programs, but Republicans want a whole lot more of that than Democrats. The last performance ended poorly. The summer 2011 standoff over the federal debt ceiling frightened markets, business and consumers. It concluded with a pact that put off a resolution until this year's sequel. So, what is different? (David Wessel, 11/14).

The Denver Post: Time Has Come For Health Exchanges
The court has decided. The elections are over. It is time for the states that have been putting off action on establishing health insurance exchanges to get in gear. The Obama administration's announcement last week that states would get more time to decide whether they'll create their own exchanges gives states a little breathing room. But not much (11/14).

Politico: Medical Device Tax Would Thwart Innovation
Unfortunately, in fewer than 60 days, a new medical device tax will hit this innovative industry, and it threatens patient care and U.S. jobs. This onerous policy -- which is expected to cost more than $30 billion -- is already having a real-world, everyday impact on our health care system and our economy. Even though it doesn't take effect until Jan. 1, medical technology companies are already announcing job cuts and canceling plans to build plants to pay for the tax. Others are trimming budgets in important areas like research and development. Put simply, this is a tax on innovation, and it is going to hurt American workers and patients most (Dan Moore, Greg Sorensen and Timothy M. Ring, 11/14).

The Milwaukee Journal Sentinel: GOP Legislators Go Rogue Over Federal Health Care Law
Nine Republicans would like to take us back -- way back -- to 1832. ... They agreed with a tea party-aligned group, the Campaign for Liberty, that they support "nullification" of the Affordable Care Act - and "authorize state and local law enforcement to arrest federal officials attempting to implement the unconstitutional health care scheme known as Obamacare." ... States may not nullify federal laws -- and certainly may not arrest federal agents charged with enforcement of those laws. No matter how much this retrograde gang may wish it wasn't so, Obamacare is the law of the land (11/14).

Los Angeles Times: The Prescription Drug Toll
If one doctor's prescriptions might be connected to the unnecessary deaths of multiple patients over several years, the state should be asking questions. Times reporters Scott Glover and Lisa Girion analyzed 3,733 prescription drug-related deaths in four Southern California counties, revealing that just 71 doctors -- one-tenth of 1 percent in those counties -- had written prescriptions in 17 percent of such fatalities over six years. One doctor profiled in the stories published Sunday had prescribed medications for 16 patients who subsequently overdosed, according to coroner's reports (11/15).

Politico: Rx For Compounding Pharmacies
Since the deadly outbreak of fungal meningitis that has resulted in the worst public health disaster in recent history, the public has asked the question: How could this have happened? Most patients who receive a drug in their doctor's office or from their neighborhood pharmacy assume it has received the Food and Drug Administration's stamp of approval for safety and effectiveness. That was not the case for drugs manufactured at the New England Compounding Center, which masqueraded as a pharmacy to avoid more stringent regulation. Contaminated vials of injectable steroids from NECC have resulted in the loss of 32 innocent lives and illness of more than 438 people in 19 states. This deadly outbreak also has exposed a regulatory black hole in the world of pharmacology -- a hole created by years of patchwork federal law and woefully limited state regulation (Rep. Ed Markey, D-Mass., 11/14).

The Sacramento Bee: The State Worker: Retiree Health Care Still A Long-Term Problem For California
The sound of backslapping between Gov. Jerry Brown and union leaders who helped put his tax initiative over the top last week could soon turn to teeth-gnashing and bargaining-table-pounding as the administration takes on a touchy subject: retiree health care. The state estimates its long-term retiree medical commitments stand at $62 billion, and it has put virtually nothing aside to pay those obligations (Jon Ortiz, 11/15).

The Dallas Morning News: Counties Can Expand Health Care
We would hope the governor wouldn't block big counties like ours if they can finance an expansion of Medicaid on their own and with Washington's help. The purpose would be to take care of people within their counties, in a way that makes sense economically. As it is now, local tax rolls are burdened when uninsured residents show up in emergency rooms. The Legislature would have to give Texas counties that kind of flexibility in next year's session, and the governor must approve the concept (11/14).

Detroit Free Press: Renew Healthy Funding For Diabetes Research
Few things ignite passion in a family more than a child's diagnosis with a serious disease. I know that soon after my son Albert was first diagnosed with Type 1 diabetes (T1D) 16 years ago, my husband and I asked ourselves how we could help. We soon joined the many families across Michigan and throughout the U.S. who are doing all they can to advance research for better treatments, prevention and -- ultimately -- a cure for T1D. We knew little about T1D when Albert was diagnosed. We quickly learned that there is nothing one can do to prevent T1D, and at present nothing one can do to get rid of it. Its onset has nothing to do with diet or lifestyle. Instead, both genetic factors and environmental triggers seem to be involved (Cynthia Ford, 11/15).

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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.