Daily Health Policy Report

Friday, November 15, 2013

Last updated: Fri, Nov 15

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Administration News

State Watch

Editorials and Opinions

Other

KHN Original Reporting & Guest Opinion

Nearly 1,500 Hospitals Penalized Under Medicare Program Rating Quality

Kaiser Health News staff writer Jordan Rau reports: "More hospitals are receiving penalties than bonuses in the second year of Medicare’s quality incentive program, and the average penalty is steeper than it was last year, government records show. Medicare has raised payment rates to 1,231 hospitals based on two-dozen quality measurements, including surveys of patient satisfaction and—for the first time—death rates. Another 1,451 hospitals are being paid less for each Medicare patient they treat" (Rau, 11/14). Read the story and take a look at the interactive chart and a chart detailing bonuses and penalties by state. Also, on KHN's blog Capsules, you can listen to Rau discussing this new quality data on NPR's Morning Edition.

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What Consumers Need To Know About The Obama Plan For Canceled Health Policies

Kaiser Health News staff writers Jay Hancock, Julie Appleby, Phil Galewitz and Anna Gorman report: "President Barack Obama's pledge to Americans that they could keep their health plans if they liked them began to backfire last month. Insurers sent cancellation letters to hundreds of thousands of customers holding individual and family policies, saying the plans didn’t comply with health law provisions effective Jan. 1. Obama eventually apologized. On Thursday he offered what he called 'an idea that will help' fix the problem, allowing insurers to renew existing plans even if they don't include the full menu of health-law benefits" (Hancock, Appleby, Galewitz and Gorman, 11/15). Read the story.

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California Considers Its Options On Canceled Insurance Plans

Kaiser Health News staff writers Anna Gorman and Sarah Varney report: "President Barack Obama's announcement Thursday that insurers can extend cancelled policies that don't comply with the health law has prompted conflicting reactions from California insurance regulators and the companies they oversee. State Insurance Commissioner Dave Jones said he will urge companies to let more than a million consumers keep their plans for an additional year, fulfilling the president’s promise that people didn’t have to switch policies if they didn't want to. 'The federal government told people in California and throughout the United States that they could stay in their plans,' he said at a press conference Thursday" (Gorman and Varney, 11/15). Read the story.

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Oregon Shines On Medicaid, As Texas Stalls On Sign-Ups

Oregon Public Broadcasting’s Kristian Foden-Vencil and KUHF’s Carrie Feibel, working in partnership with Kaiser Health News and NPR, report: "The work-around is necessary because Cover Oregon's website isn’t functioning. But the reason Oregon's website is having more problems than most states is because it included many different kinds of insurance: private policies (with or without subsidies); children qualifying for the Oregon Health Kids Plan; as well as the Oregon Health Plan (Medicaid). … Meanwhile, in Texas, the get-out-to-the-people approach hasn’t gotten much momentum. Only about 3,000 Texans have signed up for private insurance and the state isn’t expanding its Medicaid program" (Foden-Vencil and Feibel, 11/14). Read the story.

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Political Cartoon: 'Clown Hall Meeting?'

Kaiser Health News provides a fresh take on health policy developments with "Clown Hall Meeting?" by Lisa Benson.

Here's today's health policy haiku: 

LOOKING FOR AN ANSWER

Cancellation fix...
The White House offered a plan.
Will it do the trick?
-Anonymous 

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

Obama Moves To Extend Some Canceled Insurance Plans, But Will Everyone Go Along?

President Obama's one-year plan to allow insurers to keep Americans on plans previously canceled under the health law's new standards faces several questions in implementation: Will insurers, customers and state regulators will go along? Also, The Wall Street Journal reports that the move could pave the way for the insurance plans to be extended beyond 2014.

The New York Times: Obama Moves To Avert Cancellation Of Insurance
President Obama, trying to quell a growing furor over the rollout of his health care law, bowed to bipartisan pressure on Thursday and announced a policy reversal that would allow insurance companies to temporarily keep people on health plans that were to be canceled under the new law because they did not meet minimum standards (Parker and Pear, 11/14).

The Washington Post: Obama Announces Change To Address Health Insurance Cancellations
President Obama relented to pressure from the public and his own party Thursday and changed one of the bedrock requirements of the new health care law to fulfill his promise to allow people to keep their insurance plans if they want. While the move was aimed at solving a problem that was threatening the president's credibility and public faith in the law, it raised a slew of new questions, including whether insurers would adjust, whether millions of customers would pay higher premiums and whether states would make the fix available (Eilperin, Goldstein and Sun, 11/14).

The Wall Street Journal: White House To Allow Insurers To Continue Canceled Health Plans
The president's support for allowing the insurance plans to continue for existing policyholders essentially shifted responsibility for the cancellations to the insurers. Millions of people have received cancellation notices from their insurers, who said the policies aren't compliant with new requirements for coverage and have changed too much since 2010 to be eligible for a "grandfathering" exemption. It remained unclear how many insurers would restore policies they had ended, and some industry officials called Mr. Obama's reversal unworkable (Lee and Radnofsky, 11/14).

Los Angeles Times: Obama Acts To Ease Health Insurance Plan Cancellations
President Obama's plan to help millions of consumers facing health insurance cancellations calmed Democrats on Capitol Hill on Thursday even as its practical effect appeared unclear. The decision could give some consumers who like their health plans the chance to keep them into 2015, allowing the president to say he honored his pledge that his health law would not force Americans to give up their coverage (Levey, Hennessey and Memoli, 11/14).

Kaiser Health News: What Consumers Need To Know About The Obama Plan For Canceled Health Policies
President Barack Obama's pledge to Americans that they could keep their health plans if they liked them began to backfire last month. Insurers sent cancellation letters to hundreds of thousands of customers holding individual and family policies, saying the plans didn’t comply with health law provisions effective Jan. 1. Obama eventually apologized. On Thursday he offered what he called 'an idea that will help' fix the problem, allowing insurers to renew existing plans even if they don't include the full menu of health-law benefits" (Hancock, Appleby, Galewitz and Gorman, 11/15).

Los Angeles Times: Health Care Q & A: What Do Obama’s New Plans Mean? 
Millions of Americans have been notified in recent weeks by their health insurance companies that their coverage will soon be canceled because of President Obama’s health care law. To address the outrage over these cancellations, the Obama administration on Thursday outlined a new policy to allow insurers to extend current health plans into 2015 (Levey, 11/14).

The Associated Press: Policy Cancellations: President Obama Will Allow Old Plans 
Bowing to pressure, President Barack Obama on Thursday announced changes to his health care law to give insurance companies the option to keep offering consumers plans that would otherwise be canceled. The administrative changes are good for just one year, though senior administration officials said they could be extended if problems with the law persist. Obama announced the changes at the White House (11/14).

The Boston Globe: Obama Yields On Below-Par Insurance
Brought about by a self-inflicted wound, it was a major concession by the president on a core element of his 2010 Affordable Care Act. Purging substandard plans, with their low premiums but weak and patchy coverage, is considered crucial to overhauling insurance markets. The individual market for years has been the arena for coverage denials for preexisting conditions, premium increases, and the highest deductibles and copays (Jan and Bierman, 11/15).

McClatchy: Rolling Health Care Waters, Obama's Fix Could Make Matters Worse
But Obama’s much-delayed attempt to make good on his promise that Americans could keep their insurance plans if they liked them faces strong opposition from insurance companies, which warn that rates might spike, and it risks undermining the basic premise of his law, which requires quality, affordable insurance. "We fumbled the rollout on this health care law," a contrite Obama said in an hour-long news conference Thursday at the White House. "We should have done a better job getting that right on day one – not on day 28 or on day 40" (Kumar and Clark, 11/14).  

The Wall Street Journal: Officials Leave Door Open to Further Extension of Older Health Plans
The Obama administration signaled it might consider a further extension beyond 2014 of insurance plans that were initially set to be canceled at the end of this year. President Barack Obama outlined a plan earlier Thursday that aims to allow current policy holders to keep their insurance policies in 2014. Millions of Americans who have individual coverage have received notices from insurance companies canceling policies that don't meet requirements under the 2010 Affordable Care Act, but Mr. Obama's move paves the way for some of those policies to be revived (Dooren, 11/14).

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Obama's Plan Puts Onus On Insurers

Insurance executives say they were caught off guard by the White House decision to allow them to revive canceled policies and many are worried about how to make it work.

The Wall Street Journal: Health Insurers Express Worries Over Obama Shift On Policy Cancellations
The president's move to placate millions of Americans on Thursday rattled health insurers, who said they were unsure how to revive canceled policies in short order. While companies had expected the White House to address the white-hot issue of policy cancellations, President Barack Obama's decision to let people keep their old policies undercuts years of preparations for the overhaul of the health-insurance market and introduces new uncertainties. Two senior insurance executives said they had not yet received any formal direction on how to carry out the change, and had only learned the outlines of the plan Thursday morning (Martin, Weaver and Kamp, 11/14).

Politico: Barack Obama's Messy Breakup With Insurers
President Barack Obama is breaking up with the health insurance industry again. He's had a love-hate relationship with the insurers ever since the early days of the health care reform debate. He yelled at them in public for giving people skimpy coverage, then slipped them a gift-wrapped box of chocolates — the individual mandate they wanted to gain millions of new customers. Even during the implementation of Obamacare, he has stuck with the industry (Nather, 11/15).

NPR: Insurers Aren't Keen On Obama's Pledge To Extend Coverage
Remember when President Obama said, "If you like your health plan you can keep it?" Now it's more like, "If you like your health plan you can keep it — for another year, and only if your insurance company says it's OK." It's not clear whether the administration's proposal to let insurers extend the policies they've been cancelling for the past couple of months will solve the president's political problem. But it's sure not going over very well with the insurance industry (Rovner, 11/14).

The New York Times: Obama Proposal Worries Insurers And Regulators
President Obama's effort to quiet a political uproar by suggesting on Thursday that consumers should be allowed to keep their current health plans met significant resistance from many insurers and state regulators, who said they had not been consulted in advance about the proposal, doubted it could work and feared it might seriously damage the new insurance marketplace (Abelson and Goodnough, 11/14).

USA Today: Chaos Ensues After Insurance Cancellation Reversal
President Obama's announcement Thursday that consumers can keep insurance plans that don't meet the Affordable Care Act for a year will only create chaos, insurance brokers, regulators and carriers say (O’Donnell, 11/14).

Bloomberg: Obama Health Plan Cancellation Fix Draws Cost Warnings
Just hours after President Barack Obama announced a one-year reprieve for canceled insurance plans, industry executives warned it would cost taxpayers and consumers while state officials split on their support for it. With only weeks until policies are due to lapse in 2014, there was skepticism the cancellations could be undone. Insurers said the move may threaten the viability of the new Obamacare exchanges by creating a parallel market operating under different rules (Nussbaum & Wayne, 11/15).

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States Consider What Obama's Canceled Plan Request Means For Them

The president's plan to allow insurers to extend canceled health plans through 2014 has state regulators  trying to work through the details about how this will affect insurers and the health law's marketplaces in their states. In California, Insurance Commissioner Dave Jones has asked insurers and marketplace officials to comply with the president's request.

Los Angeles Times: Obama's Call For Insurers To Extend Canceled Health Plans Splits State
With 1 million Californians facing cancellation of their health insurance, state officials and the insurance industry were sharply divided over President Obama's call to let consumers extend their policies. And the state agency on the spot, California's health insurance exchange, was noncommittal on what exactly it will do for affected policyholders. Health insurers in the state warned that abruptly reversing course -- and doing what Obama wants -- could undermine California's new insurance marketplace and trigger more rate increases (Terhune, 11/14).

Kaiser Health News: California Considers Its Options On Canceled Insurance Plans
President Barack Obama's announcement Thursday that insurers can extend cancelled policies that don't comply with the health law has prompted conflicting reactions from California insurance regulators and the companies they oversee. State Insurance Commissioner Dave Jones said he will urge companies to let more than a million consumers keep their plans for an additional year, fulfilling the president's promise that people didn't have to switch policies if they didn't want to. "The federal government told people in California and throughout the United States that they could stay in their plans," he said at a press conference Thursday (Gorman and Varney, 11/15).

The Sacramento Bee: Dave Jones Says California Customers Should Be Allowed To Keep Health Plans
California Insurance Commissioner Dave Jones said he's taken steps Thursday to allow more than 1 million residents with terminating insurance plans to keep them through next year. Jones said he's asked Covered California to release insurers offering plans on the exchange from the requirement to cancel policies that don't comply with the health care overhaul. "I've asked Covered California to take this action immediately so that health insurers are free then from this contract provision and can follow the president's request, and my request, that they allow their existing customers to renew their policies into 2014," Jones, a staunch supporter of the federal health law, said in a conference call from San Francisco (Cadelago, 11/14).

The San Francisco Chronicle: California Asks Insurers To Extend Policies
Hours after President Obama encouraged insurers to let policyholders keep their current plans for now, the state's insurance commissioner, Dave Jones, called for the state's health insurance marketplace, Covered California, to lift a provision requiring health insurers to terminate individual policies that fall short of the health law's requirements. Those policies were to end by Dec. 31 and people would be offered new options that cover all the benefits in the federal health law. Jones said he doesn't have the authority to force the exchange and insurance companies to let policyholders keep their current plans, but hopes they will give people a choice (Colliver, 11/14).

The Associated Press: Chaney: No Big Impact From Canceled Policies
Mississippi consumers should not see a big impact from President Barack Obama's reversal on a key part of the federal health law, state Insurance Commissioner Mike Chaney said Thursday. But, like many state insurance commissioners across the nation, Chaney also said the president's actions could hurt the insurance industry and increase prices over time (Pettus, 11/14).

MinnPost: Obamacare Change: Minnesota Regulators, Officials Scrambling After Obama Reversal On Canceled Policies
President Obama's administrative fix for canceled and changed health care policies has Minnesota regulators, officials, insurers and the state's health exchange scrambling Thursday to figure out what to do. It may not even be possible for Minnesota’s insurers to reverse the advances they've made in coverage before the individual mandate of the Affordable Care Act goes into effect on Jan. 1. So far, the long-term effects of the president’s announcement are unclear (Nord, 11/14).

Minnesota Public Radio: Change To Health Law Has Unclear Minn. Impact 
Among the questions in Minnesota is how the president's decision will square with Minnesota insurance law which bans outright cancellation of health insurance, requiring plans instead to offer policyholders new terms instead. The president's about-face presents a difficult choice for Minnesota's insurance plans, too: if the state gives them the option of keeping the old plans on the books, they may have to go through the actuarial and bureaucratic hassle of getting them reapproved by the state -- a tall order just six weeks before the year ends. If they don't, they may risk further frustrating already disgruntled customers (Richert, 11/14).

Des Moines Register: Obamacare Fix Draws Mix Of Disapproval, Skepticism From Iowa Lawmakers
Neither of Iowa's U.S. senators is completely on board with President Barack Obama's decision Thursday to let health insurance companies continue offering current policies through 2014. U.S. Rep. Steve King also chimed in to lambaste the law and Thursday's announced fix. The president's move was meant to tamp down the controversy over the looming cancellation of millions of individual health insurance policies that don’t meet requirements of Obama’s Affordable Care Act (Leys, 11/15).

The Dallas Morning News: Rick Perry Blasts Obama's Proposed Insurance Fix 
A contrite President Obama unveiled a new rule that allows state insurance commissioners to okay the renewal of health policies for a year that don't offer sufficient coverage under the Affordable Care Act. It would allow many policyholders to retain their insurance. But Gov. Rick Perry condemned Obama for telling states to sidestep the ACA. While Texas has the greatest rate of uninsured citizens in the nation, Perry has rejected Texas establishing its own health care exchange or extending greater Medicaid coverage under the Affordable Care Act (Hoppe, 11/14).

Georgia Health News: Obama's Patch For ACA Much Like Georgia's
Facing a storm of criticism about canceled policies, Obama announced an administrative change to let insurers continue offering individual plans for another year, even if they don’t meet the Affordable Care Act's minimum benefits. In Georgia, to a large extent, such a remedy is already available. Many health insurers in Georgia are allowing individuals to retain their policies through late 2014. GHN reported earlier this month that most Georgia insurers are letting consumers have an option to renew their plan before Jan. 1 and avoid the ACA's benefits requirements (Miller, 11/14).

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Medicaid Enrollment Progresses Under Health Overhaul

Gov. Scott Walker says he wants to delay his plan to move more than 70,000 people off Medicaid because the health law online marketplaces are not working well enough yet.

USA Today: Medicaid Enrollment Is Health Law's Bright Spot
Amid the low enrollment numbers for health insurance via the HealthCare.gov website, the Obama administration found one bright spot: Medicaid. Almost 400,000 people have learned they are eligible to enroll in the states' Medicaid programs, and the numbers are high even in Republican-dominated states that have chosen not to expand the program (Kennedy, 11/14).

The New York Times: Wisconsin Governor Seeks To Extend Medicaid
Blaming an "abysmal" rollout of the new federal insurance market, Gov. Scott Walker of Wisconsin said on Thursday that he would ask the Legislature to allow thousands of low-income residents to remain in the state's Medicaid program until April 1 — a three-month extension. In a news conference, Mr. Walker, a Republican, said he would ask the Legislature, which is Republican-controlled, to return in early December to vote on his proposal. Under current state law, about 77,000 Wisconsin residents would be removed from the state's Medicaid rolls on Jan. 1 and required to obtain insurance in the subsidized online federal marketplace created by President Obama's Affordable Care Act (Yaccino, 11/14).

The Milwaukee Journal Sentinel: Scott Walker To Delay Moving Residents Off Medicaid
Responding to the troubled rollout of Obamacare, Gov. Scott Walker said Thursday he would delay for three months his plan to move more than 70,000 state residents out of state health coverage and into an online federal insurance market. At a Capitol news conference, the Republican governor said he would call lawmakers in for a special legislative session in early December to pass the change and keep those 77,500 patients from losing their state BadgerCare Plus coverage in January before the federal insurance program is ready to accept them. Walker said he wouldn't take any additional federal Medicaid money to keep the recipients on BadgerCare and instead would pay for the extra expense by delaying the roughly similar cost of adding a new group of more than 80,000 very-low-income adults to the state program (Stein, 11/14).

The Associated Press: Wis. Gov Calls Special Session On Medicaid
Gov. Scott Walker called a special legislative session Thursday to extend the deadline for moving 77,000 people of Medicaid until April, saying they need more time to sign up for private insurance through the problem-plagued online federal health care exchange. Walker, a Republican, toughened Medicaid eligibility in the state budget, saying those people could find private coverage through the exchange. He had given everyone who would lose coverage until Dec. 15 to sign up for an alternative plan through the exchange to ensure uninterrupted coverage on Jan. 1 (11/14).

In other states -

Kaiser Health News: Oregon Shines On Medicaid, As Texas Stalls On Sign-Ups
The spokeswoman for Oregon Health Authority says that while the state’s reputation is that "people haven't enrolled in the new coverage available in Oregon," in fact "that's not accurate. We have 70,000 people." She's talking about some of the state's poorest uninsured folks. A work-around helped 70,000 of them secure coverage in its version of Medicaid. ... The work-around is necessary because Cover Oregon's website isn’t functioning. ... Meanwhile, in Texas, the get-out-to-the-people approach hasn't gotten much momentum. Only about 3,000 Texans have signed up for private insurance and the state isn't expanding its Medicaid program (Foden-Vencil and Feibel, 11/14).

The Associated Press: House, Senate Panels Recommend Expanding Medicaid
House and Senate committees voted Thursday to recommend that New Hampshire expand Medicaid to an estimated 49,000 poor adults, but their plans differ on how to implement the expansion. A key difference between the two bills is how quickly New Hampshire shifts the adults from a state-managed care program to private insurance through the federal insurance marketplace. The Republican-led Senate would shift people in 2015 (Love, 11/14).

The Associated Press: Medicaid Expansion Could Save Maryland $2B
A recent report has found, Maryland’s decision to expand its Medicaid program could save the state more than $2 billion. The Daily Record reports that an assessment of the economic impact of the expansion of eligibility to another 146,000 people starting in January found that Maryland could see a net savings of more than $2 billion from 2014 to 2020 (11/14).

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Consumers Beware: Cheaper Insurance Policies Mean Higher Deductibles

Bloomberg News reports that consumers buying cheap insurance in the new health insurance marketplaces may face sticker shock if they get sick next year because of deductibles that can top $6,000 a person. Meanwhile, news outlets in Oregon and Massachusetts report on website glitches that continue to make enrollment in those states difficult.

Bloomberg: Obamacare Deductibles 26% Higher Make Cheap Rates A Risk
Americans seeking cheap insurance on the Obamacare health exchanges may be in for sticker shock if they get sick next year, as consumers trade lower premiums for out-of-pocket costs that can top $6,000 a person. Expenses for some policies can reach $6,350 for a single person and $12,700 per family, the most allowed by the health-care law, according to a survey by HealthPocket Inc. of seven states, including California and Ohio. That’s 26 percent higher than the average deductible in the seven states, and a scenario likely repeated across the country, said Kev Coleman, head of research and data at Sunnyvale, California-based HealthPocket (Nussbaum, 11/15).

The Oregonian: Cover Oregon: Health Exchange Board Puts Director Rocky King On Notice Over Stalled Website
The board of Oregon's semi-functioning health exchange sent a stern message to the head of Cover Oregon on Thursday, demanding clear information of when its semi-functioning website will work and precisely how Rocky King and his staff intend to get people enrolled by Jan. 1. The resolutions putting the exchange's executive director on notice occurred after a sometimes tense meeting in Northeast Portland where members of the board expressed strong displeasure with the shifting timelines on the project, as well as distrust of the health exchange's main information technology contractor, Oracle (Budnick, 11/14).

WBUR: Web Glitches Snarl Health Insurance Enrollment In Mass.
Frustrated Massachusetts residents who think they’ll qualify for subsidized health insurance or hope to continue a subsidized plan are posting similar stories to the Connector’s Facebook page. The Connector staff is posting occasional apologies and on Thursday laid out the problems for the agency’s board. “Things aren’t perfect,” said Scott Devonshire, the Connector’s chief information officer. “Obviously we’re having some issues on the site right now.” ... the state has not been able to process any applications yet, because the federal interface that’s supposed to verify an applicant’s income and some other factors isn’t working (Bebinger, 11/14).

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California Shuts Down 10 Sites Imitating State Insurance Marketplace

The California attorney general said her office shuttered 10 websites that had mimicked the state's official health insurance exchange "in order to lure consumers away from plans that provide the benefits of the Affordable Care Act."

The New York Times: California Shuts Down Sites Mimicking State Insurance Marketplace
The California attorney general's office has shut down 10 websites that mimicked state's official health insurance marketplace, the attorney general, Kamala Harris, announced Wednesday. "These websites fraudulently imitated Covered California in order to lure consumers away from plans that provide the benefits of the Affordable Care Act," Ms. Harris said in a prepared statement. "My office will continue to investigate and shut down these kinds of sites" (Lovett, 11/14).

The Wall Street Journal: California Shuts Down Sites Imitating State Health Exchange
California officials have shut down 10 websites they say were designed to imitate the state's official health-insurance marketplace created under the nation's new health law. California Attorney General Kamala D. Harris said Thursday her office ordered the sites to either shut down or redirect consumers to the state's official site, www.coveredca.com. All 10 sites have complied, she said (Lazlo, 11/14).

Los Angeles Times: California Orders Closure Of 10 Sites Imitating Its Health Exchange
California Atty. Gen. Kamala Harris said she has ordered 10 websites to shut down because they violated state law by imitating the official site of the state's health insurance exchange. Harris said she began investigating these misleading websites in September and multiple operators were sent cease and desist letters telling them they were in violation of state law (Terhune, 11/14).

The Sacramento Bee: Kamala Harris Shutters 10 Fake Covered California Websites
California Attorney General Kamala Harris said Thursday she has forced the removal of 10 private health insurance websites posing as the state's official online marketplace where customers obtain plans under the federal Affordable Care Act. Harris said her office two months ago launched investigations into the websites imitating coveredca.com, which began offering insurance coverage for sale on Oct. 1. The website operators were sent cease and desist letters telling them their sites violated state law and demanding their removal or transfer of their domains to the state exchange (Cadelago, 11/14).

San Francisco Chronicle: State Shuts Down Bogus Health Care Websites
One of the posers secured rights to the domain name CoveredCalifornia.com, similar to the official CoveredCa.com, Harris said. She said all were operated by private brokers or companies and contained unauthorized references to the official exchange's trademarked name and logo. ... Typically, said Nick Pacilio, a spokesman for Harris, the operators, purporting to represent the state, sold policies that fell short of the law's requirements. He said Harris has not filed criminal charges or civil fraud suits against the operators, who all agreed to shut down when the office threatened legal action (Egelko, 11/14).

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Capitol Hill Watch

Lawmakers Stake Out Positions On President's Plan, Pursue Legislative Steps

House Speaker John Boehner, R-Ohio, signaled his intent to bring a bill by Rep. Fred Upton, R-Mich., to the floor for a vote. Republican leaders expect the bill, which is viewed by the administration as an effort to undo the health law, to pass easily on a largely party-line vote. Meanwhile, House Minority Leader Nancy Pelosi, D-Calif., says Democrats have their own legislative plan. And, in the Senate, Sen. Mary Landrieu, D-La., applauded the president's step, but maintains that further legislative action is needed.

The Wall Street Journal's Washington Wire: Boehner: Health Law Needs Legislative Fix
House Speaker John Boehner (R., Ohio) said he would press ahead with a House vote Friday on a bill designed to help people whose health insurance policies have recently been cancelled, even though President Barack Obama announced a plan Thursday to accomplish a similar goal without legislation (Hook, 11/14).

The Associated Press: Boehner: Only Health Care Fix Is To Scrap Law
House Speaker John Boehner says the only way to fix President Barack Obama's health care law is to scrap it entirely. Boehner says the law has forced health coverage to be canceled and the costs of premiums to rise. He says the Obama administration can't be trusted on the issue(11/14).

The Wall Street Journal's Washington Wire: Landrieu Welcomes Obama Action On Health Law, Remains Open To Pushing Legislation
Sen. Mary Landrieu (D., La.), principal author of legislation to address the problem of individual health insurance policies being cancelled, said she welcomed President Barack Obama's Thursday announcement on the issue but that further legislative action may still be needed. "The president’s announcement was a great first step," said Ms. Landrieu. "We will probably need legislation to make it stick." Still, Ms. Landrieu did not promise a major push to force action on her bill. And she suggested that the president’s action could have broad ramifications (Hook, 11/14).

Politico: Senate Democrats Not Fully Satisfied With Obamacare Fix
Senate Democrats are still considering legislation to repair President Barack Obama’s broken Obamacare promise, despite the White House plans for an administrative fix. Sens. Mary Landrieu (D-La.) and Mark Udall (D-Colo.) still want to see votes on their separate, alternative proposals aimed at helping Americans who lost insurance plans. Several of the other Democrats who are up for reelection in 2014 want to vote on a legislative fix, too (Everett, Kim and Haberkorn, 11/14).

Politico: Democrats Not Likely To Back House GOP Obamacare Bill
House Democrats say that President Barack Obama's move to address a broken promise of Obamacare should prevent large numbers of defections on a GOP bill coming to a vote Friday that addresses the wave of health insurance cancellations. House Minority Whip Steny Hoyer (D-Md.), the chief vote-counter for House Democrats, said a "large part" of the Democratic Caucus would vote against the GOP bill called the "Keep Your Health Plan Act." Democratic leaders had earlier feared up to 100 members might vote for the bill sponsored by House Energy and Commerce Chairman Fred Upton (Haberkorn and Kim, 11/14).

Politico: Nancy Pelosi: House Democrats Have Own Obamacare Plan
House Minority Leader Nancy Pelosi said Thursday that Congressional Democrats are hoping to vote on their own plan to address the mass health insurance cancellations associated with Obamacare. She called it a "belt and suspenders" approach that would reinforce, but is not intended to compete with the administrative fix announced by President Barack Obama on Thursday (Haberkorn and Delreal, 11/14).

Roll Call: House Democrats Eye New 'If You Like It' Obamacare Fix
House Democratic leaders, in a bid to keep frustrated rank-and-file members from supporting a Republican bill to remedy the White House's broken "if you like it, you can keep it" promise, are mobilizing around a new legislative fix. As Democrats huddled in a closed-door caucus meeting Thursday afternoon with Obama administrative officials, leaders decided they would go to the House floor on Friday with a new plan to counter the bill sponsored by Energy and Commerce Chairman Fred Upton, R-Mich., a House Democratic leadership aide confirmed to CQ Roll Call (Dumain, 11/14).

The Hill: Health Vote Puts Dems In Pickle
The House will vote Friday on a GOP bill allowing insurance companies to continue offering consumers their existing, limited plans under President Obama's health care law. Republican leaders hope the bill, which is expected to pass easily on a largely partisan vote, will raise pressure on the White House over the botched rollout of Obamacare (Lillis, 11/15).

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Administration News

Health Law Fumbles Threaten Obama's Agenda

Media analyses argue the health law's rollout problems are endangering the rest of President Barack Obama's second-term agenda as his credibility and job approval ratings suffer. Others see his blunt admission of blame as an effort to improve his public standing and counter a revolt within his own party.

The New York Times: Health Law Rollout's Stumbles Draw Parallels To Bush's Hurricane Response
Barack Obama won the presidency by exploiting a political environment that devoured George W. Bush in a second term plagued by sinking credibility, failed legislative battles, fractured world relations and revolts inside his own party. President Obama is now threatened by a similar toxic mix. The disastrous rollout of his health care law not only threatens the rest of his agenda but also raises questions about his competence in the same way that the Bush administration's botched response to Hurricane Katrina undermined any semblance of Republican efficiency (Shear, 11/14).

Politico: The Obamacare Fumble
It's the cardinal rule of marketing management: Under-promise and over-deliver. If the sign at "Pirates of the Caribbean" says the wait is 45 minutes, and your kids are floating along on the ride in half that time, Disneyland really is the Happiest Place on Earth. So it's little wonder that the glaring contrast between the White House's perpetually optimistic talk about its health care plan -- "Try it! You’ll like it!" -- and the messy realities of its rollout has sent President Barack Obama's job approval ratings to all-time lows, and for the first time left the public with a negative view of his honesty in some surveys (Purdum, 11/15).

The Wall Street Journal: Obama Contrite Over Health-Law Problems
In an effort to revive his standing with Americans and suppress a growing rebellion within his own party, President Barack Obama on Thursday displayed a level of self-criticism he has seldom shown publicly in his five years in office as he acknowledged he "fumbled" the rollout of his signature legislative achievement. Throughout an hourlong news conference at the White House, Mr. Obama showed rare contrition about the political fallout from his self-described missteps -- from his failed promise that, under his 2010 health-care law, people who liked their coverage could keep it, to a problem-plagued website that has yielded embarrassingly low enrollment numbers and weeks of intense criticism of a divisive overhaul that has been a political flash point for years (Lee and Nicholas, 11/14).

The Associated Press: From Obama, A Blunt Acceptance Of Blame
Again and again, President Barack Obama on Thursday shouldered the blame for his botched health care rollout in unusually blunt terms -- a step many of his critics contend was long overdue. In an even rarer admission, he also acknowledged that the cascade of troubles was damaging his credibility with the American people and threatening to take a toll on his broader second-term agenda. The president's somber and reflective acceptance of personal responsibility for failures with his signature law marked the latest chapter in the White House's evolving posture on the "Obamacare" woes (Pace, 11/15).

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Obama Nominates Harvard Hospitalist, Early Health Law Supporter To Be Surgeon General

President Obama nominated Dr. Vivek Murthy, a hospitalist at Harvard and an early supporter of the health law, to be the nation's surgeon general.

The New York Times: Obama Selects Health Policy Advocate As Surgeon General
President Obama nominated Dr. Vivek H. Murthy, an early supporter and grass-roots advocate for the Affordable Care Act, as surgeon general on Thursday. Dr. Murthy, 36, is a founder and the president of Doctors for America, a group that campaigned for the health care law before Congress passed it in 2010 and that was an outgrowth of Doctors for Obama, which worked to help elect the president in 2008 (Kenny, 11/14).

Politico: President Obama Nominates Vivek Hallegere Murthy For Surgeon General
He is the co-founder and president of Doctors for America, which began as Doctors for Obama in 2008. He is a hospitalist attending physician and instructor in medicine at Brigham and Women’s Hospital at Harvard Medical School (Haberkorn, 11/14). 

The Boston Globe: Obama Nominates Boston Doctor As Surgeon General
President Obama will nominate Dr. Vivek Murthy of Harvard Medical School and Brigham and Women’s Hospital as surgeon general of the United States, the White House announced Thursday night. Murthy is a hospitalist at the Brigham and is co-founder and president of Doctors for America, a Washington, D.C.-based group of physicians and medical students that advocates for access to affordable, high quality health care. If he’s confirmed by the Senate, Murthy would replace acting surgeon general Boris Lushniak (Gil, 11/15).

Read related KHN interview with Murthy: Fixing Health Care Isn't About Party, 'It's About Building A Sustainable System' - The KHN Interview (Kulkarni, 11/24/2012).

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State Watch

State Highlights: Dispute Over What Doctors Can Say At Catholic Hospital

A dispute between a Colorado cardiologist and a Catholic hospital over what he says is a ban on discussing abortion with patients, even when a pregnancy threatens a woman's life, is part of today's health policy roundup from Colorado and California.

ProPublica: At A Catholic Hospital, A Dispute Over What A Doctor Can Do – And Say
A dispute between a Colorado cardiologist and the hospital he works for has highlighted a growing area of concern among patient advocates and civil libertarians: gag rules imposed on doctors and nurses by Catholic health-care providers. In a complaint filed Wednesday, ACLU of Colorado accused Mercy Regional Medical Center in Durango, in the remote southwest corner of the state, of illegally telling doctors and other employees that they cannot discuss abortion with patients, even if a pregnancy threatens a woman's life. The complaint was filed with the Colorado Department of Public Health and Environment, which oversees the state's hospitals (Martin, 11/14).

California Healthline: Interest In Exchange Running High, But Enrollment A Fraction Of States Goals
Exchange officials predicted October would be a slow month for enrollment and that enrollment would increase as the Dec. 15 deadline to sign up for the exchange in time to receive coverage on Jan. 1, 2014 draws closer. That was reflected in the written comments from Peter Lee, executive director of Covered California: "The numbers are better than encouraging," Lee said in a statement. "They show momentum and very high consumer interest. As anticipated, consumers spent October comparing plans and educating themselves about their health care options” (Gorn, 11/14).

California Healthline: Partnership Brings Clean Drinking Water To Central Valley Schools, Programs
More than 3,500 students in four public schools and five Head Start centers in the small towns of Arvin and Lamont southeast of Bakersfield in Kern County no longer have to worry about unsafe levels of arsenic in their drinking water. "We really see this project as a model for other schools and communities that are struggling with contaminated water," said Shen Huang, a technical analyst for the Community Water Center. … CWC worked with the Committee for a Better Arvin, the Arvin Union School District and the Community Action Partnership of Kern on the project. The California Endowment is a major funder of the effort, and several manufacturers provided filters at no cost (Daniel, 11/14).

The California Health Report: Practices Service Low-Income Areas Left Out Of Reform
When it comes to allowing for a sufficient number of essential community providers, the terms "sufficient" and "essential" lend themselves to interpretation. The Centers for Medicare and Medicaid Services defines essential community providers as those who "serve predominately low-income, medically underserved individuals." Covered California consulted numerous sources in determining what constituted an ECP (Fulton, 11/14).

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Editorials and Opinions

Viewpoints: 'Nation Takes Stock' Of Obama And His Health Law; Noonan Says Now Is Time To Hold Back Obamacare; Obama Needs To Be Resolute

The New York Times: A Health Care Fix
President Obama has come up with a modest fix for a self-inflicted political wound: his repeated — and wrong — assertions that Americans would be able to keep their health insurance plans if they wanted to under the health care reform law (11/14). 

The New York Times' Taking Note: Obama's Health Care Promise
There are important questions about whether the fix President Obama offered today for Americans whose insurance policies were cancelled will help them, whether it will hinder the broad goals of the health insurance reform law, and whether it will satisfy the opponents of reform. We will start to address them later on the editorial page. But this was also one of those moments when a nation takes stock of its president. And it seemed worth noting here that Mr. Obama has dealt another blow to his own already damaged credibility with this latest reminder of how he and his team bungled the rollout of health care reform (Andrew Rosenthal, 11/14). 

The Wall Street Journal: ObamaCare Disaster Recovery
Congress right now has a historic chance—really, it could wind up in the history books next to the stopping of FDR's court-packing scheme in 1937—to hold back ObamaCare. Congress can delay it, or pass a law mandating or allowing insurance companies to continue insuring everyone they just threw off coverage. Heck, they could try to vote now, under new conditions and with the American people behind them, to repeal the whole thing. And who knows, they just might (Peggy Noonan, 11/14).

The Wall Street Journal: ObamaCare's Nonfix
You know the politics of ObamaCare is bad when even President Obama is forced to concede that the rollout is a bloody mess. If only the new "administrative fix" he announced on Thursday did more to help the consumers who are losing their coverage than it does to help Democrats protect their political future (11/14).

Los Angeles Times: Kicking Obamacare's Problems Down The Road
Faced with a growing public backlash to the 2010 healthcare law's insurance reforms, the Obama administration decreed Thursday that consumers should be allowed to keep their current policies for another year, even if the coverage falls short of the law's requirements. The move is a desperate attempt to fulfill a promise President Obama never should have made, and the legal authority for it is sketchy. What's more, it may not be possible at this point for insurers to revive policies they've already canceled. Worst of all, Obama merely punted to next year the fight over the law's insurance reforms, which he has done a remarkably poor job of explaining and selling. The only good thing about the delay is that it might stop Congress from making a more damaging change to the law (11/15).

Los Angeles Times: Obamacare: Don't Be Selfish And Shortsighted, Buy A Better Plan
In an effort to placate angry (and shortsighted) Americans, President Obama announced Thursday that they could keep their substandard health insurance plans for another year so long as insurers were still willing to offer them. Never mind that these cheaper, bare-bones packages don't meet the Affordable Care Act's minimum benefits, undercutting a fundamental part of the healthcare law (Alexandra Le Tellier, 11/14).

The Washington Post: Why Liberals Are Panicked About Obamacare
So the former president [Bill Clinton] asserts that the current president continues to dishonor his "you like your plan, you can keep your plan" pledge. And calls for the Affordable Care Act to be changed, despite furious White House resistance to the very idea. Coming from the dean of the Democratic Party, this one line marked the breaching of the dam. It legitimized the brewing rebellion of panicked Democrats against Obamacare. Within hours, that rebellion went loudly public. By Thursday, President Obama had been forced into a rear-guard holding action, asking insurers to grant a one-year extension of current plans (Charles Krauthammer, 11/14).

The Washington Post: A Troubling 'Fix' For Obamacare
This is a precarious moment for President Obama. His poll ratings have slipped, and health-care reform, his most significant accomplishment, is in danger. In a White House news conference Thursday, Mr. Obama forthrightly accepted blame and offered two ways to repair the damage. One is crucial. The other is misguided. "We fumbled the rollout of this health-care law," the president declared. He admitted that he was wrong to have pledged that those who liked their insurance plans could keep them, and he took responsibility for misleading representations that other Democrats made based on his promises. He rightly said he would have to earn confidence back by making the Affordable Care Act work (11/14).

The Washington Post: Obama Was Contrite But Also Resolute
It was a necessary retreat, but President Obama made clear Thursday that his bottom line remains unchanged: "I'm not going to walk away from 40 million people who have the chance to get health insurance for the first time." The president's pledge should be the nation's bottom line as well. It came as Obama surrendered to overwhelming pressure, much of it from fellow Democrats, and allowed people to keep their bare-bones insurance policies that do not meet the Affordable Care Act's standards — at least for a year. The change was meant to correct an imbalance that cannot long be tolerated: More people are being annoyed and inconvenienced by the new law than are being helped (Eugene Robinson, 11/14).

The Washington Post: Obama's Political Malpractice
The promise and the apology are the bookends of effective politics. President Obama has, tragically and perhaps irreparably, flubbed both. Overpromising is every politician's temptation, every journalist's gotcha, every political opponent's handy club. A chicken in every pot. Read my lips. On the campaign trail, nuance is an unwelcome intruder (Ruth Marcus, 11/14).

USA Today: Obama Prescribes Ugly Fix For Obamacare
President Obama's attempt Thursday to make good on his promise to let people keep their health insurance policies was politically inevitable. With the public howling, Democrats defecting and Republicans planning a vote today to let insurers keep selling insurance that doesn't comply with the Affordable Care Act's tough new standards, he had to do something. But political necessity doesn't guarantee good policy, and the president's plan is less a solution than it is a punt (11/14).

USA Today: 'Scrap This Law Once And For All': Others View
What others are saying about the Affordable Care Act (11/14). 

Bloomberg: Obama's Foolish Obamacare Compromise
President Barack Obama is trying to make up for an exceedingly dumb promise with a moderately dumb compromise. For many people who have lost their old insurance policies, his offer may be no help at all (11/14).

Bloomberg: What the Obamacare Numbers Don't Say
Amid the hubbub over yesterday’s embarrassingly low initial enrollment numbers for the Affordable Care Act, it's worth remembering those numbers are useful for one thing only: hinting at whether the law will perform as advertised. As it turns out, the numbers provide little hint about anything (11/14).

Bloomberg: The Latest Obamacare Fix Only Makes Things Worse
In recent weeks, proponents of Obamacare have been arguing that we shouldn't make too much of its early troubles, because President George W. Bush's prescription-drug program saw early fumbles, too. (The people behind Obamacare may not be good at building websites, but they're great at manufacturing excuses.) It's perverse, of course, to suggest that the difficulties of a smaller, far less complex program are a good omen for Obamacare. But the bigger problem is that Obamacare is vulnerable to adverse selection in a way that Bush's program was not (Ramesh Ponnuru, 11/14).

Slate: How Jay Carney Spins Obamacare's Failures
Poor Jay Carney. He's a decent guy. He has an important job: press secretary to the president of the United States. I'm a total homer for his boss, and I like the Affordable Care Act, though it needs lots of repair. But right now, if you gave me a choice between cleaning bathrooms at the bus station and explaining Obamacare's snafus to reporters every day, I'd take the mop. How does Carney handle the stress? With a few creative phrases. Here's a guide (William Saletan, 11/15).

Detroit Free-Press: Stephen Henderson: This Health Care Disaster Is Obama's Fault And He Must Fix It 
Let's get this out of the way first: Presidents lie. Lyndon Johnson lied about Vietnam. Ronald Reagan lied about his policies in central America. And Bill Clinton — forget about it. There are entire books about the mendacity indulged by White House occupants over more than two centuries. They lie for political gain. They lie for personal reasons. They lie to preserve power. So is Barack Obama the Marco Polo of fibbing for telling Americans his health care reform law would allow them to keep their insurance if they liked it? (Stephen Henderson, 11/15). 

Health Policy Solutions (a Colo. news service): Grandfathered Plans, The ACA And The 'If You Like Your Plan …' Pledge
The bottom line is some people in the individual market may have to pay more for coverage. That extra cost pays for better coverage and the security of knowing that they can stay covered regardless of their gender, health status or age – and not face financial ruin in the event of a serious illness. Reports on television and news sites have talked about these customers as winners or losers, but that score-keeping is counting only the cost of changing coverage. Ultimately, these Americans will have to factor in the value of greater security and comprehensive and affordable health care against the cost of their insurance (Bob Semro, 11/14).

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Other

Democrats Remain Wary Of President's Canceled Plans Fix

President Obama's canceled insurance plans fix has satisfied neither many Democrats -- some of whom face reelections in 2014 and remain unhappy with the fix -- nor Republicans, who will again vote Friday on a bill to undermine the law.

The Washington Post: Health Care Law's Problems Test Loyalty Of Democrats In Congress
The political fallout from the botched launch of the health care law is presenting congressional Democrats with one of their toughest tests of party loyalty in the five years of the Obama administration. House Republicans are expected to pass a bill Friday that could dramatically undermine the law. And after years of trying to impale the initiative, GOP leaders are hopeful that the political turmoil over the rollout will provide them the support of a sizable bloc of Democrats (Kane and Kucinich, 11/14).

Bloomberg: Democrats With 2014 Races Unhappy With Obama Health Fix
President Barack Obama's one-year reprieve for Americans losing health insurance achieved at least one political aim: slow a Democratic rush toward a Republican bill to curtail Obamacare coming to a vote today in the House. Obama's hour-long display of contrition yesterday over his health care law, though, fell short of quelling the longer-term political crisis engulfing the president and his party over the botched rollout of the increasingly unpopular program (Davis and Bender, 11/15).

USA Today: Obama's Health Care Fix Doesn't Allay Dems' Jitters
But his proposed fix, which is intended to assist Americans in the individual insurance market who saw their policies canceled because they didn't meet minimum benefit requirements set under the ACA, failed to stanch Republican outrage and only temporarily alleviated Democratic unease over the problems arising from the law's rollout (Madhani and Davis, 11/14).

Politico: Trust Frays Between Obama, Democrats
When Denis McDonough stepped onto House Democrats' turf on Thursday, he was armed only with a PowerPoint presentation on fixing Obamacare's website and talking points about the president's proposal allowing people to keep their health care plans. The White House chief of staff might have been better off revealing a U.S. map with the president's plan for saving congressional Democrats' seats -- or just apologizing for letting so many Democrats walk out in public and repeat wildly inaccurate White House claims about the health of the enrollment website and Americans' ability to keep their insurance plans if they liked them (Allen and Sherman, 11/14).

NBC News: Still Skittish: Wary Dems Aren't Satisfied By Obamacare 'Fix'
The White House is receiving mixed reactions from allies in Washington as it tries to soothe growing unease among Democrats on Capitol Hill about the implementation of the health reform law so many of them risked their careers to pass. Many Democrats remained publicly skittish even after President Barack Obama announced a fix to the Affordable Care Act intended to honor his commitment that consumers can keep their health plans if they so desire, even if those plans are considered subpar by new standards contained in the law (O’Brien, 11/14).

CBS News: Despite Obamacare Fix, Fight Rages On In Congress
After hearing serious concerns from both Democrats and Republicans over the fact that millions of Americans are being dropped from insurance plans that no longer meet Obamacare standards, President Obama on Thursday offered a contrite apology and an administrative solution to the issue. The debate over the matter, however, isn't slowing down in Congress. The Republican-led House on Friday is voting on a bill called the "Keep Your Health Plan Act," which offers a policy change not far off from the president's solution. The legislation, which would allow plans that existed on the individual market as of Jan. 1, 2013 to stay in effect through 2014, has 161 bipartisan co-sponsors. Liberal Democrats, however, called the legislation a deceptive effort to undermine the Affordable Care Act (Condon, 11/15).

CNN: House Democrats Cool Down After Obamacare Meeting 
What a difference a day makes. On Wednesday, House Democrats lit into White House officials who couldn't explain how President Barack Obama planned to make good on his failed promise that Americans could keep their health insurance under Obamacare if they preferred. But by Thursday afternoon, rank-and-file members appeared to have cooled down after a closed-door session with White House Chief of Staff Denis McDonough (Walsh, 11/14).

PBS NewsHour: House Members Debate Obama's Proposed Fix To Insurance Cancellations 
President Obama's idea to temporarily lessen the blow for Americans whose existing insurance policies were canceled has garnered mixed reviews on Capitol Hill. Gwen Ifill gets reaction from Rep. Jan Schakowsky, D-Ill., and Rep. James Lankford, R-Okla. (Ifill, 11/14).

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Research Roundup: Other Nations Surpass U.S. Health Care

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

Health Affairs/The Commonwealth Fund: Access, Affordability, And Insurance Complexity Are Often Worse In The United States Compared To Ten Other Countries
Our 2013 survey of the general population in eleven countries—Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States—found that US adults were significantly more likely than their counterparts in other countries to forgo care because of cost, to have difficulty paying for care even when insured, and to encounter time-consuming insurance complexity. Signaling the lack of timely access to primary care, adults in the United States and Canada reported long waits to be seen in primary care and high use of hospital emergency departments, compared to other countries (Schoen, Osborn, Squires and Doty, 11/14). 

Journal of the American Medical Association (JAMA): Hospitals, Market Share, And Consolidation
What was once a set of independent hospitals having arms-length relationships with physicians and clinicians who provide ambulatory care is becoming a small number of locally integrated health systems, generally built around large, prestigious academic medical centers. The typical region in the United States has 3 to 5 consolidated health systems, spanning a wide range of care settings, and a smaller fringe of health care centers outside those systems. Consolidated health systems have advantages and drawbacks (Cutler and Morgan, 11/12).

JAMA: Increasing Demands For Quality Measurement 
The proliferation of quality measures at the clinician, hospital, and insurer level has created challenges and logistical problems. Recommendations include raising the bar for quality measurements to achieve transformational rather than incremental change in the US quality measurement system, promoting a logical set of measures for the various levels of the health system, ... reducing attention to proprietary report cards, prompt but careful transition to measures from electronic health records, and allocation of sufficient resources to accomplish the goals of an efficient, properly focused measurement system (Panzer et al., 11/12).

JAMA Surgery: Increasing Organ Donation In Hispanic Americans
Although the number of Hispanic Americans on the national organ waiting list has increased dramatically, the Hispanic American population is still 60% less likely to donate organs compared with the non-Hispanic white population. A national organ shortage at crisis proportion requires attention to this gap to increase the number of registered donors. A large presence on the waiting list matched with a historic lack of intent to donate makes the Hispanic American community a prime population on whom to focus resources and educational efforts to increase the number of registered donors. The purpose of this study was to determine whether the respondents would change their intent to donate after multiple interventions. We observed a 55% increase in the intent to donate organs in wave 3 compared with wave 1. We attribute this increase to the combination of the media and educational interventions implemented as part of our ongoing effort (Salim et al., 11/13).

AARP Public Policy Institute: Rapid Growth In Medicare Hospital Observation Services: What’s Going On?
This report summarizes the results of our analysis of growth in the frequency and duration of hospital observation services (OS) by Medicare beneficiaries between 2001 and 2009. Our study found far greater increases in both the frequency and duration of OS use than previous studies that covered shorter periods. Although only about 3.5 percent of Medicare beneficiaries used OS in 2009 during the study period, Medicare claims for OS grew by more than 100 percent, with the greatest increase occurring in cases not leading to an inpatient admission. The duration of OS visits has also increased dramatically (Zhao et al., 11/14).

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

Modern Healthcare: Analysis Finds Slow Progress Improving Outcomes, Big Jumps In Chronic Disease Since 1980
A sweeping analysis of U.S. healthcare trends over the past three decades points to slow progress on health outcomes, such as life expectancy; increased consolidation; jumps in cost-driving rates of chronic illness; and a growing focus on consumer-oriented care. The paper, published in the Nov. 13 issue of the Journal of the American Medical Association, ... highlighted a number of surprises, including a steady decline in personal out-of-pocket healthcare spending since 1980, said Dr. Hamilton Moses, a neurologist, head of the North Garden, Va.-based Alerion Institute, and the article's lead author (McKinney, 11/12).

McKnight's: Price Increases, Not A Larger Senior Population, Are Responsible For Exploding Healthcare Costs: Analysts
Escalating healthcare costs in the United States cannot be pinned on an aging population demanding more services for chronic conditions. Instead, higher costs are primarily the result of price increases, according to a new analysis in the Journal of the American Medical Association. ... The huge number of aging baby boomers is putting increased demand on the healthcare system, driving up overall costs (Mullaney, 11/13).

Medscape: Clinic Staff Relationships Affect Patient Satisfaction
The relationships between clinicians and staff play an important role in patients' perception of quality care. A new scale, known as the Work Relationship Scale (WRS), can be used to measure these relationships and may help optimize care delivery in the primary setting. Erin P. Finley, PhD, MPH, from South Texas Veterans Health Care System in San Antonio, Texas, and colleagues published the results of their study in the November/December issue of the Annals of Family Medicine. The article describes the WRS and the association between WRS scores and patient experiences of care, as determined by VA Survey of Healthcare Experiences of Patients data (Pullen, 11/14).

Medscape: Demand For Specialists Will Outpace Primary Care By 2025
The demand for adult primary care services will grow by 14% in the next 12 years, according to a study published online November 4 in Health Affairs. However, with an aging population and expanded medical coverage, demand will grow even more markedly for specialized services. Timothy M. Dall, managing director for healthcare and pharma at IHS Inc in Washington, DC, and colleagues estimate demand for vascular surgery will rise 31% by 2025, cardiology will rise 20%, and neurosurgery, radiology, and general surgery will rise by 18% each (Frellick, 11/8).

Medscape: Emerging Care Models May Ease Primary Care Doc Shortage
Forecasts that predict dire shortages of primary care physicians have not generally factored in projected changes in the way healthcare is delivered. David I. Auerbach, a policy researcher with RAND Corporation in Boston, Massachusetts, and colleagues analyzed what the picture might look like with more primary care delivered using 2 emerging models: patient-centered medical homes and nurse-managed health centers. Both models use more nurse practitioners (NPs) and physician assistants (PAs) than traditional models (Frellick, 11/8).

Reuters: ER Visits Fell After Warnings Put On Kids Cough Drugs
Fewer kids went to U.S. emergency departments for reactions related to over-the-counter cough and cold medicine after manufacturers printed new warnings on medicine bottles, says a new government study. But the researchers from the U.S. Centers for Disease Control and Prevention (CDC) say more can be done to prevent kids from accidentally taking cough and cold medicine (Seaman, 11/11).

Reuters: Don't Neglect Oral Healthcare In Frail, Elderly: Study
Advancements in dentistry make it more likely that older adults will keep their teeth longer, which means ongoing oral healthcare is essential, a new study says. Unfortunately, it's not unusual for the frail and elderly to have poor oral hygiene. "Although during recent years increasing attention has been given to improving oral health care for frail old people, there is ample evidence showing that the oral health of elderly people, in particular of care home residents is (still) poor," researchers wrote in the journal European Geriatric Medicine (Jegtvig, 11/8).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
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.