Daily Health Policy Report

Wednesday, November 20, 2013

Last updated: Wed, Nov 20

KHN Original Reporting & Guest Opinion

Administration News

Capitol Hill Watch

Health Reform

Women's Health

Health Care Marketplace

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Doctors Complain They Will Be Paid Less By Exchange Plans

Reporting for Kaiser Health News, Roni Caryn Rabin writes: "Many doctors are disturbed they will be paid less -- often a lot less -- to care for the millions of patients projected to buy coverage through the health law’s new insurance marketplaces. Some have complained to medical associations, including those in New York, California, Connecticut, Texas and Georgia, saying the discounted rates could lead to a two-tiered system in which fewer doctors participate, potentially making it harder for consumers to get the care they need" (Rabin, 11/19). Read the story.

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'Motor Voter' Meets The Health Law

Kaiser Health News staff writer Anna Gorman, working in collaboration with The Washington Post, reports: "Twenty years ago, Congress passed a controversial law requiring states to allow people to register to vote when they applied for driver’s licenses or social services. Now, that same law is bringing voter registration to the health insurance marketplaces, and again, it is expected to result in legal fights. It also could lead to more partisan debate over the Affordable Care Act as Republicans raise concerns about whether the voter registration effort will produce Democratic voters" (Gorman, 11/20). Read the story.

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Does The Insurer Have The Right To Cancel A Grandfathered Plan?

Kaiser Health News consumer columnist Michelle Andrews answers a reader's question on this topic (11/20). Read her response

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Capsules: Safety-Net Hospitals Lose More Under Medicare’s Quality-Based Payments, Analysis Finds

Now on Kaiser Health News' blog, Jordan Rau reports: "Medicare’s effort to reward hospitals for quality is leaving many of the nation’s safety-net hospitals poorer, a new analysis finds. Dr. Ashish K. Jha, a professor at the Harvard School of Public Health, has found that hospitals treating the most low-income patients on average had their payment rates reduced by 0.09 percent in the latest round of Medicare’s program that rates hospitals’ quality. The hospitals with the fewest low-income patients received an average bonus of 0.6 percent. Government-owned hospitals in particular fared poorly, with Medicare reducing their payment rates by 0.10 percent for a year, according to Jha’s analysis, which he published Tuesday on his Harvard blog" (Rau, 11/19). Check out what else is on the blog.  

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Political Cartoon: 'Ouchless?'

Kaiser Health News provides a fresh take on health policy developments with "Ouchless?" by Gary Varvel.

Here's today's health policy haiku: 


So... Forty percent
to do... Quite a long punch list...
It causes concern.

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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Administration News

Obama Seeks To Redirect Some Of The Blame For Health Law Difficulties Toward Republicans

Speaking Tuesday to the Wall Street Journal's CEO Council, President Barack Obama talked about the challenges his administration has faced recently -- and still faces in the future -- regarding the roll-out of the health overhaul. Meanwhile, another poll indicated the president's approval ratings are sinking. 

The Washington Post: Obama Says Republicans Share Some Blame For Health-Care Law's Failures
President Obama on Tuesday sought to redirect some of the political blame for the botched rollout of the federal health insurance exchange to Republicans, characterizing GOP lawmakers as rooting for the law’s failure. Addressing a gathering of business executives, Obama acknowledged that the health-care rollout “has been rough, to say the least,” and he lamented the government’s archaic information-technology procurement system (Rucker and Somashekhar, 11/19).

ABC News: Obama: Rebranding Obamacare Will Be A Challenge
President Obama admitted that, even once the health care website is working properly, he faces an uphill battle to "remarket and rebrand" his signature law in the face of political opposition. Speaking to the Wall Street Journal's CEO Council Tuesday, the president said Republican resistance contributed to the rocky Obamacare rollout (Bruce, 11/20).

NBC News: Obama: We 'Underestimated' Difficulty Of Launching Obamacare Portal
President Barack Obama said Tuesday that his administration "underestimated" the difficulty of launching the troubled HealthCare.gov web site but that political partisanship is also to blame for the law’s poor rollout. "I think that we probably underestimated the complexities of building out a website that needed to work the way it should," Obama said during an interview with the Wall Street Journal’s Gerald Seib as part of its "CEO Summit." (Dann, 11/19).

CBS News: Poll: Obamacare Support, Obama Approval Sink To New Lows
President Obama's job approval rating has plunged to the lowest of his presidency, according to a new CBS News poll released Wednesday, and Americans' approval of the Affordable Care Act has dropped it's lowest since CBS News started polling on the law. Thirty-seven percent now approve of the job Mr. Obama is doing as president, down from 46 percent in October -- a nine point drop in just a month. Mr. Obama's disapproval rating is 57 percent -- the highest level for this president in CBS News Polls ( Dutton, De Pinto, Salvanto and Backus, 11/20).

The Associated Press/Washington Post: Health Secretary Says Website Will Improve, But Still Be A Work In Progress Come December
The HealthCare.gov website will still be a work in progress beyond the end of the month, Human Services Secretary Kathleen Sebelius said Tuesday, appearing to soften a promise that the site will be working by then for the vast majority of users. "The 30th of November is not a magic go, no go date. It is a work of constant improvement. We have some very specific things we know we need to complete by the 30th and that punch list is getting knocked out every week," Sebelius told The Associated Press (11/19).

The Washington Post: Carney Says Obama Was Told About Healthcare.gov Review In April
White House press secretary Jay Carney said President Obama was told in April about a review of HealthCare.gov's problems, but Carney declined to specify the details of the briefing. A federally-commissioned review by McKinsey & Co. concluded in late March that the online enrollment system was risky because the design process was flawed, The Washington Post first reported Monday night (Eilperin, 11/19).

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Capitol Hill Watch

Administration Tech Official Says About 40% Of Healthcare.gov Remains To Be Built

Henry Chao, who has overseen much of the work on healthcare.gov, said much of the "back office" work, including the system to send insurers their payments, has not been completed.

The Washington Post: Up To 40 Percent Of Obamacare's 'Back Office' Functions Yet To Be Built, Tech Chief Says
Henry Chao, the Obama administration official who oversaw the technical development of the federal health insurance marketplace, said Tuesday that his team has yet to complete 30 to 40 percent of the overall project. Speaking before a subcommittee of the House Energy and Oversight Committee, Chao said the Centers for Medicare and Medicaid Services is still working on a number of "back office" aspects of the project, including a system to send payments to insurance companies (Somashekhar, 11/19).

The New York Times: Health Insurance Marketplace Is Still About 40 Percent Incomplete, Official Says
The official, Henry Chao, made the assessment in testimony before a panel of the House Energy and Commerce Committee. Lawmakers expressed surprise that so much work remained to be done seven weeks after the federal website opened to the public (Pear, 11/19).

The Wall Street Journal: New Tech Worries Loom For Health Law
A top government technology official told Congress on Tuesday that about 30% of the federal health-insurance marketplace "is still being developed," suggesting more tough hurdles await the administration even after the consumer portion, HealthCare.gov, is mostly fixed (Corbett Dooren, 11/19).

Politico: Tech Chief: Up To 40% Of Obamacare Work Left
A key player in the Obamacare website's creation acknowledged Tuesday that up to 40 percent of IT systems supporting the exchange still need to be built. The revelation from Deputy Chief Information Officer Henry Chao of the Centers for Medicare & Medicaid Services occurs as the administration works at its Nov. 30 deadline to shore up the website (Meyers, 11/20).

The Hill: ObamaCare IT Still 40 Percent Unfinished

CMS spokeswoman Julie Bataille explained that the back-end systems would allow the federal government to distribute tax subsidies and other payments to health insurance companies, but would not affect individual users. "It is not anything that is necessary in order for consumers to make a payment because that is something that they do outside of the marketplace, directly to issuers," she said (Hattem, 11/19).

Politico: CMS Sees Progress With Direct Plan Enrollment
Obama administration tech officials announced Tuesday that consumers can now enroll directly with insurers and avoid HealthCare.gov altogether, and their Obamacare subsidies will go with them. But insurance industry sources remained skeptical, citing a cumbersome repair effort over the past several weeks that has yet to prove itself. And officials from the Centers for Medicare & Medicaid Services said insurers have to try out the new system "in coming days" to see whether the federal portal can hold up  (Norman, 11/20).

Reuters: Some Cyber Security Experts Recommend Shutting Obamacare Site
President Barack Obama's HealthCare.gov site is riddled with security flaws that put user data of millions of people at risk and it should be shut down until fixed, several technology experts warned lawmakers on Tuesday. The testimony at a congressional hearing could increase concerns among many Americans about Obama's healthcare overhaul, popularly known as Obamacare. Opinion polls show the botched rollout of the online marketplace for health insurance policies has hurt the popularity of the effort (Finkle and Selyukh, 11/20).

CBS News: Serious Obamacare Concerns Obscured By Politics
Both Democrats and Republicans agree that there are serious concerns about the botched HealthCare.gov rollout and potential security issues on the site, but as Congress tries to get to the bottom of the site's problems, politics often gets in the way. "The exchanges need to be fixed, and they need to be fixed fast," Rep. Diana DeGette, D-Colo., said Tuesday in a House Energy and Commerce Committee subpanel hearing, referring to the new Obamacare marketplaces. However, she added, "We should not create smoke if there's no fire" (Condon, 11/19).

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On Capitol Hill, Shopping For Health Plans From The Online Insurance Marketplaces Appears To Go Smoothly

The New York Times and Wall Street Journal report on how Capitol Hill lawmakers and their staffs are having a very different experience choosing coverage than most of their constituents.

The New York Times: Perks Ease Way In Health Plans For Lawmakers
Members of Congress like to boast that they will have the same health care enrollment experience as constituents struggling with the balky federal website, because the law they wrote forced lawmakers to get coverage from the new insurance exchanges. That is true. As long as their constituents have access to "in-person support sessions" like the ones being conducted at the Capitol and congressional office buildings by the local exchange and four major insurers. Or can log on to a special Blue Cross and Blue Shield website for members of Congress and use a special toll-free telephone number — a "dedicated congressional health insurance plan assistance line" (Pear, 11/19).

The Wall Street Journal: For Lawmakers, Staff, On Capitol Hill, Obamacare Rollout Goes Smoothly
Lawmakers and their staff are getting personal experience with the Affordable Care Act—and it isn't always the same as their constituents'. Members of Congress and their aides are getting coverage through the District of Columbia's small-business exchange. That fulfills a provision in the law requiring them to obtain coverage through new insurance exchanges, not the familiar federal employee benefits program, in which Congress, like many large employers, heavily subsidized their premiums. Some users say that the exchange for lawmakers is operating much more smoothly than the troubled HealthCare.gov website that serves regular folks in 36 states (Radnofsky, 11/19). 

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Health Reform

States Split On Obama Cancellations Fix

Most of the state regulators allowing insurers to renew canceled plans, as proposed by President Barack Obama, are led by Republican governors who have opposed the law. Of the eight refusing to carry out the policy, six are in Democrat-led states that have embraced the law and who fear the extensions would undermine it.

The New York Times: In Stance On Renewal Of Old Health Policies, States Run The Gamut
Of the 13 states that have so far said they will allow consumers to renew canceled plans, all but four are led by Republican governors and have generally been opposed to the new health care law. Of the eight that have said they will not carry out the policy, six are in Democratic-led states, many of which have actively worked to put the law into effect and have argued that allowing such an extension could undermine its success. They include New York, which announced its decision on Tuesday, and Massachusetts. Many other states, including California and New Jersey, are still weighing their options (Thomas, Craig and Yourish, 11/19).

The Wall Street Journal: Most Insurance Regulators Back New Obama Plan
Insurance regulators in about half of U.S. states have now declared where they stand in response to President Barack Obama's plan to allow a one-year extension of policies canceled because they don't comply with the health law. So far, most support the initiative -- or at least aren't blocking insurers who want to take advantage of it (Scism and Martin, 11/19).

The Associated Press/Washington Post: Md. Insurance Commissioner Says Canceled Policies Can Be Renewed, But Only Through 2014
Maryland’s insurance commissioner says individual policies that don’t comply with the federal health care overhaul can be extended through the end of next year. Insurance Commissioner Therese Goldsmith said in a memo to insurers Tuesday that they can renew such policies for 2014 as long as the renewals take effect before Jan. 1 (11/19).

The Associated Press: Nevadans With Canceled Policies In Limbo
Nearly 25,000 Nevadans who received health insurance cancellation notices were still awaiting word Tuesday from the state insurance commissioner and Gov. Brian Sandoval on whether they can keep their plans for another year (Chereb, 11/19).

The Associated Press: BCBS Of Kansas To Continue Health Plans For Year
Kansas' largest health insurer said Tuesday that it will offer another year of coverage under plans that it had expected to cancel in 2014 because of the federal health care overhaul. Blue Cross and Blue Shield of Kansas said it hopes to notify about 10,000 policyholders within the next week that they can continue with their existing, individual coverage (11/19).

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Early Enrollees In State Exchanges Skew Older

More older Americans than young adults have signed up for coverage through the state marketplaces created by the health law, according to early data from four states. The federal government has not released age data for the signups on healthcare.gov. Meanwhile, Maryland has weak enrollment because of website problems, which have become an issue in the governor's race.

Reuters: Early Obamacare Data Show Older Americans More Apt To Sign Up
More older Americans than young adults so far have signed up for new insurance coverage under the state marketplaces created by President Barack Obama's health care law, according to early data from four states reporting details on their enrollment. The age balance is being closely watched to determine the financial stability of the insurance market created by the Affordable Care Act, as the participation of younger people is needed to offset costs for sicker beneficiaries (Krauskopf, 11/20).

The Wall Street Journal's Washington Wire: Connecticut's Early Health Enrollees Skew Older
Are older Americans enrolling in health insurance plans in greater numbers than young adults? Early enrollment figures released by two states suggest that could be the case. Data released Tuesday by Connecticut officials show that more people over the age of 55 enrolled in private insurance (40%) than people under the age of 35 (26%). The figures represented enrollment in private health plans as of Nov. 15 (Schatz, 11/19).

CNN: Obamacare Enrollments Pick Up Steam But Don't Include Many Young People
Obamacare might be off to a slow start but it's starting to pick up steam, at least in states that are not using the beleaguered HealthCare.gov website. Blocked out at HealthCare.gov? Bypass on way soon, feds say. For the past month, CNN has conducted a state-by-state survey to determine enrollment in the new insurance plans. As of Tuesday afternoon, at least 133,257 people had chosen new insurance plans in the 14 states with their own signup apparatuses. Nearly half of them were enrolled in the past two weeks (Hellerman, 11/19).

The Washington Post: Maryland Struggling With Technological Problems With Online Insurance Exchange
Maryland is wrestling with stubborn technological problems with its online insurance exchange, posting weak enrollment even as other states have signed up thousands of consumers for plans under President Obama’s new health-care law. In October, the exchange's first full month of operation, 1,278 people signed up for the private plans, and 465 signed up in the first week of November. Those low numbers raise questions about whether Maryland will achieve its enrollment target of 150,000 by the end of March. The state has about 800,000 uninsured residents (Sun, 11/19).

The Washington Post: Brown Accused Of 'Dropping The Ball' On Health Care In Md. As He Appears With Football Players
The two leading Democratic candidates for governor of Maryland engaged in some trash talk Tuesday over the implementation of health-care reform in the state. The campaign of Attorney General Douglas F. Gansler (D) accused Lt. Gov. Anthony G. Brown (D) of "dropping the ball" on the rollout of the Maryland Health Exchange on a day when Brown appeared alongside past and present Washington Redskins players to promote enrollment in insurance programs (Wagner, 11/19).

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Maine To Pay $1M To 'Conservative' Consultant To Study Medicaid Expansion

Maine's health department will pay a firm led by Gary Alexander, a controversial former welfare chief, to review the state's program and the potential costs of expanding it, according to several media reports. Meanwhile, Indiana, Missouri and South Carolina continue to debate whether to opt in to the health law's broadened Medicaid eligibility.

The Associated Press: Maine Hires Group For $1M Medicaid Program Review
Maine's health department will pay nearly $1 million to an outside consultant to evaluate the state's Medicaid program and study whether it should be expanded under the federal health care overhaul, officials said Tuesday. The Department of Health and Human Services signed the contract with the Alexander Group, led by Gary Alexander, a former welfare chief in Rhode Island and Pennsylvania, who has opposed an expansion of Medicaid and been criticized by Democrats and advocates for the poor and disabled for his cost-cutting efforts toward welfare (Durkin, 11/19).

Bangor Daily News: Maine Hires Conservative Firm To Study Medicaid Expansion, Bolster Welfare Efficiency
The state has contracted a conservative former welfare administrator with a history of slashing benefits to review Maine’s Medicaid system and other welfare programs. The Alexander Group, based in Rhode Island and spearheaded by former Pennsylvania and Rhode Island welfare chief Gary Alexander, will be paid nearly $1 million over eight months for its services, which will include a report on potential costs of expanding Medicaid under terms of the Affordable Care Act (Moretto, 11/19).

St. Louis Beacon: Nixon Scuttles Meeting With Legislative Leaders On Medicaid, After They Seek To Stipulate The Terms
The anticipated meeting next week between Gov. Jay Nixon and top legislative leaders, to discuss health care and Medicaid, may be on the ropes as a result of a dispute between the two camps over how and where the session would proceed. Nixon made public late Tuesday a tersely worded letter in which he took umbrage – and rejected – the terms of the meeting stipulated by the  chairmen of the House and Senate Interim Committees on Medicaid Transformation and Reform (Mannies, 11/19).

Greenville (S.C.) News: State Encouraged To Expand Medicaid
The White House and South Carolina Democrats joined forces Tuesday to encourage the state to expand its Medicaid program and provide health insurance to an additional 198,000 lower-income residents. South Carolina House Minority Leader Todd Rutherford, in a conference call with reporters arranged by the White House, said Republicans are resisting the expansion for political reasons. “It’s simply political that they don’t want 198,000 people... to gain that coverage and be able to thank a Democratic administration,” Rutherford said (Orndorff Troyan, 11/19).

Indianapolis Star: Pence Seeks Fed Meeting On Medicaid
Gov. Mike Pence wants to meet one-on-one with Health and Human Services Secretary Kathleen Sebelius to try to reach an agreement on expanding Medicaid in Indiana. Pence said in a letter sent to Sebelius last week and released by the governor’s office today that his staff and hers have been working collaboratively on the issue. “It is in that same spirit of collaboration that I wish to discuss the future of the Healthy Indiana Plan with you directly,” Pence wrote. But there remains a potentially big sticking point with the method that Pence wants to use for expanding Medicaid. Pence wants to require recipients to contribute toward their care to make them more aware of the cost of services, while federal law prevents cost-sharing for Medicaid beneficiaries who fall below the federal poverty line (Groppe, 11/19).


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Koch-Funded Group Uses Health Law To Target 3 Democrats

A political group backed by Charles and David Koch will target three of the most vulnerable Senate Democrats up for election next year by focusing on their support of the health care law, according to The New York Times. Meanwhile, Democrats are assessing whether President Barack Obama's proposed fix allowing canceled policies to be extended provides cover for vulnerable lawmakers.

The New York Times' The Caucus: Koch Brothers' Group Uses Health Care Law To Attack Democrats
Americans for Prosperity, the political group backed by the billionaire brothers Charles and David Koch, is targeting three of the most vulnerable Senate Democrats who are up for re-election next year. The group’s efforts are part of a new $3.5 million attack advertising campaign that hammers lawmakers for supporting President Obama’s health care law. The senators -- Mark Begich of Alaska, Kay Hagan of North Carolina and Mary L. Landrieu of Louisiana -- are all from conservative-leaning states that voted to elect Mitt Romney in 2012. The ads will start running in those states on Wednesday (Peters, 11/19).

Politico: Harry Reid Between Affordable Care Act And Vulnerable Democrats
Reid and his leadership team are assessing how Obama's proposed administrative fix to allow individuals to keep canceled insurance plans for one year plays in GOP-friendly states like Louisiana, Arkansas and North Carolina -- where key Democratic incumbents are up for reelection next year, leadership aides said. The hope is that the fix may blunt a recent nose dive in public approval of Obamacare (Everett and Kim, 11/19).

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Women's Health

Supreme Court Rejects Bid To Block Texas Abortion Law

In a 5-4 vote, the justices turned away an emergency application asking it to block a Texas law that opponents say prevents a third of the state's clinics from performing abortions. Meanwhile, Albuquerque voters defeated a proposal that would have outlawed most late-term abortions in New Mexico's largest city in the first municipal test of such a measure.

The New York Times: Justices Reject Bid To Block Texas Law On Abortions
The Supreme Court on Tuesday turned away an emergency application asking it to block a Texas law that requires doctors performing abortions to have admitting privileges at a nearby hospital (Liptak, 11/19).

Los Angeles Times: Supreme Court Vote Upholds Texas Abortion Law
The Supreme Court cleared the way Tuesday for Texas to enforce a strict new abortion regulation that opponents say prevents a third of the state's clinics from performing the procedure. The court, in a 5-4 vote, split along ideological lines in turning down an appeal to block the law that abortion rights advocates challenged as unconstitutional (Savage, 11/19).

Bloomberg: Texas Abortion Restrictions Allowed By U.S. Supreme Court
A divided U.S. Supreme Court let Texas enforce a law that requires abortion doctors to have admitting privileges at a local hospital, a measure that prompted at least a dozen clinics to close. On a 5-4 vote, the justices yesterday left intact a federal appeals court decision that said the law could go into effect during a legal fight over its constitutionality. Abortion clinics had asked the Supreme Court to block the law (Stohr, 11/20).

Reuters: Voters In Albuquerque, New Mexico, Defeat Measure To Limit Abortions
Voters in Albuquerque defeated a proposal on Tuesday that would have outlawed most late-term abortions in New Mexico's largest city in the first test of such a measure on a municipal ballot in the United States. The measure, which would have barred doctors within city limits from performing abortions after 20 weeks of pregnancy, unless a mother's life was in danger, was rejected 55 percent to 45 percent (Pollon, 11/20).

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Health Care Marketplace

Expiring Patents, Austerity Measures Lead to Predictions That Prescription Drug Sales Will Continue To Slow

The Associated Press/Washington Post: Prescription Drug Sales Will Continue To Slow Due To Expiring Patents And Austerity Measures
Growth in global prescription drug spending will slow to the lowest rate in decades as low-cost generic drugs continue replacing former blockbusters in the U.S. and Europe, where governments face new pressure to reduce health care spending, according to a new forecast. The projection from data firm IMS Health shows the global prescription drug market growing by 3 to 6 percent over the next four years to $1.2 trillion by 2017. That compares to a growth rate of 5.4 percent in the last four-year period (11/19).

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State Watch

State Highlights: Mo. Doctors Propose Medicaid Payment Reform Project

A selection of health policy stories from Missouri, North Carolina, California and Virginia.

The Associated Press: Doctors Propose Pilot Program For Mo. Medicaid
Some doctors want to make Missouri's Medicaid program a little more like a health club. A proposal outlined by a pair of doctors Tuesday would create a pilot project in which primary care physicians would be paid a flat monthly amount for each Medicaid patient they accept (Lieb, 11/19).

Raleigh News & Observer: Problems remain with N.C.’s Medicaid payment system
State officials said the troubled Medicaid billing system NC Tracks is operating more smoothly, but lawmakers said it still has significant problems. Doctors, hospitals and others who treat Medicaid patients began complaining about a new computer system as soon as the state started using it July 1 to pay health care bills. State officials have worked to reassure health providers and legislators that it is fixing problems and sending providers their money (Bonner, 11/19). 

Los Angeles Times: O.C. Nursing Home Pays $48 Million To Settle Medicare Fraud Case
Ensign Group Inc., a Mission Viejo company that operates nursing homes in several states, has agreed to pay $48 million to resolve allegations that it billed Medicare for unnecessary procedures performed on its patients. Two former Ensign Group therapists had accused the company in whistle-blower lawsuits of performing the unnecessary rehabilitation therapy at six skilled-nursing facilities in California. Although the lawsuits were filed in 2006, the government contended that the fraud lasted from 1999 to 2011 (Pfeifer, 11/19).

Los Angeles Times: Health Care Regulator's Move To Kaiser Under Investigation
California authorities are investigating whether laws were broken when a government regulator went to work for health care giant Kaiser Permanente, a company she spent years investigating for the state. Marcy Gallagher was a supervising attorney at the California Department of Managed Health Care, where she participated in several investigations of Kaiser. Last year, she left state employment and joined the company, where she works in a unit that responds to California regulators (Megerian, 11/19).

California Healthline: Building A New Health Care Workforce
Legislators called attention to what they called acute shortages of health care workers in the Central Valley during an Assembly hearing last week in Bakersfield. Shortages are likely to increase over the next few years for a variety of reasons, according to Assembly member and workforce committee chair Rudy Salas (D-Bakersfield). "Here in the Central Valley, we have a great need [for health care providers]," Salas said at Thursday's legislative hearing of the Assembly Select Committee on Workforce and Vocational Development in California which focused only on health care workers (Gorn, 11/19). 

Richmond Times-Dispatch: Legislators Touch On Health Care And Other Goals For 2014 Session
When the Virginia General Assembly convenes in January 2014, the Senate will be split between an equal number of Republicans and Democrats, the Republicans will outnumber Democrats 68-32 in the House of Delegates, and a new governor, Terry McAuliffe, a Democrat, will take the reins from outgoing Republican Gov. Bob McDonnell. State Sens. Ryan McDougle, R-4 (Mechanicsville), and Donald McEachin, D-9 (Henrico), each of whom represent portions of Hanover County, along with Del. Chris Peace, R-97 (Hanover), outlined diverse legislative agendas at a Nov. 14 meeting of the Hanover Business Council at Randolph-Macon College (Deal, 11/20).

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Editorials and Opinions

Viewpoints: GOP Could Fix Broken Health Law; Crisis Tests Whether Government Is Capable Of Offering Benefits Through Complex System; Rubio's Cynical Attack

The Wall Street Journal: How The GOP Should Fix ObamaCare
Republicans are the only ones who can fix President Obama's broken promise now. The problem is simply stated. Millions will be losing their individual insurance policies that they were promised they could keep. ... What can be done is Congress creating a new option in the form of a national health insurance charter under which insurers could design new low-cost policies free of mandated benefits imposed by ObamaCare (Holman W. Jenkins Jr. 11/19).

The New York Times: The Obamacare Crisis
Health care as a necessity comes only after food, shelter and income security. The mismanagement of the website HealthCare.gov and the cancellation of millions of policies pushes an underlying question out into the open: is the federal government capable of managing the provision of a fundamental service through an extraordinarily complex system? (Thomas B. Edsall, 11/19). 

Los Angeles Times: Rubio Takes The Prize On Obamacare Attacks
Step forward, Sen. Marco Rubio (R-Fla.)! You've won the prize for cynical attacks on Obamacare. In fact, keep the trophy -- you've retired it! We're talking, of course, about your proposal to repeal the provisions of the Affordable Care Act providing for "risk corridors." As we explained last month, risk corridors are a feature of the law designed to protect insurers that end up with a disproportionate share of sicker, costlier customers. ... Since the risk corridors protect the revenues of insurers in the exchanges, repealing them would drive insurers out of the exchanges and thus destroy this central feature of Obamacare. The fact that the insurance industry was awarded this central role in Obamacare largely to please conservatives like yourself -- that's why the so-called public option was dropped -- is what put your proposal over the top on cynicism points (Michael Hiltzik, 11/19).

Los Angeles Times: Obama's Reversal Of Fortune
When it comes to his healthcare law, President Obama faces a political version of what insurance folks call "adverse selection": All the bad news is sticking to him and most of the good news is sticking to someone else. Adverse selection, as we've been hearing lately, is what happens when a health insurance plan attracts too many sick people and not enough healthy ones. The plan's costs go up, its rates rise, healthy people drop out and, before you know it, you're in what actuaries call a death spiral. Obama isn't at that point yet. But the self-inflicted damage he has suffered in the last month is serious and likely to be enduring (Doyle McManus, 11/20).

The New York Times' Taking Note: No Budget, Because HealthCare.gov
After they were blamed for causing a disastrous shutdown, many Republicans seemed to want to get the year's budget fights behind them. As of a few weeks ago, some of them seemed open to relieving the sequester, which is widely hated by lawmakers in both parties, and Congressional appropriators thought they had a chance to enact real spending bills instead of running the government with yet another continuing resolution. But that's looking increasingly unlikely, and the reason is the uproar over the first six weeks of health care reform. Republicans are convinced that they are benefiting from the disastrous rollout of the new law (David Firestone, 11/19).

Los Angeles Times: Obamacare: Battle Of The Risk Pools
The Times' Maeve Reston on Monday dove into the fight that supporters and opponents of the 2010 healthcare law are waging for the hearts and minds of young adults, a constituency crucial to the new state insurance exchanges created by the law. Unless plenty of younger and healthier people sign up for coverage at the exchanges, insurers selling policies there could get stuck with too many customers who run up large medical bills. That, in turn, could drive up premiums faster, leading fewer healthy people to carry coverage, and so on in a vicious spiral (Jon Healey, 11/19).

Bloomberg: Coding Geeks Can't Save Obamacare
A recent news item reported that three programmers, all in their 20s, had whipped up an alternative to the U.S. health-insurance exchange system and claimed it was much more effective than the government’s system. The legend of the 20-something coding genius is so powerful that a major news organization seemed to accept that it should be this simple to fix the exchanges. Of course it isn’t, and boasts such as this are masking the complexity of the challenge (Norman Matloff, 11/19).

The Washington Post: The GOP's Scary-Movie Strategy
House Republican leaders could not have been more blatant in their attempts to frighten Americans if they had emerged from their weekly meeting wearing hockey masks and carrying chainsaws. "The American people are very, very worried," Majority Leader Eric Cantor (R-Va.) proclaimed to the cameras after emerging from Republicans' gathering Tuesday morning. "Moms and dads are worried that they're going to lose their health-care plan. . . . Individuals who are going onto the HealthCare.gov Web site are beginning to fear that perhaps their identity will be stolen." ... It was all I could do to keep my knees from knocking as I stood in an alcove in the Capitol basement (Dana Milbank, 11/19).

Bloomberg: Obamacare Shows How Americans Are Becoming Jerks
New Gallup poll numbers show Americans increasingly dispute the idea that government has a responsibility to make sure everybody can get health insurance. It's tempting to see that as an indictment against Obamacare, but it might just mean more Americans are becoming jerks (Christopher Flavelle, 11/19).

Los Angeles Times: Drew Altman, Obamacare's Ref
He might have become a doctor like his father, but a grad school (Harvard) summer job researching health policy changed all that. Now as the head of the Kaiser Family Foundation, Drew Altman deals not with lab numbers for a few patients but with healthcare data for millions. For years he headed up state and federal programs on welfare reform, homelessness and Medicaid. Since 1991, he's shaped the Menlo Park-based foundation as "a trusted source of information in a healthcare world dominated by vested interests." With Obamacare stumbling out of the gate, the foundation has been marshaling its data on behalf of consumers and providers to clear the fog of policy (Morrison, 11/19).

On other issues -

The New York Times' Economix: How The Safety Net Held Up In The Recession
Finally, some kind words for government. Robert A. Moffitt, an economist at Johns Hopkins University, says in a new paper that the country's social safety net did a good job during the recession, expanding by half a trillion dollars. Mr. Moffitt looked at means-tested programs including food stamps, Medicaid, unemployment benefits and the earned income tax credit to determine the increase between 2007 and 2010 (Shaila Dewan, 11/19). 

ProPublica: Five Takeaways: Why Doctors Stay Mum About Mistakes Their Colleagues Make
As I wrote this earlier month, doctors often know when a patient has been the victim of a medical error – sometimes before the patient does. But too often they don't say anything about the mistakes, according to a recent report in The New England Journal of Medicine (Marshall Allen, 11/19).

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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.