Daily Health Policy Report

Thursday, November 21, 2013

Last updated: Thu, Nov 21

KHN Original Reporting & Guest Opinion

Health Reform


State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

President's Cancellation 'Fix' Likely To Affect Limited Number Of Consumers

Kaiser Health News staff writer Julie Appleby reports: "A week after President Barack Obama urged insurers to renew policies that don’t meet all the requirements of the health law, it remains unclear how many people might be affected by the proposed fix. That’s because regulators in at least a half dozen states say they won’t allow insurers to do it and many more have yet to decide.  Even if states give insurers a green light to reinstate the policies, many insurers say they’re not sure if they can pull it off in time and no one knows how many customers who received the cancellations will want to renew" (Appleby, 11/21). Read the story.

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Hispanics Interested In 'Having Providers Who Can Appreciate Their Culture,' Medical Leader Says

Kaiser Health News staff writer Marissa Evans reports: "Dr. Elena V. Rios is president of the National Hispanic Medical Association, which she  founded in 1994 and which advocates on behalf of the nation’s 45,000 Hispanic health care professionals. One of the goals in the Affordable Care Act is building diversity in the health care workforce. The number of Hispanics attending medical school continues to increase, rising to 1,826 enrollees, according to an October 2013 report from the Association of American Medical Colleges. Despite that increase, Hispanics represent only slightly more than 9 percent of the enrollees compared with their nearly 17 percent of the population, making health care work force diversity a continuing challenge for the NHMA" (Evans, 11/21). Read the story.

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Political Cartoon: 'Mind The Gap?'

Kaiser Health News provides a fresh take on health policy developments with "Mind The Gap?" by Chip Bok.

Here's today's health policy haiku:  


Things must be bad when 
insurance commissioners
are called to White House.

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

White House Struggles With Health Law Messaging

As President Barack Obama is pilloried for the rocky rollout of the law, the White House struggles with how to refocus the public's attention, since some of the strongest arguments for the law are longer-term benefits that are harder to comprehend.

The Washington Post: Obama: Republicans Share Blame For Health-Care Problems
Seven weeks after HealthCare.gov’s troubled launch, President Obama has turned his emphasis from apologizing for the problems to criticizing Republicans ... But the strategy presents difficult challenges for Obama, who is seeking to refocus Americans’ attention on the benefits of the Affordable Care Act as the administration works on fixing the online enrollment system. Insurers and insurance commissioners, who are among the groups most closely invested in the program’s success, are questioning the Obama administration’s approach to it. The president’s own credibility with the public has ebbed in the wake of the rocky rollout. And some of the strongest arguments for the law — that it could contain health-care costs over time and ease the financial burden on hospitals required to treat uninsured patients — are longer-term benefits that are harder for the public to easily comprehend (Eilperin and Wilson, 11/20).

Politico: Obamacare Tradeoffs: Now They Tell Us…
The broken HealthCare.gov website, while an excruciating embarrassment, is on the path to repair. If Amazon and the airlines can manage millions of transactions a day over the web with ease, say experts, the federal government’s class of slow students surely will solve the problem in due course. But the problem with Obamacare’s stumbling start is that it shined a harsh light on intended consequences — more costs and more government regulation — that were always embedded in the ACA, yet were deliberately downplayed by Obama and Democrats on the way to passage. Backers hoped the costs of the ACA and its roster of losers would remain obscured after launch in a rush of good feeling about the laws benefits and its roster of winners (Harris and Nather, 11/20).

In related news -

Bloomberg: White House Says Health Law Helping Slow Rise In Costs
The White House said spending on health care in the last three years has risen at the slowest pace on record, with implications for American pocketbooks, jobs, the federal budget and the economy.  A report by President Barack Obama’s economic advisers linked slower growth of health costs to passage of the Affordable Care Act in 2010 (Runningen, 11/20).

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State Regulators Share Insurance 'Fix' Concerns With Obama

In a meeting at the White House Wednesday, a group of state insurance commissioners expressed concerns about President Barack Obama's proposal to extend canceled plans for one year that don't meet the requirements of the health law. Both sides acknowledged that each state must come to its own decision about how to proceed.

The Washington Post: Obama Meets With State Insurance Regulators
State insurance commissioners met Wednesday with President Obama at the White House, where they say he acknowledged that some states were unlikely to implement his proposal to reverse millions of health insurance cancellations. The commissioners shared their own concerns about the workability of his plan, which would give insurers an additional year to sell coverage that does not comply with the Obama health-care law’s regulations (Sun and Kliff, 11/20).

The Associated Press/Washington Post: State Insurance Regulators Meet With Obama On His Proposed Fix For Canceled Health Plans
Louisiana Insurance Commissioner Jim Donelon, president of the National Association of Insurance Commissioners, says both sides acknowledged the issues are complex and states will come to different decisions. More than 4 million people who buy their own insurance have gotten cancellation notices because their plans don’t meet requirements of Obama’s health law. The president has proposed allowing those customers to keep their existing plans for another year (11/20).

The New York Times: States Are Left To Decide On Health Plan Change
A group of state insurance commissioners emerged from a meeting with President Obama and other federal officials on Wednesday saying that state regulators would continue to decide on their own whether to go along with his recent proposal to let consumers keep older insurance plans for an extra year, even if the plans did not comply with regulations under the new health care law (Abelson and Craig, 11/20).

The Wall Street Journal: Extending Health Plans A Tall Order
Many people whose existing health-insurance policies were canceled due to the new federal health law won't be able to extend them, despite President Barack Obama's request that insurers allow them to do so. Some carriers say they may not or won't reinstate canceled policies because of a lack of time to make changes and other obstacles. Others say the one-year extensions would come with higher rates. At least five states—New York, Washington, Massachusetts, Minnesota and Rhode Island—have rebuffed Mr. Obama, meaning insurers can't reinstate policies there even if they do so elsewhere (Martin, Scism and Radnofsky, 11/20).

The Wall Street Journal’s Washington Wire: Some Insurance Regulators Turn Down White House Invitation
Not everybody hops when they get an invitation to the White House. Several state insurance regulators said “thanks but no thanks” to a planned meeting at the White House Wednesday afternoon with an association representing state insurance-department regulators to discuss difficulties carrying out President Barack Obama’s plan to allow a one-year extension of health insurance policies that were canceled because they don’t comply with the Affordable Care Act, people familiar with the matter said (Scism, 11/20).

Bloomberg: State Insurance Heads Snub Obama On Policy Cancellations
Kansas, North Dakota and other state insurance commissioners snubbed a meeting with President Barack Obama set up to discuss allowing some people to keep medical plans that don’t meet the requirements of the U.S. health law.  Six commissioners e-mailed their counterparts to say they weren’t invited or wouldn’t attend yesterday’s meeting at the White House because of reservations about the one-year reprieve for substandard health plans (Edney and Wayne, 11/21).

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Proposed Cancellation 'Fix' May Have Limited Reach

It remains unclear how many consumers may be affected because some state regulators and insurers are unlikely to go along. Meanwhile, in congressional testimony, an administration official placed the blame for the canceled policies on insurers, saying they had the opportunity to extend grandfathered plans.

Kaiser Health News: President's Cancellation 'Fix' Likely To Affect A Limited Number Of Consumers
A week after President Barack Obama urged insurers to renew policies that don’t meet all the requirements of the health law, it remains unclear how many people might be affected by the proposed fix. That’s because regulators in at least a half dozen states say they won’t allow insurers to do it and many more have yet to decide.  Even if states give insurers a green light to reinstate the policies, many insurers say they’re not sure if they can pull it off in time and no one knows how many customers who received the cancellations will want to renew (Appleby, 11/21).

Politico: Health Official Blames Cancellations On Insurers
The Obama administration’s health exchange chief squarely blamed insurers for the millions of canceled policies that have become a flash point about broken promises under Obamacare. “I believe that the law provided insurance companies an opportunity to have grandfathered plans, which would make the president’s promise true,” Gary Cohen, head of the exchange office, told a Senate panel Wednesday (Norman, 11/20).

Meanwhile, news outlets report on how specific states are proceeding -

MinnPost: Rejection Of Obamacare ‘Fix’ Also Affects Businesses
Minnesota Governor Mark Dayton said Monday that Minnesotans may not renew health plans that are noncompliant with Affordable Care Act (ACA) in 2014, despite the fact that President Barack Obama opened the door to that option. And while the attention has been focused on the individual market, the announcement may also affect plans offered by Minnesota businesses (Anderson, 11/20).

The Baltimore Sun: Policyholders Get Chance To Extend Health Plans
CareFirst BlueCross BlueShield said Wednesday that it would offer more than 55,500 customers the chance to extend their healthcare plans for another year, even though the policies don't comply with the federal Affordable Care Act. Maryland's insurance commissioner had told insurers a day earlier that such a move would be legal, and last week a beleaguered President Barack Obama asked states and insurers to consider the extensions. The president had promised Americans that if they liked their plans, they could keep them (Cohn and Cox, 11/20).

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Healthcare.gov: It's Getting Better All The Time -- But System Flaws, Failures Persist

Some states and insurers are contemplating alternatives if the website isn't ready by a critical December deadline. Meanwhile, just as Health and Human Services Secretary Kathleen Sebelius was talking up the website in Florida, it crashed before her eyes.  

The New York Times: Applicants Find Health Website Is Improving, But Not Fast Enough
Despite weeks of work by a small army of software experts to salvage HealthCare.gov, navigators in states that depend on the federal insurance exchange say they still cannot get most of their clients through the online enrollment process. Those navigators said they had seen improvements in the system since its disastrous rollout on Oct. 1, particularly in the initial steps of the application process. But the closer people come to signing up for a plan, the more the system seems to freeze or fail, many navigators said (Goodnough, 11/20).

Bloomberg: Obamacare Bailout Sought As Effort Planned To Bypass Site
States and insurers are already working to bail out President Barack Obama's health-care overhaul, anticipating the system's online insurance exchanges may not be ready by a critical December deadline. All of the alternatives have drawbacks. ... Consumers have until Dec. 15 to buy a policy that takes effect Jan. 1. They have to enroll by March 31 to avoid the 2010 law’s penalty for people who go uncovered (Nussbaum, 11/21).

Politico: Kathleen Sebelius Watches Obamacare Website Crash
Late-night TV comics who still need material about the troubled Obamacare website should have kept an eye on what happened to HealthCare.gov when HHS Secretary Kathleen Sebelius talked up the website this week in Florida. It crashed (Levine, 11/20).

Politico: White House Email Chain Reveals Launch Fears
Top White House and health officials feared that HealthCare.gov would not work correctly and would set off a wave of bad publicity, according to emails shortly before the disastrous rollout of the Obamacare enrollment website. The emails, released Wednesday evening by House Oversight Chairman Darrell Issa, included a picture of an error message that has become emblematic of the launch debacle. They were dated Sept. 25 — less than a week before the enrollment portal opened and immediately created a crisis for the White House (Cunningham, 11/21).

CQ HealthBeat: Consumers Union Says It Isn't Warning People Away From Healthcare.Gov
A Consumers Union official said Wednesday that her organization is not warning people away from healthcare.gov for security reasons. The official issued that clarification amid heightened concern on Capitol Hill about the ability of the federal website to protect visitors against identity theft (Reichard, 11/20).

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Narrow Choices For Doctors And Hospitals Could Keep Costs Down But Add To Consumer Concerns

The Associated Press offers examples of limited networks that exclude some of the most prestigious hospitals in the Chicago and New York City areas.

The Washington Post: Insurers Restricting Choice Of Doctors And Hospitals To Keep Costs Down
As Americans have begun shopping for health plans on the insurance exchanges, they are discovering that insurers are restricting their choice of doctors and hospitals in order to keep costs low, and that many of the plans exclude top-rated hospitals. The Obama administration made it a priority to keep down the cost of insurance on the exchanges, the online marketplaces that are central to the Affordable Care Act. But one way that insurers have been able to offer lower rates is by creating networks that are far smaller than what most Americans are accustomed to (Somashekhar and Cha, 11/20).

The Associated Press/Washington Post: Next Worry: Narrow Choice Of Hospitals And Doctors Seen In New Health Overhaul Insurance Plans
After they get the website fixed, then what? Keeping your doctors and hospitals may be the next vexing challenge for Americans in the new health plans created by President Barack Obama’s law. Obama promised people could keep their doctors. But in many states the new plans appear to offer a narrow choice of hospitals and doctors. Overall, it’s shaping up as less choice than what people get through Medicare or employer-based coverage. Also, it can get complicated tracking down which medical providers are in what plans (11/20).

The Associated Press/Washington Post: New Health Plans Sold Through Exchanges Not Accepted At Some Prestigious NYC Hospitals
New Yorkers buying a health plan on the state’s new insurance exchange should read the fine print if they're interested in getting care at some of the city’s top hospitals. Not all are participating in the new plans created by the Affordable Care Act (11/20).

The Associated Press: Many Exchange Health Plans Exclude Top Hospitals
Chicago's best known hospitals don't accept many of the health plans sold on the new insurance marketplace that's part of the nation's health care law, and consumer advocates are worried patients will get stuck with unexpected bills. It may turn into the next big challenge for the insurance system created by President Barack Obama's law. Obama promised Americans could keep their doctors (Johnson, 11/20).

Meanwhile, on the small business front --

The Wall Street Journal: For Small Businesses, A Hidden Tax In Health Care?
Starting next year, small businesses are among those poised to bear the brunt of a little known tax created by the Affordable Care Act that will impose an annual "fee" on health-insurance companies. The fee is expected to bring in a total of $8 billion next year and as much as $14.3 billion by 2018, according to the legislation, and will be spread out among insurers based on the percent of the market they cover. But the Congressional Budget Office and industry experts say the expense will largely be passed on to small businesses and consumers who buy their own policies in the form of higher premiums (Needleman, 11/20).

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New Medicaid 'Doughnut Hole' Creating Some Pressure On States, Federal Officials

Health law advocates are concerned about low-income residents who are left out of the health overhaul in states that are not expanding Medicaid. Meanwhile, in other states, new enrollment in the joint federal-state program is strong.

California Healthline: The New Health Coverage Gap: Will Obama Or States Take Action To Close It?
Now, there is a new doughnut hole -- a gap in health insurance options for low-income individuals in states that opt against expanding Medicaid. The Affordable Care Act was built with a safety net for people who fall short of requirements for subsidized insurance through the exchanges: the Medicaid expansion. However, with many states are refusing to participate in the expansion, observers are questioning whether federal or state officials will act first, or at all, to close the gap (Wayt, 11/20).

NPR: Medicaid Enrollment Is Brisk Despite HealthCare.gov Troubles
Buried in the paltry enrollment numbers for the Affordable Care Act that were released last week was something that came as a surprise to many — the success states are having signing people up for the Medicaid program, which provides health care to low-income people (Rovner, 11/20).

On the local scene -

Politico: Scott Walker Treads Own Path On ACA
[Wisconsin Gov. Scott] Walker built his own plan on his rejection of Obamacare's Medicaid expansion. Instead, he's taking nearly 80,000 people off the state's generous Medicaid program and encouraging them to join the Obamacare insurance exchange, where they can get federal subsidies. That would, in turn, make room to extend BadgerCare, as Medicaid is known there, to poorer people. He's calling it a "creative alternative" and using it to polish his reputation as an outside-the-box innovator. But that was before the HealthCare.gov catastrophe made it so difficult to enroll (Cheney, 11/20).

The Associated Press: Parnell Rejects Medicaid Expansion
Gov. Sean Parnell on Friday rejected calls to expand Medicaid in Alaska, citing cost concerns. The Republican governor has faced mounting pressure from health, advocacy and business organizations urging him to expand Medicaid under the federal health care law (Bohrer, 11/20).

The Associated Press: Pence Asks Sebelius For Meeting On Health Care
[Indiana] Gov. Mike Pence has requested a meeting with Health and Human Services Secretary Kathleen Sebelius to discuss issues that may be blocking a federal approval of using the state's health savings accounts to expand Medicaid coverage in Indiana, his office said Tuesday (11/20).

Health Policy Solutions (a Colo. news service): Health Insurance Customers Want Simpler System
No one mentioned cancellation notices. And no one expressed concerns about costs. Instead, at a sparsely attended public meeting about health insurance issues Tuesday evening, potential customers wanted to know if they could skip filling out Colorado's complex Medicaid application. … Colorado's new insurance commissioner, Marguerite Salazar, hosted the meeting. Her office doesn't run Medicaid programs. It regulates insurance companies and approves plans and rates. Still, most consumers wanted to know about holdups with Medicaid and no one from that office attended (Kerwin McCrimmon, 11/20).

The Associated Press: Bohlinger Calls for Medicaid Expansion
Democratic U.S. Senate candidate John Bohlinger is calling on [Montana] Gov. Steve Bullock to convene a special legislative session to expand Medicaid to another 70,000 residents, a proposal that was rejected by lawmakers earlier this year (Volz, 11/20).

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Oregon Insurance Exchange Never Worked, Officials Questioned On Problems

Oregon residents are facing a state health exchange application deadline in two weeks to get coverage at the beginning of 2014, even as the online aspect of the marketplace still doesn't work -- and never did. In the meantime, Oregon lawmakers question officials on the exchange's problems and when they knew about them.

Reuters: Oregon Health Care Exchange Website Never Worked, Has No Subscribers
Oregon, a state that fully embraced the Affordable Care Act, is enduring one of the rockiest rollouts of President Barack Obama's signature healthcare law, with an inoperative online exchange that has yet to enroll a single subscriber, requiring thousands to apply on paper instead. Unlike most other states, Oregon set an ambitious course to make its insurance exchange, dubbed Cover Oregon, an "all-in-one" website for every individual seeking health coverage, including those who are eligible for Medicaid (Kaminsky, 11/20).

The Associated Press: Cover Oregon Sets Application Deadline In 2 Weeks
People who want health coverage beginning in January through Oregon's troubled insurance exchange need to act fast. State officials said Wednesday they don't expect to have the online enrollment system working in time for people to enroll in plans that begin on the first of the year (Cooper, 11/20).

Oregonian: Cover Oregon Officials Knew Site Suffered From 'Significant Deficiencies' Last Spring
At one point Wednesday during legislative meetings on the state's problem-plagued health insurance exchange, the issue boiled down to one question: Does Cover Oregon have just one fax machine to accept the 19-page paper application that Oregonians must submit? The Cover Oregon website hasn't been able to enroll anybody since its scheduled Oct. 1 launch and won't be ready to sign people up until Dec. 16 -- one day after the deadline to enroll for benefits that go into effect Jan. 1 (Zheng, 11/20).

National Journal: Oregon Spent Millions On Trippy Commercials for A Health Care Website That Never Worked
These ads, and equally "creative" ones from other states, were meant in part to get young people aware of the exchanges, because their enrollment is crucial to the success of the marketplace. And they've worked in the sense that they've achieved some virality off the air and on the Web—where these young people tend to gather their information. In Oregon, 25,000 people have applied via paper applications because of the nonfunctioning website (Resnick, 11/20).

Exchanges, or lacks thereof, are also making news in Georgia, California and Colorado --

Atlanta Journal-Constitution: State Exchange Wouldn’t Have Solved Georgia’s Woes
You can tell Obamacare has Democrats worried, because they've shifted from telling everyone how wonderful it was going to be to blaming Republicans for how bad it's turned out (Wingfield, 11/20).

California Healthline: Exchange Readies Second Web Opening
The second unveiling happens this week for Covered California's health benefit exchange website. This time small businesses are the enrollment target. The exchange's website, which launched for individual California consumers on Oct. 1, will go through a weekend-long upgrade in preparation for a Monday re-launch with enrollment accessibility for the Small Business Health Options Program -- known as SHOP. Brokers and small-business employers will be able to sign up online starting Monday. Once employers sign up for coverage, employees will be able to look up the program online and choose a plan (Gorn, 11/20).

Health Policy Solutions (a Colo. news service): After 37-Day Delay, Cancer Patient Gets Insurance
It took 37 days of waiting in a bureaucratic black hole, 22 minutes on hold, two dropped calls and a switch to a new health system, but Donna Smith finally succeeded in signing up for new health insurance. She is one of 6,001 people who have bought insurance through Connect for Health Colorado during its first six weeks of operations. … While Smith supports Obamacare as an interim step toward universal coverage, her experience over the past six weeks has underscored the need for additional changes (Kerwin McCrimmon, 11/20).

In news related to plans available on the exchanges and affordability concerns -

The Associated Press: Begich Proposes New Tier Of Insurance Policies
U.S. Sen. Mark Begich has proposed creating a new tier of insurance policies with lower premiums under the federal health care law as a way to address affordability concerns. The Alaska Democrat said his proposed "copper plans" would cover the services listed as essential health benefits under the law, and ensure at least half of medical costs are covered (Bohrer, 11/20).

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How The Health Law Is Playing In The States

The Washington Post offers a table documenting how the overhaul is doing while USA Today chronicles successes and failures in three specific states.  

The Washington Post: How Obamacare Has Fared In Each State
A lot of ink has been spilled on the troubled rollout of the president’s landmark health-care law, but contextualizing it has been difficult (if not downright confusing). Earlier this week, our graphics department colleague Kennedy Elliott put together an easy-to-read table documenting how Obamacare has fared in each state, so we thought we’d make some charts (Chokshi, 11/21).

USA Today: How Health Care Law Is Playing Out In Three States
In August, USA Today reporters chronicled how residents of three states -- California, Texas and West Virginia -- were preparing for the Oct. 1 debut of the health care program, President Obama's signature legislative achievement. Now, eight weeks into its rocky rollout, that trio of states provides a window into the setbacks and successes of the controversial law (Schmit, Jervis and Toppo, 11/21).

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GOP Formulates New Attack Strategy To Swell Opposition To Health Law

Republicans are planning new health law attacks with an arsenal of tactics including issuing talking points to members and hammering Obama administration officials at hearings all in an attempt to further unravel the law.

The New York Times: G.O.P. Maps Out Waves Of Attacks Over Health Law
The memo distributed to House Republicans this week was concise and blunt, listing talking points and marching orders: "Because of Obamacare, I Lost My Insurance.""Obamacare Increases Health Care Costs." "The Exchanges May Not Be Secure, Putting Personal Information at Risk." "Continue Collecting Constituent Stories" (Weisman and Stohlberg, 11/20).

Politico: The House GOP's Obamacare Playbook 
The House Republican leadership is coordinating an aggressive push to keep Obamacare's problems front and center both on Capitol Hill and around the country. The House GOP effort includes investigations by at least eight committees, subpoenas for testimony from key administration officials and an initiative by Rep. Darrell Issa, chairman of the House Oversight and Government Reform Committee, to hold hearings around the country to highlight Americans’ problems with the law (Kim and Sherman, 11/20).

CNN: GOP Seeks A Groundswell Of Opposition To Obamacare
Use any metaphor you like -- predators smelling blood, invaders storming the castle, a snowball growing in size and momentum as it rolls downhill. All describe efforts by opponents of President Barack Obama's signature health care reforms to kill the 2010 law after the botched launch of the HealthCare.gov website provided a new opening for attack (Cohen, 11/21).

The New York Times' The Caucus: In An Attack Ad, An Alaskan Voter Is Really An Actress From Maryland
In a tough new advertisement from the Koch brothers-backed Americans for Prosperity, an unnamed woman looks directly into the camera and upbraids Senator Mark Begich, Democrat of Alaska. … But there is a slight problem with the commercial. The woman is not from Alaska. She is actually an actress who lives in Maryland. And to some, the elegant kitchen she is standing in, done in French country style with granite countertops, might seem out of place somewhere as rugged and frontierlike as Alaska (Peters, 11/20).

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Investigation Into Medicare Payment Decision Spotlights Issues Of Insider Trading And 'Political Intelligence'

The Wall Street Journal: Probe Of How U.S. Agency's Medicare Move Reached Investors Hits Wall
Investigators are hitting a wall in an insider-trading probe of how a government funding decision made its way to investors before it was officially released, according to people familiar with the probe. The Securities and Exchange Commission and Federal Bureau of Investigation have been examining whether anyone in government illegally passed along information April 1 about a pending decision on Medicare payments, according to officials involved in the probe (Mullins, Eaglesham and Bartlett, 11/21).

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State Watch

State Highlights: N.Y. Hospitals Scramble To Sign Uninsured Up For Care

A selection of health policy stories from New York, North Carolina, Oregon, Texas, Kansas and Georgia.

The Wall Street Journal: Hospitals Push Coverage
Many of [New York City's] financially strapped hospitals are scrambling to sign up people for health coverage through New York state's exchange or through Medicaid as they brace for federal cuts to providers of so-called charity care for the uninsured. At Montefiore Medical Center in the Bronx, the staff is posting insurance information on social-networking websites and giving presentations at churches and mosques. At Maimonides Medical Center in Brooklyn, officials have met with the Brooklyn Chamber of Commerce to ensure small businesses know their insurance options. Some hospitals are recruiting patients for coverage plans in emergency-room lobbies (Dawsey, 11/20). 

North Carolina Health News: Lawmakers Debate Medicaid's Past and Future
In a legislative meeting Tuesday, lawmakers and officials from the state Department of Health and Human Services debated changes to the state's Medicaid program and what the program might look like in the future. At issue is the question of whether the state will change the structure of the program or invite private companies to manage Medicaid, which pays for medical and other forms of care for close to 1.8 million North Carolinians. (Hoban, 11/20).

The Lund Report: CCO Data Debunks Myth Of Immigrant Burden To Medicaid
New data released this month shows that Latinos on the Oregon Health Plan are much less likely to use the emergency room or outpatient health services than other residents, disproving a myth that a recent wave of immigration from Latin America has burdened the state's Medicaid program (Gray, 11/20).

The Texas Tribune: After SCOTUS, Abortion Providers Work To Secure Access
Following the U.S. Supreme Court's decision on Tuesday not to intervene in Texas' ongoing abortion litigation, Planned Parenthood and other abortion providers are working to secure access to the procedure for women across the state (Aaronson, 11/20).

Wichita (Kan.) Eagle: Safety Net Clinics Look To Integrate Mental Health Services
For many area safety net clinics, the next big step in delivering care is to integrate medical and behavioral health services. One way to do that is through the creation of Medicaid-funded health homes. ... The health home initiative is a part of KanCare, the state’s privatized Medicaid system, and could affect up to 36,000 people statewide, according to state officials (Ryan, 11/20).

Georgia Health News: GA. Rate of Uninsured Kids Improved, But Still High
The percentage of Georgia children who are uninsured has declined, but the state still has the fourth-highest number of kids without coverage, according to a report released Wednesday. In raw numbers, Georgia has nearly 220,000 children who are uninsured, trailing only Texas, California and Florida, said the report from Georgetown University’s Center for Children and Families. All three of those states have much higher populations than Georgia (Miller, 11/20).

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Weekend Reading

Longer Looks: Parents' Crusade On Rare Diseases; Fighting Obesity

Every week reporter Ankita Rao selects interesting reading from around the Web.

The Wall Street Journal: Trials: The Children's Crusade
In the beginning, Chris Hempel noticed the clumsiness. Her girls tripped over toys on the floor. Their grandfather said he couldn't teach them to pedal their tricycles. … The Hempels learned of people who called themselves citizen-scientists. Many shared research papers and their day-to-day experience. Some talked of their willingness to try any promising drug. Others sought a role as equal partners with researchers. Scientists, while sympathetic, generally believe their work should be left to experts. Families are encouraged to raise money if they want to help, but the traditional view is that amateurs can't shape research or find cures. The Hempels found a maddening gap between the search for scientific knowledge and the search for treatments (Amy Docker Marcus, 11/2013).

Medium: Imagining the Post-Antibiotics Future
Penicillin was first discovered in 1928 and battlefield casualties got the first non-experimental doses in 1943, quickly saving soldiers who had been close to death.  ... Penicillin-resistant staph emerged in 1940, while the drug was still being given to only a few patients. ... In 2004, there were only five new antibiotics in development, compared to more than 500 chronic-disease drugs for which resistance is not an issue — and which, unlike antibiotics, are taken for years, not days. Since then, resistant bugs have grown more numerous and by sharing DNA with each other, have become even tougher to treat with the few drugs that remain (Maryn McKenna, 11/20).

Marketplace: The New Math Of Health Care
About This Collection [of stories]: The price tag for medical care, already big and getting bigger, looms over Americans. Retirees see their savings vanish. Families face tough and often bewildering choices, and uncertainties over Obamacare only add to the confusion. This special section ... examines the soaring out-of-pocket costs of staying healthy, end-of-life care, and strategies for picking doctors and health plans. We also explore what doctors facing death can teach us about dying well (11/19).

The New York Times: Planning For A Future In The Face Of Terminal Illness
Patrick Skeldon, a commercial airline pilot, started having trouble walking in the autumn of 2003. His doctor thought he had a vitamin deficiency and prescribed supplements. When those didn't work, the doctor referred him to a neurologist. The next year, he was told he had amyotrophic lateral sclerosis, more commonly known as Lou Gehrig’s disease. He was 59. … As people live longer with terminal diseases, the costs associated with their care rise. The risk is often not just that there will not be enough money to provide that care, but that a surviving spouse will be left alone and destitute. With advisers cautioning that terminal care expenses could easily rise to $1 million or more for the last years of life, they say there are simple and sophisticated strategies to make the most of the money at hand (Patrick Sullivan, 11/19).

The New York Times: To Fight Obesity, A Carrot, And A Stick
Childhood obesity, at long last, may have peaked — even among the poor, where the problem is most prevalent. Between 2008 and 2011, according to a study from the Centers for Disease Control and Prevention, 19 states and territories saw a small but significant drop in obesity rates among low-income preschoolers. … Attitudes are changing. Access to healthy food is increasing. But there's another change that's necessary, and it's probably the most important one. ... That's cost. On a limited budget, people buy cheap and unhealthy food. Community groups and cities can't solve that problem — not for more than a handful of people at a time, anyway. But the federal government can (Tina Rosenberg, 11/16).

The Wall Street Journal: Experts Views On Alternative Medicine, Medicare 
Health industry experts answer questions about the misconceptions consumers have about alternative medicine, such as "Beware the Impurities in ‘Natural’ Supplements," while others look at the proposals to change the eligibility age for Medicare (11/20).

Al Jazeera: The Military's Hidden Mental Health Crisis: Spousal Trauma
Army wife Melissa Bourgeois hit her breaking point five years ago when she was living at a U.S. military base in Vicenza, Italy, with her husband, Eric, an infantryman. Eric was just back from a harrowing second deployment to Afghanistan marked by frequent firefights. Filled with an uncontrollable rage, he spent his nights self-medicating at bars with his war buddies. … Melissa, 25 at the time, with their two small children, felt isolated in a new country where she barely spoke the language. She needed to talk to someone about her situation, but she said each time she sought mental-health care on the base, she was given Valium and sent away. ... In a U.S. military psychologically ravaged by 12 years of continuous war, troops' family members, like Melissa, are the victims of a hidden mental-health crisis (Sarah Lazare, 11/15). 

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Editorials and Opinions

Health Law Opinions: Obama Asks You To Talk ACA At Thanksgiving; Rove Says Dems Views On Success Are 'Delusional'

Commentators weigh in on the continuing troubles in the health law rollout.

The New York Times' Taking Note: Talking Health Insurance Over Thanksgiving Dinner
Here's a hypothetical scenario: You're the president. You've just botched the roll out of what should have been your signature accomplishment, a major reform of the health insurance system. The public's hopping mad because you said anyone who liked his insurance plan would be able to keep it, but that wasn't true. So what do you do now? What the actual president did was suggest we all discuss health insurance with their families this holiday season (Andrew Rosenthal, 11/20). 

Los Angeles Times: The Fixes Obamacare Really Does Need
You may have heard, unless you've been living under a rock, that the Affordable Care Act isn't perfect. Programs that aim to restructure one-sixth of the U.S. economy rarely are at the outset, and that's even more true when their introduction is accompanied by determined efforts by some politicians in some states to make them fail. ... But there are some improvements that can be managed right now. For the most part, all they require are political will -- and money (Michael Hiltzik, 11/20). 

The Wall Street Journal's The Experts: Affordable Care Act: How Obama's Signature Legislation Could Be Changed
Love it or hate it, there's no denying the Affordable Care Act is a complex piece of legislation with some positives—and some areas for improvement. With this in mind, we posed the following question to The Experts: If you could change one aspect of the Affordable Care Act, what would it be? This discussion relates to a recent Unleashing Innovation: Health Care Report and formed the basis of a discussion on The Experts blog on Nov. 18 (11/20). 

The Wall Street Journal: Worse Than Obamacare
The ObamaCare train wreck is plowing through the White House in super slow-mo on screens everywhere, splintering reputations and presidential approval ratings. Audiences watch popeyed as Democrats in distress like Senators Kay Hagan, Mary Landrieu and Mark Pryor decide whether to cling to the driverless train or jump toward the tall weeds. The heartless compilers of the Washington Post/ABC poll asked people to pick a head-to-head matchup now between Barack Obama and Mitt Romney. Mitt won. This is the most amazing spectacle of mayhem and meltdown anyone has seen in politics since Watergate (Daniel Henninger, 11/20). 

The Wall Street Journal: House Democrats Get The Yips 
For the president and key Democratic supporters, the website rollout was a glitch that should not detract from a wondrous and politically potent health-care overhaul. Just ask Democrats like House Minority Leader Nancy Pelosi, who declared on Sunday's "Meet the Press" that Democrats will proudly "stand tall" with the president in defense of ObamaCare. Or David Plouffe, the president's former senior adviser, who insisted on "This Week With George Stephanopoulos" that it's an "impossibility" Republicans will run successfully against ObamaCare next year or in 2016. Or pollster Stan Greenberg, who told me last week that the law is increasingly popular. These claims are delusional (Karl Rove, 11/20).

USA Today: GOP Better Ready Obamacare Replacement
The first weeks of Obamacare are not going well. The law's flaws are becoming more apparent every day. ... Despite the president's unambiguous promises that if we liked our plans, we could keep them, it turns out that for millions of Americans, it wasn't true. They're being shoved onto the exchanges, where many will have to pay much more for the same coverage. Most of the new policies on the exchanges, moreover, do not cover the great centers of medical excellence -- the Moffitt Cancer Center, M.D. Anderson, Memorial Sloan Kettering, the Mayo Clinic -- so we are hearing of dying cancer patients who suddenly face terrible choices (Newt Gingrich, 11/20).

The New York Times' The Conscience Of A Liberal: The State Of Obamacare
I haven't been writing about the healthcare.gov thing, for the simple reason that I have nothing to say. What's going on isn't a policy question: we know from the states with working exchanges (including California) that the underlying structure of the law is workable. Instead, it's about an implementation botch, which is an incredible mess, and reflects very badly on Obama. But the future of the reform depends not on policy per se but on whether the IT issues can be fixed well enough soon enough (Paul Krugman, 11/20). 

The Wall Street Journal: ObamaCare Forced Mom Into Medicaid
The unaffordable ObamaCare-compliant plan that her insurer offered in a Sept. 26 letter is not what makes my mother's story noteworthy. Countless individually insured Americans have received such letters; many are seeing more radical increases in premiums and deductibles. But most of these people are still being offered the chance to choose what health-care insurance they will receive, or to opt out before they are automatically enrolled in a state program. Not so my mother, Charlene Hopkins, as I soon discovered when I called after seeing her Facebook post (Nicole L. Hopkins, 11/20).

National Review: Obama Loses His Cool
Barack Obama is the coolest president we've had since John F. Kennedy, at least according to conventional standards for such things. Obama has always been a brand as much as a politician, one that has been perceived as sleek, smart and up to date. Then along came Healthcare.gov. Its failure to launch is a signal event in the long political battle over Obamacare and perhaps an inflection point in the president's image. It's hard to maintain a sense of truly being on the cutting edge of change when you can't build a website (Lowry, 11/20).

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High Court's 'Alarming' Move On Abortion; Tragic Attack In Virginia Points To Needs In Mental Health Services; A Better Way To Reduce Hospital Readmissions

The New York Times: Texas Women And Abortion Rights
In an alarming 5-to-4 ruling, the Supreme Court turned away an emergency application to block a new Texas law that is impeding access to safe and legal abortion care in the state. The ruling leaves in place an order by the United States Court of Appeals for the Fifth Circuit that allowed the law go into effect while it considers an appeal (11/20). 

Los Angeles Times: Battle Over Abortion In Texas
It's disappointing that the Supreme Court denied a request to temporarily block an onerous new abortion law in Texas from taking effect while a federal appellate court determines whether the law is constitutional. The high court's decision could force as many as a third of the abortion clinics in Texas to close, creating a hardship for thousands of women seeking to terminate their pregnancies (11/21).

Los Angeles Times: Good News And Bad News For Women As The Abortion Battle Rages
The battle over abortion continues to rage, and both sides got good news this week. In a win for antiabortion forces Tuesday, an ideologically split Supreme Court refused, 5-4, to stop the implementation of a Texas law aimed at squeezing abortion providers out of the state by requiring doctors to have admitting privileges at local hospitals. ... On the other hand, those who favor abortion rights were pleased Tuesday when the citizens of Albuquerque turned out in record numbers to overwhelmingly reject a measure that would have outlawed abortion after the 20th week of pregnancy (Robin Abcarian, 11/20).

USA Today: Deeds Attack Shows That Our System Is A Mess
The stabbing of Virginia state senator Creigh Deeds on Tuesday apparently by his son, Austin, who later committed suicide, is the latest in a string of mental health related violent incidents. Initial news reports said Austin Deeds had been turned away from a treatment center because no beds were available -- a claim later denied by state hospital officials. What's uncontestable is that Deeds didn't get the help that he needed (Pete Earley, 11/20).

The Seattle Times: The Rare Mental-Health Fixers
Crystal looked down at her bowl of handmade pasta like she expected it to suddenly disappear. You can understand her hesitation. The day before, she was in a West Seattle psychiatric hospital after being committed for wandering Seattle streets, suicidal. This day, she lived in a downtown Seattle homeless shelter, a 57-year-old woman adrift, without a phone, clothes or identification. Enter Dennis Villas and Mary McDonald. … Mary and Dennis's job title — peer bridgers — is new to the local mental-health system, but so intuitive it is a no-brainer (Jonathan Martin, 11/20).

JAMA: To Reduce Hospital Readmissions, Perhaps Focus On The Whole Patient And Not A Specific Condition
US Hospitals, which can face financial penalties for readmitting large numbers of patients within 30 days of discharging them, want to lower their 30-day readmission rates. And patients certainly don't want such return visits, either. Research appearing today in BMJ suggests that hospitals can lower 30-day readmission rates by developing strategies that focus on the whole patient rather than concentrating on such a specific time period or diagnoses that have historically been associated with a higher percentage of readmissions (Mike Mitka, 11/20).

New England Journal of Medicine: Making Medical Decisions For Patients Without Surrogates
People who are decisionally incapacitated but haven't provided advance directives for their health care and have no health care surrogates — sometimes called the "unbefriended" or "unrepresented" — are some of the most powerless and marginalized members of society. Most of the unrepresented are elderly, homeless, mentally disabled, or socially alienated. Yet medical decision making for these vulnerable patients often lacks even minimally sufficient safeguards and protections. ... We must strike an appropriate balance between a decision maker who is responsive and can make timely decisions and a decision maker who is independent from the treating clinicians. Occupying this middle ground, I would argue, is the ethics committee (Thaddeus Mason Pope, 11/21).

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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.