Daily Health Policy Report

Friday, November 22, 2013

Last updated: Fri, Nov 22

KHN Original Reporting & Guest Opinion

Administration News

Health Reform

Capitol Hill Watch

Health Care Marketplace

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

For Insurers, Obama’s Proposed Cancellation 'Fix' Changes Health Law Calculations

Kaiser Health News staff writer Jay Hancock reports: "Despite numerous problems with the health law rollout, WellPoint CEO Joseph Swedish told analysts last week he was still 'confident' in the company’s bet to be the biggest seller of Obamacare insurance. Two days later President Barack Obama changed the rules. Suddenly subscribers who were expected to buy coverage through the health law’s marketplaces from WellPoint, the nation’s No. 2 medical carrier, may end up keeping the plans they have now" (Hancock, 11/22). Read the story.

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Covered California: Older Jump In First, But Officials Buoyed By Number Of Young Enrollees

Kaiser Health News staff writers Anna Gorman and Sarah Varney report: "In a state considered crucial to the success of Obamacare, older people have enrolled in California’s new health insurance marketplace in large numbers as expected, but younger people also have showed up in force. About 56 percent of Californians who signed up for coverage in October are over 45 and nearly 23 percent of the enrollees are between 18 and 34 years old, according to data released Thursday at the Covered California board meeting in Sacramento. The older enrollees make up a higher percentage than in the state’s total population, while the proportion of younger consumers more or less match their makeup state" (Gorman and Varney, 11/22). Read the story.

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A Reader Asks: Will International Students Be Eligible For Health Law’s Subsidized Coverage?

Kaiser Health News consumer columnist Michelle Andrews responds to this reader’s question (11/22). Read her answer.

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In Iowa, Accountable Care Begins To Make A Difference

Kaiser Health News staff writer Jenny Gold, working in collaboration with NPR, reports: "Here’s how it works: a group of doctors and hospitals get together to form a network responsible for taking care of a group of Medicare patients—in this case, about 9,000 Iowans.  If the network can prove it’s keeping those patients healthier and spending less money to do so, it gets to keep some of the savings. The ACO can then use that money to do things Medicare doesn’t usually cover—like reaching out more to patients at home. But if the ACO does not succeed, it may face a financial penalty" (Gold, 11/21). Read the story.

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Capsules: Troubled Health Law Rollout Damages Public Support; Calif. To Canceled Policy Holders: Buy A New Plan

Now on Kaiser Health News' blog, Jordan Rau reports on new poll findings about the health law: "With its troubled rollout of the new insurance marketplaces, the Obama administration has achieved something Republicans have failed to do: seriously dent the popularity of the health care law, according to poll released Friday. Nearly half of Americans now hold an unfavorable view of the law and only a third like it, according to the poll from the Kaiser Family Foundation. (KHN is an editorially independent part of the foundation.)  The 16-percentage point gap between positive and negative views is almost the largest it has been since the foundation began its monthly tracking poll in April 2010. The only time the gap was bigger was in October 2011, when the Republican presidential candidates, gearing up for the primary season, were taking turns bashing the law" (Rau, 11/22).

Also on the blog, Sarah Varney reports on Covered California’s decision about canceled health plans: "California did not take President Obama up on his offer to extend canceled health policies.  The five-member board that oversees California’s health insurance marketplace, known as Covered California, voted unanimously Thursday to stay the course and cancel policies that didn’t meet the requirements of the Affordable Care Act. The board’s decision had been widely anticipated, but at the public hearing in Sacramento there was an audible sigh of relief by consumer advocates and insurance company representatives when the vote became clear" (Varney, 11/21). Check out what else is on the blog.

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Politlical Cartoon: 'Waxing Catastrophic?'

Kaiser Health News provides a fresh take on health policy developments with "Waxing Catastrophic?" by Eric Allie.

Here's today's health policy haiku:  


Young Californians
are jumping in the deep end
of health care risk pool

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

Administration Delays 2015 Individual Plan Rate Requirements

The change is designed to give insurers more time to compute the costs of individuals who come in late during the plan's first year -- which might avoid higher premiums and steer clear of the 2014 elections.

Bloomberg: Insurers To Get Extra Month To Set 2015 Obamacare Rates
The enrollment period, previously scheduled to begin Oct. 15, 2014, will now start Nov. 15, said an official with the U.S. Department of Health and Human Services who asked not to be identified because the decision isn’t public. The change is important to insurers that need more time to evaluate the first year of the government-run marketplaces (Wayne and Nussbaum, 11/22).

The Wall Street Journal: Obama Administration To Push Back Health-Insurance Enrollment For 2015
The Obama administration is planning to push back the period during which Americans sign up for coverage under the new health law in its second year of operation, a change that could reassure insurers while also avoiding the 2014 midterm elections. ... People will have until Jan. 15, 2015, rather than Dec. 7, 2014, to complete the process (Radnofsky, 11/22).

Politico: HHS To Delay 2015 Obamacare Enrollment By A Month
The date change, first reported by Bloomberg, also lengthens the enrollment period by a week. Doing so would give companies more opportunity to account for individuals, particularly young adults, who come in late during the plan’s first year, which has gotten off to a rocky start. The goal is premiums that more accurately reflect costs for those insured (Levine, 11/21). 

CNN: Obamacare Signup Delayed – For 2015 
The Department of Health and Human Services wants to give insurers, consumers and engineers more time to avoid the first go-round's site crashes, coverage train wrecks and cost surprises. ... The change will not affect this coverage year, which begins January 1, 2014 (Bohn and Brumfield, 11/22).

In related news -

CQ HealthBeat: Insurers That Renew Cancelled Policies Told How They Must Notify Consumers
Insurance companies that extend policies that otherwise would be cancelled next year under the health law must send consumers a letter with wording by the Obama administration that outlines eight ways their existing coverage is inferior to new plans in the marketplaces. Federal officials released a memo on the subject Thursday (Adams, 11/21).

The New York Times: U.S. Unveils Letters Insurers Must Send About Health Plans
he letters are blunt, declaring that the insurance that is about to be renewed "will NOT provide all of the rights and protections of the health care law." Renewal letters sent by insurance companies will have to list all the deficiencies in the policy (Shear, 11/21).




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Health Reform

Administration's Proposed Cancellation Plan Raises A New Set Of Questions, Concerns

News outlets explore a variety of issues related to President Barack Obama's proposed cancellation 'fix' -- including how this approach could alter the landscape for consumers, insurers and state insurance regulators.  

Kaiser Health News: For Insurers, Obama’s Proposed Cancellation 'Fix' Changes Health Law Calculations
Despite numerous problems with the health law rollout, WellPoint CEO Joseph Swedish told analysts last week he was still 'confident' in the company’s bet to be the biggest seller of Obamacare insurance. Two days later President Barack Obama changed the rules. Suddenly subscribers who were expected to buy coverage through the health law’s marketplaces from WellPoint, the nation’s No. 2 medical carrier, may end up keeping the plans they have now (Hancock, 11/22).

The CT Mirror: As Obamacare Fix Is Debated, Aetna Says It Discontinued 12,500 Policies
Aetna notified 12,500 individual policyholders in Connecticut that their health plans would not be renewed when they expire. But about 40 percent of them so far have chosen to buy a new policy that begins this year, allowing them to get 12 months of coverage from a plan not subject to the requirements of the federal health law. The number of canceled policies in the state, and the reasons for cancellation, have been sources of contention this week as lawmakers skirmish over whether Connecticut should allow insurers to extend plans that don’t meet the requirements of the federal health law (Becker, 11/21).

The Texas Tribune: Report: Canceled Health Plans Should Be Kept In Perspective
Critics of the Affordable Care Act have lambasted President Obama's signature legislation as it struggles with technical glitches and as thousands of people nationally report the cancellation of their existing health insurance plans. But a report released Thursday by Families USA, a national health consumer organization, attempts to put the numbers in perspective (Aaronson, 11/21).

Stateline: Q&A: Sorting Out The Controversy Over Canceled Insurance Policies
Turns out, the president’s request is not so straightforward at all. That is why, a week later, many state officials and insurance carriers are still wringing their hands over whether to comply with Obama’s request. Here is an explanation of the cancellation issue and a chart showing how states have responded so far to the president’s request (Vestal and Ollove, 11/22).

The Associated Press: Mo. Lets Insurers Renew Canceled Health Policies
Missouri will allow health insurance companies to continue offering policies that otherwise would have been canceled because they don't comply with federal law, Gov. Jay Nixon said Thursday Nationwide, more than 4 million people who buy their own insurance have received notices that their policies are ending because they don't meet minimum coverage requirements due to kick in next year under the federal health care law enacted by President Barack Obama (Lieb 11/22).

The Associated Press: Hamm Urges Renewal Of Canceled Health Plans
North Dakota Insurance Commissioner Adam Hamm on Thursday asked health insurance companies doing business in the state to renew policies that are being canceled under the federal health care law. Millions of people nationwide who buy their own insurance have gotten cancellation notices because their plans don't meet the higher benefit requirements of the Affordable Care Act (Nicholson, 11/21).

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Calif. Won't Extend Canceled Insurance Policies Despite Presidential Plea

The five-member board overseeing California's online insurance marketplace unanimously turned down President Barack Obama's call to let insurers continue some health plans that don't meet the health law's requirements. Marketplace officials for Covered California also detailed who has signed up for coverage in the marketplace.

Los Angeles Times: California Won't Extend Health Plans
Spurning President Obama's call to let insurers extend canceled health policies, California won't allow 1 million policyholders to keep their health plan for another year. The board of the Covered California health exchange voted unanimously to break with the president and keep its requirement that insurers terminate most individual policies Dec. 31 because the policies don't meet all the requirements of the Affordable Care Act (Terhune, 11/21).

The Wall Street Journal: Split Over Health Law Change
California officials rebuffed President Barack Obama Thursday and voted against letting insurers in the state reinstate canceled health policies, in a move that highlighted internal tensions among Democrats about the health law's direction. Mr. Obama proposed last week that insurers be allowed to restore the canceled policies, hoping to quiet a furor that broke out when it became clear that millions of Americans who bought individual coverage were losing it (Radnofsky, Lazo and Scism, 11/21).

Kaiser Health News: Capsules: Calif. To Canceled Policy Holders: Buy A New Plan
California did not take President Obama up on his offer to extend canceled health policies.  The five-member board that oversees California’s health insurance marketplace, known as Covered California, voted unanimously Thursday to stay the course and cancel policies that didn't meet the requirements of the Affordable Care Act. The board's decision had been widely anticipated, but at the public hearing in Sacramento there was an audible sigh of relief by consumer advocates and insurance company representatives when the vote became clear (Varney, 11/21).

Also in the news, California offered more information about its enrollment numbers -

Kaiser Health News: Covered California: Older Jump In First, But Officials Buoyed By Number Of Young Enrollees
In a state considered crucial to the success of Obamacare, older people have enrolled in California’s new health insurance marketplace in large numbers as expected, but younger people also have showed up in force. About 56 percent of Californians who signed up for coverage in October are over 45 and nearly 23 percent of the enrollees are between 18 and 34 years old, according to data released Thursday at the Covered California board meeting in Sacramento. The older enrollees make up a higher percentage than in the state's total population, while the proportion of younger consumers more or less match their makeup state (Gorman and Varney, 11/22).

The Associated Press: Details On Health Care Enrollment, Cancellations
Covered California has released details about who has signed up for health insurance coverage so far on the state exchange, as well as details about the nearly 1.1 million people who are receiving notices saying their current policies are being discontinued (11/21).

The Hill: Obamacare Enrollments Spike In California
Nearly 80,000 people have picked out a private health plan in California under ObamaCare, according to data released by the state's exchange on Thursday. Covered California, which enrolled 31,000 in October, signed up almost 50,000 additional consumers in the first 19 days of November. Those numbers include those who have made it through the enrollment process and selected a plan but have not yet made a premium payment (Easley, 11/21).

The New York Times: California Encouraged By Health Plan Enrollment
Especially encouraging, officials said, was the enrollment of young people, who are considered essential to the success of the Obama administration’s health care law (Thomas and Pollack, 11/21).

The Wall Street Journal's Washington Wire: California's Health Exchange Gains Momentum
While the federal health-insurance exchange continues to be bogged down by problems, California’s state health exchange is gaining momentum, according to new figures released by the state Thursday. As of Nov. 19, nearly 80,000 Californians had selected a private health plan, as enrollments more than doubled since the beginning of the month. Enrollment rates rose to about 2,700 per day in the second week of November from 700 per day in the initial week after the Covered California exchange opened Oct. 1, the state said (Ante, 11/21).

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Financial Analysts Say In Addition To Political Turmoil, Website Problems Could Send Stocks Into Turmoil

The website is vital to the health law's success, they argue.

Politico: Analysts: Nov. 30 Is Make-Or-Break Date For Obamacare
Wall Street health care analysts warned Thursday that a failure to successfully launch HealthCare.gov by Nov. 30 could send Democrats fleeing from Obamacare and industry stocks into turmoil. "If the website is not functioning on Nov. 30, then I think you see a stampede of Democratic legislators in risky elections next year," said Carl McDonald, a senior analyst at Citi Investment Research, at a conference organized by the Center for Studying Health System Change (Cheney, 11/21).

Medpage Today: Analysts: Website Looms Large In ACA’s Success
The Obama administration's ability to fix the troubled HealthCare.gov website in the next couple of weeks will figure prominently in the long-term success of the Affordable Care Act (ACA) and health reform in general, financial analysts said. … In the world of politics, continuing to have a dysfunctional federally run web portal to sign up for health insurance could spell political doom for ACA supporters -- and hence the law itself -- in congressional mid-term elections next year, experts said Thursday at an event hosted by the Center for Studying Health System Change (Pittman, 11/21).

The Associated Press: Experts: Healthcare.gov Fix Needs More Time, Money
[Bill Curtis, senior vice president and chief scientist at CAST, a French software analysis company] says programmers and systems analysts start fixing troubled websites by addressing the glitches they can see. But based on his analysis of the site, he believes the ongoing repairs are likely to reveal even deeper problems, making it tough to predict when all the site's issues will be resolved. "Will it eventually work? Yes, because they have to make it work," he says. But it'll be very expensive" (Fowler, 11/21).

The Washington Post: The Federal Health-Care Exchange's Abysmal Success Rate
Technical issues have plagued the rollout of the Affordable Care Act's online health insurance exchanges — digital marketplaces where individuals can browse and apply for health insurance coverage. States decided whether they would create their own exchange or, if they preferred, have the federal government do it for them (or create one through a partnership with the federal government). Typically, states that embraced the health-care law, such as California, chose to create exchanges, while states that were resistant to it, such as Florida, defaulted to the federal exchange. However, the states that defaulted to a federal exchange are facing a host of technical issues and are faring, on average, much worse than states with their own exchanges (Elliott, 11/21).

Meanwhile, new emails describe some of failures in testing shortly before the website went live.

Politico: Emails Show Little Testing On Healthcare.gov
The minimal testing done four days before the launch of HealthCare.gov failed to handle 500 people applying through the website at one time, according to internal e-mails between the top Obama administration technicians working on the site (Haberkorn, 11/22).

Reuters: Days Before Launch, Obamacare Website Failed To Handle Even 500 Users
In the last days before the botched October 1 launch of President Barack Obama's healthcare website, the team in charge was seeing alarming results from performance tests, according to internal emails released by Republican lawmakers investigating the rollout. HealthCare.gov was unable to consistently handle 500 users at once in the testing, and tests failed with 2,000 users over a three-day period, according to a series of emails between members of the information technology team at the Centers for Medicare and Medicaid Services, or CMS (Rampton, 11/21).

And in Oregon, officials worry that they may not be able to hold the contractor accountable.

The Oregonian: Oregon’s Nonworking Health Exchange Could Have Problems Holding Contractor Fully Accountable
While officials for the state and Oregon's health exchange have vowed to hold its main contractor accountable for missed deadlines and substandard work on the state's nonworking website, those efforts may be hampered by a poorly written contract, the exchange director acknowledged Thursday. Though the Cover Oregon executive director Rocky King has said he wasn't worried enough about the website to recommend a backup plan until August, emails and documents obtained through a records request by The Oregonian shows that by early May alarmed officials were sounding alarms (Budnick 11/21).

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Some Cities Delay Plans To Move Retirees To Marketplaces For Coverage

The problems with the healthcare.gov website has put a hold on those plans.

Bloomberg: Fumbled Obamacare Cools Cities' Interest In Website
The crash-plagued debut of the Obamacare website is leading cities and towns to pull back on plans to curb billions of health-care costs by sending retired workers to the federal insurance marketplace. Detroit postponed the shift of 8,000 retirees under the age of 65 in early November, a month after the healthcare.gov website opened to outages (Linskey and Christoff, 11/22).

Insurance brokers are also expected to be affected by the website problems.

The Washington Post: Insurance Brokers, Agents Also Caught In Healthcare.gov Technology Woes
Brokers and agents say a host of technological problems is blocking their ability to help consumers sign up for coverage through the federal health insurance Web site. They say it is a particular problem for people with major health issues — those considered high-risk — because they are least able to weather a gap in coverage (Sun and Kliff, 11/22).

CQ HealthBeat: Direct Enrollment Seen As Powerful Tool For Building Exchange Plan Membership
With the federal insurance exchange website sputtering, industry executives and Health and Human Services officials are looking harder at added ways to build health plan membership, with "direct enrollment" a particular focus. It's a potentially powerful tool, says one insurance expert, and if that's true, it would be welcome news for the Obama administration, whose sign-up efforts thus far through the federal marketplace have bordered on the disastrous. But developing the approach isn't going to happen overnight, analysts say (Reichard, 11/21).

Doctors say they are concerned about plans on the marketplaces.

Medpage Today: Docs Unhappy With ACA Exchange Plans
Abysmal payments. Lack of information. Even questionable business practices. Those are all complaints physicians have had in the early stages of working with health insurance companies selling plans through the Affordable Care Act's (ACA) health insurance marketplaces, also known as exchanges. MedPage Today asked several attendees at this week's American Medical Association's interim meeting about their experiences with the new plan offerings. Responses from those with experience dealing with them on the whole weren't positive (Pittman, 11/21).

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Consumers Shopping On Health Insurance Exchange Experience 'Sticker Shock'

USA Today reports prices may be higher than expected for some middle-class consumers who are not eligible for the health law's subsidies. Meanwhile, Politico highlights how one group -- older Capitol Hill staffers -- is reacting to this marketplace experience.

USA Today: Sticker Shock Hits Health Exchange Shoppers
Sweeping differences in health care exchange pricing among states and counties is leading to sticker shock for some middle-class consumers and others who aren't eligible for subsidies under the Affordable Care Act (O’Donnell and Overberg, 11/21).

Politico: Older Hill Aides Shocked By Obamacare Prices
Veteran House Democratic aides are sick over the insurance prices they'll pay under Obamacare, and they're scrambling to find a cure. "In a shock to the system, the older staff in my office (folks over 59) have now found out their personal health insurance costs (even with the government contribution) have gone up 3-4 times what they were paying before," Minh Ta, chief of staff to Rep. Gwen Moore (D-Wis.), wrote to fellow Democratic chiefs of staff in an email message obtained by Politico. "Simply unacceptable" (Allen and Haberkorn, 11/21).

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Will Embrace Of Medicaid Expansion Hurt Some GOP Presidential Hopefuls?

Some Republican governors said to have presidential aspirations, including Chris Christie of New Jersey and John Kasich of Ohio, have expanded the program in their own states, even as the party tries to unravel the law. Meanwhile, New Hampshire's Republican Senate blocked efforts to expand the program, Montana expansion advocates work to put the issue to voters and Maine's hiring of a conservative consultant to study the issue gets scrutiny.

The Washington Post: Expanding Medicaid Could Cloud Some Republicans' 2016 Hopes
Christie is one of just eight Republican governors to accept the expansion. He and Gov. John Kasich (R), of Ohio, are the only two who have both expanded Medicaid and who are said to harbor White House ambitions. Expanding Medicaid will make most adults who earn up to 138 percent of the federal poverty limit eligible for coverage. The federal government will cover 100 percent of the costs of the expansion for the first few years of the program, and 90 percent of the costs going forward (Wilson, 11/21).

The New York Times: Health Law Is Dividing Republican Governors
At the annual meeting here of the nation's Republican governors, the ones who are eyeing presidential runs in 2016 say they oppose the health care law. But there is sharp disagreement among those who have helped carry out the law and those who remain entrenched in their opposition (Martin, 11/21).

The Wall Street Journal's Washington Wire: Some GOP Governors Embrace Medicaid Expansion
The health care fight consuming Washington looks a little different at the state level where a handful of Republican governors have embraced a central tenet of the new law: expanding Medicaid to cover the poor. Prominent Republican governors have pegged their political fortunes to the expansion, including New Jersey Gov. Chris Christie, who is often mentioned as a White House hopeful in 2016, and others who have potentially difficult re-elections next year, such as Ohio Gov. John Kasich and Michigan Gov. Rick Snyder (O’Connor and Radnofsky, 11/21).

The Associated Press: N.H. Senate Blocks Medicaid Expansion
New Hampshire's Republican Senate rejected plans to extend Medicaid coverage to an estimated 49,000 low-income adults Thursday, ending hopes for expansion this year. Democratic Gov. Maggie Hassan said afterward she will keep trying to win legislative authorization (Love, 11/22).

Concord (N.H.) Monitor: No Deal On Medicaid Expansion 
A special session of the Legislature closed yesterday with no deal for expanding Medicaid to an additional 50,000 low-income adults, despite leaders on both sides of the political aisle saying they remain willing and eager to reach a compromise (Palmero, 11/22).

New Hampshire Public Radio: Senate Can't Agree On Medicaid Expansion
The State Senate couldn’t pass the plan favored by GOP leaders, and then rejected a plan embraced by Democrats on party lines. Ultimately, the Senate adopted a second GOP proposal, before laying it on the table. Two hours later it rejected a Medicaid bill passed by Democrats in the N.H. House (Rogers, 11/21).

The Washington Post: A Montana Group Wants Voters To Decide On The Obamacare Medicaid Expansion
There’s no shortage of controversy surrounding the president's landmark health care law, but one battle has been fought in each and every state: whether to expand Medicaid under the law. The nation is evenly split — half the states are moving forward with the expansion and half aren't. In some states, the decision came down from the governor and in others, the legislature. In Montana, the governor was for it, but a mistaken vote -- yes one man’s mistake -- killed its chances in the state House. But now, a coalition of groups under the banner Healthy Montana Initiative wants to put the question to voters next fall (Chokshi, 11/22).

Montana Standard: Advocates For Medicaid Expansion In Montana Launch Ballot Measure
Supporters of expanding Medicaid health coverage to 70,000 low-income Montanans submitted language Thursday for a 2014 ballot measure, which would take the issue directly to Montana voters. "This didn’t get addressed at the last Legislature, so we’re looking forward to our citizens addressing it themselves," said Lori Chovanak, executive director of the Montana Nurses Association (Dennison, 11/21).

The New York Times: Maine Hires Firm To Study Medicaid System, To Democrats' Ire
Officials in Maine have hired a consulting firm to study the state's Medicaid system, to include evaluating the cost of expanding the program under President Obama's Affordable Care Act, a move Gov. Paul R. LePage has in the past rejected (Bidgood, 11/21).

Salt Lake Tribune: Utah Legislative Panel Rejects Full Medicaid Expansion
The full expansion of Utah’s Medicaid program as envisioned by the Affordable Care Act is off the table, under a list of options whittled from nine to three Thursday by lawmakers. A full expansion is estimated to cover 150,000 Utahns earning up to 138 percent of the poverty level — about $32,000 for a family of four. Instead, the Legislative Health System Reform Task Force will weigh just three scenarios before making a final recommendation to the full Utah Legislature (Stewart, 11/21).

Kansas Health Institute: White House Officials Hold Call To Urge Medicaid Expansion In Kansas
White House officials today held a news conference with Kansas State Rep. Barbara Ballard to make the case for expanding Medicaid eligibility in Kansas. White House Principal Deputy Press Secretary Josh Earnest said the health reform law will make access to health insurance coverage available for less than $100 a month to six in 10 currently uninsured Americans (Cauthon, 11/21).

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Insurers Cut Doctors' Fees In New Health Plans

Insurers are reducing payments to medical practices in many of the plans they sell through the new health-law marketplaces, raising concerns that enrollees will have fewer doctors to choose from if low fees spark an exodus. Meanwhile, The Los Angeles Times reports that the success of the law depends in part on the actions of insurance companies, doctor groups and hospitals, all of whom are financially vested in it.

The Wall Street Journal: Insurers Cut Doctors' Fees in New Health-Care Plans
Insurers are slashing payments to medical practices in many of the plans they sell through the new health-law marketplaces—sparking worries that Americans signing up for coverage will have fewer doctors to choose from if low fees spark an exodus from the plans.  UnitedHealth Group Inc. sent some New York City physicians contract amendments as recently as this month setting rates well below what doctors normally see from private insurance, including less than $40 for a typical office visit and about $20 for reading a mammogram, according to confidential documents reviewed by The Wall Street Journal (Weaver and Beck, 11/21).

Earlier, related KHN coverage: Doctors Complain They Will Be Paid Less By Exchange Plans, (Rabin, 11/19).

Los Angeles Times: Healthcare Industry Vested In Success Of Obamacare
President Obama's healthcare law, struggling to survive its botched rollout, now depends more than ever on insurance companies, doctor groups and hospitals — major forces in the industry that are committed to the law's success despite persistent tensions with the White House  (Levey, 11/21).

PBS NewsHour: How Has The Affordable Care Act Affected You?
The PBS NewsHour set out to explore reactions to the Affordable Care Act and its online marketplaces. We found people who are benefitting from the expanded protections and health coverage of the law -- and listened to those who are angry over insurance cancellations. We talked to Mary Agnes Carey of Kaiser Health News, Julie Rovner of NPR and health policy analyst Susan Dentzer to help us put those stories into the broader context of the law (11/21).

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As Popularity Of Health Law 'Sinks,' Some Marketing Will Wait Until New Year

In the meantime, a new poll suggests the problems with the health law rollout have harmed the public's view of the law as a whole, and a second poll suggests the public sees addressing health care costs as the central issue.

The Wall Street Journal's Washington Wire: Obamacare Advocates Delay Marketing Push Until January
Advocates for the health overhaul law are significantly pushing back the timing of their big advertising blitz aimed at enrolling millions of uninsured Americans in insurance coverage. Ron Pollack, head of the Families USA consumer group and a board member of the Enroll America coalition, says groups like his are now planning on stepping up their advertising about the law in January, ... its big backers “are assuming that there’ll be a ramp-up at the beginning of the coming year,” as the website gets improved,  (Radnofsky, 11/21).

The Fiscal Times: Rebranding Obamacare May Be The Toughest Job Of All 
Even if the administration manages to meet its target of getting the federal website working effectively for “the vast majority of Americans” by month’s end, rehabilitating the Affordable Care Act’s tarnished image will be a heavy lift. ... the administration is living a public relations nightmare that will end only when it fixes the website and persuades the public that – far from being a failure – Obamacare eventually will succeed in providing affordable health insurance to millions of Americans currently without it (Pianin and Ehley, 11/22).

Kaiser Health News: Capsules: Troubled Health Law Rollout Damages Public Support
With its troubled rollout of the new insurance marketplaces, the Obama administration has achieved something Republicans have failed to do: seriously dent the popularity of the health care law, according to poll released Friday. Nearly half of Americans now hold an unfavorable view of the law and only a third like it, according to the poll from the Kaiser Family Foundation. (KHN is an editorially independent part of the foundation.) (Rau, 11/22).

Bloomberg: Public Opinion Of Obamacare Hits Low On Website Outages
33 percent of Americans surveyed in the past week said they had a favorable opinion of the Patient Protection and Affordable Care Act from 38 percent a month earlier, the lowest level since the law was signed in March 2010, the Menlo Park, California-based nonprofit research group, said today (Wayne , 11/22).

Politico: Obamacare Ratings Sink
More than two in five adults said Obamacare will leave the country “worse off,” also a high for the tracking poll, which carries a 3 percentage point margin of error. Meanwhile, the Medicare prescription drug benefit — the Bush-era entitlement that Democrats largely opposed — is enjoying strong popularity, registering 48 percent favorable compared with just 19 percent unfavorable (Cheney, 11/22).

Meanwhile --

McClatchy: Americans Agree With Rationales For Health Care Law, Gallup Finds 
Americans see cost as the nation's more urgent health care issue, according to a Gallup poll released Thursday. In its first survey since the Affordable Care Act's major provisions were rolled, it, it found "two of the main issues the law is designed to address -- health care access and cost -- remain the most vexing to Americans. In particular, the percentage citing cost as the central problem is the highest since 2008” (Lightman, 11/21). 

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Capitol Hill Watch

House Speaker Boehner Enrolls In Obamacare After Initial Errors

The Washington Post examines if Sen. Mary Landrieu actually cast the "deciding vote" for the health law as a conservative group is saying she did in an advertising campaign against her. In the meantime, House Speaker John Boehner enrolled Thursday for health coverage through the District of Columbia's online insurance marketplace -- after initially receiving errors.

The Washington Post's The Fact Checker: Did Mary Landrieu Cast The 'Deciding Vote' For Obamacare?
Americans for Prosperity, a conservative advocacy group backed by the Koch brothers, is launching ads targeting Democrats for having voted for the Affordable Care Act. As the 2014 midterm elections loom, readers should get ready for a flood of ads showing President Obama repeating his Four-Pinocchio statement that Americans could keep their health plan if they liked it. In this case, the Fact Checker was curious about the claim that Sen. Mary Landrieu (D-La.), who likely will have a tight race, cast the "deciding vote" for the law. AFP is clearly trying to undercut the publicity surrounding her effort to pass a fix to the law that would allow individual policyholders to keep their plans (Kessler, 11/22).

The Associated Press/Washington Post: Boehner Signs On To 'Obamacare' After Delay, Tweet
At one point Thursday, Boehner tweeted his frustration — "Guess I’ll just have to keep trying" — along with photos of himself at a computer and the error message he says he received. The House speaker has 583,000 followers on Twitter (11/21).

Politico: John Boehner Now Enrolled In Obamacare
About an hour after Speaker John Boehner's office said he couldn't sign up for Obamacare coverage on the District of Columbia’s exchange, his office said he's now officially enrolled. "Kept at it, and called the DC Health Link help line. They called back a few hours later, and after restarting the process on the website two more times, I just heard from DC Health Link that I have been successfully enrolled," Boehner's office wrote (Millman and Cunningham, 11/21).

CNN: Boehner Tries, Eventually Enrolls In Obamacare 
House Speaker John Boehner sat at his desk in the U.S. Capitol and attempted to enroll in Obamacare on Thursday afternoon, but was unable to log on, and called his experience "pretty frustrating." Boehner's office sent out an update that, four hours after he tried to enroll, the Speaker received an email from DC Health Link confirming he had been enrolled (Walsh, 11/21).

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Health Care Marketplace

Walgreen Co. To Move Employees Into Private Health Insurance Exchange

Bloomberg: Walgreen CEO Says Employers Want To Offer Health Benefits
Employers want to provide quality health care to attract top talent regardless of the bumpy ride so far for Obamacare, Walgreen Co. (WAG) Chief Executive Officer Gregory Wasson, said. Walgreen, the biggest U.S. drugstore chain, will move its workers into a private health insurance exchange run by Aon Plc. (AON) for company-subsidized coverage, the Deerfield, Illinois-based company said in September (Edney, 11/21).

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State Watch

State Roundup: Candidate Berwick Floats 'Single Payer;' Minn. Reps Pushing Against Med Device Tax; Restore Medi-Cal Cuts?

A roundup of state health policy news, today from Iowa, Minnesota, Massachusetts and California.

Kaiser Health News: In Iowa, Accountable Care Begins To Make A Difference
Here’s how it works: a group of doctors and hospitals get together to form a network responsible for taking care of a group of Medicare patients—in this case, about 9,000 Iowans. If the network can prove it’s keeping those patients healthier and spending less money to do so, it gets to keep some of the savings. The ACO can then use that money to do things Medicare doesn’t usually cover—like reaching out more to patients at home. But if the ACO does not succeed, it may face a financial penalty (Gold, 11/21).

WBUR: Berwick Platform: ‘Seriously’ Explore Single Payer, Review Cost Control
Granted, a candidate releasing his platform on health care for a race that’s a full year away might not strike you as big breaking news. But what if that candidate is one of the country’s leading health policy thinkers? ... That candidate is Dr. Donald Berwick, former chief of Medicare in the Obama administration, and that territory is the idea of a “single-payer” system — a sort of "Medicare for all" (Goldberg, 11/21).

Minnesota Public Radio: Minnesota Delegation Continues Fight Against Medical Device Tax
There aren't many issues that unite the Minnesota congressional delegation, but the effort to get the medical device tax repealed is one of them. The tax, part of the Affordable Care Act, went into effect in January. ... On The Daily Circuit, we get an update on the repeal effort. [Guests:] Shaye Mandle: Executive vice president and COO for LifeScience Alley, a Minnesota-based trade association .... Paul Van de Water: Senior fellow at the Center on Budget and Policy Priorities (11/21).

California Healthline: Rosier State Budget Report Prompts Talk About Restoring Health Care Cuts
Now that the general fund crisis seems to have eased, lawmakers may want to revisit some of the cuts they were forced to make in recent years, according to Scott Graves, a senior policy analyst at the California Budget Project, a not-for-profit based in Sacramento that conducts nonpartisan fiscal reviews. … "We have been saying for a long time for the Legislature to revisit the 10 percent cut in Medi-Cal provider payments," he said (Gorn, 11/21).

California Healthline: California’s Trans Fat Law Set Stage For Pending National Ban On The ‘Anti-Food’
The proposal to stop the use of partially hydrogenated oil comes five years after California lawmakers passed a partial ban on the substance. California's 2008 law was a big step toward fueling the current administrative drive to ban trans fat, according to Mark Dressner, president of the California Academy of Family Physicians, … The California law did not ban all forms of trans fat, but limited use of the substance in restaurants and some food-preparation facilities (Gorn, 11/21).

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Health Policy Research

Research Roundup: Meeting The Needs Of Assisted Living Residents; Medicaid Expansion And Community Health Centers; Money Follows The Person

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

JAMDA: American Infection Prevention And Control Standards In Assisted Living Facilities: Are Residents’ Needs Being Met? 
Assisted living facilities (ALFs) provide housing and care to persons unable to live independently, and who often have increasing medical needs. Disease outbreaks illustrate challenges of maintaining adequate resident protections in these facilities. ... Of the 50 states, 84% specify health-based admissions criteria to assisted living facilities; 60% require licensed health care professionals to oversee medical care; ... There is wide variation in how assisted living facilities are regulated in the United States. States may wish to consider regulatory changes that ensure safe health care delivery, and minimize risks of infections, outbreaks of disease, and other forms of harm among assisted living residents (Kossover, Chi, Wise, Tran, Chande and Perz, 11/18).

George Washington University: How Medicaid Expansions And Future Community Health Center Funding Will Shape Capacity To Meet The Nation's Primary Care Needs 
This brief analyzes the effect of federal and state policy decisions on the capacity of community health centers to meet future health care needs. It focuses on two particularly important policy issues: (1) the level of federal grant funding for community health centers and (2) whether states expand Medicaid coverage. ... under the low funding scenario, if Medicaid expansion plans do not change, national health center capacity would decline by one million patients by 2020, falling from 21.1 million in 2012 to 20.1 million in 2020. ... In contrast, under the high federal funding scenario, total health center capacity would rise to 35.6 million patients in 2020 (under current Medicaid expansion patterns), about two-thirds higher than 2012 levels (Ku et al., 11/18).

National Center for Health Statistics: Dementia Special Care Units In Residential Care Communities: United States, 2010
Key findings: In 2010, 17% of residential care communities had dementia special care units. Beds in dementia special care units accounted for 13% of all residential care beds. Residential care communities with dementia special care units were more likely than those without to have more beds, be chain-affiliated, and be purposely built as a residential care community, and less likely to be certified or registered to participate in Medicaid. Residential care communities with dementia special care units were more likely than those without to be located in the Northeast and in a metropolitan statistical area, and less likely to be in the West (Park-Lee, Sengupta and Harris-Kojetin, 11/18).

Urban Institute/Robert Wood Johnson Foundation/Georgetown University: Stabilizing Premiums Under the Affordable Care Act
In addition to the measures prescribed by the federal ACA, states have had an array of options to further protect against and mitigate the effects of both rate shock and adverse selection. Our survey of a cross-section of 11 states found that, while at least a few states were employing most of these strategies, no single strategy was deployed by all the states, and some strategies went unexplored. Further, policy decisions outside of the scope of this paper—such as robust outreach and enrollment efforts to encourage younger, healthier individuals to obtain coverage, and oversight of insurers marketing plans to healthy young adults outside the exchange—may further affect the short and long-term stability of rates as the reform is implemented (Blumberg, Rifkin, Corlette and Dash, 11/18).

Mathematica: Money Follows The Person 2012 Annual Evaluation Report
The Money Follows the Person (MFP) demonstration program represents a major federal initiative to give people needing long-term services and supports (LTSS) more choice about where they live and receive care, and to increase the capacity of state long-term care systems to serve people in community settings. ... Calendar year 2012 marked the fifth full year of implementation of the national MFP demonstration. Cumulative MFP enrollment climbed to 30,000 transitions by the end of December 2012, a 50 percent growth over the total number at the same point in 2011. In early 2012, three more states received planning grants bringing the total number of states to have received MFP grants to 47. ... The MFP demonstration appears to be achieving its broad goals of (1) transitioning people successfully, and (2) helping states establish the infrastructure necessary to increase the capacity of long-term care systems to serve people in the community (Irvin et al., October 2013).

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

NPR: How A Vitamin D Test Misdiagnosed African-Americans
By the current blood test for vitamin D, most African-Americans are deficient. That can lead to weak bones. So many doctors prescribe supplement pills to bring their levels up. But the problem is with the test, not the patients, according to a new study. The vast majority of African-Americans have plenty of the form of vitamin D that counts — the type their cells can readily use. ...  The conclusion from this study is that just because your total levels are low, it doesn't mean we need to replace vitamin D" using supplements, Thadhani says. The study was published Wednesday in the New England Journal of Medicine (Knox, 11/20).

Medscape: Pediatricians' Community Involvement Has Declined
Pediatricians' involvement in community child health activities has declined even though community engagement is an important professional duty, according to an analysis of 2 national mailed surveys of pediatricians (with 881 participants in 2004 and 820 in 2010). Cynthia S. Minkovitz, MD, MPP, a professor in the Department of Population, Family, and Reproductive Health at Johns Hopkins Bloomberg School of Public Health and in the Department of Pediatrics at Johns Hopkins School of Medicine, and the director of the Women's and Children's Health Policy Center in Baltimore, Maryland, and colleagues present their findings in an article published online November 18 in Pediatrics (Brown, 11/18).

HealthDay/Philadelphia Inquirer: Program Helps Heart Patients Stick With Meds After Leaving Hospital
People who are hospitalized for a heart attack or angina are more likely to take their medication properly once they leave the hospital if they receive personal attention from a pharmacist, new research indicates (11/18).

MedPage Today: Racial Flip Seen In Pancreatic Cancer Mortality
Pancreatic cancer mortality has diverged in race-defined directions, increasing in whites and decreasing in blacks for reasons that remain unclear, investigators reported. After 25 years of decline, pancreatic cancer mortality in whites has been on the increase since the mid- to-late 1990s, whereas mortality among blacks has declined steadily since the early 1990s after 20 to 25 years of increases (Bankhead, 11/12).

Time: Why You Might Skip Cancer Screening If You're Older
Cancer rates go up with age, but more experts are suggesting that older people might be better off without regular screening for the disease. That position is supported by the latest data suggesting that while early detection of cancer benefits younger people by giving them a chance to treat tumors and improve their prognosis, the same isn’t true for the elderly. They are more likely to die of other conditions like heart disease, and treating small cancers, some of which may be slow growing, that would never become an issue during the patient’s lifetime could lead to unneeded physical and mental complications (Sifferlin, 11/20).

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Editorials and Opinions

Viewpoints: Opposition To Medicaid Dooming The South; Obama's 'Blank Check' For Insurers; One Woman's Quest For Coverage

The New York Times: The South's New Lost Cause
As inapt as those comparisons are, what is distressingly similar today is how the South is once again committed to taking a backward path. By refusing to expand health care for the working poor through Medicaid, which is paid for by the federal government under Obamacare, most of the old Confederacy is committed to keeping millions of its own fellow citizens in poverty and poor health. They are dooming themselves, further, as the Left-Behind States (Timothy Egan, 11/21).

The New York Times' The Conscience Of A Liberal: News Cycle Delusions
The only thing the GOP could do with any real impact would be to sabotage the law. And they're doing that as best they can by blocking the Medicaid expansion. But if the exchanges begin to work even passably well, that won't be enough — when people, including the young, realize that real insurance is available at affordable prices, political propaganda won't keep them away (Paul Krugman, 11/21). 

The New York Times' Economix: A Conservative Alternative To Obamacare
Anticipating, or hoping, that the Affordable Care Act will collapse under the weight of its own architecture and the lack of managerial competence with which it is being put in place, The Journal exhorts Republicans to "revitalize and improve the old individual insurance market" as an alternative to the new system. For decades that “old individual insurance market” was widely viewed as dysfunctional. ... So it is fair to ask precisely what improvements in that dysfunctional market The Journal has in mind. As is well known, in health reform the angels and the devils live in the details (Uwe E. Reinhardt, 11/22). 

Los Angeles Times: Obamacare Puzzle Takes New Twists And Turns
The Rubik's Cube that is healthcare reform might have become even more puzzling for some people Thursday after the operator of California's online insurance exchange rejected President Obama's call for extending the life of canceled policies. Covered California said it'll stick with its Dec. 31 deadline. All plans that don't comply with the requirements of Obamacare must go adios by that day. Unless, that is, they've been grandfathered in (David Lazarus, 11/21). 

Los Angeles Times: Covered California To President Obama: Sorry, No
Defying President Obama, the board of directors for the state's new health insurance exchange, Covered California, voted unanimously Thursday not to allow the 11 insurers that are selling plans on the exchange to revive their canceled policies. Meanwhile, new statistics emerged that shed more light on the people losing their policies and the ones signing up through the exchange (Jon Healey, 11/21).

The Washington Post's Post Partisan: The Insiders: New Obamacare Marketing – 'Sign Up And Shut Up Or The IRS Will Be Calling'
How does the White House think they will "remarket" Obamacare to voters? Telling the truth could not possibly achieve good results. The truth reveals that under Obamacare, you can't keep your current insurance plan unless Obama's Washington likes it, you can't keep your doctor or local hospital unless you are lucky, and that you will pay higher premiums and higher deductibles to get fewer choices. Of course, there will be no chance for appeal. New slogans won't do the trick; voters would need to be hypnotized to accept the real Obamacare (Ed Rogers, 11/21).

The Wall Street Journal: The GOP's Health-Reform Opportunity
"You can't fight something with nothing," muses Tom Price, the Republican for Georgia's Sixth District. That adage, which the surgeon-turned-congressman is now repeating to any colleague who will listen, is gaining steam within the broader GOP. As the ObamaCare disaster dominates the public debate, Republicans are engaged in an animated discussion behind the scenes about their next move. Health reformers like Dr. Price, Reps. Phil Roe and Steve Scalise, and in the Senate Tom Coburn and Mike Lee, are pushing colleagues to go on offense and start selling the public on innovative, pro-market health reforms (Kimberley A. Strassel, 11/21). 

Bloomberg: Obamacare's New Blank Check For Insurers
President Barack Obama tried to salvage his health-care law last week, in the face of his broken promise that people who like their health-care plans can keep them. But in so doing, he may have made things worse. Obama's executive action allowed insurers to reinstate, for one year, plans that don't comply with some of the Affordable Care Act’s requirements, including benefits mandated by the law and the maximum cost-sharing permitted under it. Unfortunately for the Obama administration, many Americans still won’t be able to re-enroll in their insurance plans (Lanhee Chen, 11/21).

Bloomberg: Obamacare's Failings Undermine Republican Goals
The rollout of the Patient Protection and Affordable Care Act has been an utter and complete disaster, leading to a flowering of schadenfreude among Republicans who predicted Obamacare would be an utter and complete disaster. But the failure of the federal exchange website, and widespread confusion among consumers, isn't the particular disaster Republicans had predicted. And it's not a particularly auspicious one for Republican policy interests (Ezra Klein, 11/21).

Reuters: Even With A Working Website, We Must Tackle Healthcare's Opacity
Beginning January 1, 2014, everyone will be required by law to have health insurance; the marketplaces will help consumers find and purchase new plans. But what happens then? Are there easily available doctor appointments covered by these plans, or will patients come up empty-handed when seeking care? Is an insurer’s online directory up-to-date or wildly inaccurate? Which plans have better customer service and which have none? As patients, it’s vital to know the level of care access an insurance policy will actually provide. Without this basic consumer information, your brand new insurance card is like a mystery phone (Oliver Kharraz, 11/22). 

Fox News: ObamaCare Debacle Much Worse For Constitution, Presidency Than Katrina Was For Bush
Last week's delay of the Affordable Care Act’s insurance mandate has observers declaring that President Obama's Hurricane Katrina has made landfall. Or so declare pundits in the national papers and on the TV talk shows. But ObamaCare is no Katrina. It is much worse, at least for the presidency and the constitution (John Yoo, 11/21). 

WBUR: The Great Healthcare.Gov Mistake: Having An 'Older Accountant' Create It
The Center for Medicare and Medicaid Services is the behemoth federal agency that, despite limited resources, does a pretty good job of carrying out its core mission: running programs that provide health insurance for older and poorer Americans. Expecting that this agency can also run the federal health insurance exchanges for Obamacare, however, sets it up for trouble right from the start (Michael Doonan, 11/21).

CNN: Obamacare Got Me Covered
As a 36-year cancer survivor, I am watching with great interest as the debate rages over whether the Affordable Care Act strengthens the individual insurance market, as the law's supporters contend, or dismantles it, as critics say. Having been repeatedly denied health coverage I needed and wanted to buy because of my pre-existing condition, I know that provisions of the law can dramatically improve the quality and cost of insurance for people shopping for coverage on their own (Lori Greenstein Bremner, 11/21). 

On other issues -

The Washington Post: Who Will Care For American's Aging Population?
Nearly 70 percent of Americans who reach age 65 will, at some point, be unable to care for themselves without assistance. Issues of long-term care also affect millions of younger people with significant cognitive or physical functional limitations. Yet long-term care gets neither the public attention nor the policy focus that it deserves (Tom Daschle and Tommy Thompson, 11/21).

The Richmond Times-Dispatch: Michael Paul Williams: Put Politics Aside On Mental Health
[Sen. John] Watkins, a Republican from conservative Powhatan County, and state Sen. Henry L. Marsh III, a Democrat from liberal Richmond, agree on the need to get health care to the estimated 1 million uninsured Virginians who could get coverage. They also see folly in passing up federal Medicaid funding and effectively subsidizing the needs of citizens in other states instead of our own. It’s a reasonable line of thinking. But we're talking politics here (Michael Paul Williams, 11/22).

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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.