Daily Health Policy Report

Tuesday, November 26, 2013

Last updated: Tue, Nov 26

KHN Original Reporting & Guest Opinion

Health Reform

State Watch

Capitol Hill Watch

Public Health & Education

Medicare

Health Care Marketplace

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Narrow Networks’ Trigger Push-Back From State Officials

Kaiser Health News staff writer Jay Hancock, working in collaboration with PoliticoPro, reports: "Officials in at least a half dozen states are pushing back against health plans in the new insurance markets that limit choice of doctors and hospitals in a bid to control medical costs. The plans don’t start offering coverage until January but they're facing regulatory action, possible legislation, and in at least one case involving a high-profile children's hospital, litigation. The pushback against 'narrow' provider networks recalls the backlash against managed care and health maintenance organizations  in the 1990s" (Hancock, 11/25). Read the story.

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Health Law May Offer Part-Time Workers Better Options

Kaiser Health News consumer columnist Michelle Andrews writes: "In January, part-time workers who have so-called 'mini-med' health insurance plans with very limited benefits and annual caps on payments will begin to lose that coverage, which under the health care overhaul generally can't  be renewed after the beginning of the year.  Many experts say it's just as well, noting that part-timers likely will have better options in January" (Andrews, 11/26). Read the story.

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In Wonky Version Of American Idol, Georgetown Researchers Vie For Grants Before Local Donors

Caroline E. Mayer, writing for Kaiser Health News in collaboration with The Washington Post, reports: "Call it a wonky version of 'American Idol' -- or, perhaps more aptly, 'Research for a Cause.' Four Georgetown University Medical Center scientists recently delivered 15-minute sales pitches about their work, hoping to win money from an unusual panel of judges: local residents who are not experts on science. ... To become a judge, each individual agreed to donate at least $1,000 to the medical center. In return, the donor received a chance to review a handful of proposals by Georgetown researchers and vote for a top choice. The two projects garnering the most support each got a grant of $35,000" (Mayer, 11/26). Read the story.

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In California, Some Happy About Canceled Insurance Policies

KPCC's Stephanie O'Neill, working in partnership with Kaiser Health News and NPR, reports: "Barbara Neff of Santa Monica is one of the roughly 1 million Californians who recently got word that their health insurance coverage would be expiring soon. The canceled plans sparked a political firestorm as people realized President Barack Obama’s promise – 'If you like your plan, you can keep it' -- didn’t apply to everyone. But Neff, a 46-year-old self-employed writer, isn't outraged. She's relieved. Even though she makes too much money to receive a subsidy to buy insurance under the Affordable Care Act, the policy cancellation was good news for her. Neff says she's been stuck in a bad plan because treatment for a back problem years ago red-flagged her with a preexisting condition" (O'Neill, 11/26). Read the story.

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In Miami, Medicare Comes With White-Glove Treatment

The Miami Herald's Daniel Chang, working in collaboration with Kaiser Health News, reports: "The scene at Leon Medical Centers' Healthy Living Facility in Miami on a recent Thursday resembled a cross between a luxury hotel and a theme park. White-gloved doormen wearing porter uniforms ushered elderly patients from white vans into a gleaming lobby with colored terrazzo floors and a bubbling fountain. Greeters in green vests and ear bud radios welcomed the Medicare members and made sure their doctors knew that they'd arrived. Refreshments were proffered: Would they like a cafecito and pastelito for the wait? ... It’s a one-stop shopping approach for healthcare based on a level of customer service and attention that, members tell the federal government, sets Leon Medical Centers apart in the highly-lucrative and super-competitive world of South Florida’s privately managed Medicare plans, or Medicare Advantage (Chang, 11/26). Read the story.

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Websites Step Up To Fill Federal Void

The Philadelphia Inquirer's Robert Calandra, working in partnership with Kaiser Health News, reports: "Almost two months after its inglorious rollout, the healthcare.gov website appears to be slowly recuperating. But even if it is 80 percent healed by November's end, as some public statements suggest, it likely won't be the promised seamless shopping experience where consumers can compare plans and prices and see if they qualify for premium and cost-sharing subsidies" (Calandra, 11/25). Read the story.

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Political Cartoon: 'Scornucopia?' By Randy Bish, Pittsburgh Tribune-Review

Kaiser Health News provides a fresh take on health policy developments with 'Scornucopia?' By Randy Bish, Pittsburgh Tribune-Review.

Here's today's health policy haiku:  

GOBBLE, GOBBLE...

Pardon a turkey
Ritual for presidents
Hope for a website?
-Anonymous 

If you have a health policy haiku to share, please send it to us at http://www.kaiserhealthnews.org/ContactUs.aspx and let us know if you want to include your name. Keep in mind that we give extra points if you link back to a KHN original story. 

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Health Reform

Administration: Healthcare.gov On Target To Work For Most By Nov. 30

Administration officials and consumer advocates say that the enrollment website serving residents of 36 states is becoming easier for people to use, but insurers warn that flaws continue to hinder health plans. Officials acknowledge that some users will continue to experience outages and error messages. Meanwhile, Bloomberg looks at the president's efforts to monitor the situation.

The Washington Post: Obamacare Update: Consumers See Progress But Insurers Smell Trouble
As the Obama administration closes in on its self-imposed deadline to fix the troubled online health insurance marketplace, consumer advocates say it is becoming easier for people to sign up for coverage but insurers warn that critical flaws continue to hinder participating health plans (Somashekhar and Goldstein, 11/25).

CBS News: HealthCare.Gov On Track In Spite Of Another Outage, Officials Say
HealthCare.gov experienced an "unscheduled outage" for about an hour Monday morning, an Obama administration official confirmed Monday, but the administration maintains that the federal website, which serves as the portal for the Obamacare marketplaces in 36 states, will work for the "vast majority" of users by next week. "We continue to be on track to meeting the goals that we established for ourselves and established for the website on Nov. 30," White House deputy press secretary Josh Earnest told reporters. He called the website a "work in progress" (Condon, 11/25).

The Hill: Healthcare Website Won't Be Perfect On Dec. 1, Administration Says
Obama administration officials said Monday that some visitors to HealthCare.gov will experience outages, slow response times or try-again-later messages in December. The Centers for Medicare and Medicaid Services (CMS) delivered the message in the latest attempt to downplay expectations for Nov. 30, the administration’s self-imposed deadline for fixing ObamaCare’s federal enrollment site (Viebeck, 11/25).

The Hill: White House: O-Care Site Fixes On Track
The White House said Monday that teams remain "on track" to have technical issues with the ObamaCare website resolved with less than a week to go before a self-imposed deadline to have the website working (Sink, 11/25).

McClatchy: Obama Officials: HealthCare.Gov On Target To Work For Most By Nov. 30
The Obama administration on Monday expressed guarded confidence that it’s on track to get the troubled Healthcare.gov website running properly by Nov. 30, its self-imposed deadline. "The system will not work perfectly on Dec. 1, but it will operate much better than it did in October," Julie Bataille, communications director at the federal Centers for Medicare and Medicaid Services, said during a telephone briefing (Pugh, 11/25).

Kaiser Health News: Websites Step Up To Fill Federal Void
Almost two months after its inglorious rollout, the healthcare.gov website appears to be slowly recuperating. But even if it is 80 percent healed by November's end, as some public statements suggest, it likely won't be the promised seamless shopping experience where consumers can compare plans and prices and see if they qualify for premium and cost-sharing subsidies. Several websites have stepped into the breach and are helping consumers unravel the differences among the various health insurance policies (Calandra, 11/25).

Meanwhile, Bloomberg News reports that the president receives nightly progress reports on the fixes --

Bloomberg: Obama Nightly Reading Reveals Angst About Health-Site Fix
By day, Jeffrey Zients drives around Washington’s Beltway, overseeing the private contractors and government officials racing to fix the flawed Obamacare website. By night, President Barack Obama gets a rundown of Zients’ progress from White House Chief of Staff Denis McDonough during their evening stroll along the South Lawn. A fuller report follows in a briefing book Obama takes upstairs to the first-family’s quarters for late-night reading (11/26).

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Tactics To Sell The Health Law: Moms And Local News

The administration, as well as insurers and advocacy groups, will rely on several tactics to sell the public on the health law, appealing to mothers to recruit their adult children and seeking positive news coverage from local, rather than national, media. Community groups, meanwhile, are encountering challenges in enrolling Latinos, reports The Chicago Tribune.

The New York Times: New Pitch For Health Initiative: Mind Your Mom. Get Insured.
As the Obama administration's health overhaul sputters in its opening weeks, insurers and advocacy groups are pursuing a new strategy in the quest to get millions of young people to sign up for health insurance: They’re appealing to their mothers. ... Recruiting enough young people is a major goal of the Obama administration because insurers need healthy customers to offset the cost of caring for those with expensive medical needs (Thomas, 11/25).

Politico: All (Good) Obamacare News Is Local
President Barack Obama has bungled HealthCare.gov so badly that he's told senior aides to not even try to win positive coverage from the national press. Instead, they're going local. In the past month, Obama and his Cabinet have hit nine of the top 10 cities with the highest concentration of the uninsured, while senior administration officials have held almost daily reporter conference calls in nearly a dozen states to challenge Republican governors who refuse to expand Medicaid. Obama's political arm, Organizing for Action, is taking a similar approach (Budoff Brown and Epstein, 11/26).

Politico: It's Not Obamacare, It's Business
Insurance companies are ready to unleash an expensive PR blitz to get 7 million new customers once HealthCare.gov is fixed. ... Big insurers and the stock analysts that track them say that once the White House is sure its enrollment website is working, the companies will barrage the airwaves with messages encouraging people to join new health insurance exchanges, either by signing up directly with insurers or by giving the website another shot (Cheney and Winfield Cunningham, 11/25).

Chicago Tribune: Outreach To Latinos On Health Coverage Faces Obstacles
Though more than 300,000 Illinois Latinos are estimated to be newly eligible for insurance coverage under President Barack Obama's signature legislation, there are many challenges in reaching them, including language barriers, lower rates of Internet access and lingering confusion about the health care law's impact on those living in the country illegally (O'Reilly, 11/25).

Obama is also turning to donors and doctors for support for the law --

Los Angeles Times: President Obama Hits Beverly Hills For Twin Democratic Fundraisers 
In the embrace of loyal supporters at twin Beverly Hills fundraisers, President Obama on Monday night defended his troubled healthcare plan and cast his administration as one that has defended "those ideas that built this country." "When I talk about the Affordable Care Act, all the fighting that we've been having to do, it's not just a matter of dollars and cents and why it's good for the economy to make sure that people aren't going to the emergency rooms because that's the most expensive care, and why the only way we're going to lower health care costs over the long term is if we start delivering health care smarter," Obama said at a reception at the home of former Lakers star and entrepreneur Magic Johnson and his wife, Cookie. "It's also a values question" (Linthicum and Decker, 11/25).

Politico: Doctors Invited To White House Tuesday 
The White House has invited physicians to discuss insurance exchange plans that kick in next year at a meeting on Tuesday, the American Medical Association confirmed today. In an invitation emailed Friday afternoon, physician groups were asked to meet from noon to 1 p.m. with Chris Jennings and Jeanne Lambrew, deputy health policy assistants to President Barack Obama (Winfield Cunningham, 11/25).

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Health Law Coverage Bringing Changes To An Array Of Consumers

News outlets explore some of these issues, including new costs for people with "Cadillac" coverage, "narrow networks" of doctors and other health providers, new options for part-time workers and unexpected effects on smokers. In the meantime, exchanges are bracing for a busy December, and Covered California launches a hotline to help people having sign-up problems.

NBCNews: Large Employers Cite Obamacare 'Cadillac' Tax In Reducing Benefits
For 75 million Americans who get their insurance through large companies, the Affordable Care Act is a mixed bag.  Experts tell NBC News the new health care law is only slightly increasing premiums next year, but causing some companies with the most generous plans to reduce their employees’ benefits. ... The 40 percent excise tax -- often called the "Cadillac tax" --  is part of Obamacare and is levied on the most generous health plans. It's designed to bring down overall health costs by making companies and workers more cost-conscious (Reynolds and Myers, 11/25).

NPR: Health Exchanges Brace For A December Deluge
December could see a surge in demand for health insurance. "There is an avalanche coming," says Bryce Williams, managing director for exchange solutions at the benefits consulting firm Towers Watson. Williams says the firm knows from years of experience with open enrollment for Medicare patients, that the Monday after Thanksgiving is always the single busiest day for business (Rovner, 11/25).

Kaiser Health News: Narrow Networks’ Trigger Push-Back From State Officials 
Officials in at least a half dozen states are pushing back against health plans in the new insurance markets that limit choice of doctors and hospitals in a bid to control medical costs. The plans don't start offering coverage until January but they’re facing regulatory action, possible legislation, and in at least one case involving a high-profile children’s hospital, litigation. The pushback against "narrow" provider networks recalls the backlash against managed care and health maintenance organizations  in the 1990s (Hancock, 11/25).

Kaiser Health News: Insuring Your Health: Health Law May Offer Part-Time Workers Better Options
In January, part-time workers who have so-called "mini-med" health insurance plans with very limited benefits and annual caps on payments will begin to lose that coverage, which under the health care overhaul generally can’t be renewed after the beginning of the year.  Many experts say it's just as well, noting that part-timers likely will have better options in January (Andrews, 11/26).

Kaiser Health News: In California, Some Happy About Canceled Insurance Policies
Barbara Neff of Santa Monica is one of the roughly 1 million Californians who recently got word that their health insurance coverage would be expiring soon. The canceled plans sparked a political firestorm as people realized President Barack Obama’s promise -- 'If you like your plan, you can keep it' -- didn’t apply to everyone. But Neff, a 46-year-old self-employed writer, isn’t outraged. She’s relieved. Even though she makes too much money to receive a subsidy to buy insurance under the Affordable Care Act, the policy cancellation was good news for her. Neff says she's been stuck in a bad plan because treatment for a back problem years ago red-flagged her with a preexisting condition (O'Neill, 11/26).

Marketplace: Insurance Brokers: Obamacare Is Like ... (Pick A Metaphor)
California is running its own exchange. It’s going a lot smoother than the one at healthcare.gov.  So, [Craig] Gussin says that once people are done waiting to see him, he's able to help them see their way through the whole process, to get insurance and, if they qualify, a subsidy. In other states, agents tell a different story (Weissmann, 11/25).

California Healthline: Hotline Opened For Cancellation Issues
Covered California launches a hotline today to field calls related to policy cancellations. It was one of five measures the exchange board approved last week to ease the burden of some policy cancellations. Actions of the exchange board last week were overshadowed by its decision to forego the federal suggestion to extend coverage for individual, non-grandfathered insurance policies (Gorn, 11/25).

Fox News: Almost 80 Million With Employer Health Care Plan Could Have Coverage Canceled, Experts Predict 
Almost 80 million people with employer health plans could find their coverage canceled because they are not compliant with Obamacare, several experts predicted. Their losses would be in addition to the millions who found their individual coverage cancelled for the same reason (Angle, 11/26).

Fox News: Obamacare Slams Smokers With Sky-High Premium Costs, Could Backfire 
Obamacare may have backfired in its goal of making smoking so expensive that users quit, public health experts say, as sky-high insurance premiums force smokers to drop coverage altogether and lose smoking cessation programs along with it. "Tobacco surcharges are not proven to help tobacco users quit and there are major concerns that they will prevent people from getting health care coverage," the American Lung Association's Jennifer Singleterry said (La Jeunesse, 11/25).

NPR: Rep. Issa Takes Anti-Obamacare Campaign To The States
On Monday, Republicans held the second of at least four planned hearings that Rep. Darrell Issa of California, the chairman of the House Oversight Committee, has said will focus on health insurance price increases he blames on the Affordable Care Act. The first hearing was in North Carolina on Friday, in the Charlotte suburb of Gastonia. ... Issa also called for a bipartisan approach to fixing the law, but this event was anything but bipartisan, starting with its title: Obamacare Implementation: Sticker Shock of Increased Premiums for Healthcare Coverage. Issa was joined by two Republican congressmen from North Carolina. There was also a list of five approved witnesses; all were critical of not just the rollout but the law itself (Gonyea, 11/25).

Meanwhile, Fiscal Times looks at another health overhaul issue --

The Fiscal Times: Obamacare Medical Device Tax Fight Not Over Yet 
Critics of the medical device tax warn that those innovations could be at risk, along with the industry's profit margins and thousands of jobs. The hotly debated 2.3 percent excise tax went into effect at the beginning of the year and is projected to raise about $29 billion over 10 years as a way to partially offset the costs of expanding health care coverage. The medical device industry has said that some 43,000 U.S. jobs could be lost because of the tax, based on a 2011 study financed by AdvaMed, an industry trade association – and companies will look to outsourcing to offset challenging market conditions (Medrano, 11/26). 

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Supreme Court Will Decide Health Law Contraception Challenge

The justices will review provisions in the Affordable Care Act requiring employers of a certain size to offer insurance coverage for birth control and other reproductive health services without a co-pay. The owners of more than three dozen for-profit companies have argued that complying with that provision would violate their religious beliefs.

The Associated Press: Supreme Court Will Take Up New Health Law Dispute
The Supreme Court has agreed to referee another dispute over President Barack Obama's health care law, whether businesses can use religious objections to escape a requirement to cover birth control for employees. The justices said Tuesday they will take up an issue that has divided the lower courts in the face of roughly 40 lawsuits from for-profit companies asking to be spared from having to cover some or all forms of contraception (Sherman, 11/26).

NBC News: Supreme Court Will Take Up Controversial Obamacare Provision On Contraception
The challenge comes from Hobby Lobby Stores, an Oklahoma company with more than 500 arts-and-crafts stores and more than 13,000 full-time employees. The business is run by founder David Green of Oklahoma City and five members of his family. “We believe wholeheartedly that it is by God’s grace and provision that Hobby Lobby has been successful. Therefore we seek to honor Him in all that we do,” Green said (Williams, 11/26).

USA Today: Justices Will Hear Contraception Challenge To Obamacare
It's the first legal challenge to reach the high court since it upheld the law 17 months ago in a 5-4 decision written by Chief Justice John Roberts. While a loss for the government wouldn't strike down the law itself, conservatives still seething over Roberts' rescue of Obamacare say the case offers Roberts an initial chance to rule against it (Wolf, 11/26). 

Politico: Supreme Court To Consider Hearing Cases On Contraceptive Mandate
At issue is whether a for-profit, secular corporation can claim constitutional protection from the provision based on religious grounds. The Obama administration asked the court to hear the Hobby Lobby case after a lower court issued an emergency injunction blocking the contraceptive requirement. ...  It could be a rematch of sorts for Solicitor General Donald Verrilli and Paul Clement, who led the 26 states’ challenge to the law and is now representing Hobby Lobby. But this challenge is more narrow than the individual mandate and Medicaid suits heard in 2012 (Haberkorn, 11/26).

Related and very helpful, from KHN: A Guide To The Lawsuits Challenging Obamacare’s Contraception Coverage Requirements (Miller, 9/17)

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Anthem Blue Cross Exposes 24,500 Doctors' Social Security, Tax Numbers

Data breaches in Vermont and in Oregon's health insurance exchanges also make news.

Los Angeles Times: Anthem Blue Cross Posts Social Security, Tax Numbers Of 24,500 Doctors 
In a departure from most medical privacy cases, Anthem Blue Cross said it accidentally posted online Social Security or tax identification numbers for about 24,500 California doctors. ... Anthem, a unit of insurance giant WellPoint Inc., said the private information was mistakenly included with its online provider directory for about 24 hours late last month. The state's largest for-profit health insurer said once it identified the error, it removed the information from its website. Anthem said this breach didn't involve any patient data (Terhune, 11/25).

The Washington Post: Vermont Health-Care Web Site Security Breached 
Vermont confirmed Friday that a security breach of the state’s health care exchange Web site gave at least one user access to another resident’s Social Security number, a disclosure that has the exchange's top official in hot water. The Vermont Health Connect's privacy watchdog reported the security breach in a letter to the federal Centers for Medicare & Medicaid Services. The Associated Press obtained the report under Vermont's public records law (Wilson, 11/25).

The Associated Press: State Confirms Health Website Security Breach 
The consumer, whom officials would not identify, reported that he received in the mail — from an unnamed sender — a copy of his own application for insurance under the state exchange. “On the back of the envelope was hand-written ‘VERMONT HEALTH CONNECT IS NOT A SECURE WEBSITE!’ This was also (written) on the back of the last page of the printed out application,” said the incident report (Gram, 11/22).

The Oregonian: Cover Oregon: Health Exchange Workers Committed Three Data Breaches Last Week
Officials at Oregon's health exchange are reviewing privacy protections after workers there committed three personal data breaches in three days. On Nov. 20, Valarie Henderson of Salem opened her mail from Cover Oregon to find a packet that included not just a copy of her application she'd filled out weeks before, but personal information from two other people that included name, address and social security numbers (Budnick, 11/25). 

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State Watch

State Exchange News: Oregon's 'Epic Failure'; Kansas' Next Steps On Canceled Policies; Rural Challenge In Minnesota

In addition, a Colorado lawmaker is fuming over "racy" ads to promote the state health insurance exchange.

Politico: Oregon’s Obamacare Sign-Up Is An ‘Epic Failure’
Oregon once led the country in implementing Obamacare. Now it’s just about dead last. Not one person has yet enrolled in the Cover Oregon insurance exchange — a major embarrassment to state policymakers who early on had wholeheartedly embraced the Affordable Care Act even as other states tried their best to hinder it. ... The uncertainty is leading to fears that Oregonians whose plans have been canceled as of Dec. 31 will find themselves without affordable coverage when the new year begins (Winfield Cunningham, 11/26).

Earlier, related KHN story: Oregon Shines On Medicaid, As Texas Stalls On Sign-Ups (Foden-Vencil and Feibel, 11/14)

The Associated Press: Hearing Focuses On Health Care In Rural Georgia
Emma Collins, a licensed massage therapist from Ellijay, was hopeful about the new federal health care law after struggling in recent years to find insurance coverage because her artificial heart valve is considered a pre-existing condition. Then Collins said she began researching plans for her and her family and realized the costs would simply be too much to cover everyone. ... The hearing was largely critical of the law and President Barack Obama. A small group of activists attended the meeting in the hopes of being able to testify about the need for Medicaid expansion in Georgia (Cassidy, 11/25).

The Associated Press: Kansas Legislators Hear Health Care Update
A Kansas insurance department official said that the agency is working with Blue Cross and Blue Shield of Kansas to provide guidance for continuing coverage for some 10,000 policies that previously were canceled because they wouldn't have conformed to the federal health care law. Linda Shepherd, the health policy director for Insurance Commissioner Sandy Praeger, told a legislative oversight committee Monday that Blue Cross would renew the policies for one year for customers who still want them and was working to get the policies reviewed and in place (Milburn, 11/26).

Minnesota Public Radio: Efforts Increase To Get Rural Latinos To Sign Up For MNSure
Around the state, advocacy groups are ramping up efforts to inform hard-to-reach populations about MNsure and the opportunity to obtain insurance through the Affordable Care Act. But getting the message to Latinos can be especially challenging without help from trusted community organizations -- especially in rural Minnesota. "When folks are already feeling like they can't access services or things are hard to come by for them, they're going to come to folks that they trust, not a new structure or a new website," said Mandile, executive director of HealthFinders, a nonprofit with community health clinics (Baier, 11/26).

Health Policy Solutions (a Colo. news service): Exchange Boss Wants Pay Hike
Patty Fontneau, the CEO and executive director of Colorado’s health exchange, has asked for a raise and could receive a pay hike plus a bonus by year’s end. Any debate over Fontneau’s salary will happen behind closed doors. A spokeswoman for the exchange said executives requested that any compensation discussions happen in executive session. Those sessions are not open to the public, but Fontneau’s salary and any increases will be public. Colorado’s exchange board meets today, but it’s unclear how soon they’ll review Fontneau’s performance (Kerwin McCrimmon, 11/25).

Health Policy Solutions
(a Colo. news service): Racy Ads Rile Lawmakers
A Colorado lawmaker has threatened legislation to clamp down on Colorado’s health exchange after a partner’s racy ad campaign went viral around the U.S. Rep. Bob Gardner, R-Colorado Springs, attacked a social media campaign launched by the liberal group, Progress Now, and health advocates at the Colorado Consumer Health Initiative (Kerwin McCrimmon, 11/25).

Related KHN story: Sex Sells … Health Insurance? (Whitney, 11/24)

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Medicaid Expansion: Florida Stalls; Ohio Lawsuits; Kansas Hospitals Weigh In

States dominated by Republican governors and legislatures continue to wrestle with decisions about expanding Medicaid to poor people who don't currently qualify.

Politico: Rick Scott's Medicaid Push Stalled In Florida
Gov. Rick Scott stuck his political neck out earlier this year to champion covering more of his state's poor residents under Obamacare. But now talk of Medicaid expansion in Florida can, at best, be described as a hushed whisper. ... Scott has since faded from his state's health care conversation, although his 2014 reelection bid will most likely force him back into it. His disappearing act is in stark contrast to some of his conservative colleagues, like Govs. Jan Brewer of Arizona and John Kasich of Ohio, who pulled out all the stops to get expansion through in their states (Millman, 11/25).

The Associated Press: Ohio Says Board Acted Within Law In Medicaid Case
An Ohio legislative panel acted consistently with state law and standard practice when it approved a request to fund an expansion of the Medicaid program last month, state attorneys argued in a court filing Monday. Two anti-abortion groups and six Republican state representatives are suing the state Controlling Board and Ohio's Department of Medicaid over the decision that bypassed the General Assembly (Sanner, 11/25).

Kansas Health Institute: Kansas Hospitals Backing Medicaid Expansion
The Kansas Hospital Association recently completed an advertising campaign aimed at building support for expanding state’s Medicaid program. … The association, which represents all 128 hospitals in Kansas, sponsored radio and television commercials in the Wichita and Kansas City markets from Nov. 11 through Nov. 22 (Ranney 11/25).

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After Son's Death, Virginia Official Vows To Help Change State's Mental Health System

Former gubernatorial candidate Creigh Deeds, who was stabbed repeatedly by his son before the young man took his own life, says, "I am alive for a reason, and I will work for change."

Politico: Creigh Deeds: 'I Am Alive For A Reason'
Virginia State Sen. Creigh Deeds says he's "alive for a reason" in his first comments to the media following an altercation at his residence last week where he suffered multiple stab wounds to the head and torso and his son killed himself with a rifle. "I am alive for a reason, and I will work for change. I owe that to my precious son," Deeds said in an interview with a Virginia newspaper, The Recorder, published online Monday (McCalmont, 11/25).

The Washington Post: Report: Deeds Expresses Anger At State Agency That Failed Son, Vows Fight For Change
Virginia state Sen. R. Creigh Deeds, who is recuperating at home after his son attacked him with a knife before taking his own life last week, blamed a local mental-health agency for the tragedy in an interview with a Bath County newspaper Monday. Deeds told the Recorder newspaper that the Rockbridge Area Community Services Board, which administers mental-health and substance-abuse services, is "responsible" for Austin Deeds’s death. The senator, who was the 2009 Democratic nominee for governor, said it was too soon to talk in detail about his son's death but vowed to help other families in crisis receive the help they need, the Recorder reported (Kunkle, 11/25).

And in Georgia, mental health advocates are concerned about the possible loss of a program.

Georgia Health News: Funding Cuts Put Mental Health Program At Risk
Devastating. Catastrophic. A disaster. That’s how patient advocates and providers describe the effects of the possible loss of Grady Health System's mental health program. The mental health program, nevertheless, could be on the chopping block as the Atlanta safety net provider confronts nearly $100 million in funding cuts (Miller, 11/25).

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Capitol Hill Watch

Chances For Small-Bore Budget Deal Said To Improve

Despite a polarized Congress, The Associated Press reports that the prospects for a modest, end-of-year budget deal are looking up. Neither party would achieve its biggest priority with such an agreement, however.

The Associated Press: Prospects Brighten For Small-Scale Budget Deal
Despite the poisonous environment in Congress, chances are improving for a small-scale budget deal next month that would ease automatic spending decreases that threaten to cut more deeply into domestic programs and military priorities in 2014. Neither party will get its biggest priority -- for Democrats, higher taxes; for Republicans, slowing the exploding cost of retirement programs. ... Democrats have taken curbs in Social Security cost-of-living increases and higher Medicare premiums on upper-income beneficiaries off the table (Taylor, 11/25).

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Public Health & Education

FDA Orders Halt To Marketing For DNA Test Kit

The agency says the tests haven't been proven effective.

The Washington Post: FDA Warns Maker Of Genetic-Testing Kit
The Food and Drug Administration has ordered the maker of a popular genetic-testing kit to halt sales of its heavily marketed product, saying the mail-order tests haven’t been proven effective and could dangerously mislead people about their health. The move came in a sharply worded letter to 23andMe, a California start-up backed by Google. The company says that its Personal Genome Service can detect more than 240 genetic conditions and traits, flagging a person’s vulnerability to heart disease, breast cancer and other illnesses (Dennis, 11/25).

The New York Times: F.D.A. Demands A Halt To A DNA Test Kit’s Marketing
In a crackdown on genetic testing offered directly to consumers, the Food and Drug Administration is demanding that the Google-backed company 23andMe immediately cease marketing its main DNA service until it receives marketing clearance from the agency (Pollack, 11/25).

The Wall Street Journal: Genetic Test Service 23andMe Ordered To Halt Marketing By FDA
U.S. regulators ordered genetic-testing company 23andMe Inc. to stop marketing its $99 mail-order kit, citing the risk that false results could cause consumers to undergo unnecessary health procedures such as breast-cancer surgery. The warning to the  Google Inc.-backed company from the Food and Drug Administration follows a debate that has grown as hundreds of thousands of people have turned to direct-to-consumer genetic tests for clues about disease risk and ancestry (Loftus, 11/25).

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Troubled Effort To Devise New Cholesterol Guidelines

The New York Times explores what went wrong as a group of doctors struggled to find common ground on how heart issues should be treated. Other stories also look at consumer frustration about a landmark settlement on hip implants and concerns being reviewed by the FDA about emergency contraceptive pills.

The New York Times: Bumps In The Road To New Cholesterol Guidelines
It was supposed to be a moment of triumph. An august committee had for the first time relied only on the most rigorous scientific evidence to formulate guidelines to prevent heart attacks and strokes, which kill one out of every three Americans. The group had worked for five years, unpaid, to develop them. Then, at the annual meeting of the American Heart Association, it all went horribly awry. Many leading cardiologists now say the credibility of the guidelines, released Nov. 14, is shattered. And the troubled effort to devise them has raised broader questions about what kind of evidence should be used to direct medical practice, how changes should be introduced and even which guidelines to believe (Kolata, 11/25).

The New York Times: Frustration From A Deal On Flawed Hip Implants
Patients injured by a flawed hip implant sold by Johnson & Johnson have directed their anger at myriad places over the years. The regulatory system that allowed the product's sale. The company that repeatedly denied problems with the device. Even the doctors who implanted the hips. Now, some patients have found a new target for their ire: the legal system and the lawyers they hired to sue Johnson & Johnson (Meier, 11/25).

NPR: Emergency Contraceptive Pill Might Be Ineffective For Obese
The Food and Drug Administration says it is reviewing whether the maker of the most widely used emergency contraceptive pill needs to change its label in light of new evidence that it doesn't work to prevent pregnancy in overweight or obese women (Rovner, 11/25).

The Wall Street Journal: In Montana Town, A Shut Mine Leaves An Open Wound
Household after household here has packed up and moved in with relatives or to local motels while government workers in hazardous-materials suits and booties take over their homes. Wearing respirators and gloves, the workers wipe down antiques, Christmas decorations, doll collections and photographs. They vacuum out attics and crawl spaces and dig up lawns. They sometimes stay for weeks. After 14 years, and possibly many more to go, a total of 1,890 homes have been cleaned out, all in an effort to rid the town of a deadly substance: asbestos fibers (Searcey, 11/25). 

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Medicare

Miami-Area Seniors Get 'White-Glove' Treatment From Private Plans

The Miami Herald reports that seniors in South Florida have benefited from the highly lucrative and super competitive world of privately managed Medicare Advantage plans.

Kaiser Health News: In Miami, Medicare Comes With White-Glove Treatment
The scene at Leon Medical Centers' Healthy Living Facility in Miami on a recent Thursday resembled a cross between a luxury hotel and a theme park. White-gloved doormen wearing porter uniforms ushered elderly patients from white vans into a gleaming lobby with colored terrazzo floors and a bubbling fountain. ... It’s a one-stop shopping approach for health care based on a level of customer service and attention that, members tell the federal government, sets Leon Medical Centers apart in the highly-lucrative and super-competitive world of South Florida’s privately managed Medicare plans, or Medicare Advantage (Chang, 11/26).

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Health Care Marketplace

Medical Advances, Teaching Hospital Procedures Inflate Health Care Costs

Hospitals are examining "post-intensive-care syndrome" and other elements of their procedures to measure the impact on their bottom lines.

The Wall Street Journal: Hospitals Take On Post-ICU Syndrome, Helping Patients Recover
Hospitals are doing more to help the growing number of patients who receive treatment for serious illness in the intensive-care unit -- only to find their release is the start of a whole new set of problems. With medical advances, even the sickest patients now often survive potentially life-threatening conditions after a stay in intensive care. Many experience aftereffects, not only of the illness but also of the very medical care that may have saved their lives (Landro, 11/25).

California Healthline: California Hospital Officials Not Impressed By Research On 'Out-Of-Control Costs'
According to research published in the Nov. 13 Harvard Business Review, a few hospitals nationwide are responsible for the bulk of about $5.3 billion in above-average costs to CMS and patients. The authors, using CMS Medicare data, showed that 32 hospitals -- less than 1 percent of the hospitals studied -- accounted for about 25 percent of the country's above-average charges. ... CMS routinely pays teaching hospitals a higher rate for many procedures (Lauer, 11/25).

Kaiser Health News: In Wonky Version Of American Idol, Georgetown Researchers Vie For Grants Before Local Donors
Four Georgetown University Medical Center scientists recently delivered 15-minute sales pitches about their work, hoping to win money from an unusual panel of judges: local residents who are not experts on science. ... To become a judge, each individual agreed to donate at least $1,000 to the medical center. In return, the donor received a chance to review a handful of proposals by Georgetown researchers and vote for a top choice. ... The program, called Partners in Research, was launched by Georgetown in 2011 as part of an effort to develop new ways to finance biomedical research (Mayer, 11/26).

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Editorials and Opinions

Viewpoints: Local Political Fallout From Obama Insurance Pledge; 'Debunking' Sob Story; Is Single Payer Still A Possibility?

The Wall Street Journal: State Officials Vs. ObamaCare
Democratic state leaders have been some of ObamaCare's strongest advocates. To show his gratitude, President Obama is sticking them with political responsibility for the millions of insurance policies that are being cancelled because they don't comply with the law's minimum-benefits mandates. ... Renewing lapsed policies could weaken the state exchanges as healthy young people will want to keep their discontinued, lower-cost plans ... there are other political considerations. Namely, the criticism they'll face from both the right and left if they don't back the president's directive to allow policy renewals (Allysia Finley, 11/25). 

The Los Angeles Times: The Dirty Secrets Behind Boehner's 'Spiking' Obamacare Premiums
Boehner's spiking premiums is one of those claims that may be true as far as it goes, but leaves out so much that it's at best a half-truth. And the contention that Boehner's experience is at all representative of what most Americans will experience under the Affordable Care Act jumps it up from half-truth to outright lie. The real alternative for most people using the individual exchanges is not employer coverage, as it was for Boehner, but no coverage (Michael Hiltzik, 11/25).

Seattle Times: Debunking Obamacare Sob Story
[Jessica Sanford] and her teenage son had been hailed last month by President Obama as an Affordable Care Act “success story” because they were going to get insurance for the first time in 15 years. ... Except later, the state said it had goofed and calculated her income wrong. No big subsidy after all (she makes $49,000 a year). She then wrote on Facebook that she was “screwed” and “priced out” of the market and ... But a bronze-level policy for a 48-year-old woman making $49,000 can be had on the state exchange for $237 a month, and a silver-level policy for $313. ... How is that a horror story? (Danny Westneat, 11/23).

The Washington Post's Wonkblog: Is Obamacare Turning The Corner?
A spin through HealthCare.Gov this morning went smoothly. The site loaded quickly. The process progressed easily. There were no error messages or endless hangs. I didn't complete the final step of purchasing insurance but, until then, the site worked -- or at least appeared to work -- exactly as intended. My experience isn't rare. There are increasing reports that HealthCare.Gov is working better -- perhaps much better -- for consumers than it was a few short weeks ago (Ezra Klein and Evan Soltas, 11/26).

The New York Times: The Health Care 'Distraction' Conspiracy
Two things happened last week that had nothing to do with the Affordable Care Act. This, Republicans say, is proof of a devious Democratic conspiracy to distract the American people from the Affordable Care Act (Juliet Lapidos, 11/25).

The New York Times: The Single-Payer Alternative
Rush Limbaugh’s take on the disastrous rollout of the Affordable Care Act could, ironically, warm the hearts of those at the other end of the political spectrum. He contends that President Obama knew all along that the Affordable Care Act would crash and burn, but pushed it through so that the conflagration would clear the way for single-payer health insurance. The conspiracy charge sounds deranged, but problems with the new health insurance system may indeed revitalize demands for more substantive reforms, ... And while Republicans despise the Affordable Care Act despite its conformity with many of their earlier proposals, their proposed changes (other than simple rollback) look complicated, kludgy and costly to administer (Nancy Folbre, 11/25).

The New York Times: Seven Conclusions About Small-Business Health Insurance
If you need to renew your policies before Jan. 1, as I do, there is no time to waste. ... I am a small manufacturer, who currently offers coverage to my employees. I have an insurance agent who has been my primary point of contact with the insurance market. Because I am in Pennsylvania, a state that does not have its own exchange, I am forced to use the HealthCare.gov site. However, the local market is dominated by three large private insurers — Independence Blue Cross, Aetna, United Healthcare — that all have their own websites where business owners can shop directly. With that in mind, I offer seven hard-earned conclusions I have reached about the new world of small-business health insurance (Paul Downs, 11/25). 

The Wall Street Journal: The Next ObamaCare Mirage
In his 2008 campaign, Mr. Obama promised that his health-care reform plan would save a typical family $2,500 in annual premiums by the end of his first term. ... Those cost savings haven't materialized. ... To argue that the Affordable Care Act has been and will be a key driver of slower health-care spending is irreconcilable with the most basic facts about such spending over the last decade, as well as with the judgment of the executive branch's own team of actuaries responsible for health-care accounting and future projection (Thomas Miller and Abby McCloskey, 11/25).

The Wall Street Journal: The Great Destroyer
Most interestingly, the administration and congressional Democrats seem genuinely surprised that their prized legislation, which was to be the crown jewel of the president's legacy and the culmination of decades of liberal ambition, simply doesn't work. Did these folks ever study history, economics or sociology? If they had, they would have known there was little chance of success for their attempt to snatch one-sixth of our economy and thrust it under a complex set of bureaucratic regulations, market disincentives, higher costs and new taxes (Pete du Pont, 11/25).

Boston Globe: The Boston Globe: Obamacare Fail Isn’t The Site – It’s The Law
In early October, as things went sour, the White House tried to pass it all off as a simple computer glitch. Two months on, it is hard to overstate the magnitude of the failure. Three years and $600 million were spent creating a nonfunctional system that was never fully tested and has deep security flaws. ... But a working website was never the real problem; it’s the law itself — which, tragically, performs as designed. ... Simple economics tells us that nearly everyone dropped by their current insurer will see rate increases; if the law demands new features, those features will cost money (John E. Sununu, 11/25).

Bloomberg: Obamacare Is No Starship Enterprise
Back when I used to do technology consulting for banks and other financial firms, I found myself in the middle of a project with many of the characteristics that made the rollout of the Patient Protection and Affordable Care Act so difficult: hard deadlines fixed by lease expirations and some regulatory requirements, mission creep, and project requirements set by distant, hard-to-reach figures. ... We like to think that being “smart and competent” makes you less likely to make mistakes. But when you’re out of your element, it may merely enable you to make more -- and larger -- mistakes (Megan McArdle, 9/25).

Los Angeles Times: The Obamacare Success Stories You Haven't Been Hearing About
Last summer Ellen Holzman and Meredith Vezina, a married gay couple in San Diego County, got kicked off their long-term Kaiser health plan, for which they'd been paying more than $1,300 a month. ... But they were lucky, thanks to Obamacare. Through Covered California, the state's individual insurance marketplace, they've found a plan through Sharp Healthcare that will cover them both for a total premium of $142 a month, after a government subsidy based on their income (Michael Hiltzik, 11/25).

The Sacramento Bee: California Health Insurance Decision Has Political Fallout
Obama sought to protect himself and his party from fallout during next year’s elections by delaying some enrollment deadlines and calling on state insurance regulators to allow old policies to remain temporarily in force or be reissued. ... Covered California, the state’s new health care exchange, refused last week to go along with the plea, forcing upwards of a million Californians facing cancellation to quickly buy new, often more costly coverage. California’s vulnerable congressional Democrats cringed, because it gives their challengers heavy ammunition (Dan Walters, 11/26).

St. Louis Post-Dispatch: An Economic Argument For Medicaid Transformation
The most important issue facing the 2014 Missouri Legislature is whether to expand state health care coverage to working people earning up to 138 percent of the federal poverty level. I say “working people” because the vast majority of the 226,525 uninsured Missourians who fall between 19 percent of the federal poverty level — the current limit for Medicaid coverage in Missouri — and 138 percent are employed at low wage jobs. ...  I have the privilege of serving on the House Interim Committee on Medicaid Transformation. One of the things we have learned is that if one objectively evaluates all the costs and benefits of expansion, the inescapable conclusion is that expansion actually saves money in the general revenue budget (State Rep. Chris Kelly, 9/25).

The Wall Street Journal: The FDA And Thee
23andMe—named after the number of chromosome pairs in human DNA—does not make diagnoses. The company helps patients and curiosity-seekers to understand their own biology. Patients can also offer their code for research projects—nine of 10 do—to contribute to discoveries about the relationships between genetics and health that could transform traditional medicine. ... The FDA can't abide such unsupervised innovation. The agency is declaring 23andMe's service an "adulterated" product under the Federal Food, Drug and Cosmetic Act of 1938, in one more case of 20th-century law undermining medical progress in the 21st (11/25).

 

Los Angeles Times: Honest, FDA Guys, My Wife Made Me Take That 23andMe Test
Seems the FDA is concerned that some folks might actually, you know, believe the results. And then they might do something stupid, like perhaps have their breasts removed because their test showed they’re at risk for breast cancer. ... he FDA says no more test kits, but does that mean no more test results? Am I grandfathered in? Do I want to be grandfathered in? Will I ever be a grandfather? So many questions, so little time (at least, that’s what I figured my test was going to show: that I had a rare and fatal genetic disorder. ...) In the end, I’m going to do what I do really well: nothing (Paul Whitefield, 11/25).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Lisa Gillespie
Marissa Evans

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.