Daily Health Policy Report

Wednesday, November 27, 2013

Last updated: Wed, Nov 27

KHN Original Reporting & Guest Opinion

Health Reform

State Watch

Health Care Marketplace

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Even Without Expansion, S.C. Will See 16% Jump In Medicaid Enrollment

Kaiser Health News staff writer Phil Galewitz, in collaboration with McClatchy, reports: "Like half the states, South Carolina chose not to expand Medicaid under the federal health law next year, citing the program’s high costs and inefficiency. Yet, state officials still forecast a 16 percent enrollment jump by the end of June, 2015, triple that of a typical year and even higher than the 12 percent average increase expected in states that are expanding eligibility. What’s going on? South Carolina officials say publicity for the Affordable Care Act and its requirement that most people get insurance will attract tens of thousands of people who are currently eligible for Medicaid but have not enrolled" (Galewitz, 11/26). Read the story.

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Philadelphia To Launch Health-Insurance Outreach

The Philadelphia Inquirer's Don Sapatkin, in collaboration with Kaiser Health News, reports: "Come into city offices ranging from the Free Library to the Department of Records over the next few months and you will, in theory, be asked whether you have health insurance and offered information about Obamacare, including the option of getting a call from a specialist trained in enrollment. The outreach, described by Enroll America, a national nonprofit, as its biggest partnership with a city in support of the Affordable Care Act, will be announced Tuesday by Mayor Nutter" (Sapatkan, 11/26). Read the story.

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Capsules: 8 Senate Democrats Seek Obamacare Enrollment 'Alternative'

Now on Kaiser Health News' blog, Julie Appleby reports on the latest sign of Democrats' concern about the health law problems: "Eight Senate Democrats — including key leadership member Charles Schumer of New York – told the Obama administration Monday that they 'continue to be troubled by the ongoing technical difficulties' with  healthcare.gov and want an alternative way for insurers and web-based brokers to enroll subsidy-eligible consumers" (Appleby, 11/26). Check out what else is on the blog.

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Political Cartoon: 'Cold Turkey?' By Clay Bennett, Chattanooga Times Free Press

Kaiser Health News provides a fresh take on health policy developments with 'Cold Turkey?' By Clay Bennett, Chattanooga Times Free Press.

Here's today's health policy haiku:  


Happy Thanksgiving
From KHN! We will be
back at work Monday! 
-KHN Team

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

Consumers Urged To Give Healthcare.gov Another Try -- Just Not Too Many Of Them

Health and Human Services Secretary Kathleen Sebelius said Tuesday that healthcare.gov is "improved every day." But the administration delayed a big marketing campaign planned for December and is asking allies to hold back their enrollment pushes to avoid a crush of new users that might overwhelm the site again. Meanwhile, Politico reports that enrollment successes in some states show the law could work.

The New York Times: A Plea To Avoid Crush Of Users At Health Site
White House officials, fearful that the federal health care website may again be overwhelmed this weekend, have urged their allies to hold back enrollment efforts so the insurance marketplace does not collapse under a crush of new users. At the same time, administration officials said Tuesday that they had decided not to inaugurate a big health care marketing campaign planned for December out of concern that it might drive too many people to the still-fragile HealthCare.gov (Shear and Pear, 11/26).

The Wall Street Journal: Health Website Deadline Nears
With the clock ticking toward a Saturday deadline, Obama administration officials promise that the HealthCare.gov website will work better. Exactly how much better? That is hard to say. The measure of success, repeated by an array of administration officials, is that the online marketplace intended to be used by millions of Americans to obtain health insurance would be working smoothly for the "vast majority of users" by Saturday, the last day of November (Nelson, 11/26).

Politico: State Successes Show Health Law Can Work
With all the waves of bad news about the Obamacare website and the canceled policies, it would be easy to conclude that nothing in this law will ever work -- that it's just too big and complicated and messy. But that's not the complete picture of the Affordable Care Act rollout. There are a few bright spots -- just enough to suggest that, for all the early disasters, the law's fate isn't final yet. There are states that are running their own websites and enrolling a lot of people, way more than the amateur-hour federal website that serves most of the states. Medicaid enrollment, another part of the law, is going significantly better than the signups for private insurance -- nearly 400,000 people were determined to be eligible in October (Nather, 11/27).

USA Today: Sebelius: Health Site Experience 'Improved Every Day'
State and local elected officials should "not hesitate" to tell their constituents to go to HealthCare.gov and sign up, Health and Human Services Secretary Kathleen Sebelius said Tuesday. "We are definitely on track to have a significantly different user experience by the end of this month," Sebelius said. "But this isn't a magic turn-on switch. The experience is improved every day" (Kennedy, 11/26).

CNN: Sebelius: Obamacare Website Improvements 'On Track' 
With just days to go until a self-imposed deadline, fixes to the problem-plagued Obamacare website are "definitely on track," Health Secretary Kathleen Sebelius said Tuesday. In a conference call with state and local officials, Sebelius added that "this isn't a magic 'turn on the on switch'" to fix HealthCare.gov, but a continual process in which "the experience is vastly improved each and every day” (Cohen, 11/26).

The Associated Press: Health Law's Spanish Sign Up-Up Tools Delayed
Add one more delay to the list for the rollout of President Barack Obama's health care law. This time, it's a postponement of the launch of online enrollment tools in Spanish (Johnson, 11/26).

Meanwhile, CBS News reports that the contractor responsible for the financial management part of the new marketplace was hired without bids--

CBS News: Obamacare Agency Rushed In Contractor Without Bids, Documents Show 
Caught flat-footed by the challenges of building the financial-management and accounting parts of the U.S. government's new online marketplace for health insurance, officials rushed to hire a familiar contractor without seeking competing bids, according to government procurement documents reviewed by Reuters. The documents dated in August -- less than two months before the opening of online marketplaces established by President Barack Obama's landmark healthcare law -- showed the agency in charge had only "recently learned" that building the financial management functions was "beyond (its) currently available resources" (11/26).

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Political Playbooks Direct Lawmakers To Find Obamacare 'Stories'

Lawmakers are being urged by their respective parties to publicize constituents' experiences with Obamacare -- horror stories, in the case of Republicans, and success stories showing the law "delivering on its promise" for Democrats. Meanwhile, a CNN/ORC poll shows that Democrats have lost their post-government shutdown lead among registered voters in a generic ballot.

The Washington Post: Democrats Eagerly Seeking Signs Of Success With Health-Care Law
The political battle over the future of the national health-care law is about to become a media faceoff between Republican accounts of mishap and failure vs. Democratic stories that hint at eventual success. In a pre-Thanksgiving messaging memo, Democratic senators are being urged to use the holiday break to find success stories and “aggressively publicize them so that people can see the law is delivering on its promise.” The memo was prepared and distributed by the Senate Democratic Policy and Communications Committee, the Senate Democrats’ political messaging operation (O'Keefe, 11/26).

CBS News: On Lawmakers’ Thanksgiving Menus: Obamacare Stories
Democrats and Republicans are ready to talk about Obamacare over the Thanksgiving recess, and their respective communications strategies revolve largely around finding and sharing their constituents’ personal stories. In its Thanksgiving “playbook,” as reported in the Washington Post, the House Republican Conference offers its members several ways to share Obamacare horror stories. They’re encouraged to share stories via social media sites like Twitter, create videos on the subject and embed “share your story” buttons on their own websites (Condon, 11/26).

CNN: CNN/ORC Poll: Democrats Lose 2014 Edge Following Obamacare Uproar
Democrats a month ago held a 50%-42% advantage among registered voters in a generic ballot, which asked respondents to choose between a Democrat or Republican in their congressional district without identifying the candidates. That result came after congressional Republicans appeared to overplay their hand in the bitter fight over the federal government shutdown and the debt ceiling. But the Democratic lead has disappeared. A new CNN/ORC poll indicates the GOP now holds a 49%-47% edge (Steinhauser, 11/26).

The Hill: Senate Dems Want HealthCare.Gov CEO
Seven Senate Democrats are calling on President Obama to appoint a permanent "chief executive officer" to oversee the ObamaCare website after the departure of Jeffrey Zients at the end of the year. In a letter sent to the White House on Tuesday, seven Senate Democrats say the position should report directly to the president and be "empowered with the authority to ensure that healthcare.gov is fixed quickly, completely, and permanently" (Sink, 11/26).

Kaiser Health News: Capsules: 8 Senate Democrats Seek Obamacare Enrollment ‘Alternative’
Eight Senate Democrats — including key leadership member Charles Schumer of New York – told the Obama administration Monday that they 'continue to be troubled by the ongoing technical difficulties' with  healthcare.gov and want an alternative way for insurers and web-based brokers to enroll subsidy-eligible consumers (Appleby, 11/26).

The Associated Press: Obama's Gatekeeper Now Point Man On Health Care
White House chief of staff Denis McDonough was ready to vent. "I've had too much humble pie," he fumed, striding into a top aide's West Wing office. "That was the last slice. I'm full." McDonough had just finished another hand-holding meeting with health care advocates anxious over the disastrous rollout of the health care law. For weeks, President Barack Obama and White House officials had been apologizing for and promising fixes to a faulty website and an unmet promise to insurance holders that they could keep their policies. McDonough's message: It was time to change tactics, quit lamenting the problems and start emphasizing the benefits of the health care overhaul (Kuhnhenn, 11/27). 

Politico: Group To Hit Mike Enzi On Obamacare
A conservative nonprofit group is set to launch a TV attack ad Monday intimating that Republican Sen. Mike Enzi is less than pure in his opposition to Obamacare. Americans for Job Security highlights the incumbent’s support for exchanges during the 2010 debate over Obamacare (Hohmann, 11/26).

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Supreme Court To Hear Arguments On Health Law's Contraceptive Coverage Mandate

The justices accepted a pair of cases that raise questions not just about religious freedom and equality for female employees, but whether the religious beliefs of the owners of secular corporations allows them to not comply with a law.

The New York Times: Justices To Hear Contraception Cases Challenging Health Law
The Supreme Court on Tuesday agreed to hear a pair of cases on whether corporations may refuse to provide insurance coverage for contraception to their workers based on the religious beliefs of the corporations' owners. The cases present a new challenge to President Obama's health care law. The Supreme Court in 2012 upheld another part of the law, one that requires most Americans to obtain health insurance or pay a penalty. The Obama administration has exempted many religious groups from the law's requirements for contraception coverage. But it said that commercial corporations could not rely on religious objections to opt out of compliance with the law (Liptak, 11/26).

The Washington Post: Supreme Court To Review Contraceptive Coverage Mandate In Health-Care Law
The cases accepted by the court offer complex questions about religious freedom and equality for female workers, along with an issue the court has not yet confronted: whether secular, for-profit corporations are excepted by the Constitution or federal statute from complying with a law because of their owners' religious beliefs (Barnes, 11/26).

The Wall Street Journal: Justices To Decide On Companies' Religious Rights
The Supreme Court said it would decide whether businesses, like people, have a right to religious expression, in cases challenging the federal health law's mandate that employers provide contraceptive coverage to female employees. The high court upheld most of President Barack Obama's Affordable Care Act in a June 2012 decision. But lower courts have split since then on whether contraceptive coverage must be included in minimum benefits packages (Bravin, 11/26).

Politico: Supreme Court Agrees To Hear Cases On Contraceptive Mandate
The case could also rekindle the same clash that unfolded during the 2012 presidential campaign, when Republicans attempted to make the contraception rule an important issue. A ruling against the contraception coverage rule wouldn’t knock down the whole health law, but it would give more fuel to its opponents (Haberkorn, 11/27).

NPR: Supreme Court Takes Challenge To Obamacare Contraceptive Rule
In enacting the ACA, Congress required large employers who offer health care services to provide a range of preventive care, including no-copay contraceptive services. Religious nonprofits were exempted from this requirement, but not for-profit corporations. Some three dozen of these corporate entities challenged this requirement in court, contending the contraception mandate violates their religious rights. On Tuesday, the Supreme Court agreed to examine the issue, after lawyers on both sides asked for high court review (Totenberg, 11/26).

Los Angeles Times: Supreme Court To Hear Cases On Obamacare And Birth Control 
The Supreme Court agreed Tuesday to jump into a growing legal dispute between the Obama administration and businesses run by conservative Christians over whether a company must pay for birth control drugs that conflict with its owner's religious beliefs (Savage, 11/26).

Reuters: Supreme Court To Hear Obamacare Contraception Cases
The U.S. Supreme Court agreed on Tuesday to consider religious objections made by corporations to a provision of President Barack Obama's healthcare law that requires employers to provide health insurance that covers birth control. Oral arguments will likely be scheduled for March, with a ruling due by June, in what will be one of the most high-profile issues before the court this term (Hurley, 11/26).

The Associated Press: White House Welcomes Review Of Health Law Dispute
The White House is welcoming the Supreme Court's decision to referee another dispute over President Barack Obama's health care law. It involves a provision that requires most companies that offer health insurance to their workers to include contraception among a range of preventive health benefits (11/26).

The Hill: White House Faces Tough Supreme Court Fight On ObamaCare Mandate
The Obama administration faces a tough task in convincing the Supreme Court to rule in favor of ObamaCare's contraception mandate, according to legal experts. They say Chief Justice John Roberts's court, which upheld the health law in a landmark 2012 decision, has generally set a high bar for limiting religious rights (Hattem, 11/26).

Meanwhile, a labeling change to an emergency contraception pill by European health authorities may be relevant to the Supreme Court's consideration of the U.S. birth control coverage mandate --

The New York Times: New Birth Control Label Counters Lawsuit Claim
European health authorities have made two significant changes to the label of an emergency contraception pill that is equivalent to Plan B One-Step. One of the changes could be relevant to two cases that the Supreme Court added to its docket on Tuesday. The new label of the drug, Norlevo, says it “cannot stop a fertilized egg from attaching to the womb,” contradicting a claim by some abortion opponents that has fueled their objections to the Affordable Care Act (Belluck, 11/26).

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Doctors Tell White House About Their Health Law Concerns; New Insurance Regulations Raise Some Flags

At a meeting Tuesday, physician groups said they are worried that insurance plans on the health care website offer only limited networks of providers and cut reimbursement rates for doctors. Also, regulations released this week come under scrutiny.

The Wall Street Journal: Doctors: New Health Care Plans Raise Red Flags
Physicians groups told Obama administration officials Tuesday that they are worried that new insurance plans under the Affordable Care Act offer only limited networks of providers and low reimbursement rates for doctors, and that could make it difficult for millions of those enrolled to actually get health care (Radnofsky, 11/26).

Reuters: U.S. Government Plan Adjusts 2014 Risk Payments For Health Insurers
The U.S. government has issued a proposal that would likely increase risk payments in 2014 to health insurers offering plans on the Obamacare exchanges after the companies complained a recent policy change allowing people to keep their insurance policies had changed the financial equation (11/26).

Fox News: Administration Accused Of Giving Unions 'Special Treatment' With Exemption From ObamaCare Fee
The Obama administration is being accused of giving labor groups "special treatment under the law" after formally proposing a change that could exempt union health plans from a pesky ObamaCare fee. Sen. John Thune, R-S.D., who flagged the obscure rule change after it was filed in the Federal Register (see page 70), blasted the exemption as "crony capitalism at its worst” (Berger, 11/26).

NPR: 3 Ways Obamacare Is Changing How A Hospital Cares For Patients
The Affordable Care Act is transforming more than health insurance. In hospitals around the country, the legislation could transform the way doctors and nurses actually care for patients. Part of the law is designed to rein in the nation's exploding health care costs by creating hundreds of little experiments that test new ways for hospitals to save money (Chow, 11/26).

Health Policy Solutions (a Colo. news service): Price Of Smoking Could Increase Under ACA
Depending on the plans they choose, smokers and other tobacco users who enroll in health insurance plans in Colorado could pay up to 15 percent more in premiums than nonsmokers.  But questions remain about whether they will be truthful when they sign up for plans and how they’ll know about the benefits their insurance offers if they want to quit. The federal law allows health insurance companies to charge tobacco users up to 50 percent more in premiums. But the law also requires that the surcharge be eliminated if tobacco users sign up for cessation counseling (Hoback, 11/26).

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State Watch

Nearly 400,000 Poor Americans Flock To Expanded Medicaid

The Washington Post reports the rollout of the law's expanded Medicaid program appears to be 'the silver lining' in the health law's implementation -- signups of nearly 400,000 people appear to be going smoothly. Meanwhile, news outlets cover Medicaid developments in Wisconsin, Ohio and South Carolina.

The Washington Post: Obamacare's Silver Lining? (VIDEO)
For all of the issues surrounding the rollout of the President's signature health care law, one part seems to be working pretty well—the expansion of Medicaid. Close to 400,000 Americas have learned they are now eligible to enroll, but some states haven't embraced the expansion (Henderson, 11/26).

The Washington Post: Walker Calls Special Session On BadgerCare
Wisconsin Gov. Scott Walker (R) will ask state legislators to keep more than 70,000 low-income residents on the state’s Medicaid program after the rocky rollout of the Affordable Care Act jeopardized their health-care coverage. The legislature will meet next week to consider legislation delaying for three months Walker’s plan to move 77,500 patients off the BadgerCare Plus system and into the federal health-care exchange. ... Walker has also proposed extending the Health Insurance Risk-Sharing Plan, which would provide a safety net as residents transition from the state plan to the federal exchange (Wilson, 11/26).

Related, earlier KHN story: Scott Walker’s Medicaid Maneuver (Toner, 11/19)

The Washington Post: John Kasich’s Medicaid Expansion Gambit Is A Double-Edged Sword
Gov. John Kasich went against the grain of many GOP governors with his push to expand Medicaid in Ohio under the federal health-care law. How will the decision affect Kasich's reelection prospects? The early read is that it's a mixed bag. A majority of Ohio voters (51 percent) say it is a good idea to expand the scope of Medicaid ... Forty percent say it is a bad idea to broaden Medicaid to cover more individuals, and nine percent don't have an opinion. That's the good news for Kasich, whose image was once floundering but who is now the front-runner to win a second term in 2014. The bad news is that expanding Medicaid isn't really helping him secure votes. (Sullivan, 11/26).

Kaiser Health News: Even Without Expansion, S.C. Will See 16% Jump In Medicaid Enrollment
Like half the states, South Carolina chose not to expand Medicaid under the federal health law next year, citing the program’s high costs and inefficiency. Yet, state officials still forecast a 16 percent enrollment jump by the end of June, 2015, triple that of a typical year and even higher than the 12 percent average increase expected in states that are expanding eligibility. What’s going on? South Carolina officials say publicity for the Affordable Care Act and its requirement that most people get insurance will attract tens of thousands of people who are currently eligible for Medicaid but have not enrolled (Galewitz, 11/26).

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How Washington State Made Its Health Insurance Exchange Work; Philly Plans Big Exchange Push

The Wall Street Journal: State Exchanges Started Late, Clashed With Vendors
It was on a cold, sunny day in Baltimore last January that Curt Kwak, chief information officer of the Washington Health Benefit Exchange, first realized that the signature feature of President Obama’s Affordable Care Act could be in trouble. ... According to Mr. Kwak, several of his peers hadn't yet selected a systems integrator -- tech vendors who play crucial roles in fitting together the multiple components of health insurance exchanges that allow consumers to select and enroll in health plans. In contrast, Mr. Kwak had had a systems integrator in place since the previous January. ... Systems integrators were key to helping states manage information from federal and private sources that weren't built to swap large volumes of data in real time (Boulton, 11/26).

Kaiser Health News: Philadelphia To Launch Health-Insurance Outreach 
Come into city offices ranging from the Free Library to the Department of Records over the next few months and you will, in theory, be asked whether you have health insurance and offered information about Obamacare, including the option of getting a call from a specialist trained in enrollment. ... Bill England, Pennsylvania director for Enroll America. "We know that we are going to come in contact with thousands of people." He said the move, in the works for months, was a creative way to provide information and was unrelated to the highly publicized woes of Healthcare.gov (Sapatkin, 11/26).

The Associated Press: S.D. Defers To Insurance Firms On Health Care Law
South Dakota will allow insurance companies to decide whether to allow a few thousand state residents to keep their health plans that otherwise would be canceled under the federal health care law. The Division of Insurance made the announcement Tuesday in response to President Barack Obama's decision Nov. 14 to give companies the option of extending policies for another year. The state still had to approve the changes (Walker, 11/27).

The Oregonian: Cover Oregon's Hidden HSA Health Insurance Plans
Among Cover Oregon's current shortcomings: The online health-insurance exchange does not clearly identify plans that can be paired with a Health Savings Account. If you just browse the site, it would appear there are only four such high-deductible, HSA-qualified plans available to individual insurance buyers. Actually, there are 13, Cover Oregon officials confirm (Hunsberger, 11/26).

California Healthline: Exchange Applications, Website, Agents All Hit higher Marks In Second Month
Covered California yesterday released application statistics for the first three weeks of November, as well as updated numbers for agents, assisters and call center volume. The numbers showed significant improvement over October statistics for the state's new health insurance exchange. "We are receiving more than 10,000 applications every single day," said Peter Lee, the exchange's executive director. Through Nov. 23, the number of completed enrollment applications hit 385,556 -- a significant jump over the 179,562 applications reported as started but not all completed in October (Gorn, 11/27).

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State Highlights: S.C. Clinic A Model For Free Care; Mont. Doctor's Push To Treat Mine Workers Sickened By Asbestos; Fast Food Consumption in Calif. Kids

The Associated Press: SC Free Clinic Model Now Replicated Nationwide
What began two decades ago on Hilton Head Island as a free clinic using retired physicians and volunteers to care for the working poor has become a model for dozens of similar clinics nationwide. At a time when the nation debates how to pay for care, there are now 96 Volunteers in Medicine Clinics in 29 states (Smith, 11/27).

The Wall Street Journal: Doctor's Quest: Help A Town Breathe Easier 
New patients still arrive at the little medical clinic just off Mineral Avenue in [Libby, Mont.], some with cancer, others with a cough that won't go away and some with no symptoms at all. All are recent victims of what is now a well-known disease in this community, which for years was poisoned by asbestos fibers from a nearby mine, according to government health officials. ... [Brad Black, who runs the clinic] is tracking 5,540 people across the U.S. who lived near or worked at the mine to monitor their health. So far he said just over half of them show signs of asbestos disease. Along with U.S. Sen. Max Baucus (D., Mont.), he is fighting to expand a Medicare pilot program that offers to sick patients in the Libby area free medicine, gear and home modifications so that 886 other patients outside the area can also have access (Searcey, 11/26).

California Healthline: High Rate Of Fast Food Consumption Among Children 'Surprising To See
UCLA researchers yesterday released a study that shows poor eating habits among California children, including a dearth of fruits and vegetables in their diets and a glut of fast food in diets of children ages 2 to 5. … The study's findings include: 60 percent of California children ages 2 to 5 had eaten fast food at least once the previous week; 70 percent of Latino children in that same age range ate at a fast food restaurant in the previous week (Gorn, 11/25).

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Health Care Marketplace

Philadelphia Hospital Reaches Out To Homeless

The program helps reinforce the importance of health care for shelter residents and their children.

USA Today: Children's Hospital Reaches Out To Parents, Too
Amber Bailey used to travel up to an hour to see her baby's pediatrician. That was when things were looking brighter and she was living in a house with her child's father. She's homeless now with two small children, but their doctor is only five minutes away, and medical care even comes to her shelter [in Philadelphia]. Health care may dominate the news these days, but it's typically not on the minds of the homeless. But one children's hospital and a generous donor here are making sure the most vulnerable members of this city's struggling population remember the importance of their children's and their own health care and coverage. And the thanks they receive from the families adds to the satisfaction they get from meeting some of the goals of the health care overhaul (O'Donnell, 11/26).

Meanwhile, in other issues affecting medical providers --

Reuters: Easing Nurse Practitioner Laws May Save Money At Clinics
Relaxing restrictions on what services nurse practitioners can and can't provide may lead to cost savings at retail health clinics, suggests a new study. Researchers found care related to retail health clinic visits cost $34 less in states that allowed nurse practitioners to prescribe and practice independently than in states that required them to be supervised by a doctor (Seaman, 11/26).

The New York Times: Gynecologists May Treat Men, Board Says In Switch
A professional group that certifies obstetrician-gynecologists reversed an earlier directive and said on Tuesday that its members were permitted to treat male patients for sexually transmitted infections and to screen men for anal cancer. The statement from the American Board of Obstetrics and Gynecology eased restrictions announced in September, which said that gynecologists could lose their board certification if they treated men (Grady, 11/26).

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Marketplace News: Private Health Insurance Exchanges; Health Costs Rise For Big Firms

Issues in the health care marketplace are making news.

NPR: To Changing Landscape, Add Private Health Care Exchanges
We've been reporting a lot lately on the troubled rollout of President Obama's signature health care law. But at the same time, there are rumblings of a major shift in the way companies offer private health insurance to workers. It involves what are called "private health care exchanges." These are similar to -- but completely separate from -- the public exchanges you've heard so much about (Arnold, 11/27).

Related, earlier story about private exchanges: Some Employers Already Sending Workers To Exchanges to Buy Health Insurance (4/29/11)

Los Angeles Times: Health Care Costs At Big L.A. Firms Up 4.5% This Year, Survey Shows Health care costs for Los Angeles employers climbed 4.5 percent this year to $11,625 per employee, a new survey shows, and firms expect a bigger increase in 2014. Nationwide, health-benefit costs in the workplace rose just 2.1 percent in 2013 to $10,779 per worker, which includes employer and employee contributions for medical, dental and other health coverage. The figures come from a survey of employer health plans by Mercer, a benefits consulting firm (Terhune, 11/26).

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Weekend Reading

Longer Looks: Providing Dental Care In Rural Alaska; The After-Effects Of The ICU; Cure For Allergies

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

Health Affairs: In Alaska, Reaching Into Remote Corners To Provide Dental Care
Aniak, Alaska, is a Yu’pik village of 500 people on the Yukon-Kuskokwim delta, about 400 miles northwest of Anchorage. It is in this special and isolated community where I practice as a dental therapist, trained and certified to deliver some, but not all, types of dental care. Dental therapists have been practicing in Alaska for nine years and now provide routine dental care to 40,000 Native Alaskans. In the United States about forty-seven million people live in areas where there is a shortage of dentists, and millions more can’t afford to see them. For so many Americans, even the most basic dental care is out of reach. Yet right here in Alaska, I think we’ve found part of the solution (Conan Murat, November, 2013).

The New York Times: Bringing Back My Real Self With Hormones
In my early 30s, for a few months, I altered my body chemistry and hormones so that I was closer to a man in his early 20s. I was blown away by how dramatically my thoughts changed. I was angry almost all the time, thought about sex constantly, and assumed I was the smartest person in the entire world. Over the years I had met guys rather like this. I was not experimenting with hormone levels out of idle curiosity or in some kind of quirky science experiment. I was on hormone treatments because I’d had a tumor removed along with part of my pituitary gland (Mary Lou Jepsen, 11/23).

The Atlantic: After The ICU: What Does It Mean To Be 'Okay'?
As more adults survive intensive care, we've inadvertently created a new world populated by the walking wounded. Some return to work, bodies healed, but find their minds are different, slower than before. Others are depressed, anxious, tortured by flashbacks to horrific events that never occurred. As a critical care doctor, it's entirely possible for me never to see any of these outcomes. But I've come to fear that our best interventions are less meaningful, and our counsel to families shallow, if we don't fully understand what happens to our patients after they leave our units' doors. ... About one in three ICU survivors who are sick enough to require intubation might develop post-traumatic stress disorder. Recent studies have also described that those who leave the ICU also suffer high rates of impaired brain functioning, on the level of mild or moderate dementia (Daniela J. Lamas, 11/21).

The Weekly Standard: Doing Harm
My mother, who admired Linus Pauling, kept three rows of bottles filled with vitamins and herbs in her kitchen, as well as stacks of newsletters with advice about "natural" remedies. ... Despite my mother’s wide reading, I doubt that she knew about the many studies concluding that high doses of vitamins increase the risk of cancer. More than half of all Americans take vitamins—a $28 billion industry in 2010—and even unbelievers tend to think they are harmless. Do You Believe in Magic?—the charming title of which comes, of course, from the 1965 Lovin' Spoonful song—is a fun read, a fast tour through stories about villains and crackpots. Linus Pauling is among them (Temma Ehrenfeld, 11/26).

The New York Times: A Cure For The Allergy Epidemic
Will the cure for allergies come from the cowshed? ... comparative studies highlight the importance of environment, beginning, it seems, in the womb. Microbes are one intriguing protective factor. Certain ones seem to stimulate a mother’s immune system during pregnancy, preventing allergic disease in children. By emulating this naturally occurring phenomenon, scientists may one day devise a way to prevent allergies. 
... This task, though still in its infancy, has some urgency. Depending on the study and population, the prevalence of allergic disease and asthma increased between two- and threefold in the late 20th century, a mysterious trend often called the "allergy epidemic." These days, one in five American children have a respiratory allergy like hay fever, and nearly one in 10 have asthma (Moises Velasquez-Manoff, 11/9).

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Editorials and Opinions

Viewpoints: SCOTUS Should Support Contraception Mandate; Our Brains 'Not Wired' For Obamacare; President's Personality Impairs Law's Success

The New York Times: Another Challenge To The Health Care Law
More than a year after it upheld the constitutionality of the Affordable Care Act, the Supreme Court has set the stage for a showdown over the law’s requirement that employer health plans cover birth control. ... The mandate’s promotion of women’s health and equality is clearly a compelling interest. More fundamentally, the 1993 law was not intended to cover profit-making corporations, and any burden imposed on the employer’s religion is trivial — the law, after all, merely allows employees to make independent decisions about birth control (11/26).

The Washington Post: Corporations Aren't People
Individual believers and non-believers draw their own lines on all kinds of moral issues every day. That’s human nature. They are free to say that their lines adhere to or are close to specific religious doctrines. But to extend the exemptions that churches receive to secular, for-profit corporations that claim to be following religious doctrine, but may in fact be nipping it here and tucking it there, would open the door to a range of idiosyncratic management practices inflicted on employees (Harold Meyerson, 11/26).

Los Angeles Times: Supreme Court To Rule On Whether Corporations Pray
The Supreme Court's most notable expansion of corporate "personhood" rights was the infamous Citizens United case of 2010, which granted corporations the equivalent of free-speech rights in election law. ... the corporate form affords its users considerable benefits, such as limited legal liability -- and that brings obligations along with benefits. What the Hobby Lobby, Conestoga, and Autocam families are asking is to reap the benefits of incorporation but shed the obligations of operating in the secular world. The issue before the Supreme Court is whether they should be permitted to have things both ways (Michael Hiltzik, 11/26).

The Wall Street Journal: An Executive Without Energy
In the last week of September 2013, a "pre-flight checklist" indicated that 41 of the 91 Healthcare.gov functions for which a key contractor was responsible were not working. Another checklist prepared a week later showed serious, and in five cases critical, defects in functions previously categorized as working. Nonetheless, the website was launched on Oct. 1 and failed almost immediately. ... the trail of responsibility for its botched rollout ends at the Oval Office (William A. Galston, 11/26).

The Washington Post: What Medicare Can Teach Us About The Future Of Obamacare
Conservative opposition to the ACA is partly driven by fears that, once fully implemented, the program will prove popular and thus be difficult to roll back. My new research suggests that these fears may be justified. The research, conducted with Princeton's Katherine McCabe, builds on a long-standing finding from political science: Policies, once created, generate constituencies who benefit from those policies and will therefore oppose efforts to reform or repeal them. This "policy feedback" is what Republicans want to avoid and Democrats want to cultivate (Amy Lerman, 11/26).

The Washington Post: Why Are Some Feds' Health-Insurance Premiums Increasing More Than Others’?
The Office of Personnel Management (OPM) patted itself on the back when it announced an average rate hike of 3.7 percent for health insurance coverage next year in the Federal Employees Health Benefits Program (FEHBP). ... But the law of averages means some increases will be more than 3.7 percent. Sometimes a lot more (Joe Davidson, 11/26).

The Washington Post: More People Can’t Keep Their Health-Care Plans
President Obama’s broken promise that people can keep their existing health insurance is much larger than we’ve been led to believe. Until now, attention has focused on the individual insurance market: ... [which] is small, representing about 5 percent of the non-elderly population. But cancellations, under today’s law, will ultimately spread to the largest insurance market: employer-provided coverage. So Chapter Two of the broken promise looms (Robert J. Samuelson, 11/26).

Politico: Are Our Brains Just Not Wired for Obamacare?
The exchanges are based on a laudable idea: that competition, transparency and consumer choice will lead to higher-quality, more affordable products. ... But despite the good intentions behind the website, behavioral science research suggests that many consumers may be ill equipped to make good decisions in the insurance marketplaces. ... Humans have difficulty making optimal choices under conditions of uncertainty, when weighing probabilities of long-term risks and benefits, and when analyzing complex products with multiple components of unclear relative values (Dhruv Khullar, 11/26).

The Fiscal Times: Obamacare Aftermath: Fewer Doctors, Higher Costs
[M]ore money isn’t pouring into healthcare – it’s just being rearranged. It’s being taken from the Medicare system, from people who can afford to pay higher insurance premiums and manage higher deductibles, from those who don’t now have health insurance because they have chosen to self-insure (the young and healthy), from those earning high incomes and from the makers of medical devices – and distributed to people who by and large cannot afford healthcare today. This may be a worthy social adjustment, but it does not create a new generation of eager doctors (Liz Peek, 11/27). 

Politico: The Bad-Faith Presidency
At the end of the day, the root of President Obama’s mendacity on Obamacare was simple: He didn’t dare tell people how the law would work. He couldn’t tell people how the law would work. Forthrightness was the enemy. It served no useful purpose and could only bring peril, and potentially defeat. It had to be banished. Instead of candor, Obama made the sale on the basis of dubious blandishments and outright deceptions. ... Obama was a natural at delivering sweeping and sincere-seeming assurances that weren’t true. This kind of thing is his métier (Rich Lowry, 11/26).

Bloomberg: Is Obamacare Challenging Enough for Obama?
Two statements explain the huge failure of Obamacare. One is by President Barack Obama, the other is about him. ... A chief executive less bored than Obama would have stayed on top of his signature legislation. ... After the Oct. 1 rollout, he seemed as surprised as your average citizen that the exchanges weren’t working. He keeps suggesting the failure should be mitigated by the fact that his opponents were wishing for it. It took him six weeks to apologize, he still hasn’t held anyone responsible, and not one head has rolled. One reason he could say that the fiasco was “on him” is that his head can’t roll (Margaret Carlson, 11/26).

The Milwaukee Journal Sentinel: How Republicans Can Save Obamacare And Themselves
Even though Democrats passed it, the Affordable Care Act offers a hospitable environment for conservative reform. That's not just because it incorporates aspects of a proposal from the conservative Heritage Foundation, closely resembles the health care reform bill that Mitt Romney signed in Massachusetts, and bears striking similarities to earlier proposals by Republican members of Congress. No, the reason the ACA may be good for conservatives is that it provides a sound chassis for many of their health-policy proposals (Austin Frakt, 11/26).

The Fiscal Times: HealthCare.Gov May Have Risked My Identity
Last week, I received several calls from a representative who claimed to be from HealthCare.gov. She was trying to obtain some more information for my application and claimed to be from a "processing center in Arkansas." Since I've written extensively about scams elsewhere (see my "Bamboozlement" blog on Forbes.com), my nose shot up like a terrier sensing a rodent. Why would someone call me, I wondered? Wouldn't they want to send me a secure email or an old-fashioned certified snailmail letter? (John F. Wasik, 11/27).

Los Angeles Times: Peter V. Lee, Obamacare's California Savior?
By the numbers, Peter V. Lee has some reason to crow while the feds are eating crow. The executive director of Covered California can be pleased that, as of mid-November, nearly a third of all Americans who signed up under the new healthcare law were Californians. But it's not over yet: The state's success with the young and with Latinos is not a slam dunk. As California goes, so goes this national experiment, most experts say. But Lee, whose last job was working for Medicare and Medicaid in D.C., doesn't seem to be feeling the pressure (Patt Morrison, 11/27).

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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.