Daily Health Policy Report

Thursday, December 12, 2013

Last updated: Thu, Dec 12

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Health Reform

Health Care Marketplace

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

New York Data Show Hospital Charges All Over The Map

WNYC’s Fred Mogul, working in partnership with Kaiser Health News and NPR, reports: "New York State has pulled back the curtain on hospital charges. A new database shows what each hospital across the state charges for 1,400 different procedures. The differences can be dramatic: At Bellevue Hospital, the median charge for an uncomplicated birth is $6,330, and at NYU Langone Medical Center next door, the median charge is $12,222. Lutheran Medical Center in Sunset Park, Brooklyn, typically charges $5,686 and Maimonides Medical Center, a dozen miles away, $14,763" (Mogul, 12/12). Read the story.

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Health On The Hill: Sebelius Asks Inspector General To Probe Website Problems

Kaiser Health News' Mary Agnes Carey and CQ Roll Call's Emily Ethridge discuss HHS Secretary Kathleen Sebelius' testimony on Capitol Hill Wednesday, which included updates on steps officials are taking to repair the health law's online insurance exchange (12/11). Read the transcript or listen to the conversation.

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Some Ski Country Coloradans Angry About Higher Insurance Rates

Reporting for Kaiser Health News, working in partnership with NPR, writes: "In Colorado, gas, groceries and rent are all pricey in the ski country communities, including Keystone, Breckenridge and Vail compared to Denver, about 100 miles away. Health insurance costs more in the mountains of Summit and Eagle counties and residents are crying foul after being asked to pay a lot more than city folks for similar health plans. Democratic Rep. Jared Polis' district is in this area, with a high rate of uninsured. Health plans are so expensive that Polis has asked the federal government for some of his constituents to be exempt from the requirement to buy health insurance" (Whitney, 12/12). Read the story.  

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Capsules: Obesity Rate Flat For First Time In Decades, Health Rankings Find

Now on Kaiser Health News' blog, Eric Whitney reports: "An annual state-by-state survey says the country is making good progress in improving its overall health — including a flat obesity rate and a lower rate of smoking. But individual states, especially in the South, continue to lag. The 2013 edition of 'America's Health Rankings' by United Health Foundation, the American Public Health Association and Partnership for Prevention says that, 'for the first time in decades,' the nation’s obesity rate did not rise between 2012 and 2013. Americans are also becoming more physically active, the report says" (Whitney, 12/11). Check out what else is on the blog.

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Political Cartoon: 'Except-Shun-Able?'

Kaiser Health News provides a fresh take on health policy developments with "Except-Shun-Able?" by Matt Wuerker. 

And here's today's health policy haiku:  


The hot seat again
For Kathleen Sebelius
Some things never change

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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Capitol Hill Watch

Sebelius: A Review Will Probe Healthcare.gov Launch Problems

Just as the November enrollment figures were released, Health and Human Services Secretary Kathleen Sebelius testified Wednesday before a House Energy and Commerce Subcommittee where she was again grilled on the difficulties that have plagued the website.

The New York Times: U.S. Cites Rise In Health Plan Signups As Sebelius Testifies
The number of people selecting health insurance plans in the federal and state marketplaces increased last month at a brisk pace, bringing the overall figure to nearly 365,000, the Obama administration said on Wednesday. The November number was more than double the one for October, but still well below the administration’s goal (Pear, 12/11).

The Washington Post: Sebelius: Enrollment Up With Improving Healthcare.gov; Review Of Problems Launched
Health and Human Services Secretary Kathleen Sebelius said Wednesday that the ailing health insurance Web site was improving thanks to "relentless" efforts to work out the bugs, and she cited an uptick in enrollment as evidence that the program is back on track after a false start. But she told a congressional panel she has launched an investigation into what policies and management failures may have contributed to the initial failures of HealthCare.gov, the main portal for people in 36 states to buy private insurance plans under the health-care law (Somashekhar and Goldstein, 12/11).

Politico: Kathleen Sebelius Takeaways: 1 Cranky Hearing
What’s the one thing worse than taking fire from Congress in a crowded hearing room? Taking fire from really cranky members of Congress in a half-empty hearing room. That’s what Kathleen Sebelius went through on Wednesday, as she parried Obamacare questions from a House subcommittee while much of Washington had moved on to other things. But in the hearing room, the Obamacare tensions were as high as ever, with Republicans and Democrats snapping at each other and one GOP lawmaker griping that trying to get answers out of the Health and Human Services secretary was like talking to North Korea (Nather, 12/11).

The Wall Street Journal: Sebelius Calls For Review Of HealthCare.gov Contracting Practices
Health and Human Services Secretary Kathleen Sebelius, responding to the botched launch of the HealthCare.gov health-insurance website, said Wednesday she has called for a review of contracting practices and a new official to oversee risk. Mrs. Sebelius testified again on Capitol Hill Wednesday and faced questions from House Republicans about issues that have plagued the rollout of President Barack Obama's health law. Lawmakers raised concerns about the security of consumer data, the cancellation of millions of health policies, limited networks of doctors and hospitals and higher-than-expected premiums (Schatz, 12/11).

Kaiser Health News: Health On The Hill: Sebelius Asks Inspector General To Probe Website Problems
Kaiser Health News’ Mary Agnes Carey and CQ Roll Call's Emily Ethridge discuss HHS Secretary Kathleen Sebelius' testimony on Capitol Hill Wednesday, which included updates on steps officials are taking to repair the health law's online insurance exchange (12/11). Read the transcript or listen to the conversation.

CQ HealthBeat: Sebelius: Troubled Federal Health Website Needed Slower Launch, More Testing
Health and Human Services Secretary Kathleen Sebelius told House lawmakers Wednesday she is “not sure” whether it would have been better to delay the launch of the flawed federal health care exchange website (Ethridge, 12/11).

McClatchy: With Website Working, Sebelius’ Capitol Hill Hot Seat Cools Down A Little
Health and Human Services Secretary Kathleen Sebelius has asked her department’s inspector general, Daniel Levinson, to review the contracting and project management problems that led to the bungled rollout of the HealthCare.gov website. The move is one of three new initiatives Sebelius announced Wednesday morning in a blog post and during testimony before the health subcommittee of the House Energy and Commerce Committee. The directives come on the heels of new figures that show HealthCare.gov enrollments quadrupled from October to November (Pugh, 12/11).

CNN: Sebelius Orders Review Of Obamacare Website Woes
Hours ahead of her appearance Wednesday before a House subcommittee certain to grill her on the botched launch of the Obamacare website, Health Secretary Kathleen Sebelius announced an internal review of what happened and why. Then her department released the latest enrollment figures for President Barack Obama's signature health care reforms, showing a big increase in November after the site's problem-plagued rollout on October 1. The moves appeared timed to blunt criticism by the Republican-led House Energy and Commerce Subcommittee on Health of the reforms known as Obamacare and Sebelius, the Cabinet Secretary in charge of implementing them (Cohen, 12/11).

Los Angeles Times: Obamacare Sign-Ups Continue To Increase
Growing numbers of Americans are signing up for insurance through President Obama's health law, with more than 250,000 selecting a plan in November, according to a new government report. That is more than double the number in October, when problems with the new HealthCare.gov website made enrollment virtually impossible in most states for long stretches of time (Levey, 12/11).

The Associated Press/Washington Post: Health Care Sign-Ups Pick Up But May Not Close Gap
With time running short, the nation’s health care rolls still aren’t filling up fast enough. New sign-up numbers Wednesday showed progress for President Barack Obama’s health care law, but not enough to guarantee that Americans who want and need coverage by Jan. 1 will be able to get it. Crunch time is now, as people face a Dec. 23 deadline to sign up if they are to have coverage by New Year’s (12/11).

ABC News: Sebelius: Back End Of HealthCare.Gov Will Be Ready In Mid-January
Some back-end portions of HealthCare.gov won't be fully functional until mid-January, Health and Human Services Secretary Kathleen Sebelius told Congress Wednesday, but she assured them that customers enrolled on the federal website will get full coverage -- and their promised subsidies -- starting on January 1. "The financial management system, which is getting the insurance companies their money for accelerated tax credits and cost-sharing, is due to go into effect in mid-January," Sebelius told a subpanel of the House Energy and Commerce Committee. She explained, "This is reimbursing insurance companies -- it has nothing to do with enrollment” (Condon, 12/11).

The Fiscal Times: Sebelius Twice Grilled…Still Not Well Done
If congressional hearings were like baseball games, the Republicans on the House Energy and Commerce Committee would have struck out swinging during their questioning of Secretary of Health and Human Services Kathleen Sebelius in Tuesday’s hearing on Obamacare implementation. Rep. Joseph Pitts (R-PA) opened the questioning by complaining that while President Obama had once promised that average Americans’ insurance premiums would go down under Obamacare, some people were seeing premiums go up. Sebelius seemed in a forgiving mood in the early stage of the hearing – and as a result, she failed to define the term “average” for the congressman (Garver, 12/11).

The Wall Street Journal: White House Works To Attract Younger Health-Plan Users
New enrollment figures show health-insurance exchanges nationwide are attracting more customers, but the Obama administration said that it has more work to do to get enough younger, healthy people into the system. The administration said Wednesday that as of Nov. 30, nearly 365,000 people nationwide had selected private health plans in the exchanges created by the Affordable Care Act—sharply up from October, but still far from the seven million level officials are hoping to achieve by March 31. Health and Human Services Secretary Kathleen Sebelius faced renewed criticism of the health-care law's rollout at a House hearing Wednesday. Republicans suggested the plans on offer are a bad deal for many Americans, pointing to problems such as limited networks of doctors and hospitals, and higher-than-expected premiums (Schatz, 12/11).

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House GOP Appears To Be Warming To $85 Billion Budget Deal

CQ HealthBeat reports that Medicare providers would face an added two years of automatic spending cuts under the agreement. 

CQ HealthBeat: Medicare Providers Take Unexpected Hit In Budget Deal, Face 2014 Fight
Medicare’s providers face an added two years of automatic spending cuts under the budget agreement announced Tuesday evening by the leaders of the House and Senate budget committees. That would help offset the costs of temporarily easing the impact of sequester provisions of the budget control law on operating budgets of federal agencies (Young, 12/11).

The Washington Post: House Republicans Appear To Be Rallying Behind $85 Billion Budget Deal
Though they expect a strong Republican vote, GOP leadership aides said they were likely to need a sizable contingent of Democrats to push the measure across the finish line. ... That margin may be trimmed somewhat, key Democrats said, by a last-minute decision by Republicans to add an amendment to benefit doctors who see Medicare patients. Democrats support what is known as the “doc fix,” which would postpone for three months a 24 percent cut in Medicare reĀ­imbursement rates set to hit providers in January (Montgomery, 12/11). 

The Wall Street Journal: Budget Deal Picks Up Steam
Few lawmakers expressed enthusiasm for the narrowly focused agreement reached by House Budget Chairman Paul Ryan (R., Wis.) and his Senate counterpart, Budget Chairman Patty Murray (D., Wash.), to ease the effect of across-the-board spending cuts known as the sequester. But lawmakers from both parties predicted that bipartisan desire to call a cease-fire in Congress's budget wars would carry the bill through the House and into the Senate next week. "If you are for more deficit reduction, you are for this agreement," said House Speaker John Boehner (Hook and Peterson, 12/11). 

In addition, the CBO estimated the cost of the temporary "doc fix" -

The Hill: CBO: 'Doc Fix' Patch To Cost About $8.7 Billion
A proposed patch sparing Medicare physicians a 24 percent pay cut next year would cost about $8.7 billion, the Congressional Budget Office said Wednesday. The House measure would provide doctors with a 0.5 percent payment update through March 2014 while allowing Congress several months to overhaul Medicare's flawed physician payment system (Viebeck, 12/11).

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Issa Slams HHS For 'Obstructing' Investigation Of Healthcare.gov

House Oversight Committee Chairman Darrell Issa, R-Calif., says the Department of Health and Human Services is illegally interfering with his panel. 

The Hill: Issa: HHS Criminally Obstructing HealthCare.Gov Probe
The top House Republican charged with overseeing the executive branch is accusing federal health officials of criminally obstructing his investigation into the botched rollout of HealthCare.gov. Oversight Committee Chairman Darrell Issa (Calif.) claimed the Department of Health and Human Services (HHS) was illegally interfering with the ongoing probe after HHS purportedly told one private contractor not to comply with congressional requests for information (Viebeck, 12/11).

Fox News: Rep. Issa Accuses HHS Of Criminally Obstructing Probe Into ObamaCare Website
The Dec. 6 letter from CMS official Daniel Kane says that although the department understands Congress’ need for documents to continue its probe into the issues with Healthcare.gov, the agency is concerned about security risks from releasing testing information to third parties. Therefore, the letter states, the agency has decided to not allow contractors to release any documents to any third party, telling the contractors to send congressional investigators to CMS, who will handle the request themselves (12/12).

In other Capitol Hill developments -

Fox News: Congressional Staffers Told Not To Trust ObamaCare Site Info
Congressional staffers were warned Wednesday not to rely on information provided by the ObamaCare exchange website, in an email alert informing them they might not be enrolled for coverage even if they technically signed up. The "very important" message, sent to Capitol Hill officials Wednesday afternoon, is the latest sign that the government has concerns about the reliability of the system (Emanuel, 12/11).

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Health Reform

Can 7 Million People Enroll In Obamacare By March 31?

Experts debate whether the administration can meet its target by March 31. Through November, 364,682 have chosen plans -- well off the 7 million target -- but officials say they are on track because they expect a surge of signups towards the end of the open enrollment period.

The Fiscal Times: An Obscure Rule Could Boost Obamacare Enrollment
Administration officials claimed yesterday that they would meet their target of having 7 million people enrolled in Obamacare by March 31. Given the continuing problems with the healthcare.gov website, combined with problems at the state exchanges, achieving that goal could be a very heavy lift. However, officials may have a trick up their sleeve. It's a little-known provision of the law called special enrollment -- and it might be Obamacare's secret weapon after open enrollment ends, according to health policy experts (Francis, 12/11).

USA Today: Analysts Predict Surge In Health Care Enrollment
The surge in health insurance enrollment in November lifted the spirits of federal officials Wednesday, but industry experts say the potential for higher enrollments comes from a huge pool of customers who are eligible for subsidies to buy insurance but who have not used the exchanges. The government quadrupled its enrollment numbers from October to November, with 364,682 people signed up for health insurance through either the federal or state exchanges, officials announced Wednesday (Kennedy, 12/11).

Medpage Today: ACA Enrollment Rising, But Not Fast Enough
But the enrollment numbers -- a combined 364,682 -- are still well off what they need to be to hit the Obama administration's target of 7 million enrollees in private coverage through the exchanges before open enrollment ends at the end of March, several health policy experts told MedPage Today. Robert Laszewski, president of Health Policy and Strategy Associates in Alexandria, Va., noted that 20 million people will be uninsured and make too much to qualify for Medicaid. On top of that, untold numbers of people have had their current policies cancelled because they weren't ACA-compliant -- a figure that, while not known precisely, is sure to exceed ACA enrollment (Pittman, 12/11).

CNN: Obamacare Website Gets $47 Million Price Hike
The government has been cagey about revealing how much money has been spent to fix healthcare.gov, but today officials revealed the overall price tag for the troubled Obamacare website has increased by $47 million. In Washington jargon, it is called an "increase in the total amount obligated" rather than a price hike. But the end result is the same (Aigner-Treworgy, 12/11).

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Health Law Presents New Challenge For Small Businesses

Large numbers of small entrepreneurs have not yet focused on the law, and their responses for employee coverage are expected to vary. Meanwhile, news outlets examine some of the issues around paying premiums and other insurance issues.

USA Today: Entrepreneur Worry: ACA Really 'Affordable'?
Many small businesses remain in the dark about how the ACA affects them, however. When asked this year if their insurers had changed their small business' benefit package because of the law, 22 percent of 604 companies queried said they hadn't, and 34 percent said they didn't know, according to a report from the independent research organization NORC at the University of Chicago. They aren't likely to miss the big changes coming next year for ACA-compliant plans. What will be different next month: Insurers will be prohibited from refusing to cover people with pre-existing conditions, charging them more or delaying their coverage. Plans will also be required to cover certain "essential health benefits" and fully cover preventive care (O'Donnell, 12/12).

The New York Times: Dropping Health Plans, To Pick Better Coverage
For nearly 20 years, Keith Perkins offered health insurance to employees of his small electrical contracting company in Greencastle, Pa., and footed most of the bill. This year, with the arrival of the Affordable Care Act's insurance marketplace, he decided to stop. Mr. Perkins, who is 54, did the math and calculated that most of his employees, who are spread across Maryland, West Virginia and Pennsylvania, would come out ahead if he dropped his group policy and let them buy insurance individually through the new federal and state exchanges (Cowley, 12/11). 

Reuters: For Some Obamacare Shoppers, A Brief Grace Period On Premiums
As a deadline approaches for people to sign up for medical insurance under President Barack Obama's health care law, some insurers and state-run online marketplaces are giving shoppers an extra week to pay their first premiums. The shift to early January from the end of December provides a short grace period for insurers and shoppers to work through any errors in the new policies caused by technology problems dogging enrollment since it opened on October 1 (Humer and Krauskopf, 12/12).

ProPublica: Payment Due: The Obamacare Deadline No One Is Talking About
But amid the rush to enroll as many people as possible by the Dec. 23 deadline, there's a huge caveat that isn't getting much public attention: For coverage to take effect on Jan. 1, enrollees must pay their first month's premium on time. (The deadline varies somewhat by state and by insurer.) That's slow going, according to consultants and some insurers, raising the prospect that actual enrollment will be far lower than the figures HHS is releasing (Ornstein, 12/11).

The Fiscal Times: The Many Disrupted Lives Under Obamacare
Deb McEneaney of Sag Harbor, N.Y., was jolted in November when her insurance company notified her that it was canceling a group health plan that had been tailor made for her and her husband and their family-run business. Her insurance broker assured her she had nothing to worry about when the administration began the formal rollout of Obamacare on Oct.1. But the insurance company, United Healthcare Oxford, subsequently wrote her saying that it would no longer allow group health plans for two people who were related because of new restrictions under the Affordable Care Act (Pianin and Ehley, 12/12).

Marketplace: With Healthcare.Gov, Phones Finally Begin Ringing At Small Insurers
[Howard] Kahn used a single word to describe what it was like in the call center when the health exchange opened: Quiet. The 20,000 new customers Kahn was hoping for in the first month did not materialize. L.A. Care has signed up just over 1,000 members. ... But business has improved steadily (Weinberg, 12/11).

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New Enrollment Figures Give Clearer View Of Exchange Efforts In States

Officials in California, Maryland, Illinois, Kansas and Georgia give status checks on their online health insurance exchanges. In the meantime, officials in Oregon are pressuring their website contractor, Oracle, to speed up fixes to the marketplace as insurers consider extending deadlines there.

Los Angeles Times: California Enrolls 107,000 In Obamacare Policies Through November
California's health exchange has signed up 107,087 people in Obamacare policies through the end of November, federal data show, accounting for nearly a third of enrollment nationwide. The federal figures released Wednesday also show that 181,817 Californians have qualified for an expansion of Medi-Cal, the state's Medicaid program for the poor (Terhune, 12/11).

The Washington Post: O'Malley, Back From A Trade Mission, Plans To Provide Update On Health Insurance Rollout
Maryland Gov. Martin O'Malley (D), who recently returned from a trade mission to Brazil and El Salvador, plans to brief the media on Thursday regarding the status of the state's online health insurance exchange, an aide said. O'Malley's expected appearance comes just two days after Lt. Gov. Anthony Brown (D) addressed reporters on the same subject and declined to say whether the state would meet a mid-December target set by O'Malley to fix the major glitches that have hindered enrollments in private insurance plans (Wagner, 12/12). 

The Associated Press: Feds: More Than 7K Illinoisans Select Health Care Plans
More than 7,000 Illinois residents signed up for private insurance coverage in the first two months of the troubled healthcare.gov website, less than 30 percent of the federal government's projection for the state's enrollment at this point of the rollout (Johnson, 12/11).

The Associated Press: Kansans Slow To Embrace Health Marketplace In Nov.
Kansans remained slow to enroll in health insurance plans in November through the online marketplace set up under the federal health care overhaul, though enrollments did jump, figures from the U.S. Department of Health and Human Services showed Wednesday (Hanna, 12/11).

Georgia Health News: Exchange Enrollment Up, But Still Weak 
The number of Georgians signing up for a health plan through the Affordable Care Act insurance exchange increased to 6,859 by the end of last month, up from 1,390 as of Nov. 2, federal officials announced Wednesday. The rise in enrollees reflects, in part, a better-functioning federal website, which has been plagued with problems since ACA enrollment began Oct. 1. ... November enrollment in the federally run exchanges — used in Georgia and 35 other states — was more than four times greater than October’s reported enrollment number, HHS said (Miller, 12/11).

The Oregonian: Oregon's Health Exchange Woes Spark Tension With Largest Contractor, Oracle Corp. 
After Oregon's high-profile failure to build a functioning health insurance exchange, the already strained relations with its largest contractor, Oracle Corp., escalated into finger pointing and acrimony in November. Cover Oregon emails obtained by The Oregonian show that it enlisted a high-profile trio of political heavyweights for help as its website, which has cost more than $150 million, still didn't work. Democrats Gov. John Kitzaber, U.S. Sen. Jeff Merkley and U.S. Rep. Kurt Schrader took turns calling Oracle's top executives on the carpet in October and November, demanding the technology giant deliver the functional health care exchange it had promised (Manning, 12/12). 

The Oregonian: Insurers Consider Extending Deadlines To Address Cover Oregon Backlog
State officials and insurance carriers are looking at extending certain enrollment deadlines to deal with problems at the state's overwhelmed health insurance exchange, one company executive said Wednesday. Insurance executives met Tuesday with state Insurance Commissioner Laura Cali and Cover Oregon director Bruce Goldberg to discuss ways the exchange can get more time to  work through its backlog of more than 30,000 applications. At least some insurance carriers tentatively agreed to push back the deadline they would take enrollment information from Cover Oregon from Dec. 23 to Dec. 30, said Dawn Bonder, chief executive officer and president of Health Republic Insurance, one of two new Oregon-based cooperatives (Hunsberger, 12/11).

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Frustration With Minn. Insurance Exchange Mounts As Officials Race To Remedy Problems

Problems with Minnesota's online health insurance exchange -- long wait times, technology problems and security issues -- are getting extra scrutiny as officials push to fix the website ahead of the new year when coverage is slated to begin for many.

Minnesota Public Radio: Dayton: MNsure Issues Need To Be Fixed 
The ongoing technological problems that continue to plague the state's online health insurance marketplace should have been resolved by now, Gov. Mark Dayton said today. About a dozen states run their own health care exchanges and Dayton estimates that Minnesota's performance ranks it somewhere in the middle. The governor said he understands it's a complicated project but the clock is ticking (Stawicki, 12/11).

Minnesota Public Radio: Experts Criticize Security Holes In MNsure
When Minnesota's online health insurance marketplace unveiled its website in October, state I.T. officials described MNsure's security measures as "state of the art." But Internet security experts have identified flaws in MNsure's website that could compromise sensitive consumer data. They say the site is vulnerable to "rogue access points," devices that can masquerade as a standard wireless connection to the Internet (Stawicki, 12/12).

Pioneer Press: MNSure Deadline Looms As Frustration Builds; Callers Seeking Help Wait
With a deadline fast approaching, frustration is building among many MNsure users as people seek final answers about what sort of health insurance coverage they'll have next year. Lacking answers, a man in Burnsville says he's stocked up on blood-thinning medications, just in case his coverage details aren't worked out by January (Snowbeck, 12/12). 

The Star Tribune: Gov. Dayton Frets Over MNsure Glitches
Worries about Minnesota’s new online health insurance marketplace are keeping Gov. Mark Dayton awake at night. The state has just three weeks to get the MNsure site ready for Jan. 1, when Minnesotans who have signed up will expect to begin using their new health insurance and the new federal requirements to carry health insurance or face a penalty start to take effect. As many as one out of every five Minnesotans eventually may obtain their health insurance through MNsure, the state health exchange that is supposed to make shopping for health insurance cheaper and easier. But in the 2 1/2 months since the MNsure website launched, it has been plagued by glitches, crashes and long waits for customer service (Brooks and Crosby, 12/12).

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NY Frustrated By Long Wait For Medicaid Waiver

Gov. Andrew Cuomo says he wants to help struggling hospitals. In Florida, Gov. Rick Scott wouldn't say if he still supports expanding Medicaid eligibility to poor Floridians.

The Washington Post: Cuomo Spars With Obama Administration Over Medicaid Expansion
A plan to help struggling hospitals that cater to minority and low-income patients in New York City that has been under consideration for more than a year is causing friction between the state’s Congressional delegation and the Obama administration, and leading to heated words between Albany and Washington. In a tense phone call late last month, New York Gov. Andrew Cuomo (D) pushed Health and Human Services Secretary Kathleen Sebelius to act promptly on his state’s request to spend billions of dollars on Medicaid reforms, including hundreds of millions to shore up public hospitals on the brink of financial collapse (Wilson, 12/12).

Tampa Bay Times: Scott Won't Answer Question On Medicaid For More Floridians
Gov. Rick Scott refused Wednesday to say whether he still supports expanding Medicaid eligibility to more uninsured and poor Floridians, an issue Democrats are certain to stress during his re-election campaign next year. Appearing at H. Lee Moffitt Cancer Center and Research Institute on Wednesday, Scott for the second time this week publicly dodged questions about his position on expanding Medicaid, the health insurance program for the poor. Though Scott surprised many observers by endorsing expansion earlier this year, he also was criticized for failing to press House Republicans to accept the plan (Tillman, 12/11).

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Health Care Marketplace

Study: Almost Half Of Psychiatrists Don't Accept Health Insurance

The findings were published yesterday in JAMA Psychiatry.

Reuters: Psychiatrists Less Likely To Take Insurance Than Others
Psychiatrists in the U.S. are less likely to accept insurance than other types of doctors, according to a new study. Researchers found only about half of psychiatrists accepted private insurance between 2009 and 2010, compared to almost 90 percent of doctors in other specialties (Seaman, 12/11).

The New York Times: Fewer Psychiatrists Seen Taking Health Insurance
The lead author of the study, Dr. Tara F. Bishop of Weill Cornell Medical College in New York, said: “In the wake of the school killings in Newtown, Conn., and other recent mass shootings, the need for increased mental health services is now recognized. But unless patients have deep pockets, they may have a hard time finding a psychiatrist who will treat them.” Mental health care is one of 10 types of “essential health benefits” that must be provided by insurers under the new health care law (Pear, 12/11).

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State Watch

Michigan To Require Separate Abortion Coverage On Public And Private Policies

The measure became law in an unusual way. 

The Associated Press: Michigan Puts Restrictions On Abortion Insurance
Michigan will join more conservative states in requiring residents who want health insurance coverage for abortions to buy an extra policy, after Republican legislators passed the law Wednesday over the objections of Democrats who pleaded for them to take the issue to voters instead. The citizens' initiative approved 62-47 by the House and 27-11 in the Senate — almost entirely along party lines — will become law in March without the signature of Republican Gov. Rick Snyder, who vetoed similar legislation a year ago. The anti-abortion group Right to Life collected more than 300,000 signatures to put the legislation before lawmakers, who also had the option of letting it go to a statewide vote next November (Eggert, 12/11).

Detroit Free Press: Michigan Legislature OKs Initiative To Require Insurance Rider For Abortion Coverage
The initiative would require most private and all public health insurance plans to offer a separate rider for an abortion. And a person would have to buy that rider before knowing if they needed an abortion. They would not be able to buy the rider after getting pregnant by any means, including rape or incest. ... The measure passed despite emotionally debate that included highly personal stories from several women in the Legislature, including an admission by Democratic Senate Minority Leader Gretchen Whitmer that she was raped 20 years ago while she was in college (Gray, 12/11).

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State Highlights: States Scramble To Change Newborn Screening Programs

A selection of health policy stories from Wisconsin, New York, the District of Columbia, New Mexico, California and Florida.

The Milwaukee Journal Sentinel: State Moving Quickly To End Delays In Newborn Screening Programs 
States across the country are making significant changes to their newborn screening programs after a Milwaukee Journal Sentinel investigation found that thousands of hospitals were sending babies' blood samples late to state labs that test for rare yet deadly genetic disorders. From keeping labs open on weekends to identifying problem hospitals and providing them with regular performance reports, dozens of health officials are reviewing and retooling their state-run programs (Gabler, 12/11).

Kaiser Health News: Capsules: Obesity Rate Flat For First Time In Decades, Health Rankings Find
An annual state-by-state survey says the country is making good progress in improving its overall health — including a flat obesity rate and a lower rate of smoking. But individual states, especially in the South, continue to lag. The 2013 edition of 'America's Health Rankings' by United Health Foundation, the American Public Health Association and Partnership for Prevention says that, 'for the first time in decades,' the nation’s obesity rate did not rise between 2012 and 2013 (Whitney, 12/11).

Kaiser Health News: New York Data Show Hospital Charges All Over The Map
New York State has pulled back the curtain on hospital charges. A new database shows what each hospital across the state charges for 1,400 different procedures. The differences can be dramatic: At Bellevue Hospital, the median charge for an uncomplicated birth is $6,330, and at NYU Langone Medical Center next door, the median charge is $12,222. Lutheran Medical Center in Sunset Park, Brooklyn, typically charges $5,686 and Maimonides Medical Center, a dozen miles away, $14,763 (Mogul, 12/12).

The Washington Post: 'Stuck In The Safety Net,' Elderly District Veteran Hopes Crowdfunding Will Help
Eighty-year-old Ralph Bolen sat in front of the care facility where he lives, pulled on a cigarette and contemplated the four blocks separating him from his first-floor studio in a co-op near Dupont Circle. "It's one big room and it’s very comfortable, with a picture window," he said, adding that he likes to lounge on his couch there and watch TV, or sit on the steps and chat with neighbors (Bahrampour, 12/11). 

The Associated Press/Washington Post: Trial On Assisted Suicide Law Begins In New Mexico
Two doctors and a Santa Fe woman with advanced uterine cancer want physicians in New Mexico to be able to prescribe -- without the fear of prosecution -- the needed medications for terminally ill patients who want to end their lives on their own terms. Standing in their way is a decades-old New Mexico law that makes it a fourth-degree felony to assist someone in suicide (12/12).

California Healthline: Physician Group In Favor Of Provisions Dropped From New California Law
The American College of Physicians yesterday published a position paper in a medical journal that supports mandatory reporting of all prescription-drug dispensing -- a requirement that was stricken at the last minute from a California bill passed last legislative session. Yesterday's article in the Annals of Internal Medicine said physicians and policymakers should stand shoulder-to-shoulder on a provision that would require physicians to report every time they prescribe certain controlled substances (Gorn, 12/11).

The California Health Report: State Gets Mixed Reviews On Electronic Health Record Use
To make the Affordable Care Act work, one tool is critical: the electronic health record. These digital forms, known in the medical community as EHRs, can help doctors identify and offer preventive treatment to illness-prone patients, instead of waiting for a crisis and hospitalization. And EHRs are crucial to such Affordable Care Act goals as treating Medicare patients with closely integrated medical teams and curbing hospital readmissions. But according to a recent report, that road still has some potholes in California (12/12). 

Health News Florida: Dropping Doctors: About Quality Or Profits?
On Jan. 1, hundreds of Florida doctors who now treat United Healthcare's Medicare patients will be dropped. A host of patients have been affected nationwide. Ever since United started sending out letters to doctors, telling them they won’t be on United’s Medicare network next year, it’s been a big story (Gentry, 12/11).

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Editorials and Opinions

Health Law Op-Eds: Obama Must 'Fire Some People'; The Law's Many Possible Futures; Obamacare 'Is A Disaster'

Bloomberg: Obama Needs To Fire Some People
Though the site is working vastly better today than it was two months ago, the debut of HealthCare.gov was a genuine disaster. Specifically, it was a management disaster. CMS’s information technology department botched its job as systems integrator for HealthCare.gov. CMS management botched the job of recognizing that CMS’s IT department was botching its job. The failures cascaded from there, with HHS botching its oversight of CMS, and the White House botching its management of HHS. It wasn’t just the technical challenges of HealthCare.gov that the administration managed poorly. The White House was completely unprepared for the furor over canceled insurance plans; that’s a political problem that [Health and Human Services Secretary Kathleen] Sebelius, a former insurance regulator, should've seen coming (Ezra Klein, 12/11).

USA Today: Obamacare Remains Worthy: Our View
The last couple of months have been rough for the Affordable Care Act, what with the rollout of a shockingly unready website and President Obama awkwardly scrambling to make good on his ill-advised promise that all people could keep their health plans if they liked them. Unsurprisingly, this slow-motion disaster has soured Americans on Obama and his signature law (12/11). 

USA Today: Obamacare Is A Disaster
Obamacare was created with an ostensibly noble purpose: to expand health coverage to some of the uninsured and to make health care more affordable. Three-and-a-half years ago, perhaps reasonable minds could have differed as to whether it would actually work. Today, there can be no dispute that Obamacare is a disaster (Sen. Ted Cruz, R-Texas, 12/11). 

The Wall Street Journal: Democrats Face A Day Of Obamacare Reckoning
When he was asked last week how much of a political liability ObamaCare will be for Senate Democrats in the midterms, Senate Majority Leader Harry Reid told Jeff Gillan of Las Vegas's KSNV, "I think it's going to be good for them." Brave words, but the Affordable Care Act remains very unpopular. And the intensity of feeling is with its critics (Karl Rove, 12/11). 

Fox News: Republicans Can Win In 2014 If They Go On Offense Against Democrats Over ObamaCare
In next year’s midterm elections, Republican candidates in every corner of this country can and should be on offense against their Democratic opponents on the issue of ObamaCare. After all, during the debate over the health care bill four years ago, every single Republican stood unified against this monstrosity, while every single Democrat joined forces to ram the law through Congress against the will of the American people. The bad news is that all the reasons I opposed ObamaCare four years ago, have now become reality (Scott Brown, 12/11).

The New York Times: Obamacare's Many Possible Futures
The latest data on Obamacare signups is yet another rorschach test for the law's supporters and skeptics: The accelerating rate of signups is either evidence that enrollment might yet achieve escape velocity or an indicator (given how low, in absolute numbers, private enrollment remains) that even with a smoother website experience the program is never going to reach its "multiple millions of private enrollees" goal (Ross Douthat, 12/11). 

The Washington Post: In Health-Care Spending, Myths Of The ER
In America's health-care dialogue, emergency rooms have come to symbolize the system's economic and medical defects. To critics, typical ERs are swamped by the uninsured, who — lacking a regular doctor or source of care — go where they will be treated. Performing routine medicine at high prices, ERs are crowded and costly. If the uninsured had insurance, these problems would recede. Better medicine at less cost. Who could oppose that? Well, nobody. It was a selling point for the Affordable Care Act. The trouble is that the story is mostly make-believe (Robert J. Samuelson, 12/11). 

The New York Times' Economix: Health Care Prices Move to Center Stage
But a decade ago most Americans were still well insured by comprehensive coverage with low deductibles and coinsurance, so these stories affected only an easily overlooked minority of uninsured fellow citizens. For the most part, these stories on prices were ignored by the general public, by the rest of the news media and even by most health policy analysts and the sponsors funding them. Things have changed and continue to change. With ever higher deductibles, coinsurance and exclusions from coverage, employers have been shifting more and more of the cost of employment-based health insurance into the household budgets of their employees. The latest move is a shift toward "private health insurance exchanges" (Uwe E. Reinhardt, 12/12). 

Politico: The Left's Reality Problem
The erstwhile reality-based community is having a tough time of it lately, though. Most infamously, Obamacare is foundering on the flagrant deceptions used to sell it, exposed every day by the workings of the law in reality. Many liberals still don’t want to acknowledge the rather straightforward fact that if you mandate more insurance benefits in the so-called Affordable Care Act, insurance will cost more. QED. You might be able to cushion the cost increase for some people with subsidies, but not for everyone, and the underlying insurance is still more—not less—expensive (Rich Lowry, 12/11).

The Wall Street Journal: Junking The Obamacare Stats
Most of Washington seems to have bought the White House claim that the 36 federal exchanges are finally working, and glory, glory, hallelujah. But if that's really true, then what explains the ongoing secrecy and evasion? On Wednesday the Health and Human Services Department continued its Victorian-era strip tease and allowed a glimpse into the Affordable Care Act's "enrollment" for November. Out of respect for a free press, reporters ought to boycott these releases because they're so selective that they reveal little about real enrollment. But we'll try to parse the data as best we can without the White House high gloss (12/12).

The Boston Globe: Case Of Uncle Onyango Shows Obama's Credibility Gap
Whether the deception involves family relationships or health care policy, there's a pattern here. Taken together, it explains Obama's credibility gap. He lets what he believes are the higher political needs of the moment get in the way of truth-telling. And while it's hardly unusual — see Bill Clinton, above — it always ends up hurting more than it helps. It chips away at the public’s perception of presidential integrity, which is key to believing in a president’s ability to lead (Joan Vennochi, 12/12).

The New England Journal of Medicine: Implementing Obamacare In A Red State — Dispatch From North Carolina 
Two Americas have emerged in health care reform: states like California, which have embraced Obamacare, have enthusiastically implemented key provisions, and are intent on boosting enrollment and ensuring its success; and states like North Carolina, whose political leaders oppose Obamacare, resist its implementation, reject Medicaid expansion, and hope that the program collapses. ... Ultimately, Obamacare's long-term success depends on much more than a website fix. Reformers must figure out how to make the ACA work in states whose governments are rooting for and working to ensure its failure (Jonathan Oberlander and Krista Perreira, 12/11).

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Viewpoints: Problems With The 'Doc Fix;' A Lame Budget Deal; Concerns About Changes In Doctor Training

The Wall Street Journal: This 'Doc Fix' Would Be Bad For Your Health
Imagine if a provision in ObamaCare allowed Health and Human Services Secretary Kathleen Sebelius to dictate directly to doctors which services they could and could not provide their patients—what individual tests they could conduct, which treatments they could offer, and medicines they could prescribe. Americans would be outraged. Yet some Republicans on Capitol Hill are about to help Democrats pass such a provision for Medicare patients. The Senate Finance Committee is set to vote on permanent "doc-fix" legislation Thursday that grants the federal government broad new authority to determine "applicable appropriate use criteria" for the full range of outpatient medical services delivered to seniors (Scott Gottlieb, 12/11).

The New England Journal of Medicine: Improving Value In Medicare With An SGR Fix
With the end of another year approaching and a scheduled reduction of 24.4% in physician fees, physicians and policymakers are once again concerned about what the sustainable growth rate formula (SGR) that is used to calculate Medicare's physician fees could mean for physician payment. This year, however, is different ... This year, for the first time, bipartisan, bicameral attention is being directed toward developing an alternative reimbursement system that rewards physicians who improve the quality and efficiency of care, rather than just kicking the proverbial SGR can down the road for one more year (Gail R. Wilensky, 12/11).

The New York Times: The Minimalist Budget Deal
The deal will cancel 61 percent of the sequester cuts for nondefense discretionary domestic programs this fiscal year, adding back $31.5 billion over the next two years to be divided among departments like transportation, education, and health and human services. That's a significant achievement, considering that many Republicans want those cuts to continue in perpetuity (12/11).

Los Angeles Times: A Budget Deal With Pain For Republicans And Democrats
A summary of the proposed agreement describes a variety of small-bore cuts and tweaks, including a crackdown on unemployment benefit fraud, less spending on oil-drilling research and smaller cost-of-living adjustments for military personnel who retire before they turn 65. Almost a third of the savings -- $28 billion -- would come from extending the sequester two years further into the future on certain mandatory spending programs, including Medicare and housing vouchers. The agreement ignores the longer-term fiscal problems caused by rising healthcare costs and the shrinking ratio of workers to retirees (Jon Healey, 12/11). 

Los Angeles Times: Washington Lives Down To Expectations, Expects Vast Praise
The negotiators are trolling for kudos for raising revenues without raising income taxes, a maneuver that leaves the tax burden on the wealthy at close to the lowest level in half a century. Instead, they're claiming increased revenues from jacking up fees on air travel. They also expect praise -- or at least [Sen. Patty] Murray, the Democrat, does -- for averting cuts to Social Security and Medicare, which would have been intolerable considering how little is done to exact any sacrifices at all from people at the upper end of the income scale (Michael Hiltzik, 12/11). 

The New York Times: The Toll From Three Deadly Diseases
International health agencies at the United Nations have documented enormous gains made over the past decade to curb three devastating diseases: AIDS, tuberculosis and malaria. Despite this great progress, there is still a big gap between what's been accomplished and what more could be done with sufficient financing (12/11).

The New England Journal of Medicine: Hospital Industry Consolidation — Still More To Come?
The Affordable Care Act (ACA) has unleashed a merger frenzy, with hospitals scrambling to shore up their market positions, improve operational efficiency, and create organizations capable of managing population health. ... This activity could have lasting repercussions for consumers; the last hospital-merger wave (in the 1990s) led to substantial price increases with little or no countervailing benefits. ... unless new public and private initiatives are developed to discourage consolidation and to support enforcement of antitrust law, most of these deals will proceed unchallenged (Leemore Dafny, 12/11).

The New England Journal of Medicine: Getting Through the Night
[I]n my bad old days, we took call every third or fourth night and did not necessarily (read: never) get real sleep and did not necessarily (read: hardly ever) go home the morning after call, no matter how intense the night had been. ... Yet — as proof that I'm becoming what is technically called an old fart — I sometimes feel an almost overwhelming nostalgia for that schedule and the feelings that it brought on. ... I can't defend it from the perspective of patient care, and I wouldn't willingly put anyone else through it. And yet when I look back on certain aspects of that crazy, dangerous schedule, the memories have a certain sweetness (Dr. Perri Klass, 12/11).

The New England Journal of Medicine: A Resitern's Reflections on Duty-Hours Reform
My first year of residency, the majority of the workload still fell on interns, who worked more hours than almost anyone else in the hospital. ... Now, only a little over 2 years later, things have changed dramatically. The new interns still work hard, sometimes as many as 80 hours a week, but they also train for triathlons. ... As senior residents, my colleagues and I — who didn't have the same protections when we were interns — had to pick up the slack. We became "resiterns," working many more hours than the senior residents before us in order to make up for the substantial deficiency in intern staffing (Dr. Victoria Johnson, 12/12).

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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.