Daily Health Policy Report

Friday, December 13, 2013

Last updated: Fri, Dec 13

KHN Original Reporting & Guest Opinion

Administration News

Health Reform

Capitol Hill Watch

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Thousands In Obamacare's High-Risk Pools Get Month's Reprieve

Kaiser Health News staff writer Phil Galewitz reports: "About 85,000 people with a history of serious illnesses, who are enrolled in high-risk insurance pools created under the health care law, will get a month’s reprieve before they lose that coverage" (Galewitz, 12/12). Read the story.

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Health On The Hill: Congress Moves Closer To Changing How Medicare Pays Doctors

Kaiser Health News' Mary Agnes Carey and Politico Pro’s Jennifer Haberkorn discuss congressional events in which key House and Senate committees approved legislation Thursday to repeal the Sustainable Growth Rate, the formula officials use to pay doctors who treat Medicare patients (12/12). Listen to the audio or read the transcript.

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Promises To Fix Mental Health System Still Unfulfilled

Kaiser Health News staff writer Jenny Gold, working in collaboration with NPR, reports: " The shooting at Sandy Hook Elementary School in Newtown, Conn., one year ago sparked a national conversation about the country’s troubled mental health system. Politicians convened task forces and promised additional funding and new laws. But despite those promises, one year later, patients and advocates say treatment for mental health is still in shambles" (Gold, 12/13). Read the story.


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A Reader Asks: Can I Opt Out Of My Retiree Plan To Get Subsidized Insurance?

Kaiser Health News consumer columnist Michelle Andrews answers this reader's question (12/13). Read the response.

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Capsules: Marketplace Plans' Networks Are Very Small, Study Finds; Californians Continuing To Flock To New Insurance Exchange

Now on Kaiser Health News' blog, Julie Appleby reports on a new study examining provider networks in exchange plans: "To keep premium prices down for individuals and small businesses buying coverage through new online marketplaces, insurers have created smaller networks of hospitals. But consumers and policy experts have wondered, just how small? Turns out, many are very small" (Appleby, 12/12).

Also on Capsules, Anna Gorman writes about California’s latest exchange numbers: "Enrollment in California’s new health insurance marketplace is picking up speed, with more than 156,000 signed up for coverage through last week, officials announced Thursday. Nearly a third of the enrollees – 49,700 – completed their applications during the first week of December" (Gorman 12/13). Check out what else is on the blog.

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Political Cartoon: 'Stroke Of Luck?'

Kaiser Health News provides a fresh take on health policy developments with "Stroke Of Luck?" by Harley Schwadron. 

And here's today's health policy haiku:  


Thousand mile journeys
Start with just a single step
Ryan and Murray
-Beau Carter  

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

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Administration News

Feds Announce Steps To Avoid Coverage Lapses

The Obama administration announced Thursday a series of actions -- including giving consumers more time to pay their premiums and a one-month extension of a high-risk insurance program -- to help prevent lapses in insurance coverage as key parts of the health law kick in Jan. 1.

The Associated Press: Feds Try To Smooth Bumpy Health Care Transition
Anticipating more health care disruptions, the Obama administration Thursday announced a batch of measures intended to help consumers avoid lapses in their care and coverage as the president’s overhaul takes effect in January. Health and Human Services Secretary Kathleen Sebelius also announced a one-month extension of a special insurance program created by the law for people who cannot get coverage because of health problems. Scheduled to expire at the end of the year, the Pre-Existing Condition Insurance Plan will remain in place through January (Alonso-Zaldivar, 12/12). 

Politico: Health And Human Services Addresses Fear Of Jan. 1 Health Coverage Gap
HHS Secretary Kathleen Sebelius said the moves will give consumers "more peace of mind and even more confidence that it [insurance] will be there when they want and need it." She took part briefly in a press call but took no questions. The administration has faced a crisis as millions of people have learned that their current health insurance plan is being cancelled, while problems with HealthCare.gov and some of the state exchanges have made enrollment difficult. The signup system is better now but still imperfect and it's an open question whether everyone who needs to sign up this year will be able to do so. Republicans have said more people might lose coverage under Obamacare than gain it, at least in the early months (Norman, 12/12).

Politico: Obamacare: One Punt After Another
Why do Republicans even bother trying to delay Obamacare? President Barack Obama's doing it all by himself. On Thursday, the Obama administration gave customers permission to pay their premiums as late as Dec. 31 for coverage that starts Jan. 1, and officially gave customers an extra week — until Dec. 23 — to sign up for January coverage. The move was just the latest in a long list of extensions, delays and punts that have plagued the health care law (Nather and Kenen, 12/12).

The New York Times: Health Plans Urged To Extend Enrollment
With many Americans still foiled in their efforts to buy insurance under the new health care law, the Obama administration moved Thursday to give them more time to sign up and pay premiums, and it extended a program for people with cancer, heart disease and other serious illnesses (Pear, 12/12).

The Wall Street Journal: Health Insurers Told To Ease Coverage Rules
The government on Thursday announced steps to stave off unpleasant surprises for Americans when the health-overhaul law fully kicks in Jan. 1, including measures to ensure continuous care for people with serious medical conditions. The moves include a one-month extension of a federal insurance program for certain chronically ill people. The Obama administration also asked insurers to take a flexible approach about their rules when patients refill prescriptions or see their existing doctor in the early days of the new year in case new health plans haven't kicked in (Radnofsky, 12/11).

McClatchy: Administration Relaxes Some Health Care Rules, Asks Insurers To Be Flexible
In yet another acknowledgment of the difficulties Americans have faced purchasing coverage through the HealthCare.gov website, the Obama administration on Thursday announced that it would grant a one-month extension for a transitional federal program that provides health coverage to people with serious illnesses. In addition, the administration has put forward a handful of new requirements and recommendations for marketplace insurers to make it easier for people to get coverage that begins on Jan. 1. As the administration tries to overcome the disastrous rollout of the HealthCare.gov website, the new proposals and requirements could add further confusion to an already complex potpourri of deadlines, mandates and recommendations surrounding the controversial health care law (Pugh, 12/12).

USA Today: Insurance Files From Feds Not Quite There Yet
The mixed news comes as insurers, regulators and consumers rush to meet a Dec. 23 deadline for people to sign up for insurance on the federal healthcare.gov site if they want policies that take effect Jan. 1. The Department of Health and Human Services said today that it is encouraging insurers to allow consumers to pay premiums late, to cover prescriptions filled after plans expire and to let people with urgent health needs use doctors who may not be on their new health plan during the transition to new plans. Aetna said it would give people until Jan. 8 to send premiums (O’Donnell, 12/12). 

NPR: A Rush To Reconcile Health Enrollment Data, By Hand
With just a few weeks left before a deadline to get health coverage, lingering bugs lurk in the part of healthcare.gov that you can't see. And since time is running out to get things right, health officials on Thursday urged insurance companies to cover some enrollees even if their premium checks haven't come in. Under the law's guidelines, consumers have to sign up for a health insurance exchange -- and pay their first month's premium -- by the end of December if they want coverage in January (Hu, 12/12).

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High-Risk Pool Extension Gives Sick People More Time To Pick A Health Plan

The decision will give an estimated 85,000 people who were enrolled in the pre-existing condition insurance plans created by the health law, which were originally scheduled to expire on Jan. 1, an extra month to enroll in new coverage.

Kaiser Health News: Thousands In Obamacare's High-Risk Pools Get Month's Reprieve
About 85,000 people with a history of serious illnesses, who are enrolled in high-risk insurance pools created under the health care law, will get a month's reprieve before they lose that coverage (Galewitz, 12/12).

Los Angeles Times: White House Gives Sick Americans More Time To Select A Health Plan
The Obama administration moved Thursday to help tens of thousands of sick Americans who have struggled to enroll in health coverage for next year because of problems with the rollout of new insurance marketplaces created by the president’s health law. The Department of Health and Human Services announced that patients who have been enrolled in special insurance plans for consumers denied coverage elsewhere would be able to stay on those plans until the end of January. Nearly 86,000 people are currently in such plans (Levey, 12/12). 

The Associated Press: Health Website Woes Force Extension For Sickest
Technology problems with President Barack Obama’s health care website are forcing the administration to extend a federal insurance plan for some of the sickest patients by a month. The Pre-Existing Condition Insurance Plan was supposed to disappear Jan. 1, because starting next year insurers will no longer be able to turn away patients with health issues. The administration said Thursday the extension is meant to smooth the transition to new coverage, easing anxiety for tens of thousands of patients with serious illnesses such as heart disease and cancer (Alonso-Zaldivar, 12/12).

Politico: Another Obamacare Extension
The Obama administration moved Thursday to protect some of the sickest patients in the country from the possibility that they would lose health insurance on New Year's Day. Medically needy patients enrolled in temporary high-risk pools now have an extra month to sign up for new coverage because of early enrollment struggles in Obamacare nationwide, the Centers for Medicare & Medicaid Services announced. The extension seems to be the Obama administration's first tacit acknowledgement that it can't guarantee that everybody who wants to obtain coverage starting Jan. 1 will be able to do so (Millman, 12/12).

The Arizona Republic: Expiring High-Risk Plans Get Reprieve
More than 4,100 Arizonans who get health-care coverage through the Affordable Care Act’s high-risk insurance pool will be allowed to keep their expiring plans through the end of January. The one-month extension of the Pre-Existing Condition Insurance Plan is one of several minor tweaks announced Thursday by the U.S. Department of Health and Human Services to eliminate coverage gaps for consumers who enroll through either the law’s federal or state-based marketplaces. Arizona is one of 36 states on the federal exchange, healthcare.gov (Alltucker, 12/12).

The Oregonian: One-Month Extension Of U.S. High-Risk Insurance Pool Doesn't Help OMIP
The Obama Administration today said it would extend coverage for a month to about 85,000 people with a history of serious illness enrolled in a federal high-risk insurance pool. The move impacts about 1,200 Oregonians enrolled in the federal program, Oregon Health Authority spokeswoman Kim Mounts said. But it does nothing for about 4,100 enrolled in Oregon's own expiring high-risk insurance plan known as the Oregon Medical Insurance Pool (Hunsberger, 12/12).

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When Will The First Premium Payment Be Due?

Although the new rules announced on Thursday finalized the administration decision to extend the enrollment deadline for Jan. 1 coverage until Dec. 23, Health and Human Services Secretary Kathleen Sebelius also asked insurers to give consumers more time to pay their premiums.

The Washington Post: Administration Will Give Some Consumers More Time To Buy, Pay For Health Insurance
The Obama administration announced Thursday it will give some Americans more time to buy health plans through the federal insurance marketplace and urged the insurance industry to make it easier for consumers to make the transition to the new coverage. The revisions come as a Dec. 23 enrollment deadline looms for people who want insurance that begins Jan. 1. Health and Human Services Secretary Kathleen Sebelius did not extend that deadline Thursday, but for the first time directed insurers to give consumers until Dec. 31 to pay (Goldstein, 12/12). 

USA Today: HHS Seeks Insurance Deadline Extension
The government asked insurers to grant people extra time to buy health insurance to gain coverage by Jan. 1. "There's still ample time for folks to research their options, talk things over with their families and select a plan," Health and Human Services Secretary Kathleen Sebelius said Thursday. People may sign up until Dec. 23 for Jan. 1 coverage. "We're recommending that insurers extend this deadline further," she said (Kennedy, 12/12). 

CNN: Sebelius Takes New Steps To Ensure Obamacare Coverage January 1
Health Secretary Kathleen Sebelius announced new steps on Thursday to ensure that people purchasing health plans on a new insurance exchange will have coverage starting on January 1. The new rules finalize a previously-announced decision to extend the deadline to purchase insurance for coverage beginning at the start of 2014. Originally consumers had to enroll in a plan by December 15 if they wanted coverage beginning January 1, but the new rule allows individuals eight more days, pushing that deadline back to December 23 (Aigner-Treworgy, 12/12). 

Fox News: ObamaCare: Another Deadline Slips
Another Obamacare deadline was pushed back on Thursday and now the White House is asking insurers to accept late payments and still give individuals coverage in the interim. The Department of Health and Human Services extended the deadline for individuals who want to be covered on the first of the year to Dec. 31 from Dec. 23. HHS is asking insurers to accept payments through this extended date and give consumers additional time to pay their first month’s premium while still offering coverage starting on Jan. 1 (Rogers, 12/12).

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Health Reform

Red State Residents Enrolling In Obamacare At Lower Rates

People in GOP-controlled states are signing up for coverage in the health law's exchanges at lower rates than those in blue states, reports the Associated Press. Meanwhile, news outlets offer snapshots of how signups are going in Montana, Wyoming, Connecticut, Colorado, Oregon and Washington state.

The Associated Press: Republican States Lag In Health Care Coverage For Residents
Residents in some parts of the U.S. are signing up for health care coverage at a significantly greater rate than others through the new online insurance marketplaces now operating in every state. The discrepancy may trace back to the political leanings of their elected leaders (Lieb, 12/12).

The Montana Standard: Obamacare Signup: Anaconda Man's Saga Ends Happily 
After being notified he would lose his Blue Cross Blue Shield of Montana insurance policy, Hoolahan set out to sign up for health insurance on healthcare.gov Oct. 1. Like so many people across the nation, Hoolahan was met with issues on the glitchy website. ... Just when Hoolahan was becoming sure he'd have to get on blood pressure medication too, he had a breakthrough. ... Hoolahan said it took him half an hour to fill out the second application, and another half an hour to get confirmation of his new plan (12/12). 

The Associated Press: Insurance Companies Say Federal Site Functioning
The two health insurance companies offering coverage under the federal health care law in Wyoming say the website that people must use to enroll is working better and they're seeing a sharp increase in people registering. WINHealth and Blue Cross Blue Shield of Wyoming are the only two insurance companies offering coverage in Wyoming through the new federal health care exchange (Neary, 12/12).

The CT Mirror: Access Health CT Chief Says October Errors Affected 2,400 People 
At a forum in Washington Thursday, Kevin J. Counihan, CEO of Connecticut's health exchange, said he is considering marketing the exchange to other states as "an exchange in a box" that could replace the federal exchanges that more than 30 states are using. This is not as if Health Access CT has been completely error-free. Connecticut’s health exchange said Thursday that about 2,400 individuals who signed up for coverage in October who may have had a different plan than they thought they had bought (Radelat, 12/12).

Health Policy Solutions (a Colo. news service): Cancer Patient's Insurance Still On Hold
Back in October, Smith struggled to create an account because Colorado’s exchange, Connect for Health Colorado, had some IT glitches when it launched. A few days later, Smith filled out an extremely long Medicaid application, then had to wait 37 days to get a denial from Medicaid. She went ahead and picked a plan in November. Then Colorado’s floods forced Smith and her husband to move from Castle Rock to Denver. And now, the Connect for Health agents told her that changing her address is not a simple matter and that she may no longer qualify for the Kaiser plan she picked, even though her new home is less than a mile from one of Kaiser’s Denver medical offices (Kerwin McCrimmon, 12/12).

The Seattle Times: State Insurance Exchange-Website Outages Create ‘A High Level Of Frustration’
The recent prolonged outages of the state health-insurance-exchange website have fueled a sense of concern and urgency that many consumers won’t have enough time to sign up for coverage that kicks in with the new year. Officials of the Washington Health Benefit Exchange, which operates the Washington Healthplanfinder exchange, said Thursday that they have heard a lot of concern from Washington residents in recent days, especially after the four days of website outages last week and intermittent outages this week (Landa, 12/12).

And health insurance cooperatives in Oregon will postpone enrollment deadlines after problems with that state's exchange --

The Oregonian: Oregon’s Health Insurance Cooperatives Agree To Postpone Enrollment Deadlines 
The state's two new health insurance cooperatives have agreed to postpone key enrollment deadlines to ensure more Oregonians have coverage Jan. 1 through the state's troubled insurance exchange, their executives said. Oregon's Health Co-Op president and chief executive Dr. Ralph Prows said Thursday the insurer will accept initial premium payments for January coverage as late as Jan. 15. The nonprofit co-op also plans to accept enrollment information from Cover Oregon as late as Dec. 30, instead of Dec. 23 as originally planned, he said (Hunsberger, 12/12).

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Calif. Exchange Enrolls 7,100 A Day, But Latinos Lag

More than 156,000 have selected plans in California's online health insurance exchange, officials said, but some enrollees have not gotten confirmation from insurers, which means their policies may not start Jan. 1.

Los Angeles Time: California's Health Exchange Enrolls 159,000 But Few Latinos Turn Out
California's insurance exchange said 159,000 people have enrolled in private health plans through early December, but very few Latinos are signing up. In figures released Thursday, the Covered California exchange also said 179,000 people appear likely to qualify for an expansion of Medi-Cal, the state's Medicaid program for the poor (Terhune, 12/12). 

Kaiser Health News: Capsules: Californians Continuing To Flock To New Insurance Exchange
Enrollment in California's new health insurance marketplace is picking up speed, with more than 156,000 signed up for coverage through last week, officials announced Thursday. Nearly a third of the enrollees -- 49,700 -- completed their applications during the first week of December (Gorman, 12/13).

Los Angeles Times: Many Who Enrolled In Health Plans Still Await Confirmation
Thousands of Californians have overcome long waits and website glitches to sign up for Obamacare insurance, but now enrollment snags may prevent some of them from actually having coverage starting Jan. 1. Some people who picked a health plan as far back as October through the Covered California exchange say insurers are telling them they still have no record of their enrollment. As a result, bills haven't gone out and consumers can't pay their initial premium to ensure coverage takes effect in less than three weeks (Terhune, 12/12). 

The Sacramento Bee: Momentum High For State Exchange As Some Demographics Lag
Two months into its launch, 109,296 Californians have enrolled in health coverage through the state's new insurance marketplace, officials said Thursday. The figures, which came a day after the latest federal release, show the exchange is steadily increasing enrollment even as it struggles to reach certain demographics. In the first week of December, 144,000 Californians completed applications and 49,708 enrolled in a plan -- a rate of 7,100 per day or 15 times the agency's initial rate (Cadelago, 12/12). 

The San Jose Mercury News: Obamacare: Californians Signing Up At A Stunning Rate
In the first week of December, Californians signed up for private health insurance on the state's new online exchange at nearly three times the rate as the first week of last month, figures released Thursday showed. Almost 50,000 individuals signed up through Dec. 7 at a stunning rate of 7,100 per day, according to the exchange, called Covered California. Since the marketplace was launched on Oct. 1, at least 156,143 people have signed up. That means roughly a third of the people who enrolled nationally have done so through California's website (Seipel, 12/12).

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Groups Say Md. Health Insurance Exchange Problems Could Leave People Without Jan. 1 Coverage

In the meantime, despite considering delaying the launch of the exchange, Maryland Gov. Martin O'Malley said Thursday that he is confident that problems with the website will be fixed and that the exchange will meet its goal of enrolling 260,000 by the end of March 2014.

The Washington Post: Md.'s Troubled Health Exchange Prompts Groups To Warn Uninsured About Jan. Coverage
Problems with Maryland's online insurance exchange, including with paper applications that were supposed to provide a fail-safe backup plan, are so severe that community groups have begun warning uninsured clients that they may not obtain coverage as intended by Jan. 1. State officials began this week to contact all people whose applications are still pending, urging them to contact the state call center, try the state Web site again or get in touch with a certified insurance broker for help (Sun, 12/12).

The Baltimore Sun: O’Malley Considered Delaying Exchange Launch
Gov. Martin O'Malley acknowledged for the first time Thursday that he briefly considered delaying the Oct. 1 launch of the state's health insurance exchange when staff members raised concerns about potential problems. The anticipated glitches turned out to be major problems as the Maryland exchange, designed to provide one-stop shopping for the 800,000 uninsured Marylanders, experienced one of the nation's most troubled launches (Cohn and Cox, 12/12).

The Associated Press/Washington Post: O'Malley Confident Health Exchange Will Meet Goal
Despite a rocky start with health care reform, Gov. Martin O’Malley said Thursday he is still aiming to meet the goal of enrolling 260,000 people in private insurance and Medicaid through the state’s health care exchange by the end of March. O’Malley, outlining how the state is addressing challenges to enrolling people, said most of the problems with the exchange’s website have been addressed. He said a computer glitch relating to tax credits should be fixed this week. A more stubborn problem involves screens freezing, and O’Malley says progress has been made diagnosing the matter (12/12). 

The Washington Post: O’Malley Says Md. Closer To Fixing Remaining Major Problems With Health Exchange
Gov. Martin O’Malley (D) acknowledged Thursday that Maryland’s online health insurance exchange had "a very rocky launch" but provided a largely positive prognosis for fixing the remaining glitches and boosting enrollment in coming months. "The bottom line is more people are getting though the site from end to end," O’Malley told reporters during an afternoon briefing (Wagner, 12/12).

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Already-Covered Minnesotans Find Better Coverage On Health Insurance Exchange, But No Subsidies

About two-thirds of people who signed up for coverage on Minnesota's health insurance exchange won't get financial assistance, but are still finding better coverage options there. And the director of the exchange comes under fire for a two-week vacation while problems with the website persisted.

Minnesota Public Radio: Already Covered, Many Still Seek – And Find – Better Options On MNsure
The main reason for establishing health insurance exchanges such as MNsure is to provide coverage to people who lack insurance and need assistance paying for it. But initial numbers from the state's new online marketplace suggest that the site is attracting attention from people outside its target audience. Nearly two thirds of the nearly 49,000 people who have completed insurance applications through MNsure will not receive financial assistance. That's because they don't qualify for federal subsidies or didn't bother to find out if they qualify for assistance (Richert, 12/12).

The Star Tribune: MNsure Director's Tropical Vacation Amid Website Woes Draws Fire 
Last month, while Minnesota's new health insurance exchange site was scrambling to fix glitches and under fire from critics, its director was on vacation. MNsure director April Todd-Malmlov took a two-week vacation to Costa Rica around Thanksgiving. Gov. Mark Dayton defended her right to take a pre-scheduled trip, but critics of the fledgling health insurance exchange pounced. The conservative group Watchdog.org put out a press release Thursday, condemning her absence while "thousands of frustrated Minnesotans were notified about glitches and errors in their applications on the state insurance exchange” (Brooks, 12/12).

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Iowa Governor, Feds Shake Hands On Medicaid Expansion

The agreement follows the administration's announcement Tuesday that it would permit the state to charge modest premiums to enrollees making more than the federal poverty level. Meanwhile, in Arizona, Republican legislators opposed to Medicaid expansion take their case to court.

The Washington Post: Iowa's GOP Governor Expands Medicaid Program Thursday
The White House welcomed the news Thursday night that Iowa's Republican Gov. Terry Branstad agreed to expand his state’s Medicaid program under the administration's health-care law. Under a compromise with the Department of Health and Human Services, the state will be allowed to charge premiums to people who earn between 100 percent and 133 percent of the federal poverty line, to pay a modest premium for health coverage (Eilperin, 12/12). 

Des Moines Register: Branstad, Feds Strike Deal On Health Program For Poor
Gov. Terry Branstad and federal officials reached an agreement Thursday that will allow tens of thousands of poor Iowans to gain public health insurance. ... Federal officials announced Tuesday that they had approved the proposal, except for one part. They said they could not allow Iowa to charge monthly premiums to people who make less than the poverty level if they failed to comply with healthy activities, such as undergoing annual health assessments. Under the compromise reached Thursday, the state will be allowed to charge a few dollars per month in premiums for such people starting in 2015, but it won't kick them off the insurance if they fail to pay (Leys, 12/12).

The Associated Press: Arizona Governor's Medicaid Plan Heads To Court
Six months after she pushed an expansion of the state's Medicaid health insurance plan through Arizona's Legislature, Gov. Jan Brewer's effort to extend coverage to 300,000 additional residents faces a crucial test Friday. Lawyers for the conservative Republican governor are trying to convince a judge that a court challenge by fellow Republicans in the Legislature should be blocked (Christie, 12/13).

The Arizona Republic: Medicaid Battle Heads To Court
The case revolves around whether the Legislature had the authority to approve the funding plan that would be used to pay the state’s share of expanded Medicaid coverage. Lawmakers approved a "provider tax" to be levied against hospitals, over objections from most Republican lawmakers that the vote violated the state Constitution (Pitzl, 12/12).

The Associated Press: Mississippi Losing Billions By Not Extending Medicaid, Report Concludes
Mississippi is losing billions of dollars in potential economic activity because state leaders, so far, have chosen not to extend Medicaid to hundreds of thousands more people, a nonprofit group said [in] a report Thursday. Mississippi Health Advocacy Program, which supports wider availability of medical coverage, said Medicaid expansion in the state would generate more than $14 billion in new economic activity, create about 20,000 new jobs and provide a net increase of $848 million in state and local tax collections (Pettus, 12/12).

Another state is looking at the private insurance alternative adopted by Arkansas and Iowa -

The Salt Lake Tribune: Utah May Substitute Full Medicaid Expansion With Private Insurance
Utah is edging closer to an Arkansas-style alternative to expanding Medicaid. A Legislative Health Reform Task Force on Thursday revisited, tweaked and approved three expansion scenarios for recommendation to the full Legislature. Still on the table: Doing nothing and keeping Medicaid eligibility rules as they are now. But in a surprise twist, lawmakers ditched previously favored partial expansion strategies in favor of giving low-income Utahns public dollars to buy private insurance (Stewart, 12/12).

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Many Health Law Exchange Plans Have 'Narrow Networks'

Some new health insurance plans sold through the health law's online insurance exchanges -- in an effort to keep premiums down -- severely limit where new enrollees can get care.

Kaiser Health News: Capsules: Marketplace Plans' Networks Are Very Small, Study Finds; 
To keep premium prices down for individuals and small businesses buying coverage through new online marketplaces, insurers have created smaller networks of hospitals. But consumers and policy experts have wondered, just how small? Turns out, many are very small (Appleby, 12/12).

California Healthline: Narrow Networks In Covered California Plans Causing Confusion In San Diego
It's difficult to quantify just how narrow some of the provider networks are compared with those being sold outside of Covered California, and the networks remain in flux. But, a Los Angeles Times analysis of insurance data conducted prior to Covered California's Oct. 1 launch found that Health Net's exchange plans have provider networks one-third the size of those available through its employer policies. ... Statewide, the Times reported that Blue Shield of California would provide exchange customers with access to about 50 percent of its regular physician network (Zamosky, 12/12).

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Celebrities Sell Obamacare Using Rap, Social Media

Since spring, the White House has worked with stars like Jennifer Hudson and Amy Poehler to engage 18- to 34-year-olds. Now states like California are also getting into the act, enlisting rap artists and others.

Los Angeles Times: Celebrities And Social Media Promote Healthcare Enrollment
It was just last week when officials at the state's health insurance exchange, Covered California, gave the green light to Obama impersonator Iman Crosson to come up with a rap song to sell young people on the virtues of Obamacare. The turnaround was going to be quick (Reston, 12/12). 

The Associated Press: Celebrities And Word-Of-Mouth Push Health Law
As enrollments lag around the U.S., Fran Drescher and Kal Penn are among the Hollywood faces being enlisted for the “Tell a Friend Get Covered” campaign, which will urge friends, family members and neighbors around the country to talk to each other about the health care law. The hope is that familiar faces can do something Obama, thus far, has not achieved — getting millions of healthy, younger adults to enroll for coverage (12/13).

The administration also is reaching out to insurers -

The Wall Street Journal’s Washington Wire: Health Insurers Feel Obama Administration’s Love
The Obama administration has been known to bash health insurers from time to time, but now that it really needs their help, it wants them to feel the love. A top official behind the HealthCare.gov website offered his praise for insurers at a conference of industry executives in Washington Thursday. “Let me thank you again for all the work you are doing,” said Gary Cohen, director of a unit at the Centers for Medicare and Medicaid Services that is implementing the health-care overhaul. “This is an extraordinary model of a public-private partnership” (Radnofsky, 12/12). 

But there is bad news, too -

The Washington Post: Politifact Awards 'Lie Of The Year' To Obama
The fact-checking Web site Politifact has named President Obama's claim that people could keep their health insurance plans if they liked them its "Lie of the Year." Obama in recent years has repeated some variation of the following phrase: "If you like your health-care plan, you can keep it." The problem was, it wasn't true, as millions of Americans with health plans that didn't meet Obamacare's standards got cancellation notice (Blake, 12/12).

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Capitol Hill Watch

Budget Deal, With 3-Month 'Doc Fix' Moves To Senate

As the the House approved a budget deal, Republicans included a provision to prevent a scheduled pay cut for doctors who treat Medicare patients. Meanwhile, House and Senate committees approved bills to repeal that Sustainable Growth Rate formula, but prospects for passage are unclear.

The Washington Post: House GOP Conservatives Help Propel Budget Bill
After a sweeping vote by conservative Republicans controlling the House and President Barack Obama’s Democratic allies, a bipartisan budget pact is in the hands of the Senate, where it will encounter stronger but probably futile resistance from Republicans. … It leaves in place the bulk of $1 trillion or so in automatic cuts slamming the Pentagon, domestic agencies and Medicare providers through 2021 but eases an especially harsh set of cuts for 2014 and 2015 (12/12).

Los Angeles Times: Budget Deal Rolls Through House
At the last minute, Republicans tacked on a provision to prevent a scheduled cut in pay for doctors who treat Medicare patients. Many Republicans have decided their efforts should be directed elsewhere — namely, fighting President Obama's healthcare law — rather than revisiting the budget wars that have defined the last several years (Mascaro, 12/12).

The Wall Street Journal: House Passes Budget Agreement In 332-94 Vote
The budget bill also included a three-month extension of current Medicare doctors' payments, which were slated to be cut by more than 20% at year's end. There is no guarantee that the bipartisan deal signals the end of brinkmanship or that this episode of bipartisanship will reach into other areas. The most immediate test will be the next month's work on appropriations legislation, which must be enacted before Jan. 15 (Hook, 12/13). 

The Wall Street Journal: House, Senate Committees Approve 'Doc Fix' Legislation
House and Senate panels approved legislation Thursday to overhaul how Medicare doctors are paid, although action by the full House and Senate on the bill won't happen until next year. The House Ways and Means committee unanimously approved legislation that would end the way doctors are reimbursed by Medicare and replace it with a system that would reward doctors who meet quality standards. The Senate Finance Committee overwhelmingly approved similar legislation (Schatz, 12/12). 

Medpage Today: 3-Month SGR Fix Passes
The Senate is expected to take up the temporary patch next week. Meanwhile, bills to permanently repeal the SGR worked their way through committees in the House and Senate, with further action and possibly votes from the full chambers expected early next year. The bills would repeal the SGR, encourage the use of alternative payment models such as accountable care organizations, combine three quality incentive programs into one, and make numerous other changes to the way Medicare pays for the delivery of health care (Pittman, 12/12).

Kaiser Health News: Health On The Hill: Congress Moves Closer To Changing How Medicare Pays Doctors
Kaiser Health News’ Mary Agnes Carey and Politico Pro’s Jennifer Haberkorn discuss how House and Senate committees approved legislation Thursday to repeal the Sustainable Growth Rate formula, which officials use to pay doctors who treat Medicare patients (12/12). 

CQ HealthBeat: Lawmakers Forge Ahead On Long-Term Medicare ‘Doc-Fix’ But Obstacles Loom
Even as Congress made important progress Thursday in replacing how Medicare pays physicians, many hurdles large and small remain to be negotiated next year. The House on Thursday night passed, 332-94, a bipartisan budget deal that was coupled with a short-term fix to avert a scheduled 24 percent cut in physicians’ reimbursements that would begin Jan. 1 under the current formula (Ethridge, 12/12).


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Citing Security Concerns, HHS Says 'No' To Issa Document Demand

Rep. Darrell Issa has issued a subpoena to MITRE, a government contractor, to turn over documents on healthcare.gov security testing. HHS says Issa has already seen the documents he is seeking.  

Politico: HHS To Darrell Issa: We Don't Trust You
The Health and Human Services Department told House Oversight and Government Reform Committee Chairman Darrell Issa that it won’t turn over documents related to the security of the Healthcare.gov website because it can't trust him to keep secret information that could give hackers a roadmap to wreak havoc on the system. Issa has issued a subpoena to MITRE, a government contractor, to turn over unredacted copies of security-testing documents by noon Friday. ... Already, Issa has been given access to the documents he seeks "in camera" -- meaning committee staff were able to review them in a room but not keep them -- but he is seeking physical copies (Allen, 12/12).

Roll Call: HHS To Issa: You Can’t Be Trusted With Obamacare Documents
The HHS assistant secretary for legislation, Jim R. Esquea, signaled that HHS was blocking MITRE from turning over the documents, which have been subpoenaed, over concerns that Issa would -- as he has done in the past -- leak the documents to the public, potentially giving hackers a road map to the "potential vulnerabilities in the cyber defenses" (Fuller, 12/12).


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Rep. Murphy Introduces Bill To Change Mental Health Treatment

The legislation is a response to the shootings in Newtown, Conn., that killed 20 elementary students and six adults.

The Wall Street Journal's Washington Wire: Rep. Tim Murphy Introduces Mental-Health Legislation
Rep. Tim Murphy (R., Pa.), the chairman of the House Energy and Commerce subcommittee on Oversight and Investigation, introduced a wide-ranging mental health care bill that would change the way mental illness is treated. The "Helping Families in Mental Health Crisis Act of 2013" is the result of a nearly year-long examination of the nation's mental health care system by the Pennsylvania psychologist and the subcommittee in the aftermath of last year’s school shooting in Connecticut (Fields, 12/12). 

Kaiser Health News: Promises To Fix Mental Health System Still Unfulfilled
The shooting at Sandy Hook Elementary School in Newtown, Conn., one year ago sparked a national conversation about the country’s troubled mental health system. Politicians convened task forces and promised additional funding and new laws. But despite those promises, one year later, patients and advocates say treatment for mental health is still in shambles (Gold, 12/13).

Meanwhile, in Connecticut -

The CT Mirror: 7 Ways Newtown Changed Connecticut's Mental Health System
State lawmakers made several changes to the system in a high-profile gun control, school safety and mental health law passed in April. Here's a look at what's changing: The state now tracks people who have voluntarily committed themselves and prohibits them from owning guns for 6 months.  (Becker, 12/12).

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State Watch

State Highlights: Minn. Health Spending Growth Slows

A selection of health policy stories from Texas, Minnesota, California and Florida.

The Texas Tribune/New York Times: Claims Drop Under State-Run Women’s Health Program in Texas
To stop Planned Parenthood clinics from receiving public financing, Texas’ Republican leaders gambled that the state could operate a contraception and cancer-screening program for low-income women without tens of millions of federal dollars. But with the exclusion of about 40 Planned Parenthood clinics -- none of which performed abortions -- from the Texas Women’s Health Program in 2013, records showed that claims for birth control and wellness exams dropped, as did enrollment numbers (Aaronson, 12/12).

Minnesota Public Radio: Minn. Health Care Spending Grew At Slower Rate In Recent Years
A Minnesota Department of Health study finds health care spending in the state continued at a slow 2 percent growth rate from 2010 to 2011. That compares to an annual average pace of growth over the past decade of about 6 percent. The state's health care spending [growth] rate was half the nation's rate of nearly 4 percent in 2011 (Stawicki, 12/12). 

Los Angeles Times: Doctor Pleads Guilty To Fraud Scheme With Homeless 'Patients'
A doctor who conducted unnecessary procedures on mostly homeless patients and billed Medicare and Medi-Cal pleaded guilty Thursday to filing a false tax return and participating in the $1.55-million scheme, authorities said. From 2008 to 2012, Dr. Ovid Mercene, 61, admitted patients, most of them homeless, to a Los Angeles-area hospital for treatment they did not need with the purpose of defrauding taxpayer-funded health programs, according to the U.S. Attorney's office (Barragan, 12/12). 

California Healthline: Budget Blueprint Draws Quick Praise
A blueprint of priorities for the 2014-2015 California budget released by Assembly Democrats Wednesday drew quick praise for its efforts to address child poverty and public health. ... The Democrats' goals include restoring some cuts in Medi-Cal reimbursements and restoring such programs as the Early Mental Health Initiative, Asthma Public Health Initiative and Black Infant Health (Norberg, 12/12).

Health News Florida: FMA Protests Doctor-Dropping
The Florida Medical Association is backing a Connecticut lawsuit challenging UnitedHealthcare's decision to cancel Medicare Advantage contracts. The Association filed a brief late Wednesday supporting the Connecticut State Medical Society's attempt to block the insurance carrier from tearing up thousands of physician contracts (Shedden and Gentry, 12/12).

Related KHN coverage: UnitedHealthcare Dropping Hundreds Of Doctors From Medicare Advantage Plans (Jaffe, 12/1).

Georgia Health News: Poll: Many Georgians Nervous About ACA
Three in four Georgians say they're satisfied with the overall value of their health care, according to a new poll released Thursday. But Georgians show concerns about the effects of the Affordable Care Act, said the poll of 400 residents, released by Healthcare Georgia Foundation. Nearly half of respondents -- 47 percent -- expect the ACA will result in their paying more for health care, with just 11 percent saying they believe they will pay less (Miller, 12/12). 

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Health Policy Research

Research Roundup: Long-Term Care Use Varies Dramtically By State

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

National Center for Health Statistics/CDC: Long-Term Care Services In The United States: 2013 Overview
In 2012, about 58,500 paid, regulated long-term care services providers served about 8 million people in the United States. Long-term care services were provided by 4,800 adult day services centers, 12,200 home health agencies, 3,700 hospices, 15,700 nursing homes, and 22,200 assisted living and similar residential care communities. Each day in 2012, there were 273,200 participants enrolled in adult day services centers, 1,383,700 residents in nursing homes, and 713,300 residents in residential care communities; in 2011, about 4,742,500 patients received services from home health agencies, and 1,244,500 patients received services from hospices. Provider sectors differed in ownership, and average size and supply varied by region (Harris-Kojetin et al., 12/12).

Journal of Preventive Medicine: Completion Of Advanced Directives Under U.S. Consumers
Current, ongoing national surveys do not include questions about end-of-life (EOL) issues. ... Data were analyzed in 2013 from adults aged 18 years and older who participated in the 2009 or 2010 HealthStyles Survey, a mail panel survey designed to be representative of the U.S. population. ... Of the 7946 respondents, 26.3% had an advance directive. The most frequently reported reason for not having one was lack of awareness. ... These data indicate racial and educational disparities in advance directive completion and highlight the need for education about their role in facilitating EOL decisions (Rao et al., 12/10).

National Bureau of Economic Research: Is This Time Different? The Slowdown In Healthcare Spending
Why have health care costs moderated in the last decade? Some have suggested the Great Recession alone was the cause, but health expenditure growth in the depths of the recession was nearly identical to growth prior to the recession. Nor can the Affordable Care Act (ACA) can take credit, since the slowdown began prior to its implementation. Instead, we identify three primary causes of the slowdown: the rise in high-deductible insurance plans, state-level efforts to control Medicaid costs, and a general slowdown in the diffusion of new technology, particularly in the Medicare population (Chandra, Holmes and Skinner, Dec. 2013).

The Kaiser Family Foundation: A Guide To The Supreme Court's Review Of The Contraceptive Coverage Requirement
Shortly after the Department of Health and Human Services (HHS) announced the new federal rule that required all new private plans to cover prescribed FDA approved contraceptive methods without cost-sharing, a number of corporations sued claiming that this new requirement violates their religious rights. These lawsuits have worked their way through the Federal Courts and, on November 26, 2013, the Supreme Court agreed to hear two cases that involve for-profit corporations. ... While the Court's decision ... will have a direct effect on women's access to contraceptive coverage, it may also have broader ramifications for civil rights protections in the workplace. This policy brief explains the issues raised by the cases pending, answers some key questions about the parties' legal arguments and considers possible effects of the potential decisions (Sobel and Salganicoff, 12/9).

Robert Wood Johnson Foundation: Assuring Better State-Level Nursing Workforce Data Systems 
The question of how to ensure there will be enough nurses to meet the growing demand for health care services created by an aging population, insurance expansion, increase in chronic disease, and new care delivery and financing models can only be addressed through robust and accurate data on the nursing workforce. ... A new set of briefs ... address the reasons states should build data systems, how to do it, and what kinds of data should be included. ... The first brief explains why states need to build better workforce data systems and identifies the types of questions a robust, well developed, longitudinal nursing workforce data system can help address (Fraher et al., 12/12).

Journal of The American Academy of Orthopaedic Surgeons: Platelet-Rich Plasma In Orthopaedic Applications: Evidence-Based Recommendations For Treatment
Autologous platelet-rich plasma (PRP) therapies have seen a dramatic increase in breadth and frequency of use for orthopaedic conditions in the past 5 years. Rich in many growth factors that have important implications in healing, PRP can potentially regenerate tissue via multiple mechanisms. Proposed clinical and surgical applications include spinal fusion, chondropathy, knee osteoarthritis, tendinopathy, acute and chronic soft-tissue injuries, enhancement of healing after ligament reconstruction, and muscle strains. However, for many conditions, there is limited reliable clinical evidence to guide the use of PRP (Welllington et al., Dec. 2013).

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

Washington Examiner: Slow And Sloppy Review Procedures Endanger Patients At Veterans Affairs Hospitals, GAO Finds
Patients at Department of Veterans Affairs hospitals are not being adequately protected from doctors who have histories of providing substandard treatment, according to a new report from the Government Accountability Office. None of the four Veterans Affairs hospitals examined by the GAO complied with all of the requirements for peer review of patient care that results in a bad outcome, which could include patient deaths (Flatten, 12/4).

JAMA: Health Status And Use Of Preventive Services Improved After Enactment Of Massachusetts/ Health Care Reform Law
Implementation of Massachusetts' 2006 health care reform law, the model for the federal Affordable Care Act, was associated with improved health and greater use of preventive services relative to other New England states. The finding appears today in The Milbank Quarterly (Mitka, 12/10).

MedPage Today: Black Kids Don't Fare As Well With Liver Transplants
Bucking a trend in claims of greater equality in transplant outcomes, researchers recently found that young whites had better survival out to 10 years following liver transplant than black children and teens. There was a nearly 25 percentage point difference in survival rates at 10 years between teenage and pediatric white and black liver transplant patients. ... The disparities in graft failure and mortality remained significant after adjustment for socioeconomic, clinical, and demographic characteristics, they wrote online in the journal Liver Transplantation (Petrochko, 12/11).

Kaiser Health News: Capsules: People With Medicare Have Good Access To Doctors, Study Finds
As key congressional committees consider legislation to repeal Medicare's physician payment formula, a new study shows that the program’s beneficiaries have generally good access to doctors. The report, prepared by the Kaiser Family Foundation, found that 96 percent of beneficiaries report having access to a doctor’s office or clinic, and about 90 percent of beneficiaries say they can schedule timely appointments for routine and specialty care (Carey, 12/10).

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Editorials and Opinions

Viewpoints: States Need To Expand Medicaid To Benefit All; Lies About Immigrants And Doctors; Antibiotics And Animals

Bloomberg: Obamacare's Medicaid Malpractice
[Expanding Medicaid] costs states a pittance compared with the financial and social benefits they’ll receive. Denying your constituents a chance to get health insurance out of political pique comes perilously close to governmental malpractice. This is a truth that bears repeating, but especially in states that are denying their residents the benefits of expanded Medicaid coverage. Expanding Medicaid is good economics, but it’s also about fairness (12/12).

The Virginian-Pilot: Expand Medicaid To Save Virginia Money 
More efficient, and effective, managed health care will be provided to the uninsured and working poor, which in turn will reduce overall health care costs for everyone. Virginia can save some of the hundreds of millions of dollars already spent every budget biennium in subsidies to hospitals, free clinics and community health care centers for treatment of the uninsured. It's a deal state officials should take (12/13).

San Francisco Chronicle: Path To Health Insurance Can Have Potholes
I have been calling Covered California for the past month, trying to get information on my health insurance application because my current coverage terminates on Dec. 31. ... this is not what was promised. Finding health coverage was supposed to be easier, not tougher. Now we not only have to worry about how to find medical care without insurance, we also have to worry about penalty assessment. I think every American believes they deserve better (John Aiello, 12/12).

Eugene Register-Guard: The Big Lie
The final version of the ACA that President Obama signed into law on March 23, 2010, does not extend any health care insurance benefits to the nation’s 11.7 million undocumented immigrants. ... That simple truth has not prevented political conservatives and others who are opposed to the biggest change in U.S. health care insurance since the advent of Medicare and Medicaid from continuing to spread the lie that the ACA will allow those they call "illegals" to acquire health insurance coverage at taxpayers’ expense (12/12).

Los Angeles Times: Another Obamacare Myth Exposed: The California Doctor 'Boycott'
You may have heard recently that seven out of 10 California doctors were "boycotting" the state's Affordable Care Act exchange, known as Covered California. At least, you've heard it if you've been following right-wing news sources such as Fox News, which is alive to the irony that so many physicians in "deep-blue California are rebelling against the state's Obamacare health insurance exchange and won't participate."  ... It's not true (Michael Hiltzik, 12/12).

The New Republic: Can Obamacare Handle Last-Minute Enrollments?
Thanks to the repairs to healthcare.gov, most people who want to buy insurance through the federal website can. But it remains to be see whether the system can handle the inevitable, last-minute surge of customers—or whether the administration and insurers will be able to fix mistakes in applications filed in October and November, when the system was transmitting error-prone data to carriers. These and other "January 1" problems have been worrying a lot of health care advocates. They would have been an issue even if healthcare.gov had launched smoothly on October 1. The problems and delays make difficulties more likely (Jonathan Cohn, 12/12).

Journal of the American Medical Association: Implications Of New Insurance Coverage For Access To Care, Cost-Sharing, And Reimbursement
Lost in the political rhetoric around health reform and technical glitches in the HealthCare.gov website are a set of critical decisions that many physician practices will have to make in the coming years. These decisions may very well contribute to the ultimate success or failure of the ACA (A. Everette James III, Dr. Walid F. Gellad and Dr. Brian A. Primack, 12/12).

And on another issue -

Los Angeles Times: Preserving Antibiotics For People Should Be The Goal
Finally, meaningful new guidelines have been written to stem the overuse of antibiotics on livestock. On Wednesday, the Food and Drug Administration proposed new animal-husbandry practices that would phase out the routine use of medications such as tetracycline and penicillin on animals if the drugs are considered medically important for the treatment of disease in humans. The lavish use of antibiotics among livestock operations — 80% of all antibiotics in the country are fed to food animals — has contributed to the rise of resistant infections that are difficult, expensive and sometimes impossible to treat (12/12).

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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.