Daily Health Policy Report

Tuesday, December 17, 2013

Last updated: Tue, Dec 17

KHN Original Reporting & Guest Opinion

Administration News

Health Reform

Capitol Hill Watch

Health Care Marketplace

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Medicare Identifies 97 Best And 95 Worst Hospitals For Hip And Knee Replacements

Kaiser Health News staff writer Jordan Rau reports: "Medicare has begun tracking the outcomes of hip and knee replacement surgeries, identifying 95 hospitals where elderly patients were more likely to suffer significant setbacks. The government also named 97 hospitals where patients tended to have the smoothest recoveries. The analysis, which was released last week, is the latest part of the government’s push to improve quality at the nation’s hospitals instead of simply paying Medicare patients’ bills" (Rau, 12/17). Read the story and check out the accompanying table.

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How Palliative Care Helps: One Iowa Family's Journey

Kaiser Health News staff writer Jenny Gold, working in collaboration with NPR, reports: "Ihrig met the Avelleyras family last year at UnityPoint hospital in Fort Dodge, where Phyllis was given a diagnosis of congestive heart failure, which is often fatal. As all of the other physicians at the hospital were running tests and drawing blood, Ihrig had another kind of inquiry: what did Phyllis want from the rest of her life?" (Gold, 12/16). Read the story.

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In California, It's Not A Done Deal Until You Get The Insurance Card

Kaiser Health News staff writer Anna Gorman reports: "For all the attention paid to the troubles at the front end of the enrollment process in the nation’s new insurance marketplaces, the back end can be just as fraught. The path to receiving an insurance card, the key to receiving non-emergency medical care, can be tortuous. Once someone signs up, the insurance exchange still has to give the information to the insurer, which must send a confirmation packet and, even more important, a bill" (Gorman, 12/16). Read the story.

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Insuring Your Health: Readers Ask: Will Health Law Help Cover My Braces; Should A Couple File Separate Tax Returns To Avoid Penalties?

Kaiser Health News consumer columnist Michelle Andrews answers questions from readers of all ages -- teenagers to seniors – who have inquiries about the health law (Andrews, 12/17). Read the column.

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Capsules: Latest Federal Rules, Requests Put New Pressure On Insurers, Says Moody’s

Now on Kaiser Health News’ blog, Jay Hancock reports: "Insurers responded softly if not sweetly to the Obama administration’s latest requests and rule changes for individuals trying to buy coverage in online marketplaces by Jan. 1. Moody’s Investor Service, which is watching Obamacare from the outside, isn’t so tactful" (Hancock, 12/16). Check out what else is on the blog.

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Political Cartoon: 'You Sleigh Me?'

Kaiser Health News provides a fresh take on health policy developments with "You Sleigh Me?" by Lisa Benson. 

And here's today's health policy haiku:  


The hip bones connect
to... So do knee replacements...
Hospital ratings!

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

Fix In Health Website Helps Stop Freefall In Obama's Popularity

An ABC News/Washington Post poll suggests opposition to the health law has eased in the past month. Meanwhile, the administration says that the president will soon name someone to replace Jeffrey Zients to oversee the operation of the insurance website.

The Washington Post: Obama Suffers Most From Year Of Turmoil, Poll Finds
President Obama is ending his fifth year in office matching the worst public approval ratings of his presidency, with record numbers of Americans saying they disapprove of his job performance and his once-hefty advantages over Republicans in Congress eroded in many areas, according to a new Washington Post-ABC News poll. His position is all the more striking when compared with his standing a year ago, as he was preparing for his second inauguration after a solid reelection victory. That high note proved fleeting as the president faced a series of setbacks, culminating in the botched rollout of his Affordable Care Act two months ago (Balz and Clement, 12/17).

ABC News: A Drop In Opposition To Obamacare Helps Stabilize A Struggling Presidency
Public opposition to the new health care law has eased in the past month, enough to help level off Barack Obama's falling popularity – but not to turn it around. Fifty-five percent of Americans in a new ABC News/Washington Post poll disapprove of the president's job performance overall, unchanged from last month's reading as the worst of his career. Forty-three percent approve, a scant percentage point from 42 percent in November (Langer, 12/17).

The New York Times: One White House Shift Is Delayed For A Month
President Obama will soon name a new overseer to complete repairs of the government's health insurance website, but the current manager, Jeffrey D. Zients, is delaying his move to become chief White House economic adviser for about a month, administration officials said Monday (Calmes, 12/16).

And on Obama's personal insurance -

Fox News: Obama Has Yet To Enroll In Health Insurance Under Affordable Care Act
The White House said Monday that President Obama has yet to sign up for health insurance through a federal website created by his signature health care law. "The president will purchase insurance on the exchanges," White House Press Secretary Jay Carney told reporters. "When we have an update on that, we'll provide it to you." Carney, who has been asked about the president's plans at least once since enrollment in ObamaCare started Oct. 1, pointed out the deadline is not until March 31 (12/16).

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Obama Seeks Advice On Healthcare.gov From Tech Giants

President Barack Obama was slated to meet Tuesday with executives from leading technology companies, including Google, Microsoft and Apple, to solicit suggestions on the federal health care exchange website. The impact of federal surveillance efforts on those companies' customers is also expected to come up.

Reuters/The New York Times: Obama To Seek Advice On Portal At Tech Meeting
President Obama will meet executives from leading technology companies like Google and Apple on Tuesday to discuss ways to improve the federal health care exchange website, the White House said. An Obama administration official said the meeting would cover capacity issues with the site, HealthCare.gov, which has not worked well since its Oct. 1 rollout. Many people face a Dec. 23 deadline to sign up in order to have insurance on Jan. 1 (12/16).

Politico: Obama Calls In Tech To Talk Healthcare.gov, NSA
Now that the Obamacare website is functional, the administration has called the tech honchos to Washington. The White House paints President Barack Obama’s huddle with tech company leaders on Tuesday as a chat headlining HealthCare.gov progress and ways the government can fix federal IT. But the Silicon Valley heavyweights, which include Google, Microsoft, Apple, Facebook and Twitter, appear more likely to highlight another issue on the administration’s agenda -- federal surveillance efforts and the impact on their companies (Meyers, 12/17).

CNN: Obama To Meet With Apple's Tim Cook, Other Tech CEOs
President Obama will meet with more than a dozen big-named tech CEOs on Tuesday to discuss cybersecurity and the failures of the Obamacare website. In attendance will be Apple CEO Tim Cook,  Chairman Eric Schmidt, Facebook Operating Officer Sheryl Sandberg, Yahoo CEO Marissa Mayer and Netflix CEO Reed Hastings among others. A White House official said they will discuss how the tech sector can help the government avoid IT screw-ups like the healthcare.gov website rollout. They will also talk about national security and the impact of "unauthorized intelligence disclosures" (Goldman, 12/16).

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Health Reform

One Week And Counting Until Dec. 23 -- An Important Health Law Deadline

News outlets report that the Department of Health and Human Services says healthcare.gov is ready and able to meet the needs of the many customers who visit the site in order to obtain insurance by Dec. 23 -- the deadline for Jan. 1 coverage. About 1.9 million people have made it deep into the online process so far but have not yet selected coverage.

USA Today: HHS Vows It Will Be Ready For Dec. 23 Insurance Deadline
The ability of the HealthCare.gov website to keep operating despite a high number of visitors has heightened health officials' belief that the site will be ready to help customers meet the Dec. 23 deadline to enroll in insurance in order to be covered by Jan. 1. By noon Monday, 165,000 people visited the site, where people can shop for and buy health insurance, while another 500,000 went to the site over the weekend, said Julie Bataille, communications director for the Centers for Medicare and Medicaid Services (Kennedy, 12/16).

ABC News: Obamacare Countdown: One Week To First Major Deadline
For tens of thousands of Americans, the race to complete Obamacare enrollments is on. Just under a week from today, by 11:59 p.m. ET on Dec. 23, anyone seeking health insurance coverage effective Jan. 1, must have completed an application, chosen a plan and transmitted that enrollment form to their selected issuer. The deadline looms large for the roughly 1.9 million people who have made it deep into the process -- completing an application and receiving an eligibility determination -- but not yet selected a particular plan, according to the Department of Health and Human Services. Many of these consumers have been hamstrung by glitches and delays at every turn and are simply stuck in limbo (Dwyer, 12/17).

CNN: CMS Call: Latest Healthcare.gov Glitch Resolved, Obama Administration 
The Obama administration said on Monday it had resolved the latest technical glitch with the HealthCare.gov website, one that hit over the weekend and prevented people from enrolling properly in new policies under Obamacare. Everyone who has selected a plan from a private insurer through the Obamacare marketplace now should be in direct contact with an insurer to resolve billing and payment, according to the agency responsible for overseeing the website. “Everyone who selected a health plan as part of their online application and enrollment process on HealthCare.gov have now heard from HealthCare.gov – from the health insurance marketplace – about the next steps that they would need to take for coverage," said Julie Bataille, a spokeswoman for the Centers for Medicare and Medicaid Services (Aigner-Treworgy, 12/16).

CQ HealthBeat: Many Consumers Who Start Direct Enrollment Do Not Complete Process
Insurers are having difficulty enrolling people directly into their health plans, and some consumers are still having a hard time getting coverage through the federal website that handles enrollment in 36 states, industry and government officials said Monday (Adams, 12/16).

Meanwhile, Moody's takes a look at how the Obama administration's latest request to insurance companies might impact the marketplace --

Kaiser Health News: Capsules: Latest Federal Rules, Requests Put New Pressure On Insurers, Says Moody's
Insurers responded softly if not sweetly to the Obama administration’s latest requests and rule changes for individuals trying to buy coverage in online marketplaces by Jan. 1. Moody's Investor Service, which is watching Obamacare from the outside, isn’t so tactful (Hancock, 12/16).

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Problems In States' Health Insurance Exchanges Persist As Officials Ready Deadline Push

In Maryland, Gov. Martin O'Malley has hired new contractors to make sure the state's online health insurance exchange works properly even as new problems arise. In the meantime, Minnesota lawmakers are sparring over fixes to that state's exchange, and California's marketplace faces enrollment challenges as deadlines loom.

The Washington Post: Maryland Health Exchange Users Hit Snags, But O’Malley Reasserts 'Major Fixes' Are Done
Maryland's online health-insurance exchange got mixed marks from some users Monday who said the Web site continued to have serious difficulties despite Gov. Martin O'Malley's announcement this weekend that the major problems hindering enrollment had been fixed (Wagner, 12/16).

The Associated Press/Washington Post: O'Malley: Most Problems Resolved On Health Website
The governor announced that Optum/QSSI, a Columbia-based company, has been brought in to help improve the overall performance of the website. O’Malley also said CareFirst has agreed to extend the enrollment deadline from Dec. 23 to Dec. 27 to help more people get coverage that begins Jan. 1. Hours will be extended at call centers to help people enroll, O'Malley said. The administration also said health exchange officials will reach out to consumers who have started but not finished the application process through emails, regular mail and robocalls (12/16).

The Baltimore Sun: Md. Health Care Website Still Has Glitches Despite Major Fixes
Less than two days after Gov. Martin O'Malley declared that the state's online insurance marketplace finally worked for most consumers, a server crashed Monday, the call center became overwhelmed and the governor announced he was bringing in another contractor to improve the website. Some consumers and advocacy groups reported Monday that the website where consumers can buy health plans under the federal Affordable Care Act is easier to navigate (Walker and Cox, 12/16).

Pioneer Press: GOP Gubernatorial Candidate Calls For MNsure Boss' Resignation
Controversy continued Monday over MNsure executive director April Todd-Malmlov's vacation in November to Costa Rica. Scott Honour, a Republican candidate for governor, called on Todd-Malmlov to resign, saying in a statement that he "can't imagine the head of a company being on vacation during a major product rollout" (Snowbeck, 12/16).

MinnPost: GOP Leaders, Dayton Representative Spar Over MNsure Performance Criticisms
Republican leaders leveled another round of criticisms at Minnesota's embattled health insurance exchange on Monday as the deadline for consumers to select coverage looms next week. GOP legislative leaders said Gov. Mark Dayton, who in part led the effort to bring a state-based exchange to Minnesota, needs to take ownership of MNsure's failings (Nord, 12/16).

Minnesota Public Radio: Under Pressure, MNsure Pushes Data Privacy Fixes
MNsure technology officials say they're putting in security fixes to the state's online health insurance site that should be completed by Tuesday night. But they are stopping short of acknowledging a specific vulnerability uncovered a few weeks ago. The problem is complex, but it comes down to this: MNsure's website allows consumers' private data to come through unencrypted, leaving it vulnerable to an inexpensive hacking tool. That tool can capture information coming from computers or smartphones within a range of as much as 150 yards, according to Minnetonka security analyst Mark Lanterman (Stawicki, 12/17).

Minnesota Public Radio: GOP Leaders Raise MNsure
Republican leaders in the Minnesota House and Senate are calling on DFL Gov. Mark Dayton to answer key questions about the state's new health insurance exchange. House Minority Leader Kurt Daudt, R-Crown, and Senate Minority Leader David Hann, R-Eden Prairie, want the governor to reassure all MNsure applicants that they will have coverage beginning next year, even if they haven't received an insurance card (Pugmire, 12/16). 

The Star Tribune: Applicants Stuck In MNsure's Gears
Laurie Swenson quit her editing job with the Bemidji Pioneer to care for her ailing parents, counting on getting affordable health insurance through the state's new MNsure exchange. The 56-year-old completed her application on Oct. 16. She waited for the status to change from "pending" so she could complete enrollment in a health plan. As of Monday -- just a week before the deadline to get benefits that start on Jan. 1 -- Swenson’s application was still listed as pending (Olson and Crosby, 12/17). 

Kaiser Health News: In California, It's Not A Done Deal Until You Get The Insurance Card
For all the attention paid to the troubles at the front end of the enrollment process in the nation's new insurance marketplaces, the back end can be just as fraught. The path to receiving an insurance card, the key to receiving non-emergency medical care, can be tortuous. Once someone signs up, the insurance exchange still has to give the information to the insurer, which must send a confirmation packet and, even more important, a bill (Gorman, 12/16).

California Healthline: Critical Times For State Health Exchange
The key target date for the health benefit exchange is Dec. 23, the last day Californians can sign up for Covered California health insurance and be eligible for benefits starting Jan. 1. People who sign up by Dec. 23 will have until Jan. 5 to start paying premiums in California, an extension recently approved by the exchange board. Coverage will start later for Californians who sign up after Dec. 23. Open enrollment continues until Mar. 31, 2014. For small business owners looking to join through the Small-Business Health Options Program -- known as SHOP -- there is no early deadline to enroll. The Dec. 23 deadline is for individual policies only; employers have until Dec. 31 to enroll their employees for benefits that start Jan. 1 (Gorn, 12/16).

The Sacramento Bee: California Groups Report Strategies, Challenges Of Plugging Obamacare
Freebies and refreshments were effective enticement tools. Wordy brochures and door hangers didn't work as well. Common themes emerged among the nonprofits, labor unions, social services centers and dozens of other groups paid to promote the new health care law in California in their first reports to the state's health exchange (Cadelago, 12/17).

Exchanges in Florida, Colorado and Oregon also make news --

Miami Herald: Insurance Firm Recruits Nonprofits To Sell Obamacare
The Stuart-based Fiorella Insurance Agency made headlines a couple of months ago when it began using the Obamacare Enrollment Team name to insinuate official ties to the healthcare law and sell policies to unsuspecting people, setting off an ongoing state inquiry. Now the firm is reaching out to nonprofit organizations that are registered supporters of the Affordable Care Act -- so-called "Champions for Coverage" -- and trying to get these organizations to help generate leads to sell insurance (Mitchell, 12/17).

The Denver Post: Colorado Health Care Enrollments Continue To Climb As Deadlines Loom
Enrollments in Colorado's new subsidized private insurance exchange continued to climb in early December, as end-of-year deadlines loom. State officials said they had reached 23,009 enrollments on the exchange through Dec. 14, enough to creep closer to the lowest-case scenario for the month contained in a projection they made before the Oct. 1 launch (Booth, 12/16).

The Oregonian: Oregon Health Exchange Turns Up Heat On Oracle Over Programming 
As Oracle Corp. programmers try to fix problems with its work on the state's health insurance website, Cover Oregon is bringing in outside experts to make sure the company isn't adding new bugs at the same time. The exchange's interim director, Bruce Goldberg, said Monday he's hiring people with the skills to look at programming code as it is being written to ensure "it is done correctly and we don't have to continue to go back and fix bugs in the system" (Budnick, 12/16).

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New Report: Medicaid 'Gap' Hurts Minorities Most; Va.'s Outgoing Governor Ponders Expansion Review

And, The Washington Post profiles Nevada Gov. Brian Sandoval, a Republican whose state is expanding Medicaid and has its own insurance exchange.

CBS News: Report: Medicaid "Coverage Gap" Mostly Hits Minorities
Next year, the nation will be split: 25 states and the District of Columbia will expand Medicaid coverage, while 25 states won't. In those states without expanded coverage, nearly five million people will be ineligible for Medicaid as it exists currently but will be too poor to qualify for subsidies on the new Obamacare marketplaces. That so-called Medicaid coverage gap will mostly impact minorities, according to a new report -- particularly uninsured African-Americans living in the South -- and will likely widen the already-existing racial, ethnic and geographic disparities in health coverage (Condon, 12/16).

The Washington Post's Wonk Blog: Twenty-Three States Aren't Expanding Medicaid. Here's Who They Leave Behind.
Three-quarters of those who will fall into this coverage gap are adults who do not have children. ... Most of them have jobs. Of the 4.8 million people estimated to be in the coverage gap, 2.6 million are working either full- or part-time. Among those working, half are in the agriculture industry. Most work for businesses with fewer than 100 employees, which tend to be less likely to offer insurance coverage (Kliff, 12/17). 

McClatchy: Minorities Disproportionately Represented In Health Care ‘Coverage Gap’
New data from the Kaiser Family Foundation shows that minorities will make up 53 percent of the estimated 4.8 million low-income Americans who will fall into the "coverage gap," leaving them without viable options to obtain health insurance next year. In the 25 states that won't expand eligibility for the Medicaid program, many adults earn too much to qualify for Medicaid, but not enough to qualify for tax credits that would help them purchase marketplace insurance. That puts them into the bureaucratic no-man's land known as the "coverage gap” (Pugh, 12/17).

The Washington Post: In Nevada, The Republican Governor Who Doesn’t Completely Hate Obamacare
Only eight states run by Republican governors moved to expand Medicaid to cover residents making less than 138 percent of the federal poverty level. Only three states with Republican governors set up state-based health-care exchanges. Only three states with Republican governors set up state-based health-care exchanges. Just two states led by Republicans — Nevada and New Mexico — did both.... For Gov. Brian Sandoval (R), heading into an election year with sky-high approval ratings (Wilson, 12/16).

The Richmond Times-Dispatch: McDonnell Wants Review Of Any Medicaid Expansion
Even if Virginia decides to expand its Medicaid program, Gov. Bob McDonnell wants a second look in two years before the state would start paying part of the bill. McDonnell proposed Monday to put a sunset clause on any expansion of the program by the Medicaid Innovation and Reform Commission, created this year to oversee reforms that lawmakers insist be accomplished before — or, some say, at the same time as — expanding the program under the federal Affordable Care Act. ... Gov.-elect Terry McAuliffe built his successful gubernatorial campaign around support for Medicaid expansion, but his staff is reserving judgment on McDonnell’s approach to the idea in the budget (Martz, 12/17).

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Immigrants, LGBT Americans, Small Business Employees -- Does The Health Law Help Them?

News outlets examine the various groups that might be falling through the health law's coverage gaps, or that might face higher costs as well as some of the efforts underway to reach them.  

The Associated Press/Washington Post: Many Immigrants Hesitate To Seek Health Insurance
Day after day, Adonias Arevalo tried to calm his parents’ nerves, attempting to convince them it was safe for him to apply for government-subsidized health insurance through the nation’s new coverage system. Like many other immigrants, Arevalo’s parents worried that personal information on their son’s application could somehow draw immigration authorities’ attention to the couple, who emigrated here illegally from El Salvador seven years ago (12/16).

The Washington Post: On Health Care, White House And Others Reach Out To LGBT Americans
A disproportionate number of LGBT Americans are uninsured and qualify for federal premium subsidies to help buy coverage, and the administration is intensifying its efforts to get them enrolled before the end of the year. There are several reasons for this disparity, among them that same-sex partners often don’t qualify as family members for employer-based insurance plans and that individuals sometimes lose coverage when they are fired because of their sexual orientation or gender identity. The White House on Tuesday will release an infographic on the Affordable Care Act’s benefits for the LGBT community (Eilperin, 12/16).

The Hill: Obama To Moms: Please Help With ObamaCare
President Obama and First Lady Michelle Obama will look to enlist mothers in a push to encourage uninsured Americans to sign up for coverage under ObamaCare with an event Wednesday in the Oval Office. The president and first lady will host a rare joint event, designed to highlight benefits of the law — and encourage adult children to sign up for coverage (Sink, 12/16).

Politico: Next Obamacare Crisis: Small-Business Costs?
Think the canceled health policies hurt the Obamacare cause? There’s another political time bomb lurking that could explode not too long before next year’s elections: rate hikes for small businesses. Like the canceled individual health plans, it’s another example of a tradeoff that health care experts have long known about, as the new rules for health insurance prices create winners and losers. But most Americans won’t become aware of it until some small business employees learn that their premiums are going up because of a law called — oops — the Affordable Care Act (Nather, 12/17).

The New York Times: A Gap In The Affordable Care Act
The Affordable Care Act mandated that insurers cover dental care for children. Indeed, it was one of the 10 essential health benefits meant to set the bar for adequate health insurance. But pediatric dental care is handled differently from coverage of other essential benefits on federal and state exchanges. These plans are often sold separately from medical insurance, and dental coverage for children is optional. People shopping on the exchanges are not required to buy it and do not receive financial support for buying it (Saint Louis, 12/16).

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Capitol Hill Watch

GOP Support Rising In Senate For Budget Deal

The Senate could have its first vote on the agreement today.

The Washington Post: Bipartisan Senate Budget Deal Appears Likely To Pass
The deal, struck by Senate Budget Committee Chairman Patty Murray (D-Wash.) and House Budget Committee Chairman Paul Ryan (R-Wis.), is intended to end nearly three years of acrimony over the budget in Washington. It would cancel half the sequester cuts for the current fiscal year, replace them with other savings and allow Congress to avert another government shutdown in January. ... The proposal would raise about $85 billion over the next decade through a variety of policies, including trimming pensions for civil-service workers and military retirees younger than 62, raising security fees for airline passengers and extending the sequester for Medicare providers an additional two years, through 2023 (Montgomery and O'Keefe, 12/16).

The Associated Press: Several GOP Senators To Back A Vote On Budget 
Nobody is claiming the pact worked out between the high-profile [Rep. Paul] Ryan, the Republican Party's vice presidential nominee last year, and Washington state Sen. Patty Murray, a Democratic loyalist over her 21-year Senate career, is perfect. It eases $63 billion in scheduled spending cuts over the next two years and replaces them with longer-term savings measured over 10 years, many of which don't accumulate until 2022-23. Deficits would increase by $23.2 billion in 2014 and by $18.2 billion the year after that. But the deal would put a dysfunctional Washington on track to prevent unappealingly tough cuts to military readiness and weapons, as well as continued cuts to programs cherished by Democrats and Republicans alike, including health research, school aid, FBI salaries and border security (Taylor, 12/17).

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Texas Navigators In The Hot Seat During Congressional 'Field Hearing'

After allegations of wrongdoing, a congressional hearing held Monday in Richardson, Texas, focused on the required training, and the lack of background checks and fingerprinting, for those who were on the job.

CBS News: Sebelius: Issa, GOP Impugning Obamacare 'Navigators'
Health and Human Services Secretary Kathleen Sebelius and two Republican lawmakers exchanged a war of words ahead of a congressional hearing in Dallas Monday that will examine the Obamacare “navigators,” employees who are trained to help Americans understand and select their new insurance options under the law. After reports of foul play by navigators in the area – one trainee at the Urban League of Greater Dallas allegedly encouraged an applicant to lie about his income on the application – the House Oversight and Government Reform Committee scheduled a hearing in Richardson, Texas to investigate the program (Kaplan, 12/16).

The Dallas Morning News: Texas Congressmen Take Aim At Affordable Care Act’s Navigators
Four Texas congressmen took aim Monday at the federally paid navigators who are helping Texans access insurance coverage through the Affordable Care Act. Their criticism came during an unusual “field hearing” by the House Committee on Oversight and Government Reform. The hearing focused on required navigator training and the lack of background checks and fingerprinting for those on the job. “There are many problems with the Affordable Care Act, but I don’t think we ever expected it would be this bad,” said committee chairman Darrell Issa, R-Calif (Jacobson, 12/16).

Meanwhile, Sen. Marco Rubio, R-Fla., has enrolled in an Obamacare health plan and accepted the federal employer contribution -  

Miami Herald: Marco Rubio Defends $10K Subsidy After Obamacare Signup
Though a staunch Obamacare critic, U.S. Sen. Marco Rubio has enrolled his family in one of its health plans and will accept a $10,000 federal subsidy that some fellow Republicans rejected as a “special deal” (Caputo, 12/16).

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Health Care Marketplace

Insurers Object To Charity Helping Poor Buy Health Coverage

The charity, A Better LA, said it would sign up 50 low-income Californians for Obamacare plans, but insurers protested that such help could skew insurance pools toward sicker people, The Wall Street Journal reports. Other media outlets explore the increase in challenges to the tax breaks traditionally given to nonprofit hospitals and Medicare's release of data rating hospitals on hip and knee replacement surgeries.

The Wall Street Journal: Insurers Fight Hospitals' Paying Premiums
A charity's plan to help people pay for coverage through new health-care exchanges has put it at the center of a high-stakes fight between the insurance and hospital industries that could pose a challenge to the economic underpinnings of President Barack Obama's health law. A Better LA, a decade-old Los Angeles nonprofit, said last week it was signing up 50 low-income people for health plans in California's health-insurance marketplace. The charity, which said it has the blessing of the state agency overseeing the marketplace, will pay $50 to $100 a month to cover the share of the people's premiums not already financed by federal subsidies (Radnofsky and Weaver, 12/16).

The New York Times: Benefits Questioned In Tax Breaks For Nonprofit Hospitals
The billions of dollars in tax breaks granted to the nation’s nonprofit hospitals are being challenged by regulators and politicians as cities still reeling from the recession watch cash-rich medical centers expand (Rosenthal, 12/16).

Kaiser Health News: Medicare Identifies 97 Best And 95 Worst Hospitals For Hip And Knee Replacements
Medicare has begun tracking the outcomes of hip and knee replacement surgeries, identifying 95 hospitals where elderly patients were more likely to suffer significant setbacks. The government also named 97 hospitals where patients tended to have the smoothest recoveries. The analysis, which was released last week, is the latest part of the government’s push to improve quality at the nation’s hospitals instead of simply paying Medicare patients’ bills (Rau, 12/17).

Meanwhile, a health policy expert calls for a 'Manhattan Project' to help providers transition to new payment models that reward quality --

Medpage Today: 'Road Map' Needed For Switch To Accountable Care
Policymakers need to launch a "Manhattan Project" to help health care providers transition to accountable care organizations (ACOs) and other alternative payment models, a health policy expert said. Although hospitals, physicians, and other healthcare providers understand the need to move away from fee-for-service, many are unsure of how to do it, are unable to do it, or are trying to figure out how best to do it, Len Nichols, PhD, director of the Center for Health Policy Research and Ethics at George Mason University in Fairfax, Va., said here (Pittman, 12/16).

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Glaxo To Stop Paying Docs Worldwide For Drug Advocacy

The pharmaceutical giant ended the practice in the U.S. in 2011.

The New York Times: Glaxo Says It Will Stop Paying Doctors to Promote Drugs
The British drug maker GlaxoSmithKline will no longer pay doctors to promote its products and will stop tying compensation of sales representatives to the number of prescriptions doctors write, its chief executive said Monday, effectively ending two common industry practices that critics have long assailed as troublesome conflicts of interest (Thomas, 12/16).

The Wall Street Journal: GlaxoSmithKline To End Payments To Doctors For Drug Promotion
The company said sales representatives' pay would now be tied to the quality of services sales reps provide to doctors, their technical knowledge and the overall performance of GSK's business, rather than to prescriptions. The changes will apply throughout GSK's global operations, following similar moves in its U.S. business in 2011. The company said the changes weren't linked to a continuing investigation into the company in China (Plumridge and Rockoff, 12/17).

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State Watch

State Highlights: D.C. Charter School's Medicaid Billing Investigated; Va. Budget: Hospital Cuts, Medicaid Boost

A selection of health policy stories from the District of Columbia, Virginia, Georgia and Illinois.

The Washington Post: Options DC Charter School’s Medicaid Billing Is At Center Of Investigation
Federal investigators are looking into whether former leaders of the District’s Options Public Charter School committed Medicaid fraud by, among other things, exaggerating the needs of its disabled students and paying students with gift cards to ride school buses, according to several people familiar with the criminal investigation (Brown and Marimow, 12/16).

The Washington Post: Gov. Robert McDonnell Unveils Two-Year Spending Plan For Virginia That Tops $96 Billion
Outgoing Gov. Robert F. McDonnell trumpeted hefty cash reserves and investments in education and mental health Monday as he unveiled a two-year, $96 billion proposed budget that also makes some cuts to schools and hospitals. The budget is $10 billion larger than the current budget, with much of the added spending directed to Medicaid, K-12 education and state employee retirement and insurance programs. The state’s contingency fund also gets a boost, reflecting tepid economic growth and cuts to military spending that have defense-heavy Virginia bracing for a downturn (Vozzella, 12/16). 

Georgia Health News: Frustration Grows Over Delay in Docs' Pay Raise 
Nearly a year after it was supposed to take effect, the physician pay hike for Medicaid services still hasn’t been fully implemented in Georgia and other states. The delays have come in states, including Georgia, that use managed care in their Medicaid programs, a physicians organization says. The Affordable Care Act created the pay hike with the goal of reimbursing family physicians, internists and pediatricians the same for Medicaid services as they receive under Medicare (Miller, 12/16).

The Chicago Sun-Times: Same-Sex Couples Can Marry Now With Doctors’ Note: Federal Judge 
Same-sex couples in which one or both partners has a life-threatening illness now don’t have to wait until June to get married in Illinois. U.S. District Court Judge Sharon Johnson Coleman Monday ordered Cook County Clerk David Orr’s office to immediately begin issuing marriage licenses to qualifying couples. Though the suit -- brought by two Chicago couples -- names Orr's office, the ruling applies statewide and could potentially affect hundreds of couples, gay rights advocates say. Illinois last month became the 16th state to legalize gay marriage, but most couples can’t apply for licenses until June 1 (Esposito, 12/16).

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Editorials and Opinions

Viewpoints: All Eyes On Insurers; An Employer's Perspective On Health Law; Budget Peace May Not Last Long

Los Angeles Times: Obamacare: Silence Of The Insurers
When will the insurers revolt? It's a question that's popping up more and more. On the surface, the question answers itself. We're talking about pinstriped insurance company executives, not Hell's Angels. One doesn't want to paint with too broad a brush, but if you were going to guess which vocations lend themselves least to revolutionary zeal, the actuary sciences rank slightly behind embalmers (Jonah Goldberg, 12/17).

The Washington Post's Plum Line: Morning Plum: Insurance Industry Bets On Obamacare. GOP Bets On Failure.
The Wall Street Journal reports that insurance companies are set to unleash hundreds of millions of dollars in advertising to entice potential customers on to the exchanges created by Obamacare. ... All this is a reminder of just how much of a stake the industry has in the law's success, and how much it is willing to spend to try to make that happen. What's striking is that this comes even as the absolute certainty among Republicans that the law cannot do anything other than fail spectacularly — indeed, that this has already happened — has only hardened (Greg Sargent, 12/16).

The New York Times' The Conscience Of A Liberal: The Big Money Bets On Obamacare
As Greg Sargent has been pointing out for some time, the startup troubles of Obamacare have divided both the general public and the political class into two different intellectual universes. On one side, Republicans — both the base and the political leadership — have decided that health reform is already a failure; that conviction is actually helping the leadership rein in some of the crazies, by telling them that now is the time to wait and let the political payoff from Obamacare's collapse fall into their laps. On the other side, Democrats see a law that got off to a terrible start but is getting rapidly better (Paul Krugman, 12/16). 

Los Angeles Times: Employers Cut Health Coverage, Find Scapegoat: Obamacare
If there's been one inexorable trend coming out of the HR departments of major employers, it's been the steady erosion of worker pay and benefits. Razor-thin raises, defined benefit pensions replaced by 401(k) plans, shrinking healthcare--if you've been on a big company's payroll, you know the drill. Expect the trend to continue or even pick up steam, because employers have an ideal scapegoat right now: the Affordable Care Act. It looks like the blame-Obamacare game is having some effect. According to an AP poll released over the weekend, three-quarters of those with private or employer-based insurance think the Affordable Care Act is the reason for changes in their health coverage for 2014 (Michael Hiltzik, 12/16).

The New York Times: What The New Health Insurance Law Means For My Workers
In America, I told my workers, health insurance pays for three kinds of care: routine, chronic and catastrophic. Under the old system, my company bought a single policy and used it to pay for all three. And as a business owner, I got to choose whatever policy I thought was best but without good information about the various plans that were available. ... I also had no idea what our premiums might be from year to year. The insurance companies could jack our rates up or down for any number of reasons without explanation — although it appeared that if someone in the company got sick, we could expect a large increase in premiums the next year. So we always had that hanging over our heads. Now, the Affordable Care Act has removed that risk (Paul Downs, 12/16).

The Fiscal Times: Why The GOP Shouldn’t Count On An Obamacare Collapse
The disastrous rollout of the HealthCare.gov website has so far kept enrollment well below the levels the Obama administration had sought. Yet as the administration works to fix the numerous technological problems that have plagued the site (it now says that the error rates with the problematic "834 transactions" that transmit enrollment data to insurers have been close to zero since the beginning of December), HealthCare.gov will be getting some outside help in trying to lure consumers to sign up for insurance plans (Yuval Rosenberg, 12/16).

The Washington Post’s The Monkey Cage: Five Myths About The Future Of Obamacare
Both liberals and conservatives believe they are seeing the light at the end of the tunnel with the Affordable Care Act. With the HealthCare.gov Web site running more smoothly, liberals are confident that Obamacare will soon be entrenched. Just as Republicans in the 1950s came to accept Social Security to avoid electoral defeats, ACA supporters insist that conservatives are courting political disaster if they continue to oppose the law. Republicans have a different perspective. They point to millions of cancelled insurance policies, ongoing enrollment problems, and repeated implementation delays as signs that the law is on the brink of collapse. The ACA remains fundamentally flawed, they claim, and all these Band-Aid improvements will never repair a program that was defective from the start. But what do we really know about the dynamics of "policy entrenchment"— that is, whether programs survive after Congress creates them? (Eric Patashnik and Julian Zelizer, 12/16).

The Washington Post: Auto Bailout Could Be Harbinger For Obamacare
When will the criticism of Obamacare finally end? I've done some research on the question, and by my calculations, judging from current trends, this will happen approximately . . . never (Dana Milbank, 12/16).

Bloomberg: Make Obamacare Cool, Or Make It Hurt
Instead of outreach programs and sappy TV ads with parents imploring their kids to sign up for Obamacare, President Barack Obama needs to start thinking creatively if he wants his signature legislative achievement to be a success. What motivates kids? In fact, what motivates any of us? Incentives (Caroline Baum, 12/16).

Fox News: Is President Obama 'Too Big To Jail?'
A Chinese proverb says, "May you live in interesting times." We certainly do. Historians will look back on this time as "the Obama criminal years."  How lawless is the Obama administration? Many of the dirty deeds and scandals of Obama & Co. are public knowledge. Let's start with the most astonishing. Many citizens are aware that because of ObamaCare, millions of Americans are losing their health care coverage. Is this incompetence, or criminal fraud? (Wayne Allyn Root, 12/16).

Fox News: The Impossible Trinity Of ObamaCare
The problem with ObamaCare is not that it is poorly designed or sloppily implemented. The problem is in the nature of things: The Patient Protection and Affordable Care Act, as it has been envisaged, is inherently impossible. To see this, forget ObamaCare for the moment. Think health care in general (Michael S. Bernstam, 12/16).

And on other issues -

Los Angeles Times: Federal Budget Peace In Our Time? Not For Long.
It's hard to see a happy ending to this drama. For Republicans, the debt limit provides a rare opportunity to force changes in entitlement programs that spend ever-increasing amounts on autopilot. The GOP's solutions typically involve shifting more of the cost of those programs onto beneficiaries, or narrowing eligibility and trimming benefits. Democrats, who are loath to cut benefits or reduce eligibility, say they'll curb entitlements only as part of a package that also ends tax breaks for corporations and higher-income Americans. But while [Rep. Paul] Ryan and his colleagues are willing to extract higher fees for government services, raising tax revenue is a nonstarter. Even Democrats have to concede that health-related entitlements (most notably Medicare and Medicaid) are the biggest threats to the federal government's fiscal health over the long term (Jon Healey, 12/16).

USA Today: Ensure That Genetic Tests Are Accurate: Our View
Opening the door to genetic testing and its potential health benefits to anyone with $99 and the desire to spit into a test tube is an exciting prospect. But only if the tests are accurate, the interpretations meaningful, and the results understandable to the average consumer (12/16).

USA Today: FDA Oversteps On Genetic Testing: Opposing View
The FDA worries that giving Americans more information about their own genomes might lead some to get too much medical care — or not enough. ... But are Americans really so foolish with their own health? The FDA can't cite a single example of someone actually being hurt because of 23andMe. Indeed, 23andMe has peer-reviewed research showing that its customers are no more likely to over- or under-estimate their risks (Berin Szoka, 12/16).

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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.