Daily Health Policy Report

Wednesday, December 18, 2013

Last updated: Wed, Dec 18

KHN Original Reporting & Guest Opinion

Administration News

Health Reform

Capitol Hill Watch

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Capsules: Study: It’s All Healthy People — Not Just Young Adults — Who Are Critical To ACA Success

Now on Kaiser Health News’ blog, Jay Hancock writes: "Pushing back against those who warn that low levels of younger subscribers could threaten coverage sold under the health law, analysts for the Kaiser Family Foundation say enrollment of young adults 'is not as important as conventional wisdom suggests.' Even if insurance pools contain only 25 percent young adults rather than the hoped-for 40 percent, medical claims and other costs would exceed premium revenue by only about 2.4 percent, they estimate. That’s far below the kind of loss that would lead to an unsustainable spiral of huge premium increases and fewer and fewer subscribers, they say" (Hancock, 12/17). Check out what else is on the blog.

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Wash. Hospital CEO Gets Pay Cut — To Just Over $1M A Year

The Seattle Times' Lewis Lamb, working in partnership with Kaiser Health News, reports: "Washington’s highest-paid public-hospital executive has won a new two-year employment contract that will pay him more than $1 million a year in salary and bonuses. But for longtime Valley Medical Center Chief Executive Rich Roodman, the deal amounts to a pay cut. Roodman’s contract was the focus of a Kaiser Health News story last June, which looked at how incentives for hospital CEOS were driving the kind of hospital profits and expansion that many say are no longer affordable for patients, employers and taxpayers" (Lamb, 12/18). Read the story.  

Earlier, related Kaiser Health News coverage: Hospital CEO Bonuses Reward Volume And Growth (Hancock, 6/16).

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Minnesota Exchange Chief Resigns Amid Criticism

MPR News' Elizabeth Stawicki and Catherine Richert, working in partnership with Kaiser Health News and NPR, report: "The head of Minnesota's health insurance marketplace resigned Tuesday after facing criticism over the troubled rollout and a questionably timed vacation in Costa Rica. April Todd-Malmlov submitted her resignation during an emergency closed session of the government board of MNsure, Minnesota's version of the insurance exchange that's tied to the federal health care overhaul. She had been under increasing pressure over insurance sign-up problems and failed to get a vote of confidence from Democratic Gov. Mark Dayton last week" (Stawicki and Richert, 12/18). Read the story

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Political Cartoon: 'Are We There Yet?'

Kaiser Health News provides a fresh take on health policy developments with "Are We There Yet?" by Pat Bagley. 

And here's today's health policy haiku:  


Poor guy... His plan was
to retire. But instead he'll
fix healthcare.gov.

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

Ex-Microsoft Exec Takes Over Healthcare.gov Fixes

Kurt DelBene, who previously was president of the Microsoft Office Division, was named by President Barack Obama to replace Jeffrey D. Zients and oversee efforts to rescue the federal government's health care website.

The New York Times: Ex-Microsoft Executive To Take Over Health Site Repairs
President Obama has chosen a former Microsoft executive, Kurt DelBene, to replace Jeffrey D. Zients as head of the effort to finish repairs on the government’s health insurance website, administration officials said on Tuesday (Calmes, 12/17).

Los Angeles Times: Former Microsoft Executive To Lead Effort To Fix Obamacare Website
Kurt DelBene, who most recently served as president of the Microsoft Office Division, will take over from Jeffrey Zeints, a management expert whom the president asked to rescue the site after its disastrous rollout on Oct. 1 (Levey, 12 17).

The Washington Post: Kurt DelBene, Former Microsoft Executive, Will Take Over Healthcare.gov
Several lawmakers, concerned about the Web site’s rocky rollout, had pressed the administration to install an outside expert to oversee its operations once Zients left. Zients, who was appointed in late October and oversaw major improvements in the system, had requested a month’s time to prepare for his next West Wing assignment. DelBene spent two decades managing large technical teams at Microsoft and recently served as president of its Microsoft Office division; he announced in July that he would retire by the end of the year. Sebelius said that he will work with Health and Human Services officials and the site’s general contractor, QSSI (Eilperin, 12/17). 

The Associated Press/Washington Post: New Tech Honcho For Obama Health Care Website
DelBene’s appointment was announced Tuesday by Health and Human Services Secretary Kathleen Sebelius. He is married to Rep. Suzan DelBene, a Washington state Democrat, who also has a technology background. The website is the insurance portal for Obama’s health care law (12/17). 

Politico: White House To Tap Microsoft Exec To Fix Healthcare.gov
DelBene will be in that role for at least the first six months of 2014, Sebelius said. He was most recently the president of the Microsoft Office Division and has been with the company since 1992. Bill Gates, Microsoft’s chairman and founder, praised DelBene for his expertise in "managing complex large-scale technology projects" (Kim, 12/17).

USA Today: White House Taps New Chief For Health Care Website
Sebelius said DelBene would provide oversight and advice on everything from technology to marketing, as well as execute the existing plan. "The President and I believe strongly in having one person, with strong experience and expertise in management and execution, who is thinking 24/7 about HealthCare.gov," she wrote. He will continue to work with QSSI, the general contractor for HealthCare.gov (Kennedy and Jackson, 12/17). 

CQ HealthBeat: Microsoft Veteran Starts Wednesday As Six-Month Successor To Zients
Kurt DelBene, a former Microsoft executive married to Democratic Rep. Suzan DelBene of Washington state, will succeed Jeff Zients starting Wednesday as the Obama administration’s go-to figure in charge of making the federal exchange website run right. Health and Human Services Secretary Kathleen Sebelius said DelBene, 53, will be on the job for at least the first half of 2014, and will serve as her senior adviser (Reichard and Attias, 12/17).

CBS News: Former Microsoft Exec To Take Over HealthCare.Gov Oversight
Former Microsoft executive Kurt DelBene is taking over the management of HealthCare.gov, Health and Human Services Secretary Kathleen Sebelius announced Tuesday. This Wednesday, DelBene will replace former corporate executive Jeff Zients, whom the administration enlisted in October to manage the overhaul of the dysfunctional Obamacare website. In a blog post, Sebelius wrote that Zients -- who is slated in January to assume his new role as the director of the National Economic Council -- did an "outstanding job" improving the site. "Today, the site is night and day from what it was when it launched on October 1," she wrote (Condon, 12/17).

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Obama Talks Health Care Technology At Meeting With Executives

President Barack Obama met privately with executives from several technology companies to discuss the difficulties the administration has had with healthcare.gov.

USA Today: Obama Meets With Tech Execs To Talk NSA, Health Care
President Obama met privately with several tech executives Tuesday to discuss the administration's efforts to address problems with the federal online health care exchange as well as the fallout that national security leaks have had on their companies, according to the White House. Among those who were invited to the White House meeting were Apple's CEO Tim Cook, Yahoo! CEO Marissa Mayer, Facebook Chief Operating Officer Sheryl Sandberg and Google's executive chairman, Eric Schmidt (Madhani, 12/17).

The New York Times: Tech Leaders And Obama Find Shared Problem: Fading Public Trust
For months, leading technology companies have been buffeted by revelations about government spying on their customers' data, which they believe are undermining confidence in their services. The Obama administration has been blasted for the botched rollout of the health site, which prevented many people from signing up for health insurance in the first weeks of the site’s introduction, but seem to have been largely repaired since then. The meeting on Tuesday brought those two issues together into a common forum, and at least partly in the public eye (Calmes, 12/17). 

Also in the news -- 

USA Today: Government Seeks Health Website Tech Help
The government put out a call for businesses that could address concerns at HealthCare.gov, the federal health insurance exchange. The Centers for Medicare and Medicaid Services asked small businesses to describe experience that compared in "size, scope and complexity" to the skills needed to create the website (Kennedy, 12/17).

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First Lady Promotes Health Law To Moms, Minorities

In addition to joining her husband in a White House meeting with mothers, Michelle Obama will do a series of interviews with the nation's most popular African-American radio hosts to encourage people to sign up for coverage through the health law.

The Associated Press/Washington Press: Obama, First Lady Meet With Moms On Health Care
President Barack Obama and first lady Michelle Obama are meeting with mothers in the Oval Office to promote the president’s health care law. The White House says Wednesday’s meeting will focus on ways the law can benefit families. White House spokesman Jay Carney says moms are a key part of the administration’s outreach because they play a major role in helping their family members, peers and adult children sign up for health insurance coverage (12/18). 

The Hill: First Lady To Go On Radio Blitz For Obamacare
Michelle Obama will sit for a trio of interviews with urban radio stations as part of a coordinated White House blitz intended to promote ObamaCare coverage among mothers and minorities. The first lady will be interviewed Wednesday evening by Yolanda Adams, Al Sharpton, and Joe Madison, three of the nation’s most popular African American talk radio hosts (Sink, 12/17).

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Health Reform

Insurers Struggling To Meet Health Law's Shifting Deadlines

The administration's effort to stretch the enrollment period after the botched rollout of the healthcare.gov website has complicated efforts by insurers and left some consumers concerned about their coverage.

Reuters: Insurers Wary Of New Obamacare Fix For January Health Plans
Insurance companies are struggling with a new request by the Obama administration to make sure people receive medical benefits under healthcare reform come January 1, even if they miss a sign-up deadline set for next Monday. The government has sought to reassure consumers, already frustrated by technical problems that stalled access to its healthcare.gov enrollment website in October and November, that those who need coverage starting on New Year's Day will be able to sign up (Humer and Krauskopf, 12/18).

USA Today: Insurers, Consumers Await HHS Guidance As Deadline Looms
Some frustrated consumers are sending premium payments to insurers who have never heard of them. Others say they will pass up federal subsidies and pay full price through insurers, while still others have given up altogether on the promise of health insurance by Jan. 1. Consternation and confusion over applications sent through the federal healthcare.gov website continue into the last seven days before the Dec. 23 enrollment deadline. Consumers with health issues are particularly nervous about the prospect of not having insurance at the start of the new year (O'Donnell, 12/17).

Fox News: Obamacare 'Fix' One Month Later: Are People Still Covered?
Nearly six million people have had their coverage cancelled since the ACA became [law] because their plans failed to meet the required essential health benefit guidelines, which provide coverage for things like maternity care and ambulatory services. Now, consumers in states that have opted to extend previously-cancelled coverage have to decide if they want their old plans back or fine a new one. Under the Affordable Care Act, every person in the country must have insurance by the end of open enrollment period on April 1 or will face a penalty of up to $95 a year, or 1 percent of their annual income, whichever is higher. The administration announced last Thursday that insurance companies would be required to accept premium payments for those who want coverage starting on Jan. 1, until Dec. 31 (Rogers, 12/17).

Los Angeles Times: Fewer Than 20% Of Blue Shield Customers Extend Health Coverage
Given the choice, fewer than 20 percent of Blue Shield of California customers with canceled policies opted for a three-month extension of their current health plans. The San Francisco insurer said about 15,000 policyholders out of 80,000 who were affected chose to keep their health plans until March 31 (Terhune, 12/17).

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Maryland Insurers Agree To Delay Deadline For Jan. 1 Enrollment

For consumers seeking coverage on the state's health exchange, Maryland's insurers will extend the enrollment deadline from Dec. 23 to Dec. 27. Rhode Island also plans to extend its deadline. Meanwhile, news outlets offer updates from Texas, Connecticut, California, Minnesota, Wisconsin, Colorado and Washington.  

The Washington Post: Insurers Agree To Short Delay For January Enrollment Through Maryland Health Exchange
Consumers seeking to obtain coverage starting Jan. 1 through Maryland's online health insurance exchange will get a few more days to apply, Gov. Martin O'Malley said Tuesday. O'Malley (D) said that all private insurers participating in the exchange, which has been riddled with technical glitches, have agreed to extend the enrollment deadline for January from Dec. 23 to Dec. 27 (Wagner, 12/17). 

The Baltimore Sun: All Maryland Health Exchange Insurers Agree To Extend Deadline
All insurers selling policies on the state's health care exchange have agreed to extend the enrollment deadline for coverage that begins Jan. 1, state officials said Tuesday. Kaiser Permanente, United Healthcare and Evergreen Health Co-op on Tuesday joined CareFirst BlueCross BlueShield, the state's largest insurer, in agreeing to extend the deadline four days to Dec. 27 from Dec. 23 (Cohn and Cox, 12/17).

Reuters: Rhode Island, Maryland Extend State Obamacare Sign-Up Deadline
Rhode Island's new insurance marketplace said on Tuesday it will extend its deadline until the end of the year for consumers to sign up for private coverage plans under President Barack Obama's healthcare law and still get benefits on January 1. Medical insurance carriers participating in the Maryland Health Connection also agreed to extend the enrollment deadline to December 27 from December 23 to have coverage that begins on January 1, Governor Martin O'Malley's office said on its blog on Tuesday (12/17).

The Texas Tribune: In North Texas, ACA Navigators Under Scrutiny
For Martha Blaine, the 10 Affordable Care Act "navigators" who meet clients daily on behalf of the Community Council of Greater Dallas blend in with the rest of her staff. … The Community Council is one of several Texas organizations awarded a combined $11 million from the federal government to hire and train so-called navigators to help the uninsured seek insurance in the new online marketplace, which has been riddled with technical problems (Rocha, 12/18).

The CT Mirror: CT Insurance Exchange Enrollment Up More Than 50 Percent In Two Weeks
Connecticut’s health insurance exchange is enrolling about 1,400 people a day and is on track to have 50,000 to 60,000 people signed up for health care coverage by the end of the year, an official said Tuesday. Jason Madrak, chief marketing officer for Access Health CT, the state’s exchange, said about 20,000 people have signed up for private insurance plans through the marketplace, about 70 percent of whom will get federal financial assistance to discount their premiums. In addition, about 17,000 people have signed up for Medicaid coverage through the exchange, Madrak said (Becker, 12/17).

The San Jose Mercury News: Bay Area Health-Plan Enrollments Outpacing Much Of State
The Bay Area is outpacing much of the rest of California in the number of enrollees who have signed up for a plan on the state's health insurance exchange since it opened for business, experts say. Since Oct. 1, some 22,166 individuals in the Bay Area counties of Contra Costa, Alameda, Santa Clara, San Mateo and San Francisco have signed up for an insurance plan, according to new figures released Tuesday by Covered California. While the five counties have 16 percent of the state's population, they boast 20 percent of the exchange's total enrollment of 109,296 tallied by Nov. 30. An estimated 13 percent of those eligible for subsidies live in these five Bay Area counties (Seipel, 12/17).

Minnesota Public Radio: MNsure: Some May Need To Reapply
MNsure officials are telling about 1,000 health plan applicants that they need to sign into their accounts and re-apply for coverage in order to receive federal tax credits. The problem stems from earlier troubles MNsure had in calculating individual premium tax credits. It affects consumers who've applied for coverage but not enrolled and don't have a family member on a government health program such as Medical Assistance or MinnesotaCare (Stawicki, 12/17).

The Milwaukee Journal Sentinel: Latest Obamacare Problems In State Involve Online Issues For Three Insurers
In the latest round of difficulties with Obamacare in Wisconsin, plans offered by at least three insurers temporarily disappeared from the online insurance marketplace last week. Before they came off the federal healthcare.gov website for about a day, some of the plans from one company posted incorrect information about deductibles, according to the insurer. The issue occurred Dec. 11 and was fixed by the next day, though federal authorities have not explained what went wrong (Marley, 12/17).  

Health Policy Solutions (a Colo. news service): Sen. Bennet Buys Insurance, Wants Exchange Improvements
Bennet, a Democrat from Denver, is among thousands of Coloradans who are rushing to beat a Dec. 23 deadline to sign up for health insurance so they’ll be covered come Jan. 1. Connect for Health Colorado CEO and Executive Director Patty Fontneau said she reached out to Bennet’s office after learning that he had waited a long time to have his phone call answered. "It's my understanding that he found the website and system to work well," Fontneau said, but added that she’s aware of the long hold times and is working to fix them (Kerwin McCrimmon, 12/17).

The Seattle Times: Small Businesses Could Get Health Insurance Price Break
Small employers in Washington will now have a shot at a tax break that could cut their health insurance costs in half. Next year, small businesses that meet certain requirements and sign up for coverage through the Small Business Health Options Program, or SHOP, could apply for tax credits that would pay for up to 50 percent of their insurance premiums for employees (Stiffler, 12/17).

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Under Fire, MNsure Director Resigns Abruptly

Criticized about the launch of Minnesota's health insurance marketplace and about a tropical vacation, April Todd-Malmlov resigned Tuesday.

The Associated Press: Embattled Minn. Health Exchange Chief Resigns
The chief of Minnesota’s health insurance marketplace resigned Tuesday after facing criticism over the troubled rollout and a questionably timed international vacation. April Todd-Malmlov submitted her resignation during an emergency closed session of the government board of MNsure, Minnesota’s version of the insurance exchange that’s tied to the federal health care overhaul. She had been under increasing pressure over insurance sign-up problems and failed to get a vote of confidence from Democratic Gov. Mark Dayton last week (Bakst, 12/17).

Minnesota Public Radio: MNsure’s Executive Director Resigns
Assistant Commissioner for Health Care Scott Leitz will serve as the interim executive director for MNsure until the agency can find a permanent replacement for Todd-Malmlov. MNsure's technological problems coincided with ongoing political fallout from Todd-Malmlov's decision to go on a two week international vacation at the end of November with her partner, James Golden - the state Medicaid Director, who has been working on the rollout of MNsure (Stawicki and Richert, 12/17).

The Star Tribune: Embattled MNsure Director Resigns Amid Increasing Criticism
Todd-Malmlov’s abrupt departure comes as thousands of Minnesotans scramble to enroll in the state’s online insurance marketplace by Jan. 1. The implementation of Minnesota’s program has gone more smoothly than in other states, but it still has been marked by countless technical glitches, delays and frustrated consumers (Helgeson and Crosby, 12/17).

Pioneer Press: Under Fire, MNsure’s Executive Director Abruptly Resigns
[R]ecent reports that Todd-Malmlov vacationed in Costa Rica last month sparked outrage, even though MNsure board members knew of the trip and Todd-Malmlov maintained daily contact with health exchange officials. "I commend the members of the MNsure board for their strong action to change immediately the executive staff leadership," Gov. Mark Dayton said in a statement (Snowbeck, 12/17).


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Federal Officials Begin Sending States Applications From Residents Eligible For Medicaid

The administration is delivering the data to states so that they can enroll new applicants. Meanwhile, in Virginia, the legislative panel holds its last meeting of the year without a recommendation about Medicaid expansion, and Colorado reports its latest enrollment figures.

The Associated Press: States To Get Medicaid Cases From Federal Website
Federal officials have begun sending Medicaid applications to states so they can enroll people, beginning with a handful of places where technical problems that have marred the new insurance marketplace are expected to be less of an issue. Until now, the applications were not forwarded as promised to the states, which put the enrollment process in limbo for those who are eligible to get health care coverage through Medicaid (Sanner, 12/17).

The Associated Press/Washington Post: Va. Medicaid Expansion Holds Final Meeting Of Year
A Virginia legislative commission still appears a long way from deciding whether to recommend Medicaid expansion. The Medicaid Innovation and Reform Commission held its last meeting of 2013 Tuesday. The chairman, Sen. Emmett Hanger, described it as an informational meeting with presentations from experts on issues like Medicaid fraud and federal health care law revenue provisions (12/17). 

The Roanoke Times: State Medicaid Expansion Stalls
The [Virginia] General Assembly will begin its 2014 session without a plan to expand eligibility for Medicaid and obtain federal funds that would cover the full cost of expanded coverage for the first three years. A legislative commission set up to serve as a gatekeeper on the issue held its final meeting of the year Tuesday without making any recommendations for legislative action. The panel has been monitoring state-level reforms to Medicaid services and has heard lengthy presentations about the economic and health care impacts of expanding eligibility for coverage. But, like the legislature itself, the commission is divided over how the state should proceed (Sluss, 12/17).

Health Policy Solutions (a Colo. news service): Colorado Adds 50,000 To Medicaid Rolls In Two Weeks
Medicaid expansion is galloping forward in Colorado with the state adding nearly 50,000 additional people in the first two weeks of December to the state's Medicaid rolls. Altogether in Colorado, more than 114,000 people have qualified to start receiving care by Jan. 1 through Medicaid, the public health insurance program for low-income people and the disabled. Sign-ups for private health insurance through Colorado's exchange continue to increase with a deadline fast approaching on Dec. 23 to get coverage that starts on New Year's Day. As of mid-December, 23,009 people have signed up for private health plans through Connect for Health Colorado (Kerwin McCrimmon, 12/17).

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Study: Insurance Market 'Death Spiral' Unlikely

Pushing back against those who warn that low numbers of younger subscribers in new insurance marketplaces could lead to a spiral of higher premiums and falling enrollments, Kaiser Family Foundation analysts say the signup of young adults "is not as important as conventional wisdom suggests."

The Washington Post’s Wonk Blog: Why Obamacare Won’t Spiral Into Fiery, Actuarial Doom
The rumors of an Obamacare death spiral have been greatly exaggerated. So say Larry Levitt, Gary Claxton and Anthony Damico, experts at the Kaiser Family Foundation who have put together a new brief analyzing what would happen if young adults snubbed the Affordable Care Act. Even if young people sign up at half the rate the administration hopes for, it would nudge premiums up only by a few percentage points, their report says (Kliff, 12/17). 

Kaiser Health News: Capsules: Study: It’s All Healthy People — Not Just Young Adults — Who Are Critical To ACA Success
Pushing back against those who warn that low levels of younger subscribers could threaten coverage sold under the health law, analysts for the Kaiser Family Foundation say enrollment of young adults 'is not as important as conventional wisdom suggests.' Even if insurance pools contain only 25 percent young adults rather than the hoped-for 40 percent, medical claims and other costs would exceed premium revenue by only about 2.4 percent, they estimate. That’s far below the kind of loss that would lead to an unsustainable spiral of huge premium increases and fewer and fewer subscribers, they say (Hancock, 12/17).

Reuters: Obamacare Death Spiral Looks Unlikely: Study
A threat to America's health insurance overhaul has been that young people would not buy coverage in new marketplaces, possibly pushing the program into a disastrous spiral of falling enrollment and rising premiums. But this worst-case scenario is looking more far-fetched, according to a study by the Kaiser Family Foundation, which sees just slight increases in premiums in 2015 even though enrollment of younger people so far is well below the Obama administration's target (Lange, 12/17).

CQ HealthBeat: Fears About Insurance Market ‘Death Spiral’ Overblown, Kaiser Analysis Suggests
Insurers are likely to eke out small profit margins even if fewer young adults enroll in health exchanges than the administration is targeting, according to a new analysis by the nonpartisan Kaiser Family Foundation. The report suggests that the online marketplaces will be viable even if young adults enroll at a 50 percent lower rate than older people (Adams, 12/17).

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Workers And Some Employers Wary Of Incentives To Improve Health

The health law allows job-based health plans to boost the rewards for workers who adopt healthier habits.

The Boston Globe: Despite Push, US Employers Wary Of Health Incentives
Would $1,700 a year motivate you to drop a few pounds? How about $3,000 to quit smoking? That is how much, on average, the government is allowing employers to reward their workers beginning in January 2014 for doing things like losing weight, lowering their cholesterol, and keeping their blood pressure in check. A new, little-known provision of the Affordable Care Act boosts the maximum incentives for workplace programs that encourage employees to get healthier in hopes of lowering insurance costs (Jan, 12/18).

Fox News: Union Official: Smoking, Obesity, Other Health Issues Could Mean Paying More Under ObamaCare
Under ObamaCare, smoking, obesity and other health conditions sometimes penalized by wellness programs can force even those with employer-provided insurance to pay more, an officer of the National Union of Healthcare Workers said Tuesday. "I run five miles a day, I don't drink, I don't smoke. And by the Kaiser wellness program that a number of employees we represent are covered by, I'm two pounds from being overweight," said John Borsos. Kaiser said in a statement late Tuesday that its program is voluntary and does not penalize those who don't meet the program's goals, although that is not true for other programs (Angle, 12/18).

The Oregonian: Health Reform: Is Childhood Dental Insurance Required? That All Depends
Navigating health reform's rules on childhood dental insurance is turning out to be a real pain in the gums. The Affordable Care Act lists pediatric dental and vision coverage as one of 10 essential benefits that health plans must offer. But in Oregon, consumers purchasing insurance through the state's exchange don't have to buy it. And in Washington, where its purchase is required if you have kids, federal tax credits won't help offset the additional cost of the coverage (Hunsberger, 12/17).

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Insured, Uninsured Are Uncertain Over Impact Of Health Law On Them, Poll Finds

Both insured and uninsured Americans worry about what the health law means for them, a new poll reveals. In the meantime, however, another poll says that despite concerns over the measure, the public is not keen on giving control of the law to Republicans over Democrats in next year's elections.

CBS News: Poll: Both Uninsured, Insured Skeptical About Obamacare
Skepticism about the health care law extends to both insured and uninsured Americans, according to a CBS News/New York Times poll. Both groups disapprove of the law overall, and while the uninsured are more positive about the law's personal impact than those with insurance, more still think the law will hurt rather than help them. CBS News and The New York Times interviewed 702 adults who do not have health insurance for this poll. Just 15 percent of insured Americans think the health care law will help them personally, but that number rises to 33 percent among the uninsured. Still, more uninsured Americans think the health care law will hurt them (37 percent) (Dutton,  De Pinto, Salvanto and Backus, 12/17).

CBS News: For Uninsured, Obamacare Looks Like A Mixed Bag
Toni Lewis of Puyallup, Wash., is thrilled that in spite of her pre-existing conditions, she'll be able to purchase insurance next year via Obamacare. Still, the impact the Affordable Care Act will have on her life seems mixed. "It gives people that have a low income a chance to get insurance, those who have pre-existing conditions can get insurance again -- I have pre-existing conditions myself -- it generally helps people all around," Lewis told CBS News. "Unfortunately, I'm still one that kind of falls through the cracks" (Condon, 12/18).

The Washington Post: The Silver Lining For Democrats On Obamacare
The myriad problems with the rollout of HealthCare.gov and the Obamacare exchanges have pushed President Obama's approval ratings to a new low and, to hear many tell it, might give Republicans a leg up in the 2014 election. But tucked into the new Washington Post-ABC News poll released Tuesday is a cautionary tale for the GOP. It is this: Despite the country's opposition to the Affordable Care Act and Obama's leadership on it, it doesn't want to turn the reins over to Republicans (Blake and Sullivan, 12/18). 

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Capitol Hill Watch

Bipartisan Budget Opens Door To Hope For More Cooperation

The Senate is nearing final passage of a bipartisan two-year budget proposal that is giving lawmakers on both sides of the aisle hope that cooperation on other legislation is on the way.

The Associated Press/Washington Post: Bipartisan Budget Agreement Nears Final Passage
A modest, bipartisan budget pact designed to keep Washington from lurching from fiscal crisis to fiscal crisis and ease the harshest effects of automatic budget cuts is on the brink of passing the Senate. The Senate is on track to clear the bill Wednesday for President Barack Obama’s signature after a 67-33 vote Tuesday in which it easily hurdled a filibuster threshold (12/18).

The New York Times: Budget Deal Offers A Reprieve From Washington Paralysis
The question is whether it will be a turning point that will clear the way for agreements on long-stalled issues like Medicare, the tax code and immigration or simply be an asterisk in the history books. To President Obama and his strategists, the cross-aisle accord offers what one called "green shoots of hope" that next year may turn out better than this year. Along with the change in filibuster rules making it easier to confirm nominees, the White House sees prospects for progress, even if limited (Baker and Weisman, 12/17). 

Politico: Senate Poised To Pass Budget Deal
The Senate voted Tuesday to advance a bipartisan two-year budget deal -- a move that puts Capitol Hill one step closer to a thaw in the fiscal wars that have paralyzed Washington. ... The deal sets discretionary spending at $1.012 trillion for the current fiscal year and $1.014 trillion in fiscal 2015. It raises revenue through fee increases but there are no tax hikes or entitlement reforms, demands that had thrown wrenches in previous fiscal talks. Another round of sequester cuts due to take effect in January will be replaced with more targeted spending cuts (Kim, 12/17).

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State Watch

State Highlights: Va. Governor-Elect Will Keep Republican's Health Secretary

A selection of health policy stories from Virginia, Illinois and Connecticut.

The Washington Post: McAuliffe To Reappoint McDonnell's Health Secretary, Bill Hazel
Gov.-elect Terry McAuliffe will keep Gov. Robert F. McDonnell's health secretary on as his own, a choice that could help the new governor sell Medicaid expansion to wary Republicans but that also infuriates some abortion-rights activists. McAuliffe (D) will announce Wednesday that he will reappoint Dr. William A. Hazel Jr., an orthopaedic surgeon from Northern Virginia who served as secretary of health and human resources under McDonnell (R), two people familiar with the decision said (Vozzella, 12/17).

Chicago Tribune: Quinn Cuts Deal With Union On Medicaid Contract 
[Illinois] Democratic Gov. Pat Quinn is shifting the job of vetting who is eligible to receive state health care coverage for the poor from an outside company to state employees, a move Republicans criticized Tuesday as a "backroom deal" that will undermine efforts to root out fraud and abuse (Garcia, 12/17).

The CT Mirror: How's Your Health care? Community Centers Said: 'Tell Us By Texts, Postcards' 
In theory, everyone in the state has the opportunity to tell lawmakers what they think. But in practice, getting to speak at a public hearing at the state Capitol complex, or even reaching a legislator by email or telephone, can be a challenge. Public hearings often draw dozens of lobbyists and members of the public, who have to sign up early in the day and wait around, sometimes into the night, to testify for up to three minutes. Hoping to help people get their concerns heard, the Community Health Center Association of Connecticut asked consumers to share their thoughts about health care by text message, postcard or online, then conducted follow-up interviews on video with some of those who answered (Becker, 12/17).

The Richmond Times-Dispatch: VCU, U. Va. May Lose $500M For Indigent Care Under ACA
VCU Medical Center and the University of Virginia Medical Center stand to lose about $500 million in federal funds to care for people with no health insurance from 2017 to 2022 through looming cuts under the Affordable Care Act. Secretary of Health and Human Resources William A. Hazel Jr. revealed the newly estimated losses to the two academic medical centers during a meeting Tuesday of the Medicaid Innovation and Reform Commission, which is considering whether to expand Virginia's Medicaid program under the federal law. Without Medicaid expansion, the cuts in federal subsidies for indigent care would be "disastrous," said Dr. Sheldon M. Retchin, chief executive officer of the VCU Health System. "It’s going to look like Calcutta. It’s going to be bad" (Martz, 12/18).

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Editorials and Opinions

Viewpoints: New Healthcare.gov Czar Knows Something About Computer Bugs; Fears About Inadequate Drug Coverage

Los Angeles Times: Can An Ex-Microsoft Guy Cure Healthcare.gov?
Seriously, one has to hope the new guy -- Kurt DelBene, former head of the Microsoft Office Division -- brings only a portion of Microsoft's heritage along with him. Aside from the XBox, the software giant isn't known for great consumer experiences. Its products have been maddeningly complex and notoriously buggy, at least in their early versions. Kind of like HealthCare.gov! (Jon Healey, 12/17). 

The Wall Street Journal: Incompetence
I have begun to worry about the basic competency of the administration, its ability to perform the most fundamental duties of executive management. ... They do the talking part, but the doing? They had 3½ years to make sure ObamaCare will work, three years to get it right top to bottom, to rejigger parts of the law that they finally judged wouldn't work, to make the buying of a policy easy on the website. And they not only couldn't do that, which itself constitutes an astounding and historic management failure, they make it clear they were taken aback by their failure (Peggy Noonan, 12/17). 

The Washington Post: Separating Fact From Fiction In Health Care
So much of the news the past few months has been dominated by the foibles of the Affordable Care Act. Yet the truth about how good or bad various parts of this major piece of health reform are won't be known for a long time (Michelle Singletary, 12/17). 

Los Angeles Times: Who Are The New Uninsureds?
It was always the case that the nation's medically uninsured were disproportionately non-white, poor and southern. These people were the prime targets of the Affordable Care Act, which aimed to bring them coverage in part by the federally-funded expansion of Medicaid. Two surveys released Tuesday by the Kaiser Family Foundation show how the demographics of the uninsured will change, thanks to the ACA. More precisely, the surveys show how they will change as a result of inaction -- the failure of 25 states to expand Medicaid, which the ACA's drafters expected to address the coverage problems of the poor (Michael Hiltzik, 12/17).

The Wall Street Journal: (Almost) Everyone Loses
Some [people without insurance] no doubt do [desire it], and lacked insurance because a pre-existing condition made them uninsurable in the pre-ObamaCare regime. But some lack insurance because they don't want it, don't feel they need it, are completely indifferent, or think it costs too much. What does ObamaCare do for them? "To" them is more like it. It jacks up their premiums to pay for all the mandated coverages -- especially if they're young and healthy and thus least likely to think they need insurance to begin with. It then tells them that they must buy insurance, whether they want it or not (James Taranto, 12/17).

USA Today: Contraceptive Challenge Exposes Double Standard
Even as birth control coverage became mandatory and the administration fights to the Supreme Court to force compliance, The Washington Post reports that insurers "have pared their drug benefits significantly." While your plan must always cover cheap birth control pills, you better read the fine print to make sure the plan covers expensive drugs for grave afflictions such as cancer, multiple sclerosis or HIV (Robert George, 12/17). 

The Fiscal Times: HealthCare.Gov's Back-Office Problems Move Front And Center
What counts in a sale isn't so much the pitch, but the closing of the deal. Without an order and check in hand, the transaction isn't complete. HealthCare.gov – and all of the state exchanges for that matter – have made a great pitch, although it seems that the federal site and states dependent upon it have yet to fully execute their transactions. Through November, about 2 million Americans made it through the application process on the exchanges. But will they be able to choose the right plan and actually get insurance? The jury's still out (John F. Wasik, 12/18).

The Fiscal Times: Obamacare – The Lump Of Coal In America's Stocking
In the spirit of the season, I bring tidings of great joy – especially for the GOP. The country continues to heal, but President Obama is not getting much of the credit. Because Republicans in the House had a rare moment of sanity and passed a budget, their star is shining a little brighter. ... The mess that is Obamacare is a gift to Republicans, and one that can't be returned (Liz Peek, 12/18).

The Star Tribune: Back To Basics After MNsure Shakeup
The board of directors at MNsure has serious work ahead to regain Minnesotans' confidence as glitches mount and as the health insurance marketplace suddenly finds itself without a top leader. April Todd-Malmlov, the executive director of the website at which Minnesotans may shop and sign up for insurance under the Affordable Care Act, resigned under fire Tuesday evening. She is being replaced on an interim basis by Scott Leitz, an assistant commissioner at the Department of Human Services. The seven-member board, which held a closed meeting yesterday to discuss Todd-Malmlov's two-week trip to Costa Rica in the midst of MNsure's launch, needs to ensure it does nothing further to undermine the fledgling effort (12/17).

The Tennessean: Expanding Medicaid Is Not Answer For TN
State Democratic leaders continue to lambaste Gov. Bill Haslam for "the worst moral and mathematical failure in a generation" by not expanding Medicaid in Tennessee. Revisiting recent history might help shine some light on this controversial issue. In the early 1990s, Tennessee pivoted to TennCare, our Medicaid equivalent. The goal was and remains noble. Help the poor access health care and enable our state to improve managing the growing Medicaid portion of our state's budget. The reality was harsh, however (Jim Brown, 12/17).

The Tennessean: Let's Heed Golden Rule And Expand Medicaid
"Do not do to others what is hateful to you" is a commonly accepted cornerstone of all faith traditions. As people of faith, if we claim to live by the "Golden Rule", what does that mean? We don't think it means we are complacent because many sitting in our sanctuaries have the ability to obtain healthcare. If our families couldn't afford to take their children to the doctor, if some suspicion of disease in our husband or wife couldn't be checked out because the money wasn't available, or if disease was found and couldn't be treated, the roofs of our churches and synagogues would likely lift with our reverberating anguish and calls for justice. ... We urge our state officials to take immediate action to submit a proposal (The Tennessee Plan) to federal officials that can win approval to use federal funds to purchase private health insurance for Tennesseans with incomes up to 138 percent of the poverty level (The West Nashville Clergy Group, 12/16).

Philadelphia Daily News: Corbett's Medicaid Proposal Is An Unhealthy Plan
As part of the Affordable Care Act, the federal government encouraged states to expand coverage of Medicaid, and in return, would fund the cost of that expansion fully for the first few years, and 90 percent afterward. Republican governors opposed to health-care reform have rejected this expansion, leaving their most vulnerable citizens out in the cold. [Gov.] Corbett has sent a proposal to the feds with an alternate plan that he claims would be more cost-effective -- subsidizing Medicaid-eligible people to buy coverage directly from the health exchange. But there are so many punitive -- and illegal -- components of his plan that no one expects it to pass muster (12/18).

The Milwaukee Journal Sentinel: Millenials Are Smart To Avoid Obamacare
President Barack Obama has a problem with millennials. We brought the votes and the noise in 2012: 60% of us voted for him in Wisconsin. But the honeymoon is officially over. Young Americans were once the most enthusiastic supporters of Obamacare, but we are now the law's most ardent foes. The latest poll shows that 57% of people ages 18 to 29 disapprove of this law — and only 13% of my generation "definitely" plans on signing up. What turned us against the law we once liked? Reality (Evan Feinberg, 12/17). 

And on other topics -

The New York Times’ Economix: How Medicare Subsidizes Doctor Training
When Congress established Medicare in 1965, it set up payments to subsidize residencies "until the community undertakes to bear such education costs in some other way." Exactly what that meant was unclear, notes Fitzhugh Mullan, a physician and health policy professor at George Washington University. After all, who is this "community," and why would it voluntarily take over this financial responsibility if the federal government was already paying for it? (Catherine Rampell, 12/17).

JAMA: The Optimal Practice Of Evidence-Based Medicine: Incorporating Patient Preferences In Practice Guidelines
Research evidence is necessary but insufficient for making patient care decisions. An effective but toxic chemotherapeutic regimen is the treatment one patient with cancer can and will take, another patient can take but will not, and yet another patient could not take even if wanted. ... Guideline panelists must recognize, with humility, the challenges they face in working often without access to informed patient preferences and acknowledge that their recommendations should rarely assume uniform patient values and contexts in favor of a particular course of action (Dr. Victor M. Montori, Juan Pablo Brito, Dr. M. Hassan Murad, 12/17).

JAMA: Enhancing Physicians' Use Of Clinical Guidelines
In part because of inadequate adherence to guidelines, preventable harm is the third leading cause of patient death, and one-third of health care spending—estimated at nearly $1 trillion, or $9000 per household—is for therapies that do not improve patients' health. ... Increasing evidence suggests that harms once deemed inevitable, such as central line–associated bloodstream infections, are largely preventable (Dr. Peter J. Pronovost, 12/17).

Los Angeles Times: Katie Couric And The Celebrity Medicine Syndrome
An email with the subject line "OMG" recently came from one of our mothers, and it contained chilling information about the HPV vaccine. "200 people have died from it," Mom claimed, "and it does not even last long enough to prevent cervical cancer." Her source was not her doctor, a new study or the Food and Drug Administration. Her information came from a recent episode of Katie Couric's ABC talk show about "all sides" of the "HPV controversy." Since then, most of the alarmist vaccine claims made in the episode have been debunked. But Mom remains a victim of celebrity medicine: She heard a warning from someone famous, believed it and spread the misinformation. Unfortunately, Mom is not alone. Celebrities have crept into our medicine cabinets and kitchens, influencing what pills we pop, tests we order and foods we fear (Julie Belluz and Steven J. Hoffman, 12/18).

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Stephanie Stapleton

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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.