Daily Health Policy Report

Thursday, December 19, 2013

Last updated: Thu, Dec 19

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Health Care Marketplace

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

What If I Don't Like The Coverage Offered By My Employer?

Kaiser Health News consumer columnist Michelle Andrews outlines the health insurance options for people offered coverage at work (12/19). Watch the video or read the transcript.

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Political Cartoon: 'Rumpelstilt-Scare?'

Kaiser Health News provides a fresh take on health policy developments with "Rumpelstilt-Scare?" by Nate Beeler. 

And here's today's health policy haiku:  


What holiday plans?
Pajamas, hot chocolate
and health insurance!

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

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Health Reform

Insurers Extend Payment Deadline For Jan. 1 Coverage To Jan. 10

California, Connecticut and Washington, as well as some other states, have indicated that they will follow slightly different deadlines.

The New York Times: Health Insurers Extend Deadline For First Premiums
Insurance companies, worried about potential chaos next month as people begin seeking coverage under the federal health care law without completing the necessary paperwork, have agreed to give consumers an extra 10 days to pay their first-month premiums, according to a statement from the companies' trade group on Wednesday (Abelson, 12/18).

The Washington Post: Insurers Volunteer To Extend Payment Deadline For Health-Care Coverage To Jan. 10 
Just a few days remain before a Dec. 23 deadline to sign up for coverage that will begin Jan. 1, and the last-minute blitz that federal health officials have predicted appears to be materializing. It puts intense pressure on insurers to send bills to their new customers — and on consumers to pay right away. Under government rules, coverage cannot begin until people pay their first month's premium. Extending the payment deadline creates breathing room for the industry and for people who are eager for their insurance to begin, averting a holiday week in which tens of thousands of Americans might not know whether their coverage would start on time (Goldstein, 12/18).

Los Angeles Times: Health Insurers Extend Obamacare Payment Deadlines
Health insurers nationally said they would give consumers until Jan. 10 to pay for health coverage starting Jan. 1 as part of government-run exchanges under the federal healthcare law. But some state exchanges, including those of California and Connecticut, indicated they would stick with slightly different deadlines that were already extended. The extensions come amid a sharp rise in applicants and continued difficulties for many people trying to navigate the sign-up process (Terhune, 12/18).

The Associated Press: Insurers Allow More Time To Pay Under Health Law
Consumers anxious over tight insurance deadlines and lingering computer problems during the holidays will get extra time to pay their premiums under President Barack Obama's health care law, insurers announced Wednesday. The board of the industry's biggest trade group — America's Health Insurance Plans — said consumers who select a plan by Dec. 23 will now have until Jan. 10 to pay their first month's premium. That's 10 extra days beyond a New Year's Eve deadline set by the government (Alonso-Zaldivar, 12/18).

The Wall Street Journal’s Washington Wire: Health Insurers Allow Some To Pay Premiums Late
Health insurers acceded to a request from the Obama administration and said they would delay a deadline for some people to pay their insurance premiums. The move is part of the last-minute rush to get ready for the full rollout of the Affordable Care Act, also known as Obamacare, on Jan. 1. People buying coverage on the new health-insurance exchanges created by the law must choose a policy by Dec. 23 in order to get coverage starting in the new year (Landers, 12/18).

Reuters: Some Obamacare Shoppers Can Pay January 10 for January 1 Coverage
Individuals who select their health insurance plan on the exchanges set up under the national healthcare reform law by the December 23 deadline will have until January 10 to pay and still receive coverage as of January 1, 2014, the nation's largest organization of insurers said on Wednesday. Some insurers had already announced similar moves individually, but now plans selling insurance on either the state or federal exchanges will voluntarily honor the delayed payment schedule, America's Health Insurance Plans said in a statement (Humer and Krauskopf, 12/18).

CNN: Insurers Ease Deadline To Pay For Obamacare Policies 
Health insurers announced Wednesday they will give people buying coverage under Obamacare more time to make the first payment. America's Health Insurance Plans, the industry trade group, said consumers now have until Jan. 10 to make their first payment for coverage retroactive to Jan. 1. The deadline to sign up for insurance that kicks in Jan. 1 remains the same -- Dec. 23 in the vast majority of the country (Wolf, 12/18).

The Oregonian: Washington Exchange Extends Payment Deadline To Jan. 15; Cover Oregon Still Undecided
Consumers buying health insurance on Washington's exchange now have until Jan. 15 to make their first payment for coverage that starts Jan. 1, state officials said Wednesday. Nationwide, insurers said they'd give consumers buying plans on state and federal exchanges until Jan. 10 to make payments that would bind their coverage for January, the trade group America's Health Insurance Plans said today. But whether the payment deadline in Oregon will be Jan. 10 or Jan. 15 remains unclear. Cover Oregon and insurers have yet to settle on a date, a spokesman said (Hunsberger, 12/18).

McClatchy: Insurers Extend Payment Deadline For Jan. 1 Obamacare Coverage
The nation's largest health insurance industry trade group announced Wednesday that consumers, frustrated by technical problems with federal and state health insurance marketplaces, will get more time to pay for individual coverage that begins Jan. 1. The board of directors of America's Health Insurance Plans said consumers who select an individual health plan by Dec. 23 will now have until Jan. 10 to make their first month’s premium payment for retroactive coverage that begins on Jan. 1, 2014. The previous payment deadline for January 1 coverage was December 31 (Pugh, 12/18).

CQ HealthBeat: Deadlines For Paying Health Premiums Will Vary As Insurers Agree To Extend Time
America's Health Insurance Plans said Wednesday that many insurers throughout the nation are willing to provide retroactive coverage to people who enroll in the new marketplaces as long as the consumers pay by Jan. 10. But insurance exchange directors in states that are running their own marketplaces often have different deadlines, and they said they would keep them, making the insurance industry announcement somewhat less sweeping and giving rise to the possibility of confusion among consumers (Adams, 12/18).

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'Deluge' Of Signups Reported By Some State Exchanges

A handful of states with relatively smoothly operating insurance websites have seen enrollment increases of 30 percent to 40 percent this week. But others, including Massachusetts, Maryland and Colorado, continue to experience political as well as technical challenges.

USA Today: States Say Health Sign-Ups On Exchanges Increasing
States with their own well-running health insurance exchanges reported on Wednesday an increase of 30% to 40% in enrollments from last week to this week. "We're seeing huge interest," said Peter Lee, director of California's exchange, during a conference call sponsored by Families USA, a health care advocacy group that supports the Affordable Care Act. Six months ago, "no American knew about" the state exchanges (Kennedy, 12/18).

NBC News: Patients Pour On To Successful State Insurance Exchanges
People are flocking to the more successful state health insurance exchanges in the final days before a late-December deadline, exchange directors said Wednesday. So many people are calling in for help that states have had to beef up call center staffing, and insurers have agreed to let deadlines slide a bit so that as many people as possible can get coverage starting Jan 1. In just five states – California, Connecticut, Kentucky, New York and Washington – more than 436,000 people are signed up for health insurance – more than in the 36 states covered by the federal exchange. But the directors of the five exchanges say what’s happening in their states reflects much of what is going on nationwide – people want health insurance being offered by the Affordable Care Act (Fox, 12/18).

The Washington Post’s Wonk Blog: California Is Averaging 15,000 Obamacare Enrollments Each Day
State health exchanges are reporting a surge in enrollment -- and consumer interest -- as they near a late December deadline to purchase insurance coverage. If November had an Obamacare surge, consider this the December deluge. California averaged 15,000 daily enrollments early last week, about double the sign-ups the state had in early December. New York is now seeing about 4,500 residents choosing plans each day and, in Connecticut, the number is hovering around 1,400. With consumer interest seeming to spike, these states and others are increasing call center staffing by half (Kliff, 12/18).

Politico: Obamacare Crashes Into Romneycare
Massachusetts created a Romneycare-inspired template for President Barack Obama’s health reform effort. Now, as the Bay State is struggling to upgrade for the Obamacare era, its enrollment system is buckling under technical glitches like those that hobbled HealthCare.gov. State officials are increasingly concerned that thousands of Massachusetts residents seeking coverage are lost in a wilderness of misfiled applications and cybermalfunctions. Now, they’re moving ahead with a labor intensive backup plan aimed at making sure that no one loses coverage when Obamacare starts in January (Cheney, 12/18).

Los Angeles Times: California’s Health Exchange Botched Letters To 114,000 Households
Adding to consumer confusion ahead of a major enrollment deadline, California's health insurance exchange sent flawed eligibility notices to nearly 114,000 households due to a computer error. The Covered California exchange said the letters sent from Nov. 22 to Dec. 7 had blank spaces or missing information on people's eligibility for insurance or federal premium subsidies (Terhune, 12/18).

The California Health Report: Holiday Shoppers Find Insurance Help At The Mall
For the first time this year, visitors to some California malls are seeing a new kind of holiday sales promotion: the Affordable Care Act. That’s because anyone wanting health insurance under the ACA by New Year’s Day faces a Dec. 23 deadline to enroll. More than three quarters of a million people have started the sign-up process online at California’s health insurance exchange, Covered California, and more than 109,000 completed the process in the first two months of the enrollment period. Signups accelerated sharply in early December, Covered California figures show. Still, state Sen. Holly Mitchell (D-Los Angeles) said she and a group of union organizers worried that some people might fall through the cracks (Richard, 12/19).

The Washington Post: Delaney Says Maryland Still Should Weigh Switching To Federal Health Exchange
Rep. John Delaney continued to press the idea Wednesday that Maryland should consider abandoning its online health insurance exchange in favor of the federal marketplace, despite representations by Gov. Martin O’Malley that the most pressing problems hindering enrollment have been fixed. Delaney (D-Md.) said in an interview that he still believes Marylanders seeking insurance might be better served by the federal exchange. He acknowledged that the switch would present some challenges but said he doesn’t think those are necessarily greater than those posed by the state site, which has been riddled with glitches since its Oct.1 launch (Wagner, 12/18).

The Baltimore Sun: Maryland’s Health Exchange Site Running More Smoothly, Users Say
Even as work continues to mend the state's health exchange, enrollment of uninsured Marylanders is going more smoothly and a marketing push is set to get underway, users and state officials said Wednesday. Gov. Martin O'Malley announced Monday that he was bringing in Columbia-based Optum/QSSI, which worked on fixes for the federal exchange, to help the state's troubled site (Cohn, 12/18).

Fox News: Colorado Bill Would Use Tax Credits To Offset ObamaCare Penalty
Two Republican lawmakers in Colorado plan to introduce a proposal that would make it easier for residents to opt out of ObamaCare by creating a tax deduction to offset the federal penalty for not purchasing health insurance. State Reps. Dan Nordberg, R-Colorado Springs, and Jared Wright, R-Fruita, announced this week that they will introduce the Healthcare Liberty Act when the state's 2014 legislative session convenes in January, KDVR.com reported.  Under the proposal, anyone who is fined for failing to purchase health insurance would be given a state tax deduction in an amount equal to the federal tax penalty. The deadline for avoiding penalties under ObamaCare is March 31 (12/19).

The CT Mirror: GOP Senator Wants Hearing On Access Health CT Problems
The top Republican on the legislature’s insurance committee wants the head of Connecticut’s health exchange to answer more questions -- publicly -- about problems with the system. And Sen. Kevin Kelly, R-Stratford, also wants lawmakers to conduct a public hearing to allow consumers to vent their frustrations with Connecticut’s efforts to implement the federal Affordable Care Act. Kevin Counihan, the CEO of Access Health CT, appeared before the Insurance and Real Estate Committee on Nov. 22, but that stop “raised more questions than answers,” Kelly said during a late-morning press conference in the Legislative Office Building (Phaneuf, 12/18). 

Des Moines Register: Health Care For 10,000 Iowans In Limbo Over Communications Snarl
Thousands of modest-income Iowans who filled out health insurance applications via the government’s new online marketplace could be without coverage on Jan. 1, because of a lack of communication between federal and state officials. The issue involves people who might qualify for Iowa’s version of Medicaid, the public insurance program for the poor, or related programs (Leys, 12/19).

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Minnesota's Health Exchange Turmoil Continues

As of Dec. 1, fewer than 4,500 people had signed up for coverage through the state's online insurance marketplace, leading to apologies from its new director and talk of postponing the deadline for enrollment for January coverage.

The Wall Street Journal: More Turmoil In State Health Exchanges
Some states have signed up tens of thousands of new customers, ... But at least four of the 14—Hawaii, Maryland, Minnesota and Oregon—have had serious technical problems, and all four have now replaced directors less than three months after opening their exchanges. As of Dec. 1, fewer than 4,500 people had managed to sign up for private insurance in Minnesota, according to an Obama administration report (Schatz, 12/18).

The Associated Press: Minn. Could Delay Deadline For Exchange Enrollment
Leaders of Minnesota’s health insurance marketplace said Wednesday they might postpone next week’s deadline to enroll for January coverage, after a chaotic rollout of the state program that led to the resignation of its former executive director. April Todd-Malmlov, who had led Minnesota’s marketplace since its inception under the federal health care law, abruptly resigned Tuesday without a severance package (Condon, 12/18).

The New York Times: Minnesota Becomes Fourth State To Lose Chief Of Exchange
Ms. Todd-Malmlov had been in damage-control mode for weeks, but calls for her removal grew after she took a tropical vacation in November — a trip seen as politically unwise at a moment of crisis for the fledgling marketplace, while frustrated residents encountered issues with the website and call center (Yaccino, 12/18).

Minnesota Public Radio: New MNsure Exec Admits Problems, Promises Fixes
The new head of Minnesota's troubled online health insurance marketplace apologized Wednesday for the operation's turmoil and vowed to take on its monumental challenges. "We are committed 100 percent and fully committed to making this process a better one," said State Human Services Department Assistant Commissioner Scott Leitz, who took over as interim MNsure director after April Todd-Malmlov resigned (Stawicki, 12/18). 

MinnPost: New MNsure CEO Apologizes, Pledges Progress On Health Exchange Problems
Among other problems, MNsure has had to re-run roughly 30,000 applications for possible errors. Some people received incorrect tax credit calculations or were not given the right program designation, and the exchange has been unable to process paper applications. ... “We are committed to improving this process,” Leitz said at a noon press conference (Nord, 12/18).

Minnesota Public Radio: Dayton Calls On Contractor To Make MNsure Fixes
Technological problems with the state's new online health insurance marketplace continue a few days before a critical deadline, prompting Gov. Mark Dayton to contact the Ireland-based contractor that has been the source of some of MNsure's most persistent problems. In response to the governor's call Friday, IBM Curam sent a team of its top workers to St. Paul. ... IBM Curam, owned by technology giant IBM, bills itself as an expert in creating health insurance exchanges (Richert, 12/18).

Star Tribune: MNsure’s Website Contractors Draw 11th-Hour Flak
As problems with Minnesota’s health insurance exchange website persist, MNsure board members on Wednesday for the first time raised questions about the competency of the outside companies the state hired to build it. “Did we pick the wrong vendor?” Minnesota Department of Human Services Commissioner Lucinda Jesson asked. ... With a Monday deadline looming for consumers to sign up for coverage, MNsure board Chairman Brian Beutner deferred a serious discussion on outside vendors until January, but he said Jesson raised a legitimate issue (Crosby, 12/19).

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Medicaid Expansion: Wisconsin's 'Third Way'; Virginia's Health Secretary Could Ease Path

News outlets report on various developments related to two state efforts to expand the health insurance program for low-income people.

The Wall Street Journal: A Medicaid Bet In Wisconsin
If Wisconsin Gov. Scott Walker ever runs for president, expect him to talk about his "third way" for Medicaid—a plan that rejects part of President Barack Obama's health law while extending coverage to more poor in the state. It is a fine line to walk for Mr. Walker, who could face a tough re-election fight next year. But his stance shows how one battle-tested Republican is trying to appeal to voters and respect conservatives' distaste for the Affordable Care Act (Peters and Radnofsky, 12/18).

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 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. ... As a highly regarded health-policy expert and holdover from a GOP administration, [William A. Hazel Jr.] could be an asset to McAuliffe in the uphill battle that is his top priority: persuading Republican state lawmakers to expand Medicaid under the federal health-care law known as Obamacare (Vozzella, 12/18).

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Poll Findings, Health Law Messagers Grab Headlines

Just as a new poll concludes that people with and without insurance disapprove of the health law at about the same rate, the Obama administration turns to its "top seller" to promote the overhaul.  

The New York Times: Uninsured Skeptical Of Health Care Law In Poll
Americans who lack medical coverage disapprove of President Obama’s health care law at roughly the same rate as the insured, even though most say they struggle to pay for basic care, according to the latest New York Times/CBS News poll. ... The widespread skepticism, even among people who are supposed to benefit from the law, underscores the political challenge facing the Obama administration as it tries to persuade millions of Americans to enroll in coverage through new online marketplaces (Goodnough and Kopicki, 12/18).

CBS News: Poll: Many Uninsured Haven’t Explored Obamacare Options
More than two months after the health care exchanges opened, a new CBS News/New York Times poll reveals most uninsured Americans - 58 percent - say they have not looked up information about applying for insurance, while four in 10 have done that. Forty-nine percent of uninsured Americans who looked up information were able to get the information they needed, but about as many – 48 percent - were not (Dutton, De Pinto, Salvanto, 12/18).

Politico: Michelle Obama Steps Into Health Care Spotlight
President Barack Obama has struggled to sell his health care law this fall — and until now, he’s largely been without his top seller: first lady Michelle Obama. The first lady has done little to promote the Affordable Care Act in recent months, marking a shift from her usual role as the president’s middle class messenger — a move that allowed her to sidestep the political battles over the law, and questions about the administration’s trustworthiness (Epstein, 12/18).

The Associated Press: First Lady Joins President’s Push On Health Care
Mrs. Obama also was appearing on three African-American radio shows to encourage Americans to enroll. Minorities are less likely to have health insurance, so the administration has been targeting them in sign-up campaigns (Pickler, 12/18).

Bloomberg: Obama Eases Congress Health Care Jitters With House Vet
As Phil Schiliro arrived at his first meeting last week with House Democratic leaders to discuss selling Obamacare, he was greeted like family. … Schiliro met today with about a dozen Senate Democrats in a session organized by Illinois Senator Dick Durbin (Bykowicz,12/18).

And what about "pajama boy" -

ABC News: Obamacare Hipster In PJs Lures Young, Healthy
Five days before the first major Obamacare enrollment deadline, it’s an all-out battle to attract the young and healthy. Today Organizing for Action, President Obama’s independent advocacy group, launched a social media blitz urging uninsured millennials to “have the talk” about health care. An image graphic — featuring a young man wearing flannel, checkered pajamas — circulated widely on Twitter and Facebook with the slogan, “Wear pajamas. Drink hot chocolate. Talk about getting health insurance” (Dwyer, 12/18).

Fox News: Grapevine: Visions Of ObamaCare Dancing In Your Head?
ObamaCare architect Ezekiel Emanuel apparently was not joking when he told Chris Wallace on "Fox News Sunday" the government was about to launch a big PR campaign that he thought would get a lot of people to sign up. ... Well, as you would imagine, that inspired a slew of photoshopped memes and comments under the #PajamaBoy (Bream, 12/18).

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Web-Based Brokers Still Unable To Enroll Consumers

Despite promises of technical fixes by the federal government, Web-based brokers like eHealth are still unable to enroll consumers in Obamacare policies through their own sites as an alternative to healthcare.gov.

CNN: Private Exchanges: Obamacare Shopping Still Not Ready
Private health insurance exchanges still are not able to directly enroll consumers in subsidized health plans offered through Obamacare even though the government has said problems doing so should have been cleared up weeks ago. Executives from three online health exchanges that contract with both insurance companies and government agencies to enroll consumers eligible for federal subsidies in marketplace plans say the process still isn't ready to go and that more work remains. This despite several promises from government officials that technical fixes have been made to allow for business to be conducted on those sites, which are alternatives to the troubled HealthCare.gov website and health exchanges sites run by states (Aigner-Treworgy, 12/18).

Meanwhile, some experts raise questions about the timing of a plan to switch Web hosts for healthcare.gov -

Reuters: Obamacare Tech Hurdle Looms Right Before Enrollment Deadline
Some technical experts are perplexed at the U.S. government's plan to switch web hosts for its new health insurance portal, HealthCare.gov, in the midst of an expected last-minute rush to beat a March 31 enrollment deadline for 2014 coverage. Switching hosts is not in and of itself a huge risk if it is done carefully and with lots of preparation, according to technical experts interviewed by Reuters. It is the timing of the highly complex maneuver that is risky (Rampton and Begley, 12/18).

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Some Americans Reflect On Insurance They Had Pre-Health Law

Americans who are slated to have new insurance from the health law are reflecting on what their old coverage was like -- if they had it at all. Also, an architect of the Massachusetts health law reflects on the federal health law.

McClatchy: 'Junk Insurance' Comes Back To Haunt Its Policyholders 
April Capil has mixed feelings about the national outcry over canceled health insurance policies. Five years free of the stage III breast cancer that nearly claimed her life, the Boulder, Colo., resident is once again healthy, but she's still struggling to put her life back together. Like millions of Americans, Capil thought she had solid individual health insurance. Then she got sick and found that her coverage was woefully inadequate (Pugh, 12/19).

Georgia Health News: Will Health Care Reform Work Out? An Interview
Jonathan Gruber views health care reform from a unique vantage point. Gruber, an MIT economics professor, was a principal architect of the Massachusetts reform law. And he was a key adviser to the Obama administration in its crafting of the Affordable Care Act. Last week, Gruber visited Atlanta to address a forum on health costs and quality sponsored by Healthcare Georgia Foundation. In a GHN interview, he discussed the rocky rollout of the ACA, comparisons with the Massachusetts experience, Medicaid expansion, and the challenges ahead for the federal law (Miller, 12/18).

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Capitol Hill Watch

Congress Closes In On Permanent Fix To Medicare Doctors' Payments

With a bipartisan budget deal behind it, Congress may be on the verge of solving the way it makes Medicare payments to doctors. Meanwhile, national spending on health care is growing at the slowest pace ever recorded, according to The New York Times.

The Washington Post: Senate Passes Bipartisan Budget Agreement
Congressional leaders appointed Senate Budget Committee Chairman Patty Murray (D-Wash.) and House Budget Committee Chairman Paul Ryan (R-Wis.) to negotiate a cease-fire. The resulting agreement would roll back sharp spending cuts known as the sequester over the next two years, sparing the Pentagon from more reductions and restoring billions of dollars for domestic programs. The $62 billion cost would be more than covered by $85 billion in alternative policies, such as higher security fees for airline passengers, deeper cuts for Medicare providers and less generous retirement benefits for federal workers, including military retirees younger than 62. The deal makes no effort to solve the nation’s biggest budget problem: a social safety net strained by an aging population. But it also would not raise taxes or reduce Medicare benefits, leaving each party’s core ideological commitments intact (Montgomery, 12/18).

The New York Times: Growth In U.S. Health Care Spending Slows
Nationally, spending on health care is growing at the slowest pace ever recorded. Annual spending on health care often grew more than 10 percent a year during the 1970s and ’80s. Growth dipped in the 1990s, only to rise again, but starting in the early 2000s, the rate began falling. It is now just about 4 percent a year. Yet in the latest New York Times/CBS News poll, just 5 percent of all Americans — and 3 percent of uninsured respondents — said that health care spending has moderated. Half of respondents said that costs have been going up at a faster rate lately (Lowrey, 12/18). 

NPR: Congress Poised To Permanently Fix Its Medicare Payment Glitch
The two-year budget deal approved by the Senate Wednesday aims to prevent another government shutdown. It also includes a familiar annual rider — language to avert a steep pay cut to doctors who treat Medicare patients. But this time might be different, with a fix that lasts. After more than a decade of temporary solutions, it appears Congress may be on the verge of permanently solving its persistent problem in the way it makes Medicare payments to doctors. The problem was actually created by Congress itself, back in 1997, through a flawed formula called the Sustainable Growth Rate, or SGR. And every year since 2002, when the formula first began calling for cuts, the SGR has created political and fiscal fits for lawmakers (Rovner, 12/19).

Medpage Today: Senate Agrees To 3-Month SGR ‘Patch’
The Senate on Wednesday passed a budget that includes a 3-month "patch" to delay a 24 percent cut to physicians' Medicare payments set to begin Jan. 1 under the sustainable growth rate (SGR) reimbursement formula. Senators voted 64-36 on the bill, which sets federal spending levels for the rest of fiscal 2014 and fiscal 2015. Lawmakers must still fill in actual spending bills for specific government expenditures, now that they agree on the overall level of federal spending (Pittman, 12/18).

CQ HealthBeat: ‘Doc Fix’ Passage Gives Lawmakers Three Months Of Breathing Room
With Wednesday’s passage of a three-month payment patch, lawmakers have given themselves a little extra time to work on major legislation overhauling how Medicare pays physicians (Ethridge, 12/19).

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Health Care Marketplace

Value-Based Medicine Gains Momentum

Reuters: In Healthcare Experiment, Patients Pay More For ‘Bad’ Medicine
When Tanner Martin, 17, developed excruciating back pain last year, he was sure he needed an X-ray to find out what was wrong…But Konnie Martin was no ordinary parent. As chief executive officer of San Luis Valley Regional Medical Center in Alamosa, Colorado, she is at the center of an experiment, known as value-based insurance, that could transform American healthcare. … Healthcare policy wonks have been studying value-based insurance for a decade. For some consumer groups, the concept raises concerns over whether it will deter people from treatment when certain procedures are needed. But the idea has gained momentum since the passage of President Barack Obama's healthcare reform law, which includes provisions to control healthcare spending that now tops $2.7 trillion a year in the United States. About one-third of that is attributed to wasteful or ineffective care (Begley, 12/19).

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State Watch

State Highlights: Calif. Midwives Prepare For New Independence

A selection of health policy stories from California, Minnesota, Colorado, Nebraska, Maryland and Massachusetts.

The California Health Report: New Independence For California Midwives 
California licensed midwives will have increased independence and authority in attending births, potentially giving more pregnant women access to their services under a new law that goes into effect in January. Assembly Bill 1308 removes an unworkable clause that required all licensed midwives to be supervised by a physician. Licensed midwives had been unable to fulfill that requirement since it went into effect 20 years ago because physicians’ malpractice insurance prohibited them from filling that role. In addition, licensed midwives will now be authorized to operate birth centers without physician supervision and will have increased access to drugs, tests and medical devices used in their practice (Renner, 12/18).

The Star Tribune: Dayton Favors 'Structural' Changes After Meeting With Nursing Board
After meeting Wednesday with all but one member of the Minnesota Board of Nursing, Gov. Mark Dayton supports the board’s view that it needs structural changes to improve its ability to discipline problem nurses. ... Reacting to a Star Tribune investigative series that began in early October, the governor has previously criticized the board, saying it has been "asleep at the switch" and failed to use its authority to crack down on nurses who commit misconduct (Stahl, 12/18).

Health Policy Solutions/I-News (a Colo. news service): Dental Care Still Elusive Despite Coverage Under Medicaid
Almost half a million Coloradans are expected to gain dental benefits under Medicaid by 2016. That doesn't mean they’ll be able to see a dentist. Two state policy changes rolling out next year are intended to improve access to oral health care for low-income Coloradans. The state legislature earlier this year voted to expand Medicaid’s dental benefits to adults -- it now only covers children for most kinds of care (Jones, 12/18).

The Associated Press: New Nebraska Agreement Focuses On Quality Health Care
A new agreement between Nebraska health care groups and insurers will help doctors' offices focus more on preventative treatment, quality care and helping patients tend to themselves, supporters said Wednesday. Participating insurers will offer reimbursement for patient-centered medical home services under the voluntary pact brokered by two state senators in lieu of a law (Schulte, 12/18).

The Baltimore Sun: City Programs Pitch African-Americans On The Benefits Of Hospice Care
Shirley Kane didn't think she could take it any more. Her 87-year-old mother, diagnosed with terminal cancer, was bedridden at home. ... Although hospice care has dramatically increased in popularity over the past few decades, of the 1.6 million Americans who used such services last year, about 82 percent were Caucasian and fewer than 9 percent African-American (Pitts, 12/18).

The Boston Globe: Child Welfare Agency Still Lacks Medical Guidance 
Seven years ago, after two tragedies, State House investigators identified a major flaw in the Massachusetts child-protection agency: It lacked medical expertise to help caseworkers sort out the complicated conditions affecting children under its watch. The findings led lawmakers to approve reforms, but today, very little has changed. The position of physician medical director was funded by the Legislature but never filled by the agency. A plan to set up a standing panel of pediatric specialists to offer consultations on medically complex cases went unheeded by top state officials. To this day, if staffers within the agency need advice from medical experts, they are often left scrambling to find help on their own (Wen and Swidey, 12/19).

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Weekend Reading

Longer Looks: A 'Biopsy Chaperone;' Medical Errors At Assisted Living Homes

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

UT San Diego: Medical Errors Plague Care Homes
At least 80 times in recent years, employees at San Diego County assisted living homes overlooked serious medical issues, gave the wrong medication or otherwise failed to properly care for vulnerable seniors. The problems arose as a result of the unique position held by the care homes, viewed by many families as health-care facilities even though they lack the required levels of training, supervision and oversight. The new cases were examined by U-T Watchdog as part of an ongoing partnership with the CHCF Center for Health Reporting at the University of Southern California (Jeff McDonald, 12/14).

The New Yorker: Controlling Health-Care Costs
[T]he political furor over [Obamacare] has obscured a quieter but arguably more consequential development: health-care costs in this country may finally be coming under control. ... there’s good reason to think that the moderation of health-care spending will persist, because, according to Jason Yeung, an investor at Morgan Stanley’s Growth Team, we’re beginning to see deeper structural changes in the health-care system. Historically, costs have been hard to contain because most of the players in the system have had no incentive to do so. ... “What we’re moving toward instead is a world in which everybody in the system is sharing financial risk,” Yeung told me. “And therefore everybody has an incentive to control costs” (James Surowiecki, 12/9).

Health Affairs: A Resident Helps Redesign How One Institution Provides Emergency Care
Ms. Fuentes, thirty-two years old and healthy, came to the ED many hours ago for consultation on a localized finger infection. ... I cannot stop in Ms. Fuentes’s room, provide a quick and focused exam, and make a simple recommendation for the ED doctor. Although this may be valuable to the patient, it doesn’t generate revenue for the medical center or protect me against liability. Instead, I must provide a full consultation and make the incision myself. The patient’s infection could have been diagnosed and treated in a supervising hand surgeon’s clinic in minutes. Instead, ... she has had to wait well over six hours to see the least-experienced member on the orthopedic team. ... My portion of her lengthy stay took less than twenty minutes. I never saw her again. There was no tracking of her satisfaction, no knowledge as to whether her infection was eradicated, and no measure of cost at the end of her care cycle (Dr. Kamran S. Hamid, December 2013).

Billy Rubin's Blog: The E-Mail I Want To Send, But Probably Won't
Thank you for your note. I will let my patient know as soon as possible that you aren't interested in seeing him in your clinic so that he won't trouble you with his medical issues. It is true that we did have him admitted to expedite a biopsy while you were the attending on service for the [Q] team. However, as he had not yet seen a specialist in [Q] and that Dr. [Y] had provided help to me in phone consultation, we both thought that you would have been the most logical choice to see him in follow-up. The misunderstanding is all mine, as I thought you were this person called a "doctor" and that doctors do this thing called "taking care of patients". You appear to be a "biopsy chaperone". Please forgive my confusion on this point (Billy Rubin, 12/14). 

The Atlantic: Experts Decisive Against Multivitamins: 'Stop Wasting Money'
"We believe that the case is closed— supplementing the diet of well-nourished adults with (most) mineral or vitamin supplements has no clear benefit and might even be harmful. These vitamins should not be used for chronic disease prevention. Enough is enough." So reads an authoritative editorial today in one of the widest-read U.S. medical journals, Annals of Internal Medicine (James Hamblin, 12/17).

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Editorials and Opinions

Viewpoints: Republicans' 'Repeal Trap;' 'Insufferable' Pajama Boy; ADHD Epidemic; ACLU's Campaign Against Catholic Hospitals

The Washington Post’s The Plum Line: The GOP Repeal Trap
The Journal Gazette of Fort Wayne, Indiana, reports on a fascinating exchange between GOP Rep. Marlin Stutzman and a local meat market owner, Lee Albright, who likes the Affordable Care Act and quizzed the Congressman about the real world implications of the GOP repeal stance (Greg Sargent, 12/18). 

The Wall Street Journal: National Lampoon's ObamaCare Vacation
President Obama has responded to the ObamaCare debacle by bringing in Beltway liberal mastermind John Podesta as a senior West Wing hand, and he promptly announced his arrival by likening House Republicans to "a cult worthy of Jonestown" in an interview with Politico. The states running their own insurance exchanges are exacting more accountability for their ObamaCare failures. Enrollment and technical dysfunctions and security breaches akin to the 36 federal exchanges continue to beset Minnesota's operation, called MNsure. On Tuesday, April Todd-Malmlov, the exchange's executive director since 2011, resigned under political duress (12/18). 

Politico: Pajama Boy, An Insufferable Man-Child
Pajama Boy’s place in Internet infamy was secured as soon as the insufferable man-child was tweeted out by Organizing for America. He is the face of a web ad that is the latest effort by the Obama team to leverage the holidays for conversation about Obamacare. "Wear pajamas," the ad reads. "Drink hot chocolate. Talk about getting health insurance. #GetTalking." ... If he has anything to say about it, Obamacare enrollments will spike in the next few weeks in Williamsburg and Ann Arbor (Rich Lowry, 12/18).

Bloomberg: Conservatives See the Light On High Deductibles
The revelation that many plans in the Patient Protection and Affordable Care Act's health insurance exchanges have high deductibles has put many of the law's conservative opponents into a corner: Once in favor of high deductibles, these critics of Obamacare are suddenly worried about the risk to consumers. The data show why their new position makes more sense (Aaron Carroll, 12/18).

The Fiscal Times: The Obamacare 'Shotgun Wedding' – Marry Or Lose Your Home
The rollout of the Affordable Care Act has provided many real-world examples of this, but perhaps none so "unintended" as the consequences discovered by the Seattle Times this weekend.  Carol Ostrom, The Times' health reporter, told the story of 62-year-old newlyweds Sofia Prins and Gary Balhorn, who weren't exactly the models of wild, starry-eyed romantics. Their nuptials were motivated by a stronger desire to keep their house out of the hands of the federal government, thanks to a little-known key provision of Obamacare. Their meager incomes made them eligible for a federally subsidized health plan, and their assets would be protected. Does Obamacare actually allow the federal government to seize homes and other assets? (Edward Morrissey, 12/19).

Fox News: Republicans Can Win In 2014 If We Unite Around ObamaCare
"A house divided against itself cannot stand." Abraham Lincoln originally spoke these prophetic words in 1858 when describing the looming threat of the Civil War. Today, we Republicans should heed this warning as we look ahead to the challenges of the future – both for our Party and the country we all love. At this moment in time, the American people overwhelmingly agree with Republicans on the fundamental issue of next year's elections: ObamaCare (Scott Brown, 12/18).

And on other issues -

The New York Times: An Epidemic Of Attention Deficit Disorder
The hard-sell campaign by drug companies to drive up diagnoses of attention deficit hyperactivity disorder, or A.D.H.D., and sales of drugs to treat it is disturbing. The campaign focused initially on children but is now turning toward adults, who provide a potentially larger market (12/18). 

Los Angeles Times: Are Catholic Hospitals Bad For Women's Health? ACLU Says Yes.
A word of caution: If you are a woman of child-bearing age, Catholic hospitals may be hazardous to your health. Why? Because Catholic-affiliated hospitals, which now account for one of every nine acute-care hospital beds in the country, aren't allowed to provide the medically accepted standard of care if it conflicts with Catholic teachings (Robin Abcarian, 12/18). 

Roll Call: Congress Must Address The Long-Term Care Workforce
Direct-care work is undervalued and underpaid, in large part because these jobs are considered “low skill” and are performed primarily by a female workforce, more than half of whom are women of color. But ask any individual who needs personal care services — or their family members — and you are likely to find that the most valued person on the care team is the aide. ... Fortunately, the Commission on Long-Term Care’s majority and minority reports included a number of recommendations that Congress should get behind to build a 21st-century, direct-care workforce: better training and opportunities for career advancement; rate setting policies that guarantee wages sufficient to attract committed workers and reduce turnover; integration of direct-care workers into care teams; and improved data collection to inform policy decisions (Jodi M. Sturgeon, 12/18).

New England Journal of Medicine: Accelerating The Adoption of High-Value Primary Care — A New Provider Type Under Medicare? 
Although the proposed Medicare physician payment reform is an important step in the right direction, we believe that a bolder approach is needed to accelerate the adoption of [advanced primary care practice] APCP. We propose that Medicare adopt APCP as a new provider category, with its own eligibility standards and accountability for performance on patient outcomes, care, and resource use, linked to a new payment approach (Dr. Richard J. Baron and Karen Davis, 12/18).

New England Journal of Medicine: Political Tug-of-War and Pediatric Residency Funding
One of many effects of the government shutdown was the defunding of the Children's Hospitals Graduate Medical Education (CHGME) Payment Program. ... With this year's CHGME funding appropriation far from certain, pediatric residents and fellows are being paid out of clinical and other reallocated revenue — which undoubtedly creates pressures in other parts of the children's health care system. Though this stopgap measure helps to continue the training of pediatricians and the care of their patients, we hope that in the future, GME funding can avoid being caught in this type of political tug-of-war (Drs. Charlene A. Wong, Jeremiah C. Davis, David A. Asch and Richard P. Shugerman, 12/19).

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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.