Daily Health Policy Report

Monday, December 2, 2013

Last updated: Mon, Dec 2

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Medicare

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Covered California Faulted For Failing To Reach More Spanish Speakers

Kaiser Health News staff writer Anna Gorman, working in collaboration with McClatchy, reports: "Latino lawmakers and health leaders in California are sounding alarms about the insurance marketplace’s preparation and tactics for enrolling Spanish speakers and are urging changes following the recent announcement that fewer than 1,000 signed up in the health law's first month" (Gorman, 12/10). Read the story

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Medicare Seeks To Curb Spending On Post-Hospital Care

Kaiser Health News staff writer Jordan Rau, reporting in collaboration with The Washington Post, reports: "After years of trying to clamp down on hospital spending, the federal government wants to get control over what Medicare spends on nursing homes, home health services and other medical care typically provided to patients after they have left the hospital. Researchers have discovered huge discrepancies in how much is spent on these services in different areas around the country. In Connecticut, Medicare beneficiaries are more than twice as likely to end up in a nursing home as they are in Arizona. Medicare spends $8,800 on each Louisiana patient getting home health care, $5,000 more than it spends on the average New Jersey senior. In Chicago, one out of four Medicare beneficiaries receives additional services after leaving the hospital—three times the rate in Phoenix" (Rau, 12/1). Read the story and the related chart.

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UnitedHealthcare Dropping Hundreds Of Doctors From Medicare Advantage Plans

Reporting for Kaiser Health News, in collaboration with USA Today, Susan Jaffe reports: "The company is the largest Medicare Advantage insurer in the country, with nearly 3 million members. More than 14 million older or disabled Americans are enrolled in Medicare Advantage plans, an alternative to traditional Medicare that offers medical and usually drug coverage but members have to use the plan’s network of providers" (Jaffe, 12/1). Read the story.

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With Three Weeks Left, Consumers Fear They May End Up Without Health Coverage On New Year’s Day

Kaiser Health News staff writer Jordan Rau reports: "The next three weeks are critical for consumers keen on getting health coverage as soon as the health law allows it on Jan. 1. People who desire coverage by then need to sign up in the new marketplaces no later than Dec. 23. Consumers can still enroll up to the end of March, but their coverage will begin later. For people in the states with well-functioning insurance websites, such as California, New York and Kentucky, this appears to leave plenty of time. But making the deadline could be dicier for people in Arizona and the 35 other states where the federal website healthcare.gov is the path to coverage, as well as Oregon and Hawaii, which have struggled to get their sites functioning" (Rau, 12/2). Read the story.  

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Capsules: Breaking Up With Healthcare.gov; The Iowa Insurance Challenge: Rural Outreach; Should Consumers Give Healthcare.gov A Second Chance?; Doctors Groups Share Concerns About Narrow Networks, Confusion With White House

Now on Kaiser Health News’ blog, Alaska Public Radio’s Annie Feidt, working in partnership with KHN and NPR, reports: "Enrolling in healthcare.gov is not easy. In Alaska, just 53 people enrolled in the first month. Anchorage hair stylist Lara Imler is one of the few who got through. Now though, after she discovered problems with her application, Imler wants to cancel her enrollment" (Feidt, 12/1).

Also on the blog, Iowa Public Radio's Sarah McCammon, working in partnership with KHN and NPR, reports on Iowa's enrollment efforts: "With more than 200,000 Iowans lacking health insurance, there are lots of questions but not many people equipped to answer them. Iowa Insurance Commissioner Nick Gerhart says the state got about $600,000 in federal funding for pay for navigators, who help people understand their options and sign up for coverage. 'That's not a lot of money to build a statewide campaign,' he notes. 'You have to hire staff, train staff, hold events. I mean that’s expensive'" (McCammon, 11/27).

In addition, Phil Galewitz, working in collaboration with Cosmopolitan, offers this status check  on the health law: "As you probably know from all of the talking (and screaming) heads on TV, the Affordable Care Act (ACA) stumbled out of the gate with a glitch-ridden enrollment site, cancellation of some insurance policies and other technical glitches that have made Steve Jobs roll over in his grave. But if recent headlines and late-night jokes have left you confused, let us straighten it all out for you and tell you what you need to know" (Galewitz, 11/27).  

Galewitz also reports on a White House meeting with physicians: "The nation’s top physician groups told White House officials Tuesday they are worried about what consumers will encounter after Jan. 1, when millions are expected to gain coverage under the Affordable Care Act" (Galewitz, 11/27). Check out what else is new on the blog.

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Political Cartoon: 'No Lucy Necessary?'

Kaiser Health News provides a fresh take on health policy developments with "No Lucy Necessary?" By R.J. Matson.

Here's today's health policy haiku:  

GET ACTIVE

Poor drug coverage?
Exercise is medicine
The strongest there is!
-Abe Moskow

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

Administration Gives Thumbs Up To Website Fixes And Upgrades

The health law website reportedly now is operating 90 percent of the time, but more work still must be done, according to the Obama administration's Sunday progress report on their efforts to correct healthcare.gov's problems.  

The Washington Post: Healthcare.gov Meets Deadline For Fixes, Obama Administration Says
After a series of technical fixes and capacity upgrades, many of which were made over the past week, HealthCare.gov is now working more than 90 percent of the time — a big improvement over October, when the site was operating only about 43 percent of the time and frequently crashed, said Jeffrey Zients, the administration official overseeing the improvements. … Even with the improved performance, some people are likely to encounter problems on the site. And there is another worry — reports sent to insurance companies about who has enrolled in health plans include errors that could cause problems when people try to use their new insurance plans next year (Somashekhar and Sun, 12/1).

The Associated Press/Washington Post: Gov’t Diagnosis: Healthcare.gov On The Mend
Yet officials acknowledged more work remains on the website, which made its national debut two months ago with hundreds of software flaws, inadequate equipment and inefficient management. Federal workers and private contractors have undertaken an intense reworking of the system, but some users might still encounter trouble. How many problems are left? That’s the question consumers and lawmakers alike will be eying before the next crucial deadline: Dec. 23 (12/2).

Los Angeles Times: Major Health Website Bugs Fixed, Officials Say, But More Work Needed
The Obama administration said Sunday it had met its deadline to fix the major problems that have hobbled the federal healthcare website since its disastrous debut two months ago, but officials acknowledged that further repairs were necessary. … Administration officials concede that the site still may not be able to handle the crush of people expected to seek insurance this month. Consumers need to select health plans by Dec. 23 if they want coverage to begin Jan. 1. During peak times, some consumers may be put into a queue to gain access, officials said (Levey and Mascaro, 12/1).

Bloomberg: Obamacare Website Repair Goals Reached, Administration Says
President Barack Obama raised the stakes on his three-year-old health-care overhaul yesterday, declaring that fixes to his administration’s troubled insurance exchange website make it ready to sign up 800,000 people a day. The site, healthcare.gov, is sure to be tested immediately today -- “Cyber Monday” -- when deals from online retailers draw more Americans to their computers and the Internet (Wayne and Nussbaum, 12/2).

Politico: Redone Healthcare.gov Faces New Test
The test will start on what’s expected to be heavier Web traffic on Monday. And it will last through Dec. 23, the deadline for millions of people — including those who have had their policies canceled — who want to log on and get coverage that starts on Jan. 1. The soft relaunch on Sunday also resets the effort by the administration and its health care allies to have 7 million people sign up in Obamacare insurance exchanges in the next four months. If people can sign on and get covered, the White House hopes, it could start rebuilding support for President Barack Obama’s signature health law and confidence in the president himself (Haberkorn, 12/1).

Reuters: U.S. HealthCare.Gov Website Faces New Tests As Traffic Builds
President Barack Obama and his HealthCare.gov website face another critical test starting this week, as Americans who have been unable to enroll in health coverage under Obamacare rush to a site that continues to face challenges. A day after the administration said it met its weekend deadline for making HealthCare.gov operate smoothly for most users, networks of volunteer organizations are expected to resume enrollment activities after a long U.S. Thanksgiving holiday weekend, many of them with backlogs of would-be applicants waiting for access (Morgan, 12/2).

The Fiscal Times: Democrats Double-Down On Obamacare Revamp
Democrats at both the national and local levels voiced a full-throated endorsement of the Obamacare web site Sunday, one day after the administration’s self-imposed deadline to improve the broken site. Speaking on Sunday talks shows, Democrats – some of whom appeared to be wavering in their support for the troubled health care law last month – said that the fixes made to the site were a positive step. They also said that they believed the Obama administration would meet their enrollment goal of 7 million by the end of March (Francis, 12/1).

The Fiscal Times: Will Obamacare Tech Fixes Plug Political Fallout? 
The administration’s announcement over the weekend that it has achieved its promised goal of making the Obamacare website workable for the “vast majority” of users was the first piece of genuinely positive news since the disastrous rollout began Oct. 1 – one that may  have staunched the political hemorrhaging at the White House. The newly improved on-line system probably will get its first big test this week when people emerge from the Thanksgiving holiday determined to sign up or curious about the government’s claims of a vastly improving system. At the same time, critics and opponents will be watching closely or testing the system in search of new cracks (Pianin, 12/2).

Meanwhile, in terms of the numbers the site has handled so far -

Bloomberg: Obamacare Website Sign-Ups Said To Reach 100,000 In Month
About 100,000 people signed up for health insurance through the online federal exchange last month, a roughly four-fold increase from October even as a team of U.S. government and contractor programmers was fixing the troubled Affordable Care Act website, said a person familiar with program’s progress (Goldman, 12/2).

Marketplace: ACA Enrollment: Lessons From Social Security And Medicare
We’re coming up on two months since the government started signing folks up for the new Obamacare health exchanges, and let’s just say it hasn’t been the smoothest rollout in American history. If you look back a bit, there are a few times the government has pretty successfully managed to enroll a huge number of people. Like Social Security, and Medicare. So what’s so different this time? (LeMoult, 11/27).

Kaiser Health News also compiled Sunday's news coverage of the Obama administration’s progress report on website fixes (12/1).

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Insurers Worry About Back End Repairs To Healthcare.gov

The system that is supposed to deliver consumers' information to insurers still needs to be repaired -- with only 30 days to go before coverage is supposed to begin for many people. Meanwhile, Bloomberg News reports that because of another software problem insurers will initially estimate what they are owed by the government rather than have the government calculate the bill.

NPR: A New Worry Looms Online For The Affordable Care Act
As the Obama administration scrambles to fix the glitch-plagued site, experts are beginning to worry about another problem that may further impair the rollout of the Affordable Care Act. Health insurance companies say they're seeing numerous errors in a form that plays a vital part in the enrollment process. The problems are manageable so far, but many worry about what will happen if enrollment surges in the weeks to come (Zarroli, 11/30).

The New York Times: Insurers Claim Health Website Is Still Flawed
The problem is that so-called back end systems, which are supposed to deliver consumer information to insurers, still have not been fixed. And with coverage for many people scheduled to begin in just 30 days, insurers are worried the repairs may not be completed in time (Pear, 12/1).

The Wall Street Journal: Insurers Seek To Bypass Health Site
Insurers and some states are continuing to look for ways to bypass the balky technology underpinning the health-care law despite the Obama administration's claim Sunday that it had made "dramatic progress" in fixing the federal insurance website. Federal officials said they had largely succeeded in repairing parts of the site that had most snarled users in the two months since its troubled launch, but acknowledged they only had begun to make headway on the biggest underlying problems: the system's ability to verify users' identities and accurately transmit enrollment data to insurers (Radnofsky, Schatz and Ante, 12/1).

Bloomberg: Obamacare Payment System To Insurers Changed In Setback
Parts of the Obamacare enrollment system used to pay insurers are being pushed back from January in the latest technology delay for the president’s U.S. health-care overhaul. The administration is setting up a temporary process to send companies the federal subsidies used to help millions of Americans buy coverage because the online system won’t be ready as planned, said Aaron Albright, a spokesman for the Centers for Medicare & Medicaid Services. Insurers will estimate what they are owed rather than have the government calculate the bill (Nussbaum, 11/30).

The Wall Street Journal’s CIO Report: White House Tracking HealthCare.gov Performance With Real-time Analytics
Administrators of HealthCare.gov used Web analytics software to track the insurance exchange’s performance in real-time in order to identify and fix issues hampering users of the website. The software, from startup New Relic Inc., was a key tool that led to several fixes, including a new feature that alerts consumers via email when the exchange is available to process their requests. However, it’s not clear whether these improvements are enough to ensure that connections between the federal exchange and databases managed by health insurers necessary for completing insurance transactions will work properly (Boulton, 12/1).

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Oregon Struggles To Clear Health Insurance Exchange's High-Tech Hurdle

Oregon's state-based health law online insurance exchange is still struggling in its quest to sign people up, and officials there are using paper applications to get the job done -- a time-consuming task. Exchanges also make news in Kentucky, California, Mississippi and Washington state.

Los Angeles Times: Oregon May Be In Over Its High-Tech Head In Obamacare Rollout
In Oregon, a state envied for its high tech, sign-ups under the new federal health care law have been anything but. About 400 newly hired workers in Salem are processing paper applications by the thousands for health insurance under President Obama's law. They review each 19-page application, calculate eligibility for tax subsidies, and then mail back a packet of each consumer's options -- which the customers must mail back to complete the sign-up process (Reston, 11/28).

Los Angeles Times: Stores Selling Obamacare Policies Popping Up Across California 
As shoppers hunt for holiday bargains this season, they may find something unusual for sale at the mall: Obamacare. With enrollment deadlines looming, California officials, insurance companies and agents are staking out retail space to sign up thousands of people as part of the Affordable Care Act. These sales tactics reflect how dramatically the health care law is changing the insurance industry (Terhune, 11/27).

Los Angeles Times: Kentucky Governor Sees Health Law As Chance To Heal An Ailing State
But leading one of the nation's poorest, sickest states, [Kentucky Gov. Steve] Beshear has improbably overseen one of the most successful rollouts of Obama's troubled health care overhaul and become, deep in his long public career, a hero to Democrats grasping to find a redeeming figure amid the political wreckage. He's an unlikely champion, not least because Kentucky's two U.S. senators are both implacable opponents of the program (Barabak, 11/28).

USA Today/The Jackson Clarion-Ledger: Two States, Different Experiences Under Health Care Law
For a 50-year-old nonsmoker in Mississippi's most populous county, the least expensive health plan in the federal insurance marketplace costs $385 a month, nearly 40% higher than its equivalent in Kentucky. There, the same person can find a mid-range, or Silver plan, for as little as $278 a month. ... Kentucky is the only state in the Southeast running its own health care marketplace. It has some of the region's least expensive plans, a Clarion-Ledger comparison found. "We would have been a whole lot better off" with a state-based exchange, said Mississippi Insurance Commissioner Mike Chaney, who had led efforts to start one but ran into opposition from Gov. Phil Bryant (Le Coz, 12/1).

The Seattle Times: Many Health-Exchange Plans Exclude Top Hospitals From Coverage
When Bev Marcus began shopping recently for a health-insurance plan, she found one from Premera Blue Cross on Washington's online insurance exchange that seemed to offer good coverage at a reasonable price. Marcus assumed the individual Premera policy would include Swedish Medical Center’s main hospitals in Seattle, just like the Premera group plan she and her husband had in the past. … The answer startled her: None of the company's individual plans for 2014 include any of Swedish's three hospitals in Seattle or its campus in Issaquah (Ostrom and Landa, 11/30).

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Obamacare 'Navigators' Hope For Do-Over

The groups charged with helping people sign up for health coverage are looking for a fresh start after experiencing the same difficulties getting plan information as many consumers. Other stories look at the challenges of enrolling Spanish-speaking consumers, as well as those living in rural areas.

The Washington Post: Launch Of Healthcare.gov Has Been A Rough Passage For Program 'Navigators'
[Patrice] McCarron's group is one of about 100 organizations across the country that received government grants to help people sign up for coverage. These groups of "navigators" have been stymied by the same technical problems that have thwarted individual consumers, and many say they have become worn down and discouraged. Now they are hoping that this weekend will mark a turnaround for the program, which they once promoted with enthusiasm and more recently have had trouble defending (Somashekhar, 11/30).

Kaiser Health News: Covered California Faulted For Failing To Reach More Spanish Speakers
Latino lawmakers and health leaders in California are sounding alarms about the insurance marketplace's preparation and tactics for enrolling Spanish speakers and are urging changes following the recent announcement that fewer than 1,000 signed up in the health law's first month (Gorman, 12/1).

Kaiser Health News: Capsules: Breaking Up With Healthcare.gov
Enrolling in healthcare.gov is not easy. In Alaska, just 53 people enrolled in the first month. Anchorage hair stylist Lara Imler is one of the few who got through. Now though, after she discovered problems with her application, Imler wants to cancel her enrollment (Feidt, 12/1).

Kaiser Health News: Capsules: The Iowa Insurance Challenge: Rural Outreach
With more than 200,000 Iowans lacking health insurance, there are lots of questions but not many people equipped to answer them. Iowa Insurance Commissioner Nick Gerhart says the state got about $600,000 in federal funding for pay for navigators, who help people understand their options and sign up for coverage. "That's not a lot of money to build a statewide campaign," he notes. "You have to hire staff, train staff, hold events. I mean that's expensive" (McCammon, 11/27).

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Medicaid Expansion Could Exacerbate Doctor Shortage

As more people gain access to coverage as a result of the health law's expansion of the state-federal insurance program for the poor, finding doctors willing to treat them may be a challenge. Other stories look at how Americans in similar circumstances face vastly different health coverage options because of where they live. That's because half the states opted against the health law's expansion of Medicaid.

The New York Times: Medicaid Growth Could Aggravate Doctor Shortage
Dr. Ted Mazer is one of the few ear, nose and throat specialists in [the San Diego] region who treat low-income people on Medicaid, so many of his patients travel long distances to see him. But now, as California’s Medicaid program is preparing for a major expansion under President Obama’s health care law, Dr. Mazer says he cannot accept additional patients under the government insurance program for a simple reason: It does not pay enough (Goodnough, 11/28).

The Fiscal Times: Doctor Shortage Could Rise Under Medicaid Expansion
Only 25 states and the District of Columbia have signed on so far, however, as Republican governors and GOP-dominated state legislatures in most of the remaining states have opted out of the expanded program – either to protest Obamacare in general or out of fear that their states may end up having to pay a much larger share of the expanded Medicaid costs than the Obama administration promised. The result is a disturbingly stark dual system health care system determined largely by where people live and the political leanings of their home states. Now there’s an even more challenging problem: Qualifying for expanded Medicaid coverage is one thing; finding a doctor who will even accept new Medicaid patients is another (Pianin, 12/1).

Louisville Courier-Journal: Medicaid Expansion: A Case Of The Kentucky ‘Haves’ And The Indiana ‘Have-Nots’
Lorinda Fox of New Albany, Ind., hasn’t been to a doctor since her last child was born 21 years ago. Poor and uninsured, she treats her illnesses with over-the-counter remedies. ... If Fox lived in Kentucky, she would qualify for expanded Medicaid next year under the Affordable Care Act. But she lives in a state where she makes too much to qualify for traditional Medicaid, and politicians have chosen not to expand Medicaid as Obamacare intended, contending that Indiana taxpayers can’t afford it. Her predicament reveals an irony in the way Obamacare’s Medicaid expansion has played out: Residents in similar circumstances face vastly different health coverage options, depending on which side of the Ohio River they live (Ungar, 12/1).

Detroit Free Press: Eligible For Medicaid? Many In Michigan Face Bureaucratic Confusion
Across Michigan, hundreds of thousands of residents who may be eligible for the state’s Medicaid expansion remain in frustrating, bureaucratic limbo — one that could push arguably affordable coverage out of their reach if they don’t get answers soon. Those residents won’t know for sure until next year whether they’re eligible for an expanded Medicaid under the health reform law. But for many, it could be too late to access tax credits now to make policies more affordable on the Michigan Health Insurance Marketplace, or state exchange (Erb, 12/2).

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Consumers, Employers Face New Round Of Health Coverage Challenges, Decisions

News outlets offer consumer tips for using healthcare.gov and take a look at where things stand in terms of obtaining coverage as of Jan. 1.  

The Washington Post: Consumer Tips For Healthcare.gov Show Administration's Cautious Optimism
The Obama administration on Sunday reported vast improvement with the HealthCare.gov health-insurance portal that opened with extensive glitches in October, while acknowledging that the site still needs more work. One sign of ongoing problems came in the form of a blog entry and infographic that Health and Human Services Secretary Kathleen Sebelius published on Huffington Post. Both items provide tips for consumers visiting the site, most notably by encouraging them to use it during off-peak hours — mornings, nights and weekends (Hicks, 12/2).

Kaiser Health News: With Three Weeks Left, Consumers Fear They May End Up Without Health Coverage On New Year’s Day
For people in the states with well-functioning insurance websites, such as California, New York and Kentucky, this appears to leave plenty of time. But making the deadline could be dicier for people in Arizona and the 35 other states where the federal website healthcare.gov is the path to coverage, as well as Oregon and Hawaii, which have struggled to get their sites functioning. On Sunday, the government reported progress in improving healthcare.gov, saying the site now allows more than 800,000 visits a day with the rate of timeouts or crashes reduced to below 1 percent. Officials said repairs continue (Rau, 12/2).

And for employers -

The Washington Post: New Health-Care Law Pushing Employers To Make Tough Decisions About Coverage
For years, Ron Peppe spent much of his time poring over contracts that his company, Canam Steel, won to build steel infrastructure in highways, stadiums and hotels, such as the underground steel foundation it just completed for the new Marriott Marquis in downtown Washington. These days, Peppe, the head of legal and human resources at Canam, whose U.S. headquarters are in Point of Rocks, Md., still reads plenty of contracts. But he is also spending much more time reading the ongoing deluge of rules and regulations coming out of federal agencies that are meant to help guide employers as they adjust their companies’ health benefits under President Obama’s signature health-care law, the Affordable Care Act (Ho, 12/1).

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Religious Liberty Issues Color Supreme Court Consideration Of Health Law's Contraception Coverage Mandate

Other challenges to the law continue to work their way through courtrooms across the country.

Politico: Contraceptive Cases Raise Religious Liberty Issues
The Supreme Court in early spring will hear two legal challenges to Obamacare’s contraception coverage requirement, a case that addresses a complex question that has never come squarely before the court: Can a for-profit company engaged in commercial activities declare religious beliefs? Under the women’s preventive health benefit in the Affordable Care Act most employers must provide all Food and Drug Administration-approved forms of contraception with no co-pays. There are exemptions for religious organizations and ways for religious-affiliated institutions to try to work around the requirement. But owners of nonreligious businesses who oppose some or all contraceptives say the government shouldn’t be able to require them to break with their religious beliefs (Haberkorn, 12/2).

USA Today: Long-Shot Legal Challenges To Health Care Law Abound
President Obama's signature health care law could get nicked by the Supreme Court next year when the justices take up the mandate that most businesses provide free coverage for contraception. But that's not the only legal hurdle it faces. In courtrooms across the country, Republican state attorneys general and conservative groups are challenging the way the law was passed, the way it was worded and the bureaucracy it created (Wolf, 11/29).

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Physicians Voice Concerns About What The Health Law Will Bring In January

News outlets report on some of the specific issues that are causing physician organizations to worry.  

Kaiser Health News: Capsules: Doctors Groups Share Concerns About Narrow Networks, Confusion With White House
The nation's top physician groups told White House officials Tuesday they are worried about what consumers will encounter after Jan. 1, when millions are expected to gain coverage under the Affordable Care Act (Galewitz, 11/27).

Reuters: Cardiologists Strongly Back Obamacare, Worry Over Rocky Start
American cardiologists appear staunch in their support for President Barack Obama's health care reform, although some fear that its rocky launch could derail efforts to improve preventive care for needy patients. The broad support for the Affordable Care Act, popularly known as Obamacare, emerged in interviews last week in Dallas with more than 20 cardiologists at the annual scientific sessions of the American Heart Association (Pierson and Berkrot, 11/28).

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Capitol Hill Watch

Members Of Congress Get Different Health Marketplace Experience Than Most

The Los Angeles Times explores the experiences for lawmakers and their staffs as they leave the federal employee health insurance system and move to the new exchanges.

Los Angeles Times: For Congress, Health Care Plans Remain A Notch Above
Trying to align lawmakers with the people they represent, Congress three years ago decided that when the new health care plan took effect, members would give up their platinum health benefits and enroll in the online marketplaces created for millions of other Americans. In typical congressional fashion, however, things have not worked out exactly as advertised (Memoli, 12/1).

Meanwhile, several Republican doctors are running for Senate using the health law as a foil --

The Hill: Republican Doctors Running For Congress Amid Obamacare Rollout Fiasco
Eleven Republican doctors are running for the Senate, hoping that voters will see their medical expertise as an asset amid the administration's botched rollout of Obamacare. ... Doctors running in Senate races from North Carolina to Oregon are all pitching voters on their experience in the medical field (Jaffe, 12/1).

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Medicare

Medicare Looks To Narrow Discrepancy On What It Spends In Different Parts Of U.S.

Medicare wants to narrow the discrepancy on what it spends on some health services in different parts of the country. In the meantime, UnitedHealthcare is dropping hundreds of doctors from its Medicare Advantage plans and the Government Accountability Office says Medicare doesn't know how well its contractors' anti-fraud efforts are working.

Kaiser Health News: Medicare Seeks To Curb Spending On Post-Hospital Care
After years of trying to clamp down on hospital spending, the federal government wants to get control over what Medicare spends on nursing homes, home health services and other medical care typically provided to patients after they have left the hospital. Researchers have discovered huge discrepancies in how much is spent on these services in different areas around the country. In Connecticut, Medicare beneficiaries are more than twice as likely to end up in a nursing home as they are in Arizona. Medicare spends $8,800 on each Louisiana patient getting home health care, $5,000 more than it spends on the average New Jersey senior. In Chicago, one out of four Medicare beneficiaries receives additional services after leaving the hospital -- three times the rate in Phoenix (Rau, 12/1).

Kaiser Health News: UnitedHealthcare Dropping Hundreds Of Doctors From Medicare Advantage Plans
The company is the largest Medicare Advantage insurer in the country, with nearly 3 million members.  More than 14 million older or disabled Americans are enrolled in Medicare Advantage plans, an alternative to traditional Medicare that offers medical and usually drug coverage but members have to use the plan’s network of providers (Jaffe, 12/1).

Medpage Today: GAO: Medicare Lacks Info On Fraud Response
The Centers for Medicare and Medicaid Services (CMS) doesn't know how quickly its anti-fraud contractors respond to abuse, or how well they protect Medicare integrity, a government report found. CMS doesn't know the time between when its Zone Program Integrity Contractors (ZPICs) identify a suspect provider and when they take action to prevent potentially fraudulent Medicare payments, according to the Government Accountability Office (GAO). The contractors reported more than $250 million in savings to Medicare in 2012, with more than 130 investigations being accepted by law enforcement for potential prosecution, the GAO said in a report released Monday (Pittman, 11/29).

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State Watch

State Highlights: States Push Mental Health Spending After Sandy Hook

A selection of health policy stories from the states including news from Connecticut and Wisconsin.

Politico: Sandy Hook Spurs States' Mental Health Push
At least 37 states have increased spending on mental health in the year since Adam Lanza shot dead 20 children, six school employees and his mother in Newtown, Conn. It’s not just about money, either. States are experimenting with new -- and sometimes controversial -- ways to raise awareness about psychological distress, to make treatment more accessible for children and adults and to keep firearms away from those struggling with mental illness (Simon, 12/2).

The Associated Press: Proposal Delaying Medicaid Shift Could Save State $23M
Gov. Scott Walker's proposal to delay kicking about 72,000 off of Medicaid would actually save the state about $23 million because of the plan's other component -- delaying expanding coverage to poor childless adults, according to an analysis. The Legislature's budget committee is slated to take up the proposal on Monday for the three-month delay (Bauer, 12/1).

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Editorials and Opinions

Viewpoints: Where's Obama's 'Mission Accomplished' Banner?; Health Law Critics Overlooking Those Denied Affordable Care In The Past

The Wall Street Journal: Obamacare Mission Accomplished
Great news: The White House says that Healthcare.gov and the 36 federally run insurance exchanges are finally good to go. The only thing missing from Sunday's relentlessly upbeat progress report was President Obama in front of a "Mission Accomplished" banner. Sunday's eight-page report was intended to meet Mr. Obama's deadline for fixing the site after its October 1 debut was a calamity. But the more important goal was political -- namely, claiming enough progress to prevent Democrats on Capitol Hill from joining the GOP demand for delaying the individual mandate to buy insurance or even the entire program (12/1).

The New York Times: Rooting For Failure
Yes, it is a big and legitimate news story, for a presidency built on technical expertise, that the federal exchange is not working as promised. Ditto Obama's vow that people could keep their bottom-feeder health care policies. But where were the news conferences, the Fox News alerts, the parading of people who couldn’t get their lifesaving cancer treatments under the old system? Where was the media attention when thousands of people were routinely dumped once they got sick? When did Republicans in Congress hold an oversight hearing on the leading cause of personal bankruptcy -- medical debt? (Timothy Egan, 11/28). 

USA Today: Kathleen Sebelius: Improvement Dramatic Over Oct. 1
The new Marketplace is an opportunity for individuals without employer insurance to obtain coverage -- with choice and competition that was previously unavailable. Many Americans and their families are eligible for financial assistance to make insurance even more affordable. Yet, far too many of those who have visited HealthCare.gov have experienced problems. These problems are unacceptable (Secretary of Health and Human Services Kathleen Sebelius, 12/1).

USA Today: Healthcare.gov Better But Not Yet Well: Our View
A couple of weeks after the disastrous debut of its health insurance website Oct. 1, the Obama administration woke up and finally began doing what it should have done all along, bringing in a competent troubleshooter, consolidating fix-it efforts under a central coordinator and setting a real deadline -- Nov. 30 -- to repair the site. That seems to have worked, at least to some degree. The White House announced Sunday that it had hit its target of having the website function smoothly for "the vast majority" of people who want to sign up, which it defines as about 80 percent (12/1).

Los Angeles Times: As Obamacare Website Relaunches, There Is Reason To Hope
The opportunity to be reborn is a rare gift indeed, granted to few beyond the mythical phoenix and some adherents of the Baptist faith. Them -- and the Affordable Care Act, which this week will undergo what its supporters hope will be a second launch much different from its first. Reports are flowing in that HealthCare.gov, the federal enrollment website serving residents of 36 states that didn't bother to set up their own sites, is working much better than at any time since its calamitous launch on Oct. 1 (Michael Hiltzik, 12/1). 

The Washington Post: Obamacare – A Question Of Morality
There was a lot of bloviating about the Affordable Care Act on the talk shows last weekend. The Obamacare critics' chief focus was the open-enrollment fiasco, the un-kept presidential promise and the millions of cancellation notices. Overlaying the palaver was the unrestrained glee of health-reform opponents. The same weekend, in a section of our nation's capital where pompous politicians and self-important opinion-makers seldom venture, the Affordable Care Act was the subject of thanks and praise at the First Baptist Church at Randolph Street and New Hampshire Avenue NW (Colbert I. King, 11/29). 

The Wall Street Journal: In the Trenches With the Obamacare Army
Even when the Obama administration was under the impression that the launch of the Affordable Care Act was going to work splendidly, with a first-rate website, the plan still called for "navigators" to help people sign up. Now, with the ACA website Healthcare.gov hobbled, and even many of the president's supporters grumbling that the law may need a radical rethinking, the work of the tens of thousands of these helpers is more vital than ever. How's it going? Not well, to judge from a visit with navigators in North Carolina, one of 34 states that decided not to open their own health-insurance exchanges (Eliana Johnson, 11/29).

The Wall Street Journal: Obamacare's Plans Are Worse
The reason this furor will continue even if the website is fixed is that the public is learning that Obamacare's insurance costs more in return for worse coverage. Mr. Obama and his liberal allies call the old plans "substandard," but he doesn't mean from the perspective of the consumers who bought them (11/29).

Bloomberg: Obamacare: The Result Of All Politics, All The Time
Why were so many stupid, avoidable mistakes made during the preparations for the debut of HealthCare.gov? Why did they go undetected until it was too late? Why did Obama even dare to make his promise that all who wanted to keep their insurance would be able to? Why did it come as such a shock when that promise turned out to be false -- as a moment's thought at any point would have told you it was bound to be? Political dysfunction is part of the answer -- though only part (Clive Crook, 11/27).

Bloomberg: War On Contraception? No, An Attack On Religion
From reading the New York Times, you might think that religious conservatives had started a culture war over whether company health-insurance plans should cover contraception. … That way of looking at the issue will be persuasive if your memory does not extend back two years (Ramesh Ponnuru, 12/1).

The Oregonian: Obamacare Contraception Challenge Has Oregon Implications
Say this for Oregon health care policy: It doesn’t think that private employers should get to make decisions about their workers' contraception choices. Bedrooms are crowded enough these days. But a possible U.S. Supreme Court decision on the subject, concluding that because corporations are people they can hold religious beliefs, could topple not only federal law on the subject but also Oregon law. We could find ourselves with a burst of Uncover Oregon, in more ways than one (David Sarasohn, 11/30).

Dallas Morning News: As GOP States Flip, Where's The Texas Answer On Medicaid?
There's a silver lining in the fumbled rollout of Obamacare, even in Texas. Unfortunately, state leaders want nothing to do with it. While HealthCare.gov was freezing up after its Oct. 1 launch, Medicaid enrollment took off. Texas added almost 12,000 people in the first month. That's four times more than signed up on the federal exchange. And Texas isn't even expanding Medicaid (Mitchell Schnurman, 11/30).

The New York Times: Obamacare's Secret Success
The law establishing Obamacare was officially titled the Patient Protection and Affordable Care Act. And the "affordable" bit wasn't just about subsidizing premiums. It was also supposed to be about "bending the curve" -- slowing the seemingly inexorable rise in health costs. ...  So, how's it going? The health exchanges are off to a famously rocky start, but many, though by no means all, of the cost-control measures have already kicked in. Has the curve been bent? The answer, amazingly, is yes. In fact, the slowdown in health costs has been dramatic (Paul Krugman, 11/28). 

The Wall Street Journal: Obamacare's Next Legal Challenge
As millions of Americans see their health-insurance premiums increase, have their coverage dropped as a result of the Affordable Care Act, and are unable to use the federal exchange, Oklahoma has sued the Obama administration. The Sooner State and several others are trying to stop the government from imposing tax penalties on certain states, businesses and individuals in defiance of the law. If these legal challenges are successful, the deficit spending associated with the new health-care law could be reduced by approximately $700 billion over the next decade (Scott Pruitt, 12/1).

CNN: Better Health Not About Obamacare, It's About You
The website may be working better now, but to me that's not the most important issue. In my mind, the real suspense comes from whether Obamacare will really make us a healthier America, even if it succeeds in its ambitions to dramatically expand coverage. A healthier America: That is the goal we should share as Americans, but access alone won't get us anywhere close. This past spring, the New England Journal of Medicine followed up on an important experiment in Oregon (Dr. Sanjay Gupta, 12/2). 

The Oregonian: Tips To Qualify For Tax Credits On Health Exchanges Like Cover Oregon
She's 61, an on-call receptionist making less than $15,860 a year and not yet eligible for Social Security benefits. She's four years away from qualifying for Medicare, so she needs to buy health insurance to comply with the new federal law requiring coverage. But under the Patient Protection and Affordable Care Act, she earns too little to qualify for a subsidized private health plan on Cover Oregon or any other state or federal exchange. Instead, she qualifies for the Oregon Health Plan, the state's form of Medicaid. "I've never qualified for entitlements and I don't want to use them," Christine said. "I don't feel I should. And I don't want to be on Medicaid either" (Brent Hunsberger, 11/30).

On other subjects --

Los Angeles Times: AIDS Fatigue: A Dangerous Diagnosis
I saw my first AIDS case in 1981, the year the disease was identified. And for most of the time since then, I've conducted laboratory research to better understand the precise mechanisms by which the virus HIV causes AIDS. Lately, however, I've been equally worried about a related condition that is prevalent, persistent and threatens to bankrupt us. People in my world call it AIDS fatigue (Dr. Warner C. Greene, 12/1).

Bloomberg: Why It's OK To Pay Bone-Marrow Donors
Locating a marrow donor is often a needle-in-a-haystack affair. The odds that two random individuals will have the same tissue type are less than 1 in 10,000, and the chances are much lower for blacks. Among the precious few potential donors who are matched, nearly half don’t follow through with the actual donation. Too often, patients don’t survive the time it takes to hunt for another donor. Allowing compensation for donations could enlarge the pool of potential donors and increase the likelihood that compatible donors will follow through (Sally Satel, 12/1).

The New England Journal of Medicine: New Insights into the Dementia Epidemic
The combined effects of longer lives and the dramatic bulge of baby boomers reaching old age will magnify the [dementia] epidemic in future decades. ... Research on preventing late-life dementias should explore ways of reducing risk factors at both the societal and the personal levels. We don't know the extent to which better risk-factor control can reduce dementia rates. However, a potentially ominous trend that could lead to a reversal of the decrease in risk is the growing prevalence of obesity and diabetes among middle-aged and younger people. Other factors to consider in the United States and other countries with increasingly racially and ethnically diverse older populations are changes seen in some groups of second- and third-generation Americans that might drive increased risk for vascular disease (Drs. Eric B. Larson, Kristine Yaffe and Kenneth M. Langa, 11/27).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
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.