Daily Health Policy Report

Friday, December 20, 2013

Last updated: Fri, Dec 20

KHN Original Reporting & Guest Opinion

Health Reform

Administration News

Health Care Marketplace

Medicare

Women's Health

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Expect To Pay More For Your Employer-Sponsored Health Care Next Year

Kaiser Health News staff writer Julie Appleby, working in collaboration with USA Today, reports: "If you're one of the 150 million Americans who get health insurance through your job, prepare to pay more. The new year will likely bring higher deductibles and co-payments, penalties for not joining wellness programs and smaller employer contributions toward family coverage. While some workers and employers blame the federal health law for those changes, benefit experts say the law is mainly accelerating trends that predate it" (Appleby, 12/20). Read the story.

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A Reader Asks: Will My Son Overseas Have To Buy A U.S. Plan?

Kaiser Health News consumer columnist Michelle Andrews answers this readers' question (12/20). Read her response.

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Capsules: Website Repairs Have Not Bolstered Support For The Health Law, Poll Finds; After Exposure, Security Holes Sealed In Minnesota's Health Exchange; N.C. Navigator: We Didn’t Break The Rules

Now on Kaiser Health News’ blog, Jordan Rau reports on a new tracking poll about the health law: "Improvements in the government's insurance Web portal have not translated into stronger public support for the health law, a new poll shows. Nearly half of the public views the law unfavorably this month, while only a third likes it. That’s about the same as in November, when public opinion plummeted after the technologically troubled start of the health care marketplaces, according to the poll from the Kaiser Family Foundation" (Rau, 12/20). 

Also on the blog, Minnesota Public Radio’s Elizabeth Stawicki reports on Minnesota's health exchange: "A security flaw has been fixed on MNsure, Minnesota’s health insurance marketplace — one that had left users vulnerable to data interception by hackers. The fix follows an MPR story last week and a meeting Monday between forensic analyst Mark Lanterman and the state’s chief information security officer, Chris Buse. At the meeting, Lanterman explained how he discovered the flaw and how the state could resolve the problem" (Stawicki, 12/19).

In addition, Jenny Gold sets the record straight about how N.C. navigators were assisting people: "Kaiser Health News learned that the hard way after Rep. Darrell Issa, R-Calif., cited an October KHN blog post in a report about risks of fraud among navigators. We incorrectly reported that navigators with North Carolina nonprofit Mountain Projects, Inc., were mailing in paper applications on behalf of the consumers they helped enroll in the exchange back when the healthcare.gov site wasn’t working reliably" (Gold, 12/20). Check out what else is new on the blog.

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Political Cartoon: 'Where's The Coal?'

Kaiser Health News provides a fresh take on health policy developments with "Where's The Coal?" By Gary Varvel. 

And here's today's health policy haiku:  

ALL I WANT FOR CHRISTMAS...

Look under the tree
There's an unexpected gift: 
Catastrophic plan
-Anonymous  

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

People With Canceled Plans Exempted From Insurance Mandate

In addition, the administration said Thursday that those with canceled plans will be able to buy bare-bones catastrophic plans, regardless of their age, under a hardship exemption.

The New York Times: Another Rule In Health Law Is Scaled Back
Millions of people facing the cancellation of health insurance policies will be allowed to buy catastrophic coverage and will be exempt from penalties if they go without insurance next year, the White House said Thursday night (Pear, 12/19).

Los Angeles Times: Administration Opens First Hole In Health Law Mandate
The Obama administration has opened a small, but potentially important, hole in a key requirement of the new healthcare law, letting some people who have had insurance policies cancelled avoid the requirement to buy coverage next year. The change, announced Thursday night in a letter that Health and Human Services Secretary Kathleen Sebelius sent to a group of senators, marks the first exception the administration has allowed to the law's so-called individual mandate (Lauter, 12/19).

The Washington Post: Obama Administration Relaxes Rules Of Health-Care Law Four Days Before Deadline
The rule change was issued in a bulletin from the Department of Health and Human Services. It is the second major response by the Obama administration to a public and political furor that erupted in the fall when several million people who bought their own insurance began to receive notices that their policies were being canceled because they fell short of new benefit standards. The cancellations prompted complaints that President Obama had reneged on an oft-repeated promise that, under the Affordable Care Act, people who like their health plans could keep them (Goldstein, 12/19).

The Associated Press/Washington Post: Options Set For Those Lacking New Health Coverage
Under another stopgap option Sebelius announced Thursday, those whose plans were canceled will be able to buy a bare-bones catastrophic plan regardless of their age. Such plans had been intended for those under 30. A dedicated hotline for people who got cancellations, 1-866-837-0677, is being set up by the Health and Human Services Department as part of the effort to head off more bad news coming from the chaotic rollout of President Barack Obama’s health care law (12/20).

The Wall Street Journal: White House Will Allow Some To Buy Catastrophic Health Plans
Health and Human Services Secretary Kathleen Sebelius told a group of six senators in a letter that people whose policies had been canceled because of new requirements under the Affordable Care Act would be allowed to purchase "catastrophic" plans. Those plans previously had been restricted under the new law to people under the age of 30 or those who qualified for a set of specific hardship exemptions (Radnofsky, 12/19).

Reuters: Last-Minute Obamacare Exemption For Those With Canceled Plans
The Obama administration made a major last-minute policy shift on Thursday, saying the change would help Americans meet a looming deadline to replace insurance plans canceled because of new standards under Obamacare reforms. Health and Human Services Secretary Kathleen Sebelius said that this group of people - estimated by the administration to be fewer than 500,000 in number - will be allowed to claim a "hardship exemption" from the requirement in the 2010 Affordable Care Act to buy insurance (Rampton, 12/19).

Bloomberg: Obama Lifts Insurance Mandate For People With Canceled Policies
Americans whose health-insurance policies are being canceled because they don’t comply with Obamacare requirements will be exempt from the law’s mandate that they carry insurance, under a policy change the Obama administration announced late today. The change, which administration officials said will affect fewer than 500,000 people, comes days before a Dec. 23 deadline for people to buy new coverage effective Jan. 1 (Wayne and Talev, 12/19).

The Hill: HHS Changes Rules On O-Care Mandate
The Obama administration announced Thursday it would broaden exemptions from ObamaCare's requirement that people have insurance. It said it would allow individuals whose health insurance was cancelled under ObamaCare to buy catastrophic plans once intended mainly for young people (Viebeck, 12/20).

CQ HealthBeat: White House To Allow People With Canceled Health Plans To Buy Catastrophic Coverage
The Obama administration is planning to announce that it will permit Americans recently hit with notices that their insurance policies are canceled to buy catastrophic coverage plans regardless of their age, according to an insurance industry source. There are also reports from an insurance industry consultant that the administration may exempt those consumers from the individual mandate in 2014 (Reichard, 12/19).

The CT Mirror: Feds Announce New Option For Insurance Customers Facing Cancellation
The federal government on Thursday offered a new option to people whose health plans are being discontinued, allowing them to purchase “catastrophic” insurance policies with high deductibles that the federal health care law prohibits most people from buying. The announcement, less than two weeks before the first insurance policies sold as part of the Affordable Care Act take effect, drew sharp criticism from the trade group representing health insurance companies. “This latest rule change could cause significant instability in the marketplace and lead to further confusion and disruption for consumers,” Karen Ignagni, president and CEO of America’s Health Insurance Plans, said in a statement (Becker, 12/20).

CNN: White House Announces Option To Buy Catastrophic Coverage
The White House said Thursday that far fewer people than critics projected had lost their insurance plans and failed to get new coverage since the rollout of the Affordable Care Act, also known as Obamacare. The Obama administration also said it would allow those Americans who had their individual insurance policies canceled due to Obamacare to buy catastrophic coverage, as an option so they do not fall through the cracks at the start of the year. “This is a commonsense clarification of the law. For the limited number of consumers whose plans have been cancelled and are seeking coverage, this is one more option," Health and Human Services spokesperson Joanne Peters told CNN (Liptak, 12/19).

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500,000 With Canceled Health Plans Still Lack Coverage

An estimated 500,000 people who received cancellation notices have not yet signed up for new coverage, administration officials said Thursday. That’s far fewer than the millions that health law critics said would lack insurance after their old policies were terminated because they didn’t meet new standards under the health law.

Los Angeles Times: Health Insurance Cancellation Notices Leave 500,000 Uncovered
Fewer than 500,000 people who received health insurance cancellation notices have not yet signed up for new coverage, Obama administration officials said Thursday. The senior administration officials said they had arrived at the estimate over weeks of contacting insurers and combing through the administration's own enrollment data (Hennessey, 12/19).

The Associated Press: 500K With Canceled Health Plans Lack Coverage
The cancellations have become a nagging problem for the White House. President Barack Obama repeatedly promised that people who liked their insurance could keep it under the new health law. Officials say that number could shrink in the coming days (Pace, 12/19).

McClatchy: Only 500,000 People With Cancelled Policies Will Lose Health Care Coverage
Fewer than 500,000 people who had their individual insurance policies cancelled will be without coverage on January 1, the Obama administration estimated Thursday. That's far less than the millions of people that health law critics said would lack insurance after their old policies were terminated because they didn't meet new minimal standards under the Affordable Care Act. Republican lawmakers and conservative groups had maintained that anywhere from four to 14 million people might be without coverage because of the cancellations and difficulty enrolling in new coverage due to technical problems on HealthCare.gov (Pugh and Clark, 12/20). 

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Despite Repairs To Health Website, Concerns Remain And Lagging Enrollment Could Create Problems

The Associated Press examines concerns that young people may not sign up for coverage as part of the law. Other news organizations report on a new poll, some of the problems insurers face and security issues.

The Associated Press: Overhaul Website Problems May Trigger Price Hikes
Problems with the government's main health care overhaul website carry a bigger risk than frequent crashes: Higher prices could follow for many Americans if technical troubles scare off young people. The government has touted recent improvements to HeathCare.gov, which millions of Americans are expected to use to sign up for coverage. But enrollment still lags far behind projections, and that has triggered worries that legions of potential customers in their 20s and 30s might not sign up. If that happens — and older, sicker people continue to register in larger numbers — insurers might have to raise future prices to address the imbalance (Murphy, 12/19).

Kaiser Health News: Capsules: Website Repairs Have Not Bolstered Support For The Health Law, Poll Finds
Improvements in the government's insurance Web portal have not translated into stronger public support for the health law, a new poll shows. Nearly half of the public views the law unfavorably this month, while only a third likes it. That's about the same as in November, when public opinion plummeted after the technologically troubled start of the health care marketplaces, according to the poll from the Kaiser Family Foundation (Rau, 12/20).

The Wall Street Journal: Last-Minute Health-Site Enrollment Proves A Hard Sell
Insurers pressing for last-minute enrollees under the health-care law say they are running into a worrisome trend: Customers who were put off by the insurance marketplaces' early troubles are proving hard sells. Many people thwarted by the technical problems of HealthCare.gov are reluctant to try again, citing frustration with the federal site, web-security concerns and the pressure of the holidays, several insurers say (Martin and Weaver, 12/19).

CQ HealthBeat: Insurers Must Use Temporary Process To Gather Marketplace Information To Get Paid
Insurance companies in every state are scrambling to figure out by Friday how much money the federal government owes them for consumers' health tax credit subsidies. If the companies don't submit bills under a recently-created process, they won't get federal payments to offset their costs of discounting coverage in the health law’s insurance marketplaces (Adams, 12/19).

ABC News: Exclusive: Security Risks Seen At HealthCare.Gov Ahead Of Sign-Up Deadline
Nearly three months after its launch and as millions of Americans log on to shop for health plans, HealthCare.gov still has serious security vulnerabilities, according to documents and testimony obtained exclusively by ABC News. There have been "two high findings" of risk – the most serious level of concern – in testing over the past few weeks, the top Centers for Medicare and Medicaid Services (CMS) cybersecurity official told the House Oversight Committee on Tuesday in a private transcribed interview. It's a "vulnerability in the system," CMS chief information security officer Teresa Fryer told the committee of one of the issues. "They shut the module down, so this functionality is currently shut down" (Dwyer, 12/20).

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States Report Surges In Health Plan Sign-Ups; California At The Front Of The Pack

The increase has ranged from 30 percent to 40 percent, reports ABC News. In California, an estimated 50,000 people picked a health plan in the first week of December. News outlets also reported on the latest developments in Maryland, Oregon and Minnesota.  

ABC News: States Cite Surge In Obamacare Sign-Ups Ahead Of First Deadline
States running their own Obamacare insurance exchanges are reporting a significant surge in sign-ups just four days before the first major enrollment deadline. The increase has ranged from 30 percent to 40 percent in the past few weeks, according to state officials who briefed reporters Wednesday. Monday is the last day to sign up for a plan that will guarantee health coverage effective Jan. 1. California, which has one of the most successful programs, averaged 15,000 enrollments a day last week, up from an average 7,000 a day the week before, state officials said. In all of November, 80,000 Californians picked a plan; in the first week of December, 50,000 signed up (Dwyer, 12/19).

Los Angeles Times: State Healthcare Exchange Reports Share Increase In Enrollment
California's health insurance exchange reported sharply higher enrollment ahead of Monday's sign-up deadline for Jan. 1 coverage, amid mounting criticism over how it handles consumer privacy. The Covered California exchange said Thursday that 53,510 people enrolled in health plans over a three-day period this week, culminating with more than 20,000 people picking an insurance company on Wednesday alone. Last week, about 15,000 people were enrolling daily (Terhune, 12/19).

The Sacramento Bee: More Than 50K Californians Enroll In Obamacare In Three-Day Period
Covered California, the state's health insurance exchange, is experiencing a significant surge in enrollment, officials said Thursday. More than 53,500 customers selected health coverage plans in the last three days - about 60 percent more than the entire month of October when the exchange opened for business. That includes 20,506 customers Wednesday, 19,351 Tuesday and 13,653 Monday, Executive Director Peter V. Lee told reporters. He said the increases illustrate how hundreds of thousands of residents are "anxious, excited and determined to get coverage” (Cadelago, 12/19).

The Washington Post: Gansler: Maryland’s Health Exchange Reminds Him Of ‘Saturday Night Live’ Sketch
Gansler, a Democratic candidate for governor, has been highly critical of the role played by his rival, Lt. Gov. Anthony G. Brown (D), in overseeing the implementation of the federal health care law in Maryland. Brown co-chairs a council that has guided reforms in the state but has said he was not involved in the day-to-day operations of the exchange (Wagner, 12/19).

The Associated Press: Oregon Health Care Official Carolyn Lawson Resigns
A senior state manager who oversaw most of the development of Oregon's struggling health insurance exchange resigned Thursday as developers continue trying to find some way get the online enrollment system to work. Carolyn Lawson stepped down as chief information officer of the Oregon Health Authority and the Department of Human Services for "personal reasons," the agencies' leaders wrote in a terse memo to Lawson's staff and other senior officials (12/19).

The Oregonian: Cover Oregon, Insurers Extend Premium Payment Deadline To Jan. 15
Health insurance carriers and the state's troubled exchange agreed to give individuals buying coverage on Cover Oregon more time to pay their first binding premium. Consumers purchasing individual polices through Cover Oregon will have until Jan. 15 to get their first premium payment to the insurer, exchange spokesman Michael Cox said late Thursday. Coverage will be retroactive to Jan. 1. Washington's exchange announced the same extension on Wednesday, and insurers nationwide are giving consumers buying coverage on other federal and state exchanges until Jan. 10 to make a payment. The moves are being made to address technological hangups and other problems the exchanges are having meeting initial enrollment deadlines (Hunsberger, 12/19).

Minnesota Public Radio: Dayton On MNsure Problems: 'The Buck Stops Here'
DFL Gov. Mark Dayton wouldn’t say today whether he asked April Todd-Malmlov to resign earlier this week as director of Minnesota’s new health insurance exchange. Dayton declined to answer the question several times during a state Capitol news conference, which was his first public appearance since Todd-Malmlov tendered her resignation Tuesday. Dayton said he has indirect influence over the MNsure board and had publicly expressed his displeasure with recent enrollment problems. But he stressed that the independent MNsure board has sole authority over personnel decisions (Pugmire, 12/19).

Minnesota Public Radio: MNsure Officials, Insurance Companies Consider Deadline Extension
Five of the state's insurance companies and officials with the state's online health insurance marketplace are discussing a possible extension to a key deadline for people to obtain health insurance. Under current rules, consumers who use the MNsure site must pick a plan by Dec. 23 to be covered on Jan. 1. But in the midst of ongoing technical problems with the site that are preventing people from signing up, extending the deadline is a good idea, MNsure Board Chair Brian Beutner said (Richert, 12/19).

Kaiser Health News: Capsules: After Exposure, Security Holes Sealed In Minnesota's Health Exchange
A security flaw has been fixed on MNsure, Minnesota’s health insurance marketplace — one that had left users vulnerable to data interception by hackers. The fix follows an MPR story last week and a meeting Monday between forensic analyst Mark Lanterman and the state’s chief information security officer, Chris Buse. At the meeting, Lanterman explained how he discovered the flaw and how the state could resolve the problem (Stawicki, 12/19).

Pioneer Press: MNsure ‘Tech Surge’ To Rescue Health Exchange; Call Center Average Waits Top 90 Minutes
A "tech surge" has been launched at MNsure headquarters in St. Paul, with IBM workers brought in to try to rescue an overwhelmed call center and free about 1,100 insurance applications stuck in computer limbo. No state money is being spent on the extra workers, Jenni Bowring-McDonough, a MNsure spokeswoman, said in a statement (Snowbeck, 12/19).

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Medicaid Expansion Plans In Pa., Wis. Under Scrutiny

Pennsylvania advocates challenge the penalties and premium costs in Gov. Tom Corbett's proposed Medicaid expansion plan. Meanwhile, more than 70,000 low-income Wisconsin adults would keep their state BadgerCare Plus coverage for three months and a larger and poorer group would wait the same 90 days to enter the program under a GOP plan expected to become law in Wisconsin. 

The Philadelphia Inquirer: Health Experts On Pa. Plan: Any Premium Too High For Poor
Tens of thousands of low-income Pennsylvanians would pay higher premiums in 2015 under Gov. Corbett's proposed Medicaid expansion than they would in 2014 for similar policies on the Affordable Care Act exchange. Some health-policy experts are concerned about the disparity, although coverage through Corbett's private-market alternative in most cases would still be cheaper, because there are virtually no out-of-pocket costs (Sapatkin, 12/19).

The Associated Press: Wisconsin Senate Passes Medicaid Delay
Around 83,000 childless adults in Wisconsin will have to wait at least three more months to receive Medicaid after state senators voted Thursday to delay their coverage while also pushing back the removal of about 72,000 other residents from the program. The Republican-controlled Senate passed the bill 18-12 along party lines, sending the measure to Gov. Scott Walker, who has said he'll sign it Friday. The Assembly passed it earlier this month (Bauer, 12/19).

The Milwaukee Journal Sentinel: Senate Adopts Plan On BadgerCare Changes In Response To Obamacare Problems
More than 70,000 low-income adults would keep their state BadgerCare Plus health coverage for three more months and a larger and poorer group would wait the same 90 days to enter the program for the first time, under a plan advanced by the state Senate Thursday. The legislation passed 18-12, with all Republicans voting in favor and all Democrats opposing it, and now goes to Republican Gov. Scott Walker, who first proposed the measure to deal with the troubled rollout of the federal law often referred to as Obamacare. Sen. Dale Schultz (R-Richland Center) voted for the final bill but joined all Democrats in voting for several failed amendments that would have provided BadgerCare coverage to more Wisconsinites in January. Walker said he would sign the bill Friday (Stein, 12/19).

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Administration News

Obama's Aides Stay On Despite Exhaustion, Health Law Woes

President Obama's aides are largely staying attached to his administration to help bolster the president's approval ratings amid the health law's considerable problems. In the meantime, the law's proponents are pushing new ways of selling the law.

The New York Times: With Obama Now In Need, Aides Put Off Their Exits
In any White House, the end of the year typically brings staff changes, especially as exhaustion sets in during the later years of an administration. But the Obama team has been as tested as any in decades: by economic calamity, the winding down of two wars, an expansive domestic agenda, various international crises and, lately, the trouble-filled execution of the most ambitious health care program since Medicare. Controversy over the health care law has helped drive Mr. Obama's approval ratings to new lows, a trend that the White House is scrambling to reverse. Longtime aides who stayed with the president into the second term -- thinking that they would remain for months or a year to help with the transition -- are now feeling pressured to extend their service, officials said (Calmes, 12/19).

Politico: For Obamacare Boosters, All Memes Are Good Memes
When it comes to marketing Obamacare, all memes are good memes. So say progressive activists and Democratic strategists, pushing back against a wave of fresh criticism that mocks their youth outreach efforts as somewhere between slightly awkward and totally tone-deaf (Tau, 12/19).

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Health Care Marketplace

Get Ready To Pay More For Health Coverage, But It May Not Be Just Health Law's Fault

Although many blame the health law for all recent health care cost increases, trends that bump up the cost of care were in place before the law was enacted and are being driven up even more by routine costs, some say.

Kaiser Health News: Expect To Pay More For Your Employer-Sponsored Health Care Next Year
If you're one of the 150 million Americans who get health insurance through your job, prepare to pay more. The new year will likely bring higher deductibles and co-payments, penalties for not joining wellness programs and smaller employer contributions toward family coverage. While some workers and employers blame the federal health law for those changes, benefit experts say the law is mainly accelerating trends that predate it (Appleby, 12/20).

USA Today: Study: Routine Costs, Not Law, Lead To Most New Increases
Routine costs, not requirements of the Affordable Care Act, contributed to the majority of health insurance rate increases in the last year, a new study released Thursday shows. "It wasn't driven by utilization of the services, but the unit costs," said Mike McCue, lead author of the study by The Commonwealth Fund, a nonprofit group devoted to improving health services for Americans. "That will continue to be a major driver moving forward -- trying to control those medical expenses -- if they want to remain profitable" (Kennedy, 12/19).

And big tax preparation firms plan to help educate customers on how they can sign up for health law insurance coverage --

Politico: 'Tis The Season For Health And Taxes
Firms like Jackson Hewitt and H&R Block are offering health insurance checkups during the 2014 tax preparation season to explain Obamacare options to their customers, many of whom will qualify for federal tax credits to help afford health coverage but may not know it. The firms are partnering with web insurance brokers who will help people sign up as they're filing their taxes -- which in turn gives them cash on hand from tax refunds to help them pay their share of the premiums (Cunningham, 12/19).

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Medicare

Report: Examine High-Billing Docs' Medicare Billing To Root Out Fraud

A report from the Department of Health and Human Services' inspector general to be released Friday will call for closer scrutiny of doctors' total billing. Elsewhere, ProPublica looks at how ineffective federal oversight is in looking for fraud in Medicare prescribing.

The Wall Street Journal: Medicare Auditors Urged To Check Doctors' Total Billing To Prevent Fraud
Flagging doctors who bill more than $3 million a year could help prevent overbilling and save Medicare millions of dollars each year, said the report set to be released Friday by the inspector general at the Department of Health and Human Services. Obama administration officials said they were considering implementing the report's suggestions as part of efforts to root out Medicare fraud (Schatz, 12/20).

ProPublica: 'Let The Crime Spree Begin': How Fraud Flourishes In Medicare's Drug Plan
With just a handful of prescriptions to his name, psychiatrist Ernest Bagner III was barely a blip in Medicare's vast drug program in 2009. But the next year he began churning them out at a furious rate. Not just the psych drugs expected in his specialty, but expensive pills for asthma and high cholesterol, heartburn and blood clots (Weber and Ornstein, 12/19).

And officials hope to ease restrictions on Medicare telemedicine --

Medpage Today: Medicare To Expand Telemedicine Use
Medicare officials and members of Congress are taking steps to expand the use of telemedicine services by dropping -- or proposing to drop -- restrictions on their use. Both the 2014 Medicare physician fee schedule and legislation to repeal the program's sustainable growth rate (SGR) payment formula have provisions designed to improve access to telemedicine (Pittman, 12/19).

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Women's Health

Poll Finds Very Mixed Views On Morning-After Pill; Black/White Breast Cancer Disparities Widen

Several stories this morning examine tricky problems in women's health care.

NPR: Poll: Americans Favor Age Restrictions On Morning-After Pill
First, we found out [in the NPR-Truven Health Analytics Health Poll] that most people are familiar that there is a morning-after pill. ... Eighteen percent said there should be no age minimum. Around the same proportion — 17 percent — said a prescription should always be required, regardless of the buyer's age. ... About two-thirds of respondents believe that parents should have to give their permission before anyone under 18 buys the morning-after pill without a prescription. That's not a requirement now. ... Finally, most Americans believe insurers should pay for the morning-after pill(Hensley, 12/19).

The New York Times: Tackling A Racial Gap In Breast Cancer Survival
Despite 20 years of pink ribbon awareness campaigns and numerous advances in medical treatment that have sharply improved survival rates for women with breast cancer in the United States, the vast majority of those gains have largely bypassed black women. ... In the 1980s, breast cancer survival rates for the two were nearly identical. But since 1991, as improvements in screening and treatment came into use, the gap has widened, with no signs of abating. Although breast cancer is diagnosed in far more white women, black women are far more likely to die of the disease  (Parker-Pope, 12/20).

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State Watch

State Highlights: Calif. Lawmaker Seeks To Re-Fund Mentally Ill Criminal Program; Texas BCBS, HCA Reach Contract Agreement

A selection of health policy stories from California and Texas.

Los Angeles Times: Steinberg Seeks To Restore Mental Health Funds For Criminals
Senate leader Darrell Steinberg (D-Sacramento) said Thursday that he will seek to restore a state program that funded county services for mentally ill people who run afoul of the law. After a decade of state funding, the Mentally Ill Offender Crime Reduction Grants ceased in 2008 due to budget cuts. Steinberg wants to restore funding, starting with $50 million in the next budget year. But that money is contingent on whether Gov. Jerry Brown receives a delay in a federal court order to reduce state prison crowding (St. John, 12/19).

The Dallas Morning News: Blue Cross Blue Shield Of Texas And HCA Reach Agreement 
HCA, one of the largest health care providers in North Texas, and Blue Cross Blue Shield of Texas have reached agreement on a contract, just days before their existing contract was to expire. The deal means that HCA's facilities, including Medical City Dallas Hospital, will remain in network for patients covered by BCBSTx, the state's largest insurer (Jacobson, 12/19).

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Health Policy Research

Research Roundup: ACA 'Can Survive' Low Enrollment; Rural/Urban Differences In O.B. Care; Teaching Residents Cost Consciousness

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

Health Affairs: The Health Reform Monitoring Survey: Addressing Data Gaps To Provide Timely Insights Into The Affordable Care Act
The Health Reform Monitoring Survey (HRMS) was launched in 2013 as a mechanism to obtain timely information on the Affordable Care Act (ACA) ... HRMS data from summer 2013 show that more than 60 percent of those targeted by the health insurance exchanges struggle with understanding key health insurance concepts. This raises concerns about some people's ability to evaluate trade-offs when choosing health insurance plans. Assisting people as they attempt to enroll in health coverage will require targeted education efforts and staff to support those with low health insurance literacy (Long et al., 12/18).

Urban Institute/Robert Wood Johnson Foundation: The Affordable Care Act Can Survive Low Enrollment And Adverse Selection in the First Year
[S]ome adverse selection in the early years of implementation was anticipated by policy-makers. ... Second, ... [c]omponents of the ACA, such as financial assistance for the low-income (who are disproportionately young adults) and lower premiums for young adults than older adults (due to age rating), will tend to increase enrollment among the healthier populations. Third, while insurers may experience some losses in 2014 if adverse selection occurs, market competition will make it difficult for them to recoup those losses in 2015 by increasing premiums substantially (Blumberg and Holahan, Dec. 2013).

JAMA Internal Medicine: Teaching Residents To Provide Cost-Conscious Care
In August 2012, the Association of Program Directors in Internal Medicine (APDIM) electronically surveyed its membership on the state of cost-conscious care curricula as part of an annual survey of residency program directors. ... Despite the national consensus among policy makers and educators on medical education's role in cost conscious care, less than 15% of programs had a formal curriculum, while approximately 50% of programs were working on one. Use of robust teaching and assessment methods linked to practice change was limited. While faculty were the most frequently reported evaluator of resident competence in cost-conscious care, many program directors believed that their faculty did not consistently role model cost-conscious behavior (Patel et al., 12/17).

Medical Care: Rural-Urban Differences In Obstetric Care, 2002-2010, And Implications For The Future
This was a retrospective analysis of hospital discharge records for all births in the 2002–2010 Nationwide Inpatient Sample. ... In 2010, low-risk cesarean rates in rural and urban hospitals were 15.5% and 16.1%, respectively, and nonindicated cesarean rates were 16.9% and 17.8%, respectively. ... Between 2002 and 2010, rates of low-risk cesarean and nonindicated cesarean increased, and vaginal birth after cesarean (VBAC) rates decreased in both rural and urban hospitals. ... Nonindicated labor induction rates rose disproportionately faster in rural versus urban settings. Tailored clinical and policy tools are required to address differences between rural and urban hospitals (Kozhimannil et al., Jan. 2014).

California HealthCare Foundation: Monitoring Performance: A Dashboard Of Medi-Cal Managed Care
Medi-Cal managed care performs at or above the national Medicaid median on 17 of 19 quality indicators. On the two measures for which Medi-Cal lags behind the national median -- postpartum care and timeliness of prenatal care -- the gap has persisted over the last four years. On most measures of consumer experience, the program performs below the national Medicaid median. Across all measures of quality, access, and consumer satisfaction, there are considerable differences in performance among participating plans, including significant variation in plan performance within counties. Most plans participating in Medi-Cal appear to be in sound financial health (Dec. 2013).

Health Affairs: Young Adults And The Affordable Care Act
The ACA aims to substantially boost the number of Americans with health care coverage in the United States, and young adults are a prominent part of that goal--three out of ten legal US residents are ages 19-29. This age group has historically been uninsured at far higher rates than any other group. ... Cost, not hubris, appears to be the determining factor. ... It is young adults with low and moderate incomes who continue to suffer from the highest rates of uninsurance (Goldman, 12/16).

BMJ: Following Celebrities' Medical Advice: Meta-Narrative Analysis
Whether motivated by good intentions or financial rewards, celebrities can generate much publicity for health campaigns by virtue of their visibility, public interest, and perceived newsworthiness. ... But the messages espoused by celebrities can also conflict with those recommended by health professionals, public health authorities, and the best available research evidence. ... Health professionals can counter the negative influences of celebrities. ... Those times when patients mention the latest celebrity endorsement should be seen as meaningful opportunities to start important educational conversations rather than as annoyances (Hoffman and Tan, 12/17).

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

Modern Healthcare: Medical Costs, Not ACA, Blamed Most For Big Insurance Hikes So Far
Roughly half of the health plans that filed for premium increases of 10% or more from July 2012 to June 2013 put some of the blame on the Patient Protection and Affordable Care Act. But the vast majority of the hikes were attributed to medical costs and other routine factors, according to a new report by the Commonwealth Fund. "Overall, the Affordable Care Act's benefit mandates and insurer fees had only a minor effect on insurers' larger rate increases prior to 2014," concluded the report (Demko, 12/19).

Medscape: Doctors Who Favor Hospice More Likely To Discuss It
Physicians who would choose hospice care for themselves are more likely to discuss the option in a timely manner with patients than physicians who are less interested in personal hospice care, according to a research letter published online December 16 in JAMA Internal Medicine. Many physicians delay recommending hospice care for terminally ill patients for a variety of reasons. Garrett M. Chinn, MD, from the Division of General Medicine, Department of Medicine, Massachusetts General Hospital, and Harvard Medical School, Boston, and colleagues investigated associations between physicians' personal opinions about if and when to start hospice care and how they present the possibility of hospice care to their patients (Lewis, 12/16).

MedPage Today: Report: States Failing On Public Health Front
Most states scored 50% or lower on a report card assessing their ability to respond to infectious disease threats, according to an analysis released Tuesday. Just 16 states and the District of Columbia scored 60% or better on a set of 10 indicators of public health capability, according to the nonprofit Washington-based Trust for America's Health (TFAH) and the Robert Wood Johnson Foundation, based in Princeton, N.J. (Smith, 12/17).

Reuters: U.S. Hospital Admissions Weakest In A Decade: Citi Analyst
U.S. hospital admissions in November were the weakest in more than a decade, under pressure from a change in reimbursement rules for Medicare patients and confusion tied to the problem-ridden rollout of Obamacare, according to a survey by Citi Research. New billing rules for the Medicare program for the elderly and disabled require hospitals to treat patient stays lasting less than "two midnights" as an outpatient visit (Kelly, 12/17).

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Editorials and Opinions

Viewpoints: Health Announcement Creates 'Utter Chaos;' A Serious Chip In The Individual Mandate; Law's Benefits Aren't Free

Forbes: Utter Chaos: White House Exempts Millions From Obamacare's Insurance Mandate, 'Unaffordable' Exchanges
Last night, in a stunning reversal, the Centers for Medicare and Medicaid Services announced that Americans who have had their plans canceled will be exempt from enrolling in the exchanges, "because some consumers were finding other coverage options to be more expensive than their cancelled plans or policies." ... But this most recent announcement from the Obama administration is the first time it has publicly admitted that Obamacare is making health insurance less affordable, not more so, for millions of Americans. ... This decision by the administration—characterized by HHS Secretary Kathleen Sebelius as an attempt to provide "the smoothest possible transition" into the Obamacare era—has instead thrown the individual insurance market into chaos (Avik Roy, 12/20).

The Washington Post: The Individual Mandate No Longer Applies To People Whose Plans Were Canceled
This puts the first crack in the individual mandate. The question is whether it's the last. If Democratic members of Congress see this as solving their political problem with people whose plans have been canceled, it could help them stand against Republican efforts to delay the individual mandate. But if congressional Democrats use this ruling as an excuse to delay or otherwise de-fang the individual mandate for anyone who doesn't want to pay for insurance under Obamacare, then it'll be a very big problem for the law (Ezra Klein, 12/20).

The New York Times’ Economix: The Economics Of Being Kinder And Gentler In Health Care
In the late 1980s, about 35 million respondents to large nationwide surveys declared that they lacked health insurance of any kind. The comparable number now is close to 50 million. Then, as now, the endless "national conversation" went on and on, pondering ways to achieve truly universal health insurance coverage, a feat most other developed nations accomplished long ago (Uwe E. Reinhardt, 12/20). 

Los Angeles Times: Note To The White House: Obamacare's Benefits Aren't Free
With Republicans hoping to make next year's election another referendum on the 2010 healthcare law (better known as Obamacare), the White House issued a report Thursday aimed at those calling for the law to be overturned. "Repeal Would Raise Costs, Strip Protections from Families Across America," the report declares. The Times' editorial board has steadfastly supported the Patient Protection and Affordable Care Act, warts and all, because it makes a credible effort to make a more sustainable healthcare system. But it's disingenuous to pretend that the changes mandated by the law cost nothing or that the benefits it delivers magically arrive for free (Jon Healey, 12/19).

Los Angeles Times: Why You Should Stop Worrying About The Obamacare 'Death Spiral'
Among the many reasons often put forth for why the Affordable Care Act is supposedly doomed to failure -- put forth with hand-wringing by the act's supporters and with gleeful anticipation by its opponents -- is the sinister-sounding "death spiral." Like many concepts in the health insurance business, this one is highly complicated, nuanced and easily reduced to a sound bite. The Kaiser Family Foundation has now come out with a paper explaining why it's not the threat it's made out to be (Michael Hiltzik, 12/19).

The Washington Post: Story Of The Year
Obamacare was sold as simply a refinement of the current system, retaining competition among independent insurers but making things more efficient, fair and generous. Free contraceptives for Sandra Fluke. Free mammograms and checkups for you and me. Free (or subsidized) insurance for some 30 million uninsured. And, mirabile dictu, not costing the government a dime. In fact, Obamacare is a full-scale federal takeover (Charles Krauthammer, 12/19).

MinnPost: Beyond Frustrated With MNsure
I really didn't think I would be personally impacted by all of the problems plaguing MNsure, Minnesota's online health insurance exchange. But, oh, how wrong I was about that. First, a little background: Since completing a MNsure application on November 25, I've been waiting to see if I qualify for a subsidy. I got a response in 2 ½ weeks, which is a positive. ... Friday I learned that I don’t qualify for assistance, although trained assisters guiding me through the application process said I should qualify based on income guidelines. ... Then, on Monday, a MNsure rep called. Due to "technical errors, calculations were incorrect" and I may, indeed, qualify for assistance or a credit, she said. ... But then she dropped the bombshell: I would need to resubmit my application. Are you kidding? (Audrey Letscher Helbling, 12/19).

And on another topic -

The Washington Post: Hope For A Breakthrough In AIDS Research
In 1987, two medical researchers, Anthony Fauci and Cliff Lane, conducted the first clinical trial of an AIDS vaccine. They took the envelope that surrounds the virus and simply injected it into study participants, hoping to get an immune response — an approach that had worked on hepatitis B. It failed on AIDS. Thus began one of history’s most consequential scientific detective stories (Michael Gerson, 12/19).

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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.