Daily Health Policy Report

Friday, December 6, 2013

Last updated: Fri, Dec 6

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

What Happens If My Income Changes After I Receive An Insurance Subsidy?

Kaiser Health News consumer columnist Michelle Andrews answers a reader’s question about subsidies and buying insurance on the health law’s new exchanges (12/6). Read her response.

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Political Cartoon: 'Hacked Off?'

Kaiser Health News provides a fresh take on health policy developments with "Hacked Off?" by Chip Bok. 

Here's today's health policy haiku:  

A SURPRISE UNDER THE TREE?

The perfect Christmas
gift? Ask Santa Claus -- he knows...
It's health insurance.
-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

Healthcare.gov Is On The Mend, What's Next?

News outlets report on the key tasks ahead -- enrolling enough people to stabilize the insurance market and covering people whose policies were canceled. 

The Associated Press: Obama’s Fixer-Upper Website Races To Catch Up
It looks like President Barack Obama’s fickle health insurance website is finally starting to put up some respectable sign-up numbers, but its job only seems to have gotten harder. Two months in and out of the repair shop have left significantly less time to fulfill the White House goal of enrolling 7 million people by the end of open enrollment on March 31 (Alonso-Zaldivar, 12/6).

Politico: Next Up: Obamacare Worst-Case Scenario?
Enrollment surge or no enrollment surge, the next Obamacare challenge is a big one: How will the White House make sure all those people with canceled policies get new coverage by Jan. 1? At the rate the signups are going — even with the speedier, newly functioning Obamacare website — the administration has a vast distance to travel before the estimated 4 to 5 million people with canceled policies get new health coverage (Nather, 12/6).

McClatchy: Obama’s Prescription For Health Care Law Is PR
The White House's renewed effort to tout the law has two aims -- to encourage Americans to sign up for coverage and to reassure nervous Democratic lawmakers and other allies who have watched Obama's so-far unsuccessful efforts to contain the political damage. ... The messaging push is the latest White House attempt to regain control of a debate that since the Oct. 1 debut of HealthCare.gov has been dominated by discussion of website failures, error rates and software fixes (Hennessey and Parsons, 12/5).

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Snags Emerge Even In States Where Exchanges Are Working

Insurers are reporting behind-the-scenes technical glitches that could undermine Jan. 1 coverage. In addition, news outlets offer progress reports from California, Connecticut, North Carolina, Minnesota and Oregon.  

Politico: State Exchanges Hitting Data Snags, Too
Even in states where Obamacare enrollment is booming, insurance companies are running into significant behind-the-scenes technical glitches that could threaten Jan. 1 health coverage. Many of these 14 states and the District of Columbia have been eager to tout the success of their own exchanges compared with the bungled federal portal, but they now appear to be worrying about back-end problems similar to those afflicting healthcare.gov (Cheney and Millman, 12/6).

Los Angeles Times: State Health Exchange Swamped With Enrollees
California's health exchange is struggling to keep pace with a surge of applicants who are encountering long waits and website problems as they try to meet a Dec. 23 deadline. In response to higher-than-expected demand, the Covered California exchange said it is adding staff and expanding its capacity to answer consumer calls. It received 17,000 calls in less than an hour Wednesday, more than it received in an entire day in recent weeks. The exchange is also trying to dig through a backlog of 25,000 paper applications filed in October and November (Terhune, 12/5).

The Associated Press/Washington Post: Santa's Big Surprise -- A Health Insurance E-Card?
California's health insurance exchange Thursday urged holiday shoppers to think about giving young people "the gift of health." Some suggestions from Covered California: Help a young adult pay for coverage, or send an e-card with a personal message and information about the federal health care overhaul. There's also a website where family members can pledge to help get relatives coverage (12/5).

The CT Mirror: CT's Obamacare Exchange Applications Surging This Week
Application activity for the state's health insurance exchange has skyrocketed this week, with close to 1,000 people signing up for coverage each day. That compares to a previous peak of 3,544 enrollees for the entire week before Thanksgiving. "The surge is now," said Peter Van Loon, chief operating officer for the exchange, known as Access Health CT. He noted that the exchange's call center has been getting an average of 2,400 calls per day this week (Becker, 12/6).

Los Angeles Times: A Health Care Navigator In Unfriendly Waters
Rascoe is one of thousands of foot soldiers hired nationwide to sign Americans up for coverage under President Obama's Affordable Care Act. Her task is made all the more challenging because she works in one of the Republican-led states openly hostile to the act. The GOP-controlled Legislature ordered state health officials not to cooperate with the federal program. Many of the people in this rural swath of North Carolina -- despite being among the neediest potential beneficiaries of Obamacare -- remain skeptical and uninformed (Bennett, 12/6).

MinnPost: MNsure Officials Heartened By Latest Health-Insurance Sign-Up Data
MNsure officials said their latest statistics make them confident that enrollment will keep pace with their health insurance targets for the sign-up period that ends in March. Consumer interest in the state’s health exchange doubled -- and in some cases, more than doubled -- in most areas tracked since last month, according to data released Wednesday (Nord, 12/5).

In other news related to state health law policies --

The Oregonian: Oregon Violated Laws By Allowing Health Plans To Be Extended, According To Legislative Lawyers
The Oregon Legislature's lawyers think the state erred when it allowed insurers to extend health plans set to expire this year under the provisions of the Affordable Care Act. More than 140,000 Oregonians faced Dec. 31 cancellations of their health insurance until Oregon Insurance Commissioner Laura Cali announced that insurers could extend those policies until the end of next year (Gaston, 12/5).

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Refusing Medicaid Expansion To Cost States Billions, Study Says

The decision not to participate will costs states billions over the next decade which will be passed onto taxpayers, according to a study by the pro-reform Commonwealth Fund. Meanwhile, Pennsylvania Gov. Tom Corbett begins the process of seeking federal approval for his proposal to use expansion money to help the poor buy private insurance. And the Wisconsin Assembly votes to give those losing Medicaid three more months to sign up for private plans. 

The Associated Press/Washington Post: Feds’ Site Gives States Incomplete Medicaid Data
People shopping for insurance on the federal marketplace may be informed they’re eligible for Medicaid and that their information is being sent to state officials to sign them up. However, states say they aren’t able to enroll them because they’re receiving incomplete data from the Obama administration (12/5).

The Washington Post: Study: Refusing Medicaid Expansion Will Cost States Billions Of Dollars
When the Supreme Court ruled in 2012 that the federal government could not compel states to expand their Medicaid programs under the Affordable Care Act, it gave Republican opponents of the measure the opportunity to decline to participate in one of the law’s central tenets. But a new study estimates the decision not to participate will cost those states billions of dollars over the next decade — costs that will be passed on to taxpayers. The Affordable Care Act requires the federal government to pay 100 percent of the costs of expanding Medicaid for three years. After that period, the law mandates the federal government pay 90 percent of the costs of expansion (Wilson, 12/5).

The Associated Press: Corbett Seeks Federal OK For Alternative Medicaid Plan
Gov. Tom Corbett will begin the formal process Friday of seeking approval for his plan to bring billions of federal Medicaid expansion dollars to Pennsylvania to extend health insurance to half a million working poor. The process will begin with the online posting of Corbett’s approximately 100-page proposal, which lays out more detail surrounding his plan to use the expansion money to help people buy private insurance, rather than cover them under the traditional Medicaid program (Levy, 12/5).

The Associated Press: Assembly Passes Medicaid Delay Bill
As those in Wisconsin working to get people enrolled for health insurance through the federal online marketplace reported progress in recent days, the state Assembly passed a bill Wednesday that would give those losing their Medicaid coverage three more months to sign up for private plans (Bauer, 12/5).

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Consumers Are Not Insured Until They Pay 1st Premium

CNN cautions that it's not enough to sign up for a health law policy -- you need to make that first payment to your insurer. Elsewhere, ProPublica looks at healthcare.gov's back-end system to provide your sign-up information to insurers, and the Obama administration awards $55 million in grants to bolster the health care workforce.

CNN: Obamacare: You're Not Insured Until You Pay
Just because you've picked an Obamacare insurance policy doesn't mean you've got coverage. If you want to be insured come Jan. 1, you have to pay your first month's premium by your insurer's due date, often Dec. 31. Sounds simple enough, but federal officials and insurers are concerned that many consumers don't realize they have to take this last step and will remain uninsured (Luhby, 12/5).

ProPublica: Healthcare.gov's Mysterious New Number: '834' 
Now that the front-end of healthcare.gov appears to be working properly, the media's focus is quickly shifting to the back-end systems that are supposed to provide insurance companies with accurate information about consumers enrolling in their plans. The issue is an important one because if insurance companies get incorrect data, their future customers may not be enrolled properly and that could lead to headaches -- or worse -- come January when patients show up at doctors' offices or hospitals thinking they are insured but really aren't (Ornstein, 12/5).

The Washington Post: Obama Administration Awards $55 Million To Boost Health Care Workforce
The Department of Health and Human Services has awarded $55.5 million in grants to help bolster a health-care workforce that is stretched thin and possibly due for more strain under the Affordable Care Act. The health legislation, known as Obamacare, requires the uninsured to obtain medical coverage, potentially placing more stress on the nation's health care network (Hicks, 12/6).

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Gallup Poll: Most Americans Want Health Law Repealed Or Cut Back

Gallup says there hasn't been much change over the last three years.

The Hill: Majority Want Health Law Repealed On Scaled Back
A majority of people in the United States say they want ObamaCare to be scaled back or repealed altogether. According to a Gallup poll released Friday, 20 percent support a scale-back of the law, while 32 percent back efforts to repeal it (Shabad, 12/6).

Politico: Poll: Obamacare Opposition Ticks Up
Thirty-seven percent said they want the law expanded or kept as is. According to Gallup, since they began polling on the question in January 2011, at least half of Americans have wanted the walked back or repealed in each survey (Kopan, 12/6).

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Capitol Hill Watch

Congress Closes In On Modest Budget Deal

Officials say negotiators are cobbling together a deal that offsets planned sequester cuts, but which includes none of the big reductions in Medicare or other entitlements sought by Republicans, nor any of the tax increases sought by Democrats. Instead, it includes targeted measures, such as increased fees for airport-security and federal guarantees of private pensions.

The New York Times: Congress Nears Modest Accord On The Budget
The deal would increase revenue by raising some fees and would shift some cuts away from domestic and defense programs, partly alleviating the squeeze of across-the-board spending cuts imposed last year, which are set to worsen in 2014. Spending on defense and domestic programs would rise to about $1 trillion for the current fiscal year from $986 billion, the fiscal 2013 level that remains in effect under the continuing resolution passed in October. Absent a deal, further cuts would go into effect in January, and discretionary spending would be cut to $967 billion for fiscal 2014. But the agreement would leave to future negotiations the big issues of curbing future spending increases in the fast-growing entitlement programs and the proper level of tax revenues. It also would not extend unemployment benefits set to expire Dec. 28, or deal with impending cuts to Medicare health care providers (Weisman, 12/5).

The Wall Street Journal: Budget Pact Comes Into View
Officials familiar with the talks say negotiators are stitching together a package of offsets to the planned sequester cuts that would include none of the major cuts in Medicare or other entitlement programs that Mr. Ryan has wanted, nor eliminate any of the tax increases that Ms. Murray sought. Instead, it would include more targeted and arcane measures, such as increased fees for airport-security and federal guarantees of private pensions (Hook, 12/5).

CQ HealthBeat: Little Sequester Relief Seen For Health Agencies, None For Medicare
A budget deal now in the works appears likely to provide little relief from the sequester’s bite on the budgets of federal health agencies —and none at all for the Medicare program. For now, the best-case scenario for relief from the sequester provisions of the budget control law (PL 112-25) appears to be a framework under discussion that would raise spending a modest amount over the rest of this fiscal year in exchange for compensating offsets elsewhere in the budget (Young, 12/5).

CQ HealthBeat: Details Emerge On ‘Doc Fix’ Draft, But Three-Month Patch Still Likely
Lawmakers on House and Senate committees have made a number of changes to their joint, bipartisan proposal to replace how Medicare pays physicians, in hopes of having dual markups on the legislation next week.  The alterations to the draft legislative framework reflect comments from provider and patient groups, as well as other stakeholders (Ethridge, 12/5).

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Capitol Hill Workers Have Extra Month To Get Health Insurance

Washington D.C.'s insurance exchange has been having problems.

The Washington Post: House Extends Current Health Plans For Lawmakers, Staffers, If Needed
Acknowledging widespread issues with the process of enrolling for new health-care coverage, House officials reiterated Thursday that lawmakers and their staffs whose current health insurance is set to be terminated at the end of the year will automatically have that coverage extended until the end of January unless they have already enrolled in new coverage. The reminder from House administrative officials is standard operating procedure for anyone set to lose coverage under the health care program for federal employees (O’Keefe, 12/5).

Politico: House Official Presses OPM On Obamacare
[The House's chief administrative officer] Dan Strodel wrote in a message sent Thursday evening that he is well aware of the struggles that people have faced with the D.C. exchange, where members of Congress and qualifying aides will enroll for their coverage. ... In one of its latest technical problems, the website for D.C. Health Link was down for maintenance earlier Thursday -- the same time that staffers for the exchange were in a Senate office building, trying to help aides sign up (Kim, 12/5).

Roll Call: D.C. Health Link Glitch Causes Headaches At House Health Fair
On Thursday, with about five days left until the end of open enrollment, House staffers trickled out of the health benefits fair with packets of new insurance information and knowledge of a new roadblock. … DC Health Link experienced "technical difficulties with their website," according to a mass email sent to all Senate staff at 11:32 a.m. The glitch meant employees could learn more about the plans being offered by insurance carriers on the site but not enroll (Hess, 12/5).

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State Watch

U.S. Charges Russian Diplomats With Defrauding Medicaid In N.Y.C.

Federal officials say 49 Russian diplomats or their spouses defrauded Medicaid of about $1.5 million in improperly awarded benefits over ten years in New York City.

The New York Times: U.S. Says Diplomats Defrauded Medicaid
The contours of the alleged insurance fraud seemed unusual enough: The participants, men and women, were accused of improperly seeking Medicaid benefits for pregnancies, births and postnatal care. That the defendants were Russian was, perhaps, not altogether unusual, given the number of recent prosecutions for similar insurance schemes perpetrated in New York by immigrants from the former Soviet Union (Weisner, 12/5).

Los Angeles Times: Russian Diplomats Accused Of Medicaid Fraud In New York
Current and former Russian diplomats in New York claimed poverty to fraudulently collect Medicaid for their pregnant wives and children while shopping at Prada and Tiffany's and taking cruise vacations, the U.S. government charged Thursday. The Justice Department said 49 Russians or their spouses currently or formerly attached to the Russian Consulate, United Nations or trade missions illegally collected $1.5 million in benefits over about a decade in New York City (Phelps, 12/5).

The Wall Street Journal: U.S. Accuses Russian Diplomats, Spouses of Medicaid Fraud
Federal prosecutors have accused current and former Russian diplomats and their spouses of participating in an alleged scheme that garnered nearly $1.5 million dollars in fraudulent Medicaid benefits. The criminal complaint against 49 current or former Russian diplomats and their spouses, announced on Thursday, is likely to further pressure already sour relations between Moscow and Washington (Matthews, 12/5).

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Ky. Gov. Says State Is 'Gold Standard' In Implementing Health Law

Kentucky Gov. Steve Beshear touted his state's progress on implementing the health law in appearances on Capitol Hill Thursday during which he also urged his state's Republicans -- including Senate Minority Leader Mitch McConnell -- to come see how the exchange is working.

Los Angeles Times: Kentucky Governor Sees Promise For Democrats In Health Care Law
Beshear spoke to House Democrats in a closed-door meeting about his state's experience with implementation of the Affordable Care Act. The commonwealth has become "the gold standard" for implementation thus far, Beshear said, with heavy interest from residents and 69,000 enrollments so far (Memoli, 12/5).

Politico: Kentucky Gov. Steve Beshear Hits Mitch McConnell On Obamacare
Democratic Kentucky Gov. Steve Beshear took a jab at Senate Minority Leader Mitch McConnell over his continued opposition to the Affordable Care Act. Speaking on Capitol Hill on Thursday, Beshear called on McConnell and other Republicans in his state's congressional delegation to come see the exchange and the state residents who want to take advantage of the law. Kentucky's state-run insurance exchange is operating more efficiently than most other exchanges in the country, including the federal system (Gibson and Haberkorn, 12/5).

CNN: KY Gov: McConnell's Obamacare Criticism Will Hurt Him 
Senate Republican Leader Mitch McConnell's criticism of the Affordable Care Act may come back to haunt him in the next year's midterm race, according to Steve Beshear, the Democratic governor of McConnell's home state of Kentucky. "I have a U.S. Senator who keeps saying Kentuckians don't want this. Well, the facts don't prove that out," the Governor said at Thursday's Democratic House Leaders caucus meeting on Obamacare (Sommers, 12/5).

Elsewhere, Republicans and Democrats draw their battle plans for the next round of fights over the law --

Bloomberg: Republicans Change Obamacare Attacks As Website Functions
The health care website's improved performance has both U.S. political parties shifting strategies, with President Barack Obama's team preparing a January advertising blitz and a wave of celebrity promotions to boost enrollment, allies said. On Capitol Hill, Republican opponents of the health care law are emphasizing new points of attack, highlighting examples of people who are paying more for insurance -- including House Speaker John Boehner, and those losing access to their doctors as they shift plans, congressional aides said (Dorning, Wallbank and Wayne, 12/6).

The Washington Post's The Fact Checker: Obama's Claims On Death Rates And Poverty Due To A Lack Of Health Insurance
Let's first concentrate on the claim that millions of citizens are driven into "poverty" by out-of-pocket costs. The White House said this fact came from the Census Bureau's Supplemental Poverty Measure, which is a long-term effort to update the current official poverty statistic. Critics have said the current measure is out of date because it does not reflect either the effect of government policies, such as food stamps, that alleviate poverty or the impact of expenses, such as medical costs or transportation costs to work, that reduce income (Kessler, 12/6).

And in Maryland --

The Washington Post: Gansler Campaign Accuses Brown Of Ducking Responsibility For Md.’s Health-Exchange Flaws
After spending the early months of his campaign on the defensive, Maryland gubernatorial candidate Douglas F. Gansler has pounced on an issue on which he believes his leading rival is vulnerable: the botched rollout of the state’s online health-insurance exchange. On Thursday, the Gansler campaign issued its latest attack on Lt. Gov. Anthony G. Brown, accusing the fellow Democrat of dodging the news media and ducking responsibility for a task assigned to him by his boss, Gov. Martin O’Malley (Wagner, 12/5).

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State Highlights: Va. Readies New Mental Health Changes

State health policy stories from North Carolina and Virginia.

The Associated Press: Panel: Could Take Until 2020 To Stabilize Medicaid In N.C.
A consultant examining options for overhauling Medicaid in North Carolina said Thursday it could be 2020 before any plan to stabilize costs and shift risk toward the private sector is implemented fully. Bob Atlas spoke at the first meeting of an advisory panel charged by the legislature with advising the Department of Health and Human Services on what path to take on changing Medicaid, which covers more than 1.7 million North Carolina residents (12/6).

The Associated Press: Va. To Introduce New Mental Health Protocols
Virginia mental health officials are introducing changes in 2014 to ensure that hospital beds will be available for people who pose a danger to themselves or others. The promised new protocols follow the Nov. 19 death of a Virginia state senator's son less than one day after he had been released from emergency custody. Austin "Gus" Deeds attacked his father, Sen. Creigh Deeds, and then killed himself (12/6).

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Health Policy Research

Research Roundup: 'Substantial' Medicare Savings From Avoiding ERs

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

Health Affairs: Giving EMS Flexibility In Transporting Low-Acuity Patients Could Generate Substantial Medicare Savings
Some Medicare beneficiaries who place 911 calls to request an ambulance might safely be cared for in settings other than the emergency department (ED) at lower cost. Using 2005–09 Medicare claims data and a validated algorithm, we estimated that 12.9–16.2 percent of Medicare-covered 911 emergency medical services (EMS) transports involved conditions that were probably nonemergent or primary care treatable. ... If Medicare had the flexibility to reimburse EMS for managing selected 911 calls in ways other than transport to an ED, we estimate that the federal government could save $283–$560 million or more per year, while improving the continuity of patient care. If private insurance companies followed suit, overall societal savings could be twice as large (Alpert et al., 12/4).

Health Affairs: Health Information Exchange Improves Identification Of Frequent Emergency Department Users
We hypothesized that using communitywide data from a health information exchange (HIE) could improve the ability to identify frequent emergency department (ED) users—those with four or more ED visits in thirty days—by allowing ED use to be measured across unaffiliated hospitals. When we analyzed HIE-wide data instead of site-specific data, we identified 20.3 percent more frequent ED users (5,756 versus 4,785) and 16.0 percent more visits by them to the ED (53,031 versus 45,771). Additionally, we found that 28.8 percent of frequent ED users visited multiple EDs during the twelve-month study period, versus 3.0 percent of all ED users (Shapiro et al., 12/4).

Rand Corporation: New Approaches for Delivering Primary Care Could Reduce Predicted Physician Shortage
Numerous forecasts have predicted shortages of physicians in the United States, particularly in light of the expected increase in demand from the Affordable Care Act (ACA). ... RAND researchers analyzed the potential impact of two emerging models of care — the patient-centered medical home (PCMH) and the nurse-managed health center (NMHC) — on future shortages of primary care physicians. ... The study found that projected shortages of primary care physicians could be substantially reduced by increasing the prevalence of these new models of care — without increasing the number of physicians. Researchers also developed an interactive online tool that allows users to change the assumptions used in this research (Auerbach et al., 12/4).

The New England Journal of Medicine: Assessing Participant-Centered Outcomes to Improve Clinical Research
[T]hanks in part to prodding from the newly established Patient-Centered Outcomes Research Institute, patient-centered outcomes are increasingly being incorporated into clinical research. ... [W]e developed and validated a standardized Research Participant Perception Survey ... A majority of participants indicated that they did not feel pressure from research staff to join the study (94%); believed that the consent form covered the study's risks (81%), included study details (80%), and was understandable (78%); and said they had sufficient time to evaluate whether to participate (79%). ... One striking finding was that most participants wanted to receive information about the results of the study (Kost et al., 12/5).

JAMA Pediatrics: The Effects Of Poverty On Childhood Brain Development
Data from a prospective longitudinal study of emotion development in preschool children who participated in neuroimaging at school age were used to investigate the effects of poverty on brain development. Children were assessed annually ... The finding that exposure to poverty in early childhood materially impacts brain development at school age further underscores the importance of attention to the well-established deleterious effects of poverty on child development. Findings that these effects on the hippocampus are mediated by caregiving and stressful life events suggest that attempts to enhance early caregiving should be a focused public health target for prevention and early intervention (Luby et al., 12/2).

JAMA Psychiatry: National Trends In The Mental Health Care of Children, Adolescents, And Adults By Office-Based Physicians
Between 1995-1998 and 2007-2010, visits resulting in mental disorder diagnoses per 100 population increased significantly faster for youths (from 7.78 to 15.30 visits) than for adults (from 23.23 to 28.48 visits). ... Compared with adult mental health care, the mental health care of young people has increased more rapidly and has coincided with increased psychotropic medication use. A great majority of mental health care in office-based medical practice to children, adolescents, and adults is provided by nonpsychiatrist physicians calling for increased consultation and communication between specialties (Olfson et al., 11/27).

UCLA Center for Health Policy Research: Majority Of Young Children In California Eat Fast Food Regularly But Drink Less Soda
This policy brief examines the eating habits of children ages two to five years. Despite steady declines in soda consumption, 60 percent of children in this age group continue to eat fast food at least once a week. Among young Latino children, the rate is 70 percent; overall, one in ten young children eats three or more fast food meals per week. The majority of children also fall short of the state standard on fruit and vegetable consumption, ... Asian children have the lowest levels of fruit and vegetable consumption (Holtby, Zahnd and Grant, 11/21).

The Kaiser Family Foundation: Medicare Advantage 2014 Spotlight: Plan Availability And Premiums
Beneficiaries will see limited changes in the number of plans offered in 2014. Our analysis finds that beneficiaries will be able to choose from 18 plans, on average, in 2014, down from an average of 20 plans in 2013. While some plans will leave the market in 2014, others are coming in or expanding. ... Almost all will be able to stay in a similar type plan, often with the same company. Beneficiaries will continue to have access to plans with relatively low premiums. ... Of note, out-of-pocket limits are expected to be higher in 2014 than in 2013, on average, providing less financial protection to enrollees (Gold, Jacobson, Damico and Neuman, 11/25). 

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

Medscape: Study Dispels 'Urban Legends' About Frequent ED Users
Contrary to "urban legend," frequent users of emergency care actually have high rates of primary care use and only a small proportion of their emergency department (ED) visits are for substance abuse and mental health problems, a new study of Medicaid ED users in New York City shows. ... Moreover, the study also found that visits for substance abuse and mental health comprised just 5% of total visits in a single year. ... [in] the journal Health Affairs (Tucker, 12/5). 

MedPage Today: Hospital Error Rates Cut With Better Handoffs
Rates of medical errors detected at a large children's hospital declined 45% after a program to improve patient handoff procedures was implemented, researchers said. Medical errors of all types occurred at a rate of 33.8 per 100 admissions at Boston Children's Hospital during a baseline period, which then declined to 18.3 per 100 admissions  following implementation of a program targeted to interns and residents that emphasized communication and a standardized approach to handoffs, according to Amy J. Starmer, MD, MPH, of Boston Children's, and colleagues. ... in the Dec. 4 issue of the Journal of the American Medical Association (Gever, 12/3).

Reuters: Hospitals Will Quote Prices For Parking, Not Procedures
People usually don't know what their medical procedures cost until after they leave the hospital, and a new study suggests they would have a hard time finding out in advance. Inspired by an earlier study looking at hip replacement surgery costs, researchers tried to see if consumers could get price quotes for a much simpler diagnostic test from Philadelphia area hospitals. They found that parking prices were readily available by calling the hospital and asking, but only three out of 20 hospitals could provide the cost of an electrocardiogram test (Jegtvig, 12/2).

Medscape: Shingles Vaccine Uptake Disappointing
Although most adults 40 years and older are at risk for herpes zoster infection, also known as shingles, uptake of the vaccine (Zostavax) to prevent infection is disappointing, researchers say. "The risk of herpes zoster is increasing faster than the aging population," said Elizabeth Cohen, MD, from the NYU Langone Medical Center in New York City. ... As renowned bioethicist Arthur Caplan said, 'We have a moral obligation to do the right thing to change behavior'," she said (Goodman, 11/27).

MedPage Today: Kids' Psychiatric Visits a Growing Concern
Sixteen years of data from a large federal survey indicated that outpatient visits resulting in mental health diagnoses increased significantly in the U.S., especially in children and adolescents. Rates of such visits for individuals younger than 21 nearly doubled from 1995 to 2010 (from 7.78 to 15.30 per 100 population), while those for adults 21 and older rose from 23.23 to 28.48 per 100, according to Mark Olfson, MD, MPH, of Columbia University in New York City, and colleagues. .... reported online in JAMA Psychiatry  (Gever, 11/27).

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Editorials and Opinions

Viewpoints: Health Law Is Here To Stay; Problems For Obamacare Go Beyond Website; Future 'Doc Shock'

The New York Times' The Conscience of a Liberal:  On The Right, It Will Always Be October
For almost two months, the debacle of healthcare.gov allowed conservatives to live the life they always wanted. Health reform was a dismal failure; Obama would go down in history as a laughingstock; government can’t do anything; viva Ayn Rand! ... while things are far from completely fixed, the crisis is clearly over. Obamacare will have millions of beneficiaries by the time open enrollment ends; it will add many more in the 2015 cycle. Health reform is pretty much irreversible at this point (Paul Krugman, 12/5).

The Washington Post's Right Turn: Price Of Health Care
Obamacare’s problems haven’t gone away. (“The administration has received strong criticism for failing to disclose the error rate for forms known as 834s, which send information about ObamaCare enrollees to health insurers.") ... 

The refusal of young people to do as they are told — sign up in large numbers in the exchanges — remains an potentially fatal flaw in the whole shebang. ... They didn’t understand “hope and change” meant buying something you didn’t want and/or couldn’t afford (Jennifer Rubin, 12/5).

Bloomberg: ‘Doc Shock’ On Deck In Obamacare Wars
Come January, when some number of Americans have bought insurance on the new health exchanges and are starting to use the services, you can expect another controversy to arise when many of them find out just how few doctors and hospitals they have access to. Call it “doc shock,” though the biggest outcry will not come when people try to schedule an appointment with their physician, but when someone gets sick and they learn they cannot go to whatever top-notch hospital they want, only to the hospital that is included in their plan (Megan McArdle, 12/5).

New England Journal of Medicine: The Road toward Fully Transparent Medical Records 
[N]early 2 million Americans already have access to notes, and we anticipate that open records will become the standard of care, ... Given that more than half the patients we surveyed wanted to add comments to their doctors' notes and approximately a third wanted to approve what was written, we expect that patients will soon share in generating content ... Indeed, we believe that ultimately notes will be signed by both patients and providers, as they become the foundations for planning care, monitoring the course of health and illness, and evaluating care (Jan Walker, Drs. Jonathan D. Darer, Joann G. Elmore and Tom Delbanco, 12/4).

Health Affairs: A Promising Approach For Emergency Departments To Care For Patients With Substance Use And Behavioral Disorders
Millions of patients visit US emergency departments (EDs) each year because of substance use and behavioral disorders. ... A growing body of evidence suggests that screening, providing a brief intervention, and referring these patients to treatment—an approach known as SBIRT—can be effective in the ED. Typically requiring just five to ten minutes, SBIRT incorporates principles of motivational interviewing, an evidence-based counseling technique ... [This] article recommends adopting SBIRT broadly to help EDs become a coordinated part of the health care system (Steven L. Bernstein and Gail D'Onofrio, 12/4).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Marissa Evans
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.