Daily Health Policy Report

Wednesday, February 12, 2014

Last updated: Wed, Feb 12

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Health Care Marketplace

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Questions And Answers On The Latest ACA Delay

Kaiser Health News staff writers Jay Hancock, Julie Appleby and Mary Agnes Carey report: “On Monday the Obama administration announced another delay in rolling out the Affordable Care Act, weakening the requirement to offer coverage next year for large employers and postponing it for smaller ones. Here’s what it means” (Hancock, Appleby and Carey, 2/11). Read the story.

This Story: Print | Link to | Top

Telemedicine Bolsters ICU Care In Rural Maryland Hospitals

Reporting for Kaiser Health News, in collaboration with The Baltimore Sun, Rita Rubin writes: "A critical care doctor 125 miles away was monitoring the patient’s health via voice, video and high-speed data lines constantly streaming information about vital signs, medications, test results and X-rays, a telemedicine service known as Maryland eCare. The physician quickly verified that the patient had the deadly infection and arranged immediate transfer to another hospital with a surgeon who could remove the infected tissue" (Rubin, 2/12). Read the story.

This Story: Print | Link to | Top

Political Cartoon: 'Side Effects?'

Kaiser Health News provides a fresh take on health policy developments with "Side Effects?" by Jen Sorensen.

And here's today's health policy haiku:


Forget the mandate...
It's time to get groceries...
The snow is coming!

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.

This Story: Print | Link to | Top

Health Reform

Obama: Latest Employer Mandate Delay Is Method Of 'Smoothing Out' Health Law Transition

President Barack Obama also said Tuesday during a joint press conference with French President Francois Hollande that he doesn't see the employer-based health insurance system disappearing.

The Associated Press/Washington Post: Obama Doesn't Want Health Law To Punish
President Barack Obama says he's giving mid-size businesses more time to comply with his health care law because the goal is not to punish anyone. Obama says the companies are trying to get right with the law and provide insurance for their employees. But they need more time to meet their responsibility (2/11).

Los Angeles Times: Obama Says Latest Delay Is 'Smoothing Out' Shift To New Health Law
President Obama said Tuesday the latest delay in implementing his healthcare law is an example of "smoothing out this transition" for a small group of midsize businesses struggling to meet the requirement that they provide health insurance to their employees (Hennessey, 2/11).

Politico: Obama: Employer-Based Health Insurance System Not Going Anywhere
President Barack Obama on Tuesday described the latest delay in the implementation of the Affordable Care Act as a way of "smoothing out' the transition to the law and said he doesn't see the employer-based health insurance system disappearing any time soon. "The goal is to make sure folks are healthy and have decent health care, so this was an example of administratively making sure we are smoothing out this transition giving people the opportunity to get right with the law but recognizing there are going to be circumstances people try to do the right thing and it may take time," Obama said at a wide-ranging joint press conference with French President Francois Hollande (Epstein, 2/11).

Bloomberg: Health-Care Delay Gives Time For Optimal Policy: Obama
President Barack Obama said a delay until 2016 in his health care mandate for mid-sized employers is an adjustment that doesn't undermine the law. ... Employers with fewer than 100 workers won’t have to provide health insurance until 2016 under Obamacare, while larger firms have to cover at least 70 percent of the workforce starting next year, the Internal Revenue Service said in a rule issued yesterday (Mattingly and Wayne, 2/11).

The Wall Street Journal’s Washington Wire: Top White House Aide Defends Health Law Delay
A top White House aide defended the Obama administration's latest decision to delay a part of the Affordable Care Act’s implementation, saying Tuesday that policy makers were trying to create a "smoother transition" for businesses. Gene Sperling, director of the White House's National Economic Council, also blasted Republicans for criticizing the administration's decision Monday to give many small businesses additional time to comply with parts of the law (Paletta, 2/11).

This Story: Print | Link to | Top

How Much Relief Will Result From The Latest Health Law Delay?

News outlets take a closer look at the impact of Monday's Obama administration decision to postpone enforcement of the employer mandate for some businesses.

The Wall Street Journal: Some Small Firms See Little Relief In Latest Health-Law Delay
Small and midsize businesses stand to benefit the most from the latest delay in the health law's employer insurance requirement. But farm co-owner Laura Pedersen doesn't plan to take advantage of it. The Seneca Castle, N.Y., proprietor of a produce and grain farm last year rearranged her employees' schedules and workloads to keep the farm's full-time staff below 50 workers. Her goal was to avoid having to start providing insurance or pay a penalty in 2015 under the Affordable Care Act (Needleman and Colvin, 2/11).

The Associated Press: Health Care Tweak: Big Companies Get Wiggle Room
Big retail stores, hotels, restaurants and other companies with lots of low-wage and part-time workers are among the main beneficiaries of the Obama administration’s latest tweak to health care rules. Companies with 100 or more workers will be able to avoid the biggest of two potential employer penalties in the Affordable Care Act by offering coverage to 70 percent of their full-timers (Alonso-Zaldivar, 2/12).

CQ HealthBeat: Postponement Unlikely To Change Business Strategies, Analysts Say
Most employers won’t upend their health insurance strategies based on the Obama administration’s delays in the employer mandate, according to policy analysts on Tuesday who were evaluating the impacts. The number of people whose coverage changes because of the delays may be in the range of hundreds of thousands, rather than millions, although it is hard to get a firm estimate (Adams, 2/11).

Kaiser Health News: Questions And Answers On The Latest ACA Delay
On Monday the Obama administration announced another delay in rolling out the Affordable Care Act, weakening the requirement to offer coverage next year for large employers and postponing it for smaller ones. Here’s what it means (Hancock, Appleby and Carey, 2/11). 

This Story: Print | Link to | Top

Healthcare.gov Contractors Scramble To Recruit Talent, Continue System Work

Meanwhile, even as efforts are ongoing to address the federal health exchange's back end computer issues, state marketplaces in Maryland, Oregon and Minnesota face challenges.

The New York Times: Creators Still In Demand On Health Care Website
After denigrating the work of CGI and replacing it as the largest contractor on the federal health care website, the Obama administration is negotiating with the company to extend its work on the project for a few months. And the new prime contractor, Accenture, is trying to recruit and hire CGI employees to work under its supervision. The transition between the two companies has interrupted work on the "back end" of the computer system needed to pay insurers, people involved in the project said Tuesday (Pear and Austen, 2/11).

The Associated Press/Washington Post: Md. Lawmaker Wants Probe Of Exchange Procurement
A Maryland lawmaker on Tuesday renewed a call for an investigation into the state's defective health care exchange with a focus on the procurement process of the exchange's board, which has approved multimillion dollar contracts (2/11).

The Baltimore Sun: Costs Rising For State Health Exchange, Which Is Still 'Not Functional'
Maryland's poorly performing health exchange will cost taxpayers $33 million more than expected this year, bringing the state's total annual expense to $138 million, officials said Monday. The money is needed, in part, to pay the company hired to help fix the dysfunctional web site and to triple the work force at the state's call center, which has been overwhelmed by requests for help from customers struggling to buy insurance online (Cox, 2/10).

The Oregonian: Oregon Health Exchange May Soon Go Live, But Expect Bugs: Technological Troubles Explained
More than four months after Oregon's $170 million health insurance exchange was supposed to go live, officials say it could be up and partially running later this week -- though it won't be open to the public. By this weekend, Cover Oregon officials hope to allow insurance agents and others who assist clients to use a password-protected version of the site to enroll people as part of a limited launch. Exchange officials have been under great pressure to make this day happen (Budnick, 2/11).

Minnesota Public Radio: Management, Technology Failures, Miscommunication Plagued MNsure
Behind MNsure's upbeat façade was a swamp of management failures and tech glitches that would cripple the more than $100 million website. MNsure leaders blamed tight deadlines and evolving federal requirements for the website's malfunctions. However, internal MNsure documents and interviews with insurance company officials, county workers and other stakeholders reveal a more complicated story (Richert and Stawicki, 2/12).

And in California -

The California Health Report: Rocky Rollout For ACA In Northern California, But It's Working
When the Affordable Care Act took effect in California, (Dorothy) Lee was quick to take advantage of it. She saw a newspaper ad for an insurance agent, Bruce Jenkins, a certified ACA adviser who offers free consultation. She called him up. With his help, she went to the Covered California website and plugged in her income figures. To her delight, she discovered that she was eligible for subsidies that enabled her to obtain "an amazing Anthem/Blue Cross plan" for $143 per month. Negotiating the system involved "a little back and forth," she said, but it was easier than doing her taxes. One of the lesser known aspects of the roll out in California is that thousands of independent insurance brokers have taken the training that qualifies them to assist people in signing up (Speer, 2/11).

This Story: Print | Link to | Top

Some Health Law Provisions Raising Questions, Costs

News outlets examined how Medicaid costs may be affected by the ACA, and the dilemma the law poses for some IRS rules. 

Bloomberg: Obamacare Raises Medicaid Cost As Insurers Shift Tax Bill
Health insurers told to pay $150 billion in taxes over a decade to help fund Obamacare are now shifting at least part of that cost back to taxpayers. Congress passed the insurer tax four years ago to help cover the uninsured under the Patient Protection and Affordable Care Act. .. The strategy may add $36 billion to $39 billion to the cost of Medicaid over a decade, depending on how quickly the health program expands, according to an industry-funded study released today by the actuarial firm Milliman Inc.  (Nussbaum, 2/12).

Politico Pro: Some Jobs Pose ACA Rules Quandaries
What do flight attendants, cruise ship workers and temps have in common? They’re all making life complicated for Obamacare bureaucrats at the IRS. The IRS’s decision to slow-walk the health law’s requirements for businesses over the next two years is still sinking in. But it’s increasingly clear that the law’s intent — that businesses with 50 or more employees offer health coverage to full-time workers — will only work with exemptions, carve-outs and creative interpretations to accommodate the complexities of the 21st century workforce (Cheney, 2/11).

This Story: Print | Link to | Top

Capitol Hill Watch

Proposal To Change Medicare's 'Observation Status' Gains Congressional Support

After years of trying, Rep. Joe Courtney, D-Conn., says he is optimistic that Congress will change the Medicare policy that has left thousands of patients without coverage for nursing home care after leaving the hospital.

The CT Mirror: Courtney Hopeful Congress Will Address Medicare 'Observation Status'
After years of trying, U.S. Rep. Joe Courtney, D-2nd District, said Tuesday he’s optimistic that Congress will take action to address a technicality that has left thousands of Medicare patients without coverage for nursing home care after leaving the hospital. At issue is how Medicare treats patients designated by hospitals as being on “observation status.” Medicare’s hospitalization benefit covers nursing home care for patients recovering from a hospital stay, if they have spent at least three consecutive days as inpatients in a hospital. But increasingly, hospitals have been designating patients as being on observation status, even if they receive inpatient care and spend several nights in the hospital (Becker, 2/11).

CQ HealthBeat: Bid To Alter Confusing, And Sometimes Costly, Medicare 'Observation' Status Gains Support
As Rep. Joe Courtney, D-Conn., sees it, more of his colleagues are becoming aware of the ill effects that can occur when hospitals tell Medicare that a person who spent days being treated within their walls was not an “inpatient.” Courtney and many advocacy groups say that when hospitals instead slot patients as receiving “observation” services, that can deprive them of needed follow-up skilled nursing care. Or, it can cost them dearly if they use these services as after a hospital stay (Young, 2/11).

Earlier, related KHN coverage: FAQ: Hospital Observation Care Can Be Poorly Understood And Costly For Medicare Beneficiaries (Jaffe, 9/4/13).

This Story: Print | Link to | Top

Health Care Marketplace

Rural California Plans New Trauma Centers

The centers are designed to avoid expensive and often time-consuming patient transfers. Meanwhile, telemedicine bolsters intensive care services in rural Maryland, and a hospital system in Camden, N.J. overhauls the way it cares for the poorest and sickest patients.

The California Health Report: New Trauma Centers For Rural Counties
In rural California, traumatic injuries often happen hours away from medical services. Rescuers scramble helicopters or ground ambulances to rush victims of car crashes, major accidents or violence to hospitals outside of the region. Occasionally, those expensive trips to life saving aid are waylaid by weather or traffic. It can take as long as three hours to get the injured to a trauma center, even by air. Access to centers along the north and central coasts and the East Sierra is most limited. Over the past two years, communities long without trauma centers began to fill the void – designating regional hospitals as resources for those suffering from traumatic injuries (Griffy, 2/12).

Kaiser Health News: Telemedicine Bolsters ICU Care In Rural Maryland Hospitals
A critical care doctor 125 miles away was monitoring the patient’s health via voice, video and high-speed data lines constantly streaming information about vital signs, medications, test results and X-rays, a telemedicine service known as Maryland eCare. The physician quickly verified that the patient had the deadly infection and arranged immediate transfer to another hospital with a surgeon who could remove the infected tissue (Rubin, 2/12).

Marketplace: Healthcare Teams 'Wrapped Around' Patients
When you strip away all the bells and whistles at the Cooper Advanced Care Center, you see a massive effort to make primary and specialty care for the poorest and sickest patients – who for years have cost hospitals money – as easy to get as just showing up at the ER, says the clinic's executive director, Kathy Stillo. "I think we are figuring out how to redo this whole thing, how to deliver this care in a much smarter and more efficient way," she says. Transforming the whole practice has taken a financial investment and a leap of faith (Gorenstein, 2/11).

Related, earlier KHN story: New Jersey Program Finds Alternatives for ER 'Super Users' (Campbell, 3/9/2009). 

This Story: Print | Link to | Top

State Watch

State Highlights: More States Gearing Up To Combine Medicare, Medicaid

A selection of health policy stories from California, Texas, Colorado, Virginia, North Carolina, Florida and Connecticut.

Stateline: States Meld Medicare and Medicaid
They are a diverse group of low-income people who are disabled or elderly. Many have multiple chronic illnesses, or are battling depression or substance abuse. Most will need long-term care at some point in their lives. In the nearly 50 years since Medicaid and Medicare were enacted, the two health care programs -- one for the poor and the other for the elderly and disabled -- have remained separate, with different rules, duplicative benefits and conflicting financial incentives. The result has been wasted money and disjointed care for more than 10 million “dual eligibles,” the Americans who qualify for both programs (Vestal, 2/12).

Los Angeles Times: Vaccination Exemptions Still On States’ Legislative Agendas
Eighteen state legislatures, including California's, have considered exemptions to immunization mandates in the last several years -- and the issue remains a topic of debate, researchers said Tuesday. Most of the bills introduced in those 18 states sought to expand the exemptions available to school immunization requirements, but none of those bills passed, researchers wrote in the Journal of the American Medical Assn. (MacVean, 2/11).

The Dallas Morning News: Wendy Davis Backs 20-Week Abortion Ban That Defers To Women
Wendy Davis said Tuesday that she would have supported a ban on abortions after 20 weeks of pregnancy, if the law adequately deferred to a woman and her doctor. Davis, a Fort Worth senator and the likely Democratic nominee for governor, told The Dallas Morning News’ editorial board that less than one-half of 1 percent of Texas abortions occur after 20 weeks of pregnancy. Most of those were in cases where fetal abnormalities were evident or there were grave risks to the health of the woman (Jeffers, 2/11).

Health News Colorado: Garfield County Moves Forward With Lawsuit Over Rates
Garfield County’s commissioners on Monday authorized their attorney to sue Colorado officials for placing them in the state’s resort region, which has the highest health insurance prices in the nation. County Attorney Frank Hutfless plans to file the lawsuit in U.S. District Court by April. “The Division of Insurance has violated federal law in establishing these geographic rating areas,” Hutfless said. “The rating areas should not discriminate against people. The rating areas should, to the extent possible, make (health) insurance affordable. People shouldn’t be deprived of the benefits that are intended to be conferred upon them by the Affordable Care Act” (McCrimmon, 2/11).

The Washington Post: Va. Legislators Push Flurry Of Bills At Session’s Halfway Point
Virginia’s General Assembly plowed through hundreds of bills Tuesday, reaching broad consensus on ethics, school testing and mental health reforms while also picking new partisan fights and bracing for a Medicaid battle that will test Gov. Terry McAuliffe’s ability to work across the aisle. Racing against a deadline to get bills out of one chamber and into the other, legislators put the final touches on measures aimed at limiting gifts to public officials, reducing standardized tests in public schools and improving the handling of psychiatric emergencies -- all priorities that enjoy bipartisan support (Vozzella, Laris and Weiner, 2/11).

The Associated Press: NC Lawmaker Blames Medicaid For Poor Communication 
The North Carolina agency running Medicaid said Tuesday it should have informed legislators and done a better financial review before accepting a temporary delay from the federal government on changes to recalculate patient eligibility. The decision by the Division of Medical Assistance in October to accept a three-month wait could cost the state up to $2.8 million, according to the agency, adding the amount could grow if the extension were to be lengthened (2/11).

Health News Florida: Nurse Bill Goes Too Far, Critics Say
Critics of a legislative plan that would increase the authority of Florida’s nurse practitioners pushed back Monday, wondering if the massive bill would give nurses all the privileges now granted to more-educated and more-skilled physicians. The plan -- which allows qualified nurse practitioners the ability to operate independently, without a physician’s supervision -- could be seen as a short-cut to those who want to treat patients but don't want to go to medical school, said Rep. Elaine Schwartz, D-Hollywood (Shedden, 2/11).

The CT Mirror: CT Hospitals’ Group Recommends Notifying Patients On Facility Fees, Costs
Responding to concerns identified by the state attorney general, the Connecticut Hospital Association has recommended that its members provide patients with specific information about “facility fees” they could incur if they get care at hospital-owned medical offices. Attorney General George Jepsen praised the hospital association’s new policy Tuesday and described it as the first of its kind in the country. But he said he will continue to pursue legislation that would require hospitals to give patients information about the fees (Becker, 2/12).

This Story: Print | Link to | Top

Editorials and Opinions

Viewpoints: Obama's 'Cavalier Approach' To Health Law; CBO Report's Job Forecast Isn't Bad News

The Washington Post: The Obama Administration Has A Mandate On The Health-Care Law, Too
The Obama administration on Monday announced that it was delaying, once again, enforcement of the Affordable Care Act (ACA) "employer mandate." Yes, Republicans have done everything they can to impede implementation of this law. Yes, their "solution" — gutting the individual mandate — is an awful idea. And, yes, their public response to the administration’s action was predictably over-the-top. But none of that excuses President Obama's increasingly cavalier approach to picking and choosing how to enforce this law. Imagine how Democrats would respond if a President Rand Paul, say, moved into the White House in 2017 and announced he was going to put off provisions of Obamacare he thought might be too onerous to administer (2/11). 

The Washington Post: Another Day, Another Illegal Obamacare Delay
Yesterday, the Department of Treasury announced it was further delaying imposition of Obamacare's "Employer Shared Responsibility" provisions (aka, the employer mandate). These provisions were supposed to take effect at the beginning of this year. Last summer, however, the Administration pushed back the requirement until 2015. Yesterday, the requirement was pushed back another full year for companies with 50-99 employees and the 2015 requirements were relaxed for larger employers. (Employers with fewer than 50 employees are exempt.) Administration officials say this new delay is designed to help employers adjust to the law's requirements, but many observers see more political motivations (Jonathan H. Adler, 2/11). 

Reuters: Why You Should Ignore The Latest Attack On Obamacare
The latest example of deliberate obfuscation by universal healthcare's opponents comes with publication of the Congressional Budget Office's latest glimpse into the future, "The Budget and Economic Outlook: 2014 to 2024." ... What this all means is that some people now working for an employer to qualify for cheap company health insurance will stop working there. Though, as the CBO reports, this does not mean "a drop in businesses demand for labor." The vacated jobs will continue to exist and employers will seek to find others to take the place of the departed workers. With so many unemployed, most jobs will be easily and quickly filled, reducing the number of unemployed and maintaining economic growth. A headline writer could just as accurately have written, "Obamacare makes 2.5 jobs available over next 10 years" (Nicholas Wapshott, 2/11).

The New York Times' Economix: Demoralization Is Not A Policy Achievement
In the George W. Bush administration, for example, the Federal Deposit Insurance Corporation offered a mortgage modification program that created terrible work incentives. Then came the American Recovery and Reinvestment Act, under which about four million people could earn more by remaining unemployed longer, because going back to work would erase federal health assistance and multiple sources of cash benefits. The latest is the Affordable Care Act, which has created a system of health assistance that withholds its benefits on the basis of income and, in most cases, on the basis of full-time employment. A part-time worker may actually have less to spend if he takes on a full-time position. This kind of situation will occur at least a million times under the new law (Casey B. Mulligan, 2/12). 

The Fiscal Times: Obama's Workforce: Discouraged, Disincentivized, Downsized
Is work becoming optional? In our zeal to alleviate poverty, and to protect our most vulnerable, have we invited Americans to put their feet up and take it easy? That’s how many read the recent CBO report predicting job losses courtesy of Obamacare. Data on the condition of our long-term unemployed, and the impact of extended unemployment compensation points in the same direction (Liz Peek, 2/12).

The New York Times: Medicaid Expansion, Red-State Style
Some 20 states have refused to expand their Medicaid programs to cover uninsured low-income people, an important element of the health reform law. Now several states that had been opposed, mostly for ideological reasons, are seeking to cover newly eligible Medicaid beneficiaries through private insurance (2/11). 

The Hill: Medicaid Or Education?
In state capitals throughout America, a drama will play out this coming year and in every subsequent year for at least a decade. Legislators and governors will find themselves unable to provide decently for education without cutting back on the ambitious Medicaid expansion built into ObamaCare. Even in those states that opted not to participate in raising the eligibility levels for Medicaid — and took the out Chief Justice John Roberts gave them — the Medicaid rolls will rise as more of those previously eligible sign up through the well-publicized federal exchanges (Dick Morris, 2/11).

Bloomberg: Yes, We Can Trim Medicare Spending
More than 90 percent of all Medicare spending goes to treating the two-thirds of beneficiaries who suffer from more than one chronic health problem. Giving these people better care for the dollar is the key to increasing the value of the program overall. ... Fee-for-service reimbursement creates an incentive for hospitals and other providers to give more care rather than better care. Indeed, one possible explanation for the steady slowdown in Medicare spending is that most hospital executives, believing that a fee-for-service payment system will become less dominant in coming years, are already changing their practices (Peter Orszag, 2/11).

This Story: Print | Link to | Top

Stephanie Stapleton

Andrew Villegas

Lisa Gillespie
Shefali Luthra

The Kaiser Daily Health Policy Report is published by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. (c) 2014 Kaiser Health News. All rights reserved.