Daily Health Policy Report

Friday, February 14, 2014

Last updated: Fri, Feb 14

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Medicaid

Health Care Marketplace

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

The 10 Least Expensive Health Insurance Markets In The U.S.

Kaiser Health News staff writer Jordan Rau, working in collaboration with NPR, reports: "People in much of Minnesota, northwestern Pennsylvania and Tucson, Ariz., are getting the best bargains from the health care law’s new insurance marketplaces: premiums half the price or less than what insurers in the country’s most expensive places are charging. The 10 regions with the lowest premiums in the nation also include Salt Lake City, all of Hawaii and eastern Tennessee. This ranking is based on the lowest cost of a “silver” plan, the mid-range plan most consumers are choosing" (Rau, 2/13). Read the story.


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A Reader Asks: If I Am On COBRA, Do I Have To Buy A New Marketplace Plan?

Kaiser Health News' consumer columnist Michelle Andrews answers this question. Read her response.

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Libraries Serve As Health Insurance Info Hubs

Reporting for Kaiser Health News, in partnership with NPR, WHYY's Elana Gordon writes: "What can’t librarians do? Many are now becoming health insurance guides. The buzz at the American Library Association's winter meeting recently wasn't just about the annual awards (a.k.a. the book award "super bowl"); the Affordable Care Act was also on the agenda. Libraries across the country have been trying to meet a growing demand for health insurance information" (Gordon, 2/14). Read the story.

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Capsules: It’s Hot Springs Vs. Ski Slopes In Colorado Insurance Battle

Now on Kaiser Health News' blog, Eric Whitney writes: "The county with the highest health insurance premiums in the country is drafting a lawsuit against Colorado, saying the state’s approval of the rates violates anti-discrimination protections in the Affordable Care Act. Garfield County Attorney Frank Hutfless says county commissioners told him "to prepare a lawsuit to be filed against the state, and particularly the department of insurance, the insurance commissioner and perhaps the governor" (Whitney, 2/13). Check out what else is on the blog.


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Political Cartoon: 'On The Cube Farm?'

Kaiser Health News provides a fresh take on health policy developments with "On The Cube Farm?" By Pat Bagley, The Salt Lake Tribune.

And here's today's health policy haiku, plus a bonus haiku:

LOVE, HEALTH INSURANCE & RISK POOL

Waiting on the young
Insurance coverage now!
Love improved risk pool!
-- Team Haiku, Altarum 

A DIFFERENT KIND OF VALENTINE

Location ... Where you
live can mean a sweetheart deal
on health coverage.
-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

'Copper' Plans? A Push For New, Lower-Premium Coverage

Some health law proponents are urging officials to create "copper" plans that offer lower deductibles, but higher out-of-pocket costs than the health law's gold, silver and bronze plans. In the meantime, the Office of Management and Budget is reviewing a rule that would allow states to create alternatives to the law's insurance marketplace for low-income people.

The Wall Street Journal: Health Law Backers Push Skimpier 'Copper' Insurance Policies
Some backers of the 2010 health-care law are pushing to create a new kind of insurance coverage that the measure essentially had ruled out: policies offering lower premiums but significantly higher out-of-pocket costs than those now available. The plans, dubbed "copper" because they would offer a lower level of coverage than the "gold," "silver" and "bronze" options on the government-run health-care exchanges, would be a departure from the minimum level of coverage that is one of the Affordable Care Act's core principles (Radnofsky, 2/13).

CQ HealthBeat: Basic Health Plan Rules Under Final Administration Review
The Office of Management and Budget is conducting its final review of a long-delayed rule that would allow states to create health insurance programs that are affordable and stable alternatives to marketplace coverage for low-income people. A year ago, the Centers for Medicare and Medicaid Services announced that officials would delay the creation of the basic health program from 2014 to 2015 (Adams, 2/13).

And Kaiser Health News looks at costs across the nation and affordability of coverage in some Colorado counties --

Kaiser Health News: The 10 Least Expensive Health Insurance Markets In The U.S.
People in much of Minnesota, northwestern Pennsylvania and Tucson, Ariz., are getting the best bargains from the health care law’s new insurance marketplaces: premiums half the price or less than what insurers in the country’s most expensive places are charging. The 10 regions with the lowest premiums in the nation also include Salt Lake City, all of Hawaii and eastern Tennessee. This ranking is based on the lowest cost of a "silver" plan, the mid-range plan most consumers are choosing (Rau, 2/13).

Kaiser Health News: Capsules: It's Hot Springs Vs. Ski Slopes In Colorado Insurance Battle
The county with the highest health insurance premiums in the country is drafting a lawsuit against Colorado, saying the state’s approval of the rates violates anti-discrimination protections in the Affordable Care Act. Garfield County Attorney Frank Hutfless says county commissioners told him “to prepare a lawsuit to be filed against the state, and particularly the department of insurance, the insurance commissioner and perhaps the governor (Whitney, 2/13).

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Finding The Meaning Behind New Obamacare Enrollment Numbers

As the president renews his call for people -- especially African Americans and Latinos -- to enroll for insurance coverage, news outlets detail what is actually known about who has already signed up. 

Politico: Snow Falls On Sunny Obamacare News Reports
The news that the pace of enrollment in the health insurance exchanges had picked up after its lousy start earned the health law some of its most favorable coverage. The fresh numbers, a million sign-ups in January boosting the total to nearly 3.3 million, made the front pages Thursday of some of the nation’s top papers and got some positive comment on TV, too. But for many newspapers across the country, the big story and the dramatic photos were the winter storm, the snow and the ice. ... The tone of coverage matters to the administration trying to get its top domestic law on track. People may be more likely to sign up if they start hearing good things about the law (Cunningham, 2/13).  

The New York Times: One In 5 Buyers Of Insurance Under New Law Did Not Pay Premiums On Time
One in five people who signed up for health insurance under the new health care law failed to pay their premiums on time and therefore did not receive coverage in January, insurance companies and industry experts say. Paying the first month’s premium is the final step in completing an enrollment. Under federal rules, people must pay the initial premium to have coverage take effect. In view of the chaotic debut of the federal marketplace and many state exchanges, the White House urged insurers to give people more time, and many agreed to do so. But, insurers said, some people missed even the extended deadlines (Pear, 2/13).

Fox News: Insurance Industry Raises Questions About New ObamaCare Enrollment Numbers Being 'Inflated'
It’s hard to pinpoint precisely how many people have paid their premiums, since companies like Humana and United have not yet disclosed numbers. Aetna has said that 70 percent of their enrollees paid premiums in January, and of those who signed up before January, 90 percent paid their premiums. WellPoint has reported that a majority of its 500,000 enrollees have paid premiums but not a “vast majority” as of yet. Insurance industry officials are also raising questions about whether the White House really does not know how many people have paid into the system (Henry, 2/13).

The Fiscal Times: 4 Key Unanswered Questions About Obamacare
The data also shows an overwhelming 82 percent of people signing up for coverage have qualified for financial assistance. While the report offers some insight into the demand for Obamacare it lacks many details that are crucial to understanding how the law is shaping up so far. While the report offers some insight into the demand for Obamacare it lacks many details that are crucial to understanding how the law is shaping up so far (Ehley, 2/13).

The Washington Post: A Guide To Understanding Obamacare’s Sign-Up Numbers
Counting the number of people who have signed up for Obamacare turns out to be vexingly difficult -- and, after four months of open enrollment, now seems like an excellent time to break down what we do and don't know about the exact number of people gaining coverage through the Affordable Care Act. ... When you log onto healthcare.gov to shop, the Web site doesn't ask you whether or not you currently have insurance coverage (Kliff, 2/13).

The Wall Street Journal: Obama Pleads For Uninsured To Sign Up For Health Coverage
President Barack Obama said Thursday that the “big problem” with the health care law  now is that many people haven’t signed up for coverage because of politics, misinformation and the problem-plagued rollout of the federal insurance  website. In an interview on the Steve Harvey Morning Show, a radio show popular with African Americans, Mr. Obama pleaded for people to “take a look at the website or have somebody walk you through it on the phone” (Favole, 2/13).

NBC News: Obama: Tell Your Familia, Amigos, Vecinos About Obamacare
President Barack Obama is urging Hispanics through a video to sign up for coverage and then spread the word through their connections. In the video, posted Thursday on whitehouse.gov, Obama tells listeners if they are a Latino without health care to check out the government web sites in English or Spanish. And if they already have health insurance, Obama urges viewers to spread the word to “tu familia, tus amigos, tus vecinos," your family, your friends, you neighbors (Gamboa, 2/14).

The New York Times: States Struggle To Add Latinos To Health Rolls
With an estimated 15 percent of the country’s uninsured population, California is crucial to the success of President Obama’s health care overhaul. Here, that success cannot come without enrolling Latinos, who make up more than half of the state’s uninsured. But so far, enrollment of Latinos has fallen strikingly below the hopes of the law’s proponents, accounting for 20 percent or fewer of those who had signed up on the state-run health insurance exchange by the end of December (Medina and Goodnough, 2/13).

Bloomberg: Lag In Enrolling Latinos In Obamacare Spurs New California Push
Many low-wage Latinos fear that going on public assistance could harm their efforts to become U.S. citizens, or enrolling could lead to the deportation of undocumented relatives who live with them, according to community activists. At the same time, glitches on the insurance exchange website and a lack of Spanish-speaking counselors on its telephone banks aren’t helping, they say. ... almost half of California’s Latinos are eligible for subsidies under Obamacare (Vekshin, 2/14).

Kaiser Health News: Libraries Serve As Health Insurance Info Hubs
What can’t librarians do? Many are now becoming health insurance guides. The buzz at the American Library Association's winter meeting recently wasn't just about the annual awards (a.k.a. the book award "super bowl"); the Affordable Care Act was also on the agenda. Libraries across the country have been trying to meet a growing demand for health insurance information (Gordon, 2/14).

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Some States Beating Others To Health Law Enrollment Punch

News outlets take closer looks at the Obama administration's health law enrollment figures and find that some states are far outpacing others. Marketplace problems that persist in some states are also examined.

The Associated Press: Disparities Seen In Enrollments Under The Affordable Care Act
Most states are still lagging when it comes to sign-ups under President Obama’s health care law, but an Associated Press analysis of numbers reported Wednesday finds a dozen high-achievers getting ahead of the game. Huge disparities are emerging in how well states are living up to federal enrollment targets, and that will help determine if the White House reaches its unofficial goal of having 7 million signed up by the end of March, six weeks away (Alonso-Zaldivar, 2/13).

The Associated Press: Michigan Beats Health Insurance Sign-Up Targets
About 112,000 Michigan residents chose a private insurance plan under the federal health care law in the first four months of enrollment, outpacing government projections by 12,000. Numbers released Wednesday by President Barack Obama's administration show 36,500 more people in the state signed up through a federal website from Dec. 29 to Feb. 1 (2/13).

The Associated Press: Oregon Health Enrollments In The Middle Of The Pack
The latest federal figures show Oregon places in the middle of the pack among states that built their own health insurance exchanges when it comes to the number of people who've signed up for private plans under the Affordable Care Act. An analysis of new federal government figures by The Associated Press shows that Oregon is seventh when it comes to enrollments in private coverage as a percentage of states' populations. Thirteen other states and the District of Columbia have their own exchanges (2/13).

The Seattle Times: About 30,000 To Have Health Insurance By End Of March
After the uproar over insurance plans that were discontinued under the Affordable Care Act, the number of Washington residents with individual coverage is expected to increase, according to state projections released Thursday. An estimated 300,000 people are predicted to have health-insurance plans by the end of March when the individual insurance market closes for the year (Stiffler, 2/13).

The Philadelphia Inquirer: Health Sign-Ups Gaining Steam
Southeastern Pennsylvania is among the top regions in the country for enrollment in the federal insurance marketplace, which officials said Wednesday grew significantly nationwide in January. The Obama administration said about one million people signed up for private insurance under the health law last month through federal and state marketplaces combined, extending a turnaround from early days when dysfunctional websites frustrated consumers (Sapatkin, 2/13).

MinnPost: MNsure Leaders Present Proof Of Small But Measurable Progress
MNsure has proof that the exchange is working better for consumers -- a distinct change from past claims -- but the fledgling marketplace has a long way to go before it’s fully fixed and on firm ground. The exchange’s leaders went before lawmakers tasked with overseeing the marketplace on Wednesday, where they described efforts to bring on a new lead technology vendor to fix MNsure, a contract to beef up its call center and potential difficulties remaining financially solvent (Nord, 2/13). 

The Star Tribune: MNsure Error Rates Improve As Sign-Up Gets Easier 
Consumers are having an easier time getting through the MNsure website as a result of efforts to fix technology issues and beef up call center staff, officials at the state’s new online health insurance exchange said Wednesday. While the website remains "less than perfect," it is stabilizing, MNsure interim CEO Scott Leitz said in a measured progress report delivered to state lawmakers and an increasingly antsy board of directors in separate meetings. "We still have a ways to go, but we have taken significant steps forward" in reducing error rates and adding staff, Leitz said (Crosby and Meitrodt, 2/13).

WBUR: Updates, But No Solutions, From Today’s Connector Board Meeting
If you have or have tried to sign up for health insurance through the Massachusetts Health Connector, you know the website is a mess. Last week, Gov. Deval Patrick brought in a special assistant, Sarah Iselin, and and IT oversight group, Optum. Today we had the first of what are to be weekly updates, with graphics that map the problems many of you are having. If you are expecting a quick fix, you can stop reading here. But there are some important updates that might be helpful (Bebinger, 2/13).

The Boston Globe: 50,000 Filings For Health Coverage In Limbo
About 50,000 health insurance applications, many filed by low-income Massachusetts residents, have yet to be processed by the state’s troubled insurance marketplace, officials disclosed Thursday, and it may take months to get all these people enrolled in subsidized plans. For several months, residents have been encouraged to file old-fashioned paper applications because the state’s insurance website has been hobbled by error messages and has crashed frequently since it was revamped in October to comply with the more complex requirements of the federal health care law. Frustration with the broken Massachusetts Health Connector website and the paperwork backlog was evident Thursday, when Jean Yang, the agency’s executive director, wept as she told the Connector board how demoralized her staff is (Levenson, 2/14).

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Some Having Luck With Healthcare.gov, But Others Remain Stuck

Quiet fixes to healthcare.gov are helping some shoppers on the troubled website, but some still remain without insurance coverage. In the meantime, insurers are skeptical the latest marketplace enrollment numbers are cause for health law optimism.

USA Today: Help For Some -- But Not All -- Stymied Insurance Shoppers
Many consumers who have waited months to resolve insurance application issues on healthcare.gov are finally getting help, but some are still stuck in limbo without Medicaid or insurance coverage, and many of the site's most vexing problems remain, according to insurers, brokers and state Medicaid officials. Applications that take days, clueless customer service representatives and error-ridden or orphan files persist. Changes made to the website last week will solve many of these problems, but the fixes were made so quietly that few brokers and consumers were aware of them, says Jessica Waltman, senior vice president of government affairs for the National Association of Health Underwriters, which represents insurance agents and brokers (O'Donnell, 2/13).

CBS News: On Obamacare Enrollment, Insurers Don't Share Government's Optimism
According to HHS, enrollment in the Health Insurance Marketplace shot up by 53 percent in January over the previous three months and 27 percent of last month's enrollees were the highly desirable young adults ages 18-34, who are vital to making the system financially viable. HHS Secretary Kathleen Sebelius issued a press release stating that signups among young adults, nicknamed "young invincibles" in insurance industry jargon, was up 3 percentage points from October through December and outpaced all other age groups combined. "Nearly 3.3 million people enrolled in the Health Insurance Marketplace plans by Feb. 1, 2014…with January alone accounting for 1.1 million plan selections in state and federal marketplaces," read a press statement issued Wednesday by Sebelius. But the rosy portrait shatters under an alternate interpretation by insurance industry representative Robert Laszewski of Health Policy and Strategy Associates (Attkisson, 2/13).

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The Obese, People With AIDS Encounter Coverage Gaps

Many plans sold through the health law's marketplaces don't cover weight loss surgery, and none in Louisiana are accepting payments from a federal program intended to help people with HIV/AIDS. The New York Times explores who benefits from the latest employer mandate extension, and Kaiser Health News answers a question about the health law's impact on a person covered by COBRA.

The Associated Press: Health Plans Don't Cover Weight Loss Surgery
Like 78 million other Americans, MaryJane Harrison is obese. And like many critically overweight Americans, Harrison cannot afford to have weight loss surgery because her health insurance doesn't cover it. The financial burden makes it nearly impossible for her to follow the advice of three physicians who have prescribed the stomach-shrinking procedure for Harrison, who is four-feet, 10 inches and weighs 265 pounds (2/14).

Reuters: More Obamacare Insurers In Louisiana Reject AIDS Patients
The only three insurance companies in Louisiana that sell healthcare policies under President Barack Obama's healthcare law throughout the state are rejecting payments from a federal program intended to help low-income HIV patients, advocacy groups said on Thursday. The Louisiana Health Cooperative and Vantage Health Plan, two smaller insurers, made the move following a decision by the state's largest insurer, Blue Cross and Blue Shield of Louisiana, late last year to reject the payments (Begley, 2/13).

The New York Times: Assessing Who Benefits From The Latest Rulings On The Employer Mandate
Even companies that have to abide by the mandate in 2015 — that is, those with at least 100 employees — will get some leeway in that first year. The law requires that companies offer insurance to 95 percent of full-time employees in order to avoid paying a penalty, but that requirement will not take effect until 2016. Next year, a company can avoid the penalty simply by offering insurance to 70 percent of full-time employees. (Full-time employees, under the law, are those who work 30 hours a week.) This relief, however, is not quite as generous as it might seem at first glance, because the employer mandate actually contains an additional penalty: companies are also penalized for offering insurance that does not meet new standards set by health law for quality and affordability (Robb Mandelbaum, 2/13).

Kaiser Health News: A Reader Asks: If I Am On COBRA, Do I Have To Buy A New Marketplace Plan?
Kaiser Health News' consumer columnist Michelle Andrews answers this question. Cheaper deals may be available on the state exchanges, but consumers don’t have to ditch their COBRA plans. 

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Capitol Hill Watch

GOP Lawmakers Seek Probes Of State Health Insurance Exchanges

In separate requests, Republican congressmen have sought federal investigations into Maryland and Oregon's problem-riddled online insurance marketplaces.

The Washington Post: Republican Congressmen Request A Federal Probe Of Md. Health Insurance Exchange
Two Republican congressmen have called for an investigation of the tens of millions of federal dollars that Maryland spent to build an online health exchange that state officials say has so many defects that they might have to abandon parts, or even all, of it. Reps. Andy Harris (Md.) and Jack Kingston (Ga.) sent a letter Wednesday to the inspector general of the Department of Health and Human Services and asked for an immediate “formal investigation into the flagrant waste and abuse of taxpayer monies" (Johnson, 2/13).

The Associated Press: Congressman Calls For Cover Oregon Investigation
U.S. Rep. Greg Walden and three congressional colleagues — all fellow Republicans— on Thursday requested a federal investigation of Oregon's troubled health insurance exchange, which has been unable to sign up a single person through its online portal because of technical problems that were known months before it was supposed to launch (Barnard, 2/13). 

The Oregonian: Congress Mulls Probe Of Cover Oregon Health Exchange As Programmers Try To Fix It
The dose of election-year politics only boosts the pressure on the only exchange in the country to not enroll anyone electronically as envisioned by the Patient Protection and Affordable Care Act, known as Obamacare. On Thursday afternoon, the Oregon exchange's appointed board heard how the exchange continues to test the beta version of its website and software, possibly letting agents use it by this weekend. ... Oregonians seeking health care but caught in limbo, many for months after submitting applications to the exchange's makeshift manual processing system (Budnick, 2/13).

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House GOP Attacks Obama On Medicare Advantage Cuts

The letter from the Republican leadership team is a sign the GOP will seize on the cuts and blame the administration, betting the issue will help the party in the midterm elections.

Politico: Republicans Press Obama On Medicare Insurance Cuts
House Republicans are blaming President Barack Obama for upcoming cuts to a popular Medicare insurance plan in an effort to open a new front in their battle against Obamacare. Top Republicans wrote to Obama on Thursday "to express deep concern about the impact of the cuts imposed by your health care law on the Medicare Advantage (MA) program and the recent action by CMS to fundamentally dismantle the Medicare prescription drug program." "These cuts, in addition to proposed rules issued by CMS, will force millions of American seniors to face higher health care costs or lose access to their doctor, health plan, lifesaving drugs, and the benefits they’ve come to rely on," the letter reads (Sherman and Haberkorn, 2/13).

Meanwhile, CQ HealthBeat looks at the imminent departure of the top health policy staffer on the Senate Finance Committee -

CQ HealthBeat: Wyden Seeks Stability On Finance Health Staff, But Schwartz Departing
Sen. Ron Wyden, the new chairman of the Senate Finance Committee, is aiming for stability in the panel's lineup of Democratic health aides. But the man in the top spot, David Schwartz, is planning to leave the committee as of March 7, according to lobbyists and other sources close to the committee (Reichard, 2/13).

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Medicaid

N.Y., Federal Officials Reach Tentative Accord On More Medicaid Funding

The agreement would add $8 billion to help the state reconfigure the state's health insurance program for low-income residents and aid some struggling hospitals.

The New York Times: Federal Agency And New York State Are In Accord Over $8 Billion Medicaid Waiver
The Obama administration has agreed “in principle” to grant an $8 billion Medicaid adjustment for New York State that could help stabilize some hospitals in Brooklyn and would reconfigure the delivery of health care there and throughout the state, state officials said on Thursday (Hartocollis, 2/13).

The Wall Street Journal: New York State's Health System Set For $8 Billion Infusion
New York state is poised to receive a long-awaited infusion of $8 billion in federal money that could be used to make lasting changes to an outdated medical system and potentially save some cash-strapped Brooklyn hospitals. Gov. Andrew Cuomo said the state has reached an agreement in principle with the U.S. Department of Health and Human Services that would "transform the state's health care system and preserve vital health services in Brooklyn and other parts of the state including struggling hospitals" (Kusisto, 2/13).

The Associated Press: NY Officials: Agreement For $8B Medicaid Waiver
New York reached an agreement Thursday with federal officials for a waiver that would allow the state to reinvest $8 billion in Medicaid savings that officials say will be used to support hospitals and improve health care (Virtanen, 2/13).

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Health Care Marketplace

More Doctors Move To Salaried Jobs

The New York Times: As Health Care Shifts, U.S. Doctors Switch To Salaried Jobs
American physicians, worried about changes in the health care market, are streaming into salaried jobs with hospitals. Though the shift from private practice has been most pronounced in primary care, specialists are following. Last year, 64 percent of job offers filled through Merritt Hawkins, one of the nation’s leading physician placement firms, involved hospital employment, compared with only 11 percent in 2004. The firm anticipates a rise to 75 percent in the next two years (Rosenthal, 2/13).

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State Watch

Highlights: N.D. Hospital And Abortion Docs; Calif. Sugary Beverage Bill

Los Angeles Times: Democrat Leading In Florida Race Eyed As Test Of Obamacare
A Democratic candidate who has explicitly defended Obamacare holds a slight lead in a special congressional election in Florida that both parties are eyeing as a test of the political impact of the healthcare law. A poll released Thursday by the Tampa Bay Times shows Democrat Alex Sink leading her Republican opponent, David Jolly, 42% to 35% among people considered likely to vote in the March 11 special election. Another 14% of respondents said they were undecided in the poll, which has a margin of error of plus or minus 4 percentage points (Lauter, 2/13).

The Associated Press: North Dakota Abortion Clinic Gets Required Hospital Access
A Dakotas-based health care system has granted hospital-admitting privileges to doctors at North Dakota's sole abortion provider, which would bring the Fargo clinic into compliance with a new state law. In a statement Thursday to The Associated Press, Sanford Health said physicians at the Red River Women's Clinic have been credentialed at its hospital in Fargo (2/13).

Los Angeles Times: California Lawmaker Proposes Adding Health Warning Labels To Sodas 
Citing studies linking soda to obesity, a state lawmaker and medical experts proposed a first-in-the-nation bill Thursday that sugary drinks sold in California carry health warning labels similar to those on cigarette packs. They want warning labels on the fronts of all cans and bottles of soda and juice drinks that have sugar added and 75 or more calories per 12 ounces (McGreevy, 2/13).

The Associated Press: California Bill Seeks Warnings On Sugary Drinks 
California would become the first state to require warning labels on sodas and other sugary drinks under a proposal a state lawmaker announced Thursday. SB1000 would require the warning on the front of all beverage containers with added sweeteners that have 75 or more calories in every 12 ounces. The label would read: "STATE OF CALIFORNIA SAFETY WARNING: Drinking beverages with added sugar(s) contributes to obesity, diabetes, and tooth decay" (Thompson, 2/13).

The Texas Tribune: As Population Ages, So Does Supply Of Home Care Workers
As the elderly population grows in Texas and throughout the United States, more seniors are finding themselves in need of home care workers. But that workforce is aging, too, and attracting young people to the profession has proven challenging (Zaragovia, 2/14).

The Oregonian: Oregon Senate Passes Silver Alert, Medicaid Fraud Bill
Local police agencies would be required to develop Silver Alert policies to locate missing vulnerable adults under a bill passed in the Oregon Senate on Thursday. Senate Bill 1577 passed unanimously and heads to the House. The bill would also require the Oregon Health Authority to develop improved electronic systems to detect and prevent Medicaid fraud. "It’s scary to have an elderly family member disappear often because of dementia or Alzheimer’s," said Sen. Tim Knopp, R-Bend, who sponsored the bill. "The goal is to as efficiently and effectively as possible recover these seniors and get them back to their loved ones” (Zheng, 2/13).

The Milwaukee Journal Sentinel: Assembly Approves Bill On Mental Health Detentions
The Assembly overwhelmingly approved a bill Thursday aimed at reducing the number of people unnecessarily brought into Milwaukee County's Mental Health Complex by police. The measure would establish a two-year pilot program that would allow the 20 medically trained employees of Milwaukee County's mobile crisis team to determine if a patient is dangerous and needs to be held before transporting him or her to the hospital. After the two years, lawmakers would review the program and decide if they want to take the idea statewide. If they did nothing, the program would automatically end, and current policies would resume (Marley and Kissinger, 2/13).  

The Seattle Times: Feds Drop Demand That Could Privatize Mental-Health Care
The federal government has backed off a demand that Washington state change how it administers mental-health care, a reversal that removes the possibility of one of the largest privatizations of services in state history. Federal officials broke the news in a letter to the state last week (Rosenthal, 2/13).

Los Angeles Times: No Quick Fix For Strokes, But L.A. Trial Made Care Speedier, Better 
A groundbreaking Los Angeles clinical trial has proven a disappointment in demonstrating that a safe and inexpensive mineral infusion could reduce disability in stroke patients. But the researchers behind a UCLA trial called "Fast-Mag" said the eight-year effort drove dramatic improvements in the care of stroke victims across the Southland, rallying hospitals, emergency medical teams and physicians to deliver faster and more targeted care (Healy, 2/13).

The Richmond Times-Dispatch: House Budget Adds $47 Million For Mental Health
The House Appropriations Committee will propose $47 million in new funding to address gaps in Virginia’s mental health system by expanding the availability of state hospital beds and the use of therapeutic drop-off centers to help people in psychiatric crises.The proposed funding represents almost $10 million more than then-Gov. Bob McDonnell requested in December to bolster the crisis response system after Sen. R. Creigh Deeds, D-Bath, was attacked by his son, who then killed himself on Nov. 19 at their home in Millboro. House Appropriations Chairman S. Chris Jones, R-Suffolk, gave House members a glimpse at the committee’s budget proposal in a floor speech Thursday that emphasized spending on mental health, domestic violence and higher education (Martz, 2/13).

Georgia Health News: Health Leaders Teach People Like Themselves To Live Better
During a family picnic once or twice a year, [Barbara] Haynes joins forces with health professionals to screen church members for high blood pressure, elevated blood sugar levels and other problems. Shiloh Baptist is a small, predominantly African-American church in east Athens, drawing members from throughout the city and some outlying areas. ... Haynes, 60, who is retired and spends most of her time volunteering, uses her status as a church member -- and in many cases, as a friend -- to get people to pay attention and perhaps ward off preventable ailments (Hale, 2/13).

The California Health Report: California Expands Palliative Care Efforts Through Nurse Training and the State’s First Outpatient Center
When Janna Woods was diagnosed with ovarian cancer last May, the Cupertino resident was unsure how she could possibly cope with the chronic back pain that had plagued her for years, combined with the onset of cancer pain. ... Fortunately, a friend told Woods about the new Palliative Care Center Silicon Valley (PCCSV) in San Jose. The first independent, community-based, licensed outpatient palliative care center in California, the center, a division of Hospice of the Valley, opened its doors to the public in July 2013 (Childers, 2/14).

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Health Policy Research

Research Roundup: Examining Readmissions; Easing Doctor Burnout

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

Avalere Health: 2014 Industry Outlook
Despite massive early IT problems, exchange enrollment is accelerating rapidly. While enrollment may not reach 7 million by the end of March, we expect at least 5 million to have enrolled by the close of the initial open-enrollment period. If enrollment falls far short, HHS could extend open enrollment for a fixed period to reach its 7 million target. ... We project that 5 million new beneficiaries will be covered by Medicaid and the Children’s Health Insurance Program (CHIP) by the end of 2014. Medicaid managed-care enrollment of non-dual beneficiaries will increase by 20 percent from 2013 to 2014 and by 38 percent from 2013 to 2016. We expect that 75 percent of non-dual Medicaid beneficiaries will be covered by Managed Care Organizations (MCOs) starting in 2015, up from 63 percent in 2012 (Feb. 2014).

Health Affairs: Five Features Of Value-Based Insurance Design Plans Were Associated With Higher Rates Of Medication Adherence 
Value-based insurance design (VBID) plans selectively lower cost sharing to increase medication adherence. Existing plans have been structured in a variety of ways, and these variations could influence the effectiveness of VBID plans. We evaluated seventy-six plans introduced by a large pharmacy benefit manager during 2007–10. We found that after we adjusted for the other features and baseline trends, VBID plans that were more generous, targeted high-risk patients, offered wellness programs, did not offer disease management programs, and made the benefit available only for medication ordered by mail had a significantly greater impact on adherence than plans without these features. The effects were as large as 4–5 percentage points. These findings can provide guidance for the structure of future VBID plans (Choudhry et al., 2/12).

JAMA: Thirty-Day Hospital Readmission Following Discharge From Postacute Rehabilitation In Fee-for-Service Medicare Patients
Research examining 30-day readmission has focused on patients discharged from acute care hospitals. Patients discharged to postacute care institutional settings have been excluded from previous research on hospital readmission. ... We examined records for patients from the 6 largest impairment categories receiving postacute inpatient rehabilitation. These include patients with stroke, lower extremity fracture, lower extremity joint replacement, debility, neurologic disorders, and brain dysfunction. ... The 30-day readmission rate among patients discharged to the community for the 6 impairment categories was 11.8%. Readmission varied from 5.8% for patients with lower extremity joint replacement to 18.8% for patients with debility. ... Readmission rates for our sample were higher for men and non-Hispanic blacks, for beneficiaries with dual eligibility, for persons with longer lengths of stay, and for individuals with rehabilitation tier–level comorbidities (Ottenbacher et al., 2/11).

JAMA Surgery: The Relationship Between Timing Of Surgical Complications And Hospital Readmission 
This is a retrospective cohort study of national Veterans Affairs Surgical Quality Improvement Program preoperative risk and outcome data on the Surgical Care Improvement Project cohort for operations performed from January 2005 to August 2009, including colorectal, arthroplasty, vascular, and gynecologic procedures. ... Our study of 59,273 surgical procedures performed at 112 Department of Veterans Affairs (VA) hospitals found an overall complication rate of 22.6% ... Although readmission is associated with complications, almost half of readmissions are not associated with a complication currently assessed by the Veterans Affairs Surgical Quality Improvement Program (Morris et al., 2/11).

JAMA Pediatrics: Effectiveness Of Peer-Based Healthy Living Lesson Plans On Anthropometric Measures And Physical Activity In Elementary School Students
Unfortunately, most teacher-led school-based interventions have been ineffective at reducing body weight in children. In contrast to traditional school-based interventions, peer mentoring is an attractive strategy for eliciting behavior change in children. ... The present study ... [used] a cluster-randomized effectiveness trial to test the hypothesis that a school-based, peer-led healthy living program would reduce adiposity and increase physical activity among children. ... peer-based mentoring led to a reduction in waist circumference in elementary school students compared with students receiving a standard curriculum. Healthy Buddies also improved self-efficacy and knowledge of healthy eating among younger elementary school students who learned about healthy living from their older peers (Santos et al., 2/10).

The Employee Benefit Research Institute: Health Savings Accounts And Health Reimbursement Arrangements: Assets, Account Balances, and Rollovers, 2006–2013
Asset levels growing: In 2013, there was $23.8 billion in health savings accounts (HSAs) and health reimbursement arrangements (HRAs), spread across 11.8 million accounts. ... HSAs growing, but HRAs contracting: For the first time since the survey was launched in 2005, the number of HRAs fell. In 2013, there were 4.7 million HRA accounts, down from 5.1 million in 2012. ... After leveling off, average account balances increased ... Length of time with account has impact ... Total and average rollovers decrease (Fronstin, 2/12).

JAMA Internal Medicine: Patient-Centered Community Health Worker Intervention To Improve Posthospital Outcomes
Socioeconomic and behavioral factors can negatively influence posthospital outcomes among patients of low socioeconomic status (SES). Traditional hospital personnel often lack the time, skills, and community linkages required to address these factors. ... A 2-armed, single-blind, randomized clinical trial was conducted between April 10, 2011, and October 30, 2012, at 2 urban, academically affiliated hospitals. ... 446 patients (65.3%) were enrolled. ... During hospital admission, CHWs [community health workers] worked with patients to create individualized action plans for achieving patients’ stated goals for recovery. ... Patient-centered CHW intervention improves access to primary care and quality of discharge while controlling recurrent readmissions in a high-risk population (Kangovi, 2/10).

JAMA Internal Medicine: Intervention To Promote Physician Well-Being, Job Satisfaction, And Professionalism
Burnout affects nearly half of medical students, residents, and practicing physicians in the United States. ... We report the results of a randomized clinical trial testing an intervention with protected time (1 hour of paid time every other week, equal to 0.9% full-time equivalent) provided by the institution to promote well-being and reduce distress in physicians. ... this intervention involved facilitated physician discussion groups organized around a curriculum incorporating elements of mindfulness, reflection, shared experience, and small-group learning intended to promote collegiality and community at work among participants. ... Participants in the facilitated small-group intervention experienced significant improvements in meaning, empowerment, and engagement in work beyond that seen in the physicians receiving only protected time. ... These differences, which became most apparent toward the end of the study period, were sustained for 12 months after the end of the intervention period (West, 2/10).

The Kaiser Family Foundation: The ACA And Recent Section 1115 Medicaid Demonstration Waivers
Under flexibility provided by the [Affordable Care Act's] Medicaid expansion, as well as pre-existing federal Medicaid law, the [ACA's] Medicaid expansion will be implemented differently across states in terms of what specific benefits are provided and how those services are delivered. Moreover, a limited number of states have obtained or are seeking approval through Section 1115 waivers to implement the expansion in ways that extend beyond the flexibility provided by the law. ... For many years, these waivers offered the only way for states to cover otherwise ineligible childless adults; now, the ACA provides new state plan authority for states to offer Medicaid to this population without the need for a waiver. While states use Section 1115 waiver authority for a wide range of purposes, this brief focuses on waivers related to implementation of the ACA Medicaid expansion (eligible for ACA enhanced matching funds) or other coverage (not eligible for ACA enhanced matching funds) (Rudowitz, Artiga and Musumeci, 2/5).

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

The New York Times: Vast Study Casts Doubts On Value Of Mammograms
One of the largest and most meticulous studies of mammography ever done, involving 90,000 women and lasting a quarter-century, has added powerful new doubts about the value of the screening test for women of any age. It found that the death rates from breast cancer and from all causes were the same in women who got mammograms and those who did not. And the screening had harms: One in five cancers found with mammography and treated was not a threat to the woman’s health and did not need treatment such as chemotherapy, surgery or radiation (Kolata, 2/11).

Modern Healthcare: Immunization Rates For Adults Too Low, CDC Says
Immunization rates among adults are too low and risk resurgence in vaccine-preventable diseases that were all but eradicated in the U.S., a federal study warns. Data released this week by the Centers for Disease Control and Prevention showed that only 14% of adults age 19 and older in 2012 reported were vaccinated for tetanus, diphtheria and pertussis, or whooping cough within the past 10 years. The number of adults age 60 and older who reported being vaccinated for shingles was at 20% in 2012, while 35% of women between ages 19 and 26 reported getting vaccinated for human papillomavirus, which protects against cervical cancer (Johnson, 2/7).

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Editorials and Opinions

Viewpoints: Parsing Obamacare Numbers; Experts On Long-Term Care Insurance; French Cancer Care

Bloomberg: The Only Obamacare Number That Matters 
The monthly announcement of Obamacare's enrollment figures has become an exercise in confirmation bias, starting with the administration itself. Health and Human Services Secretary Kathleen Sebelius noted the "encouraging trends" in yesterday's release, while House Speaker John Boehner opted to highlight its "embarrassing failures." ... The only debate worth having is how to improve enrollment. ... enrollment numbers for Obamacare aren’t some referendum on the president's popularity or lack thereof. They’re the best way to tell whether the law is working as planned -- and how to adjust if it isn't (2/13).

Bloomberg: Obamacare's Missing Numbers
The number 3.3 million represents people enrolled in a policy, not the number who have paid for their premiums. Most of the reporting -- which comes from insurance industry sources -- suggests that about 80 percent of those who signed up have actually paid the first month’s premium. ... The demographic mix isn’t improving as hoped. ... We still have no idea how many of these people previously had insurance. If the administration knows, it is not sharing those numbers with anyone else (Megan McArdle, 2/13).

Bloomberg: Obamacare Enrollment Slowed in January. Does That Matter?
Enrollment in the Affordable Care Act's insurance exchanges grew again in January, but it grew at a much slower pace than the month before. How much of a concern that is for the law is open to interpretation. In raw numbers, total enrollment in January was indeed a win for the Barack Obama administration ... On the other hand, there are just two months left in the six-month open enrollment period ... the only game that matters right now is getting more people -- mostly young people, and young men in particular -- to sign up (Christopher Flavelle, 2/13).

The New York Times: Inequality, Dignity And Freedom
Now that the Congressional Budget Office has explicitly denied saying that Obamacare destroys jobs, some (though by no means all) Republicans have stopped lying about that issue and turned to a different argument. O.K., they concede, any reduction in working hours because of health reform will be a voluntary choice by the workers themselves — but it’s still a bad thing because, as Representative Paul Ryan puts it, they’ll lose “the dignity of work.” ... if you really care about the dignity and freedom of American workers, you should favor more, not fewer, entitlements, a stronger, not weaker, social safety net (Paul Krugman, 2/13).

The New York Times' Economix blog: Tax Subsidies And The Incentive To Work
It is worth reading Appendix C of the C.B.O. report to get a feel for what is really at stake here. In that appendix the agency explains, for example, that its “estimate that the A.C.A. will reduce employment reflects some of the inherent trade-offs involved in designing such legislation.” Further clarification was offered in a “Frequently Asked Questions” statement by the C.B.O. The agency alludes there to the fact that any program offering means-tested public assistance to citizens will do much good but implicitly confront citizens with higher marginal tax rates that may induce these beneficiaries to work fewer hours or even retire (Uwe E. Reinhardt, 2/14).

The Washington Post: Obamacare’s War On Jobs 
The honest liberal reply to the CBO report is that a disincentive to work is inherent in any means-tested government benefit. It’s the unavoidable price of helping those in need because for every new dollar you earn, you lose part of your subsidy and thus keep less and less of your nominal income. ... But Obamacare’s war on jobs goes beyond voluntary idleness. The administration is now conceding, inadvertently but unmistakably, Obamacare’s other effect — involuntary job loss (Charles Krauthammer, 2/13).

The Washington Post: The GOP's Health Crisis
The news that nearly 1.2 million people signed up last month for insurance through the Affordable Care Act exchanges is highly inconvenient for GOP candidates nationwide. ... Republicans may even have to take the drastic step of saying what they advocate, rather than harping on what they oppose. Is there a GOP plan to cover those with preexisting conditions? To cover the working poor? Is expanding access to health insurance really such an awful thing? Sorry, I didn’t catch what you said (Eugene Robinson, 2/13).

USA Today: GOP's Unhealthy Strategy
It is hard to imagine anything they could have cooked up on their own that would have enabled Republicans to feast on for so long as Obamacare. It gave them talking points, 47 opportunities to vote to repeal the law and now a narrative for the 2014 elections. And just as the GOP was beginning to discuss immigration reform, it was erased from the menu in favor of a pig-out on the flaws of the Affordable Care Act. But putting too many eggs in the Obamacare basket could leave Republicans with insufficient nourishment for the fall campaign (Ross K. Baker, 2/13). 

The Washington Post: The Tea Party Position On Obamacare
A senior member of the Louisiana Democratic Party tells me Dems will try to get a state Constitutional amendment to expand Medicaid on the ballot on Election Day 2014. The chances of succeeding at that are very slim – more on that in a moment – but this goes to the heart of a very interesting storyline that’s set to unfold in Louisiana this spring involving Americans for Prosperity, the group backed by the Koch brothers, Mary Landrieu, and the health law. This storyline also neatly captures the true nature of the Tea Party position on Obamacare (Greg Sargent, 2/13).

The Fiscal Times: Obama's Health Care Mandate: My Whim Is My Command
The latest arbitrary salvo from the Obama administration in an attempt to rescue its collapsing command health-insurance economy came from the Treasury Department earlier this week. As Barack Obama made headlines by issuing yet another delay in enforcement of the employer mandate – again ignoring the January 2014 statutory deadline for compliance in his own legislation – Treasury announced that it would keep an eagle eye on businesses that reacted to the exploding costs of compliance. The IRS would require employers to file a "self-attestation" on their tax forms "to 'certify' that they are not shedding full-time workers simply to avoid the mandate." This demand is based on … what, exactly? (Edward Morrissey, 2/13).

JAMA: Henry Waxman: Architect Of The Health Care Safety Net
As a medical student in New York and then a resident in San Francisco, I received a substantial amount of my training in safety-net hospitals. … In 2009, as a Robert Wood Johnson Health Policy Fellow, I had the opportunity to meet and work for one of the primary architects of the health care safety net, Congressman Henry A. Waxman (D, California). ... With the ACA’s expansion of health insurance coverage, questions are emerging about the future of the health care safety net. ... Without Henry Waxman in Congress, finding answers to guide the health care safety net into the future is likely to become significantly more difficult. (Dr. Andrew Bindman, 2/13).

Los Angeles Times: Will Philip Seymour Hoffman's Death Be A Wake-Up Call?
After Hoffman's death, reports surfaced that the actor, a onetime heroin addict, had been abusing prescription opiates, which ultimately led him back to heroin. That's a common path ... On the street, opiate pain pills sell for $1 a milligram, according to police and addicts I've interviewed across the country. An addict can need 150 to 300 milligrams a day. A comparable high from heroin is a fifth to a tenth the price, which is part of the reason its use has almost doubled between 2010 and 2012 ... So here's hoping that Hoffman's death, which encapsulates much of this epidemic, will also rouse us to a thing that is deadlier and quieter than any drug plague we've seen before (Sam Quinones, 2/14).

Reuters: The French Way Of Cancer Treatment
When my father, the editor and writer Andre Schiffrin, was diagnosed with stage four pancreatic cancer last spring, my family assumed we would care for him in New York. ... my father announced he wanted to stick to his normal schedule — and spend the summer in France. ... the French system is basically like an expanded Medicaid. Pretty much everyone has insurance, it explained, and the French get better primary care and more choice of doctors than we do. ... We didn’t have to worry about navigating a complicated maze of insurance and co-payments and doing battle with billing departments. Every time I sit on hold now with the billing department of my New York doctors and insurance company, I think back to all the things French healthcare got right. The simplicity of that system meant that all our energy could be spent on one thing: caring for my father (Anya Schiffrin, 2/12).

The Wall Street Journal has a panel of experts answering the question: Should healthy, younger individuals consider long-term-care insurance? The responses:

What to Consider When Considering Long-Term-Care Coverage (Sheryl Garrett, 2/13)

Get Long-Term-Care Insurance While You’re Healthy (Charles Rotblut, 2/13)

You’re Not Too Young For A Long-Term-Care Policy (Larry Zimpleman, 2/13)

Start Shopping For Long-Term-Care Insurance at 45  (Michelle Perry Higgins, 2/13)

Why Long-Term-Care Coverage Is Right for Me (Olivia Mitchell, 2/13)

Don’t Buy Long-Term-Care Insurance. Self-Fund It. (Manisha Thakor, 2/13)

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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.