Daily Health Policy Report

Monday, February 24, 2014

Last updated: Mon, Feb 24

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch


Health Care Marketplace

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Impact Of Medicare Advantage Cuts On Seniors Sharply Disputed

Kaiser Health News staff writer Phil Galewtiz reports: "The health insurance industry points to these examples as some of the more extreme cases of beneficiaries feeling the sting of federal funding cuts to Medicare Advantage plans that cover nearly 16 million senior citizens. They say the Obama administration’s additional proposed 1.9 percent in cuts to the plans for 2015, which was announced Friday, will mean millions more will see reductions in benefits and higher out-of-pocket costs. But health policy experts and advocates for seniors say most Medicare health plans have largely kept costs and benefits stable and believe the industry is scaring seniors unnecessarily (Galewitz, 2/23). Read the story.

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Obama Administration Proposes 1.9% Cut In Medicare Advantage Payments

Kaiser Health News staff writer Mary Agnes Carey reports: "Late Friday, the Centers for Medicare & Medicaid Services announced proposed rates that officials said could mean payment reductions of 1.9 percent for the private plans in the program. But insurers, who have led a fierce lobbying campaign against payment reductions, say the Medicare Advantage plans would sustain a far deeper cut. That's because the lower payment rates will be combined with new health law fees on health plans, a phase-out of the 'star rating' system that helped buffer the reductions for Medicare Advantage plans in prior years and Medicare cuts in the automatic federal spending cuts known as 'sequestration'" (Carey, 2/24). Read the story.

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Medicare Data Show Wide Differences In ACOs' Patient Care

Kaiser Health News staff writer Jordan Rau reports: "The release is the first public numbers from Medicare of how patient care is being affected by specific networks. These accountable care organizations, or ACOs, are among the most prominent of Medicare’s experiments in changing the ways physicians and health care facilities work together and are paid. The ACOs will be able to keep some of the money they save, but they also take on some of the financial risk if their patients end up being costly" (Rau, 2/21). Read the story.

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Capsules: 40% Of Enrollees Through eHealth Website Are Young Adults

Now on Kaiser Health News' blog, Julie Appleby reports: "Private online marketplace eHealth reported that the percentage of people between the ages of 18 and 34 who applied for coverage through the firm’s website in the last quarter of 2013 was well above the 25 percent rate cited by the Obama administration for enrollments through sites run by the states and the federal government" (Appleby, 2/21). Check out what else is on the blog.

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Political Cartoon: 'Fang Clubs?'

Kaiser Health News provides a fresh take on health policy developments with "Fang Clubs?" by Joe Heller.

And here's today's health policy haiku:


State health exchange stats
improve in Maryland. Why?
A research error.

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

Health Law Deadlines, And Even Statistics, Still In Flux

News outlets report on the changes that have been made to the health law and whether these tweaks may be adding new layers of complications. Meanwhile, stories also center on enrollment efforts and the current tally of enrollment numbers.

McClatchy: So Many Changes To The Health Care Law, But Are They Legal?
After President Barack Obama bowed to critics in November and allowed people with canceled health insurance policies to keep their coverage for another year, the White House quickly hit the spin cycle. In a telephone briefing with reporters that same day, senior administration officials said their “enforcement discretion” allowed them to tweak the Affordable Care Act to ensure that it would be implemented with minimal disruption. Previous administrations had done the same thing with complicated new laws, they said, and the slow-motion rollout of the sprawling health care law was sure to encounter more problems along the way (Pugh, 2/24).

Politico: The Politics Of Obamacare Delays
By now, the pattern is pretty clear: Obamacare deadlines don’t stick. .... The unanswered question is, does the extra time create more hassles than benefits for those affected - and is the goalpost-moving worth the political headaches it creates for the Obama administration? Because undeniably, every time the Obama administration bends a deadline for the Affordable Care Act — delaying the employer mandate for the second time, putting off parts of the enrollment launch, or giving customers just a little more time to sign up — it fuels the perception that the administration is just winging it, and gives Republicans new fodder to accuse the White House of rewriting laws too casually. That doesn’t mean the busted deadlines always matter in the real world, though (Nather, 2/21).

Fox News: Tracking Obamacare: As Enrollment Deadline Nears, Law Endures 28 Delays And Counting
As the administration touts the benefits of ObamaCare in a push to sign up more people before the March deadline, a FoxNews.com review shows how much of the law has really been pushed off.  Since its inception, provisions of the law have been delayed a total of 28 times; the average delay was six months and three weeks. Put another way, the cumulative delays add up to an astonishing 15 years and three months. The administration has been announcing changes to the law at a fairly steady clip.  The White House's latest delay was rolled out on Feb. 10, and allowed companies with between 50 and 99 workers to skirt the mandate to provide health care until 2016 (Walker, 2/21).

The Washington Post: Health Care Law's Small-Business Marketplace Not Attracting Many Small Businesses
Small-business owners, who were supposed to gain more choices and cheaper rates from the new online-health-insurance portals, have been slow to select plans through marketplaces since the rollout started last fall. In part, some say, that is because luring employers to the marketplaces has taken a back seat to fixing technical problems and recruiting individuals and families. As a result, businesses in many states have been left with an online-shopping portal that is only partially functional — if they have one at all (Harrison, 2/23).

Politico: Obamacare Stats Still Hard To Nail Down
The truth is, nobody has a good, real-time fix on how successful the Affordable Care Act has been in reducing the ranks of the uninsured. The Obama administration hasn’t been able to say how many of the 3.3 million people who have signed up for private health insurance coverage, or of the 6.3 million who have been determined eligible for Medicaid, were actually uninsured before — and health care experts aren’t sure yet, either (Nather, 2/23).

Kaiser Health News: Capsules: 40 Percent Of Enrollees Through eHealth Website Are Young Adults
Private online marketplace eHealth reported that the percentage of people between the ages of 18 and 34 who applied for coverage through the firm’s website in the last quarter of 2013 was well above the 25 percent rate cited by the Obama administration for enrollments through sites run by the states and the federal government (Appleby, 2/21).

The Hill: White House Pushes For Black Enrollees
The Obama administration is engaged in a “final coordinated push” to enroll blacks in ObamaCare, White House senior adviser Valerie Jarrett said Friday. Jarrett said blacks have a “disproportionately low rate of coverage,” and called enrolling them the administration’s “top priority” (Easley, 2/21).

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States Face Challenges With Attempts To 'Customize' Medicaid Expansion Plans

Stateline reports that the efforts to tailor the program take time, among other things. Meanwhile, the Washington Post examines the Obama administration claim about the number of Americans who have, for the first time, gained access to health care because of the expansion. In addition, news outlets offer updates from Virginia, Arkansas, Missouri, Florida and Indiana.

Stateline: Tough Road For States Seeking Customized Medicaid Expansion
Of the 25 states that already have expanded Medicaid under the Affordable Care Act, all but Arkansas, Iowa and Michigan simply added newly eligible adults to their existing Medicaid programs. That was the easiest approach. In contrast, the states that haven't yet expanded Medicaid but are considering doing so want to tailor the program to fit their own priorities—and that will take time. "It's not going to happen overnight," said Matt Salo, director of the National Association of Medicaid Directors (Vestal, 2/24).

The Washington Post's The Fact Checker: Obama's Claim That 7 Million Got 'Access To Health Care For The First Time' Because Of His Medicaid Expansion
The Fact Checker has written several times about the fuzziness of the Medicaid numbers issued by the Obama administration. But it is like playing whack-a-mole. Every time we rap someone for getting it wrong, the same problem pops up someplace else (Kessler, 2/24).

The Associated Press: Governors: 'Obamacare' Here To Stay
The explosive politics of health care have divided the nation, but America’s governors, Republicans and Democrats alike, suggest that President Barack Obama’s health care overhaul is here to stay. While governors from Connecticut to Louisiana sparred Sunday over how best to improve the nation's economy, governors of both parties shared a far more pragmatic outlook on the controversial program known as "Obamacare" as millions of their constituents begin to be covered (Peoples and Thomas, 2/23).

The Washington Post: Virginia And Other States Wrestle With Whether To Expand Medicaid Under Affordable Care Act
It was a purely symbolic vote, but Gov. Terry McAuliffe desperately wanted it to go his way. The Democratic governor summoned at least four Republican delegates to his office one by one last week, twisting their arms to support expanding Medicaid in a floor vote the GOP was forcing just for show (Vozzella, 2/23). 

The Richmond Times-Dispatch: McAuliffe Expands Medicaid Push
With the House of Delegates and Virginia Senate still sharply divided, the war over Medicaid expansion enters a new theater this week. Gov. Terry McAuliffe will visit Inova Loudoun Hospital in Leesburg on Monday to discuss Medicaid expansion, signaling a shift in the ground game for his top legislative priority beyond the confines of Capitol Square. The visit coincides with a Virginia Chamber of Commerce news conference scheduled for Monday at the Capitol to release what it terms its "principles for a Medicaid private option for Virginia" (Meola and Nolan, 2/23).

(Norfolk) Virginian-Pilot: Lawmakers' Health Plans Draw Fire In Medicaid Debate
Members of Virginia's part-time legislature are locked in an intensely passionate policy battle over whether to let thousands of their constituents enroll in government-backed health insurance. About three-fourths of those same General Assembly members enjoy for themselves, and their families, taxpayer-funded state health benefits under plans that in many cases are more attractive than those in the private sector. ... That nearly 75 percent participation rate by legislators on both sides of the aisle has some asking this question: Is it fair or moral for them to accept publicly subsidized health insurance as a benefit of being a lawmaker while denying government-funded coverage to people without another option? (Jeter and Walker, 2/24).

Reuters: Arkansas Lawmakers To Vote On Funds For Alternative To Obamacare
Arkansas lawmakers will try once again to provide funding this week for the state's Private Option medical insurance plan that has drawn interest from other states' lawmakers, who see it as an alternative to Obamacare. The Arkansas Senate approved the $915 million appropriation for the Private Option plan last week, but the House narrowly rejected it in four votes (Barnes, 2/24).

The Associated Press: Poor Floridians Fall Into Medical Expansion Gap
Roughly 1 million uninsured Floridians who repeatedly heard affordable health insurance was just around the corner for them thanks to President Barack Obama's new law are finding a harsh reality — they're too poor to qualify. The Florida House voted last year not to expand Medicaid under the Affordable Care Act because of fears that it could eventually cost the state hundreds of millions annually, meaning those earning below the poverty line, $11,490 for an individual or $23,550 for a family of four, aren't eligible for tax credits through the online marketplace. Without those tax credits, most people living below the poverty line can't afford coverage (Kennedy, 2/23).

The Associated Press: Report Says Expanding Medicaid In Missouri Would Create 24,000 Jobs
Missouri would get 24,000 new jobs if the state expands eligibility for its Medicaid program, a new report says, but the analysis is unlikely to sway the Republican-led legislature. The Department of Economic Development projects the new jobs would bring in $9.9 billion in new wages and generate $402 million in state revenue over the next eight years (2/23).

Indianapolis Star: Gov. Mike Pence Seeks Path To Medicaid Expansion
Gov. Mike Pence said Saturday that he is encouraged by the one-on-one discussion he had Friday with Health and Human Services Secretary Kathleen Sebelius about using the Healthy Indiana Plan to expand Medicaid here. But Pence did not indicate how the state will win approval for the alternative approach, given that the plan ­includes a provision prohibited by the federal government — that those under the poverty line contribute to the first $1,100 of their care (Groppe, 2/23).

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State Exchanges: Vt. Gov. Shumlin Says Fixes Are Working

News outlets report on the operating issues for the online exchanges.

Politico: Shumlin: 'Websites Get Fixed'
Vermont Gov. Peter Shumlin says the problems with the Affordable Care Act rollout are getting fixed – and that Republicans were boxing themselves in politically by focusing on failures instead of the successes. "Websites get fixed. We're fixing ours. They're fixing theirs. The federal exchange is working better," the Democratic governor said on "Fox News Sunday." ... Sitting on a panel with Wisconsin Republican Gov. Scott Walker, Shumlin said the refusal of some GOP governors – including Walker – to accept federal money was driven solely by animus towards President Barack Obama (Tau, 2/23).

Bloomberg: Health-Care Law Making Progress, New Hampshire Governor Says
The Affordable Care Act is overcoming its initial problems and is making progress in accomplishing its mission of expanding and improving coverage, New Hampshire Governor Maggie Hassan said (Selway and Salant, 2/22).

The Boston Globe: Progress Reported On Insurance Application Backlog
Officials running the state's troubled health insurance marketplace reported progress Friday toward addressing its most immediate challenge: a massive backlog in processing applications. Legislators have been scrutinizing the problems with the Massachusetts Health Connector website and the labyrinth many people who are not insured through an employer have had to navigate to get coverage. ... During a weekly update Friday, state officials said that over the last week, all 22,000 pending applications for health insurance that had been submitted through its website had been processed (Johnson, 2/21).

The San Francisco Chronicle: Covered California Website Stymied By Software Problems
Just as California begins its final marketing push to get people signed up for health coverage by the end of March, the portal for the state's exchange has been shut down because of software problems. Covered California officials took the exchange's enrollment portal offline Wednesday afternoon and it has been down ever since. It's a case of bad timing for Covered California officials, with a little more than a month before the March 31 enrollment window closes (Colliver, 2/22).

The Philadelphia Inquirer: Newly Insured Begin To Receive Care
Certified application counselor Eric N. Goren has spent the last five months helping people negotiate the often-perplexing path to buying health insurance on the Affordable Care marketplace. And primary care doctor Eric N. Goren is beginning to see the results of his effort at a clinic in West Philadelphia (Calandra, 2/23).

The Texas Tribune: A Focus On Helping Colonia Residents With Health Law
As she looks into buying private health insurance under the federal Affordable Care Act, which requires most people to obtain coverage in 2014, [Maria] Díaz is facing a new type of rejection: She probably does not make enough money to qualify for tax credits to purchase coverage through the federal health insurance marketplace. Thousands of residents of Texas' colonias along the U.S.-Mexico border are in similar situations after falling into the "coverage gap" created when Texas' Republican leadership declined to expand Medicaid eligibility for poor adults under the ACA, saying Medicaid was a broken system. Living in unincorporated subdivisions, where the uninsured rate is between 50 and 80 percent, colonia residents may be largely left with little hope of obtaining coverage (Ura, 2/24).

Newark Star-Ledger: Obamacare In NJ: Four Out Of Five Enrollees Have Paid Their Premiums
At least three-quarters of the New Jerseyans who have selected health insurance through the federal marketplace website have followed through by paying their first month's premium, according to the three companies selling the policies. The state's rate of paying customers is in line with figures reported across the nation (O'Brien, 2/22).

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Maryland's Health Exchange Goals Revised After Research Error

The initial goal was reportedly based on flawed data, and the newly set milepost has already been met. Still, The Baltimore Sun reports that the state has halted work on its small business marketplace and that Maryland will charge for work related to public information requests about what went wrong with the website.

The Washington Post: Maryland Has Achieved Its Health Insurance Enrollment Goal, Thanks To A Research Error
For months, it looked like Maryland would barely meet, or even miss, the first enrollment goal for its new health insurance exchange. But it turns out the goal was based on flawed data, and the state’s new goal is one that it has already beat. Instead of signing up 260,000 Marylanders for private plans or Medicaid during the first enrollment period, as was the original goal, the state is only expected to get 160,000, according to a letter the exchange’s interim executive director received from researchers Friday. So far, sign-ups tally nearly 190,000 (Johnson, 2/23). 

The Baltimore Sun: Enrollment Goals Are Revised For Maryland Health Exchange
The target long used by the Maryland health exchange of how many people would enroll in private policies through its website this year was slashed in half after an error came to light, making the state appear far closer to its goal -- but still unlikely to reach it. A top exchange official said Sunday a mistake in a chart outlining exchange projections made by outside analysts put the number of people likely to sign up for private insurance under the Affordable Care Act at close to 150,000 by the end of open enrollment on March 31 (Cohn, 2/23).

The Associated Press/Washington Post: Md. Resets Goal For Health Insurance Enrollment
Instead of signing up 260,000 Maryland residents for private insurance or Medicaid during the first enrollment period, the state is now expected to enroll 160,000 residents. So far, Maryland has signed up nearly 190,000 people. The new goal is detailed in a letter the exchange’s interim director received from researchers Friday (2/23). 

The Baltimore Sun: Work On Small Business Health Exchange Website Halted
The contractor under fire for the botched rollout of the state's troubled online health exchange for uninsured people was also hired during a closed-door meeting to develop a similar marketplace for Maryland's small businesses -- work that exchange officials acknowledge has halted. The news has further dismayed those who want to sell or buy insurance on the exchange website. It also has given fuel to critics of the procurement process and exchange launch, both outside of state government and among some top state officials (Cohn, 2/23).

The Baltimore Sun: Md. Health Exchange To Charge For Work On Public Information Requests
The online exchange where Maryland's uninsured can buy coverage under the Affordable Care Act has been troubled since its Oct. 1 launch, prompting media outlets and others to dig into what went wrong. There have been at least 65 requests for information under the state's public records laws, including emails among staff, invoices, contract details and other data (Cohn, 2/22).

Also in the news, Maryland's health exchange issues are among those being highlighted by the GOP --

The Associated Press/Washington Post: GOP Intent On Highlighting Health Care Woes
House Republicans intent on highlighting the woes of President Barack Obama’s health care law need to look no further than their own back yards, some of which are traditionally liberal strongholds. Maryland’s online health care exchange has been plagued by computer glitches since its rollout last year, reflected in abysmal enrollment numbers well below projections through January. The state’s lone Republican in Congress, Rep. Andy Harris, has asked the inspector general of the federal Health and Human Services Department to investigate (2/24).

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Federal Court Rules Against Notre Dame In Contraception Case

The Catholic university must now provide birth control coverage to students and employees as mandated in the health law.

The Wall Street Journal: Court Rules Against Notre Dame In Contraception Case
A federal appeals court Friday ruled against the University of Notre Dame in a legal proceeding claiming the Obama administration's contraception-coverage requirement is forcing it to violate its religious beliefs (Radnofsky and Kendall, 2/21).

The Hill: Court: Notre Dame Must Adhere To Obamacare Birth Control Mandate
The University of Notre Dame must provide birth control to employees and students after a federal appeals court ruled Friday, a move the school says will force it to violate its religious beliefs. In a blow to religious colleges and universities across the country, the 7th U.S. Circuit Court of Appeals in Chicago denied Notre Dame's request for an injunction to the Obamacare birth control mandate that requires the school to provide coverage for contraception (Devaney, 2/22).

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Capitol Hill Watch

GOP Readies New Votes On Health Law Mandate Repeal, Medicare Advantage Cuts

In the meantime, one Democratic senator is pulling back from comments he made on repealing the health law.

NBC News: GOP Readying Votes on Obamacare and 'Imperial Presidency'
Obamacare and flood insurance top Republicans' agenda as Congress returns to work next week. House Majority Leader Eric Cantor, R-Va., said the GOP chamber would put the president and health care in its sights as lawmakers' attention turns from legislating and toward election year posturing. Cantor labeled President Obama's recent push to sidestep Congress when he can an "imperial presidency," and said the House would act (2/21).

Fox News: Democratic Sen. Manchin Walks Back 'Repeal' Comments On Obamacare
Democratic Sen. Joe Manchin reportedly said this week he’d vote to repeal Obamacare -- but on Friday walked back his comments in a statement put out by his office. According to The Beckley Register-Herald, the West Virginia lawmaker and longtime critic of Obamacare said Wednesday “I will vote tomorrow to repeal (Obamacare), but I want to fix the problems in it.” As those comments started to gain traction, Manchin’s office sent out a statement that seemed to contradict what he said (2/21).

The Associated Press: Early House Race Tests Obamacare As Election Issue
The candidates are Alex Sink, Democrat, and David Jolly, Republican, but Obamacare is on the ballot in a big way in a competitive House race in Florida that offers a preview of the nationwide campaign for Congress this fall. Republicans and their allies wouldn't have it any other way as they test the issue's potency, even though their candidate may muddle the message, and other issues like Social Security may command a bigger role in deciding the winner. ... The candidates took different paths to their March 11 matchup to serve out the term of the late Republican Rep. C.W. "Bill" Young, who died last fall (Espo, 2/22).

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Regulators Propose 1.9% Cut To Medicare Advantage Payments

Federal regulators late Friday proposed cutting payments to private Medicare plans by 1.9 percent after recent lower health care spending growth. Insurers worry the cut could be much deeper than that after health law fees and other payment changes take effect, however, and say another cut could affect benefits for seniors.

The Wall Street Journal: Government Proposes Cuts To Insurers' Medicare Payments
Federal regulators proposed cuts to payments for insurers that run private Medicare plans, with some analysts saying the reductions appeared steeper than they had projected. The stakes on such changes are high for many health insurers, which count on Medicare dollars for a substantial chunk of their earnings (Mathews, 2/21).

Kaiser Health News: Impact Of Medicare Advantage Cuts On Seniors Sharply Disputed
The health insurance industry points to these examples as some of the more extreme cases of beneficiaries feeling the sting of federal funding cuts to Medicare Advantage plans that cover nearly 16 million senior citizens. They say the Obama administration’s additional proposed 1.9 percent in cuts to the plans for 2015, which was announced Friday, will mean millions more will see reductions in benefits and higher out-of-pocket costs. But health policy experts and advocates for seniors say most Medicare health plans have largely kept costs and benefits stable and believe the industry is scaring seniors unnecessarily (Galewitz, 2/23).

Kaiser Health News: Obama Administration Proposes 1.9% Cut In Medicare Advantage Payments
Late Friday, the Centers for Medicare & Medicaid Services announced proposed rates that officials said could mean payment reductions of 1.9 percent for the private plans in the program. But insurers, who have led a fierce lobbying campaign against payment reductions, say the Medicare Advantage plans would sustain a far deeper cut. That's because the lower payment rates will be combined with new health law fees on health plans, a phase-out of the "star rating" system that helped buffer the reductions for Medicare Advantage plans in prior years and Medicare cuts in the automatic federal spending cuts known as "sequestration" (Carey, 2/24).

Related, earlier KHN coverage: Bipartisan Group Of Senators Concerned About Medicare Advantage Cuts (Carey, 2/18).

The Associated Press/Washington Post: Medicare Advantage Plans May Face Cuts
Cuts are on the table next year for Medicare Advantage plans, the Obama administration says. The politically dicey move affecting a private insurance alternative highly popular with seniors immediately touched off an election-year fight. The announcement gave new ammunition to Republican critics of President Barack Obama’s health care law, while disappointing some Democratic senators who had called on the administration to hold rates steady. Insurers are still hoping to whittle back the cuts or dodge them altogether (2/22). 

Reuters: U.S. Government Seeks To Cut Medicare Payments To Insurers
The U.S. government on Friday proposed a cut in payments to private health insurers for 2015 Medicare Advantage plans, a move Republican lawmakers said would hurt benefits for the elderly and disabled. The proposal, released in a document by a division of the U.S. Department of Health and Human Services, appeared to cut payments by more than the 6 to 7 percent the insurance industry had expected, one Wall Street analyst said (Humer, 2/21).

Politico: Major Spending Cut Proposed For Medicare Advantage
The Obama administration is proposing a major cut in 2015 payments to Medicare Advantage, in a move that is sure to set off a ferocious campaign by the insurance industry to reverse the decision and likely will further complicate the health care politics of the midterm elections. An annual notice released Friday after the markets closed would reduce Medicare Advantage spending by 3.55 percent. The figure is based on trends in health care spending, which has grown at a historically low pace in recent years. The annual rate adjustment -- which is only one of the payment changes -- is calculated through a complicated set of formulas, and analysts were still sorting out the 148-page proposal that CMS released late in the afternoon to assess the total impact on the increasingly popular program for seniors (Norman, 2/21). 

Kaiser Health News also tracked weekend health policy headlines, including reports about proposed Medicare Advantage rates (2/23).

In other news related to Medicare -

Kaiser Health News: Medicare Data Show Wide Differences In ACOs’ Patient Care
The release is the first public numbers from Medicare of how patient care is being affected by specific networks. These accountable care organizations, or ACOs, are among the most prominent of Medicare’s experiments in changing the ways physicians and health care facilities work together and are paid. The ACOs will be able to keep some of the money they save, but they also take on some of the financial risk if their patients end up being costly (Rau, 2/21).

The New York Times: Plan To Limit Some Drugs in Medicare Is Criticized
An alliance of drug companies and patient advocates, joined by Democrats and Republicans in Congress, is fiercely opposing an Obama administration proposal that would allow insurers to limit Medicare coverage for certain classes of drugs, including those used to treat depression and schizophrenia. Opponents warn that the proposal, if enacted, could harm patients. Federal officials say it would lower costs and reduce overuse of the drugs. The proposed rule, which would lift a requirement that insurers cover “all or substantially all” drugs in certain treatment areas, is just one of a series of changes to the drug program that are being opposed by the unlikely alliance (Thomas and Pear, 2/21).

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Health Care Marketplace

Pediatricians Argue Against Retail Health Care Clinics

In the meantime, a big push for greater health care price transparency is readied, and the prominence of palliative care grows.

The Wall Street Journal: Pediatrics Group Balks At Rise Of Retail Health Clinics
Retail health clinics that are popping up in drugstores and other outlets shouldn't be used for children's primary-care needs, the American Academy of Pediatrics said, arguing that such facilities don't provide the continuity of care that pediatricians do. While retail clinics may be more convenient and less costly, the AAP said they are detrimental to the concept of a "medical home," where patients have a personal physician who knows them well and coordinates all their care (Beck and Martin, 2/24). 

The Wall Street Journal: How To Bring The Price Of Health Care Into The Open
With outrage growing over incomprehensible medical bills and patients facing a higher share of the costs, momentum is building for efforts to do just that. Price transparency, as it is known, is common in most industries but rare in health care, where "charges," "prices," "rates" and "payments" all have different meanings and bear little relation to actual costs (Beck, 2/23). 

The Wall Street Journal: Palliative Care Gains Favor As It Lowers Costs
Insurers are establishing programs that give the sickest patients the chance to receive extra care for their pain, suffering and emotional needs, in a move that turns out to cut spending substantially (Rockoff, 2/23).

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State Watch

State Highlights: Calif. Docs Fight Health Law Reimbursements; Wis. And Collective Bargaining; Kan. Navigators Restrictions

A selection of health policy stories from California, Wisconsin, Kansas, Virginia, Oregon, Georgia, North Carolina and Maine.

The San Jose Mercury News: Doctors, Insurers Face Off Over Reimbursement Rates
Lowering costs by forcing doctors and insurers to compete for millions of new patients is a primary goal of the nation's new health care law, but a group of gastroenterologists in the East Bay and internists near Chico are exposing a fissure in that plan. There often aren't enough doctors to go around. In parts of the state, the shortage of doctors participating in California's new insurance exchange is providing new leverage for medical providers to hold out for higher reimbursement rates from big insurance companies. And as a game of chicken unfolds behind the scenes between two powerful groups that are key to the law's success, the insurers are often caving in to the doctors, raising concerns that the trend could catch on and drive up the price of health insurance premiums on the exchange (Seipel, 2/23).

The New York Times: Wisconsin’s Legacy for Unions
[Gov. Scott] Walker’s landmark law -- called Act 10 -- severely restricted the power of public-employee unions to bargain collectively. ... All over the state, public executives are exercising new authority. Instead of raising teachers’ salaries, the Mequon-Thiensville School District, near Milwaukee, froze them for two years, saving $560,000. It saved an additional $400,000 a year by increasing employee contributions for health care, said its superintendent, Demond Means (Greenhouse, 2/22).

Kansas Health Institute: Hearing Set For Bill To Restrict Obamacare Navigators
A bill that would add restrictions for the application counselors who help people enroll in health coverage through the new federal marketplace in Kansas has been scheduled for a hearing Tuesday in the Senate Public Health and Welfare Committee. Senate Bill 362 would require Kansas' health insurance "navigators" to be certified by the attorney general's office after undergoing a criminal background check and credit check (Cauthon, 2/21).

The Washington Post: Work Limits May Be Easing For Va. Adjunct College Instructors; Federal Health Law At Issue
Virginia’s limits on the work schedule of part-time college instructors, imposed last year to minimize health insurance expenses of public community colleges under the Affordable Care Act, appear to be easing for at least some of the adjunct professors (Anderson, 2/21).

Los Angeles Times: Actors Draw Med School Students Into Caregiver Role
David Solomon lay in bed, a sheet draped over his legs. His darkened bedroom was silent, except for the ticking of a clock on the wall. A box of tissues sat on a bedside table; a Hebrew-and-English siddur, or prayer book, rested on his lap.The cancer that the 70-year-old cosmetics merchant had held at bay for 12 years was no longer responding to chemo. His breathing was labored, and his morphine-addled gaze wandered. It took all his effort to focus on the white-jacketed medical student who stood next to him (Brown, 2/24). 

Los Angeles Times: Mysterious Polio-Like Illnesses Reported In Some California Children
A small number of children in California have come down with polio-like illnesses since 2012 -- suffering paralysis in one or more limbs and other symptoms -- and physicians and public health officials do not yet know why.A virus may play a role, said Dr. Carol Glaser, leader of a California Department of Public Health team investigating the illnesses, which are occurring sporadically throughout the state (Brown, 2/23). 

The Oregonian: Silver Alert, Medicaid Fraud Bill Heads To Gov. John Kitzhaber
Local police agencies would be required to develop Silver Alert policies to locate missing vulnerable adults under a bill that unanimously passed the Oregon House on Friday. Senate Bill 1577 heads to Gov. John Kitzhaber after previously clearing the Senate. The bill would also require the Oregon Health Authority to develop improved electronic systems to detect and prevent Medicaid fraud. The Silver Alert policies would also include people with developmental disabilities, brain injuries and other vulnerable adults (Zheng, 2/21).

Georgia Health News: Panel Backs Autism Coverage Requirement 
The Senate Insurance and Labor Committee on Thursday approved three bills related to health care, including one that mandates private insurance coverage for treatment of children with autism. Committee Chairman Tim Golden (R-Valdosta), the lead sponsor on SB 397, said the costs of the treatment that would be covered under the legislation could not exceed $35,000 per year for each child. The eligible age for coverage would be capped at 6 years old (Craig, 2/21).

North Carolina Health News: Community Fights Closure Of Hospital And Economic Loss
Take Hwy. 264 out of Raleigh and drive east for almost three hours, and you arrive in Belhaven, a coastal town of roughly 1,600 people with a single traffic light. … Robertson cites a number of reasons for the decision to close the hospital, including the deteriorating condition of the facility and the hospital’s location in a flood zone. Decreases in reimbursements and the state’s rejection of federal Medicaid expansion under the Affordable Care Act are other factors that were considered in the hospital’s closure, Robertson said (Namkoong, 2/21).

The Associated Press: Maine Bills Seek ‘Narrow’ Network Explanations
When Roberta Lane went to her local hospital emergency room, where the doctors she's seen for years practice, she was shocked to find out her insurance wouldn't cover treatment. … Two bills the Insurance and Financial Services Committee will examine again on Tuesday aim to bring more transparency to these narrow provider networks -- both for the consumers and the hospitals that are being excluded (2/23).

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Editorials and Opinions

Viewpoints: False Arguments On Deadbeats; Fighting Cancer Without Insurance; Bridging Louisiana's Health Funding Gap

U.S. News & World Report: Obamacare Won't Cause Society To Collapse
A small war has erupted over the recent Congressional Budget Office report on the employment effects of the Affordable Care Act. Last week, the CBO itself felt compelled to offer a lengthy and detailed rebuttal to the spin that millions of Americans will "lose their jobs" as a result of Obamacare. ... It's undoubtedly true that if you give things to some people, they'll work less. But it's not true in all cases. Unfortunately, this sort of assertion is a staple of anti-government rhetoric: For any government expenditure, it can be shown to have enriched some deadbeat or rip-off artist. But so has the derivatives market. Meanwhile, plenty of people work more when you give them more (Eric Schnurer, 2/22).

The New York Times: Health Care Horror Hooey
Remember the "death tax"? The estate tax is quite literally a millionaire's tax — a tax that affects only a tiny minority of the population, and is mostly paid by a handful of very wealthy heirs. Nonetheless, right-wingers have successfully convinced many voters that the tax is a cruel burden on ordinary Americans — that all across the nation small businesses and family farms are being broken up to pay crushing estate tax liabilities. ... And now they’re trying a similar campaign against health reform (Paul Krugman, 2/23). 

The Wall Street Journal: Obamacare And My Mother's Cancer Medicine
When my mother was diagnosed with carcinoid cancer in 2005, when she was 49, it came as a lightning shock. ... And then in November, along with millions of other Americans, she lost her health insurance. She'd had a Blue Cross/Blue Shield plan for nearly 20 years. It was expensive, but given that it covered her very expensive treatment, it was a terrific plan. It gave her access to any specialist or surgeon, and to the Sandostatin and other medications that were keeping her alive (Stephen Blackwood, 2/23). 

The Boston Globe: GOP Gets Serious On Health Care
Throughout his time in Congress, [Oklahoma Sen. Tom] Coburn has been a polarizing figure on everything from abortion rights to climate change. His extreme views, such as his claim that a gay "agenda is the greatest threat to our freedom we face," can be offensive and off-putting to many people. Still, his health care proposal — whatever its merits — marks a step away from the politics of division and toward the politics of discussion (Nathaniel P. Morris, 2/13).

The Times-Picayune: Medicaid Expansion Could Ease Louisiana's Budget Woes
Gov. Bobby Jindal has a convoluted plan to balance Louisiana's budget next year by borrowing $50 million in cash from the Ernest N. Morial Convention Center in New Orleans to help pay for health care and higher education. ... There's an easier way to bridge the gap in the state budget: Take the $16 billion in additional federal Medicaid money President Obama is offering through the Affordable Care Act (2/23).

The Richmond Times-Dispatch: Medicaid's About People
For more than a year, we have debated whether to expand Virginia's Medicaid program to cover people who earn incomes below 133 percent of the poverty line. That’s $15,000 per year for individuals and $31,000 per year for a family of four. To pay for this expansion, Virginia would receive approximately $6.9 billion from the federal government over the next three years. This is money Virginians have and will continue to pay in taxes whether we expand Medicaid or not. Shouldn't that money be spent providing health insurance to approximately 400,000 Virginians, not residents of other states? (Democratic State Del. Jennifer L. McClellan, 2/23).

MSNBC: A Letter To Nate Bell, Who Opposes More Health Care In Arkansas
Last September, the [Arkansas] state Department of Human Services sent out letters to 132,000 households that get food stamps, letting them know that they qualified for expanded Medicaid. Within a month, more than 55,000 people responded, saying they wanted to sign up. That is an enormous response rate. In direct mail terms, it's practically revolutionary. Those people now make up more than half of those enrolled in the Medicaid private option. But should we ask why you’d want to handicap enrollment so much? You say it's because you're a conservative, and you want to limit government spending any way you can. Sure. Except your state estimates that it will save $89 million by expanding Medicaid—just in the first year. It will save more than $600 million from now through 2021 (Joy-Ann Reid, 2/22).

The Milwaukee Journal Sentinel: Obamacare: Only The First Step Toward Better Health Care
Given the volume of media attention focused on the Obama administration's efforts to expand access to health insurance via the Patient Protection and Affordable Care Act, it's easy to lose track of other priorities that must receive equal attention from stakeholders if we're to become a healthier nation at an affordable cost. Health care spending must consume a smaller portion of public and private spending. Health care spending in the United States has reached $2.8 trillion, or approximately 18% of the gross domestic product. While wealthier nations may elect to spend a greater portion of their GDP on health care, the U.S. currently spends twice as much on health care per capita and 50% more as a share of GDP than other industrialized nations. Despite doing so, our longevity, infant mortality and quality of care trail many other high-income countries (James Karolewicz, 2/22).

And on other health issues -

The New York Times: When Doctors Need To Lie
When I started my medical internship, in 1998, I viewed patient autonomy as an absolute good, an ethical imperative that trumped all others. I had learned in medical school about some of the most infamous breaches of autonomy in the history of medicine. ... I also learned that even well-meaning paternalism can be damaging. The doctor-patient relationship is founded on trust, and any instrument of paternalistic interference not only compromises the relationship but also can erode faith in the profession  (Dr. Sandeep Jauhar, 2/22).

The New York Times: Expand Pre-K, Not A.D.H.D.
The writing is on the chalkboard. Over the next few years, America can count on a major expansion of early childhood education. We embrace this trend, but as health policy researchers, we want to raise a major caveat: Unless we’re careful, today's preschool bandwagon could lead straight to an epidemic of 4- and 5-year-olds wrongfully being told that they have attention deficit hyperactivity disorder (Stephen P. Hinshaw and Richard M. Scheffler, 2/23). 

The Boston Globe: Doctors, Patients, And Computer Screens
I turn my chair away from the large computer monitor on my desk. I direct my full attention toward my patient. I think how lucky I am to have a job that involves making intimate connection with other human beings. I think, as my patient confides in me her fears about her health and her worries about her son's addiction and her daughter's shaky marriage: This is why I became a doctor. Suddenly, I’m aware of the time. Twenty minutes into a 30-minute visit and I’ve entered nothing into the computer! If I don’t start typing I’ll fall hopelessly behind and keep other patients waiting. ... This is not why I became a doctor (Suzanne Koven, 2/24).

The Milwaukee Journal Sentinel: Don't Wait To Reform Mental Health Care In Milwaukee County
State Rep. Joe Sanfelippo and Sen. Leah Vukmir have proposed legislation that transfers oversight and funding control of Milwaukee County mental health services from Milwaukee County government to a new mental health board. Creating a mental health board with these powers is the essential next step to finally developing a community-based mental health system that we all can be proud of. The Legislature should support this legislation because the county's mental health system is structurally broken, and, at this point, the best way to create a high-quality, cost-effective system is for the state to adopt this legislation (Lynne De Bruin, 2/22). 

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Stephanie Stapleton

Andrew Villegas

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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.