Daily Health Policy Report

Monday, February 3, 2014

Last updated: Mon, Feb 3

KHN Original Reporting & Guest Opinion

Health Reform

Administration News

Capitol Hill Watch

Women's Health

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

In Southwest Georgia, The Affordable Care Act Is Having Trouble Living Up To Its Name

Kaiser Health News staff writer Jordan Rau, working in collaboration with The Washington Post, reports: "All the dynamics that drive up health costs have coalesced here in Southwest Georgia, pushing up premiums. Expensive chronic conditions such as obesity and cancer are common among the quarter million people in this region. One hospital system dominates the area, leaving little competition. Only one insurer is offering policies in the online marketplace, and many physicians are not participating, limiting consumer choice" (Rau, 2/3). Read the story or the related sidebar detailing the 10 most expensive insurance markets in the country.

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When Your Parent Is The State, It's Tough For Young Adults To Stay Insured

Kaiser Health News staff writer Anna Gorman, working in collaboration with the Los Angeles Daily News, reports: "A little-known provision of federal health law now extends Medicaid coverage to former foster youths until they turn 26, regardless of where they live or how much they earn. The only requirements: They must have been in foster care when they turned 18 and have previously received Medicaid, the state-run insurance plan for the poor known as Medi-Cal in California" (Gorman, 2/3). Read the story and watch the video

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Joining GOP Trend, U.S. Chamber Of Commerce Urges Fix, Not Repeal, Of Obamacare

Reporting for Kaiser Health News, in partnership with NPR, Eric Whitney writes: "Some influential conservatives are now saying the health care law is too entrenched to repeal. Take the U.S. Chamber of Commerce, the powerful business lobbying group. When the Affordable Care Act Passed in 2010, the Chamber got behind a major business lawsuit to fight it at the U.S. Supreme Court. And in January, 2011 during his annual State of American Business address, Chamber President Tom Donohue said, 'It's time, in my opinion, to go back to the drawing board...and thus we support legislation in the House to repeal it'" (Whitney, 1/31). Read the story.

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Political Cartoon: 'Enrolling Out The Red Carpet?'

Kaiser Health News provides a fresh take on health policy developments with "Enrolling Out The Red Carpet?" By Larry Lambert.

And here's today's health policy haiku:


Five states are die hards
against the health law. It's clear...
They're holding the line!

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

GOP Candidates To Campaign On State Exchange Glitches

Republican candidates in states that have had troubled exchange rollouts plan to campaign on those problems in gubernatorial and state legislative races later this year, reports The New York Times. Other news outlets report on developments in Kentucky, Oregon, Rhode Island, Maryland, Minnesota, Connecticut and Pennsylvania.

The New York Times: Glitches In State Exchanges Give G.O.P. A Cudgel
Republicans have seized on the failures of homegrown exchanges in states like Maryland, Minnesota and Oregon — all plagued by technological problems that have kept customers unhappy and enrollment goals unmet — and promise to use the issue against Democratic candidates for governor and legislative seats this fall (Goodnough, 2/1).

Reuters: Two Obamacare Exchanges See More Health Insurer Competition
At least two U.S. states running their own Obamacare health insurance exchanges expect new insurers to enter their marketplaces and bolster competition in 2015, officials said on Friday. Kynect, which is Kentucky's marketplace, and the Rhode Island Health Benefits Exchange have had separate talks about 2015 with health insurers that could opt to join the online marketplaces set up under President Barack Obama's healthcare reform law (Morgan, 1/31).

The Oregonian: Kentucky Health Exchange, Not Oregon's, Gets Obama Praise: Here's How
In earlier times, President Barack Obama held up Oregon as a health-care role model for other states. But when it came to recognizing a health exchange in his State of the Union address, the president's shout-out didn't go to Gov. John Kitzhaber. It was Kentucky Gov. Steve Beshear that Obama described on Jan. 28 as "a man possessed with helping more people get coverage." Kentucky, like Oregon, chose to build its own exchange. Unlike Oregon, Kentucky's exchange is one of the best functioning in the nation (Budnick, 1/31).

The Washington Post: Maryland Leaders Accused Of Political Motives Over Long Review Of Health Exchange Problems
For nearly two months, top Maryland leaders have promised to investigate what went wrong with the launch of the state’s online health insurance marketplace. But they have been vague on when or how that would happen. Last week, legislative leaders said that instead of continuing to question health officials and request documents, they are likely to defer to a previously scheduled state audit of the exchange that is expected to begin this summer and could take a year to complete. That angered many Republicans and some Democrats who want a full accounting now (Johnson and Flaherty, 2/2). 

The Baltimore Sun: Maryland Health Exchange Enrollment Continues To Tick Up
The Maryland health exchange, where uninsured and underinsured can buy insurance, reported that 26,832 people have enrolled through the website for private coverage as of Jan. 25. That's up 1,655 from last week's report. Another 1,800 people were automatically moved from a bare-bones state program to Medicaid, bringing the total moved from that program to 95,318 (Cohn, 1/31).

The Washington Post: O'Malley Says Jail Scandal, Health Exchange Glitches Are Part Of Much Broader Record
Maryland Gov. Martin O'Malley (D) acknowledged in an interview that two episodes that emerged last year — the Baltimore jail scandal and the state’s botched rollout of its online health insurance exchange — run counter to his reputation as an effective manager. But O’Malley, who is preparing for a possible 2016 White House bid, said those events should not be considered "in isolation." ... While Maryland’s online health insurance exchange has been riddled with technical glitches since its Oct. 1 debut, O’Malley said the state remains committed to getting it right. And he noted that several other of his initiatives had taken more than one try before they were successful (Wagner, 2/2).

The CT Mirror: Anthem Extends Payment Deadline For New Members
Anthem Blue Cross and Blue Shield has extended the payment deadline for customers beginning coverage in February and will continue to provide customer service to people who visit the company’s Wallingford headquarters through the end of the month. The payment deadline for new customers beginning coverage in February is now Feb. 10, according to a message posted on Anthem's website. The deadline had been Jan. 31. Anthem has struggled to set up coverage for the thousands of state residents starting health plans with the company this year, many of whom signed up through the state’s health insurance exchange (Becker, 1/31).

The Philadelphia Inquirer: Government Health-Care Website Rebounds
Four months ago, the healthcare.gov website wasn't looking so dandy to Ted Trevorrow. The insurance veteran and freshly certified Affordable Care Act navigator was shaken by the exchange's disastrous rollout and the cascade of Web errors that followed (Calandra, 2/2).

The Star Tribune: Small Firms Running Into Big Trouble Trying To Use MNsure's Website
Minnesota’s new health insurance exchange isn’t getting off the mark with small businesses any faster than it is with consumers. As of last week, only 115 Minnesota small businesses had used the MNsure website to buy medical coverage for their workers, far below expectations. Companies have faced many of the same problems besetting individuals — a glitchy sign-up process and interminable waits to reach the MNsure call center (Crosby, 2/3).

The Star Tribune: At A Glance: Small Businesses Using MNsure
Minnesota’s Small Business Health Options Program, known as the SHOP exchange, is open to organizations with up to 50 workers. Businesses may choose a traditional group coverage plan or create a defined benefit plan, in which they contribute a certain amount of money toward insurance, and workers go to the exchange and buy the health plan that best fits their needs. But the number of small businesses using MNsure is coming in far below expectations (2/2).

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Expanded Medicaid Offers Opportunities -- But Not Without Confusion

News outlets detail how patients still don't completely understand the benefits that are now available to them.

Los Angeles Times: Medi-Cal Seen As Relief For Some, Confusing Burden For Others
Supporters of national health care reform tout the expansion of Medicaid -- called Medi-Cal in California -- as one of the great successes of the Affordable Care Act. For many needy people, learning they're eligible for the usually free program has been a tremendous relief -- assurance that, after decades of forgoing care or worrying about medical expenses, they'll now be able to afford medications, see a doctor or seek emergency care without worrying about ending up broke. But the news isn't wholly welcome for others, who find the complexities of signing up with Medi-Cal bewildering and onerous (Brown, 2/1).

USA Today: Study: Patients Need Training On New Health Insurance
New Medicaid patients in Oregon failed to use their benefits effectively because they did not understand how to use insurance or health care, according to a study released Monday in the journal Health Affairs. As a result, researchers told USA Today, patients did not receive preventive health screenings, schedule appointments to manage chronic illnesses or use their new insurance coverage for anything beyond medical emergencies (Kennedy, 2/3). 

Chicago Tribune: Experts: Moving New Medicaid Patients Out Of ER Will Take Time
In expanding Medicaid coverage, the architects of the national health care overhaul hoped to change the way low-income people obtain health care, moving -- as Morgan did -- away from emergency rooms and into the offices of doctors, where more consistent supervision may improve their health. But some health care experts say that in many cases it will take time and considerable coaching to change their behavior. People tend to use health care more after they obtain coverage, and those unfamiliar with a traditional doctor-patient relationship may stick with what's familiar (Springen, 2/3).

Meanwhile, in Medicaid news from South Dakota --

The Associated Press: SD Governor Seeks Medicaid Expansion Waiver
South Dakota Gov. Dennis Daugaard said Friday he will once again ask federal officials to let South Dakota expand its Medicaid program in a way that would provide medical services only to those most in need (Brokaw, 1/31).

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Report: 5 States, Including Texas, Are Anti-Obamacare Diehards

The report by researchers at Georgetown University’s Center on Health Insurance Reforms looked at which states declined to implement the law's major components. Meanwhile, conservative Kansas lawmakers push to sever their state from the law's authority and Indiana residents are slow to enroll in new insurance.

The Dallas Morning News: Report: Texas One Of Five States Least Engaged In Carrying Out Obamacare
You may think that a lot of so-called red states are adamantly refusing to play ball with the Obama White House on the federal health care overhaul. But according to a study released Friday afternoon, the real diehards — the give-no-ground hold outs — are Texas and just four other states: Alabama, Missouri, Oklahoma and Wyoming. Take that, Rick Scott’s Florida, Bobby Jindal’s Louisiana and Nikki Haley’s South Carolina. Texas Gov. Rick Perry, backed up by a solidly Republican Legislature, has you beat (Garrett, 1/31).

The Associated Press: Kan. Lawmakers Seek To Sever State From ACA
Some conservative Kansas lawmakers are pushing to sever the state from the authority of the Affordable Care Act. Rep. Brett Hildabrand, a Shawnee Republican, introduced a bill in the House Committee on Federal and State Affairs this past week to make Kansas a member of the Health Care Compact, which is a group of states asking Congress to give them independence from the federal healthcare law (2/2).

The Associated Press: Indiana Residents Slow To Embrace Health Exchange
Residents across Indiana are treading lightly when considering buying health insurance through the federal health exchange as they move toward a March 31 deadline to enroll. Nearly 17 percent of the state’s population, or 911,674 people, lacks insurance. Most of those residents are required to show proof they’ve obtained insurance after March to avoid a penalty under the federal health care overhaul law (LoBianco, 2/2).

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Administration Looks At Ways To Ensure Health Care Continuity

Meanwhile, tens of thousands are unable to appeal enrollment errors and a little-known provision of the law extends coverage to former foster kids until they turn 26. 

The Wall Street Journal: Administration Weighs Extending A Change To Health Law 
The Obama administration said Friday that it is considering ways to extend into 2015 efforts to prevent consumers whose health coverage changes from suddenly losing access to particular doctors. President Barack Obama was told by a Kentucky woman in a Google Hangout on Friday afternoon that she was worried her 10-year-old son would not be able to continue to see his specialist ... Mr. Obama replied: "If you have a particular specialist and you haven’t found that specialist in the network of the exchange that’s offered in Kentucky, then we are looking at rules to make sure that somebody who’s actively being treated, for example, can remain with their specialist for the duration of their treatment" (Radnofsky, Favole and Corbett Dooren, 1/31).

The Washington Post: Healthcare.gov Can't Handle Appeals Of Enrollment Errors
Tens of thousands of people who discovered that HealthCare.gov made mistakes as they were signing up for a health plan are confronting a new roadblock: The government cannot yet fix the errors. Roughly 22,000 Americans have filed appeals with the government to try to get mistakes corrected, according to internal government data obtained by The Washington Post. They contend that the computer system for the new federal online marketplace charged them too much for health insurance, steered them into the wrong insurance program or denied them coverage entirely (Goldstein, 2/2). 

Kaiser Health News: When Your Parent Is the State, It's Tough For Young Adults To Stay Insured
A little-known provision of federal health law now extends Medicaid coverage to former foster youths until they turn 26, regardless of where they live or how much they earn. The only requirements: They must have been in foster care when they turned 18 and have previously received Medicaid, the state-run insurance plan for the poor known as Medi-Cal in California (Gorman, 2/3).

Kaiser Health News Video: Former Foster Youth Stay Insured Until 26 (de Marco, 1/3)

The Washington Post: Court To Review Religious Law Once Hailed By Democrats But Now Used To Battle Obamacare
A law championed by Senate Democrats (including one named Joe Biden) to undermine a Supreme Court ruling written by Justice Antonin Scalia has become the latest obstacle to the Affordable Care Act. Who says Washington’s not bipartisan? Of course, no one knew back in 1993 that the Religious Freedom Restoration Act (RFRA) would one day be invoked by business owners who say their religious beliefs forbid offering employees health insurance plans that cover some types of contraceptives (Barnes, 2/2).

The Washington Post’s The Fact Checker: The Most Popular Fact Checks Of January (It’s Still Almost All About Obamacare)
Fact checks about the Affordable Care Act continue to dominate our monthly roundup of the most widely read fact checks. In fact, the only non-Obamacare fact check to make it in our top five list (on the Keystone XL pipeline) just narrowly beat out yet another health-care fact check. In compiling this list, we focused on full fact checks of specific claims. ... 2. The GOP claim that more Americans have lost insurance than gained it under Obamacare ... 3: Ignore claims that 3.9 million people signed up for Medicaid because of Obamacare (Kessler, 2/3).

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Kentucky, Georgia Offer Insights To Health Law Realities

The Washington Post and Kaiser Health News examine how the overhaul is working on the ground in specific locations. 

The Washington Post: Life After Jan. 1: Kentucky Clinic Offers Early Glimpse At Realities Of Health-Care Law
This is the world that many critics of the new health-care law have worried about, one in which the sick and the poor expand the ranks of Medicaid while other Americans see premiums rise, policies canceled or favorite doctors booted out of networks. Supporters of the new law argue that another scenario will unfold in places such as eastern Kentucky, in which the sick and the poor get insurance, seek treatment for long-neglected illnesses and prevent other health problems down the line, ultimately saving the health-care system billions in emergency-room visits and other costs. A week at the Breathitt County Family Health Center provides an early glimpse into how those theories are beginning to play out in a place where people have long worried about having no insurance at all (McCrummen, 2/1).

Kaiser Health News: In Southwest Georgia, The Affordable Care Act Is Having Trouble Living Up To Its Name
All the dynamics that drive up health costs have coalesced here in Southwest Georgia, pushing up premiums. Expensive chronic conditions such as obesity and cancer are common among the quarter million people in this region. One hospital system dominates the area, leaving little competition. Only one insurer is offering policies in the online marketplace, and many physicians are not participating, limiting consumer choice (Rau, 2/3).

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Labor, Chamber Of Commerce Make Clear Where They Stand On The Health Law

Labor union leaders say the Obama administration's refusal to help with health law provisions they view as unsatisfactory is undermining their support for this year's midterm elections. Meanwhile, the U.S. Chamber of Commerce is looking at ways to fix, rather than repeal, the overhaul.  

The Washington Post: Labor Union Officials Say Obama Betrayed Them In Health-Care Rollout
Labor leaders who have spent months lobbying unsuccessfully for special protections under the Affordable Care Act warned this week that the White House’s continued refusal to help is dampening union support for Democratic candidates in this year’s midterm elections. ... Their complaints reflect a broad sense of disappointment among many labor leaders, who say the Affordable Care Act has subjected union health plans to new taxes and mandates while not allowing them to share in the subsidies that have gone to private insurance companies competing on the newly created exchanges (Mufson and Hamburger, 1/31).

Kaiser Health News: Joining GOP Trend, U.S. Chamber Of Commerce Urges Fix, Not Repeal, Of Obamacare
Some influential conservatives are now saying the health care law is too entrenched to repeal. Take the U.S. Chamber of Commerce, the powerful business lobbying group. When the Affordable Care Act Passed in 2010, the Chamber got behind a major business lawsuit to fight it at the U.S. Supreme Court. And in January, 2011 during his annual State of American Business address, Chamber President Tom Donohue said, "It's time, in my opinion, to go back to the drawing board...and thus we support legislation in the House to repeal it" (Whitney, 1/31).

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Innovation Center's Methods Under The Microscope

The New York Times: Method of Study Is Criticized In Group’s Health Policy Tests
The idea seemed transformative. The Affordable Care Act would fund a new research outfit evocatively named the Innovation Center to discover how to most effectively deliver health care, with $10 billion to spend over a decade. But now that the center has gotten started, many researchers and economists are disturbed that it is not using randomized clinical trials, the rigorous method that is widely considered the gold standard in medical and social science research. Such trials have long been required to prove the efficacy of medicines, and similarly designed studies have guided efforts to reform welfare-to-work, education and criminal justice programs. But they have rarely been used to guide health care policy — and experts say the center is now squandering a crucial opportunity to develop the evidence needed to retool the nation’s troubled health care system in a period of rapid and fundamental change (Kolata, 2/2).

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Administration News

In Pre-Game Rumble, Obama Pushes Back On O'Reilly Questions About Health Care

The president told the Fox anchor that he regrets his earlier comments that people who like their insurance would be able to keep it.

Politico: Pre-Super Bowl, Obama Sparks With Bill O’Reilly
President Barack Obama faced questions Sunday on Obamacare, Benghazi and the IRS’s targeting of conservative groups during a pre-Super Bowl interview with Fox News host Bill O’Reilly and dismissed much of the criticism of him as ginned up by the cable news channel. ... Asked if the "biggest mistake" of his presidency was his claim that Americans who liked their health insurance plans would be able to keep that coverage, Obama nudged his interviewer. "Oh, Bill, you've got a long list of problems of my presidency," he said (Epstein, 2/2).

The New York Times: Obama Is Tackled By O’Reilly Before Game
Some of the hardest hits of Super Bowl Sunday came a couple of hours before kickoff. ... His answers shed little if any new light on some of the most controversial moments of Mr. Obama’s presidency, but it was a feisty 10-minute encounter that exposed the different world views of Mr. Obama and some of his sharpest critics. For Mr. Obama it may have been an unpleasant duty that was more or less unavoidable but for some conservative fans of Fox, it was an opportunity to watch the president challenged in a way they believe he has not been by the rest of the news media (Baker, 2/2).

The Wall Street Journal: Obama Defends Handling Of Controversies On O’Reilly Show 
Mr. O’Reilly began the Fox News interview by saying he wanted to "get some things on the record" and questioned the president about the Affordable Care Act. While Mr. Obama rarely gets unsettled during interviews, at several points he criticized Mr. O’Reilly and Fox News for spreading what he said was misinformation (Favole, 2/2).

USA Today: Obama, O'Reilly Battle Over Health Care, Benghazi, IRS
In a pre-Super Bowl rumble, President Obama and Fox News host Bill O'Reilly jousted Sunday over the health care law, the attack in Benghazi, and claims that the Internal Revenue Service targeted conservative organizations. Obama expressed regret for saying people who liked their health insurance plans could keep them — millions saw their policies canceled after the new law took effect in October (Montgomery, 2/2).

CBS News: Obama Defends Decisions On Sebelius, Benghazi, IRS In Fox Interview
President Obama defended his choice to keep Kathleen Sebelius on as head of the Health and Human Services Department, explained his administration’s response to the attack on the U.S. Consulate in Benghazi and said there was no corruption by the Internal Revenue Service in aggressively scrutinizing conservative groups in a pre-Super Bowl interview with Fox News. The interview -- which lasted less than 10 minutes -- was highly contentious, with Fox News’ Bill O’Reilly relaying several Republican concerns and Mr. Obama saying the issues have been overblown because of a narrative created by O’Reilly’s network. Asked why he did not fire Sebelius for the botched roll out of HealthCare.gov, Mr. Obama said, "We hold everybody up and down the line accountable but when we’re midstream, Bill, we want to make sure that our main focus is how do we make this thing work so people are able to sign up" (Kaplan, 2/2).

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Capitol Hill Watch

Cantor: GOP To Vote On Obamacare Alternative

The majority leader didn't give a timetable for a House Republican plan. 

Politico: Cantor: 'Obamacare Is On Borrowed Time'
The end of the Affordable Care Act is within sight, House Majority Leader Eric Cantor says, outlining Republican plans to propose health care legislation later this year. “In my opinion, Obamacare is on borrowed time,” the Virginia Republican said in an interview for Sunday on CBS’s “Face the Nation.” “As we begin to see the further growth in terms of implementation of this law, you will see, I believe, more and more people negatively affected. And there's going to be a real problem, a real need for an alternative” (Epstein, 2/2).

The Wall Street Journal: Cantor: Expect 2014 Vote On A GOP Health Law 
After spending much of last year bashing President Barack Obama over the stumbles of his health-care overhaul, House Majority Leader Eric Cantor (R., Va.) told House Republicans Thursday to expect a vote this year on a GOP alternative to the 2010 Affordable Care Act. The gambit is politically risky, exposing Republicans to scrutiny leading up to the 2014 midterm elections. But it gives them a chance to sound a more positive tone after last year’s intraparty warring led to a partial government shutdown  (Peterson and Meckler, 1/31).

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GOP Considers Tying Debt-Limit Deal To Repeal Of Part Of Health Law

House Republicans are considering linking their support for raising the national debt to a repeal of the health law's risk corridors, which helps mitigate risk for insurers. In other news, lawmakers continue to weigh proposals to change how Medicare pays doctors and the House health appropriations subcommittee gets many new Republican faces.

Roll Call: GOP Discusses Tying Debt Limit To Obamacare
House Republicans may again tie a debt ceiling increase to a repeal of a section of President Barack Obama's health care law, but the plan remains murky after a three-day retreat here. At an afternoon panel moderated by GOP leaders and former Congressional Budget Office Director Doug Holtz-Eakin, members expressed support for tying a one-year increase to the nation's borrowing limit to a repeal of the health law's so called risk corridors, a provision that mitigates risk for insurance companies (Newhauser, 1/31).

The Hill: House Republicans Eye Repeal Of ObamaCare 'Bailout' In Debt-Limit Bill
House Republicans are considering attaching a provision that would prevent a "bailout" of insurance companies under ObamaCare to a one-year increase in the debt limit. The Republican conference met behind closed doors Friday on the final day of their annual retreat to hash out a plan for raising the debt limit, which the Treasury Department says must happen within a month to avoid a first-ever default. The House Republican leadership has not settled on a plan, but an idea that gained support during the meeting, according to a person in the room, was to repeal the so-called "risk corridors" provision in the healthcare law, which Republicans have labeled a potential bailout of insurance companies (Berman, 1/31).

St. Louis Post-Dispatch: Way Medicare Pays Doctors May Change
Expectations are high this year that Congress will finally reach an agreement to overhaul the way Medicare pays doctors for services, scrapping a method that's been the target of criticism for more than a decade. If that happens, experts say, Medicare beneficiaries will see changes in how health care is provided, with an increased emphasis on coordinated care and preventive services (Kulash, 2/2).

CQ HealthBeat: House Newcomers Dominate Roster Of House GOP Health Appropriators
The roster announced this week of Republican members of the House Labor-HHS-Education Appropriations Subcommittee on the whole consists of relative newcomers to Congress. Only one GOP member of the House panel that oversees funding for some of the nation’s key medical agencies has been in Congress long enough to have witnessed a Labor-Health and Human Services-Education appropriations bill hit the floor as a stand-alone measure (Young, 1/31).

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Women's Health

U.S. Abortion Rate Drops, But Not For The Reasons You Might Think

A new study finds that the rates are lowest in 40 years. 

Los Angeles Times: U.S. Abortion Rate In 2011 Lowest Since 1973, Study Says
The U.S. abortion rate fell in 2011 to its lowest level since the 1973 Supreme Court decision legalizing the procedure, Roe vs. Wade, according to a new study. Research by the Guttmacher Institute, a nonprofit organization that supports abortion rights, found that in 2011 there were 16.9 abortions for every 1,000 women ages 15-44. In 1973, the rate was 16.3 abortions per 1,000 women. In all, there were about 1.1 million abortions in 2011, down 13 percent from 2008 (Hamedy, 2/2).

The Washington Post: Study: Abortion Rate At Lowest Point Since 1973
The study did not examine the reasons for the drop. But the authors suggested that one factor was greater reliance on new kinds of birth control, including intra-uterine devices such as Mirena, which can last for years and are not susceptible to user error like daily pills or condoms (Somashekhar, 2/2).

NPR: Abortions Reportedly Drop To Lowest Rate Since 1970s
[T]he authors said they found no evidence that the passage of had any impact on the latest decline. "While most of the new laws were enacted in states in the Midwest and the South, abortion incidence declined in all regions," the study noted. And some states that are generally supportive of abortion rights, including those allowing Medicaid payment for abortions for poor women, "experienced declines in their abortion rates comparable to, and sometimes greater than, the national decline," the study said (Rovner, 2/2). 

The Associated Press: Report: U.S. Abortion Rate At Lowest Since 1973
The lead author, Rachel Jones, also said there appeared to be no link to a decline in the number of abortion providers. According to the report, the total number of providers dropped by 4 percent, to 1,720, between 2008 and 2011, and the number of abortion clinics declined by just 1 percent to 839 (Crary, 2/2).

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State Watch

State Highlights: Cities, States Spending Nearly 32% Of Budgets On Health Care

A selection of health policy stories from Michigan, New York, California, Wisconsin, Maryland, Georgia, Colorado and Mississippi.

The Washington Post: Health Care Spending Still Rising For States And Cities
The Affordable Care Act, President Obama pledged, would stem the rapidly rising cost of health care. Early indications suggest it has: The growth of total U.S. health care spending ebbed in 2012 to just 4 percent. But for state and local governments, bending the cost curve hasn’t happened. In fact, a new report from the Pew Charitable Trusts shows health care spending is consuming a greater percentage of state and local government budgets than at any time since the Centers for Medicare and Medicaid Services began collecting data. State and local governments spent 31.5 percent of their budgets on health care costs in 2012, according to CMS and the Bureau of Economic Analysis (Wilson, 1/31).

The Associated Press/Wall Street Journal: Detroit, Retirees Reach Agreement On Health Insurance
The city of Detroit and its retirees have reached an agreement in a health insurance dispute that may end a lawsuit against the city. Retirees filed suit in November to stop the city from shifting them to Medicare and giving those under age 65 a $125 monthly stipend to buy their own insurance. The parties reached an agreement in principle Thursday night covering benefits through the end of 2014, mediators in Detroit's bankruptcy said Friday in a statement. Some features of the deal include the increase to $300 in the monthly stipend for retirees over age 65 who aren't eligible for Medicare. The stipend for retirees under age 65 will be increased to $175 if the household income is less than $75,000 and the retiree acquires insurance under a health care exchange (1/31).

The Associated Press: NYC, Calif. Bills Show Fight To Protect Caregivers
If you don't get a job because you're a woman, or you get fired because you're black, or you get transferred to the night shift because you're gay, there's a law for that. But if you're punished at work because you need time to take your child to the doctor or talk to your confused elderly mother, you might be out of luck. In most places around the country, there's no specific safeguard against employment discrimination based on a worker's status as a caregiver. Connecticut and the District of Columbia are exceptions. Legislation that would change that is pending in New York City and California, but business interests have objected (Fitzgerald, 2/3).

The Milwaukee Journal Sentinel: Bill Would Strip Milwaukee County Board Of Mental Health Care Oversight
After decades of missed opportunities and ignored pleas to build a better system, legislation will be introduced Monday to strip the Milwaukee County Board of its oversight of mental health care. The measure would instead place control of the county's fractured mental health system in the hands of a board appointed by the governor and made up primarily of medical professionals. The change effectively aligns the county with the rest of the state where professionals trump politicians (Kissinger, 2/2).

The Baltimore Sun: Nurse Questions All Female OB-GYN Practice
Bruce Wheatley was considering coming back to the Towson area where he grew up when he saw an advertisement for an obstetrics and gynecology practice in Columbia that pitched an all-female staff. As a nurse, he was dismayed enough to complain to St. Agnes Hospital about the affiliated office, but the hospital defended the hiring practice (Cohn and Walker, 2/2).

Georgia Health News: Piedmont Reaches Last-Minute Deal With Insurer
Just hours before their current contract expired, Piedmont Healthcare reached agreement with Aetna/Coventry on a new three-year deal. The agreement, announced Friday, means that many Aetna and Coventry members can still receive in-network rates from the five Piedmont hospitals, its outpatient centers and physicians. If the contract talks had collapsed, many patients would have had two less-than-ideal choices: 1) find a new doctor, or 2) continue to get services from Piedmont’s hospitals or doctors, but on a more costly, out-of-network basis (Miller, 1/31).

Georgia Health News: Patient Classification Is Complex, But Also A Big Deal
Last month, the wife of a retired Atlanta physician got a stunning lesson when her husband spent some time in a hospital. “We realized there might be a problem when he was not served breakfast along with the other patients,” she said. That was when they were told he had not actually been admitted to the hospital. “But he’s in a hospital bed, and he’s here in the hospital,” responded the wife (Miller, 2/2).

Health News Colorado: Controversial Health Rating Areas Won’t Change For 2015
Despite furor from members of Congress and residents in ski resort areas who face high health insurance costs, Colorado will not change its geographic ratings for 2015. And Colorado’s Insurance Commissioner, Marguerite Salazar, said there is nothing she can immediately do to lower rates or alleviate sticker shock for residents from mountain communities in Summit, Garfield, Lake, Eagle and Pitkin Counties. “It’s a really, really hard thing. I wish we could have come up with something,” said Salazar who plans to announce next week that her office has not proposed any changes to the geographic ratings (McCrimmon, 1/31).

(Jackson, Miss.) Clarion Ledger: MHA Pans Medicaid's Managed Care Proposal
The Mississippi Hospital Association has come out against a state Division of Medicaid proposal to increase participation in managed care programs. Last week, David Dzielak, executive director of the Division of Medicaid, told members of the Senate Public Health and Welfare Committee that he wants to expand managed care beyond the 45 percent of recipients allowed now by law. He said he believes it would save the state up to $40 million, but Mississippi Hospital Association president Timothy Moore expressed doubt on the figures and said going to managed care could take additional money away from hospitals, which are expected to lose money because the state didn’t expand Medicaid (Gates, 2/1).

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Editorials and Opinions

Viewpoints: 'Bailout' Isn't The Right Target For GOP; Republican Senators' Alternative 'Looks Inferior;' Uninsured Are Not Rushing To Health Market

Los Angeles Times: Another Misguided GOP Attack On Obamacare
Ever since the housing market collapse, nothing stokes the flames of public outrage quite like the phrase "government bailout." It's become the condemnation of choice for both parties when faced with a policy they don't like. Lately, conservatives have been arguing that an obscure provision of the 2010 health care law would provide a taxpayer bailout to insurance companies that don't charge high enough premiums. Funny, but they didn't have a problem with that concept when it was used to help launch Medicare's prescription drug program under (Republican) President George W. Bush. Maybe that's because it isn't really a bailout (1/31).

The Wall Street Journal: Insurer 'Bailouts' Are The Wrong Target
Republicans do not improve their reputation with their recent brainstorm to focus their opposition on Obamacare subsidies to insurance to cover the uninsured. Of the 50 million Americans who lack insurance partly because of government actions that have rendered insurance an unaffordable luxury, some by now have contracted pre-existing conditions that make them uninsurable. Even under an ideal GOP reform, handouts were always going to be needed to bring these people into the system. ... Republicans might see their heaven-sent opportunity lies elsewhere: in reforming ObamaCare's excessive coverage mandates that drive up the cost of individual policies (Holman W. Jenkins, Jr., 1/31).

The New York Times: What G.O.P.-Style Reform Looks Like
Three Republican senators -- Orrin Hatch of Utah, Tom Coburn of Oklahoma and Richard Burr of North Carolina -- have issued an alternative to the health care reforms that they deride as Obamacare. Conservative analysts have hailed their proposals as "an important milestone in the health care debate" and a "reform that has enormous promise." But the plan, which is hard to parse because it has not been put into precise legislative language, looks inferior in most respects to the existing law (2/1).

The Wall Street Journal: How Obamacare Misreads America
People learn from their mistakes. Or they can -- and should. Which is the reason we should try to learn from the revelations of mistakes about health care and health insurance since the passage of Obamacare. The evidence is not all in. But it seems that Americans are not behaving as Obamacare's architects -- and many critics -- expected. Start with the assumption that just about everyone wants health insurance. You can easily find polls that support this proposition. Obamacare architects assumed that if you offered health insurance with subsidies for those with relatively modest incomes, those currently uninsured would flock to apply. So far that seems not to have happened. A McKinsey & Co. survey of those thought to be eligible for Obamacare health care exchanges found that only 11 percent of those who bought new coverage between November 2013 and January 2014 were previously uninsured (Michael Barone, 2/2). 

The New York Times: Fewer Benefits For Target's Part-Timers
Target has announced that it will no longer provide health insurance for part-time workers but will send them instead to the new health care exchanges established by the Affordable Care Act. The change could help low-income workers who will now have access to subsidized coverage. It might distress middle-income workers ineligible for a big subsidy, and it is likely to be bad news for taxpayers, who will foot the bill for the coverage Target had provided. But the biggest unanswered question is this: Will Target raise wages to make up for the loss of the company contribution? As a matter of fairness, it should (1/31).

Los Angeles Times: Hey 'Bette,' You Can Buy Insurance Outside An Obamacare Exchange
The tale of "Bette," the beleaguered health insurance consumer highlighted in the (official) GOP response to President Obama's State of the Union address, has drawn a lot of blowback from liberal pundits in recent days. But one point left out is how Bette's tale illustrates a common misunderstanding about the law, one that is unnecessarily limiting consumers' options. ... because she opposes the law, she wouldn't even look at the exchange's website, deciding instead not to carry coverage this year. ... [T]here other sources available for those who loathe Obamacare so much that they won't patronize the new state insurance exchanges. Individual policies are still available directly from insurers or through comparison-shopping sites such as ehealthinsurance.com or healthplans.com (Jon Healey, 1/31).

The New York Times: Delusions Of Failure
The Republican response to the State of the Union was delivered by Cathy McMorris Rodgers, Republican representative from Washington -- and it was remarkable for its lack of content. A bit of uplifting personal biography, a check list of good things her party wants to happen with no hint of how it plans to make them happen. The closest she came to substance was when she described a constituent, "Bette in Spokane," who supposedly faced a $700-a-month premium hike after her policy was canceled. "This law is not working," intoned Ms. McMorris Rodgers. And right there we see a perfect illustration of just how Republicans are trying to deceive voters -- and are, in the process, deceiving themselves (Paul Krugman, 2/2).

The Wall Street Journal: Tom Coburn: The Doctor Who Is Sick of Washington
Tom Coburn stood for Congress in 1994 as a political tenderfoot for two main reasons: As an obstetrician he thought government was impinging too much on his medical practice, and the nine-term House Democrat who held his Oklahoma district's seat favored the Clinton national health plan then under consideration. Another reason Dr. Coburn entered the race, he says, was that "the cowardice of career politicians governing to win the next election above all else made me sick." Twenty years later, he finds himself amid another health care scrimmage -- and in a similar political climate (Joseph Rago, 1/31).

Richmond Times-Dispatch: Medicaid Expansion Means Quality Health Care For More Virginians
I am dedicated to finding common ground with Virginia's General Assembly to bring the tax dollars that Virginians are sending to Washington back to Virginia. This will allow us to help more than 400,000 additional Virginians access quality health care. This is the most important decision we face in this legislative session, and I am optimistic that we can sit down together and accept this deal in a way that works best for the taxpayers whom we serve. If we find common ground, we will help those 400,000 Virginians gain access to health insurance that is an essential underpinning of economic success (Gov. Terry McAuliffe, 2/2).

The Richmond Times-Dispatch: Howell And Cox: Medicaid Expansion: Promises On Future Costs Don't Ring True
The biggest debate of the 2014 General Assembly session is undoubtedly the fate of Obamacare's Medicaid expansion in Virginia. We have been very clear that we oppose Medicaid expansion for several reasons. First, Obamacare is a disaster. The website barely works, premiums have skyrocketed and perfectly good health care plans have been canceled. Virginia cannot irresponsibly entangle itself in Washington's health care mess (Dels. William J. Howell and Kirk Cox, 2/2).

Roanoke Times: Our View: Don't Dither On Health
Medicaid is an enormous program, one that has grown to meet new demands of an aging population and challenges related to serving intellectually disabled individuals. Because of its size and scope, it has been the subject of multiple quality and efficiency improvements over many years. That scrutiny should never cease. For that reason, no one is objecting to House leaders' request for yet another audit of the agency that oversees Medicaid. But Republican Sens. Emmett Hanger of Augusta County and Walter Stosch of Henrico County are wise to warn that it should not be an excuse for delaying a decision on whether to expand the insurance program or embrace a business-oriented alternative (2/2).

Los Angeles Times: Henry Waxman, The 'Tougher Than A Boiled Owl' Congressman
He said he's proud of his role in bringing the Affordable Care Act into existence, despite the program's chaotic rollout. If anything, he said, the law doesn't go far enough. "Maybe it would be helpful to have a public option, a Medicare kind of option," he said, reviving a proposal he made in the early stages of the Obamacare debate (Doyle McManus, 2/2).

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Stephanie Stapleton

Andrew Villegas

Lisa Gillespie
Shefali Luthra

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