Daily Health Policy Report

Friday, February 7, 2014

Last updated: Fri, Feb 7

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Health Care Marketplace

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Hill Plan Would Reward Medicare Doctors For Quality

Kaiser Health News staff writer Mary Agnes Carey reports: "Now comes the hard part. After negotiating for months over how to overhaul Medicare’s troubled payment system for physicians, the bipartisan leadership of three Senate and House committees has reached a deal on the policy. Their next task could be even harder – finding a way to finance repeal of the 'doc fix,' the shorthand for the 1997 formula used to set physician payments, the sustainable growth rate" (Carey, 2/7). Read the story.

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Obamacare Thrives In San Francisco's Chinatown

Kaiser Health News staff writer Sarah Varney, working in collaboration with NPR, reports: "Chinatown here is a city within a city. Built by immigrants in the latter half of the 19th century, Chinatown was a refuge from the era’s vicious prejudice. But the crowded blocks of Chinatown were also somewhat of a prison. Chinese residents feared leaving the area after dark, and they were barred from local schools and the city’s hospitals -- even during an outbreak of bubonic plague in San Francisco. It was painfully clear that when it came to medical care, they had to provide for themselves" (Varney, 2/6). Read the story.

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A Reader Asks: Can Foreign Visitors Buy Health Insurance Exchange Plans?

Kaiser Health News consumer columnist Michelle Andrews answers this reader’s question (2/7). Read her response.

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Capsules: Rocky Mountain High Insurance Prices Rankle Ski Towns

Now on Kaiser Health News’ blog, Eric Whitney writes: "Colorado Insurance Commissioner Margeurite Salazar has been getting an earful about high health insurance premiums in pockets of the state since prices she approved were unveiled Oct. 1. She is under increasing pressure to do something about them now that part of Colorado has been identified as having the most expensive premiums in the country" (Whitney, 2/6). Check out what else is on the blog.

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Political Cartoon: 'Snow Job?'

Kaiser Health News provides a fresh take on health policy developments with "Snow Job?" by Gary Varvel.

And here's today's health policy haiku:


How will Hill press corps
spend its Christmas holiday
with no doc fix fight?


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

States Struggle To Fix Failed Exchanges

The "spectacular failure" of health insurance exchanges in Minnesota, Massachusetts, Maryland and Oregon -- despite their support of the health law -- gets a closer look from ProPublica. Repair efforts in Maryland and Oregon are also covered.

ProPublica: Epic Fail: Where Four State Health Exchanges Went Wrong
Much has been written (and will continue to be written) about the spectacular failure of health insurance exchanges in Minnesota, Massachusetts, Oregon and Maryland—all blue states that support the Affordable Care Act. All were woefully unprepared for their Oct. 1 launch, and unlike HealthCare.gov, the federal marketplace, they are still having trouble getting back on their feet. ... One common element emerging in the coverage of these exchanges is that at least some state employees knew they were heading for disaster but didn’t take action early enough to remedy it (Ornstein, 2/6). 

The Associated Press/Washington Post: Md. Panel To Examine Problems With Health Exchange
The panel, which will hold its first public meeting Monday, will include five state senators and five members of the House of Delegates. A main focus will be overseeing the progress of fixing technological problems and helping as many people as possible sign up before an open enrollment deadline of March 31. Members will later look at what led to the problems in the first place with an aim toward preventing it from happening again in the future (2/6).

The Oregonian: Cover Oregon: House Bill Would Require Independent Oversight On Large IT Projects
Oregon lawmakers are considering a bill to require independent quality-assurance oversight on large information technology projects in an attempt to avoid a repeat of Cover Oregon's disastrous rollout. House Bill 4122 and amendments would require third-party oversight on all contracted technology projects that cost more than $5 million and certain projects that cost more than $1 million. It received a hearing Thursday in the House Consumer Protection and Government Efficiency Committee (Zheng, 2/6).

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Mass. Hires New Firm To Fix Online Insurance Marketplace

A report blames Massachusetts' online insurance marketplace woes on problems at the firm the state hired to build the website, CGI. Gov. Deval Patrick unveiled a plan Thursday that would hire another firm, while retaining CGI, to make fixes to the site.

The Boston Globe: State Hires Firm For $10 Million To Fix Insurance Website
Governor Deval Patrick unveiled a plan Thursday to fix the flawed Massachusetts Health Connector insurance website, by hiring technology firm Optum to fast-track repairs and appointing a chief executive officer to direct the overhaul. The state will continue working with CGI, the firm that built the site, but will keep the company on "a much shorter leash," Patrick said at a Beacon Hill press conference. The online insurance marketplace, relaunched in October to comply with the federal Affordable Care Act, has frustrated customers, left some uninsured, and required the state to provide temporary coverage for tens of thousands of people because it could not process enrollment applications (Conaboy, 2/6).

WBUR: Report Blames Mass. Health Website Troubles On Lack Of Leadership, Expertise
In the months after President Obama signed the Affordable Care Act (ACA) in 2010, officials in Massachusetts started planning for a new Health Connector website that would be compatible with the new federal regulations. UMass Medical School, the Massachusetts Health Connector and MassHealth came together to work on the project. They hired a Canadian firm, CGI, to build the site which launched in October 2013, but "was not fully operational," according to a report released Thursday by the technology firm MITRE. Residents who've tried to apply for insurance through the site use words like "disaster" (Bebinger, 2/7).

WBUR: Can This Woman Fix The Health Connector? Please.
WBUR reports that Gov. Deval Patrick is appointing an executive from Blue Cross Blue Shield of Massachusetts to help fix problems with the state's Health Connector insurance website, which has recently been plagued with technical and other glitches that have frustrated and infuriated users: Blue Cross chief strategy officer Sarah Iselin worked for the state during the rollout of the 2006 health care law. In addition, the state will also hire a Minnesota-based health care systems firm to help with fixes to the Connector site. The governor says Massachusetts residents who are on temporary health insurance coverage will know by next week if they can be moved to a permanent plan. (The temporary plans were needed because of technical problems with the Health Connector website) (Zimmerman, 2/6).

The Wall Street Journal: Massachusetts To Retain Health-Exchange Vendor CGI
Massachusetts Gov. Deval Patrick said Thursday the state will retain the company behind its online health-insurance exchange but is bringing on additional help after an outside review found problems with the performance of vendor CGI Group Inc. His decision comes after the federal government in January chose not to renew CGI's contract overseeing key parts of HealthCare.gov, the federal health exchange that got off to a rocky start in October. The site has since seen significant improvement. The Centers for Medicare and Medicaid Services chose Accenture as the new lead contractor. CGI's federal contract runs through February (Kamp, 2/6).

The Associated Press: Gov Sees Fix For Failed Mass. Health Website
Gov. Deval Patrick apologized Thursday to frustrated Massachusetts residents who have struggled to sign up for health coverage because of a problem-plagued state website and outlined a series of steps aimed at correcting the glitches. Patrick said his administration may ask the federal government for an extension of a March 31 deadline to transition people from the state's landmark 2006 health care law to the federal health care law that was modeled after Massachusetts' first-in-the-nation program (Salsberg, 2/6).

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N.H. State Senators Agree To Bipartisan Medicaid Expansion Compromise

The plan will require three federal waivers, would sunset after three years without continued 100 percent federal contributions and would use private insurance to reach the additional low-income New Hampshire residents. It's similar to the Iowa and Arkansas approaches.

New Hampshire Union Leader: State Senate Leaders Announce Bipartisan Medicaid Expansion Deal
A bipartisan group of Senate leaders announced a compromise agreement that would bring expanded health insurance coverage to about 50,000 of Granite Staters below 138 percent of the federal poverty level using 100 percent federal funding for the next three years. Senate President Chuck Morse, R-Salem, disclosing the framework of the new bill Thursday to a Senate committee with Senate Democratic Leader Sylvia Larsen of Concord, said the plan will require three federal waivers, would sunset after three years without continued 100 percent federal contributions and would use private insurance to reach the additional low-income Granite Staters (2/6).

New Hampshire Public Radio: New Hampshire Lawmakers Agree To Expand Medicaid
News of a deal on Medicaid expansion emerged just before Governor Maggie Hassan took to the microphone on Thursday to deliver her first State of the State address in Concord. The first-term Democrat relished in bringing one of her biggest priorities closer to fruition. “With today’s positive step forward, it is clear that we can work through this together, and help working people access critical health coverage,” says Hassan (Bookman, 2/6).

The Associated Press: Senate Aisle Is Crossed On Medicaid Expansion Plan
State Senate leaders announced a bipartisan deal Thursday to expand Medicaid to an estimated 49,000 poor New Hampshire adults by using federal funds to pay for private insurance. Senate President Chuck Morse, a Salem Republican, and Senate Democratic Leader Sylvia Larsen of Concord announced the agreement in a presentation before the chamber's Rules Committee. The committee voted unanimously to allow their bill's introduction (Love, 2/7).

The New York Times: New Hampshire: Deal Reached On Medicaid Expansion
State senators said Thursday that they had reached a bipartisan deal on a framework to expand Medicaid to about 50,000 low-income adults. Under the agreement, the state will use federal money to buy private insurance, similar to a method adopted last year in Iowa and Arkansas (Bidgood, 2/6).

Politico Pro: New Hampshire Medicaid Plan Could Expand Insurer Role
New Hampshire lawmakers hope that a bipartisan deal to expand Medicaid, announced Thursday by legislative leaders, does more than just cover 50,000 people. They’re also hoping it’s a giant welcome mat for the insurance industry to expand its footprint in the state. New Hampshire’s insurance market is one of the less competitive in the country. Its Obamacare insurance exchange features just one player, Anthem Blue Cross and Blue Shield. State House sources said the expansion deal, which has the support of Democratic Gov. Maggie Hassan, could lure new carriers into the state (Cheney, 2/6).

CQ HealthBeat: Tentative Deal In New Hampshire Reached To Expand Medicaid
State lawmakers in New Hampshire reached a tentative bipartisan deal on Thursday to expand Medicaid to about 49,000 New Hampshire adults. Democratic Gov. Maggie Hassan supported the compromise worked out between her state’s Senate Democrats and Senate Republicans. Republicans had initially resisted Hassan’s calls to broaden the program (Adams, 2/6).

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Arkansas' Model Medicaid Expansion Plan In Jeopardy

Arizona's efforts to expand the program are also facing challenges while a new approach is being advanced in Virginia.

The Associated Press/Washington Post: Model Arkansas Way Of Expanding Medicaid At Risk
Arkansas’ plan for expanding Medicaid by buying private insurance policies for the poor instead of adding them to the rolls was heralded as a model for convincing more Republican-leaning states to adopt a key part of President Barack Obama’s health care overhaul (2/6).

The Associated Press: House Committee Backs Repeal Of Medicaid Expansion
Some Republican legislators are attempting to reverse Arizona's 2013 decision to expand the state's Medicaid program under the federal health care law, setting up a potential rematch with Gov. Jan Brewer and those who backed the expansion with majority votes in both chambers of the Legislature last year. Republican Rep. Adam Kwasman of Oro Valley said a vote by the House Reform Human Services Committee on Thursday that advanced his House Bill 2234 is the first step in what may be a long fight by conservatives opposed to the expansion (Christie, 2/6).

Arizona Republic: 2 Bills Seek To Curb Medicaid Expansion
A House panel on Thursday approved a pair of bills aimed at curtailing Arizona’s Medicaid program, continuing the Republican backlash to the Affordable Care Act and stoking the congressional ambitions of two lawmakers. The House Committee on Reform and Human Services approved a bill that would roll back the expansion of the Arizona Health Care Cost Containment System that the Legislature approved just eight months ago (Pitzl, 2/6).

The Richmond Times-Dispatch: Senate Proposes New Option On Health Insurance Coverage
A new proposal by Senate leaders would create a private insurance marketplace they portray as a commercial alternative to expanding the state’s Medicaid program and relying on the new federal insurance exchange to cover hundreds of thousands of uninsured Virginians. Sen. John Watkins, R-Powhatan, unveiled the proposal Thursday as legislation that he wants the Senate Finance Committee to include in the two-year budget it approves Feb. 16. The proposal would then go to a House Appropriations Committee that is likely to be hostile to anything that looks like Medicaid expansion. “The idea is we’re not going to expand Medicaid, but we’re going to cover the people it would be responsible for covering,” Watkins told the Finance Committee, which welcomed but did not act on the proposal (Martz, 2/7). 

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Fact Checker Skewers Attack Ads 'Based' On CBO Report On Health Law

The first ads are already out based on the Congressional Budget Office report on the health law's impact on the labor market, and the Washington Post's Fact Checker finds plenty of distortions. Meanwhile, the White House seeks to persuade Americans that it's a good thing if the health care law means they can work less.

The Washington Post’s The Fact Checker: The First Attacks Based On The CBO Report On Obamacare And Workers
The Congressional Budget Office report on the impact of the Affordable Care Act was released on Tuesday, and already we have the first attack ads. The Fact Checker devoted one column to explaining what the CBO’s report actually meant. But we have long learned that all the fact checks in the world won’t stop politicians if they think an attack line moves voters. So how do these early attacks fare? ... But in the meantime, “costs jobs” attacks are going to keep earning Three Pinocchios (Kessler, 2/7).

Politico: White House Embraces CBO Report
The Obama administration is going all out to turn the Congressional Budget Office’s latest Obamacare report into a positive — and they’re confident they can convince Americans that it’s a good thing if the health care law means they can work less. In a White House blog post Thursday, Jason Furman, the chairman of the Council of Economic Advisers, fleshes out the administration’s defense against a wave of publicity over the CBO report that said the health care law will lead to a reduction in work hours (Nather, 2/6).

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Consumers Might Get To Keep Noncompliant Health Plans Longer

Meanwhile, groups seeking to enroll young people in coverage use techniques honed in political campaigns, and critics of the law call on consumers to take more responsibility for their health.

The Associated Press: Administration Said To Ponder Insurance Extension
The Obama administration is considering an extension of the president’s decision to let people keep their individual insurance policies even if they are not compliant with the health care overhaul, industry and government officials said Thursday. Avalere Health CEO Dan Mendelson said Thursday that the administration may let policyholders keep that coverage for as long as an additional three years, stressing that no decision has been made. Policymakers are waiting to see what rate hikes health insurers plan for the insurance exchanges that are key to the overhaul’s coverage expansions (Murphy, 2/6).

The Associated Press: A Scramble To Sign Up The Young By Health Deadline
Armed with an Apple laptop and a pile of fliers, [Daniel Bransfield's] part of the army of workers and volunteers fanned out around the country trying to enroll young — and probably healthy — people in health insurance available through President Barack Obama’s signature law. Run largely by groups with close ties to the White House, the on-the-ground recruiting effort is based in part on lessons learned from Obama’s two presidential bids, which revolutionized the way campaigns tracked and targeted voters (Pace, 2/7).

NBC News: Obamacare Foes To Newly Insured: Put Down The Donut
Commentators like Sandy Pukel, a nutritionist from Coral Gables, Fla., have joined a chorus of scolds who say that expanded access to insurance is just another example of an eroding code of personal responsibility in America. “If you’re going to go eat donuts and drink Coke and eat crap, you’re setting yourself up to be sick,” said Pukel, 68, who operates a line of healthy “food cruises.” ... Focusing on the expansion of insurance under Obamacare misses the point, supporters say. People with insurance have always paid for the uninsured, whether it’s through direct subsidies, higher premiums or higher costs to cover uncompensated care (Aleccia, 2/6).


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Capitol Hill Watch

Hill Committee Leaders Reach Deal On Replacing Medicare Doctor Pay Formula

The agreement would get rid of the troubled system that has often left doctors uncertain about their reimbursements, but the bipartisan leaders have not yet found a way to pay for such a change.

Los Angeles Times: U.S. Lawmakers Reach Accord On Paying Doctors For Medicare
In a rare bipartisan agreement, congressional leaders have settled on a plan to fix Medicare's system for paying physicians, potentially ending years of uncertainty that often held up fees for doctors who care for the nation's senior citizens. The proposed fix still must be paid for, requiring lawmakers to come up with as much as $150 billion in savings from elsewhere in the budget (Levey, 2/6).

The Wall Street Journal: Lawmakers Reach Deal On Doctor Payments
House and Senate lawmakers have agreed on a five-year plan to change how physicians are paid for treating Medicare patients, an issue that has created a recurring scramble in Congress for over a decade. Under the deal announced Thursday, Medicare would increase the amount it pays physicians by 0.5% each year for the next five years. The agreement was the result of talks that included the top members of the Senate Finance, House Energy and Commerce, and House Ways and Means committees (Radnofsky, 2/6).

Kaiser Health News: Hill Plan Would Reward Medicare Doctors For Quality
Now comes the hard part. After negotiating for months over how to overhaul Medicare’s troubled payment system for physicians, the bipartisan leadership of three Senate and House committees has reached a deal on the policy. Their next task could be even harder -- finding a way to finance repeal of the "doc fix," the shorthand for the 1997 formula used to set physician payments, the sustainable growth rate (Carey, 2/7).

The Hill: Finally, A Permanent 'Doc Fix' Bill
Committee leaders in the House and Senate have unveiled bipartisan legislation repealing Medicare's flawed physician payment system and giving doctors in the program a small pay raise. The bill was introduced Thursday after more than a year of negotiations between parties in both chambers. Its central provisions repeal Medicare's sustainable growth rate formula and increase physician reimbursement rates by 0.5 percent annually for 5 years (Viebeck, 2/6).

In other Medicare payment news --

CQ HealthBeat: Insurers Apply Pressure On CMS To Lessen Medicare Advantage Rate Impact
Seniors complain that their out-of-pocket costs are rising because of Medicare Advantage payment cuts. They say that health plans are dropping their doctors. The doctors are fighting back by suing the plans to keep them in the networks. Oh, and an election is coming up. Can action to ease the rising pressure from cuts to Medicare Advantage be long in coming? (Reichard, 2/7).

Politico Pro: Medicare Advantage Could Get Tied To Obamacare Politics
New polling in Virginia suggests that cuts to Medicare Advantage -- which could be proposed by the Obama administration later this month -- may be a political bonus for Republicans' anti-Obamacare messaging this fall. The American Action Network, a conservative leaning advocacy group, will release a poll Friday that finds more than half of likely 2014 voters -- 52 percent -- have an unfavorable opinion of cuts to the private Medicare plans. Just 22 percent favor them. The poll also finds that 52 percent have an unfavorable opinion of Obamacare, while 37 percent favor it (Norman, 2/7).


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GOP Considers Asking For 'Doc Fix,' Other Proposals, In Return For Debt-Ceiling Raise

House Republicans are considering their options on tying proposals they want to see to passing an increase in the debt ceiling, among them fixing the way Medicare pays doctors. Democrats and the White House are making it increasingly clear that they don't intend on making concessions with the debt limit.

The Washington Post: House Speaker John Boehner Mulling Over Debt-Ceiling Options
On Thursday, however, two ideas gained traction, with dozens of Republicans predicting that versions of the pitches could hit the floor next week once House members return to Washington. At the top of the list: a proposal to link a one-year extension of the debt ceiling to a restoration of recently cut military benefits. Another popular option is tying the “doc fix,” which would alter the way doctors are reimbursed for Medicare treatments, to an extension. Changes to the federal budget that would reduce fraud or mandatory spending levels also have been mentioned (Costa, 2/6).

The New York Times: Skating Close To The Edge, Again, On The Debt Ceiling
Even as some Republicans continued to hunt for one policy concession or another to demand from Democrats in exchange for lifting the ceiling, leadership has indicated it has no appetite for brinkmanship — particularly as Republicans head into a midterm campaign for control of Congress where they feel they have an upper hand, given the botched rollout of the Affordable Care Act and President Obama’s low approval ratings. And the White House has made clear that it has no intention of giving Republicans anything in exchange for increasing the limit (Lowrey, 2/6).

Immigration reform legislation stalls as the GOP focuses on the health law --

Bloomberg: Boehner Stalls On Immigration With Focus On Obamacare
The House’s chances of passing a revamp of U.S. immigration policy this year are fading as Republicans say they want to avoid distractions from their focus on blaming Democrats for Obamacare (Bender, 2/7).

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Health Care Marketplace

AOL Blames Health Law For Change In Retirement Benefits, Without Details

AOL owns websites such as Huffington Post.

The Washington Post: AOL Chief Cuts 401(k) Benefits, Blames Obamacare And Two ‘Distressed Babies’
AOL chief executive Tim Armstrong on Thursday offered a number of unusual explanations for why his company pulled back its 401(k) benefits for employees this year. The first reason: Obamacare. The second: two women at the company who had "distressed babies" in 2012. ... "As a CEO and as a management team, we have to decide: Do we pass the $7.1 million of Obamacare cost to our employees? Or do we try to eat as much of that as possible and cut benefits?," said Armstrong in the CNBC interview (Yang, 2/6).

Bloomberg: AOL Blames Obamacare For Plan To Reduce Retirement Benefits
Armstrong didn’t specify how the health-care law had increased costs for New York-based AOL. ... In a memo to employees, Armstrong said he had mentioned high-risk pregnancy “as just one of many examples of how our company supports families when they are in need.” He said AOL aims to be “open and transparent about the choices we make” (Harrison, 2/6).

NBC News: AOL Alters 401(k) Matching Contributions, Blaming Obamacare
Starting in 2014, AOL will distribute the 50 percent company match on up to 6 percent of employees' pre-tax income in a lump sum after the end of the year, instead of paying the benefit throughout the year as it had done previously. That means workers who leave AOL before Dec. 31 won't get the year's company match at all (Belvedere, 2/6).

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Despite Enrollment Jump, Aetna Says It Faces Losses From Health Exchanges

Cigna, in the meantime, saw its fourth-quarter profit dip as it lost members.

The Wall Street Journal: Aetna Expects To Lose Money On Health Law Marketplaces
Aetna Inc. said it expects to lose money on its business in the health-law marketplaces this year, with the demographics of enrollees skewing slightly more than expected toward people likely to rack up higher costs. The insurer, which is participating in public consumer exchanges in 16 states and the District of Columbia, the most of any carrier, said it has signed up about 135,000 paid members through the end of January (Mathews, 2/6).

The Wall Street Journal: Cigna Earnings Slip On Decline In Health-Care Margins
Cigna Corp. said its fourth-quarter profit declined 11% as the health insurer's global health-care margins slipped and it lost members from the prior quarter. ... Cigna has logged increased revenue in recent quarters, aided by growing membership and acquisitions. The company, which traditionally focused more on commercial health insurance, pushed further into the market for senior-focused plans by recently buying Medicare insurer HealthSpring Inc. and American Financial Group Inc.'s Medicare supplement and critical-illness businesses (Rubin, 2/7).

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State Watch

State Highlights: No Relief In Sight For High Insurance Prices In Colo. Ski Towns

A selection of health policy stories from Colorado, South Dakota, Massachusetts, Connecticut, Florida and California.

Kaiser Health News: Capsules: Rocky Mountain High Insurance Prices Rankle Ski Towns
Colorado Insurance Commissioner Margeurite Salazar has been getting an earful about high health insurance premiums in pockets of the state since prices she approved were unveiled Oct. 1. She is under increasing pressure to do something about them now that part of Colorado has been identified as having the most expensive premiums in the country (Whitney, 2/6).

Health News Colorado: Colorado Ski Towns Priciest In Nation For Insurance, No Help From Feds
Colorado’s mountain resort communities including Aspen, Vail and Summit County have the dubious distinction of being the most expensive places to buy health insurance in the country and no relief is on its way from either the state or federal government. U.S. Rep. Jared Polis, D-Boulder, has been fighting for penalty waivers for Summit County residents who don’t buy health insurance this year. But he hasn’t succeeded in getting them yet. Polis sent a letter seeking help to U.S. Health and Human Services Secretary Kathleen Sebelius and received a response late last week indicating that the federal officials can do nothing since states set up geographic areas that determine insurance prices (McCrimmon, 2/6).

The Associated Press: SD Committee Supports Prenatal Care For Immigrants
The South Dakota House Health and Human Services Committee passed a measure Thursday that would provide prenatal care to low-income women who are in the country illegally. The bill would authorize an expansion of Medicaid services for pregnant women who didn't previously qualify because of their legal status (Hertel, 2/6).

The Boston Globe: Employers Face Jump In Health Insurance Costs
Bucking marketplace changes aimed at making health care more affordable, the cost “trend” driving what Massachusetts employers are charged for insurance is expected to climb 5 to 8 percent this year, insurance executives told an employer group Thursday. That is substantially higher than the state’s target of capping increases in total medical spending at 3.6 percent, a benchmark established last year to bring costs in line with the projected rate of annual economic growth in Massachusetts. But the insurance executives stressed that their forecast -- based on a formula combining the price of health care visits, tests, and procedures with the amount of care used by patients -- does not mean the state will fall short of its goal (Weisman, 2/7).

The CT Mirror: Home Care, Medicaid Pay, Inmate Health Care In Malloy Proposal
Gov. Dannel P. Malloy's proposed budget includes money for more people to receive long-term care at home rather than in nursing homes; a new state-funded health care program for inmates in halfway houses; a health reform effort aimed at changing the way care is paid for and delivered; payment rates for primary care doctors to treat Medicaid patients, and housing and support services for people with serious mental illness. It does not include, as some had speculated, any breaks for hospitals, which have faced significant cuts in state funding during Malloy’s first three years in office (Becker, 2/6).

Health News Florida: Medicaid ‘Reform’ Pays Off: Study
Florida’s Medicaid 'reform' project, which required all beneficiaries in five counties to enroll in managed care, succeeded in curbing health inflation just as state officials had hoped, a new study reports. University of Florida researchers found that when they compared two of the pilot counties with two others over a four-year period, per-patient spending was lower in the pilot counties (Gentry, 2/6).

The Sacramento Bee: CalPERS Reopens Long-Term Care Insurance To New Applicants
CalPERS’ troubled long-term care insurance program has reopened to new applicants, ending a five-year hiatus marked by heavy financial losses and the announcement of a significant rate increase. The pension fund said Thursday it’s taking applications for a series of new insurance plans designed to be affordable. Long-term care pays for such things as stays in nursing and convalescent homes. Following years of hefty losses, the California Public Employees’ Retirement System closed the program to new applicants in 2008 (Kasler, 2/6).

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Health Policy Research

Research Roundup: Value-Based Insurance; Telemedicine In Nursing Homes

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

Health Affairs: Use Of Telemedicine Can Reduce Hospitalizations Of Nursing Home Residents And Generate Savings For Medicare
Hospitalizations of nursing home residents are frequent and result in complications, morbidity, and Medicare expenditures of more than a billion dollars annually. The lack of a physician presence at many nursing homes during off hours might contribute to inappropriate hospitalizations. Findings from our controlled study of eleven nursing homes provide the first indications that switching from on-call to telemedicine physician coverage during off hours could reduce hospitalizations and therefore generate cost savings to Medicare in excess of the facility’s investment in the service. But those savings were evident only at the study nursing homes that used the telemedicine service to a greater extent, compared to the other study facilities (Grabowski and O'Malley, 2/4).

JAMA Internal Medicine: Strategic Targeting Of Advance Care Planning Interventions
[T]he completion of an advance directive (AD) too far from or too close to the time of death can lead to end-of-life decisions that do not optimally reflect the patient’s values, goals, and preferences: a poorly chosen target patient population that is unlikely to need an AD in the near future may lead to patients making unrealistic, hypothetical choices, while assessing preferences in the emergency department or hospital in the face of a calamity is notoriously inadequate. ... A key to optimal timing and strategic selection of target patients for an ACP program is prognostication, and we briefly highlight prognostication tools and studies that may point us toward high-value AD interventions (Billings and Bernacki 2/3).

Journal of General Internal Medicine: Specialty Use Among Patients With Treated Hypertension in a Patient-Centered Medical Home
Little is known about how delivery of primary care in the patient-centered medical home (PCMH) influences outpatient specialty care use. ... INTERVENTION: System-wide PCMH redesign implemented across 26 clinics in an integrated health care delivery system, beginning in January 2009.  ... Compared to baseline, the study population averaged 7 % fewer adjusted specialty visits during implementation and 4 % fewer adjusted specialty visits in the first post-implementation year. ... Results suggest that more comprehensive primary care in this PCMH redesign enabled primary care teams to deliver more hypertension care, and that many needs of low morbidity patients were within the scope of primary care practice. New approaches to care coordination between primary care teams and specialists should prioritize high morbidity, clinically complex patients (Liss et al., 2/2014).

The Kaiser Family Foundation: Medicaid Per Enrollee Spending: Variation Across States
To participate in Medicaid, states are required to meet federal core requirements; however, states have significant flexibility to expand beyond program minimums for benefits and coverage, to determine how care is delivered and to determine what and how providers are paid. As a result of this flexibility, there is significant variation in Medicaid programs across states. ... This brief examines variation in spending per enrollee across eligibility groups, across states and over time, as well as implications for program policy and financing. ... Proposals that would change the underlying financing structure of Medicaid by placing an overall cap on federal Medicaid spending or a limit on federal Medicaid spending per enrollee would have dramatically different results across states because of the current variation (Young, Rudowitz and Garfield, 2/3).

Robert Wood Johnson Foundation/Bailit Health Purchasing: Reducing Overuse and Misuse: State Strategies to Improve Quality and Cost of Health Care
Health care purchasers in several states have implemented well-established and successful initiatives to reduce misuse and overuse of care. In Washington state, such efforts have resulted in a 94 percent reduction in bariatric surgery spending and a $10 million reduction in enteral nutrition spending. This brief by Bailit Health Purchasing focuses on actions state purchasers can take with contracted plans, providers, and other engaged purchasers to reduce misuse and overuse of health care services. Such strategies include: ... Coordinating efforts with other large health care purchasers. ... Introducing evidence-based concepts into policies, regulations, and statutes (Burns, Dyer, and Bailit, 1/14).

The Heritage Foundation: CBO Confirms: Medicare Premium Support Means Savings For Taxpayers And Seniors
A major report by the Congressional Budget Office (CBO) confirms that premium support (a defined-contribution system of health-plan financing) would make the financially troubled Medicare program more sustainable. In a new competitive system of health plans, the CBO finds that private health plans can offer the same benefit and services as traditional Medicare fee-for-service plans—at a lower cost to taxpayers. The CBO report also reveals that competition can drive lower beneficiaries’ premiums and out-of-pocket costs. The CBO analysis affirms the potential of serious savings for Medicare beneficiaries and taxpayers alike (Moffit and Hederman, 2/3).

Substance Abuse and Mental Health Services Administration: Behavioral Health Barometer, 2013
This is the first edition of the Behavioral Health Barometer: United States, one of a series of State and national reports that provide a snapshot of the state of behavioral health in the Nation. This national report presents a set of substance use and mental health indicators as measured through data collection efforts sponsored by SAMHSA (the National Survey on Drug Use and Health and the National Survey of Substance Abuse Treatment Services), the Centers for Disease Control and Prevention (the Youth Risk Behavior Survey), and the National Institute on Drug Abuse (the Monitoring the Future survey). Also included are data on the use of mental health and substance use treatment services by Medicare enrollees, as reported by the Centers for Medicare & Medicaid Services (1/31). 

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

NPR's Shots blog: Are We Paying $8 Billion Too Much For Mammograms?
The question of how often women should get mammograms remains contested, with advisory panels and medical societies disagreeing on how early and how often they should be used to find breast cancer. But those discussions rarely mention cost. And the financial implications are huge. If women got screening mammograms every year starting at age 40, as the American Cancer Society , it would cost $10 billion a year, according to an published Monday in Annals of Internal Medicine. That's compared with $2 billion a year to screen women ages 50 to 69 every other year, or $3.5 billion to follow the recommendation of the U.S. Preventive Services Task Force (Shute, 2/4).

Modern Healthcare: Drug Adherence May Improve With Incentives, But Spending Reduction Might Not Offset Cost
Eliminating or lowering drug co-pays may improve patients' adherence to their medication regimens, but the reduction in overall health spending may not be enough to offset the cost. That was the experience of one insurer in a study published Monday in the policy journal Health Affairs. ... Blue Cross and Blue Shield of North Carolina paid an additional $6.4 million during a two-year period to cover the cost of higher drug use for patients with hypertension, diabetes, hyperlipidemia and congestive heart failure after the insurer lowered drug co-pays. That amounts to $139 to $173 annually for each member. But the $5.7 million drop in the cost of all other care did not offset the expense (Evans and Robeznieks, 2/3).

Politico Pro: Report Cites Medicare Policy Research Priorities
Health care policymakers are eager for more data to help them understand shifts in Medicare and how to move ahead in an environment shaped by ACA-inspired delivery system changes, changes in spending patterns and an aging population, according to a report released Monday by AcademyHealth. The report, “The AcademyHealth Listening Project: Improving the Evidence Base for Medicare Policymaking,” surveyed people from the policymaker and research realms (Kenen, 2/3).

Medscape: Antibiotic Prescribing For Children May Be Leveling Off
A downward trend in outpatient antibiotic prescribing for children may have reached a plateau, according to an article published online February 2 in Pediatrics. In fact, in some areas, prescribing rates may have started inching back up. Louise Elaine Vaz, MD, from the Division of Infectious Diseases and Department of Laboratory Medicine, Boston Children's Hospital, Massachusetts, and colleagues analyzed pharmacy and outpatient claims from September 2000 to August 2010 for 3 regional US health plans (Hand, 2/4).

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Editorials and Opinions

Viewpoints: Health Law Distorting Or 'Undistorting' The Labor Market; Gas Stations Should Follow CVS' Lead; Ways To Fight Heroin

The New York Times: Health, Work, Lies
On Wednesday, Douglas Elmendorf, the director of the nonpartisan Congressional Budget Office, said the obvious: losing your job and choosing to work less aren't the same thing. If you lose your job, you suffer immense personal and financial hardship. If, on the other hand, you choose to work less and spend more time with your family, "we don't sympathize. We say congratulations." And now you know everything you need to know about the latest falsehood in the ever-mendacious campaign against health reform. Let's back up. On Tuesday, the budget office released a report on the fiscal and economic outlook that included two appendices devoted to effects of the Affordable Care Act (Paul Krugman, 2/6).

Los Angeles Times: Does Obamacare 'Distort' The Labor Market – Or Undistort It?
A fascinating debate has broken out among economists and economic pundits concerning the Congressional Budget Office's projections that the Affordable Care Act will allow -- or induce -- some workers to leave the job market. The debate is over whether, or how much, this is a "distortion" of the labor market caused by the healthcare law. Tyler Cowen of the free-market Mercatus Center takes a shorthand look at the issue here. But the real question should be whether Obamacare is distorting the labor market or removing a distortion that previously existed. The evidence points to the latter (Michael Hiltzik, 2/6).

USA Today: Obamacare Cures 'Job Lock'
On February 4, the Congressional Budget Office released new long-term economic projections. Over the next ten years, they envision millions of new jobs in a growing economy – but up to 2.5 million fewer full-time equivalent workers by 2024 compared with what would have been the case without the Affordable Care Act. This was decried by opponents of health reform as evidence that the law is a "job killer" (Theda Skocpol and Katherine Swartz, 2/6). 

USA Today: Obamacare Attacks American Dream
Can I really afford that paycheck? Thanks to the Affordable Care Act, two and a half million Americans will ask that question over the next decade and say "no." The Congressional Budget Office — the federal government's official number cruncher — now estimates that the ACA will cause these people to voluntarily leave the workforce or prevent them from entering it by 2024. They'll do so because it would actually be more expensive for them to draw that extra paycheck (Tim Phillips, 2/6).

Bloomberg: The Obamacare Retirement Plan
The ACA subsidies don't "kill jobs," they cause work to be abandoned. Let's give liberals that vital point. I'd say they're also right in thinking (for once) that people mostly know what's good for them. At least, it's a fair working assumption that people are the best judges of their own welfare. That just leaves one thing -- the small and strangely neglected matter of who pays for the subsidies. As a taxpayer, I'm more than happy to finance a subsidy that guarantees access to decent health care for all. I'm not so happy to subsidize your early retirement or improved work-life balance. Health care is, or should be, a basic entitlement. Your lifestyle choices aren't (Clive Crook, 2/5).

Los Angeles Times: To Help Rein In Healthcare Costs, Give 'Narrow Networks' A Try
In an effort to cut costs, many insurers in the new state health insurance exchanges are offering plans with "narrow networks" that include fewer doctors and hospitals — particularly the costlier ones with famous names, such as Cedars-Sinai. The trade-off has sparked complaints from some policyholders who've had trouble seeing their favorite doctor or, in some cases, any doctor in the right specialty. Although regulators have to address those issues, narrow networks can actually be a good thing for patients if done the right way (2/7).

Bloomberg: How To Judge Obamacare Alternatives
The rocky rollout of the Patient Protection and Affordable Care Act has forced President Barack Obama to express his openness, albeit half-heartedly, to reforms that might accomplish the law’s goals. In response, congressional Republicans have offered no fewer than three major alternatives to Obamacare, the most recent being an overhaul plan from Republican Senators Tom Coburn, Richard Burr and Orrin Hatch. All these proposals address the issue at the heart of the law’s name -- the affordability of health care (Lanhee Chee, 2/6).

The Washington Post: The Health-Care Myths We Live By
Swedish researchers report that antioxidants make cancers worse in mice. It's already known that the antioxidant beta-carotene exacerbates lung cancers in humans. Not exactly what you'd expect given the extravagant — and incessant — claims you hear made about the miraculous effects of antioxidants. In fact, they are either useless or harmful, conclude the editors of the prestigious Annals of Internal Medicine. ... But if that’s how dicey biological "facts" can be, imagine how much more problematic are the handed-down verities about the workings of our staggeringly complex health-care system (Charles Krauthammer, 2/6). 

The New York Times: Taking Tobacco Off The Shelves
CVS Caremark, the giant drugstore chain, deserves a big round of applause for deciding to phase out the sale of cigarettes and other tobacco products at its more than 7,600 stores by Oct. 1. The decision will cost the company a substantial amount of money but will place CVS where it and other pharmacy chains belong — on the side of customer health and against a product that still kills 480,000 Americans a year (2/6). 

Bloomberg: CVS Kicks The Tobacco Habit
It never made much sense that pharmacy chains would also sell cigarettes in this day and age. Sure, tobacco is a drug. Nicotine addicts crave it. And public companies are supposed to be all about boosting sales, earnings and shareholder value. But you wouldn't expect to see an adult-movie theater in the middle of Disney World, or a pot dispensary inside a Chuck E. Cheese's restaurant, or a cigarette machine inside the lobby of a physician's office. Sometimes building a brand and reputation is more important than incremental gains in revenue (Jonathan Weil, 2/5).

The Boston Globe: Gas Stations Need To Kick The Habit, Too
Leo Vercollone doesn't like smoking, but his customers do, so that's why he keeps selling cigarettes at his gas station convenience stores. CVS, the nation’s second-largest drugstore chain, got a lot of props this week for declaring it would stop selling death sticks. But if this country really wants to reduce smoking, we need to get gas stations and convenience stores to stop carrying packs of smokes, too. Here’s why: More than 60 percent of cigarette sales take place there compared with only 3.6 percent at drugstores, according to Euromonitor International, a consumer research group (Shirley Leung, 2/7).

The New York Times: How To Stop Heroin Deaths
I am an emergency physician at NYU Langone Medical Center and Bellevue Hospital, but I rarely see victims die of heroin overdose because most fatalities occur before patients get to the hospital. ... The most frustrating part is that each of these deaths is preventable, because there is an antidote to heroin overdose that is nearly universally effective. Naloxone, an opioid antidote, is a simple compound that has been in clinical use for more than 30 years. It can be administered via needle or as a nasal spray .... An analysis in the Annals of Internal Medicine last year suggested that up to 85 percent of users overdose in the presence of others. This provides an opportunity for friends, family and other non-health care providers to intervene (Robert S. Hoffman, 2/6).

Bloomberg: Breaking The Bond Of Heroin And Painkillers
A definitive cause of what killed [Philip Seymour] Hoffman hasn't been determined yet. If he moved from prescription pills to heroin (he entered a rehabilitation program last May after a reported reliance on painkillers led him back to heroin briefly), he was following a familiar path. Many individuals who have become addicted to prescription painkillers (a group that includes OxyContin, Vicodin, Percocet and Roxicodone) at some point realize that, depending on where they live, heroin, which is pharmacologically similar, is cheaper and easier to get (Sally Satel, 2/6).

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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.