Daily Health Policy Report

Friday, March 14, 2014

Last updated: Fri, Mar 14

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

Advocates Press For Insurance Subsidies For Domestic Abuse Victims

Kaiser Health News staff writer Julie Appleby reports: "Spouses who file their taxes separately, sometimes because of domestic violence or abandonment, often can’t get government subsidies to purchase health insurance -- and advocates say the Obama administration hasn’t done enough to help them. With the March 31 sign-up deadline approaching, advocates are urging the administration to give domestic violence victims more time to sign up and to make it easier for them to get tax credits even if they don’t file a joint tax return" (Appleby, 3/13). Read the story.

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Health On The Hill: Lawmakers Weigh Changes To Medicare

Kaiser Health News’ staff writer Mary Agnes Carey and Politico Pro's Jennifer Haberkorn discuss recent events on Capitol Hill, including how lawmakers this week debated a series of changes to Medicare -- including payment shifts in Medicare Advantage plans and a proposed fix to how the program pays doctors (3/13). Read the transcript or watch the video.

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A Reader Asks: Would An IRA Withdrawal Count As Income For Exchange Subsidies?

Kaiser Health News consumer columnist Michelle Andrews answers this reader’s question (3/14). Read her response.

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Capsules: Insurers May Get Cost Break Thanks To Rocky ACA Rollout

Now on Kaiser Health News’ blog, Jay Hancock and Julie Appleby report: "On Tuesday the Department of Health and Human Services signaled its intention to temporarily give insurers a break on the portion of premiums they must spend on medical care or return to policyholders. The switch could shrink consumer rebate checks. But considering what insurers have gone through with balky online marketplaces and shifting regulations, even consumer advocates don’t seem to object" (Hancock and Appleby, 3/13). Check out what else is on the blog.

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Political Cartoon: 'Split Personality?'

Kaiser Health News provides a fresh take on health policy developments with "Split Personality?" by Darrin Bell.

And here's today's health policy haiku:

COUNTING VOTES, CRAFTING STRATEGIES

Republicans feel
"jolly" that the ACA 
will "sink" Democrats.
-Anonymous

If you have a health policy haiku to share, please send it to us at http://www.kaiserhealthnews.org/ContactUs.aspx and let us know if you want to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

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Health Reform

Rule Raises More Questions About The Individual Mandate's Reach

News outlets report that a hardship exemption was added that could potentially make it much easier for people to get around the requirement that they have health insurance.

Bloomberg: Many May Avoid Obamacare Penalty As Deadline Looms
Obamacare’s requirement that all Americans carry insurance or face penalties, part of the effort to gain universal coverage, may not be much of a rule at all. Millions of people may be exempt from the requirement known as the individual mandate under rules issued by the Obama administration (Wayne, 3/14).

Fox News: Administration Adds Major Exemption For ObamaCare Individual Mandate
In what might be the death knell for ObamaCare's most controversial component -- the individual mandate to buy insurance -- the administration has added a mega-exemption that critics say would allow virtually anybody to skirt the rule. "This is a huge public policy decision that could affect millions of Americans," House Speaker John Boehner said, adding that the latest change, made ahead of the March 31 enrollment deadline, applies to "essentially everyone."  "The door's wide open," economist Doug Holtz-Eakin, who leads the conservative-leaning American Action Forum, told Fox News. "[The] mandate which they said was absolutely crucial to ObamaCare is falling apart day by day” (3/13).

Politico Pro: Boehner, Sebelius Spar Over Obamacare Mandate Exemptions
House Speaker John Boehner said Thursday that the Obama administration is quietly trying to give Americans a way out of Obamacare’s unpopular individual mandate. “There’s a real question whether the White House has abandoned the individual mandate — the heart of Obamacare itself,” Boehner said Thursday. “The White House quietly added a new hardship exemption for everyone, and it seems like they’re hoping no one will notice.” The administration did quietly extend one controversial exemption for two more years until October 2016 — but it’s not for everyone, federal officials said. In fact, they predicted the pool of eligible people should shrink over time (Norman, 3/13).

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Accommodations Sought For Chronically Ill, Victims Of Domestic Violence

Advocates press for help for thousands of consumers with pre-existing illnesses who face a March 31 closure of high-risk insurance pools and also for married victims of domestic abuse to allow them to qualify for subsidized coverage. Meanwhile, the administration signals that, because health plans have seen added costs caused by the troubled rollout of the health exchanges, the government may relax a requirement that insurers spend 80 percent of all premium dollars on medical care because of their added expense due to the troubled rollout of the exchanges.

The Wall Street Journal: Deadline Looms for 'High Risk' Enrollees
Thousands of "high risk" people with existing medical conditions remain enrolled in a federal health-insurance program slated to close March 31, making it likely the Obama administration again will have to extend the program or risk seeing sick people lose coverage. The program was set up soon after the 2010 health law was passed to offer temporary assistance to people who couldn't get coverage from commercial insurers (Radnofsky, 3/13).

Kaiser Health News: Advocates Press For Insurance Subsidies For Domestic Abuse Victims
Spouses who file their taxes separately, sometimes because of domestic violence or abandonment, often can’t get government subsidies to purchase health insurance -- and advocates say the Obama administration hasn’t done enough to help them. With the March 31 sign-up deadline approaching, advocates are urging the administration to give domestic violence victims more time to sign up and to make it easier for them to get tax credits even if they don’t file a joint tax return (Appleby, 3/13).

Kaiser Health News: Capsules: Insurers May Get Cost Break Thanks To Rocky ACA Rollout
On Tuesday the Department of Health and Human Services signaled its intention to temporarily give insurers a break on the portion of premiums they must spend on medical care or return to policyholders. The switch could shrink consumer rebate checks. But considering what insurers have gone through with balky online marketplaces and shifting regulations, even consumer advocates don’t seem to object (Hancock and Appleby, 3/13).

Politico Pro: Administration May Change MLR Rules
The Obama administration’s next adjustment to the Affordable Care Act could be just what the insurance companies ordered: changes to the MLR rules. And it’s partly because of all the extra expense the insurers incurred because of the HealthCare.gov mess. In a filing this week, federal health officials signaled that they’re considering relaxing an ACA requirement that insurers spend 80 percent of all premium dollars on medical care, rather than administrative costs. Insurers that fail to meet the medical loss ratio standard have to give rebates to customers (Cheney, 3/13).

Bloomberg: Obamacare Co-Ops Defy Forecasts To Win Market Share
In Maine, the insurer that has enrolled the most Obamacare customers isn’t the state’s well-established Blue Cross Blue Shield plan, owned by WellPoint Inc. It’s WellPoint’s only rival: Maine Community Health Options, a startup that didn’t exist three years ago. The newcomer, funded primarily by taxpayer money lent under the U.S. health-care law, has won about 80 percent of the market so far in Maine’s new insurance exchange, exceeding its own expectations, said Kevin Lewis, the chief executive officer (Wayne, 3/13).

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When It Comes To Enrollment Rates, Some States, Regions Outpace Others

The Washington Post notes that the Northeast appears to be doing the best with enrollment, but western states are doing well with implementation. Still, state marketplace directors are predicting strong gains in health insurance coverage. Meanwhile, Republicans are pushing hard to find out how many new enrollees have actually paid their premiums.

The Washington Post: The Northeast And The West Are Leading On Obamacare, In Their Own Ways
The Northeast is enrolling people in Obamacare plans at higher rates than any other region, according to data released this week. But a separate report finds that states in the West are furthest along at implementing the new law (Chokshi, 3/13).

USA Today: States Lagging On Health Care Sign-Ups Vow To Do Better
States that embraced the Affordable Care Act and created health care exchanges were supposed to lead the way in enrolling their residents in health insurance, but some of them are responsible for the federal government falling behind in its projections. Only 18 days remain before the March 31 enrollment deadline, and the government is about 1.8 million behind its goal of 6 million new health insurance customers (Kennedy, 3/13).

CQ HealthBeat: State Marketplace Directors Predict Big Net Gains In Coverage
Top officials running six state-run health insurance marketplaces said Thursday that they expect strong gains in coverage over last year, even though they don't know how many people signing up were previously uninsured. In New York, one state that is trying to track the gains, about 70 percent of applicants reported they did not have coverage when they signed up. The officials on a call with reporters were from California, Colorado, Connecticut, Kentucky, New York, and Washington (Adams, 3/13).

The San Jose Mercury News: Obamacare: Number Of Newly Insured Still A Mystery Under Nation's New Health Law
Providing coverage to the 47 million uninsured Americans is a central goal of the nation's new health care law, but just weeks before the enrollment deadline the number of newly insured is still a mystery. That's because many health exchanges signing up millions of Americans for health plans didn't clearly ask: Do you already have insurance? On Thursday, officials with Covered California trumpeted the latest enrollment numbers from the Golden State's health exchange: 923,832 people in private health plans; another 2.1 million are either newly enrolled or have been determined eligible for the state's version of Medicaid, called Medi-Cal. Nationally, about 4.2 million people have signed up for private plans, and 6.5 million enrolled or qualified to enroll for Medicaid (Seipel, 3/13).

The Wall Street Journal's Washington Wire: On Health Insurance, GOP Wants To Know Who's Paid
House Republicans are homing in on a new line of attack against the administration's health law enrollment numbers — "who’s paid" – and are now asking every insurance provider selling a plan through HealthCare.gov to tell them (Radnofsky, 3/13).

The Fiscal Times: Obamacare: 3.4 M Could Be The Real Sign-Up Number
The number of people actually gaining coverage under the president's new health care law is likely around 3.4 million -- or 800,000 fewer than the 4.2 million the White House says have signed up for Obamacare. Politico reports that the country's four largest insurance companies have provided the administration with data showing that between 15 and 20 percent of Obamacare enrollees have not paid for their premiums. This is in line with other outside estimates that the administration has refused to confirm. Without payment, these people will not be getting covered through new health plans and should not be counted in the official enrollment figures (Ehley, 3/13).

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Calif. Reports More Than 900,000 People Have Signed Up For Health Plans

But officials note that the number of Latinos and young people enrolling on the state marketplace is still below expectations. Meanwhile, the troubled Maryland exchange is reportedly gearing up to adopt the technology used by Connecticut.

Los Angeles Times: Covered California Enrolls Nearly 1 Million In Health Plans
California is nearing 1 million people enrolled in Obamacare coverage, but the state's insurance exchange is still running behind in signing up Latinos and young people. In figures released Thursday, the state said 923,832 people had picked a health plan through March 9, and about 1.5 million people have enrolled or been deemed eligible for an expansion of Medi-Cal, the state's Medicaid program for the poor (Terhune and Karlamangla, 3/13).

The Associated Press: California Health Exchange Enrolls 900,000 So Far
About 924,000 people have picked insurance plans through California's health care exchange as the race continues to attract more Latinos and younger people ahead of the enrollment deadline later this month. "We've done a good job in this state, but we are not satisfied. We need to get more people insured," Peter Lee, executive director of Covered California, said Thursday during a rally at the historic Olvera Street Mexican marketplace in downtown Los Angeles (Chang, 3/13).

The Baltimore Sun: Maryland Looks To Connecticut As Exchange Model
Maryland will likely dump all or part of the state's health insurance exchange website and adopt Connecticut's system, a move that could make it the first state to abandon a dysfunctional site. Officials with Maryland's exchange plan to turn to the "Connecticut solution," which was developed largely by Deloitte Consulting LLC and considered among the most successful in enrolling consumers in private health insurance under the Affordable Care Act, said two sources with knowledge of the situation (Cohn, 3/13).

In Oregon, the exchange board met -

The Associated Press: Cover Oregon: Exchange Won't Launch In March
Officials with Oregon's troubled health insurance exchange said the full online Cover Oregon portal will not be open to the public before the end of March, when nearly all Americans are required to have insurance under the federal health care law. The exchange's chief information officer Aaron Karjala told Cover Oregon board members Thursday that the portal has experienced "an unacceptable number of IT errors" and system-stability problems since Cover Oregon launched the online enrollment system for insurance agents and community organizations in mid-February (3/13).

The Oregonian: With March 31 Health Coverage Deadline Approaching, Oregon Hopes For Longer
As the March 31 deadline nears for Oregonians seeking health coverage, Cover Oregon health insurance exchange officials remain hopeful for some sort of grace period beyond that date. Cover Oregon's acting director, Bruce Goldberg, told the exchange board Thursday that discussions with the federal government are ongoing to get permission for Oregon to have a "special enrollment period." Thursday's discussion is significant because earlier this week federal officials appeared to rule out an extension of the open-enrollment deadline -- a request made by Oregon -- in a conference call with reporters (Budnick, 3/13).

And in news about state debates on the expansion of Medicaid -

The Washington Post: McAuliffe Visits Pr. William Health Clinic In Campaign For Medicaid Expansion
One after another, the patients at the new Prince William County health clinic told Virginia Gov. Terry McAuliffe (D) why they need health insurance. Unable to find full-time work since she was laid off in 2009, Catherine Brooks, 54, borrows money from an old high school friend so she can see a kidney specialist and get her teeth cleaned (Zauzmer, 3/13).

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Capitol Hill Watch

GOP Triumph In Florida Sets Anti-Obamacare Strategy

Congressional Republicans plan to build on their victory in the Florida special election this week by extending their campaign against Obamacare to races across the nation. Democrats, meanwhile, embark on a large-scale public opinion survey to try to blunt that strategy.

The Wall Street Journal’s Washington Wire: Obamacare Exemptions Fuel House Republicans’ Drive
The raft of tweaks to the health law released by the Obama administration last week included a further extension of an exemption to the requirement that individuals carry coverage or pay a penalty, a move that is now fueling House Republicans’ push for repealing the requirement entirely (Radnofsky and Hughes, 3/13).

The Associated Press/Washington Post: GOP Hits Hard On Obamacare After House Election
Congressional Republicans attacked Obamacare with new ferocity but sometimes questionable veracity Thursday, energized by a campaign triumph in Florida that gave health care issues their first airing of the election year. “We’re reminded this week that the American people are still concerned about the president’s health care law,” House Speaker John Boehner said at a news conference where he also challenged Obama to roll back pending cuts for private Medicare coverage plans (3/13).

The Fiscal Times: GOP Anti-Obamacare Strategy Is Fixed After Florida
Congressional Republicans plan to capitalize on their victory in the Florida special election this week by reinforcing their war on Obamacare. Many in the GOP, including House Speaker John Boehner, say the president’s signature health care plan helped Republican David Jolly defeat Democrat Alex Sink. "We're reminded this week that the American people are still concerned about the president's health care law," House Speaker John Boehner (R-OH) told reporters at a news conference on Wednesday. “More people are going to lose their policies over the next couple years, people are going to pay a lot more for the policies they’re going to have to buy at the exchanges, it’s going to get a lot worse before it gets better” (Ehley, 3/14).

CBS News: Will Republicans Overplay Their Hand On Obamacare In 2014?
After Republican David Jolly narrowly won the special election in Florida's 13th congressional district, the GOP was quick to attribute his victory in part to public opposition to Obamacare. "Congratulations to David Jolly on his victory, and congratulations to the people of Pinellas County on selecting a leader who will fight for good jobs and quality health care and against Democrats' efforts to rob Medicare Advantage to pay for Obamacare," Republican National Committee Chairman Reince Priebus said in a statement. Republicans have continued their attacks against the Affordable Care Act this year in Congress and have planned to make it a key issue this November -- the Florida race gives them little reason to change course (Condon, 3/14).

Politico: Democrats Seek The Right Obamacare Message
House Democrats are looking for a way to blunt their Obamacare woes. The Democratic Congressional Campaign Committee, House Democrats’ campaign arm, is about to embark on a large-scale public opinion survey that will -- in part -- seek to uncover how voters in key districts across America feel about the 2010 Affordable Care Act (Bresnahan and Sherman, 3/13).

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GOP, Former Mass. Sen. Brown Eye New Hampshire Seat

In Nebraska, a Republican Senate candidate opposing the health law once consulted for firms trying to implement it.

The New York Times: Scott Brown May Seek Office Again, But In New Hampshire
If Mr. Brown enters the race, polls have indicated that he would be the strongest Republican to challenge Ms. Shaheen, but the most recent poll, by Suffolk University, found him trailing by 13 percentage points. Even if he did not win, he would force the Democrats to spend a lot more time and attention in New Hampshire than they had been prepared for. With his national name recognition and the importance of the race, Mr. Brown -- who represented Massachusetts for three years -- would be expected to raise a serious amount of money. Ms. Shaheen is perceived as vulnerable because of her strong support for President Obama’s health care law, which polls show is deeply unpopular in New Hampshire (Seelye, 3/13).

Politico: Ben Sasse Aided Firm Implementing Obamacare
Nebraska Republican Ben Sasse has built his Senate campaign on his opposition to Obamacare -- but he once consulted for a firm that was working to implement it. Sasse provided early “strategic advice” to former Health and Human Services Secretary Mike Leavitt’s health care consulting firm while the firm pitched itself to clients in early 2010 to help implement the Affordable Care Act. Sasse is listed, along with his photograph and biography, as a “senior advisor” under the heading “Leavitt Partners team” in PowerPoint presentations from April and May 2010 in which Leavitt’s firm sold its Obamacare expertise (Epstein, 3/14).

Ads opposing candidates' Obamacare stances are becoming ubiquitous --

The Wall Street Journal’s Washington Wire: Americans For Prosperity Targets Pryor’s Support for Health Law
Conservative group Americans for Prosperity launched a $700,000 ad campaign targeting Sen. Mark Pryor (D., Ark.) for his support of the Affordable Care Act. The ad, which will be broadcast statewide beginning Thursday and running for the next three weeks, brings the group’s total spending on the Senate race to more than $1.3 million. In the ad, a woman identified as Wanda of Marion, Ark., says Blue Cross Blue Shield notified her and her husband that their health coverage would be canceled as of December 2014. “Well now, when somebody tells you if you like it, you can keep it, you believe them,” she says, referring to remarks President Barack Obama made when he was touting the health care law. “But that’s not so in this case” (Ballhaus, 3/13).

Bloomberg: Obamacare Foes Run Nearly Half of Early Ads For Congress
President Barack Obama’s health-care law is fueling an explosion in early television advertising before November’s congressional elections, with close to half the commercials attacking the measure. More than 66,000 ads in U.S. House and Senate races aired through March 9, more than triple what candidates and allied groups aired during a comparable period four years ago, according to New York-based Kantar Media’s CMAG, which tracks advertising (Giroux, 3/14).

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Health Care Marketplace

Lawsuit Shines Light On Doctor-Device Maker Relationship

The Wall Street Journal looks at a lawsuit that is revealing just how doctors -- and thusly consumers -- are influenced by device makers. And Google moves into the emergency room.

The Wall Street Journal: Doctors, Device Makers: Close Ties
A lawsuit involving health-products company Johnson & Johnson offers a glimpse into the close ties between the medical-device industry and doctors who provide or can influence the information consumers hear about medical products (Wang, 3/13). 

The Wall Street Journal’s CIO Report: Hospital Okays Google Glass In The Emergency Department
Beth Israel Deaconess Medical Center has modified Google Glass wearable computers so they can be used to treat patients in its emergency department without running afoul of privacy regulations. Using software from a startup, the hospital ensures no data travels over Google’s servers, says Dr. John Halamka, the hospital’s CIO (Boulton, 3/13).

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State Watch

State Highlights: Wash. State Cost And Quality Bills; Okla. Privatized Medicaid

A selection of health policy stories from Washington state, Oklahoma, Florida, North Carolina, Wisconsin, Connecticut, Massachusetts and Georgia.

The Seattle Times: New Laws Will Help Consumers Find Cheapest, Best Docs And Hospitals
Consumers will have new tools for finding out what a trip to the doctor will cost before they take it, thanks to two bills passed by Washington lawmakers. One will require insurance companies to provide customers with a tool for doing cost- and quality-comparison shopping, while the other creates a public, statewide database with information on quality, but limited price data (Stiffler, 3/13).

Tulsa World: State Senate Passes Bill To Privatize Medicaid
The Oklahoma Senate on Thursday passed a bill that would privatize Medicaid in a pilot project at a yet-to-be-determined location in the state. Senate Bill 1495, by Sen. Kim David, R-Wagoner, passed by a vote of 25-21 and heads to the House for consideration. Senate approval requires 25 votes. The Oklahoma State Medical Association opposes the bill. Managed care for Medicaid was tried in the 1990s and failed miserably, said Wes Glinsmann, Oklahoma State Medical Association spokesman (Hoberock, 3/13).

The Associated Press: FL Malpractice Law Overturned 
The Florida Supreme Court says limits on non-economic awards in medical malpractice wrongful death cases are unconstitutional. The court issued its ruling Thursday in a 5-2 decision (3/13).

The Associated Press: Additional Abortion Health Insurance Requirement To Remain Intact In Michigan
A new Michigan law requiring residents or businesses that want health insurance coverage for abortions to buy extra coverage will remain intact despite opponents' initial hopes to overturn it at the ballot box this year. When the measure goes into effect Thursday -- three months after its contentious passage -- many newly issued or renewed health plans will be prohibited from paying for elective abortion services unless an inexpensive supplemental policy is purchased (Eggert, 3/13).

North Carolina Health News: Medicaid Budget Still Unclear, Legislators Frustrated
For months, lawmakers have been asking the state Department of Health and Human Services for numbers on Medicaid budget spending, and for months, the response has been “next month.” And Wednesday, another month’s legislative oversight meeting came and went, and still the word from DHHS on Medicaid spending targets was “later” (Hoban, 3/13). 

The Milwaukee Journal Sentinel: Opponents Criticize Scott Fitzgerald's Bid To Block Cancer Drug Bill
The leader of the state Senate is going to unusual lengths to block a bipartisan bill to help cancer patients afford life-saving treatments as his brother lobbies on behalf of insurers to kill the proposal. The proposal would require health plans to provide the same coverage for chemotherapy drugs taken as pills as they do for chemotherapy administered through IVs. Audrey Van Dyke, whose 17-year-old son Alexander was diagnosed with cancer in 2010, has never understood why his chemotherapy was covered when he was in a hospital or clinic but cost additional money when taken as a pill at home (Stein and Boulton, 3/13).

The CT Mirror: Emergency Responders, Disability Advocates Back End-Of-Life Care Proposal For CT
People who provide emergency medical care say situations like this are common: A dying patient’s wishes aren’t known or are in dispute, leaving her relatives to agonize over what to do. Or a terminally ill patient comes to the hospital with no record of his treatment wishes and ends up getting more aggressive care than he'd wanted. (Dr. Joanne) Kuntz and others say there’s a better way: A process for terminally ill patients to discuss their options with a health care provider, determine what sort of end-of-life care they want, and document it in a form that would serve as a medical order for emergency responders, physicians and others in the health care system to follow (Becker, 3/14).

WBUR: All 9 Candidates For Mass. Gov: Where Do They Stand On Health Care?
Kudos to the Health Business Blog for the first full scoop on the health care positions of all nine of this year’s candidates for Massachusetts governor.  Blogger David E. Williams is not a professional journalist -- he’s a health-care consultant and president of the Health Business Group -- but he certainly seems to be first out with a roundup sure to be of interest to many in health care, the state’s biggest employer. I asked him whether he thought this November’s gubernatorial election could be a bellwether for the politics of health care (Goldberg, 3/13).

Stateline: Q&A: How States are Tackling 'Health Disparities'
African-Americans are more likely to suffer heart disease and diabetes than whites. The cancer death rate for men is a good deal higher than it is for women. American Indians and Alaska Natives are more likely to smoke tobacco than Hispanics, blacks or whites. And Native Hawaiian adults are less likely to exercise than other ethnic groups. These differences are called “health disparities,” and in the last two decades, the federal government and the states have focused on eliminating them (Ollove, 3/14).

Georgia Health News: Rural Areas May Get Basic-Service Hospitals
Rural health care may get a needed boost under a proposed regulation change that would allow a hospital to downsize its services, the commissioner of a Georgia health agency said Thursday. Clyde Reese, commissioner of the Department of Community Health, said he would ask the board of the agency to promulgate rules for such a “step-down’’ facility. Reese, speaking at a meeting of the board, said Gov. Nathan Deal would make an announcement on rural health care next week. Reese did not expand on those remarks. But industry officials told GHN that the Community Health proposal likely would allow a rural hospital that has recently closed -- or one that’s currently struggling to survive — to downsize to a facility that includes an emergency room, surgery and childbirth services (Miller, 3/13).

Georgia Health News: Senate Busy Reworking Health Bills
The Georgia Senate continued practicing its sleight of hand with House bills Thursday, making one vanish, restoring a second to its original form and causing a third to reappear as the General Assembly entered the final three days of the 2014 session. HB 913 passed the House in early March as an effort to prevent possible conflicts of interest among Department of Community Health Board members. With that stated goal, it targeted one board member in particular. But that language disappeared at a Senate Health and Human Services Committee meeting Thursday morning (Craig, 3/13).

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Health Policy Research

Research Roundup: Medicaid Eligibility; Tracking Discontinued Randomized Trials

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

Health Affairs: Medicaid And Marketplace Eligibility Changes Will Occur Often In All States; Policy Options Can Ease Impact
Under the Affordable Care Act (ACA), changes in income and family circumstances are likely to produce frequent transitions in eligibility for Medicaid and health insurance Marketplace coverage for low- and middle-income adults. We provide state-by-state estimates of potential eligibility changes ("churning") if all states expanded Medicaid under health reform, and we identify predictors of rates of churning within states. ... Higher-income states and states that had more generous Medicaid eligibility criteria for nonelderly adults before the ACA experienced more churning, although the differences were small. Even in states with the least churning, we estimated that more than 40 percent of adults likely to enroll in Medicaid or subsidized Marketplace coverage would experience a change in eligibility within twelve months (Sommers et al., 3/10).

The Urban Institute/Kaiser Family Foundation: As The Economy Improves, The Number Of Uninsured Is Falling But Not Because Of A Rebound In Employer Sponsored Insurance
The recession was marked by an increase of almost 6 million uninsured individuals between 2007 and 2010. The losses in coverage were mostly driven by large numbers of individuals losing employer-sponsored insurance, although gains in Medicaid coverage partly offset these losses. ... The main contributor to increasing post-recession coverage rates, even with increased employment, was Medicaid, not employer coverage. Employer coverage rates did stabilize after 2010 after long trends of decline predating the recession, but this change was likely caused by provisions in the Affordable Care Act (ACA) that allowed young adults to continue as dependents on parents’ private plans until age 26. Although full-time work increased and joblessness decreased after the recession, employer coverage rates continue to decline for many (Holahan and McGrath, 3/11).

Journal of the American Medical Association: Prevalence, Characteristics, And Publication Of Discontinued Randomized Trials
Our study found that 25% of initiated RCTs [randomized clinical trials] were discontinued. Although discontinuation was common for RCTs involving patients (28%), it was rare for RCTs involving healthy volunteers (3%). The most commonly reported reason for RCT discontinuation was poor recruitment (10% of included RCTs). We found that trials with investigator sponsorship (vs industry sponsorship) and those with smaller planned sample sizes were at higher risk of discontinuation due to poor recruitment. Of discontinued RCTs, up to 60% remained unpublished. Trial investigators rarely informed RECs about trial discontinuation and publication. ... Greater efforts are needed to make certain that trial discontinuation is reported to RECs and that results of discontinued trials are published (Kasenda et al., 3/11).

JAMA Neurology: Disparities In Access To Deep Brain Stimulation Surgery For Parkinson Disease
[This study examined] deep brain stimulation (DBS) use in Parkinson disease (PD) to determine which factors, among a variety of demographic, clinical, and socioeconomic variables, drive DBS use in the United States. ... Despite the fact that African American patients are more often discharged from hospitals with characteristics predicting DBS use (ie, urban teaching hospitals in areas with a higher than average density of neurologists), these patients received disproportionately fewer DBS procedures compared with their non–African American counterparts. Increased reliance on Medicaid in the African American population may predispose to the DBS use disparity (Chan et al., 3/10).

Journal Of General Internal Medicine: Regardless of Age: Incorporating Principles From Geriatric Medicine To Improve Care Transitions For Patients With Complex Needs
Patients with complex needs can benefit from optimal transitional care, regardless of age. A 50-year-old man with uncontrolled diabetes and limited mobility has similar needs to an 80-year-old woman with cognitive impairment and limited transportation. ... Additionally, lessons learned from transitions from hospitals back to the community can be applied more broadly to other transitions. ... Geriatricians’ holistic approach to patient management, caregiver support, and understanding of the continuum of care (and associated payment systems), facilitates the design, implementation, and evaluation of care delivery systems responsive to the needs of older adults and those with complex needs (Arbaje et al., 2/21).

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

Modern Healthcare: Accountable Care Organizations Face Profit Dilemma
As accountable care organizations proliferate, the ones that succeed will face a new dilemma: how to fairly distribute their share of the money they save. There are now some 360 ACOs participating in the Medicare shared savings program alone, plus many others that are participating in a variety of similar arrangements with private payers. The amount of money any of them will have to divvy up is unclear at this point, but the authors of a new commentary in the Journal of the American Medical Association indicate that the most successful of the first crop of Medicare ACOs will receive a bonus of $5.2 million, which means individual participants will stand to collect several thousand dollars each (Robeznieks, 3/12).

The New York Times: Report Says Medication Use Is Rising For Adults With Attention Disorder
The number of young American adults taking medications for attention deficit hyperactivity disorder nearly doubled from 2008 to 2012, according to a report to be released Wednesday by the nation’s largest prescription drug manager. The drug manager, Express Scripts, which processes prescriptions for 90 million Americans, also found that almost one in 10 adolescent boys were taking medications for the disorder, usually stimulants such as Adderall or Concerta. Some experts said the report provided the clearest evidence to date that the disorder is being diagnosed and treated with medication in children far beyond reasonable rates, and that steeply rising diagnoses among adults might portend similar problems (Schwartz, 3/12). 

Reuters: Nurse Numbers, Education Linked To Patient Death Rate
Both the quality and quantity of nurses on a hospital staff have significant influence on the chances patients will die following even simple surgery, according to a large new study. Researchers found the proportion of staff nurses with a bachelor's degree and the number of patients each nurse had to care for could add up to a difference of 30 percent or more in mortality rates for inpatients (Bond, 3/7).

Propublica: The Perils Of Problematic Prescribing: A Double Dose Of Warnings 
Twice this week, the Centers for Disease Control and Prevention has pointed to the harm caused by aberrant and inappropriate prescribing by physicians. First, the CDC reported Monday that doctors are a primary source of narcotic painkillers for chronic abusers at the highest risk of overdoses (Ornstein, 3/7).

Modern Healthcare: Report Says Surgical-Outcomes Data Unreliable For Comparing Hospitals
The American College of Surgeons claims that by implementing its National Surgical Quality Improvement Program, individual hospitals can prevent 250 to 500 complications, save 12 to 36 lives, and reduce costs by millions of dollars annually. But a new report posted on the JAMA Surgery website concluded that outcomes data in the NSQIP registry were unreliable measures of hospital performance (Robeznieks, 3/12).

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Editorials and Opinions

Viewpoints: Cancer's Deadly Toll In Minority Communities; GOP Candidates Need To Go On Offense Against Health Law

The New York Times: Why Black Women Die Of Cancer
Since the early 1970s, studies have shown that black Americans have a higher death rate from cancer than any other racial or ethnic group. This is especially true when it comes to breast cancer. A study published last week in the journal Cancer Epidemiology found that, in a survey of 41 of America's largest cities, black women with breast cancer are on average 40 percent more likely to die than their white counterparts (Harold P. Freeman, 3/13). 

Los Angeles Times: U.S. Should Reclassify Prescription Painkillers To Cut Rampant Theft
In his 30 years as a pharmacist, including three at a CVS Caremark store in Northern California, Wayne Wilson said it was all too common for drugstore employees to steal prescription drugs, which would often make their way to the black market. "It happens far more often than people realize," he told me. "I used to be shocked. I'm not shocked any more." Wilson said he personally intervened after a CVS pharmacy worker in Eureka was caught slipping painkillers into his pocket. That worker was arrested and fired, he said (David Lazarus, 3/13). 

The Washington Post: Making The AIDS Crisis Worse
Some of America’s closest friends in Africa have turned with a vengeance on gay people. In Nigeria, President Goodluck Jonathan recently approved a law making homosexual acts punishable by up to a 14-year jail sentence and outlawing gay organizations. In Uganda, President Yoweri Museveni signed legislation that requires a life sentence for serial offenders and mandates that witnesses report homosexual acts or face penalties themselves. ... This problem has many political, cultural and religious layers. One matter of science, however, is clear: Anti-gay laws are bad for public health (Michael Gerson, 3/13). 

The New York Times' Economix: How To Shave $1 Trillion Out Of Health Care 
Americans spend more than 17 percent of GDP on health care; other high income industrial democracies spend only about 11 percent. The 6 percent difference in our $17 trillion economy amounts to $1 trillion. ... What could Americans do with that trillion dollars each year and what would we have to give up if our health care system became more like those of our peers? (Victor R. Fuchs, 3/14). 

The New York Times: Saving A Future For Those With Disabilities
Back in the old days, when Congress did crazy things like pass legislation, a sensible bill like the ABLE Act might have sailed to the president's desk. But today, even with a long list of positives — it’s a good idea, solves a pressing problem and has lots of bipartisan support — it’s not a slam dunk, because there’s always a way in Washington to squelch good ideas, especially those that involve tweaking the tax code and spending a little money. The Achieving a Better Life Experience Act would be a boon for people with disabilities, and for their parents and other caregivers (3/13). 

WBUR: Might Personality Tests Of Patients Improve Preventive Health Care?
Before entering my freshman year of college, I was asked to complete a Myers-Briggs Type Indicator personality test so the school could match me to a compatible roommate. She and I ended up living together all four years. In fact, the Myers-Briggs tool, which classifies each individual as one of 16 personality types, is considered such a powerful tool that most college career centers and Fortune 500 companies use it to help people determine their appropriate course in the work world. Soon, doctors, too, may conduct personality tests with patients to help tailor their care (Veronica Thomas, 3/13).

And in commentary on the health law --

The Washington Post's Post Partisan: The Insiders: Sebelius Happy Talk Makes It Worse For Democrats
I think I have figured out why President Obama hasn't fired Health and Human Services Secretary Kathleen Sebelius. She will say anything. Sebelius will deny the obvious, defend the indefensible and even rewrite the law without hesitation, all while keeping a straight face. She has been willing to hide, bend and break the Obamacare law. Even moving the goalposts of what Obamacare's success would look like and changing the initial purpose of Obamacare – insuring the uninsured – doesn't cause her to break a sweat or show even the slightest bit of embarrassment (Ed Rogers, 3/13). 

The Washington Post: Deadline Looming For Affordable Care Act Enrollment
You have until the end of the month to sign up for a plan on the health-care exchanges. With the March 31 deadline nearing, the White House is pumping up and plugging HealthCare.gov to get more people to enroll, especially young adults, reports Puneet Kollipara of The Washington Post’s Wonkblog (Michelle Singletary, 3/13). 

The Wall Street Journal's Potomac Watch: A 2014 GOP Election Model
Republicans celebrating this week's victory in a Florida special House election are right to take the race as proof that they've got a potent midterm weapon in ObamaCare. Those looking to mimic the model this fall would be even wiser to view David Jolly's win in its broader context: This was a victory of offense (Kimberley A. Strassel, 3/13). 

Bloomberg: Obamacare Co-Ops Exploit Dodgy Pricing
One of the lesser-known provisions of the Affordable Care Act provided funding for the establishment of health insurance cooperatives, nonprofit local insurers that provide policies on the exchange. ... [Lower pricing offered by coops] suggests a worrying alternative possibility -- that the inexperienced co-ops have systematically priced their policies too low. That could hit the taxpayer in two ways: through the risk-corridor payments, which will make up excess losses, and through the $2.1 billion worth of government loans that have been made to these insurers (Megan McArdle, 3/13).

Bangor Daily News: Maine GOP Dismisses Medicaid Compromise That Meets Its Own Demands
On Wednesday, Maine lawmakers once again declared their positions on Medicaid expansion from the floor of the Senate. What was remarkable was that, despite the fact that the bill to expand Medicaid to 70,000 low-income residents is significantly different from last year, the arguments against it didn't really change. In fact, instead of the compromise bill drawing more support, it drew less (3/13). 

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
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.