Daily Health Policy Report

Friday, March 21, 2014

Last updated: Fri, Mar 21

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

State Watch

Public Health & Education

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

The Sign-Up Deadline Is March 31: A Consumers’ Guide

Kaiser Health News staff writer Mary Agnes Carey reports: "With just over a week until the March 31 deadline to sign up for health insurance, backers of the health law -- from President Barack Obama on down -- are engaged in a full-force campaign to enroll eligible Americans, especially younger ones who tend to be healthier and less costly to insure. ... Here's a primer on how the law might affect you" (Carey, 3/21). Read the story.

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A Reader Asks: After I Was In The Hospital, Can I Buy Insurance To Cover My Bills?

Kaiser Health News consumer columnist Michelle Andrews answers this reader’s question (3/21). Read her response.

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Capsules: Cholesterol Advice Could Mean Statins For Many Over 40

Now on Kaiser Health News' blog, Richard Knox, writing for Kaiser Health News in collaboration with NPR, reports on a New England Journal of Medicine study: "When sweeping new advice on preventing heart attacks and strokes came out last November, it wasn’t clear how many more Americans should be taking daily statin pills to lower their risk. A new analysis provides an answer: a whole lot. Nearly 13 million more, to be precise" (Knox, 3/20). Check out what else is on the blog.

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Political Cartoon: 'My Experience With Obamacare'

Kaiser Health News provides a fresh take on health policy developments with "My Experience With Obamacare" by Jen Sorensen.

And here's today's health policy haiku:


What does his bracket
have to do with enrollment?
Ask the president.


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

Marketplace Reportedly Using Wrong Guidelines For Subsidies

An article in the Philadelphia Inquirer notes the problem. In other implementation news, recent statements by a Treasury official are being touted by Republicans as evidence the Obama administration has overstepped its statutory authority.

Philadelphia Inquirer: A Glitch In Obamacare Marketplace No One Noticed
Nearly six months after the disastrous launch of Healthcare.gov, with the website running smoothly and more than five million people signed up as open enrollment heads to a close, a new glitch has come to light: Incorrect poverty-level guidelines are automatically telling what could be tens of thousands of eligible people they do not qualify for subsidized insurance. The error in the federal marketplace primarily affects households with incomes just above the poverty line in states like Pennsylvania that have not expanded Medicaid. The mistake raises the price of their insurance by thousands of dollars, making insurance so unaffordable many may just give up and go without (Sapatkin, 3/21).

The Wall Street Journal: Republicans Challenge Administration's Authority
Republicans are pointing to statements by a top Treasury Department official as evidence that the Obama administration overstepped its authority in delaying the health-care law's requirement that employers offer coverage or pay a penalty. Mark Mazur, assistant Treasury secretary for tax policy, said in a January interview with staff from the GOP-led House Oversight and Government Reform Committee that he wasn't aware of any examination of the legal basis for the administration's authority to delay the employer mandate (Radnofsky, 3/20).

In other news coverage of implementation issues -

The Associated Press: Health Care Law Has Uneven Impact On Companies
Sarah Curtis-Fawley will have to offer insurance to her workers at Pacific Pie Co. because of the health care overhaul, and the estimated $100,000 cost means she may have to raise prices or postpone opening a third restaurant. ... The Affordable Care Act, which aims to provide coverage for millions, is playing to decidedly mixed reviews in corporate America (Murphy, 3/20).

Modern Healthcare: Obamacare Insurance Mandate Could Be Toothless In 2014
The Obama administration has made the individual mandate its line in the sand for the Patient Protection and Affordable Care Act. Despite delaying or tweaking numerous provisions—most notably the requirement that businesses with more than 50 employees provide coverage. ... The financial penalty isn't particularly onerous in the first year. ... But the individual mandate is likely to prove a paper tiger in 2014 for two other reasons: the availability of hardship exemptions and lax enforcement (Demko, 3/20).

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Emanuel's Book Suggests Health Law Could Create Shift From Job-Based Plans

Although Ezekiel Emanuel was a key White House adviser on the law, other Democrats dispute his view about transitions in how Americans get coverage. Meanwhile, in other articles looking at changes the overhaul will bring, the Associated Press examines some workers' desire to leave jobs now that they can get insurance elsewhere, and the Fiscal Times explores premium costs in the future.

The New York Times: In Book, Architect of Health Law Predicts a Shift Away From Employer Coverage
Ezekiel J. Emanuel, who helped devise the Affordable Care Act, has a vision for how it will eventually work. Democrats hope it will not materialize anytime soon. Mr. Emanuel expects the law to produce an unadvertised but fundamental shift in where most working Americans get their health insurance — specifically, a sharp drop in the number of employers who offer coverage to their workers. ... His former colleagues in the Obama White House say there is no evidence the law will bring "the end of employer-sponsored insurance," as Mr. Emanuel puts it in his new book (Harwood, 3/20).

The Associated Press: With Health Law, Workers Ponder The I-Quit Option
But for Stephanie Payne of St. Louis, who already had good insurance, the law could offer another kind of escape: the chance to quit her job. At 62, Payne has worked for three decades as a nurse …. One of the selling points of the new health care plan, which has a March 31 enrollment deadline, is that it breaks the link between affordable health insurance and having a job with benefits. Payne believes she'll be able to replace her current coverage with a $400- to $500-a-month plan on Oregon's version of the new insurance exchange system set up under the law. … Last month, congressional budget analysts estimated that within 10 years, the equivalent of 2.5 million full-time workers could be working less because of the expanded coverage. But is the new option a gamble? That's a matter of debate (Johnson, 3/21).

The Fiscal Times: 4 Reasons Obamacare Premiums Will Rise Next Year
Now that the first open enrollment period under the Affordable Care Act is coming to a close, insurers they say are getting a better idea of what to expect next year—and that includes higher premiums. Early into Obamacare’s troubled launch—plagued with website problems, cancelled plans and numerous delays—several insurers were already warning that the rocky rollout would result in higher premiums in 2015. Aetna CEO Mark Bertolini first raised concerns over a potential rate shock in December, when he told investors that "in some markets,"individual-market premium increases " could go as high as 100 percent" (Ehley, 3/21).

Meanwhile, CNN examines the issues at stake in next week's Supreme Court case.

CNN: Justices To Hear 'Hobby Lobby' Case On Obamacare Birth Control Rule
Conestoga Wood Specialties was founded a half-century ago in a Pennsylvania garage. The Hahn family's commitment to quality is driven in large part by their Christian faith, which in turn may soon threaten the company's very existence. That financial and constitutional dynamic is now before the U.S. Supreme Court, in a high-stakes encore to the health care reform law known as Obamacare. The justices will hear oral arguments Tuesday in a dispute involving contraception coverage and religious liberty. The court will review provisions in the Affordable Care Act requiring for-profit employers of a certain size to offer insurance benefits for birth control and other reproductive health services without a co-pay. At issue is whether certain companies can refuse to do so on the sincere claim it would violate their owners' long-established personal beliefs (Mears, 3/21).

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Obama Presses Campaign For Health Law Enrollment

The president continues his many media appearances to help draw attention to the enrollment deadline at the end of March. Meanwhile, a new Pew poll finds that younger Americans are somewhat more interested in the law but support among Hispanics has dropped.

Los Angeles Times: Obama Enlists Help To Push Affordable Care Act
President Obama teased Ellen DeGeneres about the selfie she took at the Oscars and confessed to leaving his socks and shoes lying around while the first lady is out of town, but before the end of his Thursday appearance on her talk show, he got DeGeneres to put in a plug for the Affordable Care Act. That's Obama's deal with popular media these days as the president enlists help to boost healthcare sign-up numbers before the March 31 enrollment deadline for coverage this year. In recent days, Obama has filled out his March Madness brackets on ESPN, joked with comedian Zach Galifianakis and defended his "mom jeans" with radio host Ryan Seacrest — all with the agreement he'd get a moment to make his pitch (Parsons, 3/20).

Los Angeles Times: Younger Americans Warm Somewhat To Obamacare, Poll Shows
As the deadline approaches for enrolling in Obamacare health coverage this year, younger Americans have warmed somewhat to the president’s healthcare law, but Latinos remain closely split over it. Those findings from a large-scale Pew Research Center survey provide a glimpse at two groups that are major targets of the Obama administration’s push to get people to sign up before the March 31 deadline (Lauter, 3/20).

CBS News: Approval Of Obamacare Nosedives Among Hispanics
Four years after passage of the Affordable Care Act and less than a year into the implementation of the exchanges, the health care law's popularity is taking a nosedive among Hispanics. Hispanics are split with 47 percent approving and 47 percent disapproving, according to a new survey by the Pew Research Center. In September, 61 percent of Hispanics approved of the law. Meanwhile, overall, more Americans disapprove of Obamacare: 53 percent of the 3,335 adults who responded disapprove of the law, while just 41 percent approve -- a measure virtually unchanged since last September, before people could purchase coverage on the insurance exchanges (Kaplan, 3/20).

McClatchy: 53 Percent Disapprove Of Affordable Care Act, 43 Percent Approve, New Poll Finds
On the Affordable Care Act’s fourth anniversary, a new Pew Research Center poll released Thursday found strong disapproval of the controversial law. Fifty-three percent disapprove, while 41 percent approve. At the same time, the poll found, "when opponents of the health care law are asked about the law’s future, more want elected officials to try to make it work than to make it fail. In September opponents were more evenly divided over how they wanted elected officials to deal with the law" (Lightman, 3/20).

Several news outlets also looked a consumer issues with the law.

Kaiser Health News: The Sign-Up Deadline Is March 31: A Consumers' Guide
Kaiser Health News staff writer Mary Agnes Carey reports: "With just over a week until the March 31 deadline to sign up for health insurance, backers of the health law -- from President Barack Obama on down -- are engaged in a full-force campaign to enroll eligible Americans, especially younger ones who tend to be healthier and less costly to insure. ... Here's a primer on how the law might affect you" (Carey, 3/21).

Kaiser Health News: A Reader Asks: After I Was In The Hospital, Can I Buy Insurance To Cover My Bills?
Kaiser Health News consumer columnist Michelle Andrews answers this reader’s question (3/21).

The Associated Press: Q&A: Am I Stuck In My $$$ Workplace Health Plan?
The new health care law helps some people, hurts others and confuses almost everyone. Hoping to simplify things a bit, The Associated Press asked its Twitter, Facebook and Google Plus followers for their real-life questions about the program and the problems they're running into as the March 31 deadline approaches to sign up for coverage in new insurance markets (Woodward, 3/21).

Fox News: ObamaCare: Does It Really Cost Less Than Cell Phone Coverage?
In the midst of March Madness, the White House is making a full-court press of its own: a last-minute push to enroll more than 1.5 million young people in ObamaCare health plans by the end of this month. But in courting young people, President Obama is making a simple-yet-questionable pitch -- that new health coverage basically costs the same as 4G cell coverage.  "You can at this point get health insurance for $100 a month or less, in some cases less than your cell phone bill or your cable bill," Obama told Ellen DeGeneres this week (Doocy, 3/20).

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Capitol Hill Watch

Pelosi On Obamacare Anniversary: The Law Is 'A Winner' For Democrats

The House minority leader marks the anniversary of the law's passage by expressing confidence that the law will help Democratic candidates this fall.

CNN: Pelosi: Obamacare A Winning Issue
Marking Sunday's fourth anniversary of the Affordable Care Act, House Democratic Leader Nancy Pelosi brushed off any notion the controversial health care law was hurting Democrats politically, and predicted the measure would help those running in competitive districts in the midterm elections this fall. "I believe that it's a winner," Pelosi replied when asked Thursday how the issue would play in swing districts. "That is a case we have to make," she added and noted Democrats faced a similar dynamic when Social Security was passed in the 1930's, saying "everybody has to spread the word as to what this is” (Walsh, 3/20).

The Associated Press: Pelosi Says Health Law A Winner For Dems 
"We just couldn't be prouder" of the legislation, Pelosi told a news conference where she said the law already has resulted in "better coverage, more affordable, better quality" insurance for nearly 12 million people. The California Democrat's appearance was timed for the fourth anniversary of the bill's signing by President Barack Obama on March 23, 2010, an occurrence that few other congressional Democrats seem inclined to herald at a time when party strategists seek a strategy to blunt criticism from Republicans and their allies (Espo, 3/20).

Politico: Pelosi: Health Law Is A 'Winner' For Democrats 
Pelosi maintained that the Florida House special election last week, in which Democrat Alex Sink was defeated by a Republican in a race where the health care law was a major issue, showed that Democrats are "ready for the next putt" because the final results were close. ... "And by the way, it’s called the Affordable Care Act," she told a reporter, repeating the law’s name several times. "I know you didn’t intend anything derogatory, but it’s called the Affordable Care Act. I tell [Obama] the same thing I told you. Affordable — there’s a reason" (Cunningham, 3/20).

President Barack Obama also stressed the law's benefits -

CBS News: Obamacare Anniversary Provides More 2014 Fodder
Mr. Obama on Thursday gave Democrats a blueprint for explaining the law on the campaign trail while tying it to other Democratic campaign themes, such as expanding women's economic opportunities. "Before we passed Obamacare, it was routine for insurance companies to charge women significantly more than men for health insurance -- it's just like the dry cleaners," Mr. Obama said at a Florida event focused on women's economic issues. "You send in a blouse, I send in a shirt -- they charge you twice as much. But the same thing was happening in health insurance. And so we've banned that policy for everybody” (Condon, 3/21).

Meanwhile, Republicans consider what alternatives they can present to voters -

Fox News: Republicans Drive To Replace ObamaCare -- But With What?
All Republicans want to replace ObamaCare -- but finding that ideal plan might not be so easy. For now, Majority Whip Kevin McCarthy, R-Calif., and GOP Conference Chairwoman Cathy McMorris Rodgers, R-Wash., are trying to come up with an outline of Republican health care ideas that 30 members can present to their constituents in town-hall type meetings in April. GOP leadership aides have been looking at the "policy overlap" from a half-dozen House Republican bills already made public (Emanuel, 3/20). 

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State Watch

Calif. Marketplace Reports Half Of Callers Hang Up Before Getting Help

Officials also said that the online insurance exchange is attracting more Hispanic customers, a key constituency for the marketing effort. Also, in Minnesota, officials announce an effort to boost enrollment of young adults.

Los Angeles Times: Half Of Callers To Covered California Give Up As Deadline Looms
Nearly half of callers to California's health insurance exchange in February and March couldn't get through and abandoned their call, state figures show. … Also Thursday, the Covered California exchange reported progress on another front: low enrollment among the state's large Latino population. At its monthly board meeting, the exchange said 32% of health plan enrollees in the first two weeks of March described themselves as Latino. That was up from 18% during the first three months of enrollment that ended in December (Terhune, 3/20).

Pioneer Press: MNsure Begins Final Enrollment Push Before March 31 Deadline
It's crunch time at MNsure. If people don't get health insurance by March 31, they could face penalties under the federal Affordable Care Act (Snowbeck, 3/20).

The Associated Press: Minnesota Exchange Launches Push For Young Adults
Leaders of Minnesota's new health insurance exchange announced a final push Thursday to sign up so-called "young invincibles" by the March 31 deadline for open enrollment, targeting an underinsured group that's key to keeping premium costs down. MNsure chief Scott Leitz announced a series of outreach events for the coming week aimed at young adults (Karnowski, 3/20). 

Minnesota Public Radio: Insurance With Your Beer? MNsure Courts Young Uninsured On Their Turf
People under age 34 are considered key to the long-term financial health of online insurance exchanges like MNsure. But its leaders aren't waiting for young adults to come to them. They're going to universities, breweries and bars — and buying television ads (Stawicki, 3/20).

The Star Tribune: MNsure Enlists Oscar Nominee Abdi In Enrollment Push
MNsure is bringing a bit of Hollywood into its final act. As part of its push to get uninsured Minnesotans enrolled in a health plan by March 31, the state’s online health exchange has turned to Oscar-nominated actor Barkhad Abdi and his "Captain Phillips" co-star, Faysal Ahmed, to make public appearances and pitches over the airwaves (Crosby, 3/20).

And in other states -

Reuters: South Carolina Lawmakers Fail In Attempt To Undo Obamacare
South Carolina lawmakers failed to derail implementation of President Barack Obama's signature health care law in the state when a measure was defeated in the Republican-controlled Senate. Last year, the state House passed a bill that nullified the law by calling for criminal penalties for anyone who sought to enforce it. Late Wednesday night, however, Senators voted 33-9 to defeat an amendment regarding the Affordable Care Act, commonly known as Obamacare. The amendment would have banned state agencies and employees from helping to carry out the health care law. It would have required healthcare navigators who help people sign up for health insurance to be licensed by the state (McLeod, 3/20).

The Boston Globe: Mass. In Feud On Health Site Grant
The Obama administration’s hopes that Massachusetts would serve as a model for New England states enrolling residents in health insurance has collapsed in a bitter regional feud over tens of millions of dollars, a victim of the botched rollout of the state’s online insurance portal. Connecticut health care officials are now mounting a campaign to collect a portion of a $45 million federal innovation grant that was awarded to Massachusetts to build a state-of-the-art consumer platform for President Obama’s insurance program. The original idea was that the technical underpinnings of Massachusetts’ computer system could be shared with other New England states (Jan, 3/21).

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Gov. Kitzhaber Sweeps Out Cover Oregon Leadership, Promises Reforms

An analysis of the state marketplace by First Data released Thursday found serious problems with management and communications.

The Oregonian: Kitzhaber Cleans House, Announces Reforms In Wake Of Cover Oregon Health Insurance Exchange Report
Gov. John Kitzhaber announced a major managerial house-cleaning Thursday in response to the state's ongoing health insurance exchange fiasco. Among those departing is perhaps Kitzhaber’s closest and most important health care reform ally, Bruce Goldberg, the Oregon Health Authority director who's led Cover Oregon since January. Kitzhaber said he also asked the Cover Oregon board to remove Triz DelaRosa, chief operating officer for Cover Oregon, and Aaron Karjala, Cover Oregon’s chief information officer. "We have made mistakes and we will learn from it," Kitzhaber said, following the release of an independent report highly critical of the state's work on the project (Budnick, 3/20).

The Oregonian: Republicans Pounce On Cover Oregon Problems, Point Fingers At Gov. John Kitzhaber
Opponents of Gov. John Kitzhaber were quick to paint the Democratic incumbent as out of touch and incompetent Thursday following the release of an investigation into the mishandled Cover Oregon project. The Republican Governors Association blasted out an email tying Kitzhaber to President Barack Obama’s healthcare plan, calling it “Oregon’s nightmare.” And the Republican frontrunner in the gubernatorial primary, state Rep. Dennis Richardson, piled on (Esteve, 3/20).

The New York Times: Health Care Exchange In Oregon Not Meeting High Hopes 
As the federal health care overhaul was rolled out over the last few years, Oregon was invariably the eager overachiever in the first row, waving a hand to volunteer. The governor, John Kitzhaber, a doctor who left the emergency room for politics, made health care his main issue. … Yet for all that, by some measures Oregon has among the most dysfunctional online insurance exchanges in the nation. ... On Thursday, a grim-faced Mr. Kitzhaber released a new report, commissioned by the state with a private company, that underscored how systemic Oregon’s failure has been (Johnson, 3/20).

The Washington Post: After Disastrous Rollout, Oregon Considers Health Exchange Options 
Oregon Gov. John Kitzhaber (D) has fired the head of the state’s online health-care exchange — the second to leave the organization in three months — after chronic technical issues that left uninsured residents unable to purchase insurance mandated by the Affordable Care Act. Plagued by technical issues, breakdowns in supervisory management and shoddy work by an outside vendor that received tens of millions of dollars in state funding, Cover Oregon, the state’s online health insurance exchange has been one of the worst in the country (Wilson, 3/20).

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Ark. Court Reverses $1.2B Medicaid Ruling; Fla. Overhaulings Child Welfare

The New York Times: Arkansas Court Reverses $1.2 Billion Judgment Against Johnson & Johnson
The Arkansas Supreme Court reversed a $1.2 billion judgment against Johnson & Johnson on Thursday, finding that the state attorney general erred by suing under a law that applied to health care facilities, not drug companies. The judgment, one of the largest in history for a state fraud case, was imposed in 2012 after a jury concluded that Johnson & Johnson had improperly marketed and concealed the risks of Risperdal, an antipsychotic drug (Thomas, 3/2).

The Associated Press: Arkansas Court Tosses $1.2B Judgment Against J&J
The Arkansas Supreme Court tossed out a $1.2 billion judgment against Johnson & Johnson on Thursday, reversing a lower court verdict that found the drug maker engaged in fraudulent tactics when marketing the antipsychotic drug Risperdal. The high court ruled the state's Medicaid fraud law, which formed the basis of Arkansas' lawsuit, regulates health care facilities and that drug manufacturers, including Johnson & Johnson and its subsidiary, Janssen Pharmaceutical Inc., don't fall under its scope (Bartels, 3/20).

The Wall Street Journal: Child-Abuse Deaths Prompt Lawmakers To Weigh Overhauls
In some cases, [Department of Children and Families] documents show the agency left kids with caregivers about whom it had logged multiple warning signs. The string of deaths triggered public outcry, plunged the state's child-welfare system into crisis and led to the resignation of the DCF secretary in July. Now, the Florida Legislature has made overhauling the system one of its top priorities in the session that began earlier this month (Campo-Flores, 3/20).

The Wall Street Journal: Arizona 'Abortion Pill' Rule Faces Challenge
A federal court next week is set to hear a challenge to a new Arizona regulation that would require so-called abortion pills to be administered under a protocol that abortion-rights activists say is outdated and overly restrictive (Phillips, 3/20).

St. Louis Public Radio: Building A Pipeline Of Doctors To Help The Shortage In Missouri's Rural Communities
For someone who was clueless about what he wanted to do after finishing high school, Luke Stephens has done quite well in life. He’s now Dr. Luke Stephens, with a degree in cell and molecular biology from Missouri State University in 2004, and a medical degree from the University of Missouri at Columbia. Stephens, who is in his early 30s, is a primary care doctor who specializes in rural medicine. He’s the product of a special University of Missouri program that trains more doctors to help Missouri plug some of the holes in its primary care system in rural communities (Joiner, 3/20).

The Seattle Times: $34 Million Saved In Effort To Cut Needless ER Visits
After a contentious beginning, the state Medicaid program and a coalition of doctors and hospitals together forged a plan that helped cut nearly $34 million from expensive, unnecessary emergency-room visits last year, both sides announced Thursday. The seven-point plan included connecting hospital emergency departments across the state so doctors can check if a patient is making multiple ER visits, perhaps getting duplicate scans and other tests, as they seek drugs or relief from a chronic condition better managed in a primary-care setting (Ostrom, 3/20).

Minnesota Public Radio: A Gap Opens In Rural Mental Health Care
A mental-health provider that served thousands of people in five counties shut down early this week, abruptly creating a gap in service to rural Minnesota. Riverwood Centers operated clinics in Milaca, Cambridge, Mora, Braham, Pine City and North Branch. Kevin Wojahn, Riverwood's former executive director, told MPR News that the organization ran out of money (3/20).

The CT Mirror: CT Lawmakers, Wary Of Changing Health Care Landscape, Consider Restrictions On For-Profit Hospitals
With four of Connecticut's 28 nonprofit hospitals facing potential acquisitions by a for-profit chain, legislators are under siege from competing interests. Hospital officials say the survival of some Connecticut hospitals depends on having the ability to convert to for-profits, something that requires a change in state law. Union leaders want sweeping protections for workers in case hospitals change hands. Some union leaders and consumer advocates want an outright ban on hospitals becoming for-profit. And so far, the proposals advancing through the legislature suggest the critics of for-profit health care have the upper hand (Becker, 3/21).

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Public Health & Education

FDA Finds Medical Device Recalls Nearly Doubled In 10 Years

The Wall Street Journal says a report to be released today will spotlight the increasing number of problems.

The Wall Street Journal: Medical Device Recalls Nearly Doubled In A Decade
Recalls of defective medical devices nearly doubled in the decade from 2003 through 2012, according to a Food and Drug Administration report due Friday. The total number of recalls rose to 1,190 in 2012, up from 604 in 2003. There was a sharp increase in recalls where the defective product carried a reasonable probability of death. In 2012, there were 57 of these so-called Class I recalls, up from seven in 2003 (Burton, 3/21).

Also, the Journal looks at the dilemma for patients when the government wants to end some studies.

The Wall Street Journal: Hard Choices In Pursuit Of Rare-Disease Cures
Late last year, the National Institute on Aging, which is part of NIH, said a long-running observational study of fibromuscular dysplasia and four other rare diseases was no longer collecting data or enrolling patients, and that the study's goals had been met. Sufferers, arguing that fibromuscular dysplasia's cause or cure still isn't known, mobilized. ... The fight to continue the study exemplifies tensions that often arise between researchers and patients over which efforts yield the most valuable science. ... Both NIH and the Food and Drug Administration have said such studies are a critical early step toward drug development. But the studies are expensive and don't always lead to new trials (Marcus, 3/20).

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Health Policy Research

Research Roundup: New Medical Coding System; Choosing A Hospice

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

Health Affairs: Transitioning To ICD-10
On October 1, 2014, all health plans, health data clearinghouses, and health care providers that transmit health information electronically must use a new, significantly broader, coding system, called ICD-10, for diagnoses and inpatient procedures. The new system has the potential of improving the health care system, but its costs and complications have caused some to question whether the costs outweigh the benefits. ... Given the political fallout from the data system problems encountered with implementation of the health insurance exchanges, the Obama administration will likely be extremely sensitive to any potential problems with claims processing due to the ICD-10 conversion. Extensive testing, both of the system's connectivity and of coding accuracy, is needed to ascertain readiness for the conversion. As the implementation date approaches, CMS will have to decide if there has been sufficient progress to keep to the deadline (James, 3/20).

American Journal Of Hospice & Palliative Medicine: What Consumers Want To Know About Quality When Choosing a Hospice Provider
Despite the availability of endorsed quality measures and widespread usage of hospice, hospice quality data are rarely available to consumers. ... This study drew on focus group and survey data collected in 5 metropolitan areas. The study found that consumers reported the hospice quality indicators we tested were easy to understand. Participants placed top priority on measures related to pain and symptom management. Relative to consumers with hospice experience, consumers without previous experience tended to place less value on spiritual support for patients and caregivers, emotional support for caregivers, and after-hours availability. The National Quality Forum-approved measures resonate well with consumers. Consumers also appear to be ready for access to data on the quality of hospice providers (Smith et al., 3/4).

Annals of Family Medicine: Staffing Patterns Of Primary Care Practices In The Comprehensive Primary Care Initiative
We undertook a descriptive analysis of [nearly 500 primary care practices involved in the Centers for Medicare & Medicaid Services (CMS) Comprehensive Primary Care (CPC) initiative]. ... Consistent with the national distribution, most of the CPC initiative practices included in this study were small: 44% reported 2 or fewer full-time equivalent (FTE) physicians; 27% reported more than 4. Nearly all reported administrative staff (98%) and medical assistants (89%). Fifty-three percent reported having nurse practitioners or physician assistants; 47%, licensed practical or vocational nurses; 36%, registered nurses; and 24%, care managers/coordinators — all of these positions are more common in larger practices. ... At baseline, most CPC initiative practices used traditional staffing models and did not report having dedicated staff who may be integral to new primary care models, such as care coordinators, health educators, behavioral health specialists, and pharmacists. Without such staff and payment for their services, practices are unlikely to deliver comprehensive, coordinated, and accessible care to patients at a sustainable cost (Peikes, March/April, 2014).

JAMA Psychiatry: Chronicity Of Posttraumatic Stress Disorder And Risk Of Disability In Older Persons
Little is known about the association between posttraumatic stress disorder (PTSD) and disability into later life. Most studies of late-life psychiatric disorders and function have focused on depression and generalized anxiety disorder. ... This study provides evidence that persistence of PTSD in later life is a prominent predictor of disability in late life above and beyond other psychiatric disorders and medical conditions (Byers et al., 3/19).

The Kaiser Family Foundation: Visualizing Health Policy: What Americans Pay For Health Insurance Under The ACA
The March 2014 Visualizing Health Policy infographic shows examples of what Americans will pay for health insurance under the Affordable Care Act, using different scenarios for 40-year-old individuals living in different parts of the country (Cox et al., 3/19).

Texas A&M University's Private Enterprise Research Center/National Center for Policy Analysis: Framing Medicare Reform
This paper identifies the effects of a reform that relies on two policy levers: raising the Medicare eligibility age (MEA) and means-testing the government's Medicare contribution. ... Raising the MEA and introducing means-testing can achieve the same baseline spending path as forecast under the [Affordable Care Act's] provisions. Admittedly these policy options come with their own concerns, but they must be weighed against the most likely alternatives (Liu et al., March 2014).

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

JAMA: Emergency Visits Up In Massachusetts After Reforms Enacted
States should expect more people to use emergency departments after the Affordable Care Act is fully implemented, say the authors of a new study reporting increases in emergency care visits in Massachusetts during and after the state’s own similar reforms went into effect. The study, published online today in the Annals of Emergency Medicine, analyzed all emergency department visits in Massachusetts between October 1, 2004, and September 30, 2009 (Voelker, 3/20). 

PBS NewsHour: Study Finds Dramatic Increase In Painkiller Prescriptions For ER Patients
Researchers at George Washington University have found a significant increase in prescriptions for opioid analgesics, such as Percocet, Vicodin, oxycodone and Dilaudid, despite only a modest increase in visits for painful conditions. The report, published Friday in the journal Academic Emergency Medicine, details the growing rate of painkiller prescriptions between 2001 and 2010. The trend concerns co-author Dr. Maryann Mazer-Amirshahi, given the increase in opioid-related overdoses in recent years (Myers, 3/17).

Reuters: Obesity Prevention Programs Might Help Lower Kids' Blood Pressure
Programs designed to prevent obesity in children may help lower kids' blood pressure, according to a new review of past studies. Researchers found that programs targeting both diet and physical activity were more effective than programs that focused on one or the other (Jegtvig, 3/19).

Reuters: You're Not Alone: Medical Conspiracies Believed By Many
About half of American adults believe in at least one medical conspiracy theory, according to new survey results. Some conspiracy theories have much more traction than others, however. For example, three times as many people believe U.S. regulators prevent people from getting natural cures as believe that a U.S. spy agency infected a large number of African Americans with the human immunodeficiency virus (HIV). J. Eric Oliver, the study's lead author from University of Chicago, said people may believe in conspiracy theories because they're easier to understand than complex medical information (Seaman, 3/18).

NPR: Screening Immigrants For TB Pays Dividends In U.S.
Hundreds of people with tuberculosis wishing to come to the U.S. have been stopped before they reached U.S. borders, says a new report from the Centers for Disease Control and Prevention. Physicians overseas picked up more than 1,100 cases in prospective immigrants and refugees prior to their arrival in the U.S. The cases include 14 people with multidrug-resistant TB, the CDC says (Neel, 3/20).

NPR: Flu Drugs Saved Lives During 2009 Pandemic
Drugs used to treat the flu really did save the lives of seriously ill people during the influenza pandemic of 2009-2010, a study in The Lancet Respiratory Medicine suggests. Adults who promptly received doses of Tamiflu, Relenza or related drugs were half as likely to die in the hospital as people who were not treated. The study analyzed 78 different studies from 38 countries to reach this conclusion. ... There's been a simmering controversy, particularly in Britain, over whether the billions of dollars spent on these drugs has been worthwhile. Some independent scientists have challenged the governments' conclusions about the value of these medicines — in particular, they question whether the drugs actually prevent flu. This latest study is about treatment, not prevention (Harris, 3/18).

MinnPost: Unnecessary Headache-Related Brain Scans Are On the Rise Study Finds
Too many people who visit their doctor for a headache end up getting unnecessary — and potentially harmful — brain scans, according to a study published online this week in JAMA Internal Medicine. The study also found that the number of these unnecessary scans has increased significantly in recent years — despite several national guidelines that specifically instruct physicians to order brain scans for patients with headaches only in rare circumstances (Perry, 3/20).

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Editorials and Opinions

Viewpoints: Predictions Of Rising Premiums; Health Law Anniversary

The Arizona Republic: Sebelius' Latest "Glitch": Slow-Rising Insurance Costs
No one challenges reality like Kathleen Sebelius, who assured the world on Sept. 30, 2013 that the Affordable Care Act website would be open for business the next day. "We're very excited about tomorrow," Sebelius said. "Shutdown or no shutdown, we're ready to go." The rollout was an epic catastrophe, of course. Even now, it is difficult to find a parallel to the enormity of the belly flop it made (Doug MacEachern, 3/20).

Forbes: 4 Reasons Why Obamacare Exchange Premiums May 'Double In Some Parts Of The Country' In 2015
As we reach the end of the first year of enrollment in Obamacare’s subsidized health insurance exchanges, we’ve been trying to solve a couple of mysteries. First: how many people who have signed up for coverage were previously uninsured? Second: will the botched rollout and design flaws lead to even higher health insurance costs next year? We’re starting to get indications from insurers that premiums on the exchanges will go up significantly in 2015 (Avik Roy, 3/20).

The New York Times' Room For Debate: The Health Care Law's Checkup 
Four years ago, President Obama signed the Affordable Care Act into law. Is the law working? What needs to be fixed? And what is beyond repair? (3/20).

The Washington Post: The GOP's Need For Creative Policy 
Over the past several years, increases in insurance premiums have averaged nearly 6 percent. Because of the rocky launch, age distribution and delayed provisions of Obamacare exchanges, insurance company officials expect far larger premium increases this spring — in the double digits, if not the triple digits, in many places. This is an administration that learns nothing. Rather than preparing people for increased premiums, and trying to explain the additional benefits of the new system, it says, in effect: If you like your current health insurance premium, you can keep your current health insurance premium (Michael Gerson, 3/20).

New England Journal of Medicine: Vivek Murthy For Surgeon General 
On February 27, a bipartisan group of senators on the Health, Education, Labor, and Pensions (HELP) Committee approved [Vivek] Murthy's nomination for surgeon general and forwarded it for a vote by the full Senate. But now, astonishingly, the nomination appears to be in jeopardy and may be delayed or withdrawn altogether. How could this have happened to such a distinguished and highly qualified nominee? The answer lies with the National Rifle Association (NRA). It is of great concern to us and to many other members of the health care community that Murthy's nomination is in jeopardy because of NRA opposition. The NRA opposes Murthy solely on the grounds that he has advocated reasonable and mainstream forms of gun regulation (Gregory D. Curfman, Stephen Morrissey, Debra Malina and Jeffrey M. Drazen, 3/20).

Roll Call: Why We Are Fighting For The Birth Control Benefit
As we approach March 25, when the Supreme Court will hear oral arguments in two cases challenging the birth control benefit, Planned Parenthood Federation of America is pressing the pedal to the metal to make sure every American knows that this benefit is basic health care for women (Dana E. Singiser, 3/20).

The Washington Post: Fox News's Bret Baier Corrects Obamacare Mistake
Fox News anchor Bret Baier screwed up on Tuesday night’s edition of his acclaimed show, "Special Report." As part of a "checkup" series on Obamacare, Baier took a close look at those who would remain uninsured after the March 31 enrollment deadline expires. ... Among those who’d be left out of the party, Baier continued, were indigent folks in Republican-led states that had opted out of the Obama administration’s Medicaid expansion. Such individuals faced a certain double jeopardy, in Baier’s formulation: "For those people, they not only face the prospect of not having health insurance coverage despite Obamacare, but now they will have to pay a penalty because of it." Untrue. The law provides a hardship exemption for those people. No penalty. To his eternal credit, Baier cleared up the matter on last night’s program (Eric Wemple, 3/20).

The Washington Post: Dueling Maps Of Abortion Protesters, Providers Push Battle Into Personal Territory
Is it fair to post an online database of names, photos, home addresses and telephone numbers of abortion protesters? A Maryland-based group, Voice of Choice, did just that: It created an online map of more than 150 protesters across the nation who target doctors and health centers that provide legal abortions, complete with all the personal information it could find on each one. The map is nearly identical to one that opponents of abortion rights have at AbortionDocs.org, which pinpoints doctors and clinics. ... The truth is, none of this should be handled this way (Petula Dvorak, 3/20).

Los Angeles Times: Three Genetic Parents -- For One Healthy Baby
Since January, a new California law allows for a child to have more than two legal parents. But children are still limited to two genetic parents. That could change soon, if the Food and Drug Administration approves human clinical trials for a technique known as mitochondrial replacement, which would enable a child to inherit DNA from three parents. News of the pending application has caused a kind of panic not seen since Dolly the sheep was cloned, raising the possibility of a single genetic parent. But far from being the end of the human race as we know it, the technique might be a way to prevent hundreds of mitochondrial-linked diseases, which affect about one in 5,000 people (Judith Daar and Erez Aloni, 3/21).

Los Angeles Times: We Can't Afford Not To Spend More Money On Alzheimer's Research
A study by researchers at Rand Corp. and other institutions calculated that the direct cost of care for people with Alzheimer's and other dementia in 2010 was $109 billion. In comparison, healthcare costs for people with heart disease was $102 billion; for people with cancer, it was $77 billion. Yet cancer research will be allocated an estimated $5.4 billion this year in federal funds, and heart disease will get $1.2 billion — while research on Alzheimer's and other dementias comes in at only a fraction of that, at $666 million. It's time to substantially increase that budget (3/19).

The New York Times: TV Lowers Birthrate (Seriously) 
In the struggle to break cycles of poverty, experts have been searching for decades for ways to lower America’s astronomical birthrate among teenagers. We’ve tried virginity pledges, condoms and sex education. And, finally, we have a winner, a tool that has been remarkably effective in cutting teenage births. It’s “16 and Pregnant,” a reality show on MTV that has been a huge hit, spawning spinoffs like the “Teen Mom” franchise. These shows remind youthful viewers that babies cry and vomit, scream in the middle of the night and poop with abandon (Nicholas Kristof, 3/19).

New England Journal of Medicine: Graded Autonomy In Medical Education — Managing Things That Go Bump In The Night
Traditionally, physician training has followed the apprenticeship model: students, residents, and clinical fellows participate in delivering medical services to patients under the supervision of accredited professionals. This hierarchical system offers trainees graded responsibility, enabling them to learn their trade by performing increasingly complex functions over time and experiencing gradual reductions in supervision. Whether by design or not, the middle of the night has historically been the time when trainees were able — and indeed required — to practice more independently. ... This model ... was called into question by the death of Libby Zion in a New York emergency department in 1984. ... studies suggest that newer resident-training approaches entailing reduced work hours and curtailed autonomy may not achieve the goal of improving the safety of patients today (Scott D. Halpern and Allan S. Detsky, 3/20).

The Oregonian: Bruce Goldberg Goes, But Oregon's Health Care Challenges Remain
If Bruce Goldberg's resignation as Oregon Health Authority director wasn't inevitable before this week, it certainly became so with Thursday's release of a damning outside review of Cover Oregon's technology debacle. This report identified Rocky King, Bruce Goldberg and Carolyn Lawson as the three key decision-makers in the state's ambitious project to create a customized online health insurance exchange. King, the folksy head of Cover Oregon, and Carolyn Lawson, the hard-driving IT director imported from California, both resigned months ago. Goldberg, a respected figure in Oregon health care, was next. This housecleaning is a necessary part of holding state leaders accountable for bungling the rollout of a key government initiative (3/20).

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Andrew Villegas

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Shefali Luthra

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