Daily Health Policy Report

Friday, March 28, 2014

Last updated: Fri, Mar 28

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Health On The Hill: Permanent 'Doc Fix' May Be On Hold As House Passes Short-Term Patch

In a voice vote Thursday, the House passed yet another short-term patch to the Medicare physician payment formula. Kaiser Health News staff writer Mary Agnes Carey and CQ Roll Call's Emily Ethridge discuss what that means for the effort to make long-term changes to how providers are paid (3/27). Listen to the audio or read the transcript.

This Story: Print | Link to | Top

A Reader Asks: How Do I Get A Subsidy If I'm Hiding From My Abusive Spouse?

Kaiser Health News consumer columnist Michelle Andrews answers this reader’s question (3/28). Read her response.

This Story: Print | Link to | Top

Internet Startup Offers Californians Quick Assessments Of Some Insurance Plans

Kaiser Health News staff writer Daniela Hernandez, working in collaboration with Wired, reports: "Stride is among a handful of companies in the country capitalizing on what many consider a failing of the federal and state health insurance marketplaces: a lack of quick recommendations tailored to consumers’ specific needs. These commercial companies are aiming to augment government sites such as healthcare.gov by offering the sort of on-demand, personalized results that people have come to expect on the web from the likes of Google and Amazon" (Hernandez, 3/28). Read the story.

This Story: Print | Link to | Top

Capsules: Obama Announces 6 Million Have Signed Up For Insurance

Now on Kaiser Health News’ blog, Mary Agnes Carey reports: "President Barack Obama, who is traveling in Europe, announced the number in a conference call with groups that are helping consumers sign up for coverage. In a blog post, Centers for Medicare & Medicaid Administrator Marilyn Tavenner said the health law’s web site, healthcare.gov, and 800 number, had near record traffic Wednesday, with 1.5 million visitors and more than 430,000 phone calls" (Carey, 3/27). Check out what else is on the blog

This Story: Print | Link to | Top

Political Cartoon: 'Dear President Obama'

Kaiser Health News provides a fresh take on health policy developments with "Dear President Obama" by Mark Martin.

And here's today's health policy haiku:


The Congress scrambles
Another short-term doc fix
Here we go again

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.

This Story: Print | Link to | Top

Health Reform

As Deadline Approaches, Obamacare Sign-Ups Top 6 Million

Many questions remain about what this number means, though, including how many of those enrolling in new coverage had been uninsured before signing up and whether young and healthy people will be adequately represented.

The New York Times: White House Says Health Care Rolls Top Goal: 6 Million
The White House said on Thursday that more than six million people had signed up for medical insurance plans under President Obama’s health care law, exceeding the administration’s revised goal for enrollment by the Monday deadline. Demand for new policies has surged in recent days as the open enrollment period draws to a close, the White House said, with 1.5 million visits to HealthCare.gov and 430,000 calls to the program’s call centers on Wednesday alone. The enrollment figure is up from five million a week ago (Joachim, 3/27).

The Wall Street Journal: Health-Law Sign-Ups Top Six Million, White House Says
But left unclear was how many of those signing up had been uninsured—a key aim of the law—and whether they include many of the young and mostly healthy Americans needed to keep costs in check, and whether those signing up have actually paid premiums to bring the insurance coverage into effect (Radnofsky and McCain Nelson, 3/27).

Los Angeles Times: More Than 6 Million People Have Signed Up For Obamacare
That number, though shy of the 7 million sign-ups the administration had once hoped for, marks a significant milestone because 6 million was the projection for this year's enrollment made last month by the nonpartisan Congressional Budget Office. The figure also further underscores the strong recovery that the marketplaces have made since their disastrous debut last fall, potentially quieting concerns that the new system would fail to get a large-enough pool of consumers to work as planned (Hennessey and Levey, 3/27).

Kaiser Health News: Capsules: Obama Announces 6 Million Have Signed Up For Insurance
President Barack Obama, who is traveling in Europe, announced the number in a conference call with groups that are helping consumers sign up for coverage. In a blog post, Centers for Medicare & Medicaid Administrator Marilyn Tavenner said the health law’s web site, healthcare.gov, and 800 number, had near record traffic Wednesday, with 1.5 million visitors and more than 430,000 phone calls (Carey, 3/27).

The Washington Post: Obamacare Sign-Ups Now Exceed 6 Million
The administration originally expected 7 million to buy health plans during the law’s initial six-month enrollment period but revised its target to 6 million after the disastrous rollout of HealthCare.gov, the federal Web site (Eilperin, 3/27).

USA Today: HHS Hits 6 Million Health Care Enrollment Mark
But until the government releases demographics, numbers of those who have paid their premiums, and numbers of those newly insured, the number "enrolled" won't tell a complete story, said Brendan Buck, press secretary for House Speaker John Boehner, R-Ohio. "They won't say how many have paid, so the number is likely significantly lower," Buck said. "And every survey has shown most people who've signed up already had coverage, so they're not actually newly insured" (Kennedy, 3/27).

Reuters: Obamacare Enrollment Tops Six Million As Deadline Looms: White House
The milestone gives the White House some ammunition to counter Republican critics, who have described the program as an expensive flop in the build-up to midterm congressional campaigns in November, when Democratic control of the U.S. Senate is at stake (Rampton, 3/28).

NBC News: White House Says 6 Million Now Signed Up For Health Insurance
President Barack Obama told volunteers and navigators helping sign people up that 1.5 million people visited HealthCare.gov on Wednesday – the highest-traffic day yet. Officials have said they logged more than a million visits each day so far this week. "We are seeing near-record numbers of consumers coming to check out their options and enroll in coverage. Yesterday alone, we had 1.5 million visits to HealthCare.gov and took more than 430,000 calls at our 24/7 call center," said Marilyn Tavenner, head of the Centers for Medicare and Medicaid Services, which operated the website (Fox, 3/28).

Politico: Obamacare Enrollments: White House Says 6 Million Signed Up For Coverage
With outreach by both officials and their allies in high gear, the White House can expect the tally to keep climbing — especially as it announced this week that it would allow extra time and assistance for anyone who self-reported hitting a snag as they tried to sign up by Monday (Epstein and Kenen, 3/28).

Politico: The Obamacare Report Card
If you’re a supporter of the law, you might be cringing right now — you know the areas where the grade is not going to be good. It’s pretty obvious that the Obama administration wasn’t ready for the launch, despite three and a half years to prepare. The political messaging hasn’t impressed anyone; Democrats are scampering away from what was supposed to be a legacy achievement. No one’s going to forget that notion that everyone could keep their plans. But the critics will have to round out their picture of the law, too. The signups have now hit 6 million — a feat that seemed impossible in the worst days of the website failures — and the administration’s outreach efforts are better than they used to be. And although there are lots of complaints about the prices, some low-income customers seem to be genuinely happy with the rates and subsidies they’re getting (Nather, 3/28).

This Story: Print | Link to | Top

States Work To Clarify Enrollment Rules, Untangle Technical Problems

News outlets also report that states are still conducting outreach efforts and offering the latest tallies of people who are signing up as well as information about subsidies.   

Los Angeles Times: Covered California Q & A: Is Monday Still The Deadline To Enroll? 
Many Californians are confused by Obamacare, and news this week about changing enrollment deadlines may be giving people an even bigger headache. Here are some answers to common questions as the final days tick down for enrollment under the Affordable Care Act (Terhune, 3/27).

The San Jose Mercury News: Covered California Clarifies Health Plan Enrollment Rules Before Monday's Deadline
California's health insurance exchange on Wednesday announced the process for people who are trying to enroll, but fail to complete their application for a plan by Monday's deadline. The clarification followed formal guidance issued by the Obama administration earlier Wednesday indicating that the federal government would provide consumers a "limited amount of additional time to finish the application and enrollment period." To qualify for the extension, consumers will only have to attest that they started the process before the deadline. But the administration's extension applies only to people using the healthcare.gov website in 36 states, which does not include California. Covered California on Wednesday outlined a specific procedure that consumers must follow to be eligible to finish their application by April 15 (Seipel, 3/27).

The Wall Street Journal: In New Jersey, A Dash To The Health-Care Deadline
Gov. Chris Christie has made no secret of his disdain for the Affordable Care Act, calling it a "failed federal program" and receiving sustained applause after criticizing it at several town-hall events across New Jersey. Yet in the final days of Affordable Care Act enrollment, a band of liberal activists, community groups and Democratic politicians is trying to prove him wrong, finishing a six-month crusade to drive citizens to the marketplace. They have enlisted U.S. Health and Human Services Secretary Kathleen Sebelius, who spoke behind an army of volunteers in Montclair, and Democratic Sen. Cory Booker, who lobbied the Latino community in Union City (Dawsey, 3/27).

The Wall Street Journal’s Washington Wire: Oregon Extends Deadline For Buying Health Insurance
The website, which opened for enrollment in October, hasn’t been fully functioning. Although residents can apply online, the application must be processed manually by state workers. Still, more than 50,000 people have been enrolled in a private insurance plan in Oregon and almost 123,000 people have been enrolled in the state’s Medicaid system (Corbett Dooren, 3/27).

The Associated Press: Arkansas Health Care Exchange Enrollment Falling Below Target
Arkansas officials say more than 33,500 people have signed up for the health insurance exchange set up under the federal health law, well below the numbers they hoped to see before the enrollment deadline next week. State officials on Thursday said the signup for the exchange, a marketplace where consumers can select health plans, has lagged in comparison to enrollments in the state's "private option" compromise Medicaid expansion (3/27).

The Seattle Times: As Health-Care Sign-Up Deadline Nears, 11,500 Mired In Glitches
As the March 31 deadline to sign up for 2014 health-insurance approaches, Washington state’s online exchange has enrolled more than 500,000 people in qualified plans or in Medicaid. The overwhelming majority of those enrollments were completed online smoothly, at least after the first tumultuous weeks of the exchange’s launch (Marshall, 3/27).

Health News Florida: Florida Subsidies Average $3,000
A new study finds that 90 percent of Floridians who are enrolling in health plans under the Affordable Care Act qualify for tax credits amounting to an average of almost $3,000 apiece. And yet only one in four Floridians who qualifies for a subsidy had enrolled in a plan by March 1, the study said (Gentry, 3/27).

The CT Mirror: Obamacare Enrollment Deadline Not Changing In Connecticut
The federal government announced earlier this week that people signing up for health care coverage through the exchanges it runs could get some extra time to enroll. But that doesn’t apply in Connecticut, which runs its own health insurance exchange, known as Access Health CT. That means that if you live in Connecticut and need private insurance for 2014, you have until the end of Monday to sign up (Becker, 3/27).

The CT Mirror: CT Obamacare Exchange Enrolling More Than 3,000 People Per Day
Connecticut’s health insurance exchange has been enrolling between 3,000 and 4,000 members per day as the sign-up deadline approaches, exchange CEO Kevin Counihan said Thursday. As of Wednesday afternoon, 178,601 state residents had signed up for Medicaid or private insurance through the exchange, Access Health CT. Of those, 62 percent, or 111,050, will receive Medicaid coverage. The other 67,551 signed up for private insurance. Among private insurance customers, 78 percent are receiving federal financial aid to pay their premiums (Becker, 3/27).

Georgia Health News: ‘Navigator’ Sees Rising Interest In ACA Enrollment
For the past several months, a normal Wednesday for Kimberly Jenkins has meant meeting with four to six people wanting to know about Affordable Care Act coverage. But as the enrollment deadline draws near, as many as 30 people a day are contacting Jenkins, seeking her help with insurance applications. She is what’s known as a health insurance “navigator” and is assigned to Wilkes and 11 other rural counties in northeast Georgia. “People like to wait until the last minute,” said Jenkins (Stafford, 3/27).

Health News Colorado: Exchange Pays Outside Lawyers Up To $575 An Hour
Managers at Connect for Health Colorado have used taxpayer dollars to pay several private lawyers’ fees as high as $575 an hour for legal work for the exchange. The exchange hired one of the lawyers, Mark Grueskin, to do research on a potential audit of the exchange. Grueskin testified in the Colorado Senate on Wednesday that the state auditor has no right under Colorado law to conduct a comprehensive audit on the taxpayer-funded exchange (McCrimmon, 3/27).

This Story: Print | Link to | Top

Beyond The Health Law Enrollment Numbers, State-By-State Disparities, Penalties Draw Headlines

The Wall Street Journal reports that federal officials have sent a "nudging" email to consumers who haven't picked a plan yet. And the New York Times examines how the push to expand health coverage has taken the shape of a number of very different and uneven individual efforts instead of "a sweeping federal overhaul." Meanwhile, NPR notes that the state specific figures may turn out to be more important than the national sign up total.    

The Wall Street Journal: Talk Turns To Penalties As Obamacare Deadline Nears
The agency in charge of the health-law enrollment effort has learned to love the individual mandate as a way of getting consumers to sign up for health insurance. The Centers for Medicare and Medicaid Service (CMS) sent a nudging email Wednesday to users of HealthCare.gov who have applied for coverage but haven't yet picked a plan. The message: Hurry up (Radnofsky, 3/27).

The New York Times: Deadline Near, Health Signups Show Disparity
The disparities reveal a stark truth about the Affordable Care Act: With the first open enrollment period set to end Monday, six months after its troubled online exchanges opened for business, the program widely known as Obamacare looks less like a sweeping federal overhaul than a collection of individual ventures playing out unevenly, state to state, in the laboratories of democracy (Stolberg and Pear, 3/27).

Marketplace: Latinos Still Reluctant To Sign Up For Obamacare
Visits to healthcare.gov are surging in these last days before the Affordable Care Act enrollment deadline. But government officials are worried that they aren't getting enough of the right people to sign up. Latinos in particular are sorely needed to balance insurance pools. They tend to be younger and healthier than the general population. But states with the largest concentration of Latinos -- like California -- have been struggling to win them over. "The news gives a lot of information, [but] it confuses people. They don't know what is the truth," says Larissa Bobadilla, a health outreach worker in Los Angeles. Many Latinos are afraid that if they sign up for health insurance, their undocumented family members will get discovered, and deported. Others aren't convinced it's worth the money (Dembosky, 3/27).

NPR: Obamacare's National Enrollment Looks OK, But States Matter More
With this year's deadline to register for individual health insurance just a weekend away, much attention is being lavished on two numbers — the 6 million Americans who have signed up so far, and the percentage of those folks who are (or aren't) young. But experts say the national numbers actually don't mean very much (Rovner, 3/28).

St. Louis Post Dispatch: Insurance Deadline Extension Brings Relief, Frustration
For months, the Obama administration insisted the final deadline for individuals to sign up for insurance on the health exchanges wouldn't be extended. Well, they went back on that vow — at least somewhat (Kulash, 3/27).

This Story: Print | Link to | Top

Hospitals Find Better Care Means More Money Under The Health Law

Elsewhere, gay couples find that insurance coverage depends on where you live, and hospitals prepare to offer their own insurance plans.

USA Today: Hospitals Chart Ways To Boost Care, Funding Under ACA
Hospitals are getting creative when it comes to meeting tough new mandates in the Affordable Care Act to improve care and increase patient satisfaction -- and they're getting paid more as a result (McElhaney, 3/27).

The Associated Press: Gay Couples Find Uneven Access To Health Insurance
Nearly every day for three months, Carl Bechdel had to make calls or send emails to try to get family insurance coverage for his husband and himself under President Barack Obama’s landmark health law. The Harrisburg, Pa., couple had sent an insurer their application and a month’s premium in early December but heard nothing. Weeks later, they were told their application was not processed because Pennsylvania doesn’t recognize same-sex marriage. So Bechdel pushed back, repeatedly explaining their predicament in phone calls and emails. Finally, they got a call and apology from the president of the insurance company last month, plus a family plan that started in March (3/27).

The Fiscal Times: Hospitals Plot the End of Insurance Companies
The problems with the implementation of the Affordable Care Act may be masking another major change in the way health care is delivered to U.S. consumers, experts believe. At The Atlantic's Health Care Forum in Washington on Thursday, health care and business professionals said that there’s an increasing trend in the industry toward cutting insurance companies out of the process entirely, as large, regional hospital systems move into the insurance business. Dr. Kenneth L. Davis, CEO and  president of Mount Sinai Health System, the largest health care provider in the state of New York, said that starting next year, Mt. Sinai will begin offering its own Medicare Advantage plan. It will look for other opportunities to bring premium payments directly into the hospital system, rather than filtering them through insurance companies (Garver, 3/27).

This Story: Print | Link to | Top

In New Hampshire, Medicaid Expansion Becomes Law

Gov. Maggie Hassan signed a bill setting up a 2 and 1/2 year pilot program to provide health insurance to 50,000 low-income adults. The program will use federal Medicaid funds to pay private insurers.  

New Hampshire Union Leader: Medicaid Expansion Signed Into Law In NH
New Hampshire joined 25 other states Thursday in expanding Medicaid eligibility when Gov. Maggie Hassan signed Senate Bill 413 into law. The bipartisan legislation will provide health insurance to 50,000 low-income adults in a two-and-a-half year pilot program using private health insurers paid for with federal Medicaid money (3/27).

The Associated Press: NH Gov Signs Medicaid Expansion Into Law
New Hampshire officially expanded its Medicaid program Thursday to cover about 50,000 poor adults eligible for federal subsidies under the health care overhaul law. Gov. Maggie Hassan signed a bill that will inject hundreds of millions of dollars in federal funds into the state’s economy. New Hampshire had been one of six states that had not decided whether to expand Medicaid under the federal law. ... The state estimates that 12,000 adults could begin receiving coverage in as little as a month under an existing program to subsidize employer-based coverage, while 38,000 others would receive coverage through the state’s Medicaid managed care program starting July 1 or as soon as possible after that (3/27).

Meanwhile, how are the Medicaid expansion decisions by Illinois and Missouri playing out -

St. Louis Public Radio: Illinois Expanded Its Medicaid Program. Missouri Didn't. How Are Those Choices Working Out? 
For years in most states, Medicaid eligibility had been limited to disabled adults, seniors needing long-term care and very low-income parents with their children. Then along came the Affordable Care Act (Lacapra, 3/26).

This Story: Print | Link to | Top

Public Not Crazy About Health Law But Believes It's Here To Stay

A new Associated Press-GfK survey finds that 26 percent of Americans say they support the health law, and a narrow majority expects it to be implemented with only minor changes. Another survey shows Hispanic support for the president and the health law declining, although nearly half still approve of both.

The Associated Press: Poll: Obama Health Law Fails To Gain Support
Public support for President Barack Obama’s health care law is languishing at its lowest level since passage of the landmark legislation four years ago, according to a new poll. The Associated Press-GfK survey finds that 26 percent of Americans support the Affordable Care Act. Yet even fewer — 13 percent — think it will be completely repealed. A narrow majority expects the law to be further implemented with minor changes, or as passed (Alonso-Zaldivar and Junius, 3/28).

NBC News: Less Latino Support for Obama, Obamacare
Support for President Barack Obama and for the Affordable Care Act has gone down among the nation's Latinos, according to a new Pew Research Center analysis. An equal amount of Hispanics - 47 percent - both approve and disapprove of the health care legislation. Six months ago, 61 percent of Latinos supported the law. As for job approval ratings, 48 percent of Hispanics think the President is doing a good job, down from 63 percent in September 2013 (3/27).

CQ HealthBeat: Poll Suggests Weary Public May Be Learning to Live With Health Law
Americans are more likely than not to think ill of the health law and have been criticizing it more lately. But do they want to get rid of it? Not really. And most appear tired of the controversy and grinding debate about the overhaul. Those are some of the conclusions one might draw from the numbers in the latest Kaiser Family Foundation tracking poll assessing public attitudes toward the law (Reichard, 3/27).

This Story: Print | Link to | Top

5 Senate Dems Seek Changes To Health Law

The Democrats, and one independent, want to modify a health law provision requiring companies to provide coverage if they have more than 50 employees. The senators want to make the cutoff 100 workers. Other proposals include offering consumers additional health plan choices, among them, a less-expensive "copper" option.

The Associated Press: 5 Senate Dems Back Easing Small Business Mandate
Several Senate Democrats want to eliminate a requirement in the health care law for companies to provide coverage if they have fewer than 100 workers. The current cutoff is 50 employees, although the Obama administration has suspended the so-called small business mandate temporarily. The legislation would mean an estimated 98 percent of businesses could decline to provide insurance without fear of a penalty (3/27).

McClatchy: Democratic Senators Have New Ideas For Health Care Law
Six Senate Democrats Thursday unveiled proposals to make changes in the Affordable Care Act, the health care law under fire from conservatives and Republicans. Two senators, Mary Landrieu, D-La., and Mark Begich, D-Alaska, are considered among the most vulnerable Senate Democrats this year as they face tough re-election efforts. Joining them in proposing new ideas for the health care law are Sens. Heidi Heitkamp, D-N.D., Mark Warner, D-Va., Angus King, Ind.-Maine and Joe Manchin, D-W.Va (Lightman, 3/27).

The Richmond Times-Dispatch: Warner Introduces Heath Legislation
Amid a budget deadlock in the state legislature over whether Virginia should expand its Medicaid system to up to an additional 400,000 uninsured Virginians, Sen. Mark R. Warner, D-Va., on Thursday introduced legislation in the U.S. Senate that would provide families with additional health coverage choices. Warner’s Expanded Consumer Choice Act, co-sponsored by Sen. Mark Begich, a Democrat from Alaska, would provide for a new, lower-cost health coverage option for consumers, set up a process to allow coverage plans to be offered regionally and across state lines, and ease unnecessary reporting requirements for employers. Warner, facing a re-election campaign in a political climate charged by the controversy over the Affordable Care Act — which he supported — said Thursday that during the debate over health care reform, he had consistently pointed out that the new health care law was not perfect, and that Congress would have to revisit the law to correct [it] once it was implemented (Schmidt, 3/27).

Minnesota Public Radio: MNsure's Interim CEO To Testify At U.S. House Hearing
The Republican chairman of the U.S. House Oversight Committee is turning up the heat on Minnesota and several other states with troubled health insurance exchanges. U.S. Rep. Darrell Issa of California is sending letters to 10 governors, including Gov. Mark Dayton, and the District of Columbia's mayor, his office said. The letters seek internal documents and communications between state employees and contractors and Obama administration officials relating to their insurance exchanges from May 1, 2013 to present (Stawicki, 3/27).

This Story: Print | Link to | Top

Capitol Hill Watch

House Passes 12-Month 'Doc Fix' By Voice Vote

The bill would avoid a 24 percent reduction in payment for doctors who treat Medicare patients, but the deal is still angering some Republican rank-and-file.

The Washington Post: In Voice Vote, House Approves Medicare 'Doc Fix'
The House quickly approved another so-called "doc fix" bill early Thursday afternoon that serves as a temporary solution to an ongoing structural problem in the formula used to determine Medicare funding levels. After hours of uncertainty over whether the bill have sufficient support to pass, House Republican leaders moved quickly to approve the measure by voice vote (Lowery, 3/27).

The Wall Street Journal: House Passes 12-Month Bill To Prevent Doctor Payment Cuts
The so-called "doc fix" bill is designed to avert for one year a 24% pay cut to physicians treating elderly patients through the federal Medicare program, marking the 17th time lawmakers have sought to prevent the cuts with a short-term measure. Lawmakers last month had reached a bipartisan deal to increase the amount Medicare pays physicians by 0.5 percent annually for the next five years, but couldn't agree on whether or how to pay for its cost. Facing Monday's expiration of the previous patch, House Speaker John Boehner (R., Ohio) and Senate Majority Leader Harry Reid (D., Nev.) this week brokered the 12-month deal to ensure that the cuts didn't go into effect (Peterson, 3/27).

The Associated Press: House Approves Bill To Stop Cut To Medicare Docs
Legislation to give doctors a yearlong reprieve from a looming 24 percent cut in their payments from Medicare overcame turbulence in the House on Thursday and appears on track to clear the Senate next week, possibly just hours before a Monday midnight deadline (Taylor, 3/27).

The New York Times: Jobs And Health Bills Make For Busy Day At Capitol
The unemployment bill, however, was one among many of Mr. Boehner’s concerns as he and Republican leaders found themselves backed into a corner after it appeared that legislation they favored that would prevent a 24 percent cut in Medicare payments to doctors almost failed with an April 1 deadline looming. The bill, known as the "doc fix," ran into trouble after members of both parties objected to its temporary nature, as many prefer a permanent fix. … To avoid major disruption in hospitals and doctors' offices next week, Mr. Boehner and leaders from both parties agreed to muscle the measure through. … The drama in the House was just one episode in an unusually eventful day on Capitol Hill (Peters, 3/27).

CQ HealthBeat: Secret 'Doc Fix' Deal Angers Rank and File
The House on Thursday passed a bill that likely did not have the votes to pass. It was clear that a bill to avert a pay hike for doctors was short on support, so Republican leaders struck a closed-door agreement with Democrats to pass the bill by voice vote while members were not yet in the chamber, according to members and aides from both parties (Newhauser and Fuller, 3/27).

And a shift in how medical professionals code and bill for their services looms --

The Washington Post's Wonkblog: ICD-10 Might Be Delayed Again. How Will We Know When Squirrels Attack? 
Just last month, the Obama administration said it wouldn't again delay the scheduled shift to a new comprehensive system for coding and diseases, known as ICD-10. "There are no more delays and the system will go live on Oct. 1," Centers for Medicare and Medicaid Services Administrator Marilyn Tavenner told a conference of health information management professionals. "Let’s face it, guys, we've delayed this several times and it's time to move on." Well, the administration might not have planned on delaying it, but Congress just might (Millman, 3/27).

This Story: Print | Link to | Top

State Watch

Roundup: Texas Medicaid Fraud Settlement; Texas Abortion Law Upheld; Va. Mental Health Tragedy Details

A selection of health policy stories from Texas, Virginia, California, Michigan and Massachusetts.

The Texas Tribune: Medicaid Fraud Settlement Worries Health Providers 
With a high-profile legal settlement with Carousel Pediatrics, a children’s health provider, under its belt, the Texas Health and Human Services Commission’s Office of Inspector General says its ramped-up efforts to rein in Medicaid fraud have started to pay off. But for health providers who treat the state’s poorest patients, the Carousel case has raised questions about how the inspector general’s office distinguishes fraudulent intent from human error (Aaronson, 3/28).

The Associated Press: Court Hands Setback To Texas Abortion Law Critics
Dr. Lester Minto knows he won’t be able to reopen his clinic after a federal appeals court upheld tough new abortion restrictions in Texas. But he insists he won’t be silenced. Minto has been providing abortions for three decades, but he closed his clinic near the Mexico border earlier this month because of a law that imposes some of the nation’s strictest limitations on the procedure. The law, which was overwhelmingly approved last summer by the Republican-controlled Texas Legislature, has helped force numerous clinics to close (3/28).

The Wall Street Journal: Appeals Court Upholds Texas Abortion Rules
A federal appeals court in New Orleans upheld a Texas law restricting abortion clinics on Thursday, a ruling that could lead to a Supreme Court review of how far states can go in regulating the procedure (Bravin, 3/27). 

The Washington Post: Study: Mental Health Reform That Could Have Aided Deeds’s Son Not In Place For 2 Years 
The inaction on the reforms suggested in 2012, the report says, contributed to the failure to get help for the 24-year-old. But most of those changes -- as well as several others aimed at providing a better safety net -- were implemented by the General Assembly in the wake of the young man’s death (Weiner, 3/27).

The Richmond Times-Dispatch: Many Missteps Preceded Deeds Tragedy
An incorrect hospital fax machine number was just one of many missteps on the tragic path to the release of Austin C. “Gus” Deeds from an emergency custody order 13 hours before he wounded his father, Sen. R. Creigh Deeds, D-Bath, and killed himself on Nov. 19. A long-awaited report issued by the Office of the State Inspector General on Thursday documents a breakdown in almost every facet of Virginia’s fragmented mental health system, from the moment Gus Deeds, 24, was taken into involuntary custody Nov. 18 to the expiration of the emergency order six hours later. The report, released after the conclusion of a Virginia State Police investigation that resulted in no criminal charges, documents unnecessary delays in Gus Deeds’ emergency evaluation, unmade and unanswered phone calls to hospitals to locate an available bed, and a hospital fax number that was listed incorrectly on a list of psychiatric facilities for emergency workers to call (Martz, 3/27).

Los Angeles Times: Top L.A. County Public Health Official Announces He’s Retiring
The head of Los Angeles County's public health department has announced his intention to retire. In a letter sent to department employees Thursday, department director Jonathan Fielding wrote, "After considerable thought, I have decided to leave County service when a successor, whom I understand will be identified through a nationwide executive search, is ready to assume the post" (Sewell, 3/27).

Detroit Free Press: 62,000 Michigan Seniors Might Be Eligible For $4,000 In Drug Savings
Tens of thousands of Michigan seniors could get up to $4,000 to help cover prescription drug costs -- if they knew to ask. According to the latest data, an estimated 62,000 Michigan seniors were eligible in 2010 for Medicare’s Low Income Subsidy, or Extra Help program, but are not applying, leaving behind about $250 million in benefits each year, said Howard Bedlin, vice president of public policy and advocacy for the Washington-based National Council on Aging, a nonprofit service and advocacy organization (Erb, 3/28).

The Boston Globe: Governor Declares An Emergency On Opiate Abuse
Governor Deval Patrick declared a public health emergency Thursday to combat the growing abuse of opiates, directing that all the state’s police, firefighters, and other emergency personnel be equipped with a drug that can quickly reverse heroin overdoses. “Heroin today is cheap and highly potent,” Patrick said. “We have right now an opiate epidemic.” Using his emergency powers, Patrick told the Department of Public Health to make Narcan available immediately to all first responders, as well as more accessible to families and friends of drug abusers. Narcan, the brand name for naloxone, halts overdoses almost instantly (MacQuarrie, 3/27).

This Story: Print | Link to | Top

Health Policy Research

Research Roundup: Distance From A Transplant Center; Medicaid Prenatal Care; Metastasis Of Email; Profiting From Medicare Advantage

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

JAMA: Association Of Distance From A Transplant Center With Access To Waitlist Placement, Receipt Of Liver Transplantation, And Survival Among US Veterans 
Centralization of specialized health care services such as organ transplantation and bariatric surgery is advocated to improve quality, increase efficiency, and reduce cost. ... [This was a] retrospective study of veterans meeting liver transplantation eligibility criteria from January 1, 2003, until December 31, 2010, using data from the Veterans Health Administration's integrated, national, electronic medical record linked to Organ Procurement and Transplantation Network data. ... Among VA patients meeting eligibility criteria for liver transplantation, greater distance from a VATC or any transplant center was associated with lower likelihood of being waitlisted, receiving a liver transplant, and greater likelihood of death (Goldberg et al., 3/26).

JAMA Pediatrics: A Statewide Medicaid Enhanced Prenatal Care Program: Impact On Birth Outcomes
Policy makers and practitioners need rigorous evaluations of state-based Medicaid enhanced prenatal care programs that provide home visiting to guide improvements and inform future investments. ... Data, including birth records, Medicaid claims, and monthly program participation, were extracted from the Michigan Department of Community Health warehouse. ... Participation in MIHP reduced the risk for adverse birth outcomes in a diverse, disadvantaged population. The study adds to the evidence base for enhanced prenatal care home visiting programs and informs state and federal investments (Roman et al., March 2014). 

JAMA Pediatrics: Metastasis Of E-mail At An Academic Medical Center
At academic medical centers, e-mail provides a simple way to communicate and serve the multiple missions. ...  Less obvious is how e-mail contributes to a daunting volume of information. ... To call attention to some unintended effects of "cost-free" communication, we quantified the volume and described the content of mass distribution e-mails sent to a single physician over 1 year. ... With 629 employed physicians, the annual institutional cost was between $1,029,419 and $3,088,257 for physicians to read mass distribution e-mails (Paul and Levi, March 2014).

Urban Institute/Robert Wood Johnson Foundation: Health Insurance Coverage And Health Care Access, Use And Affordability In Massachusetts: An Update As Of Fall 2012
In 2012, Massachusetts continued to benefit from the nation's highest level of health insurance coverage following its 2006 health reform initiative. Health insurance coverage for nonelderly adults in the Bay State in 2012 continued at about 95 percent, well above the 79.7 percent that is estimated for the nation overall. ... Massachusetts residents also have continued to enjoy many of the gains in access to health care and health care affordability. ... As of 2012, most nonelderly adults in Massachusetts were connected to the health care system and had a place they usually went when they were sick. ... However, some residents of the state reported problems obtaining the care they needed, including one-third (33.5 percent) who reported going without needed health care. ... Reflecting the level of health care costs in the state, affordability of care was a problem for many nonelderly adults in Massachusetts and their families (Long and Fogel, 3/26).

Employee Benefit Research Institute: Brand-Name And Generic Prescription Drug Use After Adoption Of A Full-Replacement, Consumer-Directed Health Plan With A Health Savings Account
This report looks at the effects of the HSA plan on the absolute and relative use of brand-name and generic drugs. ... Overall, the new plan design was associated with a 4.7 percentage-point rise in GDR [generic dispensing rate] after the first year, and—before inclining slightly in the second year—settled to a level that was higher by 3.4 percentage points after four years. ... At the end of the four-year follow-up period, GDR was greater by 4.5 percentage points for hypertension, 15.4 percentage points for dyslipidemia, and 7.8 percentage points for asthma/COPD. No significant effects were detected for diabetes GDR, but the measure for depression was lower by 8.4 percentage points after 2010. ... After one year under the CDHP, 0.43 fewer generic and 0.95 fewer brand-name prescriptions were filled, on average (Fronstin and Roebuck, 3/24).

The National Bureau of Economic Research: Who Benefits When The Government Pays More? Pass-Through In The Medicare Advantage Program
In this paper we examine this issue in the Medicare Advantage (MA) program, through which the federal government contracts with private insurers to coordinate and finance health care for more than 15 million Medicare recipients. To do this, we exploit a substantial policy-induced increase in MA reimbursement in metropolitan areas with a population of 250 thousand or more relative to MSAs just below this threshold. Our results demonstrate that the additional reimbursement leads more private firms to enter this market and to an increase in the share of Medicare recipients enrolled in MA plans. Our findings also reveal that only about one-fifth of the additional reimbursement is passed through to consumers in the form of better coverage. A somewhat larger share accrues to private insurers in the form of higher profits and we find suggestive evidence of a large impact on advertising expenditures (Duggan, Storc and Vabson, 3/26).

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

MedPage Today: USPSTF: No Proven Value in Cognition Screening
Routine screening of all older individuals for cognitive impairment is not supported by the available evidence, the U.S. Preventive Services Task Force (USPSTF) has concluded.  After reviewing 55 studies examining the accuracy of screening instruments, and more than 130 studies of interventions aimed at slowing or stopping cognitive decline in patients who tested positive for cognitive impairment or relieving caregiver burdens, task force members determined that a clear benefit for screening has not been established, relative to the potential for harm (Gever, 3/24).

CBC: Canadians Spend More On Private Health Insurance For Smaller Payouts
Spending by Canadians on private health insurance has more than doubled over the past 20 years, but insurers paid out a rapidly decreasing proportion as benefits, according to a study published today in the CMAJ (Canadian Medical Association Journal). ... Approximately 60 per cent of Canadians have private health insurance. ... Over the past two decades, the gap between what insurers take in and what they pay out has increased threefold. While private insurers paid out 92 per cent of group plan insurance premiums as benefits in 1991, they paid only 74 per cent in 2011 (3/24).

News @JAMA: Report: Medicare Miscalculates Dialysis Drug Costs
Medicare is miscalculating the drug costs it pays to dialysis centers that treat patients with end-stage renal disease, making it difficult to determine whether the federal agency is making appropriate payments, concludes a report released today. ... Since 2011, Medicare began paying these facilities a "bundled" payment for all services, including dialysis-related drugs, creating an incentive for physicians to be more judicious when prescribing medications. Previously, dialysis centers were paid separately for the medications, an unintended incentive to boost profits by overuse of the medications. ... the report by the US Department of Health and Human Services' Office of Inspector General (OIG) found that the bundled payment does not reflect actual cost fluctuations of the individual drugs within the bundle (Mitka, 3/25).

Reuters: Minorities Most Vulnerable To Financial Slide After Breast Cancer
Black and Latina breast cancer patients were more than twice as likely as white women to have lingering medical debt and to skip treatments because of costs, according to a new U.S. study. Based on surveys of 1,500 women diagnosed with mostly early-stage breast cancers, researchers found that up to one quarter were struggling financially as a result of their disease (Doyle, 3/25).

This Story: Print | Link to | Top

Editorials and Opinions

Viewpoints: Nothing 'Magical' About 6 Million Enrollees; The High Cost Of Hep C Medicine

Bloomberg: Surge In Obamacare Enrollments Means Success. Or Failure.
Big news this afternoon on the Affordable Care Act: The ACA exchange signups have reached the 6 million mark. With a few more days to go before the open sign-up period closes (well, sort of) it looks like the original 7 million estimate -- which the Congressional Budget Office had revised downward after the botched October roll-out of the federal exchange -- is going to be pretty close to the mark. There’s nothing at all magical about this number. Reaching it doesn't mean that Obamacare "works." Surpassing the goal might have some effect on the federal budget (more signups, for example, presumably mean higher subsidy costs), but there's no obvious correlation between the signup total and anything else (Jonathan Bernstein, 3/27).

The Washington Post: In Maryland, Official Incompetence Has Made Signing Up For Health Coverage Too Much Work
Because Maryland's $170 million health-care exchange Web site continues to be buggier than August in Florida, [Tyrone] Keels decided to drive to the Montgomery County Health and Human Services Center in Silver Spring and sign up the old-fashioned way, before Monday's deadline (Petula Dvorak, 3/27). 

The Wall Street Journal: Ezekiel’s Prophecy
Ezekiel Emanuel, Rahm's elder brother, is a physician who helped design ObamaCare and has been one of its most intense champions. So you may be surprised to learn that in his new book, "Reinventing American Health Care," he predicts that tens of millions more Americans will lose their medical plans in the coming decade (James Taranto, 3/27). 

ABC News: Let's Restore Hourly Wages Cut by Obamacare
On Jan. 31, a fry cook asked President Obama why his hours were being cut to part-time because of Obamacare, and the president responded by saying he was pushing to raise the minimum wage. This moment between the fry cook and the president reveals the entire reasoning of the Democratic Party's push to raise the minimum wage. Rather than restore wages and hours lost by working middle-class Americans due to Obamacare, Democrats are hiding these losses behind a false debate about the minimum wage (House Majority Leader Eric Cantor, R-Va., 3/27).

The New York Times' Economix: The Dollar Value Of An Extra Year Of Life
A recent article on Kaiser Health News reported on a new drug for the treatment of hepatitis C for which the manufacturer charges $1,000 a pill, or $84,000 for a 12-week course of treatment. Chronic hepatitis C is a leading cause of serious liver disease, including cancer (Uwe E. Reinhardt, 3/28). 

The Washington Post's The Plum Line: Congress Demonstrates Yet Again Why Controlling Health-Care Costs Is So Hard
We’re talking about the Medicare "doc fix," a particularly odd piece of legislation Congress is required to pass again and again. This time around, it required a bunch of last-minute maneuvering in the House, with the bill passing on a voice vote so no one would have to be accountable for voting for it, or voting against it, depending on which of your opponent's attacks you're worried about on a given day. ... So what does this tell us about Congress, and about health care? One lesson is that when the interests of a powerful group like doctors are at stake, even a gridlocked Congress can hop to and accomplish something. But more importantly, it's a reminder of why it's so difficult for government to control health-care costs (Paul Waldman, 3/27). 

Bloomberg: Medicare Advantage Helps Insurers, Not Seniors
Earlier this year, an ad campaign in Washington showed an old man with binoculars, under the words "Seniors are watching." The ad warned Congress against cutting funding for Medicare Advantage, which pays private insurers to provide health benefits to more than a quarter of all Medicare enrollees. The campaign, funded by America's Health Insurance Plans, the industry's leading trade association, argues that rate cuts "mean higher costs, lost benefits and lost provider choices for seniors." That seems pretty compelling. A newly released paper finds that it's also mostly bogus (Christopher Flavelle, 3/27).

This Story: Print | Link to | Top

Stephanie Stapleton

Andrew Villegas

Lisa Gillespie
Shefali Luthra

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