Daily Health Policy Report

Friday, April 18, 2014

Last updated: Fri, Apr 18

KHN Original Reporting & Guest Opinion

Health Reform

Health Care Marketplace

Capitol Hill Watch

Coverage & Access

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Obama Sharply Criticizes Republicans As He Announces 8 Million Have Enrolled

Kaiser Health News staff writers Phil Galewitz and Daniela Hernandez report: “Enrollment in private health insurance on federal and state marketplaces has surged in recent weeks and now totals 8 million, a feisty President Barack Obama said Thursday. The actual number of people affected [by the refusal to expand Medicaid] is 5.7 million, the administration said. Republican leaders in Florida, Texas and other states argue that even though the federal government is paying the full cost of expansion through 2016, costs in later years would still be too high a burden. They also say they don’t trust Congress to abide by the law and maintain full federal funding. Administration data show 3.8 million people signed up for private plans in the past six weeks --- compared to 4.2 million in the first five months after enrollment began Oct. 1. Enrollment ended March 31, though people who had trouble signing up generally had until April 15 to sign up in the 36 states relying on the federal marketplace” (Galewitz and Hernandez, 4/17). Read the story.

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A Reader Asks: How Do We Prove We Have Insurance?

Kaiser Health News consumer columnist Michelle Andrews answers this reader’s question (Andrews, 4/18). Read her response.

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Obama Announces 8 Million Have Enrolled In Marketplace Plans (Video)

Kaiser Health News posted this video of Thursday’s White House news conference on enrollment figures. President Barack Obama also announced that 35 percent of people who enrolled on the federally run healthcare.gov marketplace are under age 35 (4/17). Watch it or read the transcript.

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Capsules: Biggest Insurer Shocked With Hepatitis C Costs; Incomplete Face-To-Face Doctor Exams Put Home Health Agencies In Tight Spot

Now on Kaiser Health News’ blog, Jay Hancock reports on UnitedHealth Group’s first quarter results: “UnitedHealth Group spent $100 million on hepatitis C drugs in the first three months of the year, much more than expected, the company said Thursday. The news helped drive down the biggest insurance company’s stock and underscores the challenge for all health care payers in covering Sovaldi, an expensive new pill for hepatitis C” (Hancock, 4/17). 

Also on the blog, Lisa Gillespie reports on an OIG report about Medicare’s face-to-face encounter rule: “The cost of caring for homebound patients is rising, and the government is trying to get a better grip on spending by requiring doctors to certify — with face to face examinations — Medicare beneficiaries’ eligibility for home health services, including intermittent skilled nursing care, physical therapy, speech therapy and part-time home health aide services. The OIG estimated that $2 billion in inappropriate payments were made in 2011 and 2012 because of inadequate compliance with the rule” (Gillespie, 4/18). Check out what else is on the blog.

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Fully Paid Up But Still No Coverage

The Philadelphia Inquirer's Robert Calandra, working in partnership with Kaiser Health News, reports: "Michelle Lamb recalls it being "pretty easy" buying health insurance on the Affordable Care Act marketplace last December. But using her Independence Blue Cross plan has been maddening. The 39-year-old West Oak Lane day care teacher has made three monthly premium payments at more than three times her subsidized rate just to make sure she was covered. That's a steep price for insurance that has been canceled three times - for nonpayment" (Calandra, 4/17). Read the story.

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Political Cartoon: 'Double Cross?'

Kaiser Health News provides a fresh take on health policy developments with "Double Cross?" by Clay Bennett.

Here's today's health policy haiku: 


Piece by toothy piece
MO takes up Medicaid-Lite
Few reps take a bite
-Stuart Portman

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

At 8 Million Sign-Ups, Health Law Enrollment Surpasses Target

President Barack Obama hailed the latest tally of people who gained insurance as a result of the health law. News outlets also look inside this latest round of data to find out what information the administration is providing and what is still to come.   

The New York Times: Enrollments Exceed Obama’s Target For Health Care Act
President Obama announced Thursday that eight million people have signed up for health insurance under the Affordable Care Act, including what the White House said were a sufficient number of young, healthy adults, a critical milestone that might counter election-year attacks by Republicans on the law’s success and viability. The total number of enrollees exceeds by a million the target set by the administration for people to buy insurance through government-run health care exchanges. In particular, the number of young people signing up appears to have surged during the final weeks of enrollment (Landler and Shear, 4/17).

The Washington Post: Obama Hails 8 Million Enrollees For Insurance Under Federal Health-Care Law
Speaking at an impromptu news conference, the president described how the law has helped make a difference for ordinary citizens such as a young woman in Pennsylvania with a self-employed husband and two young children who managed to get insurance despite being diagnosed with breast cancer. … Armed with those enrollment numbers, Obama challenged the political dynamic that has grown up around the law and that has unnerved some members of his party. Problems with the law have become a central theme in the Republicans’ efforts to wrest control of the Senate this fall (Eilperin and Nakamura, 4/17).

NPR: Obama: Affordable Care Act Enrollment Hits 8 Million
The latest figures represent a turnaround from the disastrous debut of the HealthCare.gov website last year. The president said it was "well past time" for Republicans to quit trying to repeal the program, something he said they have voted on "some 50 times" (Neuman, 4/17).

Politico: Obama Spikes The Football
But the final enrollment numbers, along with other recent survey findings, are strong enough to give the Obama administration a cushion against some of the most common criticisms of the enrollment trends. Here are the takeaways from Thursday’s announcement (Nather, 4/17).

Los Angeles Times: Obamacare Enrollments Hit 8 Million
The total exceeded the initial forecast by 1 million people and capped a notable comeback after a disastrous debut last fall gave rise to predictions the law would collapse in its maiden year. The health law, often called Obamacare, instead has brought about the largest increase in insurance coverage in the United States in the half a century since Medicare and Medicaid were created (Levey and Terhune, 4/17).

Kaiser Health News: Obama Sharply Criticizes Republicans As He Announces 8 Million Have Enrolled
Enrollment in private health insurance on federal and state marketplaces has surged in recent weeks and now totals 8 million, a feisty President Barack Obama said Thursday. "This thing is working,” Obama said at a White House news conference in which he lambasted Republican critics of the health law, especially those in states that did not expand Medicaid eligibility, as the law allows.  … The actual number of people affected [by the refusal to expand Medicaid] is 5.7 million, the administration said (Galewitz and Hernandez, 4/17).

Bloomberg: Obamacare Enrollment Got Younger In Late Surge, Officials Say 
People who waited until the last minute to sign up for Obamacare were significantly younger than those first in line, as the percentage of enrollees younger than 35 jumped in the last month, officials said. About 35 percent of Americans who signed up for a private plan using new insurance exchanges were in the young adult age group, state insurance commissioners said after a meeting with President Barack Obama and his top staff (Wayne, 4/17).

The Wall Street Journal: Obama Says Health-Insurance Enrollees Reach 8 Million
Some 35% of those who signed up through the federal health-insurance exchange were in the coveted under-35 demographic, Mr. Obama said. The participation of younger, relatively healthy people is needed to balance out the cost of medical claims from older and sicker ones. The announcement contained few other new details about enrollment. Republicans quickly pointed to missing information—such as the number of people who had actually gained coverage after being uninsured, as opposed to those replacing an existing policy—to suggest the figures could be overblown as a measure of success (Radnofsky and McCain Nelson, 4/17).

The Washington Post's Wonkblog: Here's How We Got To 8 Million Obamacare Signups
Last summer, the administration had hoped that 40 percent of exchange enrollees would be between 18 and 34, based on the Congressional Budget Office's estimates that 7 million people in all would enroll in 2014. Instead, the administration got 28 percent, which the White House and supporters very eagerly pointed out Thursday was nearly identical to youth enrollment in the first year of the Massachusetts health-care law that Obamacare was based on (Millman, 4/17).

The Associated Press: Late Sign-Ups Improve Outlook For Obama Health Law
A surge of eleventh-hour enrollments has improved the outlook for President Barack Obama's health care law, with more people signing up overall and a much-needed spark of interest among young adults. … Still to be announced is what share of those enrolled were previously uninsured — the true test of Obama's Affordable Care Act — and how many actually secured coverage by paying their first month's premiums (Alonso-Zaldivar and Lederman, 4/18).

McClatchy: Health Care Enrollment Hits 8 Million, Obama Says
More than 8 million Americans have signed up for health insurance through the Affordable Care Act, a triumphant President Barack Obama announced Thursday. Obama hailed the number -- which exceeds expectations -- and said that 35 percent of those who enrolled through the federal marketplace are under the age of 35, a coveted demographic that is cheaper to insure. He argued that the law has also helped tame soaring health care costs, saying that since the law took effect, health care spending has risen more slowly than at any time in the past 50 years (Clark and Wise, 4/17).

Kaiser Health News: Obama Announces 8 Million Have Enrolled In Marketplace Plans (Video)
Kaiser Health News posted this video of Thursday’s White House news conference on enrollment figures. President Barack Obama also announced that 35 percent of people who enrolled on the federally run healthcare.gov marketplace are under age 35 (4/17).

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Sign-Up Figures Trigger New Round Of Health Law Political Spin

President Barack Obama uses the new enrollment numbers to urge Democrats to be proud of the health law and call on Republicans to back off in their push to repeal the measure. GOP leaders, though, did not appear to soften their positions.

CNN: Obama: Republicans 'Were Wrong' About Obamacare
President Barack Obama called on his fellow Democrats to "forcefully defend and be proud" of the fact that millions of people have signed up for health care insurance through the federal marketplaces, and faulted Republicans who are still angling to repeal the Affordable Care Act. "I don't think we should apologize for it. I don't think we should be defensive about it. I think there is a strong, good, right story to tell," Obama said Thursday during a rare appearance at the daily White House news conference (Killough, 4/17).

Politico: Obama Tells Democrats: Defend My Law
President Barack Obama has laid out the blueprint he thinks his party should follow on Obamacare as the midterms approach: "forcefully defend and be proud" of the law — and then move on, hitting Republicans for Washington dysfunction and inaction on the economy. The question now is whether Democrats will listen (Dovere and Budoff Brown, 4/18).

The Associated Press: President Defending Health Law Good For Some Dems
President Barack Obama’s full-throated defense of his health care overhaul seems perfectly timed for Democrats who want their party to embrace the law more enthusiastically. At a White House news conference Thursday, Obama noted that health insurance enrollments under the new law are higher than expected, and costs are lower. If Republicans carried out their pledge to repeal the law, he said, it "would increase the deficit, raise premiums for millions of Americans and take insurance away from millions more" (Babington and Alonso-Zaldivar, 4/17).

Reuters: Obama Says Health Law Is Working, Private Insurance Enrollment At 8 Million
President Barack Obama delivered a vigorous defense of his signature healthcare law on Thursday, saying private insurance enrollment under it has reached 8 million people and faulting Republicans for failing to agree with him that "this thing is working. I've said before this law won't solve all the problems in our healthcare system. We know we've got more work to do. But we now know for a fact that repealing the Affordable Care Act would increase the deficit, raise premiums for millions of Americans and take insurance away from millions more," Obama told reporters at the White House (4/17).

USA Today: Obama On Health Law: 'This Thing Is Working'
Opponents of the law say they're still waiting to hear how many people pay for their policies, if enough healthy people have enrolled to make the exchanges financially workable in the future and how many of the enrollees use a month's worth of benefits to cover medical procedures they couldn't afford before but then discontinue paying for their insurance. Obama spoke shortly after meeting with a group of state insurance commissioners, some of whom reported that the president cited a rush of young people — under age 35 — signing up late (Jackson and Kennedy, 4/17).

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California Officials Announce Enrollee Tally, Note Last-Minute Surge

Covered California, the state's online health insurance marketplace, signed up 200,000 people for coverage during the two-week deadline extension -- bringing the state's total to 1.4 million. The state's initial goal was about 815,900 for the six-month enrollment period that began Oct. 1, 2013.  

Los Angeles Times: Obamacare Enrollment Nears 1.4 Million In California Exchange
Covered California signed up more than 200,000 consumers for Obamacare coverage after extending its enrollment deadline by two weeks, bringing the statewide total to nearly 1.4 million people. The health insurance exchange gave people until Tuesday to finish enrolling after the state website faltered at the end of March from a crush of last-minute applicants (Terhune, 4/17).

The Associated Press: California Health Care Sign-Ups Exceed Projections
A late surge of sign-ups pushed California's health insurance exchange nearly 100,000 enrollees beyond the original projections of the Obama administration, state officials announced Thursday. Nearly 1.4 million Californians selected a private policy through the state's exchange by Tuesday's open enrollment extension, and 88 percent were eligible for subsidies to reduce their monthly premiums (Lin, 4/17).

The San Francisco Chronicle: Covered California Enrollment Numbers Surpass Goals
More than 205,000 Californians signed up for health insurance through Covered California in the final extended two weeks of enrollment that ended April 15, bringing the total number of enrollees in the state health exchange to about 1.4 million people. The state had set an enrollment goal of about 815,900 for the six-month enrollment period, which began Oct. 1. When the numbers for people who signed up for coverage for Medi-Cal, the state-federal health program for the poor, are included, the total exceeds 3 million people. The state expanded its Medi-Cal program as part of the federal health law, often referred to as Obamacare (Colliver, 4/17).

The San Jose Mercury News: Obamacare Sign-Ups Beat Projections In U.S., California
Good news on two fronts for President Barack Obama's health care law surfaced Thursday after health plan enrollment numbers reported by California and the White House wildly exceeded expectations. Obama announced that 8 million Americans had signed up for plans, 1 million more than projected. Meanwhile, a concerted, late-stage effort by California's health insurance exchange to expand outreach efforts, particularly in Latino communities, helped boost private health insurance sign-ups in the Golden State to almost 1.4 million (Seipel, 4/17).

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Are Exchanges More Appealing To Insurers Now?

Elsewhere, in Colorado, new fees on consumers and insurance plans would raise $13 million to help run that state's exchange next year.

Modern Healthcare: Exchanges Look More Appealing To Insurers Second Time Around 
Health insurers appear to be increasingly bullish on the fledgling state and federal exchanges, in spite of disastrous rollouts in many of the online marketplaces last fall (Demko, 4/17).

The Denver Post: Colorado Health Exchange Proposes Insurer Fee to Raise $13 Million 
Colorado's new health exchange will decide this summer whether to assess a fee to insurance companies for each policy they provide exchange users. The assessment could be up to $1.80 per policy, and if approved by the exchange board would be in effect to help pay exchange operating costs next year and in 2016, according to Connect for Health Colorado CEO Patty Fontneau (McGhee, 4/18).

Health News Colorado: Fee To Fund Exchange Would Hit All Coloradans With Health Insurance
A $13 million fee on all Coloradans with health insurance would pay half the operating costs at the state health exchange next year and in 2016 under the newest financial projections. The proposed fee would affect at least 875,000 people and includes Coloradans who get their insurance through their employers or outside the exchange. Exchange managers announced earlier this week that they sold private health plans to 124,000 people through the end of March (McCrimmon, 4/17).

Meanwhile, in Medicaid expansion news --

Bangor Daily News: Maine Legislature Approves Late, Last-Ditch Push For Medicaid Expansion
The Maine Legislature on Thursday night approved a Medicaid expansion plan for the third time since March, though the bill is likely doomed to the same fate as its predecessors -- death by gubernatorial veto. The House of Representatives gave the bill final approval with a vote of 94-51. The Senate gave final approval after a 19-14 vote. ... [House Speaker Mark] Eves’ amendment offered a new twist on the 16-month-old Medicaid expansion debate by promoting a plan to use millions of federal Medicaid dollars to buy private insurance plans for tens of thousands of newly eligible low-income Mainers (Moretto, 4/17).

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Obama Presses Scrutiny Of 2015 Health Insurance Rates

The president made his appeal to state insurance commissioners at a meeting Thursday. Elsewhere, consumer spending related to the health law jumps, the GOP again demands to know the White House's involvement in the healthcare.gov rollout, and hospitals try their hand as insurers.

The Seattle Times: Kreidler: 'Robust Discussion' With Obama On Health Coverage
President Obama, in a meeting with state insurance commissioners Thursday, made it clear that he expects careful scrutiny of rates for 2015 health-insurance plans, according to Washington Insurance Commissioner Mike Kreidler. Kreidler was among more than 40 commissioners who met for an hour in the State Dining Room with the president, Vice President Joe Biden, outgoing Health and Human Services Secretary Kathleen Sebelius, Medicare administrator Marilyn Tavenner and other top health officials (Ostrom, 4/17).

NPR: Following Enrollment Deadline, Health Care Focus Turns To States
President Obama met Thursday with insurance company executives and a separate group of insurance regulators from the states, discussing their mutual interest in administering the new health care law (Horsley, 4/17).

Bloomberg: Obamacare Spurs Jump In Consumers' Health Spending Economy
Nancy Beigel has known since September that she would need hernia surgery. She couldn’t afford it on her $11,000 yearly income until she became eligible for Medicaid in January through President Barack Obama’s signature health care law. The law is prompting Beigel and others to spend more at the doctor’s office and pharmacy, and the impact is reflected in the latest data on consumer spending (Smialek, 4/17).

Fox News: GOP Steps Up Demand For Documents On White House Role In Botched Health Care Rollout
Republican Rep. Darrell Issa is ratcheting up pressure on President Obama's top aides to turn over more documents revealing the extent of the White House's direct involvement in the botched rollout of the health insurance exchanges, according to a letter to White House Counsel Kathryn Ruemmler obtained exclusively by Fox News. In the letter transmitted to Ruemmler at the White House Thursday morning, Issa asserts "senior White House officials -- as well as the President -- appear to have been far more personally involved in decision-making related to healthcare.gov than the White House previously represented. Documents obtained by the Committee show the significant involvement of senior White House officials in the rollout of healthcare.gov” (Henry, 4/17).

Fox News: Hospitals Trying Their Hand At Insurance Provider Business
As doctors, businesses and individuals around the country are adapting to the sweeping changes enacted under the Affordable Care Act, some hospitals are getting in on the provider game. Self-insurance plans are cropping up at hospitals that put the financial risks on employers for providing benefits to their workers.. Hospital officials say they can offer competitive pricing as providers to small business owners as many predict higher premium costs in the coming years. Self-insured products are often offered with employers pooling together, creating large insurance pools and spreading that risk (and thus, mitigating costs) across companies (Rogers, 4/17).

And, a Christian broadcaster wins an injunction against the health law's conception coverage mandate --

The Associated Press: Christian Broadcaster Wins Health Care Injunction
Christian radio broadcaster James Dobson has won a temporary injunction preventing the federal government from requiring his ministry to include the morning-after pill and other emergency contraception in its health insurance. A federal judge in Denver issued the injunction Thursday (4/17).

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Health Care Marketplace

UnitedHealth Cites Health Law, Costly Hepatitis Drug In Reporting Lower Earnings

The health law's effect was mixed, officials said, because the company did not participate in many of the online marketplaces, but it did see more customers for its Medicaid plans. Officials are considering a bigger role in the marketplaces next year.

The New York Times: Health Law Bellwether, UnitedHealth Posts Lower Profit
The UnitedHealth Group, one of the nation's largest health insurers, reported lower earnings on Thursday, attributing its weak results in part to the federal health care law. It said profits were also weighed down by an expensive new drug to treat hepatitis C that costs $1,000 a pill (Abelson, 4/17).

The Wall Street Journal: UnitedHealth's Profit Falls Amid Health-Law Changes
UnitedHealth said the health law pushed down earnings by around 30 cents a share, including via taxes and cuts to government payments for Medicare Advantage, which is the private version of the federal benefit program. The company also said it lost around 90,000 customers from its business selling insurance to individual consumers, as it chose to play a very limited role in the law's public marketplaces where consumers shop for coverage. But the law also helped drive an increase of 255,000 people in UnitedHealth's Medicaid plans. … The company also highlighted more than $100 million in costs tied to hepatitis C treatment in the first quarter across its Medicaid, commercial and Medicare segments (Stynes and Mathews, 4/17).

Kaiser Health News: Capsules: Biggest Insurer Shocked With Hepatitis C Costs
UnitedHealth Group spent $100 million on hepatitis C drugs in the first three months of the year, much more than expected, the company said Thursday. The news helped drive down the biggest insurance company's stock and underscores the challenge for all health care payers in covering Sovaldi, an expensive new pill for hepatitis C (Hancock, 4/17). 

Related earlier coverage: There’s a Life-Saving Hepatitis C Drug. But You May Not Be Able To Afford It. (Appleby, 3/3).

The Associated Press: UnitedHealth's 1Q Profit Tumbles 8 Percent
UnitedHealth Group's first-quarter net income slid 8 percent as funding cuts to a key product and costs imposed by the health care overhaul dented the health insurer's performance. The Minnetonka, Minn., company said Thursday the overhaul and government budget cuts added about 35 cents per share in costs during the quarter (Murphy, 4/17).

The Star Tribune: UnitedHealth Sees Impact Of Health Law; Profit Falls 8%
UnitedHealth Group Inc. pointed a finger at the new U.S. health law and cuts to Medicare payments on Thursday as it worked through a difficult first quarter. The Minnetonka-based company said earnings were down 8 percent during the quarter, as it felt the full brunt of the Affordable Care Act for the first time. Yet despite a somewhat downbeat tone from executives in a morning conference call with analysts, UnitedHealth maintained its previously stated outlook for the rest of 2014 (Crosby and Ramstad, 4/17).

The Washington Post’s Wonkblog: The Nation’s Largest Insurer Thinks Obamacare Exchanges Are Doing Just Fine
After taking a pretty cautious approach to the launch of the health insurance marketplaces in 2014, the nation's largest insurer said it's looking to expand its Obamacare footprint in 2015. UnitedHealth Group, which is participating in just five public exchanges this year, said it's likely to join more insurance marketplaces in 2015 but didn't offer specifics (Millman, 4/17).

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Capitol Hill Watch

Sebelius Says No To Kansas Senate Run

Despite recent appeals from Democrats for outgoing Health and Human Services Secretary Kathleen Sebelius to run against Sen. Pat Roberts, R-Kan., she has declined. Meanwhile, The New York Times reports that political attack ads are now trying to offer positive alternatives.

The New York Times: Sebelius Says She’s Not Interested In Senate Run
Kathleen Sebelius, the soon-to-be former secretary of the Health and Human Services Department, said through a spokeswoman on Thursday that she was not interested in running for the Senate in Kansas, despite recent entreaties from Democrats (Peters, 4/17).

CBS News: Kathleen Sebelius In The Senate? Not Likely
When Kathleen Sebelius steps down from her post as Health and Human Services secretary in a few weeks, she may best be remembered for presiding over the disastrous HealthCare.gov rollout. But in addition to running a major federal agency for five years, Sebelius has an impressive record as a state leader in Kansas. Given that history, it's understandable that she may have toyed with the idea of running against Sen. Pat Roberts, R-Kansas, as the New York Times reported this week (Condon, 4/18).

The New York Times: Political Attack Ads, Often Negative, Try Instead To Accentuate The Positive
An ad by the group supporting Representative Steve Southerland II, Republican of Florida, focuses on his record of fighting President Obama’s health care law before it concludes, “Thank Steve Southerland for fighting to keep our health care decisions in our hands.” The shift is the product of several factors -- the renewed hope that positive commercials can break through the advertising clutter; lessons of the 2012 presidential race, when Mitt Romney and outside Republican groups largely failed to offer an alternate message to an onslaught of negative spots; and the increasing prevalence of stock footage made public by campaigns that makes producing positive ads easier (Parker, 4/17).

The Wall Street Journal’s Washington Wire: N.C. Sen. Hagan’s First Ad Takes On GOP’s Thom Tillis
Democratic Sen. Kay Hagan’s re-election campaign launched its first ad of the cycle on Thursday, targeting remarks by leading GOP candidate Thom Tillis, the speaker of the North Carolina House, about the Affordable Care Act as well as his handling of a sex scandal involving staffers in 2012. The 60-second radio spot, which will air statewide, quotes Mr. Tillis calling the health care law “a great idea.” It also says that Mr. Tillis supported creating a state health exchange in North Carolina. The ad’s voice-over asks: “So Thom Tillis thinks he can attack Kay Hagan over something he called a great idea? Watch close. Seems Thom Tillis wants it both ways” (Ballhaus, 4/17)

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Coverage & Access

Physician Groups Deciding How To Spend Health Care Dollars

The New York Times: Cost Of Treatment May Influence Doctors
Saying they can no longer ignore the rising prices of health care, some of the most influential medical groups in the nation are recommending that doctors weigh the costs, not just the effectiveness of treatments, as they make decisions about patient care. The shift, little noticed outside the medical establishment but already controversial inside it, suggests that doctors are starting to redefine their roles, from being concerned exclusively about individual patients to exerting influence on how health care dollars are spent (Pollack, 4/17).  

Earlier, related KHN story: Doctors Overlook Lucrative Procedures When Naming Unwise Treatments (Rau, 4/14).

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State Watch

State Highlights: Diabetes Telemedicine in Miss.

A collection of health policy stories from Massachusetts, Oregon and Mississippi.

Reuters: A Year After Marathon Bombs, Boston Hospitals Apply Lessons Learned 
The homemade bombs that ripped through the crowd at the finish line of last year's Boston Marathon, killing three people and injuring 264, showcased the city's medical talent but also taught valuable lessons in responding to a mass disaster. By all accounts, Boston's hospitals performed well after the attacks on April 15, 2013. While many of the wounded lost limbs and a large amount of blood, all who made it to a hospital survived (Herbst-Bayliss, 4/17).

The Oregonian: Oregon Providers Make Less From Medicare, And Health, Medical Culture Explain Why
The federal government recently released data on Medicare provider reimbursements, and one of the numbers jumps out: The median Oregon reimbursement per provider in 2012 was $18,890, compared to a national median of $30,265, according to The Oregonian's analysis. Similarly, in Oregon only 9 percent of providers received $100,000 or more, compared to 21 percent nationally. And 80 percent of Oregon providers received less than $50,000. Nationally, 62 percent received less than $50,000 (Budnick, 4/17).

Stateline: Managing Diabetes With Telemedicine
Diabetes afflicts more than 22 million Americans, or 7 percent of the total population, and the number of people diagnosed every year is skyrocketing. At a cost of $245 billion in 2012, the disease’s toll on the economy has increased by more than 40 percent since 2007, according to a recent report from the American Diabetes Association. Mississippi, which ranks second after West Virginia in the percentage of residents affected by the chronic disease, is taking steps to reduce devastating effects on the state economy and the overall health of Mississippians (Vestal, 4/18).

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Health Policy Research

Research Roundup: Colonscopy In The Countryside; Retiree Health Benefits; What Should Hip Surgery Cost?

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

JAMA Surgery: Rural-Urban Differences In Access To Specialist Providers Of Colorectal Cancer Care In The United States
Rural residents who commonly seek treatment for advanced stages of colorectal cancer have been thought to lack access to cancer screening and adjuvant therapy. ... Several theories have been postulated to explain these findings, some of which include low socioeconomic status, lower educational attainment, lack of insurance coverage, underinsurance, and travel distance to health care facilities. ... Colonoscopy is the most sensitive and specific test to screen for colorectal cancer in individuals older than 50 years. ... A rural-urban disparity exists in the density of gastroenterologists, general surgeons, and radiation oncologists who traditionally provide colorectal cancer screening services and treatment. This might affect access to these services and may negatively influence outcomes for colorectal cancer in rural areas (Aboagye, Kaiser and Hayanga, 4/16).

JAMA Dermatology: Characterizing The Relationship Between Free Drug Samples And Prescription Patterns For Acne Vulgaris And Rosacea
On a national level, the provision of samples with a prescription by dermatologists has been increasing over time, and this increase is correlated with the use of the branded generic drugs promoted by these samples. Branded and branded generic drugs comprised most of the prescriptions written nationally (79%), while they represented only 17% at an academic medical center clinic without samples. Because of the increased use of branded and branded generic drugs, the national mean total retail cost of prescriptions at an office visit for acne was conservatively estimated to be 2 times higher (approximately $465 nationally vs $200 at an academic medical center without samples) (Hurley, Stafford and Lane, 4/16).

Employee Benefit Research Institute: Reference Pricing For Health Care Services: A New Twist On The Defined Contribution Concept In Employment-Based Health Benefits
This analysis examines reference pricing, a form of defined contribution health benefits, where plan sponsors pay a fixed amount or limit their contributions toward the cost of a specific health care service, and health plan members must pay the difference in price if a more costly health care provider or service is selected. Reference pricing for hip and knee replacement, colonoscopy, magnetic resonance imaging (MRI) of the spine, computerized tomography (CT) scan of the head or brain, nuclear stress test of the heart, and echocardiogram were examined because these services have fairly uniform protocols .... Potential aggregate savings could reach $9.4 billion if all employers adopted reference pricing for the health care services examined in this paper (Fronstin and Roebuck, 4/15).

Georgetown University Health Policy Institute/The Commonwealth Fund: The Role Of Medicaid Managed Care In Health Delivery System Innovation
States are increasingly turning to Medicaid managed care as a key strategy to manage costs and encourage innovation in health care delivery. This report examines health care providers' perspectives on the role of managed care in improving health services for low-income adults in four communities: Milwaukee, Wisconsin; Oakland, California; Seattle, Washington; and Washington, D.C. It finds that providers do not generally perceive Medicaid managed care as a catalyst for delivery system reform. Fragmented delivery systems, limits on the types of services for which managed care organizations are at risk, and the volatility in managed care markets all present challenges to improving care delivery (Summer and Hoadley, 4/14).

The Kaiser Family Foundation: Retiree Health Benefits At The Crossroads
A marked and growing interest in shifting to a defined contribution approach for both pre-65 and post-65 retiree coverage is fueled by the employers desire to manage future costs. Increasing interest in moving from group coverage to non-group coverage is a trend that is particularly strong with respect to Medicare-eligible retirees for whom employers can facilitate access to non-group coverage through private exchanges. ... the new federal/state marketplaces are gaining at least the consideration by employers as a possible pathway through which the employer's pre-65 retiree population might gain access to non-group coverage (McArdle, Neuman and Huang, 4/14).

Mathematica/California Healthcare Foundation/RWJF: Moving Markets: Lessons From New Hampshire's Health Care Price Transparency Experiment
Over the last decade, New Hampshire has pioneered health care price transparency to support cost-conscious consumer behavior and, ultimately, to spur competition and increase efficiency among health care providers. In 2003, the state mandated one of the nation's first all-payer claims databases .... Based on interviews with a broad range of health care stakeholders and experts, ... the analysis [shows] that consumer use of NHHealthCost.org has been modest and that the program did not fulfill a primary goal of directly encouraging consumer price-shopping (Tu and Gourevitch, April 2014).

American Economic Journal: Human Capital And Productivity In A Team Environment: Evidence From The Healthcare Sector
Using panel data from a large hospital system, this paper presents estimates of the productivity effects of human capital in a team production environment. Proxying nurses' general human capital by education and their unit-specific human capital by experience on the nursing unit, we find that greater amounts of both types of human capital significantly improve patient outcomes. Disruptions to team functioning attributable to the departure of experienced nurses, the absorption of new hires, and the inclusion of temporary contract nurses are associated with significant decreases in productivity beyond those attributable to changes in nurses' skill and experience (Bartel et al., April 2014).

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

The New York Times: For Diabetics, Health Risks Fall Sharply
Federal researchers on Wednesday reported the first broad national picture of progress against some of the most devastating complications of diabetes, which affects millions of Americans, finding that rates of heart attacks, strokes, kidney failure and amputations fell sharply over the past two decades (Tavernise and Grady, 4/16).

Minnesota Public Radio: New Alzheimer's Studies Point To New Care Options
The number of people with the memory-stealing diseases like Alzheimer's is expected to skyrocket as the baby boom generation gets older. The way we care for people with dementia is the subject of some new reports published this week by Minnesota-based researchers. One report from the University of Minnesota suggests nursing homes need to undergo a culture shift in the way they assess and care for Alzheimer's patients. It recommends government policy changes that could encourage that kind of shift. Alongside that report this week, is separate research showing family caregivers can help keep Alzheimer's patients at home longer if they receive specific targeted support (Wurzer, 4/11).

The Boston Globe: 1 In 20 Adult Outpatients Misdiagnosed, Study Reports
At least 1 in 20 adult outpatients receives an incorrect diagnosis from their doctor, according to a new study. Sometimes the consequences are minor -- calling something an "allergy" when it’s really a cold, for instance. But in more than 6 million patients a year in the United States, such misdiagnosis could have major consequences, such as a dangerous delay in cancer treatment. "The question is, can we eliminate human error, and the answer is no," said Hardeep Singh, lead author of the paper, which appeared in the journal BMJ Quality & Safety (Weintraub, 4/16).

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Editorials and Opinions

Viewpoints: The Number Keeps Rising; New Fears About Census Fracus; Patients Lose As Insurers 'Play Games'

The Washington Post: The Affordable Care Act Comes In With Better-Then-Expected Numbers
Obamacare's critics have had a bad week. On Thursday, President Obama announced that 8 million people have enrolled in new health insurance plans through the Affordable Care Act's marketplaces, and a significant portion of them are young Americans. Yes, we need to learn more about the numbers. And yes, a lot needs to happen to complete the ACA’s phase-in. The debate about how well the law is working is not over. But the initial figures are encouraging, and Mr. Obama is right to insist that continued Republican demands for repeal are unproductive and unwise (4/17). 

The Wall Street Journal: What Sweden Can Teach Us About ObamaCare
President Obama has declared the Affordable Care Act a success—a reform that is "here to stay." The question remains, however: What should we expect to come out of it, and do we want the effects to stay? If the experiences of Sweden and other countries with universal health care are any indication, patients will soon start to see very long wait times and difficulty getting access to care (Per Bylund, 4/17). 

The Wall Street Journal: None Dare Blame ObamaCare
The White House and its media phalanx are claiming the Census Bureau fracas is nothing more than a search for a conspiracy where none exists. Yet revising its health insurance survey design will make it harder to measure ObamaCare's performance over time, and now we've learned that the choice to do so is even worse than we first wrote (4/17). 

The Washington Post: Is Cantor The Key To Medicaid Expansion In Virginia?
Seventh District Republican Rep. Eric Cantor has helped lead the fight against Obamacare. But the Republican majority leader’s continued tenure in the House of Representatives may be the key to allowing Democratic Gov. Terry McAuliffe to win the Medicaid expansion envisioned by the very law Cantor opposes. While counterintuitive, let’s examine this political logic (Norman Leahy and Paul Goldman, 4/17). 

Los Angeles Times: When Health Insurers Play Games, Patients Lose
Dr. Theodore Corwin, a plastic surgeon in Thousand Oaks for the last 30 years, has had run-ins with insurers before, but never one so aggravating — and pointless — as this. A 26-year-old woman recently came to his office complaining of back, neck and shoulder pain, as well as numbness in her hands and arms, resulting from her unusually ample bust. She's 5-foot-6, not overweight, Corwin said. She wanted a breast reduction. "There seemed to be no question that her pain and numbness was caused by her carrying this excessive weight," Corwin told me. "It seemed like a straightforward diagnosis." It wasn't, at least in the eyes of the young woman's insurer, UnitedHealthcare. Its response to both a policyholder and her doctor speaks volumes about the seeming priorities of our for-profit healthcare system (David Lazarus, 4/17).

Los Angeles Times: Reproductive Services: The Hoag Hospital Compact
When Hoag Hospital, which has facilities in Irvine and Newport Beach, announced it was establishing a partnership with St. Joseph Health System, community groups say they were promised that the hospital would continue to provide the same services it always had. But soon after — and not all that surprisingly, given that St. Joseph is Catholic-run — Hoag declared that it would stop providing elective abortions (4/17).

Bloomberg: Good News For Paul Ryan's Medicare Plan
It didn't attract much attention, but the Congressional Budget Office has changed the way it looks at the Republican plan for Medicare -- and its new look at the issue is good news for the plan's chief sponsor, House Budget Committee Chairman Paul Ryan (Ramesh Ponnuru, 4/17).

Fox News: ObamaCare Proxy War? Republicans Could Use Burwell Nomination As Leverage
A 96-love Senate confirmation vote to run the White House budget office might not mean much -- when the person who secured that support is now up to run the Department of Health and Human Services. And by fiat, ObamaCare. Such is the lot facing Sylvia Mathews Burwell, whom President Obama tapped to succeed outgoing HHS Secretary Kathleen Sebelius (Chad Pergram, 4/17).

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Stephanie Stapleton

Andrew Villegas

Lisa Gillespie
Shefali Luthra

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