Daily Health Policy Report

Thursday, May 1, 2014

Last updated: Thu, May 1

KHN Original Reporting & Guest Opinion

Health Reform

Health Care Marketplace

Capitol Hill Watch


State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Medicare Seeks To Stop Overpayments For Hospice Patients' Drugs

Reporting for Kaiser Health News, in collaboration with The Washington Post, Susan Jaffe writes: “New Medicare guidance taking effect today aims to stop the federal government from paying millions of dollars to hospice organizations and drug insurance plans for the same prescriptions for seniors. But the changes may make it more difficult for dying patients to get some medications, senior advocates and hospice providers say” (Jaffe, 5/1). Read the story.

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Capsules: WellPoint Softens Forecast For Obamacare Rate Hikes

Now on Kaiser Health News’ blog, Jay Hancock reports: “Welcoming a surge of young, last-minute enrollees, the biggest player in the health law’s insurance marketplaces on Wednesday tempered its prediction for substantial 2015 rate increases” (Hancock, 4/30). Check out what else is on the blog.

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Missouri Medicaid Bill Wins Symbolic Committee Vote

The St. Louis Post-Dispatch's Virginia Young, working in partnership with Kaiser Health News, reports: " In what Missouri House Insurance Committee Chairman Chris Molendorp acknowledged was a symbolic move, a Medicaid expansion measure gained its first committee endorsement of the year today. Molendorp, R-Belton, and the four Democrats on his committee combined to recommend a wide-ranging bill that would expand the public health insurance system to about 300,000 low-income adults. The vote was 5-2, with five Republicans absent" (Young, 4/30). Read the story.

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Political Cartoon: 'Bully Pulpit?'

Kaiser Health News provides a fresh take on health policy developments with "Bully Pulpit?" by Mike Luckovich.

Here's today's health policy haiku: 


Insurance payments 
The glass might be two-thirds full
Or one-third empty

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

Health Law Gives Boost To U.S. Economy

Health spending grew at its fastest rate since the third quarter of 1980 -- a development attributed to the health law's implementation -- and thereby helped lift the nation's GDP by 1.1 percentage points.

Reuters: Obamacare Puts A Floor Under U.S. Economy In First Quarter
As the U.S. economy teetered on the brink of contraction in the first quarter, one thing stood out. Health care spending increased at its fastest pace in more than three decades. That surge is attributed to the implementation of President Barack Obama's signature health care law, the Affordable Care Act, also known as Obamacare. Because of Obamacare, the nation narrowly avoided its first decline in output in three years (Mutikani, 4/30).

The Fiscal Times: Obamacare Boosted Health Care Spending -- And GDP
Health care spending grew at the fastest rate in three decades in the first quarter of the year, boosting GDP growth by 1.1 percentage points -- enough to lift the overall economy from contraction to modest 0.1 percent expansion. The Bureau of Economic Analysis (BEA) said Wednesday that health care spending grew by 9.9 percent -- the fastest surge since the third quarter of 1980, when spending on health care shot up by 10 percent. In a note accompanying the data release, the BEA said the jump reflected “additional spending associated with the implementation of the Affordable Care Act.” The agency noted, though, that because the preliminary data used in preparing the GDP report did not reflect the effects of Obamacare, its estimates of health care spending were based on Medicaid benefits, enrollment data from the new insurance exchanges and other information. That means the data could be heavily revised in the next two months (Ehley, 4/30).

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Big Companies Likely To Move Employees To Health Exchanges

A new investor report predicted that nearly all workers' coverage would shift by 2020, triggering trillions in savings for employers by 2025.

The New York Times’ The Upshot: Implications For Employers In New Health Care Law
As the Affordable Care Act goes from thousands of pages of legalese to actual, real-life public policy, the future of employer-provided health insurance is one of the most fascinating questions. Will employers call for -- and their workers accept -- the practice of buying health insurance through government exchanges? How much will companies save, and will they pass those savings onto employees? Will it make workers more mobile and ready to shift jobs, or will employer-paid health insurance become a sought-after perk? (Irwin, 5/1).

McClatchy: Report: Large Employers Could Shift Nearly All Workers’ Health Coverage To Marketplace By 2020
A new investor report predicts that Standard & Poor's 500 companies could shift 90 percent of their workforce from job-based health coverage to individual insurance sold on the nation's marketplaces by 2020. If all U.S. companies with 50 or more employees followed suit, they could collectively save $3.25 trillion through 2025, according to the report by S&P Capital IQ, a division of McGraw Hill Financial. Standard & Poor's 500 companies could save $689 billion over the same period if they did likewise, the report found (Pugh, 5/1).

Politico Pro: Report: Big Companies Could Save Big Under ACA
A new report predicts that Obamacare will prompt most major companies to drop employees from health plans by 2020 and instead send them to the new insurance marketplaces for coverage. While the vast majority of large corporations currently provide workers with health benefits, a study by S&P Capital IQ suggests that publicly traded companies could save $700 billion by 2025 if they respond to incentives laid out in the Affordable Care Act. Those incentives include federal premium subsidies for low- and moderate-income Americans and a cap on how much companies can require workers to pay for employer-sponsored coverage (Cunningham, 5/1).

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State Exchanges Spent Far More To Reach Consumers

States that ran their own insurance marketplaces under the health law or those that partnered with the federal government spent significantly more on outreach and enrollment efforts than states that used the federal marketplace, according to a study funded by the Robert Wood Johnson Foundation. 

McClatchy: States Using Federal Marketplaces Spent Far Less On Enrollment Assistance
State-run and partnership marketplaces spent vastly more on enrollment efforts than states that used the federal marketplace, according to a new report by the Robert Wood Johnson Foundation. The five states with state/federal partnership marketplaces spent an average of $31.53 per uninsured resident for consumer enrollment assistance, according to the study conducted by researchers from the University of Pennsylvania’s Leonard Davis Institute of Health Economics. The nation's 16 state-run marketplaces averaged $17.15 per uninsured resident, while the 29 states relying on the federal HealthCare.gov website spent an average of just $5.42 per uninsured resident (Pugh, 4/30).

The Hill:  State O-Care Exchanges Spent More On Outreach
State-based health insurance marketplaces spent three times more than the federal exchange per uninsured person to educate the public about ObamaCare coverage, according to a new analysis. The findings from the Robert Wood Johnson Foundation underscore the difference between exchanges set up by the federal government and those set up by states whose leaders generally agreed with the healthcare law (Al-Faruque, 5/1).

The Chicago Sun-Times: Among Federal 'Obamacare' Partners, Illinois Spends Least On Signing Up New Patients
Among the five states partnering with the federal government to get people signed up for health insurance through the Affordable Care Act, Illinois spent the least amount per person, a new report says. Funding for these states ranged from $25.76 per eligible uninsured person in Illinois to $67.39 in Delaware, according to a Robert Wood Johnson Foundation-funded study. The federal and state funds went to paying for so-called navigators, in-person counselors or certified application counselors — all hired to help people who have needed help enrolling in different health insurance options made available for the first time by 'Obamacare' (Thomas, 4/30).

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State-Based Marketplaces Want Feds To Decide Who Is Exempted From Mandate

At least seven states have criticized an administration proposal to make state-run marketplaces responsible for determining eligibility for mandate exemptions. Meanwhile, Oregon's Legislative Counsel's Office says the exchange board does not have authority to scrap the state exchange in favor of the federal one. The legal opinion is not binding.

The Washington Post's Wonkblog: The Obamacare Change That's Unpopular In Blue States
State-run health insurance exchanges are squabbling with the Obama administration over who should be responsible for deciding who deserves a free pass from Obamacare’s unpopular individual mandate. At least seven state exchanges have sharply criticized an administration proposal that would shift responsibility for determining eligibility for mandate exemptions onto the state-run marketplaces in the 2015 enrollment period, scheduled to open Nov. 15. The states warn they don't have the technical ability or funding to handle requests from people seeking a pass from the Affordable Care Act’s requirement to obtain insurance coverage or pay a fine. Some states have urged the Department of Health and Human Services to dump the proposal, while others are asking to delay its implementation by at least a year (Millman, 4/30).

The Oregonian: Cover Oregon: Legal Opinion Could Toss Exchange Into More Turmoil
In the latest wrinkle for the state’s problem-plagued health care exchange, a new legal opinion says the Cover Oregon board does not have the authority to dump the state exchange and switch to the federal one, as the board said Friday that it plans to do. The opinion from Oregon’s Legislative Counsel Office, issued Tuesday, is not binding. But it threatens to throw the exchange, with a website that has never fully worked despite a cost of $248 million, into more turmoil (Zheng, 4/30).

Minnesota Public Radio: MNsure Names Leitz Its Permanent CEO
MNsure's board of directors has decided to give interim CEO Scott Leitz the job permanently. Credited with improving the operation of the online health insurance marketplace, Leitz will lead the organization through a critical time. He and MNsure leaders must decide whether MNsure's technical infrastructure can be salvaged or scrapped (Stawicki, 4/30).

The Star Tribune: Interim CEO Leitz Gets Nod To Lead MNsure Long Term
The MNsure board of directors on Wednesday gave its full support to Scott Leitz to run the agency for the future. Leitz has been serving as interim CEO since mid-December, when former director April Todd-Malmlov resigned over technical problems with the online health insurance exchange. "Scott's created some positive momentum, and I'd like to remove doubt about the leadership of the organization and remove the 'interim' from his title,” MNsure board Chairman Brian Beutner told members. The board discussed instituting a national search, but decided to put that off (Crosby, 5/1).

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Virginia Gov. Says Legislation Is Way To Medicaid Expansion

In Missouri, the expansion gets a symbolic committee endorsement, and the governor proposes using federal dollars to help pay for coverage for low-wage earners.

The Richmond Times-Dispatch: McAuliffe Says He Wants Medicaid Expansion Through Legislation
Gov. Terry McAuliffe pressed Wednesday for legislative action on Medicaid expansion and declared that he will not allow a government shutdown should the protracted budget battle endure. Asked on WTOP radio about the possibility of pursuing expansion through executive action, McAuliffe said with a laugh: “Everybody says that. I’d like them to tell me and all my lawyers exactly how we do that.” “This is a very complicated topic,” he added. “I ran saying I want to work in a bipartisan way. I want to get this done legislatively. It’s the right thing to do for us all to work together” (Meola, 4/30).

The St. Louis Post-Dispatch: Medicaid Bill Wins Symbolic Vote, Inches Forward In Mo. House
In what Missouri House Insurance Committee Chairman Chris Molendorp acknowledged was a symbolic move, a Medicaid expansion measure gained its first committee endorsement of the year today. Molendorp, R-Belton, and the four Democrats on his committee combined to recommend a wide-ranging bill that would expand the public health insurance system to about 300,000 low-income adults. The vote was 5-2, with five Republicans absent (Young, 4/30). 

Kansas Health Institute: Missouri Governor Proposes Health Assistance For Working Poor
Missouri Gov. Jay Nixon is proposing that the state use federal health dollars to subsidize health insurance for low-wage workers. Under a program he is calling Missouri Health Works, Nixon is proposing that the state pay a portion of employers’ health insurance costs for their employees that make below 138 percent of the poverty level, or $27,310 annually for a family of three (Sherry, 4/30).

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Woman Challenges Anthem's Health Law 'Narrow Network' In N.H.

And a new proposal from the Centers for Medicare and Medicaid Services would prohibit insurers from selling as full policies bare-bones "fixed benefit" plans, potentially exposing Democrats to midterm criticism.

The Associated Press: N.H. Patient Gets Hearing On Narrow Hospital Network
A Rochester woman will get a hearing after all on her hospital’s exclusion from the narrow provider network for individuals buying health insurance under the Affordable Care Act. State Insurance Commissioner Roger Sevigny agreed yesterday to hear a complaint from Margaret McCarthy, a patient at one of the 10 hospitals that were excluded from Anthem Blue Cross Blue Shield’s new network. Anthem had argued that McCarthy waited too long to ask for a hearing, but Sevigny said her request came less than 30 days after she found out how she would be affected by the new network and scheduled the hearing for May 14 (4/30).

The Fiscal Times: New Obamacare Fix Is Bad News For Democrats
A little-known proposed change to the president’s health care law could result in a new political nightmare for Democrats who are vulnerable in the 2014 midterm elections. Vox.com says the Centers for Medicare and Medicaid Services (CMS) issued a proposal in March that would prohibit insurers from selling fixed-benefit insurance plans as stand-alone policies. Fixed-benefit plans are so bare bones they don’t even qualify as actual health insurance under the Affordable Care Act’s individual mandate -- so people who are covered by these plans only are still subject to the penalty unless they qualify for an exemption (Ehley, 4/30).

And The Wall Street Journal looks at the uncertain and difficult world of forecasting health care costs --

The Wall Street Journal: Is This The Hardest Job In America?
The health law has reshaped the way insurers do business. Before the law, consumers often had to tell insurers if they had health conditions that might require pricey care, such as diabetes. Insurers could typically boost those consumers' premiums or refuse to cover them. Now, insurers must accept all comers and they get no health information on enrollees. That means that actuaries have little to go on when predicting medical costs -- and setting premiums. What's more, frequent regulatory tweaks from policy makers have forced actuaries to rejigger their projections and strategies on the fly. This is raising the stakes for actuaries, a word traced back to the Latin root for bookkeeper (Mathews, 5/30).

Earlier, related KHN coverage: Health Plans Scramble To Calculate 2015 Rates (Hancock, 4/28).

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Polls Show Continued Public Skepticism About Health Law

While slightly fewer than half of those polled by the Wall Street Journal and NBC think the law is a bad idea, only 21 percent want it repealed. Meanwhile, former President Bill Clinton criticized media coverage of the law, saying news organizations do a disservice by building a narrative and never straying from it, regardless of the facts.

The Wall Street Journal’s Washington Wire: Obamacare Ratings Steady Despite Busy Month -- WSJ/NBC Poll
Some 36 percent think the law is a good idea -- the same as in March 2010, when the law passed -- but up a bit from the 31 percent who supported it last September just before the law’s rollout. A steady 46 percent think the law is a bad idea, down slightly from the 50 percent peak in December 2013, but up a bit from 44 percent in September. Americans still feel that even if they don’t like the law, they don’t want it repealed. Only 21 percent of respondents thought it should be totally eliminated. Instead, 40 percent wanted to see “minor modifications to improve it” and another 28 percent said it needed a “major overhaul” (Radnofsky, 5/1).

Fox News: New Polls Show Public Skeptical About Impact Of Obamacare
New polls continue to show the public is skeptical about the impact of Obamacare, particularly when it comes to costs, something analysts have long warned about. “New Obamacare policies cost about 35 percent more and that increase can come in the form of higher premiums, higher deductibles or narrower networks," said Robert Laszewski of Health Policy and Strategy Associates. In the latest Washington Post poll, 58 percent of consumers said the new law is causing higher costs while only 11 percent said it is reducing them (Angle, 4/30).

The Washington Post: Bill Clinton Assails Media Coverage Of Obamacare
Former president Bill Clinton on Wednesday criticized the media in stark terms -- particularly for its coverage of Obamacare. In a lecture at Georgetown University, in Washington, D.C., Clinton said the media does the country a disservice by building a narrative and never straying from it, regardless of the facts (Rucker and Blake, 4/30).

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Health Care Marketplace

WellPoint Walks Back Forecast Of Big Rate Hikes

Company officials said that 2015 rates will vary by market but given a late surge of younger enrollees, increases may not be as high as initially projected. Meanwhile, Cigna's first quarter profits surged on its group disability and life operations.

The Associated Press: WellPoint Falls 21%
WellPoint's first-quarter net income fell 21 percent as the nation's second-largest health insurer adjusted to coverage changes introduced by the health care overhaul. But the Blue Cross Blue Shield insurer touted the underlying strength of its business and once again raised its 2014 forecast after reporting on Wednesday quarterly earnings that topped Wall Street expectations. Its stock climbed in premarket trading after it released results. The federal overhaul expanded coverage to millions of people starting this year, but the law also enacted taxes and fees, as well as changes to how insurers write their coverage (4/30).

The Washington Post’s Wonkblog: Major Obamacare Insurer Backs Away From Double-Digit Rate Hike Prediction
Company officials were more cagey about expectations Wednesday. Several analysts asked about expected rate increases for next year, including one analyst who asked specifically whether the insurer expects double-digit rate increases and if it felt any pressure to keep down rates after a meeting with President Obama this month. “Rates will vary by market, but given this information, they may not be what we thought from previous reports,” Wellpoint said Wednesday in an e-mailed statement (Millman, 4/30).

Kaiser Health News: Capsules: WellPoint Softens Forecast For Obamacare Rate Hikes
Welcoming a surge of young, last-minute enrollees, the biggest player in the health law’s insurance marketplaces on Wednesday tempered its prediction for substantial 2015 rate increases (Hancock, 4/30).

The Wall Street Journal: WellPoint Reports Lower Profit But Growth In Membership
WellPoint said it had enrolled around 400,000 new members through the health-law marketplaces, and expected the total would be above 600,000 when sign-ups through mid-April are added. The insurer said its marketplace sign-ups had gotten younger as the enrollment period progressed, and it reiterated that it expected margins of around 3% to 5% on the business. Chief Financial Officer Wayne DeVeydt said factors including the ramp-up in the fee the government is charging insurers under the health law would impact marketplace premiums next year, but he said the overall pricing trend would vary by market. The insurer's experience is being closely watched because of its big position in the new government marketplaces (Mathews and Rubin, 4/30).

The Associated Press: WellPoint Helps Investors Breathe Easy On Overhaul
Investors pushed WellPoint shares closer to their all-time high price on Wednesday after the company raised its 2014 forecast again and became the latest health insurer to ease some worry about a key health care overhaul coverage expansion. The Blue Cross Blue Shield insurer estimates that it will add more than 600,000 customers through state-based public insurance exchanges that started accepting enrollment last fall, and it said it still expects to make money from that business (4/30).

The Wall Street Journal: Cigna Profit Surges On Improved Group Disability, Life Operations
Cigna Corp. said its first-quarter profit surged as the company posted higher revenue, particularly from its group disability and life operations. The results easily topped analysts' expectations. … The health insurer said in February that it expected to lose money on health-care exchanges this year as enrollment numbers looked soft in the early going, particularly after a series of technical glitches in the federal HealthCare.gov site that slowed registration (Calia, 5/1).

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Capitol Hill Watch

GOP Report Finds Two-Thirds Of Enrollees Have Paid Premiums

The Obama administration questioned the accuracy of the numbers, saying they do not reflect reports from insurance companies themselves, most of which have indicated that 80 to 90 percent of enrollees have paid up.

The New York Times: Not All Health Care Premiums Are Paid Up, House Panel Says
A House committee said Wednesday that only two-thirds of people signing up for private health insurance in the federal exchange had paid their premiums by April 15. Without payment, consumers will not have coverage. The Obama administration questioned the accuracy of the numbers, but provided none of its own. Republican leaders of the panel, the House Committee on Energy and Commerce, said they had obtained the data from all insurance companies participating in the federal marketplace (Pear, 4/30).

The Wall Street Journal: Report: Two-Thirds of Insurance Exchange Enrollees Paid Premiums
Around two-thirds of people who had picked insurance plans through HealthCare.gov paid their first month's premium by April 15, according to a report released Wednesday by Republican lawmakers using data from insurers. The GOP-led House Energy and Commerce Committee asked for payment data from 160 health plans selling policies in the Affordable Care Act's federal insurance exchange. The committee's leaders said that responses showed that across the 36 states served by the federal exchange, 67% of people who had finished the sign-up process had made the premium payment to insurers and had been enrolled in coverage as of April 15 (Radnofsky and Mathews, 4/30).

The Associated Press: GOP: Health Signups Lagging
House Republicans issued a report Wednesday saying that one-third of people who signed up for health insurance through new federal exchanges hadn’t paid their first month’s premium as of mid-April, which could undermine the Obama administration’s claims of robust enrollment under the new health law (4/30).

CBS News: Many Obamacare Enrollees Haven't Paid Their Premiums Yet - Why Not?
Health and Human Services Secretary Kathleen Sebelius said as much herself: "You are not fully enrolled [in Obamacare] until you pay your premium." Yet data collected by the Republican-led House Energy and Commerce Committee shows that as of April 15, just 67 percent of enrollees in the federally-run Obamacare marketplace had paid their first month's premiums. There are a variety of factors that explain why more than 30 percent of enrollees have yet to pay (Condon, 5/1).

Fox News: House GOP: Just 67 Percent Of Federal ObamaCare Enrollees Have Paid Premiums
Just 67 percent of Americans who purchased insurance through federal-facility ObamaCare exchanges have paid their premiums, according to information insurers participating in the program gave to Congress. The information was compiled by the GOP-led House Committee on Energy and Commerce, as Americans wait to learn enrollment details from the Obama administration, two weeks after the April 15 enrollment deadline. However, Aaron Albright, a spokesman for the Centers for Medicare and Medicaid Services, said Wednesday night, "These claims are based on only about half of the approximately 300 issuers in the federally-facilitated marketplace and they do not match up with public comments from insurance companies themselves, most of which indicate that 80 to 90 percent of enrollees have paid their premium. Additionally, given the significant surge in enrollments at the end of March, it stands to reason that not all enrollees would have paid by the date of this so-called report since many people’s bills were not even due yet” (4/30).

CQ HealthBeat:  With Eyes on Health Law, Appropriators Aim to Block Census Changes
House appropriators would block a planned change to the Census Bureau’s questions on health insurance, amid GOP concerns that it could mask the effects of the health care law on the insured population.The draft fiscal 2015 spending bill for the Commerce Department, Justice Department, and science agencies would instruct the Census Bureau to continue using the same health insurance questions it has used in previous years for its annual population survey. The House Appropriations Commerce-Justice-Science Subcommittee approved the bill Wednesday (Ethridge, 4/30).

Meanwhile, Republicans plan to focus on health law criticisms in confirmation hearings of the president's nominee to head HHS -

Reuters:  Republicans To Push Anti-Obamacare Message In U.S. Senate Hearings
Republicans are relishing the chance to use confirmation hearings for Sylvia Mathews Burwell, President Barack Obama's nominee as U.S. health secretary, to re-energize their election-year attacks on his signature healthcare initiative. Republicans, who are seeking to take control of the Senate in the Nov. 4 congressional elections, view a pair of Senate hearings for Burwell as their best chance to put a spotlight on Obamacare since the program's botched rollout in October (Morgan, 5/1).

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Hill Panel Presses Medicare After IG Reports Fraud Cost $50 Billion Last Year

Lawmakers from both parties lash out at an official who has just taken over the agency in charge of cutting waste.

USA Today: House Panel Seeks Improved Medicare Fraud Efforts
Improper Medicare payments cost about $50 billion last year, a Health and Human Services official told a House panel Wednesday, testimony that prompted a rare display of bipartisanship in a usually divided House. The traditional Medicare fee-for-service program lost $36 billion, while Medicare Advantage lost $11.8 billion, said Gloria Jarmon, HHS' deputy inspector general. Improper payments in the fee-for-service program made up 10% of all payments in 2013, up for 8.5% in 2012, she said (Kennedy, 4/30).

The Hill:  Lawmakers Question 'Lack Of Leadership' On Medicare Fraud
Lawmakers Wednesday tore into the Centers for Medicare and Medicaid Services' (CMS) newly appointed director of the Center for Program Integrity for reports of massive Medicare fraud. House Ways and Means Health subcommittee Chairman Kevin Brady (R-Tx.) told Shantanu Agrawal that the agency needs to be more proactive after the Office of Inspector General reported that Medicare fraud costs taxpayers over $50 billion (Al-Faruque and Viebeck, 5/1).

CQ HealthBeat: CMS Fraudbuster Draws Bipartisan Fire at House Hearing
Questioning of the Centers for Medicare and Medicaid Services' newly appointed fraudbuster shaded more toward the curt than the courteous at a House subcommittee hearing Wednesday afternoon, with Shantanu Agrawal drawing bipartisan criticism for his agency’s failure to remove Social Security numbers from Medicare cards. "Frankly, not to take it personally, you ought to be embarrassed," Rep. Jim Gerlach, R-Pa., told Agrawal, who on March 3rd was appointed as a deputy CMS administrator and as a director of the CMS Center for Program Integrity (Reichard, 4/30).

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Medicare Proposes That Hospitals Provide More Transparency On Prices

In a proposed rule, federal officials lay out new regulations for hospitals that include offering a standard list of prices, the new federal payment rates, observation care and readmissions.

The Hill:  New Price Transparency Rules For Hospitals
Hospitals will be required to release a standard list of prices for their medical services under a new rule proposed by the Centers for Medicare and Medicaid Services (CMS). Instituted as part of the Affordable Care Act, the requirement can also be fulfilled if hospitals allow the public access to the data after an inquiry, CMS said (Viebeck, 5/1).

Modern Healthcare:  Proposed Medicare Rule Would Mean Less Money For Many Hospitals
Medicare payments for inpatient treatment at acute-care hospitals will decrease by $241 million in fiscal 2015 under a proposed rule issued by the CMS on Wednesday. The proposed change would affect roughly 3,400 hospitals nationwide. In addition, the CMS proposes increasing Medicare payments to long-term-care hospitals by 0.8% in 2015, a bump of $44 million. The change in payment methodology would affect 435 facilities. ... In response to the hostile response from healthcare providers to the so-called two-midnight rule, the agency asks for suggestions from healthcare providers on ways Medicare might approach reimbursement for short hospital stays. The American Hospital Association is suing the CMS over the policy, which indicates that most hospital visits that don’t span two midnights should be billed as outpatient observation care (Demko, 4/30).

CQ HealthBeat:  Medicare Proposes Hospital Inpatient Payment Updates
General acute care hospitals would get a 1.3 percent Medicare payment rate increase and long-term acute care facilities an 0.8 percent hike in fiscal 2015 under a proposed rule issued late Wednesday by the Centers for Medicare and Medicaid Services. The proposal would adjust payment reductions for unnecessary hospital readmissions from the current 2 percent to 3 percent. And hospitals that perform poorly in keeping patients from acquiring infections in their facilities would see inpatient payments cut by 1 percent (Reichard, 4/30).

And in another Medicare announcement - 

Kaiser Health News: New Medicare Procedures Seek To Stop Overpayment Of Drugs For Hospice Patients
New Medicare guidance taking effect today aims to stop the federal government from paying millions of dollars to hospice organizations and drug insurance plans for the same prescriptions for seniors. But the changes may make it more difficult for dying patients to get some medications, senior advocates and hospice providers say (Jaffe, 5/1).

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State Watch

State Highlights: Mich. Mental Health Funding Cuts; Ga. Rural Hospitals

A selection of health policy stories from California, Michigan, Georgia, Colorado, Florida and North Carolina.

Los Angeles Times: Senate Panel Backs Health Coverage For Those In The Country Illegally
A proposal to have the state fund an expansion of health care to cover low-income residents in the country illegally was advanced Wednesday by the state Senate Health Committee. Sen. Ricardo Lara (D-Bell Gardens) introduced SB 1005, which would use state money to expand Medi-Cal eligibility to those with an annual income of about $15,000 or less for one person but who have not been able to qualify because of their immigration status. People in the country illegally are prohibited from participating in the federal Affordable Care Act program providing subsidized care (McGreevy, 4/30). 

The Detroit Free Press: Funding Cuts Send Hundreds Of Mentally Ill Onto Detroit’s Streets 
Three months after the state released a plan to strengthen its network of services to mentally ill people, local agencies say funding cuts are endangering services to clients. In Detroit, downtown’s longtime, round-the-clock shelter for homeless and mentally ill people is scheduled to close at 6 a.m. today -- turning out hundreds of people until it reopens at 6 p.m. for 12-hour shifts (Erb, 5/1).

Modern Healthcare: Georgia Governor Acts To Bolster Faltering Rural Hospitals 
Rural hospitals in Georgia will be able to keep their licenses while offering a more limited array of services, thanks to the state's Department of Community Health approval this week of a plan advanced by Gov. Nathan Deal (Robeznieks, 4/30).

The Denver Post: Colorado Clinics Scramble To Find Place In New Health Care Environment 
Free and low-cost clinics around the metro area are scrambling to find their place in light of the Affordable Care Act and expansion of Medicaid. Some clinics that previously served only people without insurance are preparing to take Medicaid and even private insurance. Others are sticking with their mission of serving residents who don't qualify for insurance, even as that number dwindles (Kane, 5/1).

The Miami Herald: Tenet Healthcare Corp. Pays $5 Million To Settle False Claims Act Case 
Tenet Healthcare Corp., owner of four Miami-Dade hospitals, paid $5 million in December to settle a South Florida whistle-blower lawsuit alleging that the company paid kickbacks to doctors by allowing them to lease offices at below-market rates, among other favorable terms, in return for patient referrals -- a violation of federal and state laws. To settle the False Claims Act case, Tenet paid $4 million to the federal government -- with $1 million of that going to the South Florida landlord who was the whistle-blower in the case -- and an additional $1 million for legal fees and other costs. Tenet admitted no wrongdoing (Chang, 4/30).

North Carolina Health News: To Head Medicaid, Wos Taps Trusted Aid 
When state Medicaid chief Carol Steckel resigned her office last October after only eight months on the job, state health officials said they would look nationwide for a replacement to guide the agency through a promised reform process. But, in the end, Department of Health and Human Services Sec. Aldona Wos decided to tap one of her most trusted advisors, Robin Cummings, to run North Carolina’s Medicaid program (Hoban, 5/1).

Health News Colorado: Health Cost Commission Wins Nod From Lawmakers, Business Leaders
A new health cost commission will begin tackling the confounding problem of unsustainable health spending in Colorado by late summer if a bill passes the House and moves to the governor by next week. Senate Bill 14-187 would establish a bipartisan 12-member commission of experts on health costs and support it with $400,000 to hire staff, seek data from experts and commission studies on why Colorado has some of the highest health costs in the nation (McCrimmon, 4/30).

The Associated Press: GA Agency Awards $390K In Rural Health Care Grants
The Georgia Department of Community Health has awarded $390,000 in grants to bolster health care service in rural communities. The grants are being distributed by the department's Office of Rural Health, and officials said Wednesday that the agency has distributed more than $2.5 million in rural health care grants since 2007 (4/30).

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Weekend Reading

Longer Looks: New Views Of The 1918 Flu Pandemic; A Crumbling Mental Health System

Every week KHN reporter Marissa Evans finds interesting reads from around the web. ​​

CNN: A Fatal Wait: Veterans Languish And Die On A VA Hospital's Secret List
At least 40 U.S. veterans died waiting for appointments at the Phoenix Veterans Affairs Health Care system, many of whom were placed on a secret waiting list. The secret list was part of an elaborate scheme designed by Veterans Affairs managers in Phoenix who were trying to hide that 1,400 to 1,600 sick veterans were forced to wait months to see a doctor, according to a recently retired top VA doctor and several high-level sources. For six months, CNN has been reporting on extended delays in health care appointments suffered by veterans across the country and who died while waiting for appointments and care. But the new revelations about the Phoenix VA are perhaps the most disturbing and striking to come to light thus far (Scott Bronstein and Drew Griffin, 4/24).

WBUR: A Surprising New View Of Flu: Rethinking The 1918 Pandemic
Ever since 1918, the world has wondered why a novel flu virus touched off an explosive pandemic that killed as many as 50 million people – most of them healthy young adults — and whether it could happen again. Flu researchers today report some surprising news: They say the 1918 virus was no super-bug. Instead, its deadliness had to do with how very different it was from the flu viruses circulating 25 or 30 years before, when the young adults of 1918 were first exposed to the flu. Indeed, the new study says it's that first childhood exposure that determines how people will fight off – or fall prey to – every other flu virus they will encounter in a lifetime (Richard Knox, 4/28).

The Virginian-Pilot: Dangerous Minds, Insane System: Part I: Can't Hold Him
Bruce Williams couldn't sleep. It was after midnight and quiet in his Portsmouth apartment complex. Quiet, except for the voices in his head. He'd told people about them – the way they shrieked for violence, his fear they'd win. It's all there in his records. ... There was a time when someone like that would have been locked up in a mental institution. Not anymore. ... what happened in Apartment 433 was more than just another murder. It was a window into today's mental health care: a system as dysfunctional as the clients it serves. So gutted it has little power to put away even the most dangerous for any real length of time – and almost nowhere to keep them, even if it could. Last year's tragedy in [Virginia State] Sen. Creigh Deeds' family inspired at least 60 mental health bills in the General Assembly. Nothing emerged that will keep anyone any safer from someone like Williams (Janie Bryant, 4/27).

Vox: The $2.8 Trillion Question: Are Health Costs Growing Fast Again?
A four-year slowdown in health spending growth could be coming to an end. Americans' spending on health care spiked by 9.9 percent in the first quarter of 2014, new federal data shows. That data could be revised, or it could be a blip, but it adds to the evidence that health-care costs are back on the march — which is very, very bad news for the federal budget (Sarah Kliff, 4/30).

The Guardian: Antibiotics Are Losing Effectiveness In Every Country, Says WHO
Antibiotics are losing their power to fight infections in every country in the world, according to new data from the World Health Organisation – a situation that could have "devastating" consequences for public health. It raises the possibility that once-beaten diseases will re-emerge as global killers. Antibiotic resistance is a major threat to public health, says the WHO. It is no longer something to worry about in the future, but is happening now and could affect anybody, anywhere, of whatever age (Sarah Boseley, 4/30).

The New York Times: Are Med School Grads Prepared To Practice Medicine?
One night early in my internship, I received a frantic page for help from a fellow intern. Seasoned nurses had been unable to draw a patient's blood, which senior doctors had ordered be done if his fever spiked, so they'd called the covering doctor, the first-year resident on call. For more than an hour he had poked at the patient's arms and legs, littering the floor with blood-stained gauzes, used alcohol swabs and crumpled syringe and needle packaging. When the patient finally kicked him out of the room, howling, "I'll hit you if you come near me again!" he called the only people he thought he could: the other interns. "We didn't have to draw blood in medical school," he confessed, his eyes red behind his Harry Potter spectacles. "My med school didn't think it was important for us to learn" (Pauline W. Chen, 4/24). 

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Editorials and Opinions

Viewpoints: Health Overhaul Doesn't Necessarily Help The Sick; Single Payer Doesn't Mean Cheaper

The New York Times: The Problem With Free Health Care
Now that it's clear that Obamacare is here to stay, its supporters should focus on making the program better. Fixes are not a sign of weakness. They are a sign of responsiveness and of good management. And the Affordable Care Act does have its flaws. Here's a big one: It favors screening over diagnosis. ... In other words: A woman over 40 can have a free screening mammogram. But if she notices a breast lump and goes to her doctor to have it evaluated, she’ll pay for a diagnostic mammogram. That could cost $300. So the woman at lower risk for cancer — the one with no signs or symptoms of the disease — has an incentive to be tested, while the woman at higher risk — the one with the lump — faces a disincentive (H. Gilbert Welch, 4/30). 

The Wall Street Journal: The Coming Two-Tier Health System
With the unveiling of the Affordable Care Act's website, the public experienced a painful reminder of the consequences of the government's new authority over health care. While millions signed up for insurance, millions of others abruptly lost their existing coverage and access to their doctors because that coverage didn't fit new ObamaCare definitions (Scott W. Atlas, 4/30). 

Politico: Obama At A 'Dead Point'
The president keeps saying the debate over the health care law is over. If so, he lost it — at least the debate over whether the law is worthy of support. The March Obamacare enrollment surge hasn't brought springtime for President Barack Obama, just the soggy reality that he looks to be about as much of a drag on his party in November as anyone would have expected a few months ago (Rich Lowry, 4/30).

The Washington Post's The Plum Line: Schumer: Repeal Will Be Liability For McConnell In Kentucky’
Get this: Chuck Schumer thinks Mitch McConnell’s support for repealing health insurance for 400,000 people in his home state might actually become a political liability for him. This crazy notion comes in a fundraising email that Schumer is circulating for Kentucky Senate candidate Alison Lundergan Grimes. It can’t be true, of course, since it is an established fact that Obamacare can only be an enormous liability for Democrats in elections six months from now, and there can never be any pitfalls of any kind in the GOP repeal stance, no matter how many people end up enjoying the law’s benefits (Greg Sargent, 4/30). 

The New York Times’ The Upshot: Implications For Employers In New Health Care Law
As the Affordable Care Act goes from thousands of pages of legalese to actual, real-life public policy, the future of employer-provided health insurance is one of the most fascinating questions. Will employers call for — and their workers accept — the practice of buying health insurance through government exchanges? How much will companies save, and will they pass those savings onto employees? Will it make workers more mobile and ready to shift jobs, or will employer-paid health insurance become a sought-after perk? (Neil Irwin, 5/1).

Bloomberg: A Single-Payer System Won't Make Health Care Cheap
There are two potential outcomes for a "public option" health insurer: It could set rates high, in which case it wouldn't control costs, or it could jam them down to Medicaid levels, in which case no one but the very healthy or the very desperate would buy that insurance because it will be hard to actually use that coverage (Megan McArdle, 4/30).

Bloomberg: Is Obama A Bad Manager?
Or consider the fiasco of the October Healthcare.gov roll-out, which features prominently in many critiques of Obama’s management. Is it properly viewed as a sign of presidential failure? Or is it more accurate to conclude that no president can prevent all bureaucratic snafus, and that the real test is how a president mobilizes the bureaucracy to tackle the problem? By the first standard Obama fails; by the second, he does very well. There seems to be evidence to support both (Jonathan Bernstein, 4/30).

The Washington Post: Herring Rises, McAuliffe Falls
I was out of town part of last week, but I was taken aback by a poll by Christopher Newport University showing a switch in voter attitudes about expanding Medicaid for up to 400,000 Virginians. In February, a poll by the school found that a majority of voters favored Medicaid expansion, 56 to 38 percent. By April, it had switched to 53 percent opposed and 41 percent in favor. Quentin Kidd, the CNU political scientist who oversaw the poll, says the Republicans are winning the Medicaid debate. He is likely correct, and the fault is McAuliffe’s (Peter Galuszka, 4/30). 

Fort Wayne Journal Gazette: 'The Indiana Way': Hope Rises For Resolution Of Medicaid Impasse
It was, after all, only the second time an Indiana governor had visited the Neighborhood Health Clinics Inc., so the small group that awaited Mike Pence on Tuesday morning was excited about the chance to show him around. Not every community has a facility that's been providing health care to people regardless of their ability to pay for 45 years. Also auspicious on the rare bright spring morning was a sense that perhaps an impasse between Indiana and the federal government on expanding Medicaid may soon be broken. ... Pence praised NHCI and its staff and told them solving the health care challenge is on his mind every day. He said the state may be applying to the federal government within about a month for permission to pursue the expanded-HIP option in order to take care of Hoosiers "the Indiana way" (5/1).

The Fiscal Times: There’s No App For That: Why We Need A Health Care Shopping Guide
When you need work done on your car or bring a contractor into your home for some work, you can expect to get an estimate on what the job will cost. Even closing on a home mortgage and sale requires a comprehensive "good-faith estimate" of expenses before you sign on the dotted line. Unless you're paying out of pocket, that's rarely the case in health care, where bills mostly come after the service is performed, long after you've had a chance to shop around. Since most Americans rarely have to worry about the full cost of their medical bills — they are largely covered by employers — this isn't an issue. For those with high-deductible policies, choosing elective surgery or running businesses, though, getting treatment is a different ball game — one that requires honest and accurate upfront pricing disclosure (John F. Wasik, 4/30).

The Fiscal Times: Obama's Biggest Lie: The ACA Will Lower Health Care Spending
The economic news this week may have people wondering whether they have gone through the Looking Glass into Wonderland. The Bureau of Economic Analysis issued its advance estimate of first-quarter growth in 2014, which barely made it into the black with an annualized GDP growth rate of 0.1 percent. Even that terrible result – the worst quarter since 2012, and tied for second-worst since the start of the technical recovery in June 2009 – would have been worse without an explosion of health-care spending as Obamacare enters its first year of implementation. Not since 1980 has the American economy seen such a rapid expansion of health-care spending (Edward Morrissey, 5/1).

On other health care issues -

The New York Times' Room For Debate: Doctors In The Death Chamber
As a lethal mix of drugs left the murderer Clayton D. Lockett writhing and gasping before dying of a heart attack in the Oklahoma death chamber Tuesday night a doctor stood by to see if he had lost consciousness, and then died. Doctors have participated in lethal injections since they were first used, even injecting prisoners, despite professional guidelines that proscribe this. Should they be allowed to participate in executions without being disciplined? (4/30). 

news@JAMA: On Medicine And Money
As might have been anticipated, much of the media coverage of the release of the CMS data focused attention on health care professionals dubbed "Medicare millionaires" and their practice patterns. Tantalizing as such details might be, more profound issues were being sidestepped. In particular, little has been said with respect to the uncomfortable relationship between medicine and money. This is an unfortunate state of affairs, because the ethical and moral challenges associated with the juxtaposition of medicine and money are highly deserving of our attention (Eli Y. Adashi, 4/30).

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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.