Daily Health Policy Report

Friday, May 24, 2013

Last updated: Fri, May 24

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

California Insurance Exchange Rates: Not Too High, Not Too Low

Kaiser Health News staff writer Sarah Varney reports: "In the first disclosure of individual health insurance premiums by the nation's largest state, California announced on Thursday a wide array of choices for the 5.3 million people expected to qualify to purchase coverage through its online marketplace established by the Affordable Care Act" (Varney, 5/24). Read the story.

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Capsules: Mass. Advocates Want To Snuff Out Higher Premiums For Smokers

Now on Kaiser Health News' blog, WBUR's Martha Bebinger, working in partnership with KHN and NPR, reports: "The debate about whether smokers should pay more for health insurance has created unusual alliances. Tobacco companies are working alongside cancer societies and consumer groups to persuade states they should reject higher charges for smokers" (Bebinger, 5/24). Check out what else is new on the blog.

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Political Cartoon: 'An Old Dog's New Tricks?'

Kaiser Health News provides a fresh take on health policy developments with "An Old Dog's New Tricks?" by Hilary Price.

Meanwhile, here is today's health policy haiku:


California's rates...
What was it Goldilocks said?
Can they be just right?

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

Calif. Unveils Tentative Price Tags For Health Plans On The Exchange

The monthly cost for policies sold on the state-run exchange came in lower than the 30 percent rate increases some had anticipated, though some consumers will still experience sharply higher premiums. Blue Shield of California estimated that current customers would see rate increases of about 13 percent.

Kaiser Health News: California Insurance Exchange Rates: Not Too High, Not Too Low
In the first disclosure of individual health insurance premiums by the nation's largest state, California announced on Thursday a wide array of choices for the 5.3 million people expected to qualify to purchase coverage through its online marketplace established by the Affordable Care Act (Varney, 5/24).

Los Angeles Times: New California Health Insurance Rates Unveiled
Amid anxiety over rising costs from the federal healthcare law, California received better-than-expected insurance rates for a new state-run marketplace, but many consumers still won't be spared from sharply higher premiums (Terhune, 5/23).

The New York Times: California Puts Tentative Price On Health Policies Under New Law
State officials said that rate increases for individuals who already had insurance would not be as high as some had feared. Blue Shield of California, for example, estimated its current customers would see rate increases of about 13 percent. Some estimates had suggested rate increases could be 30 percent. The increases are largely the result of higher prices and the need to cover people who now have no insurance and are likely to have expensive medical problems (Abelson, 5/23).

The Washington Post: California's Likely Health Insurance Rates Under New Law Are Lower Than Expected
California health officials on Thursday unveiled the likely rates that insurers will charge under President Obama’s health-care law — and they are lower than expected, rebutting warnings by critics that many people will experience "rate shock" once the law is fully implemented. On average, a person who chooses a mid-level plan can expect to pay around $321 a month, about $100 less than the amount projected by the Congressional Budget Office when the law was being debated in Washington (Somashekhar, 5/23).

The Wall Street Journal: California Outlines Health Premiums
Early results around the U.S. indicate prices for exchange plans will vary widely—both from state to state and among consumers—as will the effect of the law on premiums. In states such as Vermont and Rhode Island, with regulations somewhat similar to the federal law's rules, the legislation is having little effect on premiums. In other places, like Maryland and Kentucky, there have been signs of sometimes-large rate increases. In California, "we're getting the best-case scenarios" on rates, with some "far lower" than projected in an actuarial report commissioned by the agency, said Peter V. Lee, executive director of Covered California. He said costs would go up for some consumers, and down for others (Mathews and Radnofsky, 5/23).

Reuters: California Reveals Prices For Health Insurance Under Obamacare
California unveiled prices on Thursday that consumers will pay for a selection of health plans offered through the state under the Affordable Care Act, providing a glimpse into how health care reform may look as it is rolled out across the nation. Under the federal health care reform law, Californians who do not get or cannot afford health insurance through their jobs can buy coverage through an exchange, at a group rate negotiated by state regulators (Bernstein, 5/23).

HealthyCal: Covered California Rolls Out Health Plan Choices, Rates
Today was a big day for Covered California, the new state-run marketplace for health insurance created under the federal Affordable Care Act. The health exchange rolled out the 13 regional and statewide plans that will be available to more than 5 million Californians eligible to buy coverage through the new system beginning Oct. 1 (Weintraub, 5/23).

CQ HealthBeat: Exchange Bids Suggest Overhaul On Track In Pivotal State Of California
The Obama administration got a respite Thursday from the rising chorus of inside-the-Beltway doubts about the health care law with news from California that its insurance exchange will offer residents in the individual market 13 plans at what officials said are affordable rates. The plans available for small businesses will be announced in June (Reichard, 5/23).

The Hill: ObamaCare Plans Cheaper Than Expected In Key Rate Filing
New insurance policies under President Obama's healthcare law will cost significantly less than expected in California. The state released rate filings Thursday for the policies that will be sold through the health law's insurance exchange (Baker, 5/23).

Sacramento Bee: California Health Exchange Reveals Premium Costs, Insurers
California's newly created health exchange announced the bottom line on its insurance policies and rates Thursday, bringing sharper focus to family impacts of next year's health care overhaul. Thirteen companies were selected to sell policies for the individual market through Covered California, a state-owned marketplace for comparing prices of coverage with identical benefits but different networks of doctors (Sanders, 5/24). 

CNN Money: Obamacare Premiums In California Lower Than Predicted
Health insurers in California will charge an average of $304 a month for the cheapest silver-level plan in state-based exchanges next year, according to rates released Thursday by Covered California, which is implementing the Affordable Care Act there. But many residents will pay a lot less than that for coverage. Rates will vary by region, age and level of coverage, and many lower-income Californians will qualify for federal subsidies that will greatly lower the premiums (Luhby, 5/23).

California Healthline: Exchange Premiums Closely Watched By Industry, Nation
California isn't the first state to announce premium rates and vendors in a new health benefit exchange, but the announcements this week from Covered California may carry more clout than those already announced -- and probably more than those yet to come. Covered California announced which health insurance plans will be offered and how much they'll cost when the new insurance marketplace opens for business this fall. It is another milestone in California's race to be ready for full implementation of the Affordable Care Act next year (Lauer, 5/23).

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Tensions, Threats Emerge In Ariz. Medicaid Expansion Debate

In addition, the legislative debate continues in Texas while in Florida there's speculation about what's to become of the state's uninsured population now that the legislature didn't take action.

Arizona Republic: Threat, Vetoes Fly As Tensions Rise Over Medicaid Expansion
Gov. Jan Brewer sent five bills to the scrap heap Thursday in a pointed gesture intended to prod lawmakers into a deal on the budget and her plan to expand Medicaid. The five vetoes, follow-through on Brewer’s promise to block legislation until her top priorities move forward, capped a tense day that saw some lawmakers receive threats over their support for the plan to provide health care for more of the state’s poor (Pitzl, 5/23).

The Associated Press/Washington Post: Republican Arizona State Representative Says She got Threatening Message Over Medicaid Support
A Republican member of the Arizona House who supports GOP Gov. Jan Brewer's push to expand Medicaid received an obscene and threatening voicemail at her office, a sign that the rancorous debate over embracing a signature component of President Barack Obama's health care overhaul in the state is far from over (5/23).

The Texas Tribune: Amendment On Medicaid Expansion Unlikely To Stick
An amendment that blocks Texas from expanding Medicaid without legislative approval doesn’t seem likely to stick. The House on Thursday knocked down a nonbinding motion to instruct conferees to keep the "anti-Medicaid expansion" amendment when they meet with Senate members to work out the final language of Senate Bill 7 (Aaronson, 5/23).

Health News Florida: Left Out: FL's Poorest Uninsured
At 7 a.m. on a Monday morning, poor people who don't qualify for government health programs such as Medicaid are lined up outside a health department building on a busy street in St. Petersburg…These are some of the people who will not gain health insurance when the federal health law kicks into high gear on Jan. 1. They'll be left out because they are in Florida, one of the states that turned down federal funds to cover adults below the poverty level – people with incomes under about $11,500 (Gentry, 5/23).

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Health Law Politics Swirl Around Scandal Reports, Implementation Frustrations

Some of the political ebb and flow is exactly as expected, with news reports noting that Rep. Michele Bachmann, R-Minn., a staunch opponent of the overhaul, is focused on linking the Internal Revenue Scandal with the health law. However, in other coverage, The Associated Press reports that some labor unions, which were strong advocates, have become increasingly frustrated with some aspects of the law, and The Hill notes that some business groups are voicing concerns about the measure's wellness program.

The Associated Press/Washington Post: Health Care Overhaul Faces Backlash From Once Supportive Labor Unions
When President Barack Obama pushed his health care overhaul plan through Congress, he counted labor unions among his strongest supporters. But some union leaders have grown frustrated and angry about what they say are unexpected consequences of the new law — problems that they say could jeopardize the health benefits offered to millions of their members (Hananel, 5/24).

The Hill: Businesses Share ObamaCare Wellness Program Worries With White House
Business groups are weighing in on an ObamaCare proposal governing incentives for employees to stay healthy. The White House is currently reviewing a proposed rule for wellness programs that give workers incentives to take part in healthy habits such as joining a gym, signing up for a weight-loss plan or participating in a scheme to stop smoking (Hattem, 5/23).

The Washington Post's The Fact Checker: Bachmann's Absurd Claim Of A Vast IRS Health Database Of 'Sensitive, Intimate' Information
With the Internal Revenue Service in the news, Rep. Michele Bachmann (R-Minn.) has taken the opportunity to marry that scandal with her ongoing battle against the president’s health care law, a.k.a. "Obamacare." The picture she has sketched is pretty frightening — that the "most personal, sensitive, intimate, private health care information is in the hands of the IRS" via a vast database. Indeed, even though our colleagues at PolitiFact and FactCheck.Org have beaten us to the punch on this language, the issues she has raised have generated enough buzz on the blogosphere that we believe we should weigh in as well. What is Bachmann talking about? (Kessler, 5/24).

McClatchy: Scandal Draws Questions About IRS Role In Enforcing Obamacare
The blossoming IRS scandal over the targeting of conservative groups is provoking new scrutiny and terse questions about the agency’s role in shaping and implementing the controversial new national health care law, with the biggest changes set to begin next year. The Internal Revenue Service is an important cog in the implementation of the Patient Protection and Affordable Care Act of 2010, commonly shorthanded as Obamacare. The tax agency must act on 47 provisions of the new law, more than half of those already in effect, including the more controversial ones taking effect in 2014 such as the requirement that nearly all non-elderly adults have health care coverage (Hall and Lightman, 5/23).

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Capitol Hill Watch

Health Care Issues Become Hurdle For Immigration Reform Measure

The key question that seems to have stalled progress for House lawmakers is how to handle immigrants who do not have health insurance.

Los Angeles Times: Immigrant Health Care Bills Stump House Group
Differences over whether immigrants should be deported for failing to have health insurance or pay their health care bills have stalled a bipartisan group of House lawmakers, who blew past a self-imposed Thursday deadline as they pressed forward on a sweeping immigration overhaul (Mascaro, 5/23).

The Wall Street Journal: House Immigration Effort Hits Bump In The Road
Last week, a bipartisan group of House lawmakers thought they had a broad deal on how to overhaul the immigration system. This week, they don't. The eight House lawmakers were forced to backtrack from the "agreement in principle" reached last Thursday after House Democratic leaders objected to a provision dealing with health care coverage for illegal immigrants living in the U.S., according to aides from both parties. The group continued to meet this week, and its members remained hopeful they would be able to strike a deal that passes muster among all involved (Peterson, 5/23).

Modern Healthcare: Taxpayers Won't Pay Health Care Costs For Undocumented Immigrants
Two days after the Senate Judiciary Committee passed a comprehensive immigration reform bill, House Minority Leader Nancy Pelosi (D-Calif.) promised that U.S. taxpayers would not bear the cost of health care coverage for undocumented immigrants who are on the path to citizenship. Earlier reports had hinted that the coverage provisions under the Patient Protection and Affordable Care Act might be a sticking point as House members draft their own immigration-reform legislation (Zigmond, 5/23).

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House Panel Considers Measure That Would Ban Abortions After 20 Weeks

The bill, which is national in scope, is a response to the conviction of abortion provider Kermit Gosnell as well as a range of new state laws.

NPR: Abortion Opponents Try To Spin Murder Case Into Legislation
As predicted, abortion opponents on Capitol Hill are wasting no time in their efforts to turn publicity over the recent murder conviction of abortion provider Kermit Gosnell to their legislative advantage (Rovner, 5/23).

Politico: House Panel Considers Abortion Bill
A bill banning most abortions after 20 weeks nationwide received consideration from a House panel on Thursday -- and the Kermit Gosnell case and recent court rulings provided a fresh backdrop. But the same familiar arguments in the fight over abortion dominated the discussion (Smith, 5/24).

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State Watch

State Highlights: La. Grand Jury To Examine $200M Medicaid Contract

A selection of health policy stories from Louisiana, Oregon, Connecticut, Kansas, North Carolina, California, and New York.

Modern Healthcare: States Delaying, Dropping Controversial Dual-Eligible Pilot Program
More than half of the states that applied to participate in a controversial CMS pilot for dual-eligible beneficiaries have either dropped out or delayed implementation of their programs, according to health policy experts. Among the 26 states that applied to participate in the CMS Financial Alignment Initiative, which stems from the Patient Protection and Affordable Care Act, six have dropped out or opted for different "customized" plans and nine have delayed their start dates (Daly, 5/23).

The Associated Press/Washington Post: Grand Jury To Look Into $200M Medicaid Contract Awarded By Jindal Administration
The Louisiana attorney general's office said a special grand jury was selected Thursday to look into possible criminal activity involving a $200 million Medicaid contract awarded by Gov. Bobby Jindal's administration. Assistant Attorney General Butch Wilson told a judge that the grand jury was being empaneled in Baton Rouge as part of an ongoing investigation into the now-canceled contract for Client Network Services Inc., or CNSI (5/23).

Lund Report: Regence Posts Strongest Profits In Oregon's Top Insurers
Regence BlueCross BlueShield of Oregon bolstered its position as the largest health insurance company in the state during the first three months of 2013. At the same, it also time delivered the strongest profits among large Oregon insurers. Regence BCBS total membership climbed by 18,800 lives during the first quarter of the year, to 491,702, and the insurer posted a $16.09 million profit, according to financial reports made available in the past week by the National Association of Insurance Commissioners (Sherwood, 5/23).

Oregonian: Nonprofit Health Insurers Often Beat For-Profits, But Not In Portland: Study
Nonprofit health insurers often beat the premiums of their for-profit competitors and usually provide better protections on out-of-pocket spending, according to a recent survey of six cities around the country, including Portland. Interestingly, in Portland the distinction between nonprofits and for-profits blurs, however. The survey, conducted by the free consumer information website, HealthPocket.com, analyzed more than 2,000 quotes, focused on individual female nonsmokers. It adds numerical context to the debate among health care insiders over the transformation of some nonprofit insurers (Budnick, 5/23).

CT Mirror: Senate Adopts Measure To Coordinate Care For Mentally Ill Children
The state Senate unanimously adopted a measure Thursday aimed at improving coordination between a wide array of caregivers and support services for children with mental illness. The bill, crafted in response to last December's tragic shooting at Sandy Hook Elementary School in Newtown, lays the groundwork for a more comprehensive, coordinated response by mental health agencies, schools and emergency mobile psychiatric services (Phaneuf and Becker, 5/23).

Kansas Health Institute: Network Execs Squabble Over Issue Of Exchange Connectivity
Following a heated exchange between two network chief executives, the board regulating digital health record exchange in Kansas voted Wednesday to prohibit the networks from charging each other connectivity fees until at least 2015. In Kansas, the exchange of digital patient information began last summer via two private networks licensed by the quasi-governmental Kansas Health Information Exchange, Inc. (KHIE) (Cauthon, 5/23).

North Carolina Health News: Bill Addresses Doctors & The Death Penalty
It’s been almost seven years now since the state of North Carolina carried out an execution, as the procedure has been subject to political pressure by anti-death penalty groups and caught up in court cases. One of the barriers to carrying out executions has been legal wrangling over the role of doctors in the procedure (Hoban, 4/24).

California Healthline: Task Force To Examine Developmental Centers
Diana Dooley, secretary of the state's Health and Human Services agency, yesterday announced formation of a task force to take a hard look at the viability of closing four developmental centers in California. "I don't know if the four developmental centers we operate can all close," Dooley said. …  Developmental centers in California have come under fire recently -- with allegations of chronic abuse of patients, investigations by multiple government agencies and loss of federal certification. The state has taken a number of steps, particularly at Sonoma Developmental Center, to investigate possible abuses and improve safety of the centers' clients (Gorn, 5/23).

The New York World: No Restraint At Drug-Dosing New York Nursing Homes
A year after a federal health agency vowed to sharply reduce the use of powerful antipsychotic drugs in nursing homes, prescriptions have declined only modestly -- and dozens of New York City facilities have actually increased their use of the medications. In May 2012, the Centers for Medicare and Medicaid Services announced an initiative to reduce antipsychotic use in nursing homes nationally 15 percent by the end of 2012 (Skinner, 5/23). 

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Health Policy Research

Research Roundup: Getting A Critical Care Doc At Night; Poverty Among Seniors

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

JAMA Internal Medicine: Firearm Legislation And Firearm-Related Fatalities In The United States – Researchers analyzed 121,084 firearms deaths in the U.S., using 2007 to 2010 data from the Centers for Disease Control and Prevention:  "The outcome measures were state-level firearm-related fatalities per 100 000 individuals per year overall, for suicide, and for homicide. In various models, we controlled for age, sex, race/ethnicity, poverty, unemployment, college education, population density, nonfirearm violence–related deaths, and household firearm ownership." They concluded that a "higher number of firearm laws in a state are associated with a lower rate of firearm fatalities in the state, overall and for suicides and homicides individually. As our study could not determine cause-and-effect relationships, further studies are necessary to define the nature of this association" (Fleegler et al., 5/13).

New England Journal Of Medicine: A Randomized Trial Of Nighttime Physician Staffing In An Intensive Care Unit – Previous studies suggest that the use of intensivists, doctors specifically trained in critical-care medicine, improve the outcomes of intensive care unit (ICU) patients. But studies analyzing the impact of nighttime staffing of intensivists in ICUs have shown mixed results. Researchers at the Hospital of the University of Pennsylvania compared nighttime staffing to the use of daytime intensivists who were available for phone-based consultation at night. More than 1,500 patients were included in their analyses. "We found no evidence that this staffing model, as compared with nighttime telephone availability of the daytime intensivist, had a significant effect on length of stay in the ICU or hospital, ICU or in-hospital mortality, readmission to the ICU, or the probability of discharge to home," the authors write. "In an academic medical ICU in the United States, nighttime in-hospital intensivist staffing did not improve patient outcomes" (Kerlin et al., 5/20).

Annals Of Family Medicine: Spreading A Medical Home Redesign: Effects On Emergency Department Use And Hospital Admissions – Patient centered medical homes (PCMH) emphasize long-term relationships between patients and providers as well as other attributes of primary care. This study analyzed how PCMHs in clinics owned by the Washington state insurance and health care system, Group Health Cooperative, affected health care use. The authors found that, one year after the implementation, Group Health patient visits to emergency departments significantly declined and there was a shift from face-to-face doctor/patient visits to greater use of secure messaging and telephone conversations.  "Group Health's experience in spreading its PCMH model shows that achieving PCMH transformation across a diverse set of primary care clinics is possible with a clear change strategy … and sufficient resources and supports," they conclude (Reid et al., May 2013).

Health Care Cost Institute: Health Care Costs From Birth To Death -- Using commercial and Medicare health care data, the author of this report (sponsored by the Society of Actuaries) analyzed cost differences based on age, sex and health status. He reports that costs are generally high in the two years of life and then drop by age 5. They pick up again in the teen years and for women increase during the child-bearing years. Among other key findings: "An aging population is not an overwhelming driver of health care spending. ... Health costs are twice as high for people with cancer or other chronic conditions. Older men are more costly than older women"  (Yamamoto, May 2013). 

Kaiser Family Foundation: A State-By-State Snapshot Of Poverty Among Seniors: Findings From Analysis Of The Supplemental Poverty Measure – The authors write: "During recent deficit reduction discussions, policymakers have put forth a variety of proposals to reduce Federal spending that would affect people on Medicare, including options that would shift costs onto beneficiaries ...  Based on the Census Bureau’s supplemental poverty measure, the poverty rate among people ages 65 and older is higher than is reflected in the official poverty measure, and is particularly high among seniors in some states.  ... Under the supplemental poverty measure, which deducts health spending from income, poverty rates could increase if beneficiaries were required to pay higher cost sharing or premiums for Medicare. ... The supplemental measure suggests that a greater share of seniors may already be struggling financially than is conveyed by the official measure" (Levinson et al., 5/20).

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

San Francisco Chronicle: 56% Of Patients Don't Follow Prescription
It might take more than a spoonful of sugar to help the medicine go down for many Americans. In a survey of more than 1,000 adult patients who are on prescription medication for chronic illnesses, 40 percent say they haven't followed doctor's instructions or have skipped taking their meds at least once in the past year. More than a quarter said they've stopped taking medications altogether or never even filled a prescription. It's a problem known as medication nonadherence and is linked to 125,000 deaths in the United States each year (Roethel, 5/21).

Medpage Today: Medical Home Transition Long But Worth It
The path to becoming a patient-centered medical home is long, rough, and varies for each practice, but getting there is essential to providing high-quality, affordable healthcare to all Americans, researchers concluded. The Agency for Healthcare Research and Quality (AHRQ) came to that conclusion in summarizing the results of 14 grants it issued in the summer of 2010 to understand the processes and determinants of transforming primary care practices. ... The results were published Monday in a special supplement of the Annals of Family Medicine (Pittman, 5/20).

Reuters: Health Sites Too Complex, Full Of Cliches: Study
The importance of health literacy hit home for Lisa Gualtieri when a Cambodian refugee diagnosed with cancer asked her to act as a patient advocate. … A new study, published Monday in JAMA Internal Medicine, suggests one potential reason for the family's confusion: Despite good intentions, many experts may be creating educational materials that are too difficult for patients and their families to grasp (Oransky, 5/20).

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Editorials and Opinions

Viewpoints: We Need More 'Socialism'; The IRS's 'Unwelcome Role'; 'Fog Of Obamacare'

Los Angeles Times: If This Health Plan Is 'Socialism,' We Need More Of It
So this is what socialism looks like: Private companies competing for people's business in an open marketplace. Californians got their first glimpse Thursday of what insurers plan to charge for coverage to be offered next year to about 5 million state residents who don't receive health insurance from employers (David Lazarus, 5/23).

The Washington Post: The Unwelcome Role Of The IRS In Obamacare
Thousands of new IRS agents will implement 40-odd provisions of the Patient Protection and Affordable Care Act — the exact number is a matter of dispute since the law itself is so confusing. The largest tax law and social policy change in a generation will be imposed on a skeptical public by a government agency whose credibility is in ruins. But the IRS is not merely implementing Obamacare. It engaged in a regulatory power grab to ensure that it could implement Obamacare (Michael Gerson, 5/23).

The Washington Post: The Fog Of Obamacare
You’ve heard of the "fog of war." Well, now we've got the fog of Obamacare. The controversial Affordable Care Act (ACA) has so many moving parts that it's hard to know how its implementation is proceeding. In 2014, many uninsured are supposed to get coverage either through insurance exchanges, where they can buy subsidized policies if their incomes are less than four times the federal poverty line, or through an expanded Medicaid. The trouble is that 20 or more states may reject the Medicaid expansion, and the exchanges aren’t yet finished. Much is unknown (Robert J. Sameulson, 5/23).

The New York Times' Economix: Debating Doctors' Compensation
Two themes run through the comments on previous blog posts that touched on the payment of the providers of health care. The first is that American doctors are paid too much. The second is that they are paid too little. Could both propositions be right? Let us explore the issue by looking at some numbers (Uwe E. Reinhardt, 5/24). 

New England Journal Of Medicine: The Gross Domestic Product And Health Care Spending
How much will the United States spend on health care during the next decade or two? The answer matters greatly to physicians, federal and state governments, businesses, and the general public. The answer will determine the type and extent of care that physicians can provide to their patients, as well as the amount of physicians' take-home pay. It will also determine how much everyone else can consume or invest in other goods and services. Unfortunately, forecasting health care spending is extremely difficult. Future spending depends in part on developments within the health care sector and in part on developments in the economy as a whole (Victor Fuchs, 5/22).

Boston Globe: Do I Miss My Breasts?
I had voluptuous breasts. I miss them, when I think about them. But I rarely think about them because I’m busy not missing my family’s milestones and ordinary moments. The kind of moments that I suspect Angelina Jolie does not want to miss. Jolie and I have more in common than being mothers and having sexy husbands. I, too, carry the BRCA1 gene alteration, a mutation that raises a woman’s lifetime risk of ovarian cancer to 40-60 percent and breast cancer to 50-80 percent (Ellen Roth, 5/22).

WBUR: Cognoscenti: The Power Of Knowing: A Daughter Who Chose BRCA Gene Testing, Against Her Mother's Will
When Angelina Jolie explained in The New York Times her decision to take action after discovering she carried the BRCA-1 mutation, I saw on social media so many women asking each other, Would you undergo genetic testing? Many expressed anger at Myriad (the company that owns the patent), at insurance companies (several do not cover the cost of the test), and at doctors they believe hold assumptions about organ removal. While some cited how removing one's organs could shorten or alter their lives, as could cancer itself, others judged individual preferences as "right" or "wrong" (Tracy Strauss, 5/24).

The New York Times' Doctor And Patient: Disability And Discrimination At The Doctor's Office
It's been nearly 23 years since the Americans With Disabilities Act, a federal law prohibiting discrimination against people with disabilities, went into effect. Despite its unequivocal language, studies in recent years have revealed that disabled patients tend not only to be in poorer health, but also to receive inadequate preventive care and to experience worse outcomes (Pauline W. Chen, MD, 5/23).

USA Today: Mental Illness Manual No 'Bible': Column
Unlike many other physical ailments, there are no acceptable scientific tests that can pinpoint mental disorders. A blood test won't tell doctors which of my son's diagnoses, if any, are accurate. Instead, psychiatrists must rely on a patient or family members to describe symptoms of the illness to make a diagnosis. The doctor then consults psychiatry's "bible" — the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) — to determine which diagnosis best fits the patient's symptoms. This process can be ripe for error, especially if a patient doesn't believe there is anything wrong, a common reaction during a psychotic break (Pete Earley, 5/23). 

The New York Times' Taking Note: Abortion After 20 Weeks
On the list of treasured Republican pastimes, trying to outlaw abortion and imposing a right-wing agenda on the District of Columbia (which is heavily Democratic and lacks any representation in Congress) both rank high. So it must have given Rep. Trent Franks of Arizona special pleasure to combine those hobbies by introducing a bill to ban abortion in D.C. after 20 weeks. But why stop there? (Andrew Rosenthal, 5/23). 

New England Journal Of Medicine: Under The Medical Tent At The Boston Marathon
Bright sunlight filtered through the awnings of the medical tent pitched in Copley Square, where I joined the many medical professionals caring for people who'd fallen ill from their 26.2-mile run. Some volunteers had been staffing the medical tent for years — one nurse had worked at the Boston Marathon more than 25 times. Sickened and stressed runners poured into our makeshift hospital. A runner stumbled in and vomited into a bag. We helped him onto a cot, where he sat shivering. "You're OK," a nurse said gently, wiping his face. But his core temperature had dropped to 96 degrees, and he began having violent rigors. We brought him Mylar blankets and hot bouillon (Sushrut Jangi, 5/23).

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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.