Daily Health Policy Report

Thursday, July 18, 2013

Last updated: Thu, Jul 18

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Health Reform

Health Disparities

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

White House Says Health Law Will Restrain Insurance Prices In 2014

Kaiser Health News staff writers Phil Galewitz and Julie Appleby report: "Ratcheting up the campaign to sell the health law, President Barack Obama was expected to deliver a speech Thursday touting how millions of individuals are benefiting from its insurance rebates, while others who buy coverage online in states such as California, New York and Oregon will pay lower-than-projected premiums" (Galewitz and Appleby, 7/18). Read the story.

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Hospitals May Soon Be Reaching For The Stars

Kaiser Health News staff writer Jordan Rau reports: "Star wars may be coming to a hospital near you. Medicare is considering assigning stars or some other easily understood symbol to hospitals so patients can more easily compare the quality of care at various institutions. The ratings would appear on Medicare’s Hospital Compare website and be based on many of the 100 quality measures the agency already publishes" (Rau, 7/18). Read the story.

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Capsules: House GOP Skeptical Exchange Information Will Be Secure; Tavenner Wasn't Consulted On Delaying Health Law's Employer Mandate

Now on Kaiser Health News' blog, Ankita Rao reports on discussions about the security of data used in the health insurance exchanges: "Henry Chao, a lead technology information officer from the Centers for Medicare & Medicaid Services, said officials have completed about 80 percent of the safeguards to protect privacy when the agency rolls out what it calls 'The Hub'" (Rao, 7/17).

Also, Rao reports on Marilyn Tavenner's comments regarding the Obama administration’s decision to delay the employer mandate: "Marilyn Tavenner said at a House subcommittee meeting Wednesday that she was not consulted on the Obama administration's decision to postpone a key part of the health law requiring employers offer health insurance plans to their workers" (Rao, 7/17). Check out what else is on the blog.

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Political Cartoon: 'Can't Stand The Wait?'

Kaiser Health News provides a fresh take on health policy developments with "Can't Stand The Wait?" by Rick McKee.

Meanwhile, here is today's health policy haiku:


Haven't made the sale
So now it is time for the
Number one pitchman

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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Capitol Hill Watch

House Votes To Delay Health Law's Mandates

Despite White House veto threats, House lawmakers on Wednesday OK'd two separate bills amending portions of the Affordable Care Act, the latest GOP moves to try to scuttle the health law. A measure putting off the employer mandate was approved 264-161 while a bill delaying the individual mandate passed 251-174.

The New York Times: House Votes To Delay Two Requirements Of The Health Care Overhaul
Defying a veto threat from President Obama, the House on Wednesday passed bills delaying two crucial parts of his health care overhaul that require most Americans to have insurance and many employers to offer it (Pear, 7/17).

The Washington Post: House Votes On Two Bills To Delay Parts Of Obamacare
The Republican-controlled House yet again passed legislation Wednesday that aims to change the Affordable Care Act. This time Republicans called for one-year delays on two key provisions, one requiring nearly all Americans to buy health insurance and the other requiring businesses with more than 50 full-time employees to provide coverage. The Obama administration has already delayed the requirement for businesses. President Obama plans to veto the House's legislation, and Senate leaders have no plans to take similar action (Johnson, 7/17).

The Wall Street Journal's Washington Wire: House Votes To Delay Health-Law Mandates
House lawmakers on Wednesday voted to approve two separate bills amending portions of the Affordable Care Act, the latest moves by the GOP to try to throw up hurdles to the Obama health law. The first bill would codify the year-long delay to the obligation on companies to provide health care coverage to their workers from next year. The second would delay a similar obligation on individuals to purchase health-care insurance (Boles, 7/17).

The Associated Press/Washington Post: Republican-Led House Votes To Delay Core Requirements Of Obama’s Health Care Law
The dual political-show votes marked the 38th time the GOP majority has tried to eliminate, defund or scale back the unpopular law since Republicans took control of the House in January 2011. The House legislation stands no chance in the Democratic-run Senate (7/17).

Politico: House Votes Put Harsh Spotlight On Obamacare Delays
House Republicans have passed anti-Obamacare legislation dozens of times and for dozens of reasons. On Wednesday, it was to make Democrats and the Obama administration squirm. In the first votes since the administration postponed the health law’s employer coverage requirements for a year, the House passed a bill authorizing the delay — and then followed it up immediately with a vote to give the same delay to the individual mandate (Cunningham and Cheney, 7/18).

The Hill: House Defies Veto Threat, Votes To Delay Obamacare Mandates
The House voted Wednesday to delay the Obamacare employer mandate, defying a White House veto threat and winning over dozens of Democrats. Republicans also approved a bill delaying the mandate that individuals purchase health insurance by 2014 (Kasperowicz, 7/17).

Fox News: House Votes To Delay Obamacare Mandates
The House voted Wednesday to delay key components of Obamacare, in a bid by emboldened Republicans to chip away at the law after the administration acknowledged new problems with its implementation. Republican leaders swiftly organized the votes after the administration, in early July, said it would delay until 2015 a requirement that businesses with 50 or more workers provide insurance coverage or pay a penalty. The House voted 264-161 for a measure that would do exactly that. But they also voted 251-174 for a measure that would delay the individual mandate -- the requirement on individuals to buy health insurance -- for a year as well (7/18).

CNN: House Passes Two Bills To Delay Key Obamacare Requirements
The House of Representatives passed two bills Wednesday postponing two key provisions of Obamacare, marking nearly 40 times that the Republican-controlled House has attempted to repeal or roll back parts of the president's signature first term accomplishment. One measure, which passed 264-161, delayed for one year the requirement that employers provide health insurance, something the Obama administration already announced it was doing earlier this month. Thirty-five Democrats joined Republicans on the vote (Walsh, 7/17).

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Health Reform

Obama's Thursday Speech To Tout Health Law Benefits

The president's chief spokesman said the speech will focus on how the overhaul is helping keep health-insurance rates low and resulting in rebates to some Americans.  

The Washington Post: Going On The Offensive, Obama To Tout Affordable Care Act Thursday
President Obama will tout a key financial benefit of the Affordable Care Act in a White House speech Thursday, highlighting a provision that requires health insurers to devote at least 80 percent of their spending on medical care and health care quality improvement or give rebates to consumers (Eilperin, 7/18).

Kaiser Health News: White House Says Health Law Will Restrain Insurance Prices In 2014
Ratcheting up the campaign to sell the health law, President Barack Obama was expected to deliver a speech Thursday touting how millions of individuals are already benefiting from its insurance rebates, while others who buy coverage in new online marketplaces in California, New York and Oregon will pay lower-than-projected premiums (Galewitz and Appleby, 7/18).

The Wall Street Journal's Washington Wire: President Plans Speech Thursday To Tout 'Obamacare'
President Barack Obama on Thursday will tout the benefits of the Affordable Care Act to a skeptical public during a speech at the White House as part of an effort to build support for the health law in the face of continued Republican efforts to block it. Mr. Obama's chief spokesman, Jay Carney, said the speech will focus on how the health law, commonly called "Obamacare," is helping keeping health-insurance rates low and resulting in rebates to some Americans. The speech is set to start at 11:25 a.m. (Favole, 7/17).

The Associated Press/Washington Post: Obama To Talk Up $500 Million In Rebates Under Health Care Law After House Votes For Delays
Eager to counter Republicans intent on repealing his health care law, President Barack Obama will argue that it's working and hold up as proof half a billion dollars in rebates insurance companies are sending to some 8.5 million consumers as a result. At the White House on Thursday, Obama will argue that his Affordable Care Act is holding insurance companies accountable and putting money back into the pockets of consumers. The rebates average about $100, spokesman Jay Carney said (7/17).

USA Today: Obama To Tout Americans Already Benefiting Of Health Law
With his administration facing deadlines to establish health care exchanges in all 50 states by Oct. 1 and GOP lawmakers continuing to call for a repeal of the law, the president is looking to trumpet the law by highlighting one of the most tangible ways Americans are benefiting from it even as his administration struggles to fully implement it (Madhani, 7/18).

Politico: Obama To Tout Tangible Health Law Benefits
After two weeks of sustained GOP assaults on his health care law, President Barack Obama tries to turn the page Thursday with a speech promoting Obamacare provisions the White House says are already saving people money (Millman, 7/18).

The Hill: President to Tout ObamaCare Savings In Thursday Address
President Obama will promote his signature health care law to the public on Thursday, focusing on a provision the White House says has saved consumers billions of dollars. The appearance will be Obama's third public address this year solely on the Affordable Care Act (Baker, 7/18).

Reuters: Obama Steps In To Push Health Plan As Critical Date Draws Near
Amid delays and a barrage of political criticism of his signature health care law, President Barack Obama will play pitchman for the plan on Thursday as a critical enrollment date draws near. Obama is due give a speech at the White House highlighting how the plan has already benefited the public by lowering insurance costs and will do so in the future, senior administration officials said (Felsenthal, 7/18).

McClatchy: The Checks Are In The Mail: Obama To Announce Health Insurance Rebates For 8.5 Million Americans
The Obama administration is pushing back against the Affordable Care Act naysayers. One day after House Republicans passed legislation to delay enforcement of the health care law's individual mandate, President Obama will take to the airwaves to announce that checks are in the mail for 8.5 million Americans who'll split more than $504 million in rebates from their health insurance company, thanks to a provision of the health law that penalizes insurers for wasteful spending. Families on the receiving end of those rebates will get checks averaging $100 (Pugh, 7/18).

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Health Law Backers Hail N.Y. News That Insurance Rates Will Drop

Gov. Andrew Cuomo announced Wednesday that premiums for health policies purchased by individuals in the state's new online marketplace will fall on average 50 percent in 2014.

The Wall Street Journal: New York Health Plan Rates Approved
Starting next year, individual insurance plans for New York consumers will carry premiums at least 50% lower than those currently available, according to rates approved by state insurance regulators in anticipation of changes to the federal health-care law, Gov. Andrew Cuomo announced on Wednesday (Orden, 7/17).

Politico: Obamacare Backers Cheer N.Y.'s Falling Rates
New York is the newest flash point in the Obamacare messaging war. Buoyed by news that premiums are poised to fall 50 percent or more for individuals next year, health law supporters trumpeted the state’s announcement — first reported by The New York Times — as proof that the health law is goosing competition and driving down costs for consumers. ... But it took less than a New York minute for Obamacare critics to poke holes in the announcement, saying the state’s current sky-high rates for individuals are actually proof of what Obamacare will do to the rest of the country (Millman and Cheney, 7/18).

Bloomberg: New York Health Exchanges Offer 50% Drop In Premiums
Health insurance premiums will drop by about 50 percent on average for consumers in New York who buy new plans through a state-run marketplace created by the U.S. Affordable Care Act. The state approved plans to be sold by 17 insurers. ... New York may have been more ripe for savings than other states. Like the federal health law, New York regulators require insurers to accept all applicants, regardless of medical conditions. Unlike the federal act, the state doesn't mandate that all residents -- including the young and healthy -- buy insurance. That's produced a market tilted toward sicker, costlier members and driven New York premiums to among the highest in the country. Starting in 2014, that will be mitigated by the federal law's subsidies for low- and middle-income customers, and its requirement that all Americans get coverage or pay a penalty (Klopott and Nussbaum, 7/17).

Marketplace: Why Many States Won't See N.Y.-Sized Savings Under Obamacare
This headline in the New York Times this morning: 'Health Plan Cost for New Yorkers Set to Fall 50%' sounded like good news for the Obama administration. But it may not be as good as federal officials are trying to make it. As a health care reporter, you know something's up when a breathless email from the U.S. Department of Health and Human Services arrives in your inbox. "Wanted to make sure that you had seen the news that premiums in New York’s individual market are set to fall under the Affordable Care Act," wrote spokeswoman Joanne Peters (Gorenstein, 7/17).

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Coverage Campaign: The White House Effort 'To Sell' The Health Law

The Washington Post details how the White House plans to sell the health law and to persuade young people to buy health insurance. Meanwhile, The Hill reports on how a public relations contract related to Obamacare is being boosted by $33 million.  

The Washington Post's Wonk Blog: Obama's Last Campaign: Inside The White House Plan To Sell Obamacare
Deep inside the White House, in a bare room that the chief of staff uses for meetings, David Simas is still thinking about turnout. Turnout has been Simas's job for years now. As director of public-opinion research and polling for President Obama's reelection campaign, Simas was at the center of the effort to find and persuade young and minority voters to go to the polls like they did in 2008 (Klein and Kliff, 7/17).

The Hill: HHS Adds $33 Million To Obamacare PR Contract
The Obama administration has added roughly $33 million to a contract with a public relations firm to help promote President Obama's signature health care law. A spokesperson for the Centers for Medicare and Medicaid Services (CMS) said the extra money was added to a contract with the PR firm Weber Shandwick (Baker, 7/17).

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Testing Requirements Could Delay Launch Of State Health Exchanges

Government officials said Wednesday during a Capitol Hill hearing that the Oct. 1 deadline may not allow enough time to test the systems that are being put in place to run these online insurance marketplaces.

The Wall Street Journal's Washington Wire: Enough Time To Test Health Insurance Exchange?
An official from the Treasury Inspector General for Tax Administration told Congress Wednesday he's concerned there isn't enough time to fully test a federal-health insurance marketplace that is being built to allow people to sign up for health insurance on Oct. 1 (Dooren, 7/17).

Reuters: Officials Warn Of Obamacare Insurance Exchange Delays
Two U.S. government officials warned on Wednesday that the launch of new state health care exchanges could potentially be delayed, raising further doubts about the implementation of President Barack Obama's signature legislation. Alan Duncan, an auditor with the Treasury Inspector General for Tax Administration, an Internal Revenue Service agency that monitors performance, said testing the systems needed to implement the exchanges "will be difficult to complete" by the October 1 start date (Temple-West and Dixon, 7/17).

House Republicans also are expressing skepticism about the security of the exchanges' data --

Kaiser Health News: Capsules: House GOP Skeptical Exchange Information Will Be Secure; Tavenner Wasn't Consulted On Delaying Health Law's Employer Mandate
Henry Chao, a lead technology information officer from the Centers for Medicare & Medicaid Services, said officials have completed about 80 percent of the safeguards to protect privacy when the agency rolls out what it calls "The Hub" (Rao, 7/17).

Medpage Today: Questions Raised About ACA Data Security
Federal watchdogs expressed concerns to lawmakers Wednesday about the security of information that will be traded through the Affordable Care Act's (ACA) health insurance exchanges. Federal tax information provided to the exchanges in order to determine benefit eligibility may not be adequately protected, an official from the Office of the Treasury Inspector General for Tax Administration said Wednesday. Alan Duncan, assistant inspector general for the Treasury Department, told the House Oversight and Government Reform Committee his office has concerns the Internal Revenue Service's (IRS) fraud controls may not be ready in time to detect ACA-related fraud schemes (Pittman, 7/17).

Meanwhile, news outlets report on state developments, including the latest from Minnesota and California.

ABC News: Where Does Your State Stand On 'Obamacare' Implementation (Video)
Washington after the Supreme Court ruled on his health care legislation. States are putting together their new health-care exchanges under the Affordable Care Act, better known as "Obamacare," and all 50 must be up and running by October 1. Where does your state stand? The Obama administration has set up a website where visitors can click on a map with information about how the Affordable Care Act will change health care in each state. For the most part, the site promotes improvements brought by the Affordable Care Act and the grant money the states have received (Good, 7/17).

MPR News: MNsure Town Hall Message: Brace Yourselves For The Information Deluge, Minnesota
Several DFL legislators and the head of the upcoming online insurance marketplace, MNsure, tried to explain the federal health care law as part of a town hall meeting last night in Minneapolis. … The group told the audience that the cost of health plan premiums will be available Oct. 1 for plans that will take effect in January 2014. They said Minnesotans should prepare for a deluge of mass media campaigns, coming in mid-August, to explain how the law will work (Stawicki, 7/17).

MPR News: MNsure Buyers Could Get Early Look At Rates
People interested in buying health insurance through the state's new online marketplace, MNsure, may get an early look at premium rates, according to a Minnesota Department of Commerce official. MNsure goes live Oct. 1 with policies that would take effect in January. "The Department of Commerce is working actively with [health insurers] to try to come to a resolution that would not only allow us to provide rate information prior to October 1, but would also be accurate and approved rate information," said Tim Vande Hey, deputy commissioner of the department's insurance division at a meeting of the MNsure board Wednesday (Richert, 7/17).

California Healthline: Training Launched For Exchange Educators
The educators got an education yesterday. Covered California, the state's health benefit exchange, held classes in Sacramento and San Gabriel in Los Angeles County for its Certified Educator program that will eventually train 2,000 people to go out into the community and recruit Californians to sign up for the exchange. … Covered California has awarded $37 million in grants to community groups throughout the state in an attempt to use existing networks to reach as many people as possible … . The ad campaign for Covered California -- television, radio, print, billboards, social media -- will launch in August (Gorn, 7/17).

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Michigan Senate Leader Says Medicaid Expansion Vote Could Come In August

Republican Randy Richardville says the debate will have to wait until a group of senators studying the issue submit their proposal.

The Associated Press: Mich. Senate Leader Eyes Medicaid Vote In August
The leader of the Republican-dominated Michigan Senate said Wednesday he is tentatively planning to hold a much-anticipated vote on Medicaid expansion legislation in late August, assuming a group of senators studying the issue proposes a plan as early as next week. Majority Leader Randy Richardville, R-Monroe, said the full Senate could vote Aug. 27 or 28 — or the following week — on whether to cover hundreds of thousands more low-income adults with government health insurance under the federal health care law (Eggert, 7/17).

Detroit Free Press: Medicaid Expansion Debate Delayed in Senate, Vote Still Weeks Away
The Medicaid expansion debate in the Senate will have to wait for at least a couple of weeks. The Senate work group is meeting privately twice a week to look at and tweak the expansion bill passed by the House of Representatives in June (Gray, 7/17). 

Meanwhile, in Louisiana --

New Orleans Times-Picayune: Rep. Boustany Says Reports He Wants Louisiana To Expand Medicaid Under 'Obamacare' Are Wrong
Two weeks ago, Rep. Charles Boustany, R-Lafayette, generated a strong response, both positive and negative, when he was quoted as saying that Louisiana should expand Medicaid coverage under the Affordable Care Act. Now, Boustany is saying it isn't his position and that he agrees with Gov. Bobby Jindal's decision not to implement the Medicaid expansion that proponents say will provide health coverage for 400,000 uninsured Louisiana residents (Alpert, 7/17).

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Small Business Owners Anxious About Health Law, Chamber Survey Finds

Small business owners are increasingly concerned about the law's impact, according to the U.S. Chamber of Commerce, while Karen Ignagni of the nation's biggest trade group of insurers says the nation's focus must move to reducing the cost of health care.

The Washington Post: Despite Temporary Reprieve, Business Owners Increasingly Anxious As Health-Care Law Looms
Despite a temporary reprieve from some of the new rules under the health care law, business owners are growing increasing anxious about its looming implementation at the end of the year, according to a pair of recent surveys. Only three out of every 10 small employers say they are prepared to comply with new regulations under the law, while seven in 10 say those regulations have made it more difficult to grow, according to a new survey from the U.S. Chamber of Commerce (Harrison, 7/17).

CT Mirror: Nation’s Focus Must Move From Coverage To Cost, Health Insurance Industry Leader Says
Karen Ignagni, the voice for the nation’s health insurers, summed up the federal health reform law with a picture of a triangle, divided into three horizontal bands. The law focuses most on expanding access to health care coverage and changing the insurance market, concepts at the base of the triangle. Far less attention was devoted to care quality, and the least -- the top sliver of the triangle -- was paid to cost. But now, as the changes the law mandates roll out, the triangle might as well be flipped on its head. Public policy discussions in the coming years will focus primarily on the cost of health care, she said (Becker, 7/17).

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Health Disparities

Funding For Native Americans' Mental Health Services Hit Hard By Sequestration

Marketplace: Sequester Hits Native Americans’ Mental Health Services
Centuries ago, tribes gave up much of their land to the federal government in exchange for promises of funded health care, education and housing. Time and time again those funds have been cut. The sequestration has been no exception. Even though suicide rates are nearly four times the national average, Indian country’s mental health services have been hit. Amber Ebarb, a budget and policy analyst with the National Congress of American Indians, says sequestration undermines American-Indian treaty rights, and makes a dire situation even worse (Morales, 7/18).

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State Watch

State Highlights: D.C. Health Care Providers Continue Wait For Payments

A selection of health policy stories from Virginia, the District of Columbia, California, Wisconsin, Georgia, South Carolina, Pennsylvania and Washington.

The Washington Post: Wait Continues For Health-Care Providers Owed By Chartered Health Plan
Despite high hopes that a quick resolution to the mess left by dissolution of D.C. Chartered Health Plan could be in the offing, it appears that city health care providers will have to wait more than a month to start receiving the nearly $50 million they are owed from the now defunct managed-care firm (DeBonis, 7/17).

The Associated Press: Georgia Plans Managed Care For Children On Medicaid
Health officials say they're looking to hire a for-profit company to oversee the care of some of the state's most vulnerable children. The Atlanta Journal-Constitution reported Wednesday that youth advocates and pediatricians say so-called "managed care" of the state's 27,000 children in foster care, adoption assistance or the juvenile justice system could help better coordinate their health care (7/18).

Modern Healthcare: Reform Update: Adventist Health Seeks Insurance License
The push by hospital operators into the health insurance business continues as pressure increases to prepare for alternatives to fee-for-service payment.  Adventist Health, a large California-based health system with 18 hospitals in four states, is expected to seek California's approval for an insurance license before the end of the year. It would be Adventist's first insurance license, though it will be a limited license (Evans, 7/17).

The Washington Post's The Fact Checker: Does Ken Cuccinelli's Book Question Whether Social Security And Medicare Should Exist? 
The ad directs readers to pages 62 and 63 of the book. This chapter mostly deals with Cuccinelli's outrage at the passage of the Affordable Care Act, a.k.a. Obamacare, which he views as an example of lawmakers in both parties creating new programs that he claims make people dependent on government largess (Kessler, 7/18).

Los Angeles Times: O.C. Biotech Firm Is Sued By Major Rival Over Breast Cancer Test
A small biotech firm in Orange County is going up against a major company over the rights to a popular genetic test that can detect breast cancer. Myriad Genetics of Salt Lake City last week filed a lawsuit against Ambry Genetics of Aliso Viejo and a Houston company after both rushed to offer the test immediately following a U.S. Supreme Court ruling last month that human genes cannot be patented (7/17).

NPR: Tuberculosis Outbreak Shakes Wisconsin City
It's a reminder that TB -- a disease most Americans may view as a relic of the 19th century -- is still an insidious threat that can pop up anywhere. In its advanced stages, tuberculosis can destroy lungs, damage other organs and cause death (Knox, 7/18).

Georgia Health News: Medicaid Pay Raise For Doctors? Not Here, Not Yet
The long-delayed Medicaid pay raise for primary care physicians is expected to begin this summer for almost all states, Kaiser Health News reported Tuesday, quoting a federal agency spokeswoman. But Georgia won’t be among them. The projected date for physicians in Georgia to get the pay bump is November, according to the state Medicaid agency (Miller, 7/17).

Bloomberg: South Carolina Psychiatric Patient Stuck 38 Days In ER
When a mentally ill patient arrived at AnMed Health Medical Centers' emergency room in May, staff at the Anderson, South Carolina, facility scurried to find a hospital with enough room for an admission…U.S. hospital emergency rooms are becoming holding pens for psychiatric patients. People are being kept on site for days and sometimes weeks, a symptom of an overtaxed health system grappling with steep cuts to mental-health services (Armour, 7/18).

The Philadelphia Inquirer: Abington, Einstein and Aria Unveil New Model For Self-Insuring
Three major Philadelphia-area health systems announced a partnership Tuesday to jointly manage health benefits and care for their tens of thousands of employees. Einstein Healthcare Network, Abington Health, and Aria Health unveiled a plan for a jointly run company that will manage insurance and care for their combined 30,000 employees and family members (Skinner, 7/17).

The Seattle Times: Dental Patients Get $35M Over Unneeded Root Canals
A judge Wednesday awarded a total $35 million to 29 former patients of a retired Shoreline dentist who is accused of performing thousands of unnecessary root canals…The state Department of Health has received 76 complaints against Duyzend, according to spokesman Donn Moyer (Cornwell, 7/18).

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Editorials and Opinions

Viewpoints: Baucus Applauds 'Listening To Customers' On Employer Mandate Delay; Unions 'Wake Up' To Problems With Health Law; Medicare's 'Two Midnights' Rule

Politico: Obamacare Provision's Timely Delay
Any successful business leader will tell you the importance of listening to customers, gathering their input and suggestions and always putting them first. That lesson was not lost on the Obama administration earlier this month when it correctly decided to push back the implementation of the Affordable Care Act's employer responsibility provision — the employer mandate — until 2015. I'm sure this was a tough call, but it was the right one. It shows the administration is listening to the business community and working to address its concerns, as well as the concerns of Congress (Sen. Max Baucus, D-Mont., 7/17).

The New York Times: The Conscience Of A Liberal: Obamacare Is The Right's Worst Nightmare
News from New York: It looks as if insurance premiums on the individual market are going to plunge thanks to Obamacare. This shouldn't come as a surprise; in fact, the New York experience perfectly illustrates why Obamacare had to look the way it does. And it also illustrates why conservatives should be terrified about this legislation, as it takes effect. Americans may have had a lot of misgivings in advance, thanks to vast, deliberately spread misinformation. But I agree with Matt Yglesias — unless the GOP finds even more ways to sabotage the plan, this thing is going to work, it's going to be extremely popular, and it's going to wreak havoc with conservative ideology (Paul Krugman, 7/17).

The New York Times' Five Thirty Eight: In Public Opinion On Abortion, Few Absolutes
As with so many other areas this blog covers, abortion is one in which selective readings of the polls can seem to prove opposite conclusions. After writing about abortion and public opinion in Sunday's Times – arguing that the issue does not benefit Democrats as much as other high-profile subjects, like immigration, guns, taxes and same-sex marriage – I wanted to dig more deeply into the polls and their trend lines. For all the assertions that advocates make about public opinion, I think that a few consistent messages emerge (David Leonhardt, 7/17). 

Los Angeles Times: New Attack On Obamacare Would Make Insurance Costlier
House Republicans continued their crusade to dismantle Obamacare on Wednesday, but an announcement from New York Gov. Andrew Cuomo should have stopped them in their tracks. The fact that it didn't shows that Republican lawmakers are so determined to undermine the law, they don't care what might happen to their constituents (Jon Healey, 7/17). 

The Wall Street Journal: Obamacare's Coalition Begins To Fracture
The letter was unusually harsh. Addressed to Senate Majority Leader Harry Reid and House Minority Leader Nancy Pelosi, it was really intended for President Barack Obama. The letter was not from Mr. Obama's GOP adversaries but from the presidents of three powerful unions. ... Union leaders are correct that ObamaCare "creates an incentive to keep employees' work hours below 30 hours a week." After all, employers can avoid a $2,000-per-worker fine if they don't provide insurance as long as employees work fewer than 30 hours a week (Karl Rove, 7/17). 

The Wall Street Journal: Big Labor Wakes Up To Obamacare
Every revolution devours its children, but it's still surprising to see some of Obamacare's keenest boosters deny paternity so soon after the birth. Witness the emotional volte-face from three top union leaders, warning that the program will "shatter not only our hard-earned health benefits, but destroy the foundation of the 40-hour workweek that is the backbone of the American middle class" (7/17). 

Milwaukee Journal Sentinel: Potholes Ahead For Obamacare
Any governor understands that to launch job growth, states have to have a strong foundation. It is not just easing the tax and regulatory burden that spells success. Without well-developed transportation infrastructure, growth is stifled. One cannot increase trade with crumbling roads and rails. Similarly, when suddenly increasing the traffic in health care by adding 34 million newly insured patients, one has to examine the infrastructure supporting the load (Tommy Thompson, 7/17).  

Fiscal Times: The Great Obamacare Workforce Exodus
Congress based the Affordable Care Act reform in 2010 on a model that made a couple of key assumptions about employment. The White House projected rosy growth that would lead to job creation; and this rapid expansion would take place prior to Obamacare’s implementation, reducing the temporary costs of safety-net programs, including Medicaid. The new employer mandate would then ensure that new and existing full-time workers would not require subsidies to purchase individual health-care plans in new state-based insurance exchanges, keeping costs and new tax revenue balanced to keep the ACA from becoming a deficit driver in its first decade. Neither of these assumptions has panned out (Edward Morrissey, 7/18).

Forbes: Will Medicare's 'Two Midnights' Rule Endanger Patients By Distracting Doctors?
A fundamental principle of the American health care system has always been that your medical care is driven by two things: your own choices and your doctor's judgment. It's what's right, and it's what works. But if a new rule proposed by the Centers for Medicare and Medicaid Services is finalized August 1, that principle will be undermined by removing provider judgment from the decision to admit a patient to the hospital. ... The new rule would be that if a patient is expected to spend at least two midnights in the hospital, the inpatient stay would be presumed to be medically necessary – and thus covered by Medicare (Dr. Kavita Patel and John Rother, 7/17).

The New York Times: A Second Chance For The World's Disabled
There was a painful moment on Capitol Hill in December when former Senator Bob Dole, seated in a wheelchair, was greeted warmly by old Republican colleagues but then rebuffed by some of those very same members after he had urged Senate ratification of a United Nations treaty defending the rights of people with disabilities. ... skittish Republicans bought into a nonsensical attack by right-wing critics that it would undermine national sovereignty. Senator Robert Menendez, a New Jersey Democrat and the chairman of the Senate Foreign Relations Committee, is now negotiating with the ranking committee Republican, Bob Corker of Tennessee, to arrange another vote (7/17). 

The New England Journal of Medicine: Communicating and Promoting Comparative-Effectiveness Research Findings
The comparative-effectiveness research (CER) movement has sparked an important debate about who may communicate research findings, for what purposes, and using what methodologic standards. CER is intended to inform discussions about what works in health care. Much of the information comes from research using retrospective databases and quasi-experimental designs rather than randomized clinical trials. ... Conceivably, the FDA will have to establish on a case-by-case basis whether any CER promotion, regardless of its intended audience, is "truthful." However, a great deal of uncertainty prevails, and it may be some time before there is clarity around the issue (Peter J. Neumann, 7/18).

The New England Journal of Medicine: Tobacco Use Among Homeless People — Addressing the Neglected Addiction
Although the prevalence of smoking in the United States has declined, vulnerable and marginalized groups continue to use tobacco at high rates. One such group is the 2.3 to 3.5 million people nation-wide who are homeless in any given year. Approximately three quarters of homeless adults are cigarette smokers ... Though the challenges of addressing tobacco use in this population are many, we believe that ignoring this issue is no longer justifiable — and that the conversation should shift away from the question of whether to address smoking among homeless people and toward the question of how (Drs. Travis P. Baggett, Matthew L. Tobey and Nancy A. Rigotti, 7/18). 

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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.