Daily Health Policy Report

Wednesday, July 3, 2013

Last updated: Wed, Jul 3

KHN Original Reporting & Guest Opinion

Health Reform

Medicare

Health Care Marketplace

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Employers To Get An Extra Year To Implement Health Law Requirement On Coverage

Kaiser Health News staff writer Mary Agnes Carey reports: "The Obama administration Tuesday announced a one-year delay in the Affordable Care Act's requirement that businesses with 50 or more employees offer coverage to their workers or pay a penalty. Administration officials said the delay was in response to employers' concerns about the law's reporting requirements" (Carey, 7/2). Read the story.

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Delay In Major Health Law Provision Raises Doubts At Critical Stage Of Rollout

Kaiser Health News staff writers Jay Hancock and Julie Appleby report: "The Obama administration's decision Tuesday to delay a major component of the Affordable Care Act -- the requirement for employers with at least 50 workers to offer health coverage -- postpones another feature of the law and hands ammunition to critics who contend it is unworkable. But it could have a relatively small effect on the number of Americans who gain medical insurance next year. The law's other two major provisions, expanding Medicaid and requiring individuals to obtain coverage or pay a penalty, were projected to add far more people to the ranks of the insured than the employer mandate, according to the nonpartisan Congressional Budget Office. Those measures are still in effect, although many states have opted not to expand Medicaid next year" (Hancock and Appleby, 7/2). Read the story.

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Business Groups, Consumer Advocates, Politicians, Policy Makers React To Mandate Decision

Kaiser Health News staff writer Phil Galewitz reports: "Opponents of the federal health law, especially business groups and conservatives, were quick to praise the decision by the Obama administration to delay enforcing the employer mandate provision by one year, until 2015. Some supporters of the law said the decision would not create major problems. Here is a roundup of some of the statements and edited quotes from interviews within the first few hours of the announcement" (Galewitz, 7/2). Read the story.

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Lawmakers To NY Docs: Screen All Baby Boomers For Deadly Liver Disease

WNYC’s Fred Mogul, working in partnership with Kaiser Health News and NPR, reports: "Hepatitis C is a life-threatening infection that attacks the liver, but the symptoms often don’t show up for years. So Dr. Alex Federman, an internist at a primary clinic at Mt. Sinai Hospital in New York City, makes sure he urges testing for many patients" (Mogul, 7/3). Read the story.

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Capsules: AMA To Do 'Whatever We Can' To Help Carry Out Health Law; Federal Rule Extends Subsidies For College Students

Now on Kaiser Health News’ blog, Mary Agnes Carey reports on the American Medical Association’s new president and her take on the health law: "In an interview taped for C-SPAN's Newsmakers, Ardis Dee Hoven, who became the AMA’s 168th president last month, said the White House has not approached her or the AMA directly about a formal role, but 'we have been in communication with many, many individuals in the administration about our role as physicians in this and what we can help them do, and what we can do to help our patients get the kind of information they need. We will continue to work with the administration and do whatever we can in our power to make this happen,' said Hoven, an infectious diseases specialist from Lexington, Ky." (Carey, 7/2).

Also on the blog, Michelle Andrews reports on college students and health care: "While expansion of coverage under the health law has helped about 3 million young people get insurance through their parents’ plans, many remain uninsured or have coverage through student health plans. But that's not an option for some students, who might look to student health plans or the online health insurance marketplaces for coverage next year" (Andrews, 7/2). Check out what else is on the blog.

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Political Cartoon: 'Conception Exception?'

Kaiser Health News provides a fresh take on health policy developments with "Conception Exception?" by Signe Wilkinson.

Meanwhile, here is today's health policy haiku:

WHAT'S ANOTHER YEAR?

Employer mandate
delayed. Penalties postponed.
Who wins? Who loses?
-Anonymous

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

Employers Get Extra Year To Carry Out Health Law Coverage Mandate

The Obama administration's surprise announcement will delay penalties for one year -- until after the mid-term elections -- and raises doubts about the implementation process at a crucial moment. Officials said the extension was a response to business requests for more time to navigate complex regulations.

Kaiser Health News: Delay In Major Health Law Provision Raises Doubts At Critical Stage Of Rollout
The Obama administration's decision Tuesday to delay a major component of the Affordable Care Act -- the requirement for employers with at least 50 workers to offer health coverage -- postpones another feature of the law and hands ammunition to critics who contend it is unworkable. But it could have a relatively small effect on the number of Americans who gain medical insurance next year. The law's other two major provisions, expanding Medicaid and requiring individuals to obtain coverage or pay a penalty, were projected to add far more people to the ranks of the insured than the employer mandate, according to the nonpartisan Congressional Budget Office. Those measures are still in effect, although many states have opted not to expand Medicaid next year (Hancock and Appleby, 7/2).

Kaiser Health News: Employers To Get An Extra Year To Implement Health Law Requirement On Coverage
The Obama administration Tuesday announced a one-year delay in the Affordable Care Act's requirement that businesses with 50 or more employees offer coverage to their workers or pay a penalty. Administration officials said the delay was in response to employers' concerns about the law's reporting requirements (Carey, 7/2).

The New York Times: Crucial Rule Is Delayed A Year for Obama's Health Law
In a significant setback for President Obama’s signature domestic initiative, the administration on Tuesday abruptly announced a one-year delay, until 2015, in his health care law’s mandate that larger employers provide coverage for their workers or pay penalties. The decision postpones the effective date beyond next year’s midterm elections (Calmes and Pear, 7/2).

The Washington Post: White House Delays Health-Care Rule That Businesses Provide Insurance To Workers
The White House on Tuesday delayed for one year a requirement under the Affordable Care Act that businesses provide health insurance to employees, a fresh setback for President Obama’s landmark health-care overhaul as it enters a critical phase. The provision, commonly known as the employer mandate, calls for businesses with 50 or more workers to provide affordable quality insurance to workers or pay a $2,000 fine per employee. Business groups had objected to the provision, which now will take effect in January 2015 (Goldfarb and Somashekhar, 7/2).

The Wall Street Journal: Health Law Penalties Delayed
Some companies had bet the law was going to be overturned by the Supreme Court last year, or by a new presidential administration after the 2012 election. After it withstood those legal and political challenges, some firms said there was too little time remaining before the provision was due to kick in. "They realized they were not ready, and we were not ready," said Neil Trautwein, vice president at the National Retail Federation, an employer trade group. "At the very least, this will give retailers and chain restaurants a chance to breathe." The decision follows media reports that companies had already cut back on some workers' hours to avoid exposure to penalties under the new health-care law. Those who work fewer than 30 hours a week aren't counted as full-time employees, according to the law (Radnofsky, 7/2).

Los Angeles Times: Obama To Delay Healthcare Law’s Employer Mandate
The one-year delay, announced by the Treasury Department late Tuesday in response to complaints from businesses, marks a major retreat in implementing the 2010 Affordable Care Act. It also underscores the immense pressure the administration is under as it tries to roll out the extremely complex law. By next year, most Americans were supposed to be guaranteed access to health coverage even if they have preexisting conditions (Levey, 7/2).

The Associated Press/Washington Post: Obama Administration Delays Central Element Of Health Care Law Until After 2014 Elections
Tuesday’s move — which caught administration allies and adversaries by surprise — sacrificed timely implementation of Obama’s signature legislation but might help Democrats politically by blunting an election-year line of attack Republicans were planning to use. The employer requirements are among the most complex parts of the health care law, designed to expand coverage for uninsured Americans (7/2).

Politico: Key Obamacare Rule For Business Delayed For Year
The delay, revealed just as the administration was stepping up efforts to educate the public about enrollment this fall, is at least partial proof of what Republicans have been predicting for months: that the health law is way too complex to be ready to go live in 2014. And that’s a message that may well resonate all through next year - including the 2014 midterm elections (Norman and Haberkorn, 7/3).

NPR: U.S. Pushes Businesses' Health Insurance Deadline To 2015
U.S. businesses that had been looking at possible penalties if they don't provide health insurance to their employees by January are getting an extra year before they must comply with the new law, the White House says. The requirement, part of the health care overhaul known as "Obamacare," affects all companies that have at least 50 employees (Chappell, 7/2).

USA Today: Obama Administration To Delay Part Of Affordable Care Act
The announcement by the Internal Revenue Service comes after numerous complaints from businesses that the requirements were too complicated and difficult to implement in time. … Other key parts of the law, including the health exchanges where individuals can buy insurance, are on schedule. The exchanges will open on Oct. 1, wrote Valerie Jarrett, a senior adviser to President Obama, in a White House blog released Tuesday (Kennedy, 7/2).

Politico: 6 Questions About The Obamacare Mandate
The bombshell announcement came from the Treasury Department on Tuesday night, catching even the administration’s close allies by surprise: A key part of Obamacare will be postponed for one year. The employer mandate — or as the administration calls it, the shared responsibility rules — was put on hold. Businesses won’t have any new requirements to cover workers, or penalties if they don’t, until 2015. The news came just as the White House was building momentum for its public education campaign and trying to send out signals that everything was on track for enrollment to begin in October. Tuesday’s announcement throws such assurances off course (Haberkorn, Millman and Norman, 7/2).

Reuters: U.S. To Delay Key Health-Reform Provision In 2015
The move raised questions about the future of other provisions of the law, including the mandate for individuals to obtain health coverage in 2014, and followed widespread complaints from businesses and their lobbyists about reporting requirements for employers with 50 or more full-time workers (Morgan, 7/2).

Marketplace: Affordable Care Act Mandate Delayed (Audio)
Late this afternoon the Obama administration said it's gonna delay a key part of the Affordable Care Act -- the part that would force companies to provide health insurance coverage for their workers or pay a $2,000 fine. Assistant Secretary for Tax Policy at the U.S. Department of the Treasury, Mark Mazur, wrote on the department’s Web site: "We have heard concerns about the complexity of the requirements and the need for more time to implement them effectively. We recognize that the vast majority of businesses that will need to do this reporting already provide health insurance to their workers, and we want to make sure it is easy for others to do so."

McClatchy: Obamacare 'Employer Mandate' Delayed Until 2015
After months of conferring with fretful employers, the Obama administration announced Tuesday that it will delay enforcement of the Affordable Care Act’s so-called "employer mandate" until 2015. A signature provision of the federal health care overhaul, the contentious measure would have required firms with more than 50 full-time employees to provide affordable health insurance or face a penalty of $2,000 per employee in 2014, when the law was set to be fully implemented (Pugh, 7/2).

PBS NewsHour: Key Provision Of Health Reform Law Delayed Until 2015
Delaying the law's "employer responsibility" provision would give employers more time to comply and give the government more time to consider ways to "simplify the new reporting requirements consistent with the law," according to a blog post from Mark J. Mazur, the assistant secretary for tax policy at the Department of Treasury. Most of the employers impacted by the delay already offer coverage to workers, Mazur said. He added that the announcement did not delay the Oct. 1 scheduled start of the online marketplaces, or exchanges, or the subsidies intended to help individuals with low to middle incomes purchase coverage or the requirement that most individuals purchase coverage or pay a fine (7/2).

Fox News: Administration Delays Key ObamaCare Insurance Mandate
The Obama administration announced Tuesday that it is delaying a major provision in the health care overhaul, putting off until 2015 a requirement that many employers offer health insurance. The announcement was made late Tuesday by the Treasury Department, at the beginning of the holiday week while Congress was on recess. It comes amid reports that the administration is running into roadblocks as it prepares to implement ObamaCare (7/2).

NBC News: Employers Get An Extra Year To Provide Health Insurance (Video)
On Tuesday the government said they could have more time to get it done. Saying the goal is to implement reform in "a careful, thoughtful manner", assistant Treasury secretary Mark Mazur said the administration would spend the extra year finding ways to simplify the process (7/2).

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Businesses Welcome Delay For The Health Overhaul's Employer Mandate

Large employers, many of which already provide coverage to full-time workers, cheered the news because it would relieve them of complex new reporting requirements. Businesses with fewer than 50 employees are not subject to the coverage mandate.

The Wall Street Journal: Employers Welcome Delay In Health-Care Overhaul Penalties
Employers and their advisers cheered a one-year delay in employer penalties under the health-care overhaul law, but said they remain wary of unsettled details and the law's long-term impact (Thurm and Berzon, 7/2).

Politico: Businesses Cheer Employer Mandate Delay
Under a decision released by the Treasury Department on Tuesday, large employers won't be penalized until 2015 — and not next year — for failing to offer coverage to full-time workers. The delay will have less of an effect on small businesses with fewer than 50 employees, who face new reporting requirements under the law but don't have to offer coverage (Cunningham, 7/2).

USA Today: Businesses React To Health Care Act Delay
Reaction marked a divide between representatives of big business, who mostly provide insurance already and were focused on complying with complex new reporting rules, and representatives of small business who said they need much bigger changes (Mullaney, 7/2).

Kaiser Health News: Business Groups, Consumer Advocates, Politicians, Policy Makers React To Mandate Decision
Opponents of the federal health law, especially business groups and conservatives, were quick to praise the decision by the Obama administration to delay enforcing the employer mandate provision by one year, until 2015. Some supporters of the law said the decision would not create major problems. Here is a roundup of some of the statements and edited quotes from interviews within the first few hours of the announcement (Galewitz, 7/2).

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Political Responses Swirl Around Administration's Announcement

As GOP lawmakers and health law critics gloat, administration officials say they are listening to concerns from business and being flexible.

The Washington Post’s Wonk Blog: The Politics Of Delaying Obamacare
By delaying a requirement that all large employers provide health insurance, the Obama administration heads off the unseemly spectacle of companies vowing to cut jobs or workers' hours to avoid the costly mandate. But the late Tuesday action is not a free pass: It contributes to critics' claims that the White House does not have the ability to launch its biggest legislative accomplishment on schedule (Kliff, 7/2).

Politico: GOP Gloats Over Obamacare Delay
Obamacare opponents on Tuesday had a "We told you so" moment. … The administration defended the delay as an effort to provide flexibility to the business community, but it's bringing negative attention to the law just as the White House and its health care allies launch a major campaign to sell Obamacare to the public. Enrollment in the exchanges starts in October (Millman, 7/2).

The Wall Street Journal’s Washington Wire: GOP, Democrats Clash On Meaning Of Health-Law Delay
Republicans pounced on the Obama administration's announcement late Tuesday that it would delay enforcement of the federal health law's mandate on employers to offer workers coverage or pay a penalty, prompting some Democratic supporters of the law to praise the administration and others to pause for thought. GOP lawmakers were quick to say the shift was a sign the law wasn't ready for prime-time — and that its most unpopular provision, the requirement that individuals carry coverage or pay a fee, should go too (Peterson and Radnofsky, 7/3).

Politico: Valerie Jarrett On Employer Mandate Delay: We're Just Listening To Business
According to Jarrett, the law's original reporting standards may have been unnecessary for businesses "that more than meet the minimum standards in the law." She also compared the delay to a move to consolidate the law's insurance application from 21 pages to three: "[W]e are working hard to adapt and to be flexible in employer and insurer reporting as we implement the law" (Cheney, 7/2).

The Hill: Jarrett: 'Full Steam Ahead' For ObamaCare Marketplaces, Despite Business Delay
White House senior adviser Valerie Jarrett said the administration remained "full steam ahead" for the implementation of health insurance marketplaces, despite the announcement of a delay in a mandate requiring businesses to provide workers with health insurance. "We are full steam ahead for the Marketplaces opening on October 1," Jarrett said in a blog post explaining the move on the White House website (Sink, 7/2).

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State Exchanges Largely Unaffected By Delay In Employer Mandate

Officials in California and Minnesota say that neither the timing, nor the content of insurance coverage offered in their new online insurance marketplaces will be affected by the administration's decision to suspend enforcement of penalties on large employers until 2015.

KQED State Of Health: Obama Administration Delays Employer Mandate For The Year; Reaction In California
The Obama administration announced Tuesday afternoon that the federal health law’s employer mandate, which requires large employers to provide health insurance to full-time workers or pay a fine, has been delayed for one year. Other key elements of the Affordable Care Act will stay in place, such as the individual requirement to have health insurance and the new marketplaces, such as Covered California. The administration’s announcement cited "concerns about the complexity of the requirements and the need for more time to implement them effectively" as the reason for the change (Aliferis, 7/2).

MPR News: MNsure Won’t Be Affected By ObamaCare Delay
The state's new health insurance exchange, MNsure, won't be affected by the Obama administration's decision today to delay a key employer mandate under the federal health care law, Minnesota officials say. The mandate requiring businesses with 50 or more full-time employees to provide health insurance or face a penalty will be delayed until 2015. The U.S. Treasury announced that the Obama administration is bowing to business groups that had pushed for extra time before the mandate kicks in (7/2).

Sacramento Bee: California's Health Care Exchanges Not Harmed By Ruling, Officials Say
The Obama administration's decision not to penalize large firms for failing to provide health insurance to workers next year will not harm California's implementation of the health care overhaul, officials said Tuesday. California is creating an exchange to sell insurance to individuals and small employers, not to large firms, spokeswoman Anne Gonzales said. Neither the timing nor the content of policies offered on the exchange – Covered California – will be affected, Gonzales said (Sanders, 7/3).

Healthy Cal: What Obama's Big ACA Announcement Could Mean For California
What will the Obama Administration's decision to suspend enforcement of penalties against employer who don't insure their workers mean for the implementation of the Affordable Care Act? That's hard to say, but it will likely complicate it further, despite the administration's assertion that they are delaying the requirements on employers because businesses said they were too complex to deal with (Weintraub, 7/2).

Meanwhile, another media outlet reports that California's exchange is telling plans to strip out dental coverage, which could increase consumer costs -  

KQED State Of Health: Covered California To Sell Children's Dental Plans Separately
The state’s health insurance marketplace, Covered California, authorized a set of benefits months ago that included dental care for children, but now the marketplace is telling insurance companies to strip out the dental coverage. People would then have to pay extra for a dental plan for their children. California’s insurance commissioner Dave Jones warns the move could reduce children’s access to dental care and urged Covered California to include the benefit in plans that will be sold when the marketplace formally opens October 1. The change will also drive up costs for consumers, he says (Small, 7/2).

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Employers Worry They'll Pay Bill For Those Exempt From Contraceptive Mandate

Businesses are concerned that non-religious employers will end up covering the bill for religious groups that refuse to pay for contraception for their employees. Meanwhile, church leaders continue their push to broaden the exemption from the contraception coverage rule.

Modern Healthcare: Employers Could Foot Bill For Religious Objectors To Contraceptive Coverage
As stakeholder groups examine HHS' recent final rule on contraceptive coverage under the health care reform law, non-religious employers and third-party benefits administrators are worried they'll have to foot the bill for contraceptives for employees of Catholic health systems and other religiously affiliated employers that opt out of paying. Late last week, the agency gave its final word on how mandated contraceptive coverage -- considered a preventive service under the Patient Protection and Affordable Care Act -- pertains to religious organizations that object to the requirement. The rule extended the effective date to Jan. 1, 2014, from its initial date of Aug. 1 of this year (Zigmond, 7/2).

Fox News: Religious Leaders Push For ObamaCare Contraception Mandate Exemptions
Leaders of religious groups representing more than 100 million Americans said Tuesday that religious institutions and business owners should not be forced to provide contraceptive coverage that violates their conscience. In an open letter unveiled at a press conference at the National Press Club in Washington, the coalition of groups urges the Department of Health and Human Services to exempt "any organization or individual that has religious or moral objections" to the so-called contraception mandate in ObamaCare (7/3).

Meanwhile, on the subject of the health law's Medicaid expansion -

The Associated Press/Washington Post: Ohio Tea Party Turning IRS To Advantage In Medicaid Expansion Battle
Tea party activists in Ohio want to turn an enemy -- the Internal Revenue Service -- into an ally as they fight continued efforts to expand Medicaid. In a confidential email sent to fellow Ohio tea party leaders and obtained by The Associated Press, Tom Zawistowski laid out a strategy for invoking a little-known IRS provision that allows citizens to challenge executive salaries and the nonprofit statuses of charitable hospitals (7/3).

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AMA President Says Docs Group Will Do 'Whatever We Can' On The Health Law

In an interview, Ardis Dee Hoven, the American Medical Association's new president, says that there is no formal role, but that the organization has been in touch with the Obama administration about how physicians can help patients get the information they need. Meanwhile, The Hill reports on a consumer survey that finds the health overhaul is not a consistent topic of conversation between doctors and patients.

Kaiser Health News: Capsules: AMA To Do 'Whatever We Can' To Help Carry Out Health Law
In an interview taped for C-SPAN's Newsmakers, Ardis Dee Hoven, who became the AMA's 168th president last month, said the White House has not approached her or the AMA directly about a formal role, but "we have been in communication with many, many individuals in the administration about our role as physicians in this and what we can help them do, and what we can do to help our patients get the kind of information they need" (Carey, 7/2).

The Hill: Survey: Half Of Docs Aren't Discussing ObamaCare With Patients
ObamaCare isn't a consistent topic of discussion between doctors and patients, even as the law's major provisions are set to take effect, according to a new consumer survey. Half of patients with a regular doctor haven't heard him or her talk about health care reform at appointments, according to HealthPocket, a consumer resource on health insurance (Viebeck, 7/2).

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Medicare

Short On Funds, HHS Failed To Investigate 1,200 Fraud Cases Last Year

HHS was unable to investigate 1,200 cases of suspected Medicare or Medicaid fraud last year because the watchdog agency inside the department is stretched so thin.

Fiscal Times: 1,200 Medicare Fraud And Abuse Cases Went Unchecked In 2012
The watchdog agency for the behemoth Department of Health and Human Services is stretched so thin that it was unable to investigate at least 1,200 cases of Medicare and Medicaid fraud and abuse last year, leaving the agency vulnerable to losing out on millions of dollars, Gary Cantrell, deputy inspector general for Health and Human Services said at a congressional hearing last week. Cantrell's announcement comes just as the auditing agency prepares to cut 400 workers nationwide from its 1,800-person workforce. Cantrell warned that with continued budget cuts and a huge reduction in staff, the agency will likely fail to investigate even more cases in the coming year (Ehley, 7/2).

In related news -

The Associated Press/Washington Post: Justice Department, 55 Hospitals Reach $34 Million Settlement Over Medicare Fraud Claims
Fifty-five hospitals in 21 states have agreed to pay $34 million to the U.S. government to settle allegations that they used more expensive inpatient procedures rather than outpatient spinal surgeries to get bigger payments from Medicare, the U.S. Justice Department said Tuesday (7/2).

Georgia Health News: 5 Hospitals Join Settlement On Overcharging
Five hospitals in Georgia are among 55 facilities in 21 states settling allegations of overcharging Medicare for a back procedure. The overall $34 million settlement, announced Tuesday, involved a false claims case involving kyphoplasty, a procedure for treating spinal fractures that are frequently caused by osteoporosis (Miller, 7/2).

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Health Care Marketplace

UnitedHealthcare To Again Review Tricare Specialty Care Referrals

The Department of Defense will once again allow UnitedHealthcare to review and authorize every specialty care referral in Tricare. The insurer also notified California that it will no longer sell individual insurance in that state.

Minneapolis Star Tribune: Pentagon Cancels Emergency Measures, Lets UnitedHealthcare Approve Tricare Referrals
The Defense Department has lifted emergency measures imposed on UnitedHealthcare because of missteps in the administration of a contract that provides health care to military members, veterans and their families. Beginning Wednesday, UnitedHealthcare’s Military & Veterans unit will once again be able to review and authorize every referral to specialty care made by primary care doctors in the government's Tricare insurance program (Spencer, 7/2).

The Associated Press/Washington Post: UnitedHealthcare Notifies California Regulators That It Will Stop Selling Individual Policies
A second health insurer notified state regulators Tuesday that it will stop selling individual policies in California. UnitedHealthcare announced it will no longer offer individual insurance plans after the end of the year. It will focus instead on its core business of group plans for large and small employers (7/2).

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State Watch

Texas Abortion Bill Sent To Full Chamber

A Texas House committee approved sweeping abortion legislation early Wednesday, setting up a new fight on the proposal that would, along with other restrictions, ban abortions after 20 weeks of pregnancy. The full chamber will take up the proposal early next week.

Dallas Morning News: House Panel Approves Abortion Measure
Democrats and Republicans sparred over far-reaching legislation to restrict abortions in Texas as a GOP-dominated House committee approved the bill early Wednesday and sent it to the full chamber to take up early next week. After hearing testimony from some of the 2,300 who had signed up to testify on the bill, the House State Affairs Committee approved the measure 8-3, with two absences. It was the first public hearing on the abortion bill in the current special session, which began Monday and was called after a Democratic filibuster killed an identical measure during another special session in June (Stutz, 7/2).

Texas Tribune: Interactive: How Texas' Proposed Abortion Restrictions Stack Up
House Bill 2 and Senate Bill 1 -- the omnibus abortion legislation filed in the second special legislative session -- have been labeled as among the strictest abortion regulations in the country. The bills would ban abortion starting 20 weeks after fertilization, under a provision stating that Texas has a compelling interest in protecting fetuses from pain; require doctors performing abortions to have admitting privileges at a hospital within 30 miles of the facility; force doctors to administer the abortion-inducing drug RU-486 in person, rather than allowing the woman to take it at home; and require abortions -- even drug-induced ones -- to be performed in ambulatory surgical centers (Aaronson, Murphy and Luthra, 7/3).

Politico: Texas Abortion Bill: Committee Approves
It was the first action on the bill since the Legislature returned to the Texas capitol for a special session starting on Monday. The full chamber will now take up the bill next week (Glueck, 7/3).

Bloomberg: Texas Lawmakers Start Over On Abortion After Filibuster
Texas lawmakers took up abortion limits again yesterday, hearing hours of testimony before voting to send a measure that Democrats blocked last week back to the state House of Representatives for renewed consideration. The State Affairs committee voted 8-3 with two abstentions to move the measure to the House floor as soon as next week after throngs of onlookers for and against the bill rallied in the Statehouse around the chamber, in halls and corridors and on the grounds outside (Deprez and Mildenberg, 7/3).

Politico: GOP Sits Out Texas Abortion Fight
The liberal side of the Texas abortion showdown has the two most powerful Democrats in Washington squarely in its corner: Barack Obama and Harry Reid — not to mention a Dixie Chick. On the right: Rick Perry’s holding down the fort without much obvious help from national Republicans. ... Republicans will talk about the abortion bill when they’re asked about it, but they aren't swooping into the fight with the same enthusiasm as liberals (Nather, 7/2).

Abortion legislation in Arizona and North Carolina also makes news --

Arizona Republic: 3 Seeking To Defend Ban On Abortions
A Republican state lawmaker, a national Christian minority organization and Maricopa County Attorney Bill Montgomery want to join in the defense of a state law restricting abortions. Civil-rights groups in May filed a lawsuit challenging a 2011 law that makes it a felony to perform an abortion if the provider knows it is sought based on the fetus' sex or race, or a woman is being coerced to have an abortion based on the fetus' sex or race. The American Civil Liberties Union of Arizona filed the lawsuit on behalf of the Maricopa County branch of the National Association for the Advancement of Colored People and the National Asian Pacific American Women’s Forum (Rau, 7/2).

North Carolina Health News: Senate Gives Tentative Approval To Broad Abortion Limitations
Not a week after a Texas senator made national headlines for filibustering a bill that would put considerable restrictions on access to abortion in that state, North Carolina senators introduced a bill that would enact many of the same provisions as the Texas statute (Hoban, 7/3).

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State Highlights: Fla. Hospices Get Close Scrutiny; Calif. Medi-Cal Provider Rate Bump Delayed

A collection of health policy stories from California, Florida, New York, Massachusetts and Missouri.

Los Angeles Times: Doctors Prescribe Narcotics Too Often For Pain, CDC Chief Says
The nation's top public health official on Tuesday sharply criticized the widespread treatment of aches and pains with narcotics, saying that doctors are prescribing such drugs too soon, too often and for too long -- putting patients at risk of addiction and overdose. Dr. Tom Frieden, director of the U.S. Centers for Disease Control and Prevention, said that doctors are relying on these powerful drugs to treat chronic pain when physical therapy, exercise and other remedies would be safer and in many cases more effective (Girion and Glover, 7/2).

Health News Florida: Hospices Under Feds' Microscope
Medicare's huge false-billing lawsuit against Miami-based Vitas Healthcare signals that federal scrutiny of hospices is going strong behind the scenes -- especially in Florida. Federal agents are investigating whether hospices have systematically billed Medicare for patients not eligible for the care  or over-billed for "crisis care" that patients didn't need, industry officials and attorneys say (Lamendola, 7/2).

California Healthline: Primary Care Provider Rate Bump Delayed
A two-year-long federally funded rate hike for Medi-Cal primary care providers was launched in January, but that money has not yet been distributed by state officials and likely will not be paid out until the fall, according to state officials and provider groups. … The rate change, good for 2013 and 2014, elevates Medi-Cal primary care provider rates up to Medicare levels. It's designed to encourage primary care physicians to take on Medi-Cal patients. The next step in the process comes on July 22, according to Norman Williams, deputy director of communications at DHCS, when primary care providers will need to fill out an online provider attestation form (Gorn, 7/2).

Kaiser Health News: Lawmakers To NY Docs: Screen All Baby Boomers For Deadly Liver Disease
Hepatitis C is a life-threatening infection that attacks the liver, but the symptoms often don’t show up for years. So Dr. Alex Federman, an internist at a primary clinic at Mt. Sinai Hospital in New York City, makes sure he urges testing for many patients (Mogul, 7/3).

Boston Globe: 2 More Officials Leave State Medical Board
The state medical board's general counsel has resigned, and its public spokesman was fired Monday, building on two years of turnover at the agency. Special Assistant Russell Aims, the spokesman, was let go after about nine years with the Board of Registration in Medicine, which is charged with licensing and disciplining doctors. General Counsel Brenda Beaton had held her position since 2006. Board chairwoman Dr. Candace Sloane would not comment specifically on the departures, but said "the board is going in the right direction," with changes to staffing and protocol and a revamped physician database, with more public information about those who have been disciplined (Conaboy, 7/2).

St. Louis Post-Dispatch: Des Peres Hospital Settles Medicare Fraud Allegations
Des Peres Hospital has agreed to pay a $900,000 penalty to settle allegations that it submitted false claims to Medicare for kyphoplasty procedures, the Justice Department announced Tuesday. The hospital was one of 55 nationwide that agreed recently to settle similar allegations and pay the federal government a total of more than $34 million for allegedly fraudulent billing. It is the only hospital in Missouri implicated in the latest round of settlements (Doyle, 7/2).

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Weekend Reading

Weekend Reading: A Researcher's Quest To Lower Suicide Rates

Every week reporter Ankita Rao selects interesting reading from around the Web.

Newsweek: The Body-Data Craze
Today, I've been on the phone four times, for an average of 24 minutes a call. My last phone call was 22 minutes 23 seconds long, according to the digital time device on my landline. It took me exactly 45 minutes and 10 seconds on the train to reach Brooklyn the other night: I counted the seconds off on my smart phone. My average mile when I ran 5K yesterday was 8 minutes and 45 seconds that showed up on the pedometer. (Nothing to boast about, I know.)  ... I am able to hold my plank at the gym for 54 seconds rather than the minute I always thought I could, which I know thanks to my phone’s stopwatch. My optimal sleep time is seven hours and 20 minutes and I wake up twice a night: I discovered that from a wristband that measures sleep duration and intensity. ... Welcome to my biography, 2013-style. It includes more data points than it possibly could have 20 years ago. And it's part of a national obsession of a people who, literally, number our days. According to a recent nationwide survey for Pew Research Center Internet & American Life Project, 7 out of 10 people self-track regularly – using everything from human memory to a memory stick – some aspect of health for themselves or for someone else (Alissa Quartz, 6/26).

Wired: Healthcare Is Broken. And This Designer Thinks She Can Fix It
Healthcare is notorious for being technophobic, clunky and downright ugly. No one knows this better than Gretchen Wustrack, who is trying desperately to change that. Wustrack, who leads the Active Health group at the design and innovation firm IDEO in San Francisco, has spent 12 years trying to give the healthcare sector a much needed facelift through design. Her approach is part of a growing movement called human-centered design, which aims to redefine how people experience healthcare by focusing on their specific needs (Daniela Hernandez, 6/24).

The New York Times: The Suicide Detective
For reasons that have eluded people forever, many of us seem bent on our own destruction. Recently more human beings have been dying by suicide annually than by murder and warfare combined. Despite the progress made by science, medicine and mental-health care in the 20th century — the sequencing of our genome, the advent of antidepressants, the reconsidering of asylums and lobotomies — nothing has been able to drive down the suicide rate in the general population. … That curiosity has made [Matthew K. Nock, the director of Harvard University’s Laboratory for Clinical and Developmental Research] 39, one of the most original and influential suicide researchers in the world. In 2011, he received a MacArthur genius award for inventing new ways to investigate the hidden workings of a behavior that seems as impossible to untangle, empirically, as love or dreams (Kim Tingley, 6/26).

The Atlantic: The LGBT Health Movement, 40 Years Since Homosexuality Was A Mental Illness
At the time of the 1973 declassification of homosexuality as a mental illness, people joked that never in history had so many "sick" people been cured so quickly. Forty years later, health researchers across the U.S. are still assessing the ongoing fallout of discrimination on LGBT health. ... While we are learning that most members of the LGBT community cope remarkably well, considering what many have lived through, there's also promise in several health movements that are developing evidence-based interventions to further optimize resilience (John-Manuel Andriote, 6/26).

The New York Times: American Way Of Birth, Costliest In The World
Seven months pregnant, at a time when most expectant couples are stockpiling diapers and choosing car seats, Renée Martin was struggling with bigger purchases.  At a prenatal class in March, she was told about epidural anesthesia and was given the option of using a birthing tub during labor. To each offer, she had one gnawing question: "How much is that going to cost?"… Like Ms. Martin, plenty of other pregnant women are getting sticker shock in the United States, where charges for delivery have about tripled since 1996, according to an analysis done for The New York Times by Truven Health Analytics. Childbirth in the United States is uniquely expensive, and maternity and newborn care constitute the single biggest category of hospital payouts for most commercial insurers and state Medicaid programs. The cumulative costs of approximately four million annual births is well over $50 billion (Elisabeth Rosenthal, 6/30).

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Editorials and Opinions

Announcement Of Delay In Health Law's Employer Mandate Sparks Heated -- And Contrary -- Views

Among the range of perspectives offered by commentators: It is "the right thing to do" but the wrong way; "administration has undermined its sole claim to greatness;" "doesn't have much effect."

The New York Times: Economix: Putting Off The Employer Mandate
Well, I didn't see that coming. The Obama administration announced Tuesday afternoon that it was going to delay an important part of the Affordable Care Act for one year. The rule requiring employers with at least 50 full-time workers to provide them with coverage or pay a penalty (also known as the employer mandate) will now be enforced starting in 2015, not 2014 as originally planned (Jared Berstein, 7/2). 

The Washington Post’s Wonk Blog: Obamacare's Employer Mandate Shouldn’t Be Delayed. It Should Be Repealed
Delaying Obamacare's employer mandate is the right thing to do. Frankly, eliminating it — or at least utterly overhauling it — is probably the right thing to do. But the administration executing a regulatory end-run around Congress is not the right way to do it (Ezra Klein, 7/2).

The Washington Post's Right Turn: Seven Reasons Obamacare's Employer Mandate Delay Is A Huge Deal
In deciding to postpone the implementation of the employer mandate, the Obama administration has undermined its sole claim to greatness and delivered a blow to Democrats on the ballot in 2014. Here are seven reasons (more will pop up in the days to come) why it is a huge setback (Jennifer Rubin, 7/2).

Bloomberg: The Side Effects Of Delaying Obamacare
The essential challenge with adjusting Obamacare is that it is an interlocking combination of policies. The coverage mandates, for instance, pair with regulations that make coverage more generous and more expensive. Without them, the higher cost of insurance might cause the healthiest to opt out, further raising insurance premiums and creating a spiraling problem known as adverse selection. The employer mandate would have worked in a similar way by relieving pressure on the individual market. That said, there is a strong case for getting rid of the employer mandate (Evan Soltas, 7/2).

Bloomberg: Is Obamacare Headed for Even More Trouble?
The decision of President Barack Obama's administration to delay a crucial component of its health-care reform law, first reported today by Bloomberg News, raises two immediate questions. First, can the White House protect other components of the law from renewed attack? Second, what does this say about the broader problems facing implementation? (Christopher Flavelle, 7/2).

Forbes: White House To Delay Obamacare's Employer Mandate Until 2015; Far-Reaching Implications For The Private Health Insurance Market
In the short term, the delay will have several effects. First, the mandate drives up the cost of labor, and therefore increases unemployment; delaying the mandate by one year may modestly mitigate that disincentive. Most importantly, the delay of the mandate means that more people will want to enroll in Obamacare’s subsidized insurance exchanges. Every year, fewer and fewer employers offer health coverage; given one more year to restructure their workforces, this process could accelerate (Avik Roy, 7/2).

The New Republic: Some Bad News About Obamacare That Isn't Bogus
I've always liked the employer mandate, largely for its symbolic value: It's a way of making sure everybody contributes to health coverage, in some manner. But economists and health policy experts will tell you, almost universally, that the employer mandate is actually bad policy. As they see it, the requirement doesn't have much effect on whether most employers decide to offer their workers coverage. For the most part, the experts say, employers will decide whether to offer coverage based largely on whether they think it helps retains employees (Jonathan Cohn, 7/2).

And on other aspects of the health law -

The New York Times: A Chance For Pro Sports To Help On Health Care
The Obama administration thought it had a smart way to publicize the benefits of health care reform: get some professional athletes to help spread the word. Millions of uninsured Americans, after all, don’t know that they will be able to sign up for free or subsidized health insurance beginning Oct. 1, and they may be more likely to pay attention to athletes explaining it than to politicians. ... But when Republicans found out the administration planned to approach the major sports leagues, they decided to commit interference (7/2).

The New York Times: Economix: Confusing The Public On The Affordable Care Act
In my previous post I explained that general statements on the probable impact of the Affordable Care Act on the pocketbooks of Americans often do not make sense and can be quite misleading. My point can be illustrated with a recent news release from the Ohio Department of Insurance, "Health Insurance Costs to Increase Significantly Under Affordable Care Act." The department states that it "released the information today to help health insurance consumers continue to prepare for the expected price increases." It offers a one-sided perspective (Uwe E. Reinhardt, 7/2). 

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Viewpoints On Medicare: Advantage Program Offers Roadmap To Improving The Program; Rare Bipartisan Support For Doctor Pay Fix

Several outlets offer opinions on the Medicare system.

USA Today: Health Advantages Of Medicare Advantage
Concern about the size and cost of Medicare is understandable. With 10,000 or so baby boomers due to reach age 65 every day for the next 18 years, Medicare enrollment is exploding, and based on our projections, by 2023 -- 10 years from now -- should reach 66 million, up from 50.3. The need to find better ways to deliver quality health care to seniors at a reasonable cost is obvious. What's interesting is that an effective way to do this already exists: the Medicare Advantage program, which some in Washington are seeking to curtail (Daniel Gorlin and John Kaplan, 7/2).

Bloomberg: Fix Doctors' Pay And Improve Health, Too
On Medicare, Republicans and Democrats don't agree about much, except this: The current fee-for-service system is unsustainable, and the broken formula used to pay doctors who treat Medicare patients is a big reason why. Fortunately, there's a consensus forming around fixing that formula -- and it's an opportunity for the kind of bipartisan cooperation we rarely see in health-care policy (Lanhee Chen, 7/2).

Health Policy Solutions (a Colo. news service): Cuts To Medicare Part B Will Hurt Older Coloradans
Older Coloradans like me who suffer from chronic diseases that afflict us for decades consider Medicare Part B coverage indispensable for our quality of life. That’s why we are worried about some in Washington who believe a smart path to a balanced budget runs through cuts in seniors’ health care. Such a wrongheaded solution will not only hurt older Americans, but could actually increase health care costs rather than spark savings. ... Reducing payments to doctors means that fewer of them will be able to afford to treat Medicare patients (Ron Haberkorn, 7/2).

In addition, a Bloomberg columnist examines retiree health costs -

Bloomberg: Retirees' Medical Bills Are Bringing Down Detroit
The emergency manager in charge of keeping Detroit afloat says the city’s $20 billion debt load can't be reduced to manageable levels without "shared sacrifice" from all stakeholders, including retirees. Pension and retiree-health-care obligations make up the bulk of the city’s unsecured debt, and their costs are rising rapidly. The emergency manager, Kevyn Orr, is right that Detroit must reduce its retirement-related debt to secure its future, but he has to be more specific about his target. Cutting retiree health care -- also referred to as "other post-employment benefits," or OPEBs -- should take priority over pensions (Stephen Eide, 7/2).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Marissa Evans
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.