Daily Health Policy Report

Wednesday, August 13, 2014

Last updated: Wed, Aug 13

KHN Original Reporting & Guest Opinion

Health Reform

Health Care Marketplace

Public Health & Education

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

16% Of Large Employers Plan To Offer Low-Benefit 'Skinny' Plans Despite ACA: Survey

Kaiser Health News staff writer Jay Hancock reports: "Nearly one company in six in a new survey from a major employer group plans to offer health coverage that doesn't meet the Affordable Care Act's requirements for value and affordability. Many thought such low-benefit "skinny plans" would be history once the health law was fully implemented this year. Instead, 16 percent of large employers in a survey released Wednesday by the National Business Group on Health said they will offer in 2015 lower-benefit coverage along with at least one health plan that does qualify under ACA standards" (Hancock, 8/13). Read the story.

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More Employers Limit Health Plan Networks But Seek To Preserve Quality, Says Adviser

Kaiser Health News staff writer Mary Agnes Carey talks with Dr. Robert Galvin, chief executive officer of Equity Healthcare, where he works with executives of nearly 50 companies that purchase health coverage for 300,000 people. Galvin says the 2010 Affordable Care Act has made employers more engaged in health benefits while encouraging their workers to be savvier health care consumers (Carey, 8/13). Read the interview.

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Political Cartoon: '.com-plicated?'

Kaiser Health News provides a fresh take on health policy developments with ".com-plicated?" by Harley Schwadron.

Meanwhile, here's today's haiku:


One uncertainty
Ripples untouched by many
Ignorant risk pool
-Kelly P. Phouyaphone

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

Citizenship, Immigration Issues Threaten Health Coverage For 310,000 People

The federal government has mailed notification to the people in three dozen states. These people have until Sept. 5 to present green cards, citizenship documents or other information to prove their eligibility for health insurance purchased through the online insurance marketplace. If this deadline is missed, the coverage will end as of Sept. 30.

The New York Times: Over 300,000 Must Prove Eligibility Or Lose Health Care
More than 300,000 people who bought subsidized health insurance under the Affordable Care Act could lose it next month if they do not provide proof that they are living in the United States legally, the Obama administration said Tuesday (Goodnough, 8/12).

The Washington Post: Administration Warns Some Could Lose Health-Care Coverage On Federal Exchange
Federal health officials are warning hundreds of thousands of people who have bought health plans through the federal insurance exchange that their coverage will be cut off unless they quickly provide proof that their citizenship or immigration status makes them eligible to be insured through the new marketplace. The warnings, in letters being mailed this week to 310,000 people in the three dozen states that rely on the exchange, give the recipients until Sept. 5 to send copies of green cards, citizenship documents or other information showing that they qualify for the coverage. If they miss the deadline, their coverage will end on Sept. 30 (Goldstein, 8/12).

The Associated Press: Deadline To Clear Up Health Law Eligibility Near
Of the 8 million people who signed up for private coverage through President Barack Obama's law, more than 2 million at one point had discrepancies of some sort that affected their eligibility. That number has been greatly reduced — but the remaining cases are proving difficult to resolve. People living in the country illegally are not allowed to get coverage. Officials at the Health and Human Services Department said the letters will notify consumers with unresolved citizenship and immigration issues that they can upload their documents to the HealthCare.gov website, or mail them in (Alonso-Zaldivar, 8/13).

The Wall Street Journal: Health Coverage To End Without Proof Of Citizenship Or Legal Residency
Immigration status has been one of the most politically charged aspects of the law. During congressional debate, supporters added a provision banning people living in the U.S. without authorization from using the exchanges to buy coverage and from receiving tax credits that many lower-income Americans and legal residents can get. Some immigration activists grudgingly accepted the restriction as necessary to maintain support for the legislation, but said it was spiteful to prohibit people from using the site entirely
(Radnofsky, 8/12).

Politico: Immigration Status May Cost People Obamacare Coverage
The individuals receiving those warning notices are a portion of the almost 1 million people with citizenship or immigration "data-matching" errors that CMS has been working to resolve since May, according to a release Tuesday (Norman, 8/12).

Bloomberg: About 300k To Lose Obamacare Unless Prove Residency
In May, the U.S. said about 1 million people who signed up for private health plans under the Patient Protection and Affordable Care Act lacked proof that they are citizens or legal residents. Since then, about 660,000 have documented their eligibility for the program or are doing so, the Centers for Medicare and Medicaid Services said today in a statement. About 8 million people signed up for plans using new health insurance exchanges by April, when the law’s first enrollment period closed (Wayne, 8/12).

CQ Healthbeat: Federal Health Exchange Asks 310,000 Consumers For Citizenship Data
CMS said that it has made some progress in whittling down the number of applications that triggered questions about applicants’ citizenship and immigration status. The agency said that it has closed about 450,000 of these cases, and another 210,000 are moving toward completion. The cases often stem from a glitch with an application, such as incomplete or inaccurate information about a Social Security number or permanent resident card. Such inconsistencies don’t necessarily mean that an applicant doesn’t qualify for aid, CMS said (Young, 8/12).

McClatchy: Thousands Might Lose Health Insurance Over Missing Documents
Some 310,000 people with inconsistencies in their citizenship and immigration materials might lose their federal marketplace health coverage Sept. 30 unless they provide proper supporting documents by Sept. 5, the Obama administration announced Tuesday. In May, the Department of Health and Human Services began contacting about 2 million people about discrepancies or errors in the personal information they’d provided in their insurance applications. The problems stem, in part, from an administration policy that allowed applicants to self-report information about their incomes, citizenship and household size, all of which contribute to determining their eligibility for tax credits to help pay for coverage (Pugh, 8/12).

The Hill: 300K Warned: Send In Documents Or Forfeit Obamacare Coverage
The last-ditch effort, announced Tuesday, is targeted at policyholders who have not responded to previous requests that they clarify their immigration status to HHS. "We want as many consumers as possible to remain enrolled in marketplace coverage, so we are giving these individuals a last chance to submit their documents before their coverage through the marketplace will end," said Centers for Medicare and Medicaid Services (CMS) Administrator Marilyn Tavenner in a statement (Viebeck, 8/12).

Miami Herald: Feds Warn 93,800 Floridians To Prove Immigration Status Or Lose Obamacare
Federal health officials are warning almost 94,000 people in Florida that they must prove they are U.S. citizens or legal immigrants in order to remain eligible for insurance under the Affordable Care Act (Madigan, 8/12).

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Insurance Rate Hikes Could Be Issue In Key States

Although rate hikes average 7.5 percent nationally for the individual health insurance market, consumers in politically key states such as Florida and North Carolina may see higher increases-- and insurers are partly blaming the administration's decision to allow consumers to hold onto their old policies.Other stories look at the long-term challenges faced by for-profit hospitals and insurers under the health law and the tech issues plaguing the website designed to show how much drugmakers give to doctors.

Politico Pro: ACA's 2014 Solution Could Be A 2015 Problem
The Obama administration’s effort to end one political crisis during the 2014 Obamacare rollout may have sown the seeds of another controversy: potential double-digit rate hikes in 2015. Although insurers’ proposed rates average 7.5 percent for much of the country, some residents in politically key states like Florida, North Carolina and Iowa would face hikes of 11 percent to nearly 18 percent if insurers have their way. Major carriers there in part blame such increases on the administration’s response to the furor that erupted when millions of Americans received notice last fall that their health policies would be canceled because they fell short of Obamacare requirements (Norman, 8/13).

Modern Healthcare: Rosy Q2 For Hospitals, Insurers Doesn’t Eliminate Long-Term Challenges
Several for-profit hospitals and health insurers have booked improved financial results in the second quarter of the calendar year, thanks in part to healthcare reform, but providers and payers still face headwinds to maintain sustained profitability, Standard & Poor's analysts say in a report. Several investor-owned hospital chains, including HCA, LifePoint Hospitals, Tenet Healthcare Corp. and Universal Health Services, said in second-quarter earnings reports that the Patient Protection and Affordable Care Act has shifted payer mix for the better and expanded each system's insured base. Many have consequently raised financial expectations for the remainder of 2014 as more covered patients enter their doors (Herman, 8/12).

Des Moines Register: Harkin: Public Clinics Still Needed As Insurance Expands
The United States should continue expanding publicly subsidized clinics even as it covers more people with health insurance, Sen. Tom Harkin said today. "The community health centers have done a wonderful service all over America," the Iowa Democrat said in Des Moines. The health centers receive substantial federal financing to care for people who have trouble finding help elsewhere. Harkin, who is the chairman of a Senate committee that helps oversee health-care spending, said the public clinics will continue to be needed, even as more Americans gain health insurance under the Affordable Care Act (Leys, 8/12).

Politico Pro: Tech Issues Continue To Bug New CMS Site
CMS and drugmakers are blaming each other for the latest derailed launch of a high-profile health care website. And at least for the moment, neither side’s pointing a finger at the contractor that built the agency’s Open Payments site — CGI Federal, the same vendor behind last fall’s HealthCare.gov meltdown. The indefinite delay of Open Payments, which will list payments and gifts that drug and medical device companies make to doctors, comes as the Obama administration is bringing in hired guns to fix all government websites. The system has been hobbled by mix-ups in doctor information and glitches preventing doctors from reviewing data for mistakes (Pittman, 8/12).

The Hill: Spammer To Pay $350K Over O-Care Emails
A company has agreed to pay $350,000 over claims that it sent threatening spam emails regarding the rollout of the Affordable Care Act. Kobeni Inc. and its president, Yair Shalev, have agreed to pay the sum to settle regulators’ charges that it sent deceptive emails that pushed recipients to register for health insurance and falsely warned that users would be violating federal law if they did not do so, the Federal Trade Commission (FTC) announced Tuesday. The FTC brought the charges — its first related to ObamaCare fraud — in January (Tummarello, 8/12).

CQ Healthbeat: CMS Moves To Define Where Medicare and Exchange Plans Overlap
The notion that the worlds of Medicare and exchange coverage never overlap is a fallacy, a new federal document shows. Most Americans 65 or older need not be concerned about exchange coverage, according to the 15-page document entitled “Frequently Asked Questions Regarding Medicare and the Marketplace” (Reichard, 8/12).

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Health Care Marketplace

Wellpoint To Change Its Name

CEO Joseph Swedish said the change was motivated by the company's belief that it was important to go with the name people know best -- Anthem. It is happening at a time when, because of the health law and changes in how employers offer workers insurance, consumers increasingly shop for their own coverage.

The Associated Press: Health Insurer Wellpoint Changes Name To Anthem
CEO Joseph Swedish says in a statement: “We believe it is important to call ourselves by the name that people know best — Anthem.” The name change comes as consumers increasingly shop for their own health benefits, in part due to the health care overhaul. The Indianapolis-based company operates plans in 14 states and primarily does business as Anthem Blue Cross and Anthem Blue Cross and Blue Shield (8/12).

The Wall Street Journal: WellPoint Changes Its Name To Anthem
The change is the latest move by a health insurer aimed at promoting a more consumer-focused identity, as the industry sells more coverage directly to individuals rather than its traditional commercial audience of business owners and human-resource executives. The shift is occurring under the federal health law, which created insurance marketplaces in each state. Also, some employers are having their workers select coverage on similar exchanges operated by private companies (Wild Mathews, 8/12).

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Public Health & Education

World Health Organization Approves Use Of Experimental Ebola Treatment

The drugs have not yet been through FDA testing, but WHO says they can be used for "compassionate use" to help in the African outbreak. However, manufacturers may not have many supplies available.

Los Angeles Times: WHO OKs Use Of Experimental Drugs For Ebola Patients In West Africa
A World Health Organization panel advised Tuesday that it was ethical to use experimental, non-approved drugs to combat the Ebola virus in West Africa, and that five such treatments were being considered for "compassionate use" (Morin and Frayer, 8/12).

USA Today: U.N. Endorses Use Of Untested Ebola Medicines
The endorsement from the U.N.'s health care agency came after two American health care workers were treated with an experimental Ebola drug. Officials warned, however, that the improvement they showed may not have been directly related to the drugs. WHO says 1,013 people have died since March in the outbreak, the vast majority of them in Liberia, Sierra Leone and Guinea. Officials estimate that Ebola kills about half of those afflicted with the disease (Bacon and Weintraub, 8/12).

PBS NewsHour: WHO Approves Use Of Untested Drugs To Fight Ebola, But Supply May Be Running Out
An ethics panel of the World Health Organization unanimously approved using untested drugs to treat Ebola in West Africa, where more than 1,000 people have died from the outbreak so far. A shipment of the U.S.-made drug ZMapp is expected to arrive in Liberia this week, but the drugmaker may have otherwise exhausted its supply (Woodruff, 8/12).

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Actor's Suicide Shows Complexities Of Depression And Its Treatment

The Washington Post looks at how Robin Williams' death has reignited a national conversation about mental health issues and treatment, and whether public attitudes toward diagnosis and treatment are changing.

The Washington Post: Robin Williams’s Death Shows The Power Of Depression And The Impulsiveness Of Suicide
Many suicides are the result of undiagnosed or untreated depression, often masked by self-medicating behaviors such as alcohol and drug use. Though we don’t yet know the exact circumstances of Williams’s death, we do know that he long battled addictions to cocaine and alcohol and, according to his publicist, was struggling with “severe depression.” But unlike many people, Williams had the resources and the motivation to seek treatment, at least for his addictions. According to this report, he had undergone rehab at the famed Hazelden Addiction Treatment Center in Minnesota two months ago, and had sought treatment in 2006 when he began drinking again after 20 years of sobriety. How, then, do we explain the death of someone who appeared to recognize the danger he faced and was trying to address it? (Bernstein, Sun and Somashekhar, 8/12).

The Washington Post’s Wonkblog: A Better Understanding Of Mental Illness Hasn’t Reduced The Stigma Around It
The tragic news of Robin Williams's death by apparent suicide on Monday has again reignited a larger conversation about the need to eliminate the social stigma still surrounding depression and mental illness. It's a conversation that seems to keep resurfacing around tragic incidents over the past couple of years, so it's worth asking whether the stigma is at all getting smaller. Unfortunately, there aren't very many rigorous polls capturing American attitudes toward diagnosis and treatment of mental illness. There are some signs of changing attitudes, though (Millman, 8/12).

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State Watch

Study Finds Big Range In State Workers' Health Costs

A first-of-its-kind study by two charitable organizations found that states paid nearly $31 billion on employee insurance last year - making it the second largest category of state health care spending after Medicaid. But the costs borne by state workers varied widely.

The Washington Post: States Spent Nearly $31 Billion On Employee Health Insurance Last Year
States paid nearly $31 billion to insure their employees last year, according to a new Pew Charitable Trusts study. The study offers a window into what is one of the largest sources of state health care spending, second only to Medicaid spending. On average, states spent $808 in premium payments per employee per month, Pew finds. But that number varied widely by state — in part due to factors policymakers can control, and in part to those they cannot (Chokshi, 8/12).

Politico Pro: Report Finds Big Range In State Workers’ Health Premiums
Health premiums for state employees vary by hundreds of dollars monthly across the country, according to a report released Tuesday by the Pew Charitable Trusts and the John D. and Catherine T. MacArthur Foundation. State workers in places such as Arkansas, Mississippi and South Carolina had plan premiums that cost between $450 and $650 a month last year. Their counterparts in New Jersey, New Hampshire, Vermont and Wisconsin had some of the highest premiums, exceeding $1,300 monthly. The two organizations enlisted Milliman Inc. to examine state employee health plans after concluding that little was known about how those plans compared to one another and with other plan types within a specific jurisdiction (Villacorta, 8/12).

The Associated Press: California Offers Workers Generous Health Benefits
Health insurance plans offered to state employees in California and elsewhere are relatively generous, with government picking up a large share of deductibles and co-pays, according to a report released Tuesday. The report by The Pew Charitable Trusts and the John D. and Catherine T. MacArthur Foundation was a first-of-its kind survey of state government health insurance plans nationwide. It found that state plans paid on average 92 percent of a typical enrollee's health care costs, which is equivalent to the best offerings — "platinum" plans — that the public can purchase on one of the new health insurance exchanges (Verdin, 8/12).

The Associated Press: Idaho Gives State Workers Premium Health Coverage
Idaho's employee health insurance plans are comparable to the federal government's most expensive option offered under the Affordable Care Act and better than what most private companies provide, according to a report released Tuesday. The report from the Pew Charitable Trusts says Idaho covers 93 percent of all medical costs for state employees. The report is the first of its kind to shine light on states' largest source of health care spending, second only to Medicaid spending (Kruesi, 8/12).

The Associated Press: State Workers in Arizona Get ‘Platinum’ Insurance
A new study released Tuesday shows most states provide their employees with health insurance that most private workers would envy — and Arizona is no exception. The study by the Pew Charitable Trusts and the MacArthur Foundation shows the vast majority of people employed by the state of Arizona are enrolled in a zero-deductible plan that would be considered a "platinum" plan under the Affordable Care Act (Christie, 8/12).

Miami Herald: Health Insurance For State Employees Gets Another Look
Compared to other states, Florida’s health insurance plan for government employees is about average. It doesn’t have the cheapest premiums or the most expensive. The state is generous to its employees, but not to an extreme. The implementation of federal health care reform has caused more states to analyze spending and a national study released Tuesday provides a snapshot of each state, including how much public workers pay for health coverage and what they get in return (Mitchell, 8/12).

The Oregonian: Oregon Has Comparatively High Health Insurance Costs For State Workers, National Study Shows
A first-of-its kind study shows that Oregon provides some of the richest health insurance benefits for state employees from around the country. The study released Tuesday by two major charitable foundations shows that Oregon's per-employee premium costs in 2013 were a third higher than the national average and were the sixth highest of the 49 states studied (Mapes, 8/12).

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State Highlights: New Rules Could Disrupt Care For Disabled Kansans

A selection of health policy stories from Oregon, Illinois, Kansas, Missouri, Georgia, Colorado, California and Texas.

The Oregonian: Providence Slammed By Court For Denying Autism Coverage, Oregon Insurance Division's Role Questioned
In a potentially far-reaching opinion, a federal judge in Portland has ruled that Providence Health Plan wrongfully denied insurance coverage for groundbreaking autism therapy for two Portland boys. U.S. District Court Judge Michael Simon ruled that Providence's denial of coverage violated both federal and state mental health parity laws. The statutes require health insurers to cover mental health issues no different than physical issues. At issue in the case was whether health insurers have to cover "applied behavioral analysis," an intense therapy for autism, which afflicts one of 88 children in the United States (Manning, 8/12).

Chicago Tribune: SEIU Stops Collecting Fees From Non-Member Home Health Workers
Various chapters of the Service Employees International Union have stopped collecting fees from home care workers who are not union members, a move that exemplifies the broader implications of a recent Supreme Court ruling. The court's decision only prevented SEIU from collecting fees of such workers in Illinois. But in an attempt to quench lawsuits by the National Right to Work Legal Defense Foundation, various chapters outside of Illinois have stopped collecting fees of similar workers (Cancino, 8/12).

Kansas Health Institute News Service: New Federal Rules Will Disrupt Care For Disabled Kansans, State Officials Say
A state official charged with overseeing Medicaid-funded services that help people with disabilities live in community-based settings rather than in nursing homes said Tuesday that coming changes in federal wage and hour rules are likely to increase costs, reduce access to care and give beneficiaries less say in deciding who will provide their care. "We have great concerns about this," said Kansas Department for Aging and Disability Services Secretary Kari Bruffett, testifying before a Statehouse meeting of the Robert G. Bethell Joint Committee on Home and Community Based Services and KanCare Oversight (Ranney, 8/12).

St. Louis Post-Dispatch: Missouri Sees Biggest Drop In Medicaid Enrollment Compared To Other States
The state of Missouri has experienced the single largest monthly drop in Medicaid enrollment, at a time when most states are reporting increases. Missouri had an average of 808,824 individuals enrolled in its Medicaid program and the Children’s Health Insurance Program at the end of June. That represents a decrease of 37,260 people, or 4.4 percent, compared with average enrollment a year earlier, according to a report released Friday by the Department of Health and Human Services (Liss, 8/13).

Georgia Health News: Medicaid Increase, Uninsured Data Show Ga. Impact
Federal figures show Georgia's Medicaid and PeachCare enrollment jumped 16 percent since October – the highest percentage increase among states that have rejected the expansion of Medicaid under the Affordable Care Act.  The Georgia jump greatly exceeds that of the second-highest increase among non-expansion states: 9.5 percent in Montana. Expanding Medicaid involves extending enrollment in the government program to many low-income people who had not previously been eligible (Miller, 8/12).

Modern Healthcare: Flood Of New Patients Worries Mental Health Workers
Many behavioral healthcare advocates and providers across the country are reporting significantly increased demand for their services because of the Medicaid expansion in some states. But they are worried about whether underfunded and understaffed mental health centers will be able to adequately serve the flood of new clients. Officials at Arapahoe/Douglas Mental Health Network and AspenPointe in Colorado say they have noticed an uptick in the number of Medicaid patients they're seeing. Those organizations did not have data on exactly how many more patients they're seeing (Dickson, 8/12).

The California Health Report: Peer Respites For Mental Health Consumers Prevent Hospitalizations
As people with mental health crises overwhelm California's hospitals, jails and homeless shelters, counties across the state are gradually embracing residential respite houses located in neighborhoods and staffed by peers — people who have been consumers of the mental health system. For people on the verge of a crisis, staying at a peer-run respite, typically for a couple of days or up to two weeks, can help them recover with support from people who have had similar experiences. That can prevent incarceration or forced hospitalization, which often damages family relationships and can cause the loss of housing or jobs, said Yana Jacobs, chief of outpatient adult services for Mental Health and Substance Abuse Services at the Santa Cruz County Health Services Agency (Graebner, 8/12).

The Associated Press: Texas Abortion Law Could Send Women Across Borders
Crossing borders is a part of life in El Paso in far West Texas, where people may walk into Mexico to visit family or commute to New Mexico for work. But getting an abortion doesn't require leaving town. That could change if a federal judge upholds new Texas rules that would ban abortions at 18 clinics starting Sept. 1, including only one that offers the procedure in El Paso, where one of the toughest anti-abortion laws in the U.S. has come under particular scrutiny at a trial ending Wednesday in Austin (Llorca and Weber, 8/12).

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Editorials and Opinions

Viewpoints: Medicaid's Good Deal; Medicare Hospital Errors; CBO On Exchange Coverage

The New York Times' The Upshot: A Deal Too Good To Turn Down, Unless It's Medicaid
If the governor and the legislature refuse to accept the federal deal [for Medicaid expansion] — as 24 states have so far — they in effect vote against one of the most fantastic cash-flow deals ever offered them. ... And it gets worse. The state’s citizens are paying taxes to the federal government to help cover the federal payments made to other states who do accept the new deal, but the state gets nothing in return. In states that accept the deal, possibly millions of poor citizens will get insurance coverage they now lack. Furthermore, doctors, hospitals and other providers of health care in the state would see their revenues increase and thus could offer more jobs to residents of the state. ... In short, this economist is puzzled by the thinking among the leaders of the 24 states who have refused to accept the highly profitable deal offered them under the Affordable Care Act (Uwe E. Reinhardt, 8/12).

Forbes: Without Oversight, Medicare Threatened By Hospital Billing Errors
Recently, in a series of back-to-back Congressional hearings on improving Medicare integrity, lawmakers sounded the alarm: Medicare is rife with waste, fraud and abuse, and it must be fixed. But in a twist, the hearings focused solely on the impact of this issue on hospitals, not patients or taxpayers. This is troubling for several reasons. According to the Centers for Medicare and Medicaid Services, Medicare lost over $36 billion to over-billings by providers in fiscal year 2013, with hospitals accounting for 88% of the waste. According to the Government Accountability Office – Congress' preeminent oversight body – these astounding losses are largely due to documentation errors, also referred to as "up-coding," in which a provider erroneously bills Medicare to recoup higher reimbursements (Becky Reeves, 8/12). 

The New Republic: Halbig Truthers Say Everyone Blew It on Obamacare. This Former Analyst Says They're Full of It.
The smartest, least dishonest argument you'll hear from Halbig Truthers goes something like this: The statutory text of the Affordable Care Act can only be read one way, and by that reading, the government isn't authorized to provide subsidies to beneficiaries in states that didn't set up their own exchanges. ... This is a stretch for a lot of reasons, starting with the assumption that the ACA can only be read one way. ... One of the central players in this drama was the Congressional Budget Office, and we know the analysts there never imagined Congress intended to condition subsidies on states setting up their own exchanges (Brian Beutler, 8/11).

Forbes: Transcending Obamacare: An Introduction To Patient-Centered, Consumer-Driven Health Reform
Today, the Manhattan Institute is publishing my 20,000-word, 68-page health reform proposal .... It represents a novel approach to health reform: neither accepting Obamacare as is, nor requiring the law’s repeal to move forward. And yet its ambition is to permanently solve our health care entitlement problem, while also expanding coverage for the uninsured. ... One of the fundamental flaws in the conservative approach to health care policy is that few—if any—Republican leaders have articulated a vision of what a market-oriented health care system would look like. Hence, Republican proposals on health reform have often been tactical and political—in opposition to whatever Democrats were pitching—instead of strategic and serious. Those days must come to an end. The problems with our health care system are too great. Health care is too expensive for the government, and too expensive for average Americans (Avik Roy, 8/13).

The Milwaukee Journal Sentinel: The GOP's Perilous Way Forward On Health Care
Obamacare is a disaster, for which it increasingly appears Democrats will pay the political price in 2014. But Republicans also have to consider the possibility that voters will hold them at least partially accountable for what happens from here on out. Regardless of their merit, if court cases from the right render the ACA more of an incomprehensible patchwork of regulations, the GOP should prepare itself for making the case for an ol' switcheroo. If the public thinks the GOP broke Obamacare, the party has to be prepared to buy it. And if Obamacare in Wisconsin collapses, Republicans could use some good political — ahem — insurance (Christian Schneider, 8/12).

The New York Times: Perpetuating Schizophrenia's Stigma
A few months ago, a patient came to our hospital, seeking help. ... He was a college graduate in his 20s and had recently been fired from his job as a high school math teacher, because of unexpected absences. He had come to believe that government agents were conspiring against him, and he had taken to living out of a truck and sleeping in different parking lots. By the time he came to us, he was exhausted. A diagnosis became clear: he had schizophrenia. We admitted him to the hospital, and after a few days, with his symptoms under control, we released him. Unfortunately, we prescribed a medication for him that could cause significant, permanent harm, instead of an equally effective drug with milder side effects — all because he was uninsured (Edward Larkin and Irene Hurford, 8/12).

Bloomberg: Robin Williams's Laughter Masked A Deadly Disease
When someone as sparklingly witty as Robin Williams commits suicide ... our first reaction is disbelief at the incongruity. Perhaps it shouldn't be. Psychologists believe that some styles of humor can mask a greater susceptibility to depression. In fact, a certain sense of humor may be a symptom of a widespread, often untreated disease that disables and kills (Leonid Bershidsky, 8/12).

Forbes: Robin Williams' Death Underscores Connection Between Creativity, Depression And Addiction
Williams was arguably one of the best examples of both extraordinary creativity and the darker sides of that sort of genius: Severe depression and addiction. ... So why are creativity – including comedy – and mental illness so intertwined? Like any creative profession – writer, musician, and artist – the answer may be that the comedian’s brain might be wired a little bit differently to begin with (Alice G. Walton, 8/12). 

The Washington Post: It Shouldn't Be This Awful And Isolating To Have HIV In The Year 2014
I was one of 725 new patients below the age of 24 to be diagnosed with HIV in the United Kingdom that year (out of 2.5 million new infections worldwide). I know nobody else my age who is positive; naturally that left me feeling isolated, alone, and a little alien. Thanks to drug advances, there’s little chance I’ll develop AIDS. But I’ll never have the freedom of a normal life, either. What I discovered after my diagnosis is that the shame and stigma attached to HIV is far more intense than the social anxiety attached to homosexuality (Patrick Reynolds, 8/12). 

The Wall Street Journal: Medtronic's Tax Lesson
Medtronic's pending acquisition of Covidien and adoption of Ireland as its legal headquarters teaches the economics of corporate inversion in one lesson. Here's the trade: Medtronic agrees to call Ireland its legal home, and in return it gets to bring $1 billion or more into the U.S. without penalty. That's how much cash is sitting on Covidien's books. True, it's not nearly as much as Medtronic already has sitting in its own foreign subsidiaries. The Minneapolis-based medical technology firm currently holds $13 billion in cash abroad. But this Medtronic money is all subject to extra taxation once it crosses the U.S. border, unlike the Covidien money, which can be brought to the U.S. and invested without penalty. The same penalty-free investing goes for all of Covidien's cash flow in the future (8/12). 

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Stephanie Stapleton

Andrew Villegas

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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.