Daily Health Policy Report

Wednesday, August 14, 2013

Last updated: Wed, Aug 14

KHN Original Reporting & Guest Opinion

Health Reform

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

A Nevada Health Plan -- Without The Insurance

Capital Public Radio's Pauline Bartolone, working in partnership with Kaiser Health News and NPR, reports: "Shelley Toreson had health insurance for years, but not anymore. Instead, she is part of an unusual Nevada nonprofit that helps connect 12,000 uninsured residents to doctors and hospitals who are willing to accept a lower-cost, negotiated fee for their services. 'The cost just kept going up and the coverage kept getting less,' says Toreson, 62, of her old insurance" (Bartolone, 8/14). Read the story.

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Capsules: How Much Of A Subsidy Will You Get In Obamacare? Here's An Estimate; What You Should Know About The Obamacare Delay On Some Out-Of-Pocket Caps

Now on Kaiser Health News' blog, Julie Appleby reports on a new report about the health law's subsidies: "If you buy your own health insurance, you’ve no doubt heard that subsidies will be available next year to help pay the premiums. But will you get a subsidy and how much? Researchers at the Kaiser Family Foundation have a report out Wednesday that provides some insight" (Appleby, 8/14).

Also on Capsules, more details about the Obama administration's delay for some of the health law's out-of-pocket spending caps (8/14). Check out what else is on the blog.

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Political Cartoon: 'The Sound Of Silence?'

Kaiser Health News provides a fresh take on health policy developments with "The Sound Of Silence?" by Jen Sorensen.

And here's today's health policy haiku:


Asleep at the wheel...
The FDA is asking:
Is it Ambien?

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

In Efforts To Implement The Health Law, Delays Stack Up

Recent news coverage has focused on a delay until 2015 for the overhaul's provision that limits out-of-pocket costs for some patients.

Bloomberg: Consumer Cost Protection In Obama Health Plan Is Delayed
Federal regulators have delayed a consumer protection in President Barack Obama's signature health law that limits the out-of-pocket costs of people with insurance. The one-year postponement of the annual limit on costs that patients must pay above what their insurance covers is another setback for a health care law that has met resistance from Republicans and faced delays in enforcement of other key provisions (Dorning, 8/13).

NPR: Obama Delays Implementing Another Part Of Affordable Care Act
The Obama administration has delayed implementation of another part of Affordable Care Act -- this time, it's the rules aimed at limiting out-of-pocket costs for patients (Varney, 8/14). This story was done in partnership with Kaiser Health News. In addition, KHN's Julie Appleby was featured on WBUR's Here and Now to discuss the delay (8/13).

KHN's earlier, related coverage: Consumer Groups Fear Patients Could Be Hit With Large Out-Of-Pocket Costs (Appleby, 4/9) and Federal Rule Allows Higher Out-Of-Pocket Spending For One Year (Andrews, 6/11).

Los Angeles Times: Federal Officials Delay Another Health-Law Provision For Employers
In another delay for the federal health care law, some employers will have until 2015 to comply with new limits on out-of-pocket medical spending for consumers. Federal regulators notified group health plans earlier this year that some would have an extra year to meet the new rules instead of January 2014 as originally proposed (Terhune, 8/13).

The Wall Street Journal: Health Law Delays Starting To Pile Up
Republicans opposed to the health care overhaul have had scant luck in overturning or delaying the law, but corporate America has succeeded in persuading the Obama administration to temporarily postpone a growing number of its provisions. In February, the administration delayed part of a requirement that some employer health-insurance plans cap employees' out-of-pocket costs (Schatz, 8/13).

The Washington Post's Wonk Blog: Four Ways To Understand The Latest Obamacare Delay
There's a rule in Obamacare that limits out-of-pocket costs -- including deductibles and co-payments -- to $6,350 for individuals and $12,700 for families. Sounds simple enough. But when the Obama administration went to implement the rule, it found it wasn't going to be that easy. Some insurers and employers lack the capacity to keep track of an individual's out-of-pocket health costs. They often use different companies to administer medical benefits and pharmaceutical benefits -- and those companies' computer systems don't speak to each other. Implementing the rule would require upgrading those systems -- and that takes time (Klein, 8/13).

CBS: Key Consumer Protection In Obamacare Delayed
The Obama administration has quietly delayed another key element of the Affordable Care Act, the New York Times reported Tuesday, exempting some insurers for a year from the new limit on out-of-pocket expenses. The Affordable Care Act, signed into law in 2010, explicitly set annual limits -- $6,350 for individuals and $12,700 for a family -- on out-of-pocket expenses. Mr. Obama touted the reform as one of the many consumer protections his sweeping health care law would include to make insurance more affordable (Condon, 8/13).

CQ HealthBeat: Out-Of-Pocket Health Spending Caps Start In 2014 With Limited Exceptions, Administration Says
The Obama administration emphasized Tuesday that a wide swath of American consumers will benefit in 2014 from first-ever federal limits on how much health insurers can require their policyholders to pay out of pocket for medical expenses, as the White House attempted to fend off a new flurry of Republican attacks on its implementation of the health law (Reichard, 8/13).

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Anticipation Leads To Questions -- Will The Health Exchanges Work?

McClatchy asks the central question: "Will it be smooth sailing or a 'train wreck'?" Meanwhile, other news outlets report on issues such as how experts view the possibility of rate shock when consumers shop for coverage from these online marketplaces, as well as other related developments in the District of Columbia, Maryland, Georgia, Ohio and Colorado.

McClatchy: Will Obamacare Rollout Be Smooth Sailing Or A 'Train Wreck'?
Just seven weeks before the new state insurance marketplaces are set to open under the Affordable Care Act, it's unclear whether the long-anticipated October rollout will be a smooth operation or the "train wreck" that some have predicted. Systems testing for the marketplaces is months behind schedule, according to recent government reports (Pugh, 8/13).

CQ HealthBeat: Experts Say Rate Shock Not Likely Under State Exchanges
The assumption by some insurers, state officials and Americans shopping for coverage that premiums under the health care law will skyrocket compared to current prices is unfair, some experts said Tuesday. Insurance rates under the state exchanges that open for enrollment on Oct. 1 will not necessarily result in a rate shock, Uwe Reinhardt, an economics and health policy professor at Princeton University, said during a webinar hosted by the Alliance for Health Reform on Tuesday (Khatami, 8/13).

The Washington Post: D.C. Groups Receive $6.4 Million To Help Uninsured Sign Up For Health Insurance
District officials awarded $6.4 million in grants Tuesday to community organizations to hire more than 150 trained experts to help uninsured residents learn about and enroll in health insurance this fall on the District's new insurance marketplace. The marketplace, known as DC Health Link, is the Web site where people can compare and shop for health insurance (Sun, 8/13).

Baltimore Sun: State Opens Health Reform Call Center
Maryland has opened the first call center where people can take their questions about health reform. The center that opened last week at 1 South Street in Baltimore has staff that can help Maryland residents and small businesses understand their insurance options and explain tax credits and other financial incentives in which they may be eligible under health reform (Walker, 8/13).

Georgia Health News: Sebelius, Hudgens Spar Over Exchanges
U.S. Health and Human Services Secretary Kathleen Sebelius on Tuesday criticized Georgia officials for what she characterized as a passive approach to the state's upcoming health insurance exchange. Exchanges, also called marketplaces, will begin enrolling consumers Oct. 1. The Affordable Care Act (ACA), sometimes called Obamacare, provides for an exchange in each state (Miller, 8/13).

The Associated Press: Advocates Question Ohio Health 'Navigators' Rules
An Ohio legislative panel on Monday cleared new state rules for professionals guiding people through the insurance marketplaces created by the federal health care law, despite concerns from some consumer groups that the regulations create confusion. The rules stem from a new state law that governs who can be a so-called insurance navigator and what duties they can perform (Sanner, 8/13).

Health Policy Solutions (a Colo. news service): Colorado Approves 242 Health Plans For Exchange
Colorado's Division of Insurance has approved 242 plans from 13 carriers for the state's health exchange, Connect for Health Colorado, which is slated to open on Oct. 1. … Most of the plans are mid-level products that would cover between 60 and 80 percent of health costs. Only two plans would provide the highest level of coverage, known as the platinum level that would pay about 90 percent of costs. If consumers want only catastrophic coverage, individuals will be able to choose from 13 different plans (Kerwin McCrimmon, 8/13).

Health Policy Solutions (a Colo. news service): Tech Errors Prompt Red Light Warning For Exchange
Just seven weeks before the Oct. 1 launch of Colorado’s health exchange, managers said that their IT systems are not getting accurate data from state Medicaid systems, prompting a warning to board members Monday. Adele Work, the project manager who leads technology for Connect for Health Colorado, shifted her readiness estimate for synching with state systems from yellow, meaning cautiously moving forward, to red, meaning not ready. She highlighted her concerns Monday that state IT systems may not properly communicate with the exchange systems by Oct. 1. Work said she's prepared to shift to contingency plans on Sept. 15 if necessary. At that point, the exchange would "freeze and deploy," meaning halt the planned system and deploy an emergency Band-aid fix (Kerwin McCrimmon, 8/13).

On the Medicaid expansion front -

Columbus Dispatch: Ohio Could Save And Expand Medicaid, Study Says
The state could expand its Medicaid program to cover more poor Ohioans and save money over the long haul, according to a new study presented yesterday to a Senate subcommittee. The savings could be big, too: $200 million next year and nearly $4 billion by 2025, according to the study done by the Health Policy Institute of Ohio and Ohio State University’s John Glenn School of Public Affairs (Varden, 8/14).

The Associated Press: State Lawmakers Hear New Medicaid Projections
Projections showing that Ohio could save state and federal dollars by expanding Medicaid are just one part of a fact-finding process for state lawmakers debating changes to the health program, a key Republican lawmaker said Tuesday. State Sen. Dave Burke, who chairs a Senate Medicaid subcommittee, said the recent analysis indicates that curbing the cost growth of Medicaid to a certain rate is feasible, even when more people are enrolled (8/13).

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Tax Credits: How Much Should Health Exchange Shoppers Expect?

A new report from the Kaiser Family Foundation concludes that about half of the consumers who currently buy their own health insurance would qualify for federal subsidies to purchase coverage on the new online marketplaces.

The Associated Press: Study: Half Who Now Buy Own Health Plan To Get Aid
About half the people who now buy their own health insurance—and potentially would face higher premiums next year under President Barack Obama's health care law—would qualify for federal tax credits to offset rate shock, according to a new private study. Many other people, however, earn too much money to be eligible for help, and could end up paying more (Alonso-Zaldivar, 8/13).

Kaiser Health News: Capsules: How Much Of A Subsidy Will You Get In Obamacare? Here's An Estimate
If you buy your own health insurance, you've no doubt heard that subsidies will be available next year to help pay the premiums. But will you get a subsidy and how much? Researchers at the Kaiser Family Foundation have a report out Wednesday that provides some insight (Appleby, 8/14).

Bloomberg: Health Exchange Shoppers Can Expect $2,700 In Tax Credits
Tax credits to buy medical coverage next year will average $2,672 per family under President Barack Obama's health-care system overhaul, a benefit that will make the plans more affordable than some critics have predicted. The subsidy should reduce the cost of the premiums by about 32 percent on average for people buying the second-lowest priced plans through state-by-state insurance exchanges set to open Oct. 1, the Kaiser Family Foundation said in a report today (Wayne, 8/14).

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ASU's Temporary Faculty Faces Reduced Hours -- Many Blame The Health Law

In other implementation news, the Internal Revenue Service has finalized its rule for sharing taxpayer information with states and other agencies, while provider groups are protesting a federal rule that would put them at financial risk when patients fail to pay their health insurance premiums.

Arizona Republic: Temporary-Faculty Hours Cut As ASU Readies For Health Law
Temporary faculty members at Arizona State University are feeling a sting from the Affordable Care Act, even though a key component of the law does not go into effect until January 2015. ASU administrators recently notified non-tenured associate faculty members that they will be limited to teaching six credit hours per semester beginning this fall, which amounts to two general-education courses. ... Beginning in January 2015, ASU will be obligated to provide health-care coverage to employees who average 30 hours or more per week (Dana, 8/13).

The Hill: IRS Moves To Share Taxpayer Information Under ObamaCare
The IRS has finalized its rule for disclosing taxpayer information under provisions of ObamaCare. The agency will share personal information such as income and tax filing status with states and other agencies to confirm whether or not people are eligible for tax credits to buy health insurance in new state-based marketplaces (Hattem, 8/13).

Modern Healthcare: Providers Protest Rule Putting Them At Financial Risk If Patients Don't Pay Premiums
Provider groups say a CMS rule interpreting the healthcare reform law that gives consumers a grace period for unpaid health insurance premiums will put them at significant risk of delivering services for which they won't get paid. The CMS rule (PDF) gives consumers a 90-day grace period if they don't pay their premiums before their insurer can drop their coverage. The rule applies to people in all states who obtain subsidized coverage through the new insurance exchanges (Block, 8/13).

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Talking Up The Health Law To Educate Consumers

News outlets report that a variety of health law advocates -- ranging from federal, state and local officials to retirees and grassroots volunteers -- are hitting the streets and knocking on doors to inform people about the law and counter what some say is "misinformation."

The Associated Press: Volunteers Get Out Word On 'Obamacare'
With just 50 days until Floridians are able to go online and shop for private health insurance under a new federal law, hundreds of volunteers are fanning out across the state to inform people about the law and the coverage opportunities available under it. Volunteers, who are mobilizing grassroots efforts similar to election campaigns, say they're finding that people are hungry to hear more (Kennedy, 8/13).

Bloomberg: Retirees In Enemy Territory Go Door-To-Door On Obamacare
Republican governors seeking to make their states enemy territory for Obamacare are facing a counteroffensive. Among the vanguard: two 74-year-old retirees walking the streets of working-class New Jersey. Margot Lee and Claude Cesard recently went door-to-door to pitch the health law’s benefits. They’re among thousands of supporters mobilized by the nonprofit group Enroll America to encourage the uninsured to sign up for the Affordable Care Act’s new health plans, one household at a time (Nussbaum, 8/14).

The Associated Press: HHS Chief, Fulton Officials Tout Health Care Law
Local and federal officials say they're working together to help Atlanta-area residents use new insurance exchanges under the 2010 federal health care overhaul, without the help of Georgia Republicans who run state government. U.S. Health and Human Services Secretary Kathleen Sebelius spoke Tuesday with Fulton County commissioners and medical providers about how to market new exchanges where consumers can shop for individual policies from private insurance firms beginning Oct. 1 (Barrow, 8/13).

St. Louis Post-Dispatch: Missouri Consumers In The Dark As Health Insurance Exchange Nears
You won't find Dwight Fine's name on the Missouri state payroll. But the retired hospital association executive has been working for state government the last three years. In health care circles, he’s known as the state’s Affordable Care Act coordinator. The Missouri Foundation for Health, a St. Louis-based nonprofit group, pays Fine’s salary and "loans" him to the state. He reports to the social services director (Young, 8/14).

Bloomberg: Health Law Success Hinges On Combatting 'Misinformation'
The U.S. government needs to offset "misinformation" about the health-care law being circulated in states led by Republican governors, according to the Obama administration official responsible for implementation (Wayne, 8/13).

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Health Law Still A Hot Topic In Town Hall Meetings And On The Campaign Trail

During Congress's August break, GOP lawmakers, armed with talking points, are maintaining strong positions against the overhaul and getting positive reinforcment from some of their constituents.

Des Moines Register: Talk To Employees About Obamacare, Senator Says
Employers should be telling their employees about how harmful Obamacare could be to job-creating businesses, a Wisconsin senator told Iowa entrepreneurs Tuesday (Leys, 8/13).

CT Mirror: Etsy Opponent Joins GOP Efforts To Distort Obamacare
President Obama’s signature accomplishment, the Affordable Care Act, continues to be a key weapon in Republican campaigns, including that of Mark Greenberg, a GOP candidate for Congress in Connecticut's 5th District. In a recent fundraising letter, Greenberg said, "Congress and (Rep.) Elizabeth Esty have just been given an exemption from Obamacare. Are you as upset as I am?" The letter said the IRS also received an exception from the ACA (Radelat, 8/14).

The Associated Press/Washington Post: In North Carolina, Many Republicans Give Clear Message To Congressman: Keep Up The Opposition
Republican Patrick McHenry's loudest constituents have no desire to see conciliation on gridlocked Capitol Hill, unless it comes from President Barack Obama and his fellow Democrats. As the congressman holds public question-and-answer sessions with constituents during Congress' summer break, conservatives and GOP loyalists who enjoy significant influence in his western North Carolina district are demanding that he and his House colleagues defund "Obamacare," refuse to raise the nation's debt limit and generally intensify opposition to the White House and Senate Majority Leader Harry Reid (8/13).

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State Watch

Calif. Lawmakers Advance Nurse Practitioner, Pharmacist Scope-Of-Practice Bills

The legislation will likely rally opposition over care quality concerns, even as the nurse bill loses a key supporter.

Los Angeles Times: Bills On Nurse Practitioners, Pharmacists Advance In Assembly
Measures that would expand the roles of nurse practitioners and pharmacists advanced in the Assembly on Tuesday, setting the stage for a fierce lobbying battle in the session's final weeks. Both measures wade into the so-called scope of practice debate over what type of medical care can be administered by non-physicians, setting off a turf war between doctors and other medical providers (Mason, 8/13).

Los Angeles Times: Bill To Curb Prescription Overdose Deaths Gains In Assembly
A bill aimed at beefing up California's prescription drug monitoring system so that it can be better used to track drug abusing patients and recklessly prescribing physicians emerged from an Assembly committee Monday on a unanimous vote. The bill by Sen. Mark DeSaulnier (D-Concord), which was backed by Atty. Gen. Kamala D. Harris, was approved 14 to 0 by members of the Assembly Committee on Business, Professions and Consumer Protection. The bill is next scheduled for consideration by the Assembly Appropriations Committee (Glover, 8/13).

California Healthline: Nurse Practitioner Bill Loses Supporter After 'Drastic' Last-Minute Amendments
An amended bill that would modify the role of nurse practitioners in California is expected to be voted on [Tuesday] by the Assembly Committee on Business, Professions and Consumer Protection. [Tuesday's] vote -- which is supposed to be taken without discussion -- has been complicated by the withdrawal of support from one its previous endorsers. The American Association of Retired Persons switched its "support" position to "oppose" yesterday for SB 491 by Sen. Ed Hernandez (D-West Covina) after amendments were introduced that AARP officials said would gut the bill. "Basically now it says nurse practitioners may not supplant a physician, and doing that would be a crime. We have a real problem with that," said Blanca Castro, advocacy director for AARP (Gorn, 8/13).

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Fla. Hospitals Reduce Hospital Readmissions By 15 Percent

The initiative headed by the Florida Hospital Association also reduced readmission rates for surgical complications and bloodstream infections and saved millions at 160 hospitals, it says.

The Associated Press: Florida Hospitals Reducing Readmission Rates
Florida hospital officials say patients who have been hospitalized recently are 15 percent less likely to be readmitted as hospitals around the country try to improve quality and save money under the Affordable Care Act. Tuesday's report from the Florida Hospital Association comes five years after the state ranked among the worst in the nation for poor health outcomes and high costs (Kennedy, 8/13).

Miami Herald: Report: Hospitals Reduced Readmissions, Surgical Complications
A five-year collaborative effort among Florida hospitals spurred a 15 percent drop in the number of patient readmissions, health care leaders announced Tuesday. The initiative, spearheaded by the Florida Hospital Association, touted other successes, including a 14.5 percent reduction in surgical complications, a 41 percent decline in bloodstream infections and millions of dollars saved at the 160 participating hospitals (McGrory, 8/13).

Earlier, related KHN coverage: Armed With Bigger Fines, Medicare To Punish 2,225 Hospitals For Excess Readmissions (Rau, 8/2).

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State Highlights: UnitedHealthcare Claims Ga. 'Rigged' Contract

A selection of health policy stories from Massachusetts, Georgia, North Carolina, California, Nevada and Florida.

WBUR: Report: Mass. Residents Pay More, Get Less From Health Insurance
If you have the feeling you're getting less coverage from your health insurance even though it's costing you more, there's proof today you're right. A state report says our premiums rose 9.7 percent between 2009 and 2011, while the value of that coverage shrank 5.1 percent (Bebinger, 8/14).

Georgia Health News: United Claims Blue Cross Got Special Favors
UnitedHealthcare has filed a strongly worded protest of the awarding of a state employees benefits contract, alleging that Georgia officials "rigged" the bid in favor of a competitor. A letter from United and its attorneys at law firms Alston & Bird and McKenna, Long & Aldridge asks the Department of Community Health's commissioner to review the award made to Blue Cross and Blue Shield of Georgia, which was formally announced Friday (Miller, 8/13).

The New York Times: North Carolinians Fear the End of a Middle Way
But with Republicans controlling all branches of the state government for the first time in more than a century, the legislature pushed through a wide range of conservative change. The Republicans not only cut taxes and business regulations, as many had expected, but also allowed stricter regulations on abortion clinics, ended teacher tenure, blocked the expansion of Medicaid, cut unemployment benefits, removed obstacles to the death penalty, allowed concealed guns in bars and restaurants, and mandated the teaching of cursive writing (Robertson, 8/13).

Los Angeles Times: L.A. County To Review Its Authority Over Contracts With Rehab Clinics
In response to a scathing report that found rampant fraud and a lack of government oversight of taxpayer-funded rehabilitation clinics in California, the Los Angeles County Board of Supervisors voted unanimously Tuesday to review its authority over such clinics and its ability to end payments to rehab operators who are breaking the law (Mehta, 8/13).

Kaiser Health News: A Nevada Health Plan -- Without The Insurance
Shelley Toreson had health insurance for years, but not anymore. Instead, she is part of an unusual Nevada nonprofit that helps connect 12,000 uninsured residents to doctors and hospitals who are willing to accept a lower-cost, negotiated fee for their services. 'The cost just kept going up and the coverage kept getting less,' says Toreson, 62, of her old insurance (Bartolone, 8/14).

The Associated Press: Nevada Board OKs More Funding For Mental Health
A state board on Tuesday endorsed pumping another $3 million into Nevada mental health services to increase bed capacity and reduce wait times for criminal defendants ordered to undergo evaluations. The funding request came amid intense scrutiny of Rawson-Neal Psychiatric Hospital in Las Vegas over discharge policies and other deficiencies (Chereb, 8/13).

Bloomberg: Florida Pharmacists Win $597 Million Blowing Whistle On Scheme
T. Mark Jones learned about the costs and benefits of health-care delivery when he treated AIDS patients in Key West, Florida, in the late 1980s. … Big Pharma was routinely reporting inflated drug prices, leading Medicare and Medicaid to overpay doctors and pharmacies by billions of dollars. Jones and his partners dedicated their lives to exposing that hard-to-detect scheme.  Ven-A-Care, operating from a quiet street in Key West, has filed whistle-blower lawsuits against dozens of pharmaceutical companies since 1995 -- many later joined by the U.S. and states -- that have recovered more than $3 billion for the U.S. government.  In those settlements, Ven-A-Care secured awards totaling $597.6 million for suing on behalf of taxpayers, making it the most successful whistle-blower in U.S. history (Voreacos, 8/13).

North Carolina Health News: Rural Hospital Mergers Make For Improved Bottom Lines, Mixed Feelings
In this second part of a three-part series, North Carolina Health News looks at the challenges facing rural hospitals and what it means for small communities when the local hospital merges with a larger hospital system. Today's story looks at some of the advantages and risks of rural hospitals merging into larger systems (Porter-Rockwell, 8/14).

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Editorials and Opinions

Viewpoints: Latest Health Law Delay Just A 'Glitch;' Feds' Overhaul Of Health Care Gets Many 'Moving Parts Wrong'

Bloomberg: Why Obamacare Won't Define 2014 Race
Today brings news of another delay in the implementation of Obamacare -- the second significant glitch this summer. … If this sounds like a winner for Republicans in 2014 it probably isn't. And the shrewder Republican candidates running in battleground states and the increasingly rare swing districts will almost certainly soft-peddle their opposition (Francis Wilkinson, 8/13).

Bloomberg:  Not Obamacare's Fatal Flaw -- Yet
What President Obama calls "glitches" and "bumps in the road" to the full implementation of the health-care law he signed in 2010, opponents see as evidence of the law's deep flaws and unworkability. Yet even opponents -- I'm one -- have to concede that sometimes a glitch is just a glitch. In the case of the latest Obamacare delay, that appears to be what we're looking at (Ramesh Ponnuru, 8/13).

Forbes: Yet Another White House Obamacare Delay: Out-Of-Pocket Caps Waived Until 2015
First, there was the delay of Obamacare's Medicare cuts until after the election. Then there was the delay of the law's employer mandate. Then there was the announcement, buried in the Federal Register, that the administration would delay enforcement of a number of key eligibility requirements for the law's health insurance subsidies, relying on the "honor system" instead. Now comes word that another costly provision of the health law -- its caps on out-of-pocket insurance costs -- will be delayed for one more year. According to the Congressional Research Service, as of November 2011, the Obama administration had missed as many as one-third of the deadlines, specified by law, under the Affordable Care Act. Here are the details on the latest one (Avik Roy, 8/13).

The New Republic: The Latest Right-Wing Freakout Over Obamacare
The headline was splashed across the top of the Drudge Report this morning: "Obamacare Cost Caps Delayed Until 2015." The link went to a New York Times story about another Obamacare regulatory decision -- in this case, a ruling that some employers have one more year before they must comply with one of the law’s key consumer protections. ... if you're on a plan like that now, you face these expenses already. This decision means only that you'll wait another year for relief -- during which time, by the way, you'll benefit from the law's other protections. For one thing, you’ll be better off because the spending cap still applies to major medical expenses, a category that includes office visits and mental health care (Jonathan Cohn, 8/13). 

The Oregonian: Hoping For Medicaid Flexibility
Someday -- with any luck, before a present-day kindergartner sits in the Oval Office -- the Affordable Care Act will exhaust its supply of jarring surprises. Until then, Americans will continue to endure plenty of complications like one worrying hundreds of Oregonians who are both guardians and paid caregivers for developmentally disabled adults receiving Medicaid assistance (8/14).

The Wall Street Journal: The High Cost of ObamaCare
A woman in Cornelius, Ore., takes care of her disabled 22-year-old daughter. The daughter has cerebral palsy, spina bifida and a condition called automonic dysreflexia. She requires 24-hour care. The mother provides it, receiving for this $1,400 a month. The mother fears -- and is apparently right to fear -- a provision of the Affordable Care Act that will, as Zheng reports, "largely prohibit guardians from serving as the paid caregiver of an adult child with developmental disabilities." ... First, no mother or child should be put in this position by a government ostensibly trying to improve their lives. Second, everyone in America knows health care is a complicated and complex subject, that a national bill will have 10 million moving parts, and that when a government far away -- that would be Washington, D.C. -- decides to take greater control of the nation's health care it will likely get many, maybe a majority, of the moving parts wrong (Peggy Noonan, 8/13). 

The Fiscal Times: Why Obamacare's Death Panel Debate Won't Die
The debate over the nefarious "death panel" is back. Controversy over Obamacare's Independent Payment Advisory Board, or IPAB -- the cost-controlling group derided by critics as a veiled bureaucratic cudgel to ration care -- has heated up in recent weeks. Former Democratic National Committee Chairman and presidential candidate Howard Dean has called for the panel to be abolished (John F. Wasik, 8/14).

The Oregonian: Tim Nesbitt: In Oregon, We're Innovating and Shaping Health Care
In the world of health care under the Affordable Care Act, aka Obamacare, states are sorting themselves into three categories. There are the eager implementers, like Oregon, and the reluctant cooperators, like Florida. And then there are the rabid resisters, including most of the red states, where governors are refusing to expand federally funded health care to low-income families and right-wing groups are waging campaigns to persuade the uninsured to pay a fine rather than accept any form of government-mandated health insurance. Those red state resisters have a lot to learn from Oregon. Here, we are not just implementing, we are innovating. We won't just adopt Obamacare; we will shape it (Tim Nesbitt, 8/13).

Boston Globe: The GOP's Obamacare Whale Hunt
Obamacare is no mere paper law. It has become a public policy white-whale for the ideological Captain Ahabs driving the GOP, a leviathan that must be harpooned at any cost. So it is that Tea Party types are now demanding that Republican officeholders resort to shut-down-the-government brinksmanship to slay the statute (Scot Lehigh, 8/14).

JAMA Internal Medicine: Using Science To Shape Medicare Physician Payment
In the 1980s, Congress decided that the long-standing method of setting payments for physician services, which was in use in Medicare, many Medicaid programs, and much of commercial insurance, was systematically undervaluing cognitive services in favor of procedures. Concerns were expressed about disincentives to enter or remain in primary care, especially at a time when the role of primary care should have been increasing. These concerns are eerily similar to those expressed today (Paul B. Ginsburg, 8/12).

The New York Times' Opinionator: The Cure For The $1000 Toothbrush
Here is a basic fact of health care in the United States: Doctors and hospitals know what they charge, but patients don't know what they pay. As in any market, when one side has no information, that side loses: price secrecy is a major reason medical bills are so high (Tina Rosenberg, 8/13).

Los Angeles Times: Raise The Cap On Malpractice Awards
For decades, advocates of tort reform have pushed to limit the amount that courts can award for noneconomic damages such as pain and suffering. ... This summer, however, nearly 40 years after California's Medical Injury Compensation Reform Act first limited noneconomic damages in malpractice cases to $250,000, trial lawyers and consumer groups have unveiled a ballot initiative that would relax the cap considerably. If the measure qualifies for the ballot and is approved by voters next year, the allowable amount for noneconomic damage payouts for victims of medical malpractice would be quadrupled. Relaxing the $250,000 cap, which has never been adjusted for inflation, is a wise move. As a reform idea, noneconomic damage caps have never made much sense (Nora Freeman Engstrom and Robert L. Rabin, 8/13).

Los Angeles Times: Assisted Reproduction: When Does A Father Become One?
When does a man become a father -- the legally recognized parent of a child, responsible for support and eligible for custody? Historically, parenthood has involved something more than simply a biological connection. In some eras that meant the law recognized only fathers who married the mothers. Today, recognition extends to unmarried parents who raise a child together. The new question on the table is whether it extends to a man who donates sperm to a woman and establishes a relationship with the child. Does he become a father if the child calls him "Daddy," or does it require something more? (Naomi Cahn and June Carbone, 8/12).

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Stephanie Stapleton

Andrew Villegas

Lisa Gillespie
Shefali Luthra

The Kaiser Daily Health Policy Report is published by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. (c) 2014 Kaiser Health News. All rights reserved.