Daily Health Policy Report

Thursday, August 14, 2014

Last updated: Thu, Aug 14

KHN Original Reporting & Guest Opinion

Health Reform

Health Care Marketplace

Quality

Veterans Health Care

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Analysis: California's Enrollment Success Is Its Greatest Challenge

Kaiser Health News staff writer Anna Gorman writes: "Even as sign-ups continue, state health officials are struggling to figure out how to serve a staggering number of Medi-Cal beneficiaries while also improving their health and keeping costs down. Many are chronically ill and have gone without insurance or regular care for years, and some new enrollees have higher expectations than in the past. Medi-Cal is the largest version of the nation's Medicaid program for low-income and disabled people. Created as an anti-poverty program in 1965, Medicaid for years primarily served families, seniors and people with disabilities. Now, in the states that chose to expand their programs, the coverage is available to single adults without children and to those who make slightly higher incomes. Real questions remain, however, about whether California is up to the task of covering so many more people, and about whether it has the health care infrastructure to handle the needs of the new enrollees. And the costs to the state will be significant" (Gorman, 8/14). Read the analysis, which also appeared in the Los Angeles Times.

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Hospitals Seek To Help Consumers With Obamacare Premiums

Kaiser Health News staff writer Julie Appleby reports: “Some hospitals in New York, Florida and Wisconsin are exploring ways to help individuals and families pay their share of the costs of government-subsidized policies purchased though the health law’s marketplaces – at least partly to guarantee the hospitals get paid when the consumers seek care. But the hospitals’ efforts have set up a conflict with insurers, who worry that premium assistance programs will skew their enrollee pools by expanding the number of sicker people who need more services” (Appleby, 8/14). Read the story.

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Political Cartoon: 'Fruitful Discussion?'

Kaiser Health News provides a fresh take on health policy developments with "Fruitful Discussion?" by Chris Wildt.

Meanwhile, here's today's haiku:

DID YOU LOOK BEHIND THE DIET SODA?

Ebola Vaccine?
Can't find yet in the drug store
refrigerator.
-Steven Munnelly

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

Small Nonprofit Hospitals At Tipping Point, Says Rating Service

Small and stand-alone nonprofit hospitals are facing mounting pressure from weak operating margins and lower patient volumes, according to a report from Standard & Poor's Rating Services. Meanwhile, hospitals cope with the changing health care landscape by exploring ways to help low-income consumers pay their Obamacare premiums and offering no-interest payment plans for those with high-deductible insurance policies.

Reuters:  Nonprofit Hospitals At A Tipping Point From Mounting Challenges
Small and stand-alone nonprofit hospitals are facing mounting pressure from weak operating margins and lower patient volumes, with more signals of stress on the way, according a report released Wednesday from Standard & Poor's Rating Services. The rating agency warned the healthcare sector was at "a tipping point where negative forces have started to outweigh many providers' ability to implement sufficient countermeasures." Beginning in 2013 and continuing into this year, credit downgrades outpaced upgrades at an accelerating rate. In particular, stand-alone providers are under greater pressure from physician departures, rising bad debt, and higher employee benefit costs (Respaut, 8/13).

Marketplace: What’s Behind No-Interest Medical Credit
A bigger and bigger chunk of the money hospitals get comes from you and me, thanks to a rise in what are known as deductible health plans, in which consumers are spending more out-of-pocket for their own care. With millions more newly insured under the Affordable Care Act holding those plans, hospitals are thinking hard about the best way to collect from us when we can't pay our bills. In some cases, that means no-interest payment plans (Gorenstein, 8/13).

Kaiser Health News: Hospitals Seek To Help Consumers With Obamacare Premiums
Some hospitals in New York, Florida and Wisconsin are exploring ways to help individuals and families pay their share of the costs of government-subsidized policies purchased though the health law’s marketplaces – at least partly to guarantee the hospitals get paid when the consumers seek care. But the hospitals’ efforts have set up a conflict with insurers, who worry that premium assistance programs will skew their enrollee pools by expanding the number of sicker people who need more services (Appleby, 8/14).

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The Rush Is On: Process Immigrant Paperwork To Keep Them Insured

The Wall Street Journal reports on reaction to the Obama administration's announcement that coverage would be cut off for as many as 310,000 people if they don't prove they are citizens or legal residents by Sept. 5. Other news outlets offer local takes on the issue. 

The Wall Street Journal: Health Law Spurs Paperwork Crunch
Backers of the health-care law say they are rushing to make sure tens of thousands of people provide more documents to prove they are in the U.S. legally and therefore entitled to the coverage they obtained through HealthCare.gov. Immigrant advocates say they felt the Obama administration moved hastily ... The federal government is taking the steps to comply with a requirement in the health law that bars unauthorized immigrants from using the online exchanges to shop for coverage, as well as from receiving federal tax credits to offset the cost of premiums  (Radnofsky, 8/13).

Des Moines Register: Obamacare Officials Ask 700 Iowans For Citizenship Proof
About 700 Iowans could lose their government-subsidized health insurance next month unless they send in documents proving they are citizens or legal immigrants, federal officials said today. The issue affects people who purchased private insurance policies via healthcare.gov, which is a key part of the Affordable Care Act. ... About 29,000 Iowans obtained health insurance this year via healthcare.gov, including nearly 25,000 who received subsidies (Leys, 8/13).

The Arizona Republic: Immigration Status Jeopardizes Obamacare Coverage For 6,600 Arizonans
The federal government sent letters this week to 6,600 Arizona residents who must clear up questions about their citizenship or immigration status or they could lose their Affordable Care Act health insurance next month. ... These people have not responded to repeated attempts to reach them by mail, phone or e-mail, according to the U.S. Department of Health and Human Services (Alltucker, 8/13).

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Texas Lawmakers Explore Market-Based Alternatives To Medicaid

Meanwhile, the success of California's enrollment drive has created a new set of challenges -- how to provide high-quality health care to 11 million Medi-Cal beneficiaries while keeping costs down.

The Associated Press: Texas Lawmakers To Discuss Market-Based Alternatives To Medicaid Expansion Today
A legislative committee is examining market-based alternatives to providing low-income Texans with health care since the state has rejected the expansion of Medicaid under the federal Affordable Care Act. Members of the state Senate Health and Human Services committee plan Thursday to discuss alternatives to the law critics call “Obamacare” (Weissert, 8/14).

Kaiser Health News: Analysis: California's Enrollment Success Is Its Greatest Challenge
Even as sign-ups continue, state health officials are struggling to figure out how to serve a staggering number of Medi-Cal beneficiaries while also improving their health and keeping costs down. Many are chronically ill and have gone without insurance or regular care for years, and some new enrollees have higher expectations than in the past.  Medi-Cal is the largest version of the nation's Medicaid program for low-income and disabled people. Created as an anti-poverty program in 1965, Medicaid for years primarily served families, seniors and people with disabilities. Now, in the states that chose to expand their programs, the coverage is available to single adults without children and to those who make slightly higher incomes. Real questions remain, however, about whether California is up to the task of covering so many more people, and about whether it has the health care infrastructure to handle the needs of the new enrollees. And the costs to the state will be significant (Gorman, 8/14).

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Colorado Market Called 'Very Competitive'; California Loses Some Plans

While some state marketplaces are adding insurance carriers -- and The Urban Institute calls Colorado's marketplace  "very competitive" -- several plans will not be returning to Covered California.

The Denver Post: Colorado’s Health Marketplace Competitive, Low-Priced, Study Says
Colorado's health insurance marketplace is "very competitive" and offers relatively low premiums, especially in its urban markets, according to a recent analysis by a health policy research group. The Urban Institute, a nonpartisan, nonprofit center has been tracking the effects of the Affordable Care Act with funding from the Robert Wood Johnson Foundation. In the Denver area, eight carriers offer coverage in the individual marketplace. The lowest-cost "silver" plan through the state exchange, called Connect for Health Colorado, costs $201 a month for a 27-year-old and $343 for a 50-year-old. Both were offered by Kaiser Permanente (Draper, 8/13).

California Healthline: Most Insurance Exchanges Just Got Bigger. Covered California Is Getting Smaller.
Kynect. Maryland Health Connection. The Washington Health Benefit Exchange. Every one of those state insurance exchanges added new carriers in preparation for Obamacare's second open enrollment period this fall. Covered California did not. Instead, the Golden State took a different approach: Its exchange is getting smaller (Diamond, 8/13).

The Star Tribune: Officials Say MNsure Will Be Ready For Open Enrollment
State officials offered assurances Wednesday that software fixes to the flawed MNsure health insurance exchange are happening as planned, and that the system should be in good working order by the Nov. 15 start of open enrollment. Still grappling with consumer fallout and political pressure over last year’s troubled rollout, MNsure officials said changes are being made to the system that will allow more time for testing and that sufficient backup plans are in development if things go wrong. MNsure is preparing for the “worst case, if that comes about,” interim Chief Operating Officer Wes Kooistra told the agency’s board of directors, but he added that all hands are on deck to ensure an “improved user experience for 2015” (Crosby, 8/13).

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Health Care Marketplace

Survey: Companies Continue Shift Of Health Costs To Workers

The main way companies are seeking to curb health care costs is by moving workers into high-deductible health plans, according to the survey by the National Business Group on Health. Nearly a third are offering such plans as the only option to their workers in 2015, the survey found.

Reuters:  U.S. Benefits Enrollment Season To Bring More Cost Cutting
When benefits enrollment season arrives this fall, employees around the country can expect to see the impact of corporate cost-cutting on their finances. Benefits costs will rise only 5 percent for employers that take certain cost-reduction measures, instead of 6.5 percent for companies that do not, according to a June survey of employers representing 7.5 million workers by the National Business Group on Health. Although costs are not rising as quickly, employees are still being squeezed. The main way companies are keeping healthcare costs in line is by shifting workers into high-deductible health plans, defined by the Internal Revenue Service as having deductibles above $1,250 for an individual (Pinsker, 8/13).

Fox News: Report: Companies Desperate To Avoid Obamacare ‘Cadillac Tax’ Shifting Costs To Workers
A  national business group representing the nation’s large employers reported Wednesday that companies desperate to avoid a 40 percent ObamaCare “Cadillac tax” are finding ways to shift the costs to workers. The so-called “Cadillac tax,” now four years away, will affect health plans that spend more than $10,200 per worker (Angle, 8/14).

Kaiser Health News: 16% Of Large Employers Plan To Offer Low-Benefit 'Skinny' Plans Despite ACA: Survey
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).

CQ Healthbeat: Companies Jockey to Avoid 2018 Tax on Health Plans
Many companies are changing their health benefits to try to avoid a tax slated to hit in 2018 on more generous insurance coverage, a survey found. The National Business Group on Health on Wednesday released results from a survey of 136 companies, most of which have more than 10,000 employees. The survey found that almost a third, 32 percent of those surveyed, plan to offer high-deductible, or consumer driven, health plans. Only 22 percent have done so this year (Young, 8/13).

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Medical Advisory Panel Recommends New Pneumonia Vaccine For Seniors

The experts expressed concern, however, that Medicare rules may hamper some people from getting the new vaccine if they have already had an older version. Also in drug issues, some patient advocates report that insurers are balking at paying for a costly drug to treat hepatitis C if the patients are in drug treatment programs.

Reuters: U.S. Advisory Panel Recommends Prevnar 13 Vaccine For Elderly
An influential U.S. medical advisory panel on Wednesday recommended that people 65 and older be given Pfizer Inc's blockbuster Prevnar 13 vaccine to protect against pneumococcal bacteria that can cause pneumonia and other infections. The Advisory Committee on Immunization Practices (ACIP), in a 13-2 vote, recommended that elderly patients take Pfizer's vaccine, even if they had previously been vaccinated with Merck & Co's leading Pneumovax vaccine. ... A Medicare official, speaking to the panel in Atlanta, said his agency would have to change its rules in order to qualify such patients for reimbursement, and that its evaluation would likely extend until January 2016 (Pierson, 8/13).

The Wall Street Journal’s Pharmalot: Sovaldi Debate Hurts Access For Opioid Treatment Patients
The tussle over the cost of the Sovaldi hepatitis C medication may prevent yet another segment of the population from being treated – people who are enrolled in opioid treatment programs. Although the drug has shown evidence of curing nine of 10 sufferers and the product labeling does not suggest Sovaldi is not safe for these patients, payers are balking at covering the medicine for people with a history of a substance use disorder, according to Alcoholism & Drug Abuse Weekly (Silverman, 8/13).

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Quality

Sunshine Act Website Marked By Technical Problems

Modern Healthcare reports that this website, which is designed to report industry payments to physicians and teaching hospitals, was temporarily suspended last week but is scheduled to be publicly accessible Sept. 30. Meanwhile, the Des Moines Register explores issues related to the National Practitioner Data Bank.

Modern Healthcare: Is the Sunshine Act Website Repeating HealthCare.Gov’s Mistakes?
A mix-up of information about two physicians with the same name in different states has opened a window on wide-ranging technical problems the CMS is facing with its Open Payments website reporting industry payments to doctors and teaching hospitals. Registration for the system, which was scheduled to be publicly accessible Sept. 30, was temporarily suspended last week after a Kentucky doctor discovered that his data had been commingled with data on another doctor with the same name. The site that was shut down had been open only to healthcare providers since last month. It allowed them to check the information that manufacturers were reporting about them and dispute any errors (Tahir, 8/13).

Des Moines Register: There Is A Database, But It Costs To Search
The case of a former Iowa doctor accused of malpractice in West Virginia illustrates why Americans should have easier access to information about physicians' histories, a national advocate said. Lisa McGiffert, an analyst for Consumers Union, said it's too difficult for the public to find out if a doctor in one state has been in trouble in another state. She expressed sympathy for relatives of Asa Carson, who said they had no clue that Dr. Robert Finley III had been accused of incompetence in Iowa. "If I'm in West Virginia, and I'm going to see this doctor, how the heck am I supposed to know he was from Iowa?" McGiffert said. The most likely place a West Virginia resident would look for information would be that state's medical board, McGiffert said. But Finley's West Virginia record includes no notice of serious allegations filed against him in 2010 in Iowa (Leys, 8/14).

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Veterans Health Care

VA Secretary: Number Of Vets Being Referred To Private Doctors Is Rising

Robert McDonald tells American Veterans national convention that his department is quickly moving to significantly increase the number of veterans referred to doctors outside the system. Also, the department announces that veterans with Lou Gehrig's Disease will be eligible for a government housing program.

The Associated Press: VA Referrals To Private Doctors On Rise
The Department of Veterans Affairs is significantly increasing its referrals of veterans to private doctors following a scandal over lengthy patient waiting times at many VA hospitals and clinics and falsified appointment records, VA Secretary Robert McDonald said Wednesday. McDonald spoke to a few hundred people at the American Veterans national convention. He is scheduled to visit [Memphis'] VA hospital on Thursday (Sainz, 8/13).

The Hill: Soldiers, Vets With Lou Gehrig's Disease Win Housing Subsidies
Veterans and active-duty service members who suffer from Lou Gehrig's disease will have immediate access to a government-funded housing program under new rules from the Department of Veterans Affairs. The VA announced Wednesday that soldiers who suffer from Lou Gehrig's disease, formally known as amyotrophic lateral sclerosis (ALS), will be eligible for its specially adapted housing program. The housing program provides grants to soldiers with disabilities, now including ALS, so they can buy new homes or fix up homes they already own to accommodate their disabilities (Devaney, 8/13).

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State Watch

Closing Arguments Made In Texas Trial Over Abortion Restrictions

U.S. District Judge Lee Yeakel promised to rule in the case as quickly as possible. Whichever side loses is likely to appeal.

Dallas Morning News: Judge Notes Travel Texans Face With Abortion Clinic Laws
New abortion restrictions that would cause many Texas women to drive hours to end unwanted pregnancies left a federal judge Wednesday signaling unease. “I have a problem believing it is reasonable for anyone to travel 150 miles for medical care when they could get the medical care closer,” U.S. District Judge Lee Yeakel said. He made the comment during closing arguments in an Austin trial of a challenge to a major piece of a sweeping anti-abortion bill signed by Republican Gov. Rick Perry last year. If the law requiring abortion facilities to meet the same standards as hospital-like surgical centers is upheld and goes into effect Sept. 1, abortions will be banned at more than a dozen clinics currently available to Texas women (8/13).

Texas Tribune: In Abortion Trial, Judge Questions "Undue Burden" Standard
As attorneys wrapped up their arguments Wednesday in a trial over a new abortion regulation, the judge presiding over the trial questioned whether the “undue burden” standard being considered in the case should be the same standard used in smaller states. The focus of the trial is a regulation, which takes effect Sept. 1, that requires abortion clinics to meet the same standards as ambulatory surgical centers. The rule applies to the facilities’ room and doorway sizes, locker room requirements, and additional infrastructure like pipelines for general anesthesia. Lawyers representing a coalition of abortion providers claimed that the measure would create an “undue burden” for women seeking access to abortion while state attorneys argued that the requirements would not create barriers for a majority of women seeking the procedure (Ura, 8/13).

Reuters: Texas Emblematic Of National Battle Against Abortion Providers
Conservative state legislatures are waging an effective fight to close down the nation’s abortion clinics, and nowhere is that battle more evident than in Texas, with one of the most restrictive abortion laws in the country. If a challenge to the state law fails in federal court, as of Sept. 1, there will be seven abortion providers left in Texas, the country’s second largest state by population and area, with 26 million people in an area about three times the size of the United Kingdom. That is a plummet from 41 providers in May 2013. “This has been an ongoing, unprecedented level of attacks on access to women’s health services,” said Sarah Wheat, vice president for community affairs at Planned Parenthood of Greater Texas, which operates in the northern and central regions of the state. Currently there are 19 abortion providers, according to the Texas Policy Evaluation Project (TxPEP) (Anderson, 8/13).

And in Mississippi -

The Associated Press: Mississippi Seeks New Ruling On Abortion Law
Mississippi is asking a federal appeals court to uphold a 2012 state law requiring abortion clinic doctors to obtain hospital admitting privileges. In late July, a panel of the 5th U.S. Circuit Court of Appeals ruled 2-1 that the law is unconstitutional because it would close Mississippi's only abortion clinic. Democratic Attorney General Jim Hood filed papers Wednesday asking the full court to reverse the three-judge panel's ruling and allow Mississippi to enforce the law (Pettus, 8/13).

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State Highlights: Mass. Hospitals See 70% Jump In Mistakes

A selection of health policy stories from Massachusetts, Maryland, Texas, California, Wisconsin and Illinois. 

The Boston Globe: Mass. Hospitals’ Mistakes List Widens
Massachusetts acute-care hospitals reported 753 serious medical errors and other patient injuries last year, a 70 percent annual jump that health officials attributed mostly to expanded definitions of what constitutes medical harm. So-called serious reportable events in other types of hospitals, including those that provide psychiatric or rehabilitative care, rose 60 percent from 2012, to 206. Instances where patients underwent a procedure on the wrong body part, were burned by an operating room fire or a too-hot heating pack, or were subject to contaminated drugs or improperly sterilized equipment saw some of the largest increases in reporting since 2012 (Kowalczyk, 8/14).

Baltimore Sun: Changes Coming To State Employee Health Plan
Maryland officials approved $16 billion in contracts Wednesday that are intended to change the way state employees use health care by offering rewards for taking steps to stay well — and imposing penalties for refusing to comply. Rewards would come in the form of free doctor visits and procedures, while penalties for failing to follow medical advice could go as high as $375 (Dresser, 8/13).

Chicago Tribune: Walgreens To Open More Health Clinics In Texas
Walgreen Co. said Wednesday it will expand its retail health clinics into the Dallas-Fort Worth metro area, part of a nationwide push to extend its health care offerings. Walgreen has expanded the clinics into stores in five new states over the past 15 months, seeking to pivot from the mold of the traditional corner drugstore into a full-service primary care provider. The Deerfield-based drugstore chain plans to open clinics in 13 stores in the Dallas-Fort Worth area and 14 others in Houston by the end of the year. Nationwide, Walgreen operates more than 400 clinics in 23 states and Washington, D.C. Typically staffed with nurse practitioners or physicians assistants, the clinics are equipped to handle minor illnesses and injuries, as well as vaccinations and diagnosis and management of chronic diseases like diabetes, asthma and hypertension (Frost, 8/13).

The Sacramento Bee: MinuteClinic Opens Its First Walk-In Health Care Clinics In Sacramento Area
Increasingly, a trip to the local drugstore offers another option besides buying cold remedies, hair care products or energy drinks. Add medical care to the list. On Wednesday, Rhode Island-based MinuteClinic opened its first two walk-in medical clinics in the Sacramento region, both inside CVS pharmacies. Patients can see a licensed nurse practitioner for treatment of minor ailments, aches and pains; get a vaccination; have their blood pressure, cholesterol and diabetes checked; or complete their child’s school, camp or sports-required physicals (Glover, 8/13).

The Milwaukee Journal Sentinel: New Health Plan May Be Coming To Southeast Wisconsin
Froedtert Health is considering getting into the business of selling health insurance, a move that would put it in direct competition with the likes of UnitedHealthcare, Humana and Anthem Blue Cross and Blue Shield in Wisconsin. The health system is negotiating with Ministry Health Care to buy an interest in Network Health, an insurer based in Menasha, with the goal of introducing a new health insurance plan in southeastern Wisconsin. The health plan would be tied to a network of hospitals and physicians — including Froedtert, Columbia St. Mary's and Wheaton Franciscan Healthcare — that would compete with a similar new network tied to Aurora Health Care (Boulton, 8/13).

Chicago Sun Times: Oak Park Man Joins Health Care Innovation Charge
Adam Piotrowski got stuck when he tried to start a medical device company here three years ago. "I knew Chicago was a great place to start a business, but it was hard to find a place to be based where I could develop and set up prototypes, work with a variety of resources nearby and get in touch with all of the people I needed to," the Oak Park native said. "I had to find my own office space, start everything from scratch, and it was hard to find and hire talent. It was hard to have conversations and network because no life science hub existed." Piotrowski is trying again, and this time he is excited to apply for membership in Chicago’s newest innovation incubator, Matter, expected to open in early 2015 next to digital tech hub 1871 at the Merchandise Mart. On Tuesday, officials with Matter — an incubator for biopharma, health IT and medical device companies — announced at a news conference that they are taking membership applications at matterchicago.com (Guy, 8/13).

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Weekend Reading

Longer Looks: A Sugar Cube Pyramid; The Suicide Checklist

Each week KHN finds interesting reads from around the web.

New York magazine: Obamacare Is Saving Thousands of Lives. And Americans Will Always Hate It.
Dean Angstadt, a 57-year-old, self-employed logger, said that the Affordable Care Act saved his life. ... Kathy Bentozi, a 58-year-old Pennsylvanian, is also thankful for Obamacare.  ... Joshua Haymore, a 27-year-old Coloradan, could not get a specialist to see him for weeks last year ... Now that he has Medicaid, his prescriptions cost $3 and his health has improved significantly. Those are just three of thousands of good-news stories coming from the insurance expansion in the Affordable Care Act. ... But there is scant evidence that Americans have started to take notice, or care (Annie Lowrey, 8/13).

Modern Healthcare: Obamacare Advocates Urge Engaged Couples To Get Health Plans
First comes love, then comes marriage, then comes ... signing up for health insurance.  As young brides and grooms prepare to tie the knot, one advocacy group wants to make sure they're registering for more than just fine china and monogrammed towels. With wedding season underway, Young Invincibles is running ads on social media sites such as Facebook and Twitter to make sure happy couples understand their health insurance options (8/9).

The Atlantic: A Junior Doctor's Salary
In April, Medicare spewed out some schismatic physician-payment numbers. The blast of decontextualized data said that one ophthalmologist received $12 million in payments. Another 4,000 physicians took in over $1 million in 2012 just from Medicare Part B. The New York Times' number generator let readers type in a doctor's name and get a dollar amount. In a lot of cases, physicians came off looking seriously flush with cash. Those numbers and the accompanying "Go to medical school, you can make more than Lebron" implications were misleading in that they represent revenue, not profit (James Hamblin, 8/6).

Pacific Standard Magazine: The Persuasive Power Of The Sugar Cube Pyramid
With New York City's ban on jumbo-sized soft drinks officially dead, it's clear that any reduction in consumption of these obesity-promoting beverages will need to be a matter of persuasion rather than law. Fortunately, a research team has found a simple way to convince consumers to think twice before taking their next swig of soda. Their method is to show people just how much sugar they are consuming per can through the use of an easily understandable visual device: A pyramid of sugar cubes (Tom Jacobs, 8/11).

The New York Times: Baby Pictures At The Doctor’s? Cute, Sure, But Illegal
For generations, obstetricians and midwives across America have proudly posted photographs of the babies they have delivered on their office walls. But this pre-digital form of social media is gradually going the way of cigars in the waiting room, because of the federal patient privacy law known as Hipaa. Under the law, the Health Insurance Portability and Accountability Act, baby photos are a type of protected health information, no less than a medical chart, birth date or Social Security number, according to the Department of Health and Human Services (Anemona Hartocollis, 8/9).

The New York Times: Opting Against Ebola Drug For Ill African Doctor
The doctor who had been leading Sierra Leone's battle against the Ebola outbreak was now fighting for his own life, and his international colleagues faced a fateful decision: whether to give him a drug that had never before been tested on people. Would the drug, known as ZMapp, help the stricken doctor? Or would it perhaps harm or even kill one of the country's most prominent physicians, a man considered a national hero, shattering the already fragile public trust in international efforts to contain the world’s worst Ebola outbreak? (Andrew Pollack, 8/12).

The Health Care Blog: The Right To Die: The Suicide Checklist
A long trail of vital documents marks our lives. These include birth certificate, diplomas, driver's and marriage license, advanced directives, wills .... Perhaps we should create a new personal document.  Its purpose would be to give each person not only permission to kill themselves, but access to the means. ... The Suicide Certificate would be a kind of application.  A legal checklist, which once complete would allow the individual to die by their own hand, but in a controlled and definite manner (Dr. James Salwitz, 8/12).

Vox: Admitting Privileges: The New Abortion Battle, Explained
A fierce fight over a new wave of abortion regulations is quickly rising through the federal courts — and experts say it could land in front of the Supreme Court as soon as next spring. ... The battle centers on admitting privilege laws, which require providers to gain the right to admit patients at a local hospital in order to preform abortions. The laws aren't new, but they've recently become much more common: nine states have passed this type of requirement since 2011. Some of these laws have, or could, lead to clinic closures if local hospitals refuse admitting privilege applications (Sarah Kliff, 8/12).

Related, earlier KHN story: FAQ: The Next Abortion Battle: The Courts And Hospital Admitting-Privilege Laws (Julie Rovner, 8/8)

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Editorials and Opinions

Viewpoints: Enrollment 'Plummeting'?; Arkansas' 'Boondoggle'; Move Medicare To Obamacare Exchanges

Los Angeles Times: Latest Obamacare Freakout: Enrollment "Plummeting" (Spoiler: Not So)
In the latest leg of their endless journey to find bad news about the Affordable Care Act, conservative analysts and websites have seized on some ambiguous figures to declare that enrollment is "plummeting," "shrinking," "sinking rapidly"--choose your headline. The most charitable interpretation of this claim is that it's based on extreme cherry-picking. The most accurate interpretation is that it's wrong (Michael Hiltzik, 8/13). 

The Wall Street Journal: How Obamacare Is Doing Better But Feeling Worse
The Affordable Care Act is like a patient who is feeling worse when key clinical indicators say he is doing better. Obamacare recovered from its Web site fiasco last October and went on to exceed enrollment projections in March. Despite predictions of "rate shock," early indications are that premiums in the new insurance marketplaces are increasing modestly in most states that have made 2015 information public and more slowly than the non-group market has grown in the past. ... Still, opinion about the ACA has not moved significantly in any direction since 2010, when the law passed, and remains decidedly more negative than positive (Drew Altman, 8/13).

The Washington Post: Where Obamacare Is Going
The liberal attraction to making government the sole source of health-care insurance has not abated even as the deficiencies in ObamaCare, a halfway move toward the single-payer model, have become increasingly evident. The question is whether growing signs of single-payer trouble overseas will be enough to discourage this country's flirtation with socialized medicine (Scott W. Atlas, 8/14). 

Forbes: Arkansas Private Option's Latest Boondoggle: "Health Independence Accounts" Increase Dependence and Increase Costs
Arkansas' "Private Option" ObamaCare Medicaid expansion has been "bumpy." Costs have run over budget every single month. Arkansas officials have signaled that they now are seeking a bailout from federal taxpayers. The Medicaid director who spearheaded the program abruptly resigned to "pursue other opportunities." The program’s chief architect, a three-term Republican state legislator, lost his primary election to a political newcomer. And the Private Option is already prioritizing coverage for able-bodied adults over care for truly needy patients .... Could things really get worse for the Private Option and its supporters? You bet (Jonathan Ingram, Nic Horton and Josh Archambault, 8/12).

Politico: Don't Repeal Obamacare, Transcend It
Conservatives don't have to repeal Obamacare in order to advance their principles. Indeed, it's actually possible to take advantage of one of the law's core provisions—its tax credits for the purchase of private coverage—to reform America's entire health-entitlement behemoth, and to finally put the country on a fiscally stable trajectory. Rep. Paul Ryan's proposal to reform Medicare—giving future retirees "premium support" subsidies to shop for private health insurance—is, in fact, quite similar to Obamacare's usage of "premium assistance" tax credits to offer coverage to the uninsured. So what if we used Obamacare to reform Medicaid and Medicare, by gradually migrating future retirees and Medicaid recipients onto a reformed version of Obamacare’s exchanges? (Avik Roy, 8/13).

The Tennessean: Congress Should Re-Fund CoverKids
Can Congress set aside a few of its differences over the nation's health care system and continue a popular program that is working to make children healthier? It should. In October, federal funding for the Children’s Health Insurance Program (CHIP), called CoverKids here in Tennessee, will expire. The expiration could take insurance coverage away from about 68,000 children in the state, and about 8 million across the country (8/12).

Bloomberg: The Best Doctors Money Can Buy?
Here's a deal you might be interested in. You get $10 billion a year of taxpayers' money to do something you may well have done anyway. You don't need to say what you spend it on, or why. You can use it wisely or wastefully; the money keeps coming regardless. That's the nice arrangement the federal government grants U.S. hospitals when it comes to training doctors. ... But this way of directing the cash has unfortunate consequences, as a recent report from the Institute of Medicine, an independent research group in Washington, explains. Payments to hospitals are all but guaranteed, "regardless of program performance, efficiency, or quality of training." There's no attention to the right mix of specialties, which means a shortage of primary-care physicians. Nobody in a position of authority is even asking what kinds of doctors the country needs (8/13).

The Wall Street Journal: Legal Pot Is A Public Health Menace
The great irony, or misfortune, of the national debate over marijuana is that while almost all the science and research is going in one direction—pointing out the dangers of marijuana use—public opinion seems to be going in favor of broad legalization. For example, last week a new study in the journal Current Addiction Reports found that regular pot use (defined as once a week) among teenagers and young adults led to cognitive decline, poor attention and memory, and decreased IQ (William J. Bennett and Robert A. White, 8/13). 

JAMA Surgery: Team-Based Surgical Care: An Important Role For Academic Health Centers
It is an inescapable fact that the expectations for the delivery of high-value, safe, and effective patient care in the hospital setting have changed dramatically over the last few years, and nowhere is this evolution more evident than in acute surgical care. ... Unfortunately the capacity for collaborative care is often constrained by the current rigid hierarchy of health care occupations and the silo divisions of labor. Traditional surgical care has routinely been taught and delivered within that vertically oriented authority gradient. How often has a senior surgeon expounded with great seriousness that the "surgeon is captain of the ship"? (Drs. Peter W. Dillon and Harold L. Paz, 8/13).

The New England Journal Of Medicine: Adverse Effects Of Prohibiting Narrow Provider Networks
Faced with ACA-based limitations on their ability to trim benefits and increase cost-sharing levels, many exchange insurers have opted to control costs by offering plans with narrow provider networks. ... I would argue that CMS and state insurance commissioners should not force insurers to contract with providers or otherwise interfere in plan–provider negotiations. In addition to increasing insurance premiums, network-adequacy regulations risk politicizing insurers' decisions about provider networks — and a provider's success shouldn't depend on its influence with key legislators or regulators. ... CMS would be wise to limit its role to ensuring that plans make their provider lists readily accessible to consumers before they choose a plan. Plans could control costs while diminishing consumer concerns about limited choice by making greater use of tiered networks (David H. Howard, 8/14).

The New England Journal Of Medicine: When Religious Freedom Clashes With Access To Care
The Obama administration's attempts to compromise on the contraceptives-coverage mandate ultimately backfired, since its efforts were used to demonstrate that applying the mandate even to secular employers was not necessarily the only way to achieve the government's interests. In the future, regulators may be less willing to seek compromise lest their efforts be similarly used against them — and it is bad news for all of us if health policy can be made only through polarization and rancor rather than compromise (I. Glenn Cohen, Holly Fernandez Lynch and Gregory D. Curfman, 8/14).

The New England Journal Of Medicine: Is It Time For A Tobacco-Free Military?
Secretary of the Navy Ray Mabus recently announced that he wanted to end tobacco sales on all Navy installations. Secretary of Defense Chuck Hagel, citing both financial costs and tobacco's harmful effects on readiness, added that military tobacco policy in general should be reviewed, including the possibility of ending tobacco sales and establishing smoke-free military installations. ... despite the underlying expectations for superlative fitness — and despite the availability of state-of-the-art tobacco-cessation programs — many military personnel still use tobacco, and its use remains accepted, accommodated, and promoted in the armed forces. Why? (Elizabeth A. Smith, Sara A. Jahnke, Walker S.C. Poston, Larry N. Williams, Christopher K. Haddock, Steven A. Schroeder and Ruth E. Malone, 8/14).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
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.