Daily Health Policy Report

Friday, August 16, 2013

Last updated: Fri, Aug 16

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Feds Award $67 Million In Grants To Help Consumers Navigate The Health Law

Kaiser Health News staff writer Phil Galewitz reports: "Hospitals, universities, Indian tribes, patient advocacy groups and local food banks were among organizations awarded $67 million in federal grants Thursday to help people sign up for coverage in new online health insurance marketplaces that open for enrollment Oct. 1" (Galewitz, 8/15). Read the story.

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Moving People Home After Nursing Home Stay Is Complicated

WBUR's Martha Bebinger, working in partnership with Kaiser Health News and NPR, reports: "Napierski, a case manager at WestMass Elder Care in Holyoke, Mass., drew up a plan for Holmes's transition. … Napierski says Holmes would not have gone home without this help, buoyed by money the federal government is giving states for a Medicaid program called Money Follows the Person. The program identifies patients, old and young, who've been in a nursing home for at least 90 days but don't really need to be there. Massachusetts is one of 45 states and the District of Columbia in the program, created by the Deficit Reduction Act of 2005" (Bebinger, 8/16). Read the story.

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Political Cartoon: 'That Won't Fly?'

Kaiser Health News provides a fresh take on health policy developments with "That Won't Fly?" by Steve Kelley.

And here's today's health policy haiku:


Staffers' health plan fix
may cause abortion issue
fracas. Go figure...

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

HHS Awards Grants To Aid In Health Law Navigation

The grants are part of the health law's outreach and assistance efforts, viewed as linchpins to the law's success.

The Associated Press: White House Awards $67M To Community Groups To Hire, Train Navigators To Enroll Uninsured
With the new health law's enrollment period set to open in just a little more than six weeks, President Barack Obama's administration announced $67 million in awards Thursday to organizations that will help people understand their new insurance opportunities and get signed up. Health and Human Services Secretary Kathleen Sebelius announced the Navigator grant awards to 105 groups in states where the federal government will run online insurance marketplaces. Sebelius said consumers are "hungry for information" (Johnson, 8/15).

The Washington Post: HHS Awards $67 Million To Help Uninsured Sign Up For Health Coverage
Many uninsured Americans don’t know about the marketplaces or have little idea how they would work, polls show. Complicating the enrollment process are the huge gaps in resources and readiness between the 17 states and the District that are running their own marketplaces and the 34 states that resisted and are being run or partly run by the federal government (Sun, 8/15).

Kaiser Health News: Feds Award $67 Million In Grants To Help Consumers Navigate The Health Law
Hospitals, universities, Indian tribes, patient advocacy groups and local food banks were among organizations awarded $67 million in federal grants Thursday to help people sign up for coverage in new online health insurance marketplaces that open for enrollment Oct. 1 (Galewitz, 8/15).

The New York Times: $67 Million Awarded To Groups Helping With Health Law
The administration had initially planned to spend less — $54 million — on navigators in the 34 states where the federal government will run all or part of new insurance markets created under the law. Chiquita Brooks-LaSure, an official with the Department of Health and Human Services, said the additional $13 million had come from a fund set up under the health law to pay for public health and preventive care initiatives (Goodnough, 8/15).

The Wall Street Journal: Groups Get $67 Million to Promote Health Exchanges
Republican opponents of the Affordable Care Act have raised various objections about the navigator program. On Wednesday, 13 Republican state attorneys general sent a letter to Ms. Sebelius raising privacy concerns. The Obama administration says that ensuring the confidentiality of personal information is a top focus and that navigators will get training in that area. In addition, some insurance brokers have questioned whether the navigators would effectively act as unlicensed brokers (Schatz, 8/15).

Politico: HHS Announces Obamacare 'Navigators'
And the navigators program could get caught up in yet more Obamacare politics. At least 19 of these states have enacted their own extra requirements for either more navigator training and licensure requirements beyond those required by Washington, according to a report from the Georgetown University Center on Health Insurance Reforms. That’s prompted concerns among Obamacare advocates of more legal skirmishes about state versus federal rules or implementation delays as the enrollment clock is ticking (Millman, 8/15).

The Hill: Officials Add Millions Of Dollars To ObamaCare Enrollment Drive
Texas was by far the biggest recipient of navigator grants, at nearly $11 million, followed by Florida at roughly $7.9 million. Both states are critical to the success of the enrollment push and, by extension, the healthcare law. In addition to navigators, HHS will operate a website and call centers where consumers can ask questions about their coverage options. The department has also inked partnerships with libraries, community health centers and other community organizations to help provide information about the law (Baker, 8/15).

CBS News: Obamacare Targets "Young Invincibles" Demographic
The government's goal is to enroll 7 million Americans in the exchanges by next spring. For the system to work, about 2.7 million of them need to be young adults between the ages 18 and 35. They help offset the costs of older, generally less healthy people, according to the Congressional Budget Office (Tracy, 8/15).

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Planned Parenthood Among Groups Tapped To Receive Health Law Grants

News outlets also highlight various other organizations that received funding to be 'navigators.'

Reuters: Planned Parenthood To Get Obamacare Funds For Enrollment Push
Across the country, 105 groups were awarded a total of $67 million in so-called navigator grants, ranging from the Epilepsy Foundation of Florida and AIDS Alabama, Inc. to the Greater Phoenix Urban League and the Legal Aid Society of Palm Beach County. The inclusion of Planned Parenthood groups in three U.S. states, which provide women's health services including contraception and abortion, drew new criticism from Republicans and others. The healthcare law has attracted major opposition and legal challenges from religious and conservative groups for requiring insurers to cover the cost of birth control (8/15).

The Hill: Planned Parenthood To Get ObamaCare 'Navigator' Funds
Three state-based Planned Parenthood affiliates will receive a total of about $655,000 from the federal government to help consumers navigate their insurance options under ObamaCare. ... The Planned Parenthood affiliates that received grants were: Iowa-based Planned Parenthood of the Heartland, Montana-based Intermountain Planned Parenthood and New Hampshire-based Planned Parenthood of Northern New England.  The three organizations received between $145,000 and $296,000 each. All organizations that received grants Thursday will operate in states where the federal government has a role in running the new insurance marketplaces (Viebeck, 8/15).

Georgia Health News: 2 Groups Get Grants For Ga. Exchange 'Navigators'
A nonprofit that helps low-income households and a unit of the University of Georgia have been named recipients of federal grants to provide "navigators"’ to help consumers sign up for the upcoming health insurance exchange in the state. SEEDCO (Structured Employment Economic Development Corporation) will receive $2.2 million, and the UGA College of Family and Consumer Sciences and Cooperative Extension Service will get $1.7 million (Miller 8/15).

Detroit Free Press: Feds Award $2.5 Million To Help Public With Exchange
[W]hile many consumers will be able to find policies easily on the exchange, others might face obstacles — a language barrier, a physical or visual disability, a lack of computer skills, or a lack of understanding of insurance basics — said Don Hazaert, director of Michigan Consumers for Healthcare. Consumers for Healthcare, one of the major advocates of the Affordable Care Act in Michigan, will receive more than $1.3 million, the largest sum of money in Michigan from the U.S. Centers for Medicare & Medicaid Services (Erb, 8/15).

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Sebelius On Making The Health Law Work

Key to achieving that goal, Health and Human Services Secretary Kathleen Sebelius said, are navigators who will help educate the public about the health law's options. The security of information on the exchanges continues to draw headlines, and so does an emerging fracas involving a possible linkage between the health law's coverage to voter registration.

USA Today: Sebelius: Focus On How To Make Health Care Law Work
The fight over the future of the 2010 health care law has moved from repeal, Health and Human Services Secretary Kathleen Sebelius said Thursday, to how to make it work in time for the opening of health care exchanges Oct. 1. In an interview with USA TODAY, Sebelius said the navigators and HHS will protect the privacy of those who use the exchanges to buy insurance and to protect against fraud (Kennedy, 8/15).

Tampa Bay Times: Sebelius Awards Obamacare Funding, Expresses Concern For Florida Consumers
U.S. Health and Human Services Secretary Kathleen Sebelius said Florida lawmakers' decision to suspend the state's power over health insurance rates leaves consumers at the mercy of the market. ... While Republican legislators have said they are looking out for consumers by refusing to go along with certain aspects of the Affordable Care Act, Sebelius said their actions suggest otherwise. "They're basically just saying, 'We're not going to look at these rates,' " she said. The federal health care law, opposed by most Republican legislators, assumed states would continue to take a lead role in setting insurance rates. Florida legislators, however, suspended that authority for two years, saying federal officials could do it since they were already planning the online insurance exchange. But the federal government says it lacks legal authority to deny rate increases in the states. Sebelius said she knows of no other state that took such a step (Tillman, 8/15).

Stateline: Obamacare And Voting Rights Clash Over Health Exchanges
Two of the fiercest political disputes between Washington and the states could soon come together in legal fights that involve tying the new federal health care overhaul to voter registration. Every state is preparing to open a health insurance exchange by Oct. 1. Whether these new agencies will offer voter registration as well as health care information is emerging as a potential fault line that could further divide states from one another and from Washington (Grovum, 8/16).

Atlanta Journal-Constitution: Olens Questions Security Of Information On Exchange
Georgia’s Sam Olens and attorneys general in 12 other states say the federal government is not doing enough to protect the medical and financial information of people who will apply for health insurance on government exchanges set to open Oct. 1 (Markiewicz and Williams, 8/15).

Meanwhile, the Obama administration continues to court small business -

The Washington Post: Obama Administration Outlines Five Ways Health Care Law Benefits Small Businesses
The Obama administration is ramping up its efforts to sell the health care law to small business owners, with the start of enrollment now only six weeks away. In a new entry on the White House blog, Ari Matusiak, the administration’s director of private sector engagement, has outlined five ways the Affordable Care Act, commonly called Obamacare, will “provides benefits and opportunities to small businesses that will help increase access to affordable coverage options” (Harrison, 8/15).

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Capitol Hill Watch

Capitol Hill Health Plan Fix Could Include Abortion Coverage

Access to abortion coverage is not offered to other federal employees who get health insurance through the government's plan. In other congressional news, more analysis of the possible budget battles that could occur over a threatened government shutdown and funds to implement the health law.

The Associated Press/Washington Post: Lawmakers, Staff May Gain Access To Abortion Coverage Under Health Law, While Other Feds Won't
It’s an issue lawmakers may not want to have to explain at town hall meetings back home: An attempt to fix a problem with the new health care law has created a situation in which members of Congress and their staffers could gain access to abortion coverage, something that currently is denied to federal employees who get health insurance through the government's plan (8/16).

The New York Times: Washington Memo: Puzzle Awaits The Capital: How To Solve 3 Fiscal Rifts
The showdown encompasses three interlocking fiscal disputes that will challenge Mr. Obama and his Republican interlocutors to bridge seemingly irreconcilable goals. Perhaps easiest to resolve is the effort by some conservative Republicans to eliminate financing for the new health care law in return for keeping the government open beyond Sept. 30, the end of the fiscal year. … A second challenge is determining the fate of the across-the-board budget cuts known as the sequester if Congress avoids a shutdown by extending government financing. … The third challenge may be the most worrisome. While the sequester pinches particular constituencies, and a government shutdown would inconvenience millions, economists warn that a default resulting from a failure to raise the government’s debt limit could tip the economy back into recession (Harwood, 8/15).

Politico: FreedomWorks Makes Big Anti-Obamacare Push
Conservatives are plotting an aggressive push during the last two weeks of August to boost the controversial effort in Congress to oppose spending bills this fall that contain funding for Obamacare. FreedomWorks is working with local conservative activists to question senators at home-state events about their objections to a letter spearheaded by Sen. Mike Lee (R-Utah) vowing to vote against bills with funding for the health care law (Everett, 8/15).

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State Watch

A California Audit Finds Oversight Lacking In Regard To Mental Health Spending

News outlets report the review concluded that the state has failed to properly monitor programs funded by the Mental Health Services Act.

Los Angeles Times: Audit Finds Lack Of Oversight Of Mental Health Services Act Spending
Nearly a decade after California voters approved a multibillion-dollar tax increase to improve mental health services, the state has failed to provide proper oversight of county programs funded by the measure, a state audit concluded Thursday. State Auditor Elaine Howle looked at the last six years, during which almost $7.4 billion from the Mental Health Services Act was directed to counties for mental health programs (McGreevy, 8/15).

The Associated Press: Audit: Mental Health Spending Not Properly Tracked
The state has failed to properly monitor more than $7 billion in voter-approved money for mental health programs from California's extra tax on millionaires and cannot reassure the public that it is going to help those most in need, the state auditor reported Thursday. California can offer "little assurance that the counties have effectively and appropriately used the almost $7.4 billion," Auditor Elaine Howle reported (Williams, 8/15).

In other news related to mental health issues -

The Texas Tribune/New York Times: As Mental Health Concerns Grow, Veterans Help Veterans
Mr. Escobedo is now a full-time peer counselor and public relations manager at the Lone Star Veterans Association in Houston, as well as a volunteer coordinator with the Military Veteran Peer Network in Texas. He is one of the network’s 20 volunteer coordinators. The state-financed program works with about 1,000 veterans, including many from the Vietnam War, who donate their time reconnecting soldiers with people in their local communities as well as available government and nonprofit resources (Rocha, 8/15).

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State Highlights: Pushback By Penn State Employees; Medi-Cal Cuts Loom

A selection of health policy stories from California, Massachusetts, North Carolina and Pennsylvania.

The Wall Street Journal: Penn State Employees Protest Wellness Effort
Pennsylvania State University employees are protesting a new wellness program that requires them to provide detailed health information or pay penalties that can total $1,200 a year, in an unusually public backlash against an increasingly common employer practice (Mathews and Martin, 8/15).

Los Angeles Times: Medi-Cal Cut Starts Next Month, State Says
A controversial cut to the California's healthcare program for the poor will begin next month, according to a bulletin distributed by state officials. Doctors and other healthcare providers who serve Medi-Cal patients will be reimbursed 10% less once the changes are fully phased in by next January. The first people to feel the pain will be dentists and medical transporters on Sept. 5. Next come providers of medical equipment and supplies on Oct. 24. The last to be affected are physicians, pharmacists and nursing facilities on Jan. 9 (Megerian, 8/15).

Kaiser Health News: Moving People Home After Nursing Home Stay Is Complicated
Napierski, a case manager at WestMass Elder Care in Holyoke, Mass., drew up a plan for Holmes's transition. … Napierski says Holmes would not have gone home without this help, buoyed by money the federal government is giving states for a Medicaid program called Money Follows the Person. The program identifies patients, old and young, who've been in a nursing home for at least 90 days but don't really need to be there. Massachusetts is one of 45 states and the District of Columbia in the program, created by the Deficit Reduction Act of 2005 (Bebinger, 8/16).

North Carolina Health News: Rural Hospitals Drive Local Economies As They Evolve
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 the evolving model of health care delivery in rural counties and what benefits rural counties derive from keeping a hospital in town (Hoban, 8/16).

WBUR: How Many Patients Does One Nurse Treat: Ballot Question On Staffing
Just Ask!” That’s the slogan for a new campaign by the Massachusetts Nurses Association (MNA). The union is encouraging people to ask how many other patients their nurses will be treating that day. The slogan is meant to draw awareness to what the nurses union sees as a growing disconnect between the profit-driven healthcare industry and the quality care of its patients (Tian, 8/15).

California Healthline: Amended Mid-Level Provider Bills OK'd
The Assembly Committee on Health this week passed two bills that would redefine the role of physician assistants, nurse practitioners and advanced pharmacists in the California health care system. SB 493 by Sen. Ed Hernandez (D-West Covina) and SB 494 by Sen. Bill Monning (D-Carmel) don't expand scope of practice, the authors of both bills said, in that mid-level practitioners and advanced pharmacists won't have new responsibilities, but they will be able to practice with a little more autonomy. The bills are an effort to address the looming access-to-care issue in California (Gorn, 8/15).

Los Angeles Times: 10 California Hospitals Fined A Total Of $675,000 
Ten California hospitals, including Ronald Reagan UCLA Medical Center and Hollywood Presbyterian Medical Center, were slapped with fines Thursday totaling $675,000 because they failed to follow certain licensing requirements that "caused, or was likely to cause, serious injury or death to patients." The fines ranged from $50,000 to $100,000, according to a news release from the California Department of Public Health (Bloomekatz, 8/15).

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Health Policy Research

Research Roundup: Doctors Aren't Paid To Talk; Savings From High-Deductible Plans

Each week, KHN compiles a selection of recently released health policy studies and briefs.

Journal of the American Medical Association: The State of US Health, 1990-2010
Understanding the major health problems in the United States and how they are changing over time is critical for informing national health policy. ... From 1990 to 2010, the United States made substantial progress in improving health. Life expectancy at birth and [healthy life expectancy] increased, all-cause death rates at all ages decreased, and age-specific rates of years lived with disability remained stable. However, morbidity and chronic disability now account for nearly half of the US health burden, and improvements in population health in the United States have not kept pace with advances in population health in other wealthy nations. The United States spends the most per capita on health care across all countries, lacks universal health coverage, and lags behind other high-income countries for life expectancy and many other health outcome measures. High costs with mediocre population health outcomes at the national level are compounded by marked disparities across communities, socioeconomic groups, and race and ethnicity groups. ... With increasing focus on population health outcomes that can be achieved through better public health, multisectoral action, and medical care, it is critical to determine which diseases, injuries, and risk factors are related to the greatest losses of health and how these risk factors and health outcomes are changing over time (US Burden of Disease Collaborators, et al, 8/14).

JAMA Internal Medicine: Medicare Payment For Cognitive Vs. Procedural Care
Health care costs in the United States are rising rapidly, and consensus exists that we are not achieving sufficient value for this investment. Historically, US physicians have been paid more for performing costly procedures that drive up spending and less for cognitive services that may conserve costs and promote population health. ... Our analysis indicates that Medicare reimburses physicians 3 to 5 times more for common procedural care than for cognitive care and illustrates the financial pressures that may contribute to the US health care system's emphasis on procedural care. We demonstrate that 2 common specialty procedures [a screening colonoscopy and extracting cataracts] can generate more revenue in 1 to 2 hours of total time than a primary care physician receives for an entire day's work (Sinsky and Dugdale, 8/12).

Employee Benefit Research Institute: Health Care Spending After Adopting A Full-Replacement, High-Deductible Health Plan With A Health Savings Account: A Five-Year Study
This study reports experience over five years from a single large employer in the Midwestern United States that adopted a high-deductible health plan with a health savings account (HSA) for all employees. This study represents one of the longest observation periods reported with a full-replacement [consumer directed health plan], and it is one of the few studies with a matched control group. ... Results show that spending was reduced significantly in the inaugural year of the HSA plan in medical, pharmacy, and total-claims categories. Further, the magnitude of the cost savings was greatest in this first year but the cost savings continued over the succeeding three years albeit at a slower pace (Fronstin and Roebuck, August 2013).

George Washington University School of Public Health and Health Services: The Bipartisan Senate Immigration Bill: Implications For Health Coverage And Health Access
Large disparities in health insurance coverage and access to care now exist, when non-citizen immigrants are compared with citizens. The changes in immigrants' health coverage and access as a result of the Senate bill would be modest and gradual. From the start, a bipartisan agreement was struck that unauthorized immigrants would remain ineligible for premium assistance or cost-sharing reductions under the ACA for many years while they are on the path to citizenship, that is, when they are in Registered Provisional Immigrant (RPI) status. Recognizing this, provisional immigrants are not subject to the ACA requirement that people must purchase insurance or pay a tax penalty. They would be permitted to buy insurance from the health insurance marketplaces (that is, the health insurance exchanges), but since federal subsidies would not be available, relatively few would be able to afford coverage. However, prior experience indicates that legalization will help these immigrants get better jobs, which could increase employer-sponsored private coverage for them and their families. They would become eligible for ACA benefits many years later, after attaining lawful permanent resident (LPR or "green card") status (Ku, 8/8).

The Rand Corp.: Delaying the Employer Mandate: Small Change In The Short Term, Big Cost In The Long Run
In July 2013, the Obama administration announced that it would delay enforcement of the Affordable Care Act's (ACA's) penalty on large employers (those with 50 or more workers) that do not offer affordable health insurance coverage to their employees. ... Given the complexity of the issues surrounding the implementation of health care reform, we felt an objective, analytically rigorous review of the impact of the one-year delay of the employer mandate would help inform debate on the issue. ... postponing the employer mandate for one year won't have a large effect on insurance coverage or firm offer rates. However, a one-year delay in implementation of the mandate will result in a 6-percent reduction (or $11 billion) in federal inflows from employer penalties. A full repeal of the employer mandate would cause revenue to fall by $149 billion over the next ten years, providing substantially less money to pay for other components of the law (Price and Saltzman, 8/8).

Here is a selection of news coverage of other recent research:

Medscape: AAP Recommendations For Male Adolescent, Young Adult Health
Pediatricians have the opportunity to improve the health of their adolescent male patients, according to a review published online August 12 in Pediatrics. The authors highlight objectives and practices for chronic illness, mortality, unintentional injury and violence, mental health and substance use, and reproductive and sexual health in young men. "Adolescent and young adult male health receives little attention, despite the potential for positive effects on adult quality and length of life and reduction of health disparities and social inequalities," write David L. Bell, MD, MPH, from the Department of Pediatrics and the Department of Population and Family Health, Columbia University Medical Center, New York City, and colleagues. "Pediatric providers, as the medical home for adolescents, are well positioned to address young men's health needs" (Barclay, 8/12).

Medscape: Electronic Patient–Physician Communications Face Barriers
Telephone calls and emails by patients can be very efficient, but these electronic communications may never be widely used unless physicians are reimbursed for them and are given extra time to do the work, according to a new study published in the August issue of Health Affairs. Despite the potential advantages associated with e-communications, a 2008 study has found that less than 7% of physicians regularly communicate with their patients electronically (Page, 8/12).

Medscape: HIV Occupational Exposure: USPHS Updates Guidelines
After any occupational exposure to HIV, healthcare personnel (HCP) should immediately receive a postexposure prophylaxis (PEP) regimen containing at least 3 antiretroviral drugs, according to updated guidelines published in the September issue of Infection Control and Hospital Epidemiology. The current recommendations from the United States Public Health Service (USPHS) update the 2005 guidelines for management of HCP with occupational HIV exposure and use of PEP. A major change in the recommendation refers to the number of drugs included in the PEP regimen. The previous guidelines recommended evaluating the risk level associated with specific exposures to help determine the optimal number of antiretroviral drugs for PEP. In contrast, the current recommendations call for consistent use of a combination of 3 or more drugs for all occupational exposures to HIV (Barclay, 8/9).

Modern Healthcare: Limiting Residents' Work Hours Didn't Hurt Patient Safety, But Cut Time Spent With Patients, Studies Say
Patient-safety issues raised by the critics of limits on resident duty hours have not materialized. But concerns about doctors-in-training spending less time with patients appear to be valid, according to two new studies in the Journal of General Internal Medicine. The Accreditation Council for Graduate Medical Education set an 80-hour weekly work limit (averaged over four weeks) in 2003. Further limits, including restricting first-year residents to 16-hour shifts went into effect in 2011 (8/15).

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Editorials and Opinions

Viewpoints: Medicare's Lessons For The Health Law; Krauthammer Says Obama Shouldn't Try To Write His Own Laws

Politico: How To Destroy Obamacare From Within
As a Sept. 30 budget deadline approaches, many in the Republican Party are pushing to repeal the Affordable Care Act, better known as Obamacare. The law's most radical opponents are even threatening to shut down the government by refusing to pass a continuing resolution, which would fund existing government programs at current or slightly adjusted levels. The political flaws of this strategy have been debated endlessly inside the GOP. But there is another important consideration: This doesn't have to be Republicans’ "last stand." Obamacare doesn’t have to be rolled back from without; it can be replaced from within. And Medicare, perhaps surprisingly, shows the way (Yevgeniy Feyman, 8/16).

The Washington Post: Can Obama Write His Own Laws?
[N]iceties must not stand in the way of an administration's agenda. Indeed, the very next day, it was revealed that the administration had unilaterally waived Obamacare's cap on a patient's annual out-of-pocket expenses — a one-year exemption for selected health insurers that is nowhere permitted in the law. It was simply decreed by an obscure Labor Department regulation. Which followed a presidentially directed 70-plus percent subsidy for the insurance premiums paid by congressmen and their personal staffs — under a law that denies subsidies for anyone that well-off. Which came just a month after the administration's equally lawless suspension of one of the cornerstones of Obamacare: the employer mandate. Which followed hundreds of Obama­care waivers granted by Health and Human Services Secretary Kathleen Sebelius to selected businesses, unions and other well-lobbied, very special interests (Charles Krauthammer, 8/15).

Bloomberg: Will Obamacare Save Taxpayer Money? That's Classified
Even as the Patient Protection and Affordable Care Act pushes to get health insurance for millions more Americans, the law is meant to work just as hard at bringing down the cost of Medicare. On this front, a principal goal has been to move the system away from fee-for-service payments, removing the incentive to provide unnecessary care. ... So it was discouraging to learn last month that a nationwide test of accountable care organizations - - a promising new payment system in which doctors and hospitals coordinate their efforts and share in the savings that may result -- didn't do so well in its first year. ... But now comes further reason to worry: The U.S. Centers for Medicare and Medicaid Services has missed the reporting deadlines, some of them mandated by Congress, for at least nine other payment-reform experiments -- and, in many cases, won't even say how late the agency is. Nor will CMS say when the data will be revealed (8/15).

The New York Times: Economix: Controlling Health Care Spending, Revisited
A hotly debated question among health policy wonks is whether the decline in the year-to-year growth in health spending in the United States, which started in 2002, will leave that growth rate at a permanently lower level (Uwe E. Reinhardt, 8/16).

The New York Times: Economix: Having More Doctors Might Reduce Health Spending. Or Maybe Increase It.
Would increasing the supply of doctors lead to lower health costs? This question came up repeatedly in my reporting for Monday's article about barriers to entry for foreign-trained physicians. It seems as if there should be a pretty straightforward answer, based on the usual laws of supply and demand: If you artificially limit the supply of doctors, that should push up the prices of the services they provide. So if you suddenly increase the supply of doctors, that should lower health care costs (Catherine Rampell, 8/15).

Fox News: A Look At ObamaCare’s Significant, Widespread And Very Real Problems
ObamaCare is poised to "destroy the foundation of the 40 hour work week that is the backbone of the American middle class." And that's the president's supporters talking. The dire warning came last month in a letter from three of the nation’s most influential union bosses to Democratic leaders in Congress (Edmund F. Haislmaier, 8/15).  

Toledo Blade: Stop Stalling On Medicaid
The federal government would pay almost all of the cost of Medicaid expansion. But GOP lawmakers remain willing to deny their constituents access to health care to satisfy the extremist Tea Party ideology, which manifests itself in knee-jerk opposition to Obamacare. Governor Kasich, balancing conservatism with pragmatism, said at a recent rally that the issue is helping real people, not swearing allegiance to political abstractions. But he is in the minority in his own party. ... So lawmakers refuse to interrupt the vacation they haven’t earned to deal with the most important issue before the state right now. They are leaving $13 billion in federal aid on the table. Instead, the state will spend more money to preserve the indefensible status quo (8/15).  

Los Angeles Times: CVS Thinks $50 Is Enough Reward For Giving Up Healthcare Privacy
Since February, CVS Caremark has been pushing its pharmacists to enroll customers in a prescription-drug rewards program. The benefit to customers is the opportunity to earn up to $50 a year in store credits that can be used to buy shampoo, toothpaste or other products. The benefit to CVS is persuading pharmacy customers, through questionable means, to give up federal privacy safeguards for their medical information and permitting the company to share people's drug purchases with others (David Lazarus, 8/15). 

Richmond Times-Dispatch: Surgery Centers: Vital Part Of Health Care Reform
It's hard to follow the news these days without seeing something about health care reform. But politics aside, today's health care system is challenged to meet the needs of patients in a cost-effective manner, while delivering quality care. That's where Ambulatory Surgery Centers, or ASCs, come into play and are prepared to have a larger role in the health reform conversation (Bruce P. Kupper, 8/16).

San Francisco Chronicle: California Needs More Interpreters For Patients
Within minutes of the Asiana Airlines Flight 214 crash in July, San Francisco General Hospital administrators knew they needed language translation services to help victims of this horrific accident. The hospital's medical staff put out the call for anyone who could interpret, and hospital personnel were able to communicate with the injured by asking Korean-speaking staff to double as interpreters. These patients were fortunate that San Francisco General found enough medical interpreters, but the unfortunate truth is that access to translation services is a major gap in our health care throughout the state (Philip Y. Ting, 8/16).

Baltimore Sun: A Supporter Sours On Obamacare
At the start of 2013, I looked forwarded to a barrage of public service announcements informing citizens on need-to-know facts about the full implementation of the ACA. I anticipated a full media blitz and a 50-state campaign to break down this tremendous bill for everyone to understand and accept wholeheartedly. Now we are two months away from full implementation, and the commercials never came. The cornerstone of President Barack Obama's first-term legacy, having survived a Supreme Court challenge, is a complete mess (Justin Cuffley, 8/15).

Los Angeles Times: Prescription Drug Crackdown
The growing death toll from prescription drug overdoses reflects the increased use of powerful painkillers and psychotherapeutic drugs, many of which are addictive and toxic when misused. Since The Times' Scott Glover and Lisa Girion began highlighting the problem late last year, state lawmakers have responded by trying to plug the information gaps that enable patients and doctors to abuse the system. Those efforts are slowly yielding results, although not to the extent that's needed (8/16).

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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.