Daily Health Policy Report

Monday, August 19, 2013

Last updated: Mon, Aug 19

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch


State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Amid Health Law Expansion, Some States Trim The Medicaid Rolls

Kaiser Health News staff writer Phil Galewitz reports: "While millions of adults nationwide will gain Medicaid coverage next year under the federal health law, more than 150,000 people could lose their coverage in the state-federal health insurance program for the poor as four states reduce eligibility" (Galewitz, 8/18). Read the story.

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Taking A New Tack To Persuade 'Young Invincibles' To Buy Health Insurance

Minnesota Public Radio's Elizabeth Stawicki, working in partnership with Kaiser Health News and NPR, reports: "Robert Bauer is young, lean and healthy - just the kind of person the government wants to buy into its new online health insurance marketplaces. Bauer doesn't see the need. The 24 year old, a 2011 graduate of the University of Minnesota, works in organic farm fields three days a week, and prides himself on eating well. He's uninsured - health coverage just hasn't been part of his lifestyle. … While Bauer generally doesn't fear a health crisis, the people building insurance exchanges worry about Bauer and the millions of other healthy Americans whom they fear may simply opt out" (Stawicki, 8/19). Read the story.

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Capsules: Colorado Exchange Releases Health Insurance Rates

Now on Kaiser Health News' blog, Colorado Public Radio’s Eric Whitney, working in partnership with KHN and NPR, reports: "Colorado released its Obamacare insurance rates on Friday, joining 13 states and the District of Columbia in making rates public. The state earlier made the call to be a clearinghouse exchange, rather than an active purchaser, and so, it has approved all 242 health plans submitted for sale on its marketplace" (Whitney, 8/19). Check out what else is on the blog.

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Political Cartoon: 'Between Barack And A Hard Place?'

Kaiser Health News provides a fresh take on health policy developments with "Between Barack And A Hard Place?" by Gustavo Rodriguez.

And here's today's health policy haiku:


What is in it for
the young and invincible
to buy insurance


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

Detailing The Health Law's Implementation Hurdles

Continued opposition to the overhaul is one of the administration's biggest challenges. In addition, many consumers eligible to buy insurance in new online marketplaces still don't understand their benefits and obligations under the law. Meanwhile, insurance companies are gearing up to sell policies.

Politico: Obamacare Tougher To Launch Than Medicare
President Barack Obama says he’s not worried that all the Obamacare fights will kill the law — because people fought the creation of Medicare and Social Security too, and now they’re more popular than ever. ... But this time there's a difference. Political opposition to Obamacare is still as strong as ever, more than three years after it was signed into law. That means the administration’s task in launching the health care law — the biggest new social program since the creation of Medicare in 1965 — is harder than anything its predecessors had to face (Nather, 8/18).

Los Angeles Times: As Healthcare Overhaul Nears, Many Consumers Still In The Dark
While government officials tout the broad benefits of the Affordable Care Act to drum up enrollment, many consumers are eager to know how the overhaul will affect them personally, from pocketbook concerns to worries about whether their local doctor and hospital will be included. And, so far, there have been considerably more questions than answers, as officials and insurers scramble to get ready and clarify many of the details that people care about the most (Terhune, 8/17).

NPR: You Ask, We Answer: More Of Your Questions About The Affordable Care Act
The Oct. 1 launch of the new health insurance exchanges is now less than two months away, and people are starting to pay attention to the changes these new marketplaces may bring to the nation's health care system. We know it's confusing, so we're spending part of the summer and fall answering at least some of your questions about the law (Rovner, 8/19).

Cleveland Plain Dealer: How Obama's Health Plan Will Affect Ohioans: Four Real Cases
Health care reform will affect everyone in different ways. Some people will pay much less than they are currently paying for their insurance and get better coverage. Those with chronic conditions will no longer be denied coverage or face higher rates, plus they will benefit from caps on out-of-pocket costs. Still, all of this information can seem abstract and difficult to wade through. To help understand its real impact, The Plain Dealer examined four real-life case studies(Villacorta, 4/17).

Dallas Morning News: Economic Snapshot: The Affordable Care Act And You
The Patient Protection and Affordable Care Act’s biggest impact so far begins on Jan. 1, when millions of Americans will be added to the rolls of health insurers. People on Medicare, Medicaid and other government insurance programs are not affected. Those who get insurance at work will basically see no change. Here’s a look at how it will work (Landers and Hogue, 8/18).

Arizona Republic: Health-Care Taxes Are Complicated Calculation
The Affordable Care Act is a complex piece of legislation. How complicated? The Internal Revenue Service has just launched a separate website, irs.gov/aca, to help explain it. The site is worth perusing, especially if you make a lot of money or run a business. Otherwise, if you can remember three key numbers about the new law, also known as “Obamacare,” that should go a long way toward simplifying things. Those numbers are $125,000, $200,000 and $250,000 (Wiles, 8/17).

Philadelphia Inquirer/Philly.Com: Insurers Gearing Up For Obamacare Business
With new federal rules and mandates, you'd think that health insurers would be beating the loudest drum in the repeal-the-Affordable Care Act band. But they're not, and there are a couple of reasons why (Calandra, 8/18).

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Rates Released For Colorado's Online Insurance Marketplace; MNsure Launches Paul Bunyan Ad Campaign

The Wall Street Journal explains to readers about the two types of health exchanges - run either by the state or federal government - which are scheduled to begin operating on Oct. 1. Other news outlets report on developments regarding these marketplaces in Minnesota, Colorado, Alabama, New Mexico, Oregon and Virginia.

The Wall Street Journal: Get Ready For Enrollment In Health Exchanges
In about six weeks, Americans will have a new kind of open enrollment to consider. Starting Oct. 1, people without health insurance can sign up for standardized coverage through new health-insurance marketplaces run either by their state, the federal government or a combination of the two—the centerpiece of the Patient Protection and Affordable Care Act (Gerencher, 8/17).

Kaiser Health News: Taking A New Tack To Persuade 'Young Invincibles' To Buy Health Insurance
Robert Bauer is young, lean and healthy - just the kind of person the government wants to buy into its new online health insurance marketplaces. Bauer doesn't see the need. The 24 year old, a 2011 graduate of the University of Minnesota, works in organic farm fields three days a week, and prides himself on eating well. He's uninsured - health coverage just hasn't been part of his lifestyle. … While Bauer generally doesn't fear a health crisis, the people building insurance exchanges worry about Bauer and the millions of other healthy Americans whom they fear may simply opt out (Stawicki, 8/19).

MPRnews: Paul Bunyan And Babe The Blue Ox New Faces Of MNsure
The state is contracting with BBDO Proximity Minneapolis for the website's roughly $9 million marketing campaign. At the campaign's launch Sunday, BBDO creative director Brian Kroening said he wanted the advertising to be easy to understand, local, and upbeat. "We liked Paul and Babe because everybody seems to recognize them. They were easy to work with. ... The ball of twine's agent was harder," Kroening said (Shenoy, 8/18)

Minneapolis Star Tribune: Minnesota Health Insurance Exchange Aims For A Big Ad Splash
James Delles is about to become a fixation of the nation’s health care marketers…As summer winds down and the Oct. 1 launch of Minnesota’s new MNsure health care exchange draws near, the state is betting millions that a pair of venerable Minnesota icons can grab the attention of young people like Delles and persuade them to buy coverage (Crosby, 8/19).

Kaiser Health News: Capsules: Colorado Exchange Releases Health Insurance Rates
Colorado released its Obamacare insurance rates on Friday, joining 13 states and the District of Columbia in making rates public. The state earlier made the call to be a clearinghouse exchange, rather than an active purchaser, and so, it has approved all 242 health plans submitted for sale on its marketplace (Whitney, 8/19).

Health Policy Solutions (a Colo. news service): Rates Higher In Resort Areas, College Towns
People living in resort areas of Colorado will have to pay higher health insurance rates than those in other regions when plans start being sold through the state’s health exchange on Oct. 1. An average 40-year-old non-smoker living in a resort area who is buying a mid-level “silver” plan could be charged a base rate as high as $667 per month compared to the least expensive silver plan for a comparable 40-year-old in Greeley, whose base rate would be about $232 per month. … But, insurance companies aren’t even offering the platinum plans in resort areas. The base rates don’t tell the whole story. Many new buyers of health insurance will pay less than the base rates because they’ll qualify for federal tax rebates designed to make insurance more affordable (Kerwin McCrimmon, 8/16).

In related news -

Medpage Today: ACA’s Mandated Benefits Create Few Problems
Insurance plans are adapting well to the new benefit mandates under the Affordable Care Act and are able to meet tight federal and state filing deadlines, according to a study from the liberal Urban Institute. Furthermore, consumers are unlikely to see dramatic changes in their covered benefits and cost next year because states had their own benefit mandates in place before the ACA, the study released Wednesday found. In the study, researchers at the Urban Institute and at Georgetown University assessed experiences in five states -- Alabama, Colorado, New Mexico, Oregon, and Virginia -- with meeting the development and regulatory requirements for the now mandated benefits. The work was funded by the Robert Wood Johnson Foundation (Pittman, 8/16).

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Health Law Critics Raise Privacy Concerns About Navigator Program

Some state attorneys general say the plans for hiring and training navigators don't have enough consumer safeguards.

The Hill: States Raise Privacy Concerns Over Health Law Navigators (Video)
Florida Attorney General Pam Bondi argued late Friday that new hires under ObamaCare could threaten the private information of people trying to get health insurance. Bondi said that the Department of Health and Human Services (HHS) is making it easier for someone to be hired as a so-called navigator, cutting back on background checks and eliminating a fingerprinting requirement, which could make it easier for a person's private information to fall into the wrong hands (Yager, 8/17).

St. Louis Beacon: Groups Named As Navigators To Help Consumers Through Maze Of Insurance Exchange
A few years ago, Missouri had a surplus of funds for assisting visually impaired people in the state but had difficulty reaching these clients. The state sought the help of the Missouri Association of Area Agencies on Aging, based in Jefferson City. … [Catherine Edwards, executive director of the association] mentions this incident as a reason federal officials might have selected the association as one of two Missouri groups to find and help tens of thousands of Missouri residents sign up for the insurance exchange program, which begins Oct. 1. The Department of Health and Human Services awarded the association $750,000 for exchange work. Slightly more than $1 million was awarded to Primaris Healthcare Business Solutions (Joiner, 8/19).

Kansas City Star/Topeka Capital-Journal: Librarians Aid In Navigating Health Care Changes
Librarians at the Topeka and Shawnee County Public Library are gearing up to help residents learn more about the Affordable Care Act and the Health Insurance Marketplace so they can choose the best insurance plan to fit their needs and budget. Lissa Staley, health information specialist at the library, said trained librarians will assist individuals with the Marketplace, which simplifies the search for health coverage by gathering all options in one place and allowing people to compare plans and explore free or low-cost programs for which they may qualify (Biles, 8/17).

Health News Florida: Grants: Who's In, Who's Out
It appears that virtually all counties in the state will receive "navigators" to help their uninsured residents learn how to get coverage under the Affordable Care Act except the one county that needs help most: Miami-Dade (Gentry, 8/16).

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With Medicaid Expansion, Some People Will Be Newly Eligible While Others Will Move To Health Exchanges

News outlets examine how the Medicaid expansion and other health law changes might reshape the program in various locations across the country.

Kaiser Health News: Amid Health Law Expansion, Some States Trim The Medicaid Rolls
While millions of adults nationwide will gain Medicaid coverage next year under the federal health law, more than 150,000 people could lose their coverage in the state-federal health insurance program for the poor as four states reduce eligibility" (Galewitz, 8/18).

Chicago Sun-Times: Health Care Enrollees Expected To Be Older, Sicker
If a pilot program in Cook County is any indication, getting people to enroll in Medicaid come Oct. 1 — when newly-eligible Illinoisans will be able to apply — is very possible. But they’re likely to be predominantly older and unhealthy when they apply (Thomas, 8/17).

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Insurers Seek Clarity On Who's Responsible If Consumers Who Receive Subsidies Don't Pay Their Share

Insurance officials are asking the Obama administration to make clear who is responsible financially if people who get federal subsidies to buy health insurance don't pay their premiums.

Bloomberg: Hospitals May Absorb Risk Of Insurers' Debtor Patients 
Less than two months before health exchanges open to the public, hospitals are asking to change a part of the Affordable Care Act that leaves them at financial risk for patients who fall behind on their insurance premiums. The hospitals said in an Aug. 15 letter that the U.S. Centers for Medicare and Medicaid Services should reconsider the way health-insurance exchanges divide the financial responsibility for delinquent customers. The letter was signed by the American Hospital Association, the Federation of American Hospitals, and the Association of American Medical Colleges (Adams, 8/17).

CQ HealthBeat: Who's On The Hook If Subsidy Recipients Don't Pay Their Premiums?
What happens if people signing up for subsidized coverage through the new insurance exchanges don' make their premium payments? That's the subject of a tug-of-war right now between hospitals and insurers. Hospitals are on the losing end -- but pushed back this week in hopes of pulling the issue back in their direction (Reichard, 8/16).

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Obama Scolds GOP For Efforts To 'Gum Up' The Health Law

In his Saturday address, the president says if Republicans continue to work to undermine the overhaul, they will be doing a disservice to their constituents. But Republican Rep. Capito warns health law is not working and calls for an implementation delay.

Politico: Obama: GOP Trying To 'Gum Up' ACA
President Barack Obama criticized Republicans for trying to "gum up the works" in the health care reform law and for refusing to help constituents sign up for coverage. "A lot of Republicans seem to believe that if they can gum up the works and make this law fail, they’ll somehow be sticking it to me. But they'd just be sticking it to you," Obama said in his weekly address (8/17).

CBS: Obama Denounces GOP's 'Empty Promises' On Government Shutdown
President Obama admonished some Republicans for offering "empty promises" to either repeal Obamacare or shut down the federal government in his weekly address on Saturday. "This isn't a game," he said. "This is about the economic security of millions of families." Meanwhile, in the weekly Republican address, Rep. Shelley Moore Capito, R-W.Va., warned that the health-care law is clearly not working the way it's supposed to, calling on the president to delay the implementation of the law's individual mandate, which requires individuals to buy health insurance or pay a fine (Miller, 8/17).

Kaiser Health News tracked weekend headlines regarding coverage of the president’s weekend address and the GOP response (8/17).

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Capitol Hill Watch

In Arkansas Race, Candidates Spar Over Who Hates The Health Law More

The two Republican rivals are both campaigning on their zeal to repeal the health law. Meanwhile, Rep. Chris Van Hollen, D-Md., says during the Sunday talk shows that he expects modifications to the health law to iron out its kinks will be necessary at some point down the road.

The Associated Press: Arkansas GOP Grapples With Health Law Fight
Lt. Gov. Mark Darr and state House Majority Leader Bruce Westerman won office three years ago riding an anti-Obama wave, with both vowing to kill the president's signature health care law. Now that they're both seeking a south Arkansas congressional seat, the two rivals are clashing over who hates the health overhaul more. Both say they want the law repealed and are touting their credentials as Republicans who have battled the overhaul at the state level (DeMillo, 8/18).

The Hill: Van Hollen Open To Modifying ObamaCare 'Down The Road'
Rep. Chris Van Hollen (D-Md.) said Sunday that he is open to changing some of the provisions contained within ObamaCare once the healthcare law was implemented. Van Hollen, a supporter of the law, said it was important for the reforms to go into effect and that any kinks could be ironed out further down the road (Yager, 8/18).

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Docs Prescribe More Radiation If They Have Financial Interest In It

Doctors who have a financial interest in prescribing radiation treatment do it more, a congressional study says. In the meantime, new Medicare payment incentives drive a rise in e-prescribing.

The New York Times: Doctors Who Profit From Radiation Prescribe It More Often, Study Finds
Doctors who have a financial interest in radiation treatment centers are much more likely to prescribe such treatments for patients with prostate cancer, Congressional investigators say in a new report (Pear, 8/18).

CQ HealthBeat: Medicare Incentives, Penalties Help Drive Increase In E-Prescribing
Medical providers are increasingly e-prescribing medications since Congress passed legislation in 2008 that created Medicare payment incentives to do so, and experts say the phenomenon is likely to keep growing. Physicians were slow to adopt e-prescribing technology until the 2008 law was enacted, directing the Centers for Medicare and Medicaid Services to provide incentive payments and payment adjustments to encourage electronic prescribing (Khatami, 8/16).

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State Watch

State Highlights: Fort Worth To Move Retirees Into Medicare Advantage Plans

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

Fort Worth Star-Telegram: Fort Worth To Move Medicare-Eligible Retirees Into Medicare Advantage Plans
City Council members gave administrators the go-ahead Friday to move the city's 1,500 Medicare-eligible retirees out of a self-insured health plan and into Medicare Advantage in January. The move could save the city $2 million in claims costs next year and more than $5 million by 2023, the city staff estimates. But retirees are skeptical (Nishimura, 8/17).

California Healthline: Process Begins For Medi-Cal Provider Cuts
The Department of Health Care Services this week outlined its plan to implement a state-ordered 10 percent cut to Medi-Cal providers' reimbursement rates. It will begin Sept. 5, starting with medical transportation and dental providers. The reimbursement rate for durable medical goods will drop starting Oct. 24  and the bulk of the cuts -- to physicians, pharmacists and clinics -- will begin Jan. 9, 2014, according to a document posted on the DHCS website on Wednesday (Gorn, 8/16).

Los Angeles Times: Patient-Interpreter Bill Aims To Overcome Language Barriers
According to a 2012 study prepared for the federal Agency for Healthcare Research and Quality, pediatric patients with limited-English-proficient families who speak Spanish "have a much greater risk for serious medical events during hospitalizations than patients whose families are English-proficient" ... [A bill that would make a statewide medical-interpretation program available to Medi-Cal patients] would require the state Department of Health Care Services to apply for federal money that would pay for a certified medical-interpreter program. Such a program is needed, supporters say, to prepare hospitals for the millions of limited-English speakers expected to use healthcare services over the next few years (Kumeh, 8/18).

The Washington Post: Pr. George's Mental Health Court Aims To Treat, Rather Than Jail, Defendants
More than half of all inmates in U.S. jails and prisons -- more than 1.2 million people -- reported symptoms of mental illness, according to a 2006 federal study, the most recent national study available. ... State and local court systems are adjusting to this reality, with about 300 jurisdictions setting up specialized dockets for judges who use the power of the legal system to impose mental health treatment on some of society's most troubled residents. They are people charged with assault, theft, arson, trespassing, harassment, stalking and other crimes short of homicide (McCrummen, 8/17).

Los Angeles Times: California Discourages Needy From Signing Up For Food Stamps
Liberal California discourages eligible people from signing up for food stamps at rates conservative activists elsewhere envy. Only about half of the Californians who qualify for help get it. That stands in contrast to other states, including some deeply Republican ones, that enroll 80 percent to 90 percent of those with incomes low enough to qualify. That public policy paradox -- one of the country's most liberal states is the stingiest on one of the nation's biggest benefit programs -- has several causes, some intentional, some not. It also has two clear consequences: Millions of Californians don't get help, and the state leaves hundreds of millions of dollars of federal money on the table (Halper, 8/17).

The New York Times: Firefighters' Survivor Benefits Value Some Lives Over Others
In life, firefighters from disparate states and backgrounds work side by side, fighting the same blazes on the same terrain. But in death, families say, they are sifted into different categories based on their official employment status. Whether they were full time or part time and whether they were employed by local, state or federal governments or private contractors can make a difference amounting to hundreds of thousands of dollars, providing some families with a financial lifeline from the government and others with barely enough to pay for a funeral (Healy, 8/18).

Baltimore Sun: Some Hospital CEOs Get Bigger Compensation Packages
Many Maryland hospital and health system CEOs received pay increases in recent years even as they complained of shrinking profit margins and warned of cutbacks unless they could increase the rates they charge. Eleven executives earning seven-figure compensation packages including salary, bonus, retirement and other pay saw their total pay rise from as little as 0.13 percent to as much as 308 percent in the fiscal year that ended in 2012, according to tax filings. Another executive earning more than $1 million saw a pay cut (Walker, 8/18).

The Associated Press: Wis. To Claim Marital Property For Medicaid Debts
Provisions buried in the new Wisconsin budget dramatically expanded the state's ability to claim dead couples' joint property, such as Green Bay Packers tickets or the family farm, to recoup Medicaid expenses -- even if the assets are protected in trusts. The language is designed to help the state recover Medicaid money spent on a number of long-term care programs, most notably Family Care, which helps keep disabled and elderly people out of costly nursing homes (Richmond, 8/18).

The Associated Press: Ill. Lawmaker Wants Care For Low-Income Stroke Patients
Low-income stroke patients on Medicaid in Illinois are offered just four sessions with a rehabilitation specialist, far too little therapy to allow them to make a strong recovery, U.S. Sen. Mark Kirk said in calling for a better standard of care. The Republican from Highland Park, who suffered a stroke in January 2012, told the (Springfield) State Journal-Register in an interview that he's working on legislation to change that and to promote what he calls "the stroke agenda (8/17).

The Associated Press: Oklahoma Pilot Program Seeks To Curb Health Costs; Will Involve 15K Employees
A $3.8 million pilot program is to start on Jan. 1 to see if it can lower health care costs for 15,000 Oklahoma state employees and their families. The program by MedEncentive was authorized in the 2011 legislative session and will be open to some workers taking part in the HealthChoice program. If the MedEncentive test can bring down costs, its methods could be spread to all 125,000 state employees on the HealthChoice plan (8/18).

The Wall Street Journal: Planned Parenthood Settles In Fraud Case
Planned Parenthood agreed to pay $4.3 million to settle a federal civil suit claiming that it fraudulently billed Medicaid for women's health services provided by some of its Texas clinics from 2003 to 2009. The non-profit organization, which estimates that it provides medical information and services, including abortions, to three million people in the U.S. each year, denied any wrongdoing as part of the settlement announced Friday by the U.S. Attorney's Office for the Eastern District of Texas (Koppel, 8/16).

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Editorials and Opinions

Viewpoints: GOP Trapped Between Angry Base And Reality Of Health Law; Small Businesses 'Scrambling;' Competing Views Of Medicaid Expansion In Va.

The New York Times: One Reform, Indivisible
Recent political reporting suggests that Republican leaders are in a state of high anxiety, trapped between an angry base that still views Obamacare as the moral equivalent of slavery and the reality that health reform is the law of the land and is going to happen (Paul Krugman, 8/18).

The Wall Street Journal: Will the Health-Care Law Help Small Businesses?
Change doesn't get much bigger than this. Or more contentious. President Obama's Patient Protection and Affordable Care Act has rewritten the rules on health insurance. And it has left small companies scrambling to figure out what it means for them (8/18).

Forbes: The Coming Liberation: Health Care For All Without Obamacare
Obamacare was pushed through on the promise of universal health coverage for everyone. But the CBO now scores Obamacare as leaving 30 million uninsured even 10 years after implementation! In fact, Obamacare will increase the uninsured rather than reduce them. Former CBO Chief Douglas Holtz-Eakin published a study in 2011 arguing that more than 40 million workers will lose their employer provided health insurance under the incentives of Obamacare. That is because employers can save enormous sums dropping the highly expensive, Obamacare mandated, employer health insurance (Peter Ferrara, 8/18).

The Tennessean/USA Today: Paying For Obamacare: Some Feel Singled Out
Johnny Drake's business is losing 2.3 percent of everything it makes because of the Affordable Care Act. He's the president of Pathfinder Technologies, a small company in Nashville with fewer than 20 employees, that got hit with an excise tax this year because it makes medical devices. Medical device manufacturers are among the federal health law losers, those that will have to pay up to cover the cost of implementing it (Tom Wilemon, 8/18). 

Bloomberg: On Republican Priorities, Obama May Have a Point
President Barack Obama has lost almost all credibility defending the Affordable Care Act: Hiccup after hiccup have marred its implementation, its taxes and spending will hurt economic growth, and it will raise consumer health costs. But Obama may have had a point when he charged last week that Republicans are talking about repealing the law without saying what should replace it. Republicans would be wise to debunk the president’s claim head on (Lanhee Chen, 8/16).

Bloomberg: Young, Healthy And Rich Need Obamacare, Too
The trick to making any health-insurance system work is to attract enough healthy and young people into the insurance pool. ... "The whole scheme is enlisting young adults to overpay, so other people can have subsidies," Dean Clancy, vice president of public policy for FreedomWorks, told my Wonkblog colleague Sarah Kliff. "That unfairness reminded us of the military draft." Clancy is wrong: The subsidies are funded by taxes on rich people and by cuts to Medicare spending, not by the premiums paid by young people. In fact, young people are likely to be the biggest beneficiaries of the subsidies because they're more likely than any other age group to be poor and uninsured (Ezra Klein, 8/16).

Atlanta Journal-Constitution: A Republican Conversion To Obamacare
One afternoon last week, though a thousand miles apart, Newt Gingrich in Boston and Clint Murphy in Savannah came to the same conclusion about Obamacare and the GOP. Their verdict: This is not August 2010, when town hall meetings erupted in a pitchforked frenzy over the slim congressional margin that had handed Democrats their dream victory of near-universal health care coverage (Jim Galloway, 8/17).

The Richmond Times-Dispatch: Expand Medicaid? NO: It's A Question Of Care, Not Coverage
The evidence overwhelmingly shows that Medicaid expansion will mean a dramatic drop in the quality of care. The most important part of any health coverage plan is access to high-quality care and the ability to forge a one-on-one doctor-patient relationship. These are the doctors who help us most to prevent disease and sickness. These doctors are who we turn to when our kids have the chicken pox, when mom or dad has arthritic flare-ups or, God forbid, when our significant other has symptoms of cancer. They’re the ones we trust. They’re our first line of defense. Unfortunately, Medicaid expansion could destroy that relationship (David Schwartz, 8/18).

The Richmond Times-Dispatch: Expand Medicaid? YES: The Facts Will Speak For Themselves
In Virginia, Medicaid is well-run, with highly efficient administrators who control costs better than private insurance companies. In addition, a full accounting of the savings the state would realize from expanding Medicaid under the Affordable Care Act shows that the expansion would pay for itself. Despite claims to the contrary, Virginia can — and should — make this important and cost-effective service available to more people who need it. ... Critics also ignore the finding that Medicaid is an effective insurance tool. The role of insurance is to protect people from catastrophic costs, and Medicaid does this very well (Massey Whorley, 8/18).

The Columbus Dispatch: Study Boosts Medicaid Plan
Ohio lawmakers wanted more details about how expanding Medicaid could affect the state's bottom line, and now that they have them, it's good news: Enabling more poor Ohioans to have health insurance would, as previously reported, save the state money in the long term. That good news won’t matter, however, unless the legislature enacts the Medicaid expansion, and so far this obviously beneficial path has been blocked by tea party Republicans for no reason other than ideological obsession (8/18).

Concord Monitor: A Moral And Financial Argument To Expand Medicaid
The economic argument for expanding Medicaid is strong. What the uninsured poor don't get is regular preventive health care that keeps them at work and out of hospitals. Instead, they get expensive treatment in emergency rooms and enormously expensive hospital stays for chronic conditions that were allowed to deteriorate. The cost of that care is shifted to employers and the insured in the form of higher health care premiums and state subsidies to hospitals. Providing health coverage increases low-income citizens' ability to exercise personal responsibility by doing more of what it takes to stay healthy and on the job instead of in a hospital or on disability payments (8/18).

Journal of the American Medical Association: Current Challenges to Academic Health Centers
Academic health centers (AHCs) have long been the exemplars of medicine in the United States. They produce "breakthrough" research, pioneer new diagnostic and therapeutic interventions, and train the best and brightest future physicians with emphasis on specialists and subspecialists. Today, they face a perilous future because the health care economic system that supports this enterprise is fading away; what [Alain] Enthoven has called "cost unconscious" third-party payment for care is being transformed into "value purchasing" (Victor R. Fuchs, 8/15).

The Washington Post: The Sequester's A Public Health Hazard
This 60th anniversary of the Clinical Center, the NIH’s beating heart, is inspiriting and depressing: Public health is being enhanced — rapidly, yet unnecessarily slowly — by NIH-supported research here, and in hundreds of institutions across the country, into new drugs, devices and treatments. Yet much research proposed by extraordinarily talented physicians and scientists cannot proceed because the required funding is prevented by the intentional irrationality by which the sequester is administered (George F. Will, 8/16).

The New York Times: When No One Is On Call
Bedside nurses are the hospital's front line, but we can't do the first-alert part of our jobs if there aren't enough of us on the floor. More demands for paperwork, along with increasing complexity of care, means the amount of time any one nurse has for all her patients is diminishing. And as hospitals face increasing financial pressure, nurse staffing often takes a hit, because nurses make up the biggest portion of any hospital's labor costs. For patients, though, the moral calculus of the nurses-for-money exchange doesn't add up. Pioneering work done by Linda H. Aiken at the University of Pennsylvania in 2002 showed that each extra patient a nurse had above an established nurse-patient ratio made it 7 percent more likely that one of the patients would die (Theresa Brown, 8/17).

USA Today: Commend Bush's Doctors
Though I am not one of Bush's personal physicians, I have ridden mountain bikes with him recently on his ranch and personally witnessed his extreme fitness. So I was as surprised as anyone to find that he underwent a cardiac catheterization. This certainly demonstrated that we are all vulnerable to a disease that kills about 600,000 Americans every year. ... The lesson for all of us is that we could be next. If a role model for fitness in older people such Bush can have significant heart disease, so can we. In terms of treatment, stents are neither good nor bad, they are simply useful when appropriate (Dr. Marc Siegel, 8/16).

The Washington Post: In Genomics, A Need To Balance Science And Privacy
In general, in the study of human genomes, it has been common practice for scientists to share sequencing data without the identity of the person from whom it came. But an important announcement from the National Institutes of Health has cast light on the need for more debate and clarity on a subject certain to challenge both science and individual privacy in the future (8/18).

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Stephanie Stapleton

Andrew Villegas

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Shefali Luthra

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