Daily Health Policy Report

Friday, August 2, 2013

Last updated: Fri, Aug 2

KHN Original Reporting & Guest Opinion

Health Spending And Fiscal Battles

Capitol Hill Watch

Health Reform

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Five Things To Know About Obamacare Premiums: A Guide For The Perplexed

Kaiser Health News staff writer Julie Appleby reports: "Premiums will skyrocket next year! Premiums will be lower than expected! Premiums will be about the same! Consumers are understandably confused after weeks of conflicting pronouncements about the expected cost of plans, for individuals and small groups, to be sold in new online insurance marketplaces under the federal health law beginning Oct. 1. … How is a consumer to make sense of this?" (Appleby, 8/1). Read the story.

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Univision Obamacare Deal Could Put WellPoint, Blues Ahead Of Competitors

Kaiser Health News staff writer Jenny Gold, working in partnership with the Miami Herald, reports: "Some 10 million Latinos stand to gain health insurance under the Affordable Care Act, and the Spanish-language media network Univision is positioning itself as a direct path to this potentially lucrative market. WellPoint and other Blues insurers in six states including Florida have signed deals with Univision for undisclosed sums to be the exclusive health insurance sponsor of the network's Peabody-award winning health initiative, 'Salud Es Vida,' which means Health Is Life" (Gold, 8/2). Read the story.

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Health On The Hill: Officials Face Obamacare 'Data Hub' Questions On Capitol Hill

Kaiser Health News staff writer Mary Agnes Carey speaks with Politico Pro's Jennifer Haberkorn about two House committee meetings on Capitol Hill Thursday where IRS and CMS officials faced questions about implementing a system to verify consumer income under the health law (8/1). Listen to the audio or read the transcript.

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Obamacare: What The Plans Will Cost

The Seattle Times' Carol M. Ostrom, working in partnership with Kaiser Health News, reports: "For some people, individual insurance plans offered through Washington’s new online exchange marketplace may cost more than those available now, but they will cover much more, state Insurance Commissioner Mike Kreidler said Thursday. And although people in some counties will have limited choices, as they do now, in most counties the 31 new plans available from four companies will offer a wide range of premiums and cost-sharing options" (Ostrom, 8/1). Read the story.

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Capsules: Health Costs Are Still Tame, Insurer Results Show

Now on Kaiser Health News' blog, Jay Hancock writes: "Some give all the credit to Obamacare. Others cite the poor economy or employers forcing workers to bear more of the cost of their medical expenses. Whatever the reason, health-cost increases stayed tame through the first half of the year, insurers say. Thursday's report from Cigna was the last dispatch on second-quarter financial results from major medical carriers. Cigna's results were similar to those of its rivals: higher-than-expected profits thanks largely to moderate increases in medical prices and the number of medical procedures" (Hancock, 8/1). Check out what else is on the blog.

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Political Cartoon: 'Trash Day?'

Kaiser Health News provides a fresh take on health policy developments with "Trash Day?" by Adam Zyglis.

Meanwhile, here is today's health policy haiku:


Does English duchess
receive maternity care
on prince's health plan?

And, because it's Friday and it's August, here's a bonus haiku:

Like young schoolchildren:
legislative tantrum
right before recess.

 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 Spending And Fiscal Battles

Talk Of Budget 'Grand Bargain' Continues

Just as lawmakers prepared to depart for their August break, President Barack Obama sought to revive interest in a budget deal combining new tax revenue with cuts to health and retirement benefits. A group of Senate Republicans appeared interested, but there were no signs of engagement by the House GOP.

The Washington Post: Budget Truce Seems Out Of Reach As Congressional Recess Looms
Just this week, President Obama tried to revive interest in a grand bargain that would pair more tax revenue, long sought by Democrats, with cuts to federal health and retirement benefits long sought by Republicans. During a speech in Tennessee, the president also called for an end to the sequester and sought fresh funding for infrastructure and jobs. But Republican leaders have so far rejected Obama's overtures, arguing that ending the sequester — part of a deal to raise the federal debt limit in 2011 — would erode their sole victory in the fight to shrink the size of government (Montgomery, 8/1).

The Wall Street Journal: Senate Republicans Eye 'Grand Bargain' On Budget
A group of Republican senators who have been meeting privately with top White House officials have concluded that they want to try again to reach a sweeping budget deal that would cut deficits and make changes to Medicare, according to participants in the meetings. The Senate contingent met for more than two hours at the White House on Thursday and got an unexpected visitor. President Barack Obama joined the meeting in White House Chief of Staff Denis McDonough's office and stayed for about an hour (Nicholas, 8/1).

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Capitol Hill Watch

40th Repeal Vote Unlikely To Be Charm For House Republicans

The vote in the GOP-controlled House, scheduled for Friday, would prevent the Internal Revenue Service from enforcing any part of the health law. Some news outlets explore why GOP lawmakers continue pushing purely symbolic votes that will go nowhere in the Democrat-controlled Senate. Others report on the intra-party split regarding the strategy to shut down the government unless the law is defunded this fall.

The Associated Press/Washington Post: House GOP To Vote On Repealing Health Care Law For 40th Time Before Leaving On Summer Break
Maybe the 40th vote to repeal President Barack Obama's health care law will be a charm for opponents of the overhaul. House Republicans are scheduled to vote Friday on a bill that would prevent the Internal Revenue Service from enforcing or implementing any part of the law they call "Obamacare." It'll mark the 40th vote by the Republican-controlled House to repeal some or all of the law (8/2).

The New York Times: Republicans Refuel Effort To Cripple Health Care Law
With the House poised to vote Friday on yet another bill to cripple President Obama's health care law, the question arises: Why do Republicans persist in their so-far futile efforts? Democrats have many theories. Republicans, they suggest, care little about the uninsured. Many, they say, dislike Mr. Obama and want him to fail (Pear, 8/1).

The Wall Street Journal's Washington Wire: Waxman: GOP Stalking Great White Whale On Obamacare
The finger-pointing and endless fighting between Democrats and Republicans over the health-care law has sunk into a familiar rut. But Rep. Henry Waxman, a California Democrat and scourge of Republicans (and some members of his own party) in the House has managed to create an interesting metaphor for the struggle. "The law has become the Republicans great white whale. They will stop at nothing to kill it," said Mr. Waxman in the latest of his many press releases complaining about Republicans trying to block implementation of the Affordable Care Act (Mundy, 8/1).

The Washington Post: Congressional Republicans Split Along Lines Of Seniority, Tactics
Congressional Republicans have splintered into generational factions over how to approach the implementation of President Obama's landmark health-care law. Younger GOP lawmakers are urging a shutdown of the federal government in the fall to demonstrate opposition to the law. Some more longtime lawmakers are trying the ease the tensions (Kane, 8/1).

Politico: Ted Cruz To Join Anti-Obamacare Town Hall
Sen. Ted Cruz will join Heritage Action for a town hall event in Dallas as part of the group's series pushing efforts to defund the Affordable Care Act, continuing his crusade to stifle the law, the group announced. Cruz will speak at the Dallas event hosted by the Heritage Foundation’s lobbying arm, joining former Sen. Jim DeMint and his father, Rafael Cruz (Anand, 8/1).

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Tavenner Challenges GOP Health Law Claims During Capitol Hill Hearing

Centers for Medicare and Medicaid Services chief Marilyn Tavenner disputed statements by Republican lawmakers that the country's health care reform law is causing workers to lose hours or benefits. The acting head of the Internal Revenue Service also testified.

Reuters: U.S. Official Challenges Claim That Obamacare Hurts Workers
At a stormy House of Representatives committee hearing, Marilyn Tavenner, who heads the Medicare and Medicaid programs, said she has found only anecdotal evidence of employers reducing work hours or benefits because of worries about President Barack Obama's landmark reforms, which take effect on January 1 (Morgan, 8/1).

The Hill: Official Disputes That Work Hours Are Being Cut Due To ObamaCare
"There are stories with both [good and bad] examples and that will continue to be the case," Tavenner told the House Energy and Commerce Committee. Republicans fired back that the Obama administration is not paying attention to news reports about the choices facing business owners under ObamaCare (Viebeck, 8/1).

The Hill: Top Implementer: ObamaCare Will Be Ready
Tavenner delivered confident predictions about ObamaCare's roll-out to members of Congress and promised that the exchanges will open for enrollment on Oct. 1 as scheduled (Viebeck, 8/1).

Medpage Today: GOP 'Sabotaging' ACA Rollout, Dems Charge
"We are so ready; I just cannot wait for those 60 days," Tavenner told MedPage Today after a House Energy and Commerce Committee hearing on the ACA's implementation. At that hearing, Democrats charged Republicans in a report of lying and generally being disingenuous at the eleventh hour of ACA implementation -- hindering "millions of their poorest constituents from receiving health insurance coverage" (Pittman, 8/1).

Kaiser Health News: Health On The Hill: Officials Face Obamacare 'Data Hub' Questions On Capitol Hill
Kaiser Health News staff writer Mary Agnes Carey speaks with Politico Pro's Jennifer Haberkorn about two House committee meetings on Capitol Hill Thursday where IRS and CMS officials faced questions about implementing a system to verify consumer income under the health law. ... [HABERKORN:] When you sign up to try to get a subsidy, your information will go through this data hub and be checked with the IRS. It will go to the Social Security Administration. All this information is going to go through there (8/1).

CBS News: GOP Questions IRS About Fraud, Taxes In Obamacare
As the IRS attempts to administer the new aspects of Obamacare, it could hit taxpayers with unexpected tax bills or end up doling out subsidies to frauds, Republicans warned in a House committee hearing Thursday. Officials from the IRS and the Centers for Medicare and Medicaid Services told members of the House Ways and Means Committee that the Obamacare rollout is proceeding as planned, insisting that the GOP's concerns about fraud and unforeseen taxes are misguided. Rep. Paul Ryan, R-Wis., countered that he wasn't misguided -- the IRS is (Condon, 8/1).

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Health Reform

Health Law Supporters Plan August Strategy To Counter Criticism

In response to efforts by some Republican lawmakers who are threatening to shut down the government as part of their attempt to stop the health law's implementation, some progressive groups plan to organize their own town hall meetings and stage protests at GOP events, among other things, to tout the law's perks. Others will go door to door to encourage consumers to enter the insurance market.  

Los Angeles Times: Liberal Groups To Counter Anti-Obama Healthcare Efforts In August
With tea party Republicans threatening to shut down the government in an effort to roll back President Obama's healthcare law, several progressive groups are teaming up in a new effort to convince skeptical voters of the benefits of the new law. During the August recess, Americans United for Change and Protect Your Care plan to counter efforts by Republicans to disparage the law. The groups will stage protests at GOP events, organize their own town halls to publicize its perks, and provide "air cover" to the law's defenders (Reston, 8/1).

The Washington Post: Groups Go Door-To-Door To Encourage Enrollment In Obamacare
For the law to succeed, groups such as Enroll America, whose officials include several veterans of Obama campaigns, will need to cajole millions of Americans, including many healthy ones, to enter the insurance market. It could be a tough sell. Confusion about the law is rampant. The online insurance sites, which open for enrollment Oct. 1, could be tricky. Some people who rarely need medical care might view even low-cost health plans as too pricey (Somashekhar, 8/1).

The Washington Post's Post Politics: OFA Launches 'Truth Team' To Defend Obamacare, Other White House Policies
Organizing for Action is launching a "Truth Team" Thursday that will enlist its supporters in efforts to counter criticism of the Affordable Act Act and other White House policies, according to the group's officials. The non-profit associated with President Obama has established a separate Facebook and Twitter account, that will provide its self-described "truth tellers" with statistics and background they can use to tout Obamacare's benefits. While the campaign is launching during the August recess, the aides said, it would continue beyond that (Eilperin, 8/1).

Politico: Kathleen Sebelius Hits The Road To Promote Obamacare
Health and Human Services Secretary Kathleen Sebelius's beyond-the-Beltway travels this summer include stops meant to activate and invigorate networks ready and waiting to promote Obamacare. She's enlisting community leaders, bloggers and health care providers for on-the-ground outreach this summer and fall. Enrollment runs from October through March, and there’s plenty of distrust and confusion across the country (Delreal, 8/2).

CQ HealthBeat: Health Law Camps To Campaign Across America During August Recess
Supporters and opponents of the health care law Thursday announced their plans to host town halls, stage events, run television ads and use other media to make their cases to the American public as lawmakers go home for the August recess and the insurance exchanges are set to open in two months (Bunis, 8/1).

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Spin Battle Over Obamacare Premiums Continues

Kaiser Health News offers five pointers to help you make sense of contradictory headlines about how much insurance could cost you when the Affordable Care Act marketplaces open for enrollment in October. Meanwhile, other media report on states' projections of what premiums may cost in the online marketplaces next year.

Kaiser Health News: Five Things To Know About Obamacare Premiums: A Guide For The Perplexed
Premiums will skyrocket next year! Premiums will be lower than expected! Premiums will be about the same! Consumers are understandably confused after weeks of conflicting pronouncements about the expected cost of plans, for individuals and small groups, to be sold in new online insurance marketplaces under the federal health law beginning Oct. 1. … "Premiums across states vary a whole lot less than the spin does," said Larry Levitt, a senior vice president at the Kaiser Family Foundation, a nonpartisan health policy research organization (Appleby, 8/1).

Los Angeles Times: Health Insurance Rates For California's Small Businesses Unveiled
California's small businesses next year will have a range of competitively priced options offered by a new state government health insurance exchange. The agency, Covered California, unveiled its portfolio of policy options for smaller businesses Thursday. They include both health maintenance organizations and preferred provider networks and will be available in all parts of the state as of Jan. 1 (Lifsher, 8/1).

Politico: Ohio Becomes Latest Battleground In Obamacare Premium Wars
The fight over Obamacare premiums has a new home base: Ohio. Customers in the key swing state can expect to pay 41 percent more on average for individual health insurance coverage next year because of Obamacare, according to projections released by the state's Republican insurance commissioner Thursday (Millman, 8/2).

Dallas Morning News: Prices Under Wraps As Texas Health Coverage Marketplace Takes Shape
In October, a federal health insurance market is coming to Texas under the auspices of Obamacare. If you don’t have health coverage, you need to check it out. What’s it going to cost? Health insurance premiums overall are likely to go up. So will  benefits. Subsidies will be available to most of those expected to shop on the new exchange. The actual plans and costs, however, are still under wraps (Landers and Garrett, 8/1). 

Health News Florida: State Releases Rates In Solo Market
Two big changes are coming to the individual market, where consumers pay their own way without help from employers.  The first: Companies can no longer screen out customers who may have health risks, or exclude coverage for certain conditions or body parts. The second follows from the first: Premiums will go up sharply for those who buy their own policies, about 30 to 40 percent (Gentry, 8/2).

The Seattle Times: Obamacare: What It Will Cost Here
For some people, individual insurance plans offered through Washington's new online exchange marketplace may cost more than those available now, but they will cover much more, state Insurance Commissioner Mike Kreidler said Thursday.  And although people in some counties will have limited choices, as they do now, in most counties the 31 new plans available from four companies will offer a wide range of premiums and cost-sharing options (Ostrom, 8/2).

Georgia Health News: State Grudgingly OKs Insurance Rates For Exchange 
Insurance Commissioner Ralph Hudgens said Thursday that federal officials did not respond to his request for an extension in the deadline for approving rates in the upcoming state insurance exchange. Wednesday was the deadline. Because he didn't get a response in his request for more time, Hudgens said, he was left "with no viable option" but to approve the premiums submitted by health insurers (Miller, 8/1).

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Deal Will Keep Federal Contributions For Insurance When Congress Moves To Exchanges

Members of the House and Senate and aides are being switched to the online marketplaces set up by the health law.

The New York Times: Deal Keeps U.S. Health Care Contribution For Congress
The Obama administration told Congress on Thursday that it would allow the federal government to continue paying a large share of the cost of health insurance for members of Congress and their aides, averting a problem for many who work on Capitol Hill. However, under the arrangement, lawmakers and many of their aides will have to get coverage through new health insurance marketplaces, or exchanges, being set up in every state (Pear, 8/2).

Politico: Capitol's Obamacare Crisis Resolved
Lawmakers and staff can breathe easy — their health care tab is not going to soar next year. The Office of Personnel Management, under heavy pressure from Capitol Hill, will issue a ruling that says the government can continue to make a contribution to the health care premiums of members of Congress and their aides, according to several Hill sources (Bresnahan and Sherman, 8/2).

Fox News: Lawmakers, Aides To Get ObamaCare Exemption
Starting in 2014, all 100 U.S. senators, 435 representatives in the House and their aides will have to get their health insurance through ObamaCare's newly formed state exchanges. But they won't see a spike in their health care costs under a deal struck before the August recess.  Congressional leadership aides tell Fox News a deal has been reached with the Office of Personnel Management, which will allow the government to continue to make employer contributions to the health plans of lawmakers and congressional staffers. The OPM, which oversees the compensation system for the federal civilian workforce, is expected to issue guidance next week to spell out a way to fix the issue (8/2).

Bloomberg: U.S. To Keep Health Premium Subsidy For Lawmakers, Staff
The U.S. government will keep paying the medical-insurance premium subsidy for members of Congress and thousands of legislative branch employees who starting next year will be forced off the federal civilian benefits plan by the 2010 health-care law.  The Office of Personnel Management has told Congress that premium subsidy payments would continue, according to two Senate aides who asked not to be identified discussing the matter (Rowley, 8/2).

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Mich. Legislative Panel Moves Medicaid Expansion Forward

The approval for making at least 320,000 low-income adults eligible for Medicaid sets the stage for a crucial Senate vote later this month.

The Associated Press: Senate Panel OKs Medicaid Bill, Two Alternatives
A Michigan legislative committee on Wednesday voted to make at least 320,000 low-income adults eligible for Medicaid health insurance in 2014 and beyond, setting the stage for a crucial vote in the Republican-dominated Senate in late August.  The Government Operations Committee also approved two alternative plans backed by conservative senators who oppose expanding the Medicaid program under the federal health care law (8/1).

In news about setting up the state online insurance exchanges -

Modern Healthcare: Reform Update: Online Insurance Brokers Get To Play On Federally Run Exchanges
Increasing enrollment in health insurance is one of the primary goals of the health reform law. The CMS took a major step to achieve that this week by signing agreements with five Web-based insurance broker firms to help enroll Americans in the insurance exchanges in the 35 states where the federal government will run them (Block, 7/1). 

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Assessing Health Law's Impact On Cities, People

Local news reports examine the effects of the health law.

Dallas Morning News: Dallas Among 30 U.S. Counties That Stand To Gain The Most From Federal Health Law
Texas is home to more than two-thirds of the nation's 30 counties most in need of expanded health insurance coverage, including Dallas, according to a liberal group. The Center for American Progress Action Fund ranked 22 Texas counties -- including Dallas -- as among the "30 worst" in the country. It cited residents' lack of insurance and poor health outcomes, such as heart attack deaths. In a report released Thursday, the advocacy group said many Republican U.S. House members "are doing everything they can to torpedo" the federal health law despite having many constituents who would benefit from new state health marketplaces that will open on Oct. 1 (Garrett, 8/1). 

Health Policy Solutions (a Colo. news service): Richest Resort Counties Rank Worst For Health Coverage
Two ritzy resort counties in Colorado have made a list of the 50 worst counties in the U.S. for working people who are living without health insurance. Eagle County, home to swanky Vail and Beaver Creek, ranked 42nd worst among U.S. counties with nearly 29 percent of people who earn between 138 and 400 percent of the poverty level surviving without health insurance.  … In Colorado’s ski resort towns, workers often have multiple jobs, none of which comes with health insurance. Even people earning decent salaries have to spend so much money on living expenses that many can’t afford health insurance (Kerwin McCrimmon, 8/1).

Marketplace: Creating A Healthier Camden
In Camden, just 8 percent of patients make up nearly 40 percent of the costs. The city's three hospitals have been awarded nearly $3 million in federal grants to help improve primary care for the sickest and most expensive patients. Brenner says the partnership among competing hospitals is just one sign that the Affordable Care Act is changing the business of health care. ... The most common emergency in a Camden ER, colds and ear aches. Translation: not enough primary care (Gorenstein, 8/1).

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State Watch

State Highlights: Working Parents Could Lose Medicaid In Fla.

A selection of health policy stories from New York, Florida, California and Oregon.

The New York Times: Brooklyn Hospital Closings A Blow To Psychiatric Care
Now the imminent closing of Interfaith Medical Center, a hospital in Bedford-Stuyvesant that is among the largest providers of acute psychiatric care in Brooklyn, is threatening the borough with a severe shortage of inpatient mental health care, other hospital officials said. With Coney Island Hospital still out of commission after Hurricane Sandy, the loss of the 120 psychiatric beds at Interfaith, which also handles about 67,000 outpatient psychiatric visits a year, is going to create a crisis, hospital officials said (Bernstein, 8/1).

Health News Florida: Working Parents Could Lose Medicaid
About 45,000 low-income working parents in Florida will lose their Medicaid coverage at the end of this year and become uninsured unless they quit their jobs, a coalition of children's advocacy groups says. KidsWell Florida says this is the surprising and unintended result of a change in the income-calculation system for Medicaid combined with the Florida Legislature's refusal to expand the insurance program for the poor under the Affordable Care Act (Gentry, 8/1).

California Healthline: Healthy Families Transition Concerns Heightened As Most Difficult Phases Start
The first two phases moving about 615,000 Healthy Families children to Medi-Cal managed care plans have gone relatively smoothly, with almost all of those children retaining their health plan and roughly 94 percent of them retaining their primary care physician, according to the Department of Health Care Services, which is overseeing the transition. Medi-Cal is California's Medicaid program, and Healthy Families is its Children's Health Insurance Program. The stark exception to "smoothly," however, has been an extended fight over the loss of coverage for a specific kind of autism treatment because of the transition (Gorn, 8/1).

The Lund Report: Quality Corporation Releases Reports On Quality And Utilization Of Health Care
The Oregon Health Care Quality Corporation released new reports last week scoring the performance of 335 hospitals, clinics, and primary care offices in Oregon. For the first time, the Quality Corporation also published scores on patient satisfaction, based on surveys collected from 10 primary care clinics (Waldroupe, 8/2).

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Health Policy Research

Research Roundup: Making Sense (Or Not) Of Health Insurance

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

Journal of Health Economics: Consumers’ Misunderstanding Of Health Insurance
The authors write: "We report results from two surveys of representative samples of Americans with private health insurance. The first examines how well Americans understand, and believe they understand, traditional health insurance coverage. The second examines whether those insured under a simplified all-copay insurance plan will be more likely to engage in cost-reducing behaviors relative to those insured under a traditional plan with deductibles and coinsurance, and measures consumer preferences between the two plans. The surveys provide strong evidence that consumers do not understand traditional plans and would better understand a simplified plan, but weaker evidence that a simplified plan would have strong appeal to consumers or change their healthcare choices" (Lowenstein et al., Sept. 2013).

The Urban Institute/The Kaiser Family Foundation: State And Local Coverage Changes Under Full Implementation Of The Affordable Care Act – Since it was deemed optional by the 2012 Supreme Court decision on the Affordable Care Act, many states have opted not to expand their Medicaid programs or are undecided. In this report, researchers highlight how the number and composition of individuals enrolled in Medicaid or the Children's Health Insurance Program would change with full implementation of the ACA, and find that Medicaid enrollment increases would vary substantially. According to the authors, "A total of 14 states are projected to experience enrollment increases in excess of 50 percent, while seven states are projected to expand their Medicaid/CHIP enrollment by less than 20 percent under the ACA," and they add: "These estimates also provide guidance on the areas that are likely to experience the largest declines in the uninsured and where the residual uninsured are likely to be concentrated"  (Kenney et al., 7/31).

The Kaiser Family Foundation provides interactive maps to "zoom in on your area and see how the number and composition of individuals enrolled in Medicaid or without insurance coverage could change if your state expands Medicaid" (7/31).

UCLA Center For Health Policy Research: The Effects Of The Great Recession On Health Insurance: Changes In The Uninsured Population From 2007 To 2009 – The 2007 economic recession's impact was proportionally greater in California than other states. According to the authors, "Unemployment in the state has been at least two percentage points higher than in the rest of the country." It took a toll on California’s medically uninsured population: "In conjunction with this increase in unemployment, the number of those who were uninsured for all or part of the past year also swelled, increasing from 6.4 million in 2007 to 7.1 million in 2009," they write. Using survey data to examine the differences between 2007 and 2009, they found that people who lacked coverage for all or part of 2009 were older, more likely to be U.S.-born citizens, had lower household incomes, and were more likely to be unemployed and looking for work. The counties with the highest impact from the recession, however, did not have the highest rate of growth in the uninsured population (Lavarreda,  Snyder and Brown, 7/30).

Kaiser Family Foundation: A Discussion With Leading Medicaid Directors: As FY 2013 Ends, Looking Toward Health Care Reform Implementation In 2014 – In this policy brief, the authors highlight the main findings of a May 2013 meeting involving "leading" state Medicaid directors. "The discussion clearly illustrated how widely divergent state decisions and approaches are on expanding Medicaid," the authors write. But, according to the directors, all states indicated they were actively working to have new streamlined eligibility and enrollment processes ready for 2014 and were continuing to improve their existing Medicaid programs. "Despite different degrees of readiness at the start, they will continue to improve processes over time after initial implementation. At the same time, states are also continuing to pursue payment and delivery system reforms to better coordinate care for complex populations that the program serves," the authors conclude (Gifford, Artiga et al, 7/31).

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

Reuters: Court-Ordered Mental Health Treatment May Save Money
State-run programs that compel people with serious mental illness to get treatment may reduce costs, according to a new analysis of New York State's system known as Kendra's Law. Addressing the concerns of some lawmakers, researchers found that treatment costs dropped by about half among those covered under the program in New York City and even more for those in other counties throughout the state, largely as a result of fewer hospital admissions. ... Four-fifths of the patients in New York City and three-quarters of those in the other counties had a diagnosis of a schizophrenia spectrum disorder, the team writes in the American Journal of Psychiatry (Seaman, 7/30).

Reuters: Cancer Trial Results Slow To See Light Of Day: Study
U.S. law requires certain research results to be posted online within a year of a study's end date, but a new analysis found that only about half of cancer drug research results are made public after three years. Researchers who looked at 646 studies examining the safety and effectiveness of cancer drugs found that 55 percent were published online or in a medical journal three years after the studies' end dates (Seaman, 7/25).

MedPage Today: Low Cost, Doc Relationship Key To BP Control
Minimizing out-of-pocket drug costs and having one provider are two factors that appear to improve blood pressure treatment, a systematic review found. When medication costs or copayments increase, adherence to antihypertensive medication and control of blood pressure decreases, according to Will Maimaris, BM, Bchir, from the London School of Hygiene & Tropical Medicine, and colleagues from McMaster University in Ontario. The group evaluated 14 quantitative studies, nine of which were done in the U.S. (Kaiser, 7/31).

Medscape: Clinical Decision Support Tool Reduces Tests, Antibiotic Use
Providers who used an integrated clinical decision support tool for the management of patients with respiratory tract infections were less likely to prescribe antibiotics or order point-of-care testing when compared with providers not using the tool. Results of the randomized controlled trial were published online July 29 in JAMA Internal Medicine (Garcia, 7/29).

MinnPost: Newly Established Medical Practices Often Prove To Be Ineffective, Study Finds
A study that analyzed articles published in just one prominent medical journal over a period of 10 years has found that newly established medical practices — even ones in wide use — are often reversed by subsequent evidence-based research. The finding, which was published online this month in the journal Mayo Clinic Proceedings, belies the common assumption that the very latest screening technology, medication or surgical technique is an improvement on care (Perry, 7/31).

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Editorials and Opinions

Viewpoints: Shutting Down The Government Over Health Law Is 'Nutty' Idea; GOP's Obamacare Playbook For Summer Recess

The Washington Post: How Fractured Is The GOP?
Led by Sens. Mike Lee and Ted Cruz, the GOP insurgents are threatening to shut down the government on Oct. 1 if the stopgap funding bill contains money for Obamacare. This is nuts. The president will never sign a bill defunding the singular achievement of his presidency. Especially when he has control of the Senate. Especially when, though a narrow 51 percent majority of Americans disapproves of Obamacare, only 36 percent favors repeal. President Obama so knows he’ll win any shutdown showdown that he's practically goading the Republicans into trying. ...  Every fiscal showdown has redounded against the Republicans (Charles Krauthammer, 8/1). 

The Washington Post: Ted Cruz's Threat Of Government Shut Down Recalls Custer
At its birth, the Affordable Care Act already seems gray, wheezing and gouty. For all its expressions of confidence, the Obama administration has been unable to implement key elements of the law. ... But there are a few bold, determined public officials who may rescue Obamacare. Among them are Sens. Ted Cruz (R-Tex.), Marco Rubio (R-Fla.) and Mike Lee (R-Utah). This is not, of course, their intention. They hate the law but have chosen to fight it in a particularly counterproductive way, which discredits responsible opposition and makes a Democratic takeover of the House more likely (Michael Gerson, 8/1). 

The Washington Post: The Party Of (Nutty) Ideas
It's not your imagination. The Republican Party really does seem to have taken leave of its senses. The House GOP majority has decided that its final act before the summer recess will be to take its 40th vote to repeal all or part of the Patient Protection and Affordable Care Act. ... Amazingly, this pointless exercise in the House makes more sense than what Republicans are doing in the Senate. There, Sen. Ted Cruz (R-Tex.) and his tea party-backed allies are threatening to shut down the whole government to strip Obamacare of all funding (Eugene Robinson, 8/1).

The New York Times: Saboteurs In The Potato Salad
[House Republicans] even have a master plan, a 31-page kit put together by the House Republican Conference, for every member to follow while back home [on summer recess] with the folks. ... Here's a sample suggestion, from Page 28, of how to stage a phony public meeting with business owners: "Confirm the theme(s) prior to the event and make sure the participants will be 100 percent on message. (Note: while they do not have to be Republicans, they need to be able to discuss the negative effects of Obamacare on their employees.)" And what if I have a child with cancer, and the insurance company plans to dump him if Republicans stop Obamacare in its tracks? Can I attend? Or what if I'm counting on buying into the new health care exchanges in my state, saving hundreds of dollars on my insurance bill? The kit has an answer: planting supporters, with prescreened softball questions, will ensure that such things never get asked (Timothy Egan, 8/1).

Los Angeles Times: 'Death Panels' Done Right
Among the most egregious distortions to cloud the health care debate in 2009 was the false notion that the Patient Protection and Affordable Care Act called for "death panels," through which the government would determine whether seniors and the disabled should receive care. So dishonest was this characterization, popularized by Alaska's then-Gov. Sarah Palin, that PolitiFact named it the "Lie of the Year." In truth, one of the provisions of the act that gave rise to Palin's critique would have done just the opposite: help patients make their own decisions about their treatment at the end of life (8/1).

The New Republic: Six Reasons Hipsters Will Bite On Obamacare
You're a 26-year-old single dude, holding down a pair of part-time jobs tending bar and painting houses, and making about $24,000 a year. Thanks to Obamacare, you can finally get decent health insurance, just like people with full-time jobs at large companies do. But when you go online to check out your options, you see that even the cheapest "bronze" plan, which has high deductibles and co-payments, will cost you about $100 a month. Obamacare's penalty for carrying no insurance next year is less than one-tenth of that. Do you buy the insurance anyway? ... But there [are] good reasons to think the critics are wrong, that young people will sign up for health insurance, and that Obamacare will work as its designers intended. Here are six of those reasons (Jonathan Cohn, 8/1).  

The New York Times Economix blog: The Sleeper In Health Care Payment Reform
In the arsenal now being assembled on the payment side of health care to address rising costs, reference pricing may well turn out to be the sleeper, because it is a potentially powerful method of "putting the patient's skin in the game," the delicate phrase we use for "cost-sharing by patients." As it is able to shift significant market power from the supply side to the payment side of the health sector, reference pricing is much feared by the providers -- physicians, hospitals, pharmaceutical companies and others (Uwe E. Reinhardt, 8/2). 

The Lund Report: Don't Let A Federal Board Override The Doctor-Patient Relationship
Imagine being told by your family doctor that the treatment she recommends is available, but not to you, because the federal government had decided its medical judgment is better than your doctor's. As Oregon and other states begin to implement the Affordable Care Act (ACA), known by many as Obamacare, much of the focus has been on the changes to insurance plans (Dr. Frank Palmrose, 8/1).

Boston Globe: You've Got Mail: Someone's Else's Medical Test Results
The first e-mail came at the end of June. It was from a doctor's office in another state -- a large cardiology group. The note listed the name of a test. It listed the full name of the patient. It listed the full name of the doctor who treated that patient. It said the test was normal and provided a number that I could call for more information. Presumably, this was supposed to be good news. But it was someone else's test result. ... Recently, though, I've noticed a new kind of misrouted e-mails that seem less trivial than some of the other unwelcome missives that show up in my inbox. These are notes or test results from other people's doctor's offices. The security of health information in the digital age is a big concern (Carolyn Johnson, 8/1). 

Des Moines Register: Iowa View: Webcam Abortions Have Nothing To Do With Health
According to the Food and Drug Administration, 2,207 women have been injured by this human abortion cocktail, known as mifepristone (or RU-486), and 14 have died from it. Here in Iowa, the RU-486 human abortion pills are being remotely dispensed by the thousands via a "telemed abortion" scheme approved by the Iowa Board of Medicine three years ago. The current board has revisited this approach to human abortion, which allows these toxic pills to be dispensed without a doctor present. They are calling for an end to telemed abortions, also called webcam abortions. The board deserves our support (Tom Quiner, 8/2).

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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.