Daily Health Policy Report

Tuesday, August 20, 2013

Last updated: Tue, Aug 20

KHN Original Reporting & Guest Opinion

Health Reform

Coverage & Access

Administration News

Public Health & Education

Health Information Technology

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Insuring Your Health: New Online Markets For Small Businesses May Offer Some Workers Greater Choices

Kaiser Health News consumer columnist Michelle Andrews writes: "The health care overhaul requires every state and the District of Columbia to establish a Small Business Health Options Program, or SHOP exchange, to enable businesses with 50 or fewer workers to offer health insurance to their employees. These exchanges will function much like the online marketplaces for individual coverage that will open this fall, but with some key differences" (Andrews, 8/20). Read the column.

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Capsules: HHS Offering Prizes For Videos Promoting Obamacare; Answering Your Questions About The Latest Obamacare Delays

Now on Kaiser Health News' blog, KUHF's Carrie Feibel, working in partnership with KHN and NPR, reports on an HHS' push for videos promoting the health law: "The 'young invincibles' are what health policy wonks call healthy young adults (18-30) who don’t see being uninsured as a problem. But it is a problem, at least for the success of the Affordable Care Act. That’s why the Department of Health and Human Services is spending $30,000 on prizes for a national video contest, in a frank appeal to the YouTube generation" (Feibel, 8/20).

Also on Capsules, Kaiser Health News' Julie Appleby was on C-SPAN’s Washington Journal Monday morning taking questions about the latest Obamacare implementation delay — this one delaying a provision of the law that limits some consumers' out-of-pocket expenses for one year. Watch the video or check out what else is new on the blog.

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Political Cartoon: 'Cash Flow?'

Kaiser Health News provides a fresh take on health policy developments with "Cash Flow?" by Chris Weyant.

And here's today's health policy haiku:

   10,000 REASONS...

Paul Bunyan and Babe
know about health insurance
and how to sell it.
-Anonymous

 

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

Selling The Idea Of Health Insurance To 'Young Invincibles'

The Obama administration is launching a national video contest designed to convince young people to sign up for coverage, spending $30,000 on prizes to draw the YouTube generation.

Kaiser Health News: Capsules: HHS Offering Prizes For Videos Promoting Obamacare
The 'young invincibles' are what health policy wonks call healthy young adults (18-30) who don't see being uninsured as a problem. But it is a problem, at least for the success of the Affordable Care Act. That's why the Department of Health and Human Services is spending $30,000 on prizes for a national video contest, in a frank appeal to the YouTube generation (Feibel, 8/20).

The Hill: HHS Targets Young Consumers With ObamaCare Video Competition
The Health and Human Services Department is teaming up with the group Young Invincibles in a new effort to encourage young people to enroll in new coverage options under ObamaCare. The HHS and Young Invincibles announced a contest Monday for videos urging young people to enroll in new insurance policies. Whoever makes the best ObamaCare video can win up to $8,500 (Baker, 8/19).

The Washington Post's Wonk Blog: Why Obamacare Is Good For Young People
The key is that not everyone uses their health insurance at the same time, or with the same frequency. Sick people use it more than healthy people. The elderly use it more than the young. Women use it more than men. The trick to making any health-insurance system work is to attract enough healthy and young people into the insurance pool. Their low costs offset the care provided to elderly and unhealthy people, who drive costs up. This is the task that obsesses the Obama administration. It's also the task that has begun to obsess its opponents (Klein, 8/19).

Los Angeles Times: Paul Bunyan, Ox Sidekick Hired As Insurance Salesmen In Minnesota
Minnesota, the land of 10,000 lakes, now has 10,000 reasons to get health insurance, too. At least that's the latest pitch from state officials launching a campaign to enroll about 1 million residents in healthcare coverage when its state-run insurance marketplace goes live Oct. 1. The state has enlisted Minnesotan folklore icons -- lumberjack Paul Bunyan and his trusty sidekick, Babe the Blue Ox -- as the face of its marketing campaign to promote MNSure, as the state's health exchange is known (Lopez, 8/19).

Kansas Health Institute: KCK Looking For Ways To Get The Word Out On Obamacare Marketplace
Health officials here estimate that Wyandotte County has about 27,000 people without health insurance and they are hoping that Obamacare and the new insurance marketplace soon expected to be operating in Kansas can help change that (Shields, 8/19).

Meanwhile, there's messaging and marketing from health law opponents, too -

The Associated Press: Group Kicks Off Nat’l Tour On Health Law Defunding
One of the chief backers of a plan to defund the federal health care law by tying it to budget negotiations said Monday that he didn't believe Republicans would be blamed for a government shutdown as supporters of the approach launched a national tour to spur support for the idea. Dismissing concerns from some Republicans, former U.S. Sen. Jim DeMint of South Carolina called the defunding idea the "last, best chance" to stop the federal health care overhaul before key parts of the law take effect later this year (DeMillo, 8/19).

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Sebelius Urges Texas Leaders To Pitch Plan To Cover Poor

Speaking in Texas, Health and Human Services Secretary Kathleen Sebelius said it was up to state leaders to propose alternative ways to expand health coverage to the poor. Meanwhile, in Florida, Gov. Rick Scott raised privacy concerns related to so-called navigators, who will be trained to walk people through their insurance options under the health law.

The Associated Press: Texas Gets Call To Talk Health Care
If Texas wants to tailor its own expansion of health care coverage through the Affordable Care Act, then it’s now up to state leaders to reach out to the federal government to have a dialogue, Health and Human Services Secretary Kathleen Sebelius said Monday (Lozano, 8/19).

The Associated Press: Scott Raises Obamacare Privacy Concerns
Gov. Rick Scott is joining other Republicans lawmakers around the country in questioning privacy issues surrounding the navigators hired to walk people through their health insurance options under the Affordable Care Act…Scott said there are many serious, unanswered questions and he plans to discuss the issue with his cabinet at a meeting Tuesday in Miami (Kennedy, 8/20).

And, a new poll shows California support for the health law remains strong, while Politifact assesses Sen. Marco Rubio's claim that Obamacare will harm his elderly mother -

The Sacramento Bee: Field Poll Shows Continued Support For Health Care Overhaul In California
A majority of California voters remain unflinching in their support of the federal health care overhaul, though nearly half of the electorate predicts it won't affect them much, according to a new Field Poll. Forty-six percent of California voters – a plurality – say they do not expect to be much better or worse off when the law is fully enacted, according to the poll. Of those who do expect their families to be affected, 23 percent predict they'll fare better, 26 percent worse (Siders, 8/20).

Tampa Bay Times/Politifact: Will Obamacare Hurt Medicare Advantage?
U.S. Sen. Marco Rubio has vigorously opposed Obamacare for many reasons. Lately, he’s been invoking his mother, suggesting she’ll be harmed by the president’s health care plan. Mrs. Rubio is one of the millions who choose to receive Medicare benefits through privately run Medicare Advantage plans. ... We won’t rate Rubio’s statement on our Truth-O-Meter, since it’s essentially a prediction. But as we’ll see, experts told us Rubio’s remarks oversimplify matters and put too much blame on the health care law for a situation that predates Obamacare (Sutton, 8/19).

 

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Virginia's Medicaid Panel Meets, But Covers Little New Ground

During a Monday planning meeting, a Virginia Medicaid policymaking panel examined what other states are doing in terms of expanding the program. Hundreds of conservative activists who oppose this health law provision rallied at the state capitol.

The Associated Press/Washington Post: Va. Medicaid Panel Learns It's Not Alone In Expansion Dilemma, But Little Else At Meeting
The Virginia policymaking panel with its hand on the throttle and foot on the brake of Medicaid expansion learned Monday that theirs isn't the only Republican-led state still wrestling with the issue. In a three-hour meeting, the Medicaid Innovation and Reform Commission learned little not already known other than how other states are handling the issue (8/19).

Roanoke Times: Virginia Medicaid Panel Leader Cites Progress In Overhaul Efforts
Virginia is making progress in an effort to reform — and then possibly expand — its Medicaid program, the leader of a legislative panel overseeing the process said Monday. “I would say that we’re a little over halfway there,” said Sen. Emmett Hanger, R-Augusta County, chairman of the Medicaid Innovation and Reform Commission, which under the new federal health care law is mulling an expansion of the government health insurance program for the poor and disabled. Meeting for the second time Monday, the commission received an update on 19 areas of reform identified by the General Assembly, which has mandated that the system must be improved before eligibility requirements are broadened (Hammack, 8/20).

Richmond Times-Dispatch: Va. Among States Seeking Middle Ground On Medicaid Expansion
Michigan Gov. Rick Snyder came up with an idea to bank initial savings from expanding the state's Medicaid program to pay for future costs of extending health care benefits to more uninsured people. Virginia got there first (Martz, 8/20).

The Associated Press/Washington Post: Hundreds Protest Medicaid Expansion At Virginia Capitol Rally
Hundreds of conservative activists expressed their opposition to Medicaid expansion at a state Capitol rally. The organization Americans for Prosperity sponsored the rally just before Monday's meeting of the state's Medicaid Innovation and Reform Commission. The General Assembly established the commission earlier this year to monitor implementation of Medicaid reforms sought by Virginia as a condition for expanding the program to an additional 400,000 uninsured low-income residents under the federal health care reform law (8/19).

In other Medicaid news -

Modern Healthcare: Reform Update: Slow Start For Medicaid Fee-For-Service Rate Bump
The Patient Protection and Affordable Care Act relies heavily on expanding Medicaid eligibility to increase insurance coverage and healthcare access. But its authors had to make sure that physicians would accept new Medicaid patients. So congressional Democrats included a temporary pay increase that ups fees for primary-care doctors serving Medicaid patients to Medicare rates for 2013 and 2014. Still, implementation has been slow (Robeznieks, 8/19).

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More States Release Prices For Obamacare Plans

The Associated Press reports that Montana released monthly premiums for health insurance plans that will be sold on that state's exchange while the Connecticut Mirror reports on rates in that state and how the exchange will enable consumers to comparison shop. Also in the news, Kansas insurance agents are encouraged to take an online course so they can sell plans that will be available in Kansas' online marketplace.

The Associated Press: Prices Released For Mont. Insurance Exchange
State officials on Monday released the Montana prices for insurance under the federal health care law insurance exchange, giving consumers their first glimpse of how much the coverage will cost. Montana Insurance Commissioner Monica Lindeen released pricing details for different plans available from three different companies (Gouras, 8/19).

CT Mirror: Compare Rates For Obamacare Health Plans Here
Starting next year, people who buy insurance on their own or work for small businesses will have the option of buying coverage through the state's new health insurance exchange, called Access Health CT, created as part of the federal health reform law. It will open for enrollment Oct. 1, selling plans that take effect Jan. 1 (Becker, 8/19).

Kansas Health Institute: Kansas Insurance Agents Seeking Obamacare Training
Kansas insurance agents and brokers are being encouraged to complete an online training course that will allow them to sell individual plans on the coming health insurance marketplace…The marketplace is designed to give consumers access to affordable health insurance in keeping with the Affordable Care Act, also known as Obamacare (Ranney, 8/19).

 

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Coverage & Access

GAO: Postal Health Plan Could Add To Retired Workers' Costs, Impact Medicare

The proposal to opt out of the federal health plan would save billions of dollars but could bring uncertainties for employees.

The Hill: Proposed USPS Health Care Shift Could Add Slight Strain To Medicare
The cash-strapped U.S. Postal Service's push to run its own health care plan could add -- if only slightly -- to Medicare's financial strains, according to a new report. The Government Accountability Office (GAO) says that the USPS's proposal to opt out of a federal health care plan would likely lead to billions of dollars in savings. But the GAO also noted that a large chunk of the savings would come from making more retired postal workers rely on Medicare services (Becker, 8/19).

The Washington Post's The Federal Diary: Postal Health Plan Would Save USPS Money, But Workers Could Pay The Price
The controversial plan by the U.S. Postal Service to pull its staffers from the Federal Employees Health Benefits Program (FEHBP) probably would save USPS lots of money, but the cost would bring significant uncertainties for postal workers. That's the finding of a report by the Government Accountability Office, which also indicated that many employees would have to pay more for care under a USPS health insurance program (Davidson, 8/19).

Meanwhile, in other news about federal workers benefits --

The Washington Post: Federal Workers To Be Surveyed About Benefits
The government soon will ask some federal employees what they think of their benefits, a survey that in the past has shown that they most highly value their retirement and health insurance programs and in general think those programs meet their needs and provide good value (Yoder, 8/20).

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Administration News

Kronick Named To AHRQ Top Spot

Medpage Today: AHRQ Names Kronick As New Director
Health reform researcher Richard Kronick, PhD, will become the new director of the Agency for Healthcare Research and Quality (AHRQ) after longtime director Carolyn Clancy, MD, leaves the post later this month. The announcement was made public in the agency's daily afternoon electronic newsletter. Kronick joined the Department of Health and Human Services (HHS) in January 2010 as deputy assistant secretary for planning and evaluation and oversaw the Office of Health Policy. Prior to that, he conducted health policy research for the University of California San Diego and also worked as director of policy and reimbursement for the Medicaid Division of the Massachusetts Department of Public Welfare (Pittman, 8/19).

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Public Health & Education

Redistricting - Not Just For Politics - Now Being Considered For Liver Transplant Waiting List System

The Associated Press/Washington Post: To Make Waiting Lists For New Livers Fairer, Specialists Consider Redistricting
Where you live can affect your chances of getting a liver transplant, and your risk of dying while waiting. The nation's transplant network says it's time to make the system fairer — and it may take a cue from how politicians redraw voting maps. "Gerrymandering for the public good" is how Johns Hopkins University transplant surgeon Dr. Dorry Segev describes a proposal to change the map that governs how donated livers are distributed around the country (8/20).

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Health Information Technology

Telemedicine Boosts ER Care For Kids In Rural Areas

New research shows that rural emergency room physicians are increasingly using videoconferences to gain access to specialty care. 

Reuters: Telemedicine Improves Care For Kids Seen In Rural ERs
Telemedicine consults can help rural emergency room doctors provide better care to seriously ill or injured young patients, new research confirms. Rural hospitals and doctors' offices are increasingly using telemedicine -- essentially, videoconferencing with another doctor from a remote location -- to gain access to specialty care, Dr. James Marcin of the University of California Davis Children's Hospital in Sacramento, the senior author of the new study, told Reuters Health (Harding, 8/19).

Also, the Food and Drug Administration published a guide for wireless health care devices -

Modern Healthcare: FDA Offers Guide On Wireless Healthcare Devices
The Food and Drug Administration has published a guide to the use of wireless healthcare devices in healthcare settings. For providers, one key issue covered is data security, including a recommendation that encryption technologies on the devices, if available, should be activated and used (Conn, 8/19).

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State Watch

Keeping NYC Hospitals Open Becomes New Issue In Mayoral Race

NYC's hospitals have become a big issue in the city's mayoral race. In the meantime, New York state health officials have posted a plethora of data online about the state's hospitals and doctors.

The Wall Street Journal: Hospitals Heat Up As An Issue
Fixing New York's ailing hospitals has emerged as a sleeper issue in the race for mayor, with three of the leading campaigns scrambling Monday to demonstrate their commitment to keeping the institutions open (Grossman, 8/19).

The Associated Press/Wall Street Journal: NY Posts Cardiac Surgery, Other Data On Web Site
New York health officials have begun posting online data about cardiac surgeries, hospitals and the doctors statewide who perform them, including their cases from 2008 to 2010 and mortality rates. Other information posted on the Health Data NY website includes environmental radiation surveys at various facilities and sites around New York. The measures of levels in the air, water, milk, fish, sediment and vegetation are used to determine normal levels and the effects from what people are doing (8/20).

In related national hospital news --

The Wall Street Journal’s The Informed Patient: More Hospitals Use Social Media to Gather Feedback from Patients' Families
Hospitals are turning to Facebook, Twitter and other forms of social media to recruit patients and their families as advisers. They are asking parents for input, via questionnaires and surveys, on improvements in care, new services and even new facility names. ... The efforts are part of a larger movement to engage patients and families in care and enhance the hospital experience. The federal Medicare program is basing some hospital payments on patient satisfaction surveys, including questions about how responsive a hospital is to concerns. Similar surveys are being developed for pediatric hospitals (Landro, 8/19).

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State Highlights: Mental Health Contract Raised Costs In La., Audit Says

A selection of health policy stories from California, Louisiana and the District of Columbia.

California Healthline: State Outlines Plan To Transition Low-Income Health Program To Medi-Cal
State officials last week said more than 90 percent of Low Income Health Program enrollees will be able to keep their primary care physician when LIHP is folded into the Medi-Cal expansion in 2014. Brian Hansen, health reform advisor in the director's office at the Department of Health Care Services, made the prediction as one of about a dozen state agency experts who spoke Thursday at a conference in Sacramento, "At the Forefront: LIHP Transition Prepares California for Health Reform," put on by DHCS and the UCLA Center for Health Policy Research. "Over 90 percent of enrollees will be assigned to their current LIHP primary care provider. We will do that to the extent that it's possible," Hansen said (Gorn, 8/19).

The Associated Press: Audit: Mental Health Contract Raised Local Costs
Gov. Bobby Jindal's hiring of a private company to manage mental health and addictive disorder treatment services has created confusion and added costs for the local human services districts that provide the care, says an audit released Monday (Deslatte, 8/19).

The New York Times: Suicides Worry Experts At Big Jail In Capital
The four suicides in less than a year are a record for the 1,800-inmate detention facility, which has experienced eight suicides over all in the past decade. The increase, which mirrors a rise in suicides over the last 10 years in jails across the country, has mental health experts concerned about what they say is a lack of supervision. The deaths have also raised questions about the mental health provider at the jail, which is on the edge of Capitol Hill and only a few miles from the White House (Banco, 8/19).

Medpage Today: Groups Push To Keep State-Based Quality Improvement Organizations
Several national provider organizations and nearly all state medical societies have asked the Centers for Medicare and Medicaid Services (CMS) not to make any changes to the current quality improvement organization (QIO) contracting process. The groups said moving to a regional or national system -- rather than keeping the current state-based arrangement -- could harm the QIOs' relationships with providers and diminish their impact (Pittman, 8/19).

California Healthline: Supreme Court Decision On Insulin Injection Shapes The State’s Use Of School Nurses
The California Supreme Court's unanimous decision last week that public schools have a right to allow unlicensed -- but trained -- school personnel to administer prescription medication to children was fueled partly by necessity. There's a dearth of school-based nurses in California to administer insulin to children. As diabetes and obesity among children have risen, the number of school nurses in California has decreased. That's where the discussion turns into a chicken-or-egg debate. Nursing advocates say the problem isn't a lack of nurses but a lack of state funding for nursing positions. They say the shortage was created by the state's layoffs and non-replacement of school nursing jobs over the past two decades (Gorn, 8/19).

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Editorials and Opinions

Viewpoints: Republican Patient Takes GOP Health Message To Task; The Deadlines The Administration Has Missed

Forbes: Unpublished CRS Memo: Obama Administration Has Missed Half Of Obamacare's Legally Imposed Implementation Deadlines
In recent months, President Obama and his subordinates have waived or delayed a number of Obamacare’s notable features, such as the law's employer mandate, and its procedures for protecting taxpayers from fraud and identity theft. Earlier this month, in that context, I obtained a heretofore-unpublished memorandum from the Congressional Research Service. The CRS, Congress' non-partisan in-house think tank, compiled 82 deadlines that the Affordable Care Act mandates upon the first three years of its own implementation. Remarkably, it turns out that the White House has missed half of the deadlines legally required by the ACA (Avik Roy, 8/18).

The Fiscal Times: How Functional Illiteracy Could Doom Obamacare
The troubles for Obamacare continue to mount. The White House has delayed the employer mandate. Those implementing the program said some computer exchanges are not expected to be ready in time. ... The underlying and perhaps most pressing concern is also the most difficult to solve: Much of the nation is simply health care illiterate and unable to understand the complex health choices the Obama administration is expected to offer starting Oct. 1 (David Francis, 8/19).

The Wall Street Journal's Political Diary: The ObamaCare Slush Fund
Last week, the Obama administration revealed that three Planned Parenthood affiliates would be among the groups receiving federal dollars to educate Americans about the Affordable Care Act. The announcement did not go unnoticed by conservative Republicans who want to defund ObamaCare. ... The latest Navigator funds are certain to intensify such investigations into the cozy relationship between groups that lobby for ObamaCare, such as Planned Parenthood, and groups that then get funds for carrying out the law (Stephen Moore, 8/19). 

The New Republic: A Republican Cancer Survivor Sends His Party A Message On Obamacare
Lots of people have been telling Republican Party leaders that simply opposing Obamacare isn't enough—that they need to develop an alternative. But few can offer such advice with the authority, or the insight, of Clint Murphy. One reason is that Murphy, 38, used to work in Republican politics. The other reason is that Murphy is a cancer survivor—and that, because of pre-existing conditions, he has apparently struggled finding health insurance. "When you say you're against it," Murphy wrote on his Facebook page, in an open letter to Republicans, "you're saying that you don’t want people like me to have health insurance." Murphy, who lives in Georgia, told the full version of his story to Jim Galloway, a columnist of the Atlanta Journal-Constitution (Jonathan Cohn, 8/19).

The (Milwaukee) Journal Sentinel: Obamacare: A Prescription For Fraud
Ever wonder why government programs are so rife with waste, fraud and abuse? Consider what's been happening with the Affordable Care Act. The administration recently announced that it was reducing by 50% — from 30 hours down to 20 — the required training for the law's navigators, individuals paid to help Americans enroll in the health care act's new entitlements (Chris Jacobs, 8/19).

The Washington Post: Progress On Obesity, But The War Is Far From Over
The Centers for Disease Control and Prevention (CDC) reported this month that the obesity rate dropped among younger, poor children in 19 states and territories between 2008 and 2011. ... Only three states saw increases. (Not enough data were collected in 10 states.) No place saw its rate decline by more than a percentage point, but the results are still striking. Public-health advocates have worried for years that the United States was entering an age of obesity, the American waistline inexorably expanding and along with it the prevalence of diabetes, heart conditions, joint trouble, even cancer. Now it seems the country may be reaching a plateau, even among at-risk children (8/19).

Bloomberg: The Huge But Essential Cost Of Lung Scans
The lung-cancer screening that the U.S. Preventive Services Task Force is now recommending could add at least $3 billion annually in new costs to the already burdened U.S. health-care system. That should worry the Barack Obama administration and anyone else concerned with the system's stability. On the other hand, the new recommendation, still in draft form, could save 20,000 lives a year. And policy makers could recoup some of the cost by limiting liability for doctors who follow the guidelines in good faith (Ford Vox, 8/19).

The New York Times: College Prep, This Time For Health
To me, the strangest thing about my son's college health forms was that they did not require my signature. From a medical point of view, an 18-year-old is a legal adult. Yes, parents may offer up pithy remarks about who is actually an adult, and in what sense, and who pays the bills. But when children head off to college, responsibility for their health unmistakably shifts. They must take care of themselves, in every sense, and now is the time to talk about how (Dr. Perri Klass, 8/19). 

JAMA Pediatrics: Adolescent Health Care Transition in Transition
The adolescent transition to adult care is embedded in a larger life course transition to the independence and responsibilities of adulthood, the period fraught with risk and challenge. ... Perhaps most distressing of all is emerging research suggesting that the health status of young adults with a variety of chronic conditions may deteriorate soon after they graduate from pediatric care. In some instances, use of emergency departments, hospitalizations, and even mortality increase (Dr. W. Carl Cooley, 8/19).

JAMA Internal Medicine: The Future of Medicare Supplemental Insurance 
Most Medicare beneficiaries 65 years or older have insurance that supplements Medicare or that replaces it entirely, generally with a more comprehensive set of benefits than those provided under the traditional Medicare program. Approximately 20% purchase Medigap coverage. Others get additional protection from retiree health benefits, Medicaid, or managed care plans called Medicare Advantage. ... the current Medicare benefit package, with its gaps in coverage and the array of deductibles and coinsurance provisions, is less than what most seniors want. This peculiar structure reflects the same problems that plague many aspects of traditional Medicare. Medicare is an insurance program that is modeled after the way insurance was provided in the mid-1960s (Gail Wilensky, 8/19).

JAMA Internal Medicine: Completing the Play Or Dropping The Ball? The Case For Comprehensive Patient-Centered Discharge Planning
In summary, having a team and setting dedicated to the discharge process has the potential to improve overall hospital quality, efficiency, and patient throughput, as well as transitions in care. If acute care physicians are confident that the patient will get needed medication, education, and follow-up care, the discharge center might even alleviate the need for hospitalization and/or allow for earlier discharge for some patients. The concept builds on evidence-based programs designed for older adults (Dr. Karin Verlaine Rhodes, 8/19).

JAMA Internal Medicine: Secondary Use Of Health Information: Are We Asking The Right Question?
Rather than "Why risk alarming our patients by using their health care data for research?" perhaps we should be asking, "Why is our first obligation not to ensure that our patients' data are used for research as they wish and expect them to be used?" Every institution must enforce strict data security and protection of patient confidentiality and patient directives, but these requirements should be no more unexpected than meticulous hand washing before examining each patient (Dr. Isaac S. Kohane, 8/19).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Marissa Evans
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.