Daily Health Policy Report

Friday, August 23, 2013

Last updated: Fri, Aug 23

KHN Original Reporting & Guest Opinion

Health Spending And Fiscal Battles

Health Reform

Capitol Hill Watch

Women's Health

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

FAQ On ACOs: Accountable Care Organizations, Explained

Kaiser Health News staff writer Jenny Gold reports: "One of the main ways the Affordable Care Act seeks to reduce health care costs is by encouraging doctors, hospitals and other health care providers to form networks to coordinate care better, which could keep costs down. To do that, the law is trying a carrot-and-stick approach in the Medicare program: Accountable Care Organizations" (Gold, 8/23). Read the story.

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Despite Additional Dollars, Texas Doc Shortage Is Hard To Fix

Kaiser Health News: Despite Additional Dollars, Texas Doc Shortage Is Hard To Fix
The Texas Tribune's Becca Aronson, working in partnership with Kaiser Health News, reports: "Texas lawmakers invested millions of additional dollars in the 2013 legislative session to address a looming physician shortage. Voters and university regents have rubber-stamped plans to open two new medical schools, in Austin and the Rio Grande Valley. But those moves have not placated the medical community, which remains concerned that Texas has no long-term solution to produce enough physicians, particularly in primary care, to support the surging population" (Aronson, 8/23). Read the story.

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Letters To The Editor: The Health Law And Alternative Medicine; Understanding Premium Rates; More On Hospital Readmissions

Letters to the Editor is a periodic Kaiser Health News feature that details readers responses to recent KHN stories (8/22). Read the comments.

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Political Cartoon: 'Up Temp-O?'

Kaiser Health News provides a fresh take on health policy developments with "Up Temp-O?" by Lisa Benson.

Here's today's health policy haiku:


Hamlet had it wrong.
To shut down or not shut down:
THAT is the question.

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

80 House GOP Members Urge Boehner To Defund Obamacare

House Speaker John Boehner floated the idea of a short-term spending bill to avoid a government shutdown in October. But conservatives in his caucus expressed opposition, insisting that funds be stripped from the health care law even if that forces a government shutdown.

The New York Times: Clock Is Ticking For Recess, And For A Deficit Deal
Given the lack of progress, those involved say Speaker John A. Boehner will need to play a crucial role in finding an agreement. House Republican leaders consulted with their rank and file via a conference call Thursday night to sound out their ideas to avoid a fiscal crisis as early as Oct. 1. Mr. Boehner pressed gingerly for a straight short-term extension of funds to avoid an immediate government shutdown in October, but faced immediate opposition from conservatives demanding that funds be stripped from the health care law. One thought is to use a short-term spending bill to keep the government running into November. … That way, with both a debt default and government shutdown looming, Republicans could apply maximum pressure on the White House to either agree to scuttle President Obama’s health care law or accept significant changes in programs like Medicare and Social Security (Weisman, 8/22).

The Associated Press/Washington Post: 80 House Republicans Urge Boehner To Block ‘Obamacare,’ Even If It Shuts Down The Government
More than a third of House Republicans urged their leader Thursday to trigger a government shutdown rather than fund the implementation of the health care overhaul they call “Obamacare.” A letter from 80 Republicans asked Speaker John Boehner, R-Ohio, to resist any spending bills that would accommodate the new health care law, which is nearing a critical stage of signing up millions of Americans for health coverage (8/23).

Politico: 80 House GOPers Urge John Boehner To Defund Obamacare
A North Carolina Republican and 79 colleagues sent a letter Wednesday to Speaker John Boehner (R-Ohio) and Majority Leader Eric Cantor (R-Va.) urging them to defund Obamacare as part of a government funding bill. Rep. Mark Meadows, who has spearheaded the effort, said in the letter that he and his colleagues “urge” the House GOP leadership to “affirmatively de-fund the implementation and enforcement of Obamacare in any relevant appropriations bill brought to the House floor in the 113th Congress, including any continuing appropriations bill” (Sherman, 8/22).

The Wall Street Journal: GOP Plans Spending Bill To Avoid Shutdown
Mr. Boehner met objections from several conservatives who want the spending bill to include a measure blocking funding for President Barack Obama's signature health-care law—a conservative demand that many lawmakers have heard at town hall meetings this summer (Boles and Hook, 8/22).

Reuters: Boehner Warns Against Shutting U.S. Government Over 'Obamacare'
U.S. House of Representatives Speaker John Boehner warned rank-and-file Republicans in a conference call on Thursday against using the threat of a government shutdown to stop the implementation of Obamacare, according to people on the call. On the call, Boehner reminded Republicans of the political backlash their party suffered when the government shut down in 1995-1996, according to one person on the call (Bohan and Younglai, 8/23).

Bloomberg: Boehner Tells Caucus House Will Keep Fighting Health Law
House Speaker John Boehner assured his Republican caucus last night that the House will continue its bid to stop implementation of President Barack Obama’s health-care law, while not addressing a push from some in his party to simply not fund the measure. Boehner also told lawmakers on a telephone conference call that deep, across-the-board government spending cuts, known as sequestration, will stay in place until Obama proposes a replacement package, according to a person who was on the line and wasn’t authorized to speak publicly about it (Tiron, 8/23).

Politico: Mike Lee: Shutdown Talk A 'False Narrative'
Pushing back against the Democratic line that his drive to defund Obamacare could lead to a government shutdown, Sen. Mike Lee (R-Utah) told supporters it was a “false narrative based on an absolute lie” and vowed to continue his efforts. “I need you to help communicate a message, a message to defeat a false narrative based on an absolute lie that has been perpetuated by the political ruling class elite in Washington, D.C., that’s been dutifully reported by an all-too-willing-to-comply media, and that lie that the effort to avoid funding Obamacare is an effort to shut down the government,” Lee said during a town hall meeting on Thursday night. "It's a darned lie and I reject it" (Bresnahan, 8/22).

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Health Reform

State Laws Could Upend Elements Of The Health Law Enrollment Effort

Twelve states have passed measures that could undermine funding for "navigators." Also, news outlets report on the latest on health exchanges from California, Wisconsin and Florida.  

Bloomberg: State Laws Hinder Obamacare Effort To Enroll Uninsured
President Barack Obama has set aside $67 million to make it easier to enroll in his health-care overhaul. Laws pushed by Republicans in 12 states may keep that from happening. Under the Affordable Care Act, the U.S. government plans to pay a network of local groups known as navigators to explain the law’s new coverage options to the uninsured and guide them through its online insurance markets (Nussbaum and Wayne, 8/23).

The Wall Street Journal: California Health Exchange Might Face Online-Enrollment Delay
California's new health-insurance exchange, the biggest of the state marketplaces emerging under the federal health overhaul law, has started telling insurers that there's a possibility it won't be ready to sign up consumers for coverage online when it launches on Oct. 1. spokesman for Covered California, the state agency creating the exchange, said the technology for its enrollment process is still being tested, and "we are fully planning on being fully functional on Oct. 1" (Mathews, 8/22).

The Associated Press: Analysis: At Least 3 Options In Area Health Exchange
There will be multiple options across Wisconsin for purchasing insurance through the new marketplaces, or exchanges, required under the federal health care overhaul, an analysis released Thursday concluded. Citizen Action of Wisconsin determined that every part of the state is covered by at least two insurance companies, at least three companies will be selling plans in nearly 99 percent of the state, and more than 68 percent of the state will be covered by at least four companies (8/23).

Health News Florida: Why Are 'Navigators' Needed For Obamacare
When the new online health insurance marketplace opens Oct. 1, millions of people will be able to buy insurance at the click of a mouse. The federal government has a website and a hotline people can call for help. But they'll also have people who can help face-to-face. They're called "navigators” (Watts, 8/22).

Also in the headlines, a look at why some employers are open to the idea of private insurance exchanges -

Modern Healthcare: Reform Update: Employers Take Closer Look At Private Insurance Exchanges
With public small-business insurance exchanges opening Oct. 1, two studies released this week show employer interest in private insurance exchanges is growing. ... the Kaiser Family Foundation found that 29% of employers with 5,000 or more employees are considering private exchanges as an option for buying healthcare coverage for their employees. A day later, consulting firm Towers Watson released its Health Care Changes Ahead survey, which found that 37% of employers think private exchanges are a reasonable alternative to traditional employer coverage in 2014 (Block, 8/22).

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Utah's Medicaid Expansion Decision On Hold

Medicaid news from Utah and Ohio.

The Salt Lake Tribune: Gov: Utah Won’t Decide On Medicaid Expansion Until 2014
Utah Gov. Gary Herbert said Thursday he will not make a decision until next year about whether to expand Medicaid to cover more of the state’s uninsured. ... "I assure you, I am not going to be rushed in this," Herbert said at his monthly news conference at KUED. The governor said he intends to make his decision "in conjunction with the Legislature. They convene in January 2014. That’s when I’m going to make the decision" (Gehrke and Dobner, 8/22).

Columbus Dispatch: Republican Legislator Proposes New Cuts To Medicaid
Thousands of poor pregnant women, parents and disabled workers would lose tax-funded health coverage under a Cincinnati-area Republican’s proposal to slash Medicaid eligibility. ... [State Rep. John Becker's]  soon-to-be-introduced legislation seeks to reduce Ohio’s Medicaid rolls as Gov. John Kasich pushes lawmakers to expand the program to reduce the number of uninsured and accept billions in federal aid. ... Ohio’s Medicaid program currently provides coverage to 2.2 million poor and disabled residents (Candisky, 8/23).

Related, earlier KHN story: Amid Health Law Expansion, Some States Trim Medicaid Rolls (Galewitz, 8/18).

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Local Governments Wrestle With Employee Hours And Health Coverage

Even though the requirement that employers -- including governments -- offer full-time employees health coverage does not kick in for 16 months, there are already changes, The Washington Post reports.

The Washington Post: Local Governments Cutting Hours Over Obamacare Costs
Many cash-strapped cities and counties ... are opting to reduce the number of hours their part-time employees work. ... Some local officials said the cuts are happening now either because of labor contracts that must be negotiated in advance, or because the local governments worry that employees who work at least 30 hours in the months leading up to the January 2015 implementation date would need to be included in their health-care plans (Wilson, 8/22).

Meanwhile, several outlets explain health-care terminology.

NPR: Say What? Jargon Busters Tackle Health Insurance
Scared you'll have no idea how to choose the best health plan come fall? ... [Dr. Ruth] Parker, a few friends at the National Academy of Science's Institute of Medicine, several young doctors and some Emory students combed through thousands of wonky Web pages and documents so you wouldn't have to. ... The volunteers who worked on the guide went out of their way to steer clear of politics, or to favor one type of insurance over another (Franklin, 8/22).

Kaiser Health News: FAQ On ACOs: Accountable Care Organizations, Explained
One of the main ways the Affordable Care Act seeks to reduce health care costs is by encouraging doctors, hospitals and other health care providers to form networks to coordinate care better, which could keep costs down. To do that, the law is trying a carrot-and-stick approach in the Medicare program: Accountable Care Organizations (Gold, 8/23).

Finally, the health law's Sunshine Act provisions continue to draw attention -

The Wall Street Journal: Doctors Face New Scrutiny Over Gifts
U.S. doctors are bracing for increased public scrutiny of the payments and gifts they receive from pharmaceutical and medical-device companies as a result of the new health law. Starting this month, companies must record nearly every transaction with doctors—from sales reps bearing pizza to compensation for expert advice on research—to comply with the so-called Sunshine Act provision of the U.S. health-care overhaul (Loftus, 8/22).

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Delta Air Lines Tells Feds: Health Law Makes Costs 'Rise Dramatically'

The airline is saying its increased health-care costs will be tens of millions of dollars.  

The Hill: Report: Delta Expecting Millions In News ObamaCare Costs
Delta Air Lines is expecting its healthcare costs to rise dramatically because of President Obama's healthcare law, the conservative website RedState.com said Thursday. RedState said it had obtained a copy of a letter Delta sent to the Obama administration in June outlining additional costs the company will face because of the Affordable Care Act (Baker, 8/22).

Atlanta Journal Constitution: Delta: Healthcare Law To Cost Us Millions
In a letter sent in June to Marilyn Tavenner, Administrator for the Centers for Medicare & Medicaid Services, Delta detailed $38 million in extra costs. It said its total health care costs will rise nearly $100 million next year if inflation is included. ... Delta had $35 billion in revenue last year, with profit of $1 billion (Markiewicz, 8/22).

Earlier, related KHN coverage: UPS Won’t Insure Spouses Of Some Employees (Hancock, 8/21).

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Capitol Hill Watch

Congressional Obamacare Sparring Matches Continue At Home

Both sides of the political aisle in Washington are continuing their Obamacare sparring sessions at home in their districts during the August recess with town hall meetings and debates on the law taking spotlight.

Los Angeles Times: Sen. Boxer Promotes Health Care Reform During Visit To Los Angeles
Sen. Barbara Boxer (D-Calif.) attacked Republicans on Thursday for their repeated attempts to repeal Obamacare, saying threats to shut down the government or limit the debt ceiling are irresponsible and ineffective. … Despite the continued discussions about repeal, Boxer said the states and federal government are moving forward with the Affordable Care Act and plan to begin enrolling people in new coverage options in October (Gorman, 8/22).

Texas Tribune/KUT News: With Spotlight On Cruz, Doggett Touts Health Care Law
As U.S. Sen. Ted Cruz brought his effort to defund the Affordable Care Act to Texas this week, U.S. Rep. Lloyd Doggett, D-Austin, tried to drum up support for the law during a visit to East Austin (Zaragovia, 8/22).

The Associated Press: Ham Breakfast Turns Into Debate On Health Care Law
Sen. Mitch McConnell and Gov. Steve Beshear squared off in a spirited debate about the federal health care law Thursday at the Kentucky Country Ham Breakfast. Beshear predicted that the law will work in Kentucky to expand coverage and fight chronic health problems. He accused the law's critics of spending more time seeking its repeal than striving to improve public health (Schreiner, 8/22).

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Women's Health

Federal Court Strikes Down Arizona Abortion Law

The measure would have kept Medicaid funding from some providers, including Planned Parenthood.

Los Angeles Times: 9th Circuit Rejects Arizona Law Banning Care By Abortion Providers
An Arizona law barring Medicaid patients from obtaining routine care from medical providers who perform elective abortions violates federal requirements and may not be enforced, a federal appeals court decided unanimously Thursday (Dolan, 8/22).

The Hill: Court Blocks Arizona’s Attempt To Cut Off Planned Parenthood Funds
The 9th Circuit Court of Appeals upheld a lower court's ruling against Arizona, which had sought to cut Planned Parenthood out of its Medicaid program because it provides abortions. Several states have tried to cut off Planned Parenthood's funding through similar laws, but have had limited success defending those restrictions in the courts (Baker, 8/22).

Bloomberg: Arizona Ban On Medicaid For Abortion Providers Voided 
The Arizona law prohibits Medicaid funding for health-care providers who perform abortions except when the pregnancy is the result of rape or incest or threatens the health or life of the mother. The measure, which had been scheduled to take effect in August, was challenged by Planned Parenthood Arizona (Gullo, 8/22).

Arizona Republic: Arizona’s Anti-Abortion Medicaid Law Struck Down
Anti-abortion leaders, who were regrouping after Thursday’s ruling, are essentially left with two options: appeal to a U.S. Supreme Court that is often more conservative in its decisions than the 9th Circuit, or try their luck with a 2014 Legislature that may be more willing to push abortion issues in an election year (Rau, 8/22).

Also -

Reuters: Indiana: State Sued Over Abortion Clinic Rules
Planned Parenthood sued on Thursday over a new state law requiring clinics that administer the so-called abortion pill to have full surgical facilities, a requirement it says would halt abortion services at a central Indiana clinic. Planned Parenthood would have to upgrade its clinic in Lafayette to surgical standards or stop administering RU-486, commonly called the abortion pill, it said in a lawsuit (Guyett, 8/22).

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State Watch

State Highlights: Colo. Effort To Reduce Hospital Readmissions Pays Off

A selection of health policy stories from Colorado, Wisconsin, Georgia, California, Texas, Arizona and North Carolina.

The Denver Post: Effort To Reduce Colorado Hospital Readmissions Shows Results
A 2-year-old initiative between the Colorado Hospital Association and UnitedHealthcare to reduce costly unnecessary readmissions is reporting major gains on a lingering problem. The readmission rate for "same cause" patients -- those coming back for the same malady as their initial visit -- dropped to just over 5 percent from 9.8 percent the year before, at 19 Colorado hospitals, according to a release by the collaboration (Booth, 8/21).

Milwaukee Journal Sentinel: State Medical Records Network Preparing To Go
Wisconsin now has in place the basic building blocks for a statewide network that could enable hospitals, clinics, nursing homes and other health care settings to exchange key information from patients' medical records securely and effortlessly. The Wisconsin Statewide Health Information Network, or WISHIN, a private nonprofit organization, expects to begin adding hospitals, including several in Milwaukee, to the network this year (Boulton, 8/23).

Georgia Health News: Phoebe, FTC Reach Deal To End Legal Fight
Phoebe Putney Health System and its local hospital authority have agreed to settle Federal Trade Commission charges that the acquisition of a rival hospital harmed competition in six South Georgia counties. The agreement, announced Thursday, does not include Phoebe Putney divesting itself of the former Palmyra Medical Center, because that would trigger a state regulatory review under the certificate of need (CON) system, the federal agency said in a statement (Miller, 8/22).

Los Angeles Times: Prison Pharmacist Wins Judgment Against Firms Tied To Senator
An Orange County pharmacist has won a $20,000 judgment against two companies he said stiffed him on pay for work he did on a state contract while the firms were co-owned by the husband of state Sen. Mimi Walters (R-Irvine). The state labor commissioner found that pharmacist Larry Drechsler of Orange County had not been paid more than $4,000 that was owed him for services provided to the companies, American Healthcare Recruiting and Drug Consultants Inc. The rest of the award was for interest and penalties (McGreevy, 8/22).

Los Angeles Times: Harassment Allegations Against California Hospital Probed
The executive recruited two years ago to correct deep-seated problems at the state's mental hospitals is the subject of a sexual harassment investigation that was launched within a week of her state Senate confirmation, according to two independent sources with firsthand knowledge of the matter (Romney, 8/22).

Texas Tribune: Despite Additional Dollars, Doctor Shortage Hard To Fix
Texas lawmakers invested millions of additional dollars in the 2013 legislative session to address a looming physician shortage. Voters and university regents have rubber-stamped plans to open two new medical schools, in Austin and the Rio Grande Valley. But those moves have not placated the medical community, which remains concerned that Texas has no long-term solution to produce enough physicians, particularly in primary care, to support the surging population (Aaronson, 8/23).

Arizona Republic: Health Group To Hire Hundreds
A unit of UnitedHealth Group said it plans to fill roughly 500 jobs in the Phoenix area over the next 60 days, with an employment fair scheduled for Tuesday in Ahwatukee Foothills. Connextions, a business unit that helps insurers enroll, retain and provide services to members, already has started to hire "engagement specialists," who will help seniors and others understand their Medicare and prescription-drug benefits so they can evaluate, enroll in and effectively use their plans (Wiles, 8/22).

North Carolina Health News: Focus On Patient Transition From Hospital To Home Pays Off
Payment regimens in the health care system are changing and, increasingly, hospitals will be penalized when patients are readmitted frequently. But a focus on patients transitioning from hospital to home is paying off (Hoban, 8/22).

California Healthline: Contested Biosimilars Bill Clears Committee
The Assembly Committee on Appropriations yesterday passed a bill to require pharmacies to notify physicians when dispensing biosimilar drugs as a replacement for biologic medication. Biosimilars are a new type of biologic that isn't yet on the market, but is expected to be sold by 2015 (Gorn, 8/22).

California Healthline: Minimal Fallout Expected From State Auditor’s Mental Health Spending Report
Potential paths after an auditor's report criticized the way California agencies and government officials have overseen spending of mental health funding range from staying the course to replacing the entire oversight commission. Repercussions from the California State Auditor's report on the Mental Health Services Act released last week will probably fall closer to the former than the latter, most experts agree. The report concludes that government representatives have "provided little oversight of counties' implementation of MHSA programs, particularly as it relates to evaluating whether these programs are effective” (Lauer, 8/22).

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Health Policy Research

Research Roundup: Moving Kids Onto Medicaid; Competitive Markets

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

JAMA Surgery: Excessively Long Hospital Stays After Trauma Are Not Related To The Severity Of Illness
Reasons related to severity of illness or medical care are commonly believed to be the main causes for prolonged hospital stays. Our study shows that delays in discharge are typically not caused by medical factors. In most cases, [excessively prolonged hospitalization] was related to administrative issues, predominantly the inability to place a patient in an appropriate rehabilitation facility, as well as to operational and insurance issues. ... patients with and without [excessively prolonged hospitalization] had similar injury severity, physiological compromise, and comorbidities. The only independent predictors of [excessively prolonged hospitalization] were issues related to insurance coverage and discharge disposition (Hwabejire et al, 8/21).

JAMA Psychiatry: Geography And The Medicaid Mental Health Care Infrastructure
Medicaid is the largest payer of mental health (MH) care in the United States, and this role will increase among states that opt into the Medicaid expansion. However, owing to the dearth of MH care providers who accept Medicaid, expanded coverage may not increase access to services. ... Our results highlight extensive gaps in the community-based MH treatment infrastructure for Medicaid enrollees across many US counties. More than one-third of counties do not have any outpatient MH facilities that accept Medicaid. Furthermore, counties with a higher percentage of residents who are black, Hispanic, or living in rural communities are significantly more likely to lack geographic access to these facilities. Among states that opt into the Medicaid expansion, our results suggest that communities with a high percentage of racial/ethnic minorities may face particular constraints on their Medicaid MH safety-net system (Cummings et al, 8/21).

Georgetown University Center for Children and Families/The Kaiser Family Foundation: Aligning Eligibility for Children: Moving The Stairstep Kids To Medicaid 
A feature of the Affordable Care Act (ACA) that has not received a lot of attention requires that Medicaid cover children with incomes up to 133 percent of the federal poverty level (FPL) ($31,322 for a family of four in 2013) as of January 2014. Today, there are "stairstep" eligibility rules for children. States must cover children under the age of six in families with income of at least 133 percent of the FPL in Medicaid while older children and teens with incomes above 100 percent of the FPL may be covered in separate state Children's Health Insurance Programs (CHIP) or Medicaid at state option. While many states already cover children in Medicaid with income up to 133 percent FPL, due to the change in law, 21 states needed to transition some children from CHIP to Medicaid. ... This brief examines how the transition of children from CHIP to Medicaid will affect children and families as well as states (Prater, 8/15).

UCLA Center for Health Policy Research/The Commonwealth Fund: Undocumented And Uninsured: Barriers To Affordable Care For Immigrant Populations 
The Affordable Care Act will significantly reduce the number of U.S. residents without health insurance to ensure appropriate access to health services, but the law specifically excludes one group from all its provisions: the approximately 11 million undocumented immigrants residing in this country. ... Undocumented residents are concentrated in a small number of states. As a result, safety-net hospitals in those states will be particularly affected by the reduction in disproportionate share hospital (DSH) payments scheduled under the Affordable Care Act that have previously cushioned the impact of providing uncompensated care. Many hospitals are expected to have a lower uncompensated care burden as a result of fewer uninsured patients, but those with a large proportion of undocumented immigrants may not experience the increase in insured patients that would otherwise be expected. Despite being in working families, most undocumented immigrants are not covered by health insurance and face significant access-to-care barriers (Wallace, Torres, Nobari and Pourat, 8/15).

Annals of Internal Medicine: A Home-Based Intervention To Reduce Depressive Symptoms And Improve Quality Of Life In Older African Americans 
Effective care models for treating older African Americans with depressive symptoms are needed. ... Design: Parallel, randomized trial stratified by recruitment site. Interviewers assessing outcomes were blinded to treatment assignment.  Setting: A senior center and participants' homes from 2008 to 2010. Patients: African Americans aged 55 years or older with depressive symptoms. Intervention: A multicomponent, home-based intervention delivered by social workers or a wait-list control group that received the intervention at 4 months. ... At 4 months, participants in the intervention group showed reduced depression severity ... and improved function ... compared with wait-list participants (Gitlin et al., 8/20).

Georgetown University Health Policy Institute/The Urban Institute: Moving To High Quality, Adequate Coverage: State Implementation Of New Essential Health Benefits Requirements
Beginning January 1, 2014, insurers selling non-grandfathered individual and small group policies must ensure they include 10 categories of essential health benefits (EHB) and restrict consumers' out-of-pocket costs. Establishing a meaningful but still affordable EHB standard generated considerable debate at the federal level and in many states.... Developing health plans that comply with the ACA's 2014 market rules has been no small lift for insurers in our [five] study states, and the review and approval process has stretched the capacity of state [departments of insurance]. However, in spite of technical glitches, most companies were able to meet federal and state filing deadlines and insurance departments have implemented practical approaches to manage the significant expansion. At the same time, in a majority of our study states, consumers are unlikely to see dramatic changes in the scope of their covered benefits, in part because states had pre-ACA benefit mandates in place. However, there remain long-term questions about the extent to which individual and small-group policies will conform to the state's benchmark benefit package (Corlette, Monahan and Lucia, 8/14).

The Heritage Foundation: Competitive Markets In Health Care: The Next Revolution
Over the course of the past several decades, federal and state lawmakers have proposed a variety of initiatives to reform America's health care system and reduce costs. One idea has been to instill competition in the health care markets to enable the industry to operate more like a traditional market. ... A classic argument, made by Kenneth Arrow and others, is that health care is inherently different from other competitive industries and is therefore incapable of functioning in a similar manner. However, the evolution of the health care industry, coupled with recent academic literature, suggests that health care can and should operate like many other industries. In fact, the academic literature suggests that proper reforms to move health care in this direction would significantly increase quality of care at lower cost. This paper discusses academic research pertaining to competition in health care and earlier attempts to instill competition into health care markets by looking at managed care, a previous attempt at competition in health care (Kevin Dayaratna, 8/19).

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

NBC News: Even Republican Young Adults Want Health Insurance, Poll Finds
Obamacare may have become a partisan issue, but more Republicans than Democrats have signed up for one of its most popular provisions, according to a survey published Wednesday. The survey also pokes holes in the idea that most 20-somethings act like "Young Invincibles" who believe they don't need health insurance. A team at the Commonwealth Fund, which strongly supports healthcare reform, looked at one of the main target groups of the 2010 Affordable Care Act – young adults who have been going without health insurance (Fox, 8/21).

Reuters: Low Prices Seen Luring Young Adults To Obamacare: Study
If uninsured young Americans shun the new health plans offered under President Barack Obama's healthcare reform law, it will be because the insurance costs too much and not because they don't expect to need much medical care, according to a study released on Wednesday (Begley, 8/21).

Medscape: Primary Care Shortage: NPs And PAs May Not Be The Answer 
Relying on nurse practitioners (NPs) and physician assistants (PAs) to relieve the primary care shortage may not be the answer, as many NPs and PAs work outside of primary care, according to a Graham Center Policy One-Pager published in the August 15 issue of American Family Physician. Stephen M. Petterson, PhD, from the Robert Graham Center for Policy Studies in Family Medicine and Primary Care, and colleagues analyzed data from the National Provider Identifier file, which identifies the locations of NP and PA clinics and identifies physicians who work in the same location. NPs and PAs practicing in clinics without a primary care physician are assumed to be practicing primary care. Those data show that only about half of NPs (52.4%) and PAs (43.2%) work in primary care, with the others choosing subspecialty areas (Brown, 8/16).

MedPage Today: Survey: Autism Dx Harder In Latinos 
Screening for autism spectrum disorders in Spanish-speaking families has posed a challenge for many pediatricians, even those whose practice includes a high proportion of Latinos, a survey indicated. Only 29% of California pediatricians surveyed offered Spanish-language screening for autism and related disorders on the recommended schedule, Katharine E. Zuckerman, MD, MPH, of Oregon Health & Science University in Portland, and colleagues found. ... fewer of those physicians in Latino-heavy practices indicated difficulty in recognizing autism spectrum disorder in white children (27%), the researchers reported in the September issue of Pediatrics (Phend, 8/19).

MedPage Today: Pre-Injury State Key To Senior's Post-Fall Function
After a hip fracture or other serious fall-related injury, how much independence older adults regained depended to a large extent on how well they were doing beforehand, a study showed. Functional trajectories were tightly linked, with rapid recovery observed only in those with no or mild disability before the fall, Thomas M. Gill, MD, of Yale University, and colleagues found. Individuals with progressive disability in the year prior to their fall had only a 25% chance of a "little recovery," whereas none with preexisting severe disability recovered at all, the researchers reported online in JAMA Internal Medicine (Phend, 8/20).

The Associated Press: Health Care Provider's Eight-Year Program Involved More Than 300,000 Patients
New research suggests giving patients easier-to-take medicine and no-copay medical visits can help drive down high blood pressure, a major contributor to poor health and untimely deaths nationwide. Those efforts were part of a big health care provider's eight-year program, involving more than 300,000 patients with high blood pressure. At the beginning, less than half had brought their blood pressure under control (Tanner, 8/20).

Reuters: Patients May Need Better Info When Leaving Hospitals
Older patients may think they understand everything doctors tell them when they are released from the hospital, but a new U.S. study found several gaps in what they remember and areas where instructions could be clearer. Out of nearly 400 patients discharged from a large academic medical center, 96 percent reported knowing why they had been hospitalized, but only about 60 percent could accurately describe their diagnoses, for instance. "Patients were very positive, but when we asked them about actual facts, they could not tell us," said Dr. Leora Horwitz, the study's lead author from the Yale School of Medicine in New Haven, Connecticut (Seaman, 8/20).

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, 8/20). 

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Editorials and Opinions

Viewpoints: Health Law Guarantees And UPS; 'Delay Coalition' Offers GOP New Playbook; Mayor Bloomberg Urges Obama Not To 'Cave' On Tobacco

Bloomberg: What's Obamacare Got To Do With It?
It’s not entirely clear why United Parcel Service Inc. (UPS) is blaming the Affordable Care Act for its decision to drop 15,000 of its workers' spouses from the company’s health-insurance plan. ... It's possible, of course, that UPS is using the health-care law as a smokescreen for cutting costs it wanted to cut anyway. And at one point its internal memo takes an abnormal interest in other people’s business. "Since the Affordable Care Act requires employers to provide affordable coverage," it reads, "we believe your spouse should be covered by their own employer." Duly noted, UPS. Also to note: The very law the company cites is helping to save people money on health care. It would be a lot harder for UPS to cut coverage to employees' spouses if those spouses were to be left without coverage at all (8/22).

Louisville Courier-Journal: UPS And Health Plans 
While the news may come as a surprise to workers at "Big Brown," known for its generous benefits including health coverage, it’s not a particularly surprising trend in the workplace where more employers are prodding employees whose spouses can get coverage elsewhere to do so. ... But before the critics of health care reform get too riled up, they should consider findings of the Kaiser-USA Today report that noted other companies have taken similar steps — unrelated to health reform — as employers seek to curb health care costs. Well before the Affordable Care Act was enacted in 2010, employers had begun efforts to cuts costs by getting spouses off the plan if the spouse had health coverage available elsewhere (8/22).

Forbes: Delta Air Lines: Next Year, Our Health Care Costs Will Increase By 'Nearly $100 Million'
We know that Obamacare will significantly increase the cost of individually-purchased health insurance in nearly every part of the country. But we've generally assumed that disruptions in the market for employer-sponsored health insurance will be less severe. In particular, large employers who self-insure should be exempt from most of Obamacare's most onerous regulations. It turns out, however, that even America’s largest companies face higher costs due to the health law. A recently-leaked letter from Delta Air Lines to the Obama administration states that the "cost of providing health care to our employees will increase by nearly $100,000,000 next year," much of it due to Obamacare (Avik Roy, 8/22). 

Forbes: Obamacare Is Really, Really Bad For You, Especially If You're Young
Starting next year, the Affordable Care Act will severely weaken the link between health insurance premiums and age-related risks. Health insurance companies won't be allowed to charge older people any more than three times what they charge younger people for premiums. This is bad news for the young (Rituparna Basu, 8/21).

The New Republic: Karl Rove Is Half-Right About Republicans And Health Care
"Republicans," [Karl Rove] writes today in the Wall Street Journal, "have plenty of sensible ideas to make health coverage more accessible and more affordable." Actually Rove is at least half-right. Republicans do have plenty of ideas. But they are not the kind of ideas that would come anywhere close to achieving universal coverage, at least in the way most people understand it. At best, Republican proposals would make insurance a bit cheaper, mostly for people who are healthy and need coverage the least. At worst, these ideas would make coverage less accessible for people with pre-existing conditions—and leave more of the insured exposed to crippling medical bills (Jonathan Cohn, 8/22).

The New York Times: The Conscience Of A Liberal: Karl Rove Shouldn’t Pretend He Understands Health Policy
Not surprisingly, what Rove actually does is demonstrate his party's intellectual bankruptcy. It's always helpful here to keep your eye on the problem of Americans with preexisting conditions. That's the best starting point for understanding why Obamacare has to look the way it does; it’s also often the best way to see what’s wrong with alleged Republican solutions (Paul Krugman, 8/22).

The Washington Post: GOP In Fantasy Land
The make-believe crusade by publicity-hound Republicans to somehow stop Obamacare is one of the most cynical political exercises we've seen in many years. And that, my friends, is saying something. Charlatans are peddling the fantasy that somehow they can prevent the Patient Protection and Affordable Care Act from becoming what it already is: the law of the land (Eugene Robinson, 8/22). 

The Wall Street Journal: A New Strategy To Take On ObamaCare 
Maybe there's hope for progress against the president's health-care law after all. The question of how the GOP should handle ObamaCare has of late been dominated by those who want the party to strip funding from the law, then shut down the government unless President Obama agrees. ... That's changing. A swelling coalition of conservative activists—card-carrying members of the "repeal ObamaCare" campaign—are lighting up the movement with a different approach. The plan aims to leverage public support, play on Democrat weaknesses, and, most notably, sidestep a shutdown fight that would damage the GOP even as it failed to kill the law. Meet the "Delay coalition" (Kimberley Strassel, 8/22). 

Baltimore Sun: Delay In ACA's Employer Mandate Nothing To Celebrate
The glee with which Republicans greeted the delay in the employer coverage provision of the Affordable Care Act is heartless. Although it is politically motivated, such reveling will prove to be a political obstacle to Republican election chances in 2014. President Barack Obama's health care law is not going away. A groundswell of public opinion will welcome the reforms now under way to help correct the fundamental inequities in America's health care system (James F. Burdik, 8/22).

Kansas City Star: Trying To Sell Selfishness To The 'Young Invincibles'
Obamacare opponents have their eye on 20- and-30-somethings also. If they can persuade enough young adults to stay out of the exchanges, maybe they can tank the entire plan. Or so the reasoning goes. They’re arguing that Obamacare will mean extra expenses for some young people. Even with discounts, it may be less costly to pay an annual fine — provided you stay out of the doctor’s office. ... FreedomWorks is telling young people they should refuse to participate in a system that asks something of them so that others can benefit. Never mind that the “subsidies” might be life-saving medical treatments (Barbara Shelly, 8/22).

Fox News: Some Final Warnings About ObamaCare
Each visit to the U.K. brings new horror stories about the National Health Service (NHS). Last month, Sir Bruce Keogh, medical director of the NHS, issued a forensic report, commissioned by the government, which found that 14 underperforming hospitals in England had substandard care, contributing to the needless deaths of nearly 13,000 people since 2005 (Cal Thomas, 8/22).

Bloomberg: Obamacare Rate Shock Isn't What You Think
If the law’s age-rating provisions aren't to blame for rate shock, what is? The truth is that premium increases for young adults will be driven by guaranteed-issue and community-rating protections -- in plain English, preventing insurers from denying coverage or basing premiums on health history. Thus, the health-care law's "rate shock" isn't a result of the young subsidizing the old. It's the result of reforming the system so it serves the needs of the sickest and most vulnerable -- something the current individual market fails to do (Adrianna McIntyre & Austin Frakt, 8/22).

Minneapolis Star Tribune: Bemidji Mayor: Paul Bunyan, Babe And MNsure
We like to do things big in Bemidji, and apparently that includes overreacting to the antics of Paul Bunyan and Babe the Blue Ox as unveiled in the new MNsure marketing campaign this week. Paul and Babe have stood in our downtown on the shores of Lake Bemidji since 1937, and they've never given us much trouble — except when Babe cracked down the middle and had to have major surgery — and the time Paul wouldn't let go of the Bemidji Curling Team’s Olympic bronze medal that was hung around his neck. ... Telling Minnesotans about MNsure is a big job. It takes a big voice. And Paul is just the guy to do it. And if he has to look a little silly in the process, so be it (Rita Albrecht, 8/22).

Detroit News: A Patient-Centered Medicaid Compromise
The most important piece of legislation in Michigan, and perhaps the country, remains idle on the floor of the Michigan Senate: Sen. Patrick Colbeck’s Patient Centered Care Act (Senate Bills 459 and 460). ... Fortunately, a crucial component of Colbeck’s plan focuses on primary care — the part of health care that we all interact with the most, and the part that can remove the need for high-cost interventions. ... With direct primary care, patients pay their primary care provider directly, usually on a monthly basis. If a patient is not satisfied with her care, the patient simply takes her direct payment elsewhere (Tom Valenti, 8/22).

The New York Times: Why Is Obama Caving On Tobacco?
Last year I endorsed President Obama for re-election largely because of his commitment to putting science and public health before politics. But now the Obama administration appears to be on the verge of bowing to pressure from a powerful special-interest group, the tobacco industry, in a move that would be a colossal public health mistake and potentially contribute to the deaths of tens of millions of people around the world (New York Mayor Michael R. Bloomberg, 8/22).

Journal of the American Medical Association: Reconsidering The Politics Of Public Health
There is an important and legitimate debate to be had about the appropriate role of regulatory approaches to improve public health. But the political conversation can quickly devolve into caricatures and false choices. Leaders devoted to public health priorities will be the exception rather than the norm unless the health community lays out a clearer path to a politically successful savvy state. This path must directly respond to prevalent and legitimate concerns embodied by nanny state critiques—while guiding political leadership toward serious and creative approaches to the modern epidemic of lifestyle-related chronic disease (Dr. Dave A. Chokshi and Dr. Nicholas W. Stine, 8/22).

New England Journal of Medicine: Taking Our Medicine — Improving Adherence In The Accountability Era
Because nonadherence leads to increased complications and hospitalizations, it costs the United States an estimated $100 billion to $290 billion annually. In a health care delivery system where physician payment will increasingly be tied to patient outcomes, nonadherence poses both new challenges and opportunities. ... The Affordable Care Act aims to shift reimbursement from fee for service toward rewarding of improved quality, outcomes, and efficiency. Payment and delivery-system models such as patient-centered medical homes (PCMHs), accountable care organizations (ACOs), and bundled payments encourage greater care coordination by holding providers accountable for total costs and outcomes in their patient populations. ... But will reforms designed to achieve more for less money motivate the development of innovative solutions to nonadherence — or harm the highest-risk patients? (Dr. Lisa Rosenbaum and Dr. William H. Shrank, 8/22).

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Stephanie Stapleton

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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.