Daily Health Policy Report

Monday, August 26, 2013

Last updated: Mon, Aug 26

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Medicare

Health Care Marketplace

Coverage & Access

Women's Health

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Bare Bones Health Plans Expected To Survive Health Law

Kaiser Health News staff writers Jay Hancock and Julie Appleby, working in collaboration with The Washington Post, report: "Consumer Reports calls it ‘junk health insurance.’ A California regulator described them as 'skeleton policies.' To an expert from the American Cancer Society, they ‘are a perfect example of why health care reform is so crucial.’ They are bare-bones health plans, and critics say they could leave consumers who become seriously ill on the hook for tens of thousands of dollars in medical costs. The Affordable Care Act was supposed to do away with them" (Hancock and Appleby, 8/25). Read the story and the related sidebar.

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Kids With Costly Medical Issues Get Help, But Not Enough

Kaiser Health News staff writer Jenny Gold, working in collaboration with NPR, reports: "Katie Doderer is a very poised 15-year-old with short blond hair and a wide smile. She's a straight A student who loves singing, dancing and performing in musicals. This could be considered something of a miracle. 'I have a complex medical condition known as congenital central hypoventilation – blah — syndrome. CCHS,' Katie explains, stumbling on the full name of her malady. 'Basically my brain doesn't tell me to breathe. So I am reliant on a mechanical ventilator'" (Gold, 8/26). Read the story.

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No Shopping Zone: Medicare Is Not Part Of New Insurance Marketplaces

Reporting for Kaiser Health News and working in collaboration with USA Today, Susan Jaffe writes: "While the Obama administration is stepping up efforts encouraging uninsured Americans to enroll in health coverage from the new online insurance marketplaces, officials are planning a campaign to convince millions of seniors to please stay away – don't call and don't sign up" (Jaffe, 8/25). Read the story.

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Political Cartoon: 'Business As Usual?'

Kaiser Health News provides a fresh take on health policy developments with "Business As Usual?" by Joel Pett.

Here's today's health policy haiku:

BARE BONES HEALTH COVERAGE

Is thin really in?
Not when it comes to health plans...
Bulky is better.
-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

Lobbying Efforts To Alter Obamacare Take On Urgency

Reuters reports how businesses, unions and advocacy groups continue to seek changes in the law, but lobbyists face uphill battles. Kaiser Health News reports on how bare-bones health plans are expected to survive the law, albeit in modified form, and also looks at the government's efforts to inform seniors they shouldn't seek coverage from new online insurance marketplaces.

Reuters: Demands To Alter Obamacare Persist Even As Launch Nears
As the clock ticks down to the launch of President Barack Obama's healthcare reform, hundreds of businesses, unions and advocacy groups are still pushing to win concessions on the far-reaching law. Restaurants want to increase the number of hours that define a full-time worker. Unionized electrical workers are seeking to change the treatment of health plans offered by multiple employers (Krauskopf, 8/23).

Kaiser Health News: Bare Bones Health Plans Expected To Survive Health Law
Consumer Reports calls it "junk health insurance." A California regulator described them as "skeleton policies." To an expert from the American Cancer Society, they "are a perfect example of why health care reform is so crucial." They are bare-bones health plans, and critics say they could leave consumers who become seriously ill on the hook for tens of thousands of dollars in medical costs. The Affordable Care Act was supposed to do away with them (Hancock and Appleby, 8/25). Read the related sidebar.

Kaiser Health News: No Shopping Zone: Medicare Is Not Part Of New Insurance Marketplaces
While the Obama administration is stepping up efforts encouraging uninsured Americans to enroll in health coverage from the new online insurance marketplaces, officials are planning a campaign to convince millions of seniors to please stay away – don't call and don't sign up (Jaffe, 8/25).

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States Scramble As Countdown Continues To The Launch Of Health Exchanges

The Washington Post reports that concerns are emerging that the tight deadline schedule has caused some states to take "shortcuts" regarding systems testing and contingency plans. But CNBC notes that the biggest threat to the success of these online insurance marketplaces may be consumers' lack of awareness.

The Washington Post: States Scramble To Get Health-Care Law's Insurance Marketplaces Up And Running
With a key deadline approaching, state officials across the country are scrambling to get the Affordable Care Act’s complex computer systems up and running, reviewing contingency plans and, in some places, preparing for delays. Oct. 1 is the scheduled launch date for the health-care law’s insurance marketplaces ... Some officials in charge of setting up the systems say that the tight deadlines have forced them to take shortcuts when it comes to testing and that some of the bells and whistles will not be ready (Kliff and Somashekhar, 8/24).

CNBC: Ignorance Of Obamacare Exchanges Threatens Plan's Success
With just 38 days to go before the opening of Obamacare insurance exchanges, public ignorance about those marketplaces remains sky-high, threatening the very goal of offering affordable health care to the uninsured, several studies show. And according to a troubling conclusion in at least one study earlier this year, awareness about the new health-care law had declined among some groups more than three years after Obamacare was signed. But whether knowledge is slipping or stagnantly low, health-care advocates are now in crunch mode (Mangan, 8/23).

Also in the news, updates about the implementation progress and outreach efforts in California, Illinois, Kentucky, Texas, West Virginia, Michigan and Minnesota -

California Healthline: Exchange Accelerating Toward Deadline
At yesterday's meeting of the Covered California health benefit exchange board, exchange officials laid out an aggressive agenda that is seemingly coming together all at once. Highlights of the meeting included: Announcement of Fresno facility. Exchange officials said they signed a lease in Fresno for one of three central call centers, to handle eligibility and enrollment questions from Californians who might be interested in exchange coverage (Gorn, 8/23).

The Associated Press: A Look At Training Of Ill. Health Outreach Workers
Illinois outreach workers are learning about the nation's new health law as they work toward their certification as "in-person counselors." Once trained and certified, the counselors will help Illinois residents sign up for new insurance options under the Affordable Care Act. Here are two hypothetical scenarios used in the training program, which was developed at the University of Illinois at Chicago. The scenarios have been slightly edited for length and readability (8/26).

Huffington Post: Kentucky Health Workers Pitch Obamacare At State Fair Alongside Corn Dogs, Fried Kool-Aid
A middle-aged man in a red golf shirt shuffles up to a small folding table with gold trim, in a booth adorned with a flotilla of helium balloons, where government workers at the Kentucky State Fair are hawking the virtues of Kynect, the state’s health benefit exchange established by Obamacare. The man is impressed. "This beats Obamacare I hope," he mutters to one of the workers (Cherkis, 8/23).

Boston Globe: Health Law Coverage Can Be Tough Sell In Some States
Idealistic and motivated, the young organizers fanned out through a neighborhood of ranch houses on a scorching midsummer morning, eager to educate Texans on the benefits coming their way under President Obama’s health insurance law. They were armed with clipboards stacked with glossy ”Get Covered’’ brochures and a script on how best to approach their uninsured targets, whose addresses had been carefully mined from a national database. But a few hours spent with the team, from a nonprofit organization called Enroll America, illustrated the enormous challenges facing the White House and supporters of the health care overhaul in states like Texas, which is hostile country (Jan, 8/26).

The Associated Press: Attorney General Says W. Va. Not Ready For Health Care Rollout
West Virginia will have a "huge problem" in meeting an Oct. 1 deadline to begin open enrollment under the new federal health care reform law, Attorney General Patrick Morrisey said. Morrisey told the State Medical Association's annual conference on Saturday at The Greenbrier resort that federal delays will make it difficult to implement the Affordable Care Act in the state (8/25).

Bloomberg: Snyder Bets On Spurned Health Exchange To Help Detroit Retirees
Michigan Governor Rick Snyder wants to reduce bankrupt Detroit’s costs by moving municipal retirees to insurance exchanges created under President Barack Obama’s health care overhaul. His fellow Republicans, who dominate the legislature, aren’t making it easy (Christoff, 8/26).

Pioneer Press: Minnesota GOP Governor Hopefuls Would Scrap Health Exchange
On a scorching-hot Sunday at the Minnesota State Fair, three Republican candidates for governor pledged that, if elected, they would work to scrap the state's health insurance exchange that is scheduled to open in October. Predicting rising costs and burdensome government regulations, Hennepin County Commissioner Jeff Johnson, state Sen. Dave Thompson and state Rep. Kurt Zellers said during a candidate forum that they would try to close the new online marketplace for health insurance that's a key component of the federal law known as Obamacare that is intended to overhaul the nation's health system (Salisbury, 8/25).

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Medicaid Expansion Still Unsettled In Some States

State legislators in Michigan could vote as early as Tuesday on a bill to expand the health insurance program for the poor. In Wyoming, lawmakers consider an alternative approach developed by Arkansas. And in Arizona, a group trying to block the expansion faces a deadline to put the matter on the ballot.

Detroit News: Michigan Legislators To Tackle Medicaid Expansion
State senators return to the capital city this week to decide whether to expand the state’s health insurance program for the poor after spending the summer considering one of Gov. Rick Snyder’s top priorities. Supporters of adding more than 400,000 to the Medicaid rolls contend a majority of the 38 senators are prepared to vote for the legislation as early as Tuesday. But that’s what they said in late June before GOP Senate leaders refused to hold a vote on the bill without the support of at least half of their 26-member majority party caucus (Livengood, 8/26).

Wyoming Tribune Eagle: State To Consider Alternative Medicaid Expansion
State lawmakers are exploring a new plan that could extend health insurance to more than 17,000 low-income residents. A legislative committee will meet today in Lovell to discuss a potential bill that would expand the state's Medicaid program though a "premium assistance" option. The plan would cover roughly the same population as the optional Medicaid expansion that Wyoming and several other states rejected earlier this year, but this idea would use the funds to enroll residents in private insurance plans through the new exchanges instead of allowing them to be Medicaid eligible. The model was first developed by Arkansas earlier in the year (Brown, 8/26).

The Associated Press: Medicaid Expansion Critics Face Upcoming Deadline
A group trying to block a new law expanding Medicaid in Arizona by collecting enough signatures to put the matter on the ballot for voters to decide says it's on track to gather enough support by an upcoming deadline. The Arizona Daily Star reports that the United Republican Alliance for Principled Conservatives declined to say how many signatures have been gathered so far (8/25).

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Capitol Hill Watch

GOP Push To Defund Health Law Spurs Capitol Hill Debate

During the weekend talk shows, Sen. Ted Cruz, R-Texas, acknowledged that he does not have the votes to be successful and that he will need the help of significant grassroots pressure to win the battle.

The Hill: Cruz: Political 'Tsunami' Needed To Win Fight To Defund ObamaCare
Sen. Ted Cruz (R-Tex.) said Sunday it would take a political "tsunami" of grassroots pressure to win his fight to defund President Obama's healthcare law in the coming budget showdown. "It is going to take a tsunami, and I am going to do everything I can to encourage that tsunami," Cruz said on CNN's "State of the Union" (Berman, 8/25).

CNN: Sen. Cruz to Candy Crowley On Defunding Obamacare: "We Do Not Have The Votes Right Now"
Today on CNN's State of the Union with Candy Crowley, Sen. Ted Cruz joined the program to discuss his effort to defund Obamacare; former Gov. Howard Dean and Heritage president Jim DeMint spoke about the 2014 election and beyond. Plus, Crowley’s conversation with Congressman John Lewis on the 50th anniversary of the march on Washington (8/25).

Fox News: Cruz Pressed Ahead With Defunding ObamaCare, Says It Will Take A 'Tsunami' Of Support
The race to stop ObamaCare before Americans can officially sign up this fall for the government-backed health insurance intensified Sunday with two of the movement’s biggest champions confident they will succeed but acknowledging it will take a "tsunami" of support (8/25).

Health News Florida: FL GOP Splits Over Shutdown
At least eight Florida Republicans in the U.S. House of Representatives have called for "defunding" the Affordable Care Act during budget talks in September, according to a list on a conservative blog. Nine Florida Republican Representatives were still listed as holdouts on the Americans for Limited Government website as of Friday morning (Gentry, 8/23).

Bloomberg: Obama Aide Burwell Rejects Year’s Delay Of Health Law
White House Budget Director Sylvia Mathews Burwell rejected delaying the health-care law as a way to get a budget deal with Congress and voiced optimism that talks with lawmakers would avoid a government shutdown. A demand by more than 90 Republican lawmakers to withhold funds for carrying out the law set to take effect Jan. 1 has drawn fire from other party members (Rowley, 8/24).

Fox News: Push To Defund ObamaCare Big Test For DeMint At Heritage And Rest Of Republicans
South Carolina Republican Sen. Jim DeMint unexpectedly quit Congress this winter, saying essentially that he could better advance the conservative cause as president of the Heritage Foundation think tank than in Congress. Roughly eight months later, DeMint has no doubt pressed Congress, and House Republicans in particular, to take a conservative stance on such issues as the Farm Bill and President Obama’s health care law (Weber, 8/25).

The Hill also takes a look at how some of those who helped write the law are now involved in lobbying efforts.

The Hill: ObamaCare's Architects Reap Windfall As Washington Lobbyists
ObamaCare has become big business for an elite network of Washington lobbyists and consultants who helped shape the law from the inside. More than 30 former administration officials, lawmakers and congressional staffers who worked on the healthcare law have set up shop on K Street since 2010 (Wilson, 8/25).

In addition, Politico takes a look at some of the health law's political dynamics, including the role of faith organizations -

Politico: The Holy War Over Obamacare
As in politics, the religious world is riven by the health law. Sympathetic faith organizations that see an opportunity to live up to their God-given mission to aid the poor are stepping up to White House efforts to get people covered. Evangelicals and conservative congregations view Obamacare as an affront to their values and personal freedoms. Each side is mobilizing its flock — both evangelicals and liberal denominations are using a different kind of bully pulpit to build support for their point of view (Cheney, 8/23).

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Medicare

Medicare: Docs Not Leaving Program; Sen. Baldwin Pushes To Protect Rural Hospital Funds

In Medicare news, doctors may not be leaving the Medicare program in droves as some think. Sen. Tammy Baldwin is pushing back against Medicare cuts to rural hospital reimbursement, and some hospitals are making follow-up care changes to lower readmission rates.

NPR's Shots Blog: Doctors Fleeing Medicare? Not So Fast, Feds Say 
Are doctors so fed up with Medicare's stagnant pay and bureaucratic rules that they're bailing out of the program? Short answer: Yes, some are. Long answer: Not as many as you might have thought. ... [S]ome analysts at the Department of Health and Human Services just ran the numbers ... [and] found that the proportion of docs taking new patients has held pretty steady for Medicare in recent years -- rising about 3 percentage points, actually, to 90.7 percent in 2012 from 87.9 percent in 2005 (Hensley, 8/23).

The Associated Press: Baldwin Leads Protest Against Cuts To Rural Hospitals
U.S. Sen. Tammy Baldwin is leading a fight against proposed cuts to Medicare reimbursements for rural hospitals that she says will reduce access to health care and weaken rural economies across the nation. The Wisconsin Democrat and 19 other senators sent a letter dated Thursday to Senate Finance Committee Chairman Max Baucus and Sen. Orrin Hatch, the ranking member on the committee, protesting changes to how Medicare classifies and pays critical access hospitals, or CAHs (Johnson, 8/25).

California Health Report: Readmission Penalties Prompt Hospitals To Improve Follow-Up Care
For every five Medicare beneficiaries discharged from a U.S. hospital, one person returns for within a month. Often, doctors and federal policymakers say, those people could have avoided that second trip to the hospital altogether if only they’d received good follow-up care (Richard, 8/23).

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Health Care Marketplace

Examining Cost: Why Are Health Care Services So Expensive?

The New York Times looks at the cost of care and asks why it's so difficult for consumers to find out what a service costs. In the meantime, new research shows ending copays and making medication easier to use drives lower rates of hypertension.

The New York Times: How To Charge $546 For Six Liters Of Saltwater
Luckily for anyone who has ever needed an IV bag to replenish lost fluids or to receive medication, it is also one of the least expensive. The average manufacturer's price, according to government data, has fluctuated in recent years from 44 cents to $1 (Bernstein, 8/25).

The Associated Press: Simpler Medications, No Co-Pays Linked To Big Drop In Hypertension
Research suggests giving patients easier-to-take medicine and medical visits with no co-pay can help drive down high blood pressure, a major contributor to poor health and untimely deaths. Those efforts were part of a big health care provider's eight-year program, involving more than 300,000 patients with high blood pressure (8/25).

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Coverage & Access

Sorting Out End-Of-Life, Long-Term Care Issues As America Ages

As America ages, end-of-life and long-term care issues increase. One doctor is helping families cope with end-of-life care while a looming shortage of caregivers worries some.

NPR: Hospice Doctor Helps Families Navigate The End Of Life
Dr. David Casarett is the director of hospice care at the Perelman School of Medicine at the University of Pennsylvania. He works with families as they try to navigate end-of-life decisions. At least once a week, Casarett says, one of his patients expresses a desire to end his or her own life. "It's a reminder to me that I have to stop whatever I was doing ... and sit back down to try to find out what is motivating that request," he says. "Is it really a carefully thought out desire to die, or is it, as it is unfortunately many times, a cry for help?" (8/25).

The Washington Post: Huge Shortage Of Caregivers Looms For Baby Boomers, Report Says
Americans should expect an enormous shortage in caregivers for older people in the coming decades, with a dearth of friends and family members available to care for the baby-boom generation as it ages, according to a report released Monday by AARP (Bahrampour, 8/26).

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VA Health System Scrutiny Draws Headlines

After a veteran commits suicide, his family takes on the challenge of improving the VA system.

The Washington Post: After Veteran Daniel Somers's Suicide, His Family Has A New Mission: Improve VA Services
Howard and Jean Somers have been meeting with VA officials and congressional staffers to tell their son’s story. "If your system is so difficult to get into," Howard Somers asked, "how the hell are you going to prevent suicides?" ... (Daniel's) service in Iraq, including multiple combat missions as a turret gunner, left him with severe post-traumatic stress disorder and traumatic brain injury. But the government, he wrote, had "turned around and abandoned me." ... And he was caught in VA's notorious disability claims backlog, which at its peak in March included more than 900,000 compensation requests from veterans, two-thirds of them waiting for more than 125 days (Vogel, 8/23).

Meanwhile, Modern Healthcare reports on the GAO's findings regarding the VA's pay-for-performance bonus system -

Modern Healthcare: Most VA Doctors Get Performance Raises, But GAO Finds No Criteria For Pay Hikes
Eight out of 10 healthcare providers working in the Veterans Health Administration, the healthcare arm of the U.S. Department of Veterans Affairs, received some form of pay-for-performance bonuses totaling $150 million in 2011. But a federal watchdog agency found no written criteria for the bonuses or any written evaluations justifying them. The Government Accountability Office visited four VA medical centers and learned that several providers who had been disciplined still received bonus pay, according to a 39-page report, "VA Health Care: Actions Needed to Improve Administration of the Provider Performance Pay and Award Systems" (Conn, 8/23).

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Women's Health

A Fundraising Cause: Abortion Access

Los Angeles Times: Raising Money To Ensure Women Have Access To Abortions
Sarah Tuttle led her bowling team to a fourth-place finish in a nationwide tournament this April that raised $553,133 to help low-income women seeking abortions. "Some people fundraise to fight breast cancer; I fundraise for abortion access," said Tuttle, a hot line operator and board member for the Lilith Fund, a Texas nonprofit that helps women pay for abortions. "It's about having access to abortion and that not being about economics." Representatives from such abortion rights organizations say new restrictions are disproportionately affecting women whose income is below the poverty line, about 42% of those who have abortions (Villeneuve, 8/25).

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State Watch

State Highlights: Iowa Asks For Federal Waiver For State Health Coverage Plan

A selection of health policy news from Iowa, Texas, Virginia, Georgia and Kansas.

Des Moines Register: Brandstad Asks Feds To Approve 'Iowa-Based' Health Care Plan
Gov. Terry Branstad filed a waiver request with federal officials on Friday, seeking expedited approval for a statewide program to expand access to health care for thousands of lower-income Iowans. "Our plan passed with bipartisan support and is designed to increase access, drive personal health ownership, and reform our health care delivery program to pay for quality, not quantity, of health care delivered," Branstad (a Republican) said in a letter to Kathleen Sebelius, secretary of the U.S. Department of Health and Human Services (Petroski, 8/23).

Texas Tribune: Lawmakers Alter Texas Health Policies
State lawmakers approved a wide range of measures in the 83rd legislative session that will affect Texans' medical care. Use this interactive to take a look at 31 ways those laws will change Texas health policy (Aaronson, 8/26).

The Washington Post: Reston Firm Helps Health Care Providers ID High-Risk Patients
In health care, not all patients are equal. Some need costly treatment while others are relatively healthy, so providers must often decide who requires more attention and resources (Ravindranath, 8/25).

Georgia Health News: Lawmakers Try To Ease Burden Of Alzheimer's
"It's about people," said U.S. Rep. Hank Johnson, a Georgia Democrat. Johnson was referring to proposed legislation (H.R. 1507) to provide enhanced services for those affected by dementia, including Alzheimer's disease. It’s the Health Outcomes, Planning, and Education Act, also known as the HOPE Act (Kanne, 8/25).

Kansas Health Institute: Cabinet Secretaries Express Support For Suicide Prevention Efforts
Kansas officials on Friday vowed to bolster support for suicide prevention and awareness efforts going on throughout the state. Suicide, they said, should be viewed as a public health issue that warrants open discussion (Ranney, 8/23).

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Editorials and Opinions

Viewpoints: 'Mixed Signals' On Employee Benefits; Michigan Debates Medicaid Expansion; Malpractice Awards Drive Safety

The New York Times: Mixed Signals On Employee Health Insurance
It is hard to know whether to rejoice or lament two striking if somewhat conflicting messages last week about the costs of employer-sponsored health insurance. An authoritative survey found that premiums for family and individual coverage at work — including both the company’s and the worker’s share — have gone up only moderately for the second year in a row. ... On the other hand, United Parcel Service told its white-collar workers that in an effort to reduce its health care costs, it will no longer cover some 15,000 spouses who can obtain coverage through their own employers (8/25).

Detroit News: Get Ready To Pay More For Health Care
A new study by the Kaiser Family Foundation further highlights the costs that will be heaped on individuals under Obamacare. Some Americans will get help from the government to pay for their health insurance. But just as many will pay more. Whether President Barack Obama likes to admit it or not, prices are going up under his championed health care law (8/26).

Detroit Free Press: Now's Not The time To Double Down On Health Law
The GOP-led state Senate may vote as early as Tuesday to accept an expansion of the federal Medicaid program and throw Michigan’s weight behind the national health care law that some call Obamacare. Any benefits of a bigger Medicaid program would be short-lived and far outweighed by long-term economic and health harms. The Senate should proceed with great caution and skepticism (Joseph G. Lehman and Clifford W. Taylor, 8/25).

MLive: Sen. Patrick Colbeck On Medicaid Expansion: There Is A Better Alternative
Michigan is on the verge of adding another long-term entitlement obligation onto the backs of our taxpayers – Medicaid Expansion. Incredulously, proponents of Medicaid Expansion claim that an increase of over $1.5B in government spending will actually "save" us money. How can this be so? Simple. They claim that we will be spending "federal" money not "state" money. The last time that I checked, both "federal" and "state" money come from the same source – taxpayers. Despite being only one of the provisions buried within the 2,409 pages of statute and almost 20,000 pages of regulations known as Obamacare, the Medicaid Expansion provision is one of the most significant. It is the path to a single payer system controlled by the federal government that will be devoid of free market pressures to drive down price and improve the quality of care for our citizens (Sen. Patrick Colbeck, 8/25).

MLive: Gov. Rick Snyder On Medicaid Expansion: Healthy Michigan Would Improve Lives Of 470,000 Michiganders
Talk to people without health insurance and you’ll hear one moving story after another. One woman told me about selling her car to pay for cancer treatments. ... I heard these stories and many more as I traveled around the state this summer to make the case for Healthy Michigan. That plan would provide health care coverage to 470,000 Michiganders, most working but earning less than $15,000 a year. While Healthy Michigan is a public policy issue or political question to some, it could be a matter of life and death for these hard-working people (Michigan Gov. Rick Snyder, 8/25).

Sioux Falls Argus Leader: Expand Medicaid Coverage In South Dakota
South Dakota should expand Medicaid coverage as intended under the federal Affordable Care Act. ... Gov. Dennis Daugaard decided against expansion last year, instead saying he wanted a committee to study the issue thoroughly and report back the advantages and disadvantages of making the move. That committee has wrapped up its work and is finalizing its report for Daugaard and the Legislature this month. At stake is health care coverage for an estimated 48,000 now-uninsured South Dakotans (8/24).

The Washington Post: Questions And Answers About Health Insurance Marketplaces
I've had health-care coverage throughout my working life. The most I've had to contend with has been the increasing amount of co-payments. And even then, they've been affordable. But having insurance hasn't kept me from understanding the plight of people whose employers don't offer coverage. ... Right now a lot [about the health law] hasn't been worked out. Still, HHS has done a good job walking people through the law considering how complicated it is. But be patient. The most important information you want to know — how much your insurance will cost — isn't posted yet (Michelle Singletary, 8/25). 

The Washington Post: Obamacare Endangers Obamacare
The best thing opponents of Obamacare have going for them is Obamacare. The implementation glitches and the ensuing delays have created a perverse system: Individuals must purchase insurance with no out-of-pocket cost cap while employers are under no obligation to provide insurance. Aside from the gross unfairness and the difficulty in rolling out the plans (e.g. exchanges aren't set up, there is no guarantee personal information will be protected, the centrality of a corrupted IRS) Obamacare's debut is bringing home several unpleasant realities (Jennifer Rubin, 8/25).

JAMA: How Serious Are The ACA Delays?
The 2014 election will be important, but with a Democratic president who regards the ACA as his signature legislation, even the election of a Republican Senate won’t make it possible to change the dynamics just described. At some point, Republicans need to start thinking about how to modify the ACA to minimize its negative effects and move it in a more positive direction (Gail Wilensky, 8/23).

Philly.com: Let's  Blame Obamacare For Everything
Two major organizations announced significant changes in their health insurance benefits last week. They will no longer cover the spouses of employees who are eligible for benefits from their own employer. United Parcel Service will implement the change for white-collar workers. The University of Virginia will implement it for everyone. The reason given for the moves? Obamacare, of course (Robert I. Field, 8/26).

The New York Times: Public Policies, Made To Fit People
It makes sense for social scientists to become more involved in policy, because many of society's most challenging problems are, in essence, behavioral. ... One reason for high health care costs is that patients fail to follow their treatment regimen. A good way to approach this problem is via a behavioral assessment, identifying obstacles to that compliance. ... for some highly effective treatments, there should be no co-payment at all. That's a good place to start (Richard H. Thaler, 824).

Los Angeles Times: Don't Cut Welfare Benefits, Make It Easier To Get A Job
Michael Tanner's provocative Op-Ed in The Times on Thursday tries to make the case that welfare benefits are too generous because they leave the recipients better off than they would be if they held a job. His argument is undermined by a number of important factors he leaves out of his calculations, such as the benefits available to low-income workers. Still, he (unwittingly) makes a good case for the provisions in the 2010 healthcare law that make insurance coverage more available and affordable to low-income Americans (Jon Healey, 8/24). 

The Washington Post: The Hospital Prince George's Deserves
Of the 32,000 Marylanders who leave the state each year to seek medical care elsewhere, about three-quarters are from Prince George's County. One reason is a "pull" factor: the abundance of health-care facilities in the District and Northern Virginia. The other reason is a "push": the paucity of high-quality health-care options in Prince George's itself (8/25). 

Bloomberg: $130 Million Verdicts Don’t Raise Medical Costs
A jury in one of New York’s most conservative counties recently returned a $130 million verdict in a medical-malpractice case, the second-largest in the state’s history. Lawyers for the losing hospital decried a "jury out of control" and called for more tort reform. Before the case went to trial, their offer of an $8 million settlement was turned down. What the defense lawyers seemed not to realize is that tort reform hasn't worked for 25 years. And large verdicts may be the most effective drivers in making health care safer (Steve Cohen, 8/25).

Bloomberg: When Government Says 'No' To Rising Costs
Health care and education pose the same basic threat to the economy: How do you keep costs down for a product that consumers must purchase? Saying "no," after all, is how consumers typically restrain costs. ... But you can't walk out on medical care for your spouse or education for your child (Ezra Klein, 8/22).

New Orleans Time-Picayune: Disabled Louisianians Need Medicaid Program To Help Them Stay In Their Homes
If you're a disabled person with limited resources who needs health care and other services to be able to stay in your home, you're probably out of luck in Louisiana. The Jindal administration last week withdrew its application for a federal Medicaid program set up to encourage more in-home care for developmentally disabled residents with low incomes. State officials said the cost is too high and the rules are too inflexible. But it's hard to believe the decision isn't political (8/25).

MedPage Today: Affording Care: A Medical Student's Story
For the 2014 academic year, "grandfathered" student health plans, which started between July 1, 2012 and Sept. 23, 2012, can continue to set an annual payout limit of $100,000. If the policy began on or after Sept. 23, 2012, it can have a $500,000 annual limit. Payment for prescription drugs and mental health benefits are included in these annual limits. If my university plan had a $100,000 annual limit, I would owe more than $500,000 in out-of-pocket expenses for my cancer treatment. This is why it's essential to have adequate healthcare -- even for medical students (Dr. Ben Hartman, 8/25).

Health Policy Solutions (a Colo. news service): The Tragedy Of Medical Ethics
The difficulty of medical ethics and culture is that it allows, indeed it makes morally obligatory, practices and behaviors that increase health care spending without regard to other public priorities that get crowded out by the incessant demands of health care. To the extent medical ethics drive resource use, they do not give adequate moral guidance to the larger distributional decisions faced by government and other third party payers. Ironically to the extent that  medical ethics drive marginal spending, they actually lower both the quality of life and well-being of the community (Richard Lamm, 8/24).

Bloomberg: Why Has Medicare Cost Growth Slowed Down?
Recently, Medicare has been growing more slowly than its historical average. The Congressional Budget Office decided to investigate why, and the answers will probably surprise you. If you had to guess why Medicare was growing more slowly, you'd probably come up with one of two answers: "Obamacare" or "the recession." (No bonus points for guessing which party prefers which answer.) But the CBO largely rejected both those answers (Megan McArdle, 8/23).

The Seattle Times: AG Affirms Women's Right To Abortions
The state attorney general's important opinion last week on reproductive-health care is a reminder that elections matter. In this case, the general election of 1991, when Washington voters affirmed, in the unambiguous language of Initiative 120, a woman's right to abortion (8/25).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
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.