Daily Health Policy Report

Tuesday, August 27, 2013

Last updated: Tue, Aug 27

KHN Original Reporting & Guest Opinion

Health Spending And Fiscal Battles

Health Reform

Capitol Hill Watch


Women's Health

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Insuring Your Health: Readers Ask: Will Premium Subsidies Come In A Lump Sum And What Happens When You Don't Pay Your Premium?

Kaiser Health News consumer columnist Michelle Andrews answers readers' questions about how online insurance marketplaces will work (8/27). Read the answers.

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Missouri's Poorest Residents Won't Benefit From Obamacare

The St. Louis Post-Dispatch's Virginia Young, working in partnership with Kaiser Health News, reports: "Cathy Hattey, 59, a former factory worker from Warsaw, Mo., isn’t pinning her hopes for affordable health insurance on the online marketplace that opens Oct. 1. Though the insurance exchange is supposed to bring down costs for people without job-sponsored coverage, it won’t help Hattey and an estimated 226,525 other uninsured Missourians. They make too little to qualify for government subsidies. Yes, too little" (Young, 8/27). Read the story

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Capsules: Colo. Insurance Commissioner Braces For Bumps In Road; Wash. Launches Ad Blitz Promoting Health Exchange; Video: How Will Obamacare Affect Employee Health Coverage?

Now on Kaiser Health News' blog, Colorado Public Radio’s Eric Whitney, working in partnership with KHN and NPR, provides a report on how things are progressing for Colorado's health exchange: "Colorado, which is preparing for the Oct. 1 launch of its new online insurance marketplace, expects bumps in the road as residents start enrolling in new health coverage options created by the Affordable Care Act. 'We're going to have 500,000 new customers,' said Marguerite Salazar, the state’s new insurance commissioner, during an Aug. 19 interview – her second day on the job. 'Just think of how many possibilities there are for things to go wrong there.' She has great faith in the staff she's now leading at Colorado's Division of Insurance, she said, but is realistic about the big changes that are coming" (Whitney, 8/27).

In addition, reporting for the Seattle Times in partnership with Kaiser Health News, Amy Snow Landa writes about new health exchange ads in Washington state: "With five weeks left until Washington state launches its online health-insurance exchange, many residents may have heard little about the program designed to offer coverage to the uninsured. That's begun to change. The state began rolling out the first phase of its ad campaign last week to let the public know about the exchange, a central part of the federal Affordable Care Act, also known as Obamacare" (Landa, 8/26).

Also on Capsules, watch video of KHN's Jay Hancock on C-SPAN’s Washington Journal Monday morning as he takes viewers’ questions about how the health law will affect employee health coverage offered by employers (8/26). Check out what else is on the blog.

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Political Cartoon: 'Code Blue?'

Kaiser Health News provides a fresh take on health policy developments with "Code Blue?" by John Deering.

Here's today's health policy haiku:


If the debt ceiling
is held back over health law

will the roof fall in?

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

Health Law In Cross Hairs As Debt-Limit Deadline Approaches

Treasury Secretary Jack Lew said Monday the nation will hit its debt limit in mid-October, setting up a potential clash between the White House and some House Republicans who say they will tie their votes on raising the debt ceiling to defunding the health law. Also in the news, a survey of business economists cites future deficits as the nation's most pressing problem, which will be exacerbated by aging baby boomers reliant on Social Security and Medicare.

The Washington Post: U.S. Faces Mid-October Deadline To Raise Debt Limit
Republicans are demanding significant new spending cuts in exchange for increasing the nation’s $16.7 trillion debt limit, with some GOP lawmakers insisting on a delay or the scrapping of President Obama’s signature health-care law. Obama, meanwhile, says he will not negotiate on the debt limit, the government’s legal cap on borrowing. With the two sides far apart, there is no clear path to resolving the differences. Not raising the limit would ultimately lead to a default, undermining the nation’s credit (Goldfarb, 8/26).

The Wall Street Journal: U.S. Treasury To Hit Debt Limit In Mid-October
The White House has spent several months working with a small group of Republican senators to discuss a budget agreement that some Democrats had hoped would clear the way for an increase in the debt ceiling. Those talks have not progressed beyond an early stage, people familiar with the process have said. House GOP leaders haven't disclosed their strategy for dealing with the debt-ceiling deadline, focusing instead on what to do to avoid a partial government shutdown at the end of next month. They have held talks with rank-and-file members over a proposal to fund the government at existing levels for the next two or three months, a proposal that many Democrats have indicated they could reluctantly accept. A vocal minority of Republicans, however, have said they would vote for a budget bill only if the White House's health-care law is defunded, a demand Democrats wouldn't accept—setting up a clash that could make it more difficult to reach a bipartisan agreement (Paletta, 8/26).

The Associated Press/Washington Post: Treasury Secretary Says U.S. Will Hit Debt Limit In Mid-Oct, Urges Congress To Raise It
Lew said it’s impossible for Treasury to predict exactly when borrowing limit will be reached. But he warns that if action isn’t taken soon, the government could be left with $50 billion in cash by mid-October. He says that wouldn’t be enough to cover Social Security payments, military personnel salaries, Medicare and other programs for an "extended period" (8/26).

Politico: Debt Limit To Be Hit By Mid-October
The deadline, sooner than what some forecasters had estimated, comes amid concern that Congress has no plan for handling the needed increase to the government’s borrowing authority. The Obama administration has said it will not negotiate over raising the debt limit, while Republicans have a long list of demands, including revising President Barack Obama’s signature health-care law (Faler, 8/26).

PBS Newshour: Republicans’ Health Care Funding Concerns Brew Spending Showdown
Lawmakers are headed for a clash of political will over funding the implementation of President Barack Obama's signature health care law. The government is funded through Sept. 30, which means there is little time to craft a new spending plan, and it seems the only agreement on the topic is that it's going to be an ugly fight (Bellatoni and Polantz, 8/26).

Los Angeles Times: Long-Term Deficit Is Chief Fiscal Problem Facing U.S., Survey Says
Many economists believe deficits in the 2020s and 2030s are a more pressing issue than current deficits or those that will be racked up in the next decade, according to a survey by the National Assn. for Business Economics. Economists were mixed on how to fix the long-term problem, which will be exacerbated by aging baby boomers who will increasingly rely on Social Security payments and Medicare (Li, 8/26).

The Associated Press/Washington Post: Survey Of Business Economists Calls Deficits In 2020s And 2030s The Biggest US Fiscal Problem
The NABE said 39 percent of those surveyed felt the best way to address the deficit-to-gross domestic product ratio in the next few decades is a mix of spending restraint and increased revenue. It said 32 percent believe the best single tool would be greater spending restraint, and 20 percent said enacting policies designed to encourage economic growth would be the best tactic. Ballooning costs for Social Security and Medicare as the U.S. population ages are expected to result in growing long-term budget deficits (8/26).

The Associated Press: Sector Wrap: Health Care Spending
A Stifel Nicolaus analyst said Monday that the threat of health care spending cuts could hurt a variety of stocks in the health care sector, including companies that own hospitals, rehabilitation and nursing facilities, and companies that own health care real estate. Because of an obsolete 1990s budget law, Medicare payments to doctors are scheduled for cuts every year (8/26).

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Health Reform

What's The Real Start Date For Health Exchanges? Oct. 1 Or Jan. 1?

The Washington Post asks this question, and offers Jan. 1 as the answer because it is the day the health law's individual mandate takes effect and the policies purchased from the new online insurance marketplaces kick in. The Oct. 1 date is the "soft launch." Meanwhile, progress reports from Colorado, Washington and California on the health exchanges.    

The Washington Post's Wonk Blog: The White House Says Obamacare Begins On Oct. 1. Not Really.
As I spent time reporting my most recent article – checking in with state marketplaces — it became increasingly clear that their big day isn’t necessarily Oct. 1. Instead, it’s Jan. 1, the day that the individual mandate takes effect and any plans purchased on the marketplace actually kick in. The space between October and December is viewed, by many standing up the health care law, as soft launch: the time to make their new Web sites live, sort out the kinks and get the site in prime condition for the beginning of 2014 (Kliff, 8/26).

Kaiser Health News: Capsules: Colo. Insurance Commissioner Braces For Bumps In Road
Colorado, which is preparing for the Oct. 1 launch of its new online insurance marketplace, expects bumps in the road as residents start enrolling in new health coverage options created by the Affordable Care Act. "We're going to have 500,000 new customers," said Marguerite Salazar, the state’s new insurance commissioner, during an Aug. 19 interview – her second day on the job. "Just think of how many possibilities there are for things to go wrong there." She has great faith in the staff she's now leading at Colorado's Division of Insurance, she said, but is realistic about the big changes that are coming (Whitney, 8/27).

Seattle Times/Kaiser Health News: Capsules: Wash. Launches Ad Blitz Promoting Health Exchange
With five weeks left until Washington state launches its online health-insurance exchange, many residents may have heard little about the program designed to offer coverage to the uninsured. That's begun to change. The state began rolling out the first phase of its ad campaign last week to let the public know about the exchange, a central part of the federal Affordable Care Act, also known as Obamacare (Landa, 8/26).

California Healthline: $9 Million Grant For Consumer Outreach
The California Endowment last week awarded a $9.2 million, three-year grant to a group of legal aid organizations to help expand the effort to educate lower-income Californians about choices under the Affordable Care Act, including coverage in the state's new health benefit exchange and the expanded version of Medi-Cal, both due to start in January. Health Consumer Alliance will receive the grant announced Thursday. It's a consortium of 11 legal aid organizations, including the Western Center on Law and Poverty, the Legal Aid Society of San Diego, Bay Area Legal Aid and the Fresno-based Central California Legal Services (Gorn, 8/26).

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Michigan Lawmakers Set To Vote On Medicaid Expansion

The Michigan Senate is weighing whether to expand Medicaid eligibility to allow 470,000 residents to qualify for the program in a closely-watched vote that has divided conservative Republicans and centrist Republican Gov. Rick Snyder. Lawmakers are slated to vote on three separate proposals Tuesday.

The Washington Post’s Gov Beat: Michigan Senate To Vote On Medicaid Expansion
The Michigan Senate is weighing whether to expand Medicaid eligibility to low-income families, a closely-watched vote that has divided conservative Republicans and centrist Gov. Rick Snyder (R) for months (Wilson, 8/27).

Detroit Free Press: Senate Could Vote For Medicaid Expansion Tuesday
For nearly three months, state Senators have been bombarded with billboards, e-mails and advertising from both sides of the Medicaid expansion issue. And it all comes down to a possible vote Tuesday on whether to approve a plan that would provide health care insurance coverage to an additional 470,000 low-income Michiganders (Gray, 8/26).

And from California, a report on how that state's expanded Medi-Cal program is being rolled out --

California Health Report: How The ACA’s Medi-Cal Expansion Will Work
The federal health reform known as the Affordable Care Act has so many moving parts that it is almost impossible to predict with confidence how it all will work once the law inches closer to full implementation on Jan. 1. But one very big piece of the Act is almost certain to roll out as intended: the expansion of the Medi-Cal program to accommodate more than a million low-income Californians who until recently had almost no access to the doctors, hospitals and labs that many people take for granted (Weintraub, 8/26).

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Obama Administration Ties Health Law To Civil Rights

When President Barack Obama met with African-American religious leaders just before the 50th anniversary of the March on Washington, he asked for their help in the final push to carry out the health law. Health and Human Services Secretary Kathleen Sebelius also noted the connection between access to health care and other opportunities.

The Wall Street Journal’s Washington Wire: Obama Asks African-American Churches For Help With Health Law
When President Barack Obama met with African-American religious leaders at the White House Monday in advance of the 50th anniversary of the March on Washington, he had a request: He asked for their help in the final push to implement the federal health care law. The president hosted representatives of major African-American denominations in the Roosevelt Room, where they discussed “how civil rights and equality are closely tied to voting rights and closing the gap on education, unemployment, and access to health care,” the White House said in a written statement (Radnofsky, 8/26).

The Hill: Sebelius Ties Health Care Law To Civil Rights Anniversary
Health and Human Services Secretary Kathleen Sebelius on Monday tied President Obama's signature healthcare law to the 50th anniversary of the March on Washington. Sebelius, in a post on the White House blog, said access to healthcare is key to other opportunities (Baker, 8/26).

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The Impact of Physicians' Retirement On Access To Health Care

Fox News: Retiring Doctors Mean Problems For Newly Insured Under Obamacare
Some 10,000 baby boomers will retire every day for the next 19 years, including many doctors. But at the same time, more people will be looking for health providers under ObamaCare -- meaning there could be a potentially wide numbers gap between those seeking treatment and those available to provide it (Angle, 8/26).

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Capitol Hill Watch

Conservatives Increase Pressure On McConnell Over Health Law Funding

Groups launch radio ads and a tour aimed at key Senate Republicans, including Minority Leader Mitch McConnell, in an effort to stop funding for the overhaul. Also, Sen. Ted Cruz, R-Texas, and Sen. Rand Paul, R-Ky., will speak at an anti-Obamacare Capitol Hill rally when Congress returns.

The Associated Press: Conservative Group Presses McConnell On Health Law
A conservative group is launching a radio ad challenging Senate Republican leader Mitch McConnell to oppose any money for President Barack Obama’s health care law even if it means triggering a government shutdown. The Senate Conservatives Fund is spending nearly $50,000 on the 60-second commercial that will begin airing on Tuesday in Kentucky, where McConnell is locked in a tough race for a sixth term. The GOP leader faces both a primary rival, businessman Matt Bevin, and a Democratic foe, Secretary of State Alison Lundergan Grimes (Cassata, 8/26).

CNN: Defund Obamacare Supporters Target Top Republicans
Conservatives backing a move to shut down the federal government if funding isn't cut off for President Barack Obama's health care law by the end of September are launching a tour starting Tuesday to put pressure on leading Republicans in Congress. The first target of the push by Tea Party Patriots and ForAmerica is Senate Minority Leader Mitch McConnell. The groups are planning a news conference in Lexington, Kentucky, Tuesday, near McConnell's offices (Steinhauser, 8/27).

Politico: Paul, Cruz Plan Anti-Obamacare Rally
Obamacare opponents are planning a defunding rally for the first day lawmakers return from August recess and just three weeks before millions can start enrolling in coverage. Republican Sens. Ted Cruz of Texas, Rand Paul of Kentucky and Mike Lee of Utah), who have been leading calls in the Senate to defund the law in any spending bills, will headline the Sept. 10 Exempt America from Obamacare event, organized by Tea Party Patriots and ForAmerica, along with other conservative groups (Millman, 8/26).

The Hill: Cruz, Paul To Headline Rally Against Funding For Obamacare
Key proponents of a plan to allow a government shutdown rather than fund ObamaCare will bring their campaign back to Washington with a major rally next month. Sens. Ted Cruz (R-Texas) and Rand Paul (R-Ky.) will speak at an event on Capitol Hill on Sept. 10, the day Congress returns from its summer recess (Viebeck, 8/26).

McClatchy: N.C. Republican Lawmakers At Odds Over Anti-Obamacare Strategy
Republicans in Congress are divided over whether to use the threat of a government shutdown to defund the president's health care law, and the split is nowhere more evident than in North Carolina. Some Republicans who have always opposed the Patient Protection and Affordable Care Act and voted against it -- Sen. Richard Burr and Reps. Renee Ellmers of Dunn, Robert Pittenger of Charlotte and Patrick McHenry of western North Carolina -- oppose the shutdown threat (Schoof, 8/26).

The Associated Press: Cotton: Keep Health Care In Spending Debate
Republican U.S. Rep. Tom Cotton on Monday said he believed the federal health care overhaul should be a part of budget negotiations this fall, but stopped short of saying he'd vote against spending measures that include funding for the 2010 law. Cotton, an Army veteran who is challenging Democratic Sen. Mark Pryor in Arkansas next year, also called for the United States to intervene in Syria over its alleged use of chemical weapons (DeMillo, 8/26).

The Associated Press: Dems, Conservatives Line Up On Health Care Fight
Supporters and opponents of the federal health care law brought their national battle to Indianapolis on Monday. Heritage Foundation President Jim DeMint was scheduled to rally conservatives against it Monday night, while the liberal Americans for United Change organized a Statehouse news conference to seek support for the law earlier in the day (LoBianco, 8/26).

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Legislation Proposed To End Federal Funding For Lawmaker's Health Insurance

Rep. Shelley Moore Capito, R-W.Va., said she will introduce the bill when Congress returns from its five-week break in September.

The Washington Post: Bill Would End Federal Funding For Lawmakers' Health Coverage
A House Republican on Monday proposed a bill that would end federal funding for the health-care premiums of members of Congress and leave lawmakers to fend for themselves after they enter new insurance exchanges forming under Obamacare. Rep. Shelley Moore Capito (R-W.V.) said she will introduce the legislation after Congress returns from a five-week break in September. "As long as Obamacare remains law, members of Congress should not receive exchange subsidies that are not provided to other Americans," she said in a statement (Hicks, 8/27).

Veterans health care is also drawing attention on Capitol Hill -

The Denver Post: Congress Demands VA Inspector Investigate Aurora Hospital Delays
A Congressional oversight committee is seeking an inspector general's probe into the construction mess and budget overruns at the Veterans Affairs hospital project in Aurora, according to a letter to be released this week. Rep. Mike Coffman, R-Aurora, chair of the veterans Subcommittee on Oversight and Investigations and the panel's ranking Democrat, planned to release a letter Tuesday asking the VA's inspector general to launch an investigation (Booth, 8/27).

NBC: Health-Care Costs For Wounded Vets To Increase For Decades To Come
No government agency has calculated fully the lifetime cost of health care for post-9/11 veterans of the wars in Iraq and Afghanistan with life-lasting wounds. But it is certain to be high, with higher survival rates, longer tours of duty and multiple injuries, plus the anticipated cost to the VA of reducing the wait times for medical appointments and reaching veterans in rural areas (Wilde, 8/27).

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Use Of Antipsychotics Down Among Nursing Home Residents

The Wall Street Journal: Nursing Homes' Drug Use Falls
A two-year effort by the federal government and the nursing-home industry has reduced the use of powerful antipsychotic drugs among elderly nursing-home residents, but the decline fell short of the program's goal, according to U.S. officials (Lagnado, 8/26).

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Women's Health

Steep Court Costs For States Defending New Abortion Limits

States often find the cost of defending new abortion limits in court can run in the millions. In the meantime, Calif. lawmakers have passed a bill that would allow some nurses to perform certain abortions.

The Washington Post's Gov Beat: Defending Abortion Limits Can Cost States Millions
Passing a controversial bill is just the first step. Then come the legal costs. Just last week, Idaho was ordered to cover the $376,000 in legal fees a woman there spent on suing the state after she was charged for an illegal abortion, according to the Associated Press. Combined with its past defense of abortion limits, the state has shelled out more than $1 million since 2000 (Chokshi, 8/26).

Bloomberg: California Senate Bill Allows Nurses To Perform Abortions
California's Senate gave final approval to a bill allowing nurse-midwives and others perform some types of abortions now done only by doctors.  The measure by Assembly Majority Leader Toni Atkins, a San Diego Democrat, passed the Senate 25-11 yesterday. The bill goes back to the Assembly, which passed it in May, to ratify amendments before it's sent to Governor Jerry Brown, a Democrat (Marois, 8/27).

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State Watch

State Highlights: N.H. Pushes Back At Health Care Costs Ahead Of Obamacare

A selection of health policy stories from New Hampshire, Kansas and California.

The Associated Press: New Hampshire Chipping Away At Health Care Costs
Health care spending has increased faster and reached higher levels in New Hampshire than in most other states, but hospitals, insurers and others have been trying to tackle the problem long before the Affordable Care Act. The New Hampshire Citizens Health Initiative, which promotes affordable, effective and accessible health care, has overseen several of the largest efforts, including a medical home pilot project in 2011 and an accountable care organization model (8/26).

Kansas Health Institute: Deadline Looming For State's Patient Record Exchange
Kansas' health information exchange has been years and millions of dollars in the making but because of an ongoing dispute between its two networks, it still lacks the capability to handle the exchange of digital patient records across the entire state. Negotiations aimed at resolving those differences have so far failed to produce a data-sharing agreement (Cauthon, 8/26).

San Francisco Chronicle: State Has Healthy Jump On Affordable Care
The program is Alameda County's iteration of the Low Income Health Program, a statewide initiative that has provided more than 500,000 low-income state residents with health care. The initiative was conceived with the federal Affordable Care Act in mind and is often referred to as a "head start" to the health reform law because it is enrolling uninsured people ahead of it (Brown, 8/27).

Los Angeles Times: Man Sentenced In Skid Row Health Fraud Scheme, Fined $9.8 Million
A Los Angeles man who recruited homeless medical patients on skid row as part of a scheme to defraud federal programs of millions of dollars was sentenced Monday to 18 months in federal prison. Estill Mitts, 68, of Los Angeles was sentenced by U.S. District Judge George H. King five years after Mitts pleaded guilty to his role in the scheme. Prosecutors said he recruited homeless people in downtown Los Angeles and sent them to hospitals, which drained their Medi-Cal and Medicare benefits before sending them back to the streets (Winton, 8/26).

California Healthline: Pros And Cons Of Step Therapy
For the third time in the past four years, the California Legislature is considering a bill that would limit and regulate a prescription drug protocol known as "step therapy." Also known as "step protocol," "fail first" and "prior authorization," step therapy is a tool used by insurers and providers to control rising costs and limit the risks of prescription drugs. The practice calls for patients to start with the most cost-effective, safest drug available and then to proceed to more costly, and sometimes more risky, drugs if the preceding step is not successful. AB 889, by Assembly member Jim Frazier (D-Oakley), proposes a limit of two steps and requires health plans to create a process for exceptions to the rule (8/26).

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Editorials and Opinions

Viewpoints: Sen. Cruz's Strategy And A Looming Deadline; Michigan Republicans Face Key Test

The New York Times' Taking Note: Ted Cruz Plays Two Truths And A Lie
Mr. Cruz also acknowledged that he does "not have the votes right now" to force a shutdown. At least 41 Senators need to play along, and, so far, only 13 have signaled their commitment to the cause. But the senator would only go so far in accepting reality. He refused to concede that even if he could send a bill to President Obama's desk that cut off funding for health care — the president would never sign it (Juliet Lapidos, 8/26). 

The Washington Post Plum Line: The Tea Party Tiger Has No Teeth
"It is going to take a [grass-roots] tsunami," he told host Candy Crowley. Then he made this astonishing admission: "Now is the single best time to stop Obamacare. If it doesn't happen now, it's never going to happen." He's absolutely right on that, of course, as once the law's exchanges go into place on Oct. 1, it will be procedurally and legally much more complicated to undo, not to mention that the political calculus flips once people start depending on Obamacare's benefits. If a "tsunami" doesn't materialize in the next month (don't hold your breath), then the defunders will demand heads (Alex Seitz-Wald, 8/26).

Los Angeles Times: Affordable Care Act: Is It Affordable?
A new report showing a relatively modest increase in premiums for employee health coverage is either a validation or an indictment of the 2010 healthcare law, depending on whose spin you believe. Supporters cite the slowing rise in healthcare spending, while opponents retort that premiums are still growing faster than the economy or consumer prices. There's a bit of truth to both sides, but more posturing. The biggest effects of the Patient Protection and Affordable Care Act won't be seen until next year at the earliest. And while there have been some promising signs, there are worrisome ones as well (8/26).

McClatchy: The Unsteady Rollout Of Obamacare
Any program as large and complex as Obamacare (not to mention one facing such entrenched opposition) is going to encounter some turbulence on its shakedown cruise. But the recent glitches are as important for what they tell us about reform, as for what they do (Caroline Poplin, 8/26).

Forbes: Report: If New Hampshire Expands Medicaid, State Hospitals Will Lose Hundreds Of Millions Of Dollars
In states that remain undecided about whether or not to expand Medicaid, as Obamacare prescribes, hospitals have lobbied furiously in expansion’s favor. That's not surprising, on its face; hospital executives' eyes widen at the possibility of hundreds of billions in additional taxpayer subsidies under the law. But an analysis from the Lewin Group, a prominent health care consulting firm, finds that if New Hampshire expands Medicaid, Granite State hospitals will actually lose $228 million in revenue over the next seven years (Avik Roy, 8/27). 

Detroit Free Press: For State Senators, A Life-Or-Death Choice
More than four years ago, Congress adopted health care reform legislation that promised to extend Medicaid eligibility to millions of working poor Americans who can't afford private health insurance. Today, all that stands between that promise and 470,000 uninsured Michigan residents is the Republican caucus of the Michigan Senate (8/27).

Bloomberg: Doctors Should Bill For Life-Or-Death Decisions
As an intern admitting emergency-room patients to a Cincinnati hospital, I saw it happen again and again: Late-stage cancer patients in the midst of medical crises would roll into our ER in need of a ventilator as expected complications mounted. We would ask for their advance directives, who had their power of attorney, and whether they had considered "do not resuscitate" orders or hospice. Too often, these concepts were unfamiliar, even for patients who had been undergoing cancer treatments for months or years. ... For too long, American medicine has pushed off the big conversations with the sickest patients until too late (Ford Vox, 8/26).

Bloomberg: Are Hospitals Already Saving Money For Medicare?
Medicare continues to exhibit remarkably slow growth: a modest 3 percent over the past year. That's great news, but a debate is raging about whether this is caused by a weak economy (and therefore will reverse as the economy recovers) or other factors (and therefore may persist, drastically improving the budget outlook).  Two new studies tilt toward the optimistic possibility (Peter Orszag, 8/26).

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Stephanie Stapleton

Andrew Villegas

Lisa Gillespie
Shefali Luthra

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