Daily Health Policy Report

Wednesday, August 28, 2013

Last updated: Wed, Aug 28

KHN Original Reporting & Guest Opinion

Health Reform

Coverage & Access

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Survey: Big Business May Shift Retirees, Part-Timers To Insurance Exchanges

Kaiser Health News staff writer Jay Hancock reports: "Corporate America is taking a hard look at moving retirees and part-time workers into health insurance marketplaces created by the Affordable Care Act, suggests a survey by the National Business Group on Health. o a lesser extent large companies also expect coverage for their full-time workers employee spouses to shift to the online, state-based marketplaces known as exchanges, according to the annual survey published Wednesday" (Hancock, 8/28). Read the story.

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Capsules: Administration Releases New Rules On Individual Mandate; Americans Hear More About Health Law, But Not From Most-Trusted Sources; ACOs' Coordinated Care Savings May Be Contagious; CDC: Schools Are Getting Healthier; Many Breast-Feeding Moms Unaware Of Health Law Help

Now on Kaiser Health News' blog, Mary Agnes Carey reports on the administration's new individual mandate rules: "As congressional Republicans push for a delay in the 2010 health law's individual mandate, the Obama administration Tuesday announced final regulations implementing the requirement that most Americans have health insurance coverage by Jan. 1 or pay a fine. The document from the Treasury Department and the Internal Revenue Service is in addition to regulations the Department of Health and Human Services published in late June" (Carey, 8/27).

Jordan Rau reports on poll findings indicating that Americans are hearing more about the health law: "The public's awareness of new marketplaces is growing, but potential customers are getting much of their information about the health law from sources they don't trust very much, according to a poll released Wednesday. … Supporters of the law and insurance companies have begun mobilizing to educate people about new insurance offerings. … The most common source of that information was the news media" (Rau, 8/28).

Also on Capsules, Jenny Gold reports on accountable care organizations and savings: "An early cost-sharing program in Massachusetts designed to cut costs for private Blue Cross Blue Shield patients also lowered costs for Medicare patients who were seen by the same providers, according to a study published Tuesday in the Journal of the American Medical Association" (Gold, 8/28).

Meanwhile, Marissa Evans reports on a Centers for Disease Control and Prevention survey about schools' health policies: "Nowadays, the hub for developing healthy habits isn’t just the gym or home. For kids, at least, it's increasingly their schools, according to a study released this week by the Centers for Disease Control and Prevention. School districts across the country are demonstrating a range of improvements in terms of nutrition, exercise and tobacco policies" (Evans, 8/27).

In addition, the Seattle Times' Lisa Stiffler, working in partnership with KHN, reports on a health law provision that helps breast-feeding moms: "New moms crave information, whether it's car-seat safety ratings, the pros and cons of pacifiers or how best to sooth a colicky infant. So it's a little surprising that many moms aren't up to speed on how the Affordable Care Act could benefit them. The law has specific requirements targeting moms, including coverage for breast pumps and consultants to help breast-feeding mothers" (8/27). Check out what else is on the blog.

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Political Cartoon: 'Sawing Red?'

Kaiser Health News provides a fresh take on health policy developments with "Sawing Red?" by Nate Beeler.

Here's today's health policy haiku:


Please stop the presses!
Palin opines: Block funding
for Obamacare

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

Michigan Senate Approves Expansion Of Medicaid

The vote was a victory for Republican Gov. Rick Snyder, who pushed for passage, bucking the sentiments of many in his party. It is now all but certain that nearly half a million residents will gain coverage when Michigan joins the list of states opting to expand the program under the federal health law.

The Wall Street Journal: Michigan Senate Votes To Expand Medicaid
Michigan lawmakers voted to extend Medicaid eligibility to hundreds of thousands of low-income adults in the state after a late legislative session Tuesday, in a boost for the Obama administration as it seeks to roll out its health law this fall. The vote was a victory for Republican Gov. Rick Snyder, who had struggled to persuade GOP legislators in his state to implement a major provision of the health law, which faced strong opposition from his party. The GOP-led state Senate voted 20-18 to expand the Medicaid program in line with the provisions of the federal Affordable Care Act (Radnofsky and Kesling, 8/27).

The New York Times: Medicaid Expansion Battle In Michigan Ends In Passage
Mr. Snyder's preferred bill — one he had lobbied for intensely for months — initially fell short by one vote, but the governor salvaged a deal hours later. The vote in the Republican-controlled Senate was 20 to 18, with only 8 Republicans in favor. The Michigan House, which had earlier approved a similar measure, will need to vote on the Senate version before Mr. Snyder can sign the bill (Davey, 8/27).

Politico: Michigan Moves Toward Medicaid Change
It’s now a near-certainty that a version of Medicaid expansion will land on the desk of Snyder, who had already broken with the GOP base to support the Obamacare program. Supporters say expansion will provide nearly half a million Michiganders with basic health insurance coverage. The federal dollars will also reach a state dealing with the fallout from Detroit’s bankruptcy (Millman and Cheney, 8/27).

Detroit Free Press: Medicaid Expansion Passes After Heated Politicking; 470,000 More Michiganders To Get Coverage
It took two votes and eight hours of mostly closed-door politicking and vote wrangling, but the state Senate approved a plan late Tuesday to expand Medicaid health care coverage to 470,000 low-income Michiganders. The historic 20-18 vote makes Michigan the 25th state in the nation to go ahead with the Medicaid expansion as part of the federal Affordable Care Act, according to the Kaiser Family Foundation. Five more states are debating the issue and 21 have decided not to go ahead with the expansion (Gray, 8/27).

The Associated Press:: GOP-Led Mich. Senate Approves Medicaid Expansion
The GOP governor, who strongly supports Medicaid expansion, had struggled to win backing in a Senate where many conservatives opposed to "Obamacare" have philosophical objections to expanding government. "It's about helping 470,000 Michiganders have a better life," Snyder said during a Capitol news conference after the vote. "Going to the ER for your health care, while we have wonderful people in the ER, is not a good solution" (Eggert, 8/27).

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Obama Administration Releases Final Rules For Individual Mandate

The rules codify the penalties under the 2010 Affordable Care Act, as well as who will be exempt from them.

Kaiser Health News: Capsules: Administration Releases New Rules On Individual Mandate
As congressional Republicans push for a delay in the 2010 health law's individual mandate, the Obama administration Tuesday announced final regulations implementing the requirement that most Americans have health insurance coverage by Jan. 1 or pay a fine. The document from the Treasury Department and the Internal Revenue Service is in addition to regulations the Department of Health and Human Services published in late June (Carey, 8/27).

The Wall Street Journal's Washington Wire: Final Rules Released On Obamacare's Individual Mandate
The Obama administration released final rules Tuesday involving the controversial so-called individual mandate that requires most individuals to carry health insurance starting in 2014 or pay fines. The rules from the Treasury Department codify the amount of penalties called for under the 2010 Affordable Care Act as well who might be exempt from the penalties (Dooren, 8/27).

CNN: IRS Finalizes Penalties For Obama Care "Individual Mandate"
The Internal Revenue Service has issued finalized rules for the individual mandate portion of the Affordable Care Act, President Obama’s healthcare plan. The individual mandate penalty has long been one of the contentious components of health care reform, with lawsuits questioning the constitutionality of the law reaching the Supreme Court (Bentz, 8/28).

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Deadline Delayed For Finalizing Details With Insurance Plans On Federal Exchanges

Reuters reports these agreements are not likely to be signed until mid-September. Also in the news, the race is on to train navigators while, in Washington state, Group Health will omit abortion coverage in exchange plans. And Republicans on Capitol Hill offer a new plan for insuring government officials.  

Reuters: Deadline For Finalizing Obamacare Health Plans
The Obama administration has delayed a step crucial to the launch of the new healthcare law, the signing of final agreements with insurance plans to be sold on federal health insurance exchanges starting October 1. The U.S. Department of Health and Human Services (HHS) notified insurance companies on Tuesday that it would not sign final agreements with the plans between September 5 and 9, as originally anticipated, but would wait until mid-September instead, according to insurance industry sources. ... Nevertheless, Joanne Peters, a spokeswoman for HHS, said the department remains "on track to open" the marketplaces on time on October 1. The reason for the hold-up was unclear. Sources attributed it to technology problems involving the display of insurance products within the federal information technology system (Morgan and Humer, 8/28).

Kansas Health Institute: Weeks Before Obamacare Marketplace Launch, Race Is On To Train Navigators
With open enrollment scheduled to start in about five weeks, the race is on to train workers to help residents around the region obtain health insurance through marketplaces established under the federal health reform law commonly referred to as Obamacare (Sherry, 8/27).

The Seattle Times: Group Health To Omit Abortion Coverage On Plans Sold On State Exchange
Group Health Cooperative will not cover abortion in its individual health-insurance plans being offered through the marketplace put in place by the Affordable Care Act, but says women who buy them will be able to access the service without paying more. Group Health said it made the decision not to include the coverage because of murky regulations about how it would have to account for federal money in plans that offered abortion (Ostrom, 8/27).

Politico: Mike Enzi, David Vitter Aim To Put More Government Officials In Exchanges
Two Republican senators plan to take aim at a recent agreement on Hill health coverage, saying they will introduce legislation requiring the president, vice president, political appointees, members of Congress and their staffs to buy insurance on the exchanges — including those currently exempted under the law. Sens. Mike Enzi (R-Wyo.) and David Vitter (R-La.) said their legislation would also ban everyone in that group from receiving any federal contributions to their health plans — except for congressional staffers (Cunningham, 8/27).

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New Models For Care Coordination And Accountability Cut Costs, Study Finds

The study, published in Tuesday's Journal of the American Medical Association, examined how some approaches that lower spending and improve quality could spill over and benefit other patients.

Kaiser Health News: Capsules: ACOs' Coordinated Care Savings May Be Contagious
An early cost-sharing program in Massachusetts designed to cut costs for private Blue Cross Blue Shield patients also lowered costs for Medicare patients who were seen by the same providers, according to a study published Tuesday in the Journal of the American Medical Association (Gold, 8/28).

Reuters: Obamacare-Like Groups May Produce 'Spillover' Savings
A program focused on primary care and coordination of services between groups of doctors and hospitals reduced costs for patients who were not even covered by the plan, according to a new study. Previous research has found that the Massachusetts accountable care organization, or ACO, saved money and improved quality of care for people it covered directly (Pittman, 8/27).

Modern Healthcare: Study Examines Changes In Spending, Quality For Medicare Beneficiaries
Medicare may enjoy the fruits of the growing and varied work among private payers and providers to boost value in healthcare, though the benefits will come sooner to costs than quality, a study suggests. The research, published in the Journal of the American Medical Association, examined the extent to which strategies that lower spending and improve quality for one group of patients would spill over and indirectly benefit other patients (Evans, 8/27).

Medpage Today: ACOs Can Save Medicare $, Study Finds
An accountable care organization (ACO) established by a private insurer reduced costs of care for Medicare enrollees, a study in Massachusetts found. Providers participating in the Alternative Quality Contract (AQC) -- an early commercial ACO backed by Blue Cross Blue Shield of Massachusetts -- reduced spending on Medicare beneficiaries by 3.4 percent after 2 years compared with enrollee costs at nonparticipating providers, researchers reported in Wednesday's Journal of the American Medical Association. However, the program didn't consistently improve quality of care for Medicare patients, Michael McWilliams, MD, PhD, of Harvard Medical School, and colleagues found (Pittman, 8/27).

The New York Times: Lessons in Maryland for Costs at Hospitals
Yet Western Maryland Health Systems, the major hospital serving this poor and isolated region, is carrying out an experiment that could leave a more profound imprint on the delivery of health care than President Obama’s reforms. Over the last three years, the hospital has taken its services outside its walls. It has opened a diabetes clinic, a wound center and a behavioral health clinic. It has hired people to follow up with older, sicker patients once they are discharged. It has added primary care practices in some neighborhoods. The goal, seemingly so simple, has so far proved elusive elsewhere: as much as possible, keep people out of hospitals, where the cost of health care is highest. Here, the experiment seems to be working (Porter, 8/27).

The Associated Press: States Experimenting To Lower Health Care Costs
Oregon health officials are concentrating on coordinating services and preventing hospital stays. New Jersey medical centers are rewarding doctors who can save money without jeopardizing patient care. And Massachusetts is expanding the role of physician assistants and nurse practitioners (Cooper, 8/28).

Boston Globe: Blue Cross Changes Alternative Quality Contract
In Massachusetts, more than 18,000 doctors care for nearly 700,000 Blue Cross Blue Shield members under an alternative way of paying for medical treatment that is meant to control costs and reward physician groups that keep patients healthier. These physicians may be changing how they treat their other patients as well, a new study suggests (Kowalczyk, 8/27).

In other hospital news -

The Wall Street Journal's Risk & Compliance Journal: Q&A With John Bandy, Memorial Health System
John Bandy was the first information security officer at the 500-bed Memorial Health System, based in Springfield, Ill. Prior to his appointment in 2010, no one in the system had primary responsibility for cyber security. He told Risk & Compliance Journal how he went about building a security program from scratch (Millman, 8/27).

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Sarah Palin Signs Up To Boost 'Defund Obamacare' Effort

Former vice presidential candidate Sarah Palin backs a GOP plan against Obamacare. Meanwhile, battles over funding continue as both sides try to speak louder than the other.

Politico: Sarah Palin Backs Defunding Obamacare
Sarah Palin on Tuesday announced she has signed onto the effort to defund Obamacare, calling it a "beast" that must be stopped. "Forced enrollment in Obama's 'Unaffordable Care Act' is weeks away," the former Alaska governor and GOP vice presidential nominee said in a statement. "This beast must be stopped -- by not funding it. Today, Todd and I joined with many of our fellow citizens to urge those in the U.S. Senate to not fund Obamacare. We the people must continue to make our voices heard and hold those elected to serve this great nation accountable" (Weinger, 8/27).

CNN: Palin Jumps Onto Defund Obamacare Effort
Palin said she was signing onto a petition from the group for the defund Obamacare effort. Backed by Senators Ted Cruz of Texas, Mike Lee of Utah, and Marco Rubio of Florida, the effort presses Republican lawmakers to pledge their opposition to any government funding measure that also funds the Affordable Care Act. ... Many Republicans oppose the tactic, saying even the threat of a government shutdown could alienate voters who are tired of partisan bickering over the nation's finances (Liptak, 8/27).

CNNDefund 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).

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, 8/27).

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Polls Offer Insights About How The Health Law Is Playing Out

One poll, conducted by the Kaiser Family Foundation, found that the public is increasingly aware of the health law and its online insurance marketplaces, but what they are hearing is not necessarily from sources they trust the most. Another survey by Deft Research found that older people are more likely to duck the individual mandate due to cost concerns.

Kaiser Health News: Capsules: Americans Hear More About Health Law, But Not From Most-Trusted Sources
The public's awareness of new marketplaces is growing, but potential customers are getting much of their information about the health law from sources they don't trust very much, according to a poll released Wednesday. … Supporters of the law and insurance companies have begun mobilizing to educate people about new insurance offerings. … The most common source of that information was the news media (Rau, 8/28).

The Hill: Older People More Likely Duck ObamaCare Mandate, Survey Finds
Older people are more likely than their younger peers to flout ObamaCare's mandate to buy health insurance due to cost concerns, according to new research. A new survey of the uninsured by Deft Research, an industry research group, found that younger people will be more likely to enter the new insurance marketplaces because their care will be cheaper overall (Viebeck, 8/27).

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Coverage & Access

Wal-Mart To Offer Health Benefits To Same-Sex Partners Of Employees

The nation's largest private employer said it's making the move to have one policy for the entire company, which must otherwise navigate each state's laws regarding civil unions and domestic partnerships.

Los Angeles Times: Wal-Mart Extends Health Insurance To Workers' Same-Sex Partners
Wal-Mart Stores Inc., the largest private employer in the country, plans to start offering health coverage next year to domestic partners of full-time employees -- including those in same-sex relationships. The extension, outlined in a postcard sent to workers this week, follows a series of recent court rulings in favor of gay marriage around the country (Hsu, 8/27).

The Wall Street Journal: Wal-Mart To Offer Health Benefits To Domestic Partners Of U.S. Workers
The extension of health benefits marks a major change for the country's largest private employer of 1.3 million U.S. workers, which has been targeted by gay-rights advocacy groups for failing to do so. Previously, Wal-Mart had offered benefits to the domestic partners of employees in states that required the retailer to do so by law (Banjo, 8/27).

Reuters: Wal-Mart Offers Health Benefits To U.S. Workers' Domestic Partners
Wal-Mart Stores Inc said on Tuesday it will offer health insurance benefits to domestic partners of its U.S. employees starting next year, following the lead of other major companies. The world's largest retailer, based in Bentonville, Arkansas, also plans to begin to offer vision care to its eligible employees and their dependents, according to information the retailer sent to workers this week (Wohl, 8/27).

The Associated Press: Wal-Mart Expands Benefits To Domestic Partners
Wal-Mart Stores Inc. will extend its health care benefits to its U.S. workers' domestic partners, including those of the same sex, starting Jan. 1. The nation's largest private employer, which has been a target of attacks by labor groups for what they criticize are skimpy wages and benefits, said Tuesday that the changes were made so it could have one uniform policy for all 50 states at a time when some states have their own definitions of what constitutes domestic partnerships and civil unions (D’Innocenzio, 8/27).

The Hill: Wal-Mart Will Offer Health Coverage To Workers' Partners Starting In 2014
The largest private employer in the United States will provide health insurance to the domestic partners of its U.S. workers starting next year in a major victory for gay rights activists. Wal-Mart Stores Inc., the world's largest retailer, announced this week that it will allow employees' partners to receive health benefits under its insurance plans (Viebeck, 8/27). 

In the meantime, before the Department of Veterans Affairs can give benefits to married, same-sex couples, the VA secretary said Tuesday that it needs more clarity from Congress or the courts --

The Associated Press/Washington Post: VA Secretary Says Law Governing Veterans Benefits Contained Similar Language To DOMA
Congress or the courts may still have more work to do before the VA can start providing federal benefits to married, same-sex couples, according to VA Secretary Eric Shinseki. The Supreme Court ruled in June that a law, the federal Defense of Marriage Act, denying federal tax, health and pension benefits to married, same-sex couples was unconstitutional. The law governing veteran's benefits contained similar provisions, Shinseki said (8/27).

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State Watch

State Highlights: Fla. Nursing Homes Quietly Drop Pediatric Units

A selection of health policy stories from New York, Florida, Virginia, California, Pennsylvania and New Jersey.

The Associated Press/Wall Street Journal: NY Doctors Now Required To Check Drug Database
New York doctors, physician assistants and nurse practitioners are now required to check the new statewide drug database before prescribing painkillers, with pharmacists responsible for recording the related prescriptions they fill. The law was enacted last year and took effect Tuesday (8/28).

Miami Herald: Florida Nursing Homes, Under Fire, Phasing Out Pediatric Wings
Even as Florida health regulators vigorously defend against two federal lawsuits accusing them of warehousing sickly and disabled children in geriatric nursing homes, the homes themselves are quietly getting out of the kids business (Miller, 8/27).

The Washington Post: Ken Cuccinelli Vows Not To Support Restrictions On Birth Controls
Virginia Attorney General Ken Cuccinelli II got in a sharp exchange over his past support for "personhood" legislation Tuesday while bringing his campaign pitch for governor to a bipartisan audience of senior citizens in Loudoun County. Cuccinelli (R) faces businessman Terry McAuliffe (D) in the contest to run the commonwealth, and both are focused on wooing vote-rich Northern Virginia (Pershing, 8/27).

Bloomberg: California Senate Bill Allows Nurses To Perform Abortions
California’s Senate gave final approval to a bill allowing nurse-midwives and others to 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).

Sacramento Bee: State Cut May Cost Sacramento County $9 million For Indigent Health Care
Sacramento County officials said Tuesday they could lose $9 million this fiscal year because of state budget cuts that Gov. Jerry Brown and lawmakers tied to the federal health care overhaul. The county has provided indigent health care for 14,000 of its poorest residents who had few other options, receiving state subsidies to help pay for it (Branan, 8/28).

California Healthline: Assembly Approves Biosimilars Bill
The Assembly yesterday passed a bill regulating how biosimilar medications are dispensed -- in advance of biosimilars themselves. The new type of biologic drug is not currently sold, marketed or approved for the U.S. market. That's one of the problems cited by opponents of the bill (Gorn, 8/27).

Philadelphia Inquirer: Medicaid Enrollment Drops In Pa., Rises In N.J.
Pennsylvania dropped more than 9 percent of children, families, and pregnant women from Medicaid last year, nearly triple the rate of any other state, according to a new national report. Most states added people. New Jersey came in 10th from the top, with nearly 5 percent growth - and No. 2 when counting all Medicaid enrollees in all categories. Pennsylvania was last on both measures (Sapatkin, 8/27).

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Editorials and Opinions

Viewpoints: Upton Says GOP Health Ideas Overlooked; Tying Insurance To Jobs Is A Bad Idea

Fox News: Mr. Obama, Republicans Do Have Health Care Solutions
In a troubling denial of reality, President Obama now claims that Republicans have no ideas when it comes to health care, saying "they don't have an agenda to provide health insurance to people at affordable rates." But Republicans do have answers – a lot of them (Rep. Fred Upton, R-Mich., 8/27).

Des Moines Register: Why Tie Insurance To Jobs?
In many households, one spouse buys health insurance through a job for the entire family. Now United Parcel Service Inc. has announced it intends to cut this coverage for working spouses of nonunion employees next year. ... Denying insurance to workers' spouses will certainly create a financial burden for families. ... Now the family needs to purchase two policies to cover both adults in the home. Also, the health insurance offered by the spouse's employer may not cover needed services or may impose higher co-payments and deductibles. Unfortunately, this is how things work in a country that has tied health insurance to employment. We have long recognized that is a bad idea (8/27).

The Wall Street Journal: Medicaid Reform That Works
Medicaid's annual price tag has exploded to $250 billion and is expected to rise even faster once ObamaCare expands the rolls by 30 million. So everyone wants to reduce costs, which is why liberal Rhode Island is the place to look (8/27). 

Miami Herald: State Errs In Obstructing Affordable Care Act
Gov. Rick Scott and the Cabinet are going out of their way to throw a monkey wrench into the process. Last week, they raised phony questions about privacy protection involving the "navigators" who will educate consumers about the new healthcare options and walk them through the enrollment process. This is nonsense. The navigators must comply with privacy and security standards and will not obtain consumers' information without their consent. Why is the Cabinet suddenly taking an interest in the welfare of health-insurance consumers? If the state cared at all, it would have set up its own insurance exchange and backed the effort to the hilt. Instead, it refused. The latest questions seem to be part of a larger effort by Gov. Scott and like-minded political allies to obstruct the process at every turn (8/25).

The Washington Post: Taxing Issues With The Affordable Care Act
Much has been made of the financial hammer that will fall on people who can afford to pay for health care under the Affordable Care Act but choose to forgo coverage. Starting next year, individuals and their dependents are required to have minimum essential health insurance unless they qualify for an exemption. That's why you are hearing so much about the new health-care exchanges, which will have open enrollment from Oct. 1 to March 31 (Michelle Singletary, 8/27). 

Forbes: Medicare's Independent Payment Advisory Board
If we are to avoid the political brinkmanship that has characterized past negotiations over the budget (the fiscal cliff debacle comes to mind) Congress must decide what programs can and should be cut–and they need to do it fast. ... For instance, one program that is up for debate is Medicare's Independent Payment Advisory Board, or IPAB. IPAB was created in 2010 following the implementation of President Obama’s Patient Protection and Affordable Care Act, and is a fifteen-member Government agency tasked with reducing Medicare costs while retaining quality of care. The debate over IPAB has been fierce, and both Republicans and a number of prominent Democrats have come out against the panel. However, despite this, President Obama, in making his requests for the 2014 budget, has proposed that the Independent Payment Advisory Board's authority only be increased (Doug Schoen, 8/27).

Forbes: How Much Will Your Life Be Worth Under Obamacare?
How much will your life be worth to the federal government under ObamaCare? Less than you might think. We can make an educated guess by looking at which medical screening tests the government U.S. Preventive Services Task Force (USPSTF) considers worthwhile. ... Patients (in consultation with their doctors) should be free to decide for themselves whether a medical test or treatment is worth it to them, based on their specific personal and economic circumstances (Paul Hsieh, 8/28). 

The New Republic: Rand Paul's Dangerous Lasik Obsession
Nobody has a "right" to health care, [Sen. Rand Paul] says, because that would mean people have a right to commandeer the labor of those who provide care. ... Of course, Paul is also making a practical argument. With less government interference and regulation, and more people paying for services directly rather than through insurance, the market would bring down prices on its own—and medical care would become more affordable for everybody. As proof, he points to a procedure ophthalmologists know well: Lasik, the laser eye surgery that eliminates the need for glasses or contact lenses. ... Libertarians and conservatives love to cite Lasik. But Lasik tells you almost nothing about the rest of the health care system (Jonathan Cohn, 8/28).

JAMA Internal Medicine: Directing Resources To Where They Are The Most Needed
Today we have highly effective antiretroviral treatment for human immunodeficiency virus (HIV) and a much better marker of how our patients are doing: the HIV viral load. Patients with undetectable virus in their blood are likely to do well as long as they keep taking their medication. The first sign of trouble is an elevated viral load. ... So, if CD4 counts are no longer driving treatment decisions in stable patients who are virally suppressed while receiving antiretroviral treatment, why do we still order these tests? Because it is our habit, and our patients expect it. Although ordering the test likely causes little harm to our patients (unnecessary anxiety if there is a false-negative drop in the count), the tests are expensive (Dr. Mitchell H. Katz, 8/26).

JAMA Internal Medicine: Policing Online Professionalism
It is hard to argue with concerns about the proper use of social media by medical students, residents, and senior physicians. In many instances, medical professionals have posted clearly offensive and inappropriate material. Yet the rush to police online behavior obscures the fact that similar issues have been debated for centuries. To what degree is proper "etiquette" part of a physician's duty? What elements of physicians' private and public lives are patients entitled to know? Should the rights of physicians outside work be more restricted than those of people with other jobs? Revisiting this history may help to develop guidance and regulations that foster professionalism but that do not unfairly restrict the online activities of doctors (Dr. Barron H. Lerner, 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.