Daily Health Policy Report

Tuesday, August 6, 2013

Last updated: Tue, Aug 6

KHN Original Reporting & Guest Opinion

Health Reform

Health Information Technology

Medicare

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Insuring Your Health: Many Consumers With High-Deductible Plans Are Concerned About Health Law Changes

Kaiser Health News consumer columnist Michelle Andrews reports: "In 2014, plans sold on the individual and small group markets will have to meet new standards for coverage and cost sharing, among other things. In addition to covering 10 so-called essential health benefits and covering many preventive care services at no cost, plans must pay at least 60 percent of allowed medical expenses, and cap annual out-of-pocket spending at $6,350 for individuals and $12,700 for families" (Andrews, 8/6). Read the column.

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Cascading Hospital Closures Loom Over Brooklyn

WNYC's Fred Mogul, working in partnership with Kaiser Health News and NPR, reports: "Brooklyn, New York, home to hipsters, an NBA team and a seemingly unlimited supply of new ultra-chic boutiques and restaurants, seems to be increasingly inhospitable to hospitals. Despite the efforts of community activists, elected officials, and blue-ribbon panels, Brooklyn is close to losing two large and historic hospitals, and others might not be far behind" (Mogul, 8/5). Read the story.

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Capsules: Consumers Can Take First Step To Enrolling In New Insurance Options Today; Making Sense Of Premium Rates In Insurance Marketplaces

Now on Kaiser Health News' blog, Phil Galewitz reports on how consumers can begin enrolling in new insurance marketplaces: "Consumers in most states can start the process of enrolling in Obamacare today — but they won't be able to compare health insurance prices or buy coverage in the new federally run insurance online marketplaces until Oct. 1, administration officials said Monday" (Galewitz, 8/5).

Also on the blog, watch Galewitz on C-SPAN's Washington Journal Monday where he talked about health insurance rates in states' health law marketplaces. KHN reporters will be returning to C-SPAN's Washington Journal each Monday throughout the summer (8/5). Checkout what else is on the blog.

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Political Cartoon: 'Observation Care?'

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

SEBELIUS: FLIPPING THE SWITCH OCT.1

She's talking the talk.
Her message: We'll be ready.
Here come exchanges!
-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

Sebelius Disputes 'Rate Shock,' Assures Exchanges' Readiness

Health and Human Services Secretary Kathleen Sebelius said in a call with reporters yesterday that the agency is "on target" to open new online marketplaces Oct. 1. She also spoke about personal "Obamacare" accounts which consumers can begin creating now in advance of being able to shop for plans.

The Wall Street Journal: Preparations For Health Exchanges On Tight Schedule
Opening day for the new health-insurance marketplaces is two months away, but efforts to recruit and train workers to help people enroll are barely off the ground in many states. With time running short before enrollment kicks off Oct. 1, the Obama administration last week cut back on training requirements for these "navigators." Officials were concerned there might not be enough time to do more-extensive training before the health-insurance exchanges open (Schatz, 8/5).

The Associated Press: Personal 'Obamacare' Accounts Debut
You can now open your own personal "Obamacare" account — but you'll have to wait awhile before you can actually use it to pick a health insurance plan. Just eight weeks before the Oct. 1 launch of open enrollment under President Barack Obama's health care overhaul law, administration officials announced Monday that the Affordable Care Act is a step closer to reality for millions of uninsured Americans (Alonso-Zaldivar, 8/5).

Kaiser Health News: Capsules: Consumers Can Take First Step To Enrolling In New Insurance Options Today
Consumers in most states can start the process of enrolling in Obamacare today — but they won't be able to compare health insurance prices or buy coverage in the new federally run insurance online marketplaces until Oct. 1, administration officials said Monday (Galewitz, 8/5).

Atlanta Journal Constitution: Obamacare Now Accepting Sign-Ups
Uninsured consumers can now go online at healthcare.gov to create a personal account as a first step to getting health coverage under Obamacare, Health and Human Services Secretary Kathleen Sebelius said Monday. While consumers will have to wait for the marketplace of insurance plans and premiums to open, they can at least establish a username and password (Seward, 8/5).

USA Today: HHS Starts Features To Help Consumers Learn Insurance
About 7 million Americans are estimated to start buying health insurance as part of the new law, but a new survey shows they don't understand the basics of how health insurance works or is provided (Kennedy, 8/5).

McClatchy: Some States Misreporting Health Insurance Costs, HHS' Sebelius Says
Health and Human Services Secretary Kathleen Sebelius said Monday that some state reports blaming Obamacare for sharply higher health insurance premiums next year were "factually incorrect." Sebelius didn't say which states she was referring to, but her push-back comes after GOP-led states such as Ohio, Georgia and Indiana recently warned of large premium rate hikes next year due to the Affordable Care Act (Pugh, 8/5).

CQ HealthBeat: Sebelius Disputes New 'Rate Shock' Claims By Some States
Health and Human Secretary Kathleen Sebelius on Monday challenged recent claims by state officials that insurance premiums will zoom next year in the new exchanges opening under the health law. Information put out at the state level is "in a couple of very specific instances ... just factually incorrect," Sebelius said in a telephone briefing updating reporters on health care law implementation (Reichard, 8/5).

The Washington Post's Wonk Blog: HHS Shielding Obamacare Outreach From Sequester Cuts
The health insurance marketplaces launch eight weeks from Tuesday, and Health and Human Services Secretary Kathleen Sebelius would like you to know that her agency is "on target and ready to flip the switch on October 1." … Sebelius spent about a half-hour earlier Monday answering a wide range of questions from reporters, mostly on the launch of the marketplaces, whether her department would be ready and what to expect in coming weeks (Kliff, 8/5).

CQ HealthBeat: OIG: CMS Must Complete 'Critical Tasks' To Assure Data Hub Security
The federal data hub that could make or break whether health insurance exchanges open on time on Oct. 1 won’t be designated as secure until the day before, according to a new analysis by the Health and Human Services Office of the Inspector General. In March, a timetable by the Centers for Medicare and Medicaid Services had built in more time between the hub being authorized as secure and the opening of exchange enrollment (Reichard, 8/5).

In related news -

The Hill: AARP Unveils Websites To Help Consumers Navigate ObamaCare
The top U.S. senior lobby is launching online tools to help consumers navigate ObamaCare and their new coverage options. AARP announced Monday that it has launched two websites — healthlawanswers.org and healthlawfacts.org — ahead of the enactment of the healthcare reform's major provisions (Viebeck, 8/5).

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In Maine, A First Look At Rates For Health Plans Available On The Exchange

News outlets also report on state efforts to implement the health law's online insurance marketplaces in Connecticut and Hawaii.

The Associated Press: Maine Compares Proposed Rates On Health Exchange
Maine residents buying health care coverage on the exchange this winter are getting their first look into how the rates compare for the various proposed plans. The state recently released side-by-side comparisons of the plans offered by Maine Community Health Options, a new health cooperative, and Anthem Blue Cross Blue Shield, the two companies offering coverage for individuals on Maine’s federally run exchange (Durkin, 8/5).

CT Mirror: Obamacare Insurance Rates Get Final Approval
The Connecticut Insurance Department has approved prices for health plans to be sold through Access Health CT, the new marketplace created by federal health reform. The monthly premiums for plans sold through Access Health's individual market range from $197 per month for a 21-year-old in Hartford County to $893.88 a month for a 64-year-old in Fairfield County (Becker, 8/5).

The Associated Press: 34 Hawaii Groups Win Grants To Sell Health Care
Hawaii's health insurance marketplace has awarded grants to 34 community organizations to help uninsured people learn about insurance options under President Barack Obama's signature health care law. The grants announced Monday total $6.7 million. ... The funds will be used to hire 191 assisters to directly talk with people about coverage options available in the marketplace, which begins open enrollment in October. Hawaii Gov. Neil Abercrombie said the grants are part of a statewide, community-based approach to informing and assisting residents with their health care (Garcia, 8/5).

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Employers' Coalition Seeks Mandate Delay 'Clarity'

In addition, the Obama administration's decision to delay the health law's employer mandate is having a ripple effect regarding other initiatives.

The Hill: Employers Urge More Clarity On ObamaCare Mandate Delay
A group of service-industry employers is asking the Obama administration for more clarity on the delay of ObamaCare's employer mandate, specifically how the decision will affect past guidance on the policy. The Employers for Flexibility in Healthcare (E-FLEX) Coalition wrote to three Cabinet secretaries on Monday asking for details on how previously released transition rules will apply in light of the mandate deferral (Viebeck, 8/5).

The Associated Press/Washington Post: Delaying Health Care Law's Employer Mandate Provides Fodder For Immigration Bill Opponents
For many House conservatives, President Barack Obama's decision to delay a central provision of his health care law has emerged as a major arguing point — not against that law but in opposition to immigration legislation. In the weeks since the announcement that employers won't have to provide health insurance for another year, complaints have increased among House Republicans that they can't trust the Obama administration to implement any law they pass. That includes strict requirements for immigrants, tighter border security and genuine workplace hiring enforcement (8/6).

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Health Information Technology

Survey: Consumers Reluctant To Enter Health Care's Digital Age

The Wall Street Journal's Risk & Compliance Journal: Electronic Medical Records Go Largely Unused: Survey
Most hospitals have implemented electronic medical records, but only 24% of consumers are making use of them, a new study shows. Hospital CIOs are working on ways to boost adoption of EMRs, which have been tied to improvements in health care, as well as billions of dollars in federal incentive payments. About 80% of hospitals make EMRs available, but the new report from researchers ... shows this is one area where consumers are reluctant to enter the digital age (Boulton, 8/5).

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Medicare

Hospitals To Face More Severe Penalties For Patients' Readmissions

News coverage continues regarding the Centers for Medicare & Medicaid Services' hospital readmissions reduction program with details of a final rule released Friday and a local look at how hospitals are faring in Georgia and Missouri.  

Modern Healthcare: Severity Of Readmission Punishments Doubling For Hospitals
The number of hospitals facing financial penalties for failing to stop patients from returning to the hospital will remain steady next year, but the potential severity of the punishments is doubling. The CMS' hospital readmissions reduction program is expected to cut Medicare spending on hospitals by about $227 million during the federal fiscal year starting Oct. 1, according to a 2,225-page final rule published Friday afternoon (Carlson, 8/5).

Georgia Health News: Most Hospitals In State Face Readmission Fines
Medicare will impose fines on 73 Georgia hospitals for excessive readmissions of patients within 30 days of discharge. Kaiser Health News reported that 68 percent of eligible hospitals in the state received a penalty — roughly the national average (Miller, 8/5).

St. Louis Post-Dispatch: Most St. Louis Area Hospitals Improve Readmissions
Readmission rates at Barnes-Jewish Hospital have improved, but the hospital still faces a federal penalty of more than $1 million. Similarly, most other St. Louis-area hospitals have reduced their numbers of Medicare patients who are readmitted within a month of discharge. But those hospitals, too, will pay substantial fines over the next year (Doyle, 8/5).

Earlier, related KHN coverage: Armed With Bigger Fines, Medicare To Punish 2,225 Hospitals For Excess Readmissions (Rau, 8/2).  

In other news related to Medicare and health care quality -

Medpage Today: Doc's Level Of Liability Worry Drives Testing
Office-based physicians who reported a high level of concern about medical malpractice lawsuits were more likely to practice defensive medicine, ordering aggressive diagnostic testing, a review of Medicare claims and physician surveys found. For instance, physicians with a high or medium level of malpractice concern were more likely to refer patients with chest pain to the ED (3.4 percent and 3.7 percent respectively) than were physicians with a low level of malpractice concern (2.5 percent). Both differences were significant atP≤0.05, according to a study published in the August issue of Health Affairs (Pittman, 8/5).

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State Watch

Doc-Owned Hospitals Thriving In Texas Despite Ban From Medicare, Medicaid

In the meantime, Brooklyn deals with imminent hospital closures and what it means for care in the New York City borough.

Dallas Morning News: Physician-Owned Hospitals Expand In Dallas-Fort Worth
George Ten Eyck is prepped for surgery by Christine Varela, a registered nurse, at Victory Healthcare in Hurst. The facility is part of a physician-owned chain that is growing despite not taking Medicare or Medicaid patients. Physician-owned hospitals in North Texas are finding ways to expand despite being banned from accepting Medicare and Medicaid patients (8/5).

Kaiser Health News: Cascading Hospital Closures Loom Over Brooklyn
WNYC's Fred Mogul, working in partnership with Kaiser Health News and NPR, reports: "Brooklyn, New York, home to hipsters, an NBA team and a seemingly unlimited supply of new ultra-chic boutiques and restaurants, seems to be increasingly inhospitable to hospitals. Despite the efforts of community activists, elected officials, and blue-ribbon panels, Brooklyn is close to losing two large and historic hospitals, and others might not be far behind" (Mogul, 8/5).

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State Highlights: Va. Governor Hopefuls Talk Mental Health, Medicaid Expansion

A selection of health policy stories from Virginia, New York, Connecticut, Massachusetts and California.

The Washington Post: Cuccinelli, McAuliffe Address Mental Health
Ken Cuccinelli II touted tax cuts and preschool vouchers while Terry McAuliffe embraced Medicaid expansion Monday night as the candidates for Virginia governor laid out different visions for improving mental health in Virginia. The rivals to succeed Gov. Robert F. McDonnell (R) appeared at a candidate forum for mental-health advocates and families affected by mental illness. Sponsored by a coalition of mental health organizations, the event drew several hundred people to an auditorium at Collegiate School in suburban Richmond (Vozzella, 8/5).

The Wall Street Journal: House Probes Cuomo Role In Audit Delay
A U.S. congressional oversight committee has opened an investigation into whether Gov. Andrew Cuomo's office interfered with a Medicaid audit of the Visiting Nurse Service of New York, the nation's largest nonprofit home-health company. The audit under scrutiny is one of the most intensive and time-consuming ever conducted by the state's Office of the Medicaid Inspector General, a state agency that supervises financial inspections of New York's $56 billion-a-year Medicaid program, according to two people familiar with the audit (Gershman, 8/5).

CT Mirror: Report: Strong Children's Mental Health Services, But Limited Access
When Jeffrey J. Vanderploeg goes to national conferences and talks about the mental health services available to children and adolescents in Connecticut, his counterparts from across the country let him know how the state compares (Becker, 8/5).

WBUR: Mass. Survey: Happy With Health Care, Concerned About Costs, ER Use Up
Last month, the Massachusetts Medical Society released its findings on how hard it is to get in to see a primary care doctor in the state. Reminder: Often pretty hard. Today, the society dropped the second shoe of its state-wide data on the health care system: So how are we feeling about it? (Goldberg, 8/5).

California Healthline: Central Valley Tries Anti-Obesity Tactics
The town of Ceres, near Modesto, is like many small towns in the San Joaquin Valley. The farmworkers who pick the fruits, nuts and vegetables or work in the canneries often don't have convenient ways to buy the produce they harvest. ... It's a story that can be told time and again in the small towns and unincorporated areas that dot the eight counties that make up the San Joaquin Valley. It's a story the advocates at the Central California Regional Obesity Prevention Project, or CCROPP, are trying to rewrite (Daniel, 8/5).

California Healthline: Can Health Reform Help Reduce Violence?
The Affordable Care Act could present opportunities for cities and counties to implement policies aimed at reducing violence, according to community leaders and violence prevention experts at a forum last week in Sacramento. "In the context of health reform, I think there are opportunities we've never seen before that really emphasize the value of violence prevention," said Leslie Mikkelsen, managing director for the Prevention Institute, a not-for-profit based in Oakland that runs health and violence prevention programs (Hart, 8/5).

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Editorials and Opinions

Viewpoints: Health Law's Marketing Challenge; GOP Not To Blame For Implementation Challenges

The Wall Street Journal's Capital Journal: Obamacare's Challenge: A Skeptical Public
More than half of working-class whites say [the federal health law] is a bad idea. Perhaps most stunningly, so do 48% of those currently without health insurance—the very people who stand to gain the most, in the form of help finding and paying for coverage. Meanwhile, by a 30-point margin, political independents think they will be worse off under the law. Let's just say the Obama administration has some marketing work to do. That is the backdrop Democrats face heading into a fall in which the big health overhaul begins kicking in (Gerald F. Seib, 8/5). 

USA Today: Excuse Me? GOP To Blame For Obamacare?
The Affordable Care Act— aka Obamacare— is off to a very rocky start, and according to the law's biggest defenders, the blame falls squarely at the feet of Republicans. It's an odd claim. Republicans did not write the law. They did not support the law. And they are not in charge of implementing it. Yet, it's got to be the GOP's fault, right? (Jonah Goldberg, 8/5). 

Bloomberg: Republicans Don’t Need To Sabotage Obamacare
David Morgan, who reports on health care at Reuters, could teach a class on how to spin a story. The Obama administration, he tells us in the lead of a recent article, is "poised for a huge public education campaign" about the health-care law. Opponents, however, aren’t "educating people" when they argue that the law is flawed. No, they’re engaged in "political maneuvers," following a "political playbook" and trying out "ploys" (Ramesh Ponnuru, 8/6). 

Los Angeles Times: Obamacare's Not-So-Special Treatment For Congress
The [Wall Street] Journal's fusillade was prompted by the Obama administration's effort to keep congressional staff members from being hurt by a pernicious feature of the 2010 law. Added by Republican Sen. Charles Grassley of Iowa during the Senate Finance Committee's mark-up, the provision requires members of Congress and their staff to obtain health insurance through the new exchanges established by the law. To the Journal, this is the sort of eat-your-own-dog-food requirement that forces lawmakers to experience what they impose on their constituents (Jon Healey, 8/5).

The Washington Post: For A Stiff Neck, Nearly $6,000 In Physical Therapy Seemed Too Much
When I showed up for my appointment, the front-desk clan was positively giddy with the news that my insurance plan would cover up to 12 physical therapy visits per quarter. And because it was the middle of June, they urged me to book 11 more sessions right away to take full advantage of my coverage this quarter. My only cost would be a $10 co-pay each time. I found it odd that the front-desk folks wanted me to book 11 more sessions before their therapist had even seen me. I said I would let them know (Chris Core, 8/5). 

Politico: Bipartisan Health Reform That Works
The debate over health-care policy has become so polarized that it's hard to see how progress on any new reforms can be possible. But here’s a health-care reform that can attract bipartisan support: transparency in price and quality information (Lanhee Chen and Topher Spiro, 8/5).

Governing: Feds Offer States Deal To Seal Medicaid HIV-Testing Holes
Though routine HIV screenings are recommended by America’s foremost public health authorities and tens of thousands of people are living in the United States with undiagnosed HIV, according to the Centers for Disease Control and Prevention (CDC), half of state Medicaid programs don't cover preventive testing. ... Part of the problem is that the public health sphere only recently came to the consensus that routine screens should be the norm. The CDC has recommended coverage of routine testing since 2006, but another critical player—the U.S. Preventive Services Task Force—didn’t recommend routine screenings until this April. The task force's recommendations serve as a benchmark for insurers, including Medicaid, as they decide what to cover (Dylan Scott, 8/5).

Madison (Wis.) Capitol Times: Let Counties Accept New Medicaid Funds
Locally elected officials from 20 counties across Wisconsin wrote to the Department of Health Services proposing an alternative local means for accepting our federal Medicaid funds. The letter called on DHS Secretary Kitty Rhodes to request a demonstration pilot project in Wisconsin that would allow interested counties the opportunity to access these federal enhanced Medicaid funds in order to fully benefit from our federal tax dollars and directly help our citizens. This proposal was modeled after Cuyahoga County in Ohio, which received a federal waiver to receive funds through the federal Medicaid expansion (State Rep. Melissa Sargent, 8/5).

Atlanta Journal-Constitution: U.S. Health Care System Must Be World’s Least Efficient
If we can set aside just for a moment the divisive debate over the pros and cons of Obamacare, the more fundamental issue is not how we pay for health care in this country, but rather how much we pay. How is it possible for other Western industrialized nations to provide care of similar or better quality, but for a mere fraction of the cost here? How does Belgium install eight or 10 rip replacements for the cost of one such replacement here in the United States? (Jay Bookman, 8/5).

Chicago Sun-Times: Government Shutdown Is No Cure For Obamacare
Health care in America has long cost too much and delivered too little. Some anti-Obamacare Republicans in Congress seem to think that's an applause line. In a move even some of their own party leaders are calling dumb, members of the Tea Party wing are threatening to shut down the government after Sept. 30 unless Democrats agree to strip out all funding for the Affordable Care Act, also known as Obamacare (8/5).

Los Angeles Times: My Melonoma, My Message
This summer, the FDA is considering new regulations for tanning beds. Currently they are regulated by the FDA as Class I medical devices, the same designation given Band-Aids and tongue depressors. Under the proposed regulations, tanning beds would have to add labels warning young people not to use them and to encourage those who do to undergo skin cancer screening. In addition, suppliers of tanning bed products would be required to demonstrate to the FDA that the electrical systems are safe, the lamps emit the right amount of energy and timers are working properly. ... people have to understand that there is no such thing as a healthy tan, particularly one that comes from a tanning bed (Travis Kidner, 8/5). 

JAMA: Who Is Now Responsible for Discovering And Warning About Adverse Effects Of Generic Drugs?
Manufacturers of brand-name and generic drugs now face different legal responsibilities for warning about the risks of what are the same drugs. Brand-name manufacturers must closely monitor the safety of their products after approval and update the adverse effects sections of their labels as necessary or else be subject to pay substantial damages based on liability to injured patients. By contrast, generic manufacturers do not face such liability. Thus, once a brand-name company’s exclusivity ends and its market share declines, or it stops production altogether, active pharmacovigilance is likely to end, reducing the chance of discovering rare or delayed adverse effects later in a drug’s market life that could vitally inform prescribing practice or change a product’s risk-benefit assessment (Dr. Aaron S. Kesselheim, Michael D. Green and Dr. Jerry Avorn, 8/5).

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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.