Daily Health Policy Report

Wednesday, August 6, 2014

Last updated: Wed, Aug 6

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Medicare

Veterans Health Care

Public Health & Education

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

A Tennessee Insurer Uses Its Monopoly To Deliver Bargain Premiums

Kaiser Health News staff writer Jordan Rau reports: “The dominion of Tennessee’s largest health insurer is reflected in its headquarters’ lofty perch above the city, atop a hill that during the Civil War was lined with Union cannons to repel Confederate troops. BlueCross BlueShield of Tennessee has used its position to establish a similarly firm foothold in the first year of the marketplaces created by the health law. The company sold 88 percent of the plans for Tennessee individuals and families. Only one other insurer, Cigna, bothered to offer policies in Chattanooga, and the premiums were substantially higher than those offered by BlueCross” (Rau, 8/6). Read the story, which also appeared in The Tennessean.

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Capsules: Advocates Say Florida Consumers To Pay For State Lawmakers’ Decision; Survey: Insurance Rates Lag In Health Law Holdout States; Large California Insurers Invite Others To Join Data Network

Now on Kaiser Health News’ blog, Capsules, Phil Galewitz reports on the impact of Florida lawmaker’s decision to cancel the state’s rate review authority: “Republicans were quick to pounce Monday on Florida’s announcement that residents buying health insurance on the individual market for next year will face a 13.2 percent average increase in monthly premiums — one of the steepest rate hikes announced for any state. ‘Obamacare is a bad law that just seems to be getting worse,’ said Florida Gov. Rick Scott, a Republican who is running for re-election. But consumer advocates and Sen. Bill Nelson, D-Fla., the state’s former insurance commissioner, blame the increases on Florida lawmakers’ decision last year to suspend the state’s authority to negotiate and approve premiums on policies sold to people who buy insurance themselves instead of getting it through an employer” (Galewitz, 8/5).

In addition, Eric Whitney reports on findings from a new Gallup poll: "The latest Gallup survey found that, nationwide, the number of uninsured Americans dropped from 18 percent in September 2013, to 13.4 percent in June 2014. States that chose to follow the ACA’s provisions most closely, both by expanding Medicaid and establishing their own new health insurance marketplaces, as a group saw their uninsured rate drop nearly twice as much as states that declined to do so" (Whitney, 8/6).

Also on the blog, Anna Gorman reports on plans for California's health data network: "Now that two of California’s biggest health insurers have teamed up on a project to share patients’ digitized medical records, they are planning to invite other companies to join. The project will initially cover about 9 million Californians, making it possible for doctors and hospitals to quickly access patients’ medical histories and avoid unnecessary tests and procedures (Gorman, 8/6). Check out what else is on the blog.

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Political Cartoon: 'Court Of First Resort?'

Kaiser Health News provides a fresh take on health policy developments with "Court Of First Resort?" by Adam Zyglis.

Meanwhile, here's today's haiku:

DOES MORE MEAN BETTER?

More and more patients
So better health care also?
Have to wait and see
-Keanan Lane 

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

Gallup Survey: States That Embraced Health Law See Big Drops In Uninsured

The study found that states that expanded Medicaid and set up their own exchanges experienced greater declines in the rate of uninsurance than those that didn’t. Nationwide, the percentage of uninsured Americans dropped from 18 percent in September 2013, to 13.4 percent in June 2014, according to the survey. 

Los Angeles Times: Divide Between Red And Blue States Over Healthcare Deepens
States that have aggressively put the Affordable Care Act into practice have cut the number of uninsured residents sharply -- in some cases in half or better -- while those that balked have improved little if at all, according to new data released Tuesday. The state-by-state numbers, from the Gallup-Healthways Well-Being Index, reinforce one of the major impacts of Obamacare so far: Political debate has widened the healthcare gap between red and blue states (Lauter, 8/5).

The Wall Street Journal’s Washington Wire: Study: States Embracing Obamacare See Biggest Drops In Uninsured
Some states that expanded Medicaid under the Affordable Care Act and set up all or part of their own insurance exchanges have seen a marked drop in the number of uninsured adults. The uninsured rates in states that opted to expand Medicaid, a health program primarily for low-income residents, and set up their own exchanges declined more in the first half of 2014 than in the states that didn’t take that approach, according to a study released Tuesday by Gallup. The survey was based on a random sample of adults through June 30 (Armour, 8/5).

Kaiser Health News: Capsules: Survey: Insurance Rates Lag In Health Law Holdout States
A Gallup poll released Tuesday says that the Affordable Care Act is significantly increasing the number of Americans with health insurance, especially in states that are embracing the law. It echoes previous Gallup surveys, and similar findings by the Urban Institute and RAND Corp. The latest Gallup survey found that, nationwide, the number of uninsured Americans dropped from 18 percent in September 2013, to 13.4 percent in June 2014. States that chose to follow the ACA’s provisions most closely, both by expanding Medicaid and establishing their own new health insurance marketplaces, as a group saw their uninsured rate drop nearly twice as much as states that declined to do so (Whitney, 8/6).

The Associated Press: Poll: Obama Health Law Is A Tale Of 2 Americas
President Obama’s health care law has become a tale of two Americas. States that fully embraced the law’s coverage expansion are experiencing a significant drop in the number of uninsured residents, according to a new survey released Tuesday. States whose leaders still object to the measure are seeing much less change. The Gallup-Healthways Well-Being Index found an overall drop of 4 percentage points in the share of uninsured residents for states accepting the law’s core coverage provisions. Those are states that expanded their Medicaid programs and also built or took an active role managing new online insurance markets (Alonso-Zaldivar, 8/6).

Seattle Times: Washington 4th In Reducing Uninsured Residents
The percentage of Washington residents without health insurance dropped from 16.8 percent last year to 10.7 percent by mid-2014 according to a national survey released Tuesday by Gallup. Only Arkansas, Kentucky and Delaware had larger declines in the percentage of uninsured residents. Oregon ranked 7th. The reductions come as a result of the Affordable Care Act, which sought to expand coverage through discounted health insurance and an expansion of who is eligible for free insurance through Medicaid. States were given the option of setting up and running their own online insurance marketplace or exchange, operating an exchange in partnership with the federal exchange, or solely using the federal exchange. They also could decide whether to expand Medicaid to cover more people (Stiffler, 8/5). 

Oregonian: Oregon Among Biggest Gainers In Health Insurance Coverage, Gallup Poll Says
Despite problems with its health insurance exchange, Oregon ranks among the top 10 states for a drop in the number of uninsured, according to a new Gallup poll. A telephone survey showed 14 percent of Oregonians were uninsured through midyear 2014, compared to 19.7 percent uninsured last year (Budnick, 8/5).

The Hill: Fewer Uninsured in Arkansas, Kentucky
Gallup said Tuesday that Arkansas and Kentucky have seen their rates of uninsured people fall the most since the healthcare law was implemented. The rate of uninsured in Arkansas dropped from 22.5 percent in 2013 to 12.4 percent this year according to Gallup. Similarly, the rate of uninsured fell from 20.4 percent to 11.9 percent in Kentucky. The statistics are significant since Arkansas and Kentucky are home to two of the hottest Senate races in the country and could help determine which party controls the upper chamber next year (Al-Faruque, 8/5).

The Fiscal Times: Uninsured Dropped Fastest in Senate Battleground States
The president’s healthcare law is about to make things on the campaign trail a little more interesting.That’s because a new Gallup poll shows that Obamacare is significantly cutting the uninsured rate in states with hotly contested Senate races where Republicans have campaigned using a strict anti-Obamacare strategy. In Kentucky, for example, where Senate Minority Leader Mitch McConnell has routinely called the health care law a disaster—ACA provisions have carved the state’s uninsured rate down from 20.4 percent to 11.9 percent (Ehley, 8/5).

The Hill: Most Back O-Care Subsidies On Both State and Federal Exchanges
A majority believes ObamaCare subsidies should be legal on both the state and federal exchanges, according to a poll released Tuesday. Fifty-eight percent of registered voters in a Morning Consult survey said all ObamaCare enrollees should be eligible for subsidies to reduce premium costs regardless of whether their insurance plan was bought on exchanges set up by states or the federal government. Only 15 percent thought otherwise (Al-Faruque, 8/5).

The Washington Post’s Wonkblog: People Don’t Get The New Obamacare Lawsuits, But They Think All Exchanges Should Provide Subsidies
It's been two weeks since a pair of federal appellate courts issued split rulings on whether Obamacare actually authorizes the 36 states relying on federal-run health insurance exchanges to provide premium subsidies helping low- and middle-income residents purchase coverage. If the legal argument pushed by critics of the law ultimately prevails, it could pretty much up-end the exchanges in states that have deferred responsibility to the federal government (Millman, 8/5).

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Officials Confront Health Law Paperwork Backlog

Meanwhile, health law insurance subsidy calculations by the Internal Revenue Service may not have been as inaccurate as first thought, an audit suggests. And the Milwaukee Journal Sentinel parses the health law stances of candidates in the race for governor.

Fox News: HHS Grapples With Massive Obamacare Backlog
Now that the Obamacare exchange websites are largely up and running, federal health officials are finding themselves swamped as they fact-check a flood of paperwork from applicants seeking taxpayer subsidies. The Department of Health and Human Services seems to be caught between critics on both sides as it confronts the task. The department, which oversees the implementation of the Affordable Care Act, has gotten hit by audits showing it hasn't done enough to crack down on fraudsters trying to scam the system. At the same time, some frustrated applicants say they have played by the rules -- signed up on time and submitted the necessary paperwork -- only to be caught up in bureaucratic red tape (Chakraborty, 8/5).

The Hill: O-Care Subsidy Calculations Accurate Last October, Audit Finds
The Internal Revenue Service (IRS) might have a better track record in determining Obamacare premium subsidies than previously thought, a new audit suggests.  A government investigation released Tuesday found that the agency was 100 percent accurate in calculating the maximum monthly subsidy for all requests in the first two weeks of October.  While the report did not track activity throughout Obamacare's first enrollment period, it hints that reports of more than 1 million incorrect subsidy determinations may overstate the problem.  The investigation was released by the Treasury Department's Inspector General for Tax Administration (TIGTA) (Viebeck, 8/5).

Milwaukee Journal Sentinel: Gov. Scott Walker And Mary Burke On The Affordable Care Act
The Milwaukee Journal Sentinel is taking a closer look at the positions being taken by Republican Gov. Scott Walker and Democrat Mary Burke, a former Trek Bicycle executive and state Commerce secretary. Each week, the newspaper will be putting questions on key issues to Burke and Walker and then running their answers on the All Politics Blog, in regular stories and in larger packages that will run closer to the November election. Here’s the next question and set of answers, this time on the Affordable Care Act: Did Wisconsin make the right decision by declining to create its own online health insurance marketplace under Obamacare and by declining to accept additional federal money to expand the state’s BadgerCare Plus Medicaid coverage? (Stein, 8/5).

And many low-income patients are still finding it difficult to get specialty care under the health law --

Milwaukee Journal Sentinel/Pittsburgh Post-Gazette: Access To Specialty Health Care Out Of Reach For Low-Income Patients
[Myrtis] Henderson, who is in her 40s, is one of many patients who fall into a yawning gap in the nation's health safety net. They need care from a specialist but are unable to get it because they don't have insurance or have inadequate coverage. They either can't get a specialist to accept them as a patient or can't afford to pay up front for the visit. The gap exists because many clinics for low-income patients have only primary care doctors and nurses on staff and often have no direct connection with specialists, who are typically affiliated with hospitals or large practices. Even when they do have connections, they can't always arrange timely, affordable specialty care. And many specialists aren't eager to take low-income patients because they aren't likely to be reimbursed well for the care. While the Affordable Care Act opens up coverage to patients who didn't have it before, some plans carry deductibles that are so high patients still can't afford to see specialists. (Hamill, 8/5).

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Some States Boost Transparency Of Insurance Rate Review Amid Criticism

Connecticut regulators deny an insurer's proposed rate increase but criticize the state's public hearing process. Meanwhile, Illinois officials give the public online access to rate filings and Florida advocates blame state lawmaker's suspension of rate review for the big premium increases in that state.

CT Mirror: Do Public Hearings Influence What Health Insurance Costs?
A Fairfield County couple traveled to Hartford in June to urge regulators not to let Anthem Blue Cross and Blue Shield raise rates on close to 66,200 health insurance policies, including their son's. It was the first public hearing in nearly four years on a proposal to raise individual-market health insurance rates in the state. A month later, the Connecticut Insurance Department rejected Anthem’s proposal and suggested it seek a smaller rate increase. But what role did the public hearing have in that outcome? Not much, according to the department’s written decision (Levin-Becker, 8/6).

Kaiser Health News: Capsules: Advocates Say Florida Consumers To Pay For State Lawmakers’ Decision
Republicans were quick to pounce Monday on Florida’s announcement that residents buying health insurance on the individual market for next year will face a 13.2 percent average increase in monthly premiums — one of the steepest rate hikes announced for any state. ‘Obamacare is a bad law that just seems to be getting worse,’ said Florida Gov. Rick Scott, a Republican who is running for re-election. But consumer advocates and Sen. Bill Nelson, D-Fla., the state’s former insurance commissioner, blame the increases on Florida lawmakers’ decision last year to suspend the state’s authority to negotiate and approve premiums on policies sold to people who buy insurance themselves instead of getting it through an employer (Galewitz, 8/5).

The Associated Press: Illinois Opens Insurance Rate Records to Public
State officials announced Tuesday that Illinois is giving the public online access for the first time to forms filed by insurers when they set the rates they'll charge, a move that consumer advocates called a step in the right direction. "We are pleased to provide consumers direct access to review rate and form filings," said Department of Insurance Director Andrew Boron in a statement. Public access online "demonstrates our commitment to protecting consumers by providing assistance and information which fosters a competitive insurance marketplace," he said (Johnson, 8/5).

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Rural Residents Pay More For Exchange Plans

Rural residents paid slightly higher premiums for exchange health plans than their city counterparts, reports Modern Healthcare. Meanwhile, Vermont's GOP leaders say they want the state's health insurance exchange to succeed, but residents are fed up with problems.

Modern Healthcare: Rural Residents Pay More for Exchange Plans Than City Dwellers
Rural residents paid slightly higher premiums on exchange plans in 2014 than their urban counterparts, according to a new analysis of plan filings. The average monthly premium for the second-cheapest silver plan, which is designed to cover 70% of medical costs, was $387 in rural counties, compared to $369 for urban counties. But those in states with a large percentage of rural residents, regardless of where they lived, saw significantly higher premiums this year. For states with less than 5% of residents living in rural counties, the average premium was $402. But for states where more than half of the population lived in rural counties, the average monthly premium was $452 (Demko, 8/5).

The Associated Press: Vermont GOP Leaders Want Health Reform
The three top Republicans in the Vermont Legislature said Tuesday they want the state's health care exchange to succeed but state residents are fed up with the problems the system is having and more options should be considered to ensure those problems are fixed. Lt. Gov. Phil Scott, Senate Minority Leader Joe Benning and House Minority Leader Don Turner spoke a day after the administration of Democratic Gov. Peter Shumlin announced the state is reducing its ties with CGI, the company that developed the problem-plagued Vermont Health Connect website (Ring, 8/5).

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Capitol Hill Watch

Wis. Senator Seeks To Appeal Recent Decision Regarding His Health Law Challenge

The focus of the lawsuit by Sen. Ron Johnson, R-Wis., is an Office of Personnel Management regulation that allows congressional staffers to get their health care subsidized under the law’s exchanges. In other news, health issues are emerging as flashpoints in this year's Arkansas senate race.

The Fiscal Times: Another Lawmaker Sues Obama Over Health Care Law
Sen. Ron Johnson (R-WI) filed an appeal on Monday to his lawsuit challenging a ruling issued by the Office of Personnel Management that allows congressional staff members to get their health care subsidized under the law’s health exchanges. Under the Affordable Care Act, many on Capitol Hill and in the executive branch were required to trade in their government health insurance policies and purchase replacement policies in the new Obamacare insurance exchanges. The OPM ruling allowed them to get federal subsidies to act as employer contributions—just as their previous government policies did. Johnson’s lawsuit would overturn that ruling, forcing members and their employees to pay the full cost of premiums out of their own pockets (Ehley, 8/5).

The Associated Press: New Ads Buys Escalate Arkansas Senate Race
The Democratic Senatorial Campaign Committee’s new ad buy targets (Republican Rep. Tom) Cotton over his vote against funding pediatric research at Arkansas Children’s Hospital. Democrats charge that the conservative Republican has failed to support federal programs important to Arkansas (DeMillo and Elliott, 8/5).

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Medicare

Report Says Feds Stop Public Disclosure Of Serious Hospital Errors

USA Today reports the federal government has stopped publicly reporting when hospitals leave foreign objects in patients' bodies or make other life-threatening mistakes. Meanwhile, Medicare spent more than $30 million on questionable HIV medications in 2012 and the agency is resuming audits for some fee-for-service claims.

USA Today: Feds Stop Public Disclosure Of Many Serious Hospital Errors
The federal government this month quietly stopped publicly reporting when hospitals leave foreign objects in patients' bodies or make a host of other life-threatening mistakes. The change, which the Centers for Medicare and Medicaid Services (CMS) denied last year that it was making, means people are out of luck if they want to search which hospitals cause high rates of problems such as air embolisms — air bubbles that can kill patients when they enter veins and hearts — or giving people the wrong blood type (O’Donnell, 8/5).

ProPublica/The Washington Post: Watchdog: Some Medicare Spending On HIV Drugs Appear Questionable In 2012 Audit
Medicare spent more than $30 million in 2012 on questionable HIV medication costs, the inspector general of the Department of Health and Human Services said in a report set for release Wednesday. The report offers a litany of possible fraud schemes, all paid for by Medicare’s prescription drug program known as Part D (Ornstein, 8/6).

Modern Healthcare: Controversial Medicare Recovery Audits Make Limited Return
The CMS is restarting audits of Medicare fee-for-service claims on a limited basis. The program has been dormant since June 1 when current audit contracts expired. Lauren Aronson, director of CMS' Office of Legislation, sent an e-mail to congressional staffers Monday announcing the resumption of the recovery audit contractor program (Demko, 8/5).

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Veterans Health Care

House Veterans Affairs Chair Accuses VA Of Misleading Panel On Deaths

Rep. Jeff Miller says the Department of Veterans Affairs may have manipulated on a fact sheet given to Congress the number of veterans who died as a result of waiting for care.

CNN: VA Misled On Number Of Deaths Tied To Care Delays, Congressman Charges
The chairman of the House Veterans Affairs Committee is accusing the VA of "what appears to be an attempt to mislead Congress and the public" by manipulating the number of veterans who died as a result of delays in care. In a letter to the VA secretary, Chairman Jeff Miller says the VA gave questionable information on a fact sheet distributed during a briefing to his committee in April and has consistently repeated that information in congressional testimony and to journalists. The VA's "fact sheet" from April 7 confirms 76 patients were harmed as a result of delays in gastrointestinal care and "of these 76 patients, 23 have passed away," citing a "national review ...of all consults since 1999." But more recent documents from the VA sent to Miller, a Florida Republican, show those deaths actually came from a much shorter period, from 2010 to 2012, which may indicate there could be more deaths because of delays than the VA has reported (Black and Devine, 8/5).

The Associated Press: VA Deputy Chief: More Employees Face Punishment
More Veterans Administration employees will be disciplined as the department sorts out a scandal over long waits for health care and falsified data, Deputy Secretary Sloan Gibson said Tuesday. The VA announced last week that it planned to fire two supervisors and discipline four other employees in Colorado and Wyoming accused of falsifying health-care data (Elliott, 8/5).

Atlanta Journal-Constitution: Atlanta VA Errs In Benefits For Disabled Vets
The Atlanta VA repeatedly makes errors in calculating benefits for disabled veterans, resulting in overpayments to some and underpayments to others, according to an audit released Tuesday (Schneider and Schrade, 8/5).

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Public Health & Education

Treating Americans With Untested Ebola Drug Raises Concerns

Using the experimental drug before it is tested in clinical trials will make it difficult to determine whether it is actually safe and effective, say scientists. Meanwhile, African officials say they have been inundated with requests from dying patients and their relatives for the same treatment. 

Los Angeles Times: Use Of Experimental Ebola Drug Raises Red Flags Among Medical Experts
Two American aid workers were gravely ill, fighting to survive infection with the deadly Ebola virus. A San Diego drug company had three doses of an experimental Ebola medicine that showed promise in monkeys but had never been tested in humans. Getting the medication to the two patients in Liberia seemed like the obvious thing to do. Members of the Centers for Disease Control and Prevention, the National Institutes of Health and the Christian aid organization Samaritan's Purse worked together to make it happen ... But what looks like a simple case of humanitarian goodwill could lead to some unintended and very negative consequences, experts said Tuesday (Morin, 8/5).

The Wall Street Journal: Ebola Virus: Giving Americans Drug Prompts Flak
Liberian officials were set to meet Wednesday with the World Health Organization to see about getting the experimental drug rushed into use for other patients, said Dr. Nyenswah. Ebola, which is usually fatal, causes fever, headaches, vomiting and diarrhea and can cause internal bleeding. The virus is transmitted through bodily fluids. The Ebola outbreak, the largest in history, started in February and has spread through Liberia, Guinea and Sierra Leone (McWhirter, Loftus and Hinshaw, 8/5).

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State Watch

Calif. Insurers Team On Huge Digital Medical Records Plan

Blue Shield of California and Anthem Blue Cross are working together to keep and share digital records for about 9 million patients, which could cost $80 million over the first three years.

The Associated Press: Insurers Launch Huge Health-Records Info Exchange
Two California insurers announced Tuesday that they are partnering for an ambitious project to establish one of the nation's largest health-information exchanges, an effort they hope will reduce duplication and improve patient outcomes. The not-for-profit Blue Shield of California and Anthem Blue Cross, a subsidiary of private insurance giant WellPoint, announced that they are starting the California Integrated Data Exchange, medical-sharing portal with information about 9 million plan members (Lin, 8/5).

Kaiser Health News: Capsules: Large California Insurers Invite Others To Join Data Network
Now that two of California’s biggest health insurers have teamed up on a project to share patients’ digitized medical records, they are planning to invite other companies to join. The project will initially cover about 9 million Californians, making it possible for doctors and hospitals to quickly access patients’ medical histories and avoid unnecessary tests and procedures (Gorman, 8/6).

McClatchy: Online Medical Records May Soon Become A Reality In California
Nearly a quarter of all Californians could soon have their medical histories accessible to doctors and emergency rooms all over the state with just a few strokes on the keyboard. Two of the state's largest insurers are launching perhaps the biggest health information network anywhere in the country, putting California at the center of the decade-long push to digitize medical records. Supporters say the project could mean faster and better healthcare, with less spending on unneeded tests — if it can clear a thicket of technical challenges and privacy concerns (Logan and Pfeifer, 8/5).

Reuters:  Health Insurance Rivals Team Up To Build California Health Exchange
Blue Shield of California and Anthem Blue Cross, two rival health insurance providers, announced on Tuesday a collaborative plan to build a non-profit health-information exchange for California residents. The California Integrated Data Exchange, or Cal Index, would become one of the largest exchanges of its kind, amassing electronic health records of some nine million California patients, a quarter of the state's population. The firms estimate they'll spend $80 million in the initial 3-year phase. Afterward, Cal Index will charge a subscription fee to care providers and insurers who use the service. The index is expected to be operational by the end of 2014 (Farr, 8/5). 

Modern Healthcare: New California Health Info Exchange Faces Obstacles
Plunking down $80 million and blending claims data from two giant California Blues health plans in a statewide health information exchange raises hopes that interoperability across the Golden State may finally be at hand. But neither money nor 9 million patient records guarantee success of an HIE in a state so vast and diverse, experts said (Conn, 8/5).

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State Highlights: Insurer Uses Tenn. Position For Bargaining Power; N.Y.'s Medicaid Cash Drain

A selection of state stories from Tennessee and New York.

Kaiser Health News: A Tennessee Insurer Uses Its Monopoly To Deliver Bargain Premiums
The dominion of Tennessee’s largest health insurer is reflected in its headquarters’ lofty perch above the city, atop a hill that during the Civil War was lined with Union cannons to repel Confederate troops. BlueCross BlueShield of Tennessee has used its position to establish a similarly firm foothold in the first year of the marketplaces created by the health law. The company sold 88 percent of the plans for Tennessee individuals and families. Only one other insurer, Cigna, bothered to offer policies in Chattanooga, and the premiums were substantially higher than those offered by BlueCross (Rau, 8/6).

The Wall Street Journal: Moody's: Medicaid Issue Is Negative Development For New York State
One of the nation's biggest credit-rating firms said the federal government's attempt to claw back nearly $1.3 billion in Medicaid payments from New York is a negative development for the state. In its report published Monday, Moody's Investors Service said a repayment "would result in an unwelcome drain on the state's cash balances," and future repayments would "pinch the state's liquidity." The U.S. Centers for Medicare and Medicaid Services told New York officials in late July that it would seek money paid out in 2010 that was used to care for about 1,300 developmentally disabled people in nine state facilities (Kravitz, 8/5). 

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Editorials and Opinions

Viewpoints: Higher Costs Don't Mean Better Health Quality; States And The Uninsured

Bloomberg: Expensive Hospitals Aren't Any Better
The good news about health care spending continues. In the first nine months of this fiscal year, Medicare spending increased only 1.2 percent in nominal terms, and for 2014, it's now projected to be $1,000 lower per beneficiary than the Congressional Budget Office said it would be as recently as 2010. Even the Medicare trustees are starting to recognize that something big may be happening. In evaluating the recent deceleration, however, a crucial question remains: Can slower cost growth continue without harming the quality of outcomes? (Peter R. Orszag, 8/5).

The New York Times' Well: Why We Should Know The Price Of Medical Tests
One of the common arguments against mandating or providing upfront prices for medical tests and procedures is that American patients are not very skilled consumers of health care and will assume high prices mean high quality. A study released Monday in the journal Health Affairs suggests we are smarter than that (Elisabeth Rosenthal, 8/5). 

The New York Times' The Upshot: States That Embraced Health Law Show Biggest Gains In Reducing Uninsured
We’ve seen a few polls now that have demonstrated a real, measurable drop in the number of Americans who lack health insurance since the Affordable Care Act’s major provisions kicked in this January. Now we finally have a picture of what’s happening at the state level (Margo Sanger-Katz, 8/5). 

Los Angeles Times: We Don't Need Underhanded Attempts To Obstruct Access To Abortion
Several states have enacted laws in recent years that require doctors who perform abortions at clinics to have admitting privileges at nearby hospitals. These laws, masquerading as measures to protect the health of women, are nothing more than underhanded attempts to obstruct access to abortion services. In every state where such a law has been passed, it would result in the closure of at least some abortion clinics, making it substantially more difficult for women to get the reproductive healthcare to which they are constitutionally entitled (8/5). 

Reuters: You Don't Need That Annual Pelvic Exam. So Why Is Your Doctor Giving You One?
In June, the American College of Physicians (ACP) reported what many doctors have known for years: There is little justification for the widespread practice of the annual pelvic exam. In its clinical guidelines, the physicians group recommended against performing the exams for non-pregnant women who don’t have pelvic pain or other symptoms that suggest a gynecologic problem. These guidelines do not apply to Pap smears for cervical cancer screening, for which there is strong evidence for their continued use. They apply to the pelvic exam, where the clinician first uses a speculum to perform an internal exam, and then with his or her hands, feels for pelvic organs. ... Despite these findings, an alarming number of physicians continue to conduct annual pelvic exams. That’s partly because of a position taken by the organization that establishes guidelines for gynecologists, the doctors who conduct the majority of pelvic exams in the United States (Deepthiman Gowda, 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.