Daily Health Policy Report

Thursday, August 7, 2014

Last updated: Thu, Aug 7

KHN Original Reporting & Guest Opinion

Health Reform

Administration News

Quality

Medicare

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Obamacare Creates 'Upheaval' At Free Clinics

Kaiser Health News staff writer Phil Galewitz reports: “Worried that patients like Milliken would leave their care and struggle to find doctors accepting new Medicaid patients, the clinic took a rather radical step: It became a Medicaid provider and started billing the state-federal health insurance program for the poor” (Galewitz, 8/7). Read the story, which also ran in USA Today.

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Capsules: First Look At Medicare Quality Incentive Program Finds Little Benefit; Fast Track For Primary Care Docs At One Calif. University

Now on Kaiser Health News’ blog, Jordan Rau reports on Medicare's quality incentive program: “The quality program, known as Hospital Value-Based Purchasing, is a pillar of the federal health law’s campaign to use the government’s financial muscle to improve patient care. Since late 2012, Medicare has been giving small increases or decreases in payments to nearly 3,000 hospitals based on how patients rated their experiences and how faithfully hospitals followed a dozen basic standards of care, such as taking blood cultures of pneumonia patients before administering antibiotics. As much as 1 percent of their Medicare payments were at stake in the first year and 1.25 percent this year, though most hospitals gained or lost a fraction of that. Hospitals were judged both on how they compare to others and how much they are improving” (Rau, 8/6).

Also on the blog, Capital Public Radio's Pauline Bartolone reports on one California medical school's fast track: "Some doctors in the state of California will soon be able to practice after three years of medical school instead of the traditional four. The American Medical Association is providing seed money for the effort in the form of a $1 million, five-year grant to the University of California at Davis" (Bartolone, 8/7). Check out what else is on the blog.

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Political Cartoon: 'Sprechen Sie Deutsch?'

Kaiser Health News provides a fresh take on health policy developments with "Sprechen Sie Deutsch?" by Darrin Bell.

Meanwhile, here's today's haiku:

TAKE CHIP OFF THE BLOCK

Politics aside
Our children should be insured
CHIP 2015
-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

Analysis: 90% Of Uninsured Exempt From Health Law Mandate

The number of people likely to face penalties for not complying with the overhaul's insurance mandate is estimated at 4 million -- down from the previous projection of 6 million, according to the Congressional Budget Office and the Joint Committee on Taxation.

The Wall Street Journal: Fewer Uninsured Face Fines As Health Law's Exemptions Swell
Almost 90% of the nation's 30 million uninsured won't pay a penalty under the Affordable Care Act in 2016 because of a growing batch of exemptions to the health-coverage requirement. The architects of the health law wanted most Americans to carry insurance or pay a penalty. But an analysis by the Congressional Budget Office and the Joint Committee on Taxation said most of the uninsured will qualify for one or more exemptions (Armour, 8/6).

The Wall Street Journal: The Short Answer: Affordable Care Act Exemptions
Almost 90% of the 30 million Americans expected to be uninsured in 2016 won’t pay a penalty under the Affordable Care Act because most will qualify for one or more exemptions, according to a June report by the nonpartisan Congressional Budget Office and the Joint Committee on Taxation. A page-one article in The Wall Street Journal examines the expansion of exemptions (8/6).

Fox News: Millions of Uninsured Americans Exempt From Obamacare Penalties in 2016, Report Finds
A new congressional report has estimated that more than 25 million Americans without health insurance will not be made to pay a penalty in 2016 due to an exploding number of ObamaCare exemptions. The Wall Street Journal, citing an analysis by the Congressional Budget Office and the Joint Committee on Taxation, reported that the number of people expected to pay the fine in 2016 has dwindled to four million people from the report's previous projection of six million. Approximately 30 million Americans are believed to be without health insurance. The latest report is likely to spark fresh concerns among insurers, who have maintained that the number of exemptions to the law's individual mandate are resulting in fewer young, healthy people signing up for health insurance (8/7).

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Florida 2015 Individual Insurance Rates Not As Bad As Feared: White House

Obama administration officials challenged reports that individual plans will go up an average of 13.2 percent next year. In addition, there are updates on Connecticut and Washington insurance cost and coverage issues.

Miami Herald: White House: Rates In Florida Will Decline For Affordable Care Act Exchange Plans
Most Floridians who buy an Obamacare health plan for 2015 will pay less in monthly premiums, White House officials said Wednesday — a rebuttal to this week's report from Florida officials saying rates will rise an average of 13.2 percent for new plans in the individual market next year. Both analyses are mathematically correct, relying on different ways to slice the Affordable Care Act numbers with Florida’s Republican-led Legislature and governor staunchly opposed to the health law, and the White House eager to show that the law is working to bring healthcare to more Americans. One important difference is that Florida officials in the report from the state Office of Insurance Regulation calculated an average for all health plans sold on the individual market — counting plans sold on the ACA exchange along with those that are not (Chang, 8/6).

The 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).

Meanwhile -- 

The Associated Press: Many Still Can’t Use Washington Health Coverage
Seven months after major glitches in the Washington health exchange were discovered, authorities acknowledge that thousands of state residents still don't have insurance they can use to go to the doctor or fill a prescription. Although some problems have been resolved during the past few weeks, new issues also have come to light in Washington's implementation of the federal health care overhaul. Insurance companies and the state insurance commissioner are concerned the total number of people who bought insurance through the exchange and are now having billing problems could be many more than the 6,000 customers identified by the exchange a few weeks ago (Blankinship, 8/6).

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Medicaid Expansion Dilemmas: Mental Health Care Demands, Impact of Managed Care, Non-Expansion States Squeezed

The health law built in changes to the system of coverage for lower-income people.

Health News Colorado: Medicaid Expansion Creates Explosion In Demand For Mental Health Care
Mental health centers in Colorado are seeing a surge in new clients seeking services under the state’s expansion of Medicaid. And while center officials say they expected an increase, the number of new calls surprised them, so they have ramped up efforts and instituted new programs to meet the demand. As part of the Affordable Care Act, Colorado is among 26 states that expanded Medicaid benefits for adults who earn up to 138 percent of the federal poverty level, ... Mental health leaders say the Medicaid increases point to a huge pent-up demand for services among people with a variety of issues who until now have not been able to get the help they need (Hoback, 8/6).

CQ Roll Call: Boom In Managed Care Alters Medicaid’s Calculations
Health insurance companies have not always been eager to cover Medicaid recipients, in part because some low-income people have complex medical needs and don’t have all the resources that help wealthier people stay healthy. But that reluctance has turned to enthusiasm in recent years as more states have switched their Medicaid programs to managed care plans, some of which seek to control costs by, among other steps, limiting a patient’s choice of physicians and the fees that doctors charge. ... The expansion of Medicaid to many more low-income Americans under the 2010 health care law is making the program even more attractive to insurers (Adams, 8/6). 

The Associated Press: Medicaid Reform Could Cut Deep At Rural Hospitals
Whenever Medicaid cuts filter down from the legislature in Raleigh [N.C.] to small-town and rural hospitals such as Southeastern Regional Medical Center in Lumberton, the pain is acutely felt. Although they disagree on just how to reform North Carolina's Medicaid program, lawmakers know they want to upend the way the state pays for and administers the health insurance program for low-income residents, including the elderly, disabled and children. They talk of contracting with private companies to manage the unpredictable and ever-rising costs of Medicaid (Ferral, 8/6).

The Associated Press: Feds Return Indiana Medicaid Waiver Request
A federal agency has asked the Pence administration to resubmit its proposal for an alternative Medicaid expansion because Indiana's initial application didn't include input from a band of Potawatomi Indians. The Centers for Medicare and Medicaid Services returned the state's proposal last month, two weeks after the state submitted the plan. ... This the second time the CMS returned a waiver request from the Pence administration (LoBianco, 8/5). 

AL.com: On Tour Of Area Hospitals, Congressman Byrne Gets Earful On Obamacare, Medicare Rates
U.S. Rep. Bradley Byrne kicked off a month-long tour of hospitals in southwest Alabama this week, getting an earful about two of their biggest concerns – Obamacare and Medicare. Hospital administrators told Byrne, R-Fairhope, that they are nervous about the impact of looming government cuts in payments to compensate for treating uninsured patients. Congress included the cuts in the Affordable Care Act under the rationale that subsidies combined with expanded Medicaid eligibility would reduce emergency room use by the uninsured. But Alabama has chosen not to expand its Medicaid program (Kirby, 8/7).

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Health Law Brings Changes For Small Business Regarding Insurance Coverage

The Wall Street Journal reports that, even though businesses with fewer than 50 employers are exempt from the health law's most stringent requirements, they still face challenges. Also, patient groups increasingly worry that coverage through the overhaul's exchanges might shift drug costs to people with chronic illnesses, and HIV and AIDS advocates have filed a formal complaint about drug pricing.

The Wall Street Journal: Small Firms Hit By Big Changes In Health Coverage
Smaller employers aren't required under the Affordable Care Act to offer coverage for their full-time workers—as larger firms must by 2016 or face penalties, for instance. But many owners of small ventures and startup entrepreneurs are nonetheless facing big changes to how they obtain their own health coverage, as well as to the benefits they're able to offer employees. ... Several thousand of the nation's smallest business owners—sole proprietors and the self-employed—were kicked off their small-business plans by carriers earlier this year. That is because new guidelines define "employers" as having at least two full-time employees, not including a spouse, in order to be eligible for group plans (Loten, 8/6).

The Associated Press: AIDS Patients Fear Discrimination In ACA Exchange
Patient advocates say some insurance companies are making HIV and AIDS drugs unaffordable in plans issued through the Affordable Care Act by shifting much of the cost to customers. While the issue applies broadly to all patients with chronic illnesses that require expensive medication, HIV and AIDS advocates say they were the first to file a formal complaint with the government about pricing (Kennedy, 8/6).

USA Today: The Kaiser Way: Lesson For U.S. Health Care?
The Affordable Care Act has been dramatically changing the way hospitals do business, forcing them to rethink which patients they admit and focus on keeping people healthy. For Kaiser Permanente, however, it's been largely business as usual, says CEO Bernard Tyson, who took the helm a year ago (O’Donnell, 8/6).

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Poll Looks At Uninsured Rates In Some States

A new Gallup poll shows that Kansas was one of just three states that saw an increase in its uninsured rate while Connecticut's rate was cut in half.

Kansas Health Institute News Service: What's Behind Jump In Rate Of Uninsured Kansans?
Kansas was one of just three states that saw their rates of people without health insurance go up since last year, according to a new survey. And, if the poll results are accurate, Kansas was the one whose rates went up the most.The data, collected as part of the Gallup-Healthways Well-Being Index, show that the uninsured population in Kansas rose from 12.5 percent in 2013 to 17.6 percent by midyear 2014 -- a whopping increase of 5.1 percentage points (Margolies, 8/6). 

The CT Mirror: Malloy Celebrates Drop In Uninsured, Credits Obamacare
The percentage of Connecticut residents without health coverage has dropped by half since 2012, prior to the expansion of coverage under the Affordable Care Act, according to a survey by the state's health exchange and a Gallup poll that found the state to have one of the nation's 10 largest reductions. The election-year news was celebrated Wednesday by Gov. Dannel P. Malloy and Lt. Gov. Nancy Wyman, Democrats who were early and strong supporters of the Obama administration initiative that is described, praised and panned with the same shorthand, "Obamacare" (Pazniokas, 8/6).

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Administration News

Obama To Sign Overhaul Of Veterans' Health Care

Veterans are expected to have an easier time getting health care under a $16.3 billion measure the president is expected to sign into law Thursday, enabling the hiring of thousands of doctors and nurses. 

Reuters: Obama To Sign $16.3B Veterans Spending Bill
President Barack Obama will travel to a military facility outside Washington on Thursday to sign a $16.3 billion plan to ease health care delays at Veterans Affairs facilities as he seeks to restore confidence in an agency tarnished by the problem. The legislation, passed just before Congress left for summer recess, is intended to clear months-long wait lists for healthcare appointments at VA hospitals and clinics. News that the agency was covering up the delays led to the ouster of VA Secretary Eric Shinseki in May. The measure contains $10 billion in new emergency spending and allows veterans to use private doctors at the department's expense if they cannot get an appointment in less than 30 days (8/6). 

The Associated Press: Obama to Sign Veterans’ Health Care Overhaul
Veterans are expected to have an easier time getting government-paid health care from local doctors under a bill that President Barack Obama is set to sign into law Thursday. The $16.3 billion measure also allows the Veterans Affairs Department to hire thousands of doctors, nurses and other health professionals at the VA's nearly 1,000 hospitals and outpatient clinics nationwide. Under the new law, employment rules will be revised to make it easier to fire senior VA executives judged to be negligent or performing poorly (Daly, 8/7)

The Associated Press: Major Provisions of Veterans Health Care Bill
A bill approved by Congress aims to alleviate delays many veterans have faced in getting treatment at Veterans Affairs hospitals and clinics and end the widespread practice of covering up long wait times for appointments. The legislation also makes it easier to fire hospital administration and other senior VA executives. Congressional budget analysts put the cost of the bill at $16.3 billion over three years and estimate it will add $10 billion to federal deficits over the next 10 years (8/7).

USA Today’s The Oval: Obama’s Day: The VA Bill
Health care for veterans tops President Obama's agenda Thursday as he signs a bill designed to reform and improve VA hospitals. The president travels to Fort Belvoir, Va., to sign the Veterans' Access to Care through Choice, Accountability, and Transparency Act of 2014 (Jackson, 8/7).

The Associated Press: Hearing Addresses VA Health Care Issues
Steps are being taken to improve access to health care for veterans across the country, but some members of Congress said Wednesday that more needs to be done when it comes to providing mental health care for rural veterans. Republican Congressman Jeff Miller of Florida visited Roswell to lead a field hearing for the House Committee on Veterans' Affairs. The panel included U.S. Reps. Steve Pearce of New Mexico and Doug Lamborn of Colorado as well as veterans from southeastern New Mexico (8/6).

Marketplace: Will The Cash From The VA Healthcare Overhaul Help?
President Barack Obama is expected to sign legislation that would pump just under $17 billion into the Department of Veterans Affairs’ struggling healthcare system. The agency came under fire earlier this year over unacceptable treatment delays and after staff manipulated patient wait lists. The money from this legislation would go toward hiring staff — nurses and doctors — and to allow some veterans to get care outside the VA system. It's a sign Congress wants veterans to get care, pronto (Gorenstein, 8/7).

The Associated Press: VA Executive: Wait Times Can Be Fixed in 2 Years
Long wait times for veterans to get health care can be cleared up in two years, along with investigations of employees accused of falsifying data to hide the problem, Deputy Veterans Affairs Secretary Sloan Gibson said Wednesday. Gibson, who toured the Denver VA hospital, said his department has to change its culture to get employees to take responsibility for solving problems. Most VA workers are dedicated and know change is necessary, he said (Elliott, 8/6).

Meanwhile, a veterans group will survey members about their experiences trying to get care --

The Washington Post: Veterans Can Share Their VA Experiences With This Survey
A veterans group on Wednesday launched a new survey to gather information about veterans’ experiences with the troubled Department of Veterans Affairs. The Iraq and Afghanistan Veterans of America, which developed the survey, including extensive wait times at the agency’s medical centers and a longstanding backlog of disability claims (Hicks, 8/6).

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Quality

Questions Arise About Hospice Companies As Discharge Rates Increase

When so many patients leave a hospice alive, it could signal problems such as inadequate care or companies seeking financial gains by enrolling people who should not have been considered hospice patients, The Washington Post reports.

The Washington Post: Rising Rates Of Hospice Discharge In U.S. Raise Questions About Quality Of Care
At hundreds of U.S. hospices, more than one in three patients are dropping the service before dying, new research shows, a sign of trouble in an industry supposed to care for patients until death. When that many patients are leaving a hospice alive, experts said, the agencies are likely to be either driving them away with inadequate care or enrolling patients who aren't really dying in order to pad their profits (Whoriskey and Keating, 8/6).

In news about Medicare's efforts to buttress quality measures at hospitals --

Kaiser Health News: Capsules: First Look At Medicare Quality Incentive Program Finds Little Benefit
One of Medicare’s attempts to improve medical quality -- by rewarding or penalizing hospitals -- did not lead to improvements in the first nine months of the program, a study has found. The quality program, known as Hospital Value-Based Purchasing, is a pillar of the federal health law’s campaign to use the government’s financial muscle to improve patient care. Since late 2012, Medicare has been giving small increases or decreases in payments to nearly 3,000 hospitals based on how patients rated their experiences and how faithfully hospitals followed a dozen basic standards of care, such as taking blood cultures of pneumonia patients before administering antibiotics (Rau, 8/6).

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Medicare

Medicare Benefits From Immigrants, Study Says

A study by the Partnership for a New American Economy concluded that immigrants make a substantial contribution to the Medicare Hospital Insurance Trust Fund -- putting more into the system than they take out. Also in the news, the Center for Public Integrity examines how Medicare Advantage plans may routinely overbill the health insurance program for older Americans.

NBC News: Immigrants Contributed Over $182 Billion to Medicare: Report
Immigrants have helped pay the nation’s bills, at least when it comes to health care, according to a new report. Immigrants contributed over $182 billion to Medicare’s Hospital Insurance Trust Fund between 1996 and 2011, according to a study released by the Partnership for a New American Economy, a group which advocates for immigration reform. The study found during that same 15-year period, U.S.-born citizens produced a $68.7 billion deficit for the same fund. On average, immigrants to the U.S. contributed over $11 billion more to the fund than was spent on their care (Passy, 8/6).

The Washington Post’s Wonkblog: Why Immigrants Are The Best Thing That Happened To Medicare
The reason lies mostly in one simple fact: Immigrants are much younger on average than the overall American populace, and younger people don't go to the doctor (or hospital, in this instance) nearly as often. By 2030, there will be more than 400 seniors to every 1,000 working-age adults in the U.S., according to estimates by the Federal Reserve Bank of Boston. For immigrants that number will be much lower (pdf), largely because Latinos, the fastest growing immigrant group in the country, pose a significantly lower financial risk, because of their relative age and health (Ferdman, 8/6).

Center for Public Integrity: How Medicare Advantage Plans Code For Cash
A new federal study shows that many Medicare Advantage health plans routinely overbill the government for treating elderly patients — and have gotten away with doing it for years. Analyzing government data never before made public, Department of Health and Human Services researchers found that many plans exaggerate how sick their patients are and how much they cost to treat. Medicare expects to pay the privately run plans — an alternative to traditional Medicare — some $160 billion this year (Schulte, 8/7).

And, in other news, Modern Healthcare tracks developments related to Medicare's 3-Day rule --

Modern Healthcare: Medicare Offers Waiver of 3-Day Rule for Some ACOs, Bundled Payments
The average number of days that patients spend hospitalized has gradually declined, as medicine and technology improve and policymakers pressure hospitals for more efficiency. That trend, however, is at odds with Medicare rules in place since that program began requiring a three-day hospital stay before the CMS will pay for skilled-nursing care. But now the CMS is offering a waiver of the controversial rule for hospitals participating in two alternative payment and delivery initiatives under the Affordable Care Act—the Medicare Pioneer accountable care organization program and bundled payments (Evans, 8/6).

Related, earlier KHN coverage: Medicare Testing Payment Options That Could End Observation Care Penalties (Jaffe, 7/22).

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State Watch

State Highlights: Abortion Curbs And Senate Fights; Vt.'s Single Payer March

A selection of health policy stories from Vermont, West Virginia, Iowa, Maryland, Missouri, Wisconsin and Massachusetts.

Politico: State Abortion Restrictions Fuel Fight For Senate
The 2014 campaign hasn’t had the equivalent of Todd Akin’s infamous rape comments driving the abortion debate. Instead, Democrats and Republicans are using a slew of new state abortion restrictions as weapons in the tight battle for control of the Senate. The fight this year centers on the dozen or so states that have banned abortions after 20 weeks of pregnancy under so-called fetal pain laws, as well as on the renewed push in a few states for personhood legislation, which confers full legal rights to an embryo from the moment of conception (Winfield Cunningham, 8/6).

Stateline: Vermont Is 'Single-Payer' Trailblazer
The outcome couldn’t be more consequential, not only for Democratic Gov. Peter Shumlin, who put single-payer health care at the center of his first gubernatorial campaign in 2010, but for many others who have long cherished the idea of universal health care built on the foundation of a single-payer system. Some believe that if the Vermont experiment is successful, other states could follow. In Canada, they note, single-payer started in one province and then spread across the country (Ollove, 8/7).

Kaiser Health News: Obamacare Creates 'Upheaval' At Free Clinics
Worried that patients like Milliken would leave their care and struggle to find doctors accepting new Medicaid patients, the clinic took a rather radical step: It became a Medicaid provider and started billing the state-federal health insurance program for the poor (Galewitz, 8/7).

Des Moines Register: Hospitals That Keep Iowans Healthy Get Refunds
Iowa’s leading health insurer says it’s starting to see results from a major effort to reward hospitals and clinics for keeping patients well instead of just treating them when they’re sick. Wellmark Blue Cross and Blue Shield is announcing today that its Accountable Care Organizations have saved $12 million in the past two years. The organizations are arrangements that pay hospitals and clinics more if they reduce health care costs by preventing patients from becoming so ill that they need intense and expensive care (Leys, 8/6).

Baltimore Sun: State Works to Reduce Preventable Hospitalizations
Top Maryland officials highlighted a change in the way hospitals are charging patients for treatment – and a related push to prevent unnecessary admissions -- during a stop Wednesday in Western Maryland. Maryland has long regulated hospital rates under a unique agreement with federal officials, but has altered its waiver in a way that provides hospitals with a budget based on their projected patient population rather than a fee for every service performed (Cohn, 8/6).

St. Louis Post-Dispatch: BJC Ends Relationship With Long-time Contractor
BJC HealthCare has hired Knoxville, Tenn.-based TeamHealth to operate nine of its emergency departments. ... Neither TeamHealth nor BJC would comment on the value or duration of the new contract. The move ends BJC’s long-term relationship with Emergency Consultants Inc., part of Traverse City, Mich.-based ECI Healthcare Partners. Hospital industry experts said that across the nation, health systems are taking a hard look at spending on purchased services, which includes contracting with third parties (Liss, 8/6). 

The Milwaukee Journal Sentinel: Six Wisconsin Health Care Systems Form Statewide Network
Aurora Health Care and five of the state's other largest health systems have created a partnership with the goal of working together to improve health care quality and lower costs. The partnership -- announced Wednesday and yet to be named -- also hopes to contract with health insurers to provide a statewide network of hospitals and clinics (Boulton, 8/6).

WBUR: A Bill Aimed To Attack State’s Opioid Epidemic Becomes Law
As Governor Patrick entered his outer office to sign a bill aimed to curb substance abuse Wednesday, applause erupted from the hundreds of people gathered to watch — many of them lawmakers and health care providers and those struggling with their own or a loved ones addiction (Becker, 8/7).

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Weekend Reading

Longer Looks: Kentucky Is Health Law Poster Child; The Ebola Outbreak

Each week, Kaiser Health News finds interesting reads from around the Web.

Time: How Kentucky Got Obamacare Right
About a year ago, on Aug. 22, a team of inspectors from the Centers for Medicare and Medicaid Services (CMS) unit of the U.S. Department of Health and Human Services arrived in Frankfort, Ky., to see if the people working out of a nondescript warehouse there were going to be able to pull off the launch of Kentucky’s Obamacare health-insurance exchange. Kentucky was one of 14 states, plus the District of Columbia, that had opted to build its own version of the Obamacare exchange; the federal government, through CMS, was building an exchange to offer insurance in the other 36 states. There was less than six weeks to go before the scheduled debut, in Kentucky and nationally, of what was perhaps the most complicated e-commerce venture ever envisioned. ...They need not have worried (Steven Bill, 7/31).

Vox: How Arkansas Explains The Politics Of Obamacare 
Arkansas was a pioneer in crafting an "alternative" Medicaid expansion. Last September, the Obama administration signed off on their unprecedented proposal to move hundreds of thousands of newly-eligible people into the state's health insurance exchange, using Medicaid dollars to pay private premiums. As the state's "private option" enters its second year, Arkansas is exploring possible changes to the program — ones that Republican-run states have already won approval for, and which could push the limits of how flexible the federal government will be with a program that covers some of the country's most vulnerable patients (Adrianna McIntyre, 8/6).

The New Republic: How Much Is Obamacare Raising Your Insurance Rate? Depends on Which State You Live In
Back in the spring, once it became apparent that enrollment in Obamacare would nearly match or even exceed projections, the law’s detractors on the right started coming up with new predictions of doom. Among the most popular: Premiums in 2015 would soar, these critics said, because the people signing up for coverage would be older and sicker than the insurance companies had expected. ... More than four months later, we have some better information. ... a group of experts that I consulted agreed that a clear trend is emerging. Coverage will get more expensive for the majority of consumers, as it almost always does. Changes in premiums will vary enormously, from state to state and from plan to plan. But, overall, the 2015 premiums increases will not be significantly worse than they were in the past. They might even be a little better (Jonathan Cohn, 8/4).

The New York Times: Dogged Persistence Pays Off, With Interest
In this episode, the story of an epic, four-year battle between a man and a health insurer. Typically, these stories end with the same score: Health Insurer 1, Patient 0. This story is different. It started in 2006, when at the age of 37, Dave Bexfield of Albuquerque learned that he had multiple sclerosis, or M.S. ... He qualified for a clinical trial, sponsored by the National Institutes of Health and conducted by the University of Texas MD Anderson Cancer Center in Houston. He spent three months there getting a stem cell transplant. His total bill was just under $200,000. (Yes, though sponsored by the N.I.H., the treatment came with a price tag.) ... His health insurer, Presbyterian Health Plan, declined to cover the treatment because at the time, officials said, it was not a covered benefit (David Segal, 8/5).

Vox: The Secret To Negotiating A Lower Medical Bill 
Earlier this year, I got an unpleasant surprise in my mailbox. A $820.19 surprise, to be exact. This was a bill from MedStar's National Rehabilitative Network, where I'd recently completed 12 half-hour physical therapy sessions over the winter. The bill was an incomprehensible, three-page mess of billing codes and charges that all totaled up to just over $800 that I owed. Even as someone who writes extensively about America's health care system — who had, coincidentally, recently attended a three-day seminar for a story on the subject — I was stuck. I thought about trying to negotiate the bill down but had no idea where to start. I ultimately paid it without protest — but, after talking to medical billing advocates this week, I'm starting to think I shouldn't have (Sarah Kliff, 8/5).

Health Affairs: A Fighting Chance: How Acute Care Training Is Failing Patients With Chronic Disease 
Slim and athletic, [Martin] was in generally good health other than his kidney disease. Another patient, James, also arrived early to his hemodialysis appointment, but that was because he arrived via ambulance, on a stretcher. ... I had admitted James to the hospital many times. ... The [medical] residents knew James very well. But they had never met Martin. As one of my healthiest patients, Martin had never been admitted to the hospital. To the residents at the hospital, and indeed to most physicians, a dialysis patient looks like James, not Martin. But in my work as a nephrologist, dialysis patients look like Martin, not James. The gulf between the residents’ understanding of chronic disease and mine has, I believe, profound implications for the care of such patients and the policies we craft around them (Dr. Dena E. Rifkin, 8/4).

Stanford Medicine: The Demise Of The Surgeon General
Nearly a year has passed, and the U.S. surgeon general post is still vacant. Does it matter? Associated Press medical reporter Mike Stobbe’s new book, Surgeon General’s Warning [University of California Press, June 2014], explains why that question is so hard to answer. His look at the history of the position and the personalities who filled it shows the good that’s come to America from having a powerful surgeon general. It also examines how politics are draining that power. ... Surgeons general have always had to take orders from their political bosses. What’s changed is that other federal health officials — like the HHS secretary and the CDC director — have developed an enduring taste for the bully pulpit, and have come to see surgeons general as unworthy competitors for it (Summer 2014).

Mother Jones: Cell Phone Carriers Are Fighting a Plan To Make It Easier To Locate 911 Callers
The nation's biggest cell phone carriers, including Verizon, AT&T, and Sprint, are opposing a government proposal that aims to save lives by making it easier for emergency responders to locate 911 callers. The companies say they lack the technology to implement the plan—which would require them to quickly find a way to deliver more accurate location information—and they're working on a better, long-term solution. Emergency responders and activists say that the cell carriers are trying to stymie the proposal because they don't want to pony up the money for the improvements (Dana Liebelson, 8/6).

The New Yorker: Outbreak 
As of this writing, more than thirteen hundred cases of Ebola-virus disease have been officially reported in Guinea, Sierra Leone, and Liberia. The virus is spreading, uncontrolled, in widening chains of infection, ... In July, as the outbreak gathered force, Daniel Bausch, an American doctor and Ebola expert, arrived in Freetown, Sierra Leone, and proceeded on to the Lassa/Ebola ward in Kenema, a facility that he helped set up. He put on personal protective equipment, known as P.P.E.—a type of biohazard gear that consists of a Tyvek whole-body suit, a Tyvek hood with an opening for the eyes, safety goggles, a breathing mask over the mouth and nose, two pairs of nitrile gloves, a plastic apron, and rubber boots—and he walked into one of the Ebola wards, a makeshift structure with walls made of plastic film (Richard Preston, 8/5).

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Editorials and Opinions

Viewpoints: Why Emory Accepted American Ebola Cases; Calls For Terrified Americans To 'Chill Out'

Los Angeles Times: The Great Ebola Scare
Blame it on Richard Preston. "The Hot Zone," his 1994 nonfiction science thriller about the spread and devastation of the Ebola virus, pretty much set the standard for terrifying contagion scenarios. ... Ebola has secured a special place in the American imagination. It's not just an illness but a phantasmagoria, a hideous acid trip come to life. Maybe that's why some people, convinced that two infected patients in a state-of-the-art isolation unit represent a direct path to a zombie apocalypse, have gone so far as to send nasty emails to the Centers for Disease Control and Prevention and to Emory University Hospital (Meghan Daum, 8/6). 

The Washington Post: I'm The Head Nurse At Emory. This Is Why We Wanted To Bring The Ebola Patients To The U.S.
A second American infected with the potentially deadly Ebola virus arrived at Emory University Hospital on Tuesday from Africa, following the first patient last weekend. Both were greeted by a team of highly trained physicians and nurses, a specialized isolation unit, extensive media coverage, and a storm of public reaction. People responded viscerally on social media, fearing that we risked spreading Ebola to the United States. Those fears are unfounded and reflect a lack of knowledge about Ebola and our ability to safely manage and contain it. Emory University Hospital has a unit created specifically for these types of highly infectious patients, and our staff is thoroughly trained in infection control procedures and protocols (Susan M. Grant, 8/6). 

Los Angeles Times: Chill Out, America: An Ebola Reality Check
Though it is impossible to predict how the crisis might have been handled had it begun in the United States or in Britain, the lack of medical infrastructure in several of the affected countries and frayed relations between civilians and hospital authorities after decades of brutal civil wars heap further pressure onto the epidemic. In the U.S., it is fair to assume that visiting a hospital will bruise your purse-strings but save your life; in Sierra Leone, Liberia, Guinea and Nigeria, that assumption is not so easy to make (Charlotte Lytton, 8/6). 

The Wall Street Journal: Experimental Medicine In A Time Of Ebola
A virologist carrying out mouse experiments in a lab in Hamburg five years ago accidentally pricked her finger. The syringe contained the Zaire Ebola virus, the same strain wreaking havoc today in Guinea, Liberia and Sierra Leone. There is no approved treatment or vaccine for Ebola, or even one that has passed the first phase of safety trials in human volunteers. Yet unlike those exposed to Ebola in West Africa recently, the Hamburg virologist was quickly offered an experimental vaccine (Jeremy Farrar, David Heymann and Peter Piot, 8/6). 

USA Today: Ebola Myths Range From Dumb To Deadly: Our View
Sometimes, misinformation can spread faster than a deadly virus, as proven in recent days by the hyperventilation about Ebola. Tuesday, while a man who had visited West Africa was screened for the disease at a New York hospital, tabloids screamed about an "Ebola scare" in the Big Apple. On Wednesday, officials said the man doesn't have the virus (8/6). 

USA Today: Ebola Research Flows Away From Poor: Other Views
More money goes into fighting baldness and erectile dysfunction than hemorrhagic fevers (8/6). 

On other health topics -

The New York Times' The Upshot: Why The Hepatitis Cure Sovaldi Is A Budgetary Disaster For Prisons
There is only one group in the United States with a constitutional right to medical care: Prisoners. That is why the introduction of an expensive new drug to treat hepatitis C is forcing prison administrators to begin wrestling with a big dilemma -- save their budgets or treat their inmates (Margot Sanger-Katz, 8/7). 

Bloomberg: Obamacare Bends The Reality Curve
In a telephone survey of 3,565 people conducted in mid-July, Bankrate asked people variations on the same question: How has their access to health care changed over the last year? Note, that's not a predictive question (What will happen?) or a question of opinion (What should happen?). The pollsters just asked people what had happened to their own situation since Obamacare's main provisions kicked in. From their answers, Republicans and Democrats seem to be living in two different universes (Christopher Flavelle, 8/7).

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EDITOR:
Stephanie Stapleton

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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.