Daily Health Policy Report

Wednesday, September 11, 2013

Last updated: Wed, Sep 11

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Health Reform

Public Health & Education

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

One Woman Living Beneath A Georgetown Bridge Finds Her Way Home

Kaiser Health News staff writer Ankita Rao reports: "Proponents of the Housing First approach, which has been replicated in 40 cities nationwide, say that investing in high risk patients like Alicia can also save taxpayers millions. Funded by government grants and charitable donations, the programs can curb the high health care costs that the more than 630,000 homeless people in the U.S. incur through repeat ER visits, hospital stays and preventable, recurring illnesses. Without health care and shelter, a homeless person in the U.S. is twice as likely to land in the ER as someone with a stable living situation, and to stay there longer, according to a study by the Denver Health Medical Center" (Rao, 9/10). Read the story and sidebar, and watch the related video.

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Applying For Marketplace Coverage Will Also Determine Eligibility For Subsidies (Video Series)

Kaiser Health News' Insuring Your Health columnist Michelle Andrews helps you navigate the new insurance marketplaces that are scheduled to launch on Oct. 1. In today's video, she answers a question about eligibility for subsidies (9/11). Watch today's video or other ones from the series.

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Rural Hospitals In Texas Wary Of Proposed Medicare Cuts

Texas Tribune reporters Becca Aaronson and Edgar Walters, working in partnership with Kaiser Health News, reports: "Small-town hospitals are worried that a federal recommendation to cut costs by re-evaluating which rural hospitals receive higher Medicare reimbursements could threaten their financial security — and even prompt them to shut their doors" (Aaronson and Walters, 9/11). Read the story.

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Capsules: Draft Report: Missourians Favor Medicaid Expansion; Rx For Docs: AMA Answers Obamacare Questions

Now on Kaiser Health News' blog, The St. Louis Post-Dispatch's Virginia Young, working in partnership with KHN, reports on how the Medicaid expansion is playing in Missouri: "They traveled to six, far-flung Missouri cities. They held marathon public hearings. They got detailed state briefings. So what did the 52-member House Citizens and Legislators Working Group on Medicaid Eligibility and Reform conclude? That people want both Medicaid expansion and reform. A seven-page draft report circulated by state Rep. Noel Torpey, R-Independence, the group’s chairman, ends with that statement. There is no elaboration. The rest of the report generally highlights testimony received, without naming witnesses" (Young, 9/11).

Also on Capsules, KHN's Mary Agnes Carey reports on a new AMA website to help doctors answer health law questions: "The website also aims to explain the law’s online marketplaces, or exchanges, which open for enrollment Oct. 1 with coverage beginning on Jan. 1" (Carey, 9/11). Check out what else is on the blog.

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Political Cartoon: 'Protest Too Much? '

Kaiser Health News provides a fresh take on health policy developments with "Protest Too Much?" by David Fitzsimmons.

Here's today's health policy haiku:


Health plan tax credits,
subsidies and discounts yield
this big, big question.

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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Capitol Hill Watch

Some House GOP Lawmakers Take Hard Line Position Against Health Law Funding In Debt Limit Debate

As Republican leaders unveiled a plan to avert a government shutdown, they faced the challenge of building support for the proposal within their own ranks because it does not defund the health law. Some within the caucus reacted with skepticism. But, if enough support can be shored up, a vote could be scheduled as early as Thursday.

The Washington Post: House Republicans Battle Over Leaders' New Budget Bill
House Republican leaders unveiled a plan Tuesday to keep the government open past Sept. 30, but were scrambling to build support within their own ranks after conservatives savaged the proposal for failing to defund President Obama’s health initiative. The plan, as presented to the party’s rank and file in a closed-door meeting Tuesday morning, calls for the government to be funded at current levels through Dec. 15, continuing the sharp budget cuts known as the sequester (Montgomery, 9/10).

The Wall Street Journal: House Conservatives Cool On GOP Spending Plan
A push by conservative House Republicans to cut funding for President Barack Obama's signature health-care law is complicating efforts to keeping the government running when the new fiscal year starts on Oct. 1. House GOP leaders on Tuesday proposed a plan to fund the government through mid-December while forcing the Senate to vote on cutting funds for the 2010 Affordable Care Act. But conservatives unhappy with the health-care law have reacted with skepticism, saying that while it may compel the Senate, controlled by Democrats, to vote on health-care cuts, it won't lead to the dismantling of the program (Boles, 9/10).

The New York Times: G.O.P. Eyes Hard Line Against Health Care Law
The House Republican leadership signaled Tuesday that Republicans would support an essential increase in the nation’s debt limit in mid-October only if President Obama and Democrats agree to delay putting his health insurance program into full effect — a demand that sets the stage for another economically risky confrontation (Calmes, 9/10).

Politico: Conservatives Upset By Defunding Ploy
House Republican leaders are performing some legislative gymnastics to placate conservatives demanding Obamacare defunding — but they’re getting pushback from conservative rank and file and advocacy groups against the short-term spending plan they hope to vote on later this week. Conservatives had already planned a back-to-Washington rally for Tuesday to build support for defunding Obamacare. Members of Congress didn’t directly criticize the leadership plan from the podium, but afterward some called it a gimmick that leaves Obamacare unscathed just weeks before enrollment in the new health marketplaces begins (Cunningham, 9/11).

ABC News: House GOP Devises Ploy To Force Senate Vote To Defund Obamacare
House Republicans will attempt to use a vote this week on a stop-gap measure to fund the government to simultaneously compel the Senate to vote to defund the Affordable Care Act, or "Obamacare." While the Democratic-led Senate is unlikely to defund the health care law, Republicans appear keen on putting vulnerable senators on the record in support of the controversial health care overhaul. "Our goal here is not to shut down the government. Our goal is to cut spending and to stop Obamacare," House Speaker John Boehner, R-Ohio, said during a news conference at the Capitol today (Parkinson, 9/10).

NBC News: House Preps Plan To Avert Shutdown, Force Senate Obamacare Vote
Aides say that GOP leaders are currently assessing Republican support for the plan. If leadership finds they have the support to pass the bill with just Republican votes, they could vote as early as Thursday. Government funding is currently scheduled to expire on September 30th if Congress fails to act (Thorp, 9/10).

NBC News: House GOP Pushes Defund Obamacare Bill; Conservative Group Calls It 'Smoke And Mirrors'
House Republican leadership aides say they are currently whipping a bill that would extend government funding until mid-December, averting a government shutdown, as well as force the Senate to vote on whether they support defunding the Affordable Care Act. ... If leadership finds they have the support to pass the bill with just Republican votes, they could vote as early as Thursday (Thorp, 9/10).

Fox News: House Leadership Pushes New Legislative Strategy To Defund Obamacare
House Republican leaders on Tuesday defended their proposal for a temporary spending bill that essentially puts the contentious issue of "defunding" ObamaCare in the hands of the Democrat-controlled Senate (Weber, 9/10).

Bloomberg: House Republicans Push For Senate Health Vote On Budget
House Republican leaders are lobbying their members to back a government financing strategy that would force the Senate to take a vote on defunding President Barack Obama’s health-care law. House Speaker John Boehner and Majority Leader Eric Cantor must persuade Republicans to vote for their plan to pair a short-term stopgap spending measure with a resolution to strip money for the health-care law. House Democrats plan to oppose the maneuver (Tiron and Rowley, 9/11).

But the defunding push doesn't see this as enough -

CNN: Obamacare Combatants Fight For Attention
It's been pushed off the radar the past couple of weeks by the 24/7 media coverage over whether Congress should authorize a military strike against Syria, but the bitter partisan battle over the new national health care law claws its way back into the spotlight on Tuesday. Proponents of the drive to defund the Affordable Care Act, better known as Obamacare, take to the West Lawn of the U.S. Capitol to hold an afternoon rally. A couple of hours earlier supporters of the law held their own gathering on Capitol Hill to push back against what they call Republican attempts to "sabotage" the health care law (Steinhauser and Walsh, 9/10).

The Hill: Tea Party Rejects GOP's Latest Strategy For Defunding ObamaCare
House GOP leadership's plan to appease conservatives on ObamaCare met with strong opposition from the Tea Party Tuesday, signaling a tough fight ahead as leaders work to pass a government funding bill this week. Powerful conservative groups FreedomWorks, Heritage Action and the Club for Growth announced that they will punish members in future elections if they support House Majority Leader Eric Cantor's (R-Va.) gambit, which places the onus for defunding ObamaCare on the Democratically controlled Senate (Viebeck, 9/10).

Politico: Tea Party Not Sold On ACA Defunding Ploy
House Republican leaders are performing some legislative gymnastics to placate conservatives demanding Obamacare defunding — but they’re getting pushback from conservative rank and file and advocacy groups against the short-term spending plan they hope to vote on later this week. Conservatives had already planned a back-to-Washington rally for Tuesday to build support for defunding Obamacare. Members of Congress didn’t directly criticize the leadership plan from the podium, but afterwards some called it a gimmick that leaves Obamacare unscathed just weeks before enrollment in the new health marketplaces begins (Cunningham, 9/10).

The reason action is necessary -

Los Angeles Times: U.S. Will Hit Debt Limit Between Oct. 18 and Nov. 1, Analysis Says
For example, if the Treasury hit its borrowing authority on Oct. 18, payments to Medicare and Medicaid providers due that day would be delayed one business day, to Oct. 21. But Social Security checks, veterans benefits and active-duty military pay due to be issued on Nov. 1 would not go out until Nov. 13. The government technically hit the debt limit in May. But the Treasury has been using what it calls "extraordinary measures" since then to juggle the nation's finances and continue paying its bills. Those measures included suspending investments in some federal pension funds and in a currency exchange rate fund (Puzzanghera, 9/10).

In other Capitol Hill news -

The Washington Post’s The Fact Checker: The GOP Attack On A Dubious Obama Health Care Pledge
What happens if a politician makes a pledge and is called out by fact checkers for being silly and misleading? And what if the pledge also concerns a plan that turns out to be different than what he proposed during the campaign? Is the pledge still valid for ridicule by the other side? That’s the interesting question raised by Sen. Barrasso’s carefully-worded remarks during the GOP’s weekly radio address. Let’s take a look. … Obama referred to this $2,500 promise at least 19 times during the 2008 campaign, according to an interesting video (Kessler, 9/11).

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Health Reform

Federal Officials, Contractors Give Health Exchange 'Data Hub' Thumbs Up

Several contractors gave positive reports about their readiness to launch the health law's new online marketplaces Oct. 1 at a House hearing Tuesday, although one expert predicted a "rocky start," and several Republicans said they were not reassured.

The Washington Post: Health-Care 'Data Hub' Is Ready, White House Officials Say
Obama administration officials, facing criticism that they are behind schedule in implementing the president’s health-care law, said Tuesday that they have finished a major piece of the technology that will help millions of Americans sign up for insurance this fall. Federal health officials said they have completed the "data hub," a complex system that will verify people’s Social Security numbers, immigration status and other information when they log on to government Web sites to buy health plans and apply for government subsidies (Somashekhar, 9/10).

The Associated Press: 'Obamacare' Contractors Project Confidence
Major contractors hooking up the internal plumbing of President Barack Obama’s health care law projected confidence Tuesday that they will be ready to go by an Oct. 1 deadline, even though the system is still being tested. With just three weeks to go before new state health insurance markets launch, efforts are ongoing to reliably link up government agencies, the markets themselves and private health plans (Alonso-Zaldivar, 9/10).

Reuters: Obamacare Exchanges Seen Headed For 'Rocky' Enrollment Start: Expert
Obamacare is likely to have a "rocky" enrollment start on October 1 in some U.S. states, because of ongoing technology challenges facing new online health insurance exchanges, a leading expert told U.S. lawmakers on Tuesday (Morgan, 9/10).

Politico: ACA Contractors: We'll Be Ready Oct. 1
Several Obamacare contractors say the massive infrastructure allowing millions of Americans to sign up for health insurance will be ready for launch on Oct. 1 despite high-profile delays of some of the law’s major provisions. Cheryl Campbell, senior vice president of CGI Federal, told the House Energy and Commerce Committee on Tuesday morning that the federal health insurance exchange her company is designing is on track with CMS’s timeline (Millman, 9/10).

CQ HealthBeat: Republicans Challenge Readiness Of Data Management And Security In Health Exchanges
Government contractors working to implement parts of the new health insurance marketplaces said Tuesday that they expect some glitches but are on track to meet deadlines, while House Republicans said they were not reassured. With three weeks before open enrollment for the exchanges begins on Oct. 1, lawmakers on the House Energy and Commerce Health Subcommittee continued to bicker over whether the programs would be ready to accept applicants and protect their personal information (Ethridge, 9/10).

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Some Big Insurers 'MIA' From State-Based Exchanges

CNN reports that health plans such as Aetna, UnitedHealthcare and Cigna are practicing watchful waiting to see how the launch of these online marketplaces and the 2014 push to expand coverage rolls out. Meanwhile, California's exchange will be ready, according to its executive director, and most uninsured Kentuckians will receive discounts, says the governor.

CNN: Big Insurers Ditch Obamacare Exchanges
When Americans start shopping on the state-based exchanges next month, a couple of big insurers will likely be MIA. Several of the larger players, including Aetna, UnitedHealthcare and Cigna, are treading cautiously into Obamacare, waiting to see how the start of the massive health care reform pans out in 2014 (Luhby, 9/10).

The Wall Street Journal: California Says Health Exchange Will Be Ready
The assurance is a change from three weeks ago, when Covered California Executive Director Peter Lee said the exchange might "phase in support" for online enrollment. Since then, Mr. Howard said, exchange officials have completed tests of the online system, including creating accounts, selecting plans and assessing eligibility for subsidies. "The core functionality has passed its test," he said (Thurm, 9/10).

Louisville Courier-Journal: Gov. Steve Beshear: Most Uninsured Kentuckians Will Receive Discounts Through Health Exchange
Eighty-five percent of the roughly 332,000 Kentuckians without health insurance will be able to obtain coverage at discounted prices through the state's new health exchange, Gov. Steve Beshear said Tuesday. During a Capitol press conference, Beshear sought to rebuff critics of the exchange, part of the controversial Affordable Care Act, who contend insurance premiums will skyrocket at almost twice the current rates. He predicted most purchasers will be "very excited" when they receive their individual premiums through open enrollment, which begins Oct. 1 (Wynn, 9/10).

NPR: Health Insurance Ads Range From Weighty To Whimsical
Some states are cracking wise in ads about the exchanges, where people will be able to shop for insurance starting in October. Others are rolling out catchy jingles. Some are all business. But in each case, the states are looking to persuade uninsured Americans, especially young ones, to go ahead and buy health insurance. Starting next year, just about everyone in the U.S. will be required to have health insurance (O’Neill, 9/10).

Health Policy Solutions (a Colo. news service): New Red Light Warning For Colorado Exchange
Twenty-two days before the slated opening of Colorado’s new health exchange, the project manager issued yet another red light warning, signaling that data-sharing with Colorado’s Medicaid systems may not work by Oct. 1 and that Connect for Health Colorado managers might have to shift to contingency plans. On top of troubles meshing with the state’s Medicaid systems, managers at Connect for Health Colorado are contending with IT snafus from the federal government (Kerwin McCrimmon, 9/10).

Also in the news, the SEIU is getting involved in the enrollment effort --

Politico: SEIU Joins Sebelius Efforts In Cross-Country Obamacare Push
Obamacare got a renewed show of support Tuesday from the SEIU after some other key unions have complained that the law they advocated for could undermine their members' health insurance. Service Employees International Union President Mary Kay Henry announced that it will partner with advocacy groups, including Enroll America and Families USA, to help the Department of Health and Human Services promote Obamacare in 30 cities in coming weeks (Norman, 9/11).

Finally, here's an update on how the Medicaid expansion is playing in Missouri -

Kaiser Health News: Capsules: Draft Report: Missourians Favor Medicaid Expansion
They traveled to six, far-flung Missouri cities. They held marathon public hearings. They got detailed state briefings. So what did the 52-member House Citizens and Legislators Working Group on Medicaid Eligibility and Reform conclude? That people want both Medicaid expansion and reform. A seven-page draft report circulated by state Rep. Noel Torpey, R-Independence, the group’s chairman, ends with that statement. There is no elaboration. The rest of the report generally highlights testimony received, without naming witnesses (Young, 9/11).

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Parsing Obamacare's Impact On Employment

A new survey shows that despite worries about the health care law, chief financial officers anticipate improved hiring conditions over the next year, according to CBS News. Other media outlets report on Florida Sen. Marco Rubio's challenge to Health and Human Services Secretary Kathleen Sebelius to visit Seaworld where he says employees' part-time hours have been capped to avoid the requirement that they be offered health coverage.

CBS News: Despite Obamacare, Execs Still Expect To Keep Hiring
Although chief financial officers routinely express concern about the impact of the Affordable Care Act on their companies, they also expect hiring conditions to improve over the next 12 months, a new survey shows. Despite concerns over the expected impact of Obamacare when it take effect next year, the executives said they expect to increase the number of full-time employees hired by their companies by 1.8 percent, according to a new Duke University/CFO Magazine poll of CFOs at 530 U.S. companies (Von Hoffman, 9/11).

Fox News: Rubio Urges Sebelius To Visit SeaWorld Over Obamacare Hours Cut
Sen. Marco Rubio says if Health and Human Services Secretary Kathleen Sebelius wants to observe the negative effects of ObamaCare, she needs to pay a visit to Shamu. The Florida Republican sent a letter to Sebelius Tuesday, urging her to speak with employees at Sea World whose part-time hours are being capped, he says due to rising costs from the health care law (9/10).

Orlando Sentinel: SeaWorld To Cut Hours For Part-Time Workers
SeaWorld Entertainment Inc. is reducing hours for thousands of part-time workers, a move that would allow the Orlando-based theme-park owner to avoid offering those employees medical insurance under the federal government's health-care overhaul. ... Under a new corporate policy, SeaWorld will schedule part-time workers for no more than 28 hours a week, down from a previous limit of 32 hours a week. The new cap is expected to go into effect by November. ... In its written statement, SeaWorld said the change "is intended to bring consistency to the part-time designation across the SeaWorld Parks system." It would not say whether the federal health-care law was a factor (Garcia, 9/9).

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Big Changes For Addiction Treatment Predicted Under Obamacare

An estimated 40 million people could enter treatment because the health law recognizes drug addiction and alcoholism as chronic diseases that must be covered by insurance plans, according to the California Health Report. Other news outlets report that Tennessee officials blame Obamacare for the shutdown of a state program that covered 16,000 people but didn't meet the law's coverage requirements and also how scam artists are trying to cash in on people's confusion over the law.

Healthy Cal: ACA Brings Big Changes For Addiction Treatment
The Affordable Care Act recognizes drug addiction and alcoholism as chronic diseases that must be covered by health insurance plans, and in so doing marks a major transformation of addiction care. The biggest change is that 40 million people could enter substance abuse treatment, opening a huge market for addiction care. “I don’t think there’s another illness that will be more affected by the Affordable Care Act,” said Dr. Thomas McLellan, former deputy director of the White House Office of National Drug Control Policy (Urevich, 9/10).

The Washington Post: Using Obamacare As Bait, Scam Artists Target Consumers And Business Owners
A number of health insurance scams have emerged in recent months as crooks try to cash in on confusion over the health care reform law, and some officials say they are bracing for more in the months ahead. Most of the schemes target uninsured individuals and employers, many of whom will soon be required to purchase a minimum level of health coverage or pay a tax penalty. In some cases, scammers have set up bogus Web sites intended to look like the law’s new health insurance exchanges, where individuals and small business owners will be allowed to shop for coverage starting on Oct. 1 (Harrison, 9/10).

Politico: Tennessee Blames Obamacare For Insurance Program’s Closure
Tennessee says it’s shuttering a state-administered insurance program that provides coverage to 16,000 residents because of Obamacare. The program, CoverTN, will cease coverage at the end of the year, according to a notice sent to enrollees this week. “CoverTN is a limited-benefit plan. It has annual benefit limits and does not cover all of the services required by the new health care law,” according to the notice. "This means your coverage through CoverTN will end on Dec. 31, 2013" (Cheney, 9/10).

Politico also reports on a news conference by Sen. David Vitter, who casts doubt on reports of a "brain drain" of Capitol Hill aides if they don't get subsidies to buy Obamacare insurance --

Politico: Vitter: Hill 'Brain Drain' Threats Over Insurance 'Wildly Overstated'
Sen. David Vitter isn’t worried about a Capitol Hill "brain drain" if staffers can’t get federal subsidies to help them buy insurance on the Obamacare exchanges. "The American people? Their first reaction is [that] these are the brains, by the way, that gave us Obamacare, we can afford some of that drain," Vitter said at a press conference Tuesday, adding that the fear of many staffers leaving if they have to pay for their own health care is "wildly overstated" (Haberkorn, 9/10).

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Public Health & Education

FDA Takes Steps To Restrict The Use Of Pain Meds

The Food and Drug Administration will require a class-wide label change for long-acting opioids aimed at limiting use of these drugs to patients with severe, refractory pain.

NPR: FDA Ratchets Down On Prescribing Of OxyContin And Other Opioids
The Food and Drug Administration today took another step toward restricting use of OxyContin and other powerful and often-abused prescription pain medications. The move comes amid an emotional debate over so-called long-acting opioid analgesics. Federal health officials and others are concerned about the rising number of Americans who are getting addicted to the drugs and overdosing on them. Pain specialists and their patients, however, fear that restrictions risk making it too hard for patients who need the drugs to get them (Stein, 9/10).

Medpage Today: FDA Tightens Opioid Labeling
The FDA has ordered a class-wide label change for long-acting opioids such as OxyContin (oxycodone) aimed at limiting use of these drugs to patients with severe, refractory pain. The move, announced at press briefing Tuesday, is part of a handful of changes that the agency hopes will curb an ongoing prescription painkiller epidemic, including a label clarification about the risks of abuse and death with the drugs, a requirement for additional postmarketing studies, and a boxed warning about the risks of neonatal opioid withdrawal syndrome (Fiore, 9/10).

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State Watch

State Highlights: S.F. Suing Nevada Over 'Dumped' Patients

A selection of health policy stories from California, Pennsylvania, Louisiana, Georgia and Oregon.

Los Angeles Times: S.F. Sues To Recoup Costs For Patients 'Dumped' By Nevada Hospital 
The San Francisco city attorney on Tuesday filed a class action lawsuit against the state of Nevada on behalf of all California local governments where patients have allegedly been bused from a Las Vegas psychiatric hospital in recent years (Romney, 9/10).

The Associated Press: San Francisco Sues Nevada Over Psychiatric Patient Moves
The San Francisco city attorney filed a lawsuit on Tuesday against the state of Nevada, claiming it has wrongfully and intentionally bused psychiatric patients to the city and declined to pay the costs connected with their care. City Attorney Dennis Herrera filed the case in San Francisco Superior Court a day after a deadline he had set for Nevada to strike an agreement with the city (Rindels, 9/10).

Modern Healthcare: San Francisco Sues Nevada Over Alleged Patient Dumping
In a class-action lawsuit, the city of San Francisco claims Nevada state-hospital officials secretly bused hundreds of homeless patients from a psychiatric hospital to California, sometimes with little more than a few days' worth of pills and instructions to call 911 on arrival (Carlson, 9/10).

The Associated Press: Feds To Pa. Governor: Switch CHIP Kids To Medicaid
Gov. Tom Corbett's administration is being told it must shift tens of thousands of Pennsylvania children from a state-subsidized health insurance program to Medicaid, although the Republican governor is not saying yet whether he will comply with the federal directive. U.S. Health and Human Services Secretary Kathleen Sebelius told Corbett in a Friday letter that the switch is required by the 2010 federal health care law and that it will simplify coverage for families by aligning children under the same program as their parents (Levy, 9/10).

The Associated Press/Washington Post: Judge Lifts Stay In Fired Medicaid Contractor Lawsuit Against State, Jindal Administration
A Maryland company can move forward with its wrongful termination lawsuit against [Louisiana] Gov. Bobby Jindal's administration for canceling the firm's $200 million Medicaid contract with the state, a judge ruled Tuesday (9/10).

Stateline: 'Peers' Seen Easing Mental Health Worker Shortage 
Peer programs such as Georgia's could become especially important once the Affordable Care Act takes effect early next year. The federal health law will require Medicaid and all other health plans to cover mental health services on par with insurance coverage of physical illnesses. ... That surge in demand, combined with an already severe shortage of mental health workers, has many worried there won’t be enough providers to serve everyone in need. States have deployed a variety of strategies to alleviate the longstanding shortage of mental health professionals. But experts agree peer specialists are the most successful (Vestal, 9/11).

The Associated Press: Ore. Looks At Beefing Up Insurance Premium Reviews
Oregon health officials are considering whether to use the state's authority to approve or reject health insurance premiums as a tool to drive down health care costs. The idea is one of several suggestions for improving the health care system that Gov. John Kitzhaber has asked the Oregon Health Policy Board to consider before state lawmakers return to Salem in February (Cooper, 9/10).

California Healthline: Deadline Nears For U.S. Supreme Court Appeal Of 10 Percent Medi-Cal Provider Cut
Last week, state officials began phased-in implementation of a 10 percent reduction in Medi-Cal reimbursement rates, but that doesn't mean efforts to rescind or reverse the cut have subsided, according to provider groups. Legislative efforts to undo the decision appear to have stalled, with two bills currently sitting in committee as the state Legislature begins its final week of the session. If the week passes without action by the Legislature, that leaves one big card left to play -- appeal to the U.S. Supreme Court (Gorn, 9/10).

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Editorials and Opinions

Viewpoints: Hopes For Single Payer System Remain; GOP's Move To Tie Debt Ceiling To Health Law Is Dangerous; Subsidy 'Fraud' Must Be Stopped

Los Angeles Times: Health Law's Ailments Can Be Cured By Single-Payer System
With the Oct. 1 rollout of a major facet of the Affordable Care Act on the horizon, you'll be hearing a lot about the glitches, loopholes and shortcomings of this most important restructuring of America's healthcare system in our lifetimes. Here are a couple of things to keep in mind: First, the vast majority of these issues result from one crucial compromise made in the drafting of the 2010 law, ostensibly to ease its passage through Congress. That was to leave the system in the hands of private health insurance companies. Second, there's an obvious way to correct this flaw: The country should progress on to a single-payer system (Michael Hiltzik, 9/10). 

Los Angeles Times: House GOP Playing With Fire By Tying Debt Ceiling To Obamacare
How do you try to stop House Republicans from doing something counterproductive and, potentially, politically ruinous to stop the 2010 healthcare law? If you're House Majority Leader Eric Cantor (R-Va.), evidently, it's by proposing something even riskier (Jon Healey, 9/10).

The National Review: The Defund-Obamacare Civil War
A handful of conservative Republicans walked into a meeting with Majority Leader Eric Cantor Monday night anticipating a discussion — an effort to find consensus. What they got instead was a perfunctory heads-up about his plan for the upcoming fight over the "continuing resolution," or CR, a bill to continue funding the government when the current appropriations run out. Under Cantor's plan, the House would pass two different bills, a standard CR and a measure to defund Obamacare. Through parliamentary wizardry, though, the House would keep the Senate from voting on the CR bill until it had also voted on the Obamacare measure (Jonathan Strong, 9/11).

The Wall Street Journal: Stopping ObamaCare Fraud
Every politician claims to hate fraud in government, and the House of Representatives will have a chance to prove it Wednesday when it votes to close a gigantic hole for potential abuse in the Affordable Care Act. The Health and Human Services Department announced in July that it won't verify individual eligibility for the tens of billions in insurance subsidies the law will dole out. Americans are supposed to receive those subsidies based on income and only if their employer doesn't provide federally approved health benefits. But until 2015 the rule will be: Come on in, the subsidy is fine (9/10). 

The New Orleans Times-Picayune: Affordable Care Act Needed To Help Stomp Out HIV In The South
There's a fire raging in America's South, but few people are paying attention. More than three decades into the HIV/AIDS epidemic, its epicenter has shifted from major metropolitan centers like New York and San Francisco to more rural Southern communities. Today, about half of all new HIV infections occur in the South, despite accounting for barely one-third of the America's total population. ... Given this, it is especially troubling that Southern states are some of the most resistant in the nation to implementation of the federal Affordable Care Act, including Louisiana. Not only are state officials perpetuating misinformation about the law and its benefits, but by refusing to implement aspects of the law -- including the Medicaid expansion -- these states are actively impeding the ability of their citizens to access much-need insurance coverage (Paul Kawata, 9/9).

Journal of the American Medical Association: Financial Incentives In Primary Care Practice
It is estimated that 66 percent of total health care spending in the United States is directed toward care for about 27 percent of individuals with multiple chronic conditions. Many policy experts suggest that improving the quality of chronic disease management is a key strategy in controlling costs. Thus, insurers and payers are creating and evaluating incentives to improve the quality of care, including reducing the underuse, overuse, and misuse of clinical services. Pay for performance (P4P) is one of the most common strategies under evaluation, and the types of P4P incentives may vary based on whether it is implemented in a capitated or fee-for-service environment or on the size of the practice (Drs. Rowena J. Dolor and Kevin A. Schulman, 9/11).

The New York Times: The Race to Improve Global Health
International health programs have greatly reduced death and sickness worldwide over the past two decades but there is still a long way to go. The United Nations General Assembly will meet later this month to assess progress — impressive in some areas, halting in others — toward achieving the United Nations' Millennium Development Goals, which were adopted in 2000 and are supposed to be reached by the end of 2015 (9/10).

Baltimore Sun: A Chance To Fix Medicare
More than 1 million men and women in Maryland have one thing in common: They are enrolled in Medicare or Tricare. These programs provide seniors, the disabled and military families the coverage they need to remain healthy and to access the care when they are sick or injured. In Maryland, a number of new health care payment and delivery models are being established to improve patient care and reduce health care costs under the Medicare system, but a broken Medicare payment formula threatens to disrupt the progress of these innovations (Dr. Brian H. Avin and Dr. Ardis D. Hoven, 9/11).

Forbes: Walgreens Buys More Drugstores While Expanding Lab Services For Obamacare
A day after announcing a new relationship to bring quicker lab tests for cholesterol and other conditions into its stores, Walgreen said it would buy a North Carolina-based retail drugstore and specialty pharmacy business. ... To be sure, Walgreen is aggressively expanding into new businesses to increase its presence into the delivery of primary care services. Its competitors, too, like CVS/Caremark and Wal-Mart Stores are also ramping up opening retail clinics (Bruce Japsen, 9/10).

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Stephanie Stapleton

Andrew Villegas

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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.