Daily Health Policy Report

Thursday, September 12, 2013

Last updated: Thu, Sep 12

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Health Reform

Coverage & Access

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Obamacare Insurance Co-Ops At The Starting Gate

Kaiser Health News staff writer Jay Hancock reports: "They have rented offices and zero customers. All their capital is borrowed. They’re trying to sign the kind of expensive, chronically ill individuals that insurers have avoided for decades. In three weeks they face mighty competitors with a hundred times the resources. But the 24 insurance-company startups created by the Affordable Care Act say they’re ready to battle the establishment, stay in business and change health care" (Hancock, 9/12). Read the story.

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Consumer, State Officials Warn Buyers To Be On The Lookout For Fake, Look-Alike Exchange

Reporting for Kaiser Health News in collaboration with Government Computer News, Kelsey Miller writes: "As states are setting up their online health insurance marketplaces, officials are watching for look-alike websites that can lead consumers to be the victims of fraud or simply, confusion" (Miller, 9/12). Read the story.

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Two Types of Subsidies To Help Cover Costs Will Be Available (Video)

Kaiser Health News columnist Michelle Andrews helps you navigate the new insurance marketplaces that are scheduled to launch on Oct. 1. Today she answers a question about the subsidies that will be available to help obtain health insurance through the new online exchanges (9/12). Watch today's video or the others in this series.

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A Road To Health? Rural Alaska Town Argues For Access

APRN’s Annie Feidt, working in partnership with Kaiser Health News and NPR, reports: "The town of King Cove, Alaska is crowded onto a narrow spit of land, surrounded by ocean and volcanic mountains. It’s an Aleut Native community of about 1,000 people, and for roughly a third of the year, weather closes its gravel air strip. When that happens, the only way residents can get to the nearest town, Cold Bay, is by boat -- two hours on choppy seas. So when an emergency call wakes up Bonita Babcock in the middle of the night, she first wants to know how bad the wind is blowing. Babcock is a community health aide and a lifelong resident of King Cove. Her job is to stabilize patients and get them to Cold Bay, where there is a year-round air strip and patients can get to the nearest hospital -- in Anchorage, 600 miles away" Feidt, 9/11). Read the story.

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Pennsylvania Governor Weighing Medicaid Expansion If Tied To Changes

The Philadelphia Inquirer’s Don Sapatkin, working in partnership with Kaiser Health News, reports: "Pennsylvania Gov. Tom Corbett is considering an expansion of Medicaid to cover hundreds of thousands of uninsured residents if he can also win significant changes to the existing part of the entitlement program, which otherwise would continue in its current form" (Sapatkin, 9/11). Read the story.

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Political Cartoon: 'All Downhill From Here?'

Kaiser Health News provides a fresh take on health policy developments with "All Downhill From Here?" by Lisa Benson.

Here's today's health policy haiku:


Defund the health law?
Republicans can't agree.
Shoot themselves in foot?
-Beau Carter

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

With Shutdown Looming, GOP Rift Over Obamacare Stalls Budget Bill

House Republican leaders delayed a vote Wednesday on the stopgap funding measure that would have kept the federal government financed until mid-December after conservatives balked because it didn't explicitly end funding for the health care law.

The New York Times’ The Caucus: House G.O.P. Delays Vote On Stopgap Budget Measure
Facing another revolt by the House’s most ardent conservatives, Republican leaders scrapped a vote this week on legislation that would keep the federal government financed through mid-December while ending financing for President Obama’s health care law. The leaders say they will bring the measure up next week, but with just a handful of legislative days left until a government shutdown, Republicans are in a squeeze (Weisman, 9/11).

The Washington Post: House Republican Leaders Delay Vote On Budget Bill Until Next Week
With a government shutdown looming in less than three weeks, Republican House leaders conceded Wednesday that they have yet to muster enough votes to approve a plan to keep federal agencies open. A vote on the measure, set for Thursday, was postponed until at least next week after conservatives balked, demanding that any deal to fund the government include a provision to cut off funding for President Obama’s signature health-care initiative (Kane, 9/11).

Los Angeles Times: GOP Split Over Healthcare Law Boosts Threat Of Government Shutdown
In the midst of an international crisis, the prospect of a government shutdown intensified Wednesday as House conservatives balked at Republican leaders' efforts to pass a spending bill that did not explicitly eliminate funds for President Obama's healthcare law (Mascaro, 9/11).

The Wall Street Journal: House Delays Vote On Funding Measure
A brewing rebellion among conservatives caused House Republican leaders to delay plans to vote this week on legislation that would fund government operations through mid-December but stop funding of the federal health-care overhaul. The decision comes as conservatives who want to undo the Affordable Care Act ramped up their opposition just before a major component of the law was set to go live, casting doubt on congressional efforts to keep the government open this fall without a big political fight (Boles, 9/11).

Politico: GOP's Obamacare Quandary
Senate Republicans still haven’t figured out how to defund Obamacare and keep funding the government. Competing factions of the party are arguing over just how aggressive they should be in seeking to dismantle the health care law (Everett, 9/12).

CBS News: GOP Rift Over Anti-Obamacare Strategy Stalls Budget Bill
For the past week, debate over Syria has overwhelmed Capitol Hill -- even though Congress has just about two weeks left to pass a budget bill before the federal government partially shuts down. Democratic and Republican leaders are meeting Thursday morning to discuss the looming budget issues, but before the two parties forge a path forward, the GOP may have to sort out its own issues. The Republican-led House had planned to vote this week on a bill to temporarily fund the government (referred to as a continuing resolution, or CR), but the vote was delayed Wednesday because Republicans divisions over its anti-Obamacare strategy (Condon, Budich, 9/12).

CNN: House GOP Leaders Delay Vote On Spending Bill After Conservatives Rebel
House Republican leaders postponed a vote on government funding legislation until next week after many conservatives made it clear they wouldn’t back it because it doesn’t fully defund Obamacare. The government will shut down if Congress does not approve a new annual spending plan by October 1, the start of the new federal budget year (Walsh, 9/11).

Fox News: House Pulls Spending Bill Amid Backlash As Government Shutdown Looms
House Republican leaders pulled their plan Wednesday to temporarily fund the federal government after rank-and-file party members said it sidestepped “defunding” ObamaCare.The action further narrowed Congress’ time to strike a budget deal before an Oct. 1 government shutdown. House Speaker John Boehner and his team pulled the plan, which could have gotten a full chamber vote as early as Thursday, after a conservative backlash led by the Tea Party movement and Heritage Action for America (Fox News, 9/12).

Meanwhile, a new CNN/ORC International poll shows public opposition to the law mounting --

Politico: Poll: Obamacare Opposition Climbs
More than half of Americans oppose most or all of the proposals in Obamacare, a sharp increase in opposition to the healthcare law from earlier this year, according to a new poll Wednesday. Fifty-seven percent of those surveyed said they opposed most or all of the proposals in the law, while just 39 percent favored most or all of the law, according to a CNN/ORC International poll. The opposition rose from 44 percent in similar survey in January, while the support for President Obama’s signature healthcare law dropped from 51 percent (Arkin, 9/11)

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As Opponent Presses McConnell On Conservative Credentials, Senate Minority Leader To Offer New Bill Delaying Health Law Provision

McConnell's legislation would delay for a year the requirement that individuals get insurance.

The Washington Post’s The Fact Checker: Has Mitch McConnell Done 'Nothing' In The Fight Against Obamacare?
This might come as news to the Obama administration—Mitch McConnell apparently has done nothing in the Senate to thwart the Affordable Care Act, aka Obamacare. At least that's the charge leveled by Matt Bevin, a tea party-backed candidate who claims the Republican leader is not conservative enough. We've previously written about this bruising battle taking place in Kentucky. How valid is Bevin's claim? (Kessler, 9/12).

Politico: Mitch McConnell Files Obamacare Amendment To Energy Bill
Senate leaders agreed to keep the debate over Syria out of an energy bill on the floor but there will be no such luck for Democrats on Obamacare. Senate Minority Leader Mitch McConnell (R-Ky.) submitted an amendment Wednesday evening to the energy efficiency bill under consideration that would delay the health care law's individual mandate for a year. It would also codify the White House's one-year delay of the employer mandate, which Republicans believe may be legally murky (Everett, 9/11).

The Hill: McConnell Pushes ObamaCare Delay On Energy Bill
Senate Minority Leader Mitch McConnell (R-Ky.) wants to transform debate on energy efficiency legislation that launched Wednesday into a battle over ObamaCare. McConnell filed an amendment Wednesday to delay the individual health insurance mandate for one year, and codify the Obama administration's one-year delay of requirements that employers provide insurance (Geman, 9/11).

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Health Reform

Several States Still Facing Debates About Medicaid Expansion

Pennsylvania and Ohio are among the states where the Medicaid question is still in play this year. Meanwhile, in Arizona, an effort to get a referendum to block the expansion fails, and an advocacy group vows to bring a lawsuit to stop it.

Politico: Reluctant States Face Medicaid: Yes? No? Punt?
Obamacare sign-up starts in less than a month but a few states are still answering a basic question: Are they in, or are they out of the law's massive expansion of Medicaid? Legislatures in pivotal swing states like Ohio and Pennsylvania are dusting off their gavels from summer recess and diving back into the high-stakes Medicaid debate over whether to extend health coverage to hundreds of thousands of low-income Americans. Others are looking at ballot measures to spur action because lawmakers won't convene again until next year. ... Here’s a look at emerging themes in this unfinished chapter of Obamacare (Cheney and Millman, 9/12).

Philadelphia Inquirer/Kaiser Health News: Pennsylvania Governor Weighing Medicaid Expansion If Tied To Changes
Pennsylvania Gov. Tom Corbett is considering an expansion of Medicaid to cover hundreds of thousands of uninsured residents if he can also win significant changes to the existing part of the entitlement program, which otherwise would continue in its current form (Sapatkin, 9/11).

The Associated Press: Medicaid Expansion Foes Fail To Block Law
Opponents of a new law expanding Medicaid in Arizona failed in their effort to block the law by forcing a referendum, conceding Wednesday that they just didn't collect enough signatures. The group was about 5,000 short of the 86,405 signatures they needed before the 5 p.m. Wednesday deadline, organizer Christine Bauserman said (Christie, 9/11).

The Arizona Republic: Goldwater To Sue Over Medicaid Law
The Goldwater Institute says it will file suit today to overturn Arizona's new law expanding Medicaid eligibility, a day after efforts failed to refer the matter to voters. The lawsuit against Gov. Jan Brewer and the state's Medicaid director, to be filed in Maricopa County Superior Court on behalf of lawmakers who voted against expansion, argues that the governor and a bipartisan legislative coalition violated the state Constitution by imposing a tax on hospitals without garnering a two-thirds majority (Reinhart, 9/11).

Meanwhile, The Associated Press looks at the issues individuals will face in states that do not expand their Medicaid rolls.

The Associated Press: Haves And Have-Nots As Health Care Markets Open
Having health insurance used to hinge on where you worked and what your medical history said. Soon that won't matter, with open-access markets for subsidized coverage coming Oct. 1 under President Barack Obama's overhaul. But there's a new wild card, something that didn't seem so critical when Congress passed the Affordable Care Act back in 2010: where you live (Alonso-Zaldivar, 9/11).

The Associated Press: Medicaid Expansion Happy Surprise For Colorado Man
Colorado is one of at least 24 states expanding Medicaid access for adults under the Affordable Care Act. In Colorado, that means single adults who earned less than $15,400 last year will have access to Medicaid. Childless adults in the state currently qualify for Medicaid only if they make less than $95 a month. Colorado estimates about 160,000 people will be added to state Medicaid rolls under the new guidelines. … [Morgan] Kinney said he feels incredibly fortunate to live in a state where he will receive basic coverage through the government program. He has seen firsthand just how expensive medical expenses can be (Wyatt, 9/12).

The Associated Press: Medicaid Politics Affect Low-Wage Pizza Employee
[Chris Gatliff's] home state, Oklahoma, opted against accepting the expansion of Medicaid under the Affordable Care Act. The result is that thousands of Oklahomans who would have qualified under the expanded program are left in limbo about their health insurance. At the same time, a Medicaid-linked program called Insure Oklahoma that provides Gatliff with his current coverage was due to expire Dec. 31. That left him facing the prospect of having no insurance at the end of the year, so the part-time pizza shop employee began planning to stockpile his medications (Murphy, 9/12).

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Federal Data System For Health Exchanges Passes A Test

Reuters reports this system has now been tested and certified as secure. Meanwhile, Medicare beneficiaries are increasingly confused by the media blitz surrounding the law's new online insurance marketplaces.  

Reuters: Federal Data System For Obamacare Exchanges Gets Security OK
The data system supporting President Barack Obama's healthcare reform has been tested and certified as secure for millions of Americans who will seek health coverage beginning on October 1, meeting a critical deadline for launching the program, the administration said on Wednesday. Concerns over whether consumer information would be secure in time were raised last month, when a government report said it could take until September 30 to sign off on the system's data protections, leaving little room for error before Obamacare is due to go live (9/11).

The Associated Press/Washington Post: Enrollment In State Exchanges Under Health Overhaul Confuses Medicare Beneficiaries
Dear seniors, your Medicare benefits aren’t changing under the Affordable Care Act. That’s the message federal health officials are trying to get out to elderly consumers confused by overlapping enrollment periods for Medicare and so-called "Obamacare." Medicare beneficiaries don’t have to do anything differently and will continue to go to Medicare.gov to sign up for plans. But advocates say many have been confused by a massive media blitz directing consumers to new online insurance exchanges set up as part of the federal health law. Many of the same insurance companies are offering coverage for Medicare and the exchanges (9/12).

Meanwhile, news outlets offer reports on the continuing evolution of state-based health exchanges in Florida, Arizona, Minnesota, West Virginia, Colorado and California.  

The Associated Press: Navigators Barred From County Health Departments
Counselors trained to help sign people up for health insurance under the Affordable Care Act won't be allowed to conduct their work at county health departments across the state, according to a recent directive from the Florida Department of Health. Local health departments can accept brochures and other outreach material about insurance under the new state exchange, but the materials will apparently only be distributed if someone asks for it (Kennedy, 9/11).

The Arizona Republic: 5 Health Insurers Outline Rates For Arizonans Under Affordable Care Act
Paperwork filed by five health insurers gives Arizona its first glimpse of how much President Barack Obama’s health-care law will cost consumers when they begin shopping for mandatory coverage next month. Major health insurers that have filed rate plans with the Arizona Department of Insurance signal that average monthly rates under the Affordable Care Act will range from $225 to $334 when the federal health-insurance marketplaces launch Oct. 1. Companies filing rate plans were Aetna, Blue Cross Blue Shield of Arizona, Cigna, Health Net and Meritus Health Plan, formerly called Compass Health Cooperative (Alltucker, 9/11).

Minnesota Public Radio: Dayton Shares Concern Over Lack of MNsure Outreach To African-American, Somali Groups
Gov. Mark Dayton said today that he shares the concerns of several prominent community organizations that Minnesota's new health insurance exchange, MNsure, has neglected African-American and Somali groups in its initial outreach effort. The Minneapolis Urban League and other groups have complained that they were excluded from MNsure's first $4 million round of grants aimed at enrolling people in the new system (Pugmire, 9/11).

The Star Tribune: Under Fire, MNsure Adds $750,000 In Grants For Minority Outreach
The board of Minnesota’s new insurance exchange responded to a barrage of criticism over grants Wednesday by freeing up as much as $750,000 in additional money for community organizations to help people sign up for coverage. The unanimous vote came a day after MNsure leaders came under fire from legislators and community leaders for excluding certain areas of need, particularly African-Americans, in announcing $2 million in grants last month (Crosby, 9/11).

Pittsburgh Post-Gazette: Highmark To Be Alone On W.Va. Exchange
It happened again this week, this time in West Virginia. A major for-profit health insurer, Coventry in this case, pulled out of that state's nascent health care marketplace, meaning Pittsburgh-based Highmark Inc.'s West Virginia branch will be the only insurer selling subsidized health policies on the exchange when it opens for business Oct. 1 (Toland, 9/12).

Charleston Gazette: Coventry/Carelink Won't Join Health Insurance Marketplace
Carelink/Coventry Health Care has pulled out of the state's individual insurance marketplace, leaving Highmark Blue Cross Blue Shield West Virginia as the only current option for West Virginia residents who buy subsidized health insurance under the Affordable Care Act. "We came to this decision [not to participate in the marketplace] as part of our ongoing review of Aetna's overall company strategy, including the impact of the Coventry acquisition which closed in May, after the original exchange filings were submitted for both companies," Walt Cherniak, a spokesman for Aetna, Carelink/Coventry's parent company, wrote in an email to the Gazette (Kersey, 9/10).

Health Policy Solutions (a Colo. news service): Health Co-Op First To Rule That Transgender Solutions Are Wrong
A new health insurance company that is offering some of the lowest prices for health coverage on Colorado’s new exchange is now the first to decide that it will cover transgender care. Colorado HealthOP, a new nonprofit member-owned health cooperative formed with federal grants under Obamacare, has vowed that it will not discriminate against any groups. Currently most plans sold in Colorado and around the country specifically bar medical care for transgender people. That means most health carriers won’t pay for hormone treatments or gender reassignment surgeries (Kerwin McCrimmon, 9/11).

California Healthline: No Health Care For Young Men? Debating A Generation’s Feelings On Obamacare
Without their presence, the exchanges would be filled with older, sicker individuals and costs would go up for both insurers and consumers. Obama administration officials have said they need to enroll 2.7 million U.S. residents between ages 18 and 35 in exchange plans to balance risk and hold down costs. However, recent news coverage raises the concern that young adults lack enough awareness of the health reform law to actually seek out coverage. Meanwhile, observers say that even if this age group had enough information, convincing them to buy a health plan still would be a tough sell. Young people might be reluctant to purchase something that they believe they'll rarely use, observers say (Wayt, 9/11).

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The Final Push For Obamacare

News outlets report on the ambitious plans of a handful of health insurance co-ops starting from scratch after being funded by the law, how smokers may be charged higher premiums if they don't take cessation classes and the challenge of explaining the law in multiple languages.

Kaiser Health News: Obamacare Insurance Co-ops At The Starting Gate
They have rented offices and zero customers. All their capital is borrowed. They're trying to sign the kind of expensive, chronically ill individuals that insurers have avoided for decades. In three weeks they face mighty competitors with a hundred times the resources. But the 24 insurance-company startups created by the Affordable Care Act say they're ready to battle the establishment, stay in business and change health care (Hancock, 9/12).

The Associated Press/Washington Post: Michigan Smoker May Face Penalty, Go Without Health Insurance Unless He Quits Long-Time Habit
The law requires insurers to accept all applicants regardless of pre-existing medical problems. But it also allows them to charge smokers premiums that are up to 50 percent higher than those offered non-smokers -- a way for insurers to ward off bad risks (9/12).

The Associated Press/Washington Post: Hard Time Understanding Health Reform Law? Try Figuring It Out In Tagalog, Hmong Or Vietnamese
Understanding the law is a challenge even for governors, state lawmakers and agency officials, but delivering its message to non-English speakers who can benefit from it is shaping up as a special complication. That is especially true in states with large and diverse immigrant populations (9/12).

The Associated Press: Key Consumer Questions About The Health Reforms 
How do I know whether "Obamacare" applies to me? Polls show many Americans remain mystified by the Patient Protection and Affordable Care Act, or "Obamacare" as it is commonly known. But there's an obvious starting point: Do you have health care coverage? If your employer provides health insurance for you, it's likely you don't have to do anything on Oct. 1, when enrollment begins. The president has said you will be able to keep your doctor and your plan (9/12).

The Associated Press/Washington Post: Key Milestones – And Potholes – In President Barack Obama’s Health Care Overhaul Law
Medicare was signed into law on July 30, 1965, and within a year seniors were receiving coverage. President Barack Obama signed the Affordable Care Act on March 23, 2010, and the uninsured start getting coverage more than three years later on Jan. 1, 2014. Some key dates in the saga of Obama’s signature legislation (9/12).

The CT Mirror: Obamacare: Big Changes Ahead For Some In Connecticut 
Several key provisions of the federal health reform law known commonly as Obamacare are taking effect Jan. 1. For some people, like the uninsured, that will bring major changes. For many others, like those who get their insurance through their jobs, not much will change. Here’s a look at how various groups of people will be affected, what their insurance options are now and what choices they’ll have beginning in 2014 (Becker, 9/12).

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Marketing Of Health Law Goes Mainstream

The Associated Press reports that applying for coverage in new online insurance marketplaces will feel like a combination of doing your taxes and making a big purchase. Other media outlets describe how insurers are opening stores to pitch directly to consumers, while a few companies are creating look-alike exchange websites -- some of which may be scams.

The Associated Press: Applying For Health Insurance? Homework Involved
Getting covered through President Barack Obama's health care law might feel like a combination of doing your taxes and making a big purchase that requires research. You'll need accurate income information for your household, plus some understanding of how health insurance works, so you can get the financial assistance you qualify for and pick a health plan that's right for your needs (Alonso-Zaldivar, 9/11).

USA Today: Health Insurance Sales Hit The Mall -- And Web
Call it the retailization of health insurance. Shopping center owners may not be courting them as they would Apple or trendy fashion brands, but health insurers are increasingly opening stores alongside far sexier retail tenants. With few people buying health insurance on their own, insurers have long focused on retaining and attracting the companies that offer it to their employees. Now, however, the new health law known as the Affordable Care Act means most uninsured Americans are required to have insurance beginning March 31 or pay a penalty at tax time in 2015 (O'Donnell, 9/12).

Kaiser Health News: Consumer, State Officials Warn Buyers To Be On The Lookout For Fake, Look-Alike Exchanges
As states are setting up their online health insurance marketplaces, officials are watching for look-alike websites that can lead consumers to be the victims of fraud or simply, confusion (Miller, 9/12).

Meanwhile, Bloomberg News reports on how Health and Human Services Secretary Kathleen Sebelius is attempting to sell the law to the nation's governors --

Bloomberg: Sebelius Bargains With Governors To Shore Up Health Law
Kathleen Sebelius quietly charmed one governor's business-executive dinner guests in Colorado and publicly berated another for his Medicaid stance in Pennsylvania. She surprised a Republican governor in Utah with her flexibility and disappointed a Democratic one in West Virginia with her lack of timely answers. Sebelius, the 65-year-old Health and Human Services secretary, has had to get creative with the task of selling President Barack Obama's health-care law to an often skeptical - - sometimes hostile -- group of governors (Davis, 9/12).

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Professional Soccer Team Signs Up To Help D.C. Health Exchanges

On the other side of the issue, the Heritage Foundation unveils a new billboard in New York City.

Politico: DC United To Help Publicize District's Obamacare Exchange
Obamacare is about to get a big assist from D.C.'s professional soccer team. The District's health exchange is teaming up with D.C. United to spread the word about coverage options in the new insurance marketplace set to open in just three weeks. The District's exchange, known as DC Health Link, disclosed the plans in a Wednesday night board meeting. A more formal announcement is still to come (Millman, 9/11).

Health Policy Solutions (a Colo. news service): Health Insurance Like Buying A BMW For Some Spanish Speakers
When new Connect for Health Colorado ads launch this fall, Spanish speakers will hear a different message from other potential customers. The call to action will be "Come and learn" rather than "Come and buy," the message that will bombard most other customers. That’s because many Spanish-speaking immigrants don’t even ponder buying health insurance since they think it's out of reach financially, according to a consultant who is advising Connect for Health (Kerwin McCrimmon, 9/11).

The Wall Street Journal's Washington Wire: Heritage Unveils Anti-Obamacare Billboard In Big Apple
Brightly lit Times Square displays singing the praises of "Mamma Mia!" and "Wicked" find themselves with an unusual new companion this week, as the Heritage Foundation unveiled a billboard blasting Obamacare on 42nd Street. The 90-foot-high, 67-foot-long billboard reads, "WARNING: Obamacare may be hazardous to your health," and encourages viewers to support defunding the health-care law. The sign displays a number viewers can text to get more information (Ballhaus, 9/11).

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AFL-CIO Ramps Up Criticism Of Health Law

The labor federation approved a resolution Wednesday urging changes to parts of President Barack Obama’s health care law that it says would drive up the costs of union-sponsored health plans to the point that workers and employers would abandon them.

The New York Times: Unions' Misgivings On Health Law Burst Into View
When President Obama phoned the president of the A.F.L.-C.I.O. last month, he shared some news that the labor leader had long wanted to hear — the administration would propose measures to reduce workplace exposure to disease-causing silica dust. But their conversation soon moved to what has become a contentious topic this summer: labor’s renewed anger over Mr. Obama’s health care law and decisions surrounding it, especially the postponement of an employer mandate to ensure coverage for workers and the potential effects of the coming health insurance exchanges on existing plans (Greenhouse and Martin, 9/11).

The Associated Press/Washington Post: Despite White House Pressure, AFL-CIO Steps Up Criticism Of Obama’s Health Law
The strongly worded resolution says the Affordable Care Act will drive up the costs of union-sponsored health plans to the point that workers and employers are forced to abandon them. Labor unions still support the law’s overall goals of reducing health costs and bringing coverage to all Americans, the resolution says, but adds that the law is being implemented in a way that is “highly disruptive” to union health care plans (9/11).

Bloomberg: Call To Change Obama’s Health Law Opens Rift With Labor
The AFL-CIO is asking for changes to the Affordable Care Act, President Barack Obama’s landmark health-care overhaul, potentially opening fissures between the White House and one of its staunch political allies. The largest U.S. labor federation approved a resolution yesterday urging amendments to the law in a voice vote on the final day of its quadrennial convention in Los Angeles (Efstathiou, 9/12).

Roll Call: GOP Leery Of Labor’s Push For A Health Care Law Fix
A simmering conflict between organized labor and the Obama administration over the 2010 health care law could drive a wedge between the White House and one of its most reliable backers. Congressional Republicans, on the other hand, are eager to expose the divide and warn the administration they will firmly oppose any attempt to acquiesce to labor’s concerns (Harrison, 9/11).

In other news, Politico reports that final rules about how lawmakers and their staffs can get coverage in the exchanges may not be published until after Oct. 1 -

Politico: Obamacare Enrollment Rules For Hill Staff May Be Delayed
The Office of Personnel Management may not issue final rules about how members of Congress and their staff can get insurance coverage through exchanges until after enrollment opens on Oct. 1, Chief Administrative Officer of the House Dan Strodel wrote in a memo to staff Wednesday. Without the final rule, Hill staff won’t be able to view their plan options, costs, benefits or final details on who must enter the exchange, he wrote (Cunningham, 9/11).

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For Small Companies And Self-Employed People, Health Law Raises Questions

This pair of stories from The Associated Press outlines how confusing the health law can be for both small business owners as well as the self-employed with high income.

The Associated Press: Health Care Law Perplexing To Business Owners
Restaurant owners Colleen and Tim Holmes were considering opening a third business in a growing upstate New York suburb but decided against it. One factor was the risk from expanding their staff beyond 50 full-time employees and having to provide them federally mandated health coverage. Despite knowing the penalty for that part of the Affordable Care Act had been postponed for a year, the couple said their margins are thin and the requirements and costs under the law remain unclear (Virtanen, 9/11).

The Associated Press/Washington Post: Health Care Reforms Likely To Raise Insurance Costs For The Self-Employed With Higher Incomes
President Obama's health care reforms will be a huge boost to the working poor but are likely to make life more expensive for Aaron Brethorst and others like him. The Seattle software developer and consultant doesn't have a problem with that because he figures he'll be able to afford quality insurance. He says his annual income is in the low six-figures, and he expects to receive better coverage once the Affordable Care Act kicks in (9/12).

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Coverage & Access

Native Americans Feel Burden Of Mental Health Budget Cuts

NPR: For Native Americans, Mental Health Budget Cuts Hit Hard
Native American tribes gave up millions of acres to the federal government in the 19th century in exchange for promises of funded health care, education and housing. But time and again, those funds have been cut. The recent across-the-board federal budget cuts, known as the sequestration, are no exception. They came with a 5 percent reduction in funding for mental health services, including suicide prevention. That's especially troubling for Native Americans, whose suicide rate are four times the national average (Morales, 9/12).

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State Watch

Feds To Pa.: Shift Some Kids On CHIP To Medicaid

Federal officials denied a request by Pennsylvania to keep more than 50,000 children on the state CHIP program and have instead instructed officials there to shift the kids' coverage to Medicaid ahead of implementation of Obamacare. 

The Associated Press: Feds Force Pennsylvania To Shift Thousands Of Kids From CHIP To Medicaid
More than 50,000 children enrolled in Pennsylvania's insurance program for low-income families will have to switch to Medicaid now that the federal government has refused to grant the state an exception under the new health care law. The Corbett Administration says the refusal to grant an exemption means more than a fourth of the nearly 190,000 children enrolled in Pennsylvania’s CHIP program will have to move to Medicaid, but advocates like Richard Weishaupt of Community Legal Services in Philadelphia say that’s a good thing (Romeo, 9/11).

Harrisburg, Pa., Patriot News: Feds Won't Let Corbett Keep Children In CHIP 
The Obama administration has informed Gov. Tom Corbett that about 50,000 children with lower incomes will have to switch from CHIP to Medicaid as a result of the Affordable Care Act. Corbett opposes moving children out of Pennsylvania's popular CHIP health insurance program, arguing it will cause disruptions such as forcing some children to change doctors. Corbett exchanged a series of letters with U.S. Secretary of Health and Human Services Kathleen Sebelius requesting flexibility on the matter. Sebelius has provided an apparently final answer, writing to Corbett that shifting the children to Medicaid will, among other things, enable children to have the same health coverage as their parents (Wenner, 9/11).

In the meantime, a third of Medicaid recipients in Connecticut now belong to a "patient-centered medical home," which aims to increase quality and reduce costs --

The CT Mirror: 'Medical Home' Program Now Reaches A Third Of Medicaid Patients 
A state program that pays health care providers to take a more active role in patient care now reaches close to a third of Connecticut’s Medicaid clients. Now in its second year, the "person-centered medical home" program allows primary care providers to earn additional money for meeting standards intended to improve outcomes and access to care for Medicaid patients. As of Sept. 5, 982 health care providers were participating in the program, either as fully qualified members or as part of a "glide path" for those still working to meet all the standards. Altogether, they see 218,511 Medicaid patients, about a third of the approximately 640,000 Connecticut residents covered by Medicaid (Becker, 9/11).

And in Iowa, billing for abortion in Medicaid makes news --

Des Moines Register: U Of I Isn’t Billing Medicaid For Recent Abortions
Gov. Terry Branstad has been spared the task of deciding whether Medicaid should pay for abortions, because the University of Iowa has declined to bill the program for such services. Legislators voted last spring to require the governor's personal approval before Medicaid could pay for any abortions. The controversial arrangement, the first of its kind in the country, was a compromise between abortion-rights advocates and abortion opponents, many of whom insist their tax dollars should not pay for abortions (9/12).

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State Highlights: Nation's Older Population Strains Budgets In Northeast

A selection of health policy stories from Michigan, Alaska, Texas, Oregon and California.

The Washington Post: The Northeast Is Getting Older, And It’s Going To Cost Them
Most of the nation's oldest population is now clustered in the Northeast and growing rapidly, according to Census data, straining medical, housing and transportation budgets and forcing lawmakers to look for new approaches. And legislators and governors are reaching the conclusion that the way to pay for the elderly is to cater to the young (Wilson, 9/12).

Detroit Free Press: Detroit May End Health Care Coverage For Retirees Under 65, Replace It With $125 Monthly Stipends
Detroit emergency manager Kevyn Orr is considering a plan to replace current health care benefits for retirees under 65 with a stipend of $125 a month to buy coverage beginning next month from the state’s new health insurance exchange, city officials said on Wednesday. The city intends to help those retirees figure out the best health insurance plan offered under the Affordable Care Act, also known as Obamacare. Michigan’s insurance marketplace where the plans will be sold launches Oct. 1 and coverage is effective Jan. 1 (9/12).

Kaiser Health News: A Road To Health? Rural Alaska Town Argues For Access
The town of King Cove, Alaska is crowded onto a narrow spit of land, surrounded by ocean and volcanic mountains. It's an Aleut Native community of about 1,000 people, and for roughly a third of the year, weather closes its gravel air strip. When that happens, the only way residents can get to the nearest town, Cold Bay, is by boat -- two hours on choppy seas. So when an emergency call wakes up Bonita Babcock in the middle of the night, she first wants to know how bad the wind is blowing. Babcock is a community health aide and a lifelong resident of King Cove. Her job is to stabilize patients and get them to Cold Bay, where there is a year-round air strip and patients can get to the nearest hospital -- in Anchorage, 600 miles away Feidt, 9/11).

Dallas Morning News: Texas Trims Private Contractor's Screening Of Applications For Children's Health Coverage 
Texas has shifted screening of some poor children's applications for health coverage from a private contractor to state workers, smoothing internal processes before next month's launch of a state health insurance marketplace under Obamacare. The state's umbrella social services agency says it transferred the work to merge the two (9/11).

The Lund Report: Ore. Health Director Tries To Shift Cost Containment Talk Away From Insurance Division
Gov. John Kitzhaber tasked the Oregon Health Policy Board with four areas to hold down health care costs, including greater oversight of rate requests by insurance companies. But the state health director, Dr. Bruce Goldberg, downplayed rate review as a way of bringing down costs at Tuesday’s meeting of the policy board (Gray, 9/11).

The Lund Report: Pfizer, Eli Lilly and Genentech Pour Money Into State Elections
Nineteen drug companies have spent a combined half a million dollars since 2011 trying to influence elections and legislation, led by Pfizer, Eli Lilly and Genentech. Pfizer, known for Viagra, Zoloft and Xanax, is the world's largest drug company by revenue, and Eli Lilly is the world's largest manufacturer of psychiatric medications, such as Prozac (Gray, 9/11).

California Healthline: War Of Words Over Abortion Clinics Only Interruption In Quiet March Of Bill Passage
The Senate this week passed a bill to change building requirements for primary care clinics that provide abortions. AB 980 by Assembly member Richard Pan (D-Sacramento) was the only health-related legislation that generated much heat on the Senate floor. And it was over building codes. "This bill simply creates parity in building standards between primary care clinics that provide abortions and other primary care clinics," said Sen. Kevin de León (D-Los Angeles), who presented the bill on the Senate floor. "This assures all clinics will be held to equal and appropriate standards” (Gorn, 9/11).

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Weekend Reading

Longer Looks: Understanding the Mind; Facebook Depression; Planning For A Successful End Of Life

Every week reporter Ankita Rao selects interesting reading from around the Web.

The New York Times: The New Science Of Mind
These days it is easy to get irritated with the exaggerated interpretations of brain imaging — for example, that a single fMRI scan can reveal our innermost feelings — and with inflated claims about our understanding of the biological basis of our higher mental processes. Such irritation has led a number of thoughtful people to declare that we can never achieve a truly sophisticated understanding of the biological foundation of complex mental activity. In fact, recent newspaper articles have argued that psychiatry is a "semi-science" whose practitioners cannot base their treatment of mental disorders on the same empirical evidence as physicians who treat disorders of the body can. The problem for many people is that we cannot point to the underlying biological bases of most psychiatric disorders. In fact, we are nowhere near understanding them as well as we understand disorders of the liver or the heart. But this is starting to change (Eric R. Kandel, 9/6).

The Wall Street Journal: The Ultimate End-Of-Life Plan
My mother died shortly before her 85th birthday, in a quiet hospital room in Connecticut. One of my brothers was down the hall, calling me in California to say, too late, that it was time to jump on a plane. We were not a perfect family. She did not die a perfect death. But she died a "good-enough" death, thanks to choices she made earlier that seemed brutal at the time. … In California, my home state, a 2012 survey by Lake Research Partners and the Coalition for Compassionate Care of California found that 70% of state residents want to die at home, and national polls have registered even higher proportions. But in fact, nationally, less than a quarter of us do. Two-fifths die in hospitals, and a tragic one-fifth in intensive care, where deaths are often harrowing. This is an amazing disconnect in a society that prides itself on freedom of choice. This disconnect has ruinous economic costs. About a quarter of Medicare's $550 billion annual budget pays for medical treatment in the last year of life (Katy Butler, 9/6).

NBC News: Shakedown: How Doctors Sought Gifts From Little Old Lady Living In The Hospital -- 'Empty Mansions' Excerpt
How tantalizing this eccentric patient was for the leaders of a nonprofit hospital dependent on fundraising. Here was a woman, well into her 90s, with something more than $300 million, and she was living in their hospital. Huguette Clark was the girl who could spin straw into gold. From age 85 to well past 100, when most people need elaborate pillboxes marked with the days of the week, Huguette was remarkably healthy, requiring no daily medications other than vitamins. Yet she stayed in the hospital for a bit more than 20 years, for 7,364 nights, though she said she couldn't stand the hospital food. Why? She said she felt safe there. When one of her round-the-clock private nurses kept urging her to move back home, Huguette fired her. On New York's Upper East Side at Doctors Hospital, which became part of Beth Israel Medical Center, the hospital's doctors and managers could have discharged her after her skin cancer was cured. But repeatedly they came back to her for larger and larger donations (Bill Dedman and Paul Clark Newell Jr., 9/11).

Slate: The Disturbing, Shameful History Of Childbirth Deaths
Bearing a child is still one of the most dangerous things a woman can do. It's the sixth most common cause of death among women age 20 to 34 in the United States. If you look at the black-box warning on a packet of birth control pills, you'll notice that at most ages the risk of death from taking the pills is less than if you don't take them—that's because they're so good at preventing pregnancy, and pregnancy kills. ... In the United States today, about 15 women die in pregnancy or childbirth per 100,000 live births. ... Evolutionarily, childbirth seems like an exceptionally bad time to die. If by definition the ultimate measure of evolutionary success is reproducing successfully, the fact that women and newborns frequently died in childbirth suggests that powerful selective forces must be at work. Why is childbirth such an ordeal? (Laura Helmuth, 9/10).

The New Yorker: How Facebook Makes Us Unhappy
No one joins Facebook to be sad and lonely. But a new study from the University of Michigan psychologist Ethan Kross argues that that's exactly how it makes us feel. Over two weeks, Kross and his colleagues sent text messages to eighty-two Ann Arbor residents five times per day. The researchers wanted to know a few things: how their subjects felt overall, how worried and lonely they were, how much they had used Facebook, and how often they had had direct interaction with others since the previous text message. Kross found that the more people used Facebook in the time between the two texts, the less happy they felt—and the more their overall satisfaction declined from the beginning of the study until its end. The data, he argues, shows that Facebook was making them unhappy (Maria Konnikova, 9/10).

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Editorials and Opinions

Viewpoints: GOP 'Obsession' With Health Law Prevents Progress On Key Financial Issues; The 'Fantasy Of Fertility;' VA Is 'Model' For Transforming U.S. Medicine

Los Angeles Times: GOP's Unhealthy Obsession With Obamacare
Try as they might, House Republican leaders are having trouble stopping their colleagues from shooting themselves in the foot -- again. Having failed to approve any of the 12 annual appropriations bills that fund federal agencies, Congress has to pass a stopgap spending bill by Sept. 30 to keep much of the federal government from shutting down. But rank-and-file Republicans in the House are resisting their leadership's proposed stopgap because it wouldn't necessarily block funding for the 2010 Patient Protection and Affordable Care Act, a.k.a. Obamacare. ... The House GOP needs to stop fighting a battle on Obamacare it can't win and get to work instead on the long-delayed "grand bargain" (9/12).

The New York Times: Selling The Fantasy Of Fertility
On Sunday in New York City, a trade show called Fertility Planit will showcase the latest inventions in the world of reproductive medicine under a banner that reads: "Everything You Need to Create Your Family." Two dozen sessions will feature many of the sponsors' products and therapies, with an emphasis on hopeful breakthroughs ranging from genetic testing to embryo thawing techniques to genome sequencing. But the fair's most powerful strategy is the suggestion that all your answers can be found within the event hall -- and that the power to overcome infertility can be found within yourself (Miriam Zoll and Pamela Tsigdinos, 9/11).

Journal of the American Medical Association: Will The Cost Of Health Insurance Under The ACA Be Lower Than Expected
As we approach October 1, the date insurance exchanges will open for business, the news has been consumed with speculation as to how the rollout of the Affordable Care Act (ACA) will proceed. … When the ACA was passed, many scoffed at projections by the Congressional Budget Office (CBO) of the law's future cost. They believed that reform would be much more expensive than the CBO's estimates. Ironically, it turns out those projections may have been too high (Dr. Aaron Carroll, 9/11).

The New England Journal of Medicine: Balancing AMCs' Missions and Health Care Costs -- Mission Impossible?
When major provisions of the Affordable Care Act (ACA) are implemented next January, few institutions will feel the pressure to control costs more acutely than academic medical centers (AMCs), which must balance the imperatives of clinical care with cost-intensive missions in research, teaching, and community health. ... AMCs' complex organizational structures and historical focus on tertiary inpatient care may appear incongruent with success in contracts requiring commitment to change and reduced use of hospital services. Charting our course under the current economic pressures won't be easy. But our AMCs have built their reputations by addressing society's most pressing health care challenges, and today's central challenge is the rising cost of health care. Fortunately, AMCs specialize in innovation (Elizabeth G. Nabel, M.D., Timothy G. Ferris, M.D., M.P.H., and Peter L. Slavin, M.D., 9/12).

JAMA Surgery: This Is Not Your Father's VA
For many years, perceptions of the VA were crystallized in Oliver Stone's 1989 movie Born on the Fourth of July. In that movie, a VA hospital was characterized by apathetic staff, disengaged physicians, rampant drug use among patients, and old, malfunctioning equipment. The image of the VA was further tarnished in 2007 with the revelations of unsatisfactory conditions at the Walter Reed Army Medical Center, a U.S. Department of Defense medical center that is not part of the VA. Finally, the recent, highly publicized concerns about delays in the processing of veterans' benefits have been incorrectly assumed to imply delayed or inefficient care in VA hospitals. In fact, the VA's health care system has become a model for the transformation of American medicine in the 21st century (Dr. Kamal M. F. Itani, 9/11).

The Washington Times: Compounding Obamacare
Most Americans think their pharmacists are doing fine now, without the federal government's help. Pharmacists, Gallup tells us, are second only to nurses on the list of America's most trusted professionals; 75 percent of those surveyed say pharmacists live up to high ethical standards. The federal government is scheming to take oversight of compounding pharmacies out of the hands of state authorities and put it in the hands of those who can only dream of positive ratings like those of pharmacists. Congressmen, at 10 percent, are found at the bottom of the trust list with used car salesmen (and Washington journalists). (9/11).

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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.