Daily Health Policy Report

Friday, September 13, 2013

Last updated: Fri, Sep 13

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Health Reform


Health Care Marketplace

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Each Marketplace Plan Must Offer 10 'Essential Benefits' (Video)

Kaiser Health News consumer columnist Michelle Andrews helps you navigate the new insurance marketplaces that are scheduled to launch on Oct. 1, answering a question about the basic benefits package health plans must offer on the new health exchanges. Watch the video or watch other earlier videos that were part of this series.

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Selling Marketplace Plans To Medicare Beneficiaries Will Be Illegal

Reporting for Kaiser Health News in collaboration with The Washington Post, Susan Jaffe writes: "After reassuring seniors that Medicare is not part of the new health insurance marketplaces, administration officials have a warning for anyone who may have other ideas: selling marketplace coverage to people who have Medicare is illegal" (Jaffe, 9/13). Read the story.  

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Capsules: Insurance Exchange Outreach In Connecticut Goes Far Afield; Campaign To Enroll LBGT Community In Health Coverage Launched At White House

Now on Kaiser Health News’ blog, WNPR's Jeff Cohen, working in partnership with KHN and NPR, reports on Connecticut’s health exchange outreach: "Across Connecticut, you can see billboards and television ads, hear radio spots and get pamphlets, all about how to get insurance under the new federal health law starting Oct. 1. But the state also is spending big bucks on less traditional ways to get the word out" (Cohen, 9/12).

Also on Capsules, Ankita Rao reports on the launch of a new effort to enroll the LGBT community in health coverage: "The Obama administration and community advocates touted the effort to reach out to those communities about new online health insurance marketplaces, where people can compare insurance plans and find out if they're eligible for government subsidies. The marketplaces open for enrollment Oct. 1, and will sell policies that take effect beginning Jan. 1" (Rao, 9/13). Check out what else is on the blog.

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Political Cartoon: 'Pain In The …'

Kaiser Health News provides a fresh take on health policy developments with "Pain In The …" by Ann Telnaes.

Here's today's health policy haiku:


Brush and floss daily.
Look both ways before crossing.
And watch what you click

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

As House GOP's Intra-Party Fiscal Fight Continues, Dems' Strategy Is To Not Give In On Health Law

House Speaker John Boehner, R-Ohio, is seeking Democratic support to advance fiscal talks to avert a government shut down and raise the debt ceiling. Meanwhile, a bloc of Republican lawmakers unveiled a yearlong funding bill that would delay the health law's implementation for a year -- adding to the budgetary chaos on Capitol Hill.

Politico: White House Determined Not To Give Ground On Obamacare
Don't blink first. That’s the strategy President Barack Obama and Capitol Hill Democrats are pursuing as the nation faces a government shutdown, a historic default on its debt and the final phase of Obamacare (Allen, 9/12).

The New York Times: Boehner Seeking Democrats' Help On Fiscal Talks
But a bloc of 43 House Republicans undercut the speaker's deficit-reduction focus, introducing yearlong funding legislation that would increase Pentagon and veterans spending and delay President Obama’s health care law for a year -- most likely adding to the budget deficit. That bloc is large enough to thwart any compromise that does not attract Democratic support (Weisman, 9/12).

The Wall Street Journal: Boehner Wants Joint Talks On Debt, Budget
Mr. Boehner said he made the same case in a private meeting with Treasury Secretary Jack Lew on Wednesday. But Mr. Lew said the White House wouldn't agree to such talks, following the 2011 political showdown that nearly led the government to begin missing payments. Mr. Boehner didn't specify the spending cuts, "changes and reforms" he would seek in exchange for raising the debt cap, but a clamor is growing among House conservatives to demand that no funding measure be approved unless it strips money from the federal health care law. Conservative opposition to the health law is making it difficult for the House to pass a short-term funding bill, known as a continuing resolution, that would keep the government operating after the new fiscal year begins Oct. 1 (Hook and Boles, 9/12).

The Associated Press/Washington Post: GOP Leaders Confounded On Stopgap Spending Bill Over Conservative Assault On 'Obamacare'
GOP leaders eager to avoid blame for a possible government shutdown next month appear confounded by conservatives' passion for using fast-approaching deadlines to derail the implementation of President Barack Obama's health care law. House Speaker John Boehner, R-Ohio, conceded Thursday his plan was all but dead for quickly passing a temporary spending bill that also defunds Obamacare, make the Senate vote on each idea separately and then send only the portion for keeping the government open to the White House for the president's signature (9/12).

PBS NewsHour: Chaos In House Over Obamacare Fight
Remember that time House Speaker John Boehner's Republican members put him in a tough spot? When lawmakers wanted to pressure him to go farther on a fiscal matter, no matter the consequences? Yeah, that's happening. Again. Republican leaders on Wednesday pulled a measure that would have funded the government beyond the end of September, delaying a scheduled Thursday vote on the spending bill until next week (Bellantoni and Burlij, 9/12).

Roll Call: 32 GOP Lawmakers Float Alternative CR That Defunds Obamacare
Forty-three House Republicans have introduced their own continuing resolution that they think would achieve the goal of both cutting spending and defunding Obamacare better than the plan GOP leaders put forth Tuesday. Rather than fund the government for a month and a half at the post-sequester top line of $988 billion, it would run through all of fiscal 2014 at the lower, $967 billion levels many Republicans favor (Dumain, 9/12).

The Hill: CR Delaying Obamacare Draws Support
Forty-three House Republicans are backing a plan to fund the government while delaying and defunding Obamacare for one year, highlighting the challenge facing GOP leadership as it seeks a middle path that would protect against a shutdown. Lawmakers affiliated with the Tea Party rejected leadership's initial proposal on Tuesday, which would have foisted a defund vote on the Senate while allowing a clean continuing resolution to move to the White House for President Obama's signature (Baker and Viebeck, 9/12).

PBS NewsHour: Obamacare Battles In The House Put Burden On Boehner As Budget Deadlines Loom
As Congress returns to Capitol Hill this week, House Speaker John Boehner, R-Ohio, is in a bind to pass major spending bills before the Oct. 1 fiscal year deadline. Gwen Ifill speaks with Todd Zwillich of Public Radio International about how the battle over Obamacare threatens to shut down the government (Ifill, 9/12).

In other fiscal news --

The Wall Street Journal: Budget Deficit On Track For Smallest Shortfall Since 2008
August was the eleventh month of the 2013 fiscal year, and the September data will likely show that 2013 was the first year since 2008 that the government had an annual deficit of less than $1 trillion. The Treasury Department said the August spending level was elevated because Social Security, Medicare, and other benefit payments scheduled to go out Sept. 1 were pushed to Aug. 30 because payments can't go out on the weekend (Paletta, 9/12).

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House Passes Bill To Hold Obamacare Subsidies Until Eligibility Verified

The bill directs that insurance subsidies for Americans be held until their eligibility is confirmed, something Republicans insisted was needed after HHS granted some states leeway on implementing Obamacare over the summer. The bill appears to be headed nowhere in the Senate.

Politico: House Passes Obamacare Verification Bill 
The House notched its 41st Obamacare vote on Thursday, this one aimed at the insurance subsidies to be handed out on the exchanges opening in less than three weeks. The bill, which passed 235-191, would mandate a verification program to make sure Americans don't collect more insurance subsidies than they're qualified for. HHS is already putting such a program in place, but Republicans insisted their measure is necessary in light of extra leeway the Obama administration granted states over the summer (Cunningham, 9/12).

The Associated Press: House Passes Bill To Delay Health Care Subsidies
The House passed a bill Thursday to ban new subsidies to help people buy health insurance until the Obama administration enacts a new verification system to ensure benefits go only to those who are eligible. Democrats say the bill, which has no chance in the Democratic-controlled Senate, would unnecessarily delay subsidies slated to start next year. The White House has threatened a veto (Ohlemacher, 9/12).

In the Senate -

Politico: Obamacare, Keystone Collide In Senate Energy Fight
The Senate's first big energy debate since 2007 quickly devolved into an accidental collision between Obamacare and the Keystone XL pipeline. On one side is Sen. David Vitter (R-La.), who has halted action on a bipartisan energy-efficiency bill while demanding a vote on an unrelated Obamacare measure. On the other is Sen. John Hoeven (R-N.D.), who wants to use the energy bill as a vehicle for a pro-Keystone amendment that he's crafted to make as much bipartisan noise as possible (Goode and Restuccia, 9/12).

In addition, a new poll indicates that Republicans are gaining ground on issues such as health care  --

The Wall Street Journal: Poll Finds Republicans Gain Favor On Key Issues
On topics such as health care, Democrats have seen their long-standing advantage whittled to lows not seen in years. … The poll found Americans giving the party increasingly less credit as stewards in areas long seen as Democratic franchises. The party holds a 17-percentage-point advantage in looking after the middle class, the lowest in decades of Journal polling on the issue. The Democrats' eight-percentage-point advantage on dealing with health care also was a new low, and half the edge the party held on that issue in February (King, 9/13).

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Health Reform

Pa. Governor Likely To Back Medicaid Expansion

Gov. Tom Corbett, a Republican, is reportedly considering models similar to those being pursued by Iowa and Arkansas that rely on private-sector plans to cover the state's poorest residents. News outlets also report on developments in Arizona and California.

Politico: Sources: Tom Corbett Preparing To Embrace Pennsylvania Medicaid Expansion
Republican Pennsylvania Gov. Tom Corbett is planning a Monday press conference to throw his support behind a version of Obamacare’s Medicaid expansion, industry and legislative sources tell POLITICO. Corbett’s eyeing versions of expansion that rely on private-sector health plans rather than adding to the public Medicaid rolls, similar to approaches being considered in Iowa and Arkansas, according to the sources. The approach would bring in billions of Obamacare dollars marked for states that back expansion and use them to buy private insurance for the state’s poorest residents (Cheney and Millman, 9/12).

The Hill: Pa. Governor To Accept Medicaid
Pennsylvania Gov. Tom Corbett will likely become the latest Republican governor to embrace ObamaCare's Medicaid expansion, the news site Lancaster Online reported Thursday. Corbett has been under intense pressure from healthcare advocates — as well as Health and Human Services Secretary Kathleen Sebelius — to sign on to the Medicaid expansion (Baker, 9/12).

Politico: Arizona Activists Fail To Get Medicaid Expansion On Ballot – But Turn To Courts
The tea party just got iced in Arizona. Conservative activists narrowly failed to gather enough signatures for a 2014 ballot initiative to derail Obamacare’s Medicaid expansion in the Grand Canyon State by the Wednesday night deadline (Cheney, 9/12).

California Healthline: Inland Empire Preps For Medi-Cal Growth
With an eye on California's Medi-Cal expansion only a few short months away, San Bernardino and Riverside counties are preparing to transition 54,000 people currently enrolled in Low Income Health Plans. The counties launched LIHPs in 2012 as part of a "bridge" program to extend health coverage to low-income residents who at the time did not qualify for Medi-Cal, California's Medicaid program. Starting Jan. 1, Medi-Cal eligibility will be broadened, and the state anticipates that the program's enrollment will increase dramatically. LIHPs were established as part of a strategy to prepare for the influx of newly insured residents under the Affordable Care Act (McSherry, 9/12).

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States Continue Health Exchange Enrollment Dance

In the news: a dust-up in Florida surrounding health exchange "navigators," Minnesota is adding funding for enrollment outreach efforts and Connecticut is using some new marketing approaches.    

ABC News: Florida Is Pushing Back Against Obamacare
A key part of Obamacare is set to take effect soon and some conservatives are desperate to halt its implementation. The newest pushback comes out of Florida. The state’s Department of Health will not allow outreach workers to help sign up uninsured residents for the Affordable Care Act at county facilities there. ... Not all healthcare centers will face the new restriction  (Deruy, 9/12).

Health News Florida: Compromise Allows Navigators Near Health Dept.
Pinellas County officials say the state Department of Health has agreed that Affordable Care Act enrollment advisors can operate within the same buildings as the local health department staff. And DOH staff can refer uninsured patients to the advisors, called Navigators, for help in enrolling in a health plan on the Marketplace when it opens Oct. 1 (Gentry, 9/12).

The Associated Press: Sebelius To Make Stops In Fla. For Health Care Law
The Obama Administration is dispatching its top health official to Florida three times in the coming days to promote the Affordable Care Act in a Republican-led state that has been increasingly resistant to carrying out the new federal health law. Health and Human Services Secretary Kathleen Sebelius' visit to Orlando on Friday comes days after Florida health officials ordered county health departments across the state to ban counselors trained to help sign people up for health insurance from conducting outreach on their property (Kennedy, 9/13).

MinnPost: Health Exchange Frees Up Funds For Bypassed Outreach Groups
African-American and immigrant groups that key lawmakers say were overlooked in MNsure’s initial outreach grant program now likely will be funded with cost savings from elsewhere in the exchange. The board of Minnesota’s health insurance exchange on Wednesday authorized up to $750,000 in new outreach funds to organizations that didn’t make the initial recipient list (Nord, 9/12).

Kaiser Health News: Capsules: Insurance Exchange Outreach In Connecticut Goes Far Afield
Across Connecticut, you can see billboards and television ads, hear radio spots and get pamphlets, all about how to get insurance under the new federal health law starting Oct. 1. But the state also is spending big bucks on less traditional ways to get the word out (Cohen, 9/12).

In addition, the White House launches another, targeted enrollment campaign -

Kaiser Health News: Capsules: Campaign To Enroll LBGT Community In Health Coverage Launched At White House
The Obama administration and community advocates touted the effort to reach out to those communities about new online health insurance marketplaces, where people can compare insurance plans and find out if they're eligible for government subsidies. The marketplaces open for enrollment Oct. 1, and will sell policies that take effect beginning Jan. 1 (Rao, 9/13).

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Iowa's Insurance Commissioner Says State Exchange Rates Should Be Lower Than Many Americans Experience

In Texas, cost and coverage questions are emerging as the launch date of federal exchanges approaches. Also, Trader Joe's is sending its part-timers to health exchanges.   

DesMoines Register: Iowa Health Exchange Prices Hold Up Well Against Other States
Iowans who buy health insurance on the government’s new online marketplace should see lower prices than many other Americans will face, the state insurance commissioner said Thursday. Commissioner Nick Gerhart, who is preparing to publish Iowa’s rates, said they will “compare very favorably” with those already released by other states (9/13).

Related, from KHN: State Premium Watch: Pricing In The New Insurance Marketplaces (Galewitz, 9/11)

The Texas Tribune/KUT: As Exchange Rollout Nears, Some Details Still Murky
As the debut of a federal health insurance exchange approaches, some Texans say they've been left with a number of key questions, like how much plans on the marketplace will cost and what they'll cover (Zaragovia, 9/13).

Bloomberg: Trader Joe's Sends Part-Timers To Obama Health Exchanges
Trader Joe’s Co., the closely held grocery store chain, will end health benefits for part-time workers next year, directing them instead to new insurance marketplaces as companies revamp medical coverage to fit the U.S. Affordable Care Act. Employees with fewer than 30 hours a week will no longer be given health coverage as of Jan. 1, and will receive $500 to help them buy insurance elsewhere, the Monrovia, California-based company said in a statement (Nussbaum, 9/13).

Here are highlights of other implementation issues drawing news coverage -

Modern Healthcare: Reports Say ACA Saves Consumers Billions, But Cuts Insurers’ Profits
The Patient Protection and Affordable Care Act saved consumers $1.7 billion on health insurance premiums last year, an HHS report found. Meanwhile, a separate study found that ACA provisions squeezed insurers' profits. The HHS report cites two provisions directly affecting health plan premiums—a rate review for premium increases that top 10% and the medical-loss ratio standard that caps how much of premium revenue insurers can use for administration, marketing and profits (Kutscher, 9/12).

The Washington Post's Wonk Blog: Obamacare Created 22 New Health Insurance Plans. Can They Succeed?
The Consumer Operated and Oriented Plans, or Co-Ops, are a small part of the health care law that could have big implications for its success. Nonprofits in 24 states have received over $2 billion in federal loans to essentially start new health insurance products from scratch. And the health care observers I talk to think that these plans have the potential to upend the health insurance market -- or end up as the next Solyndra. Right now, it’s too early to tell which direction they'll go (Kliff, 9/12).

Related, earlier KHN story: Obamacare Insurance Co-ops At The Starting Gate (Hancock, 9/12)

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Why Unions Dislike Obamacare

Several media outlets explore the reasons for the AFL-CIO's criticism of the health care law this week, including concerns about the viability of multi-employer plans which insure about 20 million people and the impact of a "Cadillac tax" starting in 2018 on the most generous plans that may affect some unions’ coverage.

The Wall Street Journal’s Washington Wire: Unfinished Business: Unions Press For Obamacare Changes
The AFL-CIO wound up passing a watered-down version of a resolution affirming what individual labor groups have been complaining about for nearly a year: Higher costs related to the Affordable Care Act could force millions of their members to lose coverage under union-sponsored health-care plans. The resolution underscored the extent to which organized labor is trying to reach a peaceful resolution with the Obama administration, which wants to smooth out the wrinkles without a messy fight (Trottman, 9/12).

Politico: AFL-CIO Demands Changes To Obamacare
AFL-CIO President Richard Trumka said the resolution raises the issue of whether "low- and moderate-income union members and their collectively bargained health care plans will be able to benefit from the same premium support that big insurance companies will receive and if they will have to pay fees to subsidize big insurance companies," a statement on the AFL-CIO site reads. "There also are concerns that smaller employers will be able to get away with taking health care away from workers while paying no penalty" (Norman, 9/12).

Fox News: Republicans Move To Halt Obamacare 'Bailout' For Angry Unions
Capitol Hill Republicans are trying to stop the Obama administration from offering labor unions a sweetheart deal on ObamaCare, as the White House tries to quell a simmering rebellion from Big Labor over the health care law. President Obama and White House officials reportedly have called union leaders to try and persuade them to tone down their complaints, pledging an accommodation. The AFL-CIO, though, on Wednesday approved a resolution anyway calling the law "highly disruptive" to union plans (Fox News, 9/12).

Politico: 5 Questions About The Unions’ Beef With Obamacare
Key parts of organized labor have a case of buyer’s remorse over Obamacare and they’re letting everyone know about it. The AFL-CIO at its convention this week passed a resolution calling President Barack Obama's health law "highly disruptive" to some union insurance plans, "substantially changing the coverage available for millions of covered employees and their families." The labor federation did back the sweeping goals of Obamacare — covering people and restraining costs —but that wasn’t the part of the message that resonated politically (Norman, 6/12).

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MedPAC Contemplates Link Between ACOs and Medigap Plans

The Medicare Payment Advisory Commission is considering whether Medicare should create supplemental Medigap coverage to encourage patients to seek treatment from an accountable care organization.  

Medpage Today: MedPAC Floats Idea Of ACO Medigap Plan
A "Medicare Select ACO supplemental plan" would provide lower cost-sharing for patients in an ACO in an attempt to increase loyalty to that ACO's providers, MedPAC staff told commissioners. A common complaint about ACOs has been that patients are free to receive care from any provider they like and not stay within that ACO, even though ACO providers remain financially responsible for that patient (Pittman, 9/12).

CQ HealthBeat: MedPAC Plans Closer Look At Medicare ACOs
The Medicare Payment Advisory Commission plans to more closely examine Medicare accountable care organizations and at its meeting on Thursday reacted to a potential new way to encourage patients within ACOs to use in-network providers. Within the next few months a contractor for MedPAC will interview some of the participants in Medicare ACOs and report back on those experiences. Currently, the Medicare shared-savings program includes 220 groups of providers and 23 groups are in the Pioneer ACOs (Adams, 9/12).

In other Medicare news -

The Center for Public Integrity: Feds Propose Shakeup For Emergency Room Billing
Federal officials for more than a decade have let hospitals decide on their own how much to charge Medicare for certain emergency room overhead and staffing costs called "facility" fees — a controversial policy some critics believe invites overcharges. Now in a major turnabout, the Centers for Medicare and Medicaid Services are seeking tighter controls over the fees as part of a plan to redirect billions of dollars Medicare spends annually on outpatient health care (Schulte, 9/12).

Earlier, related KHN story: 'Facility Fees' Are Surprise Cost For Many Patients (Boodman, 10/6/2009)

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Health Care Marketplace

Eli Lilly Files International Drug Patent Lawsuit Against Canadian Government

Politico: Eli Lilly Sues Canada On Drug Patents
U.S. pharmaceutical giant Eli Lilly has filed a $500 million international lawsuit against the Canadian government, saying it unfairly shortened the life of patents for its best-selling drugs. The case, filed Thursday under the rules of the North American Free Trade Agreement, threatens to shed a negative light on a dispute resolution mechanism also being proposed by the U.S. as part of the Pacific trade deal (Behsudi, 9/12).

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State Watch

State Highlights: Calif. Skilled Nurses Avoid Pay Cut

A selection of health policy stories from Indiana, Connecticut and California.

The Associated Press: Indiana University Health Says It Will Cut 800 Jobs At Hospitals In Indianapolis, Elsewhere
Indiana's largest hospital system said Thursday it will cut about 800 jobs and realign some services as part of a nationwide trend by large-scale providers to cut expenses and adapt to changing trends in health care. The cutbacks at Indiana University Health will go into effect by Dec. 1, company officials said at a news conference. Cuts will be felt at seven hospitals, including the system's Indianapolis-area hospitals and those in Muncie and Tipton (Wilson, 9/12).

Modern Healthcare: Indiana University Health Plans To Cut 800 Jobs
Indiana University Health is trimming its workforce by about 800 positions at seven campuses as part of a plan to slash $1 billion in costs over the next five years. Five hospitals -- IU Health University Hospital in Indianapolis; IU Health North Hospital in Carmel, IU Health Saxony Hospital in Fishers, IU Health Tipton (Ind.) Hospital and IU Ball Memorial Hospital in Muncie -- will see workforce reductions, and those losing their jobs will be notified in October (Selvam, 9/12).

California Healthline: Breakthrough Deal For Nursing Facilities
State officials yesterday agreed to a deal that will reverse the 10 percent Medi-Cal provider reimbursement cut for hospital-based, distinct-part skilled nursing facilities. The reversal was tucked into the language of SB 239 by Sen. Ed Hernandez (D-West Covina), the bill to extend the hospital quality assurance fee. That bill yesterday cleared the Assembly Committee on Health with a unanimous vote, and is headed to the Legislature floor for votes over the next two days (Gorn, 9/12).

The CT Mirror: Insurance Department Seeking Comments On Mental Health Parity
If you have something to say about how mental health parity laws are being followed, here's your chance: The Connecticut Insurance Department is soliciting written comments on how it can ensure that insurance companies comply with state and federal laws requiring that they treat mental health the same way they treat medical issues (Becker, 9/12).

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Health Policy Research

Research Roundup: Insurer Payments To Doctors Vary Across U.S.

Each week, KHN compiles a selection of recently released health policy studies and briefs. 

Health Affairs: Private Insurers' Payments For Routine Physician Office Visits Vary Substantially Across The United States
Anecdotal reports suggest that substantial variation exists in private insurers' payments for physician services, but systematic evidence is lacking. Using a retrospective analysis of insurance claims for routine office visits, consultations, and preventive visits from more than forty million physician claims in 2007, we examined variations in private payments to physicians ... Physicians at the high end of the payment distribution were generally paid more than twice what physicians at the low end were paid for the same service. Little variation was explained by patients' age or sex, physicians' specialty, place of service, whether the physician was a "network provider," or type of plan, although about one-third of the variation was associated with the geographic area of the practice (Baker, Bundorf and Royalty, 9/9).

Health Affairs: No Evidence That Primary Care Physicians Offer Less Care To Medicaid, Community Health Center, Or Uninsured Patients 
Using data from more than 31,000 visits to primary care physicians in the period 2006–10, we examined whether the length or content of a visit was different for safety-net patients—those insured by Medicaid, those who are uninsured, and those seen in a community health center—compared to patients with private insurance. We found no significant differences in the average length of a primary care visit or in the likelihood of a patient's receiving preventive health counseling. Medicaid patients received more diagnostic and treatment services, and uninsured patients received fewer services, compared to privately insured patients, but the differences were small (Bruen, Ku, Lu and Shin, 9/9).

Health Affairs: Emergency Department Visits After Surgery Are Common For Medicare Patients, Suggesting Opportunities To Improve Care
Considerable attention is being paid to hospital readmission as a marker of poor postdischarge care coordination. However, little is known about another potential marker: emergency department (ED) use. We examined ED visits for Medicare patients within thirty days of discharge for six common inpatient surgeries. We found that these visits were widespread and showed extensive variation across facilities. ... There was substantial variation—as much as fourfold—in hospital-level ED use for these patients across all six procedures. The variation might signify a failure in upstream coordination of care and therefore might represent a novel hospital quality indicator (Kocher, Nallamothu, Birkmeyer and Dimick, 9/9). 

The New England Journal of Medicine: The Public And The Conflict Over Future Medicare Spending
As we reported in the Journal in 2011, there has been little public support for major policy changes aimed at reducing Medicare spending to lower the federal deficit. This article goes further and seeks to document the underlying beliefs that may shape the public response to future efforts to substantially slow projected Medicare spending. Our thesis is that there exists today a wide gap in beliefs between experts on the financial state of Medicare and the public at large. ... We examine this thesis by analyzing data from six public opinion polls conducted in 2013 ... Although Medicare is popular, it is not seen as better run than private insurance plans, nor is it seen as particularly different from private coverage with respect to quality of care or access to physician care (Blendon and Benson, 9/12).

JAMA Pediatrics: Healthy Habits, Happy Homes: Randomized Trial to Improve Household Routines for Obesity Prevention Among Preschool-Aged Children
In this 6-month follow-up of a home-based randomized trial, we found that a multicomponent intervention that uses individually tailored counseling focused on improving household routines increased children’s sleep duration and reduced children’s TV viewing on weekends. We found that, compared with control subjects, children who participated in the intervention decreased their BMI. To our knowledge, the Healthy Habits, Happy Homes study is the first home-based randomized trial to address key household routines related to obesity risk among young children. Recent reviews of obesity prevention interventions among young children have identified the paucity of home-based interventions and have called for interventions that are appropriately tailored for families (Haines et al, 9/9).

Here is a selection of news coverage of other recent research:

Medscape: Statewide Medical Home Pilot Reduces ED Visits
A patient-centered medical home pilot program in Rhode Island showed significant improvements in medical home recognition scores and in ambulatory emergency department (ED) visits, according to an article published online September 9 in JAMA Internal Medicine. Meredith B. Rosenthal, PhD, from the Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, and colleagues analyzed multipayer claims data from 2 years before the pilot program and/or 2 years after the program began (Hand, 9/9).

Reuters: 'Futile Treatment' Common In ICUs: Study
More than one in ten patients being treated in intensive care units (ICUs) was at some point receiving what doctors deemed to be futile care, in a new study. In those cases, critical care doctors believed people would never survive outside an ICU or that the burdens of their care "grossly outweighed" any benefits. And, researchers found, treating each of those patients cost about $4,000 every day (Pittman, 9/9).

Medscape: Small Clinics: Pay-for-Performance Improved Outcomes
In small practices using electronic health records (EHRs), a pay-for-performance (P4P) program was associated with modest improvements in cardiovascular care processes and outcomes, according to findings of a cluster-randomized trial published in the September 11 issue of JAMA (Barclay, 9/11).

Medscape: Most NEJM Readers Oppose Physician-Assisted Suicide
Roughly 2 in 3 readers of the New England Journal of Medicine (NEJM) oppose physician-assisted suicide, according to survey results published online today in the journal. That level of opposition to physicians administering a lethal dose of narcotic to a terminally ill patient who requests it held true for 2356 readers in 74 countries (64.6%) as well as a subset of 1712 US readers from 49 states (67.3%) (Lowes, 9/11).

NPR's SHOTS blog: What To Avoid At The Orthopedist's Office
In a perfect world, data gleaned from clinical trials would get distilled into guidelines about which treatments work best. Doctors would follow the guidelines, making allowance for a person's particular circumstances. Patients would get high-quality, cost-effective care. ... The five not-so-great orthopedic treatments posted today are part of a coalition effort by dozens of medical specialties to change that, called "Choosing Wisely" (Shute, 9/11). 

Reuters: Hospital Infections Cost U.S. $10 Billion A Year
Infections acquired in the hospital cost the U.S. health care system $10 billion a year, new findings show. Past studies have pegged the annual cost of treating those infections at $20 billion to $40 billion, so the new numbers show progress is being made, Dr. Eyal Zimlichman of The Center for Patient Safety Research and Practice at Brigham and Women's Hospital in Boston, one of the new study's authors, told Reuters Health (Harding, 9/12).

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Editorials and Opinions

Viewpoints: Vast Number Of Insurance Products Drives Up Health Administration Costs; Fla. Governor's Effort To 'Sabotage' Health Law

The New York Times: Economix: Waste Vs. Value In American Health Care
The typical American academic health center probably employs 300 to 400 full-time workers just for billing the 50 or more different insurers, each with its own rules, for services rendered patients. ... The authors of a recent paper in Health Affairs estimated that the typical physician spent $82,975 annually in time costs interacting with multiple insurers. ... considerable savings on administrative costs ought to be attainable even within our existing system. Unfortunately, the private sector – both buyers and sellers of private insurance – have shown little inclination to rise to that challenge over the decades. By constantly expanding the supply of different insurance products, each with different rules, they have enhanced administrative complexity (Uwe E. Reinhardt, 9/13).

The New York Times: The Conscience Of A Liberal: Insurance Company With An Army Blogging 
[The] federal government is basically an insurance company with an army, and the insurance side isn't bad. Nondefense spending is dominated by Social Security, which is highly efficient; Medicare, which could do better, but is more efficient than private insurance; and Medicaid, which is much more cost-effective than private insurance. I'm sure that if you look through nondefense discretionary spending you'll find some waste, but no more than in any large organization. More broadly, the US spends twice as much on health care as other advanced countries, with no better results — and that disparity is the result of private-sector, not public-sector, waste (Paul Krugman, 9/12). 

The Wall Street Journal: The Attack On Self-Insurance
The Affordable Care Act is supposed to be a paradise for the middle class, but now that Americans are starting to eat from the tree of knowledge, the liberal deities are trying to force them to stay inside the garden. Witness their crackdown on the booming Obamacare alternative known as self-insurance (9/12).

Boston Globe: Obamacare: Affordable After All
It's not unusual to hear opponents of the Affordable Care Act claim that premiums under the new law won't be affordable. But one of the first and broadest nonpartisan studies strongly suggests that once federal tax subsidies are factored in, premiums will be well within reach for those with moderate incomes (9/13).

Arizona Republic: Fees Up, Goldwater: The Lawsuit Is About Thwarting Obamacare
The Goldwater Institute usually has a good track record of defending state and federal constitutions. Usually. Everyone errs at some point. The institute, unfortunately, picked a whale of a way to be wrong. The conservative think tank's lawsuit to halt Arizona's planned Medicaid expansion is wrong in its analysis of the issue. But more than that, it is wrong in its rationale for filing the suit in the first place, which is more about halting implementation of a federal health-care law it dislikes than about ensuring the Arizona Constitution is honored (9/12).

Tampa Bay Times: Scott's Campaign To Sabotage The Affordable Care Act
Gov. Rick Scott says he sides with Florida's families, yet he is obstructing their access to health care. Citing groundless privacy concerns, the governor is trying to block county health departments from assisting people in signing up for health insurance on the state's online marketplace that will open in a few weeks. It's one thing to voice philosophical objections to federal law. It's indefensible to stand in the doorway and deny Floridians access to health care (9/12).

The Huffington Post: Improving The Public's Health Through The Affordable Care Act
President Obama and the entire Obama administration have made prevention and public health a top priority because of the lasting effects they have on the health of Americans. That is why the Affordable Care Act provides unprecedented resources through the Prevention and Public Health Fund to support community-based strategies to prevent chronic diseases, and to improve public health. The Affordable Care Act also created the National Prevention, Health Promotion, and Public Health Council, which provides federal leadership to engage states, communities, and private partners in creating a healthier America through the recommendations of the National Prevention Strategy -- a blueprint for ensuring Americans are healthy at every stage of life (Health and Human Services Secretary Kathleen Sebelius, 9/11).

Forbes: Labor Leader: Obamacare 'Needs To Be Repealed' If Union Demands Aren't Met
This week, in Los Angeles, leaders of the nation’s labor union movement gathered together for the AFL-CIO’s annual convention. ... union leaders shared their concerns about the impact of Obamacare on union-sponsored health insurance plans. Terence O’Sullivan, president of the Laborers' International Union of North America, said, "If the Affordable Care Act is not fixed, and it destroys the health and welfare funds that we have fought for and stand for, then I believe it needs to be repealed." ... One of the major reasons that people pay dues to unions is because unions do a great job negotiating health benefits for their members. If those members instead have the opportunity to shop for their own non-union-granted coverage on the Obamacare exchanges, workers have far less incentive to join unions (Avik Roy, 9/12). 

The New Republic: The House GOP Is About To Crack Up: Three Theories Why
[The right wing House Republicans'] explicit goal, getting rid of Obamacare, would seem to be out of reach. The political cost of pursuing that goal would seem to be high. Why keep at it? Three theories come quickly to mind: They are delusional. ... They are savvy. ... They are selfish. ... Which theory best explains the right's behavior? Who knows. Probably all three have some truth. But the end result is the same. Conservatives seem determined to provoke a crisis, whether it's over funding the government past September 30 or increasing the Treasury's borrowing limit. If that happens, [Speaker John] Boehner will face a choice. He can stand by while government services and the economy suffer—or, as Greg Sargent recently suggested, he can "cut the Tea Party loose, and suffer the consequences" (Jonathan Cohn, 9/12).

Los Angeles Times: Is CVS Rewards Program Complying With California Law?
CVS Caremark insists that it's just complying with federal law by informing customers that their medical information could be "redisclosed" if they sign up for the company's prescription-drug reward program. Privacy experts, though, question whether CVS is complying with state law (David Lazarus, 9/12).

Medpage Today: Orders, Results, Meaningful Use, Oh My
Managing test orders and results in a medical practice is a critical aspect to providing quality healthcare to patients. Managing those same test orders and results efficiently is critical to controlling operational costs for a medical practice. When physicians tell me that their overhead is too high, I look at how information flows in the practice. One of the key money pits is a poorly designed process for managing orders for ancillary testing. But technology and the Meaningful Use Stage 2 requirements present opportunities to overcome hidden operational costs that have become ingrained in daily activities (Rosemarie Nelson, 9/12).

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Stephanie Stapleton

Andrew Villegas

Lisa Gillespie
Shefali Luthra

The Kaiser Daily Health Policy Report is published by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. (c) 2014 Kaiser Health News. All rights reserved.