Daily Health Policy Report

Monday, September 16, 2013

Last updated: Mon, Sep 16

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Coverage & Access

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

States Balk At Terminating Medicaid Contracts Even When There’s Fraud Or Poor Patient Care

Reporting for Kaiser Health News, in collaboration with The Washington Post, Jenni Bergal writes: "In Florida, a national managed care company’s former top executives were convicted in a scheme to rip off Medicaid. In Illinois, a state official concluded two Medicaid plans were providing 'abysmal' care. In Ohio, a nonprofit paid millions to settle civil fraud allegations that it failed to screen special needs children and faked data. Despite these problems, state health agencies in these - and other states - continued to contract with the plans to provide services to patients on Medicaid, the federal-state program for the poor and disabled. Health care experts say that’s because states are reluctant to drop Medicaid plans out of fear of leaving patients in a bind" (Bergal, 9/15). Read the story.

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The Overlooked Obamacare Sales Force: Hospitals

Kaiser Health News staff writer Jay Hancock, working in collaboration with The Washington Post, reports: "As community groups, brokers and insurers prepare to recruit members for medical plans that go on sale in October under the health law, nobody has a bigger financial stake in their success than hospitals. And few may work harder to sign consumers up for the Obamacare insurance marketplaces than hospitals themselves" (Hancock, 9/13). Read the story.

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Local Uninsured Programs Face Uncertain Times As Obamacare Ramps Up

Kaiser Health News staff writer Phil Galewitz, working in collaboration with McClatchy, reports: "Jennifer Webb works the deli counter at Publix supermarket and has thyroid problems. Her boyfriend, William May, is an artist recovering from colon cancer. The couple has relied on a county program that provides health coverage to the working poor. But their 'security blanket," as Webb calls the Alachua County CHOICES program, is being taken away at the end of December. As new coverage provisions take effect Jan. 1 under the health law, local programs that offered barebones care to the uninsured are in flux – and with them, the lives of thousands who depend on them" (Galewitz, 9/13). Read the story.

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Long-Term Care Panel Releases Recommendations But Fails To Offer Plan To Help Pay For Services

Reporting for Kaiser Health News, Susan Jaffe writes: "A commission created by Congress to address the country’s surging need for long-term health care released recommendations Friday but did not reach a consensus on how to pay for these often expensive services" (Jaffe, 9/13). Read the story.

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Individuals With Medical Conditions Will Not Pay A Penalty On Premiums (Video)

Kaiser Health News consumer columnist Michelle Andrews helps you navigate the new insurance marketplaces that are scheduled to launch on Oct. 1. In today’s video, she answers a question about premium penalties (9/15). Watch the video or watch the other videos in this series.

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Gov. Corbett To Propose Big Changes To Pennsylvania Medicaid

The Philadelphia Inquirer’s Amy Worden, Angela Couloumbis, and Harold Brubaker, working in partnership with Kaiser Health News, report: "Pennsylvania Gov. Tom Corbett will announce his plan Monday to expand health coverage for the poor by using public dollars to finance commercial insurance for 500,000 uninsured Pennsylvanians" (Worden, Couloumbis and Brubaker, 9/15). Read the story.

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Political Cartoon: 'Chop, Chop?'

Kaiser Health News provides a fresh take on health policy developments with "Chop, Chop?" by Chris Weyant.

Here's today's health policy haiku:


Set aside some time 
Lots for you to read today
on Kaiser Health News.
-KHN Editors

If you have a health policy haiku to share, please send it to us at http://www.kaiserhealthnews.org/ContactUs.aspx and let us know if you want to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

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Health Reform

New Polls Highlight The Health Law's Uphill Climb

A poll by the Wall Street Journal/NBC News found that many Americans still don't understand the overhaul and don't think it will help them. Also, A USA Today/Pew poll finds that the public view of this sweeping initiative is still very negative.

The Wall Street Journal: Health Law Faces Skepticism
New poll results show the depth of the Obama administration's challenge on the eve of the rollout of the federal health law's core provisions, as many Americans say they don't understand the law and don't think it will help them. A Wall Street Journal/NBC News poll found that even those lacking health insurance, who are supposed to be the law's biggest beneficiaries, generally believe it wouldn't do them much good (Radnofsky, 9/16).

NBC News: Poll: Obamacare Remains Highly Unpopular As Implementation Looms
A large number of Americans continue to adamantly oppose the nation’s new health care law and believe it will produce damaging results, according to a new NBC News/Wall Street Journal poll. Forty-four percent of respondents call the health-care law a bad idea, while 31 percent believe it's a good idea -- virtually unchanged from July's NBC/WSJ survey. By a 45 percent to 23 percent margin, Americans say it will have a negative impact on the country's health care system rather than a positive one (Murray, 9/16).

USA Today: USA Today/Pew Poll: Health Care Law Faces Difficult Future
Republican lawmakers have failed in dozens of attempts to repeal the Affordable Care Act, but a new USA TODAY/Pew Research Center Poll shows just how difficult they have made it for President Obama's signature legislative achievement to succeed. As the health care exchanges at the heart of the law open for enrollment in two weeks, the public's views of it are as negative as they have ever been, and disapproval of the president's handling of health care has hit a new high (Page, 9/16).

The Hill: Citing Poll, Right Argues It’s Winning Obamacare Defunding Fight
Conservatives claim a new poll shows they are winning the battle over defunding Obamacare. The CNN poll released this week found only 39 percent of voters hold favorable views of the healthcare law (Viebeck, 9/15).

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Health Law Enrollment: Gearing Up To Get The Message Out

Health law outreach efforts are proceeding with fits and starts, as one company returns its "navigator" grant because of the high level of scrutiny, while others vow they will be ready to begin enrolling people in the health law's new coverage. 

The Associated Press/Washington Post: Company Returns $800K 'Navigator' Grant As Obstacles To Implement Affordable Care Act Mount
A company that has for decades helped people enroll in Medicaid says it won't be able to sign up people for insurance under the new Affordable Care Act because there is too much scrutiny over a so-called navigator program. According to an email obtained by The Associated Press, Cardon Outreach's chief legal officer Charles Kable told the federal government it was returning more than $800,000 in federal grant money. The funds were supposed to be used to hire people in four states help explain the intricacies of health insurance to millions of people who aren't covered (9/15).

The Columbus Dispatch: Obamacare 'Navigators' Will Be Ready, Groups Vow
A probe for documents by congressional Republicans and a new state law have held back nonprofit organizations as they race to hire people who soon will help Ohioans shop for mandated health coverage. Despite the lack of new hires less than three weeks before enrollment begins for Ohio’s new federally run health-insurance marketplace, several groups hope to have some existing staff members trained and certified to help consumers by Oct. 1. Enrollment runs through March 31 (Sutherly, 9/13).

Richmond Times-Dispatch: Workers Gear Up To Prepare For Health Law
Thousands of organizations are seeking federal certification to allow their workers to help people apply for coverage, and that's creating a backlog in getting people certified, a federal official said Thursday at a meeting in Richmond (Smith, 9/14).

The Wall Street Journal: Kentucky Officials Promote Health Law Where Skepticism Runs Deep
As Kentucky prepares to implement the health law, public agencies and advocacy groups are devoting millions of dollars and scores of outreach workers to sign up a key group: uninsured people in the state's rural expanses. Of the roughly 640,000 Kentuckians who are uninsured, 45% live in nonmetropolitan counties, which are mainly rural, according to state data (Campo-Flores, 9/13).

Kaiser Health News: The Overlooked Obamacare Sales Force: Hospitals
As community groups, brokers and insurers prepare to recruit members for medical plans that go on sale in October under the health law, nobody has a bigger financial stake in their success than hospitals. And few may work harder to sign consumers up for the Obamacare insurance marketplaces than hospitals themselves (Hancock, 9/13).

Marketplace: Government Hired 'Navigators' To Help Consumers Enroll In Health Exchanges
In just about two weeks, millions of uninsured Americans will start shopping online to get coverage … in theory. In reality millions of people remain confused over what Obamacare does or if it's even still a law. To chart these murky health insurance waters, the federal government is spending millions dollars to hire navigators who can help consumers enroll. The front lines of the Affordable Care Act right now are cramped church pews, hospital conference rooms, featuring weak coffee and plenty of power point presentations (Gorenstein, 9/16).

The Sacramento Bee: California Businesses Work To Adapt To Health Care Law
Neil Crosby, director of sales for Warner Pacific Insurance Services, had surpassed 500 when he lost track of the number of presentations he has given on the new federal health care law. Addressing apprehensive audiences, Crosby tests their understanding of the challenges businesses face as they scramble to digest and meet the requirements of the Affordable Care Act. When he asks whether there is anything that requires them to provide health care for their workers, they reply, "Yes" (Cadelago, 9/16).

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Final Countdown On For Health Exchange Launches

Federal officials are happy with what may turn out to be a soft launch of the health law's insurance exchanges Oct. 1. In the meantime, states are busy readying consumers for the exchanges' kickoffs with informational sessions and campaigns designed at creating a better-informed public.

Politico: Obamacare D-Day Becomes A Soft Launch
For months all eyes have been on October 1 -- the first day people can sign up for Obamacare. But as that day approaches, many people working on the nuts and bolts of the health law are tamping down any expectations of a sign-up stampede. Not everyone will enroll immediately. And that, they say, is the way they want it (Haberkorn, 9/14).

The Associated Press: Details Elusive As Mo. Awaits Health Care Overhaul
The St. Louis Public Library auditorium was filled with a cross-section of city residents: college students, small-business owners, church volunteers, working parents, the unemployed, retirees and more. What brought them together was a chance to learn more about a linchpin of the federal Affordable Care Act -- the online health insurance marketplaces that will give the uninsured a chance to purchase coverage in the months leading up to 2014, when those without insurance under President Barack Obama's new health care plan face financial penalties (9/15).

The Associated Press: Deadline Looms For Neb. Insurance Marketplace
Community groups are hustling to meet an Oct. 1 deadline to launch a new health insurance marketplace in Nebraska, a key piece of the federal health care law designed to steer users toward a coverage plan. Nebraska state officials have maintained a hands-off approach to the marketplace, which requires hiring and training a small army of experts to guide newcomers through the process. Gov. Dave Heineman rejected a state-run option in November, saying it was too expensive for Nebraska taxpayers, so the federal government took charge of setting it up (Schulte, 9/15).

Boston Globe: Mass. Health Connector Offering Guidance With New Law 
Being a consumer in Massachusetts can be unlike the experience anywhere else. We’ve got all sorts of laws -- good as well as quirky. So it stands to reason that as the first state in the country with its own health care insurance exchange, the Massachusetts Health Connector, there might be some confusion. We’re about two weeks away from the first stage of the new federal health care law reaching consumers. And while the law is similar to what we have in Massachusetts, it isn’t the same. The result is going to be some changes that the quarter-million consumers using the Connector are going to have deal with (Lipka, 9/15).

St. Louis Beacon: No Info On Insurance Cost And Carriers Until Health Exchanges Open
Missouri consumers wanting to know who will sell them insurance and at what cost through the health reform law's online marketplace system won’t have answers until Oct. 1, the day the program begins taking applications. That's the word from Nanette Foster Reilly, consortium administrator for region 7 of the U.S. Department of Health and Human Services (Joiner, 9/16).

Miami Herald: Showcase Offered A Look Into A Health Care Hub In Action
South Florida’s emerging health care hub received a broad endorsement Thursday night: More than 300 people representing 180 companies, 25 investment groups, five hospitals, banks, universities and government turned out for the HealthTech Showcase at the University of Miami Life Science & Technology Park. While the numbers were impressive, the signs of a growing ecosystem did not end there (Dahlberg, 9/15).

Problems persist, however, with Minnesota probing that state's exchange for data security breaches, and the Labor Department says it won't penalize employers for not making the new options explicit for workers --

Minnesota Public Radio: Legislative Auditor To Probe MNsure Data Security Breach 
The state's legislative auditor will investigate a data security breach at MNsure, the state's new health insurance exchange. Auditor Jim Nobles acted after MNsure acknowledged one of its employees inadvertently emailed the names, Social Security numbers and other identifying information of 2,400 insurance agents to another broker. "We hadn't planned to be at MNsure quite this quickly, but we certainly planned to be there in the months to come," Nobles said. "It's extremely important that the public understands that we take (data privacy issues) very seriously and that we will investigate them” (Minnesota Public Radio, 9/13).

Minnesota Public Radio: Dayton Satisfied With MNsure Security, GOP Lawmakers Aren't
Gov. Mark Dayton said today that he still has great confidence in Minnesota’s new online health insurance exchange, even after the recent accidental release of some confidential information. The Star Tribune reported that a MNsure employee sent an email to an insurance brokerThursday afternoon that contained private information about hundreds of insurance agents (Pugmire, 9/13). 

CQ HealthBeat: Labor Department Won't Penalize Employers Who Don’t Notify Workers About Exchanges
Employers won't be penalized if they don't comply with a health care law requirement that they notify workers by Oct. 1 about the availability of possibly lower cost coverage on insurance exchanges, according to the Labor Department. The notification requirement was added to the health law to educate workers about their coverage options (Reichard, 9/15).

Also, more in the news on private exchanges --

Miami Herald: More Companies Steering Retirees To Private Health-Insurance Exchanges
Thousands of retirees covered by company health insurance plans will soon see their benefits shifted toward private health-insurance exchanges.  IBM and Time Warner announced the change last week. They’ll provide retirees money to buy Medicare Advantage or supplemental Medigap policies instead, part of a push by businesses to move away from the increasingly costly group-coverage model (McGrory, 9/15).

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Pa. Gov. Corbett Expected To Announce Medicaid Expansion Plan Today; Issue Also Contentious In Va. Governor's Race

Corbett, a Republican, is reportedly likely to call for a hybrid program similar to what Arkansas is doing. In Virginia, Democrat Terry McAuliffe's vows to expand the program for low-income people could hold the state's budget hostage, Republicans argue.

The Philadelphia Inquirer/Kaiser Health News: Gov. Corbett To Propose Big Changes to Pennsylvania Medicaid
Pennsylvania Gov. Tom Corbett will announce his plan Monday to expand health coverage for the poor by using public dollars to finance commercial insurance for 500,000 uninsured Pennsylvanians (Worden, Couloumbis and Brubaker, 9/15). 

Pittsburgh Post-Gazette: Corbett Expected To Make Announcement On Medicaid
Republican legislative sources say a straightforward expansion of the health care program is not being considered, and a hybrid model that would give a subsidy to low-income consumers to buy private insurance is likely, similar to what has been proposed in Arkansas. "They're looking at private options, which is appropriate," Steve Miskin, a spokesman for House Republicans, said Friday (Giammarise, 9/14).

Reuters: Pennsylvania To Unveil Proposal On Extending Medicaid Access
Governor Tom Corbett is expected to propose early next week that Pennsylvania extend Medicaid benefits to more low-income residents, likely helping them purchase private insurance using Medicaid funds, a Republican state representative said on Friday. State Representative Gene DiGirolamo, chairman of the House Human Services Committee, Corbett's proposal probably will look similar to plans in Iowa and Arkansas, other states where officials have resisted the outright expansion of the Medicaid program under President Barack Obama's healthcare reform law (Kelley, 9/13).

The Associated Press: Gov. Tom Corbett To Tour State To Pitch His Health Care Plans
Gov. Tom Corbett will start a three-day tour Monday to lay out his plans to improve health care and reveal the conditions under which he would accept additional Medicaid dollars under the sweeping federal health care law designed to provide insurance to more working poor.  A key condition for Corbett will be an idea being explored by some other states — using the Medicaid dollars to buy private insurance policies instead of expanding government rolls — where Republicans are wary of expanding traditional Medicaid coverage (9/15).

Earlier KHN Coverage: The  Arkansas Model: What You Need To Know About It (Hancock).

The Washington Post: If Elected, McAuliffe Faces Showdown With Va. House Republicans Over Obamacare
Terry McAuliffe has made Medicaid expansion central to his bid for governor, saying it would provide health insurance to 400,000 needy Virginians, create thousands of jobs and provide the state with a $2 billion a year windfall. Some Republicans say his push to expand the health-care program could lead to something less appealing: a government shutdown. "I will not sign a budget in Virginia unless it includes the Medicaid expansion," McAuliffe said this summer in an interview with AARP. ... Given overwhelming opposition to expansion in the GOP-dominated House of Delegates, that campaign promise amounts to a threat to hold the state budget hostage to McAuliffe's Medicaid goal, some Republicans say (Vozzella, 9/14).

And in other state Medicaid news -

The Orlando Sentinel: Lack Of Medicaid Expansion Puts Some Floridians In New Doughnut Hole
Nearly 1 million Floridians will fall through a large doughnut hole next month when the health insurance exchange — a key element in the Affordable Care Act — opens. The unintended coverage gap in the new health-care law will put a large group of uninsured residents right in the middle — not earning enough to qualify for tax credits available through the exchange, but earning too much to qualify for Medicaid (Jameson, 9/13).

The Columbus Dispatch: Medicaid Initiative Gets First OK
A coalition pushing to expand Medicaid coverage in Ohio moved a step closer to forcing the General Assembly to approve the proposal or placing it before voters on the statewide ballot. Ohio Attorney General Mike DeWine yesterday certified the petition for the proposed "Access to Healthcare Act." DeWine announced supporters had submitted the required 1,000 signatures from registered Ohio voters and deemed a summary of the proposal to be "fair and truthful" (Candisky, 9/14). 

The Columbus Dispatch: Medicaid Changes Are Tops On Ohio Lawmakers' To-Do List
The ongoing debate over Medicaid expansion and reform will be front and center when Ohio lawmakers return to action this fall, but it will hardly be the only issue. Both the House and Senate have spent time this summer working on Medicaid changes, after Republicans rejected Gov. John Kasich's proposal to expand Medicaid coverage to about 275,000 low-income Ohioans, bringing $13 billion in federal money to Ohio over seven years. ... Senate President Keith Faber, R-Celina, is working to clarify some issues with the federal government, particularly the ability for Ohio to make future Medicaid changes if the feds fail to uphold their funding commitment, said spokesman John McClelland (Siegel, 9/16).

Cleveland Plain Dealer: Petition Effort To Get Medicaid Expansion Law For Ohio Clears First Hurdle
Attorney General Mike DeWine today certified the summary of a proposed law that would expand Medicaid in Ohio to cover the working poor, clearing the way for the group petitioning for the law to collect nearly 115,600 signatures needed to get it before the General Assembly (Higgs, 9/13). 

Lexington Herald Leader: Newly Eligible Medicaid Members Can Choose From Anthem, Humana Or Passport
The state has signed contracts with three Medicaid managed care companies to serve Kentuckians who will be newly eligible for Medicaid under the federal Affordable Care Act, officials said Friday. Starting Oct. 1, people in 104 Kentucky counties who are newly eligible for Medicaid can choose Anthem, Humana or Passport as their Medicaid provider for coverage effective Jan. 1, 2014, according to a news release from the Cabinet for Health and Family Services (Spears, 9/13). 

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Young People Remain In The Dark As Obamacare Exchanges Prepare To Open

Several newspapers explore how uninformed many young people are about new online insurance exchanges which open in two weeks, even though their participation is considered crucial to the markets' success. Bloomberg News documents how little Texans know about the law, although millions stand to gain coverage. Meanwhile, the New York Times describes a faculty uprising at Pennsylvania State University over a new employee wellness plan that takes some ideas from the law.

The Tennessean/USA Today: Health Law Offers Quandary For Youths
Whether he and millions of other young people buy coverage is crucial for the federal health law to reach the goal of making insurance affordable. Their participation is needed to offset the cost of guaranteed coverage for older people with pre-existing conditions. But with barely more than two weeks before enrollment begins on a newly created exchange for the uninsured, most young people know little or nothing about what's at stake for them, according to polls and surveys (Wilemon, 9/15).

Salt Lake Tribune: Obamacare: Will Utah’s Young Adults Pay Or Stay Away?
Experts say getting young Americans insured is critical to the success of the ACA. Those who are young and healthy reduce the risk in the insurance pool and balance the costs for older, less-healthy people. Many speculate, however, that the so-called "young invincibles" won’t rush to buy insurance when the online marketplaces launch Oct. 1 because they don’t think they need it. It turns out, the opposite is true, said Christina Postolowski, a policy analyst for the advocacy group Young Invincibles, which is working to educate young adults about the law and get them enrolled in plans in all 50 states. "What a lot of our polling found is that only about 5 percent of people don’t have it because they think they don’t need it," Postolowski said. "A much larger percentage don’t have it because they can’t afford it" (Dobner, 9/15).

Bloomberg: Texans In Dark On Obamacare As Enrollment Startup Looms
Randy Osban’s job selling ribs and brisket from a yellow trailer on Texas’s state road 71 offers a sweeping view of the hill country beyond Austin. One benefit his business doesn’t provide is health insurance. Osban, 55, could use it now, as his wife Kathy, 59, has a heart condition and the money he makes barely covers current expenses, much less a hospital bill (Wayne, 9/13).

The New York Times: On Campus, A Faculty Uprising Over Personal Data
Improving health while holding down health care costs is the kind of having-your-cake-and-eating-it combination that most people can get behind. In fact, both ideas are embedded in the Obama administration’s Affordable Care Act. But an uprising among faculty members at Pennsylvania State University over a new employee wellness plan is challenging at least some of the methods designed to achieve those aims (Singer, 9/14).

Kaiser Health News: Local Uninsured Programs Face Uncertain Times As Obamacare Ramps Up
Jennifer Webb works the deli counter at Publix supermarket and has thyroid problems. Her boyfriend, William May, is an artist recovering from colon cancer. The couple has relied on a county program that provides health coverage to the working poor. But their 'security blanket,' as Webb calls the Alachua County CHOICES program, is being taken away at the end of December. As new coverage provisions take effect Jan. 1 under the health law, local programs that offered barebones care to the uninsured are in flux – and with them, the lives of thousands who depend on them (Galewitz, 9/13).

Des Moines Register: Ready Or Not, Here Comes Obamacare
David Fairchild and Clara Peterson are pinning their hopes on Obamacare. The couple, who own a small cleaning service, are in their mid-50s. They pay more than $900 per month for private health insurance, plus thousands of dollars a year in deductibles and co-payments. Until now, they’ve been unable to shop for other policies, because no other insurer would be willing to cover Fairchild’s chronic leukemia without charging even higher premiums. Starting Oct. 1, they and hundreds of thousands of other Iowans will be able to check out private policies offered on a new, government-run online shopping system (Leys, 9/14).

In other news, the Kansas City Star examines whether the availability of health insurance through new insurance exchanges could spur many Baby Boomers to retire early --

Kansas City Star: Obamacare Could Encourage More Early Retirements From Baby Boomers
The sound you hear could be baby boomers revving their early retirement engines. Insurance providers and financial planners expect the Affordable Care Act to encourage a flood of workplace departures from the 50-to-65 age group, which accounts for about 43 million members of the U.S. labor force. That’s because those not yet eligible for Medicare “won’t be hostage to your employer or your spouse’s employer anymore,” said David Power, a broker with PowerGroup in Overland Park. “The health care shackles are off” (Stafford, 9/15).

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Obama Administration Turns Down Unions' Request On Health Law

Organized labor had sought to get premium subsidies for workers who get insurance through union benefit plans sponsored by more than one employer, which are common in some industries.

The New York Times: Administration Rejects Union Pleas On Health Law
The federal government on Friday rejected pleas from labor unions for a dispensation from President Obama's health care law. The decision, likely to infuriate some of Mr. Obama's closest political allies, denies federal tax credits to workers who receive health coverage under employee benefit plans sponsored by more than one employer. Such plans are common in construction and other industries (Pear, 9/13).

The Wall Street Journal: Unions Won't Get Sought-After Change To Health Law
The White House said late Friday that it can't legally make the primary change unions are seeking to the new health-care law, a long-simmering dispute between President Barack Obama and one of the main backers of his signature domestic initiative. The announcement, a big blow for unions, followed an hourlong White House meeting involving several top labor officials, Mr. Obama, Vice President Joe Biden, Labor Secretary Tom Perez and top Obama advisers (Trottman, 9/13).

Politico: W.H. Rejects Labor's Bid For Obamacare Exemption
The Obama administration on Friday told labor union leaders that their health plans would not be eligible for tax subsidies under Obamacare next year. A White House official said the Treasury Department has concluded that such an exemption is not possible under the Affordable Care Act. The labor unions have been asking that their union plans, known as Taft-Hartley plans, be eligible for premium subsidies the way plans on the new insurance exchange will be (Tau and Haberkorn, 9/13).

The Hill: Administration Rejects Labor's Request For Obamacare Subsidies
Nevertheless, the administration said it plans to work with unions to make sure members can obtain coverage through the new insurance exchanges. "The administration will work with multi-employer plans and other non-profit plans and encourage them to offer coverage through the Marketplace, on an equal footing, to create new, high-quality, affordable options for all Americans," said the official (Bogardus and Sink, 9/13).

Bloomberg: Unions Denied Bid For Tax Break Under Obama Health Law
The move marks a setback for the AFL-CIO, the nation's largest health federation, which earlier this week called for classifying multiemployer health plans run by labor in a way that would make members eligible for the tax break. The AFL-CIO, a staunch political ally of the president, endorsed the Affordable Care Act when it was enacted in 2010 (Efstathiou Jr. and Shepard, 9/14).

Reuters: Union Fail To Get Fix From White House On Key 'Obamacare' Concern
Top labor leaders left the White House on Friday after an hour-long meeting with President Barack Obama, still looking for a way to address concerns that "Obamacare" will hurt their members' healthcare plans. The dispute with unions - traditional allies of Democrats - as the Obama administration begins to roll out Obama's signature healthcare reforms is providing political ammunition for Republicans who want to defund or repeal the law (Rampton, 9/13).

The Associated Press: White House: No Subsidies For Union Health Plans
Low-income workers on union health plans are not eligible for the same federal subsidies available to those who buy insurance in the new state health care marketplaces, the White House said Friday. The decision is a disappointment for labor unions, coming shortly after top union officials met for more than an hour with President Barack Obama to press their case that subsidies could be extended to union-sponsored plans (Hananel, 9/13).

Fox News: White House Backs Off ObamaCare Deal For Unions
The Obama administration on Friday appeared to rule out giving unions a special deal to offer their workers extra ObamaCare subsidies, but left the door open to other changes after a private White House meeting with labor leaders who are concerned over the law. Earlier in the day, AFL-CIO President Richard Trumka had urged the White House to act within a week to address labor unions’ concerns over ObamaCare (Fox News, 9/13).

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Capitol Hill Watch

GOP Keeps Health Law In Political Sights As Others Join In

Republicans continue their drumbeat for defunding and repealing the health law with a menu of political moves -- including taking a page from a powerful conservative group's playbook and making fundraising and radio address appeals.

The Washington Post: Club For Growth Takes Aim At Obamacare As It Continues To Take On GOP From The Right
Now the [Club for Growth] is advocating disruption on a grander scale, urging Republicans to wage what some in the party are calling a suicidal campaign to shut down the government unless President Obama agrees to defund his signature health initiative. Last week, Boehner (R-Ohio) cancelled another vote -- this time on a plan to keep the government open past Sept. 30 -- after the Club and other outside groups complained that it failed to undermine Obamacare. "Every Republican ran on defunding or repealing Obamacare. This is a test of whether they’re actually going to do what they say they’re for," said Club President Chris Chocola, a former congressman from Indiana (Montgomery, 9/14).

Roll Call: McConnell Touts Obamacare Opposition In Fundraising Appeal
With the subject line "I'm Still Fighting Against Obamacare," Senate Minority Leader Mitch McConnell laid out his record of working against President Barack Obama’s health care law in a lengthy fundraising appeal to supporters Thursday night. In the face of attacks from a Republican primary challenger in Kentucky regarding his conservative credentials, the McConnell campaign distributed the email Thursday night -- a day after the Republican leader introduced an amendment to the energy bill that would delay implementation of the individual mandate (Trygstad, 9/13).

The Hill: GOP Keeps Focus On Obamacare Repeal
House Republicans this weekend are keeping their focus on efforts to do away with President Obama's signature health care reform law.  In their weekly radio address, the GOP trumpeted legislation, passed Thursday, that would eliminate the federal subsidies for low and middle-income Americans when they buy insurance plans -- a central pillar of the Democrats' 2010 law (Lilis, 9/14).

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Obama Blasts GOP Efforts To Defund Health Law

The president, Sunday on ABC's "This Week," says Republicans are trying to use the debt ceiling as a "lever to radically cut government."

Politico: President Obama: 'Less Concerned About Style Points'
About the looming debt and deficit issues in Congress, Obama blasted the ongoing Republican insistence that his signature health care law get defunded as part of a deal to raise the debt ceiling. "I think it's fair to say that never in history have we used just making sure that the U.S. government is paying its bills as a lever to radically cut government at the kind of scale that they’re talking about," Obama said. "It's never happened before. There've been negotiations around the corners, because nobody had ever presumed that you’d actually threaten the United States to default" (Tau, 9/15).

The Associated Press: Obama: Budget Tightening Could Widen Income Gap
Obama emphasized that when it comes to a crucial deadline to raise the nation's borrowing limit next month, he would not negotiate with Republicans. They want to use the debt ceiling as leverage to cut spending further and to delay Obama's signature health care law. ... Some conservative Republicans say they will only extend current spending levels or increase the debt ceiling if Obama delays putting in place his health care law, a condition Obama has flatly rejected (Kuhnhenn, 9/15).

Politico: Price, Van Hollen Spar Over Obamacare
Reps. Tom Price and Chris Van Hollen tore into each other on "Fox News Sunday" when asked whether stopping Obamacare implementation was worth shutting down the government. Price, a Republican from Georgia, when asked whether he supported a shutdown to stop the implementation of Obamacare, demurred twice, changing course from an earlier Fox interview in which he said that he would. Instead, he pointed to a proposal to delay the law’s implementation for a year. ... Van Hollen, a Democrat from Maryland, jumped on the change. Citing the dozens of votes in the House to repeal the law, he accused Republicans of pitching the power back to insurance companies (Drusch, 9/15). 

The Hill: GOP Keeps Focus On Obamacare Repeal
In their weekly radio address, the GOP trumpeted legislation, passed Thursday, that would eliminate the federal subsidies for low and middle-income Americans when they buy insurance plans – a central pillar of the Democrats' 2010 law. Rep. Diane Black (R-Tenn.), the sponsor of the bill who delivered Saturday’s address, said her proposal is a common-sense solution to fighting fraud (Lillis, 9/14).

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Coverage & Access

Long-Term Care Panel Releases Recommendations

Though the panel narrowly approved proposals on Friday, it did not reach a consensus on how to pay for these often expensive services.

The Wall Street Journal: U.S. Faces Long-Term Care Crisis, Report Says
The U.S. is facing a long-term-care crisis and needs to do a better job of preparing for it, a new congressional report says. Government agencies should work quickly to better harness public and private resources to best provide and pay for long-term care as 78 million baby boomers, born from 1946 to 1964, head into old age at the same time many of their parents are living into their 80s and 90s, according to the federal Commission on Long-Term Care, which released a series of recommendations Friday for dealing with the problem (Greene, 9/13).

Kaiser Health News: Long-Term Care Panel Releases Recommendations But Fails To Offer Plan To Help Pay For Services
A commission created by Congress to address the country's surging need for long-term health care released recommendations Friday but did not reach a consensus on how to pay for these often expensive services (Jaffe, 9/13).

Politico: Rift Exposed Over Long-Term Care Proposals
Democrats picked to serve on a special long-term care commission organized by Congress in the aftermath of Obamacare’s discarded CLASS Act mostly rejected the panel’s recommendations — arguing that the commission failed to consider the key question of how to finance long-term care for an aging population. The special commission issued recommendations Friday for tackling the persistent policy challenge of reforming long-term care. The recommendations were approved, 9-6, but five of the nine Democratic appointees voted against the commission’s final recommendations (Millman, 9/16).

Meanwhile, the Wall Street Journal offers consumer tips about different types of at-home options --

The Wall Street Journal: When To Consider In-Home Care
Nine out of 10 Americans say they want to grow old at home and keep living in their communities as long as possible, according to AARP. Home-health providers are rushing in to meet the demand. But there are things to consider when looking into care at home—including the number of limitations a person is struggling with, whether they have supports in the community and whether the home itself is suitable. New advances in home care are allowing more people to remain in their homes because of telehealth and apps designed to keep track of an elder person's medication compliance and comings and goings, says Steve Landers, chief executive of VNA Health Group, which provides home-health services. Meanwhile, there are different types of at-home options to draw on. Maybe you need to see a doctor or nurse regularly, and these professionals do pay house calls. Personal-care assistants can help with nonmedical tasks like bathing. Assistance shopping, cooking or cleaning are also options (Forman, 9/15).

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State Watch

State Highlights: N.M. Fraud Investigation Disrupts Mental Health Care

A selection of health policy stories from Texas, New Mexico, California, New York and Kansas.

The Texas Tribune/New York Times: In State Records, Little Evidence To Back Stricter Abortion Law
In their successful push this summer for strict new regulations on abortion facilities and the doctors performing them, proponents said the legislation was needed because conditions at existing facilities made it unsafe for women seeking to terminate pregnancies. But a Texas Tribune review of state inspection records for 36 abortion clinics from the year preceding the lawmakers' vote turned up little evidence to suggest that the facilities were putting patients in imminent danger. State auditors identified 19 regulatory violations that they said presented a risk to patient safety at six licensed abortion clinics that are not ambulatory surgical centers in Texas. None of the violations was severe enough to warrant financial penalties, according to the Department of State Health Services, which deemed the facilities’ corrective action plans sufficient to protect patients (Aaronson, 9/14).

The New York Times: Fraud Investigation Unsettles Mental Health Care In New Mexico
For weeks now, New Mexico has been in the midst of a sweeping criminal investigation into 15 of its largest mental health providers, suspected of defrauding Medicaid of $36 million over three years. Arizona companies have been hired to fill in, but many patients are struggling without regular treatment. The state behavioral health system is in turmoil, with the administration of Gov. Susana Martinez under sharp attack (Frosch, 9/13).

Los Angeles Times: Bills Would Give State New Powers To Fight Prescription Drug Abuse
Last week, state lawmakers passed an ambitious slate of reforms aimed at giving authorities better tools and broader powers to crack down on doctors who recklessly prescribe narcotic painkillers and other commonly abused drugs. The three bills, which garnered strong bipartisan support, await a signature from Gov. Jerry Brown that would make them law (Glover and Girion, 9/15).

The Associated Press/Wall Street Journal: NY Building Low-Cost Housing Under Medicaid
New York plans to create low-income housing for 5,000 Medicaid recipients with significant health care needs. The housing units are planned for Manhattan and the Bronx; Monroe, Broome and Erie counties; and in the Finger Lakes Region as well as in Long Island's Suffolk County (9/15).

Kaiser Health News: States Balk At Terminating Medicaid Contracts Even When There's Fraud Or Poor Patient Care
In Florida, a national managed care company's former top executives were convicted in a scheme to rip off Medicaid. In Illinois, a state official concluded two Medicaid plans were providing 'abysmal' care. In Ohio, a nonprofit paid millions to settle civil fraud allegations that it failed to screen special needs children and faked data. Despite these problems, state health agencies in these -- and other states -- continued to contract with the plans to provide services to patients on Medicaid, the federal-state program for the poor and disabled. Health care experts say that's because states are reluctant to drop Medicaid plans out of fear of leaving patients in a bind (Bergal, 9/15).

Kansas Health Institute: Colyer Says KanCare Going Better Than Expected
Kansas' Medicaid managed care initiative is going well and is on track to achieve its promised $1 billion in savings, Lt. Gov. Jeff Colyer said in an interview broadcast Thursday on Kansas City public television station KCPT. Portions of the interview with Colyer were featured in a segment produced by KCPT health correspondent Sam Zeff for the station’s Local Show (9/13).

California Healthline: Physical Therapist Bill Headed To Governor
The Senate and Assembly this week passed a bill that could change some of the rules regarding physicians, physical therapists and patients. AB 1000 by Assembly member Bob Wieckowski (D-Fremont), designed to increase patients' direct access to physical therapists, is headed to the governor's desk. "Patients will no longer need a diagnosis from a physician before beginning treatment from a physical therapist," Wieckowski said in a statement. "This is a great victory for health care consumers in California." The bill was co-sponsored by the California Physical Therapy Association, and yet the main opposition to the bill also came from physical therapists (Gorn, 9/13).

Healthy Cal: Bill Would Bring State Billions in Extra Federal Funds
The Legislature has sent a bill to Gov. Brown that would save hospitals from a major cut in reimbursements for treating disabled people under the Medi-Cal program. In exchange the hospitals have agreed implement a fee program that will bring the state $2.4 billion a year in federal healthcare funding. SB 239, by Sen. Ed Hernandez, D-W Covina, creates a hospital quality assurance fee program imposed by hospitals upon themselves. That fee will go to the state, which will use the money to receive matching Medicaid funding from the federal government, according to Jan Emerson-Shea, Vice President of External Affairs for the California Hospital Association (Matthews, 9/15). 

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Editorials and Opinions

Viewpoints: GOP Willing To Move To Default If They Can't Cripple Health Law; It's Time To Figure Out If Workplace Wellness Programs Work

The New York Times: The Annual Republican Crisis
This year, as has been the case so often in the past, their target is President Obama's health care reform law. If it is not repealed or defunded or delayed or otherwise left bleeding in the public square, they will not pass a spending bill needed to keep the government open past Sept. 30. And if that doesn't cripple the health law (which it won't), they will resort to the far more serious threat of default, refusing to raise the nation's debt ceiling, no matter the catastrophe that would cause (9/14).

The Washington Post: Young Adults Can't Afford To Tune Out Obamacare Insurance Requirement
Thanks to the ACA, commonly referred to as Obamacare, you may now be able to get insurance or continue to be covered under a parent's plan up to the age of 26. And this coverage is available even if you're married, not living at home, attending school or are financially independent. Starting next year, young adults up to 26 can stay on their parents' employer plan even if they have another offer of coverage through an employer (Michelle Singletary, 9/14).

Philly.com: The Latest Anti-Obamacare Tactic: Keep People From Knowing About It
Even the best initiative in the world can't do any good if no one knows about it. That, apparently, is the thinking of Obamacare's opponents. They have begun aiming their attacks on navigators, the people whose job it is to inform the public about how to gain coverage through the new insurance exchanges (Robert I. Field, 9/16).

Bloomberg: Georgia's Dangerous War Against Obamacare
Open enrollment in the new state health-insurance marketplaces begins in a matter of days. With less than three weeks to go before the Oct. 1 start date, Georgia's Republican governor and insurance commissioner are doing everything in their power to make it hard to attract people to Georgia’s exchange. And the state's big health insurers have been chipping in with well-timed donations. ... In a speech last month, Ralph Hudgens, Georgia's insurance commissioner, reassured an audience of Republican Party faithful that he's solving the "problem" of Obamacare in Georgia by doing "everything in our power to be an obstructionist" (Ford Vox, 9/13).

Forbes: Why Obamacare Shouldn't Force Poor Seniors Into Medicaid
Finding better ways to serve the needs of these "dually eligible" Americans has been a bi-partisan goal that's eluded successive administrations. Whenever the issue was broached, one of the questions was whether these Americans would end up in Medicare or Medicaid — and which program would better serve their needs. The Obama Administration is betting heavily on states to take control of these patients. The states, in turn, are looking to their Medicaid systems (Scott Gottlieb, 9/16).

New Orleans Times-Picayune: Medicaid Expansion Could Help Thousands Of Uninsured Louisiana Residents
The letter drive, which was organized by the Jeremiah Group, is not the first to attempt to change the governor's mind. There was a rally on the Capitol steps during the spring legislative session. Two former secretaries of the Department of Health and Hospitals called on Gov. Jindal to do the right thing and take the almost $16 billion in new Medicaid money for Louisiana. And yet, in one of the poorest and unhealthiest states in the union, Gov. Jindal has held firm to his rejection of the money that could help thousands of residents. That is truly a shame (9/15).

Detroit Free Press: Time To Stop Fighting Affordable Care Act And Move On
The debate in the state Capitol over Medicaid expansion was as close to political hand-to-hand combat as you can get. It likely left many feeling battered and bruised, but the outcome is the right one. Now, it is crucial for health care providers and community groups to step up and take responsibility for encouraging Michiganders to take advantage of the new options available to them (Ora H. Pescovitz, 9/16).

The Washington Post’s Post Partisan: Obamacare, The Debt Ceiling And GOP Insanity
A statistic in the latest Wall Street Journal-NBC News poll drives me nuts. It's 44 percent. Here’s the question: "Do you think Congress should or should not raise the debt ceiling? If you don’t know enough to have an opinion, please just say so." The 44 percent who said the nation's borrowing limit should not be raised should have responded "I don't know" — because then they’d be telling the truth (Jonathan Capehart, 9/16).

San Jose Mercury News: Obamacare: California Can Use The ACA To Improve Its Economy And People's Lives
Many states and localities have already done this. For example, Philadelphia launched a program to auto-enroll eligible health care beneficiaries in food stamps, increasing enrollment among seniors by 23 percent in the first year. While California has been a national leader in the implementation of the ACA, we have taken only baby steps to integrate our health care and public benefit programs (Ann O'Leary and Jeffrey Selbin, 9/13).

Los Angeles Times: Do Workplace Wellness Programs Work?
Would you be willing to share with your employer how much you eat, drink, smoke or exercise? And would you be willing to make lifestyle changes in return for a break on the cost of your health insurance? The University of Minnesota offered such discounts to its workers. Actions such as completing a health questionnaire, biking to campus or setting personal fitness goals earned insurance discounts beginning at $300. Nearly 6,000 employees accepted the bargain. But do such programs have the intended effect of healthier employees and lower healthcare costs? As more businesses embrace health incentives, these questions are becoming more urgent (Rahul K. Parikh, 9/15).

And on another subject --

The New York Times: A Step To Curb Painkiller Abuses
Consumers will be less apt to overdose on prescription painkillers — but still less safe than they should be — under new labeling rules announced by the Food and Drug Administration on Tuesday for a class of drugs known as opioid analgesics (9/13).

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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.