Daily Health Policy Report

Tuesday, September 17, 2013

Last updated: Tue, Sep 17

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Health Reform

Administration News

Health Care Marketplace

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

FAQ: What You Need To Know About The New Online Marketplaces

Kaiser Health News staff writers Mary Agnes Carey and Julie Appleby, working in collaboration with The Washington Post, report: "The health law's online marketplaces, also known as exchanges, will be open for enrollment Oct. 1.  They will allow individuals and consumers to comparison shop for health insurance, much like they do now online for an airline ticket or a hotel room, and apply for subsidies, if they are eligible. If done well, proponents say, the marketplaces could make it easier to buy health insurance and possibly lead to lower prices because of increased competition. But, if designed or marketed poorly, the exchanges will not attract healthy people and will instead be left with a higher percentage of sicker people that will cause premiums to rise" (Carey and Appleby, 9/16). Read the story.

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Insuring Your Health : For Workers Leaving Their Jobs, Health Exchanges Offer Insurance Choices Beyond COBRA

Kaiser Health News consumer columnist Michelle Andrews reports: “Workers who lose their jobs and their employer-based health insurance will have new coverage options when the Affordable Care Act's state marketplaces open in October. But consumer advocates are concerned many may not realize this and lock themselves into pricier coverage than they need” (Andrews, 9/16). Read the column.

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Marketplace Premiums Likely To Mirror Plans Sold Privately (Video)

Kaiser Health News consumer columnist Michelle Andrews helps you navigate the new insurance marketplaces that are scheduled to launch on Oct. 1. Today's question is about comparison shopping between the health law’s new exchanges and the individual market (9/16). Watch today's video or watch others from this series.

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Obamacare Will Be Both Ally And Rival To eHealthInsurance

Reporting for Kaiser Health News, Eric Whitney writes: "America's biggest online health insurance retailer is getting ready for some stiff new competition from Uncle Sam. The federal government will be opening new online marketplaces for health insurance in 34 states on Oct. 1. State governments are opening their own on the same day in the remaining states" (Whitney, 9/17) Read the story.

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Little Evidence To Back Texas Abortion Law, According To Official Records

The Texas Tribune's Becca Aaronson, working in partnership with Kaiser Health News, reports: "In their successful push this summer for strict new regulations on abortion facilities and the doctors performing them, proponents of the Texas legislation said it 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 the facilities were putting patients in imminent danger" (Aaronson, 9/16). Read the story.

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Capsules: What To Know About Enrolling In Obamacare’s 'Exchanges'; Join A Live Discussion Today On washingtonpost.com

Now on Kaiser Health News' blog, watch video of KHN’s Jenny Gold on C-SPAN’s Washington Journal Monday morning taking questions about the impending enrollment period for the health law’s health insurance marketplaces and what consumers need to know (9/16).

In addition, KHN's Julie Appleby and Mary Agnes Carey, who wrote today's consumer guide to the marketplaces, are participating in an online discussion on the Washington Post website today, answering reader questions about how to navigate the new system. The discussion begins at noon ET, but you can submit your questions now at: http://live.washingtonpost.com/obamacare-enrollment-questions-answered.html. Check out what else is on the blog.

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Political Cartoon: 'Lay It On The Line?'

Kaiser Health News provides a fresh take on health policy developments with "Lay It On The Line?" by Gary Varvel.

Here's today's health policy haiku: 

MISS CONGENIALITY?

It's not about a
popularity contest,
hope health law backers.
-Anonymous

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

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Capitol Hill Watch

GOP Lawmakers Contemplate Daunting Budgetary Choices -- Defund Health Law? Avoid Gov't Shutdown? Raise Debt Ceiling?

The fiscal choices set up intra-party fissure for Republicans and draw more tough talk from President Barack Obama. 

Bloomberg: Republicans Weigh Defunding Health Law, Avoiding Shutdown
House Republicans return to Washington today still at loggerheads over how to thwart President Barack Obama’s health-care law without shutting down the federal government on Oct. 1. House Republican leaders are considering alternatives that would mollify those who want to defund and delay the president’s signature domestic achievement (Tiron, 9/17).

Politico: GOP Leaders Link Debt Hike, CR Fights
One option under consideration is an accelerated vote on the debt ceiling. There is discussion in House Republican leadership circles about setting a debt ceiling vote before Sept. 30. If Republican leaders show in the next few weeks how they will use the debt ceiling to delay Obamacare, it will display that the party's brass is serious about an all-or-nothing legislative brawl with Senate Democrats and President Barack Obama. That could help ease the passage of the continuing resolution to fund the government (Sherman and Bresnahan, 9/16).

The New York Times' Congressional Memo: Amid Revolt Over Fiscal 'Gimmicks,' Options Dwindle For G.O.P.
For three years, Congressional leaders have relied on tactical maneuvers, sleights of hand and sheer gimmickry to move the nation from one fiscal crisis to the next — with little strategy to deal with the actual problems at hand. Medicare and Social Security continue to swell with an aging population. Health care costs grow. A burdensome tax code remains unchanged, and economic revival is shadowed by the specter of Washington's crisis-driven mismanagement. Now, with a government shutdown looming at month's end and a crippling default on the nation's debt possible by mid-October, Congressional leaders may have run out the string on legislative trickery (Weisman, 9/16).

The Associated Press: 'Chaos'? Obama Goes After 'Extreme' Republicans
A potential federal shutdown looming, President Barack Obama on Monday warned congressional Republicans they could trigger national "economic chaos" if they demand a delay of his health care law as the price for supporting continued spending for federal operations. House Republican leaders were to meet Tuesday in hopes of finding a formula that would avoid a shutdown on Oct. 1 without alienating party conservatives who insist on votes to undercut the Affordable Care Act. Even more daunting is a mid- to late-October deadline for raising the nation’s borrowing limit, which some Republicans also want to use as leverage against the Obama administration (Kuhnhenn and Taylor, 9/16).

The Washington Post: Obama: I Will Not Negotiate On The Debt Ceiling
Some Republicans have threatened to hold up the funding of the government if Obamacare is funded as a part of it. Other Republicans disagree with that strategy, worrying about the consequences of a potential government shutdown. Obama said Republicans are effectively holding the government hostage by threatening to defund Obamacare. “I cannot remember a time when one faction of one party promises economic chaos when it doesn’t get everything it wants," he said (Blake, 9/16).

Arizona Republic: Congress Fight Near On Health Law, Debt
It has become familiar territory for Washington: The federal government has faced similar showdowns over budget deficits and borrowing limits three times in a little more than two years. This time, however, the Affordable Care Act has become entangled in the fight as conservative Republicans have seized on the crisis as their last chance to derail the health-reform law, which they view as an expensive government takeover of health care (Kelly, 9/16).

Roll Call: Obama Calls Out GOP On Budget, Obamacare
An angry President Barack Obama ripped into Republicans for failing to end the sequester and for even considering holding the government hostage over Obamacare. During a speech marking five years from the fiscal crisis in 2008, the president said he hoped Republicans would focus on his middle-class agenda (Dennis, 9/16).

The Hill: House GOP Shutdown Gambit Gains More Support
A leading House GOP effort to tie a defunding of ObamaCare to a bill funding the government after Oct. 1 has gained new support. The full-year continuing resolution authored by Rep. Tom Graves (R-Ga.) gained 17 new co-sponsors since it was introduced last week with 42 others on board (Wasson, 9/16).

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Health Reform

Health Insurance Exchange News: Investors Say 4 Million Americans Will Initially Enroll

This number is well below the Congressional Budget Office's prediction of seven million. Meanwhile, USA Today reports that many Americans will pay less than $100 a month in premiums, based on an HHS report to be released today.

Reuters: Investors See Four Million Signing Up For Obamacare In 2014: Survey
Investors expect 4 million Americans to initially enroll in the state insurance marketplaces created under President Barack Obama's Affordable Care Act, according to a survey released on Monday, as concerns mount that technical glitches could present obstacles to enrollment. The expectations of the investors - hedge funds, institutional clients and other investors surveyed by Citigroup, 56 in total - fall far short of a Congressional Budget Office forecast that 7 million Americans will seek subsidized health coverage through the online exchanges (Krauskopf, 9/16).

USA Today: For Millions, Insurance Will Cost Less Than $100/Month
About 6.4 million Americans eligible to buy insurance through the new health exchanges will pay $100 or less a month in premiums because of tax subsidies, according to a Department of Health and Human Services report to be released Tuesday and obtained by USA TODAY. The report by the HHS office for planning and evaluation said the lower premiums would primarily apply to insurance customers who buy what are called "silver" plans on the exchanges that open Oct. 1 (Kennedy, 9/17).

Also, news outlets offer consumers useful details about the online insurance marketplaces.

The Washington Post: Health Insurance Marketplaces Open Oct. 1. What You Need To Know To Choose A Plan.
It might not be Black Friday, the day after Thanksgiving, but Oct. 1 should be a shopping day to remember. For the first time, millions of uninsured Americans will be able to go online to compare health insurance plans, find out if they are eligible for federal help in paying the premiums and buy coverage (Sun, 9/16).

Kaiser Health News: FAQ: What You Need To Know About The New Online Marketplaces
If done well, proponents say, the marketplaces could make it easier to buy health insurance and possibly lead to lower prices because of increased competition. But, if designed or marketed poorly, the exchanges will not attract healthy people and will instead be left with a higher percentage of sicker people that will cause premiums to rise. Here are some answers to common questions about the exchanges (Carey and Appleby, 9/16).

Kaiser Health News: Obamacare Will Be Both Ally And Rival To eHealthInsurance
America's biggest online health insurance retailer is getting ready for some stiff new competition from Uncle Sam. The federal government will be opening new online marketplaces for health insurance in 34 states on Oct. 1. State governments are opening their own on the same day in the remaining states (Whitney, 9/17).

USA Today: Survey: Some Seniors Confused About Law And Medicare
About 17% of seniors incorrectly believe the Affordable Care Act replaces their Medicare with insurance policies purchased on line through the state and federal health insurance exchanges, according to a study released exclusively to USA TODAY (Kennedy, 9/17).

Related, earlier KHN story: Selling Marketplace Plans To Medicare Beneficiaries Will Be Illegal (Jaffe, 9/13)

Meanwhile, hospitals are getting into the outreach game -

Modern Healthcare: Hospital Association Leaders Push Members To Educate Patients About Exchanges
With open enrollment on the public exchanges starting in 15 days, the leaders of the nation's major hospital associations Monday urged their members to do all they can to help patients learn about the health reform law's insurance coverage options. People will enroll in coverage only if they understand what's available to them and how they can access it, American Hospital Association President and CEO Rich Umbdenstock said at the start of an hourlong webcast (Zigmond, 9/16).

And some leaders are changing their tune -

The Hill: Sen. Baucus Says He No Longer Fears 'Train Wreck' When ObamaCare Begins
Sen. Max Baucus on Monday said he no longer fears ObamaCare will be a "train wreck."  Baucus, the chairman of the Senate Finance Committee, said his memorable warning about the law earlier this year served its intended purpose by forcing the White House to deal with concerns about the rollout (Viebeck, 9/16).

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As The Clock Ticks Down, Premium Information Still Elusive In Some States

The St. Louis Beacon reports that Missouri consumers will have to wait for the Oct. 1 launch date to get answers about how much the new coverage will cost. Other news outlets offer state-specific coverage of how the marketplaces are taking shape and what types of impact they might have.

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).

The CT Mirror: Obamacare Q&A: What Will My Plan Cost? What Doctors Are Covered? And What About Dental?
Our first batch of reader questions about the federal health care reform law addresses how much individuals would pay to buy coverage, dental insurance, which health care providers are covered, and health savings accounts (Becker, 9/16).

Healthy Cal: 'Obamacare 101' Sessions in L.A. County Designed To Educate, Inform
Kandis Driscoll, the workgroup director for the Insuring the Uninsured Project, stood at the podium of a recent session of Obamacare 101 asked if anyone was familiar with what is known as the individual mandate . A smattering of hands from the 90 or so attendees gingerly went up. So Driscoll presented a slide explaining the mandate, breaking down the penalty of $95 or 1 percent of income a person will have to pay on their taxes in the first year if they don’t secure insurance and how that penalty increases in coming years. The room filled with murmurs. The individual mandate, a key provision of 2010′s Affordable Care Act and such a hotly contested issue that it took a Supreme Court ruling last year to keep it in place, was still news to some (Fulton, 9/17).

The Associated Press: Wisconsin Consumer Advocates Warn Of Health Care Fraud
Enrollment begins for a national health insurance program in two weeks, and Wisconsin officials are already bracing for what could be an unprecedented wave of fraud attempts. The National Consumers League says criminals across the nation have already begun using confusion over the Affordable Care Act to pressure consumers into divulging personal information, the Press-Gazette Media reported (9/17).

California Healthline: Researchers Helping Legislative Staff Craft Health Care Reform Message
When they see television ads or billboards for Covered California, the state's health insurance exchange, or see media stories about the huge expansion of Medi-Cal, the state's Medicaid program, Californians will have questions. A lot of those questions will go to state legislators. Assembly and Senate staff members could be deluged with calls and queries. That's where Shana Alex Lavarreda comes in. Lavarreda, director of health insurance studies at the UCLA Center for Health Policy Research, helped stage a recent symposium in Los Angeles for legislative staff members. Along with other UCLA researchers, Lavarreda briefed staffers on the mountain of health care information they're about to need (Gorn, 9/16).

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Medicaid Expansion Increasingly In Vogue With Republican Governors

Pennsylvania Gov. Tom Corbett and Michigan Gov. Rick Snyder are the most recent to express interest, and even support, for the health law's Medicaid expansion.

The Wall Street Journal: Pennsylvania Governor Seeks Expanded Health Coverage For Poor
Pennsylvania Gov. Tom Corbett said Monday he wants to expand health insurance to hundreds of thousands of low-income state residents under the federal health-care law, as long as he is allowed to use Medicaid funding to pay for private insurance policies for them. … The Department of Health and Human Services in Washington has previously said it is open to such a compromise, which is being mulled by a handful of other states including Arkansas, Ohio and Tennessee (Radnofsky, 9/16).

Politico: Pennsylvania To Take Medicaid Funds, With A Catch
Among the reforms he’s seeking: Enrollees would pay premiums on a sliding scale from $0 to $25 and unemployed Medicaid recipients would be required to submit to job training or job search programs in exchange for premium reductions. Corbett also wants to pare back Medicaid benefits to be more consistent with what’s available in the private insurance market (Cheney and Millman, 9/17).

Reuters: Pennsylvania Proposes Alternative To Expansion Of Medicaid
The plan to use Medicaid funds to purchase private insurance is modeled on similar proposals in Iowa and Arkansas, where Republican officials have also resisted efforts to expand Medicaid eligibility under Obama's Affordable Care Act - better known as Obamacare. Pennsylvania's plan, like those of the other two states, would require approval by the U.S. Department of Health and Human Services. States like Pennsylvania, Iowa and Arkansas that are refusing to expand Medicaid as envisioned under Obama's healthcare reform will forfeit billions of dollars in federal subsidies to fund the expansion (Kelley, 9/16).

Related, earlier KHN story: The Arkansas Medicaid Model: What You Need To Know About The 'Private Option' (Hancock, 5/1).

The Associated Press: Gov. Snyder Signs Medicaid Expansion Into Law
Gov. Rick Snyder checked off one of the major priorities of his first term on Monday, signing into law a measure that will make hundreds of thousands of state residents eligible for Medicaid. Snyder’s signature at the ceremony at Oakwood Hospital in Dearborn makes Michigan the largest state controlled by Republicans to support a key component of the new federal health care law (Hoiuseholder, 9/16).

Detroit Free Press: Gov. Snyder Signs Medicaid Expansion Into Law
It was a long slog, full of politics, drama and delay. But a bill to expand Medicaid to 470,000 additional low-income Michiganders was signed into law Monday by Gov. Rick Snyder…The bill helps to implement a portion of the federal Affordable Care Act, which mandates that all people have health care coverage after Jan. 1 (Gray, 9/16).

The Washington Post’s Wonk Blog: Obamacare Hits A Tipping Point: Most Governors Now Want To Expand Medicaid
Between Pennsylvania and Michigan, you're looking at more than 800,000 people becoming eligible for new health law programs. And if the Pennsylvania expansion does go through, it would be the 26th state to expand Medicaid, meaning that the majority of states had decided to opt into a massive health law provision that the Supreme Court decision last year accepted (Kliff, 9/16).

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Administration News

Census: Number Of People Without Health Insurance Largely Unchanged In 2012

The number of people without health insurance remained largely unchanged in 2012, the Census Bureau said Tuesday. The closely-watched census report found that more than 48 million Americans were uninsured during all of 2012, down from 48.6 million 2011. The rate of uninsured dropped to 15.4 percent from 15. 7 percent. Here's the press release and full report.

Here's the latest coverage of the Census data -

The Associated Press: Analysts: 2012 Poverty Rate Basically Unchanged
The Census Bureau reports the number of Americans in poverty stood at 15 percent in 2012. ... The number of people lacking health insurance dipped from 15.7 percent to 15.4 percent. ... Main provisions of the new health law don't take effect until 2014 (Yen, 9/17).

USA Today: Census: Household Incomes Holding Steady
Last year marked the second consecutive year that neither the official poverty rate nor the number of people living in poverty were statistically different from the previous year's estimates. ... But the number of people without coverage — 48 million — was also little changed from the 2011's estimate of 48.6 million (Mullaney, 9/17).

The Washington Post's Wonk Blog: Three Million People Gained Insurance In 2012. Don't Thank Obamacare.
Nearly all of that change appears to be attributable to enrollment in public programs such as Medicaid and Medicaid. Coverage in private health plans, like those that employers purchase, didn't budge. ... The expansion of Medicare coverage ... can be clearly linked to demographics. As a wave of baby boomers hits their 65th birthday, we can expect to see the entitlement program's subscriber base grow. As for the rise in the number of people in Medicaid, Obamacare may have played a small role (Kliff, 9/17).

Bloomberg: U.S. Poverty Remains High as Incomes Stall, Census Says
The Census Bureau data also show the number of Americans who lack health insurance declined to 48 million last year from 48.6 million in 2011, as many under the age of 26 took advantage of a provision in Obama’s 2010 health-care overhaul that allowed them to be covered under their parents’ plans (McCormick, 9/17).

Kaiser Health News: 48 Million Americans Remain Uninsured, Census Bureau Reports
One of the most significant changes was a decline in the rate of uninsured children, from 9.4 percent in 2011 to 8.9 percent, largely related to government efforts to make it easier for children to get coverage. "Uninsurance is already low for children, and the fact that it still appears to be declining is an encouraging sign and shows when there is a concerted public policy focus on a problem it can pay off," said Genevieve Kenney, a senior fellow at the Urban Institute. Kenney said more kids were being covered under their parents’ workplace policies. In addition, states and the federal government have made it easier to enroll in Medicaid and the Children’s Health Insurance Program and stay enrolled" (Galewitz, 9/17).

The New York Times: Percentage Of Americans Lacking Health Coverage Falls Again
One of the most popular provisions of the 2010 health care law allows young adults to stay on their parents’ insurance policies until age 26. That provision appears to be having its intended effect. Among people ages 19 to 25, the proportion who were uninsured declined to 27.2 percent in 2012. Though the bureau said that figure was not significantly different from the 2011 rate, it was down from 29.8 percent two years earlier. The proportion of children younger than 19 without health insurance declined last year, to 9.2 percent, from 9.7 percent in 2011 (Pear, 9/17).

New York Daily News The Swamp: Just Like Gun Violence, U.S. Poverty Persists But At Least Health Insurance Up, Says New Census Report
The most notable changes, said the Census data meisters, comes in the insurance area. Those with health insurance rose, as did the percentage of Americans with insurance (now 84.6 percent). The reasons, said Johnson, can be attributed to growth in Medicare and Medicaid rolls. With Medicare, that largely reflects the coming of Baby Boomers into the universe of those eligible for coverage. In an aside, the Census Bureau notes that "the uninsured rate for children in poverty (12.9 percent) was higher than the rate for children not in poverty (7.7 percent)" (Warren, 9/17).  

Reuters: The share of Americans without health insurance coverage - another key indicator economic of well-being - was 15.4 percent in 2012 compared with 15.7 percent in 2011, a change the Census Bureau described as not statistically significant (Humer and Heavey, 9/17).

Politico Pro: Census Sees Slight Dip In US Uninsurance
The rate of private health insurance held steady for the second year in a row after steadily eroding over the past decade. ... Obamacare advocates said the report that millions of Americans — about 48 million — remained uninsured, showed the need to get the law in place (Norman, 9/17).

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Health Care Marketplace

Expect Influx Of Newly Insured To Doctor Offices

The Associated Press reports on how the growth in the number of newly insured people could mean crowded physician offices while the Los Angeles Times notes that group appointments may be one of the solutions.  

The Associated Press: Newly Insured To Deepen Primary Care Doctor Gap
Getting face time with the family doctor could soon become even harder. A shortage of primary care physicians in some parts of the country is expected to worsen as millions of newly insured Americans gain coverage under the federal health care law next year. Doctors could face a backlog, and patients could find it difficult to get quick appointments (Sanner, 9/17).

Los Angeles Times: Group Meetings Turn Doctor Visits Inside Out
Shared medical appointments are becoming more widespread as physicians look for more efficient and effective ways to treat increasing numbers of patients with chronic diseases. The visits could increase significantly under the nation's healthcare overhaul when millions more Americans gain insurance coverage and need to access doctors. Multi-patient appointments are especially valuable in areas with physician shortages, proponents say (Gorman, 9/16). 

Earlier, related KHN story: Group Appointments With Doctors: When Three Isn't A Crowd (Andrews, 3/19).

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State Watch

State Highlights: New Iowa Nursing Home Regs Under Fire

A selection of health policy stories from Iowa, California, New York and Washington, D.C.

Des Moines Register: New Process For Challenging Nursing Home Fines Under Fire
New laws and regulations supported by Iowa's nursing homes are drawing fire from a former top regulator, who says lawmakers might as well turn the keys to the state inspections department over to industry lobbyists. Earlier this year, state legislators approved a bill that will require independent reviewers — rather than current or former state employees — to hear the appeals of care facilities cited and fined for substandard care (Kauffman, 9/17).

The New York Times: Hoping To Raise Awareness, 2 Leading Groups For The Blind Plan A Merger
Two venerable nonprofit organizations based in Manhattan that provide health care and rehabilitation services for blind and visually impaired people are merging, with the top officials of both groups raising the possibility of broad affiliations among similar local groups around the country (Barron, 9/16).

The Washington Post: D.C. Council May Expand Paid Sick Leave Law
A proposed law to be introduced Tuesday would change that by expanding landmark legislation from 2008 that guaranteed nearly universal paid sick leave in the District but excluded tipped wait staff, including most servers, bussers and bartenders (Sadon, 9/16).

The Texas Tribune: Clinic Closures Spark Debate Over Access To Health Care
Athena Mason's first doctor’s visit as a student at Texas A&M University was a bit awkward…The Bryan clinic was one of two abortion and women’s health providers in Texas that closed last month. All of the closing clinics cited the state’s new abortion law — which makes Mason and Bryan resident Cadence King collateral damage from the new legislative restrictions (Philpott, 9/16).

California Healthline: Pharmacist Practice Bill Going To Governor
The California Assembly and Senate last week approved a bill that will allow advanced pharmacists to practice with a little more autonomy. SB 493 by Sen. Ed Hernandez (D-West Covina) is designed to address the ongoing access-to-care issue in California by allowing pharmacists to initiate certain kinds of prescriptions and to provide clinical advice and patient consultation. That additional input could help ease the workload for primary care providers, Hernandez said (Gorn, 9/16).

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Editorials and Opinions

Viewpoints: WSJ Says GOP 'Kamikaze' Defunding Mission Will Not Go Well; Taxing Medicare Benefits; Problems With Penn. State's Wellness Program

The Wall Street Journal: The Power Of 218
These critics [like Heritage Action and the Club for Growth] portrayed the Boehner plan as a sellout because of a campaign that captured the imagination of some conservatives this summer: Republicans must threaten to crash their Zeros into the aircraft carrier of ObamaCare. Their demand is that the House pair the "must pass" CR or the debt limit with defunding the health-care bill. Kamikaze missions rarely turn out well, least of all for the pilots. The problem is that Mr. Obama is never, ever going to unwind his signature legacy project of national health care. Ideology aside, it would end his Presidency politically. And if Republicans insist that any spending bill must defund ObamaCare, then a showdown is inevitable that shuts down much of the government. Republicans will claim that Democrats are the ones shutting it down to preserve ObamaCare. Voters may see it differently given the media's liberal sympathies and because the repeal-or-bust crowd provoked the confrontation (9/16). 

CNN: The Real Problems With Obamacare
Good news: We're not going to war in Syria, at least not right away. Bad news: We're headed to a battle inside Congress that will pose its own grave threat to the U.S. and world economy. The most conservative Republicans in Congress are threatening to force default on the nation's obligations unless the president agrees to defund Obamacare. Less conservative Republicans prefer a milder version of the threat: not default, but merely shutting down the government (David Frum, 9/16).  

The Washington Post: Virginia's Next Governor Will Determine Whether Most Abortion Clinics Close
Virginia Attorney General Ken Cuccinelli II (R) was instrumental in ensuring that new regulations will result in the closure of many of the state’s abortion clinics. Two of the busiest, in Northern Virginia and Norfolk, already have closed. If Mr. Cuccinelli is elected governor in November, most of the remaining 18 clinics are likely to shut their doors within months (9/16). 

The Kansas City Star: It's Time To See Obamacare In Action
It's here.  In two weeks the nation will take the first concrete steps in a long-delayed experiment to overhaul its health care system. On Oct. 1, the online exchanges where the uninsured can shop for insurance will open…But let’s now get to it. After all the yanking — the congressional fighting, the court decisions and the constant criticism over the individual mandate and more — let's all stand aside and see whether this thing will work (Keith Chrostowski, 9/16).

Bloomberg: Obamacare Doctor Rationing Begins In California
The latest bad news for the Affordable Care Act comes from California, a state that the Obama administration has consistently pointed to as an important indicator of the law’s success. President Barack Obama even traveled to the Golden State in June to tout the health-care law’s success at "pushing down costs" for consumers. Unfortunately, several analyses have recently revealed that because of Obamacare individual health insurance premiums are headed anywhere but down for California residents (Lanhee Chen, 9/16).

The New York Times' Economix: Taxing Medicare Benefits
In my continuing series on tax expenditures, this week I want to discuss another form of income that few people recognize as being "income" – the nontaxation of Medicare benefits. First, few people probably think of any government benefits as income in any sense of the term. But if one gets back benefits far in excess of what one pays into a program like Medicare, then one is receiving income (Bruce Bartlett, 9/17). 

USA Today: Increase Alzheimer's Research Funding
It's time we launched a serious war on Alzheimer's disease. Right now, we're pursuing a "national plan to address" Alzheimer's, passed by Congress two years ago. It's a timid plan, having produced a lot of bureaucratic boilerplate but only a paltry increase in federal funding for research into the insidious disease. It includes a goal of being able to prevent and treat Alzheimer's by 2025, but without the means to achieve that goal. Why is it so difficult to get the war launched? (Don Campbell, 9/16).

Journal of the American Medical Association: The 3-Night Hospital Stay and Medicare Coverage for Skilled Nursing Care
According to current Medicare coverage policies, Medicare requires a patient to have been a hospital inpatient for at least 3 consecutive days to receive coverage for rehabilitation in a skilled nursing facility (SNF) after hospital discharge. ... Although there is little empirical evidence that elimination of the 3-night stay rule will improve patient care without increasing Medicare costs, there is justifiable concern that this rule contributes to suboptimal care and increased costs attributable to avoidable hospitalizations. There is a critical need to update payments and policies that address conditions that cause avoidable hospitalizations (Lewis A. Lipsitz, 9/16).

JAMA Pediatrics: Pediatric Faculty Diversity
Academic pediatrics has not kept pace with the changing demographics in the United States population and the children and families we serve. By 2020, the majority of children and adolescents in the United States will come from ethnic minority backgrounds. We will have a new "majority minority" population, with Latino and Asian ethnicities contributing the largest proportion. This change in demographics is significant because health care disparities occur disproportionately in those who will soon make up the largest proportion of the US population. To date, pediatric organizations have not developed national strategies to respond specifically to the ethnic diversity in our pediatric population. Doing so is critical to ensuring excellence in our profession and our professional societies (Dr. Leslie R. Walker and Dr. F. Bruder Stapleton, 9/17).

Forbes: Key Question For Innovators Isn't Where Healthcare Is Going, But When It Will Get There
Almost everyone (across the political spectrum) seems to agree that a fundamental problem with our system is the fee-for-service (FFS) model, which creates perverse incentives and is driving up costs to dangerous levels. Most also believe that the solution will ultimately arrive in the form of a value-based care (VBC) system, where payments will derive in some way from the quality of care provided, rather than the volume. Leaving aside the non-trivial question of whether this is actually possible (i.e. is it realistic, or a fool's errand, to expect to assess outcomes and value at the level of granularity that likely would be required), the question on everyone’s mind is "when?" When will this shift from FFS to VBC occur? (David Shaywitz, 9/15).

Forbes: Why Every Small Employer Should Sign Up For Obamacare's SHOP Exchange
Currently, when employers purchase health insurance through insurance companies, most are required to pay part of the premium for the employee and the employee pays the rest. ... According to the Navigator manual, with the SHOP exchange, the employer does not have to contribute ANYTHING to the cost of the premium – they can pay anywhere between zero and 100% of the premium, and the employee pays the rest. You may be thinking, "Why would I go through the bother of signing my company up for the SHOP exchange if I am not going to pay any of the premium?" Pure and simple – the tax benefit for you and your employees (Carolyn McClanahan, 9/14). 

Fox News: Americans' Personal Data Must Be Kept Safe – Time To Delay Obamacare Exchanges
Just about every week Americans learn about another problem with ObamaCare. Employer mandate? Delayed. Small business health insurance market? Delayed. Automatic enrollment? That's right, delayed. Study after study and expert after expert has sounded the alarm on ObamaCare's failings and the monumental implementation challenges that go with it (Sen. Orrin Hatch, R-Utah, 9/17).

Politico: Why Accountable Health Care Works
A recent White House report suggests that 1963 was also the last time health care inflation rose as slowly as it is rising today. It’s premature to think this trend will continue, and few would doubt that the recession and other economic factors played a role. But there’s more at work here: As a recent paper from Harvard University researchers argues, the price slowdown preceded the recession, and the corresponding decline in spending was more dramatic than a mere drop in incomes would predict (Helen Darling and Susan Devore, 9/16).

Bloomberg: The Feel-Good Promise of Wellness Programs
It has been a tough couple of months for Pennsylvania State University’s new wellness program. ... Beginning this fall, in order to avoid a $100 monthly surcharge for their health insurance, all nonunionized employees will have to submit health-history information via the online database WebMD, complete an annual health exam, and participate in periodic biometric scans that include measurement of cholesterol, blood-sugar and blood-pressure levels, body mass, and waist circumference. ... The $100 a month penalty for noncompliance is more than double the average for such programs. The Affordable Care Act may spur more employers to adopt wellness programs with large penalties; it raises the legal limit on penalties that employers can charge for health-contingent wellness programs to 30 percent of total premium costs (Austin Frakt & Aaron Carroll, 9/16).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Marissa Evans
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.