Daily Health Policy Report

Wednesday, September 18, 2013

Last updated: Wed, Sep 18

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Coverage & Access

Health Reform

Administration News

Health Care Marketplace

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

FAQ: How Is Employer-Sponsored Health Insurance Changing?

Kaiser Health News staff writer Jay Hancock reports: "Employers are raising deductibles, giving workers health savings accounts that look like 401(k) plans, mimicking the health law's online insurance marketplaces and nudging patients to compare prices and shop around for treatments. Together the moves could eventually affect far more consumers than the law's Medicaid expansion or health exchanges aimed at the uninsured and scheduled to open Oct. 1. Here's a rundown" (Hancock, 9/17). Read the story.

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48 Million Americans Remain Uninsured, Census Bureau Reports

Kaiser Health News staff writer Phil Galewitz reports: "The rate of uninsured Americans dropped slightly for the second consecutive year in 2012, from 15.7 percent to 15.4 percent, largely a result of more people enrolling in Medicare and Medicaid, the U.S. Census Bureau reported Tuesday. The closely-watched report found that about 48 million Americans were uninsured in 2012, down from 48.6 million in 2011, a change the agency said is not statistically significant. The report is the last look at the uninsured before the major coverage expansions of President Barack Obama’s health law take effect in January" (Galewitz, 9/17). Read the story.

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Labor Dept. Mandates Minimum Wage, Overtime Pay For Home Health Workers

Reporting for Kaiser Health News, Susan Jaffe writes: "The U. S. Department of Labor issued new rules Tuesday that mandate home health care agencies pay their workers the minimum wage and receive overtime pay starting in 2015. 'Almost 2 million home care workers are doing critical work, providing services to people with disabilities and senior citizens who want to live in community settings and age in place in their familiar surroundings,' said Secretary of Labor Thomas Perez" (Jaffe, 9/17). Read the story.

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Health Plans Won’t be Able To Drop Individuals From Coverage (Video)

Kaiser Health News consumer columnist Michelle Andrews helps you navigate the new insurance marketplaces that are scheduled to launch on Oct. 1. Today Andrews answers a questions about whether an insurer can drop a consumer from coverage purchased on the exchange (9/18). Watch the video or watch other videos from this series.

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A Guide To The Lawsuits Challenging Obamacare's Contraception Coverage Requirements

Reporting for Kaiser Health News, Kelsey Miller writes: "Even with so much attention focused on the Oct. 1 launch of the health law's state insurance exchanges, one of the Affordable Care Act's most controversial elements is still percolating through the nation's legal system" (9/17). Read about some of the notable cases.

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Capsules: Sebelius Spends 3rd Day In Florida; Insurance Marketplace 101: Answering Consumer Questions; Attacking Raccoons Used In Washington State Insurance Ads

Now on Kaiser Health News' blog, The Miami Herald's Daniel Chang, working in partnership with KHN, writes about Health and Human Services Secretary Kathleen Sebelius' latest Florida visit: "As home to nearly four million residents with no health insurance and state legislators opposed to Obamacare, Florida holds a large stake in the outcome of federal healthcare reform, U.S. Health and Human Services Secretary Kathleen Sebelius told students, local health officials and politicians during a visit to Miami Dade College Tuesday" (Chang, 9/18).

In addition, The Seattle Times' Amy Snow Landa, working in partnership with KHN, reports on Washington state's health exchange ad: "The Washington Health Benefit Exchange has begun airing television commercials as part of a stepped-up campaign to promote the state's online insurance marketplace, which opens for enrollment Oct. 1. The new TV spots convey the sobering message that going without health insurance is 'playing with chance' and could lead to a bad outcome" (Landa, 9/18).  

Also on the blog, KHN's Mary Agnes Carey and Julie Appleby were hosted by the Washington Post’s Charity Brown yesterday for a live discussion with Post readers about how the new online marketplaces will work under the health law. A transcript of that discussion is posted (9/17). Check out what else is on the blog.

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Political Cartoon: 'Tangled Up With Blue?'

Kaiser Health News provides a fresh take on health policy developments with "Tangled Up With Blue?" by Steve Sack.

Here's today's health policy haiku:


Sunshine state focus...
just ask K. Sebelius.
She keeps going back.

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

CBO Issues Not-So-Rosy Long-Term Budget Outlook

In the short term, the federal deficit will fall. But, starting in 2016, as more baby boomers join the Medicare ranks, the deficits again will pick up. With this news in the backdrop, Treasury Secretary Jacob Lew warned Republican lawmakers of the dangers of risking a government default as part of their efforts  to derail the implementation of the health law.  

The New York Times: Budget Office Warns That Deficits Will Rise Again Because Cuts Are Misdirected
Annual federal deficits will continue to fall in the short term, the budget office reported in its yearly long-term outlook, because of the recent spending cuts in military and domestic programs and rising tax collections in a recovering economy. … But starting in 2016, deficits are projected to rise again as more baby boomers begin drawing from Medicare, Medicaid and Social Security — the fast-growing entitlement programs, which Democrats and Republicans cannot agree on how to rein in (Calmes, 9/17).

The Associated Press/Washington Post: Congressional Budget Office Study Warns Of Long-Term Debt Woes In United States
The government has never defaulted on its obligations and Treasury Secretary Jacob Lew warned Tuesday that Congress needs to act to increase the debt limit by mid-October but he warned Republicans that President Barack Obama will never go along with their demand to derail implementation of the new health care law as part of a measure to fund the government or increase the debt limit (9/17).

Los Angeles Times: Treasury's Lew Warns Congress It's Risky To Delay Raising Debt Limit
As the nation fast approaches its debt limit, Treasury Secretary Jacob J. Lew issued his strongest warning yet to Congress about the economic consequences of waiting until just before the deadline to pass an increase. … Republicans are balking at raising the $16.7-trillion debt limit, which Congress must do by as early as mid-October, unless the Obama administration agrees to major concessions including deep spending cuts and a delay in implementing the healthcare reform law (Puzzanghera, 9/17).

In other fiscal news -

The Wall Street Journal: Medical-Price Inflation Is At Slowest Pace In 50 Years
Medical prices are rising at their slowest pace in a half century, a shift in the health-care industry that could provide relief to government and businesses' budgets while also signaling consumers are being left with a larger share of the bill. The prices paid for medical care in July rose just 1 percent from a year earlier, the slowest annual rate of growth since the early 1960s, according to Commerce Department data. Health-care increases now trail overall inflation, which itself has been historically slow in recent years (Morath and Radnofsky, 9/17).

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House GOP Considers Attaching Defunding Provision To Stopgap Measure To Prevent Shutdown

A vote could take place next week, which adds to concerns about the likelihood of a government shutdown. Also in the news, some Republicans are floating alternative strategies to help avert this drastic outcome.

Los Angeles Times: Despite Shrinking U.S. Deficit, House GOP Eyes Government Shutdown
The federal deficit has shrunk to its lowest level since 2008, according to a report released Tuesday, but House Republicans will begin the next budget battle this week with a vote that threatens to shut down the federal government unless President Obama agrees to halt his healthcare law (Mascaro, 9/17).

Bloomberg: Republicans Weigh Defunding Health Law, Avoiding Shutdown
House Republican leaders are considering including a proposal to defund President Barack Obama's health-care law in a stopgap measure to finance the U.S. government, according to lawmakers and a congressional aide. Leaders will discuss a list of options at a meeting with House Republicans scheduled for tomorrow morning at the Capitol (Tiron, 9/17).

The Associated Press: AP Sources: A Revised GOP Attack On 'Obamacare'
Moving on to Plan B, House GOP leaders appear likely to give tea party lawmakers a chance to use a routine temporary government funding bill to try to muscle the Democratic-controlled Senate into derailing President Barack Obama's health care law. It's a strategy fraught with political risk for Republicans, who could find themselves bearing the blame for any partial government shutdown that results from an impasse with the Senate (Taylor, 9/18).

CNN: Obamacare, Spending Showdown Heats Up In House
House Republican leaders are considering a vote this week on a short-term spending bill to keep the government running and defund Obamacare, according to senior House GOP aides, a move that increases the possibility of a government shutdown. House Speaker John Boehner and other top House GOP leaders have been struggling to avoid a showdown over the health care law spearheaded by President Barack Obama and funding legislation that needs approval before the end of the fiscal year on September 30 to avoid a shutdown (Walsh, 9/17).

Some Republicans are developing alternative strategies -

Fox News: New GOP Strategy Looks At Delaying Obamacare
Faced with a politically risky push by some Republicans to defund ObamaCare, other party members are turning to an alternative strategy: delay it instead. Republicans are divided on how to confront the Affordable Care Act. Some, such as Sens. Ted Cruz of Texas and Mike Lee of Utah, are pushing to permanently defund it. But attaching such a measure to a resolution that funds the government after Oct. 1 runs the risk of a government shutdown if it doesn't pass. If that happens, Republicans fear they would be blamed (Angle, 9/18).

The Associated Press/Washington Post: House Conservatives Unveiling Alternative To 'Obamacare' With Bigger Tax Break For Consumers
A large group of House conservatives intends to unveil legislation providing an expanded tax break for consumers who purchase their own health coverage and increasing the government funding for high-risk pools, according to lawmakers who said the plan marked the Republicans' first comprehensive alternative to President Barack Obama’s health care overhaul (9/18).

CBS News: Ahead Of Major Obamacare Rollout, Politicking Continues
Three years after the passage of the Affordable Care Act -- and two weeks away from the rollout of a key portion of the law -- politicians on Capitol Hill are still debating Obamacare alternatives and amendments and using the law as a campaign issue. The conservative Republican Study Committee on Wednesday is unveiling a bill designed to repeal and replace Obamacare, called the American Health Care Reform Act. The committee has been working on the legislation for months, and they're announcing it just as Republicans have ratcheted up conversation about dismantling Obamacare as part of ongoing budget discussions (Condon, 9/18).

Meanwhile, there are other squabbles shaping up in regard to the health law -

Politico: GOP Vs. GOP In Hill Obamacare Squabble
A new GOP vs. GOP battle is brewing over Obamacare — this time, over health care coverage for lawmakers and their staff. A growing number of Republicans are scoffing at Louisiana Sen. David Vitter’s push to stop federal contributions that will help pay for health coverage for lawmakers and their staff under the new Obamacare exchanges. Vitter’s crusade has effectively put his GOP colleagues in the unenviable position of hurting themselves and their staff financially or siding with another political attack on a law the party universally despises (Raju and Haberkorn, 9/18).

And, when it comes to campaign trail politics, Senate Minority Leader Mitch McConnell is still in the hot seat -

The Hill: McConnell Punts On Shutdown Solution
Senate Minority Leader Mitch McConnell (R-Ky.) on Tuesday declined to take sides in the squabble among House Republicans over a government shutdown. Speaker John Boehner (R-Ohio) has tried to convince his colleagues to support legislation that would keep the government open after Oct. 1 while forcing the Senate to vote on defunding ObamaCare (Wasson, 9/17).

Politico: Mitch McConnell Gets Support On Obamacare
An outside group boosting Senate Minority Leader Mitch McConnell is preparing to go up with TV ads lauding him for his opposition to the Affordable Care Act, POLITICO has learned. The nonprofit Kentucky Opportunity Coalition plans to spend $325,000 on a week’s worth of commercials running statewide, a strategist told POLITICO (Burns, 9/17).

The Washington Post: Boehner Agonistes (Again)
But the political right has applied serious pressure on [Speaker John Boehner] to use the negotiations to try to defund Obamacare. ... But by passing a bill that defunds Obamcare, House leaders would shift pressure to the Democratic-controlled Senate to either 1) Follow suit or 2) Demonstrate once and for all that it simply will not pass a bill that defunds Obamacare. "This puts the pressure on McConnell now," said one Republican working on the Defund Obamacare movement who spoke on the condition of anonymity to offer a candid assessment. "This whole effort started in the Senate with [Sen.] Mike Lee, so now that Boehner is going to allow the vote to happen, presuming he does, McConnell will have to decide whether to fish or cut bait. I think he'll fish" (Sullivan and Blake, 9/18).

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Coverage & Access

Percentage Of Americans Without Health Coverage Drops For 2nd Year

The small decline was credited mainly to somewhat higher enrollments in Medicare and Medicaid, as well as the Children's Health Insurance Program.

The New York Times: Percentage of Americans Lacking Health Coverage Falls Again
For the second year in a row, the proportion of Americans without health insurance declined in 2012, even though real household income and the poverty rate were not significantly different from their 2011 levels, the Census Bureau reported on Tuesday (Pear, 9/17).

Los Angeles Times: U.S. Poverty Rate Holds Steady Near A Generational High
The bureau's annual report on income, poverty and health insurance suggests that the economic wounds from the Great Recession are patched up but the economy still is struggling to return to full health. In one respect, the data released Tuesday could be seen as positive because things seemed to stabilize after the devastating recession. For the first time in five years, household income did not decrease and the poverty level did not increase last year, officials said. And there was further improvement in the healthcare coverage of Americans, an important indicator of economic security (Lee, 9/17).

The Washington Post: Household Income, Poverty Rate Are Flat For First Time Since Recession, Census Shows
If there was one bright spot in the census statistics, it was that about 400,000 more children had health insurance last year than in the previous year. Caroline Fichtenberg, director of research for the Children’s Defense Fund, said that was largely because of the success of the Children’s Health Insurance Program, which provides health coverage to children from families with incomes too high to qualify for Medicaid coverage. The census report said 3 million more people had health insurance in 2012, with the increase coming mostly from people with government health insurance, particularly Medicare. Eight in 10 Americans have health coverage, and more than half get it under employer-provided plans (Morello, 9/17).

Politico: Share Of U.S. Uninsured Falls, Census Data Show
The percentage of Americans without health insurance dipped slightly from 15.7 percent to 15.4 percent, mainly due to somewhat higher enrollments in Medicare and Medicaid, according to 2011-12 U.S. Census Bureau numbers released Tuesday. The rate of private health insurance held steady for the second year in a row after steadily eroding over the past decade (Norman, 9/18).

Kaiser Health News: 48 Million Americans Remain Uninsured, Census Bureau Reports
The rate of uninsured Americans dropped slightly for the second consecutive year in 2012, from 15.7 percent to 15.4 percent, largely a result of more people enrolling in Medicare and Medicaid, the U.S. Census Bureau reported Tuesday.The closely-watched report found that about 48 million Americans were uninsured in 2012, down from 48.6 million in 2011, a change the agency said is not statistically significant. The report is the last look at the uninsured before the major coverage expansions of President Barack Obama's health law take effect in January (Galewitz, 9/17).

Stateline: Drop In Uninsured, Growth In Medicaid
On the eve of the federal health law’s launch date, a new report from the U.S. Census Bureau shows a small decline in the number of people who lack health insurance and an increase in the number insured by public programs, including Medicaid and Medicare. Overall, the percentage of people without health insurance declined to 15.4 percent in 2012 from 15.7 percent the year before, while the total number of uninsured people fell to 48 million from 48.6 million in 2011 (Vestal, 9/17).

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Health Reform

Marketplace Enrollment Efforts Set To Move To Center Stage

Reuters examines whether there will be a sign-up surge, while other outlets look at efforts to prepare for the opening of the online insurance marketplaces next month.

Reuters: Obamacare Customers May Show Up In Fits And Starts
Will Obamacare's launch look more like Black Friday, when U.S. shoppers flood retail stores for bargains the day after Thanksgiving, or April 15, when procrastinators wait until nearly midnight to file their taxes? Officials involved in implementing President Barack Obama's healthcare law, academics who study health insurance and benefits experts interviewed by Reuters expect a little of both, with a graph of enrollment timing to be shaped like a lopsided W (Begley, 9/17).

ABC News: 5 Things To Know About The Healthcare Insurance Exchanges
One of the largest components of Obama's healthcare overhaul will go into effect in just a couple of weeks. But according to a recent Pew Research Center/USA Today survey, just a quarter of those surveyed have a very good understanding of how the law will impact them. People will be able to purchase health insurance through "exchanges" -- some of them run by the federal government, others by the states, and still others by a federal-state partnership. The law requires uninsured people to get insurance, but the survey found that uninsured people were actually the least likely to know that. That's especially true when it comes to young people. Here are five things everyone should know about the healthcare insurance exchanges (Deruy, 9/16).

Georgia Health News: Top Questions (And Answers) About The Exchange
Just two weeks remain until the opening of enrollment in the health insurance exchanges, a key component of the Affordable Care Act. Much misinformation and confusion has accompanied the run-up to the Oct. 1 start of open enrollment in the exchange, also called a marketplace. To help our readers understand this new coverage option, Georgia Health News asked the Centers for Medicare and Medicaid Services for a list of frequently asked questions about the health insurance exchanges. Here is the agency’s list of FAQs – and their answers (Miller, 9/17).

The Washington Post: Maryland Reveals Prices For Small-Business Plans On New Health Insurance Exchange
Maryland insurance officials have approved premium rates for plans to be sold on the state's small-business health insurance marketplace, which will open at the start of next year, according to an announcement Tuesday (Harrison, 9/17).

The Baltimore Sun: Maryland Approves Premiums For Small-Business Insurance Exchange
Small businesses buying health coverage for their employees through a new state insurance marketplace could pay anywhere from 5 percent less to 15 percent more in premiums next year under rates Maryland regulators approved Tuesday. The Maryland Insurance Administration approved rates that were as much as 17 percent lower and up to 9 percent higher than what 13 carriers, many of them multiple subsidiaries of the same owner, had proposed for sale on Maryland Health Connection (Dance, 9/17).

St. Louis Beacon: Dueling Town Halls For And Against Obamacare Illustrate The PR Battle Now Underway
More than 600 people packed the auditorium Tuesday night at Maryville University to hear Missouri House Speaker Tim Jones and other speakers lay out, in general, their opposition to Obamacare and their frustration that the federal health insurance changes have yet to be killed. ... A few miles away, another Affordable Care Act question-answer session was held staffed by volunteers with Organizing for Action, a pro-Obama group that’s trying to get a positive spin out to the public. Fewer than two dozen people attended (Mannies, 9/18).

North Carolina Health News: Efforts To Educate Public About Affordable Care Act Gear Up
Enroll America’s newly hired state director, Sorian Schmidt, said her organization is focusing on talking about the health insurance marketplaces. "Our research is that 78 percent of the uninsured don't know what's coming with health reform and the new marketplaces," Schmidt said. "They don't know how they'll interact with them." Schmidt's organization is part of a national effort to inform people about the changes that are coming associated with implementation of the Affordable Care Act (known as Obamacare) that gets more fully underway this fall (Hoban, 9/17).

The Hill: ObamaCare Activists Say Outreach Working
Groups working to promote ObamaCare said their efforts are making headway despite polls showing the public still in the dark about healthcare reform.  Enroll America President Anne Filipic said her group has seen a drop in confusion about the law both in surveys and on the ground since the end of last year (Viebeck, 9/17).

And in Medicaid expansion news -  

The Washington Post: Most States With Few Insured Citizens Aren't Expanding Medicaid Under Obamacare
States whose citizens are most likely to be uninsured are also more likely than not to refuse extra aid under the president's health-care law. Six of the 10 states with the lowest rates of coverage have no plans to expand low-income aid under Obamacare, according to an analysis of new Census data. Meanwhile, eight of the 10 states with the highest rates plan to allow the expansion (Chokshi, 9/17).

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Putting The Health Law Puzzle Pieces Together, And Making Sense Of It

News organizations help make sense of all the different moving parts of the health law -- attitudes, concerns, lawsuits and business decisions -- as the nation gears up for Oct. 1's launch of the health insurance exchanges.

Philly.com: Sorting Out Obamacare Facts From Fiction
We've been batting down bogus claims about the Affordable Care Act for years, since 2009, when legislation was still in the debate stage. But they've been increasing in intensity in recent months as we approach Oct. 1, the date the insurance exchanges will be open for business for those buying their own insurance, mainly with the help of federal subsidies. So, more than three years after our last health-care-whoppers piece (published just before the law was signed in 2010), we’re giving readers a rundown of the top claims (Robertson, 9/17).

Minnesota Public Radio: 'Obamacare' Or 'Affordable Care Act'?
What's in a name? Everything when it comes to polling about the health care law, officially known as the Affordable Care Act. In a new Fox News poll, 55 percent of those surveyed held an unfavorable view of the new law when the pollster referred to it as the Affordable Care Act. But when the name was replaced by "Obamacare," the negative opinion increased to 60 percent. Seventy-five percent of Republicans viewed the Affordable Care Act unfavorably -- that jumped to 83 percent when "Obamacare" was used (Collins, 9/17).

The New York Times: Concern Over Drug Costs
Among the most troubling questions facing consumers as they shop for insurance under the Obama administration's new health care law is whether the plans will cover the drugs they take -- and how much they will have to pay for them. But with less than two weeks remaining until enrollment opens on Oct. 1, the answers are still elusive and anxiety is growing for consumers whose well-being depends on expensive medications (Thomas, 9/17).

Kaiser Health News: A Guide To The Lawsuits Challenging Obamacare's Contraception Coverage Requirements
Even with so much attention focused on the Oct. 1 launch of the health law's state insurance exchanges, one of the Affordable Care Act's most controversial elements is still percolating through the nation's legal system (9/17).

The New York Times: Reaping Profit After Assisting On Health Law
Washington’s health care revolving door is spinning fast as the new online health insurance marketplaces, a central provision of President Obama’s health care law, are set to open Oct. 1. Those who had a hand in the law’s passage are now finding lucrative work in the private sector, as businesses try to understand the complex measure, reshape it by pressing for regulatory changes -- or profit from it (Stolberg, 9/17).

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Florida Battles Over Obamacare Intensify

Secretary of Health and Human Services Kathleen Sebelius made her third trip to Florida in a week to tout the health law, while state officials are taking steps to stymie enrollment in the new online insurance exchanges which open in two weeks. 

The New York Times: Florida Among States Undercutting Health Care Enrollment
As many states prepare to introduce a linchpin of the 2010 health care law — the insurance exchanges designed to make health care more affordable — a handful of others are taking the opposite tack: They are complicating enrollment efforts and limiting information about the new program (Alvarez and Pear, 9/17).

NPR: Agreeing On Health Care In The Sunshine State Isn't So Sunny
At a community center named for Florida civil rights pioneer Carrie Meek, a few dozen members of Miami's National Church of God gathered over the weekend for a tea party—and to hear from a special guest, Monica Rodriguez of Enroll for America. The organization is working to spread the word about the Affordable Care Act, the federal law that will let people without health insurance shop for coverage starting October 1 (Allen, 9/18).

Kaiser Health News: Capsules: Sebelius Makes Third Visit To Florida In A Week
As home to nearly four million residents with no health insurance and state legislators opposed to Obamacare, Florida holds a large stake in the outcome of federal healthcare reform, U.S. Health and Human Services Secretary Kathleen Sebelius told students, local health officials and politicians during a visit to Miami Dade College Tuesday (Chang, 9/18).

The Associated Press: Sebelius Makes Fla. Stops To Tout Health Care Law
The Obama administration's top health official made her third visit to Florida on Tuesday and discussed the large number of uninsured Hispanics who will benefit from coverage under the new health law. It was part of an effort to counteract Republican Gov. Rick Scott's opposition to the Affordable Care Act (Kennedy, 9/17).

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Obamacare Navigators Caught In Debate Over Data Security

As Republican congressmen demand more safeguards to ensure thieves don't impersonate government-funded navigators to steal consumer information, the Obama administration plans a high-level effort to reassure people that their data are safe. 

The Wall Street Journal: Health-Law Navigators Blasted In Republican Report
More safeguards are needed to ensure thieves don't impersonate government-funded "navigators" and nab financial details from people trying to sign up for health insurance, according to a report from Republican House investigators. The report raised concerns that official navigators, who get federal funding under the 2010 health law, won't have government IDs or other documentation to prove they are authorized to help enroll people for health insurance (Schatz, 9/18).

The Associated Press: White House Pushing Health Care Security Measures
Attorney General Eric Holder, Health and Human Services Secretary Kathleen Sebelius, Federal Trade Commission chairwoman Edith Ramirez and other federal and state officials are set to meet Wednesday at the White House to discuss security measures designed to keep scammers and identity thieves from taking advantage of what could be millions of Americans attempting to enroll for health coverage under the Affordable Care Act starting in October (9/18).

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Administration News

Labor Dept. Mandates OT Pay, Minimum Wage For Home Health Workers

The Obama administration approved new rules that beginning Jan. 1, 2015, extend minimum wage and overtime payment to nearly 2 million home healthcare workers. Many in the mostly female and minority workforce are paid more than federal minimum wage, now $7.25 an hour, but don't get time-and-a-half when they work more than 40 hours a week. 

The New York Times: U.S. To Include Home Care Aides In Wage And Overtime Law
Advocates for low-wage workers have pushed for this change, asserting that home care workers, who care for elderly and disabled Americans, were wrongly classified into the same “companionship services” category as baby sitters — a group that is exempt from minimum wage and overtime coverage. Under the new rule, home care aides, unlike baby sitters, would be covered under the Fair Labor Standards Act, the nation’s main wage and hour law (Greenhouse, 9/17).

The Associated Press/Washington Post: Home Health Care Workers Could See Higher Wages Under New Rules Extending Minimum Wage, OT Pay
The Obama administration approved new rules Tuesday that extend minimum wage and overtime pay to nearly 2 million home health care workers who help the elderly and disabled with everyday tasks such as bathing, eating or taking medicine (9/17).

The Wall Street Journal: Labor Department Adds Protections for Home-Health-Care Workers
The Labor Department's new rule will take effect on Jan. 1, 2015. Many home-health workers already are paid more than the federal minimum wage—currently $7.25 an hour—but don't get paid time-and-a-half when they work more than 40 hours a week. Many have no health-care coverage themselves, the Labor Department said (Trottman and Maher, 9/18).

Kaiser Health News: Labor Dept. Mandates Minimum Wage, Overtime Pay For Home Health Workers
The U. S. Department of Labor issued new rules Tuesday that mandate home health care agencies pay their workers the minimum wage and receive overtime pay starting in 2015. "Almost 2 million home care workers are doing critical work, providing services to people with disabilities and senior citizens who want to live in community settings and age in place in their familiar surroundings," said Secretary of Labor Thomas Perez (Jaffe, 9/17).

Bloomberg: Obama Extends Minimum Wage To 2 Million Home Health Aides
Overturning a decades-old exemption, the U.S. Department of Labor has extended minimum wage and overtime benefits to the mostly female and minority workforce of nearly 2 million home health-care workers. The Fair Labor Standards Act will be extended to direct care workers, U.S. Secretary of Labor Thomas Perez said Tuesday on a conference call with reporters (Efstathiou, 9/18).

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Health Care Marketplace

Walgreens To Put Workers Into Private Health Insurance Exchanges

The move is part of trend among businesses to shift coverage responsibilities to their employees.

Kaiser Health News: FAQ: How Is Employer-Sponsored Health Insurance Changing?
Employers are raising deductibles, giving workers health savings accounts that look like 401(k) plans, mimicking the health law’s online insurance marketplaces and nudging patients to compare prices and shop around for treatments. Together the moves could eventually affect far more consumers than the law's Medicaid expansion or health exchanges aimed at the uninsured and scheduled to open Oct. 1. Here’s a rundown (Hancock, 9/17).

The Wall Street Journal: Walgreen To Give Workers Payments To Buy Health Plans
Rising health-care costs and a climate of change brought about by the new federal health law are prompting American corporations to revisit the pact they've long had with employees over medical benefits. ... On Wednesday, the drugstore giant i[Walgreen Co.] s expected to disclose a plan to provide payments to eligible employees for the subsidized purchase of insurance starting in 2014. The plan will affect roughly 160,000 employees, and will require them to shop for coverage on a private health-insurance marketplace (Martin and Weaver, 9/17).

Bloomberg: Walgreen Joins In Exodus Of Workers To Private Exchanges
Walgreen’s decision ... follows similar action this year by Sears Holdings Corp. and Darden Restaurants Inc.  As an alternative to administering a traditional health plan, all three will send their employees to an exchange run by Aon Plc. ... The insurance options offered by the private exchange are similar to those in the Affordable Care Act’s public exchanges, though workers will get their subsidies from their companies instead of the government, said Ken Sperling of Aon (Armstrong, 9/17).

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State Watch

Wide Variation Among States In Access To Care, Coverage For Poor

State with high-performing health care systems are more likely to have poorer residents get heatlh coverage and preventive care, a new study finds.

Los Angeles Times: Access To Health Care For The Poor Varies Widely Among States
Access to affordable, quality health care for poor Americans varies dramatically among the states, according to a new study that found a wide disparity in measures of health between states with the best health care systems and those with the worst. In the highest-performing states, low-income, less educated residents are more likely to be covered by health insurance, to have a regular source of medical care and to get recommended preventive care, such as cancer screenings (Levey, 9/17).

USA Today: Study: State's Poor Health Care Affects All Income Levels
High-income people who live in states that generally do poorly in health care are worse off than low-income people in states with high health care scores, according to a Commonwealth Fund study released today (Kennedy, 9/18).

Dallas Morning News: Texans Lag In Health Care Access And Quality, Regardless Of Income, Study Finds
Whether they have a good income or a lower one, Texans lag behind much of the nation in access to and quality of health care. A study released Wednesday by a private foundation in New York found that Texans making more than $46,000 a year are about as likely to have a regular doctor as are residents of Vermont, Maine and Wisconsin who make less than $23,000. About 1 in 3 Texas Medicare patients is prescribed medications not recommended for the elderly because they can cause dizziness or falling, the report says. In Massachusetts, New York and Minnesota, it’s more like 1 in 5 (Landers, 9/18).

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State Highlights: Miss. Officials Want More Money For Mental Health, Medicaid

A selection of health policy stories from Mississippi, Massachusetts, Oklahoma and California.

The Associated Press: Mississippi Prisons, Mental Health, Medicaid Seek More Money
Mississippi's prison and mental health systems and Medicaid program are seeking millions of extra dollars to get through the budget year, then more money on top of that for the coming year. Agency leaders appeared Tuesday before the Joint Legislative Budget Committee to request money for fiscal year 2014, which ends June 30, and for fiscal 2015, which begins July 1 (9/17).

The Associated Press: Mary Fallin Blocks Same-Sex Benefits
Oklahoma Gov. Mary Fallin has ordered the National Guard to stop processing requests for military benefits for same-sex couples, her office confirmed Tuesday, despite a Pentagon directive to do so. Fallin spokesman Alex Weintz said the governor was following the wish of Oklahoma voters, who approved a constitutional amendment in 2004 that prohibits giving benefits of marriage to gay couples (9/17).

The Associated Press: Survey: Mass. Primary Care Docs In Short Supply
The state is experiencing a critical shortage of primary care physicians and stark geographical differences in the recruitment and retention of doctors, a new report says. On a more positive note, the annual Physician Workforce Study, set for release by the Massachusetts Medical Society on Wednesday, also found a growing number of doctors willing to embrace cost-saving techniques such as accountable-care organizations and global payments (Salsberg, 9/17).

Medpage Today: ED Use Could Surge Under ACA, Study Suggests
Increases in California emergency department (ED) use were driven in large part by Medicaid patients, presaging increased burdens after the Affordable Care Act kicks in completely, researchers found. From 2005 to 2010, the number of visits to California emergency departments rose by 13.2 percent from 5.4 million to 6.1 million annually, with a significant 35 percent increase in the number of patients insured through Medi-Cal (as Medicaid is known in California) driving this rise, according to Renee Hsia, MD, MSc, of the University of California San Francisco, and colleagues (Petrochko, 9/17).

California Healthline: Ruling's Effect On Autism Coverage
The Second District Court of Appeal in Los Angeles last week ruled that the Department of Managed Health Care cannot use licensure as a basis for denial of a type of autism treatment to state employees. The ruling means better access for patients to applied behavior analysis (ABA) therapy, according to Jamie Court, president of Consumer Watchdog, the consumer advocacy group that brought the lawsuit. … Court said the state previously had a policy of allowing denial of ABA therapy because of a lack of licensing -- though health plans, he said, weren't actually denying it (Gorn, 9/17).

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Editorials and Opinions

Viewpoints: Deep Flaws In Current Health System Often Overlooked In Obamacare Debate; 'Missouri Bleeds Jobs' While Neighbors Expand Medicaid; Budget Debate Is Best Shot At Stopping Health Law

USA Today: Blame Obamacare Confusion On Old System
Americans have had little understanding of the Affordable Care Act since it became law in 2010. With major provisions taking effect in January, half the country still does not know what the law does or what it means for them. While some of the confusion is no doubt due to the law's complexity and the highly charged political environment, a largely ignored but central factor is that people know little about the deeply flawed health insurance system that got us to this place (John Seffrin and Jim Guest, 9/17).

The New York Times' Taking Note: What's More Unpopular Than Health Care Reform?
A new Pew Research Center / USA Today poll indicates that Americans still haven't embraced the Affordable Care Act, President Obama's signature domestic policy measure. Fifty-three percent disapprove of the law, while 42 percent approve. That's a decline in the level of support since last July, when, in the wake of the Supreme Court decision upholding the law, 43 percent disapproved and 47 percent approved. The big caveat here is that most Americans still don't understand what the law does. ... The other caveat is that, although a majority disapproves of the Affordable Care Act, few Americans support Republican attempts to mess it up (Juliet Lapidos, 9/17).

The New York Times' Taking Note: This Debt Ceiling Fight Isn't About Spending
[Republicans are] not talking about the debt. If they were, the House and Senate might have something to negotiate over. Up to now, the House has refused to even sit at the same table as the Senate and discuss ways to reduce the long-term debt (one of which, obviously, would be higher revenues). No, House conservatives are narrowly focused on achieving one impossible thing: the end of health care reform (David Firestone, 9/17).

Los Angeles Times: The Case For Obamacare, Courtesy Of The Three Stooges
Taking a risk involves making a choice. People don't choose to have preexisting conditions. Parents don't choose to leave their children without a safety net such as health insurance. Beginning in a couple of weeks, people can choose something: They can choose to buy health insurance under the Affordable Care Act -- Obamacare, to put another president's name on it. Obamacare is a long way from charity. It's a commercial transaction. And it's in society's enlightened self-interest that people be as healthy as they can for as long as they can, that we all spend a little on prevention to save all of us the massive cost of heroic medical intervention. It means those who once couldn't afford basic doctor checkups now can keep little health problems from turning into enormously complex and expensive ones (Patt Morrison, 9/17).

The Washington Post: Mental Health Coverage To Get A Big Boost Under Obamacare
When my brother, who had severe epilepsy, died of a massive seizure at 32, I needed to see a grief counselor. I had been his primary caretaker, and his death hit me hard. I was fortunate to have access to workplace insurance that included quality mental-health services. It's a benefit I have come to really appreciate. But many people don't have access to such care (Michelle Singletary, 9/17).  

St. Louis Post-Dispatch: Border States Expanding Medicaid While Missouri Bleeds Jobs
As of Monday, 26 states -- one more than half the states in the nation -- are pursuing Medicaid expansion. Missouri, of course, is not yet one of them. ... most Missouri Republicans are so caught up in their jihad against Obamacare that they can't find a way to put the state's best interest above their own narrow political futures. Meanwhile, those neighboring states that get mentioned every time Republicans are worried about jobs hopping across state lines, are pursuing Medicaid expansion to the benefit of both their economies and the health and welfare of their working poor (9/18).

San Jose Mercury News: Expanding Medicaid: A Foolish Way To Improve Health Care Access
Expansion of Medicaid -- the jointly run federal-state health plan for low-income Americans -- has long been an essential element of progressives' vision for health care "reform." But it won't work. Medicaid already suffers from serious problems, including perpetual cost overruns, doctors who increasingly refuse to accept patients covered by the program, and low quality of care. Expanding Medicaid will only exacerbate these issues -- while doing little to improve the health of the people it covers (Sally C. Pipes, 9/17).

Forbes: Will Health Insurance In The World Of Obamacare Be Affordable? It Depends Whom You Ask
There have been a lot of competing headlines lately about whether the Affordable Care Act (ACA) will actually make health insurance premiums more or less affordable for consumers. It's easy to see why the general public might be confused: we simply don’t know yet (S. Lawrence Kocot, 9/14).

The Fiscal Times: Will Subsidies And Co-Ops Save Obamacare?
For some new policyholders signing up for health plans through the new Affordable Care Act exchanges, subsidies could be the hidden carrot that will bring in millions of buyers. According to a new report by the Department of Health and Human Services, nearly 6.4 million low-income Americans will be eligible to pay $100 or less per month. The lower premiums would be primarily available on "silver" plans, which offer a basic level of services and are the second-lowest cost policies available. Families earning up to 400 percent of federal poverty guidelines -- $94,200 for a family of four -- will qualify for the tax breaks (John Wasik, 9/18).

Fox News: The Best Shot At Defeating Obamacare
Grassroots conservatives who want to stop Obamacare are making their voices heard. There is evidence that their elected representatives are starting to listen, and it is good. When Congress left Washington for its August recess, the voices demanding action to prevent American taxpayers from paying for Obamacare – described by its chief Senate author, Democrat Senator Max Baucus as a 'train wreck' – were faint and few. Senator Mike Lee drafted a letter calling on the Senate to fund everything in the upcoming Continuing Resolution (CR), except ObamaCare (Jenny Beth Martin, L. Brent Bozell III, 9/17).

The Arizona Republic: Medicaid Expansion Good, Unconstitutional
I am in a strange position regarding the Goldwater Institute's legal challenge to the expansion of Arizona's Medicaid program. On the one hand, I believe the expansion is in the best fiscal interests of the state. On the other, I think the institute is right that the Legislature enacted it unconstitutionally. Believe it or not, there are reasons for the institute to legally challenge the expansion other than a hatred of poor people. For fiscal conservatives, there's a vital principle at stake (Robert Robb, 9/17). 

The New York Times: The Antibiotic Resistance Crisis
The overuse of antibiotics in medicine and agriculture has long been known to foster the emergence of germs that are resistant to drugs. On Monday, the Centers for Disease Control and Prevention issued the first solid numbers on the extent of the problem. It said that at least two million Americans fall ill from antibiotic-resistant infections each year, of whom at least 23,000 die from the infections, a very conservative estimate (9/17). 

Los Angeles Times: Hospital Stays: When Less Medicine Is More
This year, 36.6 million people will be admitted to U.S. hospitals. Each patient will stay an average of 4.8 days, and the cost for all those hospitalizations will reach into the billions. Is all that time spent in hospitals good for patients? (Glenn D. Braunstein, 9/18).

Los Angeles Times: Federal Debt Still A Problem, But So Is Poverty
If you're a lawmaker focused like a laser beam on the deficit, the CBO report might make you all the more determined to keep the annual sequester cuts in place while pushing harder for changes to Medicare, Medicaid, the Affordable Care Act (a.k.a. Obamacare) and other federal healthcare entitlements. … The other report came from the Census Bureau, which looked at income, poverty and health coverage in 2012. It provided a statistical picture of what it's meant to be stuck in a weak economy: stagnant wages, sustained high poverty rates, growing income inequality and an increasing number of Americans depending on the government for their health insurance (Jon Healey, 9/17). 

Bloomberg: The Practical Way to Fight Childhood Obesity
Although childhood obesity in the U.S. is a stubbornly difficult problem, some progress is being made. And the new organizations fighting obesity offer larger lessons for national policy (Peter Orszag, 9/17). 

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Andrew Villegas

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Shefali Luthra

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