Daily Health Policy Report

Thursday, September 19, 2013

Last updated: Thu, Sep 19

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Health Reform

Administration News

Health Care Marketplace

Public Health & Education

Coverage & Access

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Health Spending Over The Coming Decade Expected To Exceed Economic Growth

Kaiser Health News staff writer Jordan Rau reports: "The nation’s total health spending will bump up next year as the health law expands insurance coverage to more Americans, and then will grow by an average of 6.2 percent a year over the next decade, according to projections released Wednesday by government actuaries. That estimate is lower than typical annual increases before the recession hit. Still, the actuaries forecast that in a decade, the health care segment of the nation's economy will be larger than it is today, amounting to a fifth of the gross domestic product in 2022" (Rau, 9/18). Read the story.  

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White House Pushes Back Against Fraud Fears By Obamacare Opponents

Kaiser Health News staff writer Phil Galewitz reports: "The White House on Wednesday unveiled several steps to protect consumers from fraud in the new online health insurance marketplaces, a move that comes after 17 states hostile to the law acted to limit the spread of information about the program, and congressional Republicans raised concerns about the privacy of medical and financial records. 'We are sending a clear message that we will not tolerate anyone seeking to defraud consumers in the health insurance marketplace,' said Health and Human Services Secretary Kathleen Sebelius" (Galewitz, 9/18). Read the story.

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Different Types Of Marketplace Plans Expected To Be Available (Video)

Kaiser Health News columnist Michelle Andrews helps you navigate the new insurance marketplaces that are scheduled to launch on Oct. 1. Today she answers a questions about the plan choices that will be available on the exchanges (9/19). Watch the video or watch others from the series.

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Many Cancer Patients Overtreated In Final Days

The Philadelphia Inquirer's Stacy Burling, working in partnership with Kaiser Health News, reports: "While most older people say they don't want aggressive care at the end of life, many get it anyway. Care in the last month of life for Medicare patients with advanced cancer typically is even more aggressive in the Philadelphia area than in the nation as a whole, concludes a report from the Dartmouth Atlas of Health Care, which studies regional differences in care. It released a report last week that showed the percentage of cancer patients who died in hospitals in 2010, or were hospitalized or in an intensive care unit in their last month" (Burling, 9/18). Read the story.


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Political Cartoon: 'Sinking Feeling?'

Kaiser Health News provides a fresh take on health policy developments with "Sinking Feeling?" by John Deering.  

Here's today's health policy haiku:


GOP tough talk
does not just target Dems, but 
health law, each other.

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

House To Vote Friday On Bill Tying Govt. Funding To Repeal Effort

News outlets report that the decision by the House GOP leadership to link the two efforts increases the likelihood of a government shutdown.

The Associated Press/Washington Post: House To Vote On Stopgap Funding Bill That Seeks To Derail President’s Health Care Law
The GOP-controlled House is cruising toward a vote to gut President Barack Obama's health care plan as part of a temporary funding bill to prevent a partial government shutdown on Oct. 1. While raising the possibility of a government closure, the latest GOP plan is actually aimed at avoiding one. GOP leaders are looking to shift the fight over health care to even more important legislation required to prevent the government from defaulting on its financial obligations (9/19).

The Wall Street Journal: House GOP Ties Government Funding To Health Law
House Republicans said Wednesday that stripping funding from the health-care law championed by President Barack Obama would be their price for keeping federal agencies open after the end of this month, a move that sharply increases the risk of a partial government shutdown in two weeks. GOP leaders said the House would vote Friday on a bill to fund federal agencies for the first 2 1/2 months of the fiscal year, which starts Oct. 1, but strip all health-law funding (Hook and Peterson, 9/18).

Los Angeles Times: 'This Is The Line In The Sand,' House Republicans Say
House Republicans united Wednesday around a plan to use the threat of a government shutdown as leverage to repeal President Obama's healthcare law, confident the American people are on their side. House Speaker John A. Boehner (R-Ohio) yielded to his right flank by agreeing to attach the healthcare law repeal to a must-pass bill to keep the government funded past Sept. 30. A vote is expected Friday on a bill that would allow the government to stay open for the next few months (Mascaro, 9/18).

Politico: Shutdown Over Obamacare Won’t Stop Obamacare
The fights over Obamacare could shut down the government next month. But shutting down the government wouldn't necessarily shut down Obamacare. The shutdown date — Oct. 1 — is also the first day people can start signing up in the new health insurance exchanges. Many Republicans, particularly in the House, are determined to do whatever they can to stop it (Cunningham, 9/18).

The Associated Press/Washington Post: Avoid Government Shutdown, National Default, GOP House Leaders Say – But Also Defund Obamacare
House Republicans vowed Wednesday to pass legislation that would prevent a partial government shutdown and avoid a historic national default while simultaneously canceling out President Barack Obama’s health care overhaul, inaugurating a new round of political brinkmanship as critical deadlines approach. Obama swiftly condemned the effort as attempted political extortion, and the Republican-friendly Chamber of Commerce pointedly called on lawmakers to pass urgent spending and borrowing legislation — unencumbered by debate over "Obamacare" (9/18).

Bloomberg: Republicans Seek To Avoid Shutdown By Starving Health Law
The measure is sure to be rejected by the Democratic-led Senate, yet represents an effort by House Speaker John Boehner and Majority Leader Eric Cantor to gain support for a spending bill to keep the government open (Tiron, 9/19).

McClatchy: Showdown: House Will Tie Government Funding To Defunding Obamacare
Next week, the House plans to unveil another measure aimed at delaying the law. The new federal fiscal year begins Oct. 1, and unless Congress and Obama agree on a budget, much of the government will be out of business (Lightman and Clark, 9/18).

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House GOP Lambasts Senate Republicans For Caving On Obamacare

The showdown over the health law that some expected would unify the party has turned into a war of words between House and Senate colleagues. Meanwhile, Politico reports that while most people are focused on the threat of a government shutdown, the bigger threat is a U.S. debt default.

The Wall Street Journal’s Washington Wire: House-Senate GOP War of Words On Obamacare Bill
House GOP leaders thought they'd found the ticket to party unity Wednesday when they announced a bill to keep the government operating in the new fiscal year and strip funding from President Barack Obama’s health-care law. They hoped to rally the party behind the cause of tea party allies, who had made "defunding Obamacare" their litmus test issue. But the move has provoked a remarkable war of words — or at least of tweets — between House and Senate Republicans (Hook, 9/18).

Fox News: House Republicans Accuse Senate Colleagues Of Caving On Push To Defund Obamacare
House Republicans, in an unusually caustic intra-party squabble, are ripping their conservative colleagues in the Senate for what they see as an abrupt cave-in on the push to defund ObamaCare. “They're waving the white flag already," one House GOP lawmaker said Wednesday. The squabble started after House Speaker John Boehner earlier in the day announced he would agree to the demands of Tea Party-aligned lawmakers to tie a vote on defunding the health care law to a vote on a must-pass budget bill. The move would effectively condition the approval of the spending bill on ObamaCare being de-funded, or else risk a government shutdown when funding runs out at the end of the month (9/19).

The Fiscal Times: Gov’t Shutdown: The GOP’s Last Stand On Obamacare
Sylvia Mathews Burwell, the newly minted White House budget director, was among the few administration officials bullish that President Obama and congressional Republicans could somehow overcome their differences and negotiate a budget deal before a Sept. 30 deadline. Last month, she told skeptical reporters that “We shouldn’t all just accept that, ‘Oh, nothing can get done.’ That’s just not true." That was then. As Obama was telling business leaders yesterday that he would refuse to give in to Republican blackmail over the debt ceiling and the future of the Affordable Care Act, Burwell issued a detailed memorandum instructing department and agency heads to prepare for the possibility of a government shutdown at the end of the month (Planin and Ehley, 9/19).

Politico: Shutdown Sparring A Warm-Up For Debt Fight
Everyone in Washington and on Wall Street is fixated on the potential for a government shutdown in less than two weeks. But those in power and closest to the situation say a debt default is a bigger threat. That’s the thinking at the highest levels of Congress as Washington dives headfirst into a contentious fall. Here’s the reality: Speaker John Boehner (R-Ohio) will eventually have to bring a funding bill to the House floor that keeps the government — and Obamacare — running. That’s the bill the House will most likely receive from the Senate shortly after Boehner’s chamber resumes work on Wednesday, just days short of an Oct. 1 government shutdown (Sherman, Bresnahan, 9/19).

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Who's Leading The Charge? Politicians Jockey For Position In Battle To Undo Health Law

With a House vote set for Friday on a bill to strip the health law of funding and to avert a government shutdown, House and Senate lawmakers, state officials and other politicans angle for advantage.

The New York Times' Congressional Memo: Pressed From His Right, Speaker Yields On A Budget Showdown
With much of the government set to run out of money at the end of the month — and run out of borrowing authority by mid-October — Mr. Boehner faced a choice: he could steer a middle ground and find a way out of his fiscal dead end with Republican and Democratic votes, or he could yield to a conservative movement to strip the Affordable Care Act of financing, unite his Republican majority around that war cry, and hope for the best (Weisman, 9/18).

Politico: House GOP Doubles Down On Bad Hand
House Speaker John Boehner and Majority Leader Eric Cantor are playing the last cards in their hand — and they’re most likely losers. The House Republican leadership’s decision to try to defund Obamacare this week in its government funding bill, and their promise to wage a no-holds-barred fight to delay the health care law as part of the debt ceiling fight, is a double-barreled strategy that could set Boehner, Cantor, Majority Whip Kevin McCarthy (R-Calif.) and the House Republican Conference up for two big defeats. Nearly everyone in Washington — except a group of conservative Republicans and their allies — admits that the Senate isn’t going to vote to defund the Affordable Care Act. President Barack Obama showed his own determination on Monday not to give in, speaking just minutes after a shooting rampage in Washington to remind the nation he’s not interested in negotiating over the debt ceiling (Sherman and Bresnahan, 9/18).

The Hill: Republicans Squabble Over Who Has Lead Role In Fight To Stop ObamaCare
Tensions are rising between House and Senate Republicans over which conference will lead the fight to defund ObamaCare. Sen. Ted Cruz (R-Texas) and a spokesman for Speaker John Boehner (R-Ohio) each said Wednesday that the task is for Republicans in the other chamber as pressure rises to fund the government (Viebeck, 9/18).

CNN: House Republicans Question Cruz’s Obamacare-Defunding Fervor
Republicans in the House of Representatives expressed outrage with one of their compatriots on the other side of the Capitol Wednesday, questioning whether or not Texas Sen. Ted Cruz is really all-in on defunding Obamacare or if he’s trying to put all the onus of defunding the bill on the House. The House outrage stems directly from a statement from Cruz and fellow GOP stalwarts against Obamacare in the Senate, Marco Rubio and Mike Lee. In it, Cruz said Senate Republicans simply don’t have the votes necessary to keep defunding language in the continuing resolution to fund the government after Oct. 1. Republicans have been attempting to push a bill that would fund the rest of the government while defunding the health care law, a bill Democrats have vowed to fight (Walsh, Koenig, 9/18).

Dallas Morning News: Defund? Repeal? No, Gov. Rick Perry Wants To 'Fix' Obamacare
Gov. Rick Perry has called Obamacare a "monstrosity." He's refused to help the federal government implement reforms, including creation of a statewide insurance marketplace. On the other hand, he’s lobbied the administration for roughly $100 million available to Texas under the law. Still, it might come as a surprise that rather than push to defund the law, he’d rather tweak and improve it (Gillman, 9/18).

CNN: Bush, Jindal Offer Input On Obamacare Showdown
Two potential contenders for the 2016 GOP presidential nomination weighed in Wednesday on the congressional battle over Obamacare that's now putting a government shutdown at risk. While former Florida Gov. Jeb Bush and Louisiana Gov. Bobby Jindal agreed the president's health care law is a disaster, they had slightly different comments on House Republicans' refusal to pass an upcoming spending bill unless it kills funds for the president's health care law (Killough, 9/18).

St. Louis Beacon: Blunt, McCaskill Split Over New GOP Efforts To Derail Obamacare
U.S. Sen. Claire McCaskill, D-Mo., on Wednesday accused some House Republicans of behaving like her misspoken GOP nemesis of 2012 – former Rep. Todd Akin – with their efforts to kill the implementation of Obamacare, even if it forces a government shutdown (Mannies, 9/18).

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House Conservatives Offer Obamacare Alternative

The legislation, advanced by the Republican Study Committee, would expand tax breaks for people who buy their own health insurance and increase funding for high-risk pools.

The Associated Press/Washington Post: House Conservatives Unveiling Alternative To 'Obamacare' With Bigger Tax Break For Consumers
A large group of House conservatives unveiled legislation Wednesday providing expanded tax breaks for consumers who purchase their own insurance and increasing the government funding for high-risk pools, the Republicans’ first comprehensive alternative to President Barack Obama’s health care overhaul. Under the proposal by the Republican Study Committee, individuals who purchase coverage approved for sale in their state could claim a deduction of $7,500 against their income and payroll taxes, regardless of the cost of the insurance. Families could deduct $20,000 (9/18).

Fox News: House Conservatives Submit Bill To Replace ‘Obamacare,’ Amid ‘Defund’ Fight
A group of House conservatives introduced legislation Wednesday that members say will replace ObamaCare and its “unworkable” taxes and mandates with a plan that expands tax breaks for Americans who buy their own insurance. Under the proposal endorsed by the 175-member Republican Study Committee, Americans who purchase coverage through state-run exchanges can claim a $7,500 deduction against their income and payroll taxes, regardless of the cost of the insurance. Families could deduct $20,000. The plan -- which appears to be congressional Republicans' first comprehensive alternative to President Obama's health care overhaul -- also increases government funding for high-risk pools (9/18).

The Arizona Republic: Ariz. Rep. Gosar Touts New GOP Bill As Alternative To ‘Obamacare’
Arizona Rep. Paul Gosar and other conservative Republicans unveiled a bill Wednesday that would repeal the "Obamacare" health care law and replace it with what they describe as a “free-market” alternative. The American Health Care Reform Act was drawn up by the Republican Study Committee’s Health Care Working Group. Gosar, a dentist, is part of that group (Kelly, 9/18).

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Obama Focuses Attention On Fiscal Risks Involved In GOP Health Law Defunding Strategy

President Barack Obama issues tough talk about Capitol Hill during a speech to the Business Roundtable. Meanwhile, JP Morgan Chase & Co. backs away from a research note in which it predicted a delay was imminent in the launch of key provisions of the health law.  

The New York Times: Obama Highlights Fiscal Risks In Addressing Business Group
Mr. Obama used an appearance before the group, the Business Roundtable, to call out House Republicans who have said they will not raise the nation's debt ceiling unless they succeeded in repealing Mr. Obama's signature health care law. In his remarks, Mr. Obama accused what he called "a faction" of Republicans in the House of trying to "extort" him by refusing to raise the nation's debt ceiling unless the president's health care plan is repealed (Shear, 9/18).

Reuters: JPMorgan Backs Away From Obamacare Delay Report
JPMorgan Chase & Co backed away from a research note to clients on Wednesday that said a delay in the launch of President Barack Obama's health care reform was imminent. JPMorgan initially said in the note on Wednesday morning that based on its Washington D.C. contacts and comments from the administration, it believed an announcement of a delay could come as soon as Wednesday (9/18).

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Health Reform

White House Takes Steps To Assure Consumers About Safety Of Exchanges

The announcement of anti-fraud measures, part of a coordinated federal effort to protect consumers, came after a House committee warned of "risks of fraud and misinformation" in efforts to enroll millions of people eligible for subsidized insurance in new online marketplaces. 

The New York Times: U.S. Warns of Frauds Tied To Health Care Law
The White House warned consumers on Wednesday to beware of possible fraud by con artists taking advantage of the new insurance marketplaces being set up under President Obama's health care law ... The White House warning, part of a coordinated effort by federal agencies to protect consumers, came several hours after a House committee issued a report describing “risks of fraud and misinformation” in efforts to enroll millions of low- and moderate-income people who are eligible for subsidized insurance on the exchanges (Pear, 9/18).

The Associated Press/Washington Post: To Thwart Scam Artists, Govt Urges Consumers To Watch For Fraud Sparked By New Health Care Law
Warning to seniors on Medicare: If someone asks for your personal information for a state insurance exchange under the new health care law, he’s probably a crook. Those exchanges don’t apply to seniors. No consumer, young or old, should give out medical information or pay up-front "enrollment" fees, the government says (9/18).

Kaiser Health News: White House Pushes Back Against Fraud Fears By Obamacare Opponents
The White House on Wednesday unveiled several steps to protect consumers from fraud in the new online health insurance marketplaces, a move that comes after 17 states hostile to the law acted to limit the spread of information about the program, and congressional Republicans raised concerns about the privacy of medical and financial records. "We are sending a clear message that we will not tolerate anyone seeking to defraud consumers in the health insurance marketplace," said Health and Human Services Secretary Kathleen Sebelius (Galewitz, 9/18).

Politico: White House, GOP Battle Over Obamacare Fraud
With less than two weeks to go before millions can start enrolling in Obamacare, the White House and congressional opponents of the health law on Wednesday stepped up a battle over whether consumers can trust the new insurance marketplaces being built by the feds and the states. The White House convened a high-level meeting of Cabinet and state officials on the issue Wednesday and the administration announced a series of measures to assure the public that it’s serious about fighting fraudsters who might try to capitalize on confusion over the new health care law (Millman, 9/18).

Reuters: Obama Administration Seeks To Bolster U.S. Law Privacy
The Obama administration will announce measures to reassure Americans about the privacy and security of the information they submit when they sign up for insurance under President Barack Obama's signature healthcare law, officials said on Wednesday (9/18).

The Hill: White House Ramps Up Protections Ahead Of ObamaCare Launch
The Obama administration is taking new steps to make sure that Americans are not scammed and won't have their identities stolen under ObamaCare.  State and federal officials met at the White House on Wednesday to kick off an effort to crack down on fraud in new healthcare marketplaces, scheduled to get off the ground in less than two weeks (Hattem, 9/18).

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As Opening Day Approaches, Health Law Advocates Caution The Public To Be Ready For Some Marketplace Glitches

Stateline examines concerns about what could go wrong, and other news outlets look at enrollment, outreach and implementation efforts for the online marketplaces that will sell insurance policies.

Stateline: Expect Snags In Affordable Care Act Rollout
There will be glitches when the major provisions of the Affordable Care Act are implemented starting Oct. 1. Huge glitches. Many glitches. Bet on it. That is a prediction not only from those resolutely opposed to the ACA. Even those quite excited about President Barack Obama's federal health law have the same expectation: The rollout of the biggest new social program in nearly 50 years is not going to be pretty. "When you're dealing with tens of millions of new clients, mistakes are inevitable," said Henry Aaron, a health economist at the Brookings Institution. "You're going to have thousands of mistakes" (Ollove, 9/19).

The Wall Street Journal: Big Insurers Skip Health Exchanges
Instead, the insurance companies that are likely to draw attention on the exchanges—which are expected to enroll an estimated 7 million Americans in the first year—are lesser-known, and in many cases will be offering comparatively lower rates. The biggest health insurers are eschewing many of the exchanges out of concern that many of the individuals who will purchase coverage need it because they have chronic illnesses or other medical conditions that are expensive to treat (Martin, 9/18).

The CT Mirror: Obamacare: Doctor, Hospital Participation In Exchange Health Plans Still Being Determined
As [Connecticut's] new insurance marketplace prepares to begin selling coverage in less than two weeks, officials are still waiting to find out which doctors, hospitals and other health care providers will accept the health plans being offered. ... Chad Brooker, chief exchange policy and legal analyst for Access Health CT, the new marketplace, said the insurance companies consider the provider lists proprietary and haven't shared them. But the information is expected to be available in searchable form by Oct. 1, when customers will be able to shop for health plans through Access Health (Becker, 9/18).

McClatchy: As Enrollment In Health Care Law Looms, Some States Erect Roadblocks
The individuals and groups tasked with helping people enroll for health insurance coverage under the Affordable Care Act are facing a stiff head wind of restrictive laws, regulations and outright obstruction in some Republican-led states. In Florida, health officials won't allow these so-called "navigators" onto county health department properties to help uninsured people sign up for coverage in the new state insurance marketplaces. In Georgia, state Insurance Commissioner Ralph Hudgens recently told a gathering of Republican supporters that the state would do "everything in our power to be an obstructionist" of the Affordable Care Act (Pugh, 9/18).

The Texas Tribune: Ahead Of Health Care Rollout, Groups Seek To Answer Questions
As Gov. Rick Perry pushes for tighter rules on workers trained to help uninsured residents purchase health coverage under the Affordable Care Act, Texans can still turn to counselors, hotlines and websites for answers to lingering questions (Zaragovia, 9/19).

Fox News: States Roll Out Trippy Obamcare Ads To Lure The Uninsured
Oregon is in the running to win the prize for the weirdest commercial hyping ObamaCare. The state recently rolled out a 30-second acid-trip-style ad to tout its new healthcare exchange, Cover Oregon. The commercial, part of a multi-million-dollar ad buy that has conservative watchdog groups fuming, features a cartoon man who is lifted into the air after his magical guitar sprouts white wings (Chakraborty, 9/18).

The Seattle Times: Obamacare Signup Is By Computer – And Some Of Us Don't Have One
The 15 percent of Washington households that lack Internet access might be missing out on trivial matters such as videos of the latest celebrity gaff or Facebook updates from nearly forgotten high school friends. But come next month, these residents are also going to have a harder time signing up for health insurance available as a result of the Affordable Care Act, or Obamacare (Stiffler, 9/18).

Kansas Health Institutes: Kansas Lands It First Marketplace Navigator
Kansas has its first certified health insurance marketplace navigator. … Starting Oct. 1, he'll be one of about 250 navigators who are expected to begin helping Kansans enroll in plans available through the new health insurance marketplace, a key element of the 2010 Affordable Care Act (Ranney, 9/18).

Minnesota Public Radio: MNsure Client Aid Organizations Feeling Squeezed
MNsure wants Ruby Lee's organization to spread the word to Latino communities about the state's new health insurance marketplace. But MNsure, she says, is not making it easy. With MNsure's opening less than two weeks away, Lee's contract with MNsure wasn't finalized until Monday. She won't tap any of the nearly $100,000 contract funding until MNsure approves her overall spending plan. Lee said delays at MNsure have prevented her from hiring anyone to assist consumers with enrollment, and she has no idea when she can start training those people once she does hire them (Richert and Stawicki, 9/19).

The Star Tribune: Minnesota's Young 'Invincibles' Are Key To Health Insurance Overhaul
As Minnesota and other states get ready to launch new insurance exchanges on Oct. 1, one of the big challenges is persuading people to buy coverage. Minnesota's MNsure exchange is firing up an all-out marketing blitz, with young adults one of the key audiences. To keep costs low for everyone, insurers will have to get as many people paying for coverage as possible. The idea is to spread the cost of caring for older and sicker patients across large numbers of people with relatively few health care needs (Crosby, 9/18).

The Star Tribune: Dayton Calls MNsure Breach 'An Honest Mistake'
Gov. Mark Dayton is pushing back at critics of MNsure, the state's fledgling health insurance exchange. MNsure, an online marketplace expected to connect more than 1 million Minnesotans to private health coverage, will begin enrolling its first customers on October 1. On the rocky road to that rollout, the agency has come under fire for a series of missteps. Most recently, a MNsure employee mistakenly emailed personal data – including social security numbers – of thousands of insurance agents to another broker (Brooks, 9/18).

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States Hammering Out Medicaid Decisions On Qualifications, Expansion

In news about state Medicaid expansions, a hospital association in Missouri explores the state's place nationally and globally in caring for its poor. Elsewhere, Pennsylvania could require those out-of-work and on Medicaid to look for a job, and South Dakota mulls expanding the program.

St. Louis Beacon: Hospital Association Seeks To Reshape Medicaid Debate With 'A View Of Two Missouris'
An uninsured parent of two children would have to bring home less than $9.59 a day to qualify for Medicaid in Missouri, the federal-state insurance program for the needy. … The study frames the health care debate in global terms, noting that on matters of health and productivity, Missouri must not only compete with the state next door but with countries around the globe. In some instances, the report implies that Missouri is falling short of some poor nations (Joiner, 9/19).

Pittsburgh Post-Gazette: Corbett Stumping For Medicaid Plan
Out-of-work Medicaid recipients could be required to search for a job as part of a proposed health program overhaul in Pennsylvania -- that is, if the new plan gets the OK from the federal Department of Health and Human Services. "I think getting it approved by the federal government will be problematic," said Shannon Mace Heller, a public health attorney in Philadelphia, adding that she was not aware of any other state with a similar requirement in its Medicaid program (Giammarise, 9/19). 

Argus Leader (Sioux Falls, S.D.): Report To Daugaard: Boosting Medicaid Rewarding But Risky
Adding tens of thousands of low-income South Dakotans to the state's Medicaid program would have a big health and economic impact but raise budgetary and philosophical concerns, Gov. Dennis Daugaard was told Wednesday. ... Any benefits the state could see from expanding its Medicaid program, however, are tempered by the risk that the federal government won’t come through with its promise to pay up to 90 percent of the cost of the expansion. ... Earlier this year, Daugaard decided not to ask the Legislature to expand Medicaid. Instead, he appointed a task force to study the issue (Montgomery and Lowrey, 9/18).

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Cleveland Clinic Announces Plans To Trim Budget $330 Million As It Prepares For Health Law Funding Cuts

The clinic will offer a voluntary early retirement package to about 3,000 employees.

Akron Beacon Journal: Cleveland Clinic Warns Of Possible Layoffs
The Cleveland Clinic notified employees Wednesday that a plan to cut $330 million in expenses in 2014 will likely include layoffs. As part of its cost-cutting strategy, the Northeast Ohio health-care giant is offering a voluntary early retirement package to about 3,000 employees by late October, spokeswoman Eileen Sheil said. The Cleveland Clinic is Northeast Ohio’s largest employer, with about 44,000 employees. Hospitals throughout the nation are taking steps to reduce costs, citing lower payments from Medicare and Medicaid and expected changes from federal health-care reform, commonly called Obamacare (Powell, 9/18).

Cleveland Plain Dealer: Cleveland Clinic To Cut $330 Million From Next Year's Budget, May Cut Jobs
Cleveland Clinic Chief Executive Toby Cosgrove told employees this morning that the health system may have to eliminate jobs to meet a target of cutting $330 million from its 2014 budget. The Clinic will first offer early voluntary retirement to about 3,000 employees, who will be notified in October. It’s not clear if any further cuts in staff could be avoided if all these employees choose to retire, however. About 60 percent of the hospital system’s costs are in labor, salaries and benefits, said spokeswoman Eileen Sheil, and "there's only so much you can do with non-staff cost cutting. "Healthcare reform has really changed things, and the burden of cost is going to be falling on patients," she said. "We want to make sure we can keep care affordable" (Zeltner, 9/18).

Reuters: Cleveland Clinic Announces Job Cuts To Prepare For Obamacare
The world-renowned Cleveland Clinic said on Wednesday it would cut jobs and slash five to six percent of its $6 billion annual budget to prepare for President Barack Obama's health reforms. …The clinic is Cleveland's largest employer and the second largest in Ohio after Wal-Mart. It is the largest provider in Ohio of Medicaid health coverage for the poor, the program that will expand to cover uninsured Americans under Obamacare (Palmer, 9/18).

In other health law implementation news -

The Wall Street Journal: Should Young Adults Stay On Their Parents' Health Plan?
When Rob Wyse's 22-year-old daughter received the offer letter for her first post-college job this summer, after the congratulations the family had a decision to make: Should they keep their daughter on the family health-insurance plan or tell her to get her own? (Wieczner, 9/18).

Health Policy Solutions (a Colo. news service): Left Out – Health Reform Bypasses Some Immigrants, Resort Workers
Undocumented immigrants cannot apply for any federal subsidies through health exchanges across the U.S., so many will continue to go without health care until they have an emergency. Then they’ll get care in the most expensive setting — a hospital emergency department. The Colorado Center on Law and Policy estimated in an April report that about 180,000 undocumented immigrants live in Colorado (Kerwin McCrimmon, 9/18).

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Administration News

Reprieve Over? Health Spending Projected To Climb 6% Next Year

The nation's health care spending is slated to rise about 6 percent next year, according to a new Centers for Medicare & Medicaid Services report. This follows five years of slower growth expected to end as the nation's economy recovers and the health law expands coverage. The spending increase is likely lower than it would have been, however, if the Supreme Court hadn't allowed states to choose whether to expand Medicaid, researchers wrote.

Kaiser Health News: Health Spending Over The Coming Decade Expected To Exceed Economic Growth 
The nation's total health spending will bump up next year as the health law expands insurance coverage to more Americans, and then will grow by an average of 5.8 percent a year over the next decade, according to projections released Wednesday by government actuaries. That estimate is lower than typical annual increases before the recession hit. Still, the actuaries forecast that in a decade, the health care segment of the nation's economy will be larger than it is today, amounting to a fifth of the gross domestic product in 2022 (Rau, 9/18).

Los Angeles Times: Health Spending To Rise Amid Coverage Expansion, Economic Growth
After five years of historically slow growth, the nation's health care tab is poised to grow again as the federal health care law expands coverage and the economy improves, according to a new government report. Total U.S. spending on health care is expected to surge over the next decade, hitting $5 trillion in 2022, independent economists at the federal Centers for Medicare and Medicaid Services estimate (Terhune, 9/18).

The Wall Street Journal: Lower Rise In Health Spending Predicted
Total U.S. health-care spending will jump by 6.1 percent next year when key provisions of the federal overhaul law take effect, a slower growth pace than previously had been expected, federal number-crunchers projected Wednesday. The Centers for Medicare and Medicaid Services said the rise would result from more Americans gaining insurance coverage and using more care. But it said the growth would be slower than the 7.4 percent pace anticipated a year ago, in part because of a June 2012 Supreme Court decision that allowed states to avoid expanding their Medicaid programs as envisioned under the health overhaul (Radnofsky, 9/18).

The Washington Post's Wonk Blog: Is Health Spending Slowing For Good? Medicare's Number-Crunchers Aren't So Sure.
Health-care costs have, for four years now, grown at a historically slow rate. Instead of outpacing the rest of the economy, as the health sector has for decades now, medical costs have risen at the exact same rate, if not a little bit slower. Today, we got some bad news: The Center for Medicare Services' Office of the Actuary, in a new report, does not expect this ultra-slow growth to last forever (Kliff, 9/18).

The Associated Press/Washington Post: Government Says Obama’s Health Overhaul Will Accelerate Spending Growth To 6.1 Percent in 2014
The government attributes much of the increase next year to the new health care program, which is expected to provide insurance coverage to millions of currently uninsured Americans beginning Jan. 1 (9/18).

Reuters: U.S. Government Scales Back Obamacare Impact For 2014
The U.S. government on Wednesday scaled back its projections for Obamacare's impact in 2014, saying the law would generate slower health care spending growth and provide coverage to only half as many of America's uninsured as anticipated last year. The biggest factor in the change stems from the U.S. Supreme Court verdict last year allowing each state to decide whether to expand the public Medicaid program for the poor under President Barack Obama's health care reform law (Morgan, 9/18).

Bloomberg: Recession Not Health Law May Be Responsible For Cost Curb
The four-year slowdown in U.S. health-care spending will end next year, and there is no sign the Affordable Care Act will significantly curb the acceleration in costs, government actuaries said in a report. President Barack Obama has said the 2010 health-system overhaul helped curb national medical spending, which that year rose 3.9 percent, or about half pre-recession levels (Wayne, 9/19).

The Baltimore Sun: Health Spending TO Rise Amid Coverage Expansion, Economic Growth
After five years of historically slow growth, the nation's health care tab is poised to grow again as the federal health care law expands coverage and the economy improves, according to a new government report. Total U.S. spending on healthcare is expected to surge over the next decade, hitting $5 trillion in 2022, independent economists at the federal Centers for Medicare and Medicaid Services estimate (Terhune, 9/18).

Medpage Today: 6% Hike In Health Spending Forecast By CMS
Healthcare spending is projected to grow at 4 percent through this year but increase by 6.1 percent next year, ending a string of historically slow growth, government economists said Wednesday. The uptick in spending comes from expanded health coverage under the Affordable Care Act, which will cause physician services to grow by 7.1 percent next year, the Centers for Medicare and Medicaid Services said in the report published online in Health Affairs. Those newly covered are expected to be younger and healthier and, therefore, devote a higher percentage of their medical spending to physician services and prescription drugs than currently insured individuals, economists said (Pittman, 9/18).

Stateline: Medicaid Spending Set To Climb, But States Will Get Temporary Reprieve
Medicaid spending will climb next year by more than 12 percent to $490 billion, largely because of expanded eligibility under President Barack Obama’s new federal health law, according to a new report. The state and local share of the increase (Medicaid is a joint state-federal program) will be minimal, because under the new health care law the federal government will cover 100 percent of the costs of the Medicaid expansion for three years. After that, however, the federal contribution will taper off until it reaches 90 percent in 2020. The annual report by the Centers for Medicare and Medicaid Services (CMS) predicts that state and local spending on Medicaid will increase next year by just half a percent, from $187.6 billion to $198.1 billion. However, by 2022, state Medicaid costs are expected to rise to $340 billion, an increase of about 81 percent (Ollove, 9/18).

Politico: CMS Actuaries: ACA Helps Put End To Health Spending Slowdown 
The recent era of dramatically lower growth in health care spending is coming to a close, and Obamacare is one of the reasons why, according to a government report released Wednesday. Spending growth is expected to remain very low this year -- about 4 percent -- before Obamacare’s major insurance expansions take effect next year. But in 2014, it will jump to 6.1 percent under the health care law -- 1.6 percent of that from Obamacare -- and average nearly 6 percent through 2022. Obamacare is expected to boost the ranks of the insured through the Medicaid expansion and subsidies for those who qualify on the new insurance exchanges, not to mention the requirement that most Americans buy insurance. And people who are insured tend to use more health care (Norman, 9/18).

And Medicare's cost is also examined --

NPR: Americans' Upside-Down View Of Medicare's Problems
Medicare is big. And as America gets grayer, the health insurance program for seniors and the disabled is going to get a lot bigger -- and more expensive. About 51 million Americans were covered by Medicare in 2012, at a cost of around $574 billion, or about 3.6 percent of the nation's gross domestic product. By 2023, about 70 million people will get health care paid for by Medicare, and their tab is expected to hit $1.1 trillion (Hensley, 9/18).

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Health Care Marketplace

Employers Trim Health Costs Using Obamacare As Cover

Many of these practices began well before the federal health law took effect. But several news outlets report that the law is giving businesses cover to shift additional costs onto employees and their families -- an effort that may reinforce the law's unpopularity.

The Wall Street Journal: The Perils Of Out-Of-Pocket Health Costs
Small businesses offering health insurance tend to require their employees to cover significantly more out-of-pocket than do big companies—and new limits imposed by the health-care law likely won't ease the pain. At businesses with fewer than 200 workers, for example, employees pay an average of $1,715 a year out-of-pocket to cover their deductibles—the amount the insured pays before coverage kicks in. That is almost double the average outlay by workers with individual coverage offered by larger employers, according to the Kaiser Family Foundation (Needleman and Loten, 9/18).

NPR: Employers Trim Health Costs By Cutting Coverage For Spouses
When UPS told workers that it would no longer offer health coverage for spouses who had their own job-based insurance, it caused a big stir. But the shipping giant has plenty of company. So many employers are trying to cut back on health coverage for spouses that it has become a trend. The practice began well before the Affordable Care Act passed, and the connection to the law, in some cases, isn't that direct (Rovner, 9/19).

Bloomberg: Obamacare Unleashes Benefit Changes From Companies
Barack Obama wanted to change American health-care as we know it. And he is, in ways that go far beyond the goals of the Affordable Care Act. For weeks, headlines have cataloged the upheaval at private employers: UPS dropping coverage for employed spouses, IBM reworking retiree benefits (Nussbaum, 9/19).

Meanwhile, the St. Louis Post-Dispatch reports that the city's largest employer is preparing to cut coverage for some part-timers --

St. Louis Post-Dispatch: BJC Healthcare To Reduce Health Benefits For Part-Timers, Employees Say
BJC Healthcare, the largest St. Louis employer, is preparing to cut health insurance benefits for some of its part-time employees. According to two part-time nurses with the BJC system, managers and Human Resources representatives recently began informing certain employees that those who do not work at least 24 hours per week will be ineligible for health benefits (Doyle, 9/19).

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Public Health & Education

Mental Health Questions Re-Emerge After Shooting Deaths In Washington

Mental health is again front and center in the gun control debate with some consensus on Capitol Hill that more resources are needed to treat the mentally ill. A new study also examines the relationship between gun ownership and mental illness in several countries.

The New York Times: Mental Health Again An Issue In Gun Debate
Despite deep divisions that have kept Congress from passing new gun safety laws for almost two decades, there is one aspect of gun control on which many Democrats, Republicans and even the National Rifle Association agree: the need to give mental health providers better resources to treat dangerous people and prevent them from buying weapons (Peters and Luo, 9/18).

Los Angeles Times: Do Guns Make Us Safer? 
Just days after a Washington naval installation became the site of the fourth mass shooting in the span of a year, a pair of new studies asks a shop-worn but timely question: Do more guns make us safer? Both studies conclude the answer is no. ... The latest study, published Wednesday in the American Journal of Medicine, is ambitious: It aims to tease out the relationship among gun ownership, crime, violent death and mental illness by looking across 27 industrialized countries that keep reliable data on all of those measures. The second study, published last week in the American Journal of Public Health, focuses entirely on the United States -- a patchwork of states with differing demographics, gun cultures, gun laws and crime patterns -- and examines whether, over time, more guns have meant more or less gun-related homicides (Healy, 9/18).

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Coverage & Access

Panel Chairman Describes 'Narrow Window' To Address Long-Term Care Issues

The Washington Post interviewed the chairman of a federal commission on long-term care, which released its recommendations to improve the system Wednesday. In the meantime, California eyes its own reforms.

The Washington Post: A 'Narrow Window' To Implement Long-Term Care Policy, Federal Commission Head Says
Over 12 million Americans today rely on long-term services and supports in their home or community or in an institution. That number is expected to swell as the baby boomer generation ages and the number of available caregivers dwindles. The Washington Post spoke with Bruce Chernof, president and CEO of The SCAN Foundation and chair of the bipartisan federal Commission on Long-Term Care, which today released a report with recommendations for a targeted long-term care approach as America ages. Some had hoped the commission would develop a new public or private insurance program to help finance long-term care, but Chernof said that was not part of its mandate. The recommendations include new models of public payment, better communication with family members, better monitoring and training of caregivers, and creating a Medicare benefit for long-term care (Bahrampour, 9/18).

California Healthline: California Advocates Eagerly Awaiting Federal Report On Long-Term Care Issues
The federal Commission on Long-Term Care [Wednesday] is expected to release its comprehensive report on tactics and targets to improve care for the elderly, and that report could help focus attention on long-term care concerns in California. California has its own vision document for long-term care, developed by state officials two years ago. More specifically, the state is undertaking a major effort to overhaul care for seniors in California, and that project may be influenced by this federal attention, according to Jack Hailey, project manager at the Government Action and Communication Institute, a not-for-profit education and health advocacy group in Sacramento (Gorn, 9/18).

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State Watch

State Highlights: Penn State Ends Health Plan Penalty

A selection of health policy stories from Pennsylvania, North Carolina, Michigan, Oregon and Texas.

The New York Times: Health Plan Penalty Ends At Penn State 
After weeks of vociferous objections by faculty members, Pennsylvania State University said on Wednesday it was suspending part of a new employee wellness program that some professors had criticized as coercive and financially punitive (Singer, 9/18).

North Carolina Health News: NCTracks Frustrates Businesses Big And Small
More than two months after launch, Medicaid providers are reaching the end of their tolerance for the new NCTracks computer system (Hoban, 9/19).

Detroit Free Press: State Officials Plan To Announce Compounding Pharmacy Legislation
Michigan Attorney General Bill Schuette plans to announce legislation today aimed at tightening regulations of compounding pharmacies in the state hit hardest by a national fungal meningitis outbreak. The public health crisis that erupted last September was linked to tainted steroids prepared by the New England Compounding Center, a compounding pharmacy in Massachusetts. Hundreds of people were sickened by tainted shots, and more than 60 have died (Zaniewski, 9/19).

The Lund Report: Autism Treatment For Oregon Health Plan Faces Hurdles, But Approval For Some Kids Likely
Autism advocates presented their case for applied behavior analysis last week to an Oregon evidence-based medicine review panel, whose recommendation can make or break the ability of autistic Oregonians to receive the therapy under the Oregon Health Plan. The approval faces a high hurdle: a staff member for the Center for Evidence-Based Policy at Oregon Health & Science University, Dr. Alison Little, has testified nationally against the psychotherapy for autistic children, including a Florida case in March 2012 (Gray, 9/16).

The Texas Tribune: Abortion Opponents Criticize Patrick’s Past Investment
State Sen. Dan Patrick, R-Houston, is campaigning for Texas lieutenant governor as an unapologetic foe of abortion. But prominent abortion opponents want him to explain how he wound up owning stock in the company that makes the Plan B "morning after" pill (Root, 9/19).

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Editorials and Opinions

Viewpoints: Rove Warns GOP That Defunding Could Be 'Self-Defeating;' Jonathan Cohn Says Latest Obamacare Fight Reveals Republicans' Will To Overlook Gains From Law

The Wall Street Journal: The GOP's Self-Defeating 'Defunding' Strategy
Today, independents look more like Republicans than Democrats, especially when it comes to health care. In a new Crossroads GPS health-care policy survey conducted in 10 states likely to have competitive Senate races and in House districts that lean Republican or are swing seats, 60 percent of independents oppose President Obama's Affordable Care Act. If this holds through 2014, then Republicans should receive another big boost in the midterms. There is, however, one issue on which independents disagree with Republicans: using the threat of a government shutdown to defund ObamaCare (Karl Rove, 9/18).

The Washington Post: Why Republicans Are Desperate For A Shutdown
The coming battles over budgets, the debt ceiling, a government shutdown and Obamacare are not elements of a large political game. They involve a fundamental showdown over the role of government in stemming rising inequality and making our country a fairer and more decent place. Anyone who doesn't see this should be forgiven. The stakes in this battle are almost always buried in news accounts about tactics and obscured by an unquenchable desire across the media to provide the latest take on whether President Obama is growing "weak" and has already become the lamest of lame ducks (E.J. Dionne Jr., 9/18).

The New York Times: The March To Anarchy
Until now, the only House Republicans pushing for a government shutdown and debt crisis were a few dozen on the radical right, the ones Senator Harry Reid, the majority leader, referred to as "the anarchists." On Wednesday, however, the full Republican caucus, leadership and all, joined the anarchy movement, announcing plans to demand the defunding of health care reform as the price for keeping the government open past Sept. 30. The decision means that a government shutdown next month is now much more likely (9/18).

Bloomberg: Republicans' Phony Obamacare Replacement
A mere 48 months after the law was introduced, only 42 months after it was signed, with just two weeks until one of its main provisions takes effect, Republicans today finally offered their alternative to the Affordable Care Act. Which would be cause for genuine (if belated) congratulations, except for one thing: It's not really an alternative. Understanding why can help clarify the U.S.'s seemingly endless debate about health care. The Republican bill would give individuals tax deductions to buy health insurance, expand tax-free health savings accounts and limit insurance premiums for people with pre-existing conditions. What it wouldn't do is expand coverage to the same number of uninsured Americans -- about 25 million, according to the latest estimates -- as Obamacare (9/18).

Bloomberg: 'Party Of No' Should Focus On 'Getting To Yes'
Last week, Republicans in the U.S. House of Representatives voted for the 41st time to repeal or dismantle parts of the Patient Protection and Affordable Care Act. And no, the 42nd time is not going to be the charm. What exactly is the Republican endgame? Initially, it may have been about what House Speaker John Boehner calls the "optics": allowing newly elected members to cast a symbolic vote on the law. Now they just look like spoilers (Caroline Baum, 9/18).

The New Republic: Boehner: Surrender On Obamacare, Or It's Shutdown City 
The Congressional Budget Office estimates that, because of the law, the number of people without health insurance will fall by 14 million next year—and then nearly double, to 27 million, in the three years after that. ... Repeal Obamacare and people lose out on regulations guaranteeing them minimum levels of coverage, prohibitions of annual and lifetime limits, and (for low-income people buying on their own) extra protection against out-of-pocket spending. ... Does insisting on Obamacare defunding and delay defy political logic? Yes. But it’s the substantive claims Republicans make—the argument that a world without Obamacare is better than a world with one—that deserve the most scrutiny (Jonathan Cohn, 9/18).

The New York Times: World War O
On Wednesday, leaders of the House of Representatives announced their plans for a 42nd and 43rd vote to thwart the new health care reform law. If they don't get their way, they're threatening to defund the government and crack the debt ceiling. ... Seriously, people, why do you think the Republicans have gone so completely lunatic when it comes to this issue? (Gail Collins, 9/18).

The New York Times: Bring Back The Lyme Vaccine
The ticks that carry Lyme disease — which are prevalent in the Northeast United States, the Upper Midwest and Northern California, as well as in Central Europe and Scandinavia — can be hard to spot, too. Both nymph and adult ticks can transmit the bacteria, but the tiny nymphs — which emerge in the springtime — are hard to see with the naked eye until they mature in the fall. In other words, it's easy to be bitten and not realize it. If you are infected, it's easy for a doctor to miss the symptoms. Shouldn't there be a vaccine for such a prevalent and dangerous disease? In fact, we used to have one, and are perfectly capable of producing another, if the public demand is high and we avoid the mistakes of the past (Stanley E. Plotkin, 9/18).

Roll Call: How Telemedicine Could Change Medicare
The majority of Medicare's costs come from the treatment of chronic illnesses such as heart disease and diabetes. In fact, about 82 percent of Medicare beneficiaries have one or more chronic conditions. Unfortunately, there are proven solutions to help patients better manage chronic diseases and access primary care providers that are already reducing costs and addressing the shortage issue. Unfortunately, constrained by the Medicare law, most seniors and the disabled do not have access to these solutions (Joel White, 9/18).

Forbes: Health Insurance Exchanges: Don't Everyone Show Up At Once!
On Oct. 1, health insurance exchanges will open for business across the United States. Our advice: wait. That's also the same advice you can infer from the president on down. There will be bugs. Count on it. The always excellent Politico blog ran a story about how federal officials are looking at the exchanges as a marathon, not a sprint. And the worst thing that could happen is if everyone in the nation who needs insurance logs on to their respective state health insurance exchange on the first day (Evan Albright, 9/18).

The Fiscal Times: Business Boondoggle: Shedding The Cost Of Health Care 
On Tuesday, President Barack Obama laughed off the concerns of Americans that have driven approval for the ACA to their lowest levels ever as the start date for the individual mandate approaches on October 1st. Asked whether "everybody" is wrong to oppose Obamacare in an interview with Telemundo, Obama chuckled and replied, "Yes, they are." He insisted that the law has delivered "the lowest increase in healthcare costs in 50 years over the last several years," and that "there is no evidence at all that this is somehow making healthcare more expensive." Maybe he should tell that to his partners in the program. Walgreens, one of the nation’s largest retailers, surprised its 160,000 employees by ending employer-provided health insurance. Instead, the company will provide a fixed stipend for use in a private exchange (Edward Morrissey, 9/19).


California Healthline: A Dozen Hospitals Are Laying Off Staff And Blaming Obamacare. Don’t Believe Them.
Hospitals tend to be among the largest employers in their communities -- which means that any individual decision to lay off staff can have an outsized local impact. And taken together, a dozen recent announcements seem to paint an especially dire picture for hospitals (and their communities) around the nation. … When Obamacare was being debated in Congress, its opponents tried to tar it with a deadly label: "the job-killing health law." So is the ACA finally living down to its sobriquet? Not exactly. While the recent news makes for provocative headlines, the devil's in the details -- and the financial reports (Diamond, 9/18).

The Star Tribune: MNsure Data Breach Needs To Be Taken Seriously
Paul Bunyan and Babe the Blue Ox have had a painful couple of weeks. This time, the legendary lumberjack's injuries weren't inflicted by woodpeckers, water skiing or sledding — among the hazards that make Minnesota the land of "10,000 reasons to get health insurance,"’ according to the ads in which Bunyan and Babe promote the state's new online health coverage marketplace. Instead, the latest mishaps came at the hands of their new MNsure colleagues, who have made two disappointing mistakes recently that sapped confidence in this important marketplace in the critical lead-up to its Oct. 1 launch (9/18). 

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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.