Daily Health Policy Report

Friday, September 20, 2013

Last updated: Fri, Sep 20

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Health Reform


Public Health & Education

State Watch

Health Policy Research

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Health On The Hill: Health Law Caught In The Middle Of Budget Fight

Kaiser Health News staff writer Mary Agnes Carey talks with Politico Pro's Jennifer Haberkorn about recent Capitol Hill happenings. Specifically, with implementation of major provisions of the law looming, Republicans see this fall's budget showdown as their last chance to slow or stop the president's signature legislation from taking effect (9/19). Listen to the interview or read the transcript.


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FAQ: Obamacare And Coverage For Immigrants

Kaiser Health News staff writer Julie Appleby reports: "The U.S. is home to more than 21 million immigrants who are not citizens, and for many of them, health coverage is a concern. That is partly because so many of them--both those who came here legally and those who do not have permission to live in the United States--work in low wage jobs that don’t include health coverage" (Appleby, 9/19). Read the story.

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In Most States, Policies Will be Sold Outside The Health Law Marketplace (Video)

Kaiser Health News consumer columnist Michelle Andrews helps you navigate the new insurance marketplaces that are scheduled to launch on Oct. 1. Today she answers a question about where consumers can buy health coverage (9/20). Watch this video or others in the series.

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Capsules: Insurers’ Letters Spur Washington State Consumer Alert; Census: More Than 850,000 Texas Kids Lack Health Coverage

Now on Kaiser Health News' blog, The Seattle Times' Amy Snow Landa, working in partnership with KHN, reports on a Washington state consumer alert: "The Washington state insurance commissioner issued a consumer alert Thursday advising state residents who buy their own health insurance to know their options when choosing their next health plan. The commissioner’s office issued the alert in response to dozens of phone calls and emails from consumers upset by letters from insurance carriers informing them their current health plan would be discontinued at the end of the year" (Landa, 9/20).

In addition, The Texas Tribune's Becca Aaronson, working in partnership with KHN, reports on health insurance coverage rates  for Texas children: "Texas continued to have the highest rate of people without health insurance in 2012 at 24.6 percent, or more than 6 million residents, according to the Current Population Survey estimates released by the U.S. Census Bureau this week. Texas also has the largest number of children without health insurance and the highest rate of poor adults without health insurance, according to 2012 American Community Survey estimates" (Aaronson, 9/20). Check out what else is on the blog.

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Political Cartoon: 'Herd Mentality?'

Kaiser Health News provides a fresh take on health policy developments with "Herd Mentality?" by Mike Smith.

Here's today's health policy haiku:


Who can believe that
3 and a half years later,
So many battles! 

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 On Stopgap Funding Bill That Would Derail Health Law

The GOP-controlled chamber is expected to approve the bill, which will then face stiff opposition in the Senate. The White House has also threatened a veto.

The Associated Press/Washington Post: Showdown: House To Vote On Stopgap Funding Bill That Seeks To Derail Obama’s Health Care Law
Congressional Republicans struggled to tamp down a family feud Thursday as they approached a politically charged showdown with the White House that combines the threat of a government shutdown, a possible first-ever federal default and the GOP's bid to repeal the nation's three-year-old health care law (9/19).

Los Angeles Times: GOP Steps Up Its Vow To Kill Obama's Healthcare Law
House Speaker John A. Boehner on Thursday promised a "big victory" when the chamber votes to defund President Obama's health care law as part of a must-pass bill to keep the government running. But it may be short-lived: The White House has promised a veto. Republicans in Congress believe the American people are on their side as they head toward Friday's vote, using the threat of a government shutdown on Oct. 1 to force the president to undo his signature health care law. They insist opposition to the Affordable Care Act will force Obama to change course (Mascaro, 9/19).

Fox News: House To Vote On Plan To Defund Obamacare As Shutdown Looms
The House on Friday will vote to replace Obamacare with a plan that expands tax breaks for Americans who buy their own insurance, setting the stage for a showdown with Senate Democrats that could push the government toward a partial shutdown at the end of the month. More than 140 congressional Republicans signed on to the bill to keep the government running at existing funding levels and delay the health care law. Democrats have vowed to oppose that bill, warning the strategy risks a government shutdown, with funding set to expire by Oct. 1 (9/20).

Los Angeles Times: Government Shutdown Is No Idle Threat
The opening round of the fight comes Friday with a vote in the House. … Moreover, the fight has morphed from a straightforward battle between Republicans and Democrats into a three-way brawl in which the GOP congressional leadership must contend not only with the White House, but with conservative insurgents in their own ranks. House Speaker John A. Boehner (R-Ohio) presides over an uneasy coalition of Republican regulars and tea-party-backed conservatives. The conservatives, rallying to the demand to "defund Obamacare," have insisted that the GOP refuse to keep the government financed unless the White House and the Democratic majority in the Senate agree to block President Obama's healthcare law. The administration plans to roll out new online health insurance marketplaces — a key part of the new law — on Oct. 1 (Lauter and Mascaro, 9/19).

CBS News: Roadmap For How Obamacare Will Likely Survive Senate
The political struggle over defunding Obamacare in the Senate may turn out to be not much of fight at all. The House is scheduled on Friday to vote on the proposal that will be attached to a must-pass spending bill to fund the government. But when it all goes to the Senate next week, Democrats now expect to strip the Obamacare provision without interference from most Republicans (Barrett, 9/19).

Politico: House Might Nix Obamacare Subsidies In CR
House GOP leaders are warning they may not simply just take up a continuing resolution funding government operations if Senate Democrats strip out language defunding Obamacare. Instead, House Republicans could either sit on the bill — which is unlikely, as that would lead to a government shutdown — or insert other, more onerous provisions into the $986 billion continuing resolution or CR, and then send that revised package back to the Senate (Bresnahan, 9/19).

The Wall Street Journal's Washington Wire: Obama Issues Veto Threat On GOP Budget Bill
The White House on Thursday said President Barack Obama would veto a bill from House Republicans that would fund federal agencies into the new fiscal year but also strip all money from his signature health care law. The White House budget office said the administration strongly opposes the Republican bill’s effort to hamper the health law, saying the bill “advances a narrow ideological agenda that threatens our economy and the interests of the middle class” (Favole, 9/19).

Kaiser Health News: Health On The Hill: Health Law Caught In The Middle Of Budget Fight
Kaiser Health News staff writer Mary Agnes Carey talks with Politico Pro's Jennifer Haberkorn about recent Capitol Hill happenings. Specifically, with implementation of major provisions of the law looming, Republicans see this fall's budget showdown as their last chance to slow or stop the president's signature legislation from taking effect (9/19).

The Associated Press: The Truth: Government Won’t Really Shut Down
Here’s the truth about a government “shutdown.” The government doesn’t shut down. So the world won’t end if a dysfunctional Washington can’t find a way to pass a funding bill before the new budget year begins Oct. 1. Social Security checks will still go out. Troops will remain at their posts. Doctors and hospitals will get their Medicare and Medicaid reimbursements (Taylor, 9/20).

Meanwhile, in other Capitol Hill news -

Roll Call: Ron Johnson May Sue Over Obamacare Ruling For Congressional Staff
Sen. Ron Johnson, R-Wis., said Thursday he is laying groundwork for a court challenge to an Office of Personnel Management decision that will permit congressional staffers to continue receiving employer contributions for their health care. The OPM’s August ruling was intended to remedy a drafting error in the 2010 health care law that would require all Congressional staffers to pay for the full cost of their insurance without employer contributions (Shiner, 9/19).

The Hill: Dems Say GOP Funding Measure Would Gut Children’s Health
House Democrats are hammering a government funding measure written by Republicans for gutting the Children's Health Insurance Program. In a Thursday letter to their Democratic colleagues, the top Democrats on the House Ways and Means and Energy and Commerce committees warned that the Republicans' proposal to defund the Affordable Care Act (ACA) would “wreak havoc on Medicare and other federal health programs,” including CHIP (Lillis, 9/19).

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As Defunding Vote Triggers GOP 'Family Feud,' Strong Personalities And Tough Talk Take Center Stage

Conservatives in the House have pressured Speaker John Boehner, R-Ohio, to advance their goal of defunding the health law and criticized Senate conservative colleagues for caving on the issue. There are also threats of filibuster and concerns about the impact this strategy could have on the Republican Party.

The New York Times: Conservatives Take Turns Standing Up To The Speaker
Those in the circle of fiery House conservatives who are spearheading a fiscal showdown that threatens to shut down the government see themselves in vaunted company. "It only takes one with passion — look at Rosa Parks, Lech Walesa, Martin Luther King,” said Representative Ted Yoho of Florida, one of the rank-and-file House Republicans who have risen up to challenge their party’s leadership over whether to confront the Senate and President Obama with their demands to cut off funding for the president’s health care law. "People with passion that speak up, they’ll have people follow them because they believe the same way, and smart leadership listens to that" (Parker and Weisman, 9/19).

Politico: Conservatives Rally Around Defunding Vote
House Speaker John Boehner’s decision to allow a vote on a spending plan defunding Obamacare energized conservatives on Thursday even though their chances of actually stripping the law’s funds remain dim. Conservative House members heaped praise on their leader, saying his decision has brought back the Boehner of the good ol’ days (Cunningham, 9/19).

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. 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 (9/19).

The Wall Street Journal: Spending Battle Set For The Senate
The Senate began girding for a contentious fight over a bill to fund the government after conservatives on Thursday threatened to use delaying tactics in an effort to eliminate money for the new federal healthcare law. The vow from Sen. Ted Cruz (R., Texas), a leading foe of the health law, pointed to a protracted and uncertain Senate battle that could drag Congress close to the Oct. 1 deadline for avoiding a partial government shutdown (Hook and Peterson, 9/19).

Los Angeles Times: Cruz Vows To Do 'Everything Necessary' To Defund Health Law
Sen. Ted Cruz (R-Texas) vowed to do "everything necessary and anything possible" to ensure passage of legislation that would strip the new healthcare law of some of its funding, assuring House Republicans of his full support for a strategy that could risk a government shutdown. At a news conference Thursday, Cruz locked arms with House Republicans who have championed the "defund Obamacare" strategy, one day after conservative lawmakers bristled at a statement Cruz issued that acknowledged Republicans had little chance of succeeding in the Senate (Memoli, 9/19).

Politico: Ted Cruz In Middle Of GOP Civil War
Ted Cruz is in the middle of an escalating GOP civil war on Obamacare, a risk that could turn into a major public relations debacle for the prospective presidential hopeful. For the past few months, Cruz has been riling up the right, urging Republicans to use a government funding bill as leverage to defund Obamacare. But given Democratic control of the Senate and White House — and growing Republican reticence about shutting down the government — even Cruz’s GOP supporters acknowledge there’s virtually no chance his tactics will succeed (Raju, Everett and Sherman, 9/19).

The Washington Post: Rand Paul: Filibuster May Not Stop Obamacare Funding
Sen. Rand Paul (R-Ky.) on Thursday defended "Defund Obamacare" supporters in the Senate, who have come under criticism from House Republicans for suggesting they may not be able to stop a budget that includes funding for Obamacare. Paul noted that even his 13-hour filibuster against the Obama administration's drone policies wasn't able to stop the Senate from approving the nomination of CIA director John Brennan (Blake, 9/19).

Politico: John McCain: Defund Effort 'Not Rational'
Sen. John McCain said Thursday that it is "not rational" to think the Senate will vote to defund Obamacare. “In the United States Senate, we will not repeal, or defund, Obamacare. We will not. And to think we can is not rational,” McCain said on CNN's "The Lead with Jake Tapper" (Arkin, 9/19).

McClatchy: Republican Move Could Kill Obamacare – Or The GOP
Republicans will proclaim solidarity Friday when the House of Representatives votes to defund the 2010 health care law. Don’t be fooled: The party is bitterly divided about how and when to get rid of Obamacare. The struggle over tactics could well determine who controls the Republican Party – and just as important, its image – for years to come (Lightman, 9/19).

The Washington Post: Scott Walker Opposes Government Shutdown Over Obamacare
Wisconsin Gov. Scott Walker (R) has been an outspoken opponent of Obamacare, challenging its constitutionality in court and rejecting federal funds to expand Medicaid under the program. But that doesn't mean he backs the current House GOP strategy to risk shutting down the government over the issue (Eilperin, 9/19).

Roll Call: Corker Warns Of Inflated Expectations From Push To Defund Obamacare
Sen. Bob Corker is saying openly what other Republicans seem to be thinking behind the scenes: The strategy to defund Obamacare is raising expectations among conservatives to unrealistic levels (Lesniewski, 9/19).

Politico: Reid: ‘Any Bill That Defunds Obamacare Is Dead’
Senate Majority Leader Harry Reid (D-Nev.) declared Thursday that any government-funding legislation that takes away money for Obamacare has no chance of becoming law. Pushed by the conservative wing of their party, House Republican leaders have settled on a continuing resolution to keep the government open, or a CR, with specific language to defund the health care law. The House is slated to vote on that bill Friday (Kim, 9/19).

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Health Reform

Obama, Bill Clinton To Promote Health Law Next Week

A week before new health insurance marketplaces open for enrollment, President Barack Obama will join former President Bill Clinton in New York to have "a conversation about the benefits and future of health care reform." An ABC analysis suggests they have a lot of work to do based on the latest ABC News/Washington Post poll showing that 62 percent of people say they lack the information to understand the law's changes.

The Washington Post: Obama, Bill Clinton To Tout Health Care Law In New York
For the second time this month, President Obama will enlist the previous Democratic occupant of the White House in his push to publicize the benefits of his landmark health care law. On Tuesday in New York, Obama will attend the Clinton Global Initiative hosted by former president Bill Clinton, where the two will engage in "a conversation about the benefits and future of health care reform in America and access to quality health care around the globe," White House press secretary Jay Carney said (Nakamura, 9/19).

ABC News: Obamacare Arrives 3 Years Later, Little Understood And Not Well-Liked
More than three years after Obamacare was signed into law and fewer than two weeks before its health insurance exchanges are to launch, many Americans don’t know a lot about the pending changes except this: They don’t much like them. Sixty-two percent in a new ABC News-Washington Post poll say they lack the information needed to understand the changes that will take effect as the Affordable Care Act is implemented. Barely one in 10, moreover, thinks the federal government, their state government or the health insurance industry is fully prepared to implement the law (Ergun, 9/20).

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'Creepy Uncle Sam' Urges Young To Stay Away From Obamacare

A Virginia-based conservative group backed by the billionaire Koch brothers launched a campaign this week urging young people to "opt-out" of the law's mandate that all Americans have health insurance. Their first online ads feature young people going for doctor appointments, only to have a "Creepy Uncle Sam" pop up, ready to look them over.

CBS News: Upcoming Obamacare Kickoff Inspires Provocative Ads 
To encourage people to sign up, federal and state officials have set aside millions of dollars for public awareness campaigns. The ads that have aired in recent weeks have been creative and informative. However, they're going up against well-financed opponents of Obamacare who have been equally creative in their outreach. On Thursday, the organization Generation Opportunity, a conservative coalition with ties to the Koch brothers, announced the launch of its #OptOut campaign, designed to encourage young people to "opt out" of the new requirement, starting in 2014, that all Americans acquire health insurance (Condon, 9/20).

The New York Times' The Caucus: 'Creepy Uncle Sam' Is Anti-Health Care Law Mascot
A group seeking to persuade young people to "opt out" of President Obama’s health care law posted videos on YouTube Thursday that show young patients on exam tables recoiling in fear as a character the group is calling "Creepy Uncle Sam" appears out of nowhere and looms over them. The group, Generation Opportunity, said in a news release that the videos were part of a new, six-figure campaign to educate people between the ages of 18 and 29 about "alternatives to expensive and creepy Obamacare exchanges" (Goodnough, 9/19).

The Wall Street Journal's Washington Wire: Blowback Swift For Creepy 'Uncle Sam' Anti-Obamacare Ad
A controversial new online anti-health law ad depicting a cartoonish “Uncle Sam” as a malevolent gynecologist is -- predictably -- becoming the focus of the latest dust-up between supporters and opponents of the Obama administration. The video, by a group called Generation Opportunity that describes itself as a "national, non-partisan youth advocacy organization," encourages young people to "opt out" of a health law rather than letting "government play doctor" on a woman in stirrups (Radnofsky and Schatz, 9/19).

CNN: Uncle Sam Went To Med School? 
Is Uncle Sam board certified? That's what a series of new online ads wonder as they encourage millennials to "opt out" of Obamacare. Described by their libertarian creators as intentionally creepy, the ads by Generation Opportunity feature young people going for doctor appointments, only to have Uncle Sam pop up, ready to look them over (Koenig, 9/19).

USA Today: Koch-Based Group Launches New Attack On Health Care Law
A conservative group backed by billionaire brothers Charles and David Koch will launch a new round of advertising Thursday to attack President Obama's health care law, less than two weeks before enrollment opens for new health care exchanges (Schouten, 9/19).

ABC News: One Conservative Group's Multi-Million Dollar Quest To Repeal 'Obamacare'
The powerful and well-funded conservative group Americans for Prosperity took to the airwaves again this week, launching its biggest television advertising blitz yet against the Affordable Care Act. The Koch brothers-fueled Americans for Prosperity released a new 60-second ad on Thursday that includes a Florida woman named Tricia who tells her story of surviving cancer and shares her fears about Obamacare (Rossoll, 9/20).

The Fiscal Times: The Anti-Obamacare Movement Just Got Creepy
The war over Obamacare is getting weird. Really weird. The latest contribution to the bizarre battle over the president's health care law comes in the form of an outrageously creepy ad from Generation Opportunity, a Virginia-based conservative group that is trying to discourage people from signing up for health insurance through the Obamacare exchanges opening on October 1 (Ehley, 9/19).

Politico: Ads Show 'Uncle Sam' In Exam Room
Generation Opportunity, a conservative-leaning youth organization, premiered eerie ads Thursday meant to discourage young people from signing up for Obamacare. The two ads, one featuring a young man and another a woman left alone in exam rooms by their doctors, lying in vulnerable positions and waiting for medical tests. As their doctors exit, a creepy Uncle Sam character emerges to administer the exams (Delreal, 9/19).

Fox News: Groups Wage Grassroots Battle Ahead Of Obamacare Launch
To make it feel even more like a campaign, liberals and conservatives are battling it out on the airwaves. The group Organizing for Action (which used to be Obama For America) is running an ad that shows a restaurant owner along with the narration: "Next year, she can expand her small business thanks to tax credits." Americans for Prosperity is running ads that raise questions about whether families will be able to keep their preferred doctor. One shows a mother who asks rhetorically, "What am I getting in exchange for a higher premium and a smaller paycheck?" (Tobin, 9/19).

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Supreme Court May Hear Challenge To Obamacare's Contraception Rules

Some companies object to the health law's requirement that contraception services for women be provided free as part of a preventive care package.

Los Angeles Times: High Court May Take Up Religious Challenge To Birth Control Coverage
The Obama administration set the stage Thursday for another Supreme Court showdown on the president's healthcare law, this time to decide whether for-profit companies can be forced to provide full contraceptive coverage for their employees despite religious objections from their owners. The administration's lawyers asked the justices to take up the issue this fall to decide whether these corporations can claim a religious exemption to this part of the healthcare law (Savage, 9/19).

Reuters: Obama Asks High Court To Review Contraception Mandate Ruling
The administration wants the high court to reverse a June decision by the 10th Circuit Court of Appeals in Denver favoring arts and crafts retailer Hobby Lobby Stores Inc. That decision said for-profit companies can sometimes assert religious rights if they do not wish to comply with a federal regulation (Hurley, 9/19).

The Associated Press: US Wants Supreme Court To Take Up Hobby Lobby Case
U.S. District Judge Joe Heaton in July granted the Hobby Lobby craft store chain and Mardel, its sister company, a temporary exemption from a requirement that it provide insurance coverage for morning-after pills, similar emergency birth control methods and intrauterine devices. Lawyers for the U.S. Department of Health and Human Services filed a notice in federal court this week saying it would appeal. Heaton had given the government an Oct. 1 deadline (9/19).

Politico: DOJ To SCOTUS: Settle The Contraception Fight, Already
The company is “presently coerced to provide these items or else devastate its employees by dropping their families’ insurance coverage altogether.” But the Obama administration and its allies argue that store owners cannot dictate religious beliefs upon their employees (Haberkorn, 9/20).

In related news, lawyers for another company asked the Supreme Court to hear its challenge to the contraception coverage requirement, while Indian Health Services expands access to emergency contraception --

The Wall Street Journal: High Court Asked To Hear Health-Law Challenge
Lawyers for one of the businesses challenging the federal health law’s contraception coverage requirements asked the Supreme Court to hear their case Thursday, in the first of dozens of religious lawsuits against the provision to reach the top court. Alliance Defending Freedom, a religious legal-rights group, filed a petition on behalf of Conestoga Wood Specialties Corp., a cabinet part manufacturer owned by a Mennonite Christian family (Radnofsky, 9/19).

Earlier, related KHN coverage: A Guide To The Lawsuits Challenging Obamacare’s Contraception Coverage Requirements (Miller, 9/17).

The Associated Press: IHS Expands Access To Plan B For Native Women
Native American women seeking emergency contraception at Indian Health Services facilities managed by the federal government now can get it without a consultation or prescription. The agency had come under fire from women's health advocates who said it needed to make the morning-after pill more accessible to American Indian and Alaska Native women. IHS has no retail pharmacies, and critics said Native women faced long wait times for Plan B because they had to compete with all the other patients seeking emergency care at clinics, urgent care centers or at emergency rooms (Fonseca, 9/19).

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Home Depot Will Send Part-Timers To Health Insurance Exchanges

The giant home improvement chain said it will send almost 20,000 part-time employees to the health law's online marketplaces for insurance. Meanwhile, the Associated Press reports that small businesses are racing to renew their health policies before year's end to avoid having to comply with the health law's requirements, which take effect Jan. 1.

The Wall Street Journal: Home Depot Alters Insurance For Part-Timers
Home Depot Inc. plans to end health care coverage for almost 20,000 part-time employees, instead directing them to government-sponsored insurance exchanges. The Affordable Care Act -- President Barack Obama's health care overhaul -- precludes the company from offering the limited-liability plans that part-time workers currently receive, said spokesman Stephen Holmes. The change will affect nearly 20,000 people, which is about 5 percent of the company's work force, Mr. Holmes said (Beckerman, 9/19).

Reuters: Home Depot To Tap Health Insurance Exchanges For Part-Timers
Home Depot Inc is shifting medical coverage for part-time workers to new public marketplace exchanges ahead of new benefits requirements under the U.S. Affordable Care Act, a spokesman said on Thursday. The world's largest home improvement retail chain announced its move shortly after a similar announcement from Trader Joe's Co, a popular privately held grocery chain (9/19).

The Associated Press/Washington Post: Small Businesses Rush To Renew Health Policies In 2013, Avoid Higher Prices Under ACA
Many small businesses have found a way to temporarily sidestep some of the headaches brought on by the new health care law. One of them is Huber Capital Management. The asset management firm is renewing its health insurance policy early, in 2013 instead of 2014. By renewing its policy this year, the company doesn't have to buy insurance that conforms to the requirements of the new health care law. And it won’t have the surge in premium rates expected under the Affordable Care Act (9/19).

Related, from KHN: FAQ: How Employer-Sponsored Health Insurance Is Changing (Hancock, 9/17)

Meanwhile, a group of GOP senators urges OMB not to exempt union-sponsored health plans from the health law --

The Wall Street Journal's Washington Wire: Senators' Plea To OMB: No Carve Out For Union Health Plans
Adding insult to injury? A group of 21 Republican senators urged the Office of Management and Budget not to approve any regulations that would provide a special "carve out" to union-sponsored health plans under the Affordable Care Act. In a blow for unions, the White House already said late Friday that it can’t legally make the primary change unions want to the new health-care law. For months, unions have been warning that the law could cause millions of their members who get health insurance under multiemployer plans to lose their coverage (Trottman, 9/19).

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HHS Warns Texas Gov. Against Adding 'Cumbersome Requirements' For Navigators

The federal letter comes in response to an effort by Gov. Perry to tighten rules to protect consumers' confidential information. Also in news about the efforts to get the online marketplaces running, federal and some state officials again pledge that exchanges will be ready for operation on Oct. 1, but the Wall Street Journal reports on some new glitches.

The Houston Chronicle: Perry And Feds At Odds Over Health Care Navigators
The Obama administration is accusing Gov. Rick Perry of making a "blatant attempt to add cumbersome requirements" for people hired to help uninsured Texans enroll in health coverage, just two weeks before health care reform insurance marketplaces open. Federal officials responded to a Tuesday letter Perry sent to state Insurance Commissioner Julia Rathgeber. The governor said it is imperative that the state adopt more stringent regulations than the federal government's to protect Texans and their confidential information, including birth dates, Social Security numbers and financial information. (Hines and Hart, 9/19).

CQ HealthBeat: GOP Lawmakers Blast Oversight of Navigators, Question Exchange Readiness
With a dozen days left to go before insurance exchanges open on Oct. 1, Republicans at a House subcommittee hearing Thursday lit into one of the top federal officials in charge of implementing the health law. During two hours of questioning they accused Gary Cohen of the Centers for Medicare and Medicaid Services, the hearing's sole witness, of mismanaging the navigator program, which was created under the law to help guide uninsured Americans through the complexities of the enrollment process (Reichard, 9/19).

Politico: Obamacare Official: Go For Launch Oct. 1
Obamacare enrollment is on track to launch Oct. 1, a top Obama administration official overseeing the rollout of the massive new health care law said on Thursday. And even if there are problems in the first days of enrollment, Cohen assured the subcommittee, the millions of people who get health insurance through Obamacare won't remember them in the long run (Millman, 9/19).

The Wall Street Journal: Pricing Glitch Afflicts Rollout Of Online Health Exchanges
Less than two weeks before the launch of insurance marketplaces created by the federal health overhaul, the government's software can't reliably determine how much people need to pay for coverage, according to insurance executives and people familiar with the program (Weaver, Martin and Dooren, 9/19).

Bloomberg: California Online Health Exchange Said Ready For Oct. 1
California, the most populous U.S. state, said the health insurance exchange it's building as part of the Affordable Care Act will be ready on Oct. 1.  Delayed testing of computers and other missed milestones have raised questions about whether exchanges nationwide would be ready to start enrolling as many as 7 million customers next month for subsidized private medical plans that are the centerpiece of the 2010 health law (Marois, 9/19).

MinnPost: Reports Find Potentially Serious Problems, But MNSure Director Says Health Exchange Is A Go
Despite internal documents identifying potentially serious problems, the head of Minnesota’s new health exchange expressed confidence Thursday that the system will go online Oct. 1 with at least barebones functions. The MNsure documents, obtained by MinnPost, note staff and consultants' specific concerns about issues involving small businesses using the exchange, as well as eligibility verification and user testing (Nord, 9/19).

In other exchange news -

CT Mirror: Obamacare Insurance: What The Standard Gold, Silver And Bronze Plans Look Like
Here's a look at the deductibles, copays and coinsurance requirements for the standard plans that will be offered through Access Health CT, the state's health insurance exchange. There are six plan types listed here. Bronze, silver and gold are available to any exchange customers. The bottom three -- silver 94, silver 87 and silver 73 -- are only available to people with low incomes and have reduced cost-sharing (9/19).

The Seattle Times: Don't Be Fooled By Site Similar To Official Health Exchange
If you go to washingtonhealthplanfinder.org you’ll see a "Welcome to the exchange" message inviting you to compare and sign up for health-insurance plans. You can get quotes and there's an online chat utility you can use to ask questions.  But the site isn't what you may think it is. It isn't the Washington Healthplanfinder, the state online exchange set up under the Affordable Care Act to find and purchase individual insurance plans. You'll find that at wahealthplanfinder.org (Marshall, 9/19).

Earlier related KHN coverage: Consumer, State Officials Warn Buyers To Be On the Lookout For Fake, Look-Alike Exchange Sites (Miller, 9/12).

Minnesota Public Radio: MNsure Outreach Criticized By Minority Groups 
A state senator says the $9 million marketing campaign for the state's new online health insurance marketplace is under review for its appeal to minority groups. Marketing for MNsure may also need to be expanded, said DFL state Sen. Jeff Hayden of Minneapolis (Shenoy, 9/19).

Minnesota Public Radio: MNsure Data Security Breach Prompts New Bill 
A data security breach at the state's new online insurance marketplace has prompted two members of Minnesota's Congressional delegation to write a bill designed to prevent confidential information from being leaked again. Starting Oct. 1, uninsured Minnesotans will be using MNsure to purchase health insurance, and they'll have to provide information about themselves in the process (Richert, 9/19).

Detroit Free Press: How Michigan's Health Insurance Exchange Will Work
Because Michigan lawmakers delayed action, the Michigan Health Insurance Marketplace, also called the exchange, will be operated by the federal government. The U.S. Department of Health and Human Services (HHS) will run the exchange, as well as out-of-state call centers that will provide consumers with information (Erb, 9/19).

Also, HHS Secretary Kathleen Sebelius urges Missouri to reconsider its Medicaid actions --

St. Louis Beacon: HHS Secretary Urges Missouri To Take Medicaid Expansion Money
Missouri could lose $8 billion in federal funding during the first six years of health reform if state lawmakers continue to refuse to expand Medicaid to insure more of the needy, according to Health and Human Services Secretary Kathleen Sebelius. She spoke during a stop in St. Louis for a meeting with St. Louis Mayor Francis Slay, County Executive Charlie Dooley, health leaders and others working to help prepare consumers for the reform law’s insurance exchange marketplace, which opens for business on Oct. 1 (Joiner, 9/20).

CQ HealthBeat: How Exchanges Will Impact Medicaid On MACPAC’s Future Agenda
The Medicaid and CHIP Payment and Access Commission discussed at its meeting on Thursday its priorities for the coming year, with a focus on the implementation of the health care law and the intersection of Medicaid with new marketplaces that will start enrolling people in less than two weeks. Commissioners on the panel, known as MACPAC, batted around half a dozen ideas that they had discussed at a private planning retreat in July and said they want to explore more (Adams, 9/19).

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Obamacare And Coverage For Immigrants, Children

Media outlets look at the ways in which the law affects different immigrant groups and children.

Kaiser Health News: FAQ: Obamacare And Coverage For Immigrants
The U.S. is home to more than 21 million immigrants who are not citizens, and for many of them, health coverage is a concern. That is partly because so many of them--both those who came here legally and those who do not have permission to live in the United States--work in low wage jobs that don’t include health coverage (Appleby, 9/19).

Stateline: The ACA's 'Family Glitch' Could Hurt Families Who Need CHIP
The Affordable Care Act is primarily aimed at insuring more adults, including parents. In the process, a substantial number of uninsured children may also get coverage as their parents learn more about federal and state subsidies. Just how many will depend on whether states maintain their existing Children’s Health Insurance Program (CHIP) (Vestal, 9/20).

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25 Hospitals Ready Alliance In Response To Obamacare

A group of 25 hospitals across 7 hospital systems in New York, New Jersey and Pennsylvania will form what it calls the nation's largest health care alliance to improve care and lower costs.

The Associated Press/Wall Street Journal: 25 NJ, NY, Pa. Hospitals To Share Some Resources
Twenty-five hospitals in three states have agreed to research and share ideas about what works in a new health care alliance. AllSpire Health Partners announced its plans Wednesday night, saying the idea is designed in reaction to President Barack Obama's health insurance overhaul. The group says it can improve care and lower costs (9/19).

Reuters: Group Plans To Form largest U.S. Hospital Alliance
Seven hospital systems in New Jersey and Pennsylvania will form what executives say will be the largest U.S. health care alliance in the country. The number of hospital mergers has soared in the past several years as providers band together to increase their power to negotiate higher reimbursement rates from insurers (Jones, 9/19).

The Philadelphia Inquirer: Hospitals Tout New Alliance’s Ability to Share Knowledge, Pool Resources 
Creation of the alliance could signal the arrival in New Jersey of a trend in which hospitals form huge networks in order to strengthen their ability to achieve large-scale savings and efficiencies (9/20).

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Public Health & Education

Cases Of Elderly Dementia Projected To Triple By Mid-Century

NPR: Report: Cases Of Elderly Dementia To Nearly Triple By 2050
By the middle of the century, the number of older people suffering from Alzheimer's and other forms of dementia will nearly triple, severely straining caregiving resources, the charity Alzheimer's Disease International says in a new study released Thursday (Neuman, 9/19).

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State Watch

State Highlights: 850K Texas Kids Lack Health Coverage

A selection of health policy stories from Texas and California.

Kaiser Health News: Capsules: Census: More Than 850,000 Texas Kids Lack Health Coverage
Texas continued to have the highest rate of people without health insurance in 2012 at 24.6 percent, or more than 6 million residents, according to the Current Population Survey estimates released by the U.S. Census Bureau this week. Texas also has the largest number of children without health insurance and the highest rate of poor adults without health insurance, according to 2012 American Community Survey estimates (Aaronson, 9/20).

Healthy Cal: County Health Departments Brace For Cuts 
Counties all over California are cheering the state’s decision to expand Medi-Cal to more than 1.4 million low-income adults – and bracing for the $1.3 billion the state expects to take away from county health services over the next four years. Counties should see savings on January 1, 2014, when Medi-Cal expands to include childless adults under the age of 65 with incomes less than 138 percent of the federal poverty level or $15,856 for an individual annually. The federal government will pay 100 percent of the costs for new enrollees from 2014-2016 and 90 percent in 2020 and beyond (Graebner, 9/19).

California Healthline: Autism Advocates Praise Covered California's Expected Policy Change
The Covered California health benefit exchange board today is expected to reverse a policy that required all family members to join the exchange together, and that move is being hailed by autism advocates. They say a vital type of autism treatment now will be affordable for more California families. Many families in California cannot afford to pay for applied behavior analysis (ABA) therapy, except through health insurance, according to Karen Fessel, executive director of the Autism Health Insurance Project, a not-for-profit autism advocacy group (Gorn, 9/19).

California Healthline: Changes On Horizon For California Safety Net's Care Of Undocumented, Indigent
What is unclear, however, is how these clinics will stay afloat to provide care for millions of undocumented immigrants who will be left out of health reform. One strategy is to position themselves as a provider of choice, which will bring in additional revenue from new Medi-Cal patients, and through the private insurance market, said Shannon McConville, a health policy expert and researcher for the Public Policy Institute of California. McConville in 2012 co-wrote an extensive report examining the role of the state's safety net called, "Access to the Health Care Safety Net in California” (Hart, 9/18).

Healthy Cal: Prompted By Reform Incentives, Hospitals Aim For Customer Satisfaction 
Under national health care reform, the federal government is starting to link hospital payments to how well they treat patients, and hospitals are responding by creating new customer-satisfaction positions like Kegin’s, changing security procedures, and even timing how long people must spend on the telephone before getting needed medical information. The Affordable Care Act links about $1 billion in Medicare reimbursement payments nationwide to how hospitals score on the federal Centers for Medicare & Medicaid Services’ "Hospital Consumer Assessment of Healthcare Providers and Systems" survey, or HCAHPS (Richard, 9/20).

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Health Policy Research

Research Roundup: 'Cadillac' Plan Taxes; Long-Term Care Services

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

Health Affairs: Excise Tax On 'Cadillac' Plans
As health coverage expands to tens of millions of Americans--through Medicaid expansion in states and the new state health insurance exchanges that will soon begin selling individual health coverage--some Americans with employer-sponsored health coverage are seeing their benefits decrease. One of the most significant, and controversial, provisions of the Affordable Care Act is the new excise tax on high-cost health plans proposed to both slow the rate of growth of health costs and finance the expansion of health coverage. The provision is often called the "Cadillac" tax because it targets so-called Cadillac health plans that provide workers the most generous level of health benefits. These high-end health plans' premiums are paid for mostly by employers. ... It's not yet clear how widely the excise tax will be felt by both employers and consumers (Piotrowski, 9/12).

Journal of the American Medical Association: Chronic Care Management For Dependence On Alcohol And Other Drugs
People with substance dependence have health consequences, high health care utilization, and frequent comorbidity but often receive poor-quality care. Chronic care management (CCM) has been proposed as an approach to improve care and outcomes. ... Chronic care management is multidisciplinary patient-centered proactive care, a way to organize services that provides coordination and expertise, and has been effective for depression, medical illnesses, and tobacco dependence (a substance use disorder). ... Participants were randomized to receive CCM (n=282) or no CCM (n=281). ... Among persons with alcohol and other drug dependence, CCM compared with a primary care appointment but no CCM did not increase self-reported abstinence over 12 months. Whether more intensive or longer-duration CCM is effective requires further investigation (Saitz et al., 9/18).

Commonwealth Fund: Health Care in the Two Americas: Findings from the Scorecard on State Health System Performance for Low-Income Populations, 2013
Analyzing 30 indicators of access, prevention and quality, potentially avoidable hospital use, and health outcomes, the Scorecard documents sharp health care disparities among states. Between leading and lagging states, up to a fourfold disparity in performance exists on a range of key health care indicators for low-income populations. There are also wide differences within states by income. If all states could reach the benchmarks set by leading states, an estimated 86,000 fewer people would die prematurely and tens of millions more adults and children would receive timely preventive care. Moreover, many benchmarks for low-income populations in the top states were better than average and better than those for higher-income or more-educated individuals in the lagging states (Schoen et al., 9/18).

The Kaiser Family Foundation: Five Key Facts About the Delivery and Financing of Long-Term Services and Supports
Fact #1: People of All Ages Require Long-Term Services and Supports. As a result of physical limitations, cognitive impairments, mental illness, and/or a disabling chronic condition, an individual may need long-term assistance for several months or years. ... Fact #2: Many People Who Need Long-Term Services and Supports Rely on Unpaid, Informal Care. Family caregivers have traditionally provided informal assistance with personal care and household chores, but in many cases informal caregiving now includes skilled medical/nursing care tasks such as meal preparation for a special diet, wound care, and care coordination (9/13).

The Urban Institute/Connecticut Health Foundation: No Wrong Door: Improving Health Equity and the Health Coverage Consumer Experience in Connecticut
"No Wrong Door" (NWD): A system that allows consumers to apply for health insurance through different agencies, and then seamlessly routes them to the program for which they qualify. Full implementation is critical in order for the Affordable Care Act (ACA) to accomplish its goals. Even without NWD, the ACA would increase the number of state residents with health insurance. However, adding NWD would increase that enrollment figure by 13 percent, with the greatest advantage accruing to children and people of color. With full implementation of NWD, over the course of a year, 36,000 people who would otherwise experience periods without coverage will instead be continuously insured (Buettgens and Dorn, 9/6).

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

Medscape: Self-Referring Physicians Have Lower Threshold for Knee MRI
When physicians have a financial interest in imaging equipment, they are much more likely to order knee magnetic resonance imaging (MRI), according to a study published online September 17 in Radiology. The practice is called self-referral, meaning physicians who are not radiologists refer patients to imaging facilities in which they or their partners have a financial interest (Frellick, 9/17).

Los Angeles Times: Colon Cancer Screening Works Over The Long Term, Studies Confirm
Getting a colonoscopy is not something most people look forward to -- but a new analysis suggests that it's worth it to follow screening recommendations and have the test done every 10 years (or every five for those at high risk.) Writing in the New England Journal of Medicine on Wednesday, Harvard researcher Reiko Nishihara and co-authors assessed colonoscopy use, colorectal cancer cases and colorectal cancer deaths among participants in the multidecade Nurses' Health Study and Health Professionals Follow-up Study (Brown, 9/18).

HealthDay: Medicaid Patients Behind Jump In California ER Visits, Study Finds 
Difficulty finding primary care may explain a large rise in emergency department visits by adults in California with Medicaid coverage, according to researchers. Emergency department visits made by adults aged 19 to 64 increased 13 percent between 2005 and 2010, according to their analysis. ... The largest increase in visits occurred in 2009, likely because of the H1N1 swine flu pandemic and the effects of the economic downturn, the authors suggested in a research letter published in the Sept. 18 issue of the Journal of the American Medical Association (Preidt, 9/17).

Medscape: Dental Care in Exchange for Community Service, Program Works
Requiring indigent patients to do community service in exchange for their dental care can reduce their reliance on emergency rooms, a new study shows. Emergency room visits for dental pain in Calhoun County, Michigan, have dropped by 70% since the start of a new program called the Calhoun County Dentists' Partnership, researchers report in the September issue of Health Affairs (Harrison, 9/17).

Medscape: Delivery Room Guidelines Improve Outcomes for Preemies
Use of new evidence-based delivery room guidelines was associated with significantly improved outcomes for very low birth weight infants, according to the results of a single-institution study published online September 16 in Pediatrics. The authors, led by Sara B. DeMauro, MD, MSCE, from the Department of Pediatrics, the Children's Hospital of Philadelphia, Pennsylvania, note that events during the first moments of an infant's life can have lasting effect, especially for those born very prematurely. "Specifically, 3 aspects of newborn care that require prompt attention in the delivery room are thermoregulation, respiratory management, and oxygen delivery," they write (Fox, 9/16).

MedPage Today: Majority of Docs Still Own Their Own Practices
Despite perceptions of corporatization of American medicine, more than half of surveyed physicians (53.2%) were self-employed in 2012, according to by the American Medical Association. An even larger majority -- 60% -- worked in practices that were fully owned by physicians (Bankhead, 9/17).

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Weekend Reading

Longer Looks: Psychology Of Gun Control; Saying Goodbye; Questioning ADHD

Every week reporter Ankita Rao selects interesting reading from around the Web.

The New York Times: A Decade Of Goodbye
These weeks after the passing of my husband, Stuart, I often think of Joan Didion and her book "The Year of Magical Thinking," and about how her beloved husband, John Gregory Dunne, died suddenly of cardiac arrest while sitting in his living room.  During Stuart's illness, I considered Ms. Didion fortunate to be spared a long goodbye. How much more difficult it is when one suffers a decade of caregiving — the dash to hospitals, the languishing in emergency rooms, the years of chemo and radiation. A path that leads only to degradation as a 175-pound man, who scaled mountains and joyously ran marathons, one day transmogrifies into a 118-pound skeleton, with a failing liver and kidneys. For the last decade death has been hovering, but now it scratches at our door (Joan Marans Dim, 9/18).

The Atlantic: Why Mental Health Background Checks Are Not The Solution To Gun Violence
How was he allowed to buy a gun? It's the question people are asking after learning that Aaron Alexis, the shooter in the Washington Navy Yard massacre Monday, had been involved in at least two prior shooting incidents and as recently as August sought the assistance of police in Rhode Island because he was hearing voices. … This is the great problem at the heart of efforts to turn improved mental health reporting into our primary form of gun control. More than half of Americans experience one or more mental illnesses over the course of their lives, and around 26 percent of Americans over age 18 each year experience at least one, primarily anxiety disorders and mood disorders like depression (Garance Franke-Ruta, 9/19).

Salon: Psychiatry And Mental Illness: Has Science Gone Too Far?
The long-awaited update to the American Psychiatric Association’s "bible" for mental disorders, the DSM-5, was officially released in May. But the National Institute of Mental Health, part of the U.S. Department of Health and Human Services, has taken the official stance that the DSM is "no longer sufficient for researchers." What does this mean for the future of psychiatry — for researchers, clinicians and consumers of mental health services? Psychiatry, in its current iteration, emphasizes the clinician's judgment call for diagnosis. Such judgment calls are currently based on the DSM. But with newer technologies and increasingly sophisticated genetic research, psychiatry could become more about biology — although, as researchers are now discovering, some disorders could be easier to find biological bases for than others (Esme Weijun Wang, 9/18).

The New York Times: Complex Science At Issue In Politics Of Fetal Pain
It is a new frontier of the anti-abortion movement: laws banning abortion at 20 weeks after conception, contending that fetuses can feel pain then.  Since 2010, a dozen states have enacted them, most recently Texas. Nationally, a bill passed the Republican-dominated House of Representatives in June.  The science of fetal pain is highly complex. Most scientists who have expressed views on the issue have said they believe that if fetuses can feel pain, the neurological wiring is not in place until later, after the time when nearly all abortions occur (Pam Belluck, 9/16).

The Atlantic: ADHD, Or Childhood Narcissism
In a typical American classroom, there are nearly as many diagnosable cases of ADHD as there are of the common cold. In 2008, researchers from the Slone Epidemiology Center at Boston University found that almost 10 percent of children use cold remedies at any given time. The latest statistics out of the Centers for Disease Control and Prevention estimate that the same proportion has ADHD. The rising number of ADHD cases over the past four decades is staggering. In the 1970s, a mere one percent of kids were considered ADHD. By the 1980s, three to five percent was the presumed rate, with steady increases into the 1990s (Enrico Gnaulati, 9/17).

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Editorials and Opinions

Viewpoints: Florida's 'Sabotage' Of Health Law; The Irony Of Conservatives' 'Nightmare' Ads; Obamacare 'Crushes' American Families

The New York Times: Blocking Health Care Reform In Florida 
Kathleen Sebelius, the secretary of health and human services, has been visiting the state to encourage private groups to help residents understand what insurance policies and federal subsidies will be available to them when the enrollment period opens Oct. 1. ... Florida has been shameless in attempting to destroy what top officials call “Obamacare,” with tactics that will deprive its own poor and middle-income citizens of the benefits of the national reform law (9/19). 

Tampa Bay Times: S.C. Beats Florida When It Comes To Health Coverage
South Carolina officials are preparing for the coming changes to health insurance even as Gov. Nikki Haley opposes health care reform. They intend to encourage people to get coverage. Even without Medicaid expansion, the state has about 170,000 people eligible for Medicaid in the state who are not enrolled. ... South Carolina also is enlisting hospitals to help get the uninsured coverage (9/19).

USA Today: ObamaCare Foes Taking Hostages: Our View
Republicans' obsession with overturning ObamaCare is getting sillier and more dangerous at the same time. Now that they've failed to kill the law every way the rules allow — in Congress, the Supreme Court and in a presidential election — the opponents are taking hostages ... At some point, they need to tell their nominal followers the truth about health reform: This is a democracy. You lost on one issue. Move on (9/19).

USA Today: ObamaCare Hurts All Americans
All across America, families and small businesses are struggling to make ends meet. They're being crushed by higher taxes as well as more regulation and mandates from ObamaCare. Even labor leader Jimmy Hoffa Jr., usually a reliable supporter of President Obama, said ObamaCare will "destroy the foundation of the 40-hour work week that is the backbone of the American middle class." ObamaCare was sold as a benefit to hardworking Americans, but it is hurting the very people it was intended to help (Rep. Marlin Stutzman, R-Ind., 9/19).

The New York Times: The Crazy Party
In recent months, the G.O.P. seems to have transitioned from being the stupid party to being the crazy party. ... Some pundits insist, even now, that this is somehow Mr. Obama’s fault. Why can’t he sit down with Mr. Boehner the way Ronald Reagan used to sit down with Tip O’Neill? But O’Neill didn’t lead a party whose base demanded that he shut down the government unless Reagan revoked his tax cuts, and O’Neill didn’t face a caucus prepared to depose him as speaker at the first hint of compromise. No, this story is all about the G.O.P. (Paul Krugman, 9/19).

National Review: Congressman On Obamacare Exemption: 'Go Home And Talk To Your Wife'
A debate among congressional Republicans over a potential line of attack on Obamacare is pitting their pocketbooks against the chance at political gold. At issue is a requirement in the law that congressional staffers purchase their health insurance in the exchange markets. ... Representative Joe Barton of Texas [estimated that the change] would cost him $12,000. ... [Rep. Phil Gingrey] had little sympathy for lawmakers and even less for staff. Capitol Hill aides, he said "may be 33 years old now and not making a lot of money. But in a few years they can just go to K Street," the Washington, D.C., vernacular for becoming a lobbyist, "and make $500,000 a year. Meanwhile I’m stuck here making $172,000 a year" (Jonathan Strong, 9/18).

The New Republic: This Creepy Anti-Obamacare Ad Will Give You Nightmares
Here's the latest ad against Obamacare. It involves a young woman on a medical-exam table and a creepy Uncle Sam mask. ... This is probably the part where I should talk about policy—and the fact that, thanks to Obamacare, between 25 and 30 million additional people will have health insurance. Today, many of those people would love to get medical exams but can't, because they can't pay the bills. ... Or maybe I should point out the irony of conservatives spotlighting a gynecological exam—and insinuating that, because of Obamacare, Uncle Sam will be invading women’s privacy and personal health decisions. Isn't this the same party and movement that believes the federal government should be in the middle of reproductive health? (Jonathan Cohn, 9/19).

Los Angeles Times: Debunking The Latest Creepy Smear Of Obamacare
These are dynamite ads -- if the only thing one cares about is shock value and virality. They also happen to be wildly misleading, taking the hyperbolic "government takeover of medicine" meme to an extreme. First off, no one will "sign up for Obamacare." Those who are not covered by group plans through their employers will shop for private insurers' individual plans the same way they do today, or through new state insurance-buying exchanges created by the 2010 law (Jon Healey, 9/19).

Forbes: A Day In The Life Of A Patient: Why Can't We Do Better
Is there a patient who goes through a hospitalization who does not have stories to tell about the obstacles, errors and indignities that they endured? I just wonder sometimes. A family relative was hospitalized this week with a stroke at a hospital a few hours from me -- and his experience left me demoralized about medicine (Harlan Krumholz, 9/19).

The New York Times' Opinionator: Medicine's Search For Meaning
Every day, we are reminded that the health care system is in crisis. We are going bankrupt. There are too many lawsuits. We practice defensive medicine. We restrict access. But surveys of doctors indicate a problem that penetrates much deeper than this. Today, almost 50 percent of doctors report symptoms of burnout — emotional exhaustion, low sense of accomplishment, detachment (David Bornstein, 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.