Daily Health Policy Report

Monday, September 23, 2013

Last updated: Mon, Sep 23

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Health Reform


Editorials and Opinions

KHN Original Reporting & Guest Opinion

FAQ: Seniors On Medicare Don't Need To Apply To The Health Law Marketplaces

Kaiser Health News staff writer Mary Agnes Carey reports: "Nearly 50 million Americans are enrolled in Medicare, the federal health insurance program for the elderly and disabled. The 2010 health care law, known as the Affordable Care Act, will make some changes to the program. Here are some answers to frequently asked questions about Medicare and the health law" (Carey, 9/23). Read the story.

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A Reader Asks: How Can We Be Sure To Get A Policy That Covers Maternity Care?

Kaiser Health News consumer columnist Michelle Andrews answers a reader’s question about maternity care coverage (9/23). Read the answer.

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Views On Obamacare Closely Track Party Preference In Washington State

The Seattle Times' Lisa Stiffler, working in partnership with Kaiser Health News, reports: "If you want to know whether people in Washington state like or loathe Obamacare, you could just ask them which political party they prefer. That's because 80 percent of Democrats surveyed approve of health-care reform while 80 percent of Republicans don't, according to an Elway Poll of Washington voters conducted on behalf of The Seattle Times. Independent voters are the wild card, with 41 percent in favor and 46 percent against the overhaul, formally known as the Affordable Care Act" (Stiffler, 9/23). Read the story.

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Capsules: Report Looks At Income Disparities For Seniors On Medicare

Now on Kaiser Health News' blog, Mary Agnes Carey reports: "Lawmakers considering major changes to entitlement programs as part of a deficit reduction package might want to consider this: Future Medicare recipients won’t be much better off financially than current beneficiaries, according to a new analysis from the Kaiser Family Foundation" (Carey, 9/20). Check out what else is on the blog.

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Political Cartoon: 'Flat Out?'

Kaiser Health News provides a fresh take on health policy developments with "Flat Out?" by Bill Day.

Here's today's health policy haiku:

Exchanging Exchange Confusion

 Too many options?
Public, private exchanges!
Insurance: who, when?
-Team Haiku, Altarum

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

Budget Battle Flashpoints Highlight Debt And Health Law Issues

News outlets report on what could happen in the next eight days as congressional leaders and the White House posture around the looming government shutdown.

The Associated Press/Washington Post: 1 Week From Potential Shutdown, Congress And White House Weigh Options To Dodge Stalemate
The unyielding political posturing comes one week before Congress reaches an Oct. 1 deadline to dodge any interruptions in government services. While work continues on a temporary spending bill, a potentially more devastating separate deadline looms a few weeks later when the government could run out of money to pay its bills. Lawmakers are considering separate legislation that would let the United States avoid a first-ever default on its debt obligations. House Republicans are planning legislation that would attach a 1-year delay in the health care law in exchange for ability to increase the nation’s credit limit of $16.7 trillion (9/23).

The Washington Post: Shutdown Countdown: What The Next Eight Days Could Bring
On Friday, the House passed a measure that would keep the government running through mid-December. But it came with what Democrats consider a poison pill: It defunds President Obama’s signature health-care law, known as Obamacare. There is no way whatsoever — think pigs flying — that the Senate will agree to the House plan. Senate Majority Leader Harry M. Reid (D-Nev.) said the House bill was "dead," then for emphasis added: "Dead." That sets up eight days of brinkmanship between the Republican House and the Democratic Senate and White House, leading to midnight Sept. 30, when much of the government will shut down if there's no deal. Leaders on Capitol Hill expect the face-off to go right up to the deadline, if not beyond. Below is a day-by-day look at how it’s all likely to play out — with the caveat that events can change quickly (Kane, 9/22).

The Washington Post: Fight Over Spending, Debt And Health Law Has Risks For Republicans And Obama
The strategy to tie defunding of Obamacare to the government-funding bill has divided Republicans, producing an extraordinary spectacle of intraparty second-guessing and pointed criticism. The debate highlights a fundamental schism within the Republican Party. Can Republicans cater to their conservative base and still find ways to expand their appeal across the electorate in order to win back the White House in the future? Are the two mutually compatible or mutually exclusive? There are reasons Republicans feel emboldened to go after Obama’s health-care law. Three years after he signed the measure, the president has clearly failed in the public relations effort to win support for the Affordable Care Act (Dan Balz, 9/21).

Politico: Ted Cruz Scrambles To Salvage Strategy
After months of fiery rhetoric, Cruz and his allies are scrambling to salvage their strategy. For starters, Cruz wants Reid to make an exception to Senate rules that would make it easier for Republicans to block Obamacare funding (Everett, 9/23).

Dallas Morning News: Ted Cruz, Accused Of Using Obamacare Fight To Run For President, Prods House GOP To Stand Firm
Sen. Ted Cruz kept up the pressure on House Republicans to stand firm against Democratic efforts to fund Obamacare – suggesting yet again that he may not be able to round up enough allies in the Senate to block the health care law. “The House is the only body where the Republicans have a majority and so the House has to lead on this,” he said (Gillman, 9/22).

The Associated Press/Washington Post: Lawmakers Start Laying Groundwork For Blame Over Budget Showdown And Government Shutdown
Even before a budget deadline arrives, leaders from both parties are blaming each other — and some Republicans are criticizing their own — for a government shutdown many are treating as inevitable. The top Democrat in the House says Republicans are "legislative arsonists" who are using their opposition to a sweeping health care overhaul as an excuse to close government's doors. A leading tea party antagonist in the Senate counters that conservatives should use any tool available to stop the Affordable Care Act from taking hold. President Bill Clinton's labor secretary says the GOP is willing "to risk the entire system of government to get your way," while the House speaker who oversaw the last government shutdown urged fellow Republicans to remember "this is not a dictatorship" (9/22).

Los Angeles Times: Shutdown Threat Reveals Split In Republican Party
Senate Majority Leader Harry Reid (D-Nev.) is expected to begin debate this week on legislation approved by the Republican-led House that would keep the government running but do away with President Obama's Affordable Care Act. Because the Senate's Democratic majority is likely to have enough votes to strip out the healthcare law provision and keep Obama's signature domestic achievement on track, Republicans have few options. They can block the entire bill, joining Cruz's call for a filibuster and risking blame if the government shuts down. Or they can step aside and try to fight the healthcare law during the next budget battle in mid-October (Mascaro, 9/22).

CBS News: Budget Bill Battle Over Obamacare Opens New GOP Schism
After the House passed a bill on Friday funding the government for roughly three months but defunding Obamacare, the fight over the budget and the healthcare law shifted to the Senate. While most lawmakers, including many Republicans, have all but conceded that the Senate will never pass the House bill and will instead re-insert Obamacare funding, Sen. Ted Cruz, R-Texas, who is leading the fight against the healthcare law in the upper chamber, insisted it's still possible for the Senate to follow the House's lead (Miller, 9/22).

Fox News: Paul: We Probably Can't Get Rid Of 'Obamacare'
Kentucky Republican Sen. Rand Paul said Saturday that President Barack Obama's healthcare law is unlikely to be repealed or defunded and suggested that there were few options and not much time left for his fellow congressional Republicans to halt the law's full implementation. Speaking to reporters at a gathering of Michigan Republicans, Paul, a hot prospect for a presidential campaign in 2016, said Republicans in Congress could use votes on measures in the House and in the Senate to come up with compromise legislation that could make the law more palatable (9/22).

Kaiser Health News also tracked weekend news from the Sunday morning talk shows and the back-and-forth over defunding Obamacare (9/22) as well as details of the House vote approving a stopgap spending measure that would defund the health law (9/20).

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Health Reform

Why A Gov't Shutdown Won't Stop The Health Law's Implementation

News outlets report that government officials involved in the launch of the health law's online insurance marketplaces on Oct. 1 say they expect to have access to funding even if the federal government stops operating.

Reuters: Even In A U.S. Government Shutdown, Obamacare Exchanges Could Function
U.S. State officials behind the launch of President Barack Obama's healthcare reform on October 1 say they could weather a federal government shutdown, though the scenario would add new pressure to the political attacks and technical issues that have weighed on the program's introduction. Several officials running new state-based insurance exchanges that are due to open for enrollment next month said they expected to have access to funds in the case of a shutdown, which if it happens, would also start on October 1, the beginning of the fiscal year (Begley and Krauskopf, 9/21).

Bloomberg: Obamacare Enrollment Continues If Government Shuts Down
Shutting down the government won’t shut down the health-care law. In a quirk of the calendar, the start of enrollment for the Affordable Care Act and the first day of a shutdown would fall on the same day, Oct. 1. The good news for President Barack Obama is that cutting off funds for non-essential government programs in a shutdown wouldn’t stop funding for implementing his health care law, health policy experts said (Przybyla and Wayne, 9/23).

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Exchange Dynamics Will Dictate Consumers' Experiences, Costs

Health law advocates frequently say health insurance will cost less as a result of the health law, but news outlets report that a downside could be less choice.

The Wall Street Journal: Health-Law Implementation To Vary By State
There is just one federal health law, but the way Americans experience the debut of its main provisions on Oct. 1 will vary widely depending on where they live. Every state, whether it supports the law or not, will have a health insurance exchange where people will shop for coverage—the health overhaul's centerpiece (Schatz and Radnofsky, 9/22).

The New York Times: Lower Health Insurance Premiums To Come At Cost Of Fewer Choices
Federal officials often say that health insurance will cost consumers less than expected under President Obama’s health care law. But they rarely mention one big reason: many insurers are significantly limiting the choices of doctors and hospitals available to consumers (Pear, 9/22).

Meanwhile, CQ HealthBeat offers an update on federal exchange software issues -

CQ HealthBeat: CMS Downplays Reported Premium Errors Calculated By Federal Exchange Software
A Centers for Medicare and Medicaid Services spokesman Friday downplayed reported difficulties the government is having debugging software that calculates how much people will pay for the health coverage scheduled to be offered starting Oct. 1 by exchanges in the 36 states operated by the federal government (Reichard, 9/20).

Also, some reports from states -

The Star Tribune: MNsure Shows Growing Pains, Fewer Than Two Weeks To Launch
Botched grants, an unnerving data security breach involving more than 1,000 Social Security numbers, and ridicule from some quarters over a multimillion dollar advertising campaign have left officials for MNsure scrambling to restore public confidence less than two weeks before a closely watched launch of the only state-run health exchange in the Midwest (Crosby and Brooks, 9/22).

California Healthline: Exchange Announces Its Enrollment Goals
Yesterday, Covered California, the state's health insurance exchange, announced its projection of success -- the target number of Californians it wants to enroll in the first phase of the exchange. "Our goal is to have 500,000 to 700,000 subsidy-eligible Californians enrolled in the exchange by April 1, [2014]," Peter Lee, executive director of Covered California, said. Lee spoke at yesterday's board meeting of Covered California, which will begin enrollment Oct. 1. Coverage for early enrollees would not start until Jan. 1, 2014. The end of the first insurance enrollment period for the exchange will be April 1, 2014 (Gorn, 9/20).

And then, of course, there's the latest on private exchanges as well as how Medicare beneficiaries should steer clear of the new marketplaces -

Reuters: Analysis: Benefit Firms Create Tremors For Insurers In U.S. Healthcare Shakeup
American companies are sending shockwaves through the healthcare industry by moving a rapidly growing number of employees onto privately run online exchanges for their medical coverage. In a business already bracing for major change because of President Barack Obama's healthcare reforms, the decisions are threatening to shift more power in the market to the benefit consulting firms opening many of the exchanges (Humer and Krauskopf, 9/20).

Kaiser Health News: FAQ: Seniors On Medicare Don't Need To Apply To The Health Law Marketplaces
Nearly 50 million Americans are enrolled in Medicare, the federal health insurance program for the elderly and disabled. The 2010 health care law, known as the Affordable Care Act, will make some changes to the program. Here are some answers to frequently asked questions about Medicare and the health law (Carey, 9/23).

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Kan. Medicaid Debate May Resume Next Year As Feds Emphasize Flexibility

Kansas lawmakers may return to the question next year of whether to expand Medicaid. Meanwhile, Health and Human Services Secretary Kathleen Sebelius says the federal government welcomes state experimentation with how health coverage to the poor is provided.

The Associated Press: Another Kan. Debate Over Medicaid Likely
Kansas legislators likely will have another debate next year over expanding the state's Medicaid program, despite the antipathy from conservative Republicans toward the federal health care overhaul that prevented such a move this year. The GOP-dominated Legislature inserted provisions in the state's current and next annual budgets to block an expansion of Medicaid, which covers health care for the needy and disabled (Hanna, 9/22).

Kansas Health Institute: Sebelius: Feds Flexible On How States Expand Medicaid
The federal government welcomes state experimentation when it comes to the Medicaid expansion encouraged under the health reform law, U.S. Health and Human Services Secretary Kathleen Sebelius said Saturday. ... She cited examples of states that are expanding Medicaid using a private insurance model for higher-income Medicaid recipients and others that are incorporating wellness strategies into their programs (Sherry, 9/22).

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Lobbyists, Including Restaurant Owners, Looking To Make Changes In Health Law

The efforts, some from strident opponents of the law, suggests they may now believe that they have to learn to live with the measure, The Washington Post reports. Also, Politico examines how President Barack Obama came to embrace the notion of changing health care.

The Washington Post: With Deadlines Looming, Lobbyists Push For Changes To Obamacare
While conservatives on Capitol Hill are waging a last-ditch battle to scuttle the Affordable Care Act, some powerful Washington groups that were among the legislation's loudest critics are now trying to shape the law and how it's carried out, an acknowledgment that they need to learn to live with the landmark initiative. Other players that have been more supportive of the law are also engaged in a lobbying push, pressing Congress and federal agencies to refine provisions (Yeager, 9/21).

The San Francisco Chronicle: Restaurants Fight 30-Hour Rule In Health Care Law
Restaurant owners have serious issues with the Affordable Care Act. The sticking point for many is the legal definition of a full-time worker as anyone averaging at least 30 hours a week on the job. By 2015, any company with more than 50 such employees (including "full-time equivalent employees," according to the law) will have to offer health benefits. Last week, restaurant execs met with Congress in a lobbying effort to eliminate the 30-hour rule (Wong, 9/22).

Politico: Promises Vs. Reality: Obama's Health Care Conversion
The most important red line of Barack Obama's presidency was scrawled hastily in January 2007, a few weeks before he even announced he was running for president. ... two aides, Robert Gibbs and Jon Favreau, hit on an idea that would make him appear more prepared and committed than he actually was at the moment. Why not just announce his intention to pass universal health care by the end of his first term? Thus was born Obamacare (Budoff Brown and Thrush, 9/22).

Also, a number of news outlets look at what is happening locally.

Milwaukee Journal Sentinel: New Health Insurance Co-Op Going Door-To-Door
[Common Ground Health Cooperative]  is one of 24 nationally that received almost $2 billion in federal funding through the Affordable Care Act to start nonprofit companies to sell health insurance to individuals and small businesses. Common Ground Healthcare Cooperative is one of four health insurers that will sell health plans to individuals and one of two that will sell plans for small employers in the Milwaukee area on the exchanges, the marketplace set up under the health care law, scheduled to start on Oct. 1 (Boulton, 9/22).

Bloomberg: Doctors Brace For Health Law's Surge Of Ailing Patients
Holy Cross Hospital's health center in Aspen Hill, Maryland, is bracing for more business.  The center treats the uninsured, and has been busy since it opened in 2012 with a waiting list of more than 400 people at its clinic. Now, as a result of the U.S. Affordable Care Act, it's mulling adding staff and hours in anticipation of next year's rush of newly-insured patients, many with chronic medical conditions that have gone untreated for years (Armour, 9/23).

Atlanta Journal-Constitution: The Faces Of Obamacare In Atlanta
Georgia has one of the highest rates of uninsured people in the nation: 1.9 million residents, about 19 percent, have no coverage. The Affordable Care Act was designed to reach these very people in one of two ways: the sale of private coverage on the Health Insurance Marketplace, also called an exchange, combined with a greatly expanded Medicaid program. The exchange opens Oct. 1. But Georgia decided not to expand Medicaid, which will mean that hundreds of thousands of people remain without coverage. Many uninsured will continue to do what they’ve done for years: live without health care until a condition turns into an emergency and forces a trip to the ER (Williams, 9/22).

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New Ad Campaigns Compete Over Obamacare Enrollment

The Obama administration and its opponents in implementing the health law are readying to launch ad campaigns aimed at getting people to sign up for or stay away from new online health insurance exchanges that open Oct. 1. Many of the ads are airing in swing states, but they are also aimed at the young and uninsured in California and Texas who are uninsured in the largest numbers.

The New York Times: Ad Campaigns Compete As Health Law Rollout Looms 
Starting this week, the White House will kick off a six-month campaign to persuade millions of uninsured Americans to sign up for health coverage as part of insurance marketplaces that open for business on Oct. 1. If too few people enroll, the centerpiece of the president's Affordable Care Act could collapse. But instead of offering the kind of grudging cooperation that normally follows even the most bitter of legislative battles, Mr. Obama’s foes have intensified their opposition, trying to deepen the nation’s anger about the health insurance program, which both sides often call Obamacare. Across the country, Republicans are eager to prevent people from enrolling, fearing that once people begin receiving the benefit they will be loath to give it up (Shear, 9/21).

Los Angeles Times: Obama Looks To Hollywood To Help Promote His Healthcare Law
Wedged into the blotter on Mike Farah's desk at the Funny or Die studios in Hollywood is an index card with a list -- wrangling talent, polishing scripts and arranging shoots -- long enough to keep the comedy website executive fully occupied. But these tasks are part of a different quest: the campaign to ensure the success of President Obama's health care law (Reston, 9/20).

The Wall Street Journal: Ad Blitz Aims To Shift Views Of Health Law 
Both sides are trying to shape perceptions. A majority of Americans say they don't understand the law. Meanwhile, it has taken center stage in continued political bickering over the federal budget and the national debt ceiling. Political groups have spent roughly $500 million since the law passed in March 2010 either denouncing or defending the new law, according to Kantar Media, an ad-tracking unit of WPP PLC. A majority of that spending was on ads opposing the law. The ads also have mostly been airing in political swing states like Ohio and Virginia. Supporters of the law have been focusing their efforts on states like California and Texas, which have a large population of young, uninsured people (Schatz, 9/21).

CBS News: Campaign To Help Californians Understand Obamacare
As enrollment is soon to begin to get health insurance under the Affordable Care Act, many still do not know where to get it and how much it costs. California has invested in a $45 million ad campaign to help people understand how Obamacare will affect them (Evans, 9/21).

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The Health Law: Asking Questions And Getting Answers

News outlets detail some frequently asked health law questions and also note some of the places people will turn to find out how the overhaul will work.

The CT Mirror: Librarians Used To Queries, Gear Up For Obamacare Questions
When major provisions of the federal health reform law take effect in the next few months, (Lisa) Sprague, who works at the Enfield Public Library, expects to get lots of inquiries. So do her colleagues in libraries across the state. “When there are changes in systems, particularly at the state or federal level, the general public has a strong trust and feels safe going to the library and asking questions,” said Jennifer Keohane, executive director of the Connecticut Library Consortium (Becker, 9/23).

The Seattle Times: Obamacare: Answers To Your Most Pressing Questions
There are many opinions about the Affordable Care Act — aka "Obamacare" — but it’s heartening that all sides agree on one thing: At this point in the rollout of its most visible feature, the online exchange marketplace, there are plenty of questions. In this Q&A, we have searched out the most pressing Qs and rounded up as many As as we can get from authoritative sources. Here, in an effort to lose the rhetoric and get to the point, we offer answers to your most pressing questions (Ostrom, 9/20).

The Baltimore Sun: Confusion, Misinformation Hinder Health Outreach
Carol Cain tries to ignore the two lumps in her throat, but some days it's hard because they swell and are tender to the touch…Cain is just the kind of person being targeted as Maryland prepares for the nationwide health care reforms known as Obamacare — but she also illustrates the challenges of a burgeoning outreach campaign. Some Marylanders have let health problems fester. Others rely on hospital emergency rooms for basic care, an approach that drives up health costs (Walker, 9/21).

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Health Law Divide Opens Among GOP Presidential Hopefuls

Obamacare is dividing the GOP in the race for that party's 2016 presidential nomination and playing a pivotal role in a House special election in Alabama.

The Associated Press: Health Law Separates Potential GOP 2016 Contenders
A clear divide over the health care law separates the emerging field of potential GOP candidates for the 2016 presidential race, previewing the battles ahead as they try to rebuild their party and seize the White House. U.S. Sen. Ted Cruz says he will fight "with every breath" to stop President Barack Obama's signature domestic achievement, even if that means shutting down parts of the federal government. Florida Gov. Jeb Bush calls "quite dicey" politically for Republicans. Sen. Rand Paul of Kentucky says flatly that a shutdown is "a dumb idea" (Beaumont, 9/21).

Minnesota Public Radio: Obamacare Stars As Villain In Alabama Special Election 
To understand just how deep the GOP resistance to Obamacare runs -- and why some Republicans would risk a federal government shutdown to defund it -- look no further than the special House election in Alabama. You've probably never heard of the race because it's received virtually no attention outside Alabama. But it's a useful barometer for gauging the ferocity of opposition to the Affordable Care Act among the party faithful (Wollner, 9/22).

Dallas Morning News: Texas Republicans Work Against Obamacare But Pledge To Help Enrollees
Aides to Dallas Rep. Jeb Hensarling's office recently said that he would gladly help any constituent having trouble enrolling in a health plan under the Affordable Care Act. "Providing outstanding constituent service is a top priority," an aide said, and that includes "their dealings with all federal agencies" (9/22).

Also, Americans' views on the health law vary based on party affiliation and on which provisions of the law you're talking about --

Kaiser Health News/The Seattle Times: Views On Obamacare Closely Track Party Preference In Washington State
If you want to know whether people in Washington state like or loathe Obamacare, you could just ask them which political party they prefer. That's because 80 percent of Democrats surveyed approve of health care reform while 80 percent of Republicans don't, according to an Elway Poll of Washington voters conducted on behalf of The Seattle Times. Independent voters are the wild card, with 41 percent in favor and 46 percent against the overhaul, formally known as the Affordable Care Act (Stiffler, 9/23).

Atlanta Journal-Constitution: Georgians Dislike Health Law But Favor Key Provisions
Most Georgians don’t favor Obamacare. But they do seem to like several important parts of it. That seeming dichotomy is one of the more intriguing findings of a statewide survey on the Affordable Care Act conducted last week for The Atlanta Journal-Constitution. Among those polled, 57 percent said they have an unfavorable view of the Affordable Care Act, and only 31 percent think of it favorably. Yet nearly three-fourths support allowing children to stay on their parents’ health insurance to age 26, and two-thirds favor requiring insurers to offer coverage to people with pre-existing conditions (Markiewicz, 9/22).

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New Study Finds The Tally For Medical Mistakes Much Higher Than Previous Estimates

ProPublica/NPR: How Many Die From Medical Mistakes In U.S. Hospitals?
It seems that every time researchers estimate how often a medical mistake contributes to a hospital patient's death, the numbers come out worse. In 1999, the Institute of Medicine published the famous "To Err Is Human" report, which dropped a bombshell on the medical community by reporting that up to 98,000 people a year die because of mistakes in hospitals. … In 2010, the Office of Inspector General for the Department of Health and Human Services said that bad hospital care contributed to the deaths of 180,000 patients in Medicare alone in a given year. Now comes a study in the current issue of the Journal of Patient Safety that says the numbers may be much higher — between 210,000 and 440,000 patients each year who go to the hospital for care suffer some type of preventable harm that contributes to their death (Allen, 9/20).

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Editorials and Opinions

Viewpoints: GOP Opponents To Health Care Listening 'Only to Their Own Choir,' Congress Should Turn Down Federal Contribution For Insurance

Los Angeles Times: In Washington, Countdown To A Shutdown
Yes, a majority doesn't like Obamacare. They're unsure about what it will do and worried that it might make their health care worse. But do they really want to defund the law, and risk the chaos of a government shutdown to do it? Probably not, most polls suggest. As one Republican pollster told me, though a majority of voters don't like Obamacare, they're not angry enough about it to risk a fiscal crisis that could hurt the economy. So why are Republican lawmakers hearing a different message? Because most of them represent districts so conservative that they are listening only to their own choir (Doyle McManus, 9/22).

The Wall Street Journal: Countdown To GOP Self-Destruction
With most Americans undeniably dissatisfied with the direction of their government, why would some congressional conservatives insist on identifying Republicans as unyielding defenders of a broken status quo? Their implacable obsession with uprooting ObamaCare and their die-hard resistance to immigration reform all but guarantee near-term legislative defeats and long-term devastation to future party prospects (Michael Medved, 9/22).

The Wall Street Journal: Carve-Outs For Congress 
The Affordable Care Act requires the 11,000 people who work on Capitol Hill to purchase their health insurance on its exchanges, but many of them earn too much to qualify for subsidies. That's a financial hit worth about $5,000 for individuals and $11,000 for families. So in early August President Obama's personnel team came to the rescue with a let-the-good-times-roll regulation that entitles Members and aides to their current premium contributions, on the basis of zero legal authority. ... Republicans are sitting on a potent theme, and if they hate Obamacare as much as they claim, the least they can do is try to turn the Congressional carve-out to their advantage (9/22).

The Washington Post: Obamacare's Strange Bedfellows
Yet (Ohio Gov. John) Kasich, a one-time scourge of labor unions who was a top lieutenant in Newt Gingrich's revolution in the 1990s, has endeared himself to liberal and low-income Ohioans by insisting, loudly and incessantly, that his state participate in the Medicaid expansion under Obamacare. An unapologetic conservative is fighting the tea party and his own Republican legislature because he thinks the less privileged people of Ohio deserve health coverage (E.J. Dionne Jr., 9/22). 

Cleveland Plain Dealer: Fill The Coverage Gap For The Most Vulnerable Workers By Extending Medicaid In Ohio
Health insurance marketplaces or exchanges for uninsured working families and individuals to purchase affordable health care will soon open. ... But only those making more than 100 percent of the federal poverty level are eligible for the new federal marketplace. Ohio has chosen to have the federal government run the state's exchange. What happens to those who do not qualify for insurance through their employer and are not eligible for the state's current Medicaid plan, but are living below 100 percent of poverty and therefore are earning $23,050 or less for a family of four? These Ohioans have no coverage options (Susanna Krey, 9/22).

The Washington Post: Social Security Disability Insurance Needs Major Reform
In the debate over entitlement reform, few subjects are more fiercely debated than the cause of the explosive recent growth of Social Security Disability Insurance (SSDI). Defenders of the program, which cost a record $135 billion in fiscal 2012, argue that the rolls are increasing mainly because of technical and demographic changes. ... Critics, including a significant number of academic economists, suggest that the program's manipulable and inconsistently applied eligibility criteria have enabled millions of people who could work to sign up for benefits instead (9/21).

The New York Times: Is This A Hospital Or A Hotel?
As the new St. Joseph’s Hospital in Highland, Ill., prepared to open in August, its chief executive exulted, "You feel like you could be at the Marriott." ... In the current boom of hospital construction, private rooms have become the norm. And some health economists worry that the luxury surroundings are adding unneeded costs to the nation's $2.7 trillion health care bill. There are some medical arguments for the trend -- private rooms, for example, could lower infection rates and allow patients more rest as they heal. But the main reason for the largess is marketing (Elisabeth Rosenthal, 9/21).

Los Angeles Times: Health Care Reform Heats Up Drugstore Battle
Obamacare is driving a transformation in the way pharmacies do business, so get ready. The health care reform law will expand access to medical services for millions of people. That's going to place added pressure on primary health care providers and challenge the system to meet the new demand (Michael Hiltzik, 9/20).

Los Angeles Times: Expiration Date Nearing On Miracle Drugs
Beware of magical discoveries: They generally require careful use lest the magic wear off. Even the genie's lamp gave only three wishes. Antibiotics, which at one point were viewed as miracle drugs providing cures for previously fatal illnesses, are among the discoveries that have been used too carelessly, giving rise to an era of resistant infections. Scientists have been concerned about these resistant bacteria -- methicillin-resistant Staphylococcus aureus, or MRSA, is probably the most familiar -- for many years. But doctors have continued to prescribe antibiotics unnecessarily for illnesses such as colds that are caused by viruses, not bacteria (9/20).

The Washington Post: Our Looming Long-Term Care Crisis
I suspect many people didn't know that the Affordable Care Act, or Obamacare, was supposed to include much-needed coverage for long-term care. The enacting legislation was called, ironically, the Community Living Assistance Services and Supports (CLASS) Act. But what happened to an initiative that was meant to address a huge financial burden for families as the population ages isn't classy at all. It's sad (Michelle Singletary, 9/21).

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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.