Daily Health Policy Report

Tuesday, September 24, 2013

Last updated: Tue, Sep 24

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Health Reform

Health Information Technology

Medicare

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Swapping COBRA For Obamacare Likely To Be Windfall For Big Business

Kaiser Health News staff writer Jay Hancock, in collaboration with The Chicago Tribune, reports: "Health-law provisions taking effect next year could save U.S. employers billions of dollars in expenses now paid for workers who continue medical coverage after they leave the company, benefits experts say" (Hancock, 9/23). Read the story.

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Readers Ask: What Options Do Parents Have To Get Coverage For Their Kids?

Kaiser Health News consumer columnist Michelle Andrews answers questions from parents who have many questions about covering their children as the October launch of the state health insurance marketplaces approaches (9/24). Read the column.

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Fight Over Obamacare Is Anything But Over In Florida

The Miami Herald’s Marc Caputo, working in partnership with Kaiser Health News, reports: "Florida isn’t just a battleground state for presidential elections; it’s ground zero in the nation’s Obamacare wars. It’s all about demographics. And geography. Retiree-heavy Florida has a surplus of voting seniors nervous about Obamacare’s changes. But Hispanics — the state’s least-insured but fastest-growing population — tend to support the Affordable Care Act" (Caputo, 9/24). Read the story.

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Colorado Floods Isolate Hospital At Foot Of Rockies

Reporting for Kaiser Health News, in partnership with NPR, Eric Whitney writes: "As snow begins falling in Rocky Mountain National Park, Estes Park, the town at its doorstep, finds itself newly isolated. The only year-round road into or out of town now is the Peak to Peak Highway. It traverses a jumble of mountains all the way - not the kind of road an ambulance can scream along at 60 miles an hour" (Whitney, 9/24). Read the story.

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Missouri, Illinois Health Insurance Exchanges Gear Up Quietly

The St. Louis Post-Dispatch's Virginia Young, working in partnership with Kaiser Health News, reports: "Across the country, states are featuring celebrities, quirky songs and football game-day ads to promote the Oct. 1 debut of the online health insurance exchanges. Minnesota's multimillion-dollar campaign, for example, stars Paul Bunyan and Babe the Blue Ox in zany situations in which the lumberjack unexpectedly needs medical attention — and health insurance" (Young, 9/23). Read the story.

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What Consumers Really Want From An Obamacare Plan

The Philadelphia Inquirer's Robert Calandra, working in partnership with Kaiser Health News, reports: "It doesn't have the inherent drama of a space launch countdown, but in T-minus nine days, America will embark on a voyage into the vast, unexplored regions of the health-insurance marketplace. Actually, those regions aren't that unexplored. Insurers have been running consumers through simulated exchanges for the last several years. While insurers may not be completely comfortable with how things unfold after Oct. 1, they do have a pretty good idea about what coverage consumers want and what they will pay for it" (Calandra, 9/23). Read the story.

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Capsules: How Will Obamacare Affect Workers' Health Coverage?; Federal Judge Throws Out Lawsuit Over Hospital Observation Care

Kaiser Health News: Capsules: How Will Obamacare Affect Workers' Health Coverage?; Federal Judge Throws Out Lawsuit Over Hospital Observation Care
Now on Kaiser Health News’ blog, watch KHN staff writer Jay Hancock on C-SPAN’s Washington Journal Monday morning taking questions about how the health law will affect the health insurance coverage workers get from their employers and what they need to know (9/23).

Also on the blog, Susan Jaffe reports on action related to Medicare’s observation care status: "A federal court judge in Hartford, Conn., dismissed a lawsuit Monday which was filed against the government by 14 Medicare beneficiaries who were denied nursing home coverage" (Jaffe, 9/23).

Meanwhile, Kaiser Health News staff writers Julie Appleby and Mary Agnes Carey are back for an encore, answering Washington Post reader questions about insurance marektplaces at 12 noon ET today. Check out what else is on the blog.

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Political Cartoon: 'Meep Meep?'

Kaiser Health News provides a fresh take on health policy developments with "Meep Meep?" by Bob Englehart.

 

Here's today's health policy haiku:

NEVER A DULL MOMENT!

Government shutdown 
doesn't look very likely.
Next up: Debt ceiling
-Anonymous

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

 

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Capitol Hill Watch

Senate GOP Leader Poised To Block Cruz' Defunding Strategy

Senate Minority Leader Mitch McConnell, R-Ky., announced he won't support the pledge made by Sen. Ted Cruz, R-Texas, to use parliamentary procedures as he tries to stop Democrats from stripping a provision cutting money from the health law.

The New York Times: Senate Democratic Leader Sets Stage For Budget Showdown
The Senate's Democratic majority leader, Harry Reid, delivered a broadside this week to advocates of the House plan to tie future government financing to the gutting of President Obama’s health care law, starting the clock on a showdown that could be decided on the eve of the potential government shutdown next Tuesday (Weisman, 9/24).

The Associated Press: McConnell Won't Support Cruz On Senate Test Vote
In a break with tea party-aligned Senate conservatives, Republican leader Mitch McConnell announced Monday he will not vote to block legislation aimed at preventing a partial government shutdown, even though Democrats intend to rewrite it to restore funds needed to keep the nation's three-year-old health care law in existence. Referring to a bill the House passed last week, McConnell’s spokesman said the Kentucky lawmaker supports the measure "and will not vote to block it, since it defunds Obamacare and funds the government without increasing spending by a penny" (Espo, 9/23).

The Wall Street Journal: McConnell Won't Back Cruz On Health-Law Strategy
A push by Senate conservatives to eliminate funding for the new federal health-care law suffered a setback Monday, when Senate Minority Leader Mitch McConnell said he wouldn't support their strategy when legislation comes before the chamber this week. The announcement by Mr. McConnell (R., Ky.) put him at odds with Sen. Ted Cruz (R., Texas) and other conservatives allied with the tea-party movement. They have promised to use parliamentary tactics to support legislation that links funding for federal agencies with the conservative rallying cry of "Defund Obamacare" (Hook, 9/23).

The Hill: McConnell Splits With Cruz On ObamaCare Defunding Tactic
Senate Republican Leader Mitch McConnell (Ky.) on Monday broke with Sen. Ted Cruz (R-Tex.) and said he will oppose a filibuster of House legislation defunding ObamaCare. McConnell said he will not block the bill from coming to a final vote because it includes language to strip funding from President Obama's signature healthcare law while keeping current government funding levels in place (Bolton, 9/23).

Roll Call: Senate GOP Prepares To Shoot Down Cruz's Obamacare Strategy
Senate Minority Leader Mitch McConnell and many of his rank and file are poised to cast votes this week that will effectively rebuke Sen. Ted Cruz's effort to filibuster a stopgap spending bill that would keep the government funded past Sept. 30. Cruz has been calling on fellow Republicans to block the House-passed stopgap spending bill that defunds the president’s 2010 health care law because he sees the vote as a way to prevent Senate Majority Leader Harry Reid, D-Nev., from stripping out the Obamacare funding blockade (Lesniewski, 9/23).

Los Angeles Times: Much Theater, Little Action As Congress Ponders Government Shutdown
This latest round of brinkmanship, led by tea party Republicans trying to block President Obama's Affordable Care Act, appears to be on that same track. By Monday afternoon, the tea party effort appeared to be losing ground among Senate Republicans, but the schedule showed no sign of speeding up. The tea party conservatives have vowed to block any effort to provide money for federal agencies after the end of the current budget year unless Obama agrees to a measure that would stop his signature healthcare law from going into effect. Obama has rejected that idea (Mascaro, 9/23).

The Washington Post: Shutdown Looming, Senate Begins Debating Spending Measure
The Senate’s top two Republicans announced Monday that they will not support a conservative revolt in the GOP ranks that seeks to dismantle President Obama’s 2010 health-care law. Minority Leader Mitch McConnell (Ky.) and his deputy, John Cornyn (Tex.), said they will not join a band of senators attempting a week-long assault on the legislation. The announcement was a setback for Sens. Ted Cruz (R-Tex.) and Mike Lee (R-Utah), who plan to use whatever limited Senate procedural leverage is available to them to thwart funding for the Affordable Care Act, commonly referred to as Obamacare (O'Keefe, 9/23).

Meanwhile -

Politico: David Vitter Pushing Ban On Subsidies
A testy debate over whether lawmakers and Capitol Hill staff should receive federal subsidies for their health insurance under Obamacare is coming right back to the Senate. Sen. David Vitter (R-La.) plans to file an amendment to House-passed spending bill now under consideration by the Senate that would that require lawmakers, the president and administration appointees no longer receive those subsidies (Everett, 9/23).

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Cruz Makes Republican And Democratic Enemies With Defunding Fight

The freshman senator from Texas has led the charge to tie government financing to defunding the health law. The New York Times looks at the role of Senate Minority Leader Mitch McConnell in the effort. Other media outlets explore Sen. Rand Paul's suggestions of a compromise and Karl Rove calling out Cruz for misstatements.

The New York Times: McConnell's Deal-Making Yields To Politicking
Democrats and, increasingly, Republicans are complaining that the minority leader’s absence from many of this year’s most intense and consequential negotiations — from the immigration overhaul to the budget to a fight over internal rule changes that almost paralyzed the Senate — has created a power vacuum and left Democrats without a bargaining partner. They worry that Mr. McConnell is too hamstrung by political concerns in the Capitol and back home in Kentucky. In Washington, a rebellious crop of new Republican senators, led by Ted Cruz of Texas, has rejected his compromising brand of politics. Mr. Cruz has led the charge to tie any further government financing to gutting President Obama’s health care law, a movement that has angered many veteran Republicans and brought the federal government to the brink of a shutdown (Weisman and Peters, 9/23).

The Washington Post: Sen. Ted Cruz Happy To Be Outlier In Shutdown Showdown
Ted Cruz began a frantic effort Monday to bend the Senate to his will by employing tactics that have earned him mostly enemies in his less than nine months in the chamber. A master of fiery conservative oratory, the freshman senator is trying to block funding for President Obama’s health-care law with a strategy that, if successful, will almost certainly lead to a partial government shutdown next week. The Texan has become the face of an effort variously described as the "dumbest idea," leading Republicans to a "box canyon" and ending with their political "suicide note" (Kane, 9/23).

Los Angeles Times: Karl Rove Calls Out Fellow Republican Sen. Ted Cruz On Healthcare
When Karl Rove starts truth-squadding fellow Texas Republicans over the Affordable Care Act, aka Obamacare, you know there are some tall tales floating around. On Sunday, U.S. Sen. Ted Cruz (R-Texas) told Chris Wallace of Fox News: "You know what's interesting? Last week, the Wall Street Journal, for the first time in years, found Republicans are leading on healthcare. Americans trust Republicans more than Democrats on healthcare" (Abcarian, 9/23).

Politico: Rand Paul On Obamacare Compromise: 'Maybe'
Sen. Rand Paul acknowledged Monday the uphill battle for Republicans looking to fully defund Obamcare and said "there could be a compromise in the middle." "The president wants 100 percent of Obamacare, we want zero. Maybe we make it less bad through a compromise. So if the Republicans in the House pass defund, Democrats in the Senate continue to fund, maybe there could be a compromise in the middle where we get some rid of the taxes, and get rid of some of the bad parts of Obamacare," Paul (R-Ky.) said on Fox News’s "Fox and Friends" (McCalmont, 9/23).

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Battle Brewing Over New Regulations For Compounding Pharmacies

In addition, a bill that would require professional drivers to be tested for sleep apnea flies through the House.

Politico: Lobbyists Roll Up Sleeves For Compounding Battle
If you want to know how nervous the pharmaceutical industry is about the prospect of new federal regulation of compounding pharmacies — like the one involved in last year’s lethal fungal meningitis outbreak — look to K Street. As lawmakers have introduced bills in the House and Senate to regulate these drug-making practices, pharmacies, pharmaceutical companies and trade groups are ramping up their lobbying support for the battle to come (Drusch, 9/24).

Politico: Sleep Apnea Bill Crosses The Aisle
The tale of a sleep apnea bill shows what just might be the most efficient Congress has been in years. In a few short weeks, two House members went from writing a simple two-page bill to seeing the Federal Motor Carrier Safety Administration committing to a formal rule making on sleep apnea testing and treatment for truckers and other professional drivers (Snider, 9/24).

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Health Reform

Obama, Bill Clinton To Tout Law In Joint Appearance

The two are slated to appear together Tuesday afternoon to discuss the health care law at an event sponsored by the Clinton Global Initiative, the former president’s foundation, exactly one week before open enrollment begins in new insurance marketplaces.

The Washington Post: Health-Care Push Brings Bill Clinton, Obama Together, With Political Benefits For Both
In one of his first acts as President Obama's new health-care adviser, Chris Jennings traveled to Harlem last month to pay a visit to his old boss, Bill Clinton. Armed with a PowerPoint presentation detailing how the new health-care law will go into effect, Jennings made his pitch: Obama needs your help, both to persuade millions of uninsured Americans to sign up for coverage and to combat Republican attempts to undermine the law (Rucker, 9/23).

The Associated Press: Health Law Reuniting Obama, Bill Clinton
Health care is reuniting President Barack Obama and former President Bill Clinton. The two are set to appear together Tuesday to discuss Obama's health care law at a session sponsored by the Clinton Global Initiative, the former president's foundation (Superville, 9/24).

Politico: President Obama, Bill Clinton Begin Health Care Rollout
President Barack Obama will kick off his administration's six-month rollout of Obamacare during a "conversation" Tuesday with former President Bill Clinton. With the Obamacare insurance exchanges set to open Oct. 1, the White House is deploying the president, first lady Michelle Obama, Vice President Joe Biden and Cabinet secretaries to encourage consumers to sign up for coverage before enrollment closes March 31, 2014 (Budoff Brown, 9/23).

Bloomberg: Obama Enlists Clinton In Promoting Health-Care Law
U.S. President Barack Obama will use an international conference hosted by former President Bill Clinton tomorrow in New York to kick off what the White House is calling an aggressive campaign to promote Obamacare. With congressional Republicans trying to use the budget and the federal debt ceiling as leverage to strip funding for the president's health-care law, Obama is seeking to promote its benefits one week before Americans can begin signing up for insurance coverage under the measure (Lerer, 9/23).

Meanwhile, a new poll shows that 59 percent of Americans are opposed to defunding Obamacare if it means defaulting and shutting down the government --

The Wall Street Journal’s Washington Wire: Poll: Americans Lean Against Defunding Obamacare
According to a new CNBC poll, 59% of Americans are opposed to defunding Obamacare if it means defaulting and shutting down the government and 19% are in favor of it. Eighteen percent of people polled were unsure. In regards to solely defunding Obamacare, 44% of Americans were against it and 38% were in favor, according to the poll, done by Hart-McInturff, the same pollsters that do the Wall Street Journal-NBC News polls. Broken down by gender, 47% of women are against defunding Obamacare and 33% are in favor (Prang, 9/23).

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As Opening Day Approaches, Confusion Continues About Health Exchanges

With the Oct. 1 launch of the health law's online insurance marketplaces just days away, news outlets examine questions such as who will use them, what will make them a success, how long will it take to judge whether they are working, and other key issues.

Huffington Post: The Biggest Myth About Obamacare
The biggest part of President Barack Obama's health care overhaul is just days away from its debut, and the American public remains confused. For many consumers, the most important question is personal: What do I have to do? If you're one of the roughly 80 percent of Americans who already has health insurance through an employer or is enrolled in a government program like Medicare, the answer is: probably nothing. On Oct. 1, new health insurance websites will debut in each state. Some will be run by the state, and others will be run by the federal government. These sites, called health insurance exchanges or marketplaces, are designed to serve those without insurance and those who buy insurance on their own (Young, 9/23).

Politico: How Stakeholders Will Judge ACA On Day One
Obamacare allies couldn’t be clearer: The Oct. 1 launch of major new health coverage programs is the dawn of a new era, the first day of school for a nation that needs a health care education. And just like students, they say, Obamacare’s grades shouldn’t be based on the first day (Millman and Cheney, 9/23).

CQ HealthBeat: Would Government Shutdown Block Obamacare Marketplaces?
Whether or not the government shuts down on Oct. 1, Republicans are expected to fail in their attempts to defund and block the start of the health care law’s open enrollment period — which is scheduled to start the same day — according to former government officials, a GOP senator and a memo from the Congressional Research Service (Adams and Reichard, 9/23).

Bloomberg: Uninsured In U.S. Remain Steady As Health Exchanges Await
There was little shift in the share of people in the U.S without health insurance in the first quarter of 2013, a trend likely to change when new coverage marketplaces open next month as part of the health overhaul law. Forty-six million people didn’t have health insurance in the first quarter of the year and 57 million people, or 19 percent of the U.S., were without coverage at some point in the prior 12 months, according to a survey by the Centers for Disease Control and Prevention (Armstrong, 9/24).

ABC News: 10 Things To Know About Health Insurance Exchanges
Your health insurance options are about to change. Starting October 1, Americans will be able to shop for coverage through national and state-administered insurance exchanges. But you only have six months to make your move. Here are 10 things you need to know before open enrollment begins (Moisse, 9/24).

CBS News: Obamacare: How Affordable Is It?
One week from Tuesday, a major portion of the president's health care reform law will go into effect and change the way millions of Americans get their health care. On Oct. 1, they can start signing up to buy insurance on the new state exchanges. Obamacare is officially the Affordable Care Act, but how affordable are the premiums? (Andrews, 9/23).

CBS News: Major Obamacare Milestone One Week Away: What To Expect
One week ahead of a major Obamacare milestone, Americans still have a number of questions and concerns about how the health care law will work. The confusion over the law is to be expected: deliberations about the Affordable Care Act (ACA) rollout are ongoing at the state level, political grandstanding persists in Washington, and all the while, consumers are seeing a stream of television ads with competing messages about the law (Condon, 9/24).

In addition, here's more on the subject of navigators -

The Texas Tribune: In Texas, 'Navigator' Training Becomes Political Football
A push for stricter training requirements for insurance "navigators," who will help uninsured residents sign up for health coverage, is fueling the latest political clash over the Affordable Care Act in Texas (Zaragovia, 9/24).

The Hill: GOP Raises More Questions About ObamaCare 'Navigators'
House Republicans raised new questions Monday about ObamaCare's "navigators" — an investigation that has touched a nerve with the healthcare law's supporters. Republicans on the Energy and Commerce Committee questioned how navigators will go about the task of explaining new health insurance options (9/24).

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States Question Exchange Readiness, Appropriateness And Effects

Officials in some states are expressing pessimism that the new Obamacare health insurance exchanges will be the place for residents to buy health coverage or are questioning their readiness. In Missouri, the lieutenant governor is telling residents to stay away from the exchanges.

St. Louis Post-Dispatch/Kaiser Health News: Missouri, Illinois Health Insurance Exchanges Gear Up Quietly
Across the country, states are featuring celebrities, quirky songs and football game-day ads to promote the Oct. 1 debut of the online health insurance exchanges. Minnesota's multimillion-dollar campaign, for example, stars Paul Bunyan and Babe the Blue Ox in zany situations in which the lumberjack unexpectedly needs medical attention -- and health insurance (Young, 9/23).

The Associated Press: Kinder Urges Missouri Residents Not To Use Health Exchange
Lt. Gov. Peter Kinder has a message for the thousands of Missourians looking for health insurance: Don't get it through an online marketplace that launches next week. Kinder, a Republican who is Missouri's second-ranking executive, sought Monday to discourage participation in the health insurance exchanges that form the centerpiece of the 2010 Affordable Care Act signed by President Barack Obama (9/24).

Kansas City Star: Lt. Gov. Peter Kinder: Missouri Residents Should Skip Health Exchange
Lt. Gov. Peter Kinder has a message for the thousands of Missourians looking for health insurance: Don't get it through an online marketplace that launches next week (Lieb, 9/23).

The Associated Press: Donelon: Complexity Of Health Law 'Mind-Boggling'
Louisiana's insurance commissioner said Monday that there is "no way at all" that people have enough information to make decisions when the new health insurance marketplaces created by the federal Affordable Care Act open next week. Registration opens Oct. 1 for the thousands of people who don't get health insurance through work to shop for coverage through online marketplaces, with coverage to begin Jan. 1 (Deslatte, 9/23).

The Texas Tribune: New Health Plan Regulations Come Into Focus As Rollout Nears
Though the state has refused to implement some provisions of the Affordable Care Act, including a health insurance marketplace, new regulations of insurance plans -- and their rates -- will still take effect in Texas (Zaragovia, 9/23).

Milwaukee Journal Sentinel: 92,000 Will Lose BadgerCare Coverage On Dec. 31
Gov. Scott Walker's administration is notifying 92,000 Wisconsin residents this month that their health insurance through BadgerCare Plus will end this year, requiring them to buy a subsidized but potentially more costly commercial health plan through the federal marketplace being set up under the Affordable Care Act (Stein and Boulton, 9/23).

Other states are trying to assess their readiness and helping residents wade through the choices -

California Healthline: Hearing Will Target Launch Of Exchange
The Assembly Committee on Health today will convene a hearing on the readiness of Covered California, the state's health insurance exchange, which is set to launch its first enrollment period next week. Years of planning have gone into setting up the exchange, and its enrollment season runs from Oct. 1 through Apr. 1, 2014. Californians who enroll now for subsidized health insurance through the exchange will start receiving coverage benefits on Jan. 1, 2014. Today's hearing will look at the exchange's readiness, said Assembly member Richard Pan (D-Sacramento), as potentially millions of Californians could inquire about the program in the next few months (Gorn, 9/23).

The CT Mirror: Access Health Chief: Get Help Applying For Obamacare Coverage, And Don't Use Paper
With just over a week to go before the state’s new health insurance marketplace launches, its leader has some advice for potential shoppers: Get help enrolling. And please, whatever you do, avoid the paper application (Becker, 9/23).

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Battles Have Reduced Health Law's Impact For Consumers

Politico looks at the how the law squares with what it promised and talks to consumers in Kentucky about their expectations. Also, the Wall Street Journal examines one of the tactics health insurers are using to keep healthy customers.

Politico: Obamacare: One Blow After Another
The Obamacare that consumers will finally be able to sign up for next week is a long way from the health plan President Barack Obama first pitched to the nation. Millions of low-income Americans won't receive coverage. Many workers at small businesses won't get a choice of insurance plans right away. Large employers won't need to provide insurance for another year. Far more states than expected won't run their own insurance marketplaces. And a growing number of workers won't get to keep their employer-provided coverage (Haberkorn and Budoff Brown, 9/23).

The Wall Street Journal: Health Insurers Scramble to Keep Healthy Customers
Health insurers are making a big push to hang onto their policyholders ahead of new government-run exchanges expected to roll out next week, but state regulators have accused some of misleading those customers in the process. Several insurers, including Humana Inc. and some Blue Cross Blue Shield plans, have recently warned customers of big rate hikes if they don't immediately renew their policies for 2014. But some of those customers may be able to find cheaper policies on the insurance exchanges launching under the new federal health law (Martin, 9/23).

Earlier related KHN coverage: Insurers' Efforts To Delay Health Law Compliance Could Affect Premiums, Benefits For Millions (Appleby, 4/15).

In other news on the law's policies and impact --

The Philadelphia Inquirer/Kaiser Health News: What Consumers Really Want From An Obamacare Plan
It doesn't have the inherent drama of a space launch countdown, but in T-minus nine days, America will embark on a voyage into the vast, unexplored regions of the health-insurance marketplace. Actually, those regions aren't that unexplored. Insurers have been running consumers through simulated exchanges for the last several years. While insurers may not be completely comfortable with how things unfold after Oct. 1, they do have a pretty good idea about what coverage consumers want and what they will pay for it (Calandra, 9/23).

Kaiser Health News/The Chicago Tribune: Swapping COBRA For Obamacare Likely To Be Windfall For Big Business
Health-law provisions taking effect next year could save U.S. employers billions of dollars in expenses now paid for workers who continue medical coverage after they leave the company, benefits experts say (Hancock, 9/23).

Bloomberg: Young Invincibles Caught In Crossfire Over Obamacare Cost
Steven Binko is young, healthy and recently unemployed. He doesn't see any reason he should be required to buy health insurance next year. Since losing his job at an Olive Garden restaurant in Jacksonville, Florida, the 25-year-old said he can't afford to buy health care on his own (Armour, 9/24).

Des Moines Register: Hatch Asks Feds To Reject Health Premiums
An Iowa lawmaker is urging the federal government to reject a key part of Iowa's proposed health care program for the poor, a week before it is to start being implemented. State Sen. Jack Hatch is suggesting the U.S. Department of Health and Human Services decline to let the new Iowa program charge premiums to people who fail to undergo yearly checkups or take other steps to improve their health (Leys, 9/24).

Newshour: Businesses Weigh Bottom Line Of Health Reform's Employer Mandate
Next, we return to the impact of the new health care reform law -- tonight, how employers are preparing to comply with new rules that require them to insure their employees. Even though some portions of the mandate have been delayed, many employers remain frustrated. NewsHour's economics correspondent, Paul Solman, looks at the bottom line for different business owners, part of his Making Sense of financial news (Solman, 9/23).

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State Political Dynamics Shaping Obamacare Implementation In The States

The fights over Obamacare are far from over in Florida -- where a burgeoning Latino population is complicating opposition -- and Alabama, where the governor's stance against the Medicaid expansion and the health insurance exchange is showcasing their resistance.

The Miami Herald/Kaiser Health News: Fight Over Obamacare Is Anything But Over In Florida
Florida isn't just a battleground state for presidential elections; it's ground zero in the nation's Obamacare wars. It's all about demographics. And geography. Retiree-heavy Florida has a surplus of voting seniors nervous about Obamacare's changes. But Hispanics -- the state's least-insured but fastest-growing population -- tend to support the Affordable Care Act (Caputo, 9/24).

Al.com: Gov. Robert Bentley Says Medicaid, Exchange Decisions Part Of Fighting Obamacare 
Three months before the implementation of key provisions of the Affordable Care Act -- expanded Medicaid programs and coverage on insurance exchanges -- Gov. Robert Bentley maintains Alabama is doing the right thing by participating in neither. "I have a long-term goal for this. My long term goal is to resist the implementation of the Affordable Care Act and I believe we are going to succeed in that," Bentley said. "If you don't expand Medicaid -- I don’t care what anyone says -- you probably cannot implement the Affordable Care Act. If you don’t have a state-based exchange, it’s going to be difficult to implement the Affordable Care Act,” Bentley said (Chandler, 9/23). 

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Health Information Technology

FDA Says Most Smartphone Health Apps Won't Get Regulatory Scrutiny

The federal agency will reserve its attention for apps that function like medical devices.

New York Times: F.D.A. To Regulate Some Health Apps
The Food and Drug Administration said Monday that it would regulate only a small portion of the rapidly expanding universe of mobile health applications, software programs that run on smartphones and tablets and perform the same functions as medical devices (Tavernise, 9/23).

The Associated Press: FDA Lays Out Rules For Some Smartphone Health Apps
Food and Drug Administration officials say they will begin regulating a new wave of applications and gadgets that work with smartphones to take medical readings and help users monitor their health. With the rise of the iPhone, Android and other mobile devices has come a flood of applications designed to help people stay healthy. Industry analysts estimate there are already more than 17,000 medical applications available, ranging from calorie counters to high-tech heart monitors (9/23).

CQ HealthBeat: FDA Guidance On Medical Apps Targets Highest-Risk Programs
The Food and Drug Administration said Monday that it would not add new regulatory requirements for most smartphone medical applications but will target the relatively small number of apps that pose a greater risk to patients if they don’t work (Adams, 9/24).

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Medicare

Medicare: Judge Dismisses Observation Care Lawsuit; Medicare Penalizes Every D.C. Hospital, 5 In Va. Suburbs

A federal court judge dismissed a lawsuit Monday which was filed against the government by 14 Medicare beneficiaries who were denied nursing home coverage because they had been kept in the hospital under "observation status." Meanwhile, an analysis shows that Medicare penalized every hospital in D.C. and five in the Virginia suburbs for readmission rates, and the California Health Report looks at efforts to reduce the costs of dual eligible patients. 

Kaiser Health News: Capsules: Federal Judge Throws Out Lawsuit Over Hospital Observation Care
A federal court judge in Hartford, Conn., dismissed a lawsuit Monday which was filed against the government by 14 Medicare beneficiaries who were denied nursing home coverage (Jaffe, 9/23).

Kaiser Health News/The Washington Post: Medicare Penalizes Hospitals In Effort To Reduce The Number Of Patients Readmitted
Every hospital in the District and five in the Virginia suburbs will be penalized in the second round of Medicare's campaign to reduce the number of patients readmitted to hospitals within a month, according to federal records. Nationwide, Medicare identified 2,225 hospitals that will have their reimbursements for patient care reduced starting Oct. 1 because readmissions at each occurred more frequently than Medicare believes they should have. Hospitals that treated large proportions of low-income patients were more likely to be penalized than those treating the fewest low-income patients (Rau, 9/23).

California Health Report: Planning For The Most Expensive Patients
Some of the costliest care in the nation goes to the nine million people who are enrolled in both Medicaid and Medicare. Dubbed dual-eligibles, these low-income seniors and younger people with disabilities qualify for the insurance program for seniors (Medicare) and the insurance program for the poor (Medicaid, called Medi-Cal in California). Dual-eligibles often have complicated illnesses. But that’s not the only reason why their care is so expensive, with yearly spending for their care exceeding $300 billion (Shanafelt, 9/24).

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State Watch

State Highlights: Ohio Readies Funding For New Medicaid Computer System

A selection of health policy stories from North Carolina, Ohio, Maryland, Arkansas, New York, Colorado, South Dakota, Florida, Kansas and California.

North Carolina Health News: State Medicaid Director Carol Steckel Resigns
Carol Steckel, the state's Medicaid director, is leaving after eight months on the job. Her departure is the latest in a string of high-profile departures from the Department of Health and Human Services, which has been plagued of late by personnel issues (Hoban, 9/23).

The Associated Press: NC Medicaid Director Leaving For Private Sector
The director of North Carolina's Medicaid program announced Monday that she is leaving, eight months after taking the job. Her departure calls into question the future of a proposal to shift operations of the government health care program for the poor toward the private sector (Robertson,9/23).

The Raleigh News & Observer: NC Medicaid Director Resigns After Eight Months On Job
Legislative leaders from both parties expressed concern over Steckel’s decision. The leading House budget writer said he hoped the resignation would slow the momentum toward transferring Medicaid to commercial insurers. And the House minority leader said it was further proof that the General Assembly needs to investigate turmoil at the department and its management of the $14 billion Medicaid program (Neff and Bonner, 9/24).

The Cleveland Plain Dealer: State Board Approves Funding For New Medicaid Computer System, Financial Perks For Omnova Move
The Ohio Controlling Board on Monday approved $116 million for a new Medicaid eligibility computer system as well as state financial incentives for a number of private-sector projects in the Cleveland area. The new software system, designed to handle changes made under the Affordable Care Act, will replace the state's 32-year-old computer system used to determine Medicaid eligibility, Ohio Department of Medicaid spokesman Sam Rossi said. He said the old software is inaccurate 60 percent of the time, forcing county caseworkers to override the system by hand (Pelzer, 9/23).

Columbus Dispatch: $116 Million OK’d To Replace State Medicaid Computer System
The state Controlling Board approved $116 million in mostly federal funds to replace a 32-year-old computer system that determines eligibility for Medicaid and other government programs. With Medicaid expansion possible as state lawmakers return to action, spending requests related to the state-federal health-insurance program are getting scrutiny. Pressed by Rep. Chris Redfern, D-Port Clinton, on whether the new computer system would be able to handle the estimated 275,000 low-income Ohioans that will be added to Medicaid if an expansion is approved, Department of Administrative Services officials assured him it could (Siegel, 9/24). 

The Associated Press/Washington Post: Company Objects Over Being Disqualified From Bidding For Arkansas Medicaid Contract
The head of a Maryland company disqualified from bidding on a Medicaid contract in Arkansas complained Monday that the state relied too much on the knowledge that Louisiana had terminated a similar contract and didn't take into account the firm's performance in other states (9/23).

The Wall Street Journal: Amid Push for Clinics, Some Patients Prefer Hospitals
Health care officials are searching for funds to open smaller clinics as hospitals close. But another obstacle might prove equally hard to overcome: New Yorkers like their local hospitals. Clinics are typically open during business hours, not evenings and weekends. It often takes weeks to get an appointment. Health-care experts say clinics are sometimes perceived as less trustworthy than imposing brick hospitals that have been in the neighborhood for decades. Smaller clinics staffed by local residents create privacy fears in tightly knit cultural communities (Kusisto and Fox, 9/23).

The Wall Street Journal: Brooklyn Grapples With Struggling Hospitals And Demand For Health Care
A new vision for Brooklyn health care was unveiled two years ago with much fanfare: Several struggling hospitals would merge with others, a state panel proposed, and less-expensive outpatients clinics would spring up in their place (Kusisto, 9/23).

Kaiser Health News: Colorado Floods Isolate Hospital At Foot Of Rockies
As snow begins falling in Rocky Mountain National Park, Estes Park, the town at its doorstep, finds itself newly isolated. The only year-round road into or out of town now is the Peak to Peak Highway. It traverses a jumble of mountains all the way -- not the kind of road an ambulance can scream along at 60 miles an hour (Whitney, 9/24).

The Associated Press: South Dakota Clinic Billed As Affordable Health Care Is Expanding Into Aberdeen
A nonprofit organization that provides affordable health care at 18 medical and dental clinics in South Dakota is expanding into Aberdeen. Howard-based Horizon Health Care Inc. has been awarded an $810,000 federal grant to open the clinic and will receive additional funding to operate it, Chief Operating Officer Jeff Mengenhausen told the American News of Aberdeen (9/24).

Health News Florida: Biggest Bid-Winner: Sunshine State Health Plan
Sunshine State Health Plan, a subsidiary of Centene Corp., won more contracts than any other company in the bidding for a slice of the Florida Medicaid program as it shifts its entire enrollee population into managed-care plans. The Agency for Health Care Administration released the list of bid-winners for the general Medicaid-enrollee population -- mainly mothers and children -- late Monday afternoon, ending a nervous wait by companies, their investors and Wall Street analysts. Billions of dollars are at stake (Gentry, 9/23).

Kansas Health Institute: Work In Progress: KanCare Problems Persist For Providers
KanCare apparently looks different [in rural Smith County] than it does in Topeka. … Brownback officials have tended to paint a rosier picture, particularly when describing the program to the broader public. Lt. Gov. Jeff Colyer when asked recently about some of the problems said the KanCare initiative was going "better than expected" (Shields, 9/23).

California Healthline: San Diego County's 10-Year Public Health Initiative Shows Early Progress
Three years into a 10-year plan to alter the landscape of public health, the county Health & Human Services Agency is preparing to present its third annual report to the County Board of Supervisors about the progress of Live Well, San Diego! Live Well, San Diego! is a comprehensive public health initiative that involves widespread community partnerships to address the root causes of illness and rising health care costs (Zamosky, 9/23).

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Editorials and Opinions

Viewpoints: GOP's 'Charge Into The Fixed Bayonets;' Republican Health Plan Is Superior To Obama's; Congressional Hypocrisy On Its Health Policy

The Wall Street Journal: The Cruz Campaign Against Obamacare
So House Republicans have passed and sent to the Senate a budget that includes no funding for the Affordable Care Act, setting up a political showdown that could result in a government shutdown. We wish the GOP luck, since we support the policy if not the strategy. But however this charge into the fixed bayonets turns out, we hope the folks who planned it will take responsibility for what happens now (9/23).

The Washington Post: Obamacare's Real Danger For The GOP Is That It Will Succeed
To understand the crisis in Washington, tune out the histrionics and look at the big picture: Republicans are threatening to shut down the federal government — and perhaps even refuse to let the Treasury pay its creditors — in a desperate, last-ditch attempt to keep millions of Americans from getting health insurance. Seriously. That's what all the yelling and screaming is about. As my grandmother used to say, it's hard to know whether to laugh or cry (Eugene Robinson, 9/23).

Politico: The GOP's Reckless Stunt
The civil war that has been raging within the Republican Party is over. And now that the House has voted to shut down the government unless Obamacare is defunded, it's official: The Tea Party has won — the far right is calling the shots. This extreme faction and its captives in the GOP are so focused on undermining President Barack Obama and his plans to boost the economy and improve access to health care for all Americans that they’re willing to drive the nation over the cliff (Rep. Debbie Wasserman Schultz, D-Fla., 9/23).

Los Angeles Times: Ted Cruz's Defunding Strategy Runs Into Reality And Harry Reid
Sens. Ted Cruz (R-Texas) and Mike Lee (R-Utah) find themselves in the curious position this week of encouraging their GOP colleagues to filibuster the stopgap government funding (and Obamacare defunding) resolution that they urged the House to pass (Jon Healey, 9/23).

The New York Times' Taking Note: Sabotaging Health Care, One Lie At A Time
A Koch-brothers funded conservative group, Generation Opportunity, is out with a wildly misleading, pernicious set of ads aimed at sabotaging the Affordable Care Act by discouraging young people from signing up for health insurance exchanges (Juliet Lapidos, 9/23).

The New York Times' The Conscience Of A Liberal: Attack Of The Killer Hipsters
Never mind the polls showing approval of Obamacare moving one way or the other; they are all being taken in an environment where people are amazingly ignorant about the law, with a large minority believing that it has been repealed. What matters is how the thing works — and that, in turn, depends crucially on sufficient numbers of young, currently uninsured people signing up for the exchanges. Advocates will try to get those people signed up; Republicans will try to convince them not to. So how are the two sides' chances (Paul Krugman, 9/23).

Bloomberg: A Serious Republican Health Care Plan
House Republicans are starting to fill in the details of what health care policies they would prefer over Obamacare. The 175 conservative representatives in the Republican Study Committee released a plan last week. It's a good start, but there's room for improvement. ... Even with these flaws, though, the Republican plan is superior to Obamacare. It’s less coercive. It requires fewer taxes. It doesn't have as much potential to reduce full-time employment. And it's more likely to control costs, relying as it does on the power of competition rather than the guidance of Washington-based experts (Ramesh Ponnuru, 9/23).

Forbes: Yes, Obamacare's Exchanges Will Narrow Your Choice Of Doctors -- And That's A Good Thing
Yesterday, Robert Pear of the New York Times discussed an emerging concern with Obamacare’s soon-to-be-online health insurance exchanges. "Many insurers," he writes, "are significantly limiting the choices of doctors and hospitals available to consumers" in the market. Many critics of the health law made note of the news, holding President Obama to account for his repeated promise that "if you like your doctor, you can keep your doctor." But here's the twist: it's actually a good thing that insurers are forcing hospitals and doctors to compete on price. Indeed, these "narrow networks" may be one of Obamacare’s best features (Avik Roy, 9/24).

The Wall Street Journal: The Hypocrisy Of Congress's Gold-Plated Health Care
Today, elected officials need to be reminded of these truths. Under pressure from Congress, the White House has carved out a special exemption for Congress and its staffers from Obamacare—the law it recently deemed necessary for the entire country. No Republicans voted for Obamacare. Yet it appears that some of them support the exemption President Obama approved on his own—so they would not have to go on record with a vote for or against it (William Bennett and Christopher Beach, 9/23). 

The Wall Street Journal: Obama's Debt-Ceiling Stonewall
The national debt, if left unchecked, will eclipse our entire economic output in a mere 25 years, outstripping private investment and threatening the nation's economic health. That is the prognosis Congress's nonpartisan budget scorekeeper, the Congressional Budget Office, reported last week. The rising debt is being driven by the skyrocketing costs of America's largest entitlement programs—Medicare, Medicaid and Social Security. CBO found that "federal spending for the major health care programs and Social Security would increase to a total of 14 percent of GDP by 2038, twice the 7 percent average of the past 40 years" (Sen. Orrin Hatch, R-Utah, 9/23).

USA Today: Affordable Care In 7 Days: Our View
Most Americans are at least vaguely aware that Obamacare will require almost every citizen to have health insurance, but that starts to get real a week from Tuesday. The mandate itself doesn't take effect until January, but anyone who doesn't already get insurance at work or through government programs such as Medicare and Medicaid will be able to start signing up for private policies under the new law on Oct. 1 (9/23).

USA Today: The Not Affordable Care Act: Opposing View
Imagine that Congress passed a law requiring all cars sold in America to use hybrid engines. If you're concerned about our consumption of fossil fuels, such a law might sound great. However, as anyone who has shopped for a car knows, hybrid cars are much more expensive than conventional ones. Obamacare is doing something similar to health insurance, especially for people who buy it on their own (Avik Roy, 9/23).

The New York Times: Home Care In The Home Stretch
For nearly 40 years, home-care workers, wrongly labeled "companions," have been denied basic federal labor protections, including the right to be paid at least the minimum wage and time and a half for overtime (9/23).

Des Moines Register: Finally, Respect For Home Health Care Workers
"You can wake up at 5 in the morning, care for somebody every minute of the day, take the late bus home at night, and still make less than the minimum wage," said President Barack Obama in 2011. He was talking about the nearly 2 million workers who travel to the homes of elderly and disabled people to provide care (9/23).

Los Angeles Times: Putting A Price Tag On Contacting Your Medical Specialist
So-called concierge medicine — doctors asking their patients to pay an extra fee just to remain under their care — has been around for a while. It's an offensive idea, but I get it, especially when it comes to family practitioners who look after a patient's general well-being. The medical marketplace has room for both Corollas and Cadillacs. Yet when it comes to medical specialists, such as cardiologists, things seem different (David Lazarus, 9/23). 

The New Republic: Startling New Map: 92 Percent Of New HIV Cases Are In 25 Percent Of Counties
These maps from AIDSVu, a group that turns annual HIV infection rates data from the U.S. Centers for Disease Control (CDC) into interactive displays, show exactly where new cases were diagnosed between 2008 and 2011—information that the CDC has never mapped before, and which has big implications for public health. ... The maps display cases by county, and in major cities, by zip code; they show that 92 percent of new diagnoses between 2008 and 2011 took place in just 25 percent of U.S. counties (Caplan-Bricker, 9/24).

Journal of the American Medical Association: The Value Of Sharing Treatment Decision Making With Patients
The growing emphasis on patient-centered care is increasing the demand on physicians' time and effort to more fully engage patients and their families in treatment decision making. Thus, it is important to understand the potential effects of shared decision making (SDM) with patients on the outcomes of clinical encounters. ... The increasing expectations about the role of SDM in clinical and health policy warrant closer scrutiny of the evidence (Dr. Steven J. Katz and Sarah Hawley, 9/23).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Marissa Evans
Lisa Gillespie
Shefali Luthra

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