Daily Health Policy Report

Tuesday, September 3, 2013

Last updated: Tue, Sep 3

KHN Original Reporting & Guest Opinion

Health Reform

Quality

Medicare

Health Care Marketplace

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Insuring Your Health: Complex Personal Issues May Cloud Decisions About Buying Insurance

Kaiser Health News consumer columnist Michelle Andrews writes: "If the volume of email from readers of this column is any indication, people are beginning to focus on how the health care overhaul will affect them. With the opening of the online health insurance marketplaces less than a month away, consumers with job-based coverage want to know if they can buy a plan there (answer: yes, but they may not qualify for subsidies); those with individual coverage want to know how the plans will compare with what they currently have (answer: generally better coverage and potentially higher premiums, offset by subsidies); and those who have been unable to afford a plan or turned down because they have medical problems want to know if the marketplaces will provide better options than they currently have" (Andrews, 9/3). Read the column.

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FAQ: How Will The Individual Mandate Work?

Kaiser Health News staff writer Alvin Tran reports: "The federal health law's individual mandate, one of the key building blocks of the insurance overhaul, remains controversial as the October start date approaches for enrolling in new online marketplaces. Individuals who don't get insurance through work will shop for insurance on these websites for policies that will take effect in January. … Despite all that attention to the mandate, 26 percent of Americans aren't aware of the requirement or didn't think the law included it, according to a March 2013 Kaiser Family Foundation poll. Here are some basic questions and answers about mandate" (Tran, 9/3). Read the story.

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GOP Lawmakers Demand Information From Groups Getting Navigator Grants

Kaiser Health News staff writer Mary Agnes Carey reports: "In a move that the administration described as a 'blatant and shameful attempt to intimidate,' 15 Republican members of the House Energy and Commerce Committee are asking recipients of the $67 million in health law navigator grants to brief the panel on how they intend to spend the money" (Carey, 8/30). Read the story.

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Capsules: Washington Ranks 2nd In Nation In Uninsured Growth

Now on Kaiser Health News' blog, The Seattle Times' Carol M. Ostrom, working in partnership with Kaiser Health News, reports: "With about 16 percent of its residents uninsured, Washington state falls solidly in middle of the pack, with Texas having the highest percentage of residents without health insurance: more than 25 percent. Massachusetts, where a state health-insurance mandate has been in place for years, has the smallest percentage of uninsured residents at just under 5 percent" (Ostrom, 9/3). Check out what else is on the blog.

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Political Cartoon: 'Unnecessary Roughness?'

Kaiser Health News provides a fresh take on health policy developments with "Unnecessary Roughness?" by Joe Heller.

Here's today's health policy haiku:

FLEXING POLITICAL MUSCLES

 Raising debt ceiling
is a heavier lift with
health law funds in play.
-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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Health Reform

Health Law Spurs Concerns From Allies, As Well As Enemies

Sen. Ted Cruz, R-Texas, continues his battle to undo the health law, while a House Democrat from the deep South angers both sides of the political aisle. In other news, labor unions are frustrated the administration hasn't responded to their Obamacare concerns, while Republicans in tough re-election fights are wary of accepting big premium support to buy insurance in the exchanges.

Texas Tribune: Cruz Fighting An Uphill Battle To Defund Obamacare
On the statewide speaking circuit, U.S. Sen. Ted Cruz has made upending the federal Affordable Care Act sound simple: "The House of Representatives should pass a continuing resolution that funds the entire federal government, every bit of the federal government, except Obamacare," he told a group of Houston realtors last month (Rocha, 8/3).

The Associated Press: Barrow: Shutdown Threat Over Health Law 'Reckless'
In the past three years, Rep. John Barrow has outraged fellow Democrats with his vote against President Barack Obama's health care overhaul and been attacked by Republicans for refusing to support a full repeal. And the deep South's last white Democratic congressman is still defying both parties with his stance on the law. Before Congress adjourned Aug. 2, Barrow was among just four Democrats who sided with House Republicans voting to gut a key part of the Affordable Care Act that puts the Internal Revenue Service in charge of enforcing certain mandates (Bynum, 9/2).

Des Moines Register: Congress Preview: Rollout Of Health Care Reform
Even as major aspects of President Barack Obama’s signature Affordable Care Act are set to take effect this fall and early next year, lawmakers continue to debate changes large and small. Dozens of conservative Republicans in Congress have proposed defunding the law entirely — and have hinted at shutting down the government if they don’t get their way. Democrats and others, meanwhile, acknowledge small tweaks and fixes may be necessary as the law comes on line (Noble, 9/3).

The Hill: Labor Union Frustration Boils Over With President On ObamaCare
Unions are frustrated the Obama administration hasn’t responded to their calls for changes to ObamaCare. Labor has watched with growing annoyance as the White House has backed ObamaCare changes in response to concerns from business groups, religious organizations and even lawmakers and their staffs (Bogardus, 9/2).

Fox News Union Dumps AFL-CIO For Its Positions On Obamacare, Immigration Reform
The International Longshore and Warehouse Union has cut ties with the AFL-CIO, citing in part the private-sector union’s support for ObamaCare and immigration reform. In an August 29 letter to AFL-CIO President Richard Trumka, leaders of the 40,000-member union said they have become “increasingly frustrated” with the federation’s policy positions on such matters as immigration and health care reform (Fox News, 09/03).

Meanwhile, health insurance coverage for Capitol Hill lawmakers and their staffs may become an issue on the campaign trail -

Politico: Obamacare Litmus: Lawmaker Perks
Leaders on Capitol Hill fought quietly behind the scenes for months to tweak Obamacare rules, so the government could keep making big premium payments for aides and lawmakers when they were pushed onto the new health care exchanges. But that victory is turning into something else for Republicans up for reelection and in tight primary races across the country: the latest Obamacare purity test (Sherman and Palmer, 8/31).

Minneapolis Star Tribune: Congress, Aides Prepare For Affordable Care Act
Congress faces a fast-approaching deadline for dealing firsthand with the requirements of President Obama’s health care reform law. A wrinkle in the Affordable Care Act is taking away employee health care benefits from members, forcing the lawmakers and their aides to buy policies from state exchanges or make other arrangements starting Oct. 1 (Mitchell, 9/2).

And some other prickly questions persist -

Kaiser Health News: GOP Lawmakers Demand Information From Groups Getting Navigator Grants
In a move that the administration described as a 'blatant and shameful attempt to intimidate,' 15 Republican members of the House Energy and Commerce Committee are asking recipients of the $67 million in health law navigator grants to brief the panel on how they intend to spend the money (Carey, 8/30).

The Washington Post: Signing People Up For Obamacare? House Republicans Have Some Questions For You
The navigators have become, as of late, a flashpoint in the Obamacare debate. More than a dozen states, my colleague Sandhya Somashekhar reported this week, have put restrictions on the work that these guides can perform. ... Health and Human Services described the letter as a “shameful attempt” to intimidate groups doing Obamacare enrollment (Kliff, 8/30).

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Policies, Operations Taking Shape For Online Insurance Marketplaces

Three states plan to open call centers today to aid consumers in finding their way around new health exchanges, slated to start business on Oct. 1. Meanwhile, in Alaska, federal officials and local organizations are working to try to get a marketplace up and running before this deadline, and California's marketplace offers more details about premium rates for coverage that will be available.  

USA Today: State Health Care Call Centers Ramp Up For Oct. 1
Vermont has 45,000 uninsured residents that it's trying to attract to its new health insurance exchange. Connecticut has 344,000. Washington state is targeting 1 million people without insurance. The three states, each with its own-sized challenge, will open call centers Tuesday to help as many of these people as they can navigate a new federally mandated way to buy insurance starting Oct. 1 (O’Donnell, 9/2).

The Associated Press: Alaska Facing Deadline Without Insurance Exchange
Federal officials and Alaska nonprofits are scrambling to establish a health insurance marketplace by the Oct. 1 deadline required under the federal Affordable Care Act. Alaska is among 27 states that have refused to set up marketplaces, also known as exchanges, where the uninsured can shop for coverage (9/2).

Los Angeles Times: California Gives Consumers Detailed Rates Under Healthcare Overhaul
Californians can now see specific rates from competing health plans on a new state-run insurance market set to open Oct. 1. Covered California, the new state marketplace, launched an online feature Thursday enabling consumers to get detailed price comparisons for their area for the first time (Terhune, 8/30).

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Health Industry Stakeholders Promote Exchanges, Launch Consumer Advertising

USA Today reports that a coalition of providers and insurers are actively promoting the online insurance marketplaces in states that have opted against running their own health exchange. Meanwhile, The New York Times examines how some insurance companies are advertising the new insurance system.

USA Today: Health Care Providers, Insurers Pitch State Exchanges
A coalition of health care providers, insurers, bill collectors and community groups have stepped in to promote exchanges where people can buy health insurance even in the states that have declined to create or promote their exchanges (Kennedy, 9/2).

The New York Times: With Change Coming, Aetna Targets Employers
As the country marches toward a new health insurance system, insurance companies have spent millions on consumer advertising to position themselves as health care companies (Vega, 9/2).

The Washington Post: These Two Maps Are Incredibly Important To Obamacare
If you want to understand where Obamacare stands to have the most significant impact, check out these new maps from the Census. They show uninsured levels for every county in the United States, broken down by income level: ... these maps explain why you see a group like Enroll America focusing its work on 10 states, rather than sweeping out across the country (Kliff, 9/1).

The Wall Street Journal: Obamacare, But By Any Other Name
At the Minnesota State Fair, state employees are promoting a health-insurance marketplace called MNsure by handing out fans imprinted with pictures of Paul Bunyan and Babe the Blue Ox. ... Minnesota, along with thirteen other states and Washington, D.C. that are fully running their own health-insurance marketplaces, is marketing this way because it believes it will draw customers, even if it doesn't change popular impressions of Obamacare, the health overhaul designed to provide coverage to those who don't have it from their employer or elsewhere (Corbett Dooren, 8/30).

Earlier, related KHN story: States Use Out-Of-The-Box Approaches To Raise Awareness Of Health Exchanges (Miller, 8/21).

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Rural Poor Likely To Feel The Pinch Of State Decisions Not To Expand Medicaid

Economist says half of the rural poor who would be aided by expansion live in states that have opted not to take that step.

The Associated Press: Economist: Medicaid Expansion A Rural Issue
Rural residents will likely benefit from the health care overhaul, but many will be hurt by their states' refusal to expand Medicaid coverage, a health economist said during a recent conference on rural health care. ... He told hospital administrators and others gathered in Milwaukee that when researchers look at rural residents who could be covered by expanded Medicaid, more than half live in states that have opted out. In comparison, more than half of the urban residents eligible for coverage under the expansion live in states that are going forward with it (Johnson, 8/2).

News outlets also looked at the issue of expansion as it plays out in several states.

Dallas Morning News: Study Says Texas Premiums Will Rise With Medicaid Expansion Opposition
Texas’ refusal to expand Medicaid will cause private health insurance premiums to rise by an average of 9.3 percent for people who buy their own coverage, a new study finds. GOP lawmakers, strongly encouraged by Gov. Rick Perry, decided not to add poor adults to Medicaid’s rolls. That means about 1.3 million fewer Texans will have health coverage by 2016 than if the federal Affordable Care Act were fully implemented in the state, according to the study by the nonprofit research organization Rand Corp. (Garrett, 9/2). 

The Columbus Dispatch: Group Gathering Signatures For Medicaid Expansion Ballot Initiative
Frustrated with GOP leaders refusal to act on [Ohio] Gov. John Kasich’s proposed Medicaid expansion, advocates for the uninsured have begun collecting signatures which could send the issue to the ballot for voters to decide. The effort is being led by a broad-based coalition made up of businesses, unions, health-care providers religious organizations, consumer groups and advocates for the uninsured (Candisky, 8/31).

The Associated Press: Medicaid Debate Turns To When Expansion Occurs
The Michigan Senate’s intense, months-long debate over Medicaid expansion and the federal health care law is not over, even after the Republican-controlled chamber’s milestone vote to provide health insurance to hundreds of thousands of low-income residents.  Senators on Tuesday will reconsider the issue of when the legislation should take effect (Eggert, 9/1).

Detroit Free Press: Michigan's Medicaid Expansion A Relief For Hospitals Giving Unpaid Care
Hospitals administrators across the state are hopeful that since the Medicaid expansion bill cleared its biggest hurdle last week, they can recoup some of the hundreds of millions of dollars they lose each year providing uncompensated health care to poor and uninsured patients. ... several of the systems that serve large numbers of low-income patients, including Henry Ford Health System and St. John Providence Health System, estimated they will save roughly 10 to 15 percent on the amounts they lose each year to uncompensated care — free charity care, unpaid patient bills and services provided to uninsured people at reduced prices (Reindl, 9/2).

Meanwhile, one outlet looks at changes coming in Michigan with the new online health marketplaces -

Detroit Free Press: Companies And Organizers Prep For Michigan Exchange Rollout Oct. 1
Nearly every Michigander will have access to basic health insurance — and be required to get it — beginning Oct. 1 as federal health reform's largest provisions start snapping into place with the launch of each state’s Health Insurance Marketplace. For those with no insurance or bare-bones coverage, that could mean more generous benefits than they've ever had, once coverage becomes effective Jan. 1 (Erb, 9/1).

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Health Law Could Be Boon For Safety Net Providers -- And Crooks

News outlets report on how the law might affect clinics serving the poor, concerns about scams and details about how the individual mandate will work.

California Health Report: ACA Brings Opportunities, Challenges To Clinics Serving The Poor
With all Americans required to enroll in health insurance under the Affordable Care Act, will the existing safety net clinics become a thing of the past? For generations, grassroots-style community clinics have worked to fill the coverage gap; their mandate, to treat any patient who walks in the door, regardless of ability to pay (Bartos, 9/3).

The Philadelphia Inquirer: Beware Of Health-Insurance Scams Under ACA
Confused is the word many Americans are using to describe the Affordable Care Act…"Confusion is a crook's best friend," said James Quiggle, communications director at the Coalition Against Insurance Fraud in Washington. In ACA fraud, the key objective is your medical record (9/1).

Kaiser Health News: FAQ: How Will The Individual Mandate Work?
The federal health law's individual mandate, one of the key building blocks of the insurance overhaul, remains controversial as the October start date approaches for enrolling in new online marketplaces. Individuals who don't get insurance through work will shop for insurance on these websites for policies that will take effect in January. … Despite all that attention to the mandate, 26 percent of Americans aren't aware of the requirement or didn't think the law included it, according to a March 2013 Kaiser Family Foundation poll. Here are some basic questions and answers about mandate (Tran, 9/3).

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Quality

N.C. Program Shows Promise In Reducing Hospital Readmissions

A statewide transitional care program in North Carolina may hold hope for reducing hospital readmissions in the U.S., a new study finds. In the meantime, readmissions' financial stakes become clear for one Minnesota hospital.

Reuters: Hospital To Home Focus May Reduce Readmissions: Study
Helping people who were recently released from a hospital understand how to care for themselves and informing their primary care doctors about their stay may reduce their risk of being admitted back into the hospital, says a new study. Researchers found that implementing a statewide transitional care program for North Carolinians on Medicaid -- the state and federal insurance for the poor -- was linked to a 20 percent reduction in patients' risk of going back to the hospital during the next year (Seaman, 9/2).

Pioneer Press: Re-admissions Prove Costly For Minnesota, U.S. Hospitals
As hospitals across the country struggle to prevent patient re-admissions, the stakes in Minnesota are clearest at Fairmont Medical Center -- a small hospital just north of the Iowa border that has received low marks on a federal report card for two consecutive years. … The efforts have been spurred, in part, by the federal health care overhaul of 2010, which created the Medicare penalty program. Private health insurers also have pushed hospitals to help prevent re-admissions when possible (Snowbeck, 9/2).

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Medicare

Medicare News: When Nursing Home Benefits Run Out; Reforming Doc Pay Fix More Costly Than Repeal

News outlets examine what options nursing home patients have when their Medicare benefits run out and the latest challenge to reforming how doctors are paid by the program -- the price tag.

The Philadelphia Inquirer: When Medicare Runs Out For Nursing-Home Patients
Mary-Carol Feeney's Medicare coverage was running out, and in mid-February, her nursing home in Montgomery County told her she would have to leave. … Medicare -- public insurance for the elderly and disabled -- covers most of the costs of skilled nursing for up to 100 days after a hospital stay. But many patients do not realize that, when Medicare coverage stops, they have other options -- because, advocates say, the facilities fail to inform them (Skinner, 9/1).

Medpage Today: Paying For SGR Fix Proving A Challenge
The price tag for a bill to repeal and replace Medicare's sustainable growth rate (SGR) payment formula could cost significantly more than just repealing it, congressional staffers said. Lawmakers have worked with greater tenacity this year to repeal the SGR, in part because of a lower price to repeal the formula, which has drawn broad disdain. The Congressional Budget Office (CBO) said earlier this year it would cost $138 billion -- more than $100 billion less than it had estimated in years prior -- to do away with the system (Pittman, 8/30).

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Health Care Marketplace

Money & Medicine: Pay Differential For Women Docs Grows, Big Employers See Health Costs Jump, Rx Coupons Are No Bargain

News outlets covered various studies about health costs and doctor earnings.

Bloomberg: Pay Gap For Women Doctors Increases To $50,000 A Year
Female physicians in the U.S. continue to earn less than their male counterparts, with the pay gap widening during the past two decades to more than $50,000 annually in 2010, researchers said.  Women doctors had a median annual income of $165,278 from 2006 to 2010, compared with yearly earnings of $221,297 for male physicians, according to the report published today in JAMA Internal Medicine (Cortez, 9/2).

The Washington Post: Large Employers Project An Increase In Health Care Benefit Costs In 2014
Large employers expect their cost of health care benefits to rise 7 percent in 2014, according to annual survey conducted by the National Business Group on Health, a nonprofit whose members include 66 Fortune 100 companies (Halzack, 9/1).

Earlier, related KHN story: Survey: Big Business May Shift Retirees, Part-Timers To Insurance Exchanges(Hancock, 8/28)

The Philadelphia Inquirer: Check Up: Prescription-Discount Coupons Have Hidden Costs
Instant savings! Free 30-day trial voucher! Pay no more than $18 a month! These are the kinds of alluring phrases you can find on coupons for brand-name prescription drugs. But an article in the New England Journal of Medicine warns that behind such catchy language, there is a catch: You likely will not save money in the long run (Avril, 9/1).

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State Watch

State Highlights: Calif. Bill To Expand Nurse Role In Health Care Dies

A selection of health policy stories from California, Ohio, Mississippi and Washington.

Los Angeles Times: State Bill To Boost Use Of Nurse Practitioners Goes Nowhere
An effort to ease a shortage of primary-care doctors in some California communities by letting nurse practitioners operate more independently has flat-lined in the Legislature after a fierce lobbying battle. A bill by Sen. Ed Hernandez (D-West Covina) would have allowed nurse practitioners, who have more training than registered nurses, to practice without the direct supervision of a physician (Mason, 9/1).

Columbus Dispatch: Nonprofit Senior-Housing Developer Turns Focus To Health Care
An Upper Arlington company that is the nation's largest nonprofit provider of affordable housing for senior citizens is poised to continue its model of offering medical care and other services to people where they live. National Church Residences, or NCR, provides health care at dozens of its Ohio locations. Along with continuing-care retirement campuses, assisted-living centers, nursing homes, home health care and hospice, the company also has on-site primary-care services at a number of residences and offers health care at adult day-care centers (Viviano, 9/3).

The Associated Press: Analysis: PEER Proposes Review Of Trauma Care Cost
Two incidents that occurred within months of each other prompted Mississippi public health leaders and lawmakers to invest in a trauma care system. On Nov. 5, 1995, Gov. Kirk Fordice was severely injured when his sport utility vehicle ran off Interstate 55 north of Grenada and flipped over. He was transferred to the University of Mississippi Medical Center in Jackson, the state's only Level I trauma center (Elliot, 9/1).

Kaiser Health News: Capsules: Washington Ranks 2nd In Nation In Uninsured Growth
With about 16 percent of its residents uninsured, Washington state falls solidly in middle of the pack, with Texas having the highest percentage of residents without health insurance: more than 25 percent. Massachusetts, where a state health-insurance mandate has been in place for years, has the smallest percentage of uninsured residents at just under 5 percent (Ostrom, 9/3).

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Editorials and Opinions

Viewpoints: Shortages Of Drugs Persist; Number of Medicare Doctors Is Growing; Obamacare Undermines Health Savings Accounts

USA Today: Debt Limit Politics: Our View 
As was the case during the last debt-ceiling debacle, in 2011, playing politics with the nation's creditworthiness is irresponsible and unnecessary. Leave aside the ObamaCare obsession, because Republicans have zero chance of persuading the president to kill one of his defining achievements. After defeats in Congress, the Supreme Court and last year's presidential election, the ObamaCare opponents seem like the holdout Japanese soldiers who kept fighting World War II into the 1970s (9/2).

USA Today: Tie Debt Limit To Spending Cuts 
There is no need for market-rattling showdowns or brinksmanship in the discussion this fall. The sooner President Obama starts to work with both parties to solve Washington's spending problem, the better it will be for our economy (House Speaker John Boehner, R-Ohio, 9/2). 

The Washington Post: Republicans Should Get Out Of The Way Of Obamacare
Congress enacted the Affordable Care Act. The Supreme Court found most of its provisions to be constitutional. Republicans, having opposed the bill and supported the legal challenge to it, are entitled to be unhappy about the outcome, though in our view they are wrong on the merits. They are not entitled to obstruct and flout the laws of the United States. On the contrary, they have an obligation to cooperate in good faith with wholly legitimate laws duly passed and reviewed by all three branches of government (9/2).

The Washington Post: In Budget Fight, GOP Doesn't Act In The National Interest
Do [Republicans] really believe the president is willing to forsake his most important legislative accomplishment? Before it even comes fully into effect? This is a tragic waste of time and effort. Remember when Democrats captured the House in 2006? They worked with George W. Bush even though they disagreed with his policies (Eugene Robinson, 9/2).

The New York Times: How A Cabal Keeps Generics Scarce 
About a year ago, President Obama signed a law that was supposed to end chronic shortages of lifesaving drugs. But the critical lack of generic drugs continues unabated. It is a preventable crisis that is inflicting suffering on patients and, in some cases, causing needless deaths (Margaret Clapp, Dr. Michael A. Rie and Phillip L. Zweig, 9/2).

The New York Times: Doctors And Their Medicare Patients
Critics who want radical changes in Medicare, the public insurance program for the elderly and disabled, often allege that the program is heading for disaster because stingy payments from the government are causing a rising number of doctors to refuse to serve Medicare patients. ... Those concerns have always been greatly exaggerated. Now a new analysis by experts at the Department of Health and Human Services should demolish that mythology for good (8/31).

Bloomberg: Health Savings Accounts As Antidote To Obamacare
For years, conservative health-policy analysts have highlighted the power of consumer-directed arrangements such as health savings accounts to restrain costs, help consumers gain more control over their medical decisions and improve the quality of care. Yet Obamacare, as well as some state policies, are undermining the effectiveness of HSAs. Republicans now have an opportunity to rally around reforms to replace Obamacare and address health-care spending. Making HSAs more attractive and widely available is an important piece of the puzzle (Lanhee Chen, 9/2). 

Arizona Republic: Affordable Care Act Needs Fixes To Address Costs
TI’ve heard from families and businesses concerned about the lack of specific information regarding implementation of the ACA, what the law means for them and and what the marketplace costs and options will be. This frustrating lack of information from the federal government is hampering their ability to plan for the future. My staff and I are working to help businesses and families navigate the current law (Rep. Krysten Sinema, D-Ariz., 9/1).

Bloomberg: Free Nurse Practitioners From Supervision
Whatever its flaws, the Patient Protection and Affordable Care Act has sparked innovation across the U.S.’s sclerotic health-care system. An especially welcome example is the push to expand the role of nurse practitioners in primary care. The country’s 171,000 NPs are trained to do many jobs that primary-care doctors do: diagnose problems and treat patients, order tests, prescribe drugs and refer to specialists. And with an average income of $99,000, they’re a bargain (8/30).

The Philadelphia Inquirer: The Philadelphia Inquirer: Too Poor For A Health Premium Subsidy
Will low-income Pennsylvanians be tempted to overstate their income to the IRS in order to afford health insurance? The state's rejection of Medicaid expansion for its poorest citizens creates this perverse incentive (Michael Campbell, 9/1).

Detroit News: Has Snyder's Medicaid Expansion Mortgaged Michigan's Future?
The Michigan Legislature's bipartisan approval of [Gov. Rick] Snyder's expansion of Medicaid coverage to 133 percent of the poverty line last week was a rational decision given Obamacare’s threat to small businesses and the federal government’s promise to cover near-term expenses . ... The Medicaid deal is a short-term solution that, like Detroit’s past largesse, puts the state at long-term risk well after Snyder & Co. have left office (Henry Payne, 9/3).

St. Louis Post-Dispatch: Costs Of Not Expanding Medicaid In Missouri Begin To Hit Home
There are Republicans in Missouri who argue that the nearly 800,000 people in this state without health insurance already have access to the health-care system. They are not entirely wrong. Anyone who can get to a hospital emergency room can be seen by a doctor. If you have no means to pay, your care might even be free. But somebody always pays (9/3). 

St. Louis Dispatch: Three Reasons Why Missouri Should Expand Medicaid
Since July, the Interim Committee on Citizens and Legislators Working Group on Medicaid Eligibility and Reform has listened to testimony across Missouri. Consensus exists about ways to build on the successes of the current Medicaid program, and about some areas in which reform is needed. But these are complex issues. Missouri cannot afford to delay expanded eligibility until reforms are implemented. The opportunity to save lives and give peace of mind to more 250,000 Missourians will have passed (Ruth Roetheli Ehresman, 9/3).

Minneapolis Star Tribune: Health Care: A Roadblock To Entrepreneurial Ambition
This means that entrepreneurialism in America, the Land of Opportunity, is becoming solely the province of the young, rich, healthy and illogical. By tying health insurance to full-time employment, we have made entrepreneurialism devastatingly unlikely, because even those who could afford to live on, say, a 25-hour workweek must also forfeit affordable insurance. The solution here certainly doesn’t have to be state-run health care, and it really doesn’t even have to include state-sponsored health insurance (Andrew Finken, 9/2).

The Philadelphia Inquirer: To Implement Obamacare, Start By Explaining It
Beginning next year, you will have to maintain coverage of some sort if you can afford it, but you are guaranteed that it will be available. A simple message like this could go a long way toward reducing the confusion. It might lead many of those who disapprove of Obamacare to withhold some of their skepticism. And the task of implementing the law would become a whole lot easier (Robert Field, 9/2). 

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
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.