Daily Health Policy Report

Wednesday, September 4, 2013

Last updated: Wed, Sep 4

KHN Original Reporting & Guest Opinion

Health Reform

Health Spending And Fiscal Battles

Coverage & Access


Public Health & Education

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

FAQ: Hospital Observation Care Can Be Poorly Understood And Costly For Medicare Beneficiaries

Reporting for Kaiser Health News, Susan Jaffe writes: "Some seniors think Medicare made a mistake. Others are just stunned when they find out that being in a hospital for days doesn't always mean they were actually admitted. Instead, they received observation care, considered by Medicare to be an outpatient service. Yet, a recent government investigation found that observation patients often have the same health problems as those who are admitted. But the observation designation means they can have higher out-of-pocket expenses and fewer Medicare benefits" (Jaffe, 9/4). Read the story.

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Texas Minors Can No Longer Use Tanning Salons

The Texas Tribune's Jody Serrano, working in partnership with Kaiser Health News, reports: "The relationship between tanning beds and skin cancer has concerned lawmakers on a state and national level for years, but there has been no consensus on how to address it. The federal government requires tanning bed manufacturers to disclose the risks on warning labels, and some states require youth to have parental consent to tan" (Serrano, 9/3). Read the story.

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Capsules: Baltimore Ravens To Host Ads for Maryland Health Exchange; Study: Nearly Half Of U.S. Births Are Covered By Medicaid

Now on Kaiser Health News' blog, Jay Hancock reports on ads just unveiled for Maryland’s online health insurance marketplace: "The Ravens join Giant Food and CVS Pharmacy in the effort to get as many uninsured people as possible enrolled in the state' online marketplace, dubbed the Maryland Health Connection. With an ad budget of $2.5 million, the predominantly Democratic state hopes to enroll 180,000 in private coverage sold through the marketplace and another 110,000 in an expanded Medicaid program" Hancock, 9/3).

Also on the Capsules, Phil Galewitz writes about a study detailing the number of U.S. births covered by Medicaid: "About half the births in the United States are paid for by Medicaid — a figure higher than previous estimates – and the numbers could increase as the state-federal health insurance program expands under the Affordable Care Act, according to a study released Tuesday" (Galewitz, 8/3). Check out what else is on the blog.

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Political Cartoon: 'Pro-Choice?'

Kaiser Health News provides a fresh take on health policy developments with "Pro-Choice?" by Lisa Benson.

Here's today's health policy haiku:


Raven's part of play
for Maryland's health exchange.
Is it a touchdown?

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

NFL's Ravens To Aid Maryland's Health Exchange Enrollment Push

The state's online insurance marketplace, which is scheduled to begin operating in October, enlisted the help of the Super Bowl champs as part of an advertising campaign unveiled Tuesday.  

Baltimore Sun: Maryland To Launch Ad Campaign For Health Insurance Marketplace
Marylanders, with the help of a catchy jingle and the Baltimore Ravens, will urge residents to sign up for new health insurance coverage available through federal reforms in an advertising campaign launching this month, health officials said Tuesday. Television, radio, online and print ads featuring the faces and voices of state residents who plan to sign up for coverage will soon proliferate in the state, including in prime spots during Ravens broadcasts and eventually billboard and transit ads (Dance, 9/3).

The Wall Street Journal’s Washington Wire: Maryland Enlists NFL's Ravens On Obamacare
Maryland health officials announced Tuesday that they will partner with the Baltimore Ravens football team this fall to help spread the word about the state’s health insurance marketplace that will allow consumers to shop for health insurance starting in October. The partnership with the two-time Super Bowl champions is part of a broader campaign unveiled on Tuesday to market Maryland Health Connection that will allow consumers to shop for health insurance or sign up for Medicaid if they qualify (Corbett Dooren, 9/3).

Politico: Baltimore Ravens To Aid Obamacare Enrollment Effort In Maryland
The NFL may have spiked the White House's request for Obamacare PR help — but the Super Bowl champion Baltimore Ravens just called an audible. The team has signed onto efforts to market the health law to Marylanders, according to an announcement from Lt. Gov. Anthony Brown and officials running the state's Obamacare insurance exchange, known as Maryland Health Connection (Cheney, 9/3).

Kaiser Health News: Capsules: Baltimore Ravens To Host Ads for Maryland Health Exchange
The Ravens join Giant Food and CVS Pharmacy in the effort to get as many uninsured people as possible enrolled in the state' online marketplace, dubbed the Maryland Health Connection. With an ad budget of $2.5 million, the predominantly Democratic state hopes to enroll 180,000 in private coverage sold through the marketplace and another 110,000 in an expanded Medicaid program (Hancock, 9/3).

The Hill: Super Bowl Champion Ravens To Promote Obamacare In Md.
The Super Bowl champion Baltimore Ravens will help Maryland promote new insurance options under Obamacare, state officials announced Tuesday. It's the first official partnership formed with a sports franchise to encourage participation in President Obama's signature healthcare law (Baker, 9/3).

Meanwhile, health law critic Sen. Marco Rubio, R-Fla., is blasting a different advertising campaign, this one planned by the Department of Health and Human Services -  

The Hill: Sen. Rubio Claims HHS Planning $8.7 Million Ad Buy To Promote Obamacare
The Obama administration is planning to spend $8.7 million encouraging people to enroll in new health insurance options under Obamacare, Sen. Marco Rubio (R-Fla.) said Tuesday. Rubio criticized the expenditure, which comes as he and a handful of other conservative Republicans are threatening a government shutdown over funding to implement the healthcare law (Baker, 9/3).

Fox News Rubio Blasts $9M Obamacare Advertising Campaign
A proposed $8.7 million TV advertising campaign to promote Obamacare in the lead-up to a key launch date is being targeted by Sen. Marco Rubio, who calls the effort a “blatant misuse of federal dollars.” The Florida Republican said Tuesday that such spending is “unconscionable,” considering the uncertainty of the law and urged the Department of Health and Human Services to halt the spending (9/04).

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Call Centers Open In Several States As Exchanges Ramp Up

Reports on developments regarding federal and state exchanges in Texas, Minnesota, Washington, Wisconsin and California.

Texas Tribune: Uncertainty Lingers As Insurance Exchange Rollout Nears
The federal government is spending millions of dollars to promote health care coverage via new marketplace exchanges, but with only a few weeks left until their debut, some Texans say they've been left with more questions than answers (Zaragovia, 9/3).

Minneapolis Star Tribune: Ringing Phones Mark First Link To MNsure Health Insurance Exchange
More than two dozen call center operators took their places in neat rows of private cubicles Tuesday, providing the first official link between consumers and the state’s new health insurance exchange. The phone lines in the exchange’s downtown St. Paul headquarters were ringing. Operators took more than 200 calls in the first five hours, each lasting about four minutes, officials said (Crosby, 9/3).

The Associated Press: Call Center Will Answer Questions On Health Care
Washington residents will be able to start the process of buying insurance through the state's health exchange next month, but many likely still have a few questions about their insurance options. A Spokane-based toll-free customer support line will start taking calls at 1-855-923-4633 starting at 7:30 a.m. PDT Tuesday, and potential customers will have a live person to talk with about plan choices, costs and what kind of subsidies they might be eligible for (La Corte, 9/4).

The Associated Press: Insurance Rates Released By Walker Administration Questioned By Health Care Advocates
Health care advocates called into question information released Tuesday by Gov. Scott Walker's administration showing dramatic rate increases for insurance plans to be sold through the new marketplace created under the federal health care law. The marketplaces, or exchanges, will be open for enrollment starting Oct. 1 with coverage beginning Jan. 1 (Bauer, 9/3).

California Healthline: Exchange Ramps Up As Deadline Nears
There's the rollout of the media campaign, the community outreach effort, the health care provider outreach, finalizing details with health plans, coordinating insurance agents, creating call centers, coordinating with federal officials, working with the state and counties on a Medi-Cal expansion interface, establishing a small-business program, and launching an online eligibility determination and enrollment system. That's a pretty full plate (Gorn, 9/3).

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Michigan Gives Final Green Light To Medicaid Expansion

Meanwhile, the federal government approved a one-year waiver for the Healthy Indiana Plan.

Reuters: Michigan House Approves Expanding Medicaid Under Obamacare
The Republican-led Michigan House gave final approval on Tuesday to a bill that would expand the Medicaid health program for the poor under Democratic President Barack Obama's healthcare reform law. Representatives voted 75-32 to concur with modifications of a bill that they had approved in June and agreed to send it to Michigan Governor Rick Snyder, a Republican who has backed the expansion of the Medicaid program (Bailey, 9/3).

Detroit Free Press: Delay In Medicaid Expansion To Cost Michigan $7M A Day In Lost Federal Funds
Final approval didn’t come without hiccups. The Senate failed to give the bill immediate effect, which means that it won’t go into effect until sometime in late March or early April. That delay will end up costing the state an estimated $7 million a day in lost federal funds for the expansion, or more than $630 million if delayed to April (Gray, 9/3).

Modern Healthcare: Reform Update: Michigan Legislature Approves Medicaid Expansion, But Will The CMS?
[S]ome observers are questioning whether the Obama administration will OK the state's request to require enrollees to pay up to 5% of their income for cost-sharing. The Republican-controlled Michigan Senate narrowly approved a measure last week to expand the state's Medicaid program to include all childless adults with incomes up to 138% of the poverty line, or $15,500 for an individual; ... Five percent of a $15,500 income is nearly $800, which experts say is a lot of money for someone at that income level (Johnson, 9/3).

Reuters: U.S. Allows Indiana To Offer Health Program Outside Of Obamacare
The federal government will allow Indiana to operate its own health program temporarily, Governor Mike Pence said on Tuesday, making it the first state to receive such a major exception this year under President Barack Obama's signature medical reform law. Indiana is one of the Republican-led states that rejected the federal government's incentives to expand the Medicaid health program for the poor and declined to set up a health insurance exchange to allow consumers to shop for insurance (Guyett, 9/3).

The Associated Press: Feds Agree To One-Year Extension Of Healthy Indiana Plan
As part of a deal with the Centers for Medicare and Medicaid Services, the Pence administration will lower the amount residents can earn before they qualify for the state-run Healthy Indiana Plan while pushing more residents into the federal health insurance exchange (LoBianco, 9/3).

Chicago Sun-Times: Indiana’s Health Plan Gets One-Year Federal Waiver
Additional tools were provided to manage enrollment in the program, allowing the state to keep the program fiscally sustainable. Gov. Mike Pence viewed the decision as a victory for citizens enrolled in the plan. ... Pence and Republican legislative leaders originally wanted to use Healthy Indiana to cover more than 400,000 uninsured residents under the Medicaid expansion (Mikus, 9/3).

Fom Kentucky -

Louisville Courier-Journal: Kentucky Medicaid Expansion Clears Hurdle Of Legal Challenge
The [Gov.] Beshear administration’s plans to expand Medicaid and begin enrollment in Kentucky’s new health care exchange survived its first court challenge Tuesday. In separate rulings, Franklin Circuit Judge Phillip Shepherd upheld both decisions by Gov. Steve Beshear intended to expand access to health care to 640,000 uninsured Kentuckians under the Affordable Care Act, also known as Obamacare. The rulings swept aside the legal challenge by Nicholasville Tea Party activist David Adams and others who insisted that Beshear’s actions must be ratified by the legislature (Loftus, 9/3).

In related news -

Kaiser Health News: Study: Nearly Half Of U.S. Births Are Covered By Medicaid
About half the births in the United States are paid for by Medicaid — a figure higher than previous estimates – and the numbers could increase as the state-federal health insurance program expands under the Affordable Care Act, according to a study released Tuesday" (Galewitz, 8/3).

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Politics Of Obamacare: Checking Sen. Cruz's Claims; Democrats Campaigning In South As 'Problem Solvers'

The Washington Post Fact Checker assesses the Texas senator's TV ads that seek to drum up support for defunding the health law, while in some southern campaigns, some Democrats hope to portray their opponents as ideologically opposed to progress on issues such as health care.

The Washington Post's The Fact Checker: Ted Cruz's Claims About 'Obamacare' In New TV Ad
As part of his campaign to halt all government funding for the Affordable Care Act, a.k.a. Obamacare, Cruz makes three assertions about "bipartisan" concerns about the new health-care law. Let's look at each of these claims in detail (Kessler, 9/3).

The Associated Press: Southern Democrats Campaign As 'Problem Solvers'
As Democrats try to curtail GOP dominance in the South, the party's top recruits for 2014 elections are trying to sell themselves as problem solvers above Washington's partisan gridlock. They're casting the Republicans' anti-government mantra and emphasis on social issues like abortion and gay marriage as ideological obstacles to progress on "bread-and-butter" issues like public education, infrastructure and health care (Barrow, 9/3).

In other political developments -

The Associated Press: Conservatives Pressure Georgia Senators On Health Care
As part of a burgeoning national movement, tea party and other conservative activists are pressuring Georgia's two Republican senators to join the effort to deny money for implementing President Barack Obama's health care law. Sens. Johnny Isakson and Saxby Chambliss say they're all for stopping the law, just not shutting down most of the federal government to do it (Barrow, 9/3).

Atlanta Journal Constitution: Obamacare Defunding Effort Splits GOP
So far, only a minority of Capitol Hill Republicans are demanding the next federal spending bill not include a dime for the Affordable Care Act (Bluestein and Malloy, 9/3).

San Jose Mercury News: 10 Republicans Who Helped Implement Obamacare
While Republicans in Congress have vehemently opposed the 2010 health care law, some Republican governors have taken a more pragmatic approach. Here's a look at 10 (Beckwith, 9/4).

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Health Spending And Fiscal Battles

NIH, Other Agencies Feel Burden Of Budget Strife

The New York Times: Budget Battles Keep Agencies Guessing
The budget woes are afflicting, among others, state governments, American Indian tribes, military contractors and cancer research laboratories. Budget experts said that the short-term concerns over next year’s dollar figures were already hampering long-term planning and making government officials hesitant to commit to big projects or to hire needed employees. In an interview, Dr. Francis Collins, the director of the National Institutes of Health, called 2013 the "darkest ever" year for the agency, whose budget is at its lowest inflation-adjusted appropriations level in more than a decade. The agency has been awarding grants to an increasingly smaller sliver of applicants as well (Lowrey, 8/3).

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Coverage & Access

The New Norm? Businesses Setting Up Private Exchanges For Insurance

The Wall Street Journal examines private health insurance marketplaces in which many employees of small and mid-size businesses can expect to receive health benefits from their employer.

The Wall Street Journal: More Employers Overhaul Health Benefits
This fall, tens of thousands of U.S. workers will learn that they're getting their health benefits next year in a radical new way: Their employers will give them a fixed sum of money and let them choose their plan from an online marketplace. ... The private exchanges for employers are separate from the government-operated marketplaces that are being created in each state under the federal health law, which will serve individual consumers and small companies (Mathews, 9/3).

The Wall Street Journal's Corporate Intelligence: FAQ: What Workers Need To Know About Private Employer Exchanges
Online marketplaces, known as private exchanges, allow employers to offer their workers a range of choices for health-insurance coverage. Companies jumping in -- including benefits-consulting firms like Xerox Corp.’s Buck Consultants, Marsh & McLennan Cos.' Mercer and Towers Watson & Co., as well as insurance brokerages such as Willis Group Holdings PLC and Digital Insurance Inc. -- are betting that 2014 is the year the [private] exchanges will start to take off (Mathews, 9/3).

In the meantime, the Census Bureau says Latinos are the most likely people in the U.S. to go without health insurance --

The Washington Post: Hispanics Most Likely To Go Without Health Insurance
Hispanics are less likely to be covered by health insurance in every state in the union, according to new figures released late last week by the Census Bureau. The figures show more than 30 percent of Hispanics under the age of 65 are uninsured in 28 states, far higher than the rates of uninsured African Americans and whites (Wilson, 9/3).

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Who Will Care For Older Americans As They Age -- And Who Will Pay For It?

The implications of caring for aging Americans continues to worry many as news outlets examine workforce and cost issues related to treating older Americans.

The Wall Street Journal's Total Return: Making Caregivers Part Of The Team
AARP has crunched some alarming numbers: The number of potential caregivers available for every person who is at least 80 years old is expected to plummet by 2030, as the older population outpaces the number of younger Americans. The ratio of people in the most common caregiving age group (45 to 64) to those most likely to need long-term care (80 and over) is expected to fall to 4 to 1 by 2030 -- compared with more than 7 to 1 in 2010, AARP says. By 2050, the ratio could drop to less than 3 to 1 (Greene, 9/3).

Fox News The Cost Of Long-Term Care 
Dealing with a sick parent is emotionally draining, but it can also be financially devastating for adult children making health-care decisions. Whether children choose to put a parent in a nursing home, hire in-home professionals or go it alone, there are host of financial and emotional factors to (Fuscaldo, 09/03).

In related news -

ABC News Top 5 Ways To Reduce A Hospital Bill
Families around the country are struggling to pay the price of healthcare. Nearly 2 million Americans are living in medical bankruptcy, and one in five adults has trouble affording medical care. While we don't often think of it, discounting the price of healthcare is nothing new. Almost every major participant in the health system routinely negotiates reduced payments rates (LaMontagne, 09/04).

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Putting Seniors In The Hospital Under 'Observation' May Cost Them Thousands

Many seniors think Medicare made a mistake when they find out they were never officially admitted to the hospital despite a several-day stay.

NPR: For Hospital Patients, Observation Status Can Prove Costly
Increasingly, hospitals are placing older patients on "observation status". They may be there for days, but technically they're still outpatients. This is a big deal for someone on Medicare because followup treatment in a nursing home isn't covered unless someone has been an inpatient for at least three days. That's leaving some seniors on the hook for thousands of dollars in nursing home bills (Jaffe, 9/4).

Kaiser Health News: FAQ: Hospital Observation Care Can Be Poorly Understood And Costly For Medicare Beneficiaries
[A] recent government investigation found that observation patients often have the same health problems as those who are admitted. ... The number rose 69 percent in five years, to 1.6 million nationally in 2011, according to the most recent federal statistics. At the same time, Medicare hospital admissions have declined slightly. Here are some common questions and answers about observation care and the coverage gap that can result (Jaffe, 9/4).

Boston Globe: Ex-Medicare Chief Urges Fix To Rule For Rehab Coverage
Former Medicare chief Donald Berwick said Obama administration officials should abandon a rule that is leaving many older Americans without coverage for expensive rehabilitation care after they leave the hospital. ... Berwick said that when he ran Medicare from July 2010 to December 2011, he discussed scrapping the three-day rule. But others in the agency worried that without this requirement, people would emerge from “the woodwork’’ to check into nursing homes without any review of whether they really need to be there (Kowalczyk, 8/30).

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Public Health & Education

Seniors Make Bigger Gains Against Heart Disease Than Younger People

Media outlets report that rates for so-called avoidable deaths from cardiovascular disease declined among people under age 75, but the rates of decline were substantially slower among adults under age 65 and among blacks, according to an analysis by the Centers for Disease Control and Prevention.

The Wall Street Journal: Heart-Disease Gains Partly Elude Younger Adults
Fewer people in the U.S. are succumbing to preventable death from cardiovascular disease, but most of the improvement in rates is among the elderly, rather than among younger adults who are also at risk, according to federal data released Tuesday. The rate of so-called avoidable deaths from heart disease, stroke and hypertension declined 29% between 2001 and 2010 in people under age 75, thanks in part to healthier lifestyles and better cardiac care, according to an analysis of U.S. mortality data by the Centers for Disease Control and Prevention. But the rates of decline were substantially slower among adults under age 65, the agency said. Rates also varied widely depending on where people lived and their race or ethnicity (McKay and Winslow, 9/3).

Medpage Today: CV Deaths Down, But Still Too High, CDC Says
Preventable deaths from cardiovascular disease are on the decline but are still too high, particularly in younger adults and blacks, according to the CDC. The overall rate of avoidable deaths from heart disease, stroke, and hypertensive disease before age 75 declined 29 percent from 2001 to 2010, Linda J. Schieb, MSPH, of the CDC in Atlanta, and colleagues found. But 56 percent of these deaths were in people younger than 65, a group for whom less improvement occurred, the researchers reported in an early release in Morbidity and Mortality Weekly Report accompanying the September issue of Vital Signs (Phend, 9/3).

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State Watch

State Highlights: At Least 58 U.S. Abortion Clinics Close After New, Tighter Laws

A selection of health policy news from Minnesota, Texas, North Carolina, Connecticut and California.

Bloomberg: Abortion Clinics Close At Record Pace After States Tighten Rules
At least 58 U.S. abortion clinics -- almost 1 in 10 -- have shut or stopped providing the procedure since 2011 as access vanishes faster than ever amid a Republican-led push to legislate the industry out of existence.  A wave of regulations that makes it too expensive or logistically impossible for facilities to remain in business drove at least a third of the closings (Deprez, 9/3).

Minnesota Public Radio State To End Health Care Insurance Safety Net Program
After gathering feedback from some of Minnesota's sickest patients, the state is moving ahead with a plan to close a safety-net program that helped people with prior health problems get insurance. The federal health care law prevents insurance companies from denying people with pre-existing conditions, so high-risk pools like the Minnesota Comprehensive Health Association are no longer necessary -- at least in theory (Richert, 9/3).

The Texas Tribune/Kaiser Health News: Texas Minors Can No Longer Use Tanning Salons 
The relationship between tanning beds and skin cancer has concerned lawmakers on a state and national level for years, but there has been no consensus on how to address it. The federal government requires tanning bed manufacturers to disclose the risks on warning labels, and some states require youth to have parental consent to tan (Serrano, 9/3).

North Carolina Health News: State Health Department Sees Sharp Rise In At-Will Workers
With the passage of a new law, Gov. Pat McCrory has been given the power to make hundreds of workers in DHHS exempt from the State Personnel Act. What will that mean for the department? (Dukes and Hoban, 9/3).

CT Mirror Connecticut Officials Trying To Redesign Health Care System, But Advocates Wary 
State officials and representatives from the health care and insurance industries are developing a plan to redesign how health care is delivered and paid for in the state, an initiative aimed at affecting the vast majority of Connecticut residents. The goal is to improve the quality of health care by changing the way private insurers and public programs like Medicare pay for it (Becker, 09/03).

California Healthline: Health Bills On Docket As Legislature Moves Into Final Phase
Over the next 10 days, a number of health-related bills will get their final floor votes in the state Assembly and Senate. One of them is a proposal to expand independence of practice for pharmacists. SB 493 by Sen. Ed Hernandez (D-West Covina) passed out of Appropriations last week and is waiting for an Assembly floor vote. What won't hit the floor is SB 491, also authored by Hernandez, which would have expanded independence of practice for nurse practitioners. It was held up in the Assembly Committee on Appropriations last week (Gorn, 9/3).

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Editorials and Opinions

Viewpoints: Economic Theory Shows Health Law's Taxes Will Affect Jobs; No Indication That Part-Time Jobs Are Increasing; Doctors 'Ditching' Medicare?

The New York Times: Economix: Obamacare Vs. Romneycare: The Labor Impact
The Affordable Care Act was intended to expand the fraction of the United States population covered by health insurance. The law includes taxes on employers and various implicit taxes on employees that go into effect over the next two years. Economic theory suggests that such taxes will contract the labor market in an amount commensurate with the amount of the new taxes (Casey B. Mulligan, 9/4).

The New York Times: Economix: Testing A Premise On The Health Care Law And Part-Time Work
Since the Affordable Care Act requires businesses with at least 50 full-time workers to provide them with coverage (or it will, when the employer mandate kicks in a year from now), critics claim that it is prompting employers to shift to more part-time jobs. But as I have noted in various postings, there is no evidence to back up that claim — in fact, both involuntary and overall part-time work are declining as a share of all jobs (Jared Bernstein, 8/3).

Forbes: How Rick Perry's And Bobby Jindal's Medicaid Snubs Boost Private Insurance Costs
Health insurance rates for individuals purchasing private coverage could jump 8 to 10 percent in Louisiana, Florida and Texas where state political leaders have decided against expanding the Medicaid health insurance program for the poor under the Affordable Care Act, new research indicates. In a new study from the nonprofit research organization RAND Corp., researchers said the lack of an expanded Medicaid program will force more lower income people into the individual insurance market via exchanges created by the health law to provide more private coverage (Bruce Japsen, 9/1).

The New Republic: Read: These Documents Show What An Attempt To Sabotage Obamacare Looks Like
Republicans may have found a new way to undermine Obamacare: By harassing the organizations that are supposed to help people get health insurance. Last week, Republicans on the House Energy and Commerce Committee sent letters to at least some of the 105 organizations that, earlier this month, received federal grants to serve as "navigators" for Obamacare (Jonathan Cohn, 9/2). 

USA Today: Common Ground: Will ObamaCare Crash Or Cruise?
The Affordable Care Act has yet to prove itself the best solution to health care reform. Cal Thomas is a conservative columnist. Bob Beckel is a liberal Democratic strategist. But as longtime friends, they can often find common ground on issues that lawmakers in Washington cannot (Cal Thomas and Bob Beckel, 9/3).

Los Angeles Times: Five Ways To Think About The U.S. Debt Limit
In recent budget talks between the White House and congressional Republicans, changes to both Social Security and Medicare have been proposed. ... The budget negotiators also discussed a "complete restructuring of Medicare," according to the Washington Post. It's not clear why anything of the sort is necessary. Medicare is the most efficient provider of healthcare we have, and its rate of cost growth has been coming down sharply in recent years. Obama still hankers after a "grand bargain" encompassing the debt limit, the budget and other fiscal matters, so the chance that there will be disguised negotiations over the debt limit still lurks in the wings (Michael Hiltzik, 9/3).

Los Angeles Times: Who May Perform Abortions
Under California law, abortions may only be performed by medical doctors. But a new bill, which just won approval in the Legislature, would allow certified nurse midwives, nurse practitioners and physician assistants who complete special training to perform certain routine first trimester abortions. The bill, AB 154, by Assembly Majority Leader Toni Atkins (D-San Diego), is a reasonable and sensible measure that Gov. Jerry Brown should sign (9/3). 

The Washington Post: Long-Term, Who Will Take Care Of You?
During the discussion, a woman asked a question that so many others are asking. She wanted to know what to do about her aging parents. They have little money and many health issues. She didn't think they could afford to continue living on their own. The woman is sandwiched between taking care of her children and her parents. Her financial resources can stretch only so far (Michelle Singletary, 9/3).

The Fiscal Times Are Doctors Really Ditching Medicare?
So are doctors really abandoning their elderly patients? While many are certainly not taking Medicare patients anymore, the big picture is much more nuanced. First, a little math helps clarify what's really been happening. There are about 685,000 physicians in the U.S. who accept Medicare patients. Last year, according to the Centers for Medicare and Medicaid Services (CMS), some 9,539 doctors chose to opt out of Medicare. That's up from 3,700 in 2009, but it's still less than 2 percent, which is hardly a mass exodus (John F. Wasik, 09/04). 

Minneapolis Star Tribune: Not Too Many Sure Things At MNsure's New Hot Line
The "trained service representative" answered my call to MNsure’s new customer contact center within seconds. It was 8:24 a.m. on Tuesday, and as it turns out, I was one of the first consumers to ask questions about how the Affordable Care Act (or as I like to call it, Romneycare) will roll out (Jon Tevlin, 9/3).

San Francisco Chronicle: AMA Sells Its Members' Most Intimate Data
As of last month, physicians will have to think twice about attending a pharmaceutical-industry-sponsored lunch. August marks the implementation of the Affordable Care Act's Sunshine Rule, which requires drug and device manufacturers to disclose contributions of more than $10 to physicians (Doug Jacobs, Shawn Gogia and Joshua Lang, 9/4).

Forbes: Is 'No Worse Than Placebo' Good Enough For New Diabetes Drugs?
The state of diabetes drugs has gotten to the point where it is good news that a drug does not produce worse outcomes than a placebo. I am not kidding. ... Yesterday the New England Journal of Medicine published two trials, each testing whether a diabetes drug increased the risk of heart attacks and death from heart disease. ... But the message that these studies did not show that the drugs increased the risk of heart attacks, death from heart disease or stroke should not obscure the point that we hope that these drugs actually improve outcomes. ... We need comparative effectiveness studies of different regimens designed to determine how they fare on patient outcomes. Diabetes affects about 7% of our population and pharmaceutical sales are in the billions of dollars. Rather than mandating narrow studies of cardiovascular studies, we should be encouraging studies that let us know which regimen is best for which patients, based on what they actually do for patients (Harlan Krumholz, 9/3).

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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.