Daily Health Policy Report

Friday, September 6, 2013

Last updated: Fri, Sep 6

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

A Reader Asks: When I Retire Can My Husband Get Coverage On The Marketplace?

Kaiser Health News consumer columnist Michelle Andrews tells this reader that the spouse likely can, but the bigger question is whether he will qualify for subsidies to help defray costs (9/6). Read her complete answer.

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How Will Immigrants Fare Under Obamacare? It's Complicated

The Seattle Times' Lornet Turnbull, working in partnership with Kaiser Health News, reports: "Together with neighboring Palau and the Marshall Islands, the Federated States of Micronesia has a special compact with the U.S. under which its people, heavily recruited by the U.S. military, can live and work here indefinitely — but as noncitizens, they are denied certain federal benefits. Afkas, 48, first came to the U.S. a year ago, suffering from diabetes and heart problems, and was immediately diagnosed with kidney failure that requires three-times-a-week dialysis. Last month, he was notified that he lacked sufficient job credits to continue receiving the Medicare coverage he’s depended on to cover some of his medical bills. Now … Afkas is taking stock of his health-care options as the clock counts down to the Oct. 1 opening day for enrolling in health coverage under the federal government’s Affordable Care Act (ACA). … For him, it doesn't look so good" (Turnbull, 9/6). Read the story.

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Capsules: Washington State Call Center Logs 900 Calls On 1st Day; Physician Recruitment Trends: Demand Continues For Primary Care Docs

Now on Kaiser Health News' blog, The Seattle Times' Amy Snow Landa, working in partnership with KHN, reports on the first day of Washington state’s health exchange call center: "The phones are already busy at the Washington State Exchange call center where customer service representatives are fielding hundreds of questions about the state’s new health insurance exchange, slated to open for enrollment Oct. 1. The call center, located in Spokane, opened on Tuesday and took 900 calls that day" (Landa, 9/6).

Also on Capsules, Ankita Rao reports on trends in physician recruitment: "Doctors are reacting to changes in the health care system — and their job placements are proof. Merritt Hawkins, a national health care consulting and recruitment firm, shed some light on the situation through the company's annual look at physician recruitment trends. The 2013 review was based on a survey of 3,097 permanent doctor and advanced practitioner job assignments conducted by Merritt Hawkins and two other staffing companies" (Rao, 9/5). Check out what else is on the blog.

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Political Cartoon: 'Left Holding The Bag?'

Kaiser Health News provides a fresh take on health policy developments with "Left Holding The Bag?"by Bill Day.

Here's today's health policy haiku:


How can a body
that can't pass its budget bills 
fix the SGR?


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

IRS Proposes Rules For Health Law's Employer Mandate

On Thursday, the Internal Revenue Service published proposed rules for how companies with more than 50 employees must report health coverage for their workers. That provision was delayed a year until 2015.

The Associated Press/Washington Post: White House Proposes New Rules For Postponed Health Law Mandate That Many Firms Offer Coverage
The Obama administration on Thursday released new proposals for carrying out a major requirement of the federal health care law that was postponed earlier this summer. At issue is how to gather information that would allow the government to enforce a requirement that companies with 50 or more workers provide affordable health insurance to their full-time employees. Companies that don’t comply would risk fines (9/5).

Reuters: U.S. Moves To Ease Employers' Obama Health-Law Burden
The U.S. Treasury Department on Thursday issued proposed rules aimed at easing the requirements for companies and insurers when they report employees' health coverage information to comply with President Barack Obama's signature healthcare law. The proposed regulations are a key element of the employer mandate portion of the law. Implementation of the rules had been delayed while the Treasury Department attempted to simplify them to address concerns of employers (Dixon, 9/5).

The Hill: IRS Rules For Employer Mandate Under Obamacare
The Internal Revenue Service (IRS) on Thursday issued instructions for complying with ObamaCare's employer mandate. The mandate, which requires businesses with more than 50 workers to offer insurance or face penalties, was initially slated to take effect in January (Goad, 9/5).

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HHS Readies $12M Ad Campaign To Promote Health Law In 13 States

The advertisements, which will begin airing Sept. 30, will encourage consumers in a group of predominately red states to sign up for insurance available through the health law's new online marketplaces.

Politico: Obama Administration Plans $12M Ad Buy To Promote Health Law
The Obama administration is readying a multimillion-dollar onslaught of ads in a dozen red states to encourage Americans to sign up for Obamacare insurance exchanges, media-tracking sources tell POLITICO. The Center for Medicare Services at the Dept. of Health and Human Services has reserved at least $12 million in airtime starting Sept. 30 in Texas, Florida, Pennsylvania, Arizona, Georgia, Missouri, Ohio, Indiana, North Carolina, Oklahoma, Tennessee, Louisiana and Michigan (Burns and Cheney, 9/5).

The Hill: Report: HHS To Promote Obamacare With $12M Ad Buy
Federal health officials have reportedly booked at least $12 million in airtime across 13 states in order to promote Obamacare this fall. The ad buy, which is said to begin Sept. 30, will encourage consumers to sign up for coverage on the new insurance exchanges as they open on Oct. 1 (Viebeck, 9/5).

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For Health Exchanges, Will Soft Launches Lead To Hard Landings?

CQ HealthBeat examines whether the new online insurance marketplaces will be ready to go on Oct. 1, and what possible delays might emerge and how those delays could impact the exchanges' effectiveness. Also in the headlines, reports from Delaware, Kentucky, Washington, Pennsylvania, Arizona and Georgia.

CQ HealthBeat: Soft Launch May Not Be Threat To Exchanges – But Hard Landings Will
Since its birth, the health law has had one Damoclean sword or another suspended over it. The latest: Will health insurance exchanges actually launch given the complex streams of data they must coordinate? Right up until the exchanges' scheduled debut 26 days from now, the answer to that question won't be known for sure. But there's little evidence at the moment to suggest that exchanges won't ever launch, or that any delays will be so serious as to keep the uninsured from getting coverage by the start of 2014 (Reichard, 9/5).

The Associated Press/Washington Post: Delaware Officials Still Don't Know Premium Costs For New Health Insurance Exchange
Officials overseeing Delaware's implementation of the federal health care reform law still don't know what residents will pay for health care coverage under a new state health insurance exchange. Officials expect to begin enrolling some 35,000 people in the health insurance exchange starting Oct. 1, for coverage effective Jan. 1, 2014 (9/5).

The Louisville Courier-Journal/USA Today: Ky. Probes Humana Letter On Insurance Renewal
The letter Ray Brundige received from Humana spelled out two options — keep his health insurance policy for one more year for a $279 monthly premium or choose a new one that complies with the Affordable Care Act and pay a whopping $619 a month. But the letter also said he had to make a choice by Sept. 20, before the Oct. 1 start of Kentucky's health benefit exchange, a program designed to let him and other Kentuckians shop for less-expensive insurance that complies with the health care law, often called Obamacare, and possibly qualify for government subsidies to help pay for it (Unger, 9/5).

Kaiser Health News/Seattle Times: Capsules: Washington State Call Center Logs 900 Calls On 1st Day
The phones are already busy at the Washington State Exchange call center where customer service representatives are fielding hundreds of questions about the state's new health insurance exchange, slated to open for enrollment Oct. 1. The call center, located in Spokane, opened on Tuesday and took 900 calls that day (Landa, 9/6).

The Philadelphia Inquirer: Community Groups Feel Heat Of D.C. Health-Care Battle
The letter from Washington arrived on Laura Line's desk Wednesday, three weeks after her nonprofit won a federal grant to help consumers make sense of the health-insurance marketplaces created by the Affordable Care Act and four weeks before they were to open for business. It gave her nine days to provide Republicans on the House Committee on Energy and Commerce with all details and documents, electronic and paper, in her possession and not, involving the $953,716 her organization is getting to assist with health-insurance enrollment in 10 Pennsylvania counties (Sapatkin, 9/5).

Arizona Republic Health Care Reform Ramps Up In Arizona
Beginning what will be a years-long effort to enroll Arizonans into health-insurance coverage under the Affordable Care Act, hundreds of volunteers will canvass Phoenix and Tempe neighborhoods this weekend seeking out some of the state’s 1 million uninsured residents. Using mapping technology and political-campaign-style organization, the national non-profit group Enroll America is working with local health-care and social-service agencies to locate the uninsured, answer their questions about the federal health-care overhaul and get them signed up (Reinhart, 9/5).

Georgia Health News: Nonprofit Set To Promote Ga. Exchange Enrollment
A national nonprofit encouraging enrollment in insurance exchanges will kick off its Georgia operations this weekend with a neighborhood outreach effort in metro Atlanta. Enroll America's newly hired state director, Dante McKay, said Thursday that local staff and volunteers will educate consumers this weekend about the new exchange, or marketplace, set to begin enrolling Georgians next month (Miller, 9/5).

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'Flurry' Of New Reports Show Wide Variations On Insurance Rate Costs

News outlets continue to follow recent studies released by several health policy groups about the expected premiums for plans offered on the new online insurance marketplaces.

McClatchy: Studies Show Varying Costs For Coverage Under Obamacare
A flurry of new reports from prominent health care research organizations show the cost of individual health coverage under Obamacare will vary widely among states next year, but drastic predictions of premium "sticker shock" have not materialized thus far. New research by the Kaiser Family Foundation, the RAND Corp. and Avalere Health have found competitive, affordable prices for individual coverage in states where the information is available. Those states include Washington, California, Florida, South Carolina and Texas (Pugh, 9/5).

Marketplace: New Reports Give Estimated Costs Of Healthcare Reform Plans
The health insurance exchanges under the Affordable Care Act open in October. This week some reports are giving new estimates of how much money it will take to get into some of those plans (Hill, 9/5).

Huffington Post: Obamacare Premiums Will Vary Widely By State And City: Report
Retail prices for health insurance can be considerably different based in part on the cost of health care services where a person lives, even within the same state, the Kaiser Family Foundation reported Wednesday. Premiums also vary based on age, family size and tobacco use. But under Obamacare, prices cannot be based on someone's medical history and patients with preexisting condition cannot be turned away. The law also mandates a set of minimum benefits that includes hospitalizations, prescription drugs and maternity care (Young, 9/5).

CQ HealthBeat: Survey Shows Variation In Marketplace Premiums
Health care premiums in the new marketplaces will be lower than expected in many cases, according to two surveys released Thursday. But the costs will vary significantly for people who are getting the same kind of coverage, which could create more political problems for supporters of the law. ... Consumers also will see differences in their costs when compared to people in other states. And people who live in one region within a state are expected to face different costs than people in other regions. That variability could lead to confusion or hard feelings among consumers that other people are getting a better deal (Adams, 9/6).

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In States Resistant To The Health Law, Poorest Residents Unlikely To Get Aid

USA Today reports on how, in states that opted not to pursue the health law's Medicaid expansion, many of the poorest residents may fall through the cracks. Meanwhile, the San Jose Mercury News looks at some of the states that have been the most resistant to implementing the health law.

USA Today: Medicaid Expansion Gap Could Leave Poor Shortchanged
The decision of some states not to expand Medicaid means that the nation's poorest — those the Affordable Care Act would have helped the most — may not receive any help at all (Kennedy, 9/5).

San Jose Mercury News: 11 States That Resisted Obamacare The Most
Eleven states have resisted the 2010 health care law in four major ways, from suing to overturn it to restricting the help people can get signing up for it. Which states are resisting Obamacare the most? (Beckwith, 9/6).

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Capitol Hill Watch

Effort To Fix Doc's Medicare Pay Formula Gains Momentum

A bill now pending in the House that has cleared the Energy and Commerce Committee would repeal the sustainable growth rate -- SGR -- formula and replace it with a more quality-based system.  

NPR: After A Decade, Congress Moves To Fix Doctors' Medicare Pay
But something unusual happened just before Congress left for its summer break. The House Energy and Commerce Committee voted 51-0 for a bill that would overhaul the way Medicare pays doctors. The bill would, among other things, repeal something called the sustainable growth rate formula, or SGR, and eventually replace it with a system that would pay doctors based on how healthy they keep their patients (Rovner, 9/6).

Earlier, related KHN coverage: Health On The Hill: 'It's A Fire Sale On The SGR' (9/4).  

Meanwhile, Senate Minority Leader Mitch McConnell, R-Ky., is under attack from a conservative organization for not taking a hardline stance on defunding the health law -

Politico: Tea Party Group's Ad Hits McConnell Over Obamacare
The Senate Conservatives Fund has launched $340,000 in television ads slamming Minority Leader Mitch McConnell for not taking a hardline stance on defunding the health care law. "Obamacare starts in October but Congress can stop its funding," the ad says. "What's Mitch McConnell doing? Nothing. McConnell is the Senate Republican leader, but he refuses to lead on defunding Obamacare. What good is a leader like that?" (Cunningham, 9/5).

CBS: Conservative Group Says McConnell Doing "Nothing" To Stop Obamacare
Senate Minority Leader Mitch McConnell, R-Ky., is doing "nothing" to stop Obamacare, an influential conservative organization complained in a new TV ad, urging the Senate's top Republican to show "real leadership" by going to the mat in defunding the health care law. "McConnell's the Republican leader, but he refuses to lead on defunding Obamacare," charged the ad from the Senate Conservatives Fund (SCF), a well-funded outside group pushing Republican senators to fall in line behind a strategy to undo the law (Miller, 9/5).

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State Watch

State Highlights: N.M. High Court Rules Malpractice Law Covers Doc Businesses

A selection of health policy stories from Texas, New Mexico, California, South Carolina, Iowa, Florida, Minnesota and Massachusetts.

The Texas Tribune/New York Times: A Growing County Fights For Every Resident To Be Counted
Armed with maps, photos and data, Hidalgo County officials say they are fighting to undo the consequences of what they see as a drastic undercount of the county in the 2010 census. In this rapidly growing, overwhelmingly Hispanic county in the Rio Grande Valley, where more than a third of residents have incomes below the federal poverty level, such population figures are crucial. They can translate into millions of dollars, as federal and state programs like Medicaid use population data to allocate money (MacLaggan, 9/5).

The Associated Press: Malpractice Law Covers Doctors' Businesses
Businesses formed by doctors are covered by a state law that caps the damages that victims of medical malpractice can collect from health care providers, New Mexico's highest court ruled Thursday. The state Supreme Court said that medical professional corporations and limited liability companies fall under the law's definition of a health care provider under the state's medical malpractice law (9/5).

California Healthline: Biosimilars, Long-Term Care Ombudsman Bills Pass, Head To Governor's Desk
The state Assembly and Senate yesterday passed dozens of bills, including a proposal to regulate the dispensing of biosimilar medications and another to give more penalty authority to the office of the state's long-term care ombudsman. SB 609 by Sen. Lois Wolk (D-Davis) continues Wolk's efforts to beef up the ombudsman's office for handling long-term care complaints. Wolk authored a successful bill last year, which gave the long-term care ombudsman more of an advocacy role and called for creation of an annual report. This year's bill increases penalties for any providers of long-term care who interfere with investigations by the ombudsman's office (Gorn, 9/5).

The Associated Press: Director: Medicaid Agency Wants To Increase Access
South Carolina's Medicaid agency is working to make health care more convenient for its enrollees, as part of efforts to improve residents' health while decreasing costs, director Tony Keck told The Associated Press. Initiatives to expand access include covering visits to walk-in pharmacy clinics and paying doctors more when they see patients outside normal business hours (Adcox, 9/5).

The Associated Press: Iowa Gets Grant To Help Boost Child Dental Care
Iowa public health officials have received a $1.8 million federal grant to help ensure children and some adults get adequate dental care. The money from the U.S. Centers for Disease Control and Prevention will be used to expand a school-based dental program called I-Smile Dental Home Initiative and to monitor and evaluate the state's dental public health program (9/6).

Health News Florida: Telemedicine: The Next Big Thing?
Florida lawmakers say they have to expand access to doctors now that millions of uninsured people in the state are set to gain health insurance through the Affordable Care Act. One tool they may encourage is telemedicine. But there's a problem, as state Rep. Cary Pigman explains: Insurers don't pay for it. It's not that they can't, they just don't. Neither does Medicare (Gentry, 9/5).

Minneapolis Star Tribune: Health Law Confusion Could Draw Scammers
With consumers still confused about the federal health law and how it might affect their insurance coverage, a consumer group warned Thursday that its prime time for scammers to strike. The Better Business Bureau of Minnesota and North Dakota said reports are coming in from across the nation of consumers receiving phone calls telling them they need to provide personal or financial information to receive health coverage or to keep the coverage they currently have (Crosby, 9/5).

California Health Report: L.A. Clinic Expands Services With ACA Funding
When Ema Rowe found out that she was pregnant with her third child, her physician at Cedars-Sinai Medical Center referred the South Los Angeles resident to Eisner Pediatric & Family Medical Center. Rowe soon entered Eisner's centering pregnancy program at the clinic's main location in downtown Los Angeles. A nurse called her after noticing she had been a little depressed at a recent centering pregnancy class (Fulton, 9/5).

Boston Globe: Long Term Care Insurance Premiums On The Rise 
Sharp increases in rate requests for long-term care insurance are raising the chances that the next wave of retirees may not be able to afford coverage for assisted living, nursing homes, and related health services. Since early 2012, the Massachusetts Division of Insurance has regularly approved premium increases of about 10 percent for the insurance, which was introduced in the 1980s as a hedge against the high and extended costs of nursing care. Regulators are now reviewing requests by some companies to nearly double their rates -- potentially increasing premiums by thousands of dollars a year (Fernandes, 9/6).

California Healthline: Bill Aimed At Kaiser Hits Home Stretch
Proponents of a bill aimed squarely at Kaiser Permanente say the legislation is needed to level the playing field for health insurers setting premium prices in California. Kaiser officials say they're not playing on the same field and the attempt to put them there will be costly, confusing and ultimately a financial burden for Kaiser members. SB 746 by state Sen. Mark Leno (D-San Francisco) would require insurers selling to large employers to provide detailed reports to state officials explaining pricing and justifying premium increases. The bill would require insurers contracting with two or fewer medical groups to provide additional information on cost increases, as well as claims data to large purchasers that request it (Lauer, 9/5).

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Health Policy Research

Research Roundup: The Financial Burden Of Hospital Acquired Infections

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

JAMA Internal Medicine: Health Care–Associated Infections
Health care–associated infections (HAIs) account for a large proportion of the harms caused by health care and are associated with high costs. ... [Using a simulation, the researchers found that the] total annual costs for the 5 major infections were $9.8 billion (95% CI, $8.3-$11.5 billion), with surgical site infections contributing the most to overall costs (33.7% of the total), followed by ventilator-associated pneumonia (31.6%), central line–associated bloodstream infections (18.9%), C difficile infections (15.4%), and catheter-associated urinary tract infections (<1%). ... recent analyses indicate that at least 50% are preventable. ... However, despite the availability of solutions, the strong ethical case for improvement, and the intuitive argument that saving lives ought to save money, large-scale progress against HAIs has been slow. ... an important driver of progress is the move by payers to deny reimbursement for health care related to preventable harm (Zimlichman et al, 9/2).

JAMA Internal Medicine: Patient-Centered Medical Home Intervention at an Internal Medicine Resident Safety-Net Clinic
The patient-centered medical home (PCMH) model holds promise for improving primary care delivery, but it has not been adequately tested in teaching settings. ... we developed and implemented an intervention to improve primary care delivery at an internal medicine safety-net clinic with resident physician providers. ... Patients in the intervention clinic reported improved access to care (scheduling appointments and telephone services) and overall care. ... Although the absolute improvements in satisfaction with access to care and overall care were large, the clinical significance is uncertain. ... Our program did not reduce ED or hospital utilization. In fact, there was a small increase in hospitalization rates in the intervention clinic vs the control clinics (Hochman et al., 9/4).

Centers for Disease Control And Prevention (CDC): Raising Awareness Of Sleep As A Healthy Behavior
Sleep is an essential component of health, and its timing, duration, and quality are critical determinants of health. Sleep may play an important role in metabolic regulation, emotion regulation, performance, memory consolidation, brain recuperation processes, and learning. Because of the importance of these functions, sleep should be viewed as being as critical to health as diet and physical activity. However, public health practitioners and other health care providers have not focused major attention on the importance of sleep to health. In this essay, we briefly summarize the scientific literature about hours of sleep needed and why sleep is an important public health issue. We also suggest areas for expanding sleep research and strategies for increasing awareness of the importance of sleep and improving sleep health (Perry, Patil and Presley-Cantrell, August 2013).

The Commonwealth Fund: In States' Hands: How the Decision to Expand Medicaid Will Affect the Most Financially Vulnerable Americans
Between 2010 and 2012, nearly one-third (32%) of U.S. adults ages 19 to 64, or an estimated 55 million people, were either continuously uninsured or spent a period of time uninsured. Data from the 2011 and 2012 Commonwealth Fund Health Insurance Tracking Surveys of U.S. Adults show that people with incomes below 133 percent of the federal poverty level (i.e., the level that will make them eligible for Medicaid in 2014 under the Affordable Care Act) were uninsured at the highest rates. ... In those states that have not yet decided to expand [their Medicaid programs], as many as two of five (42%) adults who were uninsured for any time over the two years would not have access to the new coverage provisions in the law (Rasmussen, Collins, Doty and Garber, 9/5). 

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

Boston Globe: Study Says Many Patients Enter Hospice Care Too Late
Slightly more patients with terminal cancer are getting hospice care during the end of their lives, but they are still entering hospice care too late — within days of death — finds a new national analysis of Medicare patients conducted by Dartmouth researchers. And many are still dying in hospitals, often hooked to ventilators in an intensive care unit, despite studies showing that most cancer patients prefer to die at home. ... according to the analysis released Wednesday from the Dartmouth Atlas Project (Kotz, 9/05). 

Reuters: Quicker Heart Treatment Hasn't Lowered Deaths: Study
A good hospital will get heart attack victims into an operating room and get their clogged artery open within 90 minutes. But a new study shows that shortening that time even further does not significantly lower the risk of dying in the hospital. The analysis, which measured the so-called door-to-balloon time now widely used to assess the quality of heart attack care, found that shaving additional minutes off the 90-minute goal produced diminishing returns. ... In fact, patients who could not get a PCI within 90 minutes died at a rate that was roughly double that of patients who received treatment in 90 minutes or less, according to the report published in the New England Journal of Medicine (Emery, 9/4).

NPR's Shots Blog: Facebook Chats Prompt At-Risk Minority Men To Get HIV Tests
To reach young gay Latino and African-American men, researchers at the David Geffen School of Medicine and School of Public health at the UCLA trained men in the same demographic as peer leaders, giving them information on how HIV spreads. That's a time-honored public health technique. They also created a comparison group, with peer leaders trained to share general health information. ...  Over 12 weeks, 44 percent of the men in the group getting information about HIV prevention asked for a kit, compared with 20 percent in the control group. ... The results were published in the Annals of Internal Medicine (Shute, 9/3).

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Editorials and Opinions

Viewpoints: Administration Is 'Fighting Back' On Obamacare; Democrats' 'Nervous Breakdown' About GOP Inquiry On Navigators

The New York Times: Selling Health Care Reform
In Washington, Republican members of the House Committee on Energy and Commerce have sent intimidating letters to many of the groups hired as navigators, demanding all their paperwork and suggesting that the groups intend to exploit the work for fund-raising or political purposes. These are nonprofit groups that are simply trying to help uninsured people through the bureaucracy ... in less than a month, uninsured people will begin signing up for coverage. The more information they get — from the president, from the Baltimore Ravens and from the community group next door — the better their decisions will be (9/5).

The Wall Street Journal: Navigating ObamaCare Outrage
With ObamaCare scheduled to launch on October 1, Democrats seem more than a little anxious about their ability to execute. That's the only fathomable explanation for their nervous breakdown over a routine House inquiry. The Affordable Care Act is paying for "navigators," or non-government groups that received federal dollars in August to help people figure out and enroll for subsidies. ... if the handsomely financed navigators can't spare an hour or two to comply with a congressional investigation, then the law must be in bigger trouble than Democrats care to admit (9/5).

The New York Times: The Conscience Of A Liberal: It Takes A Government (To Make A Market)
Lots of reporting on the new Kaiser Family Foundation analysis of what we know so far about premiums under Obamacare. It definitely looks as if there will be a mild "rate shock" — in the right direction. ... What’s going on here? Partly it's a vindication of the idea that you can make health insurance broadly affordable if you ban discrimination based on preexisting conditions while inducing healthy individuals to enter the risk pool through a combination of penalties and subsidies. But there's an additional factor, that even supporters of the Affordable Care Act mostly missed: the extent to which, for the first time, the Act is creating a truly functioning market in nongroup insurance (Paul Krugman, 9/5).

The Washington Post's Post Partisan: Good News For Obamacare
In the conservative echo chamber, there is little doubt about Obamacare: It's an unmitigated, costly disaster. ...  But, as the nation prepares for the phase-in of the law's most important elements next month, we are starting to get real data back. And at least one major criticism — that the law will require people without employer-sponsored insurance to buy very expensive health-care coverage — looks increasingly weak (Stephen Stromberg, 9/5).

The New England Journal Of Medicine: Only the Beginning — What's Next at the Health Insurance Exchanges?
On October 1, the health insurance exchanges created by the Affordable Care Act (ACA) will open for business. ... Initial glitches are likely. Some may be serious. But with good will and persistence, they can be corrected, as Massachusetts' experience with a law similar to the ACA has shown. That is not the end of the story, however. After the exchanges are up and running, they will be in a position to make decisions that will help shape the organization, quality, and financing of all U.S. health care (Henry J. Aaron and Kevin W. Lucia, 9/4).

Minneapolis Star Tribune: Beware Of Political Spin As MNsure Rolls Out
Rates that initially seem high may well turn out to be more affordable once subsidies, other assistance or lower cost-sharing factors in. Comparing costs with coverage from previous years is also difficult, since plans on the exchange may provide better benefits or lower deductibles, for example, than plans previously purchased on the individual market. ... Not everyone will find a good deal on MNsure. Minnesotans, however, need to do the math, not accept others’ politically motivated judgments, to figure out how they will fare in this new marketplace (9/5).

The New York Times' Opinionator: Hi, It's Your Doctor
[F]ire up your DeLorean. Health care is headed back to the future. House calls are a sign that we will all see our health care going back to the “old days” when, like my father, the doctor came to our homes, giving us real personalized medicine — and saving money at the same time s (Dr. Ezekiel J. Emanuel, 9/5).

JAMA Internal Medicine: Less Tinkering, More Transforming
The patient-centered medical home (PCMH) movement has reached a sink-or-swim moment. Government and private payers are evaluating their return on investment, and many studies of PCMH interventions have not demonstrated savings despite extra investment. However, a few cases of the PCMH resulted in the contrary: large reductions in emergency department (ED) visits and hospitalizations. The difference between successful and unsuccessful examples is glaring. If medical homes emulated best practices to gain PCMH status, the transformation would prove worth the investment (Dr. David Margolius, 9/4).

Texas Tribune: Shut Down Obamacare, Not The Government
First of all, the scenario [Sen. Ted Cruz] has proposed is not analogous to the shutdown in the mid '90s. The senator has posited that Republicans should fund all of the government except Obamacare. In the mid '90s, the entire federal budget was held ransom to the shutdown. Secondly, as one close Obama advisor put it, "Never let a crisis go to waste." What we are seeing every day out of D.C. is the inability of the Affordable Care Act and its caretakers to properly implement (or understand) the law (Texas State Sen. Matt Krause, 9/5).

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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.