Daily Health Policy Report

Monday, September 9, 2013

Last updated: Mon, Sep 9

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Health Reform

Coverage & Access

Medicare

Health Care Marketplace

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Shopping For Coverage: Health Marketplaces Are Open To Nearly Everyone

In this Kaiser Health News video series, consumer columnist Michelle Andrews explains specific parts of how new health exchanges will function, including how – even though they are open to nearly all -- individuals who already have insurance through work, Medicare or Medicaid don’t need to shop there (9/9). Watch the video.

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Nurse Practitioners Try New Tack To Expand Foothold In Primary Care

Kaiser Health News staff writer Julie Appleby, working in collaboration with The Philadelphia Inquirer, reports: "Nurse practitioners say efforts to expand primary care to millions of Americans under the health law are hampered by insurance industry practices that limit or exclude their participation. Despite laws in 17 states and the District of Columbia allowing them to practice independently, nurses with advanced degrees say some insurers still don’t accept them into their credentialed networks as primary care providers, while others restrict them mainly to rural areas" (Appleby, 9/8). Read the story.

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Capsules: Colorado Exchange Watchdog Likes What It Sees; Minnesota Says Its Marketplace Rates Are Nation’s Lowest So Far

Now on Kaiser Health News’ blog, Colorado Public Radio’s Eric Whitney, working in partnership with KHN and NPR, reports on oversight of Colorado’s health exchange: "Colorado is one of 16 states and the District of Columbia that chose to set up its own exchange, via a bipartisan bill the state passed in 2011. Republicans agreed to vote for it only if it included a special legislative oversight committee that would allow a majority to block exchange funding requests. That hasn’t happened yet, but oversight committee hearings have been testy in the past. Not so last Thursday, the final hearing before the exchange’s opening day October 1. It was remarkable for the praise members from both parties heaped upon exchange leadership" (Whitney 9/9).

Also on the blog, Minnesota Public Radio’s Elizabeth Stawicki, also working in partnership with KHN and NPR, reports on Minnesota’s rates: "Minnesota consumers will be able to buy a health plan for as little as $90.59 per month on MNsure, the new state health insurance marketplace, state Commerce Commissioner Mike Rothman said Friday. Rothman said Minnesota has the lowest average rates for individuals and families compared to the other states that have revealed the costs of their plans thus far (that includes 13 states and the District of Columbia, according to a Kaiser Health News running tally). Data released Friday offered a first look at the new health insurance plans and rates that will be sold on MNsure" (Stawicki, 9/6). Check out what else is on the blog.

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Political Cartoon: 'Elective Surgery'

Kaiser Health News provides a fresh take on health policy developments with "Elective Surgery" by John Deering.

Here's today's health policy haiku:

A TAXING IDEA

The newest health tax
is certainly not a hit
with the insurers. 
-Anonymous

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

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Capitol Hill Watch

House GOP To Advance Bill To Fund Gov't Until Mid-December

The Republican leadership is also contemplating how to handle pressure from conservatives demanding they cut off all funding for the health law. Those members plan a rally Tuesday to build momentum.

Politico: House GOP To Advance Stopgap Spending Bill
Final details have not yet been released, but Republicans have stepped up their activity in anticipation of bringing a bill to the floor next week to keep the government funded into mid-December. The GOP leadership is still debating how to handle the pressure from conservatives for a vote on the CR to cut off all funding for health care reform. But the Centers for Medicare and Medicaid Services, which plays a major role in implementing the president’s initiative, is a prime example of the squeeze on Obama. The president had requested $4.82 billion last year for the CMS "program management" account but then settled for $3.8 billion last spring. … But the CR now would put Obama back at square one and at least $1.4 billion below his request for 2014 (Rogers and Bresnahan, 9/6).

The Washington Post: The Inside Story Of How Obama And Boehner Negotiate
Health-care spending was the big issue. Obama was talking about $400 billion in health-care cuts, while Boehner wanted $600 billion. "Can we split the difference here?" Boehner asked. "Can we land at $500 billion?" "I have to look at not just the numbers on a piece of paper," Obama said, "but what’s behind the numbers." The impact on elderly Medicare beneficiaries could be dramatic if they went too far. “Four hundred billion is it. I just can’t see how we go any further on that.” In a 2:30 phone call that afternoon, Boehner agreed to take increasing the Medicare eligibility age off the table. Obama said he appreciated the offer: "I’m going to give you a counter that gets us closer, so close that it would be silly for us not to get an agreement.” He called back just before 4 p.m. with $120 billion in other concessions. But Boehner realized that the extreme conservatives and tea party element among House Republicans would not go along with any of this (Woodward, 9/6).

The Hill: Effort To Defund Obamacare Tries To Regain Its Momentum This Week
Conservatives will take their defund-ObamaCare push back to Washington, D.C., this week with an event to rally support and combat a wide shift in focus away from the issue. Sens. Ted Cruz (R-Texas), Mike Lee (R-Utah), Rand Paul (R-Ky.) and a slew of House members and Tea Party leaders will host a rally Tuesday to pressure leaders not to pay for healthcare reform in the next bill to fund the government (Viebeck, 9/9).

The Hill: CBO: Delaying Obamacare Mandate Would Cut Deficit By $35 Billion
Delaying the individual insurance mandate in President Obama's signature healthcare law would reduce the federal deficit by $35 billion over the next decade, the Congressional Budget Office said Friday. The House passed a bill in July to delay the employer mandate by one year, matching the White House's delay in the law's employer mandate. ... The budget office said delaying the mandate by a year would cut federal Medicaid spending by nearly $17 billion over the next 10 years because fewer people would sign up for coverage. The delay would cut roughly $9 billion from the cost of new tax credits to help low-income households cover the cost of their premiums, the CBO said. Delaying the mandate would also increase federal revenues (Baker, 9/6).

The Hill: Cantor Plans 'Strategic Votes' To Chip Away At Obamacare
The House will continue to hold targeted anti-ObamaCare votes throughout the fall, aiming to "dismantle, defund and delay ObamaCare," Majority Leader Eric Cantor said in a memo Friday. Cantor's preview of the fall legislative session says the House will stick to its strategy of forcing votes that target unpopular pieces of the healthcare law and could put Democrats in a politically difficult position (Baker, 9/6).

In other news, the health insurance industry is ramping up a lobbying effort to get Congress to repeal a tax designed to help pay for expanded coverage --

Politico: Health Insurance Tax Faces Challenge
The health insurance industry and business allies are stepping up their campaign to repeal another new Obamacare tax this fall — one that they argue will hit consumers smack in the health care part of their wallet. As Congress returns from recess, expect to hear more about the health insurance tax, or HIT, as it’s known, a levy in the health care law to raise $116 billion through 2023. That money, in turn, is supposed to help finance expanded coverage (Norman, 9/9).

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Health Reform

Controversial Navigators Are Central In Health Law's Outreach Efforts

State officials opposed to federal overhaul target nonprofit groups that the federal government is counting on to help consumers.

The Associated Press: Groups Race To Hire, Train 'Obamacare' Guides
With the program known as "Obamacare" only weeks away from its key launch date, hectic preparations are in motion in communities across the country to deal with one of its major practical challenges: hiring and training a small army of instant experts who can explain the intricacies of health insurance to people who've never had it. More than 100 nonprofits and related organizations, which specialize in everything from running soup kitchens to organizing farm workers, have been recruited by the federal government to sign up "navigators" to help the 30 million uninsured people who can now gain coverage (Johnson, 9/9).

Stateline: Health Insurance Navigators Draw State Scrutiny
At least 16 states have passed or are considering laws to regulate navigators' work. Many have imposed their own certification and licensing requirements, a process that critics say could hinder the availability of navigators. Georgia's insurance commissioner, for example, has said he will require navigators to pass the same test as insurance brokers, even though federal law makes a clear distinction between navigators and brokers (Ollove, 9/9).

Clarksburg W.Va. Gazette Mail: Rockefeller: Morrisey Intimidated Health Group Over ACA
A Clarksburg-based nonprofit group has abruptly declined a $365,000 federal grant to help West Virginians sign up for health insurance plans under the Affordable Care Act. The decision by West Virginia Parent Training and Information Inc. came a week after state Attorney General Patrick Morrisey directed the nonprofit group to answer 26 questions about the group's personnel and hiring practices. ... Morrisey, who has called for repealing the federal health-care law, is reviewing organizations that are helping to walk people through their health insurance options. Morrisey said the groups' employees could steal personal information, such as Social Security numbers and tax documents, from people who apply for health insurance under the ACA (Eyre, 9/7).

Baltimore Sun: Maryland Seeks Out Uninsured To Inform About Health Reform
As Maryland health officials prepare for nationwide health reform, the goal is clear: enrolling the state's estimated 800,000 uninsured residents. But finding them is a challenge. There is no master list or map of the uninsured, who make up 14 percent of the state's population. And though census data can identify concentrations, including those in Baltimore City, Prince George's County and the rural Eastern Shore, it doesn't provide detailed information about neighborhoods that should be targeted (Dance, 9/7).

Kansas City Star: Health Care Marketplace Will Be Here Before Long
At the Kansas City CARE Clinic on Broadway, the waiting room is half full: the young, the old, the in-between, all seeking time with a doctor or nurse. In the corner, a large sign. "The health insurance marketplace is coming!" it says. "¡El mercado de seguro de salud está viniendo!" (Helling, 9/7).

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Sen. Barrasso Warns Of Health Insurance Marketplace Cost 'Sticker Shock'

The former orthopedic surgeon from Wyoming also warned that the law is too expensive and used the weekly GOP address Saturday to push for its repeal.

Reuters: Republican U.S. Senator Senator Warns Of 'Sticker Shock' From Obamacare
Weeks before health care exchanges under President Barack Obama's health care overhaul open next month, a Republican senator attacked the plan on Saturday by saying Americans may experience "sticker shock" from higher prices. Senator John Barrasso said in the weekly Republican address released on Saturday that the Affordable Care Act is hurting middle-class Americans (9/7).

CBS News: GOP Senator Warns of Obamacare 'Sticker Shock'
In the weekly Republican address, Sen. John Barrasso, R-Wyo., warned that Obamacare's insurance exchanges, which open on October 1, will be more expensive than many expect (CBS News, 9/7).

The Hill: Barrasso Warns Of Obamacare 'Sticker Shock' In GOP Address
Weeks before a key ObamaCare component is set to get off the ground, Sen. John Barrasso (R-Wyo.) is warning that flaws in the health care reform law will only make things harder for American families. Barrasso, who worked as an orthopedic surgeon for two decades before coming to the Senate, used the weekly Republican address to denounce the Affordable Care Act as too expensive and push for a repeal (Hattem, 9/7).

Costs to buy coverage in the marketplaces are also examined across America --

The Associated Press: Study Estimates Obamacare’s Health Insurance Premiums – And How And Where To Enroll Beginning Oct. 1
The No. 1 question about President Obama's health care law is whether consumers will be able to afford the coverage. Now the answer is coming in. The biggest study yet of premiums posted by states finds that the sticker price for a 21-year-old buying a mid-range policy will average about $270 a month (9/9). 

Kaiser Health News: Capsules: Minnesota Says Its Marketplace Rates Are Nation's Lowest So Far
Minnesota consumers will be able to buy a health plan for as little as $90.59 per month on MNsure, the new state health insurance marketplace, state Commerce Commissioner Mike Rothman said Friday. Rothman said Minnesota has the lowest average rates for individuals and families compared to the other states that have revealed the costs of their plans thus far (that includes 13 states and the District of Columbia, according to a Kaiser Health News running tally). Data released Friday offered a first look at the new health insurance plans and rates that will be sold on MNsure (Stawicki, 9/6).

The Associated Press: State Health Care Rates Lowest So Far
Individual health insurance coverage will be available for as low as $91 a month beginning next year through Minnesota's new health insurance marketplace. State officials released the first look Friday at health insurance plans and rates to be sold on MNsure, Minnesota's vehicle for delivering requirements of the new federal health care law. The marketplace is scheduled to go live Oct. 1, and coverage starts Jan. 1 (9/7).

The Associated Press: 5 Insurers Offer Health Plans Through NM Exchange
The cost of medical coverage plans available through New Mexico's health insurance exchange likely will be lower than in many other states, according to a new national study. The state's insurance regulator also said uninsured New Mexicans will find more health insurance options through the exchange than currently are available through the private insurance market (Massey, 9/6).

Kaiser Health News: Capsules: Colorado Exchange Watchdog Likes What It Sees
Colorado is one of 16 states and the District of Columbia that chose to set up its own exchange, via a bipartisan bill the state passed in 2011. Republicans agreed to vote for it only if it included a special legislative oversight committee that would allow a majority to block exchange funding requests. That hasn't happened yet, but oversight committee hearings have been testy in the past. Not so last Thursday, the final hearing before the exchange's opening day October 1. It was remarkable for the praise members from both parties heaped upon exchange leadership" (Whitney 9/9).

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Medicaid Expansion Continues To Make Political And Policy Waves In The Carolinas, Pennsylvania

While South Carolina works on its own "plan b" to pursue instead of the health law's Medicaid expansion, a North Carolina hospital plans to close its doors. Its parent company blames the state's decision against the expansion.

The New York Times: Insurance Rolls To Rise In State Fighting Plan
In her State of the State speech in January, Gov. Nikki R. Haley, a Republican, said, "South Carolina will not implement the public policy disaster that is Obamacare’s Medicaid expansion." ... The reality, however, is more complex. South Carolina officials say they welcome the prospect that more than a half-million state residents — out of a population of 4.7 million — could soon gain access to affordable coverage, even without the expansion of Medicaid eligibility. And they are working to remake Medicaid so that it does not just pay claims but produces measurable improvements in the health of poor people (Pear, 9/6).

The Huffington Post: North Carolina Hospital Closes, Citing No Medicaid Expansion
A small hospital in a coastal North Carolina community will close its doors within months and its parent company says Gov. Pat McCrory's (R) decision not to expand Medicaid under President Barack Obama's health care reform law is partly to blame. Vidant Health, a nonprofit 10-hospital network, will shutter the 49-bed Vidant Pungo Hospital in Belhaven, about an hour's drive east of the chain's Greenville headquarters, within six months, the company announced this week. Other considerations, including outdated facilities, also led to the company's decision to close the hospital but North Carolina foregoing the Medicaid expansion contributed to the decision, Vidant Health CEO David Herman told The Huffington Post (Young, 9/6).

In Pennsylvania, leaders increasingly focus on what expansion might look like in this state -

Pittsburgh Post-Gazette: Legislators Look At New Medicaid Models
For months, debate in Harrisburg has focused on whether to expand the state's Medicaid program. But the discussion has shifted in recent weeks, away from the yes/no debate and toward talks about what such an expansion would look like as part of a broader set of changes to the existing Medicaid program, which provides health care coverage to about 1 in 6 low-income and disabled Pennsylvanians (Giammarise, 9/8).

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What Does The Health Law's Future Hold For Workers, Uninsured People, Employers And Others?

News outlets examine a variety of issues related to the health law's implementation, ranging from how it might impact workers in the year ahead, to those who will not gain any benefit from the law as well as the importance of location and other news about how the overhaul will affect the health care marketplace.

Politico: With Obamacare Near, What’s In Store For Workers
With all the hullabaloo over Obamacare, you might think a radical transformation of your health insurance is imminent. But the noisy claims from both sides notwithstanding, the reality is that the changes next year are likely to be pretty subtle for the vast majority of the 170 million who get insurance through the workplace (Norman, 9/9).

The Washington Post: Left Behind: Stories From Obamacare’s 31 Million Uninsured
The Affordable Care Act, the most sweeping health care program created in a half century, is expected to extend coverage to 25 million Americans over the next decade, according to the most recent government estimates. But that will still leave a projected 31 million people without insurance by 2023. Those left out include undocumented workers and poor people living in the 21 states, such as Virginia, that have so far declined to expand Medicaid under the statute, commonly called Obamacare (Kliff and Sun, 9/8).

Los Angeles Times: As Healthcare Law Rolls Out, Its Effects Will Depend On Your State
Americans who live in states backing the Affordable Care Act will receive substantial protections and assistance unavailable to residents in states still fighting the 2010 law. That could mean confusion and higher insurance premiums for millions of consumers in states resisting the law. Leaders in these resistant states have not set up consumer hot lines. Several state insurance regulators are refusing to make sure health plans offer new protections required by the law, such as guaranteed coverage for people who are ill (Levey, 9/6).

The Philadelphia Inquirer: Checking The Facts Behind ACA Claims
Lori Robertson has been covering the Affordable Care Act from the earliest debates on it in 2009. A journalist for FactCheck.org, the nonpartisan nonprofit that monitors the accuracy of e-mails, viral claims, and statements by politicians, Robertson researches and writes about many statements involving the ACA. "We fact-check all sides," she said (Calandra, 9/8).

Politico: In Hawaii, Firms Like Longtime Employer Mandate
Obamacare’s requirement that large companies offer health insurance may be polarizing for much of the nation — but it had Hawaiians at Aloha. Unlike its 49 counterparts, Hawaii has been living with a strict employer mandate for nearly 40 years. And as businesses nationwide celebrate a one-year delay in the similar Obamacare requirement that they cover workers, supporters of Hawaii’s law say theirs is proof that the rest of the country could adjust — and even learn to like it (Cheney, 9/9).

Kaiser Health News: Nurse Practitioners Try New Tack To Expand Foothold In Primary Care
Nurse practitioners say efforts to expand primary care to millions of Americans under the health law are hampered by insurance industry practices that limit or exclude their participation. Despite laws in 17 states and the District of Columbia allowing them to practice independently, nurses with advanced degrees say some insurers still don’t accept them into their credentialed networks as primary care providers, while others restrict them mainly to rural areas (Appleby, 9/8).

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Coverage & Access

IBM, Time Warner Move Retirees To Private Health Exchanges

IBM and Time Warner are moving retirees out of company-sponsored health plans and giving them money to buy coverage in private health insurance exchanges. The companies will allocate funds that retirees can use to shop for coverage in marketplaces similar to those being set up under the federal health care law. 

The Associated Press: IBM Moving Some Retirees Off Its Health Plan
IBM plans to move many retired workers off its health plan and give them money to buy coverage on a health-insurance exchange. The move is part of a corporate trend away from providing traditional retiree health benefits as costs rise. The company says it acted after projections showed that costs under its current plan for Medicare-eligible retirees will triple by 2020 and that the increases would be paid by retirees through premiums and out-of-pocket costs (Koenig, 9/7).

The Wall Street Journal: IBM To Move Retirees Off Health Plan
IBM's shift is an indication that health-insurance marketplaces, similar to the public exchanges proposed under President Barack Obama's health-care overhaul, will play a bigger role as companies move coverage down the path taken by many pensions, paying employees and retirees a fixed sum to manage their own care. In notices signed by Chief Health Director Kyu Rhee, IBM has told retirees in recent weeks that to keep receiving coverage, they will need to pick a plan offered through Extend Health, a large private Medicare exchange run by New York-based Towers Watson & Co. (Ante, 9/7).

The Wall Street Journal: Time Warner Joins IBM In Health Shift For Retirees
Insurance exchanges are the health-care experiment du jour. Retirees are the test case. The latest indication: Media-company Time Warner Inc. plans to move its U.S. retirees from company-administered health plans to private exchanges, according to a person familiar with the matter. The company will allocate funds in special accounts that retirees can use to go shop for coverage, the person said (Ante, 9/8).

Reuters: Time Warner To Move U.S. Retirees To Healthcare Exchanges
Time Warner Inc is planning to transfer its U.S. retirees from company-sponsored health plans and move them to private insurance exchanges. According to an August memo obtained by Reuters, the media company will make allocations to a Health Reimbursement Arrangement account for retirees to use towards the purchase of coverage on an exchange. Previously, Time Warner provided an indirect subsidy through a supplementary Medicare program (9/8).

Reuters: IBM To Transfer U.S. Retirees To Healthcare Exchanges Next Year
IBM plans to move U.S. retirees off its company-sponsored health plan and shift them into new private insurance exchanges as a way of lowering costs for retirees. IBM had selected Extend Health, which is owned by Towers Watson & Co, to provide retirees with new health options for medical, prescription drug, dental and vision coverage, the company said in a statement on Friday (9/7).

The Associated Press/Washington Post: Time Warner Joins IBM In Moving Retirees To Private Health Insurance Exchanges To Cut Costs
Media and entertainment company Time Warner Inc. plans to move its retired workers off its health plan and provide money to them to purchase coverage on private exchanges at the beginning of next year (9/8).

Earlier, related KHN coverage: As More Employers Drop Coverage, Retirees Turn To Specialized Insurance Exchanges (Andrews, 8/15/2012).

In a related development, employers are also cutting health care coverage for workers' spouses -

Indianapolis Star: Kroger Health Insurance End For Spouses May Be Model For Future
Cincinnati-based grocer Kroger has become the latest major employer to cut health care coverage for workers’ spouses, negotiating an Indiana contract that could become a model for companies nationwide. The contract applies to only 11,000 Kroger workers in Indiana, but it puts Kroger at the leading edge of a growing movement to restrict or eliminate spousal coverage. ... Few [companies] have eliminated spousal coverage altogether, though. That’s beginning to change. Last year, 4 percent of companies barred coverage of spouses in the same way Kroger now does in Indiana, according to Towers Watson, a human resources consulting firm. Next year, that figure is expected to climb to 12 percent (Horn, 9/8).

The Columbus Dispatch: Employers Limit Health Plans For Spouses
Employers are placing greater limits on how two-income families get health coverage through their jobs. ... This year, 34 percent of public employers in Ohio have some type of stipulation for employees whose spouses have other means of medical coverage, according to survey results reported last month by the State Employment Relations Board. That compares with 26 percent five years ago. Most Ohio public employers who have spousal restrictions require that employee spouses use their own employer insurance as their primary form of coverage, if available, the survey found (Sutherly, 9/8).

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Medicare

Seniors Can Ignore New Health Insurance Marketplaces

Officials are reminding those on Medicare that they don't need to sign up for health insurance coverage in Obamacare's marketplaces starting Oct. 1. In the meantime, a new study says Rochester, N.Y., has the lowest Medicare spending, and the notion of investing a portion of the money in your Health Savings Account gains steam.

The Wall Street Journal: Don't Confuse Medicare With Obamacare 
The annual Medicare open-enrollment period, which runs from Oct. 15 through Dec. 7, overlaps this year with the initial registration for the Health Insurance Marketplace, a cornerstone of the Affordable Care Act (aka Obamacare). But don't confuse the two. They serve different populations. If you're already covered by Medicare, you needn't give the Marketplace another thought (Waters, 9/7).

Earlier, related KHN coverage: No Shopping Zone: Medicare Is Not Part Of New Insurance Marketplaces (Jaffe, 8/25). 

The Associated Press/Wall Street Journal: Rochester, NY, Cited For Lowest Medicare Spending
A new study finds that the Rochester area has the lowest overall Medicare spending rate in the nation, a feat health officials attribute to aggressive regional planning that keeps a lid on unneeded hospital expansions and technology upgrades that insurers ultimately pay for (9/8).

The Associated Press: How To Invest In Your Health Care
You already can invest your retirement money and your kid's college savings on Wall Street. Next on the list: your health care. A growing number of employees are required by companies to set up special savings accounts to cover part of their medical bills. Over time, they are also encouraged to invest a portion of it in stocks, bonds or a mutual fund, just like they do with a 401(k) or IRA. Americans now have $18 billion in Health Savings Accounts. … That's up more than 40 percent from a year ago (Sweet, 9/6).

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Health Care Marketplace

For Veterans, Malpractice Payouts Reach 12-Year High

Bloomberg: Malpractice Payouts To U.S. Veterans Reach 12-Year High
Christopher Ellison went to a veterans medical center in Philadelphia to get eight teeth extracted in 2007. What should have been a routine dentist visit left him permanently incapacitated. The $17.5 million Ellison and his family received in a malpractice judgment against the Department of Veterans Affairs was the largest against the agency in a dozen years -- and one of more than 400 payments the U.S. government made last year to resolve VA malpractice claims, according to agency records obtained through a Freedom of Information Act request. The total cost came to $91.7 million, also the highest sum in at least 12 years (Miller, 9/9).

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State Watch

State Highlights: Democratic Gov. Hopefuls Spar Over Hospitals In N.Y.

A selection of health policy stories from New York, Indiana, South Carolina, California and Kansas.

The New York Times: Debating A Fix For Hospitals In Dire Straits
Of all the issues in the Democratic primary for mayor, one of the few that most candidates seem to agree on is that struggling New York City hospitals need to be saved. ... Despite the discourse, it is the state that regulates hospitals and gives the grants and loans needed to keep them from failing. And Gov. Andrew M. Cuomo is not throwing the hospitals a lifeline (Hartocollis, 9/6).

The Associated Press: W. Ind. Prison Inmates Provide End-Of-Life Care
Inmates at a western Indiana prison are trained to give end-of-life care for their cellmates through a hospice program as a way to help deal with an aging prison population. The program at the Wabash Valley Correctional Institute in Carlisle, 35 miles south of Terre Haute, was the idea of a prisoner who had watched his friend die of lung cancer in 2009 without a single outside visitor. Inmate volunteers have cared for 50 convicts in their final days over the past three years, The Indianapolis Star reports (9/8).

The Associated Press: Medicaid Agency Helping School Clinics Succeed
Four high-poverty schools in Charleston County [South Carolina] could become a statewide model for in-school medical clinics that offer parents a convenient way to take their children to the doctor's office. … Agency officials say they want to simultaneously help the clinics grow and become financially stable, so services don't depend on fluctuating grants. That involves helping enroll qualifying students in the government health care program for the poor and disabled, as well as training staff on how to bill Medicaid for services (Adcox, 9/9).

The Hill: AFL-CIO Convention Avoids Health Care Union's Protests
The AFL-CIO narrowly avoided an embarrassing union-led protest by canceling convention events that spotlighted a health care company. The National Union of Healthcare Workers (NUHW) was planning to protest events highlighting Kaiser Permanente, scheduled for Sunday and Monday this week in Los Angeles (Bogardus, 9/9).

Kansas Health Institute: Inspector General's Report Has Rural Hospitals Worried
A new report from the inspector general of the U.S. Department of Health and Human Services includes recommendations that -- if acted upon -- could undermine hundreds of small, rural hospitals across the nation including scores in Kansas, hospital officials and some rural health experts say (Shields, 9/9).

California Healthline: Home Health Industry Could Use More Regulation, According To UCLA
UC-Los Angeles researchers yesterday released a study that concluded more regulation is needed among home health care workers in California. … A bill is pending in the current session, AB 1217 by Assembly member Bonnie Lowenthal (D-Long Beach), which would establish certification of home health workers. The bill has raised privacy concerns because it calls for posting of certification data -- including names of care givers -- online. Other concerns revolve around the possible rise in cost of home health services (Gorn, 9/6).

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Editorials and Opinions

Viewpoints: Navigators Become 'Major Friction Point;' Conservative Opponents Of Health Law Take Tactics From Civil Rights Conflict

The Washington Post: Obamacare Navigators Are Necessary
In the fierce debate over what would become the Affordable Care Act (ACA), the signature policy achievement of President Obama's first term, there was relatively little to-do over the question of the bill's so-called navigators. ... But in the years since the ACA became law, navigators have become a major friction point in the push to unravel Obamacare in state legislatures across the country. Insurance brokers and agents have led the charge, insisting that navigators will impede their ability to do business (9/6).

The Los Angeles Times: Obamacare: New Fight, Old Tactics
Last month, Americans took pride in celebrating the 50th anniversary of the March on Washington. Unfortunately, we are also revisiting a far darker episode in our history, a civil rights-era conflict that tells us much about the hurdles facing President Obama's Affordable Care Act, the most ambitious piece of social legislation enacted in almost half a century. That episode was the "massive resistance," a policy pushed by a phalanx of Southern white politicians, journalists and local worthies. ... Today, the Republican opponents of Obamacare, and especially those hailing from the old Confederacy, have dusted off just about every tactic and ruse once deployed by Southern segregationists (Nelson Lichtenstein, 9/8).

The New York Times: The Wonk Gap
So, another week, another denunciation of Obamacare. Who cares? But [Sen. John] Barrasso's remarks were actually interesting, although not in the way he intended. You see, all the recent news on health costs has been good. So Mr. Barrasso is predicting sticker shock precisely when serious fears of such a shock are fading fast. Why would he do that (Paul Krugman, 9/8)?

Los Angeles Times: Conservatives Are Unembarrassed By A History Of Being Wrong
And on into the 20th century, it was conservatives who fought against the franchise for women, Social Security, Medicare and racial integration. More recently, they have stood in the way of gay rights and universal health care. Even when they had the right idea – opposing Communism – they were prone to dangerous excess – McCarthyism. To be fair, the best conservative intellectuals and political leaders have provided a useful tempering of the enthusiasms of liberal social engineers. But on so many of the biggest challenges that have faced the nation, the conservatives of each era have ended up on the wrong side of history (David Horsey, 9/5).

The Washington Post: Bipartisan Rx For Health-Care Costs
"When we started this 18 months ago," Tom Daschle told me, "we assumed that there could be a grand bargain." The former Senate majority leader, a Democrat, laughed ruefully, as did his companions. Daschle was visiting The Post last week with Republican Bill Frist, also a former majority leader; former senator Pete Domenici, longtime head of the budget committee; and Alice Rivlin, former director of the Congressional Budget Office. ... In the year and a half Daschle referred to, the four former officials had crafted, under the auspices of the Bipartisan Policy Center, a plan to improve U.S. health care while controlling costs. But they no longer had any illusion that it could become one component of a larger effort to increase revenue and tame entitlement programs — to get the federal debt under control (Fred Hiatt, 9/8).

The Wall Street Journal: The Breakthrough Of Instant Diagnosis
[Elizabeth] Holmes, a 29-year-old chemical and electrical engineer and entrepreneur, dropped out of Stanford as an undergraduate after founding a life sciences company called Theranos in 2003. Her inventions, which she is discussing in detail here for the first time, could upend the industry of laboratory testing and might change the way we detect and treat disease (Rago, 9/8). 

Tampa Bay Times: The Smart Business Of Health
The chairman and CEO of Florida Blue, the state's largest health insurer and a not-for-profit company, told the Tampa Bay Times editorial board last week that "wellness and prevention" are key to containing health care costs. He wants to create financial incentives for patient-centered care, even if that means paying primary care physicians more. And he is flat-out opposed to Florida's decision to reject Medicaid expansion for nearly a million poor, uninsured adults. This is where he's picked a fight with Florida Republicans (Robyn E. Blumner, 9/5).

Dallas News: Rep. Burgess' Plan To Better Pay Medicare Physicians
Often, it seems like Washington can never get things done. Problems fester while solutions remain elusive. But to his credit, Dr. Michael Burgess, R-Lewisville, has defied the odds. The House member has found a bipartisan way to fix the way Medicare reimburses physicians (9/8).

Forbes: ObamaCare Will Make Us Smarter Healthcare Consumers
Obviously [the health law] expands the government's role in healthcare, especially by requiring everyone to have health insurance or pay a penalty, and it will bring up to 21 million people onto the government-paid Medicaid roles. However, private insurance, which covers 58% of Americans, will remain the dominant source of medical benefits. And people with private insurance will find that big brother is not taking care of them. In fact, they will be ever more exposed to the cost of their care. As a result, they will be forced to become smarter healthcare consumers (Todd Hixon, 9/9).

Forbes: Obamacare's Worst Feature? It's Wedded To 50-Year-Old Assumptions About Health And Insurance
It’s ironic that at the very moment that Obamacare is poised to spend nearly $2 trillion to expand traditional insurance coverage to about 30 million uninsured, new synergies between genomics companies and providers, advanced diagnostics for remotely monitoring patient treatment and detecting serious illness at earlier stages, and a wave of mobile health apps are unraveling old assumptions about how care should be delivered and financed (Paul Howard, 9/9).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Marissa Evans
Lisa Gillespie
Shefali Luthra

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