First Edition: May 21, 2013

Today's headlines include stories examining how the approaching implementation of some health law provisions is highlighting key policy questions.  

Kaiser Health News: How Will The 'Unbanked' Buy Insurance On The Exchanges?
Kaiser Health News staff writer Sarah Varney, working in collaboration with NPR, reports: "When movie stars become unbankable, they’re no longer a slam dunk at the box office. When investments become unbankable, they’re relegated to the junk pile. For ordinary Americans deemed unbankable, those who don’t have a traditional checking or savings account, it can be hard to simply pay bills. And that is about to become a big problem for those who also lack health coverage -- and for the health insurance companies trying to sell them coverage. After all, how do you sell a product to a customer who has no way to pay you?" (Varney, 5/20). Read the story.

Kaiser Health News: Texas' Rio Grande Valley Presses for Medicaid Expansion
Kaiser Health News staff writer Sarah Varney, working in collaboration with NPR, reports: "When the sun rises over the Rio Grande Valley, the cries of the urracas – black birds – perched on the tops of palm trees swell to an unavoidable cacophony. That is also the strategy, it could be said, that local officials, health care providers and frustrated Valley residents are trying to use to convince Gov. Rick Perry and state Republican lawmakers to set aside their opposition and expand Medicaid, a key provision of the federal health law" (Varney, 5/21). Read the story.

Kaiser Health News: Insuring Your Health: Some Individual Policies Offer A Way To Shrink Deductibles
Kaiser Health News consumer columnist Michelle Andrews writes: "There is no free lunch. As more people buy high-deductible health plans, they're discovering that while premiums for such plans are more affordable, the trade-off can be high out-of-pocket costs before coverage kicks in. However, some plans sold on the individual market offer a way for healthy people to shrink their deductibles. Under these so-called deductible-credit plans, the deductible diminishes year by year for policyholders who don't spend a lot on health care" (Andrews, 5/21). Read the column.

The Wall Street Journal: Role Of Health-Law 'Navigators' Under Fire
Lawmakers across the country are tussling over the Obama administration's plans to create a small army of assistants to guide millions of Americans as they sign up for new health-insurance options available this fall. Backers of the health-care overhaul face an uphill battle to spread the word about the law, in the face of consumer research that suggests most uninsured people know little about it and are skeptical about the value of health insurance generally. Some Democrats have openly worried that the administration is doing too little to make sure the enrollment process goes smoothly (Radnofsky, 5/20).

The New York Times: Overruns Forcing Lower Payments To Some Providers In Stopgap Health Program
The Obama administration said Monday that it was cutting payments to doctors and hospitals after finding that cost overruns are threatening to use up the money available in a health insurance program for people with cancer, heart disease and other serious illnesses (Pear, 5/20).

Los Angeles Times: Some Could Have Gaps In Medical Coverage Under New Law
When the national healthcare law takes full effect next year, millions of Americans risk disrupted health coverage because of common life events: getting married or divorced, having children or taking on a second job. As their family incomes change, so too will their eligibility for public insurance programs. And if nothing is done, policymakers warn, many low-income patients will lose access to their doctors and medications during this massive game of health coverage pingpong. Policymakers and healthcare industry leaders across the nation are paying close attention to the issue and working to close the coverage gaps before Jan. 1, said Alan Weil, executive director of the National Academy for State Health Policy (Gorman, 5/20).

Politico: Report: More Seniors Are Living In Poverty
An alternative census estimate shows that more of America’s seniors than originally thought are living in poverty — and that means the poverty rate could spike under certain Medicare reforms, a new analysis finds. The estimate, which takes into account health spending and regional cost of living, finds 1 in 7 seniors lives in poverty. It was previously thought that just 1 in 10 did (Smith, 5/21).

The Washington Post: Senior Poverty Is Much Worse Than You Think
But under the [supplemental poverty measure], you’d count as poor as $15,000 – $10,000 = $5,000, which is below the relevant SPM threshold. And despite having Medicare, many seniors struggle with out-of-pocket medical bills. As my colleague Michelle Singletary pointed out over the weekend, the Employee Benefit Research Institute has found Medicare only pays for about 60 percent of seniors’ total health costs. Sarah has written about how out-of-pocket costs tend to pile up particularly at the end of seniors’ lives. Due in part to such burdens, a new Kaiser Family Foundation report finds that the SPM poverty rate for senior citizens is actually higher than the official rate: 15 percent vs. 9 percent. And when you include people living within 200 percent of the poverty line, the picture under SPM looks even worse (Matthews, 5/20).

The New York Times: E.R.'s Account For Half Of Hospital Admissions, Study Says
Emergency rooms account for about half of the nation’s hospital admissions and accounted for virtually all of the rise in admissions between 2003 and 2009, according to a study released on Monday. Although emergency rooms are widely considered expensive places for diagnostic care, physicians are increasingly relying on them to determine whether a patient needs to be hospitalized (Abelson, 5/20).

The Washington Post: Health-Care Training And Data Storage Innovations Featured At Silicon Valley Conference
This year’s HealthBeat conference continues through Tuesday in San Francisco, with health technology innovators gathering to offer their take on what’s challenging, what’s working and what’s next in innovation for the health care industry (Kolawole, 5/20).

The Wall Street Journal: Forget To Take Medicine? These Pills Will Tell Your Doctor
Startup companies are coming up with new technologies aimed at getting people to take medicine only as directed. Taking medication haphazardly—skipping doses, lapsing between refills or taking pills beyond their expiration date—has been linked to health complications and hundreds of millions of wasted dollars for insurers and hospitals (Hay, 5/20).

The Wall Street Journal: Tip Puts Lobbyist's Career On Hold
Mark Hayes was a Washington policy wonk on a long and steady ascent: a senior Senate health-care aide, a role writing President Barack Obama's health-care overhaul and a spin through the revolving door to a lobby firm where he banked 20 years of contacts. A series of emails to a client was all it took to put that carefully crafted career on hold (Mundy and Mullins, 5/20).

The Washington Post: Federal Faces: David E. Vollman, VA Ophthalmologist
There are more than 50,000 cataract surgeries performed at Department of Veterans Affairs health facilities every year and more than 3 million throughout the country, but there has never been a system to collect detailed patient outcomes on a national level. Vollman, 34, in only his second year working at St. Louis VA Medical Center, helped organize and implement a pilot project to track cataract surgery results (5/20).

Los Angeles Times: Patient Care Workers Set To Start Walkout At Five UC Hospitals
Respiratory therapists, nursing aides, surgical technicians and other patient care workers plan to stage a walkout starting Tuesday morning at five University of California medical centers. More than 12,000 workers from the American Federation of State, County and Municipal Employees are expected to participate in the two-day strike over staffing, pay and pension reform, union officials said. An additional 3,400 workers from the University Professional and Technical Employees union plan a one-day sympathy strike (Gorman, 5/21).

The Wall Street Journal: Minnesota To Allow Home Day-Care Workers To Unionize
Minnesota is set to allow unions to organize workers who provide home day-care services and other home care, giving organized labor a rare victory at the state level. The state House, by a vote of 68 to 66, passed legislation Monday that allows unions to negotiate on behalf of providers whose clients receive government subsidies—including through Medicaid, the federal health program for low-income and disabled people (Peters and Maher, 5/20).

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This is part of Kaiser Health News' Daily Report - a summary of health policy coverage from major news organizations. The full summary of the day's news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.