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KHN

WEDNESDAY, SEPTEMBER 17, 2014

Daily Health Policy Report

Check back on Kaiser Health News for the latest headlines

KHN ORIGINAL REPORTING & GUEST OPINION

NEW FROM KHN


1. FAQ: Children’s Health Insurance Program’s Future Is Unclear Under The Health Law
2. Insuring Your Health: Health Law Tempers New State Coverage Mandates
3. Capsules: CDC Survey Finds Drop In Uninsured; California Exchange Seeks To Enroll 500,000 More People
4. In South Florida And The Nation, Health Care Costs Often Are Shrouded In Secrecy
5. Political Cartoon: 'Going Viral?'

SUMMARIES OF NEWS COVERAGE

HEALTH REFORM


6. Missing Paperwork Puts At Risk Coverage For Tens Of Thousands
7. Survey: Number Of Uninsured Dropped 3.8 Million During 2014's First Quarter
8. GAO: Many Insurers Flout Health Law's Abortion Rule
9. Covered California Unveils Ad Campaign, Awards $14.6M For Outreach

CAPITOL HILL WATCH


10. GOP Accuses VA Of Interfering With Report On Deaths

HEALTH CARE MARKETPLACE


11. More Doctors Optimistic About Future Of Medicine
12. Humana Announces New Buyback Program

STATE WATCH


13. State Highlights: N.Y. Sues Drugmaker Over Alzheimer's Drug Switch

EDITORIALS AND OPINIONS


14. Viewpoints: New Uninsured Numbers Are Outdated; Chiropractors' Unusual Move Into Nutrition

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KHN ORIGINAL REPORTING & GUEST OPINION

NEW FROM KHN


1. FAQ: Children’s Health Insurance Program’s Future Is Unclear Under The Health Law

Kaiser Health News staff writer Mary Agnes Carey answers some frequently asked questions about the Children’s Health Insurance Program, a joint federal-state program known as CHIP. The program has helped cut in half the number of uninsured children since being enacted less than two decades ago, but its future is in doubt due to limited funding in the federal health law of 2010. A year from now, CHIP will run out of money. Some advocates for the program want the federal government to finance CHIP for another four years, while other experts have suggested two would suffice. The Senate Finance Committee’s Subcommittee on Health Care will hold a hearing on the issue Tuesday (Carey,  9/16). Read the story.

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2. Insuring Your Health: Health Law Tempers New State Coverage Mandates

Kaiser Health News consumer columnist Michelle Andrews reports: “For decades, states have set rules for health coverage through mandates, laws that require insurers to cover specific types of medical care or services. The health law contains provisions aimed at curbing this piecemeal approach to coverage. States, however, continue to pass new mandates, but with a twist: Now they’re adding language to sidestep the health law, making it tougher than ever for consumers to know whether they’re covered or not” (Andrews, 9/16). Read the column.

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3. Capsules: CDC Survey Finds Drop In Uninsured; California Exchange Seeks To Enroll 500,000 More People

Now on Kaiser Health News' blog, Jordan Rau reports on a new survey from the Centers for Disease Control and Prevention: "The National Health Interview Survey of people during the first three months of this year found that the number of adults under 65 without health insurance dropped to 18.4 percent from 20.4 percent in 2013. Among all ages, the survey found that the uninsured rate dropped to 13.1 percent from 14.4 percent in 2013; 41 million people still lacked insurance" (Rau, 9/16).

Also on the blog, Daniela Hernandez reports on Covered California's plans for the next enrollment period: "Covered California, the Golden State’s online health insurance marketplace, announced Monday that it will be spending close to $100 million as it aims to enroll 500,000 new people during the second round of open enrollment, which begins in two months. The state also will be trying to help about 1.2 million Californians renew health plans they received thanks to the nation’s Affordable Care Act during the inaugural enrollment period last fall. The numbers do not include the roughly 2 million who signed up for Medi-Cal, the state’s health insurance program for the poor" (Hernandez, 9/16). Check out what else is on the blog

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4. In South Florida And The Nation, Health Care Costs Often Are Shrouded In Secrecy

The Miami Herald's Daniel Chang, working in partnership with Kaiser Health News, reports: "[Duane] Fitch and others who asked for the information never got to see precisely how Miami-Dade spends more than $400 million a year to pay healthcare claims for nearly 60,000 employees, retirees and dependents in the health plan. That’s because Miami-Dade — like many employers across the country — isn’t allowed to know the prices their own insurance plan administrators negotiate with healthcare providers, even when they’re self-insured, like Miami-Dade County, and the claims are paid with taxpayer dollars. And that means that the mayor’s healthcare committee has no more insight than the average Florida consumer on how to lower costs for their employees or themselves — frustrating everyone from union leaders to county commissioners who are trying to push down prices" (Chang, 9/15). Read the story, and two related stories, Patients Take On More Health Care Costs But Struggle To Find Prices (Chang, 9/16) and Health Care Prices: Many Moving Parts Veiled By Confidentiality Agreements (Chang, 9/15).

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5. Political Cartoon: 'Going Viral?'

Kaiser Health News provides a fresh take on health policy developments with "Going Viral?" by John Cole.

And here's today's health policy haiku:

 GILEAD TO BOOST PRICE OF NEW HEPATITS C DRUG

The new Hep-C drug?
Gilead, not Galahad
Son of Cost-a-Lot
-Beau Carter

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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SUMMARIES OF NEWS COVERAGE

HEALTH REFORM


6. Missing Paperwork Puts At Risk Coverage For Tens Of Thousands

According to the Obama administration, as many as 115,000 people could lose the new insurance they obtained under the health law because they did not prove they were legal immigrants or U.S. citizens who were eligible for that coverage. Another 363,000 people must submit documentation to verify their incomes by Sept. 30 or lose their subsidies. These two numbers combined represent about 10 percent of the people who signed up through the online insurance marketplaces.    

The New York Times: U.S. To End Coverage Under Health Care Law For Tens Of Thousands
The Obama administration said on Monday that it planned to terminate health insurance for 115,000 people on Oct. 1 because they had failed to prove that they were United States citizens or legal immigrants eligible for coverage under the Affordable Care Act. It also told 363,000 people that they could lose financial aid because their incomes could not be verified (Pear, 9/15).

Los Angeles Times: Many May Lose Obamacare Coverage Because Of Missing Paperwork
Some 115,000 people are poised to be cut from insurance rolls at the end of the month because they haven't verified their citizenship or immigration status. Another 363,000 people haven't sent in the necessary forms proving their income, a key requirement for calculating the size of government subsidies some consumers are eligible to receive under the law. Together, that represents about 10% of those who signed up for coverage on new federal marketplaces created by the law (Levey, 9/15).

The Wall Street Journal: Tens Of Thousands Likely To Lose Health Insurance At End Of September
The government is now set to inform insurers to terminate at the end of the month the coverage those people bought through HealthCare.gov. A provision in the Affordable Care Act bars people living in the U.S. without authorization from obtaining coverage through the site. Federal officials also said they would send notices to about 279,000 people whose income can't be verified, giving them until Sept. 30 to submit further documentation. Those people won't lose their coverage if they don't respond, but the tax credits that offset the cost of their premiums could be suspended (Radnofsky, 9/15).

The Washington Post: 115,000 Immigrants To Lose Health Coverage By Sept. 30 Because Of Lack Of Status Data
Those individuals can still send in the needed information to the federal exchange and if they are found eligible, they will be able to regain coverage, officials said. They will be considered under a special category reserved for people who have experienced a major life change, such as having a baby or getting divorced or losing a job with health insurance. Separately, about 363,000 consumers who have coverage could lose financial subsidies for their insurance premiums unless they clear up information about their incomes that differs from that on federal tax records. If those individuals don’t provide updated income information by Sept. 30, federal health officials will adjust their premiums to “reflect what we have in our records,” said Andy Slavitt, principal deputy administrator at the Centers for Medicare and Medicaid Services, which manages HealthCare.gov, the federal exchange (Sun, 9/15).

Reuters: U.S. Says 115,000 Could Lose Obamacare Insurance Over Immigration
The Obama administration on Monday said 115,000 people in 36 states could lose their private health insurance under Obamacare after Sept. 30, because of unresolved data problems involving their citizenship or immigration status. Another 363,000 people could see their insurance costs change, due to problems involving income data that is used to determine whether enrollees qualify for federal subsidies to help pay premiums on health plans obtained through the federal insurance marketplace, according to the administration. The U.S. Centers for Medicare and Medicaid Services (CMS), which operates the federal marketplace for consumers in 36 states, said the number of people with data problems is down from June when 966,000 had citizenship or immigration discrepancies and 1.6 million people had problem data involving income (9/15).

USA Today: Feds Give Immigrants More Time On Health Care
About 115,000 of 966,000 people who bought plans on HealthCare.gov and owed more information about their immigration status have unresolved issues, Andy Slavitt, principal deputy administrator at the Centers for Medicare and Medicaid Services, said. These people were given a deadline of Sept. 5 to submit information — they now have until Sept. 30 to provide proof of their citizenship, or they will lose coverage. After that date, those people can reapply if they can prove citizenship even though the open enrollment period is closed. The other 851,000 people either have had their cases resolved, or the cases are in the process of being resolved. Slavitt would not comment on how the resolved cases were decided. "The good news is they have been able to resolve one way or another most of the problem applications where federal databases could not verify income or legal status," says health care consultant Kip Piper, a former state and federal Medicare official (O’Donnell, 9/15).

McClatchy: Feds Offer Lifeline To 115,000 Facing Loss Of Health Coverage
After failing to respond to multiple outreach attempts, more than 100,000 people could lose their federal marketplace health coverage on Sept. 30, while more than three times that many could see their premiums increase, if they fail to verify their income, U.S. residency or immigration status as required by the Obama administration. The U.S. Department of Health and Human Services announced the deadline on Monday when it began sending out cancellation warnings to 115,000 people in 36 states who haven’t yet provided the proper citizenship and immigration documents with their applications for coverage (Pugh, 9/15).

The Fiscal Times: Thousands Of Obamacare Enrollees To Lose Coverage
Some 115,000 people who signed up for health insurance through the federal marketplace this year will lose their coverage at the end of the month for failing to provide the government with proof of citizenship or immigration status. Officials from the Centers for Medicare and Medicaid Services (CMS) said they sent out notices to 300,000 enrollees last month, asking them to verify their citizenship, which is required to receive health coverage under Obamacare (Ehley, 9/15).

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7. Survey: Number Of Uninsured Dropped 3.8 Million During 2014's First Quarter

The survey, conducted by the Centers for Disease Control and Prevention, may not reflect the late surge in enrollment before the health law's March deadline and will likely draw criticism from health law supporters and critics alike. It also tracked physical health.    

The New York Times: Number of Americans Without Health Insurance Falls, Survey Shows
Federal researchers reported on Tuesday that the number of Americans without health insurance had declined substantially in the first quarter of this year, the first federal measure of the number of uninsured Americans since the Affordable Care Act extended coverage to millions of people in January. The number of uninsured Americans fell by about 8 percent to 41 million people in the first quarter of this year, compared with 2013, a drop that represented about 3.8 million people and that roughly matched what experts were expecting based on polling by private groups, like Gallup. The survey also measured physical health but found little evidence of change (Tavernise, 9/16).

The Wall Street Journal: Tally Of Uninsured Fell By 3.8 Million In Early 2014
Shortcomings in the data are likely to limit the conclusions that either supporters or critics of the law can draw from it. The survey, based on interview responses for 27,627 people, was carried out from the beginning of January through the end of March, which is when enrollment ended for most consumers. Responses from earlier in the period wouldn't reflect the late surge in enrollment under the law, potentially making the tally of people who gained coverage artificially low (Radnofsky, 9/15).

Kaiser Health News: CDC Survey Finds Drop In Uninsured
The survey, based on data for 27,627 people and released Tuesday, provided an incomplete picture of the effect of federal health law, as its interviews occurred from January through March. Since the Obama administration estimated that nearly half of the 8 million people who signed up for Medicaid or private insurance plans in the new marketplaces did not do so until near or at the conclusion of the enrollment period at the end of March, many of those people’s new insurance status were not captured in the survey. For the initial part of the year, the survey found the most pronounced drop in uninsured coverage among adults aged 19–25. That number decreased to 20.9 percent in the beginning of 2014 from 26.5 percent in 2013. ...The new survey found that the number of young adults obtaining public insurance such as Medicaid increased to 19.9 percent in the beginning of 2014 from 16.1 percent in 2013 (Rau, 9/16).

Politico: Fewer Uninsured, CDC Finds
But the survey does not capture the tidal wave of last minute sign-ups who flooded into the new health insurance exchanges in March. They had signed up — but their coverage didn’t begin until April at the earliest, so their new health insurance won’t show up until the second quarter survey (Norman, 9/16).

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8. GAO: Many Insurers Flout Health Law's Abortion Rule

A report by the Government Accountability Office found many examples of insurance plans not complying with the health law's requirement that they separately itemize a charge for coverage of elective abortion on enrollees' bills. The agreement that no federal funds go to pay for elective abortions was the basis of a political compromise that allowed the health law to pass in 2010.

The Associated Press: New Questions Over Abortion Coverage In Health Law
A nonpartisan congressional agency is raising new questions about compliance with a key compromise on abortion that allowed the federal health care law to pass in 2010. The Government Accountability Office said in a report released late Monday that only 1 of 18 insurers it reviewed was separately itemizing a charge for coverage of elective abortions on enrollees' bills. That detail is important because the original compromise that President Barack Obama sealed with anti-abortion Democrats stipulated that no federal funds would be used to pay for elective abortions. Instead, private health plans covering the procedure would collect a separate premium, which would be segregated from federal subsidies for other medical services (Alonso-Zaldivar, 9/16).

Politico: GAO: Obamacare Abortion Rules Widely Ignored
There are widespread instances of Obamacare insurance plans violating the rigid rules surrounding whether customers can use federal health care subsidies on insurance policies that cover abortion procedures, according to a Government Accountability Office investigation. The report, commissioned by House Republican leadership and obtained by POLITICO on Monday night, found that 15 insurers in a sample of 18 are selling Obamacare plans that do not segregate funds to cover abortion (except in cases of rape, incest or the mother’s life) from their Obamacare subsidies (Haberkorn and Everett, 9/15).

Fox News: Insurance Providers Widely Ignoring Obamacare Abortion Provision, Watchdog Report Says
An ObamaCare provision that requires individuals to pay separately for abortion coverage to ensure abortions are not funded by taxpayers is being widely ignored by insurance providers, according to a government watchdog report released Monday. Republican lawmakers say the “bombshell” findings by the nonpartisan Government Accountability Office (GAO) show the Obama administration misled the American public when it insisted abortions would not be paid for by federal funds under the health care law (9/15).

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9. Covered California Unveils Ad Campaign, Awards $14.6M For Outreach

And new enrollment numbers for that state show a growing individual insurance market, officials said. Meanwhile, a Nebraska woman recounts her experience as a navigator, and Oregon officials say a tax credit error will affect fewer people than expected.

Los Angeles Times: California Health Insurance Exchange Unveils Ad Campaign And Outreach
Preparing for the second year of Obamacare enrollment, California unveiled new television ads and handed out $14.6 million to community groups for consumer outreach. The state-run insurance exchange, Covered California, said the new grant funds are in addition to $33.4 million that has already been given to clinics, unions, schools and nonprofit groups helping with enrollment (Terhune, 9/15).

Kaiser Health News: Capsules: California Exchange Seeks To Enroll 500,000 More People
Covered California, the Golden State’s online health insurance marketplace, announced Monday that it will be spending close to $100 million as it aims to enroll 500,000 new people during the second round of open enrollment, which begins in two months. The state also will be trying to help about 1.2 million Californians renew health plans they received thanks to the nation’s Affordable Care Act during the inaugural enrollment period last fall. The numbers do not include the roughly 2 million who signed up for Medi-Cal, the state’s health insurance program for the poor (Hernandez, 9/16).

California Healthline: New Enrollment Numbers Temper Fears of Individual Insurance Market Crash
It turns out the sky hasn't really fallen on the individual health insurance market. The Department of Managed Health Care last month released individual market enrollment numbers through May 1, 2014, showing growth in the market. ..."They show that, even with just one regulator reporting, the individual market is doing really well," said [Richard Figueroa, director of the health and human services department at the California Endowment]. ... More important to Figueroa, though, is the numbers show him that the health benefit exchange is not only working, but affecting the rest of the market outside of the exchange (9/15).

Lincoln Journal Star: Woman Recalls Time As Health Care Navigator
Sometimes the work Cindy Balliet did this past year touched her heart. Balliet helped a woman with chronic back pain get enrolled in the new federal health insurance program. Balliet was one of 50 people trained and licensed to help Nebraskans "navigate" the new health insurance system. She was one of nine navigators paid to work full-time at Community Action Partnership offices across the state. But the experience of working with people who desperately wanted insurance they could afford made her appreciate the program, even with its initial problems (Hicks, 9/15).

Oregonian: Cover Oregon Health Insurance Tax Credit Error Affects Fewer Than Thought, Officials Say
An error in Cover Oregon's tax credit formula will affect fewer health insurance consumers than feared, officials said Monday. Cover Oregon officials told lawmakers in Salem that a survey of 39,000 households receiving the tax credit to reduce premiums found only 775 of them are affected by an incorrect formula used by the health insurance exchange, not the greater number feared. About 3,400 households haven't yet been reviewed.  Exchange officials said while they were not pleased about the error, they are pleased the number isn't larger (Budnick, 9/15).

And, on the topic of Medicaid expansion --

The Associated Press: Arkansas Requests Changes To Private Option
Arkansas asked the federal government Monday to allow changes to the state's compromise Medicaid expansion that would require some participants to contribute monthly to health savings accounts and would impose new limits on transportation for non-emergency services. The state Department of Human Services submitted its proposal to change the "private option" program, which uses federal Medicaid funds to purchase private insurance for low-income residents. It was created last year as an alternative to the Medicaid expansion envisioned under the federal health law. More than 194,000 people are enrolled in the private option. Lawmakers earlier this year required the state to win approval for the changes by Feb. 1 in order to keep the program alive (DeMillo, 9/15).

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CAPITOL HILL WATCH


10. GOP Accuses VA Of Interfering With Report On Deaths

Meanwhile, the health-tracking device company Fitbit hires a D.C. lobbying firm to deal with privacy questions from lawmakers.

Politico: House GOP: VA Interfered With IG’s Report
Congressional Republicans are accusing the Department of Veterans Affairs of influencing an independent review of whether delayed health care resulted in the deaths of nearly three dozen patients. The VA’s inspector general released a report last month that said investigators could not “conclusively” link the deaths of 40 veterans to long wait times plaguing the agency. That shocked many Republican lawmakers, who say there’s no question that the two issues are connected (French, 9/15).

The Hill: Health Tracker Fitbit Hires Lobbying Muscle
The health-tracking device company Fitbit has hired lobbying muscle as it faces questions from Capitol Hill about its privacy protections. The company, whose wristband devices have become ubiquitous in some circles, brought on K Street heavyweight Heather Podesta + Partners to "educate lawmakers regarding health and fitness devices," according to a federal lobbying disclosure form. ... The hire comes on the heels of concerns voiced last month by Sen. Charles Schumer (D-N.Y.), that the detailed personal information Fibit and similar companies collect might be shared with other firms (Hattem, 9/15).

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HEALTH CARE MARKETPLACE


11. More Doctors Optimistic About Future Of Medicine

Family doctors are also pushing to change how the nation pays for medical education and are proposing shifting training funds away from hospitals for residencies.

The Wall Street Journal: Doctors: Skeptical About Health Law, Optimistic About Future Of Medicine
Doctors are overextended, skeptical of changes wrought by the federal health law, but more optimistic about the future of medicine than they were two years ago, according to a new survey of 20,000 U.S. physicians. Despite many specific complaints, 71 percent of those polled said they would choose to become doctors again if they were making the choice today, up from 66 percent two years ago. And 50 percent would recommend it to their children, compared with 42 percent in 2012 and 40 percent in 2008 (Beck, 9/16).

CQ Healthbeat: Family Physicians Push For Overhaul Of Medical Education Financing
The nation’s family physicians on Monday proposed significant changes to the federal government’s financing of medical residencies through graduate medical education. The proposal emphasizes support for primary care and would shift money away from hospitals. The handful of changes proposed by the association include shifting money toward the initial residency period that physicians must finish and away from follow-on fellowships in subspecialties. Getting rid of federal funding for the approximately 9,333 funded fellowship positions in the United States and using that money for more basic residency training would allow for the creation of about 7,777 new positions in the initial residency period, also known as first-certificate training program positions, according to the AAFP (Adams, 9/15).

In other news from the American Medical Association -

The Wall Street Journal: AMA Urges Overhaul Of Electronic Medical Records
It's no secret that many physicians hate the electronic-medical-records systems they use, saying they are cumbersome, poorly designed and detract from patient care. Amplifying those concerns, the American Medical Association on Tuesday is calling for a major overhaul of EMR systems to make usability and high-quality patient care a higher priority (Beck, 9/16).

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12. Humana Announces New Buyback Program

The Wall Street Journal: Humana Unveils $2 Billion Buyback Program
The new plan is slated to run through the end of 2016. About $782 million was remaining under the company's prior authorization after making $118 million in buybacks so far during the third quarter. The move comes after the board initiated a $1 billion buyback plan about five months ago, when it had $569 million left on its previous repurchase program. Humana is considered a key health insurer to watch, as its results are closely tied to Medicare Advantage plans. While membership has grown in the plans--the private-sector version of government insurance for elderly and disabled people--the government has scaled back funding for them, prompting margin concerns for Humana (Calia, 9/16).

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STATE WATCH


13. State Highlights: N.Y. Sues Drugmaker Over Alzheimer's Drug Switch

A selection of health policy stories from New York, Arizona, Texas, California, Florida, Maine, Georgia and Oregon.

The New York Times: New York Files An Antitrust Suit Against The Maker Of An Alzheimer’s Drug
New York State’s attorney general filed an antitrust lawsuit on Monday seeking to stop a pharmaceutical company from forcing patients with Alzheimer’s disease to switch to a new version of a widely used drug. The lawsuit contends that the switch is designed to blunt competition from low-priced generic versions of the medication (Pollack, 9/15).

The Associated Press: NY Bid To Halt Alzheimer’s Drug Swap
Attorney General Eric Schneiderman alleges both anti-trust and state law violations in the federal suit filed Monday in Manhattan against Dublin-based Actavis PLC and New York subsidiary Forest Laboratories (9/15).

The New York Times: Arizona Republican Official Resigns After Remarks About Medicaid Recipients
The former Arizona lawmaker who sponsored the state’s stringent anti-immigration law resigned as a top state Republican official late Sunday amid criticism for remarks he made supporting mandatory birth control or sterilization for Medicaid recipients (Medina, 9/15).

Politico: Russell Pearce Resigns After Birth Control Remarks
Former Arizona state Sen. Russell Pearce resigned from his post as vice chairman of the state’s Republican Party following recent controversial remarks about Medicaid, suggesting women be required to use birth control. However he pointed blame at media. “Recently on my radio show there was a discussion about the abuses to our welfare system. I shared comments written by someone else and failed to attribute them to the author. This was a mistake. This mistake has been taken by the media and the left and used to hurt our Republican candidates,” Pearce said in a statement in which he announced his resignation, published by the Arizona GOP on Sunday (McCalmont, 9/15). 

Texas Tribune: Advocates Warn Of Unexpected Medical Bills
Even Texans who have health insurance often face steep, unexpected costs for emergency-room care, consumer advocates told a panel of state lawmakers Monday. Senators on the State Affairs Committee met to address a charge from Lt. Gov. David Dewhurst, a Republican, to study "increasing medical price transparency" in advance of the legislative session that begins in January. Policy experts representing patients and hospitals expressed concern about the practice of “balance billing” -- when consumers are asked to pay more for out-of-network care not paid for by an insurer (Walters, 9/15).

Los Angeles Times: California Broadens Autism Therapy Coverage For Children On Medi-Cal
California children enrolled in public health care will regain access to an expensive form of autism therapy after the state Monday became the first in the country to comply with new federal guidelines. The therapy, called applied behavior analysis, was at the center of controversy last year when state officials phased out the Healthy Families program, which covered the treatment, and shifted poor children into Medi-Cal, which did not (Megerian, 9/15). 

The Associated Press: Fla.’s 'Gray Belt' A Glimpse At Nation’s Future
In Citrus County, about 70 miles north of Tampa, health care dominates the labor force. Residents prefer to get their news from a newspaper. Strip malls have an unusually high number of hearing aid businesses. The library offers Medicaid planning seminars. Voters turn out in large numbers, albeit often by absentee ballot. Having such a high concentration of elderly citizens has its trade-offs. You get an engaged citizenry with high voter turnout and volunteerism, but also an economy based on low-skill jobs such as health-care aides, retail clerks and food service workers (Schneider, 9/15).

Health News Florida: Problems Pop Up In Florida’s Medicaid Managed Care Program
Florida recently finished rolling out a new way of providing care to more than 3.5 million low-income Floridians. Nearly all of them are now enrolled in managed care plans. The state agency that runs Medicaid recently released a series of comments from various players in the industry praising the rollout. But some groups say the new system is still plagued with problems (Hatter, 9/15).

The Associated Press: Maine Gubernatorial Hopeful Outlines Ideas Around Health Care
Gubernatorial hopeful Mike Michaud on Monday touted a 10-part health care plan that includes taking advantage of telemedicine, supporting [preventive] care and improving substance abuse and mental health services. The Democrat challenging Gov. Paul LePage again pledged his support for expanding Medicaid to an estimated 70,000 residents under the Affordable Care Act -- a proposal the Republican governor fiercely opposes and has vetoed five times because he says it will be too costly for the state. LePage's campaign criticized Michaud's continued push to add more people to the Medicaid program, saying that its growth the past lead to a $400 million debt owed to the state's hospitals, which was his administration recently paid (9/15).

Georgia Health News: Another Important Change In State Benefit Plan
Blue Cross and Blue Shield of Georgia is dropping its Medicare Advantage plan for next year for retirees in the State Health Benefit Plan. That means UnitedHealthcare will be the sole provider of the Advantage plans for 2015. (Blue Cross is the sole provider for 2014.) The Georgia Department of Community Health is informing retiree health plan members about the Blue Cross move through email and letter this month, letting them know that the decision won’t affect the coverage in effect for the current year (Miller, 9/15).

Oregonian: Impasse Between Oregon Officials, Controversial Drugmaker Goes Before Lawmakers
The state of Oregon and the maker of a pricey new Hepatitis C drug may yet have room to compromise on cost, according to a hearing of the House Health Care Committee on Monday. Oregon and Gilead Sciences, maker of a $1,000-a-pill drug called Sovaldi, have been at a widely publicized impasse on the drug's potential cost to the Oregon Health Plan. Though the drugmaker has offered about a third off the list price, that price would require the state of Oregon to drop any attempt to limit consumers' access to the drug. The cost of the drug has sparked national controversy and criticism from insurers and states' Medicaid officials (Budnick, 9/15).

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EDITORIALS AND OPINIONS


14. Viewpoints: New Uninsured Numbers Are Outdated; Chiropractors' Unusual Move Into Nutrition

The New York Times' The Upshot: New Estimates On Health Coverage Are Accurate But Outdated
The federal government released some very reliable estimates of how many people had health insurance in the first three months of 2014. But the data won't tell us much about how many people got insurance through the Affordable Care Act (Margo Sanger-Katz, 9/16).

The New York Times' The Upshot: Limiting Choice To Control Health Spending: A Caution
To what extent will the recent moderation in the growth of health care prices and spending continue? This is a big question, and the answer relies on many factors. But for plans offered in the new health insurance exchanges as well as a substantial minority of employer-sponsored plans, it may depend, in part, on how long consumers are willing to trade lower premiums for less choice. History offers a cautionary tale (Austin Frakt, 9/15). 

Los Angeles Times: A Cure For Diabetes? Don't Look To Chiropractors, State Says
There are thousands of competent chiropractors in California helping people deal with back or neck pain. And then there are some who run newspaper ads with bold claims about breakthrough treatments for diabetes and other chronic illnesses. Robert Puleo, executive officer of the California Board of Chiropractic Examiners, the state's regulatory agency, can only shake his head when he sees these ads, which often include invitations to free dinners that are actually sales pitches. "It reeks of snake oil," he said. "There are some chiropractors out there who want to make a buck any way they can" (David Lazarus, 9/15). 

The Wall Street Journal: Hospital Mergers Can Lower Costs And Improve Medical Care
Decades ago, hospital mergers set off alarm bells. Some worried that they would decrease competition and raise costs. Yet thanks to cataclysmic changes in the delivery of health care, hospital mergers now offer the potential for higher quality and more efficiency (Kenneth L. Davis, 9/15). 

The Wall Street Journal's Washington Wire: Brookings Vs. Dartmouth On Health Costs
The Brookings Institution released a study last week that could turn the debate over health spending on its head. While many health analysts -- including several key advisers to the administration during the debate over Obamacare -- believe that variations in physician practice patterns could represent the key to unlocking a more efficient health system, the Brookings paper questions the degree to which such variations even exist (Chris Jacobs, 9/15). 

The Wall Street Journal: California's Obamacare Fight
One of the most expensive and contentious initiative campaigns in California this year pits progressive Democrats against the state's Obamacare exchange. The progressives want to give the state insurance commissioner veto power over health-insurance rates while the exchange backers want to prevent Obamacare from imploding (Allysia Finley, 9/15). 

Forbes: Special Session Sneak Peek: Will Virginia Lawmakers Listen To Voters On Medicaid Expansion?
This week, Virginia lawmakers will convene in a special session to consider adopting Obamacare’s Medicaid expansion. But Democrat Governor Terry McAuliffe will be rebuffed once again due to waning public and legislative support for the program. ... Perhaps finally recognizing that he does not have the authority to expand unilaterally, McAullife announced his "plan" for the special session last week. It essentially amounts to a concession on Obamacare expansion, focusing instead on expanded outreach efforts to enroll individuals who are already eligible for Medicaid and additional coverage for those with "severe mental illness" (Nic Horton and Josh Archambault, 9/16).

The Jersey Journal/New Jersey.com: A Medicaid Message For Gov Christie
In July 2012, United States District Court Judge Joel A. Pisano ruled the State of New Jersey was violating its own Medicaid regulations, the federal Medicaid statute, and the Fifth and 14th amendments to the U. S. Constitution by withholding money due [federal qualified health centers] for care of Medicaid patients. Saying FQHCs would suffer irreparable harm if the money grab continued, he ordered Medicaid to immediately make interim emergency payments to the health centers in amounts equal to what they would have received if Medicaid hadn’t been breaking all those rules. Although FQHCs received the back-due money, almost immediately Medicaid officials returned to their old ways, withholding funds (Joan Quigley, 9/16).

The Hill: Mississippians Deserve Medicaid
Thousands of Mississippi families are one major illness away from bankruptcy. Recent studies have shown that medical debt is the No. 1 cause of bankruptcy in America; yet, as governors across the country in states like Arkansas, Pennsylvania and Tennessee are working to find ways to broaden their states’ Medicaid eligibility, Mississippi Gov. Phil Bryant (R) continues to fight the Affordable Care Act (ACA). The result is failure to provide the much-needed safety net for middle-class Mississippians (Rep. Bennie Thompson, D-Miss., 9/15).

Savannah Morning News: Obamacare Adds Nearly $50M To State Budget
Two, little-reported provisions of the Affordable Care act -- Obamacare -- are expected to add nearly $50 million to the tab for Georgia taxpayers by increasing access to Medicaid and limiting one tool the state has used to catch people who aren’t eligible. ... But the biggest jolt to the budget from Obamacare comes from the federal government prohibiting state officials from checking the eligibility every six months. ... "In that six-month interval if you find someone who's no longer eligible, you take them off the rolls," said Clyde Reese, Georgia’s commissioner of community health. "Now, waiting the extra six months to 12 months, you may be paying for somebody in that (added period) who was not eligible." Checking income yearly instead of semiannually added $42 million to the state budget. Advocates for the poor say the longer period reduces hassles for people on Medicaid and lowers the risk that they are accidentally dropped from coverage because of missing paperwork (Walter C. Jones, 9/16).

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