Daily Health Policy Report

Wednesday, September 17, 2014

Last updated: 9:33 AM

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Health Information Technology

Health Care Marketplace

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Rise Of Catholic Insurance Plans Raises Questions About Contraceptive Coverage

Kaiser Health News staff writer Julie Rovner reports: “Catholic and other religious hospitals and universities have been arguing in federal court for much of the past two years that they shouldn’t have to offer or facilitate birth control as part of their employee health plans because it violates their religious beliefs. But what happens when the insurance company is itself Catholic? It turns out that Catholic health plans have for years been arranging for outside firms to provide contraceptive coverage to their enrollees” (Rovner, 9/17). Read the story, which also ran in Crux.

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In Onscreen Dramas, Health Experts Inject A Dose Of Reality

Kaiser Health News staff writer Anna Gorman reports: “In a bright office building in Beverly Hills, Kate Langrall Folb and her team at Hollywood, Health & Society are on call to field queries from the mundane to the obscure. ‘Operators are standing by,’ Folb, the group’s director, often tells TV and movie writers. The organization was established with money from the federal Centers for Disease Control and Prevention in 2001 to provide the entertainment industry with free, accurate health information. Since then, the group has worked with hundreds of television writers as they tell stories about performing complicated surgeries, coping with depression and fighting insurance companies for coverage” (Gorman, 9/17). Read the story, which also ran in USA Today

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Capsules: Frustrated AMA Calls For 'Action Plan' On Digital Records; No Time To See The Doctor? Try A Virtual Visit; One-Quarter Of ACOs Save Enough Money To Earn Bonuses

Now on Kaiser Health News’ blog, Roni Caryn Rabin writes about an action plan on digital records: “Saying that electronic health records distract doctors, take time away from care and make physicians less productive, an influential doctors’ group called on vendors and government agencies to work with them to develop better, easier-to-use technology. The American Medical Association asked the Obama administration to abandon its “all or nothing approach” requiring Medicare providers to go digital or be penalized. The group also wants the government to develop better certification criteria for vendors selling electronic record systems” (Rabin, 9/16). 

Jordan Rau reports the latest on ACOs: “About a quarter of the 243 groups of hospitals and doctors that banded together as accountable care organizations under the Affordable Care Act saved Medicare enough money to earn bonuses, the Centers for Medicare & Medicaid Services announced Tuesday. Those 64 ACOs earned a combined $445 million in bonuses, the agency said. Medicare saved $372 million after accounting for the ACOs that did not show success, including four that overspent significantly and now owe the government money” (Rau, 9/16). 

Also on Capsules, Anna Gorman reports on virtual doctors’ visits: “Patients looking for convenient medical appointments can now see UCLA Health System doctors using their cell phones, computers or tablets. It’s part of an ongoing effort at UCLA and elsewhere to extend alternatives to the in-person doctor visit to busy consumers outside rural areas” (Gorman, 9/16). Check out what else is on the blog

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Political Cartoon: 'A-Wristed Development?'

Kaiser Health News provides a fresh take on health policy developments with "A-Wristed Development?" by Daryl Cagle.

And here's today's health policy haiku:

THE CHALLENGE OF TELLING COMPLEX HEALTH STORIES

Getting the scripts right...
At least Hollywood has help.
Health experts on call.
-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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Health Reform

GAO Warns of Security Risks In Healthcare.gov

Despite improvements, the federal health insurance website has continuing security holes that put consumers' personal information at risk, the nonpartisan watchdog agency said in a report Tuesday.

The Wall Street Journal: Federal Health Care Website Faces Security Risks, Watchdog Finds
HealthCare.gov has continuing security frailties that put users' sensitive personal information at risk, a government watchdog is set to tell Congress this week. Despite the federal government's efforts to protect the website from breaches, "weaknesses remained in the security and privacy protections applied to HealthCare.gov and its supporting systems," said the Government Accountability Office. The agency released a report Tuesday on the security of the site, through which millions of Americans bought coverage under the health law last year and which millions more will be urged to use (Radnofsky and Armour, 9/16).

The Associated Press: Probe: HealthCare.gov Website Must Boost Security
HealthCare.gov, the health insurance website serving more than 5 million Americans, has significant security flaws that put users’ personal information at risk, nonpartisan congressional investigators have concluded. The Government Accountability Office said the Obama administration must resolve more than 20 specific security issues related to who can get into the system, who can make changes in it and what to do in case the complex network fails (9/16).

Reuters: GAO Report Warns Of Security Risks In U.S. Health Care Website
HealthCare.gov, President Barack Obama's health insurance exchange, has security and privacy protection vulnerabilities, a U.S. government watchdog reported on Tuesday, nearly a year after the website's troubled rollout. The General Accounting Office (GAO) said that despite steps taken by the Centers for Medicare & Medicaid Services (CMS) for security and privacy protection, weaknesses remain in the processes used for managing information security and privacy. The GAO also identified issues regarding the technical implementation of IT security controls (9/16).

Politico Pro: GAO Lashes Security Of HealthCare.Gov
HealthCare.gov has weaknesses that have put sensitive personal information at risk, according to a Government Accountability Office report expected to be released Wednesday. With the second year of enrollment just two months away, the website and its information still “remain at increased risk of unauthorized use,” according to the report obtained by POLITICO. The 78-page critique is the latest sign that CMS and its website were under-prepared for the rollout of HealthCare.gov last fall, during which 8 million people chose insurance policies (Haberkorn, 9/16).

Fox News: Watchdog Report: HealthCare.Gov Still Has Security Issues
Despite efforts to protect patient information on the HealthCare.gov website, a new government watchdog report scheduled to be released Thursday says security issues are still a concern. According to the Government Accountability Office report, “weaknesses remained in the security and privacy protections applied to HealthCare.gov and its supporting systems.” The agency will present its findings to the House Oversight and Government Reform Committee on Thursday (9/16).

Fiscal Times: Obamacare Websites Still A Mess, And Costing Millions
It’s been nearly one year since Obamacare’s nightmarish debut. The federal website was plagued with technical glitches that crippled HealthCare.gov and a number of state exchange websites suffered an even worse fate. Just as health officials are preparing for Obamacare round two, auditors are warning that both the federal and some state websites are still not ready for prime time. The Government Accountability Office released a new report Tuesday night concluding that while the federal exchange website has improved, it’s not fully secure—with two months to go before its second launch. In the report, auditors detailed an array of issues that left unaddressed pose security risks to user information and the entire website itself (Ehley, 9/17).

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Exchange News: Md. To Stagger Rollout; Vt. Temporarily Shuts Website

Maryland officials are planning a gradual rollout of the state's health insurance website to avoid problems, and Vermont officials cite security concerns as part of the reason for taking down Health Connect. Developments in Minnesota, Connecticut and Oregon are also covered.

The Washington Post: Md. To Stagger Access To Health Exchange Web Site To Address Any Technical Flaws
Maryland officials want to limit access to the state’s new health insurance Web site when it launches in November so that any glitches can be worked out and the system won’t be overwhelmed with requests. The state’s staggered approach is different from what will happen elsewhere in the country on Nov. 15, the beginning of the second enrollment period for health insurance made possible by the federal Affordable Care Act. Advocates raised concerns Tuesday that the unusual schedule planned for Maryland could further muddle an already confusing process (Johnson, 9/16).

The Baltimore Sun: Maryland Health Exchange To Have Staggered Rollout
The gradual rollout will start with a preview Nov. 9, a week before open enrollment officially begins, when people will be able to browse health plans — something users couldn't do last year without creating an account. A week later, on Nov. 15, the first sign-up event will be held at which people can enroll at a designated location that has not yet been identified. The next day the call center will begin operations so people can enroll via phone (Dresser, McDaniels and Cohn, 9/16).

Burlington Free Press: VT Health Connect Website Shut Down For Repairs
Anyone clicking on the Vermont Health Connect website sees a message in bold black letters on a pale green screen that advises the site is down for maintenance. This will be more than a short-term shut down, Gov. Peter Shumlin and his top health officials explained Tuesday. It could be weeks before health insurance customers would be able to resume buying plans, check accounts or pay electronically on Vermont Health Connect. In the interim, all Health Connect related transactions will be handled by call center personnel (Remsen, 9/16).

Vermont Public Radio: Vermont's Health Exchange Site Is Offline For Repairs
At a news conference announcing the decision, officials repeatedly cited security concerns as part of the rationale for taking Vermont Health Connect offline, but they insisted that the move was preemptive and not a response to a security breach. Shumlin said the move should not affect the coverage Vermonters have through the exchange – only how they interact with Vermont Health Connect (Dobbs, 9/16).

Minnesota Public Radio: PreferredOne pulls out of MNsure
The insurer with the lowest rates and most customers on Minnesota's health care exchange is pulling out. Golden Valley-based PreferredOne this morning confirmed its exit from MNsure. It comes as a major blow to the exchange — the next open enrollment period starts Nov. 15 and runs through Feb. 15. MNsure officials said the online insurance exchange would reach out soon to PreferredOne customers who bought coverage through MNsure last year with information on next steps (Sepic and Crann, 9/16).

Minneapolis Star-Tribune: Johnson Blasts Dayton As 'Incompetent' As Top-Selling Insurer Exits MNsure
Republican candidate for governor Jeff Johnson blasted Gov. Mark Dayton on Tuesday for what he called "breathtaking incompetence," after it was revealed that the insurance company that sold more policies on MNsure than any other is pulling out of the exchange. MNsure officials confirmed Tuesday that PreferredOne, the choice of nearly six in 10 consumers who have bought plans on the exchange, would no longer participate. Insurers are expected to release their 2015 MNsure rates in early October (Condon, 9/16).

CT Mirror: Access Health Plans Much Smaller Enrollment Assistance Effort This Time
To reach Connecticut’s remaining uninsured and help existing customers maintain their coverage when the second Obamacare enrollment period begins in two months, Connecticut’s health insurance exchange is planning an in-person outreach effort that’s a fraction of last year’s nearly $3 million sign-up blitz. Critics say it's inadequate for ensuring that Connecticut continues to reduce the number of uninsured residents, while a top exchange official says it's appropriately targeted (Levin Becker, 9/17).

Oregonian: Oracle America Accuses Oregon Of Violating Federal Copyright Law In Health Exchange Fight
In the legal fracas over the Cover Oregon health exchange, software giant Oracle America is seeking help from an unlikely source to bolster its case against the state: The U.S. Copyright Office. On Sept. 8, the firm applied for federal copyright protection for the latest version of software products it sold to Oregon as part of the insurance exchange system. Within hours, the giant technology firm filed an amended complaint in federal court accusing Oregon of copyright infringement (Budnick, 9/16).

Modern Healthcare: ACA Co-Op Plans Retool For 2015 Open Enrollment
Many consumer-governed insurance plans that struggled to attract customers during the first year of open enrollment are aggressively pricing and retooling products to be more competitive when the exchanges re-open for business on Nov. 15 (Demko, 9/16).

In other health law enrollment news -

NBC News: Report: Asian-American ACA Enrollment ‘Disproportionately High’
According to a new report by the Center for American Progress and AAPIData, Asian Americans were the most likely of all Americans to sign up for the Affordable Care Act (ACA). About 5.5 percent of the people who signed up for the first round of the Affordable Care Act were Asian American, more than the 5.1 percent of the population which was uninsured in 2012. In California, 21 percent of enrollees were Asian Americans, nearly double the 10.8 percent who were uninsured. In Washington, 10.3 percent of enrollees were Asian Americans, also higher than 7.4 percent who were uninsured (Kai-Hwa Wang, 9/16).

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Medicaid Expansion, Uninsured Coverage Issues Continue To Simmer In Virginia

Meanwhile, Michigan's expansion of the health insurance program for low-income people is a topic in the gubernatorial campaign, and in Ohio, Medicaid picks up some inmate health care costs.  

Richmond Times-Dispatch: Poll: Most Back Va. Medicaid Expansion, But Concern Continues Over Costs
More than six out of 10 Virginia voters support an expansion of Medicaid benefits to cover the estimated 400,000 state residents in the coverage gap, according to a new survey released on the eve of a special session of the Virginia General Assembly to discuss the issue. But nearly half of Virginians surveyed have doubts that the federal government would fully fund its share of the program, according to the poll, conducted by the Wason Center for Public Policy at Christopher Newport University (Nolan, 9/17).

The Associated Press: Va. Hospitals Lament Limited Health Care Expansion
With an expansion of Medicaid in Virginia all but pronounced dead, the state’s hospitals and health care systems are bracing for tough decisions on how to balance their budgets. State lawmakers are holding a special legislative session on the topic starting Thursday, but there's been no sign that Republican opposition to Medicaid expansion has wavered (9/16).

Richmond Times-Dispatch: Governor Endorses A House Republican's Proposal On Health Care
Gov. Terry McAuliffe on Tuesday endorsed a proposal by Del. Thomas D. Rust, R-Fairfax, to use federal funds to expand health care coverage for uninsured Virginians through a new system that would rely on private insurance purchased through employer group plans, Medicaid managed-care policies, or the federal insurance marketplace. McAuliffe issued a statement that called the Virginia Health Care Independence Act "a conservative compromise proposal" that the General Assembly should approve when it meets Thursday for a special session to debate whether and how to provide health coverage to hundreds of thousands of uninsured state residents under the Affordable Care Act (Martz, 9/17).

The Associated Press: Mich. Republican Governor Touts Medicaid Expansion In Re-Election Bid
Republican Gov. Rick Snyder on Tuesday touted Michigan's successful Medicaid expansion as part of his re-election bid, saying 63,000 more low-income adults have signed up than projected this year, with 3 ½ months left. The Republican governor said about 385,000 enrolled between April, when the Healthy Michigan program launched, and Monday. His administration had expected 322,000 signups by year's end. His embrace of a key component of the federal health care law roiled conservative activists. But Snyder's campaign is hoping expanded Medicaid's appeal among the broader electorate helps him in November (Eggert, 9/16).

Columbus Dispatch: Ohio Inmate Health Care Cut $10.3 Million, Mostly Due To Medicaid Expansion
Ohio paid $10.3 million less for health care for prisoners in the 2014 fiscal year, mostly due to Medicaid expansion. The Ohio Legislative Services Commission reported that most of the savings resulted from the change on July 1, 2013, when Medicaid began picking up most of the inmate medical costs. That happened as a result of Gov. John Kasich's decision to expand Medicaid under Obamacare, a decision opposed by state lawmakers. ... The total state bill for prisoners was $184.7 million (Johnson, 9/16).

Also, exploring a policy issue related to Medicaid expansion -

Modern Healthcare: Reform Update: Premiums May Prevent Low-Income Residents From Enrolling In Medicaid, Experts Say
Hungry to get holdout states to expand Medicaid, the Obama administration has been increasingly willing to allow them to impose premiums and cost-sharing on low-income residents. But policy experts generally agree that the fees will mean many newly eligible people won't enroll, and some say the administrative costs will exceed the revenue the fees generate (Dickson, 9/16).

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Parties' Disputes On Health Law Fading To 'Background Noise' In Campaign

Republicans are moving beyond their criticisms of the law in the midterm fights. Also, news outlets examine what a Republican-controlled Senate might focus on and how expanded health coverage is not working to the Democrats' advantage in Kentucky.

The Wall Street Journal: Health Law's Election Impact Is Dimming
Though Republicans continue to hammer away at the Affordable Care Act, the health-insurance law is losing some of its punch in the 2014 campaign. Polls show that voters don't see the law as a top concern, and both Democrats and Republicans say the election will turn on a range of issues. That outlook is causing both parties to adjust. While some Republicans had billed the election as a referendum on the health law, the GOP is now delivering a broader indictment of what the party describes as the Obama administration's failures. Some Democrats are cautiously stepping out to defend the law, highlighting its most popular provisions while suggesting fixes (Reinhard and Meckler, 9/16).

Politico: Obamacare: From Game-Changer To Background Noise
A year ago, it looked like Obamacare was going to have a huge role in this year's elections. And not in a good way — as a symbol of government incompetence and the Republicans' main case against President Barack Obama's record. Now, it's clear that the health care law not going to be the centerpiece of the November campaigns, in a good way or a bad way. It’s going to be more like the wallpaper (Nather, 9/17).

CBS News: Republicans Want Senate Control, But Won't Disclose Agenda
Senate Minority Leader Mitch McConnell, R-Kentucky, is being cagey about the Republicans' plans if they win the majority in November.  … McConnell then said there are "a number of things that we would like to do differently," and listed approval of the Keystone XL pipeline and a repeal of the medical device tax as two issues he would like to vote on. Last week, Sen. Rob Portman, R-Ohio, who serves as the vice chairman of the National Republican Senatorial Committee, said he suspects that repealing the Affordable Care Act will be a top priority (Kaplan, 9/16).

The New York Times: In Kentucky, Health Law Helps Voters But Saps Votes
Kentucky is arguably one of the health law’s biggest early successes, with about 10 percent of the population getting coverage through the state’s online insurance marketplace — albeit mostly through Medicaid, not private plans — and none of the technology failures that plagued other enrollment websites. The uninsured rate here has fallen to 11.9 percent from 20.4 percent, according to a recent Gallup poll that found only Arkansas had experienced a steeper decline. But there is little evidence that the expansion of health coverage will help Kentucky Democrats in this fall’s midterm elections (Goodnough, 9/16).

The Washington Post: In Iowa, Attacks On Republican Ernst Change Dynamics Of Tight Senate Race
President Obama's low approval ratings are creating a drag in almost all the truly competitive races. Democrats are relying on the performance of their candidates and the advantages they have on pocketbook and women's-health issues to withstand strong challenges from Republicans. The debate over these issues is especially pronounced in swing states that Obama has carried, such as Iowa (Rucker and Balz, 9/16).

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Coordination Pays Off For About A Quarter Of ACOs

The Centers for Medicare & Medicaid Services reported that 64 of 243 accountable care organizations -- a new health care delivery model created by the health law -- earned bonuses by saving the Medicare program money. Four ACOs overspent and now owe the government money.

Kaiser Health News: Capsules: One-Quarter Of ACOs Save Enough Money To Earn Bonuses
About a quarter of the 243 groups of hospitals and doctors that banded together as accountable care organizations under the Affordable Care Act saved Medicare enough money to earn bonuses, the Centers for Medicare & Medicaid Services announced Tuesday. Those 64 ACOs earned a combined $445 million in bonuses, the agency said. Medicare saved $372 million after accounting for the ACOs that did not show success, including four that overspent significantly and now owe the government money (Rau, 9/16).

The Hill: Small Savings Reported From New Health Care Models
New healthcare delivery models established under ObamaCare produced $372 million in savings for the Medicare program, federal health officials said Tuesday. The healthcare law's accountable care organizations (ACOs) seek to save money and enhance patient care through better coordination among healthcare providers.  The Department of Health and Human Services (HHS) said that ACOs in two separate initiatives improved this year on benchmarks for quality and patient satisfaction while saving Medicare money (Viebeck, 9/16).

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Capitol Hill Watch

Senate Hearing Previews Upcoming Debate About Future Of CHIP

And, on the House side, Ways & Means Health Subcommittee Chairman Kevin Brady, R-Texas, expresses displeasure with a Centers for Medicare & Medicaid Services plan to clear a hospital appeals backlog.

The New York Times: Fate Of Children’s Insurance Program Is Called Into Question At Senate Hearing
A Senate hearing on Tuesday set the stage for a coming debate over whether the federal government should continue financing a popular health insurance program for lower-income children who are now eligible for new coverage options under the Affordable Care Act (Goodnough, 9/16).

CQ Healthbeat: Brady Decries CMS Settlement Proposal To Cut Appeals Backlog
The chairman of the House Ways and Means Health Subcommittee Tuesday called on the Obama administration to retract a plan to clear a backlog of hospital appeals of denied Medicare payment claims, saying it is “just throwing money at a problem to make it go away.” The circumstances that apply in one case do not necessarily apply to another, said Rep. Kevin Brady, R-Texas, in a letter to HHS Secretary Sylvia Burwell. HHS is facing an enormous backlog of appeals that hospitals say is unfairly tying up their payments for years and making it difficult to overturn unjustified decisions by anti-fraud contractors. HHS recently proposed to end the backlog by proposing to pay the claims at a rate of 68 cents on the dollar. Brady asked Burwell how HHS arrived at that figure.  The Centers for Medicare and Medicaid Services “has not provided an empirical analysis to justify offering a settlment rate of 68 percent,” he said (Reichard, 9/16).

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Hillary Clinton Urges Congress To Reauthorize 9/11 Compensation Fund

The former secretary of state and member of the Senate pressed union members at a fundraiser to mobilize and push for an extension of the legislation that supports compensation for first responders who got sick at ground zero.

The Associated Press: Clinton Urges Renewal Of 9/11 Compensation Act
Former Secretary of State Hillary Rodham Clinton urged Congress on Tuesday to reauthorize federal legislation that compensates first responders who got sick working at ground zero in the aftermath of the Sept. 11 attacks, saying thousands still need help. During a fundraising event in lower Manhattan, the former U.S. senator from New York and potential Democratic presidential candidate called on union members to mobilize to fight for the extension of the James Zadroga Act (9/16).

The Wall Street Journal’s Metropolis: Hillary Clinton Discusses 9/11 Health Act At Labor Gathering
The fundraiser was to raise awareness for the impending cessation of the 9/11 Health and Compensation Act — known as the James Zadroga Act — which provides for the monitoring, medical treatment and compensation for people who sustained health problems as a result of toxic exposure after the twin towers collapsed. Mrs. Clinton said it was organized labor that came to the forefront in the aftermath of the tragedy to “begin working with me and others” on what ultimately resulted in the bill, which became law in 2010 (Bashan, 9/16). 

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Health Information Technology

UCLA Health System Promotes Virtual Doctor Visits

The health system will allow patients to see doctors using their cell phones, computers or tablets. Meanwhile, the American Medical Association calls for boosting the quality of electronic health records and asks the Obama administration to abandon its "all or nothing approach" to the shift to digital records.

Kaiser Health News: Capsules: No Time To See The Doctor? Try A Virtual Visit
Patients looking for convenient medical appointments can now see UCLA Health System doctors using their cell phones, computers or tablets. It’s part of an ongoing effort at UCLA and elsewhere to extend alternatives to the in-person doctor visit to busy consumers outside rural areas (Gorman, 9/16).

Kaiser Health News: Capsules: Frustrated AMA Calls For 'Action Plan' On Digital Records
Saying that electronic health records distract doctors, take time away from care and make physicians less productive, an influential doctors’ group called on vendors and government agencies to work with them to develop better, easier-to-use technology. The American Medical Association asked the Obama administration to abandon its “all or nothing approach” requiring Medicare providers to go digital or be penalized. The group also wants the government to develop better certification criteria for vendors selling electronic record systems (Rabin, 9/16). 

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Health Care Marketplace

Scientists Suggest Ways To Fund Medical Research

With the continuing downward trend of federal funding for biomedical research, top scientists offer their own ideas.

NPR: Top Scientists Suggest A Few Fixes For Medical Funding Crisis
Many U.S. scientists had hoped to ride out the steady decline in federal funding for biomedical research, but it's continuing on a downward trend with no end in sight. So leaders of the science establishment are now trying to figure out how to fix this broken system (Harris, 9/17).

Regarding a different point on the biomedical research funding spectrum, more pressure for the Open Payments database -  

The Wall Street Journal’s Pharmalot: CMS Asked To Eliminate Some Payments From Sunshine Database
With only two weeks until the launch of the highly anticipated Open Payments database – which will show how much money doctors receive from drug and device makers – 64 health advocacy groups are asking to eliminate an entire category of data (McCabe, 9/16).

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State Watch

Calif. Hospitals, Insurer Join Forces To Make New Health System

Some say the move, which will include UCLA Health and Cedars-Sinai, is aimed at Kaiser Permanente and is being made to hold down health costs.

The New York Times: Hospitals And Insurer Join Forces In California
In a partnership that appears to be the first of its kind, Anthem Blue Cross, a large California health insurance company, is teaming up with seven fiercely competitive hospital groups to create a new health system in the Los Angeles area. The partnership includes such well-known medical centers as UCLA Health and Cedars-Sinai (Abelson, 9/17).

Los Angeles Times: New Anthem Blue Cross Plan Takes On Kaiser
Taking aim at HMO giant Kaiser Permanente, insurer Anthem Blue Cross is joining forces with several big-name hospitals and their doctors to create an unusual health plan option for employers in Southern California. The joint venture being announced Wednesday brings together seven rival hospital groups in Los Angeles and Orange counties, including well-known institutions Cedars-Sinai Medical Center and the UCLA Health System. The deal reflects the pressure insurers and hospitals alike are facing to hold down health care costs for employers and their workers (Terhune, 9/16).

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Wis. Says It Needs $760M For Medicaid Over Next Two Years

The state was already projected to have a budget gap of $1.8 billion. Elsewhere, North Carolina plans a Medicaid reorganization.

The Associated Press: Wisconsin Needs $760M More For Medicaid
The state Department of Health Services says it needs $760 million more over the next two-year state budget to pay for current services in the Medicaid program. The new estimate was included in the agency's budget request submitted to Gov. Scott Walker's administration made public Tuesday. That budget begins in mid-2015. The governor will submit a budget proposal to the Legislature early next year. The state is already projected to have a nearly $1.8 billion shortfall heading into the next budget, without taking into account new expenses like the additional request for Medicaid (9/16).

Milwaukee Journal-Sentinel: State Needs $760 Million More For Health Care Over Next Two Years
State taxpayers will need to round up $760 million more to pay for health care for the needy over the next two years, according to a projection by Gov. Scott Walker's administration. The report by the state Department of Health Services calculates the effects of inflation in programs such as medical care for families and nursing home and in-home care for the elderly. Part of the added cost to state taxpayers for these Medicaid programs also comes from automatic decreases in federal aid that are being triggered because of Wisconsin's improving economy (Stein and Marley, 9/16).

Raleigh News & Observer: State Medicaid Office Rolls Out Reorganization Plan
Employees in the state Medicaid office got a look at a new reorganization plan Tuesday that includes more sections and more specialized units. Rather than two sections -- finance and operations, reporting to the Medicaid director -- there will be five, with compliance and oversight, clinical, business information added. Additionally, the plan calls for a new three-person strategy team reporting to the Medicaid director (Bonner, 9/16).

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State Highlights: Report: Hospitals Ill-Prepared For Sandy; Iowa Supreme Court Lets Teleabortion Go On While It Decides

A selection of health policy stories from New Jersey, Iowa, Kansas, Michigan, Illinois, California and Wisconsin.

The Associated Press: Hospitals Struggled During Sandy, Report Says
When Superstorm Sandy slammed into the Northeast nearly two years ago, hospitals found themselves dealing with surges in patients, lost power supplies and employees who couldn’t get to work -- problems that a new federal report finds they were not prepared to handle (Mulvihill, 9/17).

Des Moines Register: Iowa Supreme Court Allows Telemed-Abortion System To Continue
The Iowa Supreme Court decided Tuesday to let Planned Parenthood of the Heartland continue using its controversial video-conferencing method for dispensing abortion pills -- for the time being. The justices granted a last-minute stay of the Iowa Board of Medicine's 2013 decision to effectively ban use of the system. ... Planned Parenthood is appealing a Polk County district judge's ruling that would effectively shut down the system, which is the first of its kind in the nation (Leys, 9/16).

Kansas Health Institute News Service: Kansas Insurance Commissioner Favors Democrat To Succeed Her
The trend of Kansas Republicans crossing party lines to support Democrats running against GOP conservatives now has reached the insurance commissioner’s race. Republican incumbent Sandy Praeger, who’s not running for re-election after three terms, endorsed Democrat Dennis Anderson on Tuesday at a campaign event staged at Brewster Place, a Topeka retirement community. Praeger, a moderate Republican who bucked the party line in supporting the federal health reform law, is among more than 100 current and former GOP office holders who have endorsed Paul Davis, the Democrat challenging Republican Gov. Sam Brownback (McLean, 9/16).

The Associated Press: Doctor Pleads Guilty To Cancer Treatment Fraud
A Detroit-area cancer doctor accused of putting people through unnecessary treatments and then billing insurers for millions of dollars pleaded guilty to fraud Tuesday, admitting that he knew his patients often didn’t need chemotherapy (White, 9/16).

Chicago Sun-Times: Emanuel Defends 40-percent Hike In City Retiree Health Premiums
Mayor Rahm Emanuel on Tuesday defended his decision to save $27 million in 2015 by raising monthly health-insurance premiums by an average of 40 percent for 25,000 city retirees -- even after a precedent-setting Illinois Supreme Court ruling that could tip the scales against the city. But what about the Illinois Supreme Court ruling in July that could signal defeat in a similar case filed by city retirees? The state’s highest court ruled then that subsidized health care premiums for state employees are protected under the Illinois Constitution and that the General Assembly was "precluded from diminishing or impairing” that benefit (Spielman, 9/16).

Sacramento Bee: Most Californians Lack Knowledge About Plans’ Mental Health Benefits
Less than 40 percent of Californians realize that health insurance plans generally cover mental health treatment as well as other types of medical care, according to a new Field Poll that found a lack of knowledge about mental health assistance and varying levels of willingness to seek it. Conducted on behalf of the nonprofit California HealthCare Foundation, the poll found that more than eight in 10 Californians believe that treatment can help people with mental illnesses lead productive and healthy lives. But only 38 percent of people realize that the federal Affordable Care Act generally requires most health insurance to include mental health, alcohol and drug treatment benefits. And almost one in five Californians say they wouldn’t use such services even if they were covered by insurance (Miller, 9/17).

Milwaukee Journal-Sentinel: Report Warns Against Cutting More Acute Care Beds At Mental Health Complex
Milwaukee County should not eliminate any more beds for its acutely ill at the Mental Health Complex until more community support is established, according to a report released Tuesday. The current capacity of 60 is necessary to meet the demands of severely ill patients — many of them poor and without private health insurance, said authors of the report commissioned by the county's Behavioral Health Division. The system is at "a tipping point," the authors wrote. The study, conducted by Boston-based consultants in tandem with the Public Policy Forum, comes as Milwaukee County is considering what to do with its public psychiatric complex on W. Watertown Plank Road in Wauwatosa (Kissinger, 9/16).

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Editorials and Opinions

Viewpoints: Election Victory Could Bring Difficult Decisions For GOP; Burwell 'Presses Reset'

Los Angeles Times: What Happens If Republicans Win The Senate?
But if the GOP controls both the Senate and the House, its members will be under pressure to govern. At least in the Senate, where 60 votes are needed to move major legislation, they'll even have an incentive to compromise .… But that won't be easy. For one thing, the Senate GOP is deeply divided. On one side are pragmatic conservatives such as [Tennessee Sen. Lamar] Alexander and Ohio's Rob Portman, who want to pass a budget, rein in federal regulations and maybe even tackle tax reform -- and are willing to work with Democrats to do it. … Opposing them from within the party, however, is the take-no-prisoners caucus of Sen. Ted Cruz (R-Texas), conservatives who want to send uncompromising bills to the White House (beginning with the repeal of Obamacare) and force President Obama to veto them (Doyle McManus, 9/16). 

The Wall Street Journal: Obamacare And American Resurgence
The non-surprise revealed here is that Obamacare turns out to be just another subsidy program, throwing money at health care. In economics, you can't subsidize everybody but we're trying: 50 million Americans get help from Medicare, 65 million from Medicaid, nine million from the Department of Veterans Affairs, seven million (and counting) from Obamacare, and a whopping 149 million from the giant tax handout for employer-provided health insurance (Holman W. Jenkins Jr., 9/16). 

The Wall Street Journal’s Washington Wire: New HHS Chief Presses Reset On Health Law, Plugs Savings And Quality
A bit more than three months into her tenure as secretary of health and human services, Sylvia Mathews Burwell is moving to polish the image and improve implementation of the Affordable Care Act, an effort likely to determine whether she is seen as a success in the post. … Ms. Burwell increasingly will be calling attention to the other two: affordability and quality. In part, she’ll be highlighting favorable metrics, such as tallying savings recorded by Accountable Care Organizations (groups of doctors, hospitals, and other health-care providers join together to coordinate care to Medicare patients). In part, she’ll be publicly trying to strengthen cooperation with private-sector groups, such as the Business Roundtable and the Bipartisan Policy Center, to "engage people to make change," as she puts it (David Wessel, 9/16).

Bloomberg: Health Care Is Still For The Rich Or Lucky
Today's Census Bureau report on health insurance in 2013 shows that on the eve of Obamacare, whether you had coverage was largely a question of how much money you made .... even with the existence of Medicaid, the Children's Health Insurance Program and other assistance, health coverage in the U.S. remains a luxury good -- one that the rich can afford but others struggle, in proportion to their income, to obtain (Christopher Flavelle, 9/16).

The Washington Post: The Ramped-Up U.S. Effort Against Ebola Is Late But Welcome
With people dying in the streets of the Liberian capital, President Obama has at last ramped up the U.S. response to the worst outbreak ever of the Ebola virus in West Africa. The fresh surge of support announced Tuesday represents a welcome change of course. No one knows if the package outlined by Mr. Obama at the Centers for Disease Control and Prevention will be sufficient, but at least the United States has started to act like the world’s indispensable nation (9/16).

Bangor Daily News: A Long-Term Payoff For A Medicaid Expansion In Maine: Significantly Better Health
Gov. Paul LePage's vetoes of the Affordable Care Act’s federal subsidies for Medicaid expansion have already cost Maine thousands of jobs and hundreds of millions of dollars. Yet partisan critics of Obamacare continue to argue that expanded Medicaid coverage will have no effect on health and may actually harm the poor (Joe Feinglass, 9/16).

Deseret News: Medicaid Will Sting Beehive State's Economy
You don't need a Ph.D. in economics to recognize that tradeoffs exist in any economic decision. ... A new report published by the Federalism in Acton Project (FIA) definitively shows that Medicaid expansion will reverse the recent post-recession growth in Utah’s private sector. This means two things for Utah families: they will bring home less income and will suffer from the loss of private sector jobs (J. Scott Moody, 9/16). 

Journal of the American Medical Association: The Historic Role Of Boards Of Health In Local Innovation
Childhood and adult obesity pose major risks for cancer, diabetes, and cardiovascular disease, with poor individuals affected disproportionately. ... With current policies failing, new ideas are needed. Cities and states—in their historic role as public health "laboratories"—have demonstrated creativity. Boards of health, with their unique mandates, represent an engine of innovation, with the New York City Board of Health (NYCBH) soda portion limit offering a salient illustration. Yet on June 26, 2014, New York State’s highest court struck down the Board's rule, holding the Board lacked authority (Lawrence O. Gostin, Belinda H. Reeve and Marice Ashe, 9/15).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
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.