Daily Health Policy Report

Monday, October 20, 2014

Last updated: 9:44 AM

KHN Original Reporting & Guest Opinion

Public Health & Education

Administration News

Capitol Hill Watch

Health Reform

Coverage & Access

Health Care Marketplace

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

What CDC Can Do To Fight Ebola

Kaiser Health News staff writer Julie Rovner reports: “The Ebola epidemic in Africa and fears of it spreading in the U.S. have turned the nation’s attention to the federal government’s front-line public health agency: The Centers for Disease Control and Prevention (CDC). But as with Ebola itself, there is much confusion about the role of the CDC and what it can and cannot do to prevent and contain the spread of disease. The agency has broad authority under federal law, but defers to or partners with state and local health agencies in most cases” (Rovner, 10/20). Read the story.

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Capsules: California Nurses’ Union Pulls Ebola Into Contract Talks

Now on Kaiser Health News' blog, KQED's April Dembosky reports: "The powerful California Nurses Association has put Ebola on the bargaining table in its negotiations for a new contract with Kaiser Permanente. Contract talks have been going on for months and the nurses’ most recent demands are all about Ebola — better training, more staffing, protective gear that goes beyond what’s recommended by federal officials and even a special life insurance policy" (Dembosky, 10/20). Check out what else is on the blog.

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Political Cartoon: 'Tricky Treat?'

Kaiser Health News provides a fresh take on health policy developments "Tricky Treat?" by Gary Varvel.

And here's today's health policy haiku:

WHEN POLITICS AND PUBLIC HEALTH INTERSECT

Perfect resume
for infectious disease fight:
D.C. insider
-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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Public Health & Education

Pentagon Plans 30-Person Team To Tackle Ebola In U.S.

The Department of Defense announced Sunday that it would create a medical team to assist U.S. doctors responding to new Ebola cases, while the government issued more stringent guidelines for protective garb for health care workers treating Ebola patients. In addition, The Wall Street Journal profiles a biologist who has been working since 1997 on an Ebola vaccine that has been proven to block the disease in monkeys.

The Washington Post: Pentagon Plans Ebola Domestic-Response Team Of Medical Experts To Aid Doctors
The Pentagon announced Sunday that it will create a 30-person team of medical experts that could quickly leap into a region if new Ebola cases emerge in the United States, providing support for civilian doctors who lack proficiency in fighting the deadly virus (Kane and Ellis Nutt, 10/19).

The Washington Post: Obama: ‘We Can’t Give In To Hysteria Or Fear’ Of Ebola
President Obama on Saturday sought to tamp down fears of an Ebola outbreak and defend his administration from Republican critics who have called for a more aggressive response to the disease, including sealing off U.S. borders to visitors from countries battling widespread outbreaks ... As Ebola fears have spread, some urgent-care clinics have taken steps to identify red flags, such as recent travel to West Africa, before patients ever set foot in the clinic. AFC/Doctors Express, a national chain of more than 130 urgent-care clinics, with facilities in Alexandria, Va., Woodbridge, Va., Edgewater, Md., and Towson, Md., fields some of its patient calls through a national call center that’s designed to screen symptoms before patients show up to see a doctor (Jaffe and Brittain, 10/18).

The Wall Street Journal: New Ebola Guidelines For Hospitals To Require Full Body Cover
New, more stringent hospital guidelines for treating Ebola patients will require full body coverings and mandate that health-care workers be monitored while putting on and taking off protective garb, a top U.S. health official said. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, which is part of the National Institutes of Health, said the new guidelines will be “much more stringent” and require that no skin be exposed (Barnes, 10/19).

The Wall Street Journal: Why The Work Of Dr. Nancy J. Sullivan Could Be Key To A Potential Ebola Vaccine
The world had little interest in Ebola in 1997, which is why cell biologist Nancy J. Sullivan thought she might be able to make a mark. Today, if the scientific world is to have an answer to the world’s severest Ebola outbreak, Dr. Sullivan’s work is likely to be at its center. A senior investigator at the National Institutes of Health’s Vaccine Research Center, Dr. Sullivan has worked for years on a vaccine that has been proven to block Ebola in research monkeys. ... The vaccine is scheduled to undergo full human testing by early 2015  (Burton, 10/19).

NPR: Dallas Hospital Deals With Aftermath Of Ebola Missteps
Authorities in Texas are working to limit travel by health workers who may have been exposed to Ebola. Meanwhile, the hospital at the center of the first cases in the U.S. is trying to move forward (Goodwyn, 10/18).

Reuters: Texas Hospital Aims To Restore Image After Ebola Infections
The Texas hospital accused of mishandling care for the first Ebola patient diagnosed in the United States is hitting back at critics with an aggressive public relations campaign aimed at rehabilitating its battered image. Texas Health Presbyterian Hospital, where a Liberian man was treated for Ebola and later died and where two nurses have been infected with the virus, has weathered intense criticism from the public, healthcare workers and politicians over what have been characterized as lax safety protocols. But on Thursday night, the hospital issued a strongly worded statement that says workers followed proper safety protocols and shifts some blame to the U.S. Centers for Disease Control and Prevention (Driver, 10/17).

Reuters: Insurers To Sell Hospitals Policies Against Ebola Business Losses
Two privately owned insurance brokers have teamed up with Lloyd's of London underwriter Ark Syndicate to sell hospitals a product that insures against any loss of profit from Ebola quarantine shutdowns. British broker Miller Insurance Services LLP said the product it created with U.S. broker William Gallagher Associates would also protect hospitals against any potential losses to revenue in the aftermath of a quarantine. The policies, which Ark began underwriting on Friday, are the first of their kind. There has been "considerable interest" in the product throughout the United States, Mark Sleet, Professional Risks broker at Miller, told Reuters. The news comes as U.S. health officials said they were monitoring 16 people in Ohio, including one in quarantine, who had close contact with Ebola-infected Texas nurse Amber Joy Vinson (Naidu, 10/17).

Kaiser Health News: What CDC Can Do To Fight Ebola
The Ebola epidemic in Africa and fears of it spreading in the U.S. have turned the nation’s attention to the federal government’s front-line public health agency: The Centers for Disease Control and Prevention (CDC). But as with Ebola itself, there is much confusion about the role of the CDC and what it can and cannot do to prevent and contain the spread of disease. The agency has broad authority under federal law, but defers to or partners with state and local health agencies in most cases (Rovner, 10/20).

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Administration News

Obama's 'Ebola Czar' Pick Has Washington Know-How, Knows Less About Medicine

The White House announced Friday that Ron Klain, a veteran Washington adviser and Democratic strategist, will coordinate multi-agency strategy.

Los Angeles Times: ‘Ebola Czar' Brings Decades Of Washington Experience
The man tapped to be the country’s “Ebola czar” is a veteran Washington advisor and Democratic strategist who will oversee a multi-agency response to the outbreak in West Africa and the U.S. cases, the White House announced Friday. In a change from a career spent mainly behind the scenes, Ron Klain becomes the Obama administration's point person leading a complicated and highly-visible government Ebola strategy (Hansen, 10/17).

The Associated Press: Ebola 'Czar' Knows Washington, But Not Medicine
[Klain] does have a wealth of experience managing unruly federal bureaucracies in times of crisis. The White House says that makes him the perfect candidate to shepherd the government's response to a deadly, growing outbreak. ... Under immense pressure to step up his response, Obama turned to Klain on Friday. He's being asked to synchronize an alphabet blizzard of federal agencies: the CDC, NIH, HHS, DHS, FDA and DOD, to name a few (Lederman, 10/16).

Kaiser Health News also tracked weekend headlines regarding the Obama administration’s appointment of an Ebola czar. 

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Capitol Hill Watch

Ebola Worries Renew Push For Surgeon General Pick

More than two dozen House Democrats have called on the Senate to confirm Dr. Vivek Murthy, the Obama administration's pick for U.S. Surgeon General, so he could help lead the nation's Ebola response. But Senate support remains shaky because of Murthy's outspoken views on gun violence, which have drawn the wrath of the National Rifle Association.  

Politico Pro: House Dems Want Approval For Surgeon General Pick
More than two dozen House Democrats are calling on the Senate to swiftly approve Vivek Murthy’s nomination to serve as surgeon general to help combat the spread of the deadly Ebola virus in the U.S. Murthy’s nomination got sidelined after Republicans and vulnerable Senate Democrats voiced reservations about the Harvard Medical School physician’s outspoken views on gun violence and public health. But the House Democrats, in a letter set to be released next week, argue that the Obama administration needs a top official in place to help with Ebola response (French, 10/17).

The Wall Street Journal’s Washington Wire: Ebola Furor Renews Sparring Over Surgeon General Nomination
The political furor over the U.S. response to the Ebola outbreak has revived debate over President Barack Obama’s stalled pick for U.S. Surgeon General. Some supporters of the administration have for the past few days been trying to shift the spotlight to opposition to Vivek Murthy, Mr. Obama’s pick for the position, which focuses on public-health issues. Dr. Murthy’s nomination met resistance in March when some Senate Democrats indicated they would not vote for him after his support for gun control drew the opposition of the National Rifle Association. Senate Democratic leaders are still not expected to bring Dr. Murthy up for a vote unless enough lawmakers change their positions to confirm him, aides said. But the public health concerns kindled by the spread of Ebola have generated new sparring over his nomination (Peterson and Radnofsky, 10/17).

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Administration's Handling Of Ebola Casts Shadow On Dems' Election Hopes

A Politico poll underscores that Ebola is causing real political danger for some Democrats. It's playing big, for instance, in North Carolina's Senate race.  

Politico: Politico Poll: Democrats In Danger Over Ebola
Voters who intend to support Republicans in the most consequential Senate and House elections this November had significantly less confidence in the federal government’s response to the occurrence of Ebola, according to a new POLITICO poll. The survey underscores the dangers for Democrats in the midterms if the Obama administration is perceived as mishandling the government’s reaction to the virus (Shepard, 10/20).

NPR: Will Ebola Impact Midterm Elections?
Weekend Edition Sunday's new segment, "For the Record," kicks off with politics and Ebola. NPR's Rachel Martin asks NPR's Mara Liasson and Dallas columnist J. Floyd about the politics of the disease (10/19).

The Washington Post: Ebola, Islamic State Shift Dynamics For Hagan, Tillis In North Carolina’s Senate Race
For much of the year, the incumbent, Sen. Kay Hagan (D), and her allies had successfully framed the campaign as a referendum on the sharp conservative turn taken by the state legislature under the leadership of [Thom] Tillis, the House speaker. But in the past few weeks, the conversation has pivoted amid alarming headlines about terrorism and a virulent epidemic, further tightening what is expected to be the most expensive Senate race in U.S. history. … For his part, he spent most of his day-long swing through the state pressing the argument that Hagan operates as an extension of Obama. He ticked off a series of issues, such as Obamacare and veterans’ care, in which he said the administration — and the senator — had failed. At every stop, he added two new items on the list: the Islamic State and Ebola (Gold, 10/19).

Meanwhile, health policy, budget issues and Medicare are also resonating in a variety of congressional contests.   

Los Angeles Times: Costly, Nasty Battle Rages In San Diego Race For Congress
In its third editorial endorsing Republican congressional candidate Carl DeMaio over Democratic incumbent Scott Peters, the U-T San Diego newspaper had one description of DeMaio that not even his many critics could dispute: "One of a kind." DeMaio's hard-charging style, combined with his anti-Washington pledge to "Fix Congress First," has turned the 52nd Congressional District race into one of the tightest and costliest in the country. ... Local television is filled with attack ads. Peters warns that DeMaio plans to cut student loans. DeMaio says he is a big supporter of student loans and Medicare and that Peters represents everything that is wrong with politics: officeholders who are too comfortable with the status quo (Perry, 10/18).

Chicago Tribune: Foster, Senger Debate Health Care, Budget
Candidates to represent the 11th Congressional District clashed Saturday ... Democratic U.S. Rep. Bill Foster and Republican state Rep. Darlene Senger, Naperville residents who are vying for a seat representing parts of the west and southwest suburbs, sparred during a debate ... When they had a chance to ask each other one question, Senger queried Foster on his vote in support of the Affordable Care Act and the unfunded liability she said it left on the state's shoulders. Foster stood by the law, saying millions more are now insured (Jenco, 10/19).

Chicago Tribune: Chicago Suburb Congressional Candidates Trade Jabs On Medicare
A debate Saturday between the rivals in the north suburban 10th Congressional District – Rep. Brad Schneider, the first-term Democrat, and GOP challenger Bob Dold – grew tense on the topic of Medicare. Dold assailed Schneider as a partisan leader who's done little good for 10th District voters. "You said you wouldn't cut a single penny from Medicare. You have gutted the program by over $700 billion," Dold said to Schneider. "After you've misled the voters this many times, how can they expect to trust anything that you say?" What followed was chippy back-and-forth over the intersection of the Affordable Care Act , Medicare and past budgets proposed by Rep. Paul Ryan, R-Wis., that Dold supported when he was in Congress. In the exchange, both politicians slung partisan Medicare talking points that have been largely debunked by fact-checking organizations in recent years (Trotter, 10/18).

In other news, real history could be made in gubernatorial elections -

The Washington Post: Gubernatorial Races Poised To Make History In Two Weeks
You wouldn't know it by following the Senate-control-centric coverage of the midterm elections emanating from Washington, but we could well be headed toward a historic gubernatorial election in 15 days. Not since 1984 have more than six sitting governors lost in any one election. But, 30 years after that gubernatorial carnage, a look at this year's races puts 11 incumbents in various levels of peril — suggesting that history may be in the making (Cillizza, Blake and Sullivan, 10/19). 

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Health Reform

Renewal Wrinkles, High Deductibles And Decisions For Employers: Implementation Issues Grab Headlines

News outlets report on a range of health law implementation issues that are causing challenges for consumers, employers and Obamacare advocates.    

The New York Times: Unable To Meet The Deductible Or The Doctor
Patricia Wanderlich got insurance through the Affordable Care Act this year, and with good reason: She suffered a brain hemorrhage in 2011, spending weeks in a hospital intensive care unit, and has a second, smaller aneurysm that needs monitoring. But her new plan has a $6,000 annual deductible, ... She is skipping this year’s brain scan and hoping for the best. ... About 7.3 million Americans are enrolled in private coverage through the Affordable Care Act marketplaces, and more than 80 percent qualified for federal subsidies to help with the cost of their monthly premiums. But many are still on the hook for deductibles that can top $5,000 for individuals and $10,000 for families (Goodnough and Pear, 10/17).

Politico Pro: Obamacare Termination Issue Could Muddle Renewals
Consumers who already have an Obamacare plan could face a messy situation early next year if they pick a different insurer for their 2015 coverage because HealthCare.gov won’t be telling companies whom to terminate. In some cases, industry sources worry, a person could be double billed for premiums because two carriers have the individual on their books on Jan. 1. Other consumers could be erroneously cut from their plans after Dec. 31 if inaccuracies in the federal exchange database lead to companies getting bad information on renewals, said one insurance official who has been briefed on the issue (Pradhan, 10/17).

Atlanta Journal-Constitution: For Some Employers, It’s Decision Time On Health Coverage
Some large employers in Georgia are facing a health care crisis of their own this fall: Should they offer their workers medical insurance next year or not? That decision, which they are making now and will take effect New Year’s Day, will cost them either way. The issue for them is how to limit the financial impact while appeasing the federal government (Markiewicz, 10/17).

Fortune: What's Behind The Dramatic Rise In Medical Identity Theft?
An elderly man went to the emergency room after injuring his back. When he got there, the doctor noticed that he also had an infection. He offered the elderly man penicillin, the same medication he received during his last visit to the ER. The elderly man was confused. This was his first visit to the ER, and he was allergic to penicillin. ... It soon became clear that someone else had used the elderly man’s health insurance card ... With the increasing digitization of health information (in the form of electronic health records) and the formation of health exchanges (due to the Affordable Care Act), the trend in medical identity theft is unlikely to abate any time soon (Shin, 10/19). 

Charlotte Observer: High-Deductible Insurance Plans Can Carry Large Out-Of-Pocket Costs
Dale Seng of Charlotte thought he understood his risk when he bought high-deductible health coverage on the Affordable Care Act exchange. It seemed like a smart choice to hold down premiums for his healthy family of four. But when his daughter was hospitalized, he was furious to learn that he was on the hook for $11,000, rather than the $5,500 individual limit he thought he’d purchased. As the 2015 health insurance enrollment season begins, Seng’s story highlights a growing challenge. To cut monthly premium costs, more people are choosing high-deductible plans, gambling that they can stay healthy. More employers are pushing that option; some are giving employees no choice. The plans are so complex that even Seng, a computer programmer who did his homework, could get sandbagged by fine print that he says wasn’t disclosed when he shopped. “That’s one of the reasons why I’m so disturbed,” he said (Helms, 10/18).

CT Mirror: Obamacare, Discontinued Plans and ‘Sticker Shock,’ Round 2
Pete Spain knew he and his wife would have to find a new health plan for 2015 since their current policy is being discontinued at the end of the year. But the letter explaining it still contained a surprise: Buying a comparable plan next year would cost the Bridgeport couple nearly 58 percent more. “That’s just a bigger hit than we expected,” he said. The Spains are among more than 60,000 Connecticut residents with health plans that don’t meet the requirements of the federal health law. Many of them are receiving notices that their plans are being discontinued and that comparable, Obamacare-compliant plans will cost significantly more (Levin Becker, 10/20).

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Utah Supporters Of Medicaid Expansion Hold Rally

About 100 people rallied in Salt Lake City to urge state lawmakers to pass Gov. Gary Herbert's Medicaid expansion plan. Meanwhile, health insurance rates in Wisconsin keep pace or decline, Maryland delays efforts to recover the cost of its failed exchange, and a co-op pulls out of Iowa's Medicaid marketplace.

The Associated Press: Supporters Of Herbert’s Health Plan Hold Vigil
About 100 people rallied in Salt Lake City to urge the Legislature to pass Gov. Gary Herbert's alternative plan to Medicaid expansion. Holding lights and candles Saturday night on the steps of the Capitol, they observed a moment of silence for those who died because they couldn't afford medical care. Utah filmmaker Paul Gibbs, who organized the vigil, said it's time for state legislators to stop playing political games with people's lives. He showed a clip from his documentary film, "Entitled to Life," which tells the stories of people suffering because they can't get access to health care, The Deseret News reported (10/19).

Milwaukee Journal-Sentinel: Obamacare Plan Rates In Wisconsin To Keep Pace Or Decline Next Year
Despite the dire predictions, the cost of health plans sold on the marketplace set up under the Affordable Care Act are increasing next year at roughly the same rate as past years in Wisconsin — and several insurers are even lowering prices. Wisconsin is not among the states that have released information on what the plans will cost. That is scheduled to happen on Nov. 5, the deadline for the federal government to approve its contracts with insurers who want to sell health plans on the federal marketplaces. But information on the average price changes for insurers was posted briefly on the state Office of the Commissioner of Insurance website recently (Boulton, 10/20).

Fox News: Maryland To Delay Legal Effort To Recoup $55 Million For State’s Failed ObamaCare Site
Maryland officials reportedly have agreed to delay court action seeking $55 million from the primary contractor for the state’s problematic ObamaCare website. Officials from Maryland’s health care exchange in April fired the contractor, Noridian Healthcare Solutions, and vowed to seek court actions to recoup the money (10/19).

Baltimore Sun: Md. Has Yet To Recover Millions Spent On Failed Exchange Site
Officials from the Maryland health exchange and their prime contractor have agreed to delay potential litigation over the troubled website that frustrated thousands in their attempts to buy health insurance promised under the Affordable Care Act. State officials cut ties with Noridian Healthcare Solutions in April and said they'd see contractors in court to recover the $55 million spent developing the faulty online marketplace. But they delayed action to focus on signing up consumers for coverage; another round of open enrollment is set to begin next month. A spokeswoman for Gov. Martin O'Malley said officials are still "evaluating claims that we may pursue in litigation" (Cohn, 10/17).

Des Moines Register: CoOportunity Pulling Out Of Iowa Medicaid Expansion Plan
The insurance carrier CoOportunity Health is pulling out of an Iowa program that provides government-financed coverage to moderate-income residents. The Iowa Department of Human Services announced today that CoOportunity has decided not to continue covering participants in the Marketplace Choice Plan next year. The program is an integral part of Iowa's version of Medicaid expansion under the federal Affordable Care Act. CoOportunity's president said the company is losing money on the 9,700 people it is covering under the Marketplace Choice Plan, and couldn't continue to participate without charging more to other members. CoOportunity Health is one of two insurance carriers that provided coverage this year under the Marketplace Choice Plan. The other carrier, Coventry Health Care, plans to continue offering such coverage, the department said in a press release (Leys, 10/17).

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How The Health Law's Second Enrollment Season Could Impact Key Senate Races

Politico reports that two closely watched Senate contests -- those of Georgia and Louisiana -- could be decided by runoff elections that would take place in December. Healthcare.gov glitches could color voters' choices. News outlets also report on how Obamacare could play a role in election outcomes in states such as Colorado and Minnesota.

Politico Pro: Dems’ Runoff Nightmare: More Obamacare Glitches
The second sign-up season for health care exchanges begins November 15 — a post-election launch that was supposed to insulate Democrats from the politics of another website meltdown. But it’s almost certain that the Senate race in Louisiana will require a runoff in December, and a January runoff is also possible in Georgia. That means residents of the two states will be checking into HealthCare.gov at the exact moment they’re considering their vote — and possibly which party will control the Senate (Cheney and Wheaton, 10/19).

Politico: Health Cancellations Ripple In Colorado
More than 22,000 Coloradans were informed in the past month that their health coverage will be canceled at the end of the year, state insurance authorities disclosed this week, a spike in cancellations already roiling the state’s fierce campaigns for the Senate and governor’s seat. Republican Rep. Cory Gardner, who’s running to unseat Democratic Sen. Mark Udall, pounced on the news as evidence that Obamacare is disrupting coverage for Coloradans ... It’s unclear, though, if Obamacare is the reason for the latest wave of canceled plans. The cancellations are nearly all the result of a decision by Humana (Cheney, 10/17).

Atlanta Journal-Constitution: Obamacare At Center Of Race For Georgia’s Insurance Chief
Some may recognize Ralph Hudgens as Georgia’s insurance commissioner, charged with the task of regulating the claims industry and protecting consumers from insurance fraud. Nationally, however, the 71-year-old is better known as the Republican who promised his department would do “everything in our power to be an obstructionist” against the Affordable Care Act. Hudgens has softened his tone from a year ago, saying he was throwing the conservative crowd “some red meat.” Nonetheless, the controversial health care law known as Obamacare remains the core issue in his re-election race against Democrat Elizabeth “Liz” Johnson and Libertarian Ted Met (Fouriezos, 10/19).

Minneapolis Star-Tribune: Personal Questions And Fresh Topics Enliven Latest Dayton, Johnson Debate
Gov. Mark Dayton and Republican challenger Jeff Johnson continued hammering at each other on a broad range of topics Sunday, staking out divergent positions on issues including MNsure rate hikes, the role of state government, and a proposed copper-nickel mine in the Iron Range. (Lopez, 10/19).

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Coverage & Access

Long-Term Care Costs Weigh Heavily On Middle-Class Families

CBS News reports that for many seniors and their families, home care needs create a serious financial bind.  

CBS News: Aging In America: Stuck In The Middle
Senior citizens whose finances fall in the middle -- not rich, not poor -- can find themselves in a real bind if they need home care. And their loved ones can find themselves caught in the middle as well. ... "This is my calm before the storm," said Kathy Warren, as she sat at her kitchen table doing a puzzle. "It kind of centers me." But Warren is still keeping watch out her window, on her 92-year-old stepfather next door. ... Most of the rest of her day, in a modest mobile home park in Hayward, Calif., will be spent on his care. ... "In the middle": Not poor enough to quality for Medicaid (which, unlike Medicare, does cover many long-term care expenses), and not rich enough to pay for long-term care. So the burden falls on his stepdaughter (Braver, 10/19).

Meanwhile, The Washington Post examines the backlogged office that decides whether people qualify for disability payments -

The Washington Post: 'It's Just Maddening. There's Nothing You Can Do.'
In an obscure corner of the federal bureaucracy, there is an office that is 990,399 cases behind. ... It is bigger even than the infamous backups at Veterans Affairs, where 526,000 people are waiting in line, and the patent office, where 606,000 applications are pending. All of these people are waiting on a single office at the Social Security Administration. Social Security is best-known for sending benefits to seniors. But it also pays out disability benefits to people who can’t work because of mental or physical ailments. And it runs an enormous decision-making bureaucracy to sort out who is truly disabled enough to get the checks — and who is trying to game the systems (Fahrenthold, 10/19).

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Health Care Marketplace

Lilly CEO Explains Drug Maker's 'Toughest Year'

In other drug industry news, the Centers for Medicare & Medicaid Services makes improvements in the new doctor payment website.

The Wall Street Journal: Lilly CEO Sees Light After A Difficult Year
Eli Lilly & Co. is deep into what Chief Executive John C. Lechleiter calls the “toughest year” in the drug maker’s 138-year history. Revenue at Lilly has plunged because of generic competition that followed patent expirations for several of its top-selling drugs, including the antidepressant Cymbalta (Loftus, 10/19).

The Wall Street Journal’s Pharmalot: Better Late Than Never: CMS Improves The Doctor Payment Website
Remember how challenging it was to navigate the new government database of payments made by drug and medical-device makers to U.S. doctors? Well, the transparency initiative just became a little easier to use – more than two weeks after the database was posted online (Loftus, 10/17).

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State Watch

State Highlights: Mental Health Issues Put 34K On N.Y. No-Guns List

A selection of health policy stories from New York, Ohio, California, Tennessee, Kansas, Kentucky, North Carolina and Maryland.

The New York Times: Mental Health Issues Put 34,500 On New York’s No-Guns List
A newly created database of New Yorkers deemed too mentally unstable to carry firearms has grown to roughly 34,500 names, a previously undisclosed figure that has raised concerns among some mental health advocates that too many people have been categorized as dangerous. The database, established in the aftermath of the mass shooting in 2012 at the Sandy Hook Elementary School in Newtown, Conn., and maintained by the state Division of Criminal Justice Services, is the result of the Safe Act. ... The law, better known for its ban on assault weapons, compels licensed mental health professionals in New York to report to the authorities any patient “likely to engage in conduct that would result in serious harm to self or others" (Hartocollis, 10/19).

Chillicothe Gazatte/USA Today: Medicare Patients Pay More At Rural Hospitals
ECGs and nine other frequently provided outpatient services cost from two to six times more for Medicare patients at the nation's rural, critical access hospitals compared to other hospitals, according to a report by the U.S. Department of Health and Human Services' Inspector General (Balmert, 10/20). 

The New York Times: Doctor’s Letter Spells End of Job For Pregnant Employee
This month marks the first anniversary of the Pregnant Workers Fairness Act, which was signed into law by former Mayor Michael R. Bloomberg on Oct. 2, 2013. The law, which went into effect in January, represents a big step forward for working women. It requires employers to make reasonable accommodations for pregnant workers -- such as providing rest and water breaks, modified work schedules and light duty -- so long as the accommodations don’t cause undue hardship for the employer. Makes sense, right? It’s actually critical, particularly for low-income women who sometimes get pushed out of their jobs -- and into poverty -- when they become pregnant (Swarns, 10/17).

San Jose Mercury News: New Anti-Prop. 45 TV Ad Misleads Viewers
Proposition 45 would allow California's elected insurance commissioner to regulate health plan rates for 6 million Californians with individual policies or who get their insurance as employees of small businesses. The No on 45 campaign recently released a 30-second television ad, now running in major media markets (Seipel, 10/19).

The Tennessean: Children Left In TennCare Lurch
When Tennessee abdicated responsibility for Medicaid applications to the federal government, foster children got locked out. Adoption agencies had no way to seek coverage after TennCare made state residents apply through healthcare.gov, a website designed for families to shop for health insurance. The website has no computer equivalent to the state social workers once tasked with making sure children didn't go without medical coverage (Wilemon, 10/20).

Kansas Health Institute News Service: Advocates Ready Another Push For Mid-level Dental Providers
Advocates of licensure for mid-level dental providers have been stymied in Kansas for five years. They say the need for dental care remains high, especially in the state's rural areas, and they're pushing for legislative movement next session. Members of the Kansas Dental Project coalition met this week in Topeka to discuss the issue and hear from Steve Coen, president and chief executive officer of the Kansas Health Foundation, and Brenda Sharpe, president and CEO of the REACH Healthcare Foundation. Both groups are part of the Kansas Dental Project (Marso, 10/17).  

Bloomberg: Purdue Says Kentucky Suit Over OxyContin Could Be Painful
Purdue, which makes the best-selling painkiller OxyContin, has never gone to trial on a case of OxyContin abuse. It has won dismissals in more than 400 personal-injury lawsuits related to the drug. And while it has settled some product-liability cases related to OxyContin under secret terms, Purdue has defeated more than 10 efforts to wage class-actions against it. In this remote county courthouse in southeast Kentucky, the company faces a potential legal reckoning that its own chief financial officer called “crippling.” Purdue has already lost initial procedural decisions that may force it to go to trial with its “arms tied behind its back,” the company said in pretrial arguments (Armstrong, 10/20).

The Associated Press: Democrat Slams Plan Giving State Medicare Control
Democrat Dennis Anderson Friday criticized an interstate health care compact that would give Kansas control of Medicare within its borders, while his Republican opponent Ken Selzer backed the idea as a way to get the program out of the federal government during a face-to-face encounter in the race for state insurance commissioner. The compact measure passed by the Kansas Legislature and signed by Gov. Sam Brownback in April would allow member states to set their own health care policies while retaining federal health care dollars and give participating states the ability to exempt themselves from other federal rules in addition to the health overhaul's regulations. It hinges, however, on congressional approval, and for that to happen, Republicans would need to gain control of the U.S. Senate in November (Hegeman, 10/17).

Charlotte Observer: Charlotte ER Case Shows Challenges Of Patient Satisfaction
Miserable and desperate, Denise Schafer sought help at the Carolinas Medical Center-Pineville emergency room one Saturday in June. Four days earlier, she had swallowed something that seemed to have sharp edges and lodged in her throat. Doctors at the Pineville hospital eventually found, and removed, the cause of Schafer’s pain. But it was only after a long, frustrating day in the ER and the serendipitous appearance of a ham sandwich. Schafer and Lenore Foote, a friend who drove her to the ER, later complained to hospital officials – and then to the Observer – about their experience. … As the American health care system undergoes massive change, hospital systems across the country have begun talking more about “patient-centered care.” In the Charlotte area, Carolinas HealthCare System and Novant Health tout their scores on patient satisfaction surveys. And they’ve created jobs with titles such as “patient experience officer”  (Garloch, 10/18).

Baltimore Sun: State Proposes Reforms To Group Home Oversight
Maryland's top health official announced Sunday that his agency is reforming the way the state regulates group homes for disabled foster children. In a report sent Sunday to Maryland lawmakers and The Baltimore Sun, the state health department identified five steps it is taking to improve coordination among the multiple agencies that supervise group homes, increase scrutiny of contractors' finances and appoint an employee to implement and oversee the enhancements. The announcement follows investigations by The Sun that detailed significant problems with the state's two largest contractors for such care, including reports of abuse and management issues. Dr. Joshua Sharfstein, Maryland's health secretary, also announced the formation of a task force that has been charged with recommending more improvements by January for services to all disabled adults (Donovan, 10/19).

Baltimore Sun: Shuttered Health Clinics Plan Relaunch
Founded in 1970 to treat people in Baltimore who are uninsured and underinsured, People's closed five clinics at the end of June as debts piled up, including more than $900,000 owed to the IRS. The clinics' $2.4 million annual federal grant — which helped pay the cost for treating uninsured patients — was suspended, and Anne Arundel County's government yanked a grant that was intended for a planned clinic in Severn. Now People's Community Health Centers has formally changed its corporate name to MedHealth of Maryland (Wood, 10/18).

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Editorials and Opinions

Views On Ebola: Blame Misplaced; Conspiracy Theories Abound; 'Nasty' Politicization

Politico: What the CDC Got Wrong About Ebola
Anybody who has been following the travails of our dysfunctional health-care system can find plenty of reasons to criticize American hospitals. Many are grossly inefficient and tragically unsafe. They’re quick to deliver unnecessary procedures, so long as they’re profitable, and slow to implement less lucrative procedures, like making sure patients understand what they must do to care for themselves once they are discharged. And most of them, whether they’re for- or non-profit, charge increasingly outrageous prices. But if there’s one thing our hospitals shouldn’t be dinged for, it’s being unprepared to take care of Ebola patients (Shannon Brownlee, 10/19).

The New York Times: The Ebola Conspiracy Theories
The spread of Ebola from western Africa to suburban Texas has brought with it another strain of contagion: conspiracy theories. ... The notion, for example, that health officials are conspiring with Big Pharma to consciously spread — and then cure — Ebola as a profit-making venture might sound like the plot to a cheesy summer thriller, but in fact it touches on a genuine aspect of our health care system, said Mark Fenster, a professor at the University of Florida’s Levin College of Law and the author of "Conspiracy Theories: Secrecy and Power in American Culture" (Alan Deuer, 10/18).

USA Today: Is U.S. 'Stuck On Stupid' On Ebola Outbreak?
Watching the U.S. Ebola story develop might well cause Hurricane Katrina flashbacks, triggered by the same sort of dramatic music on cable news networks announcing a return to breathless coverage of the latest details. ... Recall the political positioning, the press conferences from operations centers, the impassioned media coverage, the official reassurances that the situation was under control. Recall emergency and medical officials lacking appropriate communications or rescue equipment. Recall the angry mayors, governors and members of Congress with their declarations of outrage about how the situation was being mishandled (Emily Metzgar, 10/18).

The Washington Post: The Nasty Politicization Of Ebola
Francis Collins, director of the National Institutes of Health, administered a dose of truth to political Washington this week. For this honest service, Collins was pilloried.  In an interview published Sunday night, Collins shared with the Huffington Post’s Sam Stein his belief that, if not for recent federal spending cuts, "we probably would have had a vaccine in time for this" Ebola outbreak. ... Collins admits it's a mistake to think "throwing money at a medical problem automatically results in breakthroughs." But there are a few major research projects on the cusp of success that could bring financial benefits far beyond the cost (Dana Milbank, 10/17).

Politico: Yes, Ebola Is Scary. But the System Is Working.
Ebola is truly scary. It has so far killed nearly 4,500 people, overwhelmingly in Guinea, Liberia and Sierra Leone—societies that had already experienced more than their fill of sorrow. There are only three confirmed cases in the United States .... In Africa, it’s a disaster; within the United States, however, Ebola is a tragic, but eminently containable public health threat that requires a calm, methodical response. The words "calm and methodical" don't quite match what we're seeing. If you're just tuning in, you might believe that America has lost its mind (Harold Pollack, 10/19).

Los Angeles Times: A Political Crisis Called Ebola
Until last week, Ebola was merely a humanitarian disaster and a threat to global health. Now it's a U.S. political crisis too. And that's not just because of the heightened vitriol between the two parties in an election year. The Obama administration's handling of the Ebola crisis has prompted legitimate questions (Doyle McManus, 10/18). 

The Wall Street Journal: Ebola Isn't A Messaging Problem
Much public skepticism about the government's response to Ebola stems from the dogmatic pronouncements of Obama administration officials. In a video message early last month on stopping the virus, for example, President Obama asserted that "we know how to do it." He was wrong. The world has learned that dealing with Ebola in remote African villages is a very different challenge from confronting an unfamiliar virus in large cities and modern hospitals (Scott Gottlieb and Tevi Troy, 10/19). 

Bloomberg: Ebola Czar Should Be A General Not a Pol
I've know Ron Klain for years, respecting him as a smart operative who understands the nexus of politics and policy. His selection yesterday by President Barack Obama as the "Ebola czar" is a bad choice that will not stop the Democrats' political problems on this issue. It is what it appears: A political decision forced on the president by political posturing and careless talk about a crisis. It appears that Klain doesn't even report directly to the president, but to National Security Adviser Susan Rice and Obama's homeland security adviser, Lisa Monaco. There was a near perfect choice for Obama: David Petraeus (Albert R. Hunt, 10/19).

Reuters: Hospital Turns To PR To Fight Ebola
I've found, however, that despite the way nonprofit hospitals and their boards like to refer to their mission in terms of providing quality care, even to those who cannot afford it, the metrics these boards typically set mostly — if not completely in some cases — have to do with two cold, hard business numbers: revenue and operating profit. How, in fact, are the bonuses at Texas Health determined? How much does the quality of the care — for which federal regulators now have multiple, comparative measures — count? One of the most important of those measures has to do with the rate of infections contracted in the hospital. Is any executive's compensation in any way based on that? Is there a separate board quality-control committee that monitors this aspect of the hospital’s performance? (Steven Brill, 10/16). 

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Viewpoints: Health Law Fails To Control Costs; GOP Alternative 'Worse Than Obamacare'

The Wall Street Journal: ObamaCare's Failing Cost Control
A major claim of ObamaCare’s political salesmen is that it will reduce U.S. health spending. The heart of this claim is the Accountable Care Organization, or ACO, but already evidence is accumulating that it isn't working. ... If the ACO goes the way of every other previous HHS adventure in false omniscience, government planners will invariably turn to rationing care. Their main tool will be the Independent Payment Advisory Board, a 15-member committee of experts whose decisions are insulated from political oversight. Under ObamaCare, medicine will always be accountable to government, not patients (10/19).

The Washington Post: A Health-Care Plan Worse Than Obamacare
Republicans calling for repeal of the Affordable Care Act, also known as Obamacare, are a dime a dozen. Fewer offer a plan to replace the law with something they claim would work better. To his credit, Virginia’s Ed Gillespie, a GOP Senate candidate, is in the more select group. ... Mr. Gillespie's proposal was developed by a conservative group called the 2017 Project .... It is a real plan, which is to be commended. But it would be worse than the Affordable Care Act (10/17). 

USA Today: Ted Cruz: Republican Priorities For 2015
By all signs, Americans are preparing to send Washington a clear message in the 2014 elections. The question is, will Washington listen? ... Here are ten critical priorities for the 2015 Congress: ... We should pass repeal legislation (forcing an Obama veto), and then pass bill after bill to mitigate the harms of Obamacare. Prevent people from having their healthcare plans cancelled, prohibit insurance company bailouts, eliminate the provisions forcing people into part-time work, and repeal the individual mandate (Sen. Ted Cruz, R-Texas, 10/19).

Bloomberg: Question Day: Could Obamacare Be Repealed?
I expect repeal of the Affordable Care Act to be the mandatory position for every Republican presidential candidate. ... Flat-out repeal stopped being a realistic option (along with the political toll it would extract because of the large number of people who are now relying on its benefits, too much has changed for a simple elimination to make sense). But out in Republican primary-land plenty of people believe the fiction that Obamacare has already collapsed on its own. Primary elections are an unlikely venue for educating rank-and-file voters about reality. And even though candidates will probably continue to embrace "repeal and replace" rhetoric, don’t expect them to roll out real replacement plans (Jonathan Bernstein, 10/17).  

Los Angeles Times: In The Obamacare Birth-Control Debate, There's A Logical Path
In case you haven't encountered enough illogic in the American healthcare system, consider this: Once a medication has been determined to be safe and effective enough to be available without a prescription, we assume it should no longer be covered by insurance. That doesn't follow, and contraceptives are an important case in point (Daniel Grossman, 10/18). 

Modern Healthcare: Chip Kahn Sees Successes, Missed Opportunities In Health IT
President Barack Obama's January 2009 pledge to "computerize the nation's health records in five years" largely has come to fruition. ... Despite our EHR successes, most hospitals are a "Tower of Babble," with numerous modules and devices unable to talk to each other without costly interfaces, overlays, or, in many cases, a nurse or other healthcare professional serving as a translator, manually transferring or transcribing data from one system to another. It is sobering to realize that hundreds of millions of dollars were spent experimenting on how to get patient X's information from Ohio to Florida, yet we cannot convey data from a digital blood pressure cuff into an EHR three feet away without some type of work-around. This reflects yet another missed opportunity (Chip Kahn, 10/18).

The Washington Post: Best State In America: Maine, For Its Hospitals
When it comes to the facilities that deal with our health, residents in Maine should feel a little less anxious: A recent study found that the state has a higher percentage of top-notch hospitals, as measured by patient safety, than anywhere else in the country (Reid Wilson, 10/17). 

The Washington Post: Let Brittany Maynard's Story Spark A Dialogue About The End Of Your Life
Tragically blindsided by brain cancer and a terminal diagnosis, [Brittany] Maynard has bravely decided to live large, to turn her terrible personal fate into a public story. ... If all the people who watched her video want to do something that truly matters, start a conversation at the kitchen table with the people you love .... Talk about what matters to you at the end of life. Choose someone who will speak for you if you can't speak for yourself. Have that conversation. I am reminded of something else Maynard said. "The thoughts that go through your mind when you find out you have so little time is everything that you need to say to everyone that you love." Don't let the moment pass (Ellen Goodman, 10/17).

The New York Times’ Opinionator: Why Doctors Need Stories
If the narrative was striking, so was its inclusion in a medical journal. In the past 20 years, clinical vignettes have lost their standing. For a variety of reasons, including a heightened awareness of medical error and a focus on cost cutting, we have entered an era in which a narrow, demanding version of evidence-based medicine prevails. As a writer who likes to tell stories, I've been made painfully aware of the shift. The inclusion of a single anecdote in a research overview can lead to a reprimand, for reliance on storytelling. My own view is that we need storytelling in medicine, need it for any number of reasons (Peter D. Kramer, 10/18).

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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.