Kaiser Health News - Insurance

Calif. Unveils Tentative Price Tags For Health Plans On The Exchange

Fri, 24 May 2013 13:42:00 GMT

The monthly cost for policies sold on the state-run exchange came in lower than the 30 percent rate increases some had anticipated, though some consumers will still experience sharply higher premiums. Blue Shield of California estimated that current customers would see rate increases of about 13 percent.

Kaiser Health News: California Insurance Exchange Rates: Not Too High, Not Too Low
In the first disclosure of individual health insurance premiums by the nation's largest state, California announced on Thursday a wide array of choices for the 5.3 million people expected to qualify to purchase coverage through its online marketplace established by the Affordable Care Act (Varney, 5/24).

Los Angeles Times: New California Health Insurance Rates Unveiled
Amid anxiety over rising costs from the federal healthcare law, California received better-than-expected insurance rates for a new state-run marketplace, but many consumers still won't be spared from sharply higher premiums (Terhune, 5/23).

The New York Times: California Puts Tentative Price On Health Policies Under New Law
State officials said that rate increases for individuals who already had insurance would not be as high as some had feared. Blue Shield of California, for example, estimated its current customers would see rate increases of about 13 percent. Some estimates had suggested rate increases could be 30 percent. The increases are largely the result of higher prices and the need to cover people who now have no insurance and are likely to have expensive medical problems (Abelson, 5/23).

The Washington Post: California's Likely Health Insurance Rates Under New Law Are Lower Than Expected
California health officials on Thursday unveiled the likely rates that insurers will charge under President Obama’s health-care law — and they are lower than expected, rebutting warnings by critics that many people will experience "rate shock" once the law is fully implemented. On average, a person who chooses a mid-level plan can expect to pay around $321 a month, about $100 less than the amount projected by the Congressional Budget Office when the law was being debated in Washington (Somashekhar, 5/23).

The Wall Street Journal: California Outlines Health Premiums
Early results around the U.S. indicate prices for exchange plans will vary widely—both from state to state and among consumers—as will the effect of the law on premiums. In states such as Vermont and Rhode Island, with regulations somewhat similar to the federal law's rules, the legislation is having little effect on premiums. In other places, like Maryland and Kentucky, there have been signs of sometimes-large rate increases. In California, "we're getting the best-case scenarios" on rates, with some "far lower" than projected in an actuarial report commissioned by the agency, said Peter V. Lee, executive director of Covered California. He said costs would go up for some consumers, and down for others (Mathews and Radnofsky, 5/23).

Reuters: California Reveals Prices For Health Insurance Under Obamacare
California unveiled prices on Thursday that consumers will pay for a selection of health plans offered through the state under the Affordable Care Act, providing a glimpse into how health care reform may look as it is rolled out across the nation. Under the federal health care reform law, Californians who do not get or cannot afford health insurance through their jobs can buy coverage through an exchange, at a group rate negotiated by state regulators (Bernstein, 5/23).

HealthyCal: Covered California Rolls Out Health Plan Choices, Rates
Today was a big day for Covered California, the new state-run marketplace for health insurance created under the federal Affordable Care Act. The health exchange rolled out the 13 regional and statewide plans that will be available to more than 5 million Californians eligible to buy coverage through the new system beginning Oct. 1 (Weintraub, 5/23).

CQ HealthBeat: Exchange Bids Suggest Overhaul On Track In Pivotal State Of California
The Obama administration got a respite Thursday from the rising chorus of inside-the-Beltway doubts about the health care law with news from California that its insurance exchange will offer residents in the individual market 13 plans at what officials said are affordable rates. The plans available for small businesses will be announced in June (Reichard, 5/23).

The Hill: ObamaCare Plans Cheaper Than Expected In Key Rate Filing
New insurance policies under President Obama's healthcare law will cost significantly less than expected in California. The state released rate filings Thursday for the policies that will be sold through the health law's insurance exchange (Baker, 5/23).

Sacramento Bee: California Health Exchange Reveals Premium Costs, Insurers
California's newly created health exchange announced the bottom line on its insurance policies and rates Thursday, bringing sharper focus to family impacts of next year's health care overhaul. Thirteen companies were selected to sell policies for the individual market through Covered California, a state-owned marketplace for comparing prices of coverage with identical benefits but different networks of doctors (Sanders, 5/24).

CNN Money: Obamacare Premiums In California Lower Than Predicted
Health insurers in California will charge an average of $304 a month for the cheapest silver-level plan in state-based exchanges next year, according to rates released Thursday by Covered California, which is implementing the Affordable Care Act there. But many residents will pay a lot less than that for coverage. Rates will vary by region, age and level of coverage, and many lower-income Californians will qualify for federal subsidies that will greatly lower the premiums (Luhby, 5/23).

California Healthline: Exchange Premiums Closely Watched By Industry, Nation
California isn't the first state to announce premium rates and vendors in a new health benefit exchange, but the announcements this week from Covered California may carry more clout than those already announced -- and probably more than those yet to come. Covered California announced which health insurance plans will be offered and how much they'll cost when the new insurance marketplace opens for business this fall. It is another milestone in California's race to be ready for full implementation of the Affordable Care Act next year (Lauer, 5/23).

Research Roundup: Getting A Critical Care Doc At Night; Poverty Among Seniors

Fri, 24 May 2013 13:16:00 GMT

Each week, KHN reporter Alvin Tran compiles a selection of recently released health policy studies and briefs.

JAMA Internal Medicine: Firearm Legislation And Firearm-Related Fatalities In The United States – Researchers analyzed 121,084 firearms deaths in the U.S., using 2007 to 2010 data from the Centers for Disease Control and Prevention: "The outcome measures were state-level firearm-related fatalities per 100 000 individuals per year overall, for suicide, and for homicide. In various models, we controlled for age, sex, race/ethnicity, poverty, unemployment, college education, population density, nonfirearm violence–related deaths, and household firearm ownership." They concluded that a "higher number of firearm laws in a state are associated with a lower rate of firearm fatalities in the state, overall and for suicides and homicides individually. As our study could not determine cause-and-effect relationships, further studies are necessary to define the nature of this association" (Fleegler et al., 5/13).

New England Journal Of Medicine: A Randomized Trial Of Nighttime Physician Staffing In An Intensive Care Unit – Previous studies suggest that the use of intensivists, doctors specifically trained in critical-care medicine, improve the outcomes of intensive care unit (ICU) patients. But studies analyzing the impact of nighttime staffing of intensivists in ICUs have shown mixed results. Researchers at the Hospital of the University of Pennsylvania compared nighttime staffing to the use of daytime intensivists who were available for phone-based consultation at night. More than 1,500 patients were included in their analyses. "We found no evidence that this staffing model, as compared with nighttime telephone availability of the daytime intensivist, had a significant effect on length of stay in the ICU or hospital, ICU or in-hospital mortality, readmission to the ICU, or the probability of discharge to home," the authors write. "In an academic medical ICU in the United States, nighttime in-hospital intensivist staffing did not improve patient outcomes" (Kerlin et al., 5/20).

Annals Of Family Medicine: Spreading A Medical Home Redesign: Effects On Emergency Department Use And Hospital Admissions – Patient centered medical homes (PCMH) emphasize long-term relationships between patients and providers as well as other attributes of primary care. This study analyzed how PCMHs in clinics owned by the Washington state insurance and health care system, Group Health Cooperative, affected health care use. The authors found that, one year after the implementation, Group Health patient visits to emergency departments significantly declined and there was a shift from face-to-face doctor/patient visits to greater use of secure messaging and telephone conversations. "Group Health's experience in spreading its PCMH model shows that achieving PCMH transformation across a diverse set of primary care clinics is possible with a clear change strategy … and sufficient resources and supports," they conclude (Reid et al., May 2013).

Health Care Cost Institute: Health Care Costs From Birth To Death -- Using commercial and Medicare health care data, the author of this report (sponsored by the Society of Actuaries) analyzed cost differences based on age, sex and health status. He reports that costs are generally high in the two years of life and then drop by age 5. They pick up again in the teen years and for women increase during the child-bearing years. Among other key findings: "An aging population is not an overwhelming driver of health care spending. ... Health costs are twice as high for people with cancer or other chronic conditions. Older men are more costly than older women" (Yamamoto, May 2013).

Kaiser Family Foundation: A State-By-State Snapshot Of Poverty Among Seniors: Findings From Analysis Of The Supplemental Poverty Measure – The authors write: "During recent deficit reduction discussions, policymakers have put forth a variety of proposals to reduce Federal spending that would affect people on Medicare, including options that would shift costs onto beneficiaries ... Based on the Census Bureau’s supplemental poverty measure, the poverty rate among people ages 65 and older is higher than is reflected in the official poverty measure, and is particularly high among seniors in some states. ... Under the supplemental poverty measure, which deducts health spending from income, poverty rates could increase if beneficiaries were required to pay higher cost sharing or premiums for Medicare. ... The supplemental measure suggests that a greater share of seniors may already be struggling financially than is conveyed by the official measure" (Levinson et al., 5/20).

Here is a selection of news coverage of other recent research:

San Francisco Chronicle: 56% Of Patients Don't Follow Prescription
It might take more than a spoonful of sugar to help the medicine go down for many Americans. In a survey of more than 1,000 adult patients who are on prescription medication for chronic illnesses, 40 percent say they haven't followed doctor's instructions or have skipped taking their meds at least once in the past year. More than a quarter said they've stopped taking medications altogether or never even filled a prescription. It's a problem known as medication nonadherence and is linked to 125,000 deaths in the United States each year (Roethel, 5/21).

Medpage Today: Medical Home Transition Long But Worth It
The path to becoming a patient-centered medical home is long, rough, and varies for each practice, but getting there is essential to providing high-quality, affordable healthcare to all Americans, researchers concluded. The Agency for Healthcare Research and Quality (AHRQ) came to that conclusion in summarizing the results of 14 grants it issued in the summer of 2010 to understand the processes and determinants of transforming primary care practices. ... The results were published Monday in a special supplement of the Annals of Family Medicine (Pittman, 5/20).

Reuters: Health Sites Too Complex, Full Of Cliches: Study
The importance of health literacy hit home for Lisa Gualtieri when a Cambodian refugee diagnosed with cancer asked her to act as a patient advocate. … A new study, published Monday in JAMA Internal Medicine, suggests one potential reason for the family's confusion: Despite good intentions, many experts may be creating educational materials that are too difficult for patients and their families to grasp (Oransky, 5/20).

Viewpoints: We Need More 'Socialism'; The IRS's 'Unwelcome Role'; 'Fog Of Obamacare'

Fri, 24 May 2013 13:11:20 GMT

Los Angeles Times: If This Health Plan Is 'Socialism,' We Need More Of It
So this is what socialism looks like: Private companies competing for people's business in an open marketplace. Californians got their first glimpse Thursday of what insurers plan to charge for coverage to be offered next year to about 5 million state residents who don't receive health insurance from employers (David Lazarus, 5/23).

The Washington Post: The Unwelcome Role Of The IRS In Obamacare
Thousands of new IRS agents will implement 40-odd provisions of the Patient Protection and Affordable Care Act — the exact number is a matter of dispute since the law itself is so confusing. The largest tax law and social policy change in a generation will be imposed on a skeptical public by a government agency whose credibility is in ruins. But the IRS is not merely implementing Obamacare. It engaged in a regulatory power grab to ensure that it could implement Obamacare (Michael Gerson, 5/23).

The Washington Post: The Fog Of Obamacare
You’ve heard of the "fog of war." Well, now we've got the fog of Obamacare. The controversial Affordable Care Act (ACA) has so many moving parts that it's hard to know how its implementation is proceeding. In 2014, many uninsured are supposed to get coverage either through insurance exchanges, where they can buy subsidized policies if their incomes are less than four times the federal poverty line, or through an expanded Medicaid. The trouble is that 20 or more states may reject the Medicaid expansion, and the exchanges aren’t yet finished. Much is unknown (Robert J. Sameulson, 5/23).

The New York Times' Economix: Debating Doctors' Compensation
Two themes run through the comments on previous blog posts that touched on the payment of the providers of health care. The first is that American doctors are paid too much. The second is that they are paid too little. Could both propositions be right? Let us explore the issue by looking at some numbers (Uwe E. Reinhardt, 5/24).

New England Journal Of Medicine: The Gross Domestic Product And Health Care Spending
How much will the United States spend on health care during the next decade or two? The answer matters greatly to physicians, federal and state governments, businesses, and the general public. The answer will determine the type and extent of care that physicians can provide to their patients, as well as the amount of physicians' take-home pay. It will also determine how much everyone else can consume or invest in other goods and services. Unfortunately, forecasting health care spending is extremely difficult. Future spending depends in part on developments within the health care sector and in part on developments in the economy as a whole (Victor Fuchs, 5/22).

Boston Globe: Do I Miss My Breasts?
I had voluptuous breasts. I miss them, when I think about them. But I rarely think about them because I’m busy not missing my family’s milestones and ordinary moments. The kind of moments that I suspect Angelina Jolie does not want to miss. Jolie and I have more in common than being mothers and having sexy husbands. I, too, carry the BRCA1 gene alteration, a mutation that raises a woman’s lifetime risk of ovarian cancer to 40-60 percent and breast cancer to 50-80 percent (Ellen Roth, 5/22).

WBUR: Cognoscenti: The Power Of Knowing: A Daughter Who Chose BRCA Gene Testing, Against Her Mother's Will
When Angelina Jolie explained in The New York Times her decision to take action after discovering she carried the BRCA-1 mutation, I saw on social media so many women asking each other, Would you undergo genetic testing? Many expressed anger at Myriad (the company that owns the patent), at insurance companies (several do not cover the cost of the test), and at doctors they believe hold assumptions about organ removal. While some cited how removing one's organs could shorten or alter their lives, as could cancer itself, others judged individual preferences as "right" or "wrong" (Tracy Strauss, 5/24).

The New York Times' Doctor And Patient: Disability And Discrimination At The Doctor's Office
It's been nearly 23 years since the Americans With Disabilities Act, a federal law prohibiting discrimination against people with disabilities, went into effect. Despite its unequivocal language, studies in recent years have revealed that disabled patients tend not only to be in poorer health, but also to receive inadequate preventive care and to experience worse outcomes (Pauline W. Chen, MD, 5/23).

USA Today: Mental Illness Manual No 'Bible': Column
Unlike many other physical ailments, there are no acceptable scientific tests that can pinpoint mental disorders. A blood test won't tell doctors which of my son's diagnoses, if any, are accurate. Instead, psychiatrists must rely on a patient or family members to describe symptoms of the illness to make a diagnosis. The doctor then consults psychiatry's "bible" — the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) — to determine which diagnosis best fits the patient's symptoms. This process can be ripe for error, especially if a patient doesn't believe there is anything wrong, a common reaction during a psychotic break (Pete Earley, 5/23).

The New York Times' Taking Note: Abortion After 20 Weeks
On the list of treasured Republican pastimes, trying to outlaw abortion and imposing a right-wing agenda on the District of Columbia (which is heavily Democratic and lacks any representation in Congress) both rank high. So it must have given Rep. Trent Franks of Arizona special pleasure to combine those hobbies by introducing a bill to ban abortion in D.C. after 20 weeks. But why stop there? (Andrew Rosenthal, 5/23).

New England Journal Of Medicine: Under The Medical Tent At The Boston Marathon
Bright sunlight filtered through the awnings of the medical tent pitched in Copley Square, where I joined the many medical professionals caring for people who'd fallen ill from their 26.2-mile run. Some volunteers had been staffing the medical tent for years — one nurse had worked at the Boston Marathon more than 25 times. Sickened and stressed runners poured into our makeshift hospital. A runner stumbled in and vomited into a bag. We helped him onto a cot, where he sat shivering. "You're OK," a nurse said gently, wiping his face. But his core temperature had dropped to 96 degrees, and he began having violent rigors. We brought him Mylar blankets and hot bouillon (Sushrut Jangi, 5/23).

State Highlights: La. Grand Jury To Examine $200M Medicaid Contract

Fri, 24 May 2013 13:11:00 GMT

A selection of health policy stories from Louisiana, Oregon, Connecticut, Kansas, North Carolina, California, and New York.

Modern Healthcare: States Delaying, Dropping Controversial Dual-Eligible Pilot Program
More than half of the states that applied to participate in a controversial CMS pilot for dual-eligible beneficiaries have either dropped out or delayed implementation of their programs, according to health policy experts. Among the 26 states that applied to participate in the CMS Financial Alignment Initiative, which stems from the Patient Protection and Affordable Care Act, six have dropped out or opted for different "customized" plans and nine have delayed their start dates (Daly, 5/23).

The Associated Press/Washington Post: Grand Jury To Look Into $200M Medicaid Contract Awarded By Jindal Administration
The Louisiana attorney general's office said a special grand jury was selected Thursday to look into possible criminal activity involving a $200 million Medicaid contract awarded by Gov. Bobby Jindal's administration. Assistant Attorney General Butch Wilson told a judge that the grand jury was being empaneled in Baton Rouge as part of an ongoing investigation into the now-canceled contract for Client Network Services Inc., or CNSI (5/23).

Lund Report: Regence Posts Strongest Profits In Oregon's Top Insurers
Regence BlueCross BlueShield of Oregon bolstered its position as the largest health insurance company in the state during the first three months of 2013. At the same, it also time delivered the strongest profits among large Oregon insurers. Regence BCBS total membership climbed by 18,800 lives during the first quarter of the year, to 491,702, and the insurer posted a $16.09 million profit, according to financial reports made available in the past week by the National Association of Insurance Commissioners (Sherwood, 5/23).

Oregonian: Nonprofit Health Insurers Often Beat For-Profits, But Not In Portland: Study
Nonprofit health insurers often beat the premiums of their for-profit competitors and usually provide better protections on out-of-pocket spending, according to a recent survey of six cities around the country, including Portland. Interestingly, in Portland the distinction between nonprofits and for-profits blurs, however. The survey, conducted by the free consumer information website, HealthPocket.com, analyzed more than 2,000 quotes, focused on individual female nonsmokers. It adds numerical context to the debate among health care insiders over the transformation of some nonprofit insurers (Budnick, 5/23).

CT Mirror: Senate Adopts Measure To Coordinate Care For Mentally Ill Children
The state Senate unanimously adopted a measure Thursday aimed at improving coordination between a wide array of caregivers and support services for children with mental illness. The bill, crafted in response to last December's tragic shooting at Sandy Hook Elementary School in Newtown, lays the groundwork for a more comprehensive, coordinated response by mental health agencies, schools and emergency mobile psychiatric services (Phaneuf and Becker, 5/23).

Kansas Health Institute: Network Execs Squabble Over Issue Of Exchange Connectivity
Following a heated exchange between two network chief executives, the board regulating digital health record exchange in Kansas voted Wednesday to prohibit the networks from charging each other connectivity fees until at least 2015. In Kansas, the exchange of digital patient information began last summer via two private networks licensed by the quasi-governmental Kansas Health Information Exchange, Inc. (KHIE) (Cauthon, 5/23).

North Carolina Health News: Bill Addresses Doctors & The Death Penalty
It’s been almost seven years now since the state of North Carolina carried out an execution, as the procedure has been subject to political pressure by anti-death penalty groups and caught up in court cases. One of the barriers to carrying out executions has been legal wrangling over the role of doctors in the procedure (Hoban, 4/24).

California Healthline: Task Force To Examine Developmental Centers
Diana Dooley, secretary of the state's Health and Human Services agency, yesterday announced formation of a task force to take a hard look at the viability of closing four developmental centers in California. "I don't know if the four developmental centers we operate can all close," Dooley said. … Developmental centers in California have come under fire recently -- with allegations of chronic abuse of patients, investigations by multiple government agencies and loss of federal certification. The state has taken a number of steps, particularly at Sonoma Developmental Center, to investigate possible abuses and improve safety of the centers' clients (Gorn, 5/23).

The New York World: No Restraint At Drug-Dosing New York Nursing Homes
A year after a federal health agency vowed to sharply reduce the use of powerful antipsychotic drugs in nursing homes, prescriptions have declined only modestly -- and dozens of New York City facilities have actually increased their use of the medications. In May 2012, the Centers for Medicare and Medicaid Services announced an initiative to reduce antipsychotic use in nursing homes nationally 15 percent by the end of 2012 (Skinner, 5/23).

Health Care Issues Become Hurdle For Immigration Reform Measure

Fri, 24 May 2013 13:10:00 GMT

The key question that seems to have stalled progress for House lawmakers is how to handle immigrants who do not have health insurance.

Los Angeles Times: Immigrant Health Care Bills Stump House Group
Differences over whether immigrants should be deported for failing to have health insurance or pay their health care bills have stalled a bipartisan group of House lawmakers, who blew past a self-imposed Thursday deadline as they pressed forward on a sweeping immigration overhaul (Mascaro, 5/23).

The Wall Street Journal: House Immigration Effort Hits Bump In The Road
Last week, a bipartisan group of House lawmakers thought they had a broad deal on how to overhaul the immigration system. This week, they don't. The eight House lawmakers were forced to backtrack from the "agreement in principle" reached last Thursday after House Democratic leaders objected to a provision dealing with health care coverage for illegal immigrants living in the U.S., according to aides from both parties. The group continued to meet this week, and its members remained hopeful they would be able to strike a deal that passes muster among all involved (Peterson, 5/23).

Modern Healthcare: Taxpayers Won't Pay Health Care Costs For Undocumented Immigrants
Two days after the Senate Judiciary Committee passed a comprehensive immigration reform bill, House Minority Leader Nancy Pelosi (D-Calif.) promised that U.S. taxpayers would not bear the cost of health care coverage for undocumented immigrants who are on the path to citizenship. Earlier reports had hinted that the coverage provisions under the Patient Protection and Affordable Care Act might be a sticking point as House members draft their own immigration-reform legislation (Zigmond, 5/23).

Health Law Politics Swirl Around Scandal Reports, Implementation Frustrations

Fri, 24 May 2013 13:10:00 GMT

Some of the political ebb and flow is exactly as expected, with news reports noting that Rep. Michele Bachmann, R-Minn., a staunch opponent of the overhaul, is focused on linking the Internal Revenue Scandal with the health law. However, in other coverage, The Associated Press reports that some labor unions, which were strong advocates, have become increasingly frustrated with some aspects of the law, and The Hill notes that some business groups are voicing concerns about the measure's wellness program.

The Associated Press/Washington Post: Health Care Overhaul Faces Backlash From Once Supportive Labor Unions
When President Barack Obama pushed his health care overhaul plan through Congress, he counted labor unions among his strongest supporters. But some union leaders have grown frustrated and angry about what they say are unexpected consequences of the new law — problems that they say could jeopardize the health benefits offered to millions of their members (Hananel, 5/24).

The Hill: Businesses Share ObamaCare Wellness Program Worries With White House
Business groups are weighing in on an ObamaCare proposal governing incentives for employees to stay healthy. The White House is currently reviewing a proposed rule for wellness programs that give workers incentives to take part in healthy habits such as joining a gym, signing up for a weight-loss plan or participating in a scheme to stop smoking (Hattem, 5/23).

The Washington Post's The Fact Checker: Bachmann's Absurd Claim Of A Vast IRS Health Database Of 'Sensitive, Intimate' Information
With the Internal Revenue Service in the news, Rep. Michele Bachmann (R-Minn.) has taken the opportunity to marry that scandal with her ongoing battle against the president’s health care law, a.k.a. "Obamacare." The picture she has sketched is pretty frightening — that the "most personal, sensitive, intimate, private health care information is in the hands of the IRS" via a vast database. Indeed, even though our colleagues at PolitiFact and FactCheck.Org have beaten us to the punch on this language, the issues she has raised have generated enough buzz on the blogosphere that we believe we should weigh in as well. What is Bachmann talking about? (Kessler, 5/24).

McClatchy: Scandal Draws Questions About IRS Role In Enforcing Obamacare
The blossoming IRS scandal over the targeting of conservative groups is provoking new scrutiny and terse questions about the agency’s role in shaping and implementing the controversial new national health care law, with the biggest changes set to begin next year. The Internal Revenue Service is an important cog in the implementation of the Patient Protection and Affordable Care Act of 2010, commonly shorthanded as Obamacare. The tax agency must act on 47 provisions of the new law, more than half of those already in effect, including the more controversial ones taking effect in 2014 such as the requirement that nearly all non-elderly adults have health care coverage (Hall and Lightman, 5/23).

First Edition: May 24, 2013

Fri, 24 May 2013 11:11:54 GMT

Today's headlines include details on California's new health insurance exchange rates, whether consumers will experience "rate shock" and what these numbers say about the health law's implementation.

Kaiser Health News: California Insurance Exchange Rates: Not Too High, Not Too Low
Kaiser Health News staff writer Sarah Varney reports: "In the first disclosure of individual health insurance premiums by the nation's largest state, California announced on Thursday a wide array of choices for the 5.3 million people expected to qualify to purchase coverage through its online marketplace established by the Affordable Care Act" (Varney, 5/24). Read the story.

The Associated Press/Washington Post: Health Care Overhaul Faces Backlash From Once Supportive Labor Unions
When President Barack Obama pushed his health care overhaul plan through Congress, he counted labor unions among his strongest supporters. But some unions leaders have grown frustrated and angry about what they say are unexpected consequences of the new law — problems that they say could jeopardize the health benefits offered to millions of their members (5/24).

The Associated Press/Washington Post: Republican Arizona State Representative Says She got Threatening Message Over Medicaid Support
A Republican member of the Arizona House who supports GOP Gov. Jan Brewer's push to expand Medicaid received an obscene and threatening voicemail at her office, a sign that the rancorous debate over embracing a signature component of President Barack Obama's health care overhaul in the state is far from over (5/23).

The Washington Post's The Fact Checker: Bachmann's Absurd Claim Of A Vast IRS Health Database Of 'Sensitive, Intimate' Information
With the Internal Revenue Service in the news, Rep. Michele Bachmann (R-Minn.) has taken the opportunity to marry that scandal with her ongoing battle against the president’s health-care law, a.k.a. "Obamacare." The picture she has sketched is pretty frightening — that the "most personal, sensitive, intimate, private health-care information is in the hands of the IRS" via a vast database. Indeed, even though our colleagues at PolitiFact and FactCheck.Org have beaten us to the punch on this language, the issues she has raised have generated enough buzz on the blogosphere that we believe we should weigh in as well. What is Bachmann talking about? (Kessler, 5/24).

The Associated Press/Washington Post: Hobby Lobby Appeal Tests Limits Of Federal Birth-Control Coverage Mandate
In the most prominent challenge of its kind, Hobby Lobby Stores Inc. asked a federal appeals court Thursday for an exemption from part of the federal health care law that requires it to offer employees health coverage that includes access to the morning-after pill. The Oklahoma City-based arts-and-crafts chain argued that businesses — not just the currently exempted religious groups — should be allowed to seek exception from that section of the health law if it violates their religious beliefs (5/23).

Los Angeles Times: Immigrant Healthcare Bills Stump House Group
Differences over whether immigrants should be deported for failing to have health insurance or pay their healthcare bills have stalled a bipartisan group of House lawmakers, who blew past a self-imposed Thursday deadline as they pressed forward on a sweeping immigration overhaul (Mascaro, 5/23).

The Wall Street Journal: House Immigration Effort Hits Bump In The Road
Last week, a bipartisan group of House lawmakers thought they had a broad deal on how to overhaul the immigration system. This week, they don't. The eight House lawmakers were forced to backtrack from the "agreement in principle" reached last Thursday after House Democratic leaders objected to a provision dealing with health-care coverage for illegal immigrants living in the U.S., according to aides from both parties. The group continued to meet this week, and its members remained hopeful they would be able to strike a deal that passes muster among all involved (Peterson, 5/23).

NPR: Abortion Opponents Try To Spin Murder Case Into Legislation
As predicted, abortion opponents on Capitol Hill are wasting no time in their efforts to turn publicity over the recent murder conviction of abortion provider Kermit Gosnell to their legislative advantage (Rovner, 5/23).

Politico: House Panel Considers Abortion Bill
A bill banning most abortions after 20 weeks nationwide received consideration from a House panel on Thursday — and the Kermit Gosnell case and recent court rulings provided a fresh backdrop. But the same familiar arguments in the fight over abortion dominated the discussion (Smith, 5/24).

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Idaho, New Mexico Ask Feds To Run Health Exchanges

Thu, 23 May 2013 14:08:00 GMT

In addition, media outlets report that the nation's largest for-profit insurers will not participate in California's online marketplace. Eleven insurers have applied to operate plans in Colorado.

The Wall Street Journal: Two States Seek Help With Health Exchanges
Two states that had planned to run their own health-insurance exchanges this fall are asking the federal government for help in the first year, a sign of the obstacles states face in carrying out a centerpiece of the health-care overhaul. Idaho and New Mexico had been among a few Republican-led states that had agreed to operate their own health exchanges, which will offer a variety of insurance plans for people who don't have coverage otherwise (Dooren, 5/22).

Kaiser Health News: Capsules: 11 Insurers Want To Play Ball In Colorado's Marketplace
Colorado became the latest state Wednesday to post proposed health insurance plans for its new online marketplace, which is slated to begin enrolling people in coverage Oct. 1. What stands out is the number of plans being proposed. A total of 11 insurers are seeking approval to market about 250 health plans to individuals and small groups in the state's online marketplace (Galewitz, 5/22).

Los Angeles Times: UnitedHealth, Aetna And Cigna Opt Out Of California Exchange
Some prominent health insurers, including industry giant UnitedHealth Group Inc., are not participating in California's new state-run health insurance market, possibly limiting the number of choices for millions of consumers. UnitedHealth, the nation's largest private insurer, Aetna Inc. and Cigna Corp. are sitting out the first year of Covered California, the state's insurance exchange and a key testing ground nationally for a massive coverage expansion under the federal healthcare law (Terhune, 5/22).

And, in Washington state -

The Associated Press: 2 Insurers Left Abortion Coverage Out Of Washington State Health Exchange Proposals
Two insurance companies who filed to compete in Washington state's health care exchange initially proposed not to provide abortion coverage, officials said Wednesday. All current Washington health plans provide abortion insurance. Stephanie Marquis, a spokeswoman with the Washington state Office of the Insurance Commissioner, said the plans without such coverage in the health exchange were recently filed by Kaiser Foundation Health Plan of The Northwest and BridgeSpan Health Company (5/22).

Viewpoints: Sen. Alexander Sees Reflections Of Oliver North In Sebelius' Quest To Raise Funds; Vaccine Scare's Legacy

Thu, 23 May 2013 04:00:00 GMT

The Wall Street Journal: Kathleen Sebelius, Meet Oliver North
Major news outlets in recent days have reported that U.S. Department of Health and Human Services Secretary Kathleen Sebelius is raising money from the private sector -- including from health care executives -- for use by a private entity that is helping to implement ObamaCare. ... Is Ms. Sebelius raising funds for a private entity and then coordinating with that entity to do something Congress has refused to authorize, or for which it has refused to appropriate funds? And is she raising money from organizations she regulates, in violation of ethics laws? (Sen. Lamar Alexander, R-Tenn., 5/22).

The New York Times: Aftermath Of An Unfounded Vaccine Scare
Britain is experiencing serious outbreaks of measles that look to be a delayed consequence of a failure to vaccinate infants and young children more than a decade ago. A prime cause of that failure was ill-founded fears among parents that a widely used vaccine to combat measles, mumps and rubella might cause autism. Because they shunned the vaccine, their children, now in their teens, are suffering the consequences (5/22).

Milwaukee Journal-Sentinel: Mandatory Vaccinations Deserve Vigorous Debate
The debate over the mandatory influenza vaccinations of employees is worthy of a vigorous public airing. Controversy has been growing nationwide over the plight of employees, particularly health care workers, being dismissed from jobs due to their refusal to accept this unwanted intrusion into their personal health care decisions. I fully recognize this argument pits two groups advocating against each other over a position based on rights. Employers demand flu vaccinations of employees, with extremely limited exceptions, as a fundamental right of an employer. Those who object stand on individual liberties to make their own personal health care decisions without the threat of dismissal (Jeremy Thiesfeldt, 5/22).

The New York Times: Kill Bill
According to statistics United Republic assembled, the prescription drug industry spent $116 million lobbying for legislation to prevent Medicare from bargaining down drug prices — legislation that enabled drug companies to make an additional $90 billion annually. That amounts to an extraordinary 77,500 percent return on investment. Oil companies, in turn, had a return on investment of 5,900 percent, and multinational companies, 22,000 percent (Thomas B. Edsall, 5/22).

The New England Journal of Medicine: The Gross Domestic Product And Health Care Spending
An examination of data from the past 60 years for the economy as a whole and for health care expenditures indicates that there has been a robust relationship between the two. ... Some observers place great emphasis on the particularly slow growth of national health care expenditures in 2010 and 2011. How useful is the experience of growth over a period of 2 years in predicting the growth rate over the next 20 years? The answer seems to be not at all. ... [T]he rate of growth of national health care expenditures in the past appears to have been substantially related to the growth of the GDP. There has been some slowing of the growth of health care spending relative to the GDP, but it began not just a few years ago, but in the 1990s (Victor R. Fuchs, 5/22).

Columbus Dispatch: Obamacare May Lead To 'Skinny' Policies
Would you like to have a "skinny" health-insurance policy? Probably not. But if you're employed by a large company, you may get one, thanks to Obamacare. That’s the conclusion of Wall Street Journal reporters Christopher Weaver and Anna Wilde Mathews. They report that insurance brokers are pitching and selling "low-benefit" policies across the country. You might be wondering what a "skinny" or "low-benefit" insurance plan is. The terms may vary, but the basic idea is that policies would cover preventive care, a limited number of doctor visits and perhaps generic drugs. They wouldn't cover things such as surgery, hospital stays or prenatal care (Michael Barrone, 5/23).

JAMA: Public Health Regulation As A Public Process
Media coverage of new public health regulations often seems to follow a template: The [regulatory agency]'s plan to implement [public health regulation] is causing controversy among [businesses affected] and [individuals who object]. … But there's another way to think about how policy is developed to improve health: as a dynamic process open to a range of policy alternatives (Dr. Joshua M. Sharfstein, 5/22).

JAMA: Encouraging Smokers to Talk With Their Physicians About Quitting
Over the next few months, physicians may see an increase in patients asking for help in quitting smoking. Why? The Office on Smoking and Health at the Centers for Disease Control and Prevention recently launched the second stage of its national media campaign, Tips from Former Smokers (Tips). Some of the ads include a new call to action with the message, "You can quit. Talk with your doctor for help." This "talk with your doctor" initiative provides physicians with a golden opportunity to help more patients quit smoking (Dr. Tim McAfee, 5/22).

The Lund Report: Physician, First Do No Harm -- To Yourself
Studies confirm most doctors are overworked, exhausted, or depressed. The tragedy: few seek help. I ask the group, "How many physicians have lost a colleague to suicide?" All hands are raised. "How many have considered suicide?" Except for one woman, all hands remain up -- including mine. "Physicians have the highest suicide rate of any profession," I explain. "In the United States we lose over 400 physicians per year to suicide. That's the equivalent of an entire medical school. Even that's an underestimate because many physician suicides are incorrectly identified as accidents" (Dr. Pamela Wible, 5/21).

MinnPost: Failed Virginia Bill On Miscarriages Reveals Ignorance About Women's Health
As I've written here before, the medical ignorance of some politicians -- particularly in regard to women's reproductive health -- is a continual source of astonishment. ... While searching through the legislative history of Virginia state Sen. Mark Obenshain, now running on the Republican ticket for his state's attorney general position, reporters found that he had authored a bill in 2009 that would have required all women in Virginia to report miscarriages to police or risk legal penalties, including as much as a year in jail (Susan Perry, 5/22).

Bloomberg: Better Death Records Can Lead To Longer Life
Here's a morbid thought atop a morbid thought: Two in three deaths worldwide -- some 35 million a year -- go unregistered. And in many cases when deaths are recorded, reliable information on what caused them is lacking. Why does this matter? Without such records, public-health authorities can't tell enough about what's killing people to minimize the dangers they face (5/22).

Oregonian: Portland And Its Aversion To Fluoride Reflects Oregon's Unusual Politics
In 2011, the board of the Santa Clara Valley Water District voted to begin fluoridating water for about 850,000 customers in and around San Jose. Anti-fluoride activists grumbled but realized they didn't have the resources to take their fight to the public. That's sure not what happened in Portland, which once again showed that this far northwest corner of the country is willing to go where other parts of the country rarely tread (Jeff Mapes, 5/22).

Federal Appellate Court Hears Arguments On Health Law's Birth Control Mandate

Thu, 23 May 2013 13:23:00 GMT

The Seventh U.S. Circuit Court of Appeals in Chicago is the first federal appellate court to hear arguments in cases challenging the mandate that took effect last August. With dozens of similar lawsuits pending, many say the issue seems likely to land before the Supreme Court. The case brought by Hobby Lobby Inc. is considered the most prominent of these efforts.

The Wall Street Journal: Contraception Violates Beliefs, Firms Tell Court
Two small-business owners challenging contraception-coverage mandates in the federal health-care law told a federal appellate court Wednesday the law would force them to violate their beliefs because they run their businesses in accordance with their religious faith. The Seventh U.S. Circuit Court of Appeals in Chicago is the first federal appellate court to hear arguments in cases challenging the mandate that took effect last August for most employers to cover contraception, including the morning-after pill, in workers' insurance plans without out-of-pocket costs (Kesling and Radnofsky, 5/22).

The Washington Post: Some Business Owners Resist Providing Employees With Contraceptive Coverage
Religiously devout business owners are waging a broad rebellion against providing their employees with contraceptive coverage, bringing dozens of lawsuits that seem certain to land the issue before the Supreme Court. The company owners say their religious beliefs take precedence over a new federal requirement, contained in President Obama’s Affordable Care Act, that they give employees insurance that covers contraceptives (Barnes, 5/22).

The Associated Press/Washington Post: Hobby Lobby Appeal Tests Limits Of Federal Birth-Control Coverage Mandate
In the most prominent challenge of its kind, Hobby Lobby Stores Inc. is asking a federal appeals court Thursday for an exemption from part of the federal health care law that requires it to offer employees health coverage that includes access to the morning-after pill. The Oklahoma City-based arts-and-crafts chain argues that businesses -- not just the currently exempted religious groups -- should be allowed to seek exception from that part of the health law if it violates their religious beliefs (5/23).

Weekend Reading: Mental Illness Stigma And Health Insurance Mazes

Thu, 23 May 2013 13:19:00 GMT

Every week reporter Ankita Rao selects interesting reading from around the Web.

The New York Times Magazine: Unexcited? There May Be A Pill For That
Linneah sat at a desk at the Center for Sexual Medicine at Sheppard Pratt in the suburbs of Baltimore and filled out a questionnaire. She read briskly, making swift checks beside her selected answers, and when she was finished, she handed the pages across the desk to Martina Miller, who gave her a round of pills. The pills were either a placebo or a new drug called Lybrido, created to stoke sexual desire in women. ... The search for a female-desire drug has been an obsession of the pharmaceutical industry for more than a decade, largely because the release of Viagra, in 1998, showed that gigantic sums of money can be made with a quick chemical solution to sexual dysfunction. But while Viagra and its competitors deal with the simple hydraulics of impotence, the most troubling difficulty for men, the psychological complexity of depleted lust has so far defeated industry giants (Daniel Bergner, 5/22).

Tampa Bay Times: Akshay Desai And The Rise And Fall Of Universal Health Care
In August, Universal Health Care Group was crumbling. Regulators circled. Bankruptcy loomed. Still, founder and CEO Akshay Desai didn't publicly hint at any problems. "As a businessman, I know all too well what it takes to make it in the private sector," he bragged at the time. It was vintage Desai — supremely confident, selective with the facts. The 55-year-old son of Indian educators built Universal on smarts and ambition (Susan Taylor Martin and Jeff Harrington, 5/13).

The New York Times Magazine: Some Of My Best Friends Are Germs
I can tell you the exact date that I began to think of myself in the first-person plural — as a superorganism, that is, rather than a plain old individual human being. ... Justin Sonnenburg, a microbiologist at Stanford, suggests that we would do well to begin regarding the human body as “an elaborate vessel optimized for the growth and spread of our microbial inhabitants.” This humbling new way of thinking about the self has large implications for human and microbial health, which turn out to be inextricably linked. Disorders in our internal ecosystem — a loss of diversity, say, or a proliferation of the “wrong” kind of microbes — may predispose us to obesity and a whole range of chronic diseases, as well as some infections (Michael Pollan, 5/22).

Slate: You Do Not Have Asperger's
The autism community is a fractious bunch. We argue over the causes of autism, the best treatments, or even if it should be treated at all. But we do share a common anxiety: the DSM-5. This latest version of the Diagnostic and Statistical Manual of Mental Disorders, released by the American Psychiatric Association this month, officially eliminates many familiar autism spectrum diagnoses. Asperger’s syndrome (typically applied to those with no intellectual disability or language deficit); pervasive developmental disorder, not otherwise specified (generally given to higher-functioning individuals who may not meet all the criteria for autism); and childhood disintegrative disorder (attached to kids who develop typically and then experience severe regression after the age of 3) are now incorporated into the single diagnosis of autism spectrum disorder. ... Yet those diagnoses had serious implications. Certain states provide services for children diagnosed with autism but not for those diagnosed with Asperger’s (Amy S.F. Lutz, 5/22).

USA Today: Glenn Close, Family Work To End Stigma Of Mental Illness
Calen Pick has schizoaffective disorder, a combination of schizophrenia and bipolar disorder. He was 15 when he realized something was wrong, 16 when he checked himself into a lockdown mental health facility, 18 when he got out and 28 when his sanity touched down on solid ground. Now 31, Pick got married last year and is working with his mother, Jessie Close, who is bipolar, and his aunt, six-time Oscar nominee Glenn Close, to help end the stigma and discrimination facing the mentally ill (Korina Lopez, 5/22).

The Nation: Cashing In On Breast Cancer Awareness
Many American women played the BRCA what-if game for the first time [last] Tuesday: what would I do if I had the mutation? Would I get a mastectomy, even though there was a chance I wouldn’t need it? ... The problem is that there is profit—a lot of profit—to be made from stoking all of this worry. The big winner on Tuesday was not women’s health; it was Myriad Genetics, the company that has held the exclusive patent on the BRCA 1 and 2 mutations since the 1990s. ... The BRCA gene speaks to the impossible dilemma of for-profit healthcare, particularly when practiced as legal monopoly: some high-risk women will be saved, but many more women will be either needlessly alarmed, financially penalized, or both, so that one corporate monopoly can make a staggering profit (Rose-Ellen Lessy, 5/16).

The New York Times: Defining My Dyslexia
I started cataloging insults in the second grade. Notable put-downs heard outside my special-ed classroom included "dimwinky," "retardochuckles" and "the meat in the sandwich of stupid." The last of which, if you think about it, is a seriously impressive use of metaphor for a 7-year-old. I learned all the jokes about dyslexia, and told them to better effect than anyone else. Making fun of myself was my best defense. The other choices — hiding from my diagnosis or accepting myself as limited — didn't appeal (Blake Charlton, 5/22).

First Edition: May 23, 2013

Thu, 23 May 2013 11:14:00 GMT

Today's headlines include various status updates about state activity regarding the health law's online insurance marketplaces.

Kaiser Health News: Can My Insurer Deny Coverage For Care At An Out-Of-Network Hospital? (Video)
Kaiser Health News consumer columnist Michelle Andrews answers a reader question about emergency room and out-of-network hospital cost changes under the health law (5/23). Watch the video or read the transcript.

Kaiser Health News: Capsules: 11 Insurers Want To Play Ball In Colorado’s Marketplace
Now on Kaiser Health News' blog, Phil Galewitz reports: "Colorado became the latest state Wednesday to post proposed health insurance plans for its new online marketplace, which is slated begin enrolling people in coverage Oct. 1. What stands out is the number of plans being proposed. A total of 11 insurers are seeking approval to market about 250 health plans to individuals and small groups in the state's online marketplace under the federal health care overhaul" (Galewitz, 5/22). Check out what else is on the blog.

Politico: Clock Ticking On Full Medicaid Expansion Funds
States still mired in the fight over the Obamacare Medicaid expansion are starting to give up on their first year of full funding — and it's unclear whether they would be able to tap into the money before 2015. Expansion remains an open question in about a dozen states after months of legislative fights. As more states continue to wrap up their budgets, some are already looking to next year's legislative sessions as their next shot at the expansion, even amid calls for state legislatures to return for special sessions (Millman, 5/23).

The Associated Press/Washington Post: Hobby Lobby Appeal Tests Limits Of Federal Birth-Control Coverage Mandate
In the most prominent challenge of its kind, Hobby Lobby Stores Inc. is asking a federal appeals court Thursday for an exemption from part of the federal health care law that requires it to offer employees health coverage that includes access to the morning-after pill. The Oklahoma City-based arts-and-crafts chain argues that businesses — not just the currently exempted religious groups — should be allowed to seek exception from that part of the health law if it violates their religious beliefs (5/23).

USA Today: Incentives Push Doctors To Electronic Medical Records
More than half of doctors' offices and 80% of hospitals that provide Medicare or Medicaid will have electronic health records by the end of the year, the Department of Health and Human Services announced Wednesday (Kennedy, 5/22).

The New York Times’ Bucks Blog: Family Medical Costs Still Rising
The good news is health care costs are going up more slowly. The bad news is that families continue to see larger medical bills. The typical cost to cover a family of four now exceeds $22,000, including the amount paid in insurance premiums and out-of-pocket costs, according to the latest Milliman Medical Index for 2013. Milliman, an actuarial and benefits consultant, puts the cost at slightly less than the amount a family might pay to send a child to an in-state public college for a year (Abelson, 5/22).

Los Angeles Times: Geography Has A Role In Elective Surgery Decisions, Study Finds
Geography plays a role in whether patients in California have elective operations such as joint replacement, weight loss surgery and gallbladder removal, according to a new study. The California HealthCare Foundation study showed wide variations in patient surgeries across the state (Gorman, 5/22).

Los Angeles Times: Most Unionized UC Hospital Workers Go To Jobs Despite Strike
As University of California patient care workers returned to the picket lines Wednesday, hospital administrators said they were gratified that so many others chose to come to work. More than three-quarters of union members who had been scheduled to work Tuesday did so, said Dianne Klein, spokeswoman for the UC office of the president. Hospital officials said they expected a similar turnout Wednesday (Gorman, 5/22).

The Associated Press/Washington Post: American Samoa To Keep Frequent Flier Miles Of Government Travelers; Use For Sick, Students
American Samoa plans to take away frequent flier miles from government workers who travel on behalf of the U.S. territory and use the loyalty points to help medical patients and students travel off the islands when necessary (5/22).

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Market Pressures May Keep Premiums Low As Health Law Kicks In

Wed, 22 May 2013 13:45:00 GMT

USA Today reports this optimisitic view is offered by some industry analysts and health insurance officials. Meanwhile, Politico does a status check on the legal challenges to the health law's birth control mandate. News reports also track the latest regarding the Internal Revenue Service controversy and the overhaul.

USA Today: Market, Insurers Will Keep Premiums Low, Analysts Say
Market forces and an impetus to attract younger, healthier people into the insurance market will help keep health insurance premiums lower as the 2010 health care law takes effect on Jan. 1, industry analysts and insurance officials say. "If they price too high, young people won't buy insurance, and that's going to hurt the companies," said Jay Angoff, who led initial implementation of the law for HHS. "They need these people to come in. It's an industry problem" (Kennedy, 5/21).

Here's an on-the-ground look at premium filings --

Oregonian: Oregon's 2014 Health Premium Filings Spark Relief, Questions
Massive health insurance premium hikes predicted as the inevitable result of federal reforms haven't materialized in Oregon. The lower-than-expected preliminary rates come as much-needed good news for the Affordable Care Act. The law, passed in 2010, has been plagued by resistance in Congress and complaints of snafus as the Jan. 1 startup for expanded coverage draws closer (Budnick, 5/21).

Also, the latest on the birth control mandate --

Politico: Courts To Hear Birth Control Mandate Lawsuits
Obamacare’s birth control mandate will go before four different appeals courts over the next three weeks as private businesses that object to the policy on religious liberty grounds bring a barrage of lawsuits that opponents hope to get before the U.S. Supreme Court as soon as this fall. On Wednesday, two for-profit companies will ask the 7th Circuit Court of Appeals to strike the requirement that they provide employees with insurance coverage that includes birth control and other drugs that they say can cause abortion. Three other companies will present oral arguments in different appeals courts by early June (Smith and Haberkorn, 5/22).

Bloomberg: Contraception Mandate Challenge Faces Appeal Court Judges
The U.S. law requiring employers to provide health insurance coverage for birth control is set to come before an appeals court in cases brought by two businesses whose owners say they operate according to Catholic doctrine. The businesses, a construction firm from southwestern Illinois and an auto-parts maker in southeastern Indiana, are scheduled today to ask the U.S. Court of Appeals in Chicago for an order barring enforcement of the measure while they challenge its constitutionality in lawsuits (Harris, 5/22).

In addition, tea party groups see the Internal Revenue Service scandal as a potential means to gin up health law opposition -

The New York Times: For Tea Party Groups, Shades Of 2010
Leaders of the Tea Party movement hope outrage over the I.R.S. inquiry will rekindle grass-roots activism that in many places went dormant after big Republican electoral defeats of November 2012. They aim to link the current scandal to other government programs they consider overweening -- principally the rollout of the health care overhaul law -- and generate a Republican wave in the 2014 midterm elections reminiscent of 2010's (Gabriel, 5/21).

In other related news --

The Hill: GOP Sen. Thune Urges IRS To Stop ObamaCare Work
Republican Sen. John Thune (S.D.) is demanding that the Internal Revenue Service (IRS) refrain from implementing ObamaCare while investigators probe the agency's targeting of conservative groups.
Thune, who leads the Senate Republican Conference, wrote to the Obama administration Tuesday connecting the scandal to Sarah Hall Ingram, an IRS official who once had oversight of tax-exempt groups (Viebeck, 5/21).

Outreach Effort Moves Forward Despite Sebelius Controversy

Wed, 22 May 2013 13:23:20 GMT

Families USA Executive Director Ron Pollack tells CQ Healthbeat that the flap won't prevent a robust effort by the nonprofit group, Enroll America, to sign up the uninsured. Meanwhile, White House Press Secretary Jay Carney draws parallels to earlier allegations about President Barack Obama's birth certificate.

CQ HealthBeat: Enroll America 'Alive And Growing' Despite Sebelius Controversy, Pollack Says
The controversy over donations to Enroll America Health that Human Services Secretary Kathleen Sebelius solicited won’t prevent the nonprofit group from waging a vigorous campaign to sign up the uninsured, its founder said in an interview Tuesday. There is no question that fundraising will be "at least significantly into eight figures; it already is," said Families USA Executive Director Ron Pollack (Reichard, 5/22).

The Hill: Carney: Questions About Sebelius Fundraising Similar To Certificate Concerns
White House press secretary Jay Carney on Tuesday unfavorably compared questions about donations solicited by Health and Human Services Secretary Kathleen Sebelius to Republicans questioning the president's birth certificate. At a tense briefing where Carney took tough questions on a series of issues that could damage the White House politically, the press secretary aligned himself with White House Communications Director Dan Pfeiffer, who over the weekend accused Republicans of engaging in "partisan fishing expeditions" (Sink, 5/21).

Viewpoints: Mass. Experience May Not Be True Test For National Health Law; 'Dishonest' Campaign By Medical Device Makers

Wed, 22 May 2013 13:13:22 GMT

The New York Times: Economix: Massachusetts Employees Will Keep Their Health Plans
Massachusetts is often held up as a window into America's health insurance future, because it embarked on what came to be called the Romneycare reform six years ago. Like the Affordable Care Act provisions going into effect nationwide next year, Romneycare aimed to increase the fraction of the population with health insurance by imposing mandates on employers and employees and by subsidizing health insurance plans for middle-class families without employer plans. ... The details and dollar amounts in the Massachusetts health care law differ from the national Affordable Care Act, and for that reason alone I hesitate to infer too much from the Massachusetts experience (Casey B. Mulligan, 5/22).

The National Review: It's Not 'Universal Coverage'
This history of Obamacare's political origins makes it all the more ironic that Obamacare, from what we now know, should not be considered a "universal coverage" plan, even by the benchmark the administration was using in 2009. Estimates from the Congressional Budget Office (CBO) point to this conclusion. In its latest assessment of the law, released in conjunction with new budget projections, the CBO indicates that the number of uninsured residents in the United States will never fall below 31 million -- three million more uninsured people than was estimated for the non-mandate plan President Obama rejected -- and that the insured will never be as much as 90 percent of the population (James C. Capretta, 5/21).

The Hill: Treat Nonprofit Health Care Fairly
For decades, unions have negotiated high quality, affordable health insurance through nonprofit Taft-Hartley plans -- one of the few reliable private providers for lower income individuals. ... In addition to being a long-standing and successful provider, these plans have been models of efficiency, achieving better cost savings than for-profit insurance carriers with medical loss ratios often exceeding 90 percent. That means 90 cents out of every dollar go to patient care. ... But as currently interpreted, the ACA would block these plans from the law's benefits (such as the subsidy for lower-income individuals and families) while subjecting them to the law's penalties (like the $63 per insured person to subsidize Big Insurance). This creates unstoppable incentives for employers to reduce weekly hours for workers currently on our plans and push them onto the exchanges where many will pay higher costs for poorer insurance with a more limited network of providers (Joseph T. Hansen, 5/20).

Los Angeles Times: Why The Medical Device Tax Needs To Stay
The chief drawback of a law as complex as the Affordable Care Act, the health insurance reform measure passed in 2010, is that it provides self-interested opponents a multitude of places to stick a wedge in and hammer away. But you'd be hard-pressed to find a campaign against the ACA as narrow-minded and dishonest as the one mounted by medical device manufacturers (Michael Hiltzik, 5/21).

Fox News: 5 Reasons The Government Is Not Prepared To Handle ObamaCare
The recent turn of events with the Obama Administration and a lack of transparency are a significant red flag to the impending catastrophe of how the proposed changes under the Affordable Care Act could be the next ensuing disaster. … The emerging IRS scandals, as they pertain to the multiple crises of the Obama Administration, are an ominous sign for how these very mistakes will impact the outcome of how the Affordable Care Act is implemented, and ultimately the lives of every American consumer (Dr. Sreedhar Potarazu, 5/21).

Fox News: Americans Beware – ObamaCare Expands How The IRS Can Hurt You
Most of us interact with the Internal Revenue Service once a year at tax time. But President Obama's Affordable Care Act health law puts us under the IRS's thumb all the time. The IRS has a history of using leaks and delays to punish people based on their politics. The latest is news that the IRS delayed processing requests for tax exempt status from the Obama administration's conservative critics, and even leaked information about them to the press (Betsy McCaughey, 5/20).

Des Moines Register: Possible Medicaid Compromise Is Encouraging
(Iowa Gov. Terry) Branstad indicated he would be willing to accept a form of Medicaid expansion if it came with assurances that if the federal government reduces funding for the program in the future, Iowans would not be left picking up the cost. On Tuesday, Sen. Jack Hatch, D-Des Moines, said legislative leaders and the governor's staff have been meeting frequently and may have a deal soon. The final, compromise plan should capture the maximum amount of federal money available, insure Iowans earning up to 138 percent of poverty level and be able to gain approval by the federal government. Whether elected officials are successful remains to be seen, but there is more hope now than there was a week ago (5/21).

Des Moines Register: Broader Medicaid Wouldn't Produce A Healthier Iowa
Bluntly, expanding Medicaid coverage would only make its recipients "feel better," but not actually be better. That makes Medicaid a very expensive feel-good program. Expanding Medicaid lives up to the name of the Affordable Care Act -- it gives "affordable care," nothing more. And the financial protection afforded Medicaid recipients is most effective in protecting against "catastrophic" health expenditures (Bob Williams, 5/21).

The Washington Post: Free Genes From Patent Restrictions
Jolie's news highlights an arcane but increasingly important question of patent law. As the sequencing of the human genome has expanded the ability to test for such genetic susceptibilities, is the discovery of the gene itself a patentable invention? (Ruth Marcus, 5/21).

The Seattle Times: Is Catholic Church Taking Over Health Care In Washington
Lord knows our schools have problems. But suppose we tried to solve them by doing something radical -- say, turning the schools over to the Catholic Church. … If put to a vote, this plan would crater. Most of us aren't Catholic, so I'm guessing we'd never go along with letting the creeds of that one faith run something as universal as education. So why are we allowing it with health care? (Danny Westneat, 5/21).

Miami Herald: Stopping Medicare Fraud
Miami has long had the sorry reputation for being the nation's leader in Medicare fraud, with seemingly just about anybody -- from convicted felons to, well, actors -- allegedly cashing in on what's supposed to be a medical safety net for the country's elderly and disabled. How can this happen? And keep on happening? ... But another part of Medicare, the administration arm that certifies that care givers who tap into Medicare reimbursements are actually qualified to do so and then verifies that they actually deliver the services they vouch for, must be much more diligent. Especially so in fraud capitals like Miami where it's so easy to find an abundance of seniors, some of whom are achingly vulnerable to crooks and cons (5/19).

JAMA: Value of Unique Device Identification in the Digital Health Infrastructure
In recent years, high-profile cases of medical device failure resulting in patient harm -- such as implantable cardioverter-defibrillator leads and metal-on-metal hip implants -- have received substantial attention both in the medical literature and popular press. These examples illustrate the need for a more effective system of monitoring device performance and protecting patient safety (Drs. Natalia A. Wilson and Joseph Drozda, 5/21).

JAMA Pediatrics: Stunting The Growth Of Child Health Research
A recent comprehensive assessment concluded that "lack of research, poor research, and poorly reported research" greatly limit child health research. Children participate in medical research at rates less than one-half those of adults, perhaps attributable to inadequate opportunities, ineffective recruitment strategies, and parents' greater concerns about their children's safety than their own in research settings. Meanwhile, health care spending on children declines every year as a share of national expenditures, causing concern that investment in child health research will decline as well (Dr. Matthew M. Davis, 5/20).

JAMA Internal Medicine: Evaluating Health System Processes With Randomized Controlled Trials
Health system processes shape and define health care and the medical experience of patients, health care practitioners, and society at large. These processes range from targeted mandates, such as gown and glove precautions for patient contact or automated computer alerts, to wider choices, such as deciding how to respond to medical emergencies, how to use (or not use) performance metrics or patient satisfaction surveys, what new health care facilities to build, or even how to finance health care costs and medical insurance. Given their unquestionable importance, we contend that health system processes should be routinely evaluated with randomized controlled trials (Drs. John P. A. Ioannidis and Vinay Prasad, 5/20).

The Medicare NewsGroup: Does Medicare Overpay Private Plans? The Debate Heats Up
The debate on whether Medicare Advantage (MA) is reducing health care costs is intensifying. A recently released analysis of government data by America's Health Insurance Plans (AHIP), the main health insurance lobby, found that seniors enrolled in MA plans in California and Nevada had better health outcomes than patients enrolled in Traditional Medicare. … Given the growing toxic environment in Washington and the fact that MA has become a political football, it's unlikely that the CMS or Congress will act before the 2014 elections, delaying a closer look (John Wasik, 5/21).

Health Policy Solutions (a Colo. news service): The Year Of Mental Health At The Colorado Legislature
In addition to other health care reforms (Medicaid expansion, improved parity for behavioral health coverage) two historic pieces of behavioral health legislation moved forward this year. One deals with Colorado's civil commitment laws -- statutes long overdue for a 21st century update. The other is a bill that includes over $20 million in funding to create a statewide behavioral health crisis response system. The governor signed both bills into law at the Jefferson Center for Mental Health on May 16 (Michael Lott-Manier, 5/21).

WBUR: Cognoscenti: Your Patient Is Your Partner: Collaboration Creates The Best Medical Outcomes
In a recent interview, physician and noted social activist Dr. Paul Farmer gave this advice to graduating medical professionals: their real impact will come when they work in teams. As the co-founder of Partners in Health and a champion of improving health in underserved communities, Farmer's work is built on building partnerships and applying successes and lessons learned to new frameworks (Laurie Edwards, 5/22).

State Roudup: Loophole Could Mean Calif. Docs Eat Some Costs

Wed, 22 May 2013 13:13:00 GMT

A selection of health policy stories from California, Kentucky, Texas, Florida, North Carolina, Oklahoma and Missouri.

Sacramento Bee: Loophole In Health Care Law Could Stick Doctors With Tab
A loophole in California's upcoming health care overhaul could be exploited by families gaming the system or responding to hardship in a way that doctors say could leave a pile of unpaid bills. A chain of events would create a two-month period during which a family has medical coverage but no insurer must pay its claims. Nonpayment of premiums for subsidized policies would trigger the oddity: Federal law provides a three-month grace period before cancellation -- but insurers are responsible only for the first month (Sanders, 5/21).

Los Angeles Times: Strike At UC Medical Centers Continues; More Picketing Wednesday
As the afternoon wore on, the number of union members on the picket lines at the University of California medical centers started to thin. But hundreds of workers concerned about staffing levels and pension reforms planned to continue striking throughout the evening. Union spokesman Todd Stenhouse said that the decision to strike was a difficult one for many (Gorman and LaGanga, 5/21).

Sacramento Bee: Thousands Strike At University Of California
As non-emergency surgeries were postponed and fill-in medical technicians were brought in from out of state, thousands of employees walked off the job Tuesday at the UC Davis Medical Center and four other University of California hospitals. The two-day strike, due to end at 4 a.m. Thursday, was billed by the union for nearly 13,000 nursing assistants, pharmacists, operating room scrubs and other workers as a walkout over medical staffing levels and patient safety (Hecht and Lindelof, 5/21).

The Associated Press: N. Ky. Health Department Stops Well-Child Exams
The health department in northern Kentucky says it plans to stop offering well-child visits because Medicaid no longer offers reimbursement for them. Health department spokeswoman Emily Gresham Wherle told The Kentucky Enquirer that the agency will not schedule any new appointments at their locations in Boone, Campbell, Kenton and Grant counties (5/21).

The Texas Tribune: Bill Lets Police Take Guns From Those In Mental Crisis
Police would have new authority to take firearms away from Texans who are in a mental crisis under a bill the House approved on Tuesday that is now headed to Gov. Rick Perry's desk. Senate Bill 1189, by state Sen. Joan Huffman, R-Southside Place, would allow police to confiscate guns from people who are experiencing a mental health crisis if they determine the person is a danger to themselves or others (Grissom, 5/21).

Health News Florida: Leapfrog Group Ranks FL 10th In Safety
Thirty-seven percent of Florida hospitals have received an "A" grade from the Leapfrog Group, a nonprofit organization that grades participating hospitals on their efforts to prevent medical errors, putting the Sunshine State in 10th place. The scoring system is based on 26 safety measures including hand-washing and care of patients with catheters or ventilators, according to the Leapfrog web site. Hospitals are given letter grades based on these scores (Burton and Gentry, 5/21).

North Carolina Health News: On the Road: Wos Takes Medicaid Message To The People
The head of the state's Department of Health and Human Services has received less than a wholehearted reception as she's traveled the state explaining the governor's proposed Medicaid overhaul (Sisk, 5/22).

North Carolina Health News: Senate Gives More Detail On Budget Plan
More details about the Senate's plans for Medicaid and the state's health care budget emerged Monday as senate leaders explained more of their thinking around their budget plans. In meetings with the media and during presentations in appropriations meetings Monday afternoon, senators reiterated several times that Medicaid has become a drag on state spending (Hoban, 5/21).

Tulsa World: House Speaker Won't Save Insure Oklahoma
Oklahoma Speaker of the House T.W. Shannon has pulled the plug on Gov. Mary Fallin's plans to save the Insure Oklahoma program, which provides health care to working poor Oklahomans. As a result, 9,000 people currently getting state and federally subsidized private insurance through the program will be left without coverage (Greene, 5/20).

St. Louis Post-Dispatch: Nixon's Changes At Medicaid Agency Puzzle Health Care Advocates
Questions continued to swirl in the state capital Tuesday about the sudden departure last week of Missouri's Medicaid director, a widely respected physician who had navigated choppy political waters for six years. Health care advocates and legislators said that former Medicaid chief Ian McCaslin was forced out by Gov. Jay Nixon's office. But none could pinpoint why (Young, 5/22).