First Edition: March 28, 2013

Mar 28 2013

Today's headlines include various stories about the health law's implementation at both the federal and state level.  

Kaiser Health News: FAQ On The Latest Study: Obamacare's Impact On Insurance Claim Costs
Kaiser Health News' staff writer Jay Hancock reports: "It's too early to know how much individual health insurance policies will cost once the online marketplaces created under the Affordable Care Act launch Jan. 1. But that hasn't stopped experts and interest groups from making predictions. The latest analysis comes from the Society of Actuaries. It's attracting attention because of the group's expertise and nonpartisanship. What actuaries do for a living -; predicting future expense based on multiple squishy factors -; is at the core of figuring out what will happen under Obamacare" (Hancock, 3/28). Read the story.

Kaiser Health News: Capsules: Tight Medicaid Eligibility Leads To More Adults Delaying Care; Audit Finds Shortcomings In Minn. Verifications Of Income, Other Information
Now on Kaiser Health News' blog, Ankita Rao reports on research related to tight Medicaid eligibility and the incidence of delayed medical care: "The research letter in the March 28 issue of the journal found this number to vary significantly across the country and to be lower in places with less restrictive eligibility criteria for Medicaid, the federal-state insurance program for low-income citizens" (Rao, 3/27).

Also on Capsules, Minnesota Public Radio's Elizabeth Stawicki, working in partnership with KHN and NPR, reports on a Minnesota audit: "An audit released Tuesday shows Minnesota's Department of Human Services has not been adequately verifying the eligibility of participants in some of its public assistance programs.  Such verifications are a requirement of state and federal law, and the legislative auditor says his office first alerted the department to some of the problems more than a decade ago" (Stawicki, 3/27). Check out what else is on the blog.

Los Angeles Times: One Date Is Not Enough: Obama To Dine Again With GOP Senators
This summer, Congress will be asked to raise the U.S. debt limit to avoid defaulting on obligations. Republicans will press the White House for budget cuts in exchange, and will likely target the Medicare and Medicaid health programs, which are driving much of the red ink. Democrats will insist on raising tax revenue to help plug the budget gaps. The debate is likely to be difficult, and one that could easily fall into the cycle of brinkmanship that has complicated past budget battles between Congress and the White House. The dinner dates may help set the tone, House Speaker John A. Boehner (R-Ohio) has said, but will not resolve the differences (Mascaro and Hennessey, 3/27).

The Wall Street Journal: Restaurant Chains Cut Estimates For Health-Law Costs
Restaurant owners have been fierce critics of the health-care overhaul law, fearing that its mandate for employers to offer insurance more broadly will drive up costs and deter hiring. Now, some operators say the law may not be that costly after all. They say many employees won't qualify for coverage, and many of those who do qualify will decline company-offered insurance (Thurm, 3/27).

The New York Times: Governor Of Tennessee Joins Peers Refusing Medicaid Plan
Gov. Bill Haslam of Tennessee said Wednesday that he would not expand Medicaid in his state as called for in the federal health care overhaul, joining 18 other Republican governors who have rejected expansion for now (Goodnough, 3/27).

The Wall Street Journal: Tennessee Holds Off On Medicaid Expansion
Mr. Haslam, a Republican, said he wants to broaden health-insurance coverage to more low-income residents in Tennessee using federal funds from the health-care law. But the governor said he wouldn't move forward until he reaches an agreement with federal regulators that allows his state to do so on its own terms. The governor told state lawmakers that he favors enrolling tens of thousands more people in private insurance policies, rather than signing them up for the state's Medicaid program (Radnofsky, 3/27).

USA Today/The Tennessean: Tenn. Gov. Won't Expand Medicaid To Cover Uninsured
Gov. Bill Haslam said he wants to leverage federal dollars to purchase private health insurance for Tennesseans without coverage who can't afford it. But the federal Department of Health and Human Services has not signed off on his idea (Sisk and Wilemon, 3/27).

The Associated Press/Washington Post: Quinnipiac Statewide Survey Shows Sharp Gender, Racial Divides In Va. Over Medicaid Expansion
A new statewide poll in Virginia shows a sharp societal divide over the question of whether to expand Medicaid -; something that won't happen for a while in the state because of reform hurdles Gov. Bob McDonnell has set for it. Quinnipiac University's survey of 1,098 registered Virginia voters found 45 percent favor expanding the federal-state program that helps pay healthcare costs for the elderly, poor and disabled to about 400,000 Virginians just above the poverty level. Forty-three percent did not (3/28).

Los Angeles Times: Low-Income California Seniors To Move Into New Managed Care Plan
In a major shift triggered by the national healthcare law, nearly half a million low-income California seniors and disabled patients will begin moving into a new managed care program this fall. The patients, who receive both Medi-Cal and Medicare, are among the most costly in the state. Officials believe that the program, Cal MediConnect, will reduce spending and improve care by shifting the patients out of a fragmented system and into one that is more coordinated (Gorman, 3/27).

NPR: When A Famous Hospital Didn't Want An Expensive New Drug
Last year, a new drug called Zaltrap was approved as a kind of last-chance therapy for patients with colorectal cancer. Studies suggested Zaltrap worked almost exactly as well as an existing drug, called Avastin. In fact, the main difference between the two drugs seemed to be the price. "I was rather stunned," Dr. Leonard Saltz, who specializes in colorectal cancer, told me. Zaltrap costs about $11,000 per month -; about twice as much as Avastin, Saltz said. Saltz and his colleagues at Memorial Sloan Kettering Cancer Center in New York made what seemed like a very reasonable decision: The hospital would not stock the more expensive drug. But taking cost into account for a new cancer drug was a very unusual decision for the hospital (Kestenbaum, 3/28).

The Wall Street Journal: Drugstores Press For Pricing Data
America's shift to generic drugs has saved consumers more than a $1 trillion over a decade, but it has taken a heavy toll on independent pharmacists. Now these small businesses are turning to state legislators across the country for help against powerful middlemen that determine how much drugstores are reimbursed for certain medicines. Currently, eight states, including Oregon, are considering such legislation (Martin, 3/27).

The New York Times: Job Prospects Are Dimming For Radiology Trainees
For years, medical students who chose a residency in radiology were said to be on the ROAD to happiness. The acronym highlighted the specialties -; radiology, ophthalmology, anesthesiology and dermatology -; said to promise the best lifestyle for doctors, including the most money for the least grueling work. Not anymore. Radiologists still make twice as much as family doctors, but are high on the list of specialists whose incomes are in steepest decline (Bernstein, 3/27).

Los Angeles Times: Judge Weighs Brown's Bid To End Court Oversight
California's bid to end court oversight of the care it gives about 33,000 mentally ill inmates was heard Wednesday by a federal judge who voiced concern that he had only days to weigh thousands of pages of contradictory claims and issue a decision (St. John, 3/27).

Los Angeles Times: California Issues Annual Ratings For Health Plans, Physician Groups
Kaiser Permanente was the only HMO to earn a top four-star rating for providing recommended care on California's annual report card, while Cigna and UnitedHealthcare led the way with three-star ratings among PPO plans. The report issued Wednesday on California's biggest HMOs and other health insurance plans showed improvement in care for children, but mixed results for treating adults with chronic medical conditions (Terhune, 3/27).

The Washington Post: Maryland Officials Outline Huge Changes To Payment System For State Hospitals
Maryland health officials on Wednesday outlined major changes to how hospital costs are paid in an effort to keep the state's unique Medicare waiver agreement with the federal government -; a deal that has provided enormous financial benefits to the state in recent decades (3/28).

The Washington Post: Three Firms Picked For D.C. Medicaid Contracts
City officials have chosen three firms to receive some of the city's largest contracts, to provide health care to low-income D.C. residents enrolled in Medicaid and other government health programs (DeBonis, 3/27).