First Edition: May 12, 2014

May 12 2014

Today's headlines include news about the inner-workings of some state-based health exchanges.

Kaiser Health News: Medicare Struggling With Hepatitis-C Cure Costs
Reporting for Kaiser Health News, in collaboration with NPR, Richard Knox writes: "Previous drug treatments didn't clear the virus from Bianco's system. But it's almost certain that potent new drugs for hep-C could cure him. However, the private insurer that handles his medication coverage for the federal Medicare program has twice refused to pay for the drugs his doctor has prescribed" (Knox, 5/12). Read the story.

Kaiser Health News: D.C. Health Insurance Tax Triggers Insurer Pushback
Kaiser Health News staff writer Lisa Gillespie reports: "Insurers who are not selling their wares on Washington, D.C.'s exchange have signaled they may sue to block a D.C. council plan to charge them a 1 percent annual tax on all health-related plans sold in the city. The revenue would pay for the continuing operation of online marketplace" (Gillespie, 5/12). Read the story. 

Kaiser Health News: Capsules: States' Medicaid Decisions Leave Health Centers, Patients In Lurch
Now on Kaiser Health News' blog, Phil Galewitz reports: "More than 1 million patients who use federally funded community health centers will remain uninsured because they live in one of 24 states that chose not to expand Medicaid under the Affordable Care Act, according to a study released Friday by researchers at George Washington University" (Galewitz, 5/9). Check out what else is on the blog.

The Wall Street Journal: Obamacare Question: Ditch Employer Mandate? 
A left-leaning think tank whose research is often taken seriously by backers of the health-care overhaul has published a paper suggesting the administration should scrap the health law's requirement that employers offer coverage or pay a penalty. "Why Don't We Just Get Rid of the Employer Mandate?", by three researchers at the Urban Institute, argues that the requirement won't lead to many more people gaining coverage, since most firms that don't currently offer benefits to all their workers will opt for the penalty, and most firms that already voluntarily offer benefits will want to carry on doing so (Radnofsky, 5/10).

The Wall Street Journal: Virginia Filings Give First Look At 2015 Health Rate Increases
In the first look at how insurers plan to adjust prices in the second year under the federal health-care law, filings from Virginia carriers show they are opting for premium increases in 2015 that will pinch consumers' pocketbooks but fall short of some bigger rate predictions. The new premium proposals, detailed in official filings to the state's insurance regulator, show health plans all opting for some increases (Radnofsky, 5/11).

Los Angeles Times: Insurance Agents Played Key Role In California's Obamacare Enrollment
As enrollment neared under the Affordable Care Act, both President Obama and California officials boasted that signing up for health insurance would be as easy as ordering a book from Amazon.com or buying a plane ticket online. With that in mind, Covered California's executive director, Peter Lee, predicted a bleak future for insurance agents selling individual policies, saying they could easily go the way of travel agents. As it turns out, reports of their demise were greatly exaggerated. Insurance agents played a major role in California's larger-than-expected enrollment of 1.4 million people in private health plans (Terhune, 5/10).

Politico: $474M For 4 Failed Obamacare Exchanges
Nearly half a billion dollars in federal money has been spent developing four state Obamacare exchanges that are now in shambles -; and the final price tag for salvaging them may go sharply higher. Each of the states -; Massachusetts, Oregon, Nevada and Maryland -; embraced Obamacare, and each underperformed. ... The federal government is caught between writing still more exorbitant checks to give them a second chance at creating viable exchanges of their own or, for a lesser although not inexpensive sum, adding still more states to HealthCare.gov (Haberkorn and Cheney, 5/11).

The Associated Press: Insurance CEO: Shut Down Hawaii Health Exchange
The chief executive of Hawaii's largest health insurance company is calling on Hawaii to shut down its beleaguered health insurance exchange, which was set up as part of President Barack Obama's signature health care law. Michael Gold, president and CEO of Hawaii Medical Services Association, says the state shouldn't keep spending money on the Hawaii Health Connector, a system that he says is financially unsustainable and does not work (Bussewitz, 5/9).

The Wall Street Journal: Rural Hospitals Feel Pinch
Rural hospitals have long been under financial pressure from the rising cost of providing health care, the dwindling number of patients staying overnight and the shift of more profitable services like cardiac care to bigger medical centers. Now, the Obama administration, saying that some rural hospitals have been receiving subsidies they weren't meant to get, has proposed eliminating a further $2.1 billion in Medicare payments next fiscal year for hospitals designated as providing "crucial access." In addition, under the new federal health law, hospitals are losing government subsidies for providing care to the uninsured (Bauerlein, 5/11). 

The Associated Press: Pregnant Women Gain New Options Under Health Law
Lower-income women who signed up for a private policy in the new insurance exchanges will have access to additional coverage from their state's Medicaid program if they get pregnant. Some women could save hundreds of dollars on their share of hospital and doctor bills (5/10). 

The Washington Post: Liberal Groups Launch Campaigns To Boost Turnout Based On Obamacare Support
Democrats and Republicans agree on one thing about the hotly contested Affordable Care Act: When it comes to voter intensity, the GOP holds a clear upper hand. But a trio of major liberal groups hopes to change that in coming months, with plans to spend tens of millions of dollars persuading residents in a dozen key states to vote for Democrats based on the issue. ... By focusing on more popular parts of the law -; including Medicaid expansion, free birth-control coverage and a bar on denying coverage for preexisting conditions -; the [The Service Employees International Union, the Planned Parenthood Action Fund and MoveOn.org] hope to coax individuals who often skip voting in midterm elections to make it to the polls (Eilperin and Somashekhar, 5/10).

Politico: Koch Brothers' Americans For Prosperity Plans $125 Million Spending Spree
The Koch brothers' main political arm intends to spend more than $125 million this year on an aggressive ground, air and data operation benefiting conservatives, according to a memo distributed to major donors and sources familiar with the group. ... AFP developed "a sophisticated new media message-testing strategy to target specific demographics in specific locations we need to move on our issues," according to the memo. The resulting advertisements increasingly have used personal stories, often told by regular folks looking directly into the camera, to critique Democratic policies like Obamacare, and the politicians who support them (Vogel, 5/11).

Politico: Bachmann, Wasserman Schultz Spar On CNN
Some clear tension arose between Democratic National Committee Chairwoman Debbie Wasserman Schultz and Republican Rep. Michele Bachmann during a segment Sunday on CNN's "State of the Union," as the two went head to head on a handful of issues, starting with the new Benghazi select committee in the House. "Republicans have clearly lost the ability, because we've had such a precipitous drop-among Republicans even-in their fervor for repealing the Affordable Care Act, that they are clearly doing this to drive their turnout," Wasserman Schultz said. "No, Candy, Candy, that is not true at all," Bachmann interjected to CNN host Candy Crowley (McCalmont, 5/11).

Politico: Hagel: We Missed VA Problems
Addressing the scandal plaguing the Department of Veterans Affairs, Defense Secretary Chuck Hagel says the backlog is an issue that should have been looked at "years ago." "I don't think it just started with [Veterans Affairs Secretary] Gen. [Eric] Shinseki's term at the VA," Hagel said in an interview with ABC's Martha Raddatz that aired Sunday on "This Week." "This is something that should've been looked at years and years ago. So. yes, we missed it" (McCalmont, 5/11).

USA Today: Veteran Reports Delay In Care At Fort Collins VA Clinic
Henry P. Leweling's chest hurt. He suffers from high cholesterol -; and a family history of heart disease ... That pain in August pushed the 68-year-old from Fort Collins, Colo., to drive to the Cheyenne, Wyo., Veterans Affairs Medical Center to receive treatment. Doctors saw him through urgent care and he was sent from Cheyenne to his primary care physician at the Fort Collins VA clinic. He remembers walking into Fort Collins, chest still aching, and telling staff he just came from Cheyenne with orders to see his doctor. He also remembers the staff's response: "We can see you in three or four months" (Coltrain, 5/11).

The Washington Post: Pain And Gain: An Alabama Clinic Stands Out Amid Data On Medicare Payments
Afflicted by pain from spinal injuries, botched surgeries or rare nerve conditions, patients from Tennessee, Georgia and Florida have flocked across state lines to see K. Dean Willis, a tanned anesthesiologist with salt-and-pepper hair who says he is among the top 30 experts on the use of pain pumps. ... Although some experts consider the implanted pain pump to be an unusual and controversial last resort of pain management, it has become a signature treatment at the Alabama Pain Center. ... For the first time, newly released Medicare data has identified the costs associated with specific doctors performing procedures or administering drugs. The data allows for the identification of "hotspots" for particular treatments (Brittain, Fallis and Keating, 5/10). 

Los Angeles Times: California Bill Would Ease Professional Licensing Rule For Immigrants
Denisse Rojas earned a biology degree from UC Berkeley and has set her sights on medical school. But one big obstacle stands in her way. To practice medicine in California, doctors must obtain a license from the state, and applicants are required to provide a Social Security number as proof of identity. Rojas, 25, does not have such a number. She is in the United States illegally, having been smuggled into the country from Mexico by her parents when she was 6 months old. But a group of legislators wants to help her -; to do for doctors, dentists, nurses, barbers, security guards and many others what they did last year for attorneys: grant those in the country illegally permission to practice their occupations (McGreevy, 5/12).

The Wall Street Journal: Los Angeles Plan Highlights Rift Over How To Treat Offenders With Mental-Health Issues
Local-government officials, residents, civil-rights activists and mental-health experts around the country differ on how best to handle criminal offenders with addiction and mental-health problems. Some leaders argue in favor of treatment within corrections systems, for reasons of public safety and to fulfill constitutional mandates to care for incarcerated offenders. Others say nonviolent offenders like Mr. Dumont should be redirected into community-based treatment, through so-called diversion programs. Jail-based treatment, they argue, is more expensive, less effective in remedying inmates' problems and, as Mr. Dumont notes, can encourage people to re-offend in hopes of getting help (Phillips, 5/9).