First Edition: June 19, 2014

Today's headlines include reports about how the 2015 insurance premium rates are shaping up across the country and details of consumers' experiences in trying to get their new coverage.

Kaiser Health News: Capsules: Future Uncertain For VA Rural Health Pilot Program
Now on Kaiser Health News' blog, Kansas Public Radio's Bryan Thompson reports: "Sen. Jerry Moran, R-Kan., said a U.S. Department of Veterans Affairs pilot program offering timely, quality health care to rural veterans is being allowed to expire in a few months, even as major legislation moves through both houses of Congress that would have similar goals as the pilot program. The pilot program is called Access Received Closer to Home, or ARCH. It's offered at five sites -; Pratt, Kansas; Caribou, Maine; Farmville, Virginia; Flagstaff, Arizona, and Billings and Anaconda, Montana. The program allows veterans to get health services from community providers if they live at least one hour from a VA health facility" (Thompson, 6/19). Check out what else is on the blog.

The Wall Street Journal: Premiums Rise At Big Insurers, Fall At Small Rivals Under Health Law
Hundreds of thousands of consumers nationwide who bought insurance plans under the Affordable Care Act will face a choice this fall: swallow higher premiums to stay in their plan, or save money by switching. That is the picture emerging from proposed 2015 insurance rates in the 10 states that have completed their filings, which stretch from Rhode Island to Washington state. In all but one of them, the largest health insurer in the state is proposing to increase premiums between 8.5% and 22.8% for next year, according to a Wall Street Journal review of the filings. That percentage represents the average rate increases for all individual health plans offered by that carrier (Radnofsky, 6/18).

The Washington Post: Federal Insurance Exchange Subsidies Cut Premiums By Average Of 76%, HHS Reports
The Americans who qualify for tax credits through the new federal insurance exchange are paying an average of $82 a month in premiums for their coverage -; about one-fourth the bill they would have faced without such financial help, according to a new government analysis. But the analysis shows wide variations among states in the premiums that people are paying for their new insurance, the amount the government is picking up and the proportion who qualify for the subsidies (Goldstein, 6/18).

The Washington Post: District Residents Find Long Delays Getting Health Insurance From Private Plans
Consumers who signed up for private health insurance through the District's new insurance marketplace are experiencing lengthy delays in getting coverage, in some cases two to three months long, because of problems processing their applications, according to residents and enrollment personnel. In some cases, delays are forcing people without insurance to postpone doctor and dental visits (Sun, 6/18).

The Associated Press: Delaware Subsidized Premiums Among Highest
Federal officials say Delawareans who are getting subsidies for health care insurance under the Affordable Care Act are getting an average monthly tax credit of $263. But figures released Wednesday also show that the 81 percent of enrollees in Delaware's health insurance exchange are paying the third-highest average monthly premium in the country after tax credits are figured in (6/18).

The Washington Post's Wonkblog: What Would It Cost To 'Fix' Obamacare
You can't find an Obamacare supporter anywhere who thinks that the massive health-care law is problem-free. Any major law regularly gets fixed through the legislative process after it's passed, but the politics surrounding the Affordable Care Act has pretty much made this impossible so far. Democrats on the campaign trail have often talked about the need for fixing and improving Obamacare without really getting into specifics. That prompted conservative policy expert Chris Jacobs of America Next to recently wonder what these fixes would cost and how they'd be paid for. So I thought it would be a fun and useful exercise to round up Obamacare "fixes" that have garnered the broadest support and look at what they could potentially cost (Millman, 6/18).

USA Today: Supreme Court Decisions Could Have Broad Impact
Fourteen of the court's 70 argued cases remain to be decided on topics ranging from abortion and contraception to Internet streaming and cellphone privacy. … A Massachusetts law creating 35-foot buffer zones around abortion clinics to keep protesters away from patients faces a potential First Amendment roadblock. The court upheld an 8-foot buffer zone in Colorado 14 years ago, but that was a close call. During oral arguments this winter, even liberal justices openly wondered if the Bay State had gone too far. … The court will decide whether for-profit companies with religious objections can be forced to offer coverage for contraceptives in their insurance plans.The case, brought by two corporations that equate certain birth control methods with abortion, threatens to become the first legal chink in the armor of the president's health care law. The court upheld the law in 2012 (Wolf, 6/19).

Los Angeles Times: Fixing VA Mess Could Cost Billions, Complicating Congress Talks
The rush to fix the VA mess is running into an age-old Washington problem: where to find the money. Legislation to allow veterans facing long waits at Department of Veterans Affairs facilities to seek private healthcare could cost $50 billion or more a year, complicating efforts in Congress to swiftly come to agreement on a compromise bill (Simon, 6/18). 

The Washington Post: The Costs Of The Senate VA Bill
Three Republicans and at least one think-tank have opposed the bipartisan veterans affairs bill that passed the Senate with overwhelming support last week, saying the legislation was rushed to a vote before the costs were known. So what do we know about the measure's price tag? First, let's look at the language of the bill. The provisions largely address the scheduling scandal within the Department of Veterans Affairs' health system, but they also expand certain benefits for former troops and their families (Hicks, 6/18).

Politico: House Creates VA Conference Committee
House and Senate lawmakers moved closer on Wednesday to new reforms to help fix problems with the Department of Veterans Affairs' medical facilities. The House approved legislation to convene a conference committee on the two VA-focused bills that would allow veterans to seek private care if they waited longer than a "standard" period of time for treatment. The bill would also give VA leadership the ability to fire department officials found to be involved with misconduct or who are under-performing (French, 6/18).

The Associated Press: VA Chief: More Vets Wait 30 Days for Appointment
About 10 percent of veterans seeking medical care at VA hospitals and clinics have to wait at least 30 days for an appointment -; more than twice the percentage of veterans the government said last week were forced to endure long waits, the acting veterans affairs secretary said Wednesday. Sloan Gibson said the higher number of veterans waiting 30 days or more is revealed in a report due out Thursday. He called the increase unfortunate, but said it was probably an indication that more reliable data was being reported by VA schedulers, rather than an actual increase in veteran wait times (6/18).

The Wall Street Journal: House Panel Is Subpoenaed As Trading Probe Heats Up
Prosecutors are gathering evidence for a grand-jury probe into whether congressional staff helped tip Wall Street traders to a change in health-care policy, an indication the long-running investigation has entered a more serious phase. Public documents show federal law-enforcement officials and the Securities and Exchange Commission are seeking records and other evidence from the House Ways and Means Committee and a top congressional health-care aide, Brian Sutter, staff director of the committee's health-care subpanel (Mullins and Ackerman, 6/18).

The New York Times: G.A.O. Tech Chief Says Washington Should Start Small On Big Projects
The most stunning example in recent memory, the HealthCare.gov insurance marketplace, speaks to that point. On Day 1, it was supposed to be both national and catering to anyone, using newer technologies with which many of the contractors did not have deep experience. "Was the project ever reviewed at an executive level while it was underway?" said Mr. Powner. "We didn't see any evidence." As this was supposed to be an Internet-based project involving cloud computing, he noted, a more common contemporary private sector approach would have been to have tested parts of the program on sectors of the economy, and then to have built them up over time (Hardy, 6/18).

The Washington Post: AMA: Doctors Must Be Licensed In Patient's State To Practice Telemedicine
The American Medical Association recently offered policy recommendations that, if implemented, would place restrictions on telemedicine, or virtual medical care. The recommendations came as the Chicago-based organization of physicians and medical students formally announced its support for the practice, claiming telemedicine could "greatly improve access and quality of care while maintaining patient safety" (Ravindranath, 6/18).

USA Today: Businesses Urged To Track Workforce Health
Out of frustration with decades of failed efforts to improve America's health and cut its health care spending, a new institute launched an effort Wednesday to attack the problem at work. The habits of working adults – smoking, lack of exercise, unhealthy eating and high stress – lay the groundwork for health problems years and decades later. Improving those health habits could dramatically reduce health care spending over the long term and make American workers more productive and competitive, said Derek Yach, executive director of the Vitality Institute for Health Promotion, a think-tank that aims to reduce non-communicable diseases such as heart disease, diabetes, mental illness and cancer (Weintraub, 6/18).

NPR: How Your State Rates In Terms Of Long-Term Care
n just 12 years, the oldest members of the huge baby-boom generation will turn 80. Many will need some kind of long-term care. A new study from AARP says that care could vary dramatically in cost and quality depending on where they live. The study was motivated by a simple fact: The number of available family caregivers is declining. In 2010, there were potentially seven for each person 80 years old or older. By the time baby boomers reach that age, there will be only four potential caregivers for each of them. And those numbers are expected to continue declining. Chalk it up to longer lives and smaller families (Jaffe, 6/19).

The New York Times: Select Home Care Weighs New Wage And Labor Regulations
Select is confronting an array of regulatory changes. A federal rule will extend the minimum wage and overtime protections of the Fair Labor Standards Act to nonmedical caregivers when it takes effect in January. The company's home state, California, has already enacted legislation that added a Domestic Worker Bill of Rights to the California Labor Code. Under the new guidelines, which went into effect Jan. 1, nonmedical home care employees are entitled to overtime pay for any more than 45 hours of work a week. In addition, California's minimum wage will rise to $9 an hour on July 1. For home care companies like Select, these changes mean shorter shifts, more employees and higher wages (Chhabra, 6/18). 

The Washington Post: McDonnell Reflects On Cantor's Loss, Gillespie's Chances At GOP Gathering In Va.
Romney also endorsed Gillespie, who he said dropped everything to work for his 2012 presidential bid, and slammed Warner over taxes, Obamacare and foreign policy. … Gillespie made a pitch for doubling the nation's economic rate, although he provided no specifics. "We know that our policies will create jobs and raise take-home pay and hold down health-care costs and reduce energy prices," he said, adding later: "Instead of having a blank check for President Obama, we can have a check on President Obama" (Portnoy, 6/18).

The New York Times: New York Legislature Reaches Deal On More Laws To Fight Heroin Problem
For the second time in two weeks, Gov. Andrew M. Cuomo gathered reporters on Wednesday to make an announcement about the state's heroin problem, which has dominated discussions at the close of the legislative session in Albany. Last week, flanked by law enforcement officers, the governor was behind a lectern emblazoned with the words "Heroin Epidemic" (Goodman and McKinley, 6/18).

The Wall Street Journal: Deal Struck In Albany On Tackling Heroin Surge
Mr. Cuomo, a Democrat, cited statistics showing heroin's increasing share of the state's illegal drug market. Between 2004 and 2013, heroin and prescription-opiate treatment admissions in New York rose to 89,269 from 63,793, according to the state. The piece of the legislation with potentially the most immediate impact involves how insurance companies define treatment that is "medically necessary," a threshold used to determine whether to cover treatment. Advocates have complained that definitions of medical necessity differ among insurance companies and are applied unevenly (Orden, 6/18).

The Associated Press: NY Assembly Passes Birth Control Insurance Bill 
A bill that would prevent employers from discriminating against workers for reproductive health decisions has passed the Democratic-led Assembly. The "Boss bill," passed 80-22 on Wednesday, seeks to close a loophole in New York's anti-discrimination laws (6/19).

Asbury Park Press/USA Today: Report: Sandy Left Mental Health Issues In Its Wake
What had long been predicted in the immediate aftermath of Sandy is finally appearing in the data research: More individuals in the 10-county area affected by Sandy in New Jersey are seeking help for behavioral health concerns such as alcohol and substance abuse, sleep disturbances, anxiety, depression and post-traumatic stress disorder (Cervenka, 6/18).