First Edition: July 18, 2014

Jul 18 2014

Today's headlines include reports from the marketplace, including UnitedHealthcare's move toward the health law's insurance marketplaces and the latest on the Securities and Exchange Commission investigation into insider trading related to a health policy change. 

Kaiser Health News: A Reader Asks: If You Have A Job-Based Plan, Can You Buy On The Marketplace?
KHN consumer columnist Michelle Andrews points out that standards for eligibility to buy a plan off the exchange is different than eligibility for subsidies (7/18). Read her response.

Kaiser Health News: Capsules: Biggest Insurer Drops Caution, Embraces Obamacare
Now on Kaiser Health News' blog, Jay Hancock reports on a signal by UnitedHealthcare that the insurer is embracing the health law's exchanges: "UnitedHealthcare, the insurance giant that largely sat out the health law's online marketplaces' first year, said Thursday it may sell policies through the exchanges in nearly half the states next year" (Hancock, 7/17). Checkout what else is on the blog.

The Washington Post's Wonkblog: The Administration Just Took Obamacare Away From The Territories
Looking for a place where Obamacare doesn't exist? Try moving to the U.S. Territories, where the Obama administration just provided a pretty big waiver from the law's major coverage provisions. The Affordable Care Act's design dealt a pretty big problem to the territories. It required insurers there to comply with the law's major market reforms -; guaranteed coverage, mandated benefits, limits on profits, etc. -; without requiring residents to get coverage or providing subsidies to help them afford coverage. The territories -; Puerto Rico, the U.S. Virgin Islands, American Samoa, Guam and the Northern Mariana Islands -; have been warning for years that would destroy their insurance markets. The individual mandate and the subsidies are the major ways the ACA tries to bring healthy people into the individual insurance market to balance out sick patients who can no longer be denied coverage (Millman, 7/17).

The Wall Street Journal's Law Blog: Health Plans Must Disclose Changes To Contraceptive Coverage
The Obama administration said Thursday that employers that stop covering contraceptives in workers' health plans must disclose the change to beneficiaries in the wake of a Supreme Court ruling. The requirement notice that appeared online follows the Supreme Court's late-June Hobby Lobby decision, which allows some closely held companies to opt out the federal law's contraceptive coverage requirements on religious grounds. It appeared on a Department of Labor website of frequently asked questions about the Affordable Care Act, which mandates contraception coverage (Armour, 7/17).

The Washington Post: New Challenge For Obamacare: Enrollees Who Don't Understand Their Insurance
Nine months after Americans began signing up for health insurance under the Affordable Care Act, a challenging new phase is emerging as confused enrollees clamor for help in understanding their coverage. Nonprofit organizations across the country are being swamped by consumers with questions. Many are low-income, have never had insurance and have little knowledge of the health-care system. The rampant confusion poses a potential hurdle for the success of the health law: If many Americans don't understand how health insurance works, that could hurt their ability to use their benefits -; or to keep their coverage altogether (Sun, 7/16).

Politico: Democrats Seek Cost Estimate Of Barack Obama Suit
Democrats on the House committee tasked with overseeing a Republican lawsuit against President Barack Obama are asking the panel's chairman to detail how much the suit will cost. The four Democrats on the Rules Committee, led by New York Democrat Louise Slaughter, sent a letter on Thursday to Committee Chairman Pete Sessions (R-Texas) asking for the total expected bill for the lawsuit and how the House plans to pay for the cost (French, 7/17).

The Washington Post: VA Uses Patient Privacy To Go After Whistleblowers, Critics Say
Is the Department of Veterans Affairs hiding behind HIPAA to hit federal whistleblowers? HIPAA is the Health Insurance Portability and Accountability Act. It protects the privacy of patients' health information. It is not meant to be a weapon against federal employees who expose wrongdoing at VA or anywhere else (Davidson, 7/17).

Politico: VA Request Complicates Reform Push
An unexpected funding request from the Department of Veterans Affairs is complicating negotiations over a bill to reform the embattled agency, Florida Republican Rep. Jeff Miller said on Thursday. On Wednesday, Acting Secretary Sloan Gibson told the Senate Committee on Veterans' Affairs the department needs $17.6 billion to hire thousands of doctors and reduce wait times at VA facilities (French, 7/17).

The Associated Press: Largest US Insurer's Move Signals Industry Shift
The nation's largest health insurer expects to play a much bigger role in the health care overhaul next year, as the federal law shifts from raising giant questions for the sector to offering growth opportunities. UnitedHealth Group said Thursday that it will participate in as many as 24 of the law's individual health insurance exchanges in 2015, up from only four this year (7/17).

The Wall Street Journal: UnitedHealth Tops Expectations, Raises Outlook
UnitedHealth said it would expand its presence in the health law's marketplaces to "as many as two dozen" states in 2015, when it expects a "better risk vintage"-;likely meaning that enrollees won't be so heavily weighted toward those with high-cost medical conditions. The company is in just four states' individual exchanges. The insurer said that despite a smoothed re-enrollment process for those who already have the marketplace plans, it believes current enrollees will still shop around during this fall's open enrollment period, and it also expects to do well among new sign-ups (Calia and Wilde Mathews, 7/17).

The Associated Press: UnitedHealth's 2Q Profit Slips 2 Percent
UnitedHealth said revenue gains, particularly in its Medicaid business and through its Optum segment, helped counter the expenses during the quarter that ended June 30. Medicaid is the state-federal program that covers the poor and elderly people. UnitedHealth's enrollment in that segment jumped nearly 19 percent to about 4.7 million people compared with last year's quarter, as the insurer expanded its business and reaped gains from the health care overhaul, the massive federal law that aims to over millions of people (7/17).

The Wall Street Journal: SEC Widens Trading Probe to Investment Firms
Federal investigators are examining nearly four dozen hedge funds, asset managers and other investment firms to determine whether they violated insider-trading rules after receiving a tip from a Washington research firm. In a new court filing, the Securities and Exchange Commission said it is looking at 44 investment funds and other entities, including "some of the largest hedge funds and asset management advisors in the nation," as part of its probe into whether anyone broke the law by buying health-insurance stocks in April 2013 ahead of a government announcement that benefited the firm (Mullins and Ackerman, 7/17).

The Wall Street Journal: Medical Experts Press Lawmakers On Hospital Safety
Medical-quality experts told Senate committee members on Thursday that government action is needed to lower the rate of hospital medical errors and infections, which are believed responsible for an estimated 1,000 or more deaths a day in the U.S. Lisa McGiffert, director of Consumers Union's Safe Patient Project, called on the federal agency that runs Medicare to require the publication of a wide range of hospital-specific infection rates and of medical outcomes such as surgical deaths and complications (Burton, 7/17).

Los Angeles Times: Indictment Accuses FedEx Of Moving Drugs For Illegal Online Pharmacies
FedEx conspired to traffic in controlled substances and misbranded prescription medications by helping distribute drugs for illegal Internet pharmacies, an indictment from a federal grand jury in San Francisco alleges. The shipping company knew as early as 2004 that it was delivering drugs to dealers and addicts, Thursday's indictment says (Raab, 7/17).

USA Today: FedEx Charged With Trafficking Drugs For Web Pharmacies
FedEx is facing drug-trafficking charges after a federal grand jury in San Francisco indicted the overnight shipping company, accusing it of conspiring to deliver prescription drugs for illegal Internet pharmacies. The indictment says FedEx knew for a decade that such pharmacies used their services. FedEx took steps to protect its business by setting up special credit policies for Internet pharmacies so it wouldn't lose money if police shut the sites down, the indictment says (Leinwand Leger, 7/17).

NPR: Head Scientist At CDC Weighs Costs Of Recent Lab Safety Breaches
It all started in mid-June, when the CDC announced that dozens of its scientists might have accidentally been exposed to anthrax. Since then, a number of other security risks in and via national laboratories have come to light: Ordinary flu virus was unknowingly contaminated with the deadly bird flu virus (sent from a CDC lab); vials of smallpox virus were found forgotten in a National Institutes of Health storage room; and just this week the FDA revealed that forgotten vials of other potential bioterrorism agents were discovered in the same storage room where the smallpox samples turned up (Manke, 7/18).

The Wall Street Journal's Pharmalot: Will Gilead's Hepatitis C Drug Bust State Budgets?
A new analysis suggests many states may, in fact, be overwhelmed as they attempt to pay for the Solvaldi medication sold by Gilead Sciences, which costs $84,000 for each patient, and several forthcoming treatments that may be priced at a similar level. More than 750,000 Americans with chronic hepatitis C receive health care coverage through Medicaid or the prison system. And in its analysis, Express Scripts, the nation's largest pharmacy benefits manager, consequently projects that states will collectively spend more than $55.2 billion to provide Sovaldi to all comers (Silverman, 7/17).

The Associated Press: NY's Medicaid Covering Post-Birth Contraceptives
Emboldened and incensed by the U.S. Supreme Court's recent decision limiting certain contraceptive coverage in the private sector, New York health officials moved forward Thursday with a plan to provide contraceptive devices to low-income women who don't want to get pregnant soon after giving birth (7/17).