Longer looks: Kentucky is health law poster child; how to negotiate a lower medical bill; the Ebola outbreak up close

Aug 8 2014

Each week, Kaiser Health News finds interesting reads from around the Web.

Time: How Kentucky Got Obamacare Right
About a year ago, on Aug. 22, a team of inspectors from the Centers for Medicare and Medicaid Services (CMS) unit of the U.S. Department of Health and Human Services arrived in Frankfort, Ky., to see if the people working out of a nondescript warehouse there were going to be able to pull off the launch of Kentucky's Obamacare health-insurance exchange. Kentucky was one of 14 states, plus the District of Columbia, that had opted to build its own version of the Obamacare exchange; the federal government, through CMS, was building an exchange to offer insurance in the other 36 states. There was less than six weeks to go before the scheduled debut, in Kentucky and nationally, of what was perhaps the most complicated e-commerce venture ever envisioned. ...They need not have worried (Steven Bill, 7/31).

Vox: How Arkansas Explains The Politics Of Obamacare 
Arkansas was a pioneer in crafting an "alternative" Medicaid expansion. Last September, the Obama administration signed off on their unprecedented proposal to move hundreds of thousands of newly-eligible people into the state's health insurance exchange, using Medicaid dollars to pay private premiums. As the state's "private option" enters its second year, Arkansas is exploring possible changes to the program -; ones that Republican-run states have already won approval for, and which could push the limits of how flexible the federal government will be with a program that covers some of the country's most vulnerable patients (Adrianna McIntyre, 8/6).

The New Republic: How Much Is Obamacare Raising Your Insurance Rate? Depends on Which State You Live In
Back in the spring, once it became apparent that enrollment in Obamacare would nearly match or even exceed projections, the law's detractors on the right started coming up with new predictions of doom. Among the most popular: Premiums in 2015 would soar, these critics said, because the people signing up for coverage would be older and sicker than the insurance companies had expected. ... More than four months later, we have some better information. ... a group of experts that I consulted agreed that a clear trend is emerging. Coverage will get more expensive for the majority of consumers, as it almost always does. Changes in premiums will vary enormously, from state to state and from plan to plan. But, overall, the 2015 premiums increases will not be significantly worse than they were in the past. They might even be a little better (Jonathan Cohn, 8/4).

The New York Times: Dogged Persistence Pays Off, With Interest
In this episode, the story of an epic, four-year battle between a man and a health insurer. Typically, these stories end with the same score: Health Insurer 1, Patient 0. This story is different. It started in 2006, when at the age of 37, Dave Bexfield of Albuquerque learned that he had multiple sclerosis, or M.S. ... He qualified for a clinical trial, sponsored by the National Institutes of Health and conducted by the University of Texas MD Anderson Cancer Center in Houston. He spent three months there getting a stem cell transplant. His total bill was just under $200,000. (Yes, though sponsored by the N.I.H., the treatment came with a price tag.) ... His health insurer, Presbyterian Health Plan, declined to cover the treatment because at the time, officials said, it was not a covered benefit (David Segal, 8/5).

Vox: The Secret To Negotiating A Lower Medical Bill 
Earlier this year, I got an unpleasant surprise in my mailbox. A $820.19 surprise, to be exact. This was a bill from MedStar's National Rehabilitative Network, where I'd recently completed 12 half-hour physical therapy sessions over the winter. The bill was an incomprehensible, three-page mess of billing codes and charges that all totaled up to just over $800 that I owed. Even as someone who writes extensively about America's health care system -; who had, coincidentally, recently attended a three-day seminar for a story on the subject -; I was stuck. I thought about trying to negotiate the bill down but had no idea where to start. I ultimately paid it without protest -; but, after talking to medical billing advocates this week, I'm starting to think I shouldn't have (Sarah Kliff, 8/5).

Health Affairs: A Fighting Chance: How Acute Care Training Is Failing Patients With Chronic Disease 
Slim and athletic, [Martin] was in generally good health other than his kidney disease. Another patient, James, also arrived early to his hemodialysis appointment, but that was because he arrived via ambulance, on a stretcher. ... I had admitted James to the hospital many times. ... The [medical] residents knew James very well. But they had never met Martin. As one of my healthiest patients, Martin had never been admitted to the hospital. To the residents at the hospital, and indeed to most physicians, a dialysis patient looks like James, not Martin. But in my work as a nephrologist, dialysis patients look like Martin, not James. The gulf between the residents' understanding of chronic disease and mine has, I believe, profound implications for the care of such patients and the policies we craft around them (Dr. Dena E. Rifkin, 8/4).

Stanford Medicine: The Demise Of The Surgeon General
Nearly a year has passed, and the U.S. surgeon general post is still vacant. Does it matter? Associated Press medical reporter Mike Stobbe's new book, Surgeon General's Warning [University of California Press, June 2014], explains why that question is so hard to answer. His look at the history of the position and the personalities who filled it shows the good that's come to America from having a powerful surgeon general. It also examines how politics are draining that power. ... Surgeons general have always had to take orders from their political bosses. What's changed is that other federal health officials -; like the HHS secretary and the CDC director -; have developed an enduring taste for the bully pulpit, and have come to see surgeons general as unworthy competitors for it (Summer 2014).

Mother Jones: Cell Phone Carriers Are Fighting a Plan To Make It Easier To Locate 911 Callers
The nation's biggest cell phone carriers, including Verizon, AT&T, and Sprint, are opposing a government proposal that aims to save lives by making it easier for emergency responders to locate 911 callers. The companies say they lack the technology to implement the plan-;which would require them to quickly find a way to deliver more accurate location information-;and they're working on a better, long-term solution. Emergency responders and activists say that the cell carriers are trying to stymie the proposal because they don't want to pony up the money for the improvements (Dana Liebelson, 8/6).

The New Yorker: Outbreak 
As of this writing, more than thirteen hundred cases of Ebola-virus disease have been officially reported in Guinea, Sierra Leone, and Liberia. The virus is spreading, uncontrolled, in widening chains of infection, ... In July, as the outbreak gathered force, Daniel Bausch, an American doctor and Ebola expert, arrived in Freetown, Sierra Leone, and proceeded on to the Lassa/Ebola ward in Kenema, a facility that he helped set up. He put on personal protective equipment, known as P.P.E.-;a type of biohazard gear that consists of a Tyvek whole-body suit, a Tyvek hood with an opening for the eyes, safety goggles, a breathing mask over the mouth and nose, two pairs of nitrile gloves, a plastic apron, and rubber boots-;and he walked into one of the Ebola wards, a makeshift structure with walls made of plastic film (Richard Preston, 8/5).