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  • Healthcare.gov Undergoes Changes, Faces Scrutiny As Clock Ticks Toward Mid-November Start Of Open Enrollment

    The New York Times reports that a redesign to the federal marketplace will allow a majority of consumers to use a simpler online form when attempting to buy health coverage, and The Associated Press details findings out today by the Department of Health and Human Services inspector general that report on government hackers' attempts to breach the site.    

    The New York Times: Healthcare.gov Is Given An Overhaul
    The Obama administration is redesigning healthcare.gov and says that 70 percent of consumers will be able to use a shorter, simpler online application form to buy health insurance when the second annual open enrollment period begins in mid-November. Federal health officials said Monday that the shorter application had fewer pages and questions, fewer screens to navigate, and would allow people to sign up with fewer clicks of a computer mouse (Pear, 9/22).

    The Associated Press: Government Hackers Try To Crack Healthcare.gov
    The government’s own watchdogs tried to hack into healthcare.gov earlier this year and found what they termed a critical vulnerability -- but also came away with respect for some of the health insurance site’s security features. Those are among the conclusions of a report being released Tuesday by the Health and Human Services Department inspector general, who focuses on health care fraud (9/23).



  • GAO Advises CMS To Step Up Tracking Of Health Law Implementation Funding
    The watchdog agency says the federal government has spent $3.7 billion during the current fiscal year on the marketplaces. News outlets also report on developments related to exchanges in California, Minnesota and Montana.

    Politico Pro: GAO Urges Better Tracking Of Health Law Financing
    The Obama administration has spent $3.7 billion during this fiscal year on implementation of the Obamacare exchanges, according to a new GAO report that advised CMS to better track the health care law’s financing. The money includes some funding that was not specifically tagged for the exchanges, GAO said. Since March 2010, it found, CMS has also spent $79.8 million on total salary expenses related to implementation of the law’s exchanges (Haberkorn, 9/22).

    Los Angeles Times: 30,000 Californians Face Obamacare Enrollment Delays, Dropped Coverage
    California's health insurance exchange is vowing to fix enrollment delays and dropped coverage for about 30,000 consumers before the next sign-up period this fall. Covered California said it failed to promptly send insurance applications for 20,000 people to health plans recently, causing delays and confusion over their coverage. Another group of up to 10,000 people have had their insurance coverage canceled prematurely because they were deemed eligible for Medi-Cal based on a check of their income, officials said (Terhune, 9/22).

    Minnesota Public Radio: Why PreferredOne Pulled Out Of MNsure
    Early next month, the state Commerce Department will reveal next year's premium rates for plans to be sold on MNsure, Minnesota's health insurance exchange. But the insurer with the lowest prices and most customers on MNsure won't be on the list next time around. PreferredOne announced last week that it's dropping out of the insurance exchange. It said selling insurance through MNsure was not sustainable. ...we discuss PreferredOne's decision [with Stephen Parente and Joel Ario] (9/23).

    The Missoulian: Three Montana Groups Get $609K In Health Care 'Navigator' Grants
    Once again, the federal government is funding "navigators" in Montana to help the uninsured buy private, subsidized health coverage this fall – with a new emphasis on Native American consumers. Earlier this month, federal officials awarded $609,000 in navigator grants to three Montana groups: Planned Parenthood of Montana, the Montana Health Network and the Montana-Wyoming Tribal Leaders Council. ... [Martha Stahl, CEO of Planned Parenthood of Montana] said her group will be working closely with the other two grant recipients and other organizations to sign up more people for health insurance under the Affordable Care Act, as well as target Native Americans (Dennison, 9/22).



  • State Highlights: Medicaid Bankruptcy Ruling Could Save Some Nursing Homes

    A selection of health policy stories from Florida, Texas, California and Colorado.

    The Wall Street Journal: Medicaid Bankruptcy Ruling Could Bolster Health-Care Facility Turnarounds
    A federal judge's recent ruling blocking Medicaid officials from cutting off a struggling nursing home could help troubled health care facilities survive using bankruptcy, according to restructuring professionals. U.S. Bankruptcy Court Judge Michael Williamson told Medicaid officials that bankruptcy's protective powers meant they must continue paying for patients at the Rehabilitation Center of St. Petersburg while the Florida facility's bankruptcy lawyers work through problems. The nursing home's Medicaid funding was at risk after health inspectors found "rampant, serious problems" at the 159-bed facility earlier this year. After the inspections, Medicaid threatened to terminate the facility's provider agreement (Stech, 9/22).

    The Washington Post: Southern States Are Now Epicenter Of HIV/AIDS In The U.S.
    Southern states now have the highest rates of new HIV diagnoses, the largest percentage of people living with the disease and the most people dying from it, according to Rainey Campbell, executive director of the Southern AIDS Coalition, a nonprofit serving 16 Southern states and the District. Fifty percent of all new HIV cases are in the South. And the HIV infection rate among African American and Latina women in the South now rivals that of sub-Saharan Africa. In some Southern states, blacks account for more than 80 percent of new HIV diagnoses among women (Wiltz, 9/22).

    The Associated Press: Citing Joan Rivers, Texas’ Perry Backs Clinic Law
    Republican Texas Gov. Rick Perry on Sunday invoked comedian Joan Rivers’ death at a surgical clinic while defending a law he signed that would close the majority of abortion facilities in the nation’s second-most populous state (9/21). 

    Stateline: A New Look At Why Surgical Rates Vary
    Several years ago, a California study showed that a half-dozen elective surgeries were being performed far more often in Humboldt County than they were in the rest of the state. The procedures included hip and knee replacements, hysterectomies and carotid endarterectomies, a surgery to remove plaque buildup in the carotid arteries. Geographical variation in the delivery of health care can harm patients and increase costs. That is especially true when it comes to surgery, which is usually more expensive and riskier than less invasive treatments. Medicaid makes up a huge portion of state budgets, so the issue of health care variation is a pressing one for states looking to hold down costs. In Humboldt County, doctors, hospitals, and others involved in health care wondered why surgeons in their area operated so often, and if they could do anything to get closer to the state norms (Ollove, 9/23).

    Bloomberg: Nursing Home Neglect Trial Fights Shell Company Transfers
    Juanita Jackson died in July 2003, five weeks after she was removed from a Florida nursing home where her family said continual neglect led to multiple bedsores, malnutrition and a fall that injured her head. ... A corporate structure designed to transfer liabilities from the nursing home operator to a shell company without assets also has kept five other families from pursuing wrongful death lawsuits or collecting judgments, said lawyers for the family of Jackson, who was 76 when she died. Trans Healthcare Inc. and Trans Health Management Inc., which the plaintiffs claimed operated the homes, never appealed or paid the 2010 verdict -- $55 million each -- awarded by a state court jury in Bartow, Florida (Fisk, 9/22).

    Denver Post: Colorado Veterans Affairs Officials Say Improvements Coming
    Veterans Affairs officials said Monday that efforts are underway to ease wait times and improve access to care. Lynette Roff, director of the Veterans Affairs Eastern Colorado Health Care System (ECHCS), addressed a small crowd of veterans and advocates during a town hall meeting for vets and family members at the VA hospital in Denver. Access to VA care has been the focus of scrutiny in recent months. Yet even before the scandal erupted over long waiting times for care in Phoenix and elsewhere, the eastern Colorado system had been working for two years to open new facilities in Golden, Pueblo and Colorado Springs, she said (Draper, 9/22).

    Denver Post: Colorado Regulators Approve Health Insurance Premiums 1 Percent Higher 
    State regulators have approved more than 1,000 health insurance plans offered by 20 carriers for 2015 that, on statewide average, will increase premiums 1.18 percent over last year. Mountain resorts and other West Slope rural communities, historically stuck with the most expensive health premiums, benefitted from the Division of Insurance's consolidation of two rating areas into one. Their 2015 rates will decrease by an average of 7.44 percent across all carriers. Likewise, the consolidation of Eastern Plains communities and southern rural areas resulted in a 5.01 percent drop in their average premiums (Draper, 9/22).



  • Drugmakers Warned Against Giving Coupons To Medicare Beneficiaries

    While brand-name drugmakers regularly use coupons to boost sales, it is illegal to induce Medicare Part D enrollees to use them. Meanwhile, a researcher asks members of the public how they would fix Medicare.

    The Wall Street Journal’s Pharmalot: Did Someone Say Kickbacks? HHS Warns About Medicare Part D Coupons
    Brand-name drug makers regularly use coupons to woo consumers and boost sales. But inducing Medicare Part D beneficiaries to use coupons is illegal. So drug makers are supposed to use safeguards to ensure these consumers do not use coupons to obtain prescription medicines (Silverman, 9/22).

    Modern Healthcare:  Medicare Gives First Glimpse Of ACO Quality Performance
    The CMS for the first time publicly released individual performance data for Medicare accountable-care organizations on 33 measures of healthcare quality (Evans, 9/22).

    Kaiser Health News: Capsules: How To Fix Medicare? Ask The Public
    Washington is full of ideas to overhaul Medicare. Some would increase the program’s eligibility age, others would charge higher-income beneficiaries more for their coverage. There’s movement to link payment to the quality — rather than the quantity — of care delivered. Marge Ginsburg decided to ask ordinary Americans how they would change the federal entitlement program (Carey, 9/23).



  • Court Dumps Obamacare Lawsuit Brought By Doctors

    A federal appeals court in Chicago tosses a lawsuit challenging the administration's delay of the health law's employer mandate -- a case similar to the one that House Republicans plan to file. Meanwhile, advocates for the drug, device and biotechnology industries raise concerns about the public database set to go live next week, showing how much doctors get from those groups.

    Politico: Court Tosses Obamacare Mandate Lawsuit Brought By Doctors
    A federal appeals court has summarily tossed a lawsuit challenging the Obama administration’s delay of Obamacare’s employer mandate — a case that is similar to the one that House Republicans plan to file against the president. This suit was filed by the Association of American Physicians and Surgeons, which argued that the delay could hurt doctors financially. But the 7th Circuit Court of Appeals in Chicago on Friday said the plaintiffs don’t have a right to sue (Haberkorn, 9/22).

    Milwaukee Journal-Sentinel: Judge Dumps Challenge To IRS Role In Obamacare Penalties
    Like U.S. District Judge William Griesbach, the 7th Circuit found that McQueeney and the physicians' group lacked standing to bring the challenge, noting the Supreme Court's repeated rejection of attempts by one person to litigate over someone else's taxes (Vielmetti, 9/22).

    The Hill: Court Nixes Obamacare Mandate Delay Lawsuit
    A federal appeals court threw out a lawsuit over the delay of ObamaCare's employer mandate, a sign that a similar challenge in the works by House Republicans might not fare well. The 7th Circuit Court of Appeals said the plaintiffs did not have standing to sue, and only parties "seeking to advance the interests" of the mandate could mount a "plausible" case against its delay.  The case was filed by the Association of American Physicians and Surgeons, which argued the administration did not have the authority to defer the requirement that most employers offer health insurance (Viebeck, 9/22).

    The Hill: Drug, Device CEOs Voice Concerns About Obamacare Project
    Advocates for the drug, device and biotechnology industries are raising concerns about the implementation of a payments database required by ObamaCare. The "Sunshine Act" system will allow the public to search how much money doctors receive from drug and device companies. It is scheduled to launch on Sept. 30, despite complaints about inaccuracies and technical glitches. But the CEOs of PhRMA, AdvaMed and the Biotechnology Industry Organization (BIO) say the Centers for Medicare and Medicaid Services (CMS) has not been clear enough about what data will be posted on the site and how it will be presented (Viebeck, 9/22).

    The Associated Press: Spin Meter: Those Changing Health Law Numbers
    The Obama administration has had to revise and refine some initial enrollment numbers for health insurance sign-ups after they turned out to be too optimistic. At other times, metrics less favorable to the president’s overhaul leaked out after officials claimed not to have such data. Parsing the numbers is a new pursuit for administration officials from President Barack Obama on down, to lawmakers of both parties and a gaggle of outside analysts (9/22).



  • Hospitals Seek To Control Costs By Setting Standards For Care

    One group in Delaware looked at high spending on cardiac monitoring for patients who really didn't need it and encouraged doctors to instead use guidelines from the American Heart Association. Costs fell by 70 percent for the monitoring, a study finds.

    The Wall Street Journal: Hospitals Cut Costs By Getting Doctors To Stick To Guidelines
    A hospital group in Delaware was concerned it was spending too much on cardiac monitoring for patients outside of intensive care who didn't need it. So it changed its computer system to encourage doctors to follow American Heart Association guidelines for using the monitors. The number of patients using the monitors, and the group's daily costs for such monitoring, fell by 70% without any harm to patient care, researchers from Wilmington, Del.-based Christiana Care Health System report in a study in JAMA Internal Medicine (Whalen, 9/22).

    NPR: Avoid The Rush! Some ERs Are Taking Appointments
    Hospitals around the country are competing for newly-insured patients, and one way to increase patient satisfaction, they figure, might be to reduce the frustratingly long wait times in the ER. To that end, Northridge and its parent company Dignity Health started offering online appointments last summer; since then, more than 22,000 patients have reserved spots at emergency rooms in California, Arizona and Nevada (Gorman, 9/23).

    Read the Kaiser Health News' earlier, related story The Latest In Medical Convenience: ER Appointments (Gorman and Colliver, 7/3).

    Meanwhile, federal officials call on nursing homes to reduce the use of antipsychotic medications -

    Modern Healthcare:  CMS' Plan To Cut Antipsychotic Use In Nursing Homes Falls Short, Critics Say
    Patient-safety advocates say the CMS' new plan to curb the use of antipsychotic medications in nursing home patients with dementia falls short of what's needed to eliminate unnecessary use. Last week, the CMS called for a 25% reduction in use of antipsychotics for this patient population by the end of 2015, and to a total of 30% by the end of 2016 (Rice, 9/22).

    And in other marketplace news -

    Marketplace: At In-Store Clinics, $4 Checkups For Wal-Mart Workers
    You can't buy a lot for $4—maybe a cup of coffee or muffin. But at about a dozen Walmart stores across the South, $4 will get employees a visit to a nurse practitioner at an in-store clinic. It's part of a new primary care program that Walmart is testing in three states. Eric Klein leads the healthcare team at the national law firm Sheppard Mullin Richter and Hampton. He says Walmart could actually come out ahead in the big picture. ... Klein says if employees go to an on-site clinic owned by Walmart, the company could save money on doctor visits and insurance premiums. Cutting out the middle men could bring down the cost of Walmart’s insurance plans (McCammon, 9/23).



  • Police, Parents Learning To Better Handle Mental Illness

    And in Arizona, a judge approved an agreement to expand services for the people with serious mental illnesses, ending a 30-year-old class action lawsuit.

    NPR: As Run-Ins Rise, Police Take Crash Courses On Handling Mentally Ill
    A number of high-profile police shootings, including that of Michael Brown in Ferguson, Mo., last month, have led to increased scrutiny of police interactions with civilians. One group that is disproportionately subject to police uses of force is people with mental illness. Many local departments hold special sessions to train officers about mental illness and how to help the people they interact with. Walking up and down the aisle of a police academy classroom in downtown St. Louis, Lt. Perri Johnson tells the officers here that responding to calls where a person is in mental distress is never easy (Bouscaren, 9/23).

    CBS News: 'Every Mom’s Worst Nightmare': Coping With A Child’s Mental Illness
    It was Dec. 14, 2012, and Liza Long headed to work at Carrington College-Boise. It was just another Friday morning until Long, the mother of four children, logged on to Facebook, where news of a mass shooting at Sandy Hook Elementary School in Newtown, Connecticut, was just beginning to emerge. "I just put my head down on my desk and started to cry," Long, 42, told CBS News. But it wasn't that Long knew any of the families that had lost a child. "I had children about that age too. It's every mom's worst nightmare. But I realized right away it's every mom's worst nightmare on two fronts, not just one." Her first thought, she later wrote, was "What if my son does that someday?" (Firger and Augenbraun, 9/22).

    Arizona Republic: Judge Ends Long-Running Behavioral-Health Suit
    A judge Monday committed to the history books a long-running lawsuit that redefines how services are delivered to the seriously mentally ill in Maricopa County. With his signature, Maricopa County Superior Court Judge Edward Bassett ended the Arnold vs. Sarn case. His action drew cheers from Gov. Jan Brewer, who had made it a priority to settle the case that has rattled around the courts since 1981, when behavioral-health advocates filed a class-action lawsuit (Pitzl, 9/22).

    The Associated Press: Judge OKs Agreement Ending 30-Year-Old Mental Health Suit
    A Maricopa County judge on Monday signed off on an agreement that increases housing, employment and other services for the seriously mentally ill. Judge Edward Bassett's action came as he dismissed a lawsuit filed more than 30 years ago challenging the state's funding of mental health services. The terms of the agreement reached in January between Gov. Jan Brewer and lawyers for the mentally ill will apply statewide. No money will be spent beyond an extra $39 million a year pumped into the system more than two years ago as part of an interim agreement ending the lawsuit. The expansion of Medicaid in Arizona that began Jan. 1 will pay for some of the additional costs. Brewer celebrated the dismissal, saying the deal provides needed treatment and puts in place a model community-based behavioral health system (Christie, 9/22).



  • Viewpoints: Surgery Surprise: Out-Of-Network Doctors' Bills; Consequences Of Making Medicaid Enrollees Pay Premiums

    Los Angeles Times: The Ugly Surprise Of Out-Of-Network Doctors And 'Balance Billing'
    The New York Times' Elisabeth Rosenthal offered an important lesson in healthcare economics over the weekend that's a must-read for anyone about to undergo a major medical procedure. Rosenthal's piece explored how charges from out-of-network providers can magically show up on a hospital bill. She focused on one particularly nasty practice, called "drive-by doctoring," in which physicians call in colleagues not in a patient's network to consult or assist on a procedure. The out-of-network provider charges the retail rate -- in some cases, hundreds of times what the government would pay them for the same work, and invariably far more than what the patient's insurer will cover. The provider then tries to collect the remainder directly from the patient, a process known as "balance billing" (Jon Healey, 9/22).

    The New York Times' The Upshot: Medicaid Gives The Poor A Reason To Say No Thanks
    While Medicaid, our safety net program for the poor, has used cost-sharing mechanisms for some time, it has been prohibited from asking people to pay premiums. In the last couple of years, federal regulators have started lifting that prohibition, which is likely to lead to some negative consequences (Aaron E. Carroll, 9/22).

    The Washington Examiner: Jindal Says Hospitals Are Shortsighted On Medicaid Expansion
    Hospitals have been pushing the issue hard, because they were counting on an expanded Medicaid program to reduce their uncompensated care costs. ... But [Louisiana Gov. Bobby] Jindal, who once served as Secretary of the Louisiana Department of Health and Hospitals, said that if Medicaid were expanded in Louisiana, the number of people who would move to Medicaid from private insurance would exceed the number of uninsured residents who would gain coverage. "I told my hospitals I thought that [supporting Medicaid expansion] was a foolish, shortsighted, short-term position," he said (Philip Klein, 9/22).

    The New Republic: How To Save Obamacare: Make It A Women's Issue
    The challenge for the next Democratic presidential nominee is thus to break the psychic link—to reshape the way the public thinks about health reform as something more than just a proxy for Obama. And whether she realizes it or not, Hillary Clinton has made a strong case that a female candidate will be better suited to the task than a male candidate. Last Thursday, Clinton joined a Center for American Progress panel about women’s economic security, focused mainly on gendered issues like equal pay and child care. But Obamacare fits neatly into the same framework (Brian Beutler, 9/22).

    The New York Times' The Upshot: Why Senate Control Matters
    Regardless of which party controls it, Republicans will almost certainly control the House, and Democrats will hold the White House. Given how far apart the two parties are on almost every major issue — climate, health care, inequality, the long-term deficit, immigration and same-sex marriage, for starters — the odds of major legislation becoming law in the next two years are scant. … And yet control of the Senate still very much matters, just not for the most obvious reasons. It matters for climate policy and the Affordable Care Act, among other big issues (David Leonhardt, 9/23). 

    The Wall Street Journal’s Political Diary: Kentucky's Desperate Democrat
    One motif that's been largely missing from Democratic campaigns this year is the Republican war on Medicare. Lo, Kentucky Democrat Alison Lundergran Grimes has disinterred the trope in a new ad that implicates Mitch McConnell in her grandfather's incapacitation. Really classy (Allysia Finley, 9/22). 

    The New York Times' Room For Debate: Hiring A Woman For Her Womb
    People unable to bear children have increasingly turned to women who bear children for them, often by transferring an embryo created by in-vitro fertilization. Because legal and social views on surrogacy vary from nation to nation (and even state to state), prospective parents often engage surrogates in the United States and in developing countries. Controversy has clouded this issue (9/22). 

    Los Angeles Times: Dad Pleads: Don't Let Health Insurance Offer My Daughters Birth Control!
    Remember the prediction that the Supreme Court's decision to let Hobby Lobby opt out of Obamacare contraception coverage would open the floodgates for more of the same? Well, it's not a flood, but it is a one-man trickle. A Missouri Republican legislator is suing in federal court for a personal opt-out for his family (Patt Morrison, 9/22). 

    The Washington Post: Has The Department Of Health And Human Services Politicized FOIA Requests?
    The Department of Health and Human Services (HHS) is denying an allegation by a top Associated Press journalist that the agency has politicized the handling of requests under the Freedom of Information Act (FOIA). "FOIA requests are handled by career staff," Kevin Griffis, an HHS spokesman, told the Erik Wemple Blog in a brief interview on Friday. Griffis was responding to a much-shared AP post summarizing "8 ways the Obama administration is blocking information," an inventory of press restrictions compiled by AP Washington Bureau Chief Sally Buzbee and presented at a meeting of the American Society of News Editors, the Associated Press Media Editors and the Associated Press Photo Managers. Under obstruction No. 7, Buzbee alleged, "The administration uses FOIAs as a tip service to uncover what news organizations are pursuing. Requests are now routinely forwarded to political appointees" (Eric Wemple, 9/22).



  • Political Cartoon: 'Suits Me?'

    Kaiser Health News provides a fresh take on health policy developments with 'Suits Me?' by Harley Schwadron.

    And here's today's health policy haiku:

    MORE THAN A FIXER-UPPER?

    Confucius might say
    Healthcare.gov not perfect
    Enemy of good
    -Beau Carter

    If you have a health policy haiku to share, please send it to us at http://www.kaiserhealthnews.org/ContactUs.aspx and let us know if you want to include your name. Keep in mind that we give extra points if you link back to a KHN original story.