KHN Morning Briefing

Summaries of health policy coverage from major news organizations.

Kaiser Health News Original Stories

Political Cartoon: 'Reality Television?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Reality Television?'" by Lee Judge, Kansas City Star.

Here's today's health policy haiku:

TILLIS’ MEDICAID EXPANSION DANCE

It’s called a  two step…
1-2-1-2… Medicaid
Move away, then toward.

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Health Law Issues And Implementation

Scrutiny Grows On MNsure's Planned Rate Increases

Elsewhere, Connecticut's plan options are examined, and the North Carolina Blues plan a 13.5 percent rate hike for its marketplace plans.

Minneapolis Star-Tribune: Experts Question MNsure Average Rate Increase Of 4.5 Percent
Almost immediately after the state’s insurance regulator earlier this month announced that rates for plans sold through MNsure would rise 4.5 percent on average, Republicans, health policy experts and other critics decried the figure as bogus and misleading. The state Commerce Department has steadfastly defended the figure — a straight average of rate changes reported by the four returning carriers to MNsure — acknowledging that some consumers will see higher or lower rate changes. State agency officials said consumers can shop around once open enrollment begins Nov. 15 “to find the best option that fits their individual health and financial needs.” But other states, like California, Colorado and Washington, report their increases in premiums for their respective exchange plans as weighted averages. Calculated that way, Minnesota’s figure for next year is not 4.5 percent, but 11.8 percent. (Lopez, 10/23)

MinnPost: PreferredOne Customers Will Face Rate Hikes On MNsure. How Much? A Lot Less Than 63%
The political hot potato of MNsure rate increases keeps getting hotter. It heated up quite a bit last week with PreferredOne’s statement that its individual market subscribers would see a 63 percent average increase next year. And though PreferredOne has pulled out of MNsure for 2015, its rate increase still carries significant implications for the debate over rates for those individuals who remain in MNsure. In fact, since nearly 60 percent of MNsure subscribers are currently enrolled with PreferredOne — which offered the lowest rates of all the providers — those nearly 33,000 Minnesotans are now faced with three options: staying with PreferredOne; moving to another provider; or slipping back into the pool of the uninsured. And though we currently know what the average rate increase will be if an individual chooses to stay with PreferredOne, a MinnPost analysis of 2015 MNsure rates shows that PreferredOne subscribers looking to find comparable plans through MNsure are likely to face substantial rate increases in 2015 — our sample showed increases from 13 to 44 percent — though nowhere near the increase they face if they stay with PreferredOne. (Brokken, 10/23)

Politico Pro: North Carolina Blues To Raise ACA Plan Rates By Double Digits
Blue Cross Blue Shield of North Carolina is set to raise rates for its Obamacare plans by 13.5 percent on average in 2015, the company announced this week, reigniting a controversial campaign issue in a battleground state weeks before the November election. Individuals that want to keep their pre-ACA plans next year — made possible by the Obama administration’s plan cancellation “transition” that allows the plans to be renewed until October 2016 — will see an even larger average rate increase of 19.2 percent, the company said. (Pradhan, 10/23)

Stateline: Beyond The 'Private Option' For Expansion
Less than a year after low-income Arkansans started receiving health coverage under the Affordable Care Act’s controversial Medicaid expansion, the state is declaring its so-called “private option” experiment a success. Hospitals saw fewer uninsured patients, state coffers were spared millions in health care costs and private insurers reported record-low premium hikes. Most important, Arkansas’ uninsured rate fell from 23 percent to 12 percent, the sharpest drop in the country. But lawmakers in Arkansas have already asked the federal government for adjustments to their groundbreaking plan, under which Arkansans used Medicaid dollars to purchase private health insurance on the insurance exchange created under ACA. Meanwhile, other Republican-controlled states are customizing their own alternative approaches to expanding Medicaid to cover adults with incomes up to 138 percent of the federal poverty level ($16,105 for an individual).

Capitol Hill Watch

Tillis Shakes Up N.C. Senate Race With Change Of Position On Medicaid

News outlets also analyze how health issues are playing out in other Senate races.

The Charlotte Observer: US Senate Candidate Thom Tillis Reverses Course, Urges NC To Expand Medicaid
In last spring’s Republican primary, U.S. Senate candidate Thom Tillis ran an ad touting his fight against an expanded Medicaid program. “Thom Tillis has a proven record fighting against Obamacare,” the narrator said. “Tillis stopped Obama’s Medicaid expansion cold. It’s not happening in North Carolina, and it’s because of Thom Tillis.” But this week Tillis struck a different note. (Morrill, 10/23)

Raleigh News & Observer: Tillis: NC Should Consider Expanding Medicaid
Asked if he thought it would be likely that the state legislature would expand Medicaid coverage after refusing to do so previously, Tillis said it might make sense once the state has better control of the financing of the program, which is notorious for its cost overruns. He said he didn’t have an ideological objection to expanding the coverage. (Jarvis, 10/21)

The Associated Press: Hagan And Tillis In A Battle Of ‘Extremes’ In NC
But Hagan, 61, has put Tillis on the defensive with a barrage of attacks on his record as House speaker in North Carolina’s legislature. She casts the businessman-turned-politician as architect of an untenable rightward march on everything from education funding and labor laws to abortion, ballot access and Medicaid expansion. (Barrow, 10/24)

Politico: Fact-Checking The Iowa Senate Race
Longtime Iowa Sen. Tom Harkin is retiring, and Democratic Rep. Bruce Braley and Republican Iowa state Sen. Joni Ernst are each hoping to be the one to replace him. Braley was once an early favorite to hold the seat for Democrats, but Ernst now has a slight lead in a very competitive race that most political forecasters rate a pure “toss-up.” Ernst — who gained national prominence with a TV ad touting her hog-castrating prowess — has been attacked for being an “extreme” candidate who wants to privatize Social Security. And Braley — whose campaign has made a number of gaffes — has faced claims that he rarely attends his congressional committee hearings and is out-of-touch with Iowa voters. (Factcheck.org, 10/24)

Fox News: Obamacare Rate Increases Fuel Republican Attacks Ahead Of Midterm Elections
ObamaCare rate increases are coming to some key battleground states, fueling Republican attacks ahead of next month’s midterm elections. “It looks like we're going to have double-digit premium increases in places like Alaska, and Iowa and Louisiana," said health economist John Goodman. “Where we've got very close races for Senate, and Republican candidates are making a big deal over this." (Angle, 10/23)

The Associated Press: Analysis: In Senate Battle, GOP’s Weapon Is Obama
Struggling to preserve their Senate majority, Democrats are attacking Republicans over Medicare and Social Security in Louisiana, spending cuts in Arkansas, offshore jobs in New Hampshire and women’s issues in Colorado. Republicans have a one-size fits-all counter-argument. It’s Barack Obama, a two-term president they’ve turned into a political punching bag and pummeled at will while Democrats avert their eyes. (Espo, 10/24)

Administration News

CMS Offers $840M In Grants To Doctors, Hospitals

The money is meant to help improve the quality of care patients receive. At the same time, family physicians are working to promote the importance of primary care.

The Associated Press: US Announces $840M To Improve Medical Care
The Obama administration is announcing an $840 million grant program to help doctors and hospitals improve the quality of care delivered to patients. Patrick Conway, Medicare’s chief medical officer, said Thursday the goal is to identify ways of delivering care that improves results for patients, and then rapidly foster the spread of those ideas throughout the system. The administration also hopes at least some approaches will save money. (10/23)

The Washington Post's Wonkblog: Primary Care Doctors To Patients: Don’t Forget About Us
With an estimated 25 million new people becoming insured over the next few years, a coalition of family physicians has a message for the country: Don't forget about us. The timing is right for the group, which on Thursday announced a five-year, $20 million campaign aimed at promoting the importance of primary care. The flood of newly insured patients presents a big opportunity for primary care doctors, when you consider this: just one-third of uninsured adults said they have a regular doctor, about half the rate of the insured population, according to a 2013 Kaiser Family Foundation survey. (Millman, 10/23)

Politico Pro: Burwell Outlines New Health Care Quality Initiative
HHS Secretary Sylvia Mathews Burwell asked family physicians Thursday for their help with lowering costs and improving quality while offering $840 million in grants to help them figure out how to do that. “We want to partner with those who are working to improve the coordination of care — both inside and outside their offices,” said Burwell, explaining the new initiative. “And we intend to build networks of clinicians who learn best practices from each other and build new networks.” (Wheaton, 10/23)

Meanwhile, in regard to biomedical research funding -

The Wall Street Journal: Lawmakers Push For Increased Funding For Biomedical Research
A bipartisan pair of senators is putting together a proposal to significantly increase federal funding for biomedical research, an issue that has taken on greater urgency in light of the Ebola outbreak. Aides to Sens. Elizabeth Warren (D., Mass.) and Orrin Hatch of Utah, the top Republican on the Senate Finance Committee, met with industry representatives this week to discuss their plan to boost funding for biomedical research by $1 billion annually over 10 years, according to people familiar with the discussion. (Peterson and Armour, 10/23)

Public Health And Education

House GOP Probes Missteps On Ebola

As the Obama administration seeks to allay anxiety over Ebola, a congressional committee known for partisan fireworks was set to take aim Friday at its response to the disease in the U.S. and its strategy for containing the virus.

The New York Times: Administration’s Ebola Response Draws Scrutiny Of House Committee
The House Committee on Oversight and Government Reform — known for partisan fireworks under the leadership of Darrell Issa, Republican of California — will turn its focus on Friday to the Obama administration’s handling of the Ebola crisis. Some Republican members of the committee have already called for a change in the administration’s approach to the epidemic (Siddons, 10/24)

Los Angeles Times: Rep. Darrell Issa's Latest Issue: Ebola
As the Obama administration works to calm public anxiety over Ebola, congressional Republicans will take fresh aim Friday at its missteps in responding to the disease and its strategy for containing the virus. The House Oversight and Government Reform Committee inquiry comes after lawmakers have already berated the administration, registering their outrage at its refusal to ban travel from African nations afflicted by Ebola and its failure to stop a nurse infected with Ebola from boarding a commercial airline in Texas. ( Halper, 10/24)

The Wall Street Journal: House Panel To Convene Ebola Hearing
Lawmakers are expected to focus on protections for U.S. troops and aid workers deployed to West Africa to help treat Ebola as a House panel convenes Friday morning for a hearing on the U.S. response to the disease, the day after a physician in New York tested positive for the virus. The Republican-led House Oversight and Government Reform Committee will hear testimony from two Defense Department officials, as well as Rabih Torbay, the senior vice president for international operations of International Medical Corps, a nonprofit group caring for Ebola patients in Liberia and Sierra Leone. (Radnofsky and Hughes, 10/24)

USA Today: House Oversight Panel Examines Response To Ebola Crisis
A House oversight panel on Friday will examine how well federal agencies are coordinating their response to the Ebola crisis. The hearing by the House Oversight and Government Reform Committee is the third Congress has held on Ebola since the Oct. 8 death of Thomas Eric Duncan in Dallas. Duncan was the first person to die of Ebola in the United States. Two of his nurses contracted the virus and are recovering. (Kelly, 10/24)

Meanwhile, a fourth Ebola case is diagnosed in New York City -

The Wall Street Journal: New York Doctor Tests Positive For Ebola
A doctor who had returned to New York City recently after treating Ebola patients in West Africa tested positive for the virus on Thursday, officials said, setting up a new front in the nation’s attempt to control the spread of the deadly disease. Craig Spencer, a 33-year-old physician who had worked with Doctors Without Borders in Guinea until returning to the U.S. a week ago, is the fourth patient to be diagnosed with Ebola in the U.S. and the ninth to be treated here. (Dawsey, Tangel and McKay, 10/24)

State Watch

State Highlights: Calif. Seeks New Waiver; New Abortion Providers

A selection of health policy stories from California, South Dakota, Wyoming, Washington state and Kansas.

California Healthline: One Waiver Down, One More To Go?
With its current waiver, California successfully expanded Medi-Cal, its Medicaid program, and launched the dual eligibles demonstration project. That federal-state agreement -- known as a Section 1115 waiver -- is due to expire in October 2015, but that doesn't mean the state is done with it. State health officials have formulated a new plan, a multifaceted proposal for payment and delivery system reforms under a new federal waiver they hope will be ready to start when the current one ends. (Gorn, 10/23)

Los Angeles Times: New Class Of Abortion Providers Helps Expand Access In California
Ever since the Planned Parenthood health center here opened, the six cushioned recliners in the recovery room had been in steady demand every Friday. That's when a physician would rotate through to perform abortions for four hours. When everyone in the crowded waiting room knew why the woman next to her was there, when they all had to walk past a cluster of antiabortion protesters. (Romney, 10/23)

Politico Pro: Insurers Oppose California, South Dakota Ballot Measures
A pair of ballot initiatives in California and South Dakota is putting health insurers on edge about November. One would give a state regulator power to shoot down health insurance premium increases. The other would require insurers to include any willing provider in their networks. Proposition 45 in California would require health insurance rate changes in the individual and small group markets to be approved by the state’s insurance commissioner before taking effect, going further than the Affordable Care Act. In South Dakota, Initiated Measure 17 would require insurers to include all providers who are willing, qualified and meet conditions for participation, something the insurance industry and business groups say will make costs skyrocket. (Pradhan, 10/23)

Kaiser Health News: The Latest In Public Health Funding: Tapping Investors
The plan is to create a “social impact bond,” a contract in which Wall Street and other investors agree to support programs with goals such as taxpayer savings and improved health outcomes. If the programs can demonstrate with solid evidence that they have met those goals, the investors recoup their principal and get a return, typically from the government. The asthma project is among the first to focus on improving health outcomes. But a rising number of 'pay for success' projects are planned or underway around the nation, including in Ohio, Connecticut, South Carolina and Massachusetts. One seeks to expand early childhood education in Utah, for instance, and another to reduce homelessness in Colorado. (Gorman, 10/23)

The Associated Press: Health Facilities Panel Release Recommendations
The state-run Wyoming Retirement Center in Basin would be privatized or closed, and the Wyoming State Hospital in Evanston and the Wyoming Life Resource Center in Lander would have their roles better defined, under recommendations made by a task force. The Wyoming Task Force on Department of Health Facilities released its final recommendations on Wednesday for the future of the state's five state-run safety net medical facilities. The panel's report now goes to the state Legislature. The state operates five health care facilities: Wyoming Life Resource Center in Lander, Wyoming State Hospital in Evanston, Wyoming Retirement Center in Basin, Wyoming Pioneer Home in Thermopolis, and the Veterans' Home of Wyoming in Buffalo. (10/23)

Los Angeles Times: UCLA Health System Fined By Federal Officials Over Banned Doctor
Federal officials fined UCLA Health System $470,000 for allowing an anesthesiologist who was banned from Medicare and other federal programs to treat patients and bill the government for their care. Dr. John Edward Miller, an anesthesiologist at Ronald Reagan UCLA Medical Center, was excluded from federal programs from April 2009 to November 2013 while working there, according to the U.S. Department of Health and Human Services. The information was obtained by The Times under a Freedom of Information Act request. (Terhune, 10/23)

The Seattle Times: At KeyArena, They're Coming By The Hundreds For Free Health Care
Piamela Seyum, 29, of Seattle, is No. 450 of those who wait patiently through the early hours of Thursday at Seattle Center’s Northwest Rooms. When free medical care is advertised for everything from a root canal to on-site prescription eyeglasses to mammograms, lines form. She’s taking advantage of a four-day eventadvertised as the state’s largest free health-services event. Some 4,000 people are expected through Sunday. If you want to see one of those working poor that get written up in news articles, here she is. Seyum works as an office manager at a small health-care office. She has Obamacare, but it mostly doesn’t cover adult dental procedures. (Lactis, 10/24)

Houston Chronicle: Austin Woman Sues Feds For Same-sex Spousal Benefits
A Texas woman who lost her wife to cancer in 2012 is taking her fight for spousal benefits to federal court, suing the Social Security Administration for denying federal benefits to same-sex couples in states with gay marriage bans. Austin resident Kathy Murphy filed suit Wednesday against Acting Social Security Administration Commissioner Carolyn Colvin, seeking to receive federal survivor benefits and death payments available to widows of opposite-sex couples. Lambda Legal, a national gay rights organization, filed the suit on behalf of Murphy and co-plaintiff National Committee to Preserve Social Security and Medicare. The U.S. Supreme Court’s decision to strike down portions of the federal Defense of Marriage Act last year meant the Colvin’s agency began disbursing federal benefits to some same-sex couples. However, the agency is still required “to follow state law in Social Security cases,” meaning many same-sex couples in states with gay marriage bans have been denied federal benefits. (McGaughy, 10/23)

Kansas Health Institute News Service: Groups Agree Overuse Of Anti-psychotic Drugs An Issue In Kansas Nursing Home
Usually, the Kansas Health Care Association and Kansas Advocates for Better Care don’t see eye to eye on much. KHCA, which represents the state’s for-profit nursing homes, is quick to argue against passing laws that might increase their costs or add to their regulatory burden. KABC typically says the state doesn’t do enough to improve conditions in poor-performing nursing homes and advocates for tighter regulation. But on Wednesday, the directors of both organizations said far too many nursing homes have come to rely on using antipsychotic drugs to control residents’ dementia-driven behaviors. (Ranney, 10/23)

Editorials And Opinions

Viewpoints: CDC's 'Smart' Ebola Strategy; Legacy Of Vaccine Fears; Unfair Transplant Law

A selection of opinions on health care from around the country.

The New York Times: Beyond Screening For Ebola
The new monitoring rules to be placed on travelers coming into the United States from three Ebola-affected countries in West Africa form a smart and workable response to a complex public health question. The measures should be more effective than a misguided ban on all travelers from Guinea, Liberia and Sierra Leone, which many in Congress have been demanding. (10/23)

The Washington Post: The World Is In Denial About Ebola’s True Threat
It is such a relief about that Ebola thing. The threat of a U.S. outbreak turned out to be overhyped. A military operation is underway to help those poor Liberians. An Ebola czar (what is his name again?) has been appointed to coordinate the U.S. government response. The growth of the disease in Africa, by some reports, seems to have slowed. On to the next crisis. except that this impression of control is an illusion, and a particularly dangerous one. (Michael Gerson, 10/23)

The New Republic: Craig Spencer Probably Never Thought He'd Get Ebola Himself: Doctors Really Do Make The Worst Patients
It is dismaying to learn that the two most egregious violations of voluntary self-quarantine for Ebola in the U.S. were committed by health care professionals. The first was the Dallas nurse, Amber Vinson, who ... broke her quarantine to board a flight shortly before developing Ebola. And on Thursday night we learned about Craig Spencer, a 33-year-old physician who had just returned home to New York City after heroically treating Ebola patients in Guinea. Astoundingly, the night before, he boarded a subway bound for Brooklyn, bowled ten frames with his friends, and returned to his apartment in Harlem that evening by taxi. The following morning, he developed a fever of 103 degrees and, shortly thereafter, found himself in the isolation unit at Manhattan's Bellevue Hospital Center. (Howard Markel, 10/24)

USA Today: CDC Lost Its Ebola Gamble
CDC has found itself in a Catch-22. It's a nearly impossible balancing act to provide accurate information without unnecessarily frightening the public. Whether CDC said too much or too little, it was going to be criticized by the news media. The outbreak spread, so the CDC was condemned for being unprepared. But if the outbreak had fizzled, it would have been chastised for fear mongering. Likely aware of this, the CDC chose the worst possible action: In an effort to keep the public calm, the CDC pretended to know more about Ebola than it actually does. (Alex Berezow, 10/24)

Los Angeles Times: An Updated Map: The Devastating Toll Of The Anti-Vaccination Movement
Marking Friday as World Polio Day, the Council on Foreign Relations has released an updated map showing the global prevalence of vaccine-preventable diseases. ... As one would expect, diseases such as polio are still rife in Africa and other parts of the Third World. But the United States and Great Britain deserve badges of shame for the resurgence of measles and whooping cough, which are almost entirely due to the ignorance and fear spread by the anti-vaccine movements in those countries. (Michael Hiltzik, 10/24)

Los Angeles Times: Vaccine Ignorance -- Deadly And Contagious
Anti-vaccine sentiments aren't limited to the developing world. The effects of Andrew Wakefield's now thoroughly debunked 1998 Lancet study claiming links between vaccinations and autism are still being felt in the Western world, as can be seen in our interactive map. Outbreaks of pertussis in wealthy California communities, of mumps in Ohio college towns and of measles throughout the United Kingdom demonstrate the broad impact of the anti-vaccination movement. In light of the paranoia evoked by Ebola, political and public health leaders must appreciate that not a single voice dispensing misinformation should go unchallenged. The general public has proved its inability to weigh facts accurately and reach a rational conclusion when fear clouds its judgment. (Laurie Garrett and Maxine Builder, 10/23)

Bloomberg: Governor's Races Show Obamacare Is Safe
There's more evidence Obamacare is here to stay. Take a look at the governor's races in nine states where Republican candidates have a decent chance of replacing Democratic incumbents. All of these states have carried out Medicaid expansions, a major part of the Affordable Care Act. But no matter how strongly these Republican candidates claim to hate Obamacare, check out their websites: Not a single one of the nine reveals any plans to roll back Medicaid expansion. (Jonathan Bernstein, 10/23)

Forbes: Should State Medicaid Programs Pay $239,000 Per Patient Year For A Medication?
Last week, an advisory board recommended that Arkansas’s Medicaid program cover Kalydeco, a cystic fibrosis drug whose wholesale cost is $311,000 per patient a year. ... But because “Arkansas appears to be the only state preventing patients who meet the eligibility criteria established by the U.S. Food and Drug Administration” the state is being sued on grounds that its policy violates a federal statute requiring state Medicaid programs to pay for all medically necessary treatments. This case illustrates some deep flaws in current Medicaid policy. (Chris Conover, 10/23)

Forbes: Are Patients To Blame For The High Cost Of Healthcare In McAllen, Texas?
For several decades now, healthcare researchers have documented often dramatic differences in the type and amount of medical care Americans receive as a result of where they live. ... But what explains these differences? Researchers have an incomplete understanding. They are pretty confident that the supply of hospital beds partly explains these geographic differences. ... New research shows that patients now, too, deserve credit (or blame) for a portion of these geographic differences. In an elegant study, three healthcare economists linked data on healthcare spending with a national survey of people’s attitudes towards healthcare, and discovered that the two were linked to each other in ways that do not appear random. (Peter Ubel, 10/23)