KHN Morning Briefing

Summaries of health policy coverage from major news organizations.

Kaiser Health News Original Stories

Political Cartoon: 'Paws and Reflect?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Paws and Reflect?'" by Ron Morgan.

Here's today's health policy haiku:

SOME HOSPITALS HIT WITH MEDICAL ERROR PENALTIES

Feds play hardball with
pay cuts for hospitals that
harm many patients.

If you have a health policy haiku to share, please Contact Us and let us know if you want us to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

Health Law Issues And Implementation

Maryland Claiming Success With Its 'Revamped' Online Insurance Marketplace

Meanwhile, in Connecticut, ConnectiCare Benefits has claimed the largest share of new customers who enrolled in health plans via the state exchange, while MNsure officials report significant progress in signing Minnesotans up for coverage despite some difficulties with the exchange system. Also, in Florida, a conflict of interest emerges as federal officials raise concerns about a public relations firm's effort to promote a state marketplace that doesn't provide the health law's subsidies.

The Associated Press: Md. Calls Revamped Health Care Exchange A Success
Maryland’s public health secretary is calling the state’s revamped health-insurance exchange a success as the second enrollment period hits a milestone. Thursday was the deadline for obtaining coverage starting Jan. 1. The enrollment period began Nov. 15 and continues through Feb. 15. (12/19)

Connecticut Mirror: ConnectiCare Leads The Pack In New Obamacare Enrollment
ConnectiCare Benefits Inc. has the largest share of the market so far among new customers signing up for insurance coverage through Connecticut’s health insurance exchange, Access Health CT. So far, 19,402 new customers have signed up for plans through the exchange. Of those, 44 percent selected ConnectiCare, while 31 percent chose plans offered by Anthem Blue Cross and Blue Shield, Connecticut’s largest carrier. (Levin Becker, 12/18)

The Miami Herald: Feds Tell PR Firm Not To Promote Florida Health Exchange
The federal government has told Tallahassee-based public relations firm Salter Mitchell that it cannot promote the state's health insurance marketplace, a long-time client, because of a conflict of interest, according to the state and the firm. Salter Mitchell also works for the federal Centers for Medicare & Medicaid Services, which administer healthcare.gov, the federally run healthcare exchange. The firm relayed the federal decision to Florida last month, saying that it would not be able to market the state exchange during the open enrollment period, from Nov. 15 to Feb. 15, when Americans can sign up for health coverage under the Affordable Care Act. (Nehamas and McGrory, 12/19)

Efforts to cut the Internal Revenue Service's budget could impact enforcement of the health law -

The Associated Press: IRS Head Says Budget Cuts Aimed at Hurting ACA Could Delay Tax Refunds, Enforcement
Budget cuts at the IRS could delay tax refunds, reduce taxpayer services and hurt enforcement efforts, IRS Commissioner John Koskinen said Thursday. The $10.9 billion budget is $1.2 billion less than the agency received in 2010, and the cuts come as the IRS is starting to play a bigger role in implementing President Barack Obama's health care law. Some Republicans in Congress have vowed to cut IRS funding as a way to hurt implementation of the health care law. Koskinen has said it won't work. He said the IRS is required to enforce the law, so other areas will have to be cut, including taxpayer services and enforcement. (Ohlemacher, 12/19)

In addition, The Washington Post Fact Checker takes a look at some of Jonathan Gruber's comments about the health law and subsidies -

Alabama Gov. Explores Block-Grant Approach To Medicaid Expansion

Gov. Robert Bentley emphasized Thursday that his administration is in the early stages of considering this approach. In other Medicaid news, members of a Wyoming state legislative panel endorsed an Indiana-style expansion plan.

The Associated Press: Governor Bentley Says He's Exploring Medicaid Expansion
Gov. Robert Bentley says he is exploring the idea of a state-created program that uses Medicaid expansion dollars to bring health care coverage to previously uninsured people living at or slightly above the poverty line. He emphasized Thursday his administration is only in the early stages of looking at a state-designed program. Bentley said he is also uncertain if the federal government would approve the work requirements he wants for recipients. (12/18)

AL.com: Gov. Robert Bentley Says Block Grant For Medicaid Expansion Not A Flip-Flop
Gov. Robert Bentley, who campaigned as an opponent of expanding Medicaid under the Affordable Care Act, now says his administration might seek a block grant for expansion. The governor said he hasn't changed his position, saying he first began talking about that in 2010. "A block grant has no strings attached," the governor said. "They give you the money and allow you as a state to design a program." (Cason, 12/18)

The Washington Post: Wyoming Lawmakers Endorse Indiana-Style Medicaid Expansion
Members of the Wyoming legislature will debate a measure to expand Medicaid during next year’s session — but it won’t be the proposal laid out by Gov. Matt Mead (R). The Joint Labor, Health and Social Services Interim Committee this week voted to endorse a measure that would model a Medicaid program on a version in Indiana, which requires newly eligible recipients to pay into a fund similar to a health savings account. (Wilson, 12/18)

And in Florida -

Tampa Bay Times: Local Groups Join Push To Close Medicaid Coverage Gap In Florida
Elisa Abolafia leaned her cane against the railing in front of City Hall and gingerly stepped to the lectern. The 60-year-old former private investigator suffers from severe scoliosis and four ruptured discs. Looking for work and too young for Medicare, Abolafia said she recently found out she is in the so-called Medicaid coverage gap, so she pays out-of-pocket for a patchwork of medical care. On Thursday, she stood beside Mayor Rick Kriseman and City Council member Darden Rice and pleaded with the state Legislature to accept federal dollars to expand the Medicaid program in Florida. ... Kriseman and Rice have joined a chorus of local officials pressuring lawmakers to accept $50 billion over 10 years offered by the federal Affordable Care Act. (Marrero, 12/18)

Hill Democrats Outline Consumer Impact If High Court Overturns Health Law's Subsidies

The suit that the Supreme Court has agreed to consider argues that the law does not allow subsidies in states that don't run their own online health marketplace. Florida and Georgia would be among the hardest hit states, according to the analysis by Democratic staffers on the House Energy and Commerce Committee.

Modern Healthcare: Supreme Court Decision Could Mean $65B In Lost Insurance Subsidies
Florida residents would lose $12.3 billion in financial assistance in 2016 if the U.S. Supreme Court strikes down insurance subsidies for states that haven't established their own exchanges, according to an analysis done by Democratic staffers on the House Energy and Commerce Committee. That's by far the largest dollar amount at stake in the King v. Burwell case that's expected be decided in June. It reflects not only that Florida has the fourth largest population in the country, but also the high level of exchange enrollments in the state during the first year of Obamacare signups. Roughly 1 million Floridians selected health plans during the first open-enrollment period, trailing only California. (Demko, 12/18)

Georgia Health News: How Court Rules On ACA Will Affect Many Georgians
Georgia would have the fourth-highest number of people affected if the U.S. Supreme Court rules against the current implementation of the Affordable Care Act, a study has found. The case, King v. Burwell, involves a legal challenge to the tax credits in states with federally run exchanges. (Miller, 12/18)

The Hill: Group Challenging ObamaCare Subsidies File New Lawsuit
The conservative advocacy group challenging the validity of billions of dollars in ObamaCare subsidies is suing the Department of Health and Human Services (HHS) for failing to respond to public records requests connected to the case. The Competitive Enterprise Institute (CEI) announced its suit on Thursday, claiming that HHS is "stonewalling" on three Freedom of Information Act (FOIA) requests that probe the development of the federal exchange and its ability to offer tax credits. (Viebeck, 12/18)

Quality

Medicare Cuts Payments To Hospitals With High Rates Of Problems That Harm Patients

The hospital-acquired condition penalties, which will total $373 million, are new this year.

Kaiser Health News: Medicare Cuts Payments To 721 Hospitals With Highest Rates Of Infections, Injuries
In its toughest crackdown yet on medical errors, the federal government is cutting payments to 721 hospitals for having high rates of infections and other patient injuries, records released Thursday show. Medicare assessed these new penalties against some of the most renowned hospitals in the nation, including the Cleveland Clinic, Brigham and Women’s Hospital in Boston, the Hospital of the University of Pennsylvania in Philadelphia and Geisinger Medical Center in Danville, Pa. (Rau, 12/18)

The Wall Street Journal and Modern Healthcare also look at other Medicare payment announcements.

The Wall Street Journal: Medicare To Cut Payments To Some Doctors, Hospitals
More than 257,000 U.S. doctors will see their Medicare payments cut by 1% next year because they didn’t meet federal goals for using electronic medical records, said the Centers for Medicare and Medicaid Services. Some 28,000 providers will be docked another 1% of Medicare pay for not prescribing medications electronically. About 200 hospitals were informed in October that they also will lose 1% of their Medicare payments in 2015 for missing a deadline for EMR use. The rules, part of the 2009 stimulus package, were designed to spur the health-care industry’s transition from paper files to electronic record keeping. (Beck, 12/18)

Modern Healthcare: More Hospitals To Get Bonuses Than Penalties In 2015 Under Value-Based Purchasing
More hospitals will see a payment bump than a penalty in the coming year under Medicare's value-based purchasing program, according to newly released federal data for more than 3,000 U.S. facilities.A total of 1,698 hospitals will have their Medicare payments boosted in 2015, 467 more than in 2014, according to a Modern Healthcare analysis of data the CMS posted Wednesday. The posted adjustments, however, range between 0.01% and 2.09%, which suggests there could be some anomalies in the data. (Rice, McKinney and Evans, 12/18)

Marketplace

Poll Finds Many Americans Think Paying For Health Care Is A Hardship

A New York Times/CBS poll examines the lengths many people must go to when trying to pay their medical bills. Also, NPR and ProPublica look at a nonprofit hospital in Missouri that has turned to lawsuits against patients who don't or can't pay their bills.

The New York Times: How The High Cost Of Medical Care Is Affecting Americans
Over the past two years, the New York Times series Paying Till It Hurts has examined the high costs of ordinary medical care in the United States, exposing the reasons and chronicling the human fallout behind the nation’s extraordinary $2.9 trillion medical bill. In response, more than 10,000 readers shared individual experiences like the ones above. But how does a collection of often heartbreaking, often startling tales reflect national experiences and attitudes? The available data did not answer all of my questions. So, using reader comments as a starting point, The Times designed a questionnaire with CBS News and conducted a national poll this month. (Rosenthal, 12/18)

CBS News: Do Americans Think Their Health Care Costs Are Affordable?
Fifty-two percent of Americans say they find basic medical care affordable, but that's down from 61 percent last December. Today, for 46 percent of Americans, paying for medical care is a hardship, up 10 points. Similarly, just over half of Americans are at least somewhat satisfied with their health care costs, while 43 percent are dissatisfied. (Dutton, De Pinto, Salvanto and Backus, 12/18)

NPR/ProPublica: When Nonprofit Hospitals Sue Their Patients
On the eastern edge of St. Joseph, Mo., lies the small city's only hospital, a landmark of modern brick and glass buildings. Everyone in town knows Heartland Regional Medical Center — many residents gave birth to their children here. Many rush here when they get hurt or sick. And there's another reason everyone knows this place: Thousands of people around St. Joseph have been sued by the hospital and had their wages seized to pay for medical bills. Some of them, given their income, could have qualified to get their bill forgiven entirely — but the hospital seized their wages anyway. (Arnold and Kiel, 12/19)

HHS Partnering With Pharmacies To Promote Obamacare Plans

Elsewhere, a lawsuit accuses Gilead of price gouging consumers in regard to its hepatitis C drug Sovaldi.

McClatchy: HHS Partners With 9 Large Pharmacies To Promote Marketplace Enrollment
The Obama administration is partnering with nine large pharmacy chains to help promote and publicize the nation’s health insurance marketplaces during the 2015 open enrollment period. The participating retailers, whose outlets encompass every state, are Ahold USA Companies, Bi-Lo Holdings, CVS Health, H-E-B, Kroger, Meijer, Rite Aid, Walgreens and Walmart. (Pugh, 12/18)

The Wall Street Journal: Lawsuit Alleges Price Gouging By Maker Of Hepatitis Drug
In arguing its case, the transit agency claims that, by using “exorbitant pricing,” Gilead has made it difficult for some consumers and government programs to afford its medication and, subsequently, has violated antitrust laws. The lawsuit also maintains the drug maker engages in discriminatory pricing, which violates the Affordable Care Act, because hepatitis C sufferers are “disabled.” (Silverman, 12/18)

State Watch

Aetna's Rate Increase For Calif. Small Business Insurance Plans Is Too Much, Says Commissioner

Based on filings, Aetna's small business rates are "excessive and unreasonable" for plans taking effect Jan. 1, said state insurance commissioner David Jones.

The Sacramento Bee: Aetna Charging Small Businesses Too Much, California Commissioner Says
With the bruising battle over Proposition 45 behind him, California Insurance Commissioner Dave Jones said Thursday that another health insurer is preparing to charge small businesses “excessive and unreasonable” rates. Jones’ actuaries determined Aetna Life Insurance Company’s filing for small-group policies – with an average 10.7 percent increase – will affect more than 64,000 people beginning Jan. 1. (Cadelago, 12/18)

Los Angeles Times: Aetna Rate Hike Excessive, California Insurance Commissioner Says
Health insurance giant Aetna Inc. is imposing excessive rate hikes on more than 5,000 small employers, according to California's insurance commissioner. Commissioner Dave Jones lashed out Thursday at the third-largest U.S. health insurer for raising premiums as much as 20% on some small businesses starting Jan. 1. The average increase of 10.7% will cost small employers and their workers $23.5 million in excessive premiums, according to the state. (Terhune, 12/18)

State Highlights: Alabama's Medicaid Overhaul; End-Of-Life Counseling Mandate In Mass.

A selection of health policy stories from Alabama, Massachusetts, Vermont, Maryland, Missouri, Arizona, Oregon, Kansas, New Jersey and North Carolina.

Montgomery Advertiser: Alabama Takes Step Toward Overhauling Medicaid Delivery
The state took another step Thursday toward changing the way it delivers Medicaid services, with the hope that the new system will improve healthcare outcomes and save the state money. Gov. Robert Bentley announced the formation of six regional care organizations (RCOs) aimed at moving the system, which provides health care to the poor, from a fee-for-service model to one closer to managed care. ... Over 1 million Alabamians receive health care through Medicaid, despite the program having some of the stiffest eligibility requirements in the country. ... The new system aims to reduce costs by getting Medicaid recipients to see primary care providers more frequently, and avoid costly hospitalizations. (Lyman, 12/18)

AL.com: Gov. Robert Bentley Updates Plan To Reform Medicaid In Alabama
The public got an update today on a plan to change Alabama's Medicaid system to a managed care approach. Gov. Robert Bentley announced the first six organizations certified on a probationary basis to provide managed care for specific regions of the state. Final approval and the start of the program is still almost two years away. The state is also awaiting approval of a waiver from the federal government. (Cason, 12/18)

WBUR: Doctors In Massachusetts Now Required To Offer End-Of-Life Counseling
Doctors, hospitals, nursing homes and other health providers in Massachusetts are now required to offer end-of-life counseling to terminally ill patients. The requirement, part of a 2012 law, takes effect Friday with the posting of rules about how it will work. It’s believed to be the first such rule in the country. (Bebinger, 12/19)

NPR: Is Your State Ready For The Next Infectious Outbreak? Probably Not
The report issued Thursday gives half of the states and the District of Columbia failing grades on 10 measures of preparedness, which include maintaining funding for public health services from 2012; getting half the population vaccinated for flu; reducing the number of bloodstream infections caused by central lines for people in the hospital; testing the response time for emergency laboratory tests; and testing 90 percent of suspected E. coli 0157 infections within four days. (Shute, 12/18)

The Baltimore Sun: Baltimore County Loses Appeal In Police Retiree Health Case
An appeals court has rejected a bid by the Baltimore County government to avoid reimbursing hundreds of police retirees who were overcharged for health insurance. The county paid more than $1.7 million in damages and interest to the Fraternal Order of Police this year under a court order. But it continued to appeal the order. In a ruling issued Wednesday, the Maryland Court of Special Appeals — the state's second-highest court — upheld the lower-court ruling. (Wood, 12/18)

The Associated Press: Missouri Home Care Workers Ask For Higher Pay
Missouri Gov. Jay Nixon is throwing his support behind home care workers, of which a handful caroled outside his mansion Thursday and called on him to ensure they receive a pay increase. But a union official cautioned the state's proposed action could hurt the cause. Office of Administration spokeswoman Ryan Burns said the Department of Health and Senior Services is drafting an administrative rule to implement wage increases for home-care workers that were negotiated by the Missouri Home Care Union. At issue are home-care attendants who are paid through the state's Medicaid program to help dress, clothe and bathe the older people or those otherwise unable to care for themselves. Those workers often are employed by companies that contract with the state. The minimum for the workers is $7.50 an hour, and the average is $8.58 an hour, according to the union. (Ballentine, 12/18)

The Oregonian: Kitzhaber Taps Prominent Nonprofit Executive And Republican Lynne Saxton To Head Troubled Oregon Health Authority
Oregon nonprofit executive Lynne Saxton has been tapped by Gov. John Kitzhaber to head the Oregon Health Authority after a year in which the agency's public image has taken a turn for the worse. Saxton, a Republican, was a member of Kitzhaber's 2010 transition team along with her husband, Ron, the 2006 Republican gubernatorial nominee. She is the executive director of Youth Villages Oregon, which provides residential treatment and in-home services for children with emotional and behavioral problems. (Budnick, 12/18)

The Associated Press: KU Hospital Provides Update On Reorganization
The University of Kansas Hospital has told the state Board of Regents that it is making progress toward streamlining clinical operations and hopes the effort will lead to cost savings and growth to help offset financial losses resulting from the state's failure to expand Medicaid. Currently, a nonprofit group that runs most of the clinics on campus has to negotiate among 18 different organizations. Between now and July 1, the plan is to combine those under the University of Kansas Hospital Authority, which has a 19-member board mostly appointed by the governor. (12/18)

NJ.com: N.J. Board Says 11 Hospitals Can Still Perform Angioplasties Without Heart Surgery Licenses
A state health board voted today to continue to allow 11 hospitals to perform the artery-clearing procedure known as angioplasty without holding a license to perform heart surgery. The approval by the state Health Care Administration Board means these 11 community hospitals would be able to continue offering elective angioplasties - a lucrative service in an increasingly competitive medical landscape. New Jersey's 18 hospitals that are licensed to perform cardiac surgery have criticized the policy, saying their fiscal health is jeopardized by allowing the additional angioplasty sites. (Livio, 12/18)

The Charlotte Observer: Second Charlotte Social Worker Charged In Medicaid Fraud
Ryce Edward Hatchett, 43, of Charlotte, a senior social worker with the county’s Department of Social Services, was charged Thursday with one count of selling the names for at least $12,000 to Ronnie Lorenzo Robinson, owner of Peaceful Alternative Resources Inc., according to a news release from U.S. Attorney Anne Tompkins. (Perlmutt, 12/18)

Health Policy Research

Research Roundup: Lowering Premiums; Basic Health Program Options; Slowdown In Medicare Spending

Each week, KHN compiles a selection of recently released health policy studies and briefs.

Journal of General Internal Medicine: CMS Reimbursement Reform and the Incidence of Hospital-Acquired Pulmonary Embolism Or Deep Vein Thrombosis
In October 2008, the Centers for Medicare & Medicaid Services (CMS) stopped reimbursing hospitals for the marginal cost of treating certain preventable hospital-acquired conditions. ... The outcome was the incidence proportion of hip and knee replacement surgery admissions that developed pulmonary embolism or deep vein thrombosis. At baseline, pulmonary embolism or deep vein thrombosis were present in 0.81 % of all hip or knee replacement surgeries for Medicare patients aged 65–69 years old. CMS payment reform resulted in a 35 % lower incidence of hospital-acquired pulmonary embolism or deep vein thrombosis in these patients (p = 0.015). ... Payment reform had the desired direction of effect. (Gidwani and Bhattacharya, 12/18)

The Kaiser Family Foundation: How Much Of The Medicare Spending Slowdown Can Be Explained? Insights And Analysis From 2014
This analysis aims to elaborate on the factors behind the gap between CBO's 2009 projections of what Medicare spending would be in 2014 and actual 2014 spending. Our analysis shows that policy choices make a difference: the ACA and [the Budget Control Act of 2011] BCA, along with various policies adopted by the Administrations, account for most of the $126 billion difference between CBO's 2009 Medicare spending projections for 2014 and actual spending this year. Yet, even after taking into account Medicare spending reductions included in the ACA and BCA, additional savings associated with slower-than-expected growth in drug spending and other changes for which we could find solid evidence of savings, we are still unable to explain what accounts for more than one-third of the gap between projected and actual spending for 2014. (White, Cubanski and Neuman, 12/17)

Health Affairs: State-Based Marketplaces Using ‘Clearinghouse’ Plan Management Models Are Associated With Lower Premiums
There is significant variation in how states have designed and implemented their Marketplaces. ... State-based Marketplaces using “clearinghouse” plan management models had significantly lower adjusted average premiums for all plans within each metal level compared to state-based Marketplaces using “active purchaser” models and the federally facilitated and partnership Marketplaces. Clearinghouse management models are those in which all health plans that meet published criteria are accepted. Active purchaser models are those in which states negotiate premiums, provider networks, number of plans, and benefits. (Krinn, Karaca-Mandic and Blewett, 12/17)

Urban Institute/Kaiser Family Foundation: The ACA’s Basic Health Program Option: Federal Requirements And State Trade-Offs
The Patient Protection and Affordable Care Act (ACA) gives states the option to implement a Basic Health Program (BHP) that covers low-income residents through state-contracting plans outside the health insurance marketplace, rather than qualified health plans (QHPs). ... BHP offers the prospect of improved affordability for low-income residents, fiscal gains for some states, and reduced churning. However, it also poses financial risks for states and has implications for state marketplaces. In the coming years, some states may investigate a range of approaches to improving affordability of coverage for their low-income residents. Which approach is best—BHP, state supplementation of marketplace subsidies, or bolder alternatives permitted under state reform waivers that begin in 2017—will depend greatly on the unique circumstances facing each individual state. (Dorn and Tolbert, 11/25)

JAMA Psychiatry: Benzodiazepine Use In The United States
Benzodiazepines are widely used in the treatment of anxiety and sleep problems. ... Despite benzodiazepine-related risks of falls, fractures, and motor vehicle crashes in older people, benzodiazepine use was approximately 3 times more prevalent in older than younger adults. ... Several factors may contribute to the observed high rates of long-term benzodiazepine use in older adults. These factors may include treatment of persistent anxiety disorders; deficits in specialized knowledge concerning benzodiazepine prescribing risks in geriatric care; limited access to alternative effective evidence-based treatments, such as cognitive behavioral therapy for insomnia; an unwillingness of some older people to consider reducing or discontinuing benzodiazepines; and competing clinical demands on physician time related to the other physical health needs of their patients. (Olfson, King and Schoenbaum, 12/17)

Urban Institute: Racial/Ethnic Differences In Uninsurance Rates Under The ACA
According to our projections, the ACA with current Medicaid expansion decisions can substantially narrow differences in uninsurance rates between whites and all racial/ethnic minorities, except blacks, who disproportionately live in nonexpansion states. Dramatic reductions are projected for the American Indian/Alaska Natives uninsurance rate: a decrease from 25.7 percent to 13.0 percent, or a 49.5 percent reduction that translates to 600,000 gaining coverage. Latinos have a projected decrease in the uninsurance rate from 31.2 percent to 19.0 percent: a 39.2 percent reduction that translates to 6.6 million gaining coverage. Both groups’ projections lead to a narrowing of the difference in their uninsurance rates compared with whites. ( Clemans-Cope, Buettgens and Recht, 12/16)

Here is a selection of news coverage of other recent research:

CQ Healthbeat: Enrollment In Medicaid Managed Care Grows Faster Than Fee-For-Service
The number of Medicaid beneficiaries enrolled through private managed care plans is growing faster than the number of people entering the traditional program, according to an analysis released Wednesday by a trade group representing health plans. The study, done by the PricewaterhouseCoopers accounting firm for the Medicaid Health Plans of America, found that 9.3 million more Medicaid beneficiaries were in managed care plans in 2014. The number in Medicaid fee-for-service programs fell for the first time, dropping by 300,000 enrollees. (Adams, 12/17)

Politico Pro: Study: Hospitals Penalized Despite Lower Readmissions
Hospitals that do a good job in reducing readmissions can still end up getting penalized under the Affordable Care Act — if they are also lowering overall admissions, according to research released Tuesday by the Altarum Institute. The findings raise questions about whether Medicare is using the right measurements, the researchers say. (Kenen, 12/16)

Reuters: California Study Finds Abortion Complications Very Rare
Less than one quarter of one percent of abortion procedures result in major complications, a very low rate that is comparable to minor outpatient procedures in the U.S., according to a study of more than 50,000 women. [in the journal Obstetrics and Gynecology.] ... Abortion is actually as safe as, or safer than, colonoscopy, said Dr. Elizabeth Raymond, and has complication rates similar to outpatient plastic surgery or dental surgery. (Doyle, 12/11)

Medscape: Maternal Mortality Ratio Has Doubled In 23 Years
The US pregnancy-related mortality ratio has continued to increase, rising to 16.0 deaths per 100,000 live births. The latest epidemiologic data from 2006 to 2010 suggest that cardiovascular conditions and infection contributed to the increase in pregnancy-related mortality. The fact that chronic diseases are playing a larger role in pregnancy-related mortality suggests there has been a change in the risk profile of the birthing population. (Pullen, 12/9)

Medscape: First-Episode Psychosis Treatment: Lots Of Room For Improvement
Almost two fifths of all first-episode psychosis (FEP) patients are prescribed drug treatment that does not meet current recommendations, new research shows. In an examination of first prescriptions among FEP patients entering a study of specialized treatment for the disorder, investigators found that prescriptions could have been improved in almost 40% of cases. (Davenport, 12/9)

Medscape: Pediatric Coverage A "Patchwork" Under Affordable Care Act
The approach used to establish the Affordable Care Act's pediatric essential health benefit has resulted in a state-by-state patchwork of coverage with inconsistent exclusions, particularly of services for children with mental or developmental disabilities, a new study finds. The results were published in the December children's health-themed issue of Health Affairs, and presented in a briefing by Aimee M. Grace, MD, a fellow in general academic paediatrics at Children's National Health System (Washington, DC). (Tucker, 12/8)

Medscape: Pharmacist Phone Call Before Physician Visit Enhances Care
Clinical pharmacists who perform medication reconciliation with new patients by telephone before their first visit to a primary care physician (PCP) can improve quality of care, researchers have found. ... They can prioritize medication concerns for the PCP so that important issues are addressed during appointments. Results of the study were presented in a poster at the American Society of Health-System Pharmacists (ASHP) Midyear Clinical Meeting (Frellick, 12/8)

Reuters: Problems At Home After Surgery? Study Says Go Back To Same Hospital
When patients have complications after surgery, it’s best to go back to the hospital where the operation was done, a new study suggests. Patients who go instead to a hospital that didn’t do the original operation have a higher risk of death, the researchers found. ... Generally, patients readmitted to a different hospital lived farther from the original facility than the one where they went for follow-up care, the researchers wrote in JAMA Surgery. (Rapaport, 12/8)

Editorials And Opinions

Viewpoints: Medicaid Surges -- In States That Didn't Expand The Program; Mumps In The NHL

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

The New York Times' The Upshot: Medicaid Rolls Surge Under Affordable Care Act
In Idaho, the number of people who signed up for Medicaid has jumped by 13.4 percent. In Georgia, it’s up 12.9 percent. In North Carolina, the rate has climbed 12.4 percent. None of those states opted to expand their Medicaid programs as part of the Affordable Care Act, but all have seen substantial enrollment increases in state health insurance. (Margot Sanger-Katz, 12/118)

The Wall Street Journal: A GOP Strategy Begins To Emerge
One result of these unforced errors is the glimmer of the strategy that Republicans appear to be concocting for the next few years. It isn’t rooted in the fury that brought in the 2010 tea party wave, or shutdown politics or grand bargains. It isn’t about ObamaCare repeal, or Medicare overhaul. It is more measured, more aimed at incremental achievement. Slow as it has been to gel, we’re beginning to see the framework take shape. (Kimberley A. Strassel, 12/18)

Bloomberg: Obamacare Isn't As Divisive As You Thought
Yes, as political scientist Matthew Dickinson mentioned in a recent post, some studies purport to show that Obamacare, specifically, cost Democrats quite a few seats in 2010 (I don’t think anyone has run numbers for 2014 yet). But I’ve been very skeptical of that finding. In particular, it’s extremely likely that if Democrats had ignored health care in 2009-2010 some other program would have symbolically done the same work. That is, Republicans would have replaced attacks on Obamacare with additional attacks on the stimulus, bailouts or Dodd-Frank. But really, voters were just reacting to Obama, his job performance and the economy. (Jonathan Bernstein, 12/18)

JAMA: In Defense Of The Employer Mandate
After 2 delays, section 1513 of the Affordable Care Act (ACA)—shared responsibility for employers—is finally slated to go into effect on January 1, 2015. The so-called employer mandate requires large employers to offer affordable “minimum-value” health insurance to full-time employees and their dependents (to age 26 years) or be subject to annual penalties if at least 1 employee receives premium tax credits for the purchase of individual health insurance via an exchange. Designed to maintain employer-sponsored coverage and to offset the public cost of subsidies to eligible employees in need of health insurance, the employer mandate constitutes an important component of the ACA. However, in the wake of the recent midterm elections, this provision is likely to be singled out for repeal by the newly elected Republican-controlled Congress. (John E. McDonough and Eli Y. Adashi, 12/18)

New England Journal of Medicine: Medicaid Payments And Access To Care
With more than 66 million beneficiaries, Medicaid is the United States' largest insurer, and its impact on health insurance coverage, access to care, and the health of the poor has been substantial. But historically, Medicaid has faced a major challenge — a relatively low rate of physician participation. ... Extensive research suggests that many factors contribute to low physician participation: complex program requirements, payment delays, and concerns about managing the care of patients with high levels of health and social risk. But research also shows that low fees play a key role and that substantial payment increases may be needed to alter physicians' behavior. (Sara Rosenbaum, 12/18)

The New York Times: Insurance Fairness For Transgender People
Gov. Andrew Cuomo advanced the cause of civil rights last week by declaring an end to a routine form of discrimination against transgender New Yorkers. New York law requires insurance policies sold in the state to cover the diagnosis and treatment of psychological disorders. In a letter sent to insurance companies, Mr. Cuomo said insurers will no longer be allowed to exclude from that coverage hormone treatments, gender reassignment surgery or other steps deemed medically necessary by a doctor for a patient with gender dysphoria. (12/18)

Bloomberg: How Hockey Got The Mumps
Over the past two months, the National Hockey League has experienced a baffling outbreak of mumps. Thirteen players are said to have it, and there's no telling when the outbreak will end. It is a story that seems to have stepped from the mid-20th century. ... We cannot know for sure, but it is not unreasonable to speculate that the outbreak among hockey players may be related to lower vaccination rates in Canada, spurred by the anti-vaccination movement. At the very least, it's clear that those who do not vaccinate their children, or themselves, are endangering not only their own families but strangers as well. (Cass R. Sunstein, 12/18)

The Washington Post: Morbid Obesity Is A Disability. Employers Should Start Treating It That Way.
Job interviews are an uncomfortable experience for most people. But for people like me who suffer from morbid obesity, they are especially grueling. It’s hard to impress someone when you’re the fat applicant. There’s the added challenge of sustaining an engaging conversation as a potential future employer walks you around the premises, a hike that leaves you winded. After that, you have to squeeze into a tiny chair and present your credentials, maintaining a charming demeanor as the blood circulation to the lower half of your body is cut off. I went through this process over and over again while I was searching for a job. I did land one eventually, as a manager in one of the world’s leading business schools. But my problems didn’t end there. ... It is clear to me that morbid obesity — defined as having a body mass index above 40 — is often a disability, irrelevant of the cause. But in many legal systems, that’s still an unanswered question. (Helen Leahey, 12/18)

The Washington Post: A Global Conspiracy Of Health
In the category of stunning, heartening, woefully underreported good news: In 2000, an estimated 9.9 million children around the world died before age 5. In 2013, the figure was 6.3 million. That is 3.6 million fewer deaths, even as the world’s population increased by about 1 billion. (Michael Gerson, 12/18)

New England Journal of Medicine: Panic, Paranoia, And Public Health — The AIDS Epidemic's Lessons For Ebola
For those of us who lived through the early days of the U.S. AIDS epidemic, the current national panic over Ebola brings back some very bad memories. The toxic mix of scientific ignorance and paranoia on display in the reaction to the return of health care workers from the front lines of the fight against Ebola in West Africa, the amplification of these reactions by politicians and the media, and the fear-driven suspicion and shunning of whole classes of people are all reminiscent of the response to the emergence of AIDS in the 1980s. (Gregg Gonsalves and Peter Staley, 12/18)