KHN Morning Briefing

Summaries of health policy coverage from major news organizations.

Kaiser Health News Original Stories

Cleveland Hospitals Grapple With Readmission Fines

The Cleveland Clinic, serving mostly insured patients, sees its Medicare fines go down, while fines go up at the city’s hospitals in low-income neighborhoods. The National Quality Forum is beginning a trial to adjust the program for hospitals that serve more poor people. (Sarah Jane Tribble, WCPN, 1/26)

Health Law Issues And Implementation Moves To Shield Consumer Information

The administration is making changes to boost privacy protections on the health insurance portal used by millions of Americans, a week after the Associated Press reported that details such as consumers' income and tobacco use were going to private companies with a commercial interest in such data. Meanwhile, a government audit confirms the agency responsible for developing the website did not properly vet contractors.

The Associated Press: Added Protections For Consumer Information On Health Website
The Obama administration appears to be making broader changes to protect consumer information on the government's health insurance website, after objections from lawmakers and privacy advocates. The Associated Press reported last week that details such as consumers' income and tobacco use were going to private companies with a commercial interest in such data. (Gillum and Alonso-Zaldivar, 1/24)

The Washington Post: Review Confirms Administration Did Not Properly Vet Contractors
The federal agency responsible for developing did not properly vet the contractors it hired to build the Web site and failed in many other aspects of planning it, according to a government review. In a report Thursday, the Department of Health and Human Services’ inspector general said that the Centers for Medicare and Medicaid Services “did not perform thorough reviews of contractor past performance when awarding two key contracts,” among other issues. (Hicks, 1/23)

And a House Republican demands information about the IRS' ties to CGI Federal, a failed Obamacare contractor -

Politico Pro: IRS Under Fire For Ties To Ditched Obamacare Contractor
A top House Republican is demanding the IRS provide details on its relationship to CGI Federal, a contractor that was terminated by HHS in part for its role in the botched rollout of The ties seem to predate the problems with the website. Still, six months after the company’s firing last January, the IRS renewed a contract with CGI for more than $4.5 million, according to Rep. Peter Roskam (R-Ill.), who chairs the House Ways and Means Oversight Subcommittee. (Dixon, 1/23)

Health Insurance Enrollment Efforts Hailed In Ga.

In the meantime, a "Night Ministry" in Illinois boosts enrollment efforts. Elsewhere, New Hampshire officials are torn over whether a proposed change to the health law's enrollment period could be good or bad for consumers.

Georgia Health News: HHS Chief Hails Exchange Success In Georgia
[Benjamin] Wills and his family are among the more than 425,000 Georgians currently signed up for coverage in the health insurance exchange in 2015. That signup number has exceeded expectations for this point in the open enrollment process. The enrollment period ends Feb. 15. (Miller, 1/23)

The Chicago Sun Times: Night Ministry Looking To Aid The Uninsured
When most of Chicago is just coming home from work, The Night Ministry is just starting its day, seeking uninsured people to make sure they’re aware of new health insurance options through the Affordable Care Act. Five nights a week, The Night Ministry — a nonprofit organization that provides housing, health care and other forms of support for homeless people or those in danger of becoming homeless — takes its Health Outreach Bus from neighborhood to neighborhood, from about 7 p.m. to midnight. (Thomas, 1/23)

The Associated Press: Proposed Insurance Enrollment Period Worries Some
A proposal to shift the Affordable Care Act's annual enrollment period could both help and hurt consumers, according to state insurance regulators and industry officials. There are still three weeks left in the current enrollment period, but insurance companies already are scrambling to prepare their 2016 plans and rates because the federal government wants future enrollment periods to run from Oct. 1-Dec. 15. (Ramer, 1/25)

Ark. Governor's Choice On Medicaid Is A Risky One

Gov. Asa Hutchinson's decision to continue the state's "private option" program while exploring other options opens him to criticism from his party.

The Associated Press: Analysis: Hutchinson Walks Fine Line In Medicaid Speech
Goodbye, private option. Hello, AsaCare. Calling on lawmakers to keep Arkansas' compromise Medicaid expansion alive through 2016 as he eyes a longer term health care plan, Republican Gov. Asa Hutchinson is trying to take ownership of an issue where he's tried to tread carefully over the past two years. It's an approach that sends him straight into the political minefield that he acknowledges has sharply divided his party. (DeMillo, 1/24)

In other Medicaid expansion news --

The Associated Press: Anti-Medicaid Expansion Lawmaker Criticizes Radio Ads
State House Republican Caucus Chairman Glen Casada, a staunch opponent of Gov. Bill Haslam's proposal to extend health coverage to 200,000 low-income Tennesseans, on Friday decried what he called "dishonest scare tactics" by a conservative group running radio ads targeting GOP lawmakers. The Tennessee chapter of the Americans for Prosperity, the organization backed by billionaire brothers Charles and David Koch, this week began running a 60-second radio ad accusing Republican state Rep. Kevin Brooks of Cleveland of "betraying" a promise to oppose President Barack Obama's health care law. (Schelzig, 1/23)

Los Angeles Times: Medi-Cal Applicants Entitled To Benefits Despite Delays, Judge Rules
California may no longer leave applicants in limbo as they wait to find out whether they qualify for the state’s healthcare program for the poor, a superior court judge has ruled. In a sharply worded decision issued in Alameda County on Tuesday, Judge Evelio M. Grillo wrote that the California Department of Health Care Services must provide Medi-Cal applicants with temporary benefits if it takes longer than 45 days — the time allowed by state law — to determine their eligibility. (Brown, 1/23)

Iowa Insurance Commissioner Will Seek Liquidation Of CoOportunity

This marks the first failure of one of the nonprofit health insurance co-ops created by the health law, which provided $146 million in federal grants and loans.

The Wall Street Journal: State Regulator To Shut Down Insurer CoOportunity Health
Iowa’s insurance regulator plans to shut down insurer CoOportunity Health, marking the first failure of one of the nonprofit cooperatives created under the Affordable Care Act. Iowa Insurance Commissioner Nick Gerhart, who had taken over operations of the insurer last month as it showed signs of faltering, said in a statement that he will ask for a court order of liquidation next week, and it would likely take effect on Feb. 28. The insurer doesn’t expect “additional cash inflow” until the second half of this year, and the amount owed on medical claims exceeds CoOportunity’s cash on hand, the regulator said. (Wilde Mathews, 1/23)

The Des Moines Register: CoOportunity Health To Be Liqudated
Iowa is pulling the plug on an experiment to have a consumer-owned cooperative sell health insurance. The state's insurance commissioner announced Friday that he would seek liquidation of CoOportunity Health, a carrier formed with $146 million in federal grants and loans under the Affordable Care Act. (Leys, 1/24)

Capitol Hill Watch

Obama's Veto Threats Seek To Protect Health Law

The president is also requesting hundreds of millions of dollars to develop personalized medical treatments. Elsewhere on Capitol Hill, Rep. Ron Kind, D-Wis., pushes to repeal the medical device tax and lawmakers debate the definition of rape.

The Associated Press: What Issues Roil Washington? Obama's Veto Threats Are Clues
In addition to delivering eight formal veto notices on specific bills under consideration, the president has sounded broader warnings that he’ll block legislative efforts that jeopardize his health care law, roll back rules governing Wall Street, reverse his immigration actions or impose new sanctions on Iran. There’s a little bit of everything in Obama’s veto threats: the culture wars (abortion), energy policy (Keystone XL oil pipeline), social matters (Obamacare), foreign policy (Iran), economic angst (financial regulation), even wonky details of governance. (1/23)

The New York Times: Obama To Request Research Funding For Treatments Tailored To Patients’ DNA
President Obama will seek hundreds of millions of dollars for a new initiative to develop medical treatments tailored to genetic and other characteristics of individual patients, administration officials say. The proposal, mentioned briefly in his State of the Union address, will be described in greater detail in his budget in the coming weeks. The effort is likely to receive support from members of both parties, lawmakers said. (Pear, 1/24)

The Hill: Groups Seize On 'Definitional Problem Of Rape' Comments
Abortion rights activists are trying to awaken a debate on rape that they believe will put the GOP in dangerous waters ahead of 2016, after a top Republican said Thursday that his party had a “definitional problem of rape.” Sen. Lindsey Graham (R-S.C.) spoke at the March for Life, a national anti-abortion rally, just hours after the issue of rape unexpectedly forced House Republicans to cancel a vote on an abortion bill. (Ferris, 1/23)

Also in the news,  a rising grassroots Republican renews his push for repealing the health law in a speech in Iowa.


Hospitals See $46B In Unpaid Bills Before Health Law's Insurance Expansions

The data comes from a 2013 survey by the American Hospital Association. Other stories look at how hospitals are faring under the law's new incentive programs to boost quality and at the vice president's call for renewed focus on patient safety.

The Hill: Hospitals Lost $46B In Unpaid Medical Bills In 2013
Hospitals footed the bill for a record $46 billion worth of unpaid medical bills in 2013, nearly double the amount from a decade ago. The costs of uncompensated care reflect data from nearly 5,000 hospitals around the country, according to surveys collected by the American Hospital Association (AHA). (Ferris, 1/23)

The Kansas City Star: Medicare Penalties May Be Working At Hospitals
Medicare is ratcheting up its demands that hospitals do a more effective job sending patients home in better shape than when they came in. For the past couple of years, hospitals have had their Medicare payments dinged if too many of their patients had to be readmitted in less than 30 days. Now, for the first time, hospitals also face financial penalties for excessive rates of catheter infections, as well as for avoidable injuries that patients suffer such as bedsores, blood clots and hip fractures. (Bavley, 1/25)

Kaiser Health News: Cleveland Hospitals Grapple With Readmission Fines
At the Cleveland Clinic’s sprawling main campus, patient Morgan Clay is being discharged. Clay arrived a couple of weeks ago suffering from complications related to acute heart failure. He’s ready to go home. But before Clay can leave, pharmacist Katie Greenlee stops by the room. 'What questions can I answer for you about the medicines?' Greenlee asks as she presents a folder of information about more than a dozen prescriptions Clay takes. "I don’t have too many questions," Clay says. "I’ve been on most of that stuff for a long time." (Tribble, 1/26)

Kaiser Health News: Vice President Joe Biden Calls For Renewed Focus On Patient Safety
Hospitals need to focus more on reducing preventable errors and infections and the government must create more economic incentives to improve patient safety, Vice President Joe Biden said at a conference in Irvine, Calif. over the weekend. "Up until now, our health care system – in my humble opinion – hasn’t sufficiently linked quality … with safety," he said. "Not enough time has been focused on keeping bad things from happening." (Gorman, 1/26)

Public Health And Education

Measles Outbreak Fails To Move Vaccine Opponents

As of late last week, 78 cases of the illness had been reported in seven states and Mexico.

Los Angeles Times: Parents Who Oppose Measles Vaccine Hold Firm To Their Beliefs
Measles can be especially severe in babies, toddlers and pregnant women, as well as other adults, according to the U.S. Centers for Disease Control and Prevention. Especially vulnerable are infants younger than 12 months, before they get their first dose of the vaccine known as MMR — for measles, mumps and rubella. But a growing anti-vaccination movement in the United States has been fueled by parents' fears that vaccines are not safe for every child. Like Monahan, some worry that the measles vaccine causes autism — a theory that has been thoroughly discredited by numerous scientific studies. In the face of the state's worst measles outbreak in 15 years, many of those aligned with the anti-vaccine movement remain unbowed. (Foxhall, 1/25)

Los Angeles Times: California Measles Outbreak Expands To 78 Cases; More Likely
The measles outbreak centered in California continues to expand, with officials now confirming 78 cases of the illness in seven states and Mexico. The California Department of Public Health said there are now 68 cases in the state – 48 that have been directly linked to being at Disneyland or Disney California Adventure last month. Some people also visited one or both of the parks while infectious in January. (Xia and Lin, 1/23)

In other public health news -

Los Angeles Times: What Do Health Experts See In Our Near Future?
What's in store for your health in the next five years? Doctors, authors, researchers and more weigh in. A sharp-eyed 20/20 look at healthcare changes by 2020. We asked some experts what they see ahead for our health — perhaps in the next year and then in five years. (1/23)

WHO Works To Reform Its Capacity To Respond To Global Health Emergencies

Following its slow start in battling the Ebola epidemic in Africa, the World Health Organization unanimously approves a resolution designed to overhaul its capacity to respond to and stop outbreaks and other health emergencies.

The New York Times: W.H.O. Members Endorse Resolution To Improve Response To Health Emergencies
As the battle to snuff out the Ebola epidemic in West Africa continues, amid hopeful signs of ebbing, fears of an even more deadly and widespread infectious disease’s emerging in the future are motivating efforts to reform global health institutions that faltered in the current outbreak. Chief among them is the World Health Organization, which has suffered withering criticism for an initially slow, disorganized and ineffective response to Ebola. (Fink, 1/25)

The Associated Press: WHO Mulls Reforms To Repair Reputation After Bungling Ebola
The World Health Organization is debating how to reform itself after botching the response to the Ebola outbreak, a sluggish performance that experts say cost thousands of lives. On Sunday, WHO's executive board planned to discuss proposals that could radically transform the United Nations health agency in response to sharp criticism over its handling of the West Africa epidemic. (Cheng, 1/25)

State Watch

Governors' Budget Plans Touch State Employee Health Benefits, Medicaid

News outlets report on the health policy impact of budget blueprints advanced by the governors of California, Georgia and Maryland.

The Sacramento Bee: Brown, Employee Unions Set To Tangle Over Health Insurance
After years of making concessions to Gov. Jerry Brown, California labor leaders had hoped that the fourth-and-final-term Democrat finally would be in a giving mood. But after the governor’s budget proposal two weeks ago, several unions are bracing for tough talks in the coming months about Brown’s determination to cut the state’s costs of insuring employees and retirees. A range of options are on the table, from cheaper insurance plans and smaller subsidies to extending how long new hires must work to qualify for retiree health benefits. (Ortiz, 1/25)

The Associated Perss: Maryland Lawmakers To Be Briefed On Budget
State analysts are scheduled to go over the governor’s plan with lawmakers on committees that will be working on the budget this legislative session. Hogan, a Republican, submitted a balanced budget plan last week that addresses a shortfall of roughly $750 million. The budget includes cuts, such as reductions in rates paid to Medicaid healthcare providers and cost-of-living adjustments for state employees. (1/26)

State Highlights: Calif. Bill Advanced To Address Doctor Network Concerns; KanCare May Go Without IG

A selection of health policy stories from California, Kansas, New York, Pennsylvania, Texas, Iowa, New Hampshire, New Mexico and Florida.

Los Angeles Times: Health Insurers May Face Tougher Rules On Obamacare Doctor Lists
In response to complaints about Obamacare doctor networks, a California lawmaker and three consumer groups are seeking legislation that would require health plans to improve provider directories. State Sen. Ed Hernandez (D-West Covina) said Friday he introduced legislation that would force health plans to update their provider lists weekly and make them more widely available online to insurance shoppers. (Terhune, 1/23)

The Kansas Health Institute News Service: Mosier: KanCare May Not Need An Inspector General
The state official who heads KanCare said Friday that the Medicaid program’s long-vacant inspector general position may not need to be filled. The KanCare inspector general would serve as a watchdog over the $3 billion contracts the state awarded to three private insurance companies to administer Medicaid services. Susan Mosier, secretary of the Kansas Department of Health and Environment, told a legislative committee Friday that the state is struggling to find a qualified candidate who will take on the job. (Marso, 1/24)

The New York Times: To Collect Debts, Nursing Homes Are Seizing Control Over Patients
Few people are aware that a nursing home can take such a step. Guardianship cases are difficult to gain access to and poorly tracked by New York State courts; cases are often closed from public view for confidentiality. But the Palermo case is no aberration. Interviews with veterans of the system and a review of guardianship court data conducted by researchers at Hunter College at the request of The New York Times show the practice has become routine, underscoring the growing power nursing homes wield over residents and families amid changes in the financing of long-term care. In a random, anonymized sample of 700 guardianship cases filed in Manhattan over a decade, Hunter College researchers found more than 12 percent were brought by nursing homes. Some of these may have been prompted by family feuds, suspected embezzlement or just the absence of relatives to help secure Medicaid coverage. But lawyers and others versed in the guardianship process agree that nursing homes primarily use such petitions as a means of bill collection — a purpose never intended by the Legislature when it enacted the guardianship statute in 1993. (Bernstein, 1/25)

The Philadelphia Inquirer: Program Glitch Wrecks Chaos For Addiction And Alcohol Treatment Providers In Pa.
A year before Healthy Pennsylvania's rollout, Michael Harle, president and CEO of Gaudenzia, the drug and alcohol treatment center, was assured by top state Medicaid officials his clients would not see their health insurance change. After Medicaid recipients began shifting to the new program on Dec. 1, "all hell broke loose," Harle said. A glitch in the system covered his clients and thousands of people across Pennsylvania in need of substance-abuse and mental-health services with private insurance instead of Healthy Plus, the new program for the medically frail. The problem is most of those private plans don't offer addiction and mental-health treatment, and those that do have less robust benefits than Healthy Plus. The result is thousands of people have been locked out of treatment centers, risking their lives, said Deb Beck, president of the Drug and Alcohol Service Providers Organization of Pennsylvania, a statewide coalition of treatment programs. (Calandra, 1/25)

The Texas Tribune: HHSC Ditching Anti-Fraud Initiative Started By Stick
When Jack Stick became the deputy inspector general of the Texas Health and Human Services Commission in 2012, he saw an opportunity to help investigators beef up their production in bringing potential fraud cases forward. For the first time, general investigators — who review whether recipients of food stamps, Children’s Medicaid and other programs were overpaid — had to produce cases totaling at least $35,000 each month. For those investigating Medicaid overpayments to health care providers, cases had to be completed within 16 weeks — some cases had previously languished for years — unless they could show more time was needed. (Langford, 1/24)

The Des Moines Register: Branstad Plan To Shut Mental Hospitals Called Illegal
Gov. Terry Branstad’s plan to unilaterally shut down mental health institutions here and in Clarinda is illegal, legislators charged Saturday. Sen. Rich Taylor told about 100 people at a community forum that state law specifically requires Iowa to have mental health institutions at Mount Pleasant, Independence, Clarinda and Cherokee. (Leys, 1/24)

The Des Moines Register: Iowan Not Alone In Home-Health Concerns
A West Des Moines quadriplegic's complaint this month of being abandoned by a home-health care agency gave rise to new complaints to the Watchdog — and underscored a worsening national problem in a notoriously low-wage industry. Michael Penniman said his hope in making public concerns with Iowa Home Care in a Jan. 11 column was to give a voice to others he said were being ignored by the home-health care provider. (Rood, 1/25)

The Associated Press: Health Department To Cut $7M In Nursing Home Funding
New Hampshire nursing homes could lose $7 million in expected Medicaid reimbursements as part of a plan to close a $58 million budget hole in the state's Department of Health and Human Services. Members of a joint legislative fiscal committee strongly opposed the cuts, but the changes do not require approval from legislators. (Ronayne, 1/23)

Stateline: States Look To Tax E-Cigarettes
With an eye on the twin concerns of public health and raising revenue, Utah is one of many states considering taxing electronic cigarettes, the battery-powered devices that deliver vaporized nicotine and provide the look and feel of smoking without the smoke and tar of traditional tobacco products. Gov. Gary Herbert, a Republican, sparked this year’s debate when he included a footnote in his budget counting on $10 million from taxing e-cigarettes. (Povich, 1/23)

The Associated Press: State May Release More Information On Health Services Audit
[New Mexico] Attorney General Hector Balderas on Friday said he’s researching the possibility of releasing more information from a 2013 audit of 15 nonprofits that provided behavioral health services for needy New Mexicans. Balderas told lawmakers during a House committee meeting that a decision was expected within a matter of days. The New Mexico Foundation for Open Government sued last September after former Attorney General Gary King’s office and the Human Services Department refused to release the audit. King had defended the secrecy of the audit, saying it was evidence related to an open investigation. (1/23)

Health News Florida: Heroin ODs Spike After Pill Mill Crackdown
Five years ago, Florida was labeled the prescription drug capital of the U.S. Seven people died every day from overdoses – until the Florida Legislature started a crackdown. The Prescription Drug Monitoring Program made opiate pills more expensive on the street, and left many addicts with a choice: Get treatment, or find a substitute. But there’s a downside in the drop in prescription drug use. Overdoses and deaths from heroin are on the rise in Florida. In 2010, 48 people died from heroin overdoses. (Aboraya, 1/23)

Editorials And Opinions

Viewpoints: Ending Health Law Is Not Immoral; 'Revolution' In Hep C Drug Prices

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

The Washington Post: End Obamacare, And People Could Die. That’s Okay.
Say conservatives have their way with Obamacare, and the Supreme Court deals it a death blow or a Republican president repeals it in 2017. Some people who got health insurance as a result of the Affordable Care Act may lose it. In which case, liberals like to say, some of Obamacare’s beneficiaries may die. ... If these are the stakes, many liberals argue, then ending Obamacare is immoral. Except, it’s not. In a world of scarce resources, a slightly higher mortality rate is an acceptable price to pay for certain goals — including more cash for other programs, such as those that help the poor; less government coercion and more individual liberty; more health-care choice for consumers, (Michael R. Strain, 1/23)

MSNBC: Theory Vs. Practice: Scrapping ACA Benefits Isn’t Easy
In theory, Republicans are desperate to destroy the Affordable Care Act and take insurance and related benefits from millions. GOP lawmakers in Congress have demonstrated their commitment to this goal with literally dozens of votes to repeal “Obamacare.” But these efforts generally come with an important caveat: they’re hollow. Republicans know these efforts won’t become law, at least not anytime soon, so it’s all for show .... When the debate is less theoretical and more practical, Republican bravado isn’t quite so effortless. Take yesterday, for example, where Arkansas’ new GOP governor was weighing whether to kill the state’s Medicaid expansion policy. ( Steve Benen, 1/23)

The Wall Street Journal: The Revolution At The Corner Drugstore
For the better part of a year, the worlds of health-care finance and health-care politics have been scandalized by the specialty drug called Sovaldi. The $84,000 cost for a course of treatment of this hepatitis-C cure was said to reveal that pharmaceutical prices were irrational or abusive; that markets were helpless to respond; and that, absent government intercession, this new wave of complex biological therapies would bankrupt the nation. Then, this winter, all of a sudden, discipline and competition arrived. (Joseph Rego, 1/23)

Los Angeles Times: A Problem With How We Treat Cancer -- And How To Fix It
I was diagnosed with cancer after giving birth to my third child. The tumor had grown especially large thanks to my body’s hormones that had been growing my baby. The medical community helped my disease, but could not help my despair. Then, five years after cancer -- and just after I finished my first triathlon -- I developed heart, liver and lung failure. My body was overtaken by damage from earlier cancer treatments. I remember one day vividly; I sat crying in my oncologist’s office after not being able to sleep for many nights, with wild mood swings, profuse sweating and persistent panic attacks. My doctor told me, “Well, at least we saved your life.” As if that was all I could hope for as I began to recover. He may well have said: “You’re alive. Be happy. Go away.” Who would save my mind? (Cindy Finch, 1/24)

Bloomberg: Vilifying Vaccines
Vaccines have done more than any other medical innovation to save lives and improve health. Yet the persistent and incorrect belief by a minority of parents that vaccines are more dangerous than beneficial is undermining those advances in the U.S. and parts of Europe. The challenge is how to protect communities against disease when some people won’t take part in public health measures that need everyone’s participation to be effective. (Makiko Kitamura,1/26)

Helena Independent Record: Martin Luther King And Montana Medicaid Expansion
The Martin Luther King challenge of economic justice is an important element in the so-called debate about Medicaid expansion in Montana. ... In this wealthiest nation in the world, part of the “fatigue of despair” he spoke of relates to the current inability of working families to afford to keep their families healthy. Uninsured families inhabit the emergency rooms of the system, if they seek healthcare at all. Preventative care is almost unheard of. ... If we believe that we should secure economic justice for all Montanans, then providing medical insurance options for the “last and the least” is the minimum of what we should do. (Evan Barrett, 1/26)

The Kansas City Star: Kansas City Area Should Provide More Mental Health Services
Karen Kelley has tried to kill herself several times, but she does not want to die. There was one way for her to get the mental health care that she desperately needed, even if it meant attempting suicide. Psychiatric hospital beds and treatment center slots are severely limited for the mentally ill, unless one poses a danger to herself or someone else. Kelley is one of many who suffers mental illness and can’t find help. One in five Americans experienced a mental illness last year. (Diane Bigler, 1/23)