KHN Morning Briefing

Summaries of health policy coverage from major news organizations.

Kaiser Health News Original Stories

Political Cartoon: 'Black Friday?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Black Friday?'" by Roy Delgado.

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Gather with loved ones
and a big, stuffed roasted bird
health care news can wait

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Health Law Issues And Implementation

A Top Democrat Says Party 'Blew Opportunity' With Health Care Focus

Sen. Charles Schumer, D-N.Y., said Democrats hurt themselves in 2009 and 2010 by putting so much effort on reforming health care, rather than on policies that would have helped a broader swath of the middle class.

The Wall Street Journal: Schumer Says Focus On Health Law Was A Political Mistake For Democrats
Democrats smarting from this year’s midterm losses need to embrace their pro-government roots and refocus on coherent policies to help the middle class, Sen. Charles Schumer of New York said Tuesday, citing the 2010 federal health-care law as a political miscalculation. Mr. Schumer, the third-ranking Democrat in the Senate, suggested his party has veered from this focus to its detriment in recent years. (Crittenden, 11/25)

Politico: Chuck Schumer Joins Criticism Chorus
Democrats’ top message man Chuck Schumer criticized how his own party handled Obamacare’s political strategy on Tuesday, joining a list of prominent Democrats who’ve chastised their own party in recent days as they struggle to come to terms with a crushing defeat earlier this month. Schumer commented at an event in Washington that Democrats “blew the opportunity the American people gave them” by concentrating on health care during the teeth of the recession in 2009 and 2010, calling it a focus on “the wrong problem.” (Everett, 11/25)

The Washington Post: Schumer: Democrats ‘Blew’ Opportunity By Focusing On ‘Wrong Problem’ — Health Care
Schumer, who voted for the health-care law and has championed it, suggested that he voiced similar concerns to colleagues back when the law was being crafted but was overruled by others who saw the moment as the best possible chance to reshape the nation's health-care system. "We should have done it. We just shouldn't have done it first," he said of what is considered by many Democrats to be President Obama's signature accomplishment. (Sullivan, 11/25)

USA Today: Schumer: Democrats Can Win If They 'Embrace Government'
“Democrats must embrace government. It’s what we believe in, it’s what unites our party and, most importantly, it’s the only thing that’s going to get the middle class going again,” Schumer said Tuesday. “If we run away from government, downplay it, or act as if we are embarrassed by its role, people won’t vote for our pale version of the Republican view — they’ll vote for the real McCoy.” (Camia, 11/25)

Bloomberg: Schumer Says Dems Erred By Passing Health Care In 2010
Schumer said Democrats should have addressed issues aiding the middle class to build confidence among voters before turning to revamping the health-care system. He said he opposed the timing of the health-care vote and was overruled by other party members. (Hunter, 11/25)

CBS News: Schumer: Democrats Wrong To Focus On Health Care
In 2009, Americans were still reeling from the effects of the financial crisis, but, said Schumer, "about 85 percent of Americans were fine with their healthcare in 2009." ... He lamented that the tea party was able to use the President's focus on health care to make the argument that "this government is aimed at someone else and not you." (Cronkite, 11/25)

The Wall Street Journal: On Twitter, Obama Loyalists Counter Schumer On Health Law
[L]oyal Obama aides and former staffers pushed back hard against Mr. Schumer on Tuesday — taking to Twitter to upbraid the veteran New York lawmaker for his comments. Former speechwriters Jon Lovett and Jon Favreau, along with former White House spokesman Tommy Vietor and current White House adviser Dan Pfeiffer all weighed in on the controversy via social media. Mr. Lovett devoted several tweets to defending the president, mincing no words and saying “a pretty good test for Democratic candidates is whether they view Schumer as someone to listen to or someone to tolerate.” (Tau and Andrews, 11/25)

HHS Plans Holiday Weekend Campaign To Remind Shoppers About Insurance Sign-Up

Also in health insurance enrollment news, the Wall Street Journal reports on problems with insurers' lists of doctors.

Politico: Obamacare, Coming To A Mall Near You
HHS is hitting the malls this weekend to make sure that Obamacare is on the minds of consumers during the busiest shopping weekend of the year. ... On three key days after Thanksgiving — Black Friday, Small Business Saturday and Cyber Monday — as well as dates beyond, Westfield Shopping Centers, the National Community Pharmacists Association and the XO Group will provide consumers with information about how they can sign up for coverage through the exchanges. (Pradhan, 11/26)

The Associated Press: Facing Health Law Hikes, Consumers Mull Options
Consumers across most of America will see their health insurance premiums go up next year for popular plans under President Barack Obama's health care law. But it will take time for families to figure out the best bang for their budgets — even as a bigger political battle brews over the program's future. For many people, government subsidies will cushion the hit. And there's a new factor: Returning customers who are savvy about health insurance and prepared to shop for a better deal. (Alonso-Zaldivar, 11/25)

The Wall Street Journal: Insurers’ Listings Of In-Network Doctors Often Out Of Date
Many insurers are offering smaller networks of doctors in their Medicare Advantage and commercial health plans this year. But those networks may be even narrower than they seem, physicians and regulators say, because the lists often include names and addresses that are erroneous or out-of-date. In some cases, the doctors shown as participating in plans have moved, retired or died, surveys show. Others are listed under the wrong specialty, work in hospitals full-time and don’t see outpatients, or don’t accept the plan being offered. (Beck, 11/25)

NBC News: Language Barriers Persist in Affordable Care Act Enrollment
It took 70 community groups working across 22 states in 41 languages to help 600,00 Asian Americans and Pacific Islanders (AAPIs) navigate the first open enrollment period for the Affordable Care Act in 2014. This year, experts say many of the same issues persist, and language remains their biggest obstacle. (Kai-Hwa Wang, 11/25)

Also in enrollment news, The Baltimore Sun reports on how sign-ups are going on Maryland's exchange.

The Baltimore Sun: Health Exchange Enrollment Tops 25,000
The Maryland Health Exchange has enrolled almost 26,000 people in public and private health insurance, officials said Tuesday, a little over a week since the site opened to consumers. More than 14,700 bought private plans and more than 11,000 were enrolled in Medicaid the federal-state health plan for the poor. (Cohn, 11/25)


The Washington Post: Feds Can Save Money By Examining Health Plans During Open Season Until Dec. 8
The holiday season also means Open Season for federal workers, retirees and their families. ... They have until Dec. 8 to change their health, dental and vision insurance companies and flexible spending accounts. Next year, average premium rates for the 8.2 million people covered by the Federal Employees Health Benefits (FEHB) Program will increase about 3.8 percent. Dental coverage premium rates will go up an average of 1.7 percent and vision benefits an average of 1.5 percent. FEHB is the nation’s largest employer-sponsored health benefits program, according to the Office of Personnel Management (OPM). (Davidson, 11/25)

New Calorie Count Rules Cause Confusion, Pushback

The Food And Drug Administration's calorie disclosure rules will affect many restaurants and other businesses.

Politico: Margaritas, Grocers Caught Up In FDA Menu Rule
Big chain restaurants are on board: They pushed for a national standard to override a patchwork of state and local menu labeling rules. McDonald’s adopted its own nationwide labeling in 2012. But grocery store and convenience store chains, the likes of Whole Foods, Sheetz and 7-Eleven, are expected to put up a fight about slapping calories next to their kale salad, nachos and Big Gulps. Movie theaters and the alcohol industry are also expected to fiercely protest being included in the mandate. A year from now, the calorie counts will have to be posted on menus right next to food items ... The rules apply to chains if they have more than 20 locations. (Bottemiller Evich, 11/25)

The Washington Post: People Literally Have No Idea How Many Calories Are In Their Food
America is about to find out how many calories are in their favorite dishes and snacks — and it could be a pretty big wake-up call. After years of delay, the FDA on Tuesday approved sweeping new rules that will mandate calorie counts at many places where Americans eat out — chain restaurants, movie theaters, pizza joints, vending machines and more. ... The big news is that the FDA rules are more comprehensive than expected, given the strong industry pushback since the menu labeling provision was included in the 2010 health-care law. (Millman, 11/25)

Advocates Cheer New Rx Rules To Prevent Discrimination

Patient groups laud new HHS rules barring insurers from discriminating against those with expensive health problems, such as AIDS, but want enforcement. Advocates for the poor draw attention to the struggle in many states to re-enroll adults and children in Medicaid.

Politico Pro: Groups Seek More Drug Benefit Enforcement
In a proposed rule issued late Friday, CMS wrote that if an insurer places “most or all” drugs for a specific condition on tiers with the greatest out-of-pocket spending requirements, “we believe that such plan designs effectively discriminate against, or discourage enrollment by, individuals who have those chronic conditions.” ... Carl Schmid, deputy executive director of the AIDS Institute, was pleased to see such language but said it will mean little if not enforced. (Pradhan, 11/25)

Modern Healthcare: Medicaid, CHIP Coverage At Risk For Thousands Of Pre-ACA Enrollees
Many states are struggling to re-enroll adults and children in Medicaid and the Children's Health Insurance Program, with hundreds of thousands of current beneficiaries at risk of losing coverage, advocates say. The enrollees who are at greatest risk are pregnant women, children and blind and disabled individuals who were enrolled in Medicaid prior to the effective date of two Patient Protection and Affordable Care Act provisions—the 2014 expansion of coverage to all adults with incomes up to 138% of the federal poverty level, and the establishment of a new formula to define household income under the Modified Adjusted Gross Income (MAGI) standard. (Dickson, 11/25)

Meanwhile, the administration warns employers against dumping high-cost workers into government insurance exchanges -

Kaiser Health News: Administration Warns Employers: Don’t Dump Sick Workers From Plans
As employers try to minimize expenses under the health law, the Obama administration has warned them against paying high-cost workers to leave the company medical plan and buy coverage elsewhere. Such a move would unlawfully discriminate against employees based on their health status, three federal agencies said in a bulletin issued this month. (Hancock, 11/25)

Kaiser Health News: Turning 21? Here’s How To Avoid A Big Hike In Health Insurance Premiums
For young people, turning 21 is generally a reason to celebrate reaching adulthood. If they’re insured through the federal health insurance marketplace that operates in about three dozen states, however, their birthday could mean a whopping 58 percent jump in their health insurance premium in 2015, according to an analysis by researchers at the Center on Budget and Policy Priorities. The reason: They’re no longer considered children under the age-rating rules insurers use to set premiums. (Andrews, 11/25)

Gruber Agrees To Testify On The Hill About Controversial Remarks

The consultant, who helped advise the White House on the health care law, will appear before the House Committee on Oversight and Government Reform next month.

Politico: Jonathan Gruber To Testify Before Issa Committee
MIT professor Jonathan Gruber has agreed to testify before the House Committee on Oversight and Government Reform after sparking outrage with his comments questioning the administration’s transparency and voters’ intelligence on the passage of Obamacare. (McCalmont, 11/25)

CNN: Jonathan Gruber Agrees To Testify In House
MIT economist and Obamacare consultant Jonathan Gruber -- most commonly now known for his comments regarding the "stupidity of the American voter" in helping to pass the President's signature health care law -- is coming to Congress. Gruber agreed Monday to testify before the House Government and Oversight Committee, the committee's spokeswoman Caitlin Carroll confirmed. (Diamond, 11/25)


Obama Order On Immigrants Could Extend Medicare Benefits

Many of the millions of people here illegally who qualify for protection under the president's executive order would likely be eligible to receive Social Security, Medicare and a wide array of other federal benefits because they pay payroll taxes, says a White House official.

The Washington Post: Illegal Immigrants Could Receive Social Security, Medicare Under Obama Action
Under President Obama’s new program to protect millions of illegal immigrants from deportation, many of those affected will be eligible to receive Social Security, Medicare and a wide array of other federal benefits, a White House official said Tuesday. ... Federal law says that people who pay the [payroll] taxes [for those programs] and are deemed “lawfully present in the United States” can collect benefits under those programs when they become eligible. They may also receive survivor and disability benefits. “If they pay in, they can draw,” White House spokesman Shawn Turner said by e-mail. (Tumulty, 11/25)

The Hill: Obama Order Extends Benefits To Immigrants
Illegal immigrants protected from deportation under President Obama's executive action will be eligible for Medicare and other benefits once they enter the federal system. The sweeping White House announcement last week means that up to 5 million people will be considered lawfully present in the United States despite having entered the country illegally. (Viebeck, 11/25)

In other Medicare news, Republicans in the House of Representatives offer a suggestion to fix complaints about hospital observation care coverage.

Modern Healthcare: House GOP Seeks Overhaul Of Short-Stay Hospital Payments
House Republicans are circulating a proposal to overhaul the way Medicare pays hospitals for short stays, including a plan to eliminate the widely criticized “two-midnight rule.” The timing of the document, described as a “discussion draft” might seem strange. It arrives in the middle of a lame-duck session .... And it was put forward by the House Ways and Means Committee, which will have a new chairman when the House reconvenes in January. But close watchers of Washington healthcare policy say they believe it's an important marker that could provide insight into the contours of the Medicare debate. (Demko, 11/25)

Public Health And Education

Weekend Reading

Longer Looks: 3-D Medical Printing; Healthier Hospitals; Early Cancer Detection Pitfalls

Each week, KHN's Shefali Luthra finds interesting reads from around the Web.

The New Yorker: How 3-D Printing Is Changing Medicine
Almost every day, I receive an e-mail from my hospital’s press office describing how yet another colleague is using a 3-D printer to create an intricately realistic surgical model—of a particular patient’s mitral valve, or finger, or optic nerve—to practice on before the actual operation. Surgeons are implanting 3-D-printed stents, prosthetics, and replacement segments of human skull. The exponents of 3-D printing contend that the technology is making manufacturing more democratic; the things we are choosing to print are becoming ever more personal and intimate. This appears to be even more true in medicine: increasingly, what we are printing is ourselves. (Jerome Groopman, 11/24)

Quartz: A Doctor Explains Why She Won’t Text Patients Their Test Results
If communicating the outcome of routine medical tests seems relatively straightforward, offering results about serious or even terminal diseases via digital technologies is an altogether different proposition. Such diagnoses must be accompanied by reassurance, prognostic information and a treatment plan. If the news is that weighty or complex, however, shouldn’t the whole conversation be had in person? Or have we arrived at an age when everything—even professional sympathy and support—can be conveyed electronically? (Esther Choo, 11/21)

Pacific Standard: Why Are America’s Poorest Toddlers Being Over-Prescribed ADHD Drugs?
Thousands of the nation’s poorest children under the age of four are being prescribed stimulants like Ritalin and Adderall for ailments they’re too young to even have. A first-ever Centers for Disease Control study estimates that under the Medicaid health care program, doctors have given some 10,000 American toddlers a diagnosis of ADHD and treated them with ADHD drugs that have not been shown to be effective or safe in children that young. The news that amphetamine-based drugs like Adderall and the methylphenidate Ritalin are being used to medicate, at a minimum, one out of every 225 toddlers nationwide outraged some medical professionals when it was first announced in May at the Georgia Mental Health Forum. (Josiah Hesse, 11/21)

Mosaic Science: Building Healthier Hospitals
The Dyson Centre, finished in 2011 and funded in part by Sir James Dyson, of vacuum cleaner fame, is an example of a new and different type of healthcare design. Deliberately distancing itself from the traditional hospital look, feel and smell, this and other places like it are drawing on a growing body of research that shows that buildings themselves can speed the recovery of patients, as well as boosting the health and happiness of the staff who work in them. (Lucy Maddox, 11/25)

The New York Times: Debate Persists Over Diagnosing Mental Health Disorders, Long After ‘Sybil’
The notion that a person might embody several personalities, each of them distinct, is hardly new. The ancient Romans had a sense of this and came up with Janus, a two-faced god. ... But few instances of the phenomenon captured Americans’ collective imagination quite like “Sybil,” the study of a woman said to have ... 16 different personalities. ... Sybil Dorsett, a pseudonym, became the paradigm of a psychiatric diagnosis once known as multiple personality disorder. ... Pre-"Sybil,” the diagnosis was rare, with only about 100 cases ever having been reported in medical journals. Less than a decade after “Sybil” made its appearance, in 1980, the American Psychiatric Association formally recognized the disorder, and the numbers soared into the thousands. (Clyde Haberman, 11/23)

FiveThirtyEight: The Case Against Early Cancer Detection
The harder we look for cancer — any cancer — the more we find. But most of these extra cases are ones like papillary thyroid cancers that never pose a threat. Researchers have a name for this — overdiagnosis, and it leads to another problem, overtreatment. Most people diagnosed with thyroid cancer get their thyroids surgically removed and must take hormone replacement drugs for the rest of their lives. (Christie Aschwanden, 11/24)

Pacific Standard: Why Are Patients Drawn To Certain Doctors?
If people can’t choose a doctor based on performance, how do they choose? For those of us who live in towns or cities with more than one doctor, social networks are still important. But what about when people can’t get a recommendation? Or when they get conflicting recommendations? And what makes people decide to stay with a doctor after an initial visit? (Eric Horowitz, 11/24)

The New York Times: How To Arrive At The Best Health Policies
Randomized controlled trials are increasingly popular in designing international development programs overseas, and trials have been used in the United States to see if policies increase voter turnout or improve homelessness assistance. They have a long history in fields like employment training. But there has been less appetite for using them in health care settings. Sometimes, the hesitation is because of ethical considerations: If we think we know a certain approach will be better, should we really withhold an intervention from some people? Sometimes it’s just practically and politically difficult to design trials. (Margot Sanger-Katz, 11/21)

State Watch

State Highlights: Texas Court Rejects Mentally Ill Man's Appeal; VA Hospital Death Probed

News outlets also look at health developments in Arkansas, Florida, Hawaii, Maine, Maryland, Oregon, Texas and Washington state.

The Texas Tribune: Court Declines Delay In Execution Of Severely Mentally Ill Man
The Texas Court of Criminal Appeals has rejected a request to delay the looming execution of a schizophrenic death row inmate. In a 5-4 decision handed down Tuesday, the court cited jurisdictional grounds in declining to stay Scott Louis Panetti’s execution, scheduled for December 3. Panetti’s attorneys argue he is too incompetent to be legally put to death. ... The 56-year-old’s mental health is deteriorating, his attorneys say. ... “Texas continues to pursue the execution of a man with an incurable, devastating mental illness that profoundly affected the crime, his trial and his death sentence,” [Kathryn Kase, Panetti’s attorney and executive director of Texas Defender Service] said in a statement. (Malewitz, 11/25)

The Baltimore Sun: Death Of Vet At VA Hospital Under Investigation
Investigators with the U.S. Department of Veterans Affairs are examining the death of a veteran in the emergency room of the Baltimore VA Medical Center early Saturday morning, officials said. The veteran was not identified. A spokeswoman for the Maryland VA Healthcare System said the man was acting suspiciously at the medical center and became agitated when questioned. The veteran's "physical state changed," spokeswoman Rosalia Scalia said in a statement. VA security officers took him to the emergency room, where he died. (Duncan, 11/25)

The Associated Press: Numerous Citations Issued Against Care Home
Federal regulators have cited a [Washington] state-run home for people with disabilities for a long list of violations, including strapping residents to chairs in front of TVs and forcing them to face a wall for hours at a time. It was the second time in less than a year that a surprise inspection led to citations at Lakeland Village Nursing Facility in Spokane County. (Mellisle, 11/25)

The Associated Press: Thompson Not Staying As State Surgeon General
Joe Thompson, who has served as Arkansas' most high-profile health official for nearly a decade and was a key advocate for the state's compromise Medicaid expansion, won't be reappointed to the post next year, Gov.-elect Asa Hutchinson announced Tuesday. Hutchinson confirmed the decision shortly after Thompson said the incoming Republican governor had told him he wouldn't stay on in the job next year. Thompson had been appointed the state's chief health officer in 2005 by Republican Gov. Mike Huckabee. Two years later, he was named the state's first surgeon general by Democratic Gov. Mike Beebe. (DeMillo, 11/25)

The Associated Press: Deficit Threatens Cuts To Big Island Hospitals
Hospitals on Hawaii's Big Island face the need to make massive cuts to services if lawmakers don't approve more funding, an official with the public health care system said. The East Hawaii operations of Hawaii Health Systems Corp. are expecting a $29 million revenue shortfall next year out of an annual budget of $160 million, said Dan Brinkman, East Hawaii interim CEO. (11/25)

The Associated Press: Oregon Economist Predicts A 'Silver Tsunami'
A prominent Oregon economist says one of the counties hardest hit by the decline of the state’s forest industries should expect a “silver tsunami” of retirees as aging baby boomers flee California and, if predictions pan out, the Pacific Northwest becomes a refuge from potential impacts elsewhere of climate change. His advice to Douglas County leaders is to make it a priority to make sure those retirees get their health care locally rather than in Eugene or Portland, the Roseburg News-Review reported. (11/25)

The Miami Herald: Feds Say Florida Health Care Company Used Expats To Bilk Medicare
Santiago B. Montoya, a 72-year-old Miami doctor, was the medical front man for a one-of-a-kind scam that raked in $25 million from Medicare for services provided to retired U.S. citizens living in Nicaragua and the Dominican Republic, authorities say. In total, a federal prosecutor said Tuesday, about 1,200 expatriates established fake Florida addresses to make the illegal claims from the taxpayer-funded program. The defendants are also accused of defrauding the parallel state Medicaid program for low-income people. Florida Healthcare Plus and its contractors deliberately misled the expatriates to exploit them in order to swindle Medicare, the indictment said. (Weaver, 11/25)

Editorials And Opinions

Viewpoints: Schumer's Second Thoughts About Obamacare; Need For 'Candor' On Welfare State

A selection of opinions on health care from around the United States.

The Wall Street Journal: Schumer’s ObamaCare Mea Culpa
Now that 28—soon probably 29—of the 60 Senate Democrats who voted for ObamaCare are out of office, one of the surviving believers is confessing a crisis of faith. New York Senator Chuck Schumer’s striking remarks on Tuesday suggest that the church of ObamaCare is losing congregants even in the front pews. Speaking at the National Press Club, the influential Senate leader identified the decline of middle-class incomes as the defining challenge of the age. Democrats can only win elections, Mr. Schumer said, as “the pro-government party”—and ObamaCare is undermining that larger political project. (11/25)

The Washington Post: Our Giant Welfare State
The Organization for Economic Cooperation and Development (OECD) — a group of wealthy nations — has recently published new figures on government social spending. ... Direct government spending isn’t the only way that societies provide social services. They also channel payments through private companies, encouraged, regulated and subsidized by government. This is what the United States does, notably with employer-provided health insurance (which is subsidized by government by not counting employer contributions as taxable income) and tax-favored retirement savings accounts. ... The main message that Americans can take from this report is that we need a higher level of candor. (Robert Samuelson, 11/25)

The New York Times: My Mission To Buy Small Business Health Insurance Begins Again
Every November, I return to my annual task of making a decision about health insurance. I’ve been offering this benefit to my employees for more than 20 years, and some aspects are predictable (cost increases) while others are different every year (my choice of plans, the consequences of dropping coverage.) Last year, obviously, was my first look at the world of Affordable Care Act plans, and I ended up spending way too much time trying to figure out what to do. (Paul Downs, 11/25)

The New York Times: The Problem With Prostate Screening
Scientific data from clinical trials provides the foundation of medical decision making, from a doctor’s prescription pad to sweeping public health policies. Public trust that the data is accurate and unbiased is the glue that binds our $3 trillion health care system. I worry that this trust, particularly when it comes to American men and their physicians and screening programs for prostate cancer, is now at risk. In 1970 I discovered the prostate-specific antigen, or PSA, which is now the most widely used tool in prostate screenings. But there has been a growing concern about whether the use of the PSA test has led to overdiagnosis and overtreatment, with millions of unnecessary surgeries, complications and deaths. (Richard J. Ablin, 11/25)

Bloomberg View: Bring Congress's Budget Watchdog Out Of The Shadows
Republicans who want a new director have disparaged some of the reports the agency issued during Elmendorf's term -- particularly its positive findings about President Barack Obama's stimulus spending and his health-care law -- and criticized the organization for not embracing "dynamic scoring." They think that when estimating how tax cuts or tax reform would affect federal revenue, for example, the CBO should take into account the possibility that the policy change would cause the economy to grow faster. (Ramesh Ponnuru, 11/25).