KHN Morning Briefing

Summaries of health policy coverage from major news organizations.

First Edition: November 16, 2012

Today's headlines include reports detailing the Obama administration's deadline extention -- now until Dec. 14 -- for states to decide how they want to proceed with the health law's insurance exchanges.

Kaiser Health News: Administration Expected To Release Soon Many New Rules For Health Law
Kaiser Health News staff writer Jordan Rau reports: "With the national health law's political future now entrenched, a deluge of new rules is expected in the coming days and weeks as the Obama administration fleshes out the law's complex components" (Rau, 11/15). Read the story.

Kaiser Health News: Obama Administration Extends Deadline For State Exchanges – Again
Kaiser Health News staff writer Phil Galewitz reports: "Bowing to a request from Republican governors, the Obama administration announced late Thursday that it would give states more time to decide whether to build online health insurance markets that will help millions of people buy coverage starting next fall. Health and Human Services Secretary Kathleen Sebelius pushed back the deadline until Dec. 14 for states to submit letters of intent to build the state-based markets, called exchanges. The original deadline had been Friday, Nov. 16" (Galewitz, 11/15). Read the story.

Kaiser Health News: Feds Say Nursing Home Overbilled Medicare By $1.5 Billion
Reporting for Kaiser Health News, Jenni Bergal writes: "At a time when the nursing home industry is lobbying Congress to avoid cuts in Medicare payments, a federal watchdog agency is reporting that taxpayers overpaid nursing homes $1.5 billion. The study released this week by the inspector general's office of the Department of Health and Human Services concluded that nursing homes billed about a quarter of claims incorrectly in 2009 – the year it studied. Most of those claims were 'upcoded,' which means Medicare was billed for services that were more extensive than what was provided or needed. Many of the claims were for intensive physical, speech or occupational therapy" (Bergal, 11/15). Read the story.

Kaiser Health News: Fiscal Cliff: What Is At Stake For Medicare And Medicaid? (Health On The Hill Video)
In this Kaiser Health News video, Jackie Judd talks to KHN's Mary Agnes Carey about the budget negotiation scenarios for Medicare, where the "doc fix" fits into the budget picture, and whether Medicaid cuts are possible (11/15). Watch the video or read the transcript.

Kaiser Health News: Capsules: Survey: Most U.S. Primary Care Docs Using EMRs; Divorce Often Means Women Lose Health Coverage
Now on Kaiser Health News' blog, Ankita Rao reports on primary care physicians and electronic medical records: "U.S. doctors are no longer the laggards when it comes to using health information technology in their practices. But they are still more weighed down by paperwork and health care costs than many of their Western counterparts" (Rao, 11/15).

In addition, Mississippi Public Radio's Jeffrey Hess, working in collaboration with Kaiser Health News and NPR, reports on Mississippi's exchange: "The Mississippi Insurance Department officially told the federal government that it will run its own health insurance exchange and plans to file the exchange blueprint Friday. If the state had not set up an insurance exchange, which is an online marketplace for comparison shopping for health insurance called for by the health overhaul law, the federal government would have set one up in Mississippi instead" (Hess, 11/16).

Also on Capsules, Shefali S. Kulkarni writes about the link for women between divorce and losing health insurance: "A study released this week from the University of Michigan reveals that roughly 115,000 American women lose their private health insurance annually after a divorce and about half of them do not get replacement coverage" (Kulkarni, 11/15). Check out what else is on the blog.

The New York Times: Senate 'Gang Of 8' Says this Isn't Its Moment In Deficit Talks
After years of wrangling, members of the bipartisan group of senators known as the Gang of Eight are ratcheting back expectations for a deficit reduction breakthrough and now say the best they can probably do is offer ideas for the one fiscal negotiation that will truly matter: talks between President Obama and Speaker John A. Boehner that begin in earnest on Friday. … Both sides insist they want a deal before January, but a rising chorus of voices, especially Democrats, say they would rather go over the cliff than accept a deal that raised too few taxes while extracting too many cuts, especially to Medicare and Medicaid. The search for a deal before January is off to a slow start. Rob Nabors, the president's chief liaison to Congress, came to the Capitol early this week to meet with Mr. Boehner's chief of staff, Mike Sommers. But little groundwork was done ahead of Friday's meeting (Weisman, 11/15).

Politico: Opening Gambit On Fiscal Cliff Negotiations
After months of talking about the fiscal cliff publicly, President Barack Obama and congressional Republicans finally expect to get down to business privately on Friday. Sort of (Budoff Brown and Sherman, 11/15).

The Associated Press/Washington Post: Analysis: Both Sides Talk Compromise On Fiscal Cliff, Without Significant New Concessions Yet
When President Barack Obama greets congressional leaders at the White House on Friday, an elaborate set of postelection rituals will be complete. Yet divided government's ability to attack the nation's economic woes is no clearer now than it has been for months. In talks that came close to a deal in 2011, Obama said he was willing to make significant cuts in the growth of benefit programs like Medicare and Medicaid, infuriating liberals. Boehner spoke of as much as $800 billion in new revenue, angering conservatives. The talks eventually collapsed (11/15).

The Associated Press/Washington Post: Obama On Tricky Path In Fiscal Cliff Negotiations With Congressional Leaders
President Barack Obama is kicking off budget dealings with congressional leaders with new leverage from last week's big win, but he confronts a decidedly tricky path to avoiding a market-rattling "fiscal cliff" that could imperil a still-fragile economy. Obama's GOP rivals promise greater flexibility on new tax revenues, but Democrats face pressure from liberal interest groups urging the president to take a hard line and avoid cutting big benefit programs like Medicare and food stamps. It's up to Obama to navigate the course toward an agreement (11/16).

The New York Times: Demystifying The Fiscal Impasse That Is Vexing Washington
Well, it's complicated — the so-called cliff, that is. And most solutions are politically painful. … Q. What spending would be cut? A. An emergency unemployment-compensation program is expiring, which would save $26 billion but end payments to millions of Americans who remain jobless and have exhausted state benefits. Medicare payments to doctors would be reduced 27 percent, or $11 billion, because this year Congress has not passed the usual so-called "doc fix" to block the cuts, which otherwise are required by a 1990s cost-control law (Calmes, 11/15).

Los Angeles Times: California Backs A 'Fiscal Cliff' Compromise – Sort Of, Poll Says
But things foundered on the details. When Democrats were asked whether cuts in Medicare and Social Security benefits should be offered to get Republican agreement on some tax hikes, or whether all reductions were off the table, they strongly opposed any benefit cuts. When Republicans were asked whether some revenue hikes should be accepted to get Democrats to agree to benefit cuts, they just as firmly opposed any tax increases (Decker, 11/15).

The New York Times: U.S. Extends Deadline For States On Health Insurance Exchanges
For the second time in a week, the Obama administration said on Thursday that it was extending the deadline for states to decide whether they will establish and operate online markets where consumers can shop for health insurance under the new health care law (Pear, 11/15).

NPR: Health Exchange Activity Heats Up As Deadline Is Extended
There's nothing quite like a deadline to focus the mind. Even a deadline that's not quite real. Friday was originally the day that states were supposed to not only tell the federal government whether they planned to run their own health exchanges but also how they planned to do it (Rovner, 11/15).

The Associated Press/Washington Post: States Deciding If They'll Help Carry Out A Key Component Of Obama's Health Care Overhaul
At issue is the creation of new health insurance markets, where millions of middle-class households and small businesses will shop for private coverage. The so-called exchanges will open for business Jan. 1, 2014, and most of their customers will be eligible for government subsidies to help pay premiums. The exchanges will also steer low-income people into expanded Medicaid programs, if states choose to broaden their safety net coverage (11/16).

The Associated Press/Washington Post: Grudging Acceptance Of 'Obamacare' Spreads As GOP-Led States Confront Implementation Choices
Ahead of a federal deadline Friday for states to declare their intentions, Associated Press reporters interviewed governors and state officials around the country, finding surprising openness to the changes in some cases. Opposition persists in others, and there is a widespread, urgent desire for answers on key unresolved details. Thursday evening, the Obama administration granted states a month’s extension, until Dec. 14. A check by the AP found that 16 states remain in the undecided column (11/15).

The Wall Street Journal: Deadline Delayed For A Month On Health Exchanges
Hours ahead of a Friday deadline, the administration told states that they could take another month to declare if they will set up their own insurance exchanges, where people can shop for approved plans and apply for tax subsidies toward the cost of health-insurance premiums. The exchanges are one of the main ways the law tries to extend coverage to up to 30 million Americans (Radnofsky and Nelson, 11/15).

Politico: HHS Pushes Back Health Exchange Deadline To Dec. 14
HHS is moving the exchange goalposts yet again. With one day to go before states were supposed to declare whether they plan to run their own exchanges, HHS gave them a last-minute reprieve Thursday night — although all but about 10 states had already made their intentions clear by then (Millman, 11/15).

The Associated Press/Washington Post: Employers Are Giving Employees The  Option Of Choosing Their own Health Insurance Plan
For some American workers, picking the right health insurance is becoming more like hunting for the perfect business suit: It takes some shopping around to find a good fit and avoid sticker shock. In a major shift in employer-sponsored health insurance coverage, companies such as Sears Holdings Corp. and Darden Restaurants Inc. are giving employees a fixed amount of money and allowing them to choose their own coverage based on their individual needs (11/15).

The New York Times: For Alzheimer's, Detection Advances Outpace Treatment Options
The new brain scan technology, which went on the market in June, is spreading fast. There are already more than 300 hospitals and imaging centers, located in most major metropolitan areas, that are ready to perform the scans, according to Eli Lilly, which sells the tracer used to mark plaque for the scan. The scans show plaques in the brain — barnaclelike clumps of protein, beta amyloid — that, together with dementia, are the defining feature of Alzheimer's disease. Those who have dementia but do not have excessive plaques do not have Alzheimer's. It is no longer necessary to wait until the person dies and has an autopsy to learn if the brain was studded with plaques (Kolata, 11/15).

Politico: Senators Grill FDA Commissioner On Outbreak
Food and Drug Administration Commissioner Margaret Hamburg acknowledged Thursday that the FDA could have acted more decisively against the company implicated in the meningitis outbreak but asked lawmakers to clarify and strengthen the agency's powers to regulate compounding pharmacies. Given more than a decade of documented safety and other violations at the New England Compounding Center, "I wish that [FDA's] responses had been more timely … that they had been better coordinated with the states," Hamburg said at a hearing of the Senate Health, Education, Labor and Pensions Committee (Norman, 11/16).

The Associated Press/Washington Post: Senate Health Chairman Promises New Drug Compounding Laws In Wake Of Meningitis Outbreak
The chairman of the Senate’s health committee pledged Thursday to move ahead with legislation to tighten oversight of compounding pharmacies, amid a deadly outbreak caused by tainted specialty medications (11/15).

The Wall Street Journal: Regulators Faulted For 'Inertia' Over Meningitis Concerns
A congressional report on Thursday released details of how federal and state regulators knew nearly a decade ago of serious safety concerns with the pharmacy tied to hundreds of meningitis cases, but failed to act decisively. Bipartisan staff of the Senate Health, Education, Labor and Pensions Committee concluded in a report that "bureaucratic inertia appears to be what allowed a bad actor to repeatedly risk public health" (Burton, 11/15).

The Texas Tribune/New York Times: Providers Push Back On Medicaid Inquiries
It has been nearly a year since Texas officials accused Dr. Glenn Wood of overbilling the state's Medicaid system by $17.9 million through his business, Carousel Pediatrics. Dr. Wood denies the accusations, but as he waits for absolution the state is holding 10 percent of Carousel's Medicaid payments — hundreds of thousands of dollars (Aaronson, 11/15).

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