Four More Hospital Systems Quit ACO Program

Three years after the Centers For Medicare & Medicaid Services selected 32 groups to participate in the Pioneer Accountable Care Organization Model program, they are down to 19 players. Officials say that navigating the program’s rules has proved challenging.

<a href="http://online.wsj.com/articles/a-Medicare-program-loses-more-health-care-providers-1411685388?KEYWORDS=Medicare” target=”_blank” data-mce-href=”http://online.wsj.com/articles/a-Medicare-program-loses-more-health-care-providers-1411685388?KEYWORDS=Medicare“>The Wall Street Journal: A Medicare Program Loses More Health-Care Providers

Four more hospital systems recently have dropped out of the Pioneer Accountable Care Organization program, a key part of the federal health law, leaving just 19 of the original 32 participants. Accountable care organizations seek to curb costs by better coordinating care. Hospitals and groups of doctors who keep costs down for large groups of Medicare patients get to share in those savings. But navigating the program’s rules has proved challenging for some hospitals, even those long experienced in coordinated care (Beck, 9/25).

<a href="http://www.modernhealthcare.com/article/20140925/NEWS/309259938/Medicares-pioneer-program-down-to-19-acos-after-three-more-exit” target=”_blank”>Modern Healthcare: Medicare’s Pioneer Program Down To 19 ACOs After Three More Exit

Three years after CMS carefully selected 32 accountable care organizations deemed best able to manage the Pioneer program’s financial risks, three more decided they no longer want to. The new departures — the program is now down to 19 ACOs — suggest even the most sophisticated health systems may be unwilling to take losses as policymakers test new payment and delivery models. Franciscan Alliance in Indianapolis, Genesys PHO in Flint, Mich., and Renaissance Health Network in Wayne, Pa., have exited the program, which is now in its third year (Evans, 9/25).

Four More Hospital Systems Quit ACO Program

Four More Hospital Systems Quit ACO Program

Three years after the Centers For Medicare & Medicaid Services selected 32 groups to participate in the Pioneer Accountable Care Organization Model program, they are down to 19 players. Officials say that navigating the program’s rules has proved challenging.

<a href="http://online.wsj.com/articles/a-Medicare-program-loses-more-health-care-providers-1411685388?KEYWORDS=Medicare” target=”_blank” data-mce-href=”http://online.wsj.com/articles/a-Medicare-program-loses-more-health-care-providers-1411685388?KEYWORDS=Medicare“>The Wall Street Journal: A Medicare Program Loses More Health-Care Providers

Four more hospital systems recently have dropped out of the Pioneer Accountable Care Organization program, a key part of the federal health law, leaving just 19 of the original 32 participants. Accountable care organizations seek to curb costs by better coordinating care. Hospitals and groups of doctors who keep costs down for large groups of Medicare patients get to share in those savings. But navigating the program’s rules has proved challenging for some hospitals, even those long experienced in coordinated care (Beck, 9/25).

<a href="http://www.modernhealthcare.com/article/20140925/NEWS/309259938/Medicares-pioneer-program-down-to-19-acos-after-three-more-exit” target=”_blank”>Modern Healthcare: Medicare’s Pioneer Program Down To 19 ACOs After Three More Exit

Three years after CMS carefully selected 32 accountable care organizations deemed best able to manage the Pioneer program’s financial risks, three more decided they no longer want to. The new departures — the program is now down to 19 ACOs — suggest even the most sophisticated health systems may be unwilling to take losses as policymakers test new payment and delivery models. Franciscan Alliance in Indianapolis, Genesys PHO in Flint, Mich., and Renaissance Health Network in Wayne, Pa., have exited the program, which is now in its third year (Evans, 9/25).

Four More Hospital Systems Quit ACO Program

First Edition: September 26, 2014

Today’s headlines include a variety of political and health policy stories.

Kaiser Health News: Debate Grows Over Employer Plans With No Hospital Benefits

Kaiser Health News staff writer Jay Hancock reports: “As companies prepare to offer medical coverage for 2015, debate has grown over government software that critics say can trap workers in inadequate plans while barring them from subsidies to buy fuller coverage on their own. At the center of contention is the calculator — an online spreadsheet to certify whether plans meet the Affordable Care Act’s toughest standard for large employers, the ‘minimum value’ test for adequate benefits” (Hancock, 9/26). Read the story.

Kaiser Health News: DEA: Vicodin, Some Other Pain Meds Will Be Harder to Get

Kaiser Health News consumer columnist Michelle Andrews writes: “The Drug Enforcement Administration is reclassifying so-called ‘hydrocodone combination products’ from Schedule III to Schedule II under the Controlled Substances Act, which will more tightly restrict access. Vicodin, for example, is an HCP because it has hydrocodone and acetaminophen” (Andrews, 9/26). Read the story.

Kaiser Health News: Capsules: Consumer Group Sues 2 More Calif. Plans Over Narrow Networks ; For Gay Men, Gaps In HIV Knowledge, Treatment Persist

Now on Kaiser Health News’ blog, Julie Appleby writes about two California lawsuits regarding narrow networks : “Both cases allege that the insurers offered inadequate networks of doctors and hospitals and that the companies advertised lists of participating providers that were incorrect. Consumers learned their doctors were not, in fact, participating in the plans too late to switch to other insurers, the suits allege, and patients had to spend hours on customer service lines trying to get answers. Both cases seek class action status” (Appleby, 9/25). 

Also on Capsules, Jenny Gold reports on two reports that explore the HIV knowledge gap: “Just 30 percent of gay and bisexual men say they were tested for HIV within the last year as recommended; another 30 percent say they have never been tested. And even when they are tested, only half of those who have been diagnosed with HIV are receiving care and treatment for their infection” (Gold, 9/25). Check out what else is on the blog.

<a href="http://online.wsj.com/articles/a-Medicare-program-loses-more-health-care-providers-1411685388?KEYWORDS=Medicare” data-mce-href=”http://online.wsj.com/articles/a-Medicare-program-loses-more-health-care-providers-1411685388?KEYWORDS=Medicare“>The Wall Street Journal: A Medicare Program Loses More Health-Care Providers

Four more hospital systems recently have dropped out of the Pioneer Accountable Care Organization program, a key part of the federal health law, leaving just 19 of the original 32 participants. Accountable care organizations seek to curb costs by better coordinating care. Hospitals and groups of doctors who keep costs down for large groups of Medicare patients get to share in those savings. But navigating the program’s rules has proved challenging for some hospitals, even those long experienced in coordinated care (Beck, 9/25).

The Washington Post: Obamacare’s Small Business Exchanges Offer Cheaper Health Coverage, Study Shows

During the lead-up to the rollout of the health care law a year ago, President Obama was adamant that new insurance marketplaces for small businesses would provide a start-to-finish online shopping experience for employers, where they could compare and buy plans with the click of a mouse. In addition, he said, by placing rates from different insurers side-by-side and offering tax breaks, the marketplaces would provide less expensive plans that what had been available to small companies (Harrison, 9/24).

The New York Times: A Father’s Last Wish, And A Daughter’s Anguish

He was still her handsome father, the song-and-dance man of her childhood, with a full head of wavy hair and blue eyes that lit up when he talked. But he was gaunt now, warped like a weathered plank, perhaps by late effects of an old stroke, certainly by muscle atrophy and bad circulation in his legs. Now she was determined to fulfill her father’s dearest wish, the wish so common among frail, elderly people: to die at home. But it seemed as if all the forces of the health care system were against her — hospitals, nursing homes, home health agencies, insurance companies, and the shifting crosscurrents of public health care spending (Bernstein, 9/25).

The Associated Press: Senators: Widen Medicaid Program For Frail Seniors

More than a dozen U.S. senators from both parties are calling on the Obama administration to broaden a Medicaid program for the nation’s frailest seniors, calling it a proven alternative to pricier nursing home care as states seek to limit long-term medical costs. In a letter released Thursday, the senators urged the Centers for Medicare and Medicaid Services to follow through on plans to loosen restrictions on the Program of All Inclusive Care for the Elderly. PACE is open to Medicaid-eligible seniors and people with disabilities who need nursing home care (9/25).

The Wall Street Journal’s Washington Wire: With Holder Leaving, Verrilli Is Back in the Spotlight

U.S. Solicitor General Donald Verrilli Jr., who successfully defended President Barack Obama’s signature health-care law in 2012, is among the possible candidates to succeed Attorney General Eric Holder, who is expected to announce Thursday that he will step down. Mr. Verrilli, 57 years old, is a veteran appellate lawyer who in private and government practice has argued numerous high-profile Supreme Court cases. In addition to defending the Affordable Care Act, Mr. Verrilli has represented the U.S. government in major cases before the high court on same-sex marriage, voting rights and this year’s challenge to contraception-coverage requirements under the health law (Adamy and Henderson, 9/25).

The Washington Post: Brady To Battle Ryan For Ways And Means Chairmanship

Rep. Kevin Brady (R-Tex.) said Thursday that he will seek the chairmanship of the powerful House Ways and Means Committee, scrambling what was expected to be a smooth ascension to the post by Rep. Paul Ryan (R-Wis.), the 2012 GOP vice-presidential nominee and the party’s architect of fiscal policy in the House. Brady said in an interview that after months of weighing his options, he has decided to battle Ryan for the gavel. The move could force Ryan’s hand on a 2016 presidential run (Costa, 9/25).

The New York Times: Ad Attacks Skinny-Dipping Congressman

The commercial refers to an incident in which Representative Kevin Yoder went skinny-dipping in the Sea of Galilee with other Republican members during a trip to Israel last year. Ms. Kultala’s ad features sound bites from conveniently covered skinny-dippers lounging at a pool, as nude puns abound about Mr. Yoder’s record. “The naked truth is Yoder voted to cut Medicare for seniors,” says one elderly couple, sidling up to the side of the pool for cover (Corasaniti, 9/25).

Los Angeles Times: Gov. Brown Signs Bills On Birth Control, Inmate Rights

Gov. Jerry Brown on Thursday signed into law bills requiring most health plans to cover a variety of contraceptive methods, banning forced or coerced sterilizations of inmates in California prisons and giving felons behind bars easier access to DNA tests that could prove their innocence. The birth control bill covers contraceptive drugs, devices and products for women, as well as related counseling, follow-up services and voluntary sterilization procedures (McGreevy and Mason, 9/25).

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First Edition: September 26, 2014

Underinsured Enrollees Flood Community Health Centers

Some low-income consumers who bought bronze plans with low premiums but high deductibles are discovering they still can’t afford health care and are turning to the community health centers which cannot turn anyone away. Meanwhile, a study finds insurance costs for small businesses are lower through the SHOP exchanges, and South Dakota lifts a $2M cap on employees’ lifetime health costs.

Modern Healthcare: Underinsured ACA Enrollees Strain Community Health Centers

Obamacare enrollees are straining the finances of community health centers around the country, some health center leaders say. The issue is that many lower-income patients with insurance coverage through the federal and state exchanges bought bronze-tier plans with lower premiums but high deductibles, coinsurance and copayments and no federal cost-sharing subsidies. When these patients face high out-of-pocket costs for care that falls below the deductible, they can’t afford it.  So the centers are subsidizing that care by offering them means-tested sliding-scale fees. When the centers, which are not allowed to turn away patients for inability to pay, try to get the insurers to pay, the claims are usually denied, and the centers have to write it off as uncompensated care (Dickson, 9/25).

The Washington Post: Obamacare’s Small Business Exchanges Offer Cheaper Health Coverage, Study Shows

During the lead-up to the rollout of the health care law a year ago, President Obama was adamant that new insurance marketplaces for small businesses would provide a start-to-finish online shopping experience for employers, where they could compare and buy plans with the click of a mouse. In addition, he said, by placing rates from different insurers side-by-side and offering tax breaks, the marketplaces would provide less expensive plans that what had been available to small companies. … It appears, based on one new study, that the exchanges are delivering [on the second promise] (Harrison, 9/24).

Kaiser Health News: Debate Grows Over Employer Plans With No Hospital Benefits

As companies prepare to offer medical coverage for 2015, debate has grown over government software that critics say can trap workers in inadequate plans while barring them from subsidies to buy fuller coverage on their own. At the center of contention is the calculator — an online spreadsheet to certify whether plans meet the Affordable Care Act’s toughest standard for large employers, the ‘minimum value’ test for adequate benefits (Hancock, 9/26).

The Associated Press: State Lifts $2M Cap On Employee Health Care Costs

South Dakota can no longer limit how much it pays out in health care coverage over the lifetime of state employees, but officials say for now that shouldn’t raise costs. Laurie Gill, the commissioner of the state’s Bureau of Human Resources, briefed legislators this week on how changes mandated by the Affordable Care Act will affect the state’s health plan. The Affordable Care Act prohibits health care plans from capping the amount of benefits employees incur over a lifetime. South Dakota had capped lifetime expenses at $2 million per individual, meaning any health care costs incurred over that amount weren’t covered. The change means the state could end up paying out more, but Tom Steckel, the state’s director of employee benefits, said in the past it’s been rare for an employee to reach the $2 million limit. Steckel said his office has been looking into how many workers surpassed the cap. So far, he said, he wasn’t aware that any had reached it last year (Burbach, 9/25).

Underinsured Enrollees Flood Community Health Centers

Four More Hospital Systems Quit ACO Program

Three years after the Centers For Medicare & Medicaid Services selected 32 groups to participate in the Pioneer Accountable Care Organization Model program, they are down to 19 players. Officials say that navigating the program’s rules has proved challenging.

The Wall Street Journal: A Medicare Program Loses More Health-Care Providers

Four more hospital systems recently have dropped out of the Pioneer Accountable Care Organization program, a key part of the federal health law, leaving just 19 of the original 32 participants. Accountable care organizations seek to curb costs by better coordinating care. Hospitals and groups of doctors who keep costs down for large groups of Medicare patients get to share in those savings. But navigating the program’s rules has proved challenging for some hospitals, even those long experienced in coordinated care (Beck, 9/25).

Modern Healthcare: Medicare’s Pioneer Program Down To 19 ACOs After Three More Exit

Three years after CMS carefully selected 32 accountable care organizations deemed best able to manage the Pioneer program’s financial risks, three more decided they no longer want to. The new departures — the program is now down to 19 ACOs — suggest even the most sophisticated health systems may be unwilling to take losses as policymakers test new payment and delivery models. Franciscan Alliance in Indianapolis, Genesys PHO in Flint, Mich., and Renaissance Health Network in Wayne, Pa., have exited the program, which is now in its third year (Evans, 9/25).

Four More Hospital Systems Quit ACO Program

Viewpoints: 'Feud' Over Health Care Compact; Humane End-Of-Life Care

Kansas City Star: Inside The Feud Over The Kansas Health Care Compact Law

Never has an issue of The Best Times, Johnson County’s monthly magazine for seniors, been so eagerly awaited. I know I’ve been on the edge of my seat. At first the draw was to read the article that had gotten some Kansas legislators so worked up that 11 of them stormed en masse into a meeting to berate the volunteer members of the Johnson County Commission on Aging for writing it. The Legislature last session passed a bill potentially enabling Kansas to shuck off Obamacare and other regulation-laden federal programs and join other states in a “health care compact.” Naturally, lawmakers would expect federal money to do this. Gov. Sam Brownback signed the bill. Members of the Commission on Aging, who advise county leaders, looked at the new law and found it alarming. They penned their concerns in an article for the October edition of The Best Times (Shelly, 9/25).

The New York Times’ Room For Debate: Finding Humane Care At The End Of Life

As the story of Joseph Andrey’s last month’s shows, many Americans will end their lives in surroundings that only add to their misery. Those who hoped to die in their own beds are often forced into nursing homes, some of which mistreat patients. Even if home care is arranged, it too can be substandard, even abusive. And those who hope for government guidance can find unreliable information (9/25). 

Los Angeles Times: Despite Obamacare, U.S. Healthcare System Still Dysfunctional

Obamacare was supposed to make our healthcare system friendlier to patients, and in many ways it’s succeeded. But we still have a long way to go. For almost her entire life, Maria Rogers has been the picture of health. …. In May, however, Rogers was diagnosed with Stage 3 cancer of the abdomen. … Rogers’ experience illustrates the challenges we face not just getting affordable healthcare but keeping it while dealing with a life-threatening illness (David Lazarus, 9/25). 

Los Angeles Times: When They Would Rather Let You Die Than Let You Have An Abortion

Have you ever wondered what a world without abortion might actually look like? Let me amend that: There will obviously never be a world without abortion. Have you ever wondered what a world without legal abortion would look like? (Robin Abcarian, 9/25). 

The Wall Street Journal‘s Washington Wire: Behind The Increase In HIV Infections Among Gay And Bisexual Men

Gay and bisexual men represent an estimated 2% of the U.S. population but more than half of all people living with HIV and 66% of new HIV infections. They are the only population group in the United States for which HIV infections are rising. Projections have shown that if current trends continue, half of all gay and bisexual men will be HIV-positive by age 50 (Drew Altman, 9/25).

Baltimore Sun: Primary Care Providers Can Handle Hepatitis C Prescriptions

The release of an extremely costly medicine (sofosbuvir) for the treatment of chronic hepatitis C illustrates a great number of dilemmas facing health care policy in America: how to appropriately manage our financial resources in caring for populations, how to ascertain which patients will benefit the most from expensive treatments, and even how other countries have gotten the same drugs — reportedly priced at about $84,000 in the U.S. for one three-month cycle of treatment — for less (Loftus, 9/25).

Los Angeles Times: No On Proposition 46 Campaign Tries To Start A Hacker Panic

Even by the political world’s low standards of truthiness, a new commercial being aired by the No on Proposition 46 campaign is jaw-droppingly deceptive. The proposition would make three major changes in the laws related to the practice of medicine in California. It would quadruple the cap on “pain and suffering” damages in medical malpractice lawsuits, require many physicians to be tested for drug and alcohol use, and force physicians and pharmacists to consult an existing state prescription database before prescribing or distributing certain medications to a patient for the first time (Jon Healey, 9/25). 

Viewpoints: 'Feud' Over Health Care Compact; Humane End-Of-Life Care

Calif. Governor Vetoes Bill To Protect Assets From Medi-Cal

This story is part of a partnership that includes Capital Public Radio, NPR and Kaiser Health News. It can be republished for free. (details)

With the stroke of a pen, Gov. Jerry Brown rejected an effort to protect the estates of Medicaid beneficiaries in California, the San Jose Mercury News reported Friday. The bill, which the Democratic governor vetoed on Thursday, would have shielded the assets of people who receive Medicaid, known as Medi-Cal in California, from being recouped by the state after their deaths.

In a three-paragraph letter to the state senate, Brown advised legislators to consider the issue during the budget process. Brown wrote: “Allowing more estate protection for the next generation may be a worthy policy goal. The cost of this change, however, needs to be considered alongside other worthwhile policy changes in the budget process next year.”

The issue is important to people like Anne-Louise Vernon, who recently signed up for Medi-Cal under the Affordable Care Act’s expansion of the program. Vernon told Pauline Bartolone of Capitol Public Radio that she fears using her new coverage.  “I feel so unsettled about this whole estate recovery thing that I’m afraid to go to the doctor,” she said.

The law has been on California’s books for two decades, but with the expansion of Medi-Cal it now has the potential to affect many more people.

More from Pauline Bartolone’s story for Kaiser Health News and Capitol Public Radio:

Elizabeth Landsberg of the Western Center on Law and Poverty said it turns what was intended to be a safety net program into a long-term loan program and undermines the security that families might pass on to the next generation.

“So in most cases it’s modest family homes that we’re talking about, and so the state will most often come back and put a lien on that home, and unfortunately it does force the kids to sell the homes sometimes,” said Landsberg.

Landsberg said the law is unfair under the Affordable Care Act, because other people buying insurance and getting premium subsidies through Covered California aren’t subject to the same rules.

“For the first time people have to have health coverage. So it’s created an inequity where the lowest income people could lose their assets, and other higher income people who are also getting publicly-subsidized health coverage have no worries,” said Landsberg.

Calif. Governor Vetoes Bill To Protect Assets From Medi-Cal

After Glitch, CVS Gives 11,000 Birth Control Refunds

CVS Health will pay refunds to about 11,000 women whom it accidentally charged co-payments for generic prescription birth control – a violation of the federal health law – due to a price coding glitch affecting Maryland, Virginia and the District of Columbia.

The company found that the charges resulted from an error that affected people covered by a single plan, CVS spokeswoman Carolyn Castel said in an email.

That plan was offered through CareFirst BlueCross BlueShield, which operates in Maryland, Virginia and Washington, D.C., according to California Democratic Rep. Jackie Speier’s office.

Speier was contacted by CVS in response to concerns she had raised earlier this month, when a congressional staffer purchased generic prescription birth control and was charged a $20 copay.

The coding error was in effect for less than two months, according to the letter, which noted that the problem should be fixed by Sept. 26. The 11,000 affected customers are expected to receive refunds by the start of October.

“We are committed to assuring that our customers receive the pharmacy benefits that are available to them and apologize for any inconvenience this issue may have caused,” Castel said in the email.

But it’s unclear whether these 11,000 are the only customers affected by the error. Also in September, women from Speier’s California district reported being charged copays, her office said. Those women would not be covered through a CareFirst plan.

CVS has not verified those complaints, Speier’s office said, but if they are correct, customers other than the 11,000 identified could have wrongly been charged out-of-pocket costs. Speier’s office will “continue gathering stories.”

Copays for birth control pills often range between $10 and $35 per month, charges which can add up over time.

Generic prescription birth control is considered part of women’s preventive care, which the health law mandates insurance plans cover without cost-sharing.

After Glitch, CVS Gives 11,000 Birth Control Refunds

California Program Trains Young Men To Change Their Lives By Saving Others

On Thursday’s PBS NewsHour, KHN’s Sarah Varney reported on an innovative program in Oakland, Calif., that trains at risk youths to be emergency medical technicians. Watch the video below and read more on the NewsHour website.

California Program Trains Young Men To Change Their Lives By Saving Others

Failure of Health IT Systems Hinders ACO Cost Savings

The inability of health IT systems to communicate with one another has hobbled the efforts of ACOs to improve care and save money, says a report by Premier Inc. and eHealth Initiative. Meanwhile, a health care executive tells why her organization quit the Pioneer ACO program, and New York’s Mount Sinai urges a judge to dismiss a lawsuit tied to a rule requiring providers to return government overpayments within 60 days.

CQ Healthbeat: ACOs Complain Current Health IT Systems Thwart Cost Savings

The Obama administration boasts of successes launching accountable care organizations and fostering adoption of health information technology systems. But the two aren’t coming together the way they are supposed to in an effort streamline the delivery of health care. That was the complaint in a survey of ACOs jointly released Wednesday by Premier Inc., a hospital consortium, and the eHealth Initiative, a nonprofit whose members include doctor, patient, insurer, public health and other groups. ACOs aim to deliver team based care using health IT systems to coordinate treatment, share medical histories and test results and order tests and prescriptions with fewer errors. But the failure of health IT systems to work together seamlessly blocks these goals, said Premier Senior Vice President Keith Figlioli (Reichard, 9/24).

California Healthline: Why One Pioneer ACO Quit The Program – And What It Reveals About The ACA

Allison Fleury is the CEO of Sharp HealthCare’s accountable care organization. She’s a senior vice president at the health system, but was trained as a CPA. And the more she looked at Medicare‘s Pioneer ACO program — arguably the government’s most ambitious accountable care pilot — the more she worried that the numbers weren’t adding up for her organization, one of the 32 original Pioneers (Diamond, 9/24).

Modern Healthcare: Mount Sinai Urges Court To Dismiss Suit Tied To Repayment Rule

Mount Sinai Health System, one of New York City’s largest not-for-profit healthcare organizations, has asked a federal court to throw out a first-of-its-kind case that involves refunding overpayments to the federal government in a timely manner. Under a little-discussed provision of the Patient Protection and Affordable Care Act, providers must return all Medicare and Medicaid overpayments within 60 days of when the overpayments were identified. Failing to do so results in liability under the False Claims Act, which carries stiff penalties: up to $11,000 for each “fraudulently delayed” claim multiplied by three. Hospitals, physicians and healthcare attorneys have slammed the rule, saying it could hurt providers for unintended actions.  Mount Sinai’s legal battle could have ramifications for other health systems, according to Shannon DeBra and Beatrice Nokuri, healthcare attorneys with Bricker & Eckler (Herman, 9/24).

Failure of Health IT Systems Hinders ACO Cost Savings

Californians Divided Over Health Law, According To Survey

In other news about how health policies are playing in this campaign season, fact checkers examine statements from the Wisconsin governor’s race and a West Virginia congressional contest. Meanwhile, abortion continues to be a topic on the Texas gubernatorial campaign trail.

Sacramento Bee: Poll: Obamacare Support Sliding, Jerry Brown, Water-Bond Up Big

The Affordable Care Act continues to divide Californians, who remain skeptical four years after its passage despite the state’s relatively smooth launch in which more than 1.2 million people enrolled in health insurance coverage. A new survey released late Tuesday found some 42 percent of state residents generally view the law favorably, while 46 percent harbor unfavorable opinions. Support is down somewhat since May, before a wave of targeted TV ads began in a handful of competitive congressional districts (Cadelago, 9/23).

PolitiFact Wisconsin: Mary Burke ‘Supports Obamacare Unequivocally’ And Wants To Expand It, Says Scott Walker

[Gov. Scott] Walker provided no evidence that [Mary] Burke has expressed unequivocal support for the Affordable Care Act, and we are not aware of any. At the same time, Burke does back the law and she supports expanding it through making more people eligible for Medicaid. Walker’s statement is partially accurate but leaves out important details. We rate it Half True (Tom Kertscher, 9/23).

Other health policy issues are in play, too –

Dallas Morning News: Wendy Davis And Greg Abbott Clash Over Abortion And Other Women’s Issues

The candidates for governor renewed their fight over women’s issues Tuesday, with Wendy Davis charging that Greg Abbott had belittled women with his strict abortion stance and Abbott countering that Davis was playing politics instead of helping solve issues important to women. Speaking at a Dallas luncheon sponsored by Annie’s List, a group that promotes progressive female candidates, Davis blistered Abbott for supporting a ban on abortion in all cases except when the woman’s life is at risk (Jeffers, 9/23).

The Washington Post’s The Fact Checker: A Sleazy Attack Puts Words In The Other Candidate’s Mouth

Our colleagues at FactCheck.org have already done yeoman work in untangling issues involving black lung benefits in the West Virginia race between Rep. Nick Rahall and challenger Evan Jenkins (R). But we don’t want to pass this one up. How often does a candidate literally put words in another candidate’s mouth? (Kessler, 9/24).

Californians Divided Over Health Law, According To Survey

HCA Faces Class-Action Lawsuit For Allegedly Concealing Revenue Declines

A Nashville district court judge allowed the shareholders’ case to move forward by rejecting the hospital chain’s arguments that the plaintiffs had missed ‘multiple opportunities’ to learn more about the company before buying shares.

Reuters: U.S. Hospital Chain HCA Must Face Class Action Over 2011 IPO

HCA Holdings Inc., one of the largest U.S. hospital chains, must face a shareholder class-action lawsuit accusing it of concealing revenue declines and its routine performance of unnecessary cardiac procedures prior to its $4.35 billion initial public offering in March 2011. U.S. District Judge Kevin Sharp in Nashville, Tennessee, rejected HCA’s claim that the plaintiffs had missed “multiple opportunities” to learn more about the company before buying their shares, including from media reports, conference calls, and disclosures during the IPO road show. Shareholders alleged that HCA, its directors, its former private equity owners and its investment banks concealed how the company was seeing adverse trends in Medicare revenue including cardiology, and Medicaid revenue per admission and accounted improperly for a 2006 reorganization and a 2010 restructuring (Stempel, 9/23).

Meanwhile, the CEO of a growing medical lab steps down amid a federal probe –

<a href="http://online.wsj.com/articles/health-diagnostic-laboratory-ceo-to-step-down-1411500521?KEYWORDS=Medicare“>The Wall Street Journal: Health Diagnostic Laboratory CEO Resigns

The chief executive officer of a fast-growing medical laboratory that has collected hundreds of millions of dollars from Medicare resigned amid a federal investigation into its payments of blood-sample fees to doctors. Health Diagnostic Laboratory Inc. CEO Tonya Mallory ceded the reins of the Richmond, Va., company to Joe McConnell, a former Mayo Clinic scientist who co-founded HDL with her five years ago. Ms. Mallory will remain on HDL’s board and serve as an adviser to Dr. McConnell, she said in a note to employees (Carreyrou, 9/23).

HCA Faces Class-Action Lawsuit For Allegedly Concealing Revenue Declines

HHS: Health Law Brings Down Hospitals' Uncompensated Care Costs

As part of a report released Wednesday, Obama administration officials cited evidence that hospitals are projected to save $5.7 billion in uncompensated care costs as previously uninsured patients gain coverage through the health law. The savings are most significant in states that expanded their Medicaid programs.

The New York Times: Affordable Care Act Reduces Costs For Hospitals, Report Says

The Obama administration increased the pressure on states to expand Medicaid on Wednesday, citing new evidence that hospitals reap financial benefits and gain more paying customers when states broaden eligibility. In states that have expanded Medicaid, the White House said, hospitals are seeing substantial reductions in “uncompensated care” as more patients have Medicaid coverage and fewer are uninsured (Pear, 9/24).

Kaiser Health News: Administration Says Hospitals Will Save $5.7B From Unpaid Bills Due To Health Law

Hospitals are projected to save $5.7 billion this year as previously uninsured patients gain coverage through the 2010 health care law, the Department of Health and Human Services said Wednesday. States that have expanded their Medicaid programs will see about 74 percent of those savings, an HHS report said. While 27 states and Washington, D.C. have expanded the federal-state insurance program for the poor to date, the survey was done when 25 states and D.C. had done so (Carey, 9/24). 

The Washington Post’s Wonkblog: HHS: Obamacare Coverage Is Reducing Hospitals’ Unpaid Bill

Millions more people with Health Insurance means fewer uninsured patients are coming through hospitals’ doors. That means fewer costs from bad debt or charity care from people unable to pay their bills, which amounted to about $50 billion for the nation’s hospitals in 2012 (Millman, 9/24).

The Associated Press: Report: Admission Of Uninsured At Hospitals Dips

The announcement of the findings is part of the Obama administration’s continuing effort to persuade states that have declined to expand their Medicaid coverage to reconsider their objections. So far, 27 states and the District of Columbia have agreed to provide Medicaid to people with income higher than poverty levels, as permitted under the health care law. What’s more, the report comes seven weeks before the start of a new round of open enrollment, a critical test for the health care law. Obama administration officials said both the Medicaid expansion and the law’s requirement that individuals obtain insurance had contributed significantly to the decrease in the number of uninsured Americans (9/24).

USA Today: HHS: Health Law Will Lead To Big Drop In Free Hospital Care

Burwell’s announcement was paired with one by Jason Furman, chairman of the Council of Economic Advisers, about the reductions in health care spending increases that the administration says are attributable to the health law. The three years after the ACA took effect in 2010 had the slowest growth in real per capita national health spending on record, Furman said. Furman called the ACA “one of most important developments in the economy in recent years,” and one that has major implications for job growth. The slower growth in premiums for employer coverage will make it easier for companies to hire workers and pay good salaries, he said (Jayne O’Donnell, 9/24).

Reuters: Obamacare To Save U.S. Hospitals $5.7B In Uncompensated Care

The report is the latest in a series of administration releases intended to show that President Barack Obama’s healthcare reform law is working. Wednesday’s announcement came weeks before the November mid-term elections, in which Republicans hope voter dislike for the Affordable Care Act will aid their efforts to win control of the U.S. Senate. Reducing the cost of “uncompensated care” among hospitals, particularly those with large populations of poor people, is a major goal of Obamacare, which offers federally subsidized private insurance to consumers in addition to expanding Medicaid (Morgan and Rampton, 9/24).

Politico Pro: Report: Hospitals To Save $5.7B In Uncompensated Care

Obamacare will save hospitals $5.7 billion this year in uncompensated care costs, with three-quarters of that going to facilities in states that expanded Medicaid eligibility, according to an HHS report released Wednesday. … In states that did not expand Medicaid, savings will total $1.5 billion (Wheaton, 9/24).

CNN: Some Hospital Costs Fall In Affordable Care Act’s First Year, Report Finds

Days ahead of the one-year anniversary of the rollout of HealthCare.gov, the Affordable Care Act’s health care exchange website that was originally plagued with numerous technical glitches, the Department of Health and Human Services has released a report highlighting the impact of the law on hospital costs (Hartfield, 9/24).

Dallas Morning News: White House Says Texas Forgoes Huge Sum By Not Expanding Medicaid

Texas taxpayers and hospitals pay a steep price for the state’s refusal to expand Medicaid, top White House officials said Wednesday, citing fresh cost projections for treating the uninsured. Hospitals nationwide will see uncompensated care drop $5.7 billion this year, according to a Department of Health and Human Services report. Three-fourths of that savings will go to the states that expanded Medicaid (Gilman, 9/24).

HHS: Health Law Brings Down Hospitals' Uncompensated Care Costs

Drug Firms Shift Sales Calls From Doctors To Administrators Controlling Hospital Formularies

Since many hospitals now work to help keep costs down by watching what drugs are used, pharmaceutical representatives must include administrators in their sales pitches. Also in the news, new concerns about the government’s plan to open a database next week on drug makers’ payments to doctors.

The Wall Street Journal: As Doctors Lose Clout, Drug Firms Redirect The Sales Call

Kendall French used to pitch drugs to doctors who could prescribe them. But many of those doctors now work for hospitals that don’t give them final say over what is on the menu of medicines they can pick. So when the GlaxoSmithKline saleswoman began plugging two new lung-disease drugs to a big San Diego hospital system this spring, it was to an administrator who doesn’t see patients but helps write the menu, also called a “formulary,” of approved medications. Ms. French urged the administrator in the system, Sharp HealthCare, to consider the two drugs’ effectiveness. It was the kind of pitch she once used to persuade doctors to write prescriptions (Rockoff, 9/24).

The Wall Street Journal’s Pharmalot: Pharma Pushes CMS For Transparency On Sunshine Database, Again

With just one week left before the launch of the controversial Open Payments database – which will reveal how much money doctors receive from drug and device makers – three of the biggest industry trade groups are complaining they have not had an opportunity to review important background information about relationships with physicians. And the trade groups – the Pharmaceutical Research and Manufacturers of America, BIO and AdvaMed – are reiterating concerns expressed last month that the Centers for Medicare and Medicaid Services has still not explained why one-third of the payment information submitted by drug and device makers, as well as group purchasing organizations, was removed from the database (Silverman, 9/24).

Drug Firms Shift Sales Calls From Doctors To Administrators Controlling Hospital Formularies

Some Small Businesses Help Workers Buy Individual Coverage

The Associated Press examines Health Insurance costs from different perspectives — that of a small businessman who provides workers with additional compensation to purchase their own coverage, rather than offering a company health plan, and that of a middle-class family facing mounting financial pressure which includes health premiums.

The Associated Press: Small Businesses Helping Workers Buy Health Plans

When Monty Hagler learned his employee insurance premiums could rise as much as 38 percent, the small business owner decided he couldn’t afford coverage that complies with the health care overhaul. He considered a variety of plans from different carriers, but they were too expensive or bare-bones. “Unless we dramatically changed our plan and went with the most basic plan, I said, ‘this is not sustainable,'” says Hagler, owner of RLF Communications, a Greensboro, North Carolina-based marketing company. So Hagler told his 12 staffers he would give them money starting in May to buy their own insurance coverage, likely to be better than what he could offer. He joined a growing number of small business owners who are forgoing coverage and paying staffers more to compensate for the lost benefits (Rosenberg, 9/24).

The Associated Press: Money Employers Give For Insurance Can Be Taxed

When employers give workers money to help pay for Health Insurance, the cash may be subject to taxes for both employer and employee. The IRS treats money given to workers as compensation, even if it’s intended to replace a benefit like insurance, says Steven Friedman, an attorney with Littler Mendelson, a New York-based firm that specializes in employment law (9/24).

The Associated Press: Middle-Class Squeeze: From Day Care To Health Care

Three years ago, Jason Prosser was stunned to discover the cost of child care for his newborn son — so much so that he and his wife postponed having a second child. The day care center they found near their Seattle home tops $10,000 a year. Next year, their son, now 3, can attend a Catholic preschool less than half as costly. He and his wife are among legions of middle-class families who are straining under the weight of accelerating costs for a range of essential services from day care to health care. And now a study by the Center for American Progress shows just how heavy the burden has grown: For a typical married couple with two children, the combined cost of child care, housing, health care and savings for college and retirement jumped 32 percent from 2000 to 2012 — and that’s after adjusting for inflation  (Rugaber, 9/25).

Meanwhile, Reuters focuses on how medical information is of more value than credit cards to hackers –

Reuters: Medical Records Worth More To Hackers Than Credit Card

Your medical information is worth 10 times more than your credit card number on the black market. Last month, the FBI warned healthcare providers to guard against cyber attacks after one of the largest U.S. hospital operators, Community Health Systems Inc, said Chinese hackers had broken into its computer network and stolen the personal information of 4.5 million patients. Security experts say cyber criminals are increasingly targeting the $3 trillion U.S. healthcare industry, which has many companies still reliant on aging computer systems that do not use the latest security features (Humer and Finkle, 9/24). 

Some Small Businesses Help Workers Buy Individual Coverage

State Highlights: N.C. Lawmakers Still Talking About Medicaid Revamp

A selection of health policy stories from North Carolina, Louisiana, Florida, Illinois, Texas, Georgia, New York, Maryland and Colorado.

The Associated Press: NC Lawmakers Talking More About Medicaid Overhaul

Legislators who couldn’t agree this year on how to overhaul North Carolina’s Medicaid program plan to spend more time talking about the issue before the General Assembly reconvenes early next year. A legislative oversight panel subcommittee charged with examining Medicaid reform and reorganization scheduled its first meeting Wednesday. Another oversight panel also examining Medicaid governance held its first meeting this month. The House and Senate approved differing versions of legislation to change how Medicaid pays for medical expenses by shifting risk from the state to either medical provider networks or private managed-care companies (9/24).

The Associated Press: La. Lawmakers Hold Hearing In Health Insurance Dispute

Controversy over Health Insurance changes planned for state workers, teachers and retirees is the focal point of a hearing expected to draw a crowd to the Louisiana Capitol. Gov. Bobby Jindal’s administration says changes are needed to address the rising costs of health care caused by medical inflation and federal law changes. But many workers and retirees are accusing the administration of mismanagement, improperly dropping premiums in past years to help balance the state budget. The insurance program is spending more money than it receives each month and is draining a reserve fund to cover costs (9/25).

Health News Florida: HCA Closing Hospital Due To Less Inpatient Occupation

For the first time since 2012, a hospital in Florida is closing its doors. HCA West Florida announced Tuesday the 38-year-old Edward White Hospital in St. Petersburg will close by the end of November and consolidate services to three nearby hospitals it also owns. Officials said operating costs at the aging facility continued to grow. And it pointed to a glut of hospital beds in the area: more than 1,000 in southern Pinellas County alone. “In this era where healthcare is migrating to the outpatient setting, we are seeing a significant rise in unoccupied licensed hospital beds throughout the region,” HCA West Florida President Peter Marmerstein said in a statement. This announcement marks the first time since 2010 any of the state’s 301 licensed hospitals closed, and just the fifth time in four years that it’s happened at all, Agency for Health Care Administration records show (Shedden, 9/24).

Stateline: Nursing Home Cameras Create Controversy

Over the years, Illinois Attorney General Lisa Madigan has consistently heard “horror stories” about the abuse or neglect of nursing home residents. Now she is trying to bring such cruelty out of the shadows and into clear view. Madigan’s office is drafting legislation, likely to be introduced in 2015, which would allow Illinois nursing home residents and their families to place cameras in their rooms to help protect them. If the measure is approved, Illinois would join at least four other states—New Mexico, Oklahoma, Texas and Washington—that have laws or regulations allowing residents to maintain cameras in their rooms. In Maryland, cameras can be placed in a resident’s room, but only if the facility permits them, according to state guidelines (Bergal, 9/25).

Texas Tribune: Disability Groups Hope Turnover Leads To Reform

As an entirely new roster of politicians takes statewide office next year, disability rights advocates are asking those future Texas leaders to work with lawmakers to address a struggling system of care for the state’s most vulnerable population. But while their traditional allies in elective office — Democrats — appear up and down the ballot, those candidates are running well behind their Republican counterparts. And at a statewide candidates forum in Austin on Wednesday hosted by the disability rights groups Coalition of Texans with Disabilities, ADAPT of Texas and The Arc of Texas, not a single Republican candidate made an in-person appearance. Attorney General Greg Abbott, the Republican front-runner for governor who uses a wheelchair after being paralyzed three decades ago by a falling tree, submitted a questionnaire in his stead, citing a prior engagement (Walters, 9/25).

Georgia Health News: Report: Disabilities System Reform Needs More Work

State health officials have major work ahead to meet a July 2015 deadline with the federal government on improving care for Georgians with mental illness and developmental disabilities. That’s a key message of a report this month from an independent reviewer regarding the state’s five-year settlement agreement with the U.S. Department of Justice, reached in 2010 (Miller, 9/24).

The Associated Press: NY Mandates Insurance Coverage For Ostomy Supplies

New York will require health insurers to provide coverage for equipment and supplies for treating ostomies, intended to help ease the financial burden for people with the chronic condition. The amendments, signed this week by Gov. Andrew Cuomo, take effect Jan. 1. An ostomy is a surgically created opening in the body for the discharge of waste (9/24).

Kaiser Health News: Personal Attention Seen As Antidote To Rising Health Costs

Kevin Wiehrs is a nurse at a busy doctor’s office in Savannah, Ga. But instead of giving patients shots or taking blood pressure readings, his job is mostly talking with patients like Susan Johnson. Johnson, 63, a retired restaurant cook who receives Medicare and Medicaid, has diabetes, and she already met with her doctor. Afterwards, Wiehrs spends another half hour with her, talking through her medication, exercise and diet (McCammon, 9/25).

Baltimore Sun: Telemedicine Program Aims To Decrease Student Absences, Improve Performance

In the coming weeks, students at five Howard County elementary schools won’t even need to leave the school building to consult with a doctor if they have a sore throat, a skin rash or an eye or ear infection. Instead, they’ll have the opportunity to talk with a University of Maryland Children’s Hospital Pediatrician remotely through Howard County’s new telemedicine technology unveiled Monday. County officials expect the program to decrease absentee rates, improve students’ educational performances and improve access to health care for students (Ames, 9/23).

Denver Post: Clinic Gets Health Services To Poor Kids

Concerned about the many students with no access to health care, two Jeffco Public School nurses set out to make sure children from low-income families could get high-quality care. Twenty-one years later, Karen Pramenko and Karen Conner appear to have accomplished their goal after the 1993 creation of Carin’ Clinic, an Arvada-based nonprofit providing medical care to underserved youth that’s getting bigger every year(Briggs, 9/25).

The Associated Press: Concerns Over Cost, Ethics Halt Texas Database Project

Plans for a massive health database have been postponed again after Texas health officials cited cost concerns, as well as the possibility that the company that won the tentative contract was receiving inside information from a state negotiator. The Health and Human Services Commission has further delayed the decades-old plan by ending negotiations this month with Truven Health Analytics of Ann Arbor, Mich., the Houston Chronicle reported. The “enterprise data warehouse” project is expected to be rebid, a process that could take months and cost the state tens of thousands of dollars in staff time (9/24).

State Highlights: N.C. Lawmakers Still Talking About Medicaid Revamp

Viewpoints: New Insurers Suggest Health Law Success; Slow Response On Ebola

Vox: In Conservative Media, Obamacare Is A Disaster. In The Real World, It’s Working.

Before Obamacare launched, conservative outlets warned that the law would collapse as insurers shunned the overpriced, overregulated insurance exchanges. … On Tuesday, the idea that insurers would flee Obamacare joined the long procession of Obamacare disasters that simply didn’t happen. Health and Human Services Secretary Sylvia Matthews Burwell announced that in the 44 states where numbers were available, the number of companies offering plans in 2015 would increase by 25 percent. So, far from fleeing the exchanges, insurers are rushing into them. Competition is increasing (Ezra Klein, 9/24).

The New Republic: Obamacare Is Such A Disaster That Even More Insurers Want To Be Part Of It

Obamacare critics hadn’t predicted the markets would evolve this way. On the contrary, they expected that that young and healthy people would stay far away from the new marketplaces, because the new coverage would be pricier than what they were paying before. Without enough business, the argument went, insurers would get skittish and withdraw. At best, the marketplaces would all become oligopolies and monopolies, with just a handful of insurers continuing to sell policies. At worst, the whole scheme would fall apart. That quite obviously isn’t happening (Jonathan Cohn, 9/24).

Bloomberg: Obamacare Is Here To Stay

The Affordable Care Act continues not to implode. In year two of the exchanges, more insurance companies are lining up to participate, which means more competition, lower prices and less waste. … “Obamacare” was unlikely to be popular no matter what. But its success so far means it won’t be repealed even if Republicans win unified control of the White House and Congress in 2016 (Jonathan Bernstein, 9/24).

The Washington Post‘s Plum Line: Some Good News About Obamacare That Even Conservatives Should Love

We now have some more good news about the implementation of the Affordable Care Act, and it’s good news of a type that ought to warm the hearts of the law’s conservative critics. There have been some developments that conservatives can lament, even as the rest of us find them cause for celebration. Some would say that the fact that eight million additional Americans have been enrolled in Medicaid because of the law is an unalloyed good, but many conservatives would think the opposite, because those people are now suckling at government’s teat. But what about when the free market embraces Obamacare? What’s a conservative to think then? (Paul Waldman, 9/24). 

Bloomberg: Reggie Jackson And The Cost Of Health Care

In contrast, in the U.S., the goal of health policy is to ensure that everyone receives whatever health care they “need.” Because there is no objective measure of need, the industry can endlessly expand what people consider necessary. So our uniquely unbudgeted public entitlements — and insurance structured as uncapped benefits — continuously add dollars to the industry, making effective price discipline impossible. Many supporters of a single-payer system in the U.S. believe it could maintain open-ended coverage while controlling prices to keep costs down. But these objectives are incompatible (David Goldhill, 9/23).

The New York Times: Warnings On Big Medical Bills

It’s not an uncommon situation for patients to be billed by doctors for costly services they did not request or, in some cases, were not even aware they had received. Egregious examples of this billing practice, described by Elisabeth Rosenthal in The Times on Sunday, include calling in consultants whose services aren’t really needed, ordering unnecessary and costly diagnostic tests, and using doctors who bill for services that nurses can perform (9/24). 

Dallas Morning News: Health Care Battles Continue To Roil

To make sure [Virginia Gov. Terry McAuliffe's effort to expand Medicaid] failed, the Legislature’s Republican majority last week again blocked what The Washington Post termed McAuliffe’s “top legislative priority.” “Once again, Terry McAuliffe has far over-promised, and mightily under-delivered,” said state GOP communications director Garren Shipley, echoing the way Republican officials regularly portray actions limiting the Affordable Care Act as defeats for Democrats like McAuliffe and President Barack Obama. In truth, preventing Medicaid expansion or other aspects of Obamacare in Virginia and other states, including Texas, is less a defeat for its political champions than a defeat for millions of Americans. After all, their participation in the landmark universal health care program is at stake when states consider the expanded Medicaid program, at mostly federal cost, or courts decide if it’s legal for them to receive a federal subsidy (Carl Leubsdorf, 9/24).

The New York Times: The Ebola Fiasco

It’s a classic case where early action could have saved lives and money. Yet the world dithered, and with Ebola cases in Liberia now doubling every two to three weeks, the latest worst-case estimate from the Centers for Disease Control and Prevention is that there could be 1.4 million cases in Liberia and Sierra Leone by late January (Nicholas Kristof, 9/24). 

The Washington Post: We Must Prioritize Drug Development To Fight Ebola

The worst-case scenarios for the Ebola outbreak in West Africa must not be ignored, even if they strain belief. Everything about this epidemic has been worst-case — the scope, the toll, the response. The Centers for Disease Control and Prevention published projections Tuesday with an upper range of 550,000 to 1.4 million cases by the end of January. The World Health Organization, which earlier estimated 20,000 cases overall, now predicts that number will be reached by early November (9/24). 

The Wall Street Journal: The Anti-Vaccination Epidemic

Almost 8,000 cases of pertussis, better known as whooping cough, have been reported to California’s Public Health Department so far this year. More than 250 patients have been hospitalized, nearly all of them infants and young children, and 58 have required intensive care. Why is this preventable respiratory infection making a comeback? In no small part thanks to low vaccination rates, as a story earlier this month in the Hollywood Reporter pointed out (Paul A. Offit, 9/24). 

Politico: The Incredibly Insipid War On Women 2.0

The “war on women” is back, and more tendentious than ever. … The recipe is one part taking offense where clearly none was intended, and one part discerning new nefarious schemes to deny women access to birth control. Granted, in the absence of Todd Akin, whose outlandish comments on rape were hung around the necks of every Republican in the country in 2012, Democrats have had to labor mightily to invent new outrages to frighten and motivate women (Rich Lowrey, 9/24).

The Advocate: Are You Being Served — Medically?

In the last five years, the federal government has taken significant steps toward recognizing and addressing health disparities that affect LGBT people. … But there are two more things that the U.S. Department of Health and Human Services can do that will make an even bigger impact on closing the gap in health care disparities between LGBT people and the general population: designate LGBT people as a medically underserved population (MUP) and as a health professional shortage area population (HPSA) (Sean Cahill, 9/24).

Viewpoints: New Insurers Suggest Health Law Success; Slow Response On Ebola

Longer Looks: ACOs And Job Shifts; Abortion's Racial Gap; Having A Stroke At 33

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

The Economist: How To Fix Obamacare

It is now nearly a year since the roll-out of Obamacare. The launch was a shambles, and Obamacare is a totem for every American who hates big government. Republicans will deride it, yet again, in the mid-term elections. Obamacare is indeed costly and overcomplicated. Yet it is not to blame for America’s health mess, and it could just contain the beginnings of a partial solution to it. But that will only happen if politicians treat health care like a patient: first, diagnose the disease, then examine whether Barack Obama’s treatment helped, and then ask what will make the patient better (9/20).

Vox: How Much Money Do We Waste On Useless Health Care?

It’s hard to overstate the importance of the Dartmouth Atlas, a research project begun in the mid-1990s by health-care researchers at (unsurprisingly) Dartmouth College. The 18-year study has shown the incredible variation in American health spending. What Medicare spends on a single patient’s hospital care ranges from $5,371 in Utah to $8,937 in Maryland (Sarah Kliff, 9/18).

The Atlantic: Abortion’s Racial Gap

In 2005, Renee Bracey Sherman, then 19, sat in the abortion clinic alone. A jumble of concerns ran through her mind. She didn’t feel ready for a baby, but still, she worried that her parents would be disappointed in her choice. More than anything, though, she didn’t want to be a statistic, another pregnant black teen. “In the moment, you never know who your allies are,” Sherman said. “You don’t want to take the chance of everyone judging you at a moment when you’re so vulnerable. There’s a very unfortunate stereotype of women of color, and black women in particular, that we are promiscuous and just have babies. You don’t want that to be you.” An African-American woman is almost five times likelier to have an abortion than a white woman, and a Latina more than twice as likely, according to the Centers for Disease Control and Prevention (Zoe Dutton, 9/22).

The New York Times: A Mother In Jail For Helping Her Daughter Have An Abortion

On Sept. 12th, Jennifer Whalen, a 39-year-old mother of three in the rural town of Washingtonville, Pa., went to jail to begin serving a 9-to-18-month sentence. Whalen’s crime was, in effect, ordering pills online that her older daughter took in the first several weeks of an unplanned pregnancy, when she was 16, to induce a miscarriage. The medication was a combination of mifepristone (formerly called RU-486) and misoprostol. The drugs have been available from a doctor with a prescription in the United States since 2000 and are used around the world to induce miscarriage. Recent research increasingly suggests that early in a pregnancy, women can safely use mifepristone and misoprostol to miscarry at home. But if the medical risk of this kind of do-it-yourself abortion is relatively small, the legal risk still looms large (Emily Bazelon, 9/22).

The New York Times: A Drug Mule For The Medicare Set

My mother has many attributes, but athleticism has never been one of them. She always hesitates before stepping onto an escalator and rarely walks beyond our circular driveway. So when her physician ordered her onto a treadmill last winter, it hardly seemed surprising that her heartbeat jumped dramatically, even when the pace was not brisk. She is 80, after all. To temper her tempo, she was soon prescribed a very expensive heart medication. “I have to take it or I might have a stroke,” she told me (a problem for me, as her future caregiver, as well as for her). Luckily, Medicare and her supplemental insurance picked up most of the cost, so a 90-day prescription’s worth of pills came to just $135 — a good rate to pay, I thought, for a good heart rate. But in July, her discount suddenly ended (Jennifer Conlin, 9/19).

Modern Healthcare: ACOs, Other Delivery Reforms Shift Job Roles At Hospitals

Phoenix obstetrician Megan Cheney no longer makes hours of telephone calls on Thursday nights to report routine results of laboratory tests to waiting patients. The calls, however, still get made every week. A medical assistant with experience in obstetrics and gynecology now handles calls involving routine findings. That has freed time for Cheney to draft the lectures she delivers twice a week to her medical resident trainees. The shift in responsibilities may be minor, a matter of hours in a lengthy work week. But it is one of many underway at Banner Health, where the drive to cut costs has triggered an extensive overhaul of employees’ roles and patient care (Melanie Evans, 9/20).

The New York Times: To Gather Drug Data, A Health Start-Up Turns To Consumers

For years, Thomas Goetz had been a spirited armchair advocate of the use of digital technology and data to improve health care. At Wired magazine, where he was executive editor, Mr. Goetz assigned and wrote articles on the subject. He organized conferences, lectured and wrote a book in 2010, “The Decision Tree,” which hailed a technology-led path toward personalized health care and better treatment decisions (Steve Lohr, 9/23).

BuzzFeed: I Had A Stroke At 33

There was a cascade of input — triangles and sky and gravel sound and music on the radio and wind and the feeling of rough cloth near my hands. I could not make sense of it all; I did not know the small triangles were trees, the larger ones mountains, the sound tires crunching snow and Snow Patrol, the jacket Gore-Tex, and that my wrists were the things attached to things called my hands. They were colors and shapes and sound and touch and sensation and my brain was no longer sorting these things out. But when I saw the red snowblowers in the parking lot turned 90 degrees and doubled, I finally had a complete thought. I comprehended what I was seeing. Red snowblowers. Sideways. Strange. That was what my stroke felt like: like I was separating from myself. It was Dec. 31, 2006. I was 33 (Christine Hyung-Oak Lee, 9/21).

Pacific Standard: Why Science Won’t Defeat Ebola

On Tuesday President Obama announced that the U.S. government will step up its efforts to help fight Ebola in West Africa. Coming six months into the crisis, and more than a month after the World Health Organization said that the outbreak was getting out of control, this major commitment of supplies and personnel by the world’s wealthiest country is long past due. The biomedical community also seems to be lagging. Ebola vaccines and drugs exist but are only available in limited quantities thanks to their experimental state. Reading the headlines, it sounds like the researchers and regulators have moved too slowly. The drugs are “still stuck in the lab.” There is a new way to quickly make enough drugs to halt the outbreak, “if only the U.S. had the boldness to try it.” The most promising vaccine was recently put on an accelerated testing schedule, but it’s too little too late (Michael White, 9/19).

Longer Looks: ACOs And Job Shifts; Abortion's Racial Gap; Having A Stroke At 33

First Edition: September 25, 2014

Today’s headlines include coverage of an Obama administration report projecting that hospitals will save billions of dollars this year as previously uninsured patients gain coverage through the health law.

Kaiser Health News: Administration Says Hospitals Will Save $5.7B From Unpaid Bills Due To Health Law

Kaiser Health News staff writer Mary Agnes Carey reports: “Hospitals are projected to save $5.7 billion this year as previously uninsured patients gain coverage through the 2010 health care law, the Department of Health and Human Services said Wednesday. States that have expanded their Medicaid programs will see about 74 percent of those savings, an HHS report said. While 27 states and Washington, D.C. have expanded the federal-state insurance program for the poor to date, the survey was done when 25 states and D.C. had done so” (Carey, 9/24). Read the story.

Kaiser Health News: Personal Attention Seen As Antidote To Rising Health Costs

Georgia Public Radio’s Sarah McCammon, working in partnership with Kaiser Health News and NPR, reports: “Kevin Wiehrs is a nurse at a busy doctor’s office in Savannah, Ga. But instead of giving patients shots or taking blood pressure readings, his job is mostly talking with patients like Susan Johnson. Johnson, 63, a retired restaurant cook who receives Medicare and Medicaid, has diabetes, and she already met with her doctor. Afterwards, Wiehrs spends another half hour with her, talking through her medication, exercise and diet” (McCammon, 9/25) Read the story.

The New York Times: Affordable Care Act Reduces Costs For Hospitals, Report Says

The Obama administration increased the pressure on states to expand Medicaid on Wednesday, citing new evidence that hospitals reap financial benefits and gain more paying customers when states broaden eligibility. In states that have expanded Medicaid, the White House said, hospitals are seeing substantial reductions in “uncompensated care” as more patients have Medicaid coverage and fewer are uninsured (Pear, 9/24).

The Washington Post’s Wonkblog: HHS: Obamacare Coverage Is Reducing Hospitals’ Unpaid Bill

The Obama administration is projecting that hospitals will face $5.7 billion less in uncompensated care costs than they otherwise would have in the first full year of the Affordable Care Act’s coverage expansion. Millions more people with Health Insurance means fewer uninsured patients are coming through hospitals’ doors. That means fewer costs from bad debt or charity care from people unable to pay their bills, which amounted to about $50 billion for the nation’s hospitals in 2012 (Millman, 9/24).

The Associated Press: Report: Admission Of Uninsured At Hospitals Dips

The number of uninsured patients admitted to hospitals has dropped markedly this year, reducing charity care and bad debt cases, particularly in states that have expanded Medicaid coverage under the new federal health care law, a government report released Wednesday concluded (9/24).

USA Today: HHS: Health Law Will Lead To Big Drop In Free Hospital Care

The Affordable Care Act will lead to $5.7 billion in savings in uncompensated hospital care costs this year, the Obama administration said Wednesday, reducing one of the biggest financial challenges hospitals face. The states that expanded Medicaid so all low-income residents would have medical coverage will reap about 74% of the savings nationally, Department of Health and Human Services Secretary Sylvia Burwell said (Jayne O’Donnell, 9/24).

Los Angeles Times: White House Reassessing Obamacare Enrollment Goal For 2015

The Obama administration, which is scrambling to prepare a new push to enroll Americans in health coverage under the federal health law, is reassessing how many more people will sign up, Health and Human Services Secretary Sylvia Mathews Burwell said Wednesday. About 7.3 million people are enrolled in health plans being sold through marketplaces created this year by the Affordable Care Act, according to federal figures (Levey, 9/24).

Los Angeles Times: Number Of Latinos With Insurance Coverage Surges Under Healthcare Law

The federal healthcare law has dramatically increased coverage among Latinos, according to a new report that provides a comprehensive look at the effects of the Affordable Care Act on a historically underinsured community. Overall, the percentage of Latinos ages 19 to 64 lacking health coverage fell from 36% to 23% between summer 2013 and spring 2014 (Levey, 9/24).

The Wall Street Journal’s Washington Wire: Burwell Steers Clear Of Specific Pledges On Healthcare.Gov

Health and Human Services Secretary Sylvia Mathews Burwell told reporters Wednesday that officials are “continuing, step by step” in their effort to get HealthCare.gov ready to open for its second year of business in 50 days’ time but steered clear of specific commitments that have haunted officials who preceded her. In her first on-the-record question session with reporters since taking the top job at HHS, Ms. Burwell got several inquiries about whether the department’s preparations to fix and revamp the site were on schedule, and answered all of them without making the kinds of comments that people could hold against her later (Radnofsky, 9/24).

The Associated Press: Money Employers Give For Insurance Can Be Taxed

When employers give workers money to help pay for Health Insurance, the cash may be subject to taxes for both employer and employee. The IRS treats money given to workers as compensation, even if it’s intended to replace a benefit like insurance, says Steven Friedman, an attorney with Littler Mendelson, a New York-based firm that specializes in employment law (9/24).

The Wall Street Journal: As Doctors Lose Clout, Drug Firms Redirect The Sales Call

Kendall French used to pitch drugs to doctors who could prescribe them. But many of those doctors now work for hospitals that don’t give them final say over what is on the menu of medicines they can pick. So when the GlaxoSmithKline GSK.LN +0.66% PLC saleswoman began plugging two new lung-disease drugs to a big San Diego hospital system this spring, it was to an administrator who doesn’t see patients but helps write the menu, also called a “formulary,” of approved medications. Ms. French urged the administrator in the system, Sharp HealthCare, to consider the two drugs’ effectiveness. It was the kind of pitch she once used to persuade doctors to write prescriptions (Rockoff, 9/24).

The Wall Street Journal’s Pharmalot: Pharma Pushes CMS For Transparency On Sunshine Database, Again

With just one week left before the launch of the controversial Open Payments database – which will reveal how much money doctors receive from drug and device makers – three of the biggest industry trade groups are complaining they have not had an opportunity to review important background information about relationships with physicians. And the trade groups – the Pharmaceutical Research and Manufacturers of America, BIO and AdvaMed – are reiterating concerns expressed last month that the Centers for Medicare and Medicaid Services has still not explained why one-third of the payment information submitted by drug and device makers, as well as group purchasing organizations, was removed from the database (Silverman, 9/24).

The Associated Press: NY Mandates Insurance Coverage For Ostomy Supplies

New York will require health insurers to provide coverage for equipment and supplies for treating ostomies, intended to help ease the financial burden for people with the chronic condition. The amendments, signed this week by Gov. Andrew Cuomo, take effect Jan. 1. An ostomy is a surgically created opening in the body for the discharge of waste (9/24).

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First Edition: September 25, 2014

Anthem Excludes Missouri's BJC HealthCare From Network Again

The Blue Cross Blue Shield plan won’t include the giant health system and its 12 hospitals, including Barnes Jewish and St. Louis Children’s Hospital, in its 2015 provider network for exchange enrollees. Meanwhile, 350,000 Medi-Cal applicants in California still wait for coverage and Colorado’s insurance rates level off.

St. Louis Post-Dispatch: BJC HealthCare Once Again Not In Anthem’s Network For Individual Marketplace

BJC HealthCare, St. Louis’ largest employer, will once again be excluded from Anthem Blue Cross Blue Shield’s provider network for individual health plans purchased on the online marketplace. Anthem spokeswoman Deb Wiethop said Tuesday the health system and its 12 hospitals will not be included in the carrier’s network for plans that start in 2015. “We have not been able to reach agreement with them to be in the network,” she said. The health system runs Barnes-Jewish Hospital, St. Louis Children’s Hospital, Christian Hospital and other hospitals in the St. Louis area (Shapiro, 9/24).

The California Health Report: Despite Progress, 350,000 Medi-Cal Applicants Still Wait For Coverage

Carlos Gutierrez of Berkeley thought his health care troubles were over when he received a letter from his county’s social service agency in May telling him he qualified for Medi-Cal. The 34-year-old single father of two had been without Health Insurance for months after losing his job as a trainer in car rental sales. He’d applied for health coverage through Covered California — the state’s Health Insurance exchange — and when the letter about Medi-Cal arrived he felt relieved. Finally, Gutierrez thought, he’d be able to take his teenage son and daughter for checkups he’d avoided because he couldn’t afford the doctor’s fees. And he’d be able to see someone about the nagging pain in his abdomen where he’d had his gall bladder removed the year before. The county letter said he’d receive follow-up information soon. But that information never came (Boyd-Barrett, 9/23).

Health News Colorado: Health Insurance Rates Leveling Off

Consumer groups are celebrating the news that overall, Health Insurance rates for next year seem to be holding steady with this year’s rates. On average across Colorado, the rates that regulators at the Division of Insurance approved for 2015 went up 1.18 percent. Because the costs will vary significantly by region, some people could find they’re paying more, while others may see decreases (Kerwin McCrimmon, 9/23).

Kaiser Health News: Insurance Brokers Key To Kentucky’s Obamacare Success

David Combs has been a Health Insurance broker in this small city in central Kentucky for more than 15 years. When the Affordable Care Act became law, he read it cover to cover. Then he ‘panicked’ and sold his agency. The mainstay of his business had been selling coverage to small companies. And here was the government, stepping in and offering to sell it online instead. Initially, Combs and his fellow brokers thought they would go the way of travel agents, no longer needed in a do-it-yourself online marketplace. But he started to think about the law in a new way after he learned that brokers could still earn a commission for selling coverage through the exchange. Kentucky built its own Health Insurance exchange – called Kynect — and to expand Medicaid (Gold, 9/23).

Anthem Excludes Missouri's BJC HealthCare From Network Again