KHN Morning Briefing

Summaries of health policy coverage from major news organizations

First Edition: February 21,2 013

Today's headlines include reports about the Obama administration's final rule on essential health benefits and about Florida Gov. Rick Scott's reversal on his state's Medicaid expansion. 

Kaiser Health News: Hospitals Clamp Down On Dangerous Early Elective Deliveries
Kaiser Health News staff writer Phil Galewitz reports: "Now, with pressure on doctors and hospitals from the federal government, private and public insurers and patient advocacy groups, the rate of elective deliveries before 39 weeks is dropping significantly, according to latest hospital survey from The Leapfrog Group, a coalition of some of the nation's largest corporations that buy health benefits for their employees" (Galewitz, 2/21). Read the story.

Kaiser Health News: In Arizona, Poorest, Sickest Patients Get Coordinated Care
Kaiser Health News staff writer Sarah Varney, working in collaboration with NPR, reports: "Can for-profit health insurance companies be trusted to take care of the nation's sickest and most expensive patients? Many states, under an effort supported by the Obama Administration, are planning to let the companies manage health care for those elderly and disabled people covered by both Medicare and Medicaid. Patient advocates have warned that private health insurance companies are ill-equipped to provide the complex medical care and at-home services many of these people need to survive. It turns out that Arizona, a state that has been known to resist federal health programs, has been doing just that for many years" (Varney, 2/20). Read the story.

Kaiser Health News: Capsules: Feds Outline What Insurers Must Cover, Down To Polyp Removal; Waiver In Hand, Florida's Rick Scott Backs Medicaid Expansion; Dartmouth Study Questions Widely Used Risk-Adjustment Methods
Now on Kaiser Health News' blog, Diane Webber offers this take on the Florida Gov.'s decision on the health law's Medicaid expansion: "Florida Gov. Rick Scott announced Wednesday that he would back expansion of the Medicaid program under the federal health law. At a hastily-called press conference, Scott, a Republican, said he supported expanding Medicaid for three years — the amount of time the federal government picks up the whole cost" (Webber, 2/20).

In addition, Julie Appleby reports on the Obama administration's final essential benefits rule: "Essential benefit requirements apply mainly to individual and small group plans. They also apply to plans provided to those newly eligible for Medicaid coverage. A few provisions also affect self-insured plans and large group plans offered by employers" (Appleby, 2/20).

Also on Capsules, Jordan Rau reports on a new Dartmouth study: "In evaluating a hospital and health plan in the increasingly expensive U.S. health care system, federal officials and researchers often first factor in an assessment of how sick their patients are. A new study, however, challenges the validity of several widely used 'risk-adjustment' efforts and suggests that Medicare is overpaying some plans and facilities while underpaying others" (Rau, 2/21). Check out what else is on the blog.

The New York Times: Budget Cuts Seen As Risk To Growth Of U.S. Economy
Sequestration would slash agencies' "budget authority" by about $85 billion, but the Congressional Budget Office this month estimated that actual outlays would fall by only about $44 billion in the 2013 fiscal year, with the rest accruing over time. That is still about 1 percent of total federal spending to be squeezed out in a matter of months. Many economists argue that the same cuts could be made with less pain by postponing some of them until later in the decade, when the economy is likely to be stronger. Many argue that growing spending on health care programs like Medicaid and Medicare is the real threat to the federal budget, not domestic spending on areas like education and support for poor families (Appelbaum and Lowrey, 2/20).

The Washington Post: Business Owners Urge Congress To Take Medicare, Social Security Cuts Off The Table
Responding to a series of policy questions posed by lobbying group Small Business Majority, 80 percent of business owners said they oppose proposals to save federal money by curbing Social Security benefits, which have been floated in varying degrees by both parties in Washington. Nearly three in four said lawmakers shouldn't cut back on Medicare, and two in three said the same about proposed cuts to Medicaid, according to the poll, which will be published Wednesday (Harrison, 2/20).

The Wall Street Journal: Health-Plan Details Unveiled
Health-insurance plans that cover tens of millions of Americans will have to pay for mental-health and substance-abuse treatments starting next year under federal rules the Obama administration finalized Wednesday. The provision, part of the 2010 Affordable Care Act, requires health plans for individuals and small businesses to cover 10 categories of services, including prescription drugs, maternity care and physical rehabilitation. Many of the specifics of what is covered in those categories will be left to states to decide (Dooren, 2/20).

USA Today: HHS Releases Rule On Insurers' Essential Health Benefits
The rule defines what must be covered in exchange plans, prohibits discrimination based on age or pre-existing conditions, describes prescription drug benefits and determines levels of coverage (Kennedy, 2/20).

The New York Times: New Federal Rule Requires Insurers To Offer Mental Health Coverage
The Obama administration issued a final rule on Wednesday defining "essential health benefits" that must be offered by most health insurance plans next year, and it said that 32 million people would gain access to coverage of mental health care as a result (Pear, 2/20).

The Associated Press/Washington Post: Government Addresses Confusion Over Preventive Care Coverage: No Charge For Polyp Removal
President Barack Obama's health care law required most private health plans to cover preventive care at no additional charge to patients. It also expanded preventive coverage without copayments for Medicare recipients. For workers and their families, the expense is borne by the company health plan, which passes on some of those costs in the form of higher premiums. Advocates say preventive care saves the health care system money over time (2/20).

Politico: Governors On ACA: Ideologues Vs. Pragmatists
The next stage of Obamacare is shaping up into a fight between two camps of Republican governors sure to duke it out in the 2016 presidential primary — ideologues versus pragmatists. The ideological purists are big-name Southern governors — like Bobby Jindal, Nikki Haley, Bob McDonnell and Rick Perry — who have all said "hell no" to major pieces of the law, even turning down free federal cash to expand Medicaid in their states (Nather and Millman, 2/21).

The New York Times: In Reversal, Florida to Take Health Law's Medicaid Expansion
Gov. Rick Scott of Florida reversed himself on Wednesday and announced that he would expand his state's Medicaid program to cover the poor, becoming the latest — and, perhaps, most prominent — Republican critic of President Obama's health care law to decide to put it into effect (Alvarez, 2/20).

The Washington Post: Affordable Care Act Clears Another Hurdle Toward Implementation
President Obama's Affordable Care Act cleared another hurdle toward implementation Wednesday when one of its fiercest opponents, Florida Gov. Rick Scott, embraced a key pillar of the law by voicing support for its critical Medicaid expansion component. Scott joins six other Republican governors who have recently come to back a provision meant to extend coverage to 17 million Americans nationwide (Kliff, 2/20).

NPR: In Reversal, Florida Gov. Scott Agrees To Medicaid Expansion
But Wednesday, Scott, a Republican, pulled a complete turnabout. He said Florida would accept the federal government's offer of funding, at least for the three years it has promised to pay the entire bill (Rovner, 2/20).

The Wall Street Journal: Florida Governor Now Supports Broader Medicaid
Mr. Scott said he would support a three-year expansion "as long as the federal government meets their commitment to pay 100% of the cost during this time." He called it a "a compassionate, common-sense step forward" (Camp-Flores, McWhirter and Martin, 2/20).

The Associated Press/Los Angeles Times: In Reversal, Florida To Expand Medicaid Under Healthcare Overhaul
Florida Gov. Rick Scott announced Wednesday that he intended to expand Medicaid coverage to about 900,000 more people in his state under the federal healthcare overhaul, a surprise decision from a vocal critic of President Obama's plan. Scott is the seventh Republican governor to propose expanding the taxpayer-funded health insurance program. The governor said he gained new perspective after his mother's death last year, calling his decision to support a key provision of the Affordable Care Act a "compassionate, common-sense step forward," and not a "white flag of surrender to government-run healthcare" (2/21).

Politico: Gov. Rick Scott Embraces Medicaid Expansion In Florida
Scott had campaigned against the health legislation even before he began running for office, and Florida led the 26 states that fought it in court. On Wednesday, that changed as he agreed to take the federally financed expansion that would cover more than 1 million people — at least for the first three years (Millman, 2/21).

The Associated Press/Washington Post: McDonnell To Budget Panel: No Medicaid Expansion Absent Federal And State Cost Cutting Reforms
Gov. Bob McDonnell warned state legislative negotiators on Wednesday not to expand Medicaid in Virginia without major federal and state cost reductions first. McDonnell wrote to the legislature’s top budget chiefs — Senate Finance Committee chairman Walter A. Stosch and House Appropriations Committee chairman Lacey E. Putney — as they and 10 other negotiators grappled with Medicaid expansion, the largest remaining obstacle to reaching a budget compromise in time for Saturday’s final adjournment (2/20).

Los Angeles Times: Doctors List Overused Medical Treatments
Nearly 100 medical procedures, tests and therapies are overused and often unnecessary, a coalition of leading medical societies says in a new report aimed at improving healthcare and controlling runaway costs (Levey, 2/20).

Los Angeles Times: Study Disputes Long-Term Medical Savings From Bariatric Surgery
Despite the daunting price tag, mounting research has boosted hopes that the stomach-stapling operations could reduce the nation's healthcare bill by weaning patients off the costly drugs and frequent doctor visits that come with chronic obesity-related diseases like diabetes and arthritis. But a new study has found that the surgery does not reduce patients' medical costs over the six years after they are wheeled out of the operating room (Healy, 2/20).

The New York Times: $500 Million Chasm Opens In Proposed State Budget
A $500 million hole has opened in Gov. Andrew M. Cuomo’s proposed state budget because of changes in how Washington plans to reimburse the state for the care of people with developmental disabilities, the governor said on Wednesday. The state has been negotiating with the federal government for several months over the state’s billing practices; federal officials have said that the state has overbilled Medicaid for the institutional care of people with disabilities (Hakim, 2/20).

Los Angeles Times: Lawmakers To Consider Rules For Health Insurance Market
Lawmakers are set to consider new rules for California's health insurance market on Wednesday, including a requirement for insurers to cover consumers who have preexisting medical conditions, and limits on how much they can charge based on age (Mishak, 2/20).

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