First Edition: October 16, 2015
Today's early morning highlights from the major news organizations.
Kaiser Health News:
HHS: Remaining Uninsured Worry About Costs Of Coverage
Department of Health and Human Services officials Thursday predicted that about an additional 1 million Americans would sign up for coverage under the federal health law next year and acknowledged that prospective enrollees are worried about the cost of health insurance, even with the law’s financial help. (Carey, 10/15)
Kaiser Health News:
N.Y. Attorney General Reaches Agreement With Urgent Care Clinics In First ‘Surprise Medical Bill’ Action
Four companies running urgent care centers in New York have agreed to disclose more fully which insurance plans they accept, following an inquiry by the state’s attorney general that found unclear or incomplete information on their websites that could result in larger-than-expected bills for consumers. The agreements mark the first enforcement action brought under New York’s new “surprise medical bill” law, seen as one of the broadest in the nation. The law aims to reduce the number of consumers who get such bills when they unknowingly see providers who are not part of their insurance plan networks. (Appleby, 10/16)
The New York Times:
Little Growth Predicted On Health Exchanges
In a surprisingly pessimistic forecast, the Obama administration predicted on Thursday that health insurance enrollment on the Affordable Care Act’s public marketplaces will only inch up from current coverage levels by the end of 2016. After an elaborate analysis of demographic data, Sylvia Mathews Burwell, the secretary of health and human services, said that 10 million people were expected to have marketplace coverage at the end of next year, up only about 100,000 from recent levels and millions short of earlier projections. She called that “a strong and realistic goal.” (Pear, 10/15)
Los Angeles Times:
Obama Administration Sets Low Bar For Health Law Enrollment In 2016
That is only a small increase over 2015, when 9.1 million Americans are expected to have coverage through the marketplaces, according to the Department of Health and Human Services. The 2016 target is also significantly lower than what the nonpartisan Congressional Budget Office had predicted. Earlier this year, the budget office estimated 21 million people would get coverage through the marketplaces next year. (Levey, 10/15)
The Wall Street Journal:
Obama Administration Projects Slim Gain For Health-Law Enrollment In 2016
This third open-enrollment season had widely been expected to make the greatest gains after the first go-round was marred by technology problems, and the second unfolded as a major challenge to the law loomed in the Supreme Court. The new season also carries a big incentive for consumers to buy insurance: to avoid the heftiest financial penalty yet on their taxes for going without coverage. (Radnofsky and Armour, 10/15)
USA Today:
10 Million — Not 20 Million — Should Have Obamacare Plans By 2017
More than 25% of those who are uninsured and eligible to buy plans on the federal and state health insurance exchanges are expected to select plans during the open enrollment that starts Nov. 1, Health and Human Services Secretary Sylvia Matthews Burwell said Thursday. The other 75% are "a little harder to reach," said Burwell. Those who don't have health insurance in 2016 will face a penalty of $695 per person on their taxes for the year. (O'Donnell, 10/15)
The Associated Press:
Is Obama's Health Overhaul Losing Steam?
Burwell called the new goal “strong and realistic.” An aide said the congressional numbers are based in part on assumptions that haven’t panned out, about employers dropping job-based plans for their workers, and about people with their own private coverage switching to HealthCare.gov. (Alonso-Zaldivar, 10/15)
The Washington Post:
White House Projects Marginal ACA Enrollment Growth In 2016
The anemic projection comes as the sprawling law is entering a new phase. Having survived the disastrous 2013 rollout of HealthCare.gov, the federal exchange’s online enrollment system, and weathered two Supreme Court challenges, the ACA has moved past critics’ early hopes that the law might quickly collapse. Proponents note that the statute has been responsible for the biggest gain in insurance coverage in decades. But questions linger over whether it can reach deep into the pockets of the nation’s most intractable uninsured populations and whether people who currently have health plans through the marketplaces will decide that the coverage is worth keeping. (Goldstein, 10/15)
USA Today:
Budget Talks May Need Billions For Medicare Fix
The nascent budget talks between Congress and the White House over how to fund the government, raise the debt ceiling and pay for highway construction just got more complicated. The Social Security Administration's announcement Thursday that benefits will not increase in 2016 means that retirees will not have extra income to pay for anticipated increases in Medicare Part B premiums and higher deductibles. ... Protecting seniors from higher deductibles and premiums could cost around $10 billion, and if Congress plans to pick up that tab, it would have to offset that with budget cuts or revenue increases elsewhere. (Singer, 10/15)
The New York Times:
No Social Security Raises Even If Medicare Soars
The 60 million people on Social Security will not receive any cost-of-living increase in their benefits in 2016, the government said Thursday, but because of a quirk in federal law, nearly one-third of Medicare beneficiaries could have record increases in their premiums unless Congress intervenes. With millions of older Americans on fixed incomes facing that one-two punch, the Obama administration is urging Congress to stop — or at least moderate — the health insurance premium increases. (Pear, 10/15)
Los Angeles Times:
No Cost Of Living Hike For Social Security Recipients Next Year, Government Says
Because Social Security benefits affect Medicare, the decision could end up costing California's Medi-Cal program an additional $550 million next year, which one state official has called an "urgent fiscal issue." (Peltz and Masunaga, 10/15)
The Wall Street Journal:
Social Security Recipients Won’t Get Cost-Of-Living Bump In 2016
The absence of any cost-of-living bump also triggers a “hold harmless” provision that prevents Medicare premiums from rising for about 70% of beneficiaries, who will continue to pay their existing monthly premiums of $104.90. Under current law, however, premiums for the other 30% of beneficiaries—including new enrollees, those who don’t receive Social Security benefits and enrollees with higher incomes—must be raised substantially to compensate. Federal actuaries estimated in July that those monthly premiums would rise 52% to $159.30. (Timiraos, 10/15)
The Washington Post:
Bad News For Retirees: No Social Security Cost-Of-Living Increase, Higher Medical Costs For Many
The lack of a raise triggers other bad news for retirees: Higher medical costs. Most Americans have their outpatient care premiums for Medicare Part B deducted directly from their Social Security checks, and the annual cost-of-living increase usually covers any increase to premiums. When it doesn’t, a longstanding “hold harmless” law protects about 70 percent of seniors from having their Social Security payments reduced. (Rein, 1015)
The Wall Street Journal:
Medicare Recipients Face Higher Drug-Plan Costs, Other Changes
Meanwhile, other changes are coming in 2016 and later years for participants in the federal health insurance program for people ages 65 and older. Here are three areas to be aware of: Higher prescription-drug costs. ... Added Medicare costs for some high earners in 2018. ... Notice to be required of hospital ‘observation’ status. (Tergesen, 10/15)
The Associated Press:
US Budget Gap For 2015 At $439 Billion, Lowest In 8 Years
he U.S. budget deficit in 2015 fell to its lowest level in eight years, spurred by gains in tax revenue that outpaced greater government spending. ... Health care programs drove some of the largest increases in spending. Medicaid, which pays for health services for the poor, reported expenses of $350 billion, 16 percent higher than in 2014. Much of that increase was attributable to greater enrollments under the Obama administration’s health care reforms. (Rugaber, 10/15)
The New York Times:
Medicaid Costs Rise, But Some States Are Spared
Spending on Medicaid rose nearly 14 percent on average in the last fiscal year, a report has found, largely because of a tide of newly eligible enrollees in the 29 states that had expanded the program by then to cover millions more low-income adults. But for most of those states, the per-member, per-month cost of the new enrollees was not higher — in a few cases, in fact, it was lower — than expected, according to the report, released Thursday by the Kaiser Family Foundation. And almost all of the additional spending was covered by federal funds, which are paying the entire cost of expanding Medicaid through 2016 and at least 90 percent thereafter. (Goodnough, 10/15)
NPR:
States That Declined To Expand Medicaid Face Higher Costs
The 22 states that didn't expand Medicaid eligibility as part of Obamacare last year saw their costs to provide health care to the poor rise twice as fast as states that extended benefits to more low-income residents. It's a counterintuitive twist for those states whose governors, most Republicans who opposed the Affordable Care Act, chose not to accept federal funds to extend Medicaid to more people. (Kodjak, 10/15)
USA Today:
Report: Medicaid Costs Hit Record High As States Look For Efficiencies
To Obamacare supporters, the report is proof the health care law is improving access to insurance coverage to those who need it most. But the report could also provide ammunition to critics who say its unwise to expand a program that is already strapping state budgets. (O'Donnell, 10/15)
The Wall Street Journal:
Kasich Tax Plan Aims To Balance U.S. Budget In 8 Years
Mr. Kasich’s proposal isn’t the largest or most radical reduction on the GOP table, but it is being offered as part of one of the most specific plans to eliminate the deficit. It is still short on many details about how the budget would be balanced but calls for drastic policy changes such as transferring responsibility for Medicaid, welfare and highway-construction funding to the states. (Hook, 10/15)
The Wall Street Journal:
UnitedHealth Has A High-Class Problem
For years, UnitedHealth Group has spoiled its investors. That came back to bite the stock Thursday. Third-quarter revenue came in at $41.5 billion and earnings per share at $1.65, both of which topped analyst estimates. Yet the shares dipped as the company’s net profit margin of 3.8% fell 1.1 percentage points from a year earlier. UnitedHealth attributed the weaker margin, in part, to greater levels of lower-paying, government-sponsored benefits business. (Grant, 10/15)
The Associated Press:
UnitedHealth Dives Deeper Into Public Insurance Exchanges
UnitedHealth will jump into 11 more public insurance exchanges next year, as the nation's biggest health insurer grows more comfortable with one of the health care overhaul's main ways of expanding coverage to millions of people. The once-reluctant exchange participant now draws 550,000 customers from that market and predicts that business will improve next year, helped by double-digit price hikes. (10/15)
The Wall Street Journal:
UnitedHealth Revenue Lifted By Recent Buy
UnitedHealth Group Inc. reported a better-than-expected 27% rise in third-quarter revenue, helped by a recent acquisition and an increase in members, but shares of the health insurer slid following cautious comments about 2016. During a conference call with analysts, UnitedHealth said it continues to expect “a further lift in the rate of earnings per share growth” in 2016. UnitedHealth’s president and chief financial officer, David S. Wichmann, suggested the company’s results would be within the “quite wide” range of analysts’ projections, but UnitedHealth guidance would likely “begin in a more conservative posture or range.” (Wilde Mathews and Dulaney, 10/15)
The Wall Street Journal:
Valeant Probe Reprises Federal Focus On Drug Pricing
Drug pricing, a key issue in the federal investigation of Valeant Pharmaceuticals International Inc., has been a frequent focus of federal prosecutions and whistleblower lawsuits in recent years. Pharmaceutical companies have paid more than $3 billion in fines to resolve pricing cases over the past decade, according to Patrick Burns, co-director of Taxpayers Against Fraud, a group that promotes whistleblowing. (Rockoff, 10/15)
The Wall Street Journal:
Hot Startup Theranos Dials Back Lab Tests At FDA’s Behest
Under pressure from regulators, laboratory firm Theranos Inc. has stopped collecting tiny vials of blood drawn from finger pricks for all but one of its tests, according to a person familiar with the matter, backing away from a method the company has touted as it rose to become one of Silicon Valley’s hottest startups. (Carreyrou, (10/15)
USA Today:
Bloodwork Darling Theranos Under Fire
Theranos, the secretive and revolutionary bloodwork analysis start-up valued at $9 billion, is under fire from a Wall Street Journal report that anonymously quotes former employees who question the efficacy and accuracy of the company's proprietary hardware. The heart of the allegations charge that of the 240 different tests Theranos offers consumers, only 15 are conducted on a machine called Edison while the rest are being outsourced to machines that are similar to those used by more traditional labs such as LabCorp and Quest Diagnostics. (della Cava, 10/15)
The Associated Press:
Bristol-Myers, Five Prime Expand Work On Cancer, Other Drugs
Drugmaker Bristol-Myers Squibb Co. is expanding its collaboration with Five Prime Therapeutics Inc., which could receive more than $1.75 billion if they succeed in turning Five Prime’s antibody-based drug candidates into approved medicines for cancer and immune-system disorders. (Johnson, 10/15)
The Associated Press:
Judge Orders Utah To Keep Cash Flowing To Planned Parenthood
A federal judge ordered Utah to keep sending money to the local arm of Planned Parenthood on Thursday amid a lawsuit over the governor’s decision to defund the organization -- at least for now. U.S. District Judge Clark Waddoups extended his earlier decision in the group’s favor, but he said he plans to issue a longer ruling later. (Price, 10/15)
The Associated Press:
VA Cites Phoenix Facility For Poor Urology Care
Staffing shortages and a lack of access to clinical records unnecessarily endangered the health of several Phoenix patients battling prostate and bladder cancer, the U.S. Department of Veterans Affairs said Thursday. In a new report, the VA’s Office of Inspector General cited several failures of the Phoenix VA’s urology care. (10/15)
The Wall Street Journal:
Massachusetts Governor Introduces Bill Aimed At Combating Painkiller Addiction
Massachusetts Gov. Charlie Baker introduced legislation to combat the state’s growing crisis of painkiller addiction that would include allowing doctors to hold people involuntarily for treatment and limiting patients’ supply of opioid painkillers. “I’ve never seen anything with the kind of negative momentum that this particular issue has,” Mr. Baker said at a news conference Thursday. (Levitz, 10/15)
The Washington Post:
Virginia Seeks Public Input On Substance Abuse Treatment
Virginia health officials are seeking the public’s input on how to improve Medicaid coverage for substance abuse disorder treatment services. The federal Centers for Medicare and Medicaid Services is inviting states to apply for waivers that would allow them to enhance or expand services. Virginia officials are soliciting public comment on that waiver request. (10/16)
The Associated Press:
Patient Attacked As Western State Hospital Faces Possible Funding Cuts
A patient attacked another patient at Washington state’s largest psychiatric hospital this week as federal regulators decide whether to cut millions of dollars to the facility over concerns about safety. Doctors at Western State Hospital say the number of violent episodes at the 800-bed facility is rising because staffing levels are inadequate, making the facility increasingly dangerous for patients and workers. The state agency in charge of mental-health services says it has asked lawmakers for more money to hire the workers needed to operate safely. (Bellisle, 10/15)