KHN Morning Briefing

Summaries of health policy coverage from major news organizations

Viewpoints: New Czar Knows Something About Computer Bugs; Fears About Inadequate Drug Coverage

Los Angeles Times: Can An Ex-Microsoft Guy Cure
Seriously, one has to hope the new guy -- Kurt DelBene, former head of the Microsoft Office Division -- brings only a portion of Microsoft's heritage along with him. Aside from the XBox, the software giant isn't known for great consumer experiences. Its products have been maddeningly complex and notoriously buggy, at least in their early versions. Kind of like! (Jon Healey, 12/17). 

The Wall Street Journal: Incompetence
I have begun to worry about the basic competency of the administration, its ability to perform the most fundamental duties of executive management. ... They do the talking part, but the doing? They had 3½ years to make sure ObamaCare will work, three years to get it right top to bottom, to rejigger parts of the law that they finally judged wouldn't work, to make the buying of a policy easy on the website. And they not only couldn't do that, which itself constitutes an astounding and historic management failure, they make it clear they were taken aback by their failure (Peggy Noonan, 12/17). 

The Washington Post: Separating Fact From Fiction In Health Care
So much of the news the past few months has been dominated by the foibles of the Affordable Care Act. Yet the truth about how good or bad various parts of this major piece of health reform are won't be known for a long time (Michelle Singletary, 12/17). 

Los Angeles Times: Who Are The New Uninsureds?
It was always the case that the nation's medically uninsured were disproportionately non-white, poor and southern. These people were the prime targets of the Affordable Care Act, which aimed to bring them coverage in part by the federally-funded expansion of Medicaid. Two surveys released Tuesday by the Kaiser Family Foundation show how the demographics of the uninsured will change, thanks to the ACA. More precisely, the surveys show how they will change as a result of inaction -- the failure of 25 states to expand Medicaid, which the ACA's drafters expected to address the coverage problems of the poor (Michael Hiltzik, 12/17).

The Wall Street Journal: (Almost) Everyone Loses
Some [people without insurance] no doubt do [desire it], and lacked insurance because a pre-existing condition made them uninsurable in the pre-ObamaCare regime. But some lack insurance because they don't want it, don't feel they need it, are completely indifferent, or think it costs too much. What does ObamaCare do for them? "To" them is more like it. It jacks up their premiums to pay for all the mandated coverages -- especially if they're young and healthy and thus least likely to think they need insurance to begin with. It then tells them that they must buy insurance, whether they want it or not (James Taranto, 12/17).

USA Today: Contraceptive Challenge Exposes Double Standard
Even as birth control coverage became mandatory and the administration fights to the Supreme Court to force compliance, The Washington Post reports that insurers "have pared their drug benefits significantly." While your plan must always cover cheap birth control pills, you better read the fine print to make sure the plan covers expensive drugs for grave afflictions such as cancer, multiple sclerosis or HIV (Robert George, 12/17). 

The Fiscal Times: HealthCare.Gov's Back-Office Problems Move Front And Center
What counts in a sale isn't so much the pitch, but the closing of the deal. Without an order and check in hand, the transaction isn't complete. – and all of the state exchanges for that matter – have made a great pitch, although it seems that the federal site and states dependent upon it have yet to fully execute their transactions. Through November, about 2 million Americans made it through the application process on the exchanges. But will they be able to choose the right plan and actually get insurance? The jury's still out (John F. Wasik, 12/18).

The Fiscal Times: Obamacare – The Lump Of Coal In America's Stocking
In the spirit of the season, I bring tidings of great joy – especially for the GOP. The country continues to heal, but President Obama is not getting much of the credit. Because Republicans in the House had a rare moment of sanity and passed a budget, their star is shining a little brighter. ... The mess that is Obamacare is a gift to Republicans, and one that can't be returned (Liz Peek, 12/18).

The Star Tribune: Back To Basics After MNsure Shakeup
The board of directors at MNsure has serious work ahead to regain Minnesotans' confidence as glitches mount and as the health insurance marketplace suddenly finds itself without a top leader. April Todd-Malmlov, the executive director of the website at which Minnesotans may shop and sign up for insurance under the Affordable Care Act, resigned under fire Tuesday evening. She is being replaced on an interim basis by Scott Leitz, an assistant commissioner at the Department of Human Services. The seven-member board, which held a closed meeting yesterday to discuss Todd-Malmlov's two-week trip to Costa Rica in the midst of MNsure's launch, needs to ensure it does nothing further to undermine the fledgling effort (12/17).

The Tennessean: Expanding Medicaid Is Not Answer For TN
State Democratic leaders continue to lambaste Gov. Bill Haslam for "the worst moral and mathematical failure in a generation" by not expanding Medicaid in Tennessee. Revisiting recent history might help shine some light on this controversial issue. In the early 1990s, Tennessee pivoted to TennCare, our Medicaid equivalent. The goal was and remains noble. Help the poor access health care and enable our state to improve managing the growing Medicaid portion of our state's budget. The reality was harsh, however (Jim Brown, 12/17).

The Tennessean: Let's Heed Golden Rule And Expand Medicaid
"Do not do to others what is hateful to you" is a commonly accepted cornerstone of all faith traditions. As people of faith, if we claim to live by the "Golden Rule", what does that mean? We don't think it means we are complacent because many sitting in our sanctuaries have the ability to obtain healthcare. If our families couldn't afford to take their children to the doctor, if some suspicion of disease in our husband or wife couldn't be checked out because the money wasn't available, or if disease was found and couldn't be treated, the roofs of our churches and synagogues would likely lift with our reverberating anguish and calls for justice. ... We urge our state officials to take immediate action to submit a proposal (The Tennessee Plan) to federal officials that can win approval to use federal funds to purchase private health insurance for Tennesseans with incomes up to 138 percent of the poverty level (The West Nashville Clergy Group, 12/16).

Philadelphia Daily News: Corbett's Medicaid Proposal Is An Unhealthy Plan
As part of the Affordable Care Act, the federal government encouraged states to expand coverage of Medicaid, and in return, would fund the cost of that expansion fully for the first few years, and 90 percent afterward. Republican governors opposed to health-care reform have rejected this expansion, leaving their most vulnerable citizens out in the cold. [Gov.] Corbett has sent a proposal to the feds with an alternate plan that he claims would be more cost-effective -- subsidizing Medicaid-eligible people to buy coverage directly from the health exchange. But there are so many punitive -- and illegal -- components of his plan that no one expects it to pass muster (12/18).

The Milwaukee Journal Sentinel: Millenials Are Smart To Avoid Obamacare
President Barack Obama has a problem with millennials. We brought the votes and the noise in 2012: 60% of us voted for him in Wisconsin. But the honeymoon is officially over. Young Americans were once the most enthusiastic supporters of Obamacare, but we are now the law's most ardent foes. The latest poll shows that 57% of people ages 18 to 29 disapprove of this law — and only 13% of my generation "definitely" plans on signing up. What turned us against the law we once liked? Reality (Evan Feinberg, 12/17). 

And on other topics -

The New York Times’ Economix: How Medicare Subsidizes Doctor Training
When Congress established Medicare in 1965, it set up payments to subsidize residencies "until the community undertakes to bear such education costs in some other way." Exactly what that meant was unclear, notes Fitzhugh Mullan, a physician and health policy professor at George Washington University. After all, who is this "community," and why would it voluntarily take over this financial responsibility if the federal government was already paying for it? (Catherine Rampell, 12/17).

JAMA: The Optimal Practice Of Evidence-Based Medicine: Incorporating Patient Preferences In Practice Guidelines
Research evidence is necessary but insufficient for making patient care decisions. An effective but toxic chemotherapeutic regimen is the treatment one patient with cancer can and will take, another patient can take but will not, and yet another patient could not take even if wanted. ... Guideline panelists must recognize, with humility, the challenges they face in working often without access to informed patient preferences and acknowledge that their recommendations should rarely assume uniform patient values and contexts in favor of a particular course of action (Dr. Victor M. Montori, Juan Pablo Brito, Dr. M. Hassan Murad, 12/17).

JAMA: Enhancing Physicians' Use Of Clinical Guidelines
In part because of inadequate adherence to guidelines, preventable harm is the third leading cause of patient death, and one-third of health care spending—estimated at nearly $1 trillion, or $9000 per household—is for therapies that do not improve patients' health. ... Increasing evidence suggests that harms once deemed inevitable, such as central line–associated bloodstream infections, are largely preventable (Dr. Peter J. Pronovost, 12/17).

Los Angeles Times: Katie Couric And The Celebrity Medicine Syndrome
An email with the subject line "OMG" recently came from one of our mothers, and it contained chilling information about the HPV vaccine. "200 people have died from it," Mom claimed, "and it does not even last long enough to prevent cervical cancer." Her source was not her doctor, a new study or the Food and Drug Administration. Her information came from a recent episode of Katie Couric's ABC talk show about "all sides" of the "HPV controversy." Since then, most of the alarmist vaccine claims made in the episode have been debunked. But Mom remains a victim of celebrity medicine: She heard a warning from someone famous, believed it and spread the misinformation. Unfortunately, Mom is not alone. Celebrities have crept into our medicine cabinets and kitchens, influencing what pills we pop, tests we order and foods we fear (Julie Belluz and Steven J. Hoffman, 12/18).

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