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Monthly Archives: February 2014

Maryland Exchange Can't Tell Whether Medicaid Enrollees Are Still Eligible

The state is unable to determine whether current enrollees continue to qualify for the state-federal program for the poor as a result of a glitch which officials estimate could cost $30.5 million over two years.

The Baltimore Sun: Medicaid Recipients May Stay In System Even If Then Don’t Qualify
Maryland must spend as much as $30Ǒ million more to provide Medicaid coverage to Marylanders because the state’s glitch-riddled health exchange website can’t tell whether they are still eligible. It’s another problem exacerbated by the software that has been causing headaches since the exchange website launched on Oct. 1 for those trying to get into the expanded Medicaid program or buy private insurance with subsidies (Cohn, 2/27).

The Washington Post: Maryland Begins To Put A Price Tag On Health-Care Exchange Debacle
The cost to taxpayers of flaws in Maryland’s online health insurance exchange is coming into focus, with officials estimating at least $30.5 million in unnecessary Medicaid spending and conceding that they have no idea how much it will take to get a system that works. The state has paid $65.4 million to the contractor hired to build the system and fired this week because of the protracted problems. Costs are likely to keep rising as Maryland figures out how to fix or replace the system (Johnson and Flaherty, 2/27).

The Associated Press: Report: Md. Health Exchange Glitch May Cost ฮ.5M
A problem with Maryland’s defective health care exchange could cost the state $30.5 million, because the state is unable to determine whether people remain eligible for Medicaid, according to a report by state budget analysts released Thursday (2/27).

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In States With Failing Exchanges, CMS Opens Door To Retroactive Premium Subsidies

A ruling by the Centers for Medicare & Medicaid Services will make it possible for consumers in some states to get federal subsidies even when they buy insurance outside of the Obamacare insurance marketplaces.

The Associated Press/Washington Post: Troubled State-Run Websites Get Health Law Fix
HHS said state residents who were unable to sign up because of technical problems may still get federal tax credits if they bought private insurance outside of the new online insurance exchanges. The federal policy change is significant because until now the administration has stressed that the only place to get taxpayer-subsidized insurance under President Barack Obama’s health law is through the new online markets, called exchanges. Previously, people who bought outside the marketplace were not eligible for subsidies, although they benefit from consumer protections in the law (2/28).

The Oregonian: Some Victims Of Cover Oregon Health Insurance Exchange Problems May Qualify For Relief
Some Oregonians who faced hassles dealing with the troubled Cover Oregon health insurance exchange received good news Wednesday: the federal government is providing an avenue for people to obtain retroactive tax credits through the exchange if the tech troubles forced them to purchase full-price coverage elsewhere (Budnick, 2/27).

Meanwhile, other states wrestle with insurance marketplace issues –

Los Angeles Times: Grim Scenario For Hawaii’s Obamacare Plan: The Numbers Don’t Add Up
As the Hawaii Legislature weighs bills that would make sweeping changes to the state’s Obamacare program, the interim director of Hawaii’s healthcare exchange on Wednesday laid out a grim financial picture facing the agency (Reston, 2/27).

Kaiser Health News: Conn. Tries To Sell Its Obamacare Success To Other States
Connecticut is widely seen as one of the states that is succeeding with the Affordable Care Act. Its website works well, and it has already exceeded its first-year enrollment goals. Other states have noticed (Cohen, 2/28).

The Boston Globe: Mass. May Give Up On Still-Failing Health Site
The lack of a working website may make it difficult to meet the June 30 deadline to move more than 200,ዀ people into insurance plans that comply with the federal Affordable Care Act, said Sarah Iselin, special assistant to Governor Deval Patrick. But she said the administration would devise a backup plan so residents would remain insured if the website is not ready — possibly by developing workarounds like the ones the state is already using to provide people temporary coverage without depending on the Health Connector website (Johnson, 2/27).

WBUR: Connector Website On The Mend, But Many Applicants Still In Limbo
The Connector has picked up the pace of processing a backlog of 72,000 applications for free and subsidized coverage. In two weeks, the backlog has dropped to 39,000, with help from Optum, the outside firm that has brought in 233 data entry folks so far. That number is supposed to rise to 318 by next Monday. But 39,000 people that have applied for coverage may not have any, and haven’t heard anything about the status of their application. The Connector says it has tried to prioritize applicants who need coverage right away (Bebinger, 2/27).

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Insurers Gather New Customers' Health Information — A Critical Step In Calculating Prices For Next Year's Plans Offered On Exchanges

Meanwhile, Reuters reports that chronically ill consumers who obtain coverage from the online insurance marketplaces may still face high drug costs despite the health law’s ban on discriminatory insurance practices. Also, news outlets report on Time magazine’s cover story that details how the Obama administration almost shutdown healthcare.gov during its early, fitful days.

The Wall Street Journal: Health Plans Rush To Size Up New Clients
Insurers are rushing to gather health information from the new customers they won on public marketplaces in a high-stakes outreach effort crucial to their hopes of profiting from the health-care law. Health plans need to know the health status of those signing up for coverage so they can project whether the costs are likely to outrun the premiums coming in. That information will be critical in figuring out prices for next year, among other things. But, under the law’s new rules, enrollees don’t have to disclose pre-existing conditions to buy insurance (Mathews, 2/27).

Reuters: Chronically Ill Facing High Drug Costs Under US Health Law
President Barack Obama’s ban on discriminatory health insurance practices against the sick has not stopped insurers from increasing up-front charges for the expensive drugs needed to control chronic illnesses from leukemia to multiple sclerosis. Actuarial studies of plans sold through health insurance marketplaces in some states found that many make consumers responsible for as much as 50 percent of the price of specialty drugs, which can cost $8,000 or more a month (Morgan, 2ቸ).

CBS News: Time Report: Obama Weighed Shutting Down Healthcare.Gov During Rollout
President Obama considered shutting down the HealthCare.gov website and starting over during its rollout, Time magazine reports in its new cover story. The administration was “pretty desperate,” according to Time contributor Steven Brill, who reported the story. “Two weeks into the launch, as the government shutdown ended, they knew all the attention was now going to be focused this website, which just wasn’t working,” he said. “So the president ordered his chief of staff to have a team come in and decide whether they should scrap the whole thing and start over or whether they could fix it” (Cochran, 2/27).

The Hill: Report: Obama Considered Scrapping Healthcare.gov And Starting Over
President Obama considered scrapping HealthCare.gov and starting over at the height of the website’s problems last fall, according to a report in Time magazine. The revelation underscores the total chaos that faced the White House and federal health officials in October when ObamaCare’s enrollment website was barely functioning (Viebeck, 2/27).

The Wall Street Journal’s Washington Wire: CMS’s Marilyn Tavenner: ‘Tired Of Talking’ About Healthcare.gov
Marilyn Tavenner, the administrator of the Centers for Medicare and Medicaid Services, said CMS should have hired a systems integrator to implement HealthCare.gov, the federal health exchange, rather than trying to do it on its own. She also said that testing HealthCare.gov prior to its Oct. 1 rollout was tough because it was such a large project. CMS only expected 10 to 12 states to work with HealthCare.gov, which ended up serving 36 states (Boulton, 2/27).

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Despite Appearances, Agreement Exists About Some Health Care Improvements

USA Today notes that consensus can be found regarding five steps. In other implementation news, NBC News reports on a new service being offered by some tax preparers — health insurance enrollment.  

USA Today: Finding Consensus On 5 Ways To Improve ACA
As President Obama hosted governors from both parties at the White House Sunday night, talk turned from how to repeal the Affordable Care Act to how best to deal with it now that it is law. As it turns out, there are several bipartisan improvements both fans and foes agree on (Kennedy, 2/27).

NBC News: Tax Preparers Offer New Service — Signing You Up For Obamacare
You’ve got to do your taxes and now also get health care coverage. Why not do both at the same time? Two major tax preparation companies are making a big push this tax season to help customers sign up for now-mandatory health insurance. H&R Block and Jackson Hewitt Tax Service are partnering with online insurance brokers GoHealth and Getinsured. They are steering customers to those brokers if the clients say they want to enroll in Obamacare insurance after getting their tax returns prepared. Given potential tax penalties under the new law, the companies see it as a natural fit—and a potentially growing service (Mangan, 2/28).

Meanwhile –  

USA Today: Federally Funded Health Centers Brace For Financial Loss
Federally funded health care centers, already straining to makes ends meet, now are fighting to block a 70% cut in their funding next year. The more than 9,000 health clinic centers, which serve 22 million mostly poor patients, were supposed to be big beneficiaries when an estimated 7 million more people were enrolled in health insurance under the Affordable Care Act . So while losing $3.6 billion a year in federal funding in October 2015 would be a steep reduction in support, it hadn’t seemed as problematic when the law passed four years ago as it does now (O’Donnell and McElhaney, 2/27).

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State Highlights: N.C. Medicaid Reform Plan Unveiled; Cutting Back Medicaid Estate Recoveries

A selection of health policy stories from Arizona, Colorado, Connecticut, D.C., Flordia, New York, and North Carolina.

North Carolina Health News: Medicaid Reform Plan Rules Out Privatization
After a nearly yearlong effort, state health officials presented their plan for overhauling the North Carolina Medicaid program, revealing a retreat from plans to offer the $13 billion program out to bid to private managed care companies. Over the course of a three-hour meeting of the Medicaid Reform Advisory Group held on Wednesday in Raleigh, officials from the Department of Health and Human Services presented a plan that would, however, put Medicaid providers at more financial risk in the program (Hoban, 2/27).

The CT Mirror: Feds Consider Scaling Back Medicaid Estate Recovery
For some adults, getting Medicaid coverage means that when they die, the state could claim some or all of their assets to recover the cost of the medical care they received. That’s left some people who qualify for the program under the federal health law wary of joining. Now the federal government, concerned about the effect on enrollment, plans to consider scaling back the practice. In a letter to state Medicaid directors, Cindy Mann, deputy administrator of the Centers for Medicare and Medicaid Services, wrote that the agency “intends to thoroughly explore options and to use any available authorities to eliminate recovery of Medicaid benefits” other than those spent on long-term care, like nursing home services or home care (Becker, 2/27).

The New York Times: D.C. Insurance Must Cover Treatment for Transgender Residents, Mayor Says
Health insurance providers in the District of Columbia must cover treatment for those given a diagnosis of gender dysphoria, including gender-reassignment surgeries, Mayor Vincent C. Gray said Thursday (Huetteman, 2/27).

Fox News: Florida Special Election A Test For ObamaCare?
Special elections rarely attract this much attention. But the race for Florida’s 13th Congressional District is a hot one — with so much at stake in November, what happens here is seen as a possible indicator of how the midterm elections could break.  “I think it’s very important because, obviously, both parties have got their eyes focused sharply on what the ObamaCare issue does,” said Susan McManus, a political science professor at the University of South Florida. “Does it push (David) Jolly, the Republican across the finish line? Or does it help (Democratic candidate Alex) Sink win?” (Roberts, 2/27).

The Associated Press/Wall Street Journal: Cuomo Proposing Out-Of-Network Health Coverage
The Cuomo administration has proposed extending out-of-network coverage requirements for emergencies and specialists to all health insurers in New York in what it says is an effort to protect consumers from big surprise medical bills (2/27). 

Tampa Bay Times: Feds To Fine State Over Limit On Medicaid Patients’ ER Visits
Florida has been limiting Medicaid patients to six emergency room visits a year even though federal officials consider such a cap illegal. As a result, the federal government intends to penalize the state by withholding a portion of Medicaid funding (Tillman and Mitchell, 2/26).

Health News Florida: Why Nurses Want More Power
A bill that would give nurse-practitioners more authority is one of the two big health issues being pushed by the House Select Committee on Health Care Workforce Innovation, which aims to increase access to primary care. The other big issue of the session, which starts March 4, is telemedicine: Ironing out how it could be paid for and regulated (Gentry, 2/27).

The Arizona Republic: Banner Scrutinized Over Medicare Ids
A federal agency placed Banner Health on “heightened monitoring” for printing the Medicare identification numbers of more than 50,000 Arizona residents on address labels of magazines mailed late last week. Medicare numbers often are identical to Social Security numbers. Banner printed the private information on labels affixed to its quarterly magazine Smart & Healthy, which arrived in mailboxes in Maricopa and Pinal counties beginning Monday (Giblin, 2/27).

Health News Colorado: New Equity Mission Targets Causes Of Poor Health
Now that the Affordable Care Act (ACA) is opening the doors to care for thousands of new patients, The Colorado Trust is embarking on an even more challenging, longer-term goal: health equity. “We’re focusing on those folks who, even with the implementation of the ACA, have a significant chance of getting left behind,” said Dr. Ned Calonge, president and CEO of The Trust. That means looking far beyond medical systems to try to reverse stubborn inequities that disproportionately affect racial and ethnic minorities, immigrants and disabled people, among others (McCrimmon, 2/28).

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Viewpoints: The Evolution Of Medicare; Generic Drugs And Patient Safety; New Food Labels

The New York Times’ Economix: How The Medical Establishment Got The Treasury’s Keys
About half a century ago, organized medicine and the hospital industry in this country struck a deal with Congress that in retrospect seems as audacious as it seems incredible: Congress was asked to surrender to these industries the keys to the United States Treasury. In return, the industries would allow Congress to pass a 1965 amendment to the Social Security Act …. We have come to know it as Medicare (Uwe E. Reinhardt, 2/28). 

The New York Times: Driving Down Childhood Obesity
There are glimmers of good news in the struggle to control obesity, one of the greatest health risks confronting the United States and other affluent nations. The latest federal report shows a significant reduction in the obesity rate among children ages 2 to 5, a vulnerable period when obesity patterns are often locked in for a lifetime. It is only a modest step in the right direction for a small slice of the population, but it suggests that further gains may be possible with a determined effort (2/27). 

Los Angeles Times: Generic Drug Industry Needs To Stand Up For Patient Safety
The Generic Pharmaceutical Assn. says a proposed federal regulation that would allow makers of generic drugs to inform people about all known health risks would create “dangerous confusion” and have “harmful consequences for patients.” And why would that be? (David Lazarus, 2/27). 

Los Angeles Times: From The FDA, A Mixed Bag Of Food Labels
The U.S. Food and Drug administration broke new ground in consumer protection when it required, more than 20 years ago, the now-familiar nutrition labels on virtually every bit of packaged food. Now, the labels are being revamped — in ways that have both benefits and downsides (2/28). 

Salt Lake Tribune: Refusing Medicaid Expansion Is A Dreadful Idea
Gov. Gary Herbert’s proposed “Healthy Utah” alternative to the Affordable Care Act’s Medicaid expansion is a dog’s dinner of denial, pipe dreams, contempt for the poor and lack of candor with the taxpayers of his state. It’s still better than the alternative proposed by the leadership of the Utah House, which ignored federal money altogether and pretended to do some good with a fraction of the funds, siphoned from other state needs. Herbert’s plan would be better if there was a snowball’s chance that the federal government would grant the waivers needed for what is, in fact, an ideologically extreme plan (2/27).

Raleigh News & Observer: With New Medicaid Plan, Time To Expand
Toss another revolutionary idea from the administration of Gov. Pat McCrory into the dust bin. After proclaiming the state’s Medicaid system “broken,” McCrory and his embattled secretary of the Department of Health and Human Services, Aldona Wos, dangerously flirted with turning the federal-state health care plan for the poor, elderly and disabled over to managed care organizations. … McCrory could now take a really significant step and support expansion of Medicaid. If he and GOP leaders in the General Assembly did that, it would answer critics who say they are unbending ideologues (2/27).

The Richmond Times-Dispatch: Yes: Expand Medicaid Coverage In Virginia
The catch is that for this expansion of coverage to occur, our legislative leaders must agree to accept the federal funds that will finance it. Federal dollars will pay for 100 percent of the cost of expanded eligibility from 2014 to 2016; 95 percent from 2017 to 2020; and 90 percent in 2021 and thereafter. In other words, starting in 2017, Virginia must pick up just 5 percent of the cost, and 10 percent starting in 2021. This expense has emerged as a major political stumbling block. Yet if Virginia continues to balk at expansion, it will be a Catch-22: Fewer people will get insurance through Medicaid, the state will lose out on significant state budget savings and Virginia will get less federal funding for hospitals that treat the uninsured (Rick Mayes, 2/28).

The Richmond Times-Dispatch: Marketplace Virginia Is Bad Policy
What are they so afraid of? That is the question that each and every resident of the commonwealth should be asking their elected officials on the topic of Medicaid expansion or, as some now like to call it, Marketplace Virginia. If Medicaid expansion really is the best policy for the future of health care in Virginia, then why are its strongest supporters running from it? Why, if Medicaid expansion will save lives, create jobs and make Virginia flush with cash, won’t its in-state architects just call Medicaid expansion by its name? (Sean Lansing, 2/28).

The Richmond Times-Dispatch: More About The Person, Less About The Dollar
Eunice Haigler of Fredericksburg is blind in one eye and lacks peripheral vision in the other as a result of a brain tumor that pressed too long on her optic nerve. She needs eyeglasses and has nearly exhausted the medication required to keep the part of the tumor that couldn’t be surgically removed from growing. She’s also about to run out of the prescription medicines that regulate her thyroid and blood pressure and provide the cortisone her body no longer produces on its own. Haigler,ಿ, lost her Medicaid coverage in December after taking on a one-day-a-week job at a day care center needed to supplement her disability income and put food on her table, she said. For her, Medicaid expansion is more than a political football to be tossed around in Richmond to score points against Obamacare (Michael Paul Williams, 2/28).

The Richmond Times-Dispatch: Medicaid Waivers — State Has Neglected Access, Services For The Disabled
As a man living with cerebral palsy, I know how difficult it is to reach my potential. A neurological disorder caused by oxygen deprivation at birth, cerebral palsy affects my speech, hearing and fine motor skills. I’ve had to battle to win simple accommodations such as a laptop for completing written assignments during my school years, or for equal consideration in employment. Through perseverance and a proactive support network, I met these challenges: I learned in a mainstream classroom, attended UNC-Chapel Hill and found gainful employment advocating public policy as an associate director at the Virginia Catholic Conference. But for people whose intellectual and physical disabilities prevent them from performing basic tasks unaided, the battle continues (Michael Lewis, 2/28).

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Research Roundup: Medicaid Peer Support; Doctor Jokes; ACA's Asset Rules For Coverage

Each week, KHN compiles a selection of recently released health policy studies and briefs.

National Academy for State Health Policy/Robert Wood Johnson Foundation: Paving The Way To Simpler: Experience From Maximizing Enrollment States In Streamlining Eligibility And Enrollment
Since 2009, the eight states (Alabama, Illinois, Louisiana, Massachusetts, New York, Utah, Virginia, and Wisconsin) participating in the Robert Wood Johnson Foundation’s Maximizing Enrollment program have worked to streamline and simplify enrollment systems, policies, and processes for children and those eligible for coverage in 2014. … States [focused] on five key areas: 1) applications, 2) eligibility determinations, 3) renewals and transfers, 4) notices, and 5) business processes.  … The following report shares the experiences of these states (Baudouin, Weiss and Hensley-Quinn, 2/21).

Health Affairs: Implementing Health Reform: Medicaid Asset Rules And The Affordable Care Act
Medicaid law has … permitted the states to impose liens on homes or other retained assets, and to recover Medicaid long-term care payments against a recipient’s estate upon the death of a recipient. … The Affordable Care Act creates a new category of Medicaid recipients — adults with incomes under 133 percent of the poverty level. It also changes income and asset eligibility rules for parents, children, and pregnant women, who were already eligible for Medicaid. Eligibility for these categories of recipients is now calculated based on “modified adjusted gross income,” or MAGI. There are no asset requirements for persons who become eligible for Medicaid under MAGI rules. … CMS intends, however, to take steps to avoid applying estate-recovery rules to MAGI-eligible individuals who do not receive [long-term care services] to keep this from becoming a barrier to Medicaid expansion eligibility (Jost, 2/24).

National Institute for Health Care Reform/Center for Studying Health System Change: Inpatient Hospital Prices Drive Spending Variation For Episodes Of Care For Privately Insured Patients
[This] analysis focuses on private health plans’ spending on episodes of care beginning with a hospitalization, … and up to 30 days after discharge, and payments for any readmission within Ǿ days of the initial discharge. …. hospital payments for initial inpatient stays accounted for two-thirds of total episode spending while related services accounted for a third. … This study’s findings—inpatient prices drive the bulk of episode-spending variation and hospitals with high spending for one service line tend to have high spending for other service lines—indicate that private purchasers can focus on hospitals’ overall inpatient price levels rather than pursue bundled payments for episodes of care (White, Reschovsky and Bond, 2/27).

Medicare & Medicaid Research Review: The Impact Of Medicaid Peer Support Utilization On Cost
Peer support programs have proliferated over the past decade, building on recovery oriented programming, yet relationships between peer support services and the costs to public programs have not been well described in literature. … Peer support was associated with $5,991 higher total Medicaid cost. Peer support was also associated with higher crisis stabilization cost and lower psychiatric hospitalization cost, but the relationships were not statistically significant. Peer support was associated with $2,100 higher prescription drug cost, $5,116 higher professional services cost, and $1,225 lower facility cost.  State policy makers must weigh the potential higher cost associated with peer support programs with efforts to redesign the delivery of mental health services (Landers and Zhou, 2/18).

JAMA/Kaiser Family Foundation: Physicians and Medicare
This month’s Visualizing Health Policy [infographic] takes a look at physicians and Medicare, including information about Medicare’s payment formula for physicians and about access to health care for people covered by Medicare. (Boccuti, Huang, Neuman, Jankiewicz, and Rousseau, 2/25). 

Kaiser Family Foundation: Kaiser Health Policy News Index: February 2014 
This month’s Index finds that the implementation of the Affordable Care Act (ACA) was the most-closely followed health policy news story this month, ranking behind news of the U.S. economy, but ahead of news about the Winter Olympics and President Obama’s State of the Union address in late January. The survey also finds that the news media is by far the public’s top source of information on the ACA, and that more say their impression of the law is based on what they’ve heard in the media than on their own experiences or those of their family and friends. The public continues to say that the media’s coverage of the law has focused more on politics and controversies than the impact on people. A plurality feel coverage is balanced but more feel it is biased against the law than for it (Hamel, Firth and Brodie, 2/27).

Journal Of Medical Internet Research/Dartmouth Institute: Did You Hear The One About The Doctor? An Examination Of Doctor Jokes Posted On Facebook 
We performed a cross-sectional study of 33,326 monitored Facebook users, 263 (0.79%) of whom posted a joke that referenced doctors on their Facebook wall during aņ-month observation period … Jokers told 156 unique doctor jokes and were the same age as nonjokers but had larger social networks (median Facebook friends 227 vs 132, P<.001) and were more likely to be divorced, separated, or widowed (P<.01). In 39.7% (62/156) of unique jokes, the joke was at the expense of doctors (Davis et al., 2/21).

Here is a selection of news coverage of other recent research:

MinnPost: Getting Opioid Painkillers From Multiple Doctors Is Common Among Medicare Patients, U Of M Study Finds
More than 30 percent of Medicare beneficiaries who have been prescribed opioid painkillers get those prescriptions from multiple health-care providers — a practice that significantly raises the risk of being hospitalized for opioid-related injuries and medical conditions, according to a study published last week in the British Medical Journal (BMJ). That 1-inDž number was unexpectedly high, said Pinar Karaca-Mandic, one of the authors of the study and an assistant professor of health policy and management at the University of Minnesota (Perry, 2/24).

Modern Healthcare: For-Profit Hospices Incur Medicare Penalties Over Longer Stays, Study Finds
Investor-owned hospice operators were far more likely than not-for-profit operators to incur Medicare penalties for admitting patients whose stay exceeded six months, a study has found. Terminally ill patients in for-profit hospices were more likely to leave alive, the new research also found (Evans, 2/24).

Reuters: Partner’s Death Tied To More Heart Attacks, Strokes
Older men and women whose partners died within the past month are at an increased risk of heart attacks and strokes, according to a new study from the UK. Researchers found the chance of having a heart attack or stroke doubled within the 30 days after people lost their significant other (Seaman, 2/24).

Reuters: Elderly Profit From Group Meetings And Home Visits
Group meetings and preventive home visits helped octogenarians maintain their health, independence and a positive outlook, according to a first-of-its-kind study in Sweden. Gerontologist Gwen Yeo told Reuters Health she was “amazed” that researchers at the Sahlgrenska Academy at the University of Gothenburg successfully documented what she has long suspected — health-promotion programs can postpone disease progression in older adults and keep them in relatively good shape … [the study was] published in the Archives of Gerontology and Geriatrics (Cohen, 2/21).

Modern Healthcare: Hip, Knee Replacement Cost-Variation For Insured Patients Driven By Hospitals: Study
The cost of new hips and knees for privately insured patients varied widely across three dozen hospitals in six states, with hospitals themselves the primary reason, a study shows (Evans, 2/26).

NPR: Scant Evidence To Support Vitamins Against Cancer, Heart Disease
Nearly half of American adults take a vitamin of some kind each a day. About a third take a multivitamin. But are they worth it? For people in good health and without any special nutritional deficiencies, there isn’t enough evidence to say it’s a good idea — at least when it comes to preventing cardiovascular disease and cancer. That’s the verdict from the U.S. Preventive Services Task Force, … The group published new guidelines on vitamins Monday in Annals of Internal Medicine (Hensley, 2/25).

The New York Times: Test Is Improved Predictor Of Fetal Disorders
A test that analyzes fetal DNA found in a pregnant woman’s blood proved much more accurate in screening for Down syndrome and another chromosomal disorder than the now-standard blood test, a new study has found. The promising results may change how prenatal screening for genetic diseases is done, though the test is costly and generally not yet covered by insurance for women at low risk (Belluck, 2/26).

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Political Cartoon: 'Plan B?'

Kaiser Health News provides a fresh take on health policy developments with “Plan B?” by Joel Pett.

And here’s today’s health policy haiku:

NOT YET…. PLEASE!!!

Political ads
trigger more health law sparring.
And it’s still early.
-Anonymous

If you have a health policy haiku to share, please send it to us at http://www.kaiserhealthnews.org/ContactUs.aspx and let us know if you want to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

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A Reader Asks: How Do I Apply For Coverage For My Son In Another State?

Q. I have a young son who lives in another state, but I claim him as a dependent for federal tax purposes. Can I apply through the marketplace in his state for his coverage, and my state’s marketplace for my coverage? How would the premium tax credits work?

A. You should be able enroll your son in a child-only policy on his state marketplace and purchase a separate plan on your own marketplace, says Brian Haile, senior vice president for tax policy at Jackson Hewitt Tax Service.

If your income is less than 400 percent of the federal poverty level ($62,040 for a family of two), you may qualify for a premium tax credit. The amount of the tax credit is generally based on the premium of the second lowest cost silver level plan in your coverage area. In a case like yours, in which family members live in different states, the Internal Revenue Service has proposed adding the premiums of the plans in the different geographic areas together and using that total as the premium on which to base the tax credit.

More From This Series Insuring Your Health

You can either take the tax credit in advance or receive it at the end of the year when you file your taxes. If you choose to take it in advance, the IRS will send the credit directly to the insurer and you’ll pay less in premiums. But in a case like yours, where you’re dealing with two health plans and two state marketplaces, it may be administratively tricky to divvy up the tax credit between the two insurers, says Haile.

If you can afford to, it would be much simpler to claim the tax credit at the end of the year when you file your taxes.

Since each exchange is different, your best bet may be to explain your situation to someone at your state marketplace when you apply for your own coverage and ask how to proceed, says Haile.  

“It’s going to take a fair amount of patience to work this out,” he says. 

Please send comments or ideas for future topics for the Insuring Your Health column to questions@kaiserhealthnews.org.

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First Edition: February 28, 2014

Today’s headlines include reports about the latest developments for those states that are running their own health insurance exchanges and facing difficulties.

Kaiser Health News: Lend Us Your Ears: Note Takers Help The Elderly At The Doctor
Reporting for Kaiser Health News in collaboration with USA Today, Susan Jaffe writes: “Wolozin is a volunteer for the Northwest Neighbors Village in Washington, D.C., one of the more than 200 ‘villages’ across the United States. These neighborhood membership organizations provide volunteers and other resources to help with everything from transportation and snow shoveling to hanging curtains and solving computer glitches. But as many of the Northwest Neighbors’ 210 dues-paying members ‘age in place’ – the village movement’s top goal — some need more than just a ride to the doctor, said executive director Marianna Blagburn. So the group is expanding its services this year with 16 newly trained ‘medical note takers’ who will accompany members into the doctor’s office armed with questions prepared in advance and take notes” (Jaffe, 2/28). Read the story.

Kaiser Health News: Conn. Tries To Sell Its Obamacare Success To Other States
WNPR’s Jeff Cohen, working in partnership with Kaiser Health News and NPR, reports: “Kevin Counihan, the CEO of Access Health CT, is walking through the 15th floor of a downtown Hartford office building that houses Connecticut’s health insurance marketplace. He passes the legal department, the IT folks and the consultants, then stops in front of three large, wall-mounted computer screens” (Cohen, 2/28). Read the story.

The Wall Street Journal: Health Plans Rush To Size Up New Clients
Insurers are rushing to gather health information from the new customers they won on public marketplaces in a high-stakes outreach effort crucial to their hopes of profiting from the health-care law. Health plans need to know the health status of those signing up for coverage so they can project whether the costs are likely to outrun the premiums coming in. That information will be critical in figuring out prices for next year, among other things. But, under the law’s new rules, enrollees don’t have to disclose pre-existing conditions to buy insurance (Mathews, 2/27).

USA Today: Finding Consensus On 5 Ways To Improve ACA
As President Obama hosted governors from both parties at the White House Sunday night, talk turned from how to repeal the Affordable Care Act to how best to deal with it now that it is law. As it turns out, there are several bipartisan improvements both fans and foes agree on (Kennedy, 2/27).

The Associated Press/Washington Post: Troubled State-Run Websites Get Health Law Fix
States that have experienced technical problems running their own health care enrollment websites are getting some help from the Obama administration. The administration quietly issued a health law fix Thursday to help those states. Several Democratic-led states, including Oregon, Maryland, Massachusetts and Hawaii, are still trying to solve website problems that have eclipsed those experienced earlier by the federal HealthCare.gov site, now largely repaired (2/Ǽ).

The Wall Street Journal’s Washington Wire: CMS’s Marilyn Tavenner: ‘Tired Of Talking’ About Healthcare.gov
Marilyn Tavenner, the administrator of the Centers for Medicare and Medicaid Services, said CMS should have hired a systems integrator to implement HealthCare.gov, the federal health exchange, rather than trying to do it on its own. She also said that testing HealthCare.gov prior to its Oct. 1 rollout was tough because it was such a large project. CMS only expected Ǫ to 12 states to work with HealthCare.gov, which ended up serving 36 states (Boulton, 2/27).

Los Angeles Times: Grim Scenario For Hawaii’s Obamacare Plan: The Numbers Don’t Add Up
As the Hawaii Legislature weighs bills that would make sweeping changes to the state’s Obamacare program, the interim director of Hawaii’s healthcare exchange on Wednesday laid out a grim financial picture facing the agency (Reston, 2/27).

The Associated Press/Washington Post: Utah Governor Rejects Full Medicaid Expansion
Utah’s Republican governor announced Thursday he wants to reject a full Medicaid expansion that would enroll more people in the government program, and instead seek federal dollars to cover the poor in private plans. Gov. Gary Herbert’s decision came after months of pushing back an announcement, making him one of the last governors in the country to announce his intentions about expanding Medicaid (2/27).

The Washington Post: Maryland Begins To Put A Price Tag On Health-Care Exchange Debacle
The cost to taxpayers of flaws in Maryland’s online health insurance exchange is coming into focus, with officials estimating at least $30.5 million in unnecessary Medicaid spending and conceding that they have no idea how much it will take to get a system that works. The state has paid $65.4 million to the contractor hired to build the system and fired this week because of the protracted problems. Costs are likely to keep rising as Maryland figures out how to fix or replace the system (Johnson and Flaherty, 2/27).

The Associated Press/Washington Post: Report: Md. Health Exchange Glitch May Cost $30.5M
A problem with Maryland’s defective health care exchange could cost the state $30.5 million, because the state is unable to determine whether people remain eligible for Medicaid, according to a report by state budget analysts released Thursday (2/27).

The Washington Post’s The Fact Checker: The Missing Context In Yet Another AFP Ad Featuring Yet Another Obamacare Victim
The Fact Checker is a little late in fact checking this ad—our colleagues at PolitiFact looked closely at it earlier in February—but given the controversy over Senate Majority Leader Harry Reid’s claim that the “vast majority” of the AFP ads are “lies,” we decided it was necessary to delve into the facts behind it. It certainly packs a punch, with Lamb’s personal anger at the president apparent, hinging on the president’s Four-Pinocchio claim that people who liked their plan could keep it. That’s turned out to be false, and the president’s ill-fated pledge is featured prominently in many of the AFP advertisements (Kessler, 2/28).

The Wall Street Journal’s Washington Wire: GOP Targets Hillary Clinton With Obamacare Attacks
Republicans see the Affordable Care Act as prime ammunition in the midterm elections. But party strategists are bent on getting mileage out of President Barack Obama’s biggest domestic initiative long after the battle for control of congress ends in November. The Republican National Committee is signaling that one line of attack against Hillary Clinton, should she run for president in 2016, will be her stance on health care (Nicholas, 2/27).

Politico: Vote On GOP Obamacare Alternative In Doubt
Suddenly, a House vote on a Republican alternative to Obamacare seems less likely. Speaker John Boehner (R-Ohio) declined to commit to an alternative measure coming up for a vote this year but said GOP leadership is going to “continue to having conversations with our members” about items like tax reform and replacing President Barack Obama’s signature domestic legislation (Sherman, 2/27).

The Associated Press/Washington Post: Senate Blocks Dems’ bill Boosting Vets’ Benefits
A divided Senate on Thursday derailed Democratic legislation that would have provided $21 billion for medical, education and job-training benefits for the nation’s veterans. The bill fell victim to election-year disputes over spending and fresh penalties against Iran (2/27).

Politico: Republicans Derail Senate Vets Bill
Members of both parties are typically reticent to oppose legislation designed to help veterans and their families, but the downfall of Sanders’s bill underscored the frosty relations in the Senate and Congress at large, where it’s been tough to get much done (Summers, 2/ǻ).

USA Today: Federally Funded Health Centers Brace For Financial Loss
Federally funded health care centers, already straining to makes ends meet, now are fighting to block a 70% cut in their funding next year. The more than 9,000 health clinic centers, which serve 22 million mostly poor patients, were supposed to be big beneficiaries when an estimated 7 million more people were enrolled in health insurance under the Affordable Care Act . So while losing $3.6 billion a year in federal funding in October 2015 would be a steep reduction in support, it hadn’t seemed as problematic when the law passed four years ago as it does now (O’Donnell and McElhaney, 2ቷ).

The Associated Press/Washington Post: Hospitals Coping Better As Drug Shortages Persist
U.S. hospitals are coping better with ongoing shortages of hundreds of medications, but a new survey indicates that obtaining drugs from alternate sources is costing them a lot of money they can’t spare. Premier Inc., the hospital group that did the survey, conservatively estimates that cost at $230 million a year for the country’s 5,000 hospitals, on average, from 2011 through 2013 (2/27).

The New York Times: D.C. Insurance Must Cover Treatment for Transgender Residents, Mayor Says
Health insurance providers in the District of Columbia must cover treatment for those given a diagnosis of gender dysphoria, including gender-reassignment surgeries, Mayor Vincent C. Gray said Thursday (Huetteman, 2/27).

The Associated Press/Wall Street Journal: Cuomo Proposing Out-Of-Network Health Coverage
The Cuomo administration has proposed extending out-of-network coverage requirements for emergencies and specialists to all health insurers in New York in what it says is an effort to protect consumers from big surprise medical bills (2/27). 

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