First Edition: December 2, 2014

Kaiser Health News: New ACO Rules Would Delay Penalties An Extra Three Years
Health care systems experimenting with a new way of being paid by Medicare would have three extra years before they could be punished for poor performance, the federal government proposed Monday. The proposal is one of dozens of changes that the Centers for Medicare & Medicaid Services wants to make to rules governing accountable care organizations. ACOs are affiliations of doctors, hospitals and other providers that jointly care for Medicare patients with the goal of pocketing a portion of what they save the government. Those that spend above Medicare estimates stand to lose money. (Rau, 12/1)

Kaiser Health News: If High Court Strikes Federal Exchange Subsidies, Health Law Could Unravel
Exactly what would happen to the Affordable Care Act if the Supreme Court invalidates tax credits in the three dozen states where the federal government runs the program? Legal scholars say a decision like that would deal a potentially lethal blow to the law because it would undermine the government-run insurance marketplaces that are its backbone, as well as the mandate requiring most Americans to carry coverage. (Rovner, 12/2)

Kaiser Health News: Insuring Your Health: EEOC Takes Aim At Wellness Programs Increasingly Offered By Employers
Do it or else. Increasingly, that’s the approach taken by employers who are offering financial incentives for workers to take part in wellness programs that incorporate screenings that measure blood pressure, cholesterol and body mass index, among other things. The controversial programs are under fire from the Equal Employment Opportunity Commission, which filed suit against Honeywell International in October charging, among other things, that the company’s wellness program isn’t voluntary. It’s the third lawsuit filed by the EEOC in 2014 that takes aim at wellness programs and it highlights a lack of clarity in the standards these programs must meet in order to comply with both the 2010 health law and the landmark Americans with Disabilities Act. ( Andrews, 12/2)

The Chicago Tribune: Some Newly Insured Still Struggle To Pay For Health Care
For Martha Gruberman, a 63-year-old resident of south suburban Steger, obtaining health insurance through the Affordable Care Act hasn't made it any easier to pay for routine medical care. ... Gruberman and others who picked plans with the lowest monthly costs have found that medical care is still out of reach because of the plans' high deductibles. As a result, many consumers with high-deductible plans are following old habits: delaying care or taking their needs to community health centers that have traditionally served the uninsured, local health administrators said. (Venteicher, 12/1)

NPR: Obamacare 'Glitch' Puts Subsidies Out Of Reach For Many Families
The Affordable Care Act is expected to provide around $10 billion in subsidies this year to make health insurance affordable for low- and middle-income people. But a quirk in the law is denying subsidies to a significant number of low income people, especially those with families. Benfield has run up against this quirk. To cover only himself, Benfield would have to pay a little more than $2,200 a year. He says he can't afford that, but that's an affordable amount, according to Obamacare regulations, and that means Benfield could not get subsidies if he tried to get coverage on the Obamacare exchange. (Ydstie, 12/2)

The Associated Press: Hispanics Targeted In 2nd Year Of Health Overhaul
Such atypical approaches to selling health insurance policies are playing out across the country since the second round of enrollment under the federal Affordable Care Act opened in mid-November. Insurance companies and some states are focusing heavily on signing up eligible Hispanics, a group that accounts for a large share of the nation’s uninsured but largely avoided applying for coverage during the first full year the health care reform law was in effect. Hispanics accounted for just 11 percent of those who enrolled in the private policies sold during the initial sign-up period, which ended in March. (Dalesio, 12/1)

The Wall Street Journal: Basic Costs Squeeze Families
Health-care spending by middle-income Americans rose 24% between 2007 and 2013, driven by an even larger rise in the cost of buying health insurance, according to a Wall Street Journal analysis of detailed consumer-spending data from the Bureau of Labor Statistics. That hit has been accompanied by increases in spending on other necessities, including food eaten at home, rent and education, as well as the soaring cost of staying connected digitally via cellphones and home Internet service. (Knutson and Francis, 12/1)

The New York Times: G.O.P. Split Over Congressional Budget Office Head
Douglas W. Elmendorf is an obscure figure beyond a narrow radius around Capitol Hill. As the director of the Congressional Budget Office, his nuts-and-bolts job is to serve as the official scorekeeper on the price of legislation and the referee on the budgetary and economic impacts of policy, from the Affordable Care Act to an increase in the minimum wage. So it is one of the stranger surprises of the midterm election fallout that the question of whether to reappoint him to his post has become a hot topic of debate — among Republicans. (Weisman, 12/1)

Politico: The New GOP Divide
Back in 2012, the GOP presidential candidates all ran promising full repeal of the president’s health care law. It was a particularly tough stance for eventual nominee Mitt Romney, who was pilloried during the primaries because the health care plan he created as Massachusetts governor also had an individual mandate. This time, several GOP governors who might run will take heat for expanding Medicaid under Obamacare. The expansion option comes with the promise that Washington will cover the full cost the first few years and 90 percent of it thereafter. (Hohmann, 12/2)

The Wall Street Journal: Jeb Bush Details Political Vision
Mr. Bush also offered some tough love to the incoming Republican majority in Congress that seemed aimed at heading off a showdown over the federal budget that could lead to a repeat of last year’s government shutdown. Quit trying to “make a point,” Mr. Bush said, and forge compromises to pass legislation. Stop seeking to repeal the Affordable Care Act, he suggested, and offer alternative health-care proposals. “We don’t have to make a point any more as Republicans,” he said. “We have to actually show that we can, in an adult-like way, we can govern, lead.” (Reinhard, 12/1)

The Wall Street Journal: Aetna Names New President
Aetna Inc. named Karen S. Rohan as its president, positioning her as a possible successor to Chief Executive Mark T. Bertolini. Mr. Bertolini, 58 years old, has served as the insurer’s president since 2007, adding the CEO title in 2010 and becoming chairman in 2011. Ms. Rohan, 51, will take on the new position on Jan 1. She has been an executive vice president overseeing local and regional business, and she now will add responsibility for national and government segments, as well as specialty products. She also has led Aetna’s integration of Coventry Health Care. (Wilde Mathews, 12/1)

The Washington Post's Wonkblog: AIDS Activists Cite A Milestone, But The Most Vulnerable Patients Are Left Behind
The HIV diagnosis rate dropped about 33 percent over a decade, from 24.1 per 100,000 population in 2002 to 16.1 per 100,000 in 2011. That's according to a recent analysis from the Centers for Disease Control and Prevention, which found significant decreases in diagnosis rates for most demographics, ... However, diagnoses attributable to male-to-male sexual contact saw increases for nearly every group, with those 13-24 years old recording the largest increase. (Millman, 12/1)

The Wall Street Journal: De Blasio Task Force Proposes Changes To Address Mentally Ill In New York City’s Criminal-Justice System
The plan represents the latest step by city officials to overhaul law enforcement, courts and jail systems in the wake of high-profile episodes involving mentally ill inmates at Rikers Island. The jail complex also has come under scrutiny after reports of dangerous conditions and lapses in treatment and supervision. (O'Brien, 12/1)

The New York Times: New York City Plans Focus On Mental Health In Justice System
In an effort to reduce the growing number of inmates with mental health and substance abuse problems in New York City’s jails, the administration of Mayor Bill de Blasio announced plans on Monday to significantly expand public health services at almost every step of the criminal justice process. City officials, who are allocating $130 million over four years to the project, said their goal was to break the revolving door of arrest, incarceration and release that has trapped many troubled individuals in the system for relatively minor, quality-of-life offenses. (Winerip and Schwirtz, 12/1)

The Associated Press: Mayor: $130M To Revamp NYC Jails For Mentally Ill
Mayor Bill de Blasio’s plans, to be announced Tuesday, are based on the recommendations of a task force he appointed following a series of reports by The Associated Press detailing problems at Rikers, including the deaths of two inmates suffering from serious mental illness. (12/2)

USA Today: Medicare House Calls On Rise In Michigan -- So Is Fraud
Medicare spending on doctors who make house calls rose to $236 million in 2012 — a 40% increase since 2006. But the effort to help aging patients with limited mobility get medical care has been riddled with fraud due to lax regulations in some areas of the U.S. Nowhere is this more pronounced than in Michigan, where nearly a fifth of all the spending on Medicare home visits nationwide take place. In 2012, physicians in Michigan received Medicare funds for home visits equal to 42 other states combined, a USA TODAY data analysis reveals. The result: more than $60 million in fraudulent billing by Michigan doctors in the past few years. (Hoyer, 12/1)

Los Angeles Times: New California Senators Take Oath Of Office; Bills Introduced
Sen. Ricardo Lara (D-Bell Gardens) reintroduced two bills, one of which would create a new Office of New Americans to help the 2.6 million people in the state illegally get services and special status proposed by the federal government to avoid deportation. ... Lara also reintroduced a proposal to provide health care coverage to some of those in the country illegally. The measure would expand state-funded Medi-Cal, and set up a mirror marketplace similar to Covered California, for those not eligible under the federal Affordable Care Act. (McGreevy, 12/1)