First Edition: October 28, 2014

Kaiser Health News: Disabled Vt. Senior Who Led Class Action Suit Sues Medicare — Again
A 78-year-old Vermont mother of four who helped change Medicare coverage for millions of other seniors is still fighting to persuade the government to pay for her own care. Glenda Jimmo, who is legally blind and has a partially amputated leg due to complications from diabetes, was the lead plaintiff in a 2011 class-action lawsuit seeking to broaden Medicare’s criteria for covering physical therapy and other care delivered by skilled professionals. In 2012, the government agreed to settle the case, saying that people cannot be denied coverage solely because they have reached a plateau and are not getting better. (Jaffe, 10/27)

Kaiser Health News: Reno Finds Medicaid Expansion Tough Hand To Play
For Carolyn Oatman, enrolling in Medicaid this year was “a dream come true.” Uninsured since she lost her job five years ago in this desert gambling city, Oatman, 57, often couldn’t afford the drugs to control her asthma and high blood pressure. She would sell her blood plasma to scrape together enough money to see a doctor. Since she signed up for Medicaid, though, her care is free, including her medicines. But there’s a downside: It can take two months to get a doctor’s appointment at a local community health center, or an all-day wait if she just shows up. Such delays are a result of the surge in newly insured patients seeking care as Nevada became one of 26 states to expand Medicaid under the Affordable Care Act in 2014. The Reno area has seen its Medicaid enrollment nearly double this year — one of the biggest jumps of any metro area nationwide. (Galewitz, 10/28)

USA Today: Some Doctors Wary Of Taking Insurance Exchange Patients
Now that many people finally have health insurance through the Affordable Care Act exchanges, some are running into a new problem: They can't find a doctor who will take them as patients. Because these exchange plans often have lower reimbursement rates, some doctors are limiting how many new patients they take with these policies, physician groups and other experts say. (O'Donnell, 10/28)

The Wall Street Journal: White House Opens Health-Insurance Portal To Small Businesses In Five States
The Obama administration has opened a new health-insurance portal to small businesses in five states after a yearlong delay of the Affordable Care Act’s online marketplace for small-employer health plans. The exchange, which was shelved last year amid mounting technical problems, quietly went live for the first time over the weekend in Delaware, Illinois, Missouri, New Jersey and Ohio. Companies in those states that have fewer than 50 full-time workers can start using the site now to buy insurance for workers for 2015. (Radnofsky, 10/27)

Los Angeles Times: Key Races May Hinge On What Voters Distrust More: Obama Or Congress
In a year in which Obama's unpopularity has been used by Republicans across the country to bludgeon Democratic senators, Kentucky — which Obama lost in 2012 by 23 percentage points — seems like the last place the party would have a chance to pick off a Republican incumbent, let alone the party's Senate leader. Yet a recent poll showed the race is within the margin of error. Ultimately Kentucky's Senate contest, and many others across the country, may come down to what voters distrust more: the Obama administration or longtime congressional incumbents like [Mitch] McConnell. Just 30% of voters here had a favorable opinion of the president in the most recent Bluegrass Poll, compared with 38% for McConnell and 40% for Grimes. (Memoli, 10/27)

The Associated Press: Democratic Attack Ads Aim To Save Senate Majority
Their majority in jeopardy, Senate Democrats unleashed a late-campaign round of attack ads Monday accusing Republicans in key races of harboring plans to cut Social Security and Medicare. The commercials in Iowa, New Hampshire, Louisiana and elsewhere appear aimed at older voters, who cast ballots in relatively large numbers in midterm elections and have tended to support Republicans in recent years. (10/27)

The Wall Street Journal: Aetna Raises Outlook, Cites Strong Results
The insurer has posted higher membership and revenue of late, but medical costs have also increased, although it has categorized that trend as moderate. Expensive treatments for hepatitis C have been among the biggest pressures on results, along with the company’s involvement in public health exchanges. Aetna’s total medical benefit ratio—the amount of premiums used to pay patients’ medical costs—was 82.3%, compared with 83.1% a year earlier. The ratio rose on the commercial side due to costs associated with hepatitis C treatments and the Affordable Care Act health law, among other reasons, but it declined for its government business. (Calia, 10/28)

The Wall Street Journal: Universal Health Services Revenue Up 11%
Universal Health Services Inc. said its third-quarter revenue rose 11% as the hospital operator continued to benefit from a rebound in admissions. Like some other hospital operators, Universal Health has been benefiting from a wave of newly insured patients under the Affordable Care Act. (Stynes, 10/27)

The Wall Street Journal: CDC Rejects Mandatory Ebola Quarantines
The new guidelines, by the Centers for Disease Control and Prevention, recommend that people at high risk of developing Ebola voluntarily isolate themselves from others for 21 days. That is less stringent than recent guidelines from New York and New Jersey, which imposed mandatory quarantines on such people and stoked tensions with the White House. (McKay, McCain Nelson and Armour, 10/27)

Los Angeles Times: CDC Recommends Looser Ebola Monitoring Than State Quarantines For Health Workers
The federal government announced new guidelines Monday for monitoring healthcare workers returning from West Africa that are far less restrictive than the quarantines that some states put in place for aid workers at risk of contracting Ebola. The guidelines call for medical workers at high risk to isolate themselves and those at lower risk to regularly report their temperature to local health officials to see whether symptoms of the virus develop. They are merely suggested practices for state and local officials, who may quarantine as they see fit. (Susman and Parsons, 10/27)

The Washington Post: No Unity Over Ebola Monitoring Of Travelers
The Pentagon announced Monday that Army personnel returning to their home base in Italy from Liberia will be held in quarantine for 21 days — even though none have symptoms of Ebola or were exposed to patients infected with the virus. The military’s policy does not appear to track new guidelines announced Monday by the Centers for Disease Control and Prevention, which called for “high-risk” individuals and health-care workers without any symptoms to be directly monitored by state and local health authorities. Nor do the states have to follow the CDC’s recommendations. (Achenbach, Dennis and Sun, 10/27)

Los Angeles Times: Disorder Among States' Ebola Strategies Raises Worries
The federal Centers for Disease Control and Prevention issued new guidelines on dealing with travelers from Ebola-stricken regions Monday, but its lack of firm rules left a patchwork of state-by-state strategies that include mandatory quarantines for some travelers. The different rules among states, and the CDC's recommendation of looser monitoring than what is being carried out in several states, highlight what some public health experts said was the problem with the current system. (Susman and Healy, 10/27).

USA Today: Quarantine Has Negative Consequences
Last Friday, the governors of New York, New Jersey and Illinois announced that U.S. health care workers returning from West Africa who had direct contact with Ebola patients will be placed under quarantine for 21 days upon arrival at airports in their states. Even though New Jersey Gov. Chris Christie and New York Gov. Andrew Cuomo have softened their stance in recent days, some continue to call for a strict 21-day quarantine of all those returning from Guinea, Liberia and Sierra Leone. Such a policy would likely lead to unintended negative consequences. (Rick Sacra, 10/27)

The Associated Press: Federal Health Official Fauci: States Have Options
For Americans wondering why President Barack Obama hasn’t forced all states to follow a single, national rule for isolating potential Ebola patients, the White House has a quick retort: Talk to the Founding Fathers. A hodgepodge of state policies, some of which directly contradict Obama’s recommendations, has sowed confusion about what’s really needed to stop Ebola from spreading in the United States. While public health advocates denounce state quarantines as draconian and scientifically baseless, anxious citizens in non-quarantine states are asking whether they’re at greater risk because their governors and the president have adopted a lesser level of caution. (Lederman, 10/28)

Politico: White House, States Fight Over Power To Quarantine
The White House threw a fit this weekend when two governors defied its Ebola policy and ordered mandatory quarantines of aid workers returning from West Africa. But then Obama officials threw up their arms, suggesting they didn’t have the legal authority to overrule the governors – even though they very well might. (Gerstein, 10/27)

USA Today: CDC Says People At High Risk For Ebola Should Stay Home
The issue of how to monitor travelers from West Africa -- and other contacts of Ebola patients -- became a matter of national debate Thursday when a New York physician was diagnosed with the disease after working with Doctors Without Borders in Guinea. The doctor, Craig Spencer, had not treated patients since his return but had ridden the subway, gone bowling and gone to a restaurant. He is being treated at Bellevue Hospital Center in New York. (Szabo, 10/27)

Politico: CDC Outlines Ebola Monitoring Policies
The new Centers for Disease Control and Prevention guidelines come after a weekend in which several states, beginning with New York and New Jersey, announced policies of their own, including mandatory quarantines for returning health care workers. Many public health officials say that’s an overreaction that may cause more harm than good. New Jersey, in particular, came under scrutiny for quarantining in a tent a nurse who had returned from working with Ebola patients in Sierra Leone, one of the three affected West African countries. (Norman, 10/28)

NPR: Medical Journal To Governors: You're Wrong About Ebola Quarantine
The usually staid New England Journal of Medicine is blasting the decision of some states to quarantine returning Ebola health care workers. In an editorial the NEJM describes the quarantines as unfair, unwise and "more destructive than beneficial." In their words, "We think the governors have it wrong." (Beaubien, 10/27)

NPR: New York's Disease Detectives Hit The Street In Search Of Ebola
A little-seen force has fanned out across New York City intent on stopping the spread of Ebola virus – disease detectives go looking for contacts who might be infected. "They're just really good at finding people," says Denis Nash. He worked for the Centers for Disease Control and Prevention and the New York City Health Department, tracing the spread of HIV and West Nile virus. He says these trained applied epidemiologists are experts at finding almost anybody, with only a vague description. (Mogul, 10/27)

The Associated Press: Lawmaker: New York Jail Heath Care Needs Oversight
A city councilman on Monday said he will hold an oversight hearing this year to examine health care services at Rikers Island and other city jails, where documents obtained by The Associated Press raised troubling questions about quality and timeliness of care in more than a dozen inmate deaths since 2009. (10/27)

The Associated Press: U.S. Sues NYC Over Medicaid Claims Worth Millions
The federal government has sued New York City, saying it ripped off Medicaid for millions of dollars by submitting tens of thousands of false claims. A civil lawsuit seeking unspecified damages was filed Monday in Manhattan federal court. (10/27)

Reuters: U.S. Sues NYC, Computer Sciences For Alleged Medicaid Fraud
The United States on Monday sued New York City and Computer Sciences Corp, accusing them of defrauding Medicaid into making millions of dollars of improper reimbursements by exploiting a computerized billing system that the company designed. According to a complaint filed in U.S. District Court in Manhattan, the defendants took advantage of the system's automatic default settings, enabling the city to improperly boost the amount and speed of reimbursements for services provided to infants and toddlers with developmental delays. U.S. Attorney Preet Bharara in Manhattan said some of these services might have been covered by private insurance, while others should not have been billed to Medicaid at all. (Stempel and Raymond, 10/27)

The New York Times: New York City Agency And Vendor Bilked Medicaid, U.S. Says
Federal authorities have accused New York City officials of a five-year effort to defraud Medicaid, working with a contractor to exploit loopholes in Medicaid’s computerized billing system to collect reimbursements that amounted to tens of millions of dollars. (Weiser, 10/27)