First Edition: October 13, 2014

Today's headlines include previews of what might happen during the health law's second open enrollment period, as well as the latest developments related to Ebola.  

Kaiser Health News: Got Insurance? You Still May Pay A Steep Price For Prescriptions
Kaiser Health News staff writer Julie Appleby reports: “Even with insurance, some patients are struggling to pay for prescription drugs for conditions such as cancer, arthritis, multiple sclerosis or HIV/AIDS, as insurers and employers shift more of the cost of high-priced pharmaceuticals to the patients who take them. Increasingly, health plans – even those offered to people with job-based coverage--require hefty payments by patients like Grooms. In some plans, patients must pay 20 to 40 percent or more of the total cost of medications that insurers deem to be specialty drugs and place in the highest tiers of patient cost sharing” (Appleby, 10/13). Read the story, which also ran in USA Today. 

The Wall Street Journal: Prepare For Health-Plan Enrollment
The second year of the Obama administration’s health-insurance program starts Nov. 15, with new deadlines, prices and options for the millions of Americans who have obtained coverage under the law—and, for the uninsured, opportunities to get coverage (Johnson, 10/11).

Politico: New Strategy: Underselling Obamacare For Year 2
The Obama administration vastly oversold how well Obamacare was going to work last year. It’s not making the same mistake this year. Gone are the promises that enrolling will be as easy as buying a plane ticket on Orbitz. ... Officials say the site won’t be perfect but will be improved. They refuse to pinpoint how many people they plan to enroll, instead describing general goals of reducing the number of uninsured and providing a positive “customer experience” — not exactly metrics that can be immediately judged (Haberkorn, 10/12).

The Associated Press: California Gives No-Bid Health Pacts
California’s health insurance exchange has awarded $184 million in contracts without the competitive bidding and oversight that is standard practice across state government, including deals that sent millions of dollars to a firm whose employees have long-standing ties to the agency’s executive director. Covered California’s no-bid contracts were for a variety of services, ranging from public relations to paying for ergonomic adjustments to work stations, according to an Associated Press review of contracting records obtained through the state Public Records Act (10/12).

The Wall Street Journal: Medicaid Backlogs Could Worsen As Health-Law Sign-Ups Resume
Hundreds of thousands of people who signed up for Medicaid months ago still don’t have coverage, a problem that could worsen when insurance sign-ups under the Affordable Care Act restart next month. California and Tennessee are facing lawsuits from residents who say they have seen long delays for coverage after signing up for Medicaid, the federal-state health program for the low income and disabled. Some say they have been waiting since late 2013 (Armour, 10/12).

Politico: An Obamacare October Surprise?
Obamacare premiums aren’t rising everywhere. They just have a way of finding the states with the biggest Senate races. And that could be very bad timing for Democrats in two of the party’s key contests. Double-digit rate hikes for individual health insurance plans have become an issue in the Louisiana and Iowa Senate races over the past week, where the Republican candidates are hammering their Democratic opponents for the steep premium increases on the way next year for some customers under the Affordable Care Act (Nather, 10/12).

The Washington Post: Ed Gillespie, Senate Candidate In Va., Unveils Alternative To Affordable Care Act
Virginia Senate candidate Ed Gillespie unveiled a health-care reform proposal Friday, offering an alternative to a law he would like to see repealed. Gillespie, a former Republican National Committee chairman who is challenging Sen. Mark R. Warner (D), has made opposition to the unpopular Affordable Care Act a cornerstone of his campaign. ... His plan would end the individual mandate to buy health insurance, the health-care exchanges and all of the law’s industry regulations. In their place, he would offer tax credits that increase with age and family size. ... In addition, under Gillespie’s proposal, family plans would no longer be required to cover young adults until age 26 (Weiner, 10/10).

The Miami Herald: Rick Scott, Charlie Crist Split On Medicaid Expansion
As he gains momentum in the race for governor, Charlie Crist is driving a conversation on Medicaid expansion. The Republican-turned-Democrat has become such a fervent supporter of the policy that he said he would consider using an executive order to get it done (McGrory, 10/12).

The New York Times: In Florida, A Chance For Democrats To Win One Back
But in an election season full of dire predictions for Democrats, the party is pinning one of its few genuine chances to reclaim a House seat on a little-known northwest Florida woman with a well-known name. Voters know her just as Gwen, but it is her last name, Graham, that resonates — a marquee Florida brand brimming with centrist political currency. And her father, Bob Graham, who was a popular longtime United States senator and governor, is usually by her side these days, chewing on pork at a fund-raiser, gobbling peanuts at a rally and extolling his eldest daughter’s pledge to put people before party as a Graham Democrat. … But Mr. Southerland, the 49-year-old co-owner of his family-run funeral home chain who co-founded a Panama City Tea Party group, has three powerful forces on his side: voters’ antipathy to President Obama, their deep-rooted opposition to his Affordable Health Care law and the growing inclination to vote Republican (Alvarez, 10/12).

The New York Times: U.S. Finds Many Failures In Medicare Health Plans
Federal officials say they have repeatedly criticized, and in many cases penalized, Medicare health plans for serious deficiencies, including the improper rejection of claims for medical services and unjustified limits on coverage of prescription drugs (Pear, 10/12).

The Washington Post: State Allows Employee Health Insurance To Cover Transgender Services
The State Department, which has been on the leading edge of policies affecting lesbian, gay, bisexual and transgender federal employees, is eliminating the “transgender exclusion” from the agency’s largest health insurance program. Insurance policies under the Federal Employees Health Benefits (FEHB) program generally exclude services “related to sex reassignment” (Davidson, 10/12).

NPR: A Benefit For Rural Vets: Getting Health Care Close To Home
Army veteran Randy Michaud had to make a 200-mile trip to the Veterans Affairs hospital in Aroostook County, Maine, near the Canadian border, every time he had a medical appointment. Michaud, who was medically retired after a jeep accident in Germany 25 years ago, moved home to Maine in 1991. He was eligible for VA medical care, but the long drive was a problem (Lawrence, 10/13). 

The New York Times: Harvoni, A Hepatitis C Drug From Gilead, Wins F.D.A. Approval
The first complete treatment for hepatitis C that requires taking only a once-a-day pill won approval Friday from the Food and Drug Administration. The drug, called Harvoni from Gilead Sciences, could shorten the duration of treatment and provide the first all-oral regimen for many patients. The new drug also appears to be a bit less expensive for some patients than Gilead’s existing blockbuster hepatitis C drug, Sovaldi, which has become the poster child for those complaining that the cost of medicines is out of control. Sovaldi costs $1,000 a pill, or $84,000 for a typical 12-week course of treatment, but it must be used with other drugs. Harvoni is even more expensive at $1,125 a pill, or $94,500 for a 12-week course of treatment (Pollack, 10/10).

The Wall Street Journal: Gilead Gets U.S. Approval To Sell New Hepatitis C Drug
Gilead Sciences Inc. won U.S. approval Friday to begin selling the first pill that promises to cure most hepatitis C patients without requiring other medicines, but its near $100,000 cost will likely further inflame tensions between drug companies and health insurers over spiraling prices. ... The escalating price for treating hepatitis C, which affects more than three million Americans, has been a sore point for health insurers and drug-benefit managers facing a mounting dilemma: how to balance use of a medicine that can prevent tens of thousands of deaths without breaking the bank (Rockoff, 10/10).

The Associated Press: Nursing Home Chain To Pay $38M In US Settlement
A nursing home chain has agreed to pay $38 million to resolve allegations that it billed Medicare and Medicaid for substandard care at nearly three dozen facilities around the country, the Justice Department said Friday. A federal investigation into Extendicare Health Services Inc. accused the company of failing to provide appropriate care, follow safety protocols or maintain enough skilled nurses. Those lapses in some cases resulted in head injuries to residents, falls, bed sores and fractures and cases of malnutrition, dehydration and infection, the government said (Tucker, 10/10).

The New York Times: Chain To Pay $38 Million Over Claims Of Poor Care
One of the nation’s biggest nursing home chains, Extendicare, has agreed to pay $38 million to resolve federal claims that it inappropriately billed for physical therapy and provided such poor care to residents that it was effectively worthless, the Justice Department said on Friday. The settlement with Extendicare, which owns about 150 homes in 11 states, is the largest settlement in the department’s history involving a nursing home chain accused of providing substandard care to residents (Thomas, 10/10).

The Wall Street Journal: Extendicare To Pay $38 Million In Medicare, Medicaid Billing Settlement
A U.S. nursing home chain has agreed to pay $38 million to end a government investigation into whether it billed Medicare and Medicaid for poor care of elderly residents. ... The company denied engaging in illegal conduct and agreed to the final settlement without any admission of wrongdoing. The company also agreed to be subject to a compliance program to monitor resident care. U.S. investigators said Extendicare Health understaffed nursing homes, alleging that in some instances it failed to provide adequate catheter care and failed to follow procedures to prevent bed sores and falls (Armour and Barrett, 10/10).

The Washington Post: U.S. Ebola Victim’s Medical Records Reported Contradictory 
On the other side of the city, at the Dallas/Fort Worth International Airport, a special Homeland Security Committee held a field meeting Friday in which Rep. Michael McCaul (R-Tex.), chair of the committee, tried to reassure the public. “Blind panic won’t help us stop (Ebola) from spreading,” he said, “and fear-mongering will only make it harder to do so. . . . The situation here at home is far different than what is happening in West Africa.” Some experts, however, say the United States and other western countries are hardly immune to a potential public health crisis. “Hubris is the greatest danger in wealthy countries,” wrote Laurie Garrett, a senior fellow for global health at the Council on Foreign Relations, in Friday’s Washington Post (Ellis Nutt, 10/10).

The Wall Street Journal: Ebola Virus: Texas Health Worker Tests Positive, CDC Confirms
Officials gave few details of how they believe she contracted the virus. CDC Director Tom Frieden called the infection a result of a “breach in protocol” at the hospital and said more cases may emerge. “Unfortunately, it is possible in the coming days that we will see additional cases of Ebola,” Dr. Frieden said in a news conference. “This is because the health-care workers who cared for this individual may have had a breach of the same nature.” The infection is the first transmitted in the U.S. and the second outside of West Africa, following that of a nurse’s aide in Spain who had cared for a missionary repatriated from Sierra Leone. The missionary died. The latest case has prompted a wider search for those possibly exposed (McKay, Bustillo and Beck, 10/13). 

The Washington Post: Health Worker Who Treated Dallas Patient Tests Positive For Ebola
The case raises new doubts about whether hospitals around the country, aside from a handful of highly-specialized facilities, are truly prepared to safely deal with the Ebola virus, and whether front-line nurses and doctors have received adequate training in diagnosing and treating the disease. The incident also seems certain to intensify fears about how easily the disease can spread, even though Ebola is transmitted only through bodily fluids and only after a patient begins showing symptoms (Dennis, Phillip and Sun, 10/12).

Los Angeles Times: Ebola Safeguards Are Being Taken, Southland Health Officials Say
So far, there have been no confirmed or suspected Ebola cases in Los Angeles County, and officials say they do not expect a major outbreak. But some on the front lines, alarmed by the death last week of a nurse in Spain who contracted the virus from a patient, are concerned that efforts to prepare healthcare workers aren't going far enough. On Sunday, officials reported a healthcare worker who treated Duncan has contracted Ebola. … Public health authorities in Los Angeles County are rolling out Ebola guidelines based on recommendations from the U.S. Centers for Disease Control and Prevention, which call for providers to don protective gear — goggles, gloves, masks and gowns — when working with a suspected Ebola patient; to isolate suspected Ebola cases in a room with its own bathroom; and — perhaps most key — to immediately ask patients with symptoms such as vomiting, nausea and fever if they have traveled to West Africa or been in contact with someone who has (Brown, 10/12). 

The Washington Post: Ebola Screening To Begin At Dulles, 3 Other Gateway U.S. Airports Thursday
Thomas Frieden, director of the Centers for Disease Control and Prevention, said Sunday that enhanced screening of international travelers for Ebola is likely to begin Thursday at Dulles International Airport and three other gateway airports (Halsey III, 10/12). 

Los Angeles Times: For Abortion Foes, A National Strategy Built At The State Level
The numbers have changed little over the decades: A majority of Americans support abortion. But across the country, the antiabortion movement has recorded major success in the last four years, part of a well-funded national strategy to legislate abortion out of existence state by state. Legislatures, many stocked with new Republican majorities, have passed laws that, if upheld, would drastically reduce access to abortion for millions of women (Semuels and La Ganga, 10/12).

The Wall Street Journal's Pharmalot blog: Texas AG Lawsuit Claims AstraZeneca Improperly Marketed Seroquel 
The Texas Attorney General has filed a lawsuit against AstraZeneca that alleges the drug maker illegally marketed its Seroquel antipsychotic pill for unapproved uses, paid kickbacks to physician and state health officials, and subsequently caused the state Medicaid program to overpay for the medicine (Silverman, 10/10).

The Washington Post/Kaiser Health News: Medicare Penalizes Washington-Area Hospitals For Readmissions
Every general hospital in the District of Columbia and its Virginia suburbs has been fined for having too many Medicare patients readmitted within a month for additional treatment, federal records show (Rau and Gillespie, 10/10).

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