First Edition: May 13, 2014

Today's headlines include reports about how the insurance marketplace is taking shape for 2015.  

Kaiser Health News: Insuring Your Health: Defining What 'Defined Contributions' Mean For Work-Based Health Insurance
Kaiser Health News consumer columnist Michelle Andrews writes: “What if employers started giving workers a chunk of cash to buy health insurance on their own instead of offering them a chance to buy into the company plan? Are workers ready to manage their own health insurance like they do their 401(k)?” (Andrews, 5/13). Read the column.

Kaiser Health News: Capsules: Harvard: Overused Medical Services Cost Medicare Billions
Now on Kaiser Health News’ blog, Capsules, Jordan Rau reports: “Medical overtreatment is the inverse of former Supreme Court Justice Potter Stewart’s definition of pornography: while easy to define in concept, it can be hard to know it when you see it” (Rau, 5/12). Check out what else is on the blog.

The Wall Street Journal: A Washington State Health Insurer Plans To Cut Rates In 2015
An insurer in Washington state selling plans under the Affordable Care Act is proposing to lower customers' health premiums next year in what appears to be one of the first such decreases proposed for 2015. The proposal by Molina Healthcare Inc. was part of a batch of state rate filings released Monday that included Washington and Indiana. While most carriers are seeking increases, Molina's filing signals that insurers that priced cautiously for 2014 could face pressure to be more competitive in the second full year of the law's insurance marketplaces (Radnofsky, 5/12).

The New York Times: More Insured, But The Choices Are Narrowing
In the midst of all the turmoil in health care these days, one thing is becoming clear: No matter what kind of health plan consumers choose, they will find fewer doctors and hospitals in their network — or pay much more for the privilege of going to any provider they want. These so-called narrow networks, featuring limited groups of providers, have made a big entrance on the newly created state insurance exchanges, where they are a common feature in many of the plans. While the sizes of the networks vary considerably, many plans now exclude at least some large hospitals or doctors’ groups. Smaller networks are also becoming more common in health care coverage offered by employers and in private Medicare Advantage plan (Abelson, 5/12).

The Washington Post’s Wonkblong: Hospitals See Blue-Red Divide Early Into Obamacare’s Coverage Expansion
A few months into Obamacare's coverage expansion, there's been plenty of debate about where the millions of newly insured have obtained coverage — whether through the law's exchanges, directly from an insurer, through expanded Medicaid or through an employer. The health-care law's immediate impact is a little more clear in hospitals, which are starting to report who's coming through their doors during the first months of expanded coverage under the Affordable Care Act (Millman, 5/12).

The Washington Post’s The Fact Checker: Michele Bachmann’s Claim That Obamacare Is ‘Hurting The Bottom Line Of U.S. Businesses
Rep. Bachmann made the comments above while appearing on one of the Sunday morning shows. (We removed the interruptions by her Democratic foil, Rep. Debbie Wasserman Schultz of Florida.) Bachmann is a Fact Checker favorite, so of course we wanted to see what was behind her data (Kessler, 5/13).

The Wall Street Journal: Merck To Sell Some Ophthalmology Assets To Santen
Merck will receive a $600 million upfront payment for the sale, as well as additional payments pegged to sales milestones. The deal is expected to close within a few months, Merck said. The products, which focus on eye treatments and care, generate about $400 million in annual sales in the markets the deal covers, Merck said (Calia, 5/13).

USA Today: The Cost Of Not Caring: Nowhere To Go
Hundreds of thousands of people with serious mental illness are falling through the cracks of a mental health system in tatters, a USA TODAY special report shows. Mentally ill Americans who have nowhere to go and find little sympathy from those around them often tumble into a de facto mental health system, made up of emergency rooms, county jails and city streets. The lucky ones find homes with family. The unlucky ones show up in the morgue. "We have replaced the hospital bed with the jail cell, the homeless shelter and the coffin," says Rep. Tim Murphy, R-Pa., a child psychologist leading an effort to remodel the mental health system. "How is that compassionate?" States looking to save money have pared away both the community mental health services designed to keep people healthy, as well as the hospital care needed to help them heal after a crisis (Szabo, 5/12).

Politico: DOD Seeks To Overhaul eHealth Records System
The Pentagon is readying an $11 billion contract to overhaul its electronic health records system, the biggest federal IT job since last fall’s HealthCare.gov debacle and one that will test the administration’s procurement finesse. DOD will issue a final request for proposals late this summer for the project aimed at arming military medicine with state-of-the-art records (Grasgreen, 5/12).

The Associated Press: The Doctor Will See You Now Via Webcam, Smartphone
Now patient groups and technology advocates are pushing to expand the digital care to people with complex chronic diseases that make a doctor’s trip more than just an inconvenience. Among the hurdles: While Medicare covers some forms of telehealth, it doesn’t typically pay for in-home video exams. Plus, doctors who practice by video-chat must be licensed in whatever states their long-distance patients live. Some states restrict the kind of care and prescribing available via telemedicine (5/12).

The Wall Street Journal’s Venture Capital Dispatch: Health Software Funding, Driven By Obamacare, Hits Post-Dot-Com High
One of the less-divisive outcomes of the Affordable Care Act has been the law’s spurring of a new generation of health-care software startups. Prompted by the ACA, better known as Obamacare, the U.S. health-care industry is relying on startups with technology to ease its transition into a new era. Health-software startups, in turn, are relying on venture capitalists at a rate not seen in more than 13 years. Such companies raised $237.5 million in the first quarter of 2013, the most raised in any single quarter since 2000, according to Dow Jones VentureSource (Zinsli, 5/12).

The Wall Street Journal’s The Informed Patient: Interactive Video Helps Patients Get Access To Medical Specialists
Even in some major population centers, medical specialists are in short supply in fields including high-risk pregnancy, behavioral health and neurology. A shortage of nearly 65,000 nonprimary-care specialists is projected by 2025, the Association of American Medical Colleges says. Big health-care systems, where most specialists work, are turning to interactive video consultations to give patients high-quality ongoing care for complex problems without requiring them to travel long distances or wait months for an appointment (Landro, 5/12).

The Wall Street Journal: Pennsylvania's Democratic Race For Governor Gets Testy
Experts say the race turned personal because the Democrats' positions are so similar. All four support taxing natural-gas drillers tapping the state's vast shale reserves, which Mr. Corbett opposes. All want to boost education funding, which had been scaled back under the governor. All support gay marriage, which the governor has fought. All support a form of Medicaid expansion under the federal health law that the governor opposes (Maher, 5/12).

The Washington Post: Boehner Spokesman Brendan Buck Departing For AHIP
Brendan Buck, who has served as one of Boehner's top spokesmen for more than three years, will depart today to head up communications for America's Health Insurance Plans, which represents thousands of health-care providers. Buck is a towering, lanky presence in the U.S. Capitol perhaps best known to political reporters nationwide as one of the few voices who speaks on behalf of Boehner and the broader House Republican Conference. He has focused especially on rapid response to comments and policy introduced by President Obama and congressional Democrats (O’Keefe, 5/12).

USA Today: Boehner Aide Takes Job With Health Insurance Lobby
House Speaker John Boehner’s spokesman, Brendan Buck, has spent a lot of time over the years helping his boss and congressional Republicans criticize President Obama’s health care law. Now Buck is leaving Capitol Hill to be spokesman for America’s Health Insurance Plans, the trade association that represents thousands of health insurance companies (Camia, 5/12).

Politico: John Boehner’s Brendan Buck Joins AHIP As Vice President
Buck, 32, a native of Alpharetta, Ga., has been Boehner’s press secretary for the past three years, and the speaker described him as “crucial” to earning back the public’s trust after Republicans took over the chamber (Allen, 5/12).

The Washington Post: Gov. McAuliffe Call For Review Of Abortion Clinic Regulations In Virginia
Gov. Terry McAuliffe moved to free Virginia’s abortion clinics from strict hospital-style building codes on Monday, loading up the state health board with abortion rights supporters and ordering it to review rules that clinic operators say threaten to put them out of business. The Democratic governor is also looking for ways to soften or suspend the rules to keep clinics open during the health board’s review, which could take more than two years. The General Assembly approved the regulations in 2011; they are set to take effect as early as June (Vozzella, 5/12).

Reuters/New York Times: Virginia: Governor Orders Review Of Last Administration’s Abortion Rules
Gov. Terry McAuliffe, a Democrat, on Monday ordered a review of what he called “extreme and punitive” state health rules that make it harder to operate abortion clinics, saying he would protect women’s rights to make health decisions. The review by the State Board of Health could overturn 2013 regulations set down by the previous Republican administration that forced abortion clinics to meet stricter hospital-style standards (5/12).

Los Angeles Times: Budget Talks Won’t Be Easy For Governor
He's also confronting higher-than-expected healthcare costs, now that one-quarter of the state's population is enrolled in Medi-Cal, which serves poor residents. More people are signing up for the program than previously anticipated as California continues to implement President Obama's federal healthcare overhaul, and there's a backlog of 900,000 applications still waiting to be processed (Megerian, 5/12). 

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