CDC, Obama Under Fire For Ebola Containment Policies

The Centers for Disease Control and Prevention Chief Thomas Frieden faced criticism Thursday on Capitol Hill over handling of the Dallas Ebola cases. Meanwhile, the White House is feeling pressure to name an "Ebola czar" to coordinate the nation's response. Also, the idea of imposing travel restrictions is gaining momentum, while Ebola is also becoming a political flashpoint.  

The Washington Post: CDC Director’s Challenge: Deadly Ebola Virus And Outbreak Of Criticism
Frieden, the 53-year-old doctor who for the past five years has served as director of the Centers for Disease Control and Prevention, is immersed in an epidemiological and political crisis. He has become the face of that crisis, and more than that, the voice. It’s a deep voice, sonorous, and he speaks slowly, deliberately, assuredly, and he declared at the end of September: “I have no doubt that we’ll stop this in its tracks in the U.S.” But his confident statements have had to compete with the onslaught of bad news, including the infection of two health-care workers in Dallas, and he is now on the defensive (Sun, Bernstein and Achenbach, 10/16).

Politico: CDC Chief Survives Trial By Fire On Hill
Tom Frieden is getting a lot of public scoldings for all of the missteps in the handling of the Dallas Ebola cases -- and there have been plenty of them. But so far, the criticisms don’t appear to be rising to the level where the director of the Centers for Disease Control and Prevention needs to worry about his job. Frieden came through a three-hour House hearing Thursday with some bruises but also with his ability to function as director seemingly intact (Nather and Norman, 10/16).

The New York Times: Obama May Name ‘Czar’ To Oversee Ebola Response
President Obama raised the possibility on Thursday that he might appoint an “Ebola czar” to manage the government’s response to the deadly virus as anxiety grew over the air travel of an infected nurse. Schools closed in two states, hospitals and airlines kept employees home from work, and Americans debated how much they should worry about a disease that has captured national attention but has so far infected only three people here (Healy, Tavernise and Goodnough, 10/16).

Politico: Obama’s Ebola Challenge
The White House playbook for handling natural disasters is clear cut: Get the president in front of the cameras early, pledge every federal resource for the recovery, make a sympathetic visit to the devastated area and never pass up an opportunity to show who’s in charge. But the strategy for dealing with a deadly infectious disease that’s unlikely to turn into an epidemic yet is still terrifying to the public? Murky, at best (Budoff Brown and Epstein, 10/17).

The Washington Post: Ebola Presents Health, Political Challenges For Obama
Cognizant of the dangers that come from going before the public without answers, Obama has emphasized the low probability that the deadly disease will become a large-scale outbreak in the United States because it is not easily transmitted. But in the wake of acknowledged errors that led to the infections of two nurses in Dallas, the White House is now engulfed in a crisis that has resurrected questions about the president’s governing style. After meeting with top aides in the Oval Office for nearly two hours Thursday night, Obama sought to address some of the criticism lawmakers have lodged against him by saying he may appoint one person, or “czar,” to oversee the federal response. But he reiterated that Americans remain safe (Eilperin, 10/16).

NPR: Health Officials Face Ebola Questions On Capitol Hill
A day after news that a second health care worker in Texas has Ebola, members of Congress grilled Centers for Disease Control and Prevent Director Tom Frieden about the federal response (10/16).

The Washington Post: Congress Presses For Ebola Travel Ban
Members of Congress sharply questioned top public health officials Thursday about banning travel from West African countries where the Ebola virus is out of control to the United States, demanding to know why the administration has not adopted that tactic. “It’s not a drill,” said Rep. Fred Upton (R-Mich.), a member of the of the House Energy and Commerce oversight and investigations subcommittee, which held Thursday’s hearing. “People’s lives are at stake, and the response so far has been unacceptable” (Berman and Berstein, 10/16).

The Wall Street Journal: U.S. Ebola Response Is Slammed By Lawmakers
President Barack Obama , after a day of withering criticism over the government’s handling of the Ebola virus, said Thursday he may name a point person to oversee the administration’s response and is open to a travel ban but isn’t planning one. His evening remarks, which sought to show a more forceful response while assuring Americans they remain safe, were the first sign the White House could adopt ideas that Republican lawmakers have emphasized in ratcheting up their attacks this week. They have called for creating an Ebola czar and for travel restrictions from virus epicenters in West Africa (Armour and Lee, 10/16).

Politico: Why A Travel Ban Wouldn’t Work
The political momentum for a travel ban on West African nations continued to swell Thursday, but health and transportation experts were uniform in saying it wouldn’t stem the spread of Ebola — and could do more harm than good. That hasn’t stopped politicians and pundits -- ranging from House Speaker John Boehner to former Obama press secretary Jay Carney -- from calling for a travel ban. The appeal is obvious: It sounds like a no-brainer to build an infectious-disease moat around the U.S., blocking some flights and barring people who come from the countries suffering the worst Ebola outbreaks (Caygle and Wolfe, 10/16).

Los Angeles Times: Dallas Hospital Shifts Blame To CDC On Ebola Protocols
The hospital's response -- its second in two days -- in part shifted responsibility to the federal Centers for Disease Control and Prevention and to the protocols the agency issued this summer to guide the handling of a patient infected by the virus, which is thought to have killed more than 4,400 people in West Africa. The hospital said the protocols changed frequently, frustrating caregivers and management (Mohan, 10/16).

The New York Times: In Cities With West African Populations, Hospitals Take Extra Steps
Hospitals in cities with large West African populations are bracing for the first patients with Ebola, a prospect that no longer seems so far-fetched, ramping up screening, protections for hospital staff, and efforts to encourage people to report symptoms and take precautions (Belluck, 10/16).

Poll: Misconceptions, Confusion Surround Public Understanding Of Ebola's Spread

The survey, which was conducted  by the Kaiser Family Foundation (KHN is an editorially independent program of the foundation), found that 70 percent of U.S. adults say they are following news reports closely about the deadly virus. 

The Washington Post’s Wonkblog: Ebola Is Scarier When You Don’t Know How It’s Spread
As Americans are becoming increasingly fearful of Ebola, there's still some pretty notable confusion about how the deadly virus is spread, according to new polling. Even though 70 percent of U.S. adults say they're closely following news about Ebola, just 36 percent know that a person infected with the deadly virus must be showing symptoms to transmit the infection to others, according to a new Kaiser Family Foundation Tracking Poll (Millman, 10/16).

Kaiser Health News: Capsules: Many Unaware How Ebola Is Spread 
The survey by the Kaiser Family Foundation found that while nearly all adults (97 percent) know a person can become infected through direct contact with the blood or other body fluids of someone who is sick with Ebola, there are still misconceptions. (KHN is an editorially independent program of the foundation.) One third of respondents are unaware they cannot become infected through the air. About 45 percent are unaware they cannot contract Ebola by shaking hands with someone who has been exposed to the virus but who does not have symptoms (Galewitz, 10/16).

State Exchanges Gird For Round Two

Covered California hopes to enroll more than half a million new residents this year, bringing total participants to about 1.7 million. Meanwhile, more than 12,000 Oregonians could owe money at tax time because of errors computing their premium subsidies, and a study of Colorado residents finds that insurance costs and signup confusion kept many on the sidelines.

Kaiser Health News: Capsules: California’s Insurance Exchange Gears Up For Round Two 
California’s insurance exchange began mailing renewal notices this week to more than 1.1 million people already enrolled in health plans, officials announced Thursday. Consumers who want to make changes must do so by Dec. 15 for coverage effective Jan. 1, while those who want to keep their current plans will be renewed automatically. The renewals are occurring as the state’s marketplace, Covered California, gears up for the open enrollment period for new consumers. Between Nov. 15 and Feb. 15, Covered California hopes to enroll more than 500,000 new people, which would bring the total to about 1.7 million (Gorman, 10/16).

Oregonian: More Than 12,000 Oregonians Could Owe At Tax Time Under Cover Oregon Subsidy Errors
More than 12,000 people who purchased policies through Cover Oregon could owe a combined $1.12 million at tax time because of errors in subsidized premiums issued by the health insurance exchange. The vast majority of people affected are expected to owe no more than $10 per month [for the period] that their policy was in effect. That figure is not final, however, because a $10,000 consultant's study intended to settle the question did not succeed. The exchange is planning to commission a second, more in-depth study (Budnick, 10/16).

Health News Colorado: Cost, Confusion Stall Hunt For Insurance
Cost and confusion prevented many uninsured people from signing up for health coverage this year in Colorado, according to two new reports. A Rand study, Barriers to Enrollment in Health Coverage in Colorado, found that some consumers didn’t want to sign up because they opposed the individual mandate. Others were frustrated that they first had to apply for Medicaid in a cumbersome process. Still others found Colorado’s exchange website confusing. And many people said costs for insurance and co-pays seemed too high (Kerwin McCrimmon, 10/16).

Meanwhile, in other news regarding the health law's implementation -

Kaiser Health News: Administration Signals Doubts About Calculator Permitting Plans Without Hospital Benefits
Insurance consultants were shocked recently to learn that Obama administration rules allow large companies to offer 2015 worker health plans that don’t include hospital benefits. Now the administration is concerned too. Treasury Department officials are preparing to reverse course on an official calculator that permits plans without hospital coverage to pass the health law’s strictest standard for large employers, said industry lawyers who have spoken to them. These sources expect the administration to disallow such coverage by the end of the year (Hancock, 10/17).

Atlanta Journal-Constitution: Big Decision Ahead For Obamacare Enrollees
A plan to automatically re-enroll thousands of Georgians in health plans they bought through the federal insurance marketplace for 2014 may allow some to happily avoid the government’s website when open enrollment starts next month. But those who stay the course instead of taking the time to sift through new coverage options for 2015 could end up paying more for their current plans. That’s because new health plans and prices to choose from will almost certainly change the size of federal tax credits consumers can qualify for to help shrink their monthly premiums (Anderson, 10/16).

Minneapolis Star Tribune: Franken: Override ‘Hobby Lobby,’ Make Contraceptives More Available To Women
U.S. Sen. Al Franken reiterated his stance Thursday that the U.S. Supreme Court’s Hobby Lobby decision that limited access to birth control must be overridden, in a women’s health roundtable in St. Paul that focused largely in the fallout from this summer’s Hobby Lobby ruling. The ruling, in which the U.S. Supreme Court said that requiring corporations to pay for insurance coverage for contraception violated federal law protecting religious freedom. Franken told the panel of assorted women lawyers, citizens and advocates that the ruling must be overturned (Simons, 10/16).

Demographics Help Shape Lawmakers' Views On Health Law

Most of the congressional districts with the greatest numbers of uninsured people are represented by Democrats, according to The Associated Press. News outlets also report on how Georgia's gubernatorial candidates and North Dakota's congressional candidates differ on the health law.

The Associated Press: Dem Push For Health Law Rooted In Demographics
While much of America was upset about the botched rollout of President Barack Obama's health care overhaul, most Democrats in Congress were still willing to give the law a chance to work. Without the law, many of their constituents wouldn't have health insurance. ... If a community has a large concentration of people without health insurance, there is a good chance it is represented by a Democrat in Congress. Of the 50 congressional districts with the most uninsured people, all but nine are represented by Democrats(Ohlemacher, 10/16).

Atlanta Journal-Constitution: Gov. Nathan Deal and Jason Carter On Top Issues
[Jason] Carter wants to expand Medicaid under the Affordable Care Act, casting it as a fiscal necessity. … [Gov. Nathan] Deal rejects Medicaid expansion and says it would inevitably cost Georgia billions of dollars in new spending (Blustein).

The Associated Press: US House Candidates Debate Health Care Law
Two of the three candidates for U.S. House in North Dakota say they would vote to repeal the federal health care law, while the third says he'd rather fix it. The Bismarck Tribune reports that incumbent Republican Rep. Kevin Cramer, Democratic challenger George Sinner and Libertarian Party candidate Jack Seaman squared off in a debate Wednesday evening. Cramer reiterated his stance that the Affordable Care Act is a massive federal overreach and a disaster. Seaman said he also thinks the law should be repealed. Sinner said there are many parts of the law that need to be fixed, but that there are many good provisions as well (10/16).

And then there's the fact checking -

The Washington Post’s Fact Checker: Obama’s Claim That Obamacare Has Helped Produce A ‘$1,800 Tax Cut’
Remember that 2008 campaign promise touted by then-candidate Obama — that his health care law would reduce the cost of premiums by $2,500 by 2014? As we have noted, he was quickly called out by fact checkers for making a dubious claim based on shaky assumptions. Moreover, the pledge came with a large asterisk: He was not saying that premiums would drop by $2,500, but that health-care costs per person would be that much lower than anticipated. Of course, the Affordable Care Act turned out to be different from the plan Obama discussed during the campaign, and longer to implement than expected, so the White House in 2011 amended the pledge to say it would $2,000 in savings by 2019 (Kessler, 10/17).

UnitedHealth Is Bullish About Health Exchanges

During a conference call with investors Thursday, company executives suggested the online marketplaces created by the Affordable Care Act could generate profit margins in the range of 3 to 5 percent. The company wasn't a major player this year, but plans to participate in two dozen states in 2015.

Minneapolis Star Tribune: UnitedHealth Group Eyes Growth On Health Exchanges
UnitedHealth Group wasn’t a major player when the federal government and some states launched new health insurance exchanges in late 2013. It’ll be a different story this fall, however, as the Minnetonka-based insurer plans to offer insurance products in nearly two dozen states through online marketplaces that were created by the federal Affordable Care Act. During a conference call with investors Thursday, company executives suggested the new market could generate profit margins in the range of 3 to 5 percent in the long run (Snowbeck, 10/16).

The Wall Street Journal: UnitedHealth’s Profit Boosted By Lower Medical Costs
UnitedHealth Group Inc. reported better-than-expected third-quarter earnings and raised its profit forecast for the year, driven by lower medical costs. “Medical utilization remained restrained,” the health insurer said in a news release Thursday. UnitedHealth added that its medical-care ratio, a key industry metric that reflects the portion of insurance premiums used for patient care, fell to 79.7% in the third quarter from 80.6% a year earlier (Calia and Wilde Mathews, 10/16).

Reuters: UnitedHealth Says Medical Use Low And Likely To Stay
UnitedHealth Group Inc said on Thursday that patients had used medical services at low rates in the third quarter, easing worries among investors that higher admissions reported by hospitals would cost insurers more than they planned. UnitedHealth reported a net profit increase that beat Wall Street expectations and described medical use as "restrained." The portion of premiums that it spent on medical claims fell, including for the division that manages health plans sold on the new Obamacare health exchanges. Both hospitals and insurers are benefiting from increased patient volume, which appears to be related to the Affordable Care Act, Leerink Partners analyst Ana Gupte said. At the same time, UnitedHealth was clear that its costs were not rising (Humer, 10/16).

VA Officials Leaving Jobs After Scandal

In Chicago, for instance, a Chicago-based regional chief for some VA hospitals stepped down earlier in October, around the same time as some other top officials.

The New York Times: After Hospital Scandal, V.A. Officials Jump Ship
After a national scandal erupted this year over veterans dying while waiting for care at Veterans Health Administration hospitals, Congress passed a law making it easier to fire executives who were responsible for the problems, which included systemic efforts to cover up lengthy wait times that kept patients from seeing doctors (Philipps, 10/16).

Chicago Sun-Times: Two Officials With Ties To Embattled Hines Left Hines VA
Two other top officials with ties to the Edward Hines, Jr. VA Hospital recently left their jobs -- around the same time the director of the hospital announced she was stepping down, the Chicago Sun-Times has learned. Dr. Jeffrey Murawsky, health care chief for the VA’s Chicago-based regional office, sent an Oct. 9 email that was forwarded to the Sun-Times, stating that he was resigning so he could pursue "a position outside of the Department of Veterans Affairs closer to my family in Southern Nevada." Murawsky had been nominated by President Obama to be the top health official at the Veterans Affairs Department but withdrew his name in June. There have been a slew of allegations about poor treatment at veteran’s hospitals across the country, including at Hines VA (Thomas, 10/16).

State Highlights: Calif.'s Prop. 45 Fight; Aetna Sheds Jobs After Medicaid Drop

A selection of health policy stories from California, North Carolina, Delaware, New York, Georgia, Pennsylvania, New Jersey, Florida and Kansas.

Los Angeles Times: Big Money, Complex Issues Make Prop. 45 Tough Issue For State Voters
Almost three decades ago, a small band of consumer activists persuaded California voters to slap tough new rate regulations on auto insurance. Now that same group wants to crack down on health insurance rates. And the insurance industry and its business allies are back with a multimillion-dollar war chest to fight Proposition 45 with an omnipresent media campaign. The combination of big money and complex regulatory issues makes Proposition 45 a tough issue for voters, said Larry Levitt, a senior policy analyst at the nonprofit, nonpartisan Kaiser Family Foundation, unrelated to insurer Kaiser Permanente (Lifsher, 10/16).

Charlotte Observer: Same-sex marriage In NC Has Some Employers Expanding Coverage
The legalization of gay marriage in North Carolina means more gay and lesbian individuals will now be eligible for health insurance coverage through their spouses’ employers, including Charlotte-Mecklenburg Schools. Some big companies such as Bank of America, Wells Fargo and Duke Energy have offered benefits to employees in same-sex partnerships for years. But other employers are now making changes or mulling them (McFadden and Rothacker, 10/16).

The News Journal: Dropping Aetna From Medicaid Means Job Losses
About two hundred Delaware-based health care jobs will be lost at the end of the year after the state department of Health and Social Services announced Wednesday it will no longer offer Medicaid coverage through one of its managed care organizations, Delaware Physicians Care Inc. Some employees working with Delaware Physicians Care, an Aetna health plan, will have opportunities to work in other plans in Maryland and in Pennsylvania, said Aetna spokesman Walt Cherniak. But by Jan. 1, the 202 jobs associated with the Aetna plan will be gone. About 137,000 Delaware Medicaid patients are enrolled in an Aetna Delaware Physicians Care plan, meaning those patients will have to transfer over to a Highmark or United Healthcare plan when open enrollment begins Nov. 15. Currently, 54,000 Medicaid patients are enrolled in a United Healthcare plan (Starkey and Offredo, 10/17).

The Associated Press: Binghamton Hospital Pays $3.4M To Settle Case
Federal authorities say a Binghamton hospital [in New York] has paid $3.4 million to resolve claims it improperly billed Medicare. Our Lady of Lourdes Memorial Hospital, a 242-bed facility, found billing issues and overpayments from the federal health care program for hyperbaric oxygen therapy (10/17). 

Georgia Health News: Health Data Thefts A Continuing Problem
A state agency says Georgia consumers’ personal data has not been compromised so far in the wake of a theft of a laptop computer that contained some people’s health information. The computer was stolen from the vehicle of an employee of the Department of Behavioral Health and Developmental Disabilities who was attending a Clayton County conference in August. The laptop contained health information on 3,397 individuals who receive services from the agency (Miller, 10/16).

Philadelphia Inquirer: Pa. Hospitals To Test Newborns For More Disorders
Before the end of the year, hospitals in Pennsylvania will be required to test newborns for certain rare disorders where early detection could help save lives. Gov. Corbett on Wednesday signed a bill to expand newborn screenings to include six disorders. "We owe these children and their families a fighting chance," Corbett said at a news conference in the Capitol. The bill signed by Corbett would bring to 35 the number of genetic conditions for which newborns receive screening in Pennsylvania. The law, which takes effect in 60 days, requires hospitals to add certain lysosomal storage disorders to the list of diseases for which a newborn is screened. Health-care providers will now test for Globoid cell leukodystrophy (Krabbe disease), Fabry, Pompe, Niemann-Pick, Gaucher, and Hurler Syndrome (Worden, 10/16).

The Associated Press: Crucial Ruling Due On Taj Mahal Casino’s Future
A federal bankruptcy court judge was expected to issue what the owners of Atlantic City's Trump Taj Mahal Casino Resort consider a life-or-death decision for the financially-troubled gambling hall. Trump Entertainment Resorts and billionaire investor Carl Icahn want the judge to cancel the casino's union contract, saying it can't survive without shedding costly pension and health care obligations. Trump Entertainment has threatened to close the casino by Nov. 13 if it cannot shed its pension and health care obligations to the Taj Mahal's 3,000 workers. Gross was to issue his decision at 3 p.m. Friday (Parry, 10/17).

Health News Florida: Sickest Medicaid Kids In ‘Chaos,’ Doctors Say
Florida pediatricians who care for severely disabled children say the state's overhaul of Medicaid has left  kids, parents and caregivers in turmoil. Extremely fragile children, including some with tracheostomies and feeding tubes, face barriers in access to specialty care, physical therapy, home medical supplies and other urgent needs, the pediatricians say. They say the barriers cropped up as the state Medicaid program rolled out its Managed Medical Assistance (MMA) program, which requires nearly all of the 3.6 million Floridians on Medicaid to be enrolled in HMOs or similar managed-care plans. That includes chronically ill and severely disabled children who until recently were cared for by a network of highly skilled doctors through a program called Children's Medical Services (CMS) (Gentry, 10/16).

Kansas Health Institute News Service: Malpractice Fund Stable, But Uncertainty Looms
A state fund meant to diffuse the costs of medical malpractice claims is on stable footing, but the fund's executive director said this week that legislators should not consider using reserve money for other purposes. Chip Wheelen, executive director of the Kansas Health Care Stabilization Fund, said the fund is in a key transition period due to changes in new legislation. That makes the financial future less certain. But even without those changes, Wheelen said, all the money in the fund should remain devoted to paying malpractice claims and the costs of administering the fund (Marso, 10/16).

Modern Healthcare: More Providers, Insurers Showing Appetite For Narrow Networks
A new health plan collaboration in Wisconsin between a hospital system and an insurer is the latest sign that providers and insurers are betting on narrow networks even as controversy continues over whether these plans offer adequate provider access for consumers (Herman, 10/16).

Research Roundup: Malpractice Reforms And Doctors' Practice

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

The New England Journal of Medicine: The Effect of Malpractice Reform On Emergency Department Care
Defensive medicine is considered by many to be a major source of wasteful medical spending in the United States. A widely cited report estimates that $210 billion is spent annually on needless care motivated by fear of malpractice litigation. ... Malpractice reforms in Texas, Georgia, and South Carolina, which changed the liability standard for emergency care from ordinary negligence to gross negligence, provide unusually broad protection for emergency physicians. We did not find evidence that these reforms decreased practice intensity, as measured by the rate of the use of advanced imaging, by the rate of hospital admission, or in two of three cases, by average charges. Although there was a small reduction in charges in one of the three states (Georgia), our results in aggregate suggest that these strongly protective laws caused little (if any) change in practice intensity among physicians caring for Medicare patients in emergency departments (Waxman et al., 10/15).

Urban Institute: In States That Don't Expand Medicaid, Who Gets New Coverage Assistance Under The ACA And Who Doesn't?
In states not expanding Medicaid, 6.3 million uninsured adults who could have qualified for Medicaid are instead ineligible, while 5.9 million other uninsured adults qualify for subsidized, private insurance. We compare these two groups and find the following: Median income for such ineligible adults is 35 percent below poverty. For eligible adults, it is 175 percent of the federal poverty level. In dollars, median incomes are under $800 a month for the ineligible uninsured and over $2,000 a month for eligible adults. As a result: Only 28.0 percent of uninsured black adults qualify for help paying for health coverage while fully 42.7 percent are ineligible because of nonexpansion. By contrast, more uninsured whites qualify (36.0 percent) than not (32.7 percent). ... Uninsured adults who are Hispanic, under age 25, or have at most a high school degree are more likely to be ineligible than eligible (Dorn, Buettgens and Dev, 10/9).

Neurology: Cost Of Informal Caregiving Associated With Stroke Among The Elderly In The United States
We selected persons aged 65 years and older in 2006 and who were also included in the 2008 follow-up survey from the Health and Retirement Study. We adapted the case-control study design by using self-reported occurrence of an initial stroke event during 2006 and 2008 to classify persons into the stroke (case) and the nonstroke (control) groups. ... The economic value of informal caregiving per stroke survivor was $8,211 per year, of which $4,356 (53%) was attributable to stroke. At the national level, the annual economic burden of informal caregiving associated with stroke among elderly was estimated at $14.2 billion in 2008 (Joo, Dunet, Fang, and Wang, 10/10).

Journal of the American Medical Association: Association Between Skilled Nursing Facility Quality Indicators And Hospital Readmissions
Hospital readmissions are common, costly, and potentially preventable. Little is known about the association between available skilled nursing facility (SNF) performance measures and the risk of hospital readmission. ... we examined the association between SNF performance on publicly available metrics (SNF staffing intensity, health deficiencies identified through site inspections, and the percentages of SNF patients with delirium, moderate to severe pain, and new or worsening pressure ulcers) and the risk of readmission or death 30 days after discharge to a SNF. ... Among fee-for-service Medicare beneficiaries who received postacute care at a US SNF, better performance on available measures of postacute care quality was not consistently associated with a lower adjusted risk of readmission or death at 30 days (Neuman, Wirtalla and Werner, 10/15).

The Kaiser Family Foundation: What's In and What's Out? Medicare Advantage Market Entries and Exits for 2015
During the debate over the Affordable Care Act (ACA), some questioned whether the Medicare Advantage market would shrink in response to the reductions in payments to Medicare Advantage plans included in the ACA .... The total number of Medicare Advantage plans will be similar to the number in 2014, declining by 3 percent from 2,014 plans in 2014 to 1,945 plans in 2015. ... In most states, the total number of plans offered in 2015 will be similar to the number in 2014. In nine states ... the number of departing plans will exceed the number of new plans by at least 10 plans, while in two states ... the number of new plans will exceed the number of departing plans by at least 10 plans in 2015. ... Plans with relatively low enrollment and plans with average star quality ratings or below comprise the majority of plans exiting the markets (Jacobson, Neuman and Damico, 10/10). 

Health Affairs/RWJF: The Ninety-Day Grace Period
From October 2013 through March 2014 more than eight million Americans enrolled in a new health plan through the Affordable Care Act's (ACA's) insurance Marketplaces. The law recognizes that for some enrollees this represents a significant period of transition, with many gaining regular health coverage for the first time in their lives. To help enrollees new to the system keep their insurance, the ACA provides a ninety-day grace period before an insurer can discontinue someone's coverage for failure to pay a monthly premium. .. Most criticism about the ninety-day grace period has come from provider organizations, such as hospital and physician groups.  ... Insurers, on the other hand, were concerned about the effect on plan premiums if they were required to pay claims for the entire ninety days (Pradhan, 10/16).

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

Reuters: Report Shows Disparities In U.S. Diabetes Prevention, Amputation
Differences in amputation rates for diabetes complications are a sign that disparities in care by region and race start much earlier, according to a new report. U.S. blacks are less likely to get routine preventive care for diabetes than other patients and three times more likely to lose a leg to amputation because of the disease, according to a new report from the Dartmouth Atlas Project, which analyzes Medicare data to see how well the healthcare system is working. ... Diabetic amputation rates in the U.S. are lower now than they were 10 or 15 years ago, but for some groups the rates are actually on the rise, he said. Amputation rates are highest in the Southeast, in rural areas and among black Americans (Doyle, 10/14).

MinnPost: Unneeded Stress Tests Cost $500M Annually, Study Finds
Inappropriate use of cardiac stress testing — particularly testing done with imaging — is costing the U.S. health care system more than half a billion dollars a year, according to a study published last week in the Annals of Internal Medicine. The study also estimates that the radiation exposure associated with inappropriate cardiac stress testing with imaging leads each year to almost 500 future cases of cancer (Perry, 10/15). 

The Washington Post’s Wonkblog: How Family Planning Programs Save Taxpayers Billions Of Dollars Each Year
Publicly-funded family planning services help low-income Americans avoid serious health conditions while saving billions of dollars each year, according to a new analysis -- benefits that go beyond providing contraception that can prevent unintended pregnancies. Past research from the Guttmacher Institute, a research organization that supports publicly funded family programs , already found that family planning services such helped prevent an estimated 2.2 million unintended pregnancies in 2010, which would have resulted in about 1.1 million unplanned births (Millman, 10/14).

Philadelphia Inquirer: More Kids Using ERs For Medical Care, Researchers Say
More children are going to the emergency room for health care, a new California study reveals. Children's visits to the emergency room in California hospitals increased 11 percent between 2005 and 2010. At the start of the study, 2.5 million children were seen in the ER. By 2010, 2.8 million children visited the ER each year, according to the study released Oct. 14 in the Journal of the American Medical Association. Children on Medicaid made up 44 percent of the visits overall, according to the study. The proportion of Medicaid-insured patients increased over the five-year period, likely due to the economic recession (Haelle, 10/14).

NPR's SHOTS blog: Sloppy Splinting Can Make A Child's Broken Arm Much Worse
About half of all boys and a quarter of all girls will break an arm or leg before they turn 16, ... In more than 90 percent of the children and teens studied [by Dr. Josh Abzug, who directs pediatric orthopedics at the University of Maryland School of Medicine in Baltimore], the fractures weren't splinted properly by the doctors or other health workers who first treated the kids in the emergency room of a community hospital or urgent care center. ... He's alerting doctors to his findings this week at the San Diego meeting of the American Academy of Pediatrics. ... with increasing specialization within medicine, and a proliferation of urgent care centers, it's more common for the doctor, nurse or other health care worker who splints the break to instruct the parent to follow up with a call to an orthopedist (Franklin, 10/10).

Reuters: Americans Have 14M Smoking-Related Ailments, Study Finds
About 14 million major medical conditions in the U.S. can be blamed on smoking, according to a study by health officials. Using surveys, the researchers found that in 2009 roughly seven million Americans reported almost 11 million major medical conditions caused by smoking. Including ailments people don't know they have or didn't report, that number climbs to 14 million medical conditions. ... These numbers are up from the 12.7 million medical conditions estimated 10 years ago by the U.S. Centers for Disease Control and Prevention (CDC) (Doyle, 10/13). 

Viewpoints: Examining The U.S. Ebola Response, Possible Solutions, Facts Vs. Fear, And The Need For Candor

The New York Times: Keeping Ebola At Bay
The Ebola cases in the United States show that American hospitals and public health officials have much to learn about effective ways to protect health care workers and the public from possible infection. Texas Health Presbyterian Hospital, the first hospital put to the test, failed to protect two nurses, who had cared for the Ebola victim Thomas Eric Duncan, from becoming infected. Perhaps more alarming are the stumbles by the Centers for Disease Control and Prevention, the lead federal agency for fighting infectious diseases (10/16). 

The Washington Post: Bipartisan Solutions, Not Blame, Can Help In Managing Ebola
The Ebola virus reached this country at the height of the 2014 campaign, so perhaps it was inevitable that the political parties would try to exploit it. To Republicans, the situation proves once again that President Obama has failed to protect Americans. In one of the milder versions of this allegation, Louisiana Gov. Bobby Jindal published an op-ed faulting Mr. Obama for spending Centers for Disease Control and Prevention resources on grants for exercise and healthy diets rather than fighting infectious disease. Some Democrats say, meanwhile, that we wouldn’t have to worry about Ebola if not for budget cuts to the CDC and the National Institutes of Health, for which the GOP alone is to blame. As one especially inflammatory TV ad puts it: “Republican cuts kill” (10/16). 

Politico Magazine: How To Stop Ebola
Like so many of the challenges we face, ending this epidemic requires proactive leadership in the form of a comprehensive strategy and focused execution. Given the rapid spread of the virus, there’s no time to waste. Here are five simple steps that will go a long way to accomplishing that goal (Sen. Rob Portman, 10/16).

The Washington Post: Fight Fear Of Ebola With The Facts
When you work in public health, you become tuned in to fear. And the fear level in the United States just ticked up a notch. All our high-tech equipment, protective gear and disease management didn’t protect two Dallas nurses from Ebola. When government officials tell us we are safe and then caregivers get sick, what does this do to trust? (Richard E. Besser, 10/15).

The Washington Post: Nothing To Fear But Panic Itself
Richard Preston, whose 1994 book “The Hot Zone” brought the Ebola virus terrifyingly to life for readers, once described how, during his research, his biohazard suit had ripped open, exposing him to a potentially fatal toxin (David Ignatius, 10/16). 

The Wall Street Journal: Who Do They Think We Are?
The administration’s handling of the Ebola crisis continues to be marked by double talk, runaround and gobbledygook. And its logic is worse than its language. In many of its actions, especially its public pronouncements, the government is functioning not as a soother of public anxiety but the cause of it. An example this week came in the dialogue between Megyn Kelly of Fox News and Thomas Frieden, director of the Centers for Disease Control (Peggy Noonan, 10/16). 

The Washington Post: On Ebola, We Need A Dose Of Candor
Let’s make a deal: We’ll all promise not to panic about Ebola if the experts — especially those at the Centers for Disease Control and Prevention — agree to get their stories straight. They should begin by giving a better explanation of why they have concluded it would be wrong to “stop the flights” arriving from the Ebola “hot zone,” beginning with the fact that there are no such flights: There is no direct commercial air service between the countries at the epicenter of the outbreak — Liberia, Sierra Leone and Guinea — and the United States (Eugene Robinson, 10/16). 

The Washington Post: Ebola Vs. Civil Liberties
Unnervingly, the U.S. public health services remain steps behind the Ebola virus. Contact tracing is what we do, Centers for Disease Control Director Tom Frieden assured the nation. It will stop the epidemic “in its tracks.” And yet nurses Nina Pham and Amber Vinson, who developed Ebola, were not even among the 48 contacts the CDC was initially following. Nor were any of the doctors and nurses who treated the “index patient,” Thomas Duncan. No one even had a full list of caregivers (Charles Krauthammer, 10/16).

Viewpoints: Abortion And Birth Control Issues In N.C. Senate Race; Replacing Obamacare; Cancellations

The New York Times: Why North Carolina’s Senate Race Has A Wide Gender Gap
But on Wednesday in Charlotte, Kay Hagan stood without hesitation next to Janet Colm, chief executive of the Planned Parenthood Action Fund of Central North Carolina, and proudly bashed her opponent, Thom Tillis, for reducing women’s rights on abortion and birth control. … Ms. Hagan needs women to show up at the polls on Nov. 4, maybe more so than candidates in other races. She has been running even with or a few points ahead of Mr. Tillis in a swing state that is better educated and more urbanized than Louisiana, and some polls have given her an advantage of as much as 20 percentage points over Mr. Tillis among women, the biggest gender gap in any Senate race (David Firestone, 10/16). 

Politico Magazine: 4 Rules For Replacing Obamacare
The Affordable Care Act remains extremely unpopular with voters for a whole host of reasons. It has raised premiums for millions of people, forced millions more out of their insurance plans and away from the doctors that they liked and were told they could keep, and is cutting Medicare and raising taxes to pay for a massive new entitlement program. If a sizeable number of anti-Obamacare candidates win, they will rightfully believe they have a mandate from their voters to take some action (Lanhee J. Chen and James C. Capretta, 10/16).

USA Today: Obamacare Cancellations, Again: Column
Last fall, millions of Americans breathed a sigh of relief when Obamacare didn't cancel their health care plans. Now they're holding their breath once again. Hundreds of thousands of Americans will soon receive cancellation letters affecting their 2015 health care plans — and that number may quickly rise into the millions. This wave of cancellations will fall into two categories. The first group hit will be in the individual market, the same group that suffered through at least 6.3 million cancellation letters last year. They will almost certainly be joined by millions of people in the small-employer market, which has 40 million plans and will be under Obamacare's control starting next year (Tim Phillips, 10/16). 

USA Today: Web Essay: Health Reform’s Impact On Medicare
Seniors and other Medicare beneficiaries should be aware that this year – perhaps more than any year in the past – is an important one to pay attention to their Medicare coverage options during the Open Enrollment Period (Oct. 15-Dec. 7). And that’s because of the Affordable Care Act (ACA). The ACA brings with it notable changes to Medicare, from more preventive care benefits to changes in costs, and beneficiaries need to understand both the upside and downside of such changes to best evaluate their options during the Open Enrollment Period (Jennifer Cohen-Smith, 10/17). 

USA Today: Health Research Needs Boost From Bold Innovators
In 1998, I went to the doctor so fatigued I was unable to get out of bed. He sent me home diagnosed with multiple sclerosis but without so much as a treatment plan, a prescription or what I needed most: hope. Come back when it gets worse, he said, the medical equivalent of a pat on the head. In the years since, I have found other doctors and new treatments that enabled me to reclaim my life. But progress has come at an agonizing, incremental pace. The 50 million people worldwide who suffer from neurologic diseases are as frustrated as I am (Ann Romney, 10/16). 

Los Angeles Times: Why Ezekiel Emanuel Is Wrong To 'Hope' For Death At 75
Emanuel's subject is our inability to accept the inevitability of decline and death. He disavows any intention to set forth general principles either for individuals or American society: "I am not saying that those who want to live as long as possible are unethical or wrong," he writes. "I’m not even trying to convince anyone I’m right. ... And I am not advocating 75 as the official statistic of a complete, good life in order to save resources, ration health care, or address public-policy issues arising from the increases in life expectancy" (Michael Hiltzik, 10/16). 

The New England Journal of Medicine: Data Sharing, Year 1 — Access To Data from Industry-Sponsored Clinical Trials
There has been considerable interest of late in increasing the transparency of clinical trials, including increasing access to the raw data from trials sponsored by the pharmaceutical industry. Since May 2013, investigators have been able to request access to deidentified patient-level data from clinical trials sponsored by GlaxoSmithKline, subject to review and oversight by an independent review panel. As the members of this panel, we now have more than 12 months of experience with this initiative — and can report that it has been a productive and successful first step (Brian L. Strom, Marc Buyse, John Hughes, and Bartha M. Knoppers, 10/16).

The New England Journal of Medicine: Diversity Dynamics — Challenges To A Representative U.S. Medical Workforce
In an era when the proportion of the U.S. population that is nonwhite has surged to 37%, two notable trends are shaping the composition of the physician workforce: the "overwhelming majority" of medical school graduates continue to be white, and the number of black men completing medical school has been trending downward since 1997. By comparison, medical school graduates of Hispanic and Asian descent have increased in number and as a percentage of total graduates. Although the Obama administration trumpets its support for improving opportunities for minority young people — and specifically black men — it has dismayed medical educators for 3 years running by proposing elimination of the Health Careers Opportunity Program (HCOP), which aims to increase diversity in the health professions (John K. Iglehart, 10/16).

The New England Journal of Medicine: The New Diversity In Medical Education
And as we aim to translate earlier versions of diversity into something serving medicine's core missions, it's worth remembering that, as with the mother from my pediatrics rotation, I've often quickly built a rapport with a patient simply because we were both black. But all diversity, visual or not, holds value. It's not just a numbers game or an annual administrative experiment. Diversity is a process that exists outside the admissions cycle and promotional photos (Mark A. Attiah, 10/16).

The Wall Street Journal: Philadelphia School Failure
Last week the Philadelphia School Reform Commission mandated that teachers chip in between 5% to 13% toward health-care premiums on a sliding scale based on salary. Teachers will pay each month an average of $49 for single coverage and $139 for a family. Government workers on average cover 15% of their premiums while private workers pay about 25%. The teachers union calls this “union-busting.” Yet the commission, which runs the Philly schools and includes three Democrats and two Republicans, unanimously backed the cost-sharing as a last resort when unions failed to negotiate a new contract (10/16).