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Backlash over networks? - Health Care Edge: Brought to you by America's Biopharmaceutical Companies

Backlash Over Networks? 

By Sam Baker, Sophie Novack and Clara Ritger

 

UNINSURED OK WITH NARROW NETWORKS: The target market for Obamacare is more comfortable with narrow provider networks than the public at large, according to the latest Kaiser Family Foundation tracking poll. Among the uninsured and people in the individual market, 54 percent said they would rather have a plan with low premiums than with access to a broad network of doctors and hospitals. The findings were reversed for the overall public, which makes sense: If you have a doctor, you probably don't want to lose him or her. But if you're uninsured, you don't have a doctor to lose, and coverage you can afford is a higher priority.

Top Health Care News

NARROW NETWORKS: "The administration is in a tough spot on network size. Republicans have laid the whole issue at Obamacare's feet, even though it's a market dynamic that Obamacare really didn't cause: It's a business decision between price and quality that existed long before the law was created." (Sam Baker, National Journal)

  • Kaiser Health tracking poll: 51 percent overall prefer higher cost plan with broader range of doctors and hospitals; 37 percent prefer lower cost with more limited range. Of those uninsured or currently purchasing their own coverage, 54 percent favor lower cost and narrower network of providers; 35 percent favor more expensive with broader range.

     

OBAMACARE ENROLLMENT HITS 4 MILLION: With five weeks to go in the open enrollment period, HHS announced private plan enrollment is growing closer to the Congressional Budget Office's revised target of 6 million. (Sam Stein, Huffington Post)

Congress

FLORIDA RACE AN EARLY TEST FOR OBAMACARE'S IMPACT ON 2014 ELECTIONS: The race to fill the late Republican Bill Young's House seat is a test case for the effectiveness of Obamacare-related campaign ads. (John Whitesides, Reuters)

VETERANS HEALTH BILL ADVANCES IN SENATE: "By a vote of 99-0, the Senate laid the groundwork for debating a bill that would create 27 new medical facilities in 18 states and Puerto Rico to help meet the growing needs of veterans of the long combat operations in Iraq and Afghanistan." (Richard Cowan, Reuters)

DEBBIE DINGELL TO RUN FOR HOUSE SEAT BEING VACATED BY JOHN DINGELL: The retiring congressman's wife is an experienced Democratic strategist who currently serves as the Wayne State University Board of Governors. (Paul Kane and Sean Sullivan, Washington Post)

 

DOCUMENTS SHOW SECURITY CONCERNS AROUND STATE COMPUTER SYSTEMS AT OCTOBER ACA LAUNCH: "More than two-thirds of state systems that were supposed to tap into federal computers to verify sensitive personal information for coverage were initially rated as "high risk" for security problems." (Ricardo Alonso-Zaldivar, Associated Press)

GOP

HOUSE GOP LEADERS TO MEET FRIDAY ON OBAMACARE ALTERNATIVE: Majority Leader Eric Cantor will meet with committee heads including Budget Committee Chairman Paul Ryan, Education and the Workforce Chairman John Kline, Ways and Means Chairman Dave Camp, and Energy and Commerce Chairman Fred Upton, to begin crafting a Republican replacement to the health care law. At a policy retreat last month, Cantor pledged a vote to repeal and replace Obamacare this year. (Daniel Newhauser, CQ Roll Call)

CBO REPORT: REPUBLICAN ACA BILL WOULD INCREASE UNINSURED, RAISE DEFICIT: A new Congressional Budget Office report finds that the Save American Workers Act--a Republican bill to change Obamacare's definition of full-time employment from 30 to 40 hours a week--would reduce the number of people receiving employer-based coverage by about 1 million; increase the number on Medicaid, CHIP, or insurance exchanges by between 500,000 and 1 million; and increase the number of uninsured by up to 500,000. As a result, CBO estimates the bill would increase the deficit by $73.7 billion over the next decade.

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Medicare

THE MYSTERY ABOUT OBAMA'S MEDICARE CUTS: Four days after the proposed 2015 payments were unveiled, no one really knows how much of a cut insurers are facing. (Clara Ritger, National Journal)

POLL: SENIORS SATISFIED WITH MEDICARE, OPPOSE CUTS: Amid debate over proposed cuts to Medicare programs, a new Morning Consult poll finds that half of seniors say the Affordable Care Act will make Medicare worse, 20 percent say the law will make Medicare better, and a quarter say it will have no effect.

Medicaid

COULD MEDICAID EXPANSION BECOME AN IMMIGRATION ISSUE? Pro-expansion lawmakers in Florida plan to argue that opting out of the provision favors immigrants over U.S. residents. The ACA allows some legal low-income immigrants to receive federal subsidies to help pay their insurance premiums, while poor U.S. citizens cannot since they were originally supposed to receive coverage through Medicaid expansion, which Florida has rejected. (Julie Appleby and Patricia Borns, Kaiser Health News/The Miami Herald)

FIFTH ARKANSAS HOUSE VOTE ON PRIVATE OPTION DELAYED: Republican House Speaker Davy Carter said Tuesday that some of the opponents that originally agreed to the private option with Rep. Nathan Bell's amendments had not negotiated in good faith, and their change in mind was leading to the current standstill. (David Ramsey, Arkansas Times)

  • The House will continue to make a "gametime" decision each day on whether to vote on the funding bill, depending on whether they have reached the needed 75 vote threshold.

  • Carter said the House would try to finish its session by March 6, but left some flexibility. If the House does not pass spending legislation for the Department of Human Services by the end of the legislative period, the governor may have to call a special session.

  • Ending the private option would take coverage away from the 100,000 Arkansans who have already enrolled in the program, whether opponents like to admit that or not.

Spending and Savings

REPORT: RECORD RECOVERIES IN HEALTH CARE FRAUD INVESTIGATIONS: The new Health Care Fraud and Abuse Control annual report released by the Department of Justice and the Department of Health and Human Services found that over the last three years, the government recovered $8.10 for every dollar spent on health care fraud and abuse investigations. The report says that HCFAC efforts have recovered a record $4.3 billion in fiscal year 2013, and $19.2 billion over the last four years. (Jonathan Easley, The Hill)

THE HEALTH CARE PARADOX IS ABOUT INEQUITIES: The U.S. has the most expensive health care system in the world, but some of the worst outcomes. A new book argues that investing in social services in areas like education, transportation, and housing could lower health care spending better than flooding dollars into the system to treat consequences after the fact. (Margot Sanger-Katz, National Journal)

Providers

TENET EXPECTS 15 PERCENT OF ITS UNINSURED TO GET ACA COVERAGE: The third largest for-profit hospital operator is not yet counting on higher profits as a result of the shift, company officials said after a call with Wall Street analysts on its fourth quarter earnings and 2014 outlook report. (Phil Galewitz, Kaiser Health News)

NEW ACA INSURANCE CAUSES HEADACHES IN SOME DOCTOR'S OFFICES: Practices have to call the insurer to verify that a patient has paid his or her premium, and sometimes it takes hours just to get through. (Jenny A. Gold, Kaiser Health News)

Wellness and Illness

OBESITY RATE DROPS 43 PERCENT AMONG CHILDREN AGES 2 TO 5 IN LAST DECADE: "The trend came as a welcome surprise to researchers. New evidence has shown that obesity takes hold young: Children who are overweight or obese between age 3 and 5 are five times as likely to be overweight or obese as adults." (Sabrina Tavernise, New York Times)

ADMINISTRATION PROPOSES SCHOOL WELLNESS GUIDELINES: The new rule would curb marketing of junk food to kids at school. (Maria Godoy, National Public Radio)

FDA CONSIDERS FERTILITY PROCEDURE TO CREATE BABY FREE OF CERTAIN GENETIC DEFECTS: The method involves combining genetic material from three people to avoid some defects, which critics say could lead to the creation of designer babies. The FDA's meeting Tuesday and Wednesday is intended to address the scientific feasibility and safety of the procedure in humans, but its use raises ethical concerns as well. (Sabrina Tavernise, New York Times)

RARE POLIO-LIKE ILLNESS MAY HAVE AFFECTED 25 CHILDREN IN CALIFORNIA: "Doctors are still not sure what caused this illness; some of the children involved have been found to have enterovirus 68, a rare virus associated with respiratory illness." (Mark Berman, Washington Post)

Happening Today

PROVIDING ACCESS TO AFFORDABLE, FLEXIBLE HEALTH PLANS THROUGH SELF-INSURANCE: The House Education and Workforce Subcommittee on Health, Employment, Labor and Pensions meets at 10:00 a.m. in 2175 Rayburn.

SURGEON GENERAL NOMINATION TO BE DISCUSSED: The Senate HELP committee is holding an executive session in 430 Dirksen at 10:00 a.m. to consider, among other nominations, Vivek Murthy for Surgeon General.

THE EFFECT OF PROPOSED MEDICARE PART D CHANGES ON SENIORS: The House Energy and Commerce Subcommittee on Health gathers in 2123 Rayburn at 10:00 a.m. to evaluate whether CMS's proposed changes will increase costs and reduces choices for Medicare beneficiaries.

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