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From Kaiser Health News:

Kaiser Health News Original Stories

3. Political Cartoon: 'Faster, Higher, Stronger'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Faster, Higher, Stronger'" by Signe Wilkinson, Philadelphia Daily News.

Here's today's health policy haiku:


Vets given a choice,
But it's not working. Wait times
Only getting worse.

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Summaries Of The News:

Health Law Issues And Implementation

4. Insurers' Losses Nearly Double In Second Year Of Health Law, Due Largely To Medical Costs

However, McKinsey & Co.'s analysis suggests that the health law’s subsidies should prevent a “death spiral,” in which an insurance market gets caught in a cycle of increasing rates and shrinking customer pools. Meanwhile, as some insurers pull out of the federal exchanges, rural areas are sometimes left with just one option.

The Wall Street Journal: Insurers’ Losses Deepened On ACA Plans In 2015
Many insurers have lost money on the Affordable Care Act plans they sell to consumers. A new analysis shows how much those losses deepened in 2015, the second year of the law’s signature exchanges. Based on insurers’ filings with state regulators, McKinsey & Co. estimates the health-insurance industry’s cumulative margin on individual plans last year was between -9% and -11%. That is roughly double the -4.8% margin the consulting firm calculated for 2014. For 2015, only about a quarter of insurers reported that they made a profit on their individual plans. (Wilde Mathews, 5/15)

The Wall Street Journal: Insurance Options Dwindle In Some Rural Regions
Health-insurance customers in a growing number of mostly rural regions will have just one insurer’s plans to choose from on the Affordable Care Act’s exchanges next year, as some companies pull out of unprofitable markets. The entire states of Alaska and Alabama are expected to have only one insurer on the health law’s signature online marketplaces next year, according to state regulators. The same is expected to be true in parts of several other states, including Kentucky, Tennessee, Mississippi, Arizona and Oklahoma, state regulators said. (Wilde Mathews and Armour, 5/15)

The Baltimore Sun: Health Insurers Seek Rate Increases In Maryland As United Healthcare Quits Market
The unanticipated costs of providing health care to customers on the state's online exchange has prompted large insurers to seek rate increases of up to 30 percent while one insurer decided not to offer individual plans at all. United Healthcare, the nation's largest insurer but a bit player in Maryland, was not included on a list released Friday by state regulators of companies seeking rate increases for 2017. Insurance Commissioner Al Redmer confirmed that the company was leaving the exchange created under the Affordable Care Act, as it has in most states across the country. It will continue to offer plans in the small-business market. (McDaniels and Cohn, 5/13)

5. HHS Extends Anti-Bias Health Care Protections To Cover Gender Identity

Under the new guidance, insurers and hospitals cannot deny services based on someone's gender identity. Some advocates are disappointed, however, that the rule does not go far enough.

The Washington Post: Obama Administration: Insurers Must Provide Services Regardless Of Gender Identity
The Obama administration unveiled two broad initiatives Friday aimed at combating discrimination against transgender Americans in schools and health-care coverage, affirming the president’s goal of elevating transgender protections to one of the central civil rights issues of his presidency. The moves, both of which had been in the works for years, prompted an immediate backlash from conservatives who disparaged the measures as government overreach. White House officials countered that they reflected one of the administration’s core principles: protecting those targeted for discrimination because of their identity. (Eilperin, 5/13)

USA Today: Feds: Insurers Can't Discriminate On LGBT Obamacare Coverage
Insurers and hospitals can't discriminate against patients because of their gender identity under the Affordable Care Act, federal officials said Friday, but patient groups complained the rule doesn't go far enough. The Department of Health and Human Services finalized a rule that prohibited discrimination in health care based on a long list of characteristics ranging from race to pregnancy, gender identity and "sex stereotyping." It doesn't mean insurers have to cover all treatments associated with gender transitioning but they just can't outright deny them either. But the rule doesn't go far enough in clarifying what is discrimination, some say. (O'Donnell, 5/13)

The Wall Street Journal: Obama Administration Extends Antibias Protections to Transgender People Seeking Health Care
Health officials included the transgender discrimination ban in a rule implementing an Affordable Care Act provision barring health providers from discriminating by sex or race. The rule includes broad protections for transgender people, like requiring insurers to cover treatments for transgender people that they would cover for other enrollees, and allowing people to use facilities that match their gender identity. The move on health care stopped short of granting such protections to gay, lesbian and bisexual people, showing the complexity of what constitutes illegal sex discrimination. Administration officials were considering whether they could include sexual orientation in the bias rule. Health and Human Services officials said that while they had wanted to set such protections for gay people, they were uncertain about whether they could. (Barrett and Radnofsky, 5/13)

Modern Healthcare: HHS Finalizes Transgender Anti-Discrimination Rule
HHS could find itself facing pushback from religious hospitals seeking exemption from some of the rule's provisions, including transition-related surgeries. Others might find it difficult to comply because of costs and complications. The rule is expected to be more costly than anticipated, requiring an estimated $960 million in training and administrative costs for state and federal agencies over its first few years of implementation, the agency said. That's up from the $558 million outlined in the proposed rule. (Dickson, 5/13)


6. Sticker Shock: About One In Three Who Visit Hospital Hit With Surprise Medical Bills

As insurers and hospitals point fingers at each other, it's the patient who ends up paying thousands unexpectedly. In other news, ER doctors weigh in on costs in a survey.

NBC News: Hefty Surprise Medical Bills Can Be A Burden For Families
According to Consumer Reports, nearly one third of Americans who have visited a hospital in the last year have received a surprise medical bill. In Texas, more than 20 percent of hospitals considered in-network by the top 3 insurers had no in-network emergency room doctors on staff. (Sterns and Capetta, 5/13)


7. Many People Still Unwillingly Confined To Nursing Homes Despite Landmark Court Decision

A Supreme Court ruling nearly 20 years ago said disabled people requiring public support were entitled to live in their community, rather than in institutions, but for many people that option is not yet a reality. In other Medicaid news, Kansas advocates are questioning plans to force enrollees to try cheaper drugs first.

The New York Times: Confined To Nursing Homes, But Longing (And Ready) For Home
Marvin L. Dawkins was a 53-year-old AT&T manager when a blocked blood vessel left him paralyzed. It took 11 years, one lawsuit, repeated tangles over Medicaid rules — and a chance meeting on a church van — before he could extract himself from a nursing home outside Baltimore. ... Across the nation, many other Americans who could live elsewhere with help are unwillingly confined to nursing homes or long-term care facilities. Nearly 20 years after the Supreme Court ruled that disabled people requiring public support were entitled to live in their community, rather than in institutions unless medically necessary, the federal government and states are still far from achieving that goal. (Thomas, Fink and Smith, 5/13)

The Associated Press: Mental Health Advocates Question Drug Bill
Mental health advocates are raising concerns about a bill passed by Kansas lawmakers that would require doctors to try cheaper drugs before more expensive ones for Medicaid recipients, but the bill's backers say the concerns are overblown. The process, called step therapy, is common in many private and public health insurance plans. It was key to resolving budget issues because it would reduce the state's cost of providing health care for poor residents by nearly $11 million a year. Gov. Sam Brownback is expected to sign the bill Monday. (Hellmann, 5/15)

And a surprising turn on the issue of Medicaid expansion—

The Associated Press: In Surprising Turnabout, Oklahoma Eyes Medicaid Expansion
Despite bitter resistance in Oklahoma for years to President Barack Obama's health care overhaul, Republican leaders in this conservative state are now confronting something that alarms them even more: a huge $1.3 billion hole in the budget that threatens to do widespread damage to the state's health care system. So, in what would be the grandest about-face among rightward leaning states, Oklahoma is now moving toward a plan to expand its Medicaid program to bring in billions of federal dollars from President Obama's new health care system. (Murphy, 5/16)

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