Kaiser Health News Original Stories

1. Former Medicare Chief Named Top Health Insurance Lobbyist

Marilyn Tavenner, a former head of the Centers for Medicare and Medicaid Services, will lead America's Health Insurance Plans, becoming the most prominent insurance industry lobbyist in the nation. (Jordan Shapiro, The St. Louis Post-Dispatch, 7/15)

Administration News

3. Tavnenner Moves Through Revolving Door, Accepts Top Lobbying Spot At Health Insurance Trade Group

Marilyn Tavenner, who stepped down from her position of administrator of the Centers for Medicare & Medicaid Services in February, was named president and CEO of America's Health Insurance Plans.

The New York Times: Head Of Obama’s Health Care Rollout To Lobby For Insurers
Marilyn B. Tavenner, the former Obama administration official in charge of the rollout of HealthCare.gov, was chosen on Wednesday to be the top lobbyist for the nation’s health insurance industry. Ms. Tavenner, who stepped down from her federal job in February, will become president and chief executive of America’s Health Insurance Plans, the trade group whose members include Aetna, Anthem, Humana, Kaiser Permanente and many Blue Cross and Blue Shield companies. (Pear, 7/16)

The Wall Street Journal: Health Insurance Trade Group Names New CEO
The latest turn of the revolving door between government and health industry comes as government business is exerting a bigger effect on insurers’ bottom lines. Under federal rules designed to minimize the opportunities for officials to pass freely between government and the private sector, Ms. Tavenner will be barred from lobbying her former colleagues for the remaining months of the Obama administration, but she isn’t subject to a similar restriction on lobbying Congress. (Radnofsky and Wilde Mathews, 7/15)

The Washington Post: Former CMS Chief To Become Top Lobbyist For Health Plans
She stepped down from CMS in February 2015. A former hospital executive and Virginia health secretary, Tavenner will replace Karen Ignagni, a highly respected insurance lobbyist with more than two decades of experience at AHIP. Ignagni resigned to become the CEO of insurance company EmblemHealth in May. The change in AHIP’s leadership is a significant moment in the group’s history as insurers adjust to the health care environment created by Obamacare and seek to protect reimbursement rates for Medicare Advantage, a popular alternative to traditional Medicare. (Viebeck, 7/15)

Politico: Former Medicare Chief To Head Health Insurance Lobby AHIP
But AHIP’s decision to hire a former Obama administration official as its next leader also signals that health insurers are committed to the health reform law. ... Tavenner, who was the first Senate-confirmed CMS administrator in almost a decade, is well-regarded by Republicans and Democrats on Capitol Hill. ... After UnitedHealth Group’s exit from AHIP there are questions about fissures. Representing the interests of both nonprofit carriers and the big national for-profit players has become increasingly challenging as insurers seek their footing in the overhauled insurance landscape. (Palmer and Demko, 7/15)

The St. Louis Post-Dispatch: Former Medicare Chief Named Top Health Insurance Lobbyist
Marilyn Tavenner will lead the trade group following the departure of former CEO Karen Ignagni earlier this year. Tavenner formerly lead the Centers for Medicare and Medicaid Services and oversaw the implementation of President Barack Obama's health law. ... It's a turbulent time for health insurers. The largest companies are consolidating and firms are still struggling with the roll out of the federal health law. Already, Aetna and Humana have announced a merger, Clayton-based Centene Corp. is in the process of acquiring Health Net Inc., and Anthem is pursuing a deal with Cigna. (Shapiro, 7/15)

Health Law Issues And Implementation

4. As Medicaid Turns 50, Debate On Expansion Clouds Celebration

Alaska's governor is expected to announce a plan for expansion there Thursday as other states are still locked up in controversy over the choice.

USA Today: Medicaid Turns 50 Mired In Controversy
Tennessee farmer Timmy Parks lives without a prosthetic for his amputated arm and endures chest pain so excruciating he sometimes doesn't want to eat — all because he has no insurance and no way to pay for health care. Yet if he lived less than five miles away, in Kentucky, he'd qualify for Medicaid, the government program designed to help the poor. As Medicaid turns 50 years old this month, it's racked with cost over-runs, bitter politics and never-ending controversies that have left millions of people around the country like Parks without health care coverage they desperately need, unable to afford everything from open heart surgery to prescriptions to prevent life-threatening seizures. (O'Donnell and Ungar, 7/15)

Reuters: Alaska Governor Pushes To Expand Medicaid Program For The Poor
Alaska Governor Bill Walker is set to announce on Thursday plans to expand the Medicaid health program for the poor, which would bring coverage to more than 40,000 uninsured residents. Walker, an independent, has already had several expansion efforts blocked by the Republican-led state legislature since he took office after winning the November 2014 election. The governor's office said Walker would lay out details of the plan on Thursday. (Quinn, 7/15)

Alaska Dispatch News: Supreme Court Ruling May Pave Way For Walker To Act On Medicaid Expansion
Gov. Walker has scheduled an announcement for Thursday on his plans for Medicaid expansion. His options could include another special session on the topic, possibly in the fall, or taking unilateral action without legislative support. Walker's press secretary Katie Marquette said it is “in our interest to ensure more Alaskans have access to health care -- expanding Medicaid is the obvious next step.” ... At the end of the regular session, the then-pending Supreme Court case, King v. Burwell, was cited as a factor against expansion by opponents such as Rep. Steve Thompson, R-Fairbanks. ... House Rules Committee Chair Craig Johnson, R-Anchorage, made similar comments at the end of the regular session, calling expansion “a billion-dollar gamble” and said no action should be taken with the issue in flux. (Forgey, 7/15)

Arkansas News: Hutchinson: State ‘Doing The Right Thing’ With Medicaid Check
Arkansas is “doing the right thing” in checking the eligibility of enrollees in Medicaid and the Medicaid expansion known as the private option and terminating coverage for thousands who do not qualify, Gov. Asa Hutchinson said Wednesday. Hutchinson told legislators in a letter Monday that within the next three months the state will have verified the eligibility of nearly 600,000 Medicaid recipients. More than 15,000 people, most of them enrollees in the private option, already have had their coverage terminated because their income levels were found to be too high for eligibility — and they did not show they were eligible within 10 days of receiving notice. (Lyon, 7/15)

Arkansas Online: Task Force Studies Ways To Trim Medicaid Costs
Striking more deals with drug companies, joining forces with the health plan for teachers and state employees, and hiring a managed care company to handle prescription drug benefits were among the options for reducing the state Medicaid program's drug costs that a legislative task force explored Wednesday. The Health Reform Legislative Task Force is examining Medicaid spending on drugs, as well as medical services, as it crafts recommendations for improving the program. Among the changes the task force is expected to recommend is a replacement program for the state's private option, which uses federal Medicaid funds to buy private insurance for more than 218,000 low-income Arkansans. (Davis, 7/15)

Salt Lake Tribune: While Medicaid Debate Drags On, Utahns Are Dying
Legislative leaders are working on an agreement to expand Medicaid coverage to tens of thousands of uninsured, low-income Utahns, but even if a deal is struck, it will be far too late for Carol Frisby. Frisby died Monday from cancer, years after she first showed symptoms but couldn't get the colonoscopy her doctor recommended because the screening wasn't covered by the state's Primary Care Network. "I'm not going to back down, and she's never been one to back down," said Carol's husband, Brent Frisby, a Vietnam War veteran. "My message to them is: Get off this childish stuff, and let's be pioneers and do something to help people." (Gehrke and Moulton, 7/15)

5. Phony Applicants Approved For Subsidies And Allowed To Re-Enroll On Healthcare.gov

A congressional watchdog filed fictitious applications last year, 11 of which were enrolled for Obamacare despite fake documents or missing information. The report raises concerns about the federal health exchange's ability to detect fraud.

The Wall Street Journal: Federal Health Exchange Approved Fake Claims
The federal exchange set up under the Affordable Care Act allowed fictitious applicants to maintain coverage and re-enroll this year, according to a report by a congressional watchdog group that raises questions about the marketplace’s ability to detect fraud. The exchange, HealthCare.gov, last year approved 11 fictitious applications submitted in an undercover operation by the Government Accountability Office, according to the report released Wednesday by the agency. (Armour, 7/15)

The Associated Press: Probe: Bogus Enrollees Kept Getting 'Obamacare'
Phony applicants that investigators signed up last year under President Barack Obama's health care law got automatically re-enrolled for 2015. Some were rewarded with even bigger taxpayer subsidies for their insurance premiums, a congressional probe has found. The nonpartisan Government Accountability Office says 11 counterfeit characters that its investigators created last year were automatically re-enrolled by HealthCare.gov, even though most had unresolved documentation issues. In Obama's terms, they got to keep the coverage they had. (Alonso-Zaldivar, 7/15)

CNN Money: Fake Enrollees Keep Getting Obamacare Subsidies
The federal Obamacare exchange, known as Healthcare.gov, did not catch 11 fictitious policyholders who were enrolled last year as part of an undercover investigation by the Government Accountability Office. The watchdog agency last summer announced that it had created 12 fake identities and 11 were able to sign up for coverage, qualifying for a total of $2,500 a month in subsidies. An update to the probe found that all 11 enrollees had their coverage automatically extended for 2015. Republican lawmakers released the new information Wednesday ahead of a Congressional hearing on Obamacare controls. (Luhby, 7/15)

6. Choice Of Doctors And Hospitals More Limited In Health Law Plans, Study Says

Analysis by consulting firm Avalere Health finds that the "narrow networks" available under the federal and state exchange plans offer 34 percent fewer medical providers than average.

The Washington Post: Report: ACA Plans Have A Third Fewer Providers Than Employer-Based Plans
Consumers who bought insurance on the health exchanges last year had access to one-third fewer doctors and hospitals, on average, than people with traditional employer-provided coverage, according to an analysis released Wednesday. The study by consulting firm Avalere Health provides a statistical basis for anecdotal reports from consumers and others about the more limited doctor and hospital choices in plans offered on marketplaces created by the Affordable Care Act. (Sun, 7/15)

The Hill: Fewer Choices Of Doctors Under ObamaCare, Study Finds
ObamaCare plans on average offer a choice of 34 percent fewer healthcare providers in the insurance plans' network, a new analysis finds. The study from the consulting firm Avalere Health says that overall figure includes an average of 42 percent fewer cancer and heart doctors to choose from. In addition, there are 24 percent fewer hospitals to choose from and 32 percent fewer primary care doctors. (Sullivan, 7/15)