Kaiser Health News Original Stories

1. Political Cartoon: 'Call Off The Dogs'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Call Off The Dogs'" by Hilary Price.

Here's today's health policy haiku:


Got a Cadillac?
If it’s a health plan, it comes
loaded with taxes.

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Health Law Issues And Implementation

2. 'Cadillac Tax' On Generous Health Plans Expected To Hit A Quarter Of Employers, Report Finds

The tax, set up under the health law, takes effect in 2018, and employers will have to pay 40 percent of the cost of the plan that exceeds government thresholds.

The Wall Street Journal: More Than A Quarter Of Employers Expected To Face ‘Cadillac Tax’
One in four companies are likely to be impacted by the “Cadillac tax” on high-cost health plans when it begins in 2018–and that could almost double in ten years, according to an analysis by the Kaiser Family Foundation. Under the Affordable Care Act, companies are subject to an excise tax on high-cost health plans, starting in 2018, also known as the “Cadillac tax.” Employers will have to pay a levy of 40% a year on the amount by which the cost of employee plans exceed government thresholds, which are $10,200 for individuals and $27,500 for families in the first year. (Chasen, 8/25)

The Washington Post's Wonkblog: 26% Of Employers Could Face The ‘Cadillac Tax’ On Health Insurance
"The 'Cadillac tax' will have a very powerful effect on health care costs, and that certainly a good thing. But the way the tax helps to keep health costs down is primarily by shifting it to workers," said Larry Levitt, a senior vice president at the Kaiser Family Foundation who did the analysis. "While it certainly sounds good to control heath care costs, the way it is likely to happen won’t feel very good to consumers." The opposition to the tax comes from a motley collection of unlikely allies, beyond the usual cast of anti-tax Republicans. (Johnson, 8/25)

NBC News: Obamacare 'Cadillac Tax' Will Lead Employers To Cut FSAs: Analysis
If you like your flexible spending account ... you might not be able to keep your flexible spending account. Obamacare's looming "Cadillac tax" on high-cost health plans threatens to hit one in four U.S. employers when it takes effect in 2018 — and will impact 42 percent of all employers by a decade later, according to a new analysis. And many of those employers will be subject to the heavy Obamacare tax because they offer popular health-care flexible spending accounts to workers, which, ironically, are designed to reduce the income tax burden to those employees. (Mangan, 8/25)

CQ Healthbeat: Health Law Tax Could Hit One In Four Employers In 2018, Study Shows
One in four employers offering health benefits could be subject to the 2010 health care law's tax on high-cost plans, with the share of those potentially affected growing to 42 percent by 2028, unless the companies revise their benefits, according to new projections from the Kaiser Family Foundation. The so-called Cadillac Tax is set to take effect in 2018 and funds coverage expansions under the law. It taxes plans at 40 percent of each worker's health benefits exceeding certain coverage thresholds -- $10,200 for self-only coverage and $27,500 for family coverage in the first year. (8/25)

3. Calif., Ga. Insurance Exchanges Marked By Narrow Networks

According to a report by University of Pennsylvania researchers, Florida and Oklahoma also topped the list of states that had a high percentage of small Obamacare provider networks.

Los Angeles Times: 75% Of Obamacare Plans In California Use Narrow Networks, Study Shows
A new study finds that 75% of California's Obamacare health plans have narrow physician networks -- more limited choices than all but three other states. The latest report examines health plans sold to consumers last year under the Affordable Care Act and shows wide variation in the prevalence of narrow networks across the country. Only Georgia, Florida and Oklahoma had a higher percentage of small provider networks than California did in the insurance company directories analyzed by University of Pennsylvania researchers. (Terhune, 8/25)

Georgia Health News: 'Narrow' Networks Are The Exchange Norm Here
Georgia had the highest percentage of “narrow’’ insurance networks in the 2014 health exchanges, a new report says. Five of six Georgia “Silver” exchange plans last year had medical provider networks with a limited choice of doctors, the report said. (Miller, 8/25)

And in Connecticut, efforts to help people understand how to use their new coverage -

The Connecticut Mirror: Insurer Coaches The Newly Covered Through The Health System
Surveys of people who gained insurance under the federal health law indicate that close to 90 percent want more information on how to use their coverage, said Sophie Stern, deputy director of the Best Practices Institute at Enroll America, a group focused on ensuring that people get and stay covered. ... The insurers selling plans through Connecticut’s exchange, Access Health CT, are using a variety of techniques to help customers new to insurance and to encourage new members to see a primary care provider. A survey of exchange customers earlier this year indicated that 28 percent did not have a primary care doctor, and 36 percent hadn’t yet used their coverage. (Levin Becker, 8/26)

Capitol Hill Watch

4. CBO Reports Smaller Deficits That Stretch Time Before Default But Warns Lawmakers Not To Delay Budget

The new projections may give congressional leaders more runway to work out a spending deal before the government hits the borrowing limit, now estimated to be in mid-November.

The Washington Post: Congress May Have Until December To Deal With Debt Ceiling
Congressional leaders may have more time to work out a deal this fall to increase the federal borrowing limit, after new projections from Congress’ scorekeeper showed tax revenues have been greater than expected this year. ... Republican leaders in both the House and the Senate are vowing to avoid a government shutdown or debt default in the coming months, but conservatives in both chambers have threatened to use the upcoming fiscal fights to advance unrelated political issues such as defunding Planned Parenthood. The later debt limit deadline may give leaders more time to try to bring conservatives on board, but aides from both parties said that formal discussions have not begun. ... The budget office on Tuesday also sounded its usual alarm that the government’s long-term budget path remains unsustainable due to the growing cost of entitlement programs, such as Medicare and Social Security. (Snell, 8/25)

The Associated Press: Budget Report Shows Shrinking Deficits But Warns Lawmakers To Act
An unforeseen flood of revenue is shrinking federal deficits to the lowest level of President Barack Obama's tenure, Congress' nonpartisan budget adviser said Tuesday. But in a report that will fuel both parties in their autumn clash over spending, the analysts also warned that perilously high shortfalls will roar back unless lawmakers act. ... Republicans said the report underscored the need to curb spending. Congress has already approved a blueprint claiming a balanced budget in a decade by squeezing savings from Medicare and Medicaid, and they want to retain caps on agency spending enacted in a 2011 budget deal. ... One major complication is conservatives' demands to halt federal spending on Planned Parenthood, whose officials were secretly captured in videos describing how they provide medical researchers with fetal tissue. Blocking that money would lead to likely clashes with Democrats and Obama. (8/25)


5. Medicare ACO Program Saves $120M For Three Massachusetts Health Systems

Nationwide, accountable care organizations saved the senior health care program $304 million in three years, federal officials say. In other Medicare news, a proposed coverage change could limit access to prosthetic limbs for amputees.

The Boston Globe: Federal Push To Cut Medicare Costs Saves $120M In Mass. Over 3 Years
A federal program to reduce the cost of providing care to seniors produced sizable savings in Massachusetts over the past three years, adding momentum to efforts to change the way doctors and hospitals are paid for providing health care. New figures show three of Massachusetts’ biggest health systems saved a combined $120 million during that period as part of the program, which aims to rein in costs by better coordinating care for Medicare patients and cutting unnecessary hospital stays and medical services. Doctors manage care for these patients in pools known as Pioneer accountable care organizations. (Dayal McCluskey, 8/25)

Roanoke Times: Proposed Medicare Change Would Limit Access To Prosthetics
[Edd Sewell] wears a high-tech leg with microprocessors in the knee that allow him full rotation and a speed that syncs up with whatever pace his natural leg allows. Quite an improvement over the prosthetics he wore after losing his leg to a congenital deformity in 1957. Those devices carried him at one wobbly speed, causing him to fall if his body’s pace differed from that of the artificial limb. ... Now the government proposes to put him back in the same rudimentary leg he wore in the 1970s. Manufacturers don’t even make those types of components anymore, said Doug Call, president of Virginia Prosthetics and Orthotics, a 49-year-old Roanoke-based company with 16 locations in Virginia and North Carolina. (Luanne Rife, 8/25)

Columbus Dispatch: Proposed Medicare Change Could Affect Amputees
Amputees enrolled in Medicare might see delays in obtaining new prosthetic lower limbs, as well as limits placed on higher-tech prostheses. Those changes, part of a proposed federal rule, would be a significant step backward for those who have lost limbs, advocates warn. ... Advocates said they’re especially concerned that, under the proposed rule, Medicare would no longer consider an amputee’s potential for enhanced mobility and function in deciding whether to cover prosthetics. The rule also would limit Medicare enrollees’ access to higher-quality prosthetics if records indicate that Medicare had paid for any other mobility aid, such as a cane or walker. And it would deny coverage of multiple-suction suspension systems, saying that’s unnecessary. Those systems help hold the prosthetic in place.(Sutherly, 8/25)

In Medicaid news, health care experts urge the Obama administration to expand access to new, expensive hepatitis C drugs -

The New York Times: White House Is Pressed To Help Widen Access To Hepatitis C Drugs Via Medicaid
Federal and state Medicaid officials should widen access to prescription drugs that could cure tens of thousands of people with hepatitis C, including medications that can cost up to $1,000 a pill, health care experts have told the White House. The experts, from the Public Health Service and President Obama’s Advisory Council on H.I.V./AIDS, said restrictions on the drugs imposed by many states were inconsistent with sound medical practice, as reflected in treatment guidelines issued by health care professionals and the Department of Veterans Affairs. (Pear, 8/25)

Veterans' Health Care

6. Vets' Mental Health Needs Still Not Met Due To Staffing Set Up, Study Says

Despite a recent hiring push, the Department of Veterans Affairs doesn't have enough full-time psychiatrists, and staff resources aren’t being used efficiently, an Inspector General report finds. In Alaska, frustrated veterans testified before state lawmakers, saying that recent VA reforms have not improved care in the state.

The Wall Street Journal: Report: VA Falls Short On Mental-Health Care Despite Hiring Push
The Department of Veterans Affairs lacks enough full-time psychiatrists to meet demand for services and those on staff aren’t being used efficiently, despite a multiyear, multibillion-dollar effort, says a report from the department’s internal watchdog. The VA hasn’t been “fully effective” in hiring psychiatrists or in using those it has, the VA’s Office of Inspector General reported Tuesday, adding that the department has focused on meeting overall hiring goals rather than on hiring personnel to fill gaps at specific facilities. (Kesling, 8/25)

The Associated Press: Vets In Alaska: Reformed VA Hurting, Not Helping
A 2014 law to reform the Veterans Affairs health care system has only made things worse in Alaska, according to veterans testifying Monday at a congressional listening session in Fairbanks. A group of about two dozen veterans at the Fairbanks North Star Borough Assembly chambers told Dr. David Shulkin, the third-in-command at the VA, that the Veterans Choice Act hasn't delivered the improved care that it promised. (8/25)