Kaiser Health News Original Stories

1. Are Medicare ACOs Working? Experts Disagree

Federal officials reported recently that in 2014 the accountable care organizations saved $411 million, but after the program paid bonuses to the successful groups, Medicare recorded a net loss of $2.6 million. So KHN asked a panel of experts to offer their views about the program. (10/21)

2. Political Cartoon: 'Suggestion (Ice) Box'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Suggestion (Ice) Box'" by Darrin Bell.

Here's today's health policy haiku:

RYAN'S RULES

He'll be the speaker
If he gets unity vow.
What's it mean for health?

If you have a health policy haiku to share, please Contact Us and let us know if you want us to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

Capitol Hill Watch

3. Ryan Says He Will Agree To Take Speaker's Job, But Only If GOP Caucus Unifies Behind Him

The House Republicans' leadership struggle has complicated the fall legislative calendar, which includes must-pass items such as the measure to raise the federal debt limit.

Politico: Ryan Will Serve As Speaker If GOP Unites Behind Him
Wisconsin Rep. Paul Ryan, who for years has resisted a move into House Republican leadership, said Tuesday night he would serve as House speaker if he is the party's "unity candidate." ... Ryan's move could put major pressure on the Freedom Caucus, which had endorsed Rep. Daniel Webster (R-Fla.) before House Majority Leader Kevin McCarthy (R-Calif.) dropped his bid to succeed Boehner. Members of the Republican Study Committee and Tuesday Group have already showered praise on Ryan, but members of the Freedom Caucus aren't quite ready yet to endorse him. (Sherman, Bresnahan and French, 10/20)

Los Angeles Times: Paul Ryan Says Republicans Have Until Friday To Unify Behind Him For House Speaker
Ryan, a former vice presidential nominee, is considered the Republican Party's best hope for uniting its divided House majority. But he had expressed reluctance at taking the difficult job without unanimous support. ... The leadership struggle has stymied the fall agenda and is complicating the next must-pass item: legislation to raise the federal debt limit to continue paying the nation's bills and avoid a credit default. ...Ryan received a partial endorsement Tuesday from one unlikely source, Sen. Harry Reid (D-Nev.), the minority leader. ... Reid added that he's no fan of Ryan's ideology or his proposals for cutting Medicare and other safety net programs. He shrugged when asked whether his backing could doom Ryan's candidacy. (Mascaro, 10/20)

4. On Capitol Hill, Lawmakers Weigh Possible Plans To Raise The Debt Ceiling

Some GOP House members are pushing for a bill that would have "strings attached" -- some of which include finding savings in Medicare and Medicaid. Many Republicans also are blaming the Democrats and the health law for the failure of the Obamacare co-ops. Meanwhile, 10 House Democrats are urging that Medicare cover the cost of end-of-life discussions.

The New York Times: Lawmakers Wrangle Over Plans To Avert, Manage Or Embrace Default
With the potential for an unprecedented federal default two weeks away, House Republicans on Wednesday plan to pass legislation not to avert disaster, but rather to manage it, channeling daily tax collections to the nation’s creditors and Social Security recipients if the government’s borrowing limit is not lifted. The Obama administration and nonpartisan authorities say the plan is unworkable... A separate coalition of conservatives that includes most House Republicans, the Republican Study Committee, on Tuesday outlined conditions it would demand that Mr. Obama meet. These include $3.8 trillion in savings, mainly from entitlements like Medicare and Medicaid, and a balanced-budget constitutional amendment, which could not win congressional approval without the leverage of a debt crisis. (Calmes and Herszenhorn, 10/20)

Politico: House GOP Weighing Debt Limit Bill With Strings Attached
With the debt ceiling deadline 14 days away, House Republican leaders will use a Tuesday night party meeting to discuss a Republican Study Committee proposal to lift the debt ceiling with a host of attached policy provisions, according to multiple senior GOP sources familiar with internal planning. (Sherman, 10/20)

The Fiscal Times: GOP Faults Obama And The ACA For Failure Of Healthcare Co-Ops
The financial crisis sweeping through a network of 23 non-profit insurance plans created under the Affordable Care Act, also known as Obamacare, is jeopardizing the coverage of hundreds of thousands of Americans and putting at risk billions of dollars in federal loans. But as HHS officials struggle to find their way out of the latest morass in President Obama’s signature health care plan, Republican leaders are doing little to help. After years of failed efforts to derail Obamacare in the courts and on Capitol Hill, Republicans say the president is getting his comeuppance for ignoring their past warnings about the program. (Pianin, 10/21)

The Hill: Dems Urge Medicare To Pay For End-Of-Life Talks
Ten House Democrats are urging the Obama administration to allow Medicare to pay for end-of-life discussions with doctors. The Centers for Medicare and Medicaid Services (CMS) proposed in July to allow Medicare to start reimbursing doctors when they have discussions with patients about their end-of-life options, such as whether they want to be kept on life support. (Sullivan, 10/20)

In other news -

ProPublica: Would Washington's FDA Fix Cure The Patients Or The Drug Industry?
This might seem to be a rough political patch for the pharmaceutical and medical device industries. The exponential price increases of several drugs have brought scrutiny to the overall rise in drug costs and have prompted several 2016 candidates, most notably Hillary Clinton, to vow action to rein in the industry. Meanwhile, thousands of complaints are pouring into the Food and Drug Administration about a contraceptive implant made by Bayer. In Congress, however, things are looking better for the manufacturers. Legislation is advancing that would speed up the FDA’s approval process for medications and medical devices, offering a rare example of how major initiatives can get traction even in today’s gridlocked Washington. (MacGillis, 10/20)

Health Law Issues And Implementation

5. Health Law's 'Cadillac Tax' Draws Conflicting Views From White House, Presidential Hopefuls And Economists

The Obama administration is stepping up its defense of this part of the 2010 health law in the face of attacks not only by Republicans in Congress, but by some Democrats, too. Meanwhile, news outlets also report on how the undoing of some health insurance co-ops could bring higher costs to the marketplace.

The Boston Globe: Tax On ‘Cadillac’ Health Plans Splits Leaders
The White House has launched a bid to preserve a tax on generous, employer-sponsored insurance plans that underpins President Obama’s health care law, trying to stem a political tide after Hillary Clinton broke with Obama and called for its repeal. Targeting the unpopular “Cadillac tax,’’ which begins in 2018, Clinton says consumers and their employers should not be saddled with new costs to achieve reductions in medical spending. But many health care economists contend generous insurance plans lead to wasteful, unnecessary care. (Jan, 10/21)

Marketplace: Health Co-Ops' Struggles Could Bring Higher Costs
From Oregon to New York, health insurance co-ops, which were designed to compete against the major insurers, are closing as fast as flop houses in a gentrifying neighborhood. Harvard’s Katherine Swartz said too many of the 23 co-ops lack deep pockets to sustain multi-year losses, and sophisticated software that makes enrolling consumers easy. But the third challenge may be the toughest problem to solve. (Gorenstein, 10/20)

In other news, a South Dakota insurer opts out of the federal exchange -

Argus Leader: DakotaCare To Leave Federal Exchange
Just two companies in South Dakota will offer individual health care policies on the federal exchange in 2016. DakotaCare offered about 7,000 individual health care policies this year on the federal health care exchange set up by the Affordable Care Act, but it won't offer the policies next year because the company can't afford them, DakotaCare CEO Kirk Zimmer said. "It's not sustainable to a point that we wouldn't want to endanger other policies," Zimmer said. (Ferguson, 10/20)

6. GOP Candidates In La. Say They Want Federal Waivers Before Seeking Medicaid Expansion

The three Republicans running for governor, who all have said they would be open to expanding Medicaid to provide health coverage to the state's low-income residents, said they would want to modify the option provided in the health law to meet their concerns. Also in the news, Alabama's governor suggests he is weighing an expansion, although he is not expecting to act soon.

New Orleans Times-Picayune: 3 Of 4 Governor's Candidates Would Seek Medicaid Expansion Changes, But That Could Get Expensive
All four of Louisiana's major gubernatorial candidates have said they'd be open to expanding Medicaid under the Affordable Care Act, a move that would expand health care coverage to nearly 300,000 people, according to one estimate, many of them working poor. But the three Republican candidates -- U.S. Sen. David Vitter, Lt. Gov. Jay Dardenne and Public Service Commissioner Scott Angelle -- say they'd seek a different version of the Medicaid expansion offered now, opening up a potentially lengthy and expensive process to obtain what's known as a waiver. Democrat John Bel Edwards has said he would accept Medicaid expansion without the waiver. (Litten, 10/21)

AL.com: Is Gov. Robert Bentley Nudging Toward Expanding Medicaid?
Is Gov. Robert Bentley nudging closer to expanding Medicaid under the Affordable Care Act? Listen to what the governor said Tuesday when asked the question. "You know I wouldn't say nudging toward it," said Bentley. "But we are certainly looking at that; not right now. We are not at that stage right now." But then the governor added this when asked about remarks he had just made to a group of seniors about the need to improve healthcare in rural areas and how Medicaid expansion might come into play: "But you know we do have to realistically look at whether we have adequate funding for rural doctors, primary care doctors. They cannot treat a third of their patients and stay in business. It is a business they run," said the governor. (Dean, 10/20)

And in other state Medicaid news from Arkansas and Pennsylvania -

The Associated Press: Official Backs Moving Some Medicaid Programs To Managed Care
Arkansas Department of Human Services Director John Selig said Tuesday he supports having a private company manage some portions, but not all, of the state's Medicaid program. Selig told a legislative task force that moving some of the program's more expensive clients to managed care makes more sense than shifting the entire program. A consultant told lawmakers this month that hiring a company to manage the care for the state's Medicaid program could save Arkansas billions of dollars. (DeMillo, 10/20)