Kaiser Health News Original Stories

3. Political Cartoon: 'Join The Club!'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Join The Club!'" by Marty Bucella.

Here's today's health policy haiku:


To repeal? Defund?
Or both? The answer depends
on “strategery.”

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Health Law Issues And Implementation

4. So Far, Studies Show Health Law Open Season Marked By Unclaimed Subsidies, Sticker Shock

News outlets report on new studies -- one from the Robert Wood Johnson Foundation and the Urban Institute, and the other from McKinsey & Co. -- and examine some of the dynamics now playing out in the insurance marketplaces.

Fox News: Many Eligible For Obamacare Subsidies Not Claiming Them, Study Finds
Most of those eligible for health insurance subsidies under the Affordable Care Act are failing to claim them, according to a new study. Researchers with the Robert Wood Johnson Foundation and the Urban Institute estimated that more than 24 million people were eligible for ObamaCare tax credits last year. By March, only 41 percent of them had selected a plan on a government insurance exchange. (Edson, 11/11)

The Fiscal Times: Millions Face Premium And Deductible Sticker Shock Under Obamacare
Millions of Americans who recently began shopping for new health insurance coverage under Obamacare may be suffering from sticker shock. Increases in 2016 premiums for health insurance coverage -- ranging from basic to top-flight policies -- will be in the double digits and easily eclipse premium hikes recorded between 2014 and 2015, according to a new analysis from consulting firm McKinsey & Co. (Pianin, 11/11)

Meanwhile, a report issued Wednesday by Avalere examines issues of coverage and drug costs -

Marketplace: Researchers: Insurers Are Steering Some Patients Away
Under the Affordable Care Act, insurers can no longer deny people coverage based on their health status. But nobody said anything about charging sick people more for their drugs. A new report out Wednesday from Avalere found if you buy insurance on the exchanges created under Obamacare and need access to HIV medications, you may have to pay a pretty penny. (Gorenstein, 11/11)

Also in the news, an "unlikely" Obamacare replacement plan -

Politico: One State’s Unlikely Obamacare Replacement Plan: Single-Payer
One of the most detailed plans to replace Obamacare this year comes not from a Republican critic, but from a group in swing-state Colorado that is proposing to scrap it for a single-payer model long sought by liberals. Supporters, who won approval this week for a 2016 ballot measure after securing nearly 110,000 signatures deemed valid, will sell the overhaul as an Obamacare replacement plan designed in Colorado, instead of in Washington. (Pradhan, 11/12)

5. In Montana, Players Race To Get Medicaid Expansion System In Place For Jan. 1 Start

Meanwhile, a battle continues in Kansas, as three state representatives who are in favor of Medicaid expansion are removed from a legislative panel that oversees health issues.

MTN (Montana) News: State, Blue Cross Race To Get Medicaid Expansion Ready By Jan. 1 Launch Date
As thousands of low-income Montanans already sign up for expanded Medicaid health coverage, the state and its contractor – Blue Cross and Blue Shield of Montana – are racing to have the system in place by its planned coverage date of Jan. 1. The state will determine who’s eligible and Blue Cross, which is managing the expansion program, must build an automated system to collect premiums, track co-payments, and process claims. John Doran, director of public relations for Blue Cross, said Wednesday the private health insurer has been working “day and night” to get ready. It plans to send enrollment cards and “welcome packets” to eligible clients by mid-December, he said. (Dennison, 11/11)

Wichita (Kan.) Eagle: Three State Reps Who Favor Medicaid Expansion Removed From Health Committee
Three moderate Republicans who support Medicaid expansion have been removed from a House committee that oversees health care issues. The move is the latest in the fight over whether the state should extend the health care program for those with disabilities or low incomes under the Affordable Care Act. “Kansans oppose expanding Obamacare, a program that has busted budget after budget in states that have expanded it, House Speaker Ray Merrick said in a statement. Merrick, who makes House committee assignments, also moved moderates off key committees dealing with the budget and education Wednesday. (Lowry, 11/11)

The Medicaid expansion question is also playing a role in Louisiana's gubernatorial election -

New Orleans Times-Picayune: Here's 4 Takeaways From The First Governor's Runoff Debate
Republican David Vitter and Democrat John Bel Edwards faced off in a slow burn of a debate on Tuesday (Nov. 10) that started with a sober discussion of policy issues and ended with a fierce clash over character questions. Here's a look at the four big themes and takeaways .... Vitter sees an opening when it comes to Medicaid expansion: Edwards has been unapologetic about his support for expanding Medicaid, a key element of the Affordable Care Act that would expand coverage to hundreds of thousands of working poor in Louisiana. But Vitter, mindful of Kentucky residents voting a Republican candidate into office last week who had an anti-Medicaid expansion platform, is now seeking to tie Edwards to the unpopular president through his support for Medicaid. (Litten, 11/10)

Capitol Hill Watch

6. GOP Moderates Raising Challenges To Defunding Planned Parenthood, Repeal Of Health Law

The cuts in funding to Planned Parenthood are included in a bill that would repeal parts of the health law. It was passed by the House, but some Senate Republican moderates are balking.

Politico: Obamacare Repeal Faces New Obstacles
Moderate Senate Republicans are voicing new opposition to a conservative-backed plan to defund Planned Parenthood — a move that could imperil the GOP’s long-cherished goal of sending an Obamacare repeal to the president’s desk. Several GOP moderates were hoping the Senate parliamentarian would help them avoid a tough election-year vote on the Planned Parenthood provisions by forcing Republican leaders to remove the defunding language from a broader House-passed bill that also dismantles Obamacare. (Haberkorn and Kim, 11/12)

The Hill: Republican Divided Over How Far To Go With ObamaCare Repeal
Senate Republicans are divided over how far to go with an ObamaCare repeal bill that they plan to send to the president’s desk by year’s end. Senate GOP leaders have told their members they will repeal as much of the 2010 healthcare reform law as possible, but some Republicans are balking at a proposal to repeal the expansion of Medicaid. (Bolton, 11/12)


7. Horizon Pharma Stock Tumbles As Relationship With Express Scripts Unravels

The latest developments come as part of the continuing drama between pharmaceutical companies like Horizon and bill payers such as Express Scripts over how some drugs are priced and sold.

The Associated Press: Express Scripts Sues Horizon As Fight Over Prescriptions Grows
Drugmaker Horizon Pharma is questioning its relationship with an Express Scripts business after the pharmacy benefits giant sued Horizon for about $140 million and dumped a pharmacy that dispenses its drugs. Shares of Horizon Pharma plunged Wednesday after it said it would reevaluate its relationship with the Express Scripts Accredo specialty pharmacy, which accounts for a bigger slice of Horizon's revenue than any other pharmacy. (11/11)

The Wall Street Journal: Horizon Pharma Responds To Express Scripts As Stock Tumbles
Horizon Pharma PLC on Wednesday fired back a response at Express Scripts Holding Co.’s business practices after the largest U.S. pharmacy-benefit manager said it was cutting off a pharmacy that sold medications made by the biopharmaceutical company. “Our philosophy of ensuring that patients get the medicine their doctors prescribe is threatening Express Scripts’ profiteering and exposing what we believe is a lack of care for patients and respect for physicians,” said Chief Executive Timothy P. Walbert. (Steele, 11/11)

Meanwhile, Turing Pharmaceuticals exec Martin Shkreli -- one of the key players in the ongoing debate about drug-pricing practices -- continues to draw headlines -