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USHL NEWS & Updates

On March 5, 2014, CMS announced that it would allow insurers to extend some health plans until October 2016 even if the plans do not meet new healthcare reform standards.

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Healthcare Subsidies At Risk - Pending Legislation Could Deny Subsidies In States Utilizing National Exchange

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Standard Analytical Service, Inc. (SAS), publishers of independent insurance reports, recently released its 2014 annual comparative report of the 25 leading domestic health insurance providers. USHL received a favorable ranking.

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USHL recently introduced its Wellness Resources Center, a convenient one-stop health and wellness information library on the USHL website which visitors can reference for a variety of objectives.

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  • Missouri Sees Urban, Rural Divide In Obamacare Signups

    Jasmin Maurer was among nearly 150,000 Missourians who signed up for insurance during the first open enrollment under President Barack Obama’s health care overhaul.

    She hadn’t been insured since she graduated from college in 2008 and her mother lost her job — along with her employer-sponsored coverage. Now Maurer had insurance for about six months, and it’s completely changed how she thinks about her health.

    “If something bad happens, I know that I will not become homeless because of it,” she said.

    Maurer is one of many consumers who’ve gained health insurance for the first time because of the Affordable Care Act. But many more still go without it, and significant challenges remain to reducing the uninsured rate. A Post-Dispatch analysis of enrollments on HealthCare.gov, the government’s online health insurance marketplace, shows where the campaign to expand coverage was successful, and where more work needs to be done when enrollment for 2015 begins on Nov. 15.

    The analysis, which looked at private plan enrollments by zip code in Missouri and Illinois, indicates that urban and suburban areas had higher rates of marketplace sign-ups than rural locations.

    “There’s a lot of misunderstanding in the rural areas about what this is,” said Ryan Barker, vice president of health policy at the Missouri Foundation for Health. “There’s just a lot of mistrust and hatred of Obamacare.”

    The analysis also highlights key differences between the two states. In Illinois, the lowest-income areas had the lowest rates of sign-ups for private insurance, although many residents likely qualified for Medicaid, the federal-state insurance program expanded under the health law. In Missouri, areas with higher uninsured rates saw a larger number of enrollments in private insurance since that was the only option available to them.

    “It really shows big gaps and opportunities for more enrollment,” said Cora Walker, a professor at the St. Louis University School of Law, who reviewed the analysis.

    For those charged with helping residents enroll in health plans, the data show more needs to be done to bring coverage to historically uninsured populations, specifically African-Americans and Latinos who in Missouri represented only 9.3 percent and 1.6 percent of marketplace enrollment, respectively, according to the Missouri Foundation for Health.

    “Everyone who is doing any kind of outreach needs to continue to do that,” said Nancy Kelley, a certified application counselor with the Missouri Foundation for Health. “There are people there who need to get the information and the plans in front of them.”

    Last month, the federal government released data on the number of people who signed up for health plans by zip code. It doesn’t indicate whether those people are still enrolled and paying their premiums.

    The data did not include zip codes where less than 50 people signed up for coverage because of privacy concerns. Although that exclusion meant there was no data for 40 percent of zip codes in federal marketplace states, those areas only accounted for 4 percent of overall marketplace enrollment.

    The Post-Dispatch compared the number of sign-ups per zip code with U.S. Census Bureau projections on median incomes, population and percentage of people without health insurance.

    Getting Covered

    The U.S. Census Bureau estimates 773,000 Missourians and about 1.6 million Illinoisans did not have health insurance at some point during 2013, before the online government insurance marketplaces and expanded Medicaid coverage took effect.

    The first enrollment period saw 152,000 people in Missouri and 217,000 in Illinois sign up, making a small dent in the number of uninsured.

    Maurer, who works at a nonprofit agency that doesn’t provide employer-sponsored health insurance, was one of them. She signed up on HealthCare.gov and qualified for a subsidy to purchase her plan.

    She said her only interaction with the health system after college was going to different federally qualified health centers when she needed care and paying based on her income.

    “I just didn’t go to the doctor for a number of years,” she said.

    Now she does. And while her marketplace plan doesn’t include vision care, Maurer said she was able to use the money she would previously have spent on primary care to repair her glasses.

    It’s difficult to decisively conclude what individual factors led people like Maurer to sign up for health plans using the marketplace, and there were some surprises in the data.

    In Missouri, there was significant marketplace participation in the southwestern part of the state around Branson, Nixa and Lebanon. Barker said that could be the result of a strong “ground game” of outreach and education there.

    In the ZIP code that includes Lebanon (65536), 1,150 people signed up for marketplace coverage — a rate of 40 sign-ups per 1,000 residents. The uninsured rate for that area is 16.1 percent, and the median household income is $38,621.

    The Medicaid Factor

    Disparities in participation in private Obamacare plans between Missouri and Illinois are clearly illustrated in the St. Louis area.

    Metro East,  for example, had a much lower enrollment rate compared with downtown St. Louis, even though the areas have similar uninsured rates.

    A ZIP code that includes Sauget and parts of East St. Louis (62201) had only eight health plan sign-ups per 1,000 residents, despite having an uninsured rate of about 21 percent. That sign-up rate is significantly lower than those on the Missouri side of the metropolitan area.

    But that doesn’t mean those Illinois residents didn’t get health insurance.

    The differences between both sides of the Mississippi could be attributed to several factors, but the biggest is that Illinois expanded Medicaid under the health care law, while Missouri did not.

    If someone qualifies for Medicaid, they would not need to buy a private marketplace plan; thus, their insurance status would not be reflected in the zip code data.

    Although anyone can sign up for a marketplace plan, tax credits to help pay the cost are available only to people with incomes above the poverty threshold since the law's framers assumed they would be eligible for expanded Medicaid.  The law mandated that states offer Medicaid coverage to everyone making up to 138 percent of the federal poverty level, or up to about $16,100 for an individual. The Supreme Court, however, made that provision optional in 2012, and 23 states, including Missouri, have declined to participate.

    The Sauget and East St. Louis zip code that saw low marketplace participation has a median income of $16,684, near the threshold to qualify for Medicaid for an individual.

    Missouri lawmakers' refusal to expand the program left some Missourians with incomes too high to qualify for Medicaid, but still unable to afford coverage through the marketplace.

    Many areas with high uninsured rates and lower incomes saw fewer sign-ups compared to places that were slightly more affluent, but had a similar uninsured rate. Having higher incomes means residents were more likely to qualify for a tax credit to buy a marketplace plan.

    Data from two adjoining zip codes in St. Louis, divided in most places along Delmar Boulevard downtown, illustrate this point.

    The southern zip code (63103) had 38 marketplace sign-ups per 1,000 residents, while the northern one (63106) had 22 signups per 1,000 residents, even though it had significantly lower income and a higher share of uninsured population.

    Medicaid expansion is just one of the many challenges going forward.

    Reaching the rural uninsured will be key. Kelley, of the Missouri Foundation for Health, said the organization plans to broaden its efforts by attending non-health care related events, such as football games or fairs.

  • North Carolinian Credits Early Cancer Diagnosis To New Health Coverage

    In March, after Kimberly Tonyan got health insurance through the Affordable Care Act exchange, she spoke at a news conference urging others to enroll. Her 11-year-old twins stood at her side in Raleigh, N.C.

    “You have nothing to lose,” the Cornelius woman said, “but your life.”

    Little did she know.

    A couple of months later, Tonyan (rhymes with “onion”) went to the doctor, complaining of abdominal pain. It was the start of a medical journey that led to an early cancer diagnosis and the discovery that she has Cowden syndrome, a rare genetic mutation that puts her at high risk for other cancers.

    It’s been a tough year. She has one surgery behind her and another ahead. For the rest of her life she’ll be closely monitored.

    But Tonyan wants to get the word out about the importance of getting insured and seeing a doctor. Despite the pain and anxiety, what matters most is that she has boosted her odds of seeing Caitlyn and Charlotte grow up.

    “The Affordable Care Act saved my life,” says Tonyan, 41. “If you don’t have coverage, you need to get it.”

    During the first year, 7.3 million people have gotten insurance through the ACA exchange. There have been problems, from a dismal debut of the website to confusion and controversy over high deductibles and limited networks of doctors in some plans.

    But Tonyan illustrates what the law was designed to accomplish: Because she had insurance, she got care before her cancer advanced. While her care has been expensive, it headed off more costly procedures, such as chemotherapy and radiation. Had she been uninsured and unable to pay, those costs would eventually have been passed along to taxpayers and insured patients.

    Because Cowden syndrome is hereditary, Tonyan’s oncologist says the diagnosis will also benefit her daughters and their descendents, who have a better chance of living long, healthy lives with proper care.

    “We can prevent so many bad things from happening to people if we know they have the syndrome,” said Dr. Matt McDonald of Novant Health Gynecologic Oncology Associates. “She’s been given a gift that will help a lot of people she knows and a lot of people she’ll never meet.”

    Insurance matters

    When Tonyan got pregnant, she and her then-husband were uninsured. It was a difficult pregnancy and the twins came early. The babies spent nine days in the neonatal intensive care unit.

    Tonyan says the couple got a bill for $89,000, and Carolinas HealthCare System sued when they couldn’t pay. They negotiated it down to about $22,000, which Tonyan’s family paid.

    Tonyan, who has worked in the family business as a barber and cared for her girls as a divorced mother, hadn’t been able to afford insurance for years. She was initially skeptical about the Affordable Care Act. She’s registered as a Republican because “I don’t believe that the government should be involved in your life.” And she had heard about the hassles that bogged down the early weeks of the online insurance exchange.

    But in December she made an appointment with Fara Soubouti, a health insurance navigator who works for Legal Services of Southern Piedmont. Tonyan learned that her income – about $20,000 from part-time caregiving, occasional barbering and working with family rental properties – qualified her for a good subsidy.

    In about an hour, she had chosen a Blue Cross and Blue Shield plan with a $500 deductible. Tax credits would cover $279 a month and she’d pay $27.91.

    Tonyan, who once won an award at Independence High for public speaking, told Soubouti she was so pleased with the experience she’d be glad to share it with others.

    As the end of 2014 open enrollment neared in March, Tonyan spoke at news conferences in Charlotte and Raleigh. Her message: Health care isn’t political – it’s humanitarian. “Everybody deserves health care.”

    Bad news

    In May, Tonyan went to the doctor about pain in her lower abdomen. She ended up having a hysterectomy for uterine fibroid tumors and an ovarian cyst.

    All indications were that both were benign. But when a pathologist examined her uterus after the surgery, a small spot of endometrial cancer was found in her uterine lining.

    Her gynecologist referred her to McDonald for follow-up. Because the cancer had been removed before it began to spread, he said, there was no need for chemotherapy or radiation.

    But he was concerned. Endometrial cancer is often found in women in their 60s or 70s, who start bleeding after they’ve gone through menopause. Because Tonyan was so young, McDonald suggested genetic testing.

    Genetic counselor Christen Csuy (pronounced soo-ee) initially suspected another syndrome. But when she got a blood sample and ran a panel screening for nine genetic flaws linked to uterine or ovarian cancer, the diagnosis was Cowden syndrome, caused by a mutation in a PTEN gene that is supposed to produce a tumor-suppressing protein.

    Many have heard of BRCA mutations, which greatly increase the risk of breast and ovarian cancer. They’re found in about 1 in 800 people, Csuy said. Actress Angelina Jolie revealed last year that she chose to have both breasts removed after learning she had a BRCA mutation that gave her an 87 percent chance of developing breast cancer.

    The mutation that causes Cowden syndrome is much rarer, occurring in 1 in 200,000 (though experts suspect it’s underdiagnosed). It brings a similar risk of breast cancer: 85 percent for a woman with the mutation. There’s also an increased risk of thyroid, uterine and kidney cancer.

    Facing the future

    Tonyan was referred to Novant’s Cancer Risk Clinic, where specialists coordinate screening and treatment for people with high genetic risk.

    A mammogram revealed a lump in Tonyan’s breast. She was relieved when a biopsy showed it was benign but has decided to have a preventive mastectomy. That surgery, while it may seem like an extreme option, is one of the few ways to actually prevent a likely cancer, as opposed to trying to catch it early, Csuy said.

    A kidney scan revealed no problems, but doctors found multiple polyps in her stomach and colon. None were malignant, but one was deemed precancerous, so Tonyan will get a colonoscopy every year.

    Caitlyn and Charlotte, who are identical twins, have a 50 percent chance of inheriting the mutation. When they reach their late teens they’ll decide whether to have genetic testing. Their doctors will know to start cancer screenings early if they test positive.

    Tonyan recently finished training to launch a new career as a medical assistant. She had been job-hunting before her diagnosis. Now she suspects she’ll have to wait until she has recovered from her double mastectomy.

    But at least she’s not facing massive debt. Her hysterectomy alone brought a bill for more than $40,000, she said.

    Csuy said the genetic panel costs $3,500. She believes Tonyan could have gotten her surgery as charity care, but she questions whether someone without insurance would have gone ahead with the test that gave Tonyan a road map to cancer detection. “You don’t know where (her treatment) would have stopped,” Csuy said.

    The next round of enrollment for subsidized health insurance starts Nov. 15. Tonyan, who seems upbeat despite her travails, says she’s eager to let people without insurance know how important it can be to seize the opportunity.

    “If my story saves a life,” she says, “it would bring a lot of joy.”

  • Pentagon Plans 30-Person Team To Tackle Ebola In U.S.

    The Department of Defense announced Sunday that it would create a medical team to assist U.S. doctors responding to new Ebola cases, while the government issued more stringent guidelines for protective garb for health care workers treating Ebola patients. In addition, The Wall Street Journal profiles a biologist who has been working since 1997 on an Ebola vaccine that has been proven to block the disease in monkeys.

    The Washington Post: Pentagon Plans Ebola Domestic-Response Team Of Medical Experts To Aid Doctors
    The Pentagon announced Sunday that it will create a 30-person team of medical experts that could quickly leap into a region if new Ebola cases emerge in the United States, providing support for civilian doctors who lack proficiency in fighting the deadly virus (Kane and Ellis Nutt, 10/19).

    The Washington Post: Obama: ‘We Can’t Give In To Hysteria Or Fear’ Of Ebola
    President Obama on Saturday sought to tamp down fears of an Ebola outbreak and defend his administration from Republican critics who have called for a more aggressive response to the disease, including sealing off U.S. borders to visitors from countries battling widespread outbreaks ... As Ebola fears have spread, some urgent-care clinics have taken steps to identify red flags, such as recent travel to West Africa, before patients ever set foot in the clinic. AFC/Doctors Express, a national chain of more than 130 urgent-care clinics, with facilities in Alexandria, Va., Woodbridge, Va., Edgewater, Md., and Towson, Md., fields some of its patient calls through a national call center that’s designed to screen symptoms before patients show up to see a doctor (Jaffe and Brittain, 10/18).

    The Wall Street Journal: New Ebola Guidelines For Hospitals To Require Full Body Cover
    New, more stringent hospital guidelines for treating Ebola patients will require full body coverings and mandate that health-care workers be monitored while putting on and taking off protective garb, a top U.S. health official said. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, which is part of the National Institutes of Health, said the new guidelines will be “much more stringent” and require that no skin be exposed (Barnes, 10/19).

    The Wall Street Journal: Why The Work Of Dr. Nancy J. Sullivan Could Be Key To A Potential Ebola Vaccine
    The world had little interest in Ebola in 1997, which is why cell biologist Nancy J. Sullivan thought she might be able to make a mark. Today, if the scientific world is to have an answer to the world’s severest Ebola outbreak, Dr. Sullivan’s work is likely to be at its center. A senior investigator at the National Institutes of Health’s Vaccine Research Center, Dr. Sullivan has worked for years on a vaccine that has been proven to block Ebola in research monkeys. ... The vaccine is scheduled to undergo full human testing by early 2015  (Burton, 10/19).

    NPR: Dallas Hospital Deals With Aftermath Of Ebola Missteps
    Authorities in Texas are working to limit travel by health workers who may have been exposed to Ebola. Meanwhile, the hospital at the center of the first cases in the U.S. is trying to move forward (Goodwyn, 10/18).

    Reuters: Texas Hospital Aims To Restore Image After Ebola Infections
    The Texas hospital accused of mishandling care for the first Ebola patient diagnosed in the United States is hitting back at critics with an aggressive public relations campaign aimed at rehabilitating its battered image. Texas Health Presbyterian Hospital, where a Liberian man was treated for Ebola and later died and where two nurses have been infected with the virus, has weathered intense criticism from the public, healthcare workers and politicians over what have been characterized as lax safety protocols. But on Thursday night, the hospital issued a strongly worded statement that says workers followed proper safety protocols and shifts some blame to the U.S. Centers for Disease Control and Prevention (Driver, 10/17).

    Reuters: Insurers To Sell Hospitals Policies Against Ebola Business Losses
    Two privately owned insurance brokers have teamed up with Lloyd's of London underwriter Ark Syndicate to sell hospitals a product that insures against any loss of profit from Ebola quarantine shutdowns. British broker Miller Insurance Services LLP said the product it created with U.S. broker William Gallagher Associates would also protect hospitals against any potential losses to revenue in the aftermath of a quarantine. The policies, which Ark began underwriting on Friday, are the first of their kind. There has been "considerable interest" in the product throughout the United States, Mark Sleet, Professional Risks broker at Miller, told Reuters. The news comes as U.S. health officials said they were monitoring 16 people in Ohio, including one in quarantine, who had close contact with Ebola-infected Texas nurse Amber Joy Vinson (Naidu, 10/17).

    Kaiser Health News: What CDC Can Do To Fight Ebola
    The Ebola epidemic in Africa and fears of it spreading in the U.S. have turned the nation’s attention to the federal government’s front-line public health agency: The Centers for Disease Control and Prevention (CDC). But as with Ebola itself, there is much confusion about the role of the CDC and what it can and cannot do to prevent and contain the spread of disease. The agency has broad authority under federal law, but defers to or partners with state and local health agencies in most cases (Rovner, 10/20).

  • Obama's 'Ebola Czar' Pick Has Washington Know-How, Knows Less About Medicine

    The White House announced Friday that Ron Klain, a veteran Washington adviser and Democratic strategist, will coordinate multi-agency strategy.

    Los Angeles Times: ‘Ebola Czar' Brings Decades Of Washington Experience
    The man tapped to be the country’s “Ebola czar” is a veteran Washington advisor and Democratic strategist who will oversee a multi-agency response to the outbreak in West Africa and the U.S. cases, the White House announced Friday. In a change from a career spent mainly behind the scenes, Ron Klain becomes the Obama administration's point person leading a complicated and highly-visible government Ebola strategy (Hansen, 10/17).

    The Associated Press: Ebola 'Czar' Knows Washington, But Not Medicine
    [Klain] does have a wealth of experience managing unruly federal bureaucracies in times of crisis. The White House says that makes him the perfect candidate to shepherd the government's response to a deadly, growing outbreak. ... Under immense pressure to step up his response, Obama turned to Klain on Friday. He's being asked to synchronize an alphabet blizzard of federal agencies: the CDC, NIH, HHS, DHS, FDA and DOD, to name a few (Lederman, 10/16).

    Kaiser Health News also tracked weekend headlines regarding the Obama administration’s appointment of an Ebola czar. 

  • State Highlights: Mental Health Issues Put 34K On N.Y. No-Guns List

    A selection of health policy stories from New York, Ohio, California, Tennessee, Kansas, Kentucky, North Carolina and Maryland.

    The New York Times: Mental Health Issues Put 34,500 On New York’s No-Guns List
    A newly created database of New Yorkers deemed too mentally unstable to carry firearms has grown to roughly 34,500 names, a previously undisclosed figure that has raised concerns among some mental health advocates that too many people have been categorized as dangerous. The database, established in the aftermath of the mass shooting in 2012 at the Sandy Hook Elementary School in Newtown, Conn., and maintained by the state Division of Criminal Justice Services, is the result of the Safe Act. ... The law, better known for its ban on assault weapons, compels licensed mental health professionals in New York to report to the authorities any patient “likely to engage in conduct that would result in serious harm to self or others" (Hartocollis, 10/19).

    Chillicothe Gazatte/USA Today: Medicare Patients Pay More At Rural Hospitals
    ECGs and nine other frequently provided outpatient services cost from two to six times more for Medicare patients at the nation's rural, critical access hospitals compared to other hospitals, according to a report by the U.S. Department of Health and Human Services' Inspector General (Balmert, 10/20). 

    The New York Times: Doctor’s Letter Spells End of Job For Pregnant Employee
    This month marks the first anniversary of the Pregnant Workers Fairness Act, which was signed into law by former Mayor Michael R. Bloomberg on Oct. 2, 2013. The law, which went into effect in January, represents a big step forward for working women. It requires employers to make reasonable accommodations for pregnant workers -- such as providing rest and water breaks, modified work schedules and light duty -- so long as the accommodations don’t cause undue hardship for the employer. Makes sense, right? It’s actually critical, particularly for low-income women who sometimes get pushed out of their jobs -- and into poverty -- when they become pregnant (Swarns, 10/17).

    San Jose Mercury News: New Anti-Prop. 45 TV Ad Misleads Viewers
    Proposition 45 would allow California's elected insurance commissioner to regulate health plan rates for 6 million Californians with individual policies or who get their insurance as employees of small businesses. The No on 45 campaign recently released a 30-second television ad, now running in major media markets (Seipel, 10/19).

    The Tennessean: Children Left In TennCare Lurch
    When Tennessee abdicated responsibility for Medicaid applications to the federal government, foster children got locked out. Adoption agencies had no way to seek coverage after TennCare made state residents apply through healthcare.gov, a website designed for families to shop for health insurance. The website has no computer equivalent to the state social workers once tasked with making sure children didn't go without medical coverage (Wilemon, 10/20).

    Kansas Health Institute News Service: Advocates Ready Another Push For Mid-level Dental Providers
    Advocates of licensure for mid-level dental providers have been stymied in Kansas for five years. They say the need for dental care remains high, especially in the state's rural areas, and they're pushing for legislative movement next session. Members of the Kansas Dental Project coalition met this week in Topeka to discuss the issue and hear from Steve Coen, president and chief executive officer of the Kansas Health Foundation, and Brenda Sharpe, president and CEO of the REACH Healthcare Foundation. Both groups are part of the Kansas Dental Project (Marso, 10/17).  

    Bloomberg: Purdue Says Kentucky Suit Over OxyContin Could Be Painful
    Purdue, which makes the best-selling painkiller OxyContin, has never gone to trial on a case of OxyContin abuse. It has won dismissals in more than 400 personal-injury lawsuits related to the drug. And while it has settled some product-liability cases related to OxyContin under secret terms, Purdue has defeated more than 10 efforts to wage class-actions against it. In this remote county courthouse in southeast Kentucky, the company faces a potential legal reckoning that its own chief financial officer called “crippling.” Purdue has already lost initial procedural decisions that may force it to go to trial with its “arms tied behind its back,” the company said in pretrial arguments (Armstrong, 10/20).

    The Associated Press: Democrat Slams Plan Giving State Medicare Control
    Democrat Dennis Anderson Friday criticized an interstate health care compact that would give Kansas control of Medicare within its borders, while his Republican opponent Ken Selzer backed the idea as a way to get the program out of the federal government during a face-to-face encounter in the race for state insurance commissioner. The compact measure passed by the Kansas Legislature and signed by Gov. Sam Brownback in April would allow member states to set their own health care policies while retaining federal health care dollars and give participating states the ability to exempt themselves from other federal rules in addition to the health overhaul's regulations. It hinges, however, on congressional approval, and for that to happen, Republicans would need to gain control of the U.S. Senate in November (Hegeman, 10/17).

    Charlotte Observer: Charlotte ER Case Shows Challenges Of Patient Satisfaction
    Miserable and desperate, Denise Schafer sought help at the Carolinas Medical Center-Pineville emergency room one Saturday in June. Four days earlier, she had swallowed something that seemed to have sharp edges and lodged in her throat. Doctors at the Pineville hospital eventually found, and removed, the cause of Schafer’s pain. But it was only after a long, frustrating day in the ER and the serendipitous appearance of a ham sandwich. Schafer and Lenore Foote, a friend who drove her to the ER, later complained to hospital officials – and then to the Observer – about their experience. … As the American health care system undergoes massive change, hospital systems across the country have begun talking more about “patient-centered care.” In the Charlotte area, Carolinas HealthCare System and Novant Health tout their scores on patient satisfaction surveys. And they’ve created jobs with titles such as “patient experience officer”  (Garloch, 10/18).

    Baltimore Sun: State Proposes Reforms To Group Home Oversight
    Maryland's top health official announced Sunday that his agency is reforming the way the state regulates group homes for disabled foster children. In a report sent Sunday to Maryland lawmakers and The Baltimore Sun, the state health department identified five steps it is taking to improve coordination among the multiple agencies that supervise group homes, increase scrutiny of contractors' finances and appoint an employee to implement and oversee the enhancements. The announcement follows investigations by The Sun that detailed significant problems with the state's two largest contractors for such care, including reports of abuse and management issues. Dr. Joshua Sharfstein, Maryland's health secretary, also announced the formation of a task force that has been charged with recommending more improvements by January for services to all disabled adults (Donovan, 10/19).

    Baltimore Sun: Shuttered Health Clinics Plan Relaunch
    Founded in 1970 to treat people in Baltimore who are uninsured and underinsured, People's closed five clinics at the end of June as debts piled up, including more than $900,000 owed to the IRS. The clinics' $2.4 million annual federal grant — which helped pay the cost for treating uninsured patients — was suspended, and Anne Arundel County's government yanked a grant that was intended for a planned clinic in Severn. Now People's Community Health Centers has formally changed its corporate name to MedHealth of Maryland (Wood, 10/18).

  • Ebola Worries Renew Push For Surgeon General Pick

    More than two dozen House Democrats have called on the Senate to confirm Dr. Vivek Murthy, the Obama administration's pick for U.S. Surgeon General, so he could help lead the nation's Ebola response. But Senate support remains shaky because of Murthy's outspoken views on gun violence, which have drawn the wrath of the National Rifle Association.  

    Politico Pro: House Dems Want Approval For Surgeon General Pick
    More than two dozen House Democrats are calling on the Senate to swiftly approve Vivek Murthy’s nomination to serve as surgeon general to help combat the spread of the deadly Ebola virus in the U.S. Murthy’s nomination got sidelined after Republicans and vulnerable Senate Democrats voiced reservations about the Harvard Medical School physician’s outspoken views on gun violence and public health. But the House Democrats, in a letter set to be released next week, argue that the Obama administration needs a top official in place to help with Ebola response (French, 10/17).

    The Wall Street Journal’s Washington Wire: Ebola Furor Renews Sparring Over Surgeon General Nomination
    The political furor over the U.S. response to the Ebola outbreak has revived debate over President Barack Obama’s stalled pick for U.S. Surgeon General. Some supporters of the administration have for the past few days been trying to shift the spotlight to opposition to Vivek Murthy, Mr. Obama’s pick for the position, which focuses on public-health issues. Dr. Murthy’s nomination met resistance in March when some Senate Democrats indicated they would not vote for him after his support for gun control drew the opposition of the National Rifle Association. Senate Democratic leaders are still not expected to bring Dr. Murthy up for a vote unless enough lawmakers change their positions to confirm him, aides said. But the public health concerns kindled by the spread of Ebola have generated new sparring over his nomination (Peterson and Radnofsky, 10/17).

  • Administration's Handling Of Ebola Casts Shadow On Dems' Election Hopes

    A Politico poll underscores that Ebola is causing real political danger for some Democrats. It's playing big, for instance, in North Carolina's Senate race.  

    Politico: Politico Poll: Democrats In Danger Over Ebola
    Voters who intend to support Republicans in the most consequential Senate and House elections this November had significantly less confidence in the federal government’s response to the occurrence of Ebola, according to a new POLITICO poll. The survey underscores the dangers for Democrats in the midterms if the Obama administration is perceived as mishandling the government’s reaction to the virus (Shepard, 10/20).

    NPR: Will Ebola Impact Midterm Elections?
    Weekend Edition Sunday's new segment, "For the Record," kicks off with politics and Ebola. NPR's Rachel Martin asks NPR's Mara Liasson and Dallas columnist J. Floyd about the politics of the disease (10/19).

    The Washington Post: Ebola, Islamic State Shift Dynamics For Hagan, Tillis In North Carolina’s Senate Race
    For much of the year, the incumbent, Sen. Kay Hagan (D), and her allies had successfully framed the campaign as a referendum on the sharp conservative turn taken by the state legislature under the leadership of [Thom] Tillis, the House speaker. But in the past few weeks, the conversation has pivoted amid alarming headlines about terrorism and a virulent epidemic, further tightening what is expected to be the most expensive Senate race in U.S. history. … For his part, he spent most of his day-long swing through the state pressing the argument that Hagan operates as an extension of Obama. He ticked off a series of issues, such as Obamacare and veterans’ care, in which he said the administration — and the senator — had failed. At every stop, he added two new items on the list: the Islamic State and Ebola (Gold, 10/19).

    Meanwhile, health policy, budget issues and Medicare are also resonating in a variety of congressional contests.   

    Los Angeles Times: Costly, Nasty Battle Rages In San Diego Race For Congress
    In its third editorial endorsing Republican congressional candidate Carl DeMaio over Democratic incumbent Scott Peters, the U-T San Diego newspaper had one description of DeMaio that not even his many critics could dispute: "One of a kind." DeMaio's hard-charging style, combined with his anti-Washington pledge to "Fix Congress First," has turned the 52nd Congressional District race into one of the tightest and costliest in the country. ... Local television is filled with attack ads. Peters warns that DeMaio plans to cut student loans. DeMaio says he is a big supporter of student loans and Medicare and that Peters represents everything that is wrong with politics: officeholders who are too comfortable with the status quo (Perry, 10/18).

    Chicago Tribune: Foster, Senger Debate Health Care, Budget
    Candidates to represent the 11th Congressional District clashed Saturday ... Democratic U.S. Rep. Bill Foster and Republican state Rep. Darlene Senger, Naperville residents who are vying for a seat representing parts of the west and southwest suburbs, sparred during a debate ... When they had a chance to ask each other one question, Senger queried Foster on his vote in support of the Affordable Care Act and the unfunded liability she said it left on the state's shoulders. Foster stood by the law, saying millions more are now insured (Jenco, 10/19).

    Chicago Tribune: Chicago Suburb Congressional Candidates Trade Jabs On Medicare
    A debate Saturday between the rivals in the north suburban 10th Congressional District – Rep. Brad Schneider, the first-term Democrat, and GOP challenger Bob Dold – grew tense on the topic of Medicare. Dold assailed Schneider as a partisan leader who's done little good for 10th District voters. "You said you wouldn't cut a single penny from Medicare. You have gutted the program by over $700 billion," Dold said to Schneider. "After you've misled the voters this many times, how can they expect to trust anything that you say?" What followed was chippy back-and-forth over the intersection of the Affordable Care Act , Medicare and past budgets proposed by Rep. Paul Ryan, R-Wis., that Dold supported when he was in Congress. In the exchange, both politicians slung partisan Medicare talking points that have been largely debunked by fact-checking organizations in recent years (Trotter, 10/18).

    In other news, real history could be made in gubernatorial elections -

    The Washington Post: Gubernatorial Races Poised To Make History In Two Weeks
    You wouldn't know it by following the Senate-control-centric coverage of the midterm elections emanating from Washington, but we could well be headed toward a historic gubernatorial election in 15 days. Not since 1984 have more than six sitting governors lost in any one election. But, 30 years after that gubernatorial carnage, a look at this year's races puts 11 incumbents in various levels of peril — suggesting that history may be in the making (Cillizza, Blake and Sullivan, 10/19). 

  • Lilly CEO Explains Drug Maker's 'Toughest Year'

    In other drug industry news, the Centers for Medicare & Medicaid Services makes improvements in the new doctor payment website.

    The Wall Street Journal: Lilly CEO Sees Light After A Difficult Year
    Eli Lilly & Co. is deep into what Chief Executive John C. Lechleiter calls the “toughest year” in the drug maker’s 138-year history. Revenue at Lilly has plunged because of generic competition that followed patent expirations for several of its top-selling drugs, including the antidepressant Cymbalta (Loftus, 10/19).

    The Wall Street Journal’s Pharmalot: Better Late Than Never: CMS Improves The Doctor Payment Website
    Remember how challenging it was to navigate the new government database of payments made by drug and medical-device makers to U.S. doctors? Well, the transparency initiative just became a little easier to use – more than two weeks after the database was posted online (Loftus, 10/17).

  • Long-Term Care Costs Weigh Heavily On Middle-Class Families

    CBS News reports that for many seniors and their families, home care needs create a serious financial bind.  

    CBS News: Aging In America: Stuck In The Middle
    Senior citizens whose finances fall in the middle -- not rich, not poor -- can find themselves in a real bind if they need home care. And their loved ones can find themselves caught in the middle as well. ... "This is my calm before the storm," said Kathy Warren, as she sat at her kitchen table doing a puzzle. "It kind of centers me." But Warren is still keeping watch out her window, on her 92-year-old stepfather next door. ... Most of the rest of her day, in a modest mobile home park in Hayward, Calif., will be spent on his care. ... "In the middle": Not poor enough to quality for Medicaid (which, unlike Medicare, does cover many long-term care expenses), and not rich enough to pay for long-term care. So the burden falls on his stepdaughter (Braver, 10/19).

    Meanwhile, The Washington Post examines the backlogged office that decides whether people qualify for disability payments -

    The Washington Post: 'It's Just Maddening. There's Nothing You Can Do.'
    In an obscure corner of the federal bureaucracy, there is an office that is 990,399 cases behind. ... It is bigger even than the infamous backups at Veterans Affairs, where 526,000 people are waiting in line, and the patent office, where 606,000 applications are pending. All of these people are waiting on a single office at the Social Security Administration. Social Security is best-known for sending benefits to seniors. But it also pays out disability benefits to people who can’t work because of mental or physical ailments. And it runs an enormous decision-making bureaucracy to sort out who is truly disabled enough to get the checks — and who is trying to game the systems (Fahrenthold, 10/19).

  • How The Health Law's Second Enrollment Season Could Impact Key Senate Races

    Politico reports that two closely watched Senate contests -- those of Georgia and Louisiana -- could be decided by runoff elections that would take place in December. Healthcare.gov glitches could color voters' choices. News outlets also report on how Obamacare could play a role in election outcomes in states such as Colorado and Minnesota.

    Politico Pro: Dems’ Runoff Nightmare: More Obamacare Glitches
    The second sign-up season for health care exchanges begins November 15 — a post-election launch that was supposed to insulate Democrats from the politics of another website meltdown. But it’s almost certain that the Senate race in Louisiana will require a runoff in December, and a January runoff is also possible in Georgia. That means residents of the two states will be checking into HealthCare.gov at the exact moment they’re considering their vote — and possibly which party will control the Senate (Cheney and Wheaton, 10/19).

    Politico: Health Cancellations Ripple In Colorado
    More than 22,000 Coloradans were informed in the past month that their health coverage will be canceled at the end of the year, state insurance authorities disclosed this week, a spike in cancellations already roiling the state’s fierce campaigns for the Senate and governor’s seat. Republican Rep. Cory Gardner, who’s running to unseat Democratic Sen. Mark Udall, pounced on the news as evidence that Obamacare is disrupting coverage for Coloradans ... It’s unclear, though, if Obamacare is the reason for the latest wave of canceled plans. The cancellations are nearly all the result of a decision by Humana (Cheney, 10/17).

    Atlanta Journal-Constitution: Obamacare At Center Of Race For Georgia’s Insurance Chief
    Some may recognize Ralph Hudgens as Georgia’s insurance commissioner, charged with the task of regulating the claims industry and protecting consumers from insurance fraud. Nationally, however, the 71-year-old is better known as the Republican who promised his department would do “everything in our power to be an obstructionist” against the Affordable Care Act. Hudgens has softened his tone from a year ago, saying he was throwing the conservative crowd “some red meat.” Nonetheless, the controversial health care law known as Obamacare remains the core issue in his re-election race against Democrat Elizabeth “Liz” Johnson and Libertarian Ted Met (Fouriezos, 10/19).

    Minneapolis Star-Tribune: Personal Questions And Fresh Topics Enliven Latest Dayton, Johnson Debate
    Gov. Mark Dayton and Republican challenger Jeff Johnson continued hammering at each other on a broad range of topics Sunday, staking out divergent positions on issues including MNsure rate hikes, the role of state government, and a proposed copper-nickel mine in the Iron Range. (Lopez, 10/19).