Westhill Healthcare Consulting Jakarta fraud prevention review Wonkbook: Why the Obama administration won’t oversell Obamacare in year two

Wonkbook’s Number of the Day: 70 percent. That’s the latest estimate of the mortality rate in the Ebola outbreak in West Africa, the World Health Organization announced.

Wonkbook’s Chart of the Day: Oil prices are falling, and fast.

Wonkbook’s Top 5 Stories: (1) Obamacare October surprises and a lower sales bar; (2) Ebola treatments for U.S. patients; (3) attorney general nomination update; (4) security threats of climate change; and (5) new help for long-term jobless.

1. Top story: With a month to go, why the Obama administration won’t oversell Obamacare in year two

Team Obama’s year-two strategy: Underselling Obamacare. “The Obama administration vastly oversold how well Obamacare was going to work last year. It’s not making the same mistake this year. Gone are the promises that enrolling will be as easy as buying a plane ticket on Orbitz. The new head of HHS is not on Capitol Hill to promise that HealthCare.gov is on track. And no one is embracing Congressional Budget Office projections of total sign-up numbers.Sobered — and burned — by last fall’s meltdown of the federal website, the administration is setting expectations for the second Obamacare open enrollment period as low as possible. Officials say the site won’t be perfect but will be improved.” Jennifer Haberkorn in Politico.

Explainer: 5 things we need to know about Obamacare before enrollment begins. Jason Millman in The Washington Post.

If you like your plan, can you keep it this time? “Health insurance companies, at least so far, seem to think HealthCare.gov is on the right track to function more smoothly for new customers. But insurers still see gaps in the system for people who want to renew their coverage, including pitfalls that threaten consumers with duplicate enrollments, unexpected cancellations, or surprising tax bills. Insurers aren’t necessarily worried about problems as dramatic as last year’s HealthCare.gov failure, but rather what one industry official called ‘a soup of kind of icky things’ that could make life difficult for returning enrollees. Some of the technical problems stem from the difficult balance between keeping people enrolled and encouraging them to shop for a better deal.” Sam Baker in National Journal.

The potential perils of auto-renewing. “If you auto-renew, you’ll most likely be assigned the same tax credit as you had for 2014. But if your income has increased, your credit may be too large — and you could end up owing the government money, when the numbers are reconciled at tax time. Consumers are supposed to report changes in income during the course of the year, he said, but it’s likely that many have not. So by re-enrolling and updating details about income, you’ll help make sure the credit is properly adjusted. Also, because of a quirk in the way the A.C.A. calculates the tax credits, some consumers who stick with their same plan actually could end up paying more — even if their original plan doesn’t raise its rates.” Ann Carrns in The New York Times.

Explainer: How the new HealthCare.gov stacks up with the old Ricardo Alonso-Zaldivar and Calvin Woodward in the Associated Press.

An Obamacare October surprise? “Obamacare premiums aren’t rising everywhere. They just have a way of finding the states with the biggest Senate races. And that could be very bad timing for Democrats in two of the party’s key contests. Double-digit rate hikes for individual health insurance plans have become an issue in the Louisiana and Iowa Senate races over the past week, where the Republican candidates are hammering their Democratic opponents for the steep premium increases on the way next year for some customers under the Affordable Care Act….The attacks could easily give the impression that the health care law is causing premiums to go through the roof around the country. They’re not.” David Nather in Politico.

For employer-based plans, expect modest premium hikes and higher consumer costs likely. “Premium increases for 2015 plans are expected to be modest on average, but the shift toward higher out-of-pocket costs overall for consumers will continue as employers try to keep a lid on their costs and incorporate health law changes. Experts anticipate that premiums will rise a modest 4 percent in 2015, on average, slightly higher than last year but lower than typical recent Increases. Even so, more employers say they’re making changes to their health plans in 2015 to rein in cost growth….They are motivated in part by upcoming changes mandated by the health law.” Michelle Andrews in Kaiser Health News.

Cities are eliminating health benefits once promised to retirees. Can Obamacare fill the gap? “Indeed, public employers across the country may soon begin following Detroit’s lead and withdrawing coverage for retirees, instead sending them to the health-care exchanges set up by the Affordable Care Act. ‘Since the passage of the Affordable Care Act, I think it is fair to say that every public-sector employer is looking at the exchanges as a potential way to get out of the unfunded liabilities that the public sector is bearing,’ said Olivia Mitchell, executive director of the Pension Research Council and a Wharton professor. ‘People are becoming more expensive to take care of.’” Alana Semuels in The Atlantic.

Medicaid backlogs could worsen once Obamacare signup season arrives. “The delays stem from various technical problems and the sheer volume of Medicaid applications states must process. Some applications that come through the federal enrollment site, HealthCare.gov, and are transferred to the states still have problems with data accuracy, said Matt Salo, executive director of the National Association of Medicaid Directors. While consumers can apply for Medicaid anytime, an influx is expected when exchanges reopen for enrollment on Nov. 15 and eligible applicants go into the Medicaid system.” Stephanie Armour in The Wall Street Journal.

Other health care reads:

Your guide to Medicare open enrollment. Jonnelle Marte in The Washington Post.

U.S. finds many failures in Medicare plans. Robert Pear in The New York Times.

KLEIN: Obfuscating on Obamacare in Kentucky. “In attempting to navigate this environment, McConnell has staked out a position that’s incoherent — arguing that he wants to wipe out the awful entity ‘Obamacare,’ while trying to create the impression that it wouldn’t affect anybody’s benefits….But Grimes wasn’t being forthright either. It’s popular to criticize Republicans for attacking Obamacare without offering an alternative. On the flip side, Grimes vowed to streamline and fix Obamacare, without offering a single workable suggestion for how she’d go about it.” Philip Klein in the Washington Examiner.

Top opinion

THOMA: What’s the best way to overcome rising economic inequality? “So my approach to fighting inequality in the short-run is to use taxation and corrective redistribution to ensure that workers receive the income they deserve, to fix the distributional problems that have allowed those at the top to capture more than their fair share of income, and enact supply-side incentives that have been shown to work as soon as possible. The hope is that the supply-side policies and corrections to the distribution of income will produce the types of jobs and equitable compensation that are needed to solve the inequality problem in the longer run. But there’s a chance that no matter what we do, the inequality problem will persist.” Mark Thoma in The Fiscal Times.

FEYMAN: Are private exchanges the future of health insurance? “In 2014, about 2.5 million people across companies of all sizes will be enrolled in health insurance through so-called private exchanges. These are analogous in some ways to Obamacare’s state and federal-based health insurance exchanges but instead are run by private consultancies like Aon Hewitt or Mercer. While these platforms generally offer a similar ‘e-commerce’ approach to purchasing health insurance — either with a single carrier or multiple carriers offering plans — as the public exchanges do, there remain key differences.” Yevgeniy Feyman in Forbes.

PORTER: The risks of cheap water. “As climate change and population growth further stress the water supply from the drought-plagued West to the seemingly bottomless Great Lakes, states and municipalities are likely to impose increasingly draconian restrictions on water use. Such efforts may be more effective than simply exhorting people to conserve. In August, for example, cities and towns in California consumed much less water — 27 billion gallons less — than in August last year. But the proliferation of limits on water use will not solve the problem because regulations do nothing to address the main driver of the nation’s wanton consumption of water: its price.” Eduardo Porter in The New York Times.

McARDLE: Don’t care about the deficit? Now you should. “As the Fed tightens up on monetary policy, our borrowing costs are going to rise, not just for the new debt we take on, but also for the debt we already have. As old debt matures, we’ve been borrowing at record-low interest rates, which has helped hold down the deficit. But as the Fed tightens, that party will end, and the numbers will start moving in the other direction. This will take time — the Obama administration has been actively working to lengthen its debt maturities in order to take advantage of the low rates. But in future years, this will place constant upward pressure on our deficit.” Megan McArdle in Bloomberg View.

CRAWFORD: A Nobel-winning message for the FCC. “Jean Tirole’s Nobel Prize in Economic Sciences is being celebrated on both sides of the Atlantic by academics and economists. But there is no joy in the power circles of U.S. telecommunications policy. More than a decade ago, federal policy makers turned their backs on Tirole’s sensible assessments of private communications utilities — and with disastrous results. Tirole’s insight was that any company controlling physical lines into homes and businesses, left to its own devices, would act as a natural monopoly, extracting tribute from every other business and customer that depends on communications capacity. To constrain that power, regulators might need to separate wholesale and retail communications-access services, and require interconnection with other networks.” Susan Crawford in Bloomberg View.

FRIEDMAN: A pump war? “Bottom line: The trend line for petro-dictators is not so good. America today has a growing advantage in what the former Assistant Energy Secretary Andy Karsner calls ‘the three big C’s: code, crude and capital.’ If only we could do tax reform, and replace payroll and corporate taxes with a carbon tax, we’d have a formula for resiliency and success far better than any of our adversaries.” Thomas L. Friedman in The New York Times.

Science interlude: Schrödinger’s cat — the thought experiment, explained.

2. How America is treating its Ebola patients

Breaking: 2nd worker who cared for Ebola patient tests positive. “The worker reported a fever Tuesday and was immediately isolated at Presbyterian hospital. Preliminary tests were performed late Tuesday by the laboratory for the Texas Department of State Health Services in Austin, and the positive results were received at about midnight. Additional tests to confirm the positive reading were underway by the federal Centers for Disease Control and Prevention in Atlanta. Officials interviewed the worker to identify anyone else who might have been exposed, the Texas Department of State Health Services said in a statement, but it was unclear whether any others were being monitored.” Manny Fernandez in The New York Times.

As nurses balk at protocols, hospital, CDC to ramp up its response measures. “A nurses’ union released a scathing statement that it said was composed by nurses at the Dallas hospital where the nurse, Nina Pham, 26, contracted Ebola. The statement told of ‘confusion and frequently changing policies and protocols,’ inadequate protection against contamination and spotty training….Officials at the hospital, Texas Health Presbyterian Hospital, defended their efforts to ‘provide a safe working environment,’ but said they would review any concerns raised by nurses. C.D.C. officials…pledged to dispatch within hours a newly created response team to any hospital that had a confirmed case of Ebola, and they increased the amount of expertise, oversight and training at the hospital.” Manny Fernandez and Jack Healy in The New York Times.

Nurse with Ebola was given serum from surviving American doctor. “In late July, when it looked like Dr. Kent Brantly wasn’t going to make it, a small news item escaped Liberia. It spoke of Brantly’s treatment — not of the Ebola vaccine, Zmapp, which Brantly later got. But of a blood transfusion. He had ‘received a unit of blood from a 14-year-old boy who had survived Ebola because of Dr. Brantly’s care,’ the missive said. Now months later, Brantly, who has since recovered from his battle with the virus, has passed on the favor. A 26-year-old Dallas nurse named Nina Pham, who contracted the illness while treating the United States’ first Ebola patient, has received Brantly’s blood.” Terrence McCoy in The Washington Post.

Why not give this blood to everyone? “It’s sheer luck that Brantly has been a match for all three. Another Ebola survivor, missionary Nancy Writebol, offered blood to Thomas Eric Duncan, but it wasn’t a match. Duncan died last week. The use of what’s called convalescent serum — blood from survivors of Ebola — is also controversial. It’s not clear whether it helps patients recover, although Brantly also received serum, in his case from a boy he treated in Liberia….Is there a way to make a ‘universal’ donor? Is there some way to make blood that doesn’t react with anyone’s blood? That’s what the makers of the experimental drug ZMapp are trying to do.” Maggie Fox in NBC News.

Company puts sole focus on experimental Ebola drug ZMapp. “As Ebola continues to ravage West Africa and spreads for the first time in the United States, a Kentucky company is putting all other work aside to concentrate solely on producing the experimental medicine ZMapp. The goal: to ramp up production of the drug and get it approved and to the people who need it more quickly. Kentucky BioProcessing, contracted by privately held drugmaker Mapp Biopharmaceutical of San Diego to produce ZMapp, makes the compound using tobacco plants. The plants act as ‘photocopiers’ to mass-produce proteins.” Laura Ungar in USA Today.

Chart: Experimental drugs used for Ebola. The Washington Post.

Experts question ethics of placebo trials for Ebola drugs. “A group of influential health experts has argued the standard practice of using placebos in drug trials would be unethical in the case of experimental medicines for Ebola, given that the world is in the middle of a deadly epidemic….A different group of disease experts last month argued in a letter to the Journal of the American Medical Association that experimental Ebola drugs were best tested in normal RCTs. A similar debate is going on in the field of cancer drugs, where researchers increasingly question whether randomisation — where some patients are given a treatment and others get a ‘control’ substance for comparison — makes sense in patients with an incurable disease.” Kate Kelland in Reuters.

Explainer: A summary of promising Ebola therapies. Liz Szabo in USA Today.

The long quest for a vaccine slowed by ethics, politics and science. “The insidious nature of the Ebola virus has been among the hurdles in the long, elusive quest to develop an effective vaccine and treatment for one of the most dangerous viruses the world has ever known. Progress also has been slowed by the hazards that come with researching it and — perhaps more than anything else — by the economic and moral questions of focusing on a pathogen that until the current outbreak had infected fewer than 2,400 people worldwide….In the coming months, as caregivers, politicians, and armies struggle to deal with the spiraling number of cases, a handful of vaccines and treatments will be tested on humans for the first time.” Karen Weintraub in National Geographic.

Has virus mutated to become more dangerous? We don’t know yet. “While scientists don’t fully understand what the changes mean, some are concerned that alterations in the virus that occur as that pathogen continues to evolve could pose new dangers. Researchers have identified more than 300 new viral mutations in the latest strain of Ebola, according to research published in the journal Science last month. They are rushing to investigate if this strain of the disease produces higher virus levels — which could increase its infectiousness. So far, there is no scientific data to indicate that.” Robert Langreth, Michelle Fay Cortez and John Lauerman in Bloomberg.

KLEIN: Panic, but not because Ebola threatens the US. “if Ebola becomes endemic in West Africa, all this will get much worse. In addition to the ongoing breakdown in basic services, it will be harder for West Africans to travel because few countries will let them in, it will be harder for them to trade because fewer businessmen will want to travel to the region, it will be harder for them to invest because international bankers will be scared off by the disease. It could set the region’s development back decades. That’s worth panicking over, not because it might kill vast numbers of Americans, but because it might cause a vast amount of human suffering. So yes, panic about Ebola. But if you live in the United States, calm down, it’s not going to kill you.” Ezra Klein in Vox.

GOTTLIEB AND TROY: Countering the domestic Ebola threat. “Health care professionals at all levels are of course not perfect and will make mistakes. Hospital protocols and public health preparedness plans must leave room for human error — especially when it comes to very hot pathogens like Ebola. But the CDC must do a better job of establishing clear and accurate procedures, take appropriate measures to reduce risk, and properly calibrate its public statements, if we’re going to inspire the public confidence that will be needed to prevent disruptions in the likely event of a wider, future outbreak.” Scott Gottlieb and Tevi Troy in Forbes.

TORREY: How the US made the Ebola crisis worse. “A 1974 report on the ‘Brain Drain’ for the House Foreign Affairs Committee noted that the current policy was widening the gap between rich and poor nations, and warned that the policy ‘has a great potential for mischief in the Nation’s future relations with the LDC [less developed countries].’ Despite such complaints, U.S. policy has continued to encourage the immigration of physicians and other health workers from poorer countries….The consequences of this policy may be more than ‘mischief.’ Ebola may be merely the first of many prices to be paid for our long-standing but shortsighted health manpower policy.” E. Fuller Torrey in The Wall Street Journal.

Animals interlude: A wrinkly bulldog puppy attempts to howl.

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Westhill Healthcare Consulting Jakarta fraud prevention review Wonkbook: Why the Obama administration won’t oversell Obamacare in year two

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