Sen. Mitch McConnell faces diverse pressures on the question of repealing the federal health-reform law

Incoming Senate Majority Leader Mitch McConnell says he still wants to get rid of Obamacare, and the Kentuckian is "under rapidly increasing pressure from conservatives to pursue an aggressive path to repealing the landmark health care law," but it won't be easy, Jennifer Haberkorn reports for Politico.

Ardent conservatives are calling for repeated repeal votes under budget reconciliation, which requires only 51 votes, not the 60 usually needed to do significant business in the Senate. But establishment Republicans "barely mentioned Obamacare" the day after the election, Haberkorn notes. McConnell indicated that 60 votes are needed for repeal, and it takes 67 votes to override a presidential veto.

"McConnell has said that he wants to use the Senate appropriations process to starve funding to the law. When asked about his strategy on Wednesday, he said Republicans would be 'addressing that issue in a variety of different ways' and hinted at using reconciliation by saying that 'There are some things we can do with 51 votes'," Haberkorn writes. "Reconciliation is tricky — it would require Congress to pass a budget resolution, which is no easy task, and in the end, even a successful Obamacare repeal bill would just get vetoed anyway. And by the time they’re done, Republicans would have squandered potentially months of their new majority debating health care."

Several Republican sources say that McConnell will all but certainly hold an early, symbolic full repeal vote that is expected to generate support from every Republican and probably no Democrats. It will fail to overcome the 60-vote threshold for a filibuster. Beyond that, the Republican conference will collectively decide the strategy: a full-bore attack on as much of the law as possible, or a selective picking and choosing of the most vulnerable pieces of the law," such as its tax on medical devices and the coming mandate that employers of more than 50 people insure employees who work 30 or more hours a week.

"While Obamacare on the whole remains unpopular, there are pitfalls in any repeal strategy that includes popular parts of the law," Haberkorn notes. "That includes helping people with pre-existing conditions get covered, the subsidies that make insurance more affordable, and the exchanges, which is particularly popular in McConnell’s home state of Kentucky."

Still, "In some quarters, anything other than the full-scale assault is unacceptable," Haberkorn reports. "When McConnell stated on Fox News the other day the simple fact that Republicans couldn’t repeal the whole thing, the backlash was swift. The Senate Conservatives Fund, which backed his Kentucky Tea Party primary opponent, accused him of being insufficiently committed and of 'making excuses for why he won’t deliver on his central campaign promise.' McConnell’s aides had to send out statements restating how much he despised the health law."

The price for health care could be right, if it's known

By Molly Burchett
Kentucky Health News

People often shop around and compare prices when making a large purchase, and some consumer advocates, employers and health plans are pushing for price transparency in health care so it's easier for consumers to compare prices. However, many questions remain about whether or not price transparency is possible, or if it would even affect health costs and outcomes.

Making it easier for consumers and patients to compare prices encourages them to look around for a better deal, says a study published in the Journal of the American Medical Association. The study focused on the use of Castlight Health's online pricing platform and explored whether there was a reduction in costs to employers and employees for laboratory tests, advanced imaging services and clinician office visits.

Lab tests and imaging saw the biggest savings in the study, dropping 14 percent and 13 percent, and primary care offices visits also dropped by 1 percent, according to the study. Additionally, the study showed that claim payments were lower for all services for employes who used Castlight versus those employees who did not.

But less expensive care doesn't always equal higher quality care. Price transparency’s impact is realized only to the extent that it empowers consumers and influences their behavior, and price is only one of the variables that consumers need to evaluate the value of health services.

"One thing the study can't answer is whether patients are making better decisions or just cheaper ones. They're finding lower-cost options, the study finds, but it doesn't tell us how patients are taking into account things like patient satisfaction, years of clinician experience and other provider characteristics," writes Jason Millman of The Washington Post.

Another important thing the study both can't and wasn't designed to predict is whether transparency will reduce overall health spending, writes Millman. Health-care economist Uwe Reinhardt writes, in a separate JAMA editorial, that early results of research suggest that price transparency in health care can result in less spending.

Other experts have expressed doubts about this "free market" approach. In a Huffington Post article, physician and systems theorist Deane Waldman says that price is not one of the pieces of information consumers need to re-install free market forces into health care because the present health-care market in the U.S. is not free.

"The consumer can have all the information in the world, but without control of his/her own money, and without sellers competing for those dollars, the market will not work. One cannot have the advantages of free market forces if the market is not free," writes Waldman.

Similarly, Reinhardt says that comparing the costs of procedures only works if people have a choice between healthcare providers. That may be a major complication for Kentuckians in rural areas where providers may be scarce or insurance coverage may not be comprehensive.

Massachusetts is the first state to mandate some level of price transparency. However, resistance from both provider and payer communities suggests that large-scale adoption of transparency initiatives will likely be both heavily debated and slow.

Early-childhood specialists want to help parents teach kids good oral-health habits; 40 percent have cavities by kindergarten

A recent report by the American Academy of Pediatric Dentistry showed that cavities are the most chronic disease for young children in the U.S. More than 40 percent of children suffer from tooth decay before kindergarten, Greg Stotelmyer reports for Public News Service. Groups of early-childhood professionals gathered in Louisville Thursday to learn how to educate parents to help improve their children's oral health.

Dr. Laura Hancock Jones, an outreach dentist with the University of Kentucky, emphasized the importance of teaching children how to brush their teeth and avoid too many sugary drinks before they turn 2. "We really need to foster the oral-health knowledge of those parents and not really delay that until [their children] are into preschool or elementary population," she said.

Molly Oliver, who runs a day-care center for the Trigg County school system, is one of those learning how to teach parents how to foster good health habits in their children. "We want to help build a relationship with our parents to try to help the parents and the children have better oral health for their families," she said.

Jones noted that food and beverage companies' marketing is making it harder for parents to steer their children away from unhealthy products. Parents need to make sure their children are brushing their teeth both morning and night. "And, for parents to understand that until their child is in second grade, they don't have the dexterity to get the job done themselves," she said. "You know, it's not enough for a parent to say, 'Hey, go brush your teeth,' when you're dealing with a 3-year-old. They still need to be in there doing the work themselves."

The Kentucky Oral Health Coalition is partnering with the UCLA Health Care Institute and the Governor's Office of Early Childhood to offer $1,000 grants to train early childhood professionals in 10 communities, Stotelmyer reports. The trainers will strive to provide children with the support of adults—both parents and child care professionals—who can help them understand how to maintain good oral health. (Read more)

Exit poll: Half of voters say Kynect works well, but almost as many say Obamacare went too far; 45% favor pot legalization

An exit poll of voters in Tuesday's election showed that half of them thought the state's health-insurance exchange, Kynect, is working well, but almost as many thought the federal health-reform law went too far.

Asked how Kynect is working, 21 percent of the electorate said it was working very well, and 29 percent said it was working somewhat well. About 13 percent were undecided, while 21 percent said it was not working too well and 15 percent said it was not working well at all.

Asked about the 2010 law that allowed creation of Kynect and subsidizes the health coverage obtained through it, 46 percent said it went too far, 22 percent said it was about right and 26 percent said it didn't go far enough.

The poll was taken primarily for the U.S. Senate race, and CNN cross-tabbed the two sets of results:

In another question that could be health-related, 45 percent of voters said they were in favor of legalizing marijuana in Kentucky while 52 percent opposed it. The poll report on CNN did not give the survey's margin of error.

Most Kentuckians who bought health insurance on Kynect will pay higher premiums next year

Most premiums for private health insurance purchased through Kentucky's health insurance exchange, Kynect, will increase in 2015.

Most of the people who have used Kynect have been added to Medicaid, the government health insurance program for the poor and disabled. Only about 85,000 Kentuckians used the site to purchase private plans.

Health insurance companies have filed their rate requests for 2015, and the state Department of Insurance has approved most of them, reports Adam Beam of The Associated Press.

Officials have approved a 15 percent average rate increase for the Kentucky Health Cooperative, which sold 75 percent of private plans on the exchange.

Humana and Anthem Blue Cross Blue Shield each sold 12.5 percent of the private plans on Kynect. Humana's premiums will rose an average of 12.8 percent, but rates for Anthem will go down an average of 4.3 percent, Beam reports. Rates apparently have not been set for two new companies that will join the exchange, CareSource and WellCare.

"Rates off the exchange are increasing, too, in both the small group and individual markets," writes Beam. For example, Time Insurance Co.'s individual rates will go up an average of 15 percent, and the small group rates for Time, Bluegrass Family Health and John Alden Life Insurance Co. will rise an average of 5 percent.

Department of Insurance spokeswoman Ronda Sloan told Beam that rates for large group plans were not available yet. The rate certification process will be finalized before open enrollment, which begins on November 15, 2014 and runs through February 15, 2015.

The averages can be misleading because that Kynect offers approximately 70,000 different rates, which vary depending on numerous variables, such as the type of plan, where people live, how old they are and whether they smoke.

Kynect was one of the few online health insurance portals that actually functioned when Obamacare launched a year ago. An estimated 521,000 Kentuckians have obtained insurance through the website, reducing the state's uninsured rate from 20 percent to 12 percent, Democratic Gov. Steve Beshear said in a recent video update.

Beshear said this sharp reduction in the uninsured proves that Kynect is working. Republicans say higher insurance premiums and difficulty finding doctors prove it isn't.