Thursday Short Cuts

Native Americans can get an exemption from the requirement that everybody have health insurance. Under the health law, however, many Native Americans can get coverage under Medicaid, which serves low-income Americans, or buy subsidized plans through insurance exchanges. That allows them to receive treatment from private doctors and hospitals rather than rely solely on government and tribal facilities.

And the coverage allows Indian health facilities, which tribal leaders say are chronically underfunded, to bill insurers for care they already provide. And that additional revenue means doctors and hospitals can also offer new services.

Advocates also see the health law as a chance to reduce the health disparities that have long afflicted Native Americans, including rates of diabetes that are three times higher than the U.S. population and a life span that is four years shorter.

"The Affordable Care Act is starting to fill the gap between need and current resources," says Doneg McDonough, a consultant to tribes on implementation of the health law. "And it is a huge gap that has to be filled in."

As an aside, the article includes an updated hard number for how many Native Americans are covered by the Indian Health Service: About 2.2 million across 35 states.

The DC Health Benefit Exchange Authority (HBX) announced the launch of the DC Health Link Universal Doctor Directory 1.0, and the introduction of a Spanish Language Beta version on

According to the District government agency in charge of the Affordable Care Act-mandated exchange, DC Health Link’s Universal Doctor Directory makes it possible for customers to easily search for doctors – in English and Spanish – by name, location, specialty, and determine which qualified health plans (QHPs) those doctors accept.

According to the report, VHA's enrollment system one year ago had roughly 867,000 "pending" records. VA's OIG found that about 35% of the pending claims were for veterans who investigators determined were deceased (Muchmore, Modern Healthcare, 9/2). The report cautioned that "data limitations" prevented investigators from ascertaining the number of now-deceased veterans who applied for benefits and when such veterans had applied. More than 50% of applications labeled as pending as of last year lack application dates, meaning VA OIG "could not reliably determine how many records were associated with actual applications for enrollment," according to the report (Daly, AP/Time, 9/2).

The Hawaii Health Connector is being criticized for the second time by the state auditor for wasting taxpayer dollars.

In a follow-up report released Tuesday, state auditor Jan Yamane repeated criticism about the state health insurance exchange’s officials improperly awarding contracts and wasting more than $11 million, The Honolulu Star-Advertiser reports ( In an initial audit in January, she said officials didn’t follow proper procedures for awarding contracts, which puts federal grants at risk.

The Affordable Care Act (ACA), passed in 2010, expressly requires transparency for health plans, including those sold inside, and outside of, the exchanges through which tax subsidies are available to individuals and businesses.  Given the phenomenal commitment of taxpayer resources to health insurers this seemed a reasonable tradeoff.  However, under the leadership of Marilyn Tavenner, the future head of America’s Health Insurance Plans, the Obama administration slow-walked implementation of this requirement.

The White House is calling for a “more aggressive strategy” to reduce improper payments made by Medicare and the Affordable Care Act, according to a newly-public letter to the Department of Health and Human Services.

The Center for Public Integrity obtained the February letter from Office of Management and Budget Director Shaun Donovan to HHS Secretary Sylvia Burwell after a Freedom of Information Act lawsuit.

In the letter, Donovan directs HHS to develop plans to reduce improper payments made by Medicare and the ACA.

“While some progress has been made on this front, we believe a more aggressive strategy can be implemented to reduce the levels of improper payments we are currently seeing,” Donovan wrote.

The New Mexico Health Insurance Exchange has released a new request for proposals (RFP) aimed at assessing "consumer behavior and stakeholder engagement" across the state. In short, NMHIX wants to better understand why the uninsured are remaining uninsured.

According to Linda Wedeen, senior director of communications, marketing and outreach for NMHIX, while the organization has conducted polls and surveys about the health care market in New Mexico before, they've never engaged in an assessment at this level.