Daily Health Policy Report

Thursday, February 20, 2014

Last updated: Thu, Feb 20

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Dental Services Are Coming Back For California's Low-Income Adults

Kaiser Health News staff writer Daniela Hernandez, working in collaboration with the San Jose Mercury-News, reports: "Across the state, many low-income California adults lack dental insurance or access to dental care, threatening their overall health, self-esteem and employability. Many end up with infected gums, decayed teeth and other complications that must be treated in emergency rooms -- at considerable cost to the government" (Hernandez, 2/20). Read the story.

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Insurance, Not Injuries, May Determine Who Goes To Trauma Centers

Kaiser Health News staff writer Sarah Varney reports: "It’s called ‘patient dumping’ – when hospitals transfer patients without insurance to public hospitals. But a new study from Stanford University has turned dumping on its head. It finds that hospitals are less likely to transfer critically injured patients to trauma centers if they have health insurance" (Varney, 2/19). Read the story.

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Capsules: California Faces Steep Challenges As Obamacare Launches, Report Finds

Now on Kaiser Health News' blog, Daniela Hernandez reports: "As it prepares to offer coverage to its millions of uninsured residents through the Affordable Care Act, California faces daunting challenges and provides useful lessons for the rest of the nation, according to a survey and analysis released Wednesday in Washington, D.C. The Kaiser Family Foundation’s report, based on a survey of 2,500 adult Californians before enrollment began in October, provides a preliminary look at the roadblocks that could hinder the implementation of the law (Hernandez, 2/20). Check out what else is on the blog.

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Missouri House Republican Files Medicaid Expansion Bill

The St. Louis Post-Dispatch's Virginia Young, working in partnership with Kaiser Health News, reports: "A Republican House member has filed a bill to expand Missouri's Medicaid program, but the bill has a new twist. To be eligible, working-age Medicaid recipients would have to have jobs, said the sponsor, Rep. Noel Torpey, R-Independence. Some participants also would have to pay monthly premiums" (Young, 2/20). Read the story.

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Corbett's Final Medicaid Expansion Plan: Gentler, But Still An Outlier

The Philadelphia Inquirer's Amy Worden and Don Sapatkin, working in partnership with Kaiser Health News, report: "Pennsylvania Gov. Tom Corbett's administration on Wednesday submitted a softer version of its Medicaid proposal that restores some benefits, but is still viewed by analysts as the most extreme state plan to expand coverage under the Affordable Care Act" (Worden and Sapatkin, 2/20). Read the story.

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Political Cartoon: 'Covered Procedure?'

Kaiser Health News provides a fresh take on health policy developments with "Covered Procedure?" by Gary Varvel.

And here's today's health policy haiku:


Latino sign-ups...
Rising or falling? Sometimes
headlines are at odds.

If you have a health policy haiku to share, please send it to us at http://www.kaiserhealthnews.org/ContactUs.aspx and let us know if you want to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

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Health Reform

Delayed Obamacare Deadlines 'Far From Unprecedented'

Enforcement of a variety of sweeping new laws has often been delayed, Bloomberg News reports. Meanwhile, Vice President Joe Biden said Wednesday that Obamacare enrollment is off to a "hell of a start."

Bloomberg: Obamacare Rewrites Of Health Law Rile Republicans
President Barack Obama’s repeated postponement of deadlines in the rollout of his health-care overhaul has sparked accusations from Republicans that he’s straying into dangerous territory by rewriting the law. He’s not the first president to follow his own timetable instead of the one passed by Congress ... Deadlines set in laws are “aspirational dates,” said Ross Baker, a political science professor at Rutgers University (Dorning, 2/20).

The Star Tribune: Biden In Minneapolis: Health Insurance Signup Is 'Hell Of A Start'
Vice President Joe Biden told visitors to a Minneapolis coffee shop on Wednesday that the millions of people likely to sign up for health insurance before a March deadline is “a hell of a start,” despite the fact that the federal government probably will fall short of its goal. ... He used the occasion to talk about the Affordable Care Act (ACA), which has been under heavy criticism since President Obama began pushing the reform and has drawn additional ire in recent months after a botched rollout (Simons, 2/19).

The Associated Press: Biden: Health Care Sign-Ups May Fall Short Of Goal
Open enrollment under the federal law ends on March 31, after which people without insurance are subject to federal tax penalties. ... Biden acknowledged the rocky rollout of the administration's Affordable Care Act website and the difficulty people have had in signing up. ... Before the exchanges launched, the Obama administration projected monthly enrollment targets based on a congressional estimate that 7 million would sign up during the six-month open enrollment period (Condon, 2/19).

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Va. GOP Pushes State House Vote On Medicaid Expansion

The recorded vote, likely to be held Thursday, is designed to demonstrate the sweeping Republican opposition to the expansion, which is one of Gov. Terry McAuliffe's main legislative goals. In addition, for the second day in a row, Arkansas legislators voted down a Medicaid compromise bill. News outlets also offer related updates from Wyoming, Montana, Pennsylvania, Missouri, Georgia and Utah.  

The Washington Post: Expanded Medicaid Will Be Subject Of Forced Vote By Republicans In Va. House
House Republicans will force a vote Thursday on whether to expand Medicaid, briefly plucking the contentious issue out of a massive state budget bill in a move meant to show overwhelming GOP opposition to Gov. Terry McAuliffe’s top legislative goal. The House will subject the expansion plan to an up-or-down floor vote — something the measure would not ordinarily get since it is part of the two-year, $96 billion state spending plan (Vozzella and Laris, 2/19).

The Richmond Times-Dispatch: House Sets Up Vote On Senate Medicaid Plan
House Republicans have filed a budget amendment mirroring the Senate’s approach to extending health care coverage, setting the stage for a robust debate and recorded vote on the proposal. Today the House of Delegates and the state Senate will vote on their versions of the state’s two-year spending plan. “We have stated all along that our caucus is opposed to Medicaid expansion. We want reforms first,” Del. S. Chris Jones, R-Suffolk, chairman of the House Appropriations Committee, told reporters Wednesday. “This will certainly demonstrate as to where the House is vis a vis Medicaid expansion” (Meola and Schmidt, 2/20).

The Associated Press/Washington Post: House To Vote On Senate Medicaid Plan
Republicans in the Virginia House of Delegates are set to vote against a proposal to accept federal Medicaid funding. A largely symbolic full floor vote is scheduled for Thursday. Republican leaders said they wanted to show they are united in opposition to a proposal by the Democratically controlled Senate to expand publicly funded health insurance coverage for low-income Virginians (2/20).

The Associated Press/Washington Post: Ark. Legislators Vote Down Medicaid Bill Again
Arkansas legislators have defeated for a second day in a row a compromise plan to expand Medicaid by purchasing private insurance, leaving the state’s health program for poor residents in jeopardy. The House voted 68-27 Wednesday to reauthorize funding for the “private option,” falling seven votes shy of the 75 needed to continue the program (2/19).

The Associated Press: Senate Committee Won’t Vote Wednesday On Medicaid
A legislative committee that heard public testimony Wednesday in favor of a bill that would expand Medicaid in Wyoming didn't vote on the matter and the committee chairman said it likely wouldn't vote Thursday, either. Sen. Charles Scott, a Casper Republican, said he wouldn't call the Senate Labor, Health and Social Services Committee back into session Wednesday because the full Senate was working into the evening (Neary, 2/19).

Helena Independent Record: Medicaid Expansion Initiative Passes Legal Review
A proposed voter-initiative to expand Medicaid for at least 70,000 low-income Montanans has passed its legal review by state officials, allowing supporters to start working to qualify it for the November ballot. Attorney General Tim Fox’s office on Tuesday found the initiative to be “legally sufficient,” one month after he identified problems with an earlier version of the initiative proposal (Dennison, 2/20).

The Associated Press: Pa. Governor Seeks US Approval Of Medicaid Plan
Gov. Tom Corbett began seeking federal approval Wednesday for his plan to bring billions of federal Medicaid expansion dollars to Pennsylvania to cover a half-million working poor residents through private health plans, although advocates for the poor and uninsured called it bureaucratic and punitive. The Corbett administration submitted the plan to the U.S. Centers for Medicare and Medicaid Services, which has given at least partial approval to proposals by other states, including Arkansas and Iowa, that sought similar modifications to the Medicaid expansion envisioned by the 2010 federal health care law (Levy, 2/19).

Pittsburgh Post-Gazette: Pennsylvania Pushing Medicaid Plan To D.C.
Months after outlining a controversial proposal to overhaul the state's Medicaid program, officials from Gov. Tom Corbett's administration said Wednesday they are submitting their plan to the federal government -- though it has been somewhat modified after seven public hearings around the state. However, the "Healthy PA" plan still retains some of what critics say could be hurdles to federal approval: work search requirements for applicants and premiums for some low-income Medicaid enrollees. To make those changes, the state needs a waiver from the federal government, and that's why the state is submitting a waiver application (Giammarise, 2/19).

The Philadelphia Inquirer: Corbett's Final Health Plan: Gentler, But Still An Outlier
The Corbett administration on Wednesday submitted a softer version of its Medicaid proposal that restores some benefits, but is still viewed by analysts as the most extreme state plan to expand coverage under the Affordable Care Act. The state seeks to use federal Medicaid dollars to subsidize commercial insurance for hundreds of thousands of uninsured Pennsylvanians. Just two other states have won approval for the type of alternative coverage plans Gov. Corbett wants to pursue (Worden and Sapatkin, 2/19).

St. Louis Post-Dispatch: Medicaid Expansion Bill Filed By Republican Legislator Who Chaired Hearings
A Republican House member has filed a bill to expand Missouri's Medicaid program, but the bill has a new twist. To be eligible, working-age Medicaid recipients would have to have jobs, said the sponsor, Rep. Noel Torpey, R-Independence. Some participants also would have to pay monthly premiums (Young, 2/18).

Georgia Health News: A Clash Of Views – And Numbers – On Expansion
The issue of Medicaid expansion drew its first full-scale 2014 General Assembly hearing Wednesday. As expected, the arguments reflected the passions surrounding the Affordable Care Act, also known as Obamacare. A House Judiciary subcommittee voted to pass HB 990, which would require the Legislature to approve any expansion of Medicaid here, rather than leaving the decision up to the governor alone. At least for the foreseeable future, this would appear to put another obstacle in the path of expansion in Georgia (Miller, 2/19).

The Salt Lake Tribune: Herbert Calls House Medicaid Plan ‘Illogical’
Gov. Gary Herbert said Wednesday a health-insurance proposal unveiled by House Republican leaders was "illogical," adding that the state should take federal dollars to provide Medicaid coverage for 54,000 Utahns living below the poverty line. "The Utah taxpayers should not have to pay more and help fewer people, and that’s the proposal I see from the House that causes me concern," Herbert said during his monthly KUED news conference. "That seems to be illogical to me" (Gerhke, 2/19).

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Ca. Sign-Ups Continue To Soar -- Latino Enrollment Viewed As Critical

Covered California has almost reached its enrollment goal for March 31, according to numbers released Wednesday. Still, the state plans to spend millions on Spanish-language advertising in the weeks remaining before the open enrollment period ends next month.   

The San Jose Mercury News: Obamacare: California's Health Insurance Enrollment Soars
With nearly six weeks to go before open enrollment ends under the new federal health care law, more than 1.7 million Californians have signed up for health coverage since Oct. 1, according to the state's insurance exchange. Through Feb. 14, the number who bought a private insurance plan on the Covered California exchange shot up to 828,638, almost reaching the 830,000 goal it hoped to hit by the March 31 open enrollment deadline. "This shows how strongly Californians are stepping up to take advantage of the Covered California opportunity,'' Peter Lee, the exchange's executive director, said at a news conference Wednesday (Seipel, 2/19).

The Associated Press: California Health Exchange Tops 800,000 Sign-Ups
More than 800,000 Californians have signed up for insurance through mid-February on the state's health care exchange. Covered California, as the exchange is known, released updated enrollment figures Wednesday showing that nearly 829,000 people had signed up for individual policies through the first two weeks of February (2/19).

The New York Times: California Health Insurance Enrollments Rise, But Hispanics Still Lag
With six weeks left in the open enrollment period for insurance under President Obama’s health care law, more than 828,000 Californians have signed up for private coverage through the state’s online health care exchange, state officials announced Wednesday (Lovett, 2/19).

Los Angeles Times: More Latinos Enrolling In Covered California Health Plans
More Latinos are signing up for Obamacare coverage in California after a slow start, and the state is spending millions of dollars more on Spanish-language ads ahead of next month's enrollment deadline. The Covered California insurance exchange said Wednesday that 828,638 people overall have enrolled in private health plans through mid-February, and an additional 1 million Californians have been deemed eligible for an expansion of Medi-Cal, the state's Medicaid program (Terhune and Karlamangla, 2/19).

CBS News: California Struggles To Get Latinos To Sign Up For Health Coverage
The state of California said Wednesday that more than 828,000 have signed up for coverage through the state's health insurance exchange, which was established under Obamacare. California is now on pace to beat enrollment projects. But few Latinos are signing up. CBS News set out to find out why (Tracy, 2/19).

Kaiser Health News: Capsules: California Faces Steep Challenges As Obamacare Launches, Report Finds
As it prepares to offer coverage to its millions of uninsured residents through the Affordable Care Act, California faces daunting challenges and provides useful lessons for the rest of the nation, according to a survey and analysis released Wednesday in Washington, D.C. The Kaiser Family Foundation’s report, based on a survey of 2,500 adult Californians before enrollment began in October, provides a preliminary look at the roadblocks that could hinder the implementation of the law (Hernandez, 2/20).

The San Francisco Chronicle: Low-Income U.S. Citizens Can Stay In Healthy S.F. - For Now
We told you Sunday about the strange predicament of low-income U.S. citizens who are part of San Francisco's universal health care program but are being bumped out of it if they qualify for health insurance through the Affordable Care Act - even if they can't afford those premiums, co-payments and deductibles. That predicament was made even stranger by the fact that immigrants living in the country illegally can remain in Healthy San Francisco because they don't qualify for the new health insurance exchanges set up under the federal law. That means they can keep their doctors and primary care clinics and keep paying the same low quarterly fees while their U.S. citizen counterparts can't (Knight, Lagos and Cote, 2/19).

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In Maryland, Support Is Solid For Health Overhaul, State's Exchange

A new poll finds 55 percent of state residents back the federal health law, even as Maryland plans to spend $2 million to address a problem with the online insurance marketplace. In related news, the deadline is approaching for states to spend federal grants they received to set up exchanges.  

The Washington Post: Poll: Majority In Maryland Back Health Reform, Want To Stick With State Online Exchange
If President Obama is weary of complaints about his struggling health-care law, he might want to spend even more time in the reliably blue state of Maryland. Fifty-five percent of state residents back the federal health-care reform effort, according to a new Washington Post poll, with more than one-third of Marylanders saying they "strongly support" it. Nationally, opinion is much more mixed (Johnson and Craighill, 2/19).

The Associated Press/Washington Post: Health Exchange Woes Come Before Md. Board
A Denver-based company will be paid up to $2 million more to help address one of the problems resulting from computer glitches with the state’s health care exchange. The Maryland Board of Public Works on Wednesday approved the modification to the contract with Policy Studies Inc. It is needed for broker services to help Medicaid-eligible residents who applied through the health exchange to choose a managed care organization (2/19).

Marketplace: States Face Deadlines For Affordable Care Act Grants
The Affordable Care Act included grants for states to set up their own health insurance exchanges, and the deadlines for spending that money are happening this winter. Some states applied for the cash but then used little, or none, of the money because of political opposition to the law, according to Larry Levitt, a senior vice president at the Kaiser Family Foundation. "Some of the states that were actively opposed to the law have actually returned the money," he says. Other states, like New Jersey, which faces a deadline Thursday, let their deadlines expire. Levitt says states that did use the grant money were able to spend some of it on outreach (Marshall-Genzer, 2/19).

Meanwhile, some news about corporate thoughts on exchanges -

The Wall Street Journal's CFO Journal: Companies Eye Exchanges For Health Plans: Report
Most U.S. employers will continue to sponsor health benefits for their employees over the next few years, but the way that benefits are provided may begin to shift for many workers, according to a report. A third of employers plan to provide health benefits to their active employees through a private health exchange in the next three to five years, according to the report by Aon Hewitt, the consulting unit of Aon PLC, an insurance broker based in London (Kapur, 2/19).

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War of Partisan Words Ramps Up For Election Season

A conservative group and "dozens of Democrats" are adjusting their messages for the midterm election.

The Washington Post’s The Fact Checker: A Hard-Hitting Anti-Obamacare Ad Makes A Claim That Doesn’t Add Up
“I was diagnosed with leukemia. ... Congressman Peters, your decision to vote Obamacare jeopardized my health.” Michigan resident Julia Boonstra, in a new ad sponsored by Americans for Prosperity, attacking Rep. Gary Peters (D-Mich.), a candidate for the Senate. This emotional and gut-wrenching attack ad should be every Democrat’s worst nightmare ... But do the facts match the emotions? ... We will initially set this rating at Two Pinocchios, and will update if we get more information (Kessler, 2/20).

McClatchy: With Voters Still Skeptical, Dozens Of Democrats Inch Away From Obamacare
Mark Kentley is the kind of voter who will help decide the short-term political verdict on the new health care law known as Obamacare. A 27-year-old who studies business administration while working at the College of the Desert, he’s swung back and forth between the Democrats and the Republicans in the last two presidential elections. Now, he sits right in the middle of one of the most contested seats for the House of Representatives, and his dislike of the law will be a major factor in deciding who gets his vote this fall. He resents that the government is forcing him to buy health insurance he doesn’t want (Kumar, 2/20).

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Capitol Hill Watch

GOP To Challenge Health Law's Definition Of Full-Time Worker

House Majority Leader Eric Cantor says Republicans will seek to change the law's definition of full-time workers to those logging more than 40 hours a week. Meanwhile, Sen. Chuck Grassley criticizes the administration's response to questions about whether insurers must accept third-party payments to cover an enrollee's premiums.

The Fiscal Times: Obamacare’s 30-Hour Workweek Challenged By GOP
Under Obamacare's employer mandate, companies with 50 or more "full-time" employees will be required to offer health insurance to their workers or pay a penalty if at least one of their employees purchases a plan through the healthcare marketplace with a federal subsidy. In an Op-Ed published in the National Review Online, House Majority Leader Eric Cantor said the House will be focusing on changing the law's definition of "full-time employees" to workers logging more than 40 hours a week or 174 hours a month for full-time equivalents (Ehley, 2/19).

The Wall Street Journal: Grassley Scolds HHS Over Health Law Guidance
The issue: As the Journal reported in December, some hospitals want to be able to pay premiums on behalf of some people so it can guarantee they have coverage if they turn up looking for treatment. Insurers say this move would be a conflict of interest for hospitals and could threaten the economic underpinnings of the law because it would likely lead to more sick people getting enrolled (Radnofsky, 2/19). 

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State Watch

State Highlights: Ky. Malpractice Bill; DOJ Enters Whistleblower Case

A selection of health policy stories from Kentucky, Texas, Georgia, South Carolina, California, Colorado and Florida.

The Associated Press: Ky. Senate Passes Bill Creating Malpractice Panels
A panel of medical experts would review proposed medical malpractice claims against health care providers before they could be pursued in court under a bill the Kentucky Senate passed Wednesday. The party-line vote in the Republican-led Senate followed a contentious debate on an issue that has drawn powerful interest groups on both sides (Schreiner and Hodge, 2/19).

The Dallas Morning News: Texas Punishes First Clinic And Doctor Under New Abortion Law
For the first time under Texas' new abortion law, the state has penalized a clinic and a doctor for failing to meet requirements. The Department of State Health Services revoked the license of Affordable Women's Medical Center in Houston after finding that the clinic's only provider of abortions, Dr. Theodore M. Herring Jr., did not have admitting privileges at a nearby hospital. In addition, the Texas Medical Board temporarily suspended Herring's medical license, pending further action. A provision of the new law, which took effect Nov. 1, requires physicians to have admitting privileges at a hospital within 30 miles of an abortion clinic and to follow federal protocols when administering abortion-inducing medication (Martin, 2/19).

The Texas Tribune: Senate Hearing Will Assess Progress On Women's Health
The state Senate Health and Human Services Committee will hold a hearing Thursday to assess Texas' efforts to expand access to women's health services across the state. But abortion rights advocates say an essential issue has been left off the agenda -- the impact of strict abortion regulations that the Legislature passed last year (Aaronson, 2/19).

Politico Pro: DOJ Enters Whistleblower Case Against Hospitals
The Department of Justice is jumping into a whistleblower lawsuit against five hospitals suspected of Medicaid and Medicare fraud in Georgia and South Carolina. DOJ alleges the hospitals paid kickbacks to clinics serving low-income women in return for referrals to deliver their babies. Then the hospitals allegedly billed Medicaid programs in Georgia and South Carolina for the services provided to the patients, who were primarily Hispanic undocumented immigrants. Four of the hospitals — Atlanta Medical Center, North Fulton Regional Hospital and Spalding Regional Hospital in Georgia and Hilton Head Hospital in South Carolina — are owned by Tenet Healthcare Corp. Clearview Regional Medical Center is owned by Health Management Associates Inc. (Cunningham, 2/19).

Kaiser Health News: Dental Services Are Coming Back For California's Low-Income Adults
Across the state, many low-income California adults lack dental insurance or access to dental care, threatening their overall health, self-esteem and employability. Many end up with infected gums, decayed teeth and other complications that must be treated in emergency rooms -- at considerable cost to the government (Hernandez, 2/20).

Health News Colorado: Insurance Commissioner, Industry Reps, Consumers Tackle Cost Drivers
Colorado Insurance Commissioner Marguerite Salazar has convened her Health Care Cost Study Group. Salazar appointed industry representatives, health policy cost experts and consumers to the group, which began meeting last week. The Colorado resort region that includes Aspen, Vail and Garfield and Summit counties has the highest health insurance premiums in the nation, according to an analysis from the Kaiser Family Foundation. Earlier this year, Salazar decided not to change Colorado’s geographic rating system for either this year or next. But she wants the study group to produce proposals for reducing health costs and premiums by May (McCrimmon, 2/19).

The Dallas Morning News: Cost Of Care Hit Texans Last Fall
Whether or not they had health insurance, a large number of Texans were struggling with the cost of care last fall, according to a survey released Wednesday. The feelings about affordability came on the eve of the federal government’s stumbling rollout of a health insurance marketplace. ... The September survey of nearly 1,600 Texas households found 27.9 percent of those without health insurance put off medical care last year because of the cost. Among Texans with health insurance, 14.4 percent said they stayed away because of affordability (Landers, 2/19).

Health News Florida: Telemedicine Ready For Legislative Reboot
Ernestine Marshall's every move is being watched: morning, noon and night. Motion-activated sensors are everywhere in her Tampa apartment: on the toilet, the front door, even the kitchen cabinet where she stores medications help manage her multiple sclerosis. … Marshall's experience is just one way technology that didn't exist a few years ago is changing how Americans are dealing with chronic conditions and acute disease (Shedden, 2/20).

Stateline: States Combat Overdose Deaths
Overdoses are the No. 1 accidental killer of Americans 25 to 64 years old, surpassing even traffic deaths. Now states are taking action to prevent some of those deaths, many of which are attributable to heroin and the illegal use of prescription pain medications. Seventeen states and the District of Columbia have passed "Good Samaritan" laws that grant limited immunity to drug users who seek help for someone who has overdosed, according to the Trust for America’s Health (TFAH), a nonpartisan research and advocacy group based in Washington, D.C. The same number have expanded access to the medication naloxone (also known by its brand name Narcan), which can quickly reverse the effects of opioid overdoses and restore breathing to a stricken person (Ollove, 2/20).

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Weekend Reading

Longer Looks: Doctor Training For ADHD, Obamacare And Epilepsy, Clues In A Drop Of Blood

Every week reporter Ankita Rao selects interesting reading from around the Web.

The New York Times: Doctors Train To Spot Signs Of A.D.H.D. In Children
Jerry, 9 years old, dissolved into his Game Boy while his father described his attentional difficulties to the family pediatrician. The child began flitting around the room distractedly, ignoring the doctor's questions and squirming in his chair — but then he leapt up and yelled: "Freeze! What do you think is the problem here?" Nine-year-old Jerry was in fact being played by Dr. Peter Jensen, one of the nation's most prominent child psychiatrists. On this Sunday in January in New York, Dr. Jensen was on a cross-country tour, teaching pediatricians and other medical providers how to properly evaluate children's mental health issues — especially attention deficit hyperactivity disorder, which some doctors diagnose despite having little professional training (Alan Schwarz, 2/18).

Salon: Obamacare Again: How The Law's Changed Life With Epilepsy 
I was diagnosed with epilepsy at 14, after I had a seizure in my junior high school cafeteria. ... For those unaccustomed to neurological illness, navigating the healthcare system is nightmarish. A series of increasingly specialized doctors is required: not only a neurologist, but a pediatric neurologist, and not only a pediatric neurologist, but a pediatric epileptologist. ... As a sophomore in college, I worked for the national office of the Epilepsy Foundation, a nonprofit devoted to furthering the quality of life of people with epilepsy. It was there that I became aware of a pertinent and disturbing reality of this disease: It not only disproportionately occurs in the poor, but also inflicts greater suffering upon them than on their wealthy counterparts (Elizabeth Stoker, 2/14).

The New York Times Magazine: How Obamacare Could Unlock Job Opportunities
In a sense, Obamacare amounts to a massive transfer of risk. Under the old system, if you quit your job and couldn’t get health insurance, you courted financial ruin every time you did something as mundane as riding your bike or playing pickup basketball. Now that risk is distributed to everyone who buys health insurance (including the government). Free of the massive financial risk of being alive, unemployed Americans can more easily take on risks associated with doing what they want to do (Shaila Dewan, 2/20).

Politico: The Next Battle In The Abortion Wars
If you want to know how the abortion wars will be waged in the months ahead, pay attention to what’s happening far away from the media's glare, in South Dakota, a state that has long been on the front lines of America’s still very much unresolved conflict over how and when women can end an unwanted pregnancy. In both 2006 and 2008, South Dakota’s voters rejected full abortion bans, and since then anti-abortion legislators have debuted a variety of abortion restrictions meant to close the last abortion clinic in the state or promote continuing unwanted pregnancies. Within just the last few years, South Dakota has passed multiple bills to restrict abortion access (Robin Marty, 2/17).

Slate: Himalayan Bath Salts Will Not Save Your Life
Have you heard that eating whole lemons prevents cancer? Or that bathing in Himalayan salt rids the body of harmful toxins? ... If you have a few Facebook friends, you've probably encountered some of these claims. The website Natural News—which seems like a parody but is unfortunately quite serious—published these preposterous stories, and many others just as silly, last week alone. Hokum like this is best ignored, but hundreds of thousands of Americans fail to do so. ... Natural News has an uncanny ability to move unsophisticated readers from harmless dietary balderdash to medical quackery to anti-government zealotry (Brian Palmer, 2/18).

Wired: This Woman Invented A Way To Run 30 Tests On Only One Drop Of Blood
As a college sophomore, Elizabeth Holmes envisioned a way to reinvent old-fashioned phlebotomy and, in the process, usher in an era of comprehensive superfast diagnosis and preventive medicine. That was a decade ago. Holmes, now 30, dropped out of Stanford and founded a company called Theranos with her tuition money. Last fall it finally introduced its radical blood-testing service in a Walgreens pharmacy near the company headquarters in Palo Alto, California. ... Instead of vials of blood—one for every test needed—Theranos requires only a pinprick and a drop of blood. With that they can perform hundreds of tests, from standard cholesterol checks to sophisticated genetic analyses. The results are faster, more accurate, and far cheaper than conventional methods (Caitlin Roper, 2/18).  

Notre Dame Magazine: My Two Emilys
Jennifer shivers, then drapes one of the white blankets over her daughter’s shoulder. Like every hospital, this one keeps the temperature low to limit nausea. I notice the particular coolness and recoil, not from the strangeness of these circumstances but from over-familiarity. My stepdaughter, Emily, looks pale. She’s in pain, which makes her angry. She will not meet anyone's eyes or respond to their questions. She is 11 years old. The medical staff members of St. Jude Children's Research Hospital probably think they can wear her down, win her over, but I know better (Mike Smith, 2/14).

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Editorials and Opinions

Viewpoints: Democrats Turn Tail; Amending ACA Is Tough; Belgium Takes Hard Stance On Dying Kids

The Wall Street Journal: The Medicare Advantage Democrats
Democrats in competitive races seem to have gotten hall passes to try to dissociate themselves from ObamaCare heading into the midterm elections, but the White House must be ruing some of the liberties their party comrades are taking with this new political independence. Witness the parade of Democrats pleading for more money for that great liberal anathema, Medicare Advantage (2/19). 

The Wall Street Journal: Democrats Change Their Obamacare Strategy
Just a few months ago Senate Majority Leader Harry Reid said ObamaCare "will be a net positive" for Democratic candidates in 2014. Former House Speaker Nancy Pelosi proclaimed "Democrats stand tall in support of the Affordable Care Act." ... That was then. Now Democrats are circulating a new strategy memo (obtained by Politico) advising candidates to distance themselves from the law (Karl Rove, 2/19). 

The Fiscal Times: CBO Shoots An Arrow In The Heart Of Obamanomics
Live by the CBO, die by the CBO.  For the second time this month, the independent economic analysts in the legislative branch have delivered a body blow to the Obama administration’s key domestic policies. First, the Congressional Budget Office – often cited by the White House for its more sympathetic analyses of the Affordable Care Act – concluded the law would result in the net loss of the equivalent of 2.5 million full-time workers, setting up the US for slower growth even as Obamacare and other entitlement programs need more workers producing more income to survive. Republicans on the Senate Budget Committee pointed out that it would cut one trillion dollars in compensation from the economy over the next decade  (Edward Morrissey, 2/20).

JAMA: How to Fix The Affordable Care Act
Like almost every major piece of legislation, the Affordable Care Act (ACA) needed fixing virtually before the statute’s ink was dry. Any bill designed to transform one-sixth of the economy was bound to have—let us say—a few rough edges. As legislation rolls out, it's common to make adjustments. But amending the ACA poses enormous challenges (Stuart Butler, 2/19).

Los Angeles Times: Belgium's Humane Stance On Dying Kids
It's an idea that, in the death-squeamish U.S., is probably too disturbing for the edgiest TV hospital drama, let alone real life and real legislation. Last week, the Belgian Parliament passed a law allowing terminally ill children to request aid in dying. Adults there have been able to do that since 2002, and a few other European countries have similar measures. But last Thursday's action, which is expected to be signed into law by King Philippe, will make Belgium the first to extend the right to minors faced with "constant and unbearable suffering" (Meghan Daum, 2/20).

The Fiscal Times: AOL's Tim Armstrong Missed The Real Message On Health Care Costs
When AOL chief executive Tim Armstrong blundered in blaming his company's 401(k) cutbacks on "two distressed babies" recently, he missed an epic opportunity to identify the bete noire of employer-sponsored U.S. health care. Employers who have health coverage for their employees are relying upon a flawed, unsustainable model that's slowly imploding. Although Armstrong later walked back his comments, he could have articulated why this model is a yoke for employers — and employees — that will eventually become a financial burden that's too heavy to bear (John F. Wasik, 2/19).

The Richmond Times-Dispatch: Stevens: Improving Newborn Screening Saves Lives
One year ago this month, my life changed forever. My husband and I became parents as our beautiful daughter came into the world. But our joy was equally mixed with fear, because she came too early. Born at only 28 weeks gestation and weighing 1 pound, 8 ounces, her very survival was uncertain. I'm embarrassed to admit that, in the blur of those first weeks, I forgot all about the two newborn screening samples that were collected during her 67-day stay in the Neonatal Intensive Care Unit (NICU). She had so many pressing health needs that it was easy to overlook another blood draw (Michelle Stevens, 2/19).

The New England Journal of Medicine: Post-Acute Care Reform — Beyond The ACA
Patients' discharge plans are often made for financial rather than clinical reasons, which contributes to the inefficient use of post-acute care and the high rate of readmissions. ... Demonstrations currently being evaluated under the Affordable Care Act (ACA) incentivize a more efficient mix of acute and post-acute care services. For example, under a bundled-payment system, hospitals and post-acute care providers are paid for a fixed "bundle" of services around a hospital episode, including post-hospitalization care. In an accountable care organization (ACO) with risk-based payment, networks of providers can share in savings if they reduce the total cost of care .... Under both approaches, provider systems have incentives to deliver cost-effective acute and post-acute care services and prevent costly readmissions. Although these payment reforms have promise, substantial regulatory and operational barriers remain (Dr. D. Clay Ackerly and David C. Grabowski, 2/20).

The New England Journal Of Medicine: Post-Acute Care — The Next Frontier For Controlling Medicare Spending
Most acute care hospitals and physicians pay little attention to post-acute care. Patients are typically discharged to a post-acute care facility or home health care with little coordination or follow-up, reappearing on the acute care provider's radar screen only if they return to the hospital in an ambulance. Under fee-for-service reimbursement, acute care providers have had little financial incentive to invest in systems to ensure effective transitions to post-acute care or to support post-acute care providers when recently hospitalized patients have complications. Medicare's recent readmission penalties have begun focusing hospitals' attention on these issues. But Medicare's new bundled-payment and shared-savings programs provide much stronger incentives to integrate acute and post-acute care (Robert Mechanic, 2/20).

The New England Journal of Medicine: The Hospital-Dependent Patient
Hospital-dependent patients differ from those with chronic critical illness, many of whom require ventilators to sustain life, in that they may be precariously and transiently compensated while hospitalized. They are often comfortable and may have an acceptable quality of life (e.g., interactions with family and friends) in the hospital when supported and comforted .... Yet they are unable to make it outside the hospital setting when the response is not quick enough or the necessary treatments are not available. ...These patients' readmissions are counted in readmission rates, and their cases may erroneously be considered to represent failures of the transition process. However, the underlying causes of these readmissions are not failed transitions and the approaches to their management must be tailored accordingly (Drs. David B. Reuben and Mary E. Tinetti, 2/20).

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Stephanie Stapleton

Andrew Villegas

Lisa Gillespie
Shefali Luthra

The Kaiser Daily Health Policy Report is published by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. (c) 2014 Kaiser Health News. All rights reserved.