Daily Health Policy Report

Friday, February 21, 2014

Last updated: Fri, Feb 21

KHN Original Reporting & Guest Opinion

Health Reform

Administration News


Health Care Fraud & Abuse

Health Care Marketplace

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Health Centers See Threat From 'Private Option' Medicaid

Kaiser Health News staff writer Phil Galewitz, working in collaboration with Politico Pro, reports: "Medicaid reimburses health centers better than private doctors because federal law requires the centers be paid in relation to the actual cost of care they provide. The higher rates are supposed to reflect the sicker and poorer patients they see and the fact they can’t limit the number of uninsured or Medicaid patients they treat. As more states look to follow Arkansas’ lead --- Utah and New Hampshire are among those considering similar expansion plans --- health centers are bracing for the worst" (Galewitz, 2/20). Read the story.

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Capsules: Latino Insurance Enrollment Picks Up In California, But …

KPCC’s Stephanie O’Neill, working in partnership with Kaiser Health News and NPR, reports: "Enrollment in health insurance plans through Covered California in the first two weeks of February maintained the same pace reported for the last two weeks of January, while Latino enrollment jumped significantly in January, according to state data released yesterday" (2/20). Check out what else is on the blog.

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A Reader Asks: Can My Doctor Charge Me For ‘Chronic Disease Management’ In My Annual Physical?

Kaiser Health News consumer columnist Michelle Andrews answers this reader's question (2/21). Read her response.  

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Political Cartoon: 'Threshold Issue?'

Kaiser Health News provides a fresh take on health policy developments with "Threshold Issue?" By Lee Judge.

And here's today's health policy haiku:


Home health care fraud scheme
Feds take one down for D.C.'s
Medicaid program.

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

Public Sector Reduces Part-Time Shifts To Avoid Health Law

Despite the administration's delays of the employer mandate, cities, counties and public schools have limited part-timers' work hours so they don't have to offer health insurance, reports The New York Times. Other media outlets report on targeted enrollment pitches to taxicab drivers, restaurant workers and artists, and on the GOP's probe of an Accenture contract for work on healthcare.gov.

The New York Times: Public Sector Cuts Part-Time Shifts To Bypass Insurance Law
Cities, counties, public schools and community colleges around the country have limited or reduced the work hours of part-time employees to avoid having to provide them with health insurance under the Affordable Care Act, state and local officials say (Pear, 2/20).

The Associated Press/Washington Post: Looking For The Uninsured? Just Hail A Taxi Driver
In recent weeks, the sign-up effort has evolved from a dragnet strategy to a highly targeted approach focused on people most likely to be uninsured — cab drivers, restaurant workers, artists, community college students — and where they can be found. Cab drivers have particular health care needs because of the hazard of traffic accidents and the long hours they spend sitting. Enroll America, a nonprofit involved in the enrollment campaign, targeted cab drivers in Philadelphia and Austin and plans to expand to other cities, hoping to reach a good portion of the 233,000 taxi and limo drivers in the U.S. The Chicago effort is chasing after the city’s 12,000 drivers (2/20).

NBC News: Young Latinos Trickle Into Obamacare Information Forum
Although the insurance that José Morales has been relying on has covered his health needs, he stopped by an information meeting to find out about Obamacare. The 23-year-old IT technician at Latin American Youth Center, where the forum was held, has been using DC Healthcare Alliance, a D.C. government-subsidized insurance plan, because that's what his mother has used. He said the plan even covered care for a knee injury. On Thursday, he found out the coverage doesn't meet the minimum standards of the Affordable Care Act or Obamacare after sitting down with Tania Ruiz, an in-person assistant trained to walk people through the new health care law. She signed him up for an appointment next week at La Clínica del Pueblo in D.C (Gamboa, 2/20).

The Hill: GOP Probes Accenture’s ObamaCare Contract
Republican lawmakers are looking into the Obama administration's decision to hire Accenture to finish work on ObamaCare's troubled federal enrollment site. GOP leaders on the House Energy and Commerce Committee wrote to the tech services company on Thursday asking for details on its HealthCare.gov contract and any related projects (Viebeck, 2/20).

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Private Exchange Benefiting From Health Law; Some State-Run Marketplaces Still Struggling

eHealthInsurance reports that interest in health coverage ginned up by the new federal law has helped new memberships rise 50 percent. Meanwhile, NPR examines the mixed record of the 14 states running their own marketplaces.

USA Today: Private Exchange Sees Surge In Health Care Enrollment
The number of customers on the nation's largest private health insurance exchange increased by 50 percent in the final three months of 2013, a direct result of demand created by the Affordable Care Act, the company's CEO said Thursday. Gary Lauer, CEO of eHealth Insurance, said individual memberships rose 50 percent in the fourth quarter of 2013 compared with the same period in 2012, from 113,600 applications in the last three months of 2012 to 169,800 in 2013 (Kennedy, 2/20).

NPR: As Deadline Nears, State Insurance Exchanges Still A Mixed Bag
With a bit more than a month left for people to sign up for health insurance plans set up under the Affordable Care Act, the federal website known as healthcare.gov finally seems to be working smoothly -- in 36 states. But what's happening in the 14 states that are running their own exchanges? (Rovner, 2/21).

Some health law supporters are concerned about mental health benefits --

Politico Pro: Mental Health Parity Supporters Worry About Exchange Plans
The long fight to ensure mental health parity is now focusing on Obamacare plans, with advocates fearing that some are already in violation of federal law and regulations. All plans sold on the Affordable Care Act’s new exchanges, plus most other private-market policies, must begin complying in July with final rules to a 2008 law that requires insurers to cover mental health care the same way they cover care for physical ailments. ... But ensuring that plans fully follow the law and its final rules will be tricky. In particular, problems are anticipated with the new state-based marketplaces since many have modeled benefits after small-group plans, which are exempt from the law if they were created before March 23, 2010 (Cunningham, 2/20).

And in other news from the states --

Los Angeles Times: Anthem Blue Cross Widens Enrollment Lead On California's Exchange
Insurance giant Anthem Blue Cross stretched its lead over rival Blue Shield of California in the state's health care-coverage exchange, new data show. Anthem signed up 223,630 people through Jan. 31, or 31 percent of California's exchange market as part of the health care law. Anthem is a unit of Indianapolis-based WellPoint Inc., the nation's second-largest health insurer (Terhune, 2/20).

The Washington Post: More Than 12,000 Congressional Staffers Have Enrolled In Health Plans Through Obamacare
Thousands of people have purchased health coverage through the District of Columbia's new small-business insurance marketplace, but only a tiny fraction of them actually own or work for a small business. The rest are members of or work for a single large organization -- Congress (Harrison, 2/20).

The CT Mirror: Access Health CT Claims An 'Olympic Bump'
Are the Olympics boosting enrollment in Connecticut's health insurance exchange? Access Health CT, as the exchange is known, has been advertising heavily during broadcasts of the winter games, and Chief Marketing Officer Jason Madrak says it's experienced something of an "Olympic bump." In the week after the opening ceremony, Access Health's website traffic rose 31 percent over the prior week, the number of accounts created rose by 24 percent, and the number of daily enrollments rose by 67 percent (Becker, 2/20).

The CT Mirror: Access Health CT Marketing Obamacare 'Exchange In A Box'
Connecticut's health insurance exchange has run more smoothly than many of its counterparts across the country, and now officials at the state's insurance marketplace are in discussions about franchising the system to other states. The concept is to market a "turnkey"-type exchange program that other states could use, rather than building their own insurance marketplaces from scratch, said Kevin Counihan, CEO of Access Health CT, the state’s exchange. He refers to it as an "exchange in a box." Counihan said Access Health officials have met with officials from five states about the idea (Becker, 2/20).

The CT Mirror: Access Health CT Spanish-Language Website To Launch Friday
After months of delays, the Spanish-language website for Connecticut's health insurance exchange is slated to be available Friday. James Wadleigh, chief information officer of Access Health CT, the state's exchange, said the Access Health website will undergo maintenance Thursday night. On Friday morning, the Spanish-language site will be up. In addition, there will be some changes to the existing website, he said, including one aimed at making it easier for people to enroll in catastrophic plans (Becker, 2/20).

The Wall Street Journal: Nevada's Health Exchange Director To Resign
Nevada's insurance exchange director, Jon Hager, announced his resignation Thursday, days after he had described "a difficult month" for the online insurance portal set up under the federal health care law. The 39-year-old former Navy pilot told the Silver State Health Insurance Exchange board that he would be leaving March 14, the board confirmed (Radnofsky, 2/20).

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Virginia Medicaid Expansion: The House Votes No, But The Senate Votes Yes

The votes will likely set up a conference committee showdown related to the state's two-year budget plan. Meanwhile, news outlets also report on developments from Arkansas, Mississippi and California.   

The Washington Post: House And Senate In Virginia At Loggerheads Over Medicaid Austerity
Virginia’s Republican-controlled House of Delegates voted overwhelmingly Thursday to reject Medicaid expansion, signaling in the strongest terms yet that the chamber does not intend to budge on the marquee issue of this year’s legislative session (Laris and Vozzella, 2/20).

The Richmond Times-Dispatch: House, Senate Set Up Medicaid Showdown
The House of Delegates on Thursday soundly rejected, and the Virginia Senate approved, a private option to Medicaid expansion, one of Gov. Terry McAuliffe’s key goals. Each chamber passed respective versions of the two-year budget that begins July 1, setting up a showdown. The competing plans will go into conference, where senior lawmakers from each side will seek a compromise before the session is scheduled to adjourn March 8. The only surprise in the House debate over Medicaid expansion was that it occurred at all (Martz, Meola and Nolan, 2/21).

The Associated Press/Washington Post: Virginia House, Senate Split On Medicaid Plan
The Virginia House and Senate cast opposing votes Thursday on whether to accept federal Medicaid funds in order to provide health insurance to as much as 400,000 low-income residents. The GOP-controlled House voted 67-32 against expanding Medicaid eligibility. The Democratically controlled Senate, with the support of a few Republicans, voted 23-17 for the expanded coverage (2/20).

The Associated Press/Washington Post: Arkansas Senate Passes, House Rejects Health Plan
A compromise plan for Medicaid expansion in Arkansas remained stalled in the state House Thursday, despite the state Senate endorsing legislation to continue the nationally watched program that is providing subsidized health coverage to more than 87,000 people. The House on Thursday voted 72-25 to reauthorize funding for the “private option,” three votes shy of the 75 needed to continue the program using federal Medicaid funds to purchase private insurance for low-income residents. Arkansas was the first state to win approval for such a plan as an alternative to expanding Medicaid under the federal health law (2/20).

The Associated Press: Mississippi House Rejects Proposal To Expand Medicaid
The Mississippi House voted Thursday against expanding Medicaid to more than 230,000 uninsured working poor residents. Rep. Cecil Brown, D-Jackson, pushed for expansion as the House considered House Bill 1481, an early version of the Medicaid budget for the year that begins July 1 (Pettus, 2/20).

Los Angeles Times: Loophole In Healthcare Law May Put Medi-Cal Patients’ Assets At Risk
Luis Rios, who lost his job at a filling station in December at the age of 56, is newly eligible for Medicaid, the healthcare program for the poor. Following the advice of state-trained medical insurance enrollment workers, he filled out the paperwork required to get coverage — but has a nagging fear that he may have put his family's financial assets at risk. That's because, in certain cases, Medi-Cal, California's version of Medicaid, will be able to collect repayment for healthcare services from the estate after a recipient dies, including placing government liens on property (Brown, 2/20).

In other Medicaid expansion news -

Kaiser Health News: Health Centers See Threat From 'Private Option' Medicaid
Medicaid reimburses health centers better than private doctors because federal law requires the centers be paid in relation to the actual cost of care they provide. The higher rates are supposed to reflect the sicker and poorer patients they see and the fact they can’t limit the number of uninsured or Medicaid patients they treat. As more states look to follow Arkansas’ lead --- Utah and New Hampshire are among those considering similar expansion plans --- health centers are bracing for the worst (Galewitz, 2/20).

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Administration News

Political Tactician Applies Skills To Selling Health Insurance

The Washington Post profiles a White House staffer who went from being a field lieutenant in President Barack Obama's re-election campaign to helping oversee the effort to persuade people to sign up for insurance under the health law.

The Washington Post: For White House Staffer, The Health-Care Law May Be Harder Sell Than Obama Was
Two years ago, Marlon Marshall was deputy national field director for President Obama’s disciplined, centralized reelection campaign. His job was to mobilize enthusiastic supporters to do something that cost them nothing: cast a vote. Now he is at the White House working on a very different, and arguably more difficult, effort: helping persuade Americans to get — and in many cases pay for — health insurance (Eilperin, 2/20).

Also, the president is expected to resubmit a proposal to require wealthy seniors to pay more for Medicare benefits as part of his proposed 2015 budget -

The Washington Post: With 2015 Budget Request, Obama Will Call For End To Era Of Austerity
The latest estimates from the nonpartisan Congressional Budget Office show the deficit falling to $514 billion this year and to $478 billion in fiscal 2015 — well below the trillion-dollar deficits the nation racked up during the recession and immediately afterward. But the CBO warned that deficits would start to grow again in a few years. In recognition of that fact, Obama would retain some parts of his grand-bargain framework, including a proposal to require wealthy seniors to pay more for Medicare benefits than they do now. White House officials said the president continues to believe that entitlement programs such as Medicare and Social Security must be reformed to be sustainable (Goldfarb, 2/20).

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GOP Strategists Prepare To Pounce On Medicare Advantage Payment Changes

The new payment rates for private Medicare Advantage plans -- expected to be announced Friday -- are likely to become political fodder in the midterm elections, reports Politico. Meanwhile, congressional Republicans come out against proposed changes in the Medicare prescription drug program which they say would increase seniors' costs.

Politico Pro: Campaign Fight Brewing Over Medicare Advantage Rates
The Medicare wars are about to reignite. The Obama administration is expected to announce Friday new payment rates for private Medicare Advantage plans next year. And strategists in both parties say that could give the GOP new ammunition to attack Democrats on Medicare in the 2014 elections. With Obamacare already such a potent political fight, some Democratic lawmakers, including senators with tough races in November, are pleading with the administration to keep Medicare Advantage off the table (Norman, 2/20).

The Hill: Is Medicare Drug Coverage In Jeopardy
Republican committee leaders are pushing the Obama administration to call off proposed changes to the Medicare prescription drug program, arguing the overhaul would jeopardize seniors' plans and raise premiums. The charges pertain to recent regulations proposed by the Centers for Medicare and Medicaid Services (CMS). The rules would allow the agency to participate in negotiations between insurance companies and pharmacies in Medicare Part D for the first time out of concerns over cost and access (Viebeck, 2/20).

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Health Care Fraud & Abuse

Justice Dept. Joins In Whistleblower Suit Against Two Hospital Operators

This suit alleges that hospitals operated by Tenet Healthcare and Health Management Associates paid kickbacks to obstetrics clinics for referring certain patients.

The Wall Street Journal: Justice Department To Join Suit Against Tenet Healthcare, Health Management Associates
The Justice Department will join a whistleblower suit against Tenet Healthcare Corp. and Health Management Associates Inc. alleging the firms' Georgia hospitals illegally paid kickbacks to obstetrics clinics for referring low-income and undocumented patients to their facilities for deliveries, the department announced Wednesday. The suit is the latest in a wave of similar cases the Justice Department is pursuing against hospital operators, including at least eight separate cases against HMA for a range of tactics (Weaver, 2/19).

The Dallas Morning News: Federal Probe Latest Fraud Inquiry Involving Tenet
A federal investigation into kickbacks allegedly paid by Tenet Healthcare Corp. marks the latest fraud inquiry involving the Dallas-based hospital giant over the last decade. The disclosure this week comes as Tenet has tried to reshape its image and operations since 2006, when it reached a $900 million settlement, one of the largest ever, with the U.S. Justice Department to resolve fraud accusations. The new investigation alleges that four Tenet hospitals in Georgia and South Carolina made improper payments in return for patient referrals. Both investigations also were triggered by whistle-blower lawsuits filed under the U.S. False Claims Act, leading federal authorities to intervene as plaintiffs (Moffeit, 2/20).

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Health Care Marketplace

Doctors' Groups Urge Members To Reduce Number Of C-Sections

The move is designed to reduce the risk of unnecessary surgery, but some physicians may resist the effort.

NPR: Doctors Urge Patience, And Longer Labor, To Reduce C-Sections
Women with low-risk pregnancies should be allowed to spend more time in labor, to reduce the risk of having an unnecessary C-section, the nation's obstetricians say. The new guidelines on reducing cesarean deliveries are aimed at first-time mothers, according to the American College of Obstetricians and the Society for Maternal-Fetal Medicine, which released the guidelines Wednesday online and in Obstetrics and Gynecology (Schute, 2/20).

The Boston Globe: New Guidelines Urge Fewer Caesarean Births
In an effort to curtail caesarean sections, two prominent medical groups issued guidelines Wednesday calling for doctors to let first-time mothers remain in labor longer, and push harder, to see if more babies can be delivered vaginally. The recommendation was driven by recent studies showing that the rise over the past decade in caesarean sections hasn't led to better health outcomes for women or babies, such as lower mortality rates. ... Some obstetricians, though, may resist the advice, which includes allowing patients more time to dilate during labor, letting first-time mothers push for three hours or even longer, and using forceps to get the baby out vaginally (Kotz, 2/20).

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State Watch

Feds Charge 25 In D.C. With Medicaid Fraud

Investigators said the scheme -- which rang up $75 million in fraudulent claims -- is the largest in the history of the city.

The Washington Post: More Than 20 Charged In Federal Crackdown On D.C. Medicaid Fraud
In announcing five federal indictments against 12 people and related D.C. Superior Court charges against 13 people, U.S. Attorney Ronald C. Machen Jr. said federal law enforcement officials had pulled off the largest health care fraud takedown “in the history of the District of Columbia.” Prosecutors, FBI agents and others had investigated the fraud for years -- much of it allegedly emanating from corrupt operators of home-care agencies and personal-care assistants, he said -- and uncovered a problem that they say has permeated a component of the city’s health-care system (Zapotosky, 2/20).

The Associated Press/Washington Post: 25 Charged In Fraud Involving Home Care In DC
Twenty-five people were charged Thursday with obtaining at least $75 million in fraudulent Medicaid payments from the District of Columbia government, a series of cases that federal prosecutors said added up to the largest health-care fraud in the city’s history (2/20).

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Legislature News: SEIU, Hospitals, Ore. Governor Cut Deal On Hospital 'Triple Aim'

Elsewhere, Kansas lawmakers advance a bill that would exempt the state from the health law and some California lawmakers work to restore Medi-Cal cuts.

The Oregonian: SEIU Withdraws Health Care Ballot Measures, Part Of Deal With Hospitals, John Kitzhaber
Gov. John Kitzhaber announced Thursday an agreement between labor unions and health care providers that will dissolve a brewing fight that was headed to the November 2014 ballot. Local 49 of the Service Employees International Union filed five ballot measure initiatives in October targeting hospital pricing, executive salary and transparency. But the union withdrew those initiatives Thursday as part of an agreement to accelerate progress toward improving patient experience, health and reducing the per capita cost of care. What Kitzhaber calls the health care "triple aim” (Gaston, 2/20).

The Associated Press: Kan. Plan For Avoiding Federal Health Law Advances 
A proposal to allow Kansas to exempt itself from the national health care overhaul is a serious attempt to shield the state from federal requirements and not merely symbolic, supporters said Thursday as the measure cleared its first significant legislative hurdle. The Kansas House Federal and State Affairs Committee approved a bill to bring the state into a compact with others to ask Congress to give them control over health care policy within their borders (Hanna, 2/20).

Los Angeles Times: Assembly Democrats Seek To Restore Cuts To Medi-Cal Funding
Two Assembly Democrats want to restore funding for California's health care program for the poor, laying the groundwork for another debate over how to make the best use of the state's financial recovery. The proposal, AB 1805, would reverse a 10 percent cut to reimbursements to doctors and other health care providers who treat Medi-Cal patients (Megerian, 2/20).

Des Moines Register:  Bill Targets Health Insurers’ Reserves
Senate Democrats want to give Iowa’s insurance commissioner authority to order health insurers to send refunds to policyholders if the companies’ bank accounts grow too fat. Senate File 2183 is aimed at Wellmark Blue Cross and Blue Shield, which dominates Iowa’s health insurance marketplace (2/20).

Detroit Free Press: Attorney General Bill Schuette Backs Lawsuit That Would Gut Tax Credits For Health Coverage
Michigan Attorney General Bill Schuette has joined a federal lawsuit in Washington, D.C., that, if successful, could cost Michigan consumers millions of dollars in health coverage tax credits. It also could gut federal health overhauls, according to some (Erb, 2/21).

Georgia Health News: DCH Conflict-Of-Interest Bill Advances 
A House panel Thursday approved a bill that targets potential conflicts of interest on the Georgia Department of Community Health board. The original HB 913 was amended before the vote to make sure medical professionals, such as physicians and dentists, were not precluded from serving on the DCH board, whose nine members are appointed by the governor. The lead sponsor of the legislation, though, acknowledged Thursday that the bill may affect current DCH board members (Craig, 2/20).

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State Highlights: 'Health Care Homes' Show Promise In Minn.; Texas Women's Health Providers; Fla.'s Hidden Costs

A selection of health policy stories from Minnesota, Texas, Louisiana, Florida, New York and Massachusetts.

Minnesota Public Radio: Study: Program Focused On Preventive Medicine, Team Treatment Shows Promise
​A health care effort focused on preventive medicine and a team approach to treatment is showing promise improving care and reducing costs, state officials say. The Health Care Homes initiative has increased patient access to clinics, particularly for people of color, while improving quality and coordination of care, according to a state study released Thursday. Health Care Homes is not home health care. The idea is to change the way clinics provide care from a traditional, illness-based model, to one that strives to improve the health of patients with chronic conditions and disabilities (Benson, 2/20).

The Star Tribune: Minnesota's New Way Of Seeing Patients Has Improved Health Care Results, Researchers Say
A new model of primary care that emphasizes disease prevention and doctor-patient collaboration appears to be lowering Minnesota’s medical costs while raising the quality of care patients receive. Patients seen at “health care homes,” created as part of far-reaching state health reforms enacted in 2008, had medical costs that were 9 percent less between 2010 and 2012 than those for patients who sought primary care at traditional clinics, according to a set of reports released Thursday by the University of Minnesota and the state Health and Human Services departments. Those patients also received more effective care for asthma, vascular disease and other chronic conditions, the researchers found (Olson, 2/20).

The Associated Press/Washington Post: Group Sues To Force Insurers To Take AIDS Money
An advocacy group has filed a federal lawsuit seeking to force insurance companies in Louisiana to take payments from a federal program that helps HIV and AIDS patients. Lambda Legal filed the suit in a Baton Rouge federal court Thursday saying at least one insurance company is violating the Affordable Care Act by refusing to take premium payments from the federal Ryan White HIV/AIDS program (2/20).

The Dallas Morning News: Texas Women’s Health Program Adds Providers, But Fewer Sign Up
State officials told lawmakers Thursday that the state has lined up providers and has the capacity to serve more poor women in the Texas Women’s Health Program, but fewer women have signed up for the help. The state’s family planning programs have been the subject of fights over budget cuts and abortion issues in recent years, with cuts to Planned Parenthood, a drop of millions in federal funding and then an infusion of state money. Now, as the dust settles, state officials told the Senate Committee on Health and Human Services that the new programs will be able to provide more poor women with family planning services than before (Martin, 2/20).

Miami Herald: Health Care’s Hidden Costs Can Take Patients By Surprise
When a rheumatologist told Linda Drake of Miami that she might have lung cancer, the former smoker did some research and discovered a study for early detection and treatment of the disease with researchers in South Florida. Drake, 57, decided to participate in the study because there was a $350 flat fee, and she could enroll through UHealth -- the University of Miami’s network of clinics and hospitals ... The results were negative. Drake breathed a sigh of relief. But a few days later, an unpleasant surprise arrived in the mail: a bill for $210 from UHealth for “hospital services” labeled as “Room and Board - All Inclusive,’’ even though she never set foot in a hospital or spent the night at the clinic (Chang, 2/20).

The New York Times: A Pharmacy Provides Salves For A Community’s Spirits
Just about no one knows the territory like a neighborhood pharmacist, membrane by membrane. On Jan. 3, 2012, Dichter Pharmacy in the Inwood section of upstate Manhattan burned to the ground along with the entire corner of 207th Street and Broadway. Under one flag or another, a drugstore had been in roughly that spot for 90 years, but this certainly seemed like the end (Dwyer, 2/20).

WBUR: A New Demand For Mass. Health Mergers: Show Proof Of Savings
What seemed like a routine meeting of a state commission in the basement of Boston’s beautiful main public library may become a milestone for health care reform in Massachusetts. It could be the “Show Me The Money” moment for health care cost control. From here on out, hospitals, physician groups and other providers proposing to merge will have to show the state’s Health Policy Commission (HPC) that the newly formed entity would save money and that those savings would be passed along to consumers (Bebinger, 2/20).

Minnesota Public Radio: Report: Prison Health Care System Needs More Accountability
A new report concludes health care services provided to the roughly 9,000 adult inmates in Minnesota prisons should be better coordinated and accountable. Perhaps because of snow-slopped roads, the official release today of the report from Minnesota Legislative Auditor Jim Nobles drew only a sparse crowd. Only three of the 12 lawmakers who typically review legislative-auditor reports attended the hearing. Nobles said he understands that the topic of prison health lacks a natural constituency (Yuen, 2/20).

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Health Policy Research

Research Roundup: Employers And Supreme Court Case On Contraception

Each week, KHN compiles a selection of recently released health policy studies and briefs.

Health Affairs: Care Delivery And Coordination In The Accountable Care Environment
In preparation for the new ACO environment, leaders recognized the contribution palliative care can make to health care "value," especially in the care of our sickest (and most expensive) patients ...  Since PHS [Partners HealthCare] became an ACO, the focus on palliative care integration has increased, and been centered on improving quality by matching a patient’s care to his or her individual goals and values. ... Partners' efforts to support and expand palliative have focused on a number of key initiatives: Creating a system of palliative care that allows us to provide integrated, coordinated care across the continuum, meeting patients' needs in all settings of care, from hospital, to clinic, to rehabilitation, home care, and hospice settings ... Pay for Performance initiatives to expand palliative care access, advance care planning , and Medical Orders for Life-Sustaining Treatment (MOLST) implementation ... We have confronted remarkably few barriers in integrating palliative care into our ACO (Block, Jackson and Lee, 2/19).

JAMA Ophthalmology: Eye Care Use Among a High-Risk Diabetic Population Seen In A Public Hospital's Clinics
Little is known regarding eye care use among low-income persons with diabetes mellitus, especially African Americans. ... [Research was conducted] in an outpatient medical clinic of a large, urban county hospital ... There were 867 patients with diabetes identified: 61.9% were women, 76.2% were non-Hispanic African American, and 61.4% were indigent, with a mean age of 51.8 years. Eye care utilization rates were 33.2% within 1 and 45.0% within 2 years. For patients aged 19 to 39 years compared with those aged 65 years or older, significantly decreased eye care utilization rates were observed within 1 year. ... Additional education efforts to increase the perception of need among urban minority populations may be enhanced if focused on younger persons with diabetes (MacLennan, 2/13).

The Kaiser Family Foundation/Health Management Associates: Integrating Physical And Behavioral Health Care: Promising Medicaid Models
Unfortunately, our physical and behavioral health care systems tend to operate independently, without coordination between them, and gaps in care, inappropriate care, and increased costs can result. ... This brief highlights five strategies currently underway in Medicaid: universal screening; navigators; co-location; health homes; and system-level integration. ... No single approach in Medicaid is likely to be a universal solution; rather, a diversity of promising strategies present options for states, health plans, and providers seeking to move further in the direction of integrating care (Nardone, Snyder and Paradise, 2/12). 

JAMA Psychiatry: Use Of Hospital-Based Services Among Young Adults With Behavioral Health Diagnoses Before And After Health Insurance Expansions
Recent calls for increased access to mental health services have raised concern that increases in coverage will fuel unsustainable increases in use and spending. We examined the effects of Massachusetts' health reform, which dramatically increased health insurance coverage, on hospital-based use. We focused on young adults aged 19 to 25 years, a group with relatively high behavioral health needs and low rates of insurance coverage prior to reform, ... Increased insurance coverage post-reform coincided with significant relative declines in inpatient admissions and ED visits for behavioral health overall. ... We also found significant declines in admissions or visits without insurance coverage in both hospital and ED settings. This change resulted from increased coverage through Commonwealth Care, private coverage, and Medicaid. This signifies much lower out of pocket burden for young adults with a behavioral health crisis, as well as less uncompensated care burdening hospitals (Meara et al., 2/19).

Robert Wood Johnson Foundation: Long-Term Care: What Are The Issues?
The vast majority of people have no insurance, either public or private, for long-term care. Private long-term care insurance can pay a set daily benefit to defray the cost of home or residential care, but with an average policy costing a healthy 60-year-old $2,000 or more per year11 (premiums increase with age), many people either can’t afford the insurance or worry that limits on benefits might make it not worthwhile. To date, fewer than 10 percent of Americans are saving specifically for long-term care. The result is that family or friends often end up providing informal and unpaid care for older, frail adults for as long as they can. This trend will be magnified as the number of older people needing long-term care increases over time (Freundlich, 2/1).

The Heritage Foundation: Obamacare Anti-Conscience Mandate At The Supreme Court
In February 2012, the U.S. Department of Health and Human Services (HHS) finalized guidelines requiring employers to pay for coverage of contraception, sterilization, and abortion-inducing drugs and granted a narrow exemption for certain religious employers. Many employers believe that complying with this mandate would violate the tenets of their faith, but failure to adhere to the law could result in steep fines ... In an effort to block the anti-conscience mandate, religious organizations and other private employers have filed over 90 lawsuits with more than 300 plaintiffs. The Supreme Court of the United States has agreed to review two of the for-profit cases ... The Court will consider two questions: Does the mandate violate the First Amendment guarantee of the free exercise of religion? Who can exercise religion under the Religious Freedom Restoration Act? (Slattery and Torre, 2/13).

The Urban Institute: The Inevitability Of Disruption In Health Reform
The recent furor over policy cancellations in the individual health insurance market demonstrates a long-standing challenge to the enactment, let alone the implementation, of effective health reform. Disruption of the 84 percent of Americans who have health insurance creates a powerful impediment to the extension of insurance to the 16 percent of Americans without it. ... This brief clarifies the realities and political risks of disruption and places the ACA in context relative to other reform proposals (Feder, 2/18).

Here is a selection of news coverage of other recent research:

Medscape: Intracranial Atherosclerosis A Major Stroke Risk In Whites
Although intracranial carotid artery calcification (ICAC) is a recognized risk factor for stroke in African Americans and Asians, a new study shows that it is also an important cause of strokes among whites. The association between ICAC and stroke shown in the study was independent of conventional cardiovascular risk factors and of calcification in other vessel beds, the researchers note (Anderson, 2/18).

Medscape: Oncologists Can Cut Costs While Maintaining Quality Of Care
The alarmingly high increases in the cost of cancer care can be reined in. However, it will require that the oncology community take responsibility for practice patterns, according to 2 experts. In a report published online in the Lancet Oncology, Thomas Smith, MD, and Ronan Kelly, MD, both from the Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medical Institutions, Baltimore, identify 3 major sources of high cancer costs that can be reduced with the least amount of harm (Nelson, 2/14).

MedPage Today: Outpatient Surgery: Is Infection A Real Risk?
The chance of a clinically significant infection after ambulatory surgery is relatively small; nonetheless, outpatient surgery related infections account for roughly one in five healthcare-associated infections. That seeming contradiction is explained by the fact that ambulatory surgery accounts for more than 63% of all operations in the U.S., so the absolute number of affected patients is large, according to Claudia Steiner, MD, of the Agency for Healthcare Research and Quality in Rockville, Md., and colleagues (Smith, 2/18).

Newark, N.J., Star-Ledger: Princeton Expert: Medicaid Rules Keep Poor Women From Getting Sterilized
File this one under the category of "It seemed like a good idea at the time." That time was 1976, when public health officials worried about poor women being permanently sterilized without their consent. The fix was a 72-hour waiting period between when a Medicaid patient consented to a tubal ligation and when the operation was done. Two years later, that waiting period was extended to 30 days. But that has created its own problem, according to researchers at Princeton University's Woodrow Wilson School. Medicaid patients who want to have their tubes tied immediately after having a baby can't do that because of the 30-day rule. If they wait 30 days, some may no longer have Medicaid coverage, since pregnancy-related eligibility ends shortly after delivery (O'Brien, 2/19).

Los Angeles Times: Healthcare Organizations Under Siege From Cyberattacks, Study Says
Add this to the list of things to freak you out: Healthcare organizations of all kinds are being routinely attacked and compromised by increasingly sophisticated cyberattacks. A new study set to be officially released Wednesday found that networks and Internet-connected devices in places such as hospitals, insurance companies and pharmaceutical companies are under siege and in many cases have been infiltrated without their knowledge (O’Brien, 2/18). Health Care Cyberthreat Report is here.

HealthDay: Many U.S. Seniors Get Prescription Painkillers From Multiple Doctors
About one-third of Medicare patients who get prescriptions for powerful narcotic painkillers receive them from multiple doctors, which raises their risk for hospitalization, according to a new study. Narcotics (also called opioids) include painkillers such as hydrocodone (Vicodin), oxycodone (Oxycontin) and morphine. Prescriptions for these drugs have risen sharply in the United States in the past 20 years -- as have overdoses. ... For the study, which was published Feb. 19 in the journal BMJ, the researchers analyzed data from 1.8 million people enrolled in Medicare's prescription benefit (Part D) who filled at least one narcotic prescription in 2010. Medicare is the taxpayer-supported insurance program for the elderly (Preidt, 2/19).

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Editorials and Opinions

Viewpoints: Docs On Drugmakers' Payrolls; No Comparison Shopping In Health Care

USA Today: Is Your Doctor On A Drug Maker’s Payroll? Our View
Doctors have long gotten small favors from drug makers: pads with logos, a deli tray sent to the office, tickets to sporting events and free drug samples. But in recent years, those trinkets have evolved into big money for doctors paid to speak to other doctors about new drugs, often using canned scripts provided by the pharmaceutical companies. Some of the paid speakers have become high-volume prescribers of the drugs. ... Taken as a whole, the practice has begun to look less like education and more like legalized bribery (2/20). 

USA Today: Doctors Learn From Other M.D.s: Opposing View
Change in medicine is relentless. New drugs and devices, new indications for old ones and newly recognized safety issues are hard for busy M.D.s to keep up with. One way to manage all this innovation has been for medical product companies to pay physicians to speak to their colleagues about products, usually at evening events in restaurants (Dr. Thomas Stossel, 2/20). 

Los Angeles Times: A Costly Pain In The Neck, And What It Says About Health Care In The U.S.
After a weeklong stay, the Barrow Neurological Institute in Phoenix sent me on my way on Jan. 5 with five stitches, a titanium alloy plate in my neck and a hard plastic Össur Miami J cervical collar that will remain on my neck until late March. A few weeks later, I learned what I'd been charged for the Miami J: $447. Had I been given the chance, I could have purchased the brace online for less than $100. Allowing that sort of comparison shopping is one small thing policymakers could do to slow the growth of health care spending. But like seemingly everything related to health care, it wouldn't be that simple (Jon Healey, 2/21).

The Star Tribune: In The Long Run, MNsure Is Important For Minnesota
Every once in a while a tough issue comes along that has the potential to split a community. Today's issue is health care reform, and more specifically, MNsure -- Minnesota's state health care exchange. In a break from conventional wisdom, and putting myself at risk for significant criticism, I believe that MNsure should and will be an important part of health care reform in Minnesota. That isn't to say the launch of MNsure has been smooth. Far from it. It is expensive, complicated and over engineered. We now know that we tried to do too much too fast, when simplicity would have been the better path (Kenneth H. Paulus, 2/20).

Des Moines Register: Iowa View: Let's Repair Health Care
Recently, President Obama delayed the full enforcement of the Affordable Care Act's employer mandate provision until 2016. Yet, the administration still insists on enforcing the individual mandate, which began earlier this year. Arguments surrounding the policy implications of these mandates are complex, but easing the employer mandate and enforcing the individual mandate illustrates the federal government's favoritism toward corporations over individuals. Our government is forgetting the intrinsic value of the individual (David Young, 2/19).

The New England Journal of Medicine: Informed Consent, Comparative Effectiveness, And Learning Health Care
Interest in learning health care systems and in comparative-effectiveness research (CER) is exploding. One major question is whether informed consent should always be required for randomized comparative-effectiveness studies, particularly studies conducted in a learning health care system. Our answer to this question is no. It will often be unethical to go forward with CER in which patients are randomly assigned to different interventions without their written, prospective, informed consent. However, in a mature learning health care system with ethically robust oversight policies and practices, some randomized CER studies may justifiably proceed with a streamlined consent process and others may not require patient consent at all (Ruth R. Faden, Tom L. Beauchamp and Nancy E. Kass, 2/20).

The New England Journal of Medicine: Informed Consent For Pragmatic Trials -- The Integrated Consent Model
In some pragmatic, randomized clinical trials comparing two commonly prescribed medications for an outpatient condition such as hypertension, the only material departure from clinical practice may be replacing the physician selection of treatment with a randomized selection. It seems unlikely that such a study can be seamlessly "embedded" in routine clinical care delivery if the traditional informed-consent process for research participation (with the usual complex, lengthy document) is required. But what are the alternatives? (Dr. Scott Y.H. Kim and Franklin G. Miller, 2/20).

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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.