Daily Health Policy Report

Monday, April 14, 2014

Last updated: Mon, Apr 14

KHN Original Reporting & Guest Opinion

Administration News

Capitol Hill Watch

Health Reform

Medicare

Health Care Marketplace

Women's Health

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Waiting – And – Waiting On The Nursing Home Inspector

Kaiser Health News staff writer Anna Gorman, working in collaboration with the Los Angeles Daily News, reports: "The case is just one example of hundreds in Los Angeles County and thousands statewide in which investigations by nursing home regulators have remained incomplete for months, sometimes years. There were 3,044 open cases in the county as of mid-March, 945 of which date back two years or more, according to an audit released last week by the Los Angeles County Auditor-Controller" (Gorman, 4/14). Read the story

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Obama Hails Sebelius' 'Extraordinary Service' (Video)

Kaiser Health News posted video clips of Friday’s remarks by President Barack Obama and Health and Human Services Secretary Kathleen Sebelius (4/11). Watch the videos.

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Political Cartoon: 'Severance Package?'

Kaiser Health News provides a fresh take on health policy developments with "Severance Package?" by John Cole.

Here's today's health policy haiku:

NUMBERS GAME

How many insured --
Not previously covered?
ACA counting …
-Team Haiku, Altarum

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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Administration News

Sebelius Notes Missteps But Praises The Health Law

In an appearance on "Meet The Press," the outgoing Health and Human Services secretary offered her views on the botched rollout of healthcare.gov and the decision to leave the Obama administration. Meanwhile, news outlets also examine how her resignation unfolded.

The Wall Street Journal: Sebelius Exits Without Regret, Despite 'Awful' Period
Outgoing Health and Human Services Secretary Kathleen Sebelius described the period last fall when HealthCare.gov was crippled by technical problems as "awful," but said she had no regrets as she prepares to leave her job. In an interview with NBC News that aired Sunday, Mrs. Sebelius said she would ask different questions about the readiness of the website if she could have a do-over (McCain Nelson, 4/13).

Los Angeles Times: Sebelius Praises Obamacare, Concedes Rollout Was Botched
Outgoing Health and Human Services Secretary Kathleen Sebelius said Sunday that the health insurance exchanges that are now up and running across the country have given uninsured Americans a true choice of insurance plans with price comparisons. "People have competitive choices and real information for the first time ever in this insurance market," Sebelius said in an interview on NBC's "Meet The Press" (Savage, 4/13).

Politico: Sebelius Says Departure Was Her Choice
Outgoing Health and Human Services Secretary Kathleen Sebelius says her departure after Obamacare’s first, rocky open enrollment period was her own choice and that it was "a logical time to leave." "The president and I began to talk, you know, after the first of the year," Sebelius told NBC's Andrea Mitchell in an interview that aired Sunday on "Meet the Press." "And I went back to him in early March and said, 'You know, I'm really optimistic we're going to meet the targets and the enrollment is good, the site is working well. I think once we finish this first chapter you really should begin to look for the next secretary who can be here through the end of your term.' And that really wasn't a commitment I was willing to make. And he knew that" (Titus, 4/13).

The Associated Press: Sebelius: Health Care Launch 'Terribly Flawed'
The Obama administration's timeline for having ready the new health care law's online sign-up system "was just flat out wrong," outgoing Health and Human Services Secretary Kathleen Sebelius said in an interview that aired Sunday. The departing health chief also said the two months when healthcare.gov was plagued with technical problems were "a pretty dismal time" and the low point of her five-year tenure. But she defended the law's impact and said millions of Americans now have access to health care because of it (Elliott, 4/13).

Fox News: Sebelius Says Timeline For ObamaCare Rollout 'Flat Out Wrong'
She also said the president setting a Dec. 1 deadline to have the website repaired was a nerve-racking experience. "Having failed once at the front of October, the first of December became a critical juncture," Sebelius said. "That was a pretty scary date" (4/14).

Reuters:  Sebelius Says She Told Obama Staying 'Wasn't An Option'
U.S. Health and Human Services Secretary Kathleen Sebelius, who resigned last week, says she made the decision to leave and told President Barack Obama last month that staying on "wasn't an option". In her first interview since the White House announced her resignation as the president's top healthcare adviser, Sebelius told NBC's "Meet the Press" on Sunday that she and Obama first spoke about her future after Obamacare enrollment began to show signs of recovering from its disastrous October 1 launch (Reed, 4/13).

The Hill: Sebelius: Pressure After Rollout Was 'Awful'
In candid remarks about the healthcare rollout, Sebelius said she regretted not asking different questions when HealthCare.gov was under construction. "If I had a magic wand and could go back to mid-September and ask different questions based on what I know now," I would, she said. "I thought I was getting the best information from the best experts but clearly that didn't go well" (Viebeck, 4/13). 

The New York Times: Sebelius's Slow-Motion Resignation From the Cabinet
The White House frustration with Ms. Sebelius crystallized by Thanksgiving, as it became clear in Washington that she would eventually have to go. Republicans were brutalizing her at congressional hearings. The health care website's problems were consuming the White House. ... But three things put off Ms. Sebelius’s departure: Mr. Obama’s fear that letting people go in the middle of a crisis would delay fixing the website; his belief that ceremonial firings are public concessions to his enemies; and the admiration and personal loyalty that Mr. Obama still felt for Ms. Sebelius and her advocacy for his chief domestic legacy (Shear, Calmes and Pear, 4/11).

Politico: The Kathleen Sebelius Sendoff: Everybody Wins
The idea that Sebelius can still claim full credit for the health care law’s achievements isn't going to fly with a lot of the public. Obamacare opponents — and some angry Democrats — insist that Sebelius had to go. She was, after all, the Health and Human Services secretary who let the broken website go live — and define Obama’s signature program with an image of incompetence. But now, because of the timing, some liberals could actually push back against the "Sebelius leaves because of failed website" storyline. What failure, many of them asked on Friday? She helped bring health care to more than 7 million people (Nather, 4/11).

CBS News: Kathleen Sebelius' Legacy On Obamacare: Failure Or Success?
Whatever the motivation behind it, her announcement ignited a fresh debate about her record in overseeing the implementation of a law that's considered the president's most significant domestic policy achievement (Miller, 4/13).

Kaiser Health News: Obama Hails Sebelius' 'Extraordinary Service' (Video)
Kaiser Health News posted video clips of Friday’s remarks by President Barack Obama and Health and Human Services Secretary Kathleen Sebelius (4/11).

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Obama Turns To 'Proven Manager' To Shepherd HHS And Health Law

Sylvia Mathews Burwell, whom President Barack Obama named to replace outgoing Health and Human Services Secretary Kathleen Sebelius, is a relatively unknown 'budget wonk' who is being asked to navigate some difficult terrain to keep the president's signature achievement on track.  

The Wall Street Journal: Obama Announces New Health Secretary Nominee
President Barack Obama's decision to place Sylvia Mathews Burwell atop the federal health agency sets up a fresh Senate fight over his signature domestic achievement, and poses a test for a relatively unknown but experienced White House official. In announcing Ms. Burwell's nomination Friday to succeed Health and Human Services Secretary Kathleen Sebelius, Mr. Obama hit refresh on a post that symbolized the fraught rollout of the Affordable Care Act. Republicans prepared to use Ms. Burwell's Senate confirmation as a new opportunity to showcase what they see as the law's flaws, a central issue in this year's midterm elections (Lee, Peterson and Paletta, 4/11).

The Washington Post: For HHS Hot Seat, Obama Chooses Burwell, A Budget Wonk
After the political tumult and technical defects that have hindered the Affordable Care Act, Obama selected a trusted budget wonk with a reputation for management acumen and a rapport with lawmakers on Capitol Hill. By choosing someone he twice called a "proven manager" in his announcement Friday, Obama signaled his need for a set of steady hands to shepherd his signature domestic initiative through the end of his tenure. Even though the administration met a first-year insurance enrollment goal, many potential obstacles lie ahead before the health-care law is fully implemented (Eilperin and Goldstein, 4/11).

Los Angeles Times: Obama Names Budget Chief As New Health Secretary 
With Burwell, who was unanimously confirmed by the Senate to her current post, the White House hopes to ensure the continued rollout of the healthcare law offers Republicans no more ammunition to attack it. ... Although the HealthCare.gov website has been fixed and 7.5 million people have now enrolled, it remains unclear how well the program will work in its critical first year. Any stumbles could rejuvenate GOP opposition to the health law. In the next few months, health insurers will begin to price premiums for 2015 in preparation for the next enrollment period that opens in November. Several insurance industry officials have warned that they may seek double-digit increases in premiums for 2015 because they did not get enough healthy enrollees in the first year. That has set off a scramble at HHS and the White House, which fears a series of major rate hikes (Parsons and Memoli, 4/11).

The Hill: Can Burwell Turn HHS Around?
But as President Obama's nominee to head the Department of Heath and Human Services (HHS), Burwell would have more on her plate than just the healthcare law. The HHS secretary is in charge of a volatile mix of programs, politics and stakeholders that makes it among the hardest of all the Cabinet positions. The job is a magnet for partisan attacks, and Burwell would assume her new role in a high-stakes election year when Republicans hope to use the healthcare law to take back the Senate (Viebeck, 4/12).

The Washington Post: Here Are The Biggest Problems For Obamacare’s Next Leader
If Sylvia Mathews Burwell is confirmed as the next secretary of Health and Human Services, it puts her in charge of a sprawling health-care overhaul that's still gaining its footing and is under constant attack from opponents. The Obama administration is celebrating the more than 7.5 million people who have signed up for coverage in Obamacare health insurance marketplaces, but there are big implementation challenges for the next HHS leader (Millman, 4/11).

The Hill:  Burwell’s Top 5 Challenges at HHS
Sylvia Burwell will have a lot on her plate as the next leader of the Department of Health and Human Services (HHS). If she's confirmed, the outgoing White House budget director will head up one of Washington's largest and most unwieldy bureaucracies (Viebeck, 4/14).

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Capitol Hill Watch

GOP Intends To Focus On Health Law Issues During Burwell's Confirmation Hearings

Senate hearings for Sylvia Mathews Burwell, President Barack Obama's pick to be the next secretary of the Department of Health and Human Services, are likely to focus more on the health law than on the nominee. Many expect the proceedings to set the scene for a heated political debate on the law that will likely be part of the midterm campaign.

USA Today: Burwell Hearings To Be Debate Over Health Care
Confirmation hearings for the next secretary of health and human services are likely to be more about the health care law than nominee Sylvia Mathews Burwell. Republicans are serving notice that they will use the Burwell hearings to spotlight what they call problems with the health care law, including canceled policies, higher premiums, and delay of some provisions (Jackson, 4/13). 

Reuters:  Obama's New Health Secretary Nominee Draws Early Republican Fire
President Barack Obama's new nominee for health secretary drew some early political fire from Republicans on Sunday in what could foreshadow a stormy election-year confirmation debate in the U.S. Senate over the future of the law known as Obamacare. Two days after Obama nominated his budget director, Sylvia Mathews Burwell, to head the Department of Health and Human Services (HHS), Republican lawmakers alleged the new nominee could help the White House exert political control over Obamacare enrollment numbers and other data showing how well the reforms are working (Morgan, 4/13).

The Associated Press: New 'Face,' But Some Old Problems For 'Obamacare'
Senate Finance Committee Chairman Ron Wyden, D-Ore., who will hold confirmation hearings for Burwell, said there's an opportunity for her to move the health care debate beyond stalemate. While a political truce is unlikely over Obama's health overhaul, Wyden ticked off a list of other issues where Republicans and Democrats might be able to find compromise. Among them: revamping the way Medicare pays doctors, providing coordinated care for patients with chronic illnesses and using data to encourage delivery of quality health care at lower cost (Alonso-Zaldivar, 4/12).

Fox News: Republicans: Burwell Confirmation Hearings Will Be Fair, But Focused On ObamaCare
A Senate Republican said Sunday that party members will use the upcoming confirmation hearing for a new Health and Human Services secretary to get more information about ObamaCare, but dismissed the notion GOP lawmakers intend to turn the proceeding into a political witch hunt. "The question is will the next secretary put the interests of Americans first, or the policies of the president," Sen. Tim Scott, R-S.C., a member of the Health, Education, Labor and Pensions committee, told "Fox News Sunday." Scott made clear the hearings in his committee and Senate Finance Committee will be an opportunity to discuss yet-to-be-disclosed final ObamaCare enrollment figures and related issues, but said, "We're going to keep the focus on the American people, not politics" (4/13).

Politico: Sylvia Mathews Burwell Pick Complicates Democrats' Plans
Senate Democrats planned to spend the spring ramping up their election-year message on income inequality — not relitigating Obamacare. Change of plans. Republicans hope to turn Sylvia Mathews Burwell’s nomination to run the Department of Health and Human Services — announced by President Barack Obama on Friday — into a proxy war over Obamacare (Kim and Everett, 4/11). 

McClatchy: Obama Looks To Pivot From Health Care Roll-Out
President Barack Obama worked to turn a page Friday on his signature health care law, nominating White House aide Sylvia Mathews Burwell to replace embattled Kathleen Sebelius as secretary of health and human services. Known for her management skills, Burwell will become the new face of the Affordable Care Act, a controversial law with a troubled track record that could threaten Democratic prospects in this fall’s congressional elections. The first test for Burwell will come in the Senate, which unanimously confirmed her as White House budget director last year but which likely will use her confirmation hearings next month to stage a partisan debate over Obamacare (Wise and Lightman, 4/11).

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Health Reform

What Is 'Preventive' Care? Answer Causing Patient-Doctor Friction

Access to preventive care at no charge to the patient is a tenet of the health law, but differences over just what's considered "preventive" are causing friction between doctors and patients, reports The Wall Street Journal. Other stories look at how California community clinics have yet to see increased demand for primary care doctors and how plans are targeting newly insured diabetics to avoid costly complications.

The Wall Street Journal: Discord Over What To Pay The Doctor
Access to preventive care at no charge to the patient is a key tenet of the federal health law. But questions about what qualifies as "preventive" are causing discord between doctors and patients, particularly when it comes to the traditional annual checkup. Some patients, anticipating free visits to address all their health issues -- past, present and potential -- are upset to find that only some of that qualifies as preventive care, exempt from deductibles and copays (Beck, 4/13). 

The Wall Street Journal: Odd-Hour Workers Face Loss Of Employer Health Plans
Ms. Caspersen, a waitress at Virtues Restaurant in the Summa Akron City Hospital, falls into part of the workforce that may feel the strongest effects of the Affordable Care Act: workers whose hours change on a weekly or seasonal basis. Thousands of these so-called variable-hour employees -- many of whom work on college campuses that don't operate during summer months -- could lose their benefits as employers use new formulas to classify workers as full time or part time. The distinction determines which employees are entitled to company-sponsored health coverage (Weber, 4/13).

McClatchy: 54 Percent Disapprove, 43 Percent Approve Of Health Care Law, Gallup Finds
A lot of people still don’t like the Affordable Care Act, a new Gallup poll released Friday found. “Americans continue to evaluate the Affordable Care Act negatively, and their basic opinions of the law have been fairly stable over the past year,” a Gallup analysis said. “That may suggest Americans have already made up their mind about the law, for the most part reflecting their underlying political orientation, and the law's implementation is not going to influence how they feel about the law” (Lightman, 4/11).

The California Health Report: Clinics Wait For More Patients In Obamacare Wake
St. James Health Center is ready for the onslaught. The community health clinic, one of the busiest in San Jose, sits on the corner of 2nd and Julian streets near downtown. Doctors, dentists, pharmacists and other health care providers here treat some of the poorest patients in Santa Clara County -- patients whom many expect to have newly-minted health insurance this year as the federal Affordable Care Act kicks in. But the clinic has, unexpectedly, not seen an increase in demand for primary-care physicians, whom the newly insured were expected to tap to finally treat ongoing aches and pains (Bookwalter, 4/14).

The Associated Press: With New Health Law, Insurers Target Diabetics
Insurers are calling diabetics when they don’t pick up prescriptions or miss appointments. They are arranging transportation to get them to the doctor’s office and some are even sending nurses on house calls in an effort to avoid costly complications that will have big impact on their bottom lines. Before the Affordable Care Act, some diabetics struggled to find insurance because of their pre-existing condition. But the new law no longer allows companies to refuse them or charge more, making early intervention even more critical (4/13).

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Va. GOP Not Backing Down In Medicaid Stalemate

Despite appeals from traditional allies such as local hospitals, chambers of commerce and business leaders, Republicans in Virginia's House of Delegates remain firm in their stand against expansion. Meanwhile, Pennsylvania's request to set up a modified expansion is moving into a negotiation phase with federal officials, and union members take the fight to voters in Florida.

The Washington Post: Va. Republicans Aren't Blinking In Showdown Over Medicaid Expansion
Virginia Republicans were supposed to be squirming by now. For months, their opposition to expanding Medicaid under the Affordable Care Act has put them at odds with some traditional allies in the business world. Hospitals, the state chamber of commerce and corporate leaders have been calling, writing, visiting and buttonholing, pushing what they call "the business case" for expanding coverage to thousands of uninsured under the health care law, with the federal government promising to pay most of the cost. Gov. Terry McAuliffe and other Democrats who favor expansion have been betting on that pressure to sway Republicans (Vozzella, 4/13).

The Associated Press: Medicaid Expansion Debate Good For Insurers
Some of the biggest health insurance companies in the country are poised to benefit from the debate over expanding Medicaid in Virginia, regardless of its outcome. If Gov. Terry McAuliffe and the Democratically controlled Virginia Senate prevail, the state will expand Medicaid eligibility to about 400,000 low-income residents. The money to insure them -- hundreds of millions of dollars a year -- will be paid by the federal government to private insurance companies. Understandably, those insurers strongly favor this option (4/13).

The Associated Press:  Corbett Plan Will Test Federal Agency On Medicaid
Billions of dollars, better health care for Pennsylvania's poor and election-year politics are riding on Republican Gov. Tom Corbett's bid to bring Medicaid expansion money to the state under the 2010 federal health care law. ... The federal government's public comment period ended Friday, and negotiations are expected to begin this month on Corbett's 124-page plan submitted in February. The outcome is anything but certain (Levy, 4/13).

Miami Herald:  Union Appeals To Voters In The Medicaid 'Coverage Gap'
The state health care workers' union has a new strategy in its fight to expand Medicaid coverage: reaching out to voters "who've been screwed out of health care coverage by their representative's refusal to act." SEIU Florida will be knocking on doors this weekend in four state House districts (McGrory and Mitchell, 4/11).

Also, a Minneapolis paper examines efforts there to sign up people for subsidized coverage --

The Star Tribune: Minnesota's Uninsured Get Public Aid At Historic Levels
On a recent weekday evening, Ibrahim Hassan was pacing the narrow corridor outside a Somali mosque in south Minneapolis, buoyantly shaking hands and waving like a politician at a campaign stop. His mission: To sign up every eligible uninsured person he met for public health coverage through the state's MNsure website. His mobile "office" consisted of a foldout table, a laptop and a small sign that read, "We can help you" in Somali and "Obama Care." Though much attention has focused on the March 31 deadline to buy private health insurance -- and the consumer frenzy that resulted -- federal health reform and the debut of MNsure have also led to a historic surge in the number of Minnesotans enrolling in public programs (Serres, 4/13).

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What Challenges Lie Ahead For Exchanges

Questions about 2015 premiums, the age and health status of the newly insured and the impact of premiums on the working poor will be answered in the months ahead. In addition, the New York Times looks at the reasons that New York's state-based exchange may have become one of the most competitive in the country.

McClatchy: With Sebelius Gone, What’s Next For Obamacare?
The resignation of Health and Human Services Secretary Kathleen Sebelius comes at an opportune time for the Obama administration. With sign-ups for private marketplace coverage now at 7.5 million and the special enrollment period nearing an end, the administration can momentarily catch its breath after a roller-coaster six-month enrollment period that saw the president’s signature legislative accomplishment nearly crash on takeoff. The Silicon Valley SWAT team that rescued the malfunctioning healthcare.gov website also saved Obamacare in the minds of a skeptical nation, nearly half of which still roots for its failure (Pugh, 4/11).

The New York Times: In New York, Hard Choices On Health Exchange Spell Success
In contrast with the early stumbles in most of the country, New York State, almost from the start, has provided a textbook lesson in how to make the Affordable Care Act work. But it has done so by making some tough decisions. New York has signed up more than 900,000 people for commercial or government plans, lured 16 insurance companies onto its exchange, provided subsidies for most customers and reduced premiums across the board (Hartocollis, 4/13).

Los Angeles Times: For The Working Poor, New Health Premiums Can Be A Burden
For nearly two decades, Barbara Garnaus maintained a modest, delicate life balance: keeping her part-time Orange County school district job and juggling her bills and credit card debt. Now 63, living alone, she counts every dollar, has no cellphone and commutes an hour in traffic so she can keep an affordable apartment in Laguna Woods (Karlamangla, 4/13).

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Conservatives Continue Health Law Attack Barrage

Leading Republicans readying for a White House run in 2016 also unofficially kicked off their campaigns in New Hampshire Saturday by hammering the health law.

The Associated Press: 'Obamacare' Under Attack As Conservatives Eye 2016
Republicans eyeing the 2016 White House race battered President Barack Obama’s health care law and nicked each other Saturday, auditioning before a high-profile gathering of conservatives that some political veterans said marked the campaign’s unofficial start. A speaking program packed with potential presidential candidates weighed in on the House Republicans’ controversial budget, the party’s struggle with Hispanics, the GOP’s future and the upcoming midterm elections while taking turns on a conference room stage facing hundreds of conservative activists gathered in New Hampshire’s largest city (4/12).

Fox News: Conservatives, White House Hopefuls Gather In New Hampshire, Attack Obamacare
The country’s leading conservative voices -- and potential 2016 presidential candidates -- gathered Saturday in New Hampshire to drive more stakes into Obamacare and urge voters to end Democrats’ control of the White House and Senate. “We win whenever we have an agenda, boldly focused on upward economic mobility for Americans,” Utah GOP Sen. Mike Lee told the crowd at the Freedom Summit, in Manchester, N.H. “Expect more from the conservative party. … Expect Congress to do its job … Join me in expecting more, expect freedom.” The conference is being hosted by Citizens United and Americans for Prosperity, which with the help of billionaire brothers Charles and David Koch has already spent millions of dollars on Obamacare-related attack ads aimed at Democratic senators in New Hampshire, North Carolina, Alaska, Colorado, Iowa and elsewhere (4/12).

The Associated Press: Gingrich Blasts ‘Ideologues’ Behind Health Law
Newt Gingrich isn’t holding back in his criticism of the Cabinet secretary and others behind the troubled rollout of the health care law. The former House speaker and Republican presidential candidate says Health and Human Services Secretary Kathleen Sebelius and other Democrats are “nut-cake ideologues” and less than competent (4/12).

In the meantime, Democrats look to improve their political fortune by suggesting improvements to the health law --

Los Angeles Times: Democrats Hoping To Succeed Rep. Waxman Square Off In Pacific Palisades
Not surprisingly, the four candidates displayed similar views on most issues: Protect the environment, improve public education, boost the minimum wage and take other steps to ease the income diversity between the rich and the poor. All said they would like to see the Affordable Health Care Act improved upon by extending Medicare to all Americans and not remain limited to those over 65. [Radio talk show host Matt] Miller also called for finding ways to cut medical costs so healthcare dollars can be spent more efficiently. Savings also could be funneled to other needs, such as education, he said (Merl, 4/13).

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Medicare

Medicare Doctor Payment Data Reveals Much About Health System

The trove of data has the potential to reveal faults in drug pricing, potential fraud and could help regulators and consumers track medical spending -- but could take years to sort out.

The Washington Post: These Maps Tell You Everything That’s Wrong With Our Drug Pricing System
The kind of health care you get and how much it costs depends a lot on where you live. Take, for example, the way that doctors across the U.S. treat a chronic eye disease, known as wet age-related macular degeneration, that among older people had long been a leading cause of blindness. There is no evidence that the disease varies from place to place. But as recent Medicare data show, the way that doctors’ treat it does, and those choices have huge effects on the U.S. and personal budgets (Rich and Whoriskey, 4/11).

Reuters:  Lawyers Start Mining The Medicare Data For Clues To Fraud
Within hours of the U.S. government's unprecedented release last week of a trove of Medicare billing data, a small fraternity of lawyers who specialize in representing whistleblowers in health care fraud cases began to mobilize. These lawyers earn their living bringing cases on behalf of employees at drug companies and health care providers who believe their bosses or colleagues may be cheating the federal Medicare system by bribing doctors to prescribe certain drugs, for example, or inflating bills (Baynes, 4/14).

Bloomberg News:  Medicare Pay List May Open Door To More Data
Doctors denounced the accuracy and value of data listing $77 billion in Medicare payments to 880,000 medical providers, while consumer and industry groups said it could make the health care system more cost-effective. The divergent views of Medicare's first-ever release of U.S. payments to physicians suggested the impact may take years to play out. U.S. officials, meanwhile, said they may follow Wednesday's report on 2012 data by providing the same information from earlier years, a move that would help regulators and consumers trace changes in health care over time (Wayne and Chen, 4/11).

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Health Care Marketplace

High Cost Of Potent Hepatitis Drug Presents Challenges Across The U.S.

Sovaldi, the hepatitis C treatment drug, is considered a breakthrough for patients with the disease. However, since it won federal approval in December, lawmakers, insurers and patient advocates have begun an all-out revolt over its high price point of $1,000 a daily pill or $84,000 over 12 weeks of treatment. 

The San Francisco Chronicle:  Cost Of Highly Effective Hepatitis Drug Spurs Revolt
The nation may have finally met a drug it cannot afford. Sovaldi is a long-awaited breakthrough for the 3 million Americans suffering from the hepatitis C virus. And at $1,000 a daily pill, or $84,000 over 12 weeks of treatment, the medication could generate as much as $19 billion nationwide in revenue in the next three years for maker Gilead Sciences in Foster City. Since Sovaldi won federal approval in December, lawmakers, insurers, pharmacy benefit managers and patient advocates have begun an all-out revolt. The dissent might represent a potential breaking point for a health care regime used to paying out gobs of money for breakthrough drugs, industry officials and analysts say (Lee, 4/12).

Reuters:  Texas Medicaid Holds Off On Proposed Limits For Gilead Hepatitis Drug
Texas is reconsidering whether to impose strict limits on Gilead Sciences' $84,000 hepatitis C treatment for patients on the state's Medicaid health plan for the poor, at the urging of outside advisers, a state official said on Friday.  The Texas Health and Human Services Commission, which oversees Medicaid, had proposed a policy to allow the drug, Sovaldi, to be used mainly for sicker patients such as those whose hepatitis C had developed into advanced liver disease, according to state documents reviewed by Reuters (Humer, 4/11).

Los Angeles Times: New Drugs Provide Cure For Hepatitis C, Research Finds
Twenty-five years after scientists first identified the hepatitis C virus, doctors are declaring victory over an infection that afflicts more than 3 million Americans and kills more of them than HIV. In a series of clinical trial results, a new generation of antiviral medications was able to clear the liver-ravaging virus from virtually all patients' bloodstreams in as little as eight weeks. Even in patients with the most stubborn infections, the new drugs were capable of suppressing the virus completely at rates well over 90%. The treatments, however, come with a steep price tag (Healy, 4/11). 

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Women's Health

New Split Over Abortions In Cases Of Rape

A rift among U.S. anti-abortion activists has spotlighted divisions about whether to exempt abortions in the case of rape or incest from anti-abortion policies. In other news, the New York Times reports on a surge in prescriptions for opioid painkillers among pregnant women.

The Associated Press: Abortion In Cases Of Rape: New Rifts In Old Debate
Poll after poll over many years has shown that Americans overwhelmingly support legal access to abortion for women impregnated by rape. Yet the issue remains divisive, as demonstrated by two current rifts — one involving U.S. aid policy overseas, the other highlighting strategy differences within the U.S. anti-abortion movement. The National Right to Life Committee recently voted to cut ties with one of its most zealous state affiliates, Georgia Right to Life. The move, which angered many anti-abortion activists nationwide, came after the affiliate defied instructions to endorse an anti-abortion bill in Congress because it included exceptions for rape and incest (Crary, 4/12).

The New York Times: Surge In Prescriptions For Opioid Painkillers For Pregnant Women
Of 1.1 million pregnant women enrolled in Medicaid nationally, nearly 23 percent filled an opioid prescription in 2007, up from 18.5 percent in 2000, according to a study published last week in Obstetrics and Gynecology, the largest to date of opioid prescriptions among pregnant women. Medicaid covers the medical expenses for 45 percent of births in the United States (Saint Louis, 4/13). 

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State Watch

Study Shows 25 Percent Of Colorado Foster Kids On Psychotropic Drugs

The rate is 12 times greater than for other children on government insurance, a new study in Colorado finds.

The Denver Post:  Colorado Responds Slowly To Psychotropic Drug Use Among Foster Kids
Diego Conde was 12 when his mother died, devastated and bursting with rage at the rotten way life was treating him. The only living thing left that mattered to him was his tiny dog, Littlefoot. Then, three months later, Littlefoot died. Diego was sent to live with strangers — a string of foster families in Denver and Aurora. He got in fights at school, started drinking alcohol and smoking marijuana, and exploded in anger at his teachers and temporary parents. At 13, he overdosed on borrowed prescriptions because he "couldn't take it anymore." And so the state medicated him heavily, with twice-daily doses of potent mood-altering psychotropic drugs he says he did not want to take.  About 4,300 of Colorado's 16,800 foster children -- more than a quarter -- were prescribed psychotropics in 2012, according to a University of Colorado analysis released to The Denver Post under open-records laws. Among teens in foster care, 37 percent were prescribed psychotropic drugs (Brown and Osher, 4/13).

The Denver Post:  Drug Firms Used Dangerous Tactics To Drive Sales To Treat Kids
Pharmaceutical companies wooed academic leaders, ghostwrote articles, suppressed damaging health data and lavished doctors with gifts to make prescribing powerful psychotropic drugs to children a blockbuster profit center, a trail of lawsuits over the past two decades shows. As a Colorado Springs sales representative for GlaxoSmithKline, Greg Thorpe tried to put a stop to the practice. His manager wrote him up for not being a "team player" after he objected to the free spa treatments and pedicures, hunting trips, tickets to sports games and skiing junkets that his supervisors expected him to give out to doctors and others (Osher and Brown, 4/14). 

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Highligts: Calif.'s Medical System For Prisons; Gender Therapy In Boston; Ga. Public Health Money

A selection of health policy stories from California, Massachusetts, Georgia and North Carolina.

Los Angeles Times: California's Medical Prison Beset By Waste And Mismanagement
California's $840-million medical prison -- the largest in the nation -- was built to provide care to more than 1,800 inmates. When fully operational, it was supposed to help the state's prison system emerge from a decade of federal oversight brought on by the persistent neglect and poor medical treatment of inmates. But since opening in July, the state-of-the-art California Health Care Facility has been beset by waste, mismanagement and miscommunication between the prison and medical staffs (St. John, 4/12).

The Boston Globe: Gender Therapy Access Pushed
City workers in Boston seeking gender reassignment surgery would for the first time have their care covered by health insurance under a City Council proposal supported by Mayor Martin J. Walsh. City Councilors at Large Michelle Wu and Ayanna Pressley said they plan to file a proposal Monday that would guarantee transgender city employees access to gender reassignment surgery, hormone therapy, and mental health services (Fox, 4/14).

Georgia Health News: Drop In Federal Funds Squeezes Public Health 
The state budget recently delivered good news for Georgia public health: an overall increase in funding. But behind those numbers are other numbers that have alarmed public health officials. About 70 percent of the overall budget for the Department of Public Health comes from federal grants. And that federal money has seen significant reductions. From fiscal 2012 to fiscal 2013, across all programs, Public Health lost about $25 million in federal money. And that drop has continued (Miller, 4/13).

Kaiser Health News: Waiting -- And -- Waiting On The Nursing Home Inspector
The case is just one example of hundreds in Los Angeles County and thousands statewide in which investigations by nursing home regulators have remained incomplete for months, sometimes years. There were 3,044 open cases in the county as of mid-March, 945 of which date back two years or more, according to an audit released last week by the Los Angeles County Auditor-Controller (Gorman, 4/14).

North Carolina Health News:  Lack of Funds Continues to Limit NC Abortion Clinic Inspections
In a new report, the N.C. Department of Health and Human Services says that funding shortfalls remain an obstacle to hiring needed inspectors for abortion clinics and other medical facilities. The report, on “additional needs to survey abortion clinics,” was issued April 1 in response to the requirements of N.C.’s new abortion law, passed late last summer. The law instructed DHHS to prepare new rules for how clinics are certified and to keep the N.C. General Assembly’s Joint Legislative Oversight Committee on Health and Human Services apprised of the process. The legislature’s directives regarding abortion clinics seemed relatively clear last summer: Do more inspections and write new rules. But neither objective has played out quickly (Elliston, 4/10).

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Editorials and Opinions

Viewpoints: Sebelius Withstood Attacks, But Wasn't 'Warrior' For Law; Burwell Offers GOP Chance To Focus On Law's Problems

The New York Times: Kathleen Sebelius Was Too Cool And Too Patient
Kathleen Sebelius was known for her patience and cool under savage attack by Republicans, who treated her as a stand-in for the health law. She sat through hearings calmly reciting talking points while they fumed and fulminated for their audience. But that turned out to be one of her biggest liabilities ... What the health law needed in its first years was a cheerful, populist warrior who could laugh at the truly ridiculous distortions and lies Republicans invented about it, and roar back with the truth. Instead, she came across as a mild technocrat. She never emerged from the defensive crouch she assumed after the law’s calamitous debut (David Firestone, 4/11).

The Los Angeles Times: Obamacare And The Sebelius Legacy
A technology wonk might have had the website working better, but would have been utterly unable to navigate the ideological shoals through which Obamacare has had to sail. There probably aren't too many political figures who could have dealt with the relentless assault on the ACA with as much equanimity as Sebelius mustered. The record of the last six months suggests that even a flawless launch of HealthCare.gov would not have stemmed the attacks on the law. After all, it's operating fine now; have you heard a single Republican acknowledge that? (Michael Hiltzik, 4/11).

Bloomberg: Kathleen Sebelius's Legacy, And Obamacare's
By one crucial and fundamental measure, the law is living up to its name: More Americans now have access to affordable health care. ... This is no small achievement, and to reach it Sebelius had to overcome the law's unwieldy structure. Its combination of subsidies, penalties and inducement was the result of political bargaining with an array of powerful and stubborn constituencies. Making it all work would have been an ambitious undertaking in any environment. But Sebelius wasn't working in just any environment: Obamacare was hounded from the outset by a Republican Party that defined itself largely by its relentless opposition to the law -- in Congress, the courts and the states (4/11).

The Wall Street Journal: Advice And ObamaCare Consent
Kathleen Sebelius has been let out a rear door of the Health and Human Services Department, and her exit is an opportunity for getting some ObamaCare accountability. President Obama tapped Sylvia Mathews Burwell as her replacement on Friday. The Senate should try to use her confirmation to expose the law's continuing troubles and improve HHS transparency (4/11).

Bloomberg: What Does Washington Have To Say About Sylvia Burwell?
These days, serving as Secretary of Health and Human Services is an impossible job. President Barack Obama has selected the perfect woman for the task. Sylvia Mathews Burwell, the director of the Office of Management and Budget, has been picked as the successor to HHS Secretary Kathleen Sebelius. ... Republicans will use her confirmation hearings as a vehicle to attack Obamacare, but she will handle it almost perfectly and win confirmation with a large number of Republican votes (Albert R. Hunt, 4/11).

Bloomberg: How Republicans Should Play The Burwell Confirmation
First, Republicans should ask themselves, who pays attention to cabinet confirmation hearings, anyway? ... In reality, almost no one pays attention to these shows. The big exceptions are the inside-the-Beltway elites and, in particular, those who are especially concerned about the policy areas covered by HHS. They should be the target of Republican efforts during the Burwell confirmation. And that’s why Obamacare opponent Philip Klein’s is smart to advise Republicans use the occasion to make the case that the ACA gives the HHS secretary unusually vast powers. And, I would add, the case that the administration has exceeded those powers (Jonathan Bernstein, 4/11).

The Washington Post: Lt. Gov. Anthony Brown Shows Gall By Claiming Md. Is 'Leader' On Health-Care Reform
Maryland Lt. Gov. Anthony Brown (D) has staked an early claim to the dubious honor of making our region’s most shameless and misleading 2014 campaign boast. In a display of world-class chutzpah, Brown's Web site asserts that he "has positioned Maryland as the national leader in the implementation of the Affordable Care Act" (Robert McCartney, 4/12).

Roanoke Times: You Have Reached Your Destination
[Virginia House Republicans] haven't made a lick of progress on the budget or the Marketplace Virginia health care program, an idea by Powhatan Republican Sen. John Watkins that would enable uninsured adults to purchase private insurance and would make the state eligible for federal funding. The plan passed the Senate, but House leaders say they won't consider Marketplace Virginia until Medicaid reforms are implemented. And they continued to say that after Health Secretary Bill Hazel told them last week that the reforms they requested were indeed a reality (4/13).

Bangor Daily News: This Medicaid Expansion Episode Has Come To A Close — And Logic Didn’t Prevail
The Senate came up two votes short of overriding Gov. Paul LePage’s damaging veto of a bill to expand Medicaid coverage to thousands of low-income parents and adults without children. The Medicaid expansion plan that lawmakers voted on was itself something worth celebrating. It was a deliberate effort by Republican Sens. Roger Katz and Tom Saviello to craft a bill that included something for both sides of the aisle and that did something important for the state. It expanded Medicaid. It included measures to control costs in an often unwieldy MaineCare program ... The reasons for rejecting the expansion just don’t add up (4/12).

The Fiscal Times: We Can Find Consensus On Health Care Cost Reforms
With the Affordable Care Act's open enrollment period now closed, perhaps there is an opportunity for constructive, bipartisan policy discussion on health care reform. One thing that both Obamacare supporters and opponents can agree on is that our health care system remains inefficient. And, although health care inflation slowed in recent years, informed observers from across the political spectrum realize that population aging will produce a new bout of cost escalation – unless something else is done (Marc Joffe, 4/13).

On other health issues -

The Washington Post: A Needed Look Into The Cost Of Medicare
For the first time, the Obama administration released doctor-specific information about Medicare payments, starting with 2012 data on $64 billion worth of billings. Journalists immediately set to work analyzing the data. Among some of the key findings: Just 2 percent of the 880,000 physicians accounted for nearly a quarter of the payments; reimbursements for prescription drugs accounted for an eighth of the spending; a handful of specialties, oncologists and ophthalmologists especially, accounted for a disproportionate share of the costs. ... disclosure had been resisted by doctors, who felt it would invade their financial privacy or distort public discussion by disseminating raw, out-of-context information. The latter concern was voiced last week, yet what was striking about the data release was how carefully news organizations explained its nuances to readers (4/12).

Bloomberg: Blame Medicare For Eye-Popping Costs
Among the surprises nestled in last week's release of Medicare payment data was this head-scratcher: Of the 50 physicians who got the most Medicare money in 2012, almost half were ophthalmologists. Some of that may come from questionable billings. But it also results from Medicare doctors' perverse incentive to choose more expensive drugs than necessary (4/13).

The Wall Street Journal: Listening To Medicare's Billing Data
Robert Krughoff, president of Consumers' Checkbook, whose legal battle (joined by The Wall Street Journal's publisher) triggered this week's data dump, has cautioned that if you want to know how rich your doctor is, you'd be better off driving past his house. Fair enough. The data, however liable to be misinterpreted, do help to debunk a liberal heirloom—the claim that Medicare is more efficient than private insurers because Medicare appears to devote such a small share of its total spending to administrative overhead (Holman W. Jenkins, Jr., 4/11).

The New York Times: A Loyal Soldier Doesn't Deserve This
Iraq is but a fading memory for most Americans, and Afghanistan may soon recede as well. But for countless others like Mike and Leigh Anna, the war continues and will for decades to come. The Department of Veterans Affairs says that it has made progress in reducing its backlog in processing disability compensation claims, but critics say that is because of the way it defines the backlog — and many hundreds of thousands of veterans are still awaiting decisions. Likewise, the V.A. has improved suicide prevention work, but, by all accounts, it's not enough, so that veterans are dying unnecessarily (Nicholas Kristof, 4/12).

The New York Times: Doubly Disabled In Life
Americans with intellectual and developmental disabilities historically have been shuttled far from society’s mainstream into segregated lives and workplace serfdom, earning wages as low as pennies per hour for the most repetitive and menial jobs. The Supreme Court in 1999 pronounced this kind of treatment a civil rights violation under the Americans With Disabilities Act, but abuse and isolation from society have continued to this day. This week, Rhode Island and the Justice Department took an important step away from that pattern by reaching a comprehensive agreement to direct these people toward community living, minimum-wage guarantees and competitive opportunities (4/11). 

USA Today: Vaccine Opt-Outs Put Public Health At Risk: Our View
Measles, which once killed 450 children each year and disabled even more, was virtually eliminated in the United States 14 years ago by nearly universal use of the MMR vaccine. But the disease is making a comeback, fueled by a growing anti-vaccine movement and misinformation that is spreading like a contagious disease. Already this year, 115 measles cases have been reported in the USA, compared with 189 for all last year (4/13). 

USA Today: Leave Parents Free To Choose Vaccines: Opposing View
The public conversation about vaccine safety and choice began after Congress passed the National Childhood Vaccine Injury Act of 1986, shielding drug companies from product liability and doctors from vaccine-injury lawsuits. Under that law, $3 billion has been paid to the vaccine injured while liability-free drug companies enjoy profits from a multibillion dollar market. U.S. health officials now recommend 69 doses of 16 vaccines for every child. States mandate up to 15 of them — twice as many as 30 years ago (Barbara Loe Fisher, 4/13). 

WBUR: Boston Marathon Medical Director: Getting Back To What The Race Is About
Last April 15 at about 2:45, Dr. Aaron Baggish was enjoying the sunny spring day and, in his role as medical director of the Boston Marathon, marveling at the low volume of runners who needed his care. Then the first bomb exploded, about 15 feet away from him. It blew out his right eardrum but the crowd blocked much of the force of the blast, and within seconds he was over the barrier and starting to work on the injured. After the bombing, Dr. Baggish, who heads the Cardiovascular Performance Program at Massachusetts General Hospital, declined requests for interviews, feeling unable to speak publicly about what happened. But as Boston gears up for its next marathon on April 21 and he prepares to help oversee the race’s medical staff once again, he agreed to share some of his thoughts (Carey Goldberg, 4/11).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Marissa Evans
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.