Daily Health Policy Report

Friday, April 25, 2014

Last updated: Fri, Apr 25

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Health Care Marketplace

Public Health & Education

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

With Medical Debts Rising, Doctors Are More Aggressive About Payments

Kaiser Health News staff writer Jenny Gold, working in collaboration with NPR, reports: “The recent economic downturn and the increasing use of high-deductible insurance plans “has driven patients to want to put off paying their bills,” Michael explains. Whether it’s for a hip replacement or a broken bone, he frequently sees patients on the hook for a $3,000 to $5,000 deductible” (Gold, 4/25). Read the story and the related sidebar by Lexie Verdon.

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What Obamacare? Meet 4 People Choosing To Remain Uninsured

Southern California Public Radio’s Stephanie O'Neill, working in partnership with Kaiser Health News and NPR, reports: “Despite a surge in enrollment in the two weeks before the April 15 deadline to enroll for insurance under the health law, many more Californians have not signed up. And they’re unlikely to. Many people are uninterested in health insurance, confused or skeptical” (O’Neill, 4/25). Read the story

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Rural Hospitals Face Tough Choices On Computerized Records

Reporting for Kaiser Health News, in partnership with NPR, Eric Whitney writes: “One of the biggest challenges American hospitals face right now is adopting electronic medical records systems. It’s costing tens of billions of dollars, eating up tons of staff time and it's especially tough for the country's 2,000 rural and small town hospitals. Rural hospitals are typically cash strapped, and people with information technology skills can be hard to find outside of big cities” (Whitney, 4/24). Read the story.

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A Reader Asks: If Our Income Changes, Can We Change Plans?

Kaiser Health News consumer columnist Michelle Andrews answer this reader’s question (4/25). Read her response.

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Capsules: Consumers In Federal High-Risk Pools Get Special Enrollment Option For Marketplace; Some Surprising Findings About Young Adults And Health Care; RAND: Medicare Should Weigh Cost In Coverage Decisions

Now on Kaiser Health News’ blog, Mary Agnes Carey reports on developments regarding federal high risk pools: "In a notice posted on the Pre-Existing Condition Insurance Plan website, officials said that participants in the high-risk program who have not yet purchased coverage through the health law’s online marketplaces, or exchanges, can qualify for the new enrollment period. These people have until June 30 to pick a plan through the federal exchange, healthcare.gov, or their state marketplace, if their state runs one. No matter when they enroll in that time frame, benefits will be effective back to May 1, officials said. State-based marketplaces are adopting a similar special enrollment period" (Carey, 4/25). 

Marissa Evans reports on young adults and health care: "Insured or uninsured, young adults seem to spend about the same out-of-pocket for health care over the course of a year. With 2009 federal data on patient spending, researchers examined how often adults up to age 25 used and paid for health care. While an awful lot has changed since then – the Affordable Care Act became law in 2010, young adults can stay on family insurance plans until age 26, they can get subsidies to buy insurance – this study in the Journal of Adolescent Health could be a baseline to see whether the ACA makes a difference in the behavior, coverage or spending of this important age group" (Evans, 4/25).

Also on Capsules, Lisa Gillespie reports on the RAND recommendations: "The agency that oversees the Medicare program should be able to consider the cost effectiveness of drugs and medical devices when making coverage determinations, according to a new report by the RAND Corporation" (Gillespie, 4/24). Check out what else is new on the blog.

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Political Cartoon: 'Watch Your Step?'

Kaiser Health News provides a fresh take on health policy developments with "Watch Your Step?" by Tim Eagan.

Here's today's health policy haiku: 

PUBLIC V. PRIVATE

Serve the public good!
Seniors need care not profits
Health Reinvestment?
-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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Health Reform

Oregon To Join Federal Health Insurance Exchange

Oregon built what is widely regarded as the worst-functioning state exchange in the nation. 

Time: Oregon Dropping Health Exchange in Favor of Federal Marketplace
Oregon is abandoning its troubled online health exchange in favor of the federal website, becoming the first state to do so. Cover Oregon’s board approved Friday a recommendation that the state switch. The vote came after it was determined that fixing the state’s current system would cost $78 million, while switching to the federal system will cost between $6 million and $8 million (Frizell, 4/24).

NBC News: Oregon To Ditch Troubled Health Insurance Exchange
Friday’s decision comes as no surprise. Independent experts recently advised the state to fold its site. Auditors have publicly lambasted its project managers for ignoring technical problems and the state is feuding with its website developer (Oracle) over payment. ... Aaron Albright, a spokesman for the Center for Medicare & Medicaid Services (CMS), said that the agency is “working with Oregon to ensure that all Oregonians have access to quality, affordable health coverage in 2015" (Cowley, 4/24).

The Oregonian: Cover Oregon Poised To Switch To Federal Insurance Exchange
Not all of Oregon's work will necessarily be scrapped. [Alex Pettit, Oregon's IT czar] expressed confidence that the portion of the exchange for eligibility and enrollment into the Medicaid-funded Oregon Health Plan can be salvaged and transferred to the Oregon Health Authority. The federal government will pick up 90 percent of the cost of the Medicaid work, Pettit said (Budnick, 4/24).

The New York Times: Oregon Panel Recommends Switch To Federal Health Exchange
State officials concluded that it would be much less expensive to use the federal site, HealthCare.gov, than to repair the one built specially for the state, Cover Oregon. The first option would cost $4 million to $6 million, while the second would cost $78 million, state officials said (Pear and Johnson, 4/24).

Los Angeles Times: Oregon Leaders To Vote On Scrapping Health Insurance Exchange
 Not a single insurance seeker was able to enroll online in a private plan under the Affordable Care Act in this high-tech state, which has long prided itself on healthcare innovation and whose governor is a former emergency room doctor. Cover Oregon instead was forced to resort to paper applications (La Ganga and Reston, 4/24).

The Washington Post: Obama Administration Prepares To Take Over Oregon’s Broken Health Insurance Exchange
The collapse of Oregon’s insurance marketplace comes as federal health officials are focusing intensely on faltering exchanges in two other states, Maryland and Massachusetts. This month, the board of the Maryland Health Connection became the first in the nation to decide to replace most of its exchange with different technology. ... Massachusetts was in the vanguard of insurance exchanges, opening its own years before the 2010 federal health-care law. But the commonwealth’s insurance marketplace developed severe technical problems as it tried to make adjustments to interact with the federal system (Goldstein, 4/24).

Politico: State Health Exchange Still Broken, Oregon Looks To Join Feds
Oregon is the first state to give up technological control of its Obamacare website and join the federal exchange, an irony considering how busted HealthCare.gov was six months ago (Haberkorn, 4/24).

Reuters : Oregon’s Broken Healthcare Exchange May Move To Federal Network
Oregon, a state that fully embraced the Affordable Care Act, has endured one of the rockiest rollouts of President Barack Obama's signature health care law, requiring tens of thousands of applicants to apply on paper since launching on October 1 (Sebens, 4/25).

Meanwhile, in Colorado --

The Denver Post:  Colorado Health Exchanges Considers Adding Life Insurance To Products
The state health exchange is considering adding new products to its line, such as life insurance, to generate more cash, Connect for Health Colorado executive director Patty Fontneau told lawmakers at a review committee hearing Thursday. "As our small group (insurance) becomes more robust, often businesses purchase their group life when they purchase their group health," Fontneau said. "We could consider it and bring it to the board” (Draper, 4/24).

Health News Colorado: Lawmakers Defend Brokers, Don’t Want Exchange Selling Life, Car Insurance
Lawmakers today defended insurance brokers and don’t want Connect for Health Colorado to start selling other forms of insurance. Sen. Ellen Roberts, R-Durango, grilled exchange CEO Patty Fontneau during a legislative oversight committee hearing today about whether she would consider selling other products from car insurance to life insurance. So far the exchange sells health and dental insurance and the board recently voted to add vision insurance. Exchange board members have been reluctant to divert from Connect for Health’s mission to sell health insurance, but Fontneau opened the door Thursday to life insurance (McCrimmon, 4/24).

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Consumers In High-Risk Pools Can Sign Up For Plans Until June 30

The federal program that provided coverage for people with chronic health problems, which often prevented them from being able to buy private insurance, is shutting at the end of the month, but participants can buy coverage through the exchanges until the end of June.

The Wall Street Journal’s Washington Wire: Insurance Program For Those With Pre-Existing Ailments To End
The Obama administration said there will be no further extensions of the federal health-insurance program for people with pre-existing health conditions, and it will close Wednesday, April 30 (Radnofsky, 4/24).

The Hill: ObamaCare Enrollment Extended Again
Sick patients who obtained health coverage through ObamaCare's federal high-risk pool will have until June 30 to select a plan at HealthCare.gov, the Obama administration said Thursday. The special enrollment period applies to patients in the Pre-Existing Condition Insurance Plan (PCIP), a temporary, federal program designed to provide coverage to people insurers had turned away (Viebeck, 4/24).

Kaiser Health News: Capsules: Consumers In Federal High-Risk Pools Get Special Enrollment Option For Marketplace
PCIP, which was started by the health law in 2010, has helped people with pre-existing conditions obtain health coverage. These consumers in the past were often turned away by commercial insurers. The program is now being discontinued because under health law rules that went into effect Jan. 1, insurers can no longer deny coverage based on an individual’s medical record (Carey, 4/25).

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Poll Finds Drop In Support For Virginia Medicaid Expansion

A survey conducted by the Wason Center at Christopher Newport University finds that 53 percent of Virginia voters oppose enrolling more people in Medicaid.

The Washington Post: Poll: Support For Medicaid Expansion Down Sharply In Virginia
McAuliffe (D) and a slim majority of the evenly divided state Senate have pushed this year to expand Medicaid under the federal Affordable Care Act, saying it would provide insurance to up to 400,000 needy Virginians and boost the economy. The Republican-dominated House has opposed expansion, raising doubts about the federal government’s ability to pay most of the $2 billion-a-year cost and stressing the need to first rein in the existing Medicaid program (Vozzella, 4/24).

The Associated Press: Poll: Majority Oppose Va. Medicaid Expansion
A poll from Christopher Newport University’s Judy Ford Wason Center for Public Policy poll released Thursday shows that Virginia voters oppose Medicaid expansion 53 percent to 41 percent. In February, the university found the majority of voters favored Medicaid expansion 56 to 38 (4/24).

The Richmond Times-Dispatch: Poll: Virginia Voters Shift On Medicaid
A majority of Virginia voters now oppose Medicaid expansion, according to a new survey, signaling a reversal on the issue since February. Fifty-three percent oppose expansion while 41 percent support it, according to a survey of 806 registered Virginia voters conducted April 16-22 by the Wason Center for Public Policy at Christopher Newport University. A CNU survey in February showed support for expansion at 56 percent, with 38 percent opposed (Nolan, 4/25).

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On The Campaign Trail, Some Democrats Embrace Health Law

One of the most notable examples is taking place in the Pennsylvania primary, where Democratic gubernatorial hopefuls are expressing support for the law.  

The New York Times: Democratic Candidates Grow More Vocal In Supporting Health Law
So far, 76 percent of all Republican-sponsored general election spots in House and Senate races this year have attacked the Affordable Care Act, making the law the most mentioned issue in such ads, according to Kantar Media/CMAG, which tracks political advertising. But Democrats, who this cycle have run largely on a “fix, don’t repeal” strategy concerning the law, are now gingerly experimenting, mostly in primaries and through outside groups, with ads that endorse the law and also say what could be lost if Republicans repeal it (Parker, 4/24).

Politico: Democrats Race To Embrace Obamacare In Pennsylvania Primary
Democrats vying to be the swing state’s next governor are trying to one-up each other in showing their support for the law ahead of the May 20 primary — airing ads boasting ties to the president, tweeting old OpEds proving their pro-health law bona fides and even suggesting one Democratic contender is a “frenemy” of the law (Schultheis, 4/24).

ABC News: Three Women (Start To) Run On Obamacare
Something unusual is brewing in Pennsylvania: A Democrat is running on – not from – Obamacare. As she seeks to emerge from a crowded Democratic primary field in Pennsylvania’s gubernatorial race, Rep. Allyson Schwartz is among the first prominent Democrats to take President Obama’s advice and defend the new health care law. “It’s a major accomplishment of the president’s,” Schwartz told reporters on a call Wednesday. “It is something I think all of us should be proud of” (Parks, 4/24).

And on the fact-checking front -

The Washington Post’s The Fact Checker: The Bogus Claim That Obamacare Has Boosted The Number Of Uninsured
Rep. Tim Huelskamp is a tea party favorite who has long been a skeptic of the Affordable Care Act, aka Obamacare, but his recent remarks during a swing of town halls jumped out at The Fact Checker. He referred to “numbers” that showed that, even after all the hoopla about 8 million Americans enrolling on the exchanges, the number of uninsured in Kansas has actually risen since the law went into effect. What is he looking at? (Kessler, 4/25).

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Study: Health Plans Dropped After Health Law May Have Been Canceled Anyway

A new study says the health law didn't lead to more cancellations of health plans than what typically occurs every year as part of the normal churn of the individual policy market.

CBS News: Study: Obamacare Didn't Necessarily Lead To Health Plan Cancellations
President Obama took some serious heat last year when insurers started dropping millions of Americans from health plans that were no longer Obamacare-compliant, seemingly breaking his promise, "If you have insurance that you like, then you will be able to keep that insurance." A new study, however, backs up the administration's claims that the cancellations were part of the normal churn of the individual health market. After analyzing patterns in the nongroup health coverage market from 2008 to 2011, Harvard professor Benjamin Sommers found that the market was characterized by high turnover before the Affordable Care Act was implemented (Condon, 4/24).

Politico Pro: Study Questions Obamacare Impact On Canceled Plans
Millions of the plans that were canceled because they did not meet Affordable Care Act requirements probably would have been canceled anyway — by the policyholders, a new study suggests. Last fall, as cancellation letters arrived in mailboxes around the country, opponents of the law cited them as evidence that President Barack Obama lied to Americans when he promised, “If you like your health care plan, you can keep it.” But most individuals who lost plans probably would not have continued them even without the law, according to the study, which was published online Wednesday in Health Affairs. Its author questions whether those cancellations contributed much to the nation’s ranks of short-term uninsured (Wheaton, 4/24).

The Boston Globe: Mass. Granted Extra Year To Comply With Affordable Care Act
Federal officials have granted Massachusetts an additional year to transition to full compliance with the Affordable Care Act, giving state health insurers until 2017 to replace their criteria for setting small business premium rates with federal criteria. Governor Deval Patrick was alerted to the extension Thursday by outgoing U.S. Health and Human Services Secretary Kathleen Sebelius, in the latest federal move to delay implementation of the health law aimed at expanding health insurance nationally. Under pressure from small business owners who feared federal criteria used to determine rates would increase their insurance premiums, state officials had asked Obama administration officials for more time and flexibility in adapting the national standards (Weisman, 4/24).

Also, news outlets examine why "young invincibles" chose to get coverage in Massachusetts and why some in California did not --

NPR: How One State Convinced Its 'Young Invicibles' To Get Health Insurance
Enrolling in health insurance often doesn't make good economic sense for healthy young people, as they can end up paying a lot for very little coverage. Why are young invincibles still willing to pay? (Kestenbaum, 4/24).

Kaiser Health News: What Obamacare? Meet 4 People Choosing To Remain Uninsured
Despite a surge in enrollment in the two weeks before the April 15 deadline to enroll for insurance under the health law, many more Californians have not signed up. And they’re unlikely to. Many people are uninterested in health insurance, confused or skeptical (O’Neill, 4/25).

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Capitol Hill Watch

Drug Companies That Are High Medicare Earners Spend Big On Lobbying Activities

USA Today: Some Top Medicare Beneficiaries Spend Heavily To Lobby
The 10 drug companies that make the most money from doctors using their products on Medicare patients spent more than $236 million to lobby Congress and the executive branch between 2009 and 2013, according to lobbying records compiled by the Center for Responsive Politics and new federal data. Those efforts came as lawmakers crafted the sweeping Affordable Care Act and as federal regulators have sought new ways to contain costs in Medicare, the federal insurance program for seniors (Kennedy, 4/24).

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Health Care Marketplace

Aetna Wary About Exchange Expansion As Earnings Climb

The insurer, which is participating in health insurance exchanges in 16 states and the District of Columbia, reported strong growth in the first quarter tied to its acquisition of Coventry Health Care Inc. The company said it expected to seek premium increases for next year's exchange plans ranging from "low single digits to over double digits."

The Wall Street Journal: Aetna Raises Outlook On Strong Quarterly Growth
Aetna, which is participating in the health-law exchanges in 16 states and the District of Columbia, ... said it had signed up about 230,000 paid members through the end of the first quarter, and was projecting it could have around 450,000 by the close of the year after a surge at the end of the enrollment period. The company said it expected to seek premium increases for next year's exchange business that could range from "low single digits to over double digits" (Mathews and Rubin, 4/24).

The Associated Press: Aetna’s 1Q Profit Jumps 36 Pct, Forecast Climbs
Its results breezed past analysts’ expectations, and Aetna shares jumped more than 5 percent Thursday after it detailed a starkly different quarter compared with competitor UnitedHealth Group, which dragged down other health insurance stocks last week after it said first quarter earnings fell 8 percent (4/24).

The Washington Post’s Wonkblog: Aetna: Late Obamacare Changes Account For Half Of 2015 Premium Increases
Major health insurers are starting to report their first quarter of financial results under Obamacare's new market rules, giving us some perspective on how they're seeing the law's new insurance marketplaces playing out (Millman, 4/24).

Modern Healthcare: Aetna Guarded About Exchange Expansion Even As Earnings Soar
Aetna remains wary about expanding its presence in public healthcare exchanges for 2015 because of lingering uncertainties about the emerging marketplaces, the company's CEO said Thursday. That news came as the Hartford, Conn.-based insurer reported that it significantly exceeded profit expectations during the first quarter of 2014, and so is projecting higher earnings for the year (Demko, 4/24).

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Doctors, Dentists Adjusting To Ups And Downs Of Changing U.S. Health Care System

Several news outlets covered trends in the industry - including how dentists who treat Medicaid patients are coping. 

Kaiser Health News: With Medical Debts Rising, Doctors Are More Aggressive About Payments
The recent economic downturn and the increasing use of high-deductible insurance plans “has driven patients to want to put off paying their bills,” Michael explains. Whether it’s for a hip replacement or a broken bone, he frequently sees patients on the hook for a $3,000 to $5,000 deductible (Gold, 4/25).

Marketplace: Doctors Can Learn A Lot From Dentists
Have dentists struck gold? Not in the mouths of their patients, but in of all places, in Medicaid, a program infamous for its low reimbursement rates. In a National Bureau of Economic Research report, University of Michigan business professor Tom Buchmueller found that in states that expanded Medicaid under the Affordable Care Act dentists saw about a 7 percent rise in income. And he says some also avoided increased patient wait times (Gorenstein, 4/25).

Marketplace: Using Data To Treat The Sickest And Most Expensive Patients
Here’s what you need to know about Dr. Jeffrey Brenner: He really likes to figure out how things work. And he’s willing to go to extremes to do it ...  Perhaps it’s not the smartest move from a guy who just last fall was named a MacArthur Genius, but this month, Brenner began to test his theory for treating some of the sickest and most expensive patients. "We can actually take the sickest and most complicated patients, go to their bedside, go to their home, go with them to their appointments and help them for about 90 days and dramatically improve outcomes and reduce cost," he says (Gorenstein, 4/24).

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Public Health & Education

FDA Approves New HPV Cervical Cancer Test

The test was approved despite objections from some that the screening had not been adequately tested.

Modern Healthcare: FDA Approves First HPV Test For Primary Cervical-Cancer Screening
The first human papillomavirus DNA test to screen women for cervical cancer was approved Thursday by the U.S. Food and Drug Administration. The stand-alone test can be used to assess whether women need to undergo additional testing and their risk of developing cervical cancer in the future (Rice, 4/24).

The New York Times: Alternative to Pap Test Is Approved By F.D.A.
A committee of outside advisers to the F.D.A. unanimously endorsed the Roche test in a meeting last month. But a coalition of 17 consumer, women’s and health groups opposed the approval, arguing that the new screening method had not been adequately tested and could upend a practice that has successfully prevented cervical cancer for decades (Pollack, 4/24).

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State Watch

State Highlights: Home Care Workers' Pay And Medicaid Budgets; Calif. Mental Health Grants; NYU ER Reopens

A selection of health policy stories from California, New York, Iowa, Massachusetts, Connecticut and Arizona.

Stateline: States Confront “New Mindset” On Home Care Workers’ Wages
A new rule from the Obama administration designed to provide better pay and working conditions to 2 million home care workers is forcing many states to rethink how they look at Medicaid payments and may result in higher Medicaid costs. Starting Jan. 1, home care workers in 29 states will, for the first time, be eligible for the federal minimum wage of $7.25 an hour and overtime pay, under a new regulation from the U.S. Department of Labor. These workers go to homes of the elderly and the disabled to help with cooking, bathing and other daily tasks, and are paid by the clients or through Medicaid (Prah, 4/25).

Los Angeles Times: State To Provide $75 Million In Mental Health Grants
State Treasurer Bill Lockyer announced the approval Thursday of $75.3 million in grants that aim to stabilize residents with severe mental illness before they land in jail or suffer multiple hospitalizations. The 20 grants will go to 28 counties for new or expanded services. They will add 827 residential mental health beds and crisis "stabilization" beds, and pay for more than three dozen vehicles and five dozen staff members for mobile support teams, which often accompany local law enforcement to defuse tense situations and direct those in need to care (Romney, 4/24).

The New York Times: NYU Langone Reopens Emergency Room That Was Closed by Hurricane Sandy
A striking sight appeared earlier this week outside the emergency room of NYU Langone Medical Center: an ambulance. Then another. And then many more. The emergency chairman, Dr. Lewis Goldfrank, watched a procession of stretchers throughout the day as if he was welcoming long-lost friends. Other doctors came around so they could witness it for themselves. The occasion was so moving that Dr. Steven Hofstetter, a surgeon, felt that one Yiddish expression for feeling pride was not enough. So he used two. "We just came down to, as they say, kvell nachus," (Hartocollis, 4/24). 

The Des Moines Register: Iowa Senate Approves Medical Cannabis Oil Bill
The Iowa Senate voted Thursday to decriminalize medical cannabis oil for the treatment of epilepsy, responding to emotional pleas of Iowa parents with children stricken by seizures. Senate File 2360 was approved 36-12 after a lengthy debate that included several Republican lawmakers who warned that legalizing any form of marijuana would send the wrong message to young people in jeopardy of abusing drugs (Peroski and Noble, 4/25).

The Boston Globe: Boston To Shutter Drug Treatment Facility
More than 400 opiate addicts in Boston who receive daily doses of methadone from a public clinic on Frontage Road will be steered to a for-profit facility by summer, health officials said. In a 6-to-1 vote last week, Boston’s Board of Health decided to end more than 40 years of city-run methadone treatment, which uses the narcotic to wean addicts from heroin and other opiates. The addiction services will now be handled by Community Substance Abuse Centers as the state confronts a startling rise in heroin overdoses and deaths (MacQuarrie, 4/25).

The CT Mirror: How Different Are For-Profit And Nonprofit Hospitals?
One of the major issues legislators are trying to tackle this session is the ability of nonprofit hospitals to convert to for-profits. It’s a complex and highly charged issue. Some people fear that without the ability to become for-profit, small community hospitals could struggle to survive. Others say allowing hospitals to become for-profit could hurt workers and communities unless protections are built into law (Becker, 4/25). 

The Arizona Republic: Phoenix VA Health-Care Probes Expected To Widen
U.S. House members kept the spotlight on the Phoenix VA Health Care System Thursday during hearings on veterans' access to mental-health care, vowing to further probe allegations that up to 40 vets died while waiting for medical appointments. The field hearing Thursday on southern Arizona veterans' experiences came as Arizona's Senate delegation announced that U.S. Sen. Bernie Sanders, I-Vt., chairman of the Senate Committee on Veterans' Affairs, will hold a hearing on allegations of VA patient neglect in Phoenix after the VA Inspector General completes an independent investigation. Rep. Mike Coffman, R-Colo., chairman of the House Veterans' Affairs Committee's Subcommittee on Oversight and Investigations, told The Arizona Republic Thursday that his staff would continue examining allegations of misconduct at the Phoenix facility as part of an ongoing inquiry into VA hospitals nationwide (Harris, 4/24).

The Arizona Republic: Health Care Nightmares Day 5: Injured Good Samaritan Billed $165,000 By Aetna
After a week of intense treatment, (Cliff) Faraci was discharged from the hospital. But he hadn't been home two full days when he received a letter from his insurance company informing him that he wasn't covered for the hospital stay. Aetna claimed Faraci's injuries were not sufficient to warrant a weeklong stay in the hospital's burn unit, which was deemed an out-of-network facility. Maricopa County Medical Center had billed him about $165,000. He filed an appeal with Aetna. It was denied in August. Almost overnight, the freeway Good Samaritan had become a victim of a health-care nightmare (Anigen, 4/24).

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Health Policy Research

Research Roundup: Structural Concerns In ACOs; Public's View Of Mandated Contraception Coverage

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

JAMA Internal Medicine: Outpatient Care Patterns And Organizational Accountability In Medicare
[The] Medicare Accountable Care Organization (ACO) programs reward participating health care provider groups that achieve slower spending growth and high quality of care. Concerns have been raised, however, that features of the programs may weaken these incentives and undermine ACO efforts to manage care. ... In this study of 145 organizations participating in the Medicare ACO programs, over one-third of beneficiaries attributed to an ACO in 2010 or 2011 was not assigned to the same ACO in both years. Thus, in any given year, a substantial share of patients for whom an ACO is held accountable may be newly or transiently assigned. ... Much of the outpatient specialty care for patients assigned to ACOs, particularly higher-cost patients with more office visits and chronic conditions, was provided by specialists outside of patients’ assigned organizations (McWilliams et al., 4/21).

Journal of General Internal Medicine: Structuring Payment To Medical Homes After The Affordable Care Act
The Patient-Centered Medical Home (PCMH) is a leading model of primary care reform, a critical element of which is payment reform for primary care services. ... The PCMH and ACO are complementary approaches to reformed care delivery: the PCMH ultimately requires strong integration with specialists and hospitals as seen under ACOs, and ACOs likely will require a high functioning primary care system as embodied by the PCMH. Aligning payment incentives within the ACO will be critical to achieving this integration and enhancing the care coordination role of primary care in these settings (Edwards et al., April, 2014).  

The Journal of the American Medical Association: Attitudes About Mandated Coverage Of Birth Control Medication And Other Health Benefits In A US National Sample
The Patient Protection and Affordable Care Act (ACA) requires most private health insurance plans to cover contraception without a shared patient cost to improve access. However, debate continues about applying the contraception coverage mandate to public corporations that object on religious grounds .... We assessed attitudes about mandated coverage of birth control medications. A cross-sectional survey was administered in November 2013. ... Overall, 69% of respondents supported mandated coverage of birth control medications in health plans, with significantly higher odds of support among women, black, and Hispanic respondents (Moniz, Davis and Chang, 4/22).

Health Affairs: Basic Health Program 
[The federal health law] provides an additional means of expanding coverage, by allowing states to run a Basic Health Program. Under such a program, states can offer public health insurance, beginning in 2015, to people whose incomes are too high to qualify for Medicaid but are below 200 percent of the federal poverty level. To help pay for benefits under this program, states are eligible to receive the federal dollars that would otherwise go to subsidizing the purchase of private insurance coverage for those people through exchanges. ... Currently, only a few states have shown an interest in implementing a Basic Health Program (Cassidy, 4/17).

The Gerontologist: Listening to Religious Music And Mental Health In Later Life 
Research has linked several aspects of religion—including service attendance, prayer, meditation, religious coping strategies, congregational support systems, and relations with God, among others—with positive mental health outcomes among older U.S. adults. This study examines a neglected dimension of religious life: listening to religious music. ... Findings suggest that the frequency of listening to religious music is associated with a decrease in death anxiety and increases in life satisfaction, self-esteem, and a sense of control (Bradshaw, 4/15).

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

Modern Healthcare: More Patients Chose Specialists Over Primary-Care Docs In 2013
It was probably just a matter of time before it happened, but 2013 may have marked the first year that office visits to specialty physicians outnumbered office visits to primary-care doctors. The development was buried in a report from the IMS Institute for Healthcare Informatics on how healthcare spending had risen after years of “self-rationing.” ... “It's the crossing of a threshold, but it's not a dramatic one-year change,” Aitken said. “Our expectation is that it will continue to grow.” Dr. Atul Grover, chief public policy officer for the Association of American Medical Colleges, observed (Robeznieks, 421).

Bloomberg: Medicare's $5 Billion Ambulance Tab Signals Area Of Abuse
The U.S. Department of Health and Human Services has identified ambulance service as one of the biggest areas of overuse and abuse in Medicare -- companies billing millions for trips by patients who can walk, sit, stand or even drive their own cars. "It's a cash cow," said Assistant U.S. Attorney Beth Leahy, who prosecuted Penn Choice and five other ambulance fraud cases. "It's basically like a taxi service except an extremely expensive one that the taxpayers are financing" (Pettypiece, 4/24).

MedPage Today: Robot Versus Surgeon: No Clear Winner
Robot-assisted radical prostatectomy (RARP) led to complication rates, readmission rates, and rates of additional cancer therapy similar to those of conventional surgical prostatectomy, a review of almost 6,000 cases showed. ... the overall complication rates did not differ. Total hospital reimbursement in the first year after surgery was significantly higher in the RARP patients, as reported online in the Journal of Clinical Oncology (Bankhead, 4/18).

MedPage Today: New Guidelines Address Cancer Survivors' Issues
Acknowledging successes in the war on cancer, three new clinical guidelines address problems frequently encountered by cancer survivors: fatigue, peripheral neuropathy, and anxiety and depression. The recommendations kick off a planned series of 18 clinical practice guidelines on survivorship care from the American Society of Clinical Oncology (ASCO) [which said,] "The release of these guidelines come at a time when the number of people with a history of cancer in the U.S. has increased dramatically, from 3 million in 1971 to about 13.7 million today" (Bankhead, 4/14).

News@JAMA: Reducing Health Disparities With Proven Programs
National and local programs that have succeeded in reducing or eliminating racial or ethnic health disparities are outlined in a new report published as a supplement to today’s Morbidity and Mortality Weekly Report. Among the interventions described in the report is the Vaccines for Children program, which was authorized by Congress in 1994. The program provides vaccines at no cost to eligible children nationwide who otherwise might not be immunized (Voelker, 4/18).

Detroit Free Press:  Teaching Seniors To Use The Internet Reduces Risk Of Depression
Depression, a common problem for older adults, might have an easy antidote: The Internet. According to new research by a Michigan State University professor, computer use among retirees reduces the risk of depression by more than 30% ... [The] research was published online last week in the Journal of Gerontology: Social Sciences. ... With other factors held constant — such as whether the seniors lived with other people — the authors found that roughly 7 in 100 Internet users were estimated to have depression, whereas 10 in 100 non-computer users were estimated to have depression (Erb, 4/21).

news@JAMA:  Mammography False Positives Briefly Boost Anxiety
Women who receive a false-positive result from mammography screening may briefly experience elevated levels of anxiety, but the effect soon wears off, according to an analysis published today in JAMA Internal Medicine. The relative risks and benefits of routine mammography screening for women have been debated for decades. Last fall, the debate took on renewed urgency as the US Preventive Services Task Force announced it would revisit its existing recommendations regarding mammography. The task force’s recommendations are influential and may affect whether health plans cover mammography (Kuehn, 4/21).

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Editorials and Opinions

Viewpoints: 'Pinocchios' For The Koch Brothers; Obamacare 'Miracle'; The Law's Effect On Hiring

The New York Times’ Taking Notes: More 'Pinocchios' For The Koch Brothers, Please
The health care ads being run by Americans for Prosperity — one of the many frantically waving arms of the Koch brothers — are a gift to fact checkers everywhere. Because they deliberately twist the truth to persuade people to "stop supporting Obamacare," they have become a machine for producing "Pinocchios," the mendacity rating system used by Glenn Kessler at The Washington Post (David Firestone, 4/24). 

USA Today: Obamacare Enrollment Miracle Or Fact? Column 
Reading the news in recent days, it's difficult to escape the impression there has been a miracle. Obamacare worked. Despite a troubled launch, disappointing early numbers and cynicism from across the political spectrum, the Affordable Care Act came through. A total of 8 million Americans have enrolled, even more than the number set by outgoing Health and Human Services Secretary Kathleen Sebelius as a benchmark for success (Emmett Rensin, 4/24).

The Wall Street Journal: The Obamacare Jobless 
A new survey demonstrates the Affordable Care Act's negative impact on employment. According to the Journal, "nearly half of small-business owners with at least five employees, or 45% of those polled, said they had had to curb their hiring plans because of the health law, and almost a third—29%—said they had been forced to make staff cuts, according to a U.S. Bancorp survey of 3,173 owners with less than $10 million in annual revenue that will be released Thursday" (James Freeman, 4/24).

McClatchy: GOP Should Stop Fighting Obamacare And Work To Improve It
There's a big difference between principle and pigheadedness. While claiming to uphold the first, congressional Republican opponents of the Affordable Care Act (Obamacare) are really engaging in the second. It's time for the GOP to accept that the ACA is the law of the land, recognize the good it has done and will do, and work with Democrats to fix the defects that are inevitable in such a large and complex program (Rice, 4/24).

The Wall Street Journal: Uncover Oregon
"This thing is working," President Obama instructed the other day, and liberals got the message to ignore ObamaCare's ongoing dysfunctions. The reality is different, especially in states like Oregon, which pulled the plug on its insurance exchange on Thursday. Democratic Governor John Kitzhaber promised to lead the nation on ObamaCare and he did—from behind. The worst-in-America launch collapsed even harder than Healthcare.gov. The exchange website known as Cover Oregon still hasn't enrolled one person, and the state has spent about $7 million signing up merely 69,000 people manually using paper applications (4/24).

The Washington Post: Virginia Plays Chicken With Medicaid 
When state governments shut down, people notice that something is badly amiss, possibly even more so than when the federal government closes. In Virginia, where Republicans in the House of Delegates have dug in their heels against Gov. Terry McAuliffe’s plan to expand Medicaid, the possibility of a shutdown this summer is growing, and the experience in other states is not exactly heartening (4/24).

Reuters:  Look Beyond Medicare Data When Shopping For Health Care
The recent release of Medicare billing records for doctors across the United States brought hope that consumers would get what they need to comparison-shop for healthcare. Although that did not turn out to be true, you do have other places to look (Lipka, 4/25). 

WBUR: Project Louise: Eat Like A Teenager? Not Anymore
So now here we are again, and once again I’m on a road trip with my son – only to the Cape this time, so I’m safe from Signore Cassano … for now. But I’ve still been tempted, most recently this morning, to abandon all restraint and eat as if I were a 16-year-old boy, with the metabolism to match. Only here’s the thing: I can’t (Louise Kennedy, 4/24).

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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.