Daily Health Policy Report

Monday, April 28, 2014

Last updated: Mon, Apr 28

KHN Original Reporting & Guest Opinion

Health Reform


State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Health Plans Scramble To Calculate 2015 Rates

Kaiser Health News staff writer Jay Hancock, working in collaboration with The Washington Post, reports: “With the results sure to affect politics as well as pocketbooks, health insurers are already preparing to raise rates next year for plans issued under the Affordable Care Act. But their calculation about how much depends on their ability to predict how newly enrolled customers – for whom little is known regarding health status and medical needs -- will affect 2015 costs” (Hancock, 4/28). Read the story.

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Low T Business Is Booming, Despite Questions About Risks

Kaiser Health News staff writer Sarah Varney, working in collaboration with NPR, reports: “It is perhaps the biggest men's health craze since Rogaine or Viagra: so-called low testosterone clinics, which have rapidly grown in cities and suburbs all across the country. But these "low T" clinics have also drawn the ire of leading urologists and endocrinologists who question the clinics’ safety” (Varney, 4/28). Read the story.

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Capsules: Oregon Raises White Flag Over Its Health Exchange; Study: Costly Breast Cancer Treatment More Common At For-Profit Hospitals; First-Aid Training For Mental Health Could Aid At-Risk Veterans

Now on Kaiser Health News’ blog, Oregon Public Radio’s Kristian Foden-Vencil reports on Oregon’s decision to switch to the federal health exchange: “Oregon has been 'all in' on health reform. Its embrace of the Affordable Care Act includes a very successful Medicaid expansion, a $2 billion federal experiment to show the state can save money by managing patients’ care better, and, of course, the state’s own online marketplace to sell Obamacare insurance. But that last point has been a huge problem. The Cover Oregon board decided on Friday to ditch its troubled website and join up with the federal Healthcare.gov exchange instead” (Foden-Vencil, 4/28). 

Also on the blog, Roni Caryn Rabin reports on a study regarding breast cancer treatment costs: "Older breast cancer patients who received radiation treatment after surgery were more likely to undergo a more expensive and somewhat controversial type of radiation called brachytherapy if they got their care at for-profit rather than nonprofit hospitals, a new study reports" (Rabin, 4/28). 

In addition, Lisa Gillespie writes about a new push for funding for mental health first aid for veterans: “When done right, first aid quickly identifies a problem and triages patients so the more urgent cases get treated first and followed up on. Now, with federal aid, that same strategy will apply to the pressing problem of veterans’ mental health. A push for new funding — and the use of existing funds — may soon make more resources available to help identify vets who need help with depression or other mental illness through the National Council for Behavioral Health’s Mental Health First Aid training” (Gillespie, 4/25). Check out what else is on the blog.

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Political Cartoon: 'Wedge Issue?'

Kaiser Health News provides a fresh take on health policy developments with "'Wedge Issue?" by Jake Fuller.

Here's today's health policy haiku: 


Oregon gives up.
After a troubled effort,
state calls on the feds.

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

The View From The Ground: How The Health Law Is Playing

News outlets examine how political stigma, expectations, understanding and misunderstanding are playing roles in the health law's impact in states like West Virginia, Kentucky and Colorado.

The New York Times: In Poorest States, Political Stigma Is Depressing Participation In Health Law
Inside the sleek hillside headquarters of Valley Health Systems, built with a grant from the health care law, two employees played an advertisement they had helped produce to promote the law’s insurance coverage for young, working-class West Virginians. The ads ran just over 100 times during the recent six-month enrollment period. But three conservative groups ran 12 times as many, to oppose the law and the local Democratic congressman who voted for it. This is a disparity with consequences. Health professionals, state officials, social workers, insurance agents and others trying to make the law work for uninsured Americans say the partisan divisions and attack ads have depressed participation in some places. They say the law has been stigmatized for many who could benefit from it, especially in conservative states like West Virginia that have the poorest, most medically underserved populations but where President Obama and his signature initiative are hugely unpopular (Calmes, 4/26).

USA Today/Louisville Courier Journal: Health Care's Appalachian Spring: Obamacare Comes To An Old Battlefield In The War On Poverty
When Eula Hall is asked about Obamacare, you expect this veteran of the war on poverty, who lives in the sickest county in one of the sickest states, to sing hosannas. Instead, she hedges. ... "We'll have to wait and see." Her ambivalence, which largely epitomizes Floyd County's reaction to Obamacare, contrasts with some outsized expectations. ... Four months after it took effect, Obamacare here is a neither a train wreck nor a cure-all. It's a work in progress, widely misrepresented and misunderstood. Some people have been helped, some hurt, and many others affected not at all (O'Donnell, Hampson, Kenning and Ungar, 4/26).

USA Today/Louisville Courier Journal: Scenes From Floyd County, Kentucky: A Closer Look At The Affordable Care Act's Impact In Eastern Kentucky
Of the many groups affected by Obamacare, small business owners -- those with at least 50 full-time employees -- are among the most aggrieved by the law's requirement to provide their workers with insurance. ... Nearly four of 10 adults in Floyd County, Ky., have lost at least six teeth because of decay or gum disease. Statewide, more than half of adults have had at least one tooth pulled, and a quarter of those over 65 have lost all their teeth. When it comes to dental care, the Affordable Care Act's reach is limited (4/27).

The Denver Post:  Health Law Presents Options, Challenges For Colorado Small Businesses
About half of small businesses in Colorado are seeing double-digit premium increases under the ACA while the other half are seeing the typical single-digit increases they have had for years, said Jim Sugden, small-business marketplace manager for the state exchange. He was not surprised that some companies are getting out of providing health insurance for employees. Jim Noon, owner of Denver cardboard box seller Centennial Container, has offered his employees health care coverage for three decades, but he isn't sure he will continue to offer the benefit after this year (Kane, 4/27).

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Relatively Few Seek Relief From The Health Law's Individual Insurance Mandate

Although people can seek exemptions from this requirement to buy coverage, only about 77,000 have done so, The Washington Post reports. Meanwhile, payment issues are also in the headlines as KHN looks at insurers' efforts to set the 2015 rates for policies on the health law's marketplaces, and the New York Times examines a panel's findings about the law's effects on doctors and hospitals treating many poor patients.

The Washington Post: Few Have Sought Exemption From Health-Care Mandate That They Have Insurance Or Pay Fine
The government left the door wide open for millions of Americans to be excused from the Affordable Care Act's requirement that most people must carry health insurance or pay a fine, but so far relatively few have asked for such a pardon. About 77,000 families and individuals have requested exemptions from the health-care law's so-called individual mandate, according to internal government documents obtained by The Washington Post. As of April 20, officials had approved tens of thousands of exemption requests and rejected none (Somashekhar, 4/25).

Kaiser Health News: Health Plans Scramble To Calculate 2015 Rates
With the results sure to affect politics as well as pocketbooks, health insurers are already preparing to raise rates next year for plans issued under the Affordable Care Act. But their calculation about how much depends on their ability to predict how newly enrolled customers – for whom little is known regarding health status and medical needs -- will affect 2015 costs (Hancock, 4/28).

The New York Times: Health Law’s Pay Policy Is Skewed, Panel Finds
Federal policies to reward high-quality health care are unfairly penalizing doctors and hospitals that treat large numbers of poor people, according to a new report commissioned by the Obama administration that recommends sweeping changes in payment policy (Pear, 4/27).

The American Academy of Pediatrics is warning families against buying high-deductible or catastrophic coverage through the online insurance marketplaces.

NBC News: Parents: Don't Buy Cheap Health Plans, Experts Advise
The cheapest health plans, with low premiums and high deductibles, are no good for families with children, pediatricians said Monday. In fact, states should consider legislation that restricts the plans only to adults, the American Academy of Pediatrics said in an advisory. That includes the lowest-tier "catastrophic" plans offered on some Obamacare exchanges. "Families with small children tend to be high users of primary care services. As such, high deductible health plans would seem to be particularly inappropriate for them," the Academy said in a policy statement published in the journal Pediatrics (Fox, 4/28). 

In other health law news -

The Fiscal Times: Polls Show Rising Acceptance For Obamacare
In February, one Florida restaurant chain—Gator's Dockside -- made headlines for slapping a one percent "Obamacare surcharge" on customers’ bills. The chain's owners said the surcharge was necessary to offset the new costs associated with the Affordable Care Act. ... Though the Florida restaurant's owners said the move to add Obamacare on every receipt was not political, the story played into the GOP’s message that Obamacare could have a harmful effect on businesses and consumers. As it turns out, the majority of Americans say they are okay with businesses adding a nominal surcharge to each bill in order to help pay for their employees health coverage (Ehley, 4/28).

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Healthcare.gov Still Under Construction

Though the website has been functioning for consumers buying insurance coverage, Politico reports that critical, back-end elements are still being built, which could have adverse effects on insurers and ultimately on next year's premiums. Meanwhile, The Washington Post extracts lessons from the rollouts of state exchanges -- some of which ran smoothly and others of which were troubled. 

Politico: Behind The Scenes, Much Of Healthcare.Gov Is Still Under Construction
The Obamacare website may work for people buying insurance, but beneath the surface, HealthCare.gov is still missing massive, critical pieces — and the deadline for finishing them keeps slipping. As a result, the system’s “back end” is a tangle of technical workarounds moving billions of taxpayer dollars and consumer-paid premiums between the government and insurers. The parts under construction are essential for key functions such as accurately paying insurers. The longer they lag, experts say, the likelier they’ll trigger accounting problems that could leave the public on the hook for higher premium subsidies or health care costs (Cheney, 4/26).

The Washington Post: Deltek: What Contractors Can Learn From The Rollout Of The State Exchanges
The open enrollment period for federally mandated health insurance is now closed, and it’s a fitting time to look back on how the state health insurance exchanges performed. Much attention was paid to the difficult rollout of the federal exchange; however, the state exchanges — with rollouts that ranged from smooth to catastrophic — are also worth examining (Dixon, 4/27).

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With First Open Enrollment Season Behind Them, States Move Ahead -- Though Slowly

Marketplace reports on the lessons learned by states operating their own online health insurance exchanges and how these experiences will affect the year ahead. In related news, the Colorado exchange reports that it's on track to meet its goal for this year while New York health officials say they will not require out-of-network coverage on next year's Affordable Care Act plans.

Marketplace: State Exchanges Going Into Year Two, But Slowly
At one point, Affordable Care Act architects thought every state would eventually run its own exchange. So far only about a quarter of states -- and the District of Columbia -- have actually done it. Or at least, they have tried their best to. Oregon’s exchange voted to have Washington run the IT side of the operation on Friday. That’s after the state received some $300 million in federal funds to get its own of the ground. There are lots of reasons why states may want to take over their exchanges from the feds sometime in the future. But here are six reasons why they may not be in such a hurry: “Hawaii, Maryland, Massachusetts, Minnesota, Oregon and Vermont,” says Caroline Pearson who tracks state exchanges for consulting firm Avalere Health (Gorenstein, 4/25).

The Associated Press:  Exchange CEO: 128K Signed Up For Private Insurance
The CEO of Colorado's health-insurance exchange say it's on track to meet enrollment goals for this year. Patty Fontneau told state lawmakers Thursday that 128,000 people have signed up for private health insurance since the fall. Another 178,000 people signed up for government-run Medicaid coverage. However, she didn't know how many of the people who got insurance were previously uninsured. Federal regulations don't require people to report that but half of exchange customers who did answer the question said they didn't have insurance before (4/25).

The New York Times: New York Will Keep Affordable Care Act Health Plans Restricted
New York State health officials said on Friday that they would not require out-of-network coverage on Affordable Care Act health plans next year, a decision likely to disappoint customers who have complained that they can no longer use their favorite doctors and hospitals. Restricting consumers to a fixed network of doctors and hospitals, called in-network coverage, helps keep costs down, and for the first year, none of the 16 insurance companies in New York’s exchange deviated from that model (Hartocollis, 4/25).

Also in the news --

Modern Healthcare:  CMS Moving To Neutralize State Control Over Exchange Navigators
The CMS wants to tighten the rules for navigators -- those who assist people in signing up for insurance on various state and federal exchanges. Its proposed rule would pre-empt recent state efforts to regulate, and some would say hobble, navigators. Stakeholders commenting on the proposal raised concerns about whether the CMS is overstepping its authority in the matter (Dickson, 4/25).

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Oregon Opts For Federal Exchange

The board overseeing Oregon's nonfunctional health insurance exchange unanimously approved the Obama administration’s plan Friday to take over the marketplace, making Oregon the first state to drop its enrollment website for healthcare.gov. The Oregonian reports that a task force also recommended the state shelve another Oracle-led project to 'revolutionize' information technology for its health services department.

Los Angeles Times: Oregon Scraps State Health Insurance Exchange
Oregon officials voted unanimously Friday to jettison the state's disastrous health insurance exchange and switch to the federal system, admitting disappointment and defeat in an arena where the state had been a trailblazer (La Ganga, 4/25).

The Wall Street Journal: Oregon To Use Healthcare.gov Technology For State Insurance Exchange
An Oregon state board unanimously agreed to a plan Friday to use the federal government's technology to run the state's health insurance exchange. The board overseeing the state's Cover Oregon health insurance exchange adopted a staff recommendation to use the technology behind the federal government's HealthCare.gov website. Gov. John Kitzhaber, a Democrat, has said he supports the decision (Corbett Dooren, 4/25).

The Washington Post: Cover Oregon Officially Admits Enrollment Site Is Broken Beyond Repair
The Oregon board overseeing the state’s deeply flawed health insurance exchange unanimously approved the Obama administration’s plan Friday to take over the marketplace, making Oregon the first state to drop its enrollment Web site for HealthCare.gov. Directors of the exchange, Cover Oregon, voted Friday to drop its enrollment Web site, which hadn’t fully recovered from a failed launch Oct. 1. Oregon, which was awarded $305 million in federal grants to build the exchange, remains the only state not allowing full online enrollment in Affordable Care Act health plans (Millman, 4/25).

Kaiser Health News: Capsules: Oregon Raises White Flag Over Its Health Exchange
Oregon has been “all in” on health reform. Its embrace of the Affordable Care Act includes a very successful Medicaid expansion, a $2 billion federal experiment to show the state can save money by managing patients’ care better, and, of course, the state’s own online marketplace to sell Obamacare insurance. But that last point has been a huge problem. The Cover Oregon board decided on Friday to ditch its troubled website and join up with the federal Healthcare.gov exchange instead (Foden-Vencil, 4/28).

The Oregonian: With Cover Oregon Switching To Federal Health Exchange, State May Scrap Second, $71-Million Oracle Project
Oregon's pending divorce from Oracle Corp. is messier than it seems. On Friday, the Cover Oregon board voted to scrap the state's nearly $250 million non-functional health insurance exchange, for which Oracle was the lead vendor. Now The Oregonian has learned that an internal task force has recommended the state shelve -- perhaps permanently -- another Oracle-led project that was intended to revolutionize information-technology and enrollment for the Department of Health Services (Budnick, 4/25).

The Oregonian: Lawmakers React To Cover Oregon Decision To Switch To Federal Health Exchange
It didn't take long for Oregon's political leaders to react to Friday's decision by Cover Oregon officials to switch to the federal health exchange. The problem-plagued exchange has cost $248 million so far and its website still doesn't fully function. Cover Oregon officials decided it's time for the state to cut its losses and switch to the federal exchange in hopes of ensuring something functional when the next open enrollment period begins in November. Senate President Peter Courtney, D-Salem, and House Speaker Tina Kotek, D-Portland, said the Joint Committee on Legislature Audits, Information Management and Technology will hold a May 6 meeting to review the decision, learn more about the transition and attempt to ensure a site is ready by open enrollment (Zheng, 4/25).

The Fiscal Times: Millions Wasted On Broken Obamacare State Websites
The state of Oregon finally decided on Friday to abandon its disastrous exchange website after spending at least $250 million in federal tax dollars and enduring six excruciating months of severe technical glitches that kept people from signing up for health insurance online. (The Medicaid portion will move to the Oregon Health Plan.) Now, the state, which has spent most of the $305 million it was allocated in federal dollars, will use an additional $5 million to switch over to the federal portal, HealthCare.gov. At a press conference Friday, Alex Pettit, Oregon’s chief information officer, called the switch the “lowest risk option,” since officials in Oregon already know the federal site works better than theirs (which doesn’t work at all). Scrapping the state site, however, is much more affordable than the alternative. Officials at Cover Oregon, the state exchange, estimated that even attempting to salvage the state’s website would cost at least an additional $75 million (Ehley, 4/27).

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Co-ops Having Impact In Some Health Markets

Politico Pro reports that some nonprofit co-ops have forced Aetna to withdraw from some state exchanges because of what Aetna CEO Mark Bertolini describes as "irrational pricing." Meanwhile, the Associated Press features Dr. Peter Beilenson, who is trying to break the mold with his co-op in Maryland.

Politico Pro: Co-ops Have Impact In Some Health Markets
What’s the latest sign that the upstart nonprofit co-ops are having an impact in the market? Aetna CEO Mark Bertolini blamed the Obamacare-backed co-op health plans for his company’s decision to back out of some state exchanges last year. On a conference call with investors on Thursday, Bertolini suggested regulators’ efforts to force Aetna’s proposed premiums down to “irrational” co-op levels drove them out of states. “If there was any irrational pricing, it happened with a few of the co-ops as they went into the exchange,” he said. “We, in those markets, actually withdrew from those markets as we were asked to match co-op pricing” (Norman, 4/25).

The Associated Press: Nonprofit Builds Different Kind Of Insurance Firm
Maryland hadn’t had a health insurance co-op for 20 years. Then Dr. Peter Beilenson came along. Although Beilenson — who has held a number of prominent health positions — describes himself as a staunch advocate for a single-payer health care system, he said he felt compelled to start an insurance company that broke the mold (4/27).

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Medicaid Battles Become Political Quagmires

While Pennsylvania Gov. Tom Corbett, a Republican, awaits a federal decision on his request to link a work requirement to Medicaid expansion benefits, Democratic governors and GOP lawmakers in Missouri, Montana and Virginia have battled each other to stalemates on the expansion.

Politico: Trio of Democrats Stuck In Medicaid Morass
In Missouri, Montana and Virginia, Democratic governors and Republican Legislatures have battled each other to stalemates, preventing hundreds of thousands of low income people from getting covered under the president’s health law and fueling the ongoing Obamacare battles leading up to the 2014 elections. Each of these three governors has made Medicaid a central plank of his agenda, and each has slammed into a wall of Republican resistance, failing where their 17 counterparts — and even nine Republican governors — have succeeded (Cheney and Haberkorn, 4/27).

The Associated Press: Pennsylvania Awaits Ruling On Medicaid Expansion
Pennsylvania Gov. Tom Corbett has softened his rhetoric while he awaits a federal decision on his request to link a work requirement to benefits under the Medicaid expansion. It’s an issue that has flared up in his hotly contested re-election campaign (4/27). 

The Richmond Times-Dispatch: Medicaid Issue May Push Budget To The Brink
If necessary, Senate Democrats pushing for the expansion of Medicaid are prepared to prolong resolution of a new, two-year state budget beyond June 30, the end of the fiscal year. “I am prepared to do whatever it takes to make sure we leave no Virginian behind when it comes to health care,” said Sen. A. Donald McEachin, D-Henrico, the chairman of the Senate Democratic Caucus. It favors accepting millions in federal dollars to fund expansion to the 400,000 uninsured, working poor in the commonwealth. House Republican leaders insist that Medicaid must be “decoupled” from the budget, so the budget can be settled in time for localities and schools to set their own spending plans (Nolan, 4/27).

The St. Louis Post Dispatch:  Missouri Hospital Board May Rethink Medicaid Decision
Western Missouri Medical Center trustees may rethink remaining neutral on state Medicaid expansion. In March, the board reaffirmed last year's decision to table the "partisan political issue.” At Friday's board meeting, Missouri Hospital Association information showed state hospitals have eliminated almost 1,000 full-time equivalent positions in the last six months and a hiring freeze has been implemented for another 2,145 positions. Much of the reduction has hit the state's rural areas (Sterling, 4/25).

The Tennessean: Time Is Growing Short For 100% Medicaid Match
Talks continue between Gov. Bill Haslam's staff and federal officials about how Tennessee can receive Medicaid expansion money, but time is running out for the state to get the full benefit. Tennessee began losing out on $6.1 million a day on Jan. 1, when the federal government began picking up all the cost for covering people who newly qualify for Medicaid under expanded guidelines — an offer that goes away at the end of 2016 (Wilemon, 4/28).


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Democrats, GOP Brace For 2016 Health Care Fight

Democrats worry that talking about the health law will not net them any positive gains in elections this year. House Speaker John Boehner also took to the air Saturday to hammer President Obama on jobs and health care.

Politico: Health Care Wonks Turn To 2016
Even before the midterm election that’s likely to turn heavily on Obamacare, health care wonks from both parties are already thinking ahead, taking the first early cracks at health care ideas the next White House candidates can use. But the challenges will be starkly different for the two parties (Nather, 4/26).

The Hill:  Dems Don’t Want To Talk O-Care
To many Democrats, Obamacare is a four-letter word. Most Democrats in competitive elections are seeking to avoid the topic, opting not to tout the controversial law on their campaign websites. In a review of battleground races, The Hill found that out of 50 Democratic candidates with active campaign websites, only 11 mention the healthcare law by name, either as "Obamacare," "Affordable Care Act," or "ACA." Fourteen more mention the law, but not its name, and half the candidates omit it entirely from their websites (Timmons, 4/26).

The Washington Post: Boehner Takes Over Response To Obama, Focuses On Jobs And Health Care
President Obama’s record is “littered” with promises -- ranging from an economic stimulus plan to a new health care law -- that have not panned out, Speaker John A. Boehner (R-Ohio) charged Saturday as he touted measures passed in recent months by the House meant to spur job creation. Boehner spoke during the Republican response to Obama’s Saturday morning radio address, a forum usually reserved for rank-and-file lawmakers or GOP governors (O'Keefe, 4/26).

And the health law becomes a major issue in the Democratic primary for governor in Maryland --

The Washington Post: Gansler Hopes To Wield Maryland Health Exchange Woes As A Club Against Brown
Maryland gubernatorial hopeful Douglas F. Gansler is pounding his chief rival, Lt. Gov. Anthony G. Brown, over the state’s deeply troubled online health exchange, convinced that the tactic will help him gain ground in the polls ahead of the all-important Democratic primary in June. Gansler, the state attorney general, brought up the health-care “debacle” barely three minutes into his introductory comments at a candidates forum last week. He has highlighted the “mess” in three television ads -- the latest debuted Thursday -- and in one lengthy radio spot. And he has set up a Web site questioning when Brown will “come clean” about the exchange’s shortcomings (Wagner, 4/26).

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Experts Examine Medicare Billing Data Limits

And The New York Times looks at one doctor's Medicare bills for more than $4 million in 2012.

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 health care. Although that did not turn out to be true, you do have other places to look. ... Experts say there are limits to how much can be learned from data tracking 880,000 doctors billing about $77 billion to the federal health care program for the elderly for some 6,000 types of procedures. ... But there are other ways to track prices, physicians and the quality of care you are receiving. Here is a look at what is available (Lipka, 4/25).

The New York Times: One Therapist, $4 Million In 2012 Medicare Billing
A few miles from the Coney Island boardwalk in Brooklyn stands an outpost of what, on paper, is a giant of American medicine. Nothing about the place hints at the money that is said to flow there. But in 2012, according to federal data, $4.1 million from Medicare coursed through the office in a modest white house on Ocean Avenue. In all, the practice treated around 1,950 Medicare patients that year. On average, it was paid by Medicare for 94 separate procedures for each one. That works out to about 183,000 treatments a year, 500 a day, 21 an hour (Creswell and Gebeloff, 4/27). 

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State Watch

State Highlights: Bankruptcy Risk For DC Specialty Hospital; Calif. Hospital Errors

A selection of health policy stories from the District of Columbia, Arizona, California, Massachusetts, Connecticut, Georgia, Kansas, Mississippi, Idaho and Indiana.

The Washington Post: Specialty Hospital Of Washington Could Be Forced Into Bankruptcy By Creditors
Creditors who say they are owed millions of dollars hope to force two D.C. hospitals into bankruptcy, threatening the city’s only facilities dedicated to the long-term care of those suffering from serious and complex maladies (DeBonis, 4/26).

The Wall Street Journal: Waits For Phoenix VA Appointments Drove Sick To ER, Ex-Employee Says
Waits to see primary-care doctors in the Phoenix VA Health Care System were lengthy enough to force some patients to seek help at the emergency room, according to a former employee whose allegations are part of an investigation by the VA's inspector general. Sam Foote, a doctor who retired in 2013 from the Phoenix VA after 24 years, has lodged a number of complaints with the agency's independent inspector general (Kesling and Phillips, 4/25).

Los Angeles Times: Senator: Hospitals Reducing Treatment Errors, But Problems Remain 
Calling hospital errors "heartbreaking," U.S. Sen. Barbara Boxer (D-Calif.) on Friday released a report detailing how some California hospitals are reducing medical mistakes that can cause infections, incorrect administration of drugs, falls and other complications. Many medical centers are preventing errors, she said, but others still need to demonstrate they are serious about addressing the problem. According to some researchers, Boxer said, between 210,000 and 440,000 Americans die as a result of medical errors each year -- making medical errors the third leading cause of death in the nation, behind heart disease and cancer (Brown, 4/25).

Los Angeles Times: More Scrutiny For UCLA's School Of Medicine
In the wake of a $10-million payout to a whistleblower, UCLA's School of Medicine is drawing more scrutiny over its financial ties to industry and the possibility that they compromised patient care. A new study in this month's Journal of the American Medical Assn. raised a red flag generally about university officials such as Eugene Washington, the dean of UCLA's medical school who also serves on the board of healthcare giant Johnson & Johnson. The world's biggest medical-products maker paid Washington more than $260,000 in cash and stock last year as a company director (Terhune, 4/25).

The Boston Globe: Urgent-Care Clinics Gain Ground
Several urgent-care medical centers are opening in the suburbs south and west of Boston, each scrambling to scoop up patients looking for convenient health care near their home or work. By July, three urgent care centers are expected to be operating on Route 1 in Norwood -- something of a medi-mile along the automile (Lang, 4/27).

The CT Mirror: CT Mission Of Mercy, In Hartford, Draws Hundreds For Free Dental Care
Standing outside the XL Center in downtown Hartford Friday morning, (Roger) Green was the 626th person in line for the Connecticut Mission of Mercy, an annual, two-day free dental clinic that typically serves more than 2,000 people. … The clinic has dual purposes: Provide free care to people who need it. And raise awareness of the extensive need for dental care in what is by some measures the wealthiest state in the country (Becker, 4/25).

Georgia Health News: Rural Health Care Surging As A Major Issue 
Hospital leaders, physicians and state lawmakers will be members of a new committee designed to help bolster rural health care in Georgia.  Gov. Nathan Deal on Friday announced appointments to the Rural Hospital Stabilization Committee, created to identify needs of rural facilities and offer potential solutions. The panel is one of Deal’s strategies to help rural hospitals survive, and comes in the wake of four rural Georgia facilities closing in the past two years (Miller, 4/25).

The California Health Report: Barriers To Mental Health Treatment Remain Under Obamacare
The Affordable Care Act covers treatment for some mental health disorders, such as depression and anxiety, but the law is not comprehensive and many Californians with mental illnesses still face challenges accessing care. As a result, whether patients are uninsured, have private coverage or government benefits determines their access to services (Bookwalter, 4/27).

Kansas Health Institute News Service:  Brownback Proposes HCBS Waiting List Reduction 
Gov. Sam Brownback today said he will ask the Kansas Legislature to approve spending an additional $2.6 million in state funds to help reduce the waiting lists for in-home, Medicaid services for the disabled. If approved, an estimated 209 additional people would receive the services. There are about 5,000 people on the waiting lists; more than 3,100 are developmentally disabled. About 1,800 physically disabled people also await services, though administration officials said they were still in the process of verifying the accuracy of that number (Shields, 4/25).

The Associated Press:  Appeals Court To Consider Miss. Abortion Law 
A federal appeals court panel on Monday will hear arguments for, and against, a 2012 Mississippi law that threatens to close the state's only abortion clinic. The law requires any physician who does abortions at a clinic to have admitting privileges at a local hospital. Jackson Women's Health Organization has been unable to obtain them. U.S. District Judge Daniel P. Jordan III let the law take effect in July 2012, after the clinic sued the state. But Jordan blocked the state from closing the clinic while it tried to comply (4/27).

The Associated Press:  Phone Prescription Draws Idaho Sanction
Telemedicine -- doctors treating patients over the phone, online or by videoconferencing -- is a growing subset of the health care system. But Idaho's medical licensing board doesn't approve and earlier this year punished a doctor for prescribing a common antibiotic over the phone. The sanctions against Dr. Ann DeJong are so severe that her board certification is threatened (4/27).

The Associated Press:  Caregivers For Disabled Lament Medicaid Cuts 
Those whose hands care for people with disabilities are frustrated. Indiana Medicaid funding has been cut for the past five years and pay for the state's personal care aides hasn't kept up with inflation. In 2012, more than a third of those caregivers were receiving food stamps. The question becomes how long the best staff, the employees who know most about their clients' needs, will be able to stay in this job rather than moving on for more money or less headache. ... A national average of 50 percent has plagued the residential services industry for decades (4/26).

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Editorials and Opinions

Viewpoints: Boehner's 'Truthful Gaffe' On Health Law; Larry Kramer's AIDS Crusade; Costly Drugs

Bloomberg: Boehner's Truthful Gaffe On Obamacare
Although "repeal and replace" has been the Republican position on Obamacare since 2010, "replace" has been there mainly because it polled well. Republicans were satisfied with the health-care status quo in 2009, and would have been glad to repeal Obamacare to return to it. As Steve Benen points out, Republicans voted for just-plain-repeal many times. ... The "replace" component never quite shows up. Flat-out repeal was a coherent policy position in fall 2010, when the Affordable Care Act was in its infancy. Now, however, reform has become a vigorous preschooler, and everyone has bought new furniture, moved to a different neighborhood, and otherwise rearranged their lives in ways that aren't going to go away if reform suddenly disappeared. Flat-out repeal is policy nonsense and has been for months, and Boehner has revealed that he knows it (Jonathan Bernstein, 4/25).

The New York Times: How To Get Better Insurance Data, Without Encouraging Conspiracy Theories
It has been a week since opponents of health-care reform accused the Obama administration of conspiring with the Census Bureau to undercount the number of uninsured Americans in an attempt to make the Affordable Care Act look more successful than it really is. It was one of the wackier attacks on the A.C.A. And yet it has gained some traction, of sorts. No one in his or her right mind is endorsing the conspiracy theory. But in the aftermath of the accusations, a handful of senators are calling on the bureau to modify its survey method. That would be fine, if they were advocating for true advancements in the bureau's already impressive statistics-gathering. Unfortunately, they seem more intent on satisfying the conspiracy theorists than in getting the best data possible (Teresa Tritch, 4/25).

New Orleans Time-Picayune: Louisiana Residents Understand Need For Medicaid Expansion, Why Don't Elected Leaders?
Every Louisiana resident will suffer the repercussions of Gov. Jindal's stubborn refusal to accept the $16 billion in new Medicaid money. Our federal tax dollars will go to fund something somewhere else, instead of being sent back to Louisiana. Hospitals and doctors will wind up treating the uninsured in emergency rooms and swallowing the cost. An estimated 15,600 new health care-related jobs that could strengthen Louisiana's economy won't materialize. The Jindal administration's arguments against the Medicaid expansion are weak and getting weaker (4/27).

The Richmond Times-Dispatch: McAuliffe Could Go It Alone On Health Care
As the health care fight enters its fourth month — and with neither the Senate nor the House of Delegates budging — there is continuing speculation that McAuliffe will take matters into his own hands: He would bypass the General Assembly altogether, issuing an executive order directing the Medicaid agency to craft and carry out a plan for bringing 400,000 uninsured Virginians under Obamacare. Such a step by McAuliffe would be dramatic. It would be high-risk, possibly triggering a paralyzing political brawl with Republicans and, maybe, a legal one. It could be high-reward, allowing McAuliffe to seize victory on his marquee issue and ensuring Democrats the support of thousands of registered — and healthier — voters, even those in GOP territory (Jeff E. Schapiro, 4/27).

Des Moines Register: Health Care System Can Learn Lessons From Iowa Dentists
Thanks to advances in molecular medicine, genetics, risk assessments and other areas of research, health care in general (including dental care) is being transformed from a system of treating disease in a reactive, one-size-fits-all manner to one that provides predictive, proactive, preventive and personalized care. Though the techniques and technology dentists use is ever-changing, the dental care model — regular preventive care visits and cleanings has proven successful. ... Reducing procedures is one way the health care system can learn from the dental community. For more than 40 years we have evidence of how important it is to make the move from treating patients when they're sick to helping them when they're well. This transition will be crucial for the long-term success of the health care industry (Jeff Russell, 4/28). 

The New York Times: New York’s Medicaid Challenge
New York State will receive a welcome infusion of $8 billion in federal funds over the next five years to improve the delivery of health care for the state's poorest residents while saving billions in unnecessary hospital and emergency room costs. The money will be allocated to providers throughout the state, but it could be especially helpful in salvaging and reshaping failing hospitals in Brooklyn whose threatened closures have sparked community protests and brought pledges of assistance from Mayor Bill de Blasio and Gov. Andrew Cuomo (4/25).

Arizona Republic: Medicaid Ruling Restores Integrity To Legislative Process
Last week, the Arizona Court of Appeals resuscitated Proposition 108, a critical voter-enacted constitutional protection that requires a two-thirds legislative supermajority to levy new taxes and fees. A trial court had previously ruled that 36 legislators who voted against a massive new tax to fund the state's Medicaid expansion lacked the standing to enforce this provision in court, even though the tax became law with the approval of only a simple majority of legislators. The unanimous decision restored the lawsuit and, more importantly, the integrity of the legislative process (Christina Sandefur, 4/27).

The New York Times: The Angel In Larry Kramer
He understood as well as anybody else did that for Americans in the 1980s to care about AIDS, they had to care about homosexuals, and to care about homosexuals, they had to realize how many they knew and loved. He appreciated the need for visibility, from which so much subsequent progress on so many other fronts flowed (Frank Bruni, 4/26).

The New York Times: For Drugs That Save Lives, A Steep Cost
This month, amid great fanfare, the Food and Drug Administration approved a portable pocket-size device that injects a drug called naloxone to rescue people who become unconscious from overdoses of heroin and other opiates. Wider dissemination of this antidote, long used in emergency rooms and by some first responders, will certainly save lives. ... But there was one question that Evzio’s manufacturer has so far declined to answer and that the F.D.A. does not consider in its approval deliberations: How much is it going to cost? (Elizabeth Rosenthal, 4/26).

The Boston Globe: Hepatitis C Cure May Be Costly — But Also Cost Effective 
Many hepatitis C patients now have the hope of receiving a therapy that can completely cure them of their infection. The drugs just approved by the FDA eradicate the hepatitis C virus from their bodies. This is a cure for not just a few lucky patients, but instead for well over 90 percent of patients. But it remains to be seen how quickly society will be able to bring these new cures to all patients who can benefit. At well over $80,000 per patient, the new therapies for hepatitis C are expensive — so much so that some insurance companies and state Medicaid officers are bridling at the thought of billions of dollars in extra costs. But given the societal benefit of completely curing patients with expensive and lethal disease, the cost-benefit analysis on these drugs appears straightforward — insurance and society should pay for these life-saving drugs, since significant chronic disease will be avoided (Dr. Christoph Westphal, 4/27).

The New York Times: Wise Controls On E-Cigarettes
The rapidly growing electronic-cigarette business would finally be brought under regulatory supervision under long-delayed rules proposed by the Food and Drug Administration on Thursday. If the rules go into effect substantially as written, they will lay the foundation to protect the public from devices whose risks and benefits are largely unknown (4/25).

Los Angeles Times: Will The Pro-Vaccine Celebs Please Speak Up?
Celebrities who question the safety of vaccines just won't shut up. It seems like every week there's another famous person spouting some anti-vaccine nonsense, from Jenny McCarthy to Kristin Cavalari to Donald Trump and now, Alicia Silverstone. The continuing spread of misinformation about vaccines by celebs is alarming. And because the power of celebrity is used to sell products and champion social causes, like it or not, what famous people say has influence. So will the pro-vaccine celebrities please stand up? And when they do, like Amanda Peet and Kim Kardashian have done, can the media make a bigger deal out of it? (Susan Rohwer, 4/25). 

The Denver Post:  Issue Of Medicating Colorado Foster Children Over-Simplified
The recent Denver Post series on the treatment with psychotropic medications of youth in foster care evokes concern among the general public, members of the Colorado Child and Adolescent Psychiatric Society and other licensed prescribers, and guardians of children and adolescents receiving mental health treatment. The series failed to acknowledge that youth in foster care often have a higher need for intensive, sometimes emergency, care than do those able to remain in families of origin (Harriet Stern, 4/26).

The Minn Post: Criminalizing Pregnant Women Who Use Illegal Drugs: 'Throwing A Lit Match'
When the Tennessee General Assembly voted last week to criminally prosecute women who use illegal narcotics during pregnancy, it ignored, among other things, the major medical community's longstanding warnings about the negative and counterproductive effects of such punitive measures. The bill, sent to Gov. Bill Haslam for consideration April 16, allows for felony assault charges against a woman "if her child is born addicted to or harmed by the narcotic drug, and the addiction or harm is a result of her illegal use of a narcotic drug taken while pregnant" (Sarah T. Williams, 4/25).

The Boston Globe: In Practice: Illness And Silver Linings
During the recent one-year anniversary of the Boston Marathon bombings, Pat said she identified with the conflicted feelings of survivors who said they wished the attacks had never occurred, yet also cherished the sense of community they'd found with fellow survivors. Pat reminds me that her family had already experienced the unexpected upside of medical misfortune. One of her grandchildren has autism and is nonverbal. She's told me that there is something about this kid that brings out the best in all the other kids, and the adults, too. Makes them more understanding, more compassionate. … the clouds of illness and disability come, not infrequently, with silver linings (Dr. Suzanne Koven, 4/28).

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Stephanie Stapleton

Andrew Villegas

Lisa Gillespie
Shefali Luthra

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