Daily Health Policy Report

Wednesday, May 1, 2013

Last updated: Wed, May 1

KHN Original Reporting & Guest Opinion

Health Reform

Health Care Marketplace

Women's Health

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Yes, Virginia, There Is A Medical Home

Virginia Public Radio's Sandy Hausman, working in partnership with Kaiser Health News and NPR, reports: "One of the persistent questions about the Affordable Care Act is how are so many people, new to insurance, going to get quality health care when the system seems so strapped already. The law does have an answer to that: the medical home. But that is not a concept that is widely understood yet. St. Francis Family Medicine near Richmond, Va., is, like many medical practices in America, evolving into a medical home, where health care services are coordinated to manage each patient's care" (Hausman, 5/1). Read the story.

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Capsules: Obama: 'We're Pushing Very Hard' To Meet Health Law Deadlines; A Shorter Exchange Application. But Is It Simpler?; Aetna Cuts Predictions For Obamacare Enrollment

Now on Kaiser Health News' blog, Mary Agnes Carey reports on comments made during Tuesday's press conference by President Barack Obama about the health law: "President Barack Obama said … he expected some 'glitches and bumps' in the road to full implementation of his health care law. 'That's pretty much true of every government program that's ever been set up,' Obama said. 'We've got a great team in place, we are pushing very hard to make sure that we're hitting all the deadlines and the benchmarks'" (Carey, 4/30).

In addition, Jenny Gold reports on the latest version of the application for health insurance for the health law's new online marketplaces: "Consumer advocates have been complaining for months that the Obama administration's 21-page application to sign up for health insurance in the exchanges is too long and complicated. The designers of the application estimated it would take 45 minutes to complete. The administration heeded the advocates’ pleas with the introduction Tuesday of a modified application of just 3 pages for individuals who are not offered health coverage from their employer" (Gold, 4/30).

Also on Capsules, Jay Hancock reports on Aetna's predictions for health law enrollment: "In a new sign that implementing the health law could take longer than expected, insurer Aetna said Tuesday it lowered the number of medical policies it expects to sell through online marketplaces that open for business in October" (Hancock, 4/30). Check out what else is on the blog.

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President on Obamacare: 'Still A Big Complicated Piece Of Business'

Kaiser Health News has posted a transcript of President Barack Obama's remarks on health care during his Tuesday news conference (4/30). Read the transcript.

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Political Cartoon: 'Jogging Suit?'

Kaiser Health News provides a fresh take on health policy developments with "Jogging Suit?" by John Darkow.

Meanwhile, here is today's health policy haiku:


Bumps... glitches... Oh my!
Road not smooth for the health law:
Fasten your seat belts.

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

Obama Aims To Tamp Down Fears About Health Law Implementation

During a Tuesday news conference, President Barack Obama acknowledged likely "bumps and glitches" as key provisions of the health law take effect, but said that many elements of the measure are already in place and "working fine."

Los Angeles Times: Obama Seeks To Allay Healthcare Law Concerns
President Obama sought to tamp down fears Tuesday that his landmark healthcare law would raise insurance costs and cause other disruptions, saying most Americans were already benefiting from it and others soon would. … But the law's signature benefit — a guarantee that all Americans can get insurance, even if they are ill — doesn't take effect until next year. Building a system to deliver on that promise has been the law's most complex and costly challenge (Levey, 4/30).

The New York Times: Health Care Law Is 'Working Fine,' Obama Says In Addressing Criticism
President Obama said Tuesday that his health care law was "working fine," and he played down concerns that the law could disrupt coverage or lead to higher premiums for people who already had health insurance. At the same time, federal officials released simplified application forms to be used by people seeking health insurance, tax credits and other government subsidies under the law, which Mr. Obama signed three years ago (Pear, 4/30).

The Wall Street Journal: Obama Sees 'Bumps' For Health Law
The stakes are high for the administration since the outcome of Mr. Obama's signature domestic-policy legislation could shape the course of his second term. Republicans are preparing to seize on any early flaws to further their campaign against the law, and make gains in 2014 elections (Radnofsky, 4/30).

The Associated Press/Washington Post: Obama Says His Health Care Law Already Benefiting Majority Of Americans Who Have Health Care
The president says despite what he calls "sky is falling" predictions, the Affordable Care Act's provisions are already in place for those with health insurance. He says what's left is to help those Americans who don't have health care coverage to obtain it. He acknowledged that is "a big undertaking" and predicted there could still be some glitches as the details are worked out (4/30).

National Journal: The 'Obamacare' Rollout's 'Glitches And Bumps' Won't Doom Health Reform
President Obama acknowledged reality when he said Tuesday that the rollout of the health reform law next year is going to be interrupted by "glitches and bumps." But if the past is any indication, an initial spate of difficulties or bad headlines won't alone spell failure (Sanger-Katz, 4/30).

Kaiser Health News: Capsules: Obama: 'We're Pushing Very Hard' To Meet Health Law Deadlines
President Barack Obama said … he expected some 'glitches and bumps' in the road to full implementation of his health care law. "That's pretty much true of every government program that's ever been set up," Obama said. 'We've got a great team in place, we are pushing very hard to make sure that we're hitting all the deadlines and the benchmarks" (Carey, 4/30).

The Hill: GOP Hits Obama Over 'Glitches' Comment
Republicans piled on President Obama over his concession Tuesday that there will be "glitches and bumps" in the rollout of his healthcare law. Republican campaign committees seized on the comments, linking them to a poll released earlier Tuesday that showed the law remains unpopular (Baker, 4/30).

Kaiser Health News: President on Obamacare: 'Still A Big Complicated Piece Of Business'
KHN has posted a transcript of President Barack Obama's remarks on implementation of the health care law during his Tuesday news conference (4/30).

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At The Florida State House, Medicaid Expansion Drama Continues

News outlets also detail the latest expansion news from Oklahoma, Iowa, Georgia, Louisiana, Maine and Arizona.

Health News Florida: Medicaid Impasse Sparks Rebellion
Democrats are so angry over House Republicans' refusal to accept federal funds to expand health coverage that they deliberately caused action on the floor to grind to a halt Tuesday afternoon. Democrats are in the minority, but they had enough votes to require that every bill be read in entirety, not just summarized-- a maneuver that takes so much time it could block many bills from getting a vote if the stall continues (Gentry, 4/30).

Orlando Sentinel: House Democrats Shut Down Chamber In Medicaid Standoff
House Democrats brought the chamber to a halt Tuesday by requiring that bills be read in full, a "nuclear option" maneuver the minority-party was employing in order to try and force Republicans to take up a health-care expansion the Senate passed earlier in the day (Deslatte, 4/30).

Tampa Bay Times: Democrats Bring House To Halt Over Health Care Stalemate
Democrats invoked the rarely used rule to call attention to the House's resistance to accept any federal money for health insurance expansion and to demand that the House allow another vote on a Senate bill that uses $51 billion in federal money over 10 years to provide health care coverage to poor Floridians. House Speaker Will Weatherford, R-Wesley Chapel, responded by plugging in a computerized auto reader to recite the bills in full, but he would not commit to taking up the Senate plan. The House had previously rejected the Senate bill on a mostly party line vote, but Democrats believe Republicans were pressured into voting against the measure (Klas and Mitchell, 4/30).

The Associated Press: Fla. Dems Stall Session To Force Health Care Vote
The annual session of the Florida Legislature nearly came to halt on Tuesday amid acrimony and finger-pointing. Florida House Democrats kicked off the turmoil by using a procedural move to stall the pace of the session, requiring that all bills be read aloud in full (Fineout, 4/30).

The Associated Press: Health Care Coverage Option Drafted In Oklahoma
A group of Republican lawmakers has developed an alternative plan to provide health coverage to uninsured Oklahomans that would require most recipients to work and pay modest copayments, The Associated Press has learned. A draft copy of a bill obtained by the AP on Tuesday shows the Oklahoma Plan for Consumer Health Choice and Accountability would apply to Oklahoma residents who earn up to 138 percent of the federal poverty level, or about $31,000 for a family of four (4/30).

Des Moines Register: House Approves Branstad's Health Plan; Changes Likely
Gov. Terry Branstad’s Healthy Iowa Plan won approval in the state House on Tuesday, clearing the way for negotiations on the ultimate shape and scope of state-sponsored health care for low-income Iowans. The proposal is the Republican alternative to an expansion of the existing Medicaid program envisioned by the federal Affordable Care Act and favored by Democrats (Noble, 4/30).

Des Moines Register: Branstad Office: Our Health Plan Costs Poor Iowans Less Than Medicaid
Gov. Terry Branstad’s office contends in a document released Tuesday that poor Iowans could wind up paying more for health care if Medicaid is expanded than they would if the state adopts the governor’s health plan. A leading Democrat disputed the contention, which was aimed at rebutting criticism of Branstad’s proposal to charge poor Iowans a monthly premium of $2 to $10 for participating in his Healthy Iowa Plan (Leys, 4/30).

The Associated Press: Iowa House Approves Low-Income Health Plan
The Republican-majority Iowa House approved Gov. Terry Branstad's health care proposal for low-income Iowa residents Tuesday, setting up a tough negotiation with the Democratic-controlled Senate, which favors a Medicaid expansion. In a 51-49 vote split mostly along party lines, the House approved legislation for the "Healthy Iowa" plan (Lucey, 4/30).

Georgia Health News: Hospital Officials Muted On Medicaid Expansion Here
State hospital associations across the Southeast and the nation are stumping hard in favor of expanding their states’ Medicaid program under the Affordable Care Act. The Georgia Hospital Association is an exception, however. GHA, in a recent email to Georgia Health News, says it is studying the expansion issue. “We are still in the process of collecting data on the issue,’’ said Kevin Bloye, a GHA vice president. “Hopefully, we’ll be able to offer more on this in the near future.” A state’s decision to reject Medicaid expansion would hurt a local hospital industry financially, experts say. The 2010 health reform law is expected to cost hospitals billions of dollars by reducing Medicare reimbursements and phasing out federal payments that compensate hospitals for providing free care to the indigent (Miller, 4/30).

Atlanta Journal Constitution: Uninsured Georgia Veterans Could Remain Ineligible For Medicaid
Poor, uninsured military veterans and their spouses in Georgia won’t gain the same access to critical health coverage that hundreds of thousands of their peers will receive in states that plan to expand Medicaid. More than 83,000 Georgia veterans and their spouses under age 65 don’t have health insurance, the fourth-largest such population among states nationwide, a recent study examining U.S. Census Bureau data shows. Nearly 40 percent of them — people like Dale Zipperer of Griffin, a Marine from the Vietnam era whose poor health prevents him from working — have incomes low enough to qualify for coverage under a Medicaid expansion set to begin in January under the Affordable Care Act (Williams, 4/30).

New Orleans Times Picayune: Medicaid Expansion Bill Clears Louisiana Senate Health Committee
A Senate Health panel narrowly approved legislation Tuesday that would require Gov. Bobby Jindal to utilize Medicaid money on the condition the additional dollars be used to help lower-income residents buy insurance plans. Senate Bill 125 by Sen. Karen Carter Peterson, D-New Orleans, was originally intended to force the governor's hand into accepting the federal Medicaid expansion under the Affordable Care Act, sometimes referred to as Obamacare. An amended version of the bill, which was passed unopposed by the Senate Committee on Health and Welfare, dramatically changed the bill's language so the measure implements a similar version of the health-care overhaul wending its way through the Arkansas Legislature (Kumar, 4/30).

Bangor Daily News: Democrats, GOP In Maine Continue Fight Over Medicaid Expansion, Hospital Repayment
Republicans and Democrats on Tuesday continued to spar over linking acceptance of Medicaid expansion funds from the federal government with repayment of the state’s outstanding Medicaid debt to 39 hospitals. Although both sides say there is no disagreement about finally paying off $484 million owed to Maine hospitals, the question of whether expanding Medicaid eligibility, which Democrats support and Republicans decry, will help contain health care costs has grown into one of the most contentious this legislative session (Cousins, 4/30).

Arizona Republic: Arizona Abortion Issue Heightens Medicaid Standoff
Democrats are growing frustrated over Gov. Jan Brewer's struggle to get her Medicaid-expansion proposal into the Legislature and say efforts to appease reluctant Republican lawmakers with anti-abortion legislation threaten their support. The governor's team is working to craft abortion legislation under pressure from one of the state's most powerful lobbying groups, which holds sway over GOP votes that Brewer desperately needs (Reinhart, 4/30).

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Insurers Face Key Health Exchange Deadline

Modern Healthcare reports that May 1 is the deadline for insurers to apply to offer heatlh plans for sale on state-run exchanges. However, the deadline for participation in states that have opted for federally run exchanges has been extended until Friday.

Modern Healthcare: Deadline For State-Run Exchanges Is Today
Today is the deadline for insurers to apply to offer qualified health plans in state-run exchanges, and the submissions will signal the vigor of competition as the marketplaces begin enrolling members in October. Late Monday, the CMS said it would extend the deadline for insurers in states with federally run exchanges to submit qualified health plans from today to Friday. Large carriers have indicated that they will be conservative in choosing where to join the fray. During a conference call Tuesday to discuss first-quarter earnings, Aetna president and CEO Mark Bertolini said the carrier plans on selling insurance in 14 exchanges (Block, 4/30).

In Minnesota and New Mexico -

The Associated Press: Gov. Dayton Names Directors Of Health Insurance Site
Gov. Mark Dayton on Tuesday appointed six people with a wide range of health care experience to serve on the board of directors for the Minnesota's health care exchange, the online marketplace where the uninsured and other residents will be able to shop for coverage under the federal health care overhaul (Condon, 4/30).

MinnPost: MNSure Board Members Ready To Shape State’s New Health Exchange
Gov. Mark Dayton on Tuesday appointed the governing board of Minnesota’s health insurance exchange, one of the final steps in getting the new MNsure agency on its feet. The exchange, authorized in late March by the Legislature, is an autonomous agency that will manage health coverage for roughly 1.3 million Minnesotans under the federal Affordable Care Act (Nord, 4/30).

Albuquerque Business First: Expert Warns Board That Launching Insurance Exchange May Take Until 2015
It will be nearly impossible for New Mexico to set up a full-blown health insurance exchange by Oct. 1 as required by federal law, the New Mexico Health Insurance Exchange board was told Monday. Instead, the board should look at getting the full exchange operational by January 2015 and should concentrate on outreach and educational programs for the uninsured, the board was told (Domrzalski, 4/30).

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New Consumer Conundrum: To Buy Insurance Or Pay The Penalty

Media outlets report on a range of health law implementation issues -- including how medical homes might be helpful in treating the newly insured as well as an analysis of the whether the health law's penalties for not buying insurance have enough bite.

Marketplace: Will You Buy Into Obamacare Or Pay The Penalty?
There's a lot of concern about how much it will cost to buy health insurance on the new exchanges coming online later this year. Some states are predicting double digit increases in premiums. But beginning next year, if you don't have coverage, you’ll pay a penalty. The individual penalty under the Affordable Care Act is $95 or one percent of your income, whichever is greater. So if you earn $40,000, you'd pay $400. That's a fraction of what insurance will cost for most people (Gorenstein, 4/30).

Kaiser Health News: Yes, Virginia, There Is A Medical Home
One of the persistent questions about the Affordable Care Act is how are so many people, new to insurance, going to get quality health care when the system seems so strapped already. The law does have an answer to that: the medical home. But it is not a concept that is widely understood yet. St. Francis Family Medicine near Richmond, Virginia is, like many medical practices in America, evolving into a medical home, where health care services are coordinated to manage each patient's care (Hausman, 5/1).

Additionally, more reports on the revised application form for health law benefits -

The Associated Press: Laying Bare Your Finances To Apply For Health Care
After a storm of complaints, the Obama administration on Tuesday unveiled simplified forms to apply for insurance under the president's new health care law. You won't have to lay bare your medical history but you will have to detail your finances. An earlier version of the forms had provoked widespread griping that they were as bad as tax forms and might overwhelm uninsured people, causing them to give up in frustration (Alonso-Zaldivar, 4/30).

Kaiser Health News: Capsules: A Shorter Exchange Application. But Is It Simpler?
Consumer advocates have been complaining for months that the Obama administration's 21-page application to sign up for health insurance in the exchanges is too long and complicated. The designers of the application estimated it would take 45 minutes to complete. The administration heeded the advocates' pleas with the introduction Tuesday of a modified application of just 3 pages for individuals who are not offered health coverage from their employer (Gold, 4/30).

And, in related developments from Capitol Hill -

The Washington Post: GOP Bill Would Force Federal Workers Onto Health-Care Exchanges
A new Republican House proposal would push federal workers off their employer-sponsored health plan and onto the insurance exchanges being established under the Affordable Care Act. Rep. Dave Camp (R-Mich.), chairman of the House Ways and Means Committee, introduced the bill Friday after talk on the Hill that Democrats were trying to exempt members of Congress and their staffs from a provision in current law that requires them to enroll in the exchanges in 2014 (Hicks, 4/30).

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42 Percent Of Americans Unsure If Health Law Stands

One poll about the health law highlights a continued lack of understanding about the measure and a second shows voters are still split in their support.

The Washington Post's Wonk Blog: Poll: 42 Percent Of Americans Unsure If Obamacare Is Still Law
If you want to know what a challenge the Obama administration faces in implementing its signature health-care law, this statistic might help: Fewer than six in 10 Americans know that the Obamacare law is still on the books. Seven percent think the Supreme Court struck it down; 12 percent say Congress repealed Obamacare (Kliff, 4/30).

NBC News: Poll: Many Americans Uninformed About Health Care Overhaul, Some Don't Know It's Law
As the Obama administration girds for "glitches and bumps" along the path to full implementation of the health-care law, a new poll indicates many Americans are still unclear about the details of the new law and, in some cases, unaware it's actually the law of the land. A whopping 42 percent of Americans do not know that the Affordable Care Act is, in fact, law. Included in that 42 percent -- 12 percent believe it has been repealed by Congress, 7 percent think the U.S. Supreme Court overturned it, and 23 percent are unsure of its status, according to a Kaiser Family Foundation health tracking poll (Montanaro, 4/30).

Fox News: Fox News Poll: 54 Percent Say Repeal Health Care Law, 85 Percent Favor Medical Marijuana
By a 54-41 percent margin, American voters would get rid of the sweeping 2010 health care law if given the option, according to a new Fox News poll. The poll, released Wednesday, also shows most voters -- 71 percent -- think the more than 15,000 pages of regulations that implement the Affordable Care Act, popularly known as Obamacare, are "way over the top." Some 19 percent say that number of pages "seems about right." The concern about the small mountain of health care rules is bipartisan. Even 56 percent of Democrats call the 15,000 pages of regulations "way over the top," as do 71 percent of independents and 87 percent of Republicans (Blanton, 5/1).

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Health Care Marketplace

Aetna Cuts Projections For Policies It Will Sell In New Marketplaces

Aetna said it expects to sell fewer health insurance policies than initially projected in the health law's online marketplaces, which are slated to open in October. The insurer also said its first-quarter profit slipped 4 percent but raised its 2013 forecast.

The Wall Street Journal: Aetna Earnings: Insurer Raises Outlook
Aetna and its peers are preparing for major changes in 2014, when the health care overhaul law calls for coverage expansion to millions more Americans. [Aetna CEO Mark] Bertolini said Aetna remains cautious about jumping into an emerging marketplace for individual health coverage, and he warned that lower government payments for Medicare Advantage next year will pose a challenge (Kamp, 4/30).

Kaiser Health News: Capsules: Aetna Cuts Predictions For Obamacare Enrollment
In a new sign that implementing the health law could take longer than expected, insurer Aetna said Tuesday it lowered the number of medical policies it expects to sell through online marketplaces that open for business in October (Hancock, 4/30).

The Associated Press/Washington Post: Aetna's 1st-Quarter Profit Slips 4 Percent, Health Insurer Raises 2013 Forecast
Aetna's first-quarter net income fell 4 percent as acquisition-related costs and rising health care expenses more than offset government business gains for the health insurer. But earnings still topped analysts' expectations, the company raised its 2013 forecast and said it expects more growth on top of that once it closes the acquisition of fellow insurer Coventry Health Care (4/30).

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Women's Health

FDA OKs Over-The-Counter 'Plan B' For Women And Girls Older Than Age 15

The move, regulators said, was made independent of a recent federal district judge's ruling that called for the emergency contraceptive to be made available over-the-counter to women of all ages without restriction.

NPR: FDA OKs Prescription-Free Plan B Pill For Women 15 And Up
In an effort to find a compromise for a politically fraught issue, the Food and Drug Administration has approved a proposal to make the emergency contraceptive pill Plan B more available to some younger teens without a prescription and to older women by moving the medication out from behind the pharmacy counter (Rovner, 4/30).

Los Angeles Times: Plan B Can Be Sold To 15-Year-Olds Without Prescription, FDA Says
The action comes roughly three weeks after a federal magistrate harshly criticized government regulators for their handling of the drug's approval process, calling their actions "politically motivated and scientifically unjustified." FDA officials said Tuesday that their decision was based on a pending, amended application submitted by the drug's manufacturer, Teva Womens' Health Inc. (Morin, 4/30).

Reuters: FDA Approves Plan B For Girls As Young As 15
The U.S. Food and Drug Administration on Tuesday said it would allow the Plan B One-Step contraceptive to be sold without a prescription to girls as young as 15 years of age. The announcement partially reverses a December 2011 decision that prevented the sale of the emergency contraceptive to all females of reproductive age, which was also overturned by a U.S. district judge in New York on April 5. The FDA said its approval was not related to the judge's ruling (4/30).

CQ HealthBeat: FDA Allows Sale Of Morning-After Pill To Women 15 And Older
The Food and Drug Administration announced late Tuesday that it has approved an application from Teva Women's Health to allow women 15 and older to buy without a prescription the Plan B One-Step morning-after pill the company manufactures. FDA officials said in a statement that their decision on the Teva application was made "independent" of an April 5 federal court order that Plan B be made available to women and teens of all ages without restrictions, as an over-the-counter drug (Norman, 4/30).

Medpage Today: FDA Lowers Age For OTC Plan B
The FDA has approved over-the-counter sale of the emergency contraceptive Plan B One-Step (levonorgestrel) to women and girls as young as 15. The agency announced late Tuesday that the approval was based on actual use studies and label-comprehension data showing that girls and women 15 and older understood that the product was not for routine use and wouldn't prevent sexually transmitted diseases. On April 5, a federal judge in the U.S. District Court's Eastern District of New York reversed a decision from the Department of Health and Human Services that restricted OTC access to levonorgestrel-containing emergency contraceptives Plan B and Plan B One-Step to women and girls 17 and older (Pittman, 4/30).

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Women's Health Care Proves Challenging For VA System

Politico: VA Steps Up On Women's Health Care
The nation's imagination may be captured by the expanding combat role of women in the U.S. military. But for the Department of Veterans Affairs, there's a more pragmatic challenge. As more women serve in the armed forces, how does a massive health care system that for decades was focused primarily on men make sure women get the health services they need — whether it's a routine Pap smear or mental health care after a sexual assault? (Smith, 5/1).

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State Watch

NY Health Care Advocates: Medicaid Managed Care Shuns The Most Disabled Users

Medicaid programs in North Carolina and Washington, D.C., also make news.  

The New York Times: Advocates Say Managed-Care Plans Shun The Most Disabled Medicaid Users
Managed-care companies in New York have come under fire for signing up vigorous older adults referred to them by social day care centers, customers whose health needs are relatively small. But on Tuesday, legal advocates for the disabled told the state's Medicaid director that the most seriously impaired people were getting the opposite treatment (Bernstein, 4/30).

North Carolina Health News: Bill Would Untie Medicaid Benefits From Recipients' Home Counties
Years ago, North Carolina counties paid part of a recipient's Medicaid tab, but that practice was phased out in the past decade. Yet, recipients' benefits are tied to their counties of origin, even if they now live across the state (Hoban, 5/1).

The Washington Post: Thrive Health Plan Approved As Medicaid Contractor
A brand-new health-care firm won the D.C. Council's approval Tuesday to do $542 million in Medicaid business with the city, but not before a legislator accused one of the company's owners of committing perjury by not making required disclosures to insurance regulators (DeBonis, 4/30).

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State Roundup: Calif. Prison Spending On Anti-Psychotics Raises Treatment Questions

A selection of health policy stories from North Dakota, California, Nevada and Massachusetts.

PBS NewsHour: States Become Central Battleground In Fight Over Access To Abortion Services (Video)
Five states have moved to adopt tighter abortion regulations, including North Dakota, where a new law prohibits abortions as soon as a fetal heartbeat is detected. Jeffrey Brown gets perspectives from Charmaine Yoest of Americans United for Life and Ilyse Hogue of NARAL Pro-Choice America (4/30).

The Associated Press: Calif. Spends Big On Anti-Psychotics
Under federal court oversight, California's prison mental health system has been spending far more on anti-psychotic drugs than other states with large prison systems, raising questions about whether patients are receiving proper treatment. Figures compiled by The Associated Press show that California has been spending a far greater percentage on anti-psychotic medication for inmates than other states with large prison systems (Thompson, 5/1).

Sacramento Bee: Two Hospital Workers Fired Over 'Dumping' Of Nevada Psychiatric Patients
Nevada state officials said Monday that two employees at Rawson-Neal Psychiatric Hospital in Las Vegas have been fired and another three will be disciplined as a result of an internal investigation into the hospital's practice of busing mentally ill patients to other states. The investigation found that 10 out of roughly 1,500 patients may have been placed on buses during the last five years without "a support system/family/friends/housing at the destination," according to a statement from Mary Woods, spokeswoman for the Nevada Department of Health and Human Services (Reese and Hubert, 4/30).

Los Angeles Times: Workers Fired From Nevada Hospital Accused Of 'Patient Dumping'
Two employees have been fired and three others disciplined at a Las Vegas hospital accused of "patient dumping" -- sending mentally ill patients to other states, including California. The Nevada Department of Health and Human Services announced Monday that 10 of roughly 1,500 patients discharged from Rawson-Neal Psychiatric Hospital had been placed on buses within the last five years without "a support system/family/friends/housing at the destination," the Sacramento Bee reported (Mather, 4/30).

The New York Times: Harvard Student's Suicide As A Case Study
A lawsuit against Harvard provides rare detail on the issues involving a diagnosis of attention deficit hyperactivity disorder from a student-health department. … Mr. Edwards's father, John, contends, among other accusations, that his son had never had A.D.H.D. and that Harvard's original diagnostic procedure, and subsequent prescriptions for Adderall, did not meet medical standards. Harvard attests that Johnny Edwards's care was "thorough and appropriate," according to a university statement. The trial is scheduled to begin next February in Massachusetts Superior Court (Schwarz, 4/30).

Los Angeles Times: Prosthetic Device Makers Reach Out To Aid Boston Marathon Victims
A group of companies that design, manufacture and service orthotic and prosthetic devices has banded together to aid uninsured and under-insured victims of the Boston Marathon bombing who have had limbs amputated and may need years of costly care. The newly formed Coalition to Walk and Run Again said its members are "committed to assuring the availability of appropriate patient care as well as artificial limbs and other mobility devices on a compassionate access basis" to those who had amputations as a result of injuries sustained in the April 15 bombing that injured 264 people and claimed the lives of three (Healy, 4/30).

California Healthline: Study: Insurers Are Palliative Care Innovators
Six major health insurers in California are expanding access to palliative care by providing more specialized case management and opening up the hospice benefit beyond its Medicare boundaries, according to a new study expected to be released today. The study, "A Better Benefit: Health Plans Try New Approaches to End-of-Life Care," is accompanied by a second paper in today's scheduled release: "End-of-Life Care in California: You Don't Always Get What You Want." The two papers are funded and published by the California HealthCare Foundation, which publishes California Healthline (Gorn, 4/30).

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Editorials and Opinions

Viewpoints: Outrage At Mistaken Report On Hill Health Coverage; Two Views Of Florida's Option On Medicaid

The New York Times' Economix: Health Coverage Worthy Of A Senator
Because members of Congress are accustomed to high-quality medical care provided to them through federal employee benefit programs, one might expect that they would push for top quality care to be delivered through the exchanges too. That is one reason why an (ultimately unfounded) report that the Grassley amendment might be reversed prompted so much outrage. (What’s actually at issue is uncertainty over whether the employer contributions in the current health plan for those on Capitol Hill can be applied to coverage through the exchanges.)  But the possibility that middle-class families could obtain care that is both top quality – good enough for your senator – and subsidized creates a number of economic problems (Casey B. Mulligan, 5/1).

The New York Times: The Republican Health Policy Trainwreck
A few weeks ago, Ezra Klein and Ben Domenech had a fairly detailed back-and-forth — culminating in this mano-a-mano exchange — about whether a Republican or conservative alternative to Obamacare actually exists. You can read or watch them go at it and form your own judgment, but I think the answer is pretty straightforward: A conservative alternative or alternatives, yes; an alternative that Republican lawmakers are ready to vote for, no (Ross Douthat, 4/30).

The Wall Street Journal: States Can Save Taxpayers $609 Billion
As the battle over Medicaid expansion rages in the states, supporters of expansion have dusted off an age-old favorite in making the case for taking federal dollars. They say: If our state doesn't take the money, those dollars will go to some other state instead. Happily, in this instance that is not true (Christian Corieri, 4/30).

Forbes: Florida Senate Republicans Vote to Expand Obamacare And Medicaid, Rejecting House's Free-Market Alternative
On April 11, the GOP-controlled Florida House of Representatives passed an innovative, consumer-driven replacement for Obamacare’s Medicaid expansion, one that could be a national template for free-market health reform. But Republicans in the state Senate rejected the House plan, electing instead to expand Medicaid, as Obamacare prescribes. Senate Republicans' inexplicable decision makes it likely that free-market reform will fail in Florida, an outcome that could easily have been avoided (Avik Roy, 5/1).

Tampa Bay Times: Weatherford Should Allow Open Vote On Medicaid Expansion
Florida has three days to measure up to Arkansas. In Arkansas, a Republican-led legislature and a Democratic governor agreed to accept federal Medicaid expansion money to help buy private insurance for low-income residents. In Florida, the state Senate on Tuesday overwhelmingly voted for a similar plan that has been endorsed by Republican Gov. Rick Scott. It is a conservative, fiscally responsible approach, and the House should approve it before the regular session ends Friday (4/30).

Kansas City Star: Brownback Still Mum On Medicaid Growth, But Solid On Biolab
Everybody does this sometimes. We decide by not making a decision. So it seems to be with Kansas Gov. Sam Brownback and Medicaid expansion. For months Brownback has been mysterious about whether he’ll be one of the Republican governors who want to insure more low-income people, or stay on the sidelines with governors like his pal, Rick Perry of Texas. Brownback still hasn't said one way or the other. But it's getting late in the session to convince a reluctant Legislature to accept an expansion and add the federal Medicaid funds to the budget (Barbara Shelly, 4/30). 

Bloomberg: Medicare Should Pay For Patients, Not Treatments
Given the partisan divide in Congress, I don’t hold out too much hope that the comprehensive-payment strategy will become law anytime soon, just because it makes sense and has support from thought leaders from both parties. Given the central role of health costs in our fiscal future, however, we would be smart to get rid of sequestration, which hurts short-term economic growth but does little to reduce America’s long-term budget deficit. Instead, we should enact this type of Medicare payment reform (Peter Orszag, 4/30).

Journal of the American Medical Association: The Boston Marathon Response: Why Did It Work So Well?
Overall, only 3 people were killed by these explosive devices, and all 3 died before reaching the hospital. Not one patient who arrived at a hospital subsequently died. How did this happen? This astoundingly high survival rate, despite the nature and severity of the injuries, is a tribute to the courageous and rapid response of bystanders and first responders, expert field triage, rapid transportation of injured persons, and the skills and coordination of the receiving hospital trauma teams. It is also, however, the product of a confluence of deliberate actions stretching back to September 11, 2001, augmented by a series of providential but not random events (Drs. Ron M. Walls and Michael J. Zinner, 4/30). 

Reuters: Learning From Breast Cancer
Americans are bad at statistics. When it comes to breast cancer, they massively overestimate the probability that early diagnosis and treatment will lead to a cure, while they also massively underestimate the probability that an undetected cancer will turn out to be harmless. They’re bad at pathology: they’re easily convinced that something called ductal carcinoma in situ (DCIS) is a form of cancer, for instance, partly because the cancer industry insists on referring to it as "Stage Zero" cancer. They’re bad at biology: they think that it’s physics, basically, and that cancers are discrete, localized growths which start small and get bigger, and that the earlier you find and treat them, in large part by physically cutting them out of the body, the more likely you are to be cured (Felix Salmon, 4/30).

Reuters: The Red-State Attack On Abortion Rights
This has been a big month for abortion rights. In North Dakota, where there is only one abortion clinic, a District Court judge voided a two-year-old set of state restrictions on the use of medications to induce first-trimester abortions. And in Mississippi last Monday, a federal judge blocked some elements of state law intended to shut down the state’s only abortion clinic. But make no mistake: The competition to shut down "the last clinics" in states with only one clinic is ongoing (Quart, 4/30).

San Francisco Chronicle: Be Prudent In Diagnosing, Medicating ADHD
Among all the changes that are about to happen in the way doctors diagnose psychiatric problems, I'm most concerned about the ones that could lead to adults and teens being misdiagnosed with attention deficit hyperactivity disorder, or ADHD. The Diagnostic and Statistical Manual of Mental Disorders is the guide by which most doctors make a diagnosis. The newest edition, the DSM-5, includes a number of changes and will be published in May. ADHD is a behavioral syndrome that is characterized by multiple symptoms of inattention or hyperactivity (Dr. Winston Chung, 4/30).

Philadelphia Inquirer: Mandatory Vaccination Saves Lives
Vaccines save lives. It has been proven time and time again for diseases ranging from polio to measles to the flu. The more people a community has who are vaccinated, the healthier it is. Those who remain unvaccinated leave themselves susceptible to serious infectious diseases. This puts everyone else at risk. That is why every state mandates that children receive vaccinations against a number of diseases, including polio and measles, as a condition of entering school. If vaccination rates were to significantly decline, the United States could face a public health crisis (Erica Cohen, 5/1).

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Stephanie Stapleton

Andrew Villegas

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