Daily Health Policy Report

Tuesday, May 14, 2013

Last updated: Tue, May 14

KHN Original Reporting & Guest Opinion

Health Reform

Health Care Marketplace

Women's Health

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Hospitals, Testing Companies Face Questions About Value Of Community Screenings

Kaiser Health News staff writer Julie Appleby, working in collaboration with The Washington Post, reports: "Hospitals hoping to attract patients and build their brands are teaming up with medical-screening companies to promote tests aimed at consumers worried about potentially deadly heart disease or strokes. What their promotions don't say is that an influential government panel recommends against using many of the tests on people without symptoms or risk factors" (Appleby, 5/13). Read the story.

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Insuring Your Health: Coverage Problems Could Still Remain For Young Adults

Kaiser Health News consumer columnist Michelle Andrews writes: "Supporters and critics of the Affordable Care Act seem to agree on at least one thing: Allowing young adults to stay on their parents' health plans until they reach age 26 is a smart move. The change, which took effect in the fall of 2010, has resulted in more than 3 million young people gaining health insurance" (Andrews, 5/14). Read the column.

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Capsules: CMS Won't Penalize Hospitals In States Slow To Expand Medicaid

Now on Kaiser Health News' blog, Phil Galewitz writes: "That sigh of relief you heard Monday was from hospital administrators in nearly two dozen states, including Florida and Texas. That's because the Obama administration announced that for the next two years, it doesn't plan to penalize states that have yet to expand Medicaid coverage under the federal health law by targeting them for reduced Medicaid funding, according to a proposed rule unveiled Monday. That money goes to hospitals that treat large numbers of poor people" (Galewitz, 5/14). Check out what else is on the blog.

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Political Cartoon: 'Gonna Wash That Law Right Out Of My Hair?'

Kaiser Health News provides a fresh take on health policy developments with "Gonna Wash That Law Right Out Of My Hair?" by Steve Sack.

Meanwhile, here is today's health policy haiku:


 Could this be the week:
CMS finally gets
An official boss?


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

GOP Probes Sebelius' Fundraising For Health Law Outreach

Congressional Republicans want to know whom she contacted and which other HHS officials are involved, while Sen. Lamar Alexander said he would ask the Government Accountability Office to investigate. A Sebelius spokesman said her actions were legal and that she had not solicited pharmaceutical and insurance companies regulated by the agency.

Los Angeles Times: GOP Slams Fundraising, Other Efforts To Promote Obama Health Law
Congressional Republicans have opened a new line of attack on President Obama's healthcare law, charging that the administration has improperly sought help from the healthcare industry and other outside groups to implement the landmark statute. Health and Human Services Secretary Kathleen Sebelius for months has been asking foundations, consumer and business groups, insurance companies and others to help enroll uninsured Americans in health insurance this fall, a key goal of the Affordable Care Act. Administration officials say those actions were entirely appropriate (Levey, 4/13).

Reuters: Senator Says Sebelius Should Stop Healthcare Fundraising
An Obama administration effort to raise private donations to help implement President Barack Obama's healthcare reform law came under fire on Monday from congressional Republicans who claim the action could violate the law. As the Republican-controlled House of Representatives prepared to mount a new vote this week to try to repeal the law, House Energy and Commerce Committee Chairman Fred Upton asked the administration to identify the companies and organizations that have received fundraising calls from Health and Human Services Secretary Kathleen Sebelius (Morgan, 5/13).

Modern Healthcare: Sebelius' Fundraising For Healthcare Reform Questioned
Republican lawmakers are digging in their teeth on the Obama administration's efforts to solicit help and donations for private organizations that are working to enroll millions of Americans in new coverage under the healthcare reform law. Sen. Lamar Alexander (R-Tenn.) said late Monday that he will ask the Government Accountability Office this week to open an investigation into the legality of HHS Secretary Katherine Sebelius' efforts to encourage private health stakeholders to spend money promoting Patient Protection and Affordable Care Act (Block, 5/13).

The Hill: GOP Probes Sebelius Fundraising Push
House Republicans sought detailed information Monday about Health and Human Services Secretary Kathleen Sebelius's effort to raise money for a group promoting President Obama's healthcare law. GOP leaders on House committees wrote to Sebelius on Monday asking for a breakdown of the groups she contacted and a list of any other HHS officials involved in the fundraising push (Baker, 5/13).

CQ HealthBeat: Sebelius Won’t Stop Seeking Funds For Enroll America From 'Non-Regulated' Groups
Health and Human Services Secretary Kathleen Sebelius is going full speed ahead with requests to industry executives and other organizations to assist private sector efforts to enroll the uninsured under the health law, despite protests from GOP lawmakers that her efforts on behalf of the group Enroll America may be illegal. HHS spokesman Jason Young said in an interview Monday that Sebelius has not solicited money from regulated entities such as pharmaceutical and insurance companies (Reichard, 5/13).

A second controversy is brewing that could also touch the health law's implementation -

Bloomberg: IRS Focus On Tea Parties Stirs Dissent On Health Care Law
A handful of Cincinnati-based Internal Revenue Service employees have accomplished what no bipartisan White House dinner ever could: uniting the U.S. Congress….Even as President Barack Obama yesterday labeled the IRS action "outrageous," the issue will complicate his ability to press other initiatives, including implementing the health-care law, in which the IRS plays an enforcement role, political scientists and strategists from both parties said yesterday (Bykowicz).

The Hill: Turmoil Toughens IRS Job On Healthcare
The nonpartisan IRS is charged with some of the law's most important functions, such as distributing tax credits and enforcing the individual mandate to buy health insurance. IRS duties on healthcare were bound to be politically charged given the controversy surrounding the law, which remains divisive with the public. Now the IRS's job has become even more difficult given the certainty of an investigation into the agency’s scrutiny of conservative groups (Viebeck, 5/13).

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Health Law Could Require Some American Indians To Buy Insurance Or Pay Penalties

The Associated Press reports that the overhaul's definition of "American Indian" only includes those tribes that are recognized by the federal government, though more than 100 tribes are recognized by state governments but not that U.S. Bureau of Indian Affairs. Other outlets report on insurance rates under the ACA, doctor-owned hospitals and the "doc fix" in Congress.

The Associated Press: Health Reforms Penalize Some American Indians
They will have to buy their own health insurance policies or pay a $695 fine from the Internal Revenue Service unless they can prove that they are "Indian enough" to claim one of the few exemptions allowed under the Affordable Care Act's mandate that all Americans carry insurance. "I'm no less Indian than I was yesterday, and just because the definition of who is Indian got changed in the law doesn't mean that it's fair for people to be penalized," said DeRouen, a former tribal administrator for the Dry Creek Rancheria Band of Pomo Indians who lost her membership amid a leadership dispute in 2009. ... The Affordable Care Act takes a narrow view of who is considered an American Indian and can avoid the tax penalty. It limits the definition to those who can document their membership in one of the approximately 560 tribes recognized by the U.S. Bureau of Indian Affairs (Burke, 5/13).

CNN Money: Who Will Pay More Under Obamacare? Young Men
The Obama administration says the Affordable Care Act will provide cheaper health insurance for millions of Americans. But some people, particularly young men who aren't insured through their employers, could see their premiums go up once coverage in the state-based insurance exchanges begins in January. Many groups have come out with reports forecasting what will happen to premiums, on average, next year. But just what folks will pay for insurance on the individual market depends on a variety of factors. They include the enrollee's income, age, gender, current coverage level and state of residence (Luhby, 5/14).

The Wall Street Journal: Doc-Owned Hospitals Prep To Fight
The Affordable Care Act aimed to end a boom in doctor-owned hospitals, a highly profitable niche known for its luxury facilities. Instead, many of the hospitals are wiggling around the federal health-care law's growth caps and even thriving. The law, passed in 2010, blocked building any new physician-owned hospitals and prevented existing ones from adding beds or operating rooms in order to qualify for Medicare payments. The drafters wanted to clamp down on a sector that some policy experts contend is prone to perform unnecessary procedures at high prices, driving up overall health spending (Mundy, 5/13).

In other news related to physicians -

Modern Healthcare: Doc Pay Reform Remains A 'Top Priority'
Physician advocates see signs of progress in the Senate Finance Committee's hearing Tuesday—the panel's first in six years on replacing Medicare's physician payment system. Sen. Max Baucus (D-Mont.) last convened a hearing to replace Medicare's sustainable growth-rate formula, which determines physician payments, on March 1, 2007. That hearing was followed by the contentious battle over the passage of the Patient Protection and Affordable Care Act, which was notably silent on Medicare's physician payment system (Daly, 5/13).

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Administration Issues Proposed Rule On Medicaid DSH Payment Reductions

These payments, known as disproportionate share hospital payments, go to hospitals that treat a high number of uninsured patients.

Politico: W.H. Plans To Delay Medicaid DSH Payment Cuts
The Obama administration has proposed delaying a potentially painful decision on whether to penalize states that refuse to expand Medicaid coverage for low-income populations under Obamacare. The national health care law calls for a gradual reduction in special federal payments — known as Disproportionate Share Hospital or DSH payments — to hospitals that take care of large numbers of uninsured patients. The idea of reducing the DSH payments, which totaled $11.3 billion in 2011, was tied to the fact that the health law's coverage expansion would reduce the burden on hospitals. If more people get covered, the hospitals should have to provide less uncompensated care (Millman, 5/14).

Kaiser Health News: Capsules: CMS Won't Penalize Hospitals In States Slow To Expand Medicaid
That sigh of relief you heard Monday was from hospital administrators in nearly two dozen states, including Florida and Texas. That's because the Obama administration announced that for the next two years, it doesn't plan to penalize states that have yet to expand Medicaid coverage under the federal health law by targeting them for reduced Medicaid funding, according to a proposed rule unveiled Monday. That money goes to hospitals that treat large numbers of poor people (Galewitz, 5/14).

The Wall Street Journal: Health Officials Detail Payment Cuts For Uninsured
The Obama administration on Monday published a plan for cuts in payments for hospitals that treat many uninsured patients and said states that decline to expand their Medicaid programs under the 2010 health law won't get preferential treatment. The federal government currently sends about $11 billion a year to states to help cover the costs of uncompensated care. The health law called for cuts in those payments, assuming that most Americans would have insurance coverage after the law took effect (Radnofsky, 5/13).

Reuters: U.S. Proposes Rule On Medicaid Payment Cuts For Hospitals
The U.S. government on Monday issued a proposed rule for cutting payments to hospitals that treat a disproportionate share of the poor, including a $500 million reduction in fiscal 2014, as part of President Barack Obama's healthcare reform law. The Patient Protection and Affordable Care Act mandates annual reductions in Medicaid payments to hospitals through fiscal 2020 in exchange for increased insurance coverage options that are expected to reduce levels of uncompensated care (5/13).

Miami Herald: Jackson And Other Hospitals May Face Cuts In Pay For Uninsured, Under Healthcare Reform
Florida hospitals that treat many uninsured patients will lose millions of dollars in funding meant to offset those costs, according to a proposal unveiled Monday by federal health officials who had anticipated that more Americans would have access to insurance under the Affordable Care Act, reducing the amount of uncompensated care delivered by hospitals. In announcing the proposed cuts, federal health officials said they would not give preferential treatment, at least at first, to states that declined to expand Medicaid, such as Florida (Chang, 5/13).

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'Navigators' To Play Pivotal Role Helping Consumers Sign Up For Health Insurance

Roll Call reports that many of the people who sign up for insurance through the exchange might face language barriers or may never have had coverage before. Also, CQ HealthBeat reports that Web-based insurance brokers want "a place at the table."

Roll Call: 'Navigators' Of State Health Insurance Exchanges Prepare To Help Applicants
When enrollment in the health care law’s new insurance exchanges opens in October, the prospects for success will turn on a crucial element: people who actually understand health insurance coverage and can explain it in plain language to consumers. Many Americans who will be signing up may never have had insurance in the past or aren’t fluent in English or might have trouble figuring out which plan will be best for their pocketbook and health condition (Norman, 5/13).

CQ HealthBeat: Web-Based Insurance Brokers Seek A Place At The Exchange Table
Web-based insurance agents and brokers are pushing hard to be part of health insurance exchanges, saying that their experience in selling to consumers online will boost outreach efforts by the Obama administration. How well they will succeed is not yet clear, and consumer advocates say it’s advisable for government officials to closely monitor any involvement of the Web-based insurers to be certain that they are not steering consumers to the companies’ preferred products (Norman, 5/13).

Meanwhile, news outlets report on exchange developments in D.C., Minnesota and Kansas.

The Washington Post: D.C. Nears Decision On Health Insurance Exchange
The D.C. Council could decide as soon as next week whether to require small-business owners to purchase their employee health insurance through a city-run exchange, highlighting a special implication of the federal health-care overhaul that has been strongly opposed by some business interests (DeBonis, 5/13).

MPR News: Small Business Wonder What Health Overhaul Has In Store For Them
Organizations representing small business have been among the sharpest critics of the federal health care overhaul. But the opposition is not universal. Some small business owners in Minnesota hope they'll find new health insurance options thanks to the law and MNSURE, the new state new online insurance marketplace it created (Stawicki, 5/13).

Kansas Health Institute: New Medicaid Enrollment System Remains On Track
The building of a new Kansas Medicaid eligibility and enrollment system intended to be interoperable with the new federal health insurance marketplace remains on budget, according to the state's project overseer. But the system's connection to the federal insurance exchange could miss the Oct. 1 timeline, if federal officials don't pick up the pace on their end (Shields, 5/13).

Also in the news -

The Associated Press/Washington Post: Faith Leaders To Gather For Summit To Learn About New Health Options
Maryland faith leaders will be gathering for a summit to learn more about new health insurance options under the federal health care overhaul. Maryland Department of Health and Mental Hygiene Secretary Joshua Sharfstein is scheduled to speak at Tuesday's event in Baltimore (5/13).

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Many Docs Reject Medicaid -- A Cause For Concern As The Expansion Approaches

McClatchy reports that projections highlight how the shortage of physicians in general as well as those who choose not to accept Medicaid patients could undermine the health law's intent. Also in the news, fits and starts surround this health law provision in Pennsylvania, Arizona, Texas, Louisiana, Ohio and Colorado.

McClatchy: Most Doctors Still Reject Medicaid As Program Expansion Nears
Because of the program's history of low payments, fewer than half of U.S. doctors and other health care professionals accept Medicaid patients, according to a recent study. For those that do, getting an appointment sometimes can take months because of the high demand, particularly among specialists. The problem is worse in rural areas such as Bonifay, in the Florida Panhandle. While 20 percent of Americans live in less-populated parts of the country, only 10 percent of U.S. doctors practice there. That's why 77 percent of the nation’s 2,000-plus rural counties are designated as health professional shortage areas, according to the National Conference of State Legislatures. Nationwide, the lack of doctors is a growing problem that will only worsen as some 27 million people get health coverage by 2016 as part of the Patient Protection and Affordable Care Act (Pugh, 5/15).

The Associated Press: Corbett Aide Doesn't Expect To See Pa. Medicaid Expansion In 2014
A top aide to Gov. Tom Corbett said expanding Medicaid eligibility in Pennsylvania under a sweeping federal health care law probably would not take effect before January 2015, even if the governor embraces the idea that would provide taxpayer-paid health care insurance to hundreds of thousands of residents. Beverly Mackereth, Corbett's Department of Public Welfare chief, told the Pittsburgh Post-Gazette on Friday that the administration would need until 2015 to negotiate with the federal government and create the program (5/13).

The Associated Press: Speaker Tobin Key To Medicaid Expansion Deal
Gov. Jan Brewer's proposal to expand the state's Medicaid program to 300,000 more poor Arizonans may pass or fail based on just one person in the Legislature: Republican House Speaker Andy Tobin. The trick for Brewer is figuring out just what Tobin wants in exchange for his support. And he's not making it easy (Christie, 5/14).

The Texas Tribune: Budget Rider Could Lay Out Terms For Medicaid Reform
The fate of Medicaid reform in Texas could rest solely on an up-or-down vote on the 2014-15 budget. State Rep. John Zerwas, R-Simonton, a member of the conference committee that is hashing out the differences between the House and Senate budget plans, said Monday he's relatively confident that a rider stipulating the Legislature's preferred Medicaid reform terms — like cost containment measures and private market reforms — for any deal with the federal government is "sticking" to the 2014-15 budget (Ramshaw and Aaronson, 5/13).

New Orleans Times Picayune: Federal Proposal For Cutting Safety-Net Money Supports Louisiana Decision To Decline Medicaid Expansion, State Says
A top Louisiana health agency official on Monday said a proposed federal rule cutting the money that funds the state's safety-net hospitals supports Gov. Bobby Jindal's decision to decline to expand the Medicaid program for the poor. The U.S. Department of Health and Human Services released a proposal for how the agency would cut "disproportionate share hospital" payments that finance hospital care for the uninsured. In Louisiana, this money is largely funneled to the LSU public hospitals that provide the bulk of the care for uninsured people. The Jindal administration and LSU are currently working on proposals to privatize operations of the public hospitals (Maggi, 5/13).

Cleveland Plain Dealer: Ohio Senate President Keith Faber Signals Hope For Medicaid 'Reform' But Not Kasich-Style Expansion
Ohio Senate President Keith Faber told a City Club of Cleveland crowd Monday that he expects state legislators to tackle Medicaid "reform" by the end of the year. But the Republican from Celina is not optimistic that a deal will reached before the June 30 deadline to pass the state's two-year budget. He also doubts the final product will resemble the Medicaid "expansion" Gov. John Kasich favors (Gomez, 5/13).

The Associated Press: Colorado Medicaid Expansion Signed Into Law
An expansion of Medicaid eligibility that's expected to add 160,000 adults to public health care assistance in Colorado was signed into law Monday. The expansion is part of the federal health care overhaul that 22 states and Washington, D.C., have accepted as of last week (Moreno, 5/13).

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Health Care Marketplace

Probe Of Medicare Advantage Leak Finds Wide Speculation On Deal

The Wall Street Journal: Health-Policy Move Widely Shared
More people than previously thought predicted a major change in U.S. health-care policy that led to a federal insider-trading probe, according to new documents assembled by congressional investigators. Justin Simon, a policy analyst with Height Securities, said in a previously unreported email that was reviewed by The Wall Street Journal that he heard about the policy change before it was made official from "like 30 people." Mr. Simon sent an alert to Wall Street traders just before markets closed April 1, sending health-insurance stocks on a tear. This and other emails indicate the extent to which Washington's insular world of health-care policy experts was buzzing about a possible deal that would result in the Centers for Medicare & Medicaid Services reversing course on previously announced Medicare funding cuts (Mullins and McGinty, 5/13).

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Subsidiary Of Indian Drug Firm Pleads Guilty, Agrees To $500 Million Penalty

The Associated Press/Washington Post: Subsidiary Of Indian Drug Maker Agrees To Pay Record $500 Million US Penalty For Impure Drugs
A subsidiary of India's largest pharmaceutical company has agreed to pay a record $500 million in fines and penalties for selling adulterated drugs and lying to federal regulators in a case that is part of an ongoing crackdown on the quality of generic drugs flowing into the U.S. Federal prosecutors say the guilty plea by Ranbaxy USA Inc. represents the largest financial penalty against a generic drug company for violations of the Federal Food, Drug and Cosmetic Act, which prohibits the sale of impure drugs (5/13).

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Women's Health

Obama Administration Asks Appeals Court To Delay Judge's Order On Emergency Contraceptive

Politico: DOJ Appeals For Stay Of Plan B One-Step Order
The federal government's legal fight over the availability of emergency contraception is heating up at the next level in the courts. The Department of Justice is seeking a delay in compliance with a district court order requiring the Food and Drug Administration to make emergency contraception available over the counter without age restrictions while it appeals that decision (Smith, 5/14).

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State Watch

Medicaid: Texas Providers Push For Higher Reimbursement; Ill. Nursing Home Supporters Call For Restoration Of Funds

Medicaid programs -- reimbursement for providers in Texas, proposed cuts in Illinois and application delays in Connecticut -- make news.

The Texas Tribune: Medicaid Providers Make A Last Push For Higher Rates
In the waning days of budget negotiations, medical providers are sounding their biennial battle cry to raise Medicaid reimbursement rates. Despite their refrain that increasing reimbursement rates could shore up the program's provider network, the rates probably won't budge much, as that is traditionally one of few variables that the Legislature relies on to contain Medicaid costs (Aaronson, 5/14).

Chicago Sun-Times: Nursing Home Supporters Call For State To Restore Medicaid Cuts
Hundreds of nursing home supporters who gathered at the Thompson Center on Monday called for the state to restore cuts in Medicaid funding and avert any new cuts for essential medical services for nursing home residents across Illinois (Thomas, 5/13).

CT Mirror: DSS Trial: Are Medicaid Application Delays Breaking The Law? 
Paul Shafer, a Trumbull resident, had a seizure disorder and no job when he applied for Medicaid in July 2011. The program would have paid for the $165-a-month anti-seizure medication Shafer relied on. By law, he should have heard back within 45 days. Instead, Shafer waited months without a decision on his application. He took half the prescribed dose of his medication to make it last longer. At one point he had a major seizure (Becker, 5/14).

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State Roundup: Ore. Health Co-Ops To Compete With Big Insurers

A selection of health policy stories from Oregon, Texas, Massachusetts, New York, Colorado and California.

Oregonian: Oregon's Upstart Health Co-Ops To Challenge Mainstream Insurers
Armed with hefty federal loans, two startup health insurers are jumping into a crowded and confusing Oregon market just as the biggest changes to U.S. health care in generations roll out this fall. Oregon's Health CO-OP and Health Republic aim to offer something different: a consumer-run experience. The two companies filed new policy details and proposed rates with the state, on oregonhealthrates.org. In October, they will go head-to-head with about a dozen established insurers to appeal to small businesses as well as more than 200,000 expected to buy their own insurance next year (Budnick, 5/13).  

Dallas Morning News: Texas Lawmakers Find Funds For Mental Health, Women’s Care In Budget Talks
Lawmakers dickering over a two-year state budget met late into the night Monday making decisions that affect millions of vulnerable Texans. While the Legislature has rebuffed President Barack Obama’s proposed addition of more than 1 million poor adults to the state's Medicaid rolls, House and Senate budget negotiators approved more money for mental health, protection of abused children and women’s health care (Garrett, 5/14).

Bradenton Herald: Florida Lawmakers Pay Peanuts For Health Insurance
Florida House Republicans last month loudly and proudly rejected billions of dollars in federal money that would have provided health insurance to 1 million poor Floridians. Quietly, they kept their own health insurance premiums staggeringly low. House members will pay just $8.34 a month for state-subsidized health care next year, or $30 a month to cover their entire family (Mitchell, 5/14).

Boston Globe: Citing Backlog, State Health Agency Pleads For Funds
The Massachusetts Department of Public Health, reeling from years of budget cuts, has fallen significantly behind in investigating consumer complaints about medical facilities and lacks sufficient staff to conduct safety inspections of every­thing from summer camps to food manufacturers to housing for migrant farm workers. There’s a wait of more than five months for investigating problems reported in Massachusetts hospitals, nursing homes, dialysis centers, and clinics. Meanwhile, medical and biological waste from roughly 600 biotechnology firms is not being routinely monitored to ensure proper disposal (Lazar, 5/14).

The Wall Street Journal: Autism Center Is Set To Target Need
Children and adults with autism will begin arriving this month at a new autism center tucked into a 214-acre mental-health campus in Westchester County, [New York], which promises to help provide an answer to the piecemeal care currently available to many. The center, run by NewYork-Presbyterian Hospital and the medical schools at Cornell and Columbia universities, attempts to address what experts say is a significant challenge: autism rates are rising around the country but access to treatment lags well behind (Kusisto, 5/13).

Lund Report: Repeal Of Insurers' Unlawful Trade Practices Act Exemption Moves Into Senate
The bill to repeal the insurance industry’s one-of-a-kind exception to Oregon's chief fraud law has moved to the Senate Consumer Protection Committee, where it faces a less certain outcome than in the House. Sen. Chip Shields, D-Portland, bolstered his case for removing insurers' exemption from the Unlawful Trade Practices Act at the Wednesday hearing, inviting an economic analyst from the Washington State Insurance Commissioner's Office to testify on the impact of a 2007 Washington law that enhanced the private right of action (Gray, 5/13).

The Denver Post: Facility Fees Inflate Hospital Prices For Common Services
The first time Jeff Shellan got a cardiac stress test for his troubled heart, the retail price was $2,166. His insurance company agreed to a discounted price of $885, of which Shellan paid $364.  When his doctor suggested a retest a year later, the charge was $8,078, the discounted rate was $3,755, and Shellan's share was $968. Same test. The only difference? Boulder Community Hospital bought the practice of Shellan's cardiologist and added a hefty "facility fee” (Booth, 5/14).

California Healthline: Health Information Sharing Deal Announced
The health information world in California is getting more connected. Many large and small HIE networks have signed an agreement to share information, state officials announced last week at the annual HIE Summit in Sacramento. … For instance, if a VA patient goes on vacation and has an accident and ends up in the emergency department out of the VA network, providers would be able to access critical health information to treat that patient properly (Gorn, 5/13).

California Healthline: $2-Per-Pack Tobacco Tax Clears First Of Legislative Hurdles
California lawmakers chose not to make smokers pay more for health insurance, but they may be more willing to make smokers pay more for cigarettes. A new bill proposing to raise the tax on tobacco by $2 per pack of cigarettes cleared its first two committee votes last week in predictably partisan votes. SB 768, by Sen. Kevin de León (D-Los Angeles), would raise the price of cigarettes to more than $8 a pack and generate about $1.4 billion a year. De León proposes the money be used to offset costs of medical care for tobacco-related diseases, anti-tobacco education and smoking-cessation programs (Lauer, 5/13).

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Editorials and Opinions

Viewpoints: Angelina Jolie On Her Decision To Have a Double Mastectomy; Justice Ginsburg's 'Blind Spot' On Abortion

The New York Times: My Medical Choice
My doctors estimated that I had an 87 percent risk of breast cancer and a 50 percent risk of ovarian cancer, although the risk is different in the case of each woman. Only a fraction of breast cancers result from an inherited gene mutation. Those with a defect in BRCA1 have a 65 percent risk of getting it, on average. Once I knew that this was my reality, I decided to be proactive and to minimize the risk as much I could. I made a decision to have a preventive double mastectomy. I started with the breasts, as my risk of breast cancer is higher than my risk of ovarian cancer, and the surgery is more complex (Angelina Jolie, 5/14).

Forbes: If You Want to Stop Hospital Harm, Don't Call a Capitalist
The Leapfrog Group has just released its latest report grading the safety of hundreds of individual hospitals, but the real news isn't the "incremental progress." It's how a group started by some of the most powerful corporations in America has quietly devolved into just one more organization hoping press releases produce change. Amid the current enthusiasm for "value-based purchasing" by employers and possible privatization of Medicare, it is worth examining why Leapfrog's initial notion that corporations would spearhead a crackdown on crummy care failed and what we can learn from that publicly unacknowledged failure (Michael Millenson, 5/12).

The New York Times' Taking Note: Ginsburg's Roe V. Wade Blind Spot
Instead, Justice Ginsburg contended, the court prevented the states from working out on their own how best to regulate abortion, short-circuiting the democratic process and provoking an angry "backlash" among conservatives and resistance to Roe that continues to this day. But as the Times editorial page summarized last month, "The real story, as explained by Linda Greenhouse, a former New York Times reporter who now teaches at Yale Law School, and Reva Siegel, a professor there, is that political conflict over abortion was escalating before the Roe decision, and that state progress on decriminalization had reached a standstill in the face of opposition from the Roman Catholic Church" (Lincoln Caplan, 5/13). 

National Review: The Medicaid Deniers
For years, progressives have claimed that they are the party of science. ... But there is at least one area of public policy where the Left has abandoned its rhetorical allegiance to science: health care. For years, studies have shown that patients on Medicaid — America’s government-run insurance program for the poor — do no better, and sometimes do worse, than those with no insurance at all (Avik Roy, 5/14).

Health Policy Solutions (a Colo. news service): New Evidence Against Colorado Medicaid Expansion
The problem is that the latest research suggests that much of the additional Medicaid spending will be wasted. Results from the Oregon Health Study Group … show that enrolling the able-bodied poor in Medicaid increases annual health spending by $1,172 per person per year without improving blood pressure, cholesterol levels or blood sugar levels. Rates of outpatient surgery, emergency department visits and hospital admissions are also unaffected. … While it is clear that Medicaid benefits the sick and helpless for whom it was originally designed, in the current environment there is little evidence of benefit from expanding Medicaid to cover able-bodied adults. In fact, the opposite may be true (Linda Gorman, 5/13).

Bloomberg/Businessweek: Want to Improve Health Care? Spend Less on It
It’s shocking that, in one of the richest countries in the world, millions are still denied access to health care—and especially preventative services—because they can't afford coverage. And the pain and disruption associated with paying medical bills is immense. The U.S.'s move toward universal health coverage is a step in the right direction. But the U.S. also needs to get more serious about keeping people out of doctors' offices and hospitals in the first place.  That's the most effective – and by far the cheapest — path to longer, healthier lives (Charles Kenny, 5/13).

JAMA: Patients' Responsibility To Participate In Decision Making And Research
It is time to reduce the artificial barriers between research on one side and patient care and practice on the other. The path to effective, sustainable patient-centered health care and decision making requires that patients let clinicians know their priorities, understand which strategies are most likely to achieve their priorities, and participate in the research that generates this evidence (Drs. Mary E. Tinetti and Ethan Basch, 5/13).

Boston Globe: Looking Past A Patient's Crimes A Difficult Challenge
It was the first day of a new rotation. I was getting to know my patients, trying to match faces and diagnoses with names on my list. A frail man with end-stage heart failure, Mr. T was too weak to walk and spent most of his time in a reclining chair. He had been in the hospital for weeks with pneumonia, kidney failure, and several other complications. I introduced myself and proceeded to examine him. … No one came to visit him. A few days into the rotation, I found myself reading through his medical record, trying to figure out what his life outside the hospital had been like, and whether there might be a friend or relative able to help care for him after discharge. I was not prepared for what I discovered (Kiran Gupta, 5/13).

WBUR: Cognoscenti: Mental Illness: The View From Within
Amid the search and subsequent capture of Boston Marathon bombing suspect Dzhokhar Tsarnaev, and in the weeks since, I was riddled with fear, dread, and curiosity. I think that range of emotions was fairly common. Perhaps slightly less common was the other emotion I felt: a vague sense of shame. As someone who struggles with mental illness, I was waiting for everyone to start speculating about depression, bipolar disorder or schizophrenia as a possible explanation (Susan Senator, 5/14).

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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.