Daily Health Policy Report

Thursday, May 2, 2013

Last updated: Thu, May 2

KHN Original Reporting & Guest Opinion

Health Reform

Women's Health

Capitol Hill Watch

Administration News

Health Care Marketplace

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

The Arkansas Medicaid Model: What You Need To Know About The 'Private Option'

Kaiser Health News staff writer Jay Hancock reports: "The Obama administration wanted Republican states to accept the health law's Medicaid expansion pretty much as is. Republicans wanted Medicaid money in no-strings block grants. Arkansas has broached what could be a deal-making compromise, giving Washington the increased coverage for the poor it wants and Republicans something that looks less like government and more like business" (Hancock, 5/1). Read the story.

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Capsules: Expanding Medicaid Didn't Lead To Big Health Gains In Oregon, Study Finds

Now on Kaiser Health News' blog, Alvin Tran reports: "Although expanding Medicaid coverage to some low-income Oregon residents substantially improved their mental health and reduced financial strains on them, it didn't significantly boost their physical health, according to a study published Wednesday in the New England Journal of Medicine" (Tran, 5/1). Check out what else is new on the blog.

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Political Cartoon: 'Paper Work?'

Kaiser Health News provides a fresh take on health policy developments with "Paper Work?" by Larry Wright.

Meanwhile, here is today's health policy haiku:


Cost of cancer drugs
leads to caution from experts:
This does patients harm.

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

Medicaid Expansion: Where Do States Stand?

Stateline reports that seven states could still go either way on pursuing this element of the health law. Kaiser Health News examines Arkansas' approach, viewed by many as a "deal-making compromise" for some states. Meanwhile, Florida lawmakers may be out of time to reach a deal, while some Nebraska lawmakers are attempting to break a logjam. In Ohio, the sparring continues.

Stateline: Finish Line Fast Approaching On Medicaid Expansion
Ever since the U.S. Supreme Court ruled last summer that expanding Medicaid to more low-income people was optional for the states, the focus has turned to what Republican governors and GOP-controlled legislatures would do. Would they forego tens of millions of dollars in federal aid that would extend health insurance to many more people and, proponents argue, provide a major boost to state economies? Or would these governors, many of whom vowed not to expand, stand their ground and insist the federal government will not be able to afford the expansion? As of May 1, 16 states plus the District of Columbia have approved the expansion or are headed in that direction, 27 have rejected it or about to and seven states could still go either way (Ollove, 5/2).

Kaiser Health News: The Arkansas Medicaid Model: What You Need To Know About The 'Private Option'
The Obama administration wanted Republican states to accept the health law's Medicaid expansion pretty much as is. Republicans wanted Medicaid money in no-strings block grants. Arkansas has broached what could be a deal-making compromise, giving Washington the increased coverage for the poor it wants and Republicans something that looks less like government and more like business (Hancock, 5/1).

The New York Times: Florida Runs Out of Time On Medicaid
Prospects for Medicaid expansion in Florida, which was embraced, improbably, by the state's Republican governor in February, are all but dead this year (Alvarez and Sexton, 5/1).

Miami Herald: Sides Entrenched, Health Care Deal Likely Dead
Lawmakers are likely to return home this week without an agreement on meaningful health care reform, despite the early endorsement of Gov. Rick Scott and the pleas of businesses and hospitals. With two days remaining in the legislative session, Republicans in the House are no closer to caving on accepting $51 billion in federal health insurance aid (Mitchell, 5/1).

The Associated Press: Neb. Lawmakers Return To Stalled Medicaid Debate
Lawmakers attempted to break an impasse Wednesday on a stalled Medicaid expansion bill, with an appeal to rural senators whose districts include small-town hospitals. Sen. Steve Lathrop of Omaha raised the issue as lawmakers debated an unrelated bill. He was followed by several others who have led the push to expand coverage as part of the federal health care law (Schulte, 5/1).

Omaha World News: Backer Of Medicaid Expansion Uses Uncommon Legislative Maneuver To Revisit Issue
Nebraska's rural hospitals could be forced to close down or cut services if the state does not expand Medicaid, an expansion proponent said Wednesday. State Sen. Steve Lathrop of Omaha took time during debate about another bill to warn about what could be at stake if the controversial expansion measure remains stalled. "There is a downside to not doing this," he said. "It will be significant for rural Nebraska" (Stoddard, 5/2).

Columbus Dispatch: State Senator, Others Push For Medicaid Expansion
Considering the burden of uninsured hospital visits, the promise of thousands of new jobs and the potential cost in penalties on employers, Medicaid expansion "should be a no-brainer," Ohio Senate Minority Leader Eric Kearney said. "Politics has gotten in the way of good policy," the Cincinnati Democrat said, joined by the Cincinnati chamber of commerce and others who would be affected by a proposed expansion to cover those making 138 percent of the federal poverty level. Gov. John Kasich proposed the expansion in his two-year budget, but House Republicans stripped it out, instead pledging to introduce an alternative option in the fall. Senate GOP leaders also closed off any chance of dealing with it in the budget, instead saying they will work on a separate Medicaid reform bill (Siegel, 5/2).

Cincinnati Enquirer: Democrats: We'll Push Kasich Medicaid Expansion
Senate Democrats have introduced a bill that could pave the way to extending Medicaid coverage to hundreds of thousands low-income and working poor Ohioans, if the plan can land bipartisan support. The move comes less than a week after Republicans stripped the plan from the state's two-year budget proposal, an action that echoed a rejection of Medicaid expansion early in April by the House Republicans (Bernard-Kuhn, 5/1).

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CMS Chief Expresses Optimism About Federal Exchange Enrollment

But other signs, such as the number of insurance carriers applying to sell policies in Illinois' health insurance marketplace, suggest cause for concern. Meanwhile, Modern Healthcare reports on the downside of the Obama administration's shorter application form for purchasing insurance through the exchanges.

CQ HealthBeat: CMS Chief Bullish On Exchange Enrollment
The head of the agency putting in place the health care law expressed confidence Wednesday that states with federal health insurance exchanges will have enough hands on deck to enroll millions of uninsured Americans. Marilyn Tavenner, acting administrator of the Centers for Medicare and Medicaid Services, also said that the feds' biggest publicity push for enrollment won’t be seen until late summer or early fall, closer to the Oct. 1 sign-up launch date (Norman, 5/1).

The Associated Press/Washington Post: Fewer Carriers Than Expected Apply For Illinois Health Marketplace; Raises National Concerns
Only six insurance carriers have told the state of Illinois they want to sell a combined 165 health policies on the state's online insurance marketplace under the nation's new health care law — numbers far lower than expected, raising concerns the trend will hold true across the country. Fewer health plans could mean less competition and possibly higher premium prices. Officials in President Barack Obama's home state had anticipated some 260 health plans would be offered by 16 different insurance carriers, based on a survey the Illinois Department of Insurance conducted last fall (5/1).

Modern Healthcare: Shorter Exchange Application Could Be A Headache For Some States
While consumers are likely to benefit from the CMS' announcement Tuesday that individuals applying for health coverage through exchanges would face a much shorter application form than the 21-page form initially proposed, the decision could be problematic for states that are already far along in developing their exchange IT system, according to the executive director of one state-run exchange. Kevin Counihan, CEO of the Connecticut Health Insurance Exchange, said the change to a shorter application comes after his exchange has already completed coding required for system integration based on the original, 21-page application, meaning that the exchange's IT system may not recognize data from the new form (Block, 5/1).

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Oregon Study Offers Insights Into Reach Of Health Law's Medicaid Expansion

The landmark study, which appears in The New England Journal of Medicine, analyzed data from the Oregon Health Study, which compared low-income people in that state who had access to Medicaid with a similar population that did not. The findings offer insights into how Medicaid coverage affects overall health and health costs.

The New York Times: Medicaid Access Increases Use of Care, Study Finds
Come January, millions of low-income adults will gain health insurance coverage through Medicaid in one of the farthest-reaching provisions of the Obama health care law. How will that change their finances, spending habits, use of available medical services and — most important — their health? New results from a landmark study, released on Wednesday in The New England Journal of Medicine, go a long way toward answering those questions. The study, called the Oregon Health Study, compares thousands of low-income people in Oregon who received access to Medicaid with an identical population that did not (Lowrey, 5/1).

NPR: Second Thoughts On Medicaid From Oregon's Unique Experiment
Two years ago, a landmark study found that having Medicaid health insurance makes a positive difference in people's lives....Now the researchers have dug a little deeper into their data, and the new results, published in the latest New England Journal of Medicine, are not quite as uniformly positive. "We don't see any improvements in this window in hypertension, high cholesterol or diabetes," said Katherine Baicker, a health economist (Rovner, 5/1).

Los Angeles Times: Medicaid Has Mixed Record On Improving Health For The Poor, Study Says 
As state leaders debate whether to expand their Medicaid programs next year under President Obama's healthcare law, new research suggests the government insurance plan for the poor has only a mixed record of improving health. Medicaid beneficiaries are less likely than the uninsured to have catastrophic medical expenses and significantly less likely to suffer from depression, researchers at the Harvard School of Public Health and the Massachusetts Institute of Technology found (Levey, 5/1).

The Associated Press/Washington Post: Study: Depression Rates For Uninsured Dropped With Medicaid Rates
If you're uninsured, getting on Medicaid clearly improves your mental health, but it doesn't seem to make much difference in physical conditions such as high blood pressure. The counterintuitive findings by researchers at Harvard and MIT, from an experiment involving low-income, able-bodied Oregonians, appear in Thursday's New England Journal of Medicine. The study offers a twist for states weighing a major Medicaid expansion under President Barack Obama's health care law, to serve a similar population of adults around the country (5/1).

The Washington Post's Wonk Blog: Study: Medicaid Reduces Financial Hardship, Doesn't Quickly Improve Physical Health
The research uses data from Oregon, where the state held a lottery among low-income adults in 2008 for a limited Medicaid expansion. Of the 90,000 people who applied, 10,000 ultimately gained coverage. The lottery gave researchers a unique opportunity to conduct the first randomized experiment on Medicaid coverage, by studying those who gained insurance through the lottery and comparing them against a similar group of adults who did not (Kliff, 5/1).

Kaiser Health News: Capsules: Expanding Medicaid Didn't Lead To Big Health Gains In Oregon, Study Finds
Although expanding Medicaid coverage to some low-income Oregon residents substantially improved their mental health and reduced financial strains on them, it didn't significantly boost their physical health, according to a study published Wednesday in the New England Journal of Medicine (Tran, 5/1).

Medpage Today: Study: Medicaid Expansion Won’t Help All Aspects Of Health
Among those accepted into the program, depression fell substantially compared with those still on the waitlist, a 9 percentage point difference in prevalence at 2 years (P=0.02), Katherine Baicker, PhD, of Harvard School of Public Health, and colleagues found. But there were no decreases in rate of uncontrolled blood pressure, glucose, or cholesterol in the newly-covered group, the researchers reported in the May 2 issue of the New England Journal of Medicine. Still, use of many preventive services improved and catastrophic out-of-pocket medical expenses were nearly eliminated with coverage (Phend, 5/1).

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Insurers' Rate Requests Provide Few Clues For Determining Costs

The Associated Press reports that, because many steps remain in the rate-setting process, the initial rates announced by insurers do not offer "clarity." In other health law news, HHS Secretary Kathleen Sebelius encouraged Latino business leaders to spread the word about the overhaul's coverage expansions, and Reuters reports on a proposed Internal Revenue Service rule about employer-sponsored health plans and wellness programs.

The Associated Press/Washington Post: Small Businesses May Get Sticker Shock, Little Clarity From 1st Health Insurance Rate Requests
Small businesses, especially those that are required, for the first time, to start providing coverage under the Affordable Care Act have been waiting for some clue about how much it will cost. Many are worried that paying for health care will hurt profits and have held back on hiring, spending or expanding. The information that's been released to date is providing some insight, but not enough for small businesses to be comfortable about making big financial moves (5/1).

CQ HealthBeat: Educating Latino Communities Could Be Make Or Break For The Health Overhaul
Health and Human Services Secretary Kathleen Sebelius tried to rally Latino business leaders Wednesday to spread the word about coverage available under the health care law, saying there is much ignorance about the overhaul and that its success is riding on educational efforts. Her remarks to a meeting sponsored by the Latino Coalition at the U.S. Chamber of Commerce came on the heels of growing concern about how effectively federal officials will be able to conduct outreach because of congressional opposition to providing more funding for implementing the law (Reichard, 5/1).

Reuters: IRS Deals Employers A Setback In Healthcare Rules: Lawyers
Employer-sponsored healthcare plans cannot include most "wellness programs" as part of minimum coverage requirements, dealing a setback to many businesses, according to new federal rules for U.S. President Barack Obama's healthcare overhaul starting next year. The Internal Revenue Service released on Tuesday proposed rules for Obama's 2010 Affordable Care Act that handed a victory to labor unions and consumer groups, tax lawyers said on Wednesday (5/1).

And from the Postal Service -

The Washington Post: Postal Temps To Gain Health Insurance Under ObamaCare
The Postal Service next year will offer healthcare coverage to its temporary employees to comply with the Affordable Care Act, also known as ObamaCare. The agency announced on Monday that it would pay United Healthcare an estimated $239 million annually to provide coverage for about 35,000 "non-career employees" (Hicks, 5/2).

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Women's Health

Obama Administration Plans Appeal Of 'Plan B' Ruling

The Obama administration signals that it will challenge a federal judge's order that would make an emergency contraception drug available over-the-counter to women of all ages. The move comes a day after the FDA said the contraception should be available in that way to anyone older than 15.

The Washington Post: Obama Administration Plans To Appeal Plan B Ruling 
The Justice Department filed notice late Wednesday that it will challenge a federal court decision requiring the government to make emergency contraceptives available over the counter to women of all ages. … In federal court documents, the Justice Department argued that [federal judge Edward] Korman overstepped his authority in ordering the FDA to make emergency contraceptives available to all women over the counter (Kliff, 5/1).

Politico: Plan B Appeal Angers White House Allies
President Barack Obama's administration on Wednesday angered allies in women's groups by appealing a judge's ruling that the morning-after pill must be available over the counter to girls of all ages. The administration has argued that the pill should not be readily available to young teens, so the appeal is consistent with that position (Smith, 5/1).

NPR: Obama Administration Appeals Judge's Order On Plan B
The Obama administration filed an appeal Wednesday of a U.S. district court ruling that ordered it to end all age restrictions on the Plan B emergency contraceptive pill. The move came a day after the Food and Drug Administration lowered the age for which the product can be purchased without a prescription from 17 to 15 (Rovner, 5/1).

Los Angeles Times: Government Will Appeal Plan B Emergency Birth Control Ruling
In Wednesday's court filing, government attorneys said the appeal was justified because it was up to the FDA, not the court, to determine how drugs were sold. "The public interest will not be served by reclassification of drugs as non-prescription by order of a court, without appropriate agency decision-making procedures being followed," wrote Loretta Lynch, U.S. attorney for the Eastern District of New York (Morin, 5/1).

The Hill: Justice Dept. To Appeal Plan B Court Ruling
The Center for Reproductive Rights, which filed the lawsuit challenging the FDA's age restrictions, slammed the appeal. "We are deeply disappointed that just days after President Obama proclaimed his commitment to women's reproductive rights, his administration has decided once again to deprive women of their right to obtain emergency contraception without unjustified and burdensome restrictions," the group said in a statement (Baker, 5/1).

CNN: Justice Department Appeals Morning-After Pill Ruling
The U.S. Justice Department filed a notice of appeal Wednesday over a federal judge's ruling that directed the Food and Drug Administration to make the morning-after birth control pill available to females of all ages without a prescription. The government also filed a motion for a temporary stay of the FDA's approval on Tuesday of the availability of the Plan B One-Step emergency contraception pill without a prescription for ages 15 and older (Brusk and Carter, 5/2)

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Capitol Hill Watch

GOP Lawmakers Offer Medicaid 'Per Capita Cap' Plan

The proposal was offered by Rep. Fred Upton, R-Mich., who chairs the Energy and Commerce Committee, and Sen. Orrin Hatch, R-Utah, the top Republican on the Finance Committee. In addition, Politico reports that advocates are lining up to attempt to convince Congress to find ways to fix the across-the-board cuts put in place by sequestration.

The Hill: Republicans Propose Medicaid Caps
Two prominent Republicans outlined a plan Wednesday to limit federal Medicaid spending and give states more control over the program. Rep. Fred Upton (R-Mich.), who chairs the Energy and Commerce Committee, and Sen. Orrin Hatch (R-Utah), the top Republican on the Finance Committee, proposed a "per capita cap" on Medicaid benefits (Baker, 5/1).

Politico: The Next Sequester Victors?
Congress and President Barack Obama spared the FAA from the full brunt of sequester, sending a clear message: We’re willing to cave. Now advocates for other agencies and programs are lining up by the newly opened door, looking for fixes to their own across-the-board budget cut woes (Samuelsohn and Nather, 5/1).

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Administration News

Subpoenas Issued Regarding Last Month's Leak Of Medicare Decision That Triggered Stock Market Surge

The Washington Post: SEC Subpoenas Firm, Individuals In A Case Of Leaked Information
The Securities and Exchange Commission has issued subpoenas to a firm and individuals in connection with the leak last month of a federal funding decision that appeared to cause a surge in stock trading of several major health companies. The move deepens the government's scrutiny of the growing "political intelligence" industry, which has been thriving on delivering valuable information from Washington to investors. … The latest case emerged April 1 when Height Securities, a Washington-based stock brokerage firm, alerted its clients that the government would soon make a decision favoring private health insurers who participate in a Medicare program (Hamburger and ElBoghdady, 5/1).

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Health Care Marketplace

Hospitals Warn Of Lost Jobs, Patient Services After Proposed Payment Changes

Changes in how hospitals are paid make news in Minnesota -- where the state's largest health plan will delay a new payment system -- and Maryland -- where hospitals say a cut in pay to them will mean fewer jobs and patient services.

MPR News: Blue Cross Blue Shield Delays Start Of Controversial Payment System
Minnesota's largest health plan will delay the start of controversial payment system for hospitals until Jan. 1. Blue Cross and Blue Shield of Minnesota were criticized last week by a Minnesota hospital trade group accusing the health plan of slashing payments to rural hospitals. Blue Cross now said it is adjusting the start date for the new payment system in response to "operational and financial planning challenges" of critical access hospitals, which are located in rural areas (Stawicki, 5/1).

Baltimore Sun: Md. Hospitals Say Rate Vote Means Job Cuts
Maryland hospitals said they will need to cut jobs and patient services after a state panel voted Wednesday to keep hospital rates flat, despite a 2 percent cut in Medicare payments required by federal sequestration. ... The 6-1 vote by the Health Services Cost Review Commission, which sets the state's hospital rates, effectively forces the hospitals to absorb the cut in Medicare reimbursement at a time when hospital margins are razor-thin. Hospital representatives who filled a hearing room to lobby for a rate increase criticized the decision, saying it will further hurt the already financially strapped industry (Walker, 5/1). 

In the meantime, health industry payments to doctors are further scrutinized in Massachusetts --

Boston Globe: 1 In 4 Mass. Physicians Received Industry Gift Or Payments
One in four physicians in Massachusetts received at least one gift or payment from pharmaceutical or medical device companies valued at $50 or more in the two and a half years after the state began tracking them. The most common gifts were food, while the most lucrative were payments for speaking engagements, consulting or other services, according to an analysis by a Harvard-led research group published online Wednesday by the New England Journal of Medicine. Between July 2009 and December 2011, industry paid for 14,251 physician meals worth $2.4 million, and made 8,432 payments to doctors for bona fide services totaling $67.3 million (Conaboy, 5/1). 

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High Costs Of Cancer Drugs May Harm Patients, Say Experts

Medscape: High Price Of Cancer Drugs Is Harming Patients
The extremely high prices of recent cancer drugs "may be causing harm to patients," a large group of international leukemia experts warns. In a forum article published online April 25 in Blood, the group of 120 experts from around the world discuss the high cost of leukemia drugs, but emphasize that their concerns extend to many other types of cancer drugs. The high price of drugs has resulted in nonadherence to treatment, they note. In the United States, about 10% of patients fail to take prescribed drugs, largely because of cost. "This is reducing their chances of survival," they point out (Chustecka, 5/1).

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Concerns Surround Medical Records Privacy Issues

The Wall Street Journal: Poor Prognosis For Privacy
The sharing of Americans' health information is set to explode in coming years, with millions of patients' medical records converted to electronic form and analyzed by health-care providers, insurers, regulators and researchers. That has prompted concerns over privacy—and now, new federal rules that aim to give patients more control over their information are posing technical and administrative problems for the doctors and hospitals that have to implement them. … The new rules are part of a revision of the 1996 Health Insurance Portability and Accountability Act, known as HIPAA. They went into effect in March, but providers have until Sept. 23 to comply. One key new provision requires doctors and hospitals not to disclose medical information to a patient's insurer if the patient requests it and pays for the services out-of-pocket (Beck, 5/1).

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State Watch

State Roundup: Calif. Regulator Says Insurer's Proposed Rate Hikes Are 'Unreasonable'

A selection of health policy stories from California, Iowa, Maryland, Georgia, Oregon and North Carolina.

Los Angeles Times: California Deems UnitedHealth Rate Hikes Unreasonable
California Insurance Commissioner Dave Jones said the nation's largest health insurer, UnitedHealth Group Inc., is imposing unreasonable rate hikes on about 5,000 small businesses. Jones said Wednesday that UnitedHealth couldn't justify the average annual increase of nearly 8 percent, which reflects both higher premiums and a reduction in benefits (Terhune, 5/1).

The Associated Press: House GOP Seeks To Bar Medicaid-Funded Abortions
Iowa's Medicaid program would no longer pay for any abortions under a massive budget bill for state health departments that the state House approved Wednesday. In a 52-46 vote, the House approved the roughly $1.7 billion state Health and Human Services budget, which includes funding for the Medicaid program. The plan approved by the Republican-controlled House offers less money for health programs than the version approved by the Democratic-majority Senate (Lucey, 5/1).

Los Angeles Times: Coalition Working On Ballot Measure To Limit Prescription Drug Abuse
Fearing lawmakers may fail to pass a package of medical reform bills, a coalition of consumer groups and trial lawyers is mounting a campaign to put before voters an even more ambitious slate of initiatives aimed at curbing prescription drug abuse and holding doctors more accountable for misconduct (Glover and Girion, 5/1).

The Associated Press/Washington Post: Fort Detrick Critics Hail Md. Law Requiring State Scrutiny Of Cancer Cluster Investigations
Critics of Fort Detrick in Frederick are hailing a bill requiring closer scrutiny of cancer cluster investigations. Gov. Martin O'Malley is set to sign the measure Thursday in Annapolis. It requires an appointed workgroup to examine the state's process for investigating suspected cancer clusters (5/2).

Georgia Health News: Phoebe Subpoenas Other Hospitals In FTC Fight
Hospital executives across Georgia have been receiving a surprise delivery in the past week: a subpoena requesting loads of financial information. The subpoenas were sent by attorneys representing Phoebe Putney Health System, which is locked in a long-running, contentious fight with the Federal Trade Commission over the 2011 Albany hospital merger. A spokesman for Phoebe Putney told GHN on Wednesday that every Georgia hospital has been sent the requests, and so have some facilities in neighboring states if they treat Georgia patients. There are two forms of requests (Miller, 5/1).

The Lund Report: Oregon Pioneered Home Care Workers, Who’ve Waited Six Years For Raise
Oregon has pioneered home care workers for the indigent elderly, helping them to live with greater dignity and freedom in their old age. Many of Oregon's 10,000 homecare workers are family members who often take on the full-time work of assisting elderly Medicaid clients with long-term care needs. Others are hired from a registry of homecare workers that’s managed by the Oregon Home Care Commission (Gray, 5/1).

North Carolina Health News: Sex-Selection Abortion Ban Heads To House Of Representatives
A new bill that seeks to restrict the practice of abortions based on the gender of the fetus. It could make doctors liable to being sued by a woman or her family members if they feel the physician should have realized that gender bias played a part in the decision to terminate the pregnancy (Hoban, 5/2).

California Healthline: Home Services Workers Balk At Regulation
The Assembly Committee on Human Services yesterday voted to approve a bill designed to register and regulate home health care workers. "An unknown number of independents operate without any oversight or regulation in California," said Gary Passmore, who sits on the board of directors at the California Congress of Seniors. "AB 1217 requires both the owners and aides of the organization to pass a background check and meet basic licensure standards. … And it requires all home care aides … to be certified." The bill also would publish the names of workers and their occupational data on a public website (Gorn, 5/1).

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Weekend Reading

Weekend Reading: Overweight Doctors; ADHD Diagnosis Wars

Every week reporter Ankita Rao selects interesting reading from around the Web.

The New York Times Magazine: Our Feel-Good War On Breast Cancer
Recently, a survey of three decades of screening published in November in The New England Journal of Medicine found that mammography's impact is decidedly mixed: it does reduce, by a small percentage, the number of women who are told they have late-stage cancer, but it is far more likely to result in overdiagnosis and unnecessary treatment, including surgery, weeks of radiation and potentially toxic drugs. And yet, mammography remains an unquestioned pillar of the pink-ribbon awareness movement. Just about everywhere I go — the supermarket, the dry cleaner, the gym, the gas pump, the movie theater, the airport, the florist, the bank, the mall — I see posters proclaiming that "early detection is the best protection" and "mammograms save lives." But how many lives, exactly, are being "saved," under what circumstances and at what cost? Raising the public profile of breast cancer, a disease once spoken of only in whispers, was at one time critically important, as was emphasizing the benefits of screening. But there are unintended consequences to ever-greater "awareness" — and they, too, affect women's health (Peggy Orenstein, 4/25).

Mother Jones: MAP: Which States Have Cut Treatment For The Mentally Ill The Most
Between 2009 and 2012, states cut a total of $4.35 billion in public mental-health spending from their budgets. According to a report by the National Alliance on Mental Illness, significant cuts to general fund appropriations for state mental health agencies have translated into a severe shortage of services, including housing, community-based treatment and access to psychiatric medications. "Increasingly, emergency rooms, homeless shelters and jails are struggling with the effects of people falling through the cracks," the report says, "due to lack of needed mental health services and supports" (Deanna Pan, 4/29).

Scientific American/Salon: Is ADHD Actually Undertreated?
A German children's book from 1845 by Heinrich Hoffman featured "Fidgety Philip," a boy who was so restless he would writhe and tilt wildly in his chair at the dinner table. Once, using the tablecloth as an anchor, he dragged all the dishes onto the floor. Yet it was not until 1902 that a British pediatrician, George Frederic Still, described what we now recognize as attention-deficit hyperactivity disorder (ADHD). ... Despite this lengthy history, the diagnosis and treatment of ADHD in today's children could hardly be more controversial. ... Yet although data point to at least some overdiagnosis, at least in boys, the extent of this problem is unclear. In fact, the evidence, with notable exceptions, appears to be stronger for the undertreatment than overtreatment of ADHD (Scott Lilienfield and Hal Arkowitz, 5/1).

The New York Times: When The Doctor Is Overweight
Dr. George Fielding, a pioneer of weight loss surgery in Australia, remembers how patients treated him in the late 1990s, when his weight reached 330 pounds on his six-foot frame. He would meet new patients, dressed in Armani suits and feeling on top of the world, and then be abruptly upended. ... Despite being an internationally recognized expert on lap band and gastric bypass surgeries, Dr. Fielding knew that his appearance was dissuading some patients from using his services. ... So Dr. Fielding wasn't at all surprised by the results of a recent study in the International Journal of Obesity showing that patients secretly — or not so secretly — look with disdain on doctors who are overweight or obese (Jan Hoffman, 5/1).

The Atlantic: The Decline Of Emergency Care
Last Monday, two bombs built to take lives exploded in a city that's built to save them. Five Boston hospitals are Level I trauma centers. Three specialize in pediatrics. Each one is ready to treat all aspects of injury. At all times, they have the full roster of emergency services available: the entire spectrum of surgical specialists; respiratory therapists; laboratory services; nurses; and radiologists. They can land helicopters. They can treat burns. And they're ready to support patients through rehabilitation. If you're severely hurt, this is where you want to be. The CDC has found that trauma centers reduce the risk of death by 25 percent. ... But across the country, more and more trauma centers and emergency departments are closing. And they're closing in communities that need them the most (Jason Silverstein, 4/26).

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Editorials and Opinions

Viewpoints: S.C. House Race Spotlights Dems' Discomfort With Health Law; Cannon, Cohn Offer Constrasting Views Of Medicaid Study

The Wall Street Journal: Democrats Dissing ObamaCare
The media tittering over Mrs. Colbert Busch's decision to publicly slap the former Republican governor over his extramarital affair obscured the more notable political comment of the night. That moment came when Mrs. Colbert Busch slammed her own party's health-care law: "Obamacare is extremely problematic, it is expensive, it is a $500 billion [higher] cost than we originally anticipated, it's cutting into Medicare benefits and it's having companies lay off their employees because they are worried about the cost of it. That is extremely problematic, it needs an enormous fix." South Carolina's first district is a conservative place—it voted overwhelmingly for Mitt Romney in last year's election—so Mrs. Colbert Busch has every political reason to distance herself from her party and its health law. Yet she becomes one of the first Democrats to attempt to win an election on the back of criticism of her president's signature achievement (Kimberley A. Strassel, 5/1). 

New England Journal of Medicine: Protecting Finances And Improving Access To Care With Medicaid    
On the eve of a substantial expansion in health insurance coverage through the implementation of the Affordable Care Act (ACA), there is still much to learn about the effects of health insurance — particularly about the effects of Medicaid coverage. ... We hope and expect that virtually all states will expand Medicaid coverage in short order. ... However, although a delay in expansion is clearly bad news for low-income people, the good news for health service researchers is that variation in the timing of the Medicaid expansion will provide an opportunity to more fully assess the effects of insurance expansion on health (Richard Kronick and Dr. Andrew B. Bindman, 5/2).

Real Clear Politics: Oregon Study Throws a Stop Sign in Front of ObamaCare's Medicaid Expansion
Today, the nation's top health economists released a study that throws a huge "STOP" sign in front of ObamaCare's Medicaid expansion. ... Consistent with lackluster results from the first year, the OHIE's second-year results found no evidence that Medicaid improves the physical health of enrollees. There were some modest improvements in depression and financial strain–but it is likely those gains could be achieved at a much lower cost than through an extremely expensive program like Medicaid (Michael Cannon, 5/2).

The New Republic: The New Study That Republicans Who Reject Medicaid Must Read
By now, you're probably familiar with the controversy over the Medicaid expansion. ... But Republicans and their allies frequently make another argument—that the program doesn’t do much good. Some go farther, and argue that people on Medicaid actually end up worse off than people with no insurance at all. That's where the new study comes in. Opponents of the expansion think the results back up their arguments. ... I think they are reading very selectively. The evidence does call into question one important claim liberals have made about Medicaid—and liberals who make that claim need to start qualifying it. But the study validates two other arugments that defenders of Medicaid make. Both of these arguments are equally important (Jonathan Cohn, 5/2).

Des Moines Register: Branstad Plan Still Pales Next To Medicaid
The Senate knows expanding Medicaid makes sense. It is a time-tested program with low administrative costs and an existing infrastructure. ... The governor was alone in his opposition to expansion until House Republicans fell in line. Now they are supporting his alternative, which will insure fewer Iowans, leave millions of dollars of federal Medicaid aid on the table and cost Iowa taxpayers $156 million — including money siphoned away from the property taxes in all 99 counties. Numerous questions remain about where an Iowan could go for health care under the Healthy Iowa Plan (5/2).

The Fiscal Times: Unravel Obamacare And You Get A Train Wreck
As 2014 draws ever closer, and the true scale of the problems of ObamaCare become apparent, expect more Democratic incumbents to commiserate with their constituents about the "extremely problematic" "train wreck" they imposed on them.  They had better not expect the voters to let them off the hook, however, no matter how many times Obama tells them they have nothing to worry about (Edward Morrissey, 5/2).

Politico: President Obama's New Budget Drops Key Reform
There is a lot not to like in the new budget recently released by President Barack Obama. The nearly $1 trillion in higher taxes would only serve to impede economic growth, and the failure to reform entitlement programs leaves them on the path to insolvency. Those are all bad, no doubt, but what was also quite unfortunate was the removal of a laudable reform that had been included in the White House’s preceding two budgets that was perhaps the only provision in any of Obama’s budgets that conservatives in Congress should welcome with open arms. The reform we are referring to is the adjustment in Federal Medical Assistance Percentages, the formula which determines the rates at which the federal government provides Medicaid funds to the states (Grover G. Norquist and Patrick Gleason, 5/2).

The New York Times: Exorbitant Prices For Leukemia Drugs
In a commentary published online by Blood, the journal of the American Society of Hematology, the experts questioned the morality of charging "astronomical" prices that may deprive some needy patients of access to drugs and could undermine the financial sustainability of the American health care system (5/1).

JAMA: The Clash Between Industry And Civil Society Over Generic Drugs
On April 1, India's Supreme Court ruled against drug company Novartis regarding its claim for a patent on the lucrative and widely used cancer drug imatinib (marketed by Novartis as Gleevec in the United States and as Glivec elsewhere). To many, this high-profile 7-year legal battle, Novartis v Union of India, epitomized a vexed relationship between health advocates and the pharmaceutical industry (Lawrence Gostin, 5/1).

Bloomberg: Smile, Doctor, You're On Candid Camera!
Doctors could use video cameras to record all their procedures. As Martin Makary, a surgeon at the Johns Hopkins School of Medicine and Bloomberg School of Public Health, recently argued in the Journal of the American Medical Association, this would improve doctors' performance and enable them to be fully transparent with patients about their work. Unfortunately, there is a legal barrier to filming medicine. Simply put, videos would provide a whole new level of evidence in malpractice lawsuits, and a rich hunting ground for trial lawyers on the lookout for big game. The health-care law could have removed this barrier by including provisions to reform medical-malpractice laws. That omission has been a missed opportunity (Ford Vox, 5/1).

New England Journal of Medicine: Discrimination at the Doctor's Office
Recent years have seen some highly publicized examples of doctors who reject patients not because of time constraints or limited expertise but on far more questionable grounds, including the patient's sexual orientation, parents' unwillingness to vaccinate (in surveys, as many as 30% of pediatricians say they have asked families to leave their practice for this reason), and most recently, the patient's weight. ... patients are likely to be discriminated against not because of their impairment (if any), which would be irrelevant at the doctor's office, but simply because of their appearance or physical characteristics ... although we should condemn all types of invidious discrimination against patients, we should be particularly vigilant against the sort of subtle discrimination that can fly under the radar (Holly Fernandez Lynch, 5/2).

New England Journal of Medicine: Distributions Of Industry Payments To Massachusetts Physicians
The federal Physician Payment Sunshine Act will soon require manufacturers to report most payments to physicians and teaching hospitals on a national level. ... Descriptors for the type of relationship will be included as well, although the ones currently used in Massachusetts are of limited value, since the dominant category of "compensation for bona fide services" encompasses legitimate scientific as well as more controversial marketing relationships. ... the transparency offered by state or federal disclosure databases could be used in the future to explore relationships between financial interactions and health care outcomes or costs. (Dr. Aaron S. Kesselheim, Christopher T. Robertson, Kent Siri, Puneet Batra and Jessica M. Franklin, 5/2).

NPR's Double Take 'Toons: Obamacare Stop Or Start?
Even as more parts of the Affordable Care Act are implemented, 42 percent of Americans are unaware that the law is still in effect, according to a recent Kaiser Family Foundation poll. Eric Allie predicts they're in for a nasty surprise, while Nick Anderson thinks the law's opponents are fighting a losing battle.

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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.