Daily Health Policy Report

Wednesday, May 22, 2013

Last updated: Wed, May 22

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Health Information Technology

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Capsules: Survey: Even In Southern States, Medicaid Expansion Is Popular; Accuracy of Blood Glucose Meters Draws Scrutiny

Now on Kaiser Health News' blog, Karl Eisenhower reports on a poll of public opinion in southern states and the health law: "Alabama, Georgia, Louisiana, Mississippi and South Carolina have a lot in common: The summers are hot and the political climates are conservative. These are states where Mitt Romney handily beat Barack Obama in the 2012 presidential election, so it's not surprising to learn that the president's signature health law is unpopular there. But despite the law's unpopularity, its expansion of Medicaid is supported by almost two-thirds of adults in these states, according to a survey by the Joint Center for Political and Economic Studies, a left-leaning think tank" (Eisenhower, 5/21).

Also on Capsules, Phil Galewitz reports on the accuracy of blood glucose meters: "Blood glucose meters, which millions of diabetics rely upon to regulate their blood sugar, have become less costly and easier and less painful to use. But they haven't become more accurate, a top Food and Drug Administration official said Tuesday at a meeting of researchers analyzing studies that show wide variation in the performance of the machines used to measure blood glucose levels" (Galewitz, 5/21). Check out what else is on the blog.

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Political Cartoon: 'Set Paperwork To Stun?'

Kaiser Health News provides a fresh take on health policy developments with "Set Paperwork To Stun?" by David Fitzsimmons.

Meanwhile, here is today's health policy haiku:

FIGHTING WORDS?

White House press guy says
"Sebelius shakedown" is
good old malarkey.
-Anonymous

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 Popular In Southern States, Despite Govs' Opposition

A poll by the Joint Center for Political and Economic Studies found popular support for this and other health law provisions in five southern states despite the conservative political climate. Meanwhile, expansion supporters are strategizing about their next moves in states where they have not been successful.

Stateline: Despite Governors' Opposition, Strong Southern Support For Medicaid Expansion
The Republican governors and legislatures in Alabama, Georgia, Mississippi, Louisiana and South Carolina have rejected the Medicaid expansion, which would extend health care coverage to more low-income people. But a poll conducted in March and April by the Joint Center for Political and Economic Studies found that 62 percent of the people in those states support the expansion, one of the key instruments in the Obama administration’s strategy to reduce the number of uninsured Americans (Ollove, 5/21).

Kaiser Health News: Survey: Even In Southern States, Medicaid Expansion Is Popular
Alabama, Georgia, Louisiana, Mississippi and South Carolina have a lot in common: The summers are hot and the political climates are conservative. These are states where Mitt Romney handily beat Barack Obama in the 2012 presidential election, so it's not surprising to learn that the president's signature health law is unpopular there. But despite the law's unpopularity, its expansion of Medicaid is supported by almost two-thirds of adults in these states, according to a survey by the Joint Center for Political and Economic Studies, a left-leaning think tank (Eisenhower, 5/21).

Georgia Health News: Medicaid Expansion Popular In South, Polls Shows
The political leadership in the five Deep South states is solidly against Medicaid expansion, and has been so for months. Republican governors in Georgia, South Carolina, Alabama, Mississippi and Louisiana, along with their GOP-controlled legislatures, have bucked proposals to open their states’ Medicaid programs to hundreds of thousands of uninsured people, as outlined under the 2010 Affordable Care Act. But a newly released survey of adults in those five Southern states shows a different sentiment among the public. Across the region, 62.3 percent of respondents view Medicaid expansion favorably, including 61 percent in Georgia, according to the survey results released Tuesday (Miller, 5/21).

Modern Healthcare: Proponents Of Medicaid Expansion Weigh Next Moves
As many state legislative sessions have finished or are nearing completion, advocates of expanding Medicaid eligibility are looking at their next steps. Expansion of Medicaid eligibility as called for by the 2010 healthcare overhaul will not happen in 19 states, and seven more states are leaning against expanding, according to the latest estimates by Avalere Health. But the failure of the expansion to pass in many recently or nearly concluded state legislative sessions is unlikely to spell the end for those measures (Daly, 5/21).

News outlets also offer updates on the latest developments in Virginia, Texas, Arizona and Florida -

The Associated Press/Washington Post: Major Savings Reform Va. Demanded To Expand Medicaid Gets Approval From Federal Officials
Federal officials approved a four-year Virginia cost-saving experiment intended to simplify and consolidate health care coverage for about 78,000 Virginians who are eligible for both Medicaid and Medicare, a major change Gov. Bob McDonnell set as a condition for expanding Medicaid (5/21).

CQ HealthBeat: Virginia Dually Eligible Demonstration Approved By Federal Officials
Virginia on Tuesday became the sixth state approved to participate in a national three-year demonstration to better coordinate care for people eligible for Medicare and Medicaid. The Centers for Medicare and Medicaid Services announced that about 78,600 Medicare-Medicaid beneficiaries in five regions of Virginia will be enrolled in managed-care plans when the demonstration begins in 2014 (Adams, 5/22).

Richmond Times-Dispatch: Va. OK’d For Dual Medicaid Pilot Project
Virginia has received federal permission to take the first and biggest step toward overhauling its Medicaid program, potentially setting the stage for expansion of coverage to hundreds of thousands of Virginians under the Affordable Care Act. More than 78,000 Virginians, including more than 24,000 in the Richmond region, will be able to use one ID card for Medicaid and Medicare services under an agreement reached between the state and federal government on Tuesday (Martz, 5/22).

The New York Times/Reuters: Texas: House Votes to Ban Medicaid Expansion
The Texas House passed a measure on Tuesday that would prevent the state from expanding its Medicaid program as outlined by President Obama's health care law (5/21).

Arizona Republic: House Turns To Medicaid Proposal
House Republicans on Tuesday began scrutinizing a Senate spending plan that includes Gov. Jan Brewer’s proposal to expand Medicaid, while their leader sought to build support for his plan to send the Medicaid question to voters. House Speaker Andy Tobin, R-Paulden, was still smarting over Senate President Andy Biggs’ decision last week to jump-start stalled Medicaid negotiations and push his budget through the upper chamber. Six Republicans joined Democrats to amend the package with the governor’s Medicaid-expansion plan and about $35 million in additional spending (Reinhart, 5/21).

Tampa Bay Times: Tampa Chamber: Businesses Concerned By Legislature's Inaction On Medicaid Expansion
For Tallahassee, refusing additional federal funds to expand Medicaid may turn out to have been the easy part. It will take longer, a half-dozen Hillsborough legislators acknowledged Tuesday, to come up with an alternative to provide health care coverage to an estimated 1 million uninsured Floridians. ... Some Tampa businesses, (Greater Tampa Chamber of Commerce Chairman Gregory Celestan told local legislators), are "very concerned about significant additional health insurance costs" because of the Legislature's "refusal to expand Medicaid." "We will be at a competitive disadvantage when recruiting new businesses or adding jobs," Celestan added. "How would you respond?" (Danielson, 5/21).

New Orleans Times-Picayune: Medicaid Expansion, Obamacare Rejection Bills Fail In Louisiana House
Two completely different bills dealing with the federal health care overhaul, one using federal funding to provide insurance to the working poor and the other trying to nullify parts of the Affordable Care Act, died on the House floor Tuesday (Kumar, 5/21).

Louisville Courier Journal: Doctor Shortages May Undercut Kentucky Medicaid Expansion
Dr. Ron Waldridge II sees up to 24 patients a day at a busy family practice in Shelbyville, and says he can’t take on any new ones unless they are family members of people he already treats. So he wonders how he and other Kentucky doctors will be able to handle the tens of thousands of Kentuckians expected to get Medicaid coverage through health reform (Ungar, 5/21).

And, on the topic of health exchanges -

The Associated Press: NM Changing Its Plans For Health Exchange
New Mexico is switching gears on its plan for a health insurance exchange and initially will partner with the federal government for computer services needed for an online insurance marketplace. The state intends to have a New Mexico-run insurance exchange ready for small businesses to shop for coverage for their employees this fall and will use a federally operated exchange to offer medical insurance plans to individuals for the next year, Dr. J.R. Damron, chairman of the exchange's governing board, said Monday (Massey, 5/20).

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Market Pressures May Keep Premiums Low As Health Law Kicks In

USA Today reports this optimisitic view is offered by some industry analysts and health insurance officials. Meanwhile, Politico does a status check on the legal challenges to the health law's birth control mandate. News reports also track the latest regarding the Internal Revenue Service controversy and the overhaul.

USA Today: Market, Insurers Will Keep Premiums Low, Analysts Say
Market forces and an impetus to attract younger, healthier people into the insurance market will help keep health insurance premiums lower as the 2010 health care law takes effect on Jan. 1, industry analysts and insurance officials say. "If they price too high, young people won't buy insurance, and that's going to hurt the companies," said Jay Angoff, who led initial implementation of the law for HHS. "They need these people to come in. It's an industry problem" (Kennedy, 5/21).

Here's an on-the-ground look at premium filings --

Oregonian: Oregon's 2014 Health Premium Filings Spark Relief, Questions
Massive health insurance premium hikes predicted as the inevitable result of federal reforms haven't materialized in Oregon. The lower-than-expected preliminary rates come as much-needed good news for the Affordable Care Act. The law, passed in 2010, has been plagued by resistance in Congress and complaints of snafus as the Jan. 1 startup for expanded coverage draws closer (Budnick, 5/21).

Also, the latest on the birth control mandate --  

Politico: Courts To Hear Birth Control Mandate Lawsuits
Obamacare’s birth control mandate will go before four different appeals courts over the next three weeks as private businesses that object to the policy on religious liberty grounds bring a barrage of lawsuits that opponents hope to get before the U.S. Supreme Court as soon as this fall. On Wednesday, two for-profit companies will ask the 7th Circuit Court of Appeals to strike the requirement that they provide employees with insurance coverage that includes birth control and other drugs that they say can cause abortion. Three other companies will present oral arguments in different appeals courts by early June (Smith and Haberkorn, 5/22).

Bloomberg: Contraception Mandate Challenge Faces Appeal Court Judges
The U.S. law requiring employers to provide health insurance coverage for birth control is set to come before an appeals court in cases brought by two businesses whose owners say they operate according to Catholic doctrine. The businesses, a construction firm from southwestern Illinois and an auto-parts maker in southeastern Indiana, are scheduled today to ask the U.S. Court of Appeals in Chicago for an order barring enforcement of the measure while they challenge its constitutionality in lawsuits (Harris, 5/22).

In addition, tea party groups see the Internal Revenue Service scandal as a potential means to gin up health law opposition -

The New York Times: For Tea Party Groups, Shades Of 2010
Leaders of the Tea Party movement hope outrage over the I.R.S. inquiry will rekindle grass-roots activism that in many places went dormant after big Republican electoral defeats of November 2012. They aim to link the current scandal to other government programs they consider overweening -- principally the rollout of the health care overhaul law -- and generate a Republican wave in the 2014 midterm elections reminiscent of 2010's (Gabriel, 5/21).

In other related news --

The Hill: GOP Sen. Thune Urges IRS To Stop ObamaCare Work
Republican Sen. John Thune (S.D.) is demanding that the Internal Revenue Service (IRS) refrain from implementing ObamaCare while investigators probe the agency's targeting of conservative groups.
Thune, who leads the Senate Republican Conference, wrote to the Obama administration Tuesday connecting the scandal to Sarah Hall Ingram, an IRS official who once had oversight of tax-exempt groups (Viebeck, 5/21).

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Outreach Effort Moves Forward Despite Sebelius Controversy

Families USA Executive Director Ron Pollack tells CQ Healthbeat that the flap won't prevent a robust effort by the nonprofit group, Enroll America, to sign up the uninsured. Meanwhile, White House Press Secretary Jay Carney draws parallels to earlier allegations about President Barack Obama's birth certificate.

CQ HealthBeat: Enroll America 'Alive And Growing' Despite Sebelius Controversy, Pollack Says
The controversy over donations to Enroll America Health that Human Services Secretary Kathleen Sebelius solicited won’t prevent the nonprofit group from waging a vigorous campaign to sign up the uninsured, its founder said in an interview Tuesday. There is no question that fundraising will be "at least significantly into eight figures; it already is," said Families USA Executive Director Ron Pollack (Reichard, 5/22).

The Hill: Carney: Questions About Sebelius Fundraising Similar To Certificate Concerns
White House press secretary Jay Carney on Tuesday unfavorably compared questions about donations solicited by Health and Human Services Secretary Kathleen Sebelius to Republicans questioning the president's birth certificate. At a tense briefing where Carney took tough questions on a series of issues that could damage the White House politically, the press secretary aligned himself with White House Communications Director Dan Pfeiffer, who over the weekend accused Republicans of engaging in "partisan fishing expeditions" (Sink, 5/21).

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Capitol Hill Watch

Health Issues Play A Part In House Immigration Talks, Budget Cuts

Politico reports that issues related to the health benefits made available to undocumented immigrants as they seek citizenship could muddy House negotiations. In addition, House Republicans have pressed forward with budget cuts that would impact Indian health care and a number of other domestic programs.

Politico: House Immigration Talks Hang On Health Care
House immigration negotiators have given themselves until the end of the week to hash out language on what kind of health benefits should be available to undocumented immigrants seeking U.S. citizenship, a crucial issue for the talks. If they can’t resolve this issue, the four-year immigration negotiations could come to a crashing halt (Sherman and Bresnahan, 5/21).

The Associated Press/Washington Post: House GOP Panel Approves Agency Budget Cuts Far Deeper Than Those Approved In March
Republicans controlling the House pressed ahead Tuesday with slashing cuts to domestic programs far deeper than the cuts departments like Education, Interior and State are facing under an already painful round of automatic austerity. Veterans Affairs, Homeland Security and the Pentagon would be spared under the plan approved by the House Appropriations Committee on a party-line vote, but legislation responsible for federal firefighting efforts and Indian health care would absorb a cut of 18 percent below legislation adopted in March (5/21).

In addition -

Modern Healthcare: Bill Takes Aim At Reform Law's Rural-Floor Provision
New legislation from Rep. Kevin Brady (R-Texas) is welcome news to 20 state hospital associations working to eliminate a contentious hospital wage-index provision in the Patient Protection and Affordable Care Act. Brady's bill—the Medicare Hospital Wage Index Equity Act of 2013—relates to the rural floor component of Medicare's hospital wage index, which guarantees the wage index for rural hospitals is not more than the index for urban hospitals. Before the 2010 healthcare overhaul, federal law required that payments for hospital wage-index adjustments be budget-neutral within a state so that only hospitals in that state would be affected by the changes (Zigmond, 5/21).

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As Hill Panels Focus On Medicare, Marketplace Examines How Part D Changed The Pharmaceutical Industry

Medicare is a topic of conversation on Capitol Hill as a Senate committee holds a hearing on the Medicare Part D drug program. Meanwhile, on the House side, members of the Ways and Means Health Subcommittee heard testimony on patient cost-sharing that triggered a broad discussion of health care incentives within the program. 

Marketplace: How Medicare Part D Changed The Drug Industry
Later today, a U.S. Senate committee is scheduled to hold a hearing on the prescription drug benefit program for seniors known as Medicare Part D. The program has been around now for 10 years. And it has meant tens of millions of new customers for pharmaceutical companies says Mark Duggan, an economist at the University of Pennsylvania. … Yale economist Fiona Scott Morton says the emphasis on cheaper drugs has pushed companies to be more innovative if they want a big payday (Gorenstein, 5/22).

MedPage Today: Focus On Medicare Cost Drivers, Congress Told
A congressional hearing on increasing patient cost sharing as a mechanism for Medicare reform turned into a call for broad changes to provider incentives in the program. Health policy experts told lawmakers Tuesday that payments need to move away from a volume-based fee-for-service if policymakers want to generate savings in Medicare. The House Ways and Means Health Subcommittee called the hearing to examine bipartisan proposals for Medicare reform. Specifically, they wanted to discuss increasing the Part B deductible, increasing Part B and D premiums for wealthier seniors, and establishing a copay for home health services, subcommittee chair Kevin Brady (R-Texas) said. But experts called before the subcommittee called the proposals short-sighted and said they wouldn't do much other than cause beneficiaries to pay more (Pittman, 5/21).

Also in the news, the Medicare NewsGroup takes a look at how slowing health care costs impact Medicare -

The Medicare NewsGroup: Does Slow Health Care Cost Growth Matter For Medicare?
Medicare spending has generally increased at a rate faster than growth in the economy and national health expenditures, and it is expected to continue to do so according to the Medicare Board of Trustees 2012 report. From 2007 to 2011, a timespan that includes the U.S economic recession, the GDP grew at an average of 1.8 percent, national health expenditures grew at an average of 4.1 percent and aggregate Medicare spending grew at an average rate of more than 6 percent (Vahlkamp, 5/21).

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Health Information Technology

More Than Half Of U.S. Docs Now Using EHRs

The Wall Street Journal: Electronic Health Data Gaining Favor
More than half of U.S. doctors have switched to electronic health records and are using them to manage patients' basic medical information and prescriptions, according to federal data set to be released Wednesday. The Department of Health and Human Services says it has reached a tipping point as it seeks to steer medical providers away from paper records (Radnofsky, 5/22).

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State Watch

Federal Appeals Court Strikes Down Arizona Ban On Abortions After 18 Weeks Of Pregnancy

A federal appeals court struck down an Arizona law Tuesday that bans most abortions in that state after 18 weeks of pregnancy. The three-judge panel said the law violates a woman's constitutional right to end a pregnancy before a fetus can survive outside the womb -- typically 24 weeks.

The New York Times: Arizona Law On Abortions Struck Down As Restrictive
A federal appellate panel struck down Arizona's abortion law on Tuesday, saying it was unconstitutional "under a long line of invariant Supreme Court precedents" that guarantee a woman's right to end a pregnancy any time before a fetus is deemed viable outside her womb -- generally at 24 weeks. The law, enacted in April 2012 despite vociferous protest by women's and civil rights groups, made abortions illegal if performed 20 weeks after a woman's last menstrual period, or roughly 18 weeks after fertilization, even if the woman learned that the fetus had no chance of surviving after birth (Santos, 5/21).

The Wall Street Journal: Appeals Court Strikes Down Arizona Abortion Law
Arizona is among a number of states that have tried to restrict the practice in recent months, while other states have weighed laws that would strengthen abortion rights. For instance, a bill recently proposed by New York Gov. Andrew Cuomo, a Democrat, would expand women's access to late-term abortions (Jones, 5/21).

The Associated Press/Los Angeles Times: Arizona Abortion Ban Struck Down
A three-judge panel of the court said the law violated a woman's constitutionally protected right to terminate a pregnancy before a fetus can survive outside the womb. "Viability" is generally considered to begin at 24 weeks. Normal pregnancies run about 40 weeks (5/21).

A planned new Planned Parenthood encounters roadblocks in Louisiana --

The Associated Press: Legislation Targets New Planned Parenthood Clinic
Lawmakers are looking for ways to create roadblocks for Planned Parenthood's construction of a new facility in New Orleans that would provide abortions in addition to other health care services for women. Planned Parenthood doesn't currently operate an abortion clinic in Louisiana (Deslatte, 5/21).

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State Roudup: Loophole Could Mean Calif. Docs Eat Some Costs

A selection of health policy stories from California, Kentucky, Texas, Florida, North Carolina, Oklahoma and Missouri.

Sacramento Bee: Loophole In Health Care Law Could Stick Doctors With Tab
A loophole in California's upcoming health care overhaul could be exploited by families gaming the system or responding to hardship in a way that doctors say could leave a pile of unpaid bills. A chain of events would create a two-month period during which a family has medical coverage but no insurer must pay its claims. Nonpayment of premiums for subsidized policies would trigger the oddity: Federal law provides a three-month grace period before cancellation -- but insurers are responsible only for the first month (Sanders, 5/21).

Los Angeles Times: Strike At UC Medical Centers Continues; More Picketing Wednesday
As the afternoon wore on, the number of union members on the picket lines at the University of California medical centers started to thin. But hundreds of workers concerned about staffing levels and pension reforms planned to continue striking throughout the evening. Union spokesman Todd Stenhouse said that the decision to strike was a difficult one for many (Gorman and LaGanga, 5/21).

Sacramento Bee: Thousands Strike At University Of California
As non-emergency surgeries were postponed and fill-in medical technicians were brought in from out of state, thousands of employees walked off the job Tuesday at the UC Davis Medical Center and four other University of California hospitals. The two-day strike, due to end at 4 a.m. Thursday, was billed by the union for nearly 13,000 nursing assistants, pharmacists, operating room scrubs and other workers as a walkout over medical staffing levels and patient safety (Hecht and Lindelof, 5/21).

The Associated Press: N. Ky. Health Department Stops Well-Child Exams
The health department in northern Kentucky says it plans to stop offering well-child visits because Medicaid no longer offers reimbursement for them. Health department spokeswoman Emily Gresham Wherle told The Kentucky Enquirer that the agency will not schedule any new appointments at their locations in Boone, Campbell, Kenton and Grant counties (5/21).

The Texas Tribune: Bill Lets Police Take Guns From Those In Mental Crisis
Police would have new authority to take firearms away from Texans who are in a mental crisis under a bill the House approved on Tuesday that is now headed to Gov. Rick Perry's desk. Senate Bill 1189, by state Sen. Joan Huffman, R-Southside Place, would allow police to confiscate guns from people who are experiencing a mental health crisis if they determine the person is a danger to themselves or others (Grissom, 5/21).

Health News Florida: Leapfrog Group Ranks FL 10th In Safety
Thirty-seven percent of Florida hospitals have received an "A" grade from the Leapfrog Group, a nonprofit organization that grades participating hospitals on their efforts to prevent medical errors, putting the Sunshine State in 10th place. The scoring system is based on 26 safety measures including hand-washing and care of patients with catheters or ventilators, according to the Leapfrog web site. Hospitals are given letter grades based on these scores (Burton and Gentry, 5/21).

North Carolina Health News: On the Road: Wos Takes Medicaid Message To The People
The head of the state's Department of Health and Human Services has received less than a wholehearted reception as she's traveled the state explaining the governor's proposed Medicaid overhaul (Sisk, 5/22).

North Carolina Health News: Senate Gives More Detail On Budget Plan
More details about the Senate's plans for Medicaid and the state's health care budget emerged Monday as senate leaders explained more of their thinking around their budget plans. In meetings with the media and during presentations in appropriations meetings Monday afternoon, senators reiterated several times that Medicaid has become a drag on state spending (Hoban, 5/21).

Tulsa World: House Speaker Won't Save Insure Oklahoma
Oklahoma Speaker of the House T.W. Shannon has pulled the plug on Gov. Mary Fallin's plans to save the Insure Oklahoma program, which provides health care to working poor Oklahomans. As a result, 9,000 people currently getting state and federally subsidized private insurance through the program will be left without coverage (Greene, 5/20).

St. Louis Post-Dispatch: Nixon's Changes At Medicaid Agency Puzzle Health Care Advocates
Questions continued to swirl in the state capital Tuesday about the sudden departure last week of Missouri's Medicaid director, a widely respected physician who had navigated choppy political waters for six years. Health care advocates and legislators said that former Medicaid chief Ian McCaslin was forced out by Gov. Jay Nixon's office. But none could pinpoint why (Young, 5/22).

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Editorials and Opinions

Viewpoints: Mass. Experience May Not Be True Test For National Health Law; 'Dishonest' Campaign By Medical Device Makers

The New York Times: Economix: Massachusetts Employees Will Keep Their Health Plans
Massachusetts is often held up as a window into America's health insurance future, because it embarked on what came to be called the Romneycare reform six years ago. Like the Affordable Care Act provisions going into effect nationwide next year, Romneycare aimed to increase the fraction of the population with health insurance by imposing mandates on employers and employees and by subsidizing health insurance plans for middle-class families without employer plans. ... The details and dollar amounts in the Massachusetts health care law differ from the national Affordable Care Act, and for that reason alone I hesitate to infer too much from the Massachusetts experience (Casey B. Mulligan, 5/22). 

The National Review: It's Not 'Universal Coverage'
This history of Obamacare's political origins makes it all the more ironic that Obamacare, from what we now know, should not be considered a "universal coverage" plan, even by the benchmark the administration was using in 2009. Estimates from the Congressional Budget Office (CBO) point to this conclusion. In its latest assessment of the law, released in conjunction with new budget projections, the CBO indicates that the number of uninsured residents in the United States will never fall below 31 million -- three million more uninsured people than was estimated for the non-mandate plan President Obama rejected -- and that the insured will never be as much as 90 percent of the population (James C. Capretta, 5/21).

The Hill: Treat Nonprofit Health Care Fairly
For decades, unions have negotiated high quality, affordable health insurance through nonprofit Taft-Hartley plans -- one of the few reliable private providers for lower income individuals. ... In addition to being a long-standing and successful provider, these plans have been models of efficiency, achieving better cost savings than for-profit insurance carriers with medical loss ratios often exceeding 90 percent. That means 90 cents out of every dollar go to patient care. ... But as currently interpreted, the ACA would block these plans from the law's benefits (such as the subsidy for lower-income individuals and families) while subjecting them to the law's penalties (like the $63 per insured person to subsidize Big Insurance). This creates unstoppable incentives for employers to reduce weekly hours for workers currently on our plans and push them onto the exchanges where many will pay higher costs for poorer insurance with a more limited network of providers (Joseph T. Hansen, 5/20).

Los Angeles Times: Why The Medical Device Tax Needs To Stay
The chief drawback of a law as complex as the Affordable Care Act, the health insurance reform measure passed in 2010, is that it provides self-interested opponents a multitude of places to stick a wedge in and hammer away. But you'd be hard-pressed to find a campaign against the ACA as narrow-minded and dishonest as the one mounted by medical device manufacturers (Michael Hiltzik, 5/21). 

Fox News: 5 Reasons The Government Is Not Prepared To Handle ObamaCare
The recent turn of events with the Obama Administration and a lack of transparency are a significant red flag to the impending catastrophe of how the proposed changes under the Affordable Care Act could be the next ensuing disaster. … The emerging IRS scandals,  as they pertain to the multiple crises of the Obama Administration, are an ominous sign for how these very mistakes will impact the outcome of how the Affordable Care Act is implemented, and ultimately the lives of every American consumer (Dr. Sreedhar Potarazu, 5/21). 

Fox News: Americans Beware – ObamaCare Expands How The IRS Can Hurt You
Most of us interact with the Internal Revenue Service once a year at tax time.  But President Obama's Affordable Care Act health law puts us under the IRS's thumb all the time. The IRS has a history of using leaks and delays to punish people based on their politics. The latest is news that the IRS delayed processing requests for tax exempt status from the Obama administration's conservative critics, and even leaked information about them to the press (Betsy McCaughey, 5/20). 

Des Moines Register: Possible Medicaid Compromise Is Encouraging
(Iowa Gov. Terry) Branstad indicated he would be willing to accept a form of Medicaid expansion if it came with assurances that if the federal government reduces funding for the program in the future, Iowans would not be left picking up the cost. On Tuesday, Sen. Jack Hatch, D-Des Moines, said legislative leaders and the governor's staff have been meeting frequently and may have a deal soon. The final, compromise plan should capture the maximum amount of federal money available, insure Iowans earning up to 138 percent of poverty level and be able to gain approval by the federal government. Whether elected officials are successful remains to be seen, but there is more hope now than there was a week ago (5/21).

Des Moines Register: Broader Medicaid Wouldn't Produce A Healthier Iowa
Bluntly, expanding Medicaid coverage would only make its recipients "feel better," but not actually be better. That makes Medicaid a very expensive feel-good program. Expanding Medicaid lives up to the name of the Affordable Care Act -- it gives "affordable care," nothing more. And the financial protection afforded Medicaid recipients is most effective in protecting against "catastrophic" health expenditures (Bob Williams, 5/21).

The Washington Post: Free Genes From Patent Restrictions
Jolie's news highlights an arcane but increasingly important question of patent law. As the sequencing of the human genome has expanded the ability to test for such genetic susceptibilities, is the discovery of the gene itself a patentable invention? (Ruth Marcus, 5/21). 

The Seattle Times: Is Catholic Church Taking Over Health Care In Washington
Lord knows our schools have problems. But suppose we tried to solve them by doing something radical -- say, turning the schools over to the Catholic Church. … If put to a vote, this plan would crater. Most of us aren't Catholic, so I'm guessing we'd never go along with letting the creeds of that one faith run something as universal as education. So why are we allowing it with health care? (Danny Westneat, 5/21).

Miami Herald: Stopping Medicare Fraud
Miami has long had the sorry reputation for being the nation's leader in Medicare fraud, with seemingly just about anybody -- from convicted felons to, well, actors -- allegedly cashing in on what's supposed to be a medical safety net for the country's elderly and disabled. How can this happen? And keep on happening? ... But another part of Medicare, the administration arm that certifies that care givers who tap into Medicare reimbursements are actually qualified to do so and then verifies that they actually deliver the services they vouch for, must be much more diligent. Especially so in fraud capitals like Miami where it's so easy to find an abundance of seniors, some of whom are achingly vulnerable to crooks and cons (5/19).

JAMA: Value of Unique Device Identification in the Digital Health Infrastructure
In recent years, high-profile cases of medical device failure resulting in patient harm -- such as implantable cardioverter-defibrillator leads and metal-on-metal hip implants -- have received substantial attention both in the medical literature and popular press. These examples illustrate the need for a more effective system of monitoring device performance and protecting patient safety (Drs. Natalia A. Wilson and Joseph Drozda, 5/21).

JAMA Pediatrics: Stunting The Growth Of Child Health Research
A recent comprehensive assessment concluded that "lack of research, poor research, and poorly reported research" greatly limit child health research. Children participate in medical research at rates less than one-half those of adults, perhaps attributable to inadequate opportunities, ineffective recruitment strategies, and parents' greater concerns about their children's safety than their own in research settings. Meanwhile, health care spending on children declines every year as a share of national expenditures, causing concern that investment in child health research will decline as well (Dr. Matthew M. Davis, 5/20).

JAMA Internal Medicine: Evaluating Health System Processes With Randomized Controlled Trials
Health system processes shape and define health care and the medical experience of patients, health care practitioners, and society at large. These processes range from targeted mandates, such as gown and glove precautions for patient contact or automated computer alerts, to wider choices, such as deciding how to respond to medical emergencies, how to use (or not use) performance metrics or patient satisfaction surveys, what new health care facilities to build, or even how to finance health care costs and medical insurance. Given their unquestionable importance, we contend that health system processes should be routinely evaluated with randomized controlled trials (Drs. John P. A. Ioannidis and Vinay Prasad, 5/20).

The Medicare NewsGroup: Does Medicare Overpay Private Plans? The Debate Heats Up
The debate on whether Medicare Advantage (MA) is reducing health care costs is intensifying. A recently released analysis of government data by America's Health Insurance Plans (AHIP), the main health insurance lobby, found that seniors enrolled in MA plans in California and Nevada had better health outcomes than patients enrolled in Traditional Medicare. … Given the growing toxic environment in Washington and the fact that MA has become a political football, it's unlikely that the CMS or Congress will act before the 2014 elections, delaying a closer look (John Wasik, 5/21).

Health Policy Solutions (a Colo. news service): The Year Of Mental Health At The Colorado Legislature
In addition to other health care reforms (Medicaid expansion, improved parity for behavioral health coverage) two historic pieces of behavioral health legislation moved forward this year. One deals with Colorado's civil commitment laws -- statutes long overdue for a 21st century update. The other is a bill that includes over $20 million in funding to create a statewide behavioral health crisis response system. The governor signed both bills into law at the Jefferson Center for Mental Health on May 16 (Michael Lott-Manier, 5/21).

WBUR: Cognoscenti: Your Patient Is Your Partner: Collaboration Creates The Best Medical Outcomes
In a recent interview, physician and noted social activist Dr. Paul Farmer gave this advice to graduating medical professionals: their real impact will come when they work in teams. As the co-founder of Partners in Health and a champion of improving health in underserved communities, Farmer's work is built on building partnerships and applying successes and lessons learned to new frameworks (Laurie Edwards, 5/22).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Marissa Evans
Lisa Gillespie
Shefali Luthra

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