Daily Health Policy Report

Thursday, May 23, 2013

Last updated: Thu, May 23

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Health Information Technology

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Can My Insurer Deny Coverage For Care At An Out-Of-Network Hospital? (Video)

Kaiser Health News consumer columnist Michelle Andrews answers a reader question about emergency room and out-of-network hospital cost changes under the health law (5/23). Watch the video or read the transcript.

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Capsules: 11 Insurers Want To Play Ball In Colorado’s Marketplace

Now on Kaiser Health News' blog, Phil Galewitz reports: "Colorado became the latest state Wednesday to post proposed health insurance plans for its new online marketplace, which is slated to begin enrolling people in coverage Oct. 1. What stands out is the number of plans being proposed. A total of 11 insurers are seeking approval to market about 250 health plans to individuals and small groups in the state's online marketplace under the federal health care overhaul" (Galewitz, 5/22). Check out what else is on the blog.

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Political Cartoon: 'Pennsylvania Railroaded?'

Kaiser Health News provides a fresh take on health policy developments with "Pennsylvania Railroaded?" by John Cole.


Meanwhile, here is today's health policy haiku:


Is Sebelius
equal to Oliver North?
That's what Lamar wrote.

And, as a bonus:


The evening commute
for KHN staff gives me
a "sinking" feeling.

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

States Embroiled In Medicaid Expansion Battles Are Running Out Of Time

Politico reports that this health law implementation issue remains an open question for about a dozen states. Some are on the brink of giving up for the first year but looking ahead to the next set of state legislature sessions. Meanwhile, news outlets report on related developments in Michigan, Texas, Ohio, California and Iowa.

Politico: Clock Ticking On Full Medicaid Expansion Funds
States still mired in the fight over the Obamacare Medicaid expansion are starting to give up on their first year of full funding — and it's unclear whether they would be able to tap into the money before 2015. Expansion remains an open question in about a dozen states after months of legislative fights. As more states continue to wrap up their budgets, some are already looking to next year's legislative sessions as their next shot at the expansion, even amid calls for state legislatures to return for special sessions (Millman, 5/23).

The Associated Press: Snyder: Mich. Could Still Get Medicaid Expansion
Republican Gov. Rick Snyder said Wednesday he is hopeful he can still broker an agreement with the Republican-led legislature to expand government health insurance for low-income adults, despite the state's tentative budget deal that leaves out the Medicaid expansion. Snyder told The Associated Press during an interview in Washington that while the budget deal he reached with GOP leaders in the legislature on Tuesday does not include the expansion, they could come up with a solution after the final budget is passed (Durkin, 5/22).

The Associated Press: After Steady Heckling, Perry Meets With Protesters
Hecklers demanding that Texas expand the Medicaid program under the White House-backed health care law repeatedly interrupted a speech by Gov. Rick Perry on Wednesday, then descended on his office for a meeting to keep pressing their case…Texas has the highest rate of uninsured in the nation, with about 6.2 million of its residents lacking health care coverage. Advocates say extending Medicaid as directed by federal health care reform could provide up to 1 million Texans with some coverage. But because Medicaid is a jointly funded federal-state program, Perry says embracing expansion could bankrupt Texas (Weissert, 5/22).

The Texas Tribune: Health Care Hecklers Meet With Perry
Gov. Rick Perry met with three health care activists who helped organize a protest of his speech before Austin business leaders Wednesday. Perry invited the activists to his office after a dozen or more protesters infiltrated a ballroom at the downtown Hilton Austin Hotel, where Perry was speaking before a gathering of the “2013 Global Business Summit” being put on by his office (Aaronson and Root, 5/22).

Des Moines Register: Expansion Includes State-Paid Premiums
After arguing for months over how to provide health care to poor Iowa adults, the Iowa Senate approved a compromise plan late Wednesday and sent it to the House. The proposal was expected to be considered today by the House, whose Republican leaders have endorsed it. Gov. Terry Branstad also supports it. The new Iowa Health and Wellness Plan would cover the same Iowans who would have been covered by Medicaid under President Barack Obama’s Affordable Care Act. But the approximately 150,000 people would have their health care covered in different ways. Poor adults making less than the federal poverty level, or about $11,500 per year for a single person, would qualify for medical benefits similar to what state employees receive. People making between that amount and about $16,000 could buy private insurance on the state’s new health insurance exchange. The government would pay premiums for at least the first year (Leys and Petroski, 5/23).

Columbus Dispatch: Bill In Ohio House Revives Medicaid Expansion
Rep. Barbara Sears, R-Sylvania, introduced legislation yesterday to provide coverage to an estimated 275,000 people with incomes under 138 percent of the federal poverty level. The cost would be paid entirely by the federal government for three years under the new health-care law. Sears said she hopes to win passage of the legislation by the end of June to give state Medicaid officials the six months they say they need to implement an expansion by Jan. 1. That’s when the federal aid becomes available, and it’s also when most Americans must have health coverage or face penalties. House Speaker William Batchelder, R-Medina, said lawmakers will be studying the proposal over the next month, and it was “possible” it could be approved by June 30 (Candisky, 5/23).

California Healthline: How Obamacare Could Change Medi-Cal For The Better (And Worse)
As many as 1.5 million Californians are expected to gain Medi-Cal coverage over the next six years, thanks to provisions in the Affordable Care Act. That might be the easy part. What's tricky: Making sure that the already-strapped Medicaid program -- which is facing a controversial 10 percent provider rate cut -- has enough dollars to go around. "Expansion of Medicaid in California is a step in the right direction," Paul Phinney, president of the California Medical Association, said in a statement last week (Diamond, 5/22).

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Idaho, New Mexico Ask Feds To Run Health Exchanges

In addition, media outlets report that the nation's largest for-profit insurers will not participate in California's online marketplace. Eleven insurers have applied to operate plans in Colorado.

The Wall Street Journal: Two States Seek Help With Health Exchanges
Two states that had planned to run their own health-insurance exchanges this fall are asking the federal government for help in the first year, a sign of the obstacles states face in carrying out a centerpiece of the health-care overhaul. Idaho and New Mexico had been among a few Republican-led states that had agreed to operate their own health exchanges, which will offer a variety of insurance plans for people who don't have coverage otherwise (Dooren, 5/22).

Kaiser Health News: Capsules: 11 Insurers Want To Play Ball In Colorado's Marketplace
Colorado became the latest state Wednesday to post proposed health insurance plans for its new online marketplace, which is slated to begin enrolling people in coverage Oct. 1. What stands out is the number of plans being proposed. A total of 11 insurers are seeking approval to market about 250 health plans to individuals and small groups in the state's online marketplace (Galewitz, 5/22).

Los Angeles Times: UnitedHealth, Aetna And Cigna Opt Out Of California Exchange
Some prominent health insurers, including industry giant UnitedHealth Group Inc., are not participating in California's new state-run health insurance market, possibly limiting the number of choices for millions of consumers. UnitedHealth, the nation's largest private insurer, Aetna Inc. and Cigna Corp. are sitting out the first year of Covered California, the state's insurance exchange and a key testing ground nationally for a massive coverage expansion under the federal healthcare law (Terhune, 5/22).

And, in Washington state -

The Associated Press: 2 Insurers Left Abortion Coverage Out Of Washington State Health Exchange Proposals
Two insurance companies who filed to compete in Washington state's health care exchange initially proposed not to provide abortion coverage, officials said Wednesday. All current Washington health plans provide abortion insurance. Stephanie Marquis, a spokeswoman with the Washington state Office of the Insurance Commissioner, said the plans without such coverage in the health exchange were recently filed by Kaiser Foundation Health Plan of The Northwest and BridgeSpan Health Company (5/22).

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Federal Appellate Court Hears Arguments On Health Law's Birth Control Mandate

The Seventh U.S. Circuit Court of Appeals in Chicago is the first federal appellate court to hear arguments in cases challenging the mandate that took effect last August. With dozens of similar lawsuits pending, many say the issue seems likely to land before the Supreme Court. The case brought by Hobby Lobby Inc. is considered the most prominent of these efforts.

The Wall Street Journal: Contraception Violates Beliefs, Firms Tell Court
Two small-business owners challenging contraception-coverage mandates in the federal health-care law told a federal appellate court Wednesday the law would force them to violate their beliefs because they run their businesses in accordance with their religious faith. The Seventh U.S. Circuit Court of Appeals in Chicago is the first federal appellate court to hear arguments in cases challenging the mandate that took effect last August for most employers to cover contraception, including the morning-after pill, in workers' insurance plans without out-of-pocket costs (Kesling and Radnofsky, 5/22).

The Washington Post: Some Business Owners Resist Providing Employees With Contraceptive Coverage
Religiously devout business owners are waging a broad rebellion against providing their employees with contraceptive coverage, bringing dozens of lawsuits that seem certain to land the issue before the Supreme Court. The company owners say their religious beliefs take precedence over a new federal requirement, contained in President Obama’s Affordable Care Act, that they give employees insurance that covers contraceptives (Barnes, 5/22).

The Associated Press/Washington Post: Hobby Lobby Appeal Tests Limits Of Federal Birth-Control Coverage Mandate
In the most prominent challenge of its kind, Hobby Lobby Stores Inc. is asking a federal appeals court Thursday for an exemption from part of the federal health care law that requires it to offer employees health coverage that includes access to the morning-after pill. The Oklahoma City-based arts-and-crafts chain argues that businesses -- not just the currently exempted religious groups -- should be allowed to seek exception from that part of the health law if it violates their religious beliefs (5/23).

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The Hill: Insurers Feel Pressure To Support Enroll America

The Hill reports that unnamed insurance industry sources say they feel that Enroll America, the non-profit group raising funds to support outreach to the uninsured, is "just an arm of the administration." In a separate story, The Hill notes new research concluding the trend toward part-time work and reduced health benefits began before the overhaul.

The Hill: Insurers Feel Pressure From Health Group With Ties To White House
The links between a nonprofit promoting President Obama’s healthcare law and the White House have created an "air of expectation" that insurers will contribute to the group, according to an insurance industry official. Current and former administration officials have taken on leadership and fundraising roles for Enroll America, a nonprofit aiming to make sure people sign up for new coverage options (Baker, 5/23).

The Hill: Trend Toward Part-Time Work, Cuts In Health Coverage Predate ObamaCare
Employers have been cutting back employees' hours and access to health insurance since before President Obama's healthcare law passed, according to new research released Wednesday. The findings are potentially significant as the healthcare law is about to take full effect (Baker, 5/22).

Fox News: 56 Percent Want To Go Back To Pre-ObamaCare System
Majorities of American voters say their family will be worse off under the Affordable Care Act, and think it would be better to go back to the pre-ObamaCare health care system. A Fox News poll released Wednesday finds that while 26 percent of voters say their health care situation will be better under the new law, twice as many -- 53 percent -- say it will be worse. Another 13 percent say it won’t make a difference. … Young voters and seniors are pessimistic about ObamaCare. Majorities of those under age 35 and those 65+ think things will be worse under the 2010 health care law (Blanton, 5/22).

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Capitol Hill Watch

Senate Immigration Bill Would Ease Restrictions On Foreign Health Workers

On Capitol Hill, several legislative efforts are moving forward on health issues. Among them is an effort by the Massachusetts delegation to keep bonus Medicare payments for the state's hospitals, while House Republicans are looking for another way to deal with a bill to fund high-risk insurance pools. In addition, a Senate measure is advancing that would increase scrutiny On compounding pharmacies.

Modern Healthcare: Immigration Bill Seeks To Ease Rules For Foreign Health Workers
After 30 hours of debate over a three-week period, the Senate Judiciary Committee has passed a bipartisan immigration bill that would seek to strengthen the country's healthcare workforce by making it easier for foreign health professionals to work in the U.S. The panel voted 13-5 on Tuesday to approve the sweeping Border Security, Economic Opportunity and Immigration Modernization Act (PDF) that Sen. Charles Schumer (D-N.Y.) introduced last month. In all, the committee considered 212 amendments in the bill that Senate Majority Leader Harry Reid has said he would like to bring to the floor for debate in June, "sometime soon" after Congress returns from a weeklong Memorial Day work period (Zigmond, 5/22).

Boston Globe: Mass. Tries To Retain $250 Million For Hospitals
The Massachusetts congressional delegation, after holding a rare emergency meeting Wednesday, launched what could be a final effort to preserve more than $250 million in bonus Medicare payments to the state's hospitals that critics call the "Bay State boondoggle." But the prospect of holding on to the windfall is dimming. The Democrat-controlled Senate voted earlier this year to end the payments, enacted under President Obama's health care overhaul law and which come at the expense of most other states. A similar bill was introduced in the Republican-led House this week (Jan, 5/23).

Reuters: Senate Committee Advances Drug Compounding Bill
A U.S. Senate committee on Wednesday unanimously approved legislation that would increase federal oversight for companies that compound and sell sterile drugs across state lines. The proposed legislation was introduced in response to a meningitis outbreak last fall that killed more than 50 people and sickened more than 700. The outbreak was traced to contamination found in steroid injections made by the New England Compounding Center (Dye, 5/22).

Kansas City Star: With Roberts' Backing, Bill To Reform Pharmacy Compounding Heads To Senate
A U.S. Senate committee on Wednesday passed bipartisan legislation that would fundamentally change how large-scale pharmacy compounding is practiced in this country. Also Wednesday, the Senate's Health, Education, Labor and Pensions Committee issued a report showing that poor compounding practices have persisted even since last fall, when a meningitis outbreak linked to contaminated steroid injections killed 55 people and sickened about 700 (Morris, 5/22).

CQ HealthBeat: Rejected High-Risk-Pool Bill To Get Another Chance
A month after House Republican leaders were forced to pull an unpopular health care law revision from the House floor, bill sponsor Rep. Joe Pitts said he expects to see a modified version under consideration again in "a couple of weeks." The reworked measure appears designed to mollify critics in the GOP rank and file who argued that the bill, as introduced, would have, in effect, just bolstered the president's signature health care law rather than repealed its provisions (Dumain and Ethridge, 5/22).

And, during a recent hearing -

McClatchy: Medical Company Declines To Answer Senate Questions On Medicare Billing
The president and chief executive officer of a medical equipment company invoked the Fifth Amendment at Senate hearing Wednesday, declining to answer questions about aggressive marketing tactics used to sell scooters, sleep apnea machines and other home medical supplies to Medicare recipients who may not need or want them. Jon Letko of U.S. Healthcare Supply LLC, based in Milford, N.J., exercised his constitutional right not to incriminate himself at the hearing before the Senate Subcommittee on Financial and Contracting Oversight (Wise, 5/22).

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Health Information Technology

HHS Report Finds Uptick In Doctors' Use Of Electronic Health Records

Also in the news, the Pentagon is in search of a new system for veterans' health care while San Francisco is "leading the way" in new health data applications.

USA Today: Incentives Push Doctors To Electronic Medical Records
More than half of doctors' offices and 80 percent of hospitals that provide Medicare or Medicaid will have electronic health records by the end of the year, the Department of Health and Human Services announced Wednesday (Kennedy, 5/22).

CQ HealthBeat: HHS Report Shows Strong Growth In Use Of Electronic Health Records
More than half of all doctors now get Medicare or Medicaid incentive payments for using electronic health records, according to a report federal officials released on Wednesday. But Republicans say medical professionals should not just use the records in their own offices but also should exchange them with other providers (Adams, 5/22).

The Associated Press: Pentagon To Seek New Records System For Vets Health Care, Says It Won’t Solve Claims Backlog
The Pentagon has decided to buy a new computerized health records system to be able to better share and merge its data with the Department of Veterans Affairs, but officials cautioned that it was part of a “long-term modernization” effort and would not help ease the backlog in VA disability claims (5/22).

California Healthline: San Francisco Leading The Way In Health Data Applications
The city of San Francisco is leading the way in using health data in innovative ways and it's paying off in a big way, according to several city officials who spoke yesterday at the Healthy Communities Data Summit. The summit was held in San Francisco and that meant a number of success stories were local, but the conference cast a wide net in its approach to innovation prompted by public release of health data (Gorn, 5/22).

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State Watch

State Highlights: Conn. Democrats Eye Shifting $400M In Medicaid Money

A selection of health policy stories from California, Connecticut, American Samoa, Georgia, Oregon and West Virginia.

Los Angeles Times: Geography Has A Role In Elective Surgery Decisions, Study Finds
Geography plays a role in whether patients in California have elective operations such as joint replacement, weight loss surgery and gallbladder removal, according to a new study. The California HealthCare Foundation study showed wide variations in patient surgeries across the state (Gorman, 5/22).

CT Mirror: Democrats May Sidestep Spending Cap
Struggling to secure the super-majority necessary to exceed the current spending cap by half-a-billion dollars, legislative leaders are weighing a plan to green-light the extra spending with a simple majority. According to sources close to budget negotiations, the Democratic majority has discussed effectively shifting more than $400 million in Medicaid spending off the books next fiscal year. The process is common in other states, but rarely used here and never involving that much money (Phaneuf and Becker, 5/22).

Modern Healthcare: HHS Finds $2.2M In Billing Errors At Cedars-Sinai
Administrators at Los Angeles' largest community hospital, Cedars-Sinai Medical Center, were well aware of the flaws in their inpatient admissions process before an audit report Wednesday from HHS' inspector general's office publicly pointed them out. The 892-bed hospital posted a case manager in its emergency department last year to review all decisions to admit so-called "short-stay" inpatients, and that person now has access to standardized admissions criteria software from InterQual to evaluate make those decisions, hospital administrators wrote to the OIG (Carlson, 5/22).

Los Angeles Times: Most Unionized UC Hospital Workers Go To Jobs Despite Strike
As University of California patient care workers returned to the picket lines Wednesday, hospital administrators said they were gratified that so many others chose to come to work. More than three-quarters of union members who had been scheduled to work Tuesday did so, said Dianne Klein, spokeswoman for the UC office of the president. Hospital officials said they expected a similar turnout Wednesday (Gorman, 5/22).

The Associated Press/Washington Post: American Samoa To Keep Frequent Flier Miles Of Government Travelers; Use For Sick, Students
American Samoa plans to take away frequent flier miles from government workers who travel on behalf of the U.S. territory and use the loyalty points to help medical patients and students travel off the islands when necessary (5/22).

Georgia Health News: State Psychiatric Hospital In Thomasville To Close
A state agency Wednesday announced that its psychiatric hospital in Thomasville will close by the end of the year. The state Department of Behavioral Health and Developmental Disabilities told GHN that Southwestern State Hospital currently has a patient census of 116, divided between people with mental illness and development disabilities, and those housed in the facility’s forensic unit. The closing of the hospital continues the revamping of the state’s services for people with mental illness and developmental disabilities in the wake of Georgia’s landmark 2010 agreement with U.S. Department of Justice, which aims to move people from mental hospitals into community living situations (Miller, 5/22).

The Lund Report: Cultural Competency In Health Care Heads To Governor
Sen. Jackie Winters said 40 or 50 years ago, when some black Americans had diabetes, they had a colloquial term for it -- "the sugars" -- which their doctors may not understand. Winters, a black Republican senator from Salem, told The Lund Report that ethnic and racial minorities often face increased health disparities, often for purely cultural reasons, since physicians and nurse practitioners are more likely to come from an ethnic group different than their own. That's what's led her to find a legislative route that would compel health professionals to become educated in cultural competency (Gray, 5/22).

The Associated Press: W. Va. Gov Picks New Health Secretary
Former hospital executive and nurse Karen Bowling will become West Virginia's Health and Human Resources secretary on July 1, Gov. Earl Ray Tomblin said Wednesday, taking over a sprawling department recently scrutinized by an audit and assigned the daunting task of expanding the state's Medicaid program (5/22).

San Jose Mercury News: California Bill Would Prevent Genetic-Testing Firms From Using Surreptitiously Obtained DNA
If you want to keep your DNA to yourself, be sure not to leave any stray hairs, Q-tips or underwear lying around. There are genetic testing companies out there willing to reveal your most intimate biological secrets to anybody -- without your knowledge or permission. And under California law, such genetic snooping is perfectly legal. Now, legislators in Sacramento are considering a bill to change that. Senate Bill 222, which faces a key hearing Thursday, would require a donor's consent to collect, analyze or share genetic information (Shugart, 5/22).

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Weekend Reading

Weekend Reading: Mental Illness Stigma And Health Insurance Mazes

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

The New York Times Magazine: Unexcited? There May Be A Pill For That
Linneah sat at a desk at the Center for Sexual Medicine at Sheppard Pratt in the suburbs of Baltimore and filled out a questionnaire. She read briskly, making swift checks beside her selected answers, and when she was finished, she handed the pages across the desk to Martina Miller, who gave her a round of pills. The pills were either a placebo or a new drug called Lybrido, created to stoke sexual desire in women. ... The search for a female-desire drug has been an obsession of the pharmaceutical industry for more than a decade, largely because the release of Viagra, in 1998, showed that gigantic sums of money can be made with a quick chemical solution to sexual dysfunction. But while Viagra and its competitors deal with the simple hydraulics of impotence, the most troubling difficulty for men, the psychological complexity of depleted lust has so far defeated industry giants (Daniel Bergner, 5/22).

Tampa Bay Times: Akshay Desai And The Rise And Fall Of Universal Health Care
In August, Universal Health Care Group was crumbling. Regulators circled. Bankruptcy loomed. Still, founder and CEO Akshay Desai didn't publicly hint at any problems. "As a businessman, I know all too well what it takes to make it in the private sector," he bragged at the time. It was vintage Desai — supremely confident, selective with the facts. The 55-year-old son of Indian educators built Universal on smarts and ambition (Susan Taylor Martin and Jeff Harrington, 5/13).

The New York Times Magazine: Some Of My Best Friends Are Germs
I can tell you the exact date that I began to think of myself in the first-person plural — as a superorganism, that is, rather than a plain old individual human being. ... Justin Sonnenburg, a microbiologist at Stanford, suggests that we would do well to begin regarding the human body as “an elaborate vessel optimized for the growth and spread of our microbial inhabitants.” This humbling new way of thinking about the self has large implications for human and microbial health, which turn out to be inextricably linked. Disorders in our internal ecosystem — a loss of diversity, say, or a proliferation of the “wrong” kind of microbes — may predispose us to obesity and a whole range of chronic diseases, as well as some infections (Michael Pollan, 5/22).

Slate: You Do Not Have Asperger's
The autism community is a fractious bunch. We argue over the causes of autism, the best treatments, or even if it should be treated at all. But we do share a common anxiety: the DSM-5. This latest version of the Diagnostic and Statistical Manual of Mental Disorders, released by the American Psychiatric Association this month, officially eliminates many familiar autism spectrum diagnoses. Asperger’s syndrome (typically applied to those with no intellectual disability or language deficit); pervasive developmental disorder, not otherwise specified (generally given to higher-functioning individuals who may not meet all the criteria for autism); and childhood disintegrative disorder (attached to kids who develop typically and then experience severe regression after the age of 3) are now incorporated into the single diagnosis of autism spectrum disorder. ... Yet those diagnoses had serious implications. Certain states provide services for children diagnosed with autism but not for those diagnosed with Asperger’s (Amy S.F. Lutz, 5/22).

USA Today: Glenn Close, Family Work To End Stigma Of Mental Illness
Calen Pick has schizoaffective disorder, a combination of schizophrenia and bipolar disorder. He was 15 when he realized something was wrong, 16 when he checked himself into a lockdown mental health facility, 18 when he got out and 28 when his sanity touched down on solid ground. Now 31, Pick got married last year and is working with his mother, Jessie Close, who is bipolar, and his aunt, six-time Oscar nominee Glenn Close, to help end the stigma and discrimination facing the mentally ill (Korina Lopez, 5/22).

The Nation: Cashing In On Breast Cancer Awareness
Many American women played the BRCA what-if game for the first time [last] Tuesday: what would I do if I had the mutation? Would I get a mastectomy, even though there was a chance I wouldn’t need it? ... The problem is that there is profit—a lot of profit—to be made from stoking all of this worry. The big winner on Tuesday was not women’s health; it was Myriad Genetics, the company that has held the exclusive patent on the BRCA 1 and 2 mutations since the 1990s. ... The BRCA gene speaks to the impossible dilemma of for-profit healthcare, particularly when practiced as legal monopoly: some high-risk women will be saved, but many more women will be either needlessly alarmed, financially penalized, or both, so that one corporate monopoly can make a staggering profit (Rose-Ellen Lessy, 5/16). 

The New York Times: Defining My Dyslexia
I started cataloging insults in the second grade. Notable put-downs heard outside my special-ed classroom included "dimwinky," "retardochuckles" and "the meat in the sandwich of stupid." The last of which, if you think about it, is a seriously impressive use of metaphor for a 7-year-old. I learned all the jokes about dyslexia, and told them to better effect than anyone else. Making fun of myself was my best defense. The other choices — hiding from my diagnosis or accepting myself as limited — didn't appeal (Blake Charlton, 5/22).

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Editorials and Opinions

Viewpoints: Sen. Alexander Sees Reflections Of Oliver North In Sebelius' Quest To Raise Funds; Vaccine Scare's Legacy

The Wall Street Journal: Kathleen Sebelius, Meet Oliver North
Major news outlets in recent days have reported that U.S. Department of Health and Human Services Secretary Kathleen Sebelius is raising money from the private sector -- including from health care executives -- for use by a private entity that is helping to implement ObamaCare. ... Is Ms. Sebelius raising funds for a private entity and then coordinating with that entity to do something Congress has refused to authorize, or for which it has refused to appropriate funds? And is she raising money from organizations she regulates, in violation of ethics laws? (Sen. Lamar Alexander, R-Tenn., 5/22). 

The New York Times: Aftermath Of An Unfounded Vaccine Scare
Britain is experiencing serious outbreaks of measles that look to be a delayed consequence of a failure to vaccinate infants and young children more than a decade ago. A prime cause of that failure was ill-founded fears among parents that a widely used vaccine to combat measles, mumps and rubella might cause autism. Because they shunned the vaccine, their children, now in their teens, are suffering the consequences (5/22). 

Milwaukee Journal-Sentinel: Mandatory Vaccinations Deserve Vigorous Debate
The debate over the mandatory influenza vaccinations of employees is worthy of a vigorous public airing. Controversy has been growing nationwide over the plight of employees, particularly health care workers, being dismissed from jobs due to their refusal to accept this unwanted intrusion into their personal health care decisions. I fully recognize this argument pits two groups advocating against each other over a position based on rights. Employers demand flu vaccinations of employees, with extremely limited exceptions, as a fundamental right of an employer. Those who object stand on individual liberties to make their own personal health care decisions without the threat of dismissal (Jeremy Thiesfeldt, 5/22). 

The New York Times: Kill Bill
According to statistics United Republic assembled, the prescription drug industry spent $116 million lobbying for legislation to prevent Medicare from bargaining down drug prices — legislation that enabled drug companies to make an additional $90 billion annually. That amounts to an extraordinary 77,500 percent return on investment. Oil companies, in turn, had a return on investment of 5,900 percent, and multinational companies, 22,000 percent (Thomas B. Edsall, 5/22). 

The New England Journal of Medicine: The Gross Domestic Product And Health Care Spending
An examination of data from the past 60 years for the economy as a whole and for health care expenditures indicates that there has been a robust relationship between the two. ... Some observers place great emphasis on the particularly slow growth of national health care expenditures in 2010 and 2011. How useful is the experience of growth over a period of 2 years in predicting the growth rate over the next 20 years? The answer seems to be not at all. ... [T]he rate of growth of national health care expenditures in the past appears to have been substantially related to the growth of the GDP. There has been some slowing of the growth of health care spending relative to the GDP, but it began not just a few years ago, but in the 1990s (Victor R. Fuchs, 5/22).

Columbus Dispatch: Obamacare May Lead To 'Skinny' Policies
Would you like to have a "skinny" health-insurance policy? Probably not. But if you're employed by a large company, you may get one, thanks to Obamacare. That’s the conclusion of Wall Street Journal reporters Christopher Weaver and Anna Wilde Mathews. They report that insurance brokers are pitching and selling "low-benefit" policies across the country. You might be wondering what a "skinny" or "low-benefit" insurance plan is. The terms may vary, but the basic idea is that policies would cover preventive care, a limited number of doctor visits and perhaps generic drugs. They wouldn't cover things such as surgery, hospital stays or prenatal care (Michael Barrone, 5/23).

JAMA: Public Health Regulation As A Public Process
Media coverage of new public health regulations often seems to follow a template: The [regulatory agency]'s plan to implement [public health regulation] is causing controversy among [businesses affected] and [individuals who object]. … But there's another way to think about how policy is developed to improve health: as a dynamic process open to a range of policy alternatives (Dr. Joshua M. Sharfstein, 5/22).

JAMA: Encouraging Smokers to Talk With Their Physicians About Quitting
Over the next few months, physicians may see an increase in patients asking for help in quitting smoking. Why? The Office on Smoking and Health at the Centers for Disease Control and Prevention recently launched the second stage of its national media campaign, Tips from Former Smokers (Tips). Some of the ads include a new call to action with the message, "You can quit. Talk with your doctor for help." This "talk with your doctor" initiative provides physicians with a golden opportunity to help more patients quit smoking (Dr. Tim McAfee, 5/22).

The Lund Report: Physician, First Do No Harm -- To Yourself
Studies confirm most doctors are overworked, exhausted, or depressed. The tragedy: few seek help. I ask the group, "How many physicians have lost a colleague to suicide?" All hands are raised. "How many have considered suicide?" Except for one woman, all hands remain up -- including mine. "Physicians have the highest suicide rate of any profession," I explain. "In the United States we lose over 400 physicians per year to suicide. That's the equivalent of an entire medical school. Even that's an underestimate because many physician suicides are incorrectly identified as accidents" (Dr. Pamela Wible, 5/21).

MinnPost: Failed Virginia Bill On Miscarriages Reveals Ignorance About Women's Health
As I've written here before, the medical ignorance of some politicians -- particularly in regard to women's reproductive health -- is a continual source of astonishment. ... While searching through the legislative history of Virginia state Sen. Mark Obenshain, now running on the Republican ticket for his state's attorney general position, reporters found that he had authored a bill in 2009 that would have required all women in Virginia to report miscarriages to police or risk legal penalties, including as much as a year in jail (Susan Perry, 5/22).

Bloomberg: Better Death Records Can Lead To Longer Life
Here's a morbid thought atop a morbid thought: Two in three deaths worldwide -- some 35 million a year -- go unregistered. And in many cases when deaths are recorded, reliable information on what caused them is lacking. Why does this matter? Without such records, public-health authorities can't tell enough about what's killing people to minimize the dangers they face (5/22).

Oregonian: Portland And Its Aversion To Fluoride Reflects Oregon's Unusual Politics
In 2011, the board of the Santa Clara Valley Water District voted to begin fluoridating water for about 850,000 customers in and around San Jose. Anti-fluoride activists grumbled but realized they didn't have the resources to take their fight to the public. That's sure not what happened in Portland, which once again showed that this far northwest corner of the country is willing to go where other parts of the country rarely tread (Jeff Mapes, 5/22). 

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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.