Daily Health Policy Report

Wednesday, May 28, 2014

Last updated: Wed, May 28

KHN Original Reporting & Guest Opinion

Coverage & Access

Administration News

Health Reform

Medicaid

Public Health & Education

Health Care Marketplace

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

7 Things You Should Know About The Next Big Benefit Change

Kaiser Health News staff writer Julie Appleby reports, "After getting a green light from the Obama administration earlier this month, more employers may begin to cap what they pay for certain medical treatments, such as joint replacements and drugs, potentially shifting more costs to workers. Done right, economists and policy experts say the move to “reference pricing,” as the approach is known, could slow health care spending by prompting consumers to choose less expensive providers or treatments— and leading providers to lower their charges. Still, consumer advocates warn that the approach is likely to make health insurance even more complex, and could expose unwitting consumers to thousands of dollars in out-of-pocket costs" (Appleby, 5/28). Read the story.

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Capsules: Can Employers Dump Workers To Health Exchanges? Yes, For A Price

Now on Kaiser Health News’ blog, Jay Hancock reports: “The latest tweak from the Internal Revenue Service essentially prohibits employers from giving workers tax-free dollars to buy policies in the online public marketplaces created by the health law. ... Nothing stops employers from canceling company plans and leaving workers to buy individual policies sold through the exchanges — as long as they pay the relevant taxes and penalties, said Christopher Condeluci, a Venable lawyer specializing in benefits and taxes. Those will vary according to a company’s size and circumstances" (Hancock, 5/28). Check out what else is on the blog.

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Political Cartoon: 'Geronimo?'

Kaiser Health News provides a fresh take on health policy developments with 'Geronimo?' By Lisa Benson.

IT'S AN EVEN-NUMBERED YEAR

First they ran away
Now the health law is embraced
It's campaign season
- 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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Coverage & Access

Insurers, Employers Trimming Costs, Consumers Paying More

News outlets cover how companies are puzzling through the increasing costs of health care.

The Wall Street Journal: Insurers Push To Rein In Spending On Cancer Care
Insurers are changing how they pay for cancer care, aiming to blunt soaring costs and push oncologists to adhere to standardized treatment guidelines. The largest effort yet is set to be unveiled by WellPoint Inc., which will begin offering oncologists a $350-per-month payment for each patient who is on one of the insurer's recommended regimens. WellPoint, the No. 2 insurer in the U.S., will roll out its new program July 1 in six states and through its entire network by the middle of next year (Wilde Mathews, 5/27).

Kaiser Health News: 7 Things You Should Know About The Next Big Benefit Change
After getting a green light from the Obama administration earlier this month, more employers may begin to cap what they pay for certain medical treatments, such as joint replacements and drugs, potentially shifting more costs to workers. Done right, economists and policy experts say the move to "reference pricing," as the approach is known, could slow health care spending by prompting consumers to choose less expensive providers or treatments— and leading providers to lower their charges. Still, consumer advocates warn that the approach is likely to make health insurance even more complex (Appleby, 5/28).

NPR: How To Shop For Long-Term Care Insurance
One of the toughest money decisions Americans face as they age is whether to buy long-term care insurance. Many people don't realize that Medicare usually doesn't cover long-term care, yet lengthy assisted-living or nursing home stays can decimate even the best-laid retirement plan. Long-term care insurance is a complex product that requires a long-term commitment if you're buying it. So how can you tell if this insurance is right for you? (Tripoli, 5/28).

USA Today: Many Employees Hit With Higher Health Care Premiums
More employees are getting hit with higher health insurance premiums and co-payments, and many don't have the money to cover unexpected medical expenses, a new report finds. More than half of companies (56%) increased employees' share of health care premiums or co-payments for doctors' visits in 2013, and 59% of employers say they intend to do the same in 2014, according to the annual Aflac WorkForces Report. It's based on a survey of 1,856 employers and 5,209 employees at small, medium and large-size companies (Hellmich, 5/28).

Reuters: Insurers Scrutinize Drug Costs After $84k Sovaldi Surprise 
Shocked by the rapid adoption of a new $84,000 hepatitis C treatment, U.S. health insurers are trying to make sure they aren’t blindsided by other drugs being developed and are looking for ways to limit their use from the day they are launched. Manufacturer Gilead Sciences Inc says 30,000 people have received hepatitis drug Sovaldi so far, and that sales hit a record-breaking $2.3 billion within a few months. The treatment, typically 84 pills taken over 12 weeks, completely cures the disease in more than 90 percent of patients (Humer and Beasley, 5/28).

Meanwhile, on Medicare -

The Hill: Investigative Reporters Suing CMS For Medicare Advantage Data
The Center for Public Integrity filed a lawsuit against the CMS Tuesday to force the agency to release copies of program audits, billing data and the identities of any health plans suspected of overcharging the government under Medicare Advantage. Fred Schulte, a senior reporter at the CPI, requested the information in May of 2013. While the CMS acknowledges it received the letter in June, the request has since stalled (Al-Faruque, 5/27).

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Administration News

Hagel Orders Review Of Military Health System After 2 Deaths

The order follows the dismissal of the commander of one of the military's busiest hospitals for active-duty personnel in Fort Bragg, N.C., after two young men died unexpectedly and amid furor over the care provided to veterans in the system run by the Department of Veterans Affairs.

The New York Times: Army Ousts Commander Of Hospital After Deaths
The Army ousted the commander of one of its busiest hospitals and suspended three top deputies on Tuesday after two patients in their 20s who had visited the hospital's emergency room died unexpectedly in the previous 10 days. The shake-up at the hospital, Womack Army Medical Center at Fort Bragg, N.C., came at a moment of heightened sensitivity about health care in the military community, stirred by the furor over treatment delays in the separate medical system serving the nation's veterans. Late Tuesday, Defense Secretary Chuck Hagel ordered a broad review to ensure that military patients — many of them active-duty service members and their families — are not facing similar problems (LaFraniere, 5/27).

The Washington Post: Hagel Orders Review Of Pentagon Health-Care Facilities
Defense Secretary Chuck Hagel on Tuesday announced a sweeping review of the Pentagon’s health-care facilities born out of concern that it could be suffering from strains similar to those afflicting the Department of Veterans Affairs system. Officials said the review, which they expect to take 90 days, was not triggered by the type of lapses and whistleblower allegations that have thrust several VA hospitals around the country into a politically charged scandal (Londoño, 5/27). 

The Wall Street Journal: Hagel Orders Review of Military Health Care
Mr. Hagel planned to meet Wednesday morning with his top deputy and military leaders to discuss the 90-day review, a senior officer said. The announcement came hours after the Army removed the head of one of its busiest hospitals where two patients unexpectedly died after visits to the emergency room in recent days, military officials said (Nissenbaum, 5/27).

NBC News: Hagel Orders Review Of Military Health System 
Defense Secretary Chuck Hagel on Tuesday ordered a 90-day comprehensive review of the military health system in the wake of allegations that Veterans Affairs hospitals falsified data about how quickly veterans were being treated. The Pentagon said Dr. Jonathan Woodson, the assistant defense secretary for health affairs, would lead the review, focusing on access to health care and quality of that care (Aegerter, 5/28).

The Associated Press:  Hagel Orders Review Of Military Health System
[The review] will assess the quality of the health care at military treatment facilities as well as the care the department buys from civilian providers. The system provides care for more than 9.6 million active duty personnel, retirees and eligible family members (Baldor, 5/27).

Reuters:  Pentagon Chief Orders Medical Care Review Amid Problems At Hospital
Rear Admiral John Kirby, the top Pentagon spokesman, said in a statement the review would examine "whether current access to care meets the department's standards" as well as "the safety and quality of care provided to all Department of Defense beneficiaries" (Alexander, 5/28).

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Michelle Obama Wades Into Political Debate On School Lunches

Republican proposals would allow some schools to delay enforcement of new standards.

The New York Times: First Lady Rebuts Effort To Weaken School-Lunch Rules
Michelle Obama turned uncharacteristically political on Tuesday, pushing back against a measure pending in the Republican-controlled House that would let some schools opt out of federal dietary standards for school lunches. The standards, approved by Congress and the president in 2010, set limits on sodium, fat and calories, and require that unhealthy menu items be replaced with fruits, vegetables and whole grains (Joachim, 5/27).

The Washington Post: Michelle Obama Says It's Time To 'Fight The Hard Fight' For School Lunch Program
"The last thing we can afford to do right now is play politics with our kids' health," she told a roundtable meeting hosted by the White House. "Now is not the time to roll back everything we have worked for" (Hamburger, 5/27).

NBC News: First Lady Responds To School Meal Critics In Congress
Serving healthier food has aided young people's academic performance and helped them develop better eating habits at a time when childhood obesity is at an alarming high, according the round table participants. The remarks came a week after a House subcommittee advanced Republican legislation that would allow some schools to waive healthier school food standards championed by the first lady. The House Appropriations Committee is expected to approve the bill this week (Rafferty, 5/28).

Los Angeles Times: First Lady Decries Plan To Lower School Lunch Nutrition Standards 
Since lobbying on behalf of the Healthy Hunger-Free Kids Act of 2010, which set new standards for school food, Obama has rarely waded into legislative or regulatory debates. ... the law is being challenged in Congress by the School Nutrition Assn., a coalition of school officials and the food companies that sell mini-pizzas, yogurt, pastas and chicken nuggets to schools. Its industry members include Pizza Hut, Coca-Cola, Chobani Greek yogurt and Tyson Food Service, according to the group's website. (Hennessey, 5/27).

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Health Reform

Some Democrats Using Health Law Against GOP

Dems are taking a "more assertive stance" as Republicans are attempting to nuance their attacks as they move past primaries and into the mid-term election. 

The Wall Street Journal: Some Democrats Talking Up Health Law On Stump 
Not long ago, many Democrats were in a defensive crouch when it came to health care, amid public anger about the botched rollout of the federal website to sign up for insurance and stories of people who lost existing coverage because it didn't meet federal standards. ... Now, in at least half a dozen competitive Senate and gubernatorial races, Democrats and their allies are airing TV commercials that directly support the legislation, focusing on its guaranteed coverage for pre-existing conditions, preventive-care benefits and a ban on charging women more for insurance (Meckler, 5/27).

The Wall Street Journal: How GOP’s Health-Law Attacks Are Evolving
Republicans have engaged in an unrelenting attack on Democrats running in tough elections over the Affordable Care Act. But as the primaries give way to the general elections, GOP strategy around health care also may shift. Republicans won’t back off their push to repeal the law, but the message is likely to be more nuanced, said Bill McInturff, a Republican pollster who has long studied the politics of health care. ... to appeal to a wider swath of voters in a general election, and to respond to increasingly aggressive Democratic attacks, he said Republicans will need to be more specific about what isn’t working (Meckler, 5/28).

The Washington Post's Fact Checker: GOP Candidate Gets CBO Finding On Obamacare Right, But His Ad Doesn’t
Mark Jacobs is a wealthy businessman seeking the Republican nomination for an open U.S. Senate seat in Iowa. He had a healthy lead, but state senator Joni Ernst has caught fire with some provocative ads, including one when she literally shoots a gun as the ad promises she will “unload” on Obamacare. Jacobs’ sober ad on CBO’s findings doesn’t pack the same punch. But it’s an interesting case of the ad makers wanting to have their cake and eat it too (Kessler, 5/27).

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Despite New IRS Rule, Employers Can Still Send Workers To The Online Marketplaces

Nothing stops companies from canceling their health plans, as long as they pay the relevant taxes and penalties, KHN reports. Meanwhile other outlets examine some of the issues hospitals and doctors are facing under the health law.

Kaiser Health News: Capsules: Can Employers Dump Workers To Health Exchange? Yes, For A Price
The latest tweak from the Internal Revenue Service essentially prohibits employers from giving workers tax-free dollars to buy policies in the online public marketplaces created by the health law. ... Nothing stops employers from canceling company plans and leaving workers to buy individual policies sold through the exchanges — as long as they pay the relevant taxes and penalties, said Christopher Condeluci, a Venable lawyer specializing in benefits and taxes. Those will vary according to a company’s size and circumstances (Hancock, 5/28).

The Hill: Hospitals Face ACA Uninsured Funding Gap
Hospitals are in a state of uncertainty as to how to cover the funding gap from uninsured patients as Medicaid and Medicare are expected to decrease payments for those bills. A new report from the Urban Institute in the most recent Health Affairs journal notes Medicare payments to help compensate for the cost of treating the uninsured in hospitals are set to drop this year as more get coverage through the Affordable Care Act (ACA). Similar payments for Medicaid will begin to fall starting in 2016, which means the healthcare providers might have to take a larger financial hit (Al-Faruque, 5/27).

Medscape: Most Medical Groups Are In ACA Exchanges And Dislike It 
Group practices are participating in new insurance plans created by healthcare reform by and large, but they are grumbling about it, mostly because of administrative hassles and narrow provider networks, according to a new survey by the Medical Group Management Association (MGMA). Almost 77% of MGMA members have agreed to be network providers in 1 or more private insurance plans sold through state marketplaces, or exchanges, under the Affordable Care Act (ACA). The leading reason for signing up, cited by 58% of participants, was to remain competitive in their local market (Lowes, 5/27).

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Georgia Disputes Reports Of Big Medicaid Enrollment Jump

According to the state's Department of Community Health, the increase in enrollment was about 37,000, significantly lower than the nearly 99,000 estimated by a consulting group earlier this year. Connecticut also releases new Medicaid enrollment figures and the issue of expansion is debated in North Carolina and Indiana.

Georgia Health News: State Disputes Report Of Big Jump In Medicaid
Earlier this month, a consulting firm reported that Georgia’s Medicaid and PeachCare programs saw a huge enrollment spike of 98,800 in the first three months of 2014. Avalere Health said the rise in beneficiaries for Georgia and 16 other states that have not expanded their Medicaid programs was due largely to the "woodwork effect" ... But the Georgia Department of Community Health, responding to a GHN request, has released a much lower enrollment increase for the first three months this year: 37,047 (Miller, 5/27).

The CT Mirror: How Much Did Medicaid Grow Under Obamacare? Not As Much As You'd Think 
Connecticut officials promoting Obamacare have touted the fact that more than 200,000 people signed up for health care coverage in the first six months the state’s new insurance marketplace was open. But that doesn't mean 200,000 more state residents have health care coverage. For one thing, it's not clear how many of those who signed up were previously uninsured. And new data indicate that while Medicaid enrollment grew to a record level, the number of people covered didn't increase nearly as much as the sign-up figures would indicate (Levin Becker, 5/28).

Raleigh News & Observer: Democrats Push For Medicaid Expansion
Democrats will rally behind a pair of duplicate bills at a news conference on Wednesday at the Legislative Building to push for an expansion of Medicaid benefits. ... Republicans said the state system wasn’t prepared to handle the enrollment growth or the extra costs. Medicaid is already going to cost more than expected, and will lead to an undetermined shortfall this year. Democrats sponsoring the bills plan to use the news conference to put public pressure on Republicans to expand the coverage. They say passing the bill would produce a $26 million savings in state money in the coming fiscal year, which could be used to help offset the overrun (Jarvis, 5/27).

The Associated Press: Public Weighs In On Indiana Expansion Health Care Proposal
State officials are hearing from the public on a proposal to expand Medicaid using the state’s Healthy Indiana Plan. Gov. Mike Pence rolled out the proposal to expand coverage for low-income residents this month. It’s based on the hybrid health savings account plan already being used by the state, but also adopts some key requirements of Medicaid. The Family and Social Services Administration will host a public hearing on the plan Wednesday morning in Indianapolis (5/28).

And on the issue of state marketplaces -

The Oregonian: Tens Of Thousands Of Oregonians Switch Health Coverage, Driven By New Premiums, Transparency 
Tens of thousands of Oregonians have changed allegiances in the Oregon health insurance market as new reports show a massive reordering of the private-plan coverage landscape. Moda Health has taken top spot among health insurers in the individual market, as of March 31 more than doubling its 2013 enrollment numbers, according to the Oregon Insurance Division (Budnick, 5/27).

The Spokesman Review/Seattle Times: State Exchange Hopes To Help Families Find Health Care For Baby
A baby's health-care costs can be surprisingly big, averaging $4,551 in the first year, according to one March of Dimes report. Washington's Health Benefit Exchange points to those high costs as it encourages new parents to use 60-day "special enrollment" periods to buy insurance through the system even after the open enrollment period, which ended in March. The exchange's online marketplace, the Washington Health Plan Finder created under the Affordable Care Act, allows private insurers to compete for business and those who qualify to sign up for Medicaid. The state exchange is trying to get the word out about the importance of coverage for infants for well-child checks and in case of illness (Rogers, 5/27).

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Medicaid

Feds Probe How States Set Medicaid Managed Care Rates

In addition, the Centers for Medicare & Medicaid Services is planning its first major update of Medicaid managed care regulations in more than 15 years, reports Modern Healthcare.

Modern Healthcare: Actuarial Study Could Affect Medicaid Managed-Care Rates
The CMS has unveiled two initiatives that could significantly affect pay and operations for Medicaid managed-care plans and healthcare providers serving millions of low-income and disabled Americans. The agency has launched a study of the adequacy of how the states set payment rates to plans, which in turn affects the adequacy of reimbursements to providers, said Camille Dobson, a senior policy adviser at the CMS, at the Institute for International Research's Medicaid Managed Care Congress in Baltimore on May 21. The analysis involves Medicaid policy staff teaming with the CMS' Office of the Actuary to determine if payments are actuarially sound. ... In addition, the CMS is in the process of drafting a sweeping new rule that will update managed Medicaid regulations (Dickson, 5/27).

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Public Health & Education

Shooting Spree Renews Mental Health, Firearms Debates

Friday's shootings spur California lawmakers to look at "gun violence restraining orders" to enable a subject's family or friends to petition a judge to grant orders prohibiting someone from keeping or purchasing a gun. They also focus attention on competing plans in Congress to help people plagued by mental illness.

USA Today: Shooting Spree Inspires Call For Mental Health Overhaul
Friday's stabbing and shooting spree in Santa Barbara, Calif., has renewed the debate over how and whether to require people with serious mental illness to get psychiatric care. Many families and advocates for people with serious mental illness say the country needs to change its standard for civil commitment, which allows people to be hospitalized against their will (Szabo, 5/27).

Los Angeles Times: Mass Killings Prompt Lawmakers To Propose New Firearms Bill 
The new firearms bill would create a "gun violence restraining order," using the same process employed for restraining orders in cases of domestic violence. If notified by a subject's family or friends that someone could harm himself or others, law enforcement officers would be able to petition a judge to grant a restraining order that could prohibit possession or purchase of a gun. ... Sam Paredes, executive director of the Gun Owners of California, called the proposal (AB 1014) offered by multiple lawmakers ..., a "knee-jerk reaction." California already has a system to prevent mentally ill people from obtaining weapons, he noted: an involuntary psychiatric detention known as a "5150" (McGreevy and Mason, 5/27).

The Boston Globe: DeLeo Pushes Tighter Gun Law 
House Speaker Robert A. DeLeo unveiled a proposal Tuesday for the most comprehensive changes to Massachusetts gun laws in 16 years, saying that the state cannot wait for federal action to curb gun violence. Under the bill, local police would be given expanded discretion to consider a person’s “suitability” to own a gun, the state would join a national database for criminal and mental-health background checks, and all private sales of firearms would be conducted in the presence of a licensed dealer (MacQuarrie, 5/28).

The Associated Press:  Isla Vista Rampage Adds Urgency For Mental Illness Laws
The killings of six people near UC Santa Barbara by an apparently deranged young man have focused attention on competing Democratic and Republican plans in Congress to improve government's ability to help people plagued by mental illness before they become front-page news. "Once again, our mental health system has failed and more families have been destroyed because Washington hasn't had the courage to fix it," Rep. Tim Murphy, R-Pa., a clinical psychologist and author of one of the bills, said hours after news of the killings in Isla Vista broke. "How many more people must lose their lives before we take action on addressing cases of serious mental illness?” (Freedman, 5/27).

The Sacramento Bee: California Democrats Call For Gun Restrictions After Isla Vista Killings 
On their first day back in the Capitol since the killing Friday night of six college students near UC Santa Barbara, Democrats in the California Legislature on Tuesday said the state should do more to keep mentally ill people from obtaining guns. Democratic Assembly members Das Williams of Santa Barbara and Nancy Skinner of Berkeley announced they will introduce a bill that would allow concerned family members or friends to notify authorities when a loved one is at risk of committing violence (Rosenhall, 5/27).

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Health Care Marketplace

UK Opens Criminal Inquiry Into GlaxoSmithKline Business Practices

The British pharmaceutical company said it is cooperating with the investigation.

The New York Times: GlaxoSmithKline Under Investigation By Serious Fraud Office
The British drug maker GlaxoSmithKline said late Tuesday that the Serious Fraud Office of Britain had opened a formal criminal investigation into its “commercial practices.” Neither GlaxoSmithKline nor the fraud office provided further details about what practices were being investigated. ... Earlier this month, the Chinese authorities accused Mark Reilly, the former head of Glaxo’s operations in China, of ordering employees to bribe doctors and other hospital staff to use the drug maker’s products, resulting in more than $150 million in illegal revenue (Bray, 5/28).

The Wall Street Journal: Glaxo Being Investigated By U.K. Serious Fraud Office
The Brentford, England-based, multinational said it had been notified of the criminal inquiry Tuesday and was cooperating with investigators. "GSK is committed to operating its business to the highest ethical standards," the company said in a statement. ... The Serious Fraud Office is an independent government department under the U.K. Attorney General that investigates alleged fraud, bribery and corruption (Armental, 5/28).

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State Watch

Ohio Informs State Veterans On Medicaid About The Option Of VA Care

Some states have saved money by shifting veterans to the federally funded VA health system.

Columbus Dispatch: Ohio Veterans On Medicaid Might Have Option Of VA Care 
The state is taking preliminary steps toward notifying Ohio’s veterans who are currently enrolled in the state’s Medicaid program that they could qualify for a potentially richer set of federal health-care benefits. An undetermined number of Ohio’s 880,000 veterans are enrolled in Medicaid, and having a formal notification program, as 15 states do, has saved some programs money (Southerly, 5/27). 

Meanwhile, in other states -

Tulsa World: Providers Fear Medicaid Cuts Could Limit Patients' Access To Care 
As part of the overall budget agreement in the state Legislature, the Oklahoma Health Care Authority will receive a flat budget next year. The authority administers the state’s Medicaid program using a combination of federal and state funds. The state is proposing to cut payments to medical providers such as Wheaton who treat Medicaid patients to make up for a projected $90 million budget deficit next fiscal year. Other proposed program cuts include eliminating dental care for pregnant women and doubling co-pays for prescriptions (Branstetter, 5/28).

Rochester Democrat & Chronicle: Xerox To Revamp NY's Medicaid System 
Xerox Corp. has been awarded a major contract to revamp the state's massive Medicaid management system, according to the state Department of Health. The document imaging giant is in line to receive the five-year contract worth an estimated $500 million, Health Department spokesman Bill Schwarz said Tuesday (Campbell and Daneman, 5/27). 

The Associated Press: Naturopaths Added To Washington State Medicaid Provider List 
Amanda Lewis and her husband use a naturopathic doctor, covered by their private insurance plan, as their primary care provider. But up until this year, Lewis had to pay $95 a visit for her young son because naturopaths in the Washington state weren’t authorized to be part of the Medicaid plan under which he was covered. That out-of-pocket cost was reduced to zero after state officials moved to change the rules that had previously excluded naturopaths from the health insurance program for low-income patients (LaCorte, 5/28).

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State Highlights: Kan. Mental Health Funding; EHR Problems Claim CEO's Job

A selection of health policy stories from Arkansas, Florida, Georgia, Kansas, Michigan, Montana, Ohio, and Wyoming.

Kansas Health Institute: Kansas Gov. Finds Additional $9.5M For Mental Health 
Gov. Sam Brownback today announced that his administration will spend an additional $9.5 million on services for the mentally ill in the fiscal year that begins July 1. “This is a major, important issue,” Brownback said during an afternoon press conference at the Statehouse. Most of new money - $7 million – will come from the state’s federally funded Temporary Assistance for Needy Families block grant (Ranney, 5/27).

Modern Healthcare: Ga. Hospital CEO Resigns After Bumpy Electronic Health Record Rollout 
Athens (Ga.) Regional Medical Center President and CEO James Thaw resigned amid complaints from the medical staff that his administration bungled the implementation of an electronic health-record system, according to local news reports. The rollout of a Cerner Corp. EHR system went live May 4 in “most areas” of the organization, according to a news release issued at the time. Plans called for the system to extend to Athens Regional's employed physician offices and its four urgent-care centers on Tuesday (Tahir, 5/27).

The Associated Press: As Tribal Health Care Woes Mount, Feds Get Blame 
Misdiagnosed illnesses, denied payments and a shortage of trained medical personnel in government-run clinics are wrecking the federal health care system for Native Americans, tribal leaders said Tuesday as they pressed officials to overhaul a system beset with problems. With the head of the Indian Health Service listening on, representatives of seven Montana and Wyoming reservations delivered a litany of health care woes suffered by their members during a U.S. Senate Indian Affairs Committee field hearing in Billings (Brown, 5/28).

The Associated Press: Ohio Programs Win Funds To Help Moms Addicted To Heroin 
Four programs in Ohio are receiving grant money to help pregnant women who are addicted to heroin or other opiates as the state looks to combat drug abuse and its effects on children. The $4.2 million, three-year pilot project is expected to help close to 300 women who are addicted to prescription painkillers and heroin. The state recently awarded some funds to treatment and counseling programs in Cuyahoga, Athens, Franklin and Hamilton counties. Ohio officials hope to reach the expectant mothers early in their pregnancies and work with them through their recovery process (Sanner, 5/27).

Miami Herald: To Promote Breastfeeding, Hospitals Stop Giving Out Infant Formula Samples 
In an effort to promote breastfeeding, Jackson Health System is no longer handing out goody bags with infant formula samples and instead is giving new mothers its own breastfeeding discharge bags that include information on support groups, where to find breast pumps and how to collect and store breast milk. The change in the longtime policy is part of an effort to achieve the Baby Friendly designation, a global standard of care program launched by the World Health Organization and UNICEF to encourage breastfeeding and recognize hospitals and birthing centers that offer support for what the American Academy of Pediatrics considers the optimal level of infant feeding (Veciana-Suarez, /27).

The Associated Press: Orthodontist Challenges Ark. Law On Stand-alone Services 
A Jonesboro orthodontist has filed a federal court challenge to an Arkansas law that bars dental specialists from offering stand-alone basic services such as cleanings and X-rays. The lawsuit filed Tuesday in U.S. District Court in Little Rock argues that it is unconstitutional to prohibit orthodontists — dentists who specialize in straightening teeth — from performing nonemergency stand-alone services outside of their specialty. Dr. Benjamin Burris, who operates offices in Blytheville, Forrest City, Jonesboro, Paragould and West Memphis, signed a consent order in November with the Arkansas Board of Dental Examiners in which he agreed to stop offering cleanings and X-rays to patients he's not fitting for braces (Bartels, 5/27). 

The Associated Press: Rape Kit Testing Rules Move Forward In Michigan Legislature 
When 11,000 untested rape kits were discovered in Detroit in 2009, Michigan officials faced two major questions going forward: How to resolve the backlog, and how to keep new rape kits from meeting the same fate. As analysis of those kits continues, lawmakers are considering legislation to speed up testing for future rape kits, which contain DNA and other evidence collected after a reported sexual assault. The state House unanimously passed a bill Thursday that would set time limits for kit retrieval and analysis by law enforcement (5/27).

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Editorials and Opinions

Viewpoints: Who Is Responsible For Mentally-Ill Shooters?; Privatizing VA

The New York Times: Why Can't Doctors Identify Killers?
Mass killers like Elliot Rodger teach society all the wrong lessons about the connection between violence, mental illness and guns — and what we should do about it. One of the biggest misconceptions, pushed by our commentators and politicians, is that we can prevent these tragedies if we improve our mental health care system. ... In every state, we should prevent individuals with a known history of serious psychiatric illness or substance abuse, both of which predict increased risk of violence, from owning or purchasing guns. (Dr. Richard A. Friedman, 5/27).

The New York Times: As Congress Sleeps, More People Die
In the days since the Isla Vista shooting, some lawmakers have talked about finding new ways to keep guns out of the hands of people with a history of mental illness. The proposals would barely reduce gun violence and could be effective only if a universal background check system were in place, but they are still worth pursuing. The best ideas along these lines require a better definition of how severe a mental illness needs to be before it prevents someone from possessing a gun, and how to share information about illness with a state or federal background system. Currently, federal law prohibits gun ownership by felons or anyone who has been involuntarily committed to a mental health institution, a high bar that obviously misses thousands of people (5/27).

USA Today: Help Keep Guns From Madmen: Our View
Like other deranged killers, many of them young men with psychosexual problems, Rodger passed background checks and bought his guns legally. ... In Santa Barbara, there was a huge missed opportunity after the shooter's parents saw their son's disturbing videos on YouTube and alerted authorities. Sheriff's deputies went to the young man's apartment — which held his guns, his ammunition and a detailed plan for his killing spree — but he easily convinced them he was no threat to himself or others (5/27). 

The Wall Street Journal: Doctors' War Stories From VA Hospitals
In my experience, the best thing that a patient in the VA system could hope for was that the services he needed were unavailable. When that is the case, the VA outsources their care to doctors in the community, where their problems are promptly addressed. But these patients still need to return to the VA system for other services and get back on a long waiting list. ... The men and women who have served in our armed forces should be supplied with a federally issued insurance card allowing them to receive their care in the community where it can be delivered better and more efficiently (Dr. Hal Scherz, 5/27).

The Wall Street Journal: Avoiding The Wrong Lessons From The VA And HealthCare.gov Problems 
Problems with the launch of HealthCare.gov and with veterans hospitals allegedly concealing long waits for care feed a narrative that government doesn’t work. But many government programs, including Medicare and Social Security, work well. And there are as many examples of corporate bungling–GM and its ignition switches, BP in the Gulf–as there are of government bungling. ... Ultimately, workarounds and corporate-sounding titles are short-term fixes. We are also likely to hear calls soon to privatize VA health care. The real challenge is to make the government work better (Drew Altman, 5/27).

Bloomberg: Why Obama Can't Fix The VA 
As it happens, I believe the administration’s supporters when they say that this scandal was a long time in the making, and that no one president can be entirely to blame. Fundamentally, this points to the difficulty of reforming any institution, and especially a government agency. Yet it also points to one of the cardinal weaknesses of Obama’s presidency: his prolonged hubris about how much a really smart, caring president could change the way government operates (Megan McArdle, 5/27).

Bloomberg: The VA Needs A Good Marine 
Obama called Shinseki in, but kept him on, even though members of both parties and the American Legion say it is time for him to go. A Vietnam vet whose right foot was partially blown off, Shinseki also showed bravery when he defied President George W. Bush by calling out his proposed troop deployment to Iraq as way too low. He’s had no such public moment in six years. It's a parody of crisis management that in a flat voice he said he was mad as hell. Let's find someone who is. As they might say in Hollywood, "Get me a Jim Webb" (Margaret Carlson, 5/27).

The Wall Street Journal: A Cautious Step Toward Republican Reform
The conservative manifesto "Room to Grow," released May 22 by the advocacy group YG Network—the YG stands for Young Guns—offers a glimpse of a similar effort among today's Republicans. The document's scope is limited—deliberately, I assume. ... Public-policy analyst James Capretta offers the best conservative proposal so far to replace the Affordable Care Act. But while he stresses the law's unpopularity, he avoids a salient fact: 58% of Americans want their politicians to improve the ACA, ... A stance that rallies the faithful in the midterms may well repel the majority in a national election (Willam A. Galston, 5/27).

The Washington Post: Would Michelle Nunn And Alison Lundergan Grimes Have Voted For Obamacare? Why They’ll Never Tell.
Democrats Alison Lundergan Grimes and Michelle Nunn have a lot in common. That's especially true when it comes to Obamacare. Neither U.S. Senate candidate will say whether she would have voted for the federal health-care law in the U.S. Senate. Why? The political realities of their races are such that they pretty much have no other choice (Sean Sullivan, 5/27). 

Forbes: A Labor Union Prepares To Strike, As Obamacare Ups Health Insurance Costs By 5.0-12.5%
Labor unions have, of course, been among President Obama’s most reliable supporters. Unions’ support was critical to the passage of Obamacare in 2010. But unions are continuing to learn, to their apparent surprise, that their members will bear many of the costs of the new health law. Now we learn that some laborers are preparing to strike, if they are forced to absorb the higher health-insurance costs that the Affordable Care Act requires (Avik Roy, 5/27).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
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.