Daily Health Policy Report

Friday, May 30, 2014

Last updated: Fri, May 30

KHN Original Reporting & Guest Opinion

Administration News

Capitol Hill Watch

Health Reform

Medicare

Health Care Marketplace

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

FAQ: VA And Military Care Are Different, But Often Confused

Kaiser Health News staff writer Julie Rovner reports: “It’s not just veterans who are having trouble with health care. Now the health system for active duty military is under the microscope, too. Longstanding issues with an overburdened system for caring for the nation’s veterans have burst into the news recently, particularly with allegations of fraudulent record-keeping to hide the size of the waiting list for care at the Phoenix Veterans Affairs Health Care System” (Rovner, 5/29). Read the story.

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A Reader Asks: Can I Cancel My Marketplace Plan If My Boss Decides To Offer Coverage?

Kaiser Health News consumer columnist Michelle Andrews answers this reader’s question (5/20). Read her response.

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Frustrated By The Affordable Care Act, One Family Opts Out

Houston Public Media’s Carrie Feibel, working in partnership with Kaiser Health News and NPR, reports: “The Robinson family of Dallas, Texas started out pretty excited about their new insurance plan under the Affordable Care Act. Nick Robinson turned to Obamacare after he lost his job last summer. He had been working as a youth pastor, and the job included benefits that covered him, his two young daughters, and his wife Rachel, a wedding photographer. Nick says he wasn't too nervous at first, because everyone was healthy. Then, he recalls, they found out Rachel was pregnant” (Feibel, 5/30). Read the story.

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Capsules: Most Americans Say The Health Law Has Not Affected Their Families: Poll

Now on Kaiser Health News’ blog, Mary Agnes Carey reports: “More than four years after enactment of the health law, six in 10 Americans say neither they nor their families have been affected by the sweeping measure, according to a poll released Friday. Among those who say the law has impacted them, Republicans are much more likely to say their families have been hurt by the law (37 percent) than helped (5 percent), while Democrats are more likely to say their families have been helped (26 percent) than hurt (8 percent), according to The Kaiser Family Foundation’s monthly tracking poll (Carey, 5/30). Check out what else is on the blog.

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Adult Foster Care Aid May Be At Risk, Advocates Say

The Detroit News' Karen Bouffard, working in partnership with Kaiser Health News, reports: "The Affordable Care Act is expected to save Michigan hundreds of millions of dollars annually in mental health costs, but there’s a growing dispute over whether the money should be immediately reinvested in mental health programs, or banked. As part of major changes associated with the health care overhaul, also known as Obamacare, Michigan opened Medicaid to nearly 500,000 additional residents. That moves their health care costs — including mental health — off the state’s books and onto the federal government’s" (Bouffard, 5/30). Read the story.

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Obamacare Lightens Load For Cancer Patients

The Chicago Tribune's Judy Peres, working in partnership with Kaiser Health News, reports: "Fiona O'Connell is familiar with the working person's health care nightmare — the one where you get too sick to work, and then you lose your job, and then you have no insurance to pay for the treatment you need. O'Connell lived that nightmare, and she's still bitter and angry. But now she can talk about it in the past tense. As of Jan. 1, the cancer survivor has medical insurance under the Affordable Care Act. One of the central provisions of the law is that no one can be denied coverage or charged higher premiums because of a pre-existing condition. And there are no annual or lifetime caps on insurance coverage" (Peres, 5/29). Read the story.

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Political Cartoon: 'Watch That Nail Gun?'

Kaiser Health News provides a fresh take on health policy developments with "Watch That Nail Gun?" by Bill Thomas.

Meanwhile, here's today's haiku:

COUNTDOWN TO SUMMER?

School is almost out.
But school lunches still cause fits.
In Congress, that is.
-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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Administration News

VA Chief Shinseki Apologizes And Says He Is Replacing Leadership At Troubled Phoenix VA Hospital

Two days after a preliminary Inspector General report confirmed secret waiting lists at a Phoenix veterans hospital, Veterans Affairs Secretary Eric Shinseki addresses a conference on homeless veterans and says the breach of integrity "is indefensible." He meets today with President Obama amid calls for his resignation in Congress.

The New York Times: Shinseki Apologizes For 'Lack of Integrity' At V.A. Hospitals
The secretary of the Department of Veterans Affairs, Eric Shinseki, apologized to veterans and lawmakers on Friday for the agency’s mismanagement of the nation’s veterans hospitals as he prepared to meet with President Obama, his job on he line, over the widening scandal. “After Wednesday’s release of an interim inspector general report, we now know that V.A. has a systemic, totally unacceptable lack of integrity within some of our veterans’ health facilities,” Mr. Shinseki told a conference of the National Coalition for Homeless Veterans. "That breach of integrity is irresponsible, it is indefensible and it is unacceptable to me," he said (Shear and Joachim, 5/30).

Politico: Eric Shinseki: VA Problems 'Indefensible'
After his remarks, Shinseki said he wanted to "address the elephant in the room" and laid out what he said were the next steps to resolve the scandal. ... But Shinseki said VA has shown before that it can solve difficult problems. He said he would remove the leadership at the Phoenix VA hospital, where the scandal began; suspend bonuses for some VA senior leaders for 2014; and endorse legislation backed by Senate Veterans Affairs’ Committee Chairman Bernie Sanders (I-Vt.) that would make it easier to fire some employees (Ewing, 5/30).

Los Angeles Times: VA Chief Eric Shinseki Pledges Urgent Healthcare Fixes
Veterans Affairs Secretary Eric K. Shinseki called in leaders of key veterans groups Thursday and pledged to keep VA hospitals open nights and weekends if necessary to set up speedy appointments for veterans whose long waits for medical care have triggered a growing crisis at the massive agency (Simon and Hennessey-Fiske, 5/29).

The Wall Street Journal: VA's Eric Shinseki Under Fire Amid Scandal
During his 38-year military career, Eric Shinseki recovered from losing half of his right foot to a land mine in Vietnam, went on to be awarded the Bronze Star for valor in combat and became the Army's chief of staff. His latest battle is to stave off bipartisan criticism long enough to rehabilitate the Department of Veterans Affairs after a report Wednesday that swayed many of his former supporters in Congress to begin calling for his resignation (Kesling and Nissenbaum, 5/29).

The New York Times: Doctor Shortage Is Cited In Delays At V.A. Hospitals
Appalled by what she saw, Dr. Hollenbeck filed a whistle-blower complaint and changed jobs. A subsequent investigation by the Department of Veterans Affairs concluded last fall that indeed the Jackson hospital did not have enough primary care doctors, resulting in nurse practitioners’ handling far too many complex cases and in numerous complaints from veterans about delayed care. “It was unethical to put us in that position,” Dr. Hollenbeck said of the overstressed primary care unit in Jackson. “Your heart gets broken” (Oppei and Goodnough, 5/29). 

ABC News: Shinseki Meets With Veterans Groups, No Sign of Resigning 
One day after the bombshell interim Inspector General report showing “secret waiting lists” at a Phoenix veterans hospital, Veterans Affairs Secretary Eric Shinseki met with leading veteran service organizations today. The embattled secretary, who faces an ever-growing list of lawmakers asking for his resignation, showed no signs he has plans to leave anytime soon, despite a growing outcry fueled by the report, which showed that as many as 1,700 veterans in need of care were “at risk of being lost or forgotten” by not being placed on the official waiting list (Marshall and Larotonda, 5/29).

The Washington Post: Calls For VA Secretary Eric Shinseki To Resign Intensify Following Watchdog Report
Veterans Affairs Secretary Eric K. Shinseki made an impassioned case Thursday to Democratic lawmakers and veterans groups that he can repair the Department of Veterans Affairs, even as calls for his resignation mounted and support from the White House appeared to wane. The White House skirted questions about whether President Obama still has confidence in Shinseki’s ability to lead the department and a spokesman said the president is withholding judgment about who is responsible for the department’s failings until he reviews pending investigations of what went wrong (Jaffe and O’Keefe, 5/29).

Kaiser Health News: FAQ: VA And Military Care Are Different, But Often Confused
It’s not just veterans who are having trouble with health care. Now the health system for active duty military is under the microscope, too. Longstanding issues with an overburdened system for caring for the nation’s veterans have burst into the news recently, particularly with allegations of fraudulent record-keeping to hide the size of the waiting list for care at the Phoenix Veterans Affairs Health Care System (Rovner, 5/29).

The Associated Press: Q &A: How Do US Veterans Get Health Care? 
The Department of Veterans Affairs, which oversees pensions, education, health care and other benefits for veterans and their families, faces allegations about treatment delays and falsified records at its hospitals around the country. The aging network of hospitals and clinics — the VA opened its first new medical center in 17 years in 2012 — is one of the world’s largest integrated health care systems (5/30).

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Capitol Hill Watch

VA Scandal Becomes Issue In Congressional Campaigns

As probes of Veterans Affairs hospitals continue, Democratic and Republican candidates are pointing fingers and attempting to find political advantage in the controversy.

CBS News: VA Scandal Makes Its Way Into The Midterm Campaign 
As federal investigators try to get to the bottom of the misconduct -- and potentially criminal activity -- in the Veterans Affairs hospital system, calls for VA Secretary Eric Shinseki to go are mounting. Politicians, however, aren't stopping there -- as they demand accountability for the serious problems in the VA system, both Democrats and Republicans are pointing fingers at their midterm opponents. "Let's Make 2014 About Veterans," the Democratic Senatorial Campaign Committee (DSCC), the Senate Democrats' campaign arm, declared at the top of a slew of press releases Thursday, slamming Republicans' records on veterans' issues (Condon, 5/30).

The Associated Press: Analysis: Seeking Political Gain Over VA Issues
Republicans and Democrats alike want it both ways when it comes to any misdeeds at veterans hospitals, each side accusing the other of seeking unseemly political gain from the misfortune of the nation’s warriors, while simultaneously maneuvering for an advantage in midterm elections (5/30).

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Lawmaker Pushes Mental Health Reform Bill In Wake Of Calif. Shooting

Rep. Tim Murphy, R-Pa., held a forum Thursday in an effort to build momentum and consensus around this legislation.

NPR: Rep. Murphy Aims For Mental Health Bill To Pass Before Next Shooting
The latest mass shooting has lawmakers on Capitol Hill talking again about overhauling the mental health system. On Thursday, psychologists and others urged Congress to do more (Sullivan, 5/30).

The Hill: Republican Pushes Mental Health After Calif. Mass Shooting
A House Republican lawmaker is pushing his stalled mental health reform bill after a young man killed six people and then himself in Santa Barbara, Calif., over the weekend. Rep. Tim Murphy (R-Pa.) convened a forum Thursday intended to build momentum for his reform legislation, which House leaders have failed to green-light despite its standing as the GOP's policy response to mass shootings (Viebeck, 5/29).

In other news -

Fox News: House GOP Lawmakers Push For Republican Alternative To Obamacare
As the GOP keeps the pressure on President Obama’s signature health care law, some House Republicans are aiming for a vote this year on a GOP health care alternative ObamaCare, in part to show that the party has a position beyond merely repealing the law. Four months after House Majority Leader Eric Cantor, R-Va., promised that the House will vote this year on an alternative to the Affordable Care Act, The Wall Street Journal reports that GOP leaders are working with lawmakers and committee chairmen to reach some sort of consensus on what the plan should include (5/30).

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Health Reform

Health Advocates Allege 4 Fla. Insurers Discriminate Against HIV Patients

In a complaint to federal officials, the groups say the companies set high out-of-pocket costs for drugs to treat HIV and AIDS in an effort to discourage gay patients from picking the plans.

The Associated Press: Complaint Accuses 4 Fla. Insurers Of Discrimination
Two health organizations filed a complaint with federal health officials Thursday alleging some Florida insurance companies are violating the Affordable Care Act by structuring their insurance plans in a way that discourage consumers with HIV and AIDS from choosing those plans (Kennedy, 5/29).

The New York Times: Bias Claims For Insurers In Coverage Of H.I.V.
Health care advocates said on Thursday that four insurers offering plans in the new federal marketplace discriminated against people with H.I.V. or AIDS by requiring them to pay high out-of-pocket costs for drugs to treat H.I.V., including generic medications (Thomas, 5/29).

The Wall Street Journal: Insurers Accused Of Discriminating Against People With HIV
The complaint says the four insurers put every HIV drug, even older generics, in the highest tier in their drug formularies, requiring patients to pay as much as 50% of the cost themselves. HIV advocacy organizations have said the issue isn't specific to Florida and they believe a decision would influence plans across the country (Radnofsky, 5/29).

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Va. Senate Republican Offers Proposal On Medicaid Impasse

State Sen. Emmett Hanger seeks a compromise on the issue that threatens to shut down the state government because it has deadlocked negotiations on the budget.

The Washington Post: Va. Republican Offers Plan To End Medicaid Deadlock
A key Republican ally in Gov. Terry McAuliffe’s bid to expand health coverage for the poor offered a plan Thursday to a break a months-long deadlock on the issue. But he also split with the governor by questioning McAuliffe’s power to keep government running without a budget or to expand Medicaid on his own. Sen. Emmett W. Hanger Jr. (R-Augusta) offered a proposal to end the General Assembly’s budget-Medicaid stalemate, which threatens to shut down state government if it is not resolved by July 1, the start of the new fiscal year (Vozzella, 5/29).

The Associated Press: Senators Offers Compromise On Medicaid Impasses
Republican state Sen. Emmett Hanger of Augusta proposed Thursday changing how the Medicaid Innovation and Reform Commission votes on whether to expand Medicaid eligibility. Under current law, no expansion can take place unless the commission votes for it. Hanger is proposing that eligibility expand automatically unless actively voted against by the commission (5/29).

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Oregon Gov. Pursues Lawsuit Against Oracle

Gov. John Kitzhaber asks the state attorney general to start legal proceedings against the company that was paid $130 million to build the state's online exchange, which never functioned properly.

The Oregonian: Cover Oregon: Kitzhaber Says It's Time To Sue Oracle For Health Exchange Disaster 
Oregon's long-simmering feud with Oracle Corp. is about to break out into open warfare. Gov. John Kitzhaber has asked Attorney General Ellen Rosenblum to initiate legal action against the giant information technology company for its central role in the state's bungled effort to build a health insurance exchange. The state has paid Oracle well over $130 million for the exchange, which never operated as intended (Manning, 5/29).

The Associated Press: Oregon: Suit Sought Over Health Site
Gov. John Kitzhaber asked the state attorney general to sue the company that built the state's online health insurance enrollment system, the failure of which resulted in multiple investigations (5/29).

The Hill:  Oregon Gov. Urges Lawsuit Over ACA Debacle
Oregon Gov. John Kitzhaber (D) is seeking a lawsuit against the tech company he says is responsible for problems with the state's ObamaCare insurance exchange, according to a report.  Kitzhaber, who is running for reelection, wrote to state Attorney General Ellen Rosenblum asking her to consider a lawsuit against Oracle Corp. The company helped build the website for Cover Oregon (Viebeck, 5/29).

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Most Americans Say Health Law Has Not Affected Them

Among those who report being impacted, Republicans are much more likely to say they know someone who has been hurt by the law, while Democrats are more likely to say their families have been helped, according to The Kaiser Family Foundation's monthly tracking poll.

The Washington Post: Republicans Are Three Times More Likely Than Democrats To Say They Know Someone Who Was Hurt By Obamacare
Thirty-four percent of Republicans say they personally know someone who lost health-insurance coverage, lost their job or had their hours cut because of the Affordable Care Act, according to a poll released today by the Kaiser Family Foundation (Fuller, 5/30).

Kaiser Health News: Capsules: Most Americans Say The Health Law Has Not Affected Their Families: Poll
More than four years after enactment of the health law, six in 10 Americans say neither they nor their families have been affected by the sweeping measure, according to a poll released Friday. Among those who say the law has impacted them, Republicans are much more likely to say their families have been hurt by the law (37 percent) than helped (5 percent), while Democrats are more likely to say their families have been helped (26 percent) than hurt (8 percent), according to The Kaiser Family Foundation’s monthly tracking poll (Carey, 5/30).

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Sticker Shock Marks Newly Insured's Health Law Coverage

Also, federal regulators ponder if e-cigarettes are considered tobacco use -- allowing insurers to charge more in premiums to their users. And one Texas family's Obamacare opt-out story.

St. Louis Post-Dispatch:  ACA Scorecard:  Saving, But Glitches And Sticker Shock Too
Coverage has already kicked in for most people who selected an insurance plan under the Affordable Care Act marketplace, and St. Louis-area customers are speaking up about how their new policies are affecting them. Some people are happy, others not so much. David O’Leary, 43, a Web developer in St. Louis, previously had a small-business plan that covered his own family as well as his sole employee and child. ... Once Affordable Care Act coverage became available, he said he dissolved his small-business plan and gave his employee a raise to cover the costs of a plan on the exchange. The employee’s plan costs about $660 a month, and O’Leary’s family plan is less than $900 a month (Kulash, 5/30).

The Wall Street Journal: Burning Insurance Question: Are 'Vapers' Smokers?
Federal regulators are weighing whether health insurers who participate in Affordable Care Act exchanges can levy a tobacco surcharge on e-cigarette users, the latest point of debate over the products' health risks. The 2010 health law allows insurers in individual and small group markets to charge tobacco users as much as 50 percent more in premiums. But it doesn't specify whether that includes users of electronic cigarettes, battery-powered devices that turn nicotine liquid into vapor (Armour, 5/29).

Kaiser Health News: Frustrated By The Affordable Care Act, One Family Opts Out
The Robinson family of Dallas, Texas started out pretty excited about their new insurance plan under the Affordable Care Act. Nick Robinson turned to Obamacare after he lost his job last summer. He had been working as a youth pastor, and the job included benefits that covered him, his two young daughters, and his wife Rachel, a wedding photographer. Nick says he wasn't too nervous at first, because everyone was healthy. Then, he recalls, they found out Rachel was pregnant (Feibel, 5/30). 

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Medicare

CMS Won't Review Billings Despite IG Report That It Overpays Doctors

The move comes even as a report points at $6.7 billion in overspending in Medicare. The HHS inspector general also says that the program paid $457 million in 2012 to detect drugs after a sharp increase in prescription drug abuse.

NPR: Medicare Frequently Overpays Doctors For Patients' Visits
Medicare spent $6.7 billion too much for office visits and other patient evaluations in 2010, according to a report from the inspector general of the Department of Health and Human Services. But in its reply to the findings, the Centers for Medicare and Medicaid Services, which runs Medicare, said it doesn't plan to review the billings of doctors who almost always charge for the most expensive visits because it isn't cost-effective to do so (Ornstein, 5/29).

MSNBC: Medicare Paid Millions Of Dollars For Wrongdoings, Report Finds
Medicare paid doctors $457 million in 2012 for 16 million tests to detect drugs -- from prescription narcotics to heroin, according to a new report from Reuters. A sharp rise in prescription drug abuse among older Americans has caused a nationwide increase in urine and blood tests, procedures that typically are potential areas of fraud among providers. The Office of the Inspector General of Health and Human Services, which heads Medicare, first started investigating scams in such tests in 2011 (Richinick, 5/29).

Reuters: Exclusive: Medicare On Drugs: 24,000 Tests For 145 Patients
Three Connecticut doctors billed Medicare for nearly 24,000 drug tests in 2012 - on just 145 patients. Despite the extraordinary number, Medicare administrators paid the doctors a total of $1.4 million, according to a Reuters analysis of government payments to health providers. The three physicians stand out in the Medicare data released last month because they conducted three to four times more drug tests per patient than any other provider in the country. In fact, they ordered so many individual tests, their patients averaged one every other day (Pell and Begley, 4/29).

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Health Care Marketplace

Medtronic Settles Whistleblower Case For $9.9 Million

Suit accused the medical device maker of giving doctors gifts in return for using its products. Elsewhere, a federal judge denied dismissal of a lawsuit against Novartis alleging a kickback campaign to boost its drugs covered by Medicare and Medicaid.

The Associated Press: Medtronic Settles Whistleblower Lawsuit For $9.9M
Medical device maker Medtronic Inc. will pay the U.S. Department of Justice $9.9 million to settle a lawsuit that accused the company of giving doctors gifts in return for using its defibrillators and pacemakers. Medtronic has not admitted any wrongdoing as a result of the settlement. The lawsuit unsealed this week accused Medtronic of funneling "millions of dollars in unrestricted grant money to physicians" to get them to encourage the use of Medtronic defibrillators and pacemakers (5/29).

Reuters:  Novartis Must Face U.S. Government Lawsuit Alleging Drug Kickbacks
A federal judge on Thursday refused to dismiss a U.S. government lawsuit accusing Novartis AG of civil fraud for having conducted two illegal kickback schemes to boost sales of drugs covered by Medicare and Medicaid. U.S. District Judge Colleen McMahon in Manhattan rejected the argument by the Swiss drugmaker's Novartis Pharmaceuticals Corp unit that the lawsuit should be dismissed because the government had failed to show how it had been defrauded (Stempel, 5/29).

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State Watch

State Highlights: Mo.'s Declining Medicaid Caseload; N.C. Budget Would Cut Medicaid Rolls

A selection of health policy stories from Missouri, North Carolina, California, Wisconsin, Connecticut, Illinois, Maryland, Montana and Louisiana.

St. Louis Post Dispatch: Missouri's Declining Medicaid Caseload Stands Out In National Report
Missouri is seeing a bigger decline in its Medicaid rolls than nearly any other state, a ranking that the Nixon administration attributes to an improving economy and critics blame on application snafus. A new federal report compares Medicaid enrollment in March to the average for the three-month period of July through September 2013. Missouri's caseload declined 3.9 percent, a drop second only to Wyoming, which declined by 5.6 percent (Young, 5/30).

Raleigh News & Observer: Senate Budget Would Cut Elderly, Blind And Disabled From Medicaid Rolls
The Senate budget proposal upends the state Department of Health and Human Services by moving to take away its biggest responsibility, Medicaid. At the same time it would cut thousands of elderly and disabled people, and other beneficiaries with high medical bills, from the government insurance plan. This appears to be a first step Senate Republicans are proposing to cut Medicaid services and shrink the number of beneficiaries (Bonner, 5/29).

North Carolina Health News: DHHS, Hospitals, Medicaid Big Losers In Senate Budget 
After a year of missteps by the Department of Health and Human Services and years of budgeting problems in the state’s Medicaid program, members of the state Senate sent a message to the department: We’ve had enough of problems with Medicaid. In the Senate budget presented to the General Assembly early Thursday, budget writers indicated they want to  pull the Medicaid program out from DHHS and have it run separately (Hoban, 5/30).

Los Angeles Times: State A Step Closer To Minimum Wage Hike, Paid Sick Leave
Legislators moved Thursday to further hike the state's minimum wage and to guarantee workers three paid sick days a year, despite opposition from the California Chamber of Commerce, which labeled both proposals "job killers" (Mason and McGreevy, 5/29). 

Reuters:  California Lawmakers Advance Bill Mandating Paid Sick Leave
California businesses would have to offer paid sick leave to employees under a bill approved by the state Assembly on Thursday, and if the measure becomes law California would join Connecticut as the only U.S. states with such a mandate. The bill passed the Assembly by a vote of 48-20 and now moves on to the state Senate. The measure, authored by Democratic Assembly member Lorena Gonzalez, requires all employers to offer one hour of paid sick leave for every 30 hours worked. It would allow employers to limit the number of sick days a worker can take to three days (Chaussee, 5/29).

St. Louis Post-Dispatch:  Medicaid Contractor Was Top Financial Performer In St. Louis 
New business opportunities to serve the poor, elderly and sick in an expanding number of states, as well as new ventures outside its core business, drove Centene Corp. last year to record financial heights. The Clayton, Mo.-based manager of health care for the uninsured and downtrodden broadened its operations last year in Texas, Mississippi, Louisiana and Florida and began serving Medicaid beneficiaries in California, Kansas and New Hampshire. Centene took steps to further diversify by buying a specialty pharmacy company, participating in new health insurance marketplaces, and providing medical care in prisons (Doyle, 5/29).

Milwaukee Journal Sentinel: Medical College Helping Lead National Concussion Study
Putting it at the forefront of one of the most important issues confronting sports -- particularly youth sports -- the Medical College of Wisconsin will take a lead research role in a $30 million national study on concussions and head impact exposure. The research was announced at a White House summit early Thursday that focused on the effects of concussions on young athletes (Trimble, 5/29).

CT Mirror: Bill Would Encourage 'Warm Handoff' For Mental Health Treatment In Connecticut
Jeff Walter looked into having the clinicians from his mental health and substance-abuse treatment agency partner with nearby primary care practices. He knew well that many people with mental illness don’t get primary care, and that many people who need mental health care don’t receive it (Levin Becker, 5/30).

Chicago Sun-Times: Audit: State Paid $12 Million In Health Costs -- For Dead People 
Cook County has long been ridiculed for allowing dead people cast votes, but the state may have just garnered a new distinction. It paid $12 million in health care for people who were already dead -- including in one case, for a person who had died in 1989 (Korecki, 5/29). 

The Baltimore Sun: More Marylanders Going To Hospital Without Insurance 
Significantly fewer people have been going to Maryland hospitals this year without health insurance, according to new data provided to The Baltimore Sun by state officials, who now say the rates that hospitals charge will rise more slowly for everyone. Hospitals are supporting a recommendation by the Health Services Cost Review Commission, which sets their rates, to reduce a proposed annual across-the-board rate increase that will take effect in July by about a quarter (Cohn, 5/29).

ProPublica: Should A Mental Illness Mean You Get Your Child Taken Away? 
Under a concept sometimes called "predictive neglect," Missouri and about 30 other states allow courts to terminate a parent's connection to a child if authorities conclude a mother or father has a mental illness that renders them incapable of safely raising the child. Officials usually must present evidence that the illness poses a threat. Most cases involve significant mental illness, not run-of-the-mill depression or anxiety. Yet there need be no evidence of actual harm or neglect, just a conclusion that there is a risk of it (Wessler, 5/30).

The Associated Press: Montana Health Dept. Computer Server Hacked
Hackers have had access to a Montana Dept. of Public Health and Human Services’ computer server for nearly a year, and agency officials don't know whether the personal information of clients and employees stored there was stolen, a spokesman said Thursday. The server contains names, addresses, dates of birth, Social Security numbers and clinical information of people the agency serves, along with the Social Security numbers and bank account information of its employees (Volz, 5/29).

The Associated Press: Consulting Contract Review Bill Headed To Jindal
After four years of calling for cuts in state consulting contracts, a Thibodaux lawmaker has won passage of a scaled-back proposal to give the Legislature more oversight of the deals signed across state agencies. Rep. Jerome "Dee" Richard, an independent, sought to force a 10 percent cut on agencies' spending on consulting and professional services contracts. Senators repeatedly rejected the idea, which Richard has proposed since 2011 and which faced opposition from Gov. Bobby Jindal's administration. But rather than kill the bill this year, senators rewrote it to provide more review of the contracts and no required reductions (Deslatte, 5/29).

North Carolina Health News: A Closer Look At Foster Care In NC 
In the wake of two abuse scandals in foster homes, House lawmakers want to study the quality of Department of Social Services policies for DSS employees who are foster parents. The recommendations from a joint legislative committee formed after last year’s legislative session advised the creation of a continued study committee to more thoroughly examine the complicated DSS system (Namkoong, 5/30).

North Carolina Health News: Medical Cannabis Patients Push For Legalization At General Assembly 
Members of the North Carolina General Assembly have in the past introduced legislation that would make access to medical cannabis easier. But the current session is the first time members have proposed a constitutional amendment. Members of the North Carolina Cannabis Patients Network came to the legislature this week to make their rounds, advocating for the support of House Bill 1161 , which would put the issue to a vote. The bill, sponsored by Democrats in the state House of Representatives, would call for an amendment to the state constitution to legalize the medical use of cannabis (Singh, 5/29).

The Associated Press: Montana VA Health Director To Resign 
The director of the Veterans Affairs Montana Health Care System plans to resign after 16 months on the job, saying she wants to spend more time with her family, officials said Thursday. Christine Gregory, who was appointed in February 2013 to oversee the system that provides health care services for Montana veterans, will step down at the end of June, VA officials said in a statement (5/29).

The Associated Press:  Abortion Doctor Must Research Privileges, Judge Says 
A federal judge told a Milwaukee abortion doctor Thursday to renew his efforts to obtain hospital admitting privileges, hinting that it could resolve a lawsuit alleging a Wisconsin law requiring such privileges is unconstitutional. U.S. District Judge William Conley said he was "bewildered" that Affiliated Medical Services abortion provider Dr. Dennis Christensen and his attorneys haven't received definitive responses from any Milwaukee hospitals. He told them to demand better answers from two facilities where Christensen is seeking admitting privileges (Richmond, 5/29).

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Health Policy Research

Research Roundup: Surviving Trauma When Older; ACA's Big Waiver For States

Each week, KHN compiles a selection of recently released health policy studies and briefs.

JAMA Internal Medicine: Stability Of End-Of-Life Preferences
Policies and practices that promote advance care planning and advance directive completion implicitly assume that patients' choices for end-of-life (EOL) care are stable over time, even with changes in health status. ... We searched for longitudinal studies of patients' preferences for EOL care in PubMed, EMBASE, and using citation review. ... In 17 studies (71%) more than 70% of patients’ preferences for EOL care were stable over time. Preference stability was generally greater among inpatients and seriously ill outpatients than among older adults without serious illnesses. Patients with higher education and who had engaged in advance care planning had greater preference stability, and preferences to forgo therapies were generally more stable than preferences to receive therapies (Auriemma et al., 5/26).

JAMA Surgery: Association Between Race And Age In Survival After Trauma
Racial disparities in survival after trauma are well described for patients younger than 65 years. Similar information among older patients is lacking .... Trauma patients were identified from the Nationwide Inpatient Sample (January 1, 2003, through December 30, 2010) .... A total of 1,073,195 patients were included .... Different racial disparities in survival after trauma exist between white and black patients depending on their age group. Although younger white patients have better outcomes after trauma than younger black patients, older black patients have better outcomes than older white patients. Exploration of this paradoxical finding may lead to a better understanding of the mechanisms that cause disparities in trauma outcomes (Hicks et al., 5/28).

Journal of Health Politics, Policy and Law: Wyden's Waiver: State Innovation On Steroids
Section 1332 of Title I of the Affordable Care Act offers to state governments the ability to waive significant portions of the ACA, including requirements related to qualified health plans, health benefit exchanges, cost sharing, and refundable tax credits. It permits state governments to obtain funding that otherwise would have gone to residents and businesses through the ACA and to use those funds to establish, beginning in 2017, an alternative health reform framework within statutory limitations. ... Section 1332 has the potential to instigate a new, varied, and unprecedented array of state health sector innovations from both sides of the political divide over health care reform (John E. McDonough, 5/19).

The Urban Institute/The Robert Wood Johnson Foundation: Who Are The Newly Insured As Of Early March 2014?
Most newly insured adults are in the income groups targeted by the ACA's Medicaid expansion and the Health Insurance Marketplace subsidies. Newly insured adults tend to be younger than adults who had coverage for the full year; however, they are more likely to report fair or poor health than full-year insured adults. Newly insured adults often lack a strong connection to the health care system; many do not have a usual source of care and have not had a routine checkup in the past year (Adele Shartzer, Sharon K. Long, and Stephen Zuckerman, 5/22).

UCLA Center for Health Policy Research: A Little Investment Goes A Long Way: Modest Cost To Expand Preventive And Routine Health Services To All Low-Income Californians
[The] California legislature is considering a proposal (Senate Bill 1005, the Health for All Act) that would expand Medi-Cal coverage to include primary and preventive care, prescription drugs, mental health care, dental care, and other routine health services for all low-income California residents regardless of immigration status. ... This report finds that the proposed Medi-Cal expansion would involve new state spending, but the cost is modest in comparison to the impact on health and coverage, and the policy also produces savings. ... The net increase in state spending is estimated to be equivalent to 2 percent of state Medi-Cal spending .... The new spending would be substantially offset by an increase in state sales tax revenue from managed care organizations, in addition to savings from reduced county spending in providing care to the uninsured (Lucia et al., 5/21).

Here is a selection of news coverage of other recent research:

The Dallas Morning News: Cost An Indirect Measure Of Waste, Medicare Researcher Says
A growing body of health care research shows significant waste can be found by looking at the overuse of certain medical services. "Cost is an indirect measure of overuse," said Dr. Aaron Schwartz, a doctoral candidate at Harvard Medical School, who co-authored a recent report on Medicare waste published in The Journal of the American Medical Association (McClure, 5/24).

NPR: When Older People Walk Now, They Stay Independent Later
Millions of older people have trouble walking a quarter of a mile, which puts them at high risk of losing their mobility, being hospitalized or dying. ... researchers got people in their 70s and 80s to walk and do simple exercises in social groups. The people who did that were less likely to become disabled than those who attended classes on successful aging, according to a report published Monday in JAMA (Shute, 5/27).

Reuters: Cancer Center Ads More Emotional Than Informative
Television and magazine advertisements from cancer centers often tug at people's heartstrings, but rarely provide information needed to make a decision about cancer treatment, says a new study. "I think there is a concern in general and among some physicians that advertising may be creating some inappropriate demand for services or providing unrealistic expectations," Dr. Yael Schenker, the study's senior author from the University of Pittsburgh, said. She and her colleagues write in the Annals of Internal Medicine that most cancer centers in the U.S. use ads to tell people about their services, but there has been little research on the content of those messages (Seaman, 5/27).

Reuters: Stressful Relationships May Raise Risk Of Death
Worries, conflicts and demands in relationships with friends, family and neighbors may contribute to an earlier death suggests a new Danish study. "Conflicts, especially, were associated with higher mortality risk regardless of whom was the source of the conflict," the authors write. "Worries and demands were only associated with mortality risk if they were related to partner or children." Men and people without jobs seemed to be the most vulnerable, Rikke Lund, a public health researcher at the University of Copenhagen, and her colleagues found (Jegtvig, 5/26).

Reuters: Most Doctors Wouldn't Want Intensive Care At End Of Life
Most doctors would not want high-intensity treatment near the end of life, according to a new study from Stanford University School of Medicine. In 2013, researchers surveyed nearly 1,100 young doctors who were finishing their training in a variety of medical specialties. Nearly nine in 10 said they would choose a do-not-resuscitate status near the end of life. "We see too much in our practice and training when high-intensity treatments actually hurt patients," says Vyjeyanthi Periyakoil, a geriatrician who led the study (Belisomo, 5/28).

Modern Healthcare: Heroin Followed Rx Painkillers To Small Towns, Study Finds
The face of drug addiction within the U.S. has changed considerably over the past 50 years, according to a new study. Heroin use has spread to the suburbs and rural areas from urban centers, the study found, sparked in large part by the rise in prescription opioid use seen over the last decade.  The study, published online Monday in JAMA Psychiatry, analyzed nearly 2,800 patients ages 18 and over across 48 states between 2010 and 2013 who reported having heroin dependence. Of those, 75% resided in small urban or non-urban areas and nearly 90% who began using heroin over the past decade were white men and women with an average age of 23 (Johnson, 5/28).

NPR: Doctors Say They Would Shun Aggressive Treatment When Near Death
In fact, nearly 9 in 10 young physicians just finishing up their residencies or fellowships wouldn't want to receive life-prolonging CPR or cardiac life support if they were terminally ill and their heart or breathing stopped, a Stanford University School of Medicine survey finds (Hobson, 5/29).

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Editorials and Opinions

Viewpoints: VA's Problems Begin With Congress; Costly Hepatitis Drug May Be A Good Buy

The Washington Post: The Real Problem With The VA? Congress. 
Politically, this critique of the VA is a no-brainer. After all, denying, delaying or incompetently delivering benefits to veterans who are entitled to them and have sacrificed so much for us is grotesque: the moral equivalent of kicking dogs and stealing food from children. But this political consensus and opportunity for reform will all be for naught unless it targets the main cause of the VA's problems: Congress. Attacks on the VA's derelictions are easy and justified, but here, as in so many areas of policy, the seeds of failure are planted on Capitol Hill (Peter H. Schuck, 5/29). 

The Wall Street Journal: How To Fix The Veterans Affairs Mess 
Veterans' benefits have clearly multiplied far beyond President Lincoln's post-Civil War promise to "care for him who shall have borne the battle, and for his widow, and his orphan." It's time for a return to original principles. Those with disabilities incurred while in service—especially in combat or while training for combat—should never again have to wait in line for health care or benefits. It's time to modernize the VA's antiquated disability compensation system—to develop a new framework that promotes wellness and compensates those whose quality of life and economic well-being have been sacrificed for our sake. Today, the country actually compensates a significant number of veterans for the expected and ordinary effects of aging based on presumptions (Anthony J. Principi, 5/29). 

Bloomberg: How To Fix The VA
The best way forward is to combine the two approaches: Strengthen the VA's ability to do what it's good at and widen veterans' access to services that don't demand its expertise. To start, that means differentiating between primary and specialty care. The inspector general's report focused on wait times for primary care, suggesting that's where the most pressing shortage is. If so, the VA could address much of the problem by paying for primary-care visits with private doctors when timely appointments aren't available at its own facilities. Veterans would continue to rely mostly on VA doctors for specialty care. Congress should ensure those specialists are available by providing more funds where they're needed (5/29). 

The Wall Street Journal: Big Labor's VA Choke Hold
We know with certainty that there is at least one person the Department of Veterans Affairs is serving well. That would be the president of local lodge 1798 of the National Federation of Federal Employees. The Federal Labor Relations Authority, the agency that mediates federal labor disputes, earlier this month ruled in favor of this union president, in a dispute over whether she need bother to show up at her workplace—the Veterans Affairs Medical Center in Martinsburg, W.Va. According to FLRA documents, this particular VA employee is 100% "official time"—D.C. parlance for federal employees who work every hour of every work day for their union, at the taxpayer's expense (Kimberley A. Strassel, 5/29). 

The Wall Street Journal: The VA Scandal Is A Crisis Of Leadership
The Veterans Administration scandal involves charges of manipulation and falsification of medical waiting lists and systemwide rigging to hide delayed or inadequate treatment, which may have caused the deaths of some of those waiting for care. There are whistle-blowers, allegations of local coverups, and the possibility of criminal charges. Also becoming clearer are two motives for those involved in what appears to have been a racket: their compensation and their career trajectories (Peggy Noonan, 5/29).

The Wall Street Journal: The VA's Bonus Culture
It must feel like Groundhog Day at the Veterans Affairs Office of Inspector General. On Wednesday it issued an interim report—its 19th since 2005—documenting excessive wait times at VA hospitals. Cue the choir in Congress demanding the heave-ho for Secretary Eric Shinseki. Yet primarily responsible for the VA scandal are politicians who continue to prop up this failing government health system (5/29). 

Los Angeles Times: VA Chief Eric Shinseki Should Resign
As calls for his ouster spread, it's become clear that Secretary of Veterans Affairs Eric Shinseki has lost the confidence of congressional leaders, whose support he needs for the significant reforms required to improve the VA's healthcare system. He should resign in the interests of those veterans, to whom he is undeniably devoted (5/29).

The New York Times: A Lifeline For Veterans Waiting For Care
In the wake of revelations that patients have waited for months to see a primary care doctor at a veterans' medical center in Phoenix, the Obama administration announced in the past few days some reasonable steps to mitigate the problems. One important measure will move veterans who have been stuck too long up the waiting list. Another will offer those still facing waits of more than 30 days the option of using private hospitals and clinics (5/29). 

And on other health care issues -

Bloomberg: McConnell's Obamacare Gaffe Deserves Its Own Category
I don’t think McConnell’s gaffe really creates problems that he can't handle. The problem already existed. In part, it’s created by a Republican Party that demands absolute loyalty to an unpopular position of wanting a flat-out repeal of the ACA, without being able to come up with an acceptable replacement. The problem also is created by voters who, in Kentucky at least, love their new health plan but hate Obamacare. It's no wonder that politicians from both parties find that situation difficult to handle (Jonathan Bernstein, 5/29).

The Wall Street Journal's Washington Wire: What’s Driving The GOP Health Plan
Conservative House Republicans are pushing for a vote on a GOP health-care plan, presumably to appeal to their base, to give GOP candidates health reform ideas to talk about on the campaign trail and to show that they have a policy position beyond repealing the Affordable Care Act. Polling shows they have a ways to go. The Kaiser Family Foundation’s May tracking poll found that just 13% of the public thinks that Republicans have an alternative to the health-care law, the same share as in March 2011. Sixty-one percent said that Republicans did not have an alternative health-reform plan. And, only 20% of Republicans say that the GOP has an alternative plan, with 53% saying they do not (Drew Altman, 5/30).

Los Angeles Times: Dog Care – Easier Than Obamacare
It tells you everything you need to know about the U.S. healthcare system that you can get more comprehensive coverage for a dog than you can for a human being. I found this out when I delved recently into the nearly $600-million pet insurance market to see about covering our dog, Teddy, a 2-year-old golden retriever/Rottweiler mix that we brought home a few months ago from the West Los Angeles Animal Shelter (David Lazarus, 5/29). 

The Washington Post: The Virginia GOP's Medicaid Plan: Just Say No
With Virginia lacking an enacted budget and facing the growing risk of a government shutdown in just over a month, the top Republicans in the House of Delegates, Speaker William J. Howell (Stafford) and Majority Leader M. Kirkland Cox (Colonial Heights), requested an urgent meeting the other day with Gov. Terry McAuliffe (D). Eager to surmount the impasse that may imperil Richmond's ability to provide public safety, health care and other basic services — to say nothing of the state's bond rating and reputation for good governance — surely the GOP bigwigs had constructive ideas, possibly even one that might sow the seeds of compromise. They didn't (5/29). 

The New York Times' Room For Debate: Can Therapists Prevent Violence?
Once again, senseless slaughter has raised questions not only about how mentally disturbed people can obtain guns, but why authorities can't intervene to prevent violence. Do the laws regarding mental health professionals' duty to warn the authorities of a threat need to be toughened to make them more effective? (5/29). 

The Washington Post: As Measles Cases Increase, A Sharp Call For Vaccinations
Even when there are significant gains against infectious diseases, there can be reversals. In 2000, measles was considered all but eliminated in the United States. For a while, there were only about 60 cases a year, mostly brought in from overseas. Now, the number of cases and outbreaks in the United States is rising again. The Centers for Disease Control and Prevention reported Thursday that there have already been more cases this year, 288, than in any full year this century (5/29). 

The Wall Street Journal: The First Ladies' Calories
One reason American politics is so polarized is the White House tendency to blindslide critics with personal attacks that misrepresent their views. This week's school lunch drive-by is a classic of the genre, with first lady Michelle Obama and even the White House cook claiming Republicans are in favor of childhood obesity (5/29). 

Bloomberg: Would You Pay $84,000 For A New Liver?
Yet when I look at it, Sovaldi seems like a bargain. Here’s a drug that likely cost hundreds of millions to develop and bring to market. It has a 10-year patent life to recoup its costs and make some money for the developers. It’s better than earlier treatments and, ... it largely negates the need for liver transplants, which cost a few hundred thousand a pop. It also, of course, means longer and healthier lives for people infected with hepatitis C. Why does this make us so angry? (Megan McArdle, 5/29).

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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.