Daily Health Policy Report

Monday, May 5, 2014

Last updated: Mon, May 5

KHN Original Reporting & Guest Opinion

Administration News

Health Reform

Health Care Marketplace

Quality

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Who Should Get Pricey Hepatitis C Drugs?

Kaiser Health News staff writer Julie Appleby, working in collaboration with The Washington Post, reports: “Simple math illustrates the challenge facing U.S. taxpayers, consumers and insurers following the launch late last year of two expensive new drugs to treat hepatitis C. If all 3 million people estimated to be infected with the virus in America are treated at an average cost of $100,000 each, the amount the U.S. spends on prescription drugs would double, from about $300 billion in one year to more than $600 billion” (Appleby, 5/5). Read the story.

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Even With Obamacare, Many Latinos Still Seek Treatment In Mexico

Kaiser Health News staff writer Anna Gorman, working in collaboration with USA Today, reports: “Irma Montalvo signed up for a health plan through California's new insurance exchange last month, getting coverage for the first time in eight years. But when she needed treatment for a painful skin rash, Montalvo didn't go to a doctor near her home in Chula Vista. Instead she drove to Mexico, about 16 miles south. Her doctor, Cecilia Espinoza, diagnosed her with shingles and prescribed medication to relieve pain and head off complications” (Gorman, 5/5). Read the story

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Political Cartoon: 'Call Of Duty: Take A Number?'

Kaiser Health News provides a fresh take on health policy developments with 'Call Of Duty: Take A Number?' By Rick McKee. 

Here's today's health policy haiku: 

UNDER INVESTIGATION

Cover Oregon
You might think it can't get worse
Here come the G-Men.
-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

Laid-Off Workers Must Be Notified Of Health Exchange Options

The Obama administration issued a rule Friday requiring employers to inform laid-off workers that, in addition to paying the full cost of their former work-based coverage under COBRA, former employees also have the option of buying insurance through the health law's online marketplaces.

The Wall Street Journal: Employers Must Notify Laid-Off Workers Of Health-Care Options, New Rule Says
Employers must inform laid-off employees that they are eligible to buy health-care coverage through new online insurance exchanges as an alternative to paying full premiums for their old employer policies, the Obama administration said Friday. Under the Consolidated Omnibus Budget Reconciliation Act of 1985, or COBRA, workers who lose their jobs have long had the option of staying on their company insurance as long as they pay their share of the premium, as well as the share their employer had been paying for them. Since employers often pay the majority of workers' premiums, the cost of continuing coverage often came as a shock to people, although some elected to bear the expense anyway because they needed to continue receiving care (Radnofsky, 5/2).

The Hill: Regs To Clarify O-Care Eligibility For People Leaving Jobs
The Obama administration proposed regulations Friday to clarify that people leaving a job may choose to purchase health coverage on ObamaCare's marketplaces rather than obtain it through COBRA. COBRA, or the Consolidated Omnibus Budget Reconciliation Act, allows workers the right to continue their health benefits for a certain amount of time after leaving a job or undergoing other qualifying life changes (Viebeck, 5/2).

Also in the news --

The Wall Street Journal: Head Of HHS Office Of Health Reform To Retire 
Michael Hash, a top Department Health and Human Services official overseeing the rollout of the Affordable Care Act, will be retiring, agency staff confirmed on Friday. Mr. Hash, 70 years old, joins a long list of health-care officials leaving the administration in the aftermath of the rollout of the law (Radnofsky, 5/2).

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Obama Uses Health Law As Laugh Line

President Barack Obama poked fun at the troubled launch of the health law's online insurance marketplaces during his speech at the White House Correspondents' Association dinner.

The New York Times: Comedian In Chief’s New Punch Line: Obamacare
Five and a half years into President Obama’s time in office, the jokes are getting a bit stale: Fox News is a “shadowy right-wing organization.” The 47 percent “called Mitt Romney to apologize.” The whole “Kenyan president” bit. Thank goodness for healthcare.gov. Mr. Obama started his annual remarks at the White House Correspondents’ Association dinner Saturday night with the recognition that the rollout of his health care website could have gone better (Shear, 5/3).

The Wall Street Journal: Obama Cracks Jokes At White House Correspondents Dinner 
Mr. Obama brought his “A” game to Saturday’s dinner. In his remarks, Mr. Obama joked about the launch of healthcare.gov, saying “it could have gone better“ and saying a theme of his presidency was ”control alt delete.” (Williamson, 5/3).

Politico: Obama Jokes ‘Stellar 2013’ At White House Correspondents' Dinner
Taking the stage, Obama deadpanned that while the launch of healthcare.gov “could’ve gone better,” it was made into one of the year’s biggest movies -- before showing a title screen for the film “Frozen.” At the end of his 20-minute remarks to the crowd of 2,600 in the Hilton ballroom, Obama even brought out former Health and Human Service Secretary Kathleen Sebelius to “fix” a technical problem that he was supposedly having with a video the president pretended he wanted to play (McCalmont, 5/3).

Los Angeles Times: Obama Slings Jokes, Jabs At White House Correspondents' Dinner 
Joel McHale, who stars on NBC's “Community” and hosts “The Soup,” followed Obama with his own roast of the president, 2016 hopefuls and gridlock in Washington. ... McHale's best jokes: ... On Obamacare: “Over 8 million people have signed up for Obamacare, which is impressive, until you realize that Ashley Tisdale has 12 million Twitter followers” (Rothberg, 5/4).

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Health Reform

FBI Turns Attention To Oregon's Health Exchange Troubles

Meanwhile, Maryland is working to rebuild its website. News outlets from Colorado and Washington also offer updates.  

The Wall Street Journal: FBI Scrutinizing Health Law Implementation Flaws in Oregon
The Federal Bureau of Investigation is looking into problems that plagued Oregon's implementation of the Affordable Care Act, after the state was forced to scrap its problematic health insurance exchange that was never fully functional, according to people familiar with the investigation (Paletta and Barrett, 5/4). 

The Oregonian: FBI, Inspector General Investigators Probing Cover Oregon Health Insurance Exchange Debacle
The law enforcement arm of the inspector general of the U.S. Department of Health and Human Services has also launched at least a preliminary inquiry into potential spillover from Cover Oregon into the state's Medicaid-funded Oregon Health Plan, The Oregonian has learned. Meanwhile, both the Government Accountability Office and the U.S. House oversight committee have announced their own investigations (Budnick, 5/2).

The Washington Post: As Md. Rebuilds Its Health Insurance Exchange, Lots Of Pressure And Little Room For Missteps
Maryland is sprinting to rebuild its malfunctioning online health insurance system on a time schedule that leaves no room for error, without the endorsement of the federal government or a clear plan for funding the project. The state has adopted software from Connecticut and hired new consultants. But many of the decision makers who led the first, flawed effort remain in place and — despite criticism — continue to operate largely behind closed doors (Johnson and Flaherty, 5/3).

The Baltimore Sun:  Maryland Wraps Up Late Enrollment On Its Health Exchange
Maryland's health exchange officials say they have contacted all 18,000 people who reported having trouble signing up for insurance through the state's online marketplace before the end of open enrollment in April and added 7,500 people to the rolls. Others enrolled on their own and still more were duplicates, said Alison Walker, a spokeswoman for the exchange (Cohn, 5/2).

The Denver Post:  Colorado Health Care Exchange Faces Financial Challenges
Connect for Health Colorado officials have touted the state's insurance exchange as frugal and having relatively low fees. But after spending at least $100 million in federal funding, the exchange is scrambling to figure out how to sustain itself beyond this year. The exchange may find itself in a difficult position as it seeks solutions in coming months because some members of its own board, along with a vocal group of legislators, oppose fee increases. Its financial outlook may have worsened Friday when the state extended through 2015 health plans that aren't compliant with the Affordable Care Act, which is likely to lower enrollments through the exchange (Kane, 5/5).

The Seattle Times: 4 More Insurers Want To Join State Health Exchange
Four additional companies want to join the competition to sell individual health-insurance plans inside the Washington Healthplanfinder online exchange, and the eight currently selling plans there all propose to return for 2015, according to the Office of the Insurance Commissioner. While the new entries mean 12 companies may be selling plans inside the exchange, 10 propose to offer plans outside the exchange, compared with nine this year (Ostrom, 5/4).

Colorado also makes news with its decision to extend plans not meeting the health law's standards while Georgia's health law opposition enters another phase -

The Denver Post: Colorado Extends Health Plans Not Meeting ACA Standards Through 2015
The Colorado Division of Insurance announced Friday it will allow insurance carriers to continue health plans for individuals and small groups that don't comply with the Affordable Care Act's new rules for minimum coverage through 2015. The insurance division said the decision was based on President Barack Obama's March announcement to extend noncompliant policies issued through the federal exchange. That decision helped defuse a political problem for Democrats in tough re-election battles this fall, and observers said the latest move is likely to do the same in Colorado, which has its own health care exchange (Draper, 5/2).

Health News Colorado: Colorado Allows Canceled Health Plans Through 2015
Colorado will allow about 100,000 people who kept previously canceled health insurance plans to extend them until the end of 2015, but very few health insurance companies are likely to keep selling the plans. ... [Insurance Commissioner Marguerite Salazar] said about 335,000 people received notices that their plan would be canceled because it did not comply with ACA requirements. Of those, Salazar estimated that 92 percent were given the option to extend their non-compliant plans. If about one-third of them took that option, about 100,000 people might be eligible to renew those plans (McCrimmon, 5/2).

Georgia Health News: Georgia’s Battle With Obamacare Enters New Phase
The most prominent opponent of Obamacare in the Georgia General Assembly says he’s not done fighting the law. Rep. Jason Spencer (R-Woodbine) pushed through the Legislature a Tea Party-supported bill that prohibits the state from running its own insurance exchange. House Bill 943, passed at the tail end of the General Assembly, also forbids state employees to advocate for Medicaid expansion, and halts the “navigator” insurance counseling program at the University of Georgia. The bill was signed into law this week by Republican Gov. Nathan Deal (Miller and Craig, 5/2). 

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Calif. Enrollment Campaign Focused On Exchange At Expense Of Medicaid Backlog

In other Medicaid expansion news, the Arkansas director is leaving and a look at what's happening - or not - in Maine. 

The California Health Report: State Officials Prioritized Insurance Exchange Over Enrollment System For The Poor
As they scrambled to open the insurance gates to millions of Californians under the federal health law, state officials prioritized the open-marketplace enrollment system over one for low-income residents, according to state documents and officials. That decision significantly contributed to the backlog of about 900,000 applications to Medi-Cal, the state's low-income health program. "People who don't have health care are all in need," said Frank Mecca, executive director of the County Welfare Directors Association, which closely monitors enrollment in Medi-Cal. "One group was prioritized over another, and I don't think that's good public policy" (Guzik, 5/4).

The Associated Press:  Arkansas Medicaid Director Allison To Leave Post
The director of Arkansas' Medicaid office who led implementation of the private option is leaving his position. Andy Allison has been Arkansas' Medicaid director since 2011. The Department of Human Services announced Friday that Allison would leave, as of June 1 to pursue other opportunities (5/2).

Bangor Daily News: Legislature Overrides 15 Of LePage’s 48 Recent Vetoes
During a return to session that people in the State House refer to as "Veto Day," lawmakers on Thursday overturned 15 of the 48 vetoes issued by Republican Gov. Paul LePage during the past two weeks. ... LePage won an expected double victory when the Legislature sustained his veto of two bills that would have expanded Medicaid under the auspices of the federal Patient Protection and Affordable Care Act, commonly referred to as Obamacare. Democrats have made the effort to expand access to publicly funded health insurance to 70,000 Mainers their top priority for two years, and have passed five bills to do so. LePage has vetoed all five, and GOP lawmakers have stood by his side to sustain each veto (Moretto, 5/2).

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College Graduation Is A Time To Reassess Health Insurance

College seniors need to add one item to their "to-do" list as graduation approaches: check out their insurance options, the Los Angeles Times reports. Also, KHN examines California Latinos' interest in getting health care in Mexico--even if they have purchased U.S. insurance.

Los Angeles Times: College Graduates Should Consider Options For Health Insurance 
Devyn Bisson is a 22-year-old Orange resident about to graduate from Chapman University with a degree in film. She knows she'll need to think about health insurance after graduation, but not just yet. "It's the last thing I'm looking at," she says. "I'm way more preoccupied with how I'm going to make money." With graduation looming, college students have many big issues to face in the coming months. They may include signing up for health insurance, and facing deadlines and even fines for laggards (Zamosky, 5/4).

Kaiser Health News: Even With Obamacare, Many Latinos Still Seek Treatment In Mexico
Irma Montalvo signed up for a health plan through California's new insurance exchange last month, getting coverage for the first time in eight years. But when she needed treatment for a painful skin rash, Montalvo didn't go to a doctor near her home in Chula Vista. Instead she drove to Mexico, about 16 miles south. Her doctor, Cecilia Espinoza, diagnosed her with shingles and prescribed medication to relieve pain and head off complications (Gorman, 5/5).

The Fiscal Times examines the legislative language setting up insurance risk corridors and the question of how many enrollees have actually paid their first month's premiums -

The Fiscal Times: A Little-Noticed Glitch Could Derail Obamacare
The Affordable Care Act's risk corridor program has drawn plenty of criticism from Republicans who have dubbed it a "bailout for insurance companies." Sen. Marco Rubio (R-FL) even introduced a bill to entirely scrap the program, which is intended to offset insurance company losses for selling policies on new exchanges. Now, it turns out, a little-known technical flaw in the law's language might do that for him. In a blog post, The Incidental Economist’s Nicholas Bagley points out that the law's vague language regarding the risk corridors may not give the Department of Health and Human Services the legal authority to fund the program (Ehley, 5/2).

The Fiscal Times: Obamacare Update: Lots Of Unanswered Questions
[W]e know that more than 8 million people signed up for health insurance on the state and federal exchanges between October and April 15...This number is significant primarily because it shows demand for the new plans. However, it does not represent how many people will actually have insurance through the exchanges, since people may drop their plans throughout the year. The figure also doesn’t account for how many people have paid their premiums. This data point is huge and will need nailed down in order to find out how many people are actually covered by these plans (Ehley, 5/4).

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Health Law Will Factor Into North Carolina Primary

GOP leaders are lining up in support of North Carolina's House Speaker Thom Tillis in hopes that he can unseat Sen. Kay Hagan, D-N.C., who has faced heavy criticism for her support of the health law. 

The Wall Street Journal: Thom Tillis Faces Test In North Carolina Primary
Republicans have criticized Ms. Hagan, who was elected on President Barack Obama's strong coattails in 2008, for consistently supporting Democratic priorities, particularly the Affordable Care Act. Conservative groups already have spent millions attacking her in ads. Mr. Tillis has the support of most party leaders, including Senate Minority Leader Mitch McConnell (R., Ky.), House Speaker John Boehner (R., Ohio) and the head of the Republican campaign arm in the Senate (O'Connor, 5/4). 

In other news, the Democratic National Committee will return a donation -

The New York Times: Democratic Group To Return Donations
The Democratic National Committee, faced with the possibility that it had accepted illegal campaign contributions from straw donors, decided Thursday to return sizable donations made last fall in the names of the children of a Florida cardiologist whose lucrative medical practice has caught the attention of Medicare regulators. The doctor, Asad U. Qamar, 50, is a prolific campaign donor who found himself politically sidelined last year once word got out that he had asked his contacts in Congress for help with a federal review of his Medicare payments (Robiles, 5/2).

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Health Care Marketplace

Health Spending Increases Hit Fastest Pace Since 1980

USA Today reports on this development, noting some of the factors that will continue to drive up costs. Also, Kaiser Health News explores issues related to who should get costly hepatitis C drugs and The Wall Street Journal reports on the delay in implementing the ICD-10. 

USA Today: Health Care Spending Surges In First Quarter
Health care spending rose at the fastest pace since 1980 in the first quarter as the new health insurance law prompted many more Americans to visit doctors and hospitals. But analysts say the sharp increase also reflects other trends that should continue to drive up both medical spending and costs in 2014 after years of slow growth (Davidson, 5/3).

Kaiser Health News: Who Should Get Pricey Hepatitis C Drugs?
Simple math illustrates the challenge facing U.S. taxpayers, consumers and insurers following the launch late last year of two expensive new drugs to treat hepatitis C. If all 3 million people estimated to be infected with the virus in America are treated at an average cost of $100,000 each, the amount the U.S. spends on prescription drugs would double, from about $300 billion in one year to more than $600 billion (Appleby, 5/5).

The Wall Street Journal: Medical Code Delay Costing Hospitals Big Bucks
A delay in the implementation of ICD-10, a new health-care coding system, will cost some hospitals hundreds of thousands of dollars, increase complexity for an already-complex system, and increase the risk that something will go wrong when the new coding system eventually kicks in (Boulton, 5/2).

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Quality

Do Hospices Decline To Treat Dying Patients In Crisis?

The Washington Post: Terminal Neglect? How Some Hospices Decline To Treat The Dying
For more than a million patients every year, the burgeoning U.S. hospice industry offers the possibility of a peaceful death, typically at home. But that promise depends upon patients getting the medical attention they need in a crisis, and hundreds of hospices provide very little care to such patients, a Washington Post investigation has found (Whoriskey and Keating, 5/3).

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State Watch

Highlights: High Colo. Insurance Rate Changes; La. Hospital Plan Rejected; VA Delays In Care

A selection of health policy stories from Colorado, Louisiana, Arizona, California, Florida and Michigan.

Health News Colorado: Rate Relief Is Sight For Mountain Resorts
Fending off a potential lawsuit from angry western Colorado residents who face the highest insurance premiums in the nation, Colorado Insurance Commissioner Marguerite Salazar on Friday announced she supports a new health insurance rating map for the state. Salazar unveiled the plan and will review comments on it before deciding by next Friday which health insurance rating map will apply for 2015. Colorado currently has 11 rating areas across the state: seven in metropolitan areas and another four that group rural counties together. The new plan would group all the western Colorado counties together — except for Mesa County, home to the City of Grand Junction. It would also group together all the counties on the Eastern Plains and in rural parts of southern Colorado (McCrimmon, 5/2).

The Associated Press: Louisiana: Hospital Plan Rejected
Federal officials have rejected financing plans by Gov. Bobby Jindal’s administration for privatization deals involving six state-run hospitals. The federal Centers for Medicare and Medicaid Services told the state on Friday that the deals do not meet federal Medicaid guidelines (5/2).

USA Today: VA Treatment Records Falsified, Probe Finds
A VA investigation of one of its outpatient clinics in Colorado reveals how ingrained delays in medical care may be for an agency struggling to rapidly treat nearly 9 million veterans a year amid allegations that dozens have died because of delays. Clerks at the Department of Veterans Affairs clinic in Fort Collins were instructed last year how to falsify appointment records so it appeared the small staff of doctors was seeing patients within the agency's goal of 14 days, according to the investigation (Zoroya, 5/4).

The Arizona Republic: Second VA Doctor Blows Whistle On Patient-Care Failures
Late on Sunday night, Dr. Katherine Mitchell said she received a phone call from a fellow employee at the Phoenix VA hospital who needed advice on how to handle a sensitive situation. Her co-worker explained that patient appointment records in the Phoenix VA Health Care System were in danger of being destroyed. But he had printed paper copies to ensure that accurate wait times for patient care would not be lost if removed from computers. The purported "secret lists," along with accusations that up to 40 Arizona veterans died awaiting care, are the subject of national controversy and investigations by Congress and the VA Inspector General (Wagner, 5/2).

The Wall Street Journal: SEIU, California Hospitals In Talks On Cooperative Deal
The nation's biggest health-care union and the California hospital industry are in talks on a deal that could allow the union to boost its ranks by thousands with the cooperation of management, according to documents reviewed by The Wall Street Journal (Trotter and Maher, 5/2).

Reuters: Florida Lawmakers Approve Medical Marijuana Bill
Florida legislators voted on Friday to allow doctors to prescribe a special strain of "non-euphoric" marijuana for treatment of chronic epileptic seizures and some other severe illnesses.Governor Rick Scott said he will sign the bill into law when it reaches his desk (Cotterell, 5/2).

The Associated Press: Health Bill Dies In Florida Legislature
Florida lawmakers ended the session Friday with a lot of last minute wrangling on an omnibus health bill that ultimately died, taking down provisions that would have expanded the powers of nurse practitioners and promoted the use of telemedicine. The House tacked on a massive amendment late Friday night by Rep. Jason Brodeur addressing everything from assisted living facilities and laser dermatology to HIV testing, orthotics and pneumonia vaccines for new nursing home residents. The changes came after the Senate killed proposals that would allow nurse practitioners to work without a doctor's supervision and promote the use of telemedicine. Proponents said both measures would reduce health care costs and address a critical shortage of primary care physicians in the state (5/3).

The Detroit Free Press: Michigan Health Officials In Tug-of-war Over Funds 
The head of the state’s health department wants to know why services to the mentally ill are being slashed when the entities that fund them have millions of dollars -- including about $41.4 million in southeast Michigan -- in unused, unrestricted funds. But local mental health officials argue that those dollars, in fact, are being tapped and that spending them down completely would be irresponsible (Erb, 5/3).

Politico Pro: Courts Diverge On Abortion Restrictions
Federal courts across the country are splitting over challenges to new state abortion restrictions, potentially setting up one or more cases that could lead to a Supreme Court ruling. Two types of laws are most likely to grab the justices’ attention, legal experts on both sides of the issue say: measures requiring abortion providers to obtain admitting privileges at a local hospital or placing stricter limitations on how medication abortions can be administered. States have passed dozens of such statutes over the past few years, leading to major legal battles between abortion-rights proponents who say the moves are just designed to limit access and shut down clinics and abortion opponents who insist they’re necessary to protect women’s health (Cunningham and Villacorta, 5/4).

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Editorials and Opinions

Viewpoints: Battle For Medicaid; GOP's Report On Enrollment Off Base; Need For Kidney Donations

Los Angeles Times: Medicaid Expansion Is The Final Battle In War Over Obamacare
The final battle of the war over the Affordable Care Act is being waged today over expanding Medicaid. ... The refusal of more than half the states to cover so many of their neediest citizens — the number who have fallen into the "coverage gap" is estimated at 5 million — amazes and frustrates health experts. That's especially so because the federal government covers 100% of the cost of expansion through 2016. After that, the federal share will slowly decline to 90% in 2020 and beyond (Michael Hiltzik, 5/4).

The Wall Street Journal: Standing To Sue Obama
The legal left and media are always last to know, but there are the makings of a correction in how the courts police conflicts between the political branches. President Obama's serial executive power abuses—on health care, immigration, marijuana and much else—may be inspiring a healthy rejoinder. Under the Constitution, Congress is supposed to create and amend laws and the President to faithfully execute them, but Mr. Obama has grabbed inherent Article I powers by suspending or rewriting statutes he opposes. The President has usurped Congress with impunity because he assumes no one has the legal standing to challenge him (5/4). 

The Wall Street Journal: What People Don't Realize About The Affordable Care Act
The Affordable Care Act enrollment numbers released this week illustrate how much more complex the health-care law is than the political debate about it. Many in politics view the ACA through a left or right perspective that sees it only as good or bad. But consider that the law is engineered for variation; it is the exact opposite of a Starbucks or McDonald’s, where you get the same product no matter where you live or what your income is (Drew Altman, 5/2).

The New York Times: Inventing A Failure
Last week, House Republicans released a deliberately misleading report on the status of health reform, crudely rigging the numbers to sustain the illusion of failure in the face of unexpected success. Are you shocked? You aren't, but you should be. Mainstream politicians didn't always try to advance their agenda through lies, damned lies and — in this case — bogus statistics. And the fact that this has become standard operating procedure for a major party bodes ill for America's future (Paul Krugman, 5/4).

The Dallas Morning News: How Has The Massachusetts Health Insurance Law Worked Out?
At Boston Medical Center, the emergency room sees more than 356 of the poorest and most disadvantaged on an average day. Many don't need to be here. They now have Medicaid or health insurance, and their pains, flu and stomach upsets could easily be tended at a doctor's office or outpatient clinic — and at far less cost. "We're still seeing a very high volume," said Dr. Andy Ulrich, vice chairman of the emergency department. "You can’t go to your primary care doctor at 8 p.m. or when you get off work." Eight years ago, as Massachusetts enacted the nation's first sweeping health insurance law, legislators expected newly insured patients to stop using the emergency room as their gateway to medical help. That did not happen. Massachusetts now has the nation’s lowest rate of uninsured — 3.1 percent — and the most expensive health care (Jim Landers, 5/3).

Richmond Times-Dispatch: Beg, Borrow & Steal
The latest twist in the long-running debate over Medicaid expansion in Virginia concerns debt. Republicans say expansion "relies on borrowed federal money." Democrats call that rubbish. After all, they say, Medicaid expansion is part of Obamacare, and Virginians are paying Obamacare taxes, so expansion is paid for. Besides, when you borrow money you have to pay it back, and it's not as if Washington is going to send Virginia a bill. That’s cute — but wrong. In fact, it's wrong in every conceivable way (5/4).

San Jose Mercury News: Impoverished Thinking About Health Care And Poverty
Two weeks ago, my friend finally saw a doctor for diagnosis and treatment of her fever and shortness of breath. Concerned she had pneumonia, I'd been prodding her for days to seek medical attention. But she was uninsured, impoverished and unwilling to accept my help. She instead planned to "hold out" until obtaining health insurance through her state's insurance exchange program that operated in concert with the Affordable Care Act. Although given no guarantee that her application was accepted, she expected to receive coverage by May. Unfortunately, her illness didn't wait that long (Dr. Kate Scannell, 5/2).

Health News Colorado: Survival Skills Needed For Health Care Exchanges When Money Runs Out
We are now at a crossroads in the implementation of Obamacare. The exchange can either continue to promote a fantasy version of what recently happened or it can double down and make real, substantive changes. The recently published feel-good statistics suggest the focus is on pay raises and bonuses for the staff. If the legislative oversight committee and the board buy it lock, stock and barrel, little change will be forthcoming (Francis M. Miller, 5/2). 

On other health issues -

The New York Times: Why People Don't Donate Their Kidneys
The national transplant list just passed a morbid milestone: More than 100,000 people now wait for kidneys. We are at this point largely because even though demand is growing, donations from living and deceased donors have remained flat, between 16,500 and 17,000 annually, for the past decade. ... The problem lies in the requirement that all organs be given altruistically (as a friend did for me in donating her right kidney eight years ago). Federal law is widely interpreted as forbidding donors to receive anything of tangible value in return for their lifesaving deeds (Sally Satel, 5/3).

Los Angeles Times: L.A.'s Jails: Where Not To Treat The Mentally Ill
Los Angeles County supervisors talked for years about how it might make more sense to provide lower-cost healthcare at outpatient clinics instead of sending ambulatory patients to costlier beds at county hospitals. They talked — but did nothing until the mid-1990s, when soaring hospital costs pushed the county close to bankruptcy. The Clinton administration bailed L.A. out, in the process requiring more clinics and fewer hospital admissions. The result was better and more appropriate patient care, smarter spending and, not inconsequentially, fiscal solvency. So if it took near-bankruptcy for the county to finally wise up on healthcare, what is it going to take to get the supervisors to finally move mentally ill offenders from costly and dangerous jail beds to more appropriate, more effective and less expensive community-based treatment? (5/4).

The New York Times: Finally, Some Optimism About Obesity
Earlier this year, we got what seemed like the first good news on obesity rates: A study in JAMA found that there had been a 43 percent drop in the obesity rates of 2- to 5-year-old children in the last decade. But then, last month, that news was contradicted by researchers at the University of North Carolina who used the same data to find that obesity rates had remained flat after all. ... if we compare the fight against obesity to the last public health challenge of similar size — the fight against smoking — it turns out that we are being much more aggressive today (Ezekiel J. Emanuel and Andrew P. Steinmetz, 5/4). 

The New York Times: Are Pap Smears On The Way Out?
Women who want to be screened for cervical cancer have just received a new option — and a new quandary. The venerable Pap smear, which has been the only screening tool to look for cancer in asymptomatic women for many decades, now has a rival, a genetic test that looks for the viruses implicated in causing cervical cancer. Adding a new option seems a positive development. Yet some critics have opposed using the new test as a primary screening tool lest it displace the Pap test, which has been credited with cutting the incidence and death rate from cervical cancer sharply in recent decades (5/4). 

Los Angeles Times: L.A. County Needs To Construct Mental Health Programs, Not Jails
For decades, the county has spent untold amounts of public money to warehouse people with mental illnesses in the Los Angeles County jail. This costly and ineffective approach has resulted in sky-high recidivism rates and increased crime. Now, the Los Angeles County Board of Supervisors is considering a proposal to spend as much as $2.3 billion on a massive jail expansion, with a significant portion of that money going to facilities for mentally ill inmates, who currently make up nearly 20% of the jail population (Terry Smerling, 5/4). 

USA Today: Budget Squeeze Jeopardizes Search For Cures: Our View
Xiao-Wei Chen is the sort of scientist you'd want to see stay in the United States. Francis Collins, director of the National Institutes of Health, calls him "one of the smartest kids that's come along in a long time." But after 12 years at the University of Michigan, most recently conducting research into how cellular secretions regulate cholesterol, he's returning to China. Some of the reasons why are ominous for U.S. biomedical research. Chen's work ranked him at the very top of a group of scientists being evaluated for research work at NIH, but a budget-caused hiring freeze meant no positions were available. At the same time, Peking University offered him a tenure-track position, funding for his research, good lab space and students to help with his work (5/4). USA Today also provides comments representing an opposing view

WBUR: Mass. Medical Society Chief: Medicare 'Data Dump' Unfair To Docs
Transparency in health care is a worthy goal, but, like any major undertaking, the success of the effort depends on how it’s done. When the Centers for Medicare and Medicaid Services released its list of $64 billion in Medicare payments to individual physicians in 2012, it fell short of its goal in helping consumers understand how care is delivered through Medicare. Provided without context and with little explanation, the payment data had the unintended consequences of creating confusion and misperceptions among patients (Dr. Ronald Dunlap, 5/2).

WBUR: Midnight Friends: How Wired Patients Are Transforming Chronic Illness
Over the years, I’ve watched my cousin Deborah Haber struggle with several chronic, painful medical conditions, including fibromyalgia and a rare incurable disorder called Ehlers-Danlos Syndrome, a connective tissue disease that causes profuse sweating, a high heart rate and insomnia, among its many symptoms. Largely housebound, and managing the life of her 11-year-old daughter, Deborah faces social isolation and persistent pain. But along the way, my cousin has discovered a lifeline that’s lifted her outlook and improved her health. It combines the best qualities of a mother, best friend, therapist and trusted doctor to help her cope: it’s social media (Nell Lake, 5/2).

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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.